Cluster randomized controlled trial evaluating the effectiveness of computer-assisted intervention

The latest Sound Start Study article has just been published:

McLeod, S., Baker, E., McCormack, J., Wren, Y., Roulstone, S. Crowe, K., Masso, S., White, P., & Howland, C. (2017). Cluster randomized controlled trial evaluating the effectiveness of computer-assisted intervention delivered by educators for children with speech sound disorders. Journal of Speech, Language, and Hearing Research. Advance online publication doi:10.1044/2017_JSLHR-S-16-0385 http://jslhr.pubs.asha.org/article.aspx?articleid=2643351

Members of the Sound Start Study Team (+Yvonne Wren and Paul White)

Here are the details of our other Sound Start Study publications: 

Crowe, K., Cumming, T., McCormack, J., Baker, E., McLeod, S., Wren, Y., Roulstone, S., & Masso, S. (2017, in press). Educators’ perspectives on facilitating computer-assisted speech intervention in early childhood settings. Child Language Teaching and Therapy. doi:10.1177/0265659017717437

Masso, S., Baker, E., McLeod, S., & Wang, C. (2017). Polysyllable speech accuracy and predictors of later literacy development in preschool children with speech sound disorders. Journal of Speech, Language, and Hearing Research. Advance online publication doi:10.1044/2017_JSLHR-S-16-0171 http://jslhr.pubs.asha.org/article.aspx?articleid=2639744

Masso, S., McLeod, S., Baker, E., & McCormack, J. (2016). Polysyllable productions in preschool children with speech sound disorders: Error categories and the Framework of Polysyllable Maturity. International Journal of Speech-Language Pathology, 18(3), 272-287. doi:10.3109/17549507.2016.1168483 http://www.tandfonline.com/doi/abs/10.3109/17549507.2016.1168483?journalCode=iasl20

Masso, S., McLeod, S., Wang, A. & Baker, E., & McCormack, J. (2017). Longitudinal changes in polysyllable maturity of preschool children with speech sound disorders. Clinical Linguistics and Phonetics, 31(6), 424-439. doi:10.1080/02699206.2017.1305450
http://www.tandfonline.com/eprint/hnFtnIR6iTvXn4IQNAV5/full

McCormack, J., Baker, E., Crowe, K., Masso, S., McLeod, S., Wren, Y., & Roulstone, S. (2017). Implementation fidelity of a computer-assisted intervention for children with speech sound disorders. International Journal of Speech-Language Pathology, 19(3), 265-276. doi:10.1080/17549507.2017.1293160
http://www.tandfonline.com/eprint/JjWu9TGPwWahCX53IuMM/full

McLeod, S., Crowe, K., & Shahaeian, A. (2015). Intelligibility in Context Scale: Normative and validation data for English-speaking preschoolers. Language, Speech, and Hearing Services in Schools, 46(3), 266-276. doi:10.1044/2015_LSHSS-14-0120 http://lshss.pubs.asha.org/article.aspx?articleid=2290674

McLeod, S., Crowe, K., Masso, S., Baker, E., McCormack, J., Wren, Y., Roulstone, S., & Howland, C. (2017). Profile of Australian preschoolers with speech sound disorders at risk for literacy difficulties. Australian Journal of Learning Difficulties. Advance online publication doi:10.1080/19404158.2017.1287105 http://www.tandfonline.com/doi/abs/10.1080/19404158.2017.1287105?journalCode=rald20

McLeod, S., Crowe, K., McCormack, J., White, P., Wren, Y., Baker, E., Masso, S., Roulstone, S. (2017). Preschool children’s communication, motor and social development: What concerns parents and educators? International Journal of Speech-Language Pathology. Advance online publication doi:10.1080/17549507.2017.1309065 http://www.tandfonline.com/doi/abs/10.1080/17549507.2017.1309065?journalCode=iasl20

Wren, Y., McCormack, J., Masso, S., McLeod, S., Baker, E. & Crowe, K. (2016, in press). Digital tools to support children’s speech and language skill. In S. Danby, M. Fleer, C. Davidson & M. Hatzigianni (Eds). Digital childhoods: Technologies in children’s everyday lives. Dordrecht, Germany: Springer.

Celebrating the end of the Sound Start Study

On 30th June, the investigators on the Sound Start Study submitted our final report to the Australian Research Council. We celebrated the official end of the Sound Start Study at CSU Olympic Park on Monday; however, we are in the midst of finalising many journal articles, book chapters, and conference presentations reporting the findings of our research.

Sarah Masso, Elise Baker, Kate Crowe, Adelaide, and Sharynne

Here in an excerpt from the report:

SUMMARY: DP130102545 (Sound Start Study) was a large-scale clustered randomized controlled trial (RCT) examining the speech and pre-literacy skills of Australian preschoolers. It was completed as planned, on budget, and on time. The project involved mass screening of preschoolers (target n=1250; actual n=1205) in early childhood centers (hereafter sites) throughout Sydney (target n=18 sites; actual n=45 sites from 77 invitations); comprehensive assessment of preschoolers whose parents or teachers were concerned about their preschooler’s speech (target n=250; actual n=275); the development of an Australian version of innovative computer-based technology designed to target preschoolers’ speech and pre-literacy skills (Phoneme Factory Sound Sorter [PFSS]); RCT of PFSS over 9 weeks (each year) involving preschoolers with speech impairment (target n=128, actual n=123) randomly assigned to PFSS (target n=64; actual n=63) or control (target 64; actual n=57); comprehensive follow-up assessments evaluating the skills of each preschooler, immediately (target n=128; actual n=114) then 6-8 weeks after PFSS (target n=128; actual n=115), and interviews with early childhood educators (n=22) about their experience of using PFSS. A central aspect of DP130102545 was the RCT involving PFSS—technology previously shown to hold promise in improving children’s speech when delivered by a speech pathologist. In the RCT, an alternate service delivery model was tested with PFSS being delivered to preschoolers with speech impairment by early childhood educators at their early childhood centre.

RESULTS: From screening and assessments, more parents (35.1%) and early childhood educators (36.8%) were concerned about their preschoolers’ speech and language than any other aspect of development. Their concerns aligned with clinical testing, underscoring the importance of parents and educators seeking advice when they have concerns. For the RCT, a statistically significant improvement was found between time points (pre PFSS, immediate post and follow-up) for both PFSS and control groups on measures of pre-literacy skills (Aim 1a), speech (Aim 1b), underlying phonological processing (Aim 1c), and wellbeing (Aim 1d); however, there was no statistically significant interaction between group and time. That is, PFSS administered by early childhood educators, was not more effective than typical classroom practices. Considerable variability was evident within each group—some preschoolers showed impressive change in speech/pre-literacy over time; others showed little change, suggesting that specialized support delivered by speech pathologists is still needed for preschoolers with speech impairment to achieve optimal outcomes before school. Child- and family-related variables were explored to identify variables associated with change in pre-literacy and speech production status. Preschoolers who had difficulty producing polysyllabic (long) words had significantly poorer pre-literacy and phonological processing skills (Aim 2); preschoolers who had more difficulty producing polysyllabic words, and had a positive family history of speech difficulties were less likely to improve (Aim 3). Facilitators and barriers to PFSS implementation were also identified encompassing personal, environmental, and PFSS-specific issues.

BENEFITS: DP130102545 has provided new insights into parents’/educators’ concern about preschoolers’ development, the relationship between speech and pre-literacy skills, the identification of preschoolers with speech impairment most at risk for on-going speech and future literacy difficulties, and the implementation of support programs for preschoolers in early childhood settings. A large dataset has been created that will be mined to address future research on preschoolers with speech impairment, their families, and the role of early childhood centres.

OUTCOMES: This research has addressed all of the proposed objectives, and resulted in the production of 2 books; 8 book chapters; 4 peer reviewed journal articles; and 32 (including 5 invited) conference presentations across 7 countries including Australia (VIC, ACT, WA), Canada, England, Ireland, New Zealand, Sweden, United States). A further 3 book chapters and 11 journal articles are in preparation/submission at the time of this report. The PhD student employed throughout the project is due to submit her thesis (comprising 6 publications) in August 2016, and another student achieved 1^st class honours for her thesis, based on DP130102545 data.

IMPACT:  A submission was made to the Australian Government Senate Inquiry Prevalence of different types of speech, language and communication disorders and speech pathology services in Australia based on DP130102545; and CI-McLeod contributed to the Education and Employment References Committee: Students with disability in the school system, referring to data from DP130102545 (Hansard 25/9/15).

Sound Start Study symposium at Speech Pathology Australia 2016

The Sound Start Study, our Australian Research Council Discovery Grant (DP1030102545) is coming to a close, so it was a privilege to present five papers within a symposium session to share some of our findings.

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  L-R: Elise Baker, Sarah Masso, Pam Enderby (keynote speaker at the conference),
  Kate Crowe, Charlotte Howland, Sharynne McLeod

Here is the abstract from the first paper in the symposium

Speech sound disorders (SSD) affect many Australian preschoolers and if it persists into the school years between 30% to 77% will have reading difficulties. Without support services, these children face increased risk of life-long social, educational, occupational limitations; however, demand for speech pathology services exceeds supply. The Sound Start Study was designed to determine if the Phoneme Factory Sound Sorter (PFSS) (Wren & Roulstone, 2013) computer software can be used enhance preschoolers' speech and pre-literacy skills. The Sound Start Study was conducted in 6 stages per year, repeated over 3 years. In stage 1, 1205 children were screened via parent and teacher questionnaire. In stage 2, children whose parents and teachers had concerns about speech were assessed (n = 275). In stage 3, children who had a phonological impairment with no known cause (n = 133) underwent additional assessment of their speech, pre-literacy and phonological processing skills. In stage 4, 123 children were eligible and randomized into a control group or intervention group. The intervention group received PFSS administered by preschool staff over 9 weeks. This innovative computer program was designed using a psycholinguistic framework to target children's perception and representations of their phonological patterns via phonemic awareness tasks. In stages 5 and 6, children were re-assessed by speech pathologists blinded to the first assessment and intervention condition. These immediate and 3-month post-intervention assessments were undertaken to determine whether the intervention improved the children’s speech and pre-literacy skills.  

Here are the titles of our presentations:

• Randomised controlled trial of software to enhance preschoolers' speech and pre-literacy skills (Presenter - Sharynne McLeod)
• Implementation of a computer-assisted intervention for children with speech sound disorders in Australian preschools (Presenter - Kate Crowe)
• The print knowledge of preschool children with speech sound disorders before and after intervention targetting speech and pre-literacy abilities (Presenter - Elise Baker)
• The relationship between polysyllable production and emergent literacy in preschool-aged children with speech sound disorders (Presenter - Sarah Masso) 
• Realization of grammatical morphemes by children with speech sound disorders (Presenter - Charlotte Howland)

We were very pleased with the large number of people in the audience and the number of people who have commented, asked questions, and contacted us about our work after the presentation. More information about all of our presentations at SPA 2016 is here and information about Charlotte's award is here.

Sound Start meetings in Sydney

Over the past 2 days we have had research meetings regarding the Sound Start Study in Sydney. We have traveled to be together to have a face-to-face meeting to discuss our progress, future plans, and to begin writing papers together. In attendance were Professor Sue Roulstone from (University of the West of England), A/Prof  Jane McCormack (CSU, Albury), Dr Elise Baker (University of Sydney), Prof Sharynne McLeod (CSU Bathurst), Dr Kate Crowe (CSU Homebush), Sarah Masso (CSU Homebush), Charlotte Howland (CSU Homebush/U of Syd) and Tamara Cumming (CSU Homebush). Dr Yvonne Wren (Bristol Speech and Language Therapy Research Unit) has been with us via Skype. It has been a productive two days.

Sound Start Team: Elise Baker, Kate Crowe, Charlotte Howland, Sharynne McLeod, Tamara Cumming, Sue Roulstone, Sarah Masso, Jane McCormack

Sound Start team meeting at CSU Homebush

A Sound Start is about to start

Last year we were awarded the following Australian Research Council (ARC) Discovery Grant: A sound start: Innovative technology to promote speech and pre-literacy skills in at-risk preschoolers (DP130102545).

Here is an overview of the project:

Speech impairment affects one in five Australian preschoolers. If the problem persists into the school years between 30% to 77% of these children will have reading difficulties. Without specialist services, these children face increased risk of life-long social, educational, vocational limitations. Three challenges exist: identification of preschoolers most at risk, development of strategies for targeting both speech and pre-literacy skills, and provision of appropriate specialist services. This project will determine if an innovative computer-based service, delivered within preschools, can address these challenges by promoting age-appropriate speech and pre-literacy skills in children with identified risk of reading difficulties. 

The project team are:

• Chief Investigators: Sharynne McLeod (CSU), Elise Baker (University of Sydney), Jane McCormack (CSU)
• Partner Investigators: Yvonne Wren and Sue Roulstone (University of the West of England)
• Project Officer: Kate Crowe
• PhD Student: Sarah Masso

The project will run from 2013 - 2015. The team met in Sydney on Thursday and Friday to plan for the project to commence in March. There is a lot to organise; however, we are looking forward to the challenges and anticipate outcomes that will be of benefit to children with speech difficulties.

Kate Crowe, Sarah Masso, Sharynne McLeod, Jane McCormack, Elise Baker

    

Media attention regarding Sound Start research grant

Our recent ARC Discovery grant success has been picked up by The Australian newspaper's IT section. The reporter Jennifer Foreshew has written a story about our project titled: SoundSorter will get the toddlers talking. Her news item was in response to the Charles Sturt University media release about recent early childhood research grants. It is exciting to see an acknowledgment of the important issues about children's speech and language acquisition in a section of the newspaper that does not traditionally cover this topic.

This morning, the Sound Start research team met for over an hour via Skype (linked with Bristol UK, Bathurst, Sydney, and Albury) to discuss the modifications of the Phoneme Factory Sound Sorter software for Australian children, and other aspects of the research so that we are ready to begin in the new year.

A systematic review of the influence of bilingualism on speech production

The following paper has been accepted for publication this week:
Hambly, H., Wren, Y., McLeod, S., & Roulstone, S. (2012, in press May). The influence of bilingualism on speech production: A systematic review. International Journal of Language and Communication Disorders.

ABSTRACT
Background: Children who are bilingual and have speech sound disorder are likely to be under-referred, possibly due to confusion about typical speech acquisition in bilingual children.
Aims: The aim of this review was to investigate what is known about the impact of bilingualism on children’s acquisition of speech in English to facilitate identification and treatment of bilingual children with speech sound disorder.
Methods: A systematic review of studies from the last 50 years was conducted. Studies investigating speech acquisition in bilingual infants and children (where one language was English) were identified through searching 7 electronic databases, bibliographies of relevant articles and emailing authors. Sixty six studies investigating bilingual speech production met inclusion criteria, with 53 describing typically developing children and 13 describing children with speech sound disorder. The 66 studies were analysed thematically and summarised in terms of methods, key findings and underlying theories.
Main Contribution:
There was limited evidence to suggest that bilingual children develop speech at a slower rate than their monolingual peers; however, there was evidence for qualitative differences and increased variation in speech production. Nearly all studies provide evidence for transfer between the two phonological and language structures, although the amount of transfer varied between studies. There was evidence of positive and negative transfer of features from the dominant language (L1) to the second language (L2) as well as from L2 to L1. Positive transfer became more evident with increased age and length of exposure to a second language. More recently researchers have moved away from investigating whether there are one or two phonological systems and accept that there are two systems that interact.  Interest has shifted to examining how phonological systems interact and to identifying factors that influence interactions. The review revealed a number of inconsistencies in the findings of studies due to differences in methodology, languages investigated, and degree of language exposure. Overall, measurement issues were addressed well but most studies provided limited sample information about language experience, schooling and socio-economic status.
Conclusions: There are differences in speech sound acquisition between monolingual and bilingual children in terms of rate and patterns of error, with both positive and negative transfer occurring in bilingual children.

Dr Yvonne Wren's visit

Over Easter Dr Yvonne Wren and her family visited Bathurst. I have worked with Yvonne in Bristol on a number of occasions, and we have worked in many other cities in the world on days before or after conferences. So, it was wonderful to have her visit my home this time. Yvonne and I have been working on a paper based on analysis of the ALSPAC longitudinal data set. We also discussed her development, computerisation and testing of Phoneme Factory Phonology Screener.

Sharynne and Yvonne exploring Bathurst

A kangaroo near the entrance of Charles Sturt University