Prevalence of childhood speech sound disorders

In our role as Chair and Deputy Chair of the Child Speech committee of the International Association of Logopedics and Phoniatrics, Dr Yvonne Wren and I have compiled the following information about prevalence of childhood speech sound disorders.

In a systematic review, prevalence estimates for childhood speech delay only ranged from 2.3 to 24.6% (Law et al., 2000). Since this systematic review, additional prevalence studies have been published.:

• 25.2% parent-identified concerns about how their child “talked and made speech sounds” (11.8% “concerned”; 13.4% “a little concerned”) (n = 4,983; 4-5 years) (McLeod & Harrison, 2009) 
• 12.0% parent-identified “speech not clear to others” (n = 4,983; 4-5 years) (McLeod & Harrison, 2009) 
• 8.7% diagnosed by a speech-language pathologist with “isolated speech impairment”, and 14.3% with “comorbid speech and language impairment” (n = 308; school students) (Jessup, Ward, Cahill & Keating, 2008) 
• 3.8% classified as having speech delay using the Speech Disorders Classification System and stimuli from conversational speech samples and a published word articulation test (n = 1,328; 6 years) (Shriberg, Tomblin & McSweeny, 1999) 
• 3.6% identified as having persistent speech sound disorder in a large population study using > 1.2 standard deviations below the mean on percentage consonants correct scores taken from connected speech samples (n = 7,390; 8 years) (Wren et al., 2016) 
• 3.4% achieved a standard score performance of ≤79 on a speech assessment (n = 1,494; 4 years) (Eadie et al., 2014) 
• 1.7% parent-identified “speech disorders” (n = 12,388; 0-14 years) (Keating, Turrell, & Ozanne 2001) 
• 1.06% teacher-identified “speech sound disorders” (n = 10,425; school students) (McKinnon, McLeod, & Reilly, 2007) 

Period prevalence of childhood speech sound disorders

• United Kingdom: The Middlesbrough Primary Care Trust of the reported period prevalence of speech difficulties was 29.1%, compared with receptive language difficulties (20.4%), expressive language difficulties (16.9%), dysfluency (5.3%), and voice or nasality disruption (2.0%) (Broomfield & Dodd, 2004) 
• United States: 55.8% of children in grades K-3 were scored on speech sound disorder and 74.7% of Pre-K students were scored on the articulation/ intelligibility ASHA Functional Communication Measures (n = >16,000 students) (Mullen & Schooling, 2010) 

References
Broomfield, J., & Dodd, B. (2004a). Children with speech and language disability: Caseload characteristics. International Journal of Language and Communication Disorders, 39(3), 303-324. 

Eadie, P., Morgan, A., Ukoumunne, O. C., Ttofari Eecen, K., Wake, M., & Reilly, S. (2015). Speech sound disorder at 4 years: Prevalence, comorbidities, and predictors in a community cohort of children. Developmental Medicine and Child Neurology, 57(6), 578-584. doi:10.1111/dmcn.12635 

Jessup, B., Ward, E., Cahill, L., & Keating, D. (2008). Prevalence of speech and/or language impairment in preparatory students in northern Tasmania. International Journal of Speech-Language Pathology, 10(5), 364 - 377. 

Keating, D., Turrell, G., & Ozanne, A. (2001). Childhood speech disorders: Reported prevalence, comorbidity and socioeconomic profile. Journal of Paediatrics & Child Health, 37(5), 431-436. 

Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (2000). Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature. International Journal of Language and Communication Disorders, 35(2), 165-188. 

McKinnon, D. H., McLeod, S., & Reilly, S. (2007). The prevalence of stuttering, voice, and speech-sound disorders in primary school students in Australia. Language, Speech, and Hearing Services in Schools, 38(1), 5-15. 

McLeod, S., & Harrison, L. J. (2009). Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and Hearing Research, 52(5), 1213-1229. doi:10.1044/1092-4388(2009/08-0085) 

Mullen, R., & Schooling, T. (2010). The National Outcomes Measurement System for pediatric speech-language pathology. Language, Speech, and Hearing Services in Schools, 41, 44-60. doi:10.1044/0161-1461(2009/08-0051) 

Shriberg, L. D., Tomblin, J. B. & McSweeny, J. L. (1999). Prevalence of speech delay in 6-year-old children and co-morbidity with language impairment. Journal of Speech, Language and Hearing Research, 42, 1461-1481. 

Wren, Y., Roulstone, S., Miller, L.L., Emond, A. & Peters, T. (2016). The prevalence, characteristics, and risk factors of persistent speech disorder. Journal of Speech, Language, and Hearing Research, 59, 647-673. 

Compiled by Sharynne McLeod, Charles Sturt University and Yvonne Wren, University of Bristol - 2018

WHO in Fiji

This morning Dr Suzanne Hopf and I met with Darryl Barrett, Technical Lead Disabilities and Rehabilitation, Regional Office for the Western Pacific for the World Health Organization. We discussed ways we can support the work of WHO in Fiji.
He highlighted his website: http://www.wpro.who.int/rehabilitation/en/ and their most recent report. Here are a few key quotes from the report:
Rehabilitation and Disability in the Western Pacific

• "In 70% of countries in the Western Pacific Region, speech and occupational therapy is not available in the majority of their tertiary hospitals." (p. 18) 
• "Occupational therapy and speech pathology are extremely limited in the lower middle-income countries and almost nonexistent in the Pacific island countries." (p. 24) 
• "In Pacific island countries, occupational therapy, rehabilitation medicine and speech pathology are not available in over 50% of tertiary hospitals. The Pacific island countries reported that some rehabilitation services are sometimes provided by “fly-in missions” from high-income countries and international volunteers, but not in substantial numbers." (p. 25)

Working with Dr Audrey Wang

Next week Dr Audrey Wang's postdoctoral research fellowship ends. Over her time working at CSU I have had the pleasure of collaborating with Audrey on numerous grants and publications. She also has co-supervised and supported many of my PhD students (including Dr Sarah Masso and Dr Suzanne Hopf) and has taught them their EER502 Quantitative Research Methods. Here is a list of publications and grants we have worked on together. I look forward to future collaborations.

Journal articles
1. Wang, C., Harrison, L. J., McLeod, S., Walker, S., & Spilt, J. L. (2017, in press). Can teacher-child relationships support human rights to freedom of opinion and expression, education, and participation? International Journal of Speech-Language Pathology.
2. Hopf, S. C., McLeod, S., McDonagh, S., Wang, C., & Rakanace, E. (2017, in press). Communication disability in Fiji: Community self-help and help-seeking support. International Journal of Speech-Language Pathology. doi:10.1080/17549507.2017.1337226
3. 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, 60, 1877-1890. doi:10.1044/2017_JSLHR-S-16-0171
4. 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, 424-439. doi:10.1080/02699206.2017.1305450

with 3 additional manuscripts in submission. 

Commissioned reports
5. McLeod, S., Harrison, L. J., Wang, C. & Verdon, S. (2017). Indigenous Australian children’s speech and language: Academic outcomes and access to services. Technical report. Bathurst, Australia: Charles Sturt University.
6. McLeod, S., Harrison, L. J., & Wang, C. (2015). NAPLAN outcomes for children identified with speech and language difficulties at age 4 to 5 years: Initial Report. Bathurst, Australia: Charles Sturt University.
7. McLeod, S., Harrison, L. J., & Wang, C. (2015). NAPLAN outcomes for children identified with speech and language difficulties in early childhood: Second Report. Bathurst, Australia: Charles Sturt University.

Grants
8. McLeod, S., Harrison, L. J., Wang, C. & Verdon, S. (2017). Indigenous Australian children’s speech and language: Academic outcomes and access to services. Commissioned research by Speech Pathology Australia.
9. McLeod, S., Harrison, L. J., Wang, C. (2015). NAPLAN outcomes and trajectories for children identified with speech and language difficulties at age 4 to 5 years. Commissioned research by Speech Pathology Australia.

Waiting for speech pathology website - under construction

During December and January we have been meant to be on leave; however, with deadlines looming for the beginning of our Waiting for Speech Pathology randomised controlled trial, we have had to finalise the website (one of the intervention conditions for the participants). Nicole McGill has been busily working on the content, cartoons, related websites and running focus groups.  Katrina Rohr,  Angela Roberts and Emily Davis have been working on creating handouts. Kate Hennessy has been creating the site. The rest of the team has been providing feedback on all of the processes. The website won't be publicly available until 2019 (after testing in our research), but here is a glimpse of how it currently looks.

Website home page

Cartoon created by Nicole McGill

Visit from Bronwyn Hemsley

Yesterday Prof. Bronwyn Hemsley visited Bathurst. We discussed many things including her new appointment as Chair of Speech Pathology Masters Program at @UTSEngage Graduate School of Health. We also planned a social media campaign for the special issue of the International Journal of Speech-Language Pathology celebrating the 70th anniversary of the Universal Declaration of Human Rights (#StandUp4HumanRights, #SpeakUp4CommRights). She also gave me another Twitter lesson. It was great to catch up in Bathurst.

First publications for 2018

At the end of 2017 my colleagues and I had 8 papers that had been accepted but were still in press (some had been accepted in 2016). It is great to see two of these are now published with 2018 publication dates:

1. Hopf, S. C., McLeod, S. & McDonagh, S. H. (2018). Linguistic multi-competence of Fiji school students and their conversational partners. International Journal of Multilingualism, 15(1), 72-91. doi:10.1080/14790718.2016.1241256
   Free access: http://www.tandfonline.com/eprint/dF57kmKWGJWdv8qpW9WB/full
2. Masso, S., McLeod, S. & Baker, E. (2018). Tutorial: Assessment and analysis of polysyllables in young children. Language, Speech, and Hearing Services in Schools, 49, 42-58. doi:10.1044/2017_LSHSS-16-0047
   http://lshss.pubs.asha.org/article.aspx?articleid=2668005

These papers were written with Dr Suzanne Hopf and Dr Sarah Masso as part of their PhD theses.

Exciting developments for speech therapy in Vietnam

Over the past few days Professor Lindy McAllister has been visiting and sharing updates about the speech therapy profession in Vietnam and the involvement of the Trinh Foundation. Plans are underway to begin new masters and bachelors courses. This will bolster speech therapy and provide further recognition of this profession in Vietnam.
The Trinh Foundation Annual Report for 2017 is here, and includes mention of Ben Pham and myself.A summary from US Aid is here.

Sharynne, Prof Lindy McAllister, Ben Pham

Merry Christmas and Happy Holidays

My PhD student Ben Pham and our families had fun
experiencing the Christmas tradition of Santa photos

Wishing everyone a very merry Christmas, happy holidays, and best wishes for 2018.

Special issue of IJSLP regarding communication rights

We have almost finalised the content for our special issue of the International Journal of Speech-Language Pathology celebrating the 70th anniversary of the Universal of Declaration of Human Rights. There will be over 30 manuscripts in the special issue with the foreword written by the Australian Human Rights Commissioner and the Australian Disability Discrimination Commissioner. Here is a summary:

The special issue of International Journal of Speech-Language Pathology (2018, volume 20, issue 1) celebrates the 70th anniversary of the Universal Declaration of Human Rights and aims to expand the discussion of communication as a human right as it relates not only to Article 19, but also to subsequent national and international conventions, declarations, legislations, policies, and practices. The special issue addresses communication as a human right from four perspectives: (1) communication rights of all people, (2) communication rights of people with communication disabilities, (3) communication rights of children, and (4) communication rights relating to language. Many papers address more than one perspective; for example, the right to Arabic literacy education for children who are Syrian refugees in the US. In order to examine a broad range of interpretations of communication as a human right, this special issue draws on divergent perspectives from across the globe (including Australia, Belgium, Canada, Fiji, Ireland, the Netherlands, New Zealand, Portugal, Rwanda, Saudi Arabia, Shetland, South Africa, Sweden, Syria, UK, and USA). First hand accounts of people whose right to communicate is compromised/upheld are included and other papers are written by people with expertise and advocacy roles in speech-language pathology, audiology, education, psychology, communications, literature, and law. This special issue has embraced the notion of imparting “information and ideas through any media and regardless of frontiers” by not only including research articles and reviews, but by including short commentaries, invited papers, drawing and poetry.

It has been a privilege to be the guest editor for this important special issue.

Waiting for Speech Pathology website

Yesterday I traveled to Orange to join Emily Davis and Katrina Rohr from Bathurst Community Health, Nicole McGill, and Kate to work on the prototype for our Waiting for Speech Pathology website. We are developing the site in conjunction with NSW Health as part of our NSW Health Translational Research Grant. We will begin using it in our randomised controlled trial in February.

Nicole McGill (on screen), Emily Davis, Kate, Sharynne, Katrina Rohr

Charles Sturt University graduations

During December, Charles Sturt University held 22 graduation ceremonies over 8 days in 9 locations graduating over 4,000 students with over 12,000 guests attending. CSU's 2017 graduation video was from the ceremony where my PhD student Suzanne Hopf graduated - and Suzanne was the PhD graduate featured in the video! https://www.youtube.com/watch?v=Ac5F3QOLeYM 
CSU also profiled Suzanne's work in a media release: http://news.csu.edu.au/latest-news/education/teacher-education/fiji-speech-and-language-research-yields-gold-standard-phd-thesis
Congratulations Suzanne.

Seeking a PhD student to join our VietSpeech project in 2018

Dr Sarah Verdon and I are looking for a PhD student to join our VietSpeech project in 2018. The project is funded by the Australian Research Council and the scholarship is sponsored by Charles Sturt University.
The link to the advertisement is here
The link to the CSU media release about our project is here
Links from this blog about our previous work about Vietnamese children's speech are here

We look forward to hearing from interested people and having someone wonderful to join our team.

A message from East Tennessee State University

This week we received the following email from our colleague Dr. Lynn Williams at East Tennessee State University and permission to post this photo to my blog. It is wonderful to see that our book is being used and enjoyed.

Dear Sharynne and Elise, I’m sending you a photo of my students on the last night of my Clinical Phonology class reviewing your book just before the final! Your book is an excellent compendium of the most current information on the clinical assessment and treatment of SSD in children! Thank you for all the work you put into creating a comprehensive, balanced, thoughtful, and clinically useful book for our profession!! Kind regards, Lynn

Congratulations Suzanne on your PhD graduation

Today Suzanne Hopf  graduated with her PhD at Charles Sturt University. She traveled from Fiji with her family to attend. Charles Sturt University selected Suzanne to profile in a media release which is here. Suzanne's graduation was featured in a CSU video here.

Suzanne's PhD was titled Supporting Fijian Children’s Communication. It was presented as a series of publications: 8 journal articles and a book chapter.

Suzanne with her supervisors:
Professor Sharynne McLeod, Dr Sarah McDonagh, and Dr Audrey Wang

PhD graduates from the Faculty of Arts and Education

The Communication Capacity Research model developed within her PhD has been published in a recent article:
Hopf, S. C. (2018). Communication Capacity Research in the Majority World: Supporting the human right to communication specialist services. International Journal of Speech-Language Pathology. doi:10.1080/17549507.2018.1400101

Here is her PhD abstract

Purpose. Fiji is a multicultural and linguistically multi-competent country. Historical ethnic divisions have socialised students into language friendships based around common languages. Recent changes to educational policy, specifically the mandating of students learning all three of the main languages in Fiji (Standard Fijian, Fiji Hindi, and English), have been introduced in the hope that cross-linguistic understanding will encourage a greater sense of national identity amongst all Fijians regardless of ethnicity. This study explores one multilingual school environment considering students’ language use, attitudes, and friendships in light of these policy changes.
Methodology. A convergent mixed-methods research design using surveying, artefact collection, student's drawing, and observation was employed.
Findings. The majority of students reported some proficiency in the language of their inter-ethnic peers; however, students’ inter-ethnic friendships predominantly relied on English language use. It was observed that most friendships amongst these Fijian primary school students were still established according to main language use at home; however, inter-ethnic peer interaction in English was observed to be friendly and respectful. These language use patterns and friendship behaviours were potentially reinforced by individual and societal multilingualism, in addition to the school environment.
Originality. The paper presents the first research linking Fijian primary school students’ language choices and friendship development.

Congratulations Suzanne!

School of Teacher Education staff at graduation

Impact of our work in South Africa

Our work has been used to inform the development of human rights-driven guidelines for South African speech-language pathologists. The following manuscript has just been published online, and uses

• the position paper written by the International Expert Panel on Multilingual Children's Speech as well as 
• the position paper we wrote for Speech Pathology Australia about working in a culturally and linguistically diverse society 

 This is an exciting impact of our work.

Pascoe, M., Klop, D., Mdlalo T., & Ndhambi, M. (2017). Beyond lip service: Towards human rights-driven guidelines for South African speech-language pathologists. International Journal of Speech-Language Pathology, Advance online publication.

A long and productive research partnership

Today Linda Harrison and I worked together on revisions of an important paper that we hope will be published next year some time. Linda and I have had a very long partnership beginning when I was allocated an office across the hallway from Linda. Together we received one research excellence award, 5 grants (including an Australian Research Council Discovery Grant), co-supervised 3 research students, and written 27 publications (book chapters and articles) as well as presented many conference papers. We have undertaken research and writing  about children's speech and language that has been highly cited.

Here are some of the papers about children's speech and language we have published together:

1. Harrison, L. J., & McLeod, S. (2010). Risk and protective factors associated with speech and language impairment in a nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and Hearing Research, 53(2), 508-529. doi:10.1044/1092-4388(2009/08-0086)
2. Harrison, L. J., McLeod, S., Berthelsen, D., & Walker, S. (2009). Literacy, numeracy, and learning in school-aged children identified as having speech and language impairment in early childhood. International Journal of Speech-Language Pathology, 11(5), 392-403. doi:doi:10.1080/17549500903093749
3. Harrison, L. J., McLeod, S., McAllister, L., & McCormack, J. (2017). Speech sound disorders in preschool children: Correspondence between clinical diagnosis and teacher and parent report. Australian Journal of Learning Difficulties, 22(1), 35-48. doi:10.1080/19404158.2017.1289964
4. Holliday, E. L., Harrison, L. J., & McLeod, S. (2009). Listening to children with communication impairment talking through their drawings. Journal of Early Childhood Research, 7(3), 244-263. doi:10.1177/1476718x09336969
5. McAllister, L., McCormack, J., McLeod, S., & Harrison, L. J. (2011). Expectations and experiences of accessing and participating in services for childhood speech impairment. International Journal of Speech-Language Pathology, 13(3), 251-267. doi:10.3109/17549507.2011.535565
6. McCormack, J., Harrison, L. J., McLeod, S., & McAllister, L. (2011). A nationally representative study of the association between communication impairment at 4-5 years and children's life activities at 7-9 years. Journal of Speech, Language and Hearing Research, 54(5), 1328-1348. doi:10.1044/1092-4388(2011/10-0155)
7. McCormack, J., McAllister, L., McLeod, S., & Harrison, L. J. (2012). Knowing, having, doing: The battles of childhood speech impairment. Child Language Teaching and Therapy, 28(2), 141-157. doi:10.1177/0265659011417313
8. McCormack, J., McLeod, S., Harrison, L. J., & McAllister, L. (2010). The impact of speech impairment in early childhood: Investigating parents' and speech-language pathologists' perspectives using the ICF-CY. Journal of Communication Disorders, 43(5), 378-396.
9. McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2009). A systematic review of the association between childhood speech impairment and participation across the lifespan. International Journal of Speech-Language Pathology, 11(2), 155-170.
10. McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2010). My speech problem, your listening problem, and my frustration: The experience of living with childhood speech impairment. Language, Speech, and Hearing Services in Schools, 41(4), 379-392. doi:10.1044/0161-1461(2009/08-0129)
11. McLeod, S., & Harrison, L. J. (2009). Epidemiology of speech and language impairment in a nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and Hearing Research, 52(5), 1213-1229. doi:10.1044/1092-4388(2009/08-0085)
12. McLeod, S., Harrison, L. J., & McCormack, J. (2012). Intelligibility in Context Scale: Validity and reliability of a subjective rating measure. Journal of  Speech, Language, and Hearing Research, 55, 648-656. doi:10.1044/1092-4388(2011/10-0130)
13. McLeod, S., Harrison, L. J., McAllister, L., & McCormack, J. (2013). Speech sound disorders in a community study of preschool children. American Journal of Speech-Language Pathology, 22(3), 503-522. doi:10.1044/1058-0360(2012/11-0123)
14. McLeod, S., Harrison, L. J., Whiteford, C., & Walker, S. (2016). Multilingualism and speech-language competence in early childhood: Impact on academic and social-emotional outcomes at school. Early Childhood Research Quarterly, 34, 53-66. doi:10.1016/j.ecresq.2015.08.005
15. McLeod, S., McAllister, L., McCormack, J., & Harrison, L. J. (2014). Applying the World Report on Disability to children’s communication. Disability and Rehabilitation, 36(18), 1518-1528. doi:10.3109/09638288.2013.833305
16. McLeod, S., McCormack, J., McAllister, L., Harrison, L. J., & Holliday, E. L. (2011). Listening to 4- to 5-year-old children with speech impairment using drawings, interviews and questionnaires. In S. Roulstone & S. McLeod (Eds.), Listening to children and young people with speech, language and communication needs. (pp. 179-186). London: J&R Press.
17. Phạm, B., McLeod, S., & Harrison, L. J. (2017). Validation and norming of the Intelligibility in Context Scale in Northern Viet Nam. Clinical Linguistics and Phonetics, 31(7-9), 665-681. doi:10.1080/02699206.2017.1306110
18. Wang, C., Harrison, L. J., McLeod, S., Walker, S., & Spilt, J. L. (2017). Can teacher–child relationships support human rights to freedom of opinion and expression, education and participation? International Journal of Speech-Language Pathology, Advance online publication. doi:10.1080/17549507.2018.1408855
     

Editorial board member

I have  been invited to be editorial board member for Language, Speech, and Hearing Services in Schools and look forward to this opportunity. This now means that I am an editorial board member of the following journals:

• Clinical Linguistics and Phonetics (since 2006)
• Child Language Teaching and Therapy (since 2007)
• Speech, Language and Hearing (since 2015)
• Language, Speech, and Hearing Services in Schools (from 2018)

Human Rights Awards

Yesterday I attended the Australian Human Rights Awards celebration in Sydney. There were over 500 people in attendance, with inspiring speeches Rosalind Croucher (President, Australian Human Rights Commission), Alistair McEwan (Disability Discrimination Commissioner), Ed Santow (Human Rights Commissioner), Megan Mitchell (Children's Commissioner), George Brandis (Attorney-General for Australia) and the award winners. The 69th anniversary of the Universal Declaration of Human Rights will be celebrated tomorrow (10th December).

Developing the waiting for speech pathology website

Over the past few months, my PhD student Nicole McGill has been working hard with the team from Bathurst and Dubbo Community Health to develop content for our waiting for speech pathology website. She has had over 100 responses to the online survey and will be conducting focus groups soon. Our work is supported by a NSW Health Translational Research Grant scheme and is part of Nicole's PhD.

The front page of the online survey

Writing together on different sides of the world

While Dr Sarah Masso has been in Canada on her Endeavour Scholarship, we have been able to continue writing together. We have submitted a book chapter and finalised some journal articles based on data from the Sound Start Study. Here is the information about our invited book chapter:

• McLeod, S. & Masso, S. (2017, submitted). Speech sound disorders in children. In J. S. Horst & J. von Koss Torkildsen (Eds.). International handbook of language development. Abingdon, UK: Routledge.

Writing with Sarah Masso via Skype on different sides of the world

Also, I have been writing with Dr Kate Crowe who is now working at the Rochester Institute of Technology in New York State. Our most recent task has to finalise revisions of a manuscript. It is great to continue writing with these scholars and colleagues.

Kate wearing her gift from my PhD students' recent visit to ASHA in LA