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Research on the language acquisition of deaf individuals who are exposed to accessible linguistic input at a variety of ages has provided evidence for a sensitive period of first language acquisition. Recent studies have shown that deaf individuals who first learn language after early childhood, late first-language learners (LL1), do not comprehend reversible Subject-Verb-Object (SVO) sentences. The present study analyzed 478 signed productions elicited with pictures depicting simple events with one or two arguments by 28 signers. The argument order patterns of native signers converged with one another and the word order patterns of American Sign Language (ASL). By contrast, the ordering patterns of the LL1 signers did not converge with one another or with the patterns of the native signers. This indicates that early childhood is a period of heightened sensitivity to basic word order and may help explain why complex structures are difficult for LL1 signers to learn.

Relative to one's default (casual) speech, clear speech contains acoustic modifications that are often perceptually beneficial. Clear speech encompasses many different styles, yet most work only compares clear and casual speech as a binary. Furthermore, the term “clear speech” is often unclear − despite variation in elicitation instructions across studies (e.g., speak clearly, imagine an L2-listener or someone with hearing loss, etc.), the generic term “clear speech” is used when interpreting results, under the tacit assumption that clear speech is monolithic. The current study examined the acoustics and intelligibility of casual speech and two clear styles (hard-of-hearing-directed and non-native-directed speech). We find: (1) the clear styles are acoustically distinct (non-native-directed speech is slower with lower mean intensity and f0); (2) the clear styles are perceptually distinct (only hard-of-hearing-directed speech enhances intelligibility); (3) no differences in intelligibility benefits are observed between L1 and L2-listeners. These results underscore the importance of considering the intended interlocutor in speaking style elicitation, leading to a discussion about the issues that arise when reference to “clear speech” lacks clarity. It is suggested that to be more clear about clear speech, greater caution should be taken when interpreting results about speaking style variation.

PurposePast research shows that parentally responsive behavior toward the child positively influences language development in both neurotypical children and children with intellectual and developmental disabilities, including those with fragile X syndrome (FXS); however, most studies have focused exclusively on the mother-child relationship. The current study examined relationships between parent behavior (i.e., responsivity and behavior management) and child language performance in both mother-child and father-child interactions, as well as relationships between child characteristics and both parent behavior and child language.MethodParticipants were 23 families of young boys with FXS between 3 and 7 years of age. Mothers and fathers independently completed questionnaires assessing child characteristics and separately engaged in 12-min play-based interactions with their child via telehealth. One parent also completed a comprehensive interview assessing child adaptive behavior. Video recordings of the parent-child interactions were transcribed and coded for parent and child behavior, and measures of parent and child language were obtained from the transcripts.ResultsMothers and fathers used similar rates of responsive behaviors during parent-child interactions, and parental responsivity was positively associated with some aspects of child language performance (i.e., talkativeness and lexical diversity). Parental behavior, however, was not associated with syntactic complexity. Older children and children with higher levels of adaptive behavior had parents who used higher rates of responsive behaviors. Fathers used higher rates of behavior management strategies compared to mothers, and this type of parent behavior was not associated with child language.ConclusionOverall, this study provides evidence that interventions focused on increasing parental responsiveness would be beneficial for families of children with FXS and that these interventions should be delivered early given the association between responsivity and child age.Supplemental materialhttps://doi.org/10.23641/asha.25229939.

In six experiments we explored how biphone probability and lexical neighborhood density influence listeners' categorization of vowels embedded in nonword sequences. We found independent effects of each. Listeners shifted categorization of a phonetic continuum to create a higher probability sequence, even when neighborhood density was controlled. Similarly, listeners shifted categorization to create a nonword from a denser neighborhood, even when biphone probability was controlled. Next, using a visual world eye-tracking task, we determined that biphone probability information is used rapidly by listeners in perception. In contrast, task complexity and irrelevant variability in the stimuli interfere with neighborhood density effects. These results support a model in which both biphone probability and neighborhood density independently affect word recognition, but only biphone probability effects are observed early in processing.

Children who receive cochlear implants develop spoken language on a protracted timescale. The home environment facilitates speech-language development, yet it is relatively unknown how the environment differs between children with cochlear implants and typical hearing. We matched eighteen preschoolers with implants (31-65 months) to two groups of children with typical hearing: by chronological age and hearing age. Each child completed a long-form, naturalistic audio recording of their home environment (appx. 16 hours/child; >730 hours of observation) to measure adult speech input, child vocal productivity, and caregiver-child interaction. Results showed that children with cochlear implants and typical hearing were exposed to and engaged in similar amounts of spoken language with caregivers. However, the home environment did not reflect developmental stages as closely for children with implants, or predict their speech outcomes as strongly. Home-based speech-language interventions should focus on the unique input-outcome relationships for this group of children with hearing loss.

PurposeThe aims of this study were (a) to evaluate the convergent validity of the Language Use Inventory (LUI) with measures of autism spectrum disorder (ASD) symptoms, language, and social skills and (b) to assess discriminant validity of the LUI with measures of nonlanguage skills, including daily living skills and motor development.MethodThis study sample included participants from a longitudinal study (n = 239) of infant siblings with elevated familial likelihood of ASD and lower familial likelihood. Assessment measures completed at 36 months included the LUI, the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), the Mullen Scales of Early Learning, and the Vineland Adaptive Behavior Scales-Second Edition. Bivariate Pearson correlations were estimated between ADOS-2 comparison scores and four language and social skills measures. Additional correlations were estimated between LUI total scores and standard scores from nonlanguage measures. A series of Fisher's Z transformations were applied to evaluate whether bivariate correlations were significantly different.ResultsAll four language and social skill measures were moderately to strongly associated with each other and ASD symptom severity scores. The correlation between ADOS-2 comparison scores and LUI total scores was significantly stronger than ADOS-2 correlations with all other measures.ConclusionsOur findings provide support for the LUI as a feasible, pragmatic language-targeted instrument for inclusion in early developmental evaluations prompted by language concerns. Administration of the LUI may accelerate earlier referral for a comprehensive assessment of ASD symptoms. Given the high correlation with ADOS-2 scores, an LUI total score in a clinical range of concern may encourage a clinician to refer families for a full diagnostic evaluation of ASD.

The process by which infants learn verbs through daily social interactions is not well-understood. This study investigated caregivers' use of verbs, which have highly abstract meanings, during unscripted toy-play. We examined how verbs co-occurred with distributional and embodied factors including pronouns, caregivers' manual actions, and infants' locomotion, gaze, and object-touching. Object-action verbs were used significantly more often during caregiver-infant joint attention interactions. Movement and cognition verbs showed distinct co-occurrences with different contexts. Cognition and volition verbs were differentiated by pronouns. These findings provide evidence for how verb acquisition may be supported by the distributional and embodied contexts in caregiver-infant interactions.

This study uses non-native perception data to examine the relationship between perceived phonetic similarity of segments and their phonological patterning. Segments that are phonetically similar to one another are anticipated to pattern together phonologically, and segments that share articulatory or acoustic properties are also expected to be perceived as similar. What is not yet clear is whether segments that pattern together phonologically are perceived as similar. This study addresses this question by examining how L1 English listeners and L1 Guébie listeners perceive non-native implosive consonants compared with plosives and sonorants. English does not have contrastive implosives, whereas Guébie has a bilabial implosive. The bilabial implosive phonologically patterns with sonorants in Guébie, to the exclusion of obstruents. Two perception experiments show English listeners make more perceptual categorization errors between implosives and voiced plosives than Guébie listeners do, but both listener groups are more likely to classify implosives as similar to voiced plosives than sonorants. The results also show that Guébie listeners are better at categorizing non-native implosive consonants (i.e., alveolar implosives) than English listeners, showing that listeners are able to extend features or gestures from their L1 to non-native implosive consonants. The results of these experiments suggest a cross-linguistic perceptual similarity hierarchy of implosives compared with other segments that are not affected by L1 phonological patterning.

Background and objectivesIn Italy, approximately 650 individuals receive a diagnosis of primary progressive aphasia (PPA) every year. Unfortunately, the frequency with which patients are referred to speech-language services is suboptimal, likely due to skepticism regarding the value of speech-language therapy in the context of neurodegeneration.Materials and methodsWe conducted a virtual survey of speech and language therapists (SLTs) across Italy, to collect information about the assessment, intervention and management of patients with PPA. To ensure that as many SLTs as possible received the survey, the Italian Federation of SLTs (Federazione Logopedisti Italiani, FLI) aided in disseminating the survey.ResultsIn total, 336 respondents participated in the online survey, 140 of whom had previous experience with PPA patients. Respondents indicated having seen a total of 428 PPA patients in the previous 24 months (three patients on average, range: 0-40). SLTs who reported never working with PPA identified underdiagnoses, low referral rates and the rarity of the clinical syndrome as major reasons for their lack of experience with PPA. SLTs with experience working with PPA indicated that patients may not have accessed services because of service dysfunction and geographical barriers. Respondents reported using informal interviews during assessments and tests developed for post-stroke aphasia, while impairment-based/restitutive interventions were utilised most often.ConclusionFindings may serve to inform health policy organisations regarding the current shortcomings and needed recommendations for improving the care of individuals with PPA in Italy. Improving awareness of the utility of rehabilitation among SLTs and other clinical service providers may serve to facilitate access to intervention, which in turn will serve to better support individuals living with PPA.What this paper addsWhat is already known on the subject Speech and language therapists (SLTs) play a crucial role in the assessment, diagnosis and treatment of people with primary progressive aphasia (PPA). However, the frequency with which individuals with PPA are referred for speech and language services is suboptimal due to skepticism regarding the value of speech and language therapy in the context of neurodegeneration, the scarcity of SLTs with expertise in the treatment of PPA and the lack of awareness of the SLT role amongst referrers. What this paper adds to existing knowledge In recognition of the lack of published information on the provision of speech and language therapy services and clinicians' approaches to the assessment and treatment of individuals with PPA in Italy, we conducted an online survey to evaluate the current referral patterns for speech and language therapy services and to examine the current barriers to access these services for individuals with PPA in Italy. What are the potential or actual clinical implications of this work? The data presented here support that SLTs view treatment as useful for individuals with PPA and other professional figures and may serve to improve access to intervention, which in turn will serve to better support individuals living with PPA. The results highlight the need to inform health policy organisations about current gaps and aid in developing recommendations for improving the care of individuals with PPA, in order to understand how SLTs can best support individuals with PPA and their families.

ObjectiveWhile the vocal fold is in direct contact anteriorly with the thyroid cartilage, posteriorly the vocal fold connects to the thyroid cartilage through a soft tissue layer in the paraglottic space. Currently the paraglottic space is often neglected in computational models of phonation, in which a fixed boundary condition is often imposed on the lateral surface of the vocal fold. The goal of this study was to investigate the effect of the paraglottic space on voice production in an MRI-based vocal fold model, and how this effect may be counteracted by vocal fold stiffening due to laryngeal muscle activation.MethodsParametric simulation study using an MRI-based computational vocal fold model.ResultsThe results showed that the presence of the paraglottic space increased the mean and amplitude of the glottal area waveform, decreased the phonation frequency and closed quotient. For the particular vocal fold geometry used in this study, the presence of the paraglottic space also reduced the occurrence of irregular vocal fold vibration. These effects of the paraglottic space became smaller with increasing paraglottic space stiffness and to a lesser degree with vocal fold stiffening.ConclusionsThe results suggest that the paraglottic space may be neglected in qualitative evaluations of normal phonation, but needs to be included in simulations of pathological phonation or vocal fold posturing.

ObjectiveEstimation of physiological control parameters of the vocal system from the produced voice outcome has important applications in clinical management of voice disorders . Previously we developed a simulation-based neural network for estimation of vocal fold geometry, mechanical properties, and subglottal pressure from voice outcome features that characterize the acoustics of the produced voice. The goals of this study are to (1) explore the possibility of improving the estimation accuracy of physiological control parameters by including voice outcome features characterizing vocal fold vibration; and (2) identify voice feature sets that optimize both estimation accuracy and robustness to measurement noise.MethodsFeedforward neural networks are trained to solve the inversion problem of estimating the physiological control parameters of a three-dimensional body-cover vocal fold model from different sets of voice outcome features that characterize the simulated voice acoustics, glottal flow, and vocal fold vibration. A sensitivity analysis is then performed to evaluate the contribution of individual voice features to the overall performance of the neural networks in estimating the physiologic control parameters.Results and conclusionsWhile including voice outcome features characterizing vocal fold vibration increases estimation accuracy, it also reduces the network's robustness to measurement noise, due to high sensitivity of network performance to voice outcome features measuring the absolute amplitudes of the glottal flow and area waveforms, which are also difficult to measure accurately in practical applications. By excluding such glottal flow-based features and replacing glottal area-based features by their normalized counterparts, we are able to significantly improve both estimation accuracy and robustness to noise. We further show that similar estimation accuracy and robustness can be achieved with an even smaller set of voice outcome features by excluding features of small sensitivity.

PurposeChildren's ability to adjust one's language according to discourse context is important for success in academic settings. This study examined whether second graders vary in linguistic and discourse features depending on discourse contexts, that is, when describing pictures in contextualized (describing the picture to an examiner while looking at it together) and decontextualized (pretending to describe the picture to a friend while sitting in front of the examiner) conditions.MethodA total of 330 English-speaking second graders in the United States (M age = 7.33 years; 53% boys; 55% Caucasian children, 35% African American children) described three pictures in contextualized and decontextualized conditions. Children's picture descriptions were transcribed verbatim and coded for linguistic (e.g., elaborated noun phrase) and discourse (e.g., proper character introduction, degree of decontextualization) features.ResultsType-token ratio was higher in the contextualized condition than in the decontextualized condition, whereas certain types of elaborated noun phrases (e.g., simple descriptive noun phrase, noun phrase with postmodification), coordinating conjunctions, and nonclauses occurred more frequently in the decontextualized condition, controlling for total productivity and student demographics. The proportion of proper character introduction was higher in the decontextualized condition, whereas higher degrees of decontextualization and complex perspective-taking were found in the contextualized condition.ConclusionVarious linguistic and discourse cues illustrated the extent to which primary grade students employ their discourse knowledge when producing oral language.

Lateral tongue bracing is a lingual posture in which the sides of the tongue are held against the palate and upper molars, and has been observed cross-linguistically. However, it is unknown whether lateral bracing makes adjustments to external perturbation like other body postures. The present study aims to test the robustness of lateral tongue bracing with three experiments. The first baseline experiment was an analysis of an electropalatogram database and the results showed lateral bracing being continuously maintained. The second experiment applied an external perturbation during speech production. A bite block was held between participants' teeth while intra-oral video was used to record contact between the sides of the tongue and upper molars during speech. The results indicated that lateral bracing was maintained most of the time during speech. The third experiment included simulations investigating the activation of tongue muscles relevant to lateral bracing at different degrees of jaw opening. The results show that bracing requires higher activation of bracing agonists and lower activation of bracing antagonists as jaw opening increases. Our results suggest that lateral tongue bracing is actively maintained and robust under external perturbation and further indicate it serves as an essential lingual posture during speech production.

Kidd and Garcia demonstrate that the field of language acquisition must consider a more diverse range of languages. This is certainly needed, to gain a deeper understanding of the basic mechanisms of language acquisition; to achieve that, we need more longitudinal studies of several children per language, with (trained) fluent-user transcription and analysis. This could, for example, help to establish the size of the unit from which the child extracts generalizations and builds categories and networks in phonological development.

PurposeThis systematic review provides a comprehensive summary of the diagnostic accuracy of English language sample analysis (LSA) measures for the identification of developmental language disorder.MethodAn electronic database search was conducted to identify English publications reporting empirical data on the diagnostic accuracy of English LSA measures for children aged 3 years or older.ResultsTwenty-eight studies were reviewed. Studies included between 18 and 676 participants ranging in age from 3;0 to 13;6 (years;months). Analyzed measures targeted multiple linguistic domains, and diagnostic accuracy ranged from less than 25% to greater than 90%. Morphosyntax measures achieved the highest accuracy, especially in combination with length measures, and at least one acceptable measure was identified for each 1-year age band up to 10 years old.ConclusionSeveral LSA measures or combinations of measures are clinically useful for the identification of developmental language disorder, although more research is needed to replicate findings using rigorous methods and to explore measures that are informative for adolescents and across diverse varieties of English.Supplemental materialhttps://doi.org/10.23641/asha.21183247.

PurposeThis study examined the relationship between voice quality and glottal geometry dynamics in patients with adductor spasmodic dysphonia (ADSD).MethodAn objective computer vision and machine learning system was developed to extract glottal geometry dynamics from nasolaryngoscopic video recordings for 78 patients with ADSD. General regression models were used to examine the relationship between overall voice quality and 15 variables that capture glottal geometry dynamics derived from the computer vision system. Two experts in ADSD independently rated voice quality for two separate voice tasks for every patient, yielding four different voice quality rating models.ResultsAll four of the regression models exhibited positive correlations with clinical assessments of voice quality (R 2s = .30-.34, Spearman rho = .55-.61, all with p < .001). Seven to 10 variables were included in each model. There was high overlap in the variables included between the four models, and the sign of the correlation with voice quality was consistent for each variable across all four regression models.ConclusionWe found specific glottal geometry dynamics that correspond to voice quality in ADSD.

Laryngeal complications (LCs) following cardiac operations contribute to increased morbidity and resource utilization. Using a nationally representative cohort of cardiac surgical patients, we characterized the incidence of LC as well as its associated clinical and financial outcomes. All adults undergoing coronary artery bypass grafting and/or valvular operations were identified using the 2010-2017 Nationwide Readmissions Database. International Classification of Diseases 9th and 10th Revision diagnosis codes were used to identify LC. Trends were analyzed using a rank-based, non-parametric test (nptrend). Multivariable linear and logistic regressions were used to evaluate risk factors for LC, and its impact on mortality, complications, resource use and 30-day non-elective readmissions. Of an estimated 2,319,628 patients, 1.7% were diagnosed with perioperative LC, with rising incidence from 1.5% in 2010 to 1.8% in 2017 (nptrend

The study aimed to determine the status of dysphagia clinics and procedures applied in dysphagia clinics during the COVID-19 pandemic. Clinicians working in an outpatient dysphagia clinic were included. A 30-question survey inquiring about the descriptive information of the participants and their clinics, their clinical practice, and the tele-health applications during the COVID-19 pandemic. The survey was administered via Google forms. The participants were asked to fill out the survey on behalf of their clinics. One survey was completed per dysphagia clinic. Twenty-three clinicians responded on behalf of their clinics. The number of patients and dysphagia evaluations decreased during the COVID-19 pandemic (p

PurposeThis research examined the expression of cortical auditory evoked potentials in a cohort of children who received cochlear implants (CIs) for treatment of congenital deafness (n = 28) and typically hearing controls (n = 28).MethodWe make use of a novel electroencephalography paradigm that permits the assessment of auditory responses to ambiently presented speech and evaluates the contributions of concurrent visual stimulation on this activity.ResultsOur findings show group differences in the expression of auditory sensory and perceptual event-related potential components occurring in 80- to 200-ms and 200- to 300-ms time windows, with reductions in amplitude and a greater latency difference for CI-using children. Relative to typically hearing children, current source density analysis showed muted responses to concurrent visual stimulation in CI-using children, suggesting less cortical specialization and/or reduced responsiveness to auditory information that limits the detection of the interaction between sensory systems.ConclusionThese findings indicate that even in the face of early interventions, CI-using children may exhibit disruptions in the development of auditory and multisensory processing.

Variegation - the presence of more than one supraglottal consonant per word - is a key challenge for children as they increase their expressive vocabulary toward the end of the single-word period. Here we consider the prosodic structures of target words and child forms in English, Finnish, French, Japanese and Mandarin to determine whether children learning these languages respond similarly to the challenge or instead differ in ways related to the phonological structure of the adult language. Based on proportional occurrence of each structure, we find that the word forms of children learning Mandarin and Japanese show more variegation than do those of children learning the European languages, although their target words do not; proportions of reduplication, consonant harmony and single-consonant words also differ by language. We conclude that experience with the structure of the language - and thus representation, as well as immature articulatory skills - shapes children's responses to variegation.

PurposeThe primary aim was to assess whether children have difficulty distinguishing similar-sounding novel words. The secondary aim was to assess what task characteristics might hinder or facilitate perceptual discrimination.MethodThree within-subjects experiments tested ninety-nine 3- to 5-year-old children total. Experiment 1 presented two cartoon characters each saying a novel word. Children were asked to report whether they said the same word or different words. Words were identical (e.g., deev/deev), were dissimilar (deev/vush), differed in onset consonant voicing (deev/teev), or differed in vowel tenseness (deev/div). Experiment 2 added accuracy feedback after each trial to remind children of task instructions. Experiment 3 interspersed many "same" trials containing a repeating standard word to assess the role of bottom-up stimulus support on difference detection.ResultsThe d' scores were highest for dissimilar words, next highest on different-vowel pairs, and lowest on different-consonant pairs. Performance was better with repeated standard stimuli (Experiment 3) than without (Experiment 1). Benefits for repeated task instructions (Experiment 2) were marginal. Exploratory analyses comparing these results to findings in a word-learning study using the same stimuli suggest an imperfect match to how easily children can learn similar-sounding words.ConclusionsOverall, similar-sounding novel words are challenging for children to discriminate perceptually, although discrimination scores exceeded chance for all levels of similarity. Clinically speaking, same/different tests may be less sensitive to sound discrimination than change/no-change tests.Supplemental materialhttps://doi.org/10.23641/asha.20151848.

Cost-effectiveness analysis, the most common type of economic evaluation, estimates a new option's additional outcome in relation to its extra costs. This is crucial to study within the clinical setting because funding for new treatments and interventions is often linked to whether there is evidence showing they are a good use of resources. This article describes how to analyze a cost-effectiveness dataset using the framework of a net benefit regression. The process of creating estimates and characterizing uncertainty is demonstrated using a hypothetical dataset. The results are explained and illustrated using graphs commonly employed in cost-effectiveness analyses. We conclude with a call to action for researchers to do more person-level cost-effectiveness analysis to produce evidence of the value of new treatments and interventions. Researchers can utilize cost-effectiveness analysis to compare new and existing treatment mechanisms.

ObjectivesThe novel coronavirus disease 2019 has posed significant limitations and barriers to providing in-person healthcare. We aim to provide a summary of learned experiences and important considerations for implementing and offering telehealth to provide laryngology subspecialty care during the COVID-19 pandemic and thereafter.Materials and methodsFour laryngologists and a voice-specialized speech-language pathologist from a tertiary-care academic Voice and Swallowing Center were engaged in a structured group consensus conference. Participants shared input, experiences, and practice patterns employed via telemedicine (via telephone or video-communication) during the early COVID-19 era.ResultsKey identified areas of consideration when offering telemedicine included (1) how to set up and structure a telemedicine visit and maintain patient confidentiality, (2) patient examination and treatment initiation, (3) optimization of the tele-visit, (4) limitations and recognition of when a tele-visit is insufficient for patient care needs, (5) billing/reimbursement considerations. Group consensus for the aforementioned topics is summarized and discussed.ConclusionDuring the COVID-19 pandemic, a telemedicine model can be effectively employed to improve patient access to subspecialty laryngology care, including a multidisciplinary care approach, with initiation of various therapeutic interventions. A major limitation given the preclusion of in-person assessment is the lack of access to laryngoscopy, which can likely be delayed safely in the majority of individuals.

PurposeCluttering is a fluency disorder that has been noted clinically in individuals with fragile X syndrome (FXS). Yet, cluttering has not been systematically characterized in this population, hindering identification and intervention efforts. This study examined the rates of cluttering in male young adults with FXS using expert clinical opinion, the alignment between expert clinical opinion and objectively quantified features of cluttering from language transcripts, and the association between cluttering and aspects of the FXS phenotype.MethodThirty-six men with FXS (aged 18-26 years; M = 22, SD = 2.35) contributed language samples and completed measures of nonverbal cognition, autism symptoms, anxiety, and symptoms of attention-deficit/hyperactivity disorder (ADHD). The presence of cluttering was determined by the consensus of two clinical experts in fluency disorders based on characteristics exhibited in the language sample. Cluttering features (speech rate, disfluencies, etc.) were also objectively quantified from the language transcripts.ResultsClinical experts determined that 50% of participants met the criteria for a cluttering diagnosis. Phrase repetitions were the most salient feature that distinguished individuals who cluttered. Although the presence of cluttering was not associated with autism symptoms or mean length of utterance, cluttering was more likely to occur when nonverbal cognitive ability was higher, ADHD symptoms were elevated, and anxiety symptoms were low.ConclusionsHalf of the male young adults with FXS exhibited cluttering, which supports FXS as a genetic diagnosis that is highly enriched for risk of cluttering. Cluttering was associated with increased ADHD symptoms and cognitive ability and reduced anxiety symptoms. This study contributes a new description of the clinical presentation of cluttering in men with FXS and may lead to improved understanding of the potential underlying mechanisms of cluttering and eventual refinements to treatment and diagnosis.

This paper argues that training Generative Adversarial Networks (GANs) on local and non-local dependencies in speech data offers insights into how deep neural networks discretize continuous data and how symbolic-like rule-based morphophonological processes emerge in a deep convolutional architecture. Acquisition of speech has recently been modeled as a dependency between latent space and data generated by GANs in Beguš (2020b), who models learning of a simple local allophonic distribution. We extend this approach to test learning of local and non-local phonological processes that include approximations of morphological processes. We further parallel outputs of the model to results of a behavioral experiment where human subjects are trained on the data used for training the GAN network. Four main conclusions emerge: (i) the networks provide useful information for computational models of speech acquisition even if trained on a comparatively small dataset of an artificial grammar learning experiment; (ii) local processes are easier to learn than non-local processes, which matches both behavioral data in human subjects and typology in the world's languages. This paper also proposes (iii) how we can actively observe the network's progress in learning and explore the effect of training steps on learning representations by keeping latent space constant across different training steps. Finally, this paper shows that (iv) the network learns to encode the presence of a prefix with a single latent variable; by interpolating this variable, we can actively observe the operation of a non-local phonological process. The proposed technique for retrieving learning representations has general implications for our understanding of how GANs discretize continuous speech data and suggests that rule-like generalizations in the training data are represented as an interaction between variables in the network's latent space.

Background: Speech of individuals with non-fluent, including Broca’s, aphasia is often characterized as “agrammatic” because their output mostly consists of nouns and, to a lesser extent, verbs and lacks function words, like articles and prepositions, and correct morphological endings. Among the earliest accounts of agrammatic output in the early 1900s was the “economy of effort” idea whereby agrammatic output is construed as a way of coping with increases in the cost of language production. This idea resurfaced in the 1980s, but in general, the field of language research has largely focused on accounts of agrammatism that postulated core deficits in syntactic knowledge. Aims: We here revisit the economy of effort hypothesis in light of increasing emphasis in cognitive science on rational and efficient behavior. Main contribution: The critical idea is as follows: there is a cost per unit of linguistic output, and this cost is greater for patients with non-fluent aphasia. For a rational agent, this increase leads to shorter messages. Critically, the informative parts of the message should be preserved and the redundant ones (like the function words and inflectional markers) should be omitted. Although economy of effort is unlikely to provide a unifying account of agrammatic output in all patients—the relevant population is too heterogeneous and the empirical landscape too complex for any single-factor explanation—we argue that the idea of agrammatic output as a rational behavior was dismissed prematurely and appears to provide a plausible explanation for a large subset of the reported cases of expressive aphasia. Conclusions: The rational account of expressive agrammatism should be evaluated more carefully and systematically. On the basic research side, pursuing this hypothesis may reveal how the human mind and brain optimize communicative efficiency in the presence of production difficulties. And on the applied side, this construal of expressive agrammatism emphasizes the strengths of some patients to flexibly adapt utterances in order to communicate in spite of grammatical difficulties; and focusing on these strengths may be more effective than trying to “fix” their grammar.

Recent research suggests that bilinguals might exhibit advantages in several areas of executive function, including working memory, inhibitory control, and attentional control. However, few studies have examined potential bilingual advantages within lower socioeconomic status (SES) populations. Here we addressed this gap in the literature by investigating whether low-SES Spanish–English bilingual preschoolers exhibited advantages in executive function relative to two monolingual control groups (English, Spanish). Across three experiments, bilingual children exhibited superior performance on two different measures of visual–spatial memory, as well as measures of inhibitory and attentional control. These results suggest that bilinguals exhibit broad advantages in executive function during the preschool years, and these advantages are evident within a disadvantaged, low-SES population.

It is well reported that articulatory movements comprising prominence units are longer, larger and faster than their non-prominent counterparts. However, it is unclear whether these effects arise at the level of lexical stress or accent or both, reflecting a hierarchy of prominence, i.e., being stronger when induced by accent as opposed to stress. It is also uncertain whether prominence-induced kinematic effects are invariant across positions of stress within the word, types of focus the accent denotes, and positions of words in the phrase. We conduct an electromagnetic articulography (EMA) study to assess the supralaryngeal kinematic correlates of prominence in Greek across three stress positions (antepenultimate, penultimate, ultimate; i.e., all possible stress positions in Greek), two accentual conditions (accented and de-accented) and two phrasal positions (phrase-medial and phrase-final). Focus type is also considered, with the accentual conditions coming from two types of focus (broad and narrow), while the de-accented conditions are by default unfocused. Our results indicate that stressed syllables involve longer, larger and faster gestures than their unstressed counterparts, regardless of the position of stress within the word. Notably, variation in velocity is accounted for by variation in displacement. Presence of accent does not further expand the stressed gestures, although it is related to minimal kinematic changes across the whole word, the exact profile of which depends on stress position. With the exception of final vowel duration, focus type is not systematically encoded in these kinematic effects. Finally, interactions are detected between the kinematic profile of prominence and that of boundaries. Implications of our findings for the hierarchy of prominence and cross-linguistic differences are discussed, and a gestural account of prominence and boundaries is put forward.

Purpose Many children with cerebral palsy (CP) are described as having altered vocal quality. The current study utilizes psychoacoustic measures, namely, low-amplitude (H1*-H2*) and high-amplitude (H1*-A2*) spectral tilt and cepstral peak prominence (CPP), to identify the vocal fold articulation characteristics in this population. Method Eight children with CP and eight typically developing (TD) peers produced vowel singletons [i, ɑ, u] and a story retell task with the same vowels in the words "beets, Bobby, boots." H1*-H2*, H1*-A2*, and CPP were extracted from each vowel. Results were analyzed with mixed linear models to identify the effect of Group (CP, TD), Task (vowel singleton, story retell), and Vowel [i, ɑ, u] on the dependent variables. Results Children with CP have lower spectral tilt values (H1*-H2* and H1*-A2*) and lower CPP values than their TD peers. For both groups, vowel singletons were associated with lower CPP values as compared to story retell. Finally, the vowel [ɑ] was associated with higher spectral tilt and higher CPP values as compared to [i, u]. Conclusions Children with CP have more constricted and creaky vocal quality due to lower spectral tilt and greater noise. Unlike adults, children demonstrate poorer vocal fold articulation when producing vowel singletons as compared to story retell. Finally, low vowels like [ɑ] seem to be produced with less constriction and noise as compared to high vowels.

Dysphagia after anterior cervical spine surgery (ACSS) may be secondary to pharyngoesophageal diverticulum. Our objectives are to (1) highlight the heterogeneity in clinical presentation, (2) discuss pathophysiology and management, and (3) present a comprehensive literature review of these diverticula. All patients undergoing pharyngoesophageal diverticulum repair between 2013 and 2019 were identified. Cases with ACSS history underwent detailed review of clinical presentation, assessment, and management. Literature review and analysis of all reported ACSS-associated pharyngoesophageal diverticula was performed. Two hundred forty-three cases of pharyngoesophageal diverticulum repair were performed during the study period; 13 cases were ACSS-associated. Four types of clinical presentation were identified: (Type A) Spinal hardware present, with videofluoroscopic evidence of exposed hardware; (Type B) Spinal hardware present, without videofluoroscopic evidence of exposed hardware; (Type C) Spinal hardware absent due to prior spinal hardware removal or ACSS performed without hardware; and (Type D) Concurrent esophago-esophageal fistula (EEF) present. All of our cases were evaluated using modified barium swallow study and esophagoscopy and definitively managed with endoscopic diverticulotomy. Literature review identified 21 cases of ACSS-associated pharyngoesophageal diverticulum repair from 18 publications. The majority of cases were identified using barium esophagram (N = 18, 86%) and managed with open diverticulectomy (N = 19, 90%). There were no reports of EEF. ACSS-associated pharyngoesophageal diverticulum must be evaluated with fluoroscopy and endoscopy, which determine presentation type. Presentation type guides management. Esophageal perforation requires hardware removal and perforation repair with flap placement. Endoscopic diverticulotomy was found essential to definitive management.Level of Evidence: 4.

Purpose Individuals with cerebellar ataxia (CA) caused by cerebellar degeneration exhibit larger reactive compensatory responses to unexpected auditory feedback perturbations than neurobiologically typical speakers, suggesting they may rely more on feedback control during speech. We test this hypothesis by examining variability in unaltered speech. Previous studies of typical speakers have demonstrated a reduction in formant variability (centering) observed during the initial phase of vowel production from vowel onset to vowel midpoint. Centering is hypothesized to reflect feedback-based corrections for self-produced variability and thus may provide a behavioral assay of feedback control in unperturbed speech in the same manner as the compensatory response does for feedback perturbations. Method To comprehensively compare centering in individuals with CA and controls, we examine centering in two vowels (/i/ and /ɛ/) under two contexts (isolated words and connected speech). As a control, we examine speech produced both with and without noise to mask auditory feedback. Results Individuals with CA do not show increased centering compared to age-matched controls, regardless of vowel, context, or masking. Contrary to previous results in neurobiologically typical speakers, centering was not affected by the presence of masking noise in either group. Conclusions The similar magnitude of centering seen with and without masking noise questions whether centering is driven by auditory feedback. However, if centering is at least partially driven by auditory/somatosensory feedback, these results indicate that the larger compensatory response to altered auditory feedback observed in individuals with CA may not reflect typical motor control processes during normal, unaltered speech production.

Purpose This study investigated the relationship between word production rates (WPRs) and phonological error rates (PERs) in generative and responsive tasks in logopenic progressive aphasia (lvPPA). We examined whether a portion of the reduced WPR during generative tasks related directly to phonological impairments affecting PER on all tasks, irrespective of other task differences that contributed to WPR. Method Two cognitive psychometric models were hypothesized and fit to the total number of words produced and the number of phonological errors produced by 22 participants on 10 tasks. Bayesian inference was used to construct posterior distributions of participant ability and task difficulty parameters. Model fit statistics were compared. Association strengths for average generative WPR and average responsive PER were also evaluated with linear least-squares regression. Results Average generative WPR and average responsive PER were significantly associated (r = -.77, p = .00002). A cognitive psychometric model that assumed reduced WPR on generative tasks reflects a portion of general phonological impairment yielded better fit than a model that ignored performance differences between generative and responsive tasks. Generative fluency tasks that elicited few phonological errors still reflected phonological impairment, via suppression. Individual participants were estimated to suppress between 62% and 93% of phonological errors on generative tasks that would have emerged on responsive tasks. Conclusions Suppression of phonological errors may present as decreased WPR on generative tasks in lvPPA. Failure to account for this suppression tendency may lead to overestimation of phonological ability. The findings indicate the need to account for task demands in assessing lvPPA.

Growing numbers of SARS-CoV-2 cases coupled with limited understanding of transmissibility and virulence, have challenged the current workflow and clinical care pathways for the dysphagia provider. At the same time, the need for non-COVID-19-related dysphagia care persists. Increased awareness of asymptomatic virus carriers and variable expression of the disease have also focused attention to appropriate patient care in the context of protection for the healthcare workforce. The objective of this review was to create a clinical algorithm and reference for dysphagia clinicians across clinical settings to minimize spread of COVID-19 cases while providing optimal care to patients suffering from swallowing disorders. Every practitioner and healthcare system will likely have different constraints or preferences leading to the utilization of one technique over another. Knowledge about this pandemic increases every day, but the algorithms provided here will help in considering the best options for proceeding with safe and effective dysphagia care in this new era.

Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) variants is particularly difficult. The challenge includes uncertainty regarding diagnosis of apraxia of speech, which is subsumed within criteria for variant classification. The purpose of this study was to determine the extent to which a variety of speech articulation and prosody metrics for apraxia of speech differentiate between nfvPPA and lvPPA across diverse speech samples. Method The study involved 25 participants with progressive aphasia (10 with nfvPPA, 10 with lvPPA, and five with the semantic variant). Speech samples included a word repetition task, a picture description task, and a story narrative task. We completed acoustic analyses of temporal prosody and quantitative perceptual analyses based on narrow phonetic transcription and then evaluated the degree of differentiation between nfvPPA and lvPPA participants (with the semantic variant serving as a reference point for minimal speech production impairment). Results Most, but not all, articulatory and prosodic metrics differentiated statistically between the nfvPPA and lvPPA groups. Measures of distortion frequency, syllable duration, syllable scanning, and-to a limited extent-syllable stress and phonemic accuracy showed greater impairment in the nfvPPA group. Contrary to expectations, classification was most accurate in connected speech samples. A customized connected speech metric-the narrative syllable duration-yielded excellent to perfect classification accuracy. Discussion Measures of average syllable duration in multisyllabic utterances are useful diagnostic tools for differentiating between nfvPPA and lvPPA, particularly when based on connected speech samples. As such, they are suitable candidates for automatization, large-scale study, and application to clinical practice. The observation that both speech rate and distortion frequency differentiated more effectively in connected speech than on a motor speech examination suggests that it will be important to evaluate interactions between speech and discourse production in future research.

Objectives/hypothesesCharismatic leaders use vocal behavior to persuade their audience, achieve goals, arouse emotional states, and convey personality traits and leadership status. This study investigates voice fundamental frequency (f0) and sound pressure level (SPL) in female and male French, Italian, Brazilian, and American politicians to determine which acoustic parameters are related to cross-gender and cross-cultural common vocal abilities, and which derive from culture-, gender-, and language-specific vocal strategies used to adapt vocal behavior to listeners' culture-related expectations.Study designSpeech corpora were collected for two formal communicative contexts (leaders address followers or other leaders) and one informal communicative context (dyadic interaction), based on the persuasive goals inherent in each context and on the relative status of the listeners and speakers. Leaders' acoustic voice profiles were created to show differences in f0 and SPL manipulation with respect to speakers' gender and language in each communicative context.ResultsCross-gender and cross-language similarities in manipulation of average f0 and in f0 and SPL ranges occurred in all communicative contexts. Patterns of f0 manipulation were shared across genders and cultures, suggesting this dimension might be biologically based and is exploited by leaders to convey dominance. Ranges for f0 and SPL seemed to be affected by the communicative context, being wider or narrower depending on the persuasive goal. Results also showed language- and speaker-specific differences in the acoustic manipulation of f0 and SPL over time.ConclusionsThese findings are consistent with the idea that specific charismatic leaders' vocal behaviors depend on a fine combination of vocal abilities that are shared across cultures and genders, combined with culturally- and linguistically-filtered vocal strategies.

BackgroundSemantic variant primary progressive aphasia (svPPA), a clinical syndrome characterized by loss of semantic knowledge, is associated with neurodegeneration that starts in the anterior temporal lobe (ATL) and gradually spreads towards posterior temporal and medial frontal areas. At the earliest stages, atrophy may be predominantly lateralized to either the left or right ATL, leading to different clinical profiles with greatest impairment of word comprehension or visual/social semantics, respectively.Methods & proceduresWe report the in-depth longitudinal investigation of cognitive and neuroanatomical features of JB, an unusual case of ATL neurodegeneration with relative sparing of left lateral ATL regions.Outcomes & resultsOver the course of nine years, neurodegeneration progressed to involve bilateral temporo-lateral and frontal regions, resulting in a relatively symmetric and diffuse frontotemporal atrophy pattern. In parallel, JB developed greater behavioral, cognitive, and language impairments, as well as signs of motor neuron disease at her last evaluation. Episodic memory and socio-emotional processing deficits arose, likely secondary to semantic verbal deficits, while visuospatial processing, executive function, and non-semantic language abilities remained largely unaffected throughout the course of the disease.ConclusionsThe details of this rare case of early medial more than lateral ATL degeneration are consistent with a bilateral organization of the semantic system and, crucially, with a functional dissociation between medial paralimbic and lateral neocortical temporal regions. Cases of frontotemporal dementia (FTD) such as JB, who initially do not meet current clinical criteria for svPPA and instead present with some features of behavioral variant FTD, highlight the need for specific criteria for the right temporal variant of FTD that we propose could be called semantic variant FTD.

OBJECTIVES:The novel coronavirus disease 2019 has posed significant limitations and barriers to providing in-person healthcare. We aim to provide a summary of learned experiences and important considerations for implementing and offering telehealth to provide laryngology subspecialty care during the COVID-19 pandemic and thereafter. MATERIALS AND METHODS:Four laryngologists and a voice-specialized speech-language pathologist from a tertiary-care academic Voice and Swallowing Center were engaged in a structured group consensus conference. Participants shared input, experiences, and practice patterns employed via telemedicine (via telephone or video-communication) during the early COVID-19 era. RESULTS:Key identified areas of consideration when offering telemedicine included (1) how to set up and structure a telemedicine visit and maintain patient confidentiality, (2) patient examination and treatment initiation, (3) optimization of the tele-visit, (4) limitations and recognition of when a tele-visit is insufficient for patient care needs, (5) billing/reimbursement considerations. Group consensus for the aforementioned topics is summarized and discussed. CONCLUSION:During the COVID-19 pandemic, a telemedicine model can be effectively employed to improve patient access to subspecialty laryngology care, including a multidisciplinary care approach, with initiation of various therapeutic interventions. A major limitation given the preclusion of in-person assessment is the lack of access to laryngoscopy, which can likely be delayed safely in the majority of individuals.

We examined the language and reading progress of 336 young DHH children in kindergarten, first and second grades. Trained assessors tested children's language, reading, and spoken and fingerspelled phonological awareness in the fall and spring of the school year. Children were divided into groups based on their auditory access and classroom communication: a spoken-only group (n = 101), a sign-only group (n = 131), and a bimodal group (n = 104). Overall, children showed delays in language and reading compared to norms established for hearing children. For language, vocabulary standard scores were higher than for English syntax. Although delayed in language, children made expected gains based on hearing norms from kindergarten to second grade. Reading scores declined from kindergarten to second grade. Spoken-only and bimodal children had similar word reading and reading comprehension abilities and higher scores than sign-only children. Spoken-only children had better spoken phonological awareness and nonword reading skills than the other two groups. The sign-only and bimodal groups made similar and significant gains in ASL syntax and fingerspelling phonological awareness.

Purpose This study was designed to test the incremental validity of more expensive vocal development variables relative to less expensive variables for predicting later expressive language in children with autism spectrum disorder (ASD). We devote particular attention to the added value of coding the quality of vocalizations over the quantity of vocalizations because coding quality adds expense to the coding process. We are also interested in the added value of more costly human-coded vocal variables relative to those generated through automated analyses. Method Eighty-seven children with ASD aged 13-30 months at study initiation participated. For quantity of vocalizations, we derived one variable from human coding of brief communication samples and one from an automated process for daylong naturalistic audio samples. For quality of vocalizations, we derived four human-coded variables and one automated variable. A composite expressive language measure was derived at study entry, and 6 and 12 months later. The 12 months-centered intercept of a simple linear growth trajectory was used to quantify later expressive language. Results When statistically controlling for human-coded or automated quantity of vocalization variables, human-coded quality of vocalization variables exhibited incremental validity for predicting later expressive language skills. Human-coded vocal variables also predicted later expressive language skills when controlling for the analogous automated vocal variables. Conclusion In sum, these findings support devoting resources to human coding of the quality of vocalizations from communication samples to predict later expressive language skills in young children with ASD despite the greater costs of deriving these variables. Supplemental Material https://doi.org/10.23641/asha.12276458.

Purpose Conducting in-depth grammatical analyses based on language samples can be time consuming. Developmental Sentence Scoring (DSS) and the Index of Productive Syntax (IPSyn) analyses provide detailed information regarding the grammatical profiles of children and can be conducted using free computer-based software. Here, we provide a tutorial to support clinicians' use of computer-based analyses to aid diagnosis and develop and monitor treatment goals. Method We analyzed language samples of a 5-year-old with developmental language disorder and an adolescent with Down syndrome using computer-based software, Computerized Language Analysis. We focused on DSS and IPSyn analyses. The tutorial includes step-by-step procedures for conducting the analyses. We also illustrate how the analyses may be used to assist in diagnosis, develop treatment goals focused on grammatical targets, and monitor progress on these treatment goals. Conclusion Clinicians should consider using Computerized Language Analysis's IPSyn and DSS analyses to support grammatical language assessments used to aid diagnosis, develop treatment goals, and monitor progress on these treatment goals. Supplemental Material https://doi.org/10.23641/asha.12021141.

Better understanding of the mechanisms underlying early reading skills can lead to improved interventions. Hence, the purpose of this study was to examine multivariate associations among reading, language, spoken phonological awareness, and fingerspelling abilities for three groups of deaf and hard-of-hearing (DHH) beginning readers: those who were acquiring only spoken English (n = 101), those who were visual learners and acquiring sign (n = 131), and those who were acquiring both (n = 104). Children were enrolled in kindergarten, first, or second grade. Within-group and between-group confirmatory factor analysis showed that there were both similarities and differences in the abilities that underlie reading in these three groups. For all groups, reading abilities related to both language and the ability to manipulate the sublexical features of words. However, the groups differed on whether these constructs were based on visual or spoken language. Our results suggest that there are alternative means to learning to read. Whereas all DHH children learning to read rely on the same fundamental abilities of language and phonological processing, the modality, levels, and relations among these abilities differ.

Purpose Recent studies confirm the utility of speech-language intervention in primary progressive aphasia (PPA); however, long-term outcomes, ideal dosage parameters, and relative benefits of intervention across clinical variants warrant additional investigation. The purpose of this study was to determine whether naming treatment affords significant, lasting, and generalized improvement for individuals with semantic and logopenic PPA and whether dosage manipulations significantly affect treatment outcomes. Method Eighteen individuals with PPA (9 semantic and 9 logopenic variant) underwent lexical retrieval treatment designed to leverage spared cognitive-linguistic domains and develop self-cueing strategies to promote naming. One group (n = 10) underwent once-weekly treatment sessions, and the other group (n = 8) received the same treatment with 2 sessions per week and an additional "booster" treatment phase at 3 months post-treatment. Performance on trained and untrained targets/tasks was measured immediately after treatment and at 3, 6, and 12 months post-treatment. Results Outcomes from the full cohort of individuals with PPA showed significantly improved naming of trained items immediately post-treatment and at all follow-up assessments through 1 year. Generalized improvement on untrained items was significant up to 6 months post-treatment. The positive response to treatment was comparable regardless of session frequency or inclusion of a booster phase. Outcomes were comparable across PPA subtypes, as was maintenance of gains over the post-treatment period. Conclusion This study documents positive naming treatment outcomes for a group of individuals with PPA, demonstrating strong direct treatment effects, maintenance of gains up to 1 year post-treatment, and generalization to untrained items. Lexical retrieval treatment, in conjunction with daily home practice, had a strong positive effect that did not require more than 1 clinician-directed treatment session per week. Findings confirm that strategic training designed to capitalize on spared cognitive-linguistic abilities results in significant and lasting improvement, despite ongoing disease progression, in PPA.

Although there is substantial rationale for a motor component in the speech of persons with Down syndrome (DS), there presently are no published estimates of the prevalence of subtypes of motor speech disorders in DS. The goal of this research is to provide initial estimates of the prevalence of types of speech disorders and motor speech disorders in adolescents with DS. Conversational speech samples from a convenience sample of 45 adolescents with DS, ages 10 to 20 years old, were analysed using perceptual and acoustic methods and measures in the Speech Disorders Classification System (SDCS). The SDCS cross-classified participants into five mutually exclusive speech classifications and five mutually exclusive motor speech classifications. For participants meeting criteria for Childhood Dysarthria or for Childhood Dysarthria concurrent with Childhood Apraxia of Speech, the SDCS provided information on participants' percentile status on five subtypes of dysarthria. A total of 97.8% of participants met SDCS criteria for Speech Disorders and 97.8% met criteria for Motor Speech Disorders, including Childhood Dysarthria (37.8%), Speech Motor Delay (26.7%), Childhood Dysarthria and Childhood Apraxia of Speech (22.2%), and Childhood Apraxia of Speech (11.1%). Ataxia was the most prevalent dysarthria subtype. Nearly all participants with DS in the present sample had some type of speech and motor speech disorder, with implications for theory, assessment, prediction, and treatment. Specific to treatment, the present findings are interpreted as support for motor speech disorders as a primary explanatory construct to guide the selection and sequencing of treatment targets for persons with DS. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; DS: Down syndrome; NSA: Normal(ized) Speech Acquisition; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SE: Speech Errors; SMD: Speech Motor Delay.

The goal of this research was to assess the support for motor speech disorders as explanatory constructs to guide research and treatment of reduced intelligibility in persons with Down syndrome (DS). Participants were the 45 adolescents with DS in the prior paper who were classified into five mutually-exclusive motor speech classifications using the Speech Disorders Classification System. An ordinal index classified participants' percentage of intelligible words in conversation as High (≥ 85%), Moderate (80% - 84.9%), or Low (< 80%). Statistical analyses tested for significant differences in intelligibility status associated with demographic, intelligence, and language variables, and intelligibility status associated with motor speech classifications and speech, prosody, and voice variables. For the 10 participants who met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech at assessment, 80% had reduced (Moderate or Low) intelligibility and 20% had High intelligibility (significant effect size: 0.644). Proportionally more of the 32 participants who met criteria for either dysarthria or apraxia had reduced intelligibility (significant effect size: 0.318). Low intelligibility was significantly associated with across-the-board reductions in phonemic and phonetic accuracy and with inappropriate prosody and voice. Findings are interpreted as support for motor speech disorders in adolescents with DS as explanatory constructs for their reduced intelligibility. Pending cross-validation of findings in diverse samples of persons with DS, studies are needed to assess the efficacy of motor speech classification status to guide selection of treatment methods and intelligibility targets. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; DS: Down syndrome; II: Intelligibility Index; No MSD: No Motor Speech Disorder; OII: Ordinal Intelligibility Index; PSD: Persistent Speech Delay; SDCS: Speech Disorders Classification System; SMD: Speech Motor Delay.

Previous research shows that experience with co-varying cues is neither sufficient nor necessary for listeners to integrate them perceptually. Auditory Enhancement theorists explain this by positing that listeners integrate two cues more readily if the cues enhance each other's percept. To isolate the role of enhancement from that of experience, we forced English adult listeners to shift attention between two enhancing cues that they do not use phonemically, pitch and breathiness, by reversing the informativeness of the two cues in a cue weighting experiment. Listeners were able to shift attention from pitch to breathiness and vice versa if the two cues were in an enhancing relation. When this relationship was reversed, listeners could shift attention from pitch to breathiness but not in the opposite direction. Clearly, both the change in informativeness and the enhancing properties of the cues influenced the listeners’ re-weighting of these cues. However, the directional asymmetry was not predicted. Moreover, the same asymmetry was observed in two new groups of listeners who have native language experience with either pitch or breathiness. We discuss the consequences of such asymmetric enhancement effects, rising from either processing limitations or articulatory contingencies, for language change.

Research on age-related changes in speech has primarily focused on comparing “young” vs. “elderly” adults. Yet, listeners are able to guess talker age more accurately than a binary distinction would imply, suggesting that acoustic characteristics of speech change continually and gradually throughout adulthood. We describe acoustic properties of vowels produced by eleven talkers based on naturalistic speech samples spanning a period of 28 years, from ages 21 to 49. We find that the position of vowels in F1/F2 space shifts towards the periphery with increasing talker age. Based on Generalized Additive Mixed Effects models, we show that this shift is not fully attributable to changes in vowel duration or to segmental context. We discuss the implications of our results for research on aging and speech, and for research in which durational shortening and spectral characteristics of vowels are assumed to reflect a unitary process of phonetic reduction.

Research on age-related changes in speech has primarily focused on comparing “young” vs. “elderly” adults. Yet, listeners are able to guess talker age more accurately than a binary distinction would imply, suggesting that acoustic characteristics of speech change continually and gradually throughout adulthood. We describe acoustic properties of vowels produced by eleven talkers based on naturalistic speech samples spanning a period of 28 years, from ages 21 to 49. We find that the position of vowels in F1/F2 space shifts towards the periphery with increasing talker age. Based on Generalized Additive Mixed Effects models, we show that this shift is not fully attributable to changes in vowel duration or to segmental context. We discuss the implications of our results for research on aging and speech, and for research in which durational shortening and spectral characteristics of vowels are assumed to reflect a unitary process of phonetic reduction.

ObjectivesThis study evaluates potential compensation strategies under conditions of glottal insufficiency.MethodsUsing a numerical respiratory-laryngeal model of voice production, voice production under conditions of glottal insufficiency is investigated across a large range of voice conditions, and compared with normal voice production.ResultsThis study shows that glottal insufficiency leads to increased noise production, reduced fundamental frequency range, and inability to produce very low-intensity voice. Glottal insufficiency also leads to significantly increased respiratory effort of phonation and difficulty in maintaining a normal breath group duration, which restricts high-intensity voice production and falsetto-like voice production. Although compensation strategies exist to alleviate these undesirable voice changes, they often require hyperfunctional laryngeal and respiratory muscle activities and thus are more likely to result in vocal fatigue.ConclusionsThe laryngeal and respiratory subsystems need to be considered as a whole to fully understand the effect of glottal insufficiency on voice production. Strategies that compensate for laryngeal weakness at the cost of compromising the normal function of the respiratory subsystem are undesirable and may impose additional constraints on voice production and the effectiveness of available compensation strategies.

PurposeChildren with primary language impairment (PLI) demonstrate deficits in morphosyntax and vocabulary. We studied how these deficits may manifest in the core vocabulary use of bilingual children with PLI.MethodThirty bilingual children with and without PLI who were matched pairwise (experimental group) narrated two Spanish and two English stories in kindergarten and first grade. Core vocabulary was derived from the 30 most frequently used words in the stories of 65 and 37 typically developing (TD) first graders (normative group) for Spanish and English, respectively. The number of words each child in the experimental group produced out of the 30 identified core vocabulary words and frequency of each of the core words produced each year were analysed.ResultChildren with PLI produced fewer core vocabulary words compared to their TD peers after controlling for total words produced. This difference was more pronounced in first grade. They produced core vocabulary words less frequently in kindergarten than their TD peers. Both groups produced core vocabulary words more frequently in English than Spanish.ConclusionsBilingual children with PLI demonstrate a less productive core vocabulary use compared to their TD peers in both their languages illustrating the nature of their grammatical and lexical-semantic deficits.