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Purpose: The purpose of this study was to examine if classroom noise levels and perceived listening difficulty were related to fatigue reported by children with and without hearing loss. Method: Measures of classroom noise and reports of classroom listening difficulty were obtained from 79 children (ages 6–12 years) at two time points on two different school days. Forty-four children had mild to moderately severe hearing loss in at least one ear. Multiple regression analyses were conducted to evaluate if measured noise levels, perceived listening difficulty, hearing status, language abilities, or grade level would predict self-reported fatigue ratings measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale. Results: Higher perceived listening difficulty was the only predictor variable that was associated with greater self-reported fatigue. Conclusions: Measured classroom noise levels showed no systematic relationship with fatigue ratings, suggesting that actual classroom noise levels do not contribute to increased reports of subjective fatigue. Instead, perceived challenges with listening appears to be an important factor for consideration in future work examining listening-related fatigue in children with and without hearing loss.

This multiple baseline across-participants single case desgin study examined the effect of small group, phonological awareness intervention on the phonological awareness skills of three school-age children with Down syndrome. Each child with Down syndrome was paired with a typical peer to participate in small group intervention, three sessions per week for seven weeks. Lessons from a single unit in the Intensive Phonological Awareness Program were adapted to incorporate repeated exposure to the curriculum and increased opportunities for practice. A functional relation between the intervention and improved phonological awareness skills was not established based on visual analysis of the probe data across the three participants. However, an increasing therapeutic trend following delayed treatment effects as well as an increase in phase means from baseline to intervention was observed for each participant. This investigation provides preliminary guidance for adapting phonological awareness standard treatment protocols for children with Down syndrome by providing repeated opportunities for practice and including peers in small group intervention.

Listening-related fatigue can be a significant burden for adults with hearing loss (AHL), and potentially those with other health or language-related issues (e.g., multiple sclerosis, traumatic brain injury, second language learners) who must allocate substantial cognitive resources to the process of listening. The 40-item Vanderbilt Fatigue Scale for Adults (VFS-A-40) was designed to measure listening-related fatigue in such populations. This article describes the development, and psychometric properties, of the VFS-A-40. Initial qualitative analyses in AHL suggested listening-related fatigue was multidimensional, with physical, mental, emotional, and social domains. However, exploratory factor analyses revealed a unidimensional structure. Item and test characteristics were evaluated using Item Response Theory (IRT). Results confirmed that all test items were of high quality. IRT analyses revealed high marginal reliability and an analysis of test-retest scores revealed adequate reliability. In addition, an analysis of differential item functioning provided evidence of good construct validity across age, gender, and hearing loss groups. In sum, the VFS-A-40 is a reliable and valid tool for quantifying listening-related fatigue in adults. We believe the VFS-A-40 will be useful for identifying those most at risk for severe listening-related fatigue and for assessing interventions to reduce its negative effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adults with hearing loss (AHL) often report feeling fatigued after being in situations that require prolonged listening, an experience referred to as listening-related fatigue. We conducted focus groups to identify key domains and constructs of listening-related fatigue. Our goal was to create a theoretical framework for understanding listening-related fatigue that could guide the development of a reliable and valid assessment tool.Eight focus group discussions were conducted using a moderator's guide. Discussions were recorded, transcribed, coded, and analysed to identify common themes related to listening-related fatigue. A hierarchical coding manual was developed iteratively as new themes and subcategories were identified during the analysis process.Forty-three adults (11 males; aged 20 to 77 years) with varying degrees of hearing loss participated in the focus groups. Participants included primarily hearing aid users (Qualitative analyses revealed the multidimensional nature of listening-related fatigue for AHL, including physical, mental, emotional, and social domains. These varied experiences were influenced by the external (acoustic/environmental) characteristics of the listening situation, the internal state of the listener (cognitive/motivational), and coping strategies implemented to modify the listening experience. The use of amplification had both positive and negative effects on listening-related fatigue.For some AHL, the consequences of listening-related fatigue can be significant, negatively impacting their quality of life. Data from these focus groups provides a framework for understanding the experience of listening-related fatigue among AHL. This is a critical first step in the development of a tool for measuring listening-related fatigue in this at-risk group.

Purpose Data mining algorithms using electronic health records (EHRs) are useful in large-scale population-wide studies to classify etiology and comorbidities ( Casey et al., 2016 ). Here, we apply this approach to developmental language disorder (DLD), a prevalent communication disorder whose risk factors and epidemiology remain largely undiscovered. Method We first created a reliable system for manually identifying DLD in EHRs based on speech-language pathologist (SLP) diagnostic expertise. We then developed and validated an automated algorithmic procedure, called, Automated Phenotyping Tool for identifying DLD cases in health systems data (APT-DLD), that classifies a DLD status for patients within EHRs on the basis of ICD (International Statistical Classification of Diseases and Related Health Problems) codes. APT-DLD was validated in a discovery sample ( N = 973) using expert SLP manual phenotype coding as a gold-standard comparison and then applied and further validated in a replication sample of N = 13,652 EHRs. Results In the discovery sample, the APT-DLD algorithm correctly classified 98% (concordance) of DLD cases in concordance with manually coded records in the training set, indicating that APT-DLD successfully mimics a comprehensive chart review. The output of APT-DLD was also validated in relation to independently conducted SLP clinician coding in a subset of records, with a positive predictive value of 95% of cases correctly classified as DLD. We also applied APT-DLD to the replication sample, where it achieved a positive predictive value of 90% in relation to SLP clinician classification of DLD. Conclusions APT-DLD is a reliable, valid, and scalable tool for identifying DLD cohorts in EHRs. This new method has promising public health implications for future large-scale epidemiological investigations of DLD and may inform EHR data mining algorithms for other communication disorders. Supplemental Material https://doi.org/10.23641/asha.12753578

Purpose The purpose of this systematic review was to identify parent education procedures implemented in intervention studies focused on expressive verbal communication for nonverbal (NV) or minimally verbal (MV) children with autism spectrum disorder (ASD). Parent education has been shown to be an essential component in the habilitation of individuals with ASD. Parents of individuals with ASD who are NV or MV may particularly benefit from parent education in order to provide opportunities for communication and to support their children across the life span. Method ProQuest databases were searched between the years of 1960 and 2018 to identify articles that targeted verbal communication in MV and NV individuals with ASD. A total of 1,231 were evaluated to assess whether parent education was implemented. We found 36 studies that included a parent education component. These were reviewed with regard to (a) the number of participants and participants' ages, (b) the parent education program provided, (c) the format of the parent education, (d) the duration of the parent education, (e) the measurement of parent education, and (f) the parent fidelity of implementation scores. Results The results of this analysis showed that very few studies have included a parent education component, descriptions of the parent education programs are unclear in most studies, and few studies have scored the parents' implementation of the intervention. Conclusions Currently, there is great variability in parent education programs in regard to participant age, hours provided, fidelity of implementation, format of parent education, and type of treatment used. Suggestions are made to provide both a more comprehensive description and consistent measurement of parent education programs.

Purpose: Growing evidence suggests that fatigue associated with listening difficulties is particularly problematic for children with hearing loss (CHL). However, sensitive, reliable, and valid measures of listening-related fatigue do not exist. To address this gap, this article describes the development, psychometric evaluation, and preliminary validation of a suite of scales designed to assess listening-related fatigue in CHL: the pediatric versions of the Vanderbilt Fatigue Scale (VFS-Peds). Method: Test development employed best practices, including operationalizing the construct of listening-related fatigue from the perspective of target respondents (i.e., children, their parents, and teachers). Test items were developed based on input from these groups. Dimensionality was evaluated using exploratory factor analyses (EFAs). Item response theory (IRT) and differential item functioning (DIF) analyses were used to identify high-quality items, which were further evaluated and refined to create the final versions of the VFS-Peds. Results: The VFS-Peds is appropriate for use with children aged 6–17 years and consists of child self-report (VFS-C), parent proxy–report (VFS-P), and teacher proxy–report (VFS-T) scales. EFA of child self-report and teacher proxy data suggested that listening-related fatigue was unidimensional in nature. In contrast, parent data suggested a multidimensional construct, composed of mental (cognitive, social, and emotional) and physical domains. IRT analyses suggested that items were of good quality, with high information and good discriminability. DIF analyses revealed the scales provided a comparable measure of fatigue regardless of the child's gender, age, or hearing status. Test information was acceptable over a wide range of fatigue severities and all scales yielded acceptable reliability and validity. Conclusions: This article describes the development, psychometric evaluation, and validation of the VFS-Peds. Results suggest that the VFS-Peds provide a sensitive, reliable, and valid measure of listening-related fatigue in children that may be appropriate for clinical use. Such scales could be used to identify those children most affected by listening-related fatigue, and given their apparent sensitivity, the scales may also be useful for examining the effectiveness of potential interventions targeting listening-related fatigue in children. Supplemental Material: https://doi.org/10.23641/asha.19836154

This systematic review examined definitions of "nonverbal" or "minimally verbal" and assessment measures used to evaluate communication in intervention studies focusing on improving expressive verbal communication in children with autism spectrum disorder (ASD). We reviewed sample size, number of participants, participant age, and male/female representation. Our analysis yielded relatively few studies with non/minimally verbal children with ASD focusing on verbal expressive communication. Further, we found large inconsistencies in measures used, definitions of "nonverbal" and "minimally verbal", and ages targeted. Guidelines are suggested to create a more uniform assessment protocol with systematic descriptions of early communication learners as a foundational step for understanding the heterogeneity in this group and replicating research findings for this subgroup of children with ASD.

Purpose: Children with hearing loss (CHL) are considered at risk for listening-related fatigue and its negative consequences. We collected data via focus groups and interviews from three stakeholder groups—CHL, their parents, and teachers/school professionals—in order to define the construct of listening-related fatigue from the perspective of CHL and key stakeholders. This is an important first step in our long-term goal to construct and validate a measure (i.e., scale) of listening-related fatigue for the pediatric population, with a focus on CHL. This article provides an overview of the data gathering process, analysis of qualitative reports, and the development of a theoretical framework for understanding the experience of listening-related fatigue in CHL. Method: We conducted focus groups and interviews in school-age children exhibiting bilateral, moderate-to-profound hearing loss ( n = 43), their parents ( n = 17), and school professionals who work with CHL ( n = 28). The discussions were audio-recorded, transcribed, and coded using a hierarchical coding system. Qualitative analysis was conducted using an iterative inductive–deductive approach. Results: We identified primary themes from the focus group/interview discussions to develop a theoretical framework of listening-related fatigue in CHL. The framework demonstrates the complex interaction among situational determinants that impact fatigue, symptoms or manifestations of fatigue, and the utilization of, and barriers to, coping strategies to reduce listening-related fatigue. Conclusions: Participant discussion suggests that listening-related fatigue is a significant problem for many, but not all, CHL. Qualitative data obtained from these stakeholder groups help define the construct and provide a framework for better understanding listening-related fatigue in children.

This study investigated the number of channels required for asymptotic speech recognition for ten pediatric cochlear implant (CI) recipients with precurved electrode arrays. Programs with 4–22 active electrodes were used to assess word and sentence recognition in noise. Children demonstrated significant performance gains up to 12 electrodes for continuous interleaved sampling (CIS) and up to 22 channels with 16 maxima. These data are consistent with the latest adult CI studies demonstrating that modern CI recipients have access to more than 8 independent channels and that both adults and children exhibit performance gains up to 22 channels.

The COVID-19 pandemic has led to many unintended, long-lasting consequences for society. Preventative practices such as mask wearing, social distancing, and virtual meetings and classrooms to address contagion concerns may negatively affect communication, particularly in the pediatric population, as schools have begun to open this fall. Increasing awareness and creating innovative methods to promote communication and language learning in settings both in person and virtual is paramount. Although more studies are needed to characterize the pandemic's impact on pediatric speech and language development, clinicians and parents should be cognizant of this phenomenon and proactive in facilitating an optimal communication environment for children.

Although reading outcomes for children with hearing loss are improving, too many of these children continue to display persistent reading difficulties. Because of these difficulties, there is an ongoing need to understand the nature of the relationships among decoding abilities, language skills, and reading achievement in this population more fully. Coincidentally, there has also been an emerging literature on the subjective fatigue in children with hearing loss, which could be directly or indirectly linked to reading ability. The purpose of this study was to examine associations among language abilities, reading skills, and subjective fatigue in 56 children with mild to moderate hearing loss (CMMHL). The results indicated that both phonological awareness and receptive language ability predicted reading achievement in CMMHL, which replicates findings for children without hearing loss. The results also indicated that CMMHL who had poor reading skills reported significantly higher levels of subjective fatigue relative to the other children with mild to moderate hearing loss in the sample.

Although reducing visual input to emphasize auditory cues is a common practice in pediatric auditory (re)habilitation, the extant literature offers minimal empirical evidence for whether unisensory auditory-only (AO) or multisensory audiovisual (AV) input is more beneficial to children with hearing loss for developing spoken language skills. Using an adapted alternating treatments single case research design, we evaluated the effectiveness and efficiency of a receptive word learning intervention with and without access to visual speechreading cues. Four preschool children with prelingual hearing loss participated. Based on probes without visual cues, three participants demonstrated strong evidence for learning in the AO and AV conditions relative to a control (no-teaching) condition. No participants demonstrated a differential rate of learning between AO and AV conditions. Neither an inhibitory effect predicted by a unisensory theory nor a beneficial effect predicted by a multisensory theory for providing visual cues was identified. Clinical implications are discussed.

Purpose The primary purposes of this study were to examine the effects of hearing loss and respondent type (self- vs. parent-proxy report) on subjective fatigue in children. We also examined associations between child-specific factors and fatigue ratings. Method Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS; Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). We compared self- and parent-proxy ratings from 60 children with hearing loss (CHL) and 43 children with normal hearing (CNH). The children ranged in age from 6 to 12 years. Results School-age CHL experienced more overall and cognitive fatigue than CNH, although the differences were smaller than previously reported. Parent-proxy report was not strongly associated with child self-report, and parents tended to underestimate their child's fatigue, particularly sleep/rest fatigue. Language ability was also associated with subjective fatigue. For CHL and CNH, as language abilities increased, cognitive fatigue decreased. Conclusions School-age CHL experience more subjective fatigue than CNH. The poor association between parent-proxy and child reports suggests that the parent-proxy version of the PedsQL-MFS should not be used in isolation when assessing fatigue in school-age children. Future research should examine how language abilities may modulate fatigue and its potential academic consequences in CHL.

Playground design is critical to school-based practice, insuring access and use for all children. The play behavior of children with special needs is qualitatively and quantitatively different than their typically developing peers. However, empirical data is needed to support the therapeutic value of playground equipment used with school-aged children. Thirty-two hours of videotape was collected from 140 children who were typically developing (male = 56%) and 41 children with a variety of developmental disabilities including autism, ADHD, sensory and regulatory disorders (male = 76%), ages 3 to 15 years. Six pieces of playground equipment were analyzed using a behavioral coding system for sensory features, social interaction, self-regulation, motor skills, and play levels. Content validity of the behavioral coding scheme was obtained through a case study. Proprioception was enhanced through active use of the playground equipment. Increased verbalizations and positive affect were observed across al...

PurposeListening-related fatigue is an understudied construct that may contribute to the auditory, educational, and psychosocial problems experienced by children with unilateral hearing loss (UHL). Herein, we present an overview of listening-related fatigue in school-age children with hearing loss (CHL), with a focus on children with UHL.MethodFollowing a review of research examining listening-related fatigue in adults and CHL, we present preliminary findings exploring the effects of unilateral and bilateral hearing loss on listening-related fatigue in children. For these exploratory analyses, we used data collected from our ongoing work developing and validating a tool, the Vanderbilt Fatigue Scale, for measuring listening-related fatigue in children. Presently, we are assessing 3 versions of the fatigue scale—child self-report, parent proxy, and teacher proxy. Using these scales, data have been collected from more than 900 participants. Data from children with unilateral and bilateral hearing loss and for children with no hearing loss are compared with adult Vanderbilt Fatigue Scale data.ResultsResults of our literature review and exploratory analyses suggest that adults and CHL are at increased risk for listening-related fatigue. Importantly, this increased risk was similar in magnitude regardless of whether the loss was unilateral or bilateral. Subjective ratings, based on child self-report and parent proxy report, were consistent, suggesting that children with unilateral and bilateral hearing loss experienced greater listening-related fatigue than children with no hearing loss. In contrast, results based on teacher proxy report were not sensitive to the effects of hearing loss.ConclusionsChildren with UHL are at increased risk for listening-related fatigue, and the magnitude of fatigue is similar to that experienced by children with bilateral hearing loss. Problems of listening-related fatigue in school-age CHL may be better identified by CHL themselves and their parents than by teachers and specialists working with the children.

Background Parent involvement in interventions for children with Autism Spectrum Disorder (ASD) provides parents with education about ASD diagnosis and treatment, improves parent-child interactions, and offers access to cost-effective resources. The Latinx population represents the fastest growing minority population in the United States and a growing percentage of children seeking ASD intervention services. Aims Identify factors that impact Latinx parent involvement in interventions for children with ASD as an example of cultural considerations for diverse families and communities. Methods and procedures In this conceptual overview, we synthesize literature on cultural considerations for intervention design/adaptation for Latinx families and parent involvement in interventions for children with ASD through the lens of the Ecological Validity Model. Outcomes and results Frameworks such as the Ecological Validity Model can be used when creating or adapting interventions for specific cultural groups. Parent-involved interventions for children with ASD in the Latinx community should consider language of intervention delivery, family make-up, community support, disability knowledge of the family, the therapeutic alliance, and methods of implementation. Conclusions and implications Incorporating cultural components into parent-involved interventions will best support intervention implementation and dissemination in diverse communities. Research is needed into the process and outcomes of intervention programs in order to increase understanding of how specific cultural dimensions impact participation in and efficacy of parent-involved interventions for Latinx families of children with ASD.

Purpose We review the evidence for attenuating visual input during intervention to enhance auditory development and ultimately improve spoken language outcomes in children with cochlear implants. Background Isolating the auditory sense is a long-standing tradition in many approaches for teaching children with hearing loss. However, the evidence base for this practice is surprisingly limited and not straightforward. We review four bodies of evidence that inform whether or not visual input inhibits auditory development in children with cochlear implants: (a) audiovisual benefits for speech perception and understanding for individuals with typical hearing, (b) audiovisual integration development in children with typical hearing, (c) sensory deprivation and neural plasticity, and (d) audiovisual processing in individuals with hearing loss. Conclusions Although there is a compelling theoretical rationale for reducing visual input to enhance auditory development, there is also a strong theoretical argument supporting simultaneous multisensory auditory and visual input to potentially enhance outcomes in children with hearing loss. Despite widespread and long-standing practice recommendations to limit visual input, there is a paucity of evidence supporting this recommendation and no evidence that simultaneous multisensory input is deleterious to children with cochlear implants. These findings have important implications for optimizing spoken language outcomes in children with cochlear implants.

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

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

Effective vocabulary interventions for children with hearing loss, including children who are bilingual, are needed because of persistent vocabulary deficits in this population. Current instructional practices for children with hearing loss who are bilingual vary in the degree to which they incorporate the language the child uses at home. Unfortunately, there is little direct evidence as to whether bilingual or monolingual instructional practices yield greater benefits for these children. Three Spanish-English-speaking children participated in this single case adapted alternating treatments design study that evaluated the effectiveness and efficiency of bilingual and monolingual teaching procedures for an expressive vocabulary intervention. Contrary to predictions from a monolingual instruction perspective, no evidence of an inhibitory effect of bilingual instruction on English performance was identified. Participants exhibited gains in Spanish for words in the bilingual condition only. Findings suggest more efficient word learning in the bilingual condition as measured by conceptual vocabulary.

Background There is considerable variability in the presentation of developmental language disorder (DLD). Disagreement amongst professionals about how to characterize and interpret the variability complicates both the research on understanding the nature of DLD and the best clinical framework for diagnosing and treating children with DLD. We describe and statistically examine three primary possible models for characterizing the variability in presentation in DLD: predictable subtypes; individual differences; and continuum/spectrum. Aims To test these three models of DLD in a population-based sample using two distinct types of cluster analyses. Methods & procedures This study included children with DLD (n = 505) from the US Epidemiological Study of Language Impairment database. All available language and cognitive measures were included. Two cluster methods were used: Ward's method and K-means. Optimal cluster sizes were selected using Bayesian information criteria (BIC). Bootstrapping and permutation methods were used to evaluate randomness of clustering. Outcomes & results Both clustering analyses yielded more than 10 clusters, and the clusters did not have spatial distinction: many of these clusters were not clinically interpretable. However, tests of random clustering revealed that the cluster solutions obtained did not arise from random aggregation. Conclusions & implications Non-random clustering coupled with a large number of non-interpretable subtypes provides empirical support for the continuum/spectrum and individual differences models. Although there was substantial support for the continuum/spectrum model and weaker support for the individual differences model, additional research testing these models should be completed. Based on these results, clinicians working with children with DLD should focus on creating treatment plans that address the severity of functioning rather than seeking to identify and treat distinct subtypes. Additional consideration should be given to reconceptualizing DLD as a spectrum condition.

Adult cochlear implant (CI) recipients demonstrate a reliable relationship between spectral modulation detection and speech understanding. Prior studies documenting this relationship have focused on postlingually deafened adult CI recipients—leaving an open question regarding the relationship between spectral resolution and speech understanding for adults and children with prelingual onset of deafness. Here, we report CI performance on the measures of speech recognition and spectral modulation detection for 578 CI recipients including 477 postlingual adults, 65 prelingual adults, and 36 prelingual pediatric CI users. The results demonstrated a significant correlation between spectral modulation detection and various measures of speech understanding for 542 adult CI recipients. For 36 pediatric CI recipients, however, there was no significant correlation between spectral modulation detection and speech understanding in quiet or in noise nor was spectral modulation detection significantly correlated with listener age or age at implantation. These findings suggest that pediatric CI recipients might not depend upon spectral resolution for speech understanding in the same manner as adult CI recipients. It is possible that pediatric CI users are making use of different cues, such as those contained within the temporal envelope, to achieve high levels of speech understanding. Further investigation is warranted to investigate the relationship between spectral and temporal resolution and speech recognition to describe the underlying mechanisms driving peripheral auditory processing in pediatric CI users.

HYPOTHESIS Image-guided cochlear implant (CI) programming can improve hearing outcomes for pediatric CI recipients. BACKGROUND CIs have been highly successful for children with severe-to-profound hearing loss, offering potential for mainstreamed education and auditory-oral communication. Despite this, a significant number of recipients still experience poor speech understanding, language delay, and, even among the best performers, restoration to normal auditory fidelity is rare. Although significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. Recently introduced techniques for image-guided CI programming (IGCIP) permit creating patient-customized CI programs by making it possible, for the first time, to estimate the position of implanted CI electrodes relative to the nerves they stimulate using CT images. This approach permits identification of electrodes with high levels of stimulation overlap and to deactivate them from a patient's map. Previous studies have shown that IGCIP can significantly improve hearing outcomes for adults with CIs. METHODS The IGCIP technique was tested for 21 ears of 18 pediatric CI recipients. Participants had long-term experience with their CI (5 mo to 13 yr) and ranged in age from 5 to 17 years old. Speech understanding was assessed after approximately 4 weeks of experience with the IGCIP map. RESULTS Using a two-tailed Wilcoxon signed-rank test, statistically significant improvement (p < 0.05) was observed for word and sentence recognition in quiet and noise, as well as pediatric self-reported quality-of-life (QOL) measures. CONCLUSION Our results indicate that image guidance significantly improves hearing and QOL outcomes for pediatric CI recipients.

A growing area of interest and relevance in the study of autism spectrum disorder (ASD) focuses on the relationship between multisensory temporal function and the behavioral, perceptual, and cognitive impairments observed in ASD. Atypical sensory processing is becoming increasingly recognized as a core component of autism, with evidence of atypical processing across a number of sensory modalities. These deviations from typical processing underscore the value of interpreting ASD within a multisensory framework. Furthermore, converging evidence illustrates that these differences in audiovisual processing may be specifically related to temporal processing. This review seeks to bridge the connection between temporal processing and audiovisual perception, and to elaborate on emerging data showing differences in audiovisual temporal function in autism. We also discuss the consequence of such changes, the specific impact on the processing of different classes of audiovisual stimuli (e.g. speech vs. nonspeech, etc.), and the presumptive brain processes and networks underlying audiovisual temporal integration. Finally, possible downstream behavioral implications, and possible remediation strategies are outlined. Autism Res 2016, 9: 720-738. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

A combined storybook and play vocabulary intervention was implemented as a single-subject study of 23 children of diverse typologies, including 10 with autism spectrum disorder (ASD), three with developmental disability (DD), five with Down Syndrome, and five with specific language impairment (SLI), who were currently receiving speech-language services and had an individual education plan (IEP) goal targeting language. Participants' ages ranged from 3 years-1 month to 7 years-4 months. A parallel treatment design was used to identify changes at (a) word level, (b) child level, and (c) in children of similar typological and developmental profiles. All children learned vocabulary words to criterion in both expressive and receptive modalities. Children of different etiological origin did not vary in the trajectory of their receptive or expressive word learning. These results suggest that the trajectory of word learning may be remarkably consistent across disability typologies. The theoretical and clinical ra...

A sizeable literature has shown that perception of prosodic elements bolsters speech comprehension across developmental stages; recent work also suggests that variance in musical aptitude predicts individual differences in prosody perception in adults. The current study investigates brain and behavioral methods of assessing prosody perception and tests the relationship with musical rhythm perception in 35 school-aged children (age range: 5;5 to 8;0 years, M = 6;7 years, SD = 10 months; 18 females). We applied stimulus reconstruction, a technique for analyzing EEG data by fitting a temporal response function that maps the neural response back to the sensory stimulus. In doing so, we obtain a measure of neural encoding of the speech envelope in passive listening to continuous narratives. We also present a behavioral prosody assessment that requires holistic judgments of filtered speech. The results from these typically developing children revealed that individual differences in stimulus reconstruction in the delta band, indexing neural synchrony to the speech envelope, are significantly related to individual differences in behavioral measurement of prosody perception. In addition, both of these measures are moderately to strongly correlated with musical rhythm perception skills. Results support a domain-general mechanism for cognitive processing of speech and music.Graphical Abstract

Up to 10% of all children have not yet begun using meaningful words by the time they reach their second birthday. Naturally, when a child begins speaking late, this can be the source of great anxiety for parents. The situation has become even more important in recent years with the implementation of early-screening identification for autism and autism spectrum disorder (ASD) as recommended by the American Academy of Pediatrics. This is especially true because one of the most salient early markers for autism is late onset of talking. However, late onset of speech is not a specific marker for ASD, as the late talking may be a symptom of not only autism, but also intellectual disabilities (formally known as mental retardation), hearing loss, speech/pronunciation difficulties, language disorders, or social communication disorder as well. In addition, for the overwhelming majority of late-talking children, the delayed onset is simply a passing developmental stage with no long-term adverse consequences for communication, achievement, or intellectual development.

The new DSM-5 diagnostic criteria for autism spectrum disorders (ASDs) include sensory disturbances in addition to the well-established language, communication, and social deficits. One sensory disturbance seen in ASD is an impaired ability to integrate multisensory information into a unified percept. This may arise from an underlying impairment in which individuals with ASD have difficulty perceiving the temporal relationship between cross-modal inputs, an important cue for multisensory integration. Such impairments in multisensory processing may cascade into higher-level deficits, impairing day-to-day functioning on tasks, such as speech perception. To investigate multisensory temporal processing deficits in ASD and their links to speech processing, the current study mapped performance on a number of multisensory temporal tasks (with both simple and complex stimuli) onto the ability of individuals with ASD to perceptually bind audiovisual speech signals. High-functioning children with ASD were compared with a group of typically developing children. Performance on the multisensory temporal tasks varied with stimulus complexity for both groups; less precise temporal processing was observed with increasing stimulus complexity. Notably, individuals with ASD showed a speech-specific deficit in multisensory temporal processing. Most importantly, the strength of perceptual binding of audiovisual speech observed in individuals with ASD was strongly related to their low-level multisensory temporal processing abilities. Collectively, the results represent the first to illustrate links between multisensory temporal function and speech processing in ASD, strongly suggesting that deficits in low-level sensory processing may cascade into higher-order domains, such as language and communication.

The papers on early identification and early intervention for autism spectrum disorders (ASD) in this scientific forum (published in volume 16(1) International Journal of Speech-Language Pathology) raise many important points, including describing the substantial progress made to date as well as analyses of current gaps and weaknesses in the existing evidence base. It is humbling to see the collective expertise of the distinguished authors contributing to this scientific forum including interdisciplinary perspectives and it is not surprising that there is ongoing debate on this important topic. In addition to discussing the points raised by these authors, this paper considers the implications of the new diagnostic criteria for ASD and for social communication disorder (SCD) in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) in the US. Differential diagnosis of ASD and SCD will be paramount in testing early intervention for ASD and the expertise of speech-language pathologists in identifying SCD in infants and toddlers will be a central feature of discovery for both early identification and for early intervention in the decades to come. Finally, a biomedical example on testing early intervention on a spectrum disorder, derived from diabetes, is presented to illustrate both the promise and the pitfalls in testing interventions in the absence of well-validated assessment and intervention paradigms.

Purpose The aim of the study was to provide an overview of population science as applied to speech and language disorders, illustrate data sources, and advance a research agenda on the epidemiology of these conditions. Method Computer-aided database searches were performed to identify key national surveys and other sources of data necessary to establish the incidence, prevalence, and course and outcome of speech and language disorders. This article also summarizes a research agenda that could enhance our understanding of the epidemiology of these disorders. Results Although the data yielded estimates of prevalence and incidence for speech and language disorders, existing sources of data are inadequate to establish reliable rates of incidence, prevalence, and outcomes for speech and language disorders at the population level. Conclusions Greater support for inclusion of speech and language disorder–relevant questions is necessary in national health surveys to build the population science in the field.

Purpose This study examined whether a particular type of therapy (Broad Target Speech Recasts, BTSR) was superior to a contrast treatment in facilitating speech comprehensibility in conversations of students with Down syndrome who began treatment with initially high verbal imitation. Method We randomly assigned 51 5- to 12-year-old students to either BTSR or a contrast treatment. Therapy occurred in hour-long 1-to-1 sessions in students' schools twice per week for 6 months. Results For students who entered treatment just above the sample average in verbal-imitation skill, BTSR was superior to the contrast treatment in facilitating the growth of speech comprehensibility in conversational samples. The number of speech recasts mediated or explained the BTSR treatment effect on speech comprehensibility. Conclusion Speech comprehensibility is malleable in school-age students with Down syndrome. BTSR facilitates comprehensibility in students with just above the sample average level of verbal imitation prior to treatment. Speech recasts in BTSR are largely responsible for this effect.

Purpose There is an ongoing need to develop assessments of spontaneous speech that focus on whether the child's utterances are comprehensible to listeners. This study sought to identify the attributes of a stable ratings-based measure of speech comprehensibility, which enabled examining the criterion-related validity of an orthography-based measure of the comprehensibility of conversational speech in students with Down syndrome. Method Participants were 10 elementary school students with Down syndrome and 4 unfamiliar adult raters. Averaged across-observer Likert ratings of speech comprehensibility were called a ratings-based measure of speech comprehensibility. The proportion of utterance attempts fully glossed constituted an orthography-based measure of speech comprehensibility. Results Averaging across 4 raters on four 5-min segments produced a reliable (G = .83) ratings-based measure of speech comprehensibility. The ratings-based measure was strongly ( r > .80) correlated with the orthography-based measure for both the same and different conversational samples. Conclusion Reliable and valid measures of speech comprehensibility are achievable with the resources available to many researchers and some clinicians.