Objective: This study investigated whether adding an additional modality, namely ultrasound tongue imaging, to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. Patients and Methods: Thirty-nine English-speaking children aged 3 to 12 with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio and probe-stabilised ultrasound. Three types of transcriptions were performed: 1. Descriptive observations from the live ultrasound by the clinician recording the data; 2. Ultrasound-aided transcription by two ultrasound-trained clinicians; and 3. Traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. Results: Both the ultrasound-aided and traditional transcriptions yielded similar error-detection rates, however these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the ultrasound transcribers was substantial (k=0.65), compared to moderate (k=0.47) for the traditional transcribers. Ultrasound-aided transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. Conclusion: Ultrasound-tongue imaging is a useful complement to traditional phonetic transcription for CLP speech.

Background: As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD. Aims: To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD. Methods: A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail. Main Contributions: Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatorybased therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity. Conclusions: The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.

The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.

Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice.

Parent involvement and home practice appear to be intricately linked within intervention for phonology-based SSDs in Australia. More high-quality research is needed to understand how to best involve parents within clinical practice.

Purpose Evidence for the multiple oppositions intervention approach indicates it should be delivered 3 times weekly; however, this high dose frequency is not provided by many speech-language pathologists worldwide. This study investigated whether parents could be involved in delivering phonological intervention to fulfill this intensity shortfall. Method Five children with moderate-to-severe phonological impairment aged 3;3–5;11 (years;months) and 1 of their parents participated in this study using a multiple-baseline across participants design. Participants attended one 60-min clinic-based session per week for 8 weeks, and parents completed home practice 2 times per week over this period after receiving training. Parents also attended a 60-min training session prior to commencing intervention. Results All children showed a treatment effect to treated words. Three of the 5 children demonstrated a large effect size for generalization to nontreatment words, with 1 child demonstrating a moderate effect and 1 child demonstrating no effect. However, all children showed qualitative changes to their speech system. Three of the 5 children experienced significant changes to communicative participation. Measures of treatment fidelity indicated that parents were able to competently deliver the intervention both within the clinic and at home. Conclusions Combined parent- and speech-language pathologist–delivered multiple oppositions intervention is effective for some children with moderate-to-severe phonological impairment. The findings indicate that parents can be trained to competently and confidently deliver phonological intervention. Further evidence is needed to identify optimal child and parent characteristics most suited to this modified service delivery approach. Supplemental Material https://doi.org/10.23641/asha.10565885

Early childhood practitioners, including speech-language pathologists (SLPs) frequently provide home practice to children and families. For children with speech sound disorders (SSD), who comprise a large proportion of SLPs' caseloads worldwide, completing home practice can increase the amount of intervention received and improve outcomes. However, little is known about parents' experiences of completing this home practice. The purpose of this qualitative study was to explore parents' experiences of completing home practice for children with SSD. Semi-structured interviews were conducted with six parents. Qualitative content analysis was used to analyze data and identify four themes: evolution over time, different roles, importance, and managing the practicalities of home practice. The findings speak to the complexities of this experience for families and the need for practitioners to collaborate with families when providing home practice. These findings have implications for the home practice that early intervention practitioners provide to children and families.

Purpose: Reporting of outcome and experience measures is critical to our understanding of the effect of intervention for speech sound disorders (SSD) in children. There is currently no agreed-upon set of measures for reporting intervention outcomes and experiences. In this article, we introduce the Speech Outcome Reporting Taxonomy (SORT), a tool designed to assist with the classification of outcome and experience measures. In a systematic search and review using the SORT, we explore the type and frequency of these measures reported in intervention research addressing phonological impairment in children. Given the integral relationship between intervention fidelity and intervention outcomes, reporting of fidelity is also examined. Method: Five literature databases were searched to identify articles written or translated into English published between 1975 and 2020. Using the SORT, outcome and experience measures were extracted and categorized. The number of intervention studies reporting fidelity was determined. Results: A total of 220 articles met inclusion criteria. The most frequently reported outcome domain was broad generalization measures ( n = 142, 64.5%), followed by specific measures of generalization of an intervention target ( n = 133, 60.5%). Eleven (5.0%) articles reported measures of the impact of the phonological impairment on children's activity, participation, quality of life, or others. Twenty articles (9.1%) reported on parent, child, or clinician experience or child engagement. Fidelity data were reported for 13.4% of studies of interventions. Conclusions: The measurement of intervention outcomes is challenging yet important. No single type of measure was reported across all articles. Through using tailored measures closely related to intervention targets in combination with a universal set of measures of intelligibility, the impact of phonological impairment on children's lives, and the experience of receiving and providing intervention, researchers and clinicians could work together to progress insights and innovations in science and practice for children with SSD. Supplemental Material: https://doi.org/10.23641/asha.19497803