JCPSLP Vol 16 Issue 1 2014

Translating research into practice

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intervention groups made gains in the maintenance period; however, there was no significant difference between the two phonological intervention conditions in terms of PCC gain. This study is the first independent and randomised controlled trial for the multiple oppositions approach. What is also good about this study is that an attempt was made to keep all constituents of intensity constant, manipulating only dose frequency and total intervention duration. This study provides evidence to support more frequent therapy sessions for preschoolers with speech sound disorder using the multiple oppositions approach, rather than more spaced out sessions. The children who received more spaced out (1 x a week) sessions did make progress but it was similar to the progress made by those in an active control group, not targeting phonological skills. The researchers carefully reported the fidelity of how they delivered the intervention – something that is needed for intervention research but should also be considered in a clinical context. The fact that the children who received the phonology intervention (P1 and P3 groups) continued to show gains in speech production accuracy 6 weeks later raises important clinical issues of balancing the need for further intervention and applying a dismissal/discharge criterion (something that also requires further research!) The multiple oppositions approach is usually indicated for children with moderate–severe speech sound disorder; however, some children in the study had mild–moderate speech sound disorder. The outcome measure used – PCC from a single word articulation test – may also not have been the most sensitive measure. A measure which includes multiple opportunities to sample each singleton consonant in initial and final position as well as consonant clusters and sounds within polysyllabic words may have provided a more sensitive and suitable measure in order to

Multiple oppositions approach for phonological impairment: Efficacy and intensity for preschoolers with speech sound disorder Allen, M. M. (2013). Intervention efficacy and intensity for children with speech sound disorder. Journal of Speech, Language and Hearing Research , 56 , 865–877. speechBITE review – Rosemary Hodges and Natalie Munro While research indicates that phonological interventions are effective with preschool children (e.g., Baker & McLeod, 2011), speech pathologists have little to guide them when it comes to making decisions about the optimal intervention intensity for children with speech sound disorders. In this study, the author takes one phonological intervention – the multiple oppositions approach (Williams, 2000a, b) – and examines the effect of dose frequency (i.e., the number of sessions per time unit) and total intervention duration (i.e., the interval for which an intervention is provided) on phonological improvement in preschool aged children (for more information about the constituents of intensity, see Warren, Fey & Yoder, 2007). Preschoolers with speech sound disorder were assigned to one of three conditions – a) multiple oppositions approach provided 3 x a week for 8 weeks (P3), b) multiple oppositions approach provided 1 x a week for 24 weeks (P1), and, c) an active control group which received a storybook intervention (C). While the two phonological interventions (P3) and (P1) have different dose frequencies and total intervention durations, they have equal cumulative intervention intensities. The children were randomly allocated to groups and a blocking procedure was used to control for age and severity of phonological impairment. The percentage of consonants correct (PCC) on a single word test were evaluated after 8 weeks, after 24 sessions and after 6-weeks maintenance. Evaluating outcomes at multiple intervals (e.g., after 8 weeks, 24 sessions and 6-weeks maintenance) allowed the author to address multiple research questions. Allen hypothesised about the possible outcomes. If it is the number of sessions alone that matters, then, at the 8-week evaluation, the P3 condition should be superior; however, after both groups had received 24 sessions, there should be no differences between groups. Yet, if the dose frequency matters, there will be differences seen between the P3 and P1 groups after 24 sessions. After 6 weeks maintenance, three possible results were suggested – regression, no gain or continued gains. Results indicated that at 8 weeks, as expected, the P3 group outperformed both the P1 and the active control group. Surprisingly, there was no significant difference between the P1 and the active control group in PCC after 8 weeks. After 24 sessions, the P3 group again outperformed the P1 group, thus suggesting that receiving 24 sessions of therapy more frequently – 3 times a week – is more effective than receiving 24 sessions of therapy once a week. Both

assess change in phonological skills. speechBITE ratings on the PEDro-P scale Eligibility specified: Y Random allocation: Y Concealed allocation: N Baseline comparability: Y Blind subjects: N Blind therapists: N Blind assessors: N Adequate follow-up: Y Intention-to-treat analysis: N Between-group comparisons: Y Point estimates and variability: Y References

Baker, E., & McLeod, S. (2011). Evidence-based practice for children with speech sound disorders: Part 1 – Narrative review. Language, Speech and Hearing Services in schools, 42 (2), 102–139.

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JCPSLP Volume 16, Number 1 2014

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