JCPSLP Vol 20 No 2 July 2018

assessment of speech sound production, (b) greater improvement in the production of treated sounds in a target word list, and (c) greater change in perceptual measures of intelligibility, level of concern reported by parents, and satisfaction with speech sound skills. Method Participants Participants in this study were school-aged children (5;4–11;8 years, mean = 8;2 years) presenting with functional speech disorders who had residual difficulties producing specifically the /s/, / ƒ /, and/or / ɹ / sounds. A total of 20 participants were recruited from existing CYPF speech pathology caseloads and waitlists within the HNE Greater Newcastle Sector and were referred to the study by CYPF staff. All those referred were accepted to the project as long as they met specified eligibility criteria (outlined below). Seventeen children ultimately participated in the treatment, all of whom had previously received therapeutic intervention. Five received private services and the remaining 12 received services within our community health service. Of these, only two had previously received service directly from one of the authors. One participant received only 3 sessions within the previous 6 months, while the other received up to 12 sessions in line with community health policy, within the previous 6 to 12 months. These participants were included in the study as it was deemed unethical to exclude them when they met all eligibility criteria. Eligibility The following eligibility criteria were applied to promote group homogeneity: • Receptive and expressive language skills: All participants attained core language standard scores of 86 and above on the Clinical Evaluation of Language Fundamentals , 4th ed. (CELF-4; Semel, Wiig, & Secord, 2006) demonstrating average language abilities. • Oromotor function: Oromotor assessments were conducted with all participants. These assessments were not standardised. No participants presented with abnormalities in structure or function of articulators (i.e., tongue placement and movement, hard and soft palate, occlusion, teeth, lips) as assessed by the referring speech-language pathologist. • Age: Participants were at least 6 years of age, or in kindergarten or above at school. • Stimulability: Children who were stimulable without cueing were excluded. • English: English was the participant’s first language (to address differences in speech sound acquisition across languages, particularly production of / ɹ / in different dialects). • Hearing: The hearing status of all participants was within normal limits, as assessed by a nurse audiometrist or audiometrist. In addition to the above criteria, participants were required to be motivated to participate in weekly 30-minute clinic-based appointments and to agree to complete 10–15 minutes home practice on most days. Participants’ parents/ carers were also required to attend (and participate) in up to 12, weekly, clinic appointments, commit to completing 10–15 minutes of home practice on most days, and complete a home practice log. All participants and parents/ carers were asked to sign a contract to reflect their commitment to these requirements. These contracts were

provided in written form and also explained verbally to the participants and parents/carers. The participants’ contracts were modified with the use of developmentally appropriate language, and approved by an external ethics committee. Design Participants were independently and randomly assigned by staff at the Hunter Medical Research Institute, who were unknown to the speech-language pathologists, into either the treatment group (using ultrasound) or control group (traditional articulation therapy). Ten participants were recruited into the first treatment and control groups, with five randomly assigned into each group. Upon completion of these groups, another 10 participants were recruited and randomly assigned into a second treatment and control group. The members of each group attended for individual intervention sessions for up to 12 weeks. Groups were similar at baseline (Table 1).

Table 1. Key characteristics of treatment and control groups at baseline

Treatment (n = 9)

Control (n=8)

p

Age (median IQR)

8.4 (7.2–9.8)

8.1 (7.0– 92)

.85

Sex

8 male, 1 female 6 male, 2 female

Target sound

.34

/ ɹ / / s / / ʃ /

4

5

5

2

0

1

In total, 10 participants were referred for difficulties with / ɹ /, eight participants were referred for difficulties with /s/ and one participant was referred for difficulties with / ʃ /. One participant was referred for difficulties with / ɹ /, / ʃ /, and /s/ sounds; however, this participant did not meet language assessment criterion and was ultimately excluded from the study following randomisation. The two treatment groups consisted of five participants targeting / ɹ /, five participants targeting /s/ and no participants targeting / ʃ /. The two control groups consisted of five participants targeting / ɹ /, three participants targeting /s/ and one participant targeting / ʃ /. Unfortunately, time limitations of the study did not allow for additional recruitment of participants having difficulty with / ʃ / sounds. The tenth participant of the control group was the child who was excluded from the study following randomisation. Pre-assessment Pre-assessment occurred two weeks prior to commencement of intervention and included language assessment using the CELF-4 (Semel, Wiig, & Secord, 2006), and speech assessment using a battery of measures including the Diagnostic Evaluation of Articulation and Phonology Articulation Subtest (DEAP; Dodd, Hua, Crosbie, Holm, & Ozanne, 2002) to obtain a measure of percentage consonants correct (PCC) (as per Shriberg & Kwiatkowski, 1982), and a 20 word list of the targeted sound comprising of syllable initial word initial (SIWI), syllable initial within word (SIWW), syllable final within word (SFWW), and syllable final word final (SFWF) (plus clusters where applicable) to obtain a percentage of target words correct. Word, phrase, and sentence level skills were assessed. Children were assessed only on the target sound word list relevant to their

77

JCPSLP Volume 20, Number 2 2018

www.speechpathologyaustralia.org.au