Speech

Banter Evidence Snapshots: bite-sized speech, language, literacy and stuttering resources for busy families

9 April 2019 by David Kinnane

Over the last five years, we’ve written hundreds of articles summarising some of the most interesting research published about speech, language, literacy, stuttering, and voice.

But who has time to read it? Even we get lost looking for some of our articles!

To make life easier for our clients and readers, we’re pleased to present new, one-page infographics summarising our most popular articles. We call them Banter Evidence Snapshots.

And we’ll be publishing two a week, starting now!

If you’d prefer to receive Banter Evidence Snapshots via social media, follow us on Facebook, Instagram, or Twitter.

Banter Evidence Snapshot: Why preschoolers with unclear speech are at risk of later reading problems: red flags to seek help

To read our full article, check out: Why preschoolers with unclear speech are at risk of later reading problems: red flags to seek help

Banter Speech & Language

Banter Speech & Language is an independent firm of speech pathologists for adults and children. We help clients in our local area, including Concord, Concord West, North Strathfield, Rhodes, and Strathfield, and all other suburbs of Sydney.

Banter Speech & Language is owned and managed by David Kinnane, a Hanen- and LSVT LOUD-certified speech-language pathologist with post-graduate training in the PreLit early literacy preparation program by MultiLit, the Spalding Method for literacy, the Lidcombe and Camperdown Programs for stuttering, and Voicecraft for voice disorders. David is also a Certified PESL Instructor for accent modification.

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David is a part-time Associate Lecturer at the University of Technology Sydney’s Graduate School of Health. David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Important update: In what order and at what age should my child learn to say his/her consonants? FAQs

24 February 2019 by David Kinnane

1. Great news!

When I first wrote about this in 2014, I had to hem and haw. I had to hedge my bets because the evidence – frankly – was all over the place!

Now I’m thrilled to be able to share an evidence-based set of answers, thanks to a fantastic review of consonant acquisition in 27 languages carried out by Drs Sharynne McLeod and Kathryn Crowe published in late 2018 (see full citation and links below).

2. Even better news! Wonderful free “knowledge translation” resources for the public developed by the researchers themselves

Usually, I have to wade through pages and pages of dry academic writing and then spend hours trying to extract practical tips for my clients and regular readers of this blog. Not this time: the researchers have done all the hard work for us by preparing simple posters summarising their key findings for us all. Here they are:

Aren’t they pretty? And wouldn’t it be great for everyone if all academics did this? (Hint, hint academic friends reading this!)

3. How is this new research changing our clinical practice?

In increments!

It’s always important to consider clinical changes based on important new evidence. But it’s also important not to over-react or to “throw the baby out with the bath water”, simply because we have a new study. We all stand on the shoulders of leading researchers, and McLeod and Crowe’s review is – by it’s very nature – an attempt to synthesise some of the great studies that have been published to date.

(a) Important, but not revolutionary

Way back in 1978, Kilminster and Laird reported that 75% of children they tested acquired:

/m, n, w, b, p, g, k, h, y, d/ and /t/ by 3 years of age;
/s, z, l/ ,”sh”, /f, h/ and “ch” by 4 1/2 years of age; and
/r, v/ and “th” (voiced and voiceless), and blends of two sounds (e.g. tr, pl and sl) by 8 1/2 years of age.

You’ll note that they weren’t a mile away from McLeod and Crowe’s conclusions in 2018, although there are some important differences – notably the timing for the acquisition of /r, v/ and the “th” sounds.

(b) Teaching old dogs new tricks – how we’re learning the new framework

Clinically, at Banter, we used to group English consonants into the three categories suggested by Dr Shriberg in 1993:

the early eight: /m, b, y, n, w, d, p/ and /h/;
the middle eight: /t/, “ng”, /k, g, f, v/, “ch”, and “j”; and
the late eight: “sh”, “th” (as in “bath”), “th” (as in “bathe”), /s, z, l, r/ and “zh” (as in “vision”).

Again, there is significant overlap between Shriberg’s framework and McLeod & Crowe’s study outcomes.

Clinically, it will be difficult to stop thinking in terms of the early, middle and late eight because it’s such a simple tool. But, to prove that we can move with the times, I’m now training myself and my team to use the revised framework, using a silly memory trick I developed, based on simple mnemonics. Here it is:

(c) From assessment to therapy targets – targeting some error patterns earlier

From an assessment and diagnostic point of view, we have used the norms underpinning one of our leading assessment tools, the Diagnostic Evaluation of Articulation and Phonology (Dodd and colleagues, 2002). In the sample used to norm this test, 75% of the children in the sample acquired:

/p, b, t, d, k, g, m, n/ “ng”, /f, v, s, z/ “zh” (as in “vision”), /h/, “ch”, “j”, /w, l/ and /y/, by 3 1/2 years of age;
“sh” by 3 years 11 months;
“th” (as in “bathe”) by 4 years 11 months;
/r/ by 5 years 5 months; and
“th” (as in “bath”) by 6 years and 5 months.

Again, pretty consistent with McLeod & Crowe’s findings, with some differences.

One area in which the new research will inform our practice is deciding when to target phonological processes like the deaffrication of “ch” and “j”, gliding of /l/ and /r/, and fricative simplification of voiced and unvoiced “th”. McLeod & Crowe found that, by 5 years of age, children produced at least 93% of consonants correctly. In 1994, Gordon-Brannan reported that typically-developing children at 4 years old are intelligible in conversational speech with unfamiliar listeners. Together, these studies give us more confidence to target some phonological processes earlier – especially for clients at risk for ongoing speech, language and/or reading difficulties.

Clinical bottom line

This hasn’t changed. If you are worried about your child’s speech – particularly if it’s affecting his or her quality of life or you are worried about it – have a chat with your local speech pathologist.

Related articles:

“He was such a good baby. Never made a sound!” Late babbling as a red flag for potential speech-language delays

Speech sound disorders in children

FAQ: 10 common speech patterns seen in children 3-5 years of age – and when you should be concerned

How to treat speech sound disorders 1: the Cycles Approach

How to treat speech sound disorders 2: the Complexity Approach

How to treat speech sound disorders 3: Contrastive Approach – Minimal and Maximal Pairs

How to identify and treat young children with both speech and language disorders

Why preschoolers with unclear speech are at risk of later reading problems: red flags to seek help

Principal source and article link:

McLeod, S., & Crowe, K. (2018). Children’s Consonant Acquisition in 27 Languages: A Cross-Linguistic Review, American Journal of Speech-Language Pathology, 27, 1546-1571, via here.

McLeod & Crowe’s Posters
More information (from Charles Sturt University)

Image: https://tinyurl.com/y54zluns

Banter Speech & Language

How to treat speech sound disorders 3: Contrastive Approach – Minimal and Maximal Pairs (with demo)

2 February 2019 by Vivien Wong

Apart from the Cycles Approach and the Complexity Approach, the “Contrastive Approach” is another common way to treat children with phonological speech disorders. In this article, we explore both the so-called “Minimal Pairs Approach” and the “Maximal Pairs Approach”. Both are contrastive approaches and are used for phonological intervention.

Let’s dive into the nuts and bolts of these two approaches.

Who developed them?

The Minimal Pairs Approach was developed by Dr Frederick F. Weiner, whilst the Maximal Pairs Approach was developed by Professor Judith Gierut and her colleagues at Indiana University.

Who is it for?

The Minimal Pairs Approach is suitable for children with mild or moderate speech sound disorders, with one or two phonological processes that are no longer age-appropriate. It can also be used with people who are looking to modify their accent.
The Maximal Pairs Approach is geared towards children with at least six sounds missing from their speech sound inventories with normal oral and speech motor abilities.

What are they?

In essence, both approaches focus on contrasting differences between phonemes (i.e. speech sounds) in order to reorganise a child’s sound system.

Phonemes can differ by:

Place – some sounds are made with the lips, tongue tip or the back of the tongue.
Manner – some sounds uses a long continuous flow of air (e.g. /s/, /z/), some sounds are short and stop as soon as they begin (e.g. /t/, /p/), etc.
Voicing – we switch our voices on to make some sounds (e.g. /b/, /g/), but turn our voices off for others (e.g. /p/, /k/).

In the case of a minimal pair, the two words differ by a single phoneme and by one or two features across place and manner of articulation and voicing.

For example, let’s look at the pair “cap” and “tap”. These two words are identical in terms of the vowel /ae/ and final consonant /p/. They only differ by the initial phoneme – /k/ and /t/ – and this involves a small difference in place of production (velar vs alveolar).

In comparison, a maximal pair includes two words that differ by a single phoneme across many featural dimensions of place, manner and voicing. An example would be the pair “be” and “see”, where the phonemes /b/ and /s/ differ across all three aspects of place (labial vs coronal), manner (stop vs fricative) and voicing (voiced vs voiceless).

In both approaches, the paired words would contain a sound a child is familiar with and a target (unfamiliar) sound.

What happens in the sessions?

For the Minimal Pairs Approach:

Identify the target phonological process. For example, a 3-year-old boy, Ben, has voicing errors. He “turns off” his voice at the start of his words when he should be “turning it on” (e.g. he says “pig” instead of “big”). In this case, we want Ben to say /b/. We call this the “target”.
Before the session, select 3-5 minimal pairs of words that contrast the paired phonemes. According to research, only three to five word pairs are needed to make permanent changes in a child’s phonological system (Elbert et al., 1991). In Ben’s case, we can choose pig/big, pay/bay, park/bark, peg/beg, pea/bee.
Introduce the minimal pair words to the child by showing them pictures of the pairs and naming them aloud. We want to make sure Ben knows the vocabulary – this is sometimes tricky when contrasting sounds with few word options.
Have the child point to the words you name. This gives us an idea whether the child can hear the difference between the two contrasting phonemes (e.g. /p/ vs /b/). This is sometimes called auditory discrimination.
Now, reverse the roles and have the child name the words.
When the child uses the “wrong sound” (e.g. pig) for the target (e.g. big), pick up the picture that the child named and not the one intended. For example, when Ben points to the picture card big but says, ‘pig’, pick up the picture of the pig.
Give the child feedback to signal he/she has made a mistake. In Ben’s case, I might say, “Oh, do you mean pig or big? I’m not sure what you mean, tell me again.” This is the teaching moment, where Ben learns he needs to say the word differently for others to understand him.
Work with the child till he/she gets it right about 60% of the time.
Move onto the other paired words (one set at a time) at sentence level. You can use carrier phrases at this stage.

Here’s a demonstration (voice and hand talents Vivien Wong and Cherie Finocchiaro):

For the Maximal Pairs Approach:

Identify the two target phonemes. For example, the sounds /m/ and /f/ are maximally opposed across by place, manner and voicing (with /m/ being a bilabial voiced nasal and /f/ being a labiodental voiceless fricative). Remember the pair should include a known versus an unknown phoneme.

Create eight pairs of words containing the target phonemes. Where no true words are available, use nonsense words, which could be associated with different monster or fairy names. For example, Mip/Fip.

Have the child imitate you and then say it on their own.

In both approaches, we also plan to add auditory bombardment and discrimination tasks.

How long does it take?

Like other approaches, the duration of therapy required is dependent on the child, the child’s phonological processes, the amount of treatment within sessions and home practice. The more repetitions we could fit into our sessions, the better.

As both approaches are suited for children with mild-to-moderate phonological impairments, with only a few age-inappropriate errors remaining, in theory at least, it should take less time than more intensive treatment approaches such as Cycles.

The idea is that, once a difference between phonemes is introduced, the gains are likely to “transfer” to untreated phonemes. (You can read more about this here.)

What does this mean?

If we think back to our earlier example with Ben, the phonemes /p/ and /b/ differ only by voicing (voiceless vs voiced). If Ben learns to “turn on” his voice in treatment of /p/ vs /b/ pairs, this same voicing contrast should be carried over to other voiceless-voiced pairs such as /t/-/d/ or /k/-/g/.

Does it work?

The Minimal Pairs Approach has been used for over twenty years, with a robust body of research supporting its clinical effectiveness (Barlow and Gierut, 2002). Tyler, Edwards and Saxman (1987) also found that this approach was best suited for children with only one or a select few phonological processes. Research comparing both the Minimal and Maximal Pairs Approach found that targeting a maximally opposed pair led to greater generalisation than a minimally opposed pair.

It is important to note that to date, most of the studies on contrast approaches are fairly small, without control groups. The current main body of available evidence is based primarily on non-randomised experimental and non-experimental studies (Baker & McLeod, 2004). More higher-quality research would help clinicians (and our clients).

Helpful Resources:

Head over to leading speech pathologist Caroline Bowen’s website, for her incredibly extensive library of useful information about both approaches, as well as her widely used resources for therapy.

Related articles:

Principal sources:

Baker, E., & McLeod, S. (2004). Evidence-based management of phonological impairment in children. Child Language Teaching and Therapy, 20(3), 261–285. Abstract available here.

Barlow, J., & Gierut, J. (2002). Minimal Pair Approaches to Phonological Remediation. Seminars In Speech And Language, 23(1), 057–068. Abstract available here.

Elbert, M., Powell, T., & Swartzlander, P. (1991). Toward a Technology of Generalization: How Many Exemplars Are Sufficient? Journal of Speech, Language, and Hearing Research, 34(1), 81–87.Abstract available here.

Tyler, A.A., Edwards, M.L., & Saxman, J.H. (1987). Clinical application of two phonologically based treatment procedures. Journal of Speech and Hearing Disorders, 52m, 393-409.

Image: https://tinyurl.com/yck6xsfg

Banter Speech & Language

Parent dilemma: What to do when your child stutters and has speech sound problems – research update

4 October 2018 by David Kinnane Leave a Comment

Stuttering can have a big, negative effect on a young child’s life. So, too, can having a speech disorder. Early treatment is important for each. So what should you do if your child has both problems?

Stuttering gets harder to treat as kids get older and go to school (Lincoln et al., 1996), so I usually recommend treating preschoolers’ stuttering first. But that doesn’t mean we can just ignore a child’s speech sound problems because:

if speech sound disorders persist past school-age, kids might have difficulties learning to read (e.g. Nathan et al., 2004);
children with speech sound disorders are at a heightened risk academically, including for maths, listening and reading comprehension and phonological awareness (e.g. Denne et al., 2005; Holm et al., 2008; Leitão & Fletcher, 2004; Rvachew & Grawburg, 2006); and
some children with speech disorders have issues with peer relationships, lowered self-esteem, and are at increased risk of dropping out of school, and poorer work outcomes (e.g. McCormack et al., 2009).

As many as 30-40% of children who stutter also have speech sound disorders (Nippold, 2004). In our clinic, we frequently work with children with both disorders.

So what to do?

There are three main treatment options:

Sequential treatment: Treat stuttering first, then speech sounds.
Cyclical treatment: e.g., treat stuttering for a while, then switch to speech, then switch back to stuttering, etc.
Treat stuttering and speech at the same time, either:
- by choosing activities to target both together (the “simultaneous approach“); or
- treating both in parallel, i.e. in the same sessions, but in different activities (“concurrent approach“).

Unfortunately, not much peer-reviewed research evidence exists to help speech pathologists decide which approach to recommend to families. As noted above, my “default” position has been to recommend treating stuttering first. But I’ve made exceptions, for example:

when working with kids with very serious speech sound disorders;
when working with children with speech and other risk factors for developmental language disorders or reading difficulties like dyslexia;
when families make the informed decision that speech is their priority; or
when health, behaviour, cognitive, family, and/or other issues make it difficult for a client to undertake an evidence-based stuttering treatment like the Lidcombe Program.

New research on treating both disorders concurrently

A small study about kids with both speech sound disorders and stuttering was published in 2017 by leading stuttering researchers, Dr Rachael Unicomb, from The University of Newcastle, and her colleagues Drs. Sally Hewat, Elizabeth Spencer and Elisabeth Harrison. It provides some support for the concurrent treatment of stuttering and speech issues.

In the study, the researchers treated five preschoolers using the Lidcombe Program for stuttering and traditional articulation and evidence-based speech sound therapies like minimal pairs and multiple oppositions for phonological issues. Both stuttering and speech treatments were administered in the same session, but in separate parts of the session, with different activities.

After 12 months, four of the participants had completed the Lidcombe Program, with fewer than 1% of their syllables stuttered. All five participants increased their percentage of consonants correct (a good proxy measure for increased intelligibility).

From reading the study, I took away some interesting clinical points for my practice:

Both the stuttering and speech treatments were evidence-based, direct behavioural treatments.
For the speech sound treatments:

the researchers used a “most knowledge” developmental approach for phonological issues. This is a treatment approach where we target earlier developing speech sounds, rather than later-developing, more complex speech sounds. The researchers cite some evidence that the most knowledge approach is preferable when working with kids who have speech issues and stutter (Sasisekaran, 2014; Wall & Myers, 1995), perhaps because more complex targets may increase the language demands of speech therapy beyond the child’s capacities, which may be unhelpful for treating stuttering (Starkweather & Gottwald, 1990); and
for articulation issues like lisps, the researchers opted for traditional articulation therapy, rather than an approach built on principles of motor learning.

One of the five study participant’s stuttering increased after treatment. The researchers noted that this client exhibited “challenging behaviours” that made it difficult for the Lidcombe Program to be administered as per the manual.
As the authors note, this preliminary study had lots of limitations, including the study design (a clinical case study), the lack of clear cause-effect relationships between treatments and outcomes, the small size of the study, the lack of control groups and clinician blinding, the different kinds of speech sound errors treated and the ways they were treated, and the mild-moderate stuttering severity levels of the participants (no participant had severe stuttering at the start of the trial).
Notably, none of the study participants was bilingual, had a history of hearing issues, a developmental language disorder, and/or autism spectrum disorder. These “exclusion criteria” are common in stuttering and speech sound research because researchers want as few variables as possible to study treatment effects. But it means that the study participants sometimes look very different to the “real world” clients speech pathologists encounter, particular in diverse communities like Sydney.

Clinical bottom line

For some preschoolers who stutter and have speech sound disorders, concurrent, direct, treatment of both disorders using the Lidcombe Program for stuttering and a most knowledge approach to phonological treatments may be an effective, safe and efficient way to reduce stuttering and improve speech. But it’s likely that this approach is not for all kids. Speech pathologists need to measure outcomes carefully and be prepared to adapt management plans, particularly if (for example) one or both disorders worsen during treatment.

We need further, larger, and more sophisticated clinical trials to be published in peer-reviewed journals to help us determine things like:

which clients are more likely to benefit from this approach, and which clients might do better with sequential treatment;
whether combining other evidence-based treatments (e.g. stuttering treatments like the Westmead Program and speech sound treatments like Cycles or the Complexity Approach) may help some kids who stutter with speech sound disorders; and
the role (if any) played by a child’s expressive language development in helping speech pathologists and families to decide which treatment approaches should be preferred, particularly in light of recent research showing that the rate of a child’s language development may be a predictor of recovery from stuttering.

As always, we are very thankful for researchers like Dr Unicomb and her colleagues who publish treatment research like this addressing issues we face regularly in clinical practice.

Related articles:

Principal source: Unicomb, R., Hewat, S., Spencer, E., & Harrison, E. (2017). Evidence for the treatment of co-occurring stuttering and speech sound disorder: A clinical case series. International Journal of Speech-Language Pathology, 19:3, 251-264.

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Banter Speech & Language

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Free Resource: Carrier Phrases for Speech, Language, Stuttering and Voice Therapy

19 September 2018 by David Kinnane Leave a Comment

Carrier phrases are short, simple “stock” phrases we use to help kids and adults practice their skills and to transfer their therapy gains from single word to phrase levels.

We use carrier phrases a lot in speech therapy to bridge the gap between single word drills and self-generated sentences. This can help clients to transfer their skills from the clinic into the real world.

For example, in the last few months, we’ve used carrier phrases:

in lisp therapy to help a young lady correct her /s/;
in phonological speech therapy to help a young gentleman learn to say /k/ (instead of /t/) at the start of his words;
with children who stutter and are being treated with the Lidcombe or Westmead Programs for childhood stuttering;
in language therapy with a young man working on regular plurals (e.g. cats) and possessive ‘s (e.g. David’s car);
in accent modification therapy with an adult working on improving his primary stress patterns to improve his intelligibility;
in voice therapy with an adult to practice healthy voicing techniques; and
in reading interventions with school-aged kids to practice decoding of high frequency words and phrases.

Let’s not waste precious time reinventing wheels! To help clients, families, members of the public and other speech pathologists, we’re pleased to present this short free resource with some of our favourite carrier phrases.

We hope you find this free resource useful. If you have any comments or other feedback, please get in touch!

Related Banter products:

Sound cards
Low Prep Possessive ‘s Story-Bootcamp Practice Pack
The Lidcombe Program for Stuttering: My 10 Favourite Therapy Activities
The Westmead Program for Stuttering: Activity List
The Westmead Program for Stuttering: Robot Talking Activity Log
The Pesky Lisp Fixer (available from our Teachers Pay Teachers store)

Banter Speech & Language

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Help your kids say new sounds: a free resource

4 September 2018 by David Kinnane Leave a Comment

Some kids can only say a few speech sounds, including many kids with speech sound disorders.*

When I work with these kids, one of my first goals is often to increase the number of different sounds they can hear and say. For many children – especially young ones – this can be tricky because you can’t see or touch sounds. This makes it hard for kids to contrast similar sounds, e.g. to distinguish short “stop” sounds like /k/ from /t/, or hissy “fricative” sounds like /s/ from /f/.

To help kids tell different speech sounds apart, and to encourage them to give new sounds a go, we use simple pictures in our clinic to represent speech sounds. We base this approach on the wonderful work of researchers like Adele Miccio and Mary Elbert who’ve been arguing for this approach since at least the mid-1990s.

To help our clients and their families practice at home, we give them copies of picture cards we’ve made for each sound. We’re now pleased to provide our cards as a free download to anyone else who might find them useful.

Please feel free to share them: our only conditions are that the cards stay free for everyone (i.e. they are not onsold) and that credit is given to Drs Miccio and Elbert who pioneered the approach we’ve adapted for use in our clinic.

A big thank you to our wonderful Administrative Assistant and Speech Pathologist in-training, Cherie, for making such lovely cards.

Enjoy!

* For more information we’ve summarised:

the ages at which most kids learn different speech sounds here;
common developmental error patterns (and when you should be concerned about them) here;
‘red flags’ for hearing related speech sound error patterns here;
the Cycles Approach to treatment here; and
the Complexity Approach to treatment here.

Principal source: Miccio, A.W. & Elbert, M. (1996). Enhancing Stimulability: A Treatment Program. Journal Communication Disorders, 29, 335-351.

Banter Speech & Language

David holds a Master of Speech Language Pathology from the University of Sydney, where he was a Dean’s Scholar. David is a Practising Member of Speech Pathology Australia and a Certified Practising Speech Pathologist (CPSP). David sits on Speech Pathology Australia’s Ethics Board and Professional Standards Advisory Committee.

Speech

Banter Evidence Snapshot: Why preschoolers with unclear speech are at risk of later reading problems: red flags to seek help

1. Great news!

2. Even better news! Wonderful free “knowledge translation” resources for the public developed by the researchers themselves

3. How is this new research changing our clinical practice?

(a) Important, but not revolutionary

(b) Teaching old dogs new tricks – how we’re learning the new framework

(c) From assessment to therapy targets – targeting some error patterns earlier

Clinical bottom line

Who developed them?

Who is it for?

What are they?

What happens in the sessions?

For the Minimal Pairs Approach:

For the Maximal Pairs Approach:

How long does it take?

Does it work?

So what to do?

New research on treating both disorders concurrently

Clinical bottom line

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