1. The Role of Speech Perception Training in Phonological Intervention Bronwyn Carrigg & Elise Baker on behalf of EBP Paediatric Speech Group 2011 NSW Speech Pathology EBP Network

2. What is Speech Perception? Where does it fit? Phonological Processing: broader term describing the use of phonological information to process spoken and written language (incl PA, Phon Working Memory, Phon Retrieval) Speech Perception and Phonological Awareness: comprise different aspects of phonological processing. In speech perception tasks (such as mispronunciation detection), child does not have to segment words into smaller units, as required in PA tasks.

3. Speech Perception: continuous acoustic signal -> discrete linguistic unit most models assume a multistage process by which Acoustic Signal -> Phonetic Units -> Phonological Rep depends on detailed acoustic-phonetic representations word/sound identification tasks (point to ‘shoe’ or X) Phonological Awareness (PA): depends on segmented phonological representations conscious awareness of sound structure of words matching & manipulating sound structures eg syllables appears to be core deficit in SLI, SSD, Dyslexia* (Rvachew & Grawburg, 2006; *Snowling et al 2000 cited in Rvachew.S. 2006)

4. Speech Perception & Phonological Awareness are related; half sample with SSD had poor speech perception & PA speech perception is pivotal in PA emergence speech perception & receptive vocab jointly predicted PA speech perception & receptive vocab->PA->emergent lit articulation accuracy did not predict PA reciprocal relationship (PA vocab; PA emerg literacy Caution…half sample had adequate speech perception & PA (Rvachew & Grawburg, 2006, 95 preschoolers with SSD with normal comp)

5. Development of clinical question Decided to focus on; Role of speech perception tasks rather than PA tasks in Rx Studies comparing Perception + Production vs Production Rx Studies using SAILS speech perception program (multiple speakers producing normal and misarticulated versions of tgt) PICO Clinical Question: In children with phonological impairment does the SAILS speech perception program plus production training compared with production training alone lead to better speech production outcomes? (x4 studies)

6. Rvachew, S (1994) Speech perception training can facilitate sound production learning. JSHR, 37, 2, p.347 Speech Perception + Production vs Production only 27 children mod-severe SSD, 3 groups, 6 sessions, unstimulable /sh/ 60 production trials/session. 60 speech perception trials/session Group 1: perception task = correct/incorrect versions of ‘shoe’ Group 2: perception task = listened to ‘shoe’ vs ‘moo’ Group 3: control group, no perception task but computer game. Conclusion: Overall, children receiving Perception + Production Rx made greater speech improvement than Production Only group on non-stimulable sounds

7. Speech Perception + Production vs Production only Group 1: n=10, 9 group Rx sessions cycles (incl audit bombardment) Group 2: n=13, 6 group Rx sessions cycles (incl audit bombardment) plus 3 individual Rx (stimulability & perception SAILS ) Conclusion: Group who received speech perception + stimulability + production training made more gains than production only group, especially on non-stimulable or poorly perceived sounds Rvachew, Rafaat, Martin (1999) Stimulability, speech perception skills and the treatment of phonological disorders AJSLP, 8, 33-43

8. Wolfe, Presley, Mesaris (2003) The importance of Sound Identification Training in Phonological intervention, AJSLP, Speech Perception + Production vs Production only 2 treatment groups (n=4, n=5), PSK severe SSD, 11 sessions Group 1: Production only Rx Group 2: Production + Speech Perception Rx Conclusion: on speech error sounds that were stimulable pre-Rx Well identified/perceived errors (pre-Rx) – No difference Poorly identified/perceived errors (pre-Rx) – Mixed better Production only training improved perception

9. Rvachew, Nowak et al (2004) Effect of phonemic perception training on speech production and phonological awareness skills of children with expressive phonological delay. AJSLP, 13, 250-263 Speech Perception + PA + Production vs Production only n=34, PSK, mod-severe SSD, mean Rx 12 sessions, ++ variability in Rx Group 1: Production and *Perception (16x15 min sessions SAILS) Group 2: Production only (16x15 min sessions computerised book) *Perception Rx included generic phonemic perception, plus letter recognition, sound symbol ass, onset/rime matching (ie PA) Conclusion: Mixed Rx (Perception+PA+Production) led to greater gains in speech production and perception than production only group No differences in PA between groups.

10. Clinical Bottom Line: In preschool children with SSD with speech perception difficulties; the evidence suggests that speech perception training, specifically the SAILS program, plus production training is more effective at improving production of stimulable and non stimulable speech sounds than production only training. Production Only treatment also improves speech perception

11. Guidelines for combining speech perception training with production practise: Authors caution that; perception Rx should always be concurrent with production Rx; production training should be explicit, ie including cues/prompts speech perception contrasts match contrasts for production Rx speech perception exercises based on child’s sound errors may start with maximum distinctions later moving to finer distinctions Speech perception, like stimulability, may provide information about underlying phonological knowledge; and may be useful to consider in selecting targets, predicting progress, as well as in treatment.

12. Problem: SAILS is for North-American speakers... POSSIBLE WAYS FORWARD... Australian adaptation of SAILS being investigated – with Australian speakers of different ages, genders (contact: Elise Baker if interested). Alternate suggestion in the meantime– provided ‘modified’ SAILS, using various people in the child’s environment: clinician, parents, siblings, grandparents The variety of speakers would provide the child with opportunities to better refine the child’s underlying representation. Need to collected INTERNAL clinical evidence from everyday practice, to determine whether this ‘modification’ would still be beneficial.

13. Current Topic: Treatment in CAS Question 1: In children with Childhood Apraxia of Speech does Dynamic Temporal and Tactile Cueing (DTTC) lead to an improvement in speech production.

14. References Rvachew, S (1994) Speech perception training can facilitate sound production learning. JSHR, 37, 2, p.347 Rvachew, S (1994) Speech Assessment and Interactive Learning System; SAILS; AVAAZ Innovations Rvachew, Rafaat, Martin (1999) Stimulability, speech perception skills and the treatment of phonological disorders. AJSLP, 8, 33-43 Wolfe, Presley, Mesaris (2003) The importance of Sound Identification Training in Phonological intervention, AJSLP, 282-288 Rvachew, Nowak et al (2004) Effect of phonemic perception training on speech production and phonological awareness skills of children with expressive phonological delay. AJSLP, 13, 250-263 Rvachew, S (2006) Longitudinal Predictors of Implicit Phonological Awareness Skills, AJSLP, 15, 165–176

15. Thank you to EBP Paed Speech members; SWAHS, SSWAHS, HNEAHS, SESIAHS, NSCCAHS University of Sydney, Private SPs, Learning Links To join contact; bronwyn.carrigg@sesiahs.health.nsw.gov.au