Purpose: Over 95 percent of parents of children with Down Syndrome report that their child has difficulty being understood by persons outside of their immediate family or social circle. This difficulty tends to persist into adulthood. Problems with speech comprehensibility can have negative consequences on educational achievement and post school outcomes. There is a widely held belief that improving speech accuracy (e.g., producing particular speech sounds) will lead to improved speech comprehensibility, yet traditional speech services in schools that focus on speech accuracy have not led to improvements in speech comprehensibility. The goal of this project is to evaluate the efficacy of a promising speech therapy compared to traditional speech therapy. The research team will test the efficacy of Broad Target Speech Recasts (BTSR) compared to the Easy Does It for Articulation (EDI) program in improving speech comprehensibility of elementary school students with Down Syndrome. BTSR focuses on the speech context through speech recasts (adult repeats words child is attempting to say, providing a model of correct pronunciation, pitch, stress, and intonation). The comparison program emphasizes drill and practice of individual sounds and sound combinations, reflecting typical services provided in school settings.

Project Activities: A randomized clinical trial will be conducted with approximately 63 children ages 5–12. The children will be randomly assigned into one of two treatments groups: Broad Target Speech Recasts or Easy Does It for Articulation. Students in both groups will be offered two 1-hour sessions per week for 24 weeks. Treatment will be provided to individual students by speech language therapists. All students will be assessed at five time points to allow for analysis of treatment effects on growth of speech comprehensibility.

Products: The products of this project include evidence of the relative efficacy of the Broad Target Speech Recasts intervention over the standard Easy Does It for Articulation intervention, as well as published reports and presentations.

Structured Abstract

Setting: The research will occur in Metropolitan Nashville Public Schools.

Population: The target population is students ages 5–12 with Down Syndrome who have less than 75 percent speech comprehensibility and scores below the 10th percentile in measures of speech accuracy.

Intervention: Broad Target Speech Recasts (BTSR) speech therapy assumes the source of the child's speech difficulties lies in inaccurate or incomplete sound templates, not merely in production of individual sounds. This sound template is not just a store for phonemic information, but also pitch, rate, and stress. The presumed “active ingredient" in BTSR is speech recasts. A speech recast is an adult utterance that immediately follows a child utterance. It gives a neutral or positive evaluation of the meaning of the child's utterance, and is an exact or reduced imitation of the word(s) that the child attempted to say using adult pronunciation. That is, speech recasts provide indirect information about accuracy of the child's production and provide models of accurate pronunciation, pitch, stress, and intonation. For example, if the child says, "Ah wa du," the speech recast might be "You want juice." The "broad target" part of BTSR is that the therapist uses speech recasts for any word the child attempts to say that is inaccurately produced and affords a developmentally appropriate recast. The delivery of at least four speech recasts per minute is the primary active ingredient in BTSR.

Research Design and Methods: The proposed research design is a longitudinal randomized control trial. Sixty-three children will be randomized at the student level into one of the two treatment groups. Children in both groups will be offered two 1-hour sessions per week for 6 months in their schools. Treatments will be delivered by project-provided speech language therapists. Children in both groups will be assessed at five time points (before treatment, 2 and 4 months into the treatment phase, immediately after intervention, and at 2 months after the treatment phase). Half of all treatment sessions will be videotaped, and these will be coded for treatment fidelity.

Control Condition: Easy Does It for Articulation (EDI) is a program that emphasizes guided practice in producing individually targeted speech sounds. The EDI model assumes the source of the child's speech difficulties is the child's inability to accurately produce sounds due to difficulties in motor execution or motor planning. EDI attempts to increase the child's oral motor execution through repetition and guided practice, and this approach addresses targeted speech sounds one at a time. The presumed "active ingredient” in EDI is child production of target sounds through massed-trial practice. This approach mirrors techniques that are currently employed by related services personnel who treat speech disorders.

Key Measures: A variety of measures will be used to assess outcomes and potential moderators including narrative and conversational speech samples, a measure of verbal imitation, and a measure of verbal short-term memory. Standardized measures include the Arizona Articulation Proficiency Scale, the Peabody Picture Vocabulary Test, and the brief form of the Stanford-Binet-V intelligence test. Fidelity measures include treatment session records and therapists' rating of methods used in the treatment sessions, as well as coding of videotaped treatment sessions.

Data Analytic Strategy: Hierarchical linear modeling (HLM) will be used to assess the growth of speech comprehensibility and the intervention's impact on the level of speech accuracy at follow up.

Products and Publications

Journal article, monograph, or newsletter

Woynaroski, T., Watson, L., Gardner, E., Newsom, C.R., Keceli-Kaysili, B., and Yoder, P. (2016). Early Predictors of Growth in Diversity of Key Consonants Used in Communication in Initially Preverbal Children With Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 46(3): 1013–1024. doi:10.1007/s10803–015–2647–7

Yoder, P. J., Camarata, S., & Woynaroski, T. (2016). Treating speech comprehensibility in students with Down syndrome. Journal of Speech, Language, and Hearing Research, 59(3), 446–459.

Yoder, P.J., Woynaroski, T., and Camarata, S. (2016). Measuring Speech Comprehensibility in Students With Down Syndrome. Journal of Speech Language Hearing Research, 59: 460–467. doi:10.1044/2015_JSLHR-S-15–0149