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Assessing Speech Fluency Problems in Typically Developing Children Aged 4 to 5 Years

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Assessing Speech Fluency Problems in Typically Developing Children Aged 4 to 5 Years UCL Assessing Speech Fluency Problems in Typically Developing Children Aged 4 to 5 Years. Avin Mirawdeli This thesis is submitted in fulfilment of the requirements for the degree of Doctor of Philosophy University College London 2 ACKNOWLEDGEMENTS There are numerous people who have contributed extensively to this work. Professor Peter Howell, Thank you! Not only have you provided help, direction and guidance whenever needed, but you have also enabled me to be free and independent. By offering me this PhD post, I was able, for the first time, to live outside of the four walls that my culture had imposed on me. For this, no amount of thank you and not a single word exists that would sufficiently express and show my gratitude. Your dedication and the hours you devote to making sure the work is absolutely perfect is incredible and truly inspiring. Mr and Mrs Barker and the Dominic Barker Trust, I am forever indebted to you, not only for funding this work, but also for welcoming me into your home and providing much support and assistance. Again, without your funding, I would not have been able to do this work. I am truly honoured to have met you all. Thank you for everything. UCL EP and Impact Fund, Thank you. You have enabled me to meet the most interesting and most successful people around in this field. The knowledge I have gained here is invaluable. Dr Alastair McClelland and Professor Charles Hulme, thank you for all your help and support. The schools, their participation and warm welcome are greatly appreciated. I would like to thank all the staff, teachers, pupils and their parents for taking part in this project. With their help I have managed to screen 1300 children in 11 schools, so a very big thanks to: Beecholme Primary School, London Bond Primary School, London Hatfeild Primary School, London Hollymount Primary School, London Lonesome Primary School, London Poplar Primary School, London Priory Primary School, London Stanford Primary School, London St Thomas of Canterbury Catholic Primary School, London And St. Matthew's CoE Primary School, Ipswich St. Helen's Primary School, Ipswich. Student assistants, thank you so much for accompanying me to the schools and helping with bringing the children and keeping them calm and entertained and for all your help in the office too. The PhD students who helped by provided initial guidance when I started: Dr Lucy Riglin, Dr Terry Ng- Knight and Dr Chris Street. A big thank you to all my friends and colleagues for their invaluable support and encouragement throughout: Terza and her parents, Nina, Celine, Matthew Jones, Eryk Walczak, Naheem Bashir, Dr Laura Speed and Dr Anthony Buhr. Finally, I would like to thank my uncle, Dr Kamal Mirawdeli and my sister, Sophia-Dila for always being there. 3 Declaration I, Avin Mirawdeli, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Avin Mirawdeli. 4 Abstract This thesis addresses the identification of children with expressive speech difficulties with a focus on stuttering. It is based on theoretical work that investigated the symptoms associated with stuttering (Howell, 2013). It also has a practical goal: The procedures that have been developed should help determine the risk of a child acquiring some form of speech difficulty. The children examined had just entered school (4-year-olds). To ensure reliable results were obtained, large, representative samples of children were required. Most of the children do not have speech difficulty. A sample of speech was obtained and analysed. The approach taken in analysis was to use an instrument that has been standardised and is currently used in research (Riley, 1994) and to apply it to the assessment of speech difficulty. Howell (2013) showed that this instrument is effective in screening for stuttering. The background to the screening work with stuttering is given in the literature review in Chapter 1. The challenges that arise when screening (a form of risk factor modelling) a real-world sample are discussed. Definitions and general features of stuttering are presented and various theories concerning how stuttering symptoms arise are reviewed. Chapters 2 to 6 report background studies, fieldwork and analyses that were conducted. Chapter 2 reports the results of a survey that was conducted to determine whether there was a need for a screening instrument and, if so, what form it should take. Chapters 3 and 4 report studies that were conducted to balance the need to keep assessments in schools short with ensuring the procedures are reliable and valid when used to identify children with speech difficulty. The assessments were based on Riley’s (1994) Stuttering Severity Instrument. Chapter 3 determined the minimum length a sample of speech needed to be and whether a spontaneous speech sample was sufficient when using Riley 5 (1994) for assessing children for speech difficulty. The Stuttering Severity Instrument has three components (percentage of syllables that are not fluent, duration of selected long stutters and a measure of physical concomitants to stuttering). Chapter 4 addressed whether all three components are required to identify children with speech difficulty, since assessing fewer components would keep the procedure simple for use in schools. Chapter 5 reports an extensive field study that used Riley (1994) for identifying children with speech difficulty. Chapter 6 examined whether adding additional symptoms to those available in the Stuttering Severity Instrument that are appropriate for other common paediatric forms of speech difficulty would enhance accuracy of screening performance. Chapter 7 summarizes the work, draws conclusions and identifies future directions this research should take. 6 CONTENTS DECLARATION 3 ABSTRACT 4 CONTENTS 6 FIGURES 12 TABLES 13 TABLE OF ABBREVIATIONS: 15 CHAPTER 1 16 LITERATURE REVIEW AND INTRODUCTION TO THE TOPIC 16 1.1 USE OF SSI-3 AS THE INSTRUMENT CHOSEN TO SCREEN CHILDREN IN THIS THESIS 20 1.2 DEMAND ON SERVICES VS. DEMAND FOR SERVICES 26 1.3 TAKING SCREENING BEYOND STUTTERING AND DEMAND FOR SERVICES 30 1.4 DEFINITIONS AND THEORIES OF STUTTERING 32 1.4.1. MODELS THAT ATTRIBUTE STUTTERING TO LANGUAGE FACTORS. 35 1.4.2. MODELS THAT ATTRIBUTE STUTTERING TO MOTOR FACTORS. 38 1.4.3. MODELS THAT PROPOSE AN INTERACTION BETWEEN MOTOR AND LANGUAGE FACTORS. 42 1.4.4. NEURO-COMPUTATIONAL MODEL OF SPEECH PRODUCTION: THE DIRECTIONS INTO VELOCITIES OF ARTICULATORS (DIVA) MODEL 47 1.5. ASSESSMENT OF STUTTERING 51 1.5.1. ASSESSMENT OF CHILDREN WHO STUTTER (CWS). 51 1.5.2. ADMINISTRATION OF SSI-3. 52 1.5.3. STUTTERING AND ADDITIONAL LANGUAGES. 56 1.6. SUMMARY 62 CHAPTER 2 64 7 A SURVEY OF UK TEACHERS’ AND SPEECH AND LANGUAGE THERAPISTS’ JOINT ROLES WITH RESPECT TO RECEPTION CLASS CHILDREN’S SPEECH LANGUAGE COMMUNICATION NEEDS 64 2.1. INTRODUCTION 64 2.1.1. SLCN AND SPEECH DIFFICULTY WHEN CHILDREN START SCHOOL 66 2.1.2. REVIEW OF WORK ON SCREENING PRE-SCHOOLERS FOR SPEECH DIFFICULTY. 67 2.1.3. DESIGN OF SURVEY FOR TEACHERS AND SLTS. 69 2.1.4. THE PRESENT STUDY. 71 2.2. METHOD 73 2.2.1. PROCEDURE. 73 2.2.2. PARTICIPANTS. 73 2.3. RESULTS 75 2.3.1. COMMUNICATIONS BETWEEN TEACHERS AND SLTS ABOUT CHILDREN WITH SPEECH DIFFICULTIES SUBSEQUENT TO INTERVENTION. 75 2.3.2. RESOURCES AVAILABLE FOR IDENTIFYING SLCN IN GENERAL AND SPEECH DIFFICULTY IN PARTICULAR. 79 2.3.3. AWARENESS OF POTENTIAL RISKS INVOLVED WHEN IDENTIFYING SPEECH DIFFICULTIES. 82 2.3.4. ROLE OF AN IDENTIFICATION PROCEDURE FOR SPEECH DIFFICULTY. 83 2.3.5. SPECIFIC INFORMATION SOLICITED ABOUT A SPEECH ASSESSMENT PROCEDURE FOR USE IN SCHOOLS. 84 2.3.6. PROVISION FOR LANGUAGE IN GENERAL AND SPEECH DIFFICULTY IN PARTICULAR FOR CHILDREN WITH EAL IN COMPARISON WITH PROVISION FOR CHILDREN WHOSE FIRST LANGUAGE IS ENGLISH. 90 2.4. DISCUSSION 93 2.4.1. COMMUNICATIONS BETWEEN TEACHERS AND SLTS ABOUT CHILDREN WITH SPEECH DIFFICULTIES SUBSEQUENT TO INTERVENTION. 94 2.4.2. RESOURCES AVAILABLE FOR IDENTIFYING SLCN IN GENERAL AND SPEECH DIFFICULTY IN PARTICULAR. 95 2.4.3. AWARENESS OF POTENTIAL RISKS INVOLVED IN IDENTIFYING SPEECH DIFFICULTY. 99 2.4.4. REFERRAL FOR SPEECH DIFFICULTY. 99 2.4.5. FORM OF SPEECH ASSESSMENT IN SCHOOLS. 100 2.4.6. PROVISION OF RESOURCES FOR LANGUAGE IN GENERAL AND SPEECH IN PARTICULAR THAT ARE APPROPRIATE FOR CHILDREN WITH ENGLISH AS THEIR FIRST LANGUAGE AND CHILDREN WITH EAL. 104 2.5. SUMMARY, LIMITATIONS AND FUTURE WORK 106 CHAPTER 3 108 8 LENGTH AND TYPE OF RECORDING 108 3.1 STANDARDIZATION OF THE SSI-3 109 3.2 PROCEDURAL CHANGES IN THE SSI-4 113 3.3 RESEARCH QUESTIONS 115 3.4. METHODS 116 3.4.1. PARTICIPANTS. 116 3.4.2. RECORDINGS. 117 3.4.3. ANNOTATIONS OF THE SPEECH SAMPLES. 117 3.4.4. ADMINISTRATION OF SSI-3. 118 3.4.5. PROCEDURE. 118 3.4.6. ANALYSES. 119 3.5. RESULTS 119 3.5.1. SAMPLE LENGTH FOR THE YOUNGER AGE GROUP. 119 3.5.2. SAMPLE LENGTH AND TEST FORM (READER/NON-READER) FOR THE OLDER AGE GROUP. 121 3.6. DISCUSSION 123 3.6.1. THE AGE EFFECT AND THE LENGTH OF THE SPEECH SAMPLES. 124 3.6.2. READER, NON-READER PROCEDURES. 125 3.6.3. LIMITATIONS. 126 3.6.4. CONCLUSION. 126 CHAPTER 4 128 IS IT NECESSARY TO ASSESS FLUENT SYMPTOMS, DURATION OF DISFLUENT EVENTS AND PHYSICAL CONCOMITANTS WHEN IDENTIFYING CHILDREN WHO ARE AT RISK OF SPEECH DIFFICULTY? 128 4.1. INTRODUCTION 128 4.1.1. EVALUATION OF RILEY’S STUTTERING SEVERITY INSTRUMENT 130 4.1.2. COMBINING THE THREE COMPONENTS: CHECKS OF COMPONENT DISTRIBUTIONS AND TRANSFORMATIONS OF SCORES.
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