If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Welcome to Allied Health Telehealth Virtual Education “Persistent Speech Sound Disorder” –the inpatient management of adolescent eating disorders Bronwyn Carrigg Speech Pathologist Sydney Children’s Hospitals Network, Randwick Please complete your online evaluation at https://www.surveymonkey.com/r/PersistentSpeechSD Persistent Speech Sound Disorder: Bronwyn Carrigg Speech Pathology Department Sydney Children’s Hospital Network, Randwick [email protected] Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 1 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Speech Sound Disorder (SSD) • Speech errors due to: ‐ structural or motor constraints ‐ cognitive‐linguistic constraints (Stein et al., 2011) • Maybe of known or unknown origin: ‐ broad definition = known & unknown origin (Shriberg, 2010; ASHA) ‐ narrow definition = unknown origin (DSM‐5, 2013) • Persistent SSD has no universally agreed cut‐off. Most agree speech errors > 8‐9 years of age (Shriberg, 2010; Wren..2012) Prevalence of SSD unknown origin: • 15.6% of 3‐year‐olds (Campbell et al., 2003) • 3.8% of 6‐year‐olds (Shriberg et al., 1999) • 3.4% of 4‐year‐olds (Eadie et al., 2015) Prevalence of Persistent SSD: known & unknown • 3.6% of 8‐year‐olds (‐1.2SD < mean) (Wren et al., 2012) • 3.0% of 8‐year‐olds (‐2SD < mean) (Wren et al., 2009) Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 2 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Speech Sound Disorder Classification • SSD is heterogeneous • Heterogeneity led to subtyping • No universally accepted classification framework. (e.g., Broomfield & Dodd, 2004; Stackhouse & Wells, 1997; Shriberg et al., 2010) Speech Disorders Classification System (SDCS) • Most comprehensively researched classification system • Work of Shriberg and colleagues (e.g., Shriberg et al., 2010) • Relates to SSD of unknown origin (currently unknown) • Persistent SSD is explicitly addressed. Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 3 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Speech Disorders Classification System – Typology (1) (2) (3) Speech Delay Motor Speech Disorder Speech Errors multiple multiple errors limited to substitutions &/ substitutions common clinical omissions omissions & distortions (r, lisp) distortions applies from 6 yrs includes CAS & dysarthria minus frank neurological abnormality (Shriberg et al., 2010) Speech Disorders Classification System – Typology Persistent Speech Disorder (PSD) –errors > 9 years (1) (2) (3) PSD‐Speech Delay PSD‐Motor Speech Disorder PSD‐Speech Errors *based on current and/or prior speech error patterns *suffix denotes the historical SSD subtype (Shriberg et al., 2010) Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 4 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Speech Disorders Classification System (Shriberg et al., 2010) Persistent SSD Research: Challenges • Focus is on early childhood SSD • More on persistent SSD of known than unknown origin • Persistent SSD of unknown origin: ‐ focus on residual common distortions ‐ failure to classify SSD → group heterogeneity ‐ range of study types → Ax, Rx, specific focus ‐ lack of comprehensive assessment Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 5 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Persistent SSD: Sources of information • Early childhood SSD follow up studies; SSD usually resolved (e.g., Lewis.. 2015) • Single cases with persistent SSD (e.g., Stackhouse et al., 1992; Zaretsky et al., 2010) • Small group studies of persistent SSD (Lewis et al., 2004; Kenny et al., 2006; Redle 2015) • One large, prospective population study (Wren et al., 2012) • Genetics cases ‐ typically syndromal ‐ some primarily speech Persistent SSD: Speech Characteristics Most published cases of PSD with multiple‐sound errors describe: • current/historical SSD in severe to profound range (e.g., Speake et al., 2012) • CAS/CAS‐like symptoms frequent (e.g., Lewis et al., 2004b; Zaretsky et al., 2010). • Lack of subtyping & diagnostic reliability • Comorbid dysarthria mod frequent in genetic cases (e.g., Fedorenko et al., 2015) • Comorbid dysarthria rare in cases w/out genetic studies (e.g., Zaretsky et al., 2010) • Orofacial praxis identified in some cases (where Ax’d) (Vargha‐Khadem.. 1995) Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 6 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Persistent SSD: Speech Characteristics n Age Diagnosis Study 28 ‐10 years CAS Snowling et al., 1983 210 years CAS Stackhouse et al., 1992* 111 years CAS Zaretsky et al., 2010 210 years ‘PSD’ Speake et al., 2012* 122 years CAS Carrigg et al., 2015* 10 8 – 11 years CAS Lewis et al., 2004 CAS = Childhood Apraxia of Speech (aka dyspraxia); * = contains speech data Persistent SSD Case: BJ aged 22 years “My speech is severely affected by my disorder. I am unable to communicate verbally with most people because my speech contains many sounds errors and is severely unintelligible. I am only able to talk to my family, but even that is difficult because I cannot say many words and I often struggle to get my message across. I don’t think most people understand the amount of effort I have to put in just to say a few words”. Email to SP aged 22.6 years (Carrigg et al., 2015., p.41) Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 7 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Persistent SSD: Speech Characteristics • Vowel distortions (Ballard et al., 2010; Carrigg et al.,, 2015; Speake et al., 2012; Zaretsky et al., 2010; McCormack et al., 2012; :Lewis et al., 2004) • Consonant distortions (Ballard et al., 2010; Carrigg et al., 2015; Zaretsky et al., 2010; Speake et al., 2012; McCormack et al., 2012) • Consonant substitutions: fronting, voicing (Lewis et al., 2004; Kenny et al., 2006; Carrigg et al., 2015) • Consonant deletions: initial consonant deletion, cluster reduction (Lewis et al., 2004; Kenny et al., 2006; Carrigg et al., 2015) • Multisyllabic words (Carrigg et al., 2015; Stackhouse et al., 1992; Lewis et al., 2004) • Prosody (Ballard et al., 2010; Carrigg et al., 2015) Persistent SSD: Language & Literacy Characteristics • Not always assessed (or partially assessed) • Impaired expressive language, literacy, &/phonological processing (e.g., Lewis et al., 2004b; Speake et al., 2012; Zaretsky et al., 2010) • Receptive language variable (e.g., Lewis et al., 2004; Stackhouse, 1992) • Receptive language > expressive language often reported Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 8 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Persistent SSD: Fine & Gross Limb Motor • Systematic assessment is rare • Limb motor difficulties frequently been noted/queried (e.g., Lewis et al., 2004b; Stackhouse & Snowling, 1992b; Zaretsky et al., 2010). Persistent SSD: Educational/Vocational Outcomes • Little research for persistent SSD • All single cases had formal learning support throughout school • Longitudinal studies of early childhood speech & language impairment: ‐ more learning support ‐ fewer years formal education ‐ less skilled occupations ‐ rate of employment did not differ (Felsenfeld et al., 1994; Johnson et al., 2010) Please complete your online evaluation at ttps://www.surveymonkey.com/r/PersistentSpeechSD 9 If you experience connection problems 10 minutes prior to or during the session, please 27/06/2016 phone the HNE Telehealth Help Desk on 02 4985 5400 and select option 1 Persistent SSD: Socio‐emotional Outcomes • Little on persistent SSD • Single cases: ‐ bullying, struggle to communicate (Carrigg et al., 2015; McCormack… 2012) ‐ crippling social anxiety disorder, depression (Carrigg et al., 2015) • Longitudinal studies: early childhood speech and language impairment ‐ significantly higher rates of anxiety disorder (Beitchman et al., 2001) ‐ no differences on subjective quality of life ratings (Felsenfeld et al., 1994) ‐ no differences on rates of marriage/living with partner (Johnson et 2010) Persistent SSD Case: BJ aged 22 years “My communication disorder has had a significant and profound impact on my life. It has affected my ability to interact with the people around me, my education, and my mental