Doctor of Philosophy, Case Western Reserve University, 2022, Communication Sciences

Childhood Apraxia of Speech (CAS) is a developmental speech sound disorder (SSD) notable for its severity and persistence of speech difficulties. A debate has surfaced historically about the cause of the speech and language deficits observed in the disorder. As children with CAS often present with comorbid language problems (i.e., receptive and expressive), learning disabilities (i.e., reading and spelling), and fine and gross motor difficulties, any conceptualization of the disorder should include an accounting of the multiple domains affected. However, CAS has been primarily viewed as a motor-speech disorder affecting speech production with consequences for expressive language. While there is extensive research about the association between an early diagnosis of other idiopathic SSD and poorer literacy outcomes, there is limited research investigating this same association for CAS. Given the increased risk of reading disorder (RD) with other idiopathic SSD, a better understanding of this association for CAS is crucial for children with this diagnosis. This dissertation research investigated literacy and literacy-related skills in a group of children with an early diagnosis of CAS (n = 16), ranging in age from 8 to 14 years. Comparisons were made with a group of children in a similar age range with a diagnosis of reading disorder without any history of SSD (RD-no SSD, n = 16). Results suggest that many children with an early diagnosis of CAS share the same degree of difficulty with word-level decoding as those diagnosed with RD-no SSD. In contrast, the two groups' phonological processing abilities were significantly different. The CAS group scored below the normative mean for phonological awareness and phonological memory, and the RD-no SSD group obtained mean scores within the average range. Additionally, subgroups were identified within the CAS participant group by average and below-average word-level decoding fluency. Below-average decoding fluency was associa (open full item for complete abstract)

Committee: Barbara Lewis (Committee Chair) Subjects: Language; Reading Instruction; Speech Therapy

Master of Arts, Miami University, 2021, Speech Pathology and Audiology

Thousands of technological apps have emerged in the past decade. Little research has been done to examine how apps are used by speech-language pathologists (SLPs), their effectiveness, and feelings regarding their use. SLPs must consider current research as a principle of evidenced-based practice when integrating technology into speech and language service delivery. The current study investigates SLPs pattern of app use and feelings towards their use in a school setting. This study aims to uncover correlations between app use and these feelings, as well as considerations made by SLPs prior to implementing apps in their sessions. A survey was distributed to school-based SLPs in Ohio, yielding 69 valid responses. Results showed 77% of SLPs reported using apps in their treatment sessions. SLPs reported generally positive feelings regarding the use of apps. SLPs considered factors such as age, cognitive ability, and disorder of the students with whom they are using apps. For the SLPs who reported not using apps, the most common reasons were personal preference and price. Results of this study carry clinical implications for evidence-based practice as the age of technology continues to develop. These results warrant future research on the efficacy and effectiveness of apps in school settings.

Committee: Arnold Olszewski Ph.D., CCC-SLP (Advisor); Amber Franklin Ph.D., CCC-SLP (Committee Member); Gerard Poll Ph.D., CCC-SLP (Committee Member) Subjects: Speech Therapy

Master of Arts, Case Western Reserve University, 2020, Communication Sciences

Purpose: The primary aims of this study were to examine narrative skills in children with childhood apraxia of speech (CAS) compared to children with speech sound disorder with and without language impairment (SSD+LI, SSD-only). Method: Participants were preschool-aged children with diagnosed CAS, SSD-only, and SSD+LI. Diagnoses were confirmed by a certified speech-language pathologist with standardized speech and language testing. Participants completed narrative retell task with the Fox and Bear story. Performance in narrative microstructure, macrostructure and comprehension were compared with analysis of variance between the three groups. Results: Participants with CAS told narratives that contained fewer story sequence items, and limited vocabulary. Analysis revealed slight differences in expressive language skills between participants with CAS and SSD+LI. Conclusions: Children with CAS experience deficits in later literacy predictors. Intervention for children with CAS should focus expressive language skills, in addition to speech sound production.

Committee: Lewis Barbara PhD (Committee Chair); Mental Rebecca CCC-SLP, PhD. (Committee Member); Short Elizabeth PhD (Committee Member) Subjects: Early Childhood Education; Language; Literacy; Speech Therapy

Master of Sciences, Case Western Reserve University, 2012, Epidemiology and Biostatistics

Speech Sound Disorders are the most common speech problems among children. However, there is little information about long-term effects of this disorder. Speech Sound Disorder can be determined through a combination of articulation and phonological processing tests. Although there are well agreed upon cut-off points for articulation measures, there are not appropriate cut-off points for phonological processing measures in order to determine if an individual has Speech Sound Disorder later in life. Because of this gap of information, this study set forth to develop appropriate cut-off points for phonological processing measures that can be used for all ages. The study then examined what childhood tests relate to Persistent Speech Sound Disorder and finally what social outcomes later in life are associated with Residual Speech Errors. Persistent Speech Sound Disorder was found to be related to cognitive functioning while Residual Speech Errors were found to be significantly associated with Childhood Depression.

Committee: Catherine Stein PhD (Committee Chair); Elaine Borawski PhD (Committee Member); Erika Trapl PhD (Committee Member) Subjects: Behavioral Sciences; Communication; Epidemiology

Master of Arts, Case Western Reserve University, 2008, Communication Sciences

The purpose of this study was to characterize articulation errors of children with Childhood Apraxia of Speech (CAS) by type and position within the syllable. Errors made by children with CAS were compared against errors of peers with isolated, non-apraxic speech sound disorders (SSD) and combined speech and language disorder (SL) at preschool- and school-age. Results suggested that CAS was different from the other disorders with different profiles at the two ages. Between-group comparisons at same-age stages showed that a) preschool-aged children with CAS made more substitutions of onset consonants than comparison groups and b) school-aged children with CAS made more omissions of coda consonants than comparison groups. A subset of children with CAS was followed longitudinally. Results suggested that speech improved from preschool- to school-age, with substitutions decreasing and the percentage of consonants correct increasing. Despite improvement, coda omission appeared to be a salient characteristic of CAS at school-age.

Committee: Patrizia Bonaventura PhD (Committee Chair); Angela Ciccia PhD (Committee Member); Stacy Williams PhD (Committee Member); Barbara Lewis PhD (Committee Member); Lisa Freebairn MA (Committee Member) Subjects: Communication; Linguistics; Speech Therapy

PhD, University of Cincinnati, 2024, Allied Health Sciences: Communication Sciences and Disorders

Speech-language pathologists (SLPs) encounter challenges when assessing speech sound disorders (SSDs) in multilingual children, particularly with Arabic-speaking children in majority English-speaking nations, where distinguishing communication differences from disorders is vital. The global increase in Arabic speakers, especially in countries like the United States of America and Canada, underscores the need for culturally sensitive tools to diagnose SSDs effectively across diverse linguistic backgrounds, including Saudi Arabic and English. This dissertation addresses this necessity through two studies, focusing on innovative approaches to characterize the speech productions of Saudi Arabian children. Study one examines functional speech intelligibility, showcasing the psychometric properties of a screening tool and its cultural and linguistic sensitivity to Saudi Arabic dialects. Study two investigates voice onset time (VOT) development in typically developing bilingual children, with a focus on the /t/-/k/ contrast, revealing differences in VOT values and variability in English and Saudi Arabic. Study two also delves into VOT patterns in bilingual children with and without SSDs, shedding light on developmental speech patterns and offering culturally responsive assessment methods for clinicians and researchers. These findings contribute significantly to enhancing the understanding of speech productions and VOT patterns in bilingual children, facilitating improved speech diagnostic assessment and the development of normative data in this understudied bilingual population.

Committee: Jennifer Vannest Ph.D. (Committee Chair); Karla Washington Ph.D. (Committee Member); Reem Khamis-Dakwar Ph.D M.A B.A. (Committee Member); Suzanne Boyce Ph.D. (Committee Member); Victoria McKenna Ph.D. (Committee Member); Amy Pratt Ph.D. (Committee Member) Subjects: Health Sciences

PhD, University of Cincinnati, 2021, Allied Health Sciences: Communication Sciences and Disorders

In typical child and adult speakers, speech generation requires coordinated activation of a network of inferior frontal, temporal, and subcortical brain regions to carry out multiple linguistic and speech motor processes. However, a portion of children who exhibit speech sound errors in development persist in these errors beyond age 9, which can lead to broader, long-term consequences in scholastic achievement, literacy, and social-emotional well-being. The goal of this project was to investigate the neural underpinnings of residual speech sound disorder (RSSD) and its remediation through a speech therapy program. In Study 1, I investigated the neural activity of children with RSSD in comparison to children with typically-developing speech (TD) at baseline (Time 1). I had anticipated to observe significant differences between RSSD and TD groups. However, in a whole-brain analysis (at p<0.05 and with Bonferroni corrections for multiple comparisons), I did not observe statistically significant differences in activation on either the SRT-Early Sounds or SRT-Late Sounds. In Study 2, I followed up with a region-of-interest approach of activation at Time 1 and Time 2. I did not detect any significant differences across task, group, or time comparisons. While this finding was not expected, it implies that, when task performance is similar, children with RSSD do not show differences in neural activity from their typical peers. I also explored the relationship between change in activation and progress in therapy. I found that children with RSSD who made more progress in therapy tended to show a decrease in activation in the left visual association cortex on the SRT-Late Sounds (R2=0.78). The left visual association cortex is not a core component of the speech production network but may indicate differences in the children's reliance on sensorimotor integration or internal speech visualization processes. Using a seed-to-voxel approach, I also explored function (open full item for complete abstract)

Committee: Suzanne Boyce Ph.D. (Committee Chair); Edwin Maas Ph.D. (Committee Member); Jonathan Preston Ph.D. (Committee Member); Erin Redle Ph.D. (Committee Member); Jennifer Vannest Ph.D. (Committee Member) Subjects: Speech Therapy

Doctor of Philosophy, Case Western Reserve University, 2019, Communication Sciences

The purpose of this study was to identify and assess a group of ambiguous language stimuli suitable for use in assessments and therapeutic interventions for students who with Language Disorder (LD). Existing standardized tests allow practitioners to assess whether students can identify when certain kinds of ambiguous language are being used. The current study seeks to create a new test, the Ambiguous Language Test (ALT), which will dive deeper into the study of ambiguous language, to investigate the degree to which students can interpret and understand ambiguity. In order to develop these materials, first a baseline understanding of how students who are typically developing (TD) can perform on the task of defining ambiguous words and phrases must be established. The study was therefore conducted in three phases. Phase One tested a large number of stimuli across the areas of multiple meaning words, metaphors, oxymorons, and paradoxes with students who are TD between the ages of 12 and 14 years. Stimuli were analyzed using the difficulty index, discrimination index, and Cronbach's alpha in order to develop a fuller understanding of words and phrases that would be suitable for more in-depth testing. In Phase Two, a narrower list of words and phrases, selected on the basis of results from Phase One, were presented to a different group of students who are TD, with a wider age range (9-15 years). These stimuli were analyzed using the difficulty index and discrimination index to verify results from Phase One and in order for the ALT to progress to the third and final development phase. Finally, Phase Three draws on the results of both earlier phases to present the test with a full range of difficulty levels, according to the difficulty index, to a group of students with LD, ages 9-15 and a group of students who are TD, ages 9-15. These test results were analyzed again using the difficulty index and discrimination index to verify previous test results. Finally, the Mann W (open full item for complete abstract)

Committee: Angela Ciccia Ph.D. (Committee Chair); Barbara Lewis Ph.D. (Committee Member); Elizabeth Short Ph.D. (Committee Member); Vera Tobin Ph.D. (Committee Member) Subjects: Speech Therapy

Master of Arts, The Ohio State University, 2018, Speech and Hearing Science

Context: Guidelines for best practice for speech and language interventions for minimally verbal preschoolers diagnosed with ASD have not been well established. Objective: To systematically review and analyze the current evidence on AAC and preschoolers with ASD through a hypothetical case study and a systematic review. Data Sources: A systematic review of English language articles using EBSCOhost databases from (2000-2018). Databases included Academic Search Complete, Academic Search Premier, CINAHL Plus with Full Text, ERIC, Health Source: Consumer Edition, Health Source Nursing/Academic Edition, MEDLINE with Full Text, and PsychINFO and were limited to peer-reviewed scholarly publications. Additional studies were identified by hand searching the bibliographies of literature reviews and studies found from the search. Search terms included alternative and augmentative communication or AAC, early intervention” and “autism spectrum disorders or autism or ASD”. Study Selection: Selection included only experimental designs and systematic reviews of moderate to high quality as designated by SCED, PEDRO or PRISMA ratings. Meta-analysis included only single case experimental designs that equivalently compared more than one mode of communication. Data Extraction: The author extracted raw data by modality from the results of the 10 comparison studies and used the TAU-U measure of effect size to meta-analyze the data and identify the most effective modalities. Data Synthesis: Data from the comparison studies indicated high moderate size for the picture exchange communication system Tau = 0.78 [90% CI:0.51, 1.0], high moderate for other picture-based communication modes Tau = 0.77 [90% CI: 0.58, 0.95], moderate for speech generating devices Tau= 0.72 [90% CI: 0.57, 0.84], and very low for manual sign Tau = 0.40 [90% CI: 0.24, 0.65] Conclusions: The evidence reviewed here indicates the best chances of finding a system of functional communication for preschoolers with ASD is to (open full item for complete abstract)

Committee: Rebecca McCauley (Advisor); Amy Sonntag (Committee Member) Subjects: Behavioral Sciences; Education; Speech Therapy

Doctor of Philosophy, Case Western Reserve University, 2018, Communication Sciences

Purpose: Although most children with speech sound disorders are able to remediate their errors, some individuals have errors that persist into late childhood and even adulthood. These individuals are considered to have residual speech sound errors (RSSEs), and they are at risk for social, academic, and employment difficulties. Most individuals with RSSEs have participated in years of traditional speech therapy with little success. Visual biofeedback provides an alternative method of treatment that may be what finally allows these individuals to remediate their errors. This study utilized Opti-Speech, a visual biofeedback software that uses electromagnetic articulography to create a threedimensional rendering of the tongue that moves in real time with the participant's own tongue, for the remediation of RSSEs. Method: This single subject multiple baseline design included 18 participants (11 males and 7 females) who ranged from 8 -22 years of age. Speech sounds addressed in treatment included "r", "s", "sh", "ch", and "l". Participants attended an average of three baseline sessions and ten treatment sessions that utilized Opti-Speech visual biofeedback, and returned for a two-month follow-up. Results: Perceptual measures were based on generalization to untreated words. Eleven of the 18 participants were able to make clinically significant improvements for their target sound by their final treatment session, and 11 of 16 participants who returned for follow19 up measures had made clinically significant improvement on their target sound. When final session perceptual ratings were compared to follow-up, eight of the nine participants who presented with clinically significant improvement for their target sound were able to maintain their progress or presented with significantly improved speech sound skills. However, generalization was not seen at the sentence level. When considered as a group, clinically significant improvements were seen overal (open full item for complete abstract)

Committee: Jennell Vick Ph.D. (Committee Chair); Barbara Lewis Ph.D. (Committee Member); Elizabeth Short Ph.D. (Committee Member); Gregory Lee Ph.D. (Committee Member); Parrill Fey Ph.D. (Committee Member) Subjects: Speech Therapy

Master of Arts in Speech Pathology and Audiology, Cleveland State University, 2015, College of Sciences and Health Professions

The purpose of this study was to document the communicative behaviors exhibited by sibling dyads comprised of one typically developing child (TDC) and their sibling diagnosed with autism spectrum disorder (SibA). Six families (five families were Caucasian and one family was African American) participated in one 45-minute home observation, one semi-structured interview with the TDCs, and one semi-structured interview with the parents. Sibling dyads varied across birth order, ages, and genders. Observations revealed that the sibling dyads produced a variety of communicative behaviors. Observational data were coded to provide information on the types of communicative behaviors produced and their frequency of occurrence. Data were analyzed to reveal the types of communicative behaviors that both the TDCs and the SibAs produced, as well as the types of communicative behaviors produced only by the TDCs and only by the SibAs. The TDCs provided relevant answers to semi-structured interview questions about their interactions with their SibAs, and the parents provided relevant answers to semi-structured interview questions about their children's relationships. Four out of the six families provided strong evidence that suggested the possibility of sibling-mediated interventions for children with autism spectrum disorder. Two out of the six families provided some evidence that suggested the possibility of sibling-mediated interventions for children with autism spectrum disorder.

Committee: Monica Gordon Pershey Ed.D. (Advisor); Myrita Wilhite Au.D., CCC-A (Committee Member); Colleen Walsh Ph.D. (Committee Member) Subjects: Speech Therapy

Doctor of Philosophy, The Ohio State University, 2012, Speech and Hearing Science

Considerable evidence has shown that kindergarten measures of phonological awareness and alphabet knowledge are significant predictors of word decoding ability in many typically developing children. Many children with speech sound disorder (SSD) have been found to exhibit poor phonological awareness; however, very few studies have provided a thorough investigation of their knowledge about letter names and letter sounds. The current study was thus designed to examine alphabet knowledge and phonological awareness, and their relationships, in kindergarten children with SSD (n = 16). Alphabet knowledge was assessed by comparing accuracy in naming of all 26 letter names and letter sounds, and was further evaluated to determine differences as a function of letter name category. Two levels of phonological awareness on an elision task (larger vs. smaller units) were compared. Finally, correlations between alphabet knowledge and phonological awareness levels were calculated. Overall, participants knew more letter names than letter sounds, and their letter sound knowledge varied according to letter name categories. Participants exhibited greater accuracy when deleting larger sized units, as compared to smaller units. Furthermore, children whose speech errors were atypical or severely delayed for their age had the lowest scores on the elision task, but performed as well as others on both measures of alphabet knowledge. Outcomes from this study suggest that some children with isolated SSD would have acquired knowledge about letter names and sounds in their kindergarten year, but may encounter difficulty in developing deeper levels of phonological awareness.

Committee: Rebecca McCauley PhD (Committee Chair); Laura Justice PhD (Committee Member); Monique Mills PhD (Committee Member); Shayne Piasta PhD (Committee Member) Subjects: Early Childhood Education; Speech Therapy

Specialist in Education, Miami University, 2008, Educational Psychology

The purpose of this study was to ascertain the effectiveness of using the Kurzweil 3000 software as part of a reading program to improve oral reading fluency and comprehension of third and fourth grade students demonstrating attention and reading difficulties. Two third and two fourth grade students participated in using Kurzweil 3000 while reading expository and narrative text. Short duration tests of proficiency in areas of oral reading fluency were used to monitor progress using an A-B accountability design. Generalization measures were assessed including maze passages, comprehension questions, formal observations and a prosody scale as pretest/posttest indicators. In addition, a measure of attention was used to determine each subject's executive function skills. Students involved in the study significantly increased their reading speed and experienced various levels of success in improving their ability to comprehend text.

Committee: Doris Bergen (Advisor) Subjects: Education, Educational Psychology

Master of Arts, Miami University, 2007, Speech Pathology and Audiology

The purpose of this study was to obtain information on parent perspectives on the speech and language services their children with autism receive in schools. Fifty-five parents of children with autism spectrum disorder completed a survey containing items concerning parental feelings regarding therapy options, IEP meetings, and speech-language pathologist (SLP) behaviors. Results suggested parents are satisfied with the speech and language services provided to their children with autism in five public school districts in southeastern Ohio. Results indicated significant correlation between parent feelings toward therapy and attitudes toward SLP attributes as well as between parent feelings toward IEP meetings and attitudes toward SLP attributes. Limitations of the study, future research, and clinical implications are discussed.

Committee: Laura Kelly (Advisor) Subjects: Health Sciences, Speech Pathology

Doctor of Philosophy, Case Western Reserve University, 2007, Epidemiology and Biostatistics

This dissertation focuses on approaches to the genetic analysis of longitudinal measures of developmental disorders (DD) with specific application to a longitudinal pedigree study of children ascertained on the basis of a Speech Sound Disorder (SSD). Analysis of this longitudinal cohort is complicated by non-normal trait distributions and a potentially non-linear cognitive developmental trajectory. Prior to developing a longitudinal model I measured the power of the SSD dataset to correctly detect linkage of a quantitative trait to a genetic marker. Assuming that the function describing the genetic effect across time is correctly specified the power of the SSD data set is .18 at a .01 level of signficance. Additional data collection is planned and by doubling the sample size (from 200 to 400 sibling pairs) and number of measurement points (from 2 to 4) the power increases to .83 for the same significance level. It is therefore reasonable to develop a longitudinal approach for use at a later date. As an alternative to the longitudinal analysis, multivariate dependence functions, called copulas, are used to develop a cross-sectional model to test for polygenic*age interaction. These functions separate a multivariate joint distribution into two parts: one describing the interdependency of the probabilities (correlation), the other describing the distribution of the margins (the phenotypes). Using these functions for analysis simultaneously addresses both the non-normality problem, as the margins can be modeled with a wide variety of parametric probability distributions and the developmental trajectory question, as we incorporate age into the analysis through the use of a correlation function, the parameter estimate of which can be tested for significance using a chi-square test statistic. Four of the 13 SSD test measures showed nominal p-values less than .05. While at the broadest level the 4 tests measure different cognitive skills, short term memory plays an importan (open full item for complete abstract)

Committee: Sudha Iyengar (Advisor) Subjects: Statistics