Running Head: RECORDING INTELLIGIBILITY FOR ADOLESCENTS WITH PSSD
The Efficacy of Recording to Gain Perception on Intelligibility for Adolescents with Persistent
Speech Sound Disorder: A Research Proposal
Cynthia Rosas
California State University, Fresno
Dr. Findley
CSDS 200
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RECORDING INTELLIGIBILITY FOR ADOLESCENTS WITH PSSD
Abstract
With a variety of methods to help adolescents who have persistent speech sound disorders
(SSD); however, a method that has not been introduced is gaining perception. Gaining
perception can be a crucial part of the session as this could help adolescents identify their
intelligibility to improve their speech. This paper proposes a study to compare the efficacy of
adolescents recording their speech during treatment and adolescents who are offered normal
speech services. A quantitative, quasi-experimental non-equivalent control group design would
be presented in this study. There would be an estimate of 50 participants. Based on the data
collected and analyzed during the study, the conclusion will be made by comparing the efficacy
of adolescents recording their speech and adolescents who are offered normal speech services.
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RECORDING INTELLIGIBILITY FOR ADOLESCENTS WITH PSSD
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The Efficacy of Recording to Gain Perception on Intelligibility for Adolescents with Persistent
Speech Sound Disorder: A Research Proposal
Introduction
Persistent Speech Sound Disorders (Persistent SSD) are “speech sound errors that persist
beyond the age at which typically developing children have acquired the adult speech sound
system, usually by 8 and 9 years of age” (NCBI, 2015, para 4). There are no biological markers
for the diagnosis of persistent SSD, which makes diagnosing and determining the prevalence of
the disorder difficult for Speech-Language Pathologists (SLPs) and researchers. The prevalence
differs with each person who has persistent SSD based by age, gender, and severity of the
disorder (NCBI, 2015). In addition, studies show “rates of persistent SSD decline with age,
occurring in only an estimated 1.4% of college freshmen” (NCBI, 2015, para 4). Although the
rate of Persistent SSD declines in age there are still those with unresolved speech errors, SLPs
should continue to provide intervention services to this population.
SLPs have a critical role in the treatment and evaluation of adolescents with persistent
SSD as intelligibility is one of the main factors to use to communicate with others. SLPs can help
target these unlearned speech errors that an adolescent has based on age and severity. In addition,
SLPs can determine whether the disorder is giving a negative impact on the child’s educational
and social impact (Krueger, 2019).
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Problem Statement
Although there is research based on children with persistent SSD, there is a lack of
research based on adolescents. In addition, adolescents not having good perception of their
intelligibility as they do not know whether they are producing the correct sounds, they continue
to talk as though they have “normal” speech. Another term for gaining perception would be
speech perception, which is defined as “the process by which the sounds of language are heard,
interpreted, and understood” (Wikipedia, para 1). Speech perception would be one of the
important factors as it would help the communication partner understand what the adolescent is
saying.
Previous studies have shown that 86.7% of the children who have persistent SSD have
shown difficulties with speech perception (Hearnshaw, Baker, & Munro, 2019). It is
demonstrated that the relationship between speech perception and production for children with
SSDs is that impaired speech perception can lead to impaired speech production (Hearnshaw, et
al., 2019). With current research showing the importance of speech perception, conducting a
study that focuses on adolescents recording themselves to give an understanding of current
speech and how they can improve themselves.
Literature Review
Persistent SSD Treated in Speech Therapy
Research on SSD treated in Speech Therapy using ultrasound visual biofeedback. A
(2019) systematic review by Sugden, Lloyd, Lam, & Cleland discovered the positive impact of
the use of ultrasound visual biofeedback (U-VBF); however, most studies used small sample
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sizes and lower strength designs. In addition, current evidence implies that U-VBF may be an
effective method for future interventions for individuals with persistent SSD despite having
previous interventions. This indicates that there is a need for more research on giving U-VBF as
this could help future treatment for individuals with persistent SSD.
A case series study was conducted to investigate the U-VBF treatment using the motorbased approach to teach new articulations for 20 children aged 6-15 with a range of mild-severe
variety of SSDs (Cleland, Scobbie, Roxburgh, Heyde, & Wrench, 2019). After the following
assessment, 5 children were excluded, and 3 had rising baselines which would indicate a difficult
time for researchers to find an improvement in this study. One withdrew midway through the
treatment and the final one had a cluster reduction (which the researchers noted that they were
only treating systemic errors). Three baseline probes with untreated wordlists were given to each
child in the first 3 weeks. After the three baselines, the researchers then “used an ultrasound
system in which the probe is stabilized with a headset” (Cleland & et al., 2019). Which allows “a
straightforward analysis of tongue shape, location, and movements both for real-time diagnostic
purposes” (Cleland & et al., 2019). The ultrasound data that the researchers used was an
Ultrasonix SonixRP machine that remotely controls the Ethernet from a PC running the
Articulate Assistant Advanced software. The intervention was then conducted with 10-12 onehour weekly mixed-content therapy sessions from weeks 4-15. 30 minutes are utilized with the
U-VBF and 30 minutes doing other activities and talking to parents/guardians about their child’s
progress. The results show that U-VBF gave a positive impact on all participants; however, a
challenge that the researchers faced was that a few children were not able to respond to the
untreated words. As well as a few limitations of children having to travel long distances and/or
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often leaving school early made it not possible for researchers to provide more baselines. This
led to difficulties in children also not arriving for a follow-up.
Treating SSD with common procedures. A longitudinal study was conducted to
investigate how to measure changes in speech output in children with severe and persisting
speech difficulties (SPSD) (Newbold, Stackhouse, & Wells, 2013). By “comparing a variety of
commonly used procedures for perceptual phonological and phonetic analysis of developmental
speech difficulties” (Newbold & et al., 2013). How the researchers measured the speech output
was including the percentage of whole words correct (PWC), percentage of consonants correct
(PCC), the proportion of whole-word proximity (PWP), phonological pattern (process) analysis,
and phonetic inventory analysis. Then comparing these measurements based on the track of
normalization between the children’s speech and their same age and language group peers
(Newbold & et al., 2013). In addition to comparing the children’s speech performance at
different times to a baseline of their speech production (Newbold & et al., 2013). There were
only four participants in this study between the ages of 4-5 years. Each participant was tasked to
do picture naming, real word repetition, non-word repetition, and transcription of 10 consecutive
connected speech utterances in conversation or during picture description. The results were that 3
out of the 4 participants improved significantly in picture naming when measuring the PWC. For
PWP the same 3 participants demonstrated a significant change of 44% and for PCC there was a
significant change in all 4 participants.
Vowel sounds are targeted while treating persistent SSD. Speake, Stackhouse, &
Pascoe's (2012) pre-test/post-test study stated there is a lack of research on the treatment of
vowels. Although there is less occurrence of vowel difficulties, the researchers believed that it
may have a significant impact on the child’s intelligibility. The vowels would be measured by
RECORDING INTELLIGIBILITY FOR ADOLESCENTS WITH PSSD
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the percentage of vowels correct and intelligibility outcomes by peer group listeners (Speake &
et al., 2012). The participants were 2 10-year-old children with SPSD. During the assessments,
the researchers found each participant’s strengths and weaknesses regarding vowel sounds. This
led to giving specific target sounds to each participant during the intervention. The materials for
this intervention included picture cards containing the specific vowel sounds and written words
with vowel symbols. The results for the first participant were 91.6% accuracy on CV word
productions compared to 83.3% pre-intervention, 100% accuracy on VC words compared to
91.6% pre-intervention, and a p < 0.003 increase for CVC words (92.7% compared to 76.3%).
As for the second participant, there was a p < 0.003 increase in VC words (25% pre- to 100%
post-intervention). CV words stayed the same due to long vowels and diphthongs were already
widely accurate in the pre-intervention. There was also an increase in the PCC score from 78%
pre- to 87.6% post-intervention. There was a p < 0.002 increase in CVC words (80% pre- to
90.8% post-intervention).
Speech Perception with SSD
Investigating children with SSD having difficulties with speech perception. The
purpose of this systematic review and meta-analysis (2019) study was whether children with
SSDs have difficulties with speech perception. When looking through past studies of children
with SSDs and speech perception, the researchers listed their inclusion and exclusion criteria.
Here are the following inclusion criteria: children between the ages 3:0 to 6:11 years and months
with SSDs and presented developmental SSD. For the exclusion criteria: children who are
younger than 3:0 or older than 6:11, presented with typically developing speech/appropriate
speech errors, presented with a known cause of SSD, and identified language impairment. This
led to only 73 articles that fit the researchers’ criteria. Of the 73 articles, most of the task fittings
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for the participants were judgment tasks, identification tasks, and comprehension of high versus
low intelligibility tasks. The assessment for speech perception varied in how many and which
phonemes were targeted (Hearnshaw & et al., 2019). According to the researchers, some of these
articles have shown that children with SSDs have difficulties with speech perception.
Comparing speech perception with children with and without phonological SSDs.
Brosseau-Lapre and Schumaker's (2020) study was to compare children with and without
phonological SSDs speech perception. 36 participants were between the ages of 4:0-5:11 years.
They were separated into two groups, one was the SSDs and the other typical development (TD).
All participants had to attend 3 testing sessions, where they were tasked to complete an
experimental task in a sound attenuating booth (Acoustic Systems) (Brosseau-Lapre and
Schumaker, 2020). They were then asked to make verbal responses while being audio-recorded
using a PMD661 MK II Marantz recorder. They were assessed with the Goldman-Fristoe Test of
Articulation-Third Edition (GFTA-3) by a graduate student. In addition, a graduate research
assistant completed transcriptions of four samples that were randomly selected from each group
of participants. Afterward, researchers gave the participants target sounds they must hear for (/k,
s, and ɹ/) in different word positions. The participants must determine whether the sounds
produced are correct or incorrect in the specific words they are given. The results showed that
children with SSDs have a lower speech perception than their typically developing peers.
However, it is noted that many, but not all, children with SSD have difficulties with speech
perception.
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Adolescents with SSD
Outcomes of adolescents who had histories of early SSDs with and/or without
language impairment (LI). The purpose of this prospective longitudinal (2014) study was the
outcomes of adolescents who had histories of early SSDs with and/or without LI. Studies have
shown that children with SSDs and comorbid LI can be at a higher risk for long-term reading and
difficulties with spelling. These outcomes were if the adolescents either have typical speech,
resolved SSD, or persistent SSD. 170 participants were recruited between the ages of 4-6 years
old and then followed to their adolescence stage between the ages of 11-18 years. Researchers
measured each participant’s speech and language (i.e., speech sound production, oral motor
skills, phonological memory, oral language, and vocabulary), literacy (i.e., word-level reading,
reading comprehension, spelling, and parent report), and other assessments were utilized. The
participants were then re-evaluated as an adolescent and they would be classified into one of the
four groups such as the following: Low multisyllabic word (MSW), persistent SSD, resolved
SSD, and no SSD. The results were that majority of the adolescents who had early SSD were
now categorized in the as resolved SSD. According to the researchers, both the no SSD and
resolved SSD groups performed better in all the measures that were mentioned above than the
groups with low MSW and persistent SSD.
Outcomes of adolescents who had histories of early SSDs. The purpose of this (2019)
retrospective longitudinal study was to determine the outcomes of adolescents who had histories
of early SSDs. This article was a subset of the previous article that was mentioned above. There
was a sample of 243 participants in this study who had with and without SSD. The researchers
utilized the same measures as the previous articles. Here are the following measures: speech
sound production, motor speech skills, vocabulary, language, and literacy skills. Assessments
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that have been administered were: GFTA, KLPA, Expressive One-Word Picture Vocabulary
Test Third Edition (EOWVPT-3), Diadochokinetic rates, etc. The participants were tested in a
quiet room at their home for 3.5-4 hours for over 2 days. During these sessions, the researchers
audio-recorded the participants. The results were that the outcomes differed based on the preschool and school age assessments, socioeconomic status, presence of cormorbid LI, gender, and
reading difficulties.
Self-monitoring and SSD
Self-monitoring using contingency management (CM) to increase motivation of
home practice. In this (2009) pretest/posttest study, the researchers compared the efficacy
between traditional articulation therapy and therapy with CM with children who have SSDs.
There were 91 participants who were between the ages 4-6 years. The participants were divided
into three groups: traditional articulation (TA) therapy, combination of traditional therapy and
CM, and no therapy. The researchers used picture labels for speech sound production errors and
compared the number of errors between the pretest and posttest. The treatment was an 8-therapy
session, that both TA and CM groups were receiving. However, with the CM group, they were
given additional information by learning the rewards and consequences they will face when
being motivated to do their homework. The parents from both groups were notified to practice
with their children at home and were given the aims and rules of the homework that would be
given to them. The results were that the CM group had a slightly lower error speech production
than the no therapy and TA groups. Therefore, giving the CM approach a positive impact to selfmonitoring for children with SSDs.
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Children self-monitoring by making recordings to hear their speech. The researcher
investigated children with phonological impairment (PI) abilities to perceive their own speech
based on age and phonological competence (StrÖmbergsson, 2012). There are two studies that
are mentioned in this article, the first study was to learn about developmental aspects and the
second study was to investigate the concerns of potential influence of having PI. Both studies
would be using the same methods and will be comparing results to each other. In the first study,
48 children who had typical speech and language development participated. These participants
were between the ages 4-8 years. StrÖmbergsson used a recording script of 24 words for
participants to read while wearing headphones for the first test session. After recording a word,
each participant is given four recording samples. Of the four samples, one of them is the
participant’s own recordings and they must identify it correctly. If the participants correctly
identify their own sample they can continue onto the next word. The second test session, which
was conducted 1-2 weeks after the first, is only for the participants to listen to the recording
samples again and identify which one is theirs. During this session, StrÖmbergsson collected data
based on the participants’ actions (listening and selecting the samples). The results showed that
immediate playback (first test session) had the most correct responses (20.3 mean test score) than
the delayed playback (second test session with 18.2 mean test score). This was due to children
being mistaken of another child’s sample of the same gender. In the second study, 21 children
who were diagnosed with PI participated. These participants were between the ages of 4-7 years.
For the participants with PI, a participant was selected from the first study to best match their
age. The results were that the immediate playback with participants without PI had the correct
responses (18.8 mean test score) than participants with PI (17 mean test score). As well as the
delayed playback, participants without PI (18.1 mean test score) had more correct responses than
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participants with PI (17.1 mean test score). Although the max score was 24 and the scores in all
the categories are low, StrÖmbergsson noted what the readers should consider when looking at
the data. The skills of perceiving one’s speech may develop after the age of 8 and other factors,
such as, differences in attention span and concentration of understanding the task that is given.
Statement of Purpose
The purpose of this paper is to present a research proposal for a quantitative quasiexperimental non-equivalent control group study that compares the efficacy of adolescents
recording their speech during treatment and adolescents who are offered normal speech services.
As stated, before there is a lack of research regarding adolescents recording themselves to gain
speech perception in their intelligibility. Although the rates of persistent SSD decline with age
and the average is up to 1.4% among college freshmen (NCBI, 2015, para 4). SLPs should
continue services for those who still have unlearned speech errors and how they could improve
themselves by recording and identifying the errors they are producing.
Research Questions
The proposed research study will aim to answer the following questions:
1. Is there a difference in efficacy of Speech-Language Services on increasing speech
perception in adolescents with persistent SSD recording themselves compared to
adolescents with persistent SSD receiving normal Speech-Language Services?
2. Does recording help increase speech perception for adolescents with persistent SSD?
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Methodology
Research Design
To answer the questions of the proposed research study, a quantitative quasi-experimental
non-equivalent control group design will be used in this study. A baseline data will be collected
before treatment begins utilizing GFTA-3 accompanied by the Khan-Lewis Phonological
Analysis-Third Edition (KLPA-3). The GFTA-3 is “utilizing large, color picture, word-level
stimuli to assess 39 consonants and blends” (Goldman & Fristoe, 2000). While the KLPA-3
“uses the target words evoked by the GFTA-3 to assess 10 phonologic processes” (Khan &
Lewis, 2015). Following 8-week treatment sessions, a generalization probe will be conducted to
determine the generalization of speech perception. The GFTA-3 and KLPA-3 will then be readministered. This research design would allow the researcher to compare the efficacy of
adolescents recording themselves to gain speech perception to the efficacy of adolescents
receiving normal Speech-Language services.
Participant Selection
The study will include an estimate of 50 students between the ages of 12-17 years with a
diagnosis of persistent SSD with a severity level of moderate-severe. The inclusion criteria
would be participants must have adolescents between the ages of 12-17 years, with moderatesevere persistent SSD, and poor speech perception. The exclusion criteria would be that the
participants must not have any concomitant disorders.
The participants will be placed into one of two groups: the group that would be offered
normal Speech-Language services or the recording themselves to gain speech perception. Each
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participant will be matched as closely as possible based on: age, gender, severity, and
socioeconomic status.
Consent to participate in this study will be obtained from the SLPs delivering services to
the parents or guardians of each student. In addition to the assent of each participant. The
parents/guardians will be informed that they have a right to withdraw at any point in time.
Independent and Dependent Variables
The independent variable in this study is the implementation of normal Speech-Language
services and Speech-Language services with participants recording themselves. The dependent
variable is gaining speech perception. The dependent variable will be measured by using GFTA3 and KLPA-3.
Setting and Materials
This study will take place over 8 weeks during the summer. The sessions will take place
at the California State University, Fresno Speech and Hearing Clinic. The treatment sessions will
be 30 minutes long and will be administered twice a week. Equipment used for recording speech
will be a Digital Voice Recorder 16GB. Both the SLP and participant will use the voice recorder
so the participants could understand what sounds they are targeting and how to produce those
sounds.
The standardized assessment tests used will be GFTA-3 and KLPA-3. These tests will be
administered by the SLP providing services to the participants. Data will be collected with direct
observation and documentation by the SLP.
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Data Collection Procedures
Before the baseline trials are conducted, the SLPs will be given a protocol to follow
throughout this study. The GFTA-3 and KLPA-3 will be administered to the participants. After
the treatment is complete, the GFTA-3 and KLPA-3 will be re-administered. Data will be
collected by direct observation and documentation by the SLPs and researchers. As well as the
researcher reviewing all the data to ensure consistency amongst the SLPs.
Data Analysis
The IBM Statistical Package for the Social Sciences (SPSS) will be used to analyze the
collected data. The descriptive statistics will be used to describe the occurrence of the dependent
variables. This would measure the percentages and frequency counts of each participant. As well
as the means and ranges of the GFTA-3 and KLPA-3 will be analyzed to compare each
participants’ level of speech production and phonological processes. Frequency data will be
collected during the probe session to analyze to participants’ speech production after treatment.
A chart would then be displayed of the frequency data for both groups. The researcher will then
use an ANOVA test to compare the means of each dependent variable in both groups to
determine the efficacy of the treatment.
Threats to Validity and Reliability
In order to reduce the internal validity of this study, the participants assigned to both
groups will be matched as closely as possible based on age and severity. By doing so, this could
help control the selection based on similar characteristics among the participants. Repetition of
the assessments that would be utilized could be a cause due to using it more than once to see how
RECORDING INTELLIGIBILITY FOR ADOLESCENTS WITH PSSD
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much each participant has improved after the treatment. Treatment fidelity will be controlled by
a protocol that the SLPs will follow in order to stay consistent in scoring.
A threat to external validity could be setting artificiality, as the treatment would be
conducted in a clinic setting. This could alter the true results of the participants as they are not in
their natural environment. After each session, participants are instructed to record themselves
and practice on gaining speech perception to help determine if the results can be generalized
outside of the clinic setting. Another threat could be selection biases, as participants can be
selected but do not have persistent SSD. This could be resolved by looking at the participants
case history before selecting them for the study.
Conclusion
The proposed study will allow the researcher to observe the efficacy of Speech-Language
services on increasing speech perception in adolescents with persistent SSD by recording their
speech. There is a lack of literature regarding this specific topic and current research indicates
the need for further studies to ensure evidence-based practice for SLPs working with this
population.
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