Journal of
C LINICAL
S PEECH
AND
L ANGUAGE
S TUDIES
Official Journal of the
Irish Association of Speech and Language Therapists
Volume 21 2014
ISSN 0791-5985
J&R Press Ltd
JOURNAL OF CLINICAL SPEECH AND LANGUAGE STUDIES
Editor’s Notes
A peer-reviewed periodical published by the Irish Association of Speech and
Language Therapists (IASLT). The purpose of the Journal is to encourage and
showcase the growing research environment in Ireland and to provide a forum
for the exchange of information and discussion of both clinical and theoretical
issues regarding communication science and disorders in children and adults,
swallowing and its disorders, as well as speech and language therapy.
The 2014 issue of the Journal of Clinical Speech and Language Studies presents
three research papers and one book review. The three research papers were
based on undergraduate research projects conducted by speech and language
therapy students in Ireland. The paper by Armstrong, O’Malley, Collins and
Carroll is a qualitative study that explores the parents’ opinions regarding
the impact of stuttering on the lives of their school-aged children. The paper
by Lee and Moore reports the usage of non-speech oral motor exercises by
clinicians in Ireland for treating speech sound disorders in children; and the
paper by Bessell and Mulhall studies the perceived location, occupation and
socio-economic class of three accents from County Cork and reported the
phonetic characteristics of these accents.
Editor
Alice Lee, University College Cork, Ireland
Advisory Editorial Board
Rozanne Barrow, Beaumont Hospital, Dublin, Ireland
Clare Carroll, National University of Ireland, Galway, Ireland
Fiona Gibbon, University College Cork, Ireland
Margaret Leahy, Trinity College Dublin, Ireland
Arlene McCurtin, University of Limerick, Ireland
Carol-Anne Murphy, University of Limerick, Ireland
Clothra Ní Cholmáin, Trinity College Dublin, Ireland
Ciara O’Toole, University College Cork, Ireland
Irene Walsh, Trinity College Dublin, Ireland
Margaret Walshe, Trinity College Dublin, Ireland
For permission to reprint or copy journal content for any other purpose, request
should be sent to the IASLT:
Irish Association of Speech and Language Therapists
Block 4, Harcourt Centre, Harcourt Road, Dublin 2, Ireland
Tel/Fax: +353 (0)85 7068707 Email: info@iaslt.ie
Website: http://www.iaslt.ie
For queries about the Journal and manuscript submission, contact the Editor:
Dr Alice Lee
Department of Speech and Hearing Sciences, University College Cork,
Brookfield Health Sciences Complex, College Road, Cork Ireland
Tel: +353 (0)21 4901540; Fax: +353 (0)21 4901542
Email: a.lee@ucc.ie
For subscription matters, contact the Publisher:
J&R Press Tel: +44 (0)1483 894256
Website: http://www.jr-press.co.uk/
I would like to thank Dr Nicola Bessell in the Department of Speech and
Hearing Sciences at University College Cork for reviewing a recently-published
title, Methods in Teaching Clinical Linguistics and Phonetics (edited by Dr
Nicole Whitworth and Dr Rachael-Anne Knight).
Finally, I would like to take the opportunity to encourage members of the IASLT
to submit to the Journal, to share the findings of your research projects!
Alice Lee
University College Cork
December 2014
Reviewers
The Journal of Clinical Speech and Language Studies would like to thank the
following colleagues who served as manuscript reviewers between October
2013 and December 2014:
Aidan Doyle, University College Cork, Ireland
Arlene McCurtin, University of Limerick, Ireland
Carol-Anne Murphy, University of Limerick, Ireland
Ciara O’Toole, University College Cork, Ireland
Elspeth McCartney, University of Strathclyde, UK
Helen Kelly, University College Cork, Ireland
Jill Hoover, University of Massachusetts Amherst, USA
Joanne Cleland, University of Strathclyde, UK
Margaret Leahy, Trinity College Dublin, Ireland
Rachel Leonard, HSE (Health Service Executive), Ireland
Raymond Hickey, University of Duisburg-Essen, Germany
Susanne Cook, University College London, UK
Tessa Bent, Indiana University, USA
Contents
A Survey of the Usage of Nonspeech Oral Motor Exercises by
Speech and Language Therapists in the Republic of Ireland
1
Alice Lee and Niamh Moore
University College Cork, Ireland
A Qualitative Exploration of Maternal Perspectives
on the Impact of Stuttering on the lives of
6–10-year-old children
41
Elizabeth Armstrong1, Mary-Pat O’Malley Keighran1,
Patricia Collins2 and Clare Carroll1
1National University of Ireland, Galway, Ireland
2Health Service Executive, Shantella, Galway, Ireland
What’s in an Accent?
Perceptions of Young Adult Listeners in Cork and Kilkenny
63
Nicola Bessell and Eimear Mulhall
University College Cork, Ireland
Book Review
Methods in Teaching Clinical Linguistics and Phonetics
87
A Survey of the Usage of
Nonspeech Oral Motor Exercises
by Speech and Language Therapists
in the Republic of Ireland
Alice Lee and Niamh Moore
University College Cork, Ireland
Correspondence to:
Alice Lee, Department of Speech and Hearing Sciences, School of Clinical
Therapies, College of Medicine and Health, University College Cork, Brookfield
Health Sciences Complex, College Road, Cork, Republic of Ireland
Email: a.lee@ucc.ie
Abstract
Objective: To collect information on the usage of nonspeech oral motor
exercises (NSOMEs) by speech and language therapists (SLTs) for treating
speech sound disorders (SSDs) in children in the Republic of Ireland.
Method: SLTs who had worked with children with SSDs were invited
to complete an online questionnaire adapted from a previous survey
conducted in the US by Lof and Watson (2008).
Main results: 22/39 (56%) of the respondents reported using NSOMEs.
Information from a colleague about the usefulness of NSOMEs, continuing
education, and literature influenced the respondents the most to use
NSOMEs. Most respondents used NSOMEs as a “warm up”, mainly
with children with childhood apraxia of speech, dysarthria, and Down
Syndrome.
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Use of Nonspeech Oral Motor Exercises
Conclusion: NSOMEs are used by over half of the respondents despite
the lack of evidence that supports this treatment approach. Continuous
effort to encourage the application of evidence-based practice in clinics
is warranted.
Key words: Nonspeech oral motor exercises, speech sound disorders,
speech and language therapists, Ireland
Introduction
Children with speech sound disorders (SSDs) “can have any combination of
difficulties with perception, articulation/motor production, and/or phonological
representation of speech segments (consonants and vowels), phonotactics
(syllable and word shapes) and prosody (lexical and grammatical tones,
rhythm, stress and intonation) that may impact speech intelligibility and
acceptability” (International Expert Panel on Multilingual Children’s Speech
[IEPMCS], 2012, p. 1). The speech difficulties can be due to structural, sensory,
and neuromuscular deficits (e.g., cleft palate, hearing impairment, etc.) but,
more often, their cause is unknown. Different approaches for treating SSDs
in children have been developed (phonetic, phonemic, and hybrid phoneticphonemic treatments; Ruscello, 2008) and the clinical decision on which
approach to use for a particular child is based mainly on the cause of the
speech problems. One alternative approach for treating SSDs is nonspeech
oral motor exercises (NSOMEs). NSOMEs have been defined as “non-speech
activities that involve sensory stimulation to or actions of the lips, jaw, tongue,
soft palate, larynx, and respiratory muscles that are intended to influence the
physiological underpinnings of the oropharyngeal mechanism to improve
its function. They may include activities described as active muscle exercise,
muscle stretching, passive exercise, or sensory stimulation” (McCauley, 2009,
p. 344). For example, nonspeech activities such as smiling, pursing, blowing
into horns, and lip massage are used to target lip mobility for the production
of speech sounds that involves the lips – /p/, /b/, and /m/ (Marshalla, 2000;
Rosenfeld-Johnson, 2001).
A few previous systematic reviews (Lass & Pannbacker, 2008; McCauley
et al., 2009; Ruscello, 2008) and a recently published Cochrane Systematic
Review (Lee & Gibbon, 2015) have shown that there is no strong evidence
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Use of Nonspeech Oral Motor Exercises
3
to support the efficacy of NSOMEs for treating SSDs in children. Moreover,
a number of articles have discussed the theoretical grounds of why NSOMEs
would not be effective; for example: the clinical forum on NSOMEs published
in 2008 in the journal Language, Speech, and Hearing Services in Schools; the
special issue on the controversies of NSOMEs published also in 2008 in the
journal Seminars in Speech and Language; and other articles and conference
papers (e.g., Bowen, 2005; Lof, 2003, 2006, 2007, 2009a, 2009b; Lof & Watson,
2010). Lof and Watson (2010) summarized the arguments about why the
effect of NSOMEs do not generalize to speech production. First, the neural
organization is task-specific rather than structure-specific. Hence, although
the same oral structures are involved in speech production and nonspeech
tasks, the neural representations of the two activities are different. Second,
many NSOMEs involve isolated training of individual speech movements;
however, practising fragmented gestures does not enhance the acquisition
of highly-integrated tasks such as speech production. Finally, as speech
production does not involve high muscular strength, there is no need to use
any activities, such as NSOMEs, to improve the muscle strength or warm up
the muscles of articulators.
Despite the lack of evidence that support the use of NSOMEs for treating
SSDs and the long-standing debate regarding the efficacy of this treatment
approach, previous surveys have shown that NSOMEs are used by many
clinicians. Three surveys published between 2005 and 2008 showed that 71.5%
of the respondents (speech and language therapists or SLTs) in the UK (Joffe
& Pring, 2008) and 85% of the respondents (speech-language pathologists or
SLPs) in the US (Lof & Watson, 2008) and in Alberta, Canada (Hodge, Salonka,
& Kollias, 2005), reported using NSOMTs in their clinical practice. Two very
recent surveys reported that 67% of the respondents in the US (Brumbaugh
& Smit, 2013) and 37.6% of the respondents in Australia (McLeod & Baker,
2014) indicated using NSOMEs. As stated by Lof and Watson (2008), the
information on how clinicians are using NSOMEs in their clinical practice is
useful when planning future research on testing the efficacy of NSOMEs. In
addition, the findings would have important implications for SLT education
and continuous professional education, particularly in the area of evidencebased practice, in Ireland. However, currently there are no statistics regarding
the use of NSOMEs by clinicians working in Ireland; therefore, the present
study was conducted to answer this question.
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Use of Nonspeech Oral Motor Exercises
Method
Ethics approval for conducting this study was obtained from the Clinical
Research Ethics Committee of the Cork Teaching Hospital in January
2014.
Participants
SLTs who had worked or were working with children with SSDs in the
Republic of Ireland were recruited to participate in this study through two
means available to the investigators. The first was the Irish Association of
Speech and Language Therapists (IASLT), who informed their members of
this study via their website and social media pages (Facebook and Twitter)
in February 2014. Members who were willing to take part in the survey were
directed to the IASLT website where they had to login as a member to access
the questionnaire. In addition, a convenience sample of 18 SLT managers
of SLT services in south HSE (Health Service Executive)1, who were on the
mailing list of the Department of Speech and Hearing Sciences at University
College Cork, were contacted by email and asked to forward the information
about this study and the link for the questionnaire to the SLTs working in
their service.
Development of the questionnaire
The questionnaire used in this study was developed by following most of
the items in that by Lof and Watson (2008) for investigating the use of
NSOMEs by SLPs in the US, as this would allow comparison of results
between the two studies. Adaptions were made to ensure the clarity and
brevity of the questionnaire. Terminologies and phrases that are relevant to
the Irish context were used; for example, “county” instead of “state”; “tick”
instead of “check”; “community care” instead of “early intervention (birth to
1 SLT managers working in the following areas were contacted: community care in
Cork (Cork North, Cork South Lee, West Cork), Kerry, South Tipperary, Waterford,
Wexford; hospitals in Cork; and voluntary agencies in Cork, Kerry, Waterford, Wexford,
and Kilkenny.
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5
3)” and “preschool”. For questions that asked about the frequency of usage,
four options – “usually, often, sometimes, never” were used instead of three
options – “usually, sometimes, never”. The 5-point ordinal scale was spelled
out in the current questionnaire (e.g., “strongly agree, agree, neutral, disagree,
strongly disagree”).
The present questionnaire consisted of four parts (see Appendix). Part A
contained six questions which enquired about the respondents’ demographic
information, such as education, location of work, and caseload information.
Part B was to be completed by respondents who used NSOMEs in their clinical
practice. This part consisted of 12 questions which collected information on
the factors that influenced the respondents’ use of NSOMEs, their opinions
towards NSOMEs, the types of NSOME tasks/materials used and how
frequently they were used, and the client groups they treated using NSOMEs.
Those who did not use NSOMEs in their clinical practice completed Part C
which contained six questions that asked for their opinions regarding this
intervention approach and the factors that influenced their opinions. Finally,
all respondents completed Part D which enquired the familiarity and use of
14 other speech therapy techniques (e.g., distinctive feature approach) for
treating SSDs in children.
The questionnaire was piloted on three SLTs-in-training, who were asked
to comment on whether the questionnaire was comprehensive and easy to
complete; whether the questions were objective enough; and the time taken
to complete the questionnaire. The SLTs-in-training commented that the
questions were objective enough and they gave suggestions regarding the
wording of some questions and other minor issues, such as font size and style.
On average, it took each person 10 to 15 minutes to complete the questionnaire.
In addition, the authors of the Lof and Watson (2008) paper were consulted
and their suggestions were employed for improving the questionnaire.
Procedure
The potential participants were notified of the present study by an electronic
information sheet which detailed the aims and rationale of the study and
included a link to access the electronic questionnaire. The questionnaire was
presented using a free online survey tool (http://esurv.org/). The first page of
the questionnaire was a consent page, where it stated that clicking the “Next”
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Use of Nonspeech Oral Motor Exercises
Use of Nonspeech Oral Motor Exercises
button at the bottom of this page constituted as willingness to participate in
the survey (see Appendix).
The participants were given four weeks to complete the questionnaire.
Two weeks into the survey, a reminder message was sent to participants via
the IASLT and the SLT managers to encourage participation in the survey.
All responses were stored in a password-protected account of the second
author on the free online survey tool. Frequency count and percentage were
used to summarize the results for each question in the questionnaire. The
responses in the account of the free online survey tool were deleted once the
data was analyzed.
Chi-square test were used to examine whether (1) the use of NSOMEs was
related to the number of years of clinical experience; (2) whether the level of
agreement or disagreement with the assumptions of NSOMEs was related to
whether the respondent was a user or non-user of NSOMEs; and (3) whether
the level of familiarity with research and theory of NSOMEs was related to
whether the respondent was a user or non-user of NSOMEs, if at least 80%
of the cells had expected frequencies of 5 or more (Pallant, 2005).
Language Therapy and 28% had a Master’s degree as their highest level of
education (see Table 1 for details). Thirty-three respondents supplied the
year of award of their Bachelor’s degree; the majority (24/33 or 73%) were
awarded in or after 2000 and others were awarded in the period of 1970 to
1999 (see Table 1). For the Master’s degree, most of the respondents received
their degree in or after 2000.
Table 1 Summary of respondents’ demographic information on education and work
location.
Demographic
Highest level of education (n = 39)
Bachelor’s degree in Speech and Language Therapy
Master’s degree
Forty-six questionnaires were returned; however, for seven of them, only Part
A on demographic information was completed. As no information regarding
the use of NSOMES could be extracted from these seven questionnaires, they
were excluded from data analysis. Of the remaining 39 questionnaires, nine
were completed in their entirety; that is, all required questions were answered
and the answers were filled out correctly. For the other 30 questionnaires,
occasional errors in filling out the questionnaire were found. These errors were,
namely, incorrect responses (e.g., entered country name instead of county
name for the question on location of work); did not answer a question; and
provided two answers where only one was required. Responses with errors
were not included in the data analysis.
Demographic information of all respondents (Part A)
All 39 respondents responded to Question 1 on academic qualifications –
two-thirds of the respondents received a Bachelor’s degree in Speech and
Number (and percent) of respondents
26 (66%)
11 (28%)
Licentiate of the College of Speech Therapists
1 (3%)
Postgraduate higher diploma
1 (3%)
Year of award of Bachelor’s degree (n = 33)
1970–79
Results
7
1 (3%)
1980-89
3 (9%)
1990-99
5 (15%)
2000-09
19 (58%)
2010-13
5 (15%)
Year of award of Bachelor’s degree (n = 10)
1980-89
1 (10%)
1990-99
1 (10%)
2000-09
6 (60%)
2010-13
2 (20%)
Work location (n = 35)
Cork
17 (49%)
Dublin
5 (14%)
Kerry
4 (11%)
Wexford
Kilkenny, Limerick, Wicklow, Galway, Longford,
Galway/Mayo, and Longford/Roscommon*
2 (6%)
7 (20%)
*These seven locations were each listed once.
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Use of Nonspeech Oral Motor Exercises
Use of Nonspeech Oral Motor Exercises
Thirty-five respondents indicated where they were working (Question
2) at the time of data collection. Almost half of them were working in Cork,
followed by Dublin, Kerry, and Wexford (see Table 1). There was one respondent
from each of these areas: Kilkenny, Limerick, Wicklow, Galway, Longford,
Galway/Mayo, and Longford/Roscommon. With regards to the work settings
(Question 3), most of the respondents worked in a single setting only (27/39
or 69%), with more than half of them working in disability services (14/27 or
52%), followed by community care (10/27 or 37%), private practice (2/27 or
7%), and hospital (1/27 or 4%). Twelve of the 39 respondents reported working
in more than one setting and the details are summarized in Table 2.
Table 2 Work settings of 12 of the respondents who reported working in more than
one setting.
Combination of work settings
Number of respondents
Community care and hospital
3
Disability services and private practice
2
Community care and disability services
1
Community care and a language class
1
Private practice and hospital
1
Hospital and on an early intervention team
1
Private practice and a non-specified “other” setting
1
Community care, hospital, and language class
1
Disability services, hospital, and community care
1
Number of
respondents
(percentage)
Number of
respondents who
used NSOMEs
Number of
respondents who did
not use NSOMEs
1 to 5 years
20 (51%)
11
9
6 to 10 years
6 (15.5%)
4
2
11 to 15 years
5 (13%)
2
3
2 (5%)
2
0
6 (15.5%)
3
3
15 to 20 years
More than 20 years
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Table 4 Size of caseload.
Demographic
Number (and percent) of respondents
Number of children on caseload (n = 39)
1–20
6 (16%)
21–40
4 (10%)
41–60
2 (5%)
More than 60
27 (69%)
Number of children with speech sound disorders on caseload (n = 39)
1–20
18 (46%)
21–40
9 (23%)
41–60
More than 60
3 (8%)
9 (23%)
For the number of years of experience working with children with speech
sound disorders (Question 4), about two-thirds of the respondents (26/39 or
66.5%) were in their first decade of working with this clinical group, whereas
the others had worked with this group for more than 10 years (see Table 3 for
details). Most of the respondents (69%) had more than 60 children on their
current caseload (Question 5; see Table 4 for details). Finally, regarding the
number of children with SSDs on the current caseload (Question 6), almost
half of the respondents (46%) had a size of 1–20 children (see Table 4).
Table 3 Number of years of experience working with children with speech sound
disorders of the 39 respondents and the number of respondents in each category
who used and did not use nonspeech oral motor exercises (NSOMEs).
Number of years
9
The use of NSOMEs by SLTs (Part B)
Twenty-two of the 39 respondents (56%) completed Part B of the questionnaire,
indicating that they used NSOMEs in their clinical practice. Table 3 shows the
number of users (and non-users) broken down by their number of years of
clinical experience. Chi-square analysis was not conducted as there were 80%
of cells that had expected count less than 5. As stated in the Method section,
SLTs who did not use NSOMEs were instructed to leave Part B blank and to
proceed to Part C. However, six of the 22 respondents who completed Part B
also completed Part C. It is evident from the answers in Part B that these six
respondents did use NSOMEs, and therefore their answers for Part B were
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Use of Nonspeech Oral Motor Exercises
analyzed whereas their answers for Part C were discarded. The results of this
part of the questionnaire are summarized in the following six sub-sections.
With whom NSOMEs were used
The respondents were asked how frequently they used NSOMEs with eight
different client groups (Question 4a to 4h); 19 to 22 respondents gave their
answers. None of the respondents indicated usually using NSOMEs with any
of the client groups (see Figure 1). NSOMEs were used often or sometimes
with children with childhood apraxia of speech (13/21 or 62%), dysarthria
(12/20 or 60%), and Down Syndrome (12/22 or 54%). Most respondents
never used NSOMEs with children with phonological disorders (14/22 or
64%), function articulation disorders (13/21 or 62%), SSD due to structural
anomalies (12/22 or 55%), SSD due to hearing impairment (15/19 or 79%),
Figure 1 The number (indicated in the columns) and percentage of respondents who
“never”, “sometimes”, “often”, or “usually” used NSOMEs with children with
speech sound disorders of different origins.
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Use of Nonspeech Oral Motor Exercises
11
and children who are regarded as “late talkers” (15/21 or 71%). The opinion
about whether NSOMEs can favour children of any age (Question 12) was
divided – 45% (9/20) of the respondents agreed with this statement whereas
the others disagreed.
Which NSOME materials and tasks were used
The questionnaire listed nine NSOME materials (Questions 5a to 5i) and 13
tasks of NSOMEs (Questions 6a to 6m), where the respondents were asked
to indicate how frequently they used them with their clients (see Figures 2
and 3). The results showed that, regarding materials, more than half of the
respondents used tongue depressors (13/22 or 59%), straws (16/22 or 73%),
and whistles (12/22 or 55%). For NSOMEs, more than half of the respondents
used the following tasks – pucker-smile alternations (11/21 or 52%), tongue
Figure 2 The number (indicated in the columns) and percentage of respondents
who “never”, “sometimes”, “often”, or “usually” used nine different NSOMEs
materials in their clinical practice
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Use of Nonspeech Oral Motor Exercises
Use of Nonspeech Oral Motor Exercises
13
professionals (e.g., teachers, occupational therapists) to use this treatment
approach (Question 11).
From where the respondents learnt about NSOMEs
More than half of the respondents indicated that they had observed improved
nonspeech oral motor skills as a results of using NSOMEs (18/21 or 86%),
and read literature, such as journal articles and book chapters (19/22 or
86%), or internet sources such as websites and blogs (14/22 or 64%) that
encourage the use of NSOMEs (Questions 1a to 1g). In addition, 50% of the
respondents (11/22) had attended continuing education offerings, workshops,
Table 5 Sources of information from where the 22 respondents who reported using
nonspeech oral motor exercises (NSOMEs) learnt about this treatment approach
and the information sources that influenced their practice the most.
Sources of information
Figure 3 The number (indicated in the columns) and percentage of respondents
who “never”, “sometimes”, “often”, or “usually” used 13 different NSOMEs
in their clinical practice.
“push-ups” (11/21 or 52%), and blowing (e.g., cotton balls) (14/19 or 74%);
and half of the respondents (10/20) used “big smile” exercises. The rest of the
materials and tasks were never used by over 50% of the respondents.
How NSOMEs were used
Seventeen of the 22 respondents answered Question 7. Thirteen (76%) of
them used these exercises as a “warm up” with the client; two (12%) used
them until the client met a set criterion; one (6%) divided therapy time
equally between NSOMEs and speech intervention, and one (6%) reported
that the therapy sessions were almost restricted to NSOMEs. In terms of
training others to use NSOMEs, most respondents (13/19 or 68%) trained the
caregivers of children with SSDs to use NSOMEs as part of a home programme
(Question 10), whereas only 10% (2/21) of the respondents trained other
a. Taught to use NSOMEs during SLT
training (lectures/tutorials)
b. Taught to use NSOMEs during SLT
training (clinical placement)
c. Observed improved speech production
after NSOMEs
d. Observed improved nonspeech oral
motor skills after NSOMEs
e. Other speech elicitation exercises did
not work for some clients
f. Informed by a colleague that NSOMEs
are useful
g. Attended continuing education on
NSOMEs
h. Read literature that encourages
NSOMEs
i Read internet sources that encourages
NSOMEs
Number of respondents
who learned about
NSOMEs from this
sourcea
Number of respondents
who found this source
influenced their use of
NSOMEs the mostb
10 (45%)
2
9 (41%)
1
10 (45%)
3
18 (86%)
1
8 (36%)
1
9 (43%)
7
11 (50%)
7
19 (86%)
6
14 (64%)
1
a22 users of NSOMEs responded to all nine statements, except statements d and f where there
was one missing data each. bFourteen of the 22 respondents identified two information sources
while one respondent indicated one only, resulting in 29 responses.
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Use of Nonspeech Oral Motor Exercises
and/or in-services on the use of NSOMEs (see Table 5). Regarding the two
most important sources of information that influenced the respondents’ use
of NSOMEs (Question 2), 15 of the 22 respondents gave their answers; one
respondent identified one information source only, yielding 29 responses.
The results were that information from a colleague about the usefulness of
NSOMEs (7/29 or 24%), continuing education offerings or workshops on
NSOMEs (7/29 or 24%), and literature (6/29 or 21%) had influenced the
respondents the most on their use of NSOMEs.
Opinions regarding some assumptions of NSOMEs
The majority of the respondents disagreed or strongly disagreed with five
of the seven statements surrounding some assumptions of NSOMEs and
treatment of SSDs (Questions 3a to 3g):
(1) the development of intelligible speech requires the use of separate
oral motor tasks (13/20 or 65%);
(2) children with SSDs frequently lack the strength needed to produce
intelligible speech (12/19 or 63%);
(3) the use of NSOMEs for treating SSDs is supported by research
literature (15/21 or 71%);
(4) dividing complex behaviours of speech into component oral motor
movements is an efficient method to treat SSDs (13/21 or 62%);
and
(5) muscle movements for nonspeech oral tasks will carry over to
muscle movements for speech sound productions (14/20 or 70%;
see Table 6).
Nearly half of the respondents (10/21 or 47%) agreed or strongly agreed that
speech develops from early oral behaviours such as sucking or chewing. Finally,
there were about the same number of respondents who (strongly-) agreed
(9/21 or 43%), or (strongly-) disagreed (8/21 or 38%) that NSOMEs serve as
groundwork for the development of more sophisticated motor movements
needed for speech production.
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Opinions regarding the benefits of NSOMEs
Most of the respondents usually, often, or sometimes used NSOMEs to achieve
the following five claimed benefits of the treatment: (1) clients’ awareness of
the articulators (16/19 or 84%), followed by (2) drooling control (15/19 or
79%), (3) tongue elevation (13/19 or 68%), (4) feeding (14/21 or 67%), and
(5) jaw stabilization (12/19 or 63%). See Table 7 for details of the results.
Table 6 The number and percentage (in brackets) of respondents who reported using
nonspeech oral motor exercises (NSOMEs) in clinical practice and their
opinions towards seven statements on some assumptions of this treatment for
speech sound disorders (SSDs). The number of respondents who answered
the question was included at the end of each item.
Assumptions of NSOMEs and
Strongly
treatment for SSDs
agree
a. Development of intelligible speech
requires the use of separate oral
2 (10%)
motor tasks (n = 20)
b. Children with SSDs frequently lack
the strength necessary to produce
1 (5%)
intelligible speech (n = 19)
c. Speech develops from early oral
behaviours (e.g., sucking or
3 (14%)
chewing) (n = 21)
d. NSOMEs serve as groundwork
for the development of more
sophisticated motor movements
1 (5%)
necessary for speech production
(n = 21)
e. The use of NSOMEs for treating
SSDs is supported by research
0
literature (n = 21)
f. Dividing complex behaviours of
speech into component oral motor
0
movements is an efficient method
to treat SSDs (n = 21)
g. Muscle movements for NSOMEs
will carry over to muscle
0
movements for speech sound
productions (n = 20)
Agree
Neutral Disagree
Strongly
disagree
1 (5%)
4 (20%)
7 (35%)
6 (30%)
3 (16%)
3 (16%)
9 (47%)
3 (16%)
7 (33%)
5 (24%)
6 (29%)
0
8 (38%)
4 (19%)
7 (33%)
1 (5%)
0
6 (29%)
7 (33%)
8 (38%)
3 (14%)
5 (24%)
8 (38%)
5 (24%)
1 (5%)
5 (25%)
7 (35%)
7 (35%)
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16
Table 7 The number and percentage (in brackets) of respondents who used nonspeech
oral motor exercises to achieve 15 claimed benefits of this treatment approach.
The number of respondents who answered the question is included at the
end of each item.
a. Lateral tongue movements (n = 21)
b. Tongue protrusion (n = 20)
c. Tongue strength (n = 21)
d. Lip protrusion (n = 21)
e. Lip strength (n = 21)
f. Tongue elevation (n = 19)
g. Jaw stabilization (n = 19)
h. Sucking ability (n = 20)
i. Drooling control (n = 19)
j. Movement of the frenulum (n = 20)
k. Biting (n = 21)
l. Velopharyngeal competence (n = 19)
m. Clients’ awareness of the articulators
(n = 19)
n. Swallowing (n = 21)
o. Feeding (n = 21)
Usually
0
0
1 (5%)
0
1 (5%)
1 (5%)
0
2 (10%)
1 (5%)
1 (5%)
2 (10%)
0
Often
5 (24%)
2 (10%)
3 (14%)
2 (10%)
1 (5%)
3 (16%)
6 (31.5%)
2 (10%)
7 (37%)
2 (10%)
1 (5%)
1 (5%)
Sometimes
5 (24%)
6 (30%)
4 (19%)
8 (38%)
6 (28%)
9 (47%)
6 (31.5%)
6 (30%)
7 (37%)
3 (15%)
6 (28%)
8 (42%)
Never
11 (52%)
12 (60%)
13 (62%)
11 (52%)
13 (62%)
6 (32%)
7 (37%)
10 (50%)
4 (21%)
14 (70%)
12 (57&)
10 (53%)
1 (5%)
3 (16%)
12 (63%)
3 (16%)
1 (5%)
2 (10%)
4 (19%)
3 (14%)
6 (28%)
9 (43%)
10 (48%)
7 (33%)
Familiarity with research and theory related to NSOMEs
Most of the respondents reported that they were very familiar or familiar with
the research that investigated the effectiveness of NSOMEs (15/21 or 71%),
the relationship between NSOMEs and the development of speech (13/20
or 65%), and the theory related to NSOMEs and the relationship to speech
(14/21 or 67%) (Questions 8a to 8c; see Table 8 for details of results).
Opinions of SLTs who do not use NSOMEs (Part C)
How NSOMEs were used
Seventeen of the 39 respondents (44%) did not use NSOMEs in their clinical
practice. However, two of the 17 respondents (12%) indicated that they
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Use of Nonspeech Oral Motor Exercises
Use of Nonspeech Oral Motor Exercises
Table 8 Familiarity with research and theory related to nonspeech oral motor exercises
(NSOMEs) by respondents who used this treatment and those who did not.
The number of respondents who answered the question was included at the
end of each item.
Familiarity with…
Respondents who used NSOMEs
a. Research that examined
NSOMEs effectiveness (n = 21)
b. Relationship between NSOMEs
and speech development (n = 20)
c. Nonspeech oral motor skills
theory and its relationship to
speech (n = 21)
Respondents who did not use
NSOMEs
a. Research that examined
NSOMEs effectiveness (n = 17)
b. Relationship between NSOMEs
and speech development (n =
17)
c. Nonspeech oral motor skills
theory and its relationship to
speech (n = 17)
Very
Very
Familiar Neutral Unfamiliar
familiar
unfamiliar
3 (14%) 12 (57%) 5 (24%)
1 (5%)
0
2 (10%) 11 (55%) 4 (20%)
3 (15%)
0
2 (9%)
12 (57%) 6 (29%)
1 (5%)
0
0
11 (65%) 3 (18%)
1 (5%)
2 (12%)
0
10 (59%) 4 (23%)
0
3 (18%)
0
9 (52%)
3 (18%)
2 (12%)
3 (18%)
trained the caregivers of children with SSDs to use NSOMEs as part of a home
programme (Question 5) and one (1/17 or 6%) trained other professionals
to use this treatment approach (Question 6).
From where the respondents learned about NSOMEs
Almost all respondents indicated that they had not observed improved
speech production skills after NSOMEs (16/17 or 94%), although many of
them (11/16 or 65%) had observed improved nonspeech oral motor skills
after the treatment (Questions 1a to 1g). Most of the respondents reported
that they were not taught to use NSOMEs during their professional training
(13/17 or 76%) and that they had not read literature that encourages the use
of NSOMEs (13/16 or 81%). In addition, more than half of the respondents
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Use of Nonspeech Oral Motor Exercises
had not heard of the usefulness of NSOMEs from a colleague (10/17 or 59%)
and they had not attended any continuing education on the use of NSOMEs
(10/17 or 59%). Finally, half of the respondents (8/16 or 50%) had not read
internet sources that encourage the use of NSOMEs.
Sixteen respondents answered Question 2 regarding the two information
sources (as listed in Questions 1a to 1g) that had influenced their opinion
on NSOMEs the most. One respondent gave one answer only and four
respondents gave their own answers but two of the responses could not be
classified; hence, 29 responses were analyzed. The results showed that the
respondents did not use NSOMEs mainly because they had not read literature
that encourages the use of NSOMEs (7/31 or 23%), had not observed improved
speech production skills after NSOMEs (4/31 or 13%), and were not taught
to use NSOMEs during their professional training (4/31 or 13%).
Opinions regarding some assumptions of NSOMEs
All 17 respondents either disagreed or strongly disagreed that muscle
movements for nonspeech oral tasks will carry over to muscle movements
for speech sound productions (Questions 3a to 3g; see Table 9). Moreover,
most of the respondents disagreed or strongly disagreed with another five
statements:
(1) the development of intelligible speech requires the use of separate
oral motor tasks (15/17 or 88%);
(2) children with SSDs frequently lack the strength needed to produce
intelligible speech (11/16 or 69%);
(3) NSOMEs serve as groundwork for the development of more
sophisticated motor movements needed for speech production
(13/17 or 76%);
Use of Nonspeech Oral Motor Exercises
19
Table 9 The number and percentage (in brackets) of respondents who did not use
nonspeech oral motor exercises (NSOMEs) in clinical practice and their
opinions towards seven statements on some assumptions of this treatment for
speech sound disorders (SSDs). The number of respondents who answered
the question was included at the end of each item.
Assumptions of NSOMEs and
Strongly
treatment for SSDs
agree
a. Development of intelligible
0
speech requires the use of
separate oral motor tasks (n = 17)
b. Children with SSDs frequently
lack the strength necessary to
0
produce intelligible speech (n
= 16)
c. Speech develops from early oral
behaviours (e.g., sucking or
0
chewing) (n = 16)
d. NSOMEs serve as groundwork
for the development of more
sophisticated motor movements
0
necessary for speech production
(n = 17)
e. The use of NSOMEs for treating
SSDs is supported by research
0
literature (n = 17)
f. Dividing complex behaviours
of speech into component oral
0
motor movements is an efficient
method to treat SSDs (n = 17)
g. Muscle movements for NSOMEs
will carry over to muscle
0
movements for speech sound
productions (n = 17)
Agree
Neutral
Disagree
Strongly
disagree
2 (12%)
0
7 (41%)
8 (47%)
2 (12%)
3 (19%)
6 (38%)
5 (31%)
5 (31%)
4 (25%)
5 (31%)
2 (13%)
1 (6%)
3 (18%)
8 (47%)
5 (29%)
0
1 (6%)
3 (18%)
13 (76%)
0
1 (6%)
6 (35%)
10 (59%)
0
0
7 (41%)
10 (59%)
(4) the use of NSOMEs for treating SSDs is supported by the research
literature (16/17 or 94%); and
(5) dividing complex behaviours of speech into component oral motor
movements is an efficient method to treat SSDs (16/17 or 94%).
Nearly half of the respondents (7/16 or 44%) disagreed or strongly disagreed
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
that speech develops from early oral behaviours. The chi-square test was not
conducted to compare the NSOMEs users and non-users regarding their
opinions on the assumptions of NSOMEs, as the assumption of using this
test was violated.
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Use of Nonspeech Oral Motor Exercises
Familiarity with research and theory related to NSOMEs
More than half of the respondents reported they were familiar with the
research that investigated the effectiveness of NSOMEs (11/17 or 64%), the
relationship between NSOMEs and the development of speech (10/17 or 59%),
and the theory related to NSOMEs and the relationship to speech (9/17 or
53%) (Questions 4a to 4c; see Table 8 for details of results). The chi-square test
was not conducted to examine whether the level of familiarity with research
and theory of NSOMEs was related to whether the respondent was a user or
non-user of NSOMEs, as the assumption of using this test was violated.
SLTs’ use of speech therapy techniques for SSDs (Part D)
Thirty-six out of 39 respondents completed the final section of the questionnaires
which enquired whether they were familiar with 14 speech therapy techniques
and, if they were familiar with them, how frequently they used them in clinical
practice. All 36 respondents indicated that they were familiar with minimal
pairs, maximal pairs, and the phonemic awareness approach. There were
three therapy techniques which were less familiar among the respondents:
40% (14/35) indicated ‘unfamiliar’ for the motokinesthetic approach, 42%
(15/36) for the morphosyntactic approach, and 44% (16/36) for the paired
stimuli approach. These three techniques, as well as Hodson’s cycles approach,
were the four that were used by less than 50% of the respondents (see Table
10). The technique that was used most frequently was minimal pairs – 50%
(or 18) of the 36 respondents usually used it, followed by 33% (12/36) who
often used it, and 11% (or 4/36) sometimes used it. This is followed by the
phonemic awareness approach (which was usually, often, or sometimes
used by 32 or 89% of the respondents), maximal pairs (30/36 or 83%), Van
Riper traditional approach for sound elicitation (28/35 or 80%), auditory
bombardment/stimulation (28/36 or 78%) and whole language approach
(28/36 or 78%), the Metaphon approach (27/36 or 75%), and the Van Riper
traditional approach for sound stabilization (25/34 or 74%). The remaining
two techniques – distinctive feature approach and sensory motor approach
– were used by half of the respondents (18/35 or 51% and 19/36 or 53%,
respectively).
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Use of Nonspeech Oral Motor Exercises
21
Table 10 The respondents’ familiarity and frequency of use of 14 therapy techniques
for speech sound disorders. The number of respondents who answered this
question was included at the end of each item.
Familiar
Unfamiliar
Therapy technique
Usually
Often Sometimes Never
Minimal pairs (n = 36)
18 (50%) 12 (33%) 4 (11%)
2 (6%)
0
Maximal pairs (n = 36)
1 (3%) 14 (39%) 15 (41%) 6 (17%)
0
Van Riper traditional approach for
7 (20%) 11 (31%) 10 (29%) 4 (11%)
3 (9%)
sound elicitation (n = 35)
Van Riper traditional approach for
5 (15%) 9 (26%) 11 (32%) 4 (12%)
5 (15%)
sound stabilization (n = 34)
Auditory bombardment/
10 (28%) 5 (14%) 13 (36%) 7 (19%)
1 (3%)
stimulation (n = 36)
Hodson’s cycles approach (n = 35)
1 (3%)
1 (3%)
9 (26%) 14 (40%) 10 (28%)
Metaphon approach (n = 36)
1 (3%)
9 (25%) 17 (47%) 8 (22%)
1 (3%)
12
Whole language approach (n = 36) 4 (11%)
12 (33.5%) 4 (11%)
4 (11%)
(33.5%)
Motokinesthetic approach (n = 35) 1 (3%)
3 (9%)
10 (28%) 7 (20%) 14 (40%)
Phonemic awareness approach (n
4 (11%) 13 (36%) 15 (42%) 4 (11%)
0
= 36)
Distinctive feature approach (n
2 (6%)
4 (11%) 12 (34%) 10 (29%) 7 (20%)
= 35)
Morphosyntactic approach (n =
0
3 (8%)
8 (22%) 10 (28%) 15 (42%)
36)
Sensory motor approach (n = 36)
3 (8%)
5 (14%) 11 (31%) 10 (28%) 7 (19%)
Paired stimuli approach (n = 36)
1 (3%)
3 (8%)
6 (17%) 10 (28%) 16 (44%)
Summary of the main findings
The present survey found that 56% (22/39) of the respondents indicated
using NSOMEs. More than half of the respondents often or sometimes used
NSOMEs with children with childhood apraxia of speech, dysarthria, and
Down Syndrome. Most of the respondents used tongue depressors, straws,
and whistles; and many used the following tasks of NSOMEs – pucker-smile
alternations, tongue “push-ups”, blowing, and “big smile” exercises. Most of
the respondents used NSOMEs as a “warm up” with clients and they trained
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Use of Nonspeech Oral Motor Exercises
the caregivers of children with SSDs to use NSOMEs as part of a home
programme. Information from a colleague about the usefulness of NSOMEs,
continuing education offerings or workshops on NSOMEs, and literature have
influenced the respondents the most in their use of NSOMEs. Non-users of
NSOMEs, however, did not use this treatment approach because they had
not read literature that encourages its use, had not observed improved speech
production skills after NSOMEs, and were not taught to use this method
during their professional training. In general, most of the users and nonusers of NSOMEs disagreed with the assumptions of NSOMEs for treating
SSDs, except one – nearly half of the users and about one-third of the nonusers agreed that speech develops from early oral behaviours (e.g., sucking).
Finally, the majority of the respondents were familiar with and frequently
used minimal pairs, maximal pairs, and phonemic awareness approaches in
their practice.
Discussion
Percentage of respondents who used NSOMEs
This study collected information on the usage of NSOMEs by SLTs who had
worked or were working with children with SSDs in the Republic of Ireland
through an online questionnaire developed by following the one devised
by Lof and Watson (2008) for investigating the same issue in the US. The
present results showed that over half of the respondents (56%) reported using
NSOMEs in their clinical practice. This finding falls between the latest figures
reported – 37.6% in Australia (McLeod & Baker, 2014) and 67% in the US
(Brumbaugh & Smit, 2013). However, caution is needed when interpreting the
results because of the small number of respondents in the present study – 39
SLTs, which is very low considering the fact that approximately 700 practising
SLTs are current members of the IASLT (A. Healy, personal communication,
7 April 2014) and in comparison to the previous surveys, which ranged
from 98 (Joffe & Pring, 2008) to 537 respondents (Lof & Watson, 2008). In
addition, although the number of years of experience working with children
with SSDs of the respondents ranged from 1–5 years to over 20 years, nearly
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Use of Nonspeech Oral Motor Exercises
23
half of them were in the category of 1–5 years of clinical experience; hence,
it is possible that the result was skewed to some extent.
With whom, which, and how NSOMEs were used
Regarding the clinical groups with which the clinicians used NSOMEs, the
present findings were similar to those reported by Lof and Watson (2008)
and Hodge et al. (2005) that this treatment was used with children with
childhood apraxia of speech, dysarthria and Down Syndrome. However, the
SLPs in the US also used NSOMEs with children with structural anomalies
(Lof & Watson, 2008) and the SLPs in Alberta used the treatment with
children with phonological/articulation disorders or cerebral palsy as well
(Hodge et al., 2005).
For the NSOMEs used, the four tasks that were used most frequently by
clinicians in Ireland – pucker-smile alternations, tongue “push-ups”, blowing,
and “big smile” exercises – were also used frequently by the SLPs who took
part in Lof and Watson’s study. However, the other five tasks that were also
used frequently by the SLPs in Lof and Watson’s study – tongue lateralizations,
tongue-to-nose and tongue-to-chin movements, cheek puffing, blowing kisses,
and tongue curling – were used (sometimes or often) by less than 50% of the
respondents in the present study.
Similar to the findings reported by Lof and Watson, the majority of the
SLTs who reported using NSOMEs in this study used this treatment as a
“warm up” (68%; Lof & Watson, 2008). However, as reviewed in previous
literature (e.g., Lof & Watson, 2010), warm-up of muscles is only needed
when engaging in activities that tax the muscular system, such as running.
As speech production does not involve high muscular strength, warm-up is
really not necessary to prepare the child to engage in speech production tasks.
In the present study, most of the respondents who reported using NSOMEs
also trained caregivers of children with SSDs to use this treatment as part of
a home programme; whereas a small number of respondents who did not
use NSOMEs (two persons) trained caregivers to use NSOMEs. For both
groups of respondents – users and non-users of NSOMEs – the majority did
not train other professionals to use this treatment. The finding that a small
number of non-users trained others to use NSOMEs is quite surprising as
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Use of Nonspeech Oral Motor Exercises
Use of Nonspeech Oral Motor Exercises
25
one would expect that a clinician would not do so if s/he did not believe in
or use the treatment approach.
articles and books. This finding again highlighted the importance of accessing
valid information regarding the efficacy of NSOMEs.
From where the respondents learned about NSOMEs
Opinions regarding some assumptions of NSOMEs
There were both similarities and discrepancies between the present results
and those reported by Lof and Watson (2008) concerning the sources of
information from which the users of NSOMEs learned about this treatment
approach. Both studies reported that most of the respondents reported having
observed improved nonspeech oral motor skills after NSOMEs (92.7% of
the respondents in Lof and Watson’s study) and that continuing education
offerings or workshops on NSOMEs was one important factor that influenced
their use of this treatment in clinical practice (87%; Lof & Watson, 2008).
However, the other two factors that influenced the SLPs in Lof and Watson’s
study to use NSOMEs – observed improved speech productions (86.3%) and
using NSOMEs because other speech elicitation techniques did not work
(68%) – were not the main reasons why the respondents in the present study
used NSOMEs. Instead, the SLTs in this study used NSOMEs because many
of them reported having read literature and internet sources that encourage
the use of this treatment or they were convinced by a colleague that NSOMEs
are useful. This finding has an important implication for SLT education and
continuous professional education – students and practising clinicians should
be given valid information regarding the efficacy of NSOMEs.
There were also similarities and discrepancies in terms of information
sources for NSOMEs between users of this treatment approach and non-users in
the present study. One similarity was that more than half of the respondents in
both groups indicated that they had observed improved nonspeech oral motor
skills after NSOMEs. However, the differences were that fewer respondents
who were non-users of NSOMEs in this study reported (1) being taught to
use this treatment during SLT training, (2) having observed improved speech
production after NSOMEs, and (3) having read literature and/or internet
sources that encourage the use of this treatment. Interestingly, many users
of NSOMEs reported having read literature that supports NSOMEs, which
is one important factor that influenced them using this treatment; and at the
same time, many non-users reported that they had not read literature that
supports NSOMEs and this is one important reason why they did not use
NSOMEs. The literature that supports NSOMEs is mostly non-peer-reviewed
The present study showed that most of the respondents who reported using
NSOMEs did not agree with most of the assumptions about this treatment
approach. None of these respondents agreed that the use of NSOMEs for
treating SSDs is supported by the research literature. There were relatively
more respondents (but still less than 50%) who agreed that speech develops
from early oral behaviours, such as sucking or chewing; and that NSOMEs
serve as groundwork for the development of motor movements needed for
speech production. Lof and Watson (2008) reported that 60% of the SLPs
believed that speech develops from early oral behaviours; however, results
for other assumptions were not reported. Nevertheless, it is speculated that,
in general, relatively fewer clinicians in the present study believed in those
assumptions of NSOMEs compared to Lof and Watson’s study which was
published six years ago.
Comparing the opinions of the respondents who used NSOMEs to
those who did not, it was found that relatively fewer respondents who were
non-users agreed with the assumptions of NSOMEs and there were three
assumptions with which none of the non-users agreed: use of NSOMEs was
supported by research literature; dividing complex articulatory gestures is an
efficient method to treat SSDs; and treatment effect of NSOMEs will carry
over to speech productions. However, relatively more respondents, regardless
whether they were users of NSOMEs or not, agreed with the assumption that
speech develops from early oral behaviours. As reviewed above and in previous
literature (see, e.g., Lof & Watson, 2008, 2010), the neural representation is
task-specific; hence, early nonspeech behaviours are not likely to generalize to
later speech development. The present findings provided useful information
for the planning of the content of future SLT education and continuous
professional education.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Opinions regarding the benefits of NSOMEs
This study found that over 60% of the respondents used NSOMEs to achieve
five claimed benefits; whereas Lof and Watson (2008) reported 10 benefits and
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Use of Nonspeech Oral Motor Exercises
Hodge et al. (2005) reported three. Enhancing the clients’ awareness of the
articulators is the one that was considered as a benefit of NSOMEs by many
respondents in the present study and the two previous studies (Hodge et al.,
2005; Lof & Watson, 2008). Moreover, the respondents in this study and the
one by Lof and Watson found NSOMEs useful for achieving tongue elevation,
jaw stabilization, and drooling control. The respondents in the current study
also found NSOMEs useful for feeding, while this was not reported in the
other two previous studies (Hodge et al., 2005; Lof & Watson, 2008). According
to Lof and Watson (2008), their respondents also found NSOMEs useful for
attaining tongue and lip strength, lateral tongue movements, tongue and lip
protrusion, velopharyngeal competence, and sucking ability. The respondents
in Hodge et al.’s study found NSOMEs useful for improving strength and/or
coordination of articulators and increasing intelligibility.
Familiarity with research and theory related to NSOMEs
This study found that over 50% of the respondents, regardless of whether they
had used NSOMEs or not, indicated that they were familiar with research
and theory related to NSOMEs. The main difference between the users and
non-users of NSOMEs was that none of the respondents who had used this
treatment indicated that they were very unfamiliar with the topic; whereas
none of the respondents who had not used this treatment indicated that they
were very familiar with the topic. The present findings are generally congruent
with the results reported by Lof and Watson (2008) where they reported a
mean rating of 3.05 (rated on a 4-point scale where 4 means very familiar)
regarding the respondents’ familiarity with research that investigated the
efficacy of NSOMEs and a mean rating of 2.74 for the theoretical basis that
supports the use of NSOMEs.
SLTs’ use of speech therapy techniques for SSDs
In general, the speech therapy techniques for SSDs that were used frequently
by most clinicians in Ireland were similar to those reported in previous studies
conducted in other countries (Brumbaugh & Smit, 2013; Joffe & Pring, 2008;
McLeod & Baker, 2014) – minimal pairs and phonological/phonemic awareness
approach were the most frequently-used therapy techniques.
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Use of Nonspeech Oral Motor Exercises
27
Limitations of the present study
As stated above, a weakness of the current study is the low number of
respondents. The low number of responses was likely to be a consequence of
the limitations in the method of distributing the questionnaire. For example,
in the two surveys conducted in the US, the investigators had access to the
American Speech-Language-Hearing Association (ASHA) membership
database (Brumbaugh & Smit, 2013; Lof & Watson, 2008) and the survey
carried out in Canada (Hodge et al., 2005) was distributed to all registered
SLPs in Alberta through the Alberta College of Speech-Language Pathologists
and Audiologists (ACSLPA). Although messages about the present survey
were made available to all IASLT members through the Association on their
website and social media pages (Facebook and Twitter), members who were
not users of those social media websites or those who do not visit these
websites regularly, and the practising SLTs who are not IASLT members were
probably not aware of this study. This was reflected in the results that most
of our respondents were relatively recent graduates, who were more likely to
be active social media users.
Another limitation of the present survey is that it did not ask the
respondents directly why they chose to use NSOMEs with their clients.
Although the answers to some of the questions (e.g., how NSOMEs were used,
from where the respondents learned about this treatment, and the sources
of information that influenced them the most regarding using NSOMEs)
provided some insights on the reasons for using NSOMEs, it would have
been useful if an open question on why NSOMEs were used was included
in the questionnaire.
Clinical implications of the present findings
The present study showed that 56% (22 out of 39 respondents) reported using
NSOMEs in their clinical practice despite the lack of evidence that supports the
efficacy of this treatment approach. The treatment was still used mostly with
children with childhood apraxia of speech, dysarthria, and Down Syndrome
and often as a “warm up”. One clinical implication of the present findings
is that we should continue our efforts in educating our students (SLT-intraining) and bring the attention of practising clinicians to the importance
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Use of Nonspeech Oral Motor Exercises
of applying evidence-based practice in clinics. This could be achieved by
ensuring that relevant topics are covered in the SLT curriculum, as well as
providing continuous education offerings where SLTs are given access to
valid sources of information or literature concerning the theory and efficacy
of NSOMEs. This suggestion is feasible and very likely to be useful, as this
study revealed that literature and professional training were the important
factors that could influence clinicians’ practice. In addition, future continuous
professional education could also include courses or talks on other speech
therapy techniques with which efficacy have been established in the literature,
so that clinicians are equipped with a wider range of techniques for managing
clients, especially those with complicated speech problems.
Another clinical implication is the need of well-designed treatment studies
for answering the question regarding the efficacy of NSOMEs. As shown in
the recent systematic reviews (Lass & Pannbacker, 2008; Lee & Gibbon, 2015;
McCauley et al., 2009; Ruscello, 2008), the current evidence on the efficacy
of NSOMEs comes mainly from small-scale controlled studies that were
associated with a number of serious methodological limitations. For example,
Lee and Gibbon (2015) found three NSOMEs treatment studies: two did not
find combined NSOMEs and conventional articulation and/or phonological
therapy to be more effective than conventional articulation and/or phonological
therapy alone; and one study reported changes (possibly improvement) in
articulation after the combined NSOMEs and speech therapy. However, the
inappropriate statistical test used and the ambiguous presentation of results
made it impossible to draw any meaningful conclusions regarding the efficacy
of NSOMEs. Hence, at present, clinicians should be aware that there is no
strong evidence of treatment efficacy of NSOMTs (Lee & Gibbon, 2015) and
that they should use other speech therapy techniques for which the efficacy
has already been established in the literature (McCauley et al., 2009).
Acknowledgements
The authors would like to thank Gregory Lof and Maggie Watson for their
useful suggestions on the development of the questionnaire and the speech
and language therapists-in-training who provided helpful feedback on the
initial version of the questionnaire. Sincerest thanks also go to the Irish
Association of Speech and Language Therapists and the speech and language
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
29
therapy managers of SLT services in southern Ireland for distributing the
questionnaire. Lastly, the authors are most grateful to the speech and language
therapists who had taken the time to participate in this study.
The paper was based on a final-year honours project titled “The use of
nonspeech oral motor exercises in the treatment of developmental speech sound
disorders by speech and language therapists in the Republic of Ireland” by
Niamh Moore (the second author), University College Cork, Ireland, 2014.
References
Bowen, C. (2005). What is the evidence for oral motor therapy? ACQuiring Knowledge in
Speech, Language and Hearing, 7, 144–147.
Brumbaugh, K.M. & Smit, A.B. (2013). Treating children ages 3–6 who have speech
sound disorder: A survey. Language, Speech, and Hearing Services in Schools,
44, 306–319.
Hodge, M., Salonka, R. & Kollias, S. (2005, November). Use of nonspeech oral-motor
exercises in children’s speech therapy. Paper presented at the 2005 ASHA (American
Speech-Language-Hearing Association) Convention, San Diego.
International Expert Panel on Multilingual Children’s Speech. (2012). Multilingual children
with speech sound disorders: Position paper. Bathurst, NSW, Australia: Research
Institute for Professional Practice, Learning and Education (RIPPLE), Charles
Sturt University. Retrieved from http://www.csu.edu.au/research/multilingualspeech/position-paper
Joffe, V. & Pring, T. (2008). Children with phonological problems: A survey of clinical
practice. International Journal of Language & Communication Disorders, 43,
154–164.
Lass, N.J. & Pannbacker, M. (2008). The application of evidence-based practice to
nonspeech oral motor treatments. Language Speech and Hearing Services in
Schools, 39(3), 408–421.
Lee, A.S.-Y. & Gibbon, F.E. (2015). Non-speech oral motor treatment for developmental
speech sound disorders in children. Cochrane Database of Systematic Reviews
2015, Issue 3. Art. No.: CD009383. DOI: 10.1002/14651858.CD009383.pub2.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
30
Use of Nonspeech Oral Motor Exercises
Use of Nonspeech Oral Motor Exercises
Lof, G.L. (2003, April). Oral motor exercises and treatment outcomes. Perspectives on
Language Learning and Education, 10(1), 7–11.
Appendix
Lof, G.L. (2006, November). Logic, theory and evidence against the use of non-speech oral
motor exercises to change speech sound productions. Paper presented at the
2006 ASHA (American Speech-Language-Hearing Association) Convention,
Miami Beach, USA.
Questionnaire
Lof, G.L. (2007, November). Reasons why non-speech oral motor exercises should not be
used for speech sound disorders. Paper presented at the 2007 ASHA Convention,
Boston, USA.
Lof, G.L. (2009a, November). Non-speech oral motor exercises: An update on the controversy.
Paper presented at the 2009 ASHA Convention, New Orleans, USA.
Lof, G.L. (2009b). The nonspeech-oral motor exercise phenomenon in speech pathology
practice. In C. Bowen (Ed.), Children’s Speech Sound Disorders (pp. 180–184).
West Sussex: Wiley-Blackwell.
Lof, G.L. & Watson, M. (2010). Five reasons why Nonspeech Oral Motor Exercises (NSOME)
do not work. Perspectives on School-Based Issues, 11, 109–117.
Lof, G.L. & Watson, M.M. (2008). A nationwide survey of nonspeech oral motor exercise
use: Implications for evidence-based practice. Language, Speech & Hearing
Services in the Schools, 39, 392–407.
Marshalla, P. (2000). Oral-motor Techniques in Articulation and Phonological Therapy.
Kirkland, WA: Marshall Speech and Language.
McCauley, R.J., Strand, E., Lof, G.L., Schooling, T. & Frymark, T. (2009). Evidence-based
systematic review: Effects of nonspeech oral motor exercises on speech. American
Journal of Speech-Language Pathology, 18(4), 343–360.
McLeod, S. & Baker, E. (2014). Speech-language pathologists’ practices regarding assessment,
analysis, target selection, intervention, and service delivery for children with
speech sound disorders. Clinical Linguistics & Phonetics, 28(7–8), 508–531.
Pallant, J. (2005). SPSS Survival Manual: A Step by Step Guide to Data Analysis using SPSS
for Windows (Version 12) (2nd ed.). Maidenhead, Berkshire: Open University
Press.
Rosenfeld-Johnson, S. (2001). Oral-motor Exercises for Speech Clarity. Tucson, AZ:
Innovative Therapists.
Ruscello, D.M. (2008). Treating Articulation and Phonological Disorders in Children. St.
Louis, MO: Mosby Elsevier.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
31
The first box shows the first page of the online questionnaire where consent
from the each respondent was obtained, and the second box shows the
second page which was displayed after the respondents had clicked on the
“next” button. The second page gives the definition of nonspeech oral motor
exercises and instructions on completing the questionnaire. The content of
the entire questionnaire follows.
A Questionnaire on the Use of Nonspeech Oral Motor Exercises in Ireland
Department of Speech and Hearing Sciences
University College Cork
Please read the following statements carefully. Please click the “next” button at the bottom
of this page if you agree with these statements; this will constitute as your willingness to
participate.
“I am a Speech and Language Therapist who has worked or works with developmental
speech sound problems in the Republic of Ireland.
I have read the information sheet of this study (sent to me by email). I am aware of the
aims of this research study and I know that I can ask questions if I want to. I am also aware
that my participation is completely voluntary and that I can withdraw from the study at
any time without consequence. In addition, I am aware that my participation in this study
and the information I give will be kept completely confidential.”
Nonspeech oral motor exercises are defined as any exercise that does not require the child
to produce a speech sound but is used to influence the development of speech abilities.
Part A must be completed by all participants.
Part B must be completed only by participants who use nonspeech oral motor
exercises.
Part C must be completed only by participants who do not use nonspeech oral motor
exercises.
Part D must be completed by all participants.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
32
Use of Nonspeech Oral Motor Exercises
PART A: DEMOGRAPHIC INFORMATION
Part A must be completed by all participants.
Enter the year each of your degrees were obtained (leave it blank if it does not apply):
Masters
Phd
Other
Bachelors
Enter the name(s) of the county/counties in which you are working:
Enter the percentage of time you work at each of the following settings. The total should add
up to 100%:
Language Class in School
Community Care
Hospital
Disability Services
Private Practice
Other
Tick the number of years you have worked with children with speech sound problems:
1-5 years
6-10 years
11-15 years
15-20 years
More than 20 years
Tick the total number of children currently on your caseload:
1-10
11-20
21-30
31-40
41-50
51-60
61-70
More than 71
Among the children currently on your caseload, tick the total number of children receiving
services for some type of speech sound disorders:
1-10
11-20
21-30
31-40
41-50
51-60
61-70
More than 71
PART B: YOUR USE OF NONSPEECH ORAL MOTOR EXERCISES
Part B must be completed only by participants who use nonspeech oral motor exercises.
1a. I was taught to use nonspeech oral motor exercises during my Speech and Language
Therapy training (lectures/tutorials).
Yes
No
1b. I was taught to use nonspeech oral motor exercises during my Speech and Language
Therapy training (clinical placement).
Yes
No
1c. I have observed improved speech production skills as a result of using nonspeech oral
motor exercises.
Yes
No
1d. I have observed improved nonspeech oral motor skills as a result of using nonspeech oral
motor exercises.
Yes
No
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Use of Nonspeech Oral Motor Exercises
33
1e. I use nonspeech oral motor exercises as I have found that other types of speech elicitation
exercises did not work for some of my clients.
Yes
No
1f. A colleague informed me about the usefulness of nonspeech oral motor exercises.
Yes
No
1g. I have attended continuing education offerings, workshops, and/or in-services on the use
of nonspeech oral motor exercises.
Yes
No
1h. I have read literature (e.g. journal articles, book chapters) that encourages the use of
nonspeech oral motor exercises.
Yes
No
1i. I have read internet sources (e.g. websites, blogs) that encourage the use of nonspeech oral
motor exercises.
Yes
No
In relation to Question 1 above, which TWO sources of information have influenced you the
most regarding your use of nonspeech oral motor exercises? Please put the question numbers
in the boxes below.
3a. The development of intelligible speech requires the use of separate oral motor tasks.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3b. Children with speech sound disorders frequently lack the strength necessary to produce
intelligible speech.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3c. Speech develops from early oral behaviours, such as sucking or chewing.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3d. Oral motor exercises serve as a groundwork for the development of more sophisticated
motor movements necessary for speech production.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3e. The use of nonspeech oral motor exercises for treating speech sound disorders is supported
by the research literature.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3f. Dividing the complex behaviours of speech into component oral motor movements is an
efficient method to treat speech sound disorders.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3g. Muscle movements for nonspeech oral tasks will carry over to muscle movements for
speech sound productions.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
4a. Indicate how often you use nonspeech oral motor exercises with children with
phonological disorders.
Usually
Often
Sometimes
Never
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34
Use of Nonspeech Oral Motor Exercises
4b. Indicate how often you use nonspeech oral motor exercises with children with Childhood
Apraxia of Speech.
Usually
Often
Sometimes
Never
4c. Indicate how often you use nonspeech oral motor exercises with children with
Dysarthria.
Usually
Often
Sometimes
Never
4d. Indicate how often you use nonspeech oral motor exercises with children with Functional
Articulation Disorders.
Usually
Often
Sometimes
Never
4e. Indicate how often you use nonspeech oral motor exercises with children with Structural
Anomalies (e.g. cleft palate).
Usually
Often
Sometimes
Never
4f. Indicate how often you use nonspeech oral motor exercises with children with Down
Syndrome.
Usually
Often
Sometimes
Never
4g. Indicate how often you use nonspeech oral motor exercises with children who are “late
talkers”.
Usually
Often
Sometimes
Never
4h. Indicate how often you use nonspeech oral motor exercises with children with hearing
impairment.
Usually
Often
Sometimes
Never
4i. Name other client groups with which you are nonspeech oral motor exercises and
indicate how often you use nonspeech oral motor exercises with these groups (usually or
sometimes).
5a. Nonspeech oral motor exercises often involve various materials. How often do you use
horns in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5b. How often do you use balloons in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5c. How often do you use tongue depressors in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5d. How often do you use straws in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5e. How often do you use bite sticks or bite blocks in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
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Use of Nonspeech Oral Motor Exercises
35
5f. How often do you use brushes in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5g. How often do you use whistles in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5h. How often do you use kazoos in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5i. How often do you use Facial Flex in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
5j. Name any other materials you use for nonspeech oral motor exercises and state how often
you use them (usually or sometimes).
6a. Nonspeech oral motor exercises often involve a variety of procedures. How often do you
use whistling in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6b. How often do you use pucker-smile alternations in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6c. How often do you use tongue “push-ups” in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6d. How often do you use tongue lateralizations (wags) in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6e. How often do you use tongue curling in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6f. How often do you use tongue grooving in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6g. How often do you use cheek puffing in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6h. How often do you use tongue to nose and tongue to chin movements in nonspeech oral
motor exercises?
Usually
Often
Sometimes
Never
6i. How often do you use jaw lateral and vertical movements in nonspeech oral motor
exercises?
Usually
Often
Sometimes
Never
6j. How often do you use blowing (e.g. cotton balls) in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6k. How often do you use “big smile” exercises in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
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Use of Nonspeech Oral Motor Exercises
6l. How often do you use exaggerated lip licking in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6m. How often do you use kiss blowing in nonspeech oral motor exercises?
Usually
Often
Sometimes
Never
6n. Name any other procedures you use for nonspeech oral motor exercises and state how
often you use them (usually or sometimes).
Please tick one box below to select which of the four options best defines your use of
nonspeech oral motor exercises (NSOMEs) when working with children who have speech
sound disorders:
I almost restrict my sessions to NSOMEs.
When the client reaches a set criterion I stop using NSOMEs.
I divide therapy time equally between NSOMEs and targeting speech productions.
I use NSOMEs as a “warm up”.
8a. How familiar are you with research that has investigated the effectiveness of using
nonspeech oral motor exercises.
Very familiar
Familiar
Neutral
Unfamiliar
Very unfamiliar
8b. How familiar are you with the relationship between nonspeech oral motor exercises and
the development of speech.
Very familiar
Familiar
Neutral
Unfamiliar
Very unfamiliar
8c. How familiar are you with the theory related to nonspeech oral motor skills and the
relationship to speech.
Very familiar
Familiar
Neutral
Unfamiliar
Very unfamiliar
9a. How often do you use nonspeech oral motor exercises to improve lateral tongue
movements?
Usually
Often
Sometimes
Never
9b. How often do you use nonspeech oral motor exercises to improve tongue protrusion?
Usually
Often
Sometimes
Never
9c. How often do you use nonspeech oral motor exercises to improve tongue strength?
Usually
Often
Sometimes
Never
9d. How often do you use nonspeech oral motor exercises to improve lip protrusion?
Usually
Often
Sometimes
Never
9e. How often do you use nonspeech oral motor exercises to improve lip strength?
Usually
Often
Sometimes
Never
9f. How often do you use nonspeech oral motor exercises to improve tongue elevation?
Usually
Often
Sometimes
Never
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Use of Nonspeech Oral Motor Exercises
37
9g. How often do you use nonspeech oral motor exercises to improve jaw stabilization?
Usually
Often
Sometimes
Never
9h. How often do you use nonspeech oral motor exercises to improve sucking ability?
Usually
Often
Sometimes
Never
9i. How often do you use nonspeech oral motor exercises to improve drooling control?
Usually
Often
Sometimes
Never
9j. How often do you use nonspeech oral motor exercises to improve movement of the
frenulum?
Usually
Often
Sometimes
Never
9k. How often do you use nonspeech oral motor exercises to improve biting?
Usually
Often
Sometimes
Never
9l. How often do you use nonspeech oral motor exercises to improve velopharyngeal
competence?
Usually
Often
Sometimes
Never
9m. How often do you use nonspeech oral motor exercises to improve client’s awareness of
the articulators?
Usually
Often
Sometimes
Never
9n. How often do you use nonspeech oral motor exercises to improve swallowing?
Usually
Often
Sometimes
Never
9o. How often do you use nonspeech oral motor exercises to improve feeding?
Usually
Often
Sometimes
Never
9p. Name other areas you target using nonspeech oral motor exercises. Also state how often
you use nonspeech oral motor exercises to improve these areas (usually or sometimes).
I generally train caregivers to carry out nonspeech oral motor exercises as part of a home
program.
Yes
No
I generally train other professionals (e.g. teachers, Occupational Therapists, Physiotherapists)
to carry out nonspeech oral motor exercises as part of a treatment program.
Yes
No
I am of the opinion that nonspeech oral motor exercises can favour children of any age.
Yes
No
PART C: YOUR OPINION ON THE USE OF NONSPEECH ORAL MOTOR
EXERCISES
Part C must be completed only by participants who do not use nonspeech oral motor
exercises.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
38
Use of Nonspeech Oral Motor Exercises
1a. During my Speech and Language Therapy training I was taught to use nonspeech oral
motor exercises.
Yes
No
1b. I have observed improved speech production skills as a result of using nonspeech oral
motor exercises.
Yes
No
1c. I have observed improved nonspeech oral motor skills as a result of using nonspeech oral
motor exercises.
Yes
No
1d. A colleague informed me about the usefulness of nonspeech oral motor exercises.
Yes
No
1e. I have attended continuing education offerings, workshops, and/or in-services on the use
of nonspeech oral motor exercises.
Yes
No
1f. I have read literature (e.g. journal articles, book chapters) that encourages the use of
nonspeech oral motor exercises.
Yes
No
1g. I have read internet sources (e.g. websites, blogs) that encourage the use of nonspeech
oral motor exercises.
Yes
No
In relation to Question 1 above, which TWO sources of information have influenced you
the most regarding your opinion concerning nonspeech oral motor exercises? Please put the
question numbers in the boxes below.
3a. The development of intelligible speech requires the use of separate oral motor tasks.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3b. Children with speech sound disorders frequently lack the strength necessary to produce
intelligible speech.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3c. Speech develops from early oral behaviours, such as sucking or chewing.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3d. Oral motor exercises serve as a groundwork for the development of more sophisticated
motor movements necessary for speech production.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3e. The use of nonspeech oral motor exercises for treating speech sound disorders is supported
by the research literature.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3f. Dividing the complex behaviours of speech into component oral motor movements is an
efficient method to treat speech sound disorders.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Use of Nonspeech Oral Motor Exercises
39
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
3g. Muscle movements for nonspeech oral tasks will carry over to muscle movements for
speech sound productions.
Strong Agree
Agree
Neutral
Disagree
Strongly Disagree
4a. How familiar are you with research that has investigated the effectiveness of using
nonspeech oral motor exercises.
Very familiar
Familiar
Neutral
Unfamiliar
Very unfamiliar
4b. How familiar are you with the relationship between nonspeech oral motor exercises and
the development of speech.
Very familiar
Familiar
Neutral
Unfamiliar
Very unfamiliar
4c. How familiar are you with the theory concerning nonspeech oral motor skills and the
relationship to speech.
Very familiar
Familiar
Neutral
Unfamiliar
Very unfamiliar
I generally train caregivers to carry out nonspeech oral motor exercises as part of a home
program.
Yes
No
I generally train other professionals (e.g. teachers, Occupational Therapists, Physiotherapists)
to carry out nonspeech oral motor exercises as part of a treatment program.
Yes
No
PART D: THERAPY TECHNIQUES FOR SPEECH SOUND PROBLEMS
Part D must be completed by all participants.
Listed below are some techniques used in therapy for speech sound disorders.
If you are not familiar with an approach then tick the “unfamiliar” box.
If you are familiar with an approach, then place a tick in only one box to indicate how often
you use the approach.
Minimal pairs
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Maximal pairs
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Van Riper traditional approach for sound elicitation
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Van Riper traditional approach for sound stabilization
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Auditory bombardment/stimulation
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Hodson’s cycles approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Metaphon approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
40
Use of Nonspeech Oral Motor Exercises
Whole language approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Motokinesthetic approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Unfamiliar
Phonemic awareness approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Distinctive feature approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Morphosyntactic approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Sensory motor approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Paired stimuli approach
Usually use
Often us
Sometimes use
Never use
Unfamiliar
Other (name any other approaches you use and state how often you use them [usually,
often, sometimes])
A Qualitative Exploration
of Maternal Perspectives
on the Impact of Stuttering
on the lives of 6–10-year-old children
Elizabeth Armstrong1, Mary-Pat O’Malley Keighran1,
Patricia Collins2 and Clare Carroll1
1National University of Ireland, Galway, Ireland
2Health Service Executive, Shantalla, Galway, Ireland
Correspondence to:
Elizabeth Armstrong, Discipline of Speech and Language Therapy, School of
Health Sciences, Aras Moyola, NUI Galway, Galway, Ireland
Email: betharmstrong91@gmail.com
Abstract
Objective: The study aimed to explore maternal perspectives of the
impact of stuttering on the lives of 6–10-year-old children’s relationships,
self-identity, and academic development.
Method: A qualitative design was used: five semi-structured interviews
were conducted with mothers of children aged 6–10 years who stutter.
The data was analyzed using thematic network analysis.
Main results: While participants differed in their perceptions of the extent
to which stuttering influenced their child’s life, all five discussed aspects of
how their child’s relationships, self-identity and academic development had
been impacted. Mothers described their child’s personal characteristics,
their school environment, how their child communicated with family
members and peers and how others related to their child.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
42
Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
Conclusion: The findings indicate that, when developing goals for therapy,
speech and language therapists should consider how stuttering may be
affecting a child in all areas of his/her life. An unexpected finding related
to maternal stress levels associated with their child’s stuttering which
may be an important variable to consider in treatment. The findings can
inform clinical decision-making regarding treatment goals for children
who stutter and their parents.
Keywords: Stuttering, impact of stuttering on children, mothers’
perceptions, relationships, communication
Background
“Stuttering is like an iceberg, with only a small part above the waterline and
a much bigger part below” (Sheehan, 1970, p. 184). There is little agreement
amongst researchers regarding a description of stuttering and the emotions
surrounding it, with some describing it as a primarily physiological entity and
others in terms of its psychological or social limitations. Attempting to define
stuttering is therefore problematic (Acton & Hird, 2004). For the purposes of
this study, stuttering is described as a complex communication impairment
which can obstruct the forward flow of speech and create negative emotions
and reactions in both speakers and listeners (Guitar, 2006). A review of the
literature suggests that, as well as communication difficulties, stuttering
can affect an individual’s daily activities, relationships, mental health and
educational or career choices (Craig, Blumgart & Tran, 2009; Enderby et al.,
2009; Yaruss, 2010). Research exists regarding teenage (Zuckner, 2010) and
preschool stuttering (Langevin, Packman & Onslow, 2010), with the age range
of preschoolers differing slightly from country to country. Children between
the ages of 6 and 10, the focus of the current study, have unique psychosocial,
emotional and behavioural developmental patterns that differ from younger
children and adolescents (Lau, Beilby, Byrnes & Hennessey, 2012).
Family relationships
A school-aged child’s primary relationships are with their parents, siblings,
peers and teachers. The majority of parents in Langevin et al.’s (2010) study
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
43
believed stuttering had not influenced their relationship with their preschool
child; however, these findings may not relate to older children. Children
who stutter (CWS) have been found to be less attached to their parents than
their non-stuttering peers (Beilby, 2014; Lau et al., 2012). Having a child
who stutters can be stressful for parents and some experience guilt and find
it difficult to cope, especially when stuttering first emerges (Goodhue et al.,
2010; Plexico & Burrus, 2012). Parents may also perceive stuttering to have
a greater effect on their child than does the child him- or herself (Cook &
Howell, 2013). Beilby, Byrnes and Young (2012) found that approximately
50% of their sample of siblings of CWS reported that having a sibling who
stuttered affected their relationship. Although many siblings reported having
a strong bond and a protective role, participants also described instances of
conflict due to perceived parental favouritism of CWS. They also reported
their occasional frustration with or embarrassment about the CWS. While
the study had a robust design and produced valuable findings, its sample size
was small (n=12) and the researchers did not compare the experiences of
younger siblings of CWS with those of older siblings. Siblings of CWS have
also been reported to engage in teasing behaviours (Langevin et al., 2010).
Peer relationships
A child’s participation in social discourse may be disrupted by stuttering,
and CWS often avoid communicatively difficult situations (Lau et al.,
2012). Crichton-Smith’s (2002) study revealed strong themes of social
limitations, beginning in childhood and continuing into adulthood. CWS
are commonly affected by bullying (Klompas & Ross, 2004; Langevin
& Narasimha Prasad, 2012) and are perceived by their peers to be less
popular and are often rejected, even though educational systems have
generally become more inclusive of children with disabilities (Davis,
Howell & Cooke, 2002).
But not all CWS are socially isolated. Hugh-Jones and Smith (1999)
and Lau et al. (2012) found that some of their participants were outgoing
and generally reported having enjoyable and supportive friendships, but
the number and extent of friends was variable and limited, and many
reported feelings of loneliness at school.
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
School environment
Unlike a preschool child whose main occupation is play, the school environment
places greater emphasis on verbal communication and can be a communicatively
demanding situation for CWS (Lau et al., 2012). Marshall, Ralph and Palmer
(2002) found that few teachers felt competent to teach children with speech
and language difficulties while Crichton-Smith (2002) notes that teachers
can often have negative reactions to their students’ stuttering. Plexico,
Plumb and Beacham (2013) found that a majority of teachers surveyed felt
helpless or anxious when a child in their class stuttered and more than half
reported having witnessed bullying of CWS. However, these findings should
be interpreted cautiously as the study had a low response rate and those
who did respond may have had a particular bias with regard to childhood
stuttering. Nonetheless, it is likely that the response of teachers to a child’s
stuttering impacts on the child’s ability to communicate and participate in
classroom activities.
O’Brian et al. (2011) found a significant negative association between
stuttering severity and educational achievement, but did not ascertain
the extent of its impact. Difficulties with reading for CWS are commonly
discussed: Guitar (2006) notes that CWS often stutter more while reading
than in spontaneous speech as they cannot alter their words, whilst Ardila
et al. (1994) found that adults who stutter had significantly higher risks of
having co-occurring dyslexia.
Self identity
Identity is described as the representation of oneself that emerges through
participation with others across varying social contexts (Hagstrom & Daniels,
2004). Self identity is developed throughout the lifespan, and school-age
children are beginning to form their identity (Daniels & Gabel, 2004; Lau
et al., 2012). Although the relationship between stuttering and identity has
been recently examined (Zuckner, 2010), there is little research specific to
6–10-year-old children. If a child’s communication is frequently interrupted
by stuttering, he/she can start to experience associated negative emotions
that may become part of their way of communicating and thus affect their
self-identity (Hagstrom & Daniels, 2004). Similarly, Boey et al. (2009) found
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that the majority of CWS were aware of their stutter and responded negatively
to it. Vanryckeghem, Hylebos, Brutten and Peleman (2001) found that such
negative emotions increased with age and stutter severity.
Self-esteem refers to a person’s disposition to evaluate one’s self positively
or negatively in a spontaneous, automatic or unconscious manner (Zuckner,
2010). Whilst Yovetich, Leschied and Flicht (2000) found that CWS, aged 7–11
years, indicated average to high levels of self-esteem, Anderson, Pellowski,
Conture and Kelly (2003) found that they were often shy, quiet, cautious or
fearful when confronted with unfamiliarity. Karrass et al. (2006) found that,
when compared to non-stuttering peers, CWS were more reactive, less able
to regulate their emotions and had poorer attention skills. However, Yaruss
and Quesal (2004) argue that researchers have not devoted enough attention
to the potential positives of having a stutter. Notably, Lau et al. (2012) found
that some CWS are self-motivated to work towards achieving fluency.
Current study
Markham and Dean (2006) identified a link between speech and language
disorders and children’s quality of life and recommended that future research
should focus on specific clinical sub-groups, for example, CWS. By developing
our understanding of the way stuttering can limit a child’s activities and
their participation in society, clinicians may be better able to address the
needs of CWS and their families in a more holistic manner (McCormack
et al., 2010). Yaruss, Coleman and Quesal (2012) state that, by addressing a
child’s entire experience of stuttering, clinicians can help children reduce its
adverse educational and social impact. The choice of this research area and
age cohort was informed by these recommendations and by the fact that
much of the research regarding CWS comes from Australia (Langevin et al.,
2010; Lau et al., 2012) and relates to preschool children of varying ages, when
spontaneous recovery is common (Mansson, 2000). It was also influenced by
an appreciation of the critical role of parents in the management of childhood
speech and language impairments (Paul, 2007).
Lau et al.’s (2012) study was particularly useful in shaping this research
although it was not directly comparable as it used a quantitative and qualitative
design and interviewed both CWS and their parents. Neither is it representative
of the school-age population because of the sample size (n=20) and age
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
range (8–14 years). The current study sought to add to the evidence base
by qualitatively exploring mothers’ perspectives on the impact of stuttering
on the lives of children aged 6–10 years, in terms of their relationships, selfidentity and academic development.
Method
47
medical conditions, hearing, cognitive, or speech and language impairments.
Table 1 outlines the profile of the participants. The children’s ages ranged
from 6–10 years, with a mean age of 8.6 years. The severity of the stutter was
not assessed as the focus was on the perceived impact of the stutter on the
child’s life rather than on its severity.
Procedure
Much research on stuttering has focused on experimental designs (Langevin
et al., 2010; Vanryckeghem et al., 2001; Yovetich et al., 2000). Since human
communication is complex and multi-dimensional, it is difficult to apply
a quantitative framework to such research (Tetnowski & Damico, 2001).
Qualitative methods focus on social phenomena which are fundamental
in speech and language therapy (Damico & Simmons-Mackie, 2003). A
qualitative methodology was therefore selected as it allowed the researchers
to gather rich data from mothers of CWS.
Participants
Following purposive sampling, five mothers of children attending speech and
language therapy for stuttering in a Health Service Executive (HSE) clinic in
County Galway were recruited. The aim was not to generate a representative
sample but to produce rich data for an in-depth exploration (Creswell, 2007).
The inclusion criteria were parents who speak fluent English and had a child
attending primary school who: had a primary stutter; was attending speech
and language therapy; had been stuttering for at least a year; and had no other
Table 1 Characteristics of parents and children.
Participant
number
Participant
characteristics
Gender of
child
Age of child
P1
P2
P3
P4
P5
Mother
Mother
Mother
Mother
Mother
Male
Male
Male
Male
Male
8
6
10
9
10
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The study used one-to-one, semi-structured interviews using a topic guide
(see Appendix) with a flexible order and open-ended questions (Denscombe,
2010). Interviews are one of the most commonly recognized forms of qualitative
research and are recommended when the researcher is interested in people’s
perceptions (Mason, 2002).
Ethical approval was granted by the ethics committees from both the
University and the HSE. The SLT manager facilitated the first author to contact
an SLT who acted as gatekeeper. The gatekeeper sent information sheets to
potential participants who satisfied the inclusion criteria, inviting them to
contact the first author. Five mothers gave their informed consent, and the
interviews took place in a quiet clinic room to maximize their comfort and
to ensure adequate audio-recording. To support the trustworthiness of the
data, the first author checked with the participants during the interviews to
ensure her understandings matched the participant’s intended meanings.
The first author also minimized any verbal or non-verbal cues that might
inadvertently influence the participants (Taylor, 2005).
Data analysis was based on the principles of thematic network analysis
(Attride-Stirling, 2001). Following completion of the interviews, they were
transcribed verbatim by the first author to ensure accuracy, which allowed
for a thorough examination of the utterances (Braun & Clarke, 2006). Themes
were identified, extracted and refined from the coded text segments (AttrideStirling, 2001). Thematic networks were then built by selecting basic themes
and rearranging them into organizing and global themes. This was achieved
through repeated reading of the data in an active manner, seeking out meanings
and patterns (Braun & Clarke, 2006) and exercising vigilance to minimize any
predisposed biases in the interpretation of the results (Tetnowski & Damico,
2001). The first author analyzed the data in the first instance. The last author,
with definitions of themes and supporting participant statements, facilitated
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
49
verification of the thematic framework by using her insight and experience.
This process verified that the description of the phenomenon was faithful
(Koch & Harrington, 1998). The researchers ensured that confidentiality
was maintained throughout with regard to participant anonymity and data
storage.
Results
Ten basic themes emerged which were subsequently grouped into four
organizing themes under a global theme of communication. This global theme
relates to the act of communication and the context and circumstances in which
it takes place. The thematic network is illustrated in Figure 1 and the organizing
themes and their corresponding basic themes are then explored.
Settings
Parents spoke frequently about the different settings in which their child
interacted and, in particular, about situations which depended on a high
level of communicative skill.
Figure 1 The thematic network
Home environment
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One mother commented on her busy household which she feels is impacting
on her child’s stuttering severity: “Nobody can get a word in, and least of all
myself sometimes” (P2). She also described how she and her husband strive to
create a relaxed environment: “We’ve tried to kind of keep you know dinnertime
calm” (P2). This idea was mirrored by two other participants, one of whom
stated that they “always try to be more relaxed around him” (P5) and another
who ensures that her children do not talk over each other: “just make sure
that they all get turns” (P1).
School life
One mother commented that her son was “very bright” (P4). While none of
the participants perceived that stuttering was affecting their child’s general
academic performance, current or past difficulties with reading were commonly
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
discussed: “He was really bad with the reading” (P3). One mother said her
son’s teacher only occasionally noticed his stuttering and another said that
her son’s speech was quite fluent at school: “He was able to stand up in school
and give his news without anything really” (P2). One mother described how
her son’s teacher was enthusiastic about helping him to achieve fluency:
“They do anything they can to help him, they’re really good” (P3). Another
described how her son stuttered mostly when he was talking to adults as he
got nervous in those situations.
Communicatively challenging situations
Parents described how their child typically reacted when they were confronted
with situations that were communicatively challenging, such as speaking in
front of the class, talking to people they were unfamiliar with, or when they
got excited: “It would come if he was coming home from school and wanted to
tell me a lot of things” (P1). Three participants explained how their child had
a part in their school play, whilst one described her son’s disappointment
when he did not get a speaking part. Another described how her child was
limited by his stutter, often refusing to communicate in situations which
were dependent on fluent speech. “He wouldn’t go into a shop and ask for
something” (P3).
Relationships
Participants’ perception of their child’s relationships emerged as a strong
theme. Some described close relationships whilst others explained how the
stutter hindered the child’s ability to form close relationships.
Friendships
Three of the participants noted that their child had many different friends
and that stuttering did not affect their friendships: “He has a lot of friends;
he’d have no problem going up and making friends with somebody” (P4). One
mother described how her son’s friends at school tended to help him out if
he was stuttering: “They’ll let him speak or they’ll finish his sentence for him
but he doesn’t mind that because they’re all good friends” (P3). Another felt
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her son did not have a lot of friends and tended not to initiate friendships:
“they’d probably have to come to him now first” (P5). However, she related this
to his personality rather than his stutter: “he’d be shy, quiet kind of...wouldn’t
be very outgoing” (P5).
Family
Most participants described how their child had positive relationships with
their siblings and felt stuttering did not explicitly affect that relationship: “they’d
be very close” (P1). Two participants mentioned occasional disagreements but
they regarded this as normal sibling behaviour. Another mother described
how siblings would get frustrated if it took the child a long time to get his
message across: “they don’t make fun of him, they’ll just say ‘oh spit it out” (P2).
Another said her son would not stay at his grandparents’ house without his
parents “in case they try making conversation” (P3). Most participants spoke
of having a close relationship with their son. One mother said: “I suppose I
would be looking out for him more” (P1), while another described how her
son “felt worse for me than he did for himself ” (P3) as he was conscious that
his stuttering upset her.
Behaviour and reaction of others
Two mothers described how their son’s peers commented on their speech:
one said: “Someone said to him that he has ‘bumpy talk’” (P1), while another
believed that her son’s peers “don’t really notice the stuttering” or had never
“made it out to be a bad thing” (P4). A common subject discussed related to
bullying although, with one exception, participants believed their child had
never been bullied. One participant described how her son’s friends often
“answer for him” or “finish his sentences” but she believed “it doesn’t faze him”
(P2). Another commented on how she thought other adults perceived her
child’s stuttering: “people kind of think it’s cute” (P4).
Child’s characteristics
This theme incorporated participants’ views of their child’s personality, how
he felt about himself and activities he enjoyed.
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
Personality and self-identity
Although there were some similarities, the participants generally differed in
their perceptions of their child’s personality, with words such as ‘outgoing’ (P1,
P2, P3) ‘confident’ (P1, P2) ‘active’ (P4), ‘messer’ (P4), ‘friendly’ (P3), ‘chatty’
(P3), ‘quiet’ (P5), ‘sensitive’ (P1, P4) and ‘good’ (P4) being used. With regard
to the emergence of self-identity, one mother described how her son was
becoming more self-aware of his stutter and beginning to notice others who
stutter, including people on television, and said that he was “coming around
to it” (P1). She told how her son, in response to his friend’s questions about
his stutter, had explained: “I’ve bumpy talk and I’m going to speech therapy”
and that “once he is confident it sort of overrides the speech” (P1). However,
another described her son as “lacking in confidence” (P5) because of his stutter.
The mother of the 6-year-old felt he didn’t notice his stuttering and it was
not part of how he viewed himself (P2). This was especially clear when she
described his delight at being given a narrator part in his school play.
Hobbies
Four mothers named sports and playing outside as their child’s favourite
pastimes with two describing their sons as “very active” (P4, P1). One mother
felt her child’s main hobby was playing computer games. None perceived that
stuttering negatively impacted on their chosen activity with one mother noting
that her child: “will never back out of things because of his stammer” (P5).
53
stutter: “He kind of gets mad… he says why am I like this?” (P5). Another stated
that her son had previously told his SLT that he felt bad, embarrassed, did not
feel confident and was afraid to ask questions (P3). One mother described
her child’s acceptance of stuttering: “I think he kind of accepts it” (P1), while
another described his frustration with it. Two mothers described what they
perceived to be positive aspects of their child’s stuttering. One attributed
her son’s sensitivity to children with disabilities to his own experience of
stuttering, while another believed that stuttering gave her child “a bit of a
focus” and “something to really work towards” (P4). She also described him
as being brave and having character because of it.
Mothers’ hopes and fears
Many participants recognized their own feelings and their impact on their
child’s reaction to his stuttering. Two commented on its early identification
and intervention and how they hoped this would benefit their child in the
long run. Some referred to the cause of their son’s speech difficulties and
wondered if it was something they themselves had done or neglected to do:
“Was it me, did I not do enough reading with him” (P1), while others recognized
their own worries: “I just wonder as well myself... I suppose that’s just what
a mother does” (P4). Each mother spoke about their hopes for their child’s
future: “Hopefully there’ll be some improvements with him” (P4) and one
expressed her concerns for her child’s transition to secondary school. Another
commented on other people’s perception of her child: “When someone has
a speech, like goes to speech therapy, they would kind of think, maybe they’re
slow in other things” (P1).
Emotions
This theme encompassed the feelings associated with stuttering and included
both the mothers’ emotions and those they attributed to their child.
Child’s response to stuttering
Three participants felt their son did not notice the stuttering much or that it
did not affect their daily lives: “The dysfluency doesn’t really bother him day to
day” (P2). One mother believed her son sometimes felt angry because of his
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Discussion
The study explored maternal perspectives on the impact of stuttering on the
lives of their child in terms of their relationships, self-identity, and academic
development. The data revealed a central theme of communication, with
mothers perceiving that many different factors influenced their child’s
stuttering. The results are discussed below under the organizing themes and
are related to the literature.
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
Relationships
Most participants believed that stuttering is not negatively impacting on their
child’s relationships within the immediate family. While these findings are
at variance with Lau et al. (2012), who found that CWS were less attached
to their parents, there is little other research specifically on parent–child
relationships in CWS with which to compare them. The findings in relation
to siblings, with all of the participants describing strong sibling bonds, are
generally consistent with those of Beilby et al. (2012). Some described how
siblings get frustrated or occasionally tease the child, similar to Langevin et
al. (2010). However, participants felt this was normal sibling behaviour.
Participants differed in their perceptions of how stuttering affected their
child’s peer relationships, as reflected in the literature. Some felt their child
found it easy to make friends (Lau et al., 2012), whilst others believed their
child had relatively few friends (Hugh-Jones & Smiths, 1999). For some
children, the fact that a peer finished sentences or said words for him was
seen as an attempt to help him (Lau et al., 2012). Alternatively, it could reflect
impatience with the time it takes him to speak. One mother believed her
son’s shyness, rather than stuttering, was the main factor in his reluctance to
initiate friendships. However, it could be argued that stuttering is contributing
to his shyness, as found by Anderson et al. (2003). Notably, the mothers of
the younger children believed that their friends were not aware or were not
bothered, whereas friends of the older children tended to be more aware
and to make comments. This finding reflects that of Langevin et al. (2010)
and suggests that age may be an important variable. Although bullying was
mentioned and is well documented in the literature (Klompas & Ross, 2004;
Langevin & Narasimha Prasad, 2012), only one mother was aware that her
child had been bullied.
55
suggesting they were less affected in the classroom. One mother commented
on how her son’s speech was more fluent at school because of the structured
classroom environment. These findings are rarely supported in the literature,
as most studies have found that children perceive the classroom to be a
demanding setting for communication (Lau et al., 2012). Each participant
mentioned that their child had, or had at some stage, difficulties with reading.
This is consistent with research on stuttering, reading and dyslexia (Ardila et
al., 1994; Guitar, 2006). All participants felt their child had no other academic
difficulties. There has been little research on academic achievement in CWS
and further exploration is warranted to gain a better understanding of how
CWS are impacted academically.
Child’s characteristics
Participants differed in their portrayal of their child’s personality, with some
describing them as shy and sensitive (Anderson et al., 2003) and others as
outgoing and confident (Yovetich et al., 2000). Similarly, not all believed that
their child’s stuttering was a factor in his personality and self-identity. While
the children differed in their favourite pastimes, they were not perceived to
be limited in activities that they enjoyed, contrary to other findings (Yaruss,
2010). The results regarding the children’s perceived responses to potentially
challenging communicative situations were also mixed. Some mothers described
their child’s excitement at being involved in their school play, suggesting that
these children have good self-esteem and did not view stuttering as a reason
not to speak in public (Yovetich et al., 2000). Contrary to this, one mother
stated that her child would not ask for something in a shop, suggesting that he
anticipated difficulties with initiating such a request and that his stutter was
emerging as a negative aspect of his self-identity. This idea is also discussed
by Anderson et al. (2003).
Settings
Some mothers facilitated their child’s fluency by promoting a calm home
environment, as described by Plexico and Burrus (2012). Although some
commented on instances in which their child stuttered in class, most believed
that stuttering was not negatively impacting on their school experience. Two
participants felt that the teachers were not conscious of their child’s stuttering,
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Emotions
In describing how their child felt about himself, some believed they did
not notice or were not bothered by their stuttering, whilst others reported
feelings of anger, embarrassment, fear and a lack of confidence. These latter
findings are consistent with those of Vanryckeghem et al. (2001) and suggest
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
that these children had strong negative emotions about their stuttering and
their ability to communicate. However, similar to Lau et al.’s (2012) study,
one mother commented on her son’s acceptance of his stutter whilst others
described their sons as being motivated to improve their speech, suggesting
that not all children perceive their stutter in a negative light. Some mothers
recognized their own feelings and behaviours surrounding stuttering; the fact
that one believed her son felt worse for her than he did for himself suggests
that, in this case at least, the stuttering had a greater impact on the mother
than on the child. Some mothers experienced guilt and wondered if they had
contributed to their child’s stuttering. This notion of guilt is also discussed
by Goodhue et al. (2010).
Strengths and limitations
This study was conducted in a methodical manner, using reflexivity, and
adhered to ethical standards. It had some limitations: principally, its sample
size and make-up, and the data analysis could be further strengthened by a
more rigorous peer review process. The findings need to be interpreted with
caution as they are not representative of all mothers of all children who stutter.
Each child involved was male, and the experiences of female children may be
different (Zuckner, 2010). Some mothers were more articulate than others,
resulting in disproportionate responses in some instances. The views of fathers
or teachers were not sought. In addition, the participants’ descriptions of how
they felt stuttering impacted their child’s life may not match how the children
themselves perceive this, as parents can often perceive the psychosocial impact
of stuttering to be greater than the child (Cook & Howell, 2013). While the
first author established good rapport with the participants who related well
to her, they may have been more relaxed in a location of their choice.
Future research and clinical implications
Further gender-specific research is required, using more representative and
longitudinal studies to determine whether the impact that stuttering has on
a child will change as they move into adolescence and adulthood. Future
studies could also interview children themselves to see if their perceptions
match those of their mothers.
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Craig, Blumgart and Tran (2009) found that stuttering negatively impacted
on the emotional stability and mental health of adults who stutter. In light
of this, the current findings highlight the need for families and clinicians to
be aware of and monitor the potential psychosocial impact of stuttering and
support the overall wellbeing of CWS.
Yaruss (2010) recommends that evaluation of treatment should include
more than just an assessment of changes in fluency. Depending on the age of
the child and the severity of their stuttering, possible options include involving
parents more in therapy sessions for this age group, therapists facilitating
conversation within families about the role stuttering plays in their child’s
everyday life, and identifying areas of particular difficulty. Effective strategies
to help manage the child’s fluency at home highlighted by participants, for
example, introducing turn-taking activities between siblings competing for
speaking time, could be shared with parents. Children may also benefit from
therapists liaising with their teachers and providing them with information
and strategies to ensure the child achieves their maximum potential in the
classroom.
Conclusion
The findings demonstrate that stuttering is a complex communication
impairment which is difficult to define (Acton & Hird, 2004) and can
manifest itself differently in children. Although generalisability was not the
goal of the research, the findings suggest that stuttering has the potential to
influence a child’s life in many different ways. Age and personality appear
to be important factors in how CWS perceive themselves. As one parent put
it: “different kids differ” (P1). It also demonstrates that, while SLTs should be
aware of the potential for stuttering to have a negative impact on a child’s life,
they should not assume that all children will perceive it as a negative factor
in their self-identity. The study also suggests that SLTs should consider the
emotional stress that parents of CWS may be struggling to deal with.
Acknowledgements
The work reported in this paper constituted a final year honours thesis by
Elizabeth Armstrong, National University of Ireland, Galway. The authors
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Maternal Perspectives on the Impact of Stuttering
would like to sincerely thank each of the mothers who participated in the
study.
Declaration of interest
The authors declare no potential conflicts of interest with respect to the
research, authorship, and/or publication of this article. The authors received
no financial support for the research, authorship, and/or publication of this
article.
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Maternal Perspectives on the Impact of Stuttering
Maternal Perspectives on the Impact of Stuttering
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Appendix
Interview Topic Guide
1. Can you tell me a little bit about your child?
2. Can you tell me about his stuttering?
3. Could you tell me how you think stuttering affects him in his
everyday life?
ÎHow would you describe X’s relationship with the rest of the
family?
ÎAre his siblings aware of his stutter?
ÎHow does his stuttering impact on his relationship with his
brothers/sisters?
ÎHow does he get on with the extended family?
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Maternal Perspectives on the Impact of Stuttering
Î How would you describe your relationship with X? Does having a
stutter impact on this relationship?
ÎDoes X make friends easily? If so, what makes it easy for him? If
not, what makes it more difficult for him?
ÎAre X’s friends aware of his stuttering? If so, how does this impact
on their relationship?
What’s in an Accent?
Perceptions of Young Adult Listeners
in Cork and Kilkenny
ÎHow would you describe X’s personality?
Nicola Bessell and Eimear Mulhall
ÎHow do you think X feels about himself? Do you think having a
stutter affects the way he feels about himself?
University College Cork, Ireland
ÎHow does X himself react to his stuttering?
ÎDoes X ever get frustrated with himself when he stutters? How
does he show this frustration?
ÎWhat would X’s typical reaction to a new or different social
situation be, such as somewhere where he has never been or
involving people he has never met?
ÎCan you tell me about how X is getting on in school?
ÎWhat kind of relationship does he have with his teacher?
ÎDoes X ever avoid situations where it may be difficult to
communicate, e.g., talking in front of the class, reading aloud,
presentations, speech and drama, etc? If so, how or why do you
think this is?
ÎDo you know if X has ever been bullied? If so, can you tell me a bit
about it?
ÎDo any of X’s friends ever try to help him out when he starts to
stutter? How do they help?
ÎAre there any aspects of having a stutter that have been positive for X?
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Correspondence to:
Nicola Bessell, Department of Speech and Hearing Sciences, Brookfield Health
Sciences Complex, College Road, Cork City, Co. Cork, Ireland
Email: n.bessell@ucc.ie
Abstract
Objective: To investigate the perceptions of Irish listeners concerning
geographical origin, occupation and socio-economic class, based on
speech samples from County Cork; to relate this information to phonetic
features of each speaker’s accent and recent changes in Irish English.
Methods: Recordings of speakers from three locations in County Cork
were analyzed for features of supra-regional and advanced Irish English
(Hickey, 1998, 2003, 2010). These recordings were played to young
adult listeners from counties Cork and Kilkenny. Listeners completed
a questionnaire assessing the location, occupation and socio-economic
class of each speaker. The results of the questionnaire were compared
with the phonetic features of the speakers.
Main results: Diphthongization of FACE and GOAT vowels, [θ, ð] for
TH, GOOSE-fronting and emerging velarised /l/ in syllable final position
tilt listener judgements towards non-regional, professional and upper
middle class. Cork City listeners are most accurate in terms of locating
Cork city speakers. Kilkenny listeners are least accurate in identifying
speaker location.
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What’s in an Accent?
Conclusions: Irish English speech varies depending on location and
gender. Perceptions of class and occupation are closely tied to gender of
speaker and type of phonetic features present. Supra-regional features
are increasingly used by young adults in County Cork, and recognized
by young adult listeners.
Key words: Accent perception, Irish English, supra-regional Irish English,
gender, socio-economic class.
Introduction
In Ireland, as in many countries, speaker accent can be a cue to geographical
origin and social class (Hickey, 2004; McWilliams, 2005). Nonetheless, Hickey
(1998, p. 83) notes that in the Republic “there is something like a supra-regional
standard which is characterized by the speech of middle-class urbanites”.
Features of this supra-regional standard include dental [t̪, d̪] in words with
TH spellings, apical alveolar fricatives [θ͇, ð͇]1 for /t, d/ in certain positions,
and clear /l/ in all syllable positions. Hickey (2010) notes that English as
spoken in Ireland over the centuries has, for various reasons, moved away
from some of its more conservative or Irish-influenced features. For instance,
the early Middle English pronunciation of /u:/ has long been replaced by the
diphthong /au/ in the MOUTH lexical set2, though this happened in Ireland
later than in England. In this sense, supra-regionalization in Irish English
has a long history, continuing in the 19th century with the introduction of
compulsory primary education and the rise of an Irish middle class (Hickey,
2002). In the 20th century, the move to supra-regional norms accelerated
during the so-called Celtic Tiger years (1990s to approximately 2005) and
continues to the present day. This most recent wave of supra-regionalization
1 We follow Pandeli, Eska, Ball and Rahilly (1997) in using the IPA-based symbols [θ͇, ð͇]
for the Irish English apical alveolar fricative pronunciation of the stop phonemes/t, d/.
Hickey uses [ṱ, ḓ], which has the advantage of highlighting the allophonic relationship
with /t, d/ . Kallen (2012) follows O’Baoill (1990) in using [t̞], which signifies a ‘lowered’
alveolar stop. This also preserves a relationship with /t/.
2 We follow the use of Wells’ lexical sets to identify vowel classes (Wells, 1982). Each
lexical set, for example MOUTH, contains words that share the pronunciation of the
key word.
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What’s in an Accent?
65
has brought some new features into Irish English. It is these features that are
examined in this paper. Hickey terms this speech style New Dublin English
(1998) and Advanced Dublin English (2005).
Hickey (2010) argues that the driving force behind Advanced Dublin
English is dissociation. He suggests that young workers coming to the
booming capital in the 1990s wanted to dissociate from the distinct local
Dublin vernacular as well as their own regional varieties of Irish English.
These speakers developed phonetic cues that extended existing differences
between educated mainstream Dublin speech and the local Dublin vernacular.
These cues included a velarised /l/ in final position, fronting of the MOUTH
diphthong from [aʊ] to [æʊ, ɛʊ], and the Dublin Vowel Shift (Hickey, 1998).
The Dublin Vowel Shift involves retraction of /aɪ/ in PRIDE to [ɑɪ]3; raising
of /ɒɪ/ in CHOICE to [ɔɪ, oɪ] and raising of the back vowels /ɒ, ɒː/ in COT
and THOUGHT to [ɔ, ɔː]. Hickey (2003) notes that these advanced Dublin
features were widespread throughout the south of Ireland by the early 2000s,
particularly among young female speakers. O’Sullivan (2013) lends support
for the increase in use of advanced Dublin features. She traced the use of
these features in radio advertisements in the Republic of Ireland, noting
their absence in data from 1977 and 1987, a minority presence in 1997
advertisements with mostly women using them, and an increased presence
in 2007 with both men and women using the features.
Cork city is the second largest city in the Republic, yet there is very
little published information on Irish English as it is spoken in the city or in
County Cork (Hickey, 2002). The county accent is generally known for its
characteristic intonational patterns (Murphy, 1994; Hickey, 2011). Within Cork
city there is a broadly recognized north/south accent distinction based on
location relative to the River Lee, which runs through the city on an east–west
axis. The population north of the river tends to use a strong vernacular and
readily identifiable ‘North Cork’ accent. South of the river, the population
in many areas uses a more standardized, middle-class accent, although there
are certainly some areas with strong working-class affiliation south of the
river. According to Frost (2000), the north-south accent divide in Cork city
is better understood as an instance of more broadly-based class distinctions,
3 Hickey (2013) notes that this feature is receding from advanced Dublin English and it
is not investigated in this study.
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67
with a clear working-class accent spoken in north Cork and some locales
south of the river, but overall a more prestigious middle-class accent spoken
in most areas south of the River Lee. (See Haase and Pratschke (2012) and
Pobal (2006) for demographic information on Cork City.)
Currently, the extent of supra-regional and advanced Dublin features in
County Cork and Cork city, and whether some features are more dominant
than others, is known only anecdotally. Similarly, although perception and
attitudes to language change have a role in the spread of innovative features,
the perception of accents of any sort within Ireland is little investigated (but
see Hickey, 2005). Very little is known about Cork speakers’ perceptions of
local or non-local accents.
To address these gaps, this paper analyzes data from male and female
speakers from three different locations in and outside Cork city, and assesses
the perceptions of young adult Irish listeners concerning the occupation,
socio-economic class and regional origin of these speakers. Using this data,
we investigate the relationship between perceived class, occupation and
location on the one hand and the degree to which each speaker adopts the
features of new Dublin English on the other.
Method
Participants
Following similar research by Bayard, Weatherall, Gallois and Pittam (2001),
two speakers aged 18–24 (one female, one male) from three different locations
were recorded reading a short paragraph (see Figure 1 for maps detailing
location of speakers). Speakers were chosen to be representative of the two
major accents within Cork city, with Macroom speakers representing a
relatively urban County Cork accent, thus avoiding the complicating factor
of rural versus urban accents. To control for educational and socio-economic
background, brother–sister pairings were recruited for Cork city south and
Macroom, but were not available for Cork city north. Female and male listeners
aged 18–19 were recruited from secondary schools in north Cork city (n=14),
south Cork city (n=15), Macroom (n=17) and Kilkenny (n=17). There were
25 female listeners and 38 male listeners for a total of 63.
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Figure 1 Speaker locations within County Cork (top) and Cork City (bottom).
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What’s in an Accent?
Materials
Speakers read a short paragraph designed to elicit a range of vowels, as well as
specific consonantal features attested in supra-regional and advanced Dublin
English, as summarized below. See Appendix 1 for text of recorded data.
1. Allophones of /t/ in initial, medial and final position, e.g., Tom,
rainwater, boat.
2. Allophones of sounds spelled with TH, e.g., thought and breathe.
3. /l/ in medial and final position, e.g., leaf and feel.
4. Vowels in the following lexical sets
FLEECE, e.g., meet
TRAP, e.g., trap
GOOSE, e.g., Bruce
DRESS, e.g., instead
MOUTH, e.g., mouth
CHOICE, e.g., choice
THOUGHT, e.g., thought
FACE, e.g., rain
GOAT, e.g., boat
Procedure
The speakers were recorded in a quiet room with an Audio Technica AT831b
cardiod condenser microphone and a 24 bit digital recorder (Roland R-05),
at a sampling rate of 44 kHz. To assess the representativeness of the speaker
data, a colleague with personal and academic knowledge of Cork area accents
evaluated the recordings. Recordings were then analyzed acoustically using
broad band spectrograms and the formant tracking facilities in PRAAT
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(Boersma & Weenink, 2014). Following procedures in Labov, Ash and Boburg
(2006), monophthongs were analyzed for first and second formant values (F1
and F2) taken at the F1 maximum. If no F1 maximum was achieved, then
frequency readings for both formants were taken at the point of F2 maximum
or minimum. If both formants were in transition throughout the duration
of the vowel, frequency readings were taken at the temporal midpoint of the
vowel. Diphthongs were measured for F1 and F2 values at one-third and twothirds of their duration. Vowel formant values were normalized and plotted
using the Watt and Fabricius modified algorithm in NORM (Fabricius, Watt &
Johnson, 2009; Thomas & Kendall, 2007). To assess clear and dark (velarized)
/l/, formant readings were taken at the temporal midpoint of word-initial and
word-final /l/. Spectrograms of /t/ were assessed visually and perceptually
for stop, flap, glottal stop, fricative or deleted allophones. Productions of
words spelled with TH were likewise visually and perceptually analyzed for
realization as stops or fricatives.
School principals in secondary schools were approached for permission
to invite Year 6 students over the age of 18 to listen to the recordings and
complete two questionnaires. Principals and participants were provided with
information sheets and signed consent was obtained. On-site classroom
computer and speaker systems were used to play the speech data. For each
participant group, a trial run was conducted using non-test data and participants
were instructed to listen to the accent of the speaker rather than the content
of the recording. After one presentation of one speaker’s data, participants
filled out a questionnaire assessing that speaker’s personal characteristics
along three dimensions of competence, power and solidarity, as in Bayard,
Weatherall, Gallois and Pittam (2001). These data are not reported on here.
After listening to the recording a second time, participants completed a second
questionnaire, assessing the speaker’s geographical location, occupation and
social class. Participants wrote down where they thought the speaker was from
and chose from four categories of occupational type (unskilled, semi-skilled,
skilled, professional) and three categories of socio-economic class (lower,
middle and upper class). Participants then listened to the next speaker and
filled out questionnaires for that speaker. Speech samples were played in a
random order until all six speakers had been assessed.
Prior to recruiting participants, ethical approval was granted by the
Clinical Research Ethics Committee of the Cork Teaching Hospitals.
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What’s in an Accent?
What’s in an Accent?
Results
Allophones of /t/
A Cork native and linguist confirmed that both north Cork speakers had
a recognizable Cork accent, the Macroom speakers less obviously so. Both
south Cork speakers were considered ‘metropolitan’ Irish English speakers,
meaning educated, middle class and lacking cues to region of origin. Our
consultant placed the age of all speakers as under forty.
Word initial /t/ for all speakers was a voiceless aspirated alveolar stop [th].
Medial /t/ had several allophones: a flap [ɾ] (NCF and SCM); an apico-alveolar
fricative [θ͇] (SCF and MF); [th] (NCM) and an unaspirated [t] (MM). All
speakers used [θ͇] for most final /t/s, with some speaker-specific variation
depending on the following word context. For example, both North Cork
speakers deleted the final /t/ in midnight, whilst both SCM and MM produced
a weakly articulated voiced allophone [d͉] when the following word began
with a vowel, as in sight of.
Consonants
The results of acoustic and perceptual analysis of /t/, /l/ and words spelled
with TH are summarized in Tables 1 and 2. Speakers are referred to as:
NCF (North Cork Female) and NCM (North Cork Male); SCF (South Cork
Female) and SCM (South Cork Male); MF (Macroom Female) and MM
(Macroom Male).
Table 1 Production of /t/ and TH for all speakers
Target
Word initial /t/
Tom
Word medial /t/
rainwater
Word final /t/
midnight
meet (an)
boat
sight (of)
fight
thought
Word initial TH
thought
Word final TH
mouth
breathe
Speakers
NCF
NCM
SCF
SCM
MF
MM
th
th
th
th
th
th
ɾ
th
θ͇
ɾ
θ͇
t
Deleted*
d
θ͇
θ͇
θ͇
θ͇
Deleted*
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
d͉
θ͇
d͉
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
θ͇
d͉
θ͇
θ͇
th
th
θ
t̪ʰ
t̪ʰ
θ
Allophones of words spelled with TH
Words with TH spellings have varied productions. Word–initially (in the word
‘thought’), both NC speakers produced an aspirated alveolar stop [tʰ]. SCM
and MF produced an aspirated dental stop [t̪ʰ], whilst SCF and MM produced
a fricative [θ], which may be dental or interdental. Final voiceless TH (in the
word ‘mouth’) is reduced to glottal stop with a creaky preceding vowel [V̰ʔ]
(North Cork speakers), weakly articulated [t͉ʰ] (MM) and voiceless fricative
[θ] by the other three speakers. Final voiced TH (in the word ‘breathe’) is
produced as a voiced alveolar stop with full, aspirated release [dʰ] by NCM
and MF, but [ð] by all other speakers.
Allophones of /l/
V̰ʔ
ð
* phoneme not produced
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V̰ʔ
dʰ
θ
ð
θ
ð
θ
dʰ
t͉h
ð
Two speakers (NCM and NCF) show no evidence of dark /l/, transcribed
[ l̴]. Three speakers (SCF, SCM and MF) show a modest rise in F1 on final /l/,
Table 2 F1 and F2 values for /l/ of all speakers. Formant values are in Hertz.
Target
Word initial /l/
leaf
Word final /l/
feel
F1
F2
F1
F2
NCF
453
1518
380
1660
NCM
342
1585
336
1669
Speakers
SCF
SCM
418
353
1917
1280
653
405
2061
1266
MF
402
1570
552
1601
MM
402
1501
397
1337
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What’s in an Accent?
What’s in an Accent?
73
consistent with some tongue lowering. MM has some F2 lowering consistent
with velarization, but no F1 rising.
Vowels
Figure 2 Scatterplot of vowel formant means for six speakers (NCF, NCM, SCF,
SCM, MF, MM), normalized using modified Watt and Fabricius method
and plotted using NORM (Thomas & Kendall, 2007).
Figure 3 Scatterplot of vowel formant means for North Cork speakers normalized
using modified Watt and Fabricius method and plotted using NORM
(Thomas & Kendall, 2007).
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Figure 2 presents normalized vowel data for all speakers. Figures 3–5 present
vowel plots for male and female pairs from each of the three locations of
North Cork, South Cork and Macroom.
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What’s in an Accent?
Figure 4 Scatterplot of vowel formant means for South Cork speakers, normalized
using modified Watt and Fabricius method and plotted using NORM
(Thomas & Kendall, 2007).
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What’s in an Accent?
75
Figure 5 Scatterplot of vowel formant means for Macroom speakers, normalized using
modified Watt and Fabricius method and plotted using NORM (Thomas
& Kendall, 2007).
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77
MOUTH fronting
Location of speakers
The MOUTH vowel was considered fronted if the onset F2 reading placed
it in front of the central TRAP vowel. By this measure, two speakers (SCF
and SCM) have strong MOUTH-fronting with an F2 onset in the region of
the DRESS vowel, two speakers have minimal MOUTH-fronting (MF and
NCF) and two speakers (MM and NCM) have no evidence of MOUTHfronting at all.
Responses to location are grouped in terms of locations within North Cork
(NC), South Cork (SC), Macroom/West Cork (M), and locations outside
County Cork (OCC). Results are presented by listener group, starting with
North Cork listeners.
NC listeners assigned NC speakers to north Cork locations (90%) and SC
speakers were mostly assigned to south Cork locations (69%). NC listeners
assigned Macroom speakers predominantly to south Cork locations (69%).
SC listeners produced a similar pattern, identifying NC speaker location
with 87% accuracy, and SC speaker location with 81% accuracy. Like the
NC listeners, SC listeners assigned Macroom speakers to SC locations (93%).
Macroom listeners were less accurate in their assignment of correct location to
NC (62%), SC (59%) and M speakers (25%), citing locations outside County
Cork for all speakers. Kilkenny listeners placed virtually all speakers outside
County Cork (94%).
CHOICE raising
The onset of CHOICE vowels was considered raised if its F1 value was higher
than that of DRESS vowels. By this measure, both North Cork speakers and
MM do not raise CHOICE, while both South Cork speakers and MF do.
THOUGHT raising
Using the same measure as with CHOICE raising, both North Cork speakers
and male speakers MM, SCM do not raise THOUGHT. SCF and MF both
raise THOUGHT.
GOOSE fronting
The GOOSE vowel falls into three clear categories. Both North Cork speakers
have a mid-back vowel whose F2 value does not exceed that of TRAP, which
is a central vowel. The Macroom speakers front GOOSE to almost exactly the
F2 value of TRAP, producing a central vowel. The SC speakers both produce
strongly fronted /u/.
FACE and GOAT diphthongization
FACE is a monophthong for three speakers: NCM, MF and MM. For all other
speakers, it is a diphthong with endpoint approaching the MEET vowel (see
Figures 3, 4, and 5). GOAT is a monophthong for NCM, MF; a wide diphthong
for SCF and a narrower diphthong for NCF, MM and SCM.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Class of speakers
All four listener groups perceived NC speakers as mostly lower class (71%)
with some middle-class perceptions (28%) mostly for NCF. All listener groups
perceived SC speakers as mostly middle class (55%) or upper class (38%),
especially for SCF. All listener groups perceived M speakers as mostly middle
class (67%), with upper-class judgements (25%) mostly for MF. In general,
females in all speaker groups received higher socio-economic rankings than
the males.
Occupation of speakers
NC speakers are viewed by all listener groups as primarily unskilled (65% of
listener responses), with some semi-skilled perceptions (24%), particularly
from Macroom listeners. SC speakers are viewed by all listener groups as
primarily skilled (45%), with some semi-skilled (18%), particularly for the
male speaker, and some professional (28%), particularly for the female speaker.
Macroom speakers were perceived by all listeners as mostly semi-skilled (37%)
and skilled (26%) with professional (20%) for the MF only.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
78
What’s in an Accent?
Discussion
New Cork features4
Recent GOOSE-fronting is reported in varieties of British English (Jansen,
2010; Docherty, 2010; Wells, 1982), Ulster English (Kallen, 2012) and American
English (Fridland, 2008). It is not reported for local Dublin English by
Ferragne and Pellegrino (2010), nor for advanced Dublin English in Hickey’s
(2005) work. However, fieldwork documents young speakers from the Cork
area and Waterford with varying degrees of GOOSE-fronting (Bessell, 2013;
fieldnotes) and acoustic analysis of some of Hickey’s advanced young Dublin
speakers indicates GOOSE-fronting (Hickey, 2013). It is unlikely that this
feature is confined to young speakers of any particular region, but acoustic
documentation is sporadic.
Diphthong realizations of FACE and GOAT are found in General American
English and Canadian English, as well as Southern British English (Wells,
1982). Hickey (2004, p. 57) records [e:] and [oʊ, o:] as the Irish English
supra-regional mainstream norm for these two vowels. Hickey (2013) notes
GOAT-diphthongization in advanced Dublin speakers, but reiterates that FACE
remains a monophthong. Ferragne and Pellegrino (2010, p. 23) note some
FACE and GOAT diphthongs among the Dublin speakers in their survey. The
more advanced supra-regional Munster English speakers recorded for this
study tend to diphthongize both vowels. There is too little data to be certain
that FACE or GOAT diphthongization are changes with a regional origin
(Cork or Dublin) but, like GOOSE-fronting, these cues are increasingly used
by young adult speakers.
O hUrdail (1997) documents the wide use of dental [t̪, d̪] for TH spellings
and Hickey (2004) notes that this is the supra-regional educated norm in
Ireland. The production of fricatives for TH words is not reported for new
Dublin English (Hickey, 2004, 2013), but in our experience a genuine fricative
does occur in the conversational speech of some young adults, particularly
4 The term “new Cork” is used since this paper documents these particular features in
the English of speakers from County Cork. If they are genuinely supra-regional features,
which is highly likely, then a more accurate term might be “new supra-regional”.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
What’s in an Accent?
79
women, attending University College Cork. Kallen (2012) notes the use of
affricates [t̪͡θ] and [d̪͡ð] outside of Ulster English. O hUrdail (1997) also
comments that the dental stop pronunciation is often a focus in elocution
and drama lessons, with fricatives being taught in their place. Students at
UCC often report being taught the rhyme, “This, that, these, those, that’s the
way the TH goes”, with emphasis on a fricative production, both at school
and in drama lessons. This may be having some influence on the use of [θ,
ð]. Whilst reading tasks such as the one used in this study may elicit more
formal fricative productions of TH words, the current database does not
allow us to assess this variable.
What we term the “new Cork” features of GOOSE fronting, FACE/GOAT
dipthongization and TH as fricatives are most frequent in the speech of SC
speakers, with the following cline: SCF>SCM>MM>MF>NCF>NCM (see
Figure 6).
This distribution is very close to the pattern of class and occupation
rankings from all listeners except that MF is usually ahead of MM. If new
Dublin features are added to new Cork features, we get exactly the same
distribution as the occupation and class rankings. From a linguistic point
of view, it seems that perception of class and occupation is sensitive to the
number of new Dublin and newer Cork features. Whilst our study adopted
the class divisions used by Bayard et al. (2001) this may not be a good fit for
the Irish population, which is commonly regarded as composed of working
class and middle class (Convery, 2013). However, our occupation categories,
which also follow Bayard et al. (2001), are close to the divisions used in modern
demographic studies of Irish society, such as Pobal (2006). We note there is
a great deal of similarity in participant judgements of occupation and class,
and it may be that future studies could reference occupation alone.
Despite the reasonably clear three-part grouping of speakers by accent
features, location assessments by all County Cork listeners divide the
speakers into two groups: north Cork city on the one hand; south Cork city
and Macroom on the other. For NC and SC listeners, more regional features
relative to supra-regional and new features mean a north Cork location and
perceptions of lower class and less skilled professions. For the same listeners,
supra-regional, new Dublin and new Cork features cue a south Cork location
and perception of higher socio-economic class and occupation. Macroom
listeners are less accurate and give a broader range of locations. For these
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
80
What’s in an Accent?
What’s in an Accent?
listeners, accent is not as reliable an indicator of location as it is for NC and
SC listeners. Nonetheless, Macroom listeners perceive occupation and class
in the same way as NC and SC listeners. Therefore, Macroom listeners must
be relying on phonetic cues to class and occupation independent of the
knowledge of Cork city accents and their locations that SC and NC speakers
have. Kilkenny listeners are not able to place any of the speakers geographically,
putting all speakers outside Cork city and County Cork. Nonetheless, Kilkenny
listeners have similar class and occupation perceptions as the NC, SC and
Macroom listeners. It seems that Kilkenny listeners are relying on phonetic
cues alone to assess occupation and class, but these same phonetic cues do
not trigger accurate location.
81
with occupation and class a level higher than their male counterparts. This
parallels the general correspondence in our data between increased use of
supra-regional, new Dublin and new Cork features on the one hand, and
higher occupation and class perceptions on the other. Given that both the
south and west Cork speakers are brother and sister pairings, this difference
in perception of class and occupation is notable. We know that the sisters are
more advanced than their brothers in shifting away from regional and even
supra-regional norms to newer Dublin and Cork features, so either this fact,
or simply being female, is triggering the difference in perception between the
genders. Our finding that the female member of each speaker pair uses more
supra-regional and new supra-regional features is consistent with work by
Trudgill (1972), Eckert and McConnell-Ginet (1999), and Labov (2001).
Gender
Overall, females are ahead of males in using features along the supra-regional,
new Dublin, new Cork cline. Likewise, females are generally perceived
Figure 6 Use of phonetic features per speaker.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
Conclusions and implications
Our data are consistent with the advance of new features of supra-regionalization
in modern-day Irish English, as noted in the literature (Hickey, 2013; O’Sullivan,
2013). We have documented the use of an expanding set of supra-regional
speech features in a location that is geographically and socially relatively
independent of the capital of Dublin. Some aspects of this expansion are
towards norms that are well established in standard international varieties of
English, such as General American English, Standard Canadian English, and
Southern British English. At the same time, uniquely Irish English features
such as final t-frication are stable and used consistently by all our speakers.
The Dublin Vowel Shift is also evident in some speakers’ vowel systems.
Based on our findings, we can predict that listeners from other regions
in the Republic of Ireland will evaluate speakers on the same model as the
Kilkenny listeners. This remains to be seen but, if so, we would have a larger
body of evidence for the decoupling of speech and location cues on the one
hand, and the tight relationship between supra-regional cues and perceptions
of higher class/occupation on the other. Both of these trends are consistent
with the effects and uses of supra-regionalization in Irish English.
Our findings contribute to an understanding of language use and perception
during a period of immense change in Ireland, so they are relevant from
the perspective of sociolinguistic variation and dialect studies in general.
However, from a clinical perspective, it is important for speech and language
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82
What’s in an Accent?
therapists to be aware of speech variation in the general population as well as
age- and region-related changes such as the ones reported here (Howard &
Heselwood, 2013). This is of increasing importance as the pool of speech and
language therapists practising in Ireland includes professionals who may not
be native Irish English speakers or may not be native speakers of English at
all. Watt (2013) notes the importance of speech professionals understanding
the linguistic structure of accent variation, and communicating to clients
and their families the linguistic equivalence of all accents, despite popular
notions of the “correctness” of standard varieties. Related to this point, the
socio-indexical information contained in the speech analyzed here is very
much tied to concepts of personal and social identity that may need to be
recognized and supported in the context of speech and language therapy.
Acknowledgements
Some of the work reported here is part of a final-year honours project by
Eimear Mulhall, University College Cork, Ireland.
References
Bayard, D., Weatherall, A., Gallois, C., & Pittam, J. (2001). Pax Americana: Accent
attitudinal evaluations in New Zealand, Australia and America. Journal of
Sociolinguistics, 5(1), 22–49.
Boersma, P. & Weenink, D. (2014). Praat: Doing phonetics by computer (Version 5.3.84)
[Computer program]. Retrieved from http://www.praat.org/
Convey, D. (Ed.) (2013). Locked Out: A Century of Irish Working Class Life. Sallins: Irish
Academic Press.
Docherty, G. (2010). Phonological innovation in contemporary spoken British English. In
A. Kirkpatrick (Ed.), The Routledge Handbook of World Englishes (pp. 59–75).
London: Routledge.
Eckert, P. & McConnell-Ginet, S. (1999). New generalizations and explanations in language
and gender research. Language in Society, 28, 185–201.
Ferragne, E. & Pelligrino, E. (2010). Formant frequencies of vowels in 13 accents of the
British Isles. Journal of the International Phonetic Association, 40(1), 1–34.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
What’s in an Accent?
83
Fabricius, A.H., Watt, D., & Johnson, K. (2009). A comparision of three speaker-instrinsic
vowel formant frequency normalization algorithms of sociophonetics. Language
Variation and Change, 21, 413–435.
Fridland, V. (2008). Patterns of /uw/, /ʊ/ and /ow/ fronting in Reno, Nevada. American
Speech, 83(4), 432–454.
Frost, P. (2000). Phonetic variation and change in the English of Cork, 2000AD: With
particular reference to substratum influence (Unpublished master’s thesis).
University College Cork, Cork, Ireland.
Haase, T., & Pratschke, J. (2012). The 2011 HP Deprivation Index for small areas: Introduction
and reference tables. Retrieved from http://trutzhaase.eu/wp/wp-content/uploads/
HP-Index-2011-SA-An-Introduction-02.pdf
Hickey, R. (1998). The Dublin Vowel Shift and the historical perspective. In J. Fisiak
& M. Krygier (Eds), English Historical Linguistics 1996 (pp. 79–106). Berlin:
Mouton de Gruyter.
Hickey, R. (2002). Historical input and the regional differentiation of English in the
Republic of Ireland. In K. Lenz & M. Görlach (Eds), Of dyuersitie & chaunge of
langage: Essays presented to Manfred Görlach on the occasion of his 65th birthday
(pp. 199–211). Heidelberg: Winter.
Hickey, R. (2003). What’s cool in Irish English? Linguistic change in contemporary Ireland. In
H.L.C. Tristram (Ed.), Celtic Englishes III (pp. 357–73). Heidelberg: Winter.
Hickey, R. (2004). A Sound Atlas of Irish English. Berlin: Mouton de Gruyter.
Hickey, R. (2005). Dublin English: Evolution and Change. Amsterdam: John Benjamins.
Hickey, R. (2010). Supraregionalisation. In L. Brinton & A. Bergs (Eds), Historical Linguistics
of English. HSK series. Berlin: Mouton de Gruyter. Retrieved from https://www.
uni-due.de/~lan300/16_Supraregionalisation_(Hickey).pdf
Hickey, R. (2013). Variation and change in Dublin English. Retrieved from https://www.
uni-due.de/VCDE/
Hickey, R. (2014). Dublin English. Retrieved from https://www.uni-due.de/IERC/
Howard, S. & Heselwood, B. (2013). The contribution of phonetics to the study of vowel
development and disorders. In M. Ball & F. Gibbon (Eds), Handbook of Vowels
and Vowel Disorders (pp. 61–112). New York: Psychology Press.
Jansen, S. (2010). High back vowel fronting in the north-west of England. Proceedings
of Sociophonetics, At the Crossroads of Speech Variation Processing and
Communication. Retrieved from http://www.academia.edu/2221538/High_
back_vowel_fronting_in_the_north-west_of_England
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Kallen J. (2012). The English language in Ireland: An introduction. International Journal
of Language, Translation and International Communication, 1(1), 25–41.
Labov, W. (2001). Principles of Linguistic Change. Volume 2: Social Factors. Oxford:
Blackwell.
Labov, W., Ash, S., & Boburg, C. (2006). Atlas of North American English: Phonetics,
Phonology and Sound Change. New York: Mouton de Gruyter.
McWilliams, D. (2005). The Pope’s Children: Ireland’s New Elite. Dublin: Gill &
Macmillan.
Murphy, S. (1994). A description of Cork English (Unpublished master’s thesis). University
College Cork, Cork, Ireland.
85
Appendix 1
Text of recorded data
Tom could feel the rainwater landing on his face as it poured down. It was
five minutes to midnight. He was walking to the pier as was arranged, to
meet an incoming boat. But when he arrived, facing him instead was Bruce.
He opened his mouth in surprise at the sight of him. He almost forgot to
breathe. He was shaking like a leaf. “It’s a trap”, he thought. He had a choice
to make, to run and hide or to stand and fight.
O’Baoill, D.P. (1990). Language contact in Ireland: The Irish phonological substratum in
Irish-English. In J.A. Edmonson, C. Feagin & P. Mühlhäusler (Eds), Development
and Diversity: Language Variation across Time and Space (pp. 147–172). Dallas:
Summer Institute of Linguistics.
O hUrdail, R. (1997). Confusion of dentality and alveolarity in dialects of HibernoEnglish. In J. Kallen (Ed.), Focus on Ireland (pp. 133–151). Amsterdam: John
Benjamins.
O’Sullivan, J. (2013). Advanced Dublin English in Irish radio advertising. World Englishes,
32(3), 358–376.
Pandeli, H., Eska, J., Ball, M., & Rahilly, J. (1997) Problems of phonetic transcription:
The case of the Hiberno-English slit-t. Journal of the International Phonetic
Association, 27, 65–75.
Pobal, (2006). Cork City: Baseline Data Report. Cork: Gamma.
Thomas, E. & Kendall, T. (2007). NORM: The vowel normalization and plotting suite.
[Online resource]. Retrieved from http://ncslaap.lib.ncsu.edu/tools/norm/
Trudgill, P. (1972). Sex, covert prestige and linguistic change in the urban British English
of Norwich. Language and Society, 1, 179–195.
Watt, D. (2013). Sociolinguistic variation in vowels. In M. Ball & F. Gibbon (Eds), Handbook
of Vowels and Vowel Disorders (pp. 207–228). New York: Psychology Press.
Wells, J. (1982). Accents of English. Cambridge: Cambridge University Press.
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
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Book Review
Whitworth, N. & Knight, R-A. (Eds) Methods in Teaching Clinical
Linguistics and Phonetics
J&R Press Ltd., Guildford, UK [196 pages].
ISBN: 978-1-907826-19-1. Price £29.99/€36.49
Future
d a Positive
This volume, as its title suggests, focuses on teaching
methods in the linguistics curriculum of speech and
g
in
ch
language therapy training programmes. The text is
a
Te
Methods inonetics
h
P
l
written from the perspective of clinical linguistics
a
ic
Clin
tics
ight
Kn
and Linguis
e
nn
rather than traditional linguistics, and addresses
l-A
ae
orth and Rach
Nicole Whitw
a large gap in readily available clinical linguistics
teaching materials. The text contains chapters on
each of the standard modules of linguistic analysis,
written by mostly UK specialists and teachers in
speech and language therapy programmes. After
the editors’ introduction, there are chapters on
articulatory phonetics, acoustic phonetics, phonology,
morphology, syntax, semantics and pragmatics. Along with the clinical focus,
there is a strong, welcome focus on teaching pedagogy and curriculum design.
Each chapter addresses the alignment of teaching and assessment methods
with learning outcomes (Biggs, 2003) and provides practical examples of this
alignment. There is an accompanying Facebook page that provides additional
samples of teaching and assessment material, though at the time of review
material was not available for all chapters.
Book chapters are structured around consideration of learning outcomes,
core curriculum components, teaching and assessment methods (including
materials and resources), and pitfalls. For instance, Chapter 2, Articulatory
Phonetics, identifies learning outcomes as contemporaneous transcription
of client speech, perception (identification, labelling, use of IPA symbols)
and production knowledge of all speech sounds. The delivery of this core
curriculum assumes two hours of phonetics per week over four terms in both
undergraduate and graduate programmes. This is an optimistic assumption,
in my experience, and hours dedicated to phonetics will vary depending on
e
Janet O’Keef
(Editor)
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
88
Book Review
Book Review
design and delivery methods. The core curriculum components suggested for
articulatory phonetics are no different than those that would be taught in an
introductory linguistics course; however, the authors stress the inclusion of
clinical data, integration with practice education, and classroom analysis of
speech samples that emphasize the link with diagnosis and treatment choices.
Teaching techniques in support of this, the authors note, might include small
tutorial groups for production and perception practice, lectures, frequent
informal testing, labs, use of interactive IPA charts, podcasts of lectures,
transcription materials on virtual learning environments and so on. A useful
and much needed emphasis throughout the text is on encouraging enjoyment
of clinical linguistics, and demystifying the analytic component. Student
learning and satisfaction is strongly supported by classroom activities and
resources that reinforce the clinical relevance of their developing skills.
Barbara Dodd’s chapter on phonology foregrounds the need for clinical
therapists to have a firm grasp of the categorical difference between disorders
of organic as opposed to functional origin, and disorders that affect articulation
rather than phonology. The latter is related to the distinction in generative
linguistics between errors of ‘performance’ versus errors of ‘competence’.
Students of linguistics often require time to absorb this distinction and
understand its consequences (as well as its limitations), despite exposure to the
concept in all domains of formal linguistics. Students of clinical linguistics are
no different, and require a lot of support and guided analysis of relevant data.
Dodd proposes co-teaching (SLT and clinical linguist) of some assessment
and intervention components as a way of compensating for the limitations
of a single perspective.
Subsequent chapters provide similar coverage of teaching practice in
other areas of linguistics, from acoustic phonetics through to pragmatics. In
all cases the authors present useful guidelines and practical suggestions that
will be of interest to lecturers and practice educators.
One outcome of this collection is a tentative identification of effective
teaching practice(s) in clinical linguistics. We all know that effective teaching
involves many factors. It is valuable, therefore, to have some of these factors
outlined and discussed so thoroughly, as in this volume.
As a linguist teaching in a clinical programme, I found this a valuable
and very useful book. In various places the chapter authors note the diversity
of training backgrounds of lecturers within Speech and Language Therapy/
JCSLS Vol. 21 2014 © IASLT/TCD/UCC
89
Human Communication departments and indeed, the wealth of perspectives
and expertise that this diversity brings. I was relieved to see that as a linguist,
I was doing many of the things that the chapter authors recommend for their
clinical audience. Of particular value for lecturers is the discussion of lecture
coverage, activities, and the practical resources mentioned in the text and
provided on the Facebook page. In general, there is a huge need for access
to structured clinical data that can be used for classroom teaching and for
independent learning. This need is only beginning to be met. National or
association-sponsored databases would contribute hugely to the quality
of teaching and self-directed learning opportunities for practitioners and
students of speech and language therapy.
Dr Nicola Bessell, Adjunct Lecturer, Department of Speech and Hearing
Sciences, University College Cork, Ireland. E-mail: n.bessell@ucc.ie
References
Biggs, J. (2003). Teaching for Quality Learning at University (2nd ed.). Maidenhead: Society
for Research into Higher Education/Open University Press.
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91
90
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