Concurrent Validity of the Conditioned Assessment of Speech
Production (CASP)
and
Speech Sample Analyses
Early Hearing Detection and Intervention Conference
Glendale, AZ
April 15, 2013
David J. Ertmer, Ph.D., CCC-SLP
Speech, Language, and Hearing Sciences
Purdue University
West Lafayette, IN USA
This project was supported by a grant from the National Institute on Deafness and other Communicative
Disorders (1R03DC04226)
Acknowledgements
• This project was supported by a grant from the National
Institute on Deafness and other Communicative Disorders
(1R03DC04226)
• Jongmin Jung, Diana True Kloiber, Denise Bradford
• Faculty at
•
•
•
•
•
Child’sVoice, Wood Dale, IL
St. Joseph Institute, St. Louis ,MO
St. Joseph Institute, Indianapolis, IN
Moog Center, St. Louis ,MO
Ohio Valley Voices, Cincinnati, OH
Background
• Newborn Hearing Screening enables children with hearing
losses to receive hearing aids (HAs) and cochlear implants (CIs)
very early in life.
• Noticeable changes in speech production are among the first
signs of CI and HA benefit
• Evidence of auditory-guided speech development can be
heard as prelinguistic utterances become progressively more
speech-like.
Prelinguistic Vocal Development
• …is a process by which infant and toddlers’
utterances become more
• phonetically diverse,
• structurally complex,
• speech-like
• Basic Canonical Syllables
• (e.g., CV, CVCV, babbling)
• Advanced Forms
• (e.g., CVC, diphthongs, jargon)
…prior to saying words on a regular basis.
Precanonical Vocalizations (PC)
(Range of emergence 0 –6 months in NH children)
• Lack true vowels and true consonants in
combination with a rapid transition between them
(Oller, 2000)
• Types
• Quasi- and fully-resonant nuclei (Oller & Lynch,
1992)
• Squeals
• Vowels / vocants in isolation or in series (Kent &
Bauer, 1985)
• Consonants / Closants in isolation or in series
(Stark, 1980)
Precanonical Video Examples
• http://www.youtube.com/watch?v=4oNhmWbn67c
• http://www.youtube.com/watch?v=lKLQOYMgf1A
Basic Canonical Syllables
(Range of emergence 6 –10 months in TD children)
• characterized by…
•
•
•
•
Normal phonation
Full vocalic resonance
At least one consonant
Rapid CV transitions
(Oller & Lynch, 1992)
• Types
• CV syllables and disyllables (CVCV)
• Reduplicated and nonreduplicated babbling
• Whispered vocalizations
Basic Canonical Syllables
•
•
•
•
http://www.youtube.com/watch?v=37JxkDNJ0Aw
http://www.youtube.com/watch?v=WRKEElUjetg
http://www.youtube.com/watch?v=bt077TOugdA&feature=related
http://www.youtube.com/watch?v=_JmA2ClUvUY&feature=relate
d
OLLER, D. K. & EILERS, R. E. (1988). THE ROLE OF AUDITION IN INFANT BABBLING. CHILD
DEVELOPMENT 59, 441 -449.
Advanced Forms
(Range of emergence in NH children: 10 - 18 months)
• … have canonical attributes but are phonetically or prosodically
more complex than BCS (Nathani, Ertmer, & Stark, 2002)
• Types
• Complex syllables (e.g. CCV or CVC)
• Jargon
• combinations of different consonants and vowels with changes in stress or
intonation
• Diphthongs
Advanced Forms
• http://www.youtube.com/watch?v=drMaxN5ohA0
• http://www.youtube.com/watch?v=WdoZ8WkfoAE
Cross-sectional Data: 30 Infants with Normal Hearing
Nathani, Ertmer, & Stark (2006)
Typically Developing Infants
100
80
Precanonicals
60
AF
40
20
0
0 - 2 Mos.
BCS
3-5 Mos.
6 - 8 Mos.
9 - 12 Mos. 13 - 15 Mos. 16 - 20 Mos.
http://www.vocaldevelopment
.com
• Definitions
• More audio examples
• Language input and response
strategies
• Video examples of strategies
• Intervention program (SPPI)
Speech Sampling
• In research, vocal development is commonly
monitored through speech sample analysis.
• Speech sample analysis…
• …requires special training in identifying many
kinds of vocalizations (Nathani, Ertmer, &
Stark, 2007)
• … time-intensive
• …may not be practical for routine clinical use
Emergence of Speech-Like
Utterances (BCS + AF)
100
* p<.05, and **p<.005
90
(n = 3)
(6)
(11)
(11)
(12)
(12)
(12)
(12)
*
80
70
**
(12)
*
(12)
**
60
CI PC
50
CI SL
**
40
TD SL
**
30
20
10
0
Pre
early
3months
6months
9 months
12 months
15 months
18 months
21 months
24 months
Basic
Canonical
Syllables *
Advanced
Forms *
Precanonical
* Speech-like
The Conditioned Assessment of Speech
Production (CASP): An alternative to speech
sampling (Ertmer & Jung, 2012; Ertmer & Stoel-Gammon, 2008)
• Easy-to-administer imitation “game”
• Vocal stimuli from 3 developmental levels of the Stark
Assessment of Early Vocal Development-Revised (SAEVD-R;
Nathani et al, 2007)
• Precanonical (PC)
• Basic Canonical Syllables (BCS)
• Advanced Forms (AF)
• For ages 18 – 48 months in children who have hearing loss
• Has been used with English, Spanish, and Korean-speaking
children
CASP Administration
• Parents and clinician provide models of
• Isolated vowels (PC) (/ʌ/, /i i/, /æ æ æ/ )
• CV syllables (BCS) ( [ba], [ma], [wa], [sa], [ka] )
• CVC, C + diphthong syllables (AF) ( [tʌk], [naI]
)
• Child’s imitative attempts are reinforced with
Classical Stacker toy
• Graduated scoring scale
• 0 = no attempt, not a close match
• 1 = partially acceptable match
• 2 = fully acceptable match
Research Question: Do CASP scores have
concurrent validity with speech sample
measures ?
• 19 children with CIs (2 with additional disabilities)
• Mean implant age = 21.5 months
• CASP and 20-minute speech samples collected after
6, 12, 18, 24 months of CI use
• 50 child-utterances from each sample classified as PC, BCS,
or AF
• Correlation variables
• Percent of CASP points earned
• Percent of speech-like utterances in speech samples
Relationship between speech-like
utterances in samples and CASP
scores (Ertmer & Jung, in press)
Mean Percent of Speech-like Utterances and
CASP scores at each interval (Ertmer & Jung, 2012)
Conclusions
• The CASP …
• has high concurrent validity with speech sample measures in English-speaking
children
• is time-efficient tool for assessing progress in vocal development after CI of HA
fitting
• Also…
• CASP may identify children with secondary disabilities as well as those with
speech delays
• Scores of two children with second disabilities were found to be >1.5 standard deviations
below the mean CASP scores at 18 months and 24 months.
• CASP scores at 2:0 in children with mild – moderate HL predict speech production on
GFTA at 3:0 (personal communication, M.P. Moeller, February 28, 2013)
• Adaptations of the AF level are needed for languages that differ from English in the
use of closed syllables and diphthongs (e.g., Japanese, French, Finish, and Italian)
• Further study needed to develop norms based on amount of hearing
experience
References , related readings,
and internet resources
• Ertmer, D. J. & Jung, J. (2012). Monitoring Progress in Vocal Development in Young
Cochlear Implant Recipients: Relationships between Speech Samples and Scores from the
Conditioned Assessment of Speech Production (CASP). American Journal of Speech-language
Pathology, 21, 313-328 (Instructions and forms in appendices)
• Ertmer, D. J. & Jung, J. (2011). Vocal development in young cochlear implant recipients
during year one of cochlear implant use: Comparisons with typically developing children.
Journal of Deaf Studies and Deaf Education. doi:10.1093/deafed/enr021
• Ertmer, D. J. & Stoel-Gammon, C. (2008) The Conditioned Assessment of Speech Production
(CASP): A tool for evaluating auditory-guided speech development in young children with
hearing loss. The Volta Review, 108, 59-80.
• Ertmer, D. J. , Young, N. M., & Nathani, S. (2007). Profiles in vocal development in young
cochlear implant recipients. Journal of Speech, Language, and Hearing Research, 50, 393407. doi:10.1044/1092-4388(2007/028)
• Nathani, S., Ertmer, D.J., & Stark, R. E. (2006). Assessing vocal development in infants and
toddlers. Clinical Linguistics and Phonetics, 20, 351-369. doi:10.1080/02699200500211451
• Video of CASP administration http://nc.agbell.org/NetCommunity/Page.aspx?pid=533.
ctions and forms www.vocaldevelopment.com