About this trial

The goal of this clinical trial is to determine whether perceptual training enhances speech perception and production outcomes in children with Residual Speech Sound Disorders (RSSD). The main questions it aims to answer are:

Does pre-treatment speech production accuracy predict treatment response?

Does perceptual acuity influence the effectiveness of perception-first versus production-first interventions?

Researchers will compare TAU+Perception-first and TAU-first treatment conditions to see if the order of intervention affects speech improvement outcomes, particularly based on participants' initial perception and production accuracy.

Participants will:

Complete pre-treatment evaluations to assess /r/ production and speech perception.

Be grouped into high or low production and perception accuracy categories based on established thresholds.

Be randomly assigned (using a blocked randomization procedure) to one of two treatment arms via telepractice.

Participate in the assigned treatment condition designed to target speech sound accuracy.

Randomization is stratified to ensure treatment groups are balanced based on pre-treatment severity in both the perception and production domains.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

None

Disqualifiers

None

Trial design

Design model

Crossover

Treatments tested in this trial

Visual acoustic biofeedback: ORDER
Behavioral
In visual-acoustic biofeedback treatment, elements of traditional articulation treatment are used, including auditory models, verbal descriptions of correct articulator placement, cues for repetitive motor practice via images and diagrams of the vocal tract as visual aids. These strategies are supplemented with a dynamic display of the speech signal in the form of the real-time LPC (Linear Predictive Coding) spectrum (Sona-Match module of PENTAX Sona- Speech software). Because correct vs incorrect productions of /r/ contrast acoustically in the frequency of the third formant (F3), participants will be cued to make their real-time LPC spectrum match a visual target characterized by a low F3 frequency. They will be encouraged to attend to the visual display while adjusting the placement of their articulators and observing how those adjustments impact F3. Knowledge of performance feedback will typically involve reference to the location of the third peak on the visual display.
Perception Training: ORDER
Behavioral
Description: Perceptual training involves self-paced presentation of auditory stimuli via a computerized software program (Gorilla). Stimuli are organized into three separate tasks. In tasks 1 and 3, which train category goodness judgment, participants will hear 75 naturally produced speech tokens containing /r/ from various speakers, with a balance of correct and incorrect productions. They will classify each /r/ as correct or incorrect and receive feedback on the accuracy of their classification. Tasks 1 and 3 differ in that task 1 will feature a subset of items designed to provide focused practice on a specific context (e.g., initial /r/ as in red; /r/ as syllable nucleus as in sir), with increasing difficulty over time, whereas task 3 will feature randomly selected items representing all contexts and difficulty levels. In task 2, participants will hear 75 items drawn from the synthetic rake-wake continuum used in the identification task administered at baseline, but they will recei

Treatment groups

60 Participants

are divided into 3 treatment groups

Group A: ORDER: Visual acoustic biofeedback trainingActive comparator 1 intervention

Group B: ORDER: Perceptual trainingExperimental treatment 1 intervention

Group C: ORDER: No treatmentNo intervention 0 interventions

Trial outcomes

Primary outcomes

1

Change in perceptually rated accuracy of /r/

To assess generalization of treatment gains to untreated words, participants will be assessed with standard probes containing 45 syllables, 50 words and 5 sentences with rhotic targets in various phonetic contexts. Stimuli in each probe will be presented individually in randomized order with blocking by stimulus type (word, syllable, sentence). No auditory models will be provided; for children with reading difficulty, semantic cues will be provided to elicit the intended word. Individual words will be isolated from the audio record of each word probe and presented in randomized order for binary rating (correct/ incorrect) by 4 trained listeners who are blind to treatment condition and time point (but will see the written representation of each target word). We will use the proportion of "correct" ratings for each token as our primary measure of perceptually rated accuracy from which we will fit a multilevel model as the primary outcome variable.

Time frame

The timepoints for comparison will be from baseline to after both groups have completed 4 weeks of VAB and when both groups have completed the target 12 weeks of treatment (all types interventions: VAB, Perception training and no treatment).

Secondary outcomes

1

Socio-emotional well-being

This 11-item survey, which asks parents to report the impact of speech disorder on their child's social, emotional, and academic well-being, was validated in a published study by members of the research team \[1\]. An impact score, calculated as described in our previous research \[1\], will be used as the primary measure of socio-emotional well-being.

Time frame

Baseline and after all interventions are completed (target time frame: 12 weeks)

2

Percent accuracy pooled across Identification Perception task

Treatment task 2 (identification) is identical to the tasks used to assess performance in the baseline phase, with the single exception that accuracy feedback is provided during the treatment phase. In Task 2, accuracy in classifying stimuli as /r/ or / w/ will be assessed relative to the mean across responses from typical participants in our online participants from the previous funding cycle.

Time frame

The timepoints for comparison will be from baseline to after both groups have completed 4 weeks of VAB and when both groups have completed the target 12 weeks of treatment (all types interventions: VAB, Perception training and no treatment).

3

Percent accuracy pooled across Category Goodness Perception task

Treatment task 3 (category goodness judgment) are identical to the tasks used to assess performance in the baseline phase, with the single exception that accuracy feedback is provided during the treatment phase. In Task 3, accuracy in category goodness judgment will be assessed relative to the "gold-standard" ratings determined by consensus across at least four expert listeners.

Time frame

The timepoints for comparison will be from baseline to after both groups have completed 4 weeks of VAB and when both groups have completed the target 12 weeks of treatment (all types interventions: VAB, Perception training and no treatment).

Online Rotating Delivery of Perception/Production Enhanced Treatment for Rhotics

About this trial

Eligibility criteria

Qualifiers

Disqualifiers

Trial design

Treatments tested in this trial

Treatment groups

Trial outcomes

Primary outcomes

Secondary outcomes

Other outcomes

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