英文摘要
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Purpose: Children with persistent speech errors and delays in the development of appropriate speech sounds are considered to have speech sound disorders (SSDs), which can decrease the clarity of speech and communication. Persistent speech errors consisting of phoneme addition, omission, distortion, or substitution may result in reduced speech intelligibility and interfere with verbal communication, social participation, and even academic performance from preschool age to adolescence. The onset of SSD symptoms during childhood cannot be accounted for by other medical or neurological conditions, such as hearing impairment, cerebral palsy, and traumatic brain injury. It is estimated that approximately 3%-6% of children aged 4-6 years experience persistent SSD. Although many children (approximately 75%) may outgrow the speech production difficulties at later ages (i.e., 6 years old), as a group, preschoolers with SSD are at increased risk for later reading difficulties. Research examining the relationships between speech and reading has demonstrated that the comorbidity of SSD and reading disability is approximately 25%-30%. One of the possible explanations for this comorbidity is the underlying deficits in the development of phonological representations. In some children with SSD, uncommon or atypical speech errors, which are infrequent in age-matched children with typical development, may be observed in their speech production. Such atypical speech errors may reflect poor phonological representation during speech processes or problems in the foundation of the phonological system. However, the exact relationships between the types of speech sound errors and literacy development in preschool-age children with SSD is not well studied. The purposes of this study were to explore the types and numbers of speech sound errors, types of phonological processing and early literacy skills in preschool-aged children with SSD, and the correlations between these speech production variables and early literacy variables to understand the underlying deficits of early literacy skills. Methods: Twenty-four preschool children aged 5-6 years old (Male = 20) with SSD participated in this study. The average age of the children with SSD was 66.78 months old (SD = 4.40). A total of 29 children with SSD were recruited through kindergartens, hospitals, and website advertisements in northern Taiwan. All participants must have performed lower than the 35th percentile on the standardized articulation test (The Articulatory and Phonological Test for Mandarin-Speaking Children, APTMSC) and above the 80th percentile on the nonverbal IQ test (Test of Nonverbal Intelligence Fourth Edition, TONI-4) to be included in the study. After screening, a total of 24 children were qualified to participate in the study. For the assessment of speech production, a subscale of APTMSC (subtask of sentence) and a self-invented speech production task (picture naming) were used to collect individual children's speech production samples in different articulation situations (including at the word and sentence levels), and we then transcribed and analyzed the types and frequencies of various speech errors and phonological processes. Both the interrater and intra-rater reliabilities were measured to ensure highly reliable speech production analysis and results. An early literacy screen checklist was also implemented to assess individuals' early literacy skills (including aspects of phonological processing, oral and written language awareness, perceptual-motor skills, visual memory, and attention). A correlation and hierarchical regression analysis were used to examine the associations of speech production variables and literacy skills in Mandarin-speaking children with SSD. Results/Findings: The most frequent types of speech errors in children with SSD in different articulation situations were consonant substitutions and vowel omissions. The most frequently appearing phonological processes in children with SSD were deretroflexion, backing, stopping, affrication, fronting and unaspiration. With reference to the severity of SSD obtained through a calculation of the average percentage of consonants correct (PCC), the average severity of SSD in the participants (67.25%) was estimated to be mild to moderate (85% > PCC ≥ 65%). Our participants' overall performance on the early literacy development checklist also indicated significantly weaker literacy performance relative to the age-matched norms. According to the correlational analysis, the number of consonant error variations, the rate of additions per vowel, and the rates of backing and deretroflexion per consonant are all significantly correlated with each individual's early literacy skills after nonverbal IQ was controlled for. For the results of hierarchical regression analysis, after controlling the nonverbal IQ, the number of consonant error variations, the rate of additions per vowels, the rates of backing and deretroflexion per consonants were significantly predictive of individual children's early literacy skills. Compared with previous studies that have shown that substitution type errors are the most common phonetic errors (especially consonants), this present study demonstrated that vowel addition errors are also significantly correlated with and predictive of early literacy skills. Addition errors in vowel production are part of the changes of syllable structure type and ought to be suppressed in the early childhood phonological development process. The persistence of this specific type of atypical speech error may indicate that the quality of phonological representations is weaker in Mandarin-speaking children with SSD, and they may become a high-risk group for impediments in, among others, literacy development. Conclusions/Implications: In conclusion, this correlational study found that the types of speech errors and the phonological process of children with SSD are related to their early literacy skill development. The field of early intervention should pay attention to the early evaluation of preschool-aged Taiwanese children with SSD by examining the total number of consonant variations, the proportions of consonant unaspiration and backing processes, and the vowel addition errors in speech production. The concurrent correlations between these speech error types and early literacy skills should be further explored to analyze the potential longitudinal correlations between specific phonetic variables and literacy development or difficulties. This study also suggests that necessary intervention should be provided as soon as possible to reduce potential difficulties in literacy among school-age children with SSD.
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