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The evaluation of a model speech training program for deaf children
JOURNAL
OF COMMUNICATION
DISORDERS
11(1978),
293-313
293
THE EVALUATION OF A MODEL SPEECH TRAINING PROGRAM FOR DEAF CHILDREN MARY The Lexington Schoolfor
JOE OSBERGER*
the Deaf, 30th Avenue and 75th Street, Jackson Heights, New York 11370 AND
Doctoral Program in Speech and Hearing Sciences, City University of New York Gra&ate School, West 42nd Street, New York, New York 10036
ANDREA Functional
JOHNSTONE
AND EILEEN SWARTS
Auditory Speech Training Program,
HARRY
The Lexington School for the Deaf
LEVI’lT
Doctoral Program in Speech and Hearing Sciences,
City University of New York Graduate School
Systematic speech training procedures were employed with a group of 20 hearing-impaired children ranging in age from 7 to 10 years. Using a primarily auditory-oral approach, the speech training program employed a hierarchical sequence in order to teach the suprasegmental patterns of English to the children. The children’s performance on the speech training hierarchy was monitored on a daily basis using a checklist system. Based on their rate of progress in the development of speech skills, the children were divided into three groupspost hoc: rapid, slow but steady, inordinately slow. Although the system worked well, on the average, approximately one-third of the children encountered serious difficulties at one or more levels of the hierarchy. Examination of the children’s background information and audiological data revealed that those children who encountered difficulty had an extremely limited amount of residual hearing and/or problems other than a hearing handicap.
Introduction
It has been well established that the speech of most profoundly deaf children is unintelligible (Brannon, 1964; John and Howarth, 1965; Markides, 1970; Smith, 1972). Throughout the years numerous research efforts have provided us with a description of the types of errors that exist in the speech of deaf children (Hudgins and Numbers, 1942; Markides, 1970; Smith, 1972 and others). As a consequence of these investigations, we now have a better understanding of error types but not how these errors render the deaf child’s speech unintelligible. Briefly, the errors can be divided into two major categories: segmental (phonemic) and suprasegmental (prosodic). The segmental errors typically in-
* Address correspondence to: Mary Joe Osberger, Doctoral Program in Speech and Hearing Sciences, City University of New York Graduate School, 33 West 42nd Street, New York, New York 10036. o Elsevier North-Holland,
Inc.,
1978
0021-9924/78/001
l-0293$01.75
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et al.
volve the omission, substitution, and distortion of vowels and consonants (Hudgins and Numbers, 1942; Markides, 1970; Smith, 1972). Many of the suprasegmental errors are a result of inappropriate and inadequate control of fundamental frequency (Green, 1956; Angelocci et al., 1964; Martony, 1968; Smith, 1972), poor control of the respiratory mechanism (Hudgins, 1937, 1946), and the failure to observe the timing patterns typical of normal speech (John and Howarth, 1965; Boothroyd et al., 1974). Once the errors have been identified in a particular child’s speech, the clinician is faced with the problem of selecting the most appropriate remediation procedures. Although speech training techniques have been described in the literature (Haycock, 1933; Ewing and Ewing, 1964; Calvert and Silverman, 1975; Ling, 1976), there have been no systematic investigations that have attempted to determine the effectiveness of the various training procedures. at this time, it is not known to what extent a deaf child’s speech production skills will improve if well-defined, systematic training procedures are employed. In addition, there is little research data that shows the length of time it takes deaf children to correct deviant speech. patterns or to develop new patterns. One approach to this problem is to develop a speech training model and objectively evaluate the effectiveness of the model. Once such a model has been evaluated, it can provide a quantitative description of a child’s ability to learn certain speech skills during a specified period of time. At the same time, inadequacies inherent in the model can be identified and appropriate changes can be made in the model. Through repeated applications and evaluations of the model, it is possible to determine in a scientific way which procedures are the most effective. The advantage of this approach is that a speech training program will gradually be generated on the basis of repeated objective measures rather than simply on clinical intuition. The present article describes a first attempt to develop and evaluate a model program for speech training. The model, which is an adaptation of Ling ‘s (1976) system, consists of a hierarchy of speech skills which are taught to the children in sequential order. A brief description of the training program will be presented as well as the preliminary data obtained on a group of deaf children’s performance on the first part of the speech training hierarchy, the suprasegmental patterns of speech. A more detailed description of the entire project is available in a laboratory report by Osberger et al. (1977). Procedures Subjects The speech training hierarchy has been employed with a group of deaf children at the Lexington School for the Deaf. Twenty children, ranging in age from 7.7
EVALUATION
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SPEECH TRAINING
PROGRAM
295
years to 10.1 years, participated in the project. Of the 20 children, 9 were females and 11 were males. The children were a representative sample of the population at the Lexington School for the Deaf with respect to hearing level, age of onset of deafness, etiology of deafness, years of special education, parental motivation, and socioeconomic status. Since one of the intents of the program was to evaluate speech training procedures with children typically found in schools for the deaf, the children were selected on a quasi-random basis and no child was excluded from participating in the program if he was suspected of having problems other than deafness. Audiological evaluations were performed on each child at the beginning of the project. Six of the children had pure tone averages (average of 500, 1000, and 2000 Hz) of 90 dB or less in the better ear; the other 14 children had pure tone averages of 90 dB or greater. For 14 of the 20 children, measurable responses could be obtained at frequencies higher than 1000 Hz. The remaining children did not have measurable responses at frequencies of 1000 Hz or higher and could be described as having comer audiograms. Pertinent background information was obtained from the children’s school records. For the majority of children, deafness was diagnosed, hearing aids were first obtained, and special education was initiated during the preschool years. One child had deaf parents and signing was the primary mode of communication in the home. The other 19 children were of hearing parents, 5 of whom spoke a language other than English. Information regarding parental cooperation, socioeconomic status, and the child’s hearing aid usage was obtained from the children’s classroom teachers. The teachers were asked to assign a rating of either 1 =good, 2=fair, or 3 =poor on each of the above mentioned variables. Parental cooperation was rated good for 7 of the children’s parents, fair for 6, and poor for 7. Socioeconomic level was rated good for 5 of the children’s parents, fair for 8, and poor for 7. Every child in the program had his or her own binaural hearing aids. Hearing aid checks were made daily by the teachers in order to insure that each child received optimal benefit from amplification. Whenver nonfunctioning aids were detected, the children were given loaner hearing aids so that they were binaurally amplified at all times. The Speech
Training Hierarchy:
Suprasegmental
Patterns
Before proceeding with a description of the hierarchy, it should be pointed out that the speech training was based primarily on an auditory-oral approach, that is, all speech training was performed only with auditory cues. However, if after a period of time a child was unable to develop the skills auditorily, other cues, such as visual or tactile, were introduced. If other cues were introduced, the individual
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working with the child was required to go back and attempt to obtain acceptable levels of performance with auditory cues only. The suprasegmental section of the hierarchy consisted of five levels which were taught in sequential order. The first five levels of the hierarchy required the child to produce and discriminate syllables that varied in (1) duration, (2) intensity, (3) intensity and duration combined, (4) pitch, (5) pitch and duration combined. On each of the five suprasegmental levels the child performed three groups of tasks: (1) production on an imitative basis, (2) production on demand, and (3) discrimination. Production on an imitative basis required the child to produce the various patterns with auditory cues only. Thus, successful performance on these tasks was dependent on both the correct perception and production of the particular suprasegmental pattern. Production on demand required the child to produce spontaneously the various suprasegmental patterns. In order to elicit the production of specific patterns, a visual cueing system was used. For example, strips of paper of various lengths were used to elicit syllables of different durations. Since responses to these tasks were elicited with visual cues rather than auditory cues, successful performance on this level was dependent only on the child’s ability to produce the desired patterns. These tasks renresent a slight departure from ,using a strictly auditory-oral approach. The tasks were incorporated in the training scheme for the following reasons: (1) to assess the child’s ability to produce the various patterns when the speech model provided by the teacher was removed and (2) to help the child develop those skills that are necessary for the successful carry-over of the various patterns to his spontaneous speech. The visual cueing system was also used for the discrimination tasks. For these tasks the teacher produced a particular pattern and the child then pointed to the symbol that corresponded to the teacher’s production. Successful performance on this level was dependent on the child’s ability to perceive and discriminate patterns through audition alone. The three groups of tasks (production on an imitative basis, production on demand, and discrimination) were not necessarily hierarchical and training was generally performed in these areas simultaneously. However, for each of these tasks there were additional subgroups which were taught in a hierarchical sequence. These subgroups involved the production (imitatively and on demand) or discrimination of suprasegmental patterns first on separate breaths and then on a single breath. For example, a child must first have been able to produce syllables that vary in duration each on a separate breath before he was expected to produce two or more syllables on a single breath. Table 1 summarizes the groups of tasks. Each child was seen for a 1%min speech tutoring session four times a week. The tutoring was performed on an individual basis by either the child’s own teacher or another teacher in the school. Each child was tutored by the same individual throughout the school year.
EVALUATION
Summary Production
OF A MODEL SPEECH TRAINING
TABLE 1 of the Tasks for the Five Suprasegmental
on an imitative basis
Production
on demand
PROGRAM
297
Levels of the Hierarchy Discrimination
1. Production of syllables of 4 different durations (or 4 different intensities, or 4 different pitches or combinations of 4 different intensity-duration patterns, or 4 different pitch-duration patterns), each on a separate breath
1. Production of syllables of 4 different durations (or 4 different intensities, or 4 different pitches or combinations of 4 different intensity-duration patterns, or 4 different pitch-duration patterns), each on a separate breath
1. Discrimination of syllables of 4 different durations (or 4 intensities, or 4 different pitches or combinations of 4 different intensity-duration patterns, or 4 different pitch-duration patterns), each syllable being produced by the teacher on a separate breath
2. Production of a string of syllables with any combination of the 4 different durations (or intensities, or pitches or intensity-du-ation patterns, or pitch-duration patterns) on one breath
2. Production of a string of syllables with any combination of the 4 different durations (or intensities, or pitches or intensity-duration patterns, or pitch-duration patterns) on one breath
2. Discrimination of a string of 4 syllables with any combination of the 4 different durations (or intensities, or pitches or intensity-duration patterns, or pitch-duration patterns), all syllables being produced by the teacher on one breath
Evaluation
Techniques
The children’s performance on the speech training hierarchy was monitored by means of a checklist system. The checklists, which corresponded to the various levels in the hierarchy, were used on a daily basis by the teachers during the 15min tutoring session. The system was implemented in order to obtain quantitative data regarding each child’s progress in the development of specific speech skills. With the use of this procedure, it was possible to obtain a quantitative individualized mapping of each child’s progress. Difficulties common to all children could be recognized and differentiated from those difficulties unique to a given child. The children were required to meet predetermined criteria for acceptable performance before a check was given for the tasks. Only when the child had correctly performed a particular task 10 out of 10 times was a check entered in the appropriate box. In addition, the child had to maintain the acceptable level of performance for 3 days before he was considered to have mastered the task. Examples of the checklists can be found in the Appendix. Results Each child’s performance on the hierarchy has been analyzed using the data obtained from the checklists. In order to facilitate the analysis of this large body
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of data, the children’s progress was monitored on a computer system.’ A recreation of a typical computer printout which details a child’s progress on the suprasegmental patterns is shown in Fig. 1. The vertical axis shows the different suprasegmental levels in the hierarchy. The lower row of numbers on the horizontal axis identifies the weeks of speech tutoring and the upper row of numbers specifies the number of days in each week that the child received speech tutoring. In most cases a week of tutoring consisted of 4 speech tutoring days. However, for some weeks, a child may have received less than 4 days of tutoring because of absence from school or school vacation. When discussing the children’s performance on the hierarchy, the rate of progress will be discussed in terms of weeks (i.e., 4 days per week) since the number of days per week for the total 39 weeks for each child was in almost every case very close to 4 days per week. The graphical symbols provide information in coded form on the progress of tutoring. The symbol + indicates that a new task on the hierarchy was attempted and that acceptable performance was achieved. The - symbol indicates that a new task was attempted but the child was unsuccessful. An analogous pair of symbols is the X and =, respectively. The X indicates that a check was carried out on a task on which the child was previously successful, and that the child maintained an acceptable level of performance. The = symbol indicates regression, i.e., when a check was carried out on a previously successful task, the child failed to maintain an acceptable level of performance. The . symbol indicates that the teacher did not have time to cover the specific task. It should be noted that time constraints did not permit work to be done on all tasks for a particular level during each 15min session. Typically, each tutoring session was devoted to groups of approximately three or four tasks. In summary, the computer printouts provide the following information: 1. The number of days each child received speech tutoring. 2. Individual rates of progress in the development of specific speech skills at each level of the hierarchy. 3. The average rate of progress for all children and the extent of individual differences at each stage (this information is obtained by comparing the checklists for all children). 4. The maintenance of speech skills over time. 5. The evidence of regression, if any. An analysis of the printouts for all children showed that some children acquired the various speech skills at a faster rate than other children. The children
‘The computer system provided a convenient way for monitoring the children’s performance. However, such a system is not considered to be essential to the implementation of the speech training program.
Fig. 1.
2 5 6 7 8 9 10 11 12 13 14 15 16 17
VEEK I 1 2
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++++++
INTENSITY
x+x+x+
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LHPENSITYDURATION
XL,+
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+. xxx+x+
+++-+-
PITaDDKATIoN
A recreation of a computer printout which shows a child’s performance on the five suprasegmental levels of the hierarchy. The six groups of tasks are (1) syllables produced or separate breaths (imitation); (2) four syllables produced on one breath (imitation); (3) syllables produced on separate breaths (on demand); (4) four syllables produced on one breath (on demand); (5) discrimination of syllables produced on separate breaths; (6) discrimination of syllables produced on separate breaths.
: 3 0 0 4 2
4 3 3 4 1 3 3 4 3
I OP DAYS .*
DURATION
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were divided into three groups, post hoc, on the basis of their rate of progress. Group 1, consisting of 7 children, acquired the new speech skills at a very rapid rate. Group 2, consisting of 6 children, showed a steady but slower rate of progress. The progress of the children in Group 3, consisting of 7 children, was inordinately slow. Figure 1, which was described above, is the printout for a typical child in Group 1. Figure 2 is a replication of Fig. 1 except that the + symbols have been connected by hand in order to illustrate more clearly the rate of progress. The rate of progress is shown as a stepped function: the smaller the horizonal section of each step, or, alternatively, the larger the vertical section, the faster the progress. For this particular child, duration and intensity patterns were acquired in 1 week, as shown by the small horizontal steps between levels. Pitch and pitch-duration patterns were acquired in 2 weeks and intensity-duration patterns were acquired in 7 weeks. Some difficulty was encountered by this child on the intensityduration level of the hierarchy, as shown by the one long horizontal step. This level usually required a relatively longer period of time for all the children to complete, even those children who showed a rapid rate of progress. Figure 3 shows the performance on the suprasegmental patterns for a typical child in Group 2. Duration and intensity-duration patterns were acquired in 3 weeks. Intensity and pitch-duration patterns were acquired in 4 weeks and pitch patterns were developed in 5 weeks. Note that this child’s performance is slower than the child’s performance in Group 1 by a similar proportion. There are, however, occasional deviations from this general pattern. For example, on the intensity-duration level; child X in Group 2 took relatively less time to complete the tasks than did the child in Group 1. On the average, the length of time required by the children in Group 2 to complete the suprasegmental levels was roughly twice as long as that required by the children in Group 1. For the third group, there was evidence of serious problems. Some of these children did not appear to progress beyond a certain level, other children showed an inability to maintain previously acquired skills, while others showed some progress but at an inordinately slow rate, e.g., 10 weeks to progress beyond a single level. Figure 4 shows the performance on the suprasegmental patterns for a typical child in Group 3. Four weeks were required for the development of duration patterns, 8 weeks were required for the development of intensity patterns, and 17 weeks were required for the development of intensity-duration patterns. Thus, for this child, training on the other suprasegmental patterns was not possible before the end of the school year was reached. The average rate of progress shown by the children in Group 3 was roughly twice as slow as the rate of progress shown by the children in Group 2 and roughly four times as slow as the rate of progress shown by the children in Group 1. An analysis of the data for all children revealed that performance on those levels of the hierarchy that involved the combination patterns (intensity-duration, pitch-duration) showed substantial variations between children. In view of the
EVALUATION
OF A MODEL
-1
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SPEECH TRAINING
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301
302
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+XKbG#X I
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et al.
EVALUATION
OF A MODEL SPEECH TRAINING PROGRAM
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idiosyncratic performance on these levels and the fact that these combinations are not entirely representative of natural speech, it was decided that these stages were in need of modification for future training programs. Since these levels were to be changed, additional analyses were performed with data from these levels deleted. Figure 5 summarizes the performance of the children on the suprasegmental levels of duration, intensity, and pitch. Since some of the children in Group 3 failed to complete the pitch level, only data for Groups 1 and 2 are shown for the pitch section of the hierarchy. Separate analyses of variance were performed on the data that were obtained.’ The first consisted of a 3-way analysis of variance which examined the effects of Group (1, 2, 3), suprasegmental level (duration, intensity), and task (six tasks for each suprasegmental level). No significant difference was found in the length of time taken to complete suprasegmental level, i.e., it took the same amount of time, on average, to complete the duration level as it did the intensity level. There were significant differences, (F=36.06, P.LcO.01) between groups. The Group 1 children took half as long as the children in Group 2 and the Group 3 children took roughly twice as long as the Group 2 children and four times as long as the Group 1 children. There were also significant differences (F= 10.16, P.LCO.01) in the time taken to complete the individual tasks within a level. As shown in Fig. 5, those tasks involving one breath were consistently the most difficult for all children. Statistically significant interactions (F=4.20, P.LGO.01) were observed between groups of children and tasks within a level. As shown in Fig. 5, Group 3 took roughly twice as long as Group 1 or 2 for imitation on separate breath tasks but took almost three times as long for imitation on one breath tasks. A similar pattern of performance was observed for the discrimination tasks. Figure 5 also shows that the imitation and discrimination tasks required a greater proportion of time for the children in Group 3 to complete than did the production of demand tasks. On the average, the Group 3 children took a much longer time to complete the imitation and discrimination tasks than did Group 1 or 2. Also, in all three cases (imitation, demand, discrimination) the relative performance of Group 3 is much worse on one breath than on separate breaths. A second analysis of variance was performed on the data obtained for the two groups of children (Group 1 and 2) who successfully completed all three suprasegmental levels. Again, the effects of group (1 i 2), suprasegmental level (duration, intensity, pitch), and task (six different tasks for each suprasegmental level) were examined. As in the previous analysis, there was a statistically significant difference (F = 2 1.65, P . L SO. 0 1) between groups of children. There was also a significant difference (F=10.18, P.LSO.01) in the length of time taken by all the children to complete the six different tasks. There was a small but statistically significant interaction between suprasegmental level and group (F=3.25, P.LsO.05). As shown in Fig. 5, the children in Group 2 took alonger period of time to complete the pitch level than to complete the duration or
EVALUATION
OF A MODEL SPEECH TRAINING
PROGRAM
305
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16
5
16
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12
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(N=s)
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(N=7)
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Breath
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DISCRIMINATION
Length of time required by the children to complete the tasks for the duration, and pitch levels of the suprasegmental section of the hierarchy.
intensity,
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MARY JOE OSBERGER
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intensity level. For the children in Group 1, the pitch level required no more time to complete than either of the other two levels. Thus, as these two groups of children progress through the various levels of the hierarchy, the difference in their performance becomes more apparent. Discussion The data obtained in this study showed that the training procedures were effective for the majority of the children. However, approximately one-third of the children failed to make satisfactory progress. An important question is, why did some children encounter so much difficulty with the training strategies employed? In an attempt to answer this question, the relevant background information and audiological data were examined for all three groups of children. Table 3 summarizes the background information. As a group, the children in Group 3 have lower IQ’s. However, a valid comparison cannot be made on this variable since the test scores were not available for some of the children in Group 3. In general, the children in Group 1 tended to be better hearing aid users than the children in Group 2 or 3. Examination of the other variables revealed no other clear-cut patterns that might account for the differences in performance between groups of children. Differences in the other areas examined appear to be fairly evenly distributed among all three groups of children. Table 4 summarizes the audiological information for the three groups of children. In this table, the pure tone thresholds are shown for the better ear for each of the children. Examination of the mean pure tone averages (average of 500, 1000, and 2000 Hz) for each group of children showed a very strong relationship between hearing level and performance on the hierarchy. The data showed that, on the average, the rate of progress decreases as the hearing level increases. In addition, 7 1% of the children in Group 1 have measurable hearing above 1000 Hz, whereas only 66% of the children in Group 2 and 42% of the children in Group 3 show responses to pure tones above 1000 Hz. Although performance on
TABLE 2 Average Length of Time in Weeks Required by the Children to Complete the Suprasegmental the Speech Training Hierarchy
Duration (weeks)
Intensity (weeks)
Intensityduration (weeks)
Levels of
Pitch (weeks)
Pitchduration (weeks)
Group 1
2
2
5
2
2.5
Group 2
3
5
6
4.5
8
Group 3
7.5
9.5
8
10.5-completed by only two children
Not yet completed by any children
s
X age: 4.5 years
_
Age at Beginning of Special Education _--_
Age when Deafness Diagnosed
Etiology of Deafness
1
Unknown: 5 Genetic: 1 Maternal rubella:
3
- -
\_ L
?
’ ,Scores not available for three children in this group.
>
.
,
-~
X age: 3.1 years
1
Unknown: 5 Maternal rubella:
2
X age: 2 years
X age: 4 years
Unknown: 6 Genetic: 1
1
^.
_
__
_
x age: 2.7 years
x age: 3 6 years
-__-__
1
6
Hearing: Deaf:
4 3
Female: Male:
x age: 8.7 years
(N = 7)
3
All hearing
3 3
Female: Male:
All hearing
X age: 7.7 years
2 5
Parents hearing
2 (N = 6)
Female: Male:
Sex
TABLE 3
-
6 1
-
rl
cd_
x age: 2.4 years
_.--_
_
Good: 4 Fair: 2 Poor: 1
Good: 3 Poor: 3
ST age: 3.1 years
Use of Hearing Aid
Good: 6 Fair: 2
-
-
Good: 3 Fair: 1 Poor: 3
Good: 2 Fair: 1 Poor: 3
Good: 2 Fair: 4 Poor: 1
X age: 4.4 years
Age First Fit with Hearing Aid
English: Sign:
English: 4 Language other than English: 2
English: 5 Language other than English: 2
Parental cooperation
GroupI, Group2, and&oup 3
Language used in the home
on the Children in
x age: 9.2 years
Age at start of the project
Information
1 (N = 7)
Group
Relevant Background
?? score: 65.5
X score: 91.5
F score: 95.4
IQ Score (WISC)
Good: 2 Fair: 1 Poor: 3
Good: 1 Fair: 4 Poor: 2
Fair: 4 Poor: 2
Good: 1
Socioeconomic status
-
308
MARY JOE OSBERGER
Pure Tone Thresholds
et al.
TABLE 4 for the Better Ear in dB (re: ANSI 1969) for the Children in Group 1, Group 2, and Group 3 Frequency
Child #
125
250
500
Group 1 1 2 5 6 I 10 20
35 a 45 65 55 = 55
55 80 55 90 60 80 70
75 100 65 90 65 100 85
110
cl
15 100 85 110 85
80 95 85 (I
Group 2 3 4 II 12 17 19
a 60 u 65 65 25
15 75 70 80 75 50
95 100 80 85 95 65
105 105 110 105 105 85
u (1 n
80 55
90 75 85 80 90 80 105
105 90 90 95 105 95 105
110 85 100 n 110 95 110
Group 3 8 9 13 14 15 16 18
10
80 80 80 90
1000
80
1500
2000
3000
95 0 85 0 ’ II
90
75
100 110 80
4000
0
8000
F’TA
a 106.6 b a 0 ’ n
81.6
73.3 96.6 85 78.3 n 106.6b 75 a 81.6 Mean pure tone average: 89.2 L2
(I
103.3 b 105.0b lOO.Ob loo = 96.6 0 a 103.3b 85 80 76.6 Mean pure tone average: 97.4 0 Y
0 (1
c1
L1
80 0 (I 100 (I LI
80 II 0 90 II (1
108.3b 86.6b lOO.Ob 105.0b 106.66 lOO.Ob 108.3b Mean pure tone average: 102.1
0 No response at the audiometric limits (65 dB at 125 Hz; 110 dB in the higher frequencies). b Pure tone average obtained by averaging in the level of the audiometric limits, i.e., 110 dB when there was no measureable response at 500, 1000, or 2000 Hz.
the hierarchy seems to be related to the severity of the hearing loss, there are some exceptions that should be discussed. First, two of the children in Group 1 (#2, #IO) have pure tone averages similar to those of the children in Group 3. For one of these children, measurable responses could not be obtained above 500 Hz; for the other child, responses to pure tones could not be obtained above 1000 Hz. Second, one third in Group 2 (#9) and one child in Group 3 (#9) have pure tone averages of 76.6 and 86.6 dB, respectively. Although the rate of progress shown by the children seems to be determined to a large extent by the severity of the hearing loss, hearing level alone does not appear to account for all the observed differences. Throughout the course of the training program, the teachers noted that some of the children in the project
EVALUATION
OF A MODEL SPEECH TRAINING
PROGRAM
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appeared to have problems other than deafness. In fact, independent reports from the school psychologists, supervisors, and teachers indicate that 5 of the 7 children in Group 3 have problems in addition to a hearing handicap, e.g., exceptionally poor auditory memory, poor sequencing abilities, and emotional disturbances. The inordinately slow rate of progress shown by the children in Group 3 seems to be due to an extremely limited amount of residual hearing and/or the presence of problems other than a hearing loss. As a result of the present study, base-line data are now available on the length of time required by a group of hearing-impaired children to learn a specified set of speech skills, using an auditory-oral approach. However, our data do not indicate whether any of these children would have achieved a higher level of performance if other approaches to speech training had been employed even with those children in Group 3. Additional research is needed to determine the relative effectiveness of various speech training strategies. The authors are indebted to Dr. Daniel Ling, McGill University, and to Janet Head and Margot &sack, Lexington School for the Deaf, for their advice and guidance throughout this project, and to Anita Davidsen, Gateway Pre-school, who was the project co-ordinator during the first year of the program. We also wish to thank Ronald Slosberg, computer programmer, CUNY Graduate School and University Center, for the computer analysis of the data. The support of Dr. Leo Connor, Executive Director of the Lexington School for the Deaf, and the participating teachers and other staff members at the school is deeply ap-’ preciated. The project was supported by private funds from the Lexington School for the Deaf. The methods of evaluating and analyzing the data were developed under PHS Grant 09252. References Angelocci, A., Kopp, Cl., Holbrook, A. The vowel formants of deaf and normal hearing eleven to fourteen year old boys. J. Speech Hear. Dis., 1964, 29, 156-170. Boothroyd, A., Nickerson, K., Stevens, K. Temporal patterns in the speech of the deaf-a study in remedial training. C. V. Hudgins Diagnostic and Research Center, Clarke School for the Deaf, Northampton, Mass., 1974. Brannon, J. B. Visual feedback of glossal motions and its influence on the speech of deaf children. Ph.D. thesis, Northwestern University, 1964. Calve.., D.,Silverman, R. Speech and deafness. Washington, D.C.: A. Cl. Bell Association, 1975. Ewing, A., Ewing, E. C. Teaching deaf children ro talk. Washington, D.C.: A. G. Bell Association, 1964. Green, D. Fundamental frequency of the speech of profoundly deaf individuals. Ph.D. thesis, Purdue University, 1956. Haycock, G. S. The reaching of speech. Washington, D.C.: A. G. Bell Association, 1933. Hudgins, C. V., Voice production and breath control in the speech of the deaf. Am. Ann. Deaf, 1937, 82, 338363. Hudgins, C. V. Speech breathing and speech intelligibility. Volta Rev., 1946, 48, 642-644. Hudgins, C. V., Numbers, G. C. An investigation of the intelligibility of the speech of the deaf. Genet. Psychol. Monogr., 1942, 25, 289-392.
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et al
John, J. E., Howarth, J. N. the effect of time distortion on the intelligibility of deaf children’s speech. Lang. Speech, 1%5, 8, 127-134. Ling, D. Speech and the hearing-impaired child: theory andpractice. Washington, D.C.: A. G. Bell Association, 1976. Markides, A. The speech of deaf and partially hearing children with special reference to factors affecting intelligibility. Er. J. Dis. Commun., 1970, 5, 126-140. Martony, J. On correction of voice pitch level of severely hard of hearing subjects. Am. Ann. Deaf, 1968, 113, 195-202. Osberger, M. J., Levitt, H., Johnstone, A., Swarts, E. The Functional Auditory Speech Training Program. CSL Research Report 9, CUNY Graduate School and University Center, 1977. Smith, C. Residual hearing and speech production imdeaf children. Ph.D. thesis, City University of New York, 1972.
Appendix: Checklists for the Suprasegmental Levels of the Hierarchy
NAME
DATE
Suprasegmental
Patterns-DURATION
PRODUCTION IMITATES: Mon
Tues
Wed
Thurs
Fti
Mon
Tues
Wed
ThUrS
Fri
Wed
Thurs
Fti
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon
Tues
1 Separate Breaths One Breath
EVALUATION
OF A MODEL SPEECH TRAINING
311
PROGRAM
DATE
NAME
Suprasegmental
Patterns-INTENSITY
PRODUCTION IMITATES: Mon
Tues
Wed
Thurs
Fri
Mon
Tues
Wed
Thurs
Fri
Wed
Thurs
Fri
Thurs
Fri
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon
Tues
Separate Breaths One Breath
DATE
NAME
Suprasegmental
Patterns-INTENSITY/DURATION
COMBINES DIFFERENT *DURATION-INTENSITY IMITATIVELY:
PATTERNS
PRODUCTION Mon Separate Breaths One Breath
Tues
Wed
312 PRODUCES
MARY JOE OSBERGER
et al.
ON DEMAND: Mon
Tues
Wed
Thurs
Fli
I I
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon
Tues
Wed
Thurs
Fri
Separate Breaths One Breath
DATE
NAME
Suprasegmental
Patterns-PITCH
PRODUCTION IMITATES: Mon
Tues
Wed
Thurs
Fri
Mon
Tues
Wed
Thurs
FIi
Wed
Thurs
Fli
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon Separate Breaths One Breath
Tues
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PROGRAM
DATE
NAME
Suprasegmental COMBINES DIFFERENT IMITATIVELY:
Patterns-PITCH/DURATION
DURATION-PITCH
PATTERNS
PRODUCTION Mon
Tues
Wed
Thurs
Fli
Mon
Tues
Wed
Thurs
Fli
Wed
Thurs
Fl-i
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon Separate Breaths One Breath
Tues
OF COMMUNICATION
DISORDERS
11(1978),
293-313
293
THE EVALUATION OF A MODEL SPEECH TRAINING PROGRAM FOR DEAF CHILDREN MARY The Lexington Schoolfor
JOE OSBERGER*
the Deaf, 30th Avenue and 75th Street, Jackson Heights, New York 11370 AND
Doctoral Program in Speech and Hearing Sciences, City University of New York Gra&ate School, West 42nd Street, New York, New York 10036
ANDREA Functional
JOHNSTONE
AND EILEEN SWARTS
Auditory Speech Training Program,
HARRY
The Lexington School for the Deaf
LEVI’lT
Doctoral Program in Speech and Hearing Sciences,
City University of New York Graduate School
Systematic speech training procedures were employed with a group of 20 hearing-impaired children ranging in age from 7 to 10 years. Using a primarily auditory-oral approach, the speech training program employed a hierarchical sequence in order to teach the suprasegmental patterns of English to the children. The children’s performance on the speech training hierarchy was monitored on a daily basis using a checklist system. Based on their rate of progress in the development of speech skills, the children were divided into three groupspost hoc: rapid, slow but steady, inordinately slow. Although the system worked well, on the average, approximately one-third of the children encountered serious difficulties at one or more levels of the hierarchy. Examination of the children’s background information and audiological data revealed that those children who encountered difficulty had an extremely limited amount of residual hearing and/or problems other than a hearing handicap.
Introduction
It has been well established that the speech of most profoundly deaf children is unintelligible (Brannon, 1964; John and Howarth, 1965; Markides, 1970; Smith, 1972). Throughout the years numerous research efforts have provided us with a description of the types of errors that exist in the speech of deaf children (Hudgins and Numbers, 1942; Markides, 1970; Smith, 1972 and others). As a consequence of these investigations, we now have a better understanding of error types but not how these errors render the deaf child’s speech unintelligible. Briefly, the errors can be divided into two major categories: segmental (phonemic) and suprasegmental (prosodic). The segmental errors typically in-
* Address correspondence to: Mary Joe Osberger, Doctoral Program in Speech and Hearing Sciences, City University of New York Graduate School, 33 West 42nd Street, New York, New York 10036. o Elsevier North-Holland,
Inc.,
1978
0021-9924/78/001
l-0293$01.75
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et al.
volve the omission, substitution, and distortion of vowels and consonants (Hudgins and Numbers, 1942; Markides, 1970; Smith, 1972). Many of the suprasegmental errors are a result of inappropriate and inadequate control of fundamental frequency (Green, 1956; Angelocci et al., 1964; Martony, 1968; Smith, 1972), poor control of the respiratory mechanism (Hudgins, 1937, 1946), and the failure to observe the timing patterns typical of normal speech (John and Howarth, 1965; Boothroyd et al., 1974). Once the errors have been identified in a particular child’s speech, the clinician is faced with the problem of selecting the most appropriate remediation procedures. Although speech training techniques have been described in the literature (Haycock, 1933; Ewing and Ewing, 1964; Calvert and Silverman, 1975; Ling, 1976), there have been no systematic investigations that have attempted to determine the effectiveness of the various training procedures. at this time, it is not known to what extent a deaf child’s speech production skills will improve if well-defined, systematic training procedures are employed. In addition, there is little research data that shows the length of time it takes deaf children to correct deviant speech. patterns or to develop new patterns. One approach to this problem is to develop a speech training model and objectively evaluate the effectiveness of the model. Once such a model has been evaluated, it can provide a quantitative description of a child’s ability to learn certain speech skills during a specified period of time. At the same time, inadequacies inherent in the model can be identified and appropriate changes can be made in the model. Through repeated applications and evaluations of the model, it is possible to determine in a scientific way which procedures are the most effective. The advantage of this approach is that a speech training program will gradually be generated on the basis of repeated objective measures rather than simply on clinical intuition. The present article describes a first attempt to develop and evaluate a model program for speech training. The model, which is an adaptation of Ling ‘s (1976) system, consists of a hierarchy of speech skills which are taught to the children in sequential order. A brief description of the training program will be presented as well as the preliminary data obtained on a group of deaf children’s performance on the first part of the speech training hierarchy, the suprasegmental patterns of speech. A more detailed description of the entire project is available in a laboratory report by Osberger et al. (1977). Procedures Subjects The speech training hierarchy has been employed with a group of deaf children at the Lexington School for the Deaf. Twenty children, ranging in age from 7.7
EVALUATION
OF A MODEL
SPEECH TRAINING
PROGRAM
295
years to 10.1 years, participated in the project. Of the 20 children, 9 were females and 11 were males. The children were a representative sample of the population at the Lexington School for the Deaf with respect to hearing level, age of onset of deafness, etiology of deafness, years of special education, parental motivation, and socioeconomic status. Since one of the intents of the program was to evaluate speech training procedures with children typically found in schools for the deaf, the children were selected on a quasi-random basis and no child was excluded from participating in the program if he was suspected of having problems other than deafness. Audiological evaluations were performed on each child at the beginning of the project. Six of the children had pure tone averages (average of 500, 1000, and 2000 Hz) of 90 dB or less in the better ear; the other 14 children had pure tone averages of 90 dB or greater. For 14 of the 20 children, measurable responses could be obtained at frequencies higher than 1000 Hz. The remaining children did not have measurable responses at frequencies of 1000 Hz or higher and could be described as having comer audiograms. Pertinent background information was obtained from the children’s school records. For the majority of children, deafness was diagnosed, hearing aids were first obtained, and special education was initiated during the preschool years. One child had deaf parents and signing was the primary mode of communication in the home. The other 19 children were of hearing parents, 5 of whom spoke a language other than English. Information regarding parental cooperation, socioeconomic status, and the child’s hearing aid usage was obtained from the children’s classroom teachers. The teachers were asked to assign a rating of either 1 =good, 2=fair, or 3 =poor on each of the above mentioned variables. Parental cooperation was rated good for 7 of the children’s parents, fair for 6, and poor for 7. Socioeconomic level was rated good for 5 of the children’s parents, fair for 8, and poor for 7. Every child in the program had his or her own binaural hearing aids. Hearing aid checks were made daily by the teachers in order to insure that each child received optimal benefit from amplification. Whenver nonfunctioning aids were detected, the children were given loaner hearing aids so that they were binaurally amplified at all times. The Speech
Training Hierarchy:
Suprasegmental
Patterns
Before proceeding with a description of the hierarchy, it should be pointed out that the speech training was based primarily on an auditory-oral approach, that is, all speech training was performed only with auditory cues. However, if after a period of time a child was unable to develop the skills auditorily, other cues, such as visual or tactile, were introduced. If other cues were introduced, the individual
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working with the child was required to go back and attempt to obtain acceptable levels of performance with auditory cues only. The suprasegmental section of the hierarchy consisted of five levels which were taught in sequential order. The first five levels of the hierarchy required the child to produce and discriminate syllables that varied in (1) duration, (2) intensity, (3) intensity and duration combined, (4) pitch, (5) pitch and duration combined. On each of the five suprasegmental levels the child performed three groups of tasks: (1) production on an imitative basis, (2) production on demand, and (3) discrimination. Production on an imitative basis required the child to produce the various patterns with auditory cues only. Thus, successful performance on these tasks was dependent on both the correct perception and production of the particular suprasegmental pattern. Production on demand required the child to produce spontaneously the various suprasegmental patterns. In order to elicit the production of specific patterns, a visual cueing system was used. For example, strips of paper of various lengths were used to elicit syllables of different durations. Since responses to these tasks were elicited with visual cues rather than auditory cues, successful performance on this level was dependent only on the child’s ability to produce the desired patterns. These tasks renresent a slight departure from ,using a strictly auditory-oral approach. The tasks were incorporated in the training scheme for the following reasons: (1) to assess the child’s ability to produce the various patterns when the speech model provided by the teacher was removed and (2) to help the child develop those skills that are necessary for the successful carry-over of the various patterns to his spontaneous speech. The visual cueing system was also used for the discrimination tasks. For these tasks the teacher produced a particular pattern and the child then pointed to the symbol that corresponded to the teacher’s production. Successful performance on this level was dependent on the child’s ability to perceive and discriminate patterns through audition alone. The three groups of tasks (production on an imitative basis, production on demand, and discrimination) were not necessarily hierarchical and training was generally performed in these areas simultaneously. However, for each of these tasks there were additional subgroups which were taught in a hierarchical sequence. These subgroups involved the production (imitatively and on demand) or discrimination of suprasegmental patterns first on separate breaths and then on a single breath. For example, a child must first have been able to produce syllables that vary in duration each on a separate breath before he was expected to produce two or more syllables on a single breath. Table 1 summarizes the groups of tasks. Each child was seen for a 1%min speech tutoring session four times a week. The tutoring was performed on an individual basis by either the child’s own teacher or another teacher in the school. Each child was tutored by the same individual throughout the school year.
EVALUATION
Summary Production
OF A MODEL SPEECH TRAINING
TABLE 1 of the Tasks for the Five Suprasegmental
on an imitative basis
Production
on demand
PROGRAM
297
Levels of the Hierarchy Discrimination
1. Production of syllables of 4 different durations (or 4 different intensities, or 4 different pitches or combinations of 4 different intensity-duration patterns, or 4 different pitch-duration patterns), each on a separate breath
1. Production of syllables of 4 different durations (or 4 different intensities, or 4 different pitches or combinations of 4 different intensity-duration patterns, or 4 different pitch-duration patterns), each on a separate breath
1. Discrimination of syllables of 4 different durations (or 4 intensities, or 4 different pitches or combinations of 4 different intensity-duration patterns, or 4 different pitch-duration patterns), each syllable being produced by the teacher on a separate breath
2. Production of a string of syllables with any combination of the 4 different durations (or intensities, or pitches or intensity-du-ation patterns, or pitch-duration patterns) on one breath
2. Production of a string of syllables with any combination of the 4 different durations (or intensities, or pitches or intensity-duration patterns, or pitch-duration patterns) on one breath
2. Discrimination of a string of 4 syllables with any combination of the 4 different durations (or intensities, or pitches or intensity-duration patterns, or pitch-duration patterns), all syllables being produced by the teacher on one breath
Evaluation
Techniques
The children’s performance on the speech training hierarchy was monitored by means of a checklist system. The checklists, which corresponded to the various levels in the hierarchy, were used on a daily basis by the teachers during the 15min tutoring session. The system was implemented in order to obtain quantitative data regarding each child’s progress in the development of specific speech skills. With the use of this procedure, it was possible to obtain a quantitative individualized mapping of each child’s progress. Difficulties common to all children could be recognized and differentiated from those difficulties unique to a given child. The children were required to meet predetermined criteria for acceptable performance before a check was given for the tasks. Only when the child had correctly performed a particular task 10 out of 10 times was a check entered in the appropriate box. In addition, the child had to maintain the acceptable level of performance for 3 days before he was considered to have mastered the task. Examples of the checklists can be found in the Appendix. Results Each child’s performance on the hierarchy has been analyzed using the data obtained from the checklists. In order to facilitate the analysis of this large body
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et al.
of data, the children’s progress was monitored on a computer system.’ A recreation of a typical computer printout which details a child’s progress on the suprasegmental patterns is shown in Fig. 1. The vertical axis shows the different suprasegmental levels in the hierarchy. The lower row of numbers on the horizontal axis identifies the weeks of speech tutoring and the upper row of numbers specifies the number of days in each week that the child received speech tutoring. In most cases a week of tutoring consisted of 4 speech tutoring days. However, for some weeks, a child may have received less than 4 days of tutoring because of absence from school or school vacation. When discussing the children’s performance on the hierarchy, the rate of progress will be discussed in terms of weeks (i.e., 4 days per week) since the number of days per week for the total 39 weeks for each child was in almost every case very close to 4 days per week. The graphical symbols provide information in coded form on the progress of tutoring. The symbol + indicates that a new task on the hierarchy was attempted and that acceptable performance was achieved. The - symbol indicates that a new task was attempted but the child was unsuccessful. An analogous pair of symbols is the X and =, respectively. The X indicates that a check was carried out on a task on which the child was previously successful, and that the child maintained an acceptable level of performance. The = symbol indicates regression, i.e., when a check was carried out on a previously successful task, the child failed to maintain an acceptable level of performance. The . symbol indicates that the teacher did not have time to cover the specific task. It should be noted that time constraints did not permit work to be done on all tasks for a particular level during each 15min session. Typically, each tutoring session was devoted to groups of approximately three or four tasks. In summary, the computer printouts provide the following information: 1. The number of days each child received speech tutoring. 2. Individual rates of progress in the development of specific speech skills at each level of the hierarchy. 3. The average rate of progress for all children and the extent of individual differences at each stage (this information is obtained by comparing the checklists for all children). 4. The maintenance of speech skills over time. 5. The evidence of regression, if any. An analysis of the printouts for all children showed that some children acquired the various speech skills at a faster rate than other children. The children
‘The computer system provided a convenient way for monitoring the children’s performance. However, such a system is not considered to be essential to the implementation of the speech training program.
Fig. 1.
2 5 6 7 8 9 10 11 12 13 14 15 16 17
VEEK I 1 2
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INTENSITY
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LHPENSITYDURATION
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PITaDDKATIoN
A recreation of a computer printout which shows a child’s performance on the five suprasegmental levels of the hierarchy. The six groups of tasks are (1) syllables produced or separate breaths (imitation); (2) four syllables produced on one breath (imitation); (3) syllables produced on separate breaths (on demand); (4) four syllables produced on one breath (on demand); (5) discrimination of syllables produced on separate breaths; (6) discrimination of syllables produced on separate breaths.
: 3 0 0 4 2
4 3 3 4 1 3 3 4 3
I OP DAYS .*
DURATION
8
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2 3
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were divided into three groups, post hoc, on the basis of their rate of progress. Group 1, consisting of 7 children, acquired the new speech skills at a very rapid rate. Group 2, consisting of 6 children, showed a steady but slower rate of progress. The progress of the children in Group 3, consisting of 7 children, was inordinately slow. Figure 1, which was described above, is the printout for a typical child in Group 1. Figure 2 is a replication of Fig. 1 except that the + symbols have been connected by hand in order to illustrate more clearly the rate of progress. The rate of progress is shown as a stepped function: the smaller the horizonal section of each step, or, alternatively, the larger the vertical section, the faster the progress. For this particular child, duration and intensity patterns were acquired in 1 week, as shown by the small horizontal steps between levels. Pitch and pitch-duration patterns were acquired in 2 weeks and intensity-duration patterns were acquired in 7 weeks. Some difficulty was encountered by this child on the intensityduration level of the hierarchy, as shown by the one long horizontal step. This level usually required a relatively longer period of time for all the children to complete, even those children who showed a rapid rate of progress. Figure 3 shows the performance on the suprasegmental patterns for a typical child in Group 2. Duration and intensity-duration patterns were acquired in 3 weeks. Intensity and pitch-duration patterns were acquired in 4 weeks and pitch patterns were developed in 5 weeks. Note that this child’s performance is slower than the child’s performance in Group 1 by a similar proportion. There are, however, occasional deviations from this general pattern. For example, on the intensity-duration level; child X in Group 2 took relatively less time to complete the tasks than did the child in Group 1. On the average, the length of time required by the children in Group 2 to complete the suprasegmental levels was roughly twice as long as that required by the children in Group 1. For the third group, there was evidence of serious problems. Some of these children did not appear to progress beyond a certain level, other children showed an inability to maintain previously acquired skills, while others showed some progress but at an inordinately slow rate, e.g., 10 weeks to progress beyond a single level. Figure 4 shows the performance on the suprasegmental patterns for a typical child in Group 3. Four weeks were required for the development of duration patterns, 8 weeks were required for the development of intensity patterns, and 17 weeks were required for the development of intensity-duration patterns. Thus, for this child, training on the other suprasegmental patterns was not possible before the end of the school year was reached. The average rate of progress shown by the children in Group 3 was roughly twice as slow as the rate of progress shown by the children in Group 2 and roughly four times as slow as the rate of progress shown by the children in Group 1. An analysis of the data for all children revealed that performance on those levels of the hierarchy that involved the combination patterns (intensity-duration, pitch-duration) showed substantial variations between children. In view of the
EVALUATION
OF A MODEL
-1
1
-I’1
-I
.I
‘I
.+
,,I”*,
ixxxx
.x
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+xxxw XXXIX
!
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SPEECH TRAINING
PROGRAM
301
302
MARY JOE OSBERGER
+XKbG#X I
+
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et al.
EVALUATION
OF A MODEL SPEECH TRAINING PROGRAM
303
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et al.
idiosyncratic performance on these levels and the fact that these combinations are not entirely representative of natural speech, it was decided that these stages were in need of modification for future training programs. Since these levels were to be changed, additional analyses were performed with data from these levels deleted. Figure 5 summarizes the performance of the children on the suprasegmental levels of duration, intensity, and pitch. Since some of the children in Group 3 failed to complete the pitch level, only data for Groups 1 and 2 are shown for the pitch section of the hierarchy. Separate analyses of variance were performed on the data that were obtained.’ The first consisted of a 3-way analysis of variance which examined the effects of Group (1, 2, 3), suprasegmental level (duration, intensity), and task (six tasks for each suprasegmental level). No significant difference was found in the length of time taken to complete suprasegmental level, i.e., it took the same amount of time, on average, to complete the duration level as it did the intensity level. There were significant differences, (F=36.06, P.LcO.01) between groups. The Group 1 children took half as long as the children in Group 2 and the Group 3 children took roughly twice as long as the Group 2 children and four times as long as the Group 1 children. There were also significant differences (F= 10.16, P.LCO.01) in the time taken to complete the individual tasks within a level. As shown in Fig. 5, those tasks involving one breath were consistently the most difficult for all children. Statistically significant interactions (F=4.20, P.LGO.01) were observed between groups of children and tasks within a level. As shown in Fig. 5, Group 3 took roughly twice as long as Group 1 or 2 for imitation on separate breath tasks but took almost three times as long for imitation on one breath tasks. A similar pattern of performance was observed for the discrimination tasks. Figure 5 also shows that the imitation and discrimination tasks required a greater proportion of time for the children in Group 3 to complete than did the production of demand tasks. On the average, the Group 3 children took a much longer time to complete the imitation and discrimination tasks than did Group 1 or 2. Also, in all three cases (imitation, demand, discrimination) the relative performance of Group 3 is much worse on one breath than on separate breaths. A second analysis of variance was performed on the data obtained for the two groups of children (Group 1 and 2) who successfully completed all three suprasegmental levels. Again, the effects of group (1 i 2), suprasegmental level (duration, intensity, pitch), and task (six different tasks for each suprasegmental level) were examined. As in the previous analysis, there was a statistically significant difference (F = 2 1.65, P . L SO. 0 1) between groups of children. There was also a significant difference (F=10.18, P.LSO.01) in the length of time taken by all the children to complete the six different tasks. There was a small but statistically significant interaction between suprasegmental level and group (F=3.25, P.LsO.05). As shown in Fig. 5, the children in Group 2 took alonger period of time to complete the pitch level than to complete the duration or
EVALUATION
OF A MODEL SPEECH TRAINING
PROGRAM
305
20 ’B 16 16 & 14 6 I2 g IO 16 w : B h
6 4 2 SB
00
SB
06
SB
06
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SE
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22
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16
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4
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(N=s)
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(N=7)
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PRODUCTION Fig. 5.
Breath
Breath
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SB
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DISCRIMINATION
Length of time required by the children to complete the tasks for the duration, and pitch levels of the suprasegmental section of the hierarchy.
intensity,
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et al.
intensity level. For the children in Group 1, the pitch level required no more time to complete than either of the other two levels. Thus, as these two groups of children progress through the various levels of the hierarchy, the difference in their performance becomes more apparent. Discussion The data obtained in this study showed that the training procedures were effective for the majority of the children. However, approximately one-third of the children failed to make satisfactory progress. An important question is, why did some children encounter so much difficulty with the training strategies employed? In an attempt to answer this question, the relevant background information and audiological data were examined for all three groups of children. Table 3 summarizes the background information. As a group, the children in Group 3 have lower IQ’s. However, a valid comparison cannot be made on this variable since the test scores were not available for some of the children in Group 3. In general, the children in Group 1 tended to be better hearing aid users than the children in Group 2 or 3. Examination of the other variables revealed no other clear-cut patterns that might account for the differences in performance between groups of children. Differences in the other areas examined appear to be fairly evenly distributed among all three groups of children. Table 4 summarizes the audiological information for the three groups of children. In this table, the pure tone thresholds are shown for the better ear for each of the children. Examination of the mean pure tone averages (average of 500, 1000, and 2000 Hz) for each group of children showed a very strong relationship between hearing level and performance on the hierarchy. The data showed that, on the average, the rate of progress decreases as the hearing level increases. In addition, 7 1% of the children in Group 1 have measurable hearing above 1000 Hz, whereas only 66% of the children in Group 2 and 42% of the children in Group 3 show responses to pure tones above 1000 Hz. Although performance on
TABLE 2 Average Length of Time in Weeks Required by the Children to Complete the Suprasegmental the Speech Training Hierarchy
Duration (weeks)
Intensity (weeks)
Intensityduration (weeks)
Levels of
Pitch (weeks)
Pitchduration (weeks)
Group 1
2
2
5
2
2.5
Group 2
3
5
6
4.5
8
Group 3
7.5
9.5
8
10.5-completed by only two children
Not yet completed by any children
s
X age: 4.5 years
_
Age at Beginning of Special Education _--_
Age when Deafness Diagnosed
Etiology of Deafness
1
Unknown: 5 Genetic: 1 Maternal rubella:
3
- -
\_ L
?
’ ,Scores not available for three children in this group.
>
.
,
-~
X age: 3.1 years
1
Unknown: 5 Maternal rubella:
2
X age: 2 years
X age: 4 years
Unknown: 6 Genetic: 1
1
^.
_
__
_
x age: 2.7 years
x age: 3 6 years
-__-__
1
6
Hearing: Deaf:
4 3
Female: Male:
x age: 8.7 years
(N = 7)
3
All hearing
3 3
Female: Male:
All hearing
X age: 7.7 years
2 5
Parents hearing
2 (N = 6)
Female: Male:
Sex
TABLE 3
-
6 1
-
rl
cd_
x age: 2.4 years
_.--_
_
Good: 4 Fair: 2 Poor: 1
Good: 3 Poor: 3
ST age: 3.1 years
Use of Hearing Aid
Good: 6 Fair: 2
-
-
Good: 3 Fair: 1 Poor: 3
Good: 2 Fair: 1 Poor: 3
Good: 2 Fair: 4 Poor: 1
X age: 4.4 years
Age First Fit with Hearing Aid
English: Sign:
English: 4 Language other than English: 2
English: 5 Language other than English: 2
Parental cooperation
GroupI, Group2, and&oup 3
Language used in the home
on the Children in
x age: 9.2 years
Age at start of the project
Information
1 (N = 7)
Group
Relevant Background
?? score: 65.5
X score: 91.5
F score: 95.4
IQ Score (WISC)
Good: 2 Fair: 1 Poor: 3
Good: 1 Fair: 4 Poor: 2
Fair: 4 Poor: 2
Good: 1
Socioeconomic status
-
308
MARY JOE OSBERGER
Pure Tone Thresholds
et al.
TABLE 4 for the Better Ear in dB (re: ANSI 1969) for the Children in Group 1, Group 2, and Group 3 Frequency
Child #
125
250
500
Group 1 1 2 5 6 I 10 20
35 a 45 65 55 = 55
55 80 55 90 60 80 70
75 100 65 90 65 100 85
110
cl
15 100 85 110 85
80 95 85 (I
Group 2 3 4 II 12 17 19
a 60 u 65 65 25
15 75 70 80 75 50
95 100 80 85 95 65
105 105 110 105 105 85
u (1 n
80 55
90 75 85 80 90 80 105
105 90 90 95 105 95 105
110 85 100 n 110 95 110
Group 3 8 9 13 14 15 16 18
10
80 80 80 90
1000
80
1500
2000
3000
95 0 85 0 ’ II
90
75
100 110 80
4000
0
8000
F’TA
a 106.6 b a 0 ’ n
81.6
73.3 96.6 85 78.3 n 106.6b 75 a 81.6 Mean pure tone average: 89.2 L2
(I
103.3 b 105.0b lOO.Ob loo = 96.6 0 a 103.3b 85 80 76.6 Mean pure tone average: 97.4 0 Y
0 (1
c1
L1
80 0 (I 100 (I LI
80 II 0 90 II (1
108.3b 86.6b lOO.Ob 105.0b 106.66 lOO.Ob 108.3b Mean pure tone average: 102.1
0 No response at the audiometric limits (65 dB at 125 Hz; 110 dB in the higher frequencies). b Pure tone average obtained by averaging in the level of the audiometric limits, i.e., 110 dB when there was no measureable response at 500, 1000, or 2000 Hz.
the hierarchy seems to be related to the severity of the hearing loss, there are some exceptions that should be discussed. First, two of the children in Group 1 (#2, #IO) have pure tone averages similar to those of the children in Group 3. For one of these children, measurable responses could not be obtained above 500 Hz; for the other child, responses to pure tones could not be obtained above 1000 Hz. Second, one third in Group 2 (#9) and one child in Group 3 (#9) have pure tone averages of 76.6 and 86.6 dB, respectively. Although the rate of progress shown by the children seems to be determined to a large extent by the severity of the hearing loss, hearing level alone does not appear to account for all the observed differences. Throughout the course of the training program, the teachers noted that some of the children in the project
EVALUATION
OF A MODEL SPEECH TRAINING
PROGRAM
309
appeared to have problems other than deafness. In fact, independent reports from the school psychologists, supervisors, and teachers indicate that 5 of the 7 children in Group 3 have problems in addition to a hearing handicap, e.g., exceptionally poor auditory memory, poor sequencing abilities, and emotional disturbances. The inordinately slow rate of progress shown by the children in Group 3 seems to be due to an extremely limited amount of residual hearing and/or the presence of problems other than a hearing loss. As a result of the present study, base-line data are now available on the length of time required by a group of hearing-impaired children to learn a specified set of speech skills, using an auditory-oral approach. However, our data do not indicate whether any of these children would have achieved a higher level of performance if other approaches to speech training had been employed even with those children in Group 3. Additional research is needed to determine the relative effectiveness of various speech training strategies. The authors are indebted to Dr. Daniel Ling, McGill University, and to Janet Head and Margot &sack, Lexington School for the Deaf, for their advice and guidance throughout this project, and to Anita Davidsen, Gateway Pre-school, who was the project co-ordinator during the first year of the program. We also wish to thank Ronald Slosberg, computer programmer, CUNY Graduate School and University Center, for the computer analysis of the data. The support of Dr. Leo Connor, Executive Director of the Lexington School for the Deaf, and the participating teachers and other staff members at the school is deeply ap-’ preciated. The project was supported by private funds from the Lexington School for the Deaf. The methods of evaluating and analyzing the data were developed under PHS Grant 09252. References Angelocci, A., Kopp, Cl., Holbrook, A. The vowel formants of deaf and normal hearing eleven to fourteen year old boys. J. Speech Hear. Dis., 1964, 29, 156-170. Boothroyd, A., Nickerson, K., Stevens, K. Temporal patterns in the speech of the deaf-a study in remedial training. C. V. Hudgins Diagnostic and Research Center, Clarke School for the Deaf, Northampton, Mass., 1974. Brannon, J. B. Visual feedback of glossal motions and its influence on the speech of deaf children. Ph.D. thesis, Northwestern University, 1964. Calve.., D.,Silverman, R. Speech and deafness. Washington, D.C.: A. Cl. Bell Association, 1975. Ewing, A., Ewing, E. C. Teaching deaf children ro talk. Washington, D.C.: A. G. Bell Association, 1964. Green, D. Fundamental frequency of the speech of profoundly deaf individuals. Ph.D. thesis, Purdue University, 1956. Haycock, G. S. The reaching of speech. Washington, D.C.: A. G. Bell Association, 1933. Hudgins, C. V., Voice production and breath control in the speech of the deaf. Am. Ann. Deaf, 1937, 82, 338363. Hudgins, C. V. Speech breathing and speech intelligibility. Volta Rev., 1946, 48, 642-644. Hudgins, C. V., Numbers, G. C. An investigation of the intelligibility of the speech of the deaf. Genet. Psychol. Monogr., 1942, 25, 289-392.
MARY JOE OSBERGER
310
et al
John, J. E., Howarth, J. N. the effect of time distortion on the intelligibility of deaf children’s speech. Lang. Speech, 1%5, 8, 127-134. Ling, D. Speech and the hearing-impaired child: theory andpractice. Washington, D.C.: A. G. Bell Association, 1976. Markides, A. The speech of deaf and partially hearing children with special reference to factors affecting intelligibility. Er. J. Dis. Commun., 1970, 5, 126-140. Martony, J. On correction of voice pitch level of severely hard of hearing subjects. Am. Ann. Deaf, 1968, 113, 195-202. Osberger, M. J., Levitt, H., Johnstone, A., Swarts, E. The Functional Auditory Speech Training Program. CSL Research Report 9, CUNY Graduate School and University Center, 1977. Smith, C. Residual hearing and speech production imdeaf children. Ph.D. thesis, City University of New York, 1972.
Appendix: Checklists for the Suprasegmental Levels of the Hierarchy
NAME
DATE
Suprasegmental
Patterns-DURATION
PRODUCTION IMITATES: Mon
Tues
Wed
Thurs
Fti
Mon
Tues
Wed
ThUrS
Fri
Wed
Thurs
Fti
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon
Tues
1 Separate Breaths One Breath
EVALUATION
OF A MODEL SPEECH TRAINING
311
PROGRAM
DATE
NAME
Suprasegmental
Patterns-INTENSITY
PRODUCTION IMITATES: Mon
Tues
Wed
Thurs
Fri
Mon
Tues
Wed
Thurs
Fri
Wed
Thurs
Fri
Thurs
Fri
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon
Tues
Separate Breaths One Breath
DATE
NAME
Suprasegmental
Patterns-INTENSITY/DURATION
COMBINES DIFFERENT *DURATION-INTENSITY IMITATIVELY:
PATTERNS
PRODUCTION Mon Separate Breaths One Breath
Tues
Wed
312 PRODUCES
MARY JOE OSBERGER
et al.
ON DEMAND: Mon
Tues
Wed
Thurs
Fli
I I
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon
Tues
Wed
Thurs
Fri
Separate Breaths One Breath
DATE
NAME
Suprasegmental
Patterns-PITCH
PRODUCTION IMITATES: Mon
Tues
Wed
Thurs
Fri
Mon
Tues
Wed
Thurs
FIi
Wed
Thurs
Fli
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon Separate Breaths One Breath
Tues
EVALUATION
OF A MODEL SPEECH TRAINING
313
PROGRAM
DATE
NAME
Suprasegmental COMBINES DIFFERENT IMITATIVELY:
Patterns-PITCH/DURATION
DURATION-PITCH
PATTERNS
PRODUCTION Mon
Tues
Wed
Thurs
Fli
Mon
Tues
Wed
Thurs
Fli
Wed
Thurs
Fl-i
Separate Breaths One Breath
PRODUCES
ON DEMAND:
Separate Breaths One Breath
RECEPTION DISCRIMINATES: Mon Separate Breaths One Breath
Tues