EBP Phonology Group:

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• EBP Phonology Group
• Summary of Critically Appraised Topics
• Bronwyn Carrigg, Sydney Childrens Hospital

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• Number of members approx 23
• Locations 12 metro sites. Liverpool
• Hospital, Peakhurst CHC, Rockdale CHC,
• Sylvania CHC, Parramatta CHC, Mt Druitt
• CHC, Blacktown CHC, Auburn Hospital,
• Sydney Uni, Sydney Childrens Hospital,
• Sydney Childrens CHC, Waverley CHC
• Number of CAPs completed 56
• Number of CATs completed 6

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• Target Selection Stimulability
• Early/Late Developing
• Phonological Knowledge
• Treatment Approaches
• Cycles PACT
• Maximal Oppositions Multiple Oppositions
• Minimal Pairs Metaphon
• Metaphonological Non-linear
• Whole Language Core Vocabulary
• Naturalistic Speech Intelligibility Training

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• Clinical Question 1 In children with
• phonological impairment of unknown origin,
• are intervention gains more widespread and
• efficient if stimulable or non-stimulable
• phonemes are targeted during phonological
• intervention? 5 papers
• Clinical Bottom Line evidence suggests that
• it is more effective to select non-stimulable
• phonemes, as children may acquire targeted
• phonemes as well as non-targeted stimulable

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• Need to consider childs level of
• attention, motivation and persistence
• during stimulability tasks (Tyler 2005).
• Williams (2005) suggests a balance of
• stimulable and non-stimulable phonemes
• may be beneficial. Would allow for some early
  progress, as well as maximise system wide change.

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• Clinical Question 2 In children with
• phonological impairment of unknown origin,
• are therapy outcomes more widespread (ie
• efficient) if the sounds targeted are
• earlier or later developing? 3 papers
• Clinical Bottom Line Selection of later
• developing phonemes led to more rapid
• change in the phonetic inventories in 2 out
• of 3 studies. In third study, more rapid
• with most knowledge phonemes over 12 wks,
• but no difference in system wide change.

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• Clinical Question 3 when selecting sound
• pairs in therapy, is it more effective to
• choose 2 unknown sounds, or one known and
• one unknown (ie homonymous, as typical of
• conventional minimal pairs)? 9 papers
• Clinical Bottom Line low level of evidence
• that selecting treatment pairs that are
• maximally opposed, rather than minimally
• opposed leads to greater change in treated
• or untreated sounds. And, when both are
• unknown, this leads to greater, or at least
• equivalent, phonological change.

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• Clinical Question 4 Does maximal
• opposition therapy result in more widespread
• gains than minimal opposition therapy? (sound
• pair differ by as few vs as many distinctive
• features as possible). 4 papers
• Clinical Bottom Line evidence suggests that
• treatment of maximal oppositions leads to
• greater improvements than treatment of
• minimal oppositions. Greater accuracies in
• treated sounds and more untreated sounds
• added to repertoire.

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• Clinical Question 5 Is the Cycles
• Approach more effective than no
• intervention, or more effective than
• other forms of intervention, in treating
• preschool children with phonological
• impairment of unknown origin? 6 papers
• Clinical Bottom Line evidence to support
• cycles approach is more effective than
• no-treatment, but limited comparative data
• to support it over other Rx approaches.

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• Clinical Question 6 Does PACT (Parents
• and Children Together) improve speech
• intelligibility in children with phonological
• impairment of unknown origin? 2 papers
• Clinical Bottom Line PACT more effective
• than no therapy, but no data comparing to
• other approaches. Unclear which aspects of
• PACT are effective.

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• Whats the Evidence for? Section in ACQ
• EBP Phonology/Elise summarised CATs on
• Stimulability and Cycles Approach. Last year,
• summary of evidence for Oral Motor Therapy
• there are many well-tried, efficacious,
  efficent,
• effective therapies for us to choose from when
• devising intervention for individual clients.
  Oral
• motor therapy is not one of them. With no
• theoretical underpinning, and in the absence of
  an
• evidence base, it is clear that oral motor
  therapies
• are not for us. (Caroline Bowen, ACQ, 2005)

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• Future Plans
• Wrap up current CAPS/CATS -gt website asap
• CATS on remaining intervention approaches,
• Evidence for various service delivery models,
• ?our own multisite research projectone day
• Continue 4 meetings per year, 3 phone link up
• and 1 face-to-face combined with PD.

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• Want to join?
• Contact Katie Carmody, Sydney Childrens
• Community Health Centre, 9382 8084
• Katie.carmody_at_sesiahs.health.nsw.gov.au