Developing a speech screener for use by teachers

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Developing a speech screener for use by teachers

• Yvonne Wren
• North Bristol NHS Trust

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Background

• NSF for Children

• co-ordinated multi-agency assessments
• prompt, convenient, responsive and high-quality
  multi-agency interventions (DoH, 2004).

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Background

• SLT limited for speech difficulties
• (Broomfield and Dodd, 2004)
• No Statement poorer access to SLT
• Lindsay et al (2002)

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Background

• Push for SLTs and teachers to work together
• Context limited SLT

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Aim

• Interactive screening and therapy system
• for children with phonological impairment
• Accessible for teachers
• Empower teachers in screening and therapy
  activities
• Standardise referrals and therapy activities

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Therapy software

• Phoneme Factory Sound Sorter
• listening and discrimination activities
• used in school, home or clinic

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Therapy software

• Pre-set activities (teacher)
• Free configuration (SLT)
• Clip art
• Records function
• Access

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Access to pre-set activities

• Guidance from SLT
• Problem limited access to SLT (Broomfield and
  Dodd, 2004)
• Develop a screener for teachers to use
• Referral decision
• Guidance on pre-set settings

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Issues in developing Screener

• Agreement on recording of childrens speech
  errors
• Correct identification of children who need
  referral
• Correct identification of the error patterns

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Phases of development

• Reliability phase
• Development of screener
• agreement on recording of childrens speech errors

• Validation phase
• Refining screener
• determine sensitivity and specificity

• Advisory groups
• Teachers and SLTs

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Reliability Phase - development

• 100 test items
• Multi-choice response
• Options reflect error patterns
• (Dodd et al, 2003)
• Training section

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Reliability phase - method

• 80 children from three regions

• Simultaneously assessed by teacher and SLT
• Responses compared
• Kappa scores used to determine agreement
• 0.6 acceptable

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Reliability phase - results
Table 8 Kappa stats for individual test items in
phase 1
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Reliability phase - outcome
Items removed

• Low kappa
• High need for prompt/repeat functions

• Items retained with kappa below 0.6

• Sock, snake, sleeping, shoe, bridge, thumb, zip

• Some response options were merged

• Algorithms added

• Roberts et al (1990) McLeod et al (2001) Dodd
  et al (2003) and Grunwell (1981)

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Validation phase algorithms
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Validation phase - method

• 130 case, 278 control children
• gold standard assessment DEAP
• Refer/not refer decision compared for Screener
  and DEAP

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Validation phase - sample
408 children assessed from six regions
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Validation phase - results

• Algorithms revised WSD 46 411

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Validation phase revised algorithms
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Validation phase - results

• Algorithms revised WSD 46 411

• Test retest reliability
• agreement 97.8
• correlation 0.96 (plt0.0005).

• Inter-rater reliability (of DEAP transcripts)
• agreement 98.7
• correlation of 0.96 (p lt 0.001).

• Sensitivity, specificity and predictive values

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Validation phase - results
True and false positives and negatives of sample
in phase two  
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Validation phase - results

• Sensitivity 71
• False negatives - gliding
• Specificity 99
• (Law et al review (1998)
• higher grade studies 65 and 88)
• Positive predictive value 81
• (Glascoe and Byrne (1993) recommend 70)

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Launch version of Screener

• 66 words
• Revised training section
• Phoneme ready reckoner
• Report function

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• Recommendation for referral to SLT
• Guide to pre-set activities on Sound Sorter
  and in book
• Error pattern graph and table of responses
• Aid to collaboration between teachers and
  SLTs
• Certificate for child

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References

• Broomfield, J. and Dodd, B. (2004) The nature of
  referred subtypes of primary speech disability.
  Child Language Teaching and Therapy, 20, 135-151.
• Department of Health (2004b) Disabled Child
  Standard, National Service Framework for
  Children, Young People and Maternity Services.
• Dodd, B., Holm, A., Hua, Z. and Crosbie, S.
  (2003) Phonological development a normative
  study of British English speaking children.
  Clinical Linguistics and Phonetics, 17, 617-643
• Dodd, B., Hua, Z., Crosbie, S., Holm, a and
  Ozanne, A. (2002) Diagnostic Evaluation of
  Articulation and Phonology. (London The
  Psychological Corporation)
• Lindsay G. Soloff N. Law J. Band S. Peacey
  N. Gascoigne M. and Radford J. (2002) Speech and
  language therapy services to education in England
  and Wales. International Journal of Language and
  Communication Disorders, 37, 273-288

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Acknowledgements

• Collaborators Sue Roulstone, Tony Hughes, Cres
  Fernandes
• Research assistants Morwenna White, Emma Sisley
• Partners Granada Learning
• Funding Department of Health, Health Technology
  Devices programme

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