Revue Canadienne D'orthophonie Et Audiologie 2022 Num 46 Vol3

CANADIAN JOURNAL OF SPEECH-LANGUAGE
PATHOLOGY & AUDIOLOGY | CJSLPA

Volume 46, No. 3, 2022
REVUE CANADIENNE D’ORTHOPHONIE ET

D’AUDIOLOGIE | RCOA
Volume 46, No. 3, 2022
Normative Nasalance Values in a Population of French-Speaking Children

JELENA TODIC, KAREN SANGUINETTI, IGOR LEUCHTER
Processing-Dependent Measures Sensitive to Language Performance Differences in Arabic

Speaking English Language Learners Compared to Children with Developmental Language Disorder
AREEJ M. A. BALILAH, LISA M. D. ARCHIBALD
Mean Length of Utterance and Use of Subordination Among First Nations School-Aged Children
PATRICIA HART BLUNDON
Exploring Practice-Based Clinical–Research Partnerships in Speech-Language Pathology:

A Scoping Review
MEGHAN VOLLEBREGT, LISA M. D. ARCHIBALD, JULIE THEURER, JANIS ORAM CARDY
Les pratiques d’intervention en orthophonie auprès des enfants francophones ayant un trouble
des sons de la parole : résultats d’un sondage québécois
LAURIE MONTEMBEAULT, VÉRONIQUE MCDUFF, MARIE-PIER GINGRAS, LOUISE DUCHESNE
CJSLPA EDITORIAL TEAM
EDITORIAL REVIEW BOARD
EDITOR-IN - CHIEF Lorraine Baqué Millet, Ph.D. Katlyn McGrattan, Ph.D., CCC-SLP EDITORIAL ASSISTANTS
David H. McFarland, Ph.D. François Bergeron, Ph.D. Trelani Milburn-Chapman, Ph.D. Karen Lowry, M.Sc.
Université de Montréal Simona Maria Brambati, Ph.D. Laura Monetta, Ph.D. Simone Poulin, M.P.O.
Monique Charest, Ph.D. Dominique Morsomme, Ph.D. Chantal Roberge, rév. a.
EDITORS
Lisa M. D. Archibald, Ph.D. Barbara Jane Cunningham, Ph.D. Mahchid Namazi, Ph.D.
The University of Western Ontario Chantal Desmarais, Ph.D. Flora Nassrallah, Ph.D. TRANSLATION
Victoria Duda, Ph.D. Britt Pados, Ph.D., R.N. Simone Poulin, M.P.O.
Paola Colozzo, Ph.D., RSLP Vincent Roxbourgh
University of British Columbia Cécile Fougeron, Ph.D. Kathleen Peets, Ed.D.
Victor Loewen, M.A.
Philippe Fournier, Ph.D., FAAA Michelle Phoenix, Ph.D.
Véronique Delvaux, Ph.D.
Hillary Ganek, Ph.D., CCC-SLP, LSLS Cert. AVT Claire Pillot-Loiseau, Ph.D. LAYOUT AND DESIGN
Université de Mons
Soha N. Garadat, Ph.D. Melissa Polonenko, Ph.D. Yoana Ilcheva
Amanda Hampton Wray, Ph.D., CCC-SLP Kendrea L. (Focht) Garand, Ph.D., Angela Roberts, Ph.D.
University of Pittsburgh CScD, CCC-SLP, BCS-S, CBIS Elizabeth Rochon, Ph.D.
Jennifer Kent-Walsh, Ph.D., CCC-SLP, S-LP(C) Alain Ghio, Ph.D. Phaedra Royle, Ph.D.
University of Central Florida Bernard Grela, Ph.D. Grant D. Searchfield, Ph.D., MNZAS
Celia Harding, Ph.D., FRCSLT Douglas Shiller, Ph.D.
Josée Lagacé, Ph.D.
Université d’Ottawa Bernard Harmegnies, Ph.D. Tijana Simic, Ph.D.
Denyse Hayward, Ph.D. Meg Simione, Ph.D., CCC-SLP
Karine Marcotte, Ph.D.
Ellen Hickey, Ph.D. Veronica Smith, Ph.D.
Université de Montréa
Lisa N. Kelchner, Ph.D., CCC/SLP, BCS-S Sigfrid Soli, Ph.D.
Bonnie Martin-Harris, Ph.D., CCC-SLP, BCS-S Amineh Koravand, Ph.D. Michelle S. Troche, Ph.D., CCC-SLP
Northwestern University
Elaine Kwok, Ph.D. Ingrid Verduyckt, Ph.D.
Stefano Rezzonico, Ph.D. Maureen A. Lefton-Greif, Ph.D., Erin Wilson, Ph.D., CCC-SLP
Université de Montréal CCC-SLP, BCS-S Catherine Wiseman-Hakes, Ph.D., CCC-SLP
Natacha Trudeau, Ph.D. Andrea MacLeod, Ph.D. Jennifer C. Wong, S-LP(C)
Université de Montréal Maxime Maheu, Ph.D.
Vincent Martel-Sauvageau, Ph.D.
Emily Zimmerman, Ph.D., CCC-SLP
Northeastern University Laurence Martin, Ph.D.
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ISSN 1913-2020 | www.cjslpa.ca Canadian Journal of Speech-Language Pathology and Audiology (CJSLPA)
MEMBRES DE L’ÉQUIPE DE RÉDACTION DE LA RCOA
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RÉDACTEUR EN CHEF Lorraine Baqué Millet, Ph.D. Katlyn McGrattan, Ph.D., CCC-SLP ASSISTANTES À LA RÉDACTION
David H. McFarland, Ph.D. François Bergeron, Ph.D. Trelani Milburn-Chapman, Ph.D. Karen Lowry, M.Sc.
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Victoria Duda, Ph.D. Britt Pados, Ph.D., R.N. Simone Poulin, M.P.O.
Paola Colozzo, Ph.D., RSLP Vincent Roxbourgh
University of British Columbia Cécile Fougeron, Ph.D. Kathleen Peets, Ed.D.
Victor Loewen, M.A.
Philippe Fournier, Ph.D., FAAA Michelle Phoenix, Ph.D.
Véronique Delvaux, Ph.D.
Hillary Ganek, Ph.D., CCC-SLP, LSLS Cert. AVT Claire Pillot-Loiseau, Ph.D.
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Soha N. Garadat, Ph.D. Melissa Polonenko, Ph.D. Yoana Ilcheva
Amanda Hampton Wray, Ph.D., CCC-SLP Kendrea L. (Focht) Garand, Ph.D., Angela Roberts, Ph.D.
University of Pittsburgh CScD, CCC-SLP, BCS-S, CBIS Elizabeth Rochon, Ph.D.
Jennifer Kent-Walsh, Ph.D., CCC-SLP, S-LP(C) Alain Ghio, Ph.D. Phaedra Royle, Ph.D.
University of Central Florida Bernard Grela, Ph.D. Grant D. Searchfield, Ph.D., MNZAS
Celia Harding, Ph.D., FRCSLT Douglas Shiller, Ph.D.
Josée Lagacé, Ph.D.
Université d’Ottawa Bernard Harmegnies, Ph.D. Tijana Simic, Ph.D.
Denyse Hayward, Ph.D. Meg Simione, Ph.D., CCC-SLP
Karine Marcotte, Ph.D.
Ellen Hickey, Ph.D. Veronica Smith, Ph.D.
Université de Montréa
Lisa N. Kelchner, Ph.D., CCC/SLP, BCS-S Sigfrid Soli, Ph.D.
Bonnie Martin-Harris, Ph.D., CCC-SLP, BCS-S Amineh Koravand, Ph.D. Michelle S. Troche, Ph.D., CCC-SLP
Northwestern University Ingrid Verduyckt, Ph.D.
Elaine Kwok, Ph.D.
Stefano Rezzonico, Ph.D. Maureen A. Lefton-Greif, Ph.D., Erin Wilson, Ph.D., CCC-SLP
Université de Montréal CCC-SLP, BCS-S Catherine Wiseman-Hakes, Ph.D.,
Natacha Trudeau, Ph.D. Andrea MacLeod, Ph.D. CCC-SLP
Université de Montréal Maxime Maheu, Ph.D. Jennifer C. Wong, S-LP(C)
Emily Zimmerman, Ph.D., CCC-SLP Vincent Martel-Sauvageau, Ph.D.

Northeastern University Laurence Martin, Ph.D.
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Revue canadienne d’orthophonie et d’audiologie (RCOA) Volume 46, No.3, 2022

TABLE OF CONTENTS TABLE DES MATIÈRES
ARTICLE 1 161 ARTICLE 1 161

Normative Nasalance Values in a Population of French- Normalisation des scores de nasalance recueillis au sein
Speaking Children d’une population d’enfants francophones
JELENA TODIC, KAREN SANGUINETTI, IGOR LEUCHTER JELENA TODIC, KAREN SANGUINETTI, IGOR LEUCHTER

Processing-Dependent Measures Sensitive to Language Mesures de traitement de l’information sensibles aux
Performance Differences in Arabic-Speaking English différences de performances langagières des apprenants
Language Learners Compared to Children with de langue anglaise arabophones lorsque comparées à
Developmental Language Disorder celles d’enfants ayant un trouble développemental du
AREEJ M. A. BALILAH, LISA M. D. ARCHIBALD langage
AREEJ M. A. BALILAH, LISA M. D. ARCHIBALD

Mean Length of Utterance and Use of Subordination Longueur moyenne des énoncés et emploi de
Among First Nations School-Aged Children subordonnées chez les enfants d’âge scolaire des
PATRICIA HART BLUNDON Premières Nations
PATRICIA HART BLUNDON

Exploring Practice-Based Clinical–Research Partnerships Exploration des partenariats de recherche clinique axée
in Speech-Language Pathology: A Scoping Review sur la pratique en orthophonie : une revue exploratoire
MEGHAN VOLLEBREGT, LISA M. D. ARCHIBALD, JULIE MEGHAN VOLLEBREGT, LISA M. D. ARCHIBALD, JULIE
THEURER, JANIS ORAM CARDY THEURER, JANIS ORAM CARDY

Speech-Language Pathology Intervention Practices for Les pratiques d’intervention en orthophonie auprès des
French-Speaking Children with Speech Sound Disorders: enfants francophones ayant un trouble des sons de la
Results of a Québec Survey parole : résultats d’un sondage québécois
LAURIE MONTEMBEAULT, VÉRONIQUE MCDUFF, MARIE-PIER LAURIE MONTEMBEAULT, VÉRONIQUE MCDUFF, MARIE-PIER
GINGRAS, LOUISE DUCHESNE GINGRAS, LOUISE DUCHESNE
ISSN 1913-2020 | www.cjslpa.ca Canadian Journal of Speech-Language Pathology and Audiology (CJSLPA)
NORMATIVE NASALANCE FOR FRENCH Canadian Journal of Speech-Language Pathology and Audiology (CJSLPA)
Normative Nasalance Values in a Population of French-

Speaking Children
Normalisation des scores de nasalance recueillis au sein

d’une population d’enfants francophones
Jelena Todic
KEYWORDS
Karen Sanguinetti
Igor Leuchter
HYPERNASALITY
NASALANCE
NASOMETER
EUROPEAN FRENCH
Jelena Todic, Karen

Sanguinetti, and Igor
Leuchter
Service d’oto-rhino-laryngologie
et de chirurgie cervico-faciale,
Hôpitaux universitaires de
Genève, Genève, SUISSE
Faculté de Médecine, Université

de Genève, Genève, SUISSE
Abstract
Normative nasalance scores are essential for diagnosis and clinical follow-up. This research was
conducted to establish a European French language protocol for nasometry and determine
normative nasalance values for European French-speaking children. One hundred and seven French-
speaking children aged 5–14 years (mean age, 9 years) with normal speech were included in this
prospective study. Participants were asked to repeat different oral and nasal sounds (phonemes,
words, sentences, and logatomes) and speech samples were recorded using a Nasometer II model.
Normative nasalance values were measured with the Nasometer II model, including differences due to
age, gender, context, and first language. Mean nasalance scores were 17% (95% CI, 6–39) for oral words,
13% (5–29) for oral sentences, 71% (50–84) for nasal words, and 63% (37–80) for nasal sentences. A
significant effect of age on nasalance (p < .05) was observed with the highest scores in the youngest
children, aged 5–6 years. There was no significant gender or mother tongue effect on nasalance scores.
Editor-in-Chief: Nasalance values of oral speech samples were comparable with those reported for other languages.
David H. McFarland Findings indicated that our protocol is a simple and rapid-to-use tool that is applicable for French-
speaking children in order to determine normative nasalance values. It can be recommended as an
evaluation tool, as well as a quality control, following surgery and/or speech therapy.

161 Volume 46, No 3, 2022
Revue canadienne d’orthophonie et d’audiologie (RCOA) NORMATIVE NASALANCE FOR FRENCH
Abrégé
La normalisation des scores de nasalance est essentielle pour le diagnostic et le suivi clinique. Les
objectifs de la présente étude étaient de développer un protocole de nasométrie pour le français
européen et d’établir des normes pour les scores de nasalance y étant recueillis auprès d’un
échantillon d’enfants européens francophones. Cent sept enfants francophones âgés de 5 à 14 ans
(âge moyen = 9 ans) et ayant une parole normale ont été inclus dans la présente étude prospective. Il
leur a été demandé de répéter différents sons oraux et nasaux (phonèmes, mots, phrases, logatomes)
et des échantillons de leur voix ont été enregistrés à l’aide d’un nasomètre (modèle II). Les normes
pour les scores de nasalance ont été établies en tenant compte des différences dues à l’âge, au sexe,
au type de son (oral ou nasal) et à la langue maternelle. Les scores moyens de nasalance étaient de
17 % (intervalle de confiance à 95 % = 6 %–39 %) pour les mots ne contenant que des phonèmes
oraux, 13 % (intervalle de confiance à 95 % = 5 %–29 %) pour les phrases ne contenant que des
phonèmes oraux, 71 % (intervalle de confiance à 95 % = 50 %–84 %) pour les mots contenant une
proportion élevée de phonèmes nasaux et 63 % (intervalle de confiance à 95 % = 37 %–80 %) pour
les phrases contenant une proportion élevée de phonèmes nasaux. Un effet significatif de l’âge a été
observé sur les scores de nasalance (p < 0,05), les scores les plus élevés étant été observés chez les
enfants plus jeunes (c.-à-d. chez les enfants âgés de 5 à 6 ans). Aucun effet significatif du sexe ou de la
langue maternelle n’a été observé sur les scores de nasalance. Les scores de nasalance obtenus pour
les mots ou phrases ne contenant que des phonèmes oraux étaient comparables à ceux obtenus
dans d’autres langues. Les résultats indiquent que le protocole présenté dans la présente étude est
simple et rapide et qu’il est applicable auprès d’enfants francophones pour déterminer les scores de
nasalance. Il s’agit d’un outil pouvant être recommandé pour évaluer et faire un suivi de la qualité de la
parole des enfants en contexte postopératoire et en orthophonie.
pages 161-170 ISSN 1913-2020 | www.cjslpa.ca 162

Hypernasality, also referred to as hypernasal speech, In 1970, Fletcher and Bishop introduced The Oral Nasal
hyperrhinolalia, or Rhinolalia aperta, is an abnormal Radiometer (TONAR), an acoustic device measuring nasal
proportion of sound energy emerging from the nasal resonance. Its successors, the Nasometer 6200, 6400,
resonators as the consequence of congenital or acquired and 6450 (KayPentax), have been commercialized since
velopharyngeal dysfunction (VPD). Hypernasality 1986. The Nasometer consists of a metal plate placed
accompanies oral vowels and consonants and gives rise perpendicular to the face at the level of the philtrum,
to an abnormal nasalized voice quality and low volume in between the base of the nose and the border of the upper
speech production. In contrast to hypernasality, hyponasality lip. Two one-directional microphones separately pick
implies a diminished sound energy emerging through the up the nasal and oral acoustic energy within a specified
nose during the production of nasal phonemes. Mixed frequency band. The acoustic signal is transmitted to a
resonance, hypernasal and hyponasal, is a combination of microprocessor, analyzed by a computer, and visualized
nasal obstruction and VPD (Kummer, 2011; Leuchter, 2015). on a monitor. The device computes a score, named
Resonance disorders may be associated with articulation “nasalance” (Fletcher & Daly, 1976), that reflects the relative
disorders and loss of intelligibility (Delvaux, 2009). amount of nasal acoustic energy in speech. Nasalance is
expressed as a percentage and defined as
The assessment of hypernasality is the key task and most
challenging aspect of the evaluation of VPD patients. As
nasal sound energy (dB)
with the evaluation of voice disorders, acoustic-perceptual Nasalance (%) = x100
assessment is essential and remains the gold standard (nasal sound energy (dB) + oral sound energy (dB))
evaluation method. However, perceptual assessment has its
limitations and may be a source of error, e.g., due to expertise Thus, high nasalance scores can be expected in VPD
of the judges, different internal standards of listeners patients, while low scores are measured in patients with
(Kreiman et al., 1993), or confounding effects such as obstruction of the nasopharynx or nasal tract. Nasalance
misarticulations or delayed language development (Keuning scores depend naturally on the phonetic composition of
et al., 2002). There is consensus in the literature about the speech samples. Fletcher et al.’s (1989) measurements of
necessity of both objective tests and subjective assessment two different speech samples in typical American children
techniques for the evaluation of nasality (Bettens et al., illustrated this fact: Nasalance scores were 35.69% for the
2018; Hirschberg, 1983). Nasality is a complex phenomenon, Rainbow Passage with an equilibrated distribution of nasal
and its measure is not linearly related with velopharyngeal consonants and 15.53% for the Zoo Passage that is free
opening or even with perceived hypernasality (Hirschberg of nasal consonants. Importantly, the protocol must be
& Van Demark, 1997). It is influenced by various factors that adapted to the patient’s language to be correctly used in
can be speaker-related or due to technical specificities clinical practice.
(Henningsson et al., 2008; Lewis et al., 2000). Two similar instruments have been developed:
There are simple clinical tests to observe nasal air loss NasalView (Tiger Electronics) and OroNasal System
during phonation, such as the Glatzel mirror test and the (Glottal Enterprises; Bressmann et al., 2006). The OroNasal
Gutzmann test (Gutzmann, 1913). The latter is simple System measures nasalance in a manner comparable
to perform: The patient is asked to produce held vowels to the Nasometer and NasalView but its microphones
such as /a/ and /i/, with and without pinching the nose. A are sensitive to the airflow coming from the mouth and
difference in sound perceived between the two conditions the nose, creating artefacts. The three systems measure
is an indicator of poor velopharyngeal closure. Instrumental nasalance in different ways and provide nasalance scores
evaluation of nasalance includes mainly nasofibroscopy, that are not interchangeable (Bressmann, 2005). In the
videofluoroscopy, aerophonometry, and nasometry (de literature, the Nasometer remains the gold standard in
Stadler & Hersh, 2015; Leuchter, 2015;). Nasofibroscopy the evaluation of nasalance: Several advantages have
allows, by means of a flexible optical fibre, the physician to been described: (a) it is an objective noninvasive measure
observe the closure of the velopharynx directly from the that provides numerical values (Seaver et al., 1991); (b)
nasopharynx (Glade & Deal, 2016). Videofluoroscopy is a users can obtain fast results in real time, even with small
radiologic exam that allows visualization of the velopharynx children (van der Heijden et al., 2011a; Sweeney et al.,
in different three-dimensional planes at rest or when closing 2004); (c) it is a tool in speech therapy for visual feedback
(Lipira et al., 2011). Aerophonometry is an aerodynamic (van der Heijden et al., 2011a); (d) it allows for objectifying a
measurement of nasality allowing clinicians to calculate a patient’s progress; and (e) it has significant correlation with
ratio of nasal and oral airflows. perceptual evaluation (Hirschberg et al., 2006).

163 Volume 46, No 3, 2022
However, nasometry has its limitations. In a study where that is, each participant was asked to produce a series of
Dalston et al. (1991) assessed 514 patients aged 3 to 56 /a/ and /i/ alternately with the nares opened and closed.
years perceptually (clinical evaluation of hypernasality by an A change in sound quality when the nares were closed
experimenter) and instrumentally (nasometric evaluation), indicated the existence of hypernasality. A recording of the
they suggested that nasometry reaches its optimal clinical voice counting from 1 to 10 was then conducted and later
utility when used in conjunction with clinical judgment; its evaluated by a phoniatrician and speech-language therapist
utility decreases when used as a single method. Further, to exclude hypernasal or hyponasal speech.
Vallino-Napoli and Montgomery (1997) pointed out that
the scoring of nasalance has limitations when comparing Nasometry Assessment Protocol
different languages, concluding that the Nasometer should Following acoustic-perceptual assessment, nasometry
always be used as a complement to clinical evaluation. was performed using a Nasometer II model, version 3.3.3,
Finally, although the Nasometer is a useful tool for which was installed on a laptop. A Nasometer consists
evaluation of hypernasality, there are still controversies over of a metal plate slightly curved with two microphones,
its usefulness for other nasal resonance problems such as one on the upper side and another on the lower side. The
hyponasality (Anderson, 1996). plate is positioned against the participant’s upper lip and
is maintained by a helmet which must be adjusted on
The aims of this study were to establish a protocol for
the head. Sidebars that connect the helmet to the plate
nasometry adapted in French and to determine normative
were adjusted for each child so that the latter remained
nasalance values for European French-speaking children
perpendicular to the vertical half of the face. We calibrated
as measured with the Nasometer II model, including
the Nasometer according to the manual's (Kay Pentax)
differences due to age, gender, context, and first language.
recommendations. The upper microphone recorded a
Method nasal sound wave and the lower microphone recorded an
oral sound wave. Recordings were done in a quiet room in a
The Institutional Review Board at the University Hospital
seated position. Children were verbally instructed to repeat
Geneva approved our research on May 14, 2014 (ethical
the sounds (phonemes, words, sentences, logatomes) the
number: 80514).
examiner pronounced. The audio recording and nasometric
Participants measures were done simultaneously, always with the same
recorder distance (30–40 cm) and a natural speaking
We recruited 111 children from Geneva, the French intensity. Recordings were completed successfully in 5
part of Switzerland, aged 5 to 14 years, selected among to 10 minutes. When an error occurred, the experimenter
three school levels and three age categories: 5–6 years repeated the complete item. The same experimenter
(Grade 2), 8–10 years (Grade 6), and 12–14 years (Grade always evaluated the repeated session.
10). Sample size was based on the recommendations
of the International Federation of Clinical Chemistry to Data processing was done using the Nasometer software.
determine the range of normality for the values, defined Each item was associated with an acoustic signal represented
between 0.025 and 0.975 percentiles (Poulsen et al., 1997). by a curve as a function of time (on the x-axis) and of the
Parents of all children completed informed consent and percentage of nasalance (on the y-axis). Each item of our
an inclusion questionnaire with medical and demographic protocol was treated individually, with the same procedure.
data. Inclusion criteria included European French-speaking First, we selected the most stable part of the signal to analyze.
children schooled in Switzerland with normal speech We used the statistics function on the laptop to get numeric
according to teachers’ evaluation. Exclusion criteria were values and entered data in an SPSS file: mean nasalance
hypernasality or hyponasality, non-French speakers, speech (mean), minimal nasalance (min), maximal nasalance (max),
and language disorders, previous surgery for cleft palate or duration of the selected signal (time range), precise moment
facial malformation, syndromic diseases and craniofacial of the start of the signal selected in seconds (start), and
malformations, acute infection of the upper airway, or hearing precise moment of the end of the signal (end).
impairment. Eleven patients had simple otolaryngologic
surgeries: adenoidectomy (n = 5), tonsillectomy (n = 4), Speech samples used in the protocol are known to
transtympanic drains (n = 2)—and were excluded. A first influence nasalance results and their selection is particularly
language different from French was not an exclusion criterion. important in cross-language studies (Lewis et al., 2000;
Watterson et al., 2005). Three types of stimuli are generally
To exclude VPD participants, we performed the used to assess nasalance: oral sentences or texts which
Gutzmann test (Gutzmann, 1913) as a first screening test; avoid nasal coarticulation (Lee & Browne, 2013; Mishima

et al., 2008; Seaver et al., 1991); nasal sentences or texts (/a, ɑ, ə, ø, œ, e, ɛ, i, o, ɔ, y, u/) and 15 consonants (/b, s, k,
which allow closed rhinolalia evaluation (Lee & Browne, d, f, g, ʒ, l, p, ʁ, t, v, z, ʃ, h/). Only eight are nasal phonemes:
2013; Seaver et al., 1991); and mixed sentences or mixed four vowels (/ɑ̃, ɔ̃, ɛ, œ̃/) and four consonants (/m, n, ɲ, ŋ/).
texts (containing both oral and nasal phonemes) which are Our protocol was designed to take into consideration the
representative of conversational speech, but provide no characteristics and peculiarities of French with phonetically
additional clinical information compared to other contexts well-balanced verbal stimuli, summarized in Table 1: five
(Dalston & Seaver, 1992). In English, three short texts usually isolated oral vowels; three isolated nasal vowels, 14 oral
serve as a standard protocol: the Zoo Passage which is words with a target consonant (/p, t, k, b, d, g, f, s, ʃ, v, z, ʒ, l,
devoid of nasal phonemes (oral text), the Rainbow Passage ʁ/), and two nasal words with a target consonant (/m, n/).
which contains 11.5% nasal phonemes (mixed text), and We designed our sentences in three ways: oral (containing
nasal phrases which contain 35% nasal phonemes (nasal only oral phonemes), mixed (with oral and nasal phonemes
text; Mayo & Mayo, 2011). in same proportion), and nasal (with high proportion
of nasal phonemes). Our protocol involved seven oral
We designed our protocol based on those described sentences (0% of nasal phonemes); two nasal sentences
in the literature (Abou-Elsaad et al., 2012; Anderson, 1996; (45.8% of nasal phonemes); one mixed sentence (11.76%
Brunnegård & van Doorn, 2009; Falé & Hub Faria, 2008; of nasal phonemes); and three logatomes. Logatomes
Hirschberg et al., 2006; Lee & Browne, 2013; Lehes et al., were designed including occlusives /p, t, k/ and fricatives /f,
2018; Nichols, 1999; Okalidou et al., 2011; Putnam Rochet et s, ʃ/ and /v, z, ʒ/. Finally, children were asked to repeat oral
al., 1998; Sweeney et al., 2004; van der Heijden et al., 2011b; and nasal vowels in an alternating manner: /a/–/ã/, /e/–/ɛ̃/,
Van Lierde et al., 2001; Whitehill, 2001). We followed specific and /o/–/õ/. The phonetic content of stimuli was carefully
principles for constructing speech samples to facilitate matched by the distribution of oral and nasal vowels. One
comparison across languages. To find the most appropriate passage was carried out with each participant.
speech materials, we based our protocol on Henningson et
al.’s (2008) speech sampling guidelines. Specifically, single Statistical Analyses
words containing only one vowel and both high and low
All data were analyzed with the Nasometer’s software to
vowels were sampled, all test words contained only one type
obtain mean nasalance scores. Descriptive statistics were
of target pressure consonant per word and were sampled
presented as the mean rate of nasalance, with the 95%
in different positions of occurrence in French, and words
confidence interval (CI) corresponding to the minimal and
did not contain nasal consonants. Sentences included all
maximal values. Data were transcribed in an Excel table. We
vowel types relevant for European French, focusing on one
analyzed four variables which could influence nasalance
pressure consonant target only, with at least one consonant
scores: age, gender, context, and first language. Children
from each of the pressure consonant categories. French
were stratified into three age groups with a balanced
has 38 phonemes: 16 vowels, 19 consonants, and three
number of participants. Statistical analyses were performed
semi-vowels. A majority of phonemes are oral: 12 vowels
using SPSS software, v. 22.0. An analysis of variance test
Table 1
Design and Illustration of Verbal Stimuli Used in Our Protocol
Speech stimuli Number Illustration
Oral vowels 5 /a/, /e/, /i/, /o/, /u/
Nasal vowels 3 /ã/, /ɛ̃/, /õ/
Oral words 14 “papier,” “tatou,” “cacao,” “baobab,” “dodu,” “gaga,” “foufou,” “saucisse,” “chou-
chou,” “vive,” “zazou,” “joujou,” “lilas,” “arrière”
Nasal words 2 “mamie” et “nana”
Oral sentences 7 t’es pas cap, boule de glace, elle se fâcha, je vais au zoo, alors relis-le, le coq fait
cocorico, apporte le petit pot
Nasal sentences 2 une nuit en montagne, un grand pain rond
Mixed sentences 1 Pierre a mangé tout le gâteau
Logatome 3 Pa-ta-ka, fa-sa-cha, vi-zi-ji

165 Volume 46, No 3, 2022
was performed to assess the impact of the age factor. An = .394). The context of nasality and first language (p = .764)
independent samples t–test was carried out to compare the did not influence nasalance scores.
mean nasalance scores for oral and nasal words according
to gender. A two-factor analysis of variance test was then Discussion
performed to compare nasalance scores as a function of Our findings showed a mean nasalance score of 13% for
the context (oral versus nasal) and gender (boys versus oral sentences and 14.5% for computed oral vowels, words,
girls). An independent samples t–test was performed to sentences, and logatomes. The nasalance values of oral
compare nasalance scores of all items combined according speech samples were comparable with those reported for
to the child's first language (French versus other languages). other languages, such as English, Finnish, Greek, and Swedish
The significance level was set at p = .05. (Haapanen, 1991; Kavanagh et al., 1994; Van Doorn & Purcell,
1998), but scores for the nasal words and sentences were
Results much higher due to the high proportion of nasal phonemes in
We analyzed recordings from 111 children (48 boys and the chosen samples. We found significantly higher nasalance
63 girls). Four participants were excluded after perceptive scores for oral stimuli in the group of youngest children. The
analysis: two presented with slightly hypernasal speech, one age effect could be due to acoustic factors. Young children
had an acute nose obstruction, and one had data that was have a high fundamental frequency that can sometimes
not interpretable. Thus, 107 children (mean age = 9 years) be close to the lower end of the acoustic filters used by the
were included for the nasalance measures. Demographic Nasometer (Delvaux, 2012). Mayo and Mayo (2011) attributed
data are summarized in Table 2. Thirty (28%) children were this difference to a change in the neuromuscular control
in Grade 2, 42 (39%) in Grade 6, and 35 (33%) in Grade 10. of the velum resulting in the enlargement of the vocal tract
Among our group, 74% of the children had European French during growth. Indeed, growth and involution of adenoids over
as their first language and 26% had another mother tongue: the years influence vocal resonance. However, other studies
Portuguese (n = 8), Spanish (n = 5), Arabic (n = 5), Albanian have observed no significant effect of age on nasalance
(n = 3), Italian (n = 2), English (n = 1), Swedish (n = 1), Serbo- scores (Brunnegård & van Doorn, 2009; Mayo & Mayo, 2011).
Croatian (n = 1), Thai (n = 1), Chinese (n = 1), and Japanese We found no effect of gender for each of the age categories
(n = 1). Regarding the language spoken at home, 94% spoke tested, which is consistent with the literature (Litzaw &
European French and 63% spoke a second language other Dalston, 1992). With regard to the first language , there was no
than French: Spanish (n = 14), Italian (n = 14), Portuguese (n significant effect on nasalance scores, which could suggest
= 13), Arabic (n = 8), English (n = 4), Albanian (n = 3), German that our measures are applicable even in children with French
(n = 2), Serbo-Croatian (n = 2), Lingala (n = 1), Creole (n = 1), as a second language.
Swedish (n = 1), Thai (n = 1), Vietnamese (n = 1), Chinese (n =
1), and Japanese (n = 1). One limitation of our study is that a variety of first
languages other than French were combined into the same
Our results showed mean nasalance scores of 16% group. In clinical practice, we cannot affirm that a child with
(3–46) for oral vowels, 69% (40–96) for nasal vowels, a first language different from French could be expected
17% (6–39) for oral words, 13% (5–9) for oral sentences, to perform within the norms established here. Nasalance
71% (50–84) for nasal words, and 63% (37–80) for nasal scores have been reported to vary with speaker regional
sentences. Nasalance scores with their mean and CIs are dialect when the same reading passage is used. Leeper
summarized in Table 3. We observed a significant effect of et al. (1992) described the presence of regional dialectal
age and school grade level on nasalance (p < .05), with the variations for nasalance among speakers of Canadian
highest scores in children in Grade 2 (5–6 years; M = 19%) English. Seaver et al. (1991) studied the influence of dialect on
compared to those in Grade 6 (8–10 years; M = 15%). The nasalance in English-speaking participants from four different
effect of age was mostly present for isolated oral vowels. geographic regions of the United States and Canada (Illinois,
Gender nasalance scores were not significantly different (p North Carolina, Alabama, and Ontario); he concluded that
Table 2
Demographic Data and Distribution of Participants
Variables Values
Male:female ratio 46:61
Mean age (years) 9

Table 3
Summary of Mean Nasalance Scores With Confidence Interval
Verbal stimuli Mean nasalance in % (95% CI)
Oral vowels 16 (3–46)
/a/ 11 (3–33)
/e/ 16 (5–44)
/i/ 30 (14–55)
/o/ 9 (2–28)
/u/ 16 (5–36)
Nasal vowels 69 (40–96)
/ã/ 55 (39–75)
/ɛ̃/ 65 (49–91)
/õ/ 82 (54–96)
Oral words 17 (6–39)
Nasal words 71 (50–84)
Oral sentences 13 (5–29)
Nasal sentences 63 (37–80)
Mixed sentences 26 (15–37)
Oral logatomes 15 (4–38)
participants from North Carolina had a higher nasalance diagnosis of VPD, there is variation in nasalance scores
score when compared to other regions. According to Kummer attributed to intraspeaker variability and variability in
(2011), dialect differences mainly concern vowels. Mayo et successive recording conditions (Sweeney et al., 2004,
al. (1996) hypothesized that differences between dialects Watterson et al., 2005). With the introduction of new
are explained by difference in closing time of the soft palate models of the Nasometer, there is also a between-machine
during the transition between nasal consonants and vowels. variation (Kummer, 2011; Watterson et al., 2005).
Finally, several studies in the literature suggested that
differences in nasalance scores according to dialect were Nasometry Normative Data
not clinically significant (Mayo & Mayo, 2011; Mayo et al., 1996; To the best of our knowledge, this is the first nasalance
Putnam Rochet et al., 1998; Seaver et al., 1991). standard established in a large population of European
French-speaking children. A previous study reported
We performed measurements in only one passage.
normative values of nasalance in a mixed-age Canadian
According to several studies, there was no significant
French speaking population (Putnam Rochet et al., 1998).
difference between two successive passages for children
There is a significant difference in nasalance norms
without language disorders, which was the case with our
among languages including speaker-specific factors
cohort. For children with language disorders, a difference of
(idiosyncrasies), age-related and gender-related factors,
up to 5% has been reported (Watterson et al., 2005).
and linguistics and dialectal factors. Nasalance scores
Nasometry is a popular tool and easy to use, even are also a function of the linguistic material included in
with small children. The usefulness of this instrumental the protocol, which can vary across studies investigating
assessment depends on correlation with acoustic- the same linguistic community. A number of studies in
perceptual evaluation of nasality. Several authors different languages have been conducted to determine the
have reported good or moderate correlation between normative values of nasalance in normal speakers (Abou-
instrumental and perceptual assessment (Fletcher & Elsaad et al., 2012; Anderson, 1996; Brunnegård & van Doorn,
Bishop, 1970; Hirschberg et al., 2006). Even though the 2009; Falé & Hub Faria, 2008; Hirschberg et al., 2006; Lee &
Nasometer is considered the gold standard for the clinical Browne, 2013; Lehes et al., 2018; Nichols, 1999; Okalidou et

167 Volume 46, No 3, 2022
al., 2011; Putnam Rochet et al., 1998; Sweeney et al., 2004; The first conclusion to be drawn from these studies
van der Heijden et al., 2011b; Van Lierde et al., 2001; Whitehill, is that nasalance scores depend on the speaker’s native
2001) and are summarized in Table 4. language. This may be explained by the different proportion
Table 4
Means for Nasalance Scores in French and Other Languages
Language Author Year N Age Gender Mean Mean Mean
pub- (years) nasalance nasalance nasalance
lished (in %): (in %): (in %):
Oral Mixed Nasal
English USA Seaver et al. 1991 148 16–63 Both 16 (T) 36 (T) 62 (S)
English Canada Kavanagh et al. 1994 52 18–33 Both 13.4 (T) 37.1 (T) 65.4 (S)
English Canada Putnam 1998 315 9–85 Both 11.3/11.5 (T) 32.9/34.5 (T) 61.6/62.7 (T)
Rochet et al.
French Canada Putnam 1998 153 9–85 Both 11.5/12.4 (T) 26/28.3 (T) 35.5/38.5 (T)
Rochet et al.
English Ireland Sweeney et al. 2004 70 4–13 Both 14 (S) 16 (S) 51 (S)
English Ireland Lee and Brown 2013 60 18–28 Both 11.5 (T) 29.6 (T) 47.6 (S)
Australian Van Doorn and 1998 245 4–9 Both 13.1 (T) – 59.6 (T)
Purcell
Cantonese Whitehill 2001 141 21 Both 16.79 (S)/13.68 35.46 (T) 55.67 (S)
(T)
Finnish Haapanen 1991 58 21 Both 13.6 (T) – 69.4 (S)
Japanese Tachimura 2000 100 24 Both 9.1 (S) – –
Japanese Mishima et al. 2008 68 23.5 Both 10.3/15.6 (T) – –
Spanish Anderson et al. 1996 40 21–43 Both 21.95 (T) 36.02 (T) 62.07 (S)
(Puerto Rican)
Spanish Nichols 1999 152 8–40 Both 17.02 (S) – 55.28 (S)
(Mexican)
Swedish Brunnegård 2009 220 9 Both 12.7 (S) 29.5 (S) 56.5 (S)
and van Doorn
Thai Prathanee 2003 188 9.5 Both 14.3 (T) 35.6 (T) 51,1 (T)
Flemish Van Lierde 2001 58 19–27 Both 10.9 (T) 33.8 (T) 55.8 (T)
Dutch Van der 2011b 55 4–6 Both 11(T) 27 (T) –
Heijden
Hungarian Hirschberg 2006 30 5–25 Both 11(S) 31.7 (S) –
Portuguese Falé and Hub 2008 25 19–27 Both 10 (T) – 44(T)
Faria
Arabic Abou–Elsaad 2012 300 3–54 Both 29/33 (S) – 77/75 (S)
et al.
Greek Okalidou et al. 2011 80 18–34 Both 12.4 (T) 25.5 (T) 42 (T)
French Our data 2022 107 5–14 Both 13 (S) 26 (S) 63 (S)
(European)
Note. T = text; S = sentences; USA = United States of America

of phonemes in each language and by the presence of therapy. The evaluation of VPD, particularly resonance and
nasalized vowels in some languages, as in French /ã, ɛ̃, speech assessment, remains challenging and the choice
õ/. It follows therefore that standard passages should be of therapy will essentially depend on the type and severity
developed for each language. In addition, studies show of the clinical manifestations and patient expectations.
that not only different languages, but also regional dialects Instrumental assessment of nasality by nasometry is one of
(Brunnegård & van Doorn, 2009; Kavanagh et al., 1994) may the cornerstones of this evaluation.
influence nasalance scores. Nasalance norms must then be
determined for each language and each region. References
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No conflicts of interest, financial or otherwise, are
declared by the authors.

PROCESSING-DEPENDENT MEASURES Canadian Journal of Speech-Language Pathology and Audiology (CJSLPA)
Processing-Dependent Measures Sensitive to Language

Performance Differences in Arabic-Speaking English
Language Learners Compared to Children with
Developmental Language Disorder
Mesures de traitement de l’information sensibles aux

différences de performances langagières des apprenants
de langue anglaise arabophones lorsque comparées à celles
KEYWORDS d’enfants ayant un trouble développemental du langage
ARABIC-SPEAKING
CHILDREN
ENGLISH LANGUAGE Areej M. A. Balilah
LEARNERS Lisa M. D. Archibald
DEVELOPMENTAL
LANGUAGE DISORDER
PROCESSING-DEPENDENT
MEASURES
Areej M. A. Balilah1 and Lisa

M. D. Archibald2
1
Childhood Studies, King
Abdulaziz University, Jeddah,
SAUDI ARABIA
2
School of Communication
Sciences and Disorders, The
University of Western Ontario,
London, CANADA
Abstract
To address concerns regarding the utility of language measures that depend on linguistic knowledge
to distinguish English language learners from those with developmental language disorder, this
study compared the performance of Arabic-speaking English language learners with diverse
language experiences to the performance of age-matched monolingual children with and without
developmental language disorder on processing-dependent measures. The group of 6- to 9-year-old
English language learners (n = 59) whose first language was Arabic, and who had been learning English
as the language of instruction in Canada, and two monolingual groups from Saudi Arabia, typically
developing Arabic-speaking children (n = 369) and Arabic-speaking children with developmental
language disorder (n = 52), completed processing-dependent measures of short-term and working
memory. No differences were found between the groups of English language learners and typically
developing children on the short-term and working memory measures, with the exception of
the Arabic nonword repetition task. The performance of the English language learners group was
comparable to that of the Arabic-speaking children with developmental language disorder group on
the Arabic nonword repetition task and significantly lower than the typically developing group. The
Editor-in-Chief: English language learners group scored significantly higher than the typically developing and Arabic-
David McFarland speaking children with developmental language disorder groups on only the digit recall subtest. The
findings suggest that processing-dependent measures may be valid assessment tools that minimize
the role of linguistic knowledge and experiences.
Processing-Dependent Measures Sensitive to Language Performance Differences in Arabic-Speaking English Language Learners
171 Volume 46, No 3, 2022
Compared to Children with Developmental Language Disorder
Revue canadienne d’orthophonie et d’audiologie (RCOA) PROCESSING-DEPENDENT MEASURES
Abrégé
Afin de répondre aux réserves relatives à l’utilité des mesures langagières qui dépendent des
connaissances linguistiques pour distinguer les apprenants de langue anglaise ayant un trouble
développemental du langage et de ceux qui n’en ont pas, la présente étude a comparé les
performances à des mesures reposant sur le traitement de l’information d’apprenants de langue
anglaise arabophones ayant différentes expériences linguistiques avec celles d’enfants unilingues
appariés sur l’âge avec et sans trouble développemental du langage. Les mémoires à court-terme
et de travail d’un groupe d’apprenants de langue anglaise âgés de 6 à 9 ans (n = 59) dont la langue
maternelle était l’arabe et dont la langue d’enseignement était l’anglais, ainsi que deux groupes
d’enfants arabophones unilingues habitant en Arabie Saoudite (c.-à-d. un groupe de 369 enfants au
développement typique et un groupe de 52 enfants ayant un trouble développemental du langage)
ont été évaluées. Aucune différence n’a été relevée entre les performances du groupe d’apprenants
de langue anglaise et du groupe d’enfants au développement typique aux mesures de mémoires à
court terme et de travail, exception faite entre les performances de ces enfants à la tâche répétition
de non-mots arabes. La performance du groupe d’apprenants de langue anglaise s’est révélée
comparable à celle du groupe d’enfants arabophones ayant un trouble développemental du langage
à la tâche de répétition de non-mots arabes et significativement inférieure à celle du groupe d’enfants
au développement typique. Uniquement à la tâche de répétition de chiffres, le groupe d’apprenants
de langue anglaise a obtenu des scores significativement plus élevés que les groupes d’enfants
arabophones au développement typique et ayant un trouble développemental du langage. Les
résultats suggèrent que les mesures reposant sur le traitement de l’information pourraient être des
outils d’évaluation valides permettant de minimiser l’influence des connaissances linguistiques et des
expériences antérieures.

The number of English language learners (ELLs), or in a language other than their minority first language.
meaning children whose first language is not English Research suggests that it can take 4 or 5 years for ELLs to
and who attend schools taught in English, is significantly gain English proficiency comparable to their monolingual
increasing in Canada (Paradis et al., 2010) and the United peers (Hakuta et al., 2000). According to Paradis (2010),
States (Goldstein, 2004). Identifying children with language there is considerable overlap in the linguistic features of
disorders in culturally and linguistically diverse communities, typically developing (TD) ELLs who are in the early stage of
such as the United States and Canada, is challenging. On developing their second language (within the first two years
one hand, many studies have found that knowledge-based in particular) and those of monolingual children with DLD,
assessment tools, such as English standardized tests of as both groups tend to have errors in vocabulary choice
language, are not accurate in identifying language disorder and grammatical morphemes (Tabors, 2008). Receiving
among ELLs who are in the process of learning English instruction in English can also impact ELLs’ learning of their
as a second language and have more limited language first language. Children whose first language is a minority
knowledge than their monolingual peers (e.g., Blom & often receive minimal community support in that language,
Boerma, 2017; Chu & Flores, 2011; Sandberg & Reschly, 2011). and the opportunities to hear and use it are diminished once
The reduced language proficiency of ELLs can result in lower they start schooling (Anderson, 2012). As proficiency in ELLs’
reliability and validity of assessments and be a source of second language grows, their skills in their first language often
measurement error when assessing ELLs (Abedi, 2006). do not develop further or even reduce and diminish across
On the other hand, processing-dependent measures, or time, a phenomenon termed incomplete acquisition or first-
measures that assess general cognitive abilities, have been language loss (Anderson, 2012). First-language loss impacts
hypothesized to contribute to processing and language lexical and grammatical systems (Anderson, 2012), two areas
learning (Park et al., 2021). Such measures probe the abilities of language commonly affected in DLD.
supporting language learning and may be less dependent
on ELLs’ linguistic knowledge (Blom & Boerma, 2017; Park et As a result of being in the early stages of English
al., 2021). Studies have investigated the utility of processing- acquisition and potential first-language loss, ELLs may
dependent tasks, such as measures of verbal short-term have weak language skills in each of the languages they
memory, in distinguishing ELLs from children with underlying are learning, which poses challenges when concerns arise
language impairment (Kohnert et al., 2006; Paradis et al., regarding language development and language learning.
2013; Wealer & Engel de Abreu, 2021). The purpose of the Several studies reported that S-LPs commonly use English
current study was to compare Arabic-speaking ELLs with norm-referenced standardized tests to assess ELLs’
diverse language experiences to children with underlying linguistic abilities (Caesar & Kohler, 2007; Gillam et al., 2013).
language impairment, using tests of verbal short-term and Evidence suggests that administering knowledge-based
working memory. assessment tools such as English standardized language
tests and interpreting scores based on monolingual norms
Children with significant and persistent limitations in may lead to overdiagnosis of DLD among ELLs (Bedore &
their language ability despite average educational and Peña, 2008; Klingner & Artiles, 2003).
experiential opportunities are referred to as children with
developmental language disorder (DLD, also known as Even assessment in their first language may
specific language impairment; Bishop et al., 2017). The underestimate language skills in ELLs. Lexical-semantic
language deficits in children with DLD can affect all areas knowledge in ELLs is often distributed across languages with,
of language (Stothard et al., 1998), although the profile of for example, some vocabulary items being experienced
language deficits can be unique for each child with DLD. mostly at school in English and other vocabulary items
Grammatical deficits in particular have been described as experienced mostly at home in the child’s first language
a hallmark deficit in DLD (Leonard et al., 1997). To identify (Gollan et al., 2008; Pearson et al., 1993; Umbel et al., 1992).
children with DLD, speech-language pathologists (S-LPs) The lower frequency of exposure and practice for individual
commonly use standardized tests that have been normed words may result in weaker links between semantic and
with a monolingual population. Children scoring significantly phonological representations in ELLs (Gollan et al., 2008).
below age expectations on such tests may be identified as As a result, even TD ELLs have been found to score below
having DLD. their monolingual peers on vocabulary measures in both
English (e.g., Bialystok et al., 2010) and their first language
Another group of children who may appear to have weak (Jackson et al., 2014). Indeed, on single language vocabulary
language skills at school is ELLs, that is, those children who measures, TD ELLs often show performance comparable to
are receiving instruction in their second language (English) monolingual children with DLD (Umbel et al., 1992; Windsor
173 Volume 46, No 3, 2022
& Kohnert, 2004). Similarly, performance on grammatical (Baddeley, 2000; Conway et al., 2005). Verbal short-term
language tasks has not been found to distinguish TD ELLs memory has been found to be a key indicator of new-word
with diverse language backgrounds from monolingual learning (Majerus et al., 2006; Masoura & Gathercole, 2005)
children with DLD (Paradis, 2005; Paradis et al., 2008). and vocabulary acquisition (Gathercole, 2006; Gathercole
Clearly, ELLs’ language performance is affected by their et al., 1992) Working memory tasks, on the other hand,
limited knowledge and experience with each target language impose demands on processing in addition to storage, and
examined (Blom & Boerma, 2017). are generally assessed by complex memory span paradigms
(Engel de Abreu, 2011). Examples of verbal complex span
Given concerns regarding the utility of any language tasks are counting recall and backwards digit recall, in which
knowledge measures to discriminate ELLs from those a participant recalls numbers after counting or reversing
with DLD, attention has turned to the use of processing- the order, respectively. Examples of corresponding
dependent measures, especially those found to visuospatial tasks involve recalling locations or orientations
differentiate monolingual groups with and without DLD, after identifying a different shape or mentally rotating an
such as processing speed, temporal integration, and image, respectively (Alloway et al., 2009). Working memory
immediate memory (Archibald & Gathercole, 2006a; Miller has been associated with complex cognitive activities,
et al., 2001; Windsor & Hwang, 1999; Windsor & Kohnert, such as language comprehension and word decoding (Cain
2004). The theory is that processing-dependent measures et al., 2004; Engel de Abreu & Gathercole, 2012). Some
may be less dependent on ELLs’ linguistic knowledge and, researchers have reported comparable performance
therefore, directly tap abilities underlying language learning between monolingual children with DLD and TD peers on
(Kohnert et al., 2006; Paradis et al., 2013; Park et al., 2021). visuospatial short-term and working memory measures
Recent studies have reported that focusing on processing- (e.g., Archibald & Gathercole, 2006b; but see Vugs et al.,
dependent measures or supplementing language 2013), suggesting disproportionately smaller DLD deficits
knowledge measures with processing-dependent measures in the visuospatial than verbal domain (Archibald &
helped distinguish between ELLs with and without DLD Gathercole, 2006b).
(Park et al., 2021; Wealer & Engel de Abreu, 2021).
Given that short-term and working memory measures
Multiple theories have been put forward to explain the emphasize the storage and processing of new information
disproportionate linguistic deficit found among children (Engel de Abreu et al., 2013), the influence of previous
with DLD. For example, domain-general theories contend knowledge has been considered to be minimal. It has been
that children with DLD have deficits in the domain-general suggested that processing-dependent measures such as
cognitive processes known to support language learning. verbal short-term memory and working memory measures
When children with DLD present with a limitation in domain- may pose similar challenges and be equally familiar (or
general information processing, it is often connected with unfamiliar) to all children, regardless of the language they
reduced space or capacity (Bishop, 1992), or slower speed speak (Engel de Abreu & Gathercole, 2012). It should be
(Kail, 1994). Working memory, defined as the ability to retain noted that the majority of research comparing ELLs with
and manipulate information for a short period of time in the monolingual children with DLD on processing-dependent
current focus of attention, is one domain-general resource measures has focused on nonword repetition measures, a
that can limit information processing speed or capacity. task involving the immediate recall of made-up or nonsense
Nevertheless, none of the DLD theories effectively explain words. Although nonword repetition has been argued to be
DLD, indicating that DLD is, in fact, a multifactorial disorder a verbal short-term memory task imposing demands for
(Bishop, 2003). The language features of children with DLD storage only (Gathercole & Baddeley, 1990), research has
are heterogeneous and the characteristics of the disorder identified additional factors influencing nonword repetition
can overlap with other neurodevelopmental disorders and perhaps imposing a load on working memory (Bishop
(Bishop, 2017). et al., 1996; Graf Estes et al., 2007). Nevertheless, nonword
repetition is expected to minimize the role of prior language
A number of studies have reported deficits in two
knowledge and experience given the use of phonological
aspects of immediate memory in DLD: verbal short-term
forms novel to all participants.
memory and working memory (Archibald & Gathercole,
2006a; Henry et al., 2012). Short-term memory tasks engage Accumulated evidence from ELL studies of nonword
temporary storage; verbal versions require serial recall repetition, however, shows that even previous sublexical
of words, letters, or digits, whereas visuospatial versions phonological knowledge and experience can influence
involve recall of visual patterns or sequences of movement children’s performance. For example, Kohnert et al.

(2006) found that the performance of TD ELLs and On the other hand, higher immediate memory scores
monolingual English-speakers with DLD did not differ in bilingual groups have been reported in several studies.
on an English nonword repetition task. Sensitivity and Broadly speaking, bilingualism is associated with increased
specificity calculations for the English nonword repetition cognitive abilities, including working memory, as reported
task, however, indicated that such a task was useful for in a meta-analysis study (Adesope et al., 2010; but see
ruling out children with DLD in the ELL group but not for Engel de Abreu, 2011). For instance, Blom et al. (2014)
identifying them. In the case of TD children, Engel de found that when controlling for socioeconomic status and
Abreu et al. (2013) similarly reported an advantage for vocabulary, 68 bilingual Turkish–Dutch children showed
monolingual over bilingual children on nonword but not cognitive advantage in verbal working memory compared
number-based repetition tasks. The researchers suggested to 52 monolingual controls. Moreover, Morales et al. (2013)
that the digits represented highly frequent lexical stimuli of reported a bilingual advantage on working memory tasks in
equal familiarity to all school-age children, eliminating any two studies. The first study found that 27 ELL 5-year-olds
advantage of language familiarity. In summary, although the from diverse language backgrounds outperformed 29
nonword repetition task is considered a less biased form of of their monolingual peers in executive functioning tasks
assessment than knowledge-based measures (Paradis et that manipulated different working memory demands.
al., 2013), nonword repetition does not completely eliminate In the second study, 62 ELLs (5- and 7-year-olds) from
the effect of children’s experience with the target language diverse language backgrounds outperformed 62 of
(Kohnert et al., 2006). their monolingual peers on visuospatial span tasks that
manipulated different executive function components.
The majority of research comparing ELLs with Nevertheless, findings of equivalent performance by 22
monolingual children with DLD on processing-dependent TD ELLs (Spanish–English-speaking) and 28 monolinguals
measures has focused on nonword repetition measures, with DLD on a task involving judging the veracity of a
and few studies have used different verbal short-term and sentence while retaining the final word (Kohnert et al., 2006)
complex memory measures. For example, Boerma and suggested that some verbal working memory tasks could
Blom (2020) and Blom and Boerma (2017) compared the be influenced by previous language experience (Kohnert,
performance of monolingual and bilingual children with 2010). The present study employed both highly familiar and
DLD to TD peers on verbal short-term and working memory unfamiliar verbal stimuli as well as verbal and visuospatial
tasks. The results indicated that monolingual and bilingual stimuli in immediate memory tasks to evaluate group
children with DLD had lower performance on verbal short- differences associated with a range of processing demands.
term and working memory tasks than their bilingual TD
peers. Moreover, Cockcroft (2016) compared 67 English In any consideration of bilingual development, the
monolingual and 53 bilingual Grade 1 students whose first specific languages being learned must be considered.
language was an African language (isiZulu or isiXhosa), and The present study was concerned with the development
who were educated at English schools, on verbal short-term of Arabic–English learners. Arabic is a Semitic language
and verbal working memory tasks. The study reported that with a nonconcatenative morphology. The morphology,
there were no group differences on any measures of working phonology, and orthography of Semitic languages are
memory. Engel de Abreu (2011) compared the performance distinct from Indo-European languages such as English.
of 22 simultaneous bilingual children (Luxembourgish and Arabic has 28 consonants and six vowels. Arabic is a root
one other European language) and 22 Luxembourgish and pattern language with complex interaction between
monolingual peers on verbal short-term and verbal working syntax, morphology, and phonology. Word roots mostly
memory tasks. When controlling for expressive vocabulary, consist of three consonants that represent the lexical
no significant differences were observed between the 6- to meaning (triliteral root; Beeston, 1970), and the pattern is
8-year-old monolinguals and bilinguals on verbal short- primarily composed of vowels inserted between the root
term and verbal working memory tasks. Similarly, Engel consonants. The roots carry a semantic meaning shared to
de Abreu et al. (2013) compared 7-year-old Portuguese- various degrees by the derivative words associated with the
speaking language minority children from Luxembourg same root (Bakalla, 1979). Moreover, the verbal inflection
to majority Portuguese-speaking children from Brazil and system of Arabic is relatively rich. Verbs are morphologically
multilingual children from Luxembourg. No difference was inflected for tense and mood, and the verb agrees with
found between the Portuguese-speaking language minority the subject for aspects of person (first, second, and third),
children and their majority language peers from Brazil and number (singular, dual, and plural), and gender (feminine
from Luxembourg on three of the four working memory and masculine; Bakalla, 1979). Arabic has many diverse
tasks administered. colloquial dialects across Arabic countries, and most
175 Volume 46, No 3, 2022
countries have their own dialect (Aljenaie, 2001). In general, from Saudi Arabia (Mage = 7;11, SD = 1.12; 139 males), and (c)
Arabic colloquial dialects are mutually intelligible, with few 52 monolingual Arabic-speaking children with DLD (A-DLD)
being mutually unintelligible (Al-Tamimi, 2011). from Saudi Arabia (Mage = 8;4, SD = 1.00; 19 males). The
two monolingual Arabic-speaking groups from this study
Only a few studies have focused on monolingual/ were drawn from a sample of 421 monolingual Arabic-
bilingual Arabic children, especially in regard to DLD. speaking children who participated in other completed
The epidemiological trends in language and cognitive studies (Balilah & Archibald, 2018). The language, nonverbal
development in Arabic-speaking children with DLD show intelligence, and maternal education measures administered
many parallels to those reported for other linguistic and in order to characterize the monolingual Arabic participants
cultural groups. For example, Abdalla and Crago (2008) overlap with previous studies (Balilah & Archibald, 2018).
found that Arabic-speaking children with DLD have a The current study included analysis of new working memory
specific difficulty with tense and subject-verb agreement measures as well as comparison to the ELL group who were
forms. Moreover, difficulty in repeating nonsense recruited for this study. All the children who participated in
phonological forms has been reported in Arabic-speaking this study ranged from Grade 1 to Grade 4 (i.e., children 6–9
children with DLD (Shaalan, 2010). Comparing Arabic- years of age). Children in the ELL group were recruited from a
speaking ELLs to monolingual Arabic children with DLD school providing instruction in both English and Arabic
is important in order to examine whether there are (n = 27) and from an extracurricular Arabic instruction class
group differences between these groups on processing- for children receiving regular schooling in English (n = 32).
dependent measures. Children in the Arabic-speaking samples were recruited
from 10 schools (5 male schools, 2 of which were public; 5
The present study compared the performance of
female, all public) in Saudi Arabia (Jeddah) based on a study
Arabic-speaking children (ELLs) with diverse language
invitation sent home (600 letters) to all parents of children
experiences on processing-dependent measures to that of
in the relevant grades. No group differences were found in
two monolingual peer groups: 1) typically developing Arabic-
gender distribution, χ² (2) = 2.964, p = .135, or age, F(3, 476) =
speaking children (A-TD), and 2) Arabic-speaking children
.608, p = .121. In addition, according to parental reports, none
with DLD (A-DLD). Given the shortcomings of knowledge-
of the children had been diagnosed with any neurological
based measures in differentiating the language performance
or psychological disorders such as hearing impairment or
profiles of children with DLD and ELL, it is important to
autism spectrum disorder.
examine whether there are group differences between
ELLs and children with underlying language impairment in Many research studies employ a clinical cutoff of 1 SD to
verbal short-term and working memory measures. At least identify children with DLD (e.g., Conti-Ramsden et al., 2001;
equivalent performance by ELL and A-TD groups, and higher Wiig et al., 1992). In our study, the following criteria were
scores by the ELL than the A-DLD groups was expected applied to identify which of the Arabic speaking children
on the processing-dependent immediate memory tasks. to include in the A-DLD group based on the norms from
However, this prediction was expected to be modified by our monolingual Arabic-speaking sample of 421 children
the verbal demands of the task, such that tasks with higher (Balilah & Archibald, 2018): (1) Scores of at least 1 SD below
verbal demands (i.e., nonword repetition) would be less the mean on two of four language measures, including the
likely to differentiate the three groups than those with low three subtests of the Arabic Language Test (ALT; Shaalan,
verbal demands (i.e., digit recall) or no verbal demands (i.e., 2010) and the Arabic Picture Vocabulary Test (APVT; Shaalan,
visuospatial short-term or working memory tasks). 2010), and (2) a standard score not lower than 86 on the
Method Test of Nonverbal Intelligence (TONI-3; Brown et al., 1997). In
the APVT, a measure of receptive vocabulary, participants
Participants were shown four pictures and were then asked to indicate
Permission to conduct this study was granted by The which photo corresponded with a specific spoken word,
University of Western Ontario Research Ethics Board for with a maximum possible score of 132. High test–retest
Non-Medical Research Involving Human Subjects (number: reliability has been reported for the APVT, r = .97 (Shaalan,
103912). There were 480 children (Mage = 7;9, SD = 1.12; 2017). In the Sentence Comprehension subtest of the ALT,
187 males) participating in three groups in this study: (a) participants were shown three to four pictures and were then
59 unselected ELLs whose first language was Arabic and asked to indicate which picture corresponded with a specific
who were learning English as the language of instruction in spoken sentence. In the Expressive Language subtest of ALT,
Canada (Mage = 7;11, SD = 1.16; 29 males), (b) 369 typically participants were provided with a sentence and then they
developing monolingual Arabic-speaking children (A-TD) had to create a phrase or spoken word, while referencing

a picture cue. In the Sentence Repetition subtest of ALT, Materials and Procedure
participants listened to an audio recording that played The participants completed a variety of assessment
sentences read by a native, adult male Arabic speaker. The measures individually in a quiet room in their school over
participants were then asked to repeat the sentences. The 4 weekly sessions of approximately 40 minutes each. The
total number of correct responses was counted for each battery included the language and vocabulary measures
subtest, with a score of 40 being the maximum possible described above as well as processing-depending
score for the Sentence Comprehension subtest and 68 measures of verbal short-term and working memory
for the Expressive Language subtest. The 41 items of the (Arabic Nonword Repetition task [A-NWR], Shaalan, 2010;
Sentence Repetition subtest were scored on a 4-point scale Automated Working Memory Assessment [AWMA], Alloway,
(3 = correct; 2 = 1 error; 1 = 2–3 errors; 0 = 4 or more errors, 2007), and nonverbal intelligence (TONI-3, Brown et al.,
or no response), with a score of 123 being the maximum 1997). A fixed order was used to administer the tests so
possible score. High test–retest reliability had been reported that A-NWR was completed in Session 1, the ALT in Session
for the three subtests of the ALT (r = .95–.97; Shaalan, 2017). 2, the APVT and TONI-3 in Session, 3 and the AWMA in
Raw scores were converted to standard scores based on the Session 4. Other tasks not reported here were additionally
normative data available (Balilah & Archibald, 2018). Finally, completed across sessions. A trained native Arabic
in the TONI-3, a measure of general nonverbal cognitive speaker tested the children in the battery of assessment
abilities, children chose a picture to complete a visual measures. Parents completed a questionnaire at the time
pattern. Raw scores of the TONI-3 were converted to the of completing the study consent form.
standard scores based on published test norms.
Short-Term and Working Memory
Descriptive statistics for criterion measures for all groups
are displayed in Figure 1. Scores were significantly lower for Eight subtests from the AWMA (Alloway, 2007) were
the ELL and A-DLD groups than the A-TD group on both the administered. Measures of verbal short-term memory (Digit
AREVT and ALST (p < .001, all cases), whereas no significant Recall; Word Recall) required the immediate repetition
differences were found between the ELL and A-DLD groups of numbers or word forms. Measures of verbal working
(AREVT, p =.112; ALST, p = .158). memory (Counting Recall; Backwards Digit Recall) required
the recall of numbers after counting or reversing the
Figure 1
140
120
100
Standard Score
80
60
40
20
0
Arabic Language Test Arabic Picture Nonverbal intelligence
Vocabulary Test (TONI-3)
ELLs A-TD A-DLD
Standard scores for criterion measures for all groups.

Note. ELL = English language learners; A-TD = typically developing Arabic-speaking children; A-DLD = Arabic-speaking children with developmental language disorder.
TONI-3 = The Test of Nonverbal Intelligence. Error bars show standard errors, standard score (M = 100, SD = 15).
177 Volume 46, No 3, 2022
order, respectively. In addition, four visuospatial short- comparison, approximately 58% of the mothers had at
term and working memory subtests from the AWMA were least some college or university education in each of the
administered. Measures of visuospatial short-term memory monolingual groups.
(Dot Matrix; Block Recall) required the recall of locations.
Measures of visuospatial working memory (Odd One Out; In addition, parents of children in only the ELL group filled
Spatial Span) required the recall of locations or orientations out a questionnaire about their child’s language background
after identifying a different shape or mentally rotating an (Kaushanskaya et al., 2010). Parents were asked to provide
image, respectively. For the two monolingual Arabic groups, information about their child’s language immersion, history,
the AWMA was administered to each child using Arabic. For use, and the parent’s rating of their child’s current language
the ELL group, the AWMA was administered to each child abilities in each language (on a scale from 0 = none to 10 =
using the child’s preferred language (Arabic or English). Of perfect). All parents in the study reported that Arabic was
the participants, 70% preferred English and 30% preferred acquired by their children as a first language from birth.
Arabic. In order to ensure that AWMA was accurately Moreover, the parents indicated that their children began
transcribed into Arabic, three translations were performed: to be exposed to English, on average, at the age of 3;3
(1) The task was translated from English to Arabic by a (SD = 2.0, range = 8–96 months). Additionally, in terms of
native Arabic-speaker who did not work in the field; (2) The their child’s current language abilities—both speaking and
translated Arabic version of the task was then translated understanding—the parents rated their children as very
back into English by an expert who is a native English- good in Arabic (M = 8.00, SD = 2.03) and in English (M = 8.00;
speaker; and (3) The final check of the translation of the SD = 2.11). None of the parents reported that their child’s
task was done through a one-to-one matching of each item current speaking and understanding abilities were a 3 (low)
of the task by another native Arabic-speaker, and the final or lower in Arabic and English. Notably, the parents of six
version of the translation was written. participants did not indicate the time when their child was
first exposed to English. In addition, complete data were
One additional verbal short-term memory task was available for all but three children from the ELL group who
administered, the A-NWR (Shaalan, 2010). In the A-NWR, did not complete all the Arabic language tasks.
participants listened to an audio recording that played
nonwords read by a native, adult male Arabic speaker. Results
The participants were then asked to repeat the nonwords. Verbal Short-Term and Working Memory
Items taken from Shaalan (2010) included 48 nonwords of
Figure 2 provides standard scores for the Verbal Short-
different lengths (two to three syllables) and cluster type
Term and Working Memory subtests of the AWMA (Digit
(no cluster, medial cluster, final cluster, and medial and
Recall, Word Recall, Counting Recall, and Backwards Digit
final clusters). Each participant answer was ranked online
Recall) and the A-NWR task for the three groups: ELL, A-TD,
as either incorrect or correct by a trained research assistant
and A-DLD. The performance of the A-DLD group was lower
with a maximum possible score of 48. For all the subtests
than the A-TD and ELL groups on all measures, whereas the
of AWMA and the A-NWR task, raw scores were converted
performance of the ELL group was similar to, or numerically
to standard scores based on the normative data (see also,
higher than, the A-TD group (except on the nonword
Balilah & Archibald, 2018).
repetition task, A-NWR).
Parent Questionnaire In order to compare the performance of the ELL, A-TD,
The parent questionnaire included questions related and A-DLD groups on the verbal short-term and working
to maternal level of education. In this study, we used memory subtests of AWMA, a multivariate analysis of
maternal level of education as a proxy for socioeconomic variance was completed on the standard scores of the
status. Parents were asked to check the highest level of verbal short-term and working memory measures (A-NWR,
education attained by the child’s mother. The descriptors Digit Recall, Word Recall, Counting Recall, and Backwards
included some high school, completed high school, some Digit Recall). Between-group analyses indicated that there
college, completed college (2 years), some university, was a significant group effect: Hotelling’s T, F(10, 938) = 8.19,
and completed university (4 years or more). Responses p < .001, η2p = .080. Significant group effects were observed
were transposed to a 3-point scale with 1 corresponding in univariate comparisons for Digit Recall, F(2,474) = 12.91,
to some/completed high school, 2 to some/completed p < .001, η2p = .052, Word Recall, F(2,474) = 13.97, p < .001,
college, and 3 to some/completed university. By parent η2p = .056, Backwards Digit Recall, F(2,474) = 5.51, p < .001,
report, approximately 80% of mothers had at least η2p = .023, A-NWR, F(2,474) = 20.67, p < .001, η2p = .080, but
some college or university education in the ELL group. In not for Counting Recall, F(2,468) = 2.63, p = 0.073.

Figure 2
140
120
100
Standard Score 80
60
40
20
0
on
l
l
al
al
al
al
ec
ec
ec
ec
iti
et
R
R
R
ep
g
d
it
it
ig
ig
or
in
R
D
D
nt
W
d
ou
ds
or
w
C
ar
on
w
ck
-N
Ba
ic
ab
Ar
ELLs A-TD A-DLD
Standard scores on the Verbal Short-Term and Working Memory subtests of the Automated Working Memory Assessment
(AWMA) and the Arabic Nonword Repetition task (A-NWR).
Error bars show standard errors, standard score (M = 100, SD = 15).
Pairwise comparisons of the significant AWMA subtests memory subtests of AWMA, a multivariate analysis of
revealed significantly higher scores for the ELL group variance was completed on the standard score of the
compared to the A-TD group on the Digit Recall subtest only visuospatial short-term and working memory subtests of
(p = .007; all remaining cases: p = 1.000). The A-DLD group, AWMA (Dot Matrix, Block Recall, Odd One Out, and Spatial
on the other hand, had significantly lower scores than either Span). The results revealed no significant group effect:
the A-TD groups (in all cases, p < .001; except for Counting Hotelling’s T, F(8, 946) = 1.628, p = .113. It should be noted
Recall, p = .068) and ELL groups (in all cases, p < .001; except that in a corresponding analysis of covariance with maternal
for Counting Recall, p = .273). For the A-NWR task, however, education as a covariate the result was unchanged.
the ELL and A-DLD groups had significantly lower scores
than the A-TD groups (p = .001), and there was no significant Discussion
difference between the ELL and A-DLD groups (p = 1.000). This study compared the performance of Arabic-
It should be noted that in the corresponding analysis of speaking ELLs with diverse language experiences on
covariance with maternal education as a covariate, the processing-dependent measures to two monolingual peer
same pattern of results was observed for all the verbal groups: typically developing A-TD children and A-DLD
short-term and working memory measures. children. The primary objective of this study was to compare
ELLs and monolingual peers with and without DLD on
Visuospatial Short-Term and Working Memory processing-dependent measures (short-term and working
Figure 3 provides standard scores for the visuospatial memory measures). On the Arabic measures (vocabulary
short-term and working memory subtests of the AWMA (Dot and language), the ELL group scored significantly more
Matrix, Block Recall, Odd One Out, and Spatial Span) for the poorly than the A-TD group and did not differ from the
three groups: ELL, A-TD, and A-DLD. The three groups had A-DLD group (see Figure 1). On the processing-dependent
almost identical performance on all visuospatial short-term measures, however, no differences were found between
and working memory subtests. the ELL and A-TD groups on the short-term and working
memory measures (see Figure 2 and 3), with the exception
To compare the performance of the ELL, A-TD, and of the Arabic nonword repetition and counting recall tasks.
A-DLD groups on the visuospatial short-term and working The performance of the ELL group on the Arabic nonword
179 Volume 46, No 3, 2022
Figure 3
140
120
100
Standard Score
80
60
40
20
0
Dot Matrix Block Recall Odd One Out Spatial Span
ELLs A-TD A-DLD
Standard scores of the Visuospatial Short-Term and Working Memory subtests of the Automated Working Memory
Assessment (AWMA)
Error bars show standard errors, standard score (M = 100, SD = 15).
repetition task was comparable to that of the A-DLD group addition to two verbal short-term subtests of the AWMA
and significantly lower than the A-TD group. Interestingly, (Digit Recall and Word Recall), may be viable options for
the ELL group scored significantly higher than the A-TD and reducing assessment bias in ELLs.
A-DLD groups on only one number-based verbal short-term
memory measure (Digit Recall). Importantly, the results of the verbal short-term and
working memory measures in this study are consistent with
On all the verbal memory tasks tapping short-term and previous evidence suggesting that the nature of the verbal
working memory (with the exception of Arabic Nonword stimuli involved in verbal short-term and working memory
Repetition), the performance of the ELL group was tasks possibly account for the considerable difference
comparable to the A-TD group, whereas the performance observed in the ELLs’ performance. There were group
of the A-DLD group was lower than the A-TD and ELL groups differences between the ELLs and A-DLD groups on verbal
on the majority of these measures (with the exception of short-term and working memory measures in this study
Counting Recall). These results, on the whole, are consistent that involved the recall of highly familiar lexical stimuli, such
with previous evidence suggesting that processing- as number words and basic words. These tasks involve
dependent measures in ELLs are less sensitive to familiar lexical stimuli that are generally acquired at an early
differences in language experience than knowledge-based age by ELLs in both their first and second languages, and
measures (Blom & Boerma, 2017; Engel de Abreu et al., that may be equally familiar to all children and less affected
2013; Wealer & Engel de Abreu, 2021). The present findings by verbal long-term memory (Engel de Abreu et al., 2013;
regarding the reduced performance of the A-DLD group but Wealer & Engel de Abreu, 2021). On the other hand, because
not the ELL group on the majority of the verbal short-term nonword repetition tasks involve unfamiliar phonological
and working memory subtests suggests that processing- forms, it has been suggested that children’s performance
dependent rather than knowledge-based measures may on these tasks relies on long-term phonological and lexico-
hold promise for differentiating between children with DLD semantic knowledge (Engel de Abreu et al., 2013). Indeed,
and ELLs. A critical finding here is that the current study the findings add to the growing body of evidence indicating
adds to the literature by showing that one verbal working that phonological structure and language experience
memory subtest of the AWMA (Backwards Digit Recall), in impact ELLs’ performance on nonword repetition tasks

(Kohnert et al., 2006; Shaalan, 2010; Windsor et al., 2010). may have differed across the monolingual and ELL groups.
Unlike nonword repetition, therefore, verbal short-term Nevertheless, the impact of this variation on the current
and working memory tasks involving familiar lexical stimuli findings may have been limited. The Arabic language skills
may be sensitive to the underlying differences between of the ELL group were weaker than those of the typically
children with DLD and ELLs. Such measures may assist developing monolingual speakers. It is possible that this
in differentiating language difference from language gap was overestimated in our sample, however, the large
impairment. Moreover, the results indicated that not all effect (8–14 standard score points on average) suggests a
processing-dependent measures are equally effective true group difference especially in light of the lack of group
in reducing the role of prior knowledge or experience in differences on the majority of processing-dependent
ELLs. Searching for effective assessment measures in measures. Certainly, as Arabic-speaking children use the
ELLs requires careful choice among verbal short-term and colloquial dialect in their daily oral communication, language
working memory measures. assessment measures should address the acquisition of
the colloquial dialect (Al-Tamimi, 2011). Unfortunately, there
The ELL group in this study scored significantly higher are no available assessment measures in the majority of
than the A-TD group on only the Digit Recall measure of Arabic colloquial dialects. In this study, dialectical variations
verbal short-term memory. Although consistent with other were matched with the participants’ spoken output and
studies suggesting a bilingual advantage on working memory commonly observed variations were considered correct.
tasks (Blom et al., 2014; Morales et al., 2013; but see Engel Future studies could examine the effects of dialectical
de Abreu, 2011), the lack of a consistent advantage across variations in greater detail. Another limitation of the study is
a range of measures weakens the finding. In fact, there was that the examiners administered the AWMA to each child
no group effect observed for another number-based task using the child’s preferred language (Arabic or English).
involving counting, Counting Recall. Although unexpected Evaluating children’s language skills by administering tests
based on previous findings (Engel de Abreu, 2011), the in one language can be more convenient. Unfortunately,
consistent group effects over multiple measures in the evidence of parallel forms for the English and Arabic
present study provide stronger evidence of a difference immediate memory measures was unavailable. Future
between the ELL and A-DLD groups on these tasks. studies should assess the impact of administration
processing-dependent measures in two different languages.
Finally, the ELL group in this study did not differ from their
monolingual peers (A-TD and A-DLD) on all visuospatial
Conclusion and Future Directions
short-term and working memory subtests (see Figure
3). Neither, however, did the A-DLD group. As a result, In this study, the performance of 6- to 9-year-old ELLs
performance on the visuospatial immediate memory whose first language was Arabic and who had been learning
groups did not differentiate the ELL and DLD groups in the English as the language of instruction in Canada was
present study. This finding is in line with evidence suggesting compared to two monolingual groups: typically developing
relative visuospatial processing strengths in children with Arabic-speaking children and Arabic-speaking children with
DLD (Archibald & Gathercole, 2006b). As such, these results DLD, on processing-dependent measures of short-term
provide substantial evidence that the immediate memory and working memory. The primary objective of this study
deficit in Arabic-speaking children with DLD primarily was to compare ELLs with diverse language experiences
involves the verbal domain, a suggestion consistent and monolingual peers with and without DLD on processing-
with observations for monolingual English DLD speakers dependent measures (short-term and working memory
(Archibald & Gathercole, 2006a, 2006b). measures). With the exception of the Arabic nonword
repetition task, the performance of the ELL group was
Study Limitations comparable to the A-TD group on all the verbal short-term
and working memory subtests, whereas the performance of
The performance of monolingual Arabic children from
the A-DLD group was lower than the A-TD and ELL groups on
Saudi Arabia was compared to Arabic-English speakers
these tasks.
from Canada in the present study. It must be assumed that
significant cultural differences exist across these groups, The findings of this study suggest that tasks that focusing
which could have impacted performance on the study on the cognitive processes that underlie language learning
tasks. Importantly, monolingual Arabic-speaking school- rather than children’s opportunities or experiences with the
age children do not exist in Canada, necessitating the test language may provide a more accurate representation
recruitment of a sample from an Arabic-majority country. of ELLs’ linguistic abilities. However, it is clear from the
Arabic, however, has a number of colloquial dialects, which verbal short-term and working memory results in this
181 Volume 46, No 3, 2022
study that not all processing-dependent measures are Archibald, L. M. D., & Gathercole, S. E. (2006a). Short-term and working
memory in specific language impairment. International Journal of
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Balilah, A., & Archibald, L. (2018). The measurement of language ability and impairment
lexical stimuli may help distinguish ELLs from children with in Arabic-speaking children. In S. Hidri (Ed.), Revisiting the assessment of second
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Author’s Note
Correspondence concerning this article should be
addressed to Dr. Lisa Archibald, School of Communication
Sciences and Disorders, Elborn College, Western University,
London, Ontario, Canada, N6G 1H1. Email: larchiba@uwo.ca
Acknowledgements
The first author of this study received funding from
King Abdulaziz University, Saudi Arabia. The second author
received a Discovery Grant from the Natural Sciences and
Engineering Research Council, Canada.
Disclosures
declared by the authors.

MLU OF FIRST NATIONS CHILDREN Canadian Journal of Speech-Language Pathology and Audiology (CJSLPA)
Mean Length of Utterance and Use of Subordination Among

First Nations School-Aged Children
Longueur moyenne des énoncés et emploi de subordonnées

chez les enfants d’âge scolaire des Premières Nations
Patricia Hart Blundon

KEYWORDS
FIRST NATIONS ENGLISH
SCHOOL-AGED
MEAN LENGTH OF
UTTERANCE
SUBORDINATE CLAUSES
Patricia Hart Blundon
University of Victoria, Victoria,

BC, CANADA
Abstract
Many First Nations children speak a variety (i.e., dialect) of English. Grammar distinctions related to
their variety may affect their Mean Length of Utterance. Also, anecdotal observations suggest that
such students may use fewer subordinate clauses as a feature of their variety, further affecting their
utterance length. Because utterance length and subordination rates are used along with standardized
tests to determine if a child presents with a language disorder, children who speak varieties might
be pathologized unnecessarily if speech-language pathologists are not aware of these differences.
Also, because it is unknown how utterance length typically changes through the grades, it is difficult
for educational professionals to determine whether a child is developing language as expected or
needs specialized support. This study aimed to investigate the Mean Length of Utterance of and use
of subordination by children who spoke a variety. Ten children in Grades 1 to 6 were asked to retell
a story. As predicted, the analysis indicated that their Mean Length of Utterance was shorter than
that obtained from peers who spoke more standard English, likely related to varietal differences. The
analysis also indicated they used fewer subordinate clauses and that this style preference was also
Editor: likely a feature of their variety. Analysis of 15 students’ Mean Length of Utterance in video-tell/retell
Lisa Archibald
language samples showed that it increased from Kindergarten to Grade 7. This study cautions the
Editor-in-Chief: use of Mean Length of Utterance and Subordination Index scores normed on standard English to
David H. McFarland
understand the development of variety English.
185 Volume 46, No 3, 2022
Revue canadienne d’orthophonie et d’audiologie (RCOA) MLU OF FIRST NATIONS CHILDREN
Abrégé
De nombreux enfants des Premières Nations parlent une variante (c.-à-d. un dialecte) de l’anglais.
Les distinctions grammaticales associées aux variantes parlées par les enfants des Premières
Nations pourraient avoir un effet sur la longueur moyenne des énoncés. De plus, des observations
anecdotiques suggèrent que ces élèves pourraient avoir moins souvent recours à des subordonnées,
une caractéristique spécifique à leurs variantes qui affecterait d’autant plus la longueur de leurs
énoncés. Puisque la longueur moyenne des énoncés et le nombre de subordonnées par phrase sont
des informations complémentaires aux tests standardisés et que ces mesures sont fréquemment
utilisées pour déterminer la présence d’un trouble du langage, il est possible que les enfants parlant
des variantes de l’anglais se voient inutilement attribuer un trouble par des orthophonistes n’ayant
pas conscience des différences entre l’anglais standard et ses variantes. De plus, comme aucune
information concernant l’évolution de la longueur des énoncés d’une année scolaire à l’autre n’est
disponible pour les enfants parlant une variante de l’anglais, il est difficile pour les professionnels de
l’éducation de déterminer si le développement du langage d’un enfant se situe dans les limites de la
normale et si un enfant a besoin d’un soutien spécialisé. La présente étude visait ainsi à examiner la
longueur moyenne des énoncés et l’emploi de subordonnées chez les enfants parlant une variante
de l’anglais. Il a été demandé à 10 enfants d’âge scolaire (entre la première et la sixième année)
de raconter une histoire qu’on leur avait précédemment présentée par vidéo. Conformément
aux prédictions, les résultats de cette analyse ont révélé que les enfants des Premières Nations
avaient des longueurs moyennes des énoncés plus courtes que leurs pairs parlant un anglais plus
standard, ce qui est probablement lié aux différences spécifiques de leur variante. Les résultats de
cette analyse ont également indiqué que les enfants des Premières Nations employaient moins de
subordonnées, suggérant que cette préférence stylistique est une caractéristique de leur variante.
De plus, les longueurs moyennes des énoncés de 15 élèves ont été calculées à partir d’échantillons
de discours recueillis dans une tâche où les enfants étaient invités à raconter une histoire leur ayant
été précédemment présentée par vidéo. Les résultats de cette analyse ont indiqué que la longueur
des énoncés augmentait de la maternelle à la 7e année. Les résultats de la présente étude invitent
à faire preuve de précaution lors de l’utilisation de normes s’appuyant sur l’anglais standard pour
comprendre le développement du langage des enfants parlant une variante de l’anglais à l’aide de la
longueur moyenne des énoncés et du nombre de subordonnées par phrase.

Among scholars of language variation, it is broadly “standardizes the process of eliciting, transcribing, and
accepted that children who speak varieties may be at an analyzing language samples. It includes a transcription
educational disadvantage (see, for example, Fletcher, editor, standard reports, and reference databases for
1983, for English as spoken by “American Indians”; Gatlin comparison with typical peers” (SALT, 2019, About Us
& Wanzek, 2015; Labov, 1982, 2003; Rickford & Rickford, section, para. 1). SALT (Miller & Iglesias, 2012) segments
1995, on African American language and other varieties in utterances by communication unit and can calculate
the United States; Malcolm, 2007, on Australian Aboriginal mean utterance length in words and morphemes. Rather
English). Differences in pronunciation (Labov, 2003), than referring to these measures as mean length of
grammar (Siegel, 2010), and vocabulary (Charity Hudley & communication unit in words and morphemes, SALT uses
Mallinson, 2011) can affect literacy development (N. P. Terry MLU in words and morphemes. SALT software was used to
et al., 2010) and learning in math and science (J. M. Terry et analyze the language samples collected for this study.
al., 2015). Cultural differences in the way language is used
can lead to teacher and student misunderstandings and Speech-language pathologists also use MLU and mean
change teacher perspectives about students, which may length of communication unit for evaluation purposes
negatively influence academic outcomes (Siegel, 2010). because they are associated with age and grade (Brown,
Teachers’ lack of understanding about varieties may cause 1973; Loban, 1976). Speech-language pathologists might
them to underestimate children’s abilities (Mallinson & use MLU as a criterion-referenced method of assessment,
Charity Hudley, 2017). Moreover, the use of assessment along with other methods such as standardized tests,
tools designed for speakers of standard varieties can result to decide whether a child’s expressive language is
in unnecessary pathologization and ineffective pedagogical developmentally typical (i.e., MLU or mean length of
approaches (Baugh, 2015; Crago & Westernoff, 1997). communication unit falls within a predicted age range) or
is disordered (i.e., MLU or mean length of communication
The Mean Length of Utterance (MLU) metric is one of unit falls below the predicted age range; Miller et al., 2011).
the tools a speech-language pathologist might use to assess Because SALT provides comparison databases of MLU
language development. MLU is commonly measured by obtained from samples of typically developing children
calculating an average number of morphemes or words per in other locations in North America, speech-language
utterance in a language sample (Craig & Washington, 2006). pathologists can use SALT to help them decide whether
Brown (1973) used morphemes as his unit of measurement a child needs their specialized help. However, it lacks
when studying preschool children’s morphological and specificity and sensitivity measures regarding the accuracy
syntactic development. He created age-related stages of with which it predicts language disorder.
language development, with each age and stage associated
with a range of MLU. Loban (1976) used words when studying Pearce and Flanagan (2019) raised concerns about using
the language development of school-aged children from MLU as an assessment tool with students who may speak a
Grade 1 to 12. He segmented utterances into communication variety. Their study of narrative language samples produced
units; he defined a communication unit as an independent by typically developing Indigenous and non-Indigenous
clause and its modifiers. Once a sample was segmented Australian children in their first year of school found that
into communication units, Loban calculated the length of Indigenous students’ sentence length was significantly
each utterance in words and an average mean length of shorter than that of non-Indigenous students. They
communication unit for the sample. Just as Brown found that suggested that their shorter MLU may be related, in part, to
an increased MLU was associated with increased language factors associated with their Australian Aboriginal English
development and age for preschoolers, Loban found that variety, such as less frequent use of subordinate clauses.
an increased mean length of communication unit was The use of MLU to assess First Nations students living
associated with increased language development, syntactic in Canada may also be questionable because there is
complexity, and school grade level. increasing consensus that many children of First Nations
MLU remains an effective measure to match peers for ancestry may also speak a variety of English (Ball &
language complexity for research (Craig & Washington, Bernhardt, 2008; Battisti et al., 2014; Epstein & Xu, 2003;
2006). Researchers also use MLU segmentation rules to Eriks-Brophy, 2014; Genee & Stigter, 2010; Hart Blundon,
count utterances in a standardized way. For instance, Van 2016; Heit & Blair, 1993; Kay-Raining Bird, 2014; Peltier, 2009;
Hofwegen and Wolfram (2010) segmented utterances into Sterzuk, 2011; Toohey, 1986; Wawrykow, 2011; Wiltse, 2011).
communication units when studying children’s African Toohey (1986) was one of the first scholars to propose
American language. They used the Systematic Analysis the existence of First Nations English varieties. Reviewing
of Language Transcripts (SALT) software to do so. SALT the work of researchers of Native American Englishes, she
187 Volume 46, No 3, 2022
noted that Canadian educators also assumed that many language. While this author’s anecdotal observations
First Nations children spoke distinct varieties of English. suggested that MLU did increase over time, the language
She cited the British Columbia’s Ministry of Education’s development of children who speak varieties has not
reference to “Indian English” in their “Language Arts for been studied in any systematic way. Lack of information
Native Indian Students” resource book as evidence of this about how their language changes provides a problem
assumption (Toohey, 1986, p. 134). Epstein and Xu (2003), for educators and educational professionals; it is difficult
Heit and Blair (1993), and Sterzuk (2011) listed differences to determine whether a child is developing language as
in pronunciation, spelling, grammar, and discourse patterns expected or requires specialized support.
that they observed being used by children in Saskatchewan.
Peltier (2008), a First Nations speech-language pathologist, This present study was undertaken to begin to address
provided observations regarding what she thought were these gaps in knowledge. It was part of a larger exploratory
pronunciation, conceptual, and grammatical features study of the First Nations English variety spoken by children
of her Nation’s variety in Northern Ontario. Genee and in a school in Northern British Columbia (Hart Blundon,
Stigter (2010) listed grammatical features that appeared 2019). In the larger study, Hart Blundon (2019, 2022) first
in the writing of Blackfoot Elders and college students in documented the presence of at least 23 grammatical
Alberta. Ball and Bernhardt (2008) summarized potential features appearing in oral narratives by retrospectively
morphological, syntactical, and phonological features analyzing kindergarten samples collected for speech-
based on anecdotal reports from participants of a First language pathology purposes. Then, using a cohort
Nations English forum held in British Columbia. Wawrykow sequential design, Hart Blundon (2019) found that children
(2011) observed that many of her First Nations students used features at high rates at school entry, lower rates in
on Vancouver Island in British Columbia did not often use Grade 3 and 4, and increased rates as they entered middle
conjunctions, which are used to form complex sentences. school. Features that appeared in their oral language also
appeared in their writing. The larger exploratory study
Hart Blundon’s (2019, 2022) research supported the concluded with an investigation of the student’s MLU, their
anecdotal observations of Canadian scholars, namely that use of subordination, and the change in their MLU over
many First Nations children who attended a school in a small grades. This latter study is the focus of this paper.
town in Northern British Columbia spoke an English variety. At
least 23 grammatical features characterized their variety (see The author’s questions were:
Appendix). For example, children did not always include the • Do school-aged children who speak a variety of English
copula or auxiliary in their speech (e.g., “They ___ waiting”), or have a different MLU than those of age-matched peers
they did not always produce final <ed> audibly when forming who speak a more standard variety of English?
past tense (e.g., “He look there yesterday”). Distinctions such
as these could lower a student’s MLU. At the same time, • Do these children use subordination of clauses less
words not typically included in standard Canadian English frequently than age-matched peers who speak a more
might be included in their variety (e.g., use of “then here” standard variety?
instead of “then”). A distinction such as this would result in a
higher MLU score because of the word “here.” • How does the children’s MLU change as they advance
through the grades?
Hart Blundon (2019, 2022) also observed that
children tended to speak in single-clause sentences, or Given Hart Blundon’s (2019, 2022) observations, it was
they tended to “string” single clauses together to form hypothesized that the MLU of First Nations students who
multiclause sentences (e.g., “And then they come out then spoke a variety would likely be shorter than the MLU of
help and sit down and have more apples”) rather than children who spoke a more standard variety, owing to word
use subordination and embedding (e.g., “The bull, who and morphemes omissions. It was also hypothesized that
helped the girl out of the water, sat down with her and the students used fewer subordinate clauses as a feature
shared some apples”). Their lack of complex sentence of a variety rather than as an indicator of language disorder.
construction appeared to be related to style preference Finally, it was hypothesized that children did develop their
and a feature of their variety rather than an indicator of language over time.
language disorder. A tendency to avoid complex sentence
Positioning the Researcher
constructions could also affect MLU.
When researchers study issues that affect First Nations
Currently, there is no information regarding how children people, they must position themselves so their biases
who speak First Nations English varieties develop their are transparent. The author is a non-Indigenous speech-

language pathologist who was raised in a white middle-class English as a second dialect (British Columbia Ministry of
home in New Brunswick, Canada. While never experiencing Education, 2021) in her role as speech-language pathology
racial discrimination, the author’s Maritime accent has been consultant. The author had designated these students
judged, which may explain the author’s interest in varieties. per British Columbia Ministry of Education guidelines that
Indigenous research methodology was used in this study, defined English as a second dialect students as those
such as personal contact with participants’ guardians and who “speak a dialect of English that differs significantly
community members, rather than written communication from Standard English used in school and in broader
alone. However, primarily Western methods of data Canadian society (i.e., significant variations in oral language
collection and analysis were applied. vocabulary and sentence structure from those used in
Standard English)” (British Columbia Ministry of Education,
Method 2021, p. 9). In British Columbia, English as a second dialect
After describing the study site and community students fall under the umbrella of English language
consultation, the methods used to address the research learners. Allocated funds are intended to be used by
questions are presented in the order in which data were districts to acquire resources to support students who
collected in the larger study carried out by Hart Blundon speak varieties to learn standard Canadian English. Most
(2019). Study 1 addresses the third research question and students designated are Indigenous.
Study 2 addresses the first and second research questions.
The learning resource teacher first mailed a letter asking
Study Site parents or guardians to permit the researcher to contact
them about the project. This third-party approach was
The study took place in a small school in Northern
intended to mitigate any pressure families might feel about
British Columbia. Due to potential negative stereotyping of
having their child participate, because the researcher was
this community’s unique way of speaking English, Elders
also speech-language pathologist consultant to the school.
and community members requested that the school
The school’s receptionist then made reminder phone calls
and community remain confidential. Thus, only limited
to families as necessary. Families of the 15 children who
information has been shared about it. The community has
gave their permission to be contacted were sent a letter
been fictitiously referred to as “Bigton” and the school,
and follow-up phone call, if necessary, that described the
“Bigton School.” This research received ethical approval
project, its goals, and intentions. All families who agreed to be
from the University of Victoria’s Human Research Ethics
contacted also agreed to allow their children to participate.
Board (Protocol Number 13-260).
Participants
Community Consultation
Fifteen participating students were in kindergarten to
Parents, the school district, and the Bigton community
Grade 5 at the onset of the 3-year study. They included
were consulted regularly both by in-person contact and
six typically developing students (NOSPED) and nine
written documents. Two Indigenous consultants helped
students who had received speech-language pathology
ensure that the project was carried out in ways that were
or special education services or designations (SPED). In
culturally safe and respectful of local protocols. Regular
British Columbia, students who are designated may fall into
presentations were made to numerous groups, including
the following categories: physically dependent; deafblind;
the Parent Advisory Council, Bigton School staff, the Bigton
moderate to profound intellectual disability; physical
community, the Band Council, and the committee that
disability or chronic health impairment; visual impairment;
oversees the Nation’s language and culture.
deaf or hard of hearing; autism spectrum disorder;
Study 1: Change in MLU as Children Advance Through the intensive behaviour intervention or serious mental illness;
Grades mild intellectual disabilities; learning disabilities; moderate
behaviour support or mental illness (British Columbia
To answer the research question, “How does MLU change
Ministry of Education, 2002). No students with a gifted
as children advance through the grades,” the oral narrative
designation participated in this study. Because the school
language samples collected to study the use of grammatical
was small with small class sizes, to protect their privacy and
features over grades in the larger exploratory study (Hart
as agreed upon with their parents, no further details will be
Blundon, 2019) were also used to calculate MLU over grades.
released concerning individual children such as their date
Recruitment of birth, gender, or details regarding their special education
designation or the support they needed in school. SPED
An attempt was made to recruit 27 Bigton School
students were included in the analysis because they
children whom the author had previously identified as
189 Volume 46, No 3, 2022
also speak dialects (Oetting et al., 2016). Also, because Each year, a different video was used to maintain student
some SPED students have language disorders, which are interest. Using a different video also mitigated potential
associated with shorter MLU and less use of subordination, practice effects that might reduce processing demands and
their data were analyzed separately to investigate whether thus enhance a child’s word fluency and sentence length
language disorder was a potential factor in their MLU and and complexity (see Dollaghan et al., 1990, on the language
use of subordination. effects of familiarity of videotaped events). Varying videos
also made it possible to determine whether grammatical
Experimental Design, Data Collection, Interrater patterns persisted in subsequent years under conditions
Reliability, and Statistical Analysis
of new vocabulary and new content. The persistence
A cohort sequential design was used (see Table 1 for the of grammatical patterns, despite changed conditions,
number of participants and a schematic of the research provided evidence that observed grammar differences
design). Narrative language samples were collected in May were features of a local variety of English (Wolfram & Adger,
and June each year for 3 years. Written samples were also 1993). While videos had been viewed previously by some
obtained, with the task order (i.e., oral-first or written-first) older participants, to the author’s knowledge, none had
being counterbalanced to control for carryover effects. Only been viewed more recently than 2.5 years before data
the analysis of oral samples is presented in this paper (see collection. Miller et al. (2011), experts in language sample
Hart Blundon, 2019, for details concerning the analysis of analysis, suggested that language sampling can be repeated
written samples). Witnessed child assent was obtained for sooner than the 6-months-to-1-year elapsed time usually
each sample. recommended for standardized testing. Thus, a 2.5-year
elapsed time further ensured a reduction in practice effects.
Three short videos were used to obtain narrative
language samples. These were Balloons (Kim, 2008; Year To collect oral samples, children were asked to watch
1), Fantasia Taurina (Pérez González, 2009; Year 2), and a video and then tell the author and researcher the story
Wasabi Guy (Ushko, 2013; Year 3). These videos were of what had happened. Because the aim of this research
selected because they had been particularly successful in was also to study the children’s use of features (see Hart
eliciting productive language samples for kindergarteners Blundon, 2019), including possible differences in verb tense,
(Hart Blundon, 2019, 2022). Two school principals had the children were also asked to tell the author what was
vetted the videos to ensure their appropriateness for use happening while watching the video and to predict what
with these school children. None of the videos featured would happen next. Elicitation protocols were also designed
Indigenous characters or themes. However, in the author’s to encourage the production of other forms identified
role as speech-language pathology consultant to the as characteristic of the local variety of English. These
school, children indicated that they were familiar with included the production of pronouns, articles, determiners,
non-Indigenous-themed YouTube videos. To mitigate any prepositions, plurals, possessive, negation, conjunctions, as
potential difficulties with unfamiliar vocabulary, students well as differences in the way utterances were constructed.
were trained on vocabulary items. A complete description
of elicitation protocols is available at Hart Blundon (2019). Instructions were placed on a table to use as a reference
but were not read. Instead, they were given orally to create
a relaxed, fun, familiar, natural, non-test-like atmosphere.
Table 1
They were rephrased or broken into smaller units depending
Experimental Design: Number of Participants on the child’s ability level and age. Additionally, in some
Grade Year 1 Year 2 Year 3 Total instances, comments like, “Now we’re going to do something
n n n special,” or “Look at me” were included to motivate the child
K 1 1 to continue or gain their attention. Some direct response
1 2 1 3 or conversation was used to establish rapport; otherwise,
comments and conversation were kept to a minimum.
2 4 2 1 7
3 3 4 1 8 Language samples were collected in a small office in
4 2 2 4 8 the school. Students were audio-recorded using a Sony
5 3 2 2 7 IC Recorder ICD-UX70 (recording format: MP3; sampling
frequency: 44.1 kHz; bit rate: 128 kbps; microphone
6 3 1 4
sensitivity set at a low level suitable for small spaces) that
7 3 3
was held approximately 46 cm from each child’s mouth.
Total 15 14 12 41
Note. K = kindergarten.

After completing SALT training, the author assessed her presence of groups with an n of 1 with 0 degrees of freedom.
ability to reliably code transcripts of the collected language Instead, Monte Carlo simulations were carried out to
samples with SALT conventions necessary to calculate MLU determine overall differences in the MLU between NOSPED
in words and morphemes by comparing her SALT-coded and SPED students.
transcripts with those of professional transcriptionists from
SALT Software. Word-by-word agreement on 2 of 15 (13.33%) Study 2: Exploration of MLU and Use of Subordination
transcripts collected in Year 1 was 93.35%, on 2 of 14 (14.69%) Study 2 was carried out to answer the first two research
collected in Year 2 was 93.94%, and 2 of 12 (16.67%) collected questions, “Do school-aged children who speak a variety
in Year 3 was 94.73%. Agreement on conventions needed to of English have a different MLU than those of age-matched
calculate MLU, including utterance segmentation, applicable peers who speak a more standard variety of English?”
SALT codes, identification of complete and intelligible and “Do children who speak a variety of English use
verbal utterances, and maze placement for Years 1, 2, and subordination of clauses less frequently than age-matched
3 was 87.85%, 88.71%, and 87.15%, respectively. Comparing peers who speak a more standard variety?”
the author’s transcription and coding to those of SALT
transcriptionists, the author was 97.64% and 98.23% accurate Participants
in calculating MLU in words and morphemes respectively for Ten children were randomly selected from the pool of
Year 1, 96.29% and 95.37% for Year 2, and 96.74% and 97.41% 15 students who participated in Study 1. Only 10 students
for Year 3. The author then used SALT scoring conventions to were selected to participate in this study to ease the
segment utterances and code orthographically transcribed demands on the other five students and still gather enough
language samples (Miller et al., 2011) and SALT to measure data to discuss trends. Data for one SPED student of the
MLU in words and morphemes. 10 participating students were removed from the analysis
because the student’s scores were more than 3.29 SD from
IBM SPSS descriptives and Microsoft Excel were used
students’ mean score in the comparison group (Tabachnick
for descriptive analyses of NOSPED, SPED, and all students
& Fidell, 2014). Five participants were NOSPED students,
(i.e., NOSPED and SPED students combined). Given the
and four were SPED students. Samples were collected in
small sample size, parametric tests were not used to
Year 2 of the cohort sequential study.
analyze results. Neither were nonparametric assessments
such as the Kruskal-Wallis assessment, which require a
Data Collection
minimum group size of five to be valid. Instead, Monte
Carlo assumption-free permutation analyses using R Students were asked to complete SALT’s narrative story
statistical software were used with 100,000 simulations retell task (Miller et al., 2011, pp. 197–204). The narrative
to generate a probability distribution (p). In addition, the story retell task was selected because SALT provided a
95% confidence limits for the mean of the simulated Subordination Index score and comparison groups for all
differences were calculated. participating students. A Canadian source, the Edmonton
Narrative Norms Instrument (ENNI; Schneider, Dubé, &
To determine whether changes in the dependent Hayward, 2005) was considered because it provided
variables MLU in words and morphemes between grades comparison groups for special education students. It was
were statistically significant, simulations were carried out not selected because it did not provide normative data for
for Grades 1 and 4 and Grades 4 and 7 for the dependent the older participants in this study or information on the rate
variables MLU in words and morphemes. Comparisons of use of subordination (Miller et al., 2011). In SALT’s narrative
for Grades 1 and 4 and Grades 4 and 7 were carried story retell task, the child listens to a story and then retells
out because observations for Grades 1, 4, and 7 were it while looking at illustrations in a version of the storybook
independent, whereas observations for comparisons of that does not contain text. This particular elicitation
other grades were not. In addition, Grade 1 can represent protocol was selected for this study because comparison
a mid-early elementary school grade, Grade 4 a mid-late groups for all participants’ grades are provided in the SALT
elementary school grade, and Grade 7 a mid-middle school database. Protocols were followed as outlined in Miller et al.
grade in British Columbia. Independent variables were (2011). For kindergarten and Grade 1 students, the author
Grade (1, 4, and 7). To assess whether there were significant followed administrative procedures outlined in Option 1 and
differences between NOSPED and SPED groups, Monte used a script rather than an audiotape of the story. Miller
Carlo simulations were carried out for Grade 1, 4, and 7 using et al. (2011) stated, “There are three options for eliciting the
R statistical software for dependent variables MLU in words samples. Use whatever option you prefer as they all elicit
and morphemes. Monte Carlo simulations could not be similar narratives” (p. 198). As in Study 1, language samples
completed for the interaction of grade by SPED due to the were collected in a small office in the school. Samples for
191 Volume 46, No 3, 2022
Study 2 were collected in the spring of Year 2 of the cohort assessment, SALT computer software was used to
sequential study, using the same recording techniques. calculate each participant’s Subordination Index score.
Then, the standard deviation of each participant’s result
Interrater Reliability and Statistical Analysis of MLU from the Subordination Index scores of age-matched
The author assessed her ability to reliably code peers was determined. Monte Carlo simulations were used
transcripts with SALT conventions needed to calculate to determine whether there were differences between
an MLU in words and morphemes by comparing her NOSPED and SPED students’ standard deviations from the
SALT-coded transcripts with those of professional mean of comparison groups.
transcriptionists from SALT Software (Miller & Iglesias,
Results
2012). Word-by-word agreement on 1 of 10 (10%)
transcripts was 91.47%. Agreement on conventions needed Study 1: Change in MLU as Children Advance Through the
to calculate MLU, including utterance segmentation, Grades
relevant SALT codes, identification of complete and Table 2 shows the mean, standard deviation, and
intelligible verbal utterances, and maze placement on 1 of sample size of MLU words and morphemes for Grades for
10 (10%) transcripts was 91.49%. Comparing the author’s NOSPED, SPED, and all students. Figures 1 and 2 illustrate
transcription and coding to SALT transcriptionists, the these data graphically. Table 2 and Figures 1 and 2 show
author was 97.66% and 97.70% accurate in calculating MLU that MLU in words and morphemes declined for all students
in words and morphemes, respectively. from kindergarten to Grade 1. There appeared to be a
levelling in MLU in words and morphemes between Grades
Upon completing reliability assessment, SALT
1 and 2, and then an increase from Grade 2 to Grade 5.
computer software was used to calculate MLU in words
Between Grades 5 and 6, there was a slight decrease in MLU
and morphemes for each participant. Then, replicating a
in words but a levelling in MLU in morphemes. A jump in
procedure that a speech-language pathologist might carry
MLU in words and morphemes occurred between Grades 6
out to help determine whether a student needed specialized
and 7. As for NOSPED and SPED students, the MLU in both
support, the standard deviation of each participant’s result
words and morphemes of NOSPED students appeared to
from the MLU of age-matched peers in SALT comparison
be longer than the MLU of SPED students from Grade 1 to
groups was determined. Comparison groups were comprised
3. From Grade 3 to 5, the two groups merged. Then, from
of “English-fluent” (Miller et al., 2011, p. 197) age-matched (+/-
Grade 4 to 7, the MLU of SPED students surpassed the MLU
6 months) students from Wisconsin and California. Students
of NOSPED students.
from Wisconsin came from homes representing a range of
socioeconomic statuses. They were typically developing as Monte Carlo analysis found that the null hypothesis
measured by their expected progress in school and absence that the observed difference of 0.62 between the means
of special education services. Students in California were of all students in Grades 1 and 4 for MLU in words could be
of average ability as per their performance in class and on produced by chance alone was accepted (p = .33), with a
standardized tests and their non-use of special education simulated mean of 0.49 with 95% confidence interval (CI;
services. They were balanced for “race, ethnicity, gender, and [0.03; 1.24]). That is to say, the MLU in words of all students
socioeconomic status” (Miller et al., 2011, p. 198). Monte Carlo in Grade 1 and Grade 4 was likely not different. Similarly, for
simulations were then used to determine whether there were MLU in morphemes, the null hypothesis that the observed
differences between NOSPED and SPED students’ standard difference of 0.63 between the means of all students for
deviations from the mean of their comparison groups. Grades 1 and 4 could be produced by chance alone was
accepted (p = .34), with a simulated mean of 0.52 with
Interrater Reliability and Statistical Analysis of Use of 95% CI [0.02; 1.31]. In other words, the MLU in morphemes
Subordination
of all students in Grades 1 and 4 was likely not different.
SALT’s Subordination Index scoring system was also However, for the difference between Grades 4 and 7,
applied to utterances in nine story retell language samples. Monte Carlo analysis found that the null hypothesis that
The Subordination Index produces a ratio of the total the observed difference of 2.07 between the means of
number of clauses to the total number of communication all students for MLU in words for Grades 4 and 7 could be
units (Miller et al., 2011). The author subsequently assessed produced by chance alone was rejected (p = .02), with a
her ability to reliably determine Subordination Index scores simulated mean of 0.74 with 95% CI [0.01; 1.88]. In other
by comparing her transcripts with those of transcriptionists words, the MLU in words of all students in Grades 4 and 7
from SALT Software. There was 100% agreement on 1 of 9 was likely different. Similarly, for MLU in morphemes, the null
(11%) transcripts. After completion of interrater reliability hypothesis that the observed difference of 2.60 between

Table 2
Descriptive Statistics for NOSPED, SPED, and All Students: Video Retell
Group MLUw SDw MLUm SDm n
Grade K
NOSPED 6.28 7.16 1
SPED
All students 6.28 7.16 1
Grade 1
NOSPED 6.21 0.19 7.01 0.25 2
SPED 5.79 6.70 1
All students 6.07 0.28 6.91 0.25 3
Grade 2
NOSPED 6.96 0.55 7.90 0.37 3
SPED 5.37 0.48 6.18 0.59 4
All students 6.05 0.97 6.92 1.03 7
Grade 3
NOSPED 6.64 1.15 7.36 1.26 2
SPED 6.53 0.94 7.42 0.91 6
All students 6.56 0.91 7.40 0.91 8
Grade 4
NOSPED 6.90 0.33 7.77 0.28 3
SPED 6.56 1.28 7.40 1.36 5
All students 6.69 1.00 7.54 1.06 8
Grade 5
NOSPED 7.52 1.23 8.48 1.23 3
SPED 7.36 1.45 8.33 1.52 4
All students 7.43 1.25 8.39 1.29 7
Grade 6
NOSPED 6.90 7.78 1
SPED 7.45 1.20 8.59 1.63 3
All students 7.31 1.02 8.39 1.39 4
Grade 7
NOSPED 8.35 9.84 1
SPED 8.96 1.21 10.30 1.10 2
All students 8.75 0.92 10.14 0.82 3
Note. NOSPED = typically developing students; SPED = students who required speech-language pathology and/or special education support; All students = total NOSPED and SPED students
combined; K = kindergarten; MLUw = mean length of utterance in words; MLUm = mean length of utterance in morphemes .
the means of all students for Grades 4 and 7 could be of NOSPED and SPED for MLU in words could be produced
produced by chance alone was rejected (p = .01), with a by chance alone was accepted (p = .84), with a simulated
simulated mean of 0.85 with 95% CI [0.03; 2.11]. In other mean of 0.57 with 95% CI [0.02; 1.47]; the MLU in words
words, the MLU in morphemes of all students in Grades 4 of the NOSPED and SPED groups was likely not different.
and 7 was likely different. The null hypothesis that the observed difference of 0.17
between the means of NOSPED and SPED for MLU in
Monte Carlo analysis showed that the null hypothesis morphemes could be produced by chance alone was
that the observed difference of 0.15 between the means accepted (p = .84), with a simulated mean of 0.65 with 95%
193 Volume 46, No 3, 2022
Figure 1 Figure 2
11 11
10 10
9 9
MLUm
MLUw
8 8
7 7
NOSPED
6 NOSPED SPED
6
SPED
All students All students
5 5
0 1 2 3 4 5 6 7 0 1 2 3 4 5 6 7
Grade Grade
Mean Length of Utterance in Words for NOSPED, SPED, Mean Length of Utterance in Morphemes for NOSPED,
and All Students by Grade: Video Retell SPED, and All Students by Grade: Video Retell
Note. MLUw = mean length of utterance in words; NOSPED = typically developing students; Note. MLUm = mean length of utterance in morphemes; NOSPED = typically developing
SPED = students with history of special education or speech-language pathology support; students; SPED = students with history of special education or speech-language pathology
All students = total NOSPED and SPED students. support; All students = total NOSPED and SPED students.
CI [0.03; 1.71]; the MLU in morphemes of the NOSPED and A Monte Carlo analysis showed that the null hypothesis
SPED groups was likely not different. that the observed difference of 0.30 between the average
standard deviation from the mean of comparison groups
In summary, the MLU for all students in Grades 1 and of NOSPED and SPED students’ MLU in words could be
4 was likely the same, whereas the MLU for all students in produced by chance alone was accepted (p = .55), with a
Grades 4 and 7 was likely different. As for the behaviour of simulated mean of 0.38 with 95% CI [0.02; 1.01]. That is to
NOSPED and SPED students, descriptive analysis indicated say, the mean standard deviation of the MLU in words of the
that in the early grades, the MLU of NOSPED students NOSPED and SPED groups was likely not different. Similarly,
exceeded the MLU of SPED students. In Grade 4, the two the null hypothesis that the observed difference of 0.27
groups performed similarly, but by Grade 7, the MLU of between the average standard deviation from the mean of
the SPED students appeared to surpass the MLU of the comparison groups of NOSPED and SPED students’ MLU in
NOSPED students. Overall, there was likely no difference morphemes could be produced by chance alone was also
between the NOSPED and SPED students. accepted (p = .60), with a simulated mean of 0.36 with 95%
CI [0.03; 0.95]. That is to say, the standard deviation of MLU in
Study 2: Exploration of MLU and Use of Subordination
morphemes of the NOSPED and SPED groups was likely not
Table 3 shows individual NOSPED (n = 5) and SPED (n different. In summary, contrary to what might be expected,
= 4) students' MLU in words and morphemes on the story the negatively skewed results obtained by the typically
retell task, the mean and standard deviation of the SALT developing students were like the SPED students’ results.
database comparison group, each participant’s standard
deviation from the SALT database comparison group Table 4 shows individual participant’s SALT
for both words and morphemes, and the n of the SALT Subordination Index scores; the mean, standard deviation,
comparison group. From an examination of Table 3, of the and n of the SALT database comparison group; and each
remaining nine participating students, the standard deviation participant’s standard deviation from the mean of the
of participating students’ MLU in words compared to SALT’s SALT comparison group for NOSPED students (n = 5) and
database of typically developing English-speaking students SPED students (n = 4). Table 4 shows that 33% (3 of 9) of
ranged from −0.39 to −2.43. The standard deviation of students’ Subordination Index scores were more than 1
students’ MLU in morphemes ranged from −0.32 to −2.26. In standard deviation below the mean of age-matched peers
summary, all participating children’s standard deviations of in SALT comparison groups. Twenty-two percent (2 of
their MLU in words and morphemes were negatively skewed 9) students obtained scores above the mean, while the
compared to the MLU’s of age-matched peers in SALT’s remaining 78% (7 of 9) obtained scores below the mean.
databases. This was the case regardless of whether students Thus, most scores appeared to be negatively skewed
had a history of receiving speech-language pathology or compared to the scores obtained by fluent speakers of
special education services or not. mainstream American English in SALT comparison groups.
This was the case for all students, including those with no
history of receiving special education services.

Table 3
Individual Students’ MLUs and Standard Deviations From Comparison Group Means; Comparison Group
Means, Standard Deviations, and Sizes: Story Retell
MLUw Mean (SD) of SD from CG MLUm Mean (SD) SD from CG
CG of CG CG n
Group NOSPED
7.35** 10.32 −2.05 8.14** 11.29 −2.01 83
(1.45) (1.57)
7.26** 10.59 −2.17 7.85** 11.63 −2.26 37

(1.54) (1.68)
9.19 9.72 −0.39 10.09 10.56 −0.32 46

(1.38) (1.49)
7.24* 8.24 −1.04 8.04* 9.26 −1.13 82

(0.96) (1.08)
6.68 7.66 −0.80 7.23 8.42 −0.88 58

(1.22) (1.36)
Group SPED
8.84 10.27 −0.98 9.60* 11.25 −1.04 91
(1.46) (1.60)
7.85* 10.30 −1.66 8.63* 11.28 −1.65 88

(1.47) (1.61)
5.72* 7.19 −1.29 6.40* 8.23 −1.42 24

(1.14) (1.29)
6.17** 8.37 −2.43 7.10** 9.42 −2.26 50

(0.90) (1.02)
Note. NOSPED = typically developing students; SPED = students who required speech-language pathology and/or special education support; MLUw = mean length of utterance in words; MLUm =
mean length of utterance in morphemes; CG = comparison group data from Systematic Analysis of Language Transcripts database using selection criteria of ± 6 months.
* At least 1 SD from CG mean. ** 2 SD or greater from CG mean.
A Monte Carlo analysis showed that the null hypothesis of clauses is likely not an indicator of language disorder. In
that the observed difference of 0.41 between the average fact, typically developing children used fewer subordinate
standard deviation from the mean of comparison groups clauses (mean standard deviation = −0.77) than the SPED
of NOSPED and SPED students’ Subordination Index students (mean standard deviation= −0.36) compared to
scores could be produced by chance alone was accepted age-matched peers in the SALT comparison groups.
(p = .40), with a simulated mean of 0.40 with 95% CI [0.01;
1.05]. That is to say, the mean standard deviation of the When comparing Table 3 to Table 4, sentence
Subordination Index score of the NOSPED and SPED complexity as measured by a Subordination Index score
groups was likely not different. was not as negatively discrepant as sentence complexity
measured by MLU in words and morphemes compared
These results suggest that students appeared to speak to SALT’s comparison groups. The explanation for the
in sentences that contained fewer subordinate clauses difference likely lies in the way the two metrics are calculated.
than those of mainstream fluent speakers of English who The Subordination Index measures the use of subordination,
live elsewhere in North America. Their less frequent use and MLU considers both the use of subordination and
195 Volume 46, No 3, 2022
Table 4
Individual Students’ Subordination Index Scores and Standard Deviations From Comparison Group
Means; Comparison Group Means, Standard Deviations, and Sizes: Story Retell
SI Mean (SD) CG SD from CG CG n
Group NOSPED
1.27* 1.51 (0.15) −1.56 83
1.29* 1.53 (0.20) −1.20 37
1.35 1.43 (0.12) −0.64 46
1.29 1.27 (0.12) 0.18 82
1.07 1.14 (0.10) −0.62 58
Group SPED
1.59 1.51 (0.16) 0.52 91
1.50 1.51 (0.16) −0.08 88
1.20 1.24 (0.11) −0.35 24
1.12 *
1.30 (0.12) −1.52 50
Note. SI = Subordination Index score; SALT = Systematic Analysis of Language Transcripts; CG = comparison group from SALT database using selection criteria of ± 6 months. NOSPED = typically
developing students; SPED = students who required speech-language pathology and/or special education support;
* At least 1 SD from CG mean.
the number of words used in grammatical structures. elsewhere in North America may be due at least in part to
Participating school children used less subordination and grammar differences between their variety of English and the
fewer words in their grammatical constructions. Therefore, standard English variety (e.g., the copula or auxiliary was not
it stands to reason that their MLU would be more negatively always included in their speech [e.g., “They ___ waitin’.”], final
discrepant than their Subordination Index scores. <ed> was not always included when forming past tense [e.g.,
“He look there yesterday.”], and so on).
In summary, participating students appeared to use
fewer sentences with subordination in their utterances than Additionally, the Subordination Index scores of students
are used by age-matched fluent speakers of mainstream appeared to be lower than scores obtained by age-matched
American English. Their MLU was even more discrepant than mainstream English-speaking peers in the United States,
the MLU obtained by age-matched peers who are fluent indicating that they used subordination less frequently.
speakers of mainstream American English in comparison This result supports the hypothesis that students who
groups. They use fewer words and fewer clauses with speak varieties use subordinate clauses less frequently
subordination, owing to their different English grammar and than speakers of more standard English. This result is
way of constructing sentences; MLU measures both factors. also like that obtained by Pearce and Flanagan (2019).
This was the case regardless of whether students had a They found that Indigenous Australian students tended
history of receiving speech-language pathology or special to use subordinate clauses less frequently, which they felt
education services or not. contributed to students’ shorter sentence length.
Discussion Both MLU and Subordination Index scores are

This investigation of the MLU of students who speak a First measurements of standard English syntactic complexity
Nations English variety suggests that they spoke in shorter (Loban, 1976; Miller et al., 2011). Failure to acquire standard
utterances than the MLU obtained by age-matched peers English grammar and complex utterance construction has
when retelling stories. This result supports the hypothesis been considered an indicator of language disorder (Miller
that students who speak varieties speak in sentences et al., 2011). However, this may not be the case for students
different from fluent speakers of mainstream English. It also who speak a variety in this school, and it may not be the
corroborates Pearce and Flanagan’s (2019) results. They case for other students who speak other varieties. Instead,
found that Indigenous children in Australia demonstrated a their MLU may be shorter due to their different English
shorter MLU than students who spoke standard Australian grammar. Also, their frequent use of simple sentences
English. Differences in the MLU shown by students who without subordination may be a stylistic feature of a local
participated in this study and English speaking students from variety, reflective of the speakers’ laconic way of speaking,
and not symptomatic of language disorder.

As for the students’ language behaviour as related place, audience, and communicative purpose” (Wheeler &
to their special education status, in the early grades, the Swords, 2004, p. 471).
MLU of NOSPED students appeared to exceed the MLU
obtained by SPED students on the video retell task. This is Another approach may be the use of linguistically
not surprising given that a shorter MLU is associated with unbiased tests that do not rely on prior knowledge. Instead,
language disorder; at least some SPED students may have they “explore children's ability to conduct psycholinguistic
had difficulty expressing themselves. However, language processing operations that are minimally dependent on prior
disorder may not be the only explanation for this result. In a knowledge or experience” (Campbell et al., 1997, para. 3). Bias
study of children’s use of grammatical varietal features over has been reduced in nonword repetition tasks that require the
grades, Hart Blundon (2019) found that SPED students used child to repeat nonsense syllables. Bias has also been reduced
features at higher rates than NOSPED students. Because in token tests. They require a student to perform commands
the use of grammatical features may be associated with using coloured geometric objects of different sizes.
fewer English words and morphemes, the shorter MLU Even though students in this community who spoke
produced by SPED students may be related to their a variety of English appeared to speak in utterances
increased use of grammatical features. As for the students’ shorter than those of age-matched peers or tended not
performance relative to age-matched peers, contrary to subordinate clauses in their utterances, their sentence
to what might be expected, there were no statistically length increased as they progressed through the grades.
significant differences between the groups regarding This was also the case for speakers of African American
their MLU or rate of use of subordination. This suggests language (Craig & Washington, 2006), with older students
that there is another explanation for the typical students’ using longer sentences. Because MLU is a measure of
performance. It is suggested that they spoke in shorter language development, it follows that the language of
sentences and used fewer subordinate clauses than age- variety-speaking students who attended Bigton School
matched peers who spoke a more standard variety because in British Columbia also developed over time, albeit in a
that is typical for their community variety. way that may be unique to their community variety. More
Given the results of this study, it is suggested that speech- research should be carried out to develop community-
language pathologists and other educational professionals based norms for other children who speak varieties.
avoid using MLU and Subordination Index scores when trying
Limitations
to determine whether students who speak varieties need
specialized support. Until assessment tools are developed Language samples were collected by a standard
that are normed on each English variety in Canada, it is English-speaking adult, which may have influenced the way
suggested that speech-language pathologists avoid all the students spoke English and their resultant sentence
assessments not standardized on the local population. length. Because the samples were collected in just one
context, no comment can be made on the students’
In the meantime, however, speech-language pathologists language behaviour in other contexts, such as when they
and educational professionals must not underdiagnose. A participate in community gatherings or interact with their
test-intervene-test type dynamic assessment may be a best family or peers, other than to make comments derived
practice at present. That is, first carrying out an assessment, from anecdotal observations. Future research should focus
then providing evidenced-based respectful interventions on studying children’s MLU and use of subordination in
such as recasting or contrastive analysis, and then conversational and expository speech in a wider variety of
reevaluating to determine whether the interventions have contexts with a broader variety of communicative partners.
been at least introductorily successful. Recasting involves
rephrasing the child’s utterances without correction. It is To explore the relationship between Bigton students’ MLU
an effective approach with children who speak varieties in and use of subordination compared to their age-matched
the United States (Edwards & Rosin, 2016) and has been peers who spoke more standard English, a story retell sample
recommended for use among First Nations children (Larre, was collected in addition to an oral and written video retell
2009). Contrastive analysis and code-switching are also sample. This third sample needed to be collected within
effective approaches (Edwards & Rosin, 2016; Wheeler a 2-to-3-day period. Because story retell was the third
& Swords, 2004). For contrastive analysis, the educator sample collected, fatigue may have influenced the results.
systematically teaches the points of contrast between the However, when questioned, many students indicated that
two varieties. Code-switching involves teaching the student they enjoyed the story retell task. It was novel in that they had
to “choose the language variety appropriate to the time, not completed this type of protocol before, which may have
increased their motivation and counteracted fatigue.
197 Volume 46, No 3, 2022
As discussed in the Methods, Study 1, Participants time, they cannot know if a student is developing language
section, SPED students’ data were included in this analysis. as expected or needs specialized support. It is critically
Some SPED students may have presented with language important that we learn more about First Nations Englishes
disorder, and language disorder is associated with shorter to cease pathologizing students for their way of speaking
MLU and less use of subordinate clauses. Determining English and, instead, celebrate their variety as a linguistic
whether their shorter MLU is related to language disorder or marker of their community.
their English variety’s grammar can be difficult. Their data
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199 Volume 46, No 3, 2022
Appendix
Grammatical Features of First Nations School-Aged Children
Feature type Examples

Verbs Present for past: He look there yesterday; Then this kid comes over and looked like she was coming
from a party
Absent copula or auxiliary: They __ waitin’
Regularization: She blowed the balloon; She poppeded the balloon
Absent 3rd person singular <s>: He kick the ball
Absent -ing: The girl is bounce all over
Absent “to”: She was waiting for the girl __ come back
Subject–verb agreement: They was coming
Gots/has: The woman gots a …

Pronouns Undifferentiated pronoun case: Her blew that to him
Absent 3rd person singular gender distinction: He (referring to a female) catches it

Articles, Use of “that” for “the”: He got in that lake
determiners
Pronoun/determiner; absent determiner: Them bees are going to get him; Then __ bull breathe in her face
Indefinite article: He gots a glasses; a apple tree; The girl is tryin’ get _ apple
Prepositions Different or absent use of preposition: The girl got along/out of the way
Non-verb-related Absent possession: The bull horns are stuck in the tree
morphology
Absent plural: The bee are gonna come out
Negation: I not know; Now they’re ain’t; He never took his nose; He don’t want him to see
Conjunctions Use of “and here” or “then here” for “and then”:
Then here he is bouncing all over; And here the bus came
Utterance-level Absent phrase: ___ waiting for her to come (the auxiliary is also absent in this example)
features
Note. Adapted from “English Grammatical Features of First Nation's Kindergarteners: Differences, Not Mistakes,” by P. Hart Blundon, 2022. Canadian Journal of Speech-Language Pathology &
String: And then they come out, then help, sit down, and Copyright
Audiology, 46(1), 65–84 (https://cjslpa.ca/files/2022_CJSLPA_Vol_46/No_1/CJSLPA_Vol_46_No_1_2022_1238.pdf). have more 2022 byapples
Speech-Language and Audiology Canada.
Topicalization: That bull, he was mad
Repetition: He got really mad and really, really mad; They were jumping out and jumping back in and
jumping out and jumping back in and jumping out
Different word order: That you see she have a balloon

PBR PARTNERSHIPS Canadian Journal of Speech-Language Pathology and Audiology (CJSLPA)
Exploring Practice-Based Clinical–Research Partnerships in

Speech-Language Pathology: A Scoping Review
Exploration des partenariats de recherche clinique axée sur

la pratique en orthophonie : une revue exploratoire
Meghan Vollebregt
KEYWORDS
Lisa M. D. Archibald
PRACTICE-BASED
Julie Theurer
RESEARCH Janis Oram Cardy
SPEECH-LANGUAGE
PATHOLOGY
COLLABORATION
PARTNERSHIP
Meghan Vollebregt1, Lisa M.

D. Archibald2, Julie Theurer2,
and Janis Oram Cardy2
Graduate Program in Health

1
and Rehabilitation Sciences,

Western University
2
School of Communication
Sciences and Disorders,
Western University
Abstract
Collaborative partnerships between speech-language pathologists and researchers present an
opportunity for practice-based research. For practice-based research to become more widely used
in speech-language pathology, a crucial step is outlining the potential purposes and outcomes of
these partnership projects. The current article is two-fold. First, we describe a model for practice-
based partnerships between researchers and speech-language pathologists. The practice-based
research cocreation model developed for this project includes three distinct partnership outcomes:
(a) creating practice, (b) capturing current practice, and (c) changing practice. Then, informed by our
model, we completed a scoping review to explore the extent and type of practice-based research in
the field of speech-language pathology to date. A literature database search identified 3510 articles
meeting our inclusion criteria. Two independent readers reviewed abstracts and titles to determine
articles for further review. Fifty-three articles were reviewed in full and 18 of these were excluded. Data
were extracted from the remaining 35 articles. Level of partnership (creating, capturing, or changing)
and type of partnership (collaborative or consultative) were coded. A thematic analysis revealed that
three of the 35 articles involved creating practice, 19 captured current practice, and 13 were aimed at
changing practice. Of the 27 articles in which details were provided about the partnerships between
Editor-in-Chief: researchers and clinicians, 18 partnerships were collaborative and 9 were consultative. This review
David H. McFarland offers an initial step in examining the use of practice-based research in speech-language pathology,
thereby demonstrating to researchers and clinicians how they can support each other to cocreate
clinically relevant research.
Exploring Practice-Based Clinical–Research Partnerships in Speech-Language Pathology: A Scoping Review

201 Volume 46, No 3, 2022
Revue canadienne d’orthophonie et d’audiologie (RCOA) PBR PARTNERSHIPS
Abrégé
Les collaborations et partenariats entre les orthophonistes et les chercheurs représentent de belles
opportunités de faire de la recherche axée sur la pratique. Afin que l’utilisation de la recherche axée
sur la pratique se généralise en orthophonie, il est crucial de d’abord définir les objectifs et les résultats
potentiels pouvant découler de ces projets de partenariat. Le présent article comporte deux volets.
Dans un premier temps, nous décrivons un modèle de partenariat de recherche axée sur la pratique
unissant orthophonistes et chercheurs. Celui-ci a été développé pour la présente étude et caractérise
les partenariats selon trois types de résultats pouvant en découler : (a) création de pratiques, (b)
évaluation des pratiques actuelles et (c) modification des pratiques. Dans un second temps, en nous
appuyant sur notre modèle, nous avons réalisé une revue exploratoire de la littérature afin de cerner
l’étendue et le type de la recherche axée sur la pratique réalisée dans le domaine de l’orthophonie.
Une recherche dans des bases de données a permis de recenser 3510 articles répondant à nos
critères d’inclusion. Deux lecteurs indépendants ont révisé les abrégés et les titres pour déterminer
quels articles se qualifiaient pour un examen approfondi. Cinquante-trois articles ont été lus en entier
et 18 ont été exclus des analyses. Les données des trente-cinq articles restants ont été extraites, puis
codées selon le niveau de partenariat (création, évaluation ou modification) et le type de partenariat
(collaboratif ou consultatif). Une analyse thématique a révélé que, parmi les 35 articles, 3 traitaient de
la création de pratiques, 19 de l’évaluation de pratiques actuelles et 13 de modification des pratiques.
Parmi les 27 articles contenant de l’information au sujet des partenariats entre les chercheurs et
les cliniciens, 18 partenariats étaient collaboratifs et 9 étaient consultatifs. Cette revue constitue un
premier pas dans l’évaluation du recours à la recherche axée sur la pratique en orthophonie et indique
par le fait même de quelle façon les chercheurs et les cliniciens peuvent s’entraider dans la cocréation
de recherches pertinentes sur le plan clinique.

It has long been recognized that laboratory-based action framework provides a means of focusing attention on
research findings with presumed clinical relevance research, practice, and the gap between them.
may have little impact on practice. Difficulty translating
knowledge from research into practice arises for a variety Despite nearly 2 decades of effort, closing the gap
of reasons related to both research pipelines and clinical between research and practice has proven a perplexing
experiences (Crooke & Olswang, 2015). Practice-based challenge (Olswang & Prelock, 2015). This research–practice
research (PBR) is an approach to systematic inquiry that gap is maintained by various barriers faced by both
involves gathering information from clinical practice to researchers and clinicians (e.g., time, resources, research
answer questions arising from practice to inform future useability, support). In the knowledge-creation cycle,
practice (Epstein, 2002). As a promising approach to researchers experience delays in producing efficacious and
knowledge creation, PBR addresses many of the limitations effective research (Ovretveit et al., 2014) and can encounter
discussed in the field of knowledge translation. Crucially, further delays when publishing their findings (Morris et al.,
PBR involves practicing research “without the gap” because 2011; Olswang & Prelock, 2015). As well, avenues valued
the research question is embedded directly in practice. By by researchers for sharing their findings, such as scholarly
cocreating knowledge at the point of consumption, PBR journals, are not necessarily accessible to practitioners
has the potential to directly impact practice with little need (Grimshaw et al., 2012). In addition, scholarly publications
for knowledge translation. PBR is well suited to the field of are often not written for a practice-based audience,
speech-language pathology given the importance of applied requiring clinicians to interpret the findings and determine
research questions and objective clinical approaches the implications for practice (Olswang & Prelock, 2015).
in the field, however, the extent to which clinicians and Considerable time, resources, knowledge expertise, and
researchers are engaged in this type of research is unknown. motivation are required to engage in such interpretative
The purpose of the present study was to examine PBR in activities and implement potential changes (Green et al.,
the field of speech-language pathology with the two-fold 2009). Although critical, necessary organizational support
goal of (a) describing potential PBR goals in a cocreation may not be available to enable such activities within
model including capturing practice, changing practice, everyday practice.
and creating practice, and (b) reporting a scoping review on Beyond the challenge of sharing and translating available
published research broadly consistent with a PBR approach research, another barrier in addressing the research–
in the field of speech-language pathology and categorized practice gap is a lack of overlap between research priorities
according to our model. and clinical concerns. Researchers and clinicians often
operate in relative isolation from one another. As a result,
The Research–Practice Gap
researchers may focus on questions that are not relevant
Knowledge generated through systematic research to clinical practice or develop solutions that are not feasible
has important implications for service providers whose within the economic or contextual constraints of practice
goals are to improve the health, education, and well-being (Olswang & Prelock, 2015). Although clinician scientists
of individuals. The traditional research pipeline of creating present another solution to the research–practice gap by
knowledge involves researchers outside of the clinical conducting research as part of practice, the focus of the
provision pathway deciding upon a research question, current review is on the partnership between researchers
designing a research study, collecting and analyzing and clinicians.
data, and sharing results. One problem noted with this
knowledge creation process has been that the shared Moving Research Into Practice
research results often fail to impact practice at the level Situated within knowledge translation is the field
of service providers (clinicians, educators, etc.; Graham of implementation science, which has been a recent
et al., 2006; Green et al., 2009; Morris et al., 2011; Straus focus in communication sciences and disorders
et al., 2009). Observations of this research–practice gap (Douglas & Burshnic, 2019). Focused on the action cycle,
gave rise to the field of knowledge translation (Canadian implementation research is the study of methods that
Institutes of Health Research, 2008; Straus et al., 2009), promote the uptake and integration of evidence into health
which centres on moving research from the laboratory policies, health care, and education (Bauer et al., 2015;
into practical use. The full knowledge-translation cycle is Proctor et al., 2013). Specifically, implementation science
captured in the knowledge-to-action framework (Graham uses methods and techniques to systematically address
et al., 2006; Straus et al., 2009), which specifies both barriers that hinder the integration of new research into
knowledge-creation and action cycles. The knowledge-to- practice (Eccles et al., 2009; Olswang & Prelock, 2015).
203 Exploring Practice-Based Clinical–Research Partnerships in Speech-Language Pathology: A Scoping Review Volume 46, No 3, 2022
In describing the process of implementation science, stakeholders to be initiated at any point in the framework.
Curran (2020) identified three components in the simplest Although collaboration at the action phase can support
terms: the thing, how to do the thing, and the stuff. The implementation, engaging in collaborative partnerships
thing refers to an intervention, or innovation for which the earlier in the process better supports rapid creation and
knowledge creation phase of effectiveness research has integration of evidence (Gagliardi, et al., 2015; Jull et al.,
been completed and the effectiveness established. The 2017). In fact, it has been suggested that the research–
question of how to do the thing, on the other hand, is the practice gap is caused by issues in knowledge production
purview of implementation research, which focuses on rather than knowledge transfer (Bowen & Graham, 2013;
applying the product of effectiveness research in practice. Jull et al., 2017). Engaging in partnerships throughout
Implementation researchers develop and investigate the knowledge-to-action framework repairs this issue as
implementation strategies, referred to as the stuff, that collaborators cocreate and apply new knowledge together.
aim to help people do the thing. These implementation
strategies, or the stuff, may improve the uptake of the thing Cocreation partnerships have been described using
by adding supports or may remove barriers allowing for many terms (i.e., research–practice partnerships, PBR
more ease to do the thing. Thus, although implementation networks) and are found within a variety of paradigms
science is aimed at minimizing the research–practice gap (design-based research, integrated knowledge translation,
(Greenhalgh et al., 2004), this area of research persists community-based participatory research, organizational
as a framework where researchers push their established participatory research, and PBR). As emerging fields under
findings into practice for application and integration the broad umbrella of knowledge translation, considerable
(Olswang & Prelock, 2015). Implementation science can overlap exists between terms and paradigms related to
be expected to be particularly effective when congruency partnered research. Although the need to include a variety
exists between research outcomes, clinical interests, and of terms when searching for research broadly consistent
practice requirements. with PBR was identified, the term evidence-based practice
was considered too general and broad to be useful in
Unfortunately, research priorities and clinical focusing the search on PBR. The term practice-based
practicalities sometimes fail to align (Olswang & Prelock, evidence describes an approach that is particularly
2015). Myriad problems arise when a large gap exists important when high-quality evidence is lacking, does
between research outcome requirements and what can not relate to an individual client, or does not provide clear
feasibly be achieved in practice. This disconnect between recommendations. A clinician scientist generates practice-
research outcomes and practice is not addressed by based evidence often through single-case experimental
approaches to knowledge translation. One solution to this designs or case studies (Lemoncello & Ness, 2013).
problem is for the point of partnership between researchers Many clinicians have played a dual clinician-researcher
and practitioners to begin much earlier and work role conducting research on their own practice (Owen
bidirectionally. In collaborative partnerships, knowledge et al., 2004; Wight & Miller, 2015). However, our focus for
creators and knowledge users work together to codesign the review was on PBR that incorporated a practitioner–
theoretically sound things that are relevant to practice and researcher partnership.
seamlessly implemented within practice (Greenhalgh et al.,
2016; Jull et al., 2017). Creating Research in Practice: PBR
PBR refers to a researcher–practitioner partnership
The Use of Partnerships where the initiation of partnership starts early in the
In recognition of the intractability of the research– knowledge-creation phase. From the beginning, researchers
practice gap, there has been a growing trend in many fields and practitioners work together to identify a problem
to use partnerships to help align research priorities and currently experienced in practice and design an applicable
clinical needs. Indeed, in knowledge-translation approaches, solution. By situating the knowledge-creation phase directly
the use of partnerships is widely acclaimed and seen as a in practice, the action cycle is either reduced or eliminated.
fundamental component of the approach (Gagliardi et al., By gathering data in practice to later inform that practice
2015; Greenhalgh et al., 2016; Jull et al., 2017; Nguyen et al., (Epstein, 2002), PBR creates research without the need for
2020). The timing of partnership initiation, however, may translation across the gap. Certainly, PBR does not replace
vary. According to the knowledge-to-action framework the need for traditional research, but it provides a valuable
(Graham et al., 2006), the boundaries between knowledge complement to traditional research. PBR represents the
creation and action are fluid to allow both for the influence pull from practice by addressing questions that arise
of one aspect on the other and for collaboration among from practice (Crooke & Olswang, 2015). It is the lived

experiences of clinicians, educators, and stakeholders that to clinical practice and ensure the protocol is sustainable in
influence all aspects of the project. practice (Crooke & Olswang, 2015). Specifically, by involving
clinicians in developing the research question, knowledge is
The potential power of PBR was first recognized by created that is highly practical and sustainable for practice
Epstein (2002), who reported that social workers routinely settings. It can be expected that PBR partnerships will vary
collected large quantities of clinical information about in the degree of engagement between researchers and
clients. Most researchers deemed this information as clinicians. Some partnerships may be more consultative,
unreliable, but Epstein (2002) argued that these data could such that partners meet at specific timepoints throughout
be mined to reveal valuable information for that clinical the process to discuss and make changes, but the
setting. Comparing a randomized control trial (Beder, 2000) partnership between the two parties is not constant. Other
and a PBR study (Dobrof et al., 2000), each conducted with partnerships might be more collaborative, with clinicians
end-stage renal dialysis patients, Auslander et al. (2002) and researchers working together on an ongoing basis to
showed comparable findings across studies. However, design, implement, solve problems, and make changes
the PBR study (Dobrof et al. 2000) provided insight into as needed. The extent to which partnerships are fully
service patterns that could not have been captured by the collaborative is often not reported clearly in the literature
randomized trial. Both Beder’s (2000) and Dobrof et al.’s (Gagliardi et al., 2016). Nevertheless, where possible, the
(2000) studies answered questions about clinical practice, partnerships were characterized as either consultative
but only Dobrof et al.’s PBR project answered questions or collaborative based on descriptions of partnerships
without adding to the workload of the clinicians and exposed reported in relevant studies of our scoping review.
service patterns that would not have been recognized
otherwise. Both evidence of enhanced knowledge Development of a Cocreation Model to Support Clinical–
outcomes and reduced research-related workload highlight Research Partnerships
the value of PBR. Although PBR has a long-standing history, its utility
for the field of speech-language pathology has not been
An important attribute of PBR is that it uses an inductive
fully explored yet. For those interested in engaging in
rather than deductive approach with key concepts coming
collaborative partnerships, there is little guidance in the
from practical insight (Epstein, 2002). PBR approaches
literature regarding the types of research that can be
can use nonexperimental or quasi-experimental data
conducted using this approach. Further, documentation
designs, include descriptive and correlational findings, be
of partnerships is inconsistent and is not systematic
collected retrospectively or prospectively, and include both
(Drahota et al., 2016), leading to little consensus on how
quantitative and qualitative information. PBR studies also
best to engage in a partnership. For PBR and the use of PBR
employ instruments from practice and recruit participants
partnerships to become more widespread and accepted
from their point of care without random assignment to
in speech-language pathology, a crucial step is to outline
alternate treatments or control groups. Similarly, unlike
the potential purposes or outcomes of these partnership
research-based practice trials, standardized assessments
projects. As a first step and to capture our emerging thinking
can be used in an unstandardized way if that is best for
in this area, we created the cocreation model (Figure 1)
clinical practice. PBR is a collaborative science based in
based on our experiences with PBR, the utility of PBR in
practice, and as such, practice requirements are of greater
other fields (Candy & Edmonds, 2018), and attributes
importance than research considerations (Epstein, 2002).
described in the literature (Epstein, 2002). This model
For the most part, PBR is built on partnerships broadly identifies the potential outcomes for partnership
between clinicians working primarily as service providers projects in which the goal is to answer clinical questions
and researchers working primarily to carry out scientific originating from practice and informing future practice.
investigation (e.g., Arcuri et al., 2016), although other
The creation of the model was informed by the
models where a clinician scientist carries out both roles
discussions of Epstein (2002), who identified that clinicians
exist (e.g., Owen et al., 2004). Given the different expertise
gather large amounts of information about their practice
the partners bring to the partnership, a willingness to
and about their clients. This information provides the
acknowledge the valuable contribution of other members
potential to understand current practice, which could, in
is necessary. Researchers offer knowledge and skills that
turn, motivate changes in practice. Further, PBR involves
enhance the scientific rigour of the study design while
initiating the partnership as a first inquiry step that could
ensuring high fidelity to the protocol, and clinicians possess
contribute to the design of new practice. The model was
insight into which research outcomes will be most significant
also informed by our experiences as practice-based
Figure 1
The practice-based research cocreation model
researchers in the areas of preschool (Kwok, 2020) and across a range of settings and implementation schedules.
school-age language development (Vollebregt et al., 2019), This purpose aligns most closely with the concept of
and motor speech and swallowing (Theurer et al., 2013). practice-based evidence, although the present review
Ongoing partnerships and projects provided insight into focused on studies based specifically on a practitioner–
the outcomes achievable through PBR. Compiling these researcher partnership. An example of research
possible outcomes from the literature reinforced our designed to capture practice could include evaluating
ideas and experiences working in PBR, bringing about the the effectiveness of a preschool program building social
cocreation model to represent how these partnerships can communication skills in children with autism that is being
produce sustainable clinical practices. Our PBR cocreation delivered in a community clinic.
model (Figure 1) describes three distinct purposes or
outcomes related to PBR: (a) creating practice, (b) capturing Changing practice describes a cocreation partnership
practice, and (c) changing current practice. whose goal is to implement evidence-based approaches
either arising from practice-based or traditional research
Creating practice refers to a cocreation partnership activities. This purpose of PBR aligns most closely with the
aimed at designing or creating a new practice and view of knowledge translation and implementation science
evaluating its effectiveness. In a practice-creation project, as taking action to move knowledge into practice or studying
clinicians and researchers may work together to integrate or the implementation process. An example of changing
adapt evidence-based practices from traditional research practice could include a researcher working with a clinician
within the constraints of a particular practice setting. to implement an alternative therapeutic approach in their
In this way, an evidence-informed practice is created clinical practice.
and evaluated. For example, a creating-practice study
might involve designing a new phonological awareness The PBR cocreation model was used in a scoping review
program, incorporating the best available evidence to further our exploration of the extent to which researchers
with modifications to suit a particular context, and then in the field of speech-language pathology are engaged in
evaluating program effectiveness. PBR. Unlike systematic reviews, scoping reviews allow the
assessment of emerging evidence and serve to provide an
Capturing practice describes a cocreation partnership overview of a broad topic (Peterson et al., 2017). Scoping
that evaluates ongoing practice to inform both the reviews consider diverse related literature and use a
clinicians and researchers. By studying current practice systematic methodological approach (Arksey & O’Malley,
directly, researchers and clinicians can build the evidence 2005). As such, scoping reviews are an appropriate
base for effective practices in speech-language pathology alternative to systematic reviews when the literature is

vast and complex or when the identified topic is emerging Articles were eligible for this scoping review if they were
or evolving. Given the emerging nature of PBR in the field related to the field of speech-language pathology and
of speech-language pathology, a scoping review was described the movement of scientific knowledge from
considered an appropriate approach to explore the extent research to practice or practice to research using one of
of research completed in the area. the following terms: implementation science, knowledge
translation, practice-based research, or practice-based
Scoping Review Examining PBR in Speech-Language evidence. The initial search yielded 3510 articles. The titles
Pathology
and abstracts of these articles were independently reviewed
The scoping review was conducted to provide an by two readers (author MV and an additional, trained
overview of PBR in the field of speech-language pathology research assistant). Any disagreement about which articles
broadly. Because this is a relatively new area of research, should be included led to discussion until consensus for
no limits were placed on the population or disorder types included articles was reached (n = 53). After that, articles
studied. The aim of this review was to acquire a general were excluded if they were systematic reviews or editorials.
sense of the available research that could be broadly Articles meeting the inclusion criteria were read in full by the
defined as using a PBR approach and consider it in relation first author. An additional 18 articles were excluded upon
to our PBR cocreation model. A first goal was to determine full text review because they outlined the importance of
whether research involving cocreation partnerships could cocreation partnerships but did not present research data.
be identified that corresponded to our three hypothesized A PRISMA flow diagram outlines the study selection process
purposes of creating, capturing, and changing current (Figure 2).
practice. Finding studies addressing the three distinct
research partnerships would provide validation to the For all studies meeting the inclusion criteria, data were
model. A second goal was to categorize these partnerships extracted using a Microsoft Excel chart developed by
as either collaborative or consultative to determine how the authors. To develop the extraction sheet, one author
partnership collaboration was being documented and (MV) completed data extraction of an article using the
if examples of these partnerships could provide insight general extraction inventory outlined by the Joanna Briggs
into how these partnerships exist. Partnerships were Institute (Peters et al., 2015). Over the course of the data
coded as collaborative if there was evidence of an ongoing extraction, the four authors met twice to discuss what
partnership throughout the research process. Partnerships information should be extracted from the articles. In the
were coded as consultative if there was some engagement first meeting, information regarding the details of the study
between researchers and stakeholders, but there was no were discussed (e.g., participants, location). The second
evidence of ongoing partnership. meeting was dedicated to creating consensus amongst
the group about how to categorize partnerships using the
Method cocreation model (changing practice, creating practice, or
Searches were conducted in the following database capturing current practice). Following the second meeting,
search engines: Web of Science, PubMed, CINAHL, and a portion of the articles were read by each of the authors
Psych Info. Articles were included if published in English in and information extracted from the articles was compared
peer-reviewed journals between 1980 and April 2020. A across authors to ensure accuracy. Data extraction
hand-search was completed on the journal Implementation included a chart outlining: journal title, authorship, year,
Science. Keywords were selected to reflect the possibility participants, service context, and setting (see Table 1).
of terms used to describe relevant clinician–researcher An additional chart was used for extraction of location of
partnerships and included implement* science, or research, study design, data source, type of analysis, level of
knowledge translat*, or practice-based research, or cocreation, and type of partnership (see Table 2).
practice-based evidence, or design research, and speech
Results
language path*, or speech therap*, or speech path*.
Evidence-based practice was excluded as a search term The scoping review yielded 35 articles from six countries.
to focus the search on articles that involved an ongoing Fourteen articles were from Australia, nine from the United
partnership between clinicians and researchers. In States, nine from Canada, one from Sweden, one from
communication sciences and disorders, the term evidence- South Africa, and one from the Netherlands. Included
based practice is widely used to describe many clinical articles were published between 2010 and 2020.
activities, so its inclusion would have produced too many
irrelevant results.
Figure 2
Identification
Records identified Additional records
through database identified through Total articles N = 3510
searching n = 3499 other sources n = 11
Records after
PRISMA Flow Chart
duplicates removed
Screening
n = 3305
Records screened Records excluded

n = 3305 n = 3252
Eligibility
Full-text assessed Full-text articles

n = 53 excluded with reason
n = 18
Included
Studies included
n = 35
PRISMA flow diagram for the scoping review process
Participants, Disorder Area, and Setting

Consistent with our purpose of examining PBR in the field Setting was only collected from an article if explicitly
of speech-language pathology, S-LPs were involved in every stated in the text. For adult participants, the settings
study except one where S-LPs were invited to participate included rehabilitation settings (9/35), acute hospital
but none responded to the call for participants (Boudreau settings (5/35), skilled nursing facilities (2/35), long-term
et al., 2019). Multiple studies included more than one group care settings (1/35), the home (1/35), university clinic
of participants. For example, Francis et al. (2019) collected (1/35), and community-based programs (1/35). The
data from patients, caregivers, and S-LPs. S-LPs were not disorders examined included stroke (10/35), cognitive
always the primary participants, in that they were not always communication impairment (2/35), dysphagia (1/35),
the source of data for the research studies. However, hypokinetic dysarthria (1/35), dementia (1/35), traumatic
S-LPs were the primary participants in the majority of the brain injury (1/35), and spinal cord injury (1/35). PBR
included articles (20/35). In other studies, participants involving children occurred in community-based programs
were allied health professionals (e.g., occupational such as preschool speech and language programs (5/35),
therapists, physiotherapists) who provided feedback on children’s treatment centres (3/35), schools (3/35), home
the implementation of a specific intervention program care (1/35), a pediatric rehabilitation centre (1/35), and a
(10/35). Other studies included parents and caregivers as nongovernment organization (1/35). Children in the studies
participants (4/35), patients (4/35), educators (2/35), nurses presented with language impairments (4/35), preschool
(1/35) and master of education students (1/35). speech and language needs (4/35), cerebral palsy (3/35),
physical disability (1/35), significant developmental delay
A variety of populations, disorder types, and settings (1/35), autism spectrum disorder (1/35), voice concerns
were represented across the reviewed articles. Populations (1/35), speech sound disorder (1/35), and augmentative
included both adults (17/35) and children (18/35). and alternative communication needs (1/35).

Table 1
Articles Included in Scoping Review: Authors, Title, Year, Participants, Disorder Area, and Setting
Author(s) Article title Year Participants Disorder area Setting
Lavesson et al. “Development of a Language Screening 2018 4-year-old children Child language Child health centres
Instrument for Swedish 4-Year-Olds”
Olswang & Prelock “Bridging the Gap Between Research and 2015 S-LPs, occupational Children with Children’s treatment centre
Practice: Implementation Science” therapists, physiotherapists physical disabilities
Vallila-Rohter et al. “Implementing a Standardized Assessment 2018 Patients with aphasia, their Aphasia Hospital
Battery for Aphasia in Acute Care” caregivers, and S-LP assistants
Allen et al. “Implementing a Shared Decision Making 2020 Interprofessional teams of Cognitive Rehabilitation hospitals
and Cognitive Strategy-Based Intervention: stroke rehabilitation hospitals impairments
Knowledge User Perspectives and following a stroke
Recommendations”
Arcuri et al. “Perceptions of Family-Centred Services in a 2016 Parents and allied health Children with Pediatric rehabilitation centre
Paediatric Rehabilitation Programme: Strengths professionals significant
and Complexities from Multiple Stakeholders” developmental
delays
Cunningham et al. “Barriers to Implementing Evidence-Based 2019 S-LPs Pediatric S-LP- Preschool speech and
Assessment Procedures: Perspectives From Children who are language services
the Front Lines in Pediatric Speech-Language deaf and hard of
Pathology” hearing
Dada et al. “Augmentative and Alternative Communication 2017 S-LPs Augmentative
Practices: A Descriptive Study of the Perceptions and alternative
of South African Speech-Language Therapists” communication
Douglas “Organizational Context Associated With Time 2016 S-LPs Cognitive Skilled nursing facility
Spent Evaluating Language and Cognitive- communication
Communicative Impairments in Skilled impairment
Nursing Facilities: Survey Results Within an
Implementation Science Framework”
Farquharson et al. “Using Hierarchical Linear Modeling to Examine 2015 S-LPs Children with Public school
How Individual S-LPs Differentially Contribute to language
Children’s Language and Literacy Gains in Public impairment
School”
Foster et al. “ ‘That Doesn’t Translate’: The Role of Evidence- 2015 S-LPs Stroke care Acute hospital
Based Practice in Disempowering Speech (aphasia)
Pathologists in Acute Aphasia Management”
Table 1 (continued)
Greenspan et al. “Clinician Perspectives on the Assessment of 2020 S-LPs Aphasia Rehabilitation hospital, acute
Short-Term Memory in Aphasia” care hospital with outpatient
services, professional
conference, and university
speech clinic
Hadely et al. “Speech Pathologists’ Experience With Stroke 2014 S-LPs Stroke care Rehabilitation
Clinical Practice Guidelines and the Barriers and
Facilitators Influencing Their Use: A National
Descriptive Study”
Hartley et al. “Practice Patterns of Speech-Language 2017 S-LPs Pediatric voice
Pathologists in Pediatric Vocal Health”
Imms et al. “Improving Allied Health Professionals’ Research 2015 Allied health professionals Children with Nongovernment organizations
Implementation Behaviours for Children With cerebral palsy
Cerebral Palsy: Protocol for a Before-After Study”
Jeng “Clinical Decision Making in Skilled Nursing/Long 2015 S-LPs Hypokinetic Long-term care
Term Care: Using and Generative Evidence in the dysarthria
Field”
Justice et al. “Designing Caregiver-Implemented Shared- 2015 Parents and their children Children with Home environment
Reading Interventions to Overcome language
Implementation Barriers” impairment
Miao et al. “Factors Affecting Speech Pathologists’ 2015 S-LPs Stroke care
Implementation of Stroke Management
Guidelines: A Thematic Analysis”
Nitsch et al. “Integrating Spinal Cord Injury - Quality of Life 2021 Allied health professionals Spinal cord injury Rehabilitation Institute of
Instruments Into Rehabilitation: Implementation Chicago
Science to Guide Adoption of Patient-Reported
Outcome Measures”
Poulin et al. “Identifying Clinicians' Priorities for the 2020 Interdisciplinary teams Traumatic brain Stoke rehabilitation centre,
Implementation of Best Practices in Cognitive and clinical coordinators, injury/acquired inpatient and outpatient
Rehabilitation Post-Acquired Brain Injury” occupational therapists, brain injury rehabilitation centre, acquired
neuropsychology, special brain injury rehabilitation
education, S-LP centre
Shrubsole et al. “Barriers and Facilitators to Meeting Aphasia 2018 S-LPs Aphasia Acute and rehabilitation
Guideline Recommendations: What Factors settings
Influence Speech Pathologists' Practice?”

Table 1 (continued)
Sugden et al. “Service Delivery and Intervention Intensity for 2018 S-LPs Phonology-based
Phonology-Based Speech Sound Disorders” speech sound
disorders
Young et al. “Factors that Influence Australian Speech- 2018 S-LPs Aphasia Inpatient acute, inpatient
Language Pathologists’ Self-Reported Uptake of rehab, outpatient
Aphasia Rehabilitation Recommendations From rehabilitation, community
Clinical Practice Guidelines” rehabilitation, university,
nursing home, private practice
Brebner et al. “Facilitating Children’s Speech, Language, and 2017 Early educators and S-LPs Pediatric S-LP Childcare centres
Communication Development: An Exploration
of an Embedded, Service-Based Professional
Development Program”
Boudreau et al. “Peer-Mediated Pivotal Response Treatment 2019 Educators and early Autism spectrum School board
for Children With Autism Spectrum Disorder: intervention providers disorder
Provider Perspectives on Acceptability, Feasibility,
and Fit at School”
Campbell et al. “A KT Intervention Including the Evidence Alert 2013 Allied health professionals Children with Community-based cerebral
System to Improve Clinician’s Evidence-Based cerebral palsy palsy services
Practice Behaviour – A Cluster Randomized
Controlled Trial”
Cunningham et al. “Promoting Consistent Use of the Communication 2016 S-LPs Preschool speech Preschool speech and
Function Classification System (CFCS)” and language language program
Cunningham et al. “Moving Research Tools Into Practice: The 2018 S-LPs Infants, toddlers,
Successes and Challenges in Promoting Uptake and school-aged
of Classification Tools” children
Cunningham & “Using Implementation Science to Engage 2020 S-LPs Pediatric speech- Preschool speech and
Oram Cardy Stakeholders and Improve Outcome language pathology language services
Measurement in a Preschool Speech-Language
Service System”
Dale et al. “Barriers and Enablers to Implementing Clinical 2015 Registered nurses, clinical Stroke care
Treatment for Fever, Hyperglycaemia, and nurse consultants, nurse unit
Swallowing Dysfunction in the Quality in Acute Stroke manager, endorsed enrolled
Care (QASC) Project – A Mixed Methods Study” nurse
Francis et al. “The Use and Impact of a Supported Aphasia- 2019 Patients with aphasia, their Aphasia Inpatient hospital
Friendly Photo Menu Tool on iPads in the caregivers, and S-LP assistants
Inpatient Hospital Setting: A Pilot Study”
Table 1 (continued)
Imms et al. “Efficacy of a Knowledge Translation Approach 2020 Allied health professionals Children with Five disability service
in Changing Allied Health Practitioner Use of cerebral palsy organizations
Evidence-Based Practices With Children With
Cerebral Palsy: A Before and After Longitudinal
Study”
Molfenter et al. “Decreasing the Knowledge-to-Action Gap 2009 S-LPs Dysphagia Rehabilitation hospitals
Through Research-Clinical Partnerships in
Speech Language Pathology”
Smith et al. “Memory and Communication Support in 2010 Family members and Dementia Home care
Dementia Research-Based Strategies for professional caregivers
Caregivers”
Weiss et al. “Transdisciplinary Approach Practicum for 2020 4 S-LP participants and Autism spectrum School board
Speech-Language Pathology and Special master students in special disorder
Education Graduate Students” education
Wielaert et al. “ImPACT: A Multifaceted Implementation for 2016 Rehabilitation professionals Aphasia Rehabilitation centres, nursing
Conversation Partner Training in Aphasia in Dutch homes with rehabilitation units
Rehabilitation Settings”
Note: S-LP = speech-language pathologist. This table outlines title, year, participants, disorder area, and setting from included articles. Articles in Table 1 are presented in order corresponding to Table 2.
Data Source and Analysis

Across the included studies, data collected were related to implementation of understanding of the role of evidence-based practice and its implementation in
the program, current practices, or what needed to be adjusted about a program. poststroke aphasia. Fewer studies reported participant reflections (3/35), patient
Regarding the type of data collected, 11 articles reported quantitative data, 10 information (3/35), and collecting information regarding the acceptability and
articles reported qualitative data, 11 articles reported mixed-method data, and 3 feasibility of implementation (2/35). One article used an existing scale, the Change
articles could not be classified. Multiple means of data collection were reported. The on Goal Attainment Scale to capture quantitative data about how PBR influenced
use of surveys (13/35), particularly online surveys, was most frequent. In one study progress towards achieving goals (Campbell et al., 2013).
conducted to assess barriers and facilitators to implementing a clinical treatment
protocol, clinicians first participated in preimplementation workshops to identify Level of Cocreation
perceived barriers (Dale et al., 2015). Postimplementation, clinicians completed
The final stage of extraction involved classifying the articles using our PBR
a mixed-method survey to determine what barriers still existed and what barriers
cocreation model. All studies were able to be classified according to the model.
were addressed through the preimplementation workshops.
Three studies were classified as creating practice. In one of these studies,
Other commonly reported practices included interviews (8/35), focus clinicians and researchers adopted a series of single-subject feasibility studies
groups (7/35), participant outcomes (6/35), and questionnaires (5/35). Foster and a randomized control trial into a triadic gaze intervention for children
and colleagues (2015) completed in-depth interviews with S-LPs to gain an (Olswang & Prelock, 2015). As the intervention was adopted into practice, they

Table 2
Articles Included in Scoping Review: Authors, Location, Data Source, Analysis, Level of Cocreation, and Partnership
Level of cocreation Type of partnership
Author Location Data source Type of Creating Capturing Changing Collaborative Consultative
analysis practice practice practice
Lavesson et Sweden Child language screening tool Quantitative, �
al., 2018 (discrepancies
resolved
though
qualitative
information)
Olswang & United States Mixed methods assessed Mixed � �
Prelock, 2015 acceptability, adoption, and
fidelity
Vallila-Rohter United States Retrospective medical review Mixed � � �
et al., 2018
Allen et al., Canada Semistructured focus group Qualitative � �
2020
Arcuri et al., Canada Parent questionnaire responses Quantitative �
2016
Cunningham Canada Online survey Quantitative � �
et al., 2019
Dada et al., South Africa Online survey Quantitative � �
2017
Douglas, United States Survey responses �
2016
Farquharson Australia Questionnaires Quantitative �
et al., 2015
Foster et al., Australia Interview responses Qualitative �
2015
Greenspan United States Semistructured interview in focus Qualitative � �
et al., 2020 group
Hadely et al., Australia Survey responses Mixed � �
2014
Hartley et al., United States Online survey Mixed � �
2017
Imms et al., Australia Survey responses and client Mixed � �
2015 outcomes
Table 2 (continued)
Jeng, 2015 United States Client performance �
Justice et al., United States Interview/survey responses Mixed �
2015
Miao et al., Australia Interview responses Qualitative � �
2015
Nitsch et al., United States Focus group Qualitative � �
2021
Poulin et al., Canada Cross sectional electronic survey Quantitative � �
2020 and focus group
Shrubsole et Australia Semistructured interviews Qualitative � �
al., 2018
Sugden et al., Australia Online survey Quantitative � �
2018
Young et al., Australia Online survey Quantitative � �
2018
Brebner et Australia Focus group and individual Qualitative � �
al., 2017 semistructured interviews
Boudreau et Canada Semistructured interviews Qualitative � �
al., 2019
Campbell et Australia Change on Goal Attainment Quantitative � �
al., 2013 Scaling
Cunningham Canada Pre–posttest intervention Mixed �
et al., 2016 responses
Cunningham Canada Pre–post survey responses Qualitative � �
et al., 2018
Cunningham Canada Pre–post survey Quantitative � �
& Oram
Cardy, 2020
Dale et al., Australia Pre–post survey responses Mixed � �
2015

Table 2 (continued)
Francis et al., Australia Each participant acted as own Mixed � �
2019 control switching the menu,
questionnaires, reflective logs,
and focus groups
Imms et al., Australia Data collected during sessions Quantitative � �
2020 at 6, 12, and 24 months,
questionnaires, and check-up
tool. Child data collected via
health records.
Molfenter et Canada Interview responses Qualitative � �
al., 2009
Smith et al., Australia � �
2010
Weiss et al., United States Pre–post questionnaires, Mixed � �
2020 reflections, and focus groups
Wielaert et Netherlands Data collected from the Mixed � �
al., 2016 recruitment administration,
questionnaires, consensus notes
from meetings with S-LP groups
Note: S-LP = speech-language pathologist. This table outlines the location, type of data collected, type of analysis, level of partnership, and level of cocreation that were identified for each included article. Table 2 is organized according to level of cocreation and then
articles are organized alphabetically within each level of cocreation.
assessed the clinician’s views on acceptability, adoption, and feasibility, and Where possible, the level of partnership was coded as either collaborative
addressed implementation barriers. Nineteen studies were classified as capturing (evidence of ongoing partnership) or consultative (evidence of some engagement
practice. As an example, Justice et al. (2015) sought to understand barriers that between researchers and stakeholders). Only 27 of 35 studies could be classified
parents face in using caregiver-implemented shared reading interventions. relative to the type of partnership; in the remaining articles, authors did not
Parents completed weekly logs to document their maintenance to the define the type of partnership or did not provide sufficient information to allow
intervention schedule and completed an exit interview to discuss implementation for characterization. Of these 27 studies, 18 were classified as incorporating a
barriers. Thirteen studies were classified as changing practice. In an example collaborative partnership and 9 were classified as consultative. For example,
study aimed at standardizing S-LPs’ use of a language assessment tool, S-LPs studies using a collaborative model described their partnerships as ongoing
completed a pretest survey, reviewed online intervention materials, and then and researchers engaged with clinicians at multiple time points throughout the
completed a postsurvey (Cunningham et al., 2016). project to collect implementation data (Olswang & Prelock, 2015). Further, they
described their partnerships as collaborative throughout all be somewhat more straightforward to carry out because
stages of implementation (Cunningham et al., 2018). As an no practice change is required. It is also possible that
example of a study using a consultative model, one study capturing current practice is the first step to determining
(Miao et al., 2015) described an organization, the National if the services are meeting current needs before services
Stroke Foundation, receiving input on guidelines from S-LPs. are changed or created. It may also be the case that more
As an example of a study where the type of partnership research involves capturing practice because capturing
could not be classified, one study described a project using practice closely aligns with Epstein’s (2002) original work
implementation science with researchers and S-LPs, but the in PBR. This type of capturing practice aligns with practice-
extent of the partnership was not described in the article based evidence where clinicians are acting as dual clinicians
and therefore not classified as collaborative or consultative and scientists conducting research on their own practice
(Farquharson et al., 2015). (Lemoncello & Ness, 2013).
Discussion PBR involving creating practice seems to be particularly

This scoping review investigated the emerging area rare given that only three studies were classified as such,
of PBR in the field of speech-language pathology. The and one of the three articles reported the practice creation
objective in the present study was to examine PBR with incidentally as part of a PBR discussion. It is possible that
the two-fold goal of (a) describing potential PBR outcomes with PBR in its infancy in speech-language pathology,
in a cocreation model including capturing practice, those engaged in partnerships have not yet envisioned a
changing practice, and creating practice, and (b) reporting level of partnership where new practice is being created.
a scoping review of published research consistent with a Another possibility is that creating practice represents a
PBR approach in the field of speech-language pathology particularly challenging research purpose. Creating practice
and categorized according to our model. As described by might place high demands on collaboration due to the
our PBR cocreation model, PBR includes research aimed need to work together on all aspects of both practice and
at creating practice, capturing practice, and changing research design. Further, given these high demands, another
practice. PBR partnerships were expected to vary, with possibility is that S-LPs have limited time to engage in these
some being highly collaborative involving researchers types of partnerships because their workloads are very high.
and clinicians working together throughout the process As potentially more S-LPs begin to engage in this type of
and others being more consultative with points of work, one possibility is the use of a knowledge broker who
contact at only specific junctures. Our review yielded 35 collaborates with both the researchers and S-LPs to lessen
articles reporting PBR involving S-LPs, other allied health the demands placed on them, support interactions, and
professionals, caregivers, patients, and other professionals. increase capacity for partnerships (Dobbins et al., 2009).
Of these articles three were categorized as creating Addressing both clinical concerns and implementation aims
practice, 19 as capturing practice, and 13 as changing in one study requires addressing the priorities and methods
practice. Eighteen studies were classified as collaborative specific to each component, which can quickly become a
and 9 were classified as consultative. In this discussion, large undertaking. It is not surprising, then, that there are few
a broad overview of PBR in speech-language pathology articles reporting this type of work (see Curran et al., 2012,
is provided and the utility of PBR in speech-language for a discussion of different approaches).
pathology is outlined. Further, attention is drawn to existing Our second goal was to characterize the collaborative
gaps in the literature and ways PBR can reduce the gap nature of PBR partnerships. Several articles reported
between practice and research are described. insufficient information to allow classification of their
partnerships as either collaborative or consultative.
Levels of Cocreation
This finding is in line with reports from other knowledge
The PBR cocreation model for this scoping review was translation approaches that observed the need for more
designed using experiences of cocreation partnerships consistent and systematic reporting of collaborative
and the existing literature of PBR in health care related research (Drahota et al., 2016). One reason that reporting
fields (Davis et al., 2020; Epstein, 2002). The model partnerships has not become a consistent practice may be
outlines three distinct levels of cocreation that can exist due to the lack of common language amongst knowledge
within PBR: creating practice, capturing current practice, translation fields and between clinicians and researchers.
and changing practice. One purpose of this review was to One hope for the PBR cocreation model is that it provides a
examine available PBR in relation to our proposed model. common language for researchers and clinicians to describe
More studies were classified as capturing practice than the goals of their partnership. In addition, a common
changing practice. Studies involving capturing practice may

language may support an explicit conversation that partnerships can propel our field into creating research that
identifies the type of partnership, thereby making labelling fits the needs of researchers and clinicians.
the partnership in dissemination activities easier (Frisby et
al., 2004). How are data collected? Our review indicated that
qualitative, quantitative, and mixed methods were
Two thirds of the classifiable studies were coded as employed to understand the changes and revisions being
collaborative partnerships. This is no doubt due to the made to the various speech, language, and swallowing
strong interest in collaborative partnerships to build therapies and protocols under study. The most common
cocreated knowledge (Greenhalgh et al., 2016; Filipe et al., method of data collection was through surveys or interviews
2017). It is also possible that successful PBR is facilitated designed to seek evaluative opinion on the effectiveness
by more collaborative partnerships. Twelve of the studies of new or changed practice. Typical interviews focused
classified as collaborative practice were coded using the PBR on clinicians’ experiences with a specific tool or program,
cocreation model as changing practice. This signifies that asked questions surrounding clinical decision making, and
the partnerships were ongoing through the research project assessed barriers to providing clinical treatment. In our
and as the change was incorporated into clinical practice. most recent search year, 2019–2020, the number of studies
Less is known about the six collaborative studies that were using participant outcomes increased compared to prior
coded as capturing practice. Most of these projects involved years (Francis et al., 2019; Imms et al., 2020). Prior to 2019,
only taking a snapshot of clinical practice, making it difficult only one PBR study included such a measure (Jeng, 2015).
to know if the collaboration continued after capturing the Another relatively new PBR outcome measure is the use of
current practice. Nevertheless, the value of collaborative participant qualitative reflections (Weiss et al., 2020).
partnerships is clear and well supported across knowledge
translation approaches (Nguyen et al., 2020). Limitations
This scoping review assessed the range of available
What areas of speech-language pathology are using
evidence related to PBR. Our search was limited to research
PBR most frequently? Our scoping review included articles
involving a practitioner–researcher collaboration in a
from a wide range of journals and encompassed all areas of
knowledge translation framework and situated as a study
speech-language pathology. In our search of the literature,
within the field of speech-language pathology. Practice-
there was equal representation of research articles focusing
based studies without evidence of a partnership and
on adults and on children. Partnerships occurred in all areas
those that did not reference speech-language pathology/
included within the scope of speech-language pathology,
speech therapy were not captured in the search process. In
although no substantial number of articles were found in
addition, if articles did not include data and only described
any one disorder area. Most of this research was occurring
theories and/or the utility of implementation science, PBR,
in hospitals, treatment centres, and rehabilitation centres.
practice-based evidence, etc., they were not included in the
Less frequent locations included public schools, home
review. Further, studies involving program evaluation, quality
care, and long-term care centres. It is difficult to interpret
assurance, codesign, participatory action research, and
(the lack of) differences in disorder areas or settings around
quality improvement were not captured in this search.
which PBR has been reported because the importance
of PBR has been recognized only relatively recently. It is The earliest study included in the present review was
possible that PBR is occurring more frequently in certain from 2010, suggesting that prior practice-based evidence
disorder areas or settings but not yet being reported in the that did not reference a knowledge-to-action framework
literature. An increase in reporting on composition, types, may not have been represented. In the field of speech-
and purposes of cocreation partnerships will support a language pathology, practice-based evidence has a long
better understanding of the practice settings and contexts tradition (Wambaugh, 2007). For example, Mecrow and
best suited for PBR. The recency of PBR is illustrated in the colleagues (2010), who are clinicians and researchers,
publication dates of the included articles in the current partnered to collect evidence for a speech and language
review. The earliest article was published in 2010, and most program in schools, but their article did not describe a
of the articles found in this search appeared after 2017. The partnership or identify a knowledge-translation approach
presence of PBR in speech-language pathology, and the and therefore was not captured in the search. Because
recognition of the value that partnerships bring to research, earlier practice-based evidence would align most closely
is a new and unique approach to our field. In discussion with capturing practice in our model, our finding that
about knowledge translation and implementation science, capturing practice was the most prevalent design is
a focus on PBR would support understanding of how accurate but possibly underestimated. An additional

217 Volume 46, No 3, 2022
limitation includes a lack of calculated interrater reliability Auslander, G., Dobrof, J., & Epstein, I. (2002). Comparing social work's role in renal
dialysis in Israel and the United States: The practice-based research potential
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treatment for children with autism spectrum disorder: Provider perspectives
The goal of the current scoping review was to examine on acceptability, feasibility, and fit at school. Canadian Journal of School
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Bowen, S., & Graham, I. D. (2013). Integrated knowledge translation. In S. E. Straus, J.
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Tetroe, & I. D. Graham (Eds.), Knowledge translation in health care (pp. 14–23).
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date, research in speech-language pathology involving the evidence alert system to improve clinician’s evidence-based practice
behavior—A cluster randomized controlled trial. Implementation Science, 8,
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PBR framework is emerging. However, inconsistencies in Canadian Institutes of Health Research. (2008). Knowledge translation strategy 2004-
the terminology to define this type of research were noted. 2009. https://cihr-irsc.gc.ca/e/26574.html
The PBR cocreation model was developed to describe Candy, L., & Edmonds, E. (2018). Practice-based research in the creative arts:
the range of research questions that can be addressed Foundations and futures from the front line. Leonardo, 51(1), 63–69. https://doi.
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using this approach. Clinicians and researchers are
Crooke, P. J., & Olswang, L. B. (2015). Practice-based research: Another pathway for
encouraged to determine the desired outcome (i.e, creating closing the research–practice gap. Journal of Speech, Language, and Hearing
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evidence-based assessment procedures: Perspectives from the front lines in
introduction of this model for clinical–research partnership pediatric speech-language pathology. Journal of Communication Disorders, 80,
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bring new terminology to those doing this type of work, and Moving research tools into practice: The successes and challenges in promoting
uptake of classification tools. Disability and Rehabilitation, 40(9), 1099–1107.
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create new knowledge surrounding the best ways to build stakeholders and improve outcome measurement in a preschool speech-
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Curran, G. M. (2020). Implementation science made too simple: A teaching tool.
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SONDAGE INTERVENTIONS SONS DE LA PAROLE Canadian Journal of Speech-Language Pathology and Audiology (CJSLPA)
Les pratiques d’intervention en orthophonie auprès des

enfants francophones ayant un trouble des sons de la parole :
résultats d’un sondage québécois
Speech-Language Pathology Intervention Practices for
French-Speaking Children with Speech Sound Disorders:
Results of a Québec Survey
MOTS-CLÉS Laurie Montembeault

TROUBLE DES SONS Véronique McDuff
DE LA PAROLE Marie-Pier Gingras
APPROCHES Louise Duchesne
D’INTERVENTION
SONDAGE
ENFANTS
PROVINCE DE QUÉBEC
Laurie Montembeault,
Véronique McDuff,
Marie-Pier Gingras
et Louise Duchesne
Département d’orthophonie,
Université du Québec à Trois-
Rivières, QC, CANADA
Abrégé
Plusieurs approches d’intervention existent pour traiter le trouble des sons de la parole et l’efficacité
de certaines d’entre elles a été démontrée par la recherche. Cependant, l’absence de lignes directrices
concernant les meilleures approches à utiliser complique l’intégration des principes scientifiques dans la
pratique des orthophonistes, bien qu’elles y soient tenues par leur ordre professionnel. L’objectif général
de cette étude était de recenser les approches utilisées par les orthophonistes du Québec et d’en discuter
selon une pratique fondée sur les preuves scientifiques. Cent six orthophonistes québécoises travaillant
auprès d’enfants ont répondu à un questionnaire. Les résultats ont montré que les quatre approches
d’intervention les plus connues sont l’approche traditionnelle d’articulation, la dynamique naturelle de
la parole, les paires minimales et les exercices oro-moteurs. Les trois approches les plus utilisées sont
l’approche traditionnelle d’articulation, la stimulation intégrale et la dynamique naturelle de la parole.
Parmi les approches dont l’efficacité a été démontrée par des études présentant un bon niveau de preuve
scientifique, seule l’approche traditionnelle d’articulation est utilisée par la majorité des répondantes.
Plusieurs questions peuvent être soulevées concernant la disponibilité des recherches scientifiques et leur
Rédacteur : applicabilité en clinique. Enfin, en comparant les résultats de la présente étude aux enquêtes menées dans
Stefano Rezzonico d’autres pays, il est possible d’observer quelques ressemblances, mais aussi des divergences quant aux
Rédacteur en chef : approches d’intervention préconisées : les orthophonistes québécoises ciblent davantage la production
David H. McFarland des sons alors que celles des pays anglophones ciblent la perception.
Les pratiques d’intervention en orthophonie auprès des enfants francophones ayant un trouble des sons de la parole : résultats d’un sondage québécois
221 Volume 46, No 3, 2022
Revue canadienne d’orthophonie et d’audiologie (RCOA) SONDAGE INTERVENTIONS SONS DE LA PAROLE
Abstract
A variety of approaches for the treatment of speech sound disorders exist, some with efficacy established
by research. The absence of guidelines regarding the best approaches to use makes it difficult for
speech-language pathologists to provide evidence-based practice even though professional regulations
require them to do so. The aim of this study was to describe interventions that are used by speech-
language pathologists in the province of Québec to treat children with speech sound disorders and to
discuss whether those interventions are supported by research. One hundred and six speech-language
pathologists working with children across Québec completed a survey. The results showed that they
are most familiar with (a) a traditional articulation approach, (b) natural speech dynamics, (c) minimal
oppositions therapy, and (d) nonspeech oral motor exercises. A traditional articulation approach, integral
stimulation speech therapy, and natural speech dynamics are the most widely used. Among approaches
proven to be effective, only the traditional articulation approach is commonly used by the respondents.
This study addresses issues regarding the availability and applicability of research results in clinical
practice. Finally, comparing the results of this survey with those conducted in different countries, we found
similarities but also a discrepancy in the approaches advocated: Speech-language pathologists in Québec
target sound production rather than perception, unlike those in English-speaking countries.

Le trouble des sons de la parole (TSP) est caractérisé Classement des approches d’intervention pour traiter le
par un développement atypique de la phonétique et de la TSP selon leur niveau de preuve scientifique
phonologie, ce qui diminue l’intelligibilité de l’enfant (MacLeod Les preuves scientifiques ne sont pas toutes de la même
et al., 2015). La dyspraxie verbale est un trouble affectant la qualité. Dans l’optique d’avoir un vocabulaire commun à
planification et la programmation des mouvements associés toutes les disciplines du domaine de la santé, les niveaux du
à la parole qui peut être classé parmi les TSP (Charron et modèle du Oxford Centre for Evidence-Based Medicine Levels
MacLeod, 2010; Williams et al., 2010). Il est en effet difficile de of Evidence Working Group (2011) sont utilisés dans plusieurs
distinguer la dyspraxie verbale des autres types de TSP parce études pour hiérarchiser les preuves scientifiques des
que les critères pour le faire ne reposent pas entièrement sur traitements (Azer et Azer, 2018; Glickman et al., 2010). C’est
des données objectives détaillant les caractéristiques de la également le modèle retenu pour classer les interventions
dyspraxie verbale en ce qui concerne leur degré de sévérité, en TSP de cette étude. Ce modèle est séparé en niveaux
leur fréquence et leur contexte (Murray et al., 2021). Pour ces de 1 à 5, soit du plus haut niveau de preuve scientifique au
raisons, la dyspraxie verbale est incluse dans l’appellation plus bas. Le niveau 1 correspond principalement aux méta-
TSP de la présente étude. Le TSP est très répandu : jusqu’à analyses d’essais cliniques randomisés; le niveau 2 aux études
15,6 % des enfants d’âge préscolaire pourraient en être contrôlées sans randomisation; le niveau 3 aux études de
affectés (Campbell et al., 2003). Les enfants d’âge préscolaire cas-témoins; le niveau 4 aux études de cas; le niveau 5 aux
présentant un tel trouble ont un risque accru de rencontrer opinions d’experts.
des difficultés durant le primaire, notamment en lecture et
en écriture. (Anthony et al., 2011; Bleile, 2018; Felsenfeld et Dans une revue systématique portant sur les approches
al., 1992). Ils sont également susceptibles de présenter des d’intervention en TSP, Baker et McLeod (2011a) ont répertorié
difficultés socio-émotionnelles dues au fait qu’ils peuvent être 134 études portant sur 46 approches d’intervention
mal compris par les personnes peu familières (McCormack et distinctes. Parmi ces dernières, 23 approches d’intervention
al., 2010). pour le TSP étaient décrites à plus d’une reprise dans les
études sélectionnées. Leurs résultats ont révélé entre autres
En recherche et en clinique, plusieurs approches que la plupart étaient des études de cas. Quant à eux, Wren
ont été développées pour traiter le TSP. Ces approches et al. (2018) ont inventorié, dans leur revue systématique, 26
d’intervention sont supportées par différents niveaux de études portant sur les approches d’intervention pour le TSP.
preuves scientifiques (Baker et McLeod, 2011a). Bien que les Leurs conclusions se sont avérées semblables à celles de
orthophonistes soient tenues par leur ordre professionnel Baker et McLeod (2011a) : la majorité des études présentaient
d’appliquer les principes scientifiques généralement de bas niveaux de preuves scientifiques. Ainsi, pour le TSP,
reconnus (LégisQuébec, 2020), leurs interventions ne sont des études de plus hauts niveaux de preuves scientifiques
pas toujours en conformité avec la recherche (Lancaster seraient nécessaires afin de mieux justifier l’efficacité des
et al, 2010). En effet, les orthophonistes combinent différentes approches d’intervention.
plusieurs approches d’intervention et les appliquent de
façon éclectique selon le profil de l’enfant ou elles utilisent Le tableau 1 détaille les 17 approches d’intervention
une seule approche en diminuant le dosage démontré en TSP ciblées dans le cadre de cette étude. Elles sont
efficace dans la littérature scientifique (Gomez et al., 2022; classées selon leur niveau de preuve scientifique, leur
Lancaster et al., 2010; Pascoe et al., 2010). nombre d’études publiées portant sur la population
pédiatrique présentant un TSP sans trouble associé (ex. :
Au cours des dernières années, quelques enquêtes ont fente palatine ou syndrome de Down), ainsi que selon
été menées concernant les modalités et les approches leur axe d’intervention (perception/production de la
d’intervention utilisées par les orthophonistes pour parole). Les revues systématiques de Baker et McLeod
le traitement du TSP chez les enfants anglophones, (2011a) et de Wren et al. (2018) incluent certaines des 17
notamment au Royaume-Uni (Hegarty et al., 2018; Joffe approches retenues pour la présente étude : l’approche
et Pring, 2008), en Australie (McLeod et Baker, 2014) traditionnelle d’articulation, les paires minimales, le
et aux États-Unis (Brumbaugh et Smit, 2013). À notre Core vocabulary, la perception de la parole/Speech
connaissance, aucune étude de ce type n’a été menée Assessment and Interactive Learning System et l’approche
auprès d’orthophonistes exerçant en milieu francophone. cyclique. La présente étude a recensé moins d’approches
Ainsi, nous nous sommes intéressées aux approches d’intervention que Baker et McLeod (2011a) et, au contraire
d’intervention utilisées par les orthophonistes québécoises de Baker et McLeod (2011a) et de Wren et al. (2018), la
francophones pour traiter le TSP et aux niveaux de preuves plupart des 17 approches choisies ont un haut niveau de
scientifiques de ces mêmes approches. preuves scientifiques. Le tableau 1 intègre également des
223 Volume 46, No 3, 2022
Tableau 1
Les approches d’intervention classées selon leur niveau de preuve scientifique
Approches Référence d’origine et Nombre d’études Axe Description de l’approche 1
d’intervention référence la plus récente répertoriées d’intervention
Niveau 1 : efficacité prouvée par une méta-analyse ou par une étude randomisée contrôlée
Approche traditionnelle/ Van Riper (1939) Acquisition d’un seul phonème problématique à la
14 Production
d’articulation Lousada et al. (2013) fois
Weiner (1981) Contraster des mots identiques à l’exception d’un
Paires minimales 42 Perception
Dodd et al. (2008) phonème, différencié par un seul trait
Gierut (1989) Contraster des mots identiques par des phonèmes
Oppositions maximales 8 Perception
Dodd et al. (2008) les plus différents
Williams (2000) Établir un contraste entre un phonème cible et
Oppositions multiples 11 Perception
Allen (2013) plusieurs autres phonèmes
Crosbie et al. (2005)
Core vocabulary 7 Production Intervenir sur un nombre de mots très fréquents
Broomfield et Dodd (2005)
Hodson et Paden (1983) Approche Plusieurs patrons phonologiques sont traités tour à
Approche cyclique 17 2
Almost et Rosenbaum (1998) combinée tour dans des cycles
Royal National Throat, Nose and
Nuffield Centre Dyspraxia Avoir le matériel et suivre le programme du même
Ear Hospital (2020) 7 Production
Programme nom
Murray et al. (2015)
Van Riper (1963) Présentation auditive de mots reliés aux patrons à
Perception de la parole/SAILS 4 Perception
Rvachew et al. (2004) traiter chez l’enfant
Niveau 2 : efficacité prouvée par des études contrôlées sans randomisation et par des études quasi-expérimentales
Metaphon ou conscience Howell et al. (1993) Améliorer la conscience des contrastes entre les
13 Perception
phonologique Dodd et Bradford (2000) phonèmes et l’autocorrection
Chumpelik (1984) Utilisation du toucher pour guider manuellement
PROMPT 12 Production
Kadis et al. (2014) l’articulation du patient
Approche non-linéaire Bernhardt (1990) Viser les niveaux du système phonologique plutôt
6 Production
Edwards (1995) que des sons spécifiques
Milisen (1954)
L’enfant doit regarder les indices fournis par le
Stimulation intégrale Gildersleeve-Neumann et 6 Production
clinicien et essayer d’imiter
Goldstein (2015)

Tableau 1 (suite)
Les approches d’intervention classées selon leur niveau de preuve scientifique
Niveaux 3 à 5 : faibles preuves d’efficacité (cas-témoins, études de cas et opinions d’experts)
Approche basée Miccio et Elbert (1996) Chaque consonne est associée à un personnage allitératif
6 Production
sur la stimulabilité Miccio (2009) et à un geste
Insister sur la position de départ du mouvement,
Application des principes Schmidt (1993) Opinions d’experts
Production les paramètres du mouvement (p. ex. trajectoire)
d’apprentissage moteur Strand (2013) seulement
et rétroaction donnée à l’enfant
Approche dont l’efficacité n’est pas démontrée
Dynamique naturelle de la Aucune étude Utilisation d’inputs auditif, visuel et/ou kinesthésique
Dunoyer de Segonzac (1991) Production
parole scientifique (mouvements du corps)
Approches prouvées inefficaces pour traiter les TSP

Hodson et Paden (1983) Présentation auditive d’une liste de mots qui sont reliés
Bombardement auditif 23 Perception
Gangloff (1991) aux patterns d’erreurs de l’enfant
Dworkin (1978) Activités non langagières (ex. : souffler) qui impliquent les
Exercices oro-moteurs 34 Production
Lee et Gibbon 5 (2015) sens et/ou l’action des articulateurs
Note. SAIL = Speech Assessment and Interactive Learning System; PROMPT = PROMPTS for Restructuring Oral Muscular Phonetic Targets
1
Résumé des descriptions des approches ciblées. 2 Inclut également l’approche cyclique utilisée avec certaines modifications. 3 Études concernant l’utilisation du bombardement auditif seulement. 4 Nombre d’études répertoriées dans la revue systématique mentionnée. 5 Revue
systématique suggérant l’inefficacité de l’approche.
approches prouvées inefficaces et des approches pour lesquelles l’efficacité n’a résultats similaires : les cinq approches d’intervention les plus utilisées pour
pas été démontrée. traiter les troubles phonologiques étaient la discrimination auditive, les paires
minimales, la conscience phonologique, l’approche traditionnelle d’articulation et
Les enquêtes menées dans les pays anglophones l’approche psycholinguistique (Hegarty et al., 2018). Aux États-Unis (Brumbaugh
Des enquêtes ont décrit les pratiques des orthophonistes intervenant auprès et Smit, 2013), les résultats ont montré qu’environ la moitié des répondantes
d’enfants ayant un TSP dans différents pays comme le Royaume-Uni (Hegarty utilisaient fréquemment l’approche traditionnelle d’articulation et que le tiers
et al., 2018; Joffe et Pring, 2008), les États-Unis (Brumbaugh et Smit, 2013) et des répondantes l’utilisait de 40 % à 60 % du temps. D’autres approches étaient
l’Australie (McLeod et Baker, 2014). Ces études portaient sur des orthophonistes aussi utilisées régulièrement, notamment la conscience phonologique, les
pratiquant auprès d’enfants anglophones. paires minimales et l’approche cyclique. Finalement, en Australie (McLeod et
Baker, 2014), les huit approches d’intervention ressorties comme étant les
Au Royaume-Uni, les trois approches les plus populaires étaient la plus utilisées étaient : la discrimination auditive, les paires minimales, Cued
discrimination auditive, les paires minimales et la conscience phonologique articulation, la conscience phonologique, l’approche traditionnelle d’articulation,
(Joffe et Pring, 2008). Les thérapies les moins utilisées étaient les oppositions le bombardement auditif, le Nuffield Centre Dyspraxia Programme et le Core
maximales, l’approche cyclique, le Core vocabulary et le bombardement vocabulary. Les auteurs ont conclu que leurs résultats étaient similaires à ceux
auditif. En 2018, un deuxième sondage distribué dans ce pays a indiqué des des autres pays comme le Royaume-Uni et les États-Unis en ce qui concerne les
225 Les pratiques d’intervention en orthophonie auprès des enfants francophones ayant un trouble des sons de la parole : résultats d’un sondage québécois Volume 46, No3, 2022
pratiques utilisées chez les enfants ayant un TSP. Certaines validée par une orthophoniste ayant une longue expérience
approches concordaient avec une pratique basée sur les en TSP. À la suite de ses recommandations, la stimulation
faits scientifiques alors que d’autres présentaient un bas intégrale et l’application des principes d’apprentissage
niveau de preuves scientifiques (McLeod et Baker, 2014). moteur ont été ajoutées. Ainsi, nous avons sondé les
orthophonistes sur 17 approches d’intervention. Pour
L’intervention auprès des enfants ayant un TSP étant certaines de ces approches, comme les paires minimales
très fréquente en clinique (Broomfield et Dodd, 2004), il est et l’approche cyclique, il existe des preuves scientifiques
primordial pour les cliniciennes de réfléchir à leur pratique (Baker et McLeod, 2011a). Pour d’autres, il existe peu de
et de s’assurer que leurs connaissances sont actualisées preuves scientifiques, voire aucune. Les approches de cette
dans ce domaine. Cette réflexion semble être commencée dernière catégorie ont été choisies pour deux raisons : 1)
dans les pays anglophones nommés précédemment, mais leur utilisation était rapportée dans d’autres études, comme
ces résultats peuvent ne pas être applicables au contexte c’est le cas pour les exercices oro-moteurs (Joffe et Pring,
québécois. En effet, les pratiques cliniques québécoises 2008), 2) leur utilisation répandue dans différents milieux
et anglo-saxonnes n’ont pas les mêmes influences. Du cliniques francophones du Québec avait été observée.
fait de sa proximité géographique avec le Canada anglais Finalement, avant sa diffusion massive, le questionnaire
et les États-Unis, la présence de l’anglais au Québec et a été envoyé à cinq orthophonistes proches des milieux
l’accès à des approches d’intervention majoritairement universitaires afin de recevoir leurs commentaires sur le
anglophones, les orthophonistes québécoises ont les sondage. Notons que chaque approche d’intervention
mêmes influences que les orthophonistes anglo-saxonnes. était sommairement décrite dans le questionnaire, puisque
Toutefois, les orthophonistes québécoises peuvent aussi c’était une limite soulevée dans le sondage mené aux États-
être portées à se tourner vers la France pour avoir accès Unis par Brumbaugh et Smit (2013).
à des pratiques qui tiennent compte de la structure du
français. Ces facteurs pourraient différencier la pratique Participantes
des orthophonistes québécoises de celles pratiquant dans
Les personnes intéressées devaient répondre à
les pays majoritairement anglophones. Conséquemment,
trois critères afin de pouvoir participer à cette étude : 1)
des données applicables au contexte clinique québécois
être membres orthophonistes réguliers de l’Ordre des
sont nécessaires.
orthophonistes et des audiologistes du Québec (OOAQ);
En 2016, notre équipe de recherche a diffusé un 2) pratiquer au Québec auprès d’enfants; 3) pratiquer
sondage en ligne à destination des 106 répondantes, auprès d’une clientèle majoritairement francophone. Au
membres de l’Ordre des orthophonistes et audiologistes total, 106 orthophonistes ont répondu au questionnaire.
du Québec travaillant auprès d’enfants. Un premier Cela représente 4,1 % des orthophonistes du Québec selon
niveau d’analyse a été réalisé dans le cadre d’un travail de l’OOAQ (2017).
recherche étudiant (McDuff, 2017). L’objectif principal de
Parmi ces personnes, 95,24 % étaient des femmes. Elles
cette étude était de recenser les approches d’intervention
provenaient de toutes les régions administratives du Québec
utilisées par les orthophonistes québécoises pour traiter
(à l’exception de la Gaspésie–Îles-de-la-Madeleine et du
le TSP en lien avec une pratique basée sur les preuves
Nord-du-Québec). Elles cumulaient entre 6 mois et 35 ans
scientifiques et d’examiner les facteurs qui guident leurs
d’expérience dans la pratique de l’orthophonie. Environ un
choix d’intervention. Plus spécifiquement, nous analysons
tiers des personnes ayant répondu avait quatre ans et moins
1) la connaissance des approches d’intervention en TSP et
d’expérience de travail (35,8 %, n = 38), un tiers avait entre 4
2) la fréquence d’utilisation de ces approches. Un objectif
et 12 ans d’expérience (33,9 %, n = 36) et un tiers avait plus
secondaire est de comparer les résultats obtenus avec
de 12 ans d’expérience (30,2 %, n = 32). En moyenne, elles
ceux des enquêtes menées dans les autres pays.
ont complété le questionnaire en 16 minutes.
Méthodologie
Outil de collecte : élaboration et diffusion
Sélection des approches
L’outil de collecte choisi était un questionnaire en ligne
L’étude a été approuvée par le Comité d'éthique de
composé de 24 questions. La plupart des questions et choix
la recherche avec des êtres humains de l'Université
de réponses étaient inspirés des quatre enquêtes menées
du Québec à Trois-Rivières (CER-16-223-07.07). Dans
dans les pays nommés précédemment (Brumbaugh
un premier temps, 15 approches d’intervention ont été
et Smit, 2013; Hegarty et al., 2018; Joffe et Pring, 2008;
sélectionnées à partir d’un ouvrage de référence portant
McLeod et Baker, 2014). Le questionnaire était séparé en
sur l’intervention du TSP (Williams et al., 2010). Dans un
trois parties : 1) les informations démographiques, 2) la
deuxième temps, la liste des approches d’intervention a été

charge de travail (caseload) et la prestation des services scientifique associé à chaque intervention correspond
et 3) les approches d’intervention. Dans le cadre de cette au plus haut niveau relevé dans la littérature. Parmi les 17
étude, seules les données concernant la troisième section approches d’intervention utilisées par les orthophonistes
ont été analysées. Les participantes ont été recrutées québécoises pour traiter le TSP, huit ont prouvé leur
par le biais des réseaux sociaux, de forum de discussion efficacité par le plus haut niveau de preuves scientifiques,
en orthophonie et d’association d’orthophonistes. Il était soit par une méta-analyse ou par une étude contrôlée
possible de répondre au sondage pendant 3 mois sur la randomisée. Parmi ces huit approches, une seule est utilisée
plateforme en ligne SimpleSondage. par la majorité des répondantes : l’approche traditionnelle
d’articulation. En revanche, les oppositions multiples,
Traitement et analyse des données Core Vocabulary, l’approche cyclique, les oppositions
Les données concernant la région de pratique des maximales, la perception de la parole, Nuffield Centre
répondantes, leur connaissance et leur utilisation des Dyspraxia Programme sont utilisés par moins de 25 % des
différentes approches d’intervention ont été importées orthophonistes bien que leur efficacité soit démontrée par
dans un fichier Excel. Elles ont été analysées à l’aide de des études scientifiques de bon niveau de preuve.
statistiques descriptives. Plus précisément, les approches
ont été classées selon le pourcentage d’orthophonistes qui Comparaison avec les enquêtes menées dans les
autres pays
les connaissaient et qui les utilisaient. Des comparaisons
descriptives ont été réalisées. Les approches d’intervention utilisées par les
orthophonistes du Québec ont été comparées à celles
Résultats mentionnées dans les enquêtes menées aux États-Unis,
au Royaume-Uni et en Australie. Le tableau 3 présente
Connaissance des approches d’intervention
une comparaison des trois approches les plus utilisées
Le sondage a permis de questionner les répondantes par les orthophonistes au Québec, en Australie, aux États-
sur leur familiarité avec les 17 approches d’intervention Unis et au Royaume-Uni. Il ressort de cette comparaison
en TSP. Pour ce faire, les répondantes devaient indiquer que l’approche la plus utilisée par les orthophonistes du
si elles connaissaient l’approche en identifiant la façon Québec (91 %), l’approche traditionnelle d’articulation,
dont elles en avaient entendu parler la première fois (p. est également la plus utilisée (49 % l’utilisent souvent ou
ex. : formation initiale, formation continue donnée en toujours) aux États-Unis (Brumbaugh et Smit, 2013). Les
groupe, article scientifiqus). Pour les approches inconnues, deux autres approches les plus populaires au Québec pour
les participantes cochaient la case « cette approche ne traiter le TSP, soit la stimulation intégrale et la DNP, ne sont
m’est pas familière ». La figure 1 présente les approches pas présentes dans les questionnaires distribués dans les
d’intervention, de la plus connue par les répondantes à la autres pays. Ces résultats ne peuvent pas être comparés.
moins connue. Les quatre approches les plus connues sont
l’approche traditionnelle/thérapie d’articulation (98 % des À l’inverse, certaines approches fréquemment utilisées
répondantes), la dynamique naturelle de la parole (DNP) selon ces enquêtes ne le sont pas autant au Québec
(98 %), les paires minimales (95 %) et les exercices oro- (Brumbaugh et Smit, 2013; Hegarty et al., 2018; Joffe et
moteurs (95 %). Les trois moyens les plus fréquents par Pring, 2008; McLeod et Baker, 2014). C’est le cas de la
lesquels les approches d’intervention ont été connues sont discrimination auditive et de la conscience phonologique.
la formation initiale (63 %), la formation continue (12 %) et La première est l’approche la plus utilisée en Australie
les collègues (9 %). Enfin, 4 % des répondantes rapportent et au Royaume-Uni (Hegarty et al., 2018; Joffe et Pring,
avoir connu des approches d’intervention par la lecture 2008; McLeod et Baker, 2014), mais elle n’apparait pas
d’articles scientifiques. dans le questionnaire québécois. La seconde fait partie
des trois approches les plus utilisées aux États-Unis et au
Utilisation des approches d’intervention Royaume-Uni (Brumbaugh et Smit, 2013; Hegarty et al.,
2018; Joffe et Pring, 2008) alors qu’elle est utilisée par 41 %
Les trois approches d’intervention les plus utilisées par
des répondantes du Québec. Semblablement, les paires
les répondantes (tous les jours, quelques fois par semaine
minimales font partie des trois approches les plus utilisées
ou quelques fois par mois) sont l’approche traditionnelle/
dans chacun des pays anglo-saxons (Brumbaugh et Smit,
thérapie d’articulation (91 % des répondantes), la
2013; Hegarty et al., 2018; Joffe et Pring, 2008; McLeod et
stimulation intégrale (66 %) et la DNP (55 %).
Baker, 2014) questionnés comparativement à 46 % chez les
Le tableau 2 présente les approches d’intervention, orthophonistes québécoises.
des plus utilisées aux moins utilisées. Le niveau de preuve
227 Volume 46, No 3, 2022
Figure 1
Les approches d’intervention ordonnées de la plus connue à la moins connue par les répondantes
Note. DPN = dynamique naturelle de la parole; PROMPT = PROMPTS for Restructuring Oral Muscular Phonetic Targets; SAIL = Speech Assessment and Interactive Learning System.
Discussion
Menée auprès de 106 orthophonistes du Québec œuvrant auprès d’une 1) d’établir un classement des approches les plus connues et les plus utilisées,
clientèle majoritairement francophone, cette étude a pour but de décrire les 2) de comparer ce classement avec le niveau de preuves scientifiques qui
pratiques actuelles au regard des approches d’intervention connues et utilisées soutiennent ces approches et 3) de noter les similitudes et les différences avec
pour traiter le TSP, en lien avec une pratique basée sur les preuves scientifiques. les enquêtes anglophones. Ainsi, ces résultats amorcent une réflexion concernant
Il s’agit aussi de comparer les résultats de la présente étude à ceux des études la disponibilité et l’applicabilité des preuves scientifiques dans la pratique auprès
effectuées dans des pays anglo-saxons. Les résultats de cette étude permettent d’enfants ayant un TSP.

Tableau 2
Classement des approches d’intervention selon leur pourcentage d’utilisation par les répondantes et leur
niveau de preuves scientifiques respectif
Approches d’intervention Pourcentage Niveau de preuves

d’utilisation 1 scientifiques
Approche traditionnelle 91 N1
Stimulation intégrale 66 N2
Dynamique naturelle de la parole 55 Efficacité non prouvée
Approche non-linéaire 54 N2
Application des principes d’apprentissage moteur 52 N5
Approche basée sur la stimulabilité 51 N4
Paires minimales 46 N1
Conscience phonologique/Metaphon 41 N2
Bombardement auditif 29 Inefficacité prouvée
PROMPT 23 N2
Oppositions multiples 16 N1
Core Vocabulary 13 N1
Exercices oro-moteurs 13 Inefficacité prouvée
Approche cyclique 13 N1
Oppositions maximales 11 N1
Perception de la parole 4 N1
Nuffield Centre Dyspraxia Programme 0 N1
Note. PROMPT = PROMPTS for Restructuring Oral Muscular Phonetic Targets; N1 = niveau 1; N2 = niveau 2; N4 =niveau 4; N5 = niveau 5.
1
Approches utilisées chaque jour, plusieurs fois par semaine ou plusieurs fois par mois.
Tableau 3
Comparaison des trois approches d’intervention les plus utilisées selon les différentes enquêtes
Québec Australie États-Unis Royaume-Uni Royaume-Uni
(Présente étude) (McLeod et Baker, (Brumbaugh et (Joffe et Pring, (Hegarty et al.,
2014) Smit, 2013) 2008) 2018)
1. Approche 1. Discrimination 1. Approche 1. Discrimination 1. Discrimination
traditionnelle auditive traditionnelle auditive auditive
2. Stimulation intégrale 2. Paires minimales 2. Conscience 2. Paires minimales 2. Paires minimales
phonologique
3. Dynamique naturelle 3. Cued articulation 1 3. Paires minimales 3. Conscience 3. Conscience
de la parole phonologique phonologique
1
Approche d’intervention où chaque son est associé à un indice fait d’un geste de la main qui représente l’endroit et la façon dont le son est produit. Un code de couleur est également utilisé pour représenter
chaque son (Passy, 2010).
Connaissance des approches

Lorsque les répondantes ont été interrogées sur la principalement : la formation initiale, les formations données
façon dont elles avaient entendu parler des approches en groupe et les échanges avec des collègues. Ces résultats
d’intervention la première fois, ce sont les moyens rejoignent les données de la littérature qui suggèrent que les
d’apprentissage où il y a un contact direct entre les nouvelles connaissances des orthophonistes proviennent
orthophonistes et d’autres personnes qui ressortent des discussions informelles avec des collègues et de
229 Les pratiques d’intervention en orthophonie auprès des enfants francophones ayant un trouble des sons de la parole : résultats d’un sondage québécois Volume 46, No 3, 2022
la formation continue en groupe (Denman et al., 2021; 15 dernières années, la DNP a été largement diffusée par
Furlong et al., 2018; McCurtin et Carter, 2015). Malgré le de nombreuses formations de groupe au Québec. La DNP
fait qu’il s’agisse d’un moyen privilégié pour l’acquisition a peut-être intégré la pratique clinique parce qu’elle est
de nouvelles connaissances, l’OOAQ a offert une seule soutenue par deux sources de connaissances privilégiées
formation sur l’intervention en TSP, donnée à trois reprises, par les orthophonistes : la formation continue de groupe
en dix ans. Celle-ci portait uniquement sur le traitement et les échanges entre collègues (en lien avec la quantité
de la dyspraxie verbale (OOAQ, rapports annuels 2010- importante de formation offerte). Son haut taux d’utilisation
2020). Également, peu de répondantes mentionnent avoir indique que les orthophonistes ne choisissent pas leurs
connu des approches d’intervention par la lecture d’articles approches de traitement uniquement sur la base du niveau
scientifiques. Ce constat concorde avec les façons de faire de preuves scientifiques. L’expérience personnelle des
des orthophonistes américaines qui lisent également peu orthophonistes demeure une variable importante dans
d’articles (Hoffman et al., 2013). Une étude menée auprès leur choix d’approche et le changement de pratique, pour
d’orthophonistes aux États-Unis et au Canada travaillant adopter des interventions plus efficaces, apparaît exigeant.
auprès d’enfants ayant une dyspraxie verbale a identifié les En effet, les cliniciennes seraient peu enclines à changer
principales barrières à la lecture d’articles scientifiques : les des pratiques qui donnent des résultats positifs selon
orthophonistes disent qu’elles sont trop occupées, que leur leurs observations en clinique, et ce, même si une étude
employeur a des attentes trop élevées quant à la quantité de démontre que l’approche qu’elles utilisent pourrait être
clients qu’elles doivent voir et qu’elles arrivent difficilement moins efficace qu’une autre (Hegarty et al., 2021; McCurtin
à accéder aux articles scientifiques (Gomez et al., 2022). et Carter, 2015). Selon Furlong et al. (2021), la familiarité
Dans notre étude, il est raisonnable de penser que les des orthophonistes avec une approche et la facilité
orthophonistes rencontrent des obstacles similaires à ceux d’implantation d’une approche sont des facteurs pouvant
décrits dans Gomez et al. (2022), comme le manque de influencer les décisions cliniques. Ainsi, la DNP présente
temps et l’accès difficile aux articles scientifiques (Greenwell ces caractéristiques : 1) l’approche est entièrement
et Walsh, 2021; McLeod et Baker, 2014). francophone ce qui la rend plus facile à implanter au
Québec, 2) des formations de groupe sont fréquemment
Utilisation des approches publicisées dans divers forums et réseaux sociaux. Enfin,
Les répondantes ont été questionnées sur la il est possible de présumer que si les orthophonistes du
connaissance et la fréquence d’utilisation des différentes Québec utilisent la DNP, c’est possiblement parce qu’elles
approches d’intervention. Les résultats montrent que les observent des résultats positifs dans leur bureau, même si
approches d’intervention les plus connues ne sont pas l’approche ne dispose d’aucun appui scientifique.
nécessairement les plus utilisées. À titre d’exemple, les
Par ailleurs, nos résultats montrent que plusieurs
approches des paires minimales et des exercices oro-
approches d’intervention sont peu utilisées par les
moteurs sont connues par 95 % des répondantes, mais elles
orthophonistes du Québec, bien qu’elles aient des appuis
ne font pas partie des approches les plus utilisées par les
scientifiques solides. C’est notamment le cas des paires
orthophonistes du Québec. À l’inverse, il arrive que d’autres
minimales (Dodd et al., 2008), des oppositions multiples
approches très connues soient également très utilisées.
(Allen, 2013), du Core Vocabulary (Broomfield et Dodd,
C’est le cas de l’approche traditionnelle d’articulation et de
2005), de l’approche cyclique (Almost et Rosenbaum,
la DNP qui se retrouvent autant parmi les approches les plus
1998), des oppositions maximales (Dodd et al., 2008), de la
connues que parmi les approches les plus utilisées.
perception de la parole (Rvachew et al., 2004) et du Nuffield
L’approche la plus utilisée par les répondantes a une Centre Dyspraxia Programme (Murray et al., 2015).
efficacité appuyée par des études de bon niveau de
Les participantes à la présente étude n’ont pas
preuves scientifiques (voir Lousada et al., 2013). Cependant,
été questionnées spécifiquement sur les raisons pour
parmi les cinq autres approches les plus utilisées, l’efficacité
lesquelles ces approches sont peu utilisées. En revanche,
d’aucune d’entre elles n’a été prouvée par le plus haut
plusieurs études ont démontré qu’il existe des barrières
niveau de preuves scientifiques possible comme une méta-
à l’implantation d’une pratique basée sur les preuves
analyse d’essais cliniques randomisés.
scientifiques en clinique, notamment une difficulté à
Il faut se questionner sur l’utilisation répandue de la transférer directement les connaissances issues des
DNP, pour laquelle il n’existe aucune preuve d’efficacité résultats d’une étude à la réalité clinique (Furlong et al.,
– ni aucune étude publiée dans une revue ayant un 2018; Hegarty et al., 2021). Plusieurs raisons expliquent
processus de révision par les pairs. Toutefois, au cours des cette difficulté comme la fréquence de traitement

recommandée, les contraintes d’organisation des services, Comparaison avec les autres pays
des résultats d’études qui se contredisent ou un faible Notre étude montre que la discrimination auditive, la
nombre d’études, un faible potentiel de généralisation conscience phonologique et les paires minimales sont
des résultats et un manque de temps des professionnels un peu moins utilisées au Québec que dans les pays
(Baker et McLeod, 2011b; Furlong et al., 2018; McCurtin anglophones (Brumbaugh et Smit, 2013; Hegarty et al.,
et Carter, 2015; Zipoli et Kennedy, 2005). Concernant ce 2018; Joffe et Pring, 2008; McLeod et Baker, 2014). Cette
dernier point, le manque de temps des professionnels divergence peut d’abord s’expliquer par le fait que les
pour la formation pourrait expliquer, du moins en partie, la orthophonistes québécoises n’ont pas été interrogées
raison pour laquelle les orthophonistes du Québec utilisent sur l’utilisation de la discrimination auditive, malgré sa
peu certaines approches d’intervention alors qu’elles sont popularité en Australie et au Royaume-Uni. Il en est ainsi,
appuyées par la recherche. En effet, une étude de Furlong car la discrimination auditive a été considérée comme une
et al. (2018) s’intéressant au processus de décision de tâche pouvant être intégrée à certaines des interventions
cliniciennes travaillant auprès d’enfants ayant un TSP a de la présente étude (p. ex. : approche cyclique, paires
démontré que les orthophonistes n’ont pas suffisamment minimales, oppositions maximales).
de temps pour s’approprier les nouvelles approches.
Ce manque de temps pour implanter les nouveaux De plus, bien que répandues aux États-Unis et au
apprentissages, jumelé à la tendance des orthophonistes Royaume-Uni, l’approche intégrant la conscience
à conserver les pratiques qui leur sont déjà familières, phonologique et l’approche des paires minimales sont
peut retarder, voire empêcher l’adoption d’une nouvelle peu utilisées au Québec. Cette différence pourrait
approche en clinique. Les orthophonistes pourraient être liée au fait que la structure de la langue française
se montrer plus ouvertes à changer leur pratique est différente de celle de la langue anglaise et que les
d’intervention si l’accès au matériel était facilité (McCabe, approches créées dans cette langue sont plus difficiles à
2018). À titre d’exemple, le choix des cibles dans l’approche appliquer en contexte francophone. À titre d’exemple, les
des paires minimales peut prendre du temps. L’accès au mots d’une seule syllabe sont particulièrement facilitants
matériel peut donc être un obstacle à un changement pour la constitution de paires minimales (p. ex. : bite,
rapide de pratiques chez les orthophonistes. bright, fight, flight, etc.). Or, les possibilités de former des
paires minimales ou maximales en français sont plus
La littérature tend à démontrer qu’il faudrait une limitées parce que les mots monosyllabiques sont moins
quinzaine d’années pour transférer les données fréquents qu’en anglais (Brosseau-Lapré et al., 2018). Pour
de la recherche à la pratique clinique (Morris et al., les orthophonistes francophones, l’implantation d’une
2011). Autrement dit, une approche connue n’est pas approche créée et publiée en anglais présente donc un
nécessairement utilisée dans l’immédiat. Pour réduire ce double défi. En effet, les orthophonistes doivent 1) acquérir
délai, Hegarty et al. (2021) suggèrent aux orthophonistes des connaissances techniques dans une langue qui n’est
de réaliser des études cliniques en équipe de travail, pas leur langue première (Durieux et al., 2015) et 2) adapter
de partager leurs connaissances sur les approches ces nouvelles connaissances à une langue pour laquelle
d’intervention qu’elles utilisent avec leurs collègues et de l’intervention initiale n’a pas été conçue à la base. Cette
prendre part à des séances d’observation par les pairs. hypothèse est appuyée par le fait que la DNP a été créée
Ainsi, la mise en œuvre d’une pratique basée sur les preuves et diffusée en langue française et qu’elle est une des
scientifiques pourrait être facilitée par la réflexion collective trois approches les plus utilisée par les orthophonistes
de plusieurs orthophonistes qui travaillent ensemble. québécoises. La faible utilisation de l’approche des paires
Enfin, même si les exercices oro-moteurs sont connus minimales par les orthophonistes québécoises, bien qu’elle
par 95 % des répondantes, cette approche n’est pas pour ait prouvé son efficacité, pourrait aussi être expliquée par
autant parmi les plus utilisées. Ce constat est encourageant l’absence d’études portant sur la langue française (Williams
étant donné que plusieurs études menées durant les et al., 2010).
années 2000 ont démontré l’inefficacité des exercices De manière générale, il apparait que les orthophonistes
oro-moteurs pour traiter les TSP (Lof et Watson, 2008; du Québec utilisent des approches d’intervention ciblant
McCauley et al., 2009; Ruscello, 2008). Les orthophonistes davantage la production que la perception, contrairement
du Québec semblent être bien informées de l’inefficacité aux orthophonistes des autres pays. En effet, au Québec,
des exercices oro-moteurs dans le traitement du TSP les trois approches d’intervention les plus utilisées sont
grâce aux études qui se sont intéressées à cette approche l’approche traditionnelle d’articulation, la stimulation
d’intervention et qui ont clairement affirmé leur inutilité. intégrale et la DNP, toutes des approches axées sur la
231 Volume 46, No 3, 2022
production. Il en est autrement aux États-Unis et en d’approches scientifiquement valides, tout comme l’ont fait
Australie où les orthophonistes utilisent majoritairement Hegarty et al. (2021). Pour ce faire, des études qualitatives à
des approches axées sur la perception comme la partir de groupes de discussion ou d’entrevues individuelles
discrimination auditive et la conscience phonologique. pourraient être menées.
Au Royaume-Uni, les trois approches les plus utilisées se
concentrent majoritairement sur la perception. Il est donc Conclusion
possible de se demander si ces différences vont au-delà Cette étude permet de détailler les approches
des distinctions entre l’anglais et le français. Les recherches d’intervention utilisées par les orthophonistes du Québec
tendent à considérer que la représentation phonologique pour traiter les enfants ayant un TSP en lien avec une
est multidimensionnelle et que les dimensions motrice/ pratique fondée sur les preuves scientifiques. En comparant
phonétique et linguistique/phonologique sont deux les résultats de l’étude aux enquêtes menées dans les
dimensions d’une même représentation (Farquharson, autres pays, quelques ressemblances ressortent, comme
2015; Munson et al., 2005). De plus, les enfants ayant un l’utilisation de l’approche traditionnelle d’articulation dont
TSP font partie d’un groupe hétérogène : certains ont un l’efficacité a été prouvée par des études de haut niveau de
trouble articulatoire ou un trouble phonologique, d’autres preuves scientifiques. Cependant, l’usage répandu de la
présentent les deux types (Dodd et al. 2018). Si toutes les DNP, pour laquelle aucune étude scientifique rigoureuse
dimensions du phonème sont à prendre en considération ne démontre son efficacité, distingue le Québec des
lors de l’intervention, il est étonnant de constater que autres pays. Un écart est donc présent entre les approches
plusieurs orthophonistes du Québec ne semblent pas supportées par des preuves scientifiques et le traitement
familières avec plusieurs approches axées sur la perception clinique du TSP au Québec. À la lumière de ces résultats,
(la perception auditive et les oppositions maximales) il faut se questionner quant à la facilité d’intégrer des
comme le démontre la figure 1. preuves scientifiques à la pratique orthophonique au
Québec. À l’instar des orthophonistes pratiquant dans
Limites de l’étude et futurs développements d’autres pays, les participantes attestent lire peu d’articles
Malgré le nombre appréciable de répondantes au scientifiques. Ainsi, les sources de nouvelles connaissances
sondage et une distribution géographique à travers tout sont davantage la formation en groupe et les contacts
le Québec, les résultats ne peuvent être généralisés à avec les collègues. Il serait donc souhaitable d’offrir aux
l’ensemble de la pratique francophone du Canada puisque orthophonistes québécoises des formations continues
seule la province de Québec est ciblée dans cette étude. Il basées sur les preuves scientifiques pour le traitement
serait pertinent d’explorer les pratiques des orthophonistes du TSP. Les résultats de cette étude permettent aux
intervenant auprès d’enfants francophones dans les orthophonistes francophones d’alimenter leur réflexion
autres provinces canadiennes. Une autre limite de notre sur leur pratique, notamment, en leur faisant découvrir de
étude consiste en la liste des approches utilisées qui nouvelles approches d’intervention avec lesquelles elles ne
pourrait ne pas être exhaustive, même si elle est issue sont pas familières et pour lesquelles il existe des études de
d’une recherche documentaire rigoureuse et validée par bon niveau de preuve scientifique. Quant aux chercheurs
une clinicienne. Il serait judicieux de faire approuver les et chercheuses, ils peuvent se baser sur les résultats
approches d’intervention par un plus grand nombre de présentés pour mettre en place des études portant sur
cliniciennes pratiquant auprès d’enfants ayant un TSP. Il des approches d’intervention qui n’ont pas fait l’objet de
est également possible que l’ensemble des répondantes recherches scientifiques rigoureuses et qui sont pourtant
n’ait pas eu la même compréhension des approches, et ce, utilisées par les orthophonistes du Québec.
bien que nous ayons fourni des descriptions succinctes
Références
pour chacune d’elles. En effet, il peut exister un manque
Allen, M. M. (2013). Intervention efficacy and intensity for children with speech sound
d’uniformité puisque nous ne savons pas comment les disorder. Journal of Speech, Language, and Hearing Research, 56(3), 865-877.
répondantes les utilisent et si elles respectent les éléments- https://doi.org/10.1044/1092-4388(2012/11-0076)
clés décrits par les auteurs des approches. Il se peut qu’une Almost, D. et Rosenbaum, P. (1998). Effectiveness of speech intervention for
phonological disorders: A randomized controlled trial. Developmental Medicine
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Munson, B., Edwards, J. et Beckman, M. E. (2005). Phonological knowledge in typical être adressée à Laurie Montembeault, Département
and atypical speech–sound development. Topics in Language Disorders, 25(3),
190-206. https://doi.org/10.1097/00011363-200507000-00003
d'orthophonie, Université du Québec à Trois-Rivières, 3351,

boul. des Forges, C. P. 500, Trois-Rivières, QC, Canada, G9A

5H7. Courriel : laurie.montembeault@gmail.com
Remerciement
Nous aimerions remercier Monsieur Jean Leblond du
Centre interdisciplinaire de recherche en réadaptation
et intégration sociale pour l’expertise statistique, de
même que Madame Line Charron pour la validation des
descriptions des approches dans le questionnaire et enfin,
les orthophonistes ayant répondu au sondage.
Déclaration
Les auteures déclarent n’avoir aucun conflit d’intérêts,
financiers ou autres.
235 Volume 46, No 3, 2022
© 2022, SAC
Copyright is held by Speech-Language & Audiology Canada. No part of this publication

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manner (electronic, mechanical, photocopy or otherwise) without written permission
from SAC. Contact pubs@sac-oac.ca. To cite appropriate credit must be given (SAC,
publication name, article title, volume number, issue number and page number[s]).
© 2022, OAC
613.567.9968
C’est Orthophonie et Audiologie Canada qui détient le droit d’auteur. Il est interdit
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CANADIAN JOURNAL OF SPEECH-LANGUAGE

PATHOLOGY & AUDIOLOGY | CJSLPA

REVUE CANADIENNE D’ORTHOPHONIE ET

Normative Nasalance Values in a Population of French-Speaking Children

Processing-Dependent Measures Sensitive to Language Performance Differences in Arabic

Exploring Practice-Based Clinical–Research Partnerships in Speech-Language Pathology:

CJSLPA REVIEWERS SCOPE AND PURPOSE OF CJSLPA

Emily Zimmerman, Ph.D., CCC-SLP Vincent Martel-Sauvageau, Ph.D.

RÉVISEURS DE LA RCOA MISSION ET BUT DE LA RCOA

Revue canadienne d’orthophonie et d’audiologie (RCOA) Volume 46, No.3, 2022

ARTICLE 1 161 ARTICLE 1 161

ARTICLE 2 171 ARTICLE 2 171

ARTICLE 3 195 ARTICLE 3 195

ARTICLE 4 201 ARTICLE 4 201

ARTICLE 5 221 ARTICLE 5 221

Normative Nasalance Values in a Population of French-

Normalisation des scores de nasalance recueillis au sein

Jelena Todic, Karen

Faculté de Médecine, Université

Normative Nasalance Values in a Population of French-Speaking Children

pages 161-170 ISSN 1913-2020 | www.cjslpa.ca 162

Normative Nasalance Values in a Population of French-Speaking Children

pages 161-170 ISSN 1913-2020 | www.cjslpa.ca 164

Normative Nasalance Values in a Population of French-Speaking Children

pages 161-170 ISSN 1913-2020 | www.cjslpa.ca 166

Normative Nasalance Values in a Population of French-Speaking Children

pages 161-170 ISSN 1913-2020 | www.cjslpa.ca 168

Normative Nasalance Values in a Population of French-Speaking Children

pages 161-170 ISSN 1913-2020 | www.cjslpa.ca 170

Processing-Dependent Measures Sensitive to Language

Mesures de traitement de l’information sensibles aux

Areej M. A. Balilah1 and Lisa

pages 171-184 ISSN 1913-2020 | www.cjslpa.ca 172

pages 171-184 ISSN 1913-2020 | www.cjslpa.ca 174

pages 171-184 ISSN 1913-2020 | www.cjslpa.ca 176

ELLs A-TD A-DLD

Standard scores for criterion measures for all groups.

pages 171-184 ISSN 1913-2020 | www.cjslpa.ca 178

pages 171-184 ISSN 1913-2020 | www.cjslpa.ca 180

pages 171-184 ISSN 1913-2020 | www.cjslpa.ca 182

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Mean Length of Utterance and Use of Subordination Among

Longueur moyenne des énoncés et emploi de subordonnées

Patricia Hart Blundon

Patricia Hart Blundon

University of Victoria, Victoria,

pages 185-200 ISSN 1913-2020 | www.cjslpa.ca 186

pages 185-200 ISSN 1913-2020 | www.cjslpa.ca 188

pages 185-200 ISSN 1913-2020 | www.cjslpa.ca 190

pages 185-200 ISSN 1913-2020 | www.cjslpa.ca 192

pages 185-200 ISSN 1913-2020 | www.cjslpa.ca 194

7.26** 10.59 −2.17 7.85** 11.63 −2.26 37

9.19 9.72 −0.39 10.09 10.56 −0.32 46

7.24* 8.24 −1.04 8.04* 9.26 −1.13 82

6.68 7.66 −0.80 7.23 8.42 −0.88 58

7.85* 10.30 −1.66 8.63* 11.28 −1.65 88

5.72* 7.19 −1.29 6.40* 8.23 −1.42 24

6.17** 8.37 −2.43 7.10** 9.42 −2.26 50

Discussion Both MLU and Subordination Index scores are

pages 185-200 ISSN 1913-2020 | www.cjslpa.ca 196

pages 185-200 ISSN 1913-2020 | www.cjslpa.ca 198

Feature type Examples

Absent copula or auxiliary: They __ waitin’

7.26 10.59 −2.17 7.85 11.63 −2.26 37

6.17 8.37 −2.43 7.10 9.42 −2.26 50