1. EBP Phonology Group: Summary of Critically Appraised Topics Bronwyn Carrigg, Sydney Children’s Hospital

2. Number of members: approx 23 Locations: 12 metro sites. Liverpool Hospital, Peakhurst CHC, Rockdale CHC, Sylvania CHC, Parramatta CHC, Mt Druitt CHC, Blacktown CHC, Auburn Hospital, Sydney Uni, Sydney Children’s Hospital, Sydney Children’s CHC, Waverley CHC Number of CAPs completed = 56 Number of CATs completed = 6

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

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

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

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

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

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

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

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

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

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

13. Want to join? Contact Katie Carmody, Sydney Children’s Community Health Centre, 9382 8084 Katie.carmody@sesiahs.health.nsw.gov.au