journal of all india institute of speech and hearing

JAIISH, Vol. 27, 2008 (The Journal of All India Institute of Speech and Hearing)

ISSN 0973-662X

Editorial Chief

Dr. Vijayalakshmi Basavaraj

Board of Editors

Dr. S. R. Savithri Prof. of Speech Sciences AIISH, Mysore.

Dr. Asha Yathiraj Prof. of Audiology AIISH, Mysore.

Dr. S. Venkatesan Prof. of Clinical Psychology AIISH, Mysore.

Dr. K. C. Shyamala Prof. of Language Pathology AIISH, Mysore.

Dr. R. Manjula Prof. of Speech Pathology AIISH, Mysore.

Dr. K.S. Prema

Prof. of Language Pathology AIISH, Mysore.

Dr. Y.V.Geetha Prof. of Speech Sciences AIISH, Mysore.

Dr. H. Sundara Raju Reader in Otorhinolaryngology AIISH, Mysore.

Mr. Ajish K. Abraham Reader in Electronics AIISH, Mysore.

Guest Editors Dr. Geetha Mukundan Deputy Director(Technical), AYJNIHH, Mumbai. Dr. A. Ramesh Associate Professor, Dept. of ENT, St John’s Medical College Hospital,

Bengaluru.

Dr. C. S. Vanaja Professor of Audiology Bharati Vidyapeeth University School of Audiology & Speech Language Patholgy, Pune

Dr. P. S. Pradeep Kumar Prof. of ENT Meenakshi ENT Speciality Centre,

Bengaluru.

Co-ordinator Dr. N. Sreedevi

Lecturer in Speech Sciences

The Journal of All India Institute of Speech and Hearing, an annual publication, carries articles pertaining

to the normal and abnormal processes and disorders of Language, Speech and Hearing. Contribution

may take the form of reports of experimental studies, theoretical papers review papers and case reports.

Manuscript already published elsewhere will not be accepted for publication in the journal.

Manuscript submitted will be reviewed by the Editorial Board on the recommendation of the Editorial Board,

author/s may be asked to revise the articles. Articles not accepted will be returned to the author. The

decision of the Editorial Board shall be final. All Editorial Correspondence should be addressed to the

Editorial-chief, JAIISH, All India Institute of Speech and Hearing, Mysore-570006, India.

Subscription: Individual Subscription Rs.250/- per year. Institutional subscription outside India $100.

Individual subscription $40.

Copy right: All India Institute of speech and Hearing, Mysore. Opinion expressed in the articles rest with

the authors and publishers are not responsible for it.

Dr. Vijayalakshmi Basavaraj Director & Editorial Chief

JAIISHJAIISHJAIISHJAIISH ISSN 0973-662X Vol. 27, 2008

Journal of All India Institute of Speech & Journal of All India Institute of Speech & Journal of All India Institute of Speech & Journal of All India Institute of Speech & HearingHearingHearingHearing

An Official Publication of

ALL INDIA INSTITUTE OF SPEECH AND HEARING Manasagangothri, Mysore – 570 006

Phone: 0821 – 2514449, 2515218, 2515905 Fax: 0821 – 2510515

Website: www.aiishmysore.com, e-mail: [email protected]

Editorial

Greetings from AIISH, Mysore!

Journal of All India Institute of Speech and Hearing (JAIISH) was resumed as an indexed journal

with the ISSN No.0973-662X in the year 2007 by bringing out its 26th volume. I am very happy that the

institute is able to bring out the 27th volume, which is the second volume of the indexed journal on time

in the year 2008.

Vol. 26 of Journal of AIISH received excellent feedback and our subscriptions increased. This is

very encouraging. I will look forward to continued feedback in the future as well.

Vol. 27 of Journal of AIISH carries very interesting nineteen articles in the area of speech, language

and hearing. I am happy to share that special educators, otolaryngologists, apart from audiologists,

speech and language pathologists have contributed to this volume. Seven articles under the category of

‘Speech’ cover topics in the area of speech sciences as well as in the area of speech pathology. Eight

articles under ‘Language’ focuses on issues related to semantic and pragmatic issues; phonological

processing; autism spectrum disorders among others. The four articles under ‘Hearing’ cover topics on

neonatal hearing screening, regenerative Myringoplasty, sudden sensory neural hearing loss, auditory memory and sequencing.

It is disappointing to note that not many articles in the area of hearing and hearing disorders were

received. I look forward to receiving more articles in these areas for the next volume. The institute is

aspiring to expand its multi-disciplinary team activities. Such an expansion will be supported if we

receive papers from the members of the multidisciplinary team dealing with communication disorders.

Apart from the designated ten editorial members of the journal, three guest editorial members

contributed in reviewing the articles. Their contribution is sincerely acknowledged. My sincere

acknowledgements are also due to all the members of the Editorial Board for meeting our deadlines in

reviewing the articles. Special appreciation to Dr. N Sreedevi, Lecturer in Speech Sciences, Department

of Speech Language Sciences for her efficient follow up work as well as for proof reading the final

version.

As I had mentioned in my previous editorial, AIISH, for the first time, published full length papers

based on the dissertations of the years 2002-03 and 2003-04. I am happy to share with you that the 3rd

volume covering the dissertation articles of the year 2004-05 was released on 9th August 2008. Since

specialized masters programs in Audiology and Speech Language Pathology were introduced in the year

2003-04, the dissertation articles have been compiled separately for Audiology and Speech Language

Pathology topics as Vol. III Part A and Vol. III Part B respectively.

The JAIISH Volume will have a section on book reviews and a section on letters to the editor. I

request you all to contribute to these sections. I look forward to your continued support in contributing

your valuable research publications in the Journal of AIISH. You may please email your suggestions in

improving the standard of the journal to [email protected].

Dr.Vijayalakshmi Basavaraj

Director & Editorial-Chief

Table of Contents

Speech

1. Effect of Vowels on Consonants in Nasalence Gopishankar R. & Pushpavathi M.

3-7

2. Investigation into Voice Source of Monozygotic Twins using Formant based Inverse Filtering Jayakumar T. & Savithri S.R.

8-14

3. Effect of Spectral Variation on Phoneme Identification Skills in 2 - 3 year old Typically Developing Children Powlin Arockia Catherine & Savithri S.R.

15-18

4. Keratosis of the Larynx Rajasudhakar R. & Sundara Raju H.

19-21

5. Nasalence Value for Rainbow Passage: Normative Data for Non- Native Speakers Sangeetha M. & Pushpavathi M.

22-28

6. Rate of Speech/Reading in Dravidian Languages Savithri S.R. & Jayaram M.

29-39

7. Speech Rhythm in Hearing-Impaired Children Savithri S.R., Ruchi Agarwal & Johnsi Rani R.

40-43

Language

8. The Semantic Association in the Mental Lexicon Gopee Krishnan & Shivani Tiwari

44-48

9. Semantic Pragmatic Attributes and Cognition in Acute and Chronic Schizophrenics: A case comparative study Mithila Poonacha, Shivani Tiwari & Rajashekhar Bellur

49-53

10. Pragmatic Skills in Typically Developing Infants Shilpashri H.N. & Shyamala K. Chengappa

54-57

11. Pragmatic Skills in Nonverbal Identical Twins with Autism Spectrum Disorders Shilpashri H.N. & Shyamala K. Chengappa

58-63

12. Continuum of Developmental Language Disorders: Where Does PLI Fall? Shivani Tiwari, Ashwini Bhat & Rajashekar Bellur

64-73

13. Analysis of Oral and Written Narratives of Children with Language Impaired Learning Disabilities Siddique Tehniat & Mukhopadhyay Sourav

74-82

14. Phonological Processes in Typically Developing Kannada Speaking Children Sreedevi N. & Shilpashree H.N.

83-88

15. A Profile of Aetiological Therapeutic Searches by Netizen Parents/Caregivers of Children on the Autism Spectrum Venkatesan S. & Purushotham K.

89-94

Hearing

16. Auditory Memory and Sequencing in Children aged 6 to 12 years Devi N., Sujitha Nair & Asha Yathiraj

95-100

17. Regenerative Myringoplasty – A Case Report Rajeshwari G. & Sundara Raju H.

101-103

18. Guidelines to Establish a Hospital Based Neonatal Hearing Screening Program in the Indian Setting Ramesh A., Nagapoornima M., Srilakshmi V., Dominic M. & Swarnarekha

104-109

19. Reversible Sudden Sensory Neural Hearing Loss – A Case Report Sundara Raju H. & Rajeshwari G.

110-113

JAIISH, Vol. 27, 2008 Effect of Vowels on Consonants in Nasalence

3

Effect of Vowels on Consonants in Nasalence

1Gopi Sankar R. &

2Pushpavathi M.

Abstract

The present study investigated the mean nasalence value of three isolated vowels and

explored the nasalence value across CV combinations based on various place of

articulation of consonants. The subjects consisted of fifty (21 males, 29 females) normal

young adults in the age range of 18 to 27 years. The subjects were instructed to repeat

the isolated vowels and CV combinations. The mean nasalence value was calculated.

Repeated measures of ANOVA were used to find the significant difference in within and

across the condition (CV combination). The results indicated significant difference

across vowels with the high nasalence value for the high front vowel / i / followed by / a/

and /u/. Unvoiced bilabial and retroflex stop consonants with / i / had high nasalence

value followed by /u/ and /a/. This results support the finding that high front vowel have

significantly higher nasalence value than other vowels. This result also aids the speech

pathologists to develop the stimuli for assessing the Velopharyngeal closure.

Key words: Nasalence, Vowels, Consonant vowel combination, Vowel effects.

Speech is a fleeting event. Researchers and clinicians strive to capture the speech signals and

to analyze the same using the sophisticated

methods. There is considerable information

available concerning the acoustic characteristics of

abnormal and normal resonance, as well as clinical

assessment and management of resonance

impairments. Nasalence is intended to be a measure of the acoustic energy that occurs

primarily on vowels, glides and liquids.

Traditionally, clinicians have used long passages,

such as the Zoo Passage, rainbow passage to

assess nasalance with the Nasometer. Shorter

stimuli have been proposed (MacKay and

Kummer, 1994; Watterson T, Hinton J &

McFarlane S 1996; Awan, 1998) to measure the

nasalence. But short stimuli create the potential for

vowel and consonant content to have a weighting

effect on the nasalance value (Karnell, 1995;

Watterson T, Lewis KE & Foley-Homan N 1999).

Because the Nasometer is designed primarily to measure the acoustic energy in vowels, the vowel

content of the short stimulus would be of particular

concern (Fletcher SG, Adams LE, & McCutcheon

MJ. 1989). Most of the studies in nasalence

measurement are focused on measuring and

comparing the nasalence for high pressure and low

pressure consonants.

In recent years, growing evidence has evolved

concerning the relation between nasalence

measurement and velopharyngeal closure

specifically on vowels. Variation in the nasalence

during the nasal airflow is closely related to the

velar height and velopharyngeal closure. Carney

and Sherman (1971) studied the effects of three speech tasks upon the perception of nasality for 10

normal subjects and 10 subjects with cleft palate.

The three speech tasks consisted of the production

of five isolated vowels, same vowels in consonant-

vowel-consonant (CVC) syllables and same CVC

in connected speech passage. The results indicated

that for both groups, CVC syllables from a

connected speech are judged to be less nasal than

either isolated vowels or isolated CVC syllables.

The variations in results were attributed to co-

articulatory influences. Subjects with cleft palate

are more nasal on high vowel than on low vowels,

while subjects without cleft palate were more nasal

on low vowels than on high vowels. MacKay and

Kummer (1994) provided data that supported the

contention that nasalance values from short stimuli

may be markedly influenced by vowel content. For

the Simplified Nasometric Assessment Procedures

Test (SNAP Test), MacKay and Kummer (1994)

1Research officer, Dept. of Clinical Services, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, email:[email protected], 2Reader in Speech Pathology, All India Institute of Speech and Hearing, Manasagangothri, Mysore- 570 006, email: [email protected].


4

provided mean nasalance data for normal subjects

using a variety of stimuli. The syllable repetition

subtest requires subjects to repeat a CV syllable 6

to 10 times (e.g., ti-ti-ti), and data were provided

for CV stimuli that differ only with respect to the

vowel. The data showed that nasalence values for

stimuli with the high front vowel /i/ were markedly

higher than nasalance values obtained from stimuli

with the low back vowel /a/. According to the

authors, individual consonant environments (i.e.,

voicing, manner, and place) exerted different

influences from vowel to vowel, where voicing

produced the greatest effects on nasal perception.

Vowels in voiced environments, and fricative

environments were found to be longer in duration, lower in fundamental frequency, and greater in

intensity than vowels in voiceless or plosive

environments. The perception of nasality increased

when these acoustic correlates (i.e., longer

duration, lower fundamental frequency, and higher

intensity) accompanied the phonetic context.

Results indicated that perception of nasality followed this progression from least to most: (a)

voiceless plosive environments /p, t/, (b) voiceless

fricative /s, f/ and voiced plosive environments /g,

d/, and (c) voiced fricative environments /v, z/.

Overall, tongue height and voicing were found to

have the most significant influence on the

perception of nasality (Lintz & Sherman, 1961). In

another study, Watterson T, Lewis KE & Foley-

Homan N (1999) compared nasalance values for

17-syllable passage, 6-syllable sentence, and 2-

syllable word from a standard 44- syllable passage.

The results showed that the longer the stimulus,

the stronger the association with the standard passage. The shortest stimulus (two-syllable word)

had insufficient criterion validity to warrant its use

in clinical applications; however, the authors

expressed concern that the vowel content might

unduly influence the nasalance value in such a

short stimulus. Kerry, L, Watterson, T, & Terasa

,Q (2000) compared the nasalence values with nine different speech stimuli with vowel content

controlled. The subjects were 19 normal children

and 19 children with velopharyngeal dysfunction.

The stimuli consisted of nine speech stimuli which

included four vowels in isolation and five

sentences which were loaded with high front, high

back, low front and low back vowels and one sentence with a mixture of vowel types, five

sentences and four sustained vowels. The result

showed that high vowels were associated with

significantly higher nasalence values than low

vowels for both sentence and sustained vowels.

For the velopharyngeal dysfunction (VPD) group,

nasalence values for high vowel sentences and

mixed vowel sentences were significantly higher

than the nasalence value for the low vowel

sentences. In both groups, nasalence values for

sustained vowels were significantly higher for the

high front vowel /i/ than for the other vowel

.Difference was evident among front / back vowel

contrasts. Nandurkar (2002) studied the Nasalance

measures in Marathi consonant-vowel-consonant

syllables with pressure consonants produced by

children with and without cleft lip and palate. The

results indicated differences between groups. As

the nasalence value may be markedly affected by

the vowel, it is necessary to determine the specific influence of various vowels in CV combination.

Hence the present study investigated the mean

nasalence value of the three isolated vowels and

explored the nasalence value across CV

combinations.

Method

Subjects: Fifty (21 males, 29 females) normal

young adults with age range of 18 to 27 years

(mean 19) participated in the study. All

participants were judged by the investigators to

possess speech and hearing within normal limits and reportedly were free from upper respiratory

infection. None of the participants had a history of

craniofacial anomalies or velopharyngeal

impairment.

Instrumentation: Nasometer model 6400 (Kay

Elemetrics, New Jersey) was used to measure

resonance using a lightweight headset made up of

a harness that holds a (oral/nasal) separation plate.

The separation plate was firmly fitted against the

area between the nose and the upper lip and had

two directional microphones mounted on either

side of it, which collected the separated acoustic

signals. The signals were transmitted to the

computer database where they were calculated and

analyzed by the Nasometer software. The resultant

acoustic values were a ratio of nasal to nasal-plus-

oral acoustic energy, which was multiplied by 100,

and expressed as a “nasalance.” Prior to testing,

the Nasometer was calibrated and disinfected in

accordance with the procedures outlined in the

instruction manual.

Stimuli: The stimuli consisted of vowels /a/, /i/,

and /u/, and CV syllables in which /p, t, k/ was

paired.


5

Procedure: Subjects were tested individually.

They were seated comfortably in a chair. The

Nasometer headset was positioned perpendicular

to the facial plane and seated firmly against the

upper lip. Subjects were instructed to sustain

vowels and nasal consonants in isolation. For CV

combination, the subjects were instructed to repeat

a CV syllables 3 times (e.g., pa-pa-pa) at a normal

speed. A single mean nasalance percentage or

nasalance values for 3 repeated stimuli was

computed. Repeated measures ANOVA were used

to find the significant difference between

conditions and CV combination.

Results and Discussion

a. Mean nasalence value for vowels in isolation:

Results showed that high front vowel /i/ had

the highest nasalence followed by low mid

vowel /a/ and high back vowel /u/. Table 1

depicts the mean and SD of nasalence.

Mean S.D

/a/ 25.56 14.17 / I / 36.84 20.25 /u / 19.70 17.62

Table 1: Mean and SD for vowels.

Results of the repeated measures of ANOVA

indicated significant difference between

vowels. Vowel /a/ had significant lower

nasalence scores compared to vowel /i/. (F (2,

98) =28.371, p<0.001).

b. Nasalence value for the oral consonants across

the vowels: results indicated higher nasalence

value for /p/, /t/ and /k/ when followed by

vowel /i/ compared to when followed by other

vowels. Figure 1 shows the mean nasalence

value for unvoiced stop consonants combined

with vowels. Consonant /k/ had higher

nasalence values compared to /t/ and /p/. That is, the nasalence value decreased as the place

of articulation moved forward the oral tract.

Figure 1: Mean scores for CV combination.

Consonants Mean /k/ 21.67 /t/ 20.33 /p/ 18.67

Table 2: Mean values for consonants.

Results of repeated measures of ANOVA

indicated significant difference between CV

combinations. Table 3 shows F and p values for

across the vowel and consonant combinations.

Across the vowel Across the consonants

F value P

value F value

P value

/pa/-/pi/ /pa/-/ta/ /pa/-/pu/ /pa/-/ka/ /pi/-/pu/

F(2,98)=27.345

<0.001

/ta/-/ka/

F(2,98)=2.481

>0.05

/ta/-/ti/ /pi/-/ti/ /ta/-/tu/ /pi/-/ti/ /ti/-/tu/

F(2,98)=34.808

<0.001

/ti/-/ki/

F(2,98)=24.203

<0.001

/ka/-/ki/ /pu/-/tu/ /ka/-/ku/ /pu/-/ku/ /ki/-/ku/

F(2,98)=72

<0.001

/tu/-/ku/

F(2,98)=3.125

>0.05

Table 3: F values on repeated measures of ANOVA.

The results indicated that front high vowel /i/

had significantly higher nasalence value compared

to low mid vowel /a/ and high back vowel /u/. This

supports the findings of Neumann and Dalston

(2001), who reported the similar findings. This

may be due to the articulatory postures assumed

during the production of these vowels. The low

mid vowel /a / is a open vowel which creates

relatively little resistance to airflow out of the

mouth. Therefore the maximum energy is

transmitted through the oral cavity. But high

vowels /i/ and /u / impose relatively high

resistance to airflow. However, during the

production of the /u/ the tongue is placed in close

proximity to the velum. This placement may tend

to dampen the velar oscillations and thereby

reduce acoustic transfer.

The results also support the findings of Moore

and Sommers (1973) who reported the greater

degree of nasality on high vowels as the high

vowels make greater demand upon the valving

function i.e higher points of posterior pharyngeal

wall/ velar contacts, tighter velopharyngeal seals

and greater velar excursion.

Kendrick (2004) provided a physiological

explanation for higher nasalence value on vowel

/i/. He has suggested a strong effect of horizontal

position of the tongue on the nasalance of vowels.

Back vowels are reported to have lower nasalance

values because some of the muscles that pull the

body of the tongue back also pull the velum down


6

securing a tight closure between the two structures.

To keep the velum from lowering during vowel

production, the muscles that elevate the velum

may be more active during back vowel production

than front vowel production to counteract the

downward force of the muscles pulling the tongue

back. The production of the higher vowel requires

the positioning of the velum in high position

making the tight velopharyngeal closure. This is a

feature of normal speech production.

Mc Donald and Baker (1951) suggested that

the correlation might be due the speaker's efforts to

maintain a "characteristic balance or ratio between

oral and nasal resonance." This resonance ratio

presumably depends on the relative sizes of the

velopharyngeal port and the posterior opening into

the oral tract. Hence, when the speaker intends to

produce no audible nasal output, a lower velum is

tolerated for an open vowel than for a close vowel.

However, the results do not partially support

the findings of Lintz and Sherman (1961) who

found that the perception of nasality increased as

tongue height decreased during sustained vowel production (i.e., low vowels were perceived as

more nasal than high vowels for normal speakers).

This may be due to methodological difference as

they used perceptual judgment and the subjects

were children whereas the present study used an

objective evaluation and the subjects were adults.

The present study is the first attempt to explore the co articulation effect based on

nasalence measures in consonant- vowel context.

Most of the studies which are cited in the literature

are based on perceptual measurement are

measuring only in sentences or words. Since

coarticulation effects allied with perceptual

phenomena operating both forward and backward in time are known to cause interactions between

adjacent phones, it is possible that a similar

interaction could also be observed in consonant-

vowel syllables. Bell-Berti, F., Baer, T, Harris, K.

S and Niimi, S (1979) have shown that the effects

of vowel height on velar height extend into

adjacent consonants. Alternatively, as Ackerman (1935) have suggested, movements of the larynx

and pharynx may determine velar position through

connections provided by the palatopharyngeus

muscles. From the results of this study it can be

speculated that tongue position had the greatest

influence on nasalance values during sustained

vowel production. If the tongue was in an elevated

and retracted position, as was on the vowel / u /,

the velum achieved increased velar elevation and

tighter VP closure, resulting in lower nasalence

values for the normal speaker. The palatoglossus

muscle, which is involved in tongue and velar

functions, is active in achieving a front tongue

position and at the same time pulls downward on

the velum. This would result in less velar

elevation, loose VP closure, and in turn higher

nasalence values. Previous research has

demonstrated that tongue height during vowel

production significantly influenced nasalence, and

the results from this study were in agreement with

the findings of MacKay & Kummer (1994), Kuehn

& Moon (1998), Lintz & Sherman, (1961).The

results of the present study indicated that unvoiced consonants do not influence the nasalence value.

However, vowels play a major role in nasalence

values.

Conclusions

The results of the study showed that nasalence

values are vowel dependent. High front vowels

had significantly higher nasalence value than other

vowels. This data also helps the speech

pathologists to develop the stimuli for assessing

the Velopharyngeal closure which is very

important for determining the nasalence value.

References

Ackerman, E. L. (1935). Action of the velum

palatinum on the velar sounds /k/and /g/,

Vox 31, 2-9. Cited in ArthurS, Abramson, Patrick W. Nye, Janette B. Henderson and

CharlesW. Marshall (1981).Vowel height

and the perception of consonantal nasality.

Journal of the Acoustic Society of America,

70(2), 329-339.

Aparna Nandurkar (2002).Nasalance measures in

Marathi consonant-vowel-consonant syllables with pressure consonants produced

by children with and without cleft lip and

palate. The Cleft palate-Cranofacial

Journal, 39(1), 59-65.

Awan SN(1998). Analysis of nasalance:

NasalView (the nasalance acquisition

system). In Zigler W, Deger K, eds. Clinical

Phonetics and Linguistics. London:Whurr,

519–527.

Bell-Berti, F., Baer, T, Harris, K. S and Niimi, S

(1979). Coarticulatery effects of vowel


7

quality on velarfunction, phonetica, 36, 187-

193.

Carney & Sherman (1971).sevearity of nasality in

three selected speech tasks. Journal of

Speech and Hearing Research, 14,396-407.

Fletcher SG, Adams LE, & McCutcheon MJ. Cleft

palate speech assessment through oral nasal

acoustic measures. In: Bzoch KR, ed.

CommunicativeDisorders Related to Cleft

Lip and Palate. Boston: Little Brown;

1989:246–257.

Karnell M P(1995). Nasometric discrimination of

hypernasality and turbulent nasal airflow.

The Cleft palate-Craniofacial Journal,

32,145–148.

Kendrick K.R (2004). Nasalance Protocol

Standardization. Unpublished Master Thesis Submitted to the Graduate Faculty of

the Louisiana State University and

Agricultural and Mechanical College.

Kerry,L, Watterson ,T, & Terasa ,Q (2000). The

Effect of vowels on nasalence Values. The

Cleft palate-Cranofacial Journal, 37(6),

584-589.

Kuehn & Moon, (1998) Velopharyngeal Closure Force and Levator Veli Palatini Activation

Levels in Varying Phonetic

Contexts,Journal of Speech Language

Hearing Research, 41, 51-62.

Lintz LB & Sherman D (1961). Phonetic elements

and perception of nasality. Journal of

Speech and Hearing Resarch, 4,381–396.

MacKay IR & Kummer A.W (1994). Simplified

Nasometric Assessment Procedures. Lincoln

Park, Kay Elemetrics, NJ.

Mc Donald & Baker (1951) nasal air flow and

nasal sound pressure level. In jhon

hajek(Eds)universals of sound change in

nasalization,pp.127-129.Boston:Blackwell.

Moore & Sommers (1973) .Phonetic contexts:

their effect on perceived nasality in cleft

palate speakers. The Cleft palate-

Craniofacial Journal, 10, 72-83.

Neumann & Dalston (2001). Nasalence Values in

noncleft individuals: Why not zero? The

Cleft palate-Craniofacial Journal, 38(2), 106-117.

Watterson T, Hinton J & McFarlane S(1996).

Novel stimuli for obtaining nasalance

measures from young children. The Cleft

palate-Craniofacial Journal. 33 ,67–73.

Watterson T, Lewis KE & Foley-Homan N (1999).

Effect of stimulus length on nasalance

values. The Cleft palate-Craniofacial Journal, 36, 243–247.

JAIISH, Vol. 27, 2008 Voice Source of Monozygotic Twins

8

Investigation into Voice Source of Monozygotic Twins using

Formant based Inverse Filtering

1Jayakumar T. &

2Savithri S.R.

Abstract

Studying glottal flow gives potential benefit in many disciplines. Several methods have

been developed for the estimation of the glottal flow. Glottal flow can be estimated from

microphone pressure signal, or Inverse filtered signal. Inverse filtering (IF) has been

used widely for the understanding of phonation type, intensity, voice quality, emotions

and vocal loading. However there is a dearth of information about the effectiveness or

reliability of IF techniques especially in the evaluation of individuals having similar voice and speech characteristics like monozygotic twins. Also, voice source through

inverse filtering has not been investigated in twins so far. In this context, the present

study investigated similarity of voice source in monozygotic twins using inverse filtering

and the consistency of inverse filtered parameters. Two groups of females participated in

the study. Group I had 6 monozygotic twins and Group II had 6, age and gender

matched unrelated pairs. None of them had any voice disorders. Subjects Phonated

vowel /a / three times at least for 5 seconds in comfortable pitch and loudness. Samples

were audio-recorded at a sampling rate of 48 kHz and phase linear recording. Samples

were inverse filtered using Vag_physio module of VAGHMI software in formant based

method. Results showed that IF parameters were reliable over the repeated trials in all

individuals. Also, ANOVA showed no significant difference between groups on voice

source characteristics. The open quotient (OQ) and speed quotient (SQ) was

significantly different across groups. However further investigation on twin pairs

selection based on perceptual similarity and confirmed genetic analysis is warranted.

Key words: Glottal flow, Genetic similarity, Reliability.

The study of the glottal flow gives insight into the voice signal, which is of potential benefit in

many disciplines such as speech synthesis, study

of vocal expression of emotions, and clinical

diagnosis and treatment of the voice. Due to the

location of the larynx, (surrounded by many

sensitive and vital organs and arteries), glottal flow

is difficult to measure directly. Hence, several

methods have been developed for the estimation of

the glottal flow. They typically use the

fundamental assumptions of Fant’s source - filter

theory. Although the source -filter theory was

formally published in 1960 (Fant, 1960), Inverse

filtering (IF) was already presented by Miller a

year earlier (Miller, 1959). Using inverse filtering

can be estimated the source of voiced speech and

the glottal flow can be acquired by removing the

effects of the estimated vocal tract and lip

radiation from a measured air-flow or pressure

waveform (Airas, 2008).

Two methods exist for the input signal in

inverse filtering. Either a flow mask may be used

to estimate the actual air-flow out of the mouth

(Rothenberg, 1973) or microphone at a certain

distance may be used to measure the speech

pressure signal (Anathapadmanabha, 1984). If

absolute flow value and measurement of the

minimum flow are required, a calibrated flow

mask has to be used. However, flow masks have poor frequency responses (linear only up to 1.6

kHz to 9 kHz), and positioning the mask tightly

around the mouth and the nose poses restriction on

natural production of speech (Rothenberg, 1977).

In contrast, good low frequency response

microphone placed at constant distance from the

speaker may overcome disadvantages of mask.

1Junior Research Fellow, Dept. of Speech Language Sciences, All India Institute of Speech and Hearing, Mysore-570006, email: [email protected], 2 Professor, Dept. of Speech Language Sciences, All India Institute of Speech and Hearing, Mysore-570006, email: [email protected].


9

The amplitude and phase response characteristics

of Condenser microphones are excellent and will

not affect natural speech production. Due to these

reasons, microphone recordings are widely used

(Airas, 2008). Inverse filtering was used widely

for different phenomena of voice production

concentrating on issues like phonation type (Alku,

Vilkman, 1996), intensity (Dromey, Stathopoulos,

Sapienza, 1992), voice quality (Gobi, NiChasaide,

2003), emotions (Airas, Alku, 2006), pitch, (Price,

1989) and vocal loading (Vinnuri et al, 2001). In

addition some studies have discussed inverse

filtering from methodological point of view (Alku,

Vilkman, Laukkanen, 1998). Given the prevalence

of IF in the field of voice science, there is dearth of information about the effectiveness or reliability

and sensitivity of the IF technique especially in the

evaluation of individuals having similar voice and

speech characteristics like monozygotic twins.

Monozygotic twins resemble each other in

many aspects like aptitude, habit, taste and style

that constitute what we think of as human individuality (Gedda, Fiori & Bruno, 1960). It

may be hypothesized that their voice also may

sound similar at least to a certain degree. It is

generally accepted that the physical characteristics

of the laryngeal mechanism, such as vocal fold

length and structure, size and shape of the

supraglottic vocal tract, and phenotypic similarities

elsewhere in the vocal mechanism are genetically

determined (Sataloff, 1997). Several research

groups have studied genetic similarities in

monozygotic twins. Though voice is unique to

individuals, studies involving listeners perception

have showed the perceptive similarity in

monozygotic twins (Decoster, Van Gysel,

Vercammen & Debruyne, 2001). Also, several

quantitative measures like fundamental frequency

in phonation (Przbyla, Hori, & Crawford 1992;

Decoster, Van Gysel, Vercammen, & Debruyne

2001; Kalaiselvi, Santhosh & Savithri 2005),

speaking fundamental frequency (Debruyne,

Decoster, Van Gysel, & Vercammen 2002),

formants (Forrai, & Gordos 1983) and Dysphonia

Severity Index (Van Lierde, Vinck, De Ley,

Clement, & Van Cauwenberge 2005) show

similarity in monozygotic twins. However, voice

source through inverse filtering has not been

investigated in twins so far. In this context, the present study investigated similarity of voice

source in monozygotic twins using inverse

filtering, and consistency of inverse filtered

parameters.

Method

Participants: Two groups of females participated

in the study. Group I had 6 monozygotic twins and

Group II had 6 age and gender unrelated pairs. All

the subjects were between 19 to 25 years of age.

Criteria for selecting the monozygotic twins

included; (a) they should be same in gender, (b)

should have the same blood group, and (c) should

have approximately similar height and weight.

Criteria for selecting the monozygotic unrelated

pairs were: (a) non siblings of the same gender and (b) height should be approximately similar. None

of the participants had any unstable voice, voice

disorders, speech disorders, neuro-motor disorders,

endocrinal disorders and/or hearing disorders.

Recordings: The recording was made in quiet

room. Participants were instructed to phonate

vowel /a / three times at least for 5 seconds at

comfortable pitch and loudness. Before the actual recording the Speech pathologist demonstrated the

phonation. All samples were audio-recorded using

Sony portable mini disk recorder MZ-R3 (Sony

Corporation, Tokyo, Japan) at a sampling rate of

48 kHz and phase linear recording. Recording was

made using Alcom-unidirectional microphone (frequency range from 40 Hz to 12000Hz (± 2dB)

placed at a distance of 10 cm from participants.

IF Procedure: The acoustic pressure waveforms

were inverse filtered using Vag _ phsio module of

VAGHMI software (Voice and Speech System,

Bangalore, India). This program has two ways to

obtain the glottal flow signal using IF- LPC

analysis and formant frequency analysis. IF using

Formant analysis gives clear glottal flow wave

with out any high frequency ripples (ripples-free)

compared to LPC based IF (Anathapadmanabha,

2008). Hence, in the present study, formant based

IF was used to obtain the glottal flow wave. The

edited downsampled phonation samples were fed

in to IF. This software also has semiautomatic

marking of the glottal flow wave to get the IF

parameters. If semiautomatic marking fails to

make decision user can switch to manual mode.

Parameterization: The glottal flow waveforms

estimated by the formant based IF were

parameterized based on temporal [Open quotient

(OQ), Speed quotient (SQ), Leakage quotient (LQ)

and Pitch Period (T0)] and spectral [Roll-off, First

Harmonic (H0), Harmonic ratio (H0-H1), EI/EE,

& Dynamic leakage (AR)] measurement. Figure 1

shows the modeled volume –velocity glottal pulse


10

and its derivative in the time domain and figure 2

shows the log spectrum of voice source.

0 – glottal Onset, P – peak flow, E – Epoch, C –

Closure, T0-Pitch period, TP-Opening Interval, TN-

Closing Interval, TL -Leakage Interval, TC-Closed

Interval.

Figure 1: Modeled glottal pulse and its derivative in

time domain.

Open quotient is defined as the ratio between

the duration of glottal opening and the

fundamental period (OQ = (TP+TN+TL) / T0.

Speed quotient is defined as the ratio between the

duration of for opening and closing of the glottis (TP/TN). Leakage quotient is defined as the ratio

between TL and T0, here TL is the time taken for

the voice source signal to return from epoch (E) to

the baseline.

Figure 2: Log Spectrum of single voice source.

Spectral roll-off indicates the smoothness of

the glottal closure or the change in the spectral level over an octave change in the frequency.

Harmonic ratio (H1-H0) is the ratio of energy at

first harmonic and fundamental frequency. EI/EE-

is the mean ratio value of positive area and the

negative area in each derivate cycle. Dynamic

leakage (AR) is the residual flow during the return

phase, which occurs from the time of excitation to

the time of complete closure.

Analyses: Phonation signals were recorded at a

sampling rate of 48 kHz. To make the signal

compatible with VAGHMI software Program

(Voice & Speech Systems, Bangalore, India),

signals were downsampled to 16 kHz using Wavesurfer software. The middle 3 second of each

phonation sample was subjected to IF analysis.

Vag _ phsio module of VAGHMI software

Program was used for IF analysis. Each parameter

was extracted 180 times each for group I and

group II (6 * 2subjects * 3 trails * Five times): All

analyses were made using semi-automatic marking

methods. Whenever software failed to make mark,

manual mode was selected for marking the glottal

cycles. Ten present of the samples were subjected

to test-re test reliability, which showed 89 %

reliability.

Statistical analysis: SPSS 10 was used to make

the statistical calculations. Pearson product correlation was used to find the relation between

the three trails measured within the subject. One

way ANOVA was used to find the difference

between the twin and co-twin as well as in

unrelated pairs. Also the Absolute difference

between the twin and co-twin as well as between

the two participants in the unrelated group was

calculated. From these values the statistical

difference were made using one way ANOVA.

Similarly the over all parameter difference was

found.

Results

Reliability over repeated trails

To check the reliability of repeated trails the mean value of three trails was correlated over

group I and group II. Tables 1 and 2 shows the r-

values of groups. r values suggest that there was

not much variability among trails, except in few

parameters.

E


11

Trial Parameters

1 & 2 1 & 3 2 & 3 T0 0.892** 0.977** 0.948** OQ 0.924** 0.891** 0.850** SQ 0.704* 0.838** 0.871** LQ 0.768** 0.716** 0.938**

EIEE 0.727** 0.916** 0.741**

AR 0.874** 0.785** 0.798** H0 0.380 0.429 0.892**

H0-H1 0.803** 0.875** 0.751** Roll-off 0.979** 0.865** 0.924**

Table 1: r- values of group I. (** p< 0.01, * p< 0.05).

Trial Parameters 1 & 2 1 & 3 2 & 3

T0 0.980** 0.973** 0.968**

OQ 0.773** 0.831** 0.752**

SQ 0.774* 0.637* 0.671*

LQ 0.482 0.706* 0.438

EIEE 0.414 0.724* 0.747*

AR 0.774** 0.725** 0.768**

H0 0.732** 0.711* 0.705*

H0-H1 0.933** 0.904** 0.836**

Roll-off 0.879** 0.865** 0.784**

Table 2: r- value of group II. (** p< 0.01, * p< 0.05).

Comparison with in group I & group II

Results of one-way ANOVA revealed no

significant difference within twins in all pairs in

various parameters. Table 3 show mean, standard

deviation of group I and Table 4 show mean, and

standard deviation in group II.

T0 OQ SQ LQ EI/EE AR H0 Ho-H1 Roll-off

Pair 1 3.81(.01)**4.08(.02)

.75(.01)

.74(.02) 1.31(.06) 1.35(.25)

.25(.04)**

.19(.06) .67(.02) .65(.07)

1.70(.29)**1.96(.15)

110.1(1.5) 108.6(4.6)

9.7(3.21) 11.5(6.33)

7.03(1.36)*5.62(.09)

Pair 2 4.02(.06)**4.83(.02)

72(.03)**.75(.01)

1.81(.24) 1.81(.17)

.23(.03)**

.19(.05) .61(.04)**.57(.01)

2.21(.14)**1.70(.38)

108(1.4)** 102 (7)

15.5(6.28) 13.8(4.44)

5.53(.16)* 5.65(.09)

Pair 3 4.53(.03)**4.48(.05)

.89(.07)**

.97(.01) 1.29(.16) 1.26(.06)

.22(.05)

.24(.02) .54(.02)**.61(.05)

1.35(.17)*1.26(.07)

108.8(1.6)**101.3(.6)

11.07(1.40)**13.55(2.55)

14.33(1.3)**12.36(.63)

Pair 4 4.54(.25)**4.17(.06)

.86(.04)**

.94(.06) 1.88(.32) 1.74(.09)

.11(.03)*

.13(.03) .39(.04)**.58(.06)

1.96(.29)**1.71(.21)

101.(1.5)** 107.(1)

5.6(.59)** 9.0(.83)

7.17(.35)** 12.47(2.50)

Pair 5 4.02(.03) 4.0(.02)

.93(.03) *

.81(.01) 1.57(.16)**2.16(.10)

.20(.03)**

.16(.01) .50(.02)**.45(.01)

1.56(.15)**2.33(.10)

100.3(.53)**98.3(.22)

9.47(.48) 3.85(.18)

15.36(.82)**15.92(.48)

Pair 6 4.58(.08)**4.46(.09)

.63(.05)**

.77(.04) 1.41(.17)**2.10(.34)

.03(.01)

.05(.02) .61(.04) .56(.09)

1.86(.11) 1.92(.18)

101.5(.53) 103.1(3.1)

3.6(.51) ** 8.3(1.2)

6.54(.74) 6.30(.58)

Table 3: Mean and SD of 1-3 twin pairs. (** p< 0.01, * p< 0.05)

T0 OQ SQ LQ EI/EE AR H0 Ho-H1 Roll-off

UPair 1 4.21(.04)** 4.31(.06)

.84(.01)*

.89(.07) 1.95(.09)** 1.55(.39)

.14(.01)**

.14(.06) .49(.03)* .55(.16)

1.46(.10)** 1.67(.44)

111.9(.72)** 106.1(2.5)

7.52(.49)** 10.7(1.04)

6.11(1.03)** 10.5(.71)

UPair 2 4.33(.10)** 4.43(.07)

.81(.04)*

.86(.05) 2.93(.72)** 1.82(.14)

.06(.03)**

.10(.03) .49(.16) .50(.08)

2.41(.71)* 1.85(.13)

101.3(4.5)** 105.8(1.5)

4.87(1.57)** 7.66(.89)

6.07(.74)** 9.23(3.22)

UPair 3 5.18(.11)** 4.87(.06)

.63(.08)**

.74(.04) 2.31(.67) 2.24(.16)

.09(.06)**

.02(.01) .37(.03)** .52(.05)

2.55(.64)** 2.09(.13)

99.(2.04)** 103.(1.06)

1.75(1.4)** 6.06(.45)

5.66(.44)** 6.24(.24)

UPair 4 4.57(.04)** 4.23(.11)

.79(.10)**

.92(.08) 1.81(.33) 1.63(.33)

.09(.04)**

.19(.06) .39(.05)** .64(.08)

2.08(.53)** 1.45(.18)

101.4(1.53) 101.2(2.19)

6.55(1.80)** 13.15(2.34)

9.47(2.36)** 9.88(.83)

UPair 5 4.42(.07)* 4.66(.03)

.94(.02)**

.80(.05) 2.13(.22)* 2.39(.26)

.16(.03)**

.10(.01) .35(.04) .35(.02)

1.96(.21)* 2.19(.14)

105.5(.86) 102.3(1.0)

6.71(1.24) 6.0(.50)

7.23(1.23) 8.27(.89)

UPair 6 5.18(.11) 4.29(.04)

.63(.08)**

.84(.01) 2.31(.67) 1.95(.09)

.09(.06)**

.14(.01) .37(.03)** .49(.03)

2.55(.64) 1.46(.10)

99.5(2.0) 111.9(.72

1.75(1.4) 7.52(.49)

5.66(.44) 6.11(1.03)

Table 4: Mean and SD of 1-3 group II. (** p< 0.01, * p< 0.05)

Comparison of IF parameters between the

groups

Absolute difference between twin, and co-

twin was used to perform one way ANOVA.

Twin, co- twin difference is the arithmetic

differences between the two members of twin

members. Similarly, pair, co-pair differences values where calculated for unrelated members.

Appendix I shows mean and standard deviation of

difference values of twin pairs and unrelated pairs.

Using the difference of twin, co twin and pair, co-pair values group comparison was made

between group I and group II. Results indicated

significant differences between groups on OQ, SQ,

LQ EI/EE, AR, and H0. Table 5 shows the mean

and SD in both groups.


12

Unrelated Twins

T0 0.33 (.28) .28 (.29) OQ 0.12 (.09) 0.08 (.06)** SQ 0.62 (.47) 0.36 (.29)** LQ 0.06 (.05) 0.05 (.04)* EI/EE 0.14 (.10) 0.08 (.06)** AR 0.60 (.52) 0.38 (.28)** H0 5.79 (3.6) 4.88 (3.6)* Ho-H1 4.52 (2.35) 4.05 (3.27) Roll-off 2.18 (1.95) 1.78 (2.14)

Table 5: Mean and SD of difference values in two

groups. (** p< 0.01, * p< 0.05)

Discussion

Very few studies have investigated the consistency of inverse filtering parameters either

in subjects with normal voice or in pathological

voice. Few studies investigated the voice source

but none of the published work had been done on

analysis of IF parameters in monozygotic twins.

Current study investigated the inverse

filtering parameters of six monozygotic twins comparing with age and gender matched unrelated

pair. The coefficient value suggested that there

was good consistency between trails of individuals

in both groups, and a good consistency of IF

parameters over repeated trials.

Secondly, within each twin (Group I), no

significant difference was found on several

parameters rather voice source similarity was very

few in group II. Speed quotient was more similar

in monozygotic twin’s pair compares all other

inverse filtering parameters. These results were in

hand with Van Lierde et al (2005). They

investigated voice quality of 45 monozygotic twins

using qualitative and quantitative assessment. The

results showed similarity in laryngeal,

aerodynamic measurement. The voice source

similarity in group I can be attributed to would be

physical characteristics of the laryngeal

mechanism, such as vocal fold length and

structure, size and shape of the supraglottic and

vocal tract. Since twins are similar in genetically

they have high similarity on voice source

characteristics (Sataloff, 1997). Variability that is

seen in the voice source of twins group can be due

to variation in genetic similarity. That is some

pairs have more genetically similar component

than others.

Using the absolute difference value the group comparison made between twin pairs and

unrelated pairs. OQ, SQ, LQ, EI/EL, AR, HO were

significantly different between groups. Open

quotient and speed quotient are parameter which is

more similar in monozygotic twin’s pair compares

all other inverse filtering parameters. It shows the

opening phase and speed of vocal fold movement

is similar in monozygotic group. OQ & SQ value

gives the overall morphology of the glottal wave.

In conclusion, IF parameters was reliable over

the repeated trials in all individuals. Monozygotic

twins showed considerable similarity in voice

source on inverse filtering. Also majority of the

parameters, specially OQ and SQ were sensitive

enough to differentiate monozygotic twin’s voice.

Further investigation on twin pairs based on

perceptual and genetic analysis is warranted.

References

Airas, M., (2008). TKK Aparat: An environment

for voice inverse filtering and

parameterization. Logopedics Phoniatrics

Vocology, 33(1), 49-64.

Airas, M., & Alku, P. (2006). Emotions in vowel

segments of continuous speech: analysis of

the glottal flow using the normalized

amplitude quotient. Phonetica,63,26-46.

Alku, P., & Vilkman, E., (1996). A comparison of

glottal voice source quantification

parameters in breathy, normal and pressed

phonation of female and male speakers.

Folia Phoniatrica Logopaedica,48, 240-

254.

Alku, P., Vilkman, E., & Laukkanen, AM. (1998).

Parameterization of the voice source by

combining spectral decay and amplitude

features of the glottal flow. Journal of

Speech Language Hearing Research, 41,

990-1002.

Ananthapadmanaba, TV. (1984). Acoustic analysis

of voice source dynamics. STL-QPSR, 1-4.

Ananthapadmanabha, T.V., (2008). Voice source

characterization by Inverse Filtering

Proceedings of the national workshop on

voice: Assessment and Management, 1-25.

Debruyne, F., Decoster, W., Van Gysel, A., &

Vercammen, J. (2002). Speaking fundamental frequency in monozygotic and

dizygotic twins. Journal of Voice, 16, 466-

471.

Decoster, W. A., Van Gysel, A., Vercammen, J., &

Debruyne, F. (2001). Voice similarity in


13

identical twins. Acta Oto Rhino

laryngological belg, 55, 49-55.

Dromey, C., Stathopoulos, E., & Sapienza, C.

(1992). Glottal airflow and EGG measures

of vocal function at multiple intensities.

Journal of Voice, 16, 44-54.

Fant, G. (1960). Acoustic theory of speech

production. The Hague, Netherland:

Mouton.

Forrai, G., & Gordos, G. (1983). A new acoustic method for the discrimination of

monozygotic and dizygotic twins. Acta

paediatrica Hungarica, 24, 315-321.

Gedda, L., Fiori, R., & Bruno, G. (1960). Viox

chez les jumeaux monozygotiques. Folia

phoniatrica, 12, 81-94.

Gobi, C., & NiChasaide, A., (2003). The role of

voice quality in communicating emotion, mood and attitude. Speech Communication,

40, 189-212.

Kalaiselvi, P. S., Santhosh, M., & Savithri, S. R.

(2005). Multi dimensional analysis of voice

in monozygotic twins. Journal of the

Acoustical Society of India, C, 25-28.

Miller, RL. (1959). Nature of the vocal Cord wave.

Journal of the Acoustical Society of

America,31, 667-77.

Price, PJ. (1989) Male and female voice source

characteristics: inverse filtering results.

Speech Communication, 8, 261-277.

Przbyla, B., Horii, T., & Crawford, M. (1992).

Vocal fundamental frequency in a twin

sample: looking for a genetic effect. Journal

of Voice, 6, 261-266.

Rothenberg, M. (1973). A new inverse-filtering

technique for deriving the glottal air flow

waveform during voicing, Journal of the

Acoustical Society of America, 53,1632-45.

Rothenberg, M. (1977). Measurement of air flow

in speech. Journal of Speech Hearing

Research, 20, I55-76.

Santosh, M., & Savithri, S. R. (2005). Voice prints

in monozygotic twins. Journal of the

Acoustical Society of India, C, 1-7.

Sataloff, R. (1997). Professional Voice, the

Science and Art of Cliniccal Care. Singular

Publishing Group, San Diego: CA.

Van Lierde, K. M., Vinck, B., De Ley, S.,

Clement, G., & Van Cauwenberge, P.

(2005). Genetics of vocal quality

characteristics in monozygotic twins: a multiparameter approach. Journal of Voice,

19, 511-518.

Vinnuri, J., Alku, P., Lauri, ER,, Sala, E., Sihvo,

M., & Vilkrnan, E. (2001) Objective

analysis of vocal warm-up with special

reference to ergonomic factors. Journal of

Voice,15,36-53.

Acknowledgements

Authors would like to extend their gratitude to

Dr. Vijayalakshmi Basavaraj, Director, All India

Institute of Speech and Hearing for allowing us to

carryout this study and also the co-operation of the participants.


14

Appendix 1 – Mean and SD of absolute difference values in both groups.

(U-unrelated pair, Pair – twin pair)

U 1 & Pair 1 U 2 & Pair 2 U 3 & Pair 3 U 4 & Pair 4 U 5 & Pair 5 U 6 & Pair 6 T0 .09(.05)

.27(.03) .13(.10) .81(.07)

.31(.14) .06(.05)

.33(.12) .37(.23)

.23(.06) .03(.03)

.88(.12) .13(.11)

OQ .07(.04) .02(.01)

.05(.03) .04(.02)

.10(.06) .08(.06)

.15(.14) .11(.04)

.14(.05) .12(.04)

.21(.09) .14(.05)

SQ .50(.26) .20(.21)

1.11(.72) .24(.15)

.68(.38) .16(.09)

.44(.24) .25(.19)

.32(.30) .59(.16)

.67(.37) .71(.33)

LQ .05(.03) .07(.04)

.03(.03) .07(.04)

.07(.07) .07(.03)

.10(.09) .03(.02)

.05(.03) .04(.03)

.08(.02) .02(.01)

EI/EE .15(.10) .06(.05)

.16(.14) .05(.03)

.15(.04) .07(.04)

.24(.10) .18(.07)

.04(.04) .05(.02)

.12(.04) .09(.06)

AR .34(.36) .27(.20)

.79(.38) .49(.18)

.75(.38) .16(.12)

.68(.53) .39(.29)

.26(.26) .79(.18)

1.5(.10) .17(.11)

H0 5.85(2.29) 3.49(1.61)

5.75(1.03) 6.87(6.58)

4.32(1.73) 7.54(2.09)

3.18(1.19) 6.39(1.30)

3.19(1.70) 2.09(.70)

12.44(2.21) 2.93(1.86)

Ho-H1 3.18(1) 4.72(6.03)

2.90(1.50) 6.14(4.15)

4.30(1.51) 2.63(1.75)

6.60(2.53) 3.42(1.07)

1.37(.93) 5.61(.51)

5.76(1.46) 4.75(.96)

Roll-off 4.40(.98) 1.41(1.35)

3.58(2.9) .16(.11)

.62(.13) 2.27(1.46)

2.19(1.01) 5.31(2.39)

1.23(.68) .91(.75)

1.03(.77) .62(.52)


15

JAIISH, Vol. 27, 2008 Effect of Spectral Variation on Phoneme Identification Skills

16

Effect of Spectral Variation on Phoneme Identification Skills in 2 - 3

year old Typically Developing Children

1Powlin Arockia Catherine S. &

2Savithri S. R.

Abstract

The present study investigated the ability of 2 to 3 year old Kannada speaking typically

developing children to identify synthetic phonemes varying in second formant frequency

(F2). Two picturable (minimal pair) words with stop consonants contrasting in place of

articulation (labial /p/ and retroflex /tA/) in word initial position in Kannada were

selected. These words as uttered by 21-year-old female native Kannada speaker were

recorded and stored onto the computer memory. Place of articulation continuum was prepared using Acophon 1 programme of SSL Pro3V3 software and tokens were audio

recorded onto a CD. The synthesized tokens were presented to thirty (15 boys and 15

girls) 2 to 3 year old children individually. Subjects were instructed to point to the

pictures placed before them as they listen to the token and the investigator noted their

responses on a scoring sheet. Percent identification scores were calculated. The results

indicated that the 50% crossover from labial to retroflex cognate occurred at 1692 Hz in

children. Also, phoneme boundary width was wider in girls compared to that in boys.

The results of the current study can be used to compare phoneme identification skills in

clinical population of same age.

Key words: Identification, Synthesis, F2 transition.

Speech perception is the decoding and

interpretation of speech by the listener. Research

on speech perception seeks to understand how human listeners recognize speech sounds and use

this information to understand spoken language.

Studies on infant speech perception postulates that

the ability to perceive universal phoneme contrast

is present at birth and with exposure infants loose

this ability and could perceive only the native

contrasts (Werker & Tees, 1984). Also cross

language studies on adults have demonstrated

language specific perception patterns (Abramson

& Lisker, 1970). Modification of perceptual

abilities takes place between infancy and

adulthood. It is important to investigate and

document the modification process in phoneme perception during language development period, as

it would strengthen our understanding of

perception-production relationship.

Of all phonemes, stop consonants are widely

studied. They are produced by occluding the oral

cavity and releasing the articulator after sufficient

air pressure is built up. Temporal and acoustic

parameters cue voicing and place of articulation in

stop consonants. Cues for place of articulation include burst spectrum at consonantal release

(Cooper, Delattre, Liberman, Borst & Gerstman,

1952; Winitz, Scheib & Reeds, 1972) and onset

frequency of second and third formants (Delattre,

Liberman, Cooper, 1955). Potter, Kopp & Green

(1947) stressed the importance of second formant

(F2) transition to cue place of articulation and

described various pattern of transitions. Rising F2

transitions are perceived as bilabials (/b/ and /p/),

F2 slight fall for front vowels and sharp fall for

back vowels are perceived as alveolars (/d/ and /t/)

and sharp F2 fall for front vowels and slight fall of

F2 for back vowels are perceived as velars (/g/ and /k/) (Borden & Harris, 1980).

In the past, several investigations (Liberman,

Delattre, Cooper and Gerstman, 1954; Liberman,

Harris, Hoffman & Griffith, 1957; Sussman, 1993)

have reported the importance of F2 onset in

identifying and discriminating place of articulation

1Junior Research Fellow, Dept. of Speech-Language Sciences, All India Institute of Speech and Hearing, Mysore, email:[email protected], 2Professor, Dept. of Speech-Language Sciences, All India Institute of Speech & Hearing, Manasagangothri, Mysore 570 006, email:[email protected],


17

of stop consonants in adults and children.

However, the F2 varies depending on the place of

articulation of the stop consonant in a language.

Also, most of the studies are in English. India

being a multilingual country offers great potential

for research in this area. While this area has

received some attention at the international level,

the scene at the national level is dismal. Although

the sources of data in non-Indian languages are

useful, there is a pressing need for experimental

evidence in various Indian languages. Both cross-

sectional and longitudinal studies are needed with

groups of children of sufficient size to allow at

least preliminary generalizations about normative

development.

In this context, the present study investigated

phoneme identification skills in typically

developing Kannada speaking children between

the age range of 2 and 3 years by systematically

varying the F2 onset frequency.

Method

Subjects: Thirty typically developing, Kannada

speaking children from four play schools in

Mysore participated in the study. The subjects

included 15 boys and 15 girls in the age range of 2

to 3 years. All the children were from middle

socio-economic status. The children were formally screened for speech, language and hearing abilities

by the experimenter and those who passed the

screening were included in the study.

Stimuli: Two meaningful, picturable, bisyllable

words with stop consonants in the initial position

in Kannada were selected. The word initial stop

consonants in the word pair contrasted in place of articulation (p- t; pa:ta – ta:ta). These words

as uttered thrice by a 21-year-old female, native

Kannada speaker were recorded onto a computer

using SSL Pro3V3 software (Voice and Speech

Systems, Bangalore) and stored onto the computer

memory. From the wide-band bar type

spectrograms with LPC analysis, the onset

frequency of first three formants, F2 transition

duration and F2 frequency of steady state of vowel

for the initial vowel of the word pair was obtained.

For /pa/, onset frequency of F1, F2 and F3 were

785 Hz, 1300 Hz and 2960 Hz, respectively and

F2 transition duration was 37 ms followed by F2

steady state of 130ms. Formant frequencies of

vowel steady state were 890 Hz (F1), 1547 Hz (F2)

and 3030 Hz (F3). F2 continuum was prepared

using formant based analysis by synthesis (FBAS)

module of Acophon 1 programme in SSLPro3V3

software. The word /pa: ta/ was analyzed with a

block duration of 40 ms and block shift of 10 ms.

Linear predictive coefficient was kept at 18 and

pre-emphasis factor was 1. Following analysis,

the F2 continuum was synthesized using edit

option by selecting glottal voice source pulse

shape. F2 onset frequency of word-initial vowel

was varied from 1300 Hz to 2400 Hz in steps of

100 Hz keeping the other formants constant in the

initial vowel. The F2 was interpolated

between onset and onset of vowel steady state and

the word was synthesized. Figure 1 illustrates F2 at

mid and end points of the continuum. A total of 12

synthetic words for a /p-t/ continuum were generated. The synthetic words were iterated

thrice, randomized and recorded onto a CD. Thus a

total of 36 tokens (12*3) formed the stimulus.

Figure1: Illustration of F2 at 1300 Hz (a), 1800 Hz (b)

and 2400 Hz (c).

Procedure: Children were tested individually.

Each child was familiarized with the pictures of

the words used in the experiment on the previous

day of the data collection. Experiment was carried

out in a quiet room. The child was seated comfortably in a chair. The stimulus was audio-

presented through two speakers placed at 45o

azimuth at a comfortable loudness. The child was

instructed to carefully listen to the stimuli and

point to the respective picture out of two picture

cards placed before him/her. The investigator

noted the child's responses on a scoring sheet.

Percent identification scores were calculated and

identification curves were drawn. Fifty percent

crossover, lower limit of phoneme boundary

(LLPB), upper limit of phoneme boundary

(ULPB) and phoneme boundary width (PBW)

were obtained (Doughty, 1949). Fifty percent

crossover is the point at which 50% of the

subject’s response corresponds to the labial

(alveolar) category. Lower limit of phoneme

boundary width is the point along the acoustic cue


18

continuum where an individual identified labial

(alveolar) stop 75% of the time and upper limit of

phoneme boundary width defined as the

corresponding point of the identification of the

labial (alveolar) cognate 75% of the time.

Phoneme boundary width was determined by

subtracting the lower limit from upper limit of

boundary width. Identification data obtained from

one child (B9) was not considered for analysis as it

didn’t show crossover.

Results

Result indicated that 50% crossover occurred

at 1680 Hz. The mean LLPB and ULPB were at

1520 Hz and 1920 Hz, respectively. The mean

PBW was 400 Hz. In girls 50% crossover, LLPB

and ULPB occurred earlier compared to those in

boys. PBW was wider in girls compared to that in

boys. Also, the range of all the measures was

wider in girls compared to those in boys. Results of independent t-test revealed significant gender

difference on LLPB [t (27) = -2.176; p<0.05]. No

significant difference was found across gender for

50% crossover [t (27) = -1.980; p>0.05], ULPB [t

(27) = -1.754; p>0.05] and PBW [t (27) = 0.462;

p>0.05]. Table 1 shows the mean values of all

parameters in children. Figures 2 and 3 shows mean percent identification in boys and girls.

Parameters Boys Girls Average

50%crossover (Range)

1820 (590)

1620 (630)

1680 (650)

LLPB (Range)

1630 (610)

1485 (650)

1520 (650)

ULPB (Range)

1995 (470)

1880 (610)

1920 (660)

PBW (Range)

365 (240)

395 (460)

400 (430)

Table 1: Mean and range values of measures of /p- t/

continuum (in Hz).

Figure 2: Mean percent identification scores in boys.

Figure 3: Mean percent identification scores in girls.

Discussion

The results revealed interesting findings.

First, it was found that F2 onset frequency was an

important cue to identify the place of articulation

of stop consonants (/p/ and /t/) in Kannada. Lower

F2 onset was perceived as bilabial /p/ and the

percept changed to retroflex /t/ at higher F2 onset

frequencies. This finding is in consonance with

Liberman, Delattre, Cooper & Gertsman (1954)

and Liberman, Harris, Hoffman & Griffith (1957)

in adult English speakers.

Second, children shifted their percept from

bilabial /p/ to retroflex /t/ at 1680 Hz. In English

speakers the shift from bilabial to alveolar place

occurred at a much earlier frequency, 1199 Hz for

4 year old children, 1120 Hz for 5 – 6 year old

children and 1144 Hz for adults (Sussman, 1993).

This difference in shift of percept can be attributed to differences in place of articulation of stop

consonants or methodological difference. In the

present study the extreme frequencies of the

continuum were between 1300 Hz and 2400 Hz

but in Sussman’s study they were 543 Hz and

1620 Hz. Also, stimulus in the current study was

bisyllable meaningful Kannada words uttered by 21 year old female native Kannada speaker and F2

continuum was prepared by manipulating the F2

onset in initial vowel using FBAS module of

Acophon 1 programme in SSLPro3V3 software. In

Sussman’s study the stimulus was synthetically

generated using Klatt synthesis package using

digital signal processing board (Data Translation model 2821).

Third, mean phoneme boundary width was

400 Hz in children and it was wider in girls (395


19

Hz) compared to boys (365 Hz). This can be

attributed to more number of girls having wider

PBW compared to that in boys.

To conclude, typically developing Kannada

speaking children in the age range of 2-3 years

were able to shift their percept from bilabial /p/ to

retroflex /t/ when F2 onset frequency increased.

Future research on older age groups and adults to

study the developmental pattern of speech

perception in Kannada and other languages are

warranted.

Conclusions

The present study provides data on phoneme

identification skills in 2-3 year old Kannada

speaking typically developing children. The

phoneme identification skills of normal children

can be compared with clinical population like late-

talking children, children with hearing impairment,

mental retardation, seizure disorder and high-risk

children. More specifically, late talking children

between 2 to 3 years who exhibit language

disorder in the absence of specific causes may be

impaired in phoneme identification. Also, using

the findings of this study as baseline, perception

training program for children in this age group can

be devised.

References

Abramson, A., & Lisker, L. (1970).

Discriminability along the voicing

continuum: Cross-language tests.

Proceedings of the sixth International congress of phonetic sciences, Academia,

Prague, pp 569-573.

Borden, G. J., & Harris, K. S. (1980). Speech

science primer- Physiology, acoustics and

perception of speech. Williams & Williams,

Baltimore, USA, 171-214.

Cooper, F. S., Delattre, P.C., Liberman, A. M.,

Borst, J., & Gerstman, L. J. (1952). Some

experiments on the perception of synthetic

speech sounds. The Journal of the

Acoustical Society of America, 24, 597-606.

Delattre, P. C., Liberman, A. M., & Cooper, F.S.

(1955). Acoustic loci and transitional cues

for consonants. The Journal of the

Acoustical Society of America, 27, 769-773.

Doughty, J. (1949). In Zlatin, M., &

Koenigsknecht, R. (1975). Development of

the voicing contrast: Perception of stop

consonants. Journal of Speech and Hearing

Research, 18, 541-553.

Liberman, A. M., Delattre, D. C., Cooper, F.S., &

Gerstman, L.J. (1954). The role of

consonant-vowel transitions in the

perception of the stop and nasal consonants.

Psychological monographs, 68, 1-13.

Liberman, A. M., Harris, K. S., Hoffman, H. S., &

Griffith, B. C. (1957). The discrimination of

speech sounds within and across phoneme boundaries. Journal of Experimental

Psychology, 54, 358-368.

Potter, R. K., Kopp, G. A., & Green, H. (1947).

Visible speech, NewYork: Van Nostran.

Sussman, J.E. (1993). Perception of formant

transition cues of place of articulation in

children with language impairments.

Journal of Speech and Hearing Research. 36, 1286-1299.

Werker, J. H., & Tees, R.C. (1984). Cross-

language speech perception. Evidence for

perceptual reorganization during the first

year of life. Infant behavior and

development, 7, 49-63.

Winitz, H., Scheib, M. E., & Reeds, J. A. (1972).

Identification of stop and vowels for the burst portion of /p,t,k/ isolated from

conversational speech. The Journal of the

Acoustical Society of America, 51, 1309-

1317.

Acknowledgements

This study is an outcome of the doctoral

research of the corresponding author. The authors

are thankful to Dr. Vijayalakshmi Basavaraj,

Director, All India Institute of Speech and Hearing

for granting permission to carry out this study.

JAIISH, Vol. 27, 2008 Keratosis of the Larynx

20

Keratosis of the Larynx

1Rajasudhakar R. &

2Sundara Raju H.

Abstract

Laryngeal keratosis is a rare condition characterized by irregular areas of thickening

and cornification of the laryngeal mucous membrane. Much controversy exists regarding

its etiology, treatment and terminology. Some authors interchange the term ‘keratosis

laryngis’ with that of ‘leukoplakia’ of the larynx. There are however, others who believe

that these terms are not inter-related. This paper made an attempt to describe some of

the characteristic features of the disease by describing a case report to emphasize the

acoustic parameters of voice before and after the medication.

Key words: Keratosis, Leukoplakia, Case history, Acoustic parameters, Medication.

Hyperkeratosis of the larynx is a localized

form of epithelial hyperplasia characterized by

white ‘leucoplakic’ raised patches on the vocal folds. It is considered a clinically premalignant

lesion that develops into invasive carcinoma in

about 7-20% of cases (García, Aranzábal, Salas,

Olano & Guimera, 1996). The condition is rare

and occurs more commonly in men. Although its

causation is often unclear, sometimes it resembles

and is associated with some chronic inflammations

of the larynx. There is a hyperplastic change in the

epithelium, leading to excessive cornification,

together with extension of the papillae into the

corium, the basement remaining intact.

Etiology

Little is known about the cause of this disease

although many theories have been postulated.

Some of them include: (a) use of tobacco, (b)

excessive use of alcohol, (c) vocal abuse, (d)

chronic postnasal discharge with laryngeal irritation, (e) Syphilis, (f) dietary deficiencies with

low vitamin A and B intake, (g) virus infection,

and (h) mycosis.

Signs and symptoms

Some of the clinical features include: (a) hoarseness which is gradual in onset and persistent

in nature, (b) occasionally associated with cough,

dyspnea and stridor, (c) white raised patches that

appear on one or both vocal cords. The anterior

and middle thirds are usually involved. These

patches may involve one side only, but more often

they are irregularly bilateral in distribution. There

is no ulceration but one may observe strict

demarcation between normal mucosa and the

borders of involved tissue. Mobility of the cords is

not impaired. The condition is considered pre-

cancerouos and ‘carcinoma in situ’ frequently

supervenes. Histopathologically, one finds the

laryngeal epithelium thickened, elevated, and

keratinized but the basement membrane is

unchanged.

Treatment

Both medical and surgical techniques are

usually employed. Intensive vitamin A, B and C

therapy is prescribed and cures have been

described following their employment, in

conjunction with laryngeal stripping procedures. Simpson, Robin, Ballantyne, & Groves (1967)

reported that vitamin A control the rate of growth

of epithelial structures. But, it tends to persist in

spite of conservative treatment. Complete voice

rest along with exclusion of alcohol, tobacco, and

spicy food is considered useful. Studies on the

voice parameters in laryngeal keratosis are limited.

This study describes the acoustic characteristics of

voice in an individual with hyperkeratosis of the

larynx before and after medication.

Case history

A 52 years old male reported to AIISH clinic

with the complaint of pain in throat for fifteen

1Junior Research Fellow, Dept. of Speech-Language Sciences, All India Institute of Speech & Hearing, Manasagangothri, Mysore-570006, email: [email protected], 2Reader in ENT, All India Institute of Speech & Hearing, Manasagangothri, Mysore-570006.


21

days. He reported of pain while speaking and was

unable to increase loudness. Excessive cough was

also reported for fifteen days. The severity of the

problem was reportedly more in morning. He had

no difficulty in swallowing solids or liquids.

Voice evaluation

Quantitative analysis

The quantitative analysis of voice was done

by using Vaghmi software (VSS, Bangalore),

MDVP (Kay Elemetrics, New Jersy) and

Electroglottograph (EGG). The results indicated

higher habitual frequency in phonation, reading

and speaking, reduced frequency and intensity range. Abnormal extent and speed of fluctuations

in intensity and frequency, reduced maximum

phonation duration in condition 1 (before

medication) compared to condition 2 (after

medication). MDVP showed abnormality in

frequency, intensity and perturbation related

measures in condition 1 compared to condition 2. Table 1 shows the measures in both conditions.

Figure 1 shows the MDVP results in condition 1

(a) and condition 2 (b).

Parameters Condition 1 Condition 2 Fundamental frequency (Fo)

/a/ /i/ /u/

135 Hz 148 Hz 136 Hz

124 Hz 128 Hz 127 Hz

Reading Fo 145 Hz 130 Hz Speaking Fo 140 Hz 126 Hz Frequency range 108-216 Hz 102-228 Hz Intensity range 88-105 dB 70-110 dB Extent of Fluctuation in -Intensity -Frequency

2.52 dB 3.19 Hz

1.25 dB 2.51 Hz

Speed of Fluctuation in -Intensity -Frequency

4.50 % 12.5 %

2.31 % 3.87 %

Maximum phonation duration /a/ /i/ /u/ /s/ /z/

15 sec 12 sec 14 sec 12 sec 10 sec

17 sec 15 sec 13 sec 12 sec 12 sec

EGG measures -Open Quotient (OQ) -Closed Quotient (CQ)

59 % 41 %

54.11 % 45.89 %

MDVP frequency, intensity and perturbation related measures affected

Normal

(Condition 1 = before medication; Condition 2 = after

medication)

Qualitative analysis

The qualitative analysis revealed high pitch,

soft severe hoarseness voice in condition 1. The

diagnosis was clinically normal voice in condition

2.

Laryngeal examination

Endoscopy revealed the presence of white

patches on both vocal folds. Figure 2 (a) shows the

endoscopic image of Keratosis larynx. The white

patches were

(a) (b)

seen in the anterior one-third region of the vocal

folds. Conservative medication like antibiotics

(Clamp, 625 mg for five days), anti-inflammatory

analgesic (Emanzen D, for seven days) and

Cobadex CZS for fifteen days was prescribed along with voice rest.

(a) (b)

Figure 2: a) view of the Keratosis larynx in condition 1;

b) view of larynx in condition 2 (after-

medication).

After fifteen days of medication, the case

came for re-evaluation. The quantitative and

qualitative voice parameters were measured in

condition 2 which revealed that the acoustic

parameters improved. Also, laryngeal endoscopy

was done where white patches were not seen on

the vocal folds. Figure 2 (b) shows the endoscopic image of larynx after medication.

Figure 1: (a) Results of MDVP parameters in condition

1; and in condition 2; (b) (beyond green

circle indicates abnormal).


22

Discussion

The results revealed several points of interest.

First of all, Fo was high in condition 1 compared

to condition 2. Owing to the keratosis in the

anterior portion of the vocal folds, the patient may

be using only the posterior part of the vocal folds

for vibration resulting in high Fo in condition 1.

Reduced MPD and increased open quotient

indicate that the vocal folds were open for longer

time in condition 1 compared to condition 2. That

is probably, the vocal folds did not close completely or the closure was not symmetrical as

indicated by abnormal perturbation values. All

these can be attributed to the presence of keratosis.

Grossman & Mathews (1976) quoted Reimann's

theory that keratosis is "a disease of shedding of

the superficial layers. These cells do not

differentiate as do normal cells, but stick together, pile up and produce the islands called as

keratinized because of an excess of keratin in the

cell". In this case, the disease may be in the initial

stage that may spread in the epithelial level of the

vocal folds. Henceforth it was controlled by the

drug before it progressed to the other layers of

vocal folds. The composition of ‘cobadex czs’

consisted of multivitamins and chromimum zinc.

According to Simpson, Robin, Ballantyne, &

Groves (1967), the rate of growth of epithelial

structures are controlled by the vitamin A. It can

be interpreted in this case that the disease might be

caused due to dietary deficiencies with low

vitamin A and B intake.

Conclusions

Early diagnosis of laryngeal keratosis, a

precancerous lesion, is important since it has the

possibility of becoming malignant change. It is

believed that laryngeal keratosis progressed to

carcinoma in situ or invasive carcinoma through

the stage of epithelial proliferation and epithelial

dysplasia. The acoustic aspects of voice in

keratosis larynx are abnormal as like other organic

dyaphonias. The quantitative and qualitative

measures of voice improve with medication unless

the disease has progressed towards the other layers

of vocal folds. Generalization of the results are

uncertain because of single case study and the

lesion size, shape, extent may vary.

References

García, R. L., Aranzábal, L. M. A., Salas, R. A.,

Olano, A. M. & Guimera, A. J. (1996). The

study of the evolution of laryngeal

premalignant lesions. Acta Otorrinolaringol

Esp., 47(2), 129-33.

Grossman, A. A. & Mathews, W. H. (1952).

Keratosis of the larynx with progression to

malignancy. Canad. M. A. J. Vol. 66. 39-41.

Simpson, J. F., Robin, I. G., Ballantyne, J. C. &

Groves, J. (1967). A synopsis of

otolaryngology. John Wright & Sons Ltd,

Bristol. 366-367.

Acknowledgements

We thank the Director, All India Institute of

Speech & Hearing, Mysore, for allowing us to

conduct the study. We extend our thanks to

Savithri, S. R., Professor of Speech Sciences,

AIISH, Mysore, for her guidance and discussion during the preparation of this paper.

JAIISH, Vol. 27, 2008 Nasalence Value for Rainbow Passage

23

Nasalence Value for Rainbow Passage: Normative Data for Non-

Native Speakers

1Sangeetha Mahesh &

2Pushpavathi M.

Abstract

The development of normal speech is the most important goals of a clinician. The speech

disorders associated with cleft lip and palate include abnormal consonant production,

abnormal nasality, nasal air emission, nasal turbulence, and unintelligible speech.

Nasality is measured subjectively and objectively. The ratio of acoustic energy output

from the oral and nasal cavities of the speaker is called “Nasalence”. Most normative

data available for assessing resonance through instrumentation have been on English speaking population. The nasalance is influenced by several parameters such as age,

language, dialect, speech stimuli and gender. Hence the present study investigated

nasalence values in Non- native English speakers using RAINBOW passage. Mean

nasalence scores were obtained from 45 normal males and 70 normal females. The

results indicated higher nasalence percent and variability in females compared to males.

The mean nasalence value was 31.39 for females and 27.93 for males. A comparison of

the nasalence values for Rainbow passage across various studies reveal significant

differences except Hutchinson etal. (1978). this difference is due to the difference across

subjects, age and the instrumentation.

Key words: Nasometer, Nasalence, Rainbow passage, Non-native English speaker.

Nasality is a common problem in subjects

with repaired / unrepaired cleft palate, which

affects the speech intelligibility. Nasal resonance

is not only seen in disordered speech, it is also

seen at certain extent in normal speech. Nasality

can be assessed by subjective as well as objective

methods. Judgment of nasality is done using

various rating scales. Instrumentation provides

explicit information with respect to certain ranges

of nasal resonance that was particularly difficult

for listeners to resolve. Earlier studies indicated

that nasalance values vary across languages.

(Anderson, 1996; Van Doorn and Purcell, 1998; Van Lierde, 2001; Whitehill, 2001; Van Lierde,

Wuyts, De Bodt, and Van Cauwenberge, 2001:

Van Lierde, Wuyts, Bodt, and Cauwenberge,

2003; Sweeney and O’Regan, 2004: Mahesh and

Pushpavathi, 2008)

An initial step towards refining the use of

nasometry as an objective measure of perceived

nasal acoustic energy involves manipulating the speech sample used. Several speech samples and

reading materials are included in the nasometry

package for use in assessment of resonance

disorders. Three standard stimuli for data

collection were recommended by Fletcher (1978) - Rainbow passage (a passage in which the

occurrence of phonemes is similar to the

occurrence in English conversational speech), Zoo

passage (which has only oral sounds) and a set of

nasal sentences. Most of the studies used speech

stimuli developed in their own languages and are

comparable to Standard English passages.

Nasalence data has been published for normal

speakers (Hutchinson, Robinson and Nerbonne,

1978: Seaver, Dalston and Leeper, 1991: Leeper,

Rochet and MacKay, 1992) as well as in clinical

groups (Fletcher, 1978).

Nasalence value also varies with reference to

the gender. Gender related differences in nasalance

value can possibly be related to basic structural

and functional differences across gender. The

resonance of voice is influenced by the size, shape

and surface of infraglottal and supraglottal

resonating structures and cavities. Previous

studies found that female speakers have

1Clinical Lecturer, Dept. of Clinical Services, All India Institute of Speech and Hearing, Manasagangothri, Mysore- 570 006, email: [email protected], 2Reader, Speech-Language Pathology, All India Institute of Speech and Hearing, Manasagangothri, Mysore- 570 006, email: [email protected]


24

significantly higher nasalance values compared to

male speakers on passage containing nasal

consonants (Seaver, Dalston, and Leeper, 1991;

Van Lierde, Wuyts, De Bodt and Van

Cauwenberge, 2001; Fletcher, 1978; Hutchinson,

Robinson, and Nerbonne, 1978).

Seaver, Dalston and Leeper (1991) compared

the nasalence values of 148 normal adult subjects

speaking four dialects of American English using

Rainbow passage, Zoo passage and a set of nasal

sentences. The mid atlantic speakers were found to

have significantly higher nasalence value in all

three stimuli. The female subjects had significantly

higher nasalence value on the nasal sentences.

They also found significant difference across

dialects. Post hoc comparison revealed significant

difference among the values of Mid Atlantic and

Mid Western speakers, Mid Atlantic and Ontario

speakers, Mid Atlantic and southern speakers.

Correlations of moderately high strength were

found between nasalence values of Rainbow

passage readings with Zoo passage readings probably due to predominance of oral consonants

and vowels, even though it does contain some

nasal consonants. Correlations of moderately high

strength were also found between nasalence values

of Rainbow passage readings with nasal passage

readings probably due to both passages contain

nasal consonants hence the instrument would

respond accordingly.

There is very limited data on nasometric

values in non-native English speakers using

rainbow passage. Normative data are available for

English speakers, as most of the studies have been

conducted in native English speakers. These data

in turn indicate that not all native English speakers

obtain the same nasalence values. Factors such as

English dialect spoken and gender of the subject

appear to affect nasalence value which suggest

cross dialect differences. These results stress the

importance of developing normative data for

various subgroups in the general population using

the standard rainbow passage. Speech pathology

clinics in India are using the Nasometer to confirm

the perceptual judgment of abnormal levels of

speech nasality. In particular, it is being used to

assess the velopharyngeal dysfunction and to

evaluate its treatment in clients with cleft palate.

Normative nasalence measures will provide the

database for future investigation on clinical population in India. In this context, the present

study developed normative data on nasalence for

non-native English speakers.

Method

Subjects: Forty five males and seventy females in

the age range of 18 to 30 years served as subjects

in the present study. All the subjects had normal

structure and function of the oral mechanism. The

subjects considered were from different parts of

India. Subject had learnt English as a second

language. Table 1 shows the subject details

considered in the present study.

Subjects Age

range Language (Mother tongue)

Kannada Malayalam Tamil Telugu Hindi Males (N=45)

18-30 yrs

12 8 7 3 15

Females (N=70)

18-30 yrs

30 15 6 2 22

Table 1: Details of the subjects.

Instrumentation and Material: The Nasometer

Model 6400 (Kay Elemetrics, New Jersy) was used in the present study. The oral and nasal

components of the subject’s speech are sensed by

microphones on either side of a sound separator

that rests on the patient’s upper lip. Nasometer

computes a ratio of the nasal to nasal –plus- oral

acoustic energy from the digitized signals.

Nasalence is expressed as a percentage value

computed from that ratio (nasalence= nasal/{oral +

nasal}X100. Prior to data collection, the nasometer

was calibrated as prescribed by the manufacturer.

One of standard passage, “Rainbow passage”

provided in the manufacturer’s manual was used

as stimuli in this study. The “Rainbow passage”

contains a mixture of oral and nasal consonants in

the approximate proportion found in everyday

speech (Fairbank, 1960). It contains about 11% of

nasal phonemes and the nasal sentences are 35%.

Procedure and analysis: Subjects were seated in

a quiet setting with the Nasometer headgear

adjusted so the separation plate rested comfortably

but firmly on the subject’s upper lip and

perpendicular to the plane of the face. Each subject

read the Rainbow passage displayed on the

monitor. Once the subject completed the task, the

mean nasalence value was computed using the

software package. For each subject’s production,

data on mean nasalence value, standard deviation, maximum and minimum nasalence value were

collected using nasometer software. Independent

‘t’ tests was computed to determine significant

differences in nasalence values across gender and

to compare with other studies.


25


Mean Nasalence value across gender

The nasalence value ranged from 16% to 35%

and the mean was 27.93 (SD 4.17) in males. In

females the range was 20 % to 56% and the mean

was 31.39 (SD-7.31). Table 2 shows the mean

nasalence value and standard deviation of

nasalence.

Rainbow passage Gender

N Mean SD Male 45 27.93 4.17 Female 70 31.39 7.31 Total 115 30.04 6.48

Table 2: Mean nasalence value for Rainbow passage.

Results of Independent “t” test showed

significant difference across gender (t= 2.85,

p<0.01) with females having higher nasalence

percent compared to males. Also, the standard

deviation was higher in females compared to males indicating higher variability among

females.This result supports the findings of Seaver

et al., 1991; Van Lierde et al., 2001; Fletcher,

1978; Hutchinson et al, 1978, who reported that

female speakers have significantly higher

nasalance values than male speaker on passage

containing nasal consonants. Gender related

differences in nasalance value can possibly be

related to basic structural and functional

differences. The resonance of voice is influenced

by the size, shape and surface of infraglottal and

supraglottal resonating structures and cavities.

Two subject variables could be associated

with increased nasal flow rate in female speakers,

increased respiratory effort and increased nasal

cross sectional area. Since females have longer

nasal cross sectional area than males such a

difference could be seen (Liu,1990). Mc Kearns

and Bzoch (1970) discovered different patterns of

velopharyngeal closure for females as determined

by cineradiographic analysis. They suggested that

different velopharygeal muscle insertions occur

across gender, which may arise from differences in

the relationship of the skull and cervical column or

differences in vocal tract dimensions.

Thompson and Hixon (1979) studied 112

normal children and adults and found that females

produced more coarticulatory anticipation of nasal

consonants and had greater degree of nasal air

flow during production of nasal consonants than

males. The nature of measurement procedure

dictates that degree of nasalence in speech will be

proportional to the acoustic energy of the signal as

it exits from nasal and oral chambers. This

proportion is controlled by the physical

characteristics of the oral and nasal chambers,

integrity of velopharygeal valve, postures of lips

and tongue and by the phonetic demands of the

sounds spoken.

The present study does not support the

findings of Fletcher (1978) who found that males

had higher mean nasalence value than females for

nasal sentences. The present study also does not

support the notion that there is no significant

difference in nasalence value across gender

(Litzaw and Dalston, 1992; Kavanagh, Fee and

Kalinowski, 1994).

Comparison of nasalence value for Rainbow

passage across studies

The normative data for sentences using

“Rainbow Passage” across various studies are

presented in Table 2. Single sample “t” test was

used to compare the present study with earlier

studies using Rainbow passage and is presented in table 3. Table 4 shows the results of single sample

“t” test.

Author (Year)

Language N Subjects Mean S.D

Fletcher et al. (1989)

American 117 Children 35.6 5.20

Adult male 35.0 6.0 Seaver etal(1991)

American 140 Adult female

36.0 6.0

North west American

30 Geriatric male

23.5 5.1 Hutchinson etal (1978) North west

American 30

Geriatric female

32.0 10.7

Mid Atlantic 15 Adult male 36.0 4.0 Litzaw & Dalston (1992)

Mid Atlantic 15 Adult female

37.0 4.0

45 Adult male 27.9 4.1 Present study (2008)

Indian 70

Adult female

31.3 7.3

Table 3: The normative data for Rainbow passage

across various studies.


26

Sl No.

Author (Year)

Subjects “t” value

“p” value

Interpretation

1 Fletcher et al. (1989)

Children 9.25 <0.001 Significant difference

Males 11.23 <0.001 Significant difference

2 Seaver etal(1991)

Females 5.23 <0.001 Significant difference

Males 7.04 <0.001 Significant difference 3

Hutchinson etal (1978)

Females 0.69 >0.05 No significant difference

Males 12.82

<0.001 Significant difference

Females 6.36 <0.001 Significant difference

4 Litzaw & Dalston (1992)

Total 9.76 <0.001 Significant difference

Table 4: Results of single sample “t” test.

The above table depicts the mean nasalence

value across studies and across age. The mean

value ranges from 23 % to 37%. This difference is

due to the difference across subjects, age and the

instrumentation. A comparison of the nasalence

values for Rainbow passage across various studies

reveal significant differences except Hutchinson

etal. (1978). They measured nasalence on elderly

subjects in the age range of 50-80 years using

TONAR II instrument. A nasalence mean value of

23.5 and 32.0 in geriatric males and geriatric

females, respectively was found in the study.

There was significant difference across mean

nasalence value in males (p<0.01) when compared

to the present study. The probable difference could

be attributed to the age and the instrument used.

Aging is accompanied by degeneration of

receptor cells, decline in number of nerve fibres in

associated neural tracts, loss of brain cells in

corresponding projection areas, decrease in

muscular strength, slowness, lack of fine

coordination of movement, cognitive slowing and

deterioration in neural density and general delay in synaptic transmission (Corso, 1975; Botwinick,

1973; Crossman and Szafran 1956; Griew, 1963).

The present results permit the general conclusion

that where relatively continuous demands for

velopharyngeal closure are required, older subjects

exhibit notably less competence than normal

young adults.

There was no significant difference across

mean nasalence value in females when compared

to the present study. Seaver etal. (1991) reported

that nasometer performance was not significantly

influenced by age. Warren and collegues, (1990)

has indicated that nasal cross sectional areas is not

affected by age after the age of 18.

On theoretical grounds, one might imagine

that Rainbow passage would be particularly useful

in sampling the acoustic consequences of

velopharyngeal behaviour since the frequency of

occurrence of phonemes in this passage roughly

mirrors that found in conversational speech.

Eleven percent of the phonetic elements are nasal

consonants. The effect of these nasal consonants is

not limited to the moment of their utterance,

however rather a coarticulatory “spread of

nasalization” is found in which the nasal

consonants are anticipated by opening of the

velopharyngeal valve prior to the onset of the nasal

element in the speech output (Fletcher 1989). On

other hand , this passage is much longer than Zoo

passage. Moreover, it is syntactically more

complex and contains a number of words that are

difficult for very young children (Dalston and

Seaver, 1992). Fletcher, (1978) determined that

Nasalence values for the rainbow passage were consistently higher than the Zoo passage.

Litzaw and Dalston, (1992) measured

nasalence on adults in the age range of above 18

years with mid atlantic dialect using Nasometer

6200 instrument. A nasalence mean value of 36.0

and 37.0 in adult males and adult females,

respectively, was found in the study. Though the

subjects taken up in both the studies were adults there was significant difference across the values.

Seaver etal.(1991) also measured nasalence in the

age range of 16 years to 63 years belonging to four

geographic regions using Nasometer 6200

instrument. A nasalence mean value of 35.0 and

36.0 in males and females respectively was found

in the study. There was significant difference

across mean nasalence value in males and females

(p<0.01) when compared to the present study.

These differences could be attributed to significant

cross dialectal (English) and cross linguistic

differences in nasometric values (Seaver et al.,

1991; Leeper, Rochet, and MacKay, 1992).

Fletcher et al. (1989) measured nasalence in Children in the age range of 5 years to 12 years

using Nasometer 6200 instrument. A nasalence

mean value of 35.69 was found in the study. There

was significant difference across mean nasalence

value in children (p<0.01) when compared to the

present study. These differences could be

attributed to subjects taken up in both the studies,

as the present study included only adults.


27

Differences in these values are difficult to interpret

because there were methodological differences in

the studies. However, the extent of the differences

may indicate that there is need to control for

dialect, age, and gender before meaningful across

study comparisons can be made.

Research has reported significant cross

dialectal and cross linguistic differences in

nasometric values (Seaver et al., 1991; Leeper et

al., 1992). Normative data for nasalence values

and clinically determined cutoff values have both

been found to be sensitive to dialectal differences

in different regions of North America. Differences

in mean Nasalence values across languages may

be explained by different use of vowels, oral and

nasal consonants across languages (Leeper et al.,

1992; Anderson, 1996).

Furthermore, even in bilingual speakers,

differences in nasometric values across languages

are significant (Leeper et al., 1992). Thus it is

essential that for establishing normative data for

nasometer, issues pertaining to dialect and

language need to be considered. Mean nasometric values obtained for a specific linguistic group may

not be valid for use with other groups, even though

they may speak the same language. Hence the

normative data for different dialectal and linguistic

populations are necessary.

Conclusions

Very few Indian studies have been done on

developing a normative data in Indian context

using “Rainbow passage” as the standard stimuli

using Nasometer 6400. The primary purpose of

this present study has been to provide speech and language pathologists with instrumental

verification of their perceptual judgements

concerning the diagnostic evaluations. There are

no Indian studies reported on nasalence value

using the Nasometer II 6400. Most of the earlier

studies used TONAR system and Nasometer 6200

to measure nasalence. The nasometer

instrumentation differs substantially from the

earlier Tonar system. The reported normative

nasalance data provide important reference

information for the assessment of nasality

disorders in adults on using Nasometer II 6400

with “Rainbow passage” as the speech stimuli. The

performance on “Rainbow passage” would provide

information over and above that available from the

values of Nasal and Zoo passage. The provision

for rapid, accurate, biometric feedback provides

opportunity to probe the modifiability of nasalence

systematically. However, study by Dalston and

Seaver, 1992 reported, that “Rainbow passage

contains a number of words that are difficult to

produce for very young children to pronounce.

Establishing the cut off values for clinically

significant abnormalities is important in many

areas of medical epidemiology. It can be

approached from a clinical or statistical

perspective (Barker and Rose, 1984). For the

Nasometer, the issue of determining cut off

nasalance value for clinical populations has been

approached from both statistical and clinical

perspective. Clinically the normative data reported

in the present study may help identifying adults

with resonance disorders. Nasalence may also be a

sensitive indicator of the presence and progress of

neuromuscular disease (Fletcher and Bishop,

1970). Speech pathologists, Otolaryngologists, and

Plastic surgeons can use the data to help objectify

and supplement their diagnostic, follow-up testing,

and treatment protocols.

References

Anderson, R. T. (1996). Nasometric values for

normal Spanish-Speaking females: A

preliminary report. Cleft Palate


Barker, D. J. P., & Rose, G. (1984). Epidemiology

in medical practice. 3rd ed.

Edinburgh: Churchill Livingstone.

Botwinick, J. (1973). Aging and behavior. New

York : Springer Publishing Co.

Corso. J. M. (1975). Sensory processes in man

during maturity and senescence. In J. M.

Ordy & K.R. Brizzee (eds.), Neurobiology

of aging. New York: Plenum press.

Crossman, E. R. F. W., & Szafran, J.(1956)

Changes with age in the speed of

information intake and discrimination .

Experiantia ( Suppl.).

Dalston, R. M., Warren, D., & Dalston, E. (1991a).

A primary investigation concerning

use of Nasometery in identifying patients with hyponasality and/or nasal

airway impairment. Journal of Speech and


Dalston, R.M., & Seaver, E.J. (1992). Relative

value of various standardized passage in the


28

nasometric assessment of patients with

velopharyngeal impairment. Cleft Palate


Fairbank, G (1960). Cited in Hutchinson, J. M.,

Robinson, K. L., & Nerbonne, M. A. (1978).

Pattern of nasalance in a sample of normal

gerontologic subjects. Journal of

Communication Disorders, 11, 469 -481.

Fletcher, S.G. (1978). Diagnosing speech disorder

from the cleft palate. New York: Grune &

Stratton.

Fletcher, S.G., & Bishop M.E (1970).

Measurement of nasality in Tonar. Cleft

palate journal. 7;610-621.

Griew, S . (1963). Information transmission and

age. In R. H. Williams, C. Tibbitts, and W.

Donahue ( eds.),Processes of Aging. New York: Atherton Press.

Hardin, M. A., Van Demark, D. R., Morris, H. L.,

& Payne, M. M. (1992). Correspondence

between nasalance value and listener

judgments of hypernasality. Cleft Palate


Hutchinson, J. M., Robinson, K. L., & Nerbonne,

M. A. (1978). Pattern of nasalance in a sample of normal gerontologic subjects.

Journal of Communication Disorders,

11,469 -481.

Kavanagh, M.L., Fee, E.J., Kalinowski, J. (1994).

Nasometric values for three dialectal groups

within the Atlantic provinces of Canada.

Journal of Speech Language Pathology

Audiology, 18, 7-13.

Leeper, H. A., Rochet, A. P., & MacKay, I. R. A.

(1992). Characterisitics of nasalance in

Canadian speaker of English and French.

International conferences on spoken

language processing (Abstract), Banff,

Alberta, October, 49-52.

Litzaw, L. L & Dalston, R. M. (1992). The effect

of gender upon nasalence values among

normal adult speakers. Journal of

Communication Disorders, 25,55 -64.

Liu, H. (1990). Cited In Litzaw, L. L & Dalston,

R. M. (1992). The effect of gender upon

nasalence values among normal adult

speakers. Journal of Communication

Disorders, 25,55 -64.

Mahesh, S & Pushpavathi, M ( 2008 ) . Nasometer

values for zoo paasage in non native

speakers: A preliminary study. Proceedings

of International Symposium on Frontiers of

Research on Speech and Music (FRSM)-

2008), 115-119.

McKearns, D., Bzoch, K. R. (1970). Variations in

velopharyngeal valving: the factor of sex.

Cleft Palate Craniofacial Journal.

652-662.

Nichols, A.C. (1999). Nasalance statistics for two

Mexican population. Cleft Palate


Seaver, E.J., Dalston, R.M., & Leeper, H. A.

(1991). A study of nasometric value for

normal nasal resonance. Journal of Speech

and Hearing Research, 34, 715-721.

Sweeney, T., Sell, D., & O’Regan, M. (2004).

Nasalance values for normal speaking Irish

children. Cleft Palate Craniofacial

Journal, 41(2), 168-174.

Thompson, A. E., & Hixon, T. J (1979) Nasal air

flow during normal speech production. Cleft

Palate Craniofacial Journal 16: 412-420.

Van Doorn, J., & Purcell, A. (1998). Nasalance level in speech of normal Australian

children. Cleft Palate Craniofacial Journal,

35, 287-292.

Van Lierde, K. M., Wuyts, F. L., Bodt, M. D., &

Cauwenberge, P (2003). Age related pattern

of nasal resonance in normal Flemish

children and Young adults. Scandinavian

Journal of Plastic Reconstructive Surgery, 37,344-350.

Van Lierde, K. M., Wuyts, F. L., De Bodt, M., &

Van Cauwenberge, P. (2001). Normative

value for normal nasal resonance in the

speech of young Flemish adults. Cleft

Palate Craniofacial Journal, 38, 112-118.

Warren, D.W., Hairfield, W. M., & Dalston, E. T.

(1990). Effect of age on nasal cross-

sectional area and respiratory mode in

children. Laryngoscope. 100:89-93.

Watterson, T., McFarlane, S., & Wright, D.S.

(1993). The relationship between nasalance

and nasality in children with cleft palate.

Journal of Communication Disorders, 26,

13-28.


29

Whitehill, T.L. (2001). Nasalance value in

Cantonese speaking women. Cleft Palate


Acknowledgements

The authors wish to thank Dr. Vijayalakshmi

Basavaraj, Director, AIISH for her encouragement

and all the support provided to conduct this study.

The authors also wish to thank all the subjects who

volunteered to serve as subjects in this study.

JAIISH, Vol. 27, 2008 Rate of Speech

30

Rate of Speech/Reading in Dravidian Languages

1Savithri S.R. &

2Jayaram M.

Abstract

Rate of speech is an important variable in the evaluation and treatment of fluency

disorders. The present study investigated rate of speech/ reading in 4 Dravidian

languages and established normative data on rate of speech in Kannada, Tamil,

Telugu, and Malayalam in subjects ranging in 10 decades of age. Four hundred and

one (Kannada = 136, Telugu = 69, Tamil = 103, Malayalam = 93) normal subjects

participated in the study. All subjects were literates and were from urban population.

Informed consent was obtained from subjects prior to collection of speech samples.

Subjects in the age range of 4-10 years described cartoons and narrated stories and

subjects in the age range of 11-100 years read passages which were developed by the

investigators. All these were audio-recorded and analyzed to obtain syllables per second,

syllables per minute and words per minute. Cool Edit software was used to eliminate

pause and calculate duration. Results indicated significant difference between age

groups, and languages. Rate of speech increased with increase in age till about 40 years

and declined after 40 years (except Tamil). Malayalam had the highest SS and SPM

compared to other languages. No significant difference between genders was observed.

The results provide normative data for clinical purposes and to set rate of speech in

persons with stuttering and cluttering.

Key words: Rate of speech, Words per minute, Syllables per minute, Dravidian languages.

Fluency is the effortless production of long,

continuous utterances at a rapid rate

(Starkweather, 1981). The rate at which speech is

produced is an important aspect of fluency.

Writers attempting a description of stuttering have

most often not included material on normal

fluency, even though a substantial scientific

literature on the rate, rhythm and timing of normal

adult speech has long existed. Descriptions of

children's fluency development have referred only

to the frequency and type of discontinuities. But it

is not just the continuity of speech that signals

fluency. The rate of speech, the length of

utterances, consistency in the duration of elements,

and the overall quantity of speech are also signs of

the facility with which speech is produced. With

increased age, these signs show developmental

change, signaling development of fluency.

Rate of speech is an important variable in the

evaluation and treatment of fluency disorders. It is

well known that the rate of speech correlates negatively with the severity of stuttering

(Bloodstein, 1944; Sander, 1961) because frequent

and/or long duration stutters result in reduced

speech output. However, a deliberate reduction in

the rate of speech has a beneficial effect on the

frequency of stutters (Adams, Lewis & Besozzi, 1973; Johnson & Rosen, 1937) and, therefore,

nearly all stuttering treatment approaches include

rate reduction as one of their goals. Rate control is

also a treatment target in cluttering (Daly, 1986).

In addition, rate of speech is an important factor in

the perceptual evaluation of normalcy of speech

following treatment of stuttering (Ingham &

Packman, 1978). Extremely slow rate of speech

even if completely devoid of dysfluencies, is

perceived as unnatural by listeners. There is some

preliminary evidence that the rate of speech of

parents may be an important factor in incipient

stuttering (Meyers & Freeman, 1985; Stephenson-

Opsai & Bernstein Ratner, 1988).

The rate of speech primarily depends on the

speed of articulatory movement and the degree of

coarticulatory overlap. It also depends on the

linguistic structure and culture. Rate of speech can

be measured in two ways. One is a measure of the

1Professor, Dept. of Speech-Language Sciences, All India Institute of Speech & Hearing, Manasagangothri, Mysore 570 006, email:[email protected], 2Professor, Dept. of Speech Pathology and Audiology, NIMHANS, Bangalore 560 029,


31

number of syllables per unit time. The second is

words per minute. The word is more of an

information unit than a speech production unit.

Consequently, words per minute are a measure of

the amount of information a speaker is producing.

It is related to but not the same as the rate at which

syllables are produced. The more syllables a word

contains, the more rapidly each syllable in the

word is produced (Klatt, 1973). Word duration and

utterance duration seem to depend on the amount

of information contained in the utterance, but

syllables per second seems independent of content,

as long as the sample is to contain a large variety

of syllables.

It is important for the practicing clinician to

know about these changes, for the assessment of

stuttering and cluttering should be made by

comparing the client's fluency with the level of

fluency that would be expected for a normal

person of the same age. Surprisingly, however,

there are few empirically derived guidelines

available for clinical measurement of rate and for setting goals for rate (Ingham & Cordes, 1997).

Adult speakers of English speak at an average rate

of 5 to 6 syllables per second (Walker & Black,

1950). When rate is measured in words per minute,

most of the variation is attributable to the duration

and frequency of pauses. When these pauses are

excluded, the variability of speech rate is much

reduced (Goldman-Eisler, 1968). The normal rate

of speech is 80-180 words per minute. However,

one can consider a rate of up to 280 words per

minute as normal provided the intelligibility is not

affected. This is supported by reports that speech

could be compressed up to 275 wpm mechanically

with little loss of comprehension, but

comprehension declines rapidly at higher speeds.

Rathna, Subba Rao & Bharadwaj (1979)

reported 361 syllables per minute and 104 words

per minute in spontaneous speech and 427

syllables per minute and 94 words per minute in

reading in Kannada. Venkatesh, Purushothama &

Poornima (1983) investigated rate of speech in 64

Kannada speakers in the age range of 17-66 years.

They reported 282 syllables per minute in adult

Kannada speakers. Rathna et. al. took 1-minute

sample and Venkatesh et. al. took males, females,

urban, rural, literate and illiterate population and

recorded conversation. Samples in both these

studies are not adequate and do not represent any specific population. Also, pauses were not

eliminated in these studies.

Some studies have investigated differences

between genders. Johnson (1961) reported higher

range and docile values for adult females than for

adult males in two spontaneous speech tasks and

one reading task. In contrast, Lutz & Mallard

(1986) found that adult male subjects talked and

read at a faster rate than adult female subjects in

their study. However, statistical tests were not

performed in either study to determine whether the

differences in rate between males and females

were significant. In a study of rate of speech in

cildren, Haselager, Slis & Rietveld (1991) reported

that the boys did not significantly differ from girls

in the rate of production of spontaneous speech. It

is not known whether the findings of Haselager et. al. would also apply to young adults. It is

important, for clinical purposes, to determine

whether statistically significant differences exist

between adult males and females in the rate of

reading and discourse.

Values of approximately 200 SPM or 150

SPM are frequently used in setting goals for rate of speech (Perkins, 1973; Boberg & Kully, 1985)

because mean rates of adult discourse tend to

converge around these values (Luchsinger, 1965).

Answers to basic questions such as the size of the

sample necessary to obtain a reliable measure of

rate and the variability or stability of rate in

different tasks typically used to measure rate in

clinical settings are not known. Johnson, Darley &

Spriesterbach (1963) recommend that a 3-minute

sample of spontaneous speech and a 300-word

reading passage be used to determine rate. Castello

& Ingham (1984) suggest that a 2-minute sample

of uninterrupted speech be used to determine the

rate during the evaluation of stuttering. However,

there is little objective data in support of these

recommendations.

There is also an uncertainty concerning the

unit of speech appropriate for the computation of

rate. Expression of rate in syllables per minute

(SPM) appears to be generally favored over the

computation involving words per minute (WPM)

because the length of syllables, whether measured

in phonemes or in units of time tends to be less

variable than length of words (Umeda & Quinn,

1980; Ingham, 1984; Costello & Ingham, 1984).

However, there is little empirical evidence to

support the view that SPM is a more valid measure

of speech rate than WPM, particularly in clinical situations where a certain amount of variability in

speech rate is expected and accepted.


32

Though the rate of speech is an important

parameter it has not been studied extensively in the

Indian context. As the linguistic structure of

Dravidian and Indo-European languages differ, it

is probable that the rate of speech also differs.

Also, most rate control therapies donot consider

age as criteria to set goals for rate of speech. It is

hypothesized that age and language have

significant effect on the rate of speech. In this

context, the present study established normative

data on rate of speech in Kannada, Tamil,

Telugu, and Malayalam in subjects ranging in

10 decades of age. The end results brought out

from this project can be utilized as normative data.

This can be used as a reference or standard to

measure rate of speech in clients with fluency

disorders.

Method

Subjects: Four hundred and one normal subjects

in four languages - Kannada, Tamil, Telugu, and

Malayalam - participated in the study. All subjects

were literates and were from urban population.

Informed consent was obtained from the subjects

prior to collection of speech samples. Table 1

shows subject details.

Age range/ Language

Kannada Telugu Tamil Malayalam

Age M F M F M F M F 3-3.11 5 5 4-4.11 5 5 5-5.11 5 5 2 2 6-6.11 5 5 3 5 7-10 5 5 5 5

11-15 5 5 5 5 5 5 5 5 16-20 5 5 5 5 5 5 5 5 21-30 5 5 5 5 5 5 5 5 31-40 5 5 5 5 5 5 5 5 41-50 5 5 5 5 5 5 5 5 51-60 5 5 5 5 5 5 5 5 61-70 5 5 3 3 5 5 5 5 71-80 5 5 1 0 5 5 5 5 81-90 5 1 2 0 0 1 5 5

91-100 0 0 0 0 0 0 1 2 Sub-total 70 66 36 33 50 53 46 47

Total 401

Table 1: Details of subjects.

Material: Cartoons (4-6 years), pictures depicting

Panchatantra stories (7-10 years), and standardized

reading passages were used to elicit spontaneous speech/reading samples. Pictures of cartoons and

Panchatantra stories were taken from Indu (1992)

Yamini (1992) and Rajendra Swamy (1995).

Passages in four languages were developed by the

experimenters. There were 304, 306, 414, and 307

words in Kannada, Telugu, Tamil, and Malayalam

passages, respectively.

Procedure: Children in the age range of 4-10

years were instructed to describe the cartoons and

story, and adults read the passage at a comfortable

pitch and loudness. All samples were audio-

recorded and were digitized at 16,000 Hz sampling

frequency. Pauses, if any, were removed from the

waveform using Cool Edit software. Each syllable

and word was highlighted using the waveform and

the duration was measured using the software. The

number of syllables per second (SS), syllables per minute (SPM) and words per minute (WPM) were

calculated by using the following formule:

SS = Total number of syllables / Total time taken

(seconds).

SPM = Total number of syllables /Total time taken

(minute).

WPM = Total number of words / Total time taken

(minute).

Statistical analysis: ONE-WAY ANOVA was

done to compare the rate of speech across age,

gender, and language, and MANOVA was used to examine the interaction effects.


33

Results

Kannada

The results indicated an increase in SS, SPM

and WPM from 3 years to 40 years and decrease in

SS, SPM and WPM in the age group of 41-90

years. Table 2 shows the mean and range of

syllables per second (SS), syllables per minute

(SPM) and words per minute (WPM) from 3 to 90 years in Kannada speaking subjects.

Age M/SD SS SPM WPM

3-3.11 Mean 4.9 291 129 SD 1.3 78 34 4-4.11 Mean 4.2 252 91 SD .79 48 17 5-5.11 Mean 4.2 254 120 SD 1.3 79 37 6-6.11 Mean 4.3 261 92 SD 0.84 50 18 7-10 Mean 4.1 250 85 SD 0.65 41 14 11-15 Mean 5.7 343 104 SD .83 48 14 16-20 Mean 7.0 425 127 SD .96 58 17 21-30 Mean 6.5 386 116 SD .96 70 21 31-40 Mean 7.2 434 131 SD .31 19 6 41-50 Mean 6.8 410 124 SD .87 53 16 51-60 Mean 6.9 415 124 SD .62 37 11 61-70 Mean 6.9 404 125 SD .73 52 12 71-80 Mean 6.4 390 118 SD .85 51 15 81-90 Mean 5.6 337 102 SD .97 58 17

Mean 5.3 318 104 SD 2.20 133 40

Table 2: Mean and SD of rate of speech in Kannada

speakers.

ONE-WAY ANOVA indicated significant

difference between age groups {SS = [F (14, 121)

= 16.70, p < 0.01], SPM = [F (14, 121) = 15.665, p

< 0.01], WPM = [F (14, 121) = 5.718, p < 0.01]}.

Tables 3 to 5 show results of the Duncan’s post-

hoc test. Values in the same column are not significantly different.

Age Group

1 2 3 4

3-3.11 4.2358 4-4.11 4.2031 5-5.11 4.2358 6-6.11 7-10 11-15 5.7000 5.7000 16-20 7.0300 21-30 6.4900 31-40 7.1800 41-50 6.7900 51-60 6.8640 61-70 6.9540 71-80 6.4400 6.4400 81-90 5.6200

Table 3: Results of Duncan’s post-hoc test for SS

(Kannada).

Age Group

1 2 3 4 5

3-3.11 290.9821 4-4.11 252.1879 5-5.11 254.1461 6-6.11 7-10 11-15 343.10 343.10 16-20 425.10 21-30 385.50 385.50 385.50 31-40 434.20 41-50 410.41 51-60 415.10 61-70 403.60 71-80 389.80 389.80 81-90 337.3400 337.34

Table 4: Results of Duncan’s post-hoc test for SPM

(Kannada). Age

Group 1 2 3

3-3.11 128.6358 4-4.11 91.3535 5-5.11 119.7360 119.7360 6-6.11 92.3000 7-10 84.5000 11-15 103.6844 103.6844 16-20 127.3501 21-30 116.2539 116.2539 31-40 131.0137 41-50 123.6824 51-60 124.1360 61-70 124.8651 71-80 117.7516 117.7516 81-90 101.7867 101.7867

Table 5: Results of Duncan’s post-hoc test for WPM

(Kannada).

Telugu

SS, SPM, and WPM increased till 30 years

and declined thereafter. Table 6 shows mean and

SD of SS, SPM, and WPM.


34

Age M/SD SS SPM WPM

11-15 Mean 7 431 123 SD 1.25 132 37 16-20 Mean 7 439 125 SD 0.61 36 10 21-30 Mean 8 466 133 SD 0.58 36 10 31-40 Mean 6 384 116 SD 0.95 54 23 41-50 Mean 7 389 117 SD 1.04 75 20 51-60 Mean 6 392 110 SD 1.04 69 18 61-70 Mean 6 336 96 SD 0.99 60 17 71-80 Mean 5 309 89 SD 0.19 11 4 81-90 Mean 5.14 309 88.82 SD 0.19 11.31 3.85

Mean SD

6.4 0.76

384 53.81

111 15.87

Table 6: Mean and SD of rate of speech in Telugu

speakers.


difference between age groups {SS = [F (8, 73) =

4.832, p < 0.01], SPM = [F (8, 731) = 2.495, p <

0.05], WPM = [F (10, 91) = 2.285, p < 0.05]}.


hoc test. Values in the same column are not

significantly different.

Age Group

1 2 3 4

11-15 6.2460 6.2460 16-20 6.9700 6.9700 21-30 7.4060 7.4060 31-40 7.7100 41-50 6.3750 6.3750 51-60 6.8970 6.8970 61-70 6.4230 6.4230 71-80 5.5990 5.5990 81-90 5.1400


(Telugu).

Age Group

1 2 3

11-15 441.1000 16-20 421.0000 421.0000 21-30 438.7000 31-40 466.1000 41-50 384.3000 384.3000 384.3000 51-60 389.4000 389.4000 389.4000 61-70 391.9000 391.9000 391.9000 71-80 337.3000 337.3000 81-90 309.0000


(Telugu).

Age Group

1 2 3

11-15 126.0180 16-20 120.3800 120.3800 21-30 125.2300 125.2300 31-40 133.1500 41-50 116.0610 116.0610 116.0610 51-60 116.6800 116.6800 116.6800 61-70 110.1630 110.1630 110.1630 71-80 96.4930 96.4930 81-90 88.8200


(Telugu).

Tamil

SS, SPM, and WPM increased from 5 years to

80 years. However, there was no consistent linear

increase in the rate of speech. Table 10 shows

mean and SD of SS, SPM, and WPM.

Age M/SD SS SPM WPM

5-5.11 Mean 4.9950 299.4675 113.9975 SD 1.0360 62.3379 23.7109 6-6.11 Mean 4.6484 278.9059 86.0060 SD 1.0709 64.2550 19.8293 7-10 Mean 6.6920 401.5178 123.8661 SD 1.6674 100.0455 30.8635 11-15 Mean 4.5113 271.7749 94.6891 SD .3627 21.8501 7.7201 16-20 Mean 6.5238 383.5347 133.0958 SD .7114 53.0329 18.4800 21-30 Mean 6.5044 390.8467 135.6623 SD 1.2267 73.5010 25.4697 31-40 Mean 5.4654 326.3887 113.5195 SD 1.1116 67.7142 23.5099 41-50 Mean 5.9058 352.6335 122.4497 SD .8357 49.1482 17.2613 51-60 Mean 5.4330 326.3735 114.8765 SD .8551 51.5573 20.3268 61-70 Mean 5.6564 339.9639 118.0024 SD 1.0284 61.8869 21.4296 71-80 Mean 5.9033 353.8821 123.3533 SD .9218 54.2288 18.5347 Average Mean 5.7169 342.1399 117.0508 SD 1.2058 72.3806 24.6119

Table 10: Mean and SD of rate of speech in Tamil

speakers.


difference between age groups {SS = [F (10, 91) =

4.719, p < 0.01], SPM = [F (10, 91) = 4.398, p <

0.01], WPM = [F (10, 91) = 4.459, p < 0.01]}.


hoc test. Values in the same column are not



35

Age Group

1 2 3 4 5

5-5.11 4.9950 4.9950 4.9950 6-6.11 4.6484 4.6484 7-10 6.6920 11-15 4.5113 16-20 6.5238 6.5238 21-30 6.5044 6.5044 31-40 5.4654 5.4654 5.4654 5.4654 41-50 5.9058 5.9058 5.9058 51-60 5.4330 5.4330 5.4330 5.4330 61-70 5.6564 5.6564 5.6564 5.6564 71-80 5.9033 5.9033 5.9033


(Tamil).

Age Group

1 2 3 4 5

5-5.11 299.4675 299.4675 299.4675 6-6.11 278.9059 278.9059 7-10 401.5178 11-15 271.7749 16-20 383.5347 383.5347 21-30 390.8467 390.8467 31-40 326.3887 326.3887 326.3887 326.3887 41-50 352.6335 352.6335 352.6335 51-60 326.3735 326.3735 326.3735 326.3735 61-70 339.9639 339.9639 339.9639 339.9639 71-80 353.8821 353.8821 353.8821

Table 12: Results of Duncan’s post-hoc test for SPM (Tamil).

Age Group

1 2 3

5-5.11 113.9975 113.9975 6-6.11 86.0060 7-10 123.8661 11-15 94.6891 94.6891 16-20 133.0958 21-30 135.6623 31-40 113.5195 113.5195 41-50 122.4497 51-60 114.8765 114.8765 61-70 118.0024 71-80 123.3533


(Tamil).

Malayalam

SS, SPM, and WPM increased from 11 years

to 30 years and decreased steadily from 31 years to 100 years. Table 14 shows mean and SD of SS,

SPM, and WPM.

Age M/SD SS SPM WPM

11-15 Mean 7.9082 474.4926 115.2427 SD .8486 50.9189 12.3654 16-20 Mean 8.8040 528.9257 128.2894 SD 1.2238 73.3538 17.7127 21-30 Mean 9.2600 557.9370 135.4231 SD .9902 61.7733 14.9202 31-40 Mean 8.2000 492.1712 119.4511 SD .6055 35.5242 8.5534 41-50 Mean 7.9000 476.6454 115.6346 SD 1.2275 80.9450 19.7229 51-60 Mean 7.9390 482.6940 117.1112 SD 1.0498 66.8788 16.1906 61-70 Mean 7.8170 447.6767 109.9117 SD .5858 66.2682 12.4797 71-80 Mean 7.0350 423.1902 102.3253 SD 1.6478 99.4643 23.9974 81-90 Mean 6.6160 397.8133 96.4343 SD .8643 51.8349 12.7868 91-100 Mean 4.2800 257.4613 62.6108 SD .7302 43.9912 10.7018

Mean SD

7.8240 1.4037

468.6865 87.6557

113.8287 21.0098

Table 14: Mean and SD of rate of speech in Malayalam

speakers.


difference between age groups conditions {SS = [F

(9, 83) = 9.173, p < 0.01], SPM = [F (10, 91) =

8.241, p < 0.01], WPM = [F (10, 91) = 8.606, p <

0.01]}. Tables 15 to 17 show results of Duncan’s

post-hoc test. Values in the same column are not


Age Group

1 2 3 4 5

11-15 7.9082 7.9082 16-20 8.8040 8.8040 21-30 9.2600 31-40 8.2000 8.2000 8.2000 41-50 7.9000 7.9000 51-60 7.9390 7.9390 61-70 7.8170 7.8170 71-80 7.0350 7.0350 81-90 6.6160 91-100 4.2800


(Malayalam).


36

Age Group

1 2 3 4 5

11-15 474.4926 474.4926 16-20 528.9257 528.9257 21-30 557.9370 31-40 492.1712 492.1712 492.1712 41-50 476.6454 476.6454 51-60 482.6940 482.6940 61-70 447.6767 447.6767 71-80 423.1902 423.1902 81-90 397.8133 91-100

257.4613


(Malayalam).

Age Group

1 2 3 4 5

11-15 115.2427 115.2427 16-20 128.2894 128.2894 21-30 135.4231 31-40 119.4511 119.4511 119.4511 41-50 115.6346 115.6346 51-60 117.1112 117.1112 61-70 109.9117 109.9117 71-80 102.3253 102.3253 81-90 96.4343 91-100

62.6108


(Malayalam).

Comparison of languages

MANOVA showed significant difference

between languages {S – [F (3,325) = 85.323, p <

0.001], SPM - [F (3,325) =64.822, p < 0.001]} on

syllables per second and syllables per minute. No

significant differences between languages on

WPM were evident. Also, no significant gender

difference was observed. Table 18 shows results of post-hoc Duncan’s test for significant difference

between languages. Results indicate no significant

difference between Tamil and Kannada and

significant difference between Telugu and other

languages, and Malayalam and other languages

(SS and SPM). Values in the same column are not


N Subset SS

Language 1 2 3 Tamil 103 5.6720 Kannada 136 5.7771 Telugu 82 6.6651 Malayalam 93 7.8240 SPM Tamil 103 339.4596 Kannada 136 346.7957 Telugu 82 406.2927 Malayalam 93 468.6865

Table 18: Results of Duncan’s test on significant difference

between languages.

Discussion

The results indicated significant differences in

rate of speech/ reading across Dravidian

languages. On an average the rate was 6, 6, 6, and

8 syllables per second in Kannada, Telugu, Tamil,

and Malayalam, respectively; the syllables per

minute was 346, 384, 342, and 469; words per

minute was 113, 111, 117, and 114 in the four

languages, respectively. The average rate of

reading in Kannada, Telugu, and Tamil are in

consonance with the earlier studies by Walker & Black (1950), Rathna et. al. (1979), and Venkatesh

et. al (1983). However, Malayalam seems to be an

exception with higher rates of SS and SPM. The

differences between languages can be attributed to

differences in syllable structure. Table 19 shows

the syllable types and percent occurrence of such

syllables in four Dravidian languages. The data is extracted from the reading passages used in this

study. Unlike in Kannada, consonants occur in

word-final position in Telugu, Tamil and

Malayalam. Higher occurrence of V type of

syllables and lower occurrence of CCV type of

syllables in Malayalam compared to Kannada and

Tamil seems to contribute to higher syllables per

second in Malayalam.

Syllable type


V 6.3 8.2 4.8 7.3 CV 73 67 54 74 CCV 21 22 0.4 3.6 CVC 1.6 38 13.4 CCVC 0.5 0.2 CCCV 0.2 VCC 0.1 0.2 VC 2.7 1.1 CVCC 0.3 0.2 Total 100 100 100 100

Table 19: Percent syllable type in four Dravidian

languages.

One of the criteria for successful treatment

outcome in fluency disorders is a speech rate

within normal limits. This is to ensure that a

reduction in stuttering is not achieved by

abnormally slowing down speech rate that might

adversely affect speech naturalness. A major basis

of this study was that speech rate data available in

the literature is not appropriate for formulating

target rates in rate control therapies because rate of

speech/ reading depends on age and language. A

rate at the lower boundary of 95% confidence

interval for mean may be appropriate for setting

goals in rate control therapies. That is the rate as


37

prescribed in Appendix I may be set as a goal in

rate control therapy depending upon the age and

language of the subjects.

Summary and Conclusions

Rate of speech is an important variable in the

evaluation and treatment of fluency disorders. It is

well known that the rate of speech correlates

negatively with the severity of stuttering because

frequent and/or long duration stutters result in

reduced speech output. However, a deliberate

reduction in the rate of speech has a beneficial

effect on the frequency of stutters and, therefore,

nearly all stuttering treatment approaches include

rate reduction as one of their goals. Rate control is

also a treatment target in cluttering. In addition,

rate of speech is an important factor in the

perceptual evaluation of normalcy of speech

following treatment of stuttering. Extremely slow

rate of speech, even if completely devoid of dysfluencies, is perceived as unnatural by listeners.

It is important for the practicing clinician to know

about these changes, for the assessment of

stuttering and cluttering should be made by

comparing the client's fluency with the level of

fluency that would be expected for a normal

person of the same age.

Surprisingly, however, there are few empirically derived guidelines available for

clinical measurement of rate and for setting goals

for rate. Values of approximately 200 SPM or 150

SPM are frequently used in setting goals for rate of

speech (Perkins, 1973; Boberg & Kully, 1985)

because mean rates of adult discourse tend to

converge around these values (Luchsinger, 1965).

However, rate of speech depends on age, gender

and language and therefore a common rate can’t be

set as a goal in rate control therapy for various age

groups and languages. But, there is little objective

data in support of these recommendations. In this

context, the present study investigated rate of

speech/ reading in 4 Dravidian languages and

established normative data on rate of speech in

Kannada, Tamil, Telugu, and Malayalam in

subjects ranging in 10 decades.

Four hundred and one (Kannada = 136,

Telugu = 69, Tamil = 103, Malayalam = 93)

normal subjects participated in the study. All

subjects were literates and were from urban

population. Informed consent was obtained from

subjects prior to collection of speech samples.

Subjects in the age range of 4-10 years described

cartoons and narrated stories and subjects in the

age range of 11-100 years read passages which

were developed by the investigators. All these

were audio-recorded and analyzed to obtain

syllables per second, syllables per minute and

words per minute. Cool Edit software was used to

eliminate pause and calculate duration.

Results indicated significant difference

between age groups, and languages. Rate of

speech increased with increase in age till about 40

years and declined after 40 years (except Tamil).

Malayalam had the highest SS and SPM compared

to other languages. No significant difference

between genders was observed. The results

provide normative data for clinical purposes and to

set rate of speech in persons with stuttering and

cluttering.

References

Adams, M., Lewis, J., & Besozzi, T. (1973). The effect of reduced reading rate on stuttering

fluency. Journal of Speech and Hearing

Research, 16, 671-675.

Bloodstein, O. (1944). Studies in the psychology

of stuttering: XIX. The relationship between

oral reading rate and severity of stuttering.

Journal of Speech Disorders, 9, 161.

Boberg, E., & Kully, D. (1985). Comprehensive

stuttering program: Clinical Manual. San

Diego, CA: College-Hill.

Costello, J. M., & Ingham, R. J (1984).

Assessment strategies in stuttering: In R. F.

Curlee & W. H. Perkins (Eds.). Nature and

treatment of stuttering: New directions. San

Diego, Ca: College-Hill Press.

Daly, D. A. (1986). The clutterer. In K. O. St.Louis (Ed.). The atypical stutterer.

Orlando, Fl: Academic Press.

Goldman-Eisler, F. (1968). Psycholinguistics:

Experiments in spontaneous speech. New

York: Academic Press.

Haselagar, G. I. T., Slis, I. H., & Rietveld, A. C.

M. (1991). An alternative method of

studying the development of rate. Clinical Linguistics and Phonetics, 5, 53-63.

Ingham, R. (1984). Stuttering and behavior

therapy: current status and experimental

foundations. San Dieogo, Ca: College-Hill

Press.


38

Ingham, R. J., & Cordes, A. K. (1997). Self-

measurement and evaluating stuttering

treatment efficacy. In R. F. Curlee & G. M.

Siegel (Eds.). Nature and treatment of

stuttering. Boston: Allyn and Bacon.

Ingham, W., & Packman, A. C. (1978). Perceptual

assessment and speaking rate and

dysfluency of adult male and female

stutteres and nonstutterers. Journal of

Speech and Hearing Research, 21, 63-73.

Johnson, W (1961). Measurements of oral reading

and speaking rate and dysfluency of adult

male and female stutterers and non

stutterers. Journal of speech and Hearing

Disorders (Monograph Supplement), 7, 1-

20.

Johnson, W., & Rosen, L. (1937). Studies in psychology of stuttering: VII. Effect of

certain changes in speech pattern upon

frequency of stuttering. Journal of Speech

Disorders, 2, 105-109.

Johnson, W., Darley, F. L., & Spriesterbach, D. C.

(1963). Diagnostic methods in speech

pathology. New York: Harper & Row.

Klatt, D. (1973). Interaction between two factors that influence o\vowel duration. Journal of

the Acoustical Society of America, 54, 1102-

1104.

Luchsinger, R. (1965). Voice – Speech -

Language. Belmont, CA: Wadsworth

Publishing Company.

Lutz, K. C., & Mallard, A. R. (1986). Disfluencies

and rate of speech in young adult nonstutterers. Journal of Fluency Disorders,

11, 307-316.

Meyers, S. C., & Freeman, F. J. (1985). Mother

and child speech rates as a variable in

stuttering and dysfluency. Journal of Speech

and Hearing Research, 28, 436-444.

Perkins, R. W. (1973). Replacement of stuttering

with normal speech: II Clinical procedures.

Journal of Speech and Hearing Disorders,

38, 283-294.

Rathna, N., Subba Rao, T. A., & Bharadwaj, A. K.

(1979). Rate of speech in Kannada. Cit. in

C. S Venkatesh, G. Purushothama, & M. S.

Poornima (1983). Normal rate of speech in

Kananda. Journal of the All India Institute

of Speech and Hearing, 15, 7-12.

Sander, E. (1961). Reliability of the Iowa speech

dysfluency test. Journal of Speech and

Hearing Disorders (Monograph Supplement), 7, 21-30.

Stephenson-Opsal, D., & Bernstein Ratner, N.

(1988). Maternal speech rate modification

and childhood stuttering. Journal of Fluency


Umeda, N., & Quinn, M. S. (1980). Some notes on

reading: Talkers, material and reading rate.

Journal of Speech and Hearing Research, 23, 56-72.

Venkatesh, C. S., Purushothama, G., & Poornima,

M. S. (1983). Normal rate of speech in

Kannada. Journal of the All India Institute

of Speech and Hearing. 15, 7-12.

Walker, C., & Black, J. (1950). The intrinsic

intensity of oral phrases (Joint Project

Report No. 2). Pensacola, Fla,: Naval Air Station, U. S. Naval School of Aviation

Medicine.


39

Appendix I– Normative data on rate of speech/reading in 4 Dravidian

languages

M = Mean, A= Average


Age SS SPM WPM SS SPM WPM SS SPM WPM

SS SPM WPM

3-3.11 M 4.9 291 129 SD 1.3 78 34 4-4.11 M 4.2 252 91 SD .79 48 17 5-5.11 M 4.2 254 120 5 299 114 SD 1.3 79 37 1 62 24 6-6.11 M 4.3 261 92 4.65 278 86 SD 0.84 50 18 1 64 20 7-10 M 4.1 250 85 6.7 402 130 SD 0.65 41 14 1.67 100 31 11-15 M 5.7 343 104 7 431 123 4.5 272 95 7.9 474 115 SD .83 48 14 1.25 132 37 .4 22 8 .8 51 12 16-20 M 7.0 425 127 7 439 125 6.5 384 133 8.8 529 128 SD .96 58 17 0.61 36 10 .7 53 18 1.2 73 18 21-30 M 6.5 386 116 8 466 133 6.5 391 136 9.3 558 135 SD .96 70 21 0.58 36 10 1.2 74 25 .9 62 15 31-40 M 7.2 434 131 6 384 116 5.5 326 114 8.2 492 119 SD .31 19 6. 0.95 54 23 1.1 68 24 .6 36 9 41-50 M 6.8 410 124 7 389 117 5.9 353 122 7.9 477 116 SD .87 53 16 1.04 75 20 .8 49 17 1.2 81 20 51-60 M 6.9 415 124 6 392 110 5.4 326 115 7.9 483 117 SD .62 37 11 1.04 69 18 .9 52 20 1 67 16 61-70 M 6.9 404 125 6 336 96 5.7 340 118 7.8 448 110 SD .73 52 12 0.99 60 17 1 62 21 .6 66 12 71-80 M 6.4 390 118 5 309 89 5.9 354 123 7 423 102 SD .85 51 15 0.19 11 4 .9 54 19 1.6 99 24 81-90 M 5.6 337 102 5.14 309 88.8 6.6 398 96 SD .97 58 17 0.19 11.3 3.85 .86 52 13 91-100 M 4.3 257 63 SD .7 44 11 A M 5.3 318 104 6.4 384 111 5.7 34 117 7.8 469 114

SD 2.20 133 40 0.76 53.8 15.9 1.2 72 25 1.4 88 21


40

95% confidence intervals for mean

LB: Lower boundary, UB: Upper boundary

Kannada

Age SS SPM WPM

LB UB LB UB LB UB

3-3.11 3.9 5.8 235 347 104 153

4-4.11 3.6 4.8 218 286 79 104

5-5.11 3.3 5.2 198 310 93 146

6-6.11 3.7 4.9 225 296 80 105

7-10 3.7 4.6 220 279 75 94

11-15 5.1 6.3 309 377 94 114

16-20 6.3 7.7 383 466 115 139

21-30 5.8 7.2 336 435 101 131

31-40 7.0 7.4 421 448 127 135

41-50 6.2 7.4 372 448 112 135

51-60 6.4 7.3 388 442 116 132

61-70 6.4 7.5 366 441 117 133

71-80 5.8 7.1 353 426 107 129

81-90 4.6 6.6 276 399 83 120

Telugu

Age SS SPM WPM

LB UB LB UB LB UB

11-15 5.4 7.1 315 567 90 162

16-20 6.1 7.9 367 475 105 136

21-30 7.0 7.8 413 464 118 132

31-40 7.3 8.1 441 492 126 141

41-50 5.7 7.1 346 422 100 132

51-60 6.2 7.6 336 443 102 131

61-70 5.7 7.2 342 441 97 123

71-80 4.9 6.2 297 377 85 108

81-90 3.4 6.9 207 411 54 123

Tamil

Age SS SPM WPM

LB UB LB UB LB UB

5-5.11 3.3 6.6 200 399 76 152

6-6.11 3.7 5.5 225 333 69 103

7-10 5.5 7.9 330 473 101 146

11-15 4.3 4.8 256 287 89 100

16-20 6.0 7.0 346 421 120 146

21-30 5.6 7.4 338 443 117 154

31-40 4.7 6.2 278 374 97 130

41-50 5.3 6.5 317 388 110 135

51-60 4.8 6.0 289 364 100 129

61-70 4.9 6.4 296 384 103 133

71-80 5.2 6.6 315 393 110 137

Malayalam

Age SS SPM WPM

LB UB LB UB LB UB

11-15 7.3 8.5 438 511 106 124

16-20 7.9 9.7 476 581 116 141

21-30 8.6 10 514 602 125 146

31-40 7.7 8.6 467 518 113 126

41-50 7.0 8.8 419 535 101 130

51-60 7.2 8.7 435 531 106 129

61-70 7.4 8.2 400 495 101 119

71-80 5.9 8.2 352 494 85 119

81-90 6.0 7.2 360 435 87 106

91-100 2.5 6.0 148 367 36 89

JAIISH, Vol. 27, 2008 Speech Rhythm in Hearing-Impaired Children

41

Speech Rhythm in Hearing-Impaired Children

1Savithri S.R.,

2Ruchi Agarwal

&

3 Johnsi Rani R.

Abstract

Rhythm, a prosodic feature, refers to an event repeated regularly over a period of time.

Research on speech rhythm in the last few years has been largely concerned with

attempting to search for the acoustic correlates of rhythmic classification. Speech

rhythm in pathological cases has not been studied extensively. In this context, the present

study investigated speech rhythm in normal and hearing-impaired children using

Pairwise Variability Index (PVI) index. The PVI is one measure used to calculate the

extent of unit-to-unit variation in speech. Twenty normal hearing and twenty hearing

impaired Kannada speaking children in the age range of 5-10 years participated in the

study. The subject's spontaneous speech and narrations were audio recorded and stored

onto computer. The vocalic and intervocalic durations were measured using Cool Edit

Pro software. The results revealed longer vocalic and intervocalic durations in hearing-

impaired children in comparison with normals. It is concluded that both the hearing-

impaired and normal children have unclassified rhythmic patterns.

Key words: Rhythm, Pair wise variability index, Rhythmic patterns.

Rhythm, a prosodicfeature, refers to an event

repeated regularly overa period of time. In stress-

timed languages, intervals between stresses or

rhythm are said to be near equal, whereas in

syllable-timed languages successive syllables are

said to be of near-equal length. A third type of

rhythm, mora timing, was proposed by Bloch

(1950), Han (1962), and Ladefoged (1975) where

successive morae are said to be near equal in

duration. Mora- timing was exemplified by

Japanese. The Pairwise Variability Index (PVI) is

a quantitative measure of acoustic correlates of

speech rhythm, which calculates the pattering of

successive vocalic and intervocalic (or

consonantal) intervals showing how one linguistic

unit differs from its neighbour (Low, 1998).

Grabe & Low (2000) developed normalized

Pairwise Variability Index (nPVI) for rhythmic analysis of vocalic durations. The raw Pairwise

Variability Index" (rPVI) is used for rhythmic

analysis of intervocalic durations. Table 1

summarizes the basic characteristics of each

language class regarding relative values of vocalic

nPVI and intervocalic rPVI.

Language Class

Languages Intervocalic rPVI

Vocalic nPVI

Stress-timed

English, Germany

High High

Syllable-timed

French, Spanish

High Low

Mora-timed Japanese Low Low

Table 1: Summary of basic characteristics of each

language class regarding relative values of

vocalic nPVI and intervocalic rPVI.

Few investigators have reported rhythm in

pathological population. Dankovicova, Gurd,

Marshall, Macmohan, Stuart-Smith, Coleman, &

Slater (2001) reported that speech of English

speaker individual with foreign accent Syndrome

and ataxic dysarthria is more syllable-timed than

that of normal controls. Using an early forerunner

of the PVI, Ackerman & Hertrich (1994) and Kent, Rosenbek, Vorperian, & Weismer (1997)

found little evidence of syllable timing for ataxic

population. As there is dearth of studies in rhythm

for hearing impaired, the present study

investigated the rhythm in normal and hearing-

impaired children.

1Professor, Dept. of Speech-Language Sciences, All India Institute of Speech & Hearing, Manasagangothri, Mysore-570006, email:[email protected]. 2Research Officer, Dept. of Speech-Language Sciences, All India Institute of Speech and Hearing, Manasagangothri, Mysore-6, email:[email protected], 3Research Officer, Dept. of Speech-Language Sciences, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, email: [email protected].


42

Method

Subjects: The experimental group included 20

hearing impaired Kannada speaking children in

the age range of 5-10 years. All subjects had

bilateral severe sensori-neural hearing loss,

normal oral structures, no other associated

psychological or neurological problems, language

age of atleast 3 years on REELS and all subjects

attended regular speech therapy or normal school.

The control group consisted of age, gender and

language age matched Kannada speaking 20 normal children.

Material: Pictures developed by Indu (1991),

Nagapoornima(1991), Yamini (1991) and

Rajendra Swamy (1992) were used to elicit

speech. In addition story telling was also used.

Procedure: Subjects were instructed to describe

the pictures, narrate the story, which were audio-

recorded using MZ-R30 digital Sony recorder and stored onto the computer. Waveform display

obtained from Cool Edit Pro software was used to

measure vocalic (V) and intervocalic (IV)

interval. The vocalic measure (nPVI) refers to the

duration of vowel, which was measured as the

time duration from the onset of voicing to the

offset of voicing for the vowels. Intervocalic measure (rPVI) refers to the duration between two

vocalic segments. It was measured as the time

duration between the offset of the previous

vocalic segment to the onset of subsequent

vocalic segment. A program in C language was

developed (Vasanthalakshmi, 2005) to compute

nPVI and rPVI. The raw Pairwise Variability

Index (rPVI) is defined as follows:

Where, m is the number of intervals and dk is the

duration of the kth interval. The normalized

Pairwise Variability Index (nPVI) is defined as

follows:

Where, m is the number of intervals and dk is the

duration of the kth interval.

The duration difference between the first and

second, the second and third vocalic segment and

so on was averaged to get nPVI. The same

procedure was used to obtain averaged

intervocalic durations. Pauses between intonation

phrases, as well as hesitations, were excluded

from the analysis.

Statistical analysis: The mean rPVI and mean

nPVI values were calculated for both normal and

hearing impaired children. Repeated measure

ANOVA was used to obtain significant

differences, if any, between groups.


Independent t-test indicated a significant

difference between groups on rPVI (intervocalic)

[t (38) = 2.54, p<0.05] and nPVI (vocalic) [t (38)

= 2.30, p<0.05] values. Both rPVI and nPVI

values were higher in hearing-impaired children

compared to normal children. Within the normal

group, no statistically significant difference was

obtained between genders for rPVI [t (18) =

0.217, p> 0.05] and nPVI [t (18) = 0.293, p>0.05].

Also, within the hearing impaired group, no

statistically significant difference was obtained

between genders for rPVI [t (18) = 0.365, p>

0.05] and nPVI [t (18) = 0.685, p>0.05]. Table 2

shows the rPVI and nPVI values of normal and

hearing impaired children. Mean and Standard

deviation of normal and hearing-impaired children is depicted in figure 1.


43

Subject Normals Hearing-Impaired rPVI nPVI rPVI nPVI

1 13.80 64.16 18.14 71.01 2 14.15 67.15 31.40 73.02 3 12.99 60.66 31.51 62.81 4 16.47 64.04 19.50 58.05 5 16.47 62.37 15.54 79.55 6 17.68 60.90 13.28 77.11 7 15.75 63.21 17.86 83.91 8 18.71 65.83 10.74 57.57 9 17.79 62.08 27.23 76.70

10 13.23 64.85 10.09 70.72 11 19.63 59.26 26.21 61.88 12 13.86 63.55 30.10 78.66 13 15.52 62.30 10.30 60.93 14 16.92 63.60 15.78 58.06 15 17.20 68.27 15.55 59.88 16 12.69 61.85 32.50 58.66 17 15.56 54.81 21.40 61.56 18 21.01 56.99 11.63 62.08 19 14.02 62.94 18.58 63.26 20 10.63 61.17 33.65 67.57

Mean 15.70 62.49 20.54 67.14

Table 2: rPVI and nPVI values in normal and hearing

impaired children.

PVIs

rPVInPVI

95

% C

I fo

r S

co

res

80

70

60

50

40

30

20

10

Groups

Normals

HI

Figure 1: Mean and standard deviation in normals and

hearing-impaired.

The results indicated high nPVI and low rPVI

values in both groups and therefore the rhythmic

pattern found in hearing impaired and normal

children remains unclassified and cannot be

placed in any of the rhythmic classes (stress-

timed, syllable-timed, mora-timed).

The results indicated several points of

interest. Firstly, the results indicated that the

rhythmic pattern found in hearing impaired and

normal children remained unclassified and cannot be placed in any of the rhythmic classes (stress-

timed, syllable-timed, mora-timed) since the nPVI

values were found to be higher than values of

rPVI in both groups which implies that the usage

of vowels in their speech was more; subjects are

still in the acquisition stage of rhythm.

Comparison of the PVI values in adults and

children showed that nPVI values were higher in

children than the adults whereas rPVI values were

higher in adults when compared to children. This

may be due to the reason that the speech task in

children is unpredictable unlike the reading task

by adults and hence would have an influence on

differences in PVI values. Figure 2 shows the

PVIs in children and adults. adults.

Figure 2: Mean rPVI and nPVI values for normal,

hearing-impaired children and adults.

Also, the types of syllable used in children

and adults were different. The percentage use of

different types of syllable structures by normal

and hearing impaired children and adults (Savithri

et.al.2005) was calculated and tabulated. Results

indicated that the type of syllable structure used

by three groups differed. Children used V, CV and CCV syllables, and adults, in addition, used

CCV syllables. The percentage use of V and CV

syllables was more in HI children compared to

normal children. Table 3 shows the percentage of

various syllables used in three groups of subjects.

Groups V CV CCV CCCV Normal children 21.15 61.62 17.21 0 HI Children 23.27 68.82 7.95 0 Adults 6.86 80.63 12.38 0.11

Table 3: Percentage use of different syllable structures.

The usage of more vocalic syllables and less

CV syllables in children compared to adults might

be a reason for low rPVI.

Conclusions

Rhythm has been defined as an effect

involving the isochronous recurrence of some

type of speech unit. Basically languages have


44

been organized under three types of rhythm i.e.

stress-timed, syllable-timed and mora-timed. The

present study investigated the rhythm in normal

and hearing-impaired children. Pair-wise

Variability Indices (PVI’s) were used to find the

vocalic and intervocalic durations. The vocalic

measure (nPVI) refers to the duration of vowel,

which was measured as the time duration from the

onset of voicing to the offset of voicing for the

vowels. Intervocalic measure (rPVI) refers to the

duration between two vocalic segments. The

results showed that the speech rhythm in normal

and hearing impaired children remained

unclassified. No gender differences were

observed in any group. A high nPVI value and low rPVI value was obtained in both groups.

Savithri, Jayaram, Kedarnath, & Goswami (2005)

classified Kannada as a mora- timed language in

normal adults. But, the results of the present study

are not in consonance with the earlier study,

which indicates that the acquisition of adult-like

rhythm is not yet achieved in the children of the present study. The syllabic structure used by

children also differed from that of the adults.

Therefore the results of the present study reveals

that the syllabic structure used by children is

simpler than the adults and children are in

acquisition stage of rhythmic patterns. Thus, it

implies that there is a need to develop the

normative data for the age at which children

acquire the adult like rhythmic pattern.

References

Ackermann, H., & Hertrich, I. (1994). Speech rate

and rhythm in cerebellar dysarthria: an

acoustic analysis of syllable timing. Folia

Phoniatrica, 46, 72-78.

Bloch, B. (1950). Studies in colloquial Japanese

IV: Phonemics. Language, 26, 86-125.

Dankovicova, J., Gurd, J., Marshall, J.,

Macmohan, M., Stuart-Smith, J., Coleman,

J., Slater, A. (2001). Aspects of non-native

pronunciation in a case of altered accent

following stroke (foreign accent

syndrome). Clinical Linguistics and

Phonetics, 15, 3, 195-218.

Grabe, E. & Low, E. L. (2000). Durational

variability in speech and rhythm class

hypothesis. In C. Gussenhoven & N.

Warner (Eds.). Laboratory Phonology. 7,

515-546. Berlin: Mouton de Gruyter.

Han, M. S. (1962). The feature of duration in

Japanese. Onsei no kenkyuu, 10, 65-80.

Indu (1990). Some aspects of fluency in children:

4-5 years. M. Jayaram, & S.R. Savithri

(Eds.). Dissertation abstract: Research at

AIISH, Vol.2, pp 171-173.

Kent, R., Rosenbek, J., Vorperian, H., & Weismer, G. (1997). A speaking task

analysis of the dysarthria in cerebellar

disease. Folia Phoniatrica et Logopaedica,

49, 63-82.

Ladefoged, P. (1975). A Course in Phonetics.

New York: Harcourt Brace Jovanovich.

Low, E. L. (1998). Prosodic prominence in

Singapore English. Unpublished Ph.D. Thesis, University of Cambridge.

Nagapoornima, M.N. (1990). Dysfluencies in

children: 3-4 years. M. Jayaram, & S.R.

Savithri (Eds.). Dissertation abstract:

Research at AIISH, Vol.2, pp 171-173.

Rajendra Swamy, (1992). Some aspects of

fluency in children: 6-7 years. M. Jayaram,

& S.R. Savithri (Eds.). Dissertation

abstract: Research at AIISH, Vol.3, pp 6-7.

Savithri, S.R., Jayaram, M., Kedarnath, D.,

Goswami, S. (2005). Rate of speech

/Reading in Dravidian languages. Journal

of the Acoustic Society of India, 33, 352-

355.

Vasantalakshmi (2005). Development of C

language program. AIISH, Mysore.

Yamini, B.K. (1990). Dysfluencies in children: 5-

6 years. M. Jayaram, & S.R. Savithri

(Eds.). Dissertation abstract: Research at

AIISH, Vol.2, 171-173.

Acknowledgements

The authors acknowledge the financial

support of ARF. The authors would like to thank

Dr.Vijayalakshmi Basavaraj, Director, AIISH, for

permitting to publish the paper. They also thank

all subjects for their participation in the study.

JAIISH, Vol. 27, 2008 Semantic Association

45

The Semantic Association in the Mental Lexicon

1Gopee Krishnan &

2Shivani Tiwari

Abstract

The organization of mental lexicon has been extensively debated and discussed in the

contemporary psycholinguistics. Specifically, this study investigated into the nature of

organization of semantically related and unrelated concepts in the mental lexicon. A

group of 19 participants (age range: 17-23 years; 11 females & 8 males) was required to

judge the semantic association between the word pairs presented through reaction time

software (DMDX). The participants judged the semantically associated word pairs faster

compared to the semantically unrelated pairs. This finding could be explained by the

Spreading activation theory of lexical processing (Collins & Loftus, 1975; Dell, 1986).

The semantic features that are in common to the words of the stimulus pairs received

double activation and this facilitated a faster judgment in the case of semantically

associated word pairs compared to unassociated word pairs.

Key words: Spreading activation theory, Speech production, Architecture of the mental lexicon, Lexical processing.

The selection of words during speech

production is an effortless act for a native speaker.

However, the underlying processes in word

production are far from the simplicity with which

it is performed. For example, while naming a

picture, the speaker performs a visual analysis to

identify the features of the picture and activates the

conceptual knowledge (lemma) associated with

that picture. The activated lemma further activates

the word form (lexeme) associated with it down

the process. This is known as the lexical selection.

Once the lexical item associated with the concept

in question is selected, the phonological encoding

takes place, where the speaker correctly selects the

various phonemes necessary for the speech

articulation and these selected phonemes are sent

to the speech articulation circuit for their

execution. Thus, a seemingly simple task such as

picture naming involves various underlying

processes such as visual analysis, semantic

activation, lexical selection, phonological

encoding and finally the speech articulation

(Costa, Colomẽ, & Caramazza, 2000).

Spreading Activation Theory in Lexical

Selection

The concept of Spreading Activation Theory

– an idea originally introduced by Collins and

Loftus (1975) – has received widespread

acceptance in the contemporary cognitive-

linguistic literature. The notion behind this theory

is that each concept spreads a proportion of its

activation to other representations with which it is

linked. For example, when naming the picture of a

dog, the concepts associated with that stimulus

such as ‘an animal’, ‘has a tail’, ‘has four legs’,

‘pet’, ‘faithful’ etc. are activated. However, some of these features are also applicable to other

animals too; say cat. The spreading activation

theory thus postulates that the presentation of the

picture of a dog also partly activates the concept

cat and other members that share the similar

features (Caramazza, 1997; Collins & Loftus,

1975; Dell, 1986). In other words, the concept cat

becomes a competitor while selecting the concept

of dog (Semantic Interference Effect) (Glaser &

Glaser, 1989; Roelofs, 1992; Starreveld & La Heij,

1995). However, under normal conditions, the

speaker does not face such difficulties as s/he

correctly picks up the right item (dog). This

selection process could be damaged in aphasic

subjects leading to, what is known as semantic

paraphasias (Caramazza & Hillis, 1990).

The partial activation received by the

semantically related concepts has some important

bearing on our understanding of the functional

1Assistant Professor, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576 104, email:[email protected] , 2Lecturer, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576 104, email:[email protected].


46

architecture of mental lexicon. In the previous

example, the presentation of the stimulus dog

activates other semantically related concepts such

as cat and various other concepts in the mental

lexicon that share some of the features (not all) of

the target item. Though there is a lack of

consensus on the amount of activation received by

each of these related concepts in the mental

lexicon, it is widely accepted that the amount of

activation received by related concepts is

proportional to the number of features shared by

both the target and the related items. Therefore, it

is possible to assume that the concept of cat

receives higher activation compared to other

members that do not share any features with the target item (for example, stone). In a way, we can

assume that the concepts cat and dog are closely

located in the mental lexicon compared to

concepts stone and dog. This type of

conceptualization about the organization of the

items in the semantic storage has gained strong

evidences from reaction time studies.

A related and simple, yet interesting question

is the robustness with which a word-pair is judged

on its semantic association. Put it in a simpler way,

are semantically associated word-pairs judged

faster compared to unassociated pairs on their

semantic association? Rubenstein, Lewis, and

Rubenstein (1971) and Stanners and colleagues

(1971) have reported that semantically associated

word pairs are judged faster with compared to the

unassociated word pairs. However, this needs to be

tested empirically again to check the validity of the

finding as well as a theoretical explanation should

be put forth for the observed finding. We address

this issue in this study.

Objectives

The objectives of the study were to replicate

the findings of previous findings and more

importantly, if similar findings were obtained, provide an explanatory hypothesis for the faster

judgment time in the case of semantically

associated word pairs compared to the

unassociated word pairs.

Method

Subjects

Nineteen subjects (11 females & 8 males)

volunteered to participate in the present study. The subjects were the undergraduate students of

Manipal University. All the subjects had English

as their medium of instruction starting at the age of

4-5 years. The mean age of the participants was 20

years (age range 17-23 years).

Materials

A pool of 110 items consisting of 56

semantically related and 54 unrelated items was initially selected. Five proficient English speakers

rated these items for their semantic association.

The raters’ task was to write either ‘yes’ or ‘no’

against each word-pair if the pair was semantically

related or unrelated, respectively. Three raters did

not agree on three semantically associated items

and two semantically unassociated items. One rater did not agree on two semantically associated

and two semantically unassociated items.

However, the items the single rater did not agree

were same as that of the other three raters,

therefore, finally rejecting three semantically

related and two semantically unrelated items from

the test stimuli. Thus, the final version consisted of

53 semantically related and 52 unrelated word

pairs. Among these 105 items, three semantically

related and two semantically unrelated items were

randomly selected for training purpose.

Procedure

The subjects were made to sit in a soundproof

room and verbal instructions were given about the

task. This was followed by the presentation of

training items and the subjects were made familiar

with the task and the response. The stimuli were presented through a computer using DMDX

reaction time software (Foster & Foster, 2003). A

semantically associated word-pair was indicated

by ‘m’ button press and unassociated pair by ‘n’

button press on the keyboard. The subjects were

instructed to rest their middle and index fingers on

these buttons while performing the task in order to avoid time delay in reaching the button while

responding.

The stimulus words appeared as black capital

letters in Times New Roman font in white

background. The font size remained 26 across the

stimuli. Before the presentation of each stimulus, a

fixation point (+) appeared for 500 ms in the center of the screen on which the participants were

instructed to fixate. This was followed by the first

word of the word pair for a duration of 750 ms.

This was further followed by a blank screen for

500 ms and the second word of the word pair. The

second word remained on the screen for 2000 ms.

The DMDX’s clock was set on with the

presentation of the second word. 100 word-pairs


47

were randomly categorized into five blocks of 20

each. At the end of each block, a rest period (1

minute) was given and for each subject, the testing

was completed in a single sitting. The

chronological sequence of the testing procedure is

seen in Figure 1.

Figure 1: The chronological sequence of the testing

procedure.

Results

The responses of the trial items were

eliminated from the reaction time analysis. The

remaining data was analyzed with SPSS.11

software for Windows. For the entire group of

subjects, 73/1026 responses (7.11 %) in semantically associated condition and 72/874

responses (8.23%) were either wrong or ‘no’

responses. For the statistical analysis, the reaction

time (RT) from correct responses was used. The

group mean for the semantically associated

condition was 737 ms (SD = 134) whereas in the

unassociated condition, the mean RT was 866 ms (SD = 171). The mean reaction times were

submitted to Paired sample Student t-test to find

out the differences between the two conditions, if

any. The t-test results revealed a significant

difference between the semantically associated and

unassociated word pairs (t = -6.51, p < 0.001). The

individual performance across the subjects is given

in Figure 2. A closer look at the Figure 2 reveals

that the reaction times were shorted for

semantically associated word pairs on an

individual basis.

Figure 2: The reaction times (ms) on semantically

associated versus unassociated conditions

across the subjects.

Discussion

The findings of the present study supported

that of similar studies done in the past (e.g.,

Rubenstein et al., 1971; Stanners et al., 1971). In

the following section, we provide an explanatory

hypothesis for the observed findings from the

perspectives of spreading activation theory of

lexical access (Collins & Loftus, 1975; Dell, 1986). As mentioned in the introduction, the

members in the mental lexicon receive partial

activation when a related item is activated. The

activation strength is a function of the number of

features shared by the target item with its

distracters (Caramazza, 1997). Therefore, an item

that shares a large number of features with the

target item will be highly activated compared to

the items that receive only minimal activation.

These highly activated items’ lexical nodes could

act as strong competitors to the target items at the

lexical selection stage.

Reaction time studies have added

significantly to our existing knowledge on the

semantic organization in the mental lexicon. In the

current study, all the subjects required lesser time

to judge a word pair as semantically associated

compared to one that was semantically

unassociated. According to the Spreading

Activation Theory (Collins & Loftus, 1975; Dell,

1986), lesser amount of time for semantically

related word pair could be interpreted as follows:

upon seeing the first word, the subject activates its

corresponding semantic concept from his/her

mental lexicon. This partially activates the

semantically related items (to the target) as well.

The presentation of the second word of the word pair soon after the first word elicits an activation

of its corresponding semantic representation. This


48

in turn could activate some of the features of the

first word that are just activated by the first word.

Therefore, as depicted in Figure 3, the set of

features shared by both words (for example,

animal) are highly activated compared to other

features that are not common to both the words of

the stimulus pair. During the semantic association

judgment, these highly activated semantic features

could facilitate a faster ‘yes’ response.

Figure 3: An increased activation of the semantic

feature (animal) shared by both words of

the stimulus pair.

In the case of a semantically unassociated

word-pair (Figure 4), each word activates a set of semantic features corresponding to its concept.

However, there is no facilitation of any semantic

features resulting from the lack of overlap of

features between the word pairs, unlike in

semantically associated condition. Hence, the

subject has to search for all the semantic features

to ascertain the presence of any heightened activation (i.e., semantic association) before

making an accurate ‘no’ judgment. Logically, this

process is more time consuming compared to

semantically associated condition where the

presence of a highly activated feature

(semantically associated) ascertain the semantic

association between the words of the stimulus pair.

In simpler terms, in the absence of any such

heightened activation, the subjects need to search

the entire semantic features (of both words of the

word pair) before making a correct response; at the

expense of increased response time.

Figure 4: Absence of heightened activation (semantic

association) in semantically unrelated word

pair.

Conclusions

The current study supported the findings of

previous similar studies on the representation of

associated and unassociated words in the mental

lexicon. More importantly, an explanatory hypothesis based on the spreading activation

theory has been put forth to explain the observed

findings. The mechanism behind faster judgment

time in the case of semantically associated word

pairs in contrast to the unassociated word pairs

may hypothesized be due to the presence/absence

of heightened activation (semantic association).

That is, the presence of heightened activation

terminates the search and a ‘yes’ response is made

whereas the absence of such activation demands

continued search until all the features are searched,

in order to make an accurate ‘no’ response, at the

expense of increased response time.

References

Caramazza, A., & Hillis, A. E. (1990). Where do

semantic errors come from? Cortex, 26, 95 –

122.

Caramazza, A. (1997). How many levels of

processing are there in lexical access?

Cognitive Neuropsychology, 14, 177 – 208.

Collins, A. M., & Loftus, E. F. (1975). A

spreading-activation theory of semantic

processing. Psychological Review, 82 (6),

407 – 428.

Costa, A. Colomẽ, A., & Caramazza, A. (2000).

Lexical Access in Speech Production: The


49

Bilingual Case. Psychologica, 21, 403 –

437.

Dell, G. S. (1986). A spreading activation theory

of retrieval in sentence production.

Psychological Review, 93, 283 – 321.

Forster, K. I., & Forster, J. C. (2003). DMDX: A

Windows display program with millisecond

accuracy. Behavior Research Methods,

Instruments, & Computers, 35, 116–124.

Glaser, W. R., & Glaser, M. O. (1989). Context effect in Stroop-like word and picture

processing. Journal of Experimental

Psychology: General, 118, 13 – 42.

Roelofs, A. (1992). A spreading-activation theory

of lemma retrieval in speaking. Cognition,

42, 107 – 142.

Rubenstein, H., Lewis, S., & Rubenstein, M.

(1971). Evidence of phonemic recording in

visual word recognition. Journal of Verbal

Learning and Verbal Behavior, 10, 645-657.

Stanners, M. S., Peterson, A., & Waters, G. S.

(1971). Reading without semantics.

Quarterly Journal of Experimental

Psychology, 23, 111-138.

Starreveld, P. A., & La Heij, W. (1995). Semantic

interference, orthographic facilitation and

their interaction in naming tasks. Journal of

Experimental Psychology: Learning,

Memory, and Cognition, 21, 686 – 698.

Acknowledgments

We thank Ms. Vanessa and Ms. Elizabeth for

their valuable help during the current study. We also thank Dr. B. Rajashekar, Head of the Dept. of

Speech and Hearing, Manipal College of Allied

Health Sciences, Manipal University, India, for

permitting us to undertake this study.

JAIISH, Vol. 27, 2008 Semantic – Pragmatic Attributes and Cognition in Schizophrenics

50

Semantic – Pragmatic Attributes and Cognition in Acute and

Chronic Schizophrenics: A Case Comparative Study

1Mithila Poonacha,

2Shivani Tiwari &

3Rajashekhar Bellur

Abstract

Schizophrenia is a thought disorder, displaying unusual language and cognitive

impairments. There exists a dearth of studies relating the language deficits to the onset

of the disorder. This study profiled few aspects of semantic and pragmatic abilities in

acute and chronic schizophrenics and compared with their cognitive abilities. One acute

schizophrenic and one chronic schizophrenic patient participated in the study. Cognition

was assessed using the “Addenbrooke’s Cognitive Examination (ACE-R)” Kannada version. Aspects of semantics (semantic storage, recall/access and the word association)

and pragmatics were assessed using a test battery.Results showed distinct variations in

both subjects in cognitive as well as linguistic aspects (semantic and pragmatic).

Abnormalities were found both at single word level as well as discourse comparable to

dysfunction of cognition, and onset of the disorder. The findings highlighted the

differences in semantic-pragmatic and cognitive aspects in terms of onset of the disorder.

Though, the study is a preliminary attempt and warrants further research for

substantiation.

Key words: Word association, Discourse.

Language disorder has long been considered a

diagnostic indicator of schizophrenic disorder

(American Psychiatric Association, 1994). Various

distinct hypotheses have been put forth by several researchers, regarding the root problem underlying

language dysfunction. Many psychopathologists

regard speech disturbances as reflective of an

underlying disorder of thinking. While, content

and form of schizophrenic speech has been

described as deviant by other group of authors.

The language disturbances in schizophrenics could be at individual levels or a combination of

different levels.

Semantics refers to the meaning of words.

Several investigators have reported that patients

with schizophrenia are slower and less accurate in

words/ word pairs as members of conceptual

categories (Chen, Wilkins, McKenna, 1994). Some

other studies also suggest that schizophrenia

maybe characterized by a disorganized semantic

memory store. Pragmatics is the study of how

language is used and how language is integrated in

the context. A number of researchers have

concluded that the primary language impairment in

schizophrenia is in the area of pragmatic

performance. Crow, (1998) argued that the language disturbances in schizophrenia are a

reflection of the way in which individuals with

schizophrenia use language.

Cognition refers to the mental processes used

in the acquisition and use of language including

sensations, perception, attention, learning,

memory, language, visuospatial abilities, thinking,

and reasoning. Schizophrenia is often associated with cognitive deficits, particularly executive

function, attention, memory and language. Specific

cognitive deficits have been linked to psychotic

phenomena, including verbal hallucinations and

disorganized speech. In addition, selective deficits

have also been described in the pattern of retrieval

from both semantic and episodic memory.

Clinically, cognitive dysfunction is a direct

predictor of poor social functioning. The existence

of specific patterns of cognitive dysfunction

1Post Graduate Student, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576 104, 2Lecturer, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576 104, email:[email protected], 3Professor, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576 104.


51

suggests several important avenues for future

research.

However, the nature of language disturbance

in relation to the onset of the disorder is poorly

understood. Thus, the study aimed at investigating

the semantic and pragmatic skills in subjects with

acute and chronic schizophrenia and comparing

with cognition.

Method

Subjects

One acute schizophrenic and one chronic

schizophrenic, diagnosed by the consultant

psychiatrist based on DSM-IV (A) criteria,

participated in the study (Table 1). The subjects

were recruited from Kasturba Hospital, Manipal

and from Government Hospital, Udupi, Karnataka.

Details Acute Schizophrenic (X)

Chronic Schizophrenic (Y)

Age/Gender 30 yrs, female 24yrs, male Language Kannada Kannada Education B.Sc. Computer

science (incomplete)

S.S.L.C (fail)

Complaint c/o no problem c/o hand pain since 4 days

Onset 2 months 2 years Pre-Morbid History

Maintaining well Well-adjusted personality

Post-Morbid History

Wandering behavior, anger outbursts, decreased personal care, decreased sleep, talking and smiling to self, increased & irrelevant speech, inappropriate dressing, belief that black magic has been done on her.

Decreased interaction, increased suspiciousness and abusive behavior, withdrawal from family, smiling & muttering to self, irrelevant talk, increased religiosity.

Diagnostic Criteria

Auditory hallucinations, delusion of love (?), socio-occupational dysfunction.

Auditory hallucinations, delusion of persecution, delusion of reference, delusion of grandiose, breaks in the train of thoughts, self-absorbed attitude, socio-occupational dysfunction.

Treatment On antipsychotic treatment for a month

On antipsychotic treatment along with electro-convulsive treatment (ECT) for more than a year

Table 1: Case details and demographics.

Materials and Procedure

The subjects were tested for cognition,

semantics and pragmatics:

Cognition: Cognitive abilities of the subjects were

assessed using “Addenbrooke’s Cognitive Examination (ACE). The first adaptation of this

test in Indian language (Malayalam) was provided

by Mathuranath, Hodges, Mathew, Cherian,

George, and Bak (2004). Further, this Malayalam

version of ACE (M-ACE) was validated on 488

subjects of age 55 – 75 yrs (Mathuranath, Cherian,

Mathew, George, Alexander, Sarma, 2007).

Kannada version of ACE was developed and

standardized on 68 subjects (age 40 – 74 yrs), by

the Department of Neurology, Kasturba Hospital,

Manipal, (2007). The test checks cognition under 5

sections of Attention and Concentration, Memory,

Verbal Fluency, Language, and Visuospatial abilities. Table 2 provides the subdivision of the

5 sections of ACE and the split of scores, with the

total score summing to 100. Instructions for the

test were given verbally, except for the section of

‘Language’ for which instructions were given in

writing. The obtained scores were then compared

to the normative (cut-off score <88).

Semantics: Included three measures:

a. Semantic storage: A spoken word-to-

picture matching task was given involving

the presentation of 10 pictures from

various lexical categories. Score of 1 was

given for each correct response.

b. Recall/access: Included three tasks:

(i) Confrontation naming task: 5 nouns

from various lexical categories and 5

verbs were presented and the subject

named the picture. Score of 1 was

given for every correct response. *(Pictures were black & white line

diagrams taken from “With a little bit

of help”, language training manual).

(ii) Category fluency task: 2 lexical

categories were given and subjects


52

were instructed to name as many items

possible under each category for 1

min. Score of 1 was given for every

correct response.

(iii) Letter fluency task: 2 phonemes,

commonly used in Kannada were

given and were asked to generate as

many words starting with the given

phoneme in 1 min. Score of 1 was

given for every correct response.

c. Word association: A list of 10 words

(abstract & concrete) was prepared and

rated on familiarity and concreteness by 3

native Kannada speakers. Equal

representations of abstract and concrete

words (5 each) were taken in the list.

Words from the list were presented orally

and the subject had to give the most

similar or associative word for the given

stimuli. The experimenter recorded the

responses and scored 1 for each of the

most associative response.

Pragmatics: A ‘pragmatic protocol’ by Prutting &

Kirchner (1987) was adopted for profiling of

pragmatics. Two conversations were recorded for

each participant, first with a familiar and second

with a non-familiar partner (15 mins each). The

protocol consists of 30 parameters classified into

verbal, paralinguistic, and nonverbal aspects. The

experimenter rated the conversation samples on

these parameters, either as appropriate or

inappropriate.

Results

Performance on cognitive measure indicated

that the acute schizophrenic had better attention

and concentration when compared to the chronic

schizophrenic, but was more impaired for memory

and verbal fluency. While both subjects’ total

score fell below the cut-off score (< 88), indicating

cognitive dysfunction (Table 2).

Acute Schizophrenic (X) Chronic schizophrenic (Y)

Attention and concentration: [Orientation:

10/10, Registration: 3/3, Attention & Concentration:

5/5] Total: 18/18

Attention and concentration: [Orientation:

5/10, Registration: 3/3, Attention & Concentration:

4/5] Total: 12/18

Memory: [Recall: 2/10, Anterograde: 3/7, Retrograde: 1/4, Recognition: 3/5]

Total: 9/26

Memory: [Recall: 3/10, Anterograde:4/7, Retrograde: 3/4, Recognition: 1/5]

Total: 11/26

Verbal fluency: [Letter: 1/7, Categorical: 3/7]

Total: 4/14

Verbal fluency: [Letter: 5/7, Categorical: 3/7]

Total: 8/14

Language: [Comprehension: 3/8,

Writing: 1/1, Repetition: 4/4, Naming: 7/12,

Reading: 1/1] Total: 16/26

Language: [Comprehension: 6/8,

Writing: 0.5/1, Repetition: 4/4, Naming: 6/12,

Reading: 1/1] Total: 17/26

Visuo-spatial abilities: [Visuo-spatial abilities :4/8,

Perceptual abilities: 8/8] Total: 12/16

Visuo-spatial abilities: [Visuo-spatial abilities :7/8,

Perceptual abilities: 8/8] Total: 14/16

Overall ACE Score: 59/100 Overall ACE Score: 62/100

Table 2: Subjects’ performance on Cognition (ACE – R, Kannada).

Semantic measure assessment revealed poor

performance by chronic schizophrenic (Y) on word association task. However, chronic

schizophrenic (Y) performed better on

recall/access task when compared to acute

schizophrenic (X) (Refer Table 3).

Acute Schizophrenic (X) Chronic Schizophrenic (Y)

Semantic storage: 10/10 Total: 10

Semantic storage: 10/10 Total: 10

Recall/access: - Confrontation naming task

(Noun & Verb): 10/10 - Category fluency task:

animals: 9, body parts: 8 - Letter fluency task: /k/- 5,

/a/- 3 Total: 35

Recall/access: - Confrontation naming

task (Noun & Verb): 9/10

- Category fluency task: animals: 9, body parts: 15

- Letter fluency task: /k/- 6, /a/- 9 Total: 48

Word association: 8 Total: 8

Word association: 3 Total: 3

Table 3: Performance on semantic measures.

Performance on pragmatic domain was

considerably impaired in both the subjects, though

on different parameters of verbal, paralinguistic

and nonverbal aspects. Table 4 shows a few of the

more significant parameters.


53

Verbal Aspects Variety of

speech acts Topic selection

Topic initiation Topic maintenance

Pause time Lexical selection

X – – – + – + Y – + + – – –

Paralinguistic Aspects Intelligibility Fluency Prosody Vocal quality X – – – – Y – – – –

Nonverbal Aspects Eye gaze Facial expression Gestures Body posture X – – – – Y – – – –

(Key: + indicates appropriate, - indicates inappropriate)

Table 4: Performance on pragmatic measures.

Discussion

There is increasing evidence that cognitive

deficits are not global and generalized, rather are specific and selective. Similarly the test of

cognition in the present study revealed a difference

in the two subjects in orientation task, memory

task, verbal fluency, aspects of language and

visuo-spatial abilities. Semantic memory has been

conceptualized as an associative network. The

pattern of recall depends upon both the strength and the number of associative links with other

words in the network. Schizophrenic patients

recall fewer words than controls in a retrieval task

(Nester, 1998). More interestingly, in this study

both subjects showed poor overall performance in

word recall, suggesting a specific impairment in

either the structure, or modulation of this associative network.

On semantic tasks, difference in performance

was observed for category and letter fluency. This

could be owing to either problem at

access/retrieval, and/or using semantic knowledge

effectively, both being impaired in individuals

with schizophrenia (Marcel, 1983). Further, Kuperberg & Caplan, (2003), reported that poor

verbal fluency in patients with chronic

schizophrenia may partly be attributable to

reduction in semantic store. Word association task

showed poor performance by both the subjects,

wherein they tended to explain meaning of the

given stimuli (word), rather than giving a similar

and the most associative word. This finding also

supported findings of Gordon’s (1982) study.

Further, Johnson and Shean (1993), in their study

found that some patients with negative symptoms

were unable to put their idiosyncratic associations

into meaningful sentences, and patients with

positive symptoms were unable to place common

associations in meaningful sentences.

For pragmatic task, performance varied for

the subjects in relation to onset. The verbal aspects

(topic selection, initiation, change, etc.) were

affected in subject with acute schizophrenia. The

increased pause time within responses can be

correlated to recall deficits, supported by the

findings of Alpert, Clarck and Pouget, (1994). On

the other hand, subject with chronic schizophrenia

had impairments more in terms of topic

maintenance and specificity of the topic. The

subject deviated much from the topic but would

eventually connect them all and make it look

meaningful. Also the variety of core speech act

was limited in both the subjects. The paralinguistic

aspects (intelligibility and fluency) were restricted

in the acute schizophrenic subject owing to limited

speech output and imprecise articulation.

However, the subject with chronic schizophrenia

exhibited inappropriate prosody (monotonic), intelligibility and vocal quality. Prutting and

Kirchner, (1987) concurred that persons with

schizophrenia show deficits in decoding basic

emotional expressions. On nonverbal aspect of

pragmatics, both subjects showed deficits

(inappropriate eye gaze, facial expression and

body posture). They also exhibited difficulties in

performing and understanding appropriate gestures

when using language in context.

Conclusions

Schizophrenia is a complex disorder demonstrating abnormalities in both language

comprehension and output. The present study

reports abnormalities at the level of single words

(deficits in the structure and function of lexico-

semantic memory) as well as in discourse


54

(abnormal relationships between sentences) in

relation to cognition and onset of symptoms in

schizophrenics. However, further validation of the

results is required to assert the findings with

relation to the onset.

References

Alpert, M., Clarck, A., & Pouget, E. R. (1994).

The syntactic role of pauses in the speech of

schizophrenic patients with alogia. Journal

of Abnormal Psychology, 4, 750-757.

American Psychiatric Association. (1994).

Diagnostic and Statistical Manual of Mental

Disorders (4th ed.). Washington, DC.

Chen, E. Y. H., Wilkins, A. J., & McKenna, P. J. (1994). Semantic memory is both impaired

and anomalous in schizophrenia.

Psychological Medicine, 24, 193-202.

Crow, T. J. (1980). Molecular pathology of

schizophrenia: more than one disease

process. British Medical Journal, 280, 1-9.

Gordon, R., Silverstein, M. L., & Harrow, M. (1982). Associative thinking in

schizophrenia: A contextualist approach.

Journal of Clinical Psychology, 38, 684-

696.

Johnson, D. E., & Shean, G. D. (1993). Word

associations and schizophrenic symptoms.

Journal Psychiatry Research, 27, 69-77.

Kuperberg, R. G., & Caplan, D. (2003). Language dysfunction in schizophrenia. In (pp. 444-

466).

Marcel, A. G. (1983). Conscious and unconscious

perception: An approach to the relations

between phenomenal experience and

perceptual processes. Cognitive Psychology,

15, 238-300.

Mathuranath, P. S., Hodges, J. R., Mathew, R.,

Cherian, J. P., George, A., & Bak, T. H.

(2004). Adaptation of the ACE for a

Malayalam speaking population in southern

India.International Journal of Geriatric

Psychiatry, 19, 1188-1194.

Mathuranath, P. S., Cherian, J. P., Mathew, R.,

George, A., Alexander, A., & Sarma, S. P.

(2007). Mini Mental State Examination and

the Adenbrooke's Cognitive Examination:

Effect of Education and norms for a

multicultural population. Neurology India,

55(2), 06-110.

Nestor, P. G., Akdag, S. J., & O'Donnell, B. F.

(1998). Word recall in schizophrenia: A

connectionist model. American Journal of

Psychiatry, 155, 1685-1690.

Prutting, C., & Kirchner, D. (1987). A clinical

appraisal of the pragmatic aspects of

language. Journal of Speech and Hearing

Disorders, 52, 105-119.

Acknowledgments

We acknowledge our subjects and family

members for their cooperation during the study.

We also thank the doctors and post graduate

students of Department of Psychiatry, Kasturba

Hospital for their support and guidance during this

study.

JAIISH, Vol. 27, 2008 Pragmatic Skills in Infants

55

Pragmatic Skills in Typically Developing Infants

1Shilpashri H.N. &

2Shyamala K. Chengappa

Abstract

Communication refers to exchange of information between the speaker and listener.

Among the various modes, language forms the primary means of human communication.

The knowledge of language is viewed as an integration of content, form and its use. The

use of language in social contexts refers to as pragmatics. Pragmatics forms a critical

intersection for children's developing language competence and social interactions. As

speech and motor milestones develop, pragmatic skills also develop during infancy. The

present study was an attempt to understand the type of pragmatic skills acquired at the

age of 6 months to 12 months of infancy with Kannada as their mother tongue. Eight

typically developing infants (4 male and 4 female) were considered for the present study.

One hour audio - video sample of mother-child interaction was recorded and analyzed

for eight different pragmatic skills. The results of the present study are discussed in

terms of acquisition of pragmatic skills during infancy.

Key words: Infants, Kannada speakers, Pragmatic skills.

The ongoing exchange of message is the act

of communication. Communication is a key

element in defining humans as social beings.

Language is primary means by which human

beings maintain interpersonal contact, socialize

with others and regulate interactions. Effective

communication requires not only linguistic

knowledge but social knowledge as well.

Efficiency in both linguistic and social abilities is

therefore necessary for contextually appropriate,

meaningful and effective interpersonal

communication (Adams, 2005). Just as learning

phonological, semantic (content) and syntactic

(structural form) rules of language, a child must

also master the rules that underlie how language is

used for the purpose of communication (Hymes,

1971). The use of language for social

communication is termed as pragmatics.

One of the keywords of interest in past

decades for speech-language pathologist has been the study of pragmatics. Focus on pragmatics has

broadened our view of communication towards the

social dimension. The term pragmatics has been

introduced into the field of speech – language

pathology by Elizabeth Bates. Bates (1976)

defined pragmatics as “rules governing the use of

language in context”.

Children’s pragmatic language development

can be observed at the infancy stage and is seen to

rapidly increase and be more sophisticated during

the preschool years. From the earliest stage of

language development itself, children’s utterances

reflect social acts more than linguistic

achievements.

Woolfolk and Lynch (1982) have reported

that infants between the age of 2 and 10 months

use eye contact and gaze exchange to regulate joint

attention on an activity. Presence of eye contact,

smiling and attention indicates that the child takes

notice of someone or something. Pointing plus vocalization suggests demand for someone or

something. Longitudinal studies that have

concentrated on children’s earliest gestural and

verbal communicative intents have demonstrated

that children begin as early as 9 to 10 months of

age to use their gestures and vocalizations for

pragmatic functions as requesting, labeling,

answering, greeting and protesting (Bates,

Camaioni & Volterra, 1975; Dale, 1980). By 12

months typical infants routinely engage in

coordinated joint attention with their caregivers

(Bakeman & Adamson, 1984; Carpenter, Nagell

1Junior Research Fellow, Dept. of Speech Language Pathology, All India Institute of Speech and Hearing, Mysore-570006, email:[email protected], 2Professor, Dept. of Speech-Language Pathology, All India Institute of Speech and Hearing, Mysore-570006, email:[email protected]


56

& Tomasello, 1998). Mathew (2004) has reported

in her study that children acquire verbal indication

of negation by 1 ½ - 2 years of age.

Studies have also focused on how caregivers

regulate interaction with the baby by selectively

responding to the baby’s gestures. These early

interactions have been referred as proto-

conversations (Bateson, 1975). Snow (1977) has

examined such conversations over several stages

between mothers and infants aged from 0 to 18

months.

Individuals who fail in using language

appropriately to the context are usually put under

the diagnosis of pragmatic disorder. In order to

identify these deficits, it is important to understand

the normative aspects. Hence, the present study

aimed to identify type of pragmatic skills acquired

by 6 months to 12 months aged typically

developing infants.

Method

The present study aimed at investigating the

type of pragmatic skills acquired by typically

developing infants between the age ranges of 6

months to 12 months. The eight pragmatic skills

studied were as follows.

1. Smiling.

2. Attention.

3. Eye contact.

4. Vocalization.

5. Play behaviors.

6. Non verbal turn taking.

7. Giving on request.

8. Non verbal indication of negation.

Subjects: 8 infants (4 male and 4 female) in the

age range of 6 months to 12 months with Kannada

as their mother tongue and their mothers (as

mother spends most of the time with the child)

were considered for the present study. These

infants were screened for speech, language, motor

development and hearing, to rule out any

associated disorder.

Sl.No. Age in months

sex Sl. No. Age in months

sex

1 06 F 5 07 M 2 09 F 6 08 M 3 09 F 7 08 M 4 11 F 8 09 M

Table 1: Demographic data.

Materials: The test materials included sound

makers, toys and picture books.

Procedure: An informed consent was obtained in

writing from the mothers of all the children, prior

to the study. An interview was conducted with the

mothers to rule out history of speech, language and

motor developmental delay and hearing problem if

any. The procedure undertaken in the present study

was audio - video recording of mother-child

interaction, at home. Prior to video recording,

mothers of all the infants were instructed to

interact naturally and to play with the child using

toys/materials given. They were also instructed to

feel free and to focus on play activity and not to

the camera. Semi-instructed method was used

where mothers were demonstrated the method of

using toys / materials given to elicit the target

behavior to be studied. One hour audio-video

sample of mother-child interaction was collected

in 2 – 3 sittings for 20 – 30 minute duration each.

Recording for all the infants were done with in a

week at their homes.

Scoring and analysis: Two point rating scale (0 and 1) was used for scoring of pragmatic skills. 0

– indicating absence of the pragmatic skill and 1 –

indicating presence of the pragmatic skill.

Three speech-language pathologists

(undergraduates, currently working for their

internship program) served as judges for the

present study. All the three judges were trained for the use of terminologies and analyzing the

pragmatic skills from the video clipping. After the

training, judges were instructed to rate the

pragmatic behavior using two point rating scale

only if the child exhibit the behavior for minimum

of three times in the whole recording.


The present study investigated the pragmatic

skills in eight typically developing infants between

the age ranges of 6 months – 12 months. The

infants were assessed for 8 pragmatic skills namely; smiling, attention, eye contact,

vocalization, play behaviors, non verbal turn

taking, giving on request, and non verbal

indication of negation. The responses were scored

by 3 judges according to the rating scale as

mentioned above.

All the 3 judges had similar ratings for all the behaviors analyzed. Table-2 and 3 gives the

summary of pragmatic skills seen in all the infants.


57

Females (age in months) Pragmatic skills

F 106 F 209 F 309 F 4 11

Smiling 1 1 1 1 Attention 1 1 1 1 Eye contact 1 1 1 1 Vocaliza -tion 1 1 1 1 Play behaviors 1 1 1 1 Non verbal turn taking

1 1 1 1

Giving on request 0 0 0 1 Non verbal indication of negation

0 0 0 1

0-Absent, 1-Present.

Table-2: Pragmatic skills of 4 typically developing

infants (females).

0 – Absent, 1 – Present

Table 3: Pragmatic skills of 4 typically developing

infants (males).

As shown in the above table – 2 & 3,

pragmatic skills namely, smiling, attention, eye

contact, vocalization, play behaviors, non verbal

turn taking, were seen in all the participants

belonging to both the gender groups. Hence, in the present study gender differences were not seen for

acquisition of pragmatic skills.

The above results obtained are in agreement

with study conducted by Woolflok & Lynch

(1982) wherein the pragmatic skills namely –

attention, eye contact, smiling, vocalization

stabilizes by 2 – 10 months of age. Owens (1984) reports nonverbal turn taking begins by first 6

month of life. Dheepa (2005) studied pragmatic

skill development in typically developing Tamil

speaking children and she has reported that

children acquire skills namely, smiling, attention

and eye contact by one year of age. As 6 months is

the lowest age considered in the present study, few

of the pragmatic skills listed may also have been

acquired before 6 months of age.

Pragmatic skills namely, non verbal

indication of negation, giving on request was seen

only in one female participant aged 11 months.

Woolflok & Lynch (1982) and Dheepa (2005)

reported that giving on request is acquired by 1 – 2

years of age. Children acquire negation generally

by 1 – 2 years (Dheepa, 2005) and more

specifically by 1 ½ – 2 years (Mathew, 2004). In

the present study, as there was only one child in

the higher age (11 months) with in the group who

confirmed, it cannot be definitely concluded

whether giving on request and non verbal

indication of negation are acquired (or not) by one

year of age.

In the present study an attempt was made to

highlight the performance of infants on few

pragmatic skills. However, further research on

large population and on various pragmatic skills is

necessary to arrive at the normative values or for

further generalization of the results.

Conclusions

Development of pragmatic skills starts during

infancy. Understanding the normal aspects of

pragmatic skills helps in identifying and planning

therapeutic intervention for children with

pragmatic disorder at an early age. The present

study aimed at identifying the type of pragmatic skills acquired by eight 6 – 12 months aged

typically developing infants. Only eight pragmatic

skills were included in the present study. The

findings of the study revealed no gender

differences on any of the eight skills studied. The

Pragmatic skills namely, smiling, attention, eye

contact, vocalization, play behaviors, non verbal

turn taking were found acquired by all the eight

infants while giving on request and non verbal

indication of negation were seen only in one

participant of 11 months age (participant of

highest age of the group studied). However,

normative data needs to be developed on a larger

sample in this regard.

References

Adams, C. (2005). Social communication

intervention for school-age children:

Rationale and description. Seminars in

Speech and Language, 26, 181-188.

Bakeman, R., & Adamson, L. (1984).

Coordinating attention to people and objects

in mother-infant and peer-infant

Males (age in months) Pragmatic skills

M 107

M 208

M 308 M 409

Smiling 1 1 1 1 Attention 1 1 1 1 Eye contact 1 1 1 1 Vocaliza -tion 1 1 1 1 Play behaviors 1 1 1 1 Non verbal turn taking

1 1 1 1

Giving on request 0 0 0 0 Non verbal indication of negation

0 0 0 0


58

interaction. Child Development, 55,

1278-1289.

Bates, E. (1976). In C. A. Prutting (1982).

Pragmatics as social competence. Journal of

Speech and Hearing Disorders, 47, 123 –

134.

Bates, E., Camaioni, L., & Volterra, V. (1975).

The acquisition of performatives prior to

speech. Merrill – Palmer Quarterly.

Bateson, (1975). Pragmatic ability in children. In M.F. McTear & G. Conti, (1992). Pragmatic

disability in children.London:Wuhrr

Publications.

Carpenter, M., Nagell, K., & Tomasello, M.

(1998). Social cognition, joint attention, and

communicative competence from 9-15

months. Monographs of the Society for Research in Child Development, 63.

Dale, P. S. (1980). Is early pragmatic development

measurable? Journal of Child Language, 8,

1-12.

Dheepa, D. (2005). Developmental protocol for

pragmatic skills Unpublished master’s

dissertation. University of Mysore, Mysore.

Hymes, D. H. (1971). In E. C. Woolfok & J. I.

Lynch, (1982). An integrative approach to

language disorders in children. New York:

Grane and Stratton.

Mathew, N. (2004). Pragmatic skills in very

young children. Unpublished master’s

dissertation. University of Mangalore,

Mangalore.

Owens, R. E. Jr. (1984). Language development.

An introduction Columbus, OH: Charles E.

Merrill.

Snow, R. (1977). Pragmatic ability in children. In

M. F. Mctear & G. Conti, (1992). Pragmatic

disability in children. London: Wuhrr

Publications.

Woolfolk, E. C. & Lynch, J. I. (1982). An

integrative approach to language disorders in children. New York: Grane and Stratton.

Acknowledgements

The authors would like to thank Dr.

Vijayalakshmi Basavaraj, Director, All India

Institute of Speech and Hearing, Mysore, for

granting permission to carry out the present

study. The authors thank all the participants for

JAIISH, Vol. 27, 2008 Pragmatic skills in Autism Spectrum Disorders

59

Pragmatic Skills in Nonverbal Identical Twins with Autism

Spectrum Disorders

1Shilpashri H.N. &

2Shyamala K. Chengappa

Abstract

The present study investigated the use of six pragmatic language skills by a pair of five

year old male identical twins with autism spectrum disorders during the course of a

session of mother-child interaction. Frequency of each pragmatic language skill used by

the mother along with type and frequency of pragmatic language skills used by the two

subjects were analyzed. Results showed similarities in use of pragmatic skills in both.

However, differences existed with respect to frequency of use.

Key words: Autism Spectrum Disorders, Identical Twins, Pragmatic Skills.

Autism Spectrum Disorders (ASDs) are a set

of complex neurobiological disorders, considered

to be one of the most profound disorders of

childhood. ASDs affect each child differently, to

different degrees of severity. However, all children with ASDs share difficulties in 3 areas: qualitative

impairments in social interaction, qualitative

impairments in communication and restricted,

repetitive and stereotyped patterns of behavior,

interest and activities (Diagnostic and Statistical

Manual of Mental Disorders, 4th edition {DSM-

IV}, 1994). The onset is always in childhood and the symptoms persist throughout life. Hence, the

term pervasive developmental disorders (PDD’s).

As per DSM-IV-TR published in 2000, the PDD’s

includes Autism, Asperger disorder, Rett’s

disorder, Childhood disintegrative disorder,

Pervasive developmental disorder (not otherwise

specified).

Autism is more common in males with the

average male to female ratio of four to one (Bailey

et al. 1995; Fombonne 1999). ASDs roughly occur

in 1 of every 150 individuals (Centers for Disease

Control and Prevention, 2007).

The etiology of autism spectrum of disorders

is unknown. The genetic component of autism was

confirmed by the first twin study in 1977 showing

significantly higher concordance rates for

monozygotic twins (MZ) (36-95%) compared to

dizygotic twins (DZ) (0-23%) (Folstein & Rutter

1977; Steffenburg et al. 1989; Bailey et al. 1995).

A current estimate for the recurrence risk of autism

in the siblings is ~3%, and the heritability estimate

is over 90% (Folstein and Rosen-Sheidley 2001).

In British twin Study (Bailey et al., 1995) an

examination of 16 MZ pairs concordant for autism or autism spectrum disorders showed clinical

heterogeneity even when pairs shared exactly the

same segregating genetic alleles.

Autism is one of the language disorder

primarily characterized by inability to relate to

other people and communicate effectively

(Bernard-Opitz,1982). Regardless of age, level of intellectual functioning, and developmental level,

all individuals with autism demonstrate deficits in

social-communicative domain (Wing, 1997;

Tager-Flusberg, Joseph, & Folstein, 2001) i.e.

pragmatic skills. Pragmatics is the linguistic

domain concerned with the appropriate

use of

language across a variety of social contexts that

provides for a listener's accurate interpretation of

the speaker's intentions and references (Berko-

Gleason, 2005). Pragmatic aspect of language

acquisition accounts for children’s growing

communicative competence, rather than focusing

on the structural forms (syntax) or content

(semantics) of their language.

Review of literature identifies a number of

studies on pragmatic deficits in children with

PDD’s / ASD’s. Aarons and Gittens (1987); Wing

(1988) have even suggested that pragmatic

disability is just another term for autism. (Ball,

1Junior Research Fellow, Dept. of Speech-Language Pathology, All India Institute of Speech and Hearing, Manasagangothri, Mysore–570006, email:[email protected], 2Professor, Dept. of Speech-Language Pathology, All India Institute of Speech and Hearing, Manasagangothri, Mysore–570006, email:[email protected].


60

1978; Cantwell, Baker & Rutter, 1978; Paul &

Cohen 1985; Loveland & Landry, 1986) have

reported that the autistic children’s language and

gestures are pragmatically deficient, even when

level of language acquisition or IQ is taken into

account. These children show pragmatic deficits

both in how they communicate (communication

means) and how they express intentions

(communicative intents) (Rollins, 1999).

The present study is an attempt to investigate

the performance of non verbal identical twins with

autism spectrum disorders on six pragmatic skills

namely, giving on request, pointing / visual

gestures for requesting, joint attention, gaze

exchange, non verbal turn taking and non verbal

indication of negation.

Aims and Objectives

The objectives of the study were manifold:

1. To study the type of pragmatic skills used by

the two twin subjects during the course of

interaction with the mother.

2. To study the frequency / percentage of each

pragmatic skill used by mother and the two

twin subjects during initiation of

communication.

3. To study the frequency / percentage of each

pragmatic skill used by mother and the two

twin subjects during response course.

4. To compare difference in the performance between the two twin subjects.

Method

Subjects: 5 years old male identical twins (A1 and

A2) primarily diagnosed as delayed speech and language with autism spectrum disorders by

qualified speech language pathologist served as

subjects for the present study.

The subjects fulfilled the following criteria

1. They had Kannada as their mother tongue.

2. Subjects had no medical history.

3. Subjects had normal hearing sensitivity and

vision.

4. Subjects had no history of regression in motor development.

Subject details (A1 & A2)

As per the information obtained from the

mother during clinical interview, the onset of the

symptoms was before 12 months for the two

subjects. Comprehension skills were reported to be poor with no speech, only vocalization (clinical

condition for speech was the same at the time of

recording). Motor development was reported to be

normal with poor socialization skills, poor

imaginative play and stereotyped repetitive

behaviors. (Subjects demographic data are given

below).

SUBJECTS

Client Report AI A2

Age of onset Before one

year Before one

year Medical history - ve - ve

Motor development

Normal Normal

Hearing Normal Normal Vision Normal Normal

Speech – language skills

No speech (only

vocalization)

No speech (only

vocalization) Social skills Poor Poor Imaginative

play Absent Absent

Stereotyped repetitive behaviors

Present Present

Table-1: Demographic data

Interventions for both the subjects were

started at 4 years of age. Both the subjects under

went speech-language therapy and occupational

therapy for two days per week at the duration of 45 minute each. Speech-language therapy was mainly

focused on improving prelinguistic skills and

communication skills using Picture Exchange

Communication System (PECS) focused mainly

on functional skills.

Materials used: The materials used to elicit

responses consisted of several toys, puzzles and building blocks.

Procedure: An informed consent was obtained in

writing from the mother, prior to the study. The

procedure undertaken in the present study

consisted of audio - video recording of mother-

child interaction using semi-instructed method.

Sony (DCR-DVD703E) digital video camera

recorder was used for video recording. Prior to video recording, mother was instructed to feel free

and to focus on play activity and not to the camera.


61

The mother was demonstrated the method of using

toys / materials given to elicit the target behaviors

to be studied. Mother was also instructed to

interact naturally and to play with the child using

toys/materials given by introducing series of

questions to elicit different pragmatic functions.

Six pragmatic functions were tapped with these

questions. These functions are 1. Giving on

request (the act of giving objects, toys, eatables,

etc to the partner on request). 2. Pointing / Visual

gestures for requesting (the act of addressing

desire for an object, action, etc). 3. Gaze exchange

(the act of maintaining eye contact in long

alternating intervals). 4. Joint attention (the act

used to direct other’s attention to an object, event or topic of communicative act). 5. Non verbal

turn taking. (The act of interactional behavior,

where the partner should wait for his / her turn

during play activity). 6. Non verbal indication of

negation (the act of confirming the absence of an

object, person, etc, nonverbally)

One hour audio-video sample of mother-child interaction was collected. Each child was recorded

separately in 3 sittings for 20 minute duration

each. Recording was done at the home and at

therapy room. All the sittings were recorded with

in a week’s time.

Analysis: The six pragmatic skills studied were

analyzed in terms of type of pragmatic skills used

and percentage of occurrence / frequency and functional appropriateness of use by mother and

the two subjects. The audio-video recorded sample

of mother-child interaction was analyzed by three

judges, including he 1st author all the three were

Master degree holders in speech-language

pathology. Before the analysis of the data, latter

two judges underwent training for the duration 3

hours. During the training period an audio-video

sample of typically developing child interacting

with the mother was introduced and the two judges

were trained for familiarization of the

terminologies used in the present study and

identifying the pragmatic skills which were

functionally appropriate to the context.

Once both the judges were confident in

identifying the pragmatic skills, audio-video

sample of 40 minute duration of mother-child

interaction of each individual subject were shown

to the judges separately. Judges were instructed to

identify the type and frequency of answering

appropriate to the context by the mother and the

two subjects separately.

Statistical analysis: Reliability analysis was

carried out to find inter and intra judge reliability.

Frequency of each pragmatic skill used by mother

and the two subjects were analyzed in terms of

percentage of occurrence using population

pyramid graph,


Inter and intra judge reliability for frequency

of occurrence of pragmatic skills was found to be

0.9. Figure 1 & 2 shows the compiled results of

all the 3 judges.

Combined communicative strategies (verbal

and nonverbal) used by the mother were

considered for analysis of percentage of

occurrence of each pragmatic language skill.

RQ: Requesting; GE: Gaze exchange; JA: joint

attention; NVTT Nonverbal turn taking; NVIN:

Nonverbal indication of negation.

Figure-1: Frequency of use of pragmatic skills

(expressed as percentage) by the mother

during the course of initiation of

communication with the two subjects A1

and A2.

Percentage of initiation of each pragmatic skill

by the Mother w.r.t the subject 1 (A1)

As shown in fig 1, 67.66% of the time,

mother introduced questions for requesting

objects, action, initiation of new task etc. Gaze


62

exchange was introduced and maintained for

10.53% of time. Joint attention was introduced and

maintained for 10.53% of times during play

activity (examples of play activity introduced,

cricket, playing with soap bubbles and action for

rhymes) and conversational task. 7.52% of the

time nonverbal turn taking task was introduced

during the play activity and 3.76% of the time

mother requested the child to identify the

item/object which was not present in the

surrounding at the time of recording.

Percentage of initiation of each pragmatic skill

by the Mother w.r.t the subject 2 (A2)

Requesting task dominated with 53.57% of

occurrence fallowed by gaze exchange (14.29%).

Introducing and maintaining Joint attention was

found to be 14.29% during play activity (examples

of play activity introduced, playing with soap

bubbles and action for rhymes) and conversational

task. . While 13.09% of the times nonverbal turn

taking task was introduced during the play activity.

The least of all was introducing question for

indication of negation (4.76%).

It is clear from figure-1 that, mother

maintained uniformity when introducing different

questions to elicit responses for the five different

pragmatic skills. Requesting task was introduced more frequently and least was the questions on

negation. But, examining for the percentage of

occurrence of each pragmatic skill, w.r.t the A1 &

A2, there were slight variations among them.

The reason for introducing requesting

questions more frequently is possibly because of

the influence of training method used at therapy

session and at home using Picture Exchange

Communication method, in terms to encourage the

subjects to perform giving task on request. The

reduced frequency of occurrence of other

pragmatic language skills (joint attention,

nonverbal indication of negation) could be due to

poor responses on the part of the two subjects (see

fig: 2)

Nonverbal responses obtained from subject-1

(A1)

As shown in fig-2, out of 67.66% of mothers requesting, contextually appropriate response was

given for 20.00% of the time. Gaze exchange was

maintained well with 21.43%. Maintenance of

Joint attention for activities was less i.e. 7.14% for

1O.53% from the mother side. Involvement for

non verbal turn taking was equally good with

30.00%. Non verbal response for negation was nil

i.e 0% (No response).

Non verbal responses obtained from subject-2

(A2)

Out of 53.57% of requesting A2 showed good

response (42.22%). Gaze exchange was maintained well with the percentage at 33.33. 0%

(No response) was obtained for maintaining Joint

attention. Involvement for non verbal turn taking

(play activity) was more (45.45%). Non verbal

response for negation was nil i.e. 0% (No

response).

RQ: Giving on Request; GE: Gaze exchange; JA: joint

attention; NVTT Nonverbal turn taking; NVIN:

Nonverbal indication of negation.

Figure-2: Frequency of use of contextually appropriate

pragmatic skills by the two subjects (A1 &

A2), (expressed as percentage).

From the results obtained (refer fig 2) it is

clear that, there were individual differences seen in

percentage of use of pragmatic skills even though

there are certain similarities in terms of type of

pragmatic skill used by the two subjects. This

result is in agreement with British twin study

(Bailey et al., 1995) that clinical heterogeneity is

commonly seen in monozygotic twin pairs with

ASDs However, further research is warranted on

the same line for generalization of the results.

It was also seen that, the percentage of

occurrence of giving on request, gaze exchange and nonverbal turn taking (taking part in play


63

activity namely, cricket, action for rhymes and

playing with soap bubbles) was highest compared

to other two pragmatic functions namely, joint

attention and non verbal indication of negation.

This pattern was similar among the two subjects.

This pattern may be mainly because of the affect

of speech-language therapy and occupational

therapy attended.

Frequency of initiation of pragmatic skills by

the two subjects (A1 & A2) during the course of

interaction with the mother

Initiation of pragmatic language skills by the

two subjects was restricted for requesting. Requesting was mainly for eatables and toys of

their interests. Picture cards were used to indicate

their requirements. Other pragmatic skills namely,

initiation of gaze exchange, initiation of joint

attention, initiations of non verbal turn taking,

nonverbal questioning for identification of non

existence of items/objects, was not introduced.

Response from the mother (i.e giving the requested

object) was 100% for the two subjects.

The result indicates poor performance by the

two subjects for initiation of pragmatic

questions/skills during the course of mother-child

interaction. The obtained results are in agreement

with the studies reporting that pragmatic skills are generally affected in children with autism

spectrum disorders (Aarons and Gittens, 1987;

Wing, 1988; Rollins, 1999).

Conclusions

The results of this study has shown that,

during the course of mother-child interaction,

initiation of pragmatic questions were mainly by

the mother as compared to the two subjects who

were limited only for requesting. On the other

hand the two subjects responded well for the

pragmatic questions introduced by the mother.

Even though the two subjects showed similar

performance in use of contextually appropriate

three of five pragmatic functions namely, giving

on request, maintain gaze exchange and non verbal

turn taking task during play behavior, they differed

in percentage of use of each function. This is an indicative of both pragmatic skill deficits in

children with autism spectrum disorders and

heterogeneity of behaviors among the group.

Hence, early identification of the condition and

individualized therapy program assume great

importance in such clinical population.

References

Aarons, M., & Gittens, T. (1987). Is this Autism?

Windsor, Berkshire: NFER-Nelson.

American Psychiatric Association. (1994).

Diagnostic and statistical manual of mental

disorders (4th ed.). Washington, DC:

American Psychiatric Association. American Psychiatric Association. (2000).

Diagnostic and statistical manual of mental

disorders (4th ed. text revision).

Washington, DC: Author.

Bailey, A., Le Couteur, A., Gottesman, I., Bolton,

P., Simonoff, E., Yuzda, E., & Rutter, M. (1995). Autism as a strongly genetic

disorder: evidence from a British twin study.

Psychological Medicine, 25, 63-77.

Ball, J. (1978). A pragmatic analysis of autistic

children’s language with respect to aphasic

and normal language development.

Unpublished Doctoral Dissertation,

Melbourne University. Melbourne.

Australia.

Berko-Gleason, J. (2005). The development of

language (6th Ed.). Boston: Pearson/Allyn

& Bacon.

Bernard-Opitz, V. (1982). Pragmatic analysis of

the communicative behavior of an autistic

child. Journal of Speech and Hearing Disorders, 47, 99-109.

Cantwell, D., Baker, L., & Rutter, M. (1978). A

comparative study of infantile autism and

specific developmental receptive language

disorder – IV. Analysis of syntax and

language function. Journal of Child

Psychology and Psychiatry, 19, 351 – 362.

Centers for Disease Control and Prevention. (2007). Prevalence of autism spectrum

disorders—autism and developmental

disabilities monitoring network, six sites,

United States, 2000. Morbidity and

Mortality Weekly Report, 56(SS-1), 1–11.

Folstein, S., & Rutter, M. (1977). Infantile autism:

a genetic study of 21 twin pairs. Journal of Child Psychology and Psychiatry, 18, 297-

321.

Folstein, S.E., & Rosen-Sheidley, B. (2001).

Genetics of autism: complex etiology for a


64

heterogeneous disorder. Nat Rev Genetics,

2, 943-955.

Fombonne, E. (1999). The epidemiology of

autism: A review. Psychological Medicine,

29(4), 769-86.

Loveland, K.A., & Landry, S. (1986). Joint

attention and language in autism and

developmental language delay. Journal of

Autism and Developmental Disorders, 16,

335 – 349.

Paul, R., & Cohen, D.J. (1985). Comprehension of

indirect requests in adults with autism

disorders and mental retardation. Journal of

Speech and Hearing Research, 28, 475 –

479.

Rollins, P.R. (1999). Early pragmatic

accomplishment and vocabulary development in Preschool children with

autism. American Journal of Speech-

Language Pathology, 8, 181 – 190.

Steffenburg, S., Gillberg, C., Hellgren, L.,

Andersson, L., Gillberg, I.C., Jakobsson, G.,

& Bohman, M. (1989). A twin study of

autism in Denmark, Finland, Iceland,

Norway and Sweden. Journal of Child

Psychology and Psychiatry, 30, 405-416.

Tager-Flusberg, H., Joseph, R.M., & Folstein, S.

(2001). Current directions in research on

autism. Mental Retardation and

Developmental Disabilities Research

Reviews, 7, 21-29.

Wing, L. (1988). The continuum of autistic

characteristics. In F. Shopler & G.B.

Mesibov (Eds.), Diagnosis and Assessment

in Autism. New York: Plenum Press.

Wing, L. (1997). Syndromes of autism and

atypical development. In D. J. Cohen & F.

R. Volkmar (Eds.), Handbook of autism and

pervasive developmental disorders. New

York: John Wiley & Sons, Inc.

Acknowledgements

The authors would like to thank Dr.

Vijayalakshmi Basavaraj, Director, All India

Institute of Speech and Hearing, Mysore, for

granting permission to carry out the present study. The authors thank all the participants for their

constant cooperation throughout the study.

JAIISH, Vol. 27, 2008 Continuum of Developmental Language Disorders

65

Continuum of Developmental Language Disorders: Where Does

PLI Fall?

1Shivani Tiwari,

2Ashwini Bhat &

3Rajashekhar Bellur

Abstract

Pragmatic Language Impairment (PLI) is a developmental communication disorder,

characterized by semantic and pragmatic deficits; relatively adequate phonology and

syntax; and mild autistic features. The symptom profile overlaps with Pervasive

Developmental Disorder (PDD) and Specific Language Impairment (SLI). The present

paper attempts to highlight the differential diagnosis of PLI with common developmental

language disorders as SLI and PDD. Two children with speech and language characteristics suggestive of PLI are discussed. Two children (5 yrs each) participated in

the study with the complaint of inadequate speech and language skills. Speech and

language skills of these two children were evaluated using formal and informal methods.

The responses were recorded and were further transcribed for analysis. The obtained

profiles of the two children were compared across the profiles of developmental

disorders as PLI, SLI and PDD. Case1 presented an early onset, delayed developmental

milestones with poor pre-linguistic skills and significant semantic and pragmatic deficits.

Case 2, in contrast, showed delayed speech milestones, relatively better pre-linguistic

skills and near normal semantic and syntactic skills. Both the cases presented with clear,

fluent speech without articulation errors. Pragmatic deficits were prominent in both the

cases, with case1 having more severe difficulties. Both case1 and case2 had mildly

impaired social skills.Differential diagnosis of PLI with other developmental language

disorders is controversial issue. PLI shares features of linguistic processing deficits with

SLI on one hand, and deficits in pragmatics, social skills and stereotyped repetitive

behaviors with PDD on the other hand. There are no well-defined boundaries amongst

these disorders. Additionally, course of PLI is such that it changes the diagnostic

category as the clinical picture varies with time. The two cases discussed in the present

paper had pragmatic deficits in common, though of varied severity and associated

features.

Key words: Specific language impairment, Pervasive developmental disorders, Semantics, Pragmatics, Syntax.

Rapin in 1982, defined Pragmatic Language

Impairment (PLI) as a developmental

communication disorder, characterized by fluent,

well-formed sentences, clear, loose, tangential or

inappropriate speech, with difficulty in

understanding discourse, having illogical train of

thought and relatively better social skills.

Children with PLI speak fluently and clearly

in long utterances. They may have a severe

impairment in pragmatics and semantics,

preservation, and significant word finding

difficulty. They usually have excessive variation in

pitch and loudness. Children with PLI may have

milder deficits in phonological and syntactic skills

in the early childhood. They may have semantic

deficits like delayed semantic development, usage

of words only in the limited contexts, difficulty in

the comprehension of meaningful verbal messages,

questions, idioms, slang expressions, abstract words and the words that relate to feelings and

emotions, and tendency to interpret messages quite

literally. These children give inappropriate

answers to questions, may show semantic

1Lecturer, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576104, email: [email protected], 2Student, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576104, 3Professor, Dept. of Speech and Hearing, Manipal College of Allied Health Sciences, Manipal University, Manipal-576104.


66

paraphasias, and use of circumlocutions (Rapin &

Allen, 1983; Adams & Bishop, 1989; Sahlen &

Nettlebladt, 1993; Bishop, 2000b). Pragmatic

deficits seen in these children include delayed

pragmatic development, and impaired

communication functions. These children have

poor turn taking skills, difficulty in establishing

discourse topics, inability to repair communication

breakdown, and tangential speech. Their speech is

characterized by excessive, irrelevant, preservative

utterances, use of self-directed speech in the

middle of conversation, and show tendency to

answer their own questions (Adams & Bishop,

1989; Leinonen & Letts, 1997; Rapin & Allen,

1983). Several etiologies of PLI have been proposed needing experimental verification. Some

of these are environmental, genetic (Conti-

Ramsden, Crutchley & Botting, 1997) and

neurological factors (Sahlen & Nettlebladt, 1993).

Rapin and Allen first described the condition

in 1983, and proposed the term as “semantic

pragmatic deficit syndrome”. As these children have problem in the specific areas of language,

Bishop and Rosenbloom in 1987 changed the term

into “semantic pragmatic language disorder”.

Bishop (2000a) proposed the label “Pragmatic

Language Impairment”; as children diagnosed

SPLD do not necessarily have semantic problems.

Further, Bishop (2000b) termed PLI-plus for

children whose pragmatic problems are

disproportionate to their other language

limitations, and are not obviously the result of

these limitations. In addition, the term PLI-pure,

was termed for children who have only pragmatic

deficits and normal language skills.

Children with PLI initially present with a

picture of language delay and receptive language

impairment, who then learn to speak fluently,

clearly and in complex sentences, with semantic

and pragmatic abnormalities becoming

increasingly evident as their verbal proficiency

increase. Whereas, at first they may be difficult to

differentiate from other developmental language

disorders, the pattern of verbal deficits looks more

distinctive as they grow older (Adams & Bishop,

1989).

As PLI exists in close boundaries of

developmental language disorders like SLI and

PDD, the differential diagnosis becomes an

essential part of assessment. PLI is differentiated

with SLI on presence of pragmatic deficits, social

skills deficits, and stereotyped

utterances/behaviors. Further, children with SLI

essentially have impairments in phonological and

syntactic skills (generally not reported in children

with PLI). Within PDD spectrum, Asperger’s can

be distinguished from PLI having late onset,

relatively normal language skills in presence of

poor social skills. However, no distinct symptoms

anchor difference between PLI and autism. Autism

and PLI are sorted only based on the severity of

impairment (PLI having milder symptoms).

Deficits in social interaction, stereotyped range of

interests, theory of mind, echolalia, eye contact,

pretend play, semantic and pragmatic deficits are

of lesser degree in PLI compared to PDD

(Boucher, 1998; Rapin, & Allen, 1983; Bishop, 1989). Perseveration is another feature of PLI,

which is otherwise not seen in developmental

language disorders.

Children’s Communication Checklist (CCC;

Bishop 1998; see Appendix) is of the tests of its

type developed to distinguish language-impaired

children having pragmatic difficulties and those of typical forms of SLI. This test provides the cutoff

scores on pragmatic component (>132 on

pragmatic composite indicates SLI), differentiating

children with PLI and SLI. Scores between 145

and 156 (on pragmatic composite of CCC) indicate

normal range. Bishop and Norbury (2002)

conducted a study on 21 children (6 to 9 yrs) with

language impairment, who were further

categorized based on CCC into 13 children with

PLI, and 8 children with typical SLI. Children with

PLI scored less than 133 on the pragmatic

composite of CCC whereas, children with SLI

scored above 132. Thus, CCC can serve as a useful

diagnostic instrument in diagnosis of PLI.

Although, this instrument lacks validity, yet it can

be used as a screening tool.

Precise diagnostic criterion for PLI is not

available. Moreover based on the literature

findings, there exists variability in the range of

features of PLI. The present study attempt to

highlight the differential diagnosis of PLI with

developmental language disorders as SLI and

PDD. Two children with communication features

suggestive of PLI with different symptoms and

varied severity are discussed.

Method

Two children (5 years old each), with

pragmatic deficits without the diagnosis of autism

were taken up for the study. Psychological


67

evaluation was done to identify the deficits in

nonverbal intelligence and social skills. Benite

Kamat Test (BKT) (measure of nonverbal

intelligence) was administered to find out the

intelligence quotient (IQ). The social skills were

measured using Vineland Social Maturity Scale

(VSMS) to obtain social quotient (SQ). Language

tests like REELS (Receptive Expressive Emergent

Language Scales), Extended REELS & Pragmatic

Checklists (Shipley & McAlfee, 1998) was

administered. In addition, informal language

assessment was carried out using black and white

line drawings (“With a little bit of help”, language

training manual) incorporating tasks like picture

naming, picture description, narration, reciting

numbers, alphabets and rhymes. The response

obtained was transcribed using IPA, and analyzed

for different language parameters.

Results

The analyzed language of the subjects are summarized as follows

CASE 1 CASE 2

Name Master N Baby A Age / Gender 5 years / Male 5 years / Female Language Kannada English Chief complaints • ↓ attention to speech

• Repetition of few sentences • Delayed responses to questions

• Language delay • ↑ level of activity

Onset • Symptoms were first noticed at the age of 1.6years as language delay & poor eye-to-eye contact.

• Symptoms were noticed by the teacher at the age of 3 years (behavioral deviations as poor social skills, echolalia)

History • No significant birth & medical history • Family history: -ve • Slight delay in motor development • Delayed language development:

-babbling at 8 months -first words at 1.6 years -phrases after 2 years • Social development: delayed recognition

of father (at 3 years)

• No significant birth & medical history • Family history: -ve • Normal motor milestones • Delay in language acquisition:

-two word utterances at 2.6 yrs -3 word utterances at 3.6yrs • Social development: unable to differentiate

between family members & strangers (extra friendly with strangers)

Audiological evaluation

Normal hearing Normal hearing

Psychological evaluation

• IQ deficits could not be ruled out (BKT) • VSMS: Borderline deficits in social &

adaptive functioning • CARS: mild autistic features

• IQ: average intellectual functioning (BKT) • VSMS: average social & adaptive functioning • CARS: non autistic

Reported to have autistic like features earlier Prelinguistic skills

• ↓ attention to speech • Poor eye contact

• ↓ attention span • Good eye contact with family members • Highly distractible

Speech skills • Respiration: normal • Phonation: pitch & quality age adequate • Articulation: cluster reduction & distortion

of /s/ • Prosody: inappropriate intonation pattern

& unable to imitate intonation for rhymes • Fluency: fluent speech.

• Respiration: normal • Phonation: pitch & quality age adequate • Articulation: cluster reduction & metathesis • Prosody: inappropriate intonation pattern • Fluency: fluent speech.

Table 1: Case history, pre linguistic and speech skills of the two cases.

The details of the children and their speech

and language behaviors are given in Tables 1 & 2.

Both children were initially brought with the

complaint of language delay. On a detailed

psychological and speech-language assessment,

case1 was found to have more problem than case2.

IQ assessment could not be completed in case1

due to deficits in comprehending the instructions.

On the administration of VSMS, he was found to

have borderline deficits in social and adaptive

behavior. He was diagnosed as having mild

autistic like features. Case2 presented with


68

average intellectual functioning and average social

and adaptive functioning. She was diagnosed as

non-autistic. Both cases had fluent and intelligible

speech. The prelinguistic skills of case1 were poor.

Case 2, in contrast had good prelinguistic skills.

CASE1 CASE2

Language Test results

RLA= 30-33 months ELA= 24-27 months Scattered findings

RLA= 4.6–5 years ELA= 4.6-5 years

Morphology

No comprehension & expression of any morphological markers

Age adequate usage

Semantics

• Vocabulary: restricted & limited use

• Can name common lexical items in a few categories

• Cannot comprehend emotions & facial expression of others

• Irrelevant utterances & perseverations noticed

• Presence of delayed &

immediate echolalia • Comprehends 1-step

commands on several repetitions

• Time & place concept absent • Cannot comprehend stories • Picture description absent • Could recite only 1-2 lines of a

rhyme with lots of prompts in flat intonation

• Vocabulary: adequate to age • Can name common lexical categories • Can comprehend emotions & facial expression

of others • Irrelevant utterances & self talk noticed.

Perseveration was absent. • Echolalia: absent • Comprehends simple & complex commands. • Gross time & place concept present • Comprehends & expresses story episodes in a

sequence with minimal prompts • Express fairly good on picture description tasks • Recites rhymes without prompts with appropriate

intonation

Syntax

• Uses 2-3 word utterances • Adjectives: comprehension is

present • Pronouns: uses 1

st & 2

nd

person pronoun; does not comprehend 3

rd person

pronoun • Does not comprehend gender

markers. • Uses few prepositions • Does not comprehend tenses

& plurals • Uses 1

st & 2

nd person

possessive markers • Difficulty with polar questions • Inappropriate answers to

questions

• Uses 4-6 word utterances • Uses adjectives • Pronoun usage is present • Gender confusion was observed • Preposition confusion is present • Uses regular tense & plural marker correctly,

has confusion with the irregular tense & plural markers.

• Uses all the possessive markers appropriately • Does not have difficulty with polar questions • Answers appropriately to questions with

occasional confusion


69

CASE1 CASE2

Pragmatics

• Communicative functions:

-attention seeking absent -rarely requests for objects -occasionally protests & denies undesired items -social greetings only

with prompts -giving & seeking information absent -comprehension of feelings

& facial expression absent • Discourse: -difficulty in topic initiation, maintenance, topic transition & turn taking -giving information absent • Imaginative play absent • Role-taking not attained • Modification in the manner if

communication is absent

• Communicative functions:

-attention seeking present -requesting is present

No request when wants to go to toilet, indicates by pointing

-occasionally protests & denies undesired items -social greetings without prompts -giving & seeking information present -comprehends feelings

& facial expression • Discourse: -difficulty in topic, maintenance, topic transition & turn taking ; topic initiation present -gives excessive information, inappropriate to the context - word finding deficits • Imaginative play absent • Role-taking not attained • Modification in the manner if communication is

absent

Secondary language skills

• Attending school since 2 years • Cannot read & write

• Attending school since 1 year • Able to read & write alphabets, numbers (1-10),

small words, her name, & can solve 1-digit addition & subtraction

Behavioral deviations • Hyperactive & irritable in

nature • Prefers to be alone; plays only

games like running & chasing with peers

• Vacant stares; biting of shirt collar & putting fingers into mouth repeatedly was noticed.

• Hyperactive & easily distractible • Prefers solo play

Stimulation • Poor stimulation both at home & school

• Good stimulation for language, reading, & writing

Previous treatment • No previous treatment. • She was attending special school along with IEP in USA as she was diagnosed to have autistic features. With treatment, there was reduction in echolalia and improvement in all aspects of language including pragmatics.

Present treatment • Demonstration therapy was carried out for 2 days.

• Activities for improving attention, vocabulary, comprehension of questions, reading, & pragmatic skills were carried out.

• Demonstration therapy was given for a month. • Attention enhancement training, activities to

improve semantic, syntactic skills, pragmatic, & cognitive skills.

Table 2: Description about the language skills of the two cases.

Case1 had deficits in syntax, semantics and

pragmatics whereas case2 had age adequate speech

and language skills. Case1 had pragmatic deficits

along with the deficits in other areas of language.

The second case had only pragmatic deficits.

Pragmatic deficits were again more severe in

case1. Case2 was previously diagnosed as having

autistic like features, at the age of 3 years. She had

received Individualized Education Program (IEP)

in California for 1-year duration. Parents reported


70

significant improvement in the performance with

respect to reduction in the echolalia, improvement

in pragmatic and social skills along with the

improvements in other areas of the language.

Communicative functions as request, denial,

seeking and giving information reported to emerge

over the course of treatment. Thus, treatment given

for case 2 further accounts for the differences in

performances between the two cases.

Table 3: Comparison of the two cases with developmental language disorders. (SLI and PDD)

Table 3 provides comparison of the two cases

with PDD and SLI. The check mark (√) indicates

presence of a behavior and the cross symbol (x)

indicates the absence of that behavior. The table

shows absence of communicative functions in children with PDD indicating severely impaired

social skills. In case of SLI, the social skills are

relatively normal and may have significant deficits

in the syntactic and phonological aspects. The

difference in the linguistic symptoms between

these cases is evident in the table. Case1 shows

milder impairment in semantic and syntactic aspects of the language (not seen in case 2).

However, the communicative functions of the

case2 are better than case1. Both the cases

exhibited echolalia, whereas perseveration was

observed only in case1. Looking into these

characteristics, case 1 was diagnosed as PLI-plus

and case2 as PLI-pure.

Discussion

The two children presented with language

deficits predominantly in pragmatics, though

scattered. Authors attempted for a differential diagnosis of the cases with similar profiles of PDD

and SLI. Due to the stringent criteria each label

subscribes to, there was a confusing picture. On

psychological evaluation, the deficits in nonverbal

intelligence could not be ruled out in case 1, owing

to deficits in following the instructions. Case 2 had

average intellectual functioning. Although autistic

like features such as social interaction problems and echolalia were present in these cases, one must

notice that the communication functions were

relatively better and behavioral problems were not

very severe. Hence, diagnosis of Autism was ruled

out. Further, the presence of language delay in

case 1 and history of language delay in case2,

ruled out the possibility of the diagnosis of

Asperger’s syndrome. Age of onset (18-24

months for case1) with relatively better social

skills in two children, rejects the diagnosis of

Pervasive Developmental Disorder-Not Otherwise

Specified (PDD-NOS). Despite the fact that both

the cases had milder deficits in semantic and

syntactic skills, a diagnosis of SLI was ruled out,

in presence of pragmatic and mild social skills

deficits.

The social skills deficits in the two children

were not as prominent as seen in PDD and more

severe in comparison to children with SLI. Hence,

these children were eventually placed under the

category of PLI, based on presenting symptoms in

accordance with literature (Rapin & Allen, 1983;

Adams & Bishop, 1989; Sahlen & Nettlebladt,

1993; Bishop, 2000b). Further look into the nature


71

of semantic syntactic and pragmatic deficits, fluent

speech with perseveration and echolalia in case1, a

diagnosis of PLI-plus was provided. Case2,

alternatively presented with relatively normal

semantic, morphological, and syntactic skills (age

adequate receptive & expressive language skills)

along with echolalia and pragmatic deficits, and

hence was given a diagnosis of PLI-pure.

There exists unresolved controversy

concerning the diagnostic criteria for PLI, the

controversy focusing on the differential diagnosis

of PLI, Autism and SLI. Some authors argued

quite strongly that PLI and autism are not distinct

condition; rather, PLI is an identifiable form of

Autism, perhaps a subtype, or mild or atypical

manifestation of prototypical autism (Brooks &

Bowler, 1992; Shields, Varley, Broks & Simpson,

1996). Bowler and Lister-Brook (1998) rejected

the use of the term ‘mild autism’, considering it

misleading in view of the persistent though subtle

nature of PLI children’s social impairment.

Boucher (1998) argued that PLI might constitute a developmental language disorder in its own right,

independent of either Autism or SLI. PLI

constitutes a distinct subtype of communication

disorder. There are qualitative differences between

the pragmatic impairments associated with PLI

and those associated with Autism (Rapin & Allen,

1983).

Neither of the two internationally recognized set of diagnostic criteria for mental and behavioral

disorders, DSM-4 and ICD-10 recognize the

existence of PLI. One well recognized difficulty is

that criteria for identifying children with PLI is

controversial, so the criteria used to select

participants vary from study to study with, not

surprisingly, confusing results.

Conclusions

Developmental language disorders comprise a

spectrum of disorders with varied severity and

symptomatology. PLI is one such disorder sharing

features of linguistic processing deficits with SLI

on one hand, and deficits in pragmatics, social

skills and stereotyped repetitive behaviors with

PDD on the other hand. Hence, supporting the

views of Bishop, (1989) it is not helpful to adopt a

rigid response to diagnostic labels, rather a flexible

approach is especially appropriate as we come to

recognize the broader spectrum of language

disorders and increasingly encounter children with

social and language impairment of

disproportionate severity.

References

Adams, C., & Bishop, D. V. M. (1989).

Conversational characteristics of children

with semantic-pragmatic disorders I:

Exchange structure, turn taking, repairs and

cohesion. British Journal of Disorders of

Communication, 24, 211-239.

Bishop, D. V. M. (1989). 'Autism, Asperger

Syndrome and Semantic-Pragmatic

Disorder: Where Are the Boundaries?'

British Journal of Disorders of


Bishop, D. V. M. (1998). Development of the

Children's Communication Checklist

(CCC): A method of assessing qualitative

aspects of communication impairment in

children. Journal of Child Psychology and

Psychiatry, 39, 879-891.

Bishop, D. V. M. (2000a). What's so special about Asperger's syndrome? The need for further

exploration of the borderlands of autism. In

A. Klin, F. R. Volkmar & S. S. Sparrow

(Eds.), Asperger Syndrome (pp. 254-277).

New York: Guildford.

Bishop, D. V. M. (2000b). Pragmatic Language

Impairment: A correlate of SLI, a distinct

subgroup, or part of the autistic continuum?

In Bishop, D.V.M. and Leonard, L., editors,

Speech and language impairments in

children: causes, characteristics,

intervention and outcome. Hove:

Psychology Press.

Bishop, D. V. M., & Baird, G. (2001). Parent and

teacher report of pragmatic aspects of

communication: Use of the Children's

Communication Checklist in a clinical

setting. Developmental Medicine and Child

Neurology, 43, 809-818.

Bishop, D. V. M., & Norbury, C. F. (2002).

Exploring the borderlands of autistic

disorder and specific language impairment: A study using standardized diagnostic

instruments. Journal of Child Psychology

and Psychiatry, 43, 917-929.

Boucher, J. (1998). SPD as a distinct diagnostic

entity: logical considerations and directions


72

for future research. International Journal of

Language and Communication Disorders,

33, 71-81.

Bowler, D. M., & Lister Brook, S. (1998). SPD

and autistic spectrum disorder. International

Journal of Language and Communication


Brook, S. L., & Bowler, D. M. (1992). 'Autism by

Another Name? Semantic and Pragmatic

Impirments in Children'. Journal of Autism

and Developmental Disorders, 22(1), 61-81.

Conti-Ramsden, G., Crutchley, A., & Botting, N.

(1997). The extent to which psychometric

tests differentiate subgroups of children with

SLI. Journal of Speech Hearing and

Language Research, 40, 765-777.

Leinonen, E., & Letts, C. (1997). Referential communication tasks: Performance by

normal and pragmatically impaired children.

European Journal of Disorders of


Rapin, I., & Allen, D. (1983). Developmental

language disorders: Nosologic

considerations. In U. Kirk (Ed.),

Neuropsychology of language, reading, and

spelling (pp. 155-184). New York:

Academic Press.

Sahlen, B., & Nettlebladt, U. (1993). 'Context and

Comprehension: A Neurolinguistic and

Interactional Approach to the Understanding

of Semantic-Pragmatic Disorder'. European

Journal of Disorders of Communication,

28(2), 117-140.

Shields, J., Varley, R., Broks, P., & Simpson, A.

(1996). 'Hemispheric Function in

Developmental Language Disorders and

High-Level Autism'. Developmental

Medicine and Child Neurology, 38, 473-

486.

Shipley, K. G., & McAlfee, J. G. (1998).

Assessment in Speech-Language Pathology: A resource manual (2nd ed.). San Diego,

London: Singular Publishing Group Inc.

Acknowledgments

We acknowledge the subjects and their family members for their cooperation throughout the

study.

Appendix: The Children’s Communication Checklist

For each statement, the rater is asked to judge

whether the statement DOES NOT APPLY,

APPLIES SOMEWHAT, or DEFINITELY

APPLIES. The option ‘unable to judge’ is also

given, but raters are discouraged from selecting this unless they have not had the opportunity to

observe the behavior in question. For each scale,

the base score is 30. For negative items (shown as

– ), 2 points are deducted from this total for each

item coded DEFINITELY APPLIES, and 1 point

is deducted for APPLIES SOMEWHAT. For

positive items (shown as +), 2 points are added to the total for DEFINITELY APPLIES and one

point is added for APPLIES SOMEWHAT. The

pragmatic composite is the sum of scales C to G.

A: Speech

1. + people can understand virtually everything

he/she says

2. – people have trouble in understanding much

of what he/she says

3. + seldom makes any errors in producing

speech sounds

4. – mispronounces one or two speech sounds

but is not difficult to understand; e.g. may

say ‘th’ for ‘s’ or ‘w’ for ‘r’.

5. – production of speech sounds seems

immature, like that of a younger child, e.g.

says things like, ‘tat’ for ‘cat’, or

‘chimbley’ for ‘chimney’, or ‘bokkle’ for

‘bottle’

6. – seems unable to produce several sounds;

e.g. might have difficulty in saying ‘k’ or

‘s’, so that ‘cat’ and ‘sat’ are both

pronounced as ‘tat’

7. – leaves off beginnings or ends of words, or

omits entire syllables (e.g. ‘bella’ for

‘umbrella’)

8. – it is much harder to understand when

he/she is talking in sentences, rather than

just producing single words.

9. + speech is extremely rapid


73

10. – seems to have difficulty in constructing the

whole of what he/she wants to say: makes

false starts, and repeats whole words and

phrases; e.g., might say ‘can I- can I- can-

can I have an – have an ice cream?’

11. +speech is clearly articulated and fluent

B: Syntax

12. – speech is mostly 2 to 3 word phrases such

as ‘me got ball’ or ‘give dolly’

13. + can produce long and complicated

sentences such as: ‘When we went to the

park I had a go on the swings’; ‘I saw this

man standing on the corner’ 14. – tends to leave out words and grammatical

endings, producing sentences such as: ‘I

find two dog’; ‘John go there yesterday’

‘My grandma cat been ill’

15. – sometimes makes errors on pronouns, e.g.

saying ‘she’ rather than ‘he’ or vice versa

C: Inappropriate initiation

16. – talks to anyone and everyone

17. – talks too much

18. – keeps telling people things that they know

already

19. – talks to himself/herself in public

20. – talks repetitively about things that no-one

is interested in

21. – asks questions although he/she knows the

answers

22. – it is sometimes hard to make sense of what he/she is saying because it seems illogical

or disconnected

23. + conversation with him/her can be

enjoyable and interesting

D: Coherence

24. + can give an easy-to-follow account of a

past event such as a birthday party or

holiday

25. + can talk clearly about what he/she plans to

do in the future (e.g. tomorrow or next

week)

26. – would have difficulty in explaining to a

younger child how to play a simple game

such as ‘snap’ or ‘happy families’

27. – has difficulty in telling a story, or

describing what he/she has done, in an

orderly sequence of events

28. – uses terms like ‘he’ or ‘it’ without making

it clear what he/she is talking about

29. – doesn’t seem to realise the need to explain

what he/she is talking about to someone

who doesn’t share his/her experiences; for

instance, might talk about ‘Johnny’

without explaining who he is

E: Stereotyped language

30. – pronounces words in an over-precise

manner: accent may sounds rather affected or ‘put-on’, as if child is mimicking a TV

personality rather than talking like those

around him/her

31. – makes frequent use of expressions such as

‘by the way’, ‘actually’, ‘you know

what?’, ‘as a matter of fact’, ‘well, you

know’ or ‘of course’ 32. – will suddenly change the topic of

conversation

33. – often turns the conversation to a favourite

theme, rather than following what the

other person wants to talk about

34. – conversation with him/her tends to go off

in unexpected directions

35. – includes over-precise information in

his/her talk, e.g. will give the exact time or

date of an event, e.g. when asked ‘when

did you go on holiday’ may say ‘13th July

1995’ rather than ‘in the summer’

36. – has favourite phrases, sentences or longer

sequences which he/she will use a great

deal, sometimes in inappropriate situations

37. – sometimes seems to say things that he/she

does not fully understand

F: Use of context

38. – tends to repeat back what others have just

said

39. – his/her ability to communicate clearly

seems to vary a great deal from one

situation to another

40. – takes in just one or two words in a sentence, and so often misinterprets what

has been said

41. +can understand sarcasm (e.g. will be

amused rather than confused when

someone says ‘isn’t it a lovely day!’ when

it is pouring with rain)

42. – tends to be over-literal, sometimes with (unintentionally) humorous results. For

instance, a child who was asked ‘Do you

find it hard to get up in the morning’

replied ‘No. You just put one leg out of

the bed and then the other and stand up’

Another child who was told ‘watch your

hands’ when using scissors, proceeded to

stare at his fingers


74

43. – gets into trouble because he/she doesn’t

always understand the rules for polite

behaviour and is regarded by others as

rude or strange

44. – may say things that are tactless or socially

inappropriate

45. – treats everyone the same way, regardless of

social status: e.g. might talk to the head

teacher the same way as to another child

G: Rapport

46. – ignores conversational overtures from

others (e.g. if asked ‘what are you

making?’ just continues working as if nothing had happened)

47. – seldom or never starts up a conversation;

does not volunteer information about what

has happened

48. – doesn’t seem to read facial expressions or

tone of voice adequately and may not

realise when other people are upset or

angry

49. – poor at using facial expression or gestures

to convey his/her feelings; he/she may

look blank when angry, or smile when

anxious

50. + makes good use of gestures to get his/her

meaning across

51. – seldom or never looks at the person he/she

is talking to: seems to actively avoid eye

contact

52. – tends to look away from the person he/she

is talking to: seems inattentive or

preoccupied 53. + smiles appropriately when talking to

people

H: Social relationships

54. + is popular with other children 55. + has one or two good friends

56. – tends to be babied, teased, or bullied by

other children

57. – is deliberately aggressive to other children

58. – may hurt or upset other children

unintentionally

59. – a loner: neglected by other children, but

not disliked

60. – perceived as odd by other children and

actively avoided

61. – has difficulty making relations with others

because of anxiety

62. – with familiar adults, he/she seems

inattentive, distant or preoccupied

63. – overly keen to interact with adults, lacking

the inhibition that most children show with

strangers

I: Interests

64. – uses sophisticated or unusual words; e.g. if

asked for animal names might say

‘aardvark’ or ‘tapir’

65. – has a large store of factual information: e.g.

may know the names of all the capitals of

the world, or the names of many varieties

of dinosaurs

66. – has one or more over-riding specific

interests (e.g. computers, dinosaurs), and

will prefer doing activities involving this

to anything else

67. + enjoys watching TV programmes intended

for children of his/her age

68. – seems to have no interests: prefers to do

nothing

69. + prefers to do things with other children

rather than on his/her own

70. – prefers to be with adults rather than other children

Adapted from Bishop & Baird (2001). Parent

and teacher report of pragmatic aspects of

communication: use of the Children’s

Communication Checklist in a clinical setting.

JAIISH, Vol. 27, 2008 Analysis of Oral and Written Narratives of Language Impaired Children

75

Analysis of Oral and Written Narratives of Children with Language

Impaired Learning Disabilities

1Siddiqi Tehniat &

2Mukhopadhyay Sourav

Abstract

This study investigated and compared oral and written narratives of children with

Language Impaired Learning Disabilities (LILD) and typically growing children as

control group using strict reliability measures. The influence of context defined in terms

of three narrative elicitation tasks for this study were story retell, story generation and

spontaneous narratives.. Three children with LILD subjects aged between 9-12 years

were compared to three typically growing children of same age group. The narratives were analysed at a micro-structural level using measures of productivity and form

complexity. A specific analysis of writing was also performed. The results of this study

indicate that the individuals with LILD did not perform well compared to control group

in most of the oral and written task. However, the differences were not found to be

statistically significant for oral task. It was also found that oral narrative productions for

individuals with LILD were better than their written task

Key words: Oral and written narrative, Discourse productions, Elicitation tasks, Language impaired learning disability.

Narratives are a form of oral or written

discourse consisting of extended units of texts

(Owens, 1999). The production of narratives is a

skill used for communication and children narrate

stories to their parents, teachers, and peers every

day (Wright & Newhoff, 2001). To produce

narratives successfully, children must be able to

organize the ideas of their narrative so as to

provide an introduction to the story, to maintain

the relationship among events or actions of the

story, and to present a logical conclusion. Studies

investigating the development of narratives indicate that the oral narratives produced by

children go from being unstructured sets of

utterances to a well-formed narrative. By the age

of around six years or by the time children start

school they have acquired the basic structure of

narratives, which tend to follow a full adult pattern

(Applebee, 1976).

In the early school years spoken and written

narrative are not so highly differentiated (Gillam

and Johnston, 1992). With increased mastery of

the mechanical aspects of writing, spoken and

written narratives start to become differentiated.

This differentiation between oral and written

modes starts to emerge between the ages of 9-12

years. Initially oral narratives are superior to

written narratives. However as the children gain

control over their written productions, written

narratives become superior to oral narratives

(Gillam and Johnston, 1992). Evidence suggests

that the grammatical and syntactical organisation

of spoken and written forms is distinct to each

other. Written texts contain sentences, whereas

spoken texts are typically made up of clausal

complexes, which may not have a clear syntactic

structure (Kress, 1982).

The study of narrative discourse is becoming

popular. This is because many individuals score

within normal limits on standardised language

tests; nevertheless deficits in language are apparent

within discourse production and processing (Van

Leer and Turkstra, 1999). Discourse analysis is

also useful for both those population groups for

whom standardised language tests are not

available, for the assessment of language in a

naturalistic setting and for the analysis of language beyond the sentence level.

Narrative analysis is an important diagnostic

tool for the assessment of language for different

1Speech Language Pathologist & Audiologist, Speech and Language Therapy Services, Gaborone Botswana, 2Lecturer, Special Education (Speech Pathology & Audiology), Dept. of Educational Foundations, University of Botswana, email:[email protected],


76

population groups such as learners with learning

disabilities, or who have aphasia. It is observed

that narratives produced by different population

groups are qualitatively different from each other

(Owens, 1999). Narratives allow for the analysis

of many different features of language, such as

syntax, morphology, pragmatics, phonology as

well as word finding difficulties (German and

Simon, 1991). These may be assessed from a

single elicitation or a compilation of different

narratives elicited from an individual.

A large number of researchers have tried to

identify the characteristic features of narratives

produced by learners with learning disabilities

(LD)1 as well as determine the influence of the

nature of the elicitation task or context on the

production of narratives. These studies mostly

compared story retelling tasks and story generation

tasks (Liles, 1993; Ripich and Griffith, 1988).

Liles (1993) cited a study carried out by Merritt

and Liles (1989). In that study, the authors

compared the story retelling tasks to story generation tasks. It was found that for both LILD

and control groups, retold stories are longer and

contain a greater amount of information.

Spontaneous narratives were less frequently

used as a method of data collection. It can be

assumed that spontaneous narratives are closer to

story generation in genre. However, the difference

would lie in the fact that for story generations task one would attempt to produce a literate adult type

model, whereas spontaneous narratives task reflect

true internalisation of this adult type model.

Newcomer and Barenbaum (1991) provided a

review of the different aspects of the written

narrative abilities of learners with LD. These

studies indicate that learners with LD made more

mechanical and spelling mistakes than normal

subjects. The essays written by these group of

learners were poorly planned and used a fewer

number of words than typically developing

children. Furthermore, learners with LD used

fewer novel words. Despite these deficiencies in

the performance of learners with LD, it was also

noticed that there was no difference between the

complexities of the syntactic constructions used by

learners with LD when compared with typically

growing children. It was observed that both

learners with LD and typically growing children

used the same number of T-Units2 (Newcomer and

Barenbaum, 1991). Gillam and Johnston (1992)

investigated the relationship between both spoken

and written narratives in children with LILD

between the ages of 9-12 years. Their findings

indicated that spoken narratives contained longer

sentences with more linguistic connective devices

but written sentences were more complex than spoken sentences. In essence these studies indicate

that learners with LD across all grade levels tended

to produce less coherent oral and written narratives

than typically developing children. In terms of

writing it was also observed that learners with LD

produce more errors of writing than normal

individuals.

In majorities previous studies failed to find

significant differences between the performances

of LILD and control groups (Ripich and Griffith,

1998 cited in Henshilwood, 1998). Strong and

Shaver (1991) suggested that these conflicting

findings on narrative productions might be due to

the unreliability of results. Therefore caution must

be taken when interpreting data from these studies,

as strict reliability measures were not always

employed (Henshilwood & Ogilvy, 1999; Strong

& Shaver, 1991). Present study aimed to assess the

microstructure parameters of narratives and

compared the performance of LILD children and

typically growing children in oral and written

narratives across three narrative tasks: story retell,

story generation and spontaneous narratives whilst

employing strict reliability measures. Furthermore,

this study aimed to assess whether single-task

narratives assessment was clinically more useful

compared to multi-task narrative assessments.

1Children with learning disabilities are defined as those with normal intelligence, intact sensory and emotional functioning but who exhibit a disorder in one or more of the basic psychological processes involved in understanding or using language, spoken or written (Donahue, Pearl and Bryan, 1982, p.397). The learning disabled group is diverse and their difficulties are not necessarily obvious on standardised test.

_________________________________

2T-unit is a main clause and any other subordinate clause that may be attached to it or embedded in it. For written narratives punctuation and capitalisation were ignored when calculating T-units (Paul and Smith, 1993; Houck and Billingsly, 1989). Segmentation into T-units was done according to the procedure outlined by Vorster (1980) for the Test for Oral Language Production (TOLP). This form of segmentation is required for the micro-structural analysis of transcriptions. T-units were judged to be complex if they were grammatically complete and correct and contained a main clause together with one or more additional coordinating, subordinating, complementing or relative clauses’ (Gillam and Johnston, 1992: p.35).


77

Method

Research Design

A multiple case study design was used. This

increased the reliability of the data obtained and

also controlled for the heterogeneity in the LILD

population. Three narratives elicited using three

different narrative elicitation tasks were used over

two sessions to ensure that the narratives were

representative of the subject’s true ability, thereby

increasing the internal reliability of the data.

Participants

Three male children with known LILD and

three aged matched typically growing male

children without learning disabilities from the Cape Town, South Africa participated in this

study. Table 2.1 provides a summary description

of the subjects and controls.

LILD1 NLD1 LILD2 NLD2 LILD3 NLD3 Chronological age at time of testing (yrs)

11.11 11.10 10.3 10.5 10.8 10.6

IQ Below Average With in normal range

Below Average

With in normal range

Above Average

With in normal range

Grade 4 6 4 5 4 5 Medication Fixonase (for

hayfever) None None None Ritalin None

Previous Therapy

Regular school with Remedial Teaching

Regular school

Regular school Remedial Teaching

Regular school

Regular school Remedial Teaching Occupational Therapy (2 yrs)

Regular school

Current Therapy and Years in Therapy

Speech Therapy- 2.6 Occupational Therapy-2.0

Speech Therapy-2.0 Occupational Therapy-4.0

Speech Therapy 4.0

Table 2.1: Biological and Educational Information of LILD and NLD subjects.

Procedure

Each participant was individually assessed

across two sessions. This was to increase reliability of the samples and to rule out

performance differences arising from subject

variables. Context defined as three different

narrative tasks: story telling, story generation, and

spontaneous speech were used to analyse micro-

structural features of narratives produced under

different contexts. Each subject was required to produce both oral and written narratives in the

same session on the same task. That is if they

retold a story orally they were required to retell the

same story in writing. Data on oral narratives were

obtained first for all types of narrative tasks.

Narrative elicitation task

Story retell task was elicited by using ‘Frog

Story’. This story was specifically constructed for

story grammar research. It consists of seventeen

events and thirteen story grammar events (Ripich

and Griffith, 1988). For story generation task, a

single picture was shown to the children. This

picture depicts a scene of a lion and a lioness

fighting viciously. The child was expected to

generate a story around this event. The child and one of the researchers were both engaged in a

drawing activity for eliciting spontaneous

narrative task. Whilst the researcher drew a

picture she related one of her own narratives. The

child was encouraged to do the same by asking

him/her if anything like that has ever happened to

him/her.

Environment and recording

Session one consisted of story retelling and

session two included story generation and

spontaneous narratives. No time limits were

imposed for any task. Subjects were to write the

written narratives on lined paper with a pen and


78

erasing equipment such as tippex was not

provided. Oral narratives were video and audio

taped. Both types of recording were used to reduce

transcription errors due to recording variables.

Each subject was required to read the written

narratives aloud so that misspelled or illegible

words could be resolved. In this study the protocol

of Gillam and Johnston, (1992), was strictly used.

Transcription and treatment of narrative

samples

Oral narratives were transcribed verbatim and

then treated by excluding pauses and fillers such as

“uhm” and “yeah”. Unintelligible utterances were transcribed phonetically and included as one word.

Written narratives were typed without alteration to

their content, spelling punctuation, capitals,

paragraph structure and format. Crossed out words

were ignored. Illegible words were verified from

the video recording of the subject reading the

narrative. Treated narratives were reformatted

according to the transcription format used in the

Computerised Profiling (Long, Fey, Chanelle,

2000) computer program.

Analysis of Data

Frequency counts and the percentages were

made for all the tasks across all the six subjects

and displayed in the tables for planned

comparisons across the tasks and within the

subjects (see table 3.1; 3.2; 3.3) and later on

analysed statistically. This involved scrutiny at the word and sentence level. The focus was to

scrutinise language at the level of syntax,

semantics, phonology or spelling in written

narratives. The measures give an indication of the

complexity and depth of the narrative produced.

Productivity and form complexity were measure

for oral narratives and specific analyses of writing were performed.

� Productivity: The total number of words and

number of different types of words per t-unit3

were calculated (Vorster, 1980)

� Form Complexity: The number of adverbs,

prepositions and co-verbs4 per t-unit were

calculated as outlined in Test of Oral Language Production (Vorster, 1980)

� For Written narratives a specific analysis of

writing was performed. Mechanical aspects of

writing productivity, syntactic maturity,

vocabulary and mechanics were analysed

based on the scoring procedures used by

Houck and Billingsley (1989).

Reliability

In order to determine the reliability, inter-rater and intra-rater reliability as well as coder

reliability were used. The intra-rater and inter-rater

transcription and coder reliability are presented in

Table 2.2. Liles (1993) indicated that conflicting

findings in many previous studies may be

influenced by poor reliability. An arbitrary value

of 90% reliability suggested by Strong and Shaver (1991) was decided as being the minimum

acceptable reliability for the present study. Both

transcription and coder reliability were calculated

for the narrative to ensure that the results obtained

for the analysis were valid. According to this

criterion both intra-rater and inter-rater measures

of reliability met the criterion, implying the

results’ accuracy.

Intra-rater Inter-rater Transcription 96.2 % 94.9%

Coder 94.0% 91.2%

Table 2.2: Inter-rater and intra-rater transcription and

coder reliability for narratives.


Productivity analysis

Productivity analysis was carried out for both

children with and without LILD. Table 3.1

displays the productivity analysis. It was found

that oral and written narratives of LILD subjects contained fewer t-units than controls’ narratives.

The number of words used by children with LILD

and the control group in oral narratives were

equally distributed. In the written narratives

children with LILD used fewer numbers of words

compared to typically growing children. Oral

narratives of children with LILD had a higher

number of words per t-unit than the oral narrative

of controls groups. But written narratives of

children LILD have a lower number of words per

t-unit than the written narratives of controls

groups. The type-token ratios (TTR) for oral and

written narratives were lower for children with

3The following formula was used: The number of complex, grammatically correct T-units X 100 Total number of T-units (Gillam and Johnston, 1992)

4Co-verb indicates relationships between noun and the main verb and forms a setting for action of the main verb for this research. [E.g. Lions are fighting outside; [are] was considered as co-verb for this research].


79

LILD than for control groups. Mann-Whitney U

test was used to check if these differences were

statistically significant. It was observed that the

differences between children with and without

LILD in oral and written task were not statistically

significant.

Analysis across oral and written tasks was

also carried out. It was observed that the number

of t-units and the number of words in the written

narratives were lower for the children with LILD, but a similar trend was not observed for the control

participants. Both the number of words and the

number of t-units dropped for children with LILD

but similar drop was not seen in the number of

words per t-unit across oral and written narratives.

The Type-Token Ratio for the children with LILD

was lower in the written narratives than the oral narratives, a difference that was not present for the

control groups. Nevertheless the differences were

not found to be statistically significant. Analysis

between narrative types showed that specific

trends for the number of t-units, number of words

and the number of words per t-unit were not

observed across the different narrative types in the oral and written modes for LILD and control

groups. The TTR tended to be higher in oral

spontaneous narratives than retold or generated

narratives for most LILD and control groups. At

the same time, these differences were not found to

be statistically significant.

Figure 3.7: Percentage of Complex T-Units in oral and

written task for all the subjects.

Form complexity

The results of the form complexity analysis of

oral and written narratives produced by all

participants are displayed in Table 3.2.

The percentage of correct complex t-units in the

oral and written story retell tasks (T1), the story

generation tasks (T2) and the spontaneous narrative tasks (T3) are graphically presented in

Figure 3.7. It is observed from the figure 3.7 that

T-units Words Word/ t-unit Type-Token Ratio Participants Narrative Types

Oral Written Oral Written Oral Written Oral Written

T1 10 7 77 57 7.7 8.1 3.6 2.8 T2 4 5 39 31 9.8 6.2 3.1 2.2 LILD1 T3 16 5 167 45 10.4 9 4.7 3.1 T1 10 7 65 46 6.5 6.6 3.4 2.6 T2 30 12 213 74 7.1 6.2 3.5 3.3 LILD 2 T3 11 4 76 27 6.9 6.8 3.8 2.6 T1 6 6 66 43 11 7.2 3.8 2.7 T2 5 4 37 29 7.4 7.3 3.0 2.6 LILD 3 T3 7 3 87 19 12.4 6.3 3.6 2.4 T1 12 10 82 75 6.8 7.5 3.3 3.8 T2 8 6 75 66 9.4 11 4.3 3.7 Control 1 T3 25 12 220 97 8.8 8.1 5.4 4.2 T1 8 8 58 64 7.3 8 3.9 3.8 T2 5 6 54 48 10.8 8 3.0 3.6 Control 2 T3 7 2 43 32 6.1 10.7 3.7 3.5 T1 10 6 73 55 7.3 11 4.1 3.5 T2 13 10 86 87 6.6 8.7 4.0 4.2 Control 3 T3 14 10 128 83 9.1 8.3 4.4 4.2

Key: T1-Task 1 (story retell); T2-Task 2 (story generation); T3-Task 3 (spontaneous narrative); T-

units- number of t-units; Words- number of words; Word/ t-unit- number of words per t-unit (one

decimal place).

Table 3.1: Productivity analysis of oral and written narratives for three different narrative types for all participants.


80

only one subject produced six adverbs, and others

did not use adverbs in both oral and written tasks.

The prepositions were present approximately

equally by both LILD and control groups in both

the oral and written modes. Children with LILD

used higher number of co-verbs in their oral

narratives than control group. However, reverse

trends were present in the written narratives of

typically developing children. They were

completely absent in the written narratives of

LILD group. A higher number of correct complex

t-units were present in the oral and written t-units

of control group versus those produced by LILD

group which was found to be statistically

significant using Mann Whitney U test (p=.001).

This increase was particularly noticeable for

written narratives. The number of connectives per

t-unit present was generally equally across LILD

and control groups’ narratives.

It was observed that the uses of prepositions

were fairly distributed across the oral and written

modes in both the groups. However, LILD group

used fewer numbers of co-verbs in the written

narratives than the oral narratives. The number of

correct complex t-units was higher in the oral

narratives of children with LILD than their written

narratives. However for the control group, the

number of correct complex t-units decreased

slightly. A fewer number of connectives per t-unit

were used in written narratives compared to oral

narratives. However, this difference was not

statistically significant between the two groups and

between oral and written task. A close observation

across tasks revealed that prepositions were most

commonly present in the story-retelling task

whereby the topic influenced the inclusion of

prepositions into narratives; co-verbs were most

commonly present in the story generation. They

were always present in the orally generated

narratives for the LILD subjects. For most oral

narratives a higher numbers of complex t-units

were present in the generated narratives of children

with and without LILD.

In summary we can say that oral and written

narratives of children with LILD were less productive and less complex then the oral and

written narratives produced by control children. In

addition the oral narratives of LILD children were

superior to their written narratives. Lastly oral

spontaneous narratives were more productive in

terms of the higher Type-Token Ratio and oral

Adverb Prep Coverbs % Complex T-units Connectives

Participants Narrative Types

Oral Written Oral Written Oral Written Oral Written Oral Written

T1 0 0 3 3 3 0 20 0 1.3 0.9 T2 0 0 0 0 2 1 0 0 0.5 0.6 LILD 1 T3 0 0 9 3 4 0 12.5 20 1.3 0.8 T1 0 0 3 4 0 0 10 0 0.7 0.6 T2 1 0 1 1 2 0 10 8.3 0.9 0.5 LILD 2 T3 1 0 0 2 0 0 9.1 0 0.5 0.5 T1 0 0 1 2 0 0 33.3 0 1.8 1.5 T2 0 0 0 0 1 0 20 25 0.8 1.5 LILD 3 T3 0 0 2 1 1 0 0 0 1.3 1.0 T1 0 0 0 3 0 1 8.3 30 0.9 0.5 T2 1 0 2 1 2 2 37.5 50 0.6 0.3 Control 1 T3 0 0 4 0 0 1 12 16.7 1.7 0.3 T1 0 6 0 3 0 0 25 25 1.3 0.1 T2 0 0 0 0 0 2 20 16.7 1.6 0.2 Control 2 T3 0 0 0 1 0 0 0 50 1.4 1.0 T1 0 0 2 2 1 0 50 33.3 1.6 1.2 T2 0 0 1 1 1 2 0 10 1.3 1.2 Control 3 T3 0 0 6 4 1 3 14.3 40 1.4 0.8

Key: T1-Task 1 (story retell); T2-Task 2 (story generation); T3-Task 3 (spontaneous narrative); Adverbs-

number of adverbs; Prep- number of prepositions; Coverbs- number of coverbs; %complex t-units-

the percentage of correct complex t-units; connectives- the number of connectives per t-unit

Table 3.2: Form complexity analysis of oral and written narratives for three different narrative types for all

subjects.


81

generated narratives were more complex with

regards to the number of complex t-units present.

However a larger sample would be needed to

assess if this fact can be generalised as an

established trend. For the present study it can be

assumed that the different types of elicitation tasks

do not result in more productive or complex

narratives. Regardless of presentation modality,

children with LILD process language more slowly,

thus reducing the ability to integrate information

successfully (McFadden & Gillam, 1996) and

retell the essential parts of the story when asked to

do so. Including all story grammar parts in the

analysis or total number of recalled story grammar

parts may add stronger support to the notion that

the children with LILD process language more

slowly.

Specific Analysis of Writing

The third specific aim of the research was to

perform a specific analysis of written narratives.

The results for this analysis for the three different

narrative types produced by all six subjects are

shown in Table 3.3.

The results in Table 3.3 indicate that a greater

number of sentences were used by the control

group compared to children with LILD and a very

high numbers of words were occasionally present

in the sentences produced by children with LILD

than the narratives used by control group. This

could relate to punctuation errors whereby actual

sentences were ‘marked’ within the written text as

they were extremely long. If the intended number

of sentences had been counted these values would

have been much different. A lower number of

morphemes per t-unit, number of words containing

seven letters or more, the percentage of correct

capitalisations and the percentage of correct

spellings were present in the narratives of LILD

subjects versus those produced by control subjects.

Mann-Whitney U test was run to see the

differences between the groups. Except for words

per sentences all the other parameters were

statistically significant (p = .001). As expected an

analysis of the mechanical aspects of writing

across the three different tasks did not indicate any

particular trend. Results from the specific analysis

of writing are in agreement to the findings of

Newcomer and Barenbaum (1991). That is

children with LILD have significantly compromised writing ability in terms of the

mechanics of writing.

Written Productivity Syntactic Maturity

Vocab Mechanics Participants

Narrative Types Number of

Sentences Word/

sentence Morpheme/t-

unit Words>7 letters

% correct caps

% correct spellings

T1 1 57 8.9 1 16.7 80.7 T2 1 31 8 1 25.0 67.7 LILD 1 T3 1 45 9.6 0 50.0 73.3 T1 4 11.5 7.1 2 60.0 84.8 T2 4 18.5 6.6 9 61.5 58.1 LILD 2

T3 1 27 7.5 0 33.3 85.0 T1 1 43 7.8 2 33.3 90.7 T2 3 9.7 8.8 4 33.3 65.5 LILD 3

T3 1 19 6.3 2 75.0 89.5 T1 8 9.4 8.6 6 100 98.7 T2 6 11 12.8 6 100 97.0 Control 1 T3 10 9.7 9.3 2 41.5 100 T1 6 10.7 9.5 3 85.7 95.3 T2 4 12 8.8 1 100 100 Control 2

T3 2 16 12.3 3 66.7 93.8 T1 4 13.75 12.2 6 100 96.4 T2 5 17.4 10 12 100 100 Control 3 T3 5 16.6 9.9 6 100 98.8

Key: T1-Task 1 (story retell); T2-Task 2 (story generation); T3-Task 3 (spontaneous narrative); Word/sentence- number of

words per sentence; Morphemes/t-unit- number of morphemes per t-unit; Words>7 let- number of words greater then 7

letters; % correct caps- Percentage of correct capitalisation; % correct spellings- Percentage of correct spelling; Vocab-

VocabularyInsert table 3.3 about here

Table 3.3: Written productivity, syntactic maturity, vocabulary and mechanics analysis of written narratives in

three different narrative types for all subjects.


82

Conclusions

The present study aimed to evaluate oral and

written narratives produced by children with

LILD and compare them to the narratives

produced by age matched control group across

three narrative elicitation tasks, namely the story

retell, story generation and spontaneous narratives.

The study also aimed to assess the influence of

context on three narrative elicitation tasks. The

narratives were analysed in terms of micro-

structure measuring productivity and form complexity. A specific analysis of writing was also

performed. Stringent transcription and coder

reliability measures were employed. The

transcription and coder reliability measures the

arbitrary criteria of 90% reliability set by Strong

and Shaver (1991). From an examination of the

influence of context on the narrative production, it appeared that the story retell task was frequently

the most superior form of narrative production

because this is essentially a short-term memory

task. The narratives produced were superior due to

the fact that an adult type model was available to

the subjects.

The differences in the story retell and spontaneous narrative task lay in the fact that in

story retell task children imitated an adult type

model, whereas spontaneous narratives,

information had to be retrieved from long-term

memory and formulated by the children. The story

generation task was self-contained less influenced

by context compared to the other two tasks and

hence it was the most salient task for the

assessment of narratives. The poorest

performances by children were for spontaneous

narratives and differences between the two groups

were highlighted in both the written and the oral

mode. This may be the result of the high level of

dependency on the surrounding context for

spontaneous narratives. It may be concluded that

the story generation task was a test of a children’s

ability to produce an adult like narrative and the

spontaneous narrative task was most useful in

highlighting differences between the two groups.

Differences between the two groups were highlighted in the written mode as well. There was

a larger discrepancy between the oral and written

production of the children with LILD whereas this

discrepancy was not evident in the control group.

Thus due to difficulties with the mechanical

aspects of writing and metalinguistic deficits for

writing (Newcomer and Barenbaum, 1991) the

children with LILD were unable to perform

equivalently across the two modes.

With regards to the methods of analysis

employed it appeared that the Type-Token Ratios

were the most useful in differentiating between the

two groups of subjects in both the oral and written

modes particularly for spontaneous narratives.

However large differences were apparent for all

measures in the written mode. However the lack of

normative data made it difficult to determine the

adequacy of the productions. This not only

motivates the need for narrative analysis as an

assessment toll but also makes narrative analysis

difficult to interpret.

The shortcomings in the present study were

that subjects were not tested across time for the

same narrative task, thereby ensuring the results

reflecting the subject’s true ability for that

particular type of narrative were questionable.

Secondly the study sample was small. Thus the

study should be replicated using a larger subject

sample. However the study illustrated that children

with LILD have poorer narrative abilities compared to children without LILD. It is also

illustrated that written narratives are poorer than

oral narratives for children with LILD perhaps due

to the fact that the mechanical demands are so high

in written narratives that the individual may lose

site of the message that they are conveying

(Robson, 1988). Lastly the spontaneous narrative task was the most crucial for differentiating

between the two groups. The story retell task

appeared essentially a short-term memory task,

useful for assessing the production of narratives

following the presentation of an auditory model.

Implications and Future Research

This study highlighted the need for multiple

narrative elicitation tasks during language

assessment particularly the spontaneous narrative

task. At present little information is available on

the narrative production of older children with

LILD. Hence further investigation in this

population would enhance the language teaching

model. Future studies may focus on comparing

different types of narrative tasks and linguistic

ability, whilst obtaining representative narrative

samples for the same task over time. Lastly,

Computerised Profiling (Long, Fey & Channell,

2000) appeared to be a timesaving tool for analysis

of narratives. It was simple to use and provided

quantified data regarding language.


83

References

Applebee, A. N. (1978). The child’s concept of

story: Ages two to seventeen. USA: The

University of Chicago press.

German, D. J. & Simon, E. (1991) Analysis of

children’s word-finding skills in discourse.

Journal of Speech and Hearing Research,

34, 309-316.

Gillam, R. B. & Johnston, J. R. (1992) Spoken and

written language relationships in

language/learning-impaired and normally

achieving school age children. Journal of

Speech and Hearing Research, 35, 1303-

1315.

Henshilwood, L. & Ogilvy, D. (1999) Narrative

discourse productions in older language

impaired learning disabled children:

employing stricter reliability measures. The

South African Journal of Communication

Disorders. 46, 45-53.

Houck, C.K. & Billingsly, B. S., (1989) Written

expression of students with and without

learning disabilities: differences across the

grades. Journal of Learning Disabilities, 22

(9), 561-568.

Kress, G. (1982) Learning to write Great Britain.

London: T. J. Press Ltd.

Liles, B., Duffy, R., Merrit, D. & Prcell, S (1995). Measurement of narrative discourse ability

in children with language disorders. Journal

of Speech and Hearing Research, 38, 415-

425.

Liles, B. Z. (1993) Narrative discourse in children

with language disorders and children with

normal language: a critical review of the literature. Journal of Speech and Hearing

Research, 36, 868-882.

Liles, B. Z. (1985) Cohesion in the narratives of

normal and language disordered children.

Journal of Speech and Hearing Research,

28, 123-133.

Long, S. H., Fey, M. E. & Channell, R. W. (2000)

Computerised profiling (version 3.9.6).

Cleveland OH: Case Western Reserve

University.

McFadden, T. U. and Gillam, R. B. (1996) An

Examination of the quality of narratives

produced by children with language

disorders. Language, Speech and Hearing

Services in Schools, 27, 48- 56.

Newcomer, P. L. & Barenbaum, E. M. (1991). the

written composing ability of children with

learning disabilities: A review of the

literature from 1980 to 1990. Journal of

Learning Disabilities, 24(10), 578-593.

Owens, R. E. (1999) Language Disorders: A

functional approach to assessment and

intervention. Boston: Allyn and Bacon

Paul, R. & Smith, R. L. (1993). Narrative skills in

4-year-olds with normal, impaired, and late-developing language. Journal of Speech and


Ripich, D. N. & Griffith, P. L. (1988) Narrative

abilities of children with learning disabilities

and non-disabled children: Story structure,

cohesion and propositions. Journal of

Learning Disabilities, 21(3), 165-173.

Strong, C. J. & Shaver, J. P. (1991) Stability of cohesion in the spoken narratives of

language-impaired and normally developing

school-aged children. Journal of Speech and


Van Leer, E. & Turkstra, L. (1999). The effect of

elicitation task on discourse coherence and

cohesion in adolescents with brain injury.

Journal of Communication Disorders, 32, 327-349.

Vorster, J. (1980). Test of Oral Language

Production. Pretoria: South African Institute

for Psychological and Psychometric

Research.

Wright, H, H & Newhoff, M. (2001). Narration

abilities of children with language-learning

disabilities in response to oral and written

stimuli. American Journal of Speech-

Language Pathology, 10(3).

JAIISH, Vol. 27, 2008 Phonological Processes in Typically Developing Children

84

Phonological Processes in Typically Developing Kannada Speaking

Children

1Sreedevi N.

&

2Shilpashree H.N.

Abstract

The present study investigated the various phonological processes occurring in 2.6- 3

year old typically developing Kannada speaking children. 8 children, i.e., 4 boys & 4

girls served as subjects. 50 simple Kannada words, which commonly occur in the

utterances of normal young children, were selected for the study. These target words

were picturized and were used to elicit the target response from the subjects. The

responses were audio recorded and the data obtained were transcribed using IPA transcription. Sound by sound analysis was carried out to identify various phonological

processes. The results indicated that out of the 12 processes observed, none of the

phonological processes qualified as a significant one in the speech of children in the age

group of 2.6 to 3 years. However, the most commonly seen processes were final vowel

deletion, retroflex fronting, /h/ deletion etc. This study indicates that most of the

phonemes in Kannada including fricatives and trills are achieved by 3 years of age and

this warrants revision of our existing norms on articulation development. The results

also expand our understanding of child phonology in the critical early language learning

period.

Key words: Phonological process, Kannada, Retroflex fronting, Typically developing children.

Children are not haphazard in their

mispronunciations of words, but they are in fact

quite systematic in their production (Ingram,

1976). The concept of phonological process was

first introduced by Stampe (1973) and according to

him learning of sound system requires suppression

of a number of innate simplifying processes and

simultaneously increasing number of contrast

sounds. Hodson and Paden (1983) defined phonological process as regularly occurring

deviation from standard adult speech patterns that

may occur across a class of sounds, a syllable

shape or syllable sequence. According to Lowe

(1996) phonological processes are systematic

simplified adult production of children. In short,

processes are description of regularly occurring

patterns observed in child’s speech, which operate

to simplify adult targets.

Study of phonological processes provide a

more comprehensive and adequate descriptive

framework for error analysis because they describe

the structural as well as the systemic

simplifications in the speech patterns and where

ever necessary take account of contextual factors

influencing production of sounds. It also provides

a parsimonious basis for selecting those classes of

phonemes which need immediate attention and

intervention. The phonological development of

children learning English as their first language

has been well described. However, as Ingram

(1981) points out, despite numerous studies on

languages other than English, we know relatively

little about phonological development in other

languages. This necessitates the need for

phonological process analysis in Indian languages

as well.

Literature reports that there are more than

forty such different processes operating during

children’s phonological development (Hodson,

1980). Stoel-Gammon and Dunn (1985) reviewed

the studies of occurrences of phonological processes and identified the processes which

disappeared by three years of age as unstressed

syllable deletion, final consonant deletion,

1Lecturer in Speech Sciences, Dept. of Speech Language Sciences, All India Institute of Speech and Hearing, Mysore-570006, email:[email protected], 2Junior Research Fellow, Dept. of Speech Language Pathology, All India Institute of Speech and Hearing, Mysore-570006,

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85

consonant assimilation, reduplication, velar

fronting, diminutization and prevocalic voicing.

And the processes, which persist after three years,

were identified as cluster reduction, epenthesis,

gliding, vocalization, stopping, de-palatalization

and final devoicing. Haelsig and Madison (1986)

studied 50 children in the age group of 3-5 years in

Native American English and reported that gliding

of liquids, cluster reduction and weak syllable

reduction to be the most frequently occurring

processes in this age range. However, the

percentage of occurrence of each of these

processes declined with age. They also reported

that the greatest reduction in the use of

phonological processes occurred between 3 and 4 years of age. Roberts, Burchinal and Footo (1990)

found that liquid gliding, fronting and de-

affrication were dropping between 2.6 and 3 years

and cluster reduction between 3.6 and 4 years

based on their analysis of the speech sample of

145 children. The age at which a process occurred

in less than 10% of the sample was interpreted as the age at which the process had dropped out for

the group.

There are sparse reports of phonological

process analysis in languages other than English

also. Becker (1982) studied 10 monolingual

Spanish children aged four years and found that

de-affrication, /r/ deficiencies, cluster reduction,

epenthesis, weak syllable deletion and alveolar

assimilation to be the most used processes in these

children. Later Martinez (1986) reported Tap/Trill

deficiencies, consonant sequence reduction, de-

affrication, stopping, affrication, fronting,

assimilation and sibilant distortion in 3-year-old

Spanish children. Topbas (1997) studied the

phonological acquisition in Turkish children and

reported that from a cross linguistic perspective,

the phonological patterns exhibited coincide

broadly with universal tendencies, although some

language specific patterns were also evident. In

Turkish children /r/ was substituted by /l/, i.e.

liquid realization of another liquid where as in

English, the /r/ is usually replaced by /w/ or /j/ a

gliding process. The same finding is reported in

Italian also (Bonoleni and Leonard, 1991). This is

explained on the basis that some phonemes are

more common where as some are rare in some

languages. For example /w/ and /j/ are rare in

Turkish and Italian where as they are more

frequent in English. On similar lines, in the Indian

context, Rahul (2006) reports that usage of /l/ for

/r/ is a frequent finding in children in the age group

of 2-3 years with Hindi as their native language.

He reasons that both /l/ and /r/ are liquids and /l/ is

easier among the two and is more preferred.

Paulson (1991) studied 30 normal developing

children of Mexican descent in the age range of 2-

5 years. She found that the 2 year olds used

phonological processes most frequently and the 4-

year olds least often. Her subjects used syllable

reduction, consonant sequence reduction,

prevocalic singleton omission, strident

deficiencies, and /r/deficiencies. And miscellaneous error patterns were stopping,

gliding, vowel deviation, epenthesis, substitution

of /l/ for /r/ and sibilant distortions. Hua and Dodd

(2000) studied the phonological acquisition in

Putonghua language (Modern Standard Chinese)

and suggested that vowels and final consonants

were mastered earlier than initial consonants.

As noted earlier, the literature on phonological processes is relatively fewer in

Indian languages. However, in the recent past a

number of such studies have been attempted in

several Indian languages focusing on the normal

phonological process usage and these have been

briefly reviewed in Table 1.

The present study intended to analyze the speech sample of typically developing Kannada

speaking children (2.6 to 3 years) to identify the

type of phonological processes present in their

utterances.

vaidehi

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vaidehi

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vaidehi

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vaidehi

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86

Author Language Age Group

Common processes seen

1 Sunil, T J (1998) Kannada 3-4 years

Fronting, Cluster reduction, Initial consonant deletion and Affrication

2 Jayashree, U P (1999)

Kannada 4-5 years

Fronting, Cluster reduction and Stopping

3 Ramadevi et al (2002)

Kannada 5-6 years

Stridency deletion, De-aspiration and Retroflex fronting

4 Sreedevi et al (2005) Kannada 2-2.6 years

Retroflex fronting, Trill deletion, Depalatalization, Affrication, Stopping, Cluster reduction etc

5 Sreedevi, N (2008) Kannada 1.6-2 years

Retroflex fronting, Initial Consonant deletion, Vowel lowering, Trill deletion, Cluster reduction etc

6 Sameer, P. (1998) Malayalam 3-4 years

Cluster reduction, Final consonant deletion, Epenthesis and De-affrication

7 Bharathy, R (2001) Tamil 3-4 years

Epenthesis, Cluster reduction, Gliding, Nasal assimilation, Voicing De-affrication & Fronting.

8 Santhosh, M (2001) Hindi 3-4 years

Cluster reduction. Epenthesis, Fronting, Gliding, Metathesis Nasalization etc

9 Rajeev Ranjan (1999)

Hindi 4-5 years

Cluster reduction, partial reduplication and aspiration

10 Rahul Banjariya (2006)

Hindi 2-2.6 years 2.6-3 years

Retroflex fronting, Deaspiration, /h/ deletion, Gliding, Initial consonant deletion Affrication, Denasalization, Monothongisation, Devoicing etc

Table 1: Review of Phonological Processes in various Indian Languages.

Method

Subjects: Eight typically developing children, 4

boys and 4 girls in the age range of 2.6 to 3 years were considered for the study. All the children had

the Mysore dialect of Kannada as their native

language. They were screened for normal speech

and language skills, hearing acuity and normal

cognitive and motor development. Subjects were

pooled from daycare centers and individual homes.

Test Material: 50 simple Kannada words, which

commonly occur in the utterances of typically

developing young children, were selected for the

study. Most of the test words used was bisyllabic,

except for a few trisyllabic ones. The word list had

the vowels of Kannada in the initial position and

the consonants were in the initial and medial

position of the target words. The target words were

picturized on white cards of 4 x 6” size in color.

The picture cards were arranged in order as per the

sequence of Kannada alphabets. The target words

included a few clusters also. The list of target

words is given in Appendix 1.

Procedure: Each individual subject was brought

into a small noise free room and seated opposite to

the examiner. Once the rapport was established,

the examiner presented the target pictures one after

another. The subjects were encouraged to name the

item in the picture card. The response obtained were audio recorded using a high fidelity portable

digital Sony tape recorder. If any of the subjects

failed to identify a target word, additional cues

were presented by the examiner. In spite of

additional cues, if the child failed to name the

target picture, the child was asked to repeat after

the examiner.

Data Analysis: The data obtained from all the 8

subjects were transcribed by two speech language

pathologists using broad and narrow IPA

transcription. The inter judge reliability was

approximately 86%. Following this a qualitative

analysis was carried out for each subject

separately. Each word utterance of the subjects

was analyzed sound-by-sound. Based on the

sound changes occurring, the phonological process

operating was identified. Further, frequency of

occurrence of the various processes was

determined. The qualitative analysis of each

child’s speech sample was carried out using the

following format:

Target word

Phonemic structure of target

Response of the subject

Phonemic Structure of the response

Phonological process used

/bΛs/ CVC /bΛt/ CVC Stopping


87


Twelve various phonological processes were

identified in typically developing children aged 2.6

to 3 years speaking Kannada as their native

language. Each subject’s utterances were analyzed

separately for the type of the process used and the

number of times it occurred. The overall

percentage of occurrence of each process was

obtained by computed by the following formula

(Newman & Creaghead, 1988).

Number of times a process occurred -----------------------------------------------------

X 100

Total number of words spoken

i.e.

------------------------------------------------------------ X 100

Percentage of occurrence of 5% or more was

considered high, following Newman & Creaghead,

1988. The processes identified are listed in

descending order of occurrence based on the

percentage of occurrence in the 8 subjects studied

in Table 2.

Phonological process observed

Total %

1. Final vowel deletion 3.00 % 2. Retroflex fronting 2.50 % 3. /h/ Deletion 1.75% 4. Cluster Reduction 1.25% 5. Velar fronting 1.25% 6. Affrication 1.00 % 7. Vowel raising 1.00 % 8. Stopping 0.75 % 9. Diphthongization 0.75 % 10. /r/ deletion 0.50 % 11. Non geminate to geminate

cluster 0.50%

12. Palatalization 0.50 %

Table 2: Phonological processes seen in 2.6 – 3 years.

The results reveal that out of the 12 processes

observed, none of them qualified as a significant

phonological process in the speech of children in

the age group of 2.6 to 3 years in Kannada. This is

because none among the 12 processes crossed the

critical value of 5% (Newman & Creaghead,

1988). However, the most commonly seen process

among all the 8 children was final vowel deletion

(3%). Final vowel deletion was mainly observed

for borrowed words from English like /bus/, /ka:r/,

/ræil/ etc. which end with the vowel /u/ in

colloquial Kannada. The next commonly seen

process was retroflex fronting (2.5%). Sreedevi

(2008) has reported that retroflex fronting was the

most dominant (18%) phonological process

operating in children aged 1.6 to 2 years in

Kannada. This can be attributed to the complexity

in its production, which involves curling the

tongue to contact the palate. Therefore most often,

a retroflex sound was substituted by an easier

dental sound, which is more frontally placed with

better visibility and which also requires relatively

lesser exertion of the tongue. It is interesting to

note that in the present age group of 2.6 -3 years,

retroflex fronting had reduced substantially to a

scanty 2.5%. As per the earlier literature reports, retroflex sounds are mastered after 3 years (4.6

years - Templin, 1956 (English); 3.6 years – Babu,

Bettagiri & Rathna, 1972 (Kannada). However, the

present study indicates that retroflex sounds are

produced correctly by 3 years of age in Kannada.

Retroflex fronting was followed by /h/

deletion (1.75 %). This is again a common feature in colloquial Kannada. This was followed by

cluster reduction and velar fronting. Cluster

reduction was fewer in occurrence as the test

sample contained only two clusters. Clusters were

not included in more numbers in the test sample as

the earlier literature reports suggested that clusters

are mastered by 7 years or so and this study

targeted a much younger age group. The finding of

velar fronting, although negligible, is quite

surprising. This can be explained on the basis that,

though velar is an early sound, as per the

developmental norms, velars are consistently

produced by 4 years or so (Fundala & Reynolds,

1986).

The remaining seven processes seen namely,

affrication, vowel raising, stopping,

diphthongization, /r/ deletion, non-geminate to

geminate cluster and palatalization were all

operating at one or less than 1% level and can be

considered as an incidental finding. It is appealing

to find that processes which are most commonly

reported in Western literature like stopping or

substitution of a stop for a fricative and /r/ deletion

are almost negligent in this group of 2.6-3 years.

This indicates that fricatives and trills are achieved

almost consistently by 3 years of age in Kannada.

Stopping and /r/ deletions are frequently reported

in the Western studies even in children of older age groups (Stoel-Gammon & Dunn, 1985).

Total number of the same type of processes exhibited by all the subjects

Total number of target words spoken by

all the subjects


88

The overall results indicate that none of the

12 phonological processes observed qualified as a

significantly operating process in the age group of

2.6 to 3 years in Kannada. Most of the processes

sparingly occurred and perhaps with a few more

repetitions, probably the child would have self

corrected the errors. This observation certainly

indicates that we need to revise our articulation

test norms which were standardized in the sixties

and early seventies. Also the processes seen were

not similar to the ones reported frequently in

Western languages. This is because of structural

differences across the languages.

Conclusions

It can be said that understanding the pattern of

reduction of phonological processes during the

course of phonological development form the basis

for dealing with the clinical population. The

present study indicates that most of the processes are suppressed considerably by three years of age

in typically developing children. Hence based on

the results obtained it can be predicted that today’s

children acquire speech sounds much sooner as

compared to their earlier counterparts. However,

further standardization of the data on a larger

population with more complex words is warranted for generalization. The findings of this

investigation also augment in screening the

appropriateness of a child’s phonological skills

especially in the clinical population.

References

Bharathy, R. (2001). Development of Phonological

Processes in Tamil: 2-3 years. Master’s

Dissertation, University of Mysore.

Deanine, M.M., and Hodson, B.W. (1994).

Spanish Speaking Children's Phonological

Assessment and Remediation, Seminars in Speech, language and Hearing Research, 3,

137-148

Fundala, J B., & Reynolds, W M.(1986). Cited in

Pena Brooks and M N Hegde (2000),

Assessment and treatment of articulation

and phonological disorders in children.

Austin, Texas: Pro- Ed.

Haelsig, P.C., & Madison, C. L. (1986). A study of phonological processes exhibited by 3-, 4-

and 5- year old children. Language, Speech

and Hearing Services in Schools, 17,107-

114.

Ingram, D. (1976). Cited in Lass N.J. Speech &

Language: Advances in Basic research and

practice. Vol.8. NY. Academic Press, 1982

Ingram, D. (1981). Procedures for the

phonological analysis of children’s

language. Baltimore: University Park Press.

Jayashree, U.P. (1999) Development of

phonological processes of 4-5 year old children in Kannada speaking population.

Unpublished Masters dissertation submitted

to the University of Mangalore.

Lowe (1996). Cited in Hegde, M. N.(2000).

Assessment and treatment of articulation

and phonological disorders in children.

Austin, TX: Pro-ED.

Rahul, B. (2006). Study of Phonological Processes in 2-3 Years old Hindi Speaking Normal

Children. Un published Master’s

Dissertation, University of Mysore.

Ramadevi, K J & Prema, K S. (2002).

Phonological process in Hearing impaired

Children. In Proceedings of the 4th ICOSAL,

Chidambaram.

Ranjan, R. (1999). Development of phonological

processes of 4-5 year old children in Hindi

speaking population. Unpublished Masters

dissertation submitted to the University of

Mangalore.

Sameer, P. (1998). Development of phonological

processes of 3-4 year old children in

Malayalam speaking population. Unpublished Masters dissertation submitted

to the University of Mangalore.

Santhosh, M. (2001). Development of

phonological processes in normal Hindi

speaking children in the 3-4 years age

group. Unpublished Masters dissertation

submitted to the University of Mumbai.

Sreedevi, N., Jayaram, M., & Shilpashree, H. N.

(2005). Development of phonological

Process in 2-2.5 year old children in

Kannada. Abstract in Souvenir, Sixth

International Conference on South Asian

Languages (ICOSAL – 6), Hyderabad

Sreedevi, N. (2008). Study of Phonological

processes in normal Kannada speaking


89

children: 1.6-2 years. Interdisciplinary

Journal of Linguistics, 1,103-110.

Stoel-Gammon, C., & Dunn, C. (1985). Normal

and disordered phonology in children.

Clinical linguistics and Phonetics, 4, 145-

160.

Acknowledgements

This study is a part of the ARF project titled

“Phonological processes in Kannada speaking

children: A Profile”. The authors wish to express

their gratitude to Dr. Vijayalakshmi Basavaraj,

Director, AIISH for permitting to carry out this

study and Dr. M Jayaram, former Director, AIISH,

for sanctioning the project. Also the authors wish

to acknowledge the subjects who participated in

the study.

Appendix 1

JAIISH, Vol. 27, 2008 Aetiological & Therapeutic Searches by Netizen Parents on Autism Spectrum

90

A Profile of Aetiological & Therapeutic Searches by Netizen

Parents/ Caregivers of Children on the Autism Spectrum

1Venkatesan S. &

2Purushotham K.

Abstract

Autism is a growing tragedy of contemporary information age. A sizeable population of

their parents is computer savvy, knowledgeable and active denizens on the new virtual

reality available on world-wide web. They spend several hours on the computer

keyboard asking questions, seeking answers, sending messages or exchanging notes

between themselves or other professionals in virtual chat rooms, internet groups or

through personal emails. The present study seeks to empirically profile the frequency, intensity and extensity of thematic concerns/searches by an organized group of internet

netizens dedicated to autism. Content analysis of transcripts derived by data mining

3436 email exchanges of the netizens in the studied sample is classified/presented under

three heads: (a) spread of information themes/choices; (b) etiology based issues/

transactions; and, (c) themes related to therapy or treatment of individuals with autism.

The highest number of discussions center around the theme of therapies/treatments

applicable for persons on the autism spectrum (N: 1697; 49.39 %). This is followed by

online concerns of the group members on behavior problems or its management (N:

1488; 43.31 %) in their children. Their etiology based explorations cover four

categories: (a) Biological; (b) Environmental; (c) Sensory; and, (d) Diet related causes

of autism. Content analysis reveals as many as 238 types of treatment related key-words

as discussed by members in the internet group. They are classified as nutrition-based,

sensory, and education-behavior based therapies, Alternate Medical Systems, bio-

medical therapies, and Instrument based therapies respectively. The implications of the

study are discussed in the context of parental quest for understanding the continuing

challenge and enigma called autism

Key words: Internet groups – Content analysis.

Autism is increasingly becoming the tragedy

of contemporary information age. The kids with

autism inhabit their inner worlds as their

parents/caregivers desperately search for an

understanding of its ever elusive causes and

therapeutic management in the outside world.

Many modern day parents are computer savvy

active denizens of the new virtual reality available

on the world-wide web. They spend several useful

hours dabbling on the computer keyboard asking

questions, seeking answers, sending messages or

exchanging notes between themselves or other

professionals in virtual chat rooms, internet

groups, or through personal emails. These voyages

are made over and above their regular and routine

consultations with friends and well wishers,

doctors, hospitals, rehabilitation professionals, and

others in the real world. Their preoccupations and

queries relate to the unfortunate predicament of

their children. There are major and recurrent

themes of information needs and exchanges that

are shared by these netizens.

Various e-based diagnostic, counseling and

therapeutic services, either professional or

otherwise, charged or freebie, are increasingly becoming the order the day. Subscriber based

Virtual Expert Clinics close the gap between high

demand for special needs services and the limited

accessibility and high existing costs of such

services. These services provide planning, training

and problem solving strategies to assist parents,

caregivers, educators and professional service

1Professor, Dept. of Clinical Psychology, All India Institute of Speech and Hearing, Mysore:570006, email:[email protected], 2Research Assistant, Dept. of Clinical Psychology, All India Institute of Speech and Hearing, Mysore: 570 006.


91

providers. Some e-therapy sites offer paid and/or

freebie services via synchronized chats, others use

emails alone. Online communication is fast, easily

accessible from home, cost effective, time

efficient, etc. Of course, this form of therapy also

carries certain disadvantages. It is not suitable for

every ones needs. It cannot be intensive and it

cannot respond immediately and effectively in

crisis situations. Internet groups related to persons

with disabilities, including autism has become a

reality in India. Several internet users (called

denizens) make use of groups and networks like

Autism India Network, Autism India Group on

Yahoo, India Developmental Disabilities, Autism

India, Help_Autism, India_autism_forum, India_autism_forum2, etc. A few examples of such

groups based abroad is ‘ASD Friendly’,

‘www.aspergersnw.org’, ‘AutismSpot’, ‘The

Autism Connection’, ‘The Autism Depot’,

‘www.templegrandin.com’,‘Auties.org’,

‘autismkey.net’,

‘[email protected]’, etc. These groups or forums have their own entry/exit

services, policies, and philosophies. Several

interested or affected individuals, parents,

caregivers, professionals and others seek and enter

into membership into these groups. They are then

regularly posted with information, introductions,

discussions, articles, essays, or other details on the

subject matter of autism. They are also given an

opportunity to post their own questions,

experiences, requirements for the peer group to

respond through an effective moderator.

Aims & Objectives

It is the objective of this study to

a. Empirically profile the frequency, intensity

and extensity of diagnostic, etiological and

therapeutic concerns by a group of internet

netizens regarding their children with

autism;

b. Attempt a qualitative and quantitative profile

in the patterns or content of their concerns as

expressed by the target sample/s on or

regarding their children with autism.

Method

The sample for this longitudinal study was

derived from an internet group for autism in India.

The group is in existence over four years. All

online transactions occur in this virtual group only

in English. One of the authors is an observing and

passive member of this group. The current

membership strength of this internet group is over

1500 denizens. During its first year, the number of

registered members and their online transactions

was meager. Data collected during that period was

not considered for inclusion in this study. An

overall of 3793 email transactions between the

members was collected and individually recorded

in the form of written transcripts from the period

between January, 2005 and December, 2007.

Within this figure, there were 357 repeat emails

that were discarded. The final inclusion comprised

3436 emails as the sample for content analysis in

this investigation.

Content analysis (or textual analysis), as

defined in this study, involves a set of procedures

for collecting and organizing the non-structured

email information into a standardized format that

allows one to make inferences about the target

phenomenon (Krippendorff, 2004; Berelson, 1971;

Holsti, 1969). It is aptly recognized as ‘study of

recorded human communications, such as, books, websites, emails, paintings and laws’ (Babbie,

2005). Content analysis of the transcripted emails

was carried out in terms of the most typical

themes, notes, messages, information, queries,

answers, or other forms of information exchange

happening between/within members of the internet

group. The shared messages between members of

the internet group were recorded on daily basis

using non-participant objective observation

methods. The transcript pro-forma recorded the

title of message, thematic concern/content, date/s

of their postings and the continued frequency or

duration of messages on that given topic of

discussion. The names of netizens, notes of self

introduction, often congratulatory and/or

acknowledgement mails were not recorded for

ethical reasons. Content analysis of the netizens’

concerns from the transcripts was carried out in

three broad domains: (a) spread of information

themes/choices; (b) etiology based

issues/transactions; and, (c) themes related to

therapy or treatment of individuals with autism.

All exchanges and discussions between the virtual

group members were classified as such.


The results of content analysis of transcripts

derived by data mining email exchanges of the

netizens are classified and presented under the

following three heads:


92

(a) Spread of Information Themes/Choices

Out of the 3436 emails eventually included for

content analysis in this study, the highest

number (N: 1697; 49.39 %) of discussions

centered on the theme of therapies or treatments for persons with autism. This is

followed by emails on self introductions (N:

1684; 49.01 %) by the netizens, and exchange

of individual/institutional contact addresses

(N: 1679; 48.78 %). The information needs of

parents/caregivers querying availability of

services/professionals is reported in several

studies (Peshwaria, Menon, Ganguly, Roy,

Pillay and Gupta, 1995; Garshelis and Mc

Connell, 1993; Gowen, Christy and Sparling,

1993; Bailey, Blasco and Simeonsson, 1992;

Bailey and Simeonsson, 1992).

This is followed by online concerns of the

group members about behavior problems (N:

1488; 43.31 %) in their children and its

management, consulting (N: 1464; 42.61 %),

or seeking peer approval on the diagnosis/

therapeutic practices being followed by them

(N: 1224; 35.62 %). The internet group

discussions offer a splendid opportunity for

the denizens to share experiences, ventilate

doubts, or deliberate on ongoing day-to-day

problems being faced by them in the rearing

and caring of their children with autistic

disorders. About a third of the discussions by

the members pertain to exploring the possible

cause/s of the condition (N: 1089; 31.69 %) in

their children. The group is also equally

preoccupied in seeking mutual clarifications

about the diagnosis in their children (N: 1087; 31.64 %). This is particularly true of new

entrants into the group who describe the

individual signs and symptoms of their

wards/children and posting questions whether

they signify anything related to disorders on

the autism spectrum.

Sl. No.

Information Themes N % Rank

1 Advocacy 601 17.49 15

2 Behavior Problems 1488 43.31 4 3 Causes 1089 31.69 7 4 Conferences & Seminars 838 24.46 11 5 Consulting 1464 42.61 5 6 Contact Addresses: Institutions or Individuals 1679 48.78 3 7 Courses 272 7.92 18 8 Diagnostic Clarifications 1087 31.64 8 9 Enquiries 984 28.64 10

10 Greetings & Congratulatory Messages 1030 29.98 9 11 Information on Forthcoming Events 623 18.13 14 12 Information on Relevant Websites 581 16.90 16 13 Introductions/Welcome Notes 628 18.28 13 14 Notes, News, Views & Reviews 830 24.16 12 15 Peer Approval 1224 35.62 6 16 Self Introductions 1684 49.01 2 17 Send Articles 328 9.55 17 18 Therapies, Treatments & Techniques 1697 49.39 1 TOTAL 3436

Table 1: Spread of Information Themes Discussed by Netizens.

There are a sizeable number of social greeting

and congratulatory messages exchanged

between the members (N: 1030; 29.98 %).

These greetings relate to local festivities,

commencement of year/s, seasonal salutations, etc. These exchanges lubricate the social

dynamics and lend a tone of informality to the

interactions between members of the virtual

group. Despite the fact that the internet group

smacks of members who are highly educated

and belong to the elitist class of intellectuals, it

is seen that their concerns have not yet reached

the level of active or belligerent advocacy (N:

601; 17.49 %) for the cause of autism in the country. There are fewer exchanges on

information related to websites (N: 581; 16.90

%), books and articles (N: 328; 9.55 %) or


93

about online/offline curses related to the field

of autism disorders.

(b) Etiology Based Issues/Transactions

The etiology based concerns of the internet

group members as reflected in their emails

pertaining to possible causes of autism was next taken up for analysis. This causal domain

analysis revealed as many as 341 possible

causes emerging from the transcripts as being

perceived, reported and discussed by the 1089

internet group members (31.69 %). The area

wise causal perceptions of the netizens are

classified into four categories: (a) Biological;

(b) Environmental; (c) Sensory; and, (d) Diet

Based respectively (Table 2).

Biological N Environmental N Sensory N Diet Based N

Allergies 28 Accidents 12 Auditory 30 Alpha Protein Deficit

13

Amygdala Neurons 14 Bad Parenting 6 Gustation 7 Diet disturbances 67

Autoimmune Disease 22 Birth Trauma 7 Hypersensitive 21 Enzyme Dysfunction

23

Brain Abnormalities 18 Emotional Trauma 10 Hyposensitive 9 Food Allergies 32 Chromosomal 16 Excess Hygiene 7 Olfactory 5 GFCF 111

Familial 8 Folic Acid 6 Tactile 7 Leaky Gut Syndrome

42

Food Additives 29 Perinatal Environment

4 Vestibular 4 Nutritional Deficiency

26

Genetic/Heredity 11 Pesticides 14 Visual 3 Poor Nutrition 27 Lead 33 Pollution 12 Maternal Antibodies 7 Poor Stimulation 19

Mercury 18 Prenatal Environment

11

Mercury Toxicity 78 Refrigerator Mother 7 Metabolic Disturbances 19 Social Factors 9 Missing Brain Protein-Cdk5

8 Stress 11

MMR Vaccine 99 Ultrasound 7 Oxidation Stress 10 Watching TV 27 Pesticides 16 Synapse Disconnection 4 Teratogens 13 Toxicity 6 Viral Infection 12 Vitamin Deficiency 24 N 22 16 8 8 Sum 493 169 86 341 Mean 22.4 10.6 10.7 42.6 SD 22.9 5.8 9.6 31.9 Sumsq 22139 2281 1570 21701 Variance 528.2 33.1 92.2 485.5

(SS-BG: 6330.8693; df: 3; MS: 2110.29; SS-WG: 19398.6307; df: 50; MS: 387.97; F: 5.44; p: 0.002572)

Table 2: Spread of Etiology Themes Discussed by Netizens.

There is obviously greater preoccupation of

the internet group members on

perceived/reported biological causes for

disorders on the autism spectrum (N: 22),

followed by environmental cases (N: 16) and

equally on sensory and diet based causes (N:

8) respectively. However, within these causal

domains, discussions on GFCF (Gluten Free

Casein Free) diet stands out as the most

discussed theme among all the supposed

causes of the netizens (N: 111; 10.19 %),

followed by chat about MMR vaccines (N: 99;

9.09 %), mercury toxicity (N: 78; 7.16 %), diet

disturbances (N: 67; 6.05 %), etc. On the

whole, the group is less attentive to remediable environmental and/or sensory issues related to

individuals on the autism spectrum. These

differences are also found to be statistically

significant (F: 5.44; p: <0.002).


94

(c) Treatment/Therapy Based Issues /

Transactions

Many members in the studied internet group

are apparently more interested on

treatment/therapy based issues (N: 1697) than upon etiology based concerns (N: 1089)

related to autism. Content analysis of available

transcripts revealed as many as 238 types of

key therapeutic or treatment related terms

being highlighted or discussed by the members

in the internet group. They are classified as

nutrition based therapies, sensory therapies,

education-behavior based therapies, Alternate

Medical Systems, bio-medical therapies, and

Instrument Based Therapies respectively.

Sl.no Category Types N Percent

A Nutrition-Diet Based Therapies

51 459 27.05

B Bio-medial Therapies 24 337 19.86

C Education-Behavior Based Therapies

40 287 16.91

D Sensory Therapies 50 199 11.73

E Alternative Medical Systems

40 189 11.14

F Medication/Drug Therapy

24 133 7.84

G Instrument Based Therapies

9 93 5.48

Total 238 1697

Table 3: Spread of Therapeutic Themes and Choices

Discussed by Netizens.

There are 51 subtypes of nutrition-diet based

therapies mentioned in the transcripts such as,

Almond, Aloe Vera Juice, Brown Barley, Brown

Rice Therapy, Calcium, Carbohydrate Diet, Cod

Liver Oil, EFA (Essential Fatty Acids) Therapy,

Feingold’s Diet Therapy, Feldenkraiz Therapy,

Fish Oil Therapy, Gluten and Casein Free Diets,

Multivitamin Therapy, No Phenol Diet, Omega-3 Fatty Acids, Rice Milk, Vitamin Therapy, Zeolite

Therapy, etc. About 50 subtypes sensory therapies

were discussed including, Animal Assisted

Therapies, Aroma Therapy, Arts Based Therapy,

Auditory Integration Therapy, Brushing Therapy,

Craniosacral Therapy, Dance Therapy, Deep

pressure, Deep Sound Therapy, Drum Therapy, Group Touching Therapy, Holding Therapy,

Hydrotherapy, Laughter Therapy, Movement

Therapy, Music Therapy, Phototherapy, Rolfing,

Swimming Therapy, Therapeutic Massage, etc.

Several education-behavior based therapies (N:

40) considered in the group discussions included

Applied Behavior Analysis (ABA), Assertiveness

Training, Biofeedback, Cognitive Behavior

Therapy, Conductive Education, Floor Time

Intervention, Discrete Trial Training (DTT), Early

Intensive Behavioral Intervention (EIBI), Face

Talk, Facilitated Communication, Family

Therapy, Family Focused Early Language

Approach Program, Home Schooling/Teaching,

Hypnotherapy, Portage Program, Prompt Therapy,

Relationship Development Intervention (RDI),

Social Skills Training, Verbal Behavior

Intervention (VBI), etc.

There is copious discussion in the group on

the pros and cons as well as possibilities or

potentials of about 40 different Alternate Medical

Systems in the treatment of autism. A few

examples of this category included Acupressure,

Acupuncture, Ayurveda, Biosys or Magnet

Therapy, Brain Gym, Chinese Medicine or

Quigong, Chiropractic Treatments, Dr. Oswal’s G

Therapy, Faith Healing, Hair Analysis and

Treatment Protocol, Homeopathy, Love Therapy,

Meditation, Miracle Therapy, Nature Cure,

Naturopathy, Neuro-Linguistic Program, Pranic Healing, Reiki, Siddha Medicine, Spiritual

Medicine, Tibetan Medicine, Unani, Yoga, etc.

Among the bio-medical therapies (N: 24) were

included in the discussions protocols or program to

treat Candida Albicans, Antibiotic Treatment,

Chelation, DAN Doctors, DMG, DMPS Therapy,

Detoxification, Fertility Treatment, Live Cell

Therapy, Maggot Debridement Therapy/

MDT/Larva Therapy, Stem Cell Therapy, etc.

Simultaneous discussions were carried out on the

experiences of interacting members related to their

use of various drugs/medications like Adderal,

Benedryl, Botox Injections, Carbamazepine,

Cucrumin, Pemoline, Encephebol, Learnol Plus,

Olanzapine, Mentat Tonic, Nystatin, Phenol

Injections, Piracetam, Prozac, Quetiapine,

Resperidol, Ritalin, Secretin, Senetin, Straterra,

etc.

There was exchange of information and

discussions between the denizens on Instrument

Based Therapies (N: 9), such as, Advanced

Biomechanical Rehabilitation, Electrical

Stimulation, Therapeutic Electrical Stimulation,

Foot Nerve Therapy, Light Sound Therapy,

Neurofeedback, Neuro-developmental Therapy,

Vibroacoustic Therapy, Video Therapy, etc.

Nutrition-diet based therapies (N: 459; 27.06 %)

was the most talked about theme of members in the internet group followed by discussions on bio-

medical therapies (N: 337; 19.86 %), education-

behavior based therapies (N: 287; 16.91 %),


95

sensory therapies (N: 199; 11.73 %), alternate

medical systems (N: 189; 11.14 %),

medication/drug therapy (N: 133; 7.84 %), and

instrument based therapies (N: 93; 5.48 %)

respectively.

Conclusions

In sum, the present study opens the internet,

web world and virtual reality as an increasingly

new or exciting vista/dimension for investigation

of social group dynamics in the field of disability

rehabilitation. Parents, caregivers and advocates

for the cause of children with special needs do not

merely exist in the real world alone. There is a

growing population of computer savvy service

providers as well as receivers with an equally

growing redoubtable knowledge base which seeks

to answer uncensored anything or everything one

wanted to know from the virtual world. However,

considering the expanse of themes and discussions on autism by the members in the studied virtual

group, it is seen that there is likelihood of one to

get lost in the quagmire of information overload

unless one is discerning in the quest for

understanding the continuing challenge and

enigma called autism.

References

Babbie, E. (2003). The Practice of Social

Research. Tenth Edition. Wadsworth:

Thomson Learning.

Bailey, D.B., and Simeonsson, R.J. (1988).

Assessing the Needs of Families with

Handicapped Infants. The Journal of Special

Education. 22.1.117-127.

Bailey, D.B., Blasco, P.M., and Simeonsson, R.J.

(1992). Needs expressed by mothers and

fathers of young children with handicaps.

American Journal of Mental Retardation.

97. 1-10.

Berelson, B. (1971). Content Analysis in

Communication Research. Glencoe: Free

Press.

Garshelis, J.A.., and Mc Connell, S.R. (1993).

Comparison of Family Needs Assessed by

mothers, individual professionals and

interdisciplinary teams. Journal of Early

Intervention. 17. 1. 36-49.

Gowen, J.P., Christy, D.S., and Sparling, J. (1993).

Information needs of parents of young children with special needs. Journal of

Early Intervention. 17. 2. 194-210.

Holsti, O.R. (1969). Content Analysis for the

Social Sciences and Humanities. New York:

Reading Mass.

Krippendorff, K. (2004). Content Analysis: An

Introduction to its Methodology. Second

Edition. Thousand Oaks: Sage Publications.

Peshawaria, R., Menon, D.K., Ganguly, R., Roy,

S., Pillay, R.P.R.S., and Gupta, A. (1995).

Understanding Indian Families Having

Persons with Mental Retardation.

Secunderabad: National Institute for the

Mentally Handicapped.

JAIISH, Vol. 27, 2008 Auditory Memory and Sequencing in Children

96

Auditory Memory and Sequencing in Children Aged 6 to 12 Years

1Devi N.,

2Sujita Nair &

3Asha Yathiraj

Abstract

Objectives: The study aimed to investigate auditory memory and sequencing ability in

typically developing children. The study also compared the performance of children

with suspected auditory memory problems with that of typically developing children.

Method: Using the Auditory Sequencing Test developed by Yathiraj and Mascarenhas

(2003), auditory memory and sequencing abilities were checked on ninety-six typically

developing children in the age range of six to twelve years. Ten children with learning

disability with suspected auditory memory problems were also tested. Results: The

results indicated that auditory memory scores increases with advance in age up to ten

years in the normal children, after which a plateau was obtained. There was no

significant difference across gender. Auditory sequencing ability was also found to

improve with increase in age up to seven years, after which a plateau was attained. A

significant difference was obtained for auditory sequencing abilities across gender in

two age groups, with the males out performing the females. Also the scores on the ten

children with suspected auditory memory problems, was compared with the obtained

data. Conclusions: The results revealed that the majority of children with learning

disability, who had indications of memory problems, were identified as having auditory

memory deficits. Hence, the obtained data on typically developing children can be used

to confirm the presence of auditory memory deficit. It could also be used to determine

the efficacy of management procedures on children with an auditory memory deficit.

Key words: Auditory memory, Auditory sequencing, Auditory processing disorder, Learning disability.

A (central) auditory processing disorder

[(C)APD] is defined as a deficit in the processing

of information that is specific to the auditory

modality, that may be exacerbated in unfavorable

acoustic environments and that may be associated

with difficulties in listening, speech understanding,

language development and learning (Jerger &

Musiek, 2000).

The underlying conceptual and philosophical

approach one has regarding auditory processing

disorders will determine the testing procedures

used for evaluation. The testing procedure can be

focused specifically on the auditory processing

disorder without the contamination of language,

memory, and attention. It can be nonlinguistic

stimuli, psychophysical methodology and / or

electrophysiological methods used for revaluation.

On the other hand, the difficulties experienced in everyday life situations involve various cognitive

processes that are intimately intervened to assess memory, attention and decoding (ASHA Task

force on Central Auditory Processing consensus

development, 1996; Jerger & Musiek, 2000).

(C)APD has been defined as a ‘deficit in the neural

processing of auditory stimuli that is not due to

higher-order language, cognitive or related factors’

(ASHA, 2005). The quality of one’s memory has

traditionally been characterized in terms of the

quantity of ideas or the number of aspects of

events that are recalled (Rhodes & Kelley, 2005).

Chermak and Musiek, 1997 have cited studies

providing information regarding memory in

children. These studies indicate different aspects

of the development of memory in children. They

report of a study by Howe and Ceci (1978), which

indicated that children gradually acquire

knowledge and appreciation of retrieval cues and

effective strategies for coding, organizing and

retrieving items in memory. In 1979, Howe and

1Lecturer, Dept. of Audiology, All India Institute of Speech and Hearing, Manasagangothri. Mysore-570006, email:[email protected], 2Audiologist, email:[email protected], 3Professor, Dept. of Audiology, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006


97

Celci reported that by age 6 years, most children

demonstrate some awareness of the limitations of

memory and the factors affecting memory. By age

8 to 10 years the children were found to

demonstrate a planned approach for encoding and

retrieval, becoming aware of mnemonics and their

benefits.

Locke (1968) has suggested that a

discrimination impairment seen in those with an

auditory processing disorder may be a byproduct

of or coexist with an auditory memory deficit.

Weisner, Tomblin, Zhang, Buckwalter,

Chynoweth and Jones (2000) have noted that

auditory memory deficits, seen in children with

learning disability, can be attributed to

phonological loop impairment. This in turn plays

an important role in the acquisition of vocabulary.

According to Cusimano (2001), students with

auditory memory deficiencies often experience

difficulty in developing a good understanding of

words, remembering terms and information that

have been presented orally. They also experience

difficulty in processing and recalling information that they have read to themselves.

Widely used measures of auditory memory

span involve the use of digits, words, sentences,

nonsense syllables, paragraphs and stories which

are to be recalled following a single presentation,

when the number of stimuli presented is increased.

The examiner tests the number of elements the subject is able to retain and retrieve (Underwood,

1964). However, there is a limit to the maximum

number of items that can be successfully

remembered in this way. An individual’s auditory

memory span is about 6 or 7 items (Roediger,

Knight and Kantouwitz, 1977; Jarold, Baddeley,

Heves, Leeke & Philips, 2004).

Cusimano (2001) opined that it is important to understand that each aspect of auditory memory is

specific unto itself. While one area of the brain

involves the intake of a series of unrelated letters,

another involves numbers, another word and there

are others that involve a contextual series of

words, sentences, and whole passages. Hence, students need to be tested to determine if they can

recall the number of items in a series proficiently

for their age.

Howe (1965) reported that if recall is

requested as soon as presentation of a list of items

is completed, the items that occur at the beginning

of the list are generally found to have become

more highly consolidated in memory than the

items that occurred later. Memory for the early

items in a list is more resistant than that for later

items to the disrupting effects of various activities.

According to Jarold et al. (2004) it also depends on

the nature of the to-be-remembered stimuli.

Auditory memory spans are smaller for words,

which sound alike or are phonologically similar

(example cat, bat and hat) than words, that are

phonologically dissimilar. In addition, spans are

shorter for multi-syllabic words, that are longer in

duration (example Helicopter and police man) than

for monosyllabic words, that are shorter (example

pig and shoe).

Owing to the fact that memory plays an

important role in spoken language processing and

learning, strengthening memory may benefit

individuals with a learning disability. In order to

detect the presence of auditory memory problems,

it is essential to evaluate children with an auditory

memory and sequencing test. The test should have

age appropriate norms to make accurate diagnosis and suggest the necessary rehabilitation strategy.

Absence of data in Indian children instigated the

present study. The study aims at obtaining age

appropriate data on auditory memory and

sequencing in typically developing children in the

age range of 6-12 years in both boys and girls. In

addition, it also aims at determining whether

children with suspected auditory memory

problems can be identified based on the data

obtained on normal children.

Method

The participants involved in the study

comprised of two groups. The study was

carriedout initially on 96 typically developing

children who were reported to have no academic

difficulties as reported by their teachers. Later 10

children with a known history of learning

disability were also evaluated to check the utility

of the test in determining auditory memory

problems. The 96 normal children were in the age

range of 6-12 years. The Screening Checklist for

Auditory Processing (SCAP) developed by

Yathiraj and Mascarenhas (2003) was

administered to rule out any auditory processing

disorder. These participants were divided into 6

age groups having 16 children in each group. The

age groups were 6 years – 6;11 years, 7 years –

7;11 years, 8 years – 8;11 years, 9 years – 9;11

years, 10 years – 10;11 years, and 11 years – 11;11


98

years. Of the 16 children in each group, 8 were

boys and 8 were girls. These children were taken

from primary and middle schools in Mysore city.

Children who passed the checklist and met the

following criteria were selected:

• Had English as a medium of instruction for at

least one year and were familiar with the

language,

• Had normal IQ based on Kaufmann

assessment battery for children,

• Had no history of hearing and speech

problems,

• No history of otological or neurological

problems,

• Hearing sensitivity within normal limits (i.e.

air conduction threshold of less than or equal to 15 dB HL in the frequency range of 250 to 8

kHz in both ears and air bone gap of less than

10 dB HL at any frequency),

• No report of speech identification problems

and,

• No illness on the day of testing.

The second group of participants also met the

same participant selection criteria as the first group

except that they failed the Early Reading Skills

Test (Rae & Pother, 1973) indicating that they had

learning disability. These children also obtained

less than 50% scores on the Screening Checklist for Auditory Processing (Yathiraj & Mascarenhas,

2003) necessitating further (C)APD evaluation.

Further, the children were included in the study

only if they failed on at least one item in the SCAP

that indicated the possible presence of a memory

problem.

Procedure

The ‘Auditory Sequencing Test’ developed by

Yathiraj and Mascarenhas (2003) was used as the

test material. In this Indian-English test, the length

of the word sequence increased from a three-word sequence to an eight-word sequence. Each

sequence group was referred to as a token. There

were 2 tokens in the 3 and 4 word sequences and 4

token each in all the other sequence (i.e. 5, 6, 7 &

8). The interval between words in each sequence

was 500 msec, while the interval between tokens

(i.e. between groups of words) was 10 seconds.

The testing was done in a quiet room that was

free from distraction. The signals were presented

at a comfortable level through a CD player

(PHILIPS AZ2160). Each child was tested

individually. The participants were seated one

meter away from the player at a zero degree

azimuth. Each child was instructed to listen to the

group of words and repeat them in the correct

order. The responses were recorded on a scoring

sheet. The children from both groups were tested

in a similar manner. A score of one was awarded

for every correct word that was recalled. An

additional score of one was awarded if the words

were recalled in the correct sequence. The

maximum attainable score was 104 for the

auditory memory subtest. Likewise a similar score

was attainable for the auditory sequencing subtest.

The raw scores obtained for the auditory

memory and the sequencing subtests were

tabulated across different age groups and gender.

Descriptive statistics was done to find out the

mean and standard deviation. ANOVA and

Duncan’s post hoc test were carried out to find out

the significance of difference between the scores.


The mean and standard deviation values of

the auditory memory subtest are depicted in Table

1 and that of the sequencing subtest are shown in

Table 2. This information is given for males and females, across the different age groups.

Tables 1, 2 reveal that with increase in age,

generally there was a steady increase in auditory

memory and auditory sequencing abilities. This

increase was more for the auditory memory than

for the auditory sequencing subtest. A similar

trend was seen in the males as well as females.

Male Female Age (in years) Mean* SD CI Mean* SD CI

6–6;11 42.12 5.59 37-47 54.37 7.24 48-61 7–7;11 57.37 10.64 48-67 60.00 7.83 53-67 8–8;11 61.62 4.95 57-66 58.12 6.72 52-64 9–9;11 68.37 7.68 61-75 57.37 10.35 48-67

10–10;11 74.00 8.33 67-81 61.87 5.43 57-67 11–11;11 73.00 4.37 69-77 70.37 10.37 61-81 Table 1: Mean Scores, Standard Deviation (SD) and

Confidence Interval (CI) of the Auditory

Memory Subtest across gender and age. *

Maximum score = 104


99

Male Female Age (in years) Mean* SD CI Mean* SD CI

6 – 6;11 22.12 7.98 15-29 25.12 10.13 16-34 7 – 7;11 32.75 9.31 24-41 27.25 7.75 20-34 8 – 8;11 33.37 10.47 24-43 23.62 3.50 20-27 9 – 9;11 34.25 9.96 25-43 26.87 8.21 20-34 10 – 10;11 43.37 16.93 29-56 27.37 5.26 22-32 11 – 11;11 39.00 5.07 34-44 33.75 12.05 23-45

Table 2: Mean scores, Standard Deviation (SD). and

Confidence Interval (CI) of the Auditory

Sequencing Subtest across age and gender. *

Maximum score = 104

The results of the one-way ANOVA test indicated that the auditory memory scores were

highly significant across the age groups [F (6, 96)

= 14.071, p < 0.001] but it was not significantly

different across gender [F (6, 96) = 1.078, p >

0.05]. However, auditory sequencing scores were

found to be significantly different across ages [F

(6, 96) = 3.316, p < 0.01] as well as gender [F (6,

96) = 10.32, p < 0.01]. Since there was a

significant difference, the Duncan’s post hoc test

was used. The results of the post hoc test on the

auditory memory scores and sequencing scores,

across age are given in Tables 3 and 4

respectively.

Age in Years

6-6;11

7-7;11

8-8;11

9-9;11

10-10;11

11-11;11

6-6;11 - 7-7;11 SD - 8-8;11 SD NSD - 9-9;11 SD NSD NSD - 10-10;11 SD SD NSD NSD - 11-11;11 SD SD SD SD NSD - Note: SD = significantly different, NSD = not significantly

different.

Table 3: Significance of difference between means for

the auditory memory subtest across ages.

From Table 3 it is evident that for the auditory

memory subtest, the 6 years olds had significantly

different scores when compared to all the older age

groups. Likewise, the oldest age group (11 years –

11; 11 years) differed significantly from the

younger age groups. In general, the older groups

did not differ significantly from the adjacent age

groups but did so from those who were one to two

years younger or older than them. It was generally

noted that as the children grew older their auditory

memory scores improved (Table 1). This

improvement was seen till age ten after which

there was a plateau in the responses.

Age in Years

6-6;11

7-7;11

8-8;11

9-9;11

10-10;11

11-11;11

6-6;11 - 7-7;11 NSD - 8-8;11 NSD NSD - 9-9;11 NSD NSD NSD - 10-10;11 SD NSD NSD NSD - 11-11;11 SD NSD NSD NSD NSD - Note: SD = significantly different, NSD = not significantly different.

Table 4: Significance of difference between means for

the auditory sequencing subtest cross ages.

In the auditory sequence subtest, the older

two age groups (10 years – 10; 11 years and 11

years – 11; 11 years) differed significantly from

the youngest age group (6 years – 6; 11 years).

There was no significant difference between the

other age groups (Table 4). However, there was a

steady non significant increase in scores with

advance in age, both in the male as well as female

participants, as can be seen in Table 2.

The ANOVA test revealed that there was no

significant difference across gender for the auditory memory subtest while it was present for

auditory sequencing subtest. Further analysis of

gender difference for the auditory sequencing for

different age groups was done using Duncan’s post

hoc test. The results revealed that this significant

difference was present only in two age groups (8

years – 8; 11 years and 10 years – 10; 11 years).

No significant difference was observed for the

other age groups. The gender difference probably

occurred due to individual variability. The males

in these two age groups had a higher standard

deviation and confidence interval when compared

to the females in the same age groups. Such variability was not seen for the other age groups.

This could account for the gender difference in

these two age groups.

Comparison between the scores of the two

subtests, auditory memory and sequencing, for

different ages showed that there was a significant

difference between them. In general it was noted that the auditory memory subtest resulted in the

children having higher scores when compared to

auditory sequencing subtest. Hence, it is

recommended that both the subtests be

administered and scored separately while

evaluating children.

It is highly possible that the processing of

auditory sequences takes place in one area of the brain while that of auditory memory taps another

area. This could account for difference in scores

obtained in the two subtests. This is similar to the


100

findings of Cusimano (2001) who noted that

different parts of the brain are responsible for

processing different aspects of memory.

The scores obtained by the ten children with

learning disability, who were suspected to have an

auditory processing problem were compared with

the age appropriate scores obtained. This was

done for the auditory memory as well as auditory

sequencing subtest. The scores obtained by the ten

children with learning disability are given in Table

5, Figures 1 and 2.

Case Age /Sex

Auditory Memory Scores

Auditory Sequencing

Scores

Interpretation*

1 7/F 35 13 Deviant 2 8;6/F 53 25 Not Deviant 3 9/M 74 43 Not Deviant 4 10/F 27 18 Deviant 5 11/F 56 17 Deviant 6 12/M 24 15 Deviant 7 12/M 36 18 Deviant 8 12/M 61 24 Deviant 9 12/F 34 15 Deviant 10 12/M 65 26 Deviant

*Based on the confidence interval given in Tables 1 and 2.

Table 5: Scores of the auditory memory and

sequencing subtests obtained by the

children with learning disability.

Figure 1: Comparison of Auditory Memory scores of

children with Learning Disability with age

appropriate norms.

Figure 2: Comparison of Auditory Sequencing scores

of children with Learning Disability with

age appropriate norms.

The result indicates that eight of the ten

children had deviant scores in auditory memory

and sequencing. Thus, it can be inferred that the

majority children with learning disability who

have indications of a memory problems based on

the SCAP, do have an auditory memory and

sequencing problem. However, not all of them

have such a problem. Based on this finding, it is

suggested that children with a learning disability

should be screened using the SCAP or any other

(C)APD screening checklist. Those showing an

indication of a memory difficulty should be

assessed for the presence of an auditory memory

or auditory sequencing problem. Appropriate

remedial steps should be provided for those who

are found to have deviant scores.

Conclusions

The present study has provided data on

auditory memory and sequencing for typically

developing children in the age range of 6-12 years.

The findings indicated that with an increase in age,

the children showed an increase in auditory

memory and sequencing abilities. The increase

was more significant for the auditory memory

subtest when compared to the auditory sequencing

subtest. No significant difference across gender

was observed for the auditory memory subtest. However, there was a significant gender difference

for the sequencing subtest in two of the age

groups. This difference was probably on account

of the large variability in scores that the males had

in these age groups.


101

It was also found that the test was useful in

determining whether children with suspected

auditory memory problems as determined through

a screening checklist do have an auditory memory

/ sequencing problem. The test results can be used

to make suggestions for remedial help for children

having deviant scores.

Thus, the test can be used for diagnosis of

auditory memory / sequencing problems in

children with suspected auditory memory

problems. In addition, it can be used to determine

the utility of management techniques in children

with auditory processing problems.

References

ASHA Task force on Central Auditory Processing

consensus development, (1996). Central

Auditory processing: current status of

research and implications for clinical

practice. American Journal of Audiology,

5(2), 41 – 54.

American Speech Language Hearing Association,

(2005). Roles of speech-language

pathologists in the identification, diagnosis,

and treatment of individuals with cognitive-

communication disorders: Position

statement. ASHA Supplement, 25.

Chermak, G. D., & Musiek, F. E., (1997). Central

Auditory Processing Disorder: New

Perspective. California: Singular

Publishing.

Cusimano, A., (2001): Auditory Memory, Learning

Disability: There is a Cure. Pennsylvania:

Achieve Publications.

Howe M. J. A., (1965). Learning and Human

Memory. In Howe, M.J.A., (Ed.) The

Psychology of Human Learning. New

York: Harper & Rou.

Howe M. J., Ceci S. J., (1978). Semantic

knowledge as a determinant of

developmental differences in recall. Journal

of Experimental child Psychology, 26, 230 –

245.

Jarold. C., Baddeley. A. D., Hewes. A. K., Leeke.

T. C., & Philips. C. E. (2004). What links

verbal short – term memory performance

and vocabulary level? Evidence of changing

relationships among individuals with

learning disability. Journal of memory and

language, 50, 134 – 148.

Jerger, J., & Musiek, F., (2000). Report of the

Consensus Conference on the Diagnosis of

Auditory Processing Disorders in School-

Aged Children. Journal of American

Academy of Audiology, 11(9), 467-474.

Locke, J., (1968). Discrimination learning in

children’s acquisition of phonology. Journal

of Speech and Hearing Research, 11, 428-434.

Rae, G., & Pother, T. C., (1973). Informal

Reading Diagnosis: A Practical Guide for

the Classroom Teacher. New Jersey:

Prentice Hall, Inc.

Rhodes M. G. & Kelley. C. M., (2005). Executive

processes, memory accuracy and memory

monitoring: an aging and individual difference analysis. Journal of memory and

language, 52, 578 – 594.

Roediger H. L. III, Knight J. L., & Kantowitz B.

H., (1977). Inferring decay in short – term

memory: The issue of capacity. Memory and

cognition, 5, 167 – 176.

Underwood B.J., (1964). The representativeness of

rote verbal learning. In A. W. Melton (Ed.): Categories of Human Learning. New York:

Academic Press.

Yathiraj, A., & Mascarenhas, K., (2003). Effect of

Auditory stimulation in Central Auditory

Processing in Children with central

Auditory Processing Disorder. A project

funded by the AIISH research fund, AIISH, Mysore.

JAIISH, Vol. 27, 2008 Regenerative Myringoplasty

102

Regenerative Myringoplasty – A Case Report

1Rajeshwari G. &

2Sundara Raju H.

Abstract

Dry perforation of the tympanic membrane cause hearing impairment and predispose the

middle ear to infections. Small dry perforations can be closed by chemical cauterization

using silver nitrate in an office setting. In a chemically induced myringoplasty all the

five layers of tympanic membrane would be present akin to the normal tympanic

membrane. It’s an effective means of tympanic membrane closure. In selected patients it

restores hearing back to normal and allaying the patient of a irritable symptoms like

tinnitus. It reduces the surgical waiting list. It also saves time and money for the patient,

surgeon and hospital. We present a case report of 35 year old male diagnosed to have

permanent perforation syndrome he was managed successfully in an office setting with

complete closure of the perforation restoring his hearing to normal.

Key words: Regenerative myringoplasty, Induction myringoplasty, Silver nitrate induced myringoplasty.

Perforations of tympanic membrane secondary to trauma or otitis media is an indication

for surgical repair of the tympanic membrane.

Surgical repair is a rule than exception. Dry

perforations can be successfully closed by

chemical means in an office setting in

appropriately selected cases. Such a conservative

managements saves the patient the risks of surgery

anesthesia and hospitalization.

Method and Results

A 35 year old male presented with history of

otohorrea, decreased perception of hearing and

tinnitus of left ear of six month duration. The

otohorrea responded to oral antibiotics and aural

drops. The decreased perception of hearing and

tinnitus persisted. Microscopic examination of his

1Reader, Dept. of ENT, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, email:[email protected], 2 Reader, Dept. of Otorhinolaryngology, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006

Table: 1

Perforation of the tympanic membrane

Normal tympanic membrane


103

left ear revealed a large central perforation

measuring about six millimeters in diameter that’s

about 3/5th of the surface area of the pars tensa.

No focus of infection was present in nasal cavity,

throat or paranasal sinuses. Tuning fork test

revealed conductive pathology on the left side.

The facial nerve, mastoid and vestibular system

was normal. Rest of otorhinolarynogological

examination, systemic examination and general

examination of the patient was normal. Patient

underwent an audiological evaluation, pure tone

thresholds showed.

Moderate hearing losses of conductive type

(Table 1) tympanogram shows B wave on the left

side, absent a acoustic reflexes on the left side, the

middle ear pressure and static compliance-no peak

attainable. However, the speech discrimination

scores was 95% on the left side. Routine

Haemotological investigations were within normal

limits and radiological examination of the

mastoids showed well pneumatised mastoids. A

diagnosis of chronic otitis media safe variety was made. In the second visit in a office setting 4%

topical xylocaine solution about 2 ml was used as

local anesthetic for the tympanic membrane.

Injection atropine was the only pre anesthetic

medication given. Ensuring ear was dry the rim of

the perforation was cauterized with a bead of silver

nitrate solution (2%). A paper patch soaked in anti

biotic solution was used to cover the tympanic

membrane perforation. The ear canal was packed

with anti biotic soaked merocel. The patient was

kept on a follow up at fortnightly intervals to

observe the regeneration of the tympanic

membrane. By 4 weeks microscopic examination

showed closure of tympanic membrane

perforation. After six weeks patient was sent for a

repeat audiological evaluation. Pure tone

thresholds had returned to normal with closure of

air bone gap, the tympanogram showed A type of

curves, acoustic reflexes had returned to normal,

patient confirmed subjective improvement in

hearing to almost normal and tinnitus had

disappeared.

Table 3

Discussion

Tympanic membrane perforations are of

special interest. Since its persistence can lead to

variety of problems like permanent perforation

syndrome, cholesteatoma tubo tympanic disease,

extra cranial complications of otitus media, intra

cranial complication of otitis media. The pars

tensa has five distinct layers, an outer most

epidermal layer, a thin dermis of fibrous tissue, an

outer radiate fibrous layer, an inner circular fibrous

layer and a mucousal layer. A perforation closure

induced by a repeated acid cautery of its rim often

results in a perfectly normal appearing, tympanic

membrane possessing all the five layers. Whereas,

spontaneous closure is only 2 layered devoid of

fibrous layer giving rise of thin tympanic

membrane. 3 guiding principles promote healing

of tympanic membrane perforation by chemical

cauterization.

i. The edges of tympanic membrane perforation

lined by statifed squamous epithelium which

prevent spontaneous closure of perforation

must be destroyed to permit fibro blastic

proliferation of the fibrous layer.

ii. The rim of the perforation must be kept moist because drying would caused death of the

young fibro blast.

iii. The edges of the perforation must be bleeding

since hyperemia induces fibro blastic

proliferation.


104

Regenerative myringoplasty must be

attempted in a perforation not involving more than

65% of the surface area of the pars tensa.

Derlacki, who has reported the largest series of

chemical cauterization of tympanic membrane

perforation about 75% of 131 perforations

recovered. Repeated cauterization may be

required in few cases. Induction myringoplasty

may not be recommended in the following

conditions.

1. Large perforation involving more than 65%

of the surface area of the pars tensa.

2. Narrow external auditory canal preventing view of the anterior edge of the perforation.

3. Patient who refused series of weekly

treatment.

4. When ingrowth of epidermis is suspected of

forming an incipient or active cholesteatoma.

Conclusions

For the central perforation of the tympanic

membrane measuring about 2 - 6 mm in diameter

without a middle ear/mastoid disease, inductive

myringoplasty can be attempted. The healing

which is promoted by such induction would result in formation of all the layers of tympanic

membrane and this would result in normal hearing

post procedure. Since it’s an office procedure

done under local anesthesia, the patient is saved

from the risk of general anesthesia hospital stay,

hospital cross infections and cost of the

hospitalization. For the surgeon it reduces the

surgical waiting list.

References

Derlacki, E.C. (1958). Repair of Central

Perforation of Tympanic Membrane, Arch

Otolaryngol, 58, 405-420.

Goldman, N.C. (2007). Chemical Closure of

Chronic Tympanic Membrane Perforations.

ANZ Journal Surgery, 77(10), 850 – 851.

Glasscock, M. E., Shambaugh, G. E. (1990).

Surgery of the Ear, 4th. Edition. Canada

:BC Decker.

Wolferman, A. (1970). Reconstructive surgery of

the middle ear. New York: Grune &

Stratton.

Scott- Brown, W.G. (1996). Scott Brown: Otology 6th Edition.Oxford: Butterworth-

Heinemann.

JAIISH, Vol. 27, 2008 Universal Hearing Screening

105

Guidelines to Establish a Hospital Based Neonatal Hearing

Screening Program in the Indian Setting

1Ramesh A.,

2Nagapoornima M.,

3Srilakshmi V.,

4Dominic M. &

5Swarnarekha

Abstract

The challenges to implement universal neonatal hearing screening (UNHS) in India are

limited funding, manpower shortages, inadequate support services, low public

awareness and uncertainty regarding commitment from health care practitioners.

Nevertheless there are isolated groups in India who have been implementing UNHS. St.

John’s Medical College Hospital, Bangalore has been implementing UNHS since

September 2002. Till date we have screened 5100 neonates. In this article we detail the steps we followed to establish the program and make it a standard of care in our

hospital. A qualitative design is used to describe every stage. A team consisting of faculty

from Neonatology, Audiology and speech Pathology, Otorhinolaryngology, Child

psychology and Medico-Social work constituted the screening team. Due to a high birth

rate the strategy we followed was as follows. All infants not at risk were screened by

behavioural audiometry using 60 and 70 dB warbled tones. The infants at risk were

screened by a two stage otoacoustic emissions (OAE) screening as well as behavioural

audiometry. As a safeguard against false negatives of our strategy all the infants

irrespective of the results were given a language and hearing milestone chart for parents

to report if the age appropriate milestone was absent. Screening in the NICU caused a

lot of referrals so it is best avoided . If a sound proof room is available adjacent to the

NICU it would be ideal. In our experience a pilot program should be run for at least one

year to get an idea of the inputs required as well as aid in formulating a screening

strategy. At regular intervals an audit should be conducted and the data published in

indexed journals so that others who want to start UNHSP can benefit. Also a national

dataset should be collated based on these data to guide institutions to initiate similar

programs so that not a single hearing impaired child in this country is neglected.

Key words: Neonatal hearing, Screening program, Behavioral audiometry.

The 2007 statement of Joint committee on

Infant Hearing (JCIH, 2007), American Academy

of Pediatrics states that every state in the United

States of America has a Universal Neonatal Hearing Screening Program (UNHSP) and 95 % of

the new borns are screened before discharge from

the hospital.(JCIH , 2007).In India we have a long

way to go before we can reach this goal. Limited

funding, manpower shortages, inadequate support

services, low public awareness and uncertainty

regarding commitment from health care

practitioners are the challenges in a developing

nation like India.(Olusanya BO et al,

2004).Nevertheless there are isolated groups in

India who have been implementing UNHS.

(Nagapoornima et al 2007 ; Malik M et al 2007 ,

Mathur NN et al , 2007). St. John’s Medical

College Hospital, Bangalore has been

implementing UNHS since September 2002. Till

date we have screened 5100 neonates. We have

published our work in a Pub Med/Medline indexed journal and cited an incidence of 5.6 hearing

impaired neonates per 1000

screened.(Nagapoornima et al 2007).This article

details the steps we followed to establish the

program. Also discussed is the logistics of running

the program so that it is an established standard of

care in our hospital. This information can be used

by other hospitals to adapt these guidelines and

1Associate Professor, Dept. of Otolaryngology Head and Neck surgery, St John’s Medical College Hospital , Bangalore-560034, email:lavirams @ yahoo.com, 2Audiologist and Speech Pathologist, St John’s Medical College Hospital , Bangalore-560034, 3Audiologist and Speech Pathologist, St John’s Medical College Hospital , Bangalore-560034, 4Professor, Community medicine, St John’s Medical College Hospital , Bangalore-560034, 5Professor, Pediatrics, St John’s Medical College Hospital , Bangalore-560034.


106

implement UNHS.

The UNHSP at our hospital commenced on

September 1, 2002. It has been functional for the

last 6 years. The description of the work has been

examined in four major steps.

1. Establishing a case for UNHSP.

2. Building a UNHS team.

3. Initial pilot run for 2 years.

4. Establishing a full fledged UNHSP.

A qualitative design is used to describe every

stage. We start every stage with description of the

technique followed by us and the limitations of the technique. The results are discussed in the light of

the JCIH, AAP, 2007 statement which

comprehensively summarises the state of UNHSP

around the world. We have concluded by putting

forth guidelines which could be adopted by

various hospital based institutions.

Creating a case for UNHS

On January, 2002 a seminar was organized at

our hospital to review the state of pediatric

audiology in India. Faculty from the specialities of

Pediatrics, Audiology and Speech Pathology,

Otolaryngology, Child Psychology, Community

medicine and Medicosocial work participated in

the seminar. At the end of deliberations it was felt

that the incidence of hearing impairment from

Indian and western literature warrants

commencement of UNHS in our hospital. One

faculty member from each speciality volunteered

to participate in the program if it was established.

There was a consensus to write up a proposal for

submission to the hospital management. We felt it

would be practical to run a pilot program for 2

years using a hired Otoacoustic emission (OAE)

screener. Accordingly a proposal was drawn up

and placed before the management for approval.

On July, 2002 the executive council of the institute

granted permission to start UNHS using a hired

OAE screener from SRC Institute of Speech and

Hearing, Bangalore.

Building a team

On August, 2002 a meeting of the faculty

members who volunteered to participate in

UNHSP was convened. The following speciality

members formed the team. Neonatology, Audiology and Speech Pathology,

Otorhinolaryngology, Child Psychology and

Medico-Social work. At the end of the meeting

each team member’s job description was defined.

Neonatologist

� Counsel parents for hearing screening and take

consent.

Otolaryngologist

� Examines the external auditory canal for any

abnormalities that may cause a false positive

result on OAE Screening.

Audiologist and Speech Pathologist:

� Performs OAE screening and Auditory

Brainstem Response (ABR) as per the protocol

shown in figure 1.

� Follows up the screening passed, not at risk

infants at 1 year of age and at risk infant at 6

months and 1 year of age. Receptive

expressive emergent language scale (REELS)

was the tool used to assess age appropriate

language development.

Figure 1: Protocol used to screen for hearing impairment in neonates at St John’s Medical

College, Bangalore


107

� Arranges for appropriate rehabilitation of

hearing impaired infants.

Child Psychologist

� For grief counseling and preparing the parents

to be active partners if rehabilitation is

required.

Medicosocial worker

� Ensuring adequate follow up of the infants and

contact infants who miss the appointment.

It is crucial to ensure that each member chose

to be part of the team. This made managing the

work responsibilities easy. There was no extra

incentive for the additional work that was taken up

by each member.

Establishing a pilot run

The logistics of establishing a pilot program

at our hospital were the following:

� Signing of a memorandum of agreement with SRC Institute of Speech and Hearing to hire

their OAE screener and staff for 2 hours a

week. A charge of Rs. 110 was levied for two

OAE screens. St. John’s Hospital collected the

amount and reimbursed to SRC Institute on a

monthly basis.

� Neonates in the NICU who were at risk based on the JCIH, 2000 were screened. Screening

was done in the NICU for one year. As the

number of referrals for second screen was very

high, due to unacceptable noise levels in the

NICU, after one year we shifted the venue of

screening to ENT OPD. The referrals for

second OAE screen reduced considerably after

this but we missed a lot of babies to follow up.

� We followed a screening protocol adapted

from JCIH, 2000. Our strategy consisted of a

two tiered OAE screen. The first screen was

completed by 6 weeks of birth and the second

screen by 3 weeks if the first screen failed.

� For a period of 6 months a hand held screener

donated by Voita Institute, Germany was used

to screen not at risk infants.

� The data recording details are described as a

separate subheading.

At the end of the pilot program for 2 years,

the data was presented to the management team

consisting of the hospital administrator and heads

of the departments involved in the program. The

issue of purchasing an OAE screener for the

hospital was discussed at the executive council

meeting. Partial funding was promised by

Christoffel Blinden Mission (CBM), a charitable

funding agency. On July 2004, the administration

approved purchase of ILO USB – I, OAE analyzer.

From January 2005, we commenced universal

hearing of all infants seeking care at our hospital.

Implementation of universal neonatal hearing

screening

The logistics of the program in our hospital is

as follows:

� The protocol for screening was altered because

we could not do OAE testing of all the

neonates. All not at risk infants were screened

by behavioural audiometry using 60 and 70 dB warbled tones. Behavioural response index

was used to standardize the response. The at-

risk infants were screened by OAE as well as

BOA. All the at risk infants who passed were

followed up at 6 months and one year to

examine for age appropriate hearing and

language milestones. Infants who had disability were rehabilitated. Children with

multiple disabilities were asked to follow up

on Wednesdays where a multispeciality

rehabilitation team provided a single window

service for physical, mental, visual and

hearing disability. This service called the Unit

of Hope provides highly subsidized care for

children with multiple disabilities. Hearing

aids are procured directly from the company

and provided at a much lower cost than

maximum retail price (MRP).

� Every 6 months an internal audit was

conducted by the person co-ordinating the

program to evaluate the performance and

compare it with JCIH 2000, recommended

parameters.

� All the data was collected and published in a

Pub Med indexed journal in 2007 for the

benefit of other groups in India, wanting to

start similar programs.

Data recording

Initially from 2002 to 2004 all the data was

recorded in a proforma (Appendix – 1) over a 2

year period. At the end of two years we realized


108

that the records were occupying a large amount of

space. To reduce this we made a register with all

the details printed in columns.

By this method we reduced the space

requirement by 90 %. The alpha numeric data was

coded and entered in another register. This was

entered in MS – Excel spread sheets in the

computer. Statistical package for social sciencers

version 15 (SPSS) was used to perform statistical

analysis.

Establishing a hospital based universal neonatal

hearing screening program – Lessons learnt

from St. John’s program.

The absence of any data on sensitivity and

specificity of OAE data in the Indian setting was a

major handicap in the initial stages of establishing

our program. Studies from the European and

American programs were used to formulate our

initial strategies for screening. Our stumbling

block was the large number of neonates to be screened due to a high delivery rate. The western

UNHSP did not have this scenario. We altered our

strategy of screening in the NICU to screening at

first visit or before discharge. Also we screened

not at risk neonates by behavioural audiometry to

cope up with high delivery rate. To avoid missing

out on false negative screens and delayed onset hearing loss, we adopted a strategy to follow up at

6 months and one year.

Our learning regarding data management was

that custom made registers were more easy to

maintain and occupied lesser space compared to

proforma sheets.Regarding follow up of screened

neonates we discovered that about 60 % of our

screened neonates were lost to follow up. This

rate, especially in the at-risk failed neonates is

alarming. Even in American screening programs

loss to follow up is upto 50 % in some centers. We

are in the process of improving on our follow up

rates by employing a person exclusively to ensure

follow up. Another measure we have incorporated

is to give a follow up card to the mother which

will outline the main milestones of hearing

development. This we intend will aid in adequate

follow up and detection of late onset hearing loss.

Universal neonatal hearing screening initiatives

in India – Need to publish in indexed journals.

UNHSP is in its embryo stage in India. A Pub

Med search using the key words “infant / neonatal

hearing screening in India” revealed only 11

articles. In 1990, a major initiative was undertaken

to review the state of pediatric audiology in India

during a workshop conducted by All India Institute

of Medical Sciences, New Delhi. The workshop

highlighted the findings of a large scale

multicenter survey conducted with the support of

Indian Council of Medical Research (ICMR) as

well as work of other researchers involved in

pediatric audiology. Following this there were no

published reports till 2002. Since 2002 there have

been isolated small scale observational studies. In

2002 a national consensus building workshop was

organized at All India Institute of Speech and

Hearing, Mysore to frame guidelines to establish a

national program for early detection and

rehabilitation of hearing impairment. Following this there has been a report of normative data for

TEOAE in Indian children. The year 2007, saw

two reports of large scale screening exercises in

indexed literature. The report from New Delhi

discussed strategy of screening after 6 weeks to

reduce referrals. A report from Bangalore,

examined the incidence data in a large neonatal population.

Though some groups in Chennai and

Trivandrum and Mumbai have been involved in

neonatal screening there is no published reports

from these centres.All the groups involved in this

work should publish their data so that a database

can be created for India. This will assist future

program to benefit from the experience of these

groups.

Conclusions

We have put forth the following guidelines

for tertiary care hospitals in the non governmental

sector who wish to start UNHSP.

1. A team consisting of faculty from

Neonatology, Audiology and speech

Pathology, Otorhinolaryngology, Child

psychology and Medico-Social work should be

constituted. Each member should choose to

contribute to the program. The job description

of each member should be defined at the

outset.

2. A pilot program for at least one year will give

an idea of the inputs required from the

management as well as help in formulating a

screening strategy.

3. A two stage OAE screen with first screen at the first follow up visit to the hospital is more

effective for at risk infants. Screening in the


109

NICU causes a lot of referrals so it is best

avoided as a venue for screening. If a sound

proof room is available adjacent to the NICU

it would be ideal.

4. At the outset of the program a dataset should

be formulated. A hard copy as well as soft

copy of the data should be created and

regularly updated. A register with columns for

all the details and rows for each case is more

space efficient compared to proformas.

5. At regular intervals an audit should be

conducted and the data published in indexed

journals so that others who want to start

UNHSP can benefit. Also a national dataset

can be collated based on these data.

References

Joint committee on infant hearing screening (2007)

Position statement. Pediatrics Vol 120 (4),

898 – 921.

Malik, M., Pradhan, S.K, Prasana, J.G, (2007).

Screening for psychosocial development

among infants in an urban slum of Delhi.

Indian J Pediatr, 74 (9), 841 – 5.

Mathur, N.N, Dhawan.R (2007). An alternative

strategy for universal infant hearing

screening in tertiary hospitals with a high

delivery rate within a developing country

using transient evoked otoacoustic

emissions and brainstem evoked response

audiometry. The Journal of Laryng and

Otol, 121, 639 – 643.

Nagapoornima,M., Ramesh,A., Srilakshmi,V.,

Suman Rao P. N, Patricia P L, Madhuri

Gore, Dominic M, Swarnarekha (2007).

Universal hearing screening . Indian Journal

of Pediatrics, 74(6), 545 – 549.

Olusanya BO, Luxon LM, Wirz SL ( 2004)

Benefits and challenges of new born hearing

screening for developing countries. Int J

Pediatr Otolaryngol. 68(3), 287 – 305.


110

Annexure 1

Dataset of St John’s Neonatal Hearing Screening Program

Name : Sex : DOB :

Duration of NICU stay :

Number Neonatal : Birth weight :

Gestation :

Hospital :

Address : Phone number :

Risk factors : 1.Hereditary hearing loss :

2.Ear deformities :

3.Hypoxic ischaemic encephalopathy : Y/N

APGAR: 5 mts - 10 mts- Bag Mask Ventilation : Y/N Endotracheal and ventilation : Y/N

4 .Duration of Medications - Genatmycin : Amikacin : Furosemide :

other ototoxic medications :

5. Infection : Sepsis - Y/N Meningitis : Y/N

6.Hyperbilirubinemia: Peak level : Duration: Phototherapy:Y/N ExchangeTransfusion:Y/N

7. Pre term : Y/N LBW : Y/N SFD/IUGR:Y/N

Method used to screen Date Result

OAE : First screen

: Second screen

BOA

ABR

Maternal Problems

Natal History Delivery : Home / Hospital

: Normal/Breech/Caesarean/Forceps

Family History

Type of family : Nuclear/Joint :

Consanguinous marriage :

Literacy of : Father

: Mother

JAIISH, Vol. 27, 2008 Reversible Sudden Sensory Neural Hearing Loss

111

Reversible Sudden Sensory Neural Hearing Loss – A Case Report

1Sundara Raju H. &

2Rajeshwari G.

Abstract

Idiopathic sudden sensorineural hearing loss is a clinical diagnosis characterized by a

sudden deafness of cochlear or retro cochlear origin in the absence of clear

precipitating factor. Most often it is taught irreversible. If it is identified early and

medical intervention is done it shows a good prognosis. Factors affecting prognosis

include age, presence of vertigo, unilateral or bilateral pathology, associated systemic

diseases and time duration between the onset of symptoms and treatment. The main stay

of treatment includes corticosteroids, anti-inflammatory drugs, neurovitamins,

antioxidants, carbogen therapy and adequate control of systemic illness. Sudden Sensori

Neural Hearing Loss through rare it is one of the medical emergency in otologists

practice. Intra tympanic injection of steroids is one of the common accepted methods of

management. I am a reporting a case of sudden sensori hearing loss where oral steroid

therapy is also equally effective in certain cases if the hearing loss is unilateral and if the

patient is of younger age group and if the patient is without any systemic illness.

Key words: Sudden sensory neural hearing loss, Reversible sensory neural hearing loss, Calorie test, Steroids.

Idiopathic sudden sensorineural hearing loss

(ISSHL), characterized by new-onset unilateral or

bilateral hearing loss that develops rapidly within

24 to 72 hours, remains a diagnostic and

therapeutic challenge for the clinician. The cause

and pathogenesis of ISSHL remain unknown.

Proposed theories of the pathogenesis of ISSHL

include viral cochleitis (1), vascular occlusion (2),

and membrane breaks.

Definitions of sudden hearing loss have been

based on severity, time course, audiometric criteria, and frequency spectrum of the loss. A

commonly used criterion to qualify for the

diagnosis is a sensorineural hearing loss of greater

than 30 dB over 3 contiguous pure – tone

frequencies. The vast majority of cases of sudden

hearing loss are unilateral, and the prognosis for

some recovery of hearing is good. Usually sudden

sensory neural hearing loss presents as unilateral

loss of hearing, bilateral involvement is rare and

simultaneous bilateral involvement is very rare.

This case is reported to stress the importance

of oral steroid therapy in certain cases of unilateral

sensori neural hearing loss in younger age group

without any systemic illness.

Methods and Results

A 35 year old male presented with a history of

sudden hearing loss in the right side 2 days

duration. He had associated symptoms of

Tinnitus, Vomiting, Headache, Numbness in the

right side of the face.

Hearing loss sudden onset and static in nature

Patient did not have any prior history of ear

discharge, ear pain. Patient had tinnitus which was

intermittent and low pitched.

• There is no history of acoustic trauma,

hypertension, diabetes, drug intake for the

past one week.

• No history of upper respiratory infection.

On examination patient is anxious about the

problem of sudden hearing loss.

• Pulse 82/minute

• Blood pressure 130/86 mm of hg

• Systemic examination – NAD

ENT examination reveals both the tympanic

membranes are normal with all the normal land

marks.

1Reader, Dept. of Otorhinolaryngology, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, 2Reader, Dept. of ENT, All India Institute of Speech and Hearing, Manasagangothri, Mysore-570006, email: [email protected].


112

• Pre aural and post aural region normal.

• Mastoid region normal.

• Facial nerve intact and normal.

• A tuning fork test reveals right sided

sensory neural hearing loss.

• Caloric test were normal.

Hematological investigations - HB %, Blood

total count, Differential count, RBS, Serum cretin,

Blood urea, were within normal limits.

• x-ray of the both mastoids were well

pneumatised and appears normal

Audiological evaluations

• PTA reveals moderate to severe sensory

neural hearing loss right side with

maximum affections in the mid

frequencies

• SIS less than 60%

• Impedance was normal with a type

tympanograph with absent of acoustic

reflex(table 1)

• ABR normal way morphology with

normal interpeak latency.

• Recruitment

Table 1

In office setting patient was treated on tablet –

Methyl Prednisolone 1 mg/kg body weight in 3

divided doses for a period of 2 weeks.

• Peripheral vasodilators like cinnarizine 25

mg was also given for 4 weeks.

• A non steroidal antiinflammtory was also

given.

• Vitamine B complex and alongwith anti

oxidents were prescribed.

• Patient was advised on low salt diet.

Neurological opinion reveals no neurological

deficits. 2 weeks later patient felt 70%

improvement in the symptoms of hearing loss and

tinnitus. Methyl Prednisolone was given on

tapered dose for another 2 weeks. All the other

drugs were continued for 2 more weeks.

After one month patient felt completely normal in his symptoms.

Audiological evaluations were done again

after one month and was revealed normal hearing.

(Table 3)


113

Table 3

Discussion

Pathophysiology

The postulated pathophysiology for idiopathic sudden sensory hearing loss (ISSHL) has 4

theoretical pathways. These are labyrinthine viral

infection, labyrinthine vascular compromise,

intracochlar membrane ruptures, and

immunemediated inner ear disease. A disease

process involving any of these theoretical

possibilities could have sudden hearing loss as a symptom. Each theory may explain a fraction an

episodes of sudden sensory hearing loss, but none

of the existing theories individually could account

for all episodes.

Viral infection

The evidence to implicate viral infection as

one of sudden idiopathic sensory hearing loss is

circumstantial. Studies of patients with ISSHL

show a moderate prevalence of recent viral – type

illness. Sometimes, evidence of recent viral

seroconversion inner ear histopathology consistent

with viral infection is present.

Vascular compromise

The cochlea is an end organ with respect to its

blood supply, with no collateral vasculature.

Cochlear function is exquisitely sensitive to

changes in blood supply. Vascular compromise of

the cochlea due to thrombosis, embolus, reduced

blood flow, or vasospasm seems to be a likely

etiology for ISSHL. The time course correlates

well with a vascular event, a sudden or abrupt loss.

A reduction in oxygenation of the cochlea is the

likely consequence of alterations in cochlear blood

flow. Alterations in perilymph oxygen tension

have measured in response to changes in systemic

blood pressure or intravascular carbon dioxide

partial pressure (pCO2).

Conclusions

Young patients with no systemic illness and

unilateral sensory neural hearing loss will have

better prognosis. This case is reported because of the treatment protocol was taken up at office base


114

setup without any admission of the patient and

without any administration of the injections.

We know that parentral use of steroids is the

established protocol for the sudden sensory neural

hearing loss. In this study we are reporting a case

of oral steroid therapy is also equally effective in

certain cases if the hearing loss is unilateral, and if

the patient is without any systemic illness and

younger age group patients.

References

Wilson, W.R., Byl, F.M., & Laird, N.(1980). The

efficacy of steroids in the treatment of

idiopathic sudden hearing loss. A double

blind clinical study. Arch Otolaryngol,12,

772-776.

Moskowitz, D., Lee, K.J., & Smith, H.W. (1984).

Steroid use in idiopathic sudden

sensiorineural hearing loss. Laryngoscope,

94(5 Pt 1), 664-666.

Kitajiri, S., Tabuchi, K., & Hiraumi, H. (2002). Is

corticosteroid therapy effective for sudden – onset sensorineural hearing loss at lower

frequencies. Arch Otolaryngol Head

NeckSurg , 128, 365-367.

Chen, C.Y., Halpin, C., & Rauch, S.D.(2003).

Oral steroid treatment of sudden onset

sensorineural hearing loss: a ten year

retrospective analysis. Otol Neurotol, 24,

728-733.

Van Dishoeck, H., & Bierman, T. (1957). Sudden

perceptive deafness and viral infection

(report of the first one hundred patients).Ann

Otol Rhinol Laryngol , 66, 963-980.

Rasmussen, H. (1949).Sudden deafness. Acta

Otolaryngol, 37, 65-70

Schuknecht, H.F., & Donovan, E.D (1986).The

pathology of sudden deafness. Arch

Otolaryngol, 243, 1-15

Yoon, T. H., Papirella, M.M., Schachern, P.A., &

Alleva, M. (1990). Histopathology of

sudden hearing loss. Laryngoscope, 100, 707-715.

Pitkaranta, A., Vasama, J.P., & Julkunen, I.

(1999). Sudden deafness and viral

infections. Otorhinolaryngol Nova, 9, 190-

197.

Tucei, D.L., Farmar, J.C., Kitch, R.D., & Witsell,

D.L. (2002). Treatment of sudden

sensorineural hearing loss with systemic steroids and Valacyclovir. Otol Neurotol,

23, 301-308.

Scheinman, R.I., Cogswell, P.C., Lofquist, A.K.,

& Baldwin, A.S. (1995). Role of

transcriptional activation of I kappa B alpha

in mediation of immunosuppression by

glucocorticoids, Science, 270, 283-286.

Scheinman, R.I., Gualberto, A., Jewell, C.M.,

Cidlowski, J.A., & Baldwin, A.s.(1995).

Characterization of Mechanisms involved

in transrepression of NF – kappa B by

activated glucocorticoid receptors. Mol Cell

Biol, 15, 943-953.

Journal of All India Institute of Speech & Hearing (JAIISH)

"Instructions to Authors"

Submission of Manuscript: Authors should submit three hard copies of the manuscripts (as per the

instructions given under "Submission of Manuscript") along with a soft copy on a CD to the

Director/Editorial Chief, All India Institute of Speech and Hearing, Manasagangothri, Mysore – 570006.

Title page: Title page must be submitted as a separate page. The title page should include (a) complete

manuscript title; (b) authors' full names, highest academic degree, and present affiliations; (c) name and

address for correspondence, including fax number, telephone number, and e-mail address of the

corresponding author.

Abstract and key words: The abstract containing not more than 300 words must be submitted in a

separate page. It should contain the following information: The objectives of the study; the method of the

study; the main results of the study and; the conclusions of the study along with clinical implications or

applicability. Three to five key words should be provided below the abstract. Authors should follow APA

conventions with regard to use of units, symbols and abbreviations.

Text: The text should be organized under the following main headings: Introduction, Method/s, Results,

Discussion, Conclusions and References. Abbreviations should be expanded at the first mention in text.

Manuscript Style: Manuscripts that do not adhere to the following instructions will be returned to the

corresponding author for technical revision before undergoing peer review.

The manuscript should be prepared based on the following guidelines:

. The matter should be in English.

. Microsoft Word is the required file format for the text of the manuscript.

. Set all margins to 1 inch

. All text, including abstracts, references, figure legends, etc., must be 1½ line spaced. Use Times

New Roman font at 12 point. Justify the text.

. The material should be sent in A4 size paper.

. Use tab key and centering functions to align headings, paragraph indents etc. Do not use space

bar.

. Headings must be used to designate the major divisions of the paper.

. Number the pages consecutively in the upper right hand corner.

. All spellings should be checked for UK spelling

. Use IPA to represent material in languages other than English

. The overall length of the paper should not exceed 20 A4 size pages.

References: All the references cited in the text should be included in the reference list. Conversely, each

entry in the reference list must be cited in text. The references should be listed alphabetically without

numbering. References should be written as per the latest APA format (5th edition). Acknowledgements

should be at the end of the text.

Figures: The figures should be numbered in the order in which they are discussed, using Arabic

numbers. All figures should have brief legends included at the bottom. Figures should also be provided

separately in jpeg format (should not be in word file) in addition to those provided in the text of the article.

Tables: The tables should be numbered in the order in which they are discussed using Arabic numbers.

All tables should have brief legends included at the bottom.

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