Purpose: This scoping review aimed to map existing research on characteristics of developmental language disorder (DLD) in adults and describe this body of research. Furthermore, assessment practices used to identify adults with DLD in the included studies were investigated. Method: A broad search was conducted across three international research databases to identify all peer-reviewed studies on DLD in adults from 1990 onward. The identified studies were collated and presented through numeric and thematic analyses. The numeric analysis comprised the categories publication period, location and language, research groups, main topic, and DLD terminology. The thematic analysis covered group identification, characteristics of language ability, domain-specific and domain-general cognitive characteristics, and biological characteristics. Results: Though the search was inclusive and spanned 35 years, only 53 studies were identified. Results supported that DLD persists in adulthood and is associated with difficulties in language ability, as well as cognitive and biological characteristics, often recognizable from child studies. There are concerns related to diversity and geographical spread in the research community. Research output over time is modest. Conclusion: There is considerable heterogeneity in the research base, making it difficult to draw firm and specific conclusions, illustrating a clear need for further research on DLD in adults.
Purpose: This review describes the historical motivations, development, and evolution of the Communication Bridge (CB) research program, which is designed to maximize quality of life and minimize burden for individuals living with dementia and their communication partners. The CB trials described comprise a series of dyadic, nonpharmacologic interventions supporting individuals with primary progressive aphasia (PPA) and their communication partners. Across trials, the CB intervention integrates speech-language, educational, and psychosocial approaches to maximize communication participation, confidence, and self-efficacy. Method: The CB trials are contextualized within the National Institutes of Health (NIH) Stage Model for Behavioral Intervention Development and the Readiness Assessment for Pragmatic Trials (RAPT) framework to illustrate a systematic pathway from feasibility to implementation readiness. Three sequential telehealth-delivered trials are described: CB1, a pilot feasibility study; CB2, an international randomized controlled trial (RCT); and CB3, an ongoing international RCT designed with clinical practice-aligned procedures to advance readiness for future implementation testing. Results: Application of the NIH Stage Model and the RAPT framework highlights how staged intervention development can support rigor, reproducibility, and implementation readiness in behavioral intervention research for neurodegenerative conditions. Across trials, person-centered outcomes demonstrated meaningful benefit and maintenance over time, while iterative design refinements addressed feasibility, fidelity, acceptability, and scalability. Conclusions: The CB research program illustrates how implementation science frameworks can be applied to advance meaningful, dyadic interventions for PPA toward real-world use. Lessons from early-phase trials underscore the importance of person-centered outcomes, staged rigor, and early attention to implementation considerations, with implications for future PPA intervention research and broader speech-language clinical trials.
Purpose: Understanding how to optimize verb-learning contexts is critical for vocabulary intervention for children with developmental language disorder (DLD). In this study, we explore the feasibility of a new experimental paradigm designed to assess whether the sequencing between a verb and its referent action impacts learning. We also consider whether what is optimal varies depending on verb meaning, contrasting manner verbs, which encode how an event unfolds, with result verbs, which encode event endstates. Method: Eight 4- and 5-year-olds with DLD participated in this feasibility study. In the before condition, children heard novel verbs before seeing their referent actions. In the after condition, children heard the verbs after the actions were viewed. Children were asked to demonstrate knowledge of the novel verbs by pointing. Probabilities were compared with the null value expected by chance (50%). Additionally, we fit an exploratory generalized estimating equation model to the data with covariates for condition and verb type. Results: Tests of predicted probabilities revealed that children did not demonstrate learning rates above chance in the before condition. Learning rates were above chance in the after condition for result but not manner verbs. Model estimates revealed differences in learning between the recall and generalization phases. Conclusions: Our new experimental paradigm has the potential to be used for further research into children's verb-learning processes. Children with DLD appear to be impacted by the sequencing between a verb and its referent action based on this feasibility study; however, further research is required to adequately understand the impact of sequencing on verb learning for children with DLD. Supplemental Material: https://doi.org/10.23641/asha.33332601
PURPOSE:Imitation and language are associated in autistic children. However, imitation involves various types. This cross-sectional study examined the associations between different imitation abilities and receptive and expressive language skills in autistic preschoolers while controlling for nonverbal IQ (NVIQ). Additionally, these associations were explored separately in two subgroups based on language level. METHOD:A sample of 176 autistic preschoolers, aged 2-6 years, was assessed using (semi)structured behavioral tasks measuring imitation (elicited object, gestural, and verbal imitation; spontaneous object imitation; and deferred object imitation), nonverbal cognitive, and language abilities. RESULTS:The model with elicited object, verbal, and spontaneous object imitation explained the largest proportion of variance in receptive language after controlling for NVIQ, although a model with elicited gestural, deferred, and spontaneous object imitation showed nearly equivalent explanatory power. Elicited verbal, deferred, and spontaneous object imitation contributed most to explaining expressive language. The interaction effects indicated that differences across subgroups only emerged for spontaneous object imitation. Within-group analyses revealed different imitation abilities contributing to the most predictive model of concurrent language skills, in the minimally speaking/some words group and the speech in sentences/fluent speech group. CONCLUSIONS:Various imitation abilities contribute to receptive and expressive language beyond NVIQ. For autistic children with varying language skills, immediate verbal and object imitation abilities were key contributors to language performance, suggesting that these may be important targets for intervention. In the minimally speaking/some words group, immediate and deferred object imitation contributed to language skills, whereas these abilities were less predictive for verbally more fluent autistic children. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33311877.
PURPOSE:The present study aimed to evaluate the effects of different immersion depth levels and subglottic pressure (Psub) levels on the oscillatory features of oral pressure (Poral; frequency, amplitude, and regularity), the degree of glottal adduction, and the subjective perception of phonatory ease when performing a water resistance tube (WRT) exercise. METHOD:Forty participants were recruited: 20 having normal voice and 20 diagnosed with functional dysphonia confirmed by laryngoscopic examination. Assessment protocol included (a) the self-assessment of ease of phonation and (b) the objective assessment of air pressure-related variables and electroglottographic (EGG) contact quotient (CQ). Participants in both groups were instructed to select and produce a sustained-vowel-like phonation into a tube immersed in a recipient filled with water at five different depths: 2, 4, 6, 8, and 10 cm (Experiment 1). Then, they were required to phonate into the tube with three different Psub targets (10, 15, and 20 cm H2O) while keeping a constant immersion level (Experiment 2). Participants were asked to self-assess the degree of ease of phonation. Objective measurements of air pressure-related variables and CQ were acquired during WRT exercises. RESULTS:Changes in depths and Psub levels showed significant effects on CQ and massage-like sensation in both groups. Poral oscillation variables (amplitude, frequency, jitter, and shimmer of oscillation) were significantly influenced by changes in the depth of immersion and Psub values. No significant differences were found for most variables when comparing both groups. CONCLUSIONS:Findings confirm that modifying immersion depth and Psub during WRT exercises induces measurable changes in vocal physiology. Across both experiments, higher loads (greater immersion or increased Psub) led to a progressive increase in CQ, accompanied by higher Poral instability and a significant reduction in perceived ease of phonation. Also, both Psub and immersion depth were shown to influence bubble characteristics, Poral oscillations, and potentially the massage-like sensation associated with WRT. Thus, careful control of these variables appears essential to optimize therapeutic outcomes in patients with voice disorders.
PURPOSE:The purpose of this study was to investigate the relationship between orthographic transcription and visual analog scale (VAS) intelligibility ratings across read and spontaneous speech in speakers with Parkinson's disease (PD), speakers with multiple sclerosis (MS), and healthy controls. METHOD:Forty-four speakers (20 PD, 20 MS, four healthy controls) provided read speech samples from the Speech Intelligibility Test and spontaneous monologue samples. Speech samples were mixed with multitalker babble and presented to 131 crowdsourced naive listeners. Listeners were randomly assigned to orthographic transcription (n = 66) or VAS rating (n = 65) tasks. The relationship between measures was examined using linear regression and linear mixed-effects modeling. RESULTS:Strong positive relationships between orthographic transcription and VAS were observed for both read speech (R2 = .75) and monologue (R2 = .72), with relationships remaining robust across all speaker groups (R2 = .52-.76). Interactions between perceptual task and speech task or between perceptual task and speaker group were not significant. Read speech was approximately 4.3 percentage points more intelligible than monologue. CONCLUSIONS:VAS and orthographic transcription yielded strongly associated intelligibility estimates across speech tasks and speaker groups, supporting VAS as an efficient alternative to orthographic transcription in diverse clinical populations and speech contexts. Clinicians should note that VAS does not capture qualitative error information and may require more listeners to achieve comparable reliability. Future work should examine speakers with more severe dysarthria and establish clinically meaningful change thresholds for spontaneous speech. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33345129.
PURPOSE:Aging is often associated with increased difficulty in speech production (e.g., increased word-finding difficulties and disfluencies), as well as with broader cognitive changes such as declines in executive function (EF) and greater sensitivity to task constraints. However, how both EF and task constraints contribute to age-related differences in speech is unclear. METHOD:We analyzed age-related differences in disfluencies and lexical diversity in spontaneous speech from 272 healthy adults, aged 20-81 years, using two narrative discourse tasks varying in structure: an open-ended prompt and a picture book description. Both tasks involve telling a story but differ in predetermined structure. The open-ended prompt is unstructured, while the picture book provides visual scaffolding to guide speech. Additionally, participants completed a battery of EF tasks. RESULTS:Overall, older adults produced more repetitions, revisions, and unfilled pauses. Filled pauses, however, decreased with age, which may be related to generational differences in lexical filler use (e.g., "like," "you know"). Additionally, there was an effect of discourse task: The open-ended prompt elicited more disfluencies overall and higher lexical diversity, despite speech samples being shorter in duration and containing fewer words. Though older adults also showed lower EF across several tasks, relationships between EF, age, and disfluencies did not survive corrections for multiple comparisons suggesting a minimal influence of EF on disfluencies in this sample. CONCLUSIONS:These findings emphasize the influence of age and task demands on speech production. However, EF showed limited associations with disfluency production and did not account for age differences. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33334365.
Purpose: Sleep plays a critical role in speech-sound learning. However, owing to methodological heterogeneity and inconsistent findings, the mechanisms by which sleep consolidates speech sounds are poorly understood. This review synthesizes evidence on sleep-dependent speech-sound consolidation to identify consistent behavioral patterns. Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched five major databases supplemented by reference list screening and expert consultation. We selected and reviewed 30 empirical articles representing 1,646 participants, primarily healthy young adults, in the full text for qualitative analysis. No meta-analysis was performed because of considerable variability in study designs and outcome measures. Results: Sleep robustly supports stabilization of fragile speech-sound traces from wake-dependent degradation, while enhancement and generalization emerge only conditionally. We observed enhancement effects in approximately half of the included studies, which were predominantly modulated by learner aptitude. Generalization occurred most consistently when the training variability was sufficient to support feature abstraction. Notably, the null findings tended to be correlated with signal degradation or elevated computational demands at encoding or assessment, suggesting that consolidation mechanisms may be resource limited and sensitive to encoding fidelity. Conclusions: Taken together, our findings suggest that sleep acts as a selective filter. The brain prioritizes the stabilization of weakly encoded speech-sound traces, while allowing active reorganization only for representations that were robustly encoded. We propose a hierarchical framework to account for the observed patterns, along with translational research directions that leverage distinct learning pathways.
PURPOSE:The purpose of this experimental study was to determine whether toddlers could learn novel adjective meanings when the adjectives appeared prenominally (e.g., "This is a fip cup") and/or when they appeared predicatively (e.g., "This cup is fip"). METHOD:Two-year-olds (N = 64) participated online on the Children Helping Science platform. They were randomly assigned to either the prenominal or predicative condition, and they viewed videos that introduced novel adjectives in that position in the context of two potential visual referents (e.g., yellow cup, blue door). At test, they viewed two new objects (e.g., yellow shirt, blue shirt) and were asked to point to the one that matched the novel adjective label. The child's caregiver clicked on the image the child pointed to. RESULTS:Toddlers learned novel adjectives that appeared prenominally, as indicated by above-chance selection of the target referent at test, but they were at chance in the predicative condition. CONCLUSIONS:The results indicate that the ease of learning a new adjective is influenced by the construction in which it appears. On a first encounter with a novel adjective, the higher frequency prenominal construction may be more supportive for learning.
PURPOSE:This review article provides a programmatic translational synthesis of a research program investigating respiratory-swallow coordination as a modifiable physiologic target underlying swallowing impairment and safety, with a focus on individuals treated for head and neck cancer (HNC). The purpose is to synthesize physiologic evidence, clinical trial outcomes, and translational advances supporting respiratory-swallow training (RST) as a mechanism-based intervention. METHOD:Evidence is drawn from a series of experimental, observational, and interventional studies conducted over more than 3 decades. Methods include synchronized videofluoroscopy and respiratory measurement to characterize respiratory-swallow coordination, clinical trials evaluating RST across chronic and earlier recovery-stage HNC populations, and ongoing work incorporating wearable sensor technology and synchronous telehealth delivery to support ambulatory monitoring and home-based training. Data from Phase I, Phase II, and ongoing randomized efficacy trials are summarized to illustrate mechanistic and clinical effects of RST. RESULTS:Across studies, swallowing was most safely and efficiently initiated during mid- to low-quiet (tidal) breathing expiratory lung volumes, whereas deviations from this pattern were associated with increased airway invasion and physiologic impairment. RST reliably increased expiratory-phase swallow initiation and was associated with improvements in swallowing impairment, airway protection, bolus clearance, functional oral intake, and patient-reported outcomes. Phases I and IIa trial data demonstrated significant reductions in physiologic impairment scores and penetration-aspiration severity following training. CONCLUSIONS:Collectively, these findings support respiratory-swallow coordination as a modifiable target for dysphagia rehabilitation that results in important physiologic and airway protection advantages. RST represents a mechanism-driven approach that extends beyond compensatory strategies and shows promise for scalable, technology-enabled delivery in both clinical and ambulatory settings. This work has implications for swallowing assessment, intervention, and future research across clinical populations.
PURPOSE:Children with developmental language disorder (DLD) often exhibit deficits in executive function. These deficits may be linked to less effective verbal mediation or the use of self-directed language to guide task performance. This study examined the role of verbal mediation during an executive shifting task. METHOD:Twenty-seven children aged 8-12 years (15 with DLD, 12 with typical development [TD]) completed a cued local-global task with verbal mediation (baseline) and without (articulatory suppression). Shifting performance was measured as accuracy and reaction time. Trial-type contrasts for mixing costs (general task demands) and switching costs (trial-level shifting) were examined. Analyses controlled for age and selective attention. RESULTS:Children with DLD responded more slowly than their peers with TD but achieved comparable accuracy. All children were slower and less accurate during articulatory suppression compared to baseline. A significant three-way interaction for accuracy indicated that mixing costs were larger for children with DLD than TD at baseline, but they were the same under articulatory suppression. Two-way interactions for reaction time indicated that mixing costs were larger in the DLD group than the TD group and larger during articulatory suppression than baseline. CONCLUSIONS:The detrimental effect of articulatory suppression was greater for children with TD than children with DLD, which suggests that language ability contributed to executive function task performance. Verbal mediation may play a larger role in sustaining task goals than in making trial-level switching decisions during shifting tasks. There is a need to further explore verbal mediation mechanisms contributing to executive function in DLD.
PURPOSE:The Intelligibility in Context Scale (ICS) is a free parent report questionnaire assessing functional intelligibility. Although it has been translated into French, it lacks validation. This study addresses two main objectives. First, we aimed to establish the psychometric properties of the European French version of the ICS (ICS-EF). Second, we explored the ICS-EF as a measure of the functional impact of speech sound disorders (SSDs), specifically investigating how communication partner familiarity influences intelligibility ratings. METHOD:A total of 189 French-speaking preschool children were recruited from preschools: 42 were classified as at risk for SSDs, and 147 were classified as typically developing. Children were assessed using a standardized single-word speech sound test. All parents completed the ICS-EF, and one third completed it a second time for test-retest reliability. Validity was analyzed through Spearman's correlations, and a repeated-measures analysis of covariance (RM-ANCOVA). Reliability was analyzed using Cronbach's alpha and intraclass correlation coefficients. Age groups, cutoffs, and discriminant accuracy were determined using K-means clustering and receiver operating characteristic curves. The effect of familiarity (intelligibility across communication partners) was examined using RM-ANCOVAs. RESULTS:The ICS-EF demonstrated good validity and reliability and was influenced by age. Three age groups were identified and revealed satisfactory sensitivity for the determined cutoffs. A significant effect of familiarity was found and was modulated by the presence/absence of SSDs. CONCLUSIONS:The ICS-EF demonstrated good psychometric properties and provides ready-to-use cutoffs. The ICS-EF can be considered both as a screening tool for SSDs in French-speaking preschoolers and as a measure of SSDs' functional impacts. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33282180.
Purpose: This study examined how orthographic transparency shapes reading comprehension (RC) among third-grade students with reading difficulties (RD). Hebrew provides a within-language test case that features both transparent and opaque scripts, thus minimizing confounds that arise in cross-language comparisons. Method: Using path analysis, we modeled the direct and indirect associations of phonological awareness (PA), morphological awareness (MA), orthographic processing, morphosyntactic awareness (MSA), vocabulary, word reading fluency, and executive function (EF) skills with RC in each script. Participants were 231 monolingual Hebrew-speaking students with RD. Results: Results revealed that, in vowelized texts, PA had the strongest association with RC, while in unvowelized texts, cognitive flexibility, MA, MSA, and vocabulary played more central roles. Word reading fluency was associated with RC in both scripts, although the association was stronger in the opaque script. EF skills were indirectly associated with RC via linguistic and literacy pathways in both models, with cognitive flexibility additionally showing a direct association in the unvowelized condition. Conclusions: These findings provide empirical support for the shifting cognitive and linguistic demands across scripts. Implications for instruction suggest that interventions for RD be adapted based on orthographic consistency. Supplemental Material: https://doi.org/10.23641/asha.33213498
Purpose: Both tinnitus and poor hearing-in-noise performance have been proposed as perceptual consequences of cochlear synaptopathy, which can occur in the absence of significant hearing loss. However, to date, no study has investigated chirp-evoked electrocochleography (ECochG) measures or examined the relationship between action potential (AP) amplitude and speech perception in noise (SPIN) performance in normal-hearing individuals with tinnitus. Method: Twenty participants with nonpulsatile tinnitus lasting at least 3 months were recruited for the tinnitus group. An additional 20 age-matched individuals without tinnitus comprised the control group. All participants underwent chirp-evoked ECochG and SPIN testing in the designated ear. AP amplitude was measured using two approaches: from the AP peak to the baseline (AP1) and from the AP peak to the subsequent trough (AP2). SPIN performance was assessed under multiple listening conditions designed to simulate challenging real-world environments. Results: While chirp-evoked AP1 amplitudes were significantly greater than those elicited by click stimuli, group differences emerged only for chirp-evoked AP2, with the tinnitus group exhibiting reduced amplitudes. Moreover, a significant correlation between chirp-evoked AP2 amplitude and SPIN performance under the most challenging listening condition was observed in the control group, with larger AP2 amplitudes associated with better SPIN performance. Conclusions: Although cochlear synaptopathy cannot be definitively verified without histopathological examination, the present findings suggest that combining chirp-evoked ECochG with SPIN testing may provide complementary, noninvasive information about auditory function in individuals with and without tinnitus. Together, these measures may provide insight into peripheral and central mechanisms contributing to tinnitus and speech-in-noise perception.
PURPOSE:This meta-analysis aimed to compare the performance of deaf and hard of hearing (DHH) children who use cochlear implants (CIs) or hearing aids (HAs) with their typically hearing (TH) peers on false belief (FB) understanding tasks. METHOD:Data were synthesized from 13 studies comprising 292 participants 1.92-14.03 years of age. A multilevel random-effects meta-analysis was conducted, followed by metaregression to examine the effects of age, mean age at onset, type of hearing amplifier, type of FB task, and method of response. RESULTS:Results indicated significantly lower performance in DHH children (g = -0.854, 95% confidence interval [-1.110, -0.599], p < .001) compared to their TH peers. Additionally, the CIs/HAs group showed a possible sensitivity when assessed with implicit tasks using eye gazing as a method of response. CONCLUSION:The results supported previous evidence on the essential role of language in FB skills development and indicated that performance in DHH children may be critically influenced by variability in task demands and method of response. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33228822.
PURPOSE:The purpose of this study was to develop and test standardized stimuli for the Pediatric Auditory-Perceptual Evaluation of Voice protocol. The use of these stimuli for cepstral/spectral voice measures was also considered. METHOD:Three sets of standardized sentences and four prompts designed to elicit connected speech were developed and tested in order to identify the most effective stimuli for use with children. One hundred forty children with (n = 50) and without (n = 90) benign vocal fold lesions recorded all potential stimuli, as well as the sentences developed for the adult Consensus Auditory-Perceptual Evaluation of Voice protocol. Sentences were evaluated for production accuracy, and cepstral/spectral voice measures were calculated to determine whether potential stimuli would separate dysphonic and normophonic voices. Spontaneous speech prompts were assessed for duration of speech sample elicited. Subsequently, auditory-perceptual voice assessments were performed using the newly developed pediatric stimuli. Production accuracy, cepstral/spectral voice measures, and auditory-perceptual rating reliability were compared across age, sex, and voice diagnosis. RESULTS:Children produced pediatric sentences significantly more accurately than sentences developed for adults. The best produced sentence set resulted in over 80% accuracy across children 3 through 17 years of age. Cepstral peak prominence calculated on these sentences was significantly lower for children with voice disorders when compared to those with typical voices. Spontaneous speech prompts elicited an average of about 40 syllables of phonation over 25-30 s in children ≤ 6 years of age, and voice samples increased in duration for older children. Auditory-perceptual ratings of voice significantly separated children with and without voice disorders and produced reliability levels similar to those previously reported for adults. CONCLUSION:Findings indicate that the developed pediatric stimuli are effective for auditory-perceptual assessments across childhood and can be produced more accurately than sentences designed for adults.
PURPOSE:Although auditory-perceptual voice assessments are crucial for evaluating pediatric voices, no protocol designed for use with children has been established. This study created and validated the Pediatric Auditory-Perceptual Evaluation of Voice (PAPE-V) protocol for use across childhood. Influence of scale type and speaker demographics on voice rating reliability was considered. METHOD:Ten speech-language pathologists (SLPs) specialized in pediatric voice rated voice samples from 102 children aged 3-17 years with and without diagnosed voice disorders (47% female). SLPs were asked to rate each voice for overall voice quality, breathiness, roughness, strain, pitch, and loudness. Voices were rated twice across two separate sessions, with 20% of voices repeated to allow for the calculation of intrarater reliability. In each session, either visual analog scales (VASs) or Likert scales were utilized (order counterbalanced across raters). Interrater and intrarater reliabilities were compared across rating scales and child demographics using intraclass correlation coefficients (ICCs) and Krippendorff's alphas. SLPs' feedback regarding both scale types was also obtained. RESULTS:Interrater and intrarater reliabilities were high across all conditions. For both scale types, ICCs were highest for overall voice quality (Likert ICC = .97, VAS ICC = .96) and lowest for pitch (Likert ICC = .82, VAS ICC = .78). Interrater reliability was significantly greater for children presenting with voice disorders than for children with healthy voices (p < .01). Interrater reliability also varied with age, and ratings for children younger than 6 years had significantly better interrater reliability than ratings for children 7-17 years old (p < .001). No significant differences in reliability were observed across scale type or sex. Clinicians indicated that Likert scales were more time efficient than VASs; however, either scale type could be used in the PAPE-V. CONCLUSIONS:The PAPE-V can be used to perform reliable auditory-perceptual voice assessments in children using either VAS or Likert scales. This protocol constitutes an important step in promoting the reliability and efficiency in pediatric voice assessments.
PURPOSE:Variability in speaking rate and sentence context affects the cognitive processing of speech. Individuals relying on a degraded speech signal may be particularly susceptible to these effects. In this study, we examine how artificial alterations to speaking rates and sentence context affect sentence comprehension and recognition memory for cochlear implant (CI) users and normal-hearing (NH) adults presented with spectrally degraded speech. METHOD:Thirty-seven adult CI users and 71 NH adults participated in the study. Participants completed a sentence verification task paired with a recognition memory task consisting of sentences with artificially manipulated speaking rates and variable sentence context. The sentences presented to NH adults were vocoder processed to simulate CI hearing. Accuracy and response times (RTs) from both the sentence verification task and the sentence recognition memory task were assessed. Logistic and ordinal regression models were constructed to assess the effects of speaking rate and sentence context on the participants' performance. RESULTS:On the sentence verification task, slow sentences had a greater accuracy of sentence comprehension and faster RTs compared to fast sentences, particularly more so for low-context sentences. On the recognition memory task, slow sentences had a greater accuracy of sentence recognition and faster RTs compared to fast sentences. However, the effect of context was less pronounced and actually favored low-context sentences. CI users and older listeners, regardless of hearing status, showed lower overall accuracy and slower RTs. CONCLUSIONS:Speaking rate and sentence context impact sentence comprehension and recognition memory for spectrally degraded speech. Slower speech facilitates processing, especially when contextual support is limited. CI users and older listeners showed slower and more effortful processing. These findings may highlight the importance of speaking rate in effective communication strategies and support theoretical approaches linking increased cognitive effort to the perception of spectrally degraded speech. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33179354.
PURPOSE:Mild cognitive impairment (MCI), a transitional state between normal aging and dementia, is associated with subtle but systematic disruptions in semantic memory, yet the representational mechanisms underlying these changes remain poorly understood. Grounded in neuropsychological evidence that semantic vulnerability in early neurodegeneration is selective across lexical categories, this study investigates whether MCI is associated with the category-specific contraction of semantic representational space. We predicted that concrete words would show reduced semantic dispersion in MCI, whereas abstract words and function words would remain mostly unaffected. METHOD:Narrative transcripts from 102 participants with MCI and 142 neurotypical controls were drawn from the DementiaBank database. Transcripts were preprocessed and processed independently using the Bidirectional Encoder Representations From Transformers (BERT) base-uncased model to extract contextualized embeddings from the final hidden layer. Semantic dispersion was quantified as Euclidean distances from individual word embeddings to group-specific centroids within each word category. Differences were analyzed using linear mixed-effects models with fixed effects for group, word category, and their interaction, controlling for word length and log-transformed lexical frequency, with random intercepts for participants and random slopes for word category within participants. RESULTS:Linear mixed-effects modeling showed significantly reduced semantic dispersion in the MCI group overall, driven specifically by the concrete word category (Holm-adjusted p = .001). No significant group differences were observed for function or abstract words. CONCLUSIONS:MCI is associated with a contracted semantic space selectively for concrete words, suggesting the early degradation of perceptually grounded semantic representations, while abstract and function word representations remain relatively preserved. These findings highlight BERT embeddings as a sensitive, theoretically interpretable tool for detecting category-specific semantic deficits in MCI, offering a mechanistic account of language changes that complements traditional neuropsychological approaches. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33060893.
PURPOSE:Speech-language pathologists often have to make consequential decisions with evidence that is incomplete, indirect, or mixed. The risk is not uncertainty itself, but the way an indirect measure, a familiar label, or a best-practice statement can begin to carry more interpretive weight than it can support. This tutorial focuses on the point where observations are turned into claims and claims are turned into recommendations. METHOD:The tutorial draws on scholarship in measurement and assessment showing that a score or result only has meaning through how it is interpreted and how it is used in practice. It also draws on clinical reasoning scholarship, including dual-process models, to support a decision rationale that is stated clearly, remains open to revision, and is tied to clear conditions for changing course. RESULTS:Across swallowing, language assessment, and hearing health, the same patterns appear. Measures that are genuinely informative are read as more definitive than they are, and labels meant to support communication begin to function as explanations. The tutorial offers brief checkpoints that ask what the current observations support, what else they could reasonably mean, and what new information would change the decision. CONCLUSIONS:Clinical reasoning is stronger when observation and interpretation are kept separate, categories are used for communication rather than as explanations, and the evidence that would change a decision is named in advance. This tutorial supports evidence-based practice by making the reasoning trail visible while still respecting the need to act in real time.
