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									EBP Phonology Group:
Summary of Critically Appraised Topics

Bronwyn Carrigg, Sydney Children’s Hospital
Number of members: approx 23

Locations: 12 metro sites. Liverpool
Hospital, Peakhurst CHC, Rockdale CHC,
Sylvania CHC, Parramatta CHC, Mt Druitt
CHC, Blacktown CHC, Auburn Hospital,
Sydney Uni, Sydney Children’s Hospital,
Sydney Children’s CHC, Waverley CHC

Number of CAPs completed = 56
Number of CATs completed = 6
Target Selection: Stimulability
                  Early/Late Developing
                  Phonological Knowledge

Treatment Approaches:
Cycles                 PACT
Maximal Oppositions    Multiple Oppositions
Minimal Pairs          Metaphon
Metaphonological       Non-linear
Whole Language         Core Vocabulary
Naturalistic Speech Intelligibility Training
Clinical Question 1: In children with
phonological impairment of unknown origin,
are intervention gains more widespread and
efficient if stimulable or non-stimulable
phonemes are targeted during phonological
intervention?                      *5 papers

Clinical Bottom Line: evidence suggests that
it is more effective to select non-stimulable
phonemes, as children may acquire targeted
phonemes as well as non-targeted stimulable
• Need to consider child’s level of
  attention, motivation and persistence
  during stimulability tasks (Tyler 2005).

• Williams (2005) suggests a balance of
  stimulable and non-stimulable phonemes
  may be beneficial. Would allow for
  some early progress, as well as maximise
  system wide change.
Clinical Question 2: In children with
phonological impairment of unknown origin,
are therapy outcomes more widespread (ie
efficient) if the sounds targeted are
earlier or later developing?      *3 papers

Clinical Bottom Line: Selection of later
developing phonemes led to more rapid
change in the phonetic inventories in 2 out
of 3 studies. In third study, more rapid
with most knowledge phonemes over 12 wks,
but no difference in system wide change.
Clinical Question 3: when selecting sound
pairs in therapy, is it more effective to
choose 2 unknown sounds, or one known and
one unknown (ie homonymous, as typical of
conventional minimal pairs)?       9 papers

Clinical Bottom Line: low level of evidence
that selecting treatment pairs that are
maximally opposed, rather than minimally
opposed leads to greater change in treated
or untreated sounds. And, when both are
unknown, this leads to greater, or at least
equivalent, phonological change.
Clinical Question 4: Does maximal
opposition therapy result in more widespread
gains than minimal opposition therapy? (sound
pair differ by as few vs as many distinctive
features as possible).            4 papers

Clinical Bottom Line: evidence suggests that
treatment of maximal oppositions leads to
greater improvements than treatment of
minimal oppositions. Greater accuracies in
treated sounds and more untreated sounds
added to repertoire.
Clinical Question 5: Is the Cycles
Approach more effective than no
intervention, or more effective than
other forms of intervention, in treating
preschool children with phonological
impairment of unknown origin?     6 papers

Clinical Bottom Line: evidence to support
cycles approach is more effective than
no-treatment, but limited comparative data
to support it over other Rx approaches.
Clinical Question 6: Does PACT (Parents
and Children Together) improve speech
intelligibility in children with phonological
impairment of unknown origin?        2 papers

Clinical Bottom Line: PACT more effective
than no therapy, but no data comparing to
other approaches. Unclear which aspects of
PACT are effective.
What’s the Evidence for…? Section in ACQ
EBP Phonology/Elise summarised CATs on
Stimulability and Cycles Approach. Last year,
summary of evidence for Oral Motor Therapy

“there are many well-tried, efficacious, efficent,
effective therapies for us to choose from when
devising intervention for individual clients. Oral
motor therapy is not one of them. With no
theoretical underpinning, and in the absence of an
evidence base, it is clear that oral motor therapies
are not for us.” (Caroline Bowen, ACQ, 2005)
      Future Plans…

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

Contact Katie Carmody, Sydney Children’s
Community Health Centre, 9382 8084

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