Treatment of Speech Disorders in Children with Down Syndrome

描述（由申请人提供）：唐氏综合征（DS）儿童的主要发育挑战是在动态成熟系统的背景下生成可理解和准确的语音，该系统由来自不成熟的动态语音处理能力的输入介导。这也许并不奇怪，言语的发展往往在DS中出错，言语障碍是一个相对高发病率的条件，通常持续到青春期到成年期，往往是一个终身残疾的特征DS。正因为如此，开发更有效的治疗方法来改善言语障碍的两个关键因素是很重要的：言语理解力和言语准确性。此外，由于DS儿童表现出相当大的异质性的能力，影响不同的语音治疗方法的反应，它是重要的是要检查特定的预处理技能之间的关系，作为潜在的预测因子或调节剂的增长和治疗的语音理解和语音准确性的差异反应。本项目的目的是检查以下预处理水平之间的关系：认知能力、言语运动能力、在诱发和自发语境中的言语准确度、在自发语境中的言语可理解度，EEG/ERP测量音素的听觉分化和（a）经历语言治疗的DS儿童的语言理解能力和语言准确性水平的增长，以及（B）对两种语言治疗的不同反应，旨在提高这些儿童的语言准确性和语言可理解性。本研究将招募60名治疗前有严重言语障碍的DS儿童。在进入研究时，将使用PCA和伊卡方法测量音素的听觉区分，以及语音准确性和语音可理解性水平。患有DS的儿童将被随机分配到两种旨在改善语言技能的治疗之一：语音知识重塑（PKR）治疗或发音训练（AT）治疗。这些儿童将以1：1的形式接受治疗，每次60分钟，每周2次，持续6个月。随后将使用自发采样方法再次检测言语可理解性和言语准确性：a）治疗期间两次，B）治疗后立即，和c）两个随访期。所有EEG/ERP测量、标准化测试测量、言语运动测量、言语准确性测量和言语可理解性测量也将在最后阶段重复进行。多元回归，多元排列测试，和增长曲线分析将被用来测试研究问题。已申请五年资助。这项研究与公共卫生的相关性：患有DS的人通常难以发展准确和可理解的语言，这反过来又对语言，教育和社会发展产生不利影响。该项目旨在为DS中的言语障碍开发更有效的治疗方法。

DESCRIPTION (provided by applicant): A major developmental challenge for children with Down Syndrome (DS) is generating comprehensible and accurate speech within the context of a dynamic, maturing system, which is mediated by input from immature, dynamic speech processing ability. It is perhaps not surprising that the development of speech often goes awry in DS, with speech disorder being a relatively high incidence condition that typically persists through adolescence into adulthood and is often a life-long disabling characteristic of DS. Because of this, it is important to develop more effective treatments that improve two key elements of speech disorders: Speech-comprehensibility and speech accuracy. In addition, because children with DS display considerable heterogeneity in abilities that affect differential response to speech treatment methods, it is important to examine the relationship between particular pretreatment skills as potential predictors or moderators of growth and differential response to treatment for speech-comprehensibility and speech accuracy. The purpose of this project is to examine the relationship between pretreatment levels of: Cognitive ability, speech-motor ability, degree of speech accuracy in elicited and spontaneous contexts, degree of speech- comprehensibility in spontaneous contexts, EEG/ERP measures of auditory differentiation of phonemes and (a) growth in levels of speech-comprehensibility and speech accuracy within children with DS who experienced speech therapy and (b) differential response to two types of speech treatment designed to increase levels of speech accuracy and speech comprehensibility in these children. Sixty children with DS who all have severe speech disorders at pretreatment will be recruited in this project. At entry into the study, auditory differentiation of phonemes will be measured using PCA and ICA methods, as will levels of speech accuracy and speech comprehensibility. The children with DS will then be randomly assigned to one of two treatments designed to improve speech skills: Phonological Knowledge Recast (PKR) treatment or Articulatory Training (AT) treatment. These children will receive treatment in a 1:1 format for 60 minutes/session, 2/week for 6 months. Speech-comprehensibility and speech accuracy will be subsequently tested again using the spontaneous sampling methods: a) twice during the treatment phase, b) immediately after treatment, and c) at two follow-up periods. All EEG/ERP measures, standardized test measures, speech-motor measures, and measures of speech accuracy, and speech-comprehensibility will also be repeated at the last period. Multiple regression, multivariate permutation tests, and growth curve analyses will be used to test the research questions. Five years of funding are requested. Relevance of this research to public health: People with DS often have difficulty developing accurate and comprehensible speech, which in turn has detrimental impacts on language, educational and social development. This project is designed to develop more effective treatments for speech disorders in DS.