Treatment of Speech Disorders in Children with Down Syndrome

描述（由申请人提供）：唐氏综合症（DS）儿童的一个主要发展挑战是在一个动态的、成熟的系统中产生可理解和准确的语言，这是由不成熟的、动态的语音处理能力输入介导的。在退行性痴呆中，语言的发展经常出现问题，这也许并不奇怪，语言障碍是一个相对较高的发病率，通常会持续到青春期到成年期，并且通常是退行性痴呆的终身残疾特征。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：言语可理解性和言语准确性。此外，由于退行性障碍儿童在影响对言语治疗方法的差异反应的能力上表现出相当大的异质性，因此研究特定的预处理技能作为生长的潜在预测因素或调节因素与言语可理解性和言语准确性治疗的差异反应之间的关系是很重要的。本项目的目的是检验预处理水平之间的关系：认知能力，言语运动能力，引出语境和自发语境下的言语准确程度，自发语境下的言语可理解程度，EEG/ERP测量音素听觉分化和(a)经历过语言治疗的退行性残疾儿童言语可理解性和言语准确性水平的增长，以及(b)两种旨在提高这些儿童言语准确性和言语可理解性水平的言语治疗的差异反应。本项目将招募60名患有退行性残疾的儿童，他们在治疗前都有严重的语言障碍。在进入研究时，音素的听觉分化将使用PCA和ICA方法进行测量，语音准确性和语音可理解性水平也是如此。然后，患有退行性障碍的儿童将被随机分配到两种旨在提高语言技能的治疗方法中的一种：语音知识重塑（PKR）治疗或发音训练（AT）治疗。这些儿童将接受1:1的治疗，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测试语音可理解性和语音准确性：a)在治疗阶段进行两次，b)治疗后立即进行，c)在两次随访期间进行。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一个阶段重复。将采用多元回归、多元置换检验和生长曲线分析对研究问题进行检验。要求提供五年的经费。这项研究与公共卫生的相关性：患有退行性障碍的人往往难以发展出准确和可理解的语言，这反过来对语言、教育和社会发展产生不利影响。该项目旨在开发更有效的治疗退行性残疾语言障碍的方法。

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.