Enhanced Treatment for Speech Sound Disorder

(ORDER Trial)

Overseen By Elaine R. Hitchcock, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Montclair State University

Disqualifiers: Developmental disability, Neurobehavioral syndrome, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores new treatments for children with Residual Speech Sound Disorders, focusing on their perception and production of the /r/ sound. Researchers aim to determine if beginning with perception training, which helps children hear sounds more accurately, enhances the effectiveness of speech therapy compared to starting with speech production activities. Two treatment paths are available: one begins with perception training and the other with speech production, both delivered through telepractice. Children who struggle with pronouncing the /r/ sound and meet specific hearing and language criteria may be suitable for this study. As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research that could improve speech therapy techniques for children.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that visual-acoustic biofeedback is a safe and non-invasive method for improving speech sounds. This technique uses visual tools to help individuals adjust their speech, and studies have not identified any major side effects.

For perception training, research also supports its safety. Auditory-perceptual training helps children hear and produce speech sounds more effectively and has demonstrated effectiveness without causing harm. This training often occurs through telepractice, which is both safe and convenient.

Both treatments aim to improve speech without known risks, making them generally well-tolerated options for children with speech sound disorders. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for Speech Sound Disorder because they explore innovative methods beyond traditional speech therapy. Perception Training enhances the ability to differentiate speech sounds, potentially leading to more effective communication skills. Visual acoustic biofeedback provides real-time feedback using visual cues, which can accelerate learning by helping participants see how their speech sounds differ from target sounds. These techniques offer a fresh approach by targeting the underlying perceptual and production skills, which might bring faster and more sustainable improvements compared to standard speech therapy alone.

What evidence suggests that this trial's treatments could be effective for speech sound disorder?

Research has shown that visual-acoustic biofeedback, one of the treatments in this trial, can improve speech in people with speech sound disorders. In one study, six out of seven participants demonstrated significant improvement in their speech after using this method. It provides real-time visual feedback to help individuals adjust their speech sounds more effectively.

Perception training, another treatment option in this trial, has also been linked to positive results in children with speech sound disorders. A review of treatment studies found that this training can lead to noticeable improvements in speech and language delays. This approach often includes exercises to help children better understand and process speech sounds, enabling them to produce those sounds more accurately. ^{6 7 8 9 10}

Who Is on the Research Team?

Elaine Hitchcock, PhD

Principal Investigator

Montclair State University

Are You a Good Fit for This Trial?

This trial is for children with Residual Speech Sound Disorders (RSSD) who have difficulty pronouncing sounds correctly. They must complete evaluations to determine their speech production and perception accuracy, which will decide their group assignment in the study.

Inclusion Criteria

Must exhibit less than 30% accuracy, based on consensus across 2 trained listeners, on a probe list eliciting rhotics in various phonetic contexts at the word level

I am between 8 and 17 years old.

Must pass a pure-tone hearing screening at 20dB hearing level

Exclusion Criteria

Must not receive a T score more than 1.3 SD below the mean on the Wechsler Abbreviated Scale of Intelligence-2 (WASI-2) Matrix Reasoning

Must not have an existing diagnosis of developmental disability or major neurobehavioral syndrome such as cerebral palsy, Down Syndrome, or Autism Spectrum Disorder

Must not receive a scaled score of 7 or higher on the Recalling Sentences and Formulated Sentences subtests of the Clinical Evaluation of Language Fundamentals-5 (CELF-5)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-treatment Evaluation

Participants complete pre-treatment evaluations to assess /r/ production and speech perception

1-2 weeks

Treatment

Participants are randomized to TAU+Perception-first or TAU-first treatment conditions via telepractice

12 weeks

No Treatment

A 4-week period of no treatment for control comparison

4 weeks

Follow-up

Participants are monitored for changes in socio-emotional well-being and speech accuracy

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Perception Training
• Visual acoustic biofeedback

Trial Overview The study tests if changing the order of teaching sound perception before production (or vice versa) affects how well children with RSSD improve their speech. It compares two methods: Perception-first and Production-first, delivered online.

How Is the Trial Designed?

Group I: ORDER: Perceptual training Experimental Treatment 1 Intervention

The investigators will use the following approach, adopted successfully for the RCT in the previous funding cycle: (1) Participants will be randomized after providing informed consent, meeting eligibility requirements, and completing the tasks and clinician-rated baselines that determine response group (High, Low). (2) For each perception accuracy group, the statistician will develop 2 batches of 10 concealed envelopes for assignment, one for high production accuracy participants and one for low production accuracy participants. Each will contain 10 participant assignments in random order: 5 TAU+ Perception-first, 5 TAU-first. Thus, once we have recruited the first 10 participants for one subgroup (e.g., Low Perceptual Accuracy, Low Production Accuracy), another batch of 10 envelopes will be generated to allocate the next 10 children recruited in that subgroup.

Group II: ORDER: Visual acoustic biofeedback training Active Control 1 Intervention

The investigators will use the following approach, adopted successfully for the RCT in the previous funding cycle: (1) Participants will be randomized after providing informed consent, meeting eligibility requirements, and completing the tasks and clinician-rated baselines that determine response group (High, Low). (2) For each perception accuracy group, the statistician will develop 2 batches of 10 concealed envelopes for assignment, one for high production accuracy participants and one for low production accuracy participants. Each will contain 10 participant assignments in random order: 5 TAU+ Perception-first, 5 TAU-first. Thus, once the investigators have recruited the first 10 participants for one subgroup (e.g., Low Perceptual Accuracy, Low Production Accuracy), another batch of 10 envelopes will be generated to allocate the next 10 children recruited in that subgroup.

Group III: ORDER: No treatment Active Control 1 Intervention

No treatment, 4-week period of no treatment

Who Is Running the Clinical Trial?

Montclair State University

Lead Sponsor

Trials

14

Recruited

1,200+

National Institute on Deafness and Other Communication Disorders (NIDCD)

Collaborator

Trials

377

Recruited

190,000+

Citations

1. asha.org asha.org/practice-portal/clinical-topics/articulation-and-phonology/?srsltid=AfmBOoonxLhhkpa-CwyYhxCJeCp1LwsK8KJ6iVgKUjHMUA7pMwsE3_tt

Speech Sound Disorders: Articulation and Phonology The following data reflect the variability: Overall, 2.1%–23% of 4- to 6-year-old children were estimated to have SSDs (Eadie et al., 2015; Jessup et al., 2008; ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8700312/

The Effectiveness of an Integrated Treatment for Functional ... A meta-analysis of five treatment efficacy studies on developmental speech and language delay disorder in children [17] demonstrated positive ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11086453/

Outcome measures for children with speech sound disorder The objective of this umbrella review paper is to provide a rigorous and detailed list of assessments, interventions and outcomes which target SSD in children.

4. bmjopenquality.bmj.com bmjopenquality.bmj.com/content/11/2/e001761

Applying evidence to practice by increasing intensity of ... Speech sound disorder (SSD) affects up to 25% of UK children and may impact on: effective communication; the development of relationships; ...

5. pubs.asha.org pubs.asha.org/doi/10.1044/2022_LSHSS-22-00065

Innovations in Treatment for Children With Speech Sound ... (2022) present the results of an innovative and timely approach to treating speech sound disorders using telepractice.

6. bmjopen.bmj.com bmjopen.bmj.com/content/14/4/e081446

Outcome measures for children with speech sound disorder The objective of this umbrella review paper is to provide a rigorous and detailed list of assessments, interventions and outcomes which target SSD in children.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4433313/

Auditory-Perceptual Learning Improves Speech Motor ... In the present study, we examined whether changes in perception of a speech sound contrast alter the capacity for speech motor learning in 5–7 year old children ...

8. mdpi.com mdpi.com/2227-9067/8/12/1190

The Effectiveness of an Integrated Treatment for Functional ... This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and ...

9. clinicaltrials.gov clinicaltrials.gov/study/NCT04858035?tab=results

Auditory-Perceptual Training Via Telepractice Participants will be randomly assigned to transition from the baseline to the treatment condition at one of 7 possible points, ranging from 3 to 9 baseline ...

10. arxiv.org arxiv.org/html/2510.23887v1

AI-Mediated Story-Based practice for Speech Sound ... Speech sound disorder (SSD) is among the most common communication challenges in preschool children. Home-based practice is essential for ...