Biofeedback improves speech in children at a faster rate than traditional methods

Run. Red. World. Pronouncing the "r" sound in these words requires precise control of the tongue. For most children, this happens naturally, but many children struggle with residual speech sound disorder (RSSD) in which speech errors persist past the age of eight.

In a large-scale study, researchers in speech pathology tested a promising treatment approach that incorporates biofeedback-a method that uses technology to provide visual feedback to improve speech. They found that children's ability to say the "r" sound improved at a much faster rate than with traditional methods during the early stages of therapy, demonstrating the value of biofeedback. Previous studies hinted at these benefits, but were limited by small sample sizes.

In traditional motor-based treatment, clinicians model sounds for children to imitate, or verbally coach children on the positioning of their mouth or tongue. In a biofeedback session, these methods are enhanced with a dynamic visual display, such as real-time video of the tongue created by an ultrasound probe positioned under the child's chin.

Traditional treatment can be frustrating for children who don't always hear the difference between their pronunciation and the model provided by their clinician, but with biofeedback, the clinician can show the difference, making it easier for the child to adjust. This study provides the first gold-standard evidence that biofeedback can accelerate progress in treating persistent 'r' difficulties."

Tara McAllister, lead author and associate professor of communicative sciences and disorders at NYU Steinhardt

McAllister and her co-authors treated 108 children aged 9-15 with residual speech sound disorder who were sorted into three groups: 1) biofeedback using an ultrasound, 2) visual-acoustic biofeedback (a depiction of their speech as "waves" on a screen), and 3) motor-based treatment. The children received sessions over the course of 10 weeks, with researchers tracking the rate of change in their improvement toward making the "r" sound (evaluated using an acoustic measure that gauges the difference between correct and incorrect pronunciation).

They found that while all treatment methods showed improvement, the rate of change over three sessions was 2.4 times greater for children who received biofeedback compared to motor-based treatment. There was no significant difference in improvement between the different types of biofeedback.

Their findings are published in the Journal of Speech, Language, and Hearing Research.

"Speech pathologists are managing ever-growing caseloads, and students who get stuck on 'r' create a real bottleneck. Biofeedback can help resolve these speech difficulties more efficiently, reducing frustration and freeing up resources for other children with communication needs," McAllister says.

This study was funded by a five-year, $3.1M grant from the National Institute on Deafness and Other Communication Disorders (R01DC017476). NYU is the lead recipient, with subaward sites at Syracuse University and Montclair State University.