Apraxia World: Deploying a Mobile Game and Automatic Speech Recognition for Independent Child Speech Therapy

Children with speech sound disorders typically improve pronunciation quality by undergoing speech therapy, which must be delivered frequently and with high intensity to be effective. As such, clinic sessions are supplemented with home practice, often under caregiver supervision. However, traditional home practice can grow boring for children due to monotony. Furthermore, practice frequency is limited by caregiver availability, making it difficult for some children to reach therapy dosage. To address these issues, this dissertation presents a novel speech therapy game to increase engagement, and explores automatic pronunciation evaluation techniques to afford children independent practice. Children with speech sound disorders typically improve pronunciation quality by undergoing speech therapy, which must be delivered frequently and with high intensity to be effective. As such, clinic sessions are supplemented with home practice, often under caregiver supervision. However, traditional home practice can grow boring for children due to monotony. Furthermore, practice frequency is limited by caregiver availability, making it difficult for some children to reach therapy dosage. To address these issues, this dissertation presents a novel speech therapy game to increase engagement, and explores automatic pronunciation evaluation techniques to afford children independent practice. The therapy game, called Apraxia World, delivers customizable, repetition-based speech therapy while children play through platformer-style levels using typical on-screen tablet controls; children complete in-game speech exercises to collect assets required to progress through the levels. Additionally, Apraxia World provides pronunciation feedback according to an automated pronunciation evaluation system running locally on the tablet. Apraxia World offers two advantages over current commercial and research speech therapy games; first, the game provides extended gameplay to support long therapy treatments; second, it affords some therapy practice independence via automatic pronunciation evaluation, allowing caregivers to lightly supervise instead of directly administer the practice. Pilot testing indicated that children enjoyed the game-based therapy much more than traditional practice and that the exercises did not interfere with gameplay. During a longitudinal study, children made clinically-significant pronunciation improvements while playing Apraxia World at home. Furthermore, children remained engaged in the game-based therapy over the two-month testing period and some even wanted to continue playing post-study. The second part of the dissertation explores word- and phoneme-level pronunciation verification for child speech therapy applications. Word-level pronunciation verification is accomplished using a child-specific template-matching framework, where an utterance is compared against correctly and incorrectly pronounced examples of the word. This framework identified mispronounced words better than both a standard automated baseline and co-located caregivers. Phoneme-level mispronunciation detection is investigated using a technique from the second-language learning literature: training phoneme-specific classifiers with phonetic posterior features. This method also outperformed the standard baseline, but more significantly, identified mispronunciations better than student clinicians

Sleep in Childhood Attention Deficit Hyperactivity Disorder

Background Sleep impairments frequently co-occur in children with Attention Deficit Hyperactivity Disorder (ADHD), and the nature of their relationship is bidirectional. Sleep problems in this population manifest as difficulties falling asleep, maintaining sleep and in poorer sleep quality, greater daytime sleepiness, altered sleep duration and increased limb movement in sleep. These concerns affect the quality of life, academic performance, cognitive functions, behavioural and family health of the child, negatively impacting their functional outcomes. Early identification and management of sleep problems in this population therefore has deep-rooted clinical utility. In this thesis we aimed to comprehensively delineate the nature of sleep problems in children with ADHD, explore the possible ADHD related cognitive/behavioural facets and environmental factors that might be influencing the child’s sleep and translate our understanding to the design of ADHD-specific sleep assessment tool for clinical utility. Methods and Results Chapter 2 reports the systematic review of studies investigating sleep in children between the age of 5-13 years who are diagnosed with ADHD. 148 empirical studies published between 2009-2019 were reviewed and a narrative synthesis was presented categorising studies into five sections. These included studies exploring the nature of these difficulties (subjective reports, sleep macrostructure and microstructure); studies exploring circadian rhythm patterns in this population, consequences of sleep problems, non-pharmacological interventions affecting sleep and ADHD symptoms, and pharmacological interventions affecting sleep in this population. We found that sleep disturbances may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep. Gaps in research focussed on the need for using mixed methodologies utilizing objective and subjective reports of sleep, designing well powered studies that define the role of sleep in ADHD clinical picture and facilitate assessment and management of sleep problems. Chapter 3 qualitatively investigated the nature of sleep problems and sleep related behaviours in children with ADHD. 26 parents of children diagnosed with ADHD aged between 6-12 years were interviewed about their child’s sleep. Thematic analysis of the interviews generated three broad themes which revolved around facets of children’s sleep difficulties as perceived by parents, the perceived impacts of these difficulties, and steps taken by parents to improve their child’s sleep. Parents expressed that sleep problems can be a significant disruptor for their children’s functioning and the wider household. Parents reported using need-based individualised behavioural and sleep hygiene approaches to counter their child’s sleep problems. Chapter 4 examined the associations of parent-rated sleep problems and sleep timings of pre-adolescent ADHD children with parental insomnia symptoms, ADHD (screener based) features and dysfunctional attitudes and beliefs about sleep (in 120 parent-child pairs). 82% of children exceeded the threshold for a paediatric sleep disorder, and parental insomnia, ADHD symptoms and dysfunctional beliefs about sleep were associated with childrens’s sleep problem scores, and with the subfactors of sleep anxiety and parasomnias. Sleep was poorer for children whose parents were both insomnia probable and had ADHD consistent features, thereby underlying the significant double impact of both on the child. In Chapter 5, a thirty-five-item parent rated sleep problems questionnaire for children with ADHD was developed. This questionnaire, called Childhood ADHD Sleep Scale (CASS), included 5 domains: Bedtime, Behaviours in Sleep, Sleep Quality, Daytime Functions and Impacts on Family, where the respondent has to choose one out of five options for a sleep problem statement (‘strongly agree’, ‘somewhat agree’, ‘neither agree or disagree’, ‘somewhat disagree’, and ‘strongly disagree’). CASS showed acceptable test-retest reliability and good internal consistency. Exploratory factor analysis of the CASS generated the 4-factor reduced CASS including sleep problems and impacts, executive and sensory regulation, daytime functions, and parasomnias. The reduced CASS demonstrated good test-retest reliability and internal consistency. Both unreduced CASS and reduced CASS were compared with scores from Child Sleep Habits Questionnaire (CSHQ) and Brown Executive Functions and Attention Scales (Brown -EFA). Differences in the trends of associations were discussed, to understand the utility of an ADHD specific sleep assessment questionnaire. In Chapter 6, we used an emotional Stroop test to assess the presence of sleep related attentional bias in 155 young adults and examined whether their Stroop test performance and sleep bias scores would associate with their ADHD screener-based symptom scores. Sleep quality scores, insomnia probability scores and social jetlag and chronotype. ADHD consistency scores, and insomnia probability scores were not found to be associated with sleep attentional bias scores. Sleep attentional bias also did not associate with chronotype or social jetlag, but it was found that habitual use of alarm clocks on workfree days did associate with greater sleep attentional bias, indicating that curtailed sleep due to functional demands on these days might increase attention towards sleep related stimulus. Conclusion This thesis highlighted how sleep functioning manifests in the clinical picture of childhood ADHD. The bidirectional relationship between the two entities were explored through varied methodological approaches to draw associations between the child’s environment, their own neurodevelopmental diversity and the accompanying sleep features that define their ADHD specific sleep functioning. We aimed at creating a framework within which sleep problems in ADHD can be understood and utilized for clinical utility, both in terms of assessment and management of these concerns. We also found that social demands can enhance cognitive processing of sleep related stimulus in older cohorts with or without ADHD features

Semantic radical consistency and character transparency effects in Chinese: an ERP study

BACKGROUND: This event-related potential (ERP) study aims to investigate the representation and temporal dynamics of Chinese orthography-to-semantics mappings by simultaneously manipulating character transparency and semantic radical consistency. Character components, referred to as radicals, make up the building blocks used dur...postprin

Non-spurious correlations between genetic and linguistic diversities in the context of human evolution

This thesis concerns human diversity, arguing that it represents not just some form of noise, which must be filtered out in order to reach a deeper explanatory level, but the engine of human and language evolution, metaphorically put, the best gift Nature has made to us. This diversity must be understood in the context of (and must shape) human evolution, of which the Recent Out-of-Africa with Replacement model (ROA) is currently regarded, especially outside palaeoanthropology, as a true theory. It is argued, using data from palaeoanthropology, human population genetics, ancient DNA studies and primatology, that this model must be, at least, amended, and most probably, rejected, and its alternatives must be based on the concept of reticulation. The relationships between the genetic and linguistic diversities is complex, including interindividual genetic and behavioural differences (behaviour genetics) and inter-population differences due to common demographic, geographic and historic factors (spurious correlations), used to study (pre)historical processes. It is proposed that there also exist nonspurious correlations between genetic and linguistic diversities, due to genetic variants which can bias the process of language change, so that the probabilities of alternative linguistic states are altered. The particular hypothesis (formulated with Prof. D. R. Ladd) of a causal relationship between two human genes and one linguistic typological feature is supported by the statistical analysis of a vast database of 983 genetic variants and 26 linguistic features in 49 Old World populations, controlling for geography and known linguistic history. The general theory of non-spurious correlations between genetic and linguistic diversities is developed and its consequences and predictions analyzed. It will very probably profoundly impact our understanding of human diversity and will offer a firm footing for theories of language evolution and change. More specifically, through such a mechanism, gradual, accretionary models of language evolution are a natural consequence of post-ROA human evolutionary models. The unravellings of causal effects of inter-population genetic differences on linguistic states, mediated by complex processes of cultural evolution (biased iterated learning), will represent a major advance in our understanding of the relationship between cultural and genetic diversities, and will allow a better appreciation of this most fundamental and supremely valuable characteristic of humanity - its intrinsic diversity

Proceedings of the 10th international conference on disability, virtual reality and associated technologies (ICDVRAT 2014)

The proceedings of the conferenc