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PURPOSE: Artificial intelligence (AI) chatbots based on large language models (LLMs) can deliver medical information, but their performance on specialized topics such as central auditory processing disorder (CAPD) remains unexplored. This study evaluated the accuracy and completeness of three AI chatbots (ChatGPT, Gemini, and Claude) in providing CAPD-related information across varying levels of question complexity. METHOD: Forty-four questions, categorized into four difficulty levels (patient level, easy, intermediate, and specialized; n = 11 each), were submitted to each chatbot, generating 132 responses. Seven clinical experts, blinded to chatbot identity, independently rated accuracy and completeness on a 1-5 Likert scale. Data were analyzed with analyses of variance, correlations, and interrater comparisons. RESULTS: Chatbot performance was similar, with mean accuracy below 4.0 and completeness about 3.5. Complex questions often scored below 3.0 across experts. Only three of the 44 questions, primarily patient level or relatively simple, received consistently high expert ratings (≥ 4 for both accuracy and completeness) across all three chatbots. Performance declined with question difficulty, although differences were not statistically significant. Accuracy and completeness were correlated across chatbots. CONCLUSIONS: Current AI chatbots provided generally accurate CAPD information but fell short of clinical standards, particularly on specialized questions. Their limited performance underscores the need for clinician oversight in CAPD assessment and management. Chatbots may serve as helpful adjuncts but should not replace expert evaluation and guidance in clinical settings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31975101.

Nasopharyngoscopy is a minimally invasive endoscopic procedure that allows visual observation and analysis of the velopharyngeal mechanism during speech. It can be used to assess both anatomic and physiologic abnormalities of the velopharyngeal valve. In cases of suspected velopharyngeal insufficiency (VPI), nasopharyngoscopy is particularly useful in determining the size, location, and cause of the velopharyngeal opening. This information is very important for surgical planning. Nasopharyngoscopy is also useful in the assessment of secondary surgery that was done for VPI. It can help determine the need for revision and the type of revision surgery that is most likely to be successful. The purpose of the chapter is to explain how nasopharyngoscopy is used in the evaluation of velopharyngeal function. This chapter includes specific tips for achieving a successful examination in children as young as age 3. Finally, important observations from nasopharyngoscopy are described. © 2025 The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG.

Narrative language samples can be used to measure language development in children, but research on narrative development in deaf and hard-of-hearing (DHH) children is scarce, limiting knowledge of developmental stages and best practices for collection and analysis. This scoping review included 39 articles that explored recent methodologies and achievements in oral or signed narratives of DHH children, including comparisons with hearing peers and within-group analyses of early auditory experience, device use, and other measures. Articles featured DHH participants aged < 4 to 18 years, varying in device use, communication modalities, and educational settings. Most studies utilized story generation tasks with early elementary-aged children and analyzed either microstructure or macrostructure. Mixed results in comparisons with hearing children emphasized the need to consider individual differences (e.g., speech perception and age of spoken language access) in DHH narrative assessments. Findings also suggest that comparability across studies would be improved by more consistent terminology and procedures in narrative collection/analysis.

Frequency importance functions quantify the contribution of spectral frequencies to perception. Frequency importance has been well-characterized for speech recognition in quiet and steady-state noise. However, it is currently unknown whether frequency importance estimates generalize to more complex conditions such as listening in a multi-talker masker or when targets and maskers are spatially separated. Here, frequency importance was estimated by quantifying associations between local target-to-masker ratios at the output of an auditory filterbank and keyword recognition accuracy for sentences. Unlike traditional methods used to measure frequency importance, this technique estimates frequency importance without modifying the acoustic properties of the target or masker. Frequency importance was compared across sentences in noise and a two-talker masker, as well as sentences in a two-talker masker that was either co-located with or spatially separated from the target. Results indicate that frequency importance depends on masker type and spatial configuration. Frequencies above 5 kHz had lower importance and frequencies between 600 and 1900 Hz had higher importance in the presence of a two-talker masker relative to a noise masker. Spatial separation increased the importance of frequencies between 600 Hz and 5 kHz. Thus, frequency importance functions vary across listening conditions.

Purpose: This longitudinal study investigated the trajectory of Spanish article accuracy in Spanish–English dual language learners (DLLs) from preschool to first grade, addressing the need for longitudinal data on the variability of Spanish grammatical skills in DLLs in English immersion classrooms. Method: Language sample analysis was conducted on 336 Spanish and English narrative retells elicited from 31 Spanish–English DLLs (range: 45–85 months). Growth curve models captured within- and between-individual change in article accuracy from the beginning of preschool to the end of first grade. Results: As a group, DLLs did not exhibit significant positive or negative growth in Spanish article accuracy over time. On average, article accuracy remained stable at 76% from preschool throughout first grade. Participants exhibited significant variability in article accuracy that was partly explained by changes in Spanish proficiency. Spanish article accuracy was lower for DLLs with lower Spanish proficiency indexed by measures from the Spanish language samples, while English proficiency indexed by the English language samples did not affect Spanish article accuracy. Conclusions: These findings suggest that expectations for Spanish grammatical performance in DLLs need to be adjusted to account for the possible impact of not receiving Spanish support in English immersion school settings. DLLs in these instructional programs do not exhibit article accuracy at a level expected for monolingual Spanish speakers. Significant individual differences in both individual status and growth rates of Spanish article accuracy highlight the broad variability in Spanish language skills of DLLs in the United States.

In this article, the authors assist teachers who are working with young students at risk for reading disabilities by helping make sense of the large—but unwieldy—scientific knowledge base. They offer a conceptual framework for thinking about beginning reading instruction and intervention across three dimensions: the content of instruction (what to teach), the delivery of instruction (how to teach), and the timing of instruction (when to teach). The authors discuss each of these dimensions and describe how teachers can use them to help organize and make sense of what we know about beginning reading instruction for students experiencing reading difficulties.

Abstract The purpose of this study was to compare 2 methods for directly teaching word meanings to kindergarten students within storybook read‐alouds that varied in instructional time and depth of instruction along with a control condition that provided students with incidental exposure to target words. Embedded instruction introduces target word meanings during storybook readings in a time‐efficient manner. Extended instruction is more time intensive but provides multiple opportunities to interact with target words outside the context of the story. Participants included 42 kindergarten students who were taught 9 target words, 3 with each method. Target words were counterbalanced in a within‐subjects design. Findings indicated that extended instruction resulted in more full and refined word knowledge, while embedded instruction resulted in partial knowledge of target vocabulary. Implications are discussed in relation to the strengths and limitations of different approaches to direct vocabulary instruction in kindergarten and the trade‐offs between instruction that focuses on teaching for breadth versus depth.

This article examines the role of direct instruction in promoting listening and reading comprehension. Instructional examples from 2 programs of intervention research focused on improving comprehension; the Story Read Aloud Program and the Embedded Story Structure Routine are used to illustrate principles of direct instruction. An analysis of these 2 approaches suggests that direct instruction principles are effective in supporting students with varied achievement levels and that these principles can be used to enhance comprehension among students at very different points in reading development. These evidence-based approaches also illustrate that direct instruction can be designed to support complex learning and the development of higher order cognitive strategies.

Two approaches to systematic word review were integrated into an 18-week program of extended vocabulary instruction with kindergarten students from three high-need urban schools. Words in the embedded and semantically related review conditions received systematic and distributed review. In the embedded review condition, brief word definitions were integrated into the narratives of multiple storybooks. In the semantically related review condition, in-depth word review with explicit emphasis on semantic features and associations was provided during extension activities. Systematic review resulted in an almost twofold increase in target word learning. Embedded review was effective and time efficient, whereas semantically related review was time intensive but resulted in higher levels of word learning. There was a significant gain in Peabody Picture Vocabulary Test—III standard scores following the intervention.

The purpose of this study was to investigate the efficacy of an 18-week program of direct and extended vocabulary instruction with kindergarten students on both proximal measures of target word knowledge and transfer measures of generalized language and literacy. A second purpose was to examine whether treatment effects would be moderated by initial receptive vocabulary knowledge measured at pretest. In a quasi-experimental design, 80 kindergarten students from schools serving large at-risk populations were taught the meanings of 54 vocabulary words within interactive story read alouds over 36 half-hour instructional lessons (2 lessons per week over 18 weeks). An additional 44 students served as a no-treatment control. Findings indicated that students who received vocabulary instruction outperformed controls on a measure of target word knowledge as well as measures of generalized receptive vocabulary and listening comprehension. In addition, initial receptive vocabulary was strongly related to posttest performance on all measures. Implications are discussed in relation to supporting vocabulary development in the early grades within a multitier framework of instruction and intervention.

The purpose of this study was to examine the effectiveness of a vocabulary intervention designed to supplement research–based classroom vocabulary instruction, implemented with students who may be at risk for language and learning difficulties. Participants included 43 kindergarten students who received research–based classroom vocabulary instruction. Students with the 20 lowest scores on the Peabody Picture Vocabulary Test–III administered at pretest received additional small–group supplemental vocabulary intervention. Results of within–subjects comparisons indicated that, overall, at–risk students made greater gains in word knowledge on target words that received the supplemental intervention as compared to words that received only classroom–based instruction. In addition, at–risk students who received the supplemental intervention demonstrated word–learning gains that approached those of their peers who received classroom instruction alone. Implications along with limitations of the current study and directions for future research are discussed.

Purpose A frequent complaint by older adults is difficulty communicating in challenging acoustic environments. The purpose of this work was to review and summarize information about how speech perception in complex listening situations changes across the adult age range. Method This article provides a review of age-related changes in speech understanding in complex listening environments and summarizes results from several studies conducted in our laboratory. Results Both degree of high frequency hearing loss and cognitive test performance limit individuals' ability to understand speech in difficult listening situations as they age. The performance of middle-aged adults is similar to that of younger adults in the presence of noise maskers, but they experience substantially more difficulty when the masker is 1 or 2 competing speech messages. For the most part, middle-aged participants in studies conducted in our laboratory reported as much self-perceived hearing problems as did older adult participants. Conclusions Research supports the multifactorial nature of listening in real-world environments. Current audiologic assessment practices are often insufficient to identify the true speech understanding struggles that individuals experience in these situations. This points to the importance of giving weight to patients' self-reported difficulties. Presentation Video http://cred.pubs.asha.org/article.aspx?articleid=2601619

The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech–language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61–1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.

In the acute-care setting patients with altered mental status as a result of such diverse etiologies as stroke, traumatic brain injury, degenerative neurologic impairments, dementia, or alcohol/drug abuse are routinely referred for dysphagia testing. A protocol for dysphagia testing was developed that began with verbal stimuli to determine patient orientation status and ability to follow single-step verbal commands. Although unknown, it would be beneficial to ascertain if this information on mental status was predictive of aspiration risk. The purpose of this investigation was to determine if there was a difference in odds for aspiration based upon correctly answering specific orientation questions, i.e., 1. What is your name? 2. Where are you right now? and 3. What year is it?, and following specific single-step verbal commands, i.e., 1. Open your mouth. 2. Stick out your tongue. and 3. Smile. In a consecutive retrospective manner data from 4070 referred patients accrued between 1 December 1999 and 1 January 2007 were analyzed. The odds of liquid aspiration were 31% greater for patients not oriented to person, place, and time (odds ratio [OR] = 1.305, 95% CI = 1.134–1.501). The odds of liquid aspiration (OR = 1.566, 95% CI = 1.307–1.876), puree aspiration (OR = 1.484, 95% CI = 1.202–1.831), and being deemed unsafe for any oral intake (OR = 1.688, 95% CI = 1.387–2.054) were, respectively, 57, 48, and 69% greater for patients unable to follow single-step verbal commands. Being able to answer orientation questions and follow single-step verbal commands provides information on odds of aspiration for liquid and puree food consistencies as well as overall eating status prior todysphagia testing. Knowledge of potential increased odds of aspiration allows for individualization of dysphagia testing thereby optimizing swallowing success.