{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:58:31Z","timestamp":1740128311494,"version":"3.37.3"},"reference-count":69,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2016,3,6]],"date-time":"2016-03-06T00:00:00Z","timestamp":1457222400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"American Speech-Language Hearing Association (2013","award":["R03DC012883"],"award-info":[{"award-number":["R03DC012883"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Maintaining an external direction of focus during practice is reported to facilitate acquisition of non\u2010speech motor skills, but it is not known whether these findings also apply to treatment for speech errors. This question has particular relevance for treatment incorporating visual biofeedback, where clinician cueing can direct the learner's attention either internally (i.e., to the movements of the articulators) or externally (i.e., to the visual biofeedback display).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study addressed two objectives. First, it aimed to use single\u2010subject experimental methods to collect additional evidence regarding the efficacy of visual\u2013acoustic biofeedback treatment for children with \/r\/ misarticulation. Second, it compared the efficacy of this biofeedback intervention under two cueing conditions. In the external focus (EF) condition, participants\u2019 attention was directed exclusively to the external biofeedback display. In the internal focus (IF) condition, participants viewed a biofeedback display, but they also received articulatory cues encouraging an internal direction of attentional focus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods &amp; Procedures<\/jats:title><jats:p>Nine school\u2010aged children were pseudo\u2010randomly assigned to receive either IF or EF cues during 8 weeks of visual\u2013acoustic biofeedback intervention. Accuracy in \/r\/ production at the word level was probed in three to five pre\u2010treatment baseline sessions and in three post\u2010treatment maintenance sessions. Outcomes were assessed using visual inspection and calculation of effect sizes for individual treatment trajectories. In addition, a mixed logistic model was used to examine across\u2010subjects effects including phase (pre\/post\u2010treatment), \/r\/ variant (treated\/untreated), and focus cue condition (internal\/external).<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes &amp; Results<\/jats:title><jats:p>Six out of nine participants showed sustained improvement on at least one treated \/r\/ variant; these six participants were evenly divided across EF and IF treatment groups. Regression results indicated that \/r\/ productions were significantly more likely to be rated accurate post\u2010 than pre\u2010treatment. Internal versus external direction of focus cues was not a significant predictor of accuracy, nor did it interact significantly with other predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results are consistent with previous literature reporting that visual\u2013acoustic biofeedback can produce measurable treatment gains in children who have not responded to previous intervention. These findings are also in keeping with previous research suggesting that biofeedback may be sufficient to establish an external attentional focus, independent of verbal cues provided. The finding that explicit articulator placement cues were not necessary for progress in treatment has implications for intervention practices for speech\u2010sound disorders in children.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1460-6984.12215","type":"journal-article","created":{"date-parts":[[2016,3,7]],"date-time":"2016-03-07T04:56:42Z","timestamp":1457326602000},"page":"384-401","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Direction of attentional focus in biofeedback treatment for \/r\/ misarticulation"],"prefix":"10.1111","volume":"51","author":[{"given":"Tara","family":"McAllister Byun","sequence":"first","affiliation":[{"name":"Department of Communicative Sciences and Disorders New York University  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle T.","family":"Swartz","sequence":"additional","affiliation":[{"name":"Department of Communicative Sciences and Disorders New York University  New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter F.","family":"Halpin","sequence":"additional","affiliation":[{"name":"Department of Communicative Sciences and Disorders New York University  New York NY USA"},{"name":"Department of Humanities and Social Sciences in the Professions"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Szeredi","sequence":"additional","affiliation":[{"name":"Department of Communicative Sciences and Disorders New York University  New York NY USA"},{"name":"Department of Linguistics"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edwin","family":"Maas","sequence":"additional","affiliation":[{"name":"Department of Communicative Sciences and Disorders New York University  New York NY USA"},{"name":"Communication Sciences and Disorders, Temple University  Philadelphia PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,3,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1044\/1058-0360(2007\/017)"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1121\/1.417972"},{"key":"e_1_2_9_4_1","first-page":"206","article-title":"Attaining the lingual components of \/r\/ with ultrasound for three adolescents with cochlear implants","volume":"34","author":"Bacsfalvi P.","year":"2010","journal-title":"Revue Canadienne d'Orthophonie et d'Audiologie"},{"key":"e_1_2_9_5_1","unstructured":"Becker M. andLevine J. 2010 Experigen \u2013 An online experiment platform. 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