Development of a Minimum Protocol for the Assessment of Communication Disorders within Moroccan Students

1.1. Communication Disorders

Communication disorder is “any disorder that affects an individual’s ability to communicate”.

There are two types of communication disorders: speech disorders and language disorders [1].

1.2. Speech Disorders

According to the U.S. Department of Education (1992), “Speech is the process that shapes sounds into meaningful units, such as words. A multitude of factors can interfere with the normal development of speech, resulting in articulation disorders, difficulty controlling the sounds produced verbally (dysarthria or apraxia), and controlling the rate and rhythm of speech (fluency)” [1].

R.D. Kent [2], reported that voice disorders occur in approximately 6% of all adults in US. R.H. Bahr et al. [1], revealed that in many developing countries, communication disorders are often unreported.

Disorders of speech include voice disorders, stuttering, and speech sound disorders [3].

Fluency disorders are defined as the abnormal flow of verbal expression, characterized by impaired rate and rhythm which may be accompanied by secondary behaviours such as tics, eye blinking and facial grimaces” [4].

1.3. Language Disorders

Language disorders are characterized by difficulties in learning and using language and can negatively impact the major areas of language including syntax, semantics, phonology and morphology [5].

1.4. Causes of Communication Disorders

A multitude of factors can interfere with the normal development of speech, language and hearing, these constitute communication disorders.

Many conditions can interfere with the communication process resulting in communication impairment, which includes both physical and behavioural conditions [3].

The causes of speech sound disorders can be divided into two categories; the first category are related to organic disorders resulting from structural, physiologic, sensory or neurologic deficits as reported by Gordon-Brannan et al. [6].

A large part of these disorders can be identified using acoustic analysis.

The second category relates to functional disorders as mentioned by Bernthal et al. [7] and behavioural disorders, which is not apparent in the first category.

1.5. Impact of Communication Disorders

Communication skills are necessity both in the academic and social atmosphere of the school environment [8].

Disordered communication can negatively affect a person’s lifestyle.

Speech, language, and/or hearing disorders have the potential to affect a student communicatively, socially, psychologically and academically [3].

Santon-Chapman et al. [8], Thatcher et al. [9], van Kleeck [10], Logan et al. [11], Gillette et al. [12] and Pufpaff [13] discuss that there are barriers providing instruction to students with communication disorders in a regular classroom.

Roulstone et al. [14], Zascavage et al. [15], Weigel et al. [16, 17], demonstrate the relationship between speech and/or language and literacy acquisition.

Catts et al. [18, 19], Nation et al. [20] and Schuele et al. [21, 22] found that many of the individuals identified with speech and/or language disorders may also exhibit subsequent deficits in reading and writing. In addition to academics, students with communication disorders may experience difficulty in social and behavioral skills required in school.

Communication is a vital skill not only necessary to succeed academically, but also required to participate effectively in social situation.

Students with communication disorders find difficult engaging in many of the academic and social activities encountered in schools.

Olusanya et al. [23], reported that the economic and social consequences of disabilities, which includes communication disorders are staggering, especially when we consider that many communication disorders are not readily apparent (e.g. Language learning disability or word finding difficulties).

Allen [24] arrived at the conclusion that having confidence in oral communication can make graduates versatile in their personal, academic, professional and civic lives.

Horwitz et al. [25, 26], found that whenever such learners endeavour to learn and speak English either as a second or a foreign language, they experience a certain level of anxiety and claim to undergo a ‘mental block’ during oral communication. Researchers have found that this mental block or anxiety severely jeopardizes the language learners’ communicative competence.

4.1. Do you Feel Comfortable When Speaking in Front of a Large Group?

After collecting the data the results for each student was scored. Excel software was used to record the data.

The studied sample showed that 75% of the students do not feel comfortable when speaking in front of a large Group as shown in Fig. (1).

The first two questions that were asked “Do you feel comfortable when speaking in front of a large group” and “Do you consult a speech therapist?” gave us important information about the studied sample.

Pareto principle states that, for many events, roughly 80% of the effects come from 20% of the causes [2].

As shown in Table 1, lack of self-confidence, stage fright, lack of experience, shyness and presence of the important group constitute 80% of the causes.

As Friedl et al. [45] explained, the functional disorder is related to organic disorder. For example, the larynx can be a site of neuromuscular tension that is caused by stress, emotional inhibition, fear or threat of communication breakdown.

Trevarthen [46] found that these disorders are impacting students’ self-confidence.

Researchers like Devi et al. [47], found that most of the language learners have some form of anxiety that interferes with their level of confidence during their speech.

Anxiety shakes the language learners’ confidence, which adversely impedes their oral performance in the target language.

Anxiety or low level of confidence restricts the chances of learning and speaking the target language posing serious threat to oral communication. Richmond and McCroskey [48], opined discussed that the high level of anxiety among language learners seriously hampers the interaction between teacher and learners, which is extremely crucial to productive teaching and learning of the target language.

Horwitz et al. [25], define this anxiety “as a type of shyness characterized by fear or apprehension about communicating [orally] with people.”

McCroskey [26, 49], defines it simply as a fear related to oral communication.

Listeners’ status and the context make the speaker uneasy and apprehensive to speak confidently Friedman [50]. Taylor [51] reveals that speech anxiety may be specific to just a few settings (e.g. public speaking) or may exist in most everyday situations.

Communication situations that cause general anxiety are present during many facets of an individual’s life. Among all four language skills, speaking is supposed to be the most anxiety-provoking skill. MacInttyre and Gardner [52], point out that the skill producing most anxiety is oral communication.

Learners who demonstrate speech anxiety/communication apprehension feel uncomfortable when required to communicate verbally in the target language in front of other individuals. Tesiplakides explains that students who experience test anxiety consider verbal communication a test situation rather than a chance for improving communication skills.

Learners who exhibit fear of negative evaluations deem errors as a danger to their image and do not consider it an accepted part of the learning process. As a consequence, they are silent and do not participate in classroom activities (Ely [53]).

Some previous researchers on language anxiety have concluded that learners’ apprehension may be aggravated by the learners’ negative self perception as cited by Krashen [54].

Tobias [55] found that highly apprehensive learners think negatively about themselves and have low-perceived self-esteem about their own performance in the target language.

4.2. Stuttering Assessment

Determine the severity and frequency of the problem by answering each question on the voice quiz by using a 5 point rating scale where: 0 = None, not a problem, 1 = A mild 2 = moderate 3= moderate-severe, 4 = severe.

Each participant fills the form with the required answers to the questions.

As shown in Fig. (2), verbal communication was responsible for stuttering.

Stuttering assessment: 20% of students indicated they are severe persons who stutter.

Before initiating communication: The feeling of being in front of a large group of people refrains students from talking, despite having the desire to speak. It also causes them to sweat, feel ashamed, and have and increase heart rate.

During communication:, The impression of having a rapid heartbeat, feeling the negative view of others, impression of a poor self-image, and fluency disorders are 80% of the reasons anxiety arises in students during communication. .

After communication: The fear of being judged, reliving the conversation and focusing on the negative aspects (e.g., communication breakdowns), the feeling of not being able to say what “I want to say” and thinking that stuttering was distracting to the listener and negatively impacted communication are 80% of the causes of anxiety after communication.

Zheng [56] claims that anxiety influences both speed and accuracy and its arousal can impact the quality of communication output as the retrieval of information may be interrupted by the ‘freezing-up’ moments that students encounter when they get anxious, Richmond and Falcione [57] discovered that learners with high levels of speech anxiety were predisposed to have poorer self-esteem than students with low speech anxiety, which in turn negatively impacts academic success.

4.3. Other Communication Disorders Assessment

For each communication disorder, we focused on the severe degree (degree 4).

The weight of each question is examined, to select 20% that represent 80% of the causes.

As shown in Fig. (3), The speech delay was the most relevant disorder, with, 54% of the students identifying themselves as having speech delay disorder.

Fifteen per cent of students have identified a degree of severity for the communication disorder.

Dealing with articulation disorders, 27% of studied sample have difficulty producing the isolated phonemes A, B, C.

Twenty three per cent feel the inability to pronounce or to form a phoneme correctly?: i- u- -é è; Ch and R.

In the present study, the speech sound disorders were the most prevalent communication disorder, given that 54% of the studied sample had difficulty selecting and linking sounds in syllables, which according to Sabir et al. [58] is more prevalent than the other kinds of communication disorders.

In regards to dysphasia, 27% of students feel they have word finding problems during oral presentations.

With respect to the dyslexia assessment, 22% of students have reading comprehension difficulty, and 13% confuse sounds fv, sz, hp-j, td, cg, mn and pbqd.

With respect to the dysphonia assessment, 14% of students feel a change in voice characteristics (more or less intensive, height too low or too high) when they are talking, and 6% have even altered their vocal cords.

4.4. Acoustic Analysis

Record of sustained vowel /a/ (duration 3 to 5 seconds).

The acoustic parameters jitter, shimmer, HNR, and pitch will be evaluated using normative data from the literature as shown in Table 2.

Table 2. Recommended values of pitch for male and female signals.

The classification pathological/healthy was based on the extracted values of acoustic parameter upon the defined threshold in the literature.

For jitter, recommended values of praat (jiiter ddp% <= 1.04%) [44], for female signal: <=0.66% [39] and for male signal: <=0.44% [39].

For shimmer, recommended values of praat (shimmer dda%): <= 3.810% [44], and female signal: <=2.7458% [39], and male signal <=: 2.2873% [39],

For harmonic-to-noise-ratio (HNR), recommended value of praat <=: <20 dB [44], for female signal recommended value <=: 15.3dB [39], and for male signal recommended value <=: 17.3 dB [39].

4.5. Synthesis Results

For each communication disorder, students use the following 0-4 scale to rate the severity of the problem: 0 = None, not a problem, 1 = A mild 2 = moderate 3= moderate-severe, 4 = severe.

The synthesis results are shown in Table 3.