ARTICULATION DISORDERS OF UNKNOWN ORIGIN IN CHILDREN

NIH GUIDE, Volume 23, Number 7, February 18, 1994



PA NUMBER:  PA-94-039



P.T.





Keywords:



National Institute on Deafness and Other Communication Disorders



PURPOSE



The National Institute on Deafness and Other Communication Disorders

(NIDCD) encourages research project applications to examine

systematically the linguistic, phonologic, motoric, perceptual,

cognitive, and other variables that have been posited to play a role

in the genesis of articulation disorders of unknown origin in

children.  Research grant applications that address the nature of the

disorder, subgroups within the disorder, and appropriate methods of

prevention, diagnosis, and treatment of the disorder are encouraged.



HEALTHY PEOPLE 2000



The Public Health Service (PHS) is committed to achieving the health

promotion and disease prevention objectives of "Healthy People 2000,"

a PHS-led national activity for setting priority areas.  This Program

Announcement, Articulation Disorders of Unknown Origin in Children,

is related to the priority area of clinical prevention services.

Potential applicants may obtain a copy of "Healthy People 2000" (Full

Report:  Stock No. 017-001-11474-0) or "Healthy People 2000" (Summary

Report:  Stock No. 017-001-11473-1) through the Superintendent of

Documents, Government Printing Office, Washington, DC 20402-9325

(telephone 202-783-3238).



ELIGIBILITY REQUIREMENTS



Applications may be submitted by domestic and foreign for-profit and

non-profit organizations, public and private, such as universities,

colleges, hospitals, laboratories, units of State or local

governments, and eligible agencies of the Federal government.

Foreign institutions are not eligible for First Independent Research

Support and Transition (FIRST) (R29) awards.  Applications from

minority individuals and women are encouraged.



MECHANISM OF SUPPORT



The support mechanisms for grants in this area will be the

investigator-initiated research grant (R01) and the FIRST (R29)

award.  The NIH policies and submission dates that govern these

mechanisms will prevail.



RESEARCH OBJECTIVES



Background



One of the most common communication disorders in childhood is that

of errors in speech sound production (articulation).  It has been

estimated that articulation disorders represent in excess of 75

percent of all speech disorders in children.  A large number of these

articulation disorders have no recognizable organic, neurogenic, or

physical correlate.  Children with articulation disorders of unknown

cause constitute 99 percent of the caseloads of speech-language

pathologists working in the schools.  Importantly, these difficulties

may have consequences throughout the lifespan of these children.



Research on articulation disorders of unknown cause has focused on

consideration of such variables as intelligence, motor skill,

auditory discrimination, auditory  memory, academic performance and

socio-economic status, in an attempt to identify a causal link.  The

clinical observation that individual differences exist among these

children and that effective intervention may depend on early

identification and consideration of these relevant individual

differences suggests that a number of complementary research

perspectives be considered.



Traditionally, these disorders have been viewed as a possible motor

disorder:  a difficulty in the motor control of articulation and the

coordinated, connected production of speech sounds.  More recently,

this view has been extended to include the general processing,

organization and cognitive representation of linguistic information.

Within this viewpoint, children's speech productions are seen as

manifestations of underlying forms and phonological processes.

Because of their presumed importance in early phonetic learning,

speech discrimination deficits have also been considered to be

potentially important factors in the development and perpetuation of

such articulation disorders.  Models of adult neurogenic speech

disorders have also been applied to this group of misarticulating

children in an attempt to examine the role that a difficulty in

programming the speech musculature for volitional production of

phonemes might play in children with articulation disorders.  The

diagnostic label of developmental apraxia of speech derives from this

model.  This term has been used to describe the speech behavior of

children with moderate to severe articulation disorders of nonorganic

cause.



Research Goals and Scope



Although no causal relationships have yet been determined, possible

causes have been proposed, and models that could explain the nature

of the articulation disorder have subsequently been developed.  As a

result, several theoretical approaches to articulation disorders of

unknown cause have emerged.  Most propose that one strong causal

factor may be accompanied by other less strong but still influential

factors contributing to the disorder.  Although a number of insights

have been gained by considering these children from these different

perspectives, many issues remain.



Studies that may be proposed in applications submitted in response to

this PA include, but are not limited to, the following:



o  Development of model systems of identification and evaluation of

children with articulation disorders that consider the linguistic,

phonologic, motoric, and cognitive aspects of normal development.

o  Identification of factors that place children at risk for

developing articulation disorders and at risk for long-term problems

of articulation.

o  Exploration of genetic factors associated with the development of

articulation disorders of unknown cause.

o  Evaluation of acoustic-phonetic features of children's speech in

order to identify predictors of subsequent articulatory disorders.

o  Delineation of subgroups of children with articulation disorders

of unknown cause, using broad and interdisciplinary examinations of

the linguistic, cognitive, motoric, perceptual, neurogenic, and

genetic bases of the disorder.

o  Identification of appropriate techniques for the differential

diagnosis and effective treatment of subgroups of this population.

o  Development, evaluation and standardization of improved

phonological, motor and linguistic assessment and treatment

procedures based on theoretical models.

o  Generation of incidence and prevalence data related to

articulation disorders of unknown cause across age levels.

o  Determination of factors that enhance or diminish the efficacy of

treatment for children with the disorder.



STUDY POPULATIONS



SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH

POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL

RESEARCH STUDY POPULATIONS



NIH policy is that applicants for NIH clinical research grants and

cooperative agreements are required to include minorities and females

in study populations so that research findings can be of benefit to

all persons at risk of the disease, disorder or condition under

study; special emphasis must be placed on the need for inclusion of

minorities and females in studies of diseases, disorders and

conditions which disproportionately affect them.  This policy is

intended to apply to males and females of all ages.  If women or

minorities are excluded or inadequately represented in clinical

research, particularly in proposed population-based studies, a clear

compelling rationale must be provided.



The composition of the proposed study population must be described in

terms of gender and racial/ethnic group.  In addition, gender and

racial/ethnic issues must be addressed in developing a research

design and sample size appropriate for the scientific objectives of

the study.  This information must be included in the form PHS 398 in

Sections 1-4 of the Research Plan AND summarized in Section 5, Human

Subjects.  Applicants are urged to assess carefully the feasibility

of including the broadest possible representation of minority groups.

However, NIH recognizes that it may not be feasible or appropriate in

all research projects to include representation of the full array of

United States racial/ethnic minority populations (i.e., Native

Americans [including American Indians or Alaskan Natives],

Asian/Pacific Islanders, African Americans, Hispanic Americans).  The

rationale for studies on single minority population groups should be

provided.



For the purpose of this policy, clinical research is defined as human

biomedical and behavioral studies of etiology, epidemiology,

prevention (and preventive strategies), diagnosis, or treatment of

diseases, disorders or conditions, including but not limited to

clinical trials.  The usual NIH policies concerning research on human

subjects also apply.  Basic research or clinical studies in which

human tissues cannot be identified or linked to individuals are

excluded.  However, every effort should be made to include human

tissues from women and racial/ethnic minorities when it is important

to apply the results of the study broadly, and this should be

addressed by applicants.



For foreign awards, the policy on inclusion of women applies fully;

since the definition of minority differs in other countries, the

applicant must discuss the relevance of research involving foreign

population groups to the United States' populations, including

minorities.



If the required information is not contained within the application,

the application will be returned.



Peer reviewers will address specifically whether the research plan in

the application conforms to these policies.  If the representation of

women or minorities in a study design is inadequate to answer the

scientific questions addressed AND the justification for the selected

study population is inadequate, it will be considered a scientific

weakness or deficiency in the study design and reflected in assigning

the priority score to the application.



All applications for clinical research submitted to NIH are required

to address these policies.  NIH funding components will not award

grants or cooperative agreements that do not comply with these

policies.



APPLICATION PROCEDURES



Applications are to be submitted on the grant application form PHS

398 (rev. 9/91) and will be accepted at the standard applications

deadlines as indicated in the application kit.  The receipt dates for

applications for AIDS-related research are found in the PHS 398

instructions.  Application kits are available at most institutional

offices of sponsored research and may be obtained from the Office of

Grants Information, Division of Research Grants, National Institutes

of Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone

301-710-0267.  The title and number of the announcement must be typed

in Section 2a on the face page of the application.



The completed original application and five legible copies must be

sent or delivered to:



Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**



REVIEW CONSIDERATIONS



Applications will be assigned on the basis of established PHS

referral guidelines.  Applications will be reviewed for scientific

and technical merit by study sections of the Division of Research

Grants, NIH, in accordance with the standard NIH peer review

procedures.  Following scientific-technical review, the applications

will receive a second-level review by the appropriate national

advisory council.



AWARD CRITERIA



Applications will compete for available funds with all other approved

applications assigned to that ICD.  The following will be considered

in making funding decisions:



o  Quality of the proposed project as determined by peer review

o  Availability of funds

o  Program priorities among research areas of the announcement.



INQUIRIES



Written and telephone inquiries concerning this PA are encouraged.

The opportunity to clarify any issues or questions from potential

applicants is welcome.



Direct inquiries regarding programmatic issues to:



Beth Ansel, Ph.D.

Division of Communication Sciences and Disorders

National Institute on Deafness and Other Communication Disorders

Executive Plaza South, Suite 400-C

Rockville, MD  20892

Telephone:  (301) 402-3461



Direct inquiries regarding fiscal matters to:



Ms. Sharon Hunt

Grants Management Branch

National Institute on Deafness and Other Communication Disorders

Executive Plaza South, Suite 400-B

Rockville, MD  20892

Telephone:  (301) 402-0909



AUTHORITY AND REGULATIONS



This program is described in the Catalog of Federal Domestic

Assistance No. 93.173.  Awards are made under authorization of the

Public Health Service Act, Title IV, Part A (Public Law 78-410, as

amended by Public Law 99-158, 42 USC 241 and 285) and administered

under PHS grants policies and Federal Regulations 42 CFR 52 and 45

CFR Part 74.  This program is not subject to the intergovernmental

review requirements of Executive Order 12372 or Health Systems Agency

review.



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