Comparing biofeedback types for children with residual /ɹ/ errors in american english: A single-case randomization design

Nina R. Benway, Elaine R. Hitchcock, Tara McAllister, Graham Tomkins Feeny, Jennifer Hill, Jonathan L. Preston

Research output: Contribution to journalArticlepeer-review


Purpose: Research comparing different biofeedback types could lead to individualized treatments for those with residual speech errors. This study examines within-treatment response to ultrasound and visual-acoustic biofeedback, as well as generalization to untrained words, for errors affecting the American English rhotic /ɹ/. We investigated whether some children demonstrated greater improvement in /ɹ/ during ultrasound or visual-acoustic biofeedback. Each participant received both biofeedback types. Individual predictors of treatment response (i.e., age, auditory-perceptual skill, oral somatosensory skill, and growth mindset) were also explored. Method: Seven children ages 9–16 years with residual rhotic errors participated in 10 treatment visits. Each visit consisted of two conditions: 45 min of ultrasound biofeedback and 45 min of visual-acoustic biofeedback. The order of biofeedback conditions was randomized within a single-case experimental design. Acquisition of /ɹ/ was evaluated through acoustic measurements (normalized F3–F2 difference) of selected nonbiofeedback productions during practice. Generalization of /ɹ/ was evaluated through acoustic measurements and perceptual ratings of pretreatment/ posttreatment probes. Results: Five participants demonstrated acquisition of practiced words during the combined treatment package. Three participants demonstrated a clinically significant degree of generalization to untreated words on posttreatment probes. Randomization tests indicated one participant demonstrated a significant advantage for visual-acoustic over ultrasound biofeedback. Participants’ auditory-perceptual acuity on an /ɹ/−/w/ identification task was identified as a possible correlate of generalization following treatment. Conclusions: Most participants did not demonstrate a statistically significant difference in acoustic productions between the ultrasound and visual-acoustic conditions, but one participant showed greater improvement in /ɹ/ during visual-acoustic biofeedback.

Original languageEnglish (US)
Pages (from-to)1819-1845
Number of pages27
JournalAmerican journal of speech-language pathology
Issue number4
StatePublished - Jul 2021


  • Adolescent
  • Biofeedback, Psychology
  • Child
  • Humans
  • Random Allocation
  • Speech
  • Speech Sound Disorder
  • Speech Therapy
  • United States

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Speech and Hearing
  • Otorhinolaryngology
  • Linguistics and Language


Dive into the research topics of 'Comparing biofeedback types for children with residual /ɹ/ errors in american english: A single-case randomization design'. Together they form a unique fingerprint.

Cite this