OBJECTIVES: To compare the diagnostic accuracy of a low-cost screening test for identifying children at risk for language disorders with that of a specific language assessment. METHODS: The study was conducted during a polio vaccination campaign in basic health units in western São Paulo, Brazil. The parents/guardians of 1000 children aged between 0 and 5 years were asked to answer questions of a specific screening test. The instrument consisted of a uniform set of questions about the main milestones in language development (from 0 to 5 years of age) with scaled scores to assess responses. There were no exclusion criteria. After the screening test, the children were referred to a specific language assessment by ABFW, following a determined flow of referrals. The results obtained in the screening were compared to those obtained in the specific language assessment; then, the sensitivity, specificity, accuracy, and positive and negative predictive values were determined for the screening test. Children who failed the screening test also underwent an audiological evaluation. The statistical significance was set at 5%. RESULTS: The majority of the participants were aged between 4 and 5 years (21.82%) and were male (51.6%). The sensitivity and specificity values were 82.5% and 98.93%, respectively. The area under the curve was 0.907 (0.887-0.925), and the screening test showed 96% accuracy. CONCLUSIONS: The screening test showed high diagnostic efficiency in determining the risk of language disorders in children aged between 0 and 5 years.

RESUMO OBJETIVOS Analisar a rede de cuidados ao bebê de risco na região Oeste do município de São Paulo, tendo a atenção primária à saúde como ordenadora, e comparar a presença e extensão dos atributos da atenção primária à saúde nos serviços prestados, de acordo com o modelo de gestão dos serviços (Estratégia Saúde da Família e unidade básica de saúde tradicional). MÉTODOS Foi feito levantamento de todos os bebês de risco nascidos na região entre 2013 e 2014. Em seguida, fez-se busca ativa dessas crianças para posterior aplicação do questionário PCATool versão criança. Foram localizadas no território 233 crianças; 113 responsáveis por crianças concordaram em participar do estudo, e 81 compuseram a amostra final. RESULTADOS Quanto aos resultados do PCATool para escores geral e essencial, as unidades com Estratégia Saúde da Família foram mais bem avaliadas pelos usuários quando comparadas com as unidades básicas de saúde tradicional, com diferença estatisticamente significante. Entretanto, estes escores apresentaram-se baixos para ambos os modelos de gestão. Quanto aos atributos, a Estratégia Saúde da Família apresentou desempenho melhor quando comparada à unidade básica de saúde tradicional para a maioria deles, com exceção de coordenação dos sistemas de informação. Dos dez atributos avaliados, sete atingiram valores ≥ 6,6 para a Estratégia Saúde da Família e dois, para unidade básica de saúde tradicional. CONCLUSÕES Independentemente do modelo de gestão, verificaram-se baixos escores geral e essencial, indicando que os responsáveis pelos bebês de risco avaliaram como insatisfatórios alguns atributos, com destaque para acessibilidade, integralidade e orientação familiar. Esse desempenho pode trazer consequências negativas para a qualidade e integralidade do cuidado ao bebê de risco.

ABSTRACT OBJECTIVES To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool – child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants’ health care.

RESUMO OBJETIVOS Analisar a rede de cuidados ao bebê de risco na região Oeste do município de São Paulo, tendo a atenção primária à saúde como ordenadora, e comparar a presença e extensão dos atributos da atenção primária à saúde nos serviços prestados, de acordo com o modelo de gestão dos serviços (Estratégia Saúde da Família e unidade básica de saúde tradicional). MÉTODOS Foi feito levantamento de todos os bebês de risco nascidos na região entre 2013 e 2014. Em seguida, fez-se busca ativa dessas crianças para posterior aplicação do questionário PCATool versão criança. Foram localizadas no território 233 crianças; 113 responsáveis por crianças concordaram em participar do estudo, e 81 compuseram a amostra final. RESULTADOS Quanto aos resultados do PCATool para escores geral e essencial, as unidades com Estratégia Saúde da Família foram mais bem avaliadas pelos usuários quando comparadas com as unidades básicas de saúde tradicional, com diferença estatisticamente significante. Entretanto, estes escores apresentaram-se baixos para ambos os modelos de gestão. Quanto aos atributos, a Estratégia Saúde da Família apresentou desempenho melhor quando comparada à unidade básica de saúde tradicional para a maioria deles, com exceção de coordenação dos sistemas de informação. Dos dez atributos avaliados, sete atingiram valores ≥ 6,6 para a Estratégia Saúde da Família e dois, para unidade básica de saúde tradicional. CONCLUSÕES Independentemente do modelo de gestão, verificaram-se baixos escores geral e essencial, indicando que os responsáveis pelos bebês de risco avaliaram como insatisfatórios alguns atributos, com destaque para acessibilidade, integralidade e orientação familiar. Esse desempenho pode trazer consequências negativas para a qualidade e integralidade do cuidado ao bebê de risco.

ABSTRACT OBJECTIVES To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool – child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants’ health care.

RESUMO Objetivo Comparar três métodos de aprendizagem sobre anatomia e fisiologia do sistema miofuncional orofacial, sendo dois interativos (uso de softwares educacionais) e um tradicional, quanto à aprendizagem conceitual de estudantes de graduação em Fonoaudiologia. Métodos Participaram 36 estudantes do segundo ano, alocados randomicamente em grupos: Grupo 1 (G1) – método interativo com jogo computacional 2D (n=12); Grupo 2 (G2) – método interativo com modelo computacional 3D (n=12); Grupo 3 (G3) – método tradicional (textos e figuras 2D) (n=12). Os métodos de aprendizagem foram aplicados durante estudo complementar, por sete semanas, após aula expositiva. Foi realizada uma avaliação de conhecimento antes da aplicação dos métodos de aprendizagem, imediatamente após e seis meses depois da conclusão, e o desempenho dos grupos, nos três momentos, foi comparado. Os dados foram analisados no software SPSS, versão 21 (nível de significância de 5%). Resultados Predominaram sujeitos do gênero feminino, com média de idade de 22,0 (±4,7) anos (F2,33=60,72, p=0,260). Os resultados indicaram que, no G1, apenas o pré-teste diferiu do pós-teste, enquanto no G2 e no G3 o pré-teste diferiu do pós-teste e do pós-teste tardio. Ao verificar a interação entre o desempenho dos grupos e os momentos de avaliação, observou-se que os resultados do GI foram inferiores aos dos demais grupos (F2,22=722,30 p<0,001). Conclusão O uso de modelo computacional 3D foi comparável ao do método tradicional para a aprendizagem conceitual e retenção de conhecimento, em curto e longo prazo, sendo ambos mais eficazes do que o uso de jogo computacional 2D.

ABSTRACT Purpose Compare three learning methods on Anatomy and Physiology of the Orofacial Myofunctional System (OMS): two interactive methods with educational software and one traditional method, regarding the conceptual learning of Speech-Language and Hearing Sciences (SLHS) undergraduate students. Methods Thirty-six students were randomly divided into three groups: Group 1 (G1) - 2D computer game-based method (n=12); Group 2 (G2) - 3D computational model method (n=12); Group 3 (G3) - traditional method (texts and 2D images) (n=12). The learning methods were applied during a complementary study schedule, for seven weeks, after a lecture. Knowledge assessments were conducted prior to the application of the learning methods, immediately after, and six months after completion; the performance of the groups at the three moments was compared. Data were analyzed in SPSS 21 software (p≤0.005). Results Female individuals were predominant, with mean age of 22.0 (±4.7) years (F2.33=60.72; p=0.260). The results show that only the pre-test differed from the short-term test in the G1, whereas the pre-test differed from the short- and the long-term tests in the G2 and G3. Regarding correlation between the performance of the groups and the moments of evaluation, it was observed that the results for the G1 were inferior (F2.22=722.30; p<0.001). Conclusion The 3D computational model was comparable to the traditional method for short- and long-term conceptual learning and knowledge retention, and both were more effective than the 2D computer game.

RESUMO Objetivo Caracterizar bebês de risco quanto ao perfil sociodemográfico e de saúde e descrever o acompanhamento de parte destes nas Unidades Básicas de Saúde (UBS), segundo diferentes modelos de gestão. Método Levantamento de dados de prontuários dos bebês de risco nascidos na região Oeste da cidade de São Paulo entre agosto de 2013 e fevereiro de 2014 em duas etapas (1 – caracterização; 2 – acompanhamento do desenvolvimento). Resultados Dos 225 indivíduos incluídos na primeira etapa, 51,1% eram do gênero feminino e 7,11% eram gemelares. Predominaram mães adolescentes (45,2%), pardas (50,56%), com ensino fundamental completo (47,60%) e solteiras (46,09%). A média de consultas pré-natais foi de 7,12. A maioria teve parto vaginal (62,21%) com idade gestacional média de 37,05 semanas. A média do Apgar foi de 7,13 no 1º minuto e 8,80 no 5º minuto. O peso médio ao nascimento foi de 2597,21 g, com 50,22% apresentando peso ≤2500g. Na segunda etapa, descreveu-se e comparou-se o acompanhamento do desenvolvimento de 55 bebês, segundo o modelo de gestão das UBS (28 em UBS/Estratégia Saúde da Família [ESF] e 27 em UBS tradicional). As UBS/ESF apresentaram maior média de consultas (p=0,006). Houve maior intervalo entre consultas nas UBS tradicionais. Da amostra, 56% não apresentaram registros referentes aos marcos de desenvolvimento. As medidas de crescimento foram registradas em maior número nas UBS/ESF. Para ambos, o número de consultas e o intervalo entre estas foram menores que o preconizado pelo Ministério da Saúde. Conclusão Ainda existem lacunas no acompanhamento ao bebê de risco, segundo as diretrizes preconizadas na Rede Cegonha.

ABSTRACT Purpose Characterize infants at risk of neurodevelopmental disorders according to sociodemographic and health profiles and describe their monitoring in Basic Health Units (UBS) under different management models. Methods Data were collected from medical records of infants at risk of neurodevelopmental disorders in the west region of the city of Sao Paulo from August 2013 to February 2014 (phase 1 – characterization; phase 2 – monitoring). Results Of the 225 individuals assessed in the first phase of the study, 51.1% were female and 7.11% were twins. Adolescent (45.2%), brown (50.56%), single (46.09%), complete primary education (47.60%) mothers were predominant. The mean number of prenatal visits was 7.12. Most mothers had vaginal delivery (62.22%) at mean gestational age of 37.05 weeks. Mean Apgar scores at the 1st and 5th minutes were 7.13 and 8.80, respectively. Mean weight at birth was 2597.21g., with 50.22% of newborns weighting ≤2500g. In its second phase, the study describes and compares the follow-up of 55 infants according to the UBS management model: 28 in UBS/“Estratégia Saúde da Família” (UBS/ESF) and 27 in traditional UBS (UBS/T). UBS/ESF presented higher mean of consultations (p=0.006). Longer interval between consultations was observed at UBS/T. No records of development milestones were found in 56% of the sample. Growth measures were better registered at UBS/ESF. In both management models, the number of consultations was smaller and the interval between them was shorter than those recommended by the Brazilian Ministry of Health. Conclusion According to the recommended guidelines of the “Rede Cegonha” public policy, gaps in the monitoring of infants at risk of neurodevelopmental disorders are still observed.

RESUMO Introdução Conhecer o fluxo de referência e contrarreferência de serviços de saúde de alta complexidade é imprescindível para o aperfeiçoamento da assistência fonoaudiológica. Objetivo Analisar o fluxo de pacientes de um serviço de Fonoaudiologia de alta complexidade no Sistema Único de Saúde (SUS). Métodos Estudo descritivo, realizado em serviço de Fonoaudiologia de hospital de alta complexidade. Foram analisados os dados de 373 usuários submetidos à triagem fonoaudiológica (consulta a prontuários). As variáveis analisadas foram: perfil sociodemográfico e fonoaudiológico; origem dos usuários (referência); tempo entre a referência e a realização da triagem; encaminhamentos após a triagem (contrarreferência); tempo entre a conclusão da triagem e o primeiro atendimento fonoaudiológico no serviço de contrarreferência; grau de satisfação com o atendimento fonoaudiológico de contrarreferência. Resultados Predominaram indivíduos com idades entre 0 e 11 anos e 11 meses, do gênero masculino, residentes na cidade de São Paulo, com ensino fundamental incompleto. A hipótese diagnóstica fonoaudiológica de disfonia foi a mais prevalente. A maioria dos usuários foi referenciada pela atenção terciária. A média de tempo de espera para a triagem foi de 56,6 dias (intervalo predominante de 51 a 60 dias). Pouco mais da metade dos sujeitos foi encaminhada para o nível terciário. O tempo de espera pelo atendimento foi maior no nível secundário. A maioria dos usuários referiu como excelente ou bom o grau de satisfação com o atendimento. Conclusão Observou-se alto grau de resolutividade no serviço analisado (atenção terciária) e necessidade de reorganização dos sistemas de referência e contrarreferência na atenção secundária e primária.

ABSTRACT Introduction For optimum quality in Speech, Language and Hearing (SLH) healthcare, it is essential to be aware of the flow of referrals and counter-referrals for high-complexity health services. Purpose To analyze the flow of patients of a high-complexity SLH service in Brazil’s Unified Health System (Sistema Único de Saúde – SUS). Methods Descriptive study, made at a Speech, language and hearing (SLH) service of a high complexity hospital. Participants were 373 users who underwent SLH screening (consultation of health records). The variables analyzed were: social-demographic profile; SLH profile; origin of referral of users; time between referral and screening being carried out; referrals after screening (counter-referral); time between conclusion of screening and first SLH consultation in the counter-referred service; and degree of satisfaction with the SLH consultation of the counter-referral. Results The largest group was the age range zero to 11 years 11 months, male, resident in the city of São Paulo, who had not completed primary education. The most prevalent initial diagnosis in SLH terms was dysphonia. The majority of users were referred to tertiary care. The average waiting time for screening was 56.6 days. Just over half the subjects were referred for tertiary care. The waiting time for care was longest at the secondary level. The majority of users stated their degree of satisfaction with the care to be excellent or good. Conclusion A high degree of resolutiveness was observed in the tertiary care service analyzed; and a need was observed in secondary and primary care for reorganization of the systems of referral and counter-referral.

OBJECTIVE: To identify children at risk for hearing and/or language disorders and to investigate the association between these risks by conducting pre-validated hearing and language screenings. METHODS: The study was conducted during a polio vaccination campaign in August of 2013 in basic health units in western São Paulo. Parents of children between 2 and 5 years of age were asked to complete two screening tools: a hearing questionnaire (regarding hearing development) and a language production and comprehension scale (including the major language development milestones). The screening tools were administered by different researchers. We compared the risk of having language disorders among children at risk for hearing loss versus children not at risk, as well as the attributable risk and odds ratios. Chi-squared tests and logistic regression analyses were used. RESULTS: The study included 479 children with a mean age of three and one-half years, of whom 26.9% were identified as at risk for deficits in language production, 8.6% were at risk for deficits in language comprehension and 14% were at risk for hearing disorders. The children at risk for hearing disorders were twice as likely as those not at risk to exhibit language production and comprehension deficits. CONCLUSION: The results of this study highlight the importance of establishing and adopting low-cost procedures such as screenings to identify children at risk of developing language and/or hearing disorders in early childhood.

RESUMO O objetivo deste estudo foi comparar três métodos de aprendizagem sobre Anatomia e Fisiologia do Sistema Miofuncional Orofacial quanto à motivação para a aprendizagem em Fonoaudiologia. Participaram 36 estudantes do segundo ano de graduação, após assinatura de termo de consentimento livre e esclarecido. Cada estudante foi alocado randomicamente nos grupos: Grupo I (GI) – 12 participantes do Método Interativo 1 (MI1); Grupo II (GII) – 12 participantes do Método Interativo 2 (MI2); Grupo III (GIII) – 12 participantes do Método Tradicional (MT). Os métodos de aprendizagem foram aplicados durante horário de estudo complementar semanal, após aula expositiva de disciplina obrigatória. Concluída a aplicação dos métodos de aprendizagem, foi aplicado o questionário Instructional Materials Motivation Survey para avaliar a motivação. Os dados foram submetidos à análise estatística no software SPSS versão 21. A comparação entre os grupos foi realizada pela ANOVA seguida pelo teste post hoc de Tukey. O nível de significância foi de 5%. Os grupos diferiram em todos os aspectos avaliados e na pontuação total (F2,33=3691,17 p<0,001). O GII teve maior pontuação geral (GI x GII = p=0,015; GI x GIII = p=0,115; GII x GIII = p<0,001). Com relação à atenção (GII x GIII = p=0,001) e à confiança (GII x GIII = p=0,003), o GII teve maior pontuação que o GIII. Não houve diferença quanto à relevância. O GII teve a maior pontuação para satisfação (GI x GII = p=0,023; GII x GIII = p<0,001). Neste estudo, foi observado que o modelo computacional 3D foi mais eficiente para motivar os estudantes durante a aprendizagem.

ABSTRACT This study aimed to compare the learning motivation of three learning methods as means of teaching Anatomy and Physiology of the Orofacial Myofunctional System of second-year Speech-Language and Hearing Sciences undergraduate students. The study was conducted with 36 students that participated after signing an informed consent form. Each student was randomly allocated to the groups: Group I (GI) – 12 participants using Interactive Method 1 (IM1); Group II (GII) – 12 participants using Interactive Method 2 (IM2); and Group III (GIII) – 12 participants using the Traditional Method (TM). The learning methods were applied during weekly complementary study schedule, following the discipline’s lectures. Upon the conclusion of the learning methods application, the Instructional Materials Motivation Survey questionnaire was administered for evaluating the students’ learning motivation. Data were analyzed using SPSS software version 21. Comparisons between groups were performed using ANOVA followed by Tukey post hoc test. The significance level was set at 5%. The groups differed in all evaluated aspects with the total score (F2,33 = 3691.17 p <0.001). The GII had the highest overall score (GI x GII = p = 0.015; GI x GIII = p = 0.115; GII x GIII = p <0.001). On attention (GII x GIII = p = 0.001) and confidence (GII x GIII = p = 0.003), GII had higher scores than GIII. There was no difference between groups on relevance. For satisfaction, GII had the highest score (GI x GII = p = 0.023; GII x GIII = p <0.001). Therefore, summatively, the 3D computer model was more efficient in enhancing students’ learning motivation.

OBJECTIVE:The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints.METHOD:This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions.RESULTS:Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment.CONCLUSIONS:The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.

OBJECTIVES: The purpose of the study was to acoustically compare the performance of children who do and do not stutter on diadochokinesis tasks in terms of syllable duration, syllable periods, and peak intensity. METHODS: In this case-control study, acoustical analyses were performed on 26 children who stutter and 20 agedmatched normally fluent children (both groups stratified into preschoolers and school-aged children) during a diadochokinesis task: the repetition of articulatory segments through a task testing the ability to alternate movements. Speech fluency was assessed using the Fluency Profile and the Stuttering Severity Instrument. RESULTS: The children who stutter and those who do not did not significantly differ in terms of the acoustic patterns they produced in the diadochokinesis tasks. Significant differences were demonstrated between age groups independent of speech fluency. Overall, the preschoolers performed poorer. These results indicate that the observed differences are related to speech-motor age development and not to stuttering itself. CONCLUSIONS: Acoustic studies demonstrate that speech segment durations are most variable, both within and between subjects, during childhood and then gradually decrease to adult levels by the age of eleven to thirteen years. One possible explanation for the results of the present study is that children who stutter presented higher coefficients of variation to exploit the motor equivalence to achieve accurate sound production (i.e., the absence of speech disruptions).

TEMA: a redução de sílaba (RS) ocorre frequentemente nas Alterações Específicas de Linguagem (AEL), podendo indicar um fator desviante no processo de aquisição fonológica destes sujeitos. OBJETIVO: verificar a ocorrência de RS na fala espontânea de crianças com AEL e a influência dos fatores extensão das palavras e tonicidade para sua ocorrência. MÉTODO: foram sujeitos 27 crianças com AEL, com idades entre 3:0 e 5:11 anos, em tratamento fonoaudiológico semanal, que apresentaram 50% de acertos em provas específicas de fonologia realizadas ou que apresentaram inteligibilidade de fala passível de análise pela fala espontânea. As amostras de fala foram obtidas a partir de interação lúdica com a pesquisadora e pelo discurso eliciado por figuras. A ocorrência de RS foi analisada considerando-se: extensão das palavras produzidas, preferência por sílabas tônicas ou átonas e posição das sílabas nas palavras em que ocorreu RS. RESULTADOS: houve predomínio na produção de palavras dissílabas (X2 = 72,49; p < 0,001), a ocorrência de redução de sílaba foi significantemente maior nas palavras polissílabas (X2 = 11,22; p < 0,004) e as sílabas iniciais foram mais reduzidas (X2 = 34,99; p < 0,001). As sílabas átonas foram reduzidas com maior frequência (Z = -5,79; p < 0,001). CONCLUSÃO: a preferência pela produção de palavras dissílabas confirma a dificuldade dos sujeitos com estruturas silábicas complexas e justifica parte de sua ininteligibilidade em fala espontânea. A predominância da redução de sílabas átonas indica a preferência pela produção do núcleo das palavras, em que a ênfase é dada na sílaba tônica durante a expressão da linguagem.

BACKGROUND: syllable deletion (SD) frequently occurs in Specific Language Impairment and can indicate a deviant factor in the phonologic acquisition process of these subjects. AIM: to verify the occurrence of SD in the spontaneous speech of children with SLI and to verify the influence of word extension and syllable stress in this process. Methods: participants were 27 children with SLI, aged between 3:0 and 5:11 years, in a weekly speech treatment, who presented 50% of correct answers in specific phonology assessment tasks or who presented speech intelligibility within levels that allowed assessment through spontaneous speech. Speech samples were obtained during a play interaction situation between the researcher and the child and through speech elicited by the presentation of a picture. The occurrence of SD was analyzed considering the following parameters: extension of the produced words, preference for stressed or unstressed syllables, position of the syllable within the word were SD occurred. RESULTS: there was a preference for the production of dissyllabic words (X2 = 72,49; p < 0,001); the occurrence of SD was significantly higher in polysyllabic words (X2 = 11,22; p < 0,004) and on initial syllables (X2 = 34,99; p < 0,001). Unstressed syllables were more often reduced (Z= -5.79, p <0001). CONCLUSION:the preference for the production of dissyllabic words reassures the difficulty of these children with complex syllabic structures and, in part, explains their spontaneous speech unintelligibility. The predominance of unstressed syllable deletion indicates the preference for producing the nucleus of words, where emphasis is given to the stressed syllable during language expression.

OBJETIVO: Verificar desempenho fonológico de pré-escolares com Alterações Específicas do Desenvolvimento da Linguagem (AEDL) em fala espontânea. MÉTODOS: Foram sujeitos 27 crianças com AEDL, entre três anos e cinco anos e 11 meses, em tratamento fonoaudiológico. Foram selecionados aqueles que realizaram ao menos 50% da avaliação da fonologia a partir de provas de nomeação e imitação de palavras, ou que apresentaram inteligibilidade de fala passível de análise. Foram coletadas amostras de fala na prova de pragmática e no discurso eliciado por figuras. Foram realizadas análises a partir da utilização de processos fonológicos do desenvolvimento de linguagem (PD) e idiossincráticos (PI). RESULTADOS: A estatística descritiva (médias de PD e PI) indicou grande variabilidade intra-grupos. Não houve variação em número de processos conforme a idade (PD: p=0,38; PI: p=0,72), porém houve predominância de PD em todas as idades, nas duas provas aplicadas (Z=-6,327; p<0,001). A ocorrência de PD e PI foi maior na prova de pragmática (p<0,001), situação em que o número de palavras produzidas também foi maior (T-valor=8,93; p=0,000). CONCLUSÃO: A grande variabilidade intra-grupo confirma a heterogeneidade dos quadros de AEDL. Pode-se atribuir a ininteligibilidade, que dificulta a avaliação da linguagem expressiva desses sujeitos, à ocorrência de PD e PI concomitantemente. Ademais, a interação desenvolvida durante a prova de pragmática mostrou-se mais efetiva para a obtenção de amostra de fala espontânea para a análise da fonologia, além de confirmar a existência de grandes dificuldades relacionadas à elaboração de idéias e sua expressão em sujeitos com AEDL.

PURPOSE: To verify the phonological performance of preschoolers with Specific Language Impairment (SLI) in spontaneous speech. METHODS: The subjects were 27 children with SLI with ages between three years and five years and 11 months, who attended Speech-Language Pathology therapy. The subjects who carried out at least 50% of the phonological assessment or who had speech intelligibility that allowed analysis were selected. Speech samples were obtained from a pragmatics evaluation and from elicited discourse. Analyses considered the use of developmental (DP) and idiossyncratic phonological processes (IP) in spontaneous speech. RESULTS: The descriptive statistics (mean DP and IP) showed large within-group variability. There was no variation in the number of processes according to age (DP: p=0.38; IP: p=0.72), but there was a prevalence of DP in all ages, in both tests (Z=-6.327; p<0.001). The occurrence of DP and IP was higher in the pragmatics evaluation (p<0.001), situation in which the number of words produced was also greater (T-value=8.93; p=0.000). CONCLUSION: The great within-group variability confirms the heterogeneity of SLI. The speech unintelligibility, which hampers the assessment of the expressive language of these subjects, can be attributed to the co-occurrence of DP and IP. Moreover, the interaction during the pragmatics evaluation was more effective for obtaining a sample of spontaneous speech for phonological analysis, and confirms the existence of major difficulties related to the development of ideas and their expression in subjects with SLI.