Voice disorders occur in 6–17% of children, resulting in dysphonia (i.e., altered vocal quality) which has
significant negative health, social, emotional, and educational consequences if left untreated. The most common
cause of dysphonia in children is vocal fold nodules (VFN), callus-like growths on the vocal folds. Although voice
therapy is the preferred treatment, over one-third of children do not show clinically meaningful improvements
from therapy. Two critical issues contribute to this lack of impactful therapeutic changes: 1) children are not mini-
adults, and 2) dysphonia reduction may not be a salient and motivating goal for all children. To maximize
treatment effectiveness for the dynamic pediatric system, we propose shifting from a narrow focus on dysphonia
to a broader focus on improving speech intelligibility. This proposal will examine previously collected speech
samples from children with VFN between 3 – 9 years, a critical developmental period. Speech samples will be
compiled from clinical databases from three top pediatric voice centers, Children’s Hospital of Philadelphia,
Boston Children’s Hospital, and Cincinnati Children’s Hospital Medical Center. Aim 1 will define the relationship
between dysphonia and measures of intelligibility (e.g., speech intelligibility, speech naturalness). As intelligible
speech production requires coordination of the vocal and articulatory systems, we hypothesize that the significant
developmental changes in these systems will impact the relationship between dysphonia and intelligibility. Aim
2 will determine the extent that acoustic measures of the developing vocal system, developing articulatory
system, and dysphonia severity contribute to the relationship between dysphonia and intelligibility. The acoustic
measures with the largest contribution to the relationship between dysphonia and intelligibility will be examined
in a subsequent R01 grant to determine which therapy tasks elicit the largest change in these measures. These
therapy tasks will then be examined in a randomized controlled trial to test their efficacy and effectiveness in
improving intelligibility in children with VFN. This research program is designed to address multiple priority areas
of the NIDCD, with an overall emphasis on improving human communication (Priority Area 4). The current grant
focuses on understanding diseases and disorders (Priority Area 2), with outcomes indicating which acoustic
measures are the ideal method of predicting intelligibility in this population. This R21 lays the groundwork for the
subsequent R01, a randomized clinical trial designed to test the effectiveness of therapy tasks at different
developmental stages. This research program will therefore optimize treatment for children with VFN (Priority
Area 3), providing information on developmentally appropriate therapy tasks for this underserved and vulnerable
population. The research will be completed at Temple University (R1 university), which maintains a robust
research environment with exceptional dedication and support to early-career faculty. Outcomes from this
proposal will lay the foundation for a paradigm shift in how we conceptualize and treat children with voice
disorders, an understudied and underserved clinical population.