Jurnal Keterapian Fisik

Vol. 7, No. 2, November 2022

https://doi.org/10.37341/jkf.v0i0.373

Original Research

Speech Intelligibility In Preschoolers Using Indonesian Intelligibility In

Context Scale
Cindy Natalia1, Hafidz Triantoro Aji Pratomo2*, Ari Sarwanto3
1,2,3
Department of Speech Therapy Poltekkes Kemenkes Surakarta, Indonesia

ABSTRACT ARTICLE HISTORY

Background: The intelligibility in Context Scale (ICS) is one of Received: November 3th, 2022
the speech intelligibility assessment procedures that measures Accepted: November 23th, 2022
how clearly an individual's speech can be understood by seven
different communicative partners. Recently, ICS has been KEYWORDS
translated into more than 60 languages across the world intelligibility in context scale, ics,
including Indonesian language. It is important to know about parent concerns, preschool-aged
ICS and how to use it in Indonesia. children, socio-demographic,
speech intelligibility;
Methods: This quantitative research is designed with a
descriptive comparative method. The population of this study is CONTACT
preschool-aged children (4-6 years old) in Semarang City. The Hafidz Triantoro Aji Pratomo
number of respondents in this current study is 158 respondents
which consists of 20 children with parental concerns and 138 [email protected]
children without parental concerns. Data analysis is performed Department of Speech Therapy
using descriptive and bivariate analysis. A Mann-Whitney U Poltekkes Kemenkes Surakarta,
test is used for the bivariate analysis. Data collection was Indonesia. Jln. Letjen Sutoyo,
carried out in Semarang City in August–September 2021. Mojosongo, Surakarta, Indonesia
57127.
Results: The total average ICS score in this study is 3.96.
Children's speech is best understood by parents and least
understood by strangers. There is a difference in average ICS
scores for paternal education (p = 0.037), paternal income (p =
0.002), and parental concerns (p = 0.01).

Conclusion: The Indonesian ICS can be used as a screening

test to assess children's speech proficiency. Paternal education,
paternal income, and parental concerns have a direct impact
on children's average Indonesian ICS score. The lower the
average Indonesian ICS score of the child, the lower his or her
speech intelligibility.

Cite this as: Natalia, C., Pratomo, H. T. A., & Sarwanto, A. (2022). Speech Intelligibility In
Preschoolers Using Indonesian Intelligibility In Context Scale. Jurnal Keterapian Fisik,
95–104. Retrieved from https://jurnalketerapianfisik.com/index.php/jpt/article/view/373

INTRODUCTION
Speech intelligibility is a perceptual judgment regarding the percentage of words
in a speech that can be understood by the listeners. Children who have speech
intelligibility problems have communication problems. It was defined as a speech
disorder. Speech disorders have a high prevalence in preschoolers. An estimated 14.7%
of preschoolers have problems with articulation (Oyono et al., 2018). Mullen &
Schooling, (2010) reported that approximately 75% of preschoolers referred due to

http://jurnalketerapianfisik.com/index.php/jkf | 95
possible communication difficulties were identified as having articulation or speech
intelligibility problems.
Communication difficulties in various contexts with and interlocutors can result
from the poor intelligibility of one's speech (McLeod, Crowe & Shahaeian, 2015).
Most, Ingber, & Heled-ariam, (2012) mentioned that speech intelligibility is very
important in social skills, building and maintaining social relationships when
communicating with peers. Poor speech intelligibility can affect the quality and
functionality of a person's life, even causing frustration, an unwillingness to speak, and
feelings of anger (Van Doornik, Gerrits, McLeod, & Terband, 2018).
Speech intelligibility is influenced by many factors, such as content and
communication context. Furthermore, language structure, length of utterance,
conversational context, quality of voice, the intelligibility of speech acoustic signals,
familiarity, as well as the presence of visual clues from individuals can also affect
speech intelligibility (Kent, Miolo & Bloedel, 2016). McLeod, (2020) added that speech
intelligibility can be influenced by age, gender, the presence of speech sound disorders
or other communication disorders in the speaker, the relationship and propinquity of the
listener and speaker, language and dialects, communication disorders in the listener, the
type of measurement of speech intelligibility and the response, as well as the
environment, which includes noise.
There are many types of speech intelligibility measurement techniques, and there
is no standard procedure for measuring children's speech intelligibility. Gordon-
Brannan, (1994) explains that there are three common ways of measuring speech
intelligibility: 1) In the open-set word identification procedure, the examiner must
transcribe a sample of speech and calculate the percentage of words that can be
identified; 2) in the closed-set word identification procedure, the listener identifies the
word that is read or imitated by the speaker from a previously assigned list of words; 3)
in the rating scale procedure, the listener is asked to assess how clearly the individual
speaks with the point scale.
Intelligibility in Context Scale (ICS) was developed as a screening tool for parents
in measuring children's speech intelligibility based on the International Classification of
Functioning, Disability and Health–Children and Youth (ICF-CY) (Kim, Ballard &
McCann, 2016). ICS is a parent's rating scale of the child's speech intelligibility with
seven communicative partners (parents, immediate family, extended family, friends,
acquaintances, teachers, and strangers). ICS has been translated into over 60 languages,
including Indonesian.
The ICS has a range of scores between 1-5 for each question (McLeod, 2020).
However, research regarding ICS is still only carried out in 14 countries with 14
different languages and has never been carried out in Indonesia. This study aims to
determine the average score of the Indonesian ICS in preschool-age children in
Semarang City and find out the difference in the average ICS score based on socio-
demographic variables (sex, age, parental education, parental occupation, parental
income) and speech-language variables.

MATERIAL AND METHODS

This research is quantitative research with a comparative descriptive research
design. Data collection was carried out in Semarang City in August–September 2021
through the online distribution of Indonesian ICS questionnaires to parents of preschool
students from 9 kindergarten schools in Semarang. The population of this study was

http://jurnalketerapianfisik.com/index.php/jkf | 96
preschool children (4-6 years) with area sampling techniques where samples were taken
from five areas of Semarang City.
The children were selected from a private kindergarten in Semarang. The
respondents to this study were 158 respondents consisting of 20 children with parental
concerns and 138 children without parental concerns. Parents are asked to fill in
informed consent forms first if they are willing to be respondents to this study.
Subsequently, parents are asked to fill in personal data that includes the child's
name, the child's age, the child's school, the relationship of the questionnaire filler with
the child, the parental education, the parental occupation, the parental income, the main
language of the child, the parental concern toward their child's speech development.
Then parents are asked to judge from a scale of 1 (never) to 5 (always) concerning how
often their child's speech is understood by seven different interlocutors for the past
month. After all the data was collected, it was descriptively analyzed and tested using
Mann-Whitney U for bivariate analysis.
The determination of whether the child will have typical or atypical speech
development is based on parental concern. If the parent chooses 'yes' then the child is
considered to have atypical speech development, while if it is 'not' then the child is
considered a typical child.

RESULTS
The average Indonesian ICS score in this study can be described based on seven
different interlocutors and the total average ICS score as a whole, in typical children and
in atypical children. Indonesia's average ICS score is illustrated in Table 1.

Table 1. Mean score of Indonesian ICS

Communicative Partners Overall Typical Atypical
Parents 4.85 4.90 4.50
Immediate members of family 4.35 4.45 3.70
Extended members of family 3.84 3.88 3.55
Child's friends 3.91 4.00 3.30
Acquaintances 3.62 3.74 2.80
Child's teachers 4.27 4.34 3.80
Strangers 2.85 2.90 2.55
Total 3.96 4.03 3.46

The table above shows that the total average ICS score in this study was 3.46, and
the average ICS score was higher in typical children (M = 4.03) than in atypical
children (M = 3.46). The child's speech is most often understood by the interlocutor
who is most familiar with the child, namely the parent, and will decline as the
familiarity between the interlocutor and the child declines. This is indicated by the
lowest Indonesian ICS score obtained from strangers.
The descriptive data of respondents in this study consisted of the number and
percentage of respondents as well as the average score of the Indonesian ICS based on
socio-demographic variables and child speech-language variables. The distribution of
respondent data can be seen in Table 2.

http://jurnalketerapianfisik.com/index.php/jkf | 97
Table 2. Data distribution
Typical Atypical Total
Independent Variables
n % M n % M mean
Male 76 55.07
3.96 12 60 3.38 3.88
Sex
Female 62 44.93
4.11 8 40 3.57 4.05
4:0-4:11 years 58 42.03
4.00 10 50 3.20 3.88
Age
5:0-6:11 years 80 57.97
4.05 10 50 3.71 4.01
High school and
66 47.83 3.91 9 45 3.11 3.82
Paternal below
Education Above high
72 52.17 4.14 11 55 3.74 4.09
school
High school and
59 42.75 3.90 6 30 3.12 3.83
Maternal below
Education Above high
79 57.25 4.13 14 70 3.60 4.05
school
Paternal Nonprivate 12 8.70 3.95 3 15 3.52 3.87
Occupation Private 126 91.30 4.04 17 85 3.45 3.97
Maternal Nonprivate 76 55.07 4.04 7 35 3.69 4.01
Occupation Private 62 44.93 4.02 13 65 3.33 3.90
Below Regional
45 32.61 3.81 6 30 2.95 3.71
Paternal Minimum Wages
Income Above Regional
93 67.39 4.14 14 70 3.67 4.08
Minimum Wages
Below Regional
92 66.67 3.98 11 55 3.47 3.92
Maternal Minimum Wages
Income Above Regional
46 33.33 4.13 9 45 3.44 4.02
Minimum Wages
English Language 131 94.93 4.03 18 80 3.48 3.96
Main
Regional
Language 7 5.07 4.10 2 20 3.29 3.92
Languages
n= number of respondents, %= percentage, M= average score of Indonesian ICS

Table 2 shows that higher mean scores were obtained in girls, children who were
more mature (4:0–4:11 years), children with higher parental education (above high
school), children with private paternal occupation, children with nonprivate maternal
occupation, and children with higher parental incomes. Bivariate analysis was carried
out using the Mann-Whitney U test to find out whether there was a difference in the
average Indonesian ICS score based on socio-demographic variables and child speech-
language variables statistically. The results of the Mann-Whitney U test were described
in Table 3.

Table 3. Results of Bivariate analysis

Independent Variables p
Male
Sex 0.169
Female
4:0-4:11 years
Age 0.319
5:0-6:11 years
Paternal Education High school and below 0.037

http://jurnalketerapianfisik.com/index.php/jkf | 98
 Independent Variables p
Above high school
High school and below
Maternal Education 0.105
Above high school
Nonprivate
Paternal Occupation 0.590
Private
Nonprivate
Maternal Occupation 0.324
Private
Below Regional Minimum Wages
Paternal Income 0.002
Above Regional Minimum Wages
Below Regional Minimum Wages
Maternal Income 0.525
Above Regional Minimum Wages
English Language
Main Language 0.815
Regional Languages
Typical
Parental Concern 0.001
Atypical

Table 3 shows that the difference in the average ICS score is only obtained in the
variables of paternal education (p = 0.037) and the father's income (p = 0.002), where
the higher the education and income of the father, the higher the average ICS score will
be. The difference in the average ICS score was also found in the parental concern
variable (p = 0.001), where children without parental concern had a higher average ICS
score than children with parental concern.

DISCUSSION
The difference in average ICS scores by sex
Gender seems to have an effect on speech sound acquisition, especially at the age
of three (Muluk et al., 2014). The girls have a better speed for developing their abilities,
especially in language skills. At the moment, basic skills differ between boys and girls.
After that, the boys can reach the same level of ability.
Results from the Mann-Whitney U test showed that there was no difference in the
average ICS score based on the sex of the child (p = 0.169). If the average ICS score of
girls is compared with the average ICS score of boys, the average result of the girls' ICS
scores is higher than the average ICS score of boys. Phạm, McLeod & Harrison, (2017)
and Neumann, Rietz & Stenneken, (2017) also found that there was no significant
difference in the average ICS score by sex.
Although the two studies were examined at a younger age, namely 2:0–5:11 years,
where previous studies showed that girls had a faster development of speech sounds
compared to boys at an early age of development, there was still no significant
difference in speech intelligibility between boys and girls. From previous studies, it can
be concluded that there is no difference in speech intelligibility between the sexes of
children.

The difference in average ICS scores by age

Previous studies have shown a positive correlation between age and improved
articulation ability in typical children. McLeod & Reilly, (2007) showed a decrease in
articulation errors and the proportion of speech sound disorders as age increased from
preschool age to grades 6 and 12. The maturity of the articulator and phonological

http://jurnalketerapianfisik.com/index.php/jkf | 99
abilities of typical children continues to increase until it reaches approximately the age
of 8 years, at which age children, in general, have acquired many speech sound systems
from adults.
Based on the test results, there is no difference in the average ICS score with the
age of the child (p = 0.319). The average ICS score in children aged 5:0–6:11 years is
higher than in children aged 4:0–4:11 years, in both typical or atypical children and
overall. This can be influenced by the age of the respondents in this study, which is 4-6
years old, where the intelligibility of children's speech at the age of 4 years should have
reached 100%, although there may still be speech errors (Bauman-Waengler, 2016).
One ICS study in Fiji also showed that there was no significant association
between age and speech intelligibility due to the fact that most of the children in this
study were older than preschool age. Meanwhile, ICS is designed to identify
preschoolers at risk of speech sound disorders, and the age of children in the study
outside the age at which many speech errors occur (Hopf, McLeod, & McDonagh,
2017). From the above, it can be concluded that a mature age cannot make a significant
difference in speech intelligibility.

Differences in average ICS scores based on parental education

Parental education is one of the components of the child's environment, so it is
one of the risk factors that is widely studied in relation to language and speech
development. Keating, Turrell, & Ozanne, (2001) examined 12,000 children aged 0–14
in Australia using a combination of household income, parental employment, and
parental education to demonstrate socio-economic status. The study reported that there
was no significant association between SES and pediatric speech disorders.
The results of the Mann-Whitney U test showed that there was a difference in the
average ICS score on paternal education (p = 0.037), but not for maternal education (p =
0.105). These results differed from the results of an ICS study in Vietnam that found
significant differences in the average ICS-VN score and maternal level of education, not
in fathers (Phạm, McLeod & Harrison, 2017). The father's level of education can
support the mother's involvement in playing with and interacting with the child.
The involvement of the mother in the child's life predicts the child's development
of speech and language. Fathers who have a higher level of education are better able to
provide resources and learning opportunities for their children compared to fathers with
lower levels of education (Tamis-LeMonda & Cabrera, 2013). Then it can be concluded
that the level of education of the father can have an effect on the difference in speech
intelligibility of the child.

The difference in average ICS scores by parental occupation

The results of this study showed that there was no difference in the average ICS
score for paternal (p = 0.590) or maternal (p = 0.324) occupations. ICS research in Italy
also found no significant relationship between parental occupation and children's speech
intelligibility (Piazzalunga et al., 2020). The average ICS score of children with fathers
working as private workers overall is higher than that of non-private workers.
Meanwhile, the average ICS score of children with mothers who work as non-
private workers is higher than that of children with maternal work as private workers.
The majority of respondents to this study were non-working mothers (50.38%), so
working mothers had less chance of spending time together with their children than
housewives. Where this can affect the duration and intensity of giving speech-language

http://jurnalketerapianfisik.com/index.php/jkf | 100
stimulation to the child. Pratomo, Adriani, & Akhyar, (2016) show that non-working
mothers have an influence on the child's language development.

The difference in average ICS scores based on parental income

Several previous studies have also examined the relationship between household
income and children's speech skills. ICS research in Germany found a significant but
weak association between socioeconomic status, including household income, and child
speech intelligibility (Neumann, Rietz, & Stenneken, 2017). Corresponding with the
study by McLeod, Crowe, & Shahaeian, (2015) which showed no relationship between
socioeconomic status and the intelligibility of the child's speech.
The results of the Mann-Whitney U test showed that there was a difference in ICS
scores with paternal income (p = 0.002), whereas there was no difference in ICS scores
with the mother's income (p = 0.525). The average ICS score of children with a paternal
income above the regional maximum wage is higher than the average ICS score of
children with a paternal income below the regional maximum wage. Low socio-
economic status is not strongly related to a child's speech sound disorder but can affect
other factors such as attention to health and stimulation of speech-language at preschool
age which can be likely to cause speech sound disorder.
Higher paternal incomes can affect the ability to provide facilities, resources, and
opportunities for families to live healthier lives, including in the provision of nutritious
food and the children's speech-language development (Tamis-LeMonda & Cabrera,
2013).

The difference in average ICS scores by primary language

The results of the Mann-Whitney U test showed that there was no difference in
the average ICS score with the main language used by the child, with a p-value of 0.815
(p > 0.05). Both typical children who use Indonesian and Regional Languages as the
main language have a higher average ICS score than children with atypical speech
development. Other ICS studies also found no link between children's primary language
and their ICS scores (Hopf, McLeod & McDonagh, 2017; McLeod, Crowe &
Shahaeian, 2015).

The difference in average ICS scores based on parental conservatism

This study found that there were differences in the average ICS scores of typical
children with atypical children, characterized by a p-value of 0.001 (p < 0.05). Parents
who suspected their child's speech development was atypical had a lower average ICS
score (M = 3.46) than parents who had no suspicion of their child's speech development
(M = 4.03). Lousada et al., (2019) examined 76 children aged 47–74 months, consisting
of 25 children identified as atypical according to parental or teacher concern and 51
children identified as typical. This study found that children with parental concern
regarding their speech had significantly lower average ICS scores (M = 3.91, SD =
0.59) compared to children without parental concern (M = 4.78, SD = 0.36).
ICS research in Vietnam has also been conducted on 181 children aged 2:0-5:11
years. The results showed that there were significant differences in the ICS mean score
between the group of children without parental concern and the group of children with
little concern from parents (p = 0.03) or with full concern from parents (p < 0.001). But
there is no difference between a group of children with little parental concern and a
group with full parental concern. This can also be seen from the average ICS score,

http://jurnalketerapianfisik.com/index.php/jkf | 101
namely children without concern (M = 4.63, SD = 0.67), with little concern (M = 4.29,
SD = 0.67), and full concern (M = 3.96, SD = 0.70) from parents (Phạm, McLeod &
Harrison, 2017).
McLeod, Crowe & Shahaeian, (2015) examined 803 Australian children aged 48–
65 months. The study found significant differences between the group of children with
parental concern (M = 3.9) and the group of children without parental concern (M =
4.6), t(796) = 16.8, p < .001, Cohen's d = 1.00. This study also showed that the average
ICS has proven effective in determining whether children who are identified or
unidentified have speech problems and speech sound disorders.
Based on the results of this study and the results of previous studies, it can be
concluded that parental concern is one of the components that needs to be considered in
the ICS assessment. Children who are identified as having atypical speech development
based on parental concern will have a lower average ICS score compared to children
without parental concern. The limitations of this study are that there are still variables
that have not been examined, such as the comparison of ICS scores of children using
one language with multi-lingual children, intelligence factors, and biomedical
conditions of children.
Then, this study only used parental concern as a determinant of whether the child
experienced typical or atypical speech development, while further assessments such as
the calculation of the percentage of speech intelligibility and the Percentage of
Consonants Correct (PCC) through speech sampling could not be carried out due to
time constraints and the lack of assessors. The sample of respondents at this age starts
from the age of 4-6 years, so the difference in speech intelligibility may not be very
significant because 4-year-olds should already have 100% speech intelligibility. The
sample of respondents in this study was only preschool-aged children in Semarang City,
so it was not enough to describe the intelligibility of speech in preschool children
throughout Indonesia.

CONCLUSION
The average Indonesian ICS score in this study was 3.96, with a higher ICS mean
score obtained in the absence of parental concern (M = 4.03, p = 0.001), children with
higher paternal education (p = 0.037), and higher paternal income (p = 0.002). The
child's speech is most often understood by the parents and weakens with the weakening
of the child's familiarity relationship with the interlocutor which is characterized by the
lowest of ICS mean scores obtained in the interlocutor of strangers. Indonesian ICS can
be used as a screening tool to identify children who are at high risk of having speech
intelligibility problems.
Further research is expected to examine several issues that are limited in this
study. Further research can examine children in a more extended age group than this
study. Further research is also expected to conduct deeper speech intelligibility
assessments, such as the percentage of speech intelligibility and PCC, to find out
whether the poor ICS mean score is a predictor of the poor percentage of speech
intelligibility and PCC. Other variables that have not been studied in this study can also
be studied in later studies.

REFERENCES
Bauman-Waengler, J. (2016). Articulation and Phonology in Speech Sound Disorders:
A Clinical Focus (5th ed.). California: Pearson Education, Inc.

http://jurnalketerapianfisik.com/index.php/jkf | 102
Hopf, S. C., McLeod, S., & McDonagh, S. H. (2017). Validation of the Intelligibility in
Context Scale for school students in Fiji. Clinical Linguistics and Phonetics,
31(7–9), 487–502. https://doi.org/10.1080/02699206.2016.1268208

Keating, D., Turrell, G., & Ozanne, A. (2001). Childhood speech disorders: reported
prevalence, comorbidity and socioeconomic profile. Journal of pediatrics and
child health, 37(5), 431–436. https://doi.org/10.1046/j.1440-1754.2001.00697.x

Kent, R., Miolo, G., & Bloedel, S. (2016). The Intelligibility of Children’s Speech: A
Review of Evaluation Procedures. American Journal of Speech-Language
Pathology, 3(2), 81–95. https://doi.org/10.1044/1058-0360.0302.81

Kim, J. H., Ballard, E., & McCann, C. M. (2016). Parent-rated measures of bilingual
childrens speech accuracy: Implications for a universal speech screen.
International Journal of Speech-Language Pathology, 18(2), 202–211.
https://doi.org/10.3109/17549507.2015.1081284

Lousada, M., Sa-Couto, P., Sutre, D., Figueiredo, C., Fazenda, M., Lousada, M. J., &
Valente, A. R. (2019). Validity and reliability of the Intelligibility in Context
Scale: European Portuguese version. Clinical Linguistics and Phonetics, 33(12),
1125–1138. https://doi.org/10.1080/02699206.2019.1589579

McKinnon, D. H., McLeod, S., & Reilly, S. (2007). The prevalence of stuttering, voice,
and speech-sound disorders in primary school students in Australia. Language,
speech, and hearing services in schools, 38(1), 5–15.
https://doi.org/10.1044/0161-1461(2007/002)

McLeod, S., Harrison, L. J., & McCormack, J. (2012). The intelligibility in context
scale: Validity and reliability of a subjective rating measure. Journal of Speech,
Language, and Hearing Research, 55(2), 648–655. https://doi.org/10.1044/1092-
4388(2011/10-0130)

McLeod, S., Crowe, K., & Shahaeian, A. (2015). Intelligibility in Context Scale:
Normative and Validation Data for English- Speaking Preschoolers. Language,
Speech, and Hearing Services in Schools, 46, 266–276.
https://doi.org/10.1044/2015

McLeod, S. (2020). Intelligibility in Context Scale: cross-linguistic use, validity, and

reliability. Speech, Language and Hearing, 23(1), 9–16.
https://doi.org/10.1080/2050571X.2020.1718837

Most, T., Ingber, S., & Heled-ariam, E. (2012). Social competence, sense of loneliness,
and speech intelligibility of young children with hearing loss in individual
inclusion and group inclusion. Journal of Deaf Studies and Deaf Education, 17(2),
259–272. https://doi.org/10.1093/deafed/enr049

http://jurnalketerapianfisik.com/index.php/jkf | 103
Mullen, R., & Schooling, T. (2010). The National Outcomes Measurement System for
pediatric speech-language pathology. Language, speech, and hearing services in
schools, 41(1), 44–60. https://doi.org/10.1044/0161-1461(2009/08-0051)

Muluk, N. B., Bayoǧlu, B., & Anlar, B. (2014). Language development and affecting
factors in 3- to 6-year-old children. European Archives of Oto-Rhino-
Laryngology, 271(5), 871–878. https://doi.org/10.1007/s00405-013-2567-0

Neumann, S., Rietz, C., & Stenneken, P. (2017). The German Intelligibility in Context
Scale (ICS-G): reliability and validity evidence. International Journal of
Language and Communication Disorders, 52(5), 585–594.
https://doi.org/10.1111/1460-6984.12303

Oyono, L. T., Pascoe, M., & Singh, S. (2018). The prevalence of speech and language
disorders in french-speaking preschool children from yaoundé (Cameroon).
Journal of Speech, Language, and Hearing Research, 61(5), 1238–1250.
https://doi.org/10.1044/2018_JSLHR-L-16-0400

Phạm, B., McLeod, S., & Harrison, L. J. (2017). Validation and norming of the
Intelligibility in Context Scale in Northern Viet Nam. Clinical Linguistics and
Phonetics, 31(7–9), 665–681. https://doi.org/10.1080/02699206.2017.1306110

Piazzalunga, S., Salerni, N., Ambrogi, F., Limarzi, S., Visconti, G., & Schindler, A.
(2020). Normative data and construct validity of a cross-linguistic functional
speech outcome, the Intelligibility in Context Scale: Italian (ICS–I). International
Journaal of Pediatric Otorhinolaryngology, 132(February), 109924.
https://doi.org/10.1016/j.ijporl.2020.109924

Pratomo, H. T. A., Adriani, R. B., & Akhyar, M. (2016). Association Between Parental
Education, Occupation, Income, Language Activity, and Language Proficiency in
Children. Indonesian Journal of Medicine, 01(03), 152–159.
https://doi.org/10.26911/theijmed.2016.01.03.02

Van Doornik, A., Gerrits, E., McLeod, S., & Terband, H. (2018). Impact of
communication partner familiarity and speech accuracy on parents’ ratings of
their child for the Intelligibility in Context Scale: Dutch. International Journal of
Speech-Language Pathology, 20(3), 350–360.
https://doi.org/10.1080/17549507.2018.1472808

http://jurnalketerapianfisik.com/index.php/jkf | 104