Differential Diagnosis of Childhood Apraxia of Speech Compared to Other Speech Sound Disorders: A Systematic Review

Purpose The aim of this study was to determine the discriminative features that might contribute to differentiation of childhood apraxia of speech (CAS) from other speech sound disorders (SSDs). Method A comprehensive literature search was conducted for articles or doctoral dissertations that included ≥ 1 child with CAS and ≥ 1 child with SSD. Of 2,071 publications screened, 53 met the criteria. Articles were assessed for (a) study design and risk of bias; (b) participant characteristics and confidence in diagnosis; and (c) discriminative perceptual, acoustic, or kinematic measures. A criterion was used to identify promising studies: American Academy of Neurology study design (Class III+), replicable participant descriptions and adequate confidence in diagnosis (≥ 3), and ≥ 1 discriminative and reliable measure. Results Over 75% of studies were retrospective, case-control designs and/or assessed English-speaking children. Many studies did not fully describe study design and quality. No studies met the Class I (highest) quality rating according to American Academy of Neurology guidelines. CAS was mostly compared to speech delay/phonological disorder. Only six studies had diagnostic confidence ratings of 1 (best). Twenty-six studies reported discriminative perceptual measures, 14 reported discriminative acoustic markers, and four reported discriminative kinematic markers. Measures were diverse, and only two studies directly replicated previous findings. Overall, seven studies met the quality criteria, and another eight nearly met the study criteria to warrant further investigation. Conclusions There are no studies of the highest diagnostic quality. There are 15 studies that can contribute to further diagnostic efforts discriminating CAS from other SSDs. Future research should utilize careful diagnostic design, support replication, and adhere to standard reporting guidelines. Supplemental Material https://doi.org/10.23641/asha.13158149.

Markedness and implicational relationships in phonological development: A cross-linguistic investigation

PURPOSE

The complexity approach to speech disorders, based on the theoretical notion of phonological markedness, has been gaining interest over the last decade. In a nutshell, this approach suggests that the acquisition of phonologically marked units (e.g. complex onsets) implies the acquisition of less marked ones (e.g. singleton onsets). However, because the notion of markedness is, itself, subject to controversies, we need to constrain what types of implications can be generalised among language learners, within and across languages.

METHOD

We report on longitudinal data from one phonologically-disordered and five typically-developing children documented across four different languages (English, French, German, Portuguese), using data from the PhonBank database (https://phonbank.talkbank.org). Using the Phon software program (https://www.phon.ca), we systematically analysed each longitudinal study for consonants in singleton onsets and codas as well as in onset clusters.

RESULT

The implicational relationships supported by our study involve units of similar types (e.g. relations between different segmental categories), while relationships that involve different types of units or processes cannot be generalised across learners.

CONCLUSION

A better understanding of implicational relationships makes the complexity approach more predictive of developmental patterns of phonology and related phonological disorders.

Facilitating Parental Involvement in Speech Therapy for Children With Speech Sound Disorders: A Survey of Speech-Language Pathologists' Practices, Perspectives, and Strategies

Purpose This study investigated the extent to which speech-language pathologists (SLPs) facilitate parents' completion of homework activities for children with speech sound disorder (SSD). In addition, this study explored factors related to more consistent communication about homework completion and strategies considered particularly effective for supporting this element of parental involvement. Method Licensed SLPs serving at least one child with SSD were invited to participate in an online survey. Questions relevant to this study gathered information regarding (a) frequency of communication about homework distribution and follow-up, (b) demographic and workplace characteristics, and (c) an open-ended question about the specific strategies used to support parental involvement and completion of homework activities. Results Descriptive results indicated considerable variability with respect to how frequently SLPs engaged in communication about homework completion, but that school-based SLPs were significantly less likely to engage in this type of follow-up. Strategies considered effective, however, were similar across therapy contexts. Conclusion These results suggest potentially important differences between school-based services and therapy in other contexts with respect to this particular aspect of service provision for children with SSD.

Clinical Reasoning for Speech Sound Disorders: Diagnosis and Intervention in Speech-Language Pathologists' Daily Practice

Purpose This study aims to give an insight in clinical reasoning (diagnosis and intervention) of speech-language pathologists (SLPs) in the Netherlands for children with speech sound disorder (SSD). Method The study featured a mixed-method (qualitative and quantitative) design. Semistructured interviews containing nondirective, open-ended questions were conducted with 33 SLPs, which were analyzed using a constant comparative analysis. Other SLPs (137) filled out a questionnaire on the same topics. Multiple-choice questions were analyzed by descriptive frequencies, while open-ended questions were analyzed thematically. Results The results indicate that SLPs use a variety of assessments to diagnose SSD, complemented by observation and, often, case history. In total, 85 different diagnostic labels were reported. The choice of intervention is based on what is appealing to the child and what matches his or her age as well as on the specific diagnosis and severity. Interventions are used for multiple speech disorders, and according to SLPs, parents play a large role in diagnostics and intervention. Conclusion These results reveal the need for (a) a clear and consistent terminology of diagnoses in the field of pediatric SSD, (b) a fast and easy-to-administer comprehensive differential diagnostic instrument in combination with an instrument to assess participation in everyday life, and (c) a tool to conduct a case history online.

A retrospective video analysis of canonical babbling and volubility in infants later diagnosed with childhood apraxia of speech

Canonical babbling and volubility are common indicators of infant vocal development. If either indicator falls below values found in typical infants, it may be an early signal of a developmental disorder. The aim of this retrospective investigation was to examine home videos for the frequency of canonical babbles, age of canonical babbling onset, and overall volubility of eight infants later diagnosed with childhood apraxia of speech and compare these data to that of six typically developing infants as well as four infants later diagnosed with a speech sound disorder. Results revealed the infants later identified with childhood apraxia of speech used fewer canonical babbles, had later onset of canonical babbling, and fewer syllables per minute (volubility) than the comparison groups. These results suggest that infants later diagnosed with childhood apraxia of speech may be less adept in vocal exploration and in the production of canonical babbles, perhaps due to fewer opportunities for mapping articulatory movement with auditory speech sound outcomes.

Predicting speech-sound disorder outcomes in school-age children with hearing loss: The VicCHILD experience

BACKGROUND

Congenital hearing loss is the most common birth anomaly, typically influencing speech and language development, with potential for later academic, social and employment impacts. Yet, surprisingly, the nuances of how speech is affected have not been well examined with regards to the subtypes of speech-sound disorder (SSD). Nor have the predictors of speech outcome been investigated within a sizeable population cohort.

AIMS

(1) To describe the subtypes and prevalence of SSD in children with hearing loss. (2) To determine which characteristics of hearing loss predict the presence of SSD.

METHODS & PROCEDURES

A total of 90 children (5-12 years of age) with permanent hearing loss were recruited from an Australian population cohort. Children completed a standardized speech assessment to determine the presence and subtype of SSD. Logistic regression was used to determine the predictors of speech outcome. Demographic, developmental and hearing-related predictors were examined.

OUTCOMES & RESULTS

The prevalence of speech disorder overall was 58%, with the most common subtype being phonological delay in 49% of the sample. Factors most predictive of speech disorder were being male, younger and a bimodal user (i.e., using both a hearing aid and a cochlear implant).

CONCLUSIONS & IMPLICATIONS

This is the first study, in a sizeable cohort, to describe the prevalence and predictive factors for SSD associated with hearing loss. Clinically, it could be beneficial to implement earlier targeted phonological interventions for children with hearing loss. What this paper adds What is already known on this subject Speech issues are common in children with hearing loss; however, the breakdown of subtypes of SSD (e.g., articulation versus phonological disorder) have not been previously described in a population cohort. This distinction is relevant, as each subtype calls for specific targeted intervention. Studies examining factors predictive of speech outcomes, across a range of hearing levels, are also lacking in a population cohort. What this paper adds to existing knowledge Data suggest the most common type of SSD in children with hearing loss is phonological delay. Males, younger children, and bimodal users were at greater risk of having a subtype of SSD. What are the potential or actual clinical implications of this work? The results are clinically pertinent as the speech diagnosis determines the targeted treatment. Phonological delay is responsive to treatment, and early targeted intervention may improve prognosis for speech outcomes for children with hearing loss.

Perception of Medial Consonants by Children With and Without Speech and Language Disorders: A Preliminary Study

Purpose The aim of this preliminary study was to investigate perception of the early-acquired consonant /p/ and later-acquired consonant /ʃ/ in medial word position by preschoolers with and without speech and language disorders. Method Twenty-four children, six with isolated speech sound disorder (SSD-only), six with SSD and concomitant developmental language disorder (SSD + DLD), and 12 with typical speech and language skills (TD) completed a battery of standardized speech and language tests as well as an identification task of /aCa/ disyllables. Targets and foils varied by only one place, manner, or voice feature. Mixed analysis of variance (participant groups × two target consonants) was conducted to compare performance of children in the three groups (between-subjects) and to compare performance on consonants that are early acquired or later acquired (within-subject). Results All groups of participants were more accurate in perceiving the early-acquired consonant than the later-acquired consonant. Overall performance by children with SSD-only did not differ significantly from children with TD. As a group, children with SSD + DLD were less accurate than children with TD and children with SSD-only for both target consonants. Conclusions Children with SSD + DLD performed less well than peers with SSD-only and with TD with both predictably easy and difficult sound contrasts. Children with SSD-only performed nominally less well than children with TD for the speech sound with which they have difficulty, but this difference did not reach statistical significance for these relatively small group sizes.

Differential Long-Term Outcomes for Individuals With Histories of Preschool Speech Sound Disorders

Purpose The goal of this study was to determine whether adolescent outcomes for individuals with histories of early speech sound disorders (SSD) could be differentiated by speech and language skills at earlier ages (preschool, 4-6 years, and school age, 7-10 years). Method The study used a retrospective longitudinal design. Participants with and without histories of early SSD were classified in adolescence as having no SSD, resolved SSD, low multisyllabic word (MSW; difficulty with MSW repetition but no errors in conversational speech), or persistent speech disorders (errors in both conversational speech and MSW repetition). Analysis of variance was employed to determine whether early speech, language, and literacy skills distinguished these adolescent outcome groups. Results Preschool and school-age skills differed for adolescents whose SSD had resolved from those who had persistent speech errors. Adolescents with errors solely in production of MSWs (Low MSW) did not differ in early speech and language skills from adolescents who had difficulty with both MSWs and persistent errors in conversation. Conclusions Speech and language assessments earlier in childhood can help establish risks for persistent SSD and other language and literacy difficulties in adolescence. Early identification of these clinically relevant subgroups of SSD may allow for early targeted interventions. Supplemental Material https://doi.org/10.23641/asha.9932279.

Reading Outcomes for Individuals With Histories of Suspected Childhood Apraxia of Speech

Purpose The primary aims of this study were to examine the speech-language correlates of decoding difficulties in children with histories of suspected childhood apraxia of speech (sCAS) and to identify predictors of low-proficiency reading levels. Method Participants were school-age children and adolescents, 7-18 years of age, diagnosed with sCAS (n = 40) or speech sound disorder but no sCAS (SSD-no sCAS; n = 119). The sCAS and SSD-no sCAS reading groups were compared on measures of performance IQ, oral language, phonological awareness, rapid automatic naming, diadochokinetic rates, single word articulation, and multisyllable and nonsense word repetition. Logistic regression analyses were employed to identify predictors of low-proficiency reading in the sCAS and SSD-no sCAS groups. Results Sixty-five percent of the participants with sCAS compared to 24% of those with SSD-no sCAS were classified as low-proficiency readers based on nonsense and single word decoding. Analysis failed to reveal significant differences in reading, oral language, or phonological awareness between low-proficiency readers with sCAS and low-proficiency readers with SSD-no sCAS. Oral language and phonological awareness skills were the best predictors of reading level for all participants, followed by performance on multisyllabic word repetition and diadochokinetic rate. Conclusions The language and phonological awareness deficits of children with sCAS are related to their risks for reading failure. To a lesser degree, motor speech deficits and speech sound production also increase risks for reading difficulties. The findings justify early intervention for this subset of children.

Quantifying phonological knowledge in children with phonological disorder

Generative phonologists use contrastive minimal pairs to determine functional phonological units in a language. This technique has been extended for clinical purposes to derive phonemic inventories for children with phonological disorder, providing a qualitative analysis of a given child's phonological system that is useful for assessment, treatment, and progress monitoring. In this study, we examine the single-word productions of 275 children with phonological disorder from the Learnability Project (Gierut, 2015b) to confirm the relationship between phonemic inventory - a measure of phonological knowledge - and consonant accuracy - a quantitative, relational measure that directly compares a child's phonological productions to the target (i.e. adult-like) form. Further, we identify potential percentage accuracy cutoff scores that reliably classify sounds as in or out of a child's phonemic inventory in speech-sound probes of varying length. Our findings indicate that the phonemic function of up to 90% of English consonants can be identified from percentage accuracy for preschool-age children with phonological disorder when a sufficiently large and thorough speech sample is used.

Validation of the Intelligibility in Context Scale for Korean-speaking pre-school children

Purpose: The Intelligibility in Context Scale (ICS) is a parent-reported screening tool focussed on parents' perception of their child's speech intelligibility. The purposes of this study were to evaluate the psychometric properties of the Korean version of the ICS (ICS-K) and to investigate whether the ICS-K is a useful tool for distinguishing between Korean-speaking children with typical development (TD) and those with speech sound disorder (SSD). Method: A total of 178 Korean-speaking pre-school children (145 children with TD and 33 children with SSD) participated in this study. Speech skills were assessed using the Assessment of Phonology and Articulation for Children. The parents of the children completed the ICS-K. Result: The ICS-K showed high internal consistency and test-retest reliability. Criterion validity was established through a significant correlation between the ICS-K and the percentage of consonants correct. Construct validity was also established through significant correlations between the ICS-K mean scores and the item scores. A discriminant analysis revealed that the ICS-K had high sensitivity (90.9%) and adequate specificity (77.9%) in classifying children into either the TD or the SSD group. Conclusion: The psychometric properties of the ICS-K support its clinical value in measuring functional speech intelligibility in Korean-speaking children with SSD.

Profiling Speech Sound Disorders for Clinical Validation of the Computer Articulation Instrument

Purpose The current article presents data from 2 studies on clinical groups of children referred for speech assessment. The aims of these studies are to validate the Computer Articulation Instrument (CAI) with the known-group validation method and to determine the differential diagnostic power of the resulting speech profiles. Method Study 1 examined known-group validity by comparing the scores of 93 children diagnosed with speech-language difficulties on the picture naming (PN) task of the CAI with intelligibility judgments given by speech-language pathologists. In Study 2, the speech profiles of 41 children diagnosed with speech sound disorders (SSDs), consisting of 4-6 factor scores extracted from the 4 tasks of the CAI, namely, PN, nonword imitation (NWI), word and nonword repetition, and maximum repetition rate (MRR), were validated against clinical judgments of severity of the SSD given by speech-language pathologists. Results In Study 1, a repeated-measures analysis of variance revealed a significant effect of intelligibility level on the PN performance of the CAI and there were highly significant correlations between intelligibility and PN performance in the expected direction. Neither intelligibility level nor PN performance was related to nonverbal intelligence and language scores. The analysis of variance and a series of t tests in Study 2 revealed significant differences between the moderate and severe groups for the CAI factors based on PN and NWI and the bisyllabic and trisyllabic sequences of MRR, but not for the factor word and nonword proportion of whole-word variability based on word and nonword repetition, and the monosyllabic sequences of MRR. These results suggest that, especially, the tasks PN, NWI, and the bisyllabic and trisyllabic sequences of MRR are most sensitive for diagnosing SSDs. Conclusions The findings of these 2 studies support the known-group validity of the CAI. Together with the results of a previous study of our group on reliability and validity ( van Haaften et al., 2019 ), we can conclude that the CAI is a reliable and valid tool for assessment of children with SSDs.

The Psychometric Evaluation of a Speech Production Test Battery for Children: The Reliability and Validity of the Computer Articulation Instrument

Purpose The aims of this study were to assess the reliability and validity of the Computer Articulation Instrument (CAI), a speech production test battery assessing phonological and speech motor skills in 4 tasks: (1) picture naming, (2) nonword imitation, (3) word and nonword repetition, and (4) maximum repetition rate (MRR). Method Normative data were collected in 1,524 typically developing Dutch-speaking children (aged between 2;0 and 7;0 [years;months]). Parameters were extracted on segmental and syllabic accuracy (Tasks 1 and 2), consistency (Task 3), and syllables per second (Task 4). Interrater reliability and test-retest reliability were analyzed using subgroups of the normative sample and studied by estimating intraclass correlation coefficients (ICCs). Construct validity was investigated by determining age-related changes of test results and factor analyses of the extracted speech measures. Results ICCs for interrater reliability ranged from sufficient to good, except for percentage of vowels correct of picture naming and nonword imitation and for the MRRs for bisyllabic and trisyllabic items. The ICCs for test-retest reliability were sufficient (picture naming, nonword imitation) to insufficient (word and nonword repetition, MRR) due to larger-than-expected normal development and learning effects. Continuous norms showed developmental patterns for all CAI parameters. The factor analyses revealed 5 meaningful factors: all picture-naming parameters, the segmental parameters of nonword imitation, the syllabic structure parameters of nonword imitation, (non)word repetition consistency, and all MRR parameters. Conclusion Its overall sufficient to good psychometric properties indicate that the CAI is a reliable and valid instrument for the assessment of typical and delayed speech development in Dutch children in the ages of 2-7 years.

Rhotic vowel accuracy and error patterns in young children with and without Speech Sound Disorders

Rhotic vowels are known to be difficult sounds for children to learn, but their acquisition has not been investigated in detail. This study examined rhotic vowel development, including accuracy and error patterns, in young children across age, diagnostic groups, and phonetic contexts. Participants included 34 children from 2 to 6 years of age with and without speech sound disorders (SSD). Data included 36 elicited single words containing stressed and unstressed rhotic monophthongs ([ɜ˞] and [ə˞]) and four rhotic diphthongs (/ɪ͡ə˞/, /ε͡ə˞/, /ɔ͡ə˞/, and /ɑ͡ə˞/). Additional words containing non-rhotic vowels and the consonant /ɹ/ were also included for comparison. A significant difference in rhotic vowel production accuracy was found between diagnostic groups (with vs. without SSD), but not across age groups or phonetic contexts. Yet, the accuracy scores for children without SSD were bimodally distributed, showing overlapping patterns with children with SSD. Error patterns were examined for all children with low rhotic vowel accuracy scores, regardless of age and diagnostic status. Results of this study highlight the variability in rhotic vowel development in young children and the importance of studying rhotic sounds using overall rhotic sound accuracy of each individual child regardless of their age or diagnostic status. Clinically, systematic within-speaker error patterns suggest the need for the detailed error pattern assessment of rhotic sounds.

Volubility, Consonant Emergence, and Syllabic Structure in Infants and Toddlers Later Diagnosed With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development: A Retrospective Video Analysis

Purpose Studies of infants' early vocalizations have proven helpful in describing the developmental characteristics of various communication disorders. However, few studies have addressed the early vocalizations of infants and toddlers who were later diagnosed, as older children, with childhood apraxia of speech (CAS). We refer to these infants and toddlers as LCAS. Extant studies also often lack a comparison group of infants and toddlers who were later diagnosed, as older children, with a speech sound disorder (SSD). We refer to these infants and toddlers as LSSD. We aimed to compare the volubility, consonant emergence, and syllabic structure from birth to age of 2 years, as observed in home videos, among 3 groups of infants and toddlers: LCAS, LSSD, and typically developing (TD). Method We assessed the speech-language skills of 17 children (3.5-8.8 years old; 7 with CAS, 5 with SSD, and 5 TD) and transcribed home videos (obtained from parents) of these same children from birth to age of 2 years. Early vocalizations were coded as nonresonant or resonant. Nonresonant vocalizations could not be transcribed with the International Phonetic Alphabet. Resonant (speechlike) vocalizations were broadly transcribed, and resonant consonants were categorized by place, manner, and voicing. Results Effect size comparisons revealed LCAS infants and toddlers were less voluble, used fewer resonant consonants, had a less diverse phonetic repertoire, and acquired resonant consonants later than either the LSSD or TD participants. For LSSD infants and toddlers, means for these dependent variables were lower than the means demonstrated by the TD group, but effect size were not strong due to LSSD variability. Conclusions Findings imply there might be clinical "red flags" that could assist the identification of infants and toddlers at risk for later diagnosis of CAS. Data did not support red flags for identifying infants and toddlers at risk for later diagnosis of SSD. Because of significant study limitations, results obtained should be considered preliminary. Supplemental Material https://doi.org/10.23641/asha.8233334.

Tongue Strength in Children With and Without Speech Sound Disorders

Purpose The purpose of this cross-sectional investigation was to expand the comparative database of pediatric tongue strength for children and adolescents with typical development, ages 3-17 years, and compare tongue strength among children with typical development, speech sound delay/disorders (SD), and motor speech disorders (MSDs). Method Tongue strength was measured using the Iowa Oral Performance Instrument in a total of 286 children and adolescents, 228 with typical development, 16 with SD, and 42 with MSDs, including classic galactosemia, a known risk factor for MSD ( n = 33) and idiopathic MSD ( n = 9). Results For all groups, tongue strength increased rapidly from 3 to 6.5 years of age and then continued to increase with age at a slower rate until 17 years of age. Children with SD's tongue strength did not differ from their typically developing (TD) peers. Children and adolescents with MSDs had decreased tongue strength compared to children with typical development or SD. Tongue strength was not related to severity of speech sound disorders in SD or MSD. Conclusion Weak tongue strength does not appear to contribute to speech errors in children with speech sound delays but does appear to be related to speech sound disorders that are neurologic in origin (developmental MSD).

Initial studies of the phenotype and persistence of speech motor delay (SMD)

Speech Motor Delay (SMD) is a recently proposed childhood motor speech disorder characterized by imprecise and unstable speech, prosody, and voice that does not meet criteria for either Childhood Dysarthria or Childhood Apraxia of Speech. The goals of the present research were to obtain information on the phenotype of SMD and initial information on the persistence of SMD in children receiving treatment for idiopathic Speech Delay (SD). Five questions about the phenotype and persistence of SMD were posed using a database of audio-recordings and participant records and longitudinal data from audio-recordings of children with early SMD treated for SD. Three phenotype questions examined associations between participant risk factors and prevalence of SMD, and described the most frequent speech, prosody, and voice signs of early SMD. To provide initial estimates of the persistence of SMD, two questions examined associations between the persistence of SMD and participant risk factors using the audio-recordings of 14 participants with SMD treated for idiopathic SD. Phenotype findings indicated that SMD is characterized by across-the-board delays in the spatiotemporal precision and stability of speech, prosody, and voice production. Persistence findings indicated that although most participants normalized early SMD by 6 years of age, SMD persisted until at least late adolescence in 21.4% of participants. Findings are interpreted to support the construct validity of SMD and the potential for research using additional assessment modalities to explicate its genomic and neuromotor causal pathways. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; PSI: Precision-Stability Index; SD: Speech Delay; SMD: Speech Motor Delay; SSD: Speech Sound Disorders.

A shift of treatment approach in speech language pathology services for children with speech sound disorders - a single case study of an intense intervention based on non-linear phonology and motor-learning principles

Even though there are documented benefits of direct intensive intervention for children with speech sound disorders (SSDs), the intensity given at Swedish Speech Language Pathology services rarely exceeds once a week. Also, indirect therapy approaches are commonly employed. The purpose of the present case study was to investigate the effects of an intensive specialist therapy, based on non-linear phonological analysis and motor learning principles. The participant was a boy aged 4:10 years with severe SSD, who previously had received indirect therapy from age 3 with, very limited results. A single subject ABA design was used. At baseline, whole word match was 0%, Word shape CV match was 39% and PCC was 22, 7%. He had no multisyllabic words, no consonant clusters and no established coronals. Intervention was given 4 days weekly for 3 weeks in two periods with a 7-week intervening break and a post therapy assessments. Therapy was focused on establishing multisyllabic words, iambic stress pattern, clusters and coronals with the principle of using already established elements for targeting new elements. At post therapy assessment, whole word match was 39%, word shape CV match was 71% and PCC 69.1%. Multisyllabic words (86%), coronals (82%) and word initial clusters (80%) were established. Without being targeted, back vowels were also present and segment timing improved. The strong treatment effects of this study demonstrate that at least severe cases of SSD require the clinical knowledge and skills that only a SLP can provide and that frequent direct therapy is both beneficial and needed.

Comorbid morphological disorder apparent in some children aged 4-5 years with childhood apraxia of speech: findings from standardised testing

There is continuing debate about the origins of productive morphological errors in children with speech sound disorders. This is the case for children with theorised phonetic and motor disorders, such as children with childhood apraxia of speech (CAS, e.g., Ekelman & Aram, 1983; McNeill & Gillon, 2013 ). The morphological skills of children with CAS remain relatively unexplored in pre-schoolers. We investigated English morphology in a retrospective, cross-sectional design of 26 children aged 4-5 years who completed the Clinical Evaluation of Language Fundamentals-Preschool (2nd edition; Wiig, Secord & Semel, 2006). The research aims were to determine: (1) the language profile of the children, (2) the accuracy of each morpheme type produced, and (3) how many of those morphological errors are explained by speech errors (clusters, late developing phonemes, central vowels or weak syllable stress)? The results indicate the group of children with CAS had poorer expressive language skills than receptive skills and 48% demonstrated difficulties with morphology in word structure and recalling sentences subtests. The children had poor accuracy and inconsistent production of a range of morphemes and despite many errors due to the speech characteristics of the stimuli on the CELF-P2, motor speech concerns could not explain all the child's morphological errors. The results suggest morphological difficulties are co-morbid to CAS and when this occurs, treatment for morphosyntax is indicated. There are also significant clinical implications in the assessment of morphosyntax for children with CAS which are discussed.

Elements of Phonological Interventions for Children With Speech Sound Disorders: The Development of a Taxonomy

PURPOSE

Our aim was to develop a taxonomy of elements comprising phonological interventions for children with speech sound disorders.

METHOD

We conducted a content analysis of 15 empirically supported phonological interventions to identify and describe intervention elements. Measures of element concentration, flexibility, and distinctiveness were used to compare and contrast interventions.

RESULTS

Seventy-two intervention elements were identified using a content analysis of intervention descriptions then arranged to form the Phonological Intervention Taxonomy: a hierarchical framework comprising 4 domains, 15 categories, and 9 subcategories. Across interventions, mean element concentration (number of required or optional elements) was 45, with a range of 27 to 59 elements. Mean flexibility of interventions (percentage of elements considered optional out of all elements included in the intervention) was 44%, with a range of 29% to 62%. Distinctiveness of interventions (percentage of an intervention's rare elements and omitted common elements out of all elements included in the intervention [both optional and required]) ranged from 0% to 30%.

CONCLUSIONS

An understanding of the elements that comprise interventions and a taxonomy that describes their structural relationships can provide insight into similarities and differences between interventions, help in the identification of elements that drive treatment effects, and facilitate faithful implementation or intervention modification. Research is needed to distil active elements and identify strategies that best facilitate replication and implementation.

The Relationship Between Speech, Language, and Phonological Awareness in Preschool-Age Children With Developmental Disabilities

PURPOSE

A number of intrinsic factors, including expressive speech skills, have been suggested to place children with developmental disabilities at risk for limited development of reading skills. This study examines the relationship between these factors, speech ability, and children's phonological awareness skills.

METHOD

A nonexperimental study design was used to examine the relationship between intrinsic skills of speech, language, print, and letter-sound knowledge to phonological awareness in 42 children with developmental disabilities between the ages of 48 and 69 months. Hierarchical multiple regression was done to determine if speech ability accounted for a unique amount of variance in phonological awareness skill beyond what would be expected by developmental skills inclusive of receptive language and print and letter-sound knowledge.

RESULTS

A range of skill in all areas of direct assessment was found. Children with limited speech were found to have emerging skills in print knowledge, letter-sound knowledge, and phonological awareness. Speech ability did not predict a significant amount of variance in phonological awareness beyond what would be expected by developmental skills of receptive language and print and letter-sound knowledge.

CONCLUSION

Children with limited speech ability were found to have receptive language and letter-sound knowledge that supported the development of phonological awareness skills. This study provides implications for practitioners and researchers concerning the factors related to early reading development in children with limited speech ability and developmental disabilities.

Treatment of Phonological Disorder: A Feasibility Study With Focus on Outcome Measures

PURPOSE

In a feasibility study for a randomized controlled trial of treatments for phonological disorders conducted over a period of 8 months, we examined 6 clinically relevant outcome measures. We took steps to reduce error variance and to maximize systematic variance.

METHOD

Six children received traditional treatment (Van Riper, 1939), and 7 received expansion points (Smit, 2000), a treatment program with both phonological and traditional elements. Outcome measures, which were applied to both word list and conversational samples, included percentage of consonants correct (PCC; Shriberg & Kwiatkowski, 1982), PCC for late and/or difficult (L/D) consonants and number of L/D consonants acquired.

RESULTS

In repeated-measures analyses of variance, all measures showed significant differences from pretreatment to posttreatment, and the word list measures were associated with very high power values. In analyses of covariance for between-groups contrasts, the adjusted expansion points mean exceeded the adjusted traditional treatment mean for every measure; however, no differences reached significance. For the L/D PCC (conversation) measure, the contrast between groups was associated with a large effect size.

CONCLUSION

We recommend that practitioners use outcome measures related to a word list. We recommend that researchers consider using L/D PCC on the basis of conversational samples to detect differences among treatment groups.

SUPPLEMENTAL MATERIALS

https://doi.org/10.23641/asha.5872677.

Model-Driven Treatment of Childhood Apraxia of Speech: Positive Effects of the Speech Motor Learning Approach

PURPOSE

The aim of the study was to propose the speech motor learning approach (Van der Merwe, 2011) as a treatment for childhood apraxia of speech and to determine if it will effect positive change in the ability of a 33-month-old child to produce untreated nonwords and words containing treated age-appropriate consonants (Set 1 sounds), untreated age-appropriate consonants (Set 2), and untreated age-inappropriate consonants (Set 3) and also to determine the nature and number of segmental speech errors before and after treatment.

METHOD

An A-B design with multiple target measures and follow-up was implemented to assess the effects of treatment of Set 1. Effect sizes for whole-word accuracy were determined, and two criterion lines were generated following the conservative dual criterion method. Speech errors were judged perceptually.

RESULTS

Conservative dual criterion analyses indicated no reliable treatment effect due to rising baseline scores. Effect sizes showed significant improvement in whole-word accuracy of untreated nonwords and real words containing age-appropriate treated sounds and real words containing age-appropriate untreated sounds. The number of errors for all three sound sets declined. Sound distortion was the most frequent error type.

CONCLUSIONS

Preliminary evidence suggests potentially positive treatment effects. However, rising baseline scores limit causal inference. Replication with more children of different ages is necessary.

SUPPLEMENTAL MATERIALS

https://doi.org/10.23641/asha.5596708.

The impact of brief restriction to articulation on children's subsequent speech production

This project explored whether disruption of articulation during listening impacts subsequent speech production in 4-yr-olds with and without speech sound disorder (SSD). During novel word learning, typically-developing children showed effects of articulatory disruption as revealed by larger differences between two acoustic cues to a sound contrast, but children with SSD were unaffected by articulatory disruption. Findings suggest that, when typically developing 4-yr-olds experience an articulatory disruption during a listening task, the children's subsequent production is affected. Children with SSD show less influence of articulatory experience during perception, which could be the result of impaired or attenuated ties between perception and articulation.

Diagnostic Accuracy of Traditional Measures of Phonological Ability for Bilingual Preschoolers and Kindergarteners

Purpose

Bilingual children whose phonological skills are evaluated using measures designed for monolingual English speakers are at risk for misdiagnosis of speech sound disorders (De Lamo White & Jin, 2011).

Method

Forty-four children participated in this study: 15 typically developing monolingual English speakers, 7 monolingual English speakers with phonological disorders, 14 typically developing bilingual Spanish-English speakers, and 8 bilingual children with phonological disorders. Children's single-word speech productions were examined on Percentage Consonants Correct-Revised (Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997a) and accuracy of early-, middle-, and late-developing sounds (Shriberg, 1993) in English. Consonant accuracy in English was compared between monolinguals and bilinguals with and without speech sound disorders. Logistic regression and receiver operating characteristic curves were used to observe diagnostic accuracy of the measures examined.

Results

Percentage Consonants Correct-Revised was found to be a good indicator of phonological ability in both monolingual and bilingual English-speaking children at the age of 5;0. No significant differences were found between language groups on any of the measures examined.

Conclusions

Our results suggest that traditional measures of phonological ability for monolinguals could provide good diagnostic accuracy for bilingual children at the age of 5;0 years. These findings are preliminary, and children younger than 5;0 years should be examined for risk of misdiagnosis.