Speech characteristics of 8-year-old children: findings from a prospective population study

Development of the Digital Speech Assessment Instrument

OBJECTIVE

This study aimed to develop a Digital Speech Assessment Instrument to evaluate the phonological and motor speech skills of Brazilian Portuguese-speaking children and adolescents through six tasks: (a) word naming, (b) word imitation, (c) pseudoword imitation, (d) word repetition, (e) pseudoword repetition, and (f) diadochokinesis.

METHOD

The assessment instrument was developed and validated in a seven-step process, beginning with stimulus selection and ending with Pilot Study 1 (involving children and adolescents with typical speech development) and Pilot Study 2 (involving children and adolescents with speech sound disorders [SSDs]). Participants of the study included expert and nonexpert judges, children, and adolescents.

RESULTS

The Digital Speech Assessment Instrument contains 91 real words (61 in the naming task, 51 in the imitation task, and five in the repetition task), 26 pseudowords (26 in the imitation task and four in the repetition task), and six stimuli for diadochokinesis. The test contains stimuli in the form of images as well as audio and video recordings and allows for the analysis and storage of participant data in a virtual database.

CONCLUSIONS

This study described the development of the Digital Speech Assessment Instrument, available in Brazilian Portuguese for the evaluation of several aspects of speech production (including word and pseudoword naming, imitation, and repetition and diadochokinesis). The test was developed for children aged 2;0 (years;months) to 17;11 and is administered fully online. In the future, the instrument can be used to provide a timely and accurate diagnosis of SSDs.

Listening and Processing Skills in Young School Children with a History of Developmental Phonological Disorder

There is a lack of longitudinal studies on the broad-based outcomes in children with Developmental Phonological Disorder (DPD). The aim of this study was to investigate listening and processing skills in a clinical sample of 7-to-10-year-old children diagnosed with DPD in their preschool years and compare these to same-aged typically developing (TD) children. The Evaluation of Children's Listening and Processing Skills (ECLiPS) was completed by parents of 115 children with DPD and by parents of 46 TD children. The total ECLiPS mean score, and the five subscale mean scores, the proportion of children with clinically significant difficulties (≤10th percentile), and the proportion of children with co-occurrence of clinically significant difficulties on more than one subscale, were calculated. Results showed that the ECLiPS mean scores did not differ between the groups. There was no difference between groups regarding language and literacy, but a higher proportion of children with DPD than TD had difficulties in the total score, speech, and auditory processing, environmental and auditory sensitivity, and pragmatic and social skills. In addition, 33.9% of children with DPD had clinically significant difficulties in two or more subscales compared to 10.9% of TD children.

Neural Changes in Children With Residual Speech Sound Disorder After Ultrasound Biofeedback Speech Therapy

PURPOSE

Children with residual speech sound disorders (RSSD) have shown differences in neural function for speech production, as compared to their typical peers; however, information about how these differences may change over time and relative to speech therapy is needed. To address this gap, we used functional magnetic resonance imaging (fMRI) to examine functional activation and connectivity on adaptations of the syllable repetition task (SRT-Early Sounds and SRT-Late Sounds) in children with RSSD before and after a speech therapy program.

METHOD

Sixteen children with RSSD completed an fMRI experiment before (Time 1) and after (Time 2) a speech therapy program with ultrasound visual feedback for /ɹ/ misarticulation. Progress in therapy was measured via perceptual ratings of productions of untreated /ɹ/ word probes. To control for practice effects and developmental change in patterns of activation and connectivity, 17 children with typical speech development (TD) completed the fMRI at Time 1 and Time 2. Functional activation was analyzed using a region-of-interest approach and functional connectivity was analyzed using a seed-to-voxel approach.

RESULTS

Children with RSSD showed a range of responses to therapy. After correcting for multiple comparisons, we did not observe any statistically significant cross-sectional differences or longitudinal changes in functional activation. A negative relationship between therapy effect size and functional activation in the left visual association cortex was on the SRT-Late Sounds after therapy, but it did not survive correction for multiple comparisons. Significant longitudinal changes in functional connectivity were observed for the RSSD group on SRT-Early Sounds and SRT-Late Sounds, as well as for the TD group on the SRT-Early Sounds. RSSD and TD groups showed connectivity differences near the left insula on the SRT-Late Sounds at Time 2.

CONCLUSION

RSSD and treatment with ultrasound visual feedback may thus be associated with neural differences in speech motor and visual association processes recruited for speech production.

The Association Between Atypical Speech Development and Adolescent Self-Harm

BACKGROUND

Adolescent self-harm is a major public health issue internationally. Various factors associated with adolescent self-harm have been identified, including being bullied and experiencing mental health problems. Stuttering and speech sound disorder are associated with both of these factors. It was hypothesized that both stuttering and speech sound disorder would be associated with self-harm. This is the first study to explore the relationship between communication disorders and adolescent self-harm.

METHOD

Secondary analysis of a large, longitudinal, prospective, community sample, the Avon Longitudinal Study of Parents and Children, was carried out. Clinicians identified children who stuttered or exhibited speech sound disorder at the age of 8 years. When the cohort members were 16 years old, they were asked to complete a questionnaire about self-harm. Multinomial logistic regression was used to examine the associations between stuttering and speech sound disorder and the self-harm outcomes, adjusting for other relevant factors.

RESULTS

Of 3,824 participants with data for both speech status and self-harm, 94 (2.5%; 95% confidence interval [CI; 2.0, 3.0]) stuttered at 8 years of age and 127 (3.3%; 95% CI [2.8, 3.9]) displayed speech sound disorder. Speech sound disorder at the age of 8 years was associated with self-harm with suicidal intent in both unadjusted and adjusted models. Differences between the adjusted and unadjusted models were small, suggesting that speech sound disorder is largely an independent risk factor for self-harm with suicidal intent. Stuttering at the age of 8 years was not associated with adolescent self-harm, and there was no association between speech sound disorder and self-harm without suicidal intent.

CONCLUSION

Compared with individuals without speech sound disorder, adolescents with speech sound disorder at the age of 8 years have twice the risk of reporting self-harm with suicidal intent, even when other important predictors are taken into account.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22573030.

Characterizing sensorimotor profiles in children with residual speech sound disorder: a pilot study

PURPOSE

Children with speech errors who have reduced motor skill may be more likely to develop residual errors associated with lifelong challenges. Drawing on models of speech production that highlight the role of somatosensory acuity in updating motor plans, this pilot study explored the relationship between motor skill and speech accuracy, and between somatosensory acuity and motor skill in children. Understanding the connections among sensorimotor measures and speech outcomes may offer insight into how somatosensation and motor skill cooperate during speech production, which could inform treatment decisions for this population.

METHOD

Twenty-five children (ages 9-14) produced syllables in an /ɹ/ stimulability task before and after an ultrasound biofeedback treatment program targeting rhotics. We first tested whether motor skill (as measured by two ultrasound-based metrics of tongue shape complexity) predicted acoustically measured accuracy (the normalized difference between the second and third formant frequencies). We then tested whether somatosensory acuity (as measured by an oral stereognosis task) predicted motor skill, while controlling for auditory acuity.

RESULTS

One measure of tongue shape complexity was a significant predictor of accuracy, such that higher tongue shape complexity was associated with lower accuracy at pre-treatment but higher accuracy at post-treatment. Based on the same measure, children with better somatosensory acuity produced /ɹ/ tongue shapes that were more complex, but this relationship was only present at post-treatment.

CONCLUSION

The predicted relationships among somatosensory acuity, motor skill, and acoustically measured /ɹ/ production accuracy were observed after treatment, but unexpectedly did not hold before treatment. The surprising finding that greater tongue shape complexity was associated with lower accuracy at pre-treatment highlights the importance of evaluating tongue shape patterns (e.g., using ultrasound) prior to treatment, and has the potential to suggest that children with high tongue shape complexity at pre-treatment may be good candidates for ultrasound-based treatment.

Predicting Which Children Will Normalize Without Intervention for Speech Sound Disorders

PURPOSE

The speech of some children does not follow a typical normalization trajectory, and they develop speech sound disorders (SSD). This study investigated predictive correlates of speech sound normalization in children who were at risk of SSD.

METHOD

A prospective population cohort study of 845 Cantonese-speaking preschoolers was conducted over 2.5 years to examine (a) children who resolved nonadult realizations of consonants (normalized) and (b) those who had persisting speech sound difficulties (did not normalize). From these 845, a sample of 82 participants characterized as having SSD (1.25 SDs below the mean in a standardized speech assessment, with a delay in initial consonant acquisition or with one or more atypical errors) was followed for 2 years at 6-month intervals or until the completion of their initial consonant inventory. Data from 43 children who did not receive speech-language pathology services were analyzed with survival analysis to model time to normalization while controlling for covariates. The target event (outcome) was the completion of their initial consonant inventory.

RESULTS

Under the no-intervention condition, the estimated median time to normalization was 6.59 years of age. Children who were more likely to normalize or normalized in a shorter time were stimulable to all errors and more intelligible as rated by caregivers using the Intelligibility in Context Scale. Those who showed atypical error patterns did not necessarily take longer to normalize. Similarly, expressive language ability was not significantly associated with speech normalization.

CONCLUSIONS

Stimulability and intelligibility were more useful prognostic factors of speech normalization when compared to (a)typicality of error patterns and expressive language ability. Children with low intelligibility and poor stimulability should be prioritized for speech-language pathology services given that their speech errors are less likely to resolve naturally.

Phonological characteristics of European and Brazilian Portuguese in children with Speech Sound Disorders

This study aims to describe and compare the phonological characteristics of European Portuguese and Brazilian Portuguese preschool and school age children with Speech Sound Disorders (SSD). Speech samples for the European Portuguese Group (EPG) (n = 13) were collected using Subteste Fonético e Fonológico of Teste Fonético e Fonológico Avaliação da Linguagem Pré-Escolar. For the Brazilian Portuguese Group (BPG) (n = 13) Prova de Nomeação de Fonologia of Teste de Linguagem Infantil ABFW was applied. Different phonological measures were considered. Groups were matched according to sex, age, and percentage of correct consonants (revised). EPG presented more weak syllable deletion (p = .00); absolute index and relative index had a higher number of omissions (p = .003). BPG had more substitutions (p = .004). Intragroup analysis showed differences between groups in the occurrence of phonological processes (p ≤ 0.00). The most occurring was gliding of liquids, cluster reduction and devoicing in both groups; for the absolute index and relative index, the EPG presented differences in omission (p = .003), and the BPG in substitution (p = .002). Results suggested differences between groups in phonological processes occurrence and a relation with the most frequent type of error. These findings may occur due to the variation of phonetic and phonological characteristics between European Portuguese and Brazilian Portuguese in the two phonological tests. Linguistic variations had not directly influenced the measures studied, which characterized SSD. European Portuguese and Brazilian Portuguese children with SSD demonstrated similar characteristics as to the type of errors and phonological processes.

Audiometric profiles in children with speech sound disorder: Subclinical hearing loss as a potential factor

In the present study, hearing sensitivity in children with speech sound disorder (SSD) is scrutinized. Middle ear function (wideband tympanometry and acoustic stapedial reflexes, ASR) and inner ear function (audiometric thresholds in the conventional_{1-8 kHz} and extended_{10-16 kHz} high frequency (EHF) range, and distortion product otoacoustic emissions (DPOAEs_{2-10 kHz}) were investigated. Hearing results were analyzed in relation to speech discrimination of phonemic contrasts (quiet and in noise conditions) and reproduction. Thirty-two children with SSD and 41 children with typical development (TD) ages 4-5 years participated. Children with SSD exhibited significantly less sensitive hearing compared to children with TD. This was demonstrated as more absent contralateral ASR (right ear SSD 43.7%; TD 22.0%), a higher prevalence of minimal hearing loss (MHL, > 15 dB HL at one or more frequencies or ears_{1-8 kHz} and PTA ≤ 20 dB HL, SSD 53.1%; TD 24.3%) and EHF hearing impairment (EHF HI, > 20 dB HL at one or more frequencies or ears_{10-16 kHz}, SSD 31.3%; TD 24.3%). At 2 kHz bilaterally, children with SSD showed significantly higher hearing thresholds than children with TD (mean difference, left ear 3.4 dB: right ear 4.3 dB), together with a significantly lower SNR in DPOAEs at 2.2 kHz (left ear 5.1 dB mean difference between groups). In all children, audiometric thresholds at the key-frequencies for speech, 2 and 4 kHz and DPOAEs within similar spectral regions, predicted 7-12% of the variance in phonemic discrimination and reproduction. Overall, these results suggest that hearing should be more fully investigated in children with SSD.

How many words make a sample? Determining the minimum number of word tokens needed in connected speech samples for child speech assessment

Connected speech (CS) is an important component of child speech assessment in both clinical practice and research. There is debate in the literature regarding what size sample of CS is required to facilitate reliable measures of speech output. The aim of this study was to identify the minimum number of word tokens required to obtain a reliable measure of CS across a range of measures. Participants were 776 5-year-olds from a longitudinal community population cohort study (Avon Longitudinal Study of Parents and Children, ALSPAC). Children's narratives from a story retell task were audio-recorded and phonetically transcribed. Automatic analysis of the transcribed speech samples was completed using an automated transcription and analysis system. Measures of speech performance extracted included: a range of profiles of percentage consonant correct; frequency of substitutions, omissions, distortions and additions (SODA); percentage of syllable and stress pattern matches; and a measure of whole word complexity (Phonological Mean Length of Utterance, pMLU). Statistical analyses compared these measures at different CS sample sizes in increments using averages and weighted moving averages, and investigated how measures performed between CS samples grouped into word tokens of at least 50, 75 and 100, and restricted to samples of 50-74, 75-99 and 100-125. Key findings showed that sample sizes of 75 word tokens and above showed minimal differences in most measures of speech output, suggesting that the minimum requirement for samples of CS is a word count of 75. The exception to this is in the case of pMLU and measures of substitutions and distortions when a word count of 100 is recommended.

Selective visual attention skills differentially predict decoding and reading comprehension performance across reading ability profiles

BACKGROUND

The purpose of this study was to examine the relationship between selective visual attention (SVA), reading decoding, listening comprehension and reading comprehension in children with and without a reading disorder.

METHODS

We used longitudinal data from the Avon Longitudinal Study of Parents and Children. We split children into four groups: Typical Readers, Dyslexics, Poor Comprehenders and Comorbid Reading Disorder. We included measures of single word reading, nonword reading, spelling, phonological processing, vocabulary, receptive language, nonverbal intelligence, selective attention and reading comprehension. We used analysis of variance, correlations and structural equation modelling to examine the relationship between SVA and reading. We fit two possible models: SVA Indirect and SVA Direct. The difference between these models was the inclusion of a direct path from SVA to reading comprehension.

RESULTS

We examined an indirect model, where SVA predicted reading comprehension through word decoding and listening comprehension, and a direct model, which included a pathway from SVA to reading comprehension. Based on our analysis of variance and correlation results, we collapsed the Dyslexic, Poor Comprehenders and Comorbid Reading Disorder groups for the structural equation modelling. We found evidence that for Typical Readers, an indirect model was the best fit, whereas the direct model was the best model for children with a reading disorder.

CONCLUSIONS

Selective visual attention is related to reading comprehension. This relationship differs for children with and without a reading disorder.

Neuroimaging of the Syllable Repetition Task in Children With Residual Speech Sound Disorder

Purpose This study investigated phonological and speech motor neural networks in children with residual speech sound disorder (RSSD) during an overt Syllable Repetition Task (SRT). Method Sixteen children with RSSD with /ɹ/ errors (6F [female]; ages 8;0-12;6 [years;months]) and 16 children with typically developing speech (TD; 8F; ages 8;5-13;7) completed a functional magnetic resonance imaging experiment. Children performed the SRT ("SRT-Early Sounds") with the phonemes /b, d, m, n, ɑ/ and an adapted version ("SRT-Late Sounds") with the phonemes /ɹ, s, l, tʃ, ɑ/. We compared the functional activation and transcribed production accuracy of the RSSD and TD groups during both conditions. Expected errors were not scored as inaccurate. Results No between-group or within-group differences in repetition accuracy were found on the SRT-Early Sounds or SRT-Late Sounds tasks at any syllable sequence length. On a first-level analysis of the tasks, the TD group showed expected patterns of activation for both the SRT-Early Sounds and SRT-Late Sounds, including activation in the left primary motor cortex, left premotor cortex, bilateral anterior cingulate, bilateral primary auditory cortex, bilateral superior temporal gyrus, and bilateral insula. The RSSD group showed similar activation when correcting for multiple comparisons. In further exploratory analyses, we observed the following subthreshold patterns: (a) On the SRT-Early Sounds, greater activation was found in the left premotor cortex for the RSSD group, while greater activation was found in the left cerebellum for the TD group; (b) on the SRT-Late Sounds, a small area of greater activation was found in the right cerebellum for the RSSD group. No within-group functional differences were observed (SRT-Early Sounds vs. SRT-Late Sounds) for either group. Conclusions Performance was similar between groups, and likewise, we found that functional activation did not differ. Observed functional differences in previous studies may reflect differences in task performance, rather than fundamental differences in neural mechanisms for syllable repetition.

Characteristics of Functional Speech Sound Disorders in Korean Children

Purpose: A speech sound disorder (SSD) is defined as the presence of a problem with articulation and phonological processes in a child. This study analyzed the clinical characteristics of Korean patients with functional SSDs without any neuromuscular abnormalities. Methods: The medical records of patients aged 36 to 72 months old who were diagnosed with SSDs were retrospectively reviewed. SSD patients who scored less than 85 in the U-Tap test were divided into two groups according to their receptive language scores on the PRES/SELSI. Results: Sixty-seven percent of patients with language impairment (LI) who were diagnosed with an SSD initially visited the hospital for a delay in language development (n=18, 66.7%). Among children with only an SSD, 26.7% (n=8) of the patients recognized it as a language developmental problem. All SSD patients had substitution errors in the onset of initial syllables (SSD, SSD+LI: 100%; typical development [TD]: 37.5%). Of particular note, SSD children with LI had more omission errors (55.6%) than patients with SSD only (16.7%). SSD patients had higher error rates than TD children in all consonants except for the glottal element (P<0.01). The lower the U-Tap score of SSD patients, the lower their expressive language score (P<0.001). Conclusion: A high percentage of children with SSD initially visited the hospital for the treatment of language development delays. Articulation tests are essential for children who suffer from language delay. Furthermore, since incorrect articulation can lead to delays in expressive language development, early interventions should be considered.

The BioVisualSpeech Corpus of Words with Sibilants for Speech Therapy Games Development

In order to develop computer tools for speech therapy that reliably classify speech productions, there is a need for speech production corpora that characterize the target population in terms of age, gender, and native language. Apart from including correct speech productions, in order to characterize the target population, the corpora should also include samples from people with speech sound disorders. In addition, the annotation of the data should include information on the correctness of the speech productions. Following these criteria, we collected a corpus that can be used to develop computer tools for speech and language therapy of Portuguese children with sigmatism. The proposed corpus contains European Portuguese children’s word productions in which the words have sibilant consonants. The corpus has productions from 356 children from 5 to 9 years of age. Some important characteristics of this corpus, that are relevant to speech and language therapy and computer science research, are that (1) the corpus includes data from children with speech sound disorders; and (2) the productions were annotated according to the criteria of speech and language pathologists, and have information about the speech production errors. These are relevant features for the development and assessment of speech processing tools for speech therapy of Portuguese children. In addition, as an illustration on how to use the corpus, we present three speech therapy games that use a convolutional neural network sibilants classifier trained with data from this corpus and a word recognition module trained on additional children data and calibrated and evaluated with the collected corpus.

What Acoustic Studies Tell Us About Vowels in Developing and Disordered Speech

Purpose Literature was reviewed on the development of vowels in children's speech and on vowel disorders in children and adults, with an emphasis on studies using acoustic methods. Method Searches were conducted with PubMed/MEDLINE, Google Scholar, CINAHL, HighWire Press, and legacy sources in retrieved articles. The primary search items included, but were not limited to, vowels, vowel development, vowel disorders, vowel formants, vowel therapy, vowel inherent spectral change, speech rhythm, and prosody. Results/Discussion The main conclusions reached in this review are that vowels are (a) important to speech intelligibility; (b) intrinsically dynamic; (c) refined in both perceptual and productive aspects beyond the age typically given for their phonetic mastery; (d) produced to compensate for articulatory and auditory perturbations; (e) influenced by language and dialect even in early childhood; (f) affected by a variety of speech, language, and hearing disorders in children and adults; (g) inadequately assessed by standardized articulation tests; and (h) characterized by at least three factors-articulatory configuration, extrinsic and intrinsic regulation of duration, and role in speech rhythm and prosody. Also discussed are stages in typical vowel ontogeny, acoustic characterization of rhotic vowels, a sensory-motor perspective on vowel production, and implications for clinical assessment of vowels.

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.

Relationship between temporal processing and phonological awareness in children with speech sound disorders

Temporal processing ability contributes to the identification of small phonetic elements that is important for speech perception. Difficulty in these interferes with normal speech perception and phoneme recognition. The present study aimed to assess the temporal and phonological processing abilities in children with speech sound disorders (SSD). Temporal processing and phonological skills were evaluated in 32 participants in the age range of 6-10 years, equally divided into two groups. Group I included typically developing children, and Group II included children with SSD. Gap detection test and duration pattern test were used to assess temporal processing abilities, and phonological sensitivity training kit in Kannada (PhoST-K) assessed phonological processing abilities. The results showed that there was a significant difference in temporal and phonological processing between the two groups of children. A significant correlation between gap detection ability and deletion tasks and between duration pattern ability and oddity tasks was obtained. Based on the results, it is recommended to assess the temporal process pertinent to central auditory processing in children with SSD, as a close relationship between temporal processing abilities and phonological awareness exists.

Prevalence and features of comorbid stuttering and speech sound disorder at age 4 years

BACKGROUND

Stuttering and speech sound disorder may co-occur during early childhood, although the exact rate of comorbidity in a community-cohort sample remains unknown. In isolation, both disorders have the potential for long-term negative effects. Comorbidity rates of 16%-46% reported in previous studies were based on parent report, speech-language therapist surveys, case file audits or direct observation studies from clinical samples. Rigorous methodology utilising a prospective, longitudinal community-cohort design is required to support these previous findings.

AIMS

First, to identify the proportion of children with comorbid stuttering and speech sound disorder at 4 years of age drawn from a community-cohort study. Second, to compare demographic and clinical features of this comorbid diagnosis group compared to children with no diagnosis of either disorder, or those with either disorder in isolation.

METHODS & PROCEDURES

Participants were drawn from a prospective, longitudinal community cohort study (the Early Language in Victoria Study) at 4 years of age (n = 1607). Demographic and clinical features for comparison were theoretically driven and included: gender, birth history, feeding status, speech and language status, family history of communication difficulties, maternal education, maternal vocabulary, maternal mental health and socioeconomic status.

OUTCOMES & RESULTS

Of the 160 children diagnosed with stuttering between 2 and 4 years of age, 6.88 % (n = 11) also had a speech sound disorder. Given the small sample size and number of comparisons performed, there was insufficient evidence to rule out that group differences observed were not simply due to chance.

CONCLUSIONS & IMPLICATIONS

The prevalence of comorbid stuttering and speech sound disorder was lower in a community cohort compared to that reported in clinical studies. Higher rates reported in clinical samples may be due to increased parental help-seeking behaviour when the two disorders co-occur. Subsequently, these children may present to clinics more frequently. Accurate representation of prevalence allows for population specific research on best practice assessment and intervention. Currently little is known about how best to manage this caseload, therefore more research is required in this area, including the determination of prognostic variables to provide efficient and effective management.

Comparing Traditional and Tablet-Based Intervention for Children With Speech Sound Disorders: A Randomized Controlled Trial

Purpose This article reports on the effectiveness of a novel tablet-based approach to phonological intervention and compares it to a traditional tabletop approach, targeting children with phonologically based speech sound disorders (SSD). Method Twenty-two Portuguese children with phonologically based SSD were randomly assigned to 1 of 2 interventions, tabletop or tablet (11 children in each group), and received intervention based on the same activities, with the only difference being the delivery. All children were treated by the same speech-language pathologist over 2 blocks of 6 weekly sessions, for 12 sessions of intervention. Participants were assessed at 3 time points: baseline; pre-intervention, after a 3-month waiting period; and post-intervention. Outcome measures included percentage of consonants correct, percentage of vowels correct, and percentage of phonemes correct. A generalization of target sounds was also explored. Results Both tabletop and tablet-based interventions were effective in improving percentage of consonants correct and percentage of phonemes correct scores, with an intervention effect only evident for percentage of vowels correct in the tablet group. Change scores across both interventions were significantly greater after the intervention, compared to baseline, indicating that the change was due to the intervention. High levels of generalization (60% and above for the majority of participants) were obtained across both tabletop and tablet groups. Conclusions The software proved to be as effective as a traditional tabletop approach in treating children with phonologically based SSD. These findings provide new evidence regarding the use of digital materials in improving speech in children with SSD. Supplemental Material https://doi.org/10.23641/asha.9989816.

A frequent acoustic sign of speech motor delay (SMD)

Recent studies report prevalence, phenotype, and persistence findings for a paediatric motor speech disorder in addition to childhood dysarthria and childhood apraxia of speech termed Speech Motor Delay (SMD). The aim of the present study was to determine if there is a frequent acoustic sign of SMD, with implications for theory, assessment, and treatment. We examined the frequency of 19 acoustic signs of SMD in audio recordings of continuous speech and word-imitation tasks in three groups of speakers with SMD: 50 children (mean age 5.1 years) with idiopathic Speech Delay (SD) from 6 USA cities; 87 children, adolescents, and adults with eight types of complex neurodevelopmental disorders; and 9 children (mean age 8.8 years) with persistent idiopathic SD from a population-based study of children in the South West of England. The 19 acoustic signs of imprecise or unstable speech, prosody, and voice were standardized on typical speakers of the appropriate dialect. The criterion for a frequent acoustic sign was that it occurred in at least 50% of participants with SMD in each of the three groups. Findings indicated that lengthened mid-vowels and diphthongs was the one sign that met criteria, occurring in 64.4% of the 146 participants with SMD, including 71% of the 87 participants with complex neurodevelopmental disorders. Findings are interpreted to support the potential of this acoustic sign, and possibly several others associated with temporal dimensions of speech sound development, to inform explication of the neuromotor substrates of SMD.

Working memory in school-age children with and without a persistent speech sound disorder

PURPOSE

The aim of this study was to explore the role of working memory processes as a possible cognitive underpinning of persistent speech sound disorders (SSD).

METHOD

Forty school-aged children were enrolled; 20 children with persistent SSD (P-SSD) and 20 typically developing children. Children participated in three working memory tasks - one to target each of the components in Baddeley's working memory model: phonological loop, visual spatial sketchpad and central executive.

RESULT

Children with P-SSD performed poorly only on the phonological loop tasks compared to their typically developing age-matched peers. However, mediation analyses revealed that the relation between working memory and a P-SSD was reliant upon nonverbal intelligence.

CONCLUSION

These results suggest that co-morbid low-average nonverbal intelligence are linked to poor working memory in children with P-SSD. Theoretical and clinical implications are discussed.

Prevalence and Predictors of Persistent Speech Sound Disorder at Eight Years Old: Findings From a Population Cohort Study

PURPOSE

The purpose of this study was to determine prevalence and predictors of persistent speech sound disorder (SSD) in children aged 8 years after disregarding children presenting solely with common clinical distortions (i.e., residual errors).

METHOD

Data from the Avon Longitudinal Study of Parents and Children (Boyd et al., 2012) were used. Children were classified as having persistent SSD on the basis of percentage of consonants correct measures from connected speech samples. Multivariable logistic regression analyses were performed to identify predictors.

RESULTS

The estimated prevalence of persistent SSD was 3.6%. Children with persistent SSD were more likely to be boys and from families who were not homeowners. Early childhood predictors identified as important were weak sucking at 4 weeks, not often combining words at 24 months, limited use of word morphology at 38 months, and being unintelligible to strangers at age 38 months. School-age predictors identified as important were maternal report of difficulty pronouncing certain sounds and hearing impairment at age 7 years, tympanostomy tube insertion at any age up to 8 years, and a history of suspected coordination problems. The contribution of these findings to our understanding of risk factors for persistent SSD and the nature of the condition is considered.

CONCLUSION

Variables identified as predictive of persistent SSD suggest that factors across motor, cognitive, and linguistic processes may place a child at risk.

The influence of (central) auditory processing disorder on the severity of speech-sound disorders in children

OBJECTIVE

To identify a cutoff value based on the Percentage of Consonants Correct-Revised index that could indicate the likelihood of a child with a speech-sound disorder also having a (central) auditory processing disorder .

METHODS

Language, audiological and (central) auditory processing evaluations were administered. The participants were 27 subjects with speech-sound disorders aged 7 to 10 years and 11 months who were divided into two different groups according to their (central) auditory processing evaluation results.

RESULTS

When a (central) auditory processing disorder was present in association with a speech disorder, the children tended to have lower scores on phonological assessments. A greater severity of speech disorder was related to a greater probability of the child having a (central) auditory processing disorder. The use of a cutoff value for the Percentage of Consonants Correct-Revised index successfully distinguished between children with and without a (central) auditory processing disorder.

CONCLUSIONS

The severity of speech-sound disorder in children was influenced by the presence of (central) auditory processing disorder. The attempt to identify a cutoff value based on a severity index was successful.

Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children

AIM

The epidemiology of preschool speech sound disorder is poorly understood. Our aims were to determine: the prevalence of idiopathic speech sound disorder; the comorbidity of speech sound disorder with language and pre-literacy difficulties; and the factors contributing to speech outcome at 4 years.

METHOD

One thousand four hundred and ninety-four participants from an Australian longitudinal cohort completed speech, language, and pre-literacy assessments at 4 years. Prevalence of speech sound disorder (SSD) was defined by standard score performance of ≤79 on a speech assessment. Logistic regression examined predictors of SSD within four domains: child and family; parent-reported speech; cognitive-linguistic; and parent-reported motor skills.

RESULTS

At 4 years the prevalence of speech disorder in an Australian cohort was 3.4%. Comorbidity with SSD was 40.8% for language disorder and 20.8% for poor pre-literacy skills. Sex, maternal vocabulary, socio-economic status, and family history of speech and language difficulties predicted SSD, as did 2-year speech, language, and motor skills. Together these variables provided good discrimination of SSD (area under the curve=0.78).

INTERPRETATION

This is the first epidemiological study to demonstrate prevalence of SSD at 4 years of age that was consistent with previous clinical studies. Early detection of SSD at 4 years should focus on family variables and speech, language, and motor skills measured at 2 years.

“He'll Grow out of it Soon—Won't He?”—The Characteristics of Older Children's Speech When They Do—and Don't—Grow out of it

Speech sound disorder is a common reason for referral to speech and language therapy services in the early years. While for some children, their difficulties are transitory and they either respond to intervention or their difficulties resolve, for others, their speech sound difficulties evolve into persistent speech disorder (PSD). The purpose of this article is to provide information on the features of PSD and how to assess children with PSD in order to identify the full range and limits of their speech sound system. Reference is made to ALSPAC, a large longitudinal population study, regarding prevalence, possible subtypes, and risk factors for PSD.