Fricative Contrast and Coarticulation in Children With and Without Speech Sound Disorders

How to cut the pie is no piece of cake: Toward a process-oriented approach to assessment and diagnosis of speech sound disorders

BACKGROUND

'Speech sound disorder' is an umbrella term that encompasses dysarthria, articulation disorders, childhood apraxia of speech and phonological disorders. However, differential diagnosis between these disorders is a persistent challenge in speech pathology, as many diagnostic procedures use symptom clusters instead of identifying an origin of breakdown in the speech and language system.

AIMS

This article reviews typical and disordered speech through the lens of two well-developed models of production-one focused on phonological encoding and one focused on speech motor planning. We illustrate potential breakdown locations within these models that may relate to childhood apraxia of speech and phonological disorders.

MAIN CONTRIBUTION

This paper presents an overview of an approach to conceptualisation of speech sound disorders that is grounded in current models of speech production and emphasises consideration of underlying processes. The paper also sketches a research agenda for the development of valid, reliable and clinically feasible assessment protocols for children with speech sound disorders.

CONCLUSION

The process-oriented approach outlined here is in the early stages of development but holds promise for developing a more detailed and comprehensive understanding of, and assessment protocols for speech sound disorders that go beyond broad diagnostic labels based on error analysis. Directions for future research are discussed.

WHAT THIS PAPER ADDS

What is already known on the subject Speech sound disorders (SSD) are heterogeneous, and there is agreement that some children have a phonological impairment (phonological disorders, PD) whereas others have an impairment of speech motor planning (childhood apraxia of speech, CAS). There is also recognition that speech production involves multiple processes, and several approaches to the assessment and diagnosis of SSD have been proposed. What this paper adds to existing knowledge This paper provides a more detailed conceptualisation of potential impairments in children with SSD that is grounded in current models of speech production and encourages greater consideration of underlying processes. The paper illustrates this approach and provides guidance for further development. One consequence of this perspective is the notion that broad diagnostic category labels (PD, CAS) may each comprise different subtypes or profiles depending on the processes that are affected. What are the potential or actual clinical implications of this work? Although the approach is in the early stages of development and no comprehensive validated set of tasks and measures is available to assess all processes, clinicians may find the conceptualisation of different underlying processes and the notion of potential subtypes within PD and CAS informative when evaluating SSD. In addition, this perspective discourages either/or thinking (PD or CAS) and instead encourages consideration of the possibility that children may have different combinations of impairments at different processing stages.

Developmental Changes in Coarticulation Degree Relate to Differences in Articulatory Patterns: An Empirically Grounded Modeling Approach

PURPOSE

Coarticulatory effects in speech vary across development, but the sources of this variation remain unclear. This study investigated whether developmental differences in intrasyllabic coarticulation degree could be explained by differences in children's articulatory patterns compared to adults.

METHOD

To address this question, we first compared the tongue configurations of 3- to 7-year-old German children to those of adults. The observed developmental differences were then examined through simulations with Task Dynamics Application, a Task Dynamics simulation system, to establish which articulatory modifications could best reproduce the empirical results. To generate syllables simulating the lack of tongue gesture differentiation, we tested three simulation scenarios.

RESULTS

We found that younger speakers use less differentiated articulatory patterns to achieve alveolar constrictions than adults. The simulations corresponding to undifferentiated control of tongue tip and tongue body resulted in (a) tongue shapes similar to those observed in natural speech and (b) higher degrees of intrasyllabic coarticulation in children when compared to adults.

CONCLUSIONS

Results provide evidence that differences in articulatory patterns contribute to developmental differences in coarticulation degree. This study further shows that empirically informed modeling can advance our understanding of changes in coarticulatory patterns across age.

Development of the voiceless sibilant fricative contrast in three-year-olds: an ultrasound and acoustic study

The study analysed spectral and tongue shape dynamics of voiceless alveolar and postalveolar fricatives produced by ten children learning Scottish English. Synchronised ultrasound tongue imaging data and acoustic data were used to characterise children's productions of the phonemic contrast. Six children had consistently accurate productions of both fricative targets, with some cross-consonant phonetic differences in the direction previously demonstrated for older children and adults, as well as some immature acoustic and articulatory dynamic patterns. Instrumental analyses made it possible to describe tongue shape for phonemic errors and phonetically distorted realisations. There was some evidence of articulatory contrast in production preceding contrast in perception. The observed patterns can be explained by the complex articulatory demands on the fricative production, in combination with the developing control of articulators. The paper concludes by discussing the implications of the results for phonological theory and for speech therapy practice.

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.

What anticipatory coarticulation in children tells us about speech motor control maturity

PURPOSE

This study aimed to evaluate the role of motor control immaturity in the speech production characteristics of 4-year-old children, compared to adults. Specifically, two indices were examined: trial-to-trial variability, which is assumed to be linked to motor control accuracy, and anticipatory extra-syllabic vowel-to-vowel coarticulation, which is assumed to be linked to the comprehensiveness, maturity and efficiency of sensorimotor representations in the central nervous system.

METHOD

Acoustic and articulatory (ultrasound) data were recorded for 20 children and 10 adults, all native speakers of Canadian French, during the production of isolated vowels and vowel-consonant-vowel (V1-C-V2) sequences. Trial-to-trial variability was measured in isolated vowels. Extra-syllabic anticipatory coarticulation was assessed in V1-C-V2 sequences by measuring the patterns of variability of V1 associated with variations in V2. Acoustic data were reported for all subjects and articulatory data, for a subset of 6 children and 2 adults.

RESULTS

Trial-to-trial variability was significantly larger in children. Systematic and significant anticipation of V2 in V1 was always found in adults, but was rare in children. Significant anticipation was observed in children only when V1 was /a/, and only along the antero-posterior dimension, with a much smaller magnitude than in adults. A closer analysis of individual speakers revealed that some children showed adult-like anticipation along this dimension, whereas the majority did not.

CONCLUSION

The larger trial-to-trial variability and the lack of anticipatory behavior in most children-two phenomena that have been observed in several non-speech motor tasks-support the hypothesis that motor control immaturity may explain a large part of the differences observed between speech production in adults and 4-year-old children, apart from other causes that may be linked with language development.

Speech Sound Disorders in Children: An Articulatory Phonology Perspective

Speech Sound Disorders (SSDs) is a generic term used to describe a range of difficulties producing speech sounds in children (McLeod and Baker, 2017). The foundations of clinical assessment, classification and intervention for children with SSD have been heavily influenced by psycholinguistic theory and procedures, which largely posit a firm boundary between phonological processes and phonetics/articulation (Shriberg, 2010). Thus, in many current SSD classification systems the complex relationships between the etiology (distal), processing deficits (proximal) and the behavioral levels (speech symptoms) is under-specified (Terband et al., 2019a). It is critical to understand the complex interactions between these levels as they have implications for differential diagnosis and treatment planning (Terband et al., 2019a). There have been some theoretical attempts made towards understanding these interactions (e.g., McAllister Byun and Tessier, 2016) and characterizing speech patterns in children either solely as the product of speech motor performance limitations or purely as a consequence of phonological/grammatical competence has been challenged (Inkelas and Rose, 2007; McAllister Byun, 2012). In the present paper, we intend to reconcile the phonetic-phonology dichotomy and discuss the interconnectedness between these levels and the nature of SSDs using an alternative perspective based on the notion of an articulatory "gesture" within the broader concepts of the Articulatory Phonology model (AP; Browman and Goldstein, 1992). The articulatory "gesture" serves as a unit of phonological contrast and characterization of the resulting articulatory movements (Browman and Goldstein, 1992; van Lieshout and Goldstein, 2008). We present evidence supporting the notion of articulatory gestures at the level of speech production and as reflected in control processes in the brain and discuss how an articulatory "gesture"-based approach can account for articulatory behaviors in typical and disordered speech production (van Lieshout, 2004; Pouplier and van Lieshout, 2016). Specifically, we discuss how the AP model can provide an explanatory framework for understanding SSDs in children. Although other theories may be able to provide alternate explanations for some of the issues we will discuss, the AP framework in our view generates a unique scope that covers linguistic (phonology) and motor processes in a unified manner.

Toddlers Process Common and Infrequent Childhood Mispronunciations Differently for Child and Adult Speakers

Purpose This study examined toddlers' processing of mispronunciations based on their frequency of occurrence in child speech and the speaker who produced them. Method One hundred twenty 22-month-olds were assigned to 1 of 4 conditions. Using the intermodal preferential looking paradigm, toddlers were shown visual displays containing 1 familiar object and 1 novel object, labeled by either a child or an adult. Familiar objects were labeled correctly or with a small mispronunciation that is either common in child speech (e.g., waisin for raisin) or infrequent (e.g., rauter for water). Results A significant interaction of speaker and type of mispronunciation showed that, for the child speaker, toddlers treated common and infrequent mispronunciations similarly, with equivalently sized mispronunciation penalties relative to correctly pronounced labels. In contrast, for the adult speaker, toddlers showed a large penalty for common mispronunciations, but infrequent mispronunciations were treated equivalently to correct pronunciations. Conclusion These results both reinforce and extend previous work on toddlers' processing of mispronunciations by revealing a complex interplay of speaker, type of mispronunciation, and specific contrast in toddlers' perceptions of mispronunciations.

Motor Performance in Children With Childhood Apraxia of Speech and Speech Sound Disorders

Purpose This study sought to determine if (a) children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development (TD) would perform differently on a standardized motor assessment and (b) whether comorbid language impairment would impact group differences. Method Speech, language, and motor abilities were assessed in children with CAS (n = 10), SSD (n = 16), and TD (n = 14) between the ages of 43 and 105 months. Motor skills were evaluated using the Movement Assessment Battery for Children-Second Edition (Henderson, Sugden, & Barnett, 2007), a behavioral assessment that is sensitive in identifying fine/gross motor impairments in children with a range of motor and learning abilities. Data were reanalyzed after reclassifying children by language ability. Results The CAS group performed below the normal limit on all components of the motor assessment and more poorly than the TD and SSD groups on Aiming and Catching and Balance. When children were reclassified by language ability, the comorbid CAS + language impairment group performed worse than the SSD-only and TD groups on Manual Dexterity and Balance and worse than the TD group on Aiming and Catching; all 7 children with CAS + language impairment evidenced performance in the disordered range compared to 1 of 3 children in the CAS-only group and 2 of 6 children in the SSD + language impairment group. Conclusions Children with CAS + language impairment appear to be at an increased risk for motor impairments, which may negatively impact social, academic, and vocational outcomes; referrals for motor screenings/assessments should be considered. Findings may suggest a higher order deficit that mediates cognitive-linguistic and motor impairments in this population.

Bang for Your Buck: A Single-Case Experimental Design Study of Practice Amount and Distribution in Treatment for Childhood Apraxia of Speech

Purpose The aim of this study was to examine 2 aspects of treatment intensity in treatment for childhood apraxia of speech (CAS): practice amount and practice distribution. Method Using an alternating-treatments single-subject design with multiple baselines, we compared high versus low amount of practice, and massed versus distributed practice, in 6 children with CAS. Conditions were manipulated in the context of integral stimulation treatment. Changes in perceptual accuracy, scored by blinded analysts, were quantified with effect sizes. Results Four children showed an advantage for high amount of practice, 1 showed an opposite effect, and 1 showed no condition difference. For distribution, 4 children showed a clear advantage for massed over distributed practice post treatment; 1 showed an opposite pattern, and 1 showed no clear difference. Follow-up revealed a similar pattern. All children demonstrated treatment effects (larger gains for treated than untreated items). Conclusions High practice amount and massed practice were associated with more robust speech motor learning in most children with CAS, compared to low amount and distributed practice, respectively. Variation in effects across children warrants further research to determine factors that predict optimal treatment conditions. Finally, this study adds to the evidence base supporting the efficacy of integral stimulation treatment for CAS. Supplemental Material https://doi.org/10.23641/asha.9630599.

Assessment of Childhood Apraxia of Speech: A Review/Tutorial of Objective Measurement Techniques

Background With respect to the clinical criteria for diagnosing childhood apraxia of speech (commonly defined as a disorder of speech motor planning and/or programming), research has made important progress in recent years. Three segmental and suprasegmental speech characteristics-error inconsistency, lengthened and disrupted coarticulation, and inappropriate prosody-have gained wide acceptance in the literature for purposes of participant selection. However, little research has sought to empirically test the diagnostic validity of these features. One major obstacle to such empirical study is the fact that none of these features is stated in operationalized terms. Purpose This tutorial provides a structured overview of perceptual, acoustic, and articulatory measurement procedures that have been used or could be used to operationalize and assess these 3 core characteristics. Methodological details are reviewed for each procedure, along with a short overview of research results reported in the literature. Conclusion The 3 types of measurement procedures should be seen as complementary. Some characteristics are better suited to be described at the perceptual level (especially phonemic errors and prosody), others at the acoustic level (especially phonetic distortions, coarticulation, and prosody), and still others at the kinematic level (especially coarticulation, stability, and gestural coordination). The type of data collected determines, to a large extent, the interpretation that can be given regarding the underlying deficit. Comprehensive studies are needed that include more than 1 diagnostic feature and more than 1 type of measurement procedure.

Back From the Future: Nonlinear Anticipation in Adults' and Children's Speech

Purpose This study examines the temporal organization of vocalic anticipation in German children from 3 to 7 years of age and adults. The main objective was to test for nonlinear processes in vocalic anticipation, which may result from the interaction between lingual gestural goals for individual vowels and those for their neighbors over time. Method The technique of ultrasound imaging was employed to record tongue movement at 5 time points throughout short utterances of the form V1#CV2. Vocalic anticipation was examined with generalized additive modeling, an analytical approach allowing for the estimation of both linear and nonlinear influences on anticipatory processes. Results Both adults and children exhibit nonlinear patterns of vocalic anticipation over time with the degree and extent of vocalic anticipation varying as a function of the individual consonants and vowels assembled. However, noticeable developmental discrepancies were found with vocalic anticipation being present earlier in children's utterances at 3-5 years of age in comparison to adults and, to some extent, 7-year-old children. Conclusions A developmental transition towards more segmentally-specified coarticulatory organizations seems to occur from kindergarten to primary school to adulthood. In adults, nonlinear anticipatory patterns over time suggest a strong differentiation between the gestural goals for consecutive segments. In children, this differentiation is not yet mature: Vowels show greater prominence over time and seem activated more in phase with those of previous segments relative to adults.

Toddlers' sensitivity to phonetic detail in child speech

Young language learners acquire their first language(s) from the speech they are exposed to in their environment. For at least some children (e.g., those in daycare), this environmental speech includes a large quantity of speech from other children. Yet, we know little about how young learners process this type of speech and its status as a source of input. Across two experiments, we assessed 21- to 23-month-olds' processing of a child's speech using the preferential looking paradigm. We found that toddlers processed the child speaker's productions as well as those of an adult and with the same level of sensitivity to phonetic detail previously shown for adult speakers. Although the amount of experience toddlers had interacting with other children outside the home had little influence on their processing of familiar words, only toddlers with high levels of experience with other children outside the home showed a disambiguation response after hearing novel labels. Whether this is truly due to the number or variety of other child speakers or to other correlated aspects of toddlers' language environments is unclear and remain intriguing questions for future research. Overall, these findings demonstrate that child speech may represent useful input for young language learners.

Pseudowords to the Phonological Therapy: a new therapeutic approach

The pseudowords are a resource rarely used in clinical practice, but may be an excellent option for phonological therapy. This study aimed to verify the therapeutic progress of children with phonological disorder, treated from a new therapeutic approach, considering the favorable linguistic environment in pseudowords and words. The sample consisted of three children, aged between 4 and 8 years old, who submitted to a new therapeutic approach to phonological basis. The children were treated with different targets involving pseudowords and real words in favorable and neutral linguistic environments. In the results, it can be observed that the therapy involving favorable linguistic environment the best results when compared to realize in neutral environment. Regarding the target words, subject treated simultaneously with pseudowords and real words presented satisfactory results, indicating that the targets were appropriate to therapy. The new therapeutic approach involving pseudowords and real words in favorable environments proved to be effective for the treatment of phonological disorders.

The dynamics of voiceless sibilant fricative production in children between 7 and 13 years old: An ultrasound and acoustic study

This study reports on dynamic tongue shape and spectral characteristics of sibilant fricatives /s/ and /ʃ/ in Scottish English speaking children aged between 7 and 13 years old. The sequences /əCa/ and /əCi/ were produced by 40 children, with ten participants in each age group, and two-year intervals between successive groups. Productions of the same sequences by ten adults were used for comparison with the children's data. Quantitative dynamic analyses were carried out on spectral information and on ultrasound imaging data on tongue shape. All age groups differentiated between the two consonants in the fricative centroid and in tongue shape. Vowel-on-consonant effects showed consonant-specific patterns across age groups without a consistent increase or decrease in the extent of coarticulation with increasing age. The extent of discriminability between the two fricatives increased with age on both acoustic and articulatory measures. Younger speakers were generally more variable than older speakers. Complementary findings from the centroid and tongue shape measures suggest that age-related differences are due to the ongoing maturation of controlling the tongue in coordination with other articulators, particularly the jaw, throughout childhood.

How Do Children Organize Their Speech in the First Years of Life? Insight From Ultrasound Imaging

PURPOSE

This study reports on a cross-sectional investigation of lingual coarticulation in 57 typically developing German children (4 cohorts from 3.5 to 7 years of age) as compared with 12 adults. It examines whether the organization of lingual gestures for intrasyllabic coarticulation differs as a function of age and consonantal context.

METHOD

Using the technique of ultrasound imaging, we recorded movement of the tongue articulator during the production of pseudowords, including various vocalic and consonantal contexts.

RESULTS

Results from linear mixed-effects models show greater lingual coarticulation in all groups of children as compared with adults with a significant decrease from the kindergarten years (at ages 3, 4, and 5 years) to the end of the 1st year into primary school (at age 7 years). Additional differences in coarticulation degree were found across and within age groups as a function of the onset consonant identity (/b/, /d/, and /g/).

CONCLUSIONS

Results support the view that, although coarticulation degree decreases with age, children do not organize consecutive articulatory gestures with a uniform organizational scheme (e.g., segmental or syllabic). Instead, results suggest that coarticulatory organization is sensitive to the underlying articulatory properties of the segments combined.