Age Norms for Auditory-Perceptual Neurophonetic Parameters: A Prerequisite for the Assessment of Childhood Dysarthria

Age Estimation and Gender Attribution in Typically Developing Children and Children With Dysarthria

PURPOSE

The purposes of this study were (a) to investigate adult listeners' perceptions of age and gender in typically developing children and children with dysarthria and (b) to identify predictors of their estimates among auditory-perceptual parameters and an acoustic measure of vocal pitch (F0). We aimed to evaluate the influence of dysarthria on the listeners' impressions of age and gender against the background of typical developmental processes.

METHOD

In a listening experiment, adult listeners completed age and gender estimates of 144 typically developing children (3-9 years of age) and 25 children with dysarthria (5-9 years of age). The Bogenhausen Dysarthria Scales for Childhood Dysarthria (BoDyS-KiD) were applied to record speech samples and to complete auditory-perceptual judgments covering all speech subsystems. Furthermore, each child's mean F0 was determined from samples of four BoDyS-KiD sentences.

RESULTS

Age estimates for the typically developing children showed a regression to the mean, whereas children with dysarthria were systematically underestimated in their age. The estimates of all children were predicted by developmental speech features; for the children with dysarthria, specific dysarthria symptoms had an additional effect. We found a significantly higher accuracy of gender attribution in the typically developing children than in the children with dysarthria. The prediction accuracy of the listeners' gender attribution in the preadolescent children by the included speech characteristics was limited.

CONCLUSIONS

Children with dysarthria are more difficult to estimate for their age and gender than their typically developing peers. Dysarthria thus alters the auditory-perceptual impression of indexical speech features in children, which must be considered another facet of the communication disorder associated with childhood dysarthria.

Vocal Characteristics of Infants at Risk for Speech Motor Involvement: A Scoping Review

PURPOSE

The purpose of this scoping review was to (a) summarize methodological characteristics of studies examining vocal characteristics of infants at high risk for neurological speech motor involvement and (b) report the state of the high-quality evidence on vocal characteristic trends of infants diagnosed or at high risk for cerebral palsy (CP).

METHOD

The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) extension for scoping reviews was followed for reporting our review. Studies measured prelinguistic vocal characteristics of infants under 24 months with birth risk or genetic conditions known to commonly present with speech motor involvement. Fifty-five studies met criteria for Part 1. Eleven studies met criteria for synthesis in Part 2.

RESULTS

A smaller percentage of studies examined infants with or at risk for CP compared to studies examining genetic conditions such as Down syndrome. The median year of publication was 1999, with a median sample size of nine participants. Most studies were conducted in laboratory settings and used human coding of vocalizations produced during caregiver-child interactions. Substantial methodological differences were noted across all studies. A small number of high-quality studies of infants with or at risk for CP revealed high rates of marginal babbling, low rates of canonical babbling, and limited consonant diversity under 24 months. Mixed findings were noted across studies of general birth risk factors.

CONCLUSIONS

There is limited evidence available to support the early detection of speech motor involvement. Large methodological differences currently impact the ability to synthesize findings across studies. There is a critical need to conduct longitudinal research with larger sample sizes and advanced, modern technologies to detect vocal precursors of speech impairment to support the accurate diagnosis and prognosis of speech development in infants with CP and other clinical populations.

Clinical Practice in Childhood Dysarthria: An Online Survey of German-Speaking Speech-Language Pathologists

PURPOSE

This survey study aimed to establish current clinical practices of German-speaking speech-language pathologists (SLPs) regarding their assessment and treatment of communication disorders in children with neurological conditions, with a particular focus on the management of childhood dysarthria.

METHOD

A 23-question cross-sectional online survey was disseminated to practicing SLPs in Germany, Austria, and Switzerland via relevant professional bodies. SLPs were invited to provide information on their current assessment and treatment practices. Demographic data including case load and clinical settings were also gathered to contextualize practices.

RESULTS

One hundred two SLPs responded to the survey, of which 68 valid responses were analyzed. German-speaking SLPs comprehensively assess and treat various aspects of overall communication, language, and swallowing functions in children with neurological conditions. Speech motor aspects did not represent a main intervention focus. In cases where the dysarthric component was targeted, specific approaches for childhood dysarthria were rarely used. Instead, SLPs reported using approaches developed for speech disorders other than dysarthria.

CONCLUSIONS

German-speaking SLPs working with children with neurological conditions use various assessment and treatment methods to support children's communication. However, dysarthria-specific approaches were not an established part of clinical practice. Results of the survey highlight the need for access to relevant developments in German and for evaluation of current curricula for speech-language pathology students and continuing education opportunities for practicing clinicians.

Developmental Cut-Points for Atypical Speech Intelligibility in Children With Cerebral Palsy

PURPOSE

Early identification of speech motor involvement (SMI) in children with cerebral palsy (CP) is difficult because of overlapping features with many aspects of typical speech development. Quantitative measures of speech intelligibility have the potential to differentiate between children with SMI and those with no SMI (NSMI). We examined thresholds for speech intelligibility development in children with CP relative to the low end of age-specific typical developmental expectations. We sought to determine whether there were intelligibility differences between children with CP and NSMI versus typically developing (TD) age-mates across the range of development and whether there were differences between children with CP who have NSMI and those with CP who have SMI across the range of development based on speech intelligibility.

METHOD

We used two large existing data sets that included speech samples from children between the ages of 2.5 and 8 years. One data set included 511 longitudinal speech samples from children with CP; the other included 505 cross-sectional speech samples from TD children. We examined receiver operating characteristic curves and sensitivity/specificity results by age for differentiating among groups of children.

RESULTS

TD children versus those with CP and NSMI showed differentiation in their speech intelligibility across all ages, but the strength of differentiation was only marginally above chance. Children with CP and NSMI showed clear differentiation in their speech intelligibility from those with CP and SMI beginning at the earliest age point. Children with CP who have intelligibility below 40% at the age of 3 years have a very high probability of having SMI.

CONCLUSIONS

Early intelligibility screening should be performed in children diagnosed with CP. Those with intelligibility below 40% at 3 years of age should be referred immediately for speech assessment and treatment.

Motor Speech Phenotypes in Children With Epilepsy: Preliminary Findings

PURPOSE

This exploratory study aimed to characterize motor speech impairments in a small sample of children with epilepsy, both with and without a known seizure etiology. A secondary aim was to evaluate the validity of the Profile for Childhood Apraxia of speech and Dysarthria (ProCAD), a newly developed tool for differential diagnosis of childhood apraxia of speech and dysarthria.

METHOD

Thirteen children with seizure disorders completed a comprehensive speech and language assessment. Three expert speech-language pathologists rated the presence of auditory-perceptual features of motor speech impairment using the ProCAD. Motor speech features, diagnoses, and standardized test scores were compared between children with a known seizure etiology and children with idiopathic epilepsy.

RESULTS

Nine of the 13 children exhibited motor speech impairment; dysarthria was the most common diagnosis. Most children (11/13) exhibited language impairment. Group comparisons showed that children with a known seizure etiology had more atypical motor speech features and lower language scores than children with idiopathic seizures.

CONCLUSION

These preliminary findings suggest a high rate of motor speech impairment among children with epilepsy.

Speech Naturalness in the Assessment of Childhood Dysarthria

PURPOSE

This study investigated perceived speech naturalness estimated by adult listeners in typically developing children and children with dysarthria. We aimed to identify predictors of naturalness among auditory-perceptual parameters and to evaluate the concept of naturalness as a clinical marker of childhood dysarthria.

METHOD

In a listening experiment, naive adult listeners rated speech naturalness of 144 typically developing children (3-9 years old) and 28 children with neurological conditions (5-9 years old) on a visual analog scale. Speech samples were recorded using the materials of the Bogenhausen Dysarthria Scales-Childhood Dysarthria, which also provides for auditory-perceptual judgments covering all speech subsystems.

RESULTS

Children with dysarthria obtained significantly lower naturalness ratings compared to typically developing children. However, there was a substantial age effect observable in the typically developing children; that is, younger typically developing children were also perceived as somewhat unnatural. The ratings of the typically developing children were influenced by the occurrence of developmental speech features; for the children with neurological conditions, specific symptoms of dysarthria had an additional effect. In both groups, the perception of naturalness was predominantly determined by the children's articulation and intelligibility.

CONCLUSIONS

Both symptoms of childhood dysarthria and developmental speech features (e.g., regarding articulation and intelligibility) were associated to some extent with unnatural speech by the listeners. Thus, perceived speech naturalness appears less suitable as a marker of dysarthria in children than in adults.

Speech assessment tool methods for speech impaired children: a systematic literature review on the state-of-the-art in Speech impairment analysis

Speech is a powerful, natural mode of communication that facilitates effective interactions in human societies. However, when fluency or flow of speech is affected or interrupted, it leads to speech impairment. There are several types of speech impairment depending on the speech pattern and range from mild to severe. Childhood apraxia of speech (CAS) is the most common speech disorder in children, with 1 out of 12 children diagnosed globally. Significant advancements in speech assessment tools have been reported to assist speech-language pathologists diagnosis speech impairment. In recent years, speech assessment tools have also gained popularity among pediatricians and teachers who work with preschoolers. Automatic speech tools can be more accurate for detecting speech sound disorders (SSD) than human-based speech assessment methods. This systematic literature review covers 88 studies, including more than 500 children, infants, toddlers, and a few adolescents, (both male and female) (age = 0-17) representing speech impairment from more than 10 countries. It discusses the state-of-the-art speech assessment methods, including tools, techniques, and protocols for speech-impaired children. Additionally, this review summarizes notable outcomes in detecting speech impairments using said assessment methods and discusses various limitations such as universality, reliability, and validity. Finally, we consider the challenges and future directions for speech impairment assessment tool research.

Use of Automated Kinematic Diadochokinesis Analysis to Identify Potential Indicators of Speech Motor Involvement in Children With Cerebral Palsy

PURPOSE

This study examined multiple variables obtained from an automated measure of lip movement during a diadochokinesis (DDK) task to identify those with potential to detect mild speech motor involvement in school-age children diagnosed with cerebral palsy (CP).

METHOD

Eight children with CP and high speech intelligibility and a matched group of eight children with typical development (TD) completed a DDK task while their lip and jaw movements were recorded. A custom MATLAB algorithm was used to automatically extract 23 kinematic measures of children's lip movements during production of the DDK sequences. Mann-Whitney U tests were used to compare groups on the kinematic measures, and receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of measures that significantly differed between groups.

RESULTS

Five of the 23 kinematic variables differed significantly between the CP and TD groups. These were two measures of overall DDK performance (i.e., duration of the DDK sequence and number of cycles) and three spatial and temporal measures of lip movement. Duration of the DDK sequence and the mean displacement of the lips across cycles had the highest diagnostic accuracy, differentiating CP and TD groups with 88% sensitivity and 88% specificity.

CONCLUSIONS

Automatically derived kinematic measures of DDK sequences differentiated children with CP and high intelligibility from typically developing children. Future research is needed to determine the clinical utility of these measures for detecting speech motor impairment.

Vowels in urban and rural Albanian: the case of the Southern Gheg dialect

Albanian comprises two main dialects, Gheg and Tosk, as well as a Tosk-based standard variety. The study was concerned with the extent to which the vocalic system of Southern Gheg, spoken in the capital city Tirana and surrounding rural area, has been shaped in urban versus rural contexts by extensive contact with Tosk and the standard. Through an apparent-time comparison across two groups of adults and first-grade children, one from Tirana and the other from the nearby village of Bërzhitë, we investigated three vocalic features of Southern Gheg: rounding of /a/, vowel lengthening and monophthongization, all of which were expected to be maintained more in the rural community than in the urban one, and also more by adults than by children. Our results showed that rounding was changing in both locations, monophthongization in the urban setting only, while lengthening was well preserved. In general, the changes found for rounding and monophthongization were more advanced in children than adults. The relative complexity of the features is the main factor explored to account for why some features change faster than others. The reasons for a possible increase in the phonological complexity of Southern Gheg are also discussed.

Intelligibility, Speech Rate, and Communication Efficiency in Children With Neurological Conditions: A Longitudinal Study of Childhood Dysarthria

PURPOSE

This study aimed to describe communication-related parameters (i.e., intelligibility, speech rate, and communication efficiency) and their developmental courses in children with neurological conditions against the background of typical development. In addition, interrelations between the developmental courses of communication-related parameters and auditory-perceptual ratings related to speech subsystems were investigated.

METHOD

Fourteen children with neurological conditions (CNC) and 14 typically developing children (CTD), matched for age and gender (four girls; 5;1-8;4 [years;months] at first examination), were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen-Kindliche Dysarthrien (English: Bogenhausen Dysarthria Scales-Childhood Dysarthria), a German tool for the assessment of childhood dysarthria. To assess intelligibility, naïve listeners transcribed audio samples of sentence repetitions of the children. Speech rate was measured by acoustic analyses, and communication efficiency was determined by multiplying the proportion of correctly transcribed syllables with speech rate. Age normalization was performed following a recently published approach.

RESULTS

On the group level, CNC had conspicuous raw and normalized scores for the three communication-related parameters and were more variable than the CTD group regarding their developmental courses. These differences were more pronounced for intelligibility than for speech rate. A strong relationship between communication-related and speech subsystems-related auditory-perceptual characteristics was apparent only between intelligibility and articulation/resonance.

CONCLUSIONS

For the first time, age-normalized scores for communication-related parameters were reported in children with neurological disorders and put into a developmental context within the framework of a longitudinal study. Age-normalized intelligibility was more vulnerable to large developmental changes than speech rate and was best predicted by changes in articulation and resonance. Overall, this study may contribute to a more comprehensive and valid clinical assessment of childhood dysarthria and to a better understanding of its developmental dynamics.

An Investigation to Identify Optimal Setup for Automated Assessment of Dysarthric Intelligibility using Deep Learning Technologies

Recent advances in deep learning have provided an opportunity to improve and automate dysarthria intelligibility assessment, offering a cost-effective, accessible, and less subjective way to assess dysarthric speakers. However, reviewing previous literature in the area determines that the generalization of results on new dysarthric patients was not measured properly or incomplete among the previous studies that yielded very high accuracies due to the gaps in the adopted evaluation methodologies. This is of particular importance as any practical and clinical application of intelligibility assessment approaches must reliably generalize on new patients; otherwise, the clinicians cannot accept the assessment results provided by the system deploying the approach. In this paper, after these gaps are explained, we report on our extensive investigation to propose a deep learning–based dysarthric intelligibility assessment optimal setup. Then, we explain different evaluation strategies that were applied to thoroughly verify how the optimal setup performs with new speakers and across different classes of speech intelligibility. Finally, a comparative study was conducted, benchmarking the performance of our proposed optimal setup against the state of the art by adopting similar strategies previous studies employed. Results indicate an average of 78.2% classification accuracy for unforeseen low intelligibility speakers, 40.6% for moderate intelligibility speakers, and 40.4% for high intelligibility speakers. Furthermore, we noticed a high variance of classification accuracies among individual speakers. Finally, our proposed optimal setup delivered an average of 97.19% classification accuracy when adopting a similar evaluation strategy used by the previous studies.

Childhood Dysarthria: Auditory-Perceptual Profiles Against the Background of Typical Speech Motor Development

PURPOSE

The purpose of this study was to describe childhood dysarthria by means of auditory-perceptual analyses covering all speech subsystems. We aimed to identify the most seriously affected auditory-perceptual dimensions in the observed dysarthria profiles and to detect specific markers of childhood dysarthria against the backdrop of typical speech development. Moreover, the relationship between the speech disorder and other relevant aspects of multiple disability was investigated.

METHOD

Thirty-one children with neurologic conditions were assessed with Bogenhausen Dysarthria Scales for Childhood Dysarthria, a German tool for the auditory-perceptual analysis of dysarthria in children. Nine relevant speech dimensions (scales, e.g., voice quality [VOQ]) and 29 individual symptoms (features, e.g., breathy) were evaluated. Moreover, we documented motor, communicative, and cognitive-linguistic measures (i.e., Gross Motor Function Classification System [GMFCS], Communication Function Classification System [CFCS], Test for Reception of Grammar [TROG-D], and memory span). Recently published data from typically developing children were used for the purpose of age normalization.

RESULTS

Dysarthria severity was moderately correlated with GMFCS and CFCS but not with TROG-D and memory span. At the group level, respiration, articulation, and prosodic modulation were most severely affected, whereas voice function was only mildly affected or even spared in the majority of children. Four features were identified as most relevant markers of childhood dysarthria: conspicuous rhythm/stress pattern, hypernasality, strained-strangled voice, and reduced articulatory precision.

CONCLUSIONS

Childhood dysarthria is part of a complex multiple disability, but speech motor skills may still dissociate from gross-motor and cognitive-linguistic functions. Auditory-perceptual analyses incorporating age norms allow for a comprehensive description and identification of childhood dysarthria.

A Tool for Differential Diagnosis of Childhood Apraxia of Speech and Dysarthria in Children: A Tutorial

PURPOSE

While there has been mounting research centered on the diagnosis of childhood apraxia of speech (CAS), little has focused on differentiating CAS from pediatric dysarthria. Because CAS and dysarthria share overlapping speech symptoms and some children have both motor speech disorders, differential diagnosis can be challenging. There is a need for clinical tools that facilitate assessment of both CAS and dysarthria symptoms in children. The goals of this tutorial are to (a) determine confidence levels of clinicians in differentially diagnosing dysarthria and CAS and (b) provide a systematic procedure for differentiating CAS and pediatric dysarthria in children.

METHOD

Evidence related to differential diagnosis of CAS and dysarthria is reviewed. Next, a web-based survey of 359 pediatric speech-language pathologists is used to determine clinical confidence levels in diagnosing CAS and dysarthria. Finally, a checklist of pediatric auditory-perceptual motor speech features is presented along with a procedure to identify CAS and dysarthria in children with suspected motor speech impairments. Case studies illustrate application of this protocol, and treatment implications for complex cases are discussed.

RESULTS

The majority (60%) of clinician respondents reported low or no confidence in diagnosing dysarthria in children, and 40% reported they tend not to make this diagnosis as a result. Going forward, clinicians can use the feature checklist and protocol in this tutorial to support the differential diagnosis of CAS and dysarthria in clinical practice.

CONCLUSIONS

Incorporating this diagnostic protocol into clinical practice should help increase confidence and accuracy in diagnosing motor speech disorders in children. Future research should test the sensitivity and specificity of this protocol in a large sample of children with varying speech sound disorders. Graduate programs and continuing education trainings should provide opportunities to practice rating speech features for children with dysarthria and CAS.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19709146.

Oral and Laryngeal Diadochokinesis Across the Life Span: A Scoping Review of Methods, Reference Data, and Clinical Applications

PURPOSE

The aim of this study was to conduct a scoping review of research on oral and laryngeal diadochokinesis (DDK) in children and adults, either typically developing/developed or with a clinical diagnosis.

METHOD

Searches were conducted with PubMed/MEDLINE, Google Scholar, CINAHL, and legacy sources in retrieved articles. Search terms included the following: DDK, alternating motion rate, maximum repetition rate, sequential motion rate, and syllable repetition rate.

RESULTS

Three hundred sixty articles were retrieved and included in the review. Data source tables for children and adults list the number and ages of study participants, DDK task, and language(s) spoken. Cross-sectional data for typically developing children and typically developed adults are compiled for the monosyllables /pʌ/, /tʌ/, and /kʌ/; the trisyllable /pʌtʌkʌ/; and laryngeal DDK. In addition, DDK results are summarized for 26 disorders or conditions.

DISCUSSION

A growing number of multidisciplinary reports on DDK affirm its role in clinical practice and research across the world. Atypical DDK is not a well-defined singular entity but rather a label for a collection of disturbances associated with diverse etiologies, including motoric, structural, sensory, and cognitive. The clinical value of DDK can be optimized by consideration of task parameters, analysis method, and population of interest.

Speech Development Between 30 and 119 Months in Typical Children II: Articulation Rate Growth Curves

Purpose We aimed to develop normative growth curves for articulation rate during sentence repetition for typically developing children. Our primary goal was the development of quantile/percentile growth curves so that typical variation in articulation rate with age could be estimated. We also estimated when children became adultlike in their articulation rate, and we examined the contributions of age and utterance length to articulation rate. Method This cross-sectional study involved collection of in-person speech samples from 570 typically developing children (297 girls; 273 boys) who passed speech, language, and hearing screening measures. Pauses greater than 150 ms in duration were removed from the samples, and articulation rate was measured in syllables per second (sps). Results Articulation rate reliably increased with age and utterance length. Rate in all key percentiles increased with age. The median rate (50th percentile) increased from 2.7 sps at 36 months to 3.3 sps at 96 months. The 5th percentile increased from 2.3 to 3.1 sps over the same age range. Using 3.2 sps as a benchmark for adultlike speech, we found the 25th, 50th, and 75th percentiles reached adultlike rates at 99, 75, and 53 months, respectively. Conclusions Articulation rate increases from early childhood into middle childhood, and it is generally adultlike by 10 years of age. Variability in articulation rate among typical children was substantial. Implications for prior research and for clinical usage are discussed.

Intelligibility, Articulation Rate, Fluency, and Communicative Efficiency in Typically Developing Children

Purpose This article describes the developmental trajectories of four communication-related parameters (i.e., intelligibility, articulation rate, fluency, and communicative efficiency) in a cross-sectional study of typically developing children between 3 and 9 years. The four target parameters were related to auditory-perceptual parameters of speech function. Method One hundred forty-four typically developing children (ages 3;0-9;11 [years;months]; 72 girls and 72 boys) participated. Speech samples were collected using the materials of the Bogenhausen Dysarthria Scales for Childhood Dysarthria, a German assessment tool for childhood dysarthria, and analyzed following established auditory-perceptual criteria on relevant speech functions. To assess intelligibility, naïve listeners transcribed sentences repeated by the children. Articulation rate and fluency were measured by acoustic analyses; communicative efficiency was determined by multiplying the proportion of correctly transcribed syllables by speech rate. Results Intelligibility showed a steep developmental trajectory, with the majority of children obtaining a proportion of intelligible syllables close to 1.0 at the age of 5 years. Articulation rate demonstrated a flatter trajectory, with high variability still within the older children. Disfluencies, on the contrary, occurred only in the youngest children. By definition, communicative efficiency shared the characteristics of intelligibility and rate curves. A principal component analysis revealed, among other findings, strong connections between intelligibility and articulation, as well as between communicative efficiency, articulation, and rate measures. Conclusions While children speak intelligibly, in terms of the applied assessment, at a comparably young age, other communication-relevant parameters show a slower developmental progress. Knowledge on the typical development of communication-related parameters and on their complex relationships with functional speech variables is crucial for the clinical assessment of childhood dysarthria. Supplemental Material https://doi.org/10.23641/asha.14880285.

Reliability of Perceptual Judgments of Phonetic Accuracy and Hypernasality Among Speech-Language Pathologists for Children With Dysarthria

Purpose The objectives of this study were to: (a) compare interrater reliability of practicing speech-language pathologists' (SLPs) perceptual judgments of phonetic accuracy and hypernasality between children with dysarthria and those with typical development, and (b) to identify speech factors that influence reliability of these perceptual judgments for children with dysarthria. Method Ten SLPs provided ratings of speech samples from twenty 5-year-old children with dysarthria and twenty 5-year-old children with typical development on two tasks via a web-based platform: a hypernasality judgment task and a phonetic accuracy judgment task. Interrater reliability of SLPs' ratings on both tasks was compared between children with dysarthria and children with typical development. For children with dysarthria, four acoustic speech measures, intelligibility, and a measure of phonetic accuracy (percent stops correct) were examined as predictors of reliability of SLPs' perceptual judgments. Results Reliability of SLPs' phonetic accuracy judgments and hypernasality ratings was significantly lower for children with dysarthria than for children with typical development. Among children with dysarthria, interrater reliability of perceptual judgments ranged from strong to weak. Percent stops correct was the strongest predictor of interrater reliability for both phonetic accuracy judgments and hypernasality ratings. Conclusions Reliability of perceptual phonetic accuracy judgments and hypernasality ratings among practicing SLPs for children with dysarthria is reduced compared to ratings for children with typical development. Findings underscore the need for more reliable methods to assess phonetic accuracy and hypernasality for children with dysarthria.

Developmental Courses in Childhood Dysarthria: Longitudinal Analyses of Auditory-Perceptual Parameters

Purpose The aim of this longitudinal study was to describe developmental courses of childhood dysarthria against the background of typical speech motor development by collecting auditory-perceptual data. Method Fourteen children (four girls, 10 boys; 5;1-8;4 [years;months] at Time 1) with neurological conditions (CNC) and 14 typically developing children (CTD) matched for age and gender were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen-Kindliche Dysarthrien (BoDyS-KiD; in English: Bogenhausen Dysarthria Scales-Childhood Dysarthria), a German tool for the assessment of childhood dysarthria, and analyzed by means of nine perceptual scales covering all clinically relevant speech components. Age normalization was performed according to a method published recently. Data from the matched controls were used to estimate whether the gradients of the CNC group's developmental trajectories exceeded those of typical development. Results The children with neurological conditions presented heterogeneous speech profiles with a wide range of severity. At the group level, relatively stable trajectories of the age-normalized dysarthria total score were found over the observation period. The nine perceptual scales showed more or less parallel developments. All patients except two followed the growth curve describing the developmental course of the typically developing children. Conclusions Most children took advantage of the developmental dynamics as they developed parallel to the age norm. With its comprehensive description of the developmental courses of 14 children with neurological conditions, this study may contribute to a more valid, statistically verified clinical assessment of the course of childhood dysarthria.

Dysarthria syndromes in children with cerebral palsy

AIM

To investigate whether dysarthria syndromes acquired in adulthood can also be observed in children with cerebral palsy (CP) and, if so, whether they align with children's CP subtypes.

METHOD

Twenty-six children with CP participated (mean age 7y 8mo [SD 1y 2mo], 5y 1mo-9y 10mo; 16 males and 10 females). Speech samples were elicited in a computer-based game and were analysed using the auditory perceptual criteria of the Bogenhausen Dysarthria Scales (BoDyS). For statistical classification, three comparison groups of adults with standard dysarthria syndromes (i.e. spastic, hyperkinetic, and ataxic) were used. Their BoDyS data were entered into a mixture discriminant analysis, with data from the comparison groups as the training sample and those from the children with CP as the test sample. Results were related to findings in a group of adults with CP.

RESULTS

Among the children with CP, most had spastic (n=14), while fewer had ataxic (n=9) or hyperkinetic (n=3), dysarthria. However, syndrome allocations were significantly more ambiguous than in adults with CP. For 11 children, their dysarthria syndromes did not align with their CP subtype.

INTERPRETATION

Dysarthria syndromes are less clear cut in children than in adults with CP because of a number of developmental factors.

WHAT THIS PAPER ADDS

Children with cerebral palsy (CP) show diverse patterns of dysarthric symptoms. Dysarthria syndromes do not seem to manifest fully during childhood. Dysarthria syndrome and CP subtype may not align in children with CP.

Identifying Bilingual Children at Risk for Language Impairment: The Implication of Children's Response Speed in Narrative Contexts

The purpose of the study was to examine whether monolingual adults can identify the bilingual children with LI on the basis of children’s response speed to the examiner. Participants were 37 monolingual English-speaking young adults. Stimuli were 48 audio clips from six sequential bilingual children (48 months) who were predominately exposed to Cantonese (L1) at home from birth and started to learn English (L2) in preschool settings. The audio clips for each child were selected from an interactive story-retell task in both Cantonese and English. Three of the children were typically developing, and three were identified as having a language impairment. The monolingual adult participants were asked to judge children’s response times for each clip. Interrater reliability was high (Kalpha = 0.82 for L1; Kalpha = 0.75 for L2). Logistic regression and receiver operating characteristic curves were used to examine the diagnostic accuracy of the task. Results showed that monolingual participants were able to identify bilingual children with LI based on children’s response speed. Sensitivity and specificity were higher in Cantonese conditions compared to English conditions. The results added to the literature that children’s response speed can potentially be used, along with other measures, to identify bilingual children who are at risk for language impairment.