Poor Speech Perception Is Not a Core Deficit of Childhood Apraxia of Speech: Preliminary Findings

Preliminary Speech Perception Performance Profiles of School-Age Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development

PURPOSE

Limited research exists assessing speech perception in school-age children with speech sound disorder (SSD) and childhood apraxia of speech (CAS); despite early evidence that speech perception may lead to error-prone motor planning/programming. In this study, we examine speech perception performance in school-age children with and without speech production deficits.

METHOD

Speech perception was assessed using the Wide Range Acoustic Accuracy Scale to determine the just-noticeable difference in discrimination for three consonant-vowel syllable contrasts (/bɑ/-/wɑ/, /dɑ/-/gɑ/, /ɹɑ/-/wɑ/), each varying along a single acoustic parameter for seven children with CAS with rhotic errors, seven children with SSD with rhotic errors, and seven typically developing (TD) children.

RESULTS

Findings revealed statistically significant mean differences between perceptual performance of children with CAS when compared to TD children for discrimination of /ɹɑ/-/wɑ/ contrasts. Large effect sizes were also observed for comparisons of /ɹɑ/-/wɑ/ contrasts between children with CAS, SSD, and TD peers. Additionally, large effect sizes were observed for /dɑ/-/gɑ/ contrasts between children with CAS and SSD and TD children despite nonsignificant mean differences in group performance.

CONCLUSIONS

Overall, mean outcome scores suggest that school-age children with CAS and persistent rhotic errors demonstrated less accurate speech perception skills relative to TD children for the /ɹɑ/-/wɑ/ contrasts. However, the relatively small sample sizes per group limit the extent to which these findings may be generalized to the broader population.

Manual Rhythmic Sequencing Skills in Children With Childhood Apraxia of Speech

PURPOSE

Rhythm is one procedural mechanism that underlies language and motor skill acquisition and has been implicated in children with childhood apraxia of speech (CAS). The purpose of this study is to investigate manual rhythmic sequencing skills in children with a history of or current CAS (hx/CAS) compared to children with typical development (TD).

METHOD

Thirty-eight children (18 with hx/CAS, 20 with TD), ages 5;0-12;8 (years;months), from across the United States participated in an online study. Participants imitated two rhythms in two different conditions, clapping and tapping. We assessed overall accuracy, mean number of beats, pause marking, and rhythmic sequence variability using the Mann-Whitney U test. Effect sizes were calculated to examine the influence of coordinative complexity on performance.

RESULTS

Compared to children with TD, children with hx/CAS marked fewer trials with a pause in both conditions of the easier rhythm and showed lower overall accuracy and more variable rhythmic sequences in both rhythms and conditions. The mean number of beats produced by children with hx/CAS and children with TD did not differ in three out of four rhythms/conditions. Unlike children with TD, children with hx/CAS showed little improvement from clapping to tapping across most dependent measures; reducing coordination demands did not improve performance in children with hx/CAS.

CONCLUSIONS

We found that children with hx/CAS show manual rhythmic deficits that are similar to the deficits they display in speech. These findings provide support for a domain-general cognitive mechanisms account of the rhythmic deficits observed across linguistic and nonlinguistic tasks in children with hx/CAS.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24052821.

Lexical tone perception and production in Cantonese-speaking children with childhood apraxia of speech: a pilot study

Childhood apraxia of speech (CAS) is a paediatric motor speech disorder. We investigated the lexical tone perception and production abilities of children with CAS and the relationships between the two. Three children with CAS, aged between 3;7 and 5;8, were given the Cantonese Tone Identification Test (CANTIT) and the Hong Kong Cantonese Articulation Test (HKCAT) for assessment of tone perception and production, respectively. Accuracy and error patterns were investigated based on their performance on the two tests. Correlation analysis was performed on children's perception and production scores. Two children scored at the lowest rank on the CANTIT, while one child obtained a Z score of 0. All children scored three standard deviations below the mean on the HKCAT. No statistical differences were found among the six tones with respect to perception accuracy, H(5) = 3.731, p = 0.589. Error analysis showed that children with CAS demonstrated more confusion on perceiving tones compared with TD peers. There were no main effects for task (F(1,2) = 0.040, p = 0.859) or tone (F(5,10 = 0.997, p = 0.467); nor were there task or tone interaction effects on perception versus production accuracy (F(5,10) = 1.772, p = 0.206). Tone perception and production accuracy were not significantly correlated (r² = 0.181, p = 0.078). Tone perception deficits were evident in two out of three children with CAS, while all children had lexical tone production difficulties. In this small sample, tone production was more universally affected than tone perception.

Assessment and Diagnostic Standards of Apraxia of Speech in Chinese-Speaking Adults and Children: A Scoping Review

PURPOSE

Apraxia of speech (AOS) and childhood apraxia of speech (CAS) are motor-based speech disorders that have been well studied in Indo-European languages. There is limited understanding of these disorders in speakers of Sino-Tibetan languages, such as Chinese. The purpose of this study is to review methods used in research studies for the assessment and diagnosis of AOS and CAS in Chinese speakers.

METHOD

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Articles with a focus on AOS or CAS in Chinese speakers were systematically searched in seven English and six Chinese databases. Three reviewers performed independent screening, data extraction, and quality assessment after obtaining 100% agreement on the prescreening exercise. A qualitative analysis was conducted to rate the quality of diagnoses, ranging from high (Level I) to low (Level III), with Level IV assigned to studies for which the appropriate rating was unclear due to insufficient evidence.

RESULTS

Twenty-eight AOS articles and five CAS articles were identified. A variety of assessment and diagnostic methods were reported. No study of Chinese speakers with AOS or CAS received a rating of Level I. The highest level achieved was Level IIIa for both AOS and CAS studies.

CONCLUSIONS

There is no reliable and valid test or method for the diagnosis of AOS or CAS in Chinese speakers. The current gold standard of diagnosis is based upon expert perceptual judgment. Further single-language and cross-linguistic investigations of AOS and CAS and the future development of assessment and diagnostic methods are recommended.

Speech Perception Variability in Childhood Apraxia of Speech: Implications for Assessment and Intervention

PURPOSE

Beyond hallmark production deficits characterizing childhood apraxia of speech (CAS), largely attributed to disruption(s) in speech motor planning, children with CAS often present with co-occurring speech perception and language difficulties. Thus, careful consideration of the potential for speech perception difficulties to have cascading downstream effects on intervention responsiveness and real-life functioning for some children with CAS is highly important. The purpose of this tutorial was to consider the impact of speech perception abilities in children with CAS, which carries implications for caring for the needs of the whole child.

METHOD

This tutorial summarizes the current literature on speech perception and how it relates to speech production, language, and reading abilities for children with CAS. We include case illustrations that are adapted from real clinical scenarios illustrating how speech perception difficulties may impact some children with CAS and provide recommendations for incorporating speech perception into assessment and intervention practices.

RESULTS

Although speech perception difficulties do not seem to be a core deficit of CAS, they are strongly linked to language difficulties, which are highly prevalent among children with CAS. Speech perception and language difficulties are also associated with reading difficulties and risk for lower academic achievement.

CONCLUSIONS

Children with CAS who have co-occurring language difficulties likely also demonstrate speech perception deficits, which puts them at heightened risk for reading difficulties and struggles with academic achievement. Comprehensive assessment of children with CAS should address speech perception and production, language, and reading abilities, which carries important implications for multifaceted approaches to intervention.

Prologue to the Forum: Care of the Whole Child: Key Considerations When Working With Children With Childhood Apraxia of Speech

PURPOSE

This prologue introduces the LSHSS Forum: Care of the Whole Child: Key Considerations When Working With Children With Childhood Apraxia of Speech. The goals of the forum are to provide (a) an overview of several co-occurring conditions and challenges that may affect children in this population and (b) methods and materials to enhance diagnostic accuracy and treatment efficacy to help children with childhood apraxia of speech (CAS) to thrive.

METHOD

The prologue provides an overview of what it means to care for the whole child and introduces the five articles in the forum, including research and clinical focus articles as well as tutorials. Infographics, assessment templates, video examples, case studies, and treatment goals are included throughout the forum to promote translation from research to practice.

CONCLUSION

Children with CAS may experience a breadth of skills, challenges, and diagnoses. By learning (a) to identify possible co-occurring conditions, (b) when to make referrals, and (c) how to best accommodate and treat children when different conditions are present, speech-language pathologists can further increase the quality of care provided and ability to advocate for some of our most vulnerable clients and their families.

An Investigation of Developmental Coordination Disorder Characteristics in Children With Childhood Apraxia of Speech

PURPOSE

Children with childhood apraxia of speech (CAS) evidence a high rate of co-occurring fine and gross motor deficits. This clinical focus article reports a preliminary investigation of characteristics of developmental coordination disorder (DCD), a neurodevelopmental disorder categorized by poor motor proficiency and functional limitations, in this population.

METHOD

Children with CAS underwent a comprehensive motor evaluation using the Movement Assessment Battery for Children-Second Edition, the Developmental Coordination Disorder Questionnaire, and a developmental history questionnaire to determine if they met criteria for a DCD diagnosis as specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

RESULTS

Six out of seven participants met DCD criteria based on the DSM-5 criteria. Four of these children had a co-occurring diagnosis of developmental language disorder, and all met criteria for DCD.

CONCLUSIONS

Consistent with previous research, the majority of participants demonstrated motor deficits and 85% met criteria for DCD. Despite this high rate of motor deficits, only 57% had previously undergone a physical/occupational therapy evaluation and intervention and only one had a previous diagnosis of DCD. These findings suggest that formal movement assessments are essential for children with a CAS diagnosis.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20540193.

Reading Skills in Children With Suspected Childhood Apraxia of Speech and Children With Reading Disorders: Same or Different?

PURPOSE

The primary aim of this study was to compare decoding and literacy-related skills of children with suspected childhood apraxia of speech (sCAS) to children with reading disorders (RD) and no history of speech sound disorder (RD-no SSD) to determine if the groups differ in decoding and the endophenotypes that contribute to RD. We also explored the association between language impairment (LI) and decoding and literacy-related skills within the participant group with sCAS.

METHOD

Participants were school-age children and adolescents, 8-14 years of age, with a diagnosis of sCAS (n = 13) or RD-no SSD (n = 16). The sCAS and RD-no SSD groups were compared on measures of single-word decoding, oral language, motor-speech skills, phonological processing, and speech-in-noise perception, employing t tests and analysis of covariance. The sCAS + LI and sCAS-only groups were compared on similar measures using t tests.

RESULTS

Compared to the RD-no SSD group, the sCAS group performed significantly worse on measures of phonological processing, multisyllable word repetition, diadochokinetic rate, and speech-in-noise perception. The groups did not differ on measures of single-word decoding, with mean scores for both groups falling below average. All participants with sCAS + LI demonstrated deficits in literacy and literacy-related skills compared to a smaller percentage of the sCAS-only group.

CONCLUSIONS

Children with sCAS and children with RD-no SSD demonstrate similar impairments in literacy. However, the endophenotypes underlying these difficulties can differ between the groups. Deficits in skills needed for literacy may require specifically tailored interventions to address reading difficulties for children with sCAS, especially for those with comorbid LI.

Predicting Treatment Outcomes in Rapid Syllable Transition Treatment: An Individual Participant Data Meta-Analysis

PURPOSE

The purpose of this study is to identify predictors of treatment outcomes in Rapid Syllable Transition Treatment (ReST) for childhood apraxia of speech through an individual participant data meta-analysis.

METHOD

A systematic literature search identified nine ReST studies for inclusion. Individual participant data were obtained, and studies were coded for methodological design, baseline participant characteristics, service delivery factors, and treatment outcomes. Bivariate analyses were conducted to identify potential predictor variables. Multiple linear regressions were then performed to identify predictors of treatment outcomes.

RESULTS

Data for 36 participants from seven studies were included in the statistical analyses. In multivariate modeling, better performance on treated pseudowords posttreatment was predicted by higher baseline expressive language and Goldman-Fristoe Test of Articulation scores, lower speech inconsistency and percentage of vowels correct, and higher pretreatment accuracy on pseudoword targets. Better performance on untreated real words posttreatment was predicted by higher pretreatment accuracy on real words. Gains in performance and retention of gains were not significantly predicted by any individual variable or combination of variables.

CONCLUSIONS

Baseline speech and expressive language skills and accuracy on pseudowords and real words were significant predictors of absolute posttreatment performance. Regardless of baseline characteristics, all children were statistically as likely to achieve gains during ReST and retain these gains for up to 4 weeks posttreatment. Large-scale prospective research is required to further examine the effects of dose frequency and co-occurring language impairments on treatment outcomes and the complex co-effects of percentage of vowels correct with other potential predictors.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19611714.

Clinical Considerations for Speech Perception in School-Age Children With Speech Sound Disorders: A Review of the Current Literature

PURPOSE

The purpose of this study was to synthesize the methodological variability in the speech perception literature for school-age children with residual speech sound disorder (RSSD), with the primary intention of using the existing knowledge to inform clinical decisions and optimize treatment outcomes for children.

METHOD

Ten electronic databases were systematically searched to identify articles examining the speech perception skills of school-age children with RSSD. A total of 11 articles met inclusion criteria, reporting of methodological characteristics was rated and compared across studies, and findings were summarized.

RESULTS

The majority of studies reviewed here confirmed the presence of a perceptual deficit for a subset of children with RSSD. However, marked variability across study methodologies limits clinical interpretation and application of the findings.

CONCLUSIONS

Despite limited research in children with RSSD and wide variability across study procedures, stimulus type, perception type, and task type emerged as potential key factors that provide critical insight into a child's perceptual skill. The current evidence suggests that deficits in speech perception may significantly impact acquisition of accurate phoneme production for children with RSSD. Furthermore, these findings suggest that assessment and treatment of speech perception may be a critical component of an intervention program for school-age children, although further research is needed to determine effective clinical procedures.

Implementing Speech Perception and Phonological Awareness Intervention for Children With Speech Sound Disorders

PURPOSE

Children with speech sound disorders have more difficulties producing speech sounds accurately than same-age peers. In addition, they often have difficulties with speech perception, and weaker phonological awareness skills than their peers and are at risk for negative long-term academic and socio-emotional outcomes. In this tutorial, we describe ways in which clinicians can target speech perception and/or phonological awareness within the context of speech production practice.

METHOD

First, we briefly describe the speech perception and phonological awareness skills of children with speech sound disorders and summarize previous intervention studies that targeted speech production and speech perception and/or phonological awareness skills. Next, we demonstrate how clinicians may incorporate speech perception and phonological awareness intervention in speech therapy through example instructional objectives and activities and include a case study.

CONCLUSION

Incorporating speech perception and phonological awareness into speech production intervention may improve speech and literacy outcomes for children with speech sound disorders.

Speech feature profiles in Swedish 5-year-olds with speech sound disorder related to suspected childhood apraxia of speech or cleft palate

Purpose: To study the occurrence of speech features commonly associated with Childhood Apraxia of Speech (CAS) in Swedish children with suspected CAS (sCAS) or Speech Sound Disorder (SSD) related to Cleft Palate and/or Lip (CP ± L).Method: Thirty-four children (4.10-5.11) with SSD related to sCAS (n = 15) or repaired CP ± L (n = 19) participated. Consensus judgement of presence/absence of CAS features in single words were based on a checklist with operationalised definitions. Speech sound production measures were based on semi-narrow phonetic transcription. Intra- and inter-transcriber agreement was determined.Result: Twelve participants (ten with sCAS (67%) and two with CP ± L (11%)) shared a CAS profile of phonemic speech inconsistency for consonants and vowels and a set of four features: vowel error, voicing error, difficulty achieving initial articulatory configurations or transitionary movement gestures and stress errors. The most frequent speech difficulties in children with non-CAS CP ± L (n = 17) were consonant distortion (88%) and hypernasal resonance (76%). Prosodic impairment was rare.Conclusion: A distinct CAS speech feature profile was found for children with CAS, differing in number and distribution compared to children with CP ± L and SSD. CAS was found more frequently in CP ± L and SSD compared to reported estimates of clinical prevalence.

Retrospective Case-Control Study of Communication and Motor Abilities in 143 Children With Suspected Childhood Apraxia of Speech: Effect of Concomitant Diagnosis

Purpose

This study sought to determine if children with childhood apraxia of speech (CAS) plus another major diagnosis (CAS+) are equivalent in communication and motor profiles to those with a primary diagnosis of CAS and no indication or report of any other diagnosis (CAS-Primary).

Method

This retrospective case-control study included a chart review of 143 children who were suspected of having CAS at Children's Hospital-Wisconsin between 1998 and 2004. Participants were between 30 and 127 months old and included 107 males. Participants were assigned to the suspected CAS-Primary group (n = 114) if they had characteristics of CAS but no other major diagnosis (e.g., galactosemia) and to the CAS+ group (n = 29) if a comorbid diagnosis was present. Groups were compared across demographic, communication, and motor characteristics.

Results

Children with CAS+ evidenced more severe motor profiles than those with CAS-Primary, χ² = (1, n = 122) = 4.952, p = .026, and a small-to-medium effect size (Φ = .201). On average, communication profiles also tended to be more severe among those with CAS+ wherein receptive language was poorer and phonemic inventories were smaller than those with CAS-Primary.

Conclusions

These retrospective data suggest that comorbid diagnosis may play an important role in communication and motor development in children with suspected CAS. These exploratory findings should motivate future prospective studies that consider the role of concomitant diagnoses in symptom profile and response to treatment in children with CAS.

A Modeling-Guided Case Study of Disordered Speech in Minimally Verbal Children With Autism Spectrum Disorder

Purpose Understanding what limits speech development in minimally verbal (MV) children with autism spectrum disorder (ASD) is important for providing highly effective targeted therapies. This preliminary investigation explores the extent to which developmental speech deficits predicted by Directions Into Velocities of Articulators (DIVA), a computational model of speech production, exemplify real phenotypes. Method Implementing a motor speech disorder in DIVA predicted that speech would become highly variable within and between tokens, while implementing a motor speech plus an auditory processing disorder predicted that DIVA's speech would become highly centralized (schwa-like). Acoustic analyses of DIVA's output predicted that acoustically measured phoneme distortion would be similar between the two cases, but that in the former case, speech would show more within- and between-token variability than in the latter case. We tested these predictions quantitatively on the speech of children with MV ASD. In Study 1, we tested the qualitative predictions using perceptual analysis methods. Speech pathologists blinded to the purpose of the study tallied the signs of childhood apraxia of speech that appeared in the speech of 38 MV children with ASD. K-means clustering was used to create two clusters from the group of 38, and analysis of variance was used to determine whether the clusters differed according to perceptual features corresponding to within- and between-token variability. In Study 2, we employed acoustic analyses on the speech of the child from each cluster who produced the largest number of analyzable tokens to test the predictions of differences in within-token variability, between-token variability, and vowel space area. Results Clusters produced by k-means analysis differed by perceptual features that corresponded to within-token variability. Nonsignificant differences between clusters were found for features corresponding to between-token variability. Subsequent acoustic analyses of the selected cases revealed that the speech of the child from the high-variability cluster showed significantly more quantitative within- and between-token variability than the speech of the child from the low-variability cluster. The vowel space of the child from the low-variability cluster was more centralized than that of typical children and that of the child from the high-variability cluster. Conclusions Results provide preliminary evidence that subphenotypes of children with MV ASD may exist, characterized by (a) comorbid motor speech disorder and (b) comorbid motor speech plus auditory processing disorder. The results motivate testable predictions about how these comorbidities affect speech. Supplemental Material https://doi.org/10.23641/asha.14384432.

Procedural Learning, Grammar, and Motor Skills in Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typically Developing Speech

Purpose This case-control study sought to determine if (a) children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development would perform differently on a procedural learning assessment and (b) whether grammatical ability would impact group differences. Method Communication, motor, and procedural learning abilities were assessed in 48 children with CAS (n = 13), SSD (n = 20), and typical development (n = 15), between 43 and 97 months of age (M = 66 months, SD = 12 months). Results On average, children with CAS demonstrated grammatical and motor impairments and required an increased number of exposures to the visuospatial sequence to demonstrate procedural learning, compared to peers with SSD or typical development. A subset of children from each group demonstrated an unanticipated procedural learning pattern wherein they evidenced an uptick in reaction time during the second sequenced block. Children with CAS with this pattern still evidenced procedural learning gains by the fifth sequenced block. In contrast, children with SSD and typical development with this pattern showed poor procedural learning outcomes and were characterized by lower scores on language and motor assessments as well. Conclusions This research provides partial support for the procedural learning deficit hypothesis in children with CAS and for a subset of children with SSD as well. Future research should examine the role of a serial reaction time task in identifying children at risk of multisystem communication and motor deficits. Supplemental Material https://doi.org/10.23641/asha.14173532.

Sound discrimination and explicit mapping of sounds to meanings in preschoolers with and without developmental language disorder

PURPOSE

To investigate links between sound discrimination and explicit sound-meaning mapping by preschoolers with and without developmental language disorder (DLD).

METHOD

We tested 26 children with DLD and 26 age- and gender-matched peers with typical language development (TLD). Inclusion was determined via results of standardised assessments of language and cognitive skills and a hearing screening. Children completed two computerised tasks designed to assess pitch and duration discrimination and explicit mapping of pitch- and duration-contrasting sounds to objects.

RESULT

Children with TLD more successfully mapped pitch categories to meanings than children with DLD. Children with TLD also showed significantly better overall sound discrimination than children with DLD. Sound-discrimination scores were marginally associated with overall sound-meaning mapping in multivariate analyses of covariance (MANCOVAs). Correlation tests indicated significant associations between discrimination and mapping, with moderate to large effect sizes. Thus, significant sound-discrimination differences between the groups may contribute to differences in sound-meaning-mapping accuracy.

CONCLUSION

Children with DLD had more difficulty mapping sound categories to meanings than TLD peers. We discuss possible explanations for this finding and implications for theoretical accounts of the aetiology of DLD.

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.

Vowel Accuracy and Segmental Variability Differentiate Children With Developmental Language Disorder in Nonword Repetition

Purpose Poor nonword repetition accuracy is a hallmark of children with developmental language disorder (DLD). However, other diagnostic categories also show impaired nonword repetition performance relative to children with typical development (TD); therefore, this task is currently a sensitive but nonspecific index of DLD. In this study, we investigated segmental and kinematic aspects of nonword repetition performance to further specify the diagnostic utility of nonword repetition tasks (NRTs) in diagnosing DLD. Method Forty children, ages 48-86 months, participated, including children with DLD (n = 12), speech sound disorder (SSD; n = 14), and TD (n = 14). All children completed an assessment battery to determine group classification, a classic NRT (Dollaghan & Campbell, 1998), and an experimental NRT designed to measure segmental and articulatory (specifically lip aperture) variability. We assessed nonword repetition accuracy in the classic and experimental NRTs and segmental and kinematic variability in the experimental NRT. Results In both the classic and experimental NRTs, children with SSD and DLD produced nonwords with lower phoneme and consonant accuracy compared to children with TD. Children with DLD produced more vowel errors compared to children with TD in both tasks. In the experimental NRT, children with DLD produced nonwords with high levels of segmental variability compared to children with TD. Children with SSD did not differ from children with TD or children with DLD in the vowel accuracy or the segmental variability measures. The articulatory variability measure did not reveal any group differences. Conclusions In the presence of speech sound difficulties, low nonword repetition accuracy does not aid in the diagnosis of DLD. However, vowel accuracy and segmental variability appear specific to DLD status in NRTs.

Perception of Correctly and Incorrectly Produced Words in Children With and Without Phonological Speech Sound Disorders

Purpose The purpose of this study was to examine the perception of correctly and incorrectly produced words in children with and without phonological speech sound disorder (SSD) with similar vocabulary and language skills. Method Thirty-six monolingual English-speaking children aged 4 and 5 years, half with SSD and half with typical speech and language skills, participated in this study. Participants completed standardized speech and language tests as well as a mispronunciation detection task targeting omissions and substitutions of the phonemes /k, s, ɹ/ in five word positions/shapes. Results The children with SSD obtained significantly lower perceptual accuracy than the children with typical development. There was no statistically significant effect for phoneme. Omissions were more likely to be detected by both groups of participants compared with substitutions, and children with SSD had greater difficulty identifying substitutions as incorrectly produced words. Conclusions Speech perception difficulties may be a distinguishing feature of children with phonological SSD and without concomitant language difficulties. Further research is needed to investigate specific speech contexts in which perception predicts accurate production in children with SSD.

Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review

Purpose Despite having distinct etiologies, acquired apraxia of speech (AOS) and childhood apraxia of speech (CAS) share the same central diagnostic challenge (i.e., isolating markers specific to an impairment in speech motor planning/programming). The purpose of this review was to evaluate and compare the state of the evidence on approaches to differential diagnosis for AOS and CAS and to identify gaps in each literature that could provide directions for future research aimed to improve clinical diagnosis of these disorders. Method We conducted a scoping review of literature published between 1997 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. For both AOS and CAS, literature was charted and summarized around four main methodological approaches to diagnosis: speech symptoms, quantitative speech measures, impaired linguistic-motor processes, and neuroimaging. Results Results showed that similar methodological approaches have been used to study differential diagnosis of apraxia of speech in adults and children; however, the specific measures that have received the most research attention differ between AOS and CAS. Several promising candidate markers for AOS and CAS have been identified; however, few studies report metrics that can be used to assess their diagnostic accuracy. Conclusions Over the past two decades, there has been a proliferation of research identifying potential diagnostic markers of AOS and CAS. In order to improve clinical diagnosis of AOS and CAS, there is a need for studies testing the diagnostic accuracy of multiple candidate markers, better control over language impairment comorbidity, more inclusion of speech-disordered control groups, and an increased focus on translational work moving toward clinical implementation of promising measures.

Measuring Speech Perception Using the Wide-Range Acoustic Accuracy Scale: Preliminary Findings

Purpose

Speech perception requires individuals to hear and differentiate acoustic signals integral to effective communication. Measuring speech perception in children is challenging because speech perception methodology typically requires lengthy experiments that may fatigue children, resulting in limited knowledge of developmental perceptual skills. In this study, we used an adaptive tracking measure along with a wide range of acoustic stimuli to explore how adults, typically developing (TD) children, and children with speech sound disorder (SSD) perceive small acoustic differences in synthetic speech stimuli.

Method

Twenty-four adults, 15 TD children, and 15 children with SSD between the ages of 7;0–14;0 (years;months) were administered a newly developed perceptual assessment, the Wide-Range Acoustic Accuracy Scale, to determine the just-noticeable difference in discrimination for three separate syllable contrasts. Each syllable contrast varied along a single acoustic parameter: formant transition duration for /bɑ/–/wɑ/, F3 onset frequency for /dɑ/–/ɡɑ/, and F3–F2 distance for /rɑ/–/wɑ/.

Results

Findings revealed that adults and TD children did not differ in their discrimination of any syllable contrast, but adults significantly differed from SSD children on all syllable contrasts. TD children and children with SSD differed only on the /rɑ/–/wɑ/ contrast.

Conclusions

Children with SSD demonstrate less accurate and more variable perception skills relative to adults and TD children for /bɑ/–/wɑ/, /dɑ/–/ɡɑ/, and /rɑ/–/wɑ/ syllable contrasts. Clinical implications of the utility of the Wide-Range Acoustic Accuracy Scale are discussed.

Phonemic discrimination and reproduction in 4-5-year-old children: Relations to hearing

OBJECTIVE

The long-term objective of this research is to highlight the importance of speech perception assessment in children with developmental language disorder (DLD), and to investigate how hearing contributes to speech and language skills. As a first step in fulfilling this aim, the present study explored relations between phonemic discrimination and reproduction, and sensitive measures of hearing in young healthy children.

METHODS

The American Listen-Say test was developed and served as speech perception tool. This test reports speech discrimination of phonemic contrasts quantitatively for both quiet and in noise conditions, along with reproduction scores, all measured within one session. Speech tokens were perceptually homogenized in noise. Forty-one 4-5-year-old American children participated. Phonemic discrimination (quiet and speech shaped noise) and phonemic reproduction, audiometric thresholds in the conventional (1-8 kHz) and extended high frequency (EHF; 10-16 kHz) range, and distortion product otoacoustic emissions (DPOAEs) were examined.

RESULTS

All children had normal hearing thresholds within the conventional range (mean PTA bilaterally 8.6 dB HL). Ten (24.3%) of the children had elevated EHF thresholds (> 20 dB HL) for one or more frequencies or ears, and six (14.6%) had DPOAE signal to noise ratios (SNR) < 6 dB. EHF thresholds and DPOAE SNRs were significantly associated. Children's phonemic discrimination was impaired in noise, relative to quiet. There was a moderate, significant correlation between overall phonemic discrimination in noise and EHF audiometric thresholds.

CONCLUSIONS

Overall, the present study showed that sensitive hearing measures enabled the detection of subtle hearing difficulties in young healthy children. In particular, phonemic discrimination in noise showed associations with hearing. Implications of including sensitive hearing measures in children with DLD are discussed.

The Applicability of the Clinical Features of English Childhood Apraxia of Speech to Cantonese: A Modified Delphi Survey

Purpose Childhood apraxia of speech (CAS), a motor-based speech disorder, has been well studied in English contexts. However, there is a limited understanding of the applicability of its features to other languages. Thus, this study sought to determine the applicability of the features identified in the English CAS literature to Cantonese CAS. Method A two-round modified Delphi survey of experts was used to identify the clinical features of CAS in Cantonese speakers. Ten Cantonese-speaking qualified speech therapists were recruited as experts. In Round 1, the experts were asked an open-ended question about the clinical features of Cantonese CAS. In Round 2, the experts were asked to rate the importance of the proposed clinical features for making differential diagnoses of Cantonese CAS on a 5-point Likert scale ranging from 1 (very important) to 5 (not important at all). Results In Round 1, the expert panel identified 79 clinical features in nine domains. Sixty-two features (78.5%) were consistent with English CAS. Three English features were not identified in this study, while three features specifically related to Cantonese phonology were identified. In Round 2, 29 clinical features across six domains were found to meet the statistical criteria and were therefore regarded as important for making differential diagnoses of CAS among Cantonese speakers. Conclusions The results suggest that the clinical features identified in the English CAS literature are applicable to Cantonese CAS. The consistency of the findings implies that core and possible co-occurring features are shared between English and Cantonese CAS. The six features that were not common in both languages were discussed. Further investigation of CAS in and between different languages is recommended. This study is not the end point. Future studies can empirically examine the lexical tones or pitch variations to develop a possible objective measure for CAS.

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

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

A Survey of Clinicians With Specialization in Childhood Apraxia of Speech

Purpose Little is known about how clinicians develop expertise in childhood apraxia of speech (CAS), a rare speech disorder with heterogeneous presentation. The purpose of this survey study was to examine the beliefs and practices of clinicians specializing in CAS. Method Speech-language pathologists who self-identify as having expertise in CAS (n = 165) completed an online survey regarding influences on clinical practice and beliefs about CAS. Practice patterns and perspectives regarding CAS were analyzed for respondents who self-identify as having expertise in CAS, across 4 experience bands (1-5, 6-10, 11-15, and 15+ years). Results A majority of the respondents to this survey provide treatment to preschool-age children with CAS. Respondents report features used in differential diagnosis aligned with the American Speech-Language-Hearing Association's (2007) technical report, with inconsistency as a key feature. Results suggest that continuing education courses are highly influential in the perceived development of expertise and perspectives regarding CAS. Respondents expressed uncertainty about comorbidity of CAS with other communication disorders. Overall, beliefs and practices are relatively uniform across levels of clinical experience. Conclusions Practices and perspectives of clinicians who self-identify as having expertise with CAS are influenced by factors noted in previous literature. Results of this survey highlight the need for research on the development of expertise in the clinical management of CAS, updated consensus statements that reflect advances in current research, clarification regarding comorbidity of CAS with other communication disorders, and evaluation of continuing education opportunities. Supplemental Material https://doi.org/10.23641/asha.9755459.

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

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

Speech characteristics of childhood apraxia of speech: A survey research

PURPOSE

There has not been any valid method for the clinical diagnosis of Childhood Apraxia of Speech (CAS) up to now, and the golden standard for diagnosis is the expert's opinion. The current research was conducted to obtain criteria used by the Iranian Speech-Language Pathologists (SLPs) to establish speech characteristics and co-occurring problems of CAS based on their knowledge and clinical experience.

METHODS

This research used a questionnaire-based survey design for data collection. The questionnaire was filled out by 260 anonymous participants, both physically and online.

RESULTS

The nine top speech characteristics reported with 75.6% agreement as the core symptoms of CAS included: inconsistency (86.9%), consonant sequencing problems (75%), low intelligibility (75%), groping (72.7%), slow diadochokinetic (DDK) (72.3%), articulatory configuration problems (66.2%), difficulty with multisyllabic words (62.7%), suprasegmental disturbances (56.2%) and metathesis (53.5%). The consent of the Iranian practicing SLPs was consistent with the American Speech-Language-Hearing Association (ASHA) diagnostic criteria, Strand's 10-point checklist, and Ozanne's cluster model. More than half of the respondents have been identified with fine motor deficit and language impairment as the most common co-occurring problems of CAS.

CONCLUSIONS

The results of this study are in accordance with the findings of previous practicing SLPs' surveys in different languages. Carrying out researches on the speech characteristics of Persian-speaking children suspected of CAS and compare with the results of clinicians' surveys will help us to find a reliable standard for differential diagnosis of Persian-speaking children in Iran.

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.

Vowel Duration Discrimination of Children With Childhood Apraxia of Speech: A Preliminary Study

Purpose The ability of 5- and 6-year-old male children (23 participants) between the chronological ages of 5;0 and 6;11 (years;months) with childhood apraxia of speech (CAS; n = 9) and with typical development (TD; n = 14) to detect differences in vowel duration of syllable pairs is explored. We asked whether the children with CAS show different patterns of performance on the vowel duration difference experimental task than those of their similarly aged peers with TD. Method A male adult audio-recorded the syllable /bɑ/. The /ɑ/ was digitally lengthened and shortened, while maintaining uniform fundamental frequency and amplitude of the vowel and duration of the consonant /b/ at 42 ms. Vowel lengths increased in 40-ms increments, ranging from 208 to 488 ms. Eight pairs of syllables, 1 with equal length and 7 with differing vowel lengths, were randomly presented to the children 10 times in blocks of 16 pairs via a computer application. Results Numerous complementary analyses indicated patterns of performance differed for children with CAS compared to the children with TD. The children with CAS were notably less accurate in their duration discrimination and evidenced greater variability in their performances across duration difference conditions than their peers with TD, signifying they were generally challenged to discriminate the vowel duration differences. Conclusion These results suggest that CAS, which is more generally considered a motor speech disorder, may have a perceptual component of CAS related to vowel duration discrimination. Further research directions and clinical implications are discussed. Supplemental Material https://doi.org/10.23641/asha.8411876.

Emergence of an Action Repository as Part of a Biologically Inspired Model of Speech Processing: The Role of Somatosensory Information in Learning Phonetic-Phonological Sound Features

A comprehensive model of speech processing and speech learning has been established. The model comprises a mental lexicon, an action repository and an articulatory-acoustic module for executing motor plans and generating auditory and somatosensory feedback information (Kröger and Cao, 2015). In this study a “model language” based on three auditory and motor realizations of 70 monosyllabic words has been trained in order to simulate early phases of speech acquisition (babbling and imitation). We were able to show that (i) the emergence of phonetic-phonological features results from an increasing degree of ordering of syllable representations within the action repository and that (ii) this ordering or arrangement of syllables is mainly shaped by auditory information. Somatosensory information helps to increase the speed of learning. Especially consonantal features like place of articulation are learned earlier if auditory information is accompanied by somatosensory information. It can be concluded that somatosensory information as it is generated already during the babbling and the imitation phase of speech acquisition is very helpful especially for learning features like place of articulation. After learning is completed acoustic information together with semantic information is sufficient for determining the phonetic-phonological information from the speech signal. Moreover it is possible to learn phonetic-phonological features like place of articulation from auditory and semantic information only but not as fast as when somatosensory information is also available during the early stages of learning.

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

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