Subtyping Children With Speech Sound Disorders by Endophenotypes

Are Speech Sound Difficulties Risk Factors for Difficulties in Language and Reading Skills? A Systematic Review and Meta-Analysis

BACKGROUND

Children with speech sound difficulties often require educational psychology services, yet systematic reviews examining the association between these difficulties and language or reading problems are lacking. This meta-analysis examines whether these children are at higher risk of language and reading difficulties compared to their peers.

METHOD

The study analyzed 290 effect sizes from cross-sectional and longitudinal studies that compared language and reading skills between children with speech sound difficulties and controls. Additionally, we evaluated 37 effect sizes from correlational studies in general populations to examine the relationship between speech sound skills and language or reading skills.

RESULTS

Children with speech sound difficulties showed significant concurrent language (Hedges' g = -0.60) and reading (Hedges' g = -0.58) problems. Correlational studies also demonstrated a relationship between speech sound skills and language (r = .23) and reading (r = .23) skills. Phonological awareness and study quality were significant moderators. Longitudinal studies showed persistent or increasing group differences over time in language (Hedges' g = -0.85) and reading (Hedges' g = -0.50). These findings were consistent regardless of the severity or types of speech sound difficulties, nonverbal IQ, country, age, and publication year. However, a precision-effect test and the precision-effect estimate with standard errors analysis suggested a potential decrease in effect size due to publication bias from small sample sizes in primary studies.

CONCLUSION

Children with speech sound difficulties are at an increased risk of language and reading difficulties, emphasizing the need for broader language assessments and early interventions to mitigate future academic difficulties.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27849828.

Importance of copy number variants in childhood apraxia of speech and other speech sound disorders

Childhood apraxia of speech (CAS) is a severe and rare form of speech sound disorder (SSD). CAS is typically sporadic, but may segregate in families with broader speech and language deficits. We hypothesize that genetic changes may be involved in the etiology of CAS. We conduct whole-genome sequencing in 27 families with CAS, 101 individuals in all. We identify 17 genomic regions including 19 unique copy number variants (CNVs). Three variants are shared across families, but the rest are unique; three events are de novo. In four families, siblings with milder phenotypes co-inherited the same CNVs, demonstrating variable expressivity. We independently validate eight CNVs using microarray technology and find many of these CNVs are present in children with milder forms of SSD. Bioinformatic investigation reveal four CNVs with substantial functional consequences (cytobands 2q24.3, 6p12.3-6p12.2, 11q23.2-11q23.3, and 16p11.2). These discoveries show that CNVs are a heterogeneous, but prevalent, cause of CAS.

Whole Genome Analysis in Consanguineous Families Reveals New Loci for Speech Sound Disorder (SSD)

Speech is the most common means of communication in humans. Any defect in accurate speech production ability results in the development of speech sound disorder (SSD), a condition that can significantly impair an individual's academic performance, social interactions, and relationships with peers and adults. This study investigated the genetic basis of SSD in three Pakistani families. We performed family-based genome-wide parametric linkage analysis and homozygosity mapping in three consanguineous families with SSD from the Punjab province of Pakistan. The Test for Assessment of Articulation and Phonology in Urdu (TAAPU) was used to analyze the speech articulation data and determine the Percentage Correct Consonants (PCC) score. The PCC score defined the affected and unaffected individuals in each family. Parametric linkage analysis revealed a linkage to chromosome 5 (5q21.3-5q23.1) with a significant logarithm of the odds (LOD) score of 3.13 in a Pakistani family with specific language impairment-97 (PKSLI-97) under an autosomal recessive mode of inheritance. The other two families showed a suggestive linkage at 6p22.1, 14q12, and 16q12.1 under the recessive mode of inheritance. Interestingly, homozygosity mapping showed a loss of heterozygosity in the linkage region at 5q15-5q23.1, shared among seven affected (mostly in the younger generation) and one unaffected individual of PKSLI-97. Our analysis identified the 6p22 locus previously implicated in dyslexia, childhood apraxia of speech (CAS), and language impairment, confirming the role of KIAA0319 and DCDC2 in this locus. These findings provide statistical evidence for the genomic regions associated with articulation disorder and offer future opportunities to further the role of genes in speech production.

Improving Text-Independent Forced Alignment to Support Speech-Language Pathologists with Phonetic Transcription

Problem: Phonetic transcription is crucial in diagnosing speech sound disorders (SSDs) but is susceptible to transcriber experience and perceptual bias. Current forced alignment (FA) tools, which annotate audio files to determine spoken content and its placement, often require manual transcription, limiting their effectiveness. Method: We introduce a novel, text-independent forced alignment model that autonomously recognises individual phonemes and their boundaries, addressing these limitations. Our approach leverages an advanced, pre-trained wav2vec 2.0 model to segment speech into tokens and recognise them automatically. To accurately identify phoneme boundaries, we utilise an unsupervised segmentation tool, UnsupSeg. Labelling of segments employs nearest-neighbour classification with wav2vec 2.0 labels, before connectionist temporal classification (CTC) collapse, determining class labels based on maximum overlap. Additional post-processing, including overfitting cleaning and voice activity detection, is implemented to enhance segmentation. Results: We benchmarked our model against existing methods using the TIMIT dataset for normal speakers and, for the first time, evaluated its performance on the TORGO dataset containing SSD speakers. Our model demonstrated competitive performance, achieving a harmonic mean score of 76.88% on TIMIT and 70.31% on TORGO. Implications: This research presents a significant advancement in the assessment and diagnosis of SSDs, offering a more objective and less biased approach than traditional methods. Our model's effectiveness, particularly with SSD speakers, opens new avenues for research and clinical application in speech pathology.

Comorbidity and Severity in Childhood Apraxia of Speech: A Retrospective Chart Review

PURPOSE

The purpose of this study was to investigate comorbidity prevalence and patterns in childhood apraxia of speech (CAS) and their relationship to severity.

METHOD

In this retroactive cross-sectional study, medical records for 375 children with CAS (M age = 4;9 [years;months], SD = 2;9) were examined for comorbid conditions. The total number of comorbid conditions and the number of communication-related comorbidities were regressed on CAS severity as rated by speech-language pathologists during diagnosis. The relationship between CAS severity and the presence of four common comorbid conditions was also examined using ordinal or multinomial regressions.

RESULTS

Overall, 83 children were classified with mild CAS; 35, with moderate CAS; and 257, with severe CAS. Only one child had no comorbidities. The average number of comorbid conditions was 8.4 (SD = 3.4), and the average number of communication-related comorbidities was 5.6 (SD = 2.2). Over 95% of children had comorbid expressive language impairment. Children with comorbid intellectual disability (78.1%), receptive language impairment (72.5%), and nonspeech apraxia (37.3%; including limb, nonspeech oromotor, and oculomotor apraxia) were significantly more likely to have severe CAS than children without these comorbidities. However, children with comorbid autism spectrum disorder (33.6%) were no more likely to have severe CAS than children without autism.

CONCLUSIONS

Comorbidity appears to be the rule, rather than the exception, for children with CAS. Comorbid intellectual disability, receptive language impairment, and nonspeech apraxia confer additional risk for more severe forms of CAS. Findings are limited by being from a convenience sample of participants but inform future models of comorbidity.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22096622.

Relationship among Connectivity of the Frontal Aslant Tract, Executive Functions, and Speech and Language Impairment in Children with Childhood Apraxia of Speech

Childhood apraxia of speech (CAS) is a subtype of motor speech disorder usually co-occurring with language impairment. A supramodal processing difficulty, involving executive functions (EFs), might contribute to the cognitive endophenotypes and behavioral manifestations. The present study aimed to profile the EFs in CAS, investigating the relationship between EFs, speech and language severity, and the connectivity of the frontal aslant tract (FAT), a white matter tract involved in both speech and EFs. A total of 30 preschool children with CAS underwent speech, language, and EF assessments and brain MRIs. Their FAT connectivity metrics were compared to those of 30 children without other neurodevelopmental disorders (NoNDs), who also underwent brain MRIs. Alterations in some basic EF components were found. Inhibition and working memory correlated with speech and language severity. Compared to NoND children, a weak, significant reduction in fractional anisotropy (FA) in the left presupplementary motor area (preSMA) FAT component was found. Only speech severity correlated and predicted FA values along with the FAT in both of its components, and visual-spatial working memory moderated the relationship between speech severity and FA in the left SMA. Our study supports the conceptualization of a composite and complex picture of CAS, not limited to the speech core deficit, but also involving high-order cognitive skills.

Working memory span and receptive vocabulary assessment in Urdu speaking children with speech sound disorder

Emerging evidence suggests that impaired speech may be related to reduced working memory (WM). The current study aimed to validate and compare the influence of articulation, short-term memory (STM), WM, and receptive vocabulary abilities of Pakistani children with speech sound disorder (SSD; N = 50) versus typically developing (TD; N = 30) children aged 7-13 years. Assessments included the Test for Assessment of Articulation and Phonology in Urdu (TAAPU), Peabody Picture Vocabulary Test-4, translated to Urdu (U-PPVT-4), and Digit Memory Test (DMT) used to determine speech articulation, receptive vocabulary, and memory abilities respectively. The percentage correct consonants (PCC) score was used to divide the SSD group further into SSD severity groups. The TD and SSD groups significantly differed in performance on all tasks (p < 0.05). Moreover, the SSD severity groups showed significant differences (p < 0.0001) in performance on different components of TAAPU (total errors and substitution errors) and DMT tasks. However, the SSD severity groups did not show significant differences in performance on the U-PPVT-4. Correlational analyses indicate statistically significant correlations of PCC with STM, WM, and receptive vocabulary. Regression analyses suggested that both WM and STM contribute to speech intelligibility in children with SSD. Our findings in Urdu-speaking children support previous results in English-speaking children suggesting the articulation skills, receptive vocabulary, STM, and WM were less developed in children with SSD than in TD children.

The impact of articulatory consciousness training on reading and spelling literacy in students with severe dyslexia: an experimental single case study

This study evaluates the effect of an intervention whose aim is to make articulatory consciousness a tool in decoding and spelling. The sample comprises 11 students with severe dyslexia (2 SD below the mean pseudoword scores), and the intervention programme consists of 32 individual sessions over 8 weeks. The study applies a multiple baseline/probe design with five baseline tests that correspond to a control condition, eight tests during the intervention and five post-intervention tests. On average, the results show significant improvement in all reading and spelling outcomes. However, there were also significant effects on an irrelevant control task (the pegboard test), perhaps indicating testing effects on the dependent variables, making it difficult to draw firm conclusions from the study. Consequently, testing the intervention in randomised trials of children with severe dyslexia is recommended to draw more firm conclusions about its efficacy for this group.

Identification of Phonology-Related Genes and Functional Characterization of Broca's and Wernicke's Regions in Language and Learning Disorders

Impaired phonological processing is a leading symptom of multifactorial language and learning disorders suggesting a common biological basis. Here we evaluated studies of dyslexia, dyscalculia, specific language impairment (SLI), and the logopenic variant of primary progressive aphasia (lvPPA) seeking for shared risk genes in Broca's and Wernicke's regions, being key for phonological processing within the complex language network. The identified "phonology-related genes" from literature were functionally characterized using Atlas-based expression mapping (JuGEx) and gene set enrichment. Out of 643 publications from the last decade until now, we extracted 21 candidate genes of which 13 overlapped with dyslexia and SLI, six with dyslexia and dyscalculia, and two with dyslexia, dyscalculia, and SLI. No overlap was observed between the childhood disorders and the late-onset lvPPA often showing symptoms of learning disorders earlier in life. Multiple genes were enriched in Gene Ontology terms of the topics learning (CNTNAP2, CYFIP1, DCDC2, DNAAF4, FOXP2) and neuronal development (CCDC136, CNTNAP2, CYFIP1, DCDC2, KIAA0319, RBFOX2, ROBO1). Twelve genes showed above-average expression across both regions indicating moderate-to-high gene activity in the investigated cortical part of the language network. Of these, three genes were differentially expressed suggesting potential regional specializations: ATP2C2 was upregulated in Broca's region, while DNAAF4 and FOXP2 were upregulated in Wernicke's region. ATP2C2 encodes a magnesium-dependent calcium transporter which fits with reports about disturbed calcium and magnesium levels for dyslexia and other communication disorders. DNAAF4 (formerly known as DYX1C1) is involved in neuronal migration supporting the hypothesis of disturbed migration in dyslexia. FOXP2 is a transcription factor that regulates a number of genes involved in development of speech and language. Overall, our interdisciplinary and multi-tiered approach provided evidence that genetic and transcriptional variation of ATP2C2, DNAAF4, and FOXP2 may play a role in physiological and pathological aspects of phonological processing.

A preliminary validation of a dynamic speech motor assessment for Swedish-speaking children with childhood apraxia of speech

OBJECTIVE

Children with speech sound disorders (SSDs) have difficulties affecting different levels of speech production. For treatment to be beneficial, it is important to differentiate between Childhood Apraxia of Speech (CAS) - a motor speech disorder with deficits in speech praxis - and other SSDs (nonCAS-SSD). We have previously developed a motor speech examination Dynamisk motorisk talbedömning (DYMTA). We aimed to evaluate DYMTAs reliability and validity in a small-scale sample to estimate DYMTAs usability in diagnostic settings.

METHODS

Speech, language, and oral motor abilities were assessed in 45 children between 40 and 106 months. Intra- and inter-rater reliability of DYMTA were analyzed. Further, DYMTAs ability to validly discriminate between children with CAS and nonCAS-SSD was assessed.

RESULTS

The intra-rater reliability for the scores of DYMTA was strong, with ICCs ranging from 0.97 to 1.0. DYMTA total score had strong inter-rater reliability as evidenced both by the agreement estimates (DYMTA-A: 0.91 and DYMTA-B: 0.87) and the ICCs (0.97 and 0.96). Inter-rater reliability was also strong for the separate subscores on agreement estimates and for all subscores on ICCs, except for the Prosody subscores. DYMTA accurately discriminated between children with CAS and nonCAS-SSD in this small sample with an AUC of 0.92 for DYMTA-A and 0.94 for DYMTA-B.

CONCLUSIONS

With its focus on speech movements, DYMTA could serve as a valuable addition to other tests when assessing children's speech motor performance. This first examination suggests that DYMTA may be both a reliable and valid tool in the diagnostic process of SSD.

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

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

Associations Between Speech Perception, Vocabulary, and Phonological Awareness Skill in School-Aged Children With Speech Sound Disorders

Purpose Prior studies report conflicting descriptions of the relationships between phonological awareness (PA), vocabulary, and speech perception in preschoolers with speech disorders. This study sought to determine the nature of these relationships in a sample of school-aged children with residual speech sound errors affecting /ɹ/. Method Participants included 110 children aged 7;0-17;4 (years;months) with residual errors impacting /ɹ/. Data on perceptual acuity and perceptual bias in an /ɹ/ identification task, receptive vocabulary, and PA were obtained. A theoretically and empirically motivated path model was constructed with vocabulary mediating the relationship between two measures of speech perception and PA. Model parameters were determined through maximum likelihood estimation with standard errors that were robust to nonnormality. Monte Carlo simulation was used to examine achieved power at the current sample size. Results The saturated path model explained 19% of the variance in PA. The direct path between age-adjusted perceptual acuity and PA was significant, as was the direct path between vocabulary and PA. Contrary to our hypothesis, there was no evidence in the current sample that vocabulary skill mediated the relationship between speech perception and PA. Each individual path was adequately powered at the current sample size. Conclusions The overall model provided evidence for a continued relationship between speech perception, measured by perceptual acuity of the sound in error, and PA in school-aged children with residual speech errors. Thus, measures of speech perception remain relevant to the assessment of school-aged children and adolescents in this population. Supplemental Material https://doi.org/10.23641/asha.13641275.

Feature-driven classification reveals potential comorbid subtypes within childhood apraxia of speech

Background

Childhood apraxia of speech (CAS) is a neurodevelopmental disorder with heterogeneous communication and other comorbid manifestations. While previous studies have characterized speech deficits associated with CAS, few studies have examined variability in reading and language and/or other developmental comorbidities. We sought to identify comorbid subgroups within CAS that could be clinically relevant as well as genetically distinctive.

Methods

In a group of 31 children with CAS and 8 controls, we performed hierarchical cluster analysis utilizing measures of articulation, vocabulary, and reading. We also conducted a chart review of the children with CAS to examine other clinical characteristics in these children and their association with subgroup membership.

Results

We identified 3 comorbid subgroups within CAS of varying severity. The high severity subgroup was characterized by poor reading and vocabulary, and the moderate severity subgroup by poor reading and non-word repetition but average vocabulary, compared to the mild severity subgroup. Subgroups were indistinguishable with respect to speech sound production, the hallmark of CAS, all demonstrating poor articulation. Children in the most severe subgroup were more likely to have early problems feeding (p = 0.036).

Conclusions

Children with CAS may potentially be classified into comorbidity groups based on performance on vocabulary and reading measures, providing additional insight into the heterogeneity within CAS with implications for educational interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-020-02421-1.

Identification of the factors associated with the severity of the speech production problems in children with comorbid speech sound disorder and developmental language disorder

It has been suggested that factors such as auditory perception, oral motor skills, phonological awareness, and working memory are all associated with speech production problems in children with speech sound disorder (SSD) and developmental language disorder (DLD). However, it remains unclear whether the severity of the speech production problems in these children can be explained by an interaction among the aforementioned factors. The aim of this study was to determine which of these four factors best explain the severity of the speech production problems in children with SSD and DLD and whether an interaction between factors occurs. Forty-one children with SSD and DLD between 5 and 5;11 years old were selected. The number of phonological process errors was used as a measure of the severity of the speech production problems. The association between the number of phonological process errors and performance in auditory perception, oral motor skills, phonological awareness, and working memory along with the severity of the DLD was explored using univariate and multivariate regression models (with and without an interaction term). The results showed that the number of phonological process errors was largely explained by working memory and phonological awareness. An interaction between these two factors was also found. This means that working memory and phonological awareness interact to have an effect on the number of phonological process errors that is more than the sum of their parts. In addition, the severity of the DLD was significantly associated with the number of phonological process errors. These findings suggest that phonological awareness and working memory should be considered when assessing and treating children with comorbid SSD and DLD.

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.

Speech profiles of Spanish-Catalan children with developmental language disorder

Children with developmental language disorders (DLD) are especially characterised by morphosyntactic difficulties. Nevertheless, previous studies have also shown that children with DLD have phonological difficulties. This paper aims to describe the productive and perceptive phonological speech profile of Spanish-Catalan children with DLD at the age of six in order to characterise the underlying nature of their difficulties. Fourteen Spanish-Catalan six-year-old children with DLD and 14 control children without language difficulties who attended the same class were assessed with the screening and discrimination tasks of the A-RE-HA: Análisis del Retraso del Habla (Speech Delay Analysis - Catalan and Spanish version). We analysed the production of words, syllables and phonemes, phoneme discrimination and phonological simplification processes used by these children. The results showed that children with DLD have a lower percentile in correct word structures, syllabic structures and phonemes, and have more difficulty discriminating phonemes. Detailed analyses revealed more difficulties with the most complex word and syllabic templates, and with almost all phonemes. Furthermore, children with DLD applied more phonological simplification processes than the control group. An individual analysis showed that only ten of the children with DLD also had a speech delay (percentile < 25), while four had scores in line with their age. These results show that most of the six-year-old children with DLD maintain speech difficulties, which are mainly phonological and not (or not only) articulatory. Therefore, individual differences with respect to speech delay in DLD must be taken into consideration to better detect these children.

Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay

The goal of this research was to obtain initial estimates of the prevalence of each of four types of motor speech disorders in children with idiopathic Speech Delay (SD) and to use findings to estimate the population-based prevalence of each disorder. Analyses were completed on audio-recorded conversational speech samples from 415 children recruited for research in idiopathic SD in six USA cities during the past three decades. The speech and motor speech status of each participant was cross-classified using standardized measures in the finalized version of the Speech Disorders Classification System described in the Supplement. Population-based prevalence estimates for the four motor speech disorders were calculated from epidemiological studies of SD conducted in Australia, England, and the USA. A total of 82.2% of the 415 participants with SD met criteria for No Motor Speech Disorder at assessment, 12% met criteria for Speech Motor Delay, 3.4% met criteria for Childhood Dysarthria, 2.4% met criteria for Childhood Apraxia of Speech, and 0% met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech. The estimated population-based prevalence of each of the first three motor speech disorders at 4 to 8 years of age were Speech Motor Delay: 4 children per 1,000; Childhood Dysarthria: 1 child per 1,000; and Childhood Apraxia of Speech: 1 child per 1,000. The latter finding cross-validates a prior prevalence estimate for Childhood Apraxia of Speech of 1-2 children per 1,000. Findings are interpreted to indicate a substantial prevalence of motor speech disorders in children with idiopathic SD. Abbreviations: CAS, childhood apraxia of speech; CD, childhood dysarthria; CND, complex neurodevelopmental disorders; DI, dysarthria index; DSI, dysarthria subtype indices; MSD, motor speech disorder; No MSD, no motor speech disorder; NSA, normal(ized) speech acquisition; PEPPER, programs to examine phonetic and phonologic evaluation records; PM, pause marker; PMI, pause marker index; PSD, persistent speech delay; PSE, persistent speech errors; SD, speech delay; SDCS, speech disorders classification system; SDCSS, speech disorders classification system summary; SE, speech errors; SMD, speech motor delay.

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

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

Working memory span in Persian-speaking children with speech sound disorders and normal speech development

OBJECTIVES

The aim of this study was to compare working memory span in Persian-speaking preschool children with speech sound disorder (SSD) and their typically speaking peers. Additionally, the study aimed to examine Non-Word Repetition (NWR), Forward Digit Span (FDS) and Backward Digit Span (BDS) in four groups of children with varying severity levels of SSD.

METHODS

The participants in this study comprised 35 children with SSD and 35 typically developing (TD) children -matched for age and sex-as a control group. The participants were between the age range of 48 and 72 months. Two components of working memory including phonological loop and central executive were compared between two groups. We used two tasks (NWR and FDS) to assess phonological loop component, and one task (BDS) to assess central executive component. Percentage of correct consonants (PCC) was used to calculate the severity of SSD.

RESULTS

Significant differences were observed between the two groups in all tasks that assess working memory (p < 0.001). In addition, the comparison of the phonological loop of working memory between the various severity groups indicated significant differences between different severities of both NWR and FDS tasks among the SSD children (p < 0.001). Nevertheless, comparison of the central executive between various severity groups, which was assessed with the BDS task, did not show any significant differences (p > 0.05). The result showed that PCC scores in TD children were associated with NWR (p < 0.001), FDS (p = 0.001), and BDS (p < 0.001). Furthermore, PCC scores in SSD children were associated with NWR and FDS (p < 0.001), but not with BDS (p > 0.05).

CONCLUSION

The working memory skills were weaker in SSD children, in comparison to TD children. In addition, children with varying levels of severity of SSD differed in terms of NWR and FSD, but not BDS.

A Diagnostic Marker to Discriminate Childhood Apraxia of Speech From Speech Delay: I. Development and Description of the Pause Marker

Purpose

The goal of this article (PM I) is to describe the rationale for and development of the Pause Marker (PM), a single-sign diagnostic marker proposed to discriminate early or persistent childhood apraxia of speech from speech delay.

Method

The authors describe and prioritize 7 criteria with which to evaluate the research and clinical utility of a diagnostic marker for childhood apraxia of speech, including evaluation of the present proposal. An overview is given of the Speech Disorders Classification System, including extensions completed in the same approximately 3-year period in which the PM was developed.

Results

The finalized Speech Disorders Classification System includes a nosology and cross-classification procedures for childhood and persistent speech disorders and motor speech disorders (Shriberg, Strand, & Mabie, 2017). A PM is developed that provides procedural and scoring information, and citations to papers and technical reports that include audio exemplars of the PM and reference data used to standardize PM scores are provided.

Conclusions

The PM described here is an acoustic-aided perceptual sign that quantifies one aspect of speech precision in the linguistic domain of phrasing. This diagnostic marker can be used to discriminate early or persistent childhood apraxia of speech from speech delay.

Sensibilidade e especificidade da Porcentagem de Consoantes Corretas Revisada na identificação do transtorno fonológico

RESUMO Objetivo Verificar a sensibilidade, especificidade e estabelecer pontos de corte para o índice Porcentagem de Consoantes Corretas Revisado (PCC-R) em crianças com e sem transtorno fonológico falantes do Português Brasileiro. Método Participaram 72 crianças com idade entre 5:00 e 7:11 anos, sendo 36 sem queixas de alteração de fala e linguagem e 36 crianças com diagnóstico fonoaudiológico de transtorno fonológico. O índice de gravidade PCC-R foi aplicado nas provas de nomeação de figuras e de imitação de palavras do Teste de Linguagem Infantil ABFW. Os resultados foram analisados estatisticamente. Foi realizada a curva Roc e obtidos os valores de sensibilidade e especificidade do índice. Resultados O grupo de crianças sem transtorno fonológico apresentou valores do PCC-R maiores nas duas provas, independentemente do gênero dos participantes. O valor de corte na prova de nomeação de figuras foi de 93,4%, com sensibilidade de 0,89 e especificidade de 0,94, independentemente da idade. Já na prova de imitação de palavras, os valores obtidos variaram de acordo com a idade. Para a faixa etária ≤6:5 anos, o valor de corte foi de 91,0%, com sensibilidade de 0,77 e especificidade de 0,94. Para a faixa etária >6:5 anos, o valor de corte foi de 93,9%, com sensibilidade de 0,93 e especificidade de 0,94. Conclusão Dada a alta sensibilidade e especificidade do PCC-R, o índice foi efetivo na discriminação e identificação de crianças com e sem transtorno fonológico.

Nexus to Lexis: Phonological Disorders in Children

Research on phonological disorders in children has conventionally emphasized the speech sound in search of causes, diagnoses, treatments, and prevention of the disorder. This article aims to shift the research focus to the word instead. The motivation comes from advances in psycholinguistics that demonstrate the word is central to the perception, production, and acquisition of phonological information. Three strands of potential study are outlined in evaluation of how words might initiate and boost, but perhaps also, interrupt learning for children with phonological disorders.

An exploration of the role of executive functions in preschoolers' phonological development

There is limited yet compelling evidence that domain-general processes may contribute to speech sound change. This study explored whether executive functions contribute to the achievement of adult-like speech production. Children who are 4 to 5 years old, 42 with high-average speech production skills, 11 with low-average and nine with speech sound disorder (SSD), participated in a battery of executive function and speech production tasks. Performance accuracy was compared across groups and also correlated with speech sound accuracy from a single-word naming task. Children with SSD demonstrated poorer performance than other groups on forward digit span, whereas children with low-average speech skills underperformed their peers on the Flexible Item Selection Task (FIST). These preliminary results suggest that children with speech errors may have less mature working memory than peers who have mastered phonological targets earlier in development.

When Is EEG Indicated in Attention-Deficit/Hyperactivity Disorder?

The authors investigated the parameters for predicting epileptiform abnormalities in a group of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 148 subjects aged between 6 and 13 (8.76 ± 1.26; 25.7% female) years. Subtypes of ADHD and comorbid psychiatric disorders were defined according to DSM-IV criteria. The Wechsler Intelligence Scale for Children-Revised was applied to all patients. Most of the subjects (89.2%) had wakefulness and sleep electroencephalography examinations lasting about one hour. The authors found out that the coexistence of speech sound disorder (odds ratio [OR] 3.90, 95% confidence interval [CI]: 1.61-9.48) and higher Digit Span test performance (OR 1.24, 95% CI: 1.06-1.44) predicted the presence of accompanying epileptiform abnormalities. The prevalence of epileptiform abnormalities was 26.4%, and they were frequently localized in the frontal (41%) and centrotemporal (28.2%) regions. Higher percentage of speech sound disorder co-occurrence (64%) in subjects with rolandic spikes suggests that epileptiform abnormalities associated with ADHD can be determined genetically at least in some cases. Pathophysiology of epileptiform abnormalities in ADHD might have complex genetic and maturational background.

Differential diagnosis of children with suspected childhood apraxia of speech

PURPOSE

The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differentiate CAS from other speech disorders.

METHOD

Seventy-two children (4-12 years of age) diagnosed with suspected CAS by community speech-language pathologists were screened. Forty-seven participants underwent diagnostic assessment including presence or absence of perceptual CAS features. Twenty-eight children met two sets of diagnostic criteria for CAS (American Speech-Language-Hearing Association, 2007b; Shriberg, Potter, & Strand, 2009); another 4 met the CAS criteria with comorbidity. Fifteen were categorized as non-CAS with phonological impairment, submucous cleft, or dysarthria. Following this, 24 different measures from the diagnostic assessment were rated by blinded raters. Multivariate discriminant function analysis was used to identify the combination of measures that best predicted expert diagnoses.

RESULTS

The discriminant function analysis model, including syllable segregation, lexical stress matches, percentage phonemes correct from a polysyllabic picture-naming task, and articulatory accuracy on repetition of /pətəkə/, reached 91% diagnostic accuracy against expert diagnosis.

CONCLUSIONS

Polysyllabic production accuracy and an oral motor examination that includes diadochokinesis may be sufficient to reliably identify CAS and rule out structural abnormality or dysarthria. Testing with a larger unselected sample is required.

Speech Abilities in Preschool Children With Speech Sound Disorder With and Without Co-Occurring Language Impairment

Purpose

The authors compared preschool children with co-occurring speech sound disorder (SSD) and language impairment (LI) to children with SSD only in their numbers and types of speech sound errors.

Method

In this post hoc quasi-experimental study, independent samples t tests were used to compare the groups in the standard score from different tests of articulation/phonology, percent consonants correct, and the number of omission, substitution, distortion, typical, and atypical error patterns used in the production of different wordlists that had similar levels of phonetic and structural complexity.

Results

In comparison with children with SSD only, children with SSD and LI used similar numbers but different types of errors, including more omission patterns ( p < .001, d = 1.55) and fewer distortion patterns ( p = .022, d = 1.03). There were no significant differences in substitution, typical, and atypical error pattern use.

Conclusions

Frequent omission error pattern use may reflect a more compromised linguistic system characterized by absent phonological representations for target sounds (see Shriberg et al., 2005). Research is required to examine the diagnostic potential of early frequent omission error pattern use in predicting later diagnoses of co-occurring SSD and LI and/or reading problems.

Reading skills of students with speech sound disorders at three stages of literacy development

PURPOSE

The relationship between phonological awareness, overall language, vocabulary, and nonlinguistic cognitive skills to decoding and reading comprehension was examined for students at 3 stages of literacy development (i.e., early elementary school, middle school, and high school). Students with histories of speech sound disorders (SSD) with and without language impairment (LI) were compared to students without histories of SSD or LI (typical language; TL).

METHOD

In a cross-sectional design, students ages 7;0 (years;months) to 17;9 completed tests that measured reading, language, and nonlinguistic cognitive skills.

RESULTS

For the TL group, phonological awareness predicted decoding at early elementary school, and overall language predicted reading comprehension at early elementary school and both decoding and reading comprehension at middle school and high school. For the SSD-only group, vocabulary predicted both decoding and reading comprehension at early elementary school, and overall language predicted both decoding and reading comprehension at middle school and decoding at high school. For the SSD and LI group, overall language predicted decoding at all 3 literacy stages and reading comprehension at early elementary school and middle school, and vocabulary predicted reading comprehension at high school.

CONCLUSION

Although similar skills contribute to reading across the age span, the relative importance of these skills changes with children's literacy stages.

Speech-Sound Disorders and Attention-Deficit/Hyperactivity Disorder Symptoms

PURPOSE

The purpose of this study was to examine the association of speech-sound disorders (SSD) with symptoms of attention-deficit/hyperactivity disorder (ADHD) by the severity of the SSD and the mode of transmission of SSD within the pedigrees of children with SSD.

PARTICIPANTS AND METHODS

The participants were 412 children who were enrolled in a longitudinal family study of SSD. Children were grouped on the basis of the severity of their SSD as determined by their scores on the Goldman-Fristoe Test of Articulation and history of an SSD. Five severity groups were compared: no SSD, resolved SSD, mild SSD, mild-moderate SSD, and moderate-severe SSD. Participants were also coded for comorbid language impairment (LI), based on scores on a standardized language test. Pedigrees of children were considered to represent bilineal inheritance of disorders if there was a history for SSD on both the maternal and paternal sides of the family. Parents completed the ADHD rating scale and a developmental questionnaire for each of their children.

RESULTS AND CONCLUSIONS

Children with moderate-severe SSD had higher ratings on the inattention and hyperactive/impulsivity scales than children with no SSD. Children whose family pedigrees demonstrated bilineal inheritance had higher ratings of inattention than children without bilineal inheritance. To determine the best predictors of ADHD ratings, multiple linear regression analyses were conducted. LI was more predictive of ADHD symptoms than SSD severity, bilineal inheritance of SSD, age, or gender. Findings support that LI rather than SSD is associated with ADHD.