Speech Sound Disorders in Children: An Articulatory Phonology Perspective

A systematic review of language and motor skills in children with developmental coordination disorder (DCD) and developmental language disorder (DLD)

AIM

To investigate: (a) language difficulties in children with developmental coordination disorder (DCD), and (b) motor difficulties in children with developmental language disorder (DLD).

METHOD

In this systematic review, PubMed, CINAHL, PsycINFO, and Embase were searched to identify peer-reviewed studies. Two researchers independently identified, screened and evaluated the methodological quality of the included studies following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). For objective (a), we combined the terms: "developmental coordination disorder" AND "language skills" AND "children". For objective (b) we combined the terms: "developmental language disorder" AND "motor skills" AND "children".

RESULTS

Ten studies on language skills in children with DCD and 34 studies on motor skills in children with DLD are included, most with relatively good methodological quality. The results for language comprehension and production in children with DCD are contradictory, but there is evidence that children with DCD have communication and phonological problems. Evidence for general motor problems in children with DLD is consistent. Studies report problems in balance, locomotor, and fine motor skills in children with DLD. Evidence for aiming and catching skills is inconsistent.

INTERPRETATION

The findings of this systematic review highlight the co-occurrence of language impairments in children with DCD and motor impairments in children with DLD. Healthcare professionals involved in the assessment and diagnosis of children with DCD or DLD should be attentive to this co-occurrence. In doing so, children with DCD and DLD can receive optimal interventions to minimize problems in their daily life.

Malocclusion and Its Relationship with Sound Speech Disorders in Deciduous and Mixed Dentition: A Scoping Review

Objectives: The intricate relationship between malocclusions and speech sound disorders (SSDs) is yet to be fully understood. This is particularly true for pediatric patients during the deciduous and mixed dentition stages. Employing a methodical scoping review approach, this study scrutinizes the recent literature to elucidate how these dental misalignments impact speech articulation and phonetic clarity. Methods: The present scoping review has been conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The selected articles have been found using PubMed, Scopus, Web of Science, and The Cochrane Library; the scope was limited to studies describing cases of patients in the deciduous or mixed dentition stage and the presence of both malocclusion and SSDs. Results: Out of the 1880 articles found, 44 passed the initial screening and 12 met the eligibility criteria and have been included in this review. Conclusions: The analysis reveals that while there is a consensus on the influence of malocclusions on speech production, the extent and specific nature of these effects vary across studies. anterior open bite is frequently associated with speech disorders, affecting phonemes by altering airflow and tongue placement. The review highlights the need for multidisciplinary approaches for effective treatment and calls for further investigation into the causative relationships between malocclusions and SSDs.

Phonological and speech motor abilities in children with childhood apraxia of speech

Childhood apraxia of speech (CAS) is a motor speech disorder in which the precision and consistency of speech sounds are impaired due to deficits in motor planning and programming. The literature on CAS suggests that the clinical features of CAS cannot be limited to one level of speech processing and that a more comprehensive understanding of how all levels involved in speech production are part of a complex system is needed. The aim of this study was to investigate the relationship between phonological and speech motor abilities in children with CAS and to determine the extent to which speech motor performance accounts for phonological processing in children with CAS. Croatian children with CAS (n = 30) and typically developing children (n = 28) aged 5-7 years participated in this study. Behavioural measures representing different aspects of the speech production chain were created taking into account the inevitable overlap of linguistic and motor processes underlying each task. The results showed that children with CAS performed significantly worse on all measured tasks. Spearman correlation analysis revealed positive relationships between the speech motor tasks and the expressive and receptive phonological processing tasks. A hierarchical regression analysis showed that both receptive phonological processing and speech motor performance contribute significantly to expressive phonological processing in children with CAS, with monosyllabic MRR emerging as a significant predictor. These results emphasise the interconnectedness of phonological and speech motor skills in CAS and provide valuable insights for assessment and intervention.

Thoughts From the Front Lines: Canadian Perspectives in Adopting and Implementing Recommended Clinical Labels in Preschool Speech-Language Pathology

PURPOSE

Previous literature has proposed barriers to speech-language pathologists (SLPs) using standard clinical labels; however, the perspectives of SLPs have been studied to a lesser extent. This quality improvement project reports on SLPs' perceived barriers and facilitators to using currently recommended clinical labels for preschool communication disorders and identifies next steps to support implementation in one preschool communicative health system.

METHOD

This project aimed to establish the consistent use of clinical labels in one large Canadian preschool speech and language program. After completing a web-based training and a 3-month trial period, 387 SLPs completed an exit survey to share their perceived barriers and facilitators to label use. Qualitative survey data were analyzed using a hybrid codebook inductive/deductive thematic analysis approach.

RESULTS

Six themes were identified, which aligned with the diffusion of innovations theory. SLPs identified several facilitators and barriers to using the recommended clinical labels within each theme. Major facilitators included improved communication, better caregiver understanding of children's communication, positive feedback from caregivers, SLPs' increased confidence in sharing labels, and improved access to services for children. Major barriers related to additional time required to share labels, SLPs' perceptions of caregivers' values, SLPs' views surrounding the recommended labels, lack of comfort using some labels, and limited opportunity to practice label use or observe successful label use by others.

CONCLUSIONS

Contextual barriers continue to impact SLPs' use of the recommended clinical labels. Ongoing collaboration with SLPs and caregivers will be critical for supporting implementation. Further research examining SLPs' perspectives across other clinical settings and geographic areas is needed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27296970.

Quality of Life of Families of Children with Speech Disorders

Background

Under the influence of numerous life factors, speech constantly undergoes changes. Parents of children with speech and language disorders have a lower quality of life compared to the parents of children without. The study examined different domains of the quality of life of families with and without speech disorders.

Methods

A cross-sectional study was conducted in Serbia, in 2024, on a sample of 206 preschool children aged 5-7 years and their parents/guardians. As a research instrument, in addition to the General Questionnaire on sociodemographic characteristics of children and parents' respondents/guardians, the Family Quality of Life Survey (FQOL) was used to assess the family's quality of life.

Results

Articulation disorder was detected in 78.2% of children. Difference between the two groups of parents was found in terms of place of residence, work status, education levels, and children's age. From the five domains of family quality of life, significance was found in the domain of family interaction regarding the support, support related to disability, and family safety. Regarding the physical/material well-being domain, the significance was found for dental care and parenting domains. No differences were found in the domain of emotional well-being.

Conclusion

The importance of the study reflects in the possibility of applying the obtained research results for the creation of educational programs that will encourage positive attitudes of parents and children about speech therapy interventions, which can influence successful rehabilitation of speech disorders and improve family quality of life.

Impact of an early educational protocol on the oral language of children born preterm exhibiting phonological fragility: a multicenter randomized clinical trial

We conducted a six-center, prospective, randomized, open-label trial to assess whether an early standardized educational protocol provided from 42 to 48 months of age improved the progression of oral language and phonological development in children born preterm. A total of 552 children with phonological fragility were included in this study. The children were randomized to receive the educational protocol (guided arm, n = 87) or not (non-guided arm, n = 78). In the guided arm, the oral language development used a short "say and do" type educational protocol designed to maintain visual attention and train the developmental phonology/lexicon/morphosyntax structural links. In contrast, a conservative approach was used in the non-guided arm. A total of 70 guided and 73 non-guided children completed the study. After 6 months, the educated children showed a non-significant increase in their phonology score (p = 0.37), while the variations in the scores of the expressive lexicon (secondary endpoints) were significantly improved (p = 0.0008). We conclude that the short, standardized stimulation of the sensorimotor aspects of language in children born very preterm increased the expressive lexicon. This protocol improved the language of the premature children, especially those with minimal motor skills, with more significant improvement in the phonological scores.

Clinical trial registration

clinicaltrials.gov, identifier NCT01426659.

The PraxiFala Battery: A diagnostic accuracy study

PURPOSE

To present the sensitivity and specificity and establish cutoff points (receiver operating characteristic [ROC] curve) for the PraxiFala Battery.

METHOD

The sample included 308 Brazilian-speaking children aged 3;0-7;11. Twenty-one children had motor speech disorders (MSD), 58 children had phonological disorder (PD), and 229 had typical speech (TS) development. Participants were administered the PraxiFala Battery, which contains verbal (word and sentence production), nonverbal (orofacial praxis), and diadochokinetic tasks. The sensitivity and specificity of items in each task were then calculated using ROC curves.

RESULT

Total scores on the verbal (word production), nonverbal (orofacial praxis), and diadochokinetic tasks had good sensitivity and specificity. The only scores with poor sensitivity and specificity in differentiating between TS, PD, and MSD were consistency and prosody in the verbal tasks (sentence production), and item /ta/ in the diadochokinetic task. Area under the ROC curve (AUC) values were greater than 0.7 for most items in the comparison between TS vs. MSD and PD vs. MSD. AUC values were poor or fair among children with TS and PD, suggesting that this instrument may not be accurate in identifying these groups.

CONCLUSION

The verbal, nonverbal, and diadochokinetic tasks in the PraxiFala Battery had good sensitivity and specificity.

Effectiveness of the Kaufman Speech to Language Protocol for Children With Childhood Apraxia of Speech and Comorbidities When Delivered in a Dyadic and Group Format

PURPOSE

The current study is a Phase I clinical study with the goal of determining feasibility and the effectiveness of the Kaufman Speech to Language Protocol (K-SLP) for children with childhood apraxia of speech (CAS) and comorbidities. We hypothesized that K-SLP intervention would result in improved outcomes and maintenance of treatment effect at 3-4 months postintervention.

METHOD

Single-subject experimental design with multiple baselines across behaviors was replicated across a group of six children. Five out of six participants completed the study. The K-SLP intervention was administered in dyads four times a week for three consecutive weeks. Outcomes included assessment of word/syllable shapes, articulation accuracy, speech intelligibility, and functional communication. Treatment progress was measured through: (a) the administration of custom probe word lists and (b) assessments carried out at pretreatment, immediately following intervention and approximately 3-4 months after the study period.

RESULTS

Four out of five participants demonstrated significant improvements to words targeted in treatment and three out of five generalized these to untreated words. Furthermore, three out of five participants showed immediate and clinically significant posttreatment improvements in speech intelligibility and functional outcomes, and this increased to four out of five participants at 3-4 months follow-up.

CONCLUSIONS

The study provides preliminary support for the effectiveness of the K-SLP program when delivered in dyads to children with CAS with comorbidities. The study replicates earlier findings and reaffirms the positive outcomes of K-SLP for children with CAS.

Predictors of Functional Communication Outcomes in Children With Idiopathic Motor Speech Disorders

PURPOSE

The purpose of the study was to investigate child- and intervention-level factors that predict improvements in functional communication outcomes in children with motor-based speech sound disorders.

METHOD

Eighty-five preschool-age children with childhood apraxia of speech (n = 37) and speech motor delay (n = 48) participated. Multivariable logistic regression models estimated odds ratios and 95% confidence intervals for the association between minimal clinically important difference in the Focus on the Outcomes of Communication Under Six scores and multiple child-level (e.g., age, sex, speech intelligibility, Kaufman Speech Praxis Test diagnostic rating scale) and intervention-level predictors (dose frequency and home practice duration).

RESULTS

Overall, 65% of participants demonstrated minimal clinically important difference changes in the functional communication outcomes. Kaufman Speech Praxis Test rating scale was significantly associated with higher odds of noticeable change in functional communication outcomes in children. There is some evidence that delivering the intervention for 2 times per week for 10 weeks provides benefit.

CONCLUSION

A rating scale based on task complexity has the potential for serving as a screening tool to triage children for intervention from waitlist and/or determining service delivery for this population.

Toward Process-Oriented, Dimensional Approaches for Diagnosis and Treatment of Speech Sound Disorders in Children: Position Statement and Future Perspectives

BACKGROUND

Children with speech sound disorders (SSD) form a heterogeneous group, with respect to severity, etiology, proximal causes, speech error characteristics, and response to treatment. Infants develop speech and language in interaction with neurological maturation and general perceptual, motoric, and cognitive skills in a social-emotional context.

PURPOSE

After a brief introduction into psycholinguistic models of speech production and levels of causation, in this review article, we present an in-depth overview of mechanisms and processes, and the dynamics thereof, which are crucial in typical speech development. These basic mechanisms and processes are: (a) neurophysiological motor refinement, that is, the maturational articulatory mechanisms that drive babbling and the more differentiated production of larger speech patterns; (b) sensorimotor integration, which forms the steering function from phonetics to phonology; and (c) motor hierarchy and articulatory phonology describing the gestural organization of syllables, which underlie fluent speech production. These dynamics have consequences for the diagnosis and further analysis of SSD in children. We argue that current diagnostic classification systems do not do justice to the multilevel, multifactorial, and interactive character of the underlying mechanisms and processes. This is illustrated by a recent Dutch study yielding distinct performance profiles among children with SSD, which allows for a dimensional interpretation of underlying processing deficits.

CONCLUSIONS

Analyses of mainstream treatments with respect to the treatment goals and the speech mechanisms addressed show that treatment programs are quite transparent in their aims and approach and how they contribute to remediating specific deficits or mechanisms. Recent studies into clinical reasoning reveal that the clinical challenge for speech-language pathologists is how to select the most appropriate treatment at the most appropriate time for each individual child with SSD. We argue that a process-oriented approach has merits as compared to categorical diagnostics as a toolbox to aid in the interpretation of the speech profile in terms of underlying deficits and to connect these to a specific intervention approach and treatment target.

Accuracy of Speech Sound Analysis: Comparison of an Automatic Artificial Intelligence Algorithm With Clinician Assessment

PURPOSE

Automatic speech analysis (ASA) and automatic speech recognition systems are increasingly being used in the treatment of speech sound disorders (SSDs). When utilized as a home practice tool or in the absence of the clinician, the ASA system has the potential to facilitate treatment gains. However, the feedback accuracy of such systems varies, a factor that may impact these gains. The current research analyzes the feedback accuracy of a novel ASA algorithm (Amplio Learning Technologies), in comparison to clinician judgments.

METHOD

A total of 3,584 consonant stimuli, produced by 395 American English-speaking children and adolescents with SSDs (age range: 4-18 years), were analyzed with respect to automatic classification of the ASA algorithm, clinician-ASA agreement, and interclinician agreement. Further analysis of results as related to phoneme acquisition categories (early-, middle-, and late-acquired phonemes) was conducted.

RESULTS

Agreement between clinicians and ASA classification for sounds produced accurately was above 80% for all phonemes, with some variation based on phoneme acquisition category (early, middle, late). This variation was also noted for ASA classification into "acceptable," "unacceptable," and "unknown" (which means no determination of phoneme accuracy) categories, as well as interclinician agreement. Clinician-ASA agreement was reduced for misarticulated sounds.

CONCLUSIONS

The initial findings of Amplio's novel algorithm are promising for its potential use within the context of home practice, as it demonstrates high feedback accuracy for correctly produced sounds. Furthermore, complexity of sound influences consistency of perception, both by clinicians and by automated platforms, indicating variable performance of the ASA algorithm across phonemes. Taken together, the ASA algorithm may be effective in facilitating speech sound practice for children with SSDs, even in the absence of the clinician.

Computer-assisted syllable analysis of continuous speech as a measure of child speech disordera)

In this study, a computer-driven, phoneme-agnostic method was explored for assessing speech disorders (SDs) in children, bypassing traditional labor-intensive phonetic transcription. Using the SpeechMark® automatic syllabic cluster (SC) analysis, which detects sequences of acoustic features that characterize well-formed syllables, 1952 American English utterances of 60 preschoolers were analyzed [16 with speech disorder present (SD-P) and 44 with speech disorder not present (SD-NP)] from two dialectal areas. A four-factor regression analysis evaluated the robustness of seven automated measures produced by SpeechMark® and their interactions. SCs significantly predicted SD status (p < 0.001). A secondary analysis using a generalized linear model with a negative binomial distribution evaluated the number of SCs produced by the groups. Results highlighted that children with SD-P produced fewer well-formed clusters [incidence rate ratio (IRR) = 0.8116, p ≤ 0.0137]. The interaction between speech group and age indicated that the effect of age on syllable count was more pronounced in children with SD-P (IRR = 1.0451, p = 0.0251), suggesting that even small changes in age can have a significant effect on SCs. In conclusion, speech status significantly influences the degree to which preschool children produce acoustically well-formed SCs, suggesting the potential for SCs to be speech biomarkers for SD in preschoolers.

Four Cases of Children With Phonological Impairment and Precocious Vocabulary: Making Sense of a Clinical Conundrum

PURPOSE

The purpose of this study was to describe the speech production, speech perception, vocabulary, and word learning abilities of lexically precocious 4-year-old children with phonological impairment, in an effort to better understand the underlying nature of phonological impairment in children.

METHOD

Using a case series approach, we identified four children with phonological impairment and precocious vocabulary abilities. Each child completed routine speech production and vocabulary assessments, as well as experimental speech perception and word learning tasks. The results from these tasks were then used to create profiles of each child's individual strengths and needs across the abilities assessed.

RESULTS

Although all four children presented with phonological impairment and lexically precocious receptive and expressive vocabulary, they differed in their specific speech errors. One child presented with phonological speech errors only, while the other three children presented with an interdental lisp alongside their phonological errors. Three children presented with average speech perception abilities, and one child presented with poorer speech perception. The same three children also showed some learning of novel nonwords 1 week post-initial exposure, while the other child showed no evidence of word learning 1 week post-initial exposure.

CONCLUSIONS

The clinical profiles of lexically precocious children with phonological impairment offered different insights into the nature of the problem. Although one child appeared to present with underspecified underlying representations of words, the other three children appeared to present with well-specified underlying representations. Of the three children with well-specified underlying representations, two appeared to have difficulty abstracting particular rules of the ambient phonological system. Further research is needed to improve our understanding of the underlying nature of phonological impairment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26307640.

The Effects of an Accelerated Auditory Matching Protocol for Early Intervention Students

We employed a multiple probe design to test the effects of an accelerated auditory matching protocol with five toddlers receiving early intervention services (four males, one female) for developmental delays. All participants emitted poorly articulated vocal mands and tacts. The dependent variables were the number of full echoics, partial echoics, and incorrect responses within a set of 20 two-syllable words. The independent variable was an accelerated Auditory Matching Protocol that targets auditory discrimination using an iPad App. Each phase of the protocol targets different sound discriminations with growing complexity. Four out of five participants emitted more full or partial echoic responses upon mastery of the Auditory Matching Protocol. Moreover, compared to those who received the full dosage of the standard Auditory Matching Protocol in previous studies, the participants in this study required fewer learn units to master all phases and to demonstrate improvement.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00882-1.

Working Toward Recommended Terminology in the Canadian Preschool Speech-Language Pathology Context

PURPOSE

This quality improvement project aimed to address the inconsistent use of clinical labels across a preschool speech and language program in Ontario, Canada. The study investigated whether a multicomponent knowledge translation (KT) intervention could increase speech-language pathologists' (SLPs') knowledge about the recommended clinical labels, motivate their intentions to use the labels, and facilitate practice change during a 3-month pilot period.

METHOD

The diffusion of innovations theory was utilized to identify and address known and suspected barriers and facilitators that could influence the adoption of consistent terminology. The intervention was evaluated using a pre-experimental study design (with pre, post, and follow-up testing) and included two phases: Phase 1 involved the pretraining survey, KT intervention, and posttraining survey, and Phase 2 included an exit survey after a 3-month pilot period.

RESULTS

Five hundred twenty-nine SLPs in Phase 1 and 387 SLPs in Phase 2 participated. Following the web-based intervention, SLPs demonstrated improved knowledge about the recommended labels with most indicating intentions to communicate the labels going forward. SLPs also reported increased comfort using labels and positive views on their importance and value. After the 3-month pilot period, SLPs' reported use of most recommended labels decreased, as did ratings of comfort, value, and importance. However, most SLPs reported intentions to use the labels going forward.

CONCLUSIONS

Despite having intentions to adopt the recommended labels, the lack of implementation by SLPs suggests the presence of additional barriers impacting their use of the recommended clinical labels in practice. Future work should investigate clinician-identified barriers to inform future implementation efforts.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25254940.

Acquisition of the feature [+spread glottis] in Icelandic

The feature [+spread glottis] ([+s.g.]) denotes that a speech sound is produced with a wide glottal aperture with audible voiceless airflow. Icelandic is unusual in the degree to which [+spread glottis] is involved in the phonology: in /h/, pre-aspirated and post-aspirated stops, voiceless fricatives and voiceless sonorants. The ubiquitousness of the feature could potentially affect the rate and process of its acquisition. This paper investigates the development of [+s.g.] in Icelandic, both in general and in a range of contexts, in a cross-sectional study of 433 typically developing Icelandic-speaking children aged two to seven years. As a feature, [+s.g.] is acquired early in Icelandic, although specific sound classes lag behind due to other output constraints. Children reach mastery of [+s.g.] by age three except in word-initial post-aspirated stops and voiceless nasals. Findings are interpreted in light of the literature on the feature and its development.

A single case experimental design study using an operationalised version of the Kaufman Speech to Language Protocol for children with childhood apraxia of speech

PURPOSE

A Phase I study was conducted to examine the treatment effectiveness of the Kaufman Speech to Language Protocol using a research-operationalised protocol. It was hypothesised that articulatory accuracy would improve as a result of the treatment and that these improvements would be maintained after treatment was discontinued.

METHOD

A single case experimental design was used to evaluate the effectiveness of the Kaufman Speech to Language Protocol. Four children with a confirmed childhood apraxia of speech diagnosis were included in this study. Each child received 12 individual 1 hr treatment sessions that each consisted of an approximation setting phase and a practice phase. Probe data was collected during treatment and at post-treatment time points to measure treatment effectiveness and to measure changes in the untreated words. Untreated (control) sounds were included to test whether recorded improvements in articulatory accuracy could be attributed to the Kaufman Speech to Language Protocol.

RESULT

Two of the four children demonstrated a response to the intervention and maintenance of these changes, while the two remaining children demonstrated some generalisation in the absence of improved target (treatment) words. No specific child factors were clearly associated with positive treatment outcomes.

CONCLUSION

This study replicated the findings of an earlier pilot study and found that the operationalised protocol for the Kaufman Speech to Language Protocol is effective in improving articulatory accuracy for some children with childhood apraxia of speech. Additional replication with a further refined treatment protocol and a larger sample size is needed to support a recommendation of clinical use of the Kaufman Speech to Language Protocol.

Child speech developmental norms in Greek monolinguals: whole word and consonant accuracy

Child phonological development in standard Greek is aptly represented by both single-case and cross-sectional studies. While some quantitative measures exist, such as the 75% criterion in the acquisition of singletons and clusters, reported norms require replication to fine-tune existing indicators, inform non-existent ones, and better reflect children's typical developmental speech in contemporary Greece. Our cross-sectional study addresses this gap, in terms of consonant inventory acquisition, and percentage accuracy of words, singletons, clusters, and cluster reductions. Phonological Assessment for Greek (PAel) procedures facilitated data elicitation from 254 Greek-speaking participants, aged 2;0-7;0, equally represented for gender. Our study comprehensively informs quantitative norms on whole word accuracy (WWA), percentage of consonants correct (PCC), PCC variation across the different age groups of children, and the WWA-PCC correlation along the developmental path in this cross-sectional study. A schematic representation models children's normative PCC-WWA profiles, facilitating the determination of phonological disorder in Greek with direct clinical application on diagnosis and intervention.

Articulatory and segmental performance in children with and without speech disorder: A multiple case pilot study

This multiple case pilot study explored how nonword imitation influences articulatory and segmental performance in children with and without speech disorder. Eight children, ages 4- to 8-years-old, participated, including two children with childhood apraxia of speech (CAS), four children with phonological disorder (PD), and two children with typical development (TD). Tokens included two complexity types and were presented in random order. Minimal feedback was provided and nonwords were never associated with a referent. Kinematic and transcription data were analysed to examine articulatory variability, segmental accuracy, and segmental variability in session 1 and session 5. Descriptive statistics, percent change, effect sizes, and Pearson correlations are reported. In session 1, the two participants with CAS showed high articulatory variability, low segmental accuracy, and high segmental variability compared to the participants with PD and TD. By session 5, both participants with CAS, two with PD, and one with TD showed increased articulatory variability in the lowest complexity nonword. Segmental accuracy remained low and variability remained high for the two participants with CAS in session 5, whereas several participants with PD and TD showed improved segmental performance. Articulatory and segmental variability were not significantly correlated. The results of this study suggest that motor practice with minimal feedback and no assignment of a lexical referent can instantiate positive changes to segmental performance for children without apraxia. Positive changes to segmental performance are not necessarily related to increased articulatory control; these two processing levels can show distinct and disparate learning trajectories.

Music and musical elements in the treatment of childhood speech sound disorders: A systematic review of the literature

PURPOSE

Music-based interventions are used in the treatment of childhood speech sound disorders (SSDs). Hypotheses on working mechanisms are being developed, focussing on shared neural processes. However, evidence of the effect of treatment with musical elements in SSDs in children is lacking. This study reviews the literature regarding the use of music-based interventions in the treatment of childhood SSDs.

METHOD

A systematic search in six databases was conducted, yielding 199 articles, eight of which met the inclusion criteria. Included articles were reviewed on study characteristics, patient characteristics, interventions, outcomes and methodological quality.

RESULT

This review included four case studies, three single-subject design studies and one cohort study. Seven studies reported positive outcomes on speech production, but outcome measures in the four studies with experimental design were not all aimed at the level of speech (motor) processes. Methodological quality was sufficient in one study.

CONCLUSION

Seven out of eight studies in this review report positive outcomes of music-based interventions in the treatment of SSDs. However, these outcomes are not sufficiently supported by evidence due to insufficient methodological quality. Suggestions for improving methodological quality in future research are presented.

Tongue Shape Complexity in Children With and Without Speech Sound Disorders

PURPOSE

This study investigates the hypothesis that younger speakers and speakers with more severe speech sound disorders are more likely to use simpler (undifferentiated) tongue gestures due to difficulties with, or immaturity of, lingual motor control.

METHOD

The hypothesis is tested using cross-sectional secondary data analysis of synchronous audio and high-speed ultrasound recordings from children with idiopathic speech sound disorders (n = 30, aged 5;0-12;11 [years;months]) and typically developing children (n = 29, aged 5;8-12;10), producing /a/, /t/, /ɹ/, /l/, /s/, and /ʃ/ in an intervocalic /aCa/ environment. Tongue shape complexity is measured using NINFL (Number of INFLections) and modified curvature index (MCI) from splines fitted to ultrasound images at the point of maximal lingual gesture. Age, perceived accuracy, and consonant are used as predictors.

RESULTS

The results suggest that as age increases, children with speech sound disorders have lower MCI compared to typically developing children. Increase in age also led to decrease of MCI for the typically developing group. In the group of children with speech sound disorders, perceptually incorrect /ɹ/ productions have lower MCI than correct productions, relative to /a/.

CONCLUSIONS

There is some evidence of systematic tongue shape complexity differences between typically developing children and children with speech sound disorders when accounting for increase in age. Among children with speech sound disorders, increase in age and perceptually incorrect consonant realizations are associated with decreasing tongue shape complexity.

The Effectiveness of Rapid Syllable Transition Treatment in Improving Communication in Children with Cerebral Palsy: A Randomized Controlled Trial

Cerebral palsy (CP) is a movement disorder and majority of children with CP have communication impairments which impact participation with this population. Rapid Syllable Transition Treatment (ReST) is a motor speech intervention primarily for children with Childhood Apraxia of Speech (CAS). A recent pilot study in which ReST was trialed with children with CP showed improved speech performance. Therefore, a single blind randomized controlled trial to compare ReST to usual care with 14 children with moderate-to-severe CP and dysarthria was conducted. ReST was provided on telehealth. ANCOVA with 95% confidence intervals indicated significant group differences in favor of ReST in speech accuracy (F = 5.1, p = .001), intelligibility (F = 2.8, p = .02) and communicative participation on both the FOCUS (F = 2, p = .02) and Intelligibility in Context Scale (F = 2.4, p = .04). ReST was found to be more effective than usual care.

Auditory-perceptual evaluation with visual analogue scale: feasibility and preliminary evidence of ultrasound visual feedback treatment of Finnish [r]

Accumulating evidence suggests that ultrasound visual feedback increases the treatment efficacy for persistent speech sound errors. However, the available evidence is mostly from English. This is a feasibility study of ultrasound visual feedback for treating distortion of Finnish [r]. We developed a web-based application for auditory-perceptual judgement. We investigated the impact of listener's experience on perceptual judgement and the intra-rater reliability of listeners. Four boys (10-11 years) with distortion of [r], otherwise typical development, partook in eight ultrasound treatment sessions. In total, 117 [r] samples collected at pre- and post-intervention were judged with visual analogue scale (VAS) by two listener groups: five speech and language therapists (SLTs) and six SLT students. We constructed a linear mixed-effects model with fixed effects for time and listener group and several random effects. Our findings indicate that measurement time had a significant main effect on judgement results, χ² = 78.82, p < 0.001. Effect of listener group was non-significant, but a significant main effect of interaction of group × time, χ² = 6.33, p < 0.012 was observed. We further explored the effect of group with nested models, and results revealed a non-significant effect of group. The average intra-rater correlation of the 11 listeners was 0.83 for the pre-intervention samples and 0.92 for post-intervention showing a good or excellent degree of agreement. Finnish [r] sound can be evaluated with VAS and ultrasound visual feedback is a feasible and promising method in treatment for distortion of [r], and its efficacy should be further assessed.

Variability, accuracy, and cross-linguistic transfer in bilingual children speaking Jamaican Creole and English

Due to the lack of normative data about bilingual speech development and limited availability of diagnostic tools optimised for this population, bilingual children under consideration for speech-language services are at an elevated risk of misdiagnosis. In the absence of validated assessment tools, speech-language pathologists may use measures of accuracy and variability of speech production to diagnose suspected speech sound disorders in bilingual children. Research in general motor development suggests that variability and accuracy may trade off in the course of maturation, whereby movement variability spikes before the transition to a more mature stage of motor control. Such variability-accuracy tradeoffs have been described in monolingual speech development but are understudied in bilingual populations, where cross-linguistic transfer occurs. This study aimed to examine variability, accuracy, and cross-linguistic transfer in the speech of 20 bilingual children speaking Jamaican Creole and English. We hypothesised that children who showed higher accuracy in their productions would also exhibit more variable speech, indicating a variability-accuracy tradeoff. The Word Inconsistency Assessment from the Diagnostic Evaluation of Articulation and Phonology was administered to measure accuracy and variability in the English context, where misdiagnosis is likely to occur. Contrary to our hypothesis, we observed that individuals with higher accuracy tended to be less variable in their productions. Future research should examine longitudinal trajectories of accuracy and variability and consider a more culturally-appropriate definition of 'accuracy' in documenting bilingual speech sound development.

What Do Differences between Alternating and Sequential Diadochokinetic Tasks Tell Us about the Development of Oromotor Skills? An Insight from Childhood to Adulthood

Oral diadochokinetic (DDK) tasks are common research and clinical tools used to test oromotor skills across different age groups. They include alternating motion rate (AMR) and sequential motion rate (SMR) tasks. AMR tasks involve repeating a single syllable, whereas SMR tasks involve repeating varying syllables. DDK performance is mostly discussed regarding the increasing rates of AMR and SMR tasks from childhood to adulthood, although less attention is given to the performance differences between SMR and AMR tasks across age groups. Here, AMR and SMR syllabic rates were contrasted in three populations: 7-9-year-old children, 14-16-year-old adolescents and 20-30-year-old adults. The results revealed similar syllabic rates for the two DDK tasks in children, whereas adolescents and adults achieved faster SMR rates. Acoustic analyses showed similarities in prosodic features between AMR and SMR sequences and in anticipatory coarticulation in the SMR sequences in all age groups. However, a lower degree of coarticulation was observed in children relative to adults. Adolescents, on the contrary, showed an adult-like pattern. These findings suggest that SMR tasks may be more sensitive to age-related changes in oromotor skills than AMR tasks and that greater gestural overlap across varying syllables may be a factor in achieving higher rates in SMR tasks.

Life of p: A consonant older than speech

Which sounds composed the first spoken languages? Archetypal sounds are not phylogenetically or archeologically recoverable, but comparative linguistics and primatology provide an alternative approach. Labial articulations are the most common speech sound, being virtually universal across the world's languages. Of all labials, the plosive 'p' sound, as in 'Pablo Picasso', transcribed /p/, is the most predominant voiceless sound globally and one of the first sounds to emerge in human infant canonical babbling. Global omnipresence and ontogenetic precocity imply that /p/-like sounds could predate the first major linguistic diversification event(s) in humans. Indeed, great ape vocal data support this view, namely, the only cultural sound shared across all great ape genera is articulatorily homologous to a rolling or trilled /p/, the 'raspberry'. /p/-like labial sounds represent an 'articulatory attractor' among living hominids and are likely among the oldest phonological features to have ever emerged in linguistic systems.

Characterizing Speech Sound Productions in Bilingual Speakers of Jamaican Creole and English: Application of Durational Acoustic Methods

PURPOSE

This study examined the speech acoustic characteristics of Jamaican Creole (JC) and English in bilingual preschoolers and adults using acoustic duration measures. The aims were to determine if, for JC and English, (a) child and adult acoustic duration characteristics differ, (b) differences occur in preschoolers' duration patterns based on the language spoken, and (c) relationships exist between the preschoolers' personal contextual factors (i.e., age, sex, and percentage of language [%language] exposure and use) and acoustic duration.

METHOD

Data for this cross-sectional study were collected in Kingston, Jamaica, and New York City, New York, United States, during 2013-2019. Participants included typically developing simultaneous bilingual preschoolers (n = 120, ages 3;4-5;11 [years;months]) and adults (n = 15, ages 19;0-54;4) from the same linguistic community. Audio recordings of single-word productions of JC and English were collected through elicited picture-based tasks and used for acoustic analysis. Durational features (voice onset time [VOT], vowel duration, whole-word duration, and the proportion of vowel to whole-word duration) were measured using Praat, a speech analysis software program.

RESULTS

JC-English-speaking children demonstrated developing speech motor control through differences in durational patterns compared with adults, including VOT for voiced plosives. Children's VOT, vowel duration, and whole-word duration were produced similarly across JC and English. The contextual factor %language use was predictive of vowel and whole-word duration in English.

CONCLUSIONS

The findings from this study contribute to a foundation of understanding typical bilingual speech characteristics and motor development as well as schema in JC-English speakers. In particular, minimal acoustic duration differences were observed across the post-Creole continuum, a feature that may be attributed to the JC-English bilingual environment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21760469.

Process-Oriented Profiling of Speech Sound Disorders

The differentiation between subtypes of speech sound disorder (SSD) and the involvement of possible underlying deficits is part of ongoing research and debate. The present study adopted a data-driven approach and aimed to identify and describe deficits and subgroups within a sample of 150 four to seven-year-old Dutch children with SSD. Data collection comprised a broad test battery including the Computer Articulation Instrument (CAI). Its tasks Picture Naming (PN), NonWord Imitation (NWI), Word and NonWord Repetition (WR; NWR) and Maximum Repetition Rate (MRR) each render a variety of parameters (e.g., percentage of consonants correct) that together provide a profile of strengths and weaknesses of different processes involved in speech production. Principal Component Analysis on the CAI parameters revealed three speech domains: (1) all PN parameters plus three parameters of NWI; (2) the remaining parameters of NWI plus WR and NWR; (3) MRR. A subsequent cluster analysis revealed three subgroups, which differed significantly on intelligibility, receptive vocabulary, and auditory discrimination but not on age, gender and SLPs diagnosis. The clusters could be typified as three specific profiles: (1) phonological deficit; (2) phonological deficit with motoric deficit; (3) severe phonological and motoric deficit. These results indicate that there are different profiles of SSD, which cover a spectrum of degrees of involvement of different underlying problems.

Consonants lost: a Swedish girl with protracted phonological development

This paper addresses the phonology of a Swedish girl, aged 3 years 10 months, with extensive phonological difficulties that include an unusual phonological pattern. She had relatively well-developed phonological building blocks in terms of features, stress pattern and word length (number of syllables), but had extensive difficulties regarding syllable and word shapes, with frequent deletions of both segments and whole syllables. Word-initial position was dominated by non-continuant consonants, both voiced and voiceless, with extensive deletion. Word-medial position was dominated by voiceless obstruents, with extensive use of [j] in place of voiced consonants. Word-final position was similar to word-medial, but with more deletion than [j]. Non-initial stressed syllables resemble word-initial syllables. Consonant clusters mirrored singletons, i.e. with similar substitution patterns or deletions. We present a non-linear analysis of her speech production, and a plan for intervention targeting her special difficulties.

Malocclusion in children with speech sound disorders and motor speech involvement: a cross-sectional clinical study in Swedish children

OBJECTIVES

The objectives of this study were to investigate the occurrence, types and severity of malocclusions in children with speech sound disorder (SSD) persisting after 6 years of age, and to compare these findings to a control group of children with typical speech development (TSD).

METHODS

In total, 105 children were included: 61 with SSD and motor speech involvement (mean age 8:5 ± 2:8 years; range 6:0-16:7 years, 14 girls and 47 boys) and 44 children with TSD (mean age 8:8 ± 1:6; range 6:0-12:2 years, 19 girls and 25 boys). Extra-oral and intra-oral examinations were performed by an orthodontist. The severity of malocclusion was scored using the IOTN-DHC Index.

RESULTS

There were differences between the SSD and TSD groups with regard to the prevalence, type, and severity of malocclusions; 61% of the children in the SSD group had a malocclusion, as compared to 29% in the TSD group. In addition, the malocclusions in the SSD group were rated as more severe. Functional posterior crossbite and habitual lateral and/or anterior shift appeared more frequently in the SSD group. Class III malocclusion, anterior open bite and scissors bite were found only in the SSD group.

CONCLUSION

Children with SSD and motor speech involvement are more likely to have a higher prevalence of and more severe malocclusions than children with TSD.

Clinical feasibility, utility, and usability of the Profile of Preschool Communication: A pilot test in community settings

AIM

. This study aimed to pilot test, assess usability and utility of, and identify barriers to implementation for the Profile of Preschool Communication (PPC) - a new data collection tool designed to support outcome monitoring in preschool speech-language programs and practice-based research.

METHODS

. This pilot study was conducted with three sites in the Ontario Preschool Speech and Language (PSL) program. Twenty-three speech-language pathologists used the PPC for all outcome monitoring assessments for 2-3-months and provided feedback about their experience using it in practice. Then, 18 of the 23 speech-language pathologists completed online surveys to rate usability and utility, and report their perceived implementation barriers and facilitators.

RESULTS

. Speech-language pathologists reported difficulties completing some sections of the PPC, most notably obtaining data related to maternal education and family history of mental health concerns. Usability and utility were generally rated favorably with some items rated as neutral. Barriers to implementation included the paper format, completion time, requirement to ask personal questions, and the perception by some that data were useful for outcome monitoring but not practice. Facilitators included ease of use, an improvement over the existing tool, and the collection of data to support service planning.

CONCLUSIONS

. The PPC shows potential as an outcome monitoring data collection tool in preschool speech-language pathology programs. Findings will be of interest to researchers engaged in practice-based research and those interested in engaging end users to develop clinically meaningful tools.

Dynamic assessment of multilingual children's word learning

BACKGROUND

Teachers and clinicians may struggle to provide early identification to support multilingual children's language development. Dynamic assessments are a promising approach to identify and support children's language development.

AIMS

We developed and studied a novel word learning task that is dynamic and language neutral. It makes use of multilingual children's abilities to apply language transfer, fast mapping and socially embedded language to the learning of new words.

METHODS & PROCEDURES

A total of 26 children attending kindergarten in French participated in this study. Within this group, 13 different home languages were spoken. Children took part in a dynamic assessment task of their word learning that consisted of a test-teach-retest task. Children's scores on this task were compared with their language abilities reported by their parents, amount of language exposure and scores on standardized tests of vocabulary. All tasks were delivered in French.

OUTCOMES & RESULTS

Children had higher accuracy for known words as compared with new words in the task, which may suggest transfer of knowledge from their first language. They also showed increased accuracy in identifying and naming the new words across the three trials, suggesting fast mapping of these new vocabulary items. Finally, the scores on the dynamic task correlated to children's vocabulary scores on the standardized tests, but not parent report of language development, or the amount of exposure to the language of school.

CONCLUSIONS & IMPLICATIONS

This novel dynamic assessment task taps into the process of vocabulary learning, but is less influenced by prior language knowledge. Together, these findings provide insight into early word learning by young multilingual children and proposes a conceptual model for identifying strategies to support second language acquisition.

WHAT THIS PAPER ADDS

What is already known on the subject Many barriers exist with regards to assessing the language abilities of multilingual children when a clinician aims to assess their language abilities in both languages. An alternative approach is to measure children's language processing abilities. What this paper adds to existing knowledge A novel dynamic and multilingual task was developed and implemented in this study. This task builds on children's word learning abilities that include cross-language transfer, fast-mapping, and socially imbedded learning. This multilingual task was found to tap into vocabulary learning but was not influenced by prior language knowledge. What are the potential or actual clinical implications of this work? Applying a task that focuses on language processing abilities is a promising strategy to capture language abilities in multilingual children. In addition, the dynamic nature of this tasks allows a clinician to identify scaffolding strategies that best support children's word learning.

Nonverbal Oro-Motor Exercises: Do They Really Work for Phonoarticulatory Difficulties?

Articulation disorders are deficiencies in the realization of speech sounds unrelated to organic or neurological disorders. Over the last decade, there has been a debate on the efficiency of non-verbal oro-motor exercises, which are orofacial movements programmed and organized in an intentional and coordinated way to control lips, tongue, and soft palate muscles. Of the 122 children evaluated, 52 presented articulatory difficulties. An intervention with nonverbal oro-motor exercises was applied, and children were again assessed following treatment. The results showed no differences between the experimental and control groups, either in the number of sounds that improved after this period or in the severity of difficulties (we categorized those with articulation difficulties in two to six sounds as ‘medium’ and those with difficulties in articulating more than seven sounds as ‘severe’). These results indicated that nonverbal oro-motor exercises alone are not efficient for intervention in difficulties in the realization of sounds in 4-year-old children.

Auditory phoneme discrimination, articulation, and language disorders in patients with genetic epilepsy with febrile seizures plus: A case-control study

INTRODUCTION

Genetic epilepsy with febrile seizures plus (GEFS+) is an epilepsy syndrome with clinical heterogeneity that was first described in 1997. Central auditory processing (CAP) is defined as the neurophysiological process in decoding sound waves from the outer ear to the auditory cortex. The present study aimed to analyze CAP and phonological disorders in preschool-age children with GEFS+.

MATERIAL AND METHOD

This is a prospective case-control study. Twenty-seven patients diagnosed with GEFS+ aged between 4 years and 6 years and 6 months and 31 healthy controls in the same age range were included in the study. Phonological sensitivity test (SAT) and auditory discrimination test (İAT) were applied to both groups, and the results of both groups were statistically compared.

RESULTS

The SAT and İAT raw and Z scores of the subjects in the study group were found to be significantly higher than those of the control group (p = 0.001; p < 0.01). Electroencephalography (EEG) status of the patients or the duration of antiseizure medication use did not have a statistically significant effect on the outcome.

CONCLUSION

Patients with GEFS+ have a significantly high impairment in both articulation and auditory discrimination of phonemes compared with the healthy population. Early diagnosis and early treatment of this condition can prevent potential literacy problems and the development of dyslexia in the future.

Phonological productive processes in full-term schoolchildren and small for gestational age: a case-control study

PURPOSE

To characterize the use of phonological productive processes in a group of full-term children and small for gestational age and compare it with children appropriate for gestational age.

METHODS

Observational, analytical, case-control and non-paired study, nested in a cohort with the outcome of phonological disorder. We assessed 36 children according to the predetermined sample calculation, 24 (66.7%) without phonological disorders and 12 (33.3%) with phonological disorders. Of these, 24 (66.7%) children were classified as small for gestational age (SGA) and 12 (33%) as appropriate for gestational age (AGA). Phonological aspects of oral language were assessed by the ABFW children's language test (2004). The results were subjected to descriptive analysis and, in order to assess the existence of an association among categorical variables, we used Fisher's exact test for association.

RESULTS

The SGA group revealed a significantly higher number of phonological processes that change the syllable structure when compared to the AGA group. We noted that the phonological processes present and unexpected for age in the SGA population were: fricative plosivation, liquid simplification, palatal posteriorization and frontalization, plosive and fricative deafening, in addition to simplifying the consonant cluster and simplifying the final consonant, which were the most frequent in both groups.

CONCLUSION

Although no association was found between phonological disorders and SGA children, we have noted a greater use of productive phonological processes in this group.

The Effectiveness of an Integrated Treatment for Functional Speech Sound Disorders-A Randomized Controlled Trial

BACKGROUND

The treatment of functional speech sound disorders (SSDs) in children is often lengthy, ill-defined, and without satisfactory evidence of success; effectiveness studies on SSDs are rare. This randomized controlled trial evaluates the effectiveness of the integrated SSD treatment program PhonoSens, which focuses on integrating phonological and phonetic processing according to the Integrated Psycholinguistic Model of Speech Processing (IPMSP).

METHODS

Thirty-two German-speaking children aged from 3.5 to 5.5 years (median 4.6) with functional SSD were randomly assigned to a treatment or a wait-list control group with 16 children each. All children in the treatment group and, after an average waiting period of 6 months, 12 children in the control group underwent PhonoSens treatment.

RESULTS

The treatment group showed more percent correct consonants (PCC) and a greater reduction in phonological processes after 15 therapy sessions than the wait-list control group, both with large effect sizes (Cohen's d = 0.89 and 1.04). All 28 children treated achieved normal phonological abilities: 21 before entering school and 7 during first grade. The average number of treatment sessions was 28; the average treatment duration was 11.5 months.

CONCLUSION

IPMSP-aligned therapy is effective in the treatment of SSD and is well adaptable for languages other than German.

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

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

Maximum repetition rate in a large cross-sectional sample of typically developing Dutch-speaking children

Purpose: The current study aims to provide normative data for the maximum repetition rate (MRR) development of Dutch-speaking children based on a large cross-sectional study using a standardised protocol.Method: A group of 1014 typically developing children aged 3;0 to 6;11 years performed the MRR task of the Computer Articulation Instrument (CAI). The number of syllables per second was calculated for mono-, bi-, and trisyllabic sequences (MRR-pa, MRR-ta, MRR-ka, MRR-pata, MRR-taka, MRR-pataka). A two-way mixed ANOVA was conducted to compare the effects of age and gender on MRR scores in different MRR sequences.Result: The data analysis showed that overall MRR scores were affected by age group, gender and MRR sequence. For all MRR sequences the MRR increased significantly with age. MRR-pa was the fastest sequence, followed by respectively MRR-ta, MRR-pata, MRR-taka, MRR-ka and MRR-pataka. Overall MRR scores were higher for boys than for girls, for all MRR sequences.Conclusion: This study presents normative data of MRR of Dutch-speaking children aged 3;0 to 6;11 years. These norms might be useful in clinical practice to differentiate children with speech sound disorders from typically developing children. More research on this topic is necessary. It is also suggested to collect normative data for other individual languages, using the same protocol.

The Systematic Review and Meta-analysis of Oral Sensory Challenges in Children and Adolescents with Autism Spectrum Disorder

OBJECTIVES

The purpose of the systematic review was to provide a summary and evaluation of oral sensory challenges in children and adolescents with autism spectrum disorder (ASD).

MATERIALS AND METHODS

The review evaluated 19 studies that met the inclusion and search criteria. The review is registered in Prospero Database (CRD42020179852). The 14 studies (8 case-control, 4 cohort, 1 observational, and 1 randomized clinical trial) were related to speech disorders and five studies (case-control studies) were associated with feeding and eating behavior in ASD. The meta-analysis of speech and feeding behavior was analyzed by using risk ratios (RRs) and standardized mean difference (SMD), with 95% confidence interval (CI).

RESULTS

The meta-analysis found a statistically significant difference of speech disorder between children and adolescents of ASD when compared with typically developed or other neurotypical children of similar age [0.4891 (95% CI = -2.4580; 1.4799), fixed effect; -0.1726 (95% CI = -14.2925; 7.5697), random effect]. Feeding and eating behavior reported a statistically significant difference between ASD children and adolescents with similar age group of typically developed controls [0.0433 (95% CI = -0.3531; 0.4398), fixed-effect; 0.3711 (95% CI = -3.0751; 3.8172), random effect].

CONCLUSION

The speech errors and feeding behavior were more consistent in ASD than in typically developed controls. The oral sensory challenges such as speech disorder and feeding behavior were more prevalent in ASD children and adolescents than in typically developed children and adolescents of the same age group. There was a significant lack in oral sensory-motor synchronization, incomplete motor planning, and poor oral neuromuscular coordination.

Articulatory settings and L2 English coronal consonants

Background/aims: We explore the potential contribution of Articulatory Settings (AS) theory to L2 speech production research, testing the hypothesis that L2 segmental speech learning should involve a gradual, overall shift in both place and constriction degree, simultaneously affecting all consonants of a series as opposed to a set of parallel but unrelated changes in learners' production of individual sounds. Methods: We conducted an electropalatography study of four francophone learners' production of French and English word-initial and -medial /t d s z n l/ via carrier-sentence reading tasks. Results: L1-L2 differences in tongue shape are more common than those in constriction location, first and foremost for sonorants, and, thus, our results are not completely consistent with AS theory's claims. Conclusions: AS theory provides a potentially rich framework for exploring the L2 speech learning of consonantal phenomena including low-level L1-L2 differences in place of articulation. We propose that the observed lack of systematic between-language articulatory differences could be attributed to a number of factors to be explored in future research, such as the targeting of voicing and manner differences before the adjustment of small place differences as well as individual patterns of entrenchment of L1 articulatory routines.

Extending Ultrasound Tongue Shape Complexity Measures to Speech Development and Disorders

Purpose Generalizations can be made about the order in which speech sounds are added to a child's phonemic inventory and the ways that child speech deviates from adult targets in a given language. Developmental and disordered speech patterns are presumed to reflect differences in both phonological knowledge and skilled motor control, but the relative contribution of motor control remains unknown. The ability to differentially control anterior versus posterior regions of the tongue increases with age, and thus, complexity of tongue shapes is believed to reflect an individual's capacity for skilled motor control of speech structures. Method The current study explored the relationship between tongue complexity and phonemic development in children (ages 4-6 years) with and without speech sound disorder producing various phonemes. Using established metrics of tongue complexity derived from ultrasound images, we tested whether tongue complexity incrementally increased with age in typical development, whether tongue complexity differed between children with and without speech sound disorder, and whether tongue complexity differed based on perceptually rated accuracy (correct vs. incorrect) for late-developing phonemes in both diagnostic groups. Results Contrary to hypothesis, age was not significantly associated with tongue complexity in our typical child sample, with the exception of one association between age and complexity of /t/ for one measure. Phoneme was a significant predictor of tongue complexity, and typically developing children had more complex tongue shapes for /ɹ/ than children with speech sound disorder. Those /ɹ/ tokens that were rated as perceptually correct had higher tongue complexity than the incorrect tokens, independent of diagnostic classification. Conclusions Quantification of tongue complexity can provide a window into articulatory patterns characterizing children's speech development, including differences that are perceptually covert. With the increasing availability of ultrasound imaging, these measures could help identify individuals with a prominent motor component to their speech sound disorder and could help match those individuals with a corresponding motor-based treatment approach. Supplemental Material https://doi.org/10.23641/asha.14880039.

Development and Validation of a Probe Word List to Assess Speech Motor Skills in Children

Purpose The aim of the study was to develop and validate a probe word list and scoring system to assess speech motor skills in preschool and school-age children with motor speech disorders. Method This article describes the development of a probe word list and scoring system using a modified word complexity measure and principles based on the hierarchical development of speech motor control known as the Motor Speech Hierarchy (MSH). The probe word list development accounted for factors related to word (i.e., motoric) complexity, linguistic variables, and content familiarity. The probe word list and scoring system was administered to 48 preschool and school-age children with moderate-to-severe speech motor delay at clinical centers in Ontario, Canada, and then evaluated for reliability and validity. Results One-way analyses of variance revealed that the motor complexity of the probe words increased significantly for each MSH stage, while no significant differences in the linguistic complexity were found for neighborhood density, mean biphone frequency, or log word frequency. The probe word list and scoring system yielded high reliability on measures of internal consistency and intrarater reliability. Interrater reliability indicated moderate agreement across the MSH stages, with the exception of MSH Stage V, which yielded substantial agreement. The probe word list and scoring system demonstrated high content, construct (unidimensionality, convergent validity, and discriminant validity), and criterion-related (concurrent and predictive) validity. Conclusions The probe word list and scoring system described in the current study provide a standardized method that speech-language pathologists can use in the assessment of speech motor control. It can support clinicians in identifying speech motor difficulties in preschool and school-age children, set appropriate goals, and potentially measure changes in these goals across time and/or after intervention.

Reliability of Speech-Language Pathologists' Categorizations of Preschoolers' Communication Impairments in Practice

Purpose An efficient and reliable way to categorize children's communication impairments based on routine clinical assessments is needed to inform research and clinical decisions. This preliminary study assessed interrater reliability of speech-language pathologists' categorization of preschoolers' speech, language, and communication impairments using a clinical consensus document. Method Six speech-language pathologists at three community sites worked in pairs to assess 38 children aged 1-5 years, then used the clinical consensus document to categorize children's communication impairments broadly. Identified language and speech sound impairments were further subcategorized. Results Speech-language pathologists had substantial to almost perfect agreement for three broadly focused impairment categories. Agreement for whether language difficulties/disorders were developmental or associated with a biomedical condition was almost perfect, but moderate for whether difficulties impacted receptive or expressive language, or social communication skills. Agreement was fair for rule-based speech delays/disorders, but low for motor-based and mixed speech impairments. Conclusions Results support use of the clinical consensus document to collect data for reliable categories. Additional work is needed to confirm reliability for some broadly focused impairment categories and for subcategorization of speech impairments.

Range of motion (ROM) in the lips and jaw during vowels assessed with 3D motion analysis in Swedish children with typical speech development and children with speech sound disorders

PURPOSE

The aim was to compare movement patterns of lips and jaw in lateral, vertical and anteroposterior directions during vowel production in children with typical speech development (TSD) and in children with speech sound disorders (SSD) persisting after the age of six.

METHODS

A total of 93 children were included, 42 children with TSD (6:0-12:2 years, mean age 8:9 ± 1:5, 19 girls and 23 boys) and 51 children with SSD (6:0-16:7 years, mean age 8:5 ± 3:0, 14 girls and 37 boys). Range of motion (ROM) in lips and jaw in the vowels [a, ʊ, ɪ] produced in a syllable repetition task and median values in resting position were measured with a system for 3D motion analysis. The analysis was based on the coordinates for the mouth corners and the chin centre.

RESULTS

There were significant differences between the groups on movements in lateral direction in both lips and jaw. Children with TSD had generally smaller and more, symmetrical movements in the lips and jaw, in all three dimensions compared to children with SSD. There were no significant differences between the groups in resting position.

CONCLUSION

Children with SSD persisting after the age of six years show more asymmetrical and more variable movement patterns in lips and jaw during vowel production compared with children with TSD in a simple syllable repetition task. Differences were more pronounced in lateral direction in both lips and jaw.

Speech sound development in typically developing 2-7-year-old Dutch-speaking children: A normative cross-sectional study

BACKGROUND

Dutch is a West-Germanic language spoken natively by around 24 million speakers. Although studies on typical Dutch speech sound development have been conducted, norms for phonetic and phonological characteristics of typical development in a large sample with a sufficient age range are lacking.

AIM

To give a detailed description of the speech sound development of typically developing Dutch-speaking children from 2 to 7 years.

METHODS & PROCEDURES

A total of 1503 typically developing children evenly distributed across the age range of 2;0-6;11 years participated in this normative cross-sectional study. The picture-naming task of the Computer Articulation Instrument (CAI) was used to collect speech samples. Speech development was described in terms of (1) percentage consonants correct-revised (PCC-R) and percentage vowels correct (PVC); (2) consonant, vowel and syllabic structure inventories; (3) degrees of complexity (phonemic feature hierarchy); and (4) phonological processes.

OUTCOMES & RESULTS

A two-way mixed analysis of variance (ANOVA) confirmed a significant increase in the number of PCC-R and PVC between the ages of 2;0 and 6;11 years (p < 0.001). The consonant inventory was found to be complete at 3;7 years of age for the syllable-initial consonants, with the exception of the voiced fricatives /v/ and /z/, and the liquid /r/. All syllable-final consonants were acquired before age 4;4 years. At age 3;4 years, all children had acquired a complete vowel inventory, and at age 4;7 years they produced most syllable structures correctly, albeit that the syllable structure CCVCC was still developing. All phonological contrasts were produced correctly at 3;8 years of age. Children in the younger age groups used more phonological simplification processes than the older children, and by age 4;4 years, all had disappeared, except for the initial cluster reduction from three to two consonants and the final cluster reduction from two to one consonant.

CONCLUSIONS & IMPLICATIONS

This paper describes a large normative cross-sectional study of Dutch speech sound development which, in clinical practice, can help Dutch speech-language pathologists to differentiate children with delayed or disordered speech development from typically developing children. What this paper adds What is already known on this subject In recent years many studies have been conducted worldwide to investigate speech sound development in different languages, including several that explored the typical speech sound development of Dutch-speaking children, but none of these latter studies explored both phonetic and phonological progress within a comprehensive age range and a large sample that is representative of the Dutch population. What this study adds to existing knowledge This study serves to fill this gap by providing normative cross-sectional results obtained in 1503 typically developing Dutch-speaking children aged between 2;0 and 6;11 years on informative parameters of speech development: PCC-R and PVC, consonant, vowel and syllabic structure inventories, degrees of complexity (phonemic feature hierarchy), and phonological simplification processes. What are the potential or actual clinical implications of this work? The detailed description of typical Dutch speech sound development provides speech-language pathologists with pertinent information to determine whether a child's speech development progresses typically or is delayed or disordered.