Comments regarding the investigation of developmental apraxia of speech: response to Shriberg, Aram, and Kwiatkowski.

Abstract

The conclusions and discussion were based on only 16 children who were identified based on clearly described criteria. Those subjects have widely varying ages, unspecified treatment histories, and varying receptive language status. The authors did not claim that these results are generalizable to a larger population of children, but I fear that their results will be interpreted that way by others. Identifying unusual phrasal stress deficits in 8 of 16 children with suspected DAS should not be construed or implied as evidence for a diagnostic marker for a subtype of DAS. I strongly agree with the authors that longitudinal studies of children with persistent and unusual speech disorders are needed. Studies concerning children's responses to treatment are also needed. Although models of adult onset apraxia (AOS) may provide useful procedures for measuring or describing speech and nonspeech characteristics of DAS, using AOS as a theoretical model or clinical analogy to DAS leads us to ask less relevant questions about children with unusual and persistent speech disorders. Children with suspected DAS are different from adults who have AOS. Children who have never spoken normally or used language normally are different from adults who have acquired a speech disorder after decades of using spoken and written language normally. In order to intervene efficiently and appropriately, we need to know whether and how children with DAS differ from other children, not how they might resemble adults with an acquired disorder.