ABSTRACT This study compared single-modality and audiovisual (crossmodally congruent and incongruent) speech perception in Brazilian Portuguese-speaking children with and without Speech Sound Disorders (SSD). Thirty-six children (17 with and 19 without SSD; average age = 6;7) participated in an adapted syllable identification test. The auditory and visual stimuli consisted of monosyllabic consonant-vowel utterances involving [p,b,t,d,k,g,f,v,s,z,ʃ,ʒ,m,n,ɲ,l,ʎ,ɾ,χ,w], produced in the context of [a] vowel. The stimuli were presented in different modality conditions: auditory-only (AO), visual-only (VO), audio-visual congruent (AV+), and audio-visual incongruent (AV-). As expected, children with SSD showed lower perceptual accuracy than TD children across all modalities (AO, VO, and AV+), indicating that their difficulties are not restricted to the visual domain. The prediction that SSD children would show reduced audiovisual integration was not confirmed. No differences were observed between groups in terms of visual gain from congruent audiovisual stimuli or susceptibility to the McGurk illusion, although both groups exhibited the effect. Exploratory analyses revealed that age accounts for part of the group differences, particularly in the VO condition, while differences in AO and AV+ remained partially independent of age. Within the SSD group, PCC-R showed no significant multivariate effect, although univariate results indicated positive associations with AO and AV+, but not VO. Although SSD children show reduced accuracy in speech perception across sensory modalities, audiovisual speech integration appears preserved. The variability observed within the SSD group suggests a complex and heterogeneous developmental profile that cannot be fully explained by age or severity, underscoring the need for integrated and individualised intervention approaches.

This systematic review synthesized cross-linguistic evidence on speech error patterns in children with speech sound disorders (SSDs), focusing on percent consonants correct (PCC), SODA (substitution, omission, distortion, and addition) error profiles, and phonological processes, as well as factors contributing to variations in error patterns. Comprehensive searches were conducted in PubMed, CINAHL Ultimate, Scopus, Web of Science, and Linguistics and Language Behavior Abstracts in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies included empirical research on children with phonological, articulation, or functional SSDs that reported quantitative error analyses. Twenty-eight studies met the inclusion criteria. Methodological quality, evaluated using a 16-item framework, ranged from 50.0% to 100.0% (M = 82.7%). The 28 studies spanned nine languages (English, German, Spanish, Portuguese, Italian, French, Turkish, Korean, and Chinese), including three dialects each of Spanish and Chinese and two dialects of Portuguese. Reported PCC values (typically 65.0%-85.0%) indicated predominantly mild-moderate to moderate impairment. Substitution errors were the most prevalent across languages, followed by omissions and distortions. Both language-common and language-specific phonological processes were documented. The findings indicate that PCC is generally comparable across languages, whereas SODA error profiles and phonological processes reflect both cross-linguistic similarities and language-specific characteristics. Phonological processes, in particular, exhibit greater cross-linguistic variation. Collectively, these results emphasize the need for culturally responsive diagnostic practices and highlight the importance of developing cross-linguistic frameworks to guide the assessment of SSDs. https://doi.org/10.23641/asha.32649549.

This study aims to demonstrate that speech sound disorders associated with central auditory processing disorder stem from a processing disorder in the central auditory pathways during listening, rather than from an articulation-based disorder. Included 25 children with articulation problems (WAP; 7 females, 18 males) and 25 typically developing children without articulation problems (WoAP; 10 females, 15 males), aged 5-8years. Assessments comprised the Hacettepe Articulation Test, Scan-C subtests (Filtered Words, Auditory Figure-Ground, Competing Words, Competing Sentences), and the Denver II Developmental Screening Test. The Children in the WAP group scored low on the left ear only in the dichotic words and dichotic sentences tests. Left ear performance was significantly lower in the dichotic words test (p = 0.026, Cohen's d = 0.609) and the dichotic sentences (p = 0.001, r = 0.427). These results suggest that articulation disorders may indicate a central auditory processing deficit, particularly a delay in right-hemisphere auditory maturation. It has been observed that in children with central auditory processing disorder, whatever speech sounds they process defectively during listening, they also produce those same sounds defectively. In this context, this study offers a new perspective on the relationship between articulation disorders and central auditory processing. Therefore, it is recommended that central auditory processing screening be conducted in children with articulation disorders to distinguish the underlying disorder.

Purpose: We examined initial consonant deletion among bilingual (Spanish–English) children with speech sound disorder by comparing errors on Spanish–English cognates, providing a level of phonological control across languages. Method: Participants included 12 children between the ages of 4 and 6 years. Half were bilingual Spanish- and English-speaking children, and half were matched monolingual English-speaking children, all with speech sound disorder. Participants completed single-word speech production tasks, including articulation tests and a list of English–Spanish cognates. Results: No monolingual English-speaking children omitted initial consonants. Bilingual Spanish- and English-speaking children omitted some initial consonants in both languages. Bilingual children who omitted initial consonants in one form of a cognate produced the initial consonant in the other language. Conclusions: Initial consonant deletion may be more common in Spanish-dominant bilingual children than in monolingual English-speaking children. Clinicians who include error type analysis in their assessments should carefully consider error typicality in both of the child's languages when working with bilingual children.

This review article aimed to provide an overview of the information available to guide speech-language pathologists (SLPs) regarding treatment of co-occurring stuttering and speech sound disorder (SSD) in children aged 0-18 years. Systematic searches of 10 databases, gray literature sources (e.g., textbooks, ProQuest dissertations), and nontraditional sources (e.g., websites, social media) were conducted. The search was limited to sources that were (a) published in 1990 or later, (b) published in English, (c) referenced children (0-18 years old) with co-occurring stuttering and SSDs, and (d) described intervention strategies that targeted either stuttering, SSD, or both disorders concurrently. Thirty-four items were identified and extracted. This review article highlighted that there is limited empirical research and information/advice for children with co-occurring stuttering and SSD, with six intervention studies, three survey studies, and two qualitative studies identified. Results revealed 23 sources of expert opinions, including book chapters, journal articles, and websites. This review article provides a useful summary of information that is available to guide SLPs managing children within this population. While expert opinions and frameworks offer valuable clinical advice, the review article highlighted gaps in the literature, especially a lack of intervention studies involving children with co-occurring stuttering and SSD. https://doi.org/10.23641/asha.32408586.

Copy number variants are an important source of normal and pathogenic genome variations. Constitutional deletions involving the distal part of the short arm of chromosome 12(12p13.33p13.32) are very rare. These deletions are associated with an emerging condition associated with variable phenotype, including a specific speech delay sound disorder, labeled childhood apraxia of speech, intellectual disability, and neurobehavioral problems. Trisomy of distal chromosome 15q has rarely been reported. It is generally believed that the terminal duplication of 15q26.2q26.3 is related to overgrowth phenotype, distinct facial features and intellectual disability. A 21-year-old woman (gravida 1, para 0) underwent amniocentesis at 26 weeks' gestation following the detection of a persistent left superior vena cava of the fetus on prenatal ultrasound. In this research, GTG-banding karyotype analysis, chromosomal microarray analysis (CMA), whole-exome sequencing (WES), and fluorescence in-situ hybridization (FISH) were performed. CMA detected a 4.36 Mb deletion on chromosome 12p13.33p13.32 and a 7.59 Mb duplication on chromosome 15q26.2q26.3 of the fetus. No abnormality was found in the parents' genetic examination. After genetic counselling, the parents decided to continue the pregnancy. We provide a detailed description of the prenatal diagnosis and genetic counselling of a rare de-novo 12p13.33p13.32 deletion and 15q26.2q26.3 duplication in a Chinese family. A combination of karyotype analysis, CMA, WES, FISH, prenatal ultrasound, and genetic counselling is helpful for the prenatal diagnosis of chromosomal deletions/duplications and pathogenic gene variants.

Children with Speech Sound Disorders (SSD) may have difficulties with speech perception and/or phonological awareness. Research on this area remains limited in children who speak tonal languages, such as Thai. This study aims to investigate whether Thai-speaking preschool children with SSD show difficulties in speech perception and phonological awareness compared to age-matched typically developing (TD) children. The study also examines the relationships among age, speech production, vocabulary abilities, and speech perception and phonological awareness within both SSD and TD groups. A total of 76 Thai-speaking children (SSD n = 32, TD n = 44) in kindergarten levels 2-3, aged 4;0-6;6 years, participated in this study. All children completed speech and vocabulary assessments, as well as speech perception and phonological awareness experiments. The speech perception experiment included two tasks: 1) phonemic discrimination and 2) lexical and phonetic judgement. The phonological awareness experiment included three tasks: 1) initial phoneme identification, 2) rime awareness, and 3) lexical tone awareness. Children with SSD did not perform differently from their TD peers when controlling for age and receptive vocabulary. Age predicted performance on phonemic discrimination and rime awareness in the SSD group, and on lexical and phonetic judgment and rime awareness in the TD group. Receptive vocabulary predicted only rime awareness in the SSD group. Speech production, as measured by percentage consonants correct, was not a significant predictor of performance in either group. The findings provide new evidence on speech perception and phonological awareness performance in Thai-speaking children. Children with SSD did not show difficulties in speech perception or phonological awareness in this study, which may be explained by the mild to moderate severity of SSD in these children. This study highlights the need to develop standardised Thai articulation and phonological assessments to facilitate more precise classification of children into specific SSD subtypes in future studies. .

Non-word repetition (NWR) is a frequently used task in speech and language assessments. This study investigated NWR performance in children with childhood apraxia of speech (CAS) and speech motor delay (SMD), examining its relation to auditory discrimination (AD) and oral motor performance. Participants were 54 children with persistent speech-sound disorders (SSD) (31 with CAS and 23 with SMD) and 39 children with typical speech development (TSD) aged 6–16 years. Assessments of word naming, NWR, AD, and oral-motor performance were conducted. Percentage consonants correct (PCC), and percentage vowels correct (PVC) were calculated from phonetic transcriptions. The results revealed a difference between children with SSD and children with TSD on all variables and also revealed some differences between children with CAS and children with SMD. Children with CAS had a lower PCC and PVC score on NWR and a lower AD score than those with SMD. More parents of children with CAS reported difficulties with reading and writing. A large proportion of both children with SMD and children with CAS were found to have orofacial dysfunction. Our findings suggest that assessing AD skills and oral-motor skills is important for understanding the underlying difficulties of motor speech disorders in children. Our results indicate differences related to motor planning and motor execution, underscoring the importance of broad assessment approaches to facilitate accurate diagnoses and tailored interventions.

No study has validated English-based classification systems of speech-sound disorders (SSD) with French-speaking children. This study aimed to determine whether SSDs in French-speaking children could be classified into three groups: motor speech, phonological (or speech delay), and articulation (or speech errors), and whether the phonological group could be further divided into phonological delay, consistent phonological disorder, and inconsistent phonological disorder, as proposed in current classification systems. Participants included 59 children with SSD and 40 children with typical development (TD), aged 4 to 8 years. They were administered a battery of tests that targeted phonological and motor speech aspects of production. Focusing primarily on three motor speech tasks (intra-word variability, diadochokinetic (DDK) rate, and an oral motor examination), we examined whether children exhibited difficulty across all three tasks (consistent with a motor speech disorder), displayed difficulty on the intra-word variability test (inconsistent phonological disorder), or did not exhibit difficulty with any of these three tasks (phonology group). In the case of children classified in the phonology group, we examined their transcription data to determine whether their errors were usual (phonological delay), unusual (phonological disorder) or restricted to difficulty with /s/ and /r/ (articulation). Categorization using strict criteria was unsuccessful leading to alternative approaches to categorization. Focusing primarily on two tests, DDK and intra-word variability, we found support for a motor speech group (n=15), an inconsistent phonological group (n=18), and a phonological delay group (n=26). One child was classified as having an articulation disorder and no child was classified as having a consistent phonological disorder. Findings with French-speaking children provide mixed support for current SSD classification systems. Results were consistent with alternative categorizations of SSD that posit three groupings (motor speech, inconsistent phonological, phonological) or with studies that document a continuum of severity on the phonological - motor speech continuum.

This study aimed to examine the phonological awareness (PA), morphological awareness (MA), and vocabulary skills of preschool children with speech sound disorders (SSD), as well as the relationships among these three skills-known to be critical for literacy development-within the context of Turkish, a morphologically rich and phonologically transparent language. Thirty children (17 boys and 13 girls, aged 48-72 months; M = 63.03, SD = 7.79) with SSD participated. Parental consent was obtained using the History Form. Children were assessed with the Turkish School-Age Language Development Test subtests (Picture, Relational, and Oral Vocabulary, Morphological Completion) and the Turkish Articulation and Phonology Test subtests (Articulation Screening Test, Auditory Discrimination Test) for SSD. PA was assessed using the Turkish Phonological Awareness Test. All assessments were face to face. Preschool children with SSD showed heterogeneous performance across PA, MA, and vocabulary measures. A statistically significant strong positive correlation was observed between children's MA skills and PA skills at the word, rhyme, and syllable levels (r = .50-.79). A strong positive correlation was found between children's ability to generate oral definitions (an expressive vocabulary skill) and MA skills (r = .68, 95% CI [0.42, 0.84], p < .001). In addition, a moderate positive correlation was observed between children's ability to orally express relationships between spoken stimulus words (relational vocabulary) and MA skills (r = .51, 95% CI [0.18, 0.73], p < .01). This study demonstrates strong relationships among MA, PA, and vocabulary in Turkish-speaking preschool children with SSD, highlighting the interconnected nature of these skills in early language and literacy development.

Reversed sound symbolism in speech sound disorders: Evidence for atypical cross-modal integration in a transparent language (Turkish).

The purpose of the present study was to report the phonological neighborhood density, phonotactic probability, and word frequency of the stimuli in 12 commonly used articulation and/or phonological tests. We extend the work of Macrae (2017), who identified variability in stimulus items across consonant singletons, consonant clusters, vowels, phoneme complexity, and bound morpheme. This study sought to augment that work with a deeper analysis of lexical and sublexical features of these stimuli. The stimuli from 12 articulation and/or phonological tests were extracted, resulting in 667 stimuli. All stimuli were run through a phonological neighborhood density and phonotactic probability calculator. Word frequency was determined using Moe et al.'s (1982) database. Means and ranges for all lexical characteristics were computed across each of the 12 tests. Most stimuli were from sparse phonological neighborhoods, and included common sound sequences. Although the average word frequency value was in the high range, overall, very few test stimuli were high-frequency words. There was not one articulation and/or phonological test that considered or balanced these three lexical properties. We discuss the linguistic constraints surrounding developing such a test. We also discuss future research opportunities to examine if these lexical properties may result in over- and underidentification of children with speech sound disorders.

The current preliminary study examined the effects of a computer-based training program designed to improve the accuracy of bilingual speech-language pathology clinicians in identifying dialect-specific phonetic features and distinguishing dialectal differences from speech sound disorders across various Spanish dialects. A single-case multiple-baseline design across six bilingual Spanish-English graduate students was employed. The training intervention utilized the Teach-Model-Coach-Review instructional framework across two modules focused on dialectal feature identification and accurate classification of dialectal differences versus disorders. Data were graphed and analyzed for the presence of a functional relation between variables. Participants also provided qualitative feedback on the program's feasibility, usability, and relevance for clinical practice. All participants showed significant improvement from baseline to intervention in accurately identifying dialectal phonetic features (Tau-U = 1.00, p < .01) and differentiating dialectal differences from disorders (Tau-U = 1.00, p < .05). These improvements were maintained over the maintenance period. Qualitative analyses indicated that participants felt increased comfort, confidence, and clinical preparedness after training. Findings support the efficacy of structured, computer-based dialectal training to enhance critical diagnostic skills among bilingual Spanish-English speech-language pathology clinicians by enhancing assessment accuracy and reducing the risk of misdiagnosis in Spanish-speaking clients.

Phonological processing and decoding abilities in early elementary school-aged children with speech sound disorders and developmental dyslexia.

Introduction The quality of relationships between speech and language therapists (SLTs) and clients, in this case, children with speech sound disorder (SSD) of unknown origin, is a crucial factor for successful intervention. These relationships are affected by how services are configured and what SLTs are asking of the children. The public and patients’ views are therefore vital in the evaluation or redesign of services. The aim of the present work was, through public and patient involvement and engagement, to gain insight into experiences of young children who had received intervention for SSD. Methods A total of seven children (seen individually) aged 4- to 7-years-old with SSD took part in four activities. The activities took place in a clinical setting with two qualified SLTs facilitating the interactions, one of whom was previously known to the children. Emotional mapping activities- drawing, using toy figurines, emojis and pictures – facilitated the children in telling us about their experiences of SSD interventions. Results Children drew, pointed and verbalised who, what, where and when they had intervention and how they felt about it. Children selected ‘happy’ or ‘cool’ emoji to indicate how they felt during therapy. Children commented on environmental factors, such as being taken out of the classroom to see the SLTs, as a positive thing as ‘other children are too noisy’, and said that it is ‘special time’ for them to ‘work on my sounds’. They also mentioned that they ‘liked’ their SLTs and personal factors such as the ‘big bag with a flower on it, that is full of toys’. Conclusions Children are able to communicate their experiences of speech and language therapy for SSD through emotional mapping activities.

Background This study aimed to compare speech intelligibility and articulation-phonological skills of children with congenital severe-to-profound sensorineural hearing loss who received cochlear implantation at one of three implantation-age ranges (12–17, 18–23, and 24–29 months) with those of age-matched peers with typical hearing. Methods The study included 45 children (32 males and 13 females) who received cochlear implants at 12–17, 18–23, or 24–29 months and were 5–7 years old at data collection. Each implantation-age subgroup consisted of n = 15 children. A control group of 15 children (7 males and 8 females) with typical hearing, aged 5–7, was also included. The Turkish Articulation and Phonology Test (SST) were used to assess articulation and phonological skills. The Intelligibility in Context Scale (ICS) was used to assess speech intelligibility. Results Children implanted at 12–17 months demonstrated significantly more advanced articulation and phonological skills compared with those implanted at later ages. Nonetheless, even early-implanted children did not attain articulation, phonological skills or speech intelligibility levels observed in age-matched peers with typical hearing. Conclusions These findings underscore the importance of early cochlear implantation during infancy. While early implantation is associated with improved speech outcomes, children with cochlear implants may continue to exhibit speech sound disorders affecting their articulation, phonological skills, and intelligibility. This suggests a need for ongoing, speech-focused intervention, in addition to general language support, with continuous monitoring and active family involvement.

Speech sound disorders are common in children and are associated with an increased risk of academic reading difficulties. The COVID-19 pandemic further highlighted the need for remote and digitalized assessment tools. In South Korea, standardized instruments such as the Urimal Test of Articulation and Phonation and Assessment of Phonology and Articulation for children are widely used but have limitations, including reliance on face-to-face evaluation, and the absence of automated scoring. This study aimed to develop and establish the content validity of an articulation assessment tool that can overcome these limitations and be integrated into digital therapeutics (DTx). A 3-round modified Delphi survey was conducted between July and September 2025 with 92% (23/25) of the invited experts, including 52.2% (12/23) physiatrists and 47.8% (11/23) speech-language pathologists, with a mean professional experience of 10.69 (SD 5.09) years. All participants (23/23, 100%) completed all rounds. Panelists evaluated the appropriateness of word lists, phonological environments, and scoring criteria. Quantitative analyses, including calculations of content validity ratio (CVR), content validity index (CVI), and median and IQR, were performed. Consensus thresholds were set at a CVR of ≥0.39, a CVI of ≥0.78, a median of ≥3.5, and an IQR of ≤1.0. Items were retained only when all 4 criteria were satisfied. While formal qualitative analysis was not performed, the research team internally reviewed and synthesized core keywords and themes from the experts' open-ended responses to guide the refinement of items. These findings were summarized into four key areas: (1) modernization of word stimuli, (2) expansion of phonological coverage, (3) refinement of scoring criteria to reduce ambiguity, and (4) enhancement of result interpretability through visualization. In round 2, a revised 35-word list was evaluated across 25 items, of which 20 (80%) met all consensus criteria. In total, 20% (5/25) of the items failed to meet at least one threshold, including phonological environment adequacy (CVR=0.48; CVI=0.74), scoring redundancy (CVR=0.13; CVI=0.57), usefulness of proportion of whole-word correctness or percentage of word proximity (CVR=0.39; CVI=0.70), contribution of mean phonological length (CVR=0.22; CVI=0.61), and usefulness of feature-based indexes (CVR=0.30; CVI=0.65; IQR 2). Items that reached consensus showed CVR values of 0.57 to 0.91, CVI values of 0.78 to 0.96, a median score of 4, and IQR values of 0 to 1. In round 3, all remaining items achieved consensus. This Delphi study developed a novel articulation assessment tool with robust content validity. This tool includes updated word stimuli, diverse analysis indexes, and visualization features, thereby enhancing its clinical utility and suitability for integration into artificial intelligence-based DTx. By standardizing and digitalizing articulation assessments, this tool has the potential to support personalized and accessible interventions for children with speech sound disorders.

This study evaluated the effects of computerized perceptual training by incorporating key modifications to address limitations identified in prior research. Training was specifically targeted to children identified as having "atypical perception," considered good candidates for perceptual training. Ten monolingual English-speaking children aged 9;0-11;7 (years;months) with residual speech sound disorder (RSSD) affecting /ɹ/ participated in a multiple-baseline study, completing three to six baselines before receiving twelve 30-min perceptual training sessions. A midpoint production probe was administered immediately after the perceptual training phase to assess preliminary changes in /ɹ/ accuracy. Subsequently, participants engaged in exploratory practice sessions, focused on facilitating rhotic production, followed by three postprobe sessions and a 1-month follow-up. All study activities were conducted online. Visual inspection of individual trajectories and calculation of standardized effect sizes revealed meaningful changes in auditory-perceptual skills following the perception training. The majority of participants exhibited a reduction in categorical labeling consistency, suggesting more consistent categorization of speech stimuli along the /ɹ/-/w/ continuum, and all participants showed increased perceptual accuracy in the identification task. Category goodness ratings of /ɹ/ words also improved for all participants, with effect size values indicating clinically meaningful change. This study demonstrates that online computerized perceptual training holds promise as an effective intervention for improving speech, particularly when tailored to the needs of children with RSSD and atypical speech perception. With the long-term goal of making these tools freely available to clinical practitioners, we aim to empower clinicians to deliver targeted, effective interventions that accelerate progress for clients with RSSD. https://doi.org/10.23641/asha.32015043.

Introduction: Recurrent otitis media, defined as ≥3 episodes in 6 months or ≥4 in 12 months, may lead to fluctuating conductive hearing loss during a critical period of phonological development (6-36 months), potentially affecting speech sound acquisition. Objectives: To analyze the association between recurrent otitis media and speech sound disorders in Portuguese preschool children (M=66.45 months, SD=4.39), hypothesizing higher phonological process prevalence in recurrent otitis media cases (n=30) versus controls (n=30) due to cumulative auditory deprivation affecting lingual and labial precision. Methodology: A case-control study was conducted with 60 Portuguese children aged 5-6years (n=39 with recurrent otitis media; n=30 controls). Speech production was assessed by the Psychology Center at the University of Porto Articulation Test. Statistical analyses included descriptive and inferential tests (χ² and Mann-Whitney U), with significance set at p&lt;0.05. Results: Children with recurrent otitis media showed a higher prevalence of speech sound disorders compared to controls (90% vs. 60%, p=0.007). Cluster reduction was the most frequent phonological process (87% vs. 57%, p=0.010). Other processes, including liquid omissions and substitutions, were also more frequent in the recurrent otitis media group. Conclusion: Recurrent otitis media is associated with a higher prevalence of speech sound disorder in preschool children. These findings highlight the importance of monitoring speech development in children with a history of recurrent otitis media. However, results should be interpreted with caution due to the limitations of the study design.

ABSTRACT Corpora of speech sound disorder are precious resources in Speech and Language Therapy (SLT) education, but their development is costly in terms of time and funding. This paper reports on an initiative that created a dataset of Irish English-based materials for teaching and assessing phonetic transcription at the pre-registration level. The dataset includes audio recordings of single words, sentences and spontaneous speech elicited from five children with speech sound disorder, five children with typical speech development and five typical adults with no speech difficulties. In order to design and evaluate the resource, SLT students and Practice Educators were surveyed before and after resource creation. We report on the overall process, discuss results from the surveys and outline future directions in resource development for teaching purposes. Overall, our respondents agreed that the resource filled a gap in teaching materials for SLT education.