Speech Sound Disorders Research Articles

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

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

Morphosyntactic profiles among preschoolers with and without speech sound disorders

ABSTRACT The aim of the current study was to identify whether certain morphosyntactic constructs are more difficult for children with speech sound disorder than children with typical speech development. In this post-hoc study, we used chi-square analyses to identify group differences on individual questions on a standardised test of expressive morphosyntax. Participants included 80 preschool-age children, 40 with typical speech and language development (TD), and 40 with speech sound disorder and typical language development (SSD). A chi-square analysis revealed group (TD vs. SSD) differences in usage of subject pronouns, irregular past tense verbs, and yes/no interrogative formation. Ordinal logistic regression revealed that phonological awareness was related to irregular past tense verb use. Children with SSD may present with subclinical morphosyntax difficulties. Speech-language pathologists should consider incorporating morphosyntax assessment into test batteries for children with SSD.

Assistive Magnetic Skin System for Speech Reconstruction: An Empowering Technology for Aphonic Individuals

Individuals with a voice disorder or speech sound disorder (SSD) (i.e., aphonic or mute people) can have any combination of difficulties with perception, articulation/motor production, and phonotactics, which may impact their speech intelligibility and acceptability, thus finding challenging to communicate with the public. As a result, many individuals suffer from frustration, isolation, and depression. Natural verbal communication for SSD patients is now more feasible than ever thanks to advancements in wearable artificial skins and machine learning. This article presents an assistive magnetic skin system for speech reconstruction (AM2S‐SR), which enables SSD‐afflicted people to communicate with their mouths. Using magnetic field sensors integrated into Magnetphones, the system reads the movement of the mouth by tracking the movement of magnetic skin patches attached next to the bottom lip. The measured magnetic field signals data are then processed using a Fine K‐Nearest Neighbor machine learning classifier. The classified data are then exported verbally on speakers, or visually on a display. AM2S‐SR successfully identifies the full English alphabets with average success rate of 94.96%, thus enabling SSD people to talk using the mouth and have a more natural conversation with others.

Assessing Phonological Processing in Children With Speech Sound Disorders

Purpose: Phonological processing skills, or using phoneme knowledge to process language, in preschool- and kindergarten-age children are an important indicator of children's future reading abilities. However, assessing phonological processing skills can be difficult in children with speech sound disorders because scoring often requires that children produce speech sound accurately. This tutorial presents assessment tasks that are appropriate for children with speech sound disorders to better identify children with phonological processing difficulties. Conclusions: The following phonological processing assessment tasks are recommended for children with speech sound disorders: receptive tasks for phonological awareness, the Syllable Repetition Task for phonological memory, and limited letter choices for rapid automatized naming in phonological retrieval tasks. These tasks can be modified for multilingual children. Appropriate assessment of phonological processing skills will help speech-language pathologists in differential diagnosis of children with true phonological processing difficulties and children whose speech sound errors may mask phonological processing abilities. Assessment of phonological processing skills is particularly important for children with speech sound disorders, whose speech errors may be evidence of phonological processing difficulties.

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

Limited research exists assessing speech perception in school-age children with speech sound disorder (SSD) and childhood apraxia of speech (CAS); despite early evidence that speech perception may lead to error-prone motor planning/programming. In this study, we examine speech perception performance in school-age children with and without speech production deficits. Speech perception was assessed using the Wide Range Acoustic Accuracy Scale to determine the just-noticeable difference in discrimination for three consonant-vowel syllable contrasts (/bɑ/-/wɑ/, /dɑ/-/gɑ/, /ɹɑ/-/wɑ/), each varying along a single acoustic parameter for seven children with CAS with rhotic errors, seven children with SSD with rhotic errors, and seven typically developing (TD) children. Findings revealed statistically significant mean differences between perceptual performance of children with CAS when compared to TD children for discrimination of /ɹɑ/-/wɑ/ contrasts. Large effect sizes were also observed for comparisons of /ɹɑ/-/wɑ/ contrasts between children with CAS, SSD, and TD peers. Additionally, large effect sizes were observed for /dɑ/-/gɑ/ contrasts between children with CAS and SSD and TD children despite nonsignificant mean differences in group performance. Overall, mean outcome scores suggest that school-age children with CAS and persistent rhotic errors demonstrated less accurate speech perception skills relative to TD children for the /ɹɑ/-/wɑ/ contrasts. However, the relatively small sample sizes per group limit the extent to which these findings may be generalized to the broader population.

Phonological awareness training and phonological therapy approaches for specific language impairment children with speech sound disorders: a comparative outcome study.

Children with specific language impairment (SLI) might present with speech sound disorder (SSD) and phonological awareness (PA) deficits which put them at risk of potential reading problems. This work aimed to organizean intervention program in Arabic forphonologicaltraining and to assess the effect of PA training versus the phonological therapy (PT) for children with SLI and SSD. The study was carried out on 60 children with comorbid SLI and SSD, aged 5-7 years. Children were equally divided into two groups; each group received language therapy combined with (PT or PA training). Measures of language development, phonological output, and PA were taken before therapy and at 4 month post-therapy for all children. The two therapy groups made nearly the same amount of progress in the development of language and phonological production, with no significant differences regarding language age and percent of consonants correct (PCC). The PA training group progressed more on the PA skills than children who received PT over the same time. PA training could facilitate the development of phonological skills by targeting the child's awareness of phonemes and improving the production of sound patterns.

Traditional and Visual-Acoustic Biofeedback Treatment via Telepractice for Residual Speech Sound Disorders Affecting /ɹ/: Pilot study.

This study aimed to examine the feasibility of telepractice delivery of a treatment package including visual-acoustic biofeedback and motor-based treatment for residual speech sound disorder affecting /ɹ/ in school-age children. The overall study used a single-case randomization design; however, this preliminary report will simply quantify changes in accuracy before and after completion of the treatment package. The present analysis did not differentiate between the relative contributions of biofeedback and motor-based treatments. Seven children aged 9-14 received speech therapy for /ɹ/ distortions via telepractice. The study design consisted of three phases: baseline (four sessions), treatment (20 sessions), and post-treatment (three sessions). Treatment included two sessions weekly for a duration of 10 weeks. The participants received one motor-based/non-biofeedback session and one visual-acoustic biofeedback session per week. The order of treatment within each week was randomly determined prior to the start of therapy. Overall progress was assessed using untrained listeners' ratings of word probes administered in the baseline and posttreatment phases. Findings revealed that six of the seven participants showed a clinically significant response to the overall treatment package, although the magnitude of individual responses varied across speech contexts (consonantal and vocalic) and participants. The present results suggest that a treatment combining visual-acoustic biofeedback and motor-based treatment for residual /ɹ/ errors treatment can be effectively delivered via telepractice. Considerations for technology setup and treatment protocols are provided.

Understanding capacity for implementing new interventions: A qualitative study of speech and language therapy services for children with speech sound disorder.

Many speech sound disorder (SSD) interventions with a long-term evidence base are 'new' to clinical practice, and the role of services in supporting or constraining capacity for practice change is underexplored. Innovations from implementation science may offer solutions to this research-practice gap but have not previously been applied to SSD. To explain variation in speech and language therapy service capacity to implement new SSD interventions. We conducted an intensive, case-based qualitative study with 42 speech and language therapists (SLTs) in three NHS services (n = 39) and private practice (n = 3) in Scotland. We explored therapists' diverse experiences of SSD practice change through individual interviews (n = 28) or self-generated paired (n = 2) or focus groups (n = 3). A theoretical framework (Normalization Process Theory) helped us understand how the service context contributed to the way therapists engaged with different practice changes. We identified six types ('cases') of practice change, two of which involved the new SSD interventions. We focus on these two cases ('Transforming' and 'Venturing') and use Normalization Process Theory's Cognitive participation construct to explain implementation (or not) of new SSD interventions in routine practice. Therapists were becoming aware of the new interventions through knowledge brokers, professional networks and an intervention database. In the Transforming case, new SSD interventions for selected children were becoming part of local routine practice. Transforming was the result of a favourable service structure, a sustained and supported 'push' that made implementation of the new interventions a service priority, and considerable collective time to think about doing it. 'Venturing' happened where the new SSD interventions were not a service priority. It involved individual or informal groups of therapists trying out or using one or more of the new interventions with selected children within the constraints of their service context. New, evidence-based SSD interventions may be challenging to implement in routine practice because they have in common a need for therapists who understand applied linguistics and can be flexible with service delivery. Appreciating what it really takes to do routine intervention differently is vital for managers and services who have to make decisions about priorities for implementation, along with realistic plans for resourcing and supporting it. What is already known on the subject Many SSD interventions have an evidence base but are not widely adopted into routine clinical practice. Addressing this is not just about individual therapists or education/training, as workplace pressures and service delivery models make it difficult to change practice. What this paper adds to the existing knowledge This paper applies innovations from implementation science to help explain how what is going on in services can support or constrain capacity for implementing evidence-based SSD interventions. What are the potential or actual clinical implications of this work? Service managers and therapists will have a clearer idea of the time and support they may realistically have to invest for new SSD interventions to be used routinely.

Diagnosing inconsistent phonological disorder: quantitative and qualitative measures

ABSTRACT Studies of children’s consistency of word production allow identification of speech sound disorder. Inconsistent errors are reported for two groups of children: childhood apraxia of speech (CAS) due to difficulty with the motoric precision and consistency of speech movements; and inconsistent phonological disorder (IPD) attributed to impaired phonological planning. This paper describes the inconsistent productions of children with IPD in comparison to typically developing children. In two studies of suspected SSD (N = 135), 22 children pronounced ≥40% of 25 words inconsistently on three repeated trials. No participant had symptoms of CAS. They were monolingual and spoke Australian- or Irish-English. Assessment determined the proportions of words said consistently (i.e. the same across productions: all correct or with the same error) or inconsistently (i.e. differently across productions: at least one correct and one error or different errors in productions). Qualitative analyses examined error types and explored the effect of target words’ characteristics on inconsistency. Children with IPD produced 52% of words with different errors. While 56% of all phoneme errors were developmental (age appropriate or delayed), atypical errors typified inconsistency: default sounds and word structure errors. Words with more phonemes, syllables and consonant clusters were vulnerable to inconsistency, but their frequency of occurrence had no effect. TD children and those with IPD had different quantitative and qualitative error profiles, confirming IPD as a diagnostic category of SSD. Qualitative analyses supported the hypothesised deficit in phonological planning of words’ production for children with IPD.

Decision Tree Versus Linear Support Vector Machine Classifier in the Screening of Medial Speech Sounds: A Quest for a Sound Rationale.

This paper describes the latest development in the classification stage of our Speech Sound Disorder (SSD) Screening algorithm and presents the results achieved by using two classifier models: the Classification and Regression Tree (CART)-based model versus the Single Decision Hyperplane-based Linear Support Vector Machine (SVM) model. For every single speech sound in medial position, 10 features extracted from the audio samples along with an 11th feature representing the validation of the (mis)pronunciation by the Speech Language Pathologist (SLP) were fed into the 2 classifiers to compare and discuss their performance. The accuracy achieved by the two classifiers on a data test size of 30% of the analyzed samples was 98.2% for the Linear SVM classifier, and 100% for the Decision Tree classifier, which are optimal results that encourage our quest for a sound rationale.

Performances of Pointing Phonological Memory Tasks between Children with and without Speech Sound Disorders

Objectives: A new phonological memory task using pointing responses was developed and the performance of each sub-task was compared between children with and without speech sound disorders (SSD). Methods: 16 children with SSD and 14 typically developing children (TD) performed pointing memory tasks, which consists of four sub-tasks—auditory short-term, auditory working, visual short-term, and visual working memory; and performances between groups and between each sub-task were compared. In addition, the correlation between the new task and the existing task (digit span task), vocabulary sizes and the accuracy of consonants was analyzed. Results: First, the SSD group showed significantly lower performance in the pointing memory tasks than the TD group. Second, both the SSD and TD groups showed significantly higher performance in auditory stimulation compared with visual stimulation, and in short-term memory than working memory. Third, in the case of the TD group, the performance of the auditory short-term memory task was much better, and there were no significant differences among the other three sub-tasks, while the SSD group showed a sequential decline in performances among the four sub-tasks. Finally, there was a high correlation between the new task and the existing task, vocabulary sizes, and the accuracy of consonants. Conclusion: The low performance in the phonological memory task of the SSD group is not due to weakness in articulation or in auditory processing, but to defects in phonological short-term/working memory itself. The results of this study provide meaningful information on the different performance patterns of phonological memory tasks according to stimulus modalities between the SSD and TD groups.

The development of speech output processing skills in Greek-speaking children

ABSTRACT There is a growing body of literature on phonological development in Greek-speaking children, either typically developing (TD) or with speech sound disorders (SSD). In this paper, a cross-sectional longitudinal approach was used to investigate the development of speech output processing skills in TD Greek-speaking preschool-aged children. Moreover, a group of Greek-speaking children with SSD were assessed to identify potential loci of impairment in atypical development. The developmental study involved two groups: group 1 (n = 16) aged 3;0–3;5 years and group 2 (n = 22) aged 4;6–5;0 years, assessed at three assessment points six months apart. Children with SSD (n = 15) aged 5;6–6;0 years were assessed to be compared with performance of group 2 TD children (at the third assessment point). Assessment tasks included (a) a picture naming task, (b) a task of real word repetition and (c) a task of nonword repetition. A strong time effect was found in both groups of TD children in the development of speech output processing abilities. Performance accuracy was higher on tasks including real words than nonwords; children performed more accurately on repetition rather than spontaneous naming of real words; repetition accuracy on 2–3 syllables items was significantly better than on 4–5 syllables items. Children with SSD were outperformed by TD children of the same age in all assessment tasks; lexicality and word length effect were found in the clinical group. Findings from the present study may be used as a starting point to diagnose children with speech production difficulties in Greece.

Ultrasound Tongue Imaging in Research and Practice with People with Cleft Palate ± Cleft Lip.

Ultrasound tongue imaging is becoming popular as a tool for both phonetic research and biofeedback for treating speech sound disorders. Despite this, it has not yet been adopted into cleft palate ± cleft lip care. This paper explores why this might be the case by highlighting recent research in this area and exploring the advantages and disadvantages of using ultrasound in cleft palate ± cleft lip care. Research suggests that technological advances have largely overcome some of the difficulties of employing ultrasound with this population and we predict a future increase in the clinical application of the tool.

APPLICATION OF MOTOR SENSORY APPROACH TO IMPROVE ARTICULATION SKILLS IN CHILDREN WITH INTELLECTUAL DISABILITIES

Several studies have shown that speech sound disorders in children with intellectual disabilities impact communication with their environment. They have more difficulty with expressive language and speech intelligibility than receptive. Interventions are needed to improve speech skills, especially in articulation skills. Purpose: This study aims to determine the effect of sensory motor methods in improving articulation skills. Method: using a single subject experiment, using a one group pretest-posttest design. The participant is a girl aged 7:6 years old with articulation disorder on consonants /p/, /b/, /m/, /n/, /w/, /t/, /d/, /k/, /g/, /ŋ/, /j/, /c/, /f/, /w/, /v/, /h/, /r/, /y/, /z/, /fr/, /br/, /dw/, /gr/, /kl/, /pr/, /sk/, /sp/, /st/, /sw/. Data collection was done through interviews with the client's parents, direct observation of the client, and tests. Speech therapy was conducted for 10 sessions with an emphasis on sensory-motor integration. Perceptual assessment was carried out by comparing the ability to produce the phoneme /p/ in the initial position of the word with a combination of vowels /a/ before and after therapy. Results: in the post speech therapy assessment, there was an increase of 40%. Conclusion: from the therapy activities for 10 session with the Sensory Motor Approach, the client was quite successful in producing /p/ in the initial position of the word with a combination of vowels /a/. Suggestion: this study suggests designing a therapy cycle in order to find out the effectiveness of the Sensory Motor Approach more deeply.

Intelligibility in Context Scale: Psychometric evidence and implications for Saudi Arabic-English-speaking preschoolers

Purpose: To evaluate the reliability, validity, and diagnostic accuracy (sensitivity, specificity) of the Intelligibility in Context Scale in Saudi Arabic (ICS-SA) and English (ICS-E) as potential measures of functional speech intelligibility in bilingual preschool-aged Saudi Arabian children. Method: The study included 36 parent-child (aged 3;0 to 6;5 years; months) dyads who were bilingual speakers of Saudi Arabic and English, which included two groups—typically developing (TD, n = 29) and suspected speech sound disordered (sSSD, n = 7). The children’s intelligibility was evaluated in both languages using the ICS-SA and ICS-E. Children’s single-word productions were collected in both languages and calculated for percentage of consonants, vowels, and phonemes correct (i.e. PCC/PVC/PPC) to establish their speech-sound competence. Result: The mean scores for the entire sample (n = 36) were 4.43 (SD = 0.79) for the ICS-SA and 4.48 (SD = 0.79) for the ICS-E, showing that parents rated their children’s intelligibility in both languages similarly. Both the ICS-SA and ICS-E demonstrated excellent internal consistency (α = 0.96 and α = 0.95, respectively). There was high inter-rater and test-retest reliability for the ICS-SA, while there was fair to high inter-rater and test-retest reliability in ICS-E. Significant correlations were found for the ICS-SA, but weak correlations were noted for the ICS-E, which indicated fair to moderate evidence of criterion validity. Construct validity efforts indicated a weak correlation with age on both the ICS-SA and ICS-E. The findings also indicated high discriminant accuracy for both the ICS-SA (0.86, 0.86) and ICS-E (0.71, 0.69). Conclusion: This study provides initial validation and reliability evidence for using the ICS-SA and ICS-E with Saudi Arabic- and English-speaking preschoolers, however, ICS-E scores suggest further testing is warranted. By extension, these findings expand the bilingual knowledge base and offer new tools for identifying children in Saudi Arabia who may be at risk for having a speech sound disorder.

Relations Between Selective Mutism and Speech Sound Disorder in Children With 7q11.23 Duplication Syndrome.

The aim of this study was to explore relations between speech sound disorder severity and selective mutism in a group of children with 7q11.23 duplication syndrome (Dup7), a genetic condition predisposing children to childhood apraxia of speech (CAS) and other speech sound disorders and to anxiety disorders, including selective mutism and social anxiety disorder. Forty-nine children aged 4-17 years with genetically confirmed Dup7 completed the Goldman-Fristoe Test of Articulation-Second Edition (GFTA-2), the Expressive Vocabulary Test-Second Edition (EVT-2), and the Differential Ability Scales-Second Edition (DAS-II). Parents completed the Anxiety Disorders Interview Schedule-Parent (ADIS-P). Mean standard scores (SSs) were 65.67 for the GFTA-2, 92.73 for the EVT-2, and 82.69 for the DAS-II General Conceptual Ability (GCA; similar to IQ). Standard deviations for all measures were larger than for the general population. GFTA-2 SS was significantly correlated with both EVT-2 SS and DAS-II GCA. Based on the ADIS-P, 22 participants (45%) were diagnosed with selective mutism and 29 (59%) were diagnosed with social anxiety disorder. No significant differences in performance on any of the measures were found either between the group with a selective mutism diagnosis and the group that did not have selective mutism or between the group with a selective mutism and/or social anxiety disorder diagnosis and the group that did not have either disorder. For children with Dup7, neither the diagnosis of selective mutism nor the diagnosis of selective mutism and/or social anxiety disorder was related to severity of speech sound disorder, expressive vocabulary ability, or overall intellectual ability. Accordingly, treatment for speech sound disorder alone is unlikely to lead to remission of selective mutism or social anxiety disorder. Instead, selective mutism and/or social anxiety disorder should be treated directly. Further research is needed to determine if these findings generalize to other populations, such as children with idiopathic CAS.

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

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. 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). 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. 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.

How differences in anatomy and physiology and other aetiology affect the way we label and describe speech in individuals with cleft lip and palate.

Speech in individuals with cleft lip and/or palate (CLP) is a complex myriad of presenting symptoms. It is uniquely associated with the structural difference of velopharyngeal insufficiency (VPI), together with a wide and heterogeneous range of other aetiologies which often co-occur. The nature of the speech sound disorder (SSD) including VPI may also change over the course of an individual's care pathway. Differences in terminology and approaches to analysis are currently used, resulting in confusion internationally. Additionally, current diagnostic labels and classification systems in SSD do not capture the complexity and full nature of speech characteristics in CLP. This paper aims to explore the different aetiologies of cleft palate/VPI speech and to relate aetiology with speech characteristic(s). In so doing, it attempts to unravel the different terminology used in the field, describing commonalities and differences, and identifying overlaps with the speech summary patterns used in the United Kingdom and elsewhere. The paper also aims to explore the applicability of current diagnostic labels and classification systems in the non-cleft SSD literature and illustrate certain implications for speech intervention in CLP. The different aetiologies were identified from the literature and mapped onto cleft palate/VPI speech characteristics. Different terminology and approaches to analysis are defined and overlaps described. The applicability of current classification systems in SSD is discussed including additional diagnostic labels proposed in the field. Aetiologies of cleft palate/VPI speech identified include developmental (cognitive-linguistic), middle ear disease and fluctuating hearing loss, altered oral structure, abnormal facial growth, VPI-structural (abnormal palate muscle) and VPI-iatrogenic (maxillary advancement surgery). There are four main terminologies used to describe cleft palate/VPI speech: active/passive and compensatory/obligatory, which overlap with the four categories used in the UK speech summary patterns: anterior oral cleft speech characteristics (CSCs), posterior oral CSCs, non-oral CSCs and passive CSCs, although not directly comparable. Current classification systems in non-cleft SSD do not sufficiently capture the full nature and complexity of cleft palate/VPI speech. Our attempt at identifying the heterogeneous range of aetiologies provides clinicians with a better understanding of cleft palate/VPI speech to inform the management pathway and the nature and type of speech intervention required. We hope that the unravelling of the different terminology in relation to the UK speech summary patterns, and those used elsewhere, reduces confusion and provides more clarity for clinicians in the field. Diagnostic labels and classification require international agreement. What is already known on the subject Speech associated with cleft palate/velopharyngeal insufficiency (VPI) is a complex myriad of speech characteristics with a wide and heterogeneous range of aetiologies. Different terminology and speech summary patterns are used to describe the speech characteristics. The traditional classification of cleft palate/VPI speech is Articulation Disorder, although evidence is building for Phonological Disorder and contrastive approaches in cleft speech intervention. What this paper adds to existing knowledge This paper explores the range of aetiologies of cleft palate/VPI speech (e.g., altered oral structure, abnormal facial growth, abnormal palate muscle and iatrogenic aetiologies) and attempts to relate aetiology with speech characteristic(s). An attempt is made at unravelling the different terminology used in relation to a well-known and validated approach to analysis, used in the United Kingdom and elsewhere. Complexities of current diagnostic labels and classifications in Speech Sound Disorder to describe cleft palate/VPI speech are discussed. What are the potential or actual clinical implications of this work? There needs to be a common language for describing and summarising cleft palate/VPI speech. Speech summary patterns based on narrow phonetic transcription and correct identification of aetiology are essential for the accurate classification of the speech disorder and identification of speech intervention approaches. There is an urgent need for research to identify the most appropriate type of contrastive (phonological) approach in cleft lip and/or palate.

Phonological Awareness in Children with and Without Speech Sound Disorder

Phonological Awareness in Children with and Without Speech Sound Disorder

The Reliability of Expert Diagnosis of Childhood Apraxia of Speech.

The current standard for clinical diagnosis of childhood apraxia of speech (CAS) is expert clinician judgment. The psychometric properties of this standard are not well understood; however, they are important for improving clinical diagnosis. The purpose of this study is to determine the extent to which experts agree on the clinical diagnosis of CAS using two cohorts of children with mixed speech sound disorders (SSDs). Speech samples of children with SSDs were obtained from previous and ongoing research from video recordings of children aged 3-8 years (n = 36) and audio recordings of children aged 8-17 years (n = 56). A total of 23 expert, English-speaking clinicians were recruited internationally. Three of these experts rated each speech sample to provide a description of the observed features and a diagnosis. Intrarater reliability was acceptable at 85% agreement. Interrater reliability on the presence or absence of CAS among experts was poor both as a categorical diagnosis (κ = .187, 95% confidence interval [CI] [0.089, 0.286]) and on a continuous "likelihood of CAS" scale (0-100; intraclass correlation = .183, 95% CI [.037, .347]). Reliability was similar across the video-recorded and audio-only samples. There was greater agreement on other diagnoses (such as articulation disorder) than on the diagnosis of CAS, although these too did not meet the predetermined standard. Likelihood of CAS was greater in children who presented with more American Speech-Language-Hearing Association CAS consensus features. Different expert raters had different thresholds for applying the diagnosis of CAS. If expert clinician judgment is to be used for diagnosis of CAS or other SSDs, further standardization and calibration is needed to increase interrater reliability. Diagnosis may require operationalized checklists or reliable measures that operate along a diagnostic continuum. https://doi.org/10.23641/asha.23949105.