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We investigated whether phonological awareness mediated the relationship between speechreading and reading comprehension in Chinese adults with hearing impairment (HI) and normal hearing (NH). Speechreading, phonological awareness, and reading comprehension tests were administered to 154 young adults with HI and 97 young adults with NH in China. Results revealed significant correlations between speechreading, phonological awareness, and reading comprehension in adults with HI, but not those with NH. Phonological awareness did not mediate the relationship between speechreading and reading comprehension in either group of participants. These results suggest that visual speech information (speechreading) contributes to the development of phonological representations in adults with HI, which in turn supports reading comprehension. This relationship was not observed in the adults with NH. Teachers and clinicians working with HI students need to have an understanding of this difference, and take into account the developmental nature of the relationship between speechreadaing, phonological awareness and reading comprehension in the HI students for differentiated reading intervention. If attention to the visual speech information via speechreading indeed contributes to better phonological awareness, HI students may benefit from other visual methods to develop component skills that are foundational to reading success. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate if multiple oppositions intervention (MOI) generated widespread change in the phonological systems of two children with cleft lip and palate (CLP) and severe speech sound disorders (SSD). We treated two children (ages 5;4 and 5;6) with CLP and severe SSD using MOI for 24 and 29 sessions. We measured the percentage consonants correct (PCC) for target consonants and untreated consonants in non-treatment single words, as well as PCC for connected speech. Data points were collected in the baseline, intervention, and maintenance phase with post-tests conducted immediately after intervention and at 1, 3, 6 and 12 months. Two speech and language therapists (SLTs) unfamiliar with the children performed phonetic transcriptions, and we calculated intra- and inter-rater agreement. We graphed the data, and used permutation tests to analyse the probability that the observed increases in PCC were due to random chance. Both children experienced considerable improvements in PCC across all measures at the first post-test, supporting the impact of MOI on their entire phonological system. The PCC continued to increase during the maintenance phase. By the final post-test, the PCC in connected speech exceeded 90% for both children, reducing their SSD classification to mild. Our findings support that a phonological, contrastive intervention approach targeting multiple consonants simultaneously can create system-wide phonological change for children with CLP and severe SSD. Further research with more participants is needed to strengthen these findings. [ABSTRACT FROM AUTHOR]

The literature reports contradictory results regarding the influence of visual cues on speech perception tasks in children with phonological disorder (PD). This study aimed to compare the performance of children with (n = 15) and without PD (n = 15) in audiovisual perception task in voiceless fricatives. Assuming that PD could be associated with an inability to integrate phonological information from two sensory sources, we presumed that children with PD would present difficulties in integrating auditory and visual cues compared to typical children. A syllable identification task was conducted. The stimuli were presented according to four conditions: auditory-only (AO); visual-only (VO); audiovisual congruent (AV+); and audiovisual incongruent (AV-). The percentages of correct answers and the respective reaction times in the AO, VO, and AV+ conditions were considered for the analysis. The correct percentage of auditory stimuli was considered for the AV- condition, as well as the percentage of perceptual preference: auditory, visual, and/or illusion (McGurk effect), with the respective reaction time. In comparing the four conditions, children with PD presented a lower number of correct answers and longer reaction time than children with typical development, mainly for the VO. Both groups showed a preference for auditory stimuli for the AV- condition. However, children with PD showed higher percentages for visual perceptual preference and the McGurk effect than typical children. The superiority of typical children over PD children in auditory-visual speech perception depends on type of stimuli and condition of presentation. [ABSTRACT FROM AUTHOR]

Purpose: Speech disorders associated with velopharyngeal dysfunction (VPD) are common. Some require surgical management, while others are responsive to speech therapy. This is related to whether the speech error is obligatory (passive) or compensatory (active). Accurate identification of speech errors is necessary to facilitate timely and appropriate intervention. Recent studies have supported the role of magnetic resonance imaging (MRI) in the assessment process for VPD. The purpose of this study was to utilize MRI to support differential diagnosis and treatment planning in a child presenting with inconsistent nasal air escape, mild hypernasality, and compensatory speech errors. Method: A nonsedated, fully awake, velopharyngeal (VP) MRI protocol was implemented to acquire anatomic data at rest and during phonation. Segmentations and visualization of the tongue, palate, adenoids, and nasopharyngeal airway were completed. Anatomic linear measurements were obtained for VP variables to assess VP function, establish a baseline, and monitor change over time. Results: VP anatomy was successfully visualized on MRI in multiple imaging planes. All anatomic measurements fell within normative expectations. Elevation and retraction of the soft palate occurred against the adenoid pad. A pharyngeal fricative was documented, resulting a small VP gap during speech. In contrast, adequate VP closure was obtained for vowels and other oral consonant sounds. Conclusions: Quantitative assessment and visualization of the anatomy demonstrated adequate VP closure capabilities and a pharyngeal fricative substitution that had not been adequately perceived during routine clinical assessments. This study suggests a promising additive role for VP MRI for enhanced differential diagnosis and therapeutic monitoring in children with VPD and concomitant speech disorders. Supplemental Material: https://doi.org/10.23641/asha.27905451 [ABSTRACT FROM AUTHOR]

The current study aimed to assess the effectiveness of incorporating ultrasound visual biofeedback (UVB) into a treatment programme addressing persistent speech sound disorders linked to cleft palate in children who have been unresponsive to traditional therapy approaches. Materials and Methods. A single-subject multiple baseline experiment was conducted with five children aged 6:5–13:5 over a period of 16 therapy sessions. Treatment focused on providing cues from real-time ultrasound images to assist children in modifying their tongue movements. Probe data were collected before, mid, and post-treatment to assess target consonant accuracy for 50 untreated words. The results of the statistical analysis suggested participants showed a significant increase in percent target consonant accuracy as a result of intervention using UVB. Although most of the participants exhibited progress in generalising learned phonemes to untreated words, some did not show improvement in gaining generalisation from treated phonemic contexts to those untreated ones. When traditional methods fail to yield significant progress, incorporating ultrasound biofeedback into the treatment programme emerges as a viable option to enhance sound accuracy in children with persistent speech sound disorders resulting from cleft palate. [ABSTRACT FROM AUTHOR]

Background: The ongoing COVID-19 pandemic and the current shortage of speech-language pathologists in Thailand have limited access to speech services for children with cleft palate with or without cleft lip (CP± L). A combination of telepractice (TP) and face-to-face therapy could address the lack of continuous service and improve accessibility to speech therapy providers. This study aimed to compare the percentage of consonants correct (PCC) before and after speech therapy in children with CP± L. Methods: This study included 19 children with CP± L, aged 5 to 13 years, who underwent primary cheiloplasty and palatoplasty. A perceptual assessment was conducted using the Thai Speech Parameters for Patients with Cleft Palate in a Universal Reporting System to evaluate speech before and after therapy. The intervention consisted of five 30-minute face-to-face speech therapy sessions and fifteen 30-minute TP sessions, totaling twenty sessions. Paired t-tests were used to analyze the mean differences in PCC for pre- and post-articulation errors, as well as caregiver satisfaction levels at the conclusion of the evaluation period. Results: Children with CP± L exhibited a significant increase in PCC; the mean difference (standard deviation, SD) was 9.36 (11.87), with a 95% confidence interval (CI) of 3.64 to 15.08 at the word level, and a mean difference (SD) of 13.25 (13.71), with a 95% CI of 6.65 to 19.86 at the sentence level. Caregivers rated their satisfaction as excellent. Conclusion: The integration of TP with traditional face-to-face speech therapy has proven to be a highly effective approach for reducing articulation errors in children with CP± L. Additionally, this method was well-suited for the constraints imposed by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: The relationship between ankyloglossia and speech is controversial. Our objective in the present study was to determine the most appropriate intervention and optimal timing for infants with speech articulation caused by ankyloglossia. Patients and Methods: A total of 341 pediatric patients (aged 2 to 5 years) being referred for speech concerns due to ankyloglossia were enrolled in a randomized trial and assigned to either a surgical intervention (N = 166) or a no surgical intervention (N = 175) group. Subsequently, patients were further categorized into 3 groups according to age: 2 to < 3 years, 3 to < 4 years, and 4 to < 5 years. Measures of tongue appearance, tongue mobility, speech production, and parent and clinician intelligibility ratings were collected at preintervention (T0), 2-month postintervention (T1), 6-month postintervention (T2), and 12-month postintervention (T3). Results: No statistically significant difference was found between surgical intervention and no surgical intervention groups for tongue appearance, tongue mobility, speech production, and intelligibility in the 2 to < 3 years age. However, there was significantly improved speech production and intelligibility in the surgical intervention group when compared to the no surgical intervention group in the 3 to < 4 and 4 to < 5 years old age. Conclusion: Surgical intervention should not be performed too early for infants aged 2 to < 3 years with speech articulation caused by ankyloglossia, but rather watch and wait for the physiological growth of the lingual frenulum. The optimal timing range for surgical intervention is 4 to 5 years. This should provide certain significant guidance for infants with speech articulation caused by ankyloglossia. [ABSTRACT FROM AUTHOR]

Brunner syndrome is a rare genetic disorder that associated with mutations in the MAOA gene. It has been linked to a number of psychiatric disorders. We present detailed information on psychiatric evaluation of a case carrying a novel MAOA gene variant of p.(Thr408Met). The patient was referred to our clinic with a history of attention problems, motor coordination difficulties and a tendency to bite objects. Following a comprehensive psychiatric evaluation, the patient was diagnosed with developmental coordination disorder, articulation disorder and attention deficit hyperactivity disorder (ADHD). MAOA mutations are rarely reported in the literature. To date, a total of 23 MAOA gene variants, mostly missense variants, have been reported through the HGMD database (Professional 2023.4). Neurodevelopmental symptoms may vary in severity and diversity among patients with Brunner syndrome. Different degrees of intellectual disability have been found in previously reviewed cohorts of Brunner syndrome. In our affected patient, cognitive development and academic achievement were at a similar level to his peers. Additionally, our patient exhibited symptoms suggestive of developmental coordination disorder. Our findings show that genetic mutations in MAOA can lead to a wide range of clinical symptoms and underline the need for comprehensive genetic and clinical evaluations. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review covers the current stage of research on subtle cognitive impairment with connected speech. It aims at surveying the linguistic features in use to single out those that can best identify patients with mild neurocognitive disorders (mNCDs), whose cognitive changes remain underdiagnosed. Method: We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and proposed a full definition of features for the analysis of speech features. Fifty-one studies met the inclusion criteria. Most of them focused on age-related progressive diseases and included fewer than 30 subjects. Results: A total of 384 features labeled with 335 different names was retrieved, yielding various results in discriminating individuals with mNCDs from controls. Conclusions: This finding highlights the need for harmonized labels to further investigate mNCDs with linguistic markers. We suggest two different ways of assessing a feature's reliability. We also point out potential methodological issues that remain to be resolved, along with recommendations for reproducible research in the field. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Large defects of the lip pose a reconstructive challenge due to the prominent facial location, significant impact on self-image and quality of life, and effects on functional needs such as oral competence, sensation, articulation, and maintenance of normal range of incisal opening. Current lip reconstruction practice follows guidelines based on defect depth and size. Optimal outcomes are achieved with use of local tissues which achieve better color, texture match, and ability to maintain sensation and orbicularis function. However, this is not usually possible in large defects. Cleft repair principles revolve around many of the similar goals of traumatic and oncologic lip reconstruction—to improve function and aesthetics. The authors present a case of a young male who sustained a traumatic lower lip avulsion defect involving greater than 75% of his lower lip. This was fully reconstructed using principles borrowed from cleft lip component repair, thus eliminating the need for a free flap without or without a tendon graft. This approach optimized aesthetic and functional outcomes, while avoiding several of the drawbacks of the classic oral flap reconstruction, especially in a young patient without static rhytids to camouflage reconstructive scars. In the presented technique, the senior author (OAA) successfully designed a modification of the classic Karapandzic repair technique utilizing principles from cleft lip reconstruction to address skin, muscle, and mucosa in separate components. This new modification of a classic technique presented by the authors utilizes principles from cleft lip reconstruction for improved functional and aesthetic outcomes in a single-stage reconstruction. This cross-pollination of principles resulted in the successful modification of traditional techniques leading to improved aesthetics, sensate reconstruction, complete oral competence, good maximal incisal opening and color match, and decreased scar burden. [ABSTRACT FROM AUTHOR]

The study aimed at the effectiveness of a communication training program to develop linguistic awareness and its impact on performance phonetic errors in a sample of students with developmental phonological disorder. The research was applied to a sample of (20) fourth-grade primary school students with developmental phonological disorder who are enrolled in primary schools in the New Valley Governorate. The study sample was randomly divided into two equal groups, the first experimental group with (10) students, including five males and five females, and the second control group (10) including eight males and five females. The current study tools included a linguistic awareness scale, a developmental phonological disorder scale, and a communication training program for linguistic awareness (16 sessions), all of which were prepared by the researcher. The results of the study indicated that there were statistically significant differences between the control group and the experimental group in linguistic awareness and performance phonetic errors in favor of the experimental group. The results also showed that there were no differences between the post- and follow-up measurements, which indicates the continuity of the program's effect in improving linguistic awareness and its positive effect on Eliminating performance phonetic errors in a sample of students with developmental phonological disorders. The study recommended the necessity of training in language awareness skills in speech disorders programs due to its positive effect in eliminating language disorders. [ABSTRACT FROM AUTHOR]

Background: Speech sound disorders (SSDs) in children are heterogeneous. Differentiating children with SSDs into distinct subtypes is important so that each child receives a treatment approach well suited to the particular difficulties they are experiencing. Aims: To study the distinct underlying processes that differentiate phonological processing, phonological planning or motor planning deficits. Method: The literature on the nature of SSDs is reviewed to reveal diagnostic signs at the level of distal causes, proximal factors and surface characteristics. Main Contribution: Subtypes of SSDs may be identified by linking the surface characteristics of the children's speech to underlying explanatory proximal factors. The proximal factors may be revealed by measures of speech perception skills, phonological memory and speech–motor control. The evidence suggests that consistent phonological disorder (CPD) can be identified by predictable patterns of speech error associated with speech perception errors. Inconsistent phonological disorder (IPD) is associated with a deficit in the selection and sequencing of phonemes, that is, revealed as within‐word inconsistency and poor phonological memory. The motor planning deficit that is specific to childhood apraxia of speech (CAS) is revealed by transcoding errors on the syllable repetition task and an inability to produce [pətəkə] accurately and rapidly. Conclusions & Implications: Children with SSDs form a heterogeneous population. Surface characteristics overlap considerably among those with severe disorders, but certain signs are unique to particular subtypes. Careful attention to underlying causal factors will support the accurate diagnosis and selection of personalized treatment options. WHAT THIS PAPER ADDS: What is already known on the subject: SSD in children are heterogenous, with numerous subtypes of primary SSD proposed. Diagnosing the specific subtype of SSD is important in order to assign the most efficacious treatment approach for each child. Identifying the distinct subtype for each child is difficult because the surface characteristics of certain subtypes overlap among categories (e.g., CPD or IPD; CAS). What this paper adds to the existing knowledge: The diagnostic challenge might be eased by systematic attention to explanatory factors in relation to the surface characteristics, using specific tests for this purpose. Word identification tasks tap speech perception skills; repetition of short versus long strings of nonsense syllables permits observation of phonological memory and phonological planning skills; and standard maximum performance tests provide considerable information about speech motor control. What are the potential or actual clinical implications of this work?: Children with SSDs should receive comprehensive assessments of their phonological processing, phonological planning and motor planning skills frequently, alongside examinations of their error patterns in connected speech. Such assessments will serve to identify the child's primary challenges currently and as they change over developmental time. [ABSTRACT FROM AUTHOR]

Background: Accurate nonword repetition (NWR) is contingent on many underlying skills, including encoding, memory and motor planning and programming. Though vowel errors are frequently associated with childhood apraxia of speech (CAS), several recent studies have found that children with developmental language disorder (DLD) produce high rates of vowel errors in NWR tasks. Aims: This retrospective analysis explored whether the overall frequency and types of vowel errors produced in NWR distinguish children with DLD, children with CAS, children with speech sound disorder (SSD) and children with typical development (TD). Methods and Procedure: We present data for 24 children (six per DLD, CAS, SSD and TD groups), ranging in age from 50–92 months. Children with DLD, CAS and SSD showed similar articulation scores and children with DLD and children with CAS showed similar expressive language scores. Total vowel errors, total monophthong errors, monophthong substitutions, diphthongization errors, total diphthong errors, diphthong substitutions and diphthong reduction errors were calculated by syllable length and group. Repeated measures analyses of variance were used to examine group differences. Outcomes and Results: Children with DLD and children with CAS produced a higher frequency of total vowel errors compared to children with TD. Children with DLD produced more total monophthong errors than children with TD. Children with DLD and children with CAS produced more total diphthong errors than children with TD. For children with DLD, these were characterised by diphthong substitutions. For children with CAS, these were characterised by diphthong substitutions and diphthong reduction errors. For all measures, error rates in children with SSD did not significantly differ from any of the other three groups. Conclusion: Preliminary evidence indicates that children with DLD and children with CAS both show high rates of vowel errors in NWR tasks and weaknesses in encoding and memory. For children with CAS, additional motor planning difficulties are associated with an increased likelihood to reduce diphthongs. Children with SSD show more mild processing difficulties than children with DLD and children with CAS, though they do not perform as well as TD peers. Future work should replicate and further specify the processing weaknesses that affect vowel accuracy in NWR tasks in a larger sample. WHAT THIS PAPER ADDS: What is already known on the subject: Nonword repetition (NWR) tasks are often included in diagnostic batteries to identify children with developmental language disorder (DLD). Poor performance on these tasks have historically been attributed to phonological working memory deficits in children with DLD. However, repeating nonwords relies on a number of underlying processing skills and many of these skills are affected to varying degrees in children with speech and language disorders. An in‐depth analysis of vowel errors has the potential to reveal the shared as well as specific underlying processing weaknesses in children with DLD, children with childhood apraxia of speech (CAS) and children with speech sound disorder (SSD). What this paper adds to existing knowledge: We found that children with DLD and children with CAS show low vowel competence compared to children with typical development. A nuanced examination of vowel error types further revealed that children with DLD and children with CAS show weaknesses in encoding and memory. Motor planning and programming weaknesses were unique to CAS. Children with SSD show more mild processing deficits and their performance did not significantly differ from any of the other three groups. What are the clinical implications of this work?: Examining the types of vowel errors produced by children with DLD, children with CAS and children with SSD in NWR allows us to further specify the underlying processing weaknesses that differentiate these three groups. This research informs theoretical accounts of language processing in children with different types of speech and language disorders and has the potential to improve the diagnostic utility of NWR tasks. [ABSTRACT FROM AUTHOR]

Background: Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs. Aim: To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken. Methods & Procedures: An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks. Outcomes & Results: There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues. Conclusions & Implications: Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence‐based interventions to provide adequate care. WHAT THIS PAPER ADDS: What is already known on the subject: FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge: This is the first UK‐wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence‐based interventions. What are the practical and clinical implications of this work?: This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence‐based practice. [ABSTRACT FROM AUTHOR]

Background: Within cohorts of children with autism spectrum disorder (ASD) there is considerable variation in terms of language ability. In the past, it was believed that children with ASD either had delayed articulation and phonology skills or excelled in those areas compared to other language domains. Very little is known about speech sound ability in relation to language ability and non‐verbal ability in Swedish preschool children with ASD. Aim: The current study aimed to describe language variation in a group of 4–6‐year‐old children with ASD, focusing on in‐depth analyses of speech sound error patterns with and without non‐phonological language disorder and concomitant non‐verbal delays. Method & Procedures: We examined and analysed the speech sound skills (including consonant inventory, percentage of correct consonants and speech sound error patterns) in relation to receptive language skills in a sample of preschool children who had screened positive for ASD in a population‐based screening at 2.5 years of age. Seventy‐three children diagnosed with ASD participated and were divided into subgroups based on their receptive language (i.e., non‐phonological language) and non‐verbal abilities. Outcomes & Results: The subgroup division revealed that 29 children (40%) had language delay/disorder without concurrent non‐verbal general cognitive delay (ALD), 27 children (37%) had language delay/disorder with non‐verbal general cognitive delay (AGD), and 17 children (23%) had language and non‐verbal abilities within the normal range (ALN). Results revealed that children with ALD and children with AGD both had atypical speech sound error patterns significantly more often than the children with ALN. Conclusions & Implications: This study showed that many children who had screened positive for ASD before age 3 years – with or without non‐verbal general cognitive delays – had deficits in language as well as in speech sound ability. However, individual differences were considerable. Our results point to speech sound error patterns as a potential clinical marker for language problems (disorder/delay) in preschool children with ASD. WHAT THIS PAPER ADDS: What is already known on the subject: Children with autism spectrum disorder (ASD) have deficits in social communication, restricted interests and repetitive behaviour. They show very considerable variation in both receptive and expressive language abilities. Previously, articulation and phonology were viewed as either delayed in children with ASD or superior compared with other (non‐phonological) language domains. What this paper adds to existing knowledge: Children with ASD and language disorders also have problems with speech sound error patterns. What are the potential or actual clinical implications of this work?: About 75% of children with ASD experience language delays/disorders, as well as speech sound problems, related to speech sound error patterns. Understanding/acknowledging these phonological patterns and their implications can help in the diagnosis and intervention of speech sound disorders in children with ASD. Direct intervention targeting phonology might lead to language gains, but more research is needed. [ABSTRACT FROM AUTHOR]

Background: Classification systems in healthcare support shared understanding of conditions for clinical communication, service monitoring and development, and research. Children born with cleft palate with or without cleft lip (CP+/−L) are at high risk of developing cleft‐related speech sound disorder (SSD). The way cleft‐related SSD is represented and described in SSD classification systems varies. Reflecting on the potential causal pathways for different cleft‐related speech features, including the role of speech processing skills, may inform how cleft‐related SSD is represented in classification systems. Aim & Approach: To explore and reflect on how cleft‐related SSD is represented in current SSD classification systems in the context of considering how speech processing skills and other factors may be involved in causal pathways of cleft speech characteristics (CSCs). Main Contribution: Variation in the representation of cleft‐related SSD in classification systems is described. Potential causal pathways for passive cleft‐ related speech features and different active CSCs are explored. The factors involved in the development and/or persistence of different active CSCs may vary. Some factors may be specific to children born with CP+/−L, but if speech processing skills are also involved, this is an overlap with other SSD subtypes. Current evidence regarding relationships between different speech processing skills and active CSCs is limited. Implications for the representation of cleft‐related SSD in SSD classification systems are discussed. Conclusion: There are different categories of cleft‐related speech features which are essential to understand and identify in children with cleft‐related SSD to ensure appropriate management. Representation of these feature categories in classification systems could support understanding of speech in this population. Speech processing skills could be involved in the development and/or persistence of different active CSCs in individual children. Reflection and discussion on how cleft‐related SSD is represented in classification systems in relation to other SSD subtypes may inform future iterations of these systems. Further work is needed to understand factors influencing the development and/or persistence of active CSCs, including speech processing skills. What this paper adds: What is already known on the subject: Cleft‐related speech sound disorder (SSD) is commonly described as being of known origin. The features of cleft‐related SSD have been described extensively and several authors have also examined factors which may contribute to speech development and outcomes in children born with cleft palate +/− lip. There is limited evidence regarding the role of speech processing in the development and persistence of cleft‐related SSD. What this study adds: This paper reflects on how cleft‐related SSD is represented in SSD classification systems in relation to key feature categories of cleft‐related SSD and possible causal pathways for passive features and active cleft speech characteristics (CSCs). The role of cognitive speech processing skills is specifically considered alongside other factors that may contribute to the development of active CSCs. What are the clinical implications of this work?: Causal pathways for different features of cleft‐related SSD may vary, particularly between passive and active features, abut also between different active CSCs. Speech and language therapists (SLTs) need to differentially diagnose passive speech features and active CSCs. Consideration of the role of different speech processing skills and interactions with other potentially influencing factors in relation to active CSCs may inform clinical hypotheses and speech and language therapy (SLT) intervention. Representing key features of cleft‐related SSD in classification systems may support understanding of cleft‐related SSD in relation to other SSD subtypes. [ABSTRACT FROM AUTHOR]

Background: The dialect spoken by children influences diagnostic decision‐making regarding the identification and severity of speech sound disorder (SSD). Aims: The primary objective was to review papers that examined the influence of dialect on the identification of SSD in Vietnamese‐speaking children. Methods & Procedures: Five studies of mono‐ and multilingual Vietnamese‐speaking children living in Vietnam and Australia were reviewed to examine the influence of dialect on the assessment and analysis children's speech. The main Vietnamese dialects (Standard, Northern, Central, Southern) differ in the production of consonants, vowels and tones. Main contribution: Most speech assessments define correct production using the standard dialect of a language. Insights from recent studies of Vietnamese provide recommendations for also considering dialect in diagnostic decision‐making. First, we recommend adding column(s) to the assessment score sheet that includes the dialectal variants spoken by adults in the child's family or community. Second, we calculate the accuracy of production twice, based on the standard form and dialectal form. Third, we report the percentage of consonants correct—standard (PCC‐S) and percentage of consonants correct—dialect (PCC‐D). Conclusions & Implications: Diagnostic decision‐making is influenced by dialectal variation in children's speech, so speech and language therapists need to compare standard and dialectal productions when undertaking assessments, analysis and diagnostic decision‐making. WHAT THIS PAPER ADDS: What is already known on the subject: Most speech assessments use the standard form of a dialect as the correct production. The standard dialect is used for diagnosis of SSD and identification of intervention targets. What this paper adds to the existing knowledge: This paper examines five research studies of Vietnamese to identify ways to consider dialect in speech and language therapy assessment and analysis. Vietnamese provides a complex environment for this examination since there are numerous Vietnamese dialects and they differ according to consonants, vowels and tones. What are the potential or actual clinical implications of this work?: Speech and language therapists are encouraged to add column(s) to their assessment score sheet that includes the dialectal variants spoken by adults and to report the PCC‐S and PCC‐D. [ABSTRACT FROM AUTHOR]

Background: The publication of phase 2 of the CATALISE project in 2017 clarified terminology for children with developmental language disorder (DLD) or delay but unintentionally muddied the water for children with unintelligible speech. A diagnostic label of DLD (phonology) indicates poor prognosis and phonological disorder that persists into middle childhood. However, in contrast to other diagnostic labels that fall under the overarching term of speech sound disorder (SSD), DLD (phonology) does not elucidate the characteristics of the child's speech nor does it point us in the direction of appropriate intervention. Aims: The aim of this paper is to discuss terminology in SSD leading to an evidence‐based model which builds on the model of DLD developed in CATALISE, supports descriptive diagnosis and signposts intervention. Methods: Following a focused review of literature proposing or describing terminology for SSD, an expert group of researchers in developmental SSD proposed a revised model of existing terminology. Groups of UK speech and language therapists (SLTs) who provide services for children with SSD were asked to comment on its acceptability and feasibility. Discussion: A three‐level terminology model was developed. This comprised an overarching Level 1 term; Level 2 terms that differentiated SSD of unknown origin from SSD with associated or underlying conditions; and specific diagnostic terms at Level 3 to support further assessment and intervention decisions. Consulted SLTs generally expressed agreement with the proposed terminology and a willingness to adopt it in practice. Conclusions: Existing terminology for childhood SSD provides a good basis for clinical decision‐making. A modified version of Dodd's (2005) terminology was found to be acceptable to UK SLTs. There is an evident overlap of SSD with CATALISE terminology. However more detailed and specialist terminology than 'DLD (phonology)' is required to support clinical decision‐making. It is proposed that endorsement by the UK Royal College of Speech and Language Therapists would obviate the need for a Delphi process. What this paper adds: What is already known on this subject: Over nearly a hundred years, as our knowledge and understanding of speech sound disorder (SSD) has increased, so has the terminology that is used to describe those disorders. Current terminology not only describes subtypes of SSD but can also signpost us to effective interventions. With the publication, in 2017, of phase 2 of CATALISE a new term of 'developmental language disorder (DLD) (phonology)' was introduced with the unintentional consequence of challenging more specific descriptive terms for SSD. What this paper adds: In the context of CATALISE and DLD (phonology), the history and nature of SSD terminology are reappraised. Building on the model of DLD developed in CATALISE, a tiered model that supports descriptive diagnosis and signposts intervention is proposed for discussion. Clinical implications of this study: The proposed model of terminology for SSD provides descriptive and detailed labels that will support accuracy in differential diagnosis of developmental SSD by speech and language therapists. Furthermore, a decision‐making tree for SSD demonstrates the pathway from diagnostic use of the terminology to the selection of evidence‐based, effective interventions. [ABSTRACT FROM AUTHOR]

Background: 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. Aims: 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. Methods and Procedures: 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. Outcomes and Results: 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. Conclusions and Implications: 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 THIS PAPER ADDS: 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. [ABSTRACT FROM AUTHOR]

Background: 'Speech sound disorder' is an umbrella term that encompasses dysarthria, articulation disorders, childhood apraxia of speech and phonological disorders. However, differential diagnosis between these disorders is a persistent challenge in speech pathology, as many diagnostic procedures use symptom clusters instead of identifying an origin of breakdown in the speech and language system. Aims: This article reviews typical and disordered speech through the lens of two well‐developed models of production—one focused on phonological encoding and one focused on speech motor planning. We illustrate potential breakdown locations within these models that may relate to childhood apraxia of speech and phonological disorders. Main Contribution: This paper presents an overview of an approach to conceptualisation of speech sound disorders that is grounded in current models of speech production and emphasises consideration of underlying processes. The paper also sketches a research agenda for the development of valid, reliable and clinically feasible assessment protocols for children with speech sound disorders. Conclusion: The process‐oriented approach outlined here is in the early stages of development but holds promise for developing a more detailed and comprehensive understanding of, and assessment protocols for speech sound disorders that go beyond broad diagnostic labels based on error analysis. Directions for future research are discussed. What this paper adds: What is already known on the subject: Speech sound disorders (SSD) are heterogeneous, and there is agreement that some children have a phonological impairment (phonological disorders, PD) whereas others have an impairment of speech motor planning (childhood apraxia of speech, CAS). There is also recognition that speech production involves multiple processes, and several approaches to the assessment and diagnosis of SSD have been proposed. What this paper adds to existing knowledge: This paper provides a more detailed conceptualisation of potential impairments in children with SSD that is grounded in current models of speech production and encourages greater consideration of underlying processes. The paper illustrates this approach and provides guidance for further development. One consequence of this perspective is the notion that broad diagnostic category labels (PD, CAS) may each comprise different subtypes or profiles depending on the processes that are affected. What are the potential or actual clinical implications of this work?: Although the approach is in the early stages of development and no comprehensive validated set of tasks and measures is available to assess all processes, clinicians may find the conceptualisation of different underlying processes and the notion of potential subtypes within PD and CAS informative when evaluating SSD. In addition, this perspective discourages either/or thinking (PD or CAS) and instead encourages consideration of the possibility that children may have different combinations of impairments at different processing stages. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated articulatory patterns for American English /ɹ/ in children with and without a history of residual speech sound disorder (RSSD). It was hypothesized that children without RSSD would favor bunched tongue shapes, similar to American adults reported in previous literature. Based on clinical cueing practices, it was hypothesized that children with RSSD might produce retroflex tongue shape patterns at a higher relative rate. Finally, it was hypothesized that, among children who use a mixture of bunched and retroflex shapes, phonetic context would impact tongue shape as reported in the adult literature. Method: These hypotheses were tested using ultrasound data from a stimul-ability task eliciting /ɹ/ in syllabic, postvocalic, and onset contexts. Participants were two groups of children/adolescents aged 9-15 years: 36 with RSSD who completed a study of ultrasound biofeedback treatment and 33 with no history of RSSD. Tongue shapes were qualitatively coded as bunched or retroflex using a flowchart from previous research. Results: Children with no history of RSSD were found to use bunched-only tongue shape patterns at a rate higher than adults, but those who used a mixture of shapes for /ɹ/ followed the expected phonetic contextual patterning. Children with RSSD were found to use retroflex-only patterns at a substantially higher rate than adults, and those using a mixture of shapes did not exhibit the expected patterning by phonetic context. Conclusions: These findings suggest that clients receiving ultrasound biofeedback treatment for /ɹ/ may be most responsive to clinician cueing of retroflex shapes, at least early on. However, retroflex-only cueing may be a limiting and insufficient strategy, particularly in light of our finding of a lack of typical variation across phonetic contexts in children with remediated /ɹ/. Future research should more specifically track cueing strategies to better understand the relationship between clinician cues, tongue shapes, and generalization across a range of contexts. [ABSTRACT FROM AUTHOR]

The usefulness and effectiveness of telepractice have been reported in recent years. Treatment of cleft palate patients with compensatory articulation is based on perceptual identification. Telepractice using videoconferencing platforms causes voice signal distortion and impacts auditory‐perceptual perception. This study aimed acoustically examine voice signal distortion and determine the optimal videoconferencing platforms, in addition to the phonemes that can be discriminated with the same quality as in face‐to‐face interactions. ATR503 with 50 phoneme‐balanced Japanese speech sentences was used as a reference corpus. Four videoconferencing platforms, —Zoom, Cisco Webex, Skype, and Google Meet, —and five devices, —iPhone, Android, iPad Air, Windows, and MacBook Pro were used as transmission conditions to examine voice signal distortions with the objective measure log‐spectral distortion (LSD). Tukey's test was conducted to evaluate the degree of consonant distortion related to voicings (voiceless and voiced), places of articulation (bilabial, alveolar, alveolo‐palatal, palatal, velar, labial‐velar, and glottal), and manners of articulation (plosive, fricative, affricate, tap or flap, nasal, and approximant). With statistically significant differences, voiced, bilabial, labial‐velar, nasal, and plosive consonants exhibited smaller distortions. In contrast, voiceless, alveolo‐palatal, fricative, and affricate consonants exhibited larger distortions. Google Meet exhibited the lowest distortion among videoconferencing platforms and MacBook exhibited the lowest distortion among devices. This study provides significant insights into the telepractice strategies with the appropriate videoconferencing platform and device, and useful settings for cleft palate patients with compensatory articulations with respect to acoustics. [ABSTRACT FROM AUTHOR]

Objective: This study explored factors affecting speech improvement in patients with an edentulous maxilla after the delivery of a complete‐arch implant‐supported fixed dental prosthesis (IFDP). Materials and Methods: Patients who had received IFDP for edentulous maxilla were enrolled, and various potential speech improvement‐related factors were considered, including patient demographics, anterior residual bone volume, preoperative facial features, preoperative acoustic parameters, and adaptation time. Acoustic analysis and perceptual ratings were used to assess three fricatives [s], [f], and [ɕ]. Correlation and regression analyses were conducted to assess the association between changes in fricatives and potential factors (α =.05). Results: The study included 50 patients (18 females and 32 males, aged 50.62 ± 15.71 years, range 19–76). Significant correlations were found among the change in the center of gravity (ΔCoG) of [s] and anterior residual bone volume, zygomatic implants number and proportion (p <.05). These correlations were largely mirrored in the perceptual score (ΔPS) changes. After controlling for age, sex, preoperative acoustic parameters, and adaptation time, the ΔCoG and ΔPS of fricatives were mainly correlated with the anterior residual bone volume, preoperative acoustic parameters, and adaptation time. Conclusion: Speech improvements post‐IFDP delivery are mainly related to preoperative speech characteristics, anterior residual bone volume, and adaptation time. The residual bone volume's impact on consonants varies with specific articulatory gestures. This study provides insights into forecasting speech outcomes following IFDP restoration and provides recommendations and methods for data collection in developing future prediction models. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The 8p23.1 duplication syndrome is a rare genetic condition with an estimated prevalence rate of 1 out of 58,000. Although the syndrome was associated with speech and language delays, a comprehensive assessment of speech and language functions has not been undertaken in this population. To address this issue, the present study reports rigorous speech and language, in addition to oral-facial and developmental, assessment of a 50-month-old Turkish-speaking boy who was diagnosed with the 8p23.1 duplication syndrome. Standardized tests of development, articulation and phonology, receptive and expressive language and a language sample analysis were administered to characterize speech and language skills in the patient. The language sample was obtained in an ecologically valid, free play and conversation context. The language sample was then analyzed and compared to a database of age-matched typically-developing children (n = 33) in terms of intelligibility, morphosyntax, semantics/vocabulary, discourse, verbal facility and percentage of errors at word and utterance levels. The results revealed mild to severe problems in articulation and phonology, receptive and expressive language skills, and morphosyntax (mean length of utterance in morphemes). Future research with larger sample sizes and employing detailed speech and language assessment is needed to delineate the speech and language profile in individuals with the 8p23.1 duplication syndrome, which will guide targeted speech and language interventions. [ABSTRACT FROM AUTHOR]

Several studies suggest that a valuable tool to examine linguistic skills in communication disorders is offered by procedures of narrative discourse assessment. Following this line of research, we present an exploratory study aimed to investigate storytelling abilities of autistic children to better define the characteristics of their story production. Participants included 41 autistic children and 41 children with typical development aged between 7.02 and 11.03 years matched on age, gender, level of formal education, intelligence quotient, working memory, attention skills, theory of mind, and phonological short-term memory. Narrative production was assessed by analysing the language samples obtained through the "Nest Story" description task. A multilevel analysis including micro- and macro-linguistic variables was adopted for narrative assessment. Group differences emerged on both micro- and macro-linguistic dimensions: autistic children produced narratives with more phonological errors and semantic paraphasias (microlinguistic variables) as well as more errors of global coherence and a fewer number of visible events and inferred events (macrolinguistic variables) than the control group.This study shows that even autistic children with adequate cognitive skills display several limitations in their narrative competence and that such weaknesses affect both micro- and macrolinguistic aspects of story production. [ABSTRACT FROM AUTHOR]

Background: Following primary cleft palate repair, individuals face a heightened risk of hearing problems, particularly conductive hearing loss, compensatory articulation disorders (CADs), resonance disorders, delayed speech and language development, and voice disorders. This study aimed to investigate the prevalence and impact of these challenges in children with cleft palate with or without cleft lip (CP± L). Methods: This cross-sectional study included 38 children with CP± L aged 5 to 13 years. A comprehensive evaluation involved audiological assessments (audiograms, tympanograms) by an audiologist and speech-language pathology assessments (Thai Speech Parameters for Patients with Cleft Palate, Articulation Screening Test) by speech-language pathologists. Results: The prevalence of hearing loss affected 27.63% of participants (21 out of 76 ears) and majority of cases involved conductive hearing loss. Velar substitution was the most common CAD, followed by nasalized voiced pressure consonants, phoneme-specific nasal air emission, and pharyngeal substitution. A moderate correlation was found between these CAD patterns and hypernasality at the word, sentence, and screening levels (r= 0.44, p< 0.01; r= 0.43, p< 0.01; and r= 0.40, p= 0.01). Conclusion: For summary, the most common type of hearing loss was conductive hearing loss. The predominant CAD pattern was velar substitution. The protocol could be designed to enhance early improvement in hearing and articulation, thereby supporting academic achievement and long-term quality of life. [ABSTRACT FROM AUTHOR]

Purpose: People with Parkinson's disease (PwP) typically experience impairments in vowel articulation; however, less is known about how this measure varies with speech task type and clinical characteristics such as cognitive impairment. We characterized vowel space in PwP with and without mild cognitive impairment (MCI) comparing performance across phonation, reading, and picture description tasks. We evaluated associations between vowel space and cognitive impairment, as well as motor symptom severity to elucidate the factors contributing to variability in this acoustic measure. Method: PwP (n = 48) and age-matched controls (n = 15) performed sustained phonation of corner vowels, a reading passage, and a picture description task (Cookie Theft picture). PwP participants were classified as with normal cognition (PD-NC) or MCI (PD-MCI), and motor symptoms were assessed using the Movement Disorders Society Unified Parkingson's Disease Rating Scale Part III (MDSUPDRS Part III). Vowel articulation index (VAI) for each task and mean difference in VAI between tasks was compared between the groups using linear mixed models adjusted for age, sex, and education. The impact of motor severity was assessed by additionally adjusting the model for MDS-UPDRS Part III score. Results: In the adjusted mixed model, mean VAI was significantly lower in the PD-MCI group compared to the PD-NC group for all tasks. Within participants, adjusted mean differences demonstrated that all groups declined in VAI when sustained phonation was compared to either reading or picture description tasks. Adjustment for MDS-UPDRS Part III did not alter the results, suggesting no major association of motor impairment with vowel space variability within or between individuals or groups. Conclusions: Variability in vowel space is impacted by cognitive impairment and speech task in PwP. These findings are relevant to the further development of speech markers in PwP and other neurogenerative diseases that impact both cognitive and motor functions. [ABSTRACT FROM AUTHOR]

Purpose: We provide a case report of "Zoe," a 4-year-old deaf child from a deaf signing family, who presented with a possible case of Childhood Apraxia of Sign (CASign). Method: The description is based on reports from the child's speech-language pathologist, her Individualized Education Program report, and a clinician-created sign imitation task. Results: Zoe's sign articulation errors in American Sign Language differed from those reported for typically developing deaf children and were parallel to the types of errors observed for hearing children with childhood apraxia of speech. Specifically, Zoe produced inconsistent errors across signs, substituted more complex handshapes for simple handshapes, made errors on both unmarked (common) and marked (less common) forms, produced articulatory distortions (rather than substitutions), and exhibited "groping" behaviors (a sequence of attempts to move her hands into the correct position). In addition, Zoe sometimes self-corrected her errors by manipulating her own hands, for example, using her left hand to move the thumb of her right hand into the correct position. Conclusion: Zoe's pattern of sign errors is consistent with an underlying deficit in motor planning and/or programming and may constitute the first reported case of CASign. [ABSTRACT FROM AUTHOR]

Non-Word Repetition (NWR) tasks effectively identify language impairments and assess phonological skills across diverse populations and languages, including Arabic. Prior research revealed heterogeneity of performance in children with Autism Spectrum Disorder (ASD) on NWR tasks. The current study is the first to evaluate phonological skills of Palestinian-Arabic-speaking children with and without ASD, employing a Palestinian-Arabic NWR task. A total of 142 Palestinian-Arabic-speaking children, aged 5–11 participated in the study, including 75 children with Typical Language Development (TLD) and 67 children with ASD. The NWR task included 18 non-words of varying length (1–4 syllables) and complexity (with and without consonant clusters). Quantitative analysis examined the effects of length and phonological complexity on the NWR accuracy scores in children with TLD and ASD. Error pattern analysis accounting for phoneme and syllable substitutions/deletions/additions and lexicalisations aimed to shed light on the phonological representations of children with and without ASD. Within the ASD group, two subgroups emerged: 72% exhibited age-appropriate NWR performance, while 28% showed performance at-risk for phonological impairment. Non-word length, rather than complexity, significantly influenced the children’s performance. Consonant substitution was the most frequent error pattern across all groups. On the theoretical side, these findings extend cross-linguistic evidence of phonological skill heterogeneity in children with ASD to Arabic-speaking children. Additionally, they highlight an overall delayed but qualitatively similar pattern of phonological development in children with ASD. On the clinical side, results underscore the importance of comprehensive language assessment in children with ASD. [ABSTRACT FROM AUTHOR]

Dysarthria and Apraxia of Speech (AoS) are motor speech disorders in which neurological lesions differentially affect motor control, possibly leading to noticeable differences in articulation and consequently sound production. Among the sounds requiring greater motor capacity because of its articulatory complexity is the voiceless alveolar sibilant fricative /s/. The aim of this study was to identify acoustic variables able to distinguish between dysarthria and AoS, and between these disorders and normal speech in Spanish speakers. The production of this fricative was acoustically examined in 28 individuals with motor neurological disorders (20 with dysarthria, 8 with AoS) and in 28 neurologically healthy persons. Participants repeated 12 monosyllabic words containing the fricative plus one of the five Spanish vowels. The variables measured were absolute durations of the fricative, vowel, and fricative+vowel sequence, along with the vowel-to-fricative duration ratio. Findings indicate that duration of the fricative can distinguish between controls and speakers with dysarthria, but not between controls and speakers with AoS. Measures related to vowel duration served to distinguish between speakers with dysarthria and speakers with AoS and between each of them and controls. Further, speakers with dysarthria and those with AoS differed from each other and from controls in terms of articulatory variability; speakers with dysarthria showing most variability. In the latter participants, articulatory variability was higher for unrounded segments, vowels and fricatives, while in speakers with AoS this variability was higher for rounded segments. These observations are discussed within a framework of motor control models. [ABSTRACT FROM AUTHOR]

Purpose: Treatment fatigue is a complex, multidimensional, multicausal, and subjective phenomenon that is not yet well explored and understood in the area of speech therapy. The purpose of this study was to investigate speech-related treatment fatigue and speech treatment dropout in parents and children with a cleft (lip and) palate receiving or having received speech treatment for cleftrelated articulation disorders. Method: Thirteen participants were included in this study (n = seven parents with a median age of 40 years and n = six children with a median age of 10 years). Qualitative semistructured interviews were conducted separately with parents and children to investigate their experiences with cleft speech treatment. An inductive thematic approach was used to analyze the data and construct different themes. Rigor of the data was verified by conducting an investigator triangulation and by performing member checks. Results and Conclusions: The analyses of the interviews yielded three major themes of importance to the children and their parents: (a) physical symptoms of treatment fatigue, (b) psychological symptoms of treatment fatigue, and (c) from treatment fatigue to treatment dropout. Physical symptoms of treatment fatigue were mainly related to transportation burden. On a psychological level, speech treatment may potentially lead to a cognitive-emotional overload. These feelings are primarily related to the practical issue of scheduling required treatment sessions in the family agenda. The decision to discontinue speech treatment was reported to be multifactorial. In this decision-making process, data suggested that the child's perspective must be heard more. [ABSTRACT FROM AUTHOR]

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 wellspecified 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. [ABSTRACT FROM AUTHOR]

Purpose: 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. Method: 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). Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Purpose: The study's primary aims were to describe the long-term speech outcomes for adolescents and young adults with a history of childhood apraxia of speech (CAS) and to examine the association of persistent speech sound errors with measures of literacy skills, phonological processing, motor speech production, and parent report of early motor difficulty. Method: Data from a large longitudinal 25-year study were used to explore outcomes for 32 individuals with a history of CAS, ages 12;6 (years; months) to 25 years (M = 17.4, SD = 4.7). Persistent and nonpersistent groups were compared on decoding, phonological processing, multisyllabic word repetition, diadochokinetic rate, and parent report of motor involvement. Parametric (Welch's t tests) and nonparametric tests (Wilcoxon and Fisher exact tests) were used to identify differences between the groups' distributions. Developmental trajectories of speech production were plotted. Results: Outcomes for individuals with CAS are highly variable, with some demonstrating speech sound errors into adolescence and young adulthood. Speech sound errors were primarily on later developing sounds. Persistence was significantly associated with early motor difficulties. Difficulties with multisyllabic words, phonological processing, and literacy were often present regardless of persistence or nonpersistence of speech errors. Conclusions: Children with CAS are at risk for persistent speech sound errors into adulthood. For children showing limited progress with more traditional speech therapy, alternative interventions should be explored. Individuals with persistent speech sound errors are more likely to have a history of early motor deficits. Regardless of persistence, participants with CAS demonstrated ongoing weaknesses in literacy, phonological processing skills, and complex speech production tasks. [ABSTRACT FROM AUTHOR]

Background: Speech and language are interconnected systems, and language disorder often co-occurs with childhood apraxia of speech (CAS) and non-CAS speech sound disorders (SSDs). Potential trade-off effects between speech and language in connected speech in children without overt language disorder have been less explored. Method: Story retell narratives from 24 children (aged 5;0-6;11 [years;months]) with CAS, non-CAS SSD, and typical development were analyzed in Systematic Analysis of Language Transcripts (SALT) regarding morphosyntactic complexity (mean length of C-unit in words [MLCU]), lexical diversity (moving-average type-token ratio [MATTR]), and linguistic accuracy (any linguistic error/bound morpheme omissions) and compared to 128 age-matched children from the SALT database. Linear and mixed-effects logistic regressions were performed with speech accuracy (percent phonemes correct [PPC]) and diagnostic group as predictors of the narrative variables. Results: PPC predicted all narrative variables. Poorer PPC was associated with lower MLCU and MATTR as well as a higher likelihood of linguistic errors. Group differences were only observed for the error variables. Comparison to the SALT database indicated that 13 of 16 children with CAS and SSD showed a higher-than-expected proportion of linguistic errors, with a small proportion explained by individual speech errors only. Conclusions: The high occurrence of linguistic errors, combined with the relationship between PPC and linguistic errors in children with CAS/SSD, suggests a trade-off between speech accuracy and language output. Longitudinal studies are needed to investigate whether children with SSDs without language disorder show more language difficulties over time as linguistic demands increase. [ABSTRACT FROM AUTHOR]

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 lateacquired 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. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to thoroughly analyze postoperative consonant errors by tongue cancer (TC) patients with speech disorders and also to investigate the correlation between the pathological factors and the speech performance using our Consonant-based Articulation Assessment Battery (CAAB). Method: The participants were 57 monolingual Mandarin TC patients (26 women, 31 men) after surgery (aged 20-80 years). All participants were literate and had normal vision and hearing, enabling them to comprehend and comply with our instructions. In order to quickly evaluate their articulation performance based on the place and manner of articulation, they were instructed to pronounce the characters in CAAB. The analysis removed speech samples impacted by speakers' dialects, while recording and documenting all other responses. Results: The study uncovered a significant correlation between pathological factors (e.g., size of tongue resection, specific resection site, and tumor size) and the accuracy of consonant articulation. Furthermore, tongue damage predominantly impacts the place of articulation (63.85%) than the manner of articulation (20.78%). The damage in the anterior part of the tongue has the most prominent influence on consonant production. Conclusions: CAAB can fast capture the idiosyncratic characteristics of speech production by TC patients, and the articulation deficits are quite different from other types of organic or nonorganic speech disorders, for example, cleft lip and cleft palate. Hence, CAAB can be designated as an assessment tool for articulation disorders caused by stomatognathic damages. Our findings also shed light on the possible oral cancer surgery plan and the postoperative speech rehabilitation training. [ABSTRACT FROM AUTHOR]

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

Purpose: Print knowledge is a powerful predictor of later reading abilities, which are crucial to children's academic success. Children with speech sound disorders (SSDs) are at risk for literacy difficulties. Speech sound therapy is an opportune time to address not only speech sound production but also the connections between speech sounds and their associated letters and letter patterns. This tutorial aims to provide a rich source of evidence to support the use of print and print-referencing in speech sound therapy sessions. We include feasible suggestions for speech-language pathologists (SLPs) to facilitate print-rich experiences for children with SSDs. Incorporating orthography into therapy sessions, through activities such as shared book reading, allows SLPs to address speech sound errors while supporting children's literacy development. Conclusions: This tutorial provides an overview of the risk of literacy deficits in children with SSDs and describes the theoretical underpinnings of why incorporating print is a powerful learning tool. We expand on the research behind print referencing in preschool classrooms. Finally, we provide detailed examples, including book lists and therapy ideas for a variety of ages, to help SLPs add print referencing to their therapy toolkit. [ABSTRACT FROM AUTHOR]

Purpose: Repetitive transcranial magnetic stimulation (rTMS) can enhance aphasia recovery. Most studies have used inhibitory stimulation targeting the right inferior frontal gyrus. However, the motor cortex, observed to contribute to the prediction of aphasia recovery, is involved in word production and could be an appropriate target for rTMS. We aimed to observe behavioral changes in a picture naming task induced by inhibitory rTMS targeting the right motor cortex of the lips in people with poststroke aphasia. Method: Using a single-case experimental design, we included three participants with chronic poststroke aphasia who had phonological deficits. Each participant performed a verbal picture naming task 3 times a week for 2, 3, or 4 weeks (pseudorandom across participants) to establish a baseline naming ability for each participant. These were not therapy sessions, and no feedback was provided. Then, each participant received the intervention, inhibitory continuous theta burst stimulation targeting the right motor cortex of the lips, 3 times a week for 2 weeks. Naming testing continued 3 times a week, for these latter 2 weeks. No therapy was performed at any time during the study. Results: Visual analysis of the graphs showed a positive effect of rTMS for P2 and P3 on picture naming accuracy and a tendency toward improvement for P1. Statistical analysis showed an improvement after rTMS for P1 (τ = 0.544, p = .013, SETau = 0.288) and P2 (τ = 0.708, p = .001, SETau = 0.235). For P3, even if the intervention allowed some improvement, this was statistically nonsignificant due to a learning effect during the baseline naming testing, which lasted the longest, 4 weeks. Regarding specific language features, phonological errors significantly decreased in all patients. Conclusions: The motor cortex of the lips could be an appropriate target for rTMS to improve naming in people with poststroke aphasia suffering from a phonological deficit. This suggests the possibility to individualize the target for rTMS, according to the patient's linguistic impairment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to characterize the communicative participation and functional speech intelligibility (i.e., how children use communication and how well they are understood across everyday life) of typically developing (TD) bilingual Jamaican preschoolers and those with functionally defined speech sound disorders (fSSDs) in the COVID-19 milieu. Findings were also compared to an existing corpus of baseline data to document and explore differences in children's speech-language outcomes secondary to pandemic-related social restrictions. Method: Thirty bilingual Jamaican preschoolers, 21 TD and nine with fSSDs, were assessed during the pandemic via telepractice. Association and univariate mean testing were completed to characterize children's communicative participation and functional speech intelligibility. Data were then compared to an existing corpus of baseline data (collected in person between 2013 and 2019), which included direct child assessment and parent reports and consisted of TD (n = 226) Jamaican Creole-English--speaking preschoolers and those with fSSDs (n = 39) to compare performance profiles across data sets. All participants attended schools in Kingston, Jamaica. Results: Measures of communicative participation remained stable in the context of the COVID-19 milieu for children in the TD and fSSD groups, but functional speech intelligibility outcomes for children with fSSDs deviated between in-person findings collected from children pre-pandemic. Between-groups differences were also found on measures of speech production accuracy but were no longer significant when considering telepractice as a covariate. Conclusions: Findings from this investigation serve to characterize the communicative participation and functional speech intelligibility of TD bilingual Jamaican preschoolers and those with fSSDs in the COVID-19 milieu. By extension, the results comparing data from preschoolers collected during the pandemic to an existing corpus of baseline data from a different group of preschoolers provide critical insights about multilingual children's speech-language outcomes in the context of acutely changing environmental circumstances. [ABSTRACT FROM AUTHOR]

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Background: To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/− adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine‐enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after "standard‐of‐care" SOC rehabilitation. Method: Pilot prospective 8‐week (TEBER) program following 8 weeks of (SOC) rehabilitation. Results: Twenty‐seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, "range‐of‐liquids" improved by +0.36 [95% CI, 0.02–0.70, p = 0.05] and "range‐of‐solids" improved by +0.73 [95% CI, 0.12–1.34, p = 0.03]. There was a positive trend toward better oral cavity obliteration; residual volume decreased by −1.2 [95% CI, −2.45 to 0.053, p = 0.06], and "nutritional‐mode" increased by +0.55 [95% CI, −0.15 to 1.24, p = 0.08]. Conclusion: This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion. [ABSTRACT FROM AUTHOR]