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This report presents findings supporting the hypothesis of a clinically relevant subtype of childhood speech sound disorder, provisionally titled speech delay--developmental psychosocial involvement (SD-DPI). Conversational speech samples from 29 children who met inclusionary criteria for SD-DPI were selected from a case record archive at a university speech clinic for children. Participants with SD-DPI had been characterized by speech clinicians and caregivers as having speech delay with psychosocial issues that required attention in the course of at least 1 semester of speech treatment. The 29 participants were divided into 2 subgroups, based on clinicians' and parents' records indicating either approach-related negative affect (n = 23) or withdrawal-related negative affect (n = 6). Each participant with SD-DPI was matched by age, gender, and type of speech involvement to 3 comparison speakers with speech delay of unknown origin (n = 87). Analyses of the conversational speech samples indicated that in comparison with participants in the control group, those with SD-DPI had significantly more severe speech delay, averaging approximately 7% to 10% lowered speech competence in conversation. The clinical prevalence of SD-DPI was estimated at approximately 12% of children referred to the university speech clinic in the present study. The authors interpret the present findings to indicate that approach-related or withdrawal-related negative affect, negative emotionality or mood, and decreased task persistence or attention are risk factors for increased severity of expression of speech delay.

A study of 35 3-year-olds followed since infancy in a university-affiliated pediatrics clinic and 50 Native American children followed since infancy in a tribal health clinic found early recurrent otitis media with effusion was only associated with increased risk for speech disorder in the Native American children. (Contains extensive references.) (CR)

This study provides a clinical profile of 178 children (ages 3-6) with developmental phonological disorders, based on prior reports and new data on 64 children. Data discussed include gender, age, and severity; speech profiles; prosody-voice profiles; causal-correlates profiles; and a prevalence profile. (Author/JDD)

Fifteen caregivers each glossed a simultaneously videotaped and audiotaped sample of their child with speech delay in conversation with a clinician. Comparison with a reference gloss developed for each sample indicated that caregivers accurately understood an average of 58% of the utterances and 73% of the words. (Author/DB)

The self-monitoring and generalization behaviors of eight preschool children were observed as they progressed in management programs for their developmental phonological disorders. Self-monitoring behaviors varied in type, frequency, and point of onset in relation to generalization data. Self-monitoring behaviors did not always nor only occur in temporal association with generalization. (Author/JDD)

Waldron cannot reasonably criticize a study on development apraxia of speech based on a sample of 16 children for being unrepresentative of a bigger population since the goal of all research is really to come up with specific observations that may be extended or generalized by other researches. Furthermore, Waldron also errs in his insistence that studying the incidence of apraxia in children should be undertaken to the exclusion of an investigation into adult onset aphaxia.

Prior articles in this series provide a descriptive profile of 178 children with developmental phonological disorders (Shriberg & Kwiatkowski, 1994) and predictive correlates of short-term speech-sound normalization in 54 children (Shriberg, Kwiatkowski, & Gruber, 1994). The present article reports findings from a study of 10 children with developmental phonological disorders whose progress was followed at least once yearly for 7 years. Analyses characterize the sequence, rates, and error patterns of long-term speech-sound normalization in relation to developmental perspectives on the nature of children's phonological disorders. Findings are interpreted to support the hypothesis of a critical period for speech-sound development, with long-term normalization of significant speech delay reaching a chronological age boundary at approximately 8.5 years. KEY WORDS: phonology, disorders, prosody, development, prediction

A companion paper (Shriberg & Kwiatkowski, 1994) provides a descriptive profile of three samples of children (n = 178) with developmental phonological disorders. The present paper describes a conceptual framework for short-term and long-term speech-sound normalization research and reports 1-year normalization outcomes for 54 of the children described in the companion paper. Although certain individual speech variables were significantly associated with normalization, there were no speech, prosody-voice, or risk-factor variables that discriminated children who achieved short-term speech-sound normalization in 1 year. Findings are discussed in relation to a two-factor framework to study and predict speech-sound normalization in developmental phonological disorders (Kwiatkowski & Shriberg, 1993; Shriberg, Kwiatkowski, & Gruber, 1992). KEY WORDS: phonology, disorders, prosody, developmental, prediction

Detailed information on the speech, language, prosody, and voice characteristics of children with developmental phonological disorders is central to diverse research questions. The present study provides a clinical profile of 178 children with developmental phonological disorders. It includes information from prior reports (Shriberg & Kwiatkowski, 1982a; Shriberg, Kwiatkowski, Best, Hengst, & Terselic-Weber, 1986) and from several new measures on a sample of 64 children. The speech, prosody-voice, and causal-correlates profiles for the most recent sample are consistent with prior findings, providing a descriptive profile for forthcoming subgroup research and companion studies addressing short-term (Shriberg, Kwiatkowski, & Gruber, 1994) and long-term (Shriberg, Gruber, & Kwiatkowski, 1994) speech-sound normalization. KEY WORDS: phonology, disorders, prosody, developmental, causal-correlates

Five conditions for sampling the continuous speech of 12 speech-delayed children were defined and compared. Conditions differed on variables associated with examiner behavior and stimulus materials. General findings of few significant differences associated with sampling conditions support the validity of continous speech sampling for phonologic analyses of speech-delayed children. (Author/CL)

This study reviewed the exceptional educational needs histories of 36 children who had received preschool speech services at a phonology clinic. Findings indicated that 75-80 percent of children continued to have speech/language and other special education needs as they neared middle school and beyond. (Author/DB)

Retrospective study of case records of speech-delayed children (N=73) given 14 different management programs over seven years suggested that age and error type may be predictors of potential spontaneous generalization and that the inclusion of self-monitoring procedures may increase the probability of early spontaneous generalizations of target sounds to continuous speech. (Author/CB)

A conceptual framework for management of phonological disorders is proposed. The framework includes a 10-element system for describing the structure of management programs and invokes a diagnostic classification system for determining appropriate management content. Data from three serial studies of management structure describe four modes of management: drill, drill play, structured play, and play. (Author/SEW)

A diagnostic classification system for phonological disorders is presented which is oriented to the goals of explanation, prediction, and management. Data supporting the validity and utility of the system are also provided, based on a retrospective classification of 43 children with delayed speech. (Author/SEW)

According to the Centers for Medicare & Medicaid Services (CMS), the future of older adult care in the United States has arrived in a provider-sponsored health plan model that integrates medical, behavioral, and social care for frail elders. This approach gives the provider complete control over patient outcomes and total cost of care and enables participants to live safely in the community - rather than a nursing home - for an extra four years, on average. This article reviews the Program of All-inclusive Care for the Elderly (PACE) model, whose roots go back to the 1970s in California, and offers case studies on two PACE-RI participants with chronic healthcare needs. In both examples, the patients reduced hospitalizations and increased mental and physical health, all while alleviating caregiver stress. With the older population slated to double by 2060, the time has come to expand PACE to more people. [ABSTRACT FROM AUTHOR]

Two prior studies in this series (Shriberg, Aram, & Kwiatkowski, 1997a, 1997b) address the premise that children with developmental apraxia of speech (DAS) can be differentiated from children with speech delay (SD) on the basis of one or more reliable differences in their speech. The first study compared segmental and prosody-voice profiles of a group of 14 children with suspected DAS to profiles of 73 children with SD. Results suggest that the only linguistic domain that differentiates some children with suspected DAS from those with SD is inappropriate stress. The second study cross-validated these findings, using retrospective data from a sample of 20 children with suspected DAS evaluated in a university phonology clinic over a 10-year period. The present study is of particular interest because it cross-validates the prior stress findings, using conversational speech samples from 19 children with suspected DAS provided by five DAS researchers at geographically diverse diagnostic facilities in North America. Summed across the three studies, 52% of 48 eligible samples from 53 children with suspected DAS had inappropriate stress, compared to 10% of 71 eligible samples from 73 age-matched children with speech delay of unknown origin. Discussion first focuses on the implications of stress findings for theories of the origin and nature of DAS. Perspectives in psycholinguistics, neurolinguistics, and developmental biolinguistics lead to five working hypotheses pending validation in ongoing studies: (a) inappropriate stress is a diagnostic marker for at least one subtype of DAS, (b) the psycholinguistic loci of inappropriate stress in this subtype of DAS are in phonological representational processes, (c) the proximal origin of this subtype of DAS is a neurogenically specific deficit, (d) the distal origin of this form of DAS is an inherited genetic polymorphism, and (e) significant differences between acquired apraxia of speech in adults and findings for this subtype of DAS call into question the inference that it is an apractic, motor speech disorder. Concluding discussion considers implications of these findings for research in DAS and for clinical practice. KEY WORDS: apraxia, phonology, speech, children, disorders

This second paper in a series on developmental apraxia of speech (DAS) (Shriberg, Aram, & Kwiatkowski, 1997a) reports findings from two studies. Study I compares speech and prosody-voice profiles of a group of 14 children with suspected DAS to profiles of 73 children with speech delay (SD). Results suggest that the only linguistic domain that differentiates some children with suspected DAS from those with SD is inappropriate stress. Study II cross-validates these findings, using retrospective data from a sample of 20 children with suspected DAS evaluated in a university phonology clinic over a 10-year period. Discussion considers methodological and conceptual issues in the measurement of linguistic stress. Theoretical issues and implications for research and clinical practice are deferred for synthesis of the present findings with those from a multi-site cross-validation project (Shriberg, Aram, & Kwiatkowski, 1997b). KEY WORDS: apraxia, phonology, speech, children, disorders

Developmental apraxia of speech (DAS) is a putative diagnostic category for children whose speech errors presumedly (a) differ from the errors of children with developmental speech delay (SD) and (b) resemble the errors of adults with acquired apraxia of speech. The studies reported in this series (Shriberg, Aram, & Kwiatkowski, 1997a, 1997b) concern both premises, with primary focus on the first - that children with DAS can be differentiated from children with SD on the basis of one or more reliable differences in their speech error profiles. Immediate goals are to identify a diagnostic marker for DAS and to consider implications for research and clinical practice. A long-term goal is to identify the phenotype marker for DAS, on the assumption that it may be a genetically transmitted disorder. This first paper reviews relevant descriptive and theoretical perspectives. Findings from a local ascertainment study support the clinical functionality of the term suspected DAS. KEY WORDS: apraxia, phonology, speech, children, disorders

Discusses developmental phonological disorders on short-term speech-sound normalization. Discussion of a framework for research in speech-sound normalization in young children; Prediction research and practice in developmental phonological disorders; Group-level descriptive analyses of speech-sound normalization.

According to the Centers for Medicare & Medicaid Services (CMS), the future of older adult care in the United States has arrived in a provider-sponsored health plan model that integrates medical, behavioral, and social care for frail elders. This approach gives the provider complete control over patient outcomes and total cost of care and enables participants to live safely in the community - rather than a nursing home - for an extra four years, on average. This article reviews the Program of All-inclusive Care for the Elderly (PACE) model, whose roots go back to the 1970s in California, and offers case studies on two PACE-RI participants with chronic healthcare needs. In both examples, the patients reduced hospitalizations and increased mental and physical health, all while alleviating caregiver stress. With the older population slated to double by 2060, the time has come to expand PACE to more people. A few years ago, the acting administrator of the Centers for Medicare & Medicaid Services (CMS) said he was "glimpsing into our future" when he visited a provider-sponsored health plan that integrated medical, behavioral, and social care for frail elders, allowing them to remain in the community rather than live in a nursing home.[1] This approach to aging services successfully braided Medicare and Medicaid funding and gave the provider complete control over patient outcomes and total cost of care over a significant period - the key elements to delivering "value-based care." What is noteworthy is that this program of the "future" has been in Rhode Island since 2005 and in other parts of the country since 1973! It helps its medically complex participants live at home for an extra four years on average and retain a much higher quality of life, all while controlling associated costs for the government through capitated payment arrangements.[5] The program is called PACE - short for Program of All-inclusive Care for the Elderly - and it is a comprehensive and community-based model of care that coordinates medical, behavioral, and social services for individuals ages fifty-five and older who have high care needs but can remain safely in the community. PACE is currently offered in 31 states.[2] The model is backed by the National PACE Association and serves 50,000 seniors in 126 sponsoring organizations at 260 PACE centers across the country. While PACE has already had some success at scaling its integrated services, emerging demographics and heightened outreach poise the program for significant growth.