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Oscillogram (uppermost window) and spectrogram (lowermost window) of the utterance /he: de#sxikw:r/. The little triangles in the oscillogram display the markers that were placed at segment transitions; the small black dots in the spectrogram represent the formant values.
Source publication
The aim of the present study was to investigate whether children with developmental apraxia of speech (DAS) show a deficit in planning syllables in speech production. Six children with DAS and six normally speaking (NS) children produced high- and low-frequency of occurrence syllable utterances, in which the syllable structure was systematically ma...
Similar publications
Purpose:
To present a systematic review of single-case experimental treatment studies for childhood apraxia of speech (CAS).
Method:
A search of 9 databases was used to find peer-reviewed treatment articles from 1970 to 2012 of all levels of evidence with published communication outcomes for children with CAS. Improvement rate differences (IRDs)...
Purpose:
This study aimed to test whether an approach to distinguishing errors arising in phonological processing from those arising in motor planning also predicts the extent to which repetition-based training can lead to improved production of difficult sound sequences.
Method:
Four individuals with acquired speech production impairment who pr...
The current study investigated the impact of a dual treatment approach that included stimulability training protocol (STP) paired with a modified core vocabulary treatment (mCVT) on the speech sounds produced by children with CAS. The combined treatment was assessed for changes in consistency and expansion of the phonetic inventories of four partic...
Intra-word inconsistency in a child is perceived as an indicator of speech impairment. Because the speech of typically developing children is highly variable, the extent and nature of the inconsistency must be defined when used as a diagnostic marker of speech impairment (McLeod, S., & Hewett, S. R. (2008). Variability in the production of words co...
Purpose:
The goal of this study was to identify new candidate genes and genomic copy-number variations associated with a rare, severe, and persistent speech disorder termed childhood apraxia of speech. Childhood apraxia of speech is the speech disorder segregating with a mutation in FOXP2 in a multigenerational London pedigree widely studied for i...
Citations
... It is important to note that CAS was the current diagnostic label applied to each child in school and outpatient therapy even though we anticipated that not all children would not meet this stringent CAS criteria. We coded for the presence of CAS features by administering the following tasks via online assessment: build upon word imitation (e.g., please, pleasing, pleasingly; Iuzzini-Seigel, 2019, 2021), sentence imitation (e.g., Buy Bobby a puppy; Iuzzini-Seigel et al., 2017), imitation of isolated (e.g., round lips) and sequenced (e.g., smile -puff cheeks) oral movements (e.g., Aziz et al., 2010), alternating (e.g., /pʌpʌpʌ/) and sequential (e.g., /pʌtʌkʌ/) motion rates (e.g., Murray et al., 2015;Nijland et al., 2003), two language samples obtained from two narrative generation tasks (e.g., Case & Grigos, 2021;Iuzzini-Seigel, 2019), and spontaneous/ conversational speech (e.g., Nijland et al., 2003). The video recordings were independently coded for the presence of CAS features by two individuals, the first author, a licensed and certified SLP with 15 years of clinical experience and expertise in CAS, and a pediatric SLP with more than 18 years of clinical experience and recognized expertise in CAS by Apraxia Kids. ...
... It is important to note that CAS was the current diagnostic label applied to each child in school and outpatient therapy even though we anticipated that not all children would not meet this stringent CAS criteria. We coded for the presence of CAS features by administering the following tasks via online assessment: build upon word imitation (e.g., please, pleasing, pleasingly; Iuzzini-Seigel, 2019, 2021), sentence imitation (e.g., Buy Bobby a puppy; Iuzzini-Seigel et al., 2017), imitation of isolated (e.g., round lips) and sequenced (e.g., smile -puff cheeks) oral movements (e.g., Aziz et al., 2010), alternating (e.g., /pʌpʌpʌ/) and sequential (e.g., /pʌtʌkʌ/) motion rates (e.g., Murray et al., 2015;Nijland et al., 2003), two language samples obtained from two narrative generation tasks (e.g., Case & Grigos, 2021;Iuzzini-Seigel, 2019), and spontaneous/ conversational speech (e.g., Nijland et al., 2003). The video recordings were independently coded for the presence of CAS features by two individuals, the first author, a licensed and certified SLP with 15 years of clinical experience and expertise in CAS, and a pediatric SLP with more than 18 years of clinical experience and recognized expertise in CAS by Apraxia Kids. ...
Purpose:
Rhythm is one procedural mechanism that underlies language and motor skill acquisition and has been implicated in children with childhood apraxia of speech (CAS). The purpose of this study is to investigate manual rhythmic sequencing skills in children with a history of or current CAS (hx/CAS) compared to children with typical development (TD).
Method:
Thirty-eight children (18 with hx/CAS, 20 with TD), ages 5;0-12;8 (years;months), from across the United States participated in an online study. Participants imitated two rhythms in two different conditions, clapping and tapping. We assessed overall accuracy, mean number of beats, pause marking, and rhythmic sequence variability using the Mann-Whitney U test. Effect sizes were calculated to examine the influence of coordinative complexity on performance.
Results:
Compared to children with TD, children with hx/CAS marked fewer trials with a pause in both conditions of the easier rhythm and showed lower overall accuracy and more variable rhythmic sequences in both rhythms and conditions. The mean number of beats produced by children with hx/CAS and children with TD did not differ in three out of four rhythms/conditions. Unlike children with TD, children with hx/CAS showed little improvement from clapping to tapping across most dependent measures; reducing coordination demands did not improve performance in children with hx/CAS.
Conclusions:
We found that children with hx/CAS show manual rhythmic deficits that are similar to the deficits they display in speech. These findings provide support for a domain-general cognitive mechanisms account of the rhythmic deficits observed across linguistic and nonlinguistic tasks in children with hx/CAS.
Supplemental material:
https://doi.org/10.23641/asha.24052821.
... Speech Motor Chaining emphasizes the principles of acquisition by targeting core syllables, comprised of sounds and transitions that are of low accuracy for a given child, in order to address speech sound errors in the context of movement sequences that transition into and out of the target sound. The syllable is emphasized (versus sounds in isolation) due to evidence that many aspects of speech planning occur in syllabic units (Laganaro et al., 2012;Nijland et al., 2003;Rogers & Storkel, 1998). As performance increases, the emphasis of Speech Motor Chaining adapts to learning and the core syllables are embedded within longer units (monosyllabic words, multisyllabic words, phrases, and sentences). ...
Purpose:
This study examines how ultrasound biofeedback and intensive treatment distribution affect speech sound generalization during an evidence-based treatment, Speech Motor Chaining, for children with persisting speech errors associated with childhood apraxia of speech (CAS).
Method:
In a 2 × 2 factorial randomized controlled trial, children ages 9-17 years meeting CAS criteria were randomized to receive (a) a distributed treatment (20 sessions twice weekly over 10 weeks) or intensive treatment (20 hr in 5 weeks, with 10 hr in Week 1) and (b) treatment with or without biofeedback. Due to the COVID pandemic, some participants were randomized to distributed/intensive telepractice treatment only. The primary outcome was percent target sounds correct on untreated phrases (i.e., generalization) at the 10-week time point. More than 50,000 narrow phonetic transcriptions were analyzed.
Results:
Forty-eight participants completed treatment. Intensive treatment significantly increased generalization at all time points. The effect of biofeedback was significant at 5 weeks from the start of treatment but not significant at the primary 10-week time point. However, when comparing each group immediately after their 20 hr of treatment finished, generalization was significantly greater in intensive over distributed treatment and greater in ultrasound over no-ultrasound treatment (with a significant interaction favoring intensive treatment with ultrasound). Only the advantage of intensive treatment remained significant 5 weeks after groups finished treatment. There was no significant difference between face-to-face and telepractice modalities.
Conclusions:
When the number of treatment hours is fixed, an intensive schedule of Speech Motor Chaining facilitated greater improvement than a distributed schedule. Ultrasound biofeedback initially accelerated learning, but the benefits may dissipate as treatment continues or after it ends.
... Systematic vowel gaps have not been verified in infants and toddlers with sCAS, though it appears that older children with CAS produce vowels with greater variability in vowel length and formant frequencies than children with TD (Blech et al., 2007;Lenoci et al., 2021;Nijland et al., 2002Nijland et al., , 2003. Beerman (2011) found no difference between the vowels of seven toddlers (aged 2;6-2;11 [years;months]) with CAS and two older groups (preschoolers [aged 4;0-4;11] and school-age children [aged 5;0-9;9]) with CAS with respect to the number of articulatory production errors, vowel-to-vowel movement errors, or consonant-to-vowel movement errors on the Kaufman Speech Praxis Test (Kaufman, 1995). ...
Purpose
The purpose of this tutorial is to (a) provide an updated review of the literature pertaining to proposed early features of childhood apraxia of speech (CAS), (b) discuss the findings of recent treatment studies of infants and toddlers with suspected CAS (sCAS), and (c) present evidence-based strategies and tools that can be used for the identification of and intervention for infants and toddlers with sCAS or at high risk for the disorder.
Method
Since Davis and Velleman's (2000) seminal work on assessment and intervention in infants and toddlers with sCAS, limited research has guided clinicians in the complex task of identifying and treating early speech motor difficulties prior to a definitive diagnosis of CAS. Following the structure of Davis and Velleman, we explore the proposed early characteristics of CAS with reference to contemporary research. Next, we describe the limited treatment studies that have investigated intervention for infants and toddlers at risk of or suspected of having CAS. Finally, we present practical suggestions for integrating this knowledge into clinical practice.
Conclusions
Many of the originally proposed correlates of CAS in infants and toddlers now have research supporting their presence. However, questions remain about the developmental trajectory of the disorder. Although limited in number and restricted by lack of experimental control, emerging treatment studies can help guide clinicians in providing appropriate intervention to infants and toddlers with sCAS who need not wait for a definitive diagnosis to initiate intervention.
... Childhood apraxia of speech (CAS) is a complex speech motor disorder that results in severely impaired speech production and has been historically resistant to conventional treatment approaches (American Speech-Language-Hearing Association [ASHA], 2007; Davis et al., 1998;Teverovsky et al., 2009). Deficits in the planning and programming of speech movements are known to underlie characteristics of CAS (Case & Grigos, 2016;Crary, 1984;Grigos & Kolenda, 2010;Grigos et al., 2015;Moss & Grigos, 2012;Nijland, Maassen, van der Meulen, Gabreëls, et al., 2003;Terband et al., 2011). Although motor-based treatments are posited as the optimal means of improving speech production in children with CAS (e.g., Maas et al., 2014), it has not yet been established whether such approaches refine speech motor control over the course of intervention. ...
... Using this information as a foundation for studying speech motor control in children with speech impairment, researchers aim to tease apart maturational changes from those reflecting refinement of the impaired system. This line of inquiry is critical to advancing our understanding of CAS, an impairment in which deficits in speech motor control are known to underlie difficulties planning and programming speech movements (Case & Grigos, 2016, 2020, 2021Crary, 1984;Grigos & Kolenda, 2010;Grigos et al., 2015;Moss & Grigos, 2012;Nijland, Maassen, van der Meulen, Gabreëls, et al., 2003;Terband et al., 2011). ...
... With respect to speech timing, children with CAS produce sounds (Nijland, Maassen, van der Meulen, Gabreëls, et al., 2003) and words (Bahr, 2005) that are longer in acoustic duration, as compared to children with TD. Studies of articulator movement have also shown that children with CAS, other speech sound disorders (SSDs), and developmental language disorder display speech movement durations that are longer than those produced by their peers with TD (Case, 2019;Case & Grigos, 2016;Goffman, 1999Goffman, , 2004Grigos et al., 2015;Moss & Grigos, 2012). ...
Purpose:
Speech motor skill is refined over the course of practice, which is commonly reflected by increased accuracy and consistency. This research examined the relationship between auditory-perceptual ratings of word accuracy and measures of speech motor timing and variability at pre- and posttreatment in children with childhood apraxia of speech (CAS). Furthermore, the degree to which individual patterns of baseline probe word accuracy, receptive language, and cognition predicted response to treatment was explored.
Method:
Probe data were collected from seven children with CAS (aged 2;5-5;0 [years;months]) who received 6 weeks of Dynamic Temporal and Tactile Cueing (DTTC) treatment. Using a multidimensional approach to measuring speech performance, auditory-perceptual (whole-word accuracy), acoustic (whole-word duration), and kinematic (jaw movement variability) analyses were conducted on probe words produced pre- and posttreatment. Standardized tests of receptive language and cognition were administered pretreatment.
Results:
There was a negative relationship between auditory-perceptual measures of word accuracy and movement variability. Higher word accuracy was associated with lower jaw movement variability following intervention. There was a strong relationship between word accuracy and word duration at baseline, which became less robust posttreatment. Furthermore, baseline word accuracy was the only child-specific factor to predict response to DTTC treatment.
Conclusions:
Following a period of motor-based intervention, children with CAS appeared to refine speech motor control in conjunction with improvements in word accuracy. Those who demonstrated the poorest performance at treatment onset displayed the greatest degree of gains. Taken together, these results reflect a system-wide change following motor-based intervention.
... The MACS has the benefit of being able to highlight clinical gains not captured by these measures. Furthermore, as motor planning and programming of speech movements occurs at the level of the syllable (Nijland et al., 2003), measurement of gains in word structure may capture the beginning of organizational changes in the programming of speech movements that other measures would not evaluate. ...
Purpose:
The Multilevel word Accuracy Composite Scale (MACS) is a novel whole-word measure of speech production accuracy designed to evaluate behaviors commonly targeted in motor-based intervention for childhood apraxia of speech (CAS). The MACS yields a composite score generated through ratings of segmental accuracy, word structure maintenance, prosody, and movement transition. This study examined the validity of the MACS through comparison to established measures of speech accuracy. Reliability was also examined within and between practicing speech-language pathologists (SLPs).
Method:
The MACS was used to rate 117 tokens produced by children with severe CAS. Ratings were performed in the laboratory setting by two expert raters and by practicing SLPs (N = 19). Concurrent validity was estimated through comparison of expert MACS ratings (i.e., MACS score and each component rating) to measures of speech accuracy (percent phoneme correct and the 3-point scale) using correlational analyses. Reliability was examined between expert raters and across SLP raters using the intraclass correlation coefficient to examine interrater reliability of expert ratings, in addition to inter- and intrarater reliability of SLP ratings.
Results:
Correlation analyses between MACS ratings (i.e., MACS score and component ratings) and existing measures of speech accuracy revealed small to large positive correlations between measures. Reliability analyses revealed moderate to excellent reliability for MACS ratings performed by expert raters and between (interrater) and within (intrarater) SLP raters.
Conclusions:
Analyses of concurrent validity indicate that the MACS aligns with established measures, yet contributes novel elements for rating speech accuracy. Results further support the MACS as a reliable measure for rating speech accuracy in children with severe speech impairment for ratings performed by expert raters and practicing clinicians.
... A clinical diagnosis of CAS is primarily determined by the presence of inconsistent articulation errors, inappropriate stress patterns, and/or disrupted co-articulatory transitions between sounds and syllables (American Speech- Language-Hearing Association, 2007). Although the etiology of CAS remains unclear, the core deficits that characterize CAS have largely been attributed to disruption(s) in speech motor planning or programming (e.g., Iuzzini-Seigel et al., 2015;Nijland et al., 2003;Shriberg et al., 2012;Terband & Maassen, 2010). Planning of speech movements is modeled in prominent theories of speech production as the process of translating stored motor programs for individual speech Correspondence to Jennifer Zuk: jzuk@bu.edu. ...
... Typically, as children grow and develop, motor programs are established that enable more patterned and consistent speech production (McNeill et al., 2009b;Spencer & Rogers, 2005). By contrast, for children with CAS, the ability to translate stored motor programs into speech is thought to be disrupted (Bohland et al., 2010;Nijland et al., 2003). Numerous factors have been suggested that may cause these disruptions, including atypical neural pathways for auditory-motor integration, disrupted somatosensation of the tongue and palate, overreliance on auditory feedback, or even poor speech perception (Iuzzini-Seigel et al., 2015;Maassen et al., 2003;Nijland, 2009;Shriberg et al., 2012;Terband & Maassen, 2010). ...
Purpose
Beyond hallmark production deficits characterizing childhood apraxia of speech (CAS), largely attributed to disruption(s) in speech motor planning, children with CAS often present with co-occurring speech perception and language difficulties. Thus, careful consideration of the potential for speech perception difficulties to have cascading downstream effects on intervention responsiveness and real-life functioning for some children with CAS is highly important. The purpose of this tutorial was to consider the impact of speech perception abilities in children with CAS, which carries implications for caring for the needs of the whole child.
Method
This tutorial summarizes the current literature on speech perception and how it relates to speech production, language, and reading abilities for children with CAS. We include case illustrations that are adapted from real clinical scenarios illustrating how speech perception difficulties may impact some children with CAS and provide recommendations for incorporating speech perception into assessment and intervention practices.
Results
Although speech perception difficulties do not seem to be a core deficit of CAS, they are strongly linked to language difficulties, which are highly prevalent among children with CAS. Speech perception and language difficulties are also associated with reading difficulties and risk for lower academic achievement.
Conclusions
Children with CAS who have co-occurring language difficulties likely also demonstrate speech perception deficits, which puts them at heightened risk for reading difficulties and struggles with academic achievement. Comprehensive assessment of children with CAS should address speech perception and production, language, and reading abilities, which carries important implications for multifaceted approaches to intervention.
... [21][22][23] Specifically, acoustic measures of the speech of children with CAS show evidence of a disruption in temporal control of speech, marked by increased duration and reduced variability in duration of speech segments. 15,[24][25][26][27][28][29] Ballard et al. provided strong preliminary evidence as to the utility of acoustic measures as sensitive indices of treatmentrelated change in CAS in the first single-case design study of TEMPO SM , 15 but there is otherwise a lack of acoustic evidence as to the efficacy of CAS treatment. Therefore, the application of these durational acoustic measures in a larger group study is a critical next step to advance our understanding of the specific mechanisms through which TEMPO SM improves prosody in CAS. ...
Purpose: This study investigated the efficacy of Treatment for Establishing Motor Program Organization (TEMPOSM) in childhood apraxia of speech (CAS).
Method: A mixed between- and within-participant design with multiple baselines across participants and behaviors was used to examine acquisition, generalization, and maintenance of skills. TEMPOSM was administered in four one-hour sessions a week over a four-week period for eleven participants (ages 5 to 8), allocated to either an immediate treatment group or a wait-list control group. Acoustic and perceptual variables were measured at baseline, immediate post-treatment, and one-month post-treatment.
Results: Children demonstrated significant improvements in specific acoustic measures of segmentation and lexical stress, as well as perceptual measures of fluency, lexical stress, and speech-sound accuracy. Treatment and generalization effects were maintained one-month post-treatment with generalization to untreated stimuli.
Conclusion: TEMPOSM was efficacious in improving segmental and suprasegmental impairments in the speech of children with CAS.
... [21][22][23] Specifically, acoustic measures of the speech of children with CAS show evidence of a disruption in temporal control of speech, marked by increased duration and reduced variability in duration of speech segments. 15,[24][25][26][27][28][29] Ballard et al. provided strong preliminary evidence as to the utility of acoustic measures as sensitive indices of treatmentrelated change in CAS in the first single-case design study of TEMPO SM , 15 but there is otherwise a lack of acoustic evidence as to the efficacy of CAS treatment. Therefore, the application of these durational acoustic measures in a larger group study is a critical next step to advance our understanding of the specific mechanisms through which TEMPO SM improves prosody in CAS. ...
... Other studies documented impairments in appropriately producing temporal distinctions. For instance, children with CAS were found to make vowels longer, relative to normally speaking children (Nijland et al., 2003;N =, p. 6) and to reduce the temporal distinction between tense and lax vowels (Peter & Stoel-Gammon, 2005;N = , p. 2). ...
Open Access: https://www.tandfonline.com/doi/full/10.1080/02699206.2020.1853811
Phoneme production may be affected by limited speech motor control in Childhood Apraxia of Speech (CAS), with a general instability of acoustic targets across multiple repetitions of speech stimuli. This acoustic and Ultrasound Tongue Imaging (UTI) study shows that increased variability and reduction of contrast in vowel production is found in native Italian speakers with CAS, particularly as far as the height dimension is concerned. The data suggest that vowel produc- tion should play a major role in CAS diagnosis and treatment. Moreover, this study shows that a combined acoustic and articulatory approach allows direct observation of lingual dynamics together with an estimation of changes in the acoustic dimension. The two dimen- sions are shown not to correspond in a straightforward way in the speech of children with CAS, and encourage consideration of articu- latory compensation strategies aimed at saving the acoustic identity of vowels.
... The study of speech motor control is of particular interest for CAS, as this is a pediatric motor speech disorder characterized by deficits in the programming and planning of speech movements that result in poor co-articulatory transitions, prosodic deficits, and inconsistent speech production errors (ASHA, 2007). Children with CAS have been found to have longer acoustic and kinematic duration as compared to children with TD (Bahr, 2005;Case & Grigos, 2016;Grigos & Kolenda, 2010;Grigos et al., 2015;Nijland et al., 2003). Longer duration in children with CAS is interpreted as secondary to motor deficits, as children have less efficient speech motor patterning and require additional time to achieve articulatory targets (Case & Grigos, 2016;Grigos et al., 2015). ...
Introduction
The current work presents a framework of motoric complexity where stimuli differ according to movement elements across a sound sequence (i.e., consonant transitions and vowel direction). This framework was then examined in children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development (TD).
Method
Twenty-four children (CAS, n = 8; SSD, n = 8; TD, n = 8), 5–6 years of age, participated in this study. The children produced words that varied in motoric complexity while transcription, acoustic, and kinematic data were collected. Multidimensional analyses were conducted to examine speech production accuracy, speech motor variability, and temporal control.
Results
Analyses revealed poorer accuracy, longer movement duration, and greater speech motor variability in children with CAS than TD (across all measures) and other SSDs (accuracy and variability). All children demonstrated greater speech motor variability and longer duration as movement demands increased within the framework of motoric complexity. Diagnostic grouping did not mediate performance on this task.
Conclusions
Results of this study are believed to reveal gradations of complexity with increasing movement demands, thereby supporting the proposed framework of motoric complexity. This work also supports the importance of considering motoric properties of sound sequences when evaluating speech production skills and designing experimental and treatment stimuli.
