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Correlations between data from medical records, isolated and sequenced oro-motor skills, DDK, speech and language measures.
Contexts in source publication
Context 1
... variables within each aggregation correlated positively with each other (see Table 1) and were grouped as follows: ...Context 2
... aggregation provides evidence in support of a strong association between speech-motor and language measures in CAS. As shown in Table 1, all the variables correlated significantly with each other. -IV Aggregation: Early developmental milestones. ...Context 3
... correlations were also found between inconsistency of errors, expressive grammar and (to a lesser degree) DDK. As shown in Table 1, after adjustment for multiple comparisons, not all of them retained statistical significance. ...Similar publications
Speech Motor Delay (SMD) is a recently proposed childhood motor speech disorder characterized by imprecise and unstable speech, prosody, and voice that does not meet criteria for either Childhood Dysarthria or Childhood Apraxia of Speech. The goals of the present research were to obtain information on the phenotype of SMD and initial information on...
Background
Childhood apraxia of speech (CAS) is a speech sound disorder in which the precision and consistency of movements underlying speech are impaired in absence of neuromuscular deficits. It is important to differentiate between language disorders and CAS to avoid misdiagnosis. The objective of this study was to develop a test battery for CAS...
Objective:
Children with speech sound disorders (SSDs) have difficulties affecting different levels of speech production. For treatment to be beneficial, it is important to differentiate between Childhood Apraxia of Speech (CAS) - a motor speech disorder with deficits in speech praxis - and other SSDs (nonCAS-SSD). We have previously developed a m...
Citations
... Difficulties in early oromotor and phono-articulatory aspects of speech acquisition in CAS may stem from weaker systematic mappings between articulatory gestures and their auditory effects [3]. Along with its isolated presentation, CAS usually co-occurs with language impairment (LI) [4][5][6], particularly in the expressive domain (grammar and lexicon). ...
Childhood apraxia of speech (CAS) is a subtype of motor speech disorder usually co-occurring with language impairment. A supramodal processing difficulty, involving executive functions (EFs), might contribute to the cognitive endophenotypes and behavioral manifestations. The present study aimed to profile the EFs in CAS, investigating the relationship between EFs, speech and language severity, and the connectivity of the frontal aslant tract (FAT), a white matter tract involved in both speech and EFs. A total of 30 preschool children with CAS underwent speech, language, and EF assessments and brain MRIs. Their FAT connectivity metrics were compared to those of 30 children without other neurodevelopmental disorders (NoNDs), who also underwent brain MRIs. Alterations in some basic EF components were found. Inhibition and working memory correlated with speech and language severity. Compared to NoND children, a weak, significant reduction in fractional anisotropy (FA) in the left presupplementary motor area (preSMA) FAT component was found. Only speech severity correlated and predicted FA values along with the FAT in both of its components, and visual-spatial working memory moderated the relationship between speech severity and FA in the left SMA. Our study supports the conceptualization of a composite and complex picture of CAS, not limited to the speech core deficit, but also involving high-order cognitive skills.
... CAS may occur as isolated or associated with other disorders. It can appear as an idiopathic disorder in otherwise healthy children (Chilosi et al., 2015) but it may be also symptomatic of neurometabolic pathologies, such as galactosemia (Shriberg, Potter, & Strand, 2011) and creatine transporter deficiency (Battini et al., 2007), or associated with syndromic conditions (Wilson, Abbeduto, Camarata, & Shriberg, 2019). ...
Background
Childhood Apraxia of Speech is a severe and persistent clinical subtype of Speech Sound Disorder. Given the difficulties in the acquisition, programming and control of the movements underlying speech and the slowdown in a wide range of non-linguistic skills, the difficulty in implicit learning of sequential information could play a role in the disorder, contributing to understand its etiopathological mechanisms and behavioral manifestations.
Aims
The present study was aimed at investigating implicit learning in children with Childhood Apraxia of Speech.
Methods and procedures
Twenty-five children with Childhood Apraxia of Speech, aged between 4 and 12 years, were matched for IQ and age to a control group of 25 typically developing children. Implicit learning of participants was assessed by Serial Reaction Time Task.
Outcome and results
Children with Childhood Apraxia of Speech did not show implicit learning, as documented by the absence of differences between reaction times in the sequenced block and the random block, usually considered as a measure of implicit learning effect.
Conclusion and implications
Our results underline an implicit learning deficit in children with Childhood Apraxia of Speech, supporting the concept of a disorder not only confined to the speech domain, but also involving non-linguistic skills, in a composite and complex picture.
... Mutations in FOXP2, originally described in the multigenerational KE family [7], account for a small proportion of cases [8,9]. The use of chromosome microarray analysis (CMA) and the application of next generation sequencing techniques have denoted a large genetic heterogeneity in the past few years [10][11][12][13][14][15][16] with the identification of gene variants that may implicate shared pathways in broad transcriptional regulation during normal speech development [16][17][18][19][20]. Regarding the neural correlates, routine clinical magnetic resonance (MR) usually does not detect unequivocal causative brain abnormalities in idiopathic CAS [21][22][23]. ...
... Isolated CAS seems to account for only a part of the cases, while children with complex comorbid profiles represent a large population with different needs in terms of diagnosis, healthcare, treatment and educational support [23]. Furthermore, the co-occurrence of CAS and language impairment (LI) is frequently documented in literature [4,6,[22][23][24][25]. In English-speaking children with CAS, some authors described [24,26] the presence of morphological errors that were not entirely explained by the motor speech deficits, thus suggesting a possible linguistic origin. ...
... It was assumed that the complex syntactic and morphological structure of Italian, might account for a higher vulnerability of the developing language system in the presence of a severe and persistent primary motor speech disorder. Previous research carried out by our group on a small sample of Italian children with CAS showed the presence of language impairment in most of the children [22]. We were therefore particularly interested in broadening our clinical approach to CAS conceived as a "symptom complex" [29,30] that must be studied considering a wide number of interacting variables. ...
Childhood apraxia of speech (CAS) is a motor speech disorder often co-occurring with language impairment and complex neurodevelopmental disorders. A cohort of 106 children with CAS associated to other neurodevelopmental disorders underwent a multidimensional investigation of speech and language profiles, chromosome microarray analysis and structural brain magnetic resonance (MR). Our aim was to compare the clinical profiles of children with CAS co-occurring with only language impairment with those who, in addition to language impairment, had other neurodevelopmental disorders. Expressive grammar was impaired in the majority of the sample in the context of similar alterations of speech, typical of the core symptoms of CAS. Moreover, children with complex comorbidities also showed more severe and persistent receptive language deficits. About 25% of the participants harbored copy number variations (CNVs) already described in association to neurodevelopmental disorders. CNVs occurred more frequently in children with complex comorbidities. MR structural/signal alterations were found in a small number of children and were of uncertain pathogenic significance. These results confirm that CAS needs multidimensional diagnostic and clinical management. The high frequency of language impairment has important implications for early care and demands a personalized treatment approach in which speech and language goals are consistently integrated.
... Childhood apraxia of speech is usually interpreted as a motor speech disorder, whose core deficit involves the planning and/or programming of the spatiotemporal parameters of speech movement sequences. 1 The majority of children with idiopathic childhood apraxia of speech presents with normal structural brain magnetic resonance imaging (MRI), 2,3 suggesting that brain abnormalities might be too subtle to be detected by conventional MRI, 2,4 but possibly could be revealed by the use of advanced brain imaging techniques. Fiori et al 5 assessed whole brain connectivity in Italian children with childhood apraxia of speech and found significant alterations of inter-and intra-hemispheric connections of bilateral brain regions, correlating with a set of clinical speech measures. ...
... Speech and language were evaluated according to the procedure described in Chilosi et al, 3 which included the following speech measures: evaluation of phonetic inventory, assignment of an intelligibility score (by 2 independent observers blinded to the assigned treatment group), word accuracy scored as the percentage of consonants correct in a picture-naming task; inconsistency of lexical productions after 2 presentations of the same naming task; diadochokinesis rate and accuracy assessed by a maximum performance task (fast repetition for 20 seconds of 2 and 3 syllable nonwords). ...
We report a case series of children with childhood apraxia of speech, by describing behavioral and white matter microstructural changes following 2 different treatment approaches.
Five children with childhood apraxia of speech were assigned to a motor speech treatment (PROMPT) and 5 to a language, nonspeech oral motor treatment. Speech assessment and brain MRI were performed pre- and post-treatment. The ventral (tongue/larynx) and dorsal (lips) corticobulbar tracts were reconstructed in each subject. Mean fractional anisotropy and mean diffusivity were extracted. The hand corticospinal tract was assessed as a control pathway. In both groups speech improvements paralleled changes in the left ventral corticobulbar tract fractional anisotropy. The PROMPT treated group also showed fractional anisotropy increase and mean diffusivity decrease in the left dorsal corticobulbar tract. No changes were detected in the hand tract. Our results may provide preliminary support to the possible neurobiologic effect of a multimodal speech motor treatment in childhood apraxia of speech.
... Diadochokinesis was assessed with Maximum performance rate [16]. This task is used to test the ability to repeat a syllable sequence (/pataka/) as quickly as possible for 20 s in order to look at motor speech skills separate from the effects related to word familiarity. ...
Background:
To analyze the oral motor, speech and language phenotype in a sample of pediatric patients with GLUT 1 transporter deficiency syndrome (GLUT1DS).
Methods:
eight Italian-speaking children with GLUT1DS (aged 4.6-15.4 years) in stable treatment with ketogenic diet from a variable time underwent a specific and standardized speech and language assessment battery.
Results:
All patients showed deficits with different degrees of impairment in multiple speech and language areas. In particular, orofacial praxis, parallel and total movements were the most impaired in the oromotor domain; in the speech domain patients obtained a poor performance in the diadochokinesis rate and in the repetition of words that resulted as severely deficient in seven out of eight patients; in the language domain the most affected abilities were semantic/phonological fluency and receptive grammar.
Conclusions:
GLUT1DS is associated to different levels of speech and language impairment, which should guide diagnostic and therapeutic intervention. Larger population data are needed to identify more precisely a speech and language profile in GLUT1DS patients.
... Despite the growing interest in the study of CAS, etiology and neural correlation remain poorly understood as this disorder is idiopathic [38]. Thus, since the central auditory system is a network of intertwined structures that extend through the medulla, bridge, midbrain, thalamus and temporal lobes of the cortex, this network is also intrinsically connected to other systems such as the sensory, motor and cognitive systems [39], which may justify speech processing to occur in an altered way in these children. ...
Objective
to compare the Frequency Following Responses of children with childhood apraxia of speech with typical development children.
Method
this is an observational cross-sectional analytical study approved by Human Research Ethics Committee. Thirty normal hearing children have participated in the study.
They were divided into two groups
1) study group – composed by 15 children diagnosed with childhood apraxia of speech (between the chronological ages of 3 and 11 years, mean age of 5,7 years); and 2) control group: composed by 15 children with typical development, paired by age and gender with study group. Frequency Following Response were recorded using the/da/syllable presentation rate at 10.9 milliseconds.
Results
there was a significant delay in latencies of waves V, A and C of children with apraxia of speech, suggesting difficulties in the ability to process sounds.
Conclusion
The delay on Frequency Following Response´s latencies (waves V, A and C) in children with apraxia of speech maybe related to atypical neural coding of speech sounds, suggesting that apraxia of speech must not be purely considered as a motor speech disorder.
... According to past literature, children with CAS exhibit deficits across all levels of speech production, including lexical representation (Marquardt et al., 2004), phonological encoding (Thoonen et al., 1997), speech motor planning and speech motor programming. As such, CAS speech is often characterized by impaired motor control phenomena such as errors in the production of consonants and vowels, simplifications of clusters and complex syllables, prosodic anomalies and higher than normal token-to-token variability (see Chilosi et al., 2015;Forrest, 2003;Grigos et al., 2015;Iuzzini & Forrest, 2008;Iuzzini-Seigel et al., 2016;Jacks et al., 2006;Lewis et al., 2004;Marquardt et al., 2004). Among the symptoms, the observed inconsistency of speech sound articulation is essential for identifying children with (or at risk for) CAS, considering that token-to-token variability has been found by some scholars to be more marked in CAS than in other conditions of speech delay (e.g., Grigos et al., 2015;Iuzzini, 2012;Marquardt et al., 2004), particularly in the case of isolated multisyllabic words (whereas at the phrase level, children with CAS were not significantly different from children with language impairment, according to Iuzzini-Seigel et al., 2016). ...
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.
... CAS is a neurological childhood speech motor disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits [5], and is included among Speech Sound Disorders (SSD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]. CAS core-deficit involves the planning and/or programming of the spatiotemporal parameters of movement sequences necessary for speech control [5] and is very frequently associated with an expressive language disorder [6]. ...
... CAS diagnosis was conducted by a multidisciplinary team on the basis of a comprehensive clinical, instrumental and neurological assessment as well as a video recorded speech-language evaluation. Following the international criteria for CAS diagnosis, speech and language performances were analysed by two independent expert observers according to a checklist including American Speech-Language-Hearing Association (ASHA) criteria [5] and Strand's features of CAS [6,10,34]. Inclusion criteria were: (a) age between 34 and 71 months, (b) NVIQ ≥ 70, (c) no ASD symptoms documented by neuropsychiatric and psychological observation. ...
Autism Spectrum Disorder (ASD) and Childhood Apraxia of Speech (CAS) are developmental disorders with distinct diagnostic criteria and different epidemiology. However, a common genetic background as well as overlapping clinical features between ASD and CAS have been recently reported. To date, brain structural language-related abnormalities have been detected in both the conditions, but no study directly compared young children with ASD, CAS and typical development (TD). In the current work, we aim: (i) to test the hypothesis that ASD and CAS display neurostructural differences in comparison with TD through morphometric Magnetic Resonance Imaging (MRI)-based measures (ASD vs. TD and CAS vs. TD); (ii) to investigate early possible disease-specific brain structural patterns in the two clinical groups (ASD vs. CAS); (iii) to evaluate predictive power of machine-learning (ML) techniques in differentiating the three samples (ASD, CAS, TD). We retrospectively analyzed the T1-weighted brain MRI scans of 68 children (age range: 34-74 months) grouped into three cohorts: (1) 26 children with ASD (mean age ± standard deviation: 56 ± 11 months); (2) 24 children with CAS (57 ± 10 months); (3) 18 children with TD (55 ± 13 months). Furthermore, a ML analysis based on a linear-kernel Support Vector Machine (SVM) was performed. All but one brain structures displayed significant higher volumes in both ASD and CAS children than TD peers. Specifically, ASD alterations involved fronto-temporal regions together with basal ganglia and cerebellum, while CAS alterations are more focused and shifted to frontal regions, suggesting a possible speech-related anomalies distribution. Caudate, superior temporal and hippocampus volumes directly distinguished the two conditions in terms of greater values in ASD compared to CAS. The ML analysis identified significant differences in brain features between ASD and TD children, whereas only some trends in the ML classification capability were detected in CAS as compared to TD peers. Similarly, the MRI structural underpinnings of two clinical groups were not significantly different when evaluated with linear-kernel SVM. Our results may represent the first step towards understanding shared and specific neural substrate in ASD and CAS conditions, which subsequently may contribute to early differential diagnosis and tailoring specific early intervention.
... Adding to this, segmental errors increase as the words get longer, and/or the phonemes are part of an accented syllable (Chilosi, Lorenzini, Cerri & Cipriani, 2014). The speed of articulation of CAS subjects, measured in number of syllables per second, is significantly slower than their peers (Chilosi, Lorenzini, Fiori, Graziosi, Rossi, Pasquariello, Cipriani & Cioni, 2015). CAS subjects may also present several markers of morphological and syntactic disorders. ...
... CAS subjects may also present several markers of morphological and syntactic disorders. Syntactic structures suffer from the limitations of the vocabulary and CAS children tend to produce sentences of less than average length and with a simpler grammatical structure compared to their peers (Chilosi et al., 2015). It has been hypothesized that the small vocabularies of children with CAS have an upstream impact on the cognitive-linguistic aspects of phonology (Velleman, 2011). ...
Instability of speech production as a marker of Childhood Apraxia of Speech (CAS): Segmental and acoustic evidence According to ASHA (2007), CAS is "a neurological childhood disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuro-muscular deficits". The present study aims to verify whether the extreme variability (at seg-mental as well as acoustic level) in the production of the very same linguistic unit (word or syllable) is a marker of CAS. We engaged three CAS subjects in multiple productions of the same linguistic units using the TFPI, a new phonetic test not yet published. Then we analyzed the recorded signals by means of different metrics, chosen among the most sensitive ones to track speech variability, in order to assess the consistency and stability of CAS subjects production. This was compared to that of the control groups, i.e. lexical age peers (calcu-lated with the Italian version of MacArthur Communicative Development Inventories or CDI), chronological age peers and adults. The results suggest that CAS speech is characterized by phonological inconsistency, i.e., multiple productions of the same target very often do not share the same phonological form, especially with the longest words. Moreover, the analysis of intra-syllabic CV anticipatory coarticulation suggests that CAS children have an immature speech motor control, similar to that of 2-or 3-years-old children.
... A third conceptualization of CAS is as a motor speech disorder with a complex set of associated deficits arising from a heterogeneous genetic source (Chilosi et al., 2015;Worthey et al., 2013). In this conceptualization, CAS is not a unitary disorder with all children demonstrating the same set of symptoms (Nijland, Terband, & Maassen, 2015;Velleman, 2016); instead, children can evidence differing levels of severity of motor speech deficit and differing patterns of cognitive, language, and literacy deficits (Nijland et al., 2015;Peter, Button, Stoel-Gammon, Chapman, & Raskind, 2013;Peter et al., 2016;Worthey et al., 2013). ...
Purpose
The primary aims of this study were to examine the speech-language correlates of decoding difficulties in children with histories of suspected childhood apraxia of speech (sCAS) and to identify predictors of low-proficiency reading levels.
Method
Participants were school-age children and adolescents, 7–18 years of age, diagnosed with sCAS ( n = 40) or speech sound disorder but no sCAS (SSD-no sCAS; n = 119). The sCAS and SSD-no sCAS reading groups were compared on measures of performance IQ, oral language, phonological awareness, rapid automatic naming, diadochokinetic rates, single word articulation, and multisyllable and nonsense word repetition. Logistic regression analyses were employed to identify predictors of low-proficiency reading in the sCAS and SSD-no sCAS groups.
Results
Sixty-five percent of the participants with sCAS compared to 24% of those with SSD-no sCAS were classified as low-proficiency readers based on nonsense and single word decoding. Analysis failed to reveal significant differences in reading, oral language, or phonological awareness between low-proficiency readers with sCAS and low-proficiency readers with SSD-no sCAS. Oral language and phonological awareness skills were the best predictors of reading level for all participants, followed by performance on multisyllabic word repetition and diadochokinetic rate.
Conclusions
The language and phonological awareness deficits of children with sCAS are related to their risks for reading failure. To a lesser degree, motor speech deficits and speech sound production also increase risks for reading difficulties. The findings justify early intervention for this subset of children.
