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Developmental Courses in Childhood Dysarthria: Longitudinal Analyses of Auditory-Perceptual Parameters

American Speech-Language-Hearing Association
Journal of Speech, Language, and Hearing Research
Authors:
Elisabet Haas at Ludwig-Maximilians-Universität in Munich
Elisabet Haas
Wolfram Ziegler at Ludwig-Maximilians-Universität in Munich
Wolfram Ziegler
Theresa Schölderle at Ludwig-Maximilians-Universität in Munich
Theresa Schölderle
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Abstract and Figures

Purpose The aim of this longitudinal study was to describe developmental courses of childhood dysarthria against the background of typical speech motor development by collecting auditory-perceptual data. Method Fourteen children (four girls, 10 boys; 5;1–8;4 [years;months] at Time 1) with neurological conditions (CNC) and 14 typically developing children (CTD) matched for age and gender were assessed at three points in time over an 18-month period. Speech samples were collected using the Bogenhausener Dysarthrie Skalen–Kindliche Dysarthrien (BoDyS-KiD; in English: Bogenhausen Dysarthria Scales–Childhood Dysarthria), a German tool for the assessment of childhood dysarthria, and analyzed by means of nine perceptual scales covering all clinically relevant speech components. Age normalization was performed according to a method published recently. Data from the matched controls were used to estimate whether the gradients of the CNC group's developmental trajectories exceeded those of typical development. Results The children with neurological conditions presented heterogeneous speech profiles with a wide range of severity. At the group level, relatively stable trajectories of the age-normalized dysarthria total score were found over the observation period. The nine perceptual scales showed more or less parallel developments. All patients except two followed the growth curve describing the developmental course of the typically developing children. Conclusions Most children took advantage of the developmental dynamics as they developed parallel to the age norm. With its comprehensive description of the developmental courses of 14 children with neurological conditions, this study may contribute to a more valid, statistically verified clinical assessment of the course of childhood dysarthria.
Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) profile of CNC02 (female, 5;6 [years;months]) at Time 1. Dashed line: age-normalized scores (left side axis). Normalized scores > 1 (dotted red line) indicate impairment. Solid line: raw scores (right-side axis). Note that the right-side axis extends from 0 to 4. To facilitate comparison, the raw score axis is reversed.
Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) profile of CNC02 (female, 5;6 [years;months]) at Time 1. Dashed line: age-normalized scores (left side axis). Normalized scores > 1 (dotted red line) indicate impairment. Solid line: raw scores (right-side axis). Note that the right-side axis extends from 0 to 4. To facilitate comparison, the raw score axis is reversed.
… 
Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) profiles (age normalized) of the children with neurological conditions (CNC) at Time 1. The solid lines at 0 represent the median of the reference group of 144 typically developing children; the dotted red lines at + 1 represent the 2.5% cutoff (Schölderle et al., 2020). The three motor components of speech (i.e., speech breathing, voice, articulation/resonance) and the prosody scales are highlighted by gray or white background color.
Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) profiles (age normalized) of the children with neurological conditions (CNC) at Time 1. The solid lines at 0 represent the median of the reference group of 144 typically developing children; the dotted red lines at + 1 represent the 2.5% cutoff (Schölderle et al., 2020). The three motor components of speech (i.e., speech breathing, voice, articulation/resonance) and the prosody scales are highlighted by gray or white background color.
… 
Normalized Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) total scores for Time 1, Time 2, and Time 3. Gray background color indicates the age-normalized 95% range of the reference group of typically developing children (Schölderle et al., 2020). Left: typically developing children (CTD group). Right: children with neurological conditions (CNC group).
Normalized Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) total scores for Time 1, Time 2, and Time 3. Gray background color indicates the age-normalized 95% range of the reference group of typically developing children (Schölderle et al., 2020). Left: typically developing children (CTD group). Right: children with neurological conditions (CNC group).
… 
Box plots of z-transformed difference scores for the 18-month period (Time 3–Time 1) in the CNC group. The 0 line represents the average normalized CTD differences within this period; units are standard deviations of the CTD group. The dotted red lines mark the ± 2-sigma range of the changes observed in the CTD group. Positive values indicate a deterioration relative to the predicted developmental change over the 18-month period; negative values reflect improvement. Values outside the 2-sigma range exceed the amount of change observed in children with no neurological conditions. CTD = typically developing children; CNC = children with neurological conditions.
Box plots of z-transformed difference scores for the 18-month period (Time 3–Time 1) in the CNC group. The 0 line represents the average normalized CTD differences within this period; units are standard deviations of the CTD group. The dotted red lines mark the ± 2-sigma range of the changes observed in the CTD group. Positive values indicate a deterioration relative to the predicted developmental change over the 18-month period; negative values reflect improvement. Values outside the 2-sigma range exceed the amount of change observed in children with no neurological conditions. CTD = typically developing children; CNC = children with neurological conditions.
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Developmental trajectories (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) of the Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) profiles of two children of the CNC group. Gray background color indicates 95% range, with + 1 representing the 2.5% cutoff of the reference group of 144 typically developing children (Schölderle et al., 2020). Left: CNC07 (male, 7;1 [years;months] at Time 1); right: CNC03 (male, 6;0 [years;months] at Time 1). Significant changes across the 18-month period are marked with asterisks. CNC = children with neurological conditions.
Developmental trajectories (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) of the Bogenhausen Dysarthria Scales–Childhood Dysarthria (BoDyS-KiD) profiles of two children of the CNC group. Gray background color indicates 95% range, with + 1 representing the 2.5% cutoff of the reference group of 144 typically developing children (Schölderle et al., 2020). Left: CNC07 (male, 7;1 [years;months] at Time 1); right: CNC03 (male, 6;0 [years;months] at Time 1). Significant changes across the 18-month period are marked with asterisks. CNC = children with neurological conditions.
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JSLHR
Clinical Focus
Developmental Courses in Childhood
Dysarthria: Longitudinal Analyses of
Auditory-Perceptual Parameters
Elisabet Haas,
a
Wolfram Ziegler,
a
and Theresa Schölderle
a
Purpose: The aim of this longitudinal study was to describe
developmental courses of childhood dysarthria against
the background of typical speech motor development by
collecting auditory-perceptual data.
Method: Fourteen children (four girls, 10 boys; 5;1–8;4 [years;
months] at Time 1) with neurological conditions (CNC) and
14 typically developing children (CTD) matched for age
and gender were assessed at three points in time over an
18-month period. Speech samples were collected using
the Bogenhausener Dysarthrie Skalen–Kindliche Dysarthrien
(BoDyS-KiD; in English: Bogenhausen Dysarthria Scales–
Childhood Dysarthria), a German tool for the assessment
of childhood dysarthria, and analyzed by means of nine
perceptual scales covering all clinically relevant speech
components. Age normalization was performed according
to a method published recently. Data from the matched
controls were used to estimate whether the gradients of the
CNC group’s developmental trajectories exceeded those
of typical development.
Results: The children with neurological conditions presented
heterogeneous speech profiles with a wide range of severity.
At the group level, relatively stable trajectories of the age-
normalized dysarthria total score were found over the
observation period. The nine perceptual scales showed
more or less parallel developments. All patients except two
followed the growth curve describing the developmental
course of the typically developing children.
Conclusions: Most children took advantage of the
developmental dynamics as they developed parallel to
the age norm. With its comprehensive description of the
developmental courses of 14 children with neurological
conditions, this study may contribute to a more valid,
statistically verified clinical assessment of the course of
childhood dysarthria.
Many children with neurological conditions show
symptoms of dysarthria. The most relevant
cause of childhood dysarthria is cerebral palsy
(CP), with up to 90% of the affected children experiencing
dysarthria (Bax et al., 2006; Mei et al., 2014; Nordberg
et al., 2013). Furthermore, other neurological conditions
can also cause dysarthria, such as cerebellar or brainstem
tumors (Murdoch & Hudson-Tennent, 1994; Richter et al.,
2005; van Mourik et al., 1998) and traumatic brain injury
(Cahill et al., 2002, 2003, 2005). Dysarthria usually manifests
itself on all functionally relevant components of speech,
that is, speech breathing, voice production, articulation/
resonance, and prosody. As a result, perceptual deviations
of speech features can occur to varying degrees in any one
or several of these components (Duffy, 2013; Workinger &
Kent, 1991).
Dysarthric impairment in most cases interferes with
the children’s ability to communicate, compromising, for
instance, intelligibility and naturalness of speech (Hustad
et al., 2018, 2012; Patel et al., 2012; Pennington & Mc-
Conachie, 2001). As a consequence, research indicates that
the children’s social and educational participation is often
restricted, and their quality of life can be negatively af-
fected (Dickinson et al., 2007; Fauconnier et al., 2009;
Mei et al., 2014; Pennington & McConachie, 2001). This
is especially burdening as children with dysarthria—due
to the early onset of the disorder—are confronted with
these limitations throughout their entire lives. An early
diagnosis and detailed characterization of the speech dis-
order of affected children are therefore essential to ensure
adequate treatment at an early stage in order to achieve
maximum treatment outcomes (Romski & Sevcik, 2005;
Sigurdardottir & Vik, 2011).
a
Clinical Neuropsychology Research Group, Institute of Phonetics
and Speech Processing, LMU Munich, Germany
Correspondence to Elisabet Haas: elisabet.haas@ekn-muenchen.de
Editor-in-Chief: Bharath Chandrasekaran
Editor: Stephanie Borrie
Received August 19, 2020
Revision received October 30, 2020
Accepted December 15, 2020
https://doi.org/10.1044/2020_JSLHR-20-00492
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
Journal of Speech, Language, and Hearing Research •Vol. 64 •1421–1435 •May 2021 •Copyright © 2021 American Speech-Language-Hearing Association 1421
... This study was approved by the Medical Faculty's Ethics Committee of the Ludwig-Maximilians-Universität München (LMU Munich). As there is some overlap with previous publications, details on participants, assessment materials, and auditory-perceptual analyses beyond the information provided herein can be obtained from Schölderle et al. (2020Schölderle et al. ( , 2021Schölderle et al. ( , 2022Schölderle et al. ( , 2023 as well as Haas et al. (2021Haas et al. ( , 2022. The present article refers to age and gender estimates in CTD and in CWD collected in a comprehensive listening experiment with adult listeners. ...
... Several children from both the CTD (14 of 144) and CWD groups (11 of 25) participated in a longitudinal study, with three or four assessments in 9-month intervals (see Haas et al., 2021). This results in a total of 175 sets of recordings of CTD and 47 of CWD. ...
... for Childhood Dysarthria (BoDyS-KiD; seeHaas et al., 2020Haas et al., , 2021Schölderle et al., 2020). The BoDyS-KiD assessment tool builds upon the BoDyS proposed byZiegler et al. in 2018 as an approach established ...
Age Estimation and Gender Attribution in Typically Developing Children and Children With Dysarthria
Article
Full-text available
Purpose The purposes of this study were (a) to investigate adult listeners' perceptions of age and gender in typically developing children and children with dysarthria and (b) to identify predictors of their estimates among auditory-perceptual parameters and an acoustic measure of vocal pitch (F0). We aimed to evaluate the influence of dysarthria on the listeners' impressions of age and gender against the background of typical developmental processes. Method In a listening experiment, adult listeners completed age and gender estimates of 144 typically developing children (3–9 years of age) and 25 children with dysarthria (5–9 years of age). The Bogenhausen Dysarthria Scales for Childhood Dysarthria (BoDyS-KiD) were applied to record speech samples and to complete auditory-perceptual judgments covering all speech subsystems. Furthermore, each child's mean F0 was determined from samples of four BoDyS-KiD sentences. Results Age estimates for the typically developing children showed a regression to the mean, whereas children with dysarthria were systematically underestimated in their age. The estimates of all children were predicted by developmental speech features; for the children with dysarthria, specific dysarthria symptoms had an additional effect. We found a significantly higher accuracy of gender attribution in the typically developing children than in the children with dysarthria. The prediction accuracy of the listeners' gender attribution in the preadolescent children by the included speech characteristics was limited. Conclusions Children with dysarthria are more difficult to estimate for their age and gender than their typically developing peers. Dysarthria thus alters the auditory-perceptual impression of indexical speech features in children, which must be considered another facet of the communication disorder associated with childhood dysarthria.
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... Dysarthria research is traditionally focused on adults; the topic of childhood dysarthria is relatively new. Knowledge about the clinical picture and prognosis of childhood dysarthria is still emerging, with the majority of articles on which current knowledge is based being published over the last 10 years (e.g., Allison & Hustad, 2018;Boliek & Fox, 2017;Haas et al., 2021;Hustad et al., 2019;Kuschmann & Lowit, 2021;Levy et al., 2021;Mei et al., 2014;Nordberg et al., 2013;Pennington, Roelant, et al., 2013;Schölderle et al., 2022). In addition, as some of the most common textbooks on dysarthria do not yet consider children as a client group (English: Duffy, 2020;German: Ziegler & Vogel, 2010), it can be challenging for SLPs to acquire knowledge specific to childhood dysarthria. ...
... However, results showed that the presence or absence of professional training in childhood dysarthria did not affect how many assessment instruments respondents used for the purposes of dysarthria assessment. In this context, it is important to note that many of the instruments (e.g., BoDyS-KiD [see Haas et al., 2021], the Intelligibility in Context Scale-German version [see Neumann et al., 2017]) have only recently become available or been translated into German, respectively. They may therefore not have been covered as part of their professional education at the time they were in training. ...
Clinical Practice in Childhood Dysarthria: An Online Survey of German-Speaking Speech-Language Pathologists
Article
Full-text available
Purpose This survey study aimed to establish current clinical practices of German-speaking speech-language pathologists (SLPs) regarding their assessment and treatment of communication disorders in children with neurological conditions, with a particular focus on the management of childhood dysarthria. Method A 23-question cross-sectional online survey was disseminated to practicing SLPs in Germany, Austria, and Switzerland via relevant professional bodies. SLPs were invited to provide information on their current assessment and treatment practices. Demographic data including case load and clinical settings were also gathered to contextualize practices. Results One hundred two SLPs responded to the survey, of which 68 valid responses were analyzed. German-speaking SLPs comprehensively assess and treat various aspects of overall communication, language, and swallowing functions in children with neurological conditions. Speech motor aspects did not represent a main intervention focus. In cases where the dysarthric component was targeted, specific approaches for childhood dysarthria were rarely used. Instead, SLPs reported using approaches developed for speech disorders other than dysarthria. Conclusions German-speaking SLPs working with children with neurological conditions use various assessment and treatment methods to support children's communication. However, dysarthria-specific approaches were not an established part of clinical practice. Results of the survey highlight the need for access to relevant developments in German and for evaluation of current curricula for speech-language pathology students and continuing education opportunities for practicing clinicians.
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... Notably, the BoDyS-KiD total scores and the intelligibility scores (see section on Listening Experiment for details) show that a substantial proportion of the CNC sample had severe speech deficits and intelligibility restrictions, respectively. On the other hand, the agenormalized BoDyS-KiD total score (see Haas et al., 2021) • • • demonstrated that three children from the CNC group ranged within their age norm and, hence, were not classified as dysarthric (i.e., CNC05, CNC08, and CNC09). They were included as part of the CNC sample in the following analyses. ...
... Standard speech samples were obtained using the protocol of the BoDyS-KiD (see Haas et al., 2021;Schölderle et al., 2020). This tool builds upon the BoDyS, proposed by Ziegler et al. (2018) as an approach established for adults with dysarthria. ...
Speech Naturalness in the Assessment of Childhood Dysarthria
Article
Full-text available
Purpose This study investigated perceived speech naturalness estimated by adult listeners in typically developing children and children with dysarthria. We aimed to identify predictors of naturalness among auditory-perceptual parameters and to evaluate the concept of naturalness as a clinical marker of childhood dysarthria. Method In a listening experiment, naive adult listeners rated speech naturalness of 144 typically developing children (3–9 years old) and 28 children with neurological conditions (5–9 years old) on a visual analog scale. Speech samples were recorded using the materials of the Bogenhausen Dysarthria Scales–Childhood Dysarthria, which also provides for auditory-perceptual judgments covering all speech subsystems. Results Children with dysarthria obtained significantly lower naturalness ratings compared to typically developing children. However, there was a substantial age effect observable in the typically developing children; that is, younger typically developing children were also perceived as somewhat unnatural. The ratings of the typically developing children were influenced by the occurrence of developmental speech features; for the children with neurological conditions, specific symptoms of dysarthria had an additional effect. In both groups, the perception of naturalness was predominantly determined by the children's articulation and intelligibility. Conclusions Both symptoms of childhood dysarthria and developmental speech features (e.g., regarding articulation and intelligibility) were associated to some extent with unnatural speech by the listeners. Thus, perceived speech naturalness appears less suitable as a marker of dysarthria in children than in adults.
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... CD may result from dysfunction of the respiratory system, larynx, and/or articulatory organs, resulting in difficulties producing clear speech. The characteristics of dysarthria in children may include distorted speech sounds, irregular speech rhythm, changes in voice quality (such as breathiness, hoarseness, or hypernasality), and difficulties with speech volume, pitch, and rate (Haas et al., 2021;Yorkston et al., 2010). The exact speech signs of CD and their severity vary widely among individuals, depending on the underlying cause and the specific muscles affected. ...
Exploring Motor Speech Disorders in Low and Minimally Verbal Autistic Individuals: An Auditory-Perceptual Analysis
Article
Full-text available
Purpose Motor deficits are widely documented among autistic individuals, and speech characteristics consistent with a motor speech disorder have been reported in prior literature. We conducted an auditory-perceptual analysis of speech production skills in low and minimally verbal autistic individuals as a step toward clarifying the nature of speech production impairments in this population and the potential link between oromotor functioning and language development. Method Fifty-four low or minimally verbal autistic individuals aged 4–18 years were video-recorded performing nonspeech oromotor tasks and producing phonemes, syllables, and words in imitation. Three trained speech-language pathologists provided auditory perceptual ratings of 11 speech features reflecting speech subsystem performance and overall speech production ability. The presence, attributes, and severity of signs of oromotor dysfunction were analyzed, as were relative performance on nonspeech and speech tasks and correlations between perceptual speech features and language skills. Results and Conclusions Our findings provide evidence of a motor speech disorder in this population, characterized by perceptual speech features including reduced intelligibility, decreased consonant and vowel precision, and impairments of speech coordination and consistency. Speech deficits were more associated with articulation than with other speech subsystems. Speech production was more impaired than nonspeech oromotor abilities in a subgroup of the sample. Oromotor deficits were significantly associated with expressive and receptive language skills. Findings are interpreted in the context of known characteristics of the pediatric motor speech disorders childhood apraxia of speech and childhood dysarthria. These results, if replicated in future studies, have significant potential to improve the early detection of language impairments, inform the development of speech and language interventions, and aid in the identification of neurobiological mechanisms influencing communication development.
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... The respiratory subsystem provides the driving pressure required to produce speech. Respiratory physiological impairments contribute to auditory-perceptual features of speech motor involvement such as inappropriate phrasing, reduced stress, voice quality changes, and difficulties regulating loudness, all of which are common in children with CP (Haas et al., 2021;Workinger & Kent, 1991). Respiration for speech, or speech breathing, is a carefully regulated process. ...
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Purpose This study examined speech breathing during two connected speech tasks in children with cerebral palsy (CP) and typically developing (TD) peers. Understanding how the respiratory system supports speech production during various speech tasks can help researchers construct appropriate models of speech production and clinicians remediate speech disorders effectively. Method Four children with CP and four age- and sex-matched TD peers completed two speech tasks, reading and extemporaneous speech. Respiratory kinematic and acoustic data were collected. Dependent variables included utterance length, speech rate, sound pressure level, and lung volume variables. Results Based on descriptive results, children with CP and speech motor involvement demonstrated reduced utterance length and speech rate, equivalent intensity levels, and changes in lung volume variables indicative of respiratory physiological impairment as compared to their TD peers. However, children with CP and no speech motor involvement exhibited speech production and speech breathing variables in the more typical range. In relation to task effects, the majority of children (CP and TD) produced shorter utterances, slower speech rates, equivalent intensity levels, higher lung volume initiation, termination, excursion, higher percent vital capacity per syllable, and longer inspiratory duration during extemporaneous speech as compared to reading. Conclusions Two major themes emerged from the data: (a) Children with CP, particularly those with concomitant speech motor involvement, demonstrate different speech production and speech breathing patterns than their TD peers. (b) Speech task impacts speech production and speech breathing variables in both children with CP and their TD peers, but the extemporaneous speech task did not seem to exaggerate group differences.
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ASSESSMENT PRACTICES OF SPEECH AND LANGUAGE PATHOLOGISTS FOR COGNITIVE COMMUNICATION IMPAIRMENT AFTER TRAUMATIC BRAIN INJURY
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Background of the Study: The aim of the present research was to examine the assessment practices of Speech-Language Pathologists for Cognitive Communication Disorders after Traumatic Brain Injury. Methodology: It was a cross-sectional survey method, a convenient sampling technique. Research was carried out from January 2021 to June 2021. The sample size was n=21, out of which n= 9 (42.8%) participants, each from Rawalpindi and Islamabad n= 3 (14.4%) participants from Lahore filled in their responses. Medium; being Online, the questionnaire was distributed either through email, WhatsApp or Facebook MessengerApp. SLPs who were undergraduates or who had no experience working with TBI clients were excluded. Questionnaire included 12 items. Responses of research participants were recorded using Google Forms and presented in the form of n (%). The data were analyzed using descriptive analysis, and chi-square analysis was performed to confirm the association between settings, city of practice and years of experience through Statistical Package of Social Sciences (SPSS) Version 22.0. Results: Speech-Language Pathologists reported that they routinely assessed (62% each) Receptive and Expressive communication. However; less than half of the participants routinely evaluated domains like verbal pragmatic skills (43.3%), functional communication (33.3%) and phonemic awareness (33.3%). SLPs assessed their clients by employing tests like MoCA (55.62%), Quick Aphasia Battery (18.75%), Cognitive Assessment (LOTCA Protocol) (14.35%) and a combination of Formal (48%) and Informal (52%) clinical interviews. Conclusion: Informal discourse assessment is incorporated more frequently as compared to informal discourse evaluation in assessment practices of Speech-Language pathologists of Pakistan for cognitive communication impairment followed by traumatic brain injury. Keywords: Brain injuries, cognitive dysfunction, language therapy, rehabilitation, speech therapy, traumatic.
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Purpose The purpose of this scoping review was to (a) summarize methodological characteristics of studies examining vocal characteristics of infants at high risk for neurological speech motor involvement and (b) report the state of the high-quality evidence on vocal characteristic trends of infants diagnosed or at high risk for cerebral palsy (CP). Method The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) extension for scoping reviews was followed for reporting our review. Studies measured prelinguistic vocal characteristics of infants under 24 months with birth risk or genetic conditions known to commonly present with speech motor involvement. Fifty-five studies met criteria for Part 1. Eleven studies met criteria for synthesis in Part 2. Results A smaller percentage of studies examined infants with or at risk for CP compared to studies examining genetic conditions such as Down syndrome. The median year of publication was 1999, with a median sample size of nine participants. Most studies were conducted in laboratory settings and used human coding of vocalizations produced during caregiver–child interactions. Substantial methodological differences were noted across all studies. A small number of high-quality studies of infants with or at risk for CP revealed high rates of marginal babbling, low rates of canonical babbling, and limited consonant diversity under 24 months. Mixed findings were noted across studies of general birth risk factors. Conclusions There is limited evidence available to support the early detection of speech motor involvement. Large methodological differences currently impact the ability to synthesize findings across studies. There is a critical need to conduct longitudinal research with larger sample sizes and advanced, modern technologies to detect vocal precursors of speech impairment to support the accurate diagnosis and prognosis of speech development in infants with CP and other clinical populations.
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  • AUGMENT ALTERN COMM
The purpose of this paper was to review best-practice methods of collecting and analyzing speech production data from minimally verbal autistic speakers. Data on speech production data in minimally verbal individuals are valuable for a variety of purposes, including phenotyping, clinical assessment, and treatment monitoring. Both perceptual ("by ear") and acoustic analyses of speech can reveal subtle improvements as a result of therapy that may not be apparent when correct/incorrect judgments are used. Key considerations for collecting and analyzing speech production data from this population are reviewed. The definition of "minimally verbal" that is chosen will vary depending on the specific hypotheses investigated, as will the stimuli to be collected and the task(s) used to elicit them. Perceptual judgments are ecologically valid but subject to known sources of bias; therefore, training and reliability procedures for perceptual analyses are addressed, including guidelines on how to select vocalizations for inclusion or exclusion. Factors to consider when recording and acoustically analyzing speech are also briefly discussed. In summary, the tasks, stimuli, training methods, analysis type(s), and level of detail that yield the most reliable data to answer the question should be selected. It is possible to obtain rich high-quality data even from speakers with very little speech output. This information is useful not only for research but also for clinical decision-making and progress monitoring.
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Longitudinal Growth in Intelligibility of Connected Speech From 2 to 8 Years in Children With Cerebral Palsy: A Novel Bayesian Approach
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Aim The aim of the study was to examine longitudinal growth in intelligibility in connected speech from 2 to 8 years of age in children with cerebral palsy. Method Sixty-five children with cerebral palsy participated in the longitudinal study. Children were classified into speech-language profile groups using age-4 data: no speech motor impairment (SMI), SMI with typical language comprehension, and SMI with impaired language comprehension. We fit a Bayesian nonlinear mixed-effects model of intelligibility growth at the child and group levels. We compared groups by age of steepest growth, maximum growth rate, and predicted intelligibility at 8 years of age. Results The no SMI group showed earlier and steeper intelligibility growth and higher average outcomes compared to the SMI groups. The SMI groups had more variable growth trajectories, but the SMI with typical language comprehension group had higher age-8 outcomes and steeper rates of maximum growth than the SMI with impaired language comprehension group. Language comprehension impairment at age of 4 years predicted lower intelligibility outcomes at age of 8 years, compared to typical language at age of 4 years. Interpretation Children with SMI at age of 4 years show highly variable intelligibility growth trajectories, and comorbid language comprehension impairment predicts lower intelligibility outcomes. Supplemental Material https://doi.org/10.23641/asha.12777659
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Purpose Accurate measurement of speech intelligibility is essential for children with speech production deficits, but wide variability exists in the measures and protocols used. The current study sought to examine relationships among measures of speech intelligibility and the capacity of different measures to capture change over time. Method Forty-five children with cerebral palsy (CP) with and without speech motor impairment were observed at ages 6, 7, and 8 years. The speech performance of each child was rated using four measures at each time point: standardized articulation test scores, multiword intelligibility scores obtained from naïve listeners, parent ratings of intelligibility, and percent intelligible utterances obtained from language transcripts. We analyzed the correlations of measures within each age and within three different severity groups, and we analyzed how these measures changed year over year in each severity group. Results For children with CP who have mild and moderate speech deficits, different measures of speech production were weakly associated, and for children with CP with severe speech impairment, these measures showed stronger associations. The four measures also differed in their ability to capture change over time. Finally, results from standardized assessments of articulation were not found to inform overall speech intelligibility for children with mild and moderate speech deficits. Conclusions Results suggest that speech production is not fully described by any single clinical measure. In order to adequately describe functional speaking abilities and to capture change over time, multiple levels of measurement are required.
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Purpose The aim of this study was to collect auditory-perceptual data on established symptom categories of dysarthria from typically developing children between 3 and 9 years of age, for the purpose of creating age norms for dysarthria assessment. Method One hundred forty-four typically developing children (3;0–9;11 [years;months], 72 girls and 72 boys) participated. We used a computer-based game specifically designed for this study to elicit sentence repetitions and spontaneous speech samples. Speech recordings were analyzed using the auditory-perceptual criteria of the Bogenhausen Dysarthria Scales, a standardized German assessment tool for dysarthria in adults. The Bogenhausen Dysarthria Scales (scales and features) cover clinically relevant dimensions of speech and allow for an evaluation of well-established symptom categories of dysarthria. Results The typically developing children exhibited a number of speech characteristics overlapping with established symptom categories of dysarthria (e.g., breathy voice, frequent inspirations, reduced articulatory precision, decreased articulation rate). Substantial progress was observed between 3 and 9 years of age, but with different developmental trajectories across different dimensions. In several areas (e.g., respiration, voice quality), 9-year-olds still presented with salient developmental speech characteristics, while in other dimensions (e.g., prosodic modulation), features typically associated with dysarthria occurred only exceptionally, even in the 3-year-olds. Conclusions The acquisition of speech motor functions is a prolonged process not yet completed with 9 years. Various developmental influences (e.g., anatomic–physiological changes) shape children's speech specifically. Our findings are a first step toward establishing auditory-perceptual norms for dysarthria in children of kindergarten and elementary school age. Supplemental Material https://doi.org/10.23641/asha.12133380
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Longitudinal Growth in Single-Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Effects of Speech-Language Profile Group Membership on Outcomes
Article
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Purpose We examined whether there were differences among speech-language profile groups of children with cerebral palsy (CP) in age of crossing 25%, 50%, and 75% intelligibility thresholds; age of greatest intelligibility growth; rate of intelligibility growth; maximum attained intelligibility at 8 years; and how well intelligibility at 36 months predicts intelligibility at 96 months when group membership is accounted for. Profile groups were children with no speech motor impairment (NSMI), those with speech motor impairment and language comprehension that is typically developing (SMI-LCT), and those with speech motor impairment and language comprehension impairment (SMI-LCI). Method Sixty-eight children with CP were followed longitudinally between 24 and 96 months of age. A total of 564 time points were examined across children (M = 8.3 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations, allowing for differences between profile groups. We used the fitted model trajectories to generate descriptive analyses of intelligibility growth by group and to generate simulations to analyze how well 36-month intelligibility data predicted 96-month data accounting for profile groups. Results Children with CP who have NSMI have different growth and better intelligibility outcomes than those with speech motor impairment. Children with SMI-LCT tend to have better outcomes but similar intelligibility growth as children with SMI-LCI. There may be a subset of children that cut across SMI-LCI and SMI-LCT groups who have severe speech motor involvement and show limited growth in intelligibility. Conclusions Intelligibility outcomes for children with CP are affected by profile group membership. Intelligibility growth tends to be delayed in children with speech motor impairment. Intelligibility at 3 years is highly predictive of later outcomes regardless of profile group. Intervention decision making should include consideration of early intelligibility, and treatment directions should include consideration of augmentative and alternative communication.
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Longitudinal Change in Speech Rate and Intelligibility Between 5 and 7 Years in Children With Cerebral Palsy
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Purpose We examined growth between 5 and 7 years in speech intelligibility, speech rate, and intelligible words per minute (IWPM) in 3 groups of children: those who were typically developing (TD), those with cerebral palsy (CP) and clinical speech motor impairment (SMI), and those with CP and no SMI (NSMI). Method Twenty-six children with CP, 16 with SMI, and 10 with NSMI were each seen at 5, 6, and 7 years of age. A cross-sectional group of 30 age-matched TD children, 10 in each age group, were included as controls. All children produced a corpus of utterances of 2–7 words. Results All groups of children showed increases in intelligibility and IWPM between 5 and 7 years. Only children with SMI showed increases in speech rate over time. Patterns of change were similar for children in the TD and NSMI groups but different for children in the SMI group. Conclusions The window of time between 5 and 7 years is an important period of growth for the production of connected speech where nearly all children, regardless of group, made significant changes in speech intelligibility and IWPM. Interventions focusing specifically on enhancing intelligibility in this age range may help facilitate even further growth in children with SMI, who still had marked intelligibility reductions at 7 years of age.
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Longitudinal Growth in Single Word Intelligibility Among Children With Cerebral Palsy From 24 to 96 Months of Age: Predicting Later Outcomes From Early Speech Production
Article
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Purpose Children with cerebral palsy (CP) are at risk for significant communication problems. Reduced speech intelligibility is common, even for those who do not have speech motor deficits. Development of intelligibility has not been comprehensively quantified in children with CP; as a result, we are currently unable to predict later speech outcomes. Such information would advance treatment decision making. We sought to examine growth in speech intelligibility among children with CP using a prospective longitudinal design, with a focus on age of crossing target intelligibility thresholds, age of greatest intelligibility growth, and how well intelligibility at 36 months predicted intelligibility at 96 months. Method Sixty-nine children with CP were followed longitudinally between 24 and 96 months of age. A total of 566 time points were examined across children (M = 8.2 time points per child, SD = 2.6). We fitted a nonlinear random effects model for longitudinal observations and then used the fitted model trajectories to generate descriptive analyses of growth. We used results of the model to generate a set of simulations, which we analyzed to determine how well 36-month intelligibility data predicted 96-month data. Results Half of children crossed 25% and 50% intelligibility thresholds at 36 and 49 months of age, respectively. Slightly more than half of children did not reach 75% intelligibility by 96 months of age. Age of crossing 25%, 50%, and 75% intelligibility thresholds was highly negatively correlated with intelligibly at 96 months. Children had the steepest intelligibility growth at 36 months, followed by 48 and 60 months. Intelligibility at 36 months was highly predictive of intelligibility at 96 months. Conclusions The developmental window from 3 to 5 years constitutes a time of rapid growth in speech intelligibility in children with CP. Children who cross intelligibility thresholds of 25%, 50%, and 75% at earlier ages have better outcomes when they are older; early performance is highly predictive of later speech intelligibility outcomes. Children with CP as a group have delayed speech intelligibility development but are still growing through 96 months of age.
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Data-Driven Classification of Dysarthria Profiles in Children With Cerebral Palsy
Article
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Purpose The objectives of this study were to examine different speech profiles among children with dysarthria secondary to cerebral palsy (CP) and to characterize the effect of different speech profiles on intelligibility. Method Twenty 5-year-old children with dysarthria secondary to CP and 20 typically developing children were included in this study. Six acoustic and perceptual speech measures were selected to quantify a range of segmental and suprasegmental speech characteristics and were measured from children's sentence productions. Hierarchical cluster analysis was used to identify naturally occurring subgroups of children who had similar profiles of speech features. Results Results revealed 4 naturally occurring speech clusters among children: 1 cluster of children with typical development and 3 clusters of children with dysarthria secondary to CP. Two of the 3 dysarthria clusters had statistically equivalent intelligibility levels but significantly differed in articulation rate and degree of hypernasality. Conclusion This study provides initial evidence that different speech profiles exist among 5-year-old children with dysarthria secondary to CP, even among children with similar intelligibility levels, suggesting the potential for developing a pediatric dysarthria classification system that could be used to stratify children with dysarthria into meaningful subgroups for studying speech motor development and efficacy of interventions.
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Characteristics of Speech Rate in Children With Cerebral Palsy: A Longitudinal Study
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Purpose The purpose of this longitudinal study was to examine the effect of time and sentence length on speech rate and its characteristics, articulation rate and pauses, within 2 groups of children with cerebral palsy (CP). Method Thirty-four children with CP, 18 with no speech motor involvement and 16 with speech motor involvement, produced sentences of varying lengths at 3 time points that were 1 year apart (mean age = 56 months at first time point). Dependent measures included speech rate, articulation rate, proportion of time spent pausing, and average number and duration of pauses. Results There were no significant effects of time. For children with no speech motor involvement, speech rate increased with longer sentences due to increased articulation rate. For children with speech motor involvement, speech rate did not change with sentence length due to significant increases in the proportion of time spent pausing and average number of pauses in longer sentences. Conclusions There were no significant age-related differences in speech rate in children with CP regardless of group membership. Sentence length differentially impacted speech rate and its characteristics in both groups of children with CP. This may be due to cognitive–linguistic and/or speech motor control factors.
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Longitudinal growth of receptive language in children with cerebral palsy between 18 months and 54 months of age
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  • May 2018
en Aim We examined receptive language developmental trajectories between 18 months and 54 months for three clinical speech‐language profile groups of children with cerebral palsy (those with speech motor involvement, without speech motor involvement, and with anarthria) and quantified differences from age‐level expectations. We identified latent classes of comprehension development, related these classes to clinical profile groups, and examined how well early receptive language predicted outcomes. Method We used a prospective longitudinal design. Eighty‐five children with cerebral palsy (43 females, 42 males) were followed longitudinally from 18 to 54 months of age. Children were seen two to eight times (322 data points). Children were classified into clinical profile groups. Language comprehension age‐equivalent scores were the primary measures of interest. Results Children with anarthria had significant language delays, limited developmental change over time, and comprised their own latent class. Children with speech motor impairment had slight receptive language delays over time. Children with no speech motor impairment had age‐appropriate receptive language over time. Early language comprehension scores were highly predictive of later latent profile group membership. Interpretation Early language comprehension abilities are highly predictive of language comprehension growth trajectory and suggest that children with early language delay, particularly those who are non‐speaking, should receive language intervention to support development. What this paper adds • There are two growth trajectories for language comprehension among children with cerebral palsy. • Children with speech motor impairment had a constant 6‐month receptive language delay. • Children without speech motor impairment had age‐appropriate receptive language. • Non‐speaking children had significant receptive language delay. • Early language comprehension change was highly predictive of later trajectory group. Resumen es Crecimiento longitudinal del lenguaje receptivo en niños con parálisis cerebral entre los 18 y 54 meses de edad Objetivo Examinamos las trayectorias del desarrollo del lenguaje receptivo de tres grupos clínicos entre 18 y 54 meses, según el perfil del habla y el lenguaje de niños con parálisis cerebral (aquellos con afectación motora, sin afectación motora del habla y con anartria) y diferencias cuantificadas de las expectativas del nivel de edad. Identificamos tipos de desarrollo de comprensión latentes, relacionando estas clases con grupos de perfiles clínicos y examinamos qué tan bien pronosticaron los resultados del lenguaje receptivo temprano. Metodo Usamos un diseño longitudinal prospectivo. Ochenta y cinco niños con parálisis cerebral (43 mujeres, 42 varones) fueron seguidos longitudinalmente desde los 18 a los 54 meses de edad. Los niños fueron vistos de dos a ocho veces (322 puntos de datos). Los niños fueron clasificados en grupos de perfiles clínicos. Los puntajes de la comprensión del lenguaje equivalentes a la edad fueron las principales medidas de interés. Resultados Los niños con anartria tuvieron retrasos significativos en el lenguaje, con un cambio limitado en el desarrollo a lo largo del tiempo y conformaron su propio tipo latente. Los niños con discapacidad motora del habla tuvieron retrasos leves en el lenguaje receptivo al pasar el tiempo. Los niños sin discapacidad motora del habla tenían un lenguaje receptivo apropiado para su edad a lo largo del tiempo. Las puntuaciones de comprensión del lenguaje tempranas fueron altamente predictivas de la membresía al grupo latente según el perfil posterior. Interpretacion Las habilidades tempranas de comprensión del lenguaje son altamente predictivas de la trayectoria de crecimiento de la comprensión del lenguaje y sugieren que los niños con retraso temprano del lenguaje, particularmente aquellos que no hablan, deben recibir intervención del lenguaje para apoyar el desarrollo. Resumo pt Desenvolvimento longitudinal da linguagem receptiva em crianças com paralisia cerebral entre 18 e 54 meses de idade Objetivo Nós examinamos as trajetórias do desenvolvimento da linguagem receptiva entre 18 e 54 meses para grupos de crianças com paralisia cerebral com três perfis clínicos de linguagem receptiva (aqueles com envolvimento motor da fala, sem envolvimento motor da fala, e com anartria) Identificamos as classes latentes de desenvolvimento da compreensão, relacionadas a estes perfis clínicos, e examinamos quão bem a linguagem receptiva precoce foi preditiva dos resultados. Método Usamos um desenho prospectivo longitudinal. Oitenta e cinco crianças com paralisia cerebral (43 do sexo feminino, 42 do sexo masculino) foram acompanhadas longitudinalmente dos 18 aos 54 meses de idade. As crianças foram vistas de duas a oito vezes (322 pontos de dados) e foram classificadas nos grupos de acordo com o perfil clínico. Os escores equivalentes à idade para compreensão da linguagem foram as medidas primárias de interesse. Resultados Crianças com anartria tinham atraso significativo na linguagem, mudança desenvolvimental limitada com o passar do tempo, e formaram sua própria classe latente. Crianças com envolvimento motor da fala tinha leve atraso na linguagem receptiva com o tempo. Crianças sem comprometimento motor da fala tinham linguagem receptiva adequada para a idade com o passar do tempo. Os escores precoces de compreensão da fala foram altamente preditivos do pertencimento ao grupo de perfil latente posteriormente. Interpretação Habilidades precoces de compreensão da linguagem são altamente preditivas da trajetória de desenvolvimento da comrpeensão da linguagem, e sugerem que crianças com atraso precoce, particularmente as que não falam, devem receber intervenção de linguagem para favorecer seu desenvolvimento.
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Dysarthriediagnostik mit Kindern – das Testmaterial der BoDyS-KiD
Article
  • Dec 2020
Kindliche Dysarthrien stellen ein häufiges Störungsbild dar. Trotzdem existieren kaum geeignete Untersuchungsmethoden. Dieser Beitrag erläutert spezifische Herausforderungen in der Diagnostik kindlicher Dysarthrien und stellt ein neues Untersuchungsmaterial vor. Dieses ermöglicht es, kindgerecht und motivierend standardisierte Sprechproben von Kindern mit Dysarthrie zu elizitieren und stellt so die Basis für umfassende auditive Analysen dar. Childhood dysarthria is a common disorder. However, specific assessment tools are scarce. The current paper illustrates challenges related to the assessment of childhood dysarthria and introduces assessment materials that allow for the elicitation of standardized speech samples from children with dysarthria in a child-oriented and motivating way. Thus, it provides the basis for comprehensive auditory-perceptual analyses.
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