Research Priorities for Childhood Apraxia of Speech: A Long View.

This article introduces the Journal of Speech, Language, and Hearing Research Special Issue: Selected Papers From the 2022 Apraxia Kids Research Symposium. The field of childhood apraxia of speech (CAS) has developed significantly in the past 15 years, with key improvements in understanding of basic biology including genetics, neuroscience, and computational modelling; development of diagnostic tools and methods; diversity of evidence-based interventions with increasingly rigorous experimental designs; and understanding of impacts beyond impairment-level measures. Papers in this special issue not only review and synthesize the some of the substantial progress to date but also present novel findings addressing critical research gaps and adding to the overall body of knowledge. A second aim of this prologue is to report the current research needs in CAS, which arose from symposium discussions involving researchers, clinicians, and Apraxia Kids community members (including parents of children with CAS). Four primary areas of need emerged from discussions at the symposium. These were: (a) What questions should we ask? (b) Who should be in the research? (c) How do we conduct the research? and (d) How do we move from research to practice? Across themes, symposium attendees emphasized the need for CAS research to better account for the diversity of people with CAS and improve the timeliness of implementation of high-level evidence-based practice across the lifespan. It is our goal that the articles and prologue discussion in this special issue provide an appreciation of advancements in CAS research and an updated view of the most pressing needs for future research.

Preliminary Speech Perception Performance Profiles of School-Age Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development.

PURPOSE: Limited research exists assessing speech perception in school-age children with speech sound disorder (SSD) and childhood apraxia of speech (CAS); despite early evidence that speech perception may lead to error-prone motor planning/programming. In this study, we examine speech perception performance in school-age children with and without speech production deficits. METHOD: Speech perception was assessed using the Wide Range Acoustic Accuracy Scale to determine the just-noticeable difference in discrimination for three consonant-vowel syllable contrasts (/bɑ/-/wɑ/, /dɑ/-/gɑ/, /ɹɑ/-/wɑ/), each varying along a single acoustic parameter for seven children with CAS with rhotic errors, seven children with SSD with rhotic errors, and seven typically developing (TD) children. RESULTS: Findings revealed statistically significant mean differences between perceptual performance of children with CAS when compared to TD children for discrimination of /ɹɑ/-/wɑ/ contrasts. Large effect sizes were also observed for comparisons of /ɹɑ/-/wɑ/ contrasts between children with CAS, SSD, and TD peers. Additionally, large effect sizes were observed for /dɑ/-/gɑ/ contrasts between children with CAS and SSD and TD children despite nonsignificant mean differences in group performance. CONCLUSIONS: Overall, mean outcome scores suggest that school-age children with CAS and persistent rhotic errors demonstrated less accurate speech perception skills relative to TD children for the /ɹɑ/-/wɑ/ contrasts. However, the relatively small sample sizes per group limit the extent to which these findings may be generalized to the broader population.

Subtract Before You Add: Toward the Development of a De-Implementation Approach in School-Based Speech Sound Therapy.

PURPOSE: It is often difficult for school-based speech-language pathologists (SLPs) to prioritize implementing new practices for children with speech sound disorders (SSDs), given burgeoning caseloads and the myriad of other workload tasks. We propose that de-implementation science is equally as important as implementation science. De-implementation science is the recognition and identification of areas that are of "low-value and wasteful." Critically, the idea of de-implementation suggests that we first remove something from a clinician's workload before requesting that they learn and implement something new. METHOD: Situated within the Sustainability in Healthcare by Allocating Resources Effectively (SHARE) framework, we review de-implementation science and current speech sound therapy literature to understand the mechanisms behind continuous use of practices that are no longer supported by science or legislation. We use vignettes to highlight real-life examples that clinicians may be facing in school-based settings and to provide hypothetical solutions, resources, and/or next steps to these common challenges. RESULTS: By focusing on Phase 1 of the SHARE framework, we identified four primary practices that can be de-implemented to make space for new evidence-based techniques and approaches. These four practices were determined based on an in-depth review of SLP-based survey research: (a) overreliance on speech sound norms for eligibility determinations, (b) the omission of phonological processing skills within evaluations, (c) homogeneity of service delivery factors, and (d) the use of only one treatment approach for all children with SSDs. CONCLUSIONS: De-implementation will take work and may lead to some difficult discussions. Implementing a framework, such as SHARE, can guide SLPs toward a reduction in workloads and improved outcomes for children with SSDs.

Speech Sound Disorder Treatment Approaches Used by School-Based Clinicians: An Application of the Experience Sampling Method.

PURPOSE: Children with speech sound disorders (SSDs) comprise a large portion of caseloads for school-based speech-language pathologists (SLPs). Despite the existence of several evidence-based SSD intervention approaches, the translation from research to practice is often limited by ecological validity because of various factors unique to school settings (e.g., scheduling constraints, caseload size, child availability). The purpose of this study was to use the experience sampling method (ESM) to examine the current practices of school-based SLPs when treating children with SSDs on their caseloads. METHOD: SLPs (N = 106) from 42 different states working full-time in school-based K-12 settings participated in this study. At the beginning of the study, each SLP completed a one-time demographic survey about treatment practices for children with SSDs. The SLPs then participated in a series of brief surveys every day for one workweek using a specialized ESM phone application that randomly alerted participants to report on their treatment practices for children with SSDs. RESULTS: Findings revealed that although most SLPs reported using a variety of SSD intervention approaches in a one-time survey, the majority of SLPs reported using one of three approaches in situ: the traditional articulation therapy approach, cycles, and minimal pairs. We also report a significant negative relationship between the years of experience of an SLP and the number of different approaches used. CONCLUSIONS: This study is the first to use the ESM to determine which approaches school-based SLPs use to treat children with SSDs. Findings demonstrate that SLPs have knowledge of many different SSD approaches but tend to utilize only a few in school-based settings.

Clinical Considerations for Speech Perception in School-Age Children With Speech Sound Disorders: A Review of the Current Literature.

PURPOSE: The purpose of this study was to synthesize the methodological variability in the speech perception literature for school-age children with residual speech sound disorder (RSSD), with the primary intention of using the existing knowledge to inform clinical decisions and optimize treatment outcomes for children. METHOD: Ten electronic databases were systematically searched to identify articles examining the speech perception skills of school-age children with RSSD. A total of 11 articles met inclusion criteria, reporting of methodological characteristics was rated and compared across studies, and findings were summarized. RESULTS: The majority of studies reviewed here confirmed the presence of a perceptual deficit for a subset of children with RSSD. However, marked variability across study methodologies limits clinical interpretation and application of the findings. CONCLUSIONS: Despite limited research in children with RSSD and wide variability across study procedures, stimulus type, perception type, and task type emerged as potential key factors that provide critical insight into a child's perceptual skill. The current evidence suggests that deficits in speech perception may significantly impact acquisition of accurate phoneme production for children with RSSD. Furthermore, these findings suggest that assessment and treatment of speech perception may be a critical component of an intervention program for school-age children, although further research is needed to determine effective clinical procedures.

Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits.

Purpose: Children with dyslexia have speech production deficits in a variety of spoken language contexts. In this article, we discuss the nature of speech production errors in children with dyslexia, including those who have a history of speech sound disorder and those who do not, to familiarize speech-language pathologists with speech production-specific risk factors that may help predict or identify dyslexia in young children. Method: In this tutorial, we discuss the role of a phonological deficit in children with dyslexia and how this may manifest as speech production errors, sometimes in conjunction with a speech sound disorder but sometimes not. We also briefly review other factors outside the realm of phonology that may alert the speech-language pathologist to possible dyslexia. Results: Speech-language pathologists possess unique knowledge that directly contributes to the identification and remediation of children with dyslexia. We present several clinical recommendations related to speech production deficits in children with dyslexia. We also review what is known about how and when children with speech sound disorder are most at risk for dyslexia. Conclusion: Speech-language pathologists have a unique opportunity to assist in the identification of young children who are at risk for dyslexia.

Children With Dyslexia Benefit From Orthographic Facilitation During Spoken Word Learning.

Purpose: Orthographic facilitation describes the phenomenon in which a spoken word is produced more accurately when its corresponding written word is present during learning. We examined the orthographic facilitation effect in children with dyslexia because they have poor learning and recall of spoken words. We hypothesized that including orthography during spoken word learning would facilitate learning and recall. Method: Children with dyslexia and children with typical development (n = 46 per group), 7-9 years old, were matched for grade and nonverbal intelligence. Across 4 blocks of exposure in 1 session, children learned pairings between 4 spoken pseudowords and novel semantic referents in a modified paired-associate learning task. Two of the pairings were presented with orthography present, and 2 were presented with orthography absent. Recall of newly learned spoken words was assessed using a naming task. Results: Both groups showed orthographic facilitation during learning and naming. During learning, both groups paired pseudowords and referents more accurately when orthography was present. During naming, children with typical development showed a large orthographic facilitation effect that increased across blocks. For children with dyslexia, this effect was present initially but then plateaued. Conclusions: We demonstrate for the first time that children with dyslexia benefit from orthographic facilitation during spoken word learning. These findings have direct implications for teaching spoken vocabulary to children with dyslexia.

Poor Speech Perception Is Not a Core Deficit of Childhood Apraxia of Speech: Preliminary Findings.

Purpose: Childhood apraxia of speech (CAS) is hypothesized to arise from deficits in speech motor planning and programming, but the influence of abnormal speech perception in CAS on these processes is debated. This study examined speech perception abilities among children with CAS with and without language impairment compared to those with language impairment, speech delay, and typically developing peers. Method: Speech perception was measured by discrimination of synthesized speech syllable continua that varied in frequency (/dɑ/-/ɡɑ/). Groups were classified by performance on speech and language assessments and compared on syllable discrimination thresholds. Within-group variability was also evaluated. Results: Children with CAS without language impairment did not significantly differ in syllable discrimination compared to typically developing peers. In contrast, those with CAS and language impairment showed significantly poorer syllable discrimination abilities compared to children with CAS only and typically developing peers. Children with speech delay and language impairment also showed significantly poorer discrimination abilities, with appreciable within-group variability. Conclusions: These findings suggest that speech perception deficits are not a core feature of CAS but rather occur with co-occurring language impairment in a subset of children with CAS. This study establishes the significance of accounting for language ability in children with CAS. Supplemental Materials: https://doi.org/10.23641/asha.5848056.

Assessing Working Memory in Children: The Comprehensive Assessment Battery for Children - Working Memory (CABC-WM).

The Comprehensive Assessment Battery for Children - Working Memory (CABC-WM) is a computer-based battery designed to assess different components of working memory in young school-age children. Working memory deficits have been identified in children with language-based learning disabilities, including dyslexia1,2 and language impairment3,4, but it is not clear whether these children exhibit deficits in subcomponents of working memory, such as visuospatial or phonological working memory. The CABC-WM is administered on a desktop computer with a touchscreen interface and was specifically developed to be engaging and motivating for children. Although the long-term goal of the CABC-WM is to provide individualized working memory profiles in children, the present study focuses on the initial success and utility of the CABC-WM for measuring central executive, visuospatial, phonological loop, and binding constructs in children with typical development. Immediate next steps are to administer the CABC-WM to children with specific language impairment, dyslexia, and comorbid specific language impairment and dyslexia.

Short-term Memory in Childhood Dyslexia: Deficient Serial Order in Multiple Modalities.

In children with dyslexia, deficits in working memory have not been well-specified. We assessed second-grade children with dyslexia, with and without concomitant specific language impairment, and children with typical development. Immediate serial recall of lists of phonological (non-word), lexical (digit), spatial (location) and visual (shape) items were included. For the latter three modalities, we used not only standard span but also running span tasks, in which the list length was unpredictable to limit mnemonic strategies. Non-word repetition tests indicated a phonological memory deficit in children with dyslexia alone compared with those with typical development, but this difference vanished when these groups were matched for non-verbal intelligence and language. Theoretically important deficits in serial order memory in dyslexic children, however, persisted relative to matched typically developing children. The deficits were in recall of (1) spoken digits in both standard and running span tasks and (2) spatial locations, in running span only. Children with dyslexia with versus without language impairment, when matched on non-verbal intelligence, had comparable serial order memory, but differed in phonology. Because serial orderings of verbal and spatial elements occur in reading, the careful examination of order memory may allow a deeper understanding of dyslexia and its relation to language impairment. Copyright © 2017 John Wiley & Sons, Ltd.

Word Learning Deficits in Children With Dyslexia.

Purpose: The purpose of this study is to investigate word learning in children with dyslexia to ascertain their strengths and weaknesses during the configuration stage of word learning. Method: Children with typical development (N = 116) and dyslexia (N = 68) participated in computer-based word learning games that assessed word learning in 4 sets of games that manipulated phonological or visuospatial demands. All children were monolingual English-speaking 2nd graders without oral language impairment. The word learning games measured children's ability to link novel names with novel objects, to make decisions about the accuracy of those names and objects, to recognize the semantic features of the objects, and to produce the names of the novel words. Accuracy data were analyzed using analyses of covariance with nonverbal intelligence scores as a covariate. Results: Word learning deficits were evident for children with dyslexia across every type of manipulation and on 3 of 5 tasks, but not for every combination of task/manipulation. Deficits were more common when task demands taxed phonology. Visuospatial manipulations led to both disadvantages and advantages for children with dyslexia. Conclusion: Children with dyslexia evidence spoken word learning deficits, but their performance is highly dependent on manipulations and task demand, suggesting a processing trade-off between visuospatial and phonological demands.

Speech Perception and Working Memory in Children with Residual Speech Errors: A Case Study Analysis.

Some children with residual deficits in speech production also display characteristics of dyslexia; however, the causes of these disorders--in isolation or comorbidly--remain unknown. Presently, the role of phonological representations is an important construct for considering how the underlying system of phonology functions. In particular, two related skills--speech perception and phonological working memory--may provide insight into the nature of phonological representations. This study provides an exploratory investigation into the profiles of three 9-year-old children: one with residual speech errors, one with residual speech errors and dyslexia, and one who demonstrated typical, age-appropriate speech sound production and reading skills. We provide an in-depth examination of their relative abilities in the areas of speech perception, phonological working memory, vocabulary, and word reading. Based on these preliminary explorations, we suggest implications for the assessment and treatment of children with residual speech errors and/or dyslexia.