Perceptual measurement of articulatory goodness in young children: Relationships with age, speech sound acquisition, and intelligibility.

Speech language pathologists regularly use perceptual methods in clinical practice to assess children's speech. In this study, we examined relationships between measures of speech intelligibility, clinical articulation test results, age, and perceptual ratings of articulatory goodness for children. We also examined the extent to which established measures of intelligibility and clinical articulation test results predicted articulatory goodness ratings, and whether goodness ratings were influenced by intelligibility. A sample of 164 (30-47 months) typically developing children provided speech samples and completed a standardised articulation test. Single word intelligibility scores and ratings of articulatory goodness were gathered from 328 naïve listeners; scores on a standardised articulation test were obtained from each child. Bivariate Pearson correlation, linear regression, and linear mixed effects modelling were used for analysis. Results showed that articulatory goodness ratings had the highest correlation with intelligibility, followed by age, followed by articulation score. Age and clinical articulation scores were both significant predictors of goodness ratings, but articulation scores made only a small contribution to prediction. Articulatory goodness ratings were substantially lower for unintelligible words compared to intelligible words, but articulatory goodness scores increased with age at the same rate for unintelligible and intelligible words. Perceptual ratings of articulatory goodness are sensitive to developmental changes in speech production (regardless of intelligibility) and yield a different kind of information than clinical articulation scores from standardised measures.

Functional Communication Abilities in Youth With Cerebral Palsy: Association With Impairment Profiles and School-Based Therapy Goals.

PURPOSE: The aim of this study was to examine the relationship between functional communication skills, underlying speech, language, and cognitive impairments and school-based speech pathology services in students with cerebral palsy (CP). METHOD: Thirty-five participants with CP who had Individualized Education Programs (IEPs) were classified according to the Communication Function Classification System (CFCS). Participants completed laboratory assessments of speech, receptive language, executive functioning, and nonverbal cognition. Each participant's speech and language IEP goals were coded into treatment units and then categorized into seven, mutually exclusive target goal areas. Nonparametric analyses were employed to examine differences among CFCS groups in the number of deficit areas and the number of goal areas from the IEP. Descriptive analyses were used to evaluate the extent to which deficit and goal areas in the IEP co-occurred by CFCS level. RESULTS: Those in more involved CFCS levels demonstrated more severe speech, receptive language, and cognitive impairments. However, there were no significant differences in the number of deficit areas across CFCS groups. Regardless of CFCS level, there were no differences in the number of treatment goals specified in the IEP. Literacy was the only goal area addressed across all CFCS levels. Those in the most involved CFCS levels had augmentative and alternative communication (AAC) goals, but those with more moderate restrictions in functional communication who also had markedly reduced speech intelligibility did not typically have speech or AAC goals. INTERPRETATION: Individuals with CP across CFCS levels demonstrate variability in underlying deficit profiles, suggesting that measures of both functional communication and of underlying deficits are necessary to provide a complete picture of communication needs. Literacy goals were common across all CFCS levels, but AAC goals were limited to the most severely involved individuals, suggesting that continuing education may be necessary to support speech-language pathologists in developing treatments involving the integration of AAC and speech to foster functional communication at school. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.16968073.

Validity of Parent Ratings of Speech Intelligibility for Children with Cerebral Palsy.

Aim: To examine the relationship between subjective parent ratings of intelligibility and objectively measured intelligibility scores for children with cerebral palsy (CP) with differing levels of speech severity. Method: Fifty children (84-96 months) with CP were classified into groups based on intelligibility scores during a speech elicitation task - high intelligibility (90% or higher), mild-moderate intelligibility reduction (61-89%), and severe intelligibility reduction (60% or lower). Parent ratings of understandability (on a 7-point scale) were compared to intelligibility scores gathered from 100 naïve listeners. Results: For children with mild-moderate and severe intelligibility reduction, there was a large range of variability in parent ratings. For children with high intelligibility, ratings were consistent with intelligibility scores. There was a range of intelligibility scores within each rating, especially in the middle of the scale. Conclusions: For children with mild-moderate intelligibility deficits, parent ratings may best be used in conjunction with objective measurement of intelligibility.

Measuring Speech Production Development in Children With Cerebral Palsy Between 6 and 8 Years of Age: Relationships Among Measures.

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.

Effects of Rate Manipulation on Intelligibility in Children With Cerebral Palsy.

Purpose We evaluated the effects of a speech supplementation strategy to reduce rate and improve intelligibility in children with cerebral palsy. Method Twenty-five children with cerebral palsy (M age = 12.08 years) completed a structured speaking task in 2 speech conditions: habitual speech and slow speech. Fifteen children had mild intelligibility deficits; 10 had moderate-severe intelligibility deficits. In each condition, children repeated utterances of 2-7 words in length. In the habitual speech condition, children used their natural and unaltered speaking rate. In the slow speech condition, children were cued to insert pauses between words. Intelligibility ratings were obtained from orthographic transcriptions by unfamiliar adult listeners (n = 100). Speech rate, in words per minute, was measured for each utterance. Results All children, regardless of severity group, were able to reduce their rate of speech when implementing the slow speech strategy. Only children in the moderate-severe group showed an improvement in intelligibility when implementing the slow speech strategy. Although there was considerable individual variability, there was a greater improvement in intelligibility for longer utterances compared to shorter ones. Conclusion A slow speech strategy may be beneficial for children with moderate-severe intelligibility deficits who speak in longer utterances. Future studies should seek to further examine the clinical feasibility of slow speech for children with reduced intelligibility.

Differentiating Typical From Atypical Speech Production in 5-Year-Old Children With Cerebral Palsy: A Comparative Analysis.

Objective Early diagnosis of speech disorders in children with cerebral palsy (CP) is of critical importance. A key problem is differentiating those with borderline or mild speech motor deficits from those who are within an age-appropriate range of variability. We sought to quantify how well functional speech measures differentiated typically developing (TD) children from children with CP. Method We studied speech production in 45 children with CP (26 with clinical speech motor impairment [SMI] and 19 with no evidence of speech motor impairment [NSMI]) and in 29 TD children of the same age. Speech elicitation tasks were used. Intelligibility, speech rate, and intelligible words per minute were examined. Results All measures differentiated between all 3 groups of children with considerable precision based on area under the receiver operating characteristic curve (AUC) data. AUC was highest for overall intelligibility, which ranged from .88 to .99. Intelligible words per minute also yielded very strong AUCs, ranging from .81 to .99. In each of the receiver operating characteristic models, discrimination between groups was highest for children with speech motor impairment versus TD children. Data indicated that 90% of TD children had overall intelligibility above 87% at 5 years of age, but that no child was 100% intelligible. Furthermore, 90% children with SMI had intelligibility below 72%. Conclusion Findings suggest that functional speech measures differentiate very clearly between children with and without CP and that even children who do not show evidence of speech motor impairment have functional differences in their speech production ability relative to TD peers.

Longitudinal Change in Speech Rate and Intelligibility Between 5 and 7 Years in Children With Cerebral Palsy.

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.

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.

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.

Characteristics of Speech Rate in Children With Cerebral Palsy: A Longitudinal Study.

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.

Executive function in school-aged children with cerebral palsy: Relationship with speech and language.

BACKGROUND AND AIMS: Although children with cerebral palsy (CP) are at an increased risk for developing speech, language, and executive function (EF) impairments, little is known regarding the relationship among these risk factors. The current study examined how different profiles of speech and language impairment might be associated with impairments in EF skills in school-aged children with CP. METHODS AND PROCEDURES: Forty-seven school-aged children with CP were included. Each child contributed between one and four data points for a total of 87 data points. Children were classified into speech and language profile groups at each data point. EF skills were examined using the Behavior Rating Inventory of Executive Function questionnaire. OUTCOMES AND RESULTS: Compared to a mean of 50 from a normative population of children, mean scores on all measures of EF were significantly elevated for all groups (p<.05). The proportion of children with CP with elevated EF scores was significantly higher for all groups compared to the expected proportion in a normal population of children (p<.05). CONCLUSIONS AND IMPLICATIONS: Children with CP who do not have impairments in speech or language may be at risk for EF difficulties which may negatively affect social communication, academic performance, and functional independence.

Longitudinal growth of receptive language in children with cerebral palsy between 18 months and 54 months of age.

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.

Longitudinal development of communication in children with cerebral palsy between 24 and 53 months: Predicting speech outcomes.

OBJECTIVE: To determine whether communication at 2 years predicted communication at 4 years in children with cerebral palsy (CP); and whether the age a child first produces words imitatively predicts change in speech production. METHOD: 30 children (15 males) with CP participated and were seen 5 times at 6-month intervals between 24 and 53 months (mean age at time 1 = 26.9 months (SD 1.9)). Variables were communication classification at 24 and 53 months, age that children were first able to produce words imitatively, single-word intelligibility, and longest utterance produced. RESULTS: Communication at 24 months was highly predictive of abilities at 53 months. Speaking earlier led to faster gains in intelligibility and length of utterance and better outcomes at 53 months than speaking later. CONCLUSION: Inability to speak at 24 months indicates greater speech and language difficulty at 53 months and a strong need for early communication intervention.