Speech sound development in typically developing 2-7-year-old Dutch-speaking children: A normative cross-sectional study.

BACKGROUND: Dutch is a West-Germanic language spoken natively by around 24 million speakers. Although studies on typical Dutch speech sound development have been conducted, norms for phonetic and phonological characteristics of typical development in a large sample with a sufficient age range are lacking. AIM: To give a detailed description of the speech sound development of typically developing Dutch-speaking children from 2 to 7 years. METHODS & PROCEDURES: A total of 1503 typically developing children evenly distributed across the age range of 2;0-6;11 years participated in this normative cross-sectional study. The picture-naming task of the Computer Articulation Instrument (CAI) was used to collect speech samples. Speech development was described in terms of (1) percentage consonants correct-revised (PCC-R) and percentage vowels correct (PVC); (2) consonant, vowel and syllabic structure inventories; (3) degrees of complexity (phonemic feature hierarchy); and (4) phonological processes. OUTCOMES & RESULTS: A two-way mixed analysis of variance (ANOVA) confirmed a significant increase in the number of PCC-R and PVC between the ages of 2;0 and 6;11 years (p < 0.001). The consonant inventory was found to be complete at 3;7 years of age for the syllable-initial consonants, with the exception of the voiced fricatives /v/ and /z/, and the liquid /r/. All syllable-final consonants were acquired before age 4;4 years. At age 3;4 years, all children had acquired a complete vowel inventory, and at age 4;7 years they produced most syllable structures correctly, albeit that the syllable structure CCVCC was still developing. All phonological contrasts were produced correctly at 3;8 years of age. Children in the younger age groups used more phonological simplification processes than the older children, and by age 4;4 years, all had disappeared, except for the initial cluster reduction from three to two consonants and the final cluster reduction from two to one consonant. CONCLUSIONS & IMPLICATIONS: This paper describes a large normative cross-sectional study of Dutch speech sound development which, in clinical practice, can help Dutch speech-language pathologists to differentiate children with delayed or disordered speech development from typically developing children. What this paper adds What is already known on this subject In recent years many studies have been conducted worldwide to investigate speech sound development in different languages, including several that explored the typical speech sound development of Dutch-speaking children, but none of these latter studies explored both phonetic and phonological progress within a comprehensive age range and a large sample that is representative of the Dutch population. What this study adds to existing knowledge This study serves to fill this gap by providing normative cross-sectional results obtained in 1503 typically developing Dutch-speaking children aged between 2;0 and 6;11 years on informative parameters of speech development: PCC-R and PVC, consonant, vowel and syllabic structure inventories, degrees of complexity (phonemic feature hierarchy), and phonological simplification processes. What are the potential or actual clinical implications of this work? The detailed description of typical Dutch speech sound development provides speech-language pathologists with pertinent information to determine whether a child's speech development progresses typically or is delayed or disordered.

Reliability of the Dutch Cleft Speech Evaluation Test and Conversion to the Proposed Universal Scale.

The Dutch cleft speech evaluation test (DCSET) has been implemented by the speech-language pathologists nationwide in the Netherlands since 2003, but the inter- and intrarater reliability was unknown. Two speech-language pathologists experienced in evaluating cleft speech assessed audio recordings of 20 children with cleft speech using the DCSET, and reassessed the recordings 2 weeks later. Intra- and interrater reliability was calculated, but found to be unacceptable after the first phase of this study using audio recordings. Following consensus training and some modifications in the scoring scales, the study was repeated using video recordings of 20 different children with cleft speech. Results from the second phase of this study using standardized video recordings showed fair, moderate, and good reliability on different subsets of the DCSET. Intrarater reliability (Kappa 0.59-1.00) was greater than interrater reliability (Kappa 0.33-0.79). Interrater reliability agreement was good (Kappa 0.63-0.79) for consonant production errors and speech understandability and acceptability, moderate (Kappa 0.59) for the resonance of the nasal passage, and fair (Kappa 0.33-0.37) for the resonance of the mixed and denasal passages. Subsequently, an algorithm was made to convert the DCSET scales to universal scales for international comparison of cleft speech as suggested by Henningsson et al in 2008.

The influence of (central) auditory processing disorder on the severity of speech-sound disorders in children.

OBJECTIVE: To identify a cutoff value based on the Percentage of Consonants Correct-Revised index that could indicate the likelihood of a child with a speech-sound disorder also having a (central) auditory processing disorder . METHODS: Language, audiological and (central) auditory processing evaluations were administered. The participants were 27 subjects with speech-sound disorders aged 7 to 10 years and 11 months who were divided into two different groups according to their (central) auditory processing evaluation results. RESULTS: When a (central) auditory processing disorder was present in association with a speech disorder, the children tended to have lower scores on phonological assessments. A greater severity of speech disorder was related to a greater probability of the child having a (central) auditory processing disorder. The use of a cutoff value for the Percentage of Consonants Correct-Revised index successfully distinguished between children with and without a (central) auditory processing disorder. CONCLUSIONS: The severity of speech-sound disorder in children was influenced by the presence of (central) auditory processing disorder. The attempt to identify a cutoff value based on a severity index was successful.

The influence of (central) auditory processing disorder on the severity of speech-sound disorders in children

OBJECTIVE: To identify a cutoff value based on the Percentage of Consonants Correct-Revised index that could indicate the likelihood of a child with a speech-sound disorder also having a (central) auditory processing disorder . METHODS: Language, audiological and (central) auditory processing evaluations were administered. The participants were 27 subjects with speech-sound disorders aged 7 to 10 years and 11 months who were divided into two different groups according to their (central) auditory processing evaluation results. RESULTS: When a (central) auditory processing disorder was present in association with a speech disorder, the children tended to have lower scores on phonological assessments. A greater severity of speech disorder was related to a greater probability of the child having a (central) auditory processing disorder. The use of a cutoff value for the Percentage of Consonants Correct-Revised index successfully distinguished between children with and without a (central) auditory processing disorder. CONCLUSIONS: The severity of speech-sound disorder in children was influenced by the presence of (central) auditory processing disorder. The attempt to identify a cutoff value based on a severity index was successful.

Ease of articulation: A replication.

UNLABELLED: Researchers, as well as the lay public and the popular press, have become increasingly concerned about the lack of reproducibility of research findings. Despite this concern, research has shown that replications of previously published work comprise a very small proportion of published studies. Moreover, there are fewer published direct replications of research studies by independent investigators, and this type of replication is much less likely to confirm the results of the original research than are replications by the original investigator or conceptual replications. A search of the communication disorders research literature reveals that direct replications by independent investigators are virtually non-existent. The purpose of this project was to describe the major issues related to research reproducibility and report the results of a direct replication of a study by Locke (1972) regarding ease of articulation. Two methods for rating ease of articulation were employed. We were able to reproduce the results of the original study for the first method, obtaining a moderate positive correlation between our rankings of phoneme difficulty and Locke's rankings. We obtained a very high positive correlation between our phoneme rankings and rankings obtained in the original study for the second method. Moreover, we found a higher correlation between difficulty rankings and order of speech sound acquisition for American English than was found in the original study. Direct replication is not necessary for all studies in communication disorders, but should be considered for high impact studies, treatment studies, and those that provide data to support models and theories. LEARNING OUTCOMES: The reader will be able to: (1) describe the major concerns related to the replicability of research findings; (2) describe the status of research replications in communication disorders; (3) describe how ease of articulation may relate to the order of speech sound acquisition in children; (4) list some types/areas of research that might be candidates for replication in the field of communication disorders.

Quantification of rhythm problems in disordered speech: a re-evaluation.

Disordered speech can present with rhythmic problems, impacting on an individual's ability to communicate. Effective treatment relies on the availability of sensitive methods to characterize the problem. Rhythm metrics based on segmental durations originally designed for cross-linguistic research have the potential to provide such information. However, these measures may be associated with problems that impact on their clinical usefulness. This paper aims to address the perceptual validity of cross-linguistic metrics as indicators of rhythmic disorder. Speakers with dysarthria and matched healthy participants performed a range of tasks, including syllable and sentence repetition and a spontaneous monologue. A range of rhythm metrics as well as clinical measures were applied. Results showed that none of the metrics could differentiate disordered from healthy speakers, despite clear perceptual differences, suggesting that factors beyond segment duration impacted on rhythm perception. The investigation also highlighted a number of areas where caution needs to be exercised in the application of rhythm metrics to disordered speech. The paper concludes that the underlying speech impairment leading to the perceptual and acoustic characterization of rhythmic problems needs to be established through detailed analysis of speech characteristics in order to construct effective treatment plans for individuals with speech disorders.

[Guideline-conform diagnostics in language impairments]. / Leitliniengerechte Diagnostik bei Spracherwerbsstörungen.

In order to distinguish more accurately and easily between language difficulties in need of therapy or special support versus language impairments a S2K guideline was developed by interdisciplinary teams of different (medical) societies and professional associations. This guideline was published in 2011 and has replaced all existing monodisciplinary guidelines. According to the new S2K guideline standardised measures of language testing are mandatory. Apart from reviewing the S2K guidelines, this article aims to suggest how these guidelines can be established in clinical practice. By closely following this new guideline, testing and diagnosing children with language difficulties is believed to be enhanced considerably, and also comply with quality management standards.

Alternating and sequential motion rates in older adults.

BACKGROUND: Alternating motion rate (AMR) and sequential motion rate (SMR) are tests of articulatory diadochokinesis that are widely used in the evaluation of motor speech. However, there are no quality normative data available for adults aged 65 years and older. AIMS: There were two aims: (1) to obtain a representative, normative dataset of diadochokinetic rates from adults aged 65 years and older; and (2) to examine the effects of age and gender on those rates. METHODS & PROCEDURES: Seventy-six healthy adults (65-86 years) were recruited; 45 females and 31 males. Participants were divided across two age groups (65-74 and 75-86 years) and audio-recorded while undertaking AMR (/pa/, /ta/ and /ka/) and SMR (/pataka/). The rate of the first nine syllables for each task was measured using acoustic analysis software, and age and gender effects were examined using a series of generalized linear models. The effect of age on rate variability between groups was also assessed. OUTCOMES & RESULTS: Normative data were obtained for both age groups and across gender. Age was not a significant factor for any task. Males had significantly higher AMR than females (/pa/ p = 0.001, /ta/ p = 0.001, /ka/ p = 0.010). No such gender difference was found for SMR. There was no significant difference in rate variability between the age groups. CONCLUSIONS & IMPLICATIONS: Normative values for AMR and SMR in both genders and across two older age groups were acquired. Diadochokinetic rates outside such values cannot be attributed to normal ageing, so will merit further clinical investigation.

A normative-speaker validation study of two indices developed to quantify tongue dorsum activity from midsagittal tongue shapes.

This study reported adult scores on two measures of tongue shape, based on midsagittal tongue shape data from ultrasound imaging. One of the measures quantified the extent of tongue dorsum excursion, and the other measure represented the place of maximal excursion. Data from six adult speakers of Scottish Standard English without speech disorders were analyzed. The stimuli included a range of consonants in consonant-vowel sequences, with the vowels /a/ and /i/. The measures reliably distinguished between articulations with and without tongue dorsum excursion, and produced robust results on lingual coarticulation of the consonants. The reported data can be used as a starting point for collecting more typical data and for analyzing disordered speech. The measurements do not require head-to-transducer stabilization. Possible applications of the measures include studying tongue dorsum overuse in people with cleft palate, and typical and disordered development of coarticulation.

Numerical instabilities and three-dimensional electromagnetic articulography.

The AG500 electromagnetic articulograph is widely used to reconstruct the movements of the articulatory organs. Nevertheless, some anomalies in its performance have been observed. It is well known that accuracy of the device is affected by electromagnetic interference and possible hardware failures or damage to the sensors. In this study, after eliminating any hardware or electromagnetic source of disturbance, a set of trials was carried out. The tests prove that anomalies in sensor position tracking are systematic in certain regions within the recording volume and, more importantly, show a specific pattern that can be clearly attributed to a wrong convergence of the calculation method.

Toward a quantitative basis for assessment and diagnosis of apraxia of speech.

PURPOSE: We explored the reliability and validity of 2 quantitative approaches to document presence and severity of speech properties associated with apraxia of speech (AOS). METHOD: A motor speech evaluation was administered to 39 individuals with aphasia. Audio-recordings of the evaluation were presented to 3 experienced clinicians to determine AOS diagnosis and to rate severity of 11 speech dimensions. Additionally, research assistants coded 11 operationalized metrics of articulation, fluency, and prosody in the same speech samples and in recordings from 20 neurologically healthy participants. RESULTS: Agreement among the 3 clinicians was limited for both AOS diagnosis and perceptual scaling, but inter-observer reliability for the operationalized metrics was strong. The relationships between most operationalized metrics and mean severity ratings for corresponding perceptual dimensions were moderately strong and statistically significant. Both perceptual scaling and operationalized quantification approaches were sensitive to the presence or absence of AOS. CONCLUSIONS: Perceptual scaling and operationalized metrics are promising quantification techniques that can help establish diagnostic transparency for AOS. However, because satisfactory reliability cannot be assumed for scaling techniques, effective training and calibration procedures should be implemented. Operationalized metrics show strong potential for enhancing diagnostic objectivity and sensitivity.

Error variability in apraxia of speech: a matter of controversy.

PURPOSE: Error variability has traditionally been considered a hallmark of apraxia of speech (AOS). However, in some of the current AOS literature, relatively invariable error patterns are claimed as a mandatory criterion for a diagnosis of AOS. This paradigm shift has far-reaching consequences for our understanding of the disorder and for its (differential) diagnosis. Against the background of this controversy, the present article aims to further examine error variability in AOS. METHOD: Four patients with relatively pure, mild-to-moderate AOS participated in the study. They repeated 8 target words in 2 different phrase contexts, 10 times each. Error analyses were based on phonetic transcription. Error variability was determined using several measures of (a) consistency of error occurrence and (b) consistency of error type. RESULTS: All patients produced highly inconsistent reactions across multiple trials in some of the target words. However, other words were more consistently accurate or inaccurate. Several factors influencing error variability were identified. CONCLUSIONS: Because this study has disclosed clear indications of variable behavior in AOS, diagnostic guidelines claiming error consistency as a mandatory criterion cannot be maintained. Because error variability is difficult to operationalize, we recommend to no longer use (in)consistency as a strict diagnostic marker of AOS.

Assessing the treatment effects in apraxia of speech: introduction and evaluation of the Modified Diadochokinesis Test.

BACKGROUND: The number of reliable and valid instruments to measure the effects of therapy in apraxia of speech (AoS) is limited. AIMS: To evaluate the newly developed Modified Diadochokinesis Test (MDT), which is a task to assess the effects of rate and rhythm therapies for AoS in a multiple baseline across behaviours design. METHODS: The consistency, accuracy and fluency of speech of 24 adults with AoS and 12 unaffected speakers matched for age, gender and educational level were assessed using the MDT. The reliability and validity of the instrument were considered and outcomes compared with those obtained with existing tests. RESULTS: The results revealed that MDT had a strong internal consistency. Scores were influenced by syllable structure complexity, while distinctive features of articulation had no measurable effect. The test-retest and intra- and inter-rater reliabilities were shown to be adequate, and the discriminant validity was good. For convergent validity different outcomes were found: apart from one correlation, the scores on tests assessing functional communication and AoS correlated significantly with the MDT outcome measures. The spontaneous speech phonology measure of the Aachen Aphasia Test (AAT) correlated significantly with the MDT outcome measures, but no correlations were found for the repetition subtest and the spontaneous speech articulation/prosody measure of the AAT. CONCLUSIONS & IMPLICATIONS: The study shows that the MDT has adequate psychometric properties, implying that it can be used to measure changes in speech motor control during treatment for apraxia of speech. The results demonstrate the validity and utility of the instrument as a supplement to speech tasks in assessing speech improvement aimed at the level of planning and programming of speech.

Speech timing and pausing in children with specific language impairment.

Articulation rate, speaking rate, as well as the duration and location of pauses, were analysed in 10 children with specific language impairment (SLI) and a comparison group of seven younger children producing utterances of similar lengths. Children with SLI were significantly slower in articulation rate, but not speaking rate or pausing time, indicating a group difference attributable to longer syllable duration. The correlation between the duration of the pause preceding a child's speaking turn and the length of the subsequent child utterance was calculated as an indication of children's use of the pause for planning the utterance. The correlation was not significant in either group, and not significantly different between groups. An analysis of the position of pauses within speaking turns showed more syllables following than preceding the pause, with no significant group differences. Theoretical implications are discussed.

Articulatory-to-acoustic relations in response to speaking rate and loudness manipulations.

PURPOSE: In this investigation, the authors determined the strength of association between tongue kinematic and speech acoustics changes in response to speaking rate and loudness manipulations. Performance changes in the kinematic and acoustic domains were measured using two aspects of speech production presumably affecting speech clarity: phonetic specification and variability. METHOD: Tongue movements for the vowels /ia/ were recorded in 10 healthy adults during habitual, fast, slow, and loud speech using three-dimensional electromagnetic articulography. To determine articulatory-to-acoustic relations for phonetic specification, the authors correlated changes in lingual displacement with changes in acoustic vowel distance. To determine articulatory-to-acoustic relations for phonetic variability, the authors correlated changes in lingual movement variability with changes in formant movement variability. RESULTS: A significant positive linear association was found for kinematic and acoustic specification but not for kinematic and acoustic variability. Several significant speaking task effects were also observed. CONCLUSION: Lingual displacement is a good predictor of acoustic vowel distance in healthy talkers. The weak association between kinematic and acoustic variability raises questions regarding the effects of articulatory variability on speech clarity and intelligibility, particularly in individuals with motor speech disorders.

Using standardized tests to inventory consonant and vowel production: a comparison of 11 tests of articulation and phonology.

PURPOSE: This report considered the validity of making conclusions about a child's phonetic inventory (the sounds a child can and cannot produce spontaneously without a prior model or other stimulation) based on the data from standardized single-word tests of articulation or phonology. METHOD: We evaluated the opportunities for production of word-initial consonants, word-final consonants, and vowels within the words included on 11 tests. Only words that met specific phonetic criteria (termed phonetically controlled words) were counted as opportunities for each consonant or vowel. RESULTS: None of the tests provided sufficient coverage of consonants or vowels for establishing a phonetic inventory and making conclusions about the segments that a child can and cannot produce. CONCLUSION: Use of the data from a single standardized test of articulation or phonology would not be sufficient for completely inventorying a child's consonant and vowel production and selecting targets for therapy. It is recommended that clinicians supplement test data by probing production in additional phonetically controlled words.

Direct magnitude estimation of articulation rate in boys with fragile X syndrome.

PURPOSE: To compare the perceived articulation rate of boys with fragile X syndrome (FXS) with that of chronologically age-matched (CA) boys and to determine segmental and/or prosodic factors that account for perceived rate. METHOD: Ten listeners used direct magnitude estimation procedures to judge the articulation rates of 7 boys with FXS only, 5 boys with FXS and a diagnosis of autism spectrum disorder (ASD), and 12 CA boys during sentence repetition. Sentences had similar articulation rates in syllables per second as determined acoustically. Four segmental/prosodic factors were used to predict perceived rate: (a) percentage consonants correct, (b) overall fundamental frequency (F(0)) level, (c) sentence-final F(0) drop, and (d) acoustically determined articulation rate with the final word of the sentence excluded. RESULTS: Boys with FXS and ASD were judged to talk faster than CA controls. Multiple linear regression indicated that articulation rate with the final word of the sentence excluded and sentence-final F(0) drop accounted for 91% of the variance for perceived rate. CONCLUSIONS: Descriptions of speakers with FXS as having fast and/or fluctuating articulation rates may be influenced by autism status. Also, atypical sentence-final prosody may be related to perceived rate in boys with FXS and ASD.

Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction.

BACKGROUND: Nasometry has supplemented perceptual assessments of nasality, using speech stimuli, which are devoid of nasal consonants. However, such speech stimuli are not representative of conversational speech. A weak relationship has been found in previous studies between perceptual ratings of hypernasality and nasalance scores for passages containing nasal consonants. AIMS: This study aimed to evaluate the relationship between perceptual assessment and acoustic measurements of nasality using controlled speech stimuli. METHODS & PROCEDURE: A perceptual scale (the Temple Street Scale) describing nasality was devised for this study. Fifty children presenting with nasality were assessed using the Temple Street Scale and nasalance scores were obtained for specified speech samples using the Nasometer (Kay Elemetrics 6200.3). The relationship between the perceptual ratings and the nasometry results was evaluated using correlation analysis, test sensitivity, specificity, and overall efficiency. OUTCOMES & RESULTS: Correlation coefficients for perceptual ratings of nasality and nasalance scores ranged from 0.69 to 0.74. The sensitivity of the Nasometer ranged from 0.83 to 0.88; its specificity ranged from 0.78 to 0.95; while its overall efficiency was between 0.82 and 0.92. CONCLUSIONS: The strong relationship between perceptual and acoustic assessments of nasality indicated that the Temple Street Scale and the Nasometer are both valid clinical tools for the evaluation of nasality when a carefully constructed speech sample is used. The need to use the Nasometer as a supplement to perceptual assessment is highlighted.

Reliability of speech diadochokinetic test measurement.

BACKGROUND: Measures of articulatory diadochokinesis (DDK) are widely used in the assessment of motor speech disorders and they play a role in detecting abnormality, monitoring speech performance changes and classifying syndromes. Although in clinical practice DDK is generally measured perceptually, without support from instrumental methods that display the acoustic waveform, no standard measurement procedures are employed and studies on inter- and intra-rater reliability are lacking. AIMS: To investigate the inter- and intra-rater reliability of perceptual DDK measurement and the possible impact of experience on rating performance. METHODS & PROCEDURES: Ten speech and language therapists and ten untrained controls rated 12 DDK speech samples, including two pairs of identical samples, of speakers with different neurological speech disorders. We compared timing for repetitions as close as possible to 5 s, for 5 s exactly, and for as long as the speaker could manage; as well as four qualitative features (rhythm, distinctness, loudness and overall impression). Counts by time were compared with objective outcomes from sound spectrograms. OUTCOMES & RESULTS: Inter- and intra-rater reliability was lower than should be acceptable for clinical diagnostic and outcome assessment. The most accurate and repeatable procedure (compared with objective measurement) was counting the syllables within the first 5 s. There was no unequivocal influence of clinical experience on accuracy. CONCLUSIONS: The findings suggest caution in employing and interpreting clinical DDK measures as diagnostic and outcome measures. More research is necessary to settle the influence of experience on time and count accuracy and what modifications to timing might bring increased agreement that permits DDK to realize its full potential in assessment.

Phonological performance measured by speech severity indices compared with correlated factors

CONTEXT AND OBJECTIVE: Some factors seem to influence speech impairment among phonologically disordered children. The aim was to compare severity indices with some correlated factors. DESIGN AND SETTING: Observational, analytical and cross-sectional study conducted within the Language-Speech-Hearing Sciences Course, Universidade de São Paulo. METHOD: Fifty phonologically disordered children with ages ranging from 4 to 11 years took part. The indices were calculated from phonology tests and were correlated with anamnesis and audiological data. Student’s t test and Spearman’s correlation were used to compare percentages of consonants correct (PCC) and process density index (PDI) for children with and without otitis, upper respiratory histories and audiological abnormalities, with regard to whether or not they were comprehended during assessment, their ages when they started to speak and their ages at the assessment. RESULTS: The higher the age at the assessment was, the higher the PCC (imitation: 0.468; naming: 0.431; Spearman’s correlation) and the lower the PDI (imitation: 0.459; naming: 0.431); the later the child started to speak, the lower the PCC (imitation p = 0.064; naming p = 0.050) and the higher the PDI (imitation p = 0.067; naming p = 0.042). There were differences between groups with and without upper respiratory history (PCC: imitation p = 0.016, naming p = 0.005; PDI: imitation p = 0.014, naming p = 0.008). There was no difference between the groups regarding otitis, comprehension during the assessment and audiological data. CONCLUSIONS: Children with upper respiratory histories who began to speak later presented more severe speech impairment indices.

CONTEXTO E OBJETIVO: Alguns fatores parecem influenciar a gravidade dos distúrbios de fala em crianças com transtorno fonológico. O objetivo foi comparar índices de gravidade e fatores correlatos. DESENHO E LOCAL: Observacional, analítico, transversal. Curso de Fonoaudiologia, Universidade de São Paulo. MÉTODO: Cinqüenta crianças com transtorno fonológico, entre 4 e 11 anos. Calcularam-se os índices nos testes de fonologia e correlacionaram-nos com dados de anamnese e audiometria. O teste t de Student e a correlação de Spearman compararam a Porcentagem de Consoantes Corretas (PCC) e a Densidade de Processos Fonológicos (DPF) em crianças com e sem otite e história de infecções de vias aéreas superiores, alteração de audiometria, se eram ou não compreendidas na época da avaliação e quando começaram a falar e a idade em que começaram a falar e na avaliação. RESULTADOS: Quanto mais velha a criança na avaliação, maior a PCC (correlação de Spearman: 0,468, imitação; 0,431, nomeação) e menor a DPF (0,459, imitação; 0,431, nomeação); quanto mais tarde a criança começou a falar, menor a PCC (imitação p = 0,064; nomeação p = 0,050) e maior a DPF (imitação p = 0,067; nomeação p = 0,042). Observaram-se diferenças nas crianças com e sem infecções de vias aéreas (PCC: imitação: p = 0,016; nomeação: p = 0,005; DPF: imitação: p = 0,014 e nomeação: p = 0,008). Não houve diferença quanto à otite, compreensão na avaliação e audiometria. CONCLUSÃO: Crianças com história de infecções de vias aéreas e que começaram a falar mais tarde apresentaram maior comprometimento de índices de gravidade.