Do Acoustic Characteristics of Dysarthria in People With Parkinson's Disease Differ Across Languages?

PURPOSE: Cross-language studies suggest more similarities than differences in how dysarthria affects the speech of people with Parkinson's disease (PwPD) who speak different languages. In this study, we aimed to identify the relative contribution of acoustic variables to distinguish PwPD from controls who spoke varieties of two Romance languages, French and Portuguese. METHOD: This bi-national, cross-sectional, and case-controlled study included 129 PwPD and 124 healthy controls who spoke French or Portuguese. All participants underwent the same clinical examinations, voice/speech recordings, and self-assessment questionnaires. PwPD were evaluated off and on optimal medication. Inferential analyses included Disease (controls vs. PwPD) and Language (French vs. Portuguese) as factors, and random decision forest algorithms identified relevant acoustic variables able to distinguish participants: (a) by language (French vs. Portuguese) and (b) by clinical status (PwPD on and off medication vs. controls). RESULTS: French-speaking and Portuguese-speaking individuals were distinguished from each other with over 90% accuracy by five acoustic variables (the mean fundamental frequency and the shimmer of the sustained vowel /a/ production, the oral diadochokinesis performance index, the relative sound level pressure and the relative sound pressure level standard deviation of the text reading). A distinct set of parameters discriminated between controls and PwPD: for men, maximum phonation time and the oral diadochokinesis speech proportion were the most significant variables; for women, variables calculated from the oral diadochokinesis were the most discriminative. CONCLUSIONS: Acoustic variables related to phonation and voice quality distinguished between speakers of the two languages. Variables related to pneumophonic coordination and articulation rate were the more effective in distinguishing PwPD from controls. Thus, our research findings support that respiration and diadochokinesis tasks appear to be the most appropriate to pinpoint signs of dysarthria, which are largely homogeneous and language-universal. In contrast, identifying language-specific variables with the speech tasks and acoustic variables studied was less conclusive.

Serious Games for Developing Social Skills in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review.

Serious games represent a promising avenue for intervention with children diagnosed with autism spectrum disorder, a neurodevelopmental disorder marked by persistent challenges in social communication and the presence of restricted, repetitive behaviors. Despite this potential, comprehensive reviews on this subject are scarce. This systematic review aims to evaluate the effectiveness of serious games and their specific characteristics in enhancing social skills among children and adolescents with autism. Employing PICO strategies and adhering to PRISMA guidelines, we screened 149 studies initially identified through PubMed and EBSCOhost databases. Nine studies met inclusion criteria and found a positive influence of serious games on social skills and related domains, encompassing emotion recognition/encoding/decoding, emotional regulation, eye gaze, joint attention, and behavioral skills. Nevertheless, despite these promising results, the limited available evidence underscores the need for rigorous study designs to consolidate findings and integrate evidence-based intervention strategies.

Adaptation and validation of the European Portuguese Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant-Toddler Checklist.

BACKGROUND: As delays or disorders in early language and communication are the most prevalent symptom in children with disabilities, early screening is crucial to promote prevention, early diagnosis, and intervention. However, to the best of our knowledge, no screening tool is available for the joint assessment of early language and social communication skills in European Portuguese (EP)-learning children, which is critical for screening, monitoring and enrolment in appropriate early intervention services. AIMS: (1) To adapt and validate the EP version of the Communication and Symbolic Behaviour Scales Developmental Profile™ (CSBS DP™) Infant-Toddler Checklist, a parental report for the screening of early language and social communication skills. (2) To conduct a cross-cultural comparison between the EP adaptation and the original US version. METHODS & PROCEDURES: A total of 611 EP-learning children (ages 6-24 months) were assessed on the CSBS DP Infant-Toddler Checklist. Normative data, psychometric characteristics (i.e., internal consistency and test-retest reliability), and cross-cultural comparison between the EP and the original version were explored. OUTCOMES & RESULTS: Internal consistency ranged from good to excellent and the test-retest reliability was excellent. The performance of the EP and US samples matched on almost all scores. However, EP children performed significantly better than their American peers in the Social compositive at 22 months and in the Symbolic composite at 20 months. No further differences were found. CONCLUSIONS & IMPLICATIONS: These findings showed that the EP CSBS DP Infant-Toddler Checklist seems to be a reliable screening tool of communicative and symbolic behaviours for EP-learning children, which can be particularly relevant for decision-making in clinical practice. WHAT THIS PAPER ADDS: What is already known on the subject Early communication skills are known to be related to later language outcomes. Thus, screening tools for the early identification of children at risk for language and communication impairments, which may lead to monitoring and early intervention, have the potential to promote better outcomes. However, to the best of our knowledge, no screening tool is available for the assessment of early communication abilities in EP-learning children. What this paper adds to existing knowledge This study adapted and validated the EP CSBS DP Infant-Toddler Checklist, the first published parental report checklist for the assessment of early communication skills in EP. It described the psychometric characteristics of the adapted checklist, summarized the newly available normative data for EP-learning infants and toddlers, and compared the performance of EP-learning children with the original standardization sample reported for American English. The results demonstrated that this tool is a reliable instrument for the early screening of language, communicative and symbolic behaviours for EP-learning children between 6 and 24 months of age. What are the potential or actual clinical implications of this work? Given that early screening is crucial to promote prevention, early diagnosis and intervention, the availability of this tool is particularly relevant for children monitoring and their enrolment in appropriate early intervention services, helping decision-making in clinical practice, in line with current guidelines regarding early monitoring and intervention to promote and support better outcomes. Thus, the tool and related normative data will be useful for paediatricians, family doctors, primary healthcare providers, developmental psychologists and speech-language therapists, among other professionals in the healthcare and educational fields, concerned with speech, language, and communication development and impairments.

Development and validation of a parental report of toddlers' prosodic skills.

This study describes the development and validation of Proso-Quest, a parental report of toddlers' prosodic skills that aims to assess early prosodic development in European Portuguese. The development and validation of Proso-Quest proceeded in three phases. Phase 1 was undertaken (a) to establish the structure of the parental report and select the items considering previous work, (b) to collect input from experts on prosodic development, and (c) to revise the report after a pilot study. Phase 2 examined internal consistency, reliability, test-retest reliability, and correlations between Proso-Quest and a valid measure of vocabulary development. Finally, Phase 3 evaluated the discriminant validity of this report in a clinical sample that frequently presents prosodic impairments. The psychometric properties of Proso-Quest indicated an excellent internal consistency, high test-retest reliability, significant correlations with a valid measure of vocabulary development, and sensitivity to identify prosodic delays. This parental report showed evidence of reliability and validity in describing early prosodic development and impairment, and it may be a useful tool in research and educational assessments, as well as in clinical-based assessments.

Executive Functions and Language Skills in Preschool Children: The Unique Contribution of Verbal Working Memory and Cognitive Flexibility.

The development of language skills requires a range of linguistic abilities and cognitive processes, such as executive functions (EFs, i.e., a set of skills involved in goal-directed activities which are crucial for regulating thoughts and actions). Despite progress in understanding the link between language and EFs, the need for more research on the extent and directionality of this link is undeniable. This study examined whether specific components of EFs account for a significant amount of variance in language abilities above and beyond gender, age, and nonverbal intelligence. The sample comprised 79 typically developing children attending the last year of preschool (Mage = 64.5 months, SD = 3.47). EFs were assessed through tasks that explored three predictor variables: inhibitory control, working memory, and cognitive flexibility. The language outcomes included receptive and expressive language. After controlling for age, gender, and nonverbal intelligence, findings showed that working memory and cognitive flexibility, respectively, explained an additional 16% and 19% of the variance. Inhibition skills did not increase the amount of explained variance in language outcomes. These results highlight the potential added importance of assessing working memory and cognitive flexibility in the prediction of language skills in preschool children.

Early predictors of language outcomes in Down syndrome: A mini-review.

As children with Down syndrome (DS) typically manifest significant delays in language development, the research has pointed out the predictors of later language skills for this clinical population. The purpose of this study was to systematically explore the evidence for early predictors of language outcomes in infants and toddlers with DS from studies published between 2012 and 2022. After the search, nine studies met the inclusion criteria. The results indicated that maternal educational level, adaptive level of functioning, cognitive function, attention skills, communicative intent of the child, early vocalizations, gestures, baby signs, parents' translation of their children's gestures into words, and vocabulary level are significant predictors of language outcomes in children with DS. These findings provide a timely and warranted summary of published work that contributes to current understanding of the development of language and communication in DS. They are therefore useful to researchers, clinicians, and families.

Early Word Segmentation Behind the Mask.

Infants have been shown to rely both on auditory and visual cues when processing speech. We investigated the impact of COVID-related changes, in particular of face masks, in early word segmentation abilities. Following up on our previous study demonstrating that, by 4 months, infants already segmented targets presented auditorily at utterance-edge position, and, using the same visual familiarization paradigm, 7-9-month-old infants performed an auditory and an audiovisual word segmentation experiment in two conditions: without and with an FFP2 face mask. Analysis of acoustic and visual cues showed changes in face-masked speech affecting the amount, weight, and location of cues. Utterance-edge position displayed more salient cues than utterance-medial position, but the cues were attenuated in face-masked speech. Results revealed no evidence for segmentation, not even at edge position, regardless of mask condition and auditory or visual speech presentation. However, in the audiovisual experiment, infants attended more to the screen during the test trials when familiarized with without mask speech. Also, the infants attended more to the mouth and less to the eyes in without mask than with mask. In addition, evidence for an advantage of the utterance-edge position in emerging segmentation abilities was found. Thus, audiovisual information provided some support to developing word segmentation. We compared 7-9-monthers segmentation ability observed in the Butler and Frota pre-COVID study with the current auditory without mask data. Mean looking time for edge was significantly higher than unfamiliar in the pre-COVID study only. Measures of cognitive and language development obtained with the CSBS scales showed that the infants of the current study scored significantly lower than the same-age infants from the CSBS (pre-COVID) normative data. Our results suggest an overall effect of the pandemic on early segmentation abilities and language development, calling for longitudinal studies to determine how development proceeds.

(Dys)Prosody in Parkinson's Disease: Effects of Medication and Disease Duration on Intonation and Prosodic Phrasing.

The phonology of prosody has received little attention in studies of motor speech disorders. The present study investigates the phonology of intonation (nuclear contours) and speech chunking (prosodic phrasing) in Parkinson's disease (PD) as a function of medication intake and duration of the disease. Following methods of the prosodic and intonational phonology frameworks, we examined the ability of 30 PD patients to use intonation categories and prosodic phrasing structures in ways similar to 20 healthy controls to convey similar meanings. Speech data from PD patients were collected before and after a dopaminomimetic drug intake and were phonologically analyzed in relation to nuclear contours and intonational phrasing. Besides medication, disease duration and the presence of motor fluctuations were also factors included in the analyses. Overall, PD patients showed a decreased ability to use nuclear contours and prosodic phrasing. Medication improved intonation regardless of disease duration but did not help with dysprosodic phrasing. In turn, disease duration and motor fluctuations affected phrasing patterns but had no impact on intonation. Our study demonstrated that the phonology of prosody is impaired in PD, and prosodic categories and structures may be differently affected, with implications for the understanding of PD neurophysiology and therapy.

Early Visual Attention Abilities and Audiovisual Speech Processing in 5-7 Month-Old Down Syndrome and Typically Developing Infants.

Communicative abilities in infants with Down syndrome (DS) are delayed in comparison to typically developing (TD) infants, possibly affecting language development in DS. Little is known about what abilities might underlie poor communication and language skills in DS, such as visual attention and audiovisual speech processing. This study compares DS and TD infants between 5-7 months of age in a visual orientation task, and an audiovisual speech processing task, which assessed infants' looking pattern to communicative cues (i.e., face, eyes, mouth, and waving arm). Concurrent communicative abilities were also assessed via the CSBS-DP checklist. We observed that DS infants orient their visual attention slower than TD infants. Both groups attended more to the eyes than the mouth, and more to the face than the waving arm. However, DS infants attended less to the eyes than the background, and equally to the face and the background, suggesting their difficulty to assess linguistically relevant cues. Finally, communicative skills were related to attention to the eyes in TD, but not in DS infants. Our study showed that early attentional and audiovisual abilities are impaired in DS infants, and might underlie their communication skills, suggesting that early interventions in this population should emphasize those skills.

European Portuguese-Learning Infants Look Longer at Iambic Stress: New Data on Language Specificity in Early Stress Perception.

The ability to perceive lexical stress patterns has been shown to develop in language-specific ways. However, previous studies have examined this ability in languages that are either clearly stress-based (favoring the development of a preference for trochaic stress, like English and German) or syllable-based (favoring the development of no stress preferences, like French, Spanish, and Catalan) and/or where the frequency distributions of stress patterns provide clear data for a predominant pattern (like English and Hebrew). European Portuguese (EP) is a different type of language, which presents conflicting sets of cues related to rhythm, frequency, and stress correlates that challenge existing accounts of early stress perception. Using an anticipatory eye movement (AEM) paradigm implemented with eye-tracking, EP-learning infants at 5-6 months demonstrated sensitivity to the trochaic/iambic stress contrast, with evidence of asymmetrical perception or preference for iambic stress. These results are not predicted by the rhythmic account of developing stress perception, and suggest that the language-particular phonological patterns impacting the frequency of trochaic and iambic stress, beyond lexical words with two or more syllables, together with the prosodic correlates of stress, drive the early acquisition of lexical stress. Our findings provide the first evidence of sensitivity to stress patterns in the presence of segmental variability by 5-6 months, and highlight the importance of testing developing stress perception in languages with diverse combinations of rhythmic, phonological, and phonetic properties.

The Sense of Sounds: Brain Responses to Phonotactic Frequency, Phonological Grammar and Lexical Meaning.

Two outstanding questions in spoken-language comprehension concern (1) the interplay of phonological grammar (legal vs. illegal sound sequences), phonotactic frequency (high- vs. low-frequency sound sequences) and lexicality (words vs. other sound sequences) in a meaningful context, and (2) how the properties of phonological sequences determine their inclusion or exclusion from lexical-semantic processing. In the present study, we used a picture-sound priming paradigm to examine the ERP responses of adult listeners to grammatically illegal sound sequences, to grammatically legal sound sequences (pseudowords) with low- vs. high-frequency, and to real words that were either congruent or incongruent to the picture context. Results showed less negative N1-P2 responses for illegal sequences and low-frequency pseudowords (with differences in topography), but not high-frequency ones. Low-frequency pseudowords also showed an increased P3 component. However, just like illegal sequences, neither low- nor high-frequency pseudowords differed from congruent words in the N400. Thus, phonotactic frequency had an impact before, but not during lexical-semantic processing. Our results also suggest that phonological grammar, phonotactic frequency and lexicality may follow each other in this order during word processing.

Emerging word segmentation abilities in European Portuguese-learning infants: new evidence for the rhythmic unit and the edge factor.

Word segmentation plays a crucial role in language acquisition, particularly for word learning and syntax development, and possibly predicts later language abilities. Previous studies have suggested that this ability develops differently across languages, possibly affected by the languages' rhythmic properties (Rhythmic Segmentation Hypothesis) and target word location in the prosodic structure (Edge Hypothesis). The present study investigates early word segmentation in a language, European Portuguese, that exhibits both stress- and syllable-timed properties, as well as strong cues to both higher-level prosodic boundaries and the word level. Infants aged 4-10 months old were tested with target words located in utterance-medial and utterance-final positions. Evidence for word segmentation was found early in development but only for utterance-edge located target words, suggesting the more salient prosodic cues play a crucial role. There was some evidence for segmentation in utterance-medial position by 10 months, demonstrating that this ability is not yet fully developed, possibly due to mixed rhythmic properties.

Executive Functions and Prosodic Abilities in Children With High-Functioning Autism.

Little is known about the relationship between prosodic abilities and executive function skills. As deficits in executive functions (EFs) and prosodic impairments are characteristics of autism, we examined how EFs are related to prosodic performance in children with high-functioning autism (HFA). Fifteen children with HFA (M = 7.4 years; SD = 1.12), matched to 15 typically developing peers on age, gender, and non-verbal intelligence participated in the study. The Profiling Elements of Prosody in Speech-Communication (PEPS-C) was used to assess prosodic performance. The Children's Color Trails Test (CCTT-1, CCTT-2, and CCTT Interference Index) was used as an indicator of executive control abilities. Our findings suggest no relation between prosodic abilities and visual search and processing speed (assessed by CCTT-1), but a significant link between prosodic skills and divided attention, working memory/sequencing, set-switching, and inhibition (assessed by CCTT-2 and CCTT Interference Index). These findings may be of clinical relevance since difficulties in EFs and prosodic deficits are characteristic of many neurodevelopmental disorders. Future studies are needed to further investigate the nature of the relationship between impaired prosody and executive (dys)function.

Revisiting Stress "Deafness" in European Portuguese - A Behavioral and ERP Study.

European Portuguese (EP) is a language with variable stress, and the main cues for stress are duration and vowel reduction. A previous behavioral study has reported a stress "deafness" effect in EP when vowel quality cues are unavailable. The present study recorded both event-related potentials (ERPs) and behavioral data to examine the stress processing by native EP speakers in the absence of the vowel quality cues. Our behavioral result was consistent with previous research, showing that when vowel reduction is absent EP speakers demonstrated a stress "deafness" effect similar to that found in speakers of languages with fixed stress or without any lexical stress marking. In the ERP task, both the trochaic and iambic conditions yielded mismatch negativity (MMN) and late negativity, suggesting that EP speakers are able to discriminate the two stress patterns without vowel reduction at the pre-attentive stage. Moreover, the ERP and behavioral data revealed compatible results regarding the pattern of stress bias in EP. In the EPR task, the MMN and late negativity components were more negative and span over a larger temporal window in the iambic condition than in the trochaic condition, indicating a higher sensitivity for the iambic stress pattern. In the behavioral task, EP speakers responded more accurately and more quickly to the iambic stress. These results match recent developmental findings in the acquisition of stress, but speak against the dominant view in EP phonological literature which assumes penultimate stress to be the regular stress pattern. In addition, both the ERP and the behavioral data showed that EP speakers' stress processing was influenced by their working memory (WM) capacity. The participants with high WM capacity outperformed the participants with limited WM capacity in the iambic condition. In sum, our results broaden the current knowledge on stress processing by EP speakers at both the pre-attentive and attentive levels.

Atypical preference for infant-directed speech as an early marker of autism spectrum disorders? A literature review and directions for further research.

Autism spectrum disorders (ASD) refer to a complex group of neurodevelopmental disorders causing difficulties with communication and interpersonal relationships, as well as restricted and repetitive behaviours and interests. As early identification, diagnosis, and intervention provide better long-term outcomes, early markers of ASD have gained increased research attention. This review examines evidence that auditory processing enhanced by social interest, in particular auditory preference of speech directed towards infants and young children (i.e. infant-directed speech - IDS), may be an early marker of risk for ASD. Although this review provides evidence for IDS preference as, indeed, a potential early marker of ASD, the explanation for differences in IDS processing among children with ASD versus other children remains unclear, as are the implications of these impairments for later social-communicative development. Therefore, it is crucial to explore atypicalities in IDS processing early on development and to understand whether preferential listening to specific types of speech sounds in the first years of life may help to predict the impairments in social and language development.

Dysarthria in individuals with Parkinson's disease: a protocol for a binational, cross-sectional, case-controlled study in French and European Portuguese (FraLusoPark).

INTRODUCTION: Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). METHODS AND ANALYSIS: Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. ETHICS AND DISSEMINATION: The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. TRIAL REGISTRATION NUMBER: NCT02753192, Pre-results.

A stress "deafness" effect in European Portuguese.

Research on the perception of word stress suggests that speakers of languages with non-predictable or variable stress (e.g., English and Spanish) are more efficient than speakers of languages with fixed stress (e.g., French and Finnish) at distinguishing nonsense words contrasting in stress location. In addition, segmental and suprasegmental cues to word stress may also impact on the ability of speakers to perceive stress. European Portuguese (EP) is a language with variable stress and vowel reduction. Previous studies on EP have identified duration as the main cue for stress. In the present study, we investigated the perception of word stress in EP, both in nuclear (NP) and post-nuclear (PN) positions, by means of three experiments. Experiment I was an ABX discrimination task with stress and phoneme contrasts, without vowel reduction. Experiments 2 and 3 were sequence recall tasks with stress and phoneme contrasts, vowel reduction being added to the stress contrast only in experiment 3. Results showed significantly higher error rates in the stress contrast condition than in the phoneme contrast condition, when duration alone (PN), or duration and pitch accents (NP), are present in the stimuli (experiments I and 2). When vowel reduction is added, EP speakers are able to perceive stress contrasts (experiment 3). The results show that vowel reduction appears to be the most robust cue for stress in EP. In the absence of vowel quality cues, a stress "deafness" effect may emerge in a language with non-predictable stress that combines both suprasegmental and segmental information to signal word stress. These findings have implications for claims of a prosodic-based cross-linguistic perception of word stress in the absence of vowel quality, and for stress "deafness" as a consequence of a predictable stress grammar.

Atypical prosody in Asperger syndrome: perceptual and acoustic measurements.

It is known that individuals with Asperger syndrome (AS) may show no problems with regard to what is said (e.g., lexical content) but tend to have difficulties in how utterances are produced, i.e., they may show prosodic impairments. In the present study, we focus on the use of prosodic features to express grammatical meaning. Specifically, we explored the sentence type difference between statements and questions that is conveyed by intonation, using perceptual and acoustic measurements. Children aged 8 and 9 years with AS (n = 12) were matched according to age and nonverbal intelligence with typically developing peers (n = 17). Although children with AS could produce categorically accurate prosodic patterns, their prosodic contours were perceived as odd by adult listeners, and acoustic measurements showed alterations in duration and pitch. Additionally, children with AS had greater variability in fundamental frequency contours compared to typically developing peers.