Purpose

The current research sought to determine (a) if speech inconsistency is a core feature of childhood apraxia of speech (CAS) or if it is driven by comorbid language impairment that affects a large subset of children with CAS and (b) if speech inconsistency is a sensitive and specific diagnostic marker that can differentiate between CAS and speech delay.

Method

Participants included 48 children ranging between 4;7 to 17;8 (years;months) with CAS (n = 10), CAS + language impairment (n = 10), speech delay (n = 10), language impairment (n = 9), or typical development (n = 9). Speech inconsistency was assessed at phonemic and token-to-token levels using a variety of stimuli.

Results

Children with CAS and CAS + language impairment performed equivalently on all inconsistency assessments. Children with language impairment evidenced high levels of speech inconsistency on the phrase “buy Bobby a puppy.” Token-to-token inconsistency of monosyllabic words and the phrase “buy Bobby a puppy” was sensitive and specific in differentiating children with CAS and speech delay, whereas inconsistency calculated on other stimuli (e.g., multisyllabic words) was less efficacious in differentiating between these disorders.

Conclusions

Speech inconsistency is a core feature of CAS and is efficacious in differentiating between children with CAS and speech delay; however, sensitivity and specificity are stimuli dependent.

References

  • Alcock, K. J., Passingham, R. E., Watkins, K. E., & Vargha-Khadem, F. (2000). Oral dyspraxia in inherited speech and language impairment and acquired dysphasia.Brain and Language, 75, 17–33.
  • American Academy of Audiology. (2011). Childhood hearing screening guidelines. Retrieved from http://www.cdc.gov/ncbddd/hearingloss/documents/
  • American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech [Position Statement]. Retrieved from www.asha.org/policy
  • Aram, D. M., & Glasson, C. (1979, November). Developmental apraxia of speech. Paper presented at the Annual Convention of the American Speech-Language-Hearing Association, Los Angeles, CA.
  • M. A. (Ed.). Arbib (2006). The mirror system hypothesis on the linkage of action and languages.In Action to language via the mirror neuron system (pp. 3–47). Los Angeles: University of Southern California.
  • Archibald, L. M., & Gathercole, S. E. (2007). Nonword repetition in specific language impairment: More than a phonological short-term memory deficit.Psychonomic Bulletin & Review, 14, 919–924.
  • Baddeley, A. D. (1966). The influence of acoustic and semantic similarity on long-term memory for word sequences.Quarterly Journal of Experimental Psychology, 18, 302–309.
  • Ballard, K. J., Robin, D. A., McCabe, P., & McDonald, J. (2010). A treatment for dysprosody in childhood apraxia of speech.Journal of Speech, Language, and Hearing Research, 53, 1227–1245.
  • Bernstein, N. (1967). The coordination and regulation of movements. Oxford, UK: Pergamon.
  • Betz, S. K., & Stoel-Gammon, C. (2005). Measuring articulatory error consistency in children with developmental apraxia of speech.Clinical Linguistics & Phonetics, 19, 53–66.
  • Blumstein, S. E., Cooper, W. E., Goodglass, H., Statlender, S., & Gottlieb, J. (1980). Production deficits in aphasia: A voice-onset time analysis.Brain and Language, 9, 153–170.
  • Bracke-Tolkmitt, R., Linden, A., Canavan, A. G. M., Rockstroh, B., Scholz, E., Wessel, K., & Diener, H. C. (1989). The cerebellum contributes to mental skills.Behavioral Neuroscience, 103, 442.
  • Bridgeman, E., & Snowling, M. (1988). The perception of phoneme sequence: A comparison of dyspraxic and normal children.International Journal of Language & Communication Disorders, 23, 245–252.
  • Catts, H. W., Adlof, S. M., Hogan, T. P., & Weismer, S. E. (2005). Are specific language impairment and dyslexia distinct disorders?.Journal of Speech, Language, and Hearing Research, 48, 1378–1396.
  • Centanni, T. M., Sanmann, J. N., Green, J. R., Iuzzini-Seigel, J., Bartlett, C., Sanger, W. G., & Hogan, T. P. (2015). The role of candidate-gene CNTNAP2 in childhood apraxia of speech and specific language impairment.American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 168, 536–543.
  • Cermak, S. A., Ward, E. A., & Ward, L. M. (1986). The relationship between articulation disorders and motor coordination in children.American Journal of Occupational Therapy, 40, 546–550.
  • Chen, Y. P., & Yang, T. F. (2007). Effect of task goals on the reaching patterns of children with cerebral palsy.Journal of Motor Behavior, 39, 317–325.
  • Cohen, R. G., & Sternad, D. (2009). Variability in motor learning: Relocating, channeling and reducing noise.Experimental Brain Research, 193, 69–83.
  • Coltheart, V. (1993). Effects of phonological similarity and concurrent irrelevant articulation on short-term-memory recall of repeated and novel word lists.Memory & Cognition, 21, 539–545.
  • Conrad, R. (1964). Acoustic confusions in immediate memory.British Journal of Psychology, 55, 75–84.
  • Conrad, R. (1965). Order error in immediate recall of sequences.Journal of Verbal Learning and Verbal Behavior, 4, 161–169.
  • Davis, B. L., Jakielski, K. J., & Marquardt, T. P. (1998). Developmental apraxia of speech: Determiners of differential diagnosis.Clinical Linguistics & Phonetics, 12, 25–45.
  • Dodd, B., & Bradford, A. (2000). A comparison of three therapy methods for children with different types of developmental phonological disorder.International Journal of Language & Communication Disorders, 35, 189–209.
  • Dodd, B., & Iacano, T. (1989). Phonological disorders in children: Changes in phonological process use during treatment.International Journal of Language & Communication Disorders, 24, 333–352.
  • Dodd, B., Zhu, H., Crosbie, S., Holm, A., & Ozanne, A. (2002). Diagnostic evaluation of articulation and phonology (DEAP). London: Psychology Corporation.
  • Edwards, J., Fox, R. A., & Rogers, C. L. (2002). Final consonant discrimination in children: Effects of phonological disorder, vocabulary size, and articulatory accuracy.Journal of Speech, Language, and Hearing Research, 45, 231–242.
  • Ekelman, B. L., & Aram, D. M. (1984). Spoken syntax in children with developmental verbal apraxia.Seminars in Speech and Language, 5, 97–110.
  • Forrest, K. (2003). Diagnostic criteria of developmental apraxia of speech used by clinical speech-language pathologists.American Journal of Speech-Language Pathology, 12, 376–380.
  • Forrest, K., Dinnsen, D. A., & Elbert, M. (1997). Impact of substitution patterns on phonological learning by misarticulating children.Clinical Linguistics & Phonetics, 11, 63–76.
  • Forrest, K., & Elbert, M. (2001). Treatment for phonologically disordered children with variable substitution patterns.Clinical Linguistics & Phonetics, 15, 41–45.
  • Forrest, K., Elbert, M., & Dinnsen, D. A. (2000). The effect of substitution patterns on phonological treatment outcomes.Clinical Linguistics & Phonetics, 14, 519–531.
  • Forrest, K., Weismer, G., Elbert, M., & Dinnsen, D. A. (1994). Spectral analysis of target- appropriate /t/ and /k/ produced by phonologically disordered and normally articulating children.Clinical Linguistics & Phonetics, 8, 267–281.
  • Gierut, J., Elbert, M., & Dinnsen, D. (1987). A functional analysis of phonological knowledge and generalization learning in misarticulating children.Journal of Speech, Language, and Hearing Research, 30, 462–479.
  • Goffman, L. (1999). Prosodic influences on speech production in children with specific language impairment and speech deficits: Kinematic, acoustic, and transcription evidence.Journal of Speech, Language, and Hearing Research, 42, 1499–1517.
  • Goffman, L. (2004). Kinematic differentiation of prosodic categories in normal and disordered language development.Journal of Speech, Language, and Hearing Research, 47, 1088–1102.
  • Goffman, L. (2010). Dynamic interaction of motor and language factors in development.In B. Maassen, P. H. H. M. van Lieshout, R. Kent, & W. Hulstijn (Eds.), Speech motor control: New developments in applied research (pp. 137–152). Oxford, UK: Oxford University Press.
  • Goldman, R., & Fristoe, M. (2000). Goldman-Fristoe Test of Articulation, Second Edition. Circle Pines, MN: Pearson.
  • Gopnik, M., & Crago, M. B. (1991). Familial aggregation of a developmental language disorder.Cognition, 39, 1–50.
  • Green, J. R., Moore, C. A., & Reilly, K. J. (2002). The sequential development of jaw and lip control for speech.Journal of Speech, Language, and Hearing Research, 45, 66–79.
  • Green, J. R., & Nip, I. S. B. (2010). Organization principles in the development of early speech.In B. Maaseen & P. H. H. M. van Lieshout (Eds.), Speech motor control: New developments in basic and applied research (pp. 171–188). Oxford, UK: Oxford University Press.
  • Grigos, M. I. (2009). Changes in articulator movement variability during phonemic development: A longitudinal study.Journal of Speech, Language, and Hearing Research, 52, 164–177.
  • Hayden, D. A., & Square, P. A. (1994). Motor speech treatment hierarchy: A systems approach.Clinics in Communication Disorders, 4, 162–174.
  • Hill, E. L., Bishop, D. V. M., & Nimmo-Smith, I. (1998). Representational gestures in developmental coordination disorder and specific language impairment: Error-types and the reliability of ratings.Human Movement Science, 17, 655–678.
  • Hintzman, D. L. (1965). Classification and aural coding in short-term memory.Psychonomic Science, 3, 161–162.
  • Hodge, M. (1994). Assessment of developmental apraxia of speech: A rationale.Clinics in Communication Disorders, 4, 91–101.
  • Holm, A., Crosbie, S., & Dodd, B. (2007). Differentiating normal variability from inconsistency in children's speech: Normative data.International Journal of Language & Communication Disorders, 42, 467–486.
  • Holm, A., Farrier, F., & Dodd, B. (2008). Phonological awareness, reading accuracy and spelling ability of children with inconsistent phonological disorder.International Journal of Language & Communication Disorders, 43, 300–322.
  • Iuzzini, J. (2012). Inconsistency of speech in children with childhood apraxia of speech, phonological disorders, and typical speech (Unpublished doctoral dissertation). Indiana University, Bloomington.
  • Iuzzini, J., & Forrest, K. (2008, March). Acoustic vowel area in phonologically disordered, CAS, and normal speech. Poster presented at the Conference for Motor Speech, Monterey, CA.
  • Iuzzini, J., & Forrest, K. (2010). Evaluation of a combined treatment approach for childhood apraxia of speech.Clinical Linguistics & Phonetics, 24, 335–345.
  • Iuzzini, J., Hogan, T. P., & Green, J. R. (2014, November). Inconsistency is task dependent in children with CAS and speech delay. Technical session at the Annual Convention of the American Speech-Language-Hearing Association, Orlando, FL.
  • Iuzzini-Seigel, J., Hogan, T. P., Guarino, A., & Green, J. R. (2015). Reliance on auditory feedback in children with childhood apraxia of speech.Journal of Communication Disorders, 54, 32–42.
  • Iuzzini-Seigel, J., Hogan, T. P., Rong, P., & Green, J. R. (2015). Longitudinal development of speech motor control: Motor and linguistic factors.Journal of Motor Learning and Development, 3, 53–68.
  • Jäncke, L., Siegenthaler, T., Preis, S., & Steinmetz, H. (2007). Decreased white-matter density in a left-sided fronto-temporal network in children with developmental language disorder: Evidence for anatomical anomalies in a motor-language network.Brain and Language, 102, 91–98.
  • Johnston, R. B., Stark, R. E., Mellits, E. D., & Tallal, P. (1981). Neurological status of language impaired and normal children.Archives of Neurology, 10, 159–163.
  • Kent, R. D. (2004). The uniqueness of speech among motor systems.Clinical Linguistics & Phonetics, 18, 495–505.
  • Kleinow, J., & Smith, A. (2000). Influences of length and syntactic complexity on the speech motor stability of the fluent speech of adults who stutter.Journal of Speech, Language, and Hearing Research, 43, 548–559.
  • Leiner, H. C., Leiner, A. L., & Dow, R. S. (1991). The human cerebro-cerebellar system: Its computing, cognitive, and language skills.Behavioural Brain Research, 44, 113–128.
  • Leonard, L. B., Miller, C., & Gerber, E. (1999). Grammatical morphology and the lexicon in children with specific language impairment.Journal of Speech, Language, and Hearing Research, 42, 678–689.
  • Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., & Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech.Language, Speech, and Hearing Services in Schools, 35, 122–140.
  • Maassen, B., Nijland, L., & Van Der Meulen, S. (2001). Coarticulation within and between syllables by children with developmental apraxia of speech.Clinical Linguistics & Phonetics, 15, 145–150.
  • Macken, M. A., & Barton, D. (1980). The acquisition of the voicing contrast in Spanish: A phonetic and phonological study of word-initial stop consonants.Journal of Child Language, 7, 433–458.
  • Macrae, T., Tyler, A. A., & Lewis, K. E. (2014). Lexical and phonological variability in preschool children with speech sound disorder.American Journal of Speech-Language Pathology, 23, 27–35.
  • Malmenholt, A., Lohmander, A., & McAllister, A. (2016). Childhood apraxia of speech: A survey of praxis and typical speech characteristics.Logopedics Phoniatrics Vocology, 1–9.
  • Marquardt, T. P., Jacks, A., & Davis, B. L. (2004). Token-to-token variability in developmental apraxia of speech: Three longitudinal case studies.Clinical Linguistics & Phonetics, 18, 127–144.
  • Miller, C. A., Kail, R., Leonard, L. B., & Tomblin, J. B. (2001). Speed of processing in children with specific language impairment.Journal of Speech, Language, and Hearing Research, 44, 416–433.
  • Millspaugh, S., & Weiss, D. (2006, November). Diagnosing childhood apraxia of speech: A national survey of speech-language-pathologists. Poster presentation at the Annual Convention of the American Speech-Language-Hearing Association, Miami Beach, FL.
  • Murray, E., McCabe, P., Heard, R., & Ballard, K. J. (2015). Differential diagnosis of children with suspected childhood apraxia of speech.Journal of Speech, Language, and Hearing Research, 58, 43–60.
  • Nicolson, R. I., & Fawcett, A. J. (2007). Procedural learning difficulties: Reuniting the developmental disorders?.Trends in Neurosciences, 30, 135–141.
  • Nijland, L. (2009). Speech perception in children with speech output disorders.Clinical Linguistics & Phonetics, 23, 222–239.
  • Nijland, L., Maassen, B., Meulen, S. V. D., Gabreëls, F., Kraaimaat, F. W., & Schreuder, R. (2002). Coarticulation patterns in children with developmental apraxia of speech.Clinical Linguistics & Phonetics, 16, 461–483.
  • Nijland, L., Maassen, B., van der Meulen, S., Gabreëls, F., Kraaimaat, F. W., & Schreuder, R. (2003). Planning of syllables in children with developmental apraxia of speech.Clinical Linguistics & Phonetics, 17, 1–24.
  • Nip, I. S., Green, J. R., & Marx, D. B. (2011). The co-emergence of cognition, language, and speech motor control in early development: A longitudinal correlation study.Journal of Communication Disorders, 44, 149–160.
  • Ojemann, G. A. (1984). Common cortical and thalamic mechanisms for language and motor functions.American Journal of Physiology, Regulatory, Integrative, and Comparative Physiology, 246, R901–R903.
  • Paul, R. (2007). Language disorders from infancy through adolescence: Assessment & intervention. St. Louis, MO: Mosby.
  • Perkell, J. S., Guenther, F. H., Lane, H., Matthies, M. L., Stockmann, E., Tiede, M., & Zandipour, M. (2004). The distinctness of speakers' productions of vowel contrasts is related to their discrimination of the contrasts.Journal of the Acoustical Society of America, 116, 2338–2344.
  • Plante, E., & Vance, R. (1994). Selection of preschool language tests: A data-based approach.Language, Speech, and Hearing Services in Schools, 25, 15–24.
  • Plante, E., & Vance, R. (1995). Diagnostic accuracy of two tests of preschool language.American Journal of Speech-Language Pathology, 4(2), 70–76.
  • Powell, R. P., & Bishop, D. V. (1992). Clumsiness and perceptual problems in children with specific language impairment.Developmental Medicine & Child Neurology, 34, 755–765.
  • Raaymakers, E. M., & Crul, T. A. (1988). Perception and production of the final /s-ts/ contrast in Dutch by misarticulating children.Journal of Speech and Hearing Disorders, 53, 262–270.
  • Reynolds, C. R., & Kamphaus, R. W. (2003). Reynolds Intellectual Assessment Scales. Lutz, FL: PAR Inc.
  • Rintala, P., Pienimaki, K., Ahonen, T., & Cantell, M. (1998). Effects of a psychomotor training programme on motor skill development in children with developmental language disorders.Human Movement Science, 17, 721–737.
  • Rosenthal, J. B. (1994). Rate control therapy for developmental apraxia of speech.Clinics in Communication Disorders, 4, 190.
  • Rvachew, S. (1994). Speech perception training can facilitate sound production learning.Journal of Speech, Language, and Hearing Research, 37, 347–357.
  • Schumacher, J. G., McNeil, M. R., Vetter, D. K., & Yoder, D. E. (1986, November). Articulatory consistency and variability in apraxic and non-apraxic children. Paper presented at the Annual Convention of the American Speech-Language-Hearing Association, Detroit, MI.
  • Semel, E., Wiig, E. H., & Secord, W. A. (2003). Clinical Evaluation of Language Fundamental–Fourth Edition. San Antonio, TX: Pearson.
  • Shriberg, L. D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders.Journal of Speech, Language, and Hearing Research, 36, 105–140.
  • Shriberg, L. D., Aram, D. M., & Kwiatkowski, J. (1997). Developmental apraxia of speech I. Descriptive and theoretical perspectives.Journal of Speech, Language, and Hearing Research, 40, 273–285.
  • Shriberg, L. D., Green, J. R., Campbell, T. F., McSweeny, J. L., & Scheer, A. R. (2003). A diagnostic marker for childhood apraxia of speech: The coefficient of variation ratio.Clinical Linguistics & Phonetics, 17, 575–595.
  • Shriberg, L. D., Jakielski, J. J., & Strand, E. A. (2010, November). Diagnostic markers of childhood apraxia of speech. Paper presented at the Annual Convention of the American Speech-Language-Hearing Association, Philadelphia, PA.
  • Shriberg, L. D., Lohmeier, H. L., Strand, E. A., & Jakielski, K. J. (2012). Encoding, memory, and transcoding deficits in childhood apraxia of speech.Clinical Linguistics & Phonetics, 26, 445–482.
  • Shriberg, L. D., Potter, N. L., & Strand, E. A. (2011). Prevalence and phenotype of childhood apraxia of speech in youth with galactosemia.Journal of Speech, Language, and Hearing Research, 54, 487–519.
  • Smith, A., & Goffman, L. (1998). Stability and patterning of speech movement sequences in children and adults.Journal of Speech, Language, and Hearing Research, 41, 18–30.
  • Smith, A., & Zelaznik, H. N. (2004). Development of functional synergies for speech motor coordination in childhood and adolescence.Developmental Psychobiology, 45, 22–33.
  • Smits-Engelsman, B., & Wilson, P. H. (2013). Noise, variability, and motor performance in developmental coordination disorder.Developmental Medicine & Child Neurology, 55(Suppl. 4), 69–72.
  • Sosa, A. V., & Stoel-Gammon, C. (2006). Patterns of intra-word phonological variability during the second year of life.Journal of Child Language, 33, 31–50.
  • Stackhouse, J. (1992). Developmental verbal dyspraxia I: A review and critique.International Journal of Language & Communication Disorders, 27, 19–34.
  • Storkel, H. L., & Hoover, J. R. (2010). An online calculator to compute phonotactic probability and neighborhood density on the basis of child corpora of spoken American English.Behavior Research Methods, 42, 497–506.
  • Tallal, P., Miller, S., & Fitch, R. H. (1993). Neurobiological basis of speech: A case for the preeminence of temporal processing.Annals of the New York Academy of Sciences, 682, 27–47.
  • Templin, M. C. (1957). Certain language skills in children: Their development and interrelationships. Minneapolis: University of Minnesota Press.
  • Terband, H., & Maassen, B. (2010). Speech motor development in childhood apraxia of speech: Generating testable hypotheses by neurocomputational modeling.Folia Phoniatrica et Logopaedica, 62, 134–142.
  • Terband, H., Maassen, B., Guenther, F. H., & Brumberg, J. (2014). Auditory–motor interactions in pediatric motor speech disorders: Neurocomputational modeling of disordered development.Journal of Communication Disorders, 47, 17–33.
  • Thelen, E., & Smith, L. B. (1994). A dynamic systems approach to the development of cognition and action. Cambridge, MA: MIT Press.
  • Thoonen, G., Maassen, B., Gabreels, F., Schreuder, R., & de Swart, B. (1997). Towards a standardised assessment procedure for developmental apraxia of speech.International Journal of Language & Communication Disorders, 32, 37–60.
  • Tyler, A. A., Lewis, K. E., & Welch, C. M. (2003). Predictors of phonological change following intervention.American Journal of Speech-Language Pathology, 12, 289–298.
  • Van Waelvelde, H., De Weerdt, W., De Cock, P., Peersman, W., & Smits-Engelsman, B. C. M. (2004). Ball catching performance in children with developmental coordination disorder.Adapted Physical Activity Quarterly, 21, 348–363.
  • Velleman, S. L., & Strand, K. (1994). Developmental verbal dyspraxia.In J. E. Bernthal & N. W. Bankson (Eds.), Child phonology: Characteristics, assessment, and intervention with special populations (pp. 110–139). New York: Thieme Medical Publishers.
  • Vuolo, J., & Goffman, L. (2014, November). Phonetic and speech motor variability in children with childhood apraxia of speech and phonological disorders. Technical session at the American Speech-Language Hearing Association Convention, Orlando, FL.
  • Walsh, B., Smith, A., & Weber-Fox, C. (2006). Short-term plasticity in children's speech motor systems.Developmental Psychobiology, 48, 660–674.
  • Weismer, S. E., Tomblin, J. B., Zhang, X., Buckwalter, P., Chynoweth, J. G., & Jones, M. (2000). Nonword repetition performance in school-age children with and without language impairment.Journal of Speech, Language, and Hearing Research, 43, 865–878.
  • Wiig, E. H., Secord, W. A., & Semel, E. (2004). Clinical Evaluation of Language Fundamental–Preschool Second Edition. Bloomington, MN: Pearson.
  • Yao-Tresguerres, S., Iuzzini, J., & Forrest, K. (2009, November). The effect of therapy on children's use of inconsistent substitutes. Poster presented at the Annual Convention of the American Speech-Language-Hearing Association, New Orleans, LA.
  • Zelaznik, H. N., & Goffman, L. (2010). Generalized motor abilities and timing behavior in children with specific language impairment.Journal of Speech, Language, and Hearing Research, 53, 383–393.
  • Zuk, J., Iuzzini-Seigel, J., Cabbage, K., Green, J., & Hogan, T. (2015, November). Auditory perception in children with childhood apraxia of speech: language matters. Technical session at the Annual Convention of the American Speech-Language-Hearing Association, Denver, CO.

Additional Resources