No AccessAmerican Journal of Speech-Language PathologyResearch Article15 Jul 2019

Profiling Speech Sound Disorders for Clinical Validation of the Computer Articulation Instrument


    The current article presents data from 2 studies on clinical groups of children referred for speech assessment. The aims of these studies are to validate the Computer Articulation Instrument (CAI) with the known-group validation method and to determine the differential diagnostic power of the resulting speech profiles.


    Study 1 examined known-group validity by comparing the scores of 93 children diagnosed with speech-language difficulties on the picture naming (PN) task of the CAI with intelligibility judgments given by speech-language pathologists. In Study 2, the speech profiles of 41 children diagnosed with speech sound disorders (SSDs), consisting of 4–6 factor scores extracted from the 4 tasks of the CAI, namely, PN, nonword imitation (NWI), word and nonword repetition, and maximum repetition rate (MRR), were validated against clinical judgments of severity of the SSD given by speech-language pathologists.


    In Study 1, a repeated-measures analysis of variance revealed a significant effect of intelligibility level on the PN performance of the CAI and there were highly significant correlations between intelligibility and PN performance in the expected direction. Neither intelligibility level nor PN performance was related to nonverbal intelligence and language scores. The analysis of variance and a series of t tests in Study 2 revealed significant differences between the moderate and severe groups for the CAI factors based on PN and NWI and the bisyllabic and trisyllabic sequences of MRR, but not for the factor word and nonword proportion of whole-word variability based on word and nonword repetition, and the monosyllabic sequences of MRR. These results suggest that, especially, the tasks PN, NWI, and the bisyllabic and trisyllabic sequences of MRR are most sensitive for diagnosing SSDs.


    The findings of these 2 studies support the known-group validity of the CAI. Together with the results of a previous study of our group on reliability and validity (van Haaften et al., 2019), we can conclude that the CAI is a reliable and valid tool for assessment of children with SSDs.


    • Baker, E., Croot, K., McLeod, S., & Paul, R. (2001). Psycholinguistic models of speech development and their application to clinical practice.Journal of Speech, Language, and Hearing Research, 44(3), 685–702.
    • Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., Adams, C., Archibald, L., … House, A. (2017). Phase 2 of CATALISE: A multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology.The Journal of Child Psychology and Psychiatry, 58(10), 1068–1080.
    • Davis, B. L., Jakielski, K. J., & Marquardt, T. P. (1998). Developmental apraxia of speech: Determiners of differential diagnosis.Clinical Linguistics & Phonetics, 12(1), 25–45.
    • Dodd, B. (1995a). Children's acquisition of phonology.In B. Dodd (Ed.), Differential diagnosis and treatment of children with speech disorder (pp. 21–48). London, England: Whurr.
    • Dodd, B. (1995b). Children with speech disorder: Defining the problem. .B. Dodd (Ed.), Differential diagnosis and treatment of children with speech disorder. (pp. 1–19). London, England: Whurr.
    • Dodd, B. (1995c). Procedures for classification of subgroups of speech disorder.In B. Dodd (Ed.), Differential diagnosis and treatment of children with speech disorder (pp. 49–64). London, England: Whurr.
    • Dodd, B. (2011). Differentiating speech delay from disorder: Does it matter?.Topics in Language Disorders, 31(2), 96–111.
    • Dodd, B. (2014). Differential diagnosis of pediatric speech sound disorder.Current Developmental Disorders Reports, 1(3), 189–196.
    • Doyle, P. C., Swift, E. R., & Haaf, R. G. (1989). Effects of listener sophistication on judgments of tracheoesophageal talker intelligibility.Journal of Communication Disorders, 22(2), 105–113.
    • Eadie, P., Morgan, A., Ukoumunne, O. C., Ttofari Eecen, K., Wake, M., & Reilly, S. (2015). Speech sound disorder at 4 years: Prevalence, comorbidities, and predictors in a community cohort of children.Developmental Medicine & Child Neurology, 57(6), 578–584.
    • Forrest, K. (2003). Diagnostic criteria of developmental apraxia of speech used by clinical speech-language pathologists.American Journal of Speech-Language Pathology, 12(3), 376–380.
    • Gathercole, S. E. (2006). Nonword repetition and word learning: The nature of the relationship.Applied Psycholinguistics, 27(4), 513.
    • Geronikou, E., & Rees, R. (2016). Psycholinguistic profiling reveals underlying impairments for Greek children with speech disorders.Child Language Teaching and Therapy, 32(1), 95–110.
    • Gordon-Brannan, M., & Hodson, B. (2000). Intelligibility/severity measurements of prekindergarten children's speech.American Journal of Speech-Language Pathology, 9(2), 141–150.
    • Hodges, R., Baker, E., Munro, N., & McGregor, K. K. (2017). Responses made by late talkers and typically developing toddlers during speech assessments.International Journal of Speech-Language Pathology, 19(6), 587–600.
    • Holm, A., Crosble, S., & Dodd, B. (2007). Differentiating normal variability from inconsistency in children's speech: Normative data.International Journal of Language & Communication Disorders, 42(4), 467–486.
    • Iuzzini-Seigel, J., Hogan, T. P., & Green, J. R. (2017). Speech inconsistency in children with childhood apraxia of speech, language impairment, and speech delay: Depends on the stimuli.Journal of Speech, Language, and Hearing Research, 60(5), 1194–1210.
    • Krishnan, S., Alcock, K. J., Carey, D., Bergström, L., Karmiloff-Smith, A., & Dick, F. (2017). Fractionating nonword repetition: The contributions of short-term memory and oromotor praxis are different.PLOS ONE, 12(7), 1–18.
    • Lagerberg, T. B., Hartelius, L., Johnels, J. Å., Ahlman, A.-K., Börjesson, A., & Persson, C. (2015). Swedish Test of Intelligibility for Children (STI-CH)—Validity and reliability of a computer-mediated single word intelligibility test for children.Clinical Linguistics & Phonetics, 29(3), 201–215.
    • Landa, S., Pennington, L., Miller, N., Robson, S., Thompson, V., & Steen, N. (2014). Association between objective measurement of the speech intelligibility of young people with dysarthria and listener ratings of ease of understanding.International Journal of Speech-Language Pathology, 16(4), 408–416.
    • Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (2000). Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature.International Journal of Language & Communication Disorders, 35(2), 165–188.
    • Levelt, W. (1989). Speaking: From intention to articulation. Cambridge, MA: MIT Press.
    • Levelt, W., Roelofs, A., & Meyer, A. S. (1999). A theory of lexical access in speech production.Behavioral and Brain Sciences, 22(1), 1–75.
    • Lohmander, A., Lundeborg, I., & Persson, C. (2016). SVANTE—The Swedish Articulation and Nasality Test—Normative data and a minimum standard set for cross-linguistic comparison.Clinical Linguistics & Phonetics, 31, 137–154.
    • Maassen, B., & Terband, H. (2015). Process-oriented diagnosis of childhood and adult apraxia of speech (CAS and AOS).In M. A. Redford (Ed.), The handbook of speech production (1st ed., pp. 331–350). United Kingdom: Wiley.
    • Maassen, B., van Haaften, L., Diepeveen, S., Terband, H., van den Engel-Hoek, L., Veenker, T., & De Swart, B. (2019). Computer articulation instrument. Amsterdam, the Netherlands: Boom Uitgevers.
    • 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.
    • McLeod, S., Harrison, L. J., & McCormack, J. (2012). The intelligibility in context scale: Validity and reliability of a subjective rating measure.Journal of Speech, Language, and Hearing Research, 55(2), 648–656.
    • Mullen, R., & Schooling, T. (2010). The national outcomes measurement system for pediatric speech-language pathology.Language, Speech, and Hearing Services in Schools, 41(1), 44–60.
    • Neumann, S., Rietz, C., & Stenneken, P. (2017). The German Intelligibility in Context Scale (ICS-G): Reliability and validity evidence.International Journal of Language & Communication Disorders, 52(5), 585–594.
    • Nijland, L. (2003). Developmental apraxia of speech: Deficits in phonetic planning and motor programming. Wageningen, the Netherlands: Ponson & Looijen.
    • Nijland, L., Maassen, B., & van der Meulen, S. (2003). Evidence of motor programming deficits in children diagnosed with DAS.Journal of Speech, Language, and Hearing Research, 46(2), 437–450.
    • 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), 1–24.
    • Nijland, L., Terband, H., & Maassen, B. (2015). Cognitive functions in childhood apraxia of speech.Journal of Speech, Language, and Hearing Research, 58(3), 550–565.
    • Portney, L., & Watkins, M. (2009). Foundations of clinical research: Applications to practice. Upper Saddle River, NJ: Prentice Hall.
    • Rvachew, S., Hodge, M., & Ohberg, A. (2005). Obtaining and interpreting maximum performance tasks from children: A tutorial.Journal of Speech-Language Pathology and Audiology, 29(4), 146–157.
    • Schlichting, L. (2005). Peabody Picture Vocabulary Test–III Dutch version (PPVT-III-NL). Amsterdam, the Netherlands: Pearson Assessment and Information B.V.
    • Schlichting, L., & Spelberg, H. L. (2010a). Schlichting Test voor Taalbegrip [Schlichting Test for Language Comprehension]. Houten, the Netherlands: Bohn Stafleu van Loghum.
    • Schlichting, L., & Spelberg, H. L. (2010b). Schlichting Test voor Taalproductie-II [Schlichting Test for Language Production]. Houten, the Netherlands: Bohn Stafleu van Loghum.
    • Shriberg, L. D., & Kwiatkowski, J. (1994). Developmental phonological disorders I: A clinical profile.Journal of Speech and Hearing Research, 37(5), 1100–1126.
    • Shriberg, L. D., Strand, E. A., Fourakis, M., Jakielski, K. J., Hall, S. D., Karlsson, H. B., … Wilson, D. L. (2017). A diagnostic marker to discriminate childhood apraxia of speech from speech delay: I. Development and description of the pause marker.Journal of Speech, Language, and Hearing Research, 60(4), 1096–1117.
    • Snijders, J. T., Tellegen, P. J., Winkel, M., & Laros, J. A. (2003). Snijders-Oomen Nonverbal Intelligence Test–Revised SON-R 5–17 jaar. Lisse, the Netherlands: Swets & Zeitlinger.
    • Sosa, A. V. (2015). Intraword variability in typical speech development.American Journal of Speech-Language Pathology, 24(1), 24–35.
    • Sosa, A. V., & Stoel-Gammon, C. (2012). Lexical and phonological effects in early word production.Journal of Speech, Language, and Hearing Research, 55(2), 596–608.
    • Staiger, A., Schölderle, T., Brendel, B., Bötzel, K., & Ziegler, W. (2017). Oral motor abilities are task dependent: A factor analytic approach to performance rate.Journal of Motor Behavior, 49(5), 482–493.
    • Terband, H., & Maassen, B. (2012). Childhood apraxia of speech: From symptom based diagnosis to process-oriented diagnosis.Logopedie en Foniatrie, 84, 229–234.
    • Thoonen, G., Maassen, B., Gabreëls, F., & Schreuder, R. (1994). Feature analysis of singleton consonant errors in developmental verbal dyspraxia (DVD).Journal of Speech and Hearing Research, 37(6), 1424–1440.
    • Thoonen, G., Maassen, B., Gabreels, F., & Schreuder, R. (1999). Validity of maximum performance tasks to diagnose motor speech disorders in children.Clinical Linguistics & Phonetics, 13(1), 1–23.
    • Thoonen, G., Maassen, B., Wit, J., Gabreëls, F., & Schreuder, R. (1996). The integrated use of maximum performance tasks in differential diagnostic evaluations among children with motor speech disorders.Clinical Linguistics & Phonetics, 10(4), 311–336.
    • van Haaften, L., Diepeveen, S., Van den Engel-Hoek, L., Jonker, M., de Swart, B., & Maassen, B. (2019). The psychometric evaluation of a speech production test battery for children: The reliability and validity of the computer articulation instrument (CAI).Journal of Speech, Language, and Hearing Research. Advance online publication.
    • Van Weerdenburg, M., Verhoeven, L., & Van Balkom, H. (2006). Towards a typology of specific language impairment.The Journal of Child Psychology and Psychiatry, 47(2), 176–189.
    • Vance, M., Stackhouse, J., & Wells, B. (2005). Speech-production skills in children aged 3–7 years.International Journal of Language & Communication Disorders, 40(1), 29–48.
    • Waring, R., & Knight, R. (2013). How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems.International Journal of Language & Communication Disorders, 48(1), 25–40.

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