Föreläsningar och seminarier Gästseminarium, predisputationsseminarium: Helena Björelius

Helena Björelius, 
doktorand vid KI-DS

Background

Atypical speech sound development in children encompasses a range of conditions affecting the planning, coordination, and execution of speech movements and is among the most common developmental delays in childhood. The umbrella term speech sound disorders (SSDs) is broadly used to describe speech production difficulties that fall outside typical developmental norms and is applied across speech-language pathology settings. SSDs vary widely in severity, ranging from isolated speech sound delays to pervasive speech production impairments, and may arise from motor-based and/or phonological dysfunctions of known or unknown origin. Increasingly, SSDs are recognised as neurodevelopmental in nature, reflecting disruptions in the complex interplay of genetic, neurological, and environmental factors that support speech and language acquisition. Children with SSDs frequently present with co-occurring language difficulties, delays in fine and gross motor development, and atypical sensory processing patterns, suggesting broader neurobiological vulnerabilities affecting sensorimotor integration. The children included in the present project were referred for specialist assessment of suspected oral-motor and speech motor difficulties. In this thesis, the term SSD is used to denote the broader clinical phenotype observed in this population, characterised by the co-occurrence of motor-based and language-based speech impairments, and is therefore adopted as an overarching framework for the thesis.

Aim

The overall aim of this doctoral project was to explore chewing efficiency, sensory processing patterns, and multimodal developmental risk indicators in a clinically representative population of children aged 4–9 years referred for specialist assessment of oral-motor and speech motor dysfunction. A further aim was to discuss quality of life in relation to the functional challenges encountered by these children in everyday life.

Methods

The thesis comprises three observational studies based on a consecutive cohort of children aged 4–9 years referred to a specialist clinic for eating, speech, and oral motor function (the Oral Motor Centre; OMC), Division of speech language pathology, Danderyd hospital, Stockholm for differential diagnostic assessment. An age‑matched control group was included in two of the studies. The work was conducted within established clinical pathways at the clinic, with the intention of reflecting real-world specialist speech-language pathology care. At the start of the research project, chewing efficiency, assessed using the Hue-Check chewing gum test, and caregiver-reported sensory profiles (Sensory Profile 2) were incorporated into the clinic’s standard assessment battery to evaluate their clinical relevance and their potential integration into routine assessment. Clinical diagnoses were documented in the medical record using ICD-10 codes as part of routine clinical practice and reflected an overall clinical synthesis based on assessment findings and the professional judgement of experienced speech-language pathologists working at the clinic. For research purposes, individual clinical diagnoses were regrouped into four analytic subgroups: motor speech disorder (MSD; with or without oral motor developmental delay and/or language-oriented disorder); language-oriented disorder with oral motor developmental delay (LD+ODD; no MSD); oral motor developmental delay only (ODD-only); and language-oriented disorder only (LD-only) reflecting common and clinically meaningful constellations of symptoms. These subgroupings were applied consistently across all studies based on the same clinical cohort. Although diagnostic labels informed subgrouping, clinical management at the OMC is primarily guided by each child’s functional symptom profile rather than by diagnostic category alone.

Results and conclusions

Across three studies, the results demonstrate that children referred for assessment of oral-motor and speech motor difficulties frequently present with multidimensional profiles, including chewing inefficiency, sensory-behavioural differences, and developmental risk indicators. Study I (N = 177) show reduced chewing efficiency in older children with motor speech disorders compared with typically developing peers, suggesting oral motor involvement that may form part of a broader symptom complex, especially given the frequent co‑occurrence of oral motor developmental delay within SSD. Study II (N = 143) examines sensory processing patterns and demonstrates that sensory modulation difficulties are common across children with SSD, including those with combined oral motor and language difficulties, with potential consequences for participation in daily activities as well as with compliance in therapy. Study III (N = 275) explores developmental and medical risk indicators, highlighting the relevance of early language development, motor milestones, sensory characteristics, and hereditary factors, indicating complex developmental trajectories.

Taken together, the findings show that speech sound difficulties in childhood commonly co‑occur with variability in oral motor performance, sensory processing characteristics, and early developmental patterns. These interacting functional features suggest that difficulties do not arise in isolation but reflect broader developmental constellations that influence how children respond to everyday demands and intervention. Recognising and addressing this heterogeneity is therefore crucial for the development of tailored, functionally informed intervention approaches that accommodate individual profiles and support effective therapy outcomes. The findings further emphasise the value of situating diagnostic and assessment procedures within their clinical context when investigating complex, real-world clinical populations.

List of scientific papers

Björelius H, Tsilingaridis G, Johansson F, Trang J, Grigoriadis A, Thorman R, et al. Chewing efficiency in children with motor speech disorders. Eur Arch Paediatr Dent. 2025:1–11.https://doi.org/10.1007/s40368- 025-01095-6

Björelius H, Tükel S, Tsilingaridis G, Malmenholt A, Terband H. Sensory profiles inchildren with speech sound disorders. Folia Phoniatr Logop. 2025;1–14. https://doi.org/ 10.1159/000548782

Björelius, H., Terband, H., Johansson, F., Tsilingaridis, G., & Tükel, Ş. (2026). Multidomain Developmental Indicators in 4–9-Year-Old Children with Oral Motor and Speech Sound Disorders. Folia Phoniatr Logop. https://doi.org/ 10.1159/000551061