Föreläsningar och seminarier Predisputationsseminarium: Susanne Rex
Differential diagnosis and assessment procedure in Childhood Apraxia of Speech
Deltagande via Zoom https://ki-se.zoom.us/j/64518518631
Enheten för logopedi
Childhood Apraxia of Speech (CAS) is a rare disorder of speech motor planning and programming affecting the ability to transform the linguistic code into movements needed for intelligible speech. CAS is difficult to differential diagnose from other speech sound disorders (SSDs) and the diagnostic procedure involves many decisions on outcomes from assessments before arriving at the appropriate diagnose/s. Some children with CAS also have coexisting difficulties possible affecting treatment. Consequently, it is important for the clinician to describe and be aware of these difficulties. The overall aim of this project is to contribute with new knowledge for the assessment procedure of three to nine-year old Swedish children with SSD and CAS through developing and describing a Swedish test for assessment of speech motor skills, investigating speech characteristics, and coexisting functional difficulties in children with CAS, and in parallel describing the speech motor performance of typically developing same-aged children.
This project consists of four studies with a total of 139 participants in the age range of 3:1 to 8:10 years (37 to 106 months).
In Study I, a newly developed test for motor speech skills, Dynamisk motorisk talbedömning (DYMTA) was described. 94 children (37 to 106 months old) with typical speech- and language development participated (45 boys/49 girls) including 17 bilingual children, were assessed with DYMTA as well as a comprehensive test battery of language, speech, and orofacial function.
In Study II, reliability and validity of DYMTA was analyzed to evaluate its ability to discriminate between children with a diagnose of CAS from children with other SSDs. 45 children (31 boys/14 girls, 40 to 106 months) were assessed with DYMTA as well as with a comprehensive test battery of language, speech, and orofacial function.
In Study III, the number and types of characteristics associated with CAS (CAS-SC) were investigated in two different speech samples for each child, one using dynamic assessment (DA) and the other static assessment (SA). 33 children (22 boys/11 girls, 40 to 106 months) with a CAS diagnosis were included and a perceptual assessment of present and absent characteristics were performed.
In Study IV, a parental questionnaire, specifically designed for this project asking about 40 body functions based on domains in the ICF, was given to caregivers of 33 children with CAS (the same group as in study III). An agglomerative clustering analysis was applied to the individual item-responses and presented in a dendrogram and heatmap.
The main result in Study I was that Swedish children with typical speech- and language development perform well on tasks in DYMTA already at the age of three. Outcome measures on some subscores and subtests were close to ceiling from five years, while others showed a protracted refinement into early school-age.
In Study II, intra- rater reliability was found to be strong for the total scores and subscores in both DYMTA-A and DYMTA-B. Inter-rater reliability (point-by-point and ICC) was strong for total score and all subscores except for the ICC value of the subscore Prosody. The validity (e.g., AUC of 0.92/0.94) showed that the results on DYMTA have good to excellent potential to differentiate children with CAS from children with other SSDs.
In Study III, the most prominent CAS-SC (CAS-Speech Characteristics) apart from inconsistency in the dynamic task were deviant transitionary movements, prosody, and vowel errors, evidenced in all participants, and in the naming task vowel errors in all participants, followed by voicing errors and prosody errors. The distribution of detected CAS-SC was on average 6.85 in DA and 5.24 in SA.
In Study IV the parent reported functional difficulties ranged from 1 to 27 across the participants. The hierarchical cluster analysis identified four functional profiles: 1A) few difficulties, 1B) difficulties mainly in voice and rhythm domains, 2A) difficulties in mental functions (e.g., attention) and 2B) difficulties in diverse functions, including motor functions.
The findings from this thesis support benefits of the speech motor test DYMTA in the diagnostic procedure of CAS. First, our preliminary study on validity and reliability showed good results for separating children with CAS and other SSDs. Also, the investigation on detected speech characteristics associated with CAS support current knowledge on the benefits of a dynamic test method, adding information on the child’s speech motor skills when cuing was allowed. Apart from the results from assessments on speech performance itself, clinicians should also be aware of the various functional profiles on coexisting difficulties in children with CAS and its effects on prescribed interventions.