Hayo Terband

Purpose: This study aimed to evaluate the evidence on speech perception abilities of children with speech sound disorders (SSDs) to understand how the perceptual skills contribute to the diagnosis and characterization of SSDs. Method: We conducted a systematic and meta-analysis by searching four electronic databases for studies published between 2017 and 2025 that examined the speech perception skills of children with SSDs. We qualitatively evaluated the included studies based on study characteristics and methodological quality and performed a meta-analysis for the eligible homogeneous studies. Results: Forty-nine papers met the inclusion criteria for the qualitative synthesis. Half of the studies featured identification tasks, while the other half featured discrimination, judgment, or neurophysiological paradigms. Methodological quality ranged from 74% to 96%. Seven homogeneous studies that used the forced-choice identification task were included for the meta-analysis. The pooled effect size based on 277 participants (SSD: n = 140, typically developing [TD]: n = 137) was statistically significant (Hedges's g = 0.84, p < .001), indicating that the speech perception scores of children with SSDs are lower than those of TD children. Conclusions: These findings demonstrate that children with SSDs show measurable deficits in speech perception, underscoring the clinical importance of assessing perceptual skills when diagnosing SSDs. Identification tasks currently provide the most consistent evidence, while emerging neurophysiological methods expand insight into underlying processing mechanisms. Recommendations for future research include examining perception in more natural listening conditions, such as speech perception in noise, and testing whether perceptual interventions can improve speech outcomes. Supplemental Material: https://doi.org/10.23641/asha.33246702

Childhood Apraxia of Speech (CAS) is a type of speech sound disorder (SSD) in which speech production is disrupted at the level of speech motor planning and programming. CAS can occur because of kn...

Introduction: Persistent speech sound disorders (SSDs) are common in childhood and affect communication, literacy, and social development. Identifying risk indicators (RIs) and predictors for atypical oral motor and speech development is crucial for early intervention. This study examined medical, developmental, oral-behavioural, and hereditary RIs in children with SSD and compared diagnostic subgroups to typically developing peers. Methods: A clinical cohort of 198 children (ages 4–9) referred for specialist assessment was compared to 77 age-matched controls. Children were classified into four subgroups: motor speech disorder, with/without oral motor developmental delay and/or language-oriented disorder (MSD+), language-oriented disorder with oral motor developmental delay, no MSD (LD + ODD), ODD-only, and LD-only. Thirty-one RIs were analyzed using the chi-square or Fisher’s exact tests with Bonferroni correction. Multivariate binary backwards logistic regression identified predictors of group membership (clinical vs. control). Results: The clinical group showed 11 of 31 RIs significantly more prevalent than controls (p < 0.0016). Children with multiple diagnoses (MSD+ and LD + ODD) had the highest RI counts (12 and 11, respectively), while single-diagnosis groups showed fewer RIs (LD-only: 2; ODD-only: 6). Significant RIs included medical (adenoid surgery, pulmonary disease), oral behaviours (mouth stimuli, selective eating), and developmental indicators (abnormal or absent crawling, delayed bladder control, fine/gross motor delay, non-canonical babble, poor attention during story listening). Family history of speech/language delay and literacy difficulties was also significant. The regression model demonstrated an excellent fit (Nagelkerke R2 = 0.69; classification accuracy = 86.8%). Strong predictors for having an oral motor and/or a speech disorder included adenoid surgery (OR = 63.49), ear tube surgery (OR = 60.53), mouth stimuli behaviours (OR = 9.77), non-canonical babble (OR = 10.45), abnormal crawling (OR = 12.20), and family history of speech/language delay (OR = 9.89). Conclusion: Children with SSD often present multiple RIs across medical, developmental, oral-behavioural, and hereditary domains, especially those with combined diagnoses. Findings highlight the need for early, multidomain assessment and suggest that RIs such as oral motor behaviours and early developmental delays may inform screening and intervention strategies, supporting clinicians in identifying children who could benefit from tailored early intervention.

Purpose: This study aims to improve our knowledge of how young children with speech sound disorders (SSD) perceive their own speech and communication in comparison with typically developing (TD) children and how these perceptions relate to parental judgment of communicative participation, intelligibility in different contexts, and an expert measure of children's speech accuracy (percentage of consonants correct in syllable initial position [PCCI]). Method: Participants were 111 Dutch-speaking children (48–89 months old): 65 with SSD and 46 who were TD. Children's self-reports on the Dutch version of the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT-NL) were compared (a) between SSD and TD groups and (b) with the parents' ratings. Parents' ratings were obtained from two parental questionnaires: Focus on the Outcomes of Communication Under Six–34: Dutch (FOCUS-34NL) measuring communicative participation and the Intelligibility in Context Scale: Dutch (ICS-NL). The KiddyCAT-NL, FOCUS-34NL, and ICS-NL outcomes were also compared with (c) speech accuracy measured by speech-language pathologists (SLPs) as the PCCI using the picture-naming task of the Computer Articulation Instrument. Results: Statistical analysis revealed that young children in the SSD group perceived their speech and communication differently than children in the TD group. Only in the SSD group was there a moderate positive correlation between speech accuracy and intelligibility in context and only a weak correlation with the child's perception of speech and communication. Parents' and children's perceptions were weakly correlated. Conclusions: Information on children's perception of their own speech is complementary to information obtained from the parents and SLPs' formal assessment of speech accuracy. To fully understand the impact of SSD, it is therefore important to actively elicit and include children's perspectives on speech and communication.

Introduction: Intact sensory processing functions are essential in the development of speech and language, cognitive and motor milestones, and for supporting participation in daily activities. This study investigated in detail which specific modalities of sensory processing are affected in children with speech sound disorders (SSDs), including relevant clinical subgroups. Methods: A consecutive sample of 143 children between 4 and 9 years (6:0 years) of age referred for differential diagnosis of oral and speech motor disorders to the centre of eating, speech, and oral motor function (OMC) was included. Caregivers completed the Swedish version of the Sensory Profile 2 (SP2), which assesses sensory responses in everyday situations. Standardized norms were used for comparison. Results: Children with motor speech disorders (MSDs) (n = 82) and those with a language-oriented speech disorder (LD) with concomitant oral motor developmental delay (ODD) (n = 27) exhibited significantly more sensory processing difficulties than typically developing peers. Children in the MSD group also frequently presented with co-occurring LD and ODD diagnoses (MSD+). Conclusion: The findings of this study indicate that children with SSD, particularly those in the MSD+ and LD + ODD subgroups, show a higher degree of sensory processing difficulties. These difficulties may significantly affect their participation in daily life activities. Gaining an understanding of how sensory processing dysfunctions shape a child’s actions and reactions is of vital importance for speech language pathologists (SLPs) working with these children. This knowledge can inform more tailored and effective intervention strategies within speech and language therapy.

Purpose: This study aimed to investigate chewing efficiency in children with speech sound disorders (SSD). With a focus on those with motor speech disorders (MSD). Method: A clinical sample of 101 children with SSDs (78 with MSD), aged 4–9 years, and a control group of 76 typically developing (TD) children participated. Chewing efficiency was assessed using the two-colour Hue-Check ^© chewing gum test. A computer-based image analysis measured colour mixing after 20 chewing cycles, generating the outcome variable SDHue. Results: An independent samples t-test showed that children with SSD chewed less efficiently than TD children. A one-way ANOVA revealed that children with MSD + (i.e., all children with MSD who also had concomitant language-oriented diagnoses [LD] and/or oral motor developmental delay [ODD]) aged 7–9 years had significantly lower chewing efficiency than age-matched TD peers ( p < 0.001, η ² = 0.305). Conclusion: Children with MSD demonstrated reduced chewing efficiency compared to their TD peers. Possibly reflecting a broader, not yet fully understood, symptom complex. Oral motor developmental delay (ODD) was common across the entire SSD group. These findings underline the importance of future research exploring symptom interrelations and guiding targeted interventions.

Purpose: Determining if suspected speech errors in bilingual children are due to bilingual language acquisition or a speech sound disorder is challenging for speech-language pathologists (SLPs). This study investigates how the productions of nonword imitation (NWI) tasks of English–Dutch bilingual children differ from other speech tasks, both in direct comparison and relative to norm data. Method: Seventy-seven typically developing Australian English–Dutch bilingual children aged 4–12 years participated in this study. All children completed the Dutch test battery called the Computer Articulation Instrument. Data on language exposure were collected through parent/caregiver questionnaires. Results: The English–Dutch bilingual children scored lower than the norm data on the picture-naming and consistency task but not on NWI and diadochokinesis tasks. Specific phonological processes were more evident in bilingual children, and these patterns differed according to the task. The consistency task revealed a unique pattern of production in bilingual children. Conclusions: The results confirm that the NWI task may be the most language neutral. Detailed phonological error analysis indicates that SLPs assessing English–Dutch bilingual children should pay attention to voice onset time, fricatives, and vowels.

Background: Children with speech sound disorders (SSD) form a heterogeneous group, with respect to severity, etiology, proximal causes, speech error characteristics and response to treatment. Infants develop speech and language in interaction with neurological maturation, and general perceptual, motoric and cognitive skills in a social-emotional context. Purpose: After a brief introduction into psycholinguistic models of speech production and levels of causation, in this paper we present an in-depth overview of mechanisms and processes, and the dynamics thereof, which are crucial in typical speech development. These basic mechanisms and processes are: [1] neurophysiological motor refinement, that is, the maturational articulatory mechanisms that drive babbling and the more differentiated production of larger speech patterns; [2] sensori-motor integration, which forms the steering function from phonetics to phonology; and [3] motor hierarchy and articulatory phonology describing the gestural organization of syllables, that underlie fluent speech production. These dynamics have consequences for the diagnosis and further analysis of SSD in children. We argue that current diagnostic classification systems do not do justice to the multi-level, multi-factorial and interactive character of the underlying mechanisms and processes. This is illustrated by a recent Dutch study yielding distinct performance profiles among children with SSD, which allows for a dimensional interpretation of underlying processing deficits. Conclusions: Analyses of mainstream treatments with respect to the treatment goals and the speech mechanisms addressed, show that treatment programs are quite transparent in their aims and approach and how they contribute to remediating specific deficits or mechanisms. Recent studies into clinical reasoning reveal that the clinical challenge for SLPs is how to select the most appropriate treatment at the most appropriate time for each individual child with SSD. We argue that a process-oriented approach has merits as compared to categorical diagnostics as a toolbox to aid in the interpretation of the speech profile into underlying deficits and connect these to a specific intervention approach and treatment target.

Background: Children with speech sound disorders (SSD) are at higher risk of communication breakdown, but the impact of having an SSD may vary from child to child. Determining the severity of SSD helps speech‐language therapists (SLTs) to recognise the extent of the problem and to identify and prioritise children who require intervention.Aims: This study aimed to identify severity factors for SSD in order to develop a multifactorial Speech Sound Disorder Severity Construct (SSDSC) using SLTs’ views and the International Classification of Functioning, Disability and Health (ICF).Method: In an explorative five‐staged qualitative study, the research question was answered: ‘How do SLTs determine the severity of SSD in children?’. A total of 91 SLTs from The Netherlands participated in data collection and analysis. The iterative process included three different qualitative research methodologies (thematic analysis [TA], constructivist grounded theory [CGT] and content analysis [CA]) to ensure validation of the results by means of method triangulation.Results: SLTs considered nine themes: intelligibility, speech accuracy, persistence, the child's perception, impact, communicative participation, concomitant factors, professional point of view, and environmental factors. The themes were summarised in three main severity factors: (I) Speech accuracy, (II) The child's perception of the impact of their speech, and (III) Intelligibility in communication. Other severity factors were concomitant factors and impact. Expertise and support were identified as facilitators or barriers that may worsen or relieve the severity of SSD.Conclusions: This study highlights the need for SLTs to rethink how they think about severity as a simplistic construct reflecting only speech accuracy. It is recommended that a broader holistic approach to measuring severity is adopted.WHAT THIS PAPER ADDS: What is already known on the subject: Although there are several proposals aiming to define the severity of SSD, the extent to which these align with clinical practice is not well understood. In recent years, speech accuracy and other factors such as intelligibility have been suggested as possible indicators of SSD severity. Flipsen et al. (2005) concluded that experienced clinicians evaluated the number, type and consistency of speech errors as well as intelligibility, considering articulatory competence at both the segmental and whole word level when determining severity. Enderby et al. (2013) developed ICF‐based Therapy Outcome Measures (TOMs), including a TOM for phonological disorder. Although there is evidence in the literature that multiple factors should be considered when determining severity, there is still no clear guidance on this. In this discussion, the perspective of SLTs is an important contribution to the development of a measure of severity, but is lacking in the known literature. What this paper adds to the existing knowledge: As a first step, this study examines SLT's perspectives on how they define and measure severity of SSD, and determines how those views align with the ICF in order to develop a severity construct that can be further tested and validated. Using the views of SLTs and the ICF, this qualitative study resulted in the multifactorial SSDSC. What are the potential or actual clinical implications of this work?: The practical experience of SLTs, combined with what is known from the literature, provides insight into the different factors that may contribute to severity of SSD. These factors may be considered in developing a measure of SSD severity in the future.