Single-word severity and intelligibility in CAS (Chenausky et al., 2022)

<b>Purpose: </b>The purpose of this study was to investigate the association between perceived single-word speech severity and intelligibility in children with childhood apraxia of speech (CAS), with and without comorbid language impairment (LI), and to investigate the contribution of different CAS signs to perceived single-word speech severity and single-word intelligibility.<b>Method: </b>Thirty children with CAS, 18 with comorbid LI, completed the Goldman-Fristoe Test of Articulation–Second Edition (GFTA-2). Trained judges coded children’s responses for signs of CAS and percent phonemes correct. Nine listeners, blind to diagnoses, rated speech severity using a visual analog scale. Intelligibility was assessed by comparing listeners’ orthographic transcriptions of children’s responses to target responses.<b>Results: </b>Measures of speech severity (GFTA-2 standard score, number of unique CAS signs, total CAS signs, and mean severity rating) were significantly correlated with measures of intelligibility (GFTA-2 raw score, percent phonemes correct, and mean intelligibility score). Speech severity and intelligibility did not differ significantly between children with and without LI. Only consonant errors contributed significant variability to speech severity. Consonant errors and stress errors contributed significant variability to intelligibility.<b>Conclusions: </b>Findings suggest that visual analog scale ratings are a valid and convenient measure of single-word speech severity and that GFTA-2 raw score is an equally convenient measure of single-word intelligibility. The result that consonant errors were by far the major contributor to single-word speech severity and intelligibility in children with CAS, with stress errors also making a small contribution to intelligibility, suggests that consonant accuracy and appropriate lexical stress should be prime therapeutic targets for these children in the context of treatment addressing motor planning/programming, self-monitoring, and self-correcting.<br><b>Supplemental Material S1.</b>Table S1a. Detailed subject information for participants from University of Nebraska. Table S1b. Detailed subject information for participants from Miami University. <br><br><b>Supplemental Material S2. </b>Table S2a. CAS sign information for participants from University of Nebraska. Table S2b. CAS sign information for participants from Miami University. <br>Chenausky, K. V., Gagné, D., Stipancic, K. L., Shield, A., &amp; Green, J. R. (2022). The relationship between single-word speech severity and intelligibility in childhood apraxia of speech. <i>Journal of Speech, Language, and Hearing Research</i>. Advance online publication. https://doi.org/10.1044/2021_JSLHR-21-00213

**研究目的**：本研究旨在探究伴与不伴共病语言障碍（comorbid language impairment, LI）的儿童言语失用症（childhood apraxia of speech, CAS）患者的主观单词语语严重程度与可懂度之间的关联，并分析不同CAS特征对主观单词语语严重程度及单词语可懂度的贡献。
**研究方法**：本研究纳入30名CAS儿童，其中18名合并共病语言障碍，所有参与者均完成戈德曼-弗里斯特发音测验第二版（Goldman-Fristoe Test of Articulation–Second Edition, GFTA-2）。经过培训的评估者对儿童的发音反应进行CAS特征编码，并计算正确音素百分比。9名对诊断信息不知情的听者采用视觉模拟量表（visual analog scale）对言语严重程度进行评分。可懂度通过将听者对儿童发音的正字法转写结果与目标应答进行比对来评估。
**研究结果**：言语严重程度相关指标（GFTA-2标准分、独特CAS特征数量、总CAS特征数及平均严重程度评分）与可懂度相关指标（GFTA-2原始分、正确音素百分比及平均可懂度评分）均呈显著相关。伴与不伴语言障碍的CAS儿童在言语严重程度与可懂度上均无显著差异。仅辅音错误对言语严重程度存在显著影响，而辅音错误与重音错误则对可懂度存在显著影响。
**研究结论**：本研究结果表明，视觉模拟量表评分是一种有效且便捷的单词语语严重程度评估方式，而GFTA-2原始分同样是便捷的单词语可懂度评估指标。相较于其他因素，辅音错误是CAS儿童单词语语严重程度与可懂度的最主要影响因素，重音错误也对可懂度存在小幅影响，这提示在针对该类儿童开展运动规划/编程、自我监控及自我修正的治疗中，辅音发音准确度与恰当的词汇重音应作为核心治疗目标。
**补充材料S1**：表S1a：内布拉斯加大学参与受试者的详细信息。表S1b：迈阿密大学参与受试者的详细信息。

**补充材料S2**：表S2a：内布拉斯加大学参与受试者的CAS特征信息。表S2b：迈阿密大学参与受试者的CAS特征信息。
Chenausky, K. V., Gagné, D., Stipancic, K. L., Shield, A., & Green, J. R. (2022). 儿童言语失用症中单词语语严重程度与可懂度的关联。《言语、语言与听力研究杂志》，预印在线发表。https://doi.org/10.1044/2021_JSLHR-21-00213