Acoustic Analyses of Tone Productions in Sequencing Contexts Among Cantonese-Speaking Preschool Children With and Without Childhood Apraxia of Speech.

PURPOSE: Pitch variations (tone productions) have been reported as a measure to differentiate Cantonese-speaking children with and without childhood apraxia of speech (CAS). This study aims to examine fundamental frequency (F0) changes within syllables and the effects of syllable structure, lexical status, and syllable positions on F0 in Cantonese-speaking preschool children with and without CAS. METHOD: Six children with CAS, six children with non-CAS speech sound disorder plus language disorder (S&LD), 22 children with speech sound disorder only (SSD), and 63 children with typical speech-language development (TD) performed the tone sequencing task (TST). Growth curve analysis was employed to analyze and compare the F0 values within syllables with three Cantonese tones (high level, high rising, and low falling). The analysis considered the effects of syllable structure (vowel and consonant-vowel), lexical status (word and nonword), and syllable position (initial, medial, and final) on F0, as well as comparisons within and between groups. RESULTS: Within each group, the effects of syllable structure and position on F0 values were found with different patterns. Between-group comparisons showed that the CAS group had reduced F0 contrasts. The CAS group could be differentiated from the control groups based on interactions of F0 with syllable structure and position, but not lexical status. The dissimilarity of F0 values detected between the CAS and SSD/TD groups was more prominent than that observed between the CAS and S&LD groups. CONCLUSIONS: This study demonstrated that Cantonese-speaking children with CAS had difficulty in varying F0 within syllables as compared to those without CAS, suggesting pitch variation difficulty and language-specific impairment profiles in CAS. Future investigations of objective measures for identifying Cantonese speakers with CAS and cross-linguistic investigations using growth curve analysis and the TST are suggested.

Pitch Variation Skills in Cantonese Speakers With Apraxia of Speech After Stroke: Preliminary Findings of Acoustic Analyses.

PURPOSE: Literature on apraxia of speech (AOS) in Chinese speakers is sparse compared to the English literature. This study aims to examine the pitch variation skills of Cantonese adults with AOS poststroke in terms of perceptual tone accuracy, acoustic fundamental frequency (fo) changes, and repetition durations on items with different syllable structures, lexical status, and tone syllables in various positions in a sequencing context. METHOD: Six Cantonese adults with AOS poststroke (AOS group), six adults without AOS poststroke (nAOS group), and six healthy controls (HC group) performed the tone sequencing task (TST), which was adapted from oral diadochokinetic tasks, with three different tone syllables. Tone accuracy, fo values across 10 time points, and acoustic repetition durations were compared within and between the groups. RESULTS: The AOS group produced significantly lower tone accuracy and different fo changes on the three Cantonese tone syllables compared with the control groups and significantly longer repetition durations than the HC group. The AOS group showed more difficulty with the tone syllables with the consonant-vowel structure, while a priming effect was observed on the T2 (high-rising) syllables with lexical meanings. A unique lowering of fo in the final syllable of the trisyllabic items was observed only in the AOS group. CONCLUSIONS: The AOS group showed degraded pitch variation skills. The effects of the three linguistic elements were discussed. Future investigations are called for to adapt the TST in other tonal languages to determine if degraded pitch variation skills are present in other tonal language speakers with AOS.

An online survey of clinical practice and confidence in diagnosing acquired apraxia of speech in Cantonese speakers.

PURPOSE: The assessment and diagnosis of apraxia of speech (AOS) have been well studied in the English context, yet there is limited understanding of the clinical practice in speakers of other languages, like Cantonese. This study aimed to obtain information about the clinical practice of assessment methods and diagnostic criteria used, and confidence in diagnosing, AOS in Cantonese speakers. METHOD: An online survey constructed with Google Forms was completed by 27 speech-language pathologists (SLPs) in Hong Kong. The questionnaire comprised 12 questions covering (a) demographic information, (b) experience working with speakers with AOS, (c) confidence in making AOS diagnosis in Cantonese speakers, (d) assessment tasks or methods used for assessing AOS in Cantonese speakers, (e) clinical features used for diagnostic purposes, and (f) assessment tasks used to determine the presence of clinical features for diagnostic purposes. RESULT: All respondents (100%) made AOS diagnoses based on the observed clinical features, while no respondents made diagnoses using only standardised tests or quantitative measures. Six clinical features were commonly used by most of the respondents: articulatory groping (100%), inconsistent articulatory errors (100%), length effects (85.2%), difficulty initiating speech (81.5%), automaticity effects (81.5%), and sound distortions (77.8%). More than half of the respondents collected connected speech samples (64%), and conducted diadochokinesis (64%) and repetition tasks (64%). The average confidence level of the respondents for making AOS diagnoses was fair (3.63/5). CONCLUSION: The SLPs in Hong Kong make AOS diagnoses based on the observed clinical features that have been reported in the English literature. Although some of the clinical features have been updated as non-discriminatory for AOS, they are still being used for AOS diagnosis in Cantonese speakers. Tendencies were observed with respect to the assessment tasks selected. The fair diagnostic confidence level suggests a need for future investigations of AOS in Cantonese speakers and the development of assessment tools.

Clinical practice of childhood apraxia of speech in Hong Kong: A web-based survey study.

BACKGROUND: A survey study on clinical practice not only provides insight into the implementation of knowledge, but also informs future investigations. There is a limited understanding of childhood apraxia of speech (CAS) in Cantonese speakers. This study examined the clinical practice of CAS in Hong Kong and discussed future directions of research for better evidence-based practice. METHODS: Qualified Hong Kong pediatric speech-language pathologists (SLPs) completed the online questionnaire, which had a total of 48 questions regarding their knowledge of and experience with CAS in Cantonese speakers, including assessment, diagnosis, and treatment. RESULTS: Seventy-seven responses were received from Hong Kong SLPs. Most of the SLPs (83.2%) rated their understanding of CAS as either "a little" or "fair". About half (53.2%) of the respondents had worked with children with CAS. No standardized assessment or objective/quantitative measures were used clinically. Instead, seven assessment tasks, including imitation of polysyllabic words and speech and language samples were used commonly. Perceptual judgment of clinical features is still the most popular approach for diagnosis, with a variety of lists in use. Of concern was that, in addition to using some evidence-based approaches, local SLPs treated CAS using approaches that have limited evidence, in the context of less treatment frequency, targeting both speech and language skills within the same session, and with only partial implementation of the approaches. CONCLUSIONS: The results suggest that the understanding of CAS among local SLPs requires attention. One reason for this is that evidence regarding the assessment, diagnosis, and treatment of Cantonese speakers with CAS is still limited. Future investigations are needed.

Lexical tone perception and production in Cantonese-speaking children with childhood apraxia of speech: a pilot study.

Childhood apraxia of speech (CAS) is a paediatric motor speech disorder. We investigated the lexical tone perception and production abilities of children with CAS and the relationships between the two. Three children with CAS, aged between 3;7 and 5;8, were given the Cantonese Tone Identification Test (CANTIT) and the Hong Kong Cantonese Articulation Test (HKCAT) for assessment of tone perception and production, respectively. Accuracy and error patterns were investigated based on their performance on the two tests. Correlation analysis was performed on children's perception and production scores. Two children scored at the lowest rank on the CANTIT, while one child obtained a Z score of 0. All children scored three standard deviations below the mean on the HKCAT. No statistical differences were found among the six tones with respect to perception accuracy, H(5) = 3.731, p = 0.589. Error analysis showed that children with CAS demonstrated more confusion on perceiving tones compared with TD peers. There were no main effects for task (F(1,2) = 0.040, p = 0.859) or tone (F(5,10 = 0.997, p = 0.467); nor were there task or tone interaction effects on perception versus production accuracy (F(5,10) = 1.772, p = 0.206). Tone perception and production accuracy were not significantly correlated (r2 = 0.181, p = 0.078). Tone perception deficits were evident in two out of three children with CAS, while all children had lexical tone production difficulties. In this small sample, tone production was more universally affected than tone perception.

The Use of Segmental and Suprasegmental Sequencing Skills to Differentiate Children With and Without Childhood Apraxia of Speech: Protocol for a Comparative Accuracy Study.

BACKGROUND: Childhood apraxia of speech (CAS) is a motor-based speech sound disorder (SSD) with a core impairment in the planning and programming of spatiotemporal parameters of speech movement sequences. CAS may cause deficits in both segmental and suprasegmental components of speech, and it can severely affect children's ability to speak intelligibly and communicate effectively and impact their quality of life. Assessment tasks, such as the maximum performance tasks (MPT) and Syllable Repetition Task (SRT), examine children's segmental sequencing skills to assist with the diagnosis of CAS. In Hong Kong, although the MPT and SRT have been used clinically to diagnose CAS in Cantonese-speaking children, their validity has not been reported. There is an urgent need for such investigations. Suprasegmentally, lexical stress errors have been reported as a consensual feature and to aid in the diagnosis of CAS. However, there are challenges in diagnosing CAS in children who speak tonal languages like Cantonese. A recent study has reported lexical tone errors in Cantonese-speaking children with CAS. Furthermore, deficits in pitch-variation skills were found in Cantonese-speaking children with CAS using a tone sequencing task (TST). It is hypothesized that there is a universal deficit in pitch-variation skills among tonal and nontonal language speakers with CAS. Further investigations of pitch-variation skills using the TST in Cantonese-speaking children with CAS may shed light on suprasegmental deficits in tonal languages and contribute to the development of a valid diagnostic tool for CAS in children who speak other tonal languages, such as Vietnamese, Thai, and Mandarin. OBJECTIVE: This study aims to examine the diagnostic potential of the MPT, SRT, and TST in diagnosing Cantonese-speaking children with CAS and to investigate pitch-variation skills in Cantonese-speaking children with and without CAS. METHODS: A total of 25 children with CAS and 3 groups of age- and gender-matched controls (non-CAS SSD only group, non-CAS SSD co-occurring with language impairment group, and typical development group) will be recruited. All participants will perform the MPT, SRT, and TST measures. Their performances on these tools will be perceptually judged and acoustically measured. RESULTS: Data collection will last from January 1, 2022, to October 30, 2023. As of August 2022, the project has recruited 4 children in the CAS group, 21 children in the non-CAS SSD group, 4 children in the speech and language impairment group, and 53 children in the typical development group. CONCLUSIONS: It is anticipated that Cantonese-speaking children with CAS will have poorer pitch-variation skills than the control groups and that the MPT, SRT, and TST will be appropriate diagnostic tools for identifying CAS in Cantonese-speaking children. The project will benefit the field of speech-language pathology locally and internationally, with short- and long-term impacts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40465.

Pitch Variation in Children With Childhood Apraxia of Speech: Preliminary Findings.

Introduction Pitch variation, which refers to one's ability to vary fundamental frequency (F0) within or between syllables when speaking, has not been investigated in children with childhood apraxia of speech (CAS). However, pitch variation plays an important role in tone languages, as varying F0 patterns communicate different lexical meanings. This study investigated pitch variation abilities in individuals with CAS via the tone-sequencing tasks (TSTs), focusing on task performance and the effects of syllable structure, lexical status, and tones. Method Three Cantonese-speaking children with CAS (aged 3;7-5;8 [years;months]) and six children without CAS participated in the study. Children without CAS were divided into two control groups, comprising those with speech and/or language impairment or typical development. TSTs consisted of 56 sets of five repetitions of stimuli. The stimuli varied in syllable structure, lexical status, and tones. Percentage of tones correct (PTC), consistency scores, F0 values, and acoustic repetition duration were measured. Results The CAS group performed more poorly than the control groups on the TST with respect to tone accuracy, consistency, and repetition duration. No interaction effects between group and syllable structure or group and lexical status were found. No significant difference was found on F0 values across time between Tone 1 and Tone 2 syllables in the CAS group. However, interaction effects between group and time points of F0 values on Tone 2 syllables were found. Discussion The results suggest that children with CAS have difficulty with pitch variation, which was revealed on the TST with respect to tone accuracy, consistency, and repetition duration. Moreover, children with CAS have difficulty in varying F0 values to produce high-rising tones and tend to use high-level tones to substitute. Clinically, the TST may be useful to assist in the diagnosis of CAS. Isolated vowel stimuli may be useful to test young children or children with severe impairment. Future investigations and development of a normed tool for children with CAS are suggested.

The Applicability of the Clinical Features of English Childhood Apraxia of Speech to Cantonese: A Modified Delphi Survey.

Purpose Childhood apraxia of speech (CAS), a motor-based speech disorder, has been well studied in English contexts. However, there is a limited understanding of the applicability of its features to other languages. Thus, this study sought to determine the applicability of the features identified in the English CAS literature to Cantonese CAS. Method A two-round modified Delphi survey of experts was used to identify the clinical features of CAS in Cantonese speakers. Ten Cantonese-speaking qualified speech therapists were recruited as experts. In Round 1, the experts were asked an open-ended question about the clinical features of Cantonese CAS. In Round 2, the experts were asked to rate the importance of the proposed clinical features for making differential diagnoses of Cantonese CAS on a 5-point Likert scale ranging from 1 (very important) to 5 (not important at all). Results In Round 1, the expert panel identified 79 clinical features in nine domains. Sixty-two features (78.5%) were consistent with English CAS. Three English features were not identified in this study, while three features specifically related to Cantonese phonology were identified. In Round 2, 29 clinical features across six domains were found to meet the statistical criteria and were therefore regarded as important for making differential diagnoses of CAS among Cantonese speakers. Conclusions The results suggest that the clinical features identified in the English CAS literature are applicable to Cantonese CAS. The consistency of the findings implies that core and possible co-occurring features are shared between English and Cantonese CAS. The six features that were not common in both languages were discussed. Further investigation of CAS in and between different languages is recommended. This study is not the end point. Future studies can empirically examine the lexical tones or pitch variations to develop a possible objective measure for CAS.