Orofacial dysfunction after stroke-A multidisciplinary approach.

OBJECTIVE: This paper describes the study protocol in an ongoing clinical trial evaluating oral screen training as part of a post-stroke rehabilitation programme. Baseline data were related to four domains: dysphagia, lip function, masticatory performance and patient-related outcome measures (PROM). BACKGROUND: Stroke is one of the most common causes of disability-adjusted life years, and dysphagia is a common remaining problem after stroke. Rehabilitation using oral screen training has been suggested to improve swallowing, but evidence is still insufficient. MATERIALS AND METHODS: Patients diagnosed with stroke with persisting objective and/or subjective swallowing dysfunction after primary rehabilitation were assessed for eligibility. In total, 25 patients were included. Objective function was assessed by swallowing capacity test (SCT), lip force and masticatory performance, subjective function by EAT-10 and NOT-S and PROM by LiSat-11 and ESAS. RESULTS: Baseline data presented a heterogeneous pattern with no significant association between objective and subjective dysfunction. Most of the participants (20/25) showed impaired swallowing capacity in SCT, and 23/24 revealed orofacial dysfunction according to NOT-S. The most common subjective item reported was chewing and swallowing problems (19/24). CONCLUSION: The heterogenous findings in the included tests and the lack of correlations emphasise the importance of multidisciplinary approaches to identify objective and subjective orofacial post-stroke dysfunction in clinical practice to be able to offer evidence-based individualised care. The included participants were representative of stroke patients with dysphagia, which supports proceeding with the planned intervention.

Eating and drinking ability and nutritional status in adults with cerebral palsy.

AIM: To describe eating and drinking ability in adults with cerebral palsy (CP) relative to sex, age, subtype, and severity of gross motor and hand function and nutritional status. METHOD: This was a cross-sectional study based on data of 2035 adults with CP, median age 26 years (range 18-78 years). The Eating and Drinking Ability Classification System (EDACS), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS) were used in addition to subtype, body weight, height, body mass index (BMI), skin fold thickness, and gastrostomy. Linear regression models were used to estimate associations between body weight and the other variables. RESULTS: More than half of the adults (52.5%) eat and drink safely and 32.4% have dysphagia with limitations to eating and drinking safety. Weight, height, and BMI decreased with increasing EDACS levels. In EDACS level V, 86% had a gastrostomy, 23.4% in EDACS levels III to V were underweight, whereas 42.3% in EDACS levels I to II had a BMI over 25, indicating overweight or obesity. Increasing EDACS levels and need of support during meals were associated with lower body weight. INTERPRETATION: Adults with CP should be routinely screened and treated for dysphagia to avoid nutritional complications. Being dependent on others during mealtimes is a risk factor for low body weight.

Orofacial Function, Articulation Proficiency, and Intelligibility in 5-Year-Old Children Born With Cleft Lip and Palate.

OBJECTIVE: To explore and describe orofacial function in 5-year-old children born with clefts affecting the palate and to investigate potential relationship with articulation proficiency and intelligibility. DESIGN: A prospective cohort study of 88 consecutive patients born with cleft lip and palate (CLP) between July 2009 and June 2011. PARTICIPANTS: Excluding internationally adopted children and children with no speech production resulted in 52 children with different cleft types and additional malformations, examined at age 5. Data on orofacial function were available for 43 children. OUTCOME MEASURES: Screening of orofacial function resulted in a profile and a total score, narrow phonetic transcription of test consonants produced a percentage of consonants correct (PCC) score, and ratings of intelligibility by speech and language pathologists (SLPs) and by parents gave 2 estimates. Inter- and intra-transcriber agreement was calculated. RESULTS: Orofacial dysfunction was found in 37% of children, with results not significantly different between cleft types but significantly more frequent than in children born without CLP. Age-appropriate articulation proficiency was found in 39%, 49% presented below -2 standard deviations. Just above 50% had good intelligibility and were always understood by different communication partners according to both SLP and parent ratings. No significant correlation was found between orofacial dysfunction and PCC or intelligibility. CONCLUSIONS: Orofacial dysfunction was not found to be an explanatory factor for speech outcome in children born with CLP.

Orofacial function and monitoring of oral care in amyotrophic lateral sclerosis.

OBJECTIVE: The aim was to assess orofacial function and monitor oral care in patients with amyotrophic lateral sclerosis (ALS) to maintain oral comfort and oral health. MATERIALS AND METHODS: A case series of 14 patients newly diagnosed with ALS accepted to participate in a quality improvement project. After initial examinations, baseline oral conditions were obtained and the patients were seen every 3 months. Nordic Orofacial Test-Screening (NOT-S) was used for evaluation of orofacial function. RESULTS: Patients were grouped according to initial symptoms in a bulbar group and a spinal group with eight and six patients, respectively. The mean age at diagnosis was 62.8 years. All were dentate with a mean of 26.7 natural teeth. Most patients had very good oral and dental conditions. As expected, orofacial functions were differently affected in the two groups; at initial NOT-S registration, the mean total score was 5.6 (range 3-8 domains) in the bulbar group and 0.7 (0-2 domains) in the spinal group. At final registration, the corresponding figures were 6.1 and 3.2. Oral and dental aids were introduced according to need. CONCLUSIONS: In the bulbar group, several orofacial functions became impaired at an early stage of disease development, and at final registrations many vital orofacial functions were severely compromised. The spinal group was less severely affected orally. However, all individuals irrespective of type of initial symptoms needed assistance in performing oral hygiene measures in the latter part of the disease period. Good oral health and oral comfort could be maintained in all participants and no other dental treatment was needed.

Profiles of orofacial dysfunction in different diagnostic groups using the Nordic Orofacial Test (NOT-S)--a review.

OBJECTIVE: The Nordic Orofacial Test-Screening (NOT-S) was developed as a comprehensive method to assess orofacial function. Results from the screening protocol have been presented in 11 international publications to date. This study reviewed these publications in order to compile NOT-S screening data and create profiles of orofacial dysfunction that characterize various age groups and disorders. MATERIALS AND METHODS: NOT-S results of nine reports meeting the inclusion criteria were reviewed. Seven of these studies not only provided data on the mean and range of total NOT-S scores, but also on the most common domains of orofacial dysfunction (highest rate of individuals with dysfunction scores), allowing the construction of orofacial dysfunction profiles based on the prevalence of dysfunction in each domain of NOT-S. RESULTS: The compiled data comprised 669 individuals, which included healthy control subjects (n = 333) and various patient groups (n = 336). All studies reported differences between individuals with diagnosed disorders and healthy control subjects. The NOT-S data could measure treatment effects and provided dysfunction profiles characterizing the patterns of orofacial dysfunction in various diagnoses. CONCLUSIONS: This review corroborates previous results that the NOT-S differentiates well between patients and healthy controls and can also show changes in individuals after treatment. NOT-S could be used as a standard instrument to assess orofacial dysfunction, evaluate the outcomes of oral habilitation and rehabilitation and improve comparability in clinical practice and research.

Learning in the tutorial group: a balance between individual freedom and institutional control.

The study investigates factors in problem-based learning tutorial groups which promote or inhibit learning. The informants were tutors and students from speech-language pathology and physiotherapy programmes. Semi-structured focus-group interviews and individual interviews were used. Results revealed three themes: Responsibility. Time and Support. Under responsibility, the delicate balance between individual and institutional responsibility and control was shown. Time included short and long-term perspectives on learning. Under support, supporting documents, activities and personnel resources were mentioned. In summary, an increased control by the program and tutors decreases student's motivation to assume responsibility for learning. Support in tutorial groups needs to adapt to student progression and to be well aligned to tutorial work to have the intended effect. A lifelong learning perspective may help students develop a meta-awareness regarding learning that could make tutorial work more meaningful.

Impaired language function in generalized epilepsy: inadequate suppression of the default mode network.

We aimed to study the effect of a potential default mode network (DMN) dysfunction on language performance in epilepsy. Language dysfunction in focal epilepsy has previously been connected to brain damage in language-associated cortical areas. In this work, we studied generalized epilepsy (GE) without focal brain damage to see if the language function was impaired. We used functional magnetic resonance imaging (fMRI) to investigate if the DMN was involved. Eleven persons with GE and 28 healthy controls were examined with fMRI during a sentence-reading task. We demonstrated impaired language function, reduced suppression of DMN, and, specifically, an inadequate suppression of activation in the left anterior temporal lobe and the posterior cingulate cortex, as well as an aberrant activation in the right hippocampal formation. Our results highlight the presence of language decline in people with epilepsy of not only focal but also generalized origin.

Children's voice and voice disorders.

This article discusses the differences between children's voices and adult voices. We give an overview of the anatomy in the head and neck and specifically the anatomy of the respiratory system and the larynx. We also describe the development of children's voices including different physiological measures and voice quality. The development and consequences for voice production and voice quality are addressed and related to gender differences in the growing child. We also discuss the prevalence of voice problems and hoarseness in children. Environmental and other factors contributing to voice problems in children are described, and finally, issues related to intervention and evidence-based practice are discussed.

Range of motion (ROM) in the lips and jaw during vowels assessed with 3D motion analysis in Swedish children with typical speech development and children with speech sound disorders.

PURPOSE: The aim was to compare movement patterns of lips and jaw in lateral, vertical and anteroposterior directions during vowel production in children with typical speech development (TSD) and in children with speech sound disorders (SSD) persisting after the age of six. METHODS: A total of 93 children were included, 42 children with TSD (6:0-12:2 years, mean age 8:9 ± 1:5, 19 girls and 23 boys) and 51 children with SSD (6:0-16:7 years, mean age 8:5 ± 3:0, 14 girls and 37 boys). Range of motion (ROM) in lips and jaw in the vowels [a, ʊ, ɪ] produced in a syllable repetition task and median values in resting position were measured with a system for 3D motion analysis. The analysis was based on the coordinates for the mouth corners and the chin centre. RESULTS: There were significant differences between the groups on movements in lateral direction in both lips and jaw. Children with TSD had generally smaller and more, symmetrical movements in the lips and jaw, in all three dimensions compared to children with SSD. There were no significant differences between the groups in resting position. CONCLUSION: Children with SSD persisting after the age of six years show more asymmetrical and more variable movement patterns in lips and jaw during vowel production compared with children with TSD in a simple syllable repetition task. Differences were more pronounced in lateral direction in both lips and jaw.

Speech feature profiles in Swedish 5-year-olds with speech sound disorder related to suspected childhood apraxia of speech or cleft palate.

Purpose: To study the occurrence of speech features commonly associated with Childhood Apraxia of Speech (CAS) in Swedish children with suspected CAS (sCAS) or Speech Sound Disorder (SSD) related to Cleft Palate and/or Lip (CP ± L).Method: Thirty-four children (4.10-5.11) with SSD related to sCAS (n = 15) or repaired CP ± L (n = 19) participated. Consensus judgement of presence/absence of CAS features in single words were based on a checklist with operationalised definitions. Speech sound production measures were based on semi-narrow phonetic transcription. Intra- and inter-transcriber agreement was determined.Result: Twelve participants (ten with sCAS (67%) and two with CP ± L (11%)) shared a CAS profile of phonemic speech inconsistency for consonants and vowels and a set of four features: vowel error, voicing error, difficulty achieving initial articulatory configurations or transitionary movement gestures and stress errors. The most frequent speech difficulties in children with non-CAS CP ± L (n = 17) were consonant distortion (88%) and hypernasal resonance (76%). Prosodic impairment was rare.Conclusion: A distinct CAS speech feature profile was found for children with CAS, differing in number and distribution compared to children with CP ± L and SSD. CAS was found more frequently in CP ± L and SSD compared to reported estimates of clinical prevalence.

Infection and speech: Disfluency and other speech symptoms in Pediatric Acute-onset Neuropsychiatric Syndrome.

INTRODUCTION: In the early 20th century a link between infection and speech disfluency was discussed. Recent reports indicate that PANS (Pediatric Acute-onset Neuropsychiatric Syndrome), and PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) may be associated with a high incidence of speech disfluency. The present study specifically investigates disfluency and other speech symptoms following onset of PANS and PANDAS. Prevalence of previously reported speech related symptoms vocal tics, selective mutism and "baby talk" is included. The present study also aims to explore possible changes in articulation and intelligibility, distress due to speech impairment, and effect of PANS or PANDAS medication on speech symptoms. METHODS: A questionnaire was distributed to caregivers of children with diagnosed or suspected PANS or PANDAS. In total 55 individuals in Sweden were included. RESULTS: Onset of speech disfluency in association with PANS or PANDAS was reported by 54.5% of the caregivers. Most frequent disfluency symptoms were higher speech rate, superfluous verbal behavior, verbal blocks and associated motor symptoms. Previous findings of vocal tics, baby talk and mutistic behavior are supported. The present study also exposed previously unreported symptoms such as impaired articulation, reduced intelligibility, reduced speech production and language impairment. Eleven caregivers reported that medical treatment had a positive effect on speech fluency. CONCLUSIONS: A connection between PANS and PANDAS and speech disfluency is supported, and a possible link between infection and disfluency is reactualized. Reported disfluency shares several characteristics with stuttering and cluttering, but the caregivers did not consistently associate it with stuttering. The present study also sheds new light on how symptoms of "baby talk", selective mutism and vocal tics might be viewed in this population. In all, the results indicate a substantial impact on speech fluency, speech and language in affected children, reducing quality of life.

A preliminary validation of a dynamic speech motor assessment for Swedish-speaking children with childhood apraxia of speech.

OBJECTIVE: Children with speech sound disorders (SSDs) have difficulties affecting different levels of speech production. For treatment to be beneficial, it is important to differentiate between Childhood Apraxia of Speech (CAS) - a motor speech disorder with deficits in speech praxis - and other SSDs (nonCAS-SSD). We have previously developed a motor speech examination Dynamisk motorisk talbedömning (DYMTA). We aimed to evaluate DYMTAs reliability and validity in a small-scale sample to estimate DYMTAs usability in diagnostic settings. METHODS: Speech, language, and oral motor abilities were assessed in 45 children between 40 and 106 months. Intra- and inter-rater reliability of DYMTA were analyzed. Further, DYMTAs ability to validly discriminate between children with CAS and nonCAS-SSD was assessed. RESULTS: The intra-rater reliability for the scores of DYMTA was strong, with ICCs ranging from 0.97 to 1.0. DYMTA total score had strong inter-rater reliability as evidenced both by the agreement estimates (DYMTA-A: 0.91 and DYMTA-B: 0.87) and the ICCs (0.97 and 0.96). Inter-rater reliability was also strong for the separate subscores on agreement estimates and for all subscores on ICCs, except for the Prosody subscores. DYMTA accurately discriminated between children with CAS and nonCAS-SSD in this small sample with an AUC of 0.92 for DYMTA-A and 0.94 for DYMTA-B. CONCLUSIONS: With its focus on speech movements, DYMTA could serve as a valuable addition to other tests when assessing children's speech motor performance. This first examination suggests that DYMTA may be both a reliable and valid tool in the diagnostic process of SSD.

Three Professional Singers' Vocal Tract Dimensions in Operatic Singing, Kulning, and Edge-A Multiple Case Study Examining Loud Singing.

OBJECTIVE: A comprehensive understanding of how vocal tract dimensions vary among different types of loud voice productions has not yet been fully formed. This study aims to expand the existing knowledge on the topic. METHODS: Three trained professional singers together practiced the vocal techniques underlying Opera and Kulning singing styles for one hour and, afterwards, phonated using these techniques on vowel [iː] at pitch C5 (523 Hz), while their vocal tracts were scanned via MRI. One of the participants also produced the samples in the Edge vocal mode using [ɛː]. Several dimensional vocal tract measurements were calculated from the MRIs. Spectral analysis was conducted on the filtered audio recorded during the MRI. RESULTS: The Operatic technique demonstrated a lower larynx, a larger tongue-palate distance, and larger epilaryngeal and pharyngeal tube diameters compared to Kulning. Edge showed the highest laryngeal position, narrowest pharynx and epilarynx tubes, and the least forward-tilted larynx out of the styles studied. The spectra of Opera and Kulning showed a dominant first harmonic, while in Edge, the second harmonic was the strongest. CONCLUSIONS: The results shed light on the magnitude of vocal tract changes necessary for genre-typical vocal projection. This information can be pedagogically helpful.

Children and adolescents with speech sound disorders are more likely to have orofacial dysfunction and malocclusion.

BACKGROUND: Children with speech sound disorders (SSD) form a heterogeneous group that differs in terms of underlying cause and severity of speech difficulties. Orofacial dysfunction and malocclusions have been reported in children with SSD. However, the association is not fully explored. OBJECTIVES: Our aims were to describe differences in orofacial function and malocclusion between a group of children and adolescents with compared to without SSD and to explore associations between those parameters among the group with SSD. METHODS: A total of 105 participants were included, 61 children with SSD (6.0-16.7 years, mean age 8.5 ± 2.8, 14 girls and 47 boys) and 44 children with typical speech development (TSD) (6.0-12.2 years, mean age 8.8 ± 1.6, 19 girls and 25 boys). Assessments of orofacial function included an orofacial screening test and assessment of bite force, jaw stability, chewing efficiency, and intraoral sensory-motor function. Possible malocclusions were also assessed. RESULT: Children with SSD had both poorer orofacial function and a greater prevalence of malocclusion than children with TSD. Furthermore, children with SSD and poorer orofacial function had a greater risk of malocclusion. CONCLUSION: Our result suggests that children with SSD are more prone to having poorer orofacial function and malocclusion than children with TSD. This illustrates the importance of assessing coexisting orofacial characteristics in children with SSD, especially since orofacial dysfunction may be linked to an increased risk of malocclusion. This result highlights the need for a multiprofessional approach.

Performance of Swedish children on a dynamic motor speech assessment.

Purpose: This study was designed to evaluate the performance of typically developing Swedish-speaking children on DYMTA (Dynamisk Motorisk Talbedömning), a Swedish dynamic motor speech assessment.Method: Participants were 94 children, 45 boys/49 girls (9/8 multilingual), with typical oral motor, speech, and language skills, between 37 and 106 months divided into five age-groups. They performed two speech motor assessments, DYMTA-A and DYMTA-B using dynamic assessment.Result: Typically developing children show good motor speech performance on targeted speech characteristics already at the age of three. DYMTA median total score was high for all ages; 90% of maximum or above. A significant correlation with age was found for DYMTA-A (p = 0.000, r = 0.49) and DYMTA-B (p = 0.000, r = 0.77). No significant differences were found across gender or concerning being mono- or multilingual.Conclusion: DYMTA is the first Swedish assessment tool designed to identify children with CAS. The results of this study demonstrate that typically developing Swedish children perform well on DYMTA and that the test has possible utility for both mono- and multilingual children.

Measuring intelligibility in spontaneous speech using syllables perceived as understood.

PURPOSE: Intelligibility, the ability to convey a message by speech, is one of the most important variables in speech-language pathology. The assessment of intelligibility is a challenge especially when it comes to spontaneous speech. The aim of the study was to investigate validity and reliability of a method for assessment of intelligibility, syllables perceived as understood (SPU); a method that is more time-efficient than previous methods based on transcription, as it does not require a master transcript for reference. METHOD: A group of 20 adult listeners transcribed stimuli consisting of spontaneous speech from 16 children (14 with speech sound disorder and two with typical speech and language development, age 4:4 to 8:1, M = 6:0). Intelligibility was calculated based on these orthographic transcripts, as a) proportion of syllables perceived as understood (SPU) and b) proportion of syllables correctly understood (SCU), with reference to a master transcript. Validity was checked through investigation of the correlation and difference between these two measures. Reliability was analysed with inter-listener reliability by intra-class correlation. RESULTS: The correlation between SPU and SCU (the gold standard intelligibility score) was strong and statistically significant, with SPU being consistently higher than SCU. Inter-listener reliability for single measures of intra-class correlation of the assessment by syllables perceived as understood was moderate to low, whereas the inter-listener reliability for average measures of intra-class correlation was high. CONCLUSIONS: The method based on SPU might be used for assessment of intelligibility if the median from several listeners is used or when comparing results from the same listener over time. The SPU method might therefore be a valuable tool in a clinical and research context as a more valid option than rating scales and a more time-efficient method than the gold standard SCU method. However, it should be noted that the reliability of the SPU is not as high as for the SCU.

Similar Profile and Magnitude of Cognitive Impairments in Focal and Generalized Epilepsy: A Pilot Study.

Introduction: Cognitive impairments in epilepsy are not well-understood. In addition, long-term emotional, interpersonal, and social consequences of the underlying disturbances are important to evaluate. Purpose: To compare cognitive function including language in young adults with focal or generalized epilepsy. In addition, quality of life and self-esteem were investigated. Patients and Methods: Young adults with no primary intellectual disability, 17 with focal epilepsy and 11 with generalized epilepsy participated and were compared to 28 healthy controls. Groups were matched on age (mean = 26 years), sex, and education. Participants were administered a battery of neuropsychological tasks and carried out self-ratings of quality of life, self-esteem, and psychological problems. Results: Similar impairments regarding cognitive function were noted in focal and generalized epilepsy. The cognitive domains tested were episodic long-term memory, executive functions, attention, working memory, visuospatial functions, and language. Both epilepsy groups had lower results compared to controls (effect sizes 0.24-1.07). The total number of convulsive seizures was predictive of episodic long-term memory function. Participants with focal epilepsy reported lower quality of life than participants with generalized epilepsy. Lowered self-esteem values were seen in both epilepsy groups and particularly in those with focal epilepsy. Along with measures of cognitive speed and depression, the total number of seizures explained more than 50% of variation in quality of life. Conclusion: Interestingly, similarities rather than differences characterized the widespread cognitive deficits that were seen in focal and generalized epilepsy, ranging from mild to moderate. These similarities were modified by quality of life and self-esteem. This study confirms the notion that epilepsy is a network disorder.

Communication Profile of a Minimally Verbal School-Age Autistic Child: A Case Study.

Purpose The present clinical focus draws on an intrinsic case study to provide a thick description of the communication profile of John, a 9-year-old minimally verbal autistic student. Method Specifically, traditional behavioral assessments, classroom video observations, and semistructured interviews were used to gather information regarding John's communication profile and potential sensory-motor differences. Results Convergent evidence indicated that John's expressive profile was characterized by single words, emergent word combinations, some conventional gestures, and a low frequency of communicative initiations. Concomitant language comprehension challenges and poor intelligibility associated with motor speech impairment were also indicated. His sensory-motor profile was marked by fine motor impairment, relative strengths in gross motor abilities, and sensory differences across visual, hearing, and tactile modalities. Conclusion Direct implications for supporting minimally verbal autistic students like John include the need to (a) consider sensory-motor influences on social interaction and (b) support flexible use of multimodal communication resources, including augmentative and alternative communication. Supplemental Material https://doi.org/10.23641/asha.12202448.

Audience Response System-Based Evaluation of Intelligibility of Children's Connected Speech - Validity, Reliability and Listener Differences.

PURPOSE: We assessed audience response systems (ARS)-based evaluation of intelligibility, with a view to find a valid and reliable intelligibility measure that is accessible to non-trained participants. In addition, we investigated potential listener differences between pediatric speech and language pathologists (SLPs) and untrained adults. METHOD: Sixteen one-minute samples of connected speech were compiled, collected from 14 children with a speech sound disorder (SSD) and two children with typical speech. 16 SLPs and 13 untrained adults participated in a series of ARS listening sessions, where they were fitted with headphones and hand controls, and instructed to click a button whenever they did not understand the child speaking. Listeners' button clicks were registered and, for each speech sample, totaled into an (un)intelligibility index. The proportion of syllables perceived correctly - based on orthographic listener transcripts - was used as a reference score of intelligibility. RESULTS: The ARS-based intelligibility scores correlated strongly with the intelligibility reference score. Reliability was high across listener groups and weaker for single listeners. No significant difference was found between the evaluations of SLPs and untrained adults. CONCLUSIONS: ARS-based evaluation offers a valid and reliable measure of intelligibility of particular value in research as a practical tool for collecting input from listeners without experience or knowledge of SSDs. We stress that the ARS design presupposes a listener panel, and that evaluations obtained from individual listeners are predictably inadequate in terms of reliability.

Orofacial function in children with Speech Sound Disorders persisting after the age of six years.

Purpose: The aim was to investigate, describe and analyse speech characteristics, intelligibility, orofacial function and co-existing neurodevelopmental symptoms in children with SSD of unknown origin, persisting after six years of age.Method: The study included 61 children with SSD (6-17 years) of unknown origin, referred for a speech and oral motor examination. The severity of SSD was estimated using Percentage Consonants Correct (PCC) and Percentage Vowels Correct (PVC) and assessments of resonance based on Swedish Articulation and Nasality Test (SVANTE). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Parents completed the Intelligibility in Context Scale (ICS) and a questionnaire including questions about heredity, medical and neurodevelopmental conditions, and speech development.Result: SSD varied according to PCC (8-95%) and PVC (55-100%) measurements. Percentages of co-occurring disorders included: 51% resonance deviations, 90% intelligibility issues, and 87% orofacial difficulties. The most affected orofacial domains were "Chewing and swallowing" (41%), "Masticatory muscles and jaw function" (38%) and "Sensory function" (38%). The majority (64%) had co-existing dysfunctions relating to general motor and neurodevelopmental disorders.Conclusion: Children with persistent SSD are at risk for orofacial dysfunction, general motor difficulties and other neurodevelopmental disorders and therefore should be screened for co-occurring disorders.