Introducing a novel clinical tool to describe child engagement in telehealth speech and language assessments.

Purpose: Telehealth may be a solution to access barriers in speech-language pathology. Previous investigations of telehealth assessment have alluded to factors affecting children's engagement, though these factors have not been comprehensively described.Aim: This study aimed to develop a novel clinical tool to describe the factors affecting children's engagement in paediatric telehealth assessments.Method: The Factors Affecting Child Engagement in Telehealth Sessions (FACETS) tool was developed using a mixed methods approach. Iterative analysis was conducted through a qualitative evidence synthesis, followed by the application of the tool to seven children aged between 4;3 and 5;7 years old who participated in a speech and language assessment via telehealth. Descriptive data were obtained regarding engagement on both a child-by-child and task-by-task basis. Reliability of the FACETS was determined via percent agreement and Cohen's kappa between two independent raters.Result: Using a mixed methods design, the FACETS framework was developed and refined. Application of the tool to seven case studies revealed variability in engagement with acceptable inter-rater reliability.Conclusion: The FACETS may be a useful resource for describing the factors that influence children's engagement in telehealth during the assessment. The FACETS requires further testing with clinical populations.

Evaluating resources required to evaluate child outcomes following indirect services in early childhood education centres: A scoping review.

ISSUE ADDRESSED: Speech-language pathologists (SLPs) may provide indirect services focusing on the promotion of rich communication environments in early childhood education centres. Evaluating children's outcomes following SLP-led professional development in early childhood education centres is challenging. The aim of this scoping review was to identify how child outcomes were measured in studies exploring SLP professional development in early childhood education. METHODS: A systematic search of seven databases was conducted to identify studies that included the provision of an indirect SLP service and measurement of child outcomes. Twelve studies were identified that met all inclusion criteria for the scoping review. Information about the research design, professional development training provided and child outcome measures collected were all extracted from the identified studies. RESULTS: Half of the identified studies relied on the direct assessment of child language and seven studies utilised video-recording of interactions between educators and child/ren in their care. CONCLUSIONS: Evaluating child outcomes following SLP professional development in early childhood education centres is not only challenging but also expensive. Considerations for the allocation of suitable resources to evaluate indirect services are discussed. SO WHAT?: SLPs may need to demonstrate the impact of indirect services focusing on health promotion through the evaluation of child outcomes. The findings of this investigation outline the challenges identifying appropriate tools to capture the outcomes of children.

Harnessing automatic speech recognition to realise Sustainable Development Goals 3, 9, and 17 through interdisciplinary partnerships for children with communication disability.

PURPOSE: To showcase how applications of automatic speech recognition (ASR) technology could help solve challenges in speech-language pathology practice with children with communication disability, and contribute to the realisation of the Sustainable Development Goals (SDGs). RESULT: ASR technologies have been developed to address the need for equitable, efficient, and accurate assessment and diagnosis of communication disability in children by automating the transcription and analysis of speech and language samples and supporting dual-language assessment of bilingual children. ASR tools can automate the measurement of and help optimise intervention fidelity. ASR tools can also be used by children to engage in independent speech production practice without relying on feedback from speech-language pathologists (SLPs), thus bridging the long-standing gap between recommended and received intervention intensity. These innovative technologies and tools have been generated from interdisciplinary partnerships between SLPs, engineers, data scientists, and linguists. CONCLUSION: To advance equitable, efficient, and effective speech-language pathology services for children with communication disability, SLPs would benefit from integrating ASR solutions into their clinical practice. Ongoing interdisciplinary research is needed to further advance ASR technologies to optimise children's outcomes. This commentary paper focusses on industry, innovation and infrastructure (SDG 9) and partnerships for the goals (SDG 17). It also addresses SDG 1, SDG 3, SDG 4, SDG 8, SDG 10, SDG 11, and SDG 16.

The emergent literacy skills of 4- to 5-year-old children with and without a history of late talking.

PURPOSE: To explore the emergent literacy skills of 4- to 5-year-old children with a history of late talking (H-LT) and a history of typical development (H-TD) by: (1) determining if the two groups differ on measures of emergent literacy, and (2) identifying the proportion in each group presenting with weak emergent literacy profiles. METHOD: The emergent literacy skills of 4- to 5-year-old children with a H-LT (n = 13) and a H-TD (n = 11) were compared on measures of phonological awareness, print awareness (including print concepts and letter-sound knowledge), and narrative. Cut-off scores reflecting weak performance for each measure were determined. Children scoring below the cut-off on at least two measures were identified as having a weak emergent literacy profile. RESULT: Group means indicated poorer emergent literacy performance in children with a H-LT compared to a H-TD, however, comparisons were not statistically significant (p > 0.05). Proportionally, more children with a H-LT had a weak emergent literacy profile (8/13; 62%) compared to children with a H-TD (2/11; 18%). CONCLUSION: Children with a H-LT may be more vulnerable for emergent literacy difficulties. By assessing multiple emergent literacy skills, individualised profiles for children can be determined and reported alongside between-group comparisons.

Dynamic Assessment for Children With Communication Disorders: A Systematic Scoping Review and Framework.

PURPOSE: The aim of this systematic scoping review was to identify the elements that exist in dynamic assessments of communication in children, synthesize and arrange them into a framework, and investigate how these elements have been used in published literature. METHOD: Seven databases were searched using clusters of keywords themed around "dynamic assessment," "communication," and "children." Papers were reviewed against eligibility criteria by two independent reviewers at both title/abstract and full-text screening stages. Data charting included information about study design and the methodological characteristics of identified dynamic assessments. RESULTS: Sixty-five papers met inclusion criteria. Dynamic assessments were used in a range of areas of communication and used diverse methodologies. A total of 23 elements were identified and formulated into a Dynamic Assessment Framework, arranged into eight categories within two broad domains. A majority of assessments utilized prompting or cueing as instruction (54%), provided a predetermined amount of instruction (55%), measured child performance (63%), and were prescripted (60%). CONCLUSIONS: Dynamic assessments are complex. Utilizing a dynamic assessment in clinical practice or research requires a deep understanding of the purpose, clinical population, implementation, and data collection and measurement requirements. From our review of research involving dynamic assessments of communication in children, there is a need for greater transparency of reporting of the elements comprising dynamic assessments. The Dynamic Assessment Framework presented in this review article offers researchers and clinicians a way to have transparent discussions and extend our collective insights into the value of dynamic assessment of children's communication skills. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20151830.

Optimizing Outcomes for Children With Phonological Impairment: A Systematic Search and Review of Outcome and Experience Measures Reported in Intervention Research.

PURPOSE: Reporting of outcome and experience measures is critical to our understanding of the effect of intervention for speech sound disorders (SSD) in children. There is currently no agreed-upon set of measures for reporting intervention outcomes and experiences. In this article, we introduce the Speech Outcome Reporting Taxonomy (SORT), a tool designed to assist with the classification of outcome and experience measures. In a systematic search and review using the SORT, we explore the type and frequency of these measures reported in intervention research addressing phonological impairment in children. Given the integral relationship between intervention fidelity and intervention outcomes, reporting of fidelity is also examined. METHOD: Five literature databases were searched to identify articles written or translated into English published between 1975 and 2020. Using the SORT, outcome and experience measures were extracted and categorized. The number of intervention studies reporting fidelity was determined. RESULTS: A total of 220 articles met inclusion criteria. The most frequently reported outcome domain was broad generalization measures (n = 142, 64.5%), followed by specific measures of generalization of an intervention target (n = 133, 60.5%). Eleven (5.0%) articles reported measures of the impact of the phonological impairment on children's activity, participation, quality of life, or others. Twenty articles (9.1%) reported on parent, child, or clinician experience or child engagement. Fidelity data were reported for 13.4% of studies of interventions. CONCLUSIONS: The measurement of intervention outcomes is challenging yet important. No single type of measure was reported across all articles. Through using tailored measures closely related to intervention targets in combination with a universal set of measures of intelligibility, the impact of phonological impairment on children's lives, and the experience of receiving and providing intervention, researchers and clinicians could work together to progress insights and innovations in science and practice for children with SSD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19497803.

Identifying segmental and prosodic errors associated with the increasing word length effect in acquired apraxia of speech.

Purpose: Individuals with stroke-related apraxia of speech (AOS) plus aphasia tend to produce more speech errors with increasing word length. The Words of Increasing Length task (WIL) uses a 3-point scale to score word accuracy but penalises for error types that can arise either from language or motor impairment, reducing the test's sensitivity and specificity. The purpose here was to identify error types explaining variance in the WIL score, and those associated with AOS and word length.Method: Speech errors were perceptually identified on the WIL task for 51 Australian English-speaking adults with stroke-related aphasia, 25 with concomitant AOS. Multiple regression and linear mixed effects modelling were applied.Result: Variance in WIL scores was best explained with four error types: consonant additions, incorrect number of syllables, false starts and consonant substitutions/distortions. False starts were significantly associated with AOS diagnosis. Incorrect number of syllables, consonant omissions, false starts, and lexical stress errors increased in frequency for longer words and, while the interaction with diagnosis did not reach significance, the effect appeared driven by the AOS group.Conclusion: Findings provide further support for using polysyllabic word production to assess apraxic speech. The WIL task has limitations that may bias patients' performance and clinicians' perceptual evaluation. Data provide valuable information for designing a more sensitive diagnostic protocol for AOS.

Vocabulary Acquisition and Usage for Late Talkers Treatment: Effect on Expressive Vocabulary and Phonology.

Purpose This study examined the effect of Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment on toddlers' expressive vocabulary and phonology. Parent acceptability of VAULT treatment was also considered. Method We used a nonconcurrent multiple baseline single case experimental design with three late talking toddlers aged 21-25 months. The treatment was delivered twice weekly in 30-min sessions for 8 weeks by a rotating team of four speech-language pathologists. Toddlers heard three of their 10 strategically selected target words a minimum of 64 times in play activities each session. Expressive vocabulary and phonology was assessed pre-post, with parent interviews conducted posttreatment. Results All toddlers increased production of target words and expressive vocabulary. Ambient expressive vocabulary size increased by an average of 16 words per week (range of 73-169 words learned over the treatment period). On a 20-item, single-word speech assessment, the toddlers' phonetic inventories increased on average from three to seven consonants, and five to eight vowels. Two toddlers used protowords pretreatment, which were replaced by recognizable attempts at words posttreatment. Parents reported the treatment was acceptable for the child and their family with future consideration of parent-based delivery of the treatment in the home. Conclusions The results of this treatment provide further evidence of a model of intervention informed by the principles of implicit learning, and the interconnectedness of phonological and lexical learning. Investigation is required to establish the efficacy and feasibility of VAULT in clinical contexts. Supplemental Material https://doi.org/10.23641/asha.14714733.

Protocol for the Connected Speech Transcription of Children with Speech Disorders: An Example from Childhood Apraxia of Speech.

OBJECTIVE: While it is known that connected speech has different features to single-word speech, there are currently few recommendations regarding connected speech transcription. This research therefore aimed to develop a clinically feasible protocol for connected speech transcription. The protocol was then used to assist with description of the connected speech of children with childhood apraxia of speech (CAS), as little is known about their connected speech characteristics. PARTICIPANTS AND METHODS: Following a literature review, the Connected Speech Transcription Protocol (CoST-P) was iteratively developed and trialled. The CoST-P was then used to transcribe 50 connected utterances produced by 12 children (aged 6-13 years) with CAS. The characteristics of participants' connected speech were analysed to capture independent and relational analyses. RESULTS: The CoST-P was developed, trialled, and determined to have adequate reliability and fidelity. The frequency of inter-word segregation (mean = 29) was higher than intra-word segregation (mean = 4). Juncture accuracy was correlated with intelligibility metrics such as percentage of consonants correct. CONCLUSION: Connected speech transcription is challenging. The CoST-P may be a useful resource for speech-language pathologists and clinical researchers. Use of the CoST-P assisted in displaying CAS speech characteristics unique to connected speech (e.g., inter-word segregation and juncture).

Transcription of Vietnamese Adults' and Children's Consonants by English-Speaking Speech-Language Pathologists.

OBJECTIVE: To examine English-speaking speech-language pathologists' (SLPs) transcription of consonants in Vietnamese words and identification of correct/incorrect productions of Vietnamese children's speech. PARTICIPANTS AND METHODS: Twenty English-speaking SLPs completed three tasks. Task 1: transcription of 22 English words using the International Phonetic Alphabet. Task 2: transcription of 47 words spoken by Vietnamese adults. Task 3: transcription of 94 Vietnamese words spoken by Vietnamese children and identification of correct/incorrect productions. Participants completed questionnaires exploring language proficiency, transcription skill, musicality and confidence with multilingual clients. RESULTS: Task 1: participants demonstrated good accuracy transcribing English words (M = 97.2%). Task 2: an average of 52.9% consonants were transcribed correctly (89.4% when Vietnamese-English common transcription errors were considered). Common transcription errors included voicing of plosives, place and syllable-final omission. Accuracy was higher on shared English and Vietnamese consonantal articulations (e.g., /b/ and /m/). Task 3: on average, SLPs correctly identified accuracy of 73.8% of Vietnamese children's productions and transcribed 69.2% consonants correctly (83.8% when Vietnamese-English common transcription errors were considered). Musicality was correlated with SLPs' accuracy of transcription. CONCLUSION: English-speaking SLPs have some skills transcribing Vietnamese adults and transcribing and identifying correct/incorrect productions of children's speech. SLPs may use knowledge of common transcription errors to support understanding of their transcription of speech.

Screening Children's Speech: The Impact of Imitated Elicitation and Word Position.

Purpose Diagnostic decision making is influenced by the attributes of assessments. In order to propose time-efficient protocols for screening children's speech, this study aimed to determine whether eliciting imitated responses and analyzing productions in different word positions resulted in different levels of consonant accuracy. Method Participants were 267 English-speaking preschool-age children in the Sound Start Study whose parents were concerned about their speech. They were assessed using the International Speech Screener: Research Version (ISS; McLeod, 2013 ) using either imitated or spontaneous elicitation. Productions were compared with an established diagnostic assessment of speech accuracy (Diagnostic Evaluation of Articulation and Phonology; Dodd, Hua, Crosbie, Holm, & Ozanne, 2002 ). Results Participants' performance on the ISS was significantly correlated with performance on the Diagnostic Evaluation of Articulation and Phonology. Eliciting imitated productions on the ISS ( M = 2:18 min, SD = 0:59 min) took significantly less time than spontaneous productions ( M = 6:32 min, SD = 2:34 min). There was no significant difference in accuracy of imitated versus spontaneous productions in word-initial position; however, consonants were significantly less accurate in spontaneous than imitated productions in other word positions. Overall, participants had significantly lower consonant accuracy in word-initial position than within-word or word-final positions. Examination of the influence of word position on test discrimination, using receiver operating characteristic analyses, revealed acceptable test discrimination for percentage of consonants correct across word positions. Conclusion This research supports using imitated elicitation and analysis of percentage of consonants correct in word-initial position as a time-efficient procedure when screening the speech of English-speaking preschool children.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment.

AIMS: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. METHODS: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. RESULTS: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. CONCLUSION: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

Preschool children's communication, motor and social development: Parents' and educators' concerns.

PURPOSE: During early childhood, it is important to identify which children require intervention before they face the increased demands of school. This study aimed to: (1) compare parents' and educators' concerns, (2) examine inter-rater reliability between parents' and educators' concerns and (3) determine the group difference between level of concern and children's performance on clinical testing. METHOD: Parents and educators of 1205 4- to 5-year-old children in the Sound Start Study completed the Parents' Evaluation of Developmental Status. Children whose parents/educators were concerned about speech and language underwent direct assessment measuring speech accuracy (n = 275), receptive vocabulary (n = 131) and language (n = 274). RESULT: More parents/educators were concerned about children's speech and expressive language, than behaviour, social-emotional, school readiness, receptive language, self-help, fine motor and gross motor skills. Parents' and educators' responses were significantly correlated (except gross motor). Parents' and educators' level of concern about expressive speech and language was significantly correlated with speech accuracy on direct assessment. Educators' level of concern was significantly correlated with a screening measure of language. Scores on a test of receptive vocabulary significantly differed between those with concern and those without. CONCLUSION: Children's communication skills concerned more parents and educators than other aspects of development and these concerns generally aligned with clinical testing.

Tutorial: Assessment and Analysis of Polysyllables in Young Children.

Purpose: Polysyllables, words of 3 or more syllables, represent almost 30% of words used in American English. The purpose of this tutorial is to support speech-language pathologists' (SLPs') assessment and analysis of polysyllables, extending the focus of published assessment tools that focus on sampling and analyzing children's segmental accuracy and/or the presence of phonological error patterns. Method: This tutorial will guide SLPs through a review of 53 research papers that have explored the use of polysyllables in assessment, including the sampling and analysis procedures used in different research studies. The tutorial will also introduce two new tools to analyze and interpret polysyllable speech samples: the Word-Level Analysis of Polysyllables (WAP; Masso, 2016b) and the Framework of Polysyllable Maturity (Framework; Masso, 2016a). Results: Connected speech and single-word sampling tasks were used across the 53 studies to elicit polysyllables, and a number of analysis methods were reported, including measures of segmental accuracy and measures of structural and suprasegmental accuracy. The WAP and the Framework extend SLPs' depth of analysis of polysyllables. Conclusion: SLPs need a range of clinical tools to support the assessment and analysis of polysyllables. A case study comparing different speech analysis methods demonstrates the clinical value in utilizing the WAP and the Framework to interpret children's polysyllable productions in addition to traditional methods of speech sampling and analysis.

Cluster-Randomized Controlled Trial Evaluating the Effectiveness of Computer-Assisted Intervention Delivered by Educators for Children With Speech Sound Disorders.

Purpose: The aim was to evaluate the effectiveness of computer-assisted input-based intervention for children with speech sound disorders (SSD). Method: The Sound Start Study was a cluster-randomized controlled trial. Seventy-nine early childhood centers were invited to participate, 45 were recruited, and 1,205 parents and educators of 4- and 5-year-old children returned questionnaires. Children whose parents and educators had concerns about speech were assessed (n = 275); 132 children who were identified with phonological pattern-based errors underwent additional assessment. Children with SSD and no difficulties with receptive language or hearing, typical nonverbal intelligence, and English as their primary language were eligible; 123 were randomized into two groups (intervention n = 65; control n = 58), and 3 withdrew. The intervention group involved Phoneme Factory Sound Sorter software (Wren & Roulstone, 2013) administered by educators over 9 weeks; the control group involved typical classroom practices. Participants were reassessed twice by a speech-language pathologist who was unaware of the initial assessment and intervention conditions. Results: For the primary outcome variable (percentage of consonants correct), the significant mean change from pre- to postintervention for the intervention group (mean change = +6.15, p < .001) was comparable in magnitude to the significant change for the control group (mean change = +5.43, p < .001) with a small between-groups effect size for change (Cohen's d = 0.08). Similar results occurred for measures of emergent literacy, phonological processing, participation, and well-being. Conclusion: Computer-assisted input-based intervention administered by educators did not result in greater improvement than typical classroom practices.

Polysyllable Speech Accuracy and Predictors of Later Literacy Development in Preschool Children With Speech Sound Disorders.

Purpose: The aim of this study was to determine if polysyllable accuracy in preschoolers with speech sound disorders (SSD) was related to known predictors of later literacy development: phonological processing, receptive vocabulary, and print knowledge. Polysyllables-words of three or more syllables-are important to consider because unlike monosyllables, polysyllables have been associated with phonological processing and literacy difficulties in school-aged children. They therefore have the potential to help identify preschoolers most at risk of future literacy difficulties. Method: Participants were 93 preschool children with SSD from the Sound Start Study. Participants completed the Polysyllable Preschool Test (Baker, 2013) as well as phonological processing, receptive vocabulary, and print knowledge tasks. Results: Cluster analysis was completed, and 2 clusters were identified: low polysyllable accuracy and moderate polysyllable accuracy. The clusters were significantly different based on 2 measures of phonological awareness and measures of receptive vocabulary, rapid naming, and digit span. The clusters were not significantly different on sound matching accuracy or letter, sound, or print concept knowledge. Conclusions: The participants' poor performance on print knowledge tasks suggested that as a group, they were at risk of literacy difficulties but that there was a cluster of participants at greater risk-those with both low polysyllable accuracy and poor phonological processing.

Longitudinal changes in polysyllable maturity of preschool children with phonologically-based speech sound disorders.

Children's polysyllables were investigated for changes in (1) consonant and vowel accuracy, (2) error frequency and (3) polysyllable maturity over time. Participants were 80 children (4;0-5;4) with phonologically-based speech sound disorders who participated in the Sound Start Study and completed the Polysyllable Preschool Test (Baker, 2013) three times. Polysyllable errors were categorised using the Word-level Analysis of Polysyllables (WAP, Masso, 2016a) and the Framework of Polysyllable Maturity (Framework, Masso, 2016b), which represents five maturity levels (Levels A-E). Participants demonstrated increased polysyllable accuracy over time as measured by consonant and vowel accuracy, and error frequency. Children in Level A, the lowest level of maturity, had frequent deletion errors, alterations of phonotactics and alterations of timing. Participants in Level B were 8.62 times more likely to improve than children in Level A at Time 1. Children who present with frequent deletion errors may be less likely to improve their polysyllable accuracy.

Implementation fidelity of a computer-assisted intervention for children with speech sound disorders.

BACKGROUND: Implementation fidelity refers to the degree to which an intervention or programme adheres to its original design. This paper examines implementation fidelity in the Sound Start Study, a clustered randomised controlled trial of computer-assisted support for children with speech sound disorders (SSD). METHOD: Sixty-three children with SSD in 19 early childhood centres received computer-assisted support (Phoneme Factory Sound Sorter [PFSS] - Australian version). Educators facilitated the delivery of PFSS targeting phonological error patterns identified by a speech-language pathologist. Implementation data were gathered via (1) the computer software, which recorded when and how much intervention was completed over 9 weeks; (2) educators' records of practice sessions; and (3) scoring of fidelity (intervention procedure, competence and quality of delivery) from videos of intervention sessions. RESULT: Less than one-third of children received the prescribed number of days of intervention, while approximately one-half participated in the prescribed number of intervention plays. Computer data differed from educators' data for total number of days and plays in which children participated; the degree of match was lower as data became more specific. Fidelity to intervention procedures, competency and quality of delivery was high. CONCLUSION: Implementation fidelity may impact intervention outcomes and so needs to be measured in intervention research; however, the way in which it is measured may impact on data.

Polysyllable productions in preschool children with speech sound disorders: Error categories and the Framework of Polysyllable Maturity.

PURPOSE: Children with speech sound disorders (SSD) find polysyllables difficult; however, routine sampling and measurement of speech accuracy are insufficient to describe polysyllable accuracy and maturity. This study had two aims: (1) compare two speech production tasks and (2) describe polysyllable errors within the Framework of Polysyllable Maturity. METHOD: Ninety-three preschool children with SSD from the Sound Start Study (4;0-5;5 years) completed the Polysyllable Preschool Test (POP) and the Diagnostic Evaluation of Articulation and Phonology (DEAP-Phonology). RESULT: Vowel accuracy was significantly different between the POP and the DEAP-Phonology. Polysyllables were analysed using the seven Word-level Analysis of Polysyllables (WAP) error categories: (1) substitution of consonants or vowels (97.8% of children demonstrated common use), (2) deletion of syllables, consonants or vowels (65.6%), (3) distortion of consonants or vowels (0.0%), (4) addition of consonants or vowels (0.0%), (5) alteration of phonotactics (77.4%), (6) alteration of timing (63.4%) and (7) assimilation or alteration of sequence (0.0%). The Framework of Polysyllable Maturity described five levels of maturity based on children's errors. CONCLUSIONS: Polysyllable productions of preschool children with SSD can be analysed and categorised using the WAP and interpreted using the Framework of Polysyllable Maturity.