Psychological Disorders in Childhood and Adolescent Age - New Classifications.

INTRODUCTION: The eleventh revision of the International Classification of Diseases (ICD-11) is planned to be published in 2018. So called, "beta version" of the chapter of mental and behavioral disorders (ICD-11) is already available and it is considered that there will be no significant deviations in the final version. The DSM-5 was released in 2013. Changes related to mental disorders in child and adolescent psychiatry have been made in both of these classifications. To identify changes in the classifications of mental disorders in childhood and adolescent age in beta version of ICD-11 and DSM-5. METHODS: Review of mental disorders in childhood and adolescent age and their classification in ICD-11 and DSM-5. RESULTS: For disorders that are classified as "mental retardation" in ICD-10, a new term "intellectual development disorders" has been introduced in ICD-11, ie "intellectual disabilities" in DSM-5. Hyperactivity disorders and attention deficit is a separate entity in relation to ICD-10, in which it is classified as a hyperkinetic disorder. Asperger's syndrome, which is isolated from autism spectrum disorders in DSM-5, does not appear under that name in ICD-11 either. Elimination disorders are in a separate block MKB-11 and DSM-5. Speech and language disorders are classified as communication disorders in the DSM-5 classification. Selective mutism and anxiety separation disorder in childhood are in the block of anxiety and fear-related disorders in ICD-11, and among anxiety disorders in DSM-5, respectively. Reactive emotional disorder and disinhibited attachment disorder of childhood are classified as stress-related disorders in ICD-11 and DSM-5. CONCLUSIONS: The new classifications (ICD-11 and DSM-5) classify mental disorders in child and adolescent psychiatry somewhat differently from their antecedents. New entities have also been formed.

Semantic Similarity Analysis Reveals Robust Gene-Disease Relationships in Developmental and Epileptic Encephalopathies.

More than 100 genetic etiologies have been identified in developmental and epileptic encephalopathies (DEEs), but correlating genetic findings with clinical features at scale has remained a hurdle because of a lack of frameworks for analyzing heterogenous clinical data. Here, we analyzed 31,742 Human Phenotype Ontology (HPO) terms in 846 individuals with existing whole-exome trio data and assessed associated clinical features and phenotypic relatedness by using HPO-based semantic similarity analysis for individuals with de novo variants in the same gene. Gene-specific phenotypic signatures included associations of SCN1A with "complex febrile seizures" (HP: 0011172; p = 2.1 × 10-5) and "focal clonic seizures" (HP: 0002266; p = 8.9 × 10-6), STXBP1 with "absent speech" (HP: 0001344; p = 1.3 × 10-11), and SLC6A1 with "EEG with generalized slow activity" (HP: 0010845; p = 0.018). Of 41 genes with de novo variants in two or more individuals, 11 genes showed significant phenotypic similarity, including SCN1A (n = 16, p < 0.0001), STXBP1 (n = 14, p = 0.0021), and KCNB1 (n = 6, p = 0.011). Including genetic and phenotypic data of control subjects increased phenotypic similarity for all genetic etiologies, whereas the probability of observing de novo variants decreased, emphasizing the conceptual differences between semantic similarity analysis and approaches based on the expected number of de novo events. We demonstrate that HPO-based phenotype analysis captures unique profiles for distinct genetic etiologies, reflecting the breadth of the phenotypic spectrum in genetic epilepsies. Semantic similarity can be used to generate statistical evidence for disease causation analogous to the traditional approach of primarily defining disease entities through similar clinical features.

Quantitative Assessment of Speech in Cerebellar Ataxia Using Magnitude and Phase Based Cepstrum.

The clinical assessment of speech abnormalities in Cerebellar Ataxia (CA) is time-consuming and inconsistent. We have developed an automated objective system to quantify CA severity and thereby facilitate remote monitoring and optimisation of therapeutic interventions. A quantitative acoustic assessment could prove to be a viable biomarker for this purpose. Our study explores the use of phase-based cepstral features extracted from the modified group delay function as a complement to the features obtained from the magnitude cepstrum. We selected a combination of 15 acoustic measurements using RELIEF feature selection algorithm during the feature optimisation process. These features were used to segregate ataxic speakers from normal speakers (controls) and objectively assess them based on their severity. The effectiveness of our study has been experimentally evaluated through a clinical study involving 42 patients diagnosed with CA and 23 age-matched controls. A radial basis function kernel based support vector machine (SVM) classifier achieved a classification accuracy of 84.6% in CA-Control discrimination [area under the ROC curve (AUC) of 0.97] and 74% in the modified 3-level CA severity estimation (AUC of 0.90) deduced from the clinical ratings. The strong classification ability of selected features and the SVM model supports this scheme's suitability for monitoring CA related speech motor abnormalities.

Borg scale: a new method for hypernasality rating. / Escala de Borg: um novo método para avaliação da hipernasalidade de fala.

PURPOSE: To investigate the reliability in auditory-perceptual assessment of hypernasality of the Borg centiMax scale and the influence of the speech material on the reliability of two scales. METHODS: Four experienced speech-language pathologists rated hypernasality of 80 audio recordings of patients with repaired cleft palate (40 single-word string and 40 sentences) using the 5-point ordinal scale and the Borg centiMax scale. Intra and inter-rater reliability were calculated for both scales and for both types of speech samples. The comparison between the agreement coefficients of the two speech samples was calculated using the Z test and between the scales was calculated by Spearman correlation coefficient, considering as significant p<0.05. RESULTS: A very high and statistically significant correlation was found between the Borg centiMax scale and the ordinal scale for both speech samples. Intra- and inter-rater reliability was higher for Borg scale as compared to ordinal scale. Good to excellent intra-rater reliability was found for Borg scale for both speech samples. Poor to excellent intra-rater reliability was found for ordinal scale for both stimuli. Higher inter-rater reliability was demonstrated for Borg scale than ordinal scale for both speech samples. There was a significant difference between the single words string and sentences for intra- and inter-rater reliability using Borg scale, and for inter-rater reliability using ordinal scale. CONCLUSION: The Borg centiMax scale showed better intra and inter-rater reliability. Additionally, the speech material comprising of single words string showed better reliability in most of the comparisons for both scales.

OBJETIVO: Investigar a confiabilidade da escala Borg centiMax como método de avaliação perceptivo-auditiva da hipernasalidade e a influência do tipo de amostra de fala sobre a confiabilidade das avaliações. MÉTODO: Quatro fonoaudiólogas experientes classificaram a hipernasalidade de 80 amostras de fala de pacientes com fissura de palato reparada (40 vocábulos e 40 sentenças) utilizando a escala ordinal de 5 pontos e a escala Borg centiMax. Os índices de concordância intra e interavaliadores foram estabelecidos para ambas as escalas e amostras. A comparação desses índices foi feita pelo teste Z e a comparação entre as escalas foi feita pelo coeficiente de correlação de Spearman (p<0,05). RESULTADOS: Verificou-se correlação muito alta e significante entre a Escala Borg centiMax e a escala ordinal, para ambas as amostras. Os índices de concordância intra-avaliadores (CCI) para a escala Borg centiMax variaram de excelente a bom e, para a escala ordinal (Kappa), de excelente a pobre, em ambas as amostras. A concordância interavaliadores (CCI) para a escala Borg centiMax variou de excelente a moderada e, para a escala ordinal (Kappa), variou de moderada a pobre, para vocábulos e sentenças. Diferença estatisticamente significante, com melhores índices de concordância intra e interavaliadores para vocábulos, foi obtida com a escala Borg centiMax. Para a escala ordinal, diferença significante entre vocábulos e sentenças foi observada apenas para a comparação interavaliador. CONCLUSÃO: A escala Borg centiMax apresentou melhores índices de concordância intra e interavaliadores. A amostra contendo vocábulos mostrou melhores índices de concordância na maioria das comparações, para ambas as escalas.

Introduction: Motor Speech Disorders in Idiopathic Speech Delay and in Complex Neurodevelopmental Disorders: Introduction.

This introduction to a special issue of Clinical Linguistics & Phonetics includes an overview of the contents of each of the six articles. Each of the articles use the finalized version of the Speech Disorders Classification System (SDCS).

Estimates of the prevalence of speech and motor speech disorders in adolescents with Down syndrome.

Although there is substantial rationale for a motor component in the speech of persons with Down syndrome (DS), there presently are no published estimates of the prevalence of subtypes of motor speech disorders in DS. The goal of this research is to provide initial estimates of the prevalence of types of speech disorders and motor speech disorders in adolescents with DS. Conversational speech samples from a convenience sample of 45 adolescents with DS, ages 10 to 20 years old, were analysed using perceptual and acoustic methods and measures in the Speech Disorders Classification System (SDCS). The SDCS cross-classified participants into five mutually exclusive speech classifications and five mutually exclusive motor speech classifications. For participants meeting criteria for Childhood Dysarthria or for Childhood Dysarthria concurrent with Childhood Apraxia of Speech, the SDCS provided information on participants' percentile status on five subtypes of dysarthria. A total of 97.8% of participants met SDCS criteria for Speech Disorders and 97.8% met criteria for Motor Speech Disorders, including Childhood Dysarthria (37.8%), Speech Motor Delay (26.7%), Childhood Dysarthria and Childhood Apraxia of Speech (22.2%), and Childhood Apraxia of Speech (11.1%). Ataxia was the most prevalent dysarthria subtype. Nearly all participants with DS in the present sample had some type of speech and motor speech disorder, with implications for theory, assessment, prediction, and treatment. Specific to treatment, the present findings are interpreted as support for motor speech disorders as a primary explanatory construct to guide the selection and sequencing of treatment targets for persons with DS. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; DS: Down syndrome; NSA: Normal(ized) Speech Acquisition; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SE: Speech Errors; SMD: Speech Motor Delay.

Speech and motor speech disorders and intelligibility in adolescents with Down syndrome.

The goal of this research was to assess the support for motor speech disorders as explanatory constructs to guide research and treatment of reduced intelligibility in persons with Down syndrome (DS). Participants were the 45 adolescents with DS in the prior paper who were classified into five mutually-exclusive motor speech classifications using the Speech Disorders Classification System. An ordinal index classified participants' percentage of intelligible words in conversation as High (≥ 85%), Moderate (80% - 84.9%), or Low (< 80%). Statistical analyses tested for significant differences in intelligibility status associated with demographic, intelligence, and language variables, and intelligibility status associated with motor speech classifications and speech, prosody, and voice variables. For the 10 participants who met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech at assessment, 80% had reduced (Moderate or Low) intelligibility and 20% had High intelligibility (significant effect size: 0.644). Proportionally more of the 32 participants who met criteria for either dysarthria or apraxia had reduced intelligibility (significant effect size: 0.318). Low intelligibility was significantly associated with across-the-board reductions in phonemic and phonetic accuracy and with inappropriate prosody and voice. Findings are interpreted as support for motor speech disorders in adolescents with DS as explanatory constructs for their reduced intelligibility. Pending cross-validation of findings in diverse samples of persons with DS, studies are needed to assess the efficacy of motor speech classification status to guide selection of treatment methods and intelligibility targets. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; DS: Down syndrome; II: Intelligibility Index; No MSD: No Motor Speech Disorder; OII: Ordinal Intelligibility Index; PSD: Persistent Speech Delay; SDCS: Speech Disorders Classification System; SMD: Speech Motor Delay.

Initial studies of the phenotype and persistence of speech motor delay (SMD).

Speech Motor Delay (SMD) is a recently proposed childhood motor speech disorder characterized by imprecise and unstable speech, prosody, and voice that does not meet criteria for either Childhood Dysarthria or Childhood Apraxia of Speech. The goals of the present research were to obtain information on the phenotype of SMD and initial information on the persistence of SMD in children receiving treatment for idiopathic Speech Delay (SD). Five questions about the phenotype and persistence of SMD were posed using a database of audio-recordings and participant records and longitudinal data from audio-recordings of children with early SMD treated for SD. Three phenotype questions examined associations between participant risk factors and prevalence of SMD, and described the most frequent speech, prosody, and voice signs of early SMD. To provide initial estimates of the persistence of SMD, two questions examined associations between the persistence of SMD and participant risk factors using the audio-recordings of 14 participants with SMD treated for idiopathic SD. Phenotype findings indicated that SMD is characterized by across-the-board delays in the spatiotemporal precision and stability of speech, prosody, and voice production. Persistence findings indicated that although most participants normalized early SMD by 6 years of age, SMD persisted until at least late adolescence in 21.4% of participants. Findings are interpreted to support the construct validity of SMD and the potential for research using additional assessment modalities to explicate its genomic and neuromotor causal pathways. Abbreviations: CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; PSI: Precision-Stability Index; SD: Speech Delay; SMD: Speech Motor Delay; SSD: Speech Sound Disorders.

Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders.

Estimates of the prevalence of speech and motor speech disorders in persons with complex neurodevelopmental disorders (CND) can inform research in the biobehavioural origins and treatment of CND. The goal of this research was to use measures and analytics in a diagnostic classification system to estimate the prevalence of speech and motor speech disorders in convenience samples of speakers with one of eight types of CND. Audio-recorded conversational speech samples from 346 participants with one of eight types of CND were obtained from a database of participants recruited for genetic and behavioural studies of speech sound disorders (i.e., excluding dysfluency) during the past three decades. Data reduction methods for the speech samples included narrow phonetic transcription, prosody-voice coding, and acoustic analyses. Standardized measures were used to cross-classify participants' speech and motor speech status. Compared to the 17.8% prevalence of four types of motor speech disorders reported in a study of 415 participants with idiopathic Speech Delay (SD), 47.7% of the present participants with CND met criteria for one of four motor speech disorders, including Speech Motor Delay (25.1%), Childhood Dysarthria (13.3%), Childhood Apraxia of Speech (4.3%), and concurrent Childhood Dysarthria and Childhood Apraxia of Speech (4.9%). Findings are interpreted to indicate a substantial prevalence of speech disorders, and notably, a substantial prevalence of motor speech disorders in persons with some types of CND. We suggest that diagnostic classification information from standardized motor speech assessment protocols can contribute to research in the pathobiologies of CND. Abbreviations: 16p: 16p11.2 deletion and duplication syndrome; 22q: 22q11.2 deletion syndrome; ASD: Autism Spectrum Disorder; CAS: Childhood Apraxia of Speech; CD: Childhood Dysarthria; CND: Complex Neurodevelopmental Disorder; DS: Down syndrome; FXS: Fragile X syndrome; GAL: Galactosemia; IID: Idiopathic Intellectual Disability; MSD: Motor Speech Disorder; No MSD: No Motor Speech Disorder; NSA: Normal(ized) Speech Acquisition; PEPPER: Programs to Examine Phonetic and Phonologic Evaluation Records; PSD: Persistent Speech Delay; PSE: Persistent Speech Errors; SD: Speech Delay; SDCS: Speech Disorders Classification System; SDCSS: Speech Disorders Classification System Summary; SE: Speech Errors; SMD: Speech Motor Delay; SSD: Speech Sound Disorders; TBI: Traumatic Brain Injury.

A frequent acoustic sign of speech motor delay (SMD).

Recent studies report prevalence, phenotype, and persistence findings for a paediatric motor speech disorder in addition to childhood dysarthria and childhood apraxia of speech termed Speech Motor Delay (SMD). The aim of the present study was to determine if there is a frequent acoustic sign of SMD, with implications for theory, assessment, and treatment. We examined the frequency of 19 acoustic signs of SMD in audio recordings of continuous speech and word-imitation tasks in three groups of speakers with SMD: 50 children (mean age 5.1 years) with idiopathic Speech Delay (SD) from 6 USA cities; 87 children, adolescents, and adults with eight types of complex neurodevelopmental disorders; and 9 children (mean age 8.8 years) with persistent idiopathic SD from a population-based study of children in the South West of England. The 19 acoustic signs of imprecise or unstable speech, prosody, and voice were standardized on typical speakers of the appropriate dialect. The criterion for a frequent acoustic sign was that it occurred in at least 50% of participants with SMD in each of the three groups. Findings indicated that lengthened mid-vowels and diphthongs was the one sign that met criteria, occurring in 64.4% of the 146 participants with SMD, including 71% of the 87 participants with complex neurodevelopmental disorders. Findings are interpreted to support the potential of this acoustic sign, and possibly several others associated with temporal dimensions of speech sound development, to inform explication of the neuromotor substrates of SMD.

Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay.

The goal of this research was to obtain initial estimates of the prevalence of each of four types of motor speech disorders in children with idiopathic Speech Delay (SD) and to use findings to estimate the population-based prevalence of each disorder. Analyses were completed on audio-recorded conversational speech samples from 415 children recruited for research in idiopathic SD in six USA cities during the past three decades. The speech and motor speech status of each participant was cross-classified using standardized measures in the finalized version of the Speech Disorders Classification System described in the Supplement. Population-based prevalence estimates for the four motor speech disorders were calculated from epidemiological studies of SD conducted in Australia, England, and the USA. A total of 82.2% of the 415 participants with SD met criteria for No Motor Speech Disorder at assessment, 12% met criteria for Speech Motor Delay, 3.4% met criteria for Childhood Dysarthria, 2.4% met criteria for Childhood Apraxia of Speech, and 0% met criteria for concurrent Childhood Dysarthria and Childhood Apraxia of Speech. The estimated population-based prevalence of each of the first three motor speech disorders at 4 to 8 years of age were Speech Motor Delay: 4 children per 1,000; Childhood Dysarthria: 1 child per 1,000; and Childhood Apraxia of Speech: 1 child per 1,000. The latter finding cross-validates a prior prevalence estimate for Childhood Apraxia of Speech of 1-2 children per 1,000. Findings are interpreted to indicate a substantial prevalence of motor speech disorders in children with idiopathic SD. Abbreviations: CAS, childhood apraxia of speech; CD, childhood dysarthria; CND, complex neurodevelopmental disorders; DI, dysarthria index; DSI, dysarthria subtype indices; MSD, motor speech disorder; No MSD, no motor speech disorder; NSA, normal(ized) speech acquisition; PEPPER, programs to examine phonetic and phonologic evaluation records; PM, pause marker; PMI, pause marker index; PSD, persistent speech delay; PSE, persistent speech errors; SD, speech delay; SDCS, speech disorders classification system; SDCSS, speech disorders classification system summary; SE, speech errors; SMD, speech motor delay.

Sub-classification of apraxia of speech in patients with cerebrovascular and neurodegenerative diseases.

Some studies have hypothesized that primary progressive apraxia of speech (ppAOS) consists of heterogeneous symptoms that can be sub-classified; however, no study has classified stroke-induced AOS (sAOS) and ppAOS according to common criteria. The purpose of this study was to elucidate the symptoms and relevant brain regions associated with sAOS and ppAOS for sub-classification. Participants included 8 patients with sAOS following lesions in the left precentral gyrus and/or underlying white matter, and 3 patients with ppAOS. All patients with sAOS could be classified into three subtypes: type I, with prominent distorted articulation; type II, with prominent prosodic abnormalities or type III, with similarly distorted articulation and prosodic abnormalities. This sub-classification was consistent with the subtypes of ppAOS proposed in previous reports. All patients with ppAOS were classified as type III, and exhibited three characteristics distinguishable from those of sAOS. First, they showed prominent lengthened syllables compared with the segmentation of syllables. Second, they could not always complete the production of multi-syllabic single words in one breath. Finally, they showed dysfunctional lesions in the bilateral supplementary motor area. We conclude that sAOS and ppAOS can be sub-classified and are universal symptoms that are common between the English and Japanese populations.

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip / Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip

Abstract Introduction: The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. Objective: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. Methods: Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05). Results: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively). Conclusion: The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

Resumo: Introdução: A interpretação dos resultados de fala obtidos com o retalho miomucoso do músculo bucinador no tratamento da insuficiência velofaríngea em pacientes fissurados tem sido limitada pela restrição do número de pacientes e do tempo de seguimento pós-operatório. Objetivo: Avaliar o efeito do retalho miomucoso do músculo bucinador sobre a hipernasalidade da fala no tratamento de pacientes fissurados com insuficiência velofaríngea. Método: Foram avaliados pacientes com fissura palatina (± lábio) reparada, com retalho miomucoso do músculo bucinador bilateral para a correção cirúrgica da insuficiência velofaríngea. A hipernasalidade (escores 0 [ausente], 1 [leve], 2 [moderada] ou 3 [severa]) foi analisada por três avaliadores por meio da mensuração dos registros audiovisuais coletados nos períodos pré-operatório e pós-operatórios recente e tardio (3 e 12 meses, respectivamente). Os valores foram considerados significativos para um intervalo de confiança de 95% (p < 0,05). Resultado: Foram incluídos 37 pacientes fissurados com hipernasalidade moderada (16,2%) ou severa (83,8%) no período pré-operatório. As análises do período pós-operatório tardio revelaram que a hipernasalidade (0,5 ± 0,7) foi significativamente (p < 0,05) menor do que a hipernasalidade dos períodos pré-operatório e pós-operatório recente (2,8 ± 0,4 e 1,7 ± 0,9; respectivamente). Conclusão: O retalho miomucoso do músculo bucinador é eficaz na redução/eliminação da hipernasalidade nos pacientes fissurados com insuficiência velofaríngea.

Reliability of the Dutch Cleft Speech Evaluation Test and Conversion to the Proposed Universal Scale.

The Dutch cleft speech evaluation test (DCSET) has been implemented by the speech-language pathologists nationwide in the Netherlands since 2003, but the inter- and intrarater reliability was unknown. Two speech-language pathologists experienced in evaluating cleft speech assessed audio recordings of 20 children with cleft speech using the DCSET, and reassessed the recordings 2 weeks later. Intra- and interrater reliability was calculated, but found to be unacceptable after the first phase of this study using audio recordings. Following consensus training and some modifications in the scoring scales, the study was repeated using video recordings of 20 different children with cleft speech. Results from the second phase of this study using standardized video recordings showed fair, moderate, and good reliability on different subsets of the DCSET. Intrarater reliability (Kappa 0.59-1.00) was greater than interrater reliability (Kappa 0.33-0.79). Interrater reliability agreement was good (Kappa 0.63-0.79) for consonant production errors and speech understandability and acceptability, moderate (Kappa 0.59) for the resonance of the nasal passage, and fair (Kappa 0.33-0.37) for the resonance of the mixed and denasal passages. Subsequently, an algorithm was made to convert the DCSET scales to universal scales for international comparison of cleft speech as suggested by Henningsson et al in 2008.

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip.

INTRODUCTION: The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. OBJECTIVE: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. METHODS: Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p<0.05). RESULTS: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5±0.7) was significantly (p<0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8±0.4 and 1.7±0.9, respectively). CONCLUSION: The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

The "Comprehensive ICF Core Set for Head and Neck Cancer": a Delphi consensus survey among German speaking speech and language therapists.

The "Comprehensive ICF Core Set for Head and Neck Cancer" (ICF-HNC) is an application of the "International Classification of Functioning, Disability and Health" (ICF), representing the characteristic spectrum of issues in patients with head and neck cancer (HNC). Our primary aim was to evaluate which categories of the ICF-HNC are dealt with by speech and language therapists (SLTs) in Germany, Austria, and Switzerland. The secondary aim was to identify outcome measures used by SLTs to measure the categories of the ICF-HNC in clinical practice. SLTs experienced in the treatment of HNC patients evaluated the categories of the ICF-HNC in a three-round Delphi survey. They were asked whether the listed categories represented issues treated by SLTs in HNC patients, and what outcome measures were used to assess them. Altogether, 31 SLTs completed the survey. 47 of 108 previously selected categories of the ICF-HNC achieved the cut-off value. Out of these, 40.4% were derived from the component "Body Functions", 36.2% from "Body Structures", 12.8% from "Environmental Factors", and 10.6% from "Activities and Participation". Altogether, 82 of the mentioned outcome measures were considered as reasonable from the perspective of SLTs. Of these, only 37 achieved more than 50% approval. This study emphasises the importance of "Body Structures" and "Body Functions" for SLTs in Germany and Switzerland in treating patients with HNC. Moreover, the results highlighted the need to agree on evidence-based outcome measures in speech and language therapy.

Validity of the Communication Function Classification System for use with preschool children with communication disorders.

AIM: To evaluate construct and predictive validity of the Communication Function Classification System (CFCS) for use with preschool children with a range of speech and language disorders. METHOD: Seventy-seven preschool children with speech and language disorders (50 males, 27 females; mean 2y 7mo, standard deviation [SD] 1y) participated in this cohort study. Preschool children had speech and language, language-only, or speech-only disorders. Together with parent input, speech-language pathologists (SLPs) completed the CFCS at time 1. Parents and SLPs then independently completed a validated change-detecting functional communication outcome measure, the Focus on the outcomes of Communication Under Six (FOCUS), three times: at assessment (time 1), at the start of treatment (time 2), and at the end of treatment (time 3). RESULTS: There was a significant negative correlation between CFCS classifications and FOCUS scores at all three measurement points for the ratings by both parents and SLPs (correlations ranged from -0.60 to -0.76). As expected, no correlations between CFCS classifications and FOCUS change scores were statistically significant. INTERPRETATION: This study provides evidence of construct and predictive validity of the CFCS, demonstrating its value as a discriminative tool for use with preschool children with a range of speech and language disorders.

Labels, identity and narratives in children with primary speech and language impairments.

PURPOSE: There has been debate about labels in relation to speech and language impairments. However, children's views are missing from this debate, which is risky considering that labels with negative associations may result in stigma. The aim of this study was to explore the range of identities which children with primary speech and language impairments presented in their narratives and to investigate their evaluations of these identities with a view to understanding the values they attach to labels. METHOD: Eleven children aged 9-12 years with primary speech and language impairments were recruited to the study. Fifty nine semi-structured interviews were conducted with the aim of generating storied accounts of everyday experiences. The data were analysed using thematic analysis. Two themes were identified in the data: desired identities and undesired identities. RESULT: The findings suggest that the children were actively involved in identity construction and wanted to be seen in positive ways. They disliked labels assigned by others, which they considered portrayed them in negative ways. CONCLUSION: The debate about labels could be progressed by consulting with children themselves asking for their ideas in relation to labels in specialist education, and speech and language pathology.

Atypical speech and language development: a consensus study on clinical signs in the Netherlands.

BACKGROUND: Atypical speech and language development is one of the most common developmental difficulties in young children. However, which clinical signs characterize atypical speech-language development at what age is not clear. AIM: To achieve a national and valid consensus on clinical signs and red flags (i.e. most urgent clinical signs) for atypical speech-language development in children from 1 to 6 years of age. METHODS & PROCEDURES: A two-round Delphi study in the Netherlands with a national expert panel (n = 24) of speech and language therapists was conducted. The panel members responded to web-based questionnaires addressing clinical signs. Consensus was defined as ≥ 70% of the experts agreeing on an issue. OUTCOMES & RESULTS: The first round resulted in a list of 161 characteristics of atypical speech and language development. The second round led to agreement on 124 clinical signs and 34 red flags. CONCLUSIONS & IMPLICATIONS: Dutch national consensus concerns 17-23 clinical signs per age year for the description of an atypical speech-language development in young children and three to 10 characteristics per age year being red flags for atypical speech-language development. This consensus contributes to early identification and diagnosis of children with atypical speech-language development, awareness and research.