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Assessment issues:
Developmental verbal dyspraxia
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ASHA recommendations
…”report does not include specific guidelines
for the assessment and treatment of CAS
primarily due to lack of research support todate…”
“Deferred to future ASHA policy documents”
General recommendations by expert clinical
practitioners included under Professional
issues
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ASHA – Assessment domains for
childhood apraxia of speech Non-speech oral motor skills
Speech production
Prosody
Voice
Speech perception
Language Metalinguistic literacy skills (older children)
Case History
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Assessment of any child with a
speech disorder Detailed case history
Hearing information and auditory
discrimination Language skills (VC & VX)
Screening of speech output
Detailed assessment of speech output Assessment of Oral skills
Phonological awareness skills
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Case History
Family history
Early speech development, including
babbling Feeding –history and current
Oral skills – history and current
Hearing
General motor development
Language development
Current speech and language skills
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Hearing and auditory
discrimination Important to know whether the child has
normal hearing
Look out for intermittent conductivehearing loss caused by “glue ear”
Also need to check that child is able to
discriminate words, non-words andsounds
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Language skills
It is important to assess the language
skills (receptive and expressive
language) of any child who has aspeech disorder
Many children with verbal dyspraxia
have expressive languagedelay/disorder; some also have
receptive language difficulties
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Phonological awareness skills(1)
The ability to reflect on and manipulatethe structure of spoken language
PA tasks include: rhyme, syllable andsound segmentation and blending
Important skill required to make sense
of alphabetic script PA is associated with reading and
spelling performance
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Phonological awareness (2)
PA tasks at level of phoneme are bestpredictors of reading outcome eg
segmenting or blending of individualsounds: c-a-t to make “cat”
Letter knowledge is also a strongpredictor of reading outcome
Focus on “synthetic phonics” to teachreading is back in favour in UK
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Oral Skills
Why do we assess them?
“The assessment of oro-motor skills is anintegral part of the initial assessment of a child presenting with disordered
speech”
Bradford and Dodd 1996
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Oral Dyspraxia (1)
Inability to copy volitional movements of
oral organs (tongue, lips, jaw face) on
command or demonstration in theabsence of attempts to articulate
(Milloy 1991)
Drooling or dribbling may be indicatorsof poor control of oral movements.
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Oral Dyspraxia (2)
The child has difficulties with carrying
out oral movements on verbal request,
or through copying – these may be
single or sequences of movements.
Literature suggests sequences of
movement are particularly difficult.
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Key features of Oral Dyspraxia
Difficulties are withvolitional control
Child can:
Lick an ice cream
which is close to hismouth
Child cannot:
Stick out his tongue
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Does Oral Dyspraxia always
accompany Verbal Dyspraxia?
“Oral dyspraxia is considered adominant, although not mandatory,attribute of developmental apraxia of
speech”
Crary (1993)
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Relationship between Oro-motor
and Speech Difficulties (1)
Wide variation in clinical presentation
some children with typical features of DVD have severe OM difficulties; others
do not (Evans 1994)
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Relationship between Oro-motor
and Speech Difficulties (2)
Some children with poor speech have good
oro-motor skills and others with strong
speech skills have very poor oro-motor skills; Some authors therefore propose that control
of oro-motor and speech skills are
independent. (Lancaster and Pope 1989)
Others report a close neurological link
between non-speech oral movement and
speech production. (Crary 1993)
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What are DDK skills?
Diadochokinesia – “…motor control
integrity in bodily functions through
performance in rapidly alternatingmovements”
In speech…sound/ syllable repetition at
a maximum rate of utterance(Fletcher 1972)
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Relationship between Diadochokinetic
(DDK) skills and DVD
Difficulties with DDK tasks often used to select participants with dvd in research
Difficulties with DDK tasks apply to children withother speech disorders (i.e. not only those w DVD)
(Ozanne 1996)
As part of a speech assessment, DDK tasks can beuseful for assessing motor programming and
planning skills.
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What published oro-motor
assessments can be used?
Diagnostic Evaluation of Articulation andPhonology (DEAP) – oromotor assessment(Dodd, Hua, Crosbie, Holm and Ozanne2002)
Nuffield Dyspraxia Programme (NDP)assessment – oromotor assessment (1985;1992; 2004)
Paediatric Oral Skills Package (POSP),(Brindley, Cave, Crane, Lees and Moffat1996)
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DEAP
Standardised screening assessment of
oral skills (based on Ozanne’s study
1992) Isolated oral movements
Sequenced oral movements
DDK assessment
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NDP assessment:
Oro-motor tasks easily achieved by 4 year olds (80% + level)
Sharples (1989)
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Ozanne’s study (1992)
Study of sequenced oral
movements andmovements in context for
children aged 3-5 years
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Ozanne’s findings:
Below 4 years – wide variability in oro-motor function
Above 4 years – most children can performroutine oro-motor tasks
Tasks vary in difficulty – tongue elevation most
difficult
Children often cooperated for tasks in context (e.g.licking and blowing) but would not produce oral
movements on command or imitation.
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Williams and Stackhouse (2000)
Study of 30 normally-
developing 3 -5 year olds, on production of isolated and
sequenced oral movements
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Williams and Stackhouse (2000)
Difficulties with tongue elevation were shown by :
- 7/10 three year olds
- 4/10 four year olds
- 7/10 five year olds
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Williams and Stackhouse (2000)
Difficulties on silent lip and tongue DDK
sequences:
3 years 4 years 5 years
Lips 4/10 1/10 1/10
Tongue 7/10 3/10 5/10
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Fletcher 1972; 1978
384 children aged 6 – 13
Assessed on:
single consonant repetition
repetition of 2-consonant sequences
repetition of 3-consonant sequences
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Fletcher 1972 /1978
Speed of performance increased
with age on all tasks.
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Williams and Stackhouse (2000)
Study of 30 normally-developing 3-5 year
olds
Assessed on spoken DDK tasks:
Repetition of real words
Repetition of non-words
2 and 3 syllable sequences
Scored for accuracy, consistency and rate
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Williams and Stackhouse (2000)
3-year olds varied in performance, but generallyhighly consistent even if inaccurate
4 and 5 year olds generally both accurate andconsistent
Speed increases with age. Little difference between 3, 4 and 5 year olds
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Assessing speech production
ASHA ideally assessment in multiple contexts:
Spontaneous
Elicited Imitation
Syllable
Single word
Phrase
Sentence
Discourse
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Tests for screening speech
Diagnostic Evaluation of Assessment
and Phonology (UK)- standardised
South Tyneside Assessment of Phonology (UK)
Goldman-Fristoe (USA)
Hodson Assessment of PhonologicalPatterns-3rd edition (USA)
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Speech assessment - DEAP
Typical profile of a child with dvd:
Poor performance on oro-motor
assessment
Poor performance on isolated speech
sounds
Poor performance on Inconsistencyassessment
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Speech assessment - NDP
Imitation of single sounds (consonants andvowels)
Single word naming (CV, VC, CVC, CVCV,multisyllabic, clusters etc
Imitation of phrases and sentences
Oro-motor assessment
DDK assessment Prosody assessment
Connected speech assessment
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NDP - Data are analysed at each level, in
terms of:
Sounds, or sequences of sounds, correct
Sounds, or sequences of sounds, incorrect
Patterns in incorrect sounds/sequences
Problems with syllable structure and
junction between sounds
Voice and prosodic features
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NDP - Interpretation
NDP is not standardized. Research intoearlier edition:
a normally developing 4 year old can say
almost all single sounds and words on theCV, CVC, and CVCV lists.
But will make some errors on more complexmulti-syllabic, clusters and phrases andsentences
For more information see NDP Manual,chapter 3
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How can the NDP assessment
data be used? To provide an individual profile of the
child’s speech difficulties
To help identify the nature of the child’sproblem (differential diagnosis)
To set therapy targets
To provide a basement measurement torecord progress following intervention