Differential diagnosis of children with suspected childhood apraxia of speech.

PURPOSE: The gold standard for diagnosing childhood apraxia of speech (CAS) is expert judgment of perceptual features. The aim of this study was to identify a set of objective measures that differentiate CAS from other speech disorders.

METHOD: Seventy-two children (4-12 years of age) diagnosed with suspected CAS by community speech-language pathologists were screened. Forty-seven participants underwent diagnostic assessment including presence or absence of perceptual CAS features. Twenty-eight children met two sets of diagnostic criteria for CAS (American Speech-Language-Hearing Association, 2007b; Shriberg, Potter, & Strand, 2009); another 4 met the CAS criteria with comorbidity. Fifteen were categorized as non-CAS with phonological impairment, submucous cleft, or dysarthria. Following this, 24 different measures from the diagnostic assessment were rated by blinded raters. Multivariate discriminant function analysis was used to identify the combination of measures that best predicted expert diagnoses.

RESULTS

The discriminant function analysis model, including syllable segregation, lexical stress matches, percentage phonemes correct from a polysyllabic picture-naming task, and articulatory accuracy on repetition of /pətəkə/, reached 91% diagnostic accuracy against expert diagnosis.

CONCLUSIONS

Polysyllabic production accuracy and an oral motor examination that includes diadochokinesis may be sufficient to reliably identify CAS and rule out structural abnormality or dysarthria. Testing with a larger unselected sample is required.