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

Erin M Wilson, Leonard Abbeduto, Stephen M Camarata, Lawrence D Shriberg, Erin M Wilson, Leonard Abbeduto, Stephen M Camarata, Lawrence D Shriberg

Abstract

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.

Keywords: Apraxia; assessment; classification; dysarthria; speech motor delay.

Conflict of interest statement

Disclosure Statement

The authors report no declarations of interest.

Figures

Figure 1
Figure 1
Intelligibility Index (II) scores and ordinal intelligibility index (OII) classification findings for 50 adolescents with Down syndrome.
Figure 2
Figure 2
Subtypes of dysarthria as explanatory constructs for low intelligibility in adolescents with Down syndrome. Panel A includes the mean percentage scores on each of the dysarthria subtype indices for participants with high and low intelligibility, and panel B includes the mean percentile scores on each index for participants with high and low intelligibility.
Figure 3
Figure 3
Comparative information on diagnostic classifications of motor speech status as an explanatory construct for reduced intelligibility in adolescents with Down syndrome. Figure 3a includes intelligibility findings for 45 speakers with DS in the original sample. Figure 3b includes intelligibility findings for 301 speakers with seven types of complex neurodevelopmental disorders (Shriberg, Strand, et al., 2019). Figure 3c includes intelligibility findings for 415 speakers with idiopathic Speech delay (Shriberg, Campbell, et al., 2019). No MSD: No Motor Speech disorder; SMD: Speech Motor delay; CD: Childhood Dysarthria; CAS: Childhood Apraxia of Speech: CD & CAS: Concurrent CD & CAS.
Figure 4
Figure 4
Four measures of consonant and vowel production in Conversational Speech (CS) in adolescents with Down syndrome. In each of the four panels, filled circles indicate participants with High (H) intelligibility; open circles indicate participants with Low (L) intelligibility. Statistically significant comparisons in the upper numeric section of each panel are indicated both by boxes around them and by effect size information.
Figure 5
Figure 5
Sibilant distortions and intelligibility in Conversational Speech (CS) in adolescents with Down syndrome. Filled circles indicate participants with High (H) intelligibility; open circles indicate participants with Low (L) intelligibility.
Figure 6
Figure 6
Inappropriate prosody and voice and intelligibility in Conversational Speech (CS) in adolescents with Down syndrome. Filled circles indicate participants with High (H) intelligibility; open circles indicate participants with Low (L) intelligibility. See text for description of the data in each panel.

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