Joan Kwiatkowski

Phonological Disorders I: A Diagnostic Classification System.

Data are presented to support the validity and utility of a diagnostic classification system for persons with phonological disorders. Rationale for the classification system is developed from current reviews of issues and concepts in phonology and classification systems. The system proceeds from a worksheet for reduction of phonological and other assessment data, through five hierarchical levels of classification entries. The system will accommodate lower-level elaboration of etiological subgrouping, pending appropriate research. A retrospective classification study of 43 children with delayed speech is described. Procedural details relating classification procedures to two companion papers (Shriberg & Kwiatkowski, 1982a, 1982b) are provided.

Developmental Phonological Disorders I: A Clinical Profile

Detailed information on the speech, language, prosody, and voice characteristics of children with developmental phonological disorders is central to diverse research questions. The present study provides a clinical profile of 178 children with developmental phonological disorders. It includes information from prior reports (Shriberg & Kwiatkowski, 1982a; Shriberg, Kwiatkowski, Best, Hengst, & Terselic-Weber, 1986) and from several new measures on a sample of 64 children. The speech, prosody-voice, and causal-correlates profiles for the most recent sample are consistent with prior findings, providing a descriptive profile for forthcoming subgroup research and companion studies addressing short-term (Shriberg, Kwiatkowski, & Gruber, 1994) and long-term (Shriberg, Gruber, & Kwiatkowski, 1994) speech-sound normalization.

Developmental Apraxia of Speech: I. Descriptive and Theoretical Perspectives

Developmental apraxia of speech (DAS) is a putative diagnostic category for children whose speech errors presumedly (a) differ from the errors of children with developmental speech delay (SD) and (b) resemble the errors of adults with acquired apraxia of speech. The studies reported in this series (Shriberg, Aram, & Kwiatkowski, 1997a, 1997b) concern both premises, with primary focus on the first--that children with DAS can be differentiated from children with SD on the basis of one or more reliable differences in their speech error profiles. Immediate goals are to identify a diagnostic marker for DAS and to consider implications for research and clinical practice. A long-term goal is to identify the phenotype marker for DAS, on the assumption that it may be a genetically transmitted disorder. This first paper reviews relevant descriptive and theoretical perspectives. Findings from a local ascertainment study support the clinical functionality of the term suspected DAS.

Developmental Apraxia of Speech: II. Toward a Diagnostic Marker

This second paper in a series on developmental apraxia of speech (DAS) (Shriberg, Aram, & Kwiatkowski, 1997a) reports findings from two studies. Study I compares speech and prosody-voice profiles of a group of 14 children with suspected DAS to profiles of 73 children with speech delay (SD). Results suggest that the only linguistic domain that differentiates some children with suspected DAS from those with SD is inappropriate stress. Study II cross-validates these findings, using retrospective data from a sample of 20 children with suspected DAS evaluated in a university phonology clinic over a 10-year period. Discussion considers methodological and conceptual issues in the measurement of linguistic stress. Theoretical issues and implications for research and clinical practice are deferred for synthesis of the present findings with those from a multi-site cross-validation project (Shriberg, Aram, & Kwiatkowski, 1997b).

Phonological Disorders II: A Conceptual Framework for Management

A conceptual framework for management of phonological disorders is proposed. The framework includes a 10-element system for describing the structure of management programs and invokes a diagnostic classification system for determining appropriate management content. Data from three serial studies of management structure describe the effectiveness, efficiency, and clinician acceptance of four modes of management: Drill, Drill Play, Structured Play and Play. Review of past, present, and future content of management programs emphasizes the central role of individual differences among persons with phonological disorders.

A diagnostic marker for speech delay associated with otitis media with effusion: the intelligibility-speech gap.

The goal of this study was to determine if notably reduced intelligibility is a potential diagnostic marker for children with speech delay and histories of early recurrent otitis media with effusion (SD‐OME). Intelligibility was assessed in one 5–10 minute conversational speech sample from each of 281 speakers. The OME histories of 148 of these children with normal speech acquisition were described in two prior reports. OME histories of 85 additional children with speech delay were obtained from case history reports. For both groups, the children with positive OME (OME+) histories had significantly lower intelligibility scores but significantly higher speech production scores than children with negative OME (OME−) histories. Findings for a diagnostic marker to discriminate speech delayed children with OME+ versus OME− histories were promising, considering that the data were obtained retrospectively and did not include audiological information characterizing childrens concurrent fluctuant hearing loss. The formula for the diagnostic marker, termed the Intelligibility‐Speech Gap, was identified by a machine learning routine. Diagnostic accuracy findings for the marker were as follows: positive predictive value=74%, negative predictive value=86%, sensitivity=79%, specificity=83%, positive likelihood ratio=4.6 and negative likelihood ratio=0.25. Discussion considers speech processing perspectives on the source of the intelligibility‐speech gap in children with suspected SD‐OME, and methodological perspectives on its development as a diagnostic marker of one etiological subtype of speech delay.

Speech Normalization in Developmental Phonological DisordersA Retrospective Study of Capability-Focus Theory

A two-factor theory is proposed to explain individual differences in intervention outcomes for children with speech delays. Indices of Capability include linguistic measures of a childs comprehens...

The Capability-Focus Treatment Framework for Child Speech Disorders

The goals of this report are to describe a treatment framework for child speech disorders, to summarize findings on the predictive validity of the framework, and to stimulate discussion of associat...

Self-Monitoring and Generalization in Preschool Speech-Delayed Children.

Self-monitoring and generalization were observed as eight preschool children progressed in management programs for their developmental phonological disorders. Changes in the production of target an...

A Retrospective Study of Spontaneous Generalization in Speech-Delayed Children

Programming for rapid generalization of target responses to spontaneous speech is perhaps the central goal of management. To determine whether any child or management factor was associated with gen...