12 Nov The Reliability of Expert Diagnosis of Childhood Apraxia of Speech
Summary by Elizabeth Murray, PhD
We wanted to determine whether speech language pathologist (SLP) CAS experts would agree on the answer to the question, “What is the child’s speech diagnosis?”
We asked 23 SLPs to review video or audio clips of children performing speech tasks such as naming pictures or describing a scene. The expert SLPs had at least 5 years of experience working with speech sound disorders (SSD) and CAS and at least 1 publication or international or national presentation about CAS. They spoke English and had normal hearing and vision. Three SLPs were randomly assigned to rate each of the 92 children.
The children were between 3-18 years old and had moderate to severe SSD, CAS, or 2-3 persistent (“residual”) speech errors.
The SLPs used an online rating form to identify the child’s speech symptoms and decide on their speech diagnosis. The possible diagnoses were:
- CAS
- CAS + Other communication diagnosis or
- Other (not CAS).
Results: Agreement for all three categories was below the benchmarks the authors had set for the study. Agreement was highest for diagnosis of Other (not CAS). The experts used similar symptoms to rate CAS, but they did not agree on how strongly each symptom had to be observed to diagnose CAS.
Conclusions: Expert English-speaking speech-language pathologists did not agree on whether the included children had CAS or not. Some were more conservative than others in making a diagnosis. Based on this, we need to improve the reliability of expert diagnosis. We can do this by defining CAS symptoms more precisely, improving cut off information as to how much we need to observe each symptom, and using more objective measures to support our listening judgments. For now, SLPs need to be careful when they try to diagnose CAS based on listening to a child’s speech. SLPs should get support from more experienced colleagues. They also need to complete thorough assessments, with multiple tools, to identify other possible communication issues and SSDs. They should decide which tool is most important for diagnosis for that particular person.
Murray, E., Velleman, S., Preston, J. L., Heard, R., Shibu, A., & McCabe, P. (2024). The reliability of expert diagnosis of childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 67 (9S). 3309-3326. https://doi.org/10.1044/2023_JSLHR-22-00677
Summary by Elizabeth Murray, PhD
We wanted to determine whether speech language pathologist (SLP) CAS experts would agree on the answer to the question, “What is the child’s speech diagnosis?”
We asked 23 SLPs to review video or audio clips of children performing speech tasks such as naming pictures or describing a scene. The expert SLPs had at least 5 years of experience working with speech sound disorders (SSD) and CAS and at least 1 publication or international or national presentation about CAS. They spoke English and had normal hearing and vision. Three SLPs were randomly assigned to rate each of the 92 children.
The children were between 3-18 years old and had moderate to severe SSD, CAS, or 2-3 persistent (“residual”) speech errors.
The SLPs used an online rating form to identify the child’s speech symptoms and decide on their speech diagnosis. The possible diagnoses were:
- CAS
- CAS + Other communication diagnosis or
- Other (not CAS).
Results: Agreement for all three categories was below the benchmarks the authors had set for the study. Agreement was highest for diagnosis of Other (not CAS). The experts used similar symptoms to rate CAS, but they did not agree on how strongly each symptom had to be observed to diagnose CAS.
Conclusions: Expert English-speaking speech-language pathologists did not agree on whether the included children had CAS or not. Some were more conservative than others in making a diagnosis. Based on this, we need to improve the reliability of expert diagnosis. We can do this by defining CAS symptoms more precisely, improving cut off information as to how much we need to observe each symptom, and using more objective measures to support our listening judgments. For now, SLPs need to be careful when they try to diagnose CAS based on listening to a child’s speech. SLPs should get support from more experienced colleagues. They also need to complete thorough assessments, with multiple tools, to identify other possible communication issues and SSDs. They should decide which tool is most important for diagnosis for that particular person.
Murray, E., Velleman, S., Preston, J. L., Heard, R., Shibu, A., & McCabe, P. (2024). The reliability of expert diagnosis of childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 67 (9S). 3309-3326. https://doi.org/10.1044/2023_JSLHR-22-00677
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