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Lateral jaw stability in children with developmental speech disorders

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 Lateral Jaw Stability in Adults,
Children, and Children with
Developmental Speech Disorders

Hayo Terband, M.A., LLM, Ph.D.*

Centre for Language and Cognition & University Medical Centre, University of Groningen,
Groningen, the Netherlands

Yvonne van Zaalen, Ph.D.

School of Health Innovations and Technology, Fontys University of Applied Sciences,
Eindhoven, the Netherlands

Ben Maassen, Ph.D.

Centre for Language and Cognition & University Medical Centre, University of Groningen,
Groningen, the Netherlands

Keywords: speech motor control, speech motor development, perception-action,

­developmental speech disorders, computational neural modeling

This study investigated the contribution of lateral movement to articulatory (in)stability.

Using an optical three-dimensional movement analysis system, ­articulographic data on
jaw movements were collected on the reiterated productions of the words /spa:/ and /pa:s/
­(consisting of the same sequence of speech sounds but with a ­different ­syllabic structure)
of 18 adults, 16 5- to 6-year-olds typically developing children, and five ­children (ages,
4–7 years) with a variety of speech sound disorders (SSDs).
Results of earlier studies showed that in the midsagittal plane, articulatory ­movement tra-
jectories become more stable with age and during linguistic and phonemic ­development.
The current results on the stability of jaw movements in the coronal plane corroborate
these findings. Furthermore, the results indicate deviances from the norm data for the
children with SSDs; however, in the midsagittal plane, no deviances were found for jaw
movements for children with SSDs and subtype childhood apraxia of speech compared
with control participants in a previous study. These results suggest that assessing lateral
movement stability is important for the profiling of SSDs and might provide direct start-
ing points for therapy planning.

INTRODUCTION
It has been well established that children’s
­articulatory movements become more stable with
*currently at Utrecht institute of Linguistics OTS, Utrecht
University, Utrecht, the Netherlands
age and during linguistic and phonemic ­development
(Goffman & Smith, 1999; Grigos, 2009; Smith &
­Goffman, 1998). However, different ­articulators
show different developmental ­trajectories. Jaw
movements stabilize first and precede the stabili-
zation of upper and lower lip (Green & Nip, 2010;

Journal of Medical Speech-Language Pathology

Volume 20, Number 4, pp. 112–118
Copyright © 2013 Delmar Cengage Learning

26551_ch20_ptg01_112-120.indd 112 25/03/13 4:27 PM

 Lateral Jaw Stability
Moore, 2004) and tongue tip (Terband, van Brenk,
van Lieshout, ­Nijland, & Maassen, 2009) ­movements
in speech tasks. The jaw is thought to serve an
­important function as a stable platform, allowing
the differentiation and development of lower lip and
tongue movements (Hayden & Square, 1994; Moore,
2004). The development of jaw stability thus likely
plays a central role in speech motor development.
Previous studies have focused on ­articulatory
movement trajectories in the midsagittal plane. The
stability of articulatory movements in the coronal
plane has not yet been studied. In ­general, move-
ments in the coronal plane are of less ­relevance for
speech research. Because of anatomical and speech
motor control principles, most relevant events in
speech production occur in the midsagittal plane
(with some exceptions involving the shape of the
tongue). Clinical ­observation, however, indicates
that children with developmental speech disor-
ders, especially children with childhood apraxia
of speech (CAS), may show lateral movements of
articulators. For example, in the authors’ clinical
observation, ­lateral movements of articulators are
often visible during groping or searching articula-
tory behavior. The recent development of three-
dimensional (3D) movement recording systems
allows us to investigate lateral movements of ar-
ticulators during speech production.
In the current study, we set out to investigate
the lateral stability of jaw movements in children
with a variety of developmental speech disorders
compared with typically developing control
­p articipants using an optical 3D movement
­analysis system (Codamotion cx1). This type of
analysis has not yet been applied to speech data
of adults or children, including children with
speech disorders. The stability of jaw movements
in the coronal plane was assessed by means of the
mean deviation of movement trajectories from
the ­midsagittal plane, the maximum deviation or
range, and the variability. First, we compared the
lateral jaw stability in typically speaking children
and adults. Then we compared the jaw movement
trajectories of five children with a variety of speech
sound disorders (SSDs) with these norm data.
METHOD AND MATERIALS
Participants
Five children with developmental speech ­disorders
participated in the study. Three ­children were
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26551_ch20_ptg01_112-120.indd 113
113
­ iagnosed with phonetic articulation ­d isorder
d
(PAD; ages 5.4, 5.5, and 4.1 years; all boys), one
girl with phonological disorder (PD; age 6.8 years),
and one boy with CAS (age 5.0 years). Norm data
were collected on 16 typically developing children
(age mean, 5.7 years; range, 4.9–6.6 years; seven
boys and nine girls) and 18 young adults (age
mean, 23.3 years; range, 20.9–26.1 years; eight
men and 10 women).
The children with developmental speech
­disorders were referred by speech ­pathologists,
and the typically developing children were
­recruited from a nearby school. No participants
had hearing problems (pure-tone thresholds not
exceeding 25 dB HL), language comprehension
problems (a score ,1 standard deviation [SD] be-
low population average), subnormal intelligence
(IQ ,1 SD below population average), organic
disorders in the orofacial area, gross motor dis-
turbances, or dysarthria. The diagnosis of the chil-
dren with speech sound disorders was established
using standardized speech perception and
­p roduction tests and anamnesis (medical his-
tory; see ­Appendix 1). Detailed overviews of the
­classification of the children with speech sound
disorders and the diagnostic data can be found in
Appendices 1 and 2.
Data Collection, Processing, and Analysis
The speech task and experimental procedures
followed previous studies from our laboratory
(Terband, Maassen, Van Lieshout, & Nijland,
2011; Terband et al., 2009) and consisted of the
reiterated production of the Dutch monosyllabic
words /spa:/ and /pa:s/ in 12-sec recording trials.
The use of minimal word pairs that consist of the
same speech gestures but in a different order or
phase relationship (Goldstein & Fowler, 2003; Van
Lieshout & Goldstein, 2008) provides a window on
the role of syllabic structure in movement stabil-
ity. Jaw movement data were collected using an
optical 3D movement analysis system, the
­Codamotion cx1. This system is well established
in the area of gait and posture analysis (e.g., Kelly,
O’Regan, Jenkinson, & O’Brien, 1997).
The data were collected as part of a larger
study involving multiple target utterances. The
participants were instructed to repeat the words
at a self-chosen normal pace. Each trial was pre-
ceded by a preparation interval in which the par-
ticipants were told what to repeat. If necessary,
the experimenter modeled the target utterance
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 114 Journal Of Medical Speech-Language Pathology, Vol. 20, No. 4

once or twice. The participants were instructed to
take a deep breath to allow them to repeat the stim-
ulus for the length of the trial on a single breath
(if possible). During each trial, the validity of the
trial was judged by the experimenters. In the case
of clear slips of the tongue, pauses, interruptions, or
rate changes, the trial was repeated. Each session
took 30 to 40 minutes per participant on average.
All movement data were screened for visible
artifacts. The number of words or cycles per trial
differed per child and per stimulus and was not
equally distributed over groups. For this reason,
the analyses were limited to a maximum number
of eight cycles for all subjects. The lateral move-
ment of the jaw was assessed by the angle of the
jaw movement trajectories over time, expressing
the deviation from the midline. For each move-
ment trajectory, average angle (mean angle of all
cycles), angle range (maximum deviation from the
mean in both directions), and angle variability
(SD of the mean) were calculated.
Statistical testing was done by means of a linear
mixed model, with subject and task as correlated
terms, and group (adults and 5- and 6-year-old
control participants) and task (/spa:/ and /pa:s/)
as fixed factors, with the level of significance set
at 0.05. Separate analyses were performed for the
children with SSD. First, we calculated 95% con-
fidence intervals (95% CI) for both control groups
(adults and 5- and 6-year old children) separately.
Then the jaw movements of the five children with
SSD were compared casewise with these norm
data (95% CIs of age-matched typically develop-
ing children).
RESULTS
The norm data (adults and control children) are
presented in Table 1. Statistical analysis revealed
a main effect of group for angle range (F[1,60.595]
5 12.254; p , .001) and angle variability
(F[1,64.353] 5 7.862; p , .01), indicating a larger
lateral movement and a larger lateral movement
variability of the jaw for the typically developing
5- and 6-year-old children compared with adults.
No main or interaction effects involving task and
no effects with respect to the average angle of jaw
movements were found.
Table 2 presents the results for the children
with speech disorders. Values that are signifi-
cantly different from the norm data of the 5- and
6-year-old typically developing control children
are marked by asterisks. Where meaningful, the
direction of the effect is indicated by an arrow.
Both children with SSD (PD and CAS) and the
youngest child with PAD (PAD 3) show aver-
age angles that are deviant from the norm data.
Regarding the effect of task, results show large
differences in average angle between /spa:/ and
/pa:s/ for children diagnosed with SSD but no dif-
ferences for PAD compared to the control partici-
pants (Table 3). Furthermore, all of the children
with speech disorders show deviant differences
in angle range between /spa:/ vs. /pa:s/, but the
effect takes different directions for different
children.
PAD 1 shows a deviant average angle, a larger
range and higher variability compared with
the control participants for /spa:/ but not for
/pa:s/. (However, note that the difference in av-
erage angle between /spa:/ than /pa:s/ does not
differ from the normative data.) PAD 2 shows
a slightly increased angle range in /spa:/ com-
pared with the control participants, although
the range is smaller than in /pa:s/. Furthermore,
no deviations in average angle or variability are
observed. PAD 3 shows an opposite pattern of
PAD 1, with a larger range and higher variabil-
ity in /pa:s/ than in /spa:/. In contrast to PAD 1,

TABLE 1. Norm Data: Average Angle, Angle Range, and Angle Variability of Jaw Movement Trajectories in the
Coronal Plane in Reiterated Productions of the Words /spa:/ and /pa:s/ in Children and Adults

Group Task Average Angle Angle Range Angle Variability

(degrees) (degrees) (degrees)
Mean (SD) Mean (SD) Mean (SD)
Adults (n 5 18) /spa:/ 178.77 (4.84) 8.00 (2.35) 1.59 (0.54)
/pa:s/ 179.27 (4.66) 8.77 (2.60) 1.88 (0.72)
5- and 6-year children (n 5 16) /spa:/ 180.84 (6.02) 10.10 (3.62) 2.13 (0.88)
/pa:s/ 180.66 (5.95) 12.74 (5.29) 2.41 (0.98)

SD 5 standard deviation.

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 Lateral Jaw Stability 115

TABLE 2. Average Angle, Angle Range, and Angle Variability of Jaw Movement Trajectories in the Coronal Plane
in Reiterated Productions of the Words /spa:/ and /pa:s/ in Five children with Speech Sound Disorders Compared with
Typically Developing Children and Adults*

Measure Task Subjects

Adults 5- and PAD 1 PAD 2 PAD 3 PD CAS
(95% CI) 6-Year-Old (Age (Age (Age (Age (Age
Children 5.4 5.5 4.1 6.8 5.0
(95% CI) Years) Years) Years) Years) Years)
Average angle /spa:/ 176.16–181.38 178.16–183.53 184.29* 181.85 171.43* 177.98* 170.70*
(degrees) /pa:s/ 176.72–181.83 178.04–183.29 182.43 183.10 172.59* 175.11* 179.90
Angle range /spa:/ 6.55−9.46 8.60–11.59 19.72* 12.44* 11.36 9.50 12.28*
(degrees) /pa:s/ 6.79−10.75 10.71–14.78 13.23 12.75 18.93* 8.57* 11.30
Angle variability /spa:/ 1.25−1.94 1.76−2.49 4.94* 2.05 2.16 1.80 2.65*
(degrees) /pa:s/ 1.47−2.30 1.99−2.83 2.15 2.79 2.65 1.73* 2.19

*Values that are significantly different from the normative data of the 5- and 6-year-old typically developing children.
CAS 5 childhood apraxia of speech; CI 5 confidence interval; PAD 5 phonetic articulation disorder; PD 5 phonological disorder.

TABLE 3. Differences in Average Angle, Angle Range, and Angle Variability of Jaw Movement Trajectories in the
Coronal Plane in Reiterated Productions of the Words /spa:/ vs. /pa:s/ in Five Children with Speech Sound Disorders
Compared with Typically Developing Children and Adults

Measure Subject
(/spa:/ - /pa:s/) Adults 5- and PAD 1 PAD 2 PAD 3 PD CAS
(95% CI) 6-Year-Old (Age (Age (Age (Age (Age
Children 5.4 5.5 4.1 6.8 5.0
(95% CI) Years) Years) Years) Years) Years)
Change in average –0.98–0.03 –1.55–0.55 1.86* –1.25 –1.16 2.87* –9.20*
angle (degrees)
Change in angle –2.11–0.47 –3.16–0.19 6.49* –0.31 –7.57* 0.93* 0.98*
range (degrees)
Change in angle –0.58–0.00 –0.51–0.01 2.79* –0.74* –0.49 0.07* 0.47*
variability
(degrees)

*Values that are significantly different from the norm data of the 5- and 6-year-old typically developing control children are
marked. A negative value means that the measure is higher in /pa:s/ than in /spa:/.
CAS 5 childhood apraxia of speech; CI 5 confidence interval; PAD 5 phonetic articulation disorder; PD 5 phonological disorder.

however, PAD 3 shows an average angle that is DISCUSSION

largely different from the control participants
for both /spa:/ and /pa:s/. PD also shows a dif-
ferent average angle compared with the control
participants for both speech tasks but combines
this with a small angle range and low variability
in /pa:s/. Angle range and variability in /spa:/ are
within normal range. CAS shows the exact same
pattern as PAD 1 with a deviant average angle,
a large range, and high variability for /spa:/ but
not for /pa:s/.
The purpose of this study was to investigate
the contribution of lateral movement to ar-
ticulatory (in)stability. Results of earlier stud-
ies showed that in the midsagittal plane,
articulatory movement trajectories become
more stable with age and during linguistic and
phonemic development (e.g., Green, Moore,
Higashikawa, & Steeve, 2000; Grigos, 2009;
Smith & Goffman, 1998; Terband et al., 2009).

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26551_ch20_ptg01_112-120.indd 115 25/03/13 4:27 PM

 116 Journal Of Medical Speech-Language Pathology, Vol. 20, No. 4
The present data on the stability of jaw move-
ments in the coronal plane corroborate these
findings. The group of typically developing 5- and
6-year-old children showed larger and more vari-
able lateral movement of the jaw during the reit-
erated production of monosyllabic words /spa:/ and
/pa:s/ compared with adults. In correspondence
with previous findings (Terband et al., 2009), we
observed no effects of syllabic structure.
For the children with SSD, the results indicate
clear deviances from the norm data. With the
exception of the child with PD, all children with
SSD showed increased lateral movement range
and variability for either of the two target words
(see Tables 2 and 3). Furthermore, all showed a
task effect, that is, differences in average ­angle,
range, or variability between the two target
words (/spa:/ and /pa:s/). More specifically, the
children with PD and CAS both showed a large
difference in average angle depending on task,
indicating that their jaw movement trajectories
were qualitatively different for /spa:/ than for
/pa:s/. The child with PD showed a different
­a verage angle compared with control partici-
pants for /pa:s/ and to lesser extent for /spa:/.
Also, this child showed a significantly smaller
angle range and lower variability for /pa:s/ com-
pared with the 5- and 6-year-old children. At first
sight, this might indicate a lack of flexibility, but
the values are well within the adults’ norms. Our
interpretation therefore is that the child with PD
exhibits deviant jaw movements but managed
to stabilize them, especially in the syllable with-
out a consonant cluster (/pa:s/). The child with
CAS also exhibited deviant jaw movements but
only for the target word with a consonant cluster
(/spa:/). In contrast to PD, this is combined with
a significantly larger lateral movement range
and a higher variability. The values for /pa:s/ on
the other hand, were all within normal range.
These results indicate that this child has much
difficulty with consonant clusters (which is also
expressed in the intake data in the low propor-
tion syllable structures correct; see Appendix 2),
which is in line with previous studies that have
found that children with CAS make more sub-
stitution errors in producing a consonant–­
consonant–vowel (CCV) sequence in a cluster
than when the consonants are separated by a
syllable boundary (Maassen, Nijland, & Van der
Meulen, 2001; Nijland, Maassen, Van der ­Meulen,
Gabreels, Kraaimaat, & Schreuder, 2003). In
­c onclusion, this case provides an interesting
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26551_ch20_ptg01_112-120.indd 116
e­ xample of the intricate mutual relationship be-
tween movement stability and higher level plan-
ning processes.
With respect to the children that were diag-
nosed with PAD, the results paint divergent
pictures. One child, PAD 1, showed the same pat-
tern of results as the child with CAS, indicating
that /spa:/ was more difficult to produce than
/pa:s/. This similarity is also visible in the intake
data: PAD 1 exhibited some apraxic character-
istics (inconsistency in articulation errors and
sometimes groping behavior), difficulties with
the diadochokinesis task (he was able to produce
/pataka/ in sequence in normal rate but was not
able to speed up), and oral motor movement dif-
ficulties (see Appendix 2). Together, this suggests
that this child actually may have a mild form of
CAS instead of or in addition to PAD. These find-
ings exemplify the difficulty of classifying SSD,
and strengthen our view that “CAS characteris-
tics are likely to be present to some extent in each
case of developmental speech sound disorder. . .
[and that] . . . at the symptom level, the charac-
terization of CAS within the larger diagnosis
of SSD is rather one of degree of involvement”
(Terband & Maassen, 2010, p. 135). PAD 2, how-
ever, is characterized by very “normal” values.
No deviations in average angle or variability
were observed, and although the range of the
lateral movement in /spa:/ is slightly increased
compared with the control participants, it is
smaller than the movement range in /pa:s/. Lat-
eral jaw stability therefore does not appear to be
aberrant in this child. The third child with PAD
(PAD 3) showed an average angle that is largely
different from the control participants for both
/spa:/ and /pa:s/ but managed to stabilize his jaw
movements for /spa:/ but nor for /pa:s/. In the case
of PAD 3, the results showed a pattern largely
­opposite to the pattern of PAD 1 and CAS with a
larger range and higher variability when the con-
sonants were separated by a syllable boundary
(/pa:s/) than when in producing a CCV sequence
in a cluster (/spa:/). Although consonant–­vowel–
consonant (CVC) sequences develop earlier than
CCV (Levelt, Schiller, & Levelt, 1999), this does
not mean that the production of these syllables
in connected or reiterated speech is easier from
a motor control perspective. In fact, many of the
current experiments’ participants reported that
they experienced the reiterative production of the
CCV sequences to be easier than CVC. According
to articulatory phonology, the coupling ­between
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 Lateral Jaw Stability
gestures that compose a syllable onset (i.e.,
tongue tip and lip gestures in the onset cluster
/sp/) is much stronger than the gestural coupling
of consonant clusters across syllable boundar-
ies (Goldstein & Fowler, 2003; Van Lieshout
& ­G oldstein, 2008). In the case of PAD 3, this
­d ifference in coupling strength could explain
why he ­managed to stabilize jaw ­movements in
/spa:/ but not in /pa:s/.
CONCLUSIONS
Because of obvious limitations, the findings
­r eported in this paper should be considered
­t entative. Only five children diagnosed with
­different SSDs were investigated, and the ­results
need to be verified with a larger ­n umbers of
­children for each of the three diagnoses. Other
main issues for further research lie in ­expanding
the age range of the control children and in
­e xpanding the set of speech tasks, such that
the role of developmental complexity can be
­assessed. Despite these limitations, the present
results ­suggest that assessing lateral movement
­stability is important for the profiling of SSDs.
Where a previous study showed no deviances
for jaw ­movements in the midsagittal plane for
children with SSDs and subtype CAS compared
with control participants (Terband et al., 2011),
the present results indicate clear deviances from
the collected norm data for children with SSD
in lateral movement and movement stability of
the jaw. With respect to jaw movements, all rel-
evant events in speech production occur in the
midsagittal plane. The jaw is thought to serve an
important function as a stable platform for the
development of lower lip and tongue movements
(Hayden & Square, 1994; Moore, 2004). Assessing
lateral movement stability may therefore provide
direct starting points for therapy planning.
Acknowledgment The authors wish to thank
Sally Hommeles, Astrid Martens, Nicole Savelkoul, and
Benedicte Vanwanseele for their help in data collection.
Furthermore, we gratefully thank all adults, children
(and their parents), speech therapists, and schools for
participating in this study.
Address Correspondence to Hayo Terband, M.A.,
LLM, Ph.D., Centre for Language and Cognition
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26551_ch20_ptg01_112-120.indd 117
117
(CLCG), Faculty of Arts, University of Groningen,
Oude Kijk in ‘t Jatstraat 26, Groningen, 9712 EB,
The Netherlands, Phone: +31(0)50 3635800 / 5858,
Mobile: +31(0)633821241
e-mail: h.r.terband@umcg.nl
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26551_ch20_ptg01_112-120.indd 118 25/03/13 4:27 PM

 Appendix 1: Classification of the Children
with Speech Sound Disorders*

Three variables were used to differentiate between SSD:

• Clinical judgment: based on semi-spontaneous utterances, picture naming, word repetition, and oral-motor
movement assessment, each child was clinically diagnosed as having PAD, PD, or CAS.
• The percentage of apraxic and phonological characteristics (in the present or past) as reported by the
speech therapists. The apraxic characteristics were defined as unintelligible speech for parents and others,
inconsistency in articulation errors, groping or searching articulation (both prevocalic groping or silent posturing
and searching articulatory behavior during sound production), slow progress in therapy, and articulation errors
comprising simplifications but also more complex patterns. The phonological characteristics were defined as
unintelligible speech for others but not for parents, consistency in articulation errors, and consonantal errors
mostly consisting of simplifications. Percentages from 67% and upward were qualified as high.
• The abilities in a maximum performance task (diadochokinesis). Inability was concluded when children could not
produce [pataka] in isolation or in a sequence of two repetitions.

Classification was implemented as follows:

• (Clinical judgment 5 CAS or PD/CAS) 1 ([pataka] could not be produced) → CAS classification
• (Clinical judgment 5 CAS or PD/CAS) 1 (High % CAS characteristics) 1 ([pataka] in sequence but no
acceleration) → CAS classification
• (Clinical judgment 5 PD or PD/CAS) 1 (No evident [pataka] problems) → PD classification
• (Clinical judgment 5 PD or PD/CAS) 1 (High % PD characteristics) 1 ([pataka] in sequence incorrect but
speeding up on two different consonants) → PD classification
• (Clinical judgment 5 PAD or PAD/PD) 1 (Low % PD characteristics) 1 ([pataka] in sequence but no
acceleration) → PAD classification
• (Clinical judgment 5 PAD or PAD/PD) 1 (High % PD characteristics) 1 ([pataka] in sequence incorrect but
speeding up on two different consonants) → PD classification.
• (Clinical judgment 5 PAD or PAD/CAS) 1 (no evident [pataka] problems) → PAD classification
• (Clinical judgment 5 PAD or PAD/CAS) 1 (High % CAS characteristics) 1 ([pataka] in sequence incorrect but
speeding up on two different consonants) → CAS classification
*Terband, et al., 2011, pp. 63–64.
CAS 5 childhood apraxia of speech; PAD 5 phonetic articulation disorder; PD 5 phonological disorder;
SSD 5 speech sound disorder.

Journal of Medical Speech-Language Pathology

Volume 20, Number 4, p. 119
Copyright © 2013 Delmar Cengage Learning

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Appendix 2: Overview of the Children with Speech
Sound Disorders Who Participated in the Study*

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Volume 20, Number 4, p. 120
Copyright © 2013 Delmar Cengage Learning
Journal of Medical Speech-Language Pathology
Subject Classifi- Age Sex Clinical Apraxic Phonological Diadochokinesis Oral-Motor Movement
ID cation (yr) Judgment Characteristics Characteristics ([pataka]) Assessment
(%) (%) Score† Judgment‡ Isolation Sequential Sequential Fast
(proportion (proportion (proportion
correct) correct) correct)
PAD 1 PAD 5.4 Male PAD 40    0 1 1 0.92 0.72 0.60
PAD 2 PAD 5.5 Male PAD 40 33 1 0 0.92 0.78 0.90
PAD 3 PAD 4.1 Male PAD — — 1 0 0.92 0.94 0.90
PD PD 6.8 Female PD/CAS 80 100 1 0 0.88 0.89 0.60
CAS CAS 5.0 Male CAS — — 0 4 0.62 0.28 0.30
Subject Classifi- PALPA Picture Naming 1 Picture Naming 2 Word Repetition Nonword Repetition
ID cation (Auditory (50 Words Logo Art) (PN2; 10 Words) (WR; 10 Words Same (10 Nonwords Similar
Discrimination) As PN2) To WR)
Words Nonwords Atypical Syllable Atypical Syllable Atypical Syllable Atypical Syllable
(proportion (proportion Substitution Structures Substitution Structures Substitution Structures Substitution Structures
correct) correct) Processes (proportion Processes (proportion Processes (proportion Processes (proportion
(proportion) correct) (proportion) correct) (proportion) correct) (proportion) correct)

PAD 1 PAD 0.86 0.89 — — — — 0 0.96 0 0.88

PAD 2 PAD 0.94 0.83 0 0.96 0 0.96 0 0.88 0 0.88
PAD 3 PAD 0.58 0.61 0 0.91 0 0.96 0 1 0 0.84
PD PD 0.92 0.83 0.33 1 0 0.96 0 0.92 0 0.96
CAS CAS 0.50 0.53 0.44 0.64 0.40 0.64 — — — —

*A detailed description of the diagnostic tasks can be found in Terband et al. (2011, p. 71).
†Diadochokinesis Score 0 5 [pataka] could not be produced; 1 5 [pataka] could be produced.
‡Diadochokinesis Judgment 0 5 perfect; 1 5 [pataka] in sequence in normal rate, but no acceleration; 2 5 [pataka] in sequence incorrect ([t] or [k]

could not be pronounced), but speeding up on two different consonants ([pata], [taka]) was possible; 3 5 no fluent [pataka], not in sequence;
4 5 no [pataka] production either in isolation or in a sequence of two.
CAS 5 childhood apraxia of speech; PAD 5 phonetic articulation disorder; PALPA 5 auditory discrimination; PD 5 phonological disorder;
PN 5 picture naming; WR 5 word repetition.

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