DEMSS Dynamic Evaluation of Motor Speech Skill

Name___________________________________________________________________________________ Clinic number______________________________________________

Month Day Year Age___________________________________________ Examiner__________________________________________________

Birthdate
Test date

Checklist of information to obtain before beginning the DEMSS

❑ Phonetic and phonemic inventory ❑ Oral structural functional exam ❑ List consistent error types_______________________
❑ Nonverbal oral apraxia exam ❑ Articulation test, if possible ______________________________________________

As you begin the DEMSS

• Make sure the child understands the nature of the imitation task required by the DEMSS and is motivated to complete it.
• Assure the child that your goal is to watch how he or she tries.
• Help the child understand that you will help him or her get closer to the correct production, but it is fine if they do not do it right.
• Play with the child, producing a few words simultaneously as this may be unfamiliar to the child and awkward at first.

During the DEMSS

• Use a moderate to slightly slow, but natural, rate and natural prosody.
• Continue to direct the child’s attention to your face.
• Give specific instructions: “Watch my face and then try to say what I say. I will help you if it is a hard one.”

If the child cannot complete all parts of the DEMSS

• If the child makes an attempt at the response but is unsuccessful, then score a 0 for as many as he or she can attempt (see page 13 of Chapter 2).
• If the child is scoring mostly 0s during the first few subtests and you predict he or she will not do any better on subsequent subtests, then discontinue
testing and provide a narrative summary of his or her performance (see case examples in Chapter 2).

Dynamic Evaluation of Motor Speech Skill (DEMSS) Response Form, by Edythe A. Strand, Ph.D. © 2019 by the Mayo Foundation for Medical Education and Research.
The DEMSS Response Form is made available under a limited licensing agreement from the Mayo Foundation to Brookes Publishing. Permission is granted to make copies of the
Response Form for clinical and research use only. All rights reserved. Users may not generate revenues from their use of the Response Form. The DEMSS Manual is
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 A. Consonant-Vowel

Initial attempt After cueing Brief Scoring Reminders

Articulatory Articulatory
Vowel Accuracy Accuracy Accuracy Consistency INITIAL ATTEMPT Optional
(score 2, 1, or 0) (score 4, 3, or 2) (score 2, 1, or 0) (score 1 or 0) Vowel Accuracy Articulatory Accuracy transcription
2 = correct 4 = correct on first attempt
Me 1 = uncertain 3 = consistent develop-
0 = distortion mental substitution error
Hi
2 = correct after self-
Toy correction with no
intervening model
Day
AFTER CUEING
Show Final scoring is always done in direct imitation
after all the cued practice trials.
Pow
Articulatory Accuracy
Do 2 = correct after first cued trial
1 = correct after additional cued trials
Go 0 = not correct on final noncued elicitation after
all cued attempts
Bye
Consistency is judged only after all attempts have
You been made. If any two trials differ, then score as
inconsistent.
Total score 1 = consistent
0 = inconsistent

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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 B. Vowel-Consonant

Initial attempt After cueing Brief Scoring Reminders

Articulatory
Vowel Accuracy Accuracy Consistency INITIAL ATTEMPT Optional
(score 2, 1, or 0) (score 4, 3, or 2) (score 2, 1, or 0) (score 1 or 0) Vowel Accuracy Articulatory Accuracy transcription
2 = correct 4 = correct on first attempt
Up 1 = uncertain 3 = consistent develop-
0 = distortion mental substitution error
Out
2 = correct after self-
Eat correction with no
intervening model
Ice
AFTER CUEING
“M” (em) Final scoring is always done in direct imitation
after all the cued practice trials.
Ape
Articulatory Accuracy
Off 2 = correct after first cued trial
1 = correct after additional cued trials
At 0 = not correct on final noncued elicitation after
all cued attempts
On
Consistency is judged only after all attempts have
In been made. If any two trials differ, then score as
inconsistent.
Total score 1 = consistent
0 = inconsistent

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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 C. Reduplicated Syllables

Initial attempt After cueing Brief Scoring Reminders

Prosodic Articulatory Articulatory
Vowel Accuracy Accuracy Accuracy Accuracy INITIAL ATTEMPT Optional
(score 2, 1, or 0) (score 1 or 0) (score 4, 3, or 2) (score 2, 1, or 0) Vowel Accuracy Articulatory Accuracy transcription
2 = correct 4 = correct on first attempt
Papa 1 = uncertain 3 = consistent develop-
0 = distortion mental substitution error
DeeDee 2 = correct after self-
Prosodic Accuracy
Cuckoo Binary scoring correction with no
1 = correct intervening model
Boo-boo 0 = incorrect
AFTER CUEING
Total score
Final scoring is always done in direct imitation
after all the cued practice trials.
Articulatory Accuracy
Prosodic Error Types 2 = correct after first cued trial
1. Segmented 1 = correct after additional cued trials
0 = not correct on final noncued elicitation after
2. Equal stress all cued attempts

3. Incorrect stress
4. Weak syllable deletion
5. Added syllable

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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 D. Consonant-Vowel-Consonant (CVC1: same first and last phoneme)

Initial attempt After cueing Brief Scoring Reminders

Articulatory
Vowel Accuracy Accuracy Consistency INITIAL ATTEMPT Optional
(score 2, 1, or 0) (score 4, 3, or 2) (score 2, 1, or 0) (score 1 or 0) Vowel Accuracy Articulatory Accuracy transcription
2 = correct 4 = correct on first attempt
Mom 1 = uncertain 3 = consistent develop-
0 = distortion mental substitution error
Pop
2 = correct after self-
Peep correction with no
intervening model
Sis
AFTER CUEING
Dad Final scoring is always done in direct imitation
after all the cued practice trials.
Coke
Articulatory Accuracy
Total score 2 = correct after first cued trial
1 = correct after additional cued trials
0 = not correct on final noncued elicitation after
all cued attempts
Consistency is judged only after all attempts have
been made. If any two trials differ, then score as
inconsistent.
1 = consistent
0 = inconsistent

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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 E. Consonant-Vowel-Consonant (CVC2: different first and last phoneme)

Initial attempt After cueing Brief Scoring Reminders

Articulatory
Vowel Accuracy Accuracy Consistency INITIAL ATTEMPT Optional
(score 2, 1, or 0) (score 4, 3, or 2) (score 2, 1, or 0) (score 1 or 0) Vowel Accuracy Articulatory Accuracy transcription
2 = correct 4 = correct on first attempt
Home 1 = uncertain 3 = consistent develop-
0 = distortion mental substitution error
Mine
2 = correct after self-
Hop correction with no
intervening model
Bus
AFTER CUEING
Town Final scoring is always done in direct imitation
after all the cued practice trials.
Mad
Articulatory Accuracy
Bed 2 = correct after first cued trial
1 = correct after additional cued trials
Book 0 = not correct on final noncued elicitation after
all cued attempts
Cat
Consistency is judged only after all attempts have
Sip been made. If any two trials differ, then score as
inconsistent.
Total score 1 = consistent
0 = inconsistent

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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 F. Bisyllabic (One Consonant, Two Vowels)

Initial attempt After cueing Brief Scoring Reminders

Prosodic Articulatory Articulatory
Vowel Accuracy Accuracy Accuracy Accuracy INITIAL ATTEMPT Optional
(score 2, 1, or 0) (score 1 or 0) (score 4, 3, or 2) (score 2, 1, or 0) Vowel Accuracy Articulatory Accuracy transcription
2 = correct 4 = correct on first attempt
Uh oh 1 = uncertain 3 = consistent develop-
0 = distortion mental substitution error
Baby 2 = correct after self-
Prosodic Accuracy
Daddy Binary scoring correction with no
1 = correct intervening model
Mommy 0 = incorrect
AFTER CUEING
Puppy
Final scoring is always done in direct imitation
Cookie after all the cued practice trials.
Articulatory Accuracy
Total score
2 = correct after first cued trial
1 = correct after additional cued trials
0 = not correct on final noncued elicitation after
Prosodic Error Types all cued attempts

1. Segmented
2. Equal stress
3. Incorrect stress
4. Weak syllable deletion
5. Added syllable

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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G. Bisyllabic (more varied syllabic shapes)

Initial attempt After cueing Brief Scoring Reminders

Prosodic Articulatory Articulatory
Vowel Accuracy Accuracy Accuracy Accuracy
INITIAL ATTEMPT Optional
(score 2, 1, or 0) (score 1 or 0) (score 4, 3, or 2) (score 2, 1, or 0) Vowel Accuracy Articulatory Accuracy transcription
2 = correct 4 = correct on first attempt
Bunny 1 = uncertain 3 = consistent develop-
0 = distortion mental substitution error
Happy 2 = correct after self-
Prosodic Accuracy
correction with no
Open Binary scoring
1 = correct intervening model
Forget 0 = incorrect
AFTER CUEING
Today
Final scoring is always done in direct imitation
Canoe after all the cued practice trials.
Articulatory Accuracy
Movie 2 = correct after first cued trial
Balloon 1 = correct after additional cued trials
0 = not correct on final noncued elicitation after
Total score all cued attempts

Prosodic Error Types

1. Segmented
2. Equal stress
3. Incorrect stress
4. Weak syllable deletion
5. Added syllable

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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H. Multisyllabic Words

Initial attempt After cueing Brief Scoring Reminders

Articulatory
Prosodic Articulatory Accuracy Consistency INITIAL ATTEMPT
Vowel Accuracy Accuracy Accuracy (score 2, 1, (score 1 Vowel Accuracy Articulatory Accuracy Optional
(score 2, 1, or 0) (score 1 or 0) (score 4, 3, or 2) or 0) or 0) 2 = correct 4 = correct on first attempt transcription
1 = uncertain 3 = consistent develop-
Banana 0 = distortion mental substitution error
2 = correct after self-
Potato Prosodic Accuracy
Binary scoring correction with no
Video 1 = correct intervening model
0 = incorrect
Peekaboo AFTER CUEING
Honeydew Final scoring is always done in direct imitation
after all the cued practice trials.
Lemonade Articulatory Accuracy
Total score 2 = correct after first cued trial
1 = correct after additional cued trials
0 = not correct on final noncued elicitation after
all cued attempts
Consistency is judged only after all attempts have
been made. If any two trials differ, then score as
inconsistent.
1 = consistent
Prosodic Error Types 0 = inconsistent
1. Segmented
2. Equal stress
3. Incorrect stress
4. Weak syllable deletion
5. Added syllable

Note
Inconsistent voicing errors Trial or error Difficulty with multisyllabic words
Groping Vowel or consonant distortion Awkward movement transitions
Intrusive schwa Lexical stress errors
Slow rate Segmentation

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 Summary Scores

(Number
of words/items) Vowel Accuracy Prosodic Accuracy Overall Accuracy Consistency
A. Consonant-vowel (10)
B. Vowel-consonant (10)
C. Reduplicated syllables (4)
D. CVC1 (6)
E. CVC2 (10)
F. Bisyllabic 1 (6)
G. Bisyllabic 2 (8)
H. Multisyllabic (6)
Number of items (60 items) (24 items) (60 items) (42 items)
Range of scores (0–120) (0–24) (0–240) (0–42)
Totals
Overall Total Score Total possible score = 426

(Prosodic score types are for descriptive purposes)

Prosodic error types Segmentation Equal stress Incorrect stress Weak syllable deletion Added syllable
Reduplicated syllables (4)
Bisyllabic 1 (6)
Bisyllabic 2 (8)
Multisyllabic (6)

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 Observations for Additional Evidence to Consider in Diagnosis

Mark each subtest in which observations of the characteristic were made.

Subtest A B C D E F G H Total number Spontaneous
Observation CV VC RS CVC1 CVC2 Bisyllabic 1 Bisyllabic 2 Multisyllabic of subtests speech
Inconsistent
voicing errors
Groping
Intrusive schwa
Slow rate
Trial and error
Vowel or consonant
distortion
Lexical stress errors
Segmentation
Difficulty with
multisyllabic words
Awkward movement
transitions

Observations of speech characteristics across context: Number of features noted _______ Number of subtests on which features noted _______

Comments on severity of any pertinent characteristics __________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________________________

Severity will vary across these characteristics (e.g., vowel distortions may be more severe than segmentation) and even within each characteristic (e.g., short
intervals in segmentation would be milder than long intervals). Therefore, thinking about the severity as well as the number of features noted and the number of
subtests in which they were seen may be helpful to your judgments of childhood apraxia of speech (CAS) severity and your treatment planning. (Keep in mind,
however, if a child also has dysarthria, slow rate, and some distortions, then it may be due to the dysarthria and not CAS.)

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 DEMSS TOTAL SCORE

Increasing likelihood that the CAS diagnosis is correct

Some evidence for at

Significant evidence for CAS Little or no evidence of CAS
least mild CAS

0 323 373 426

Scores

List any aspects of the medical and developmental history that may be pertinent.

__________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

Summary of other related testing or other observations (e.g., DDK, NVOA testing if completed). Please refer to Chapter 3, page 46 of the manual for a discussion
of interpretation of these additional results.

__________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

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Diagnostic statement, including CAS severity (see examples in Chapter 3)

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 Treatment Planning (Clinical Decisions)

A. Approach

• Examine relative contribution of CAS versus phonologic impairment versus dysarthria.

• Consider coexisting factors such as cognitive level, attention, and family support.

If CAS is severe or the primary problem, then

• Choose an approach focused on motor skill
• Incorporate principles of motor learning, for example
• Dosage is key: schedule sessions as frequently as possible, even if they need to be short
• Smaller stimulus set size for severe CAS
• Modified block approach, moving to more random practice as performance improves
• Provide specific frequent feedback at first, gradually reducing to less specific and less frequent

B. Stimuli choice should take into account the following variables:

Severity (overall total score and responses to cueing) __________________________

(For example, if CAS is severe, use fewer stimulus items at the beginning of therapy)

Vowels in error ________ ________ ________ ________ ________ ________ ________

Syllable shapes containing errors ________ ________ ________ ________ ________ ________

Types of prosodic error ________ ________ ________ ________ ________

Salient meaningful words/phrases for the child containing the vowels in error, yet at the syllable shape/length appropriate given responses on the DEMSS

____________________ ____________________ ____________________ ____________________

____________________ ____________________ ____________________ ____________________

The stimulus set may be larger and likely contain more varied phonemes and more phonetically difficult content for older children or less severe CAS. These sets
would also be composed of longer words, phrases, or sentences.

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