Benway & Preston (2020)

January 31, 2022


Comparison/Nonintervention Research 


CAS = childhood apraxia of speech

eta =   partial eta squared 

MSWR = multisyllable word repetition 

NA = Not Applicable

nonCAS SSD = speech sound disorder without the diagnosis of childhood apraxia of speech

P = participant or patient

PCC = Percent Consonants Correct 

pmh = Patricia Hargrove, blog developer

SD = standard deviation(s)

SLP = speech-language pathologist

SS = standard score

SSD = speech sound disorders

SOURCE:  Benway, N. R., & Preston, J. L. (2020). Differences between school-age children with apraxia of speech and other speech sound disorders on multisyllable repetition. Perspectives of the ASHA Special Interest Groups, 5(4) 794-808 2020.


DATE: January 29, 2022


TAKE AWAY:  This investigation compared 7 to 17 year-old children with childhood apraxia of speech (CAS) with children with other speech sound disorders (SSD) on a task involving the repetition of multisyllabic words. The purpose of the investigation was to determine which of 15 features derived from the extant research could be used to distinguish the 2 groups of school-aged children. The investigators analyzed previously recorded imitations of multisyllable words of children with CAS and SSD using the 15 features. They determined that the children’s production 4 of the perceptual features differed significantly. One of these features was correct lexical stress. (The others were prevalence of voicing changes, percentage of structurally correct words, and syllable deletions.) Thus, incorrect stress may continue through childhood and has potential for distinguishing children with CAS and SSD (along with the other perceptual features.)

1.  What type of evidence was identified? 

• What was the type of design? Comparison Research and Retrospective, Nonrandomized Group Design with Controls

• What was the focus of the research? Clinically Related

• What was the level of support associated with the type of evidence?  Level = not applicable (NA). This was not an intervention study.

2.  Group membership determination: 

• If there were groups, were participants randomly assigned to groups? No 

• If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?  No

3.  Were experimental conditions concealed?

• from participants? No 

• from administrators of experimental conditions? No 

• from analyzers/judges? Yes 

4.  Were the groups adequately described?  Variable 

 How many participants were involved in the study? 

•  total # of Ps: 61

•  # of groups: 2

•  List names of groups and the number of Ps in each group:  

     – CAS = 21

     – nonCAS SSD = 40

•  Did all groups maintain membership throughout the investigation? Yes  


•  age:  7 to 17 years

•  cognitive skills:  nonverbal IQ of not less than 1.33 standard deviations (SD) below the mean


•  receptive language:  not less than 1.33 standard deviations (SD) below the mean

•  articulation:  below the 7th percentile on a standardized articulation test

•  Hearing:  passed a hearing screening


•  age:  

     – CAS = 11.92 (mean)

     – nonCAS SSD =  11.06 (mean)

•  gender: 

     – CAS = 16 (80%, male); 4 (20%, female) 

     – nonCAS SSD = 23 (56%, male); 18 (44%, female). 

•  phonological processing:  

     – CAS = 85.55 (mean)

     – nonCAS SSD = 101.44 (mean)

•  receptive vocabulary:

     – CAS = 103.15 (mean)

     – nonCAS SSD =  113.56 (mean)

• Syllable Repetition Task- Percent Consonants Correct (PCC):  

     – CAS = 85% (mean)

     – nonCAS SSD = 92% (mean)

• Syllable Repetition Task- Additions:  

     – CAS =  3.37  (mean)

     – nonCAS SSD = 0.75 (mean)

•  articulation skill:

     – CAS = standard score (SS) was 53.5 (mean)

     – nonCAS SSD =  SS  was 72.2  (mean)

•  Maximum Performance Task- Dysarthria Score:

     – CAS =  0.26 (mean)

     – nonCAS SSD =  0.05 (mean)

•  Maximum Performance Task- Apraxia Score:

     – CAS =  1.58 0.26 (mean)

     – nonCAS SSD = 0.73 0.26 (mean)

–  Were the groups similar? No  

–  Were the communication problems adequately described? No  

     •  disorder types:  Childhood Apraxia of Speech; Speech Sound Disorder without diagnosis of Childhood Apraxia of Speech

5.  What were the different conditions for this research?

•  Subject (Classification) Groups? Yes :

     – CAS

     – nonCAS SSD

•  Experimental Task? Yes 

     – Ps imitated recordings of 20 words consisting of 3 to 5 syllables

•  Criterion/Descriptive Conditions? Yes

Articulatory movements impacting segments

     – voicing change

     – lengthened vowels 

     – nasal changes

Phonological structure

     – percent structurally correct words

     – percent full syllable deletion 

     – migrations  

     – epenthesis 

     – percent full syllable addition 

     – lenitions  

     – metathesis 


     – percent stress correct  

     – syllable segregation

Overall segmental accuracy

     – percent consonants correct 

     – percent phonemes correct 

     – percent vowels correct 

6.   Were the groups controlled acceptably? Yes 

7.  Were dependent measures appropriate and meaningful? Yes 

     – OUTCOME #1: voicing change 

     – OUTCOME #2: percent structurally correct words

     – OUTCOME #3: percent stress correct  

     – OUTCOME #4: percent full syllable deletion 

     – OUTCOME #5: percent consonants correct

     – OUTCOME #6: migrations 

     – OUTCOME #7: lengthened vowels 

     – OUTCOME #8: percent phonemes correct 

     – OUTCOME #9: percent vowels correct 

     – OUTCOME #10: epenthesis 

     – OUTCOME #11: nasal changes

     – OUTCOME #12: percent full syllable addition

     – OUTCOME #13: lenitions 

     – OUTCOME #14: metathesis 

     – OUTCOME #15: syllable segregation

• All the dependent measures were subjective.

• None of the dependent measures were objective.

8.  Were reliability measures provided?

  Interobserver for analyzers?  Yes. The investigators provided reliability data for transcribing of

          – segment accuracy (.97), 

          – segregated syllables (.83), and 

          – lexical stress deviations (.71).   

•  Intraobserver for analyzers?  No  _

•  Treatment or test administration fidelity for investigators?  NA 

9.  Description of design: 

• The investigation involved 2 questions. The first question involved a review of the literature in which over 190 features were identified as potentially being able to differentiate between children (7-17 years) with CAS and those with SSD but not CAS (nonCAS SSD).

• The investigators systematically reduced the original of list of features to 15 perceptual features. (Only of 2 these features were prosody related.) These 15 features were selected for involvement in question two.

• The purpose of the second question was to determine if children with CAS could be distinguished from children with nonCAS SSD. Using the 15 perceptual features, the investigators analyzed previously recorded productions on a multisyllable word repetition (MSWR) task of 61 children (CAS = 20; nonCAS SSD = 41) 

10.  What were the results of the statistical (inferential) testing?

• Because of multiple statistical comparisons, a correction was applied to the results of the inferential tests. Accordingly, the p values for comparisons that were labelled as significant ranged from .0004 to .0034.

• The following features were judged to be significantly different:

     – OUTCOME #1: voicing change

     – OUTCOME #2: percentage of structurally correct words

     – OUTCOME #3: percent stress correct

     – OUTCOME #4: percent full syllable deletion

•  What was the statistical test used to determine significance? Mann-Whitney U

•  Were effect sizes provided? Yes 

     – OUTCOME #1: voicing change  (derived Cohen’s d = 0.95, large)

     – OUTCOME #2: percentage of structurally correct words (derived Cohen’s d = 0.907, large)

     – OUTCOME #3: percent stress correct (derived Cohen’s d = 0.865, large)

     – OUTCOME #4: percent full syllable deletion (derived Cohen’s d = 0.74, moderate)

•  Were confidence interval (CI) provided?  Yes. For the most part no, but they were provided for reliability data.

11.  Summary of correlational results:   The investigators provided these data but they are not the focus of this review.

12.  Summary of descriptive results:  Qualitative research.  NA

13.  Brief summary of clinically relevant results:  

The investigators determined that the CAS and nonCAS SSD children’s performance on a MSWR task could be distinguished using 4 features: correct lexical stress, prevalence of voicing changes, percentage of structurally correct words, and syllable deletions. With respect to prosody, incorrect stress may continue through childhood for students diagnosed with CAS. 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: NA, this is not an intervention study.


Fairbanks (1960, Ch. 13, Phrases)

January 13, 2022


(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-third of the way down this post. 


C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 13, Phrases) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 146-151)

Reviewer(s):  pmh

Date:  January 13, 2022

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

Level of Evidence:  Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

Take Away: This chapter of Fairbanks (1960) is concerned with the use of phrasing. Fairbanks focuses on two aspects of phrasing: the prosodic marking of phrases and the correspondence between phrases and breathing. This review, however, is only concerned with phrases. 

1.  Was there a review of the literature supporting components of the intervention?  No 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  Not Applicable (NA)

3.  Was the intervention based on clinically sound clinical procedures?  Yes 

4.  Did the author provide a rationale for components of the intervention?  Variable

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1: Appropriate phrasing by modifying location and duration of pauses

•  Outcome #2: Appropriate use of stress (prominence)

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No


PURPOSE:  To produce appropriate phrasing using pausing (location and duration) and stress (prominence) 



ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  phrasing, stress (prominence)

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  pauses, duration, intensity, pitch, rate


ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.   


1. The author defines phrases and explains that the same passage can be divided into a variety of phrasing patterns. Because of the variation, the development of norms a challenge. Nevertheless, the author provides the following guide for the reading aloud of factual information:  6 to 7 words per phrase or 25 to 30 phrases per minute.

2. C provides P with sentences (see Fairbanks, 1960, p. 146, #1) marked for pausing. P reviews the sentences (e.g., If you get the ice cream,| chocolate sprinkles,| and the whipped cream,| we can get started|) and P

     ∞reads the sentence aloud attending to the markings and then 

     ∞ reads the same passage with alternative pausing suggesting a different meaning.

3. P reads the passages from #2 with inappropriate pausing.

4. P reads the passages from #2 with unconventional but meaningful pausing.

5. C provides a set of sentences that increase in length from 2 words to 20 words but only have one pause. (See Fairbanks, 1960, p. 146, #4.) P reads aloud the series of sentences. 

6. P marks each sentence from #5 with 2 pauses and then reads aloud the sentences as marked.

7. P again marks the sentences from #5 but this time identifies optimal pausing. P then reads the sentences aloud. 

8. Using a graphic/visual representation of pausing of phases in a short passage, P reads the passage aloud attempting to replicate the pauses and the duration of the phrases on the representation.

9. P reviews a conventionally written paragraph (see Fairbanks, 1960, p. 147, #8) and marks appropriate pausing. P then reads aloud the passage with the designated pausing.

10. P reads aloud a paragraph that is written with no capitalizations or punctuations. (See Fairbanks, 1960, p. 147-148, #8.) 

     ∞ The first time P reads the paragraph aloud, the objective is continuous speaking with pauses only for breathing. 

     ∞ P reviews the paragraph and marks pauses that are appropriate to the meaning and then reads it aloud.

11. P reads a 100-word factual paragraph silently and then reads it aloud with appropriate phrasing. NOTE: P does not mark the paragraph for pauses.

12. C provides 18 sentences to the P. (See Fairbanks, 1960, p. 148, #11.) Each sentence is bounded by 1, 2,  or 3 bars representing short, medium, or long pauses. P reads aloud the sentences with the designated pauses 

13. P rereads the 18 sentences from #12:

     – with all short pauses, 

     – then with all medium pauses, and

     – finally with all long pauses.

14. C provides P with a set of sentences consisting of 2 phrases/clauses. (See Fairbanks, 1960, p. 148, #13.)

     – P marks each sentence with a single bar (|) signifying an appropriate place for a pause.

     – P then experiments with the length of pauses in each sentence and settles on a pause duration for each of the bars that is appropriate for an imagined content (emotional state, situation) for each sentence.

     – P then marks the sentences with the new pause durations (short |, medium ||, long |||) and reads the sentences aloud.

15. C provides a paragraph with no punctuation. (See Fairbanks, 1960, p. 149, #14.)  P reviews the paragraph and adds marks (bars) for place of pauses and the duration. P then reads aloud the paragraph.

18. C provides a paragraph with content that focuses on prominence/stress and opportunities to produces varying degrees of prominence/stress. (See Fairbanks, 1960, p. 150, #17.)

16. C provides sentences containing 3 marked phrases each (see Fairbanks, 1960, p. 149-150, #16). P reads aloud the sentences with special attention to the 2nd phrase within each sentence. Fairbanks claims that the 2nd phrase likely 

     ∞ is produced with the pause after the phrase longer than the pause before it

     ∞ has less intensity, lower pitch, and/or faster rate (i.e., less prominence/stress).

     ∞ P then rereads the sentences with attention to prominence 

17. C rewrites the sentence from #16, but transposes the second phrase in each sentence with the third. (For Example, the sentence “| It’s too bad | I said, | that you can’t go.| “is transposed to  “| It’s too bad | that you can’t go | I said. |”

     ∞ P reviews the revised sentences and marks the phrases with pause durations that are appropriate to any new meanings.

     ∞ P then reads the transposed sentence aloud with appropriate pause (locations and durations) while also attending to prominence.

     ∞ P reviews the paragraph marking phrase and noting potential use of prominence.

     ∞ P reads aloud the paragraph.

19. C provides a paragraph with no punctuation about grammar and phrasing. (See Fairbanks, 1960, pp. 150-151, #18.)

     ∞ P reviews the paragraph as well as marks for location and duration of pauses.

     ∞ P reads aloud the marked paragraph while also producing appropriate prominences/stresses.