Differential Diagnosis in Children with Speech Sound Disorders
Stefania Gazzola
The differential diagnosis of speech sound disorders (SSD) in childhood poses a major clinical challenge, particularly when distinguishing conditions along a continuum of increasing motor involvement, such as childhood apraxia of speech (CAS), dysarthria, and phonological disorders. This paper presents the Italian adaptation of the Clinical Assessment of Oropharyngeal Motor Development in Young Children (Robbins & Klee) and examines its clinical utility in the assessment of SSD. The protocol integrates speech evaluation with objective measures of anatomical structure, oral and phonatory motor control, articulatory diadochokinesis, maximum phonation time, and lexical variability. It was administered to 191 typically developing children aged 2.6 – 6.11 years and to 152 children with SSD. In typical development, functional scores as well as measures of speed and duration increased proportionally with age, supporting the sensitivity of the instrument in tracking the maturation of motor control systems, while anatomical structure appeared adequate from the earliest age ranges. Distinct profiles emerged in children with SSD: motor speech disorders were characterized by significant impairments in oral and phonatory functions, whereas lexical variability proved to be a valuable clinical marker for differentiating CAS and inconsistent phonetic–phonological disorders from other SSD subtypes. These findings support the clinical relevance of the protocol in reducing diagnostic ambiguity in pediatric SSD.
Keywords
Speech sound disorders; Childhood apraxia of speech; Dysarthria; Lexical variability; Oral motor control.
