Methods of assessing of childhood apraxia of speech: systematic review

Oliveira, Aline Mara de; Nunes, Isadora; Cruz, Greicyhelen Santos da; Gurgel, Léia Gonçalves

doi:10.1590/2317-6431-2021-2524

Brasil

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Literature Review • Audiol., Commun. Res. 26 • 2021 • https://doi.org/10.1590/2317-6431-2021-2524 linkcopy

Methods of assessing of childhood apraxia of speech: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose Systematically review the protocols and/or assessments that contribute to the diagnosis of CAS and classify them according to the clinical dimension evaluated

Research strategy Study of systematic literature review in the databases MEDLINE (accessed via PubMed), LILACS, Scopus and SciELO with the descriptors Apraxias, Childhood apraxia of speech, Evaluation, Assessment, Validation Studies, Evaluation Studies, Language Therapy, Rehabilitation of Speech and Language Disorders, Child and Child, Preschool.

Selection criteria The search for scientific articles in the databases was conducted by three independent researchers. Studies that clearly assessed subjects with suspected or diagnosed PIA were included. The reviewers performed data collection with regard to methodological characteristics, interventions and study outcomes using standardized forms. The main data collected was related to the assessment procedures of CAS.

Results Most studies (14 of the 21 included) made an association between the assessment of motor and/or articulatory and segmental skills. Five performed an evaluation of all listed aspects: motor and/or articulatory, segmental and suprasegmental; and two underwent only motor and/or articulatory assessment. The age of the subjects in the present study ranged from 3 to 12 years.

Conclusion The assessment of CAS generally involves the association between the assessment of motor and/or articulatory and segmental skills. It is suggested that further studies in order to evidence validity for the assessment of CAS.

Keywords: Rehabilitation of speech and language disorders; Speech; Speech intelligibility; Apraxias; Child

Authors and year of publication	Periodical and IF	Títle	Objective	Delimitation	Number and Sample Type	Valuation Dimension	Used instrument(s)
Keske-Soares et al., 2018⁽¹⁷⁾	CODAS (N.A.)	Performance of children with speech sound disorders in the instrument “Dynamic evaluation of motor speech skills”	Compare the performance of children with typical speech acquisition, phonological disorder and CAS in the variables production accuracy and consistency of the instrument “Dynamic evaluation of motor speech skills” (DEMSS-BR).	Cross-sectional, descriptive, quantitative.	18 children; both male and female; 4 years and 6 months to 5 years and 8 months of age.	Motor/or articulatory, segmental and suprasegmental aspects.	Dynamic Evaluation of Motor Speech Skills DEMSS-BR⁽¹⁸⁾
Gomez et al., 2018⁽¹⁹⁾	Lang Speech Hear Serv Sch. (N.A.)	Treating Childhood Apraxia of Speech With the Kaufman Speech to Language Protocol: A Phase I Pilot Study	Expand the evidence base for the treatment of Childhood Apraxia of Speech by completing a feasibility study on the Kaufman Speech to Language Protocol approach (Kaufman, 2014).	Experimental study before and after intervention.	2 children; one male with 5 years and 8 months of age and another female with 4 years and 4 months of age.	Motor/or articulatory and segmental aspects.	Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾; Test of Polysyllables⁽ ²¹⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾;
							Oral and Speech Motor Control Protocol⁽²³⁾.
Thomas et al., 2018⁽²⁴⁾	Speech Lang Pathol. (1,280)	Combined clinician parent delivery of Rapid Syllable Transition (ReST) treatment for childhood apraxia of speech	Report treatment and fidelity results on the combination of treatment with rapid syllable transition (ReST) linked with home practice.	Case series study	5 children; both male and female; from 5 years and 1 month to 11 years and 7 months of age.	Motor/or articulatory and segmental aspects.	Goldman-Fristoe: Test of Articulation–Second Edition⁽²⁰⁾;
	Speech Lang Pathol. (1,280)						Test of Polysyllables⁽²¹⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾;
							Oral and Speech Motor Control Protocol⁽²³⁾.
Preston et al., 2017⁽²⁵⁾	Am J Speech Lang Pathol (1,713)	Variable Practice to Enhance Speech Learning in Ultrasound Biofeedback Treatment for Childhood Apraxia of Speech: A Single Case Experimental Study	Evaluate the role of variability of practice through prosodic variation during speech training, in the treatment of biofeedback for children with CAS.	Experimental case study	6 children; school age.	Motor/or articulatory, segmental and suprasegmental aspects.	Goldman-Fristoe: Test of Articulation–Second Edition⁽²⁰⁾;
							Emphatic stress task⁽¹³⁾;
							Multisyllabic Word Repetition Task⁽¹²⁾;
							Maximum performance task ⁽ ¹⁶ ^, ²⁶ ⁾;
							Syllable Repetition Task⁽ ¹⁷ ⁾, percentages of correct consonants and the percentage of items with additionals ⁽ ²⁵ ⁾ .
Thomas et al., 2016⁽²⁷⁾	Lang Commun Disord (1,504)	Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech	Conduct a Phase 1 efficacy study of CAS treatment through teleconsultation and in person, in addition to discussing the efficacy of ReST treatment.	Case series study	5 children; both male and female; from 5 years and 5 months to 11 years and 2 months of age.	Motor/or articulatory and segmental aspects.	Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾;
							Test of Polysyllables⁽²¹⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾;
							Oral and Speech Motor Control Protocol⁽²³⁾.
Murray et al., 2015⁽²⁸⁾	J Speech Lang Hear (1,906)	A Randomized Controlled Trial for Children With Childhood Apraxia of Speech Comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme-Third Edition	Compare the experimental treatment of Rapid Syllable Transition Treatment (ReST) and the Nuffield Dyspraxia Program - Third Edition.	Case series study	26 children; 18 boys and 8 girls; 4 to 12 years old.	Motor/or articulatory and segmental aspects.	Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾;
							Test of Polysyllables⁽ ²¹ ⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾;
							Oral and Speech Motor Control Protocol⁽²³⁾;
							Strand’s 10-point checklist⁽²⁹⁾.
Murray et al., 2015⁽⁵⁾	J Speech Lang Hear (1,906)	Differential Diagnosis of Children with Suspected Childhood Apraxia of Speech	Identify a set of objective measures that differentiate CAS from other speech alterations.	Cross-sectional, descriptive, quantitative.	72 children; both male and female; 4 to 12 years old.	Motor/or articulatory and segmental aspects.	Test of Polysyllables⁽²¹⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾;
							Oral and Speech Motor Control Protocol⁽²³⁾;
							Strand’s 10-point checklist⁽²⁹⁾.
Tükel et al., 2015⁽¹⁸⁾	Speech Lang Pathol	Motor functions and adaptive behavior in children with childhood apraxia of speech	Understand the extent of undiagnosed motor and behavioral problems in children with CAS, determining the profile and relationships between motor functions of non-oral, manual and global body speech/production and adaptive behaviors in CAS.	Cross-sectional, descriptive, quantitative.	18 children; 5 girls and 13 boys; 4 years and 4 months old to 10 years and 6 months old.	Motor/or articulatory aspects.	Verbal Motor Production Assessment for Children–VMPAC⁽¹⁰⁾
Tükel et al., 2015⁽¹⁸⁾	-0.8			Cross-sectional, descriptive, quantitative.		Motor/or articulatory aspects.	Verbal Motor Production Assessment for Children–VMPAC⁽¹⁰⁾
Namasivayam et al., 2015⁽³⁰⁾	Lang Commun Disord. (1,504)	Treatment intensity and childhood apraxia of speech	Investigate the effects of treatment intensity on outcome measures related to articulation, communication and speech intelligibility for children with CAS submitted to individual motor speech intervention.	Experimental study before and after intervention.	37 children; 9 girls and 28 boys; between 32-54 months of age.	Motor/or articulatory and segmental aspects.	Kaufman Speech Praxis Test for Children⁽⁹⁾;
							Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾;
							Children’s Speech Intelligibility Measure—CSIM⁽³¹⁾;
							Beginner’s Intelligibility Test—BIT⁽³²⁾.
McCabe et al., 2014⁽³³⁾	Dev Neurorehabil. (1,578)	Orthographically sensitive treatment for dysprosody in children with childhood apraxia of speech using ReST intervention	Report the efficacy of the ReST intervention used in conjunction with pseudoword stimuli, containing orthographic cues that are strongly associated with strong-weak or weak-strong patterns of lexical stress.	Case study with follow-up.	4 children; 4 boys; 5 years and 5 months old to 8 years and 6 months of age.	Motor/or articulatory and segmental aspects.	Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾
Dale and Hayden, 2013⁽³⁴⁾	Speech Lang Pathol (0.80)	Treating speech subsystems in childhood apraxia of speech with tactual input: the PROMPT approach	Examinar sistematicamente a eficácia do PROMPT para crianças com apraxia da fala na infância (AFI). Systematically examine the efficacy of PROMPT for children with Childhood Apraxia of Speech (CAS).	Case series study	4 children; 3 boys and one girl; between 3 years and 6 months and 6 years old.	Motor/or articulatory and segmental aspects.	Verbal Motor Production Assessment for Children–VMPAC⁽¹⁰⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾;
							Intelligibility Test of Children’s Speech–TOCS+⁽³⁵⁾
Strand et al., 2013⁽¹¹⁾	Speech Lang Hear	A motor speech assessment for children with severe speech disorders: reliability and validity evidence	Report evidence of reliability and validity for the Dynamic Evaluation of Motor Speech Skills (DEMSS).	Validation study	81 children; 63 boys and 18 girls; 36 to 79 months of age.	Motor/or articulatory, segmental and suprasegmental aspects.	Dynamic Evaluation Motor of Speech Skills–DEMSS⁽¹¹⁾
Preston et al., 2013⁽³⁶⁾	Speech Lang Pathol (0.80)	Ultrasound biofeedback treatment for persisting childhood apraxia of speech	Evaluate the effectiveness of a treatment program for children with persistence of speech sound errors - includes ultrasound biofeedback - associated with CAS.	Case series study	6 children; all male; Nine to ten years old.	Motor/or articulatory and segmental aspects.	Verbal Motor Production Assessment for Children–VMPAC⁽¹⁰⁾;
							Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾;
							Emphatic Stress Task⁽¹³⁾.
Maas et al., 2012⁽³⁷⁾	Speech Lang Pathol (1,906)	Feedback frequency in treatment for childhood apraxia of speech	Examine the role of feedback frequency in the treatment of CAS.	Case series study	4 children; 2 boys and 2 girls; 5 to 8 years old.	Motor/or articulatory, segmental and suprasegmental aspects.	Dynamic Evaluation Motor of Speech Skills–DEMSS⁽ ¹¹ ⁾;
Maas et al., 2012⁽³⁷⁾	Speech Lang Pathol (1,906)			Case series study	4 children; 2 boys and 2 girls; 5 to 8 years old.		Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾;
Murray et al., 2012⁽³⁸⁾	BMC Pediatr. (1,983)	A comparison of two treatments for childhood apraxia of speech: methods and treatment protocol for a parallel group randomised control trial	Conduct a larger-scale clinical trial of rapid syllable transition treatment (ReST) compared to the Nuffield Dyspraxia Programme – Third Edition (NDP3).	Randomized controlled trial.	20 children; N.A.; between 4 and 12 years old.	Motor/or articulatory, segmental and suprasegmental aspects.	Diagnostic Evaluation of Articulation and Phonology–DEAP⁽ ²² ⁾;
							Test of Polysyllables⁽²¹⁾;
							Profiling Elements of Prosody in Speech Communication–PEPS-C⁽³⁷⁾;
							Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾.
Ballard et al., 2010⁽²³⁾	Speech Lang Hear (1,906)	A treatment for dysprosody in childhood apraxia of speech	Phase II study with 3 children. Investigate the effectiveness of a treatment that aims to improve the control of the relative durations of non-word syllables, composed of 3 syllables representing strong-weak and weak-strong emphasis patterns.	Case series study	3 children; 2 boys and 1 girl; between 7 and 10 years old.	Motor/or articulatory and segmental aspects.	Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾;
							Children's Test of Nonword Repetition–CNRep⁽³⁹⁾;
							Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾.
Iuzzini and Forrest, 2010⁽²⁰⁾	Clin Linguist Phon (N.A.)	Evaluation of a combined treatment approach for childhood apraxia of speech	Investigate the impact of a dual treatment approach that includes a stimulability training protocol paired with a modified basic vocabulary treatment focused on speech sounds produced by children with CAS.	Case study	4 children; 2 boys and 2 girls; between 3 and 6 years old.	Motor/or articulatory and segmental aspects.	Goldman-Fristoe Test of Articulation–Second Edition⁽²⁰⁾;
Iuzzini and Forrest, 2010⁽²⁰⁾	Clin Linguist Phon (N.A.)			Case study	4 children; 2 boys and 2 girls; between 3 and 6 years old.	Motor/or articulatory and segmental aspects.	Diagnostic Evaluation of Articulation and Phonology–DEAP⁽²²⁾.
Aziz et al., 2010⁽²²⁾	J Pediatr Otorhinolaryngol. (1,125)	Childhood apraxia of speech and multiple phonological disorders in Cairo-Egyptian Arabic speaking children: Language, speech, and oro-motor differences	Question a possible significant difference in oral speech, speech and non-speech performance among children with childhood apraxia of speech, with multiple phonological disorder and typical children that can be used for differential diagnostic purposes.	Case-control study	30 children; 16 boys and 14 girls; between 4 and 6 years old.	Motor/or articulatory and segmental aspects.	Arabic Articulation Test⁽ ²⁹ ⁾
Aziz et al., 2010⁽²²⁾	J Pediatr Otorhinolaryngol. (1,125)			Case-control study		Motor/or articulatory and segmental aspects.	The Arabic Syllable Accuracy Word Task (ASAWT)⁽⁴⁰⁾
Sealey and Giddens, 2010⁽²¹⁾	Clin Linguist Phon (N.A.)	Aerodynamic indices of velopharyngeal function in childhood apraxia of speech	Document differences in velopharyngeal function in children diagnosed with CAS and children with typical speech development.	Case-control study.	6 children; N.A.; between 5 and 9 years old.	Motor/or articulatory and segmental aspects.	Kaufman Speech Praxis Test for Children ⁽ ⁹ ⁾
Newmeyer et al., 2009⁽³⁹⁾	Phys Occup Ther Pediatr. (0.75)	Results of the Sensory Profile in children with suspected childhood apraxia of speech	Review and compare the results of the sensory profile in children with a specific type of phonological disorder, childhood apraxia of speech and explore the relationship between sensory processing deficit and sound production.	Cross-sectional study	38 children; 33 boys and 5 girls; Three to 10 years old.	Motor/or articulatory and segmental aspects.	Kaufman Speech Praxis Test for Children ⁽ ⁹ ⁾

Author and Year	Name and Authors	Target Audience	What it assesses	Objectives	Peculiarities	Psychometric properties
Gomez et al., 2018⁽¹⁹⁾; Thomas et al., 2018⁽²⁴⁾; Murray et al., 2015⁽²⁸⁾; Murray et al., 2015⁽⁵⁾	Oral and Speech Motor Control Protocol (Robbins and Klee, 1987)⁽⁴⁴⁾	American children from 2 years and 6 months to 6 years and 11 months of age.	It evaluates orofacial structures and functions.	Determine whether deficits in oral structures or functions might justify speech difficulties.	It contains three parts:	It presents measures of reliability and internal consistency
					1. Evaluation of structures, made from visual inspections;	(Robbins and Klee, 1987)⁽⁴⁴⁾.
					2. Functional evaluation, made from verbal commands;
					3. Evaluation of the syllable repetition rate and the duration of vowel extension.
Gomez et al., 2018⁽¹⁹⁾; Thomas et al., 2018⁽²⁴⁾; Preston et al., 2017⁽²⁵⁾; Thomas et al., 2016⁽²⁷⁾; Murray et al., 2015⁽²⁸⁾; Ballard et al., 2010⁽²³⁾; Iuzzini and Forrest, 2010⁽²⁰⁾	Goldman-Fristoe Test of Articulation	It can be used in a wide age group: 2 years and 0 months old to 21 years and 11 months of age.	It evaluates the production of consonants in initial, medial and final position, as well as the production of consonant clusters.	Measure the articulation of consonant sounds and determine the types of speech production errors.	It consists of 34 images that allow you to obtain up to 53 target words.	Validated for the English language and standardized by gender (male and female) for the American population.
	GFTA-2
	(Goldman and Fristoe, 2000)⁽⁴¹⁾
Tükel et al., 2015⁽¹⁸⁾; Dale and Hayden, 2013⁽³⁴⁾; Preston et al., 2013⁽³⁶⁾	Verbal Motor Production Assessment	Children aged 3 years to 12 years and 11 months old.	It evaluates the motor functions of speech as well as the oral structures.	Analyze the accuracy and quality of motor movements, identifying the levels of motor speech interruption.	It consists of 82 items, subdivided into 5 areas:	Study and reliability test-retest and among examiners; content and construct validity; standardized (McCauley and Strand, 2008)⁽⁴⁵⁾
	for Children- VMPAC (Hayden and Square, 1999)⁽¹⁰⁾				1. Global motor control;
					2. Oromotor control;
					3. Sequencing;
					4. Connected speech and oral language;
					5. Speech characteristics.
Aziz et al., 2010⁽²²⁾	Arabic Articulation Test (Kotby et al., 1986)⁽²⁹⁾	N.A.	It evaluates the production of consonants and vowels alone besides in different positions of the words (initial, intermediate and final).	Analyze the production of the word at the articulatory level.	It consists of 23 images that should be named, allowing the evaluation of 23 Arab consonants along with 6 vowels.	N.A.

Author and Year	Name and Authors	Target Audience	What it assesses	Objectives	Peculiarities	Psychometric properties
Gomez et al., 2018⁽¹⁹⁾; Thomas et al., 2018⁽²⁴⁾; Thomas et al., 2016⁽²⁷⁾; Murray et al., 2015⁽²⁸⁾⁾; Murray et al., 2015⁽⁵⁾; Murray et al., 2012⁽³⁸⁾	Single Word Test of Polysyllables (Gozzard et al., 2004)⁽⁴³⁾	Children within the age range of 4-12 years old.	It assesses syllable segregation, coarticulatory transitions and errors of lexical stress.	Evaluate speech production from polysyllabic words.	It presents 25 polysyllabic words.	N.A.
Ballard et al., 2010⁽²³⁾	Children's Test of Nonword Repetition - CNRep (Gathercole and Baddeley, 1996)⁽⁴⁶⁾	Children within the age range of 4-8 years old.	It evaluates, by means of a task of repetition, short-term memory.	To analyze the transient storage of unknown phonological forms, observing working memory, fundamental for the development of reading and writing.	It consists of 40 pseudowords of different lengths (ranging from 2 to 5 syllables). These are presented to the child, who should repeat them immediately.	It presents high test-retest reliability. It has standardization measures.
Ballard et al., 2010⁽²³⁾		Children within the age range of 4-8 years old.				(Gathercole and Baddeley, 1996) ⁽⁴⁶⁾.
Preston et al., 2017⁽²⁵⁾	Syllable Repetition Task (Shriberg et al., 2009)⁽⁴⁷⁾	It evaluates a wide age group.	It evaluates, by means of an imitation task, the speaker's ability to repeat pseudowords composed of 2 to 4 syllables.	Analyze the transient storage of unknown phonological forms.	It consists of 18 items, which merge combinations between sound consonants /b/, /d/, /m/ and /n/, in addition to the vowel /e/.	It presents internal reliability, simultaneous validity, transcription validity and reliability (Shriberg et al., 2009)⁽⁴⁷⁾
Preston et al., 2017⁽²⁵⁾	Syllable Repetition Task (Shriberg et al., 2009)⁽⁴⁷⁾	It evaluates a wide age group.			For example: /bede/, /debeme/ and /menebede/.
Aziz et al., 2010⁽²²⁾	The Arabic Syllable Accuracy Word Task - ASAWT (Velleman, 2002)⁽⁴⁰⁾	N.A.	Evaluates the syllabic accuracy from repetition tasks.	Analyze the individual's ability to produce accurately a number, shape or sequence of syllables.	It consists of 32 items of different syllabic structures, such as CV and CVC. The levels of tasks were organized into 8 categories with increasing task difficulty.	N.A.
Namasivayam et al., 2015⁽³⁰⁾	Beginner’s Intelligibility Test - BIT (Osberger et. al, 1994)⁽³²⁾	Children within the age range of 4-8 years old.	It evaluates, by means of sentence repetition tasks, the intelligibility of the individual's speech.	Analyze the therapy effectiveness, as well as the impact of the disorder on the understanding of the individual's speech.	It has 4 lists, each consisting of 10 sentences. The evaluator reads them and the patient should repeat them in sequence. The therapist records in audio the individual's speech, which is analyzed by independent listeners later on.	N.A.
Dale and Hayden, 2013⁽³⁴⁾	Intelligibility Test of Children’s Speech - TOCS (Hodge et al., 2009)⁽³⁵⁾	Children within the age range of 3-7 years old.	It evaluates the intelligibility of words and phrases from the patient's speech.	N.A.	It consists of a software that presents, on a computer, a spoken model (words and/or phrases) and its image, for the patient to imitate.	N.A.
Wilcox and Morris, 1999⁽³¹⁾	Children’s Speech Intelligibility Measure - CSIM (Wilcox and Morris, 1999)⁽³¹⁾	N.A.	It evaluates, by means of word repetition tasks, the intelligibility of the individual's speech.	Analyze the therapy efficacy, as well as the impact of the disorder on the understanding of the patient's speech.	It is composed of lists of 50 words, which differ in pre- and post-treatment evaluation. The patient should imitate the therapist's model and his/her speech should be recorded in audio. It is analyzed by independent listeners later on.	N.A.
Rvachew et al., (2005)⁽⁴⁸⁾	Maximum Performance Task (Rvachew et al., 2005⁽⁴⁸⁾	N.A.	It evaluates the motor functioning of speech.	Analyze the duration of phonation, how quickly syllables can be repeated, etc.	It is composed of tasks with sustentation of fricatives and vowels, as well as repeated production of monosyllables and trisyllable /pataka/.	Standardization; Predictive validity: sensitivity and specificity⁽¹⁶⁾.

Author and Year	Name and Authors	Target Audience	What it assesses	Objectives	Peculiarities	Psychometric properties
Shriberg et al., 2010⁽¹³⁾	Emphatic	N.A.	It evaluates the ability to imitate the phrasal stress correctly.	Verify if the child perceives the contrast between the words, differentiating the stressed words from the unstressed ones.	It consists of phrases like “João LOVES to play soccer”.	It was recently translated into Portuguese (Oliveira, et al. 2020)⁽⁶⁾
	Stress Task				The evaluator utters the sentence and the child must repeat it.
	(Shriberg et al., 2010)⁽¹³⁾
Peppé and McCann, (2003)⁽⁴⁹⁾	Profiling Elements of Prosody in Speech- Communication- PEPS-C	Wide age group, which covers both adults and children.	It evaluates receptive and expressive prosodic skills on two levels, formal and functional	Evaluate prosodic impairment in individuals with speech and language disorders.	A spoken expression is played, while two image options appear on a computer screen. The patient should choose the one that corresponds with the statement heard (when the task is receptive); or talk about the images, when the task is expressive.	PEPS-C is not standardized and there are only some normative data. However, it has already been adapted to several languages⁽⁴⁹⁾.
Peppé and McCann, (2003)⁽⁴⁹⁾	(Peppé and McCann, 2003)⁽⁴⁹⁾	Wide age group, which covers both adults and children.

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[1] Subtitle: IF = impact factor; N.A. = not available; PROMPT = Prompts for Restructuring Oral Muscular Phonetic Targets