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Diagnosing Apraxia of Speech in Children and Adults When There Is No Gold Standard: A Scoping Review About the Diagnostic Process.

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Title: Diagnosing Apraxia of Speech in Children and Adults When There Is No Gold Standard: A Scoping Review About the Diagnostic Process.
Authors: Haley, Katarina L.1 Katarina_Haley@med.unc.edu, Jacks, Adam1, Mailend, Marja-Liisa2
Source: American Journal of Speech-Language Pathology. Mar2026, Vol. 35 Issue 2, p840-859. 20p.
Subject Terms: *Human services programs, *Verbal behavior testing, *Articulation (Speech), *Children, *Adults, Reference values, Consensus (Social sciences), Research funding, Diagnostic imaging, CINAHL database, Diagnostic errors, Descriptive statistics, Systematic reviews, MEDLINE, Stroke, Online information services, Speech apraxia, Psychology information storage & retrieval systems, Sensitivity & specificity (Statistics), Disease complications
Abstract: Purpose: Childhood apraxia of speech (CAS), stroke-induced apraxia of speech (AOS), and progressive apraxia of speech (PAOS) cannot be diagnosed with an error-free gold standard test or measure. Reference standards are sensible approximations but are vulnerable to bias. In this scoping review, we characterize the diagnostic process for reference standards that have been used in recent diagnostic literature and evaluate the extent to which bias-reducing strategies have been implemented. Method: We extracted data about the diagnostic process for studies of speech characteristics in CAS, AOS, and PAOS that were published between 2014 and 2024. Observational studies published in peer-reviewed journals and in English were included, whereas treatment studies, surveys, case studies, and reviews were excluded. Results: Of 198 included studies, the most common diagnostic method was consensus or confirmation by two to three diagnosticians (38.4%), followed by checklist verification (25.3%), and simple clinical impression (19.2%). Testing or measurement techniques were used less frequently for diagnostic purposes (9.6%). The diagnostic process varied by etiology, and strategies to reduce bias were minimally implemented across the board. Conclusions: There is a need to accept that current diagnostic reference standards are inherently imperfect and to reduce risk of bias by using converging evidence, defining syndrome features operationally, standardizing consensus formation, and estimating reliability of classification. A focus shift to how speech profiles, tests, and measures relate directly to prognosis and treatment response may expedite scientific discovery, as may strategy-sharing among those who work with children, adult stroke survivors, and adults with progressive disease. [ABSTRACT FROM AUTHOR]
Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: Diagnosing Apraxia of Speech in Children and Adults When There Is No Gold Standard: A Scoping Review About the Diagnostic Process.
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  Data: <searchLink fieldCode="AR" term="%22Haley%2C+Katarina+L%2E%22">Haley, Katarina L.</searchLink><relatesTo>1</relatesTo><i> Katarina_Haley@med.unc.edu</i><br /><searchLink fieldCode="AR" term="%22Jacks%2C+Adam%22">Jacks, Adam</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Mailend%2C+Marja-Liisa%22">Mailend, Marja-Liisa</searchLink><relatesTo>2</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22American+Journal+of+Speech-Language+Pathology%22">American Journal of Speech-Language Pathology</searchLink>. Mar2026, Vol. 35 Issue 2, p840-859. 20p.
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  Data: *<searchLink fieldCode="DE" term="%22Human+services+programs%22">Human services programs</searchLink><br />*<searchLink fieldCode="DE" term="%22Verbal+behavior+testing%22">Verbal behavior testing</searchLink><br />*<searchLink fieldCode="DE" term="%22Articulation+%28Speech%29%22">Articulation (Speech)</searchLink><br />*<searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br />*<searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Reference+values%22">Reference values</searchLink><br /><searchLink fieldCode="DE" term="%22Consensus+%28Social+sciences%29%22">Consensus (Social sciences)</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnostic+imaging%22">Diagnostic imaging</searchLink><br /><searchLink fieldCode="DE" term="%22CINAHL+database%22">CINAHL database</searchLink><br /><searchLink fieldCode="DE" term="%22Diagnostic+errors%22">Diagnostic errors</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Systematic+reviews%22">Systematic reviews</searchLink><br /><searchLink fieldCode="DE" term="%22MEDLINE%22">MEDLINE</searchLink><br /><searchLink fieldCode="DE" term="%22Stroke%22">Stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Online+information+services%22">Online information services</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+apraxia%22">Speech apraxia</searchLink><br /><searchLink fieldCode="DE" term="%22Psychology+information+storage+%26+retrieval+systems%22">Psychology information storage & retrieval systems</searchLink><br /><searchLink fieldCode="DE" term="%22Sensitivity+%26+specificity+%28Statistics%29%22">Sensitivity & specificity (Statistics)</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+complications%22">Disease complications</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: Childhood apraxia of speech (CAS), stroke-induced apraxia of speech (AOS), and progressive apraxia of speech (PAOS) cannot be diagnosed with an error-free gold standard test or measure. Reference standards are sensible approximations but are vulnerable to bias. In this scoping review, we characterize the diagnostic process for reference standards that have been used in recent diagnostic literature and evaluate the extent to which bias-reducing strategies have been implemented. Method: We extracted data about the diagnostic process for studies of speech characteristics in CAS, AOS, and PAOS that were published between 2014 and 2024. Observational studies published in peer-reviewed journals and in English were included, whereas treatment studies, surveys, case studies, and reviews were excluded. Results: Of 198 included studies, the most common diagnostic method was consensus or confirmation by two to three diagnosticians (38.4%), followed by checklist verification (25.3%), and simple clinical impression (19.2%). Testing or measurement techniques were used less frequently for diagnostic purposes (9.6%). The diagnostic process varied by etiology, and strategies to reduce bias were minimally implemented across the board. Conclusions: There is a need to accept that current diagnostic reference standards are inherently imperfect and to reduce risk of bias by using converging evidence, defining syndrome features operationally, standardizing consensus formation, and estimating reliability of classification. A focus shift to how speech profiles, tests, and measures relate directly to prognosis and treatment response may expedite scientific discovery, as may strategy-sharing among those who work with children, adult stroke survivors, and adults with progressive disease. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of American Journal of Speech-Language Pathology is the property of American Speech-Language-Hearing Association and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=192247772
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      – Type: doi
        Value: 10.1044/2025_AJSLP-25-00178
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      – Code: eng
        Text: English
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        PageCount: 20
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    Subjects:
      – SubjectFull: Human services programs
        Type: general
      – SubjectFull: Verbal behavior testing
        Type: general
      – SubjectFull: Articulation (Speech)
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Adults
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      – SubjectFull: Reference values
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      – SubjectFull: Consensus (Social sciences)
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      – SubjectFull: Research funding
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      – SubjectFull: Diagnostic imaging
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      – SubjectFull: CINAHL database
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      – SubjectFull: Diagnostic errors
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Systematic reviews
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      – SubjectFull: MEDLINE
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      – SubjectFull: Stroke
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      – SubjectFull: Online information services
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      – SubjectFull: Speech apraxia
        Type: general
      – SubjectFull: Psychology information storage & retrieval systems
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      – SubjectFull: Sensitivity & specificity (Statistics)
        Type: general
      – SubjectFull: Disease complications
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    Titles:
      – TitleFull: Diagnosing Apraxia of Speech in Children and Adults When There Is No Gold Standard: A Scoping Review About the Diagnostic Process.
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            NameFull: Haley, Katarina L.
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              Text: Mar2026
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              Y: 2026
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