儿童言语运动障碍专家诊断的可靠性。
The Reliability of Expert Diagnosis of Childhood Apraxia of Speech.
机构信息
The University of Sydney, New South Wales, Australia.
Remarkable Speech + Movement, Sydney, New South Wales, Australia.
出版信息
J Speech Lang Hear Res. 2024 Sep 26;67(9S):3309-3326. doi: 10.1044/2023_JSLHR-22-00677. Epub 2023 Aug 29.
PURPOSE
The current standard for clinical diagnosis of childhood apraxia of speech (CAS) is expert clinician judgment. The psychometric properties of this standard are not well understood; however, they are important for improving clinical diagnosis. The purpose of this study is to determine the extent to which experts agree on the clinical diagnosis of CAS using two cohorts of children with mixed speech sound disorders (SSDs).
METHOD
Speech samples of children with SSDs were obtained from previous and ongoing research from video recordings of children aged 3-8 years ( = 36) and audio recordings of children aged 8-17 years ( = 56). A total of 23 expert, English-speaking clinicians were recruited internationally. Three of these experts rated each speech sample to provide a description of the observed features and a diagnosis. Intrarater reliability was acceptable at 85% agreement.
RESULTS
Interrater reliability on the presence or absence of CAS among experts was poor both as a categorical diagnosis (κ = .187, 95% confidence interval [CI] [0.089, 0.286]) and on a continuous "likelihood of CAS" scale (0-100; intraclass correlation = .183, 95% CI [.037, .347]). Reliability was similar across the video-recorded and audio-only samples. There was greater agreement on other diagnoses (such as articulation disorder) than on the diagnosis of CAS, although these too did not meet the predetermined standard. Likelihood of CAS was greater in children who presented with more American Speech-Language-Hearing Association CAS consensus features.
CONCLUSIONS
Different expert raters had different thresholds for applying the diagnosis of CAS. If expert clinician judgment is to be used for diagnosis of CAS or other SSDs, further standardization and calibration is needed to increase interrater reliability. Diagnosis may require operationalized checklists or reliable measures that operate along a diagnostic continuum.
SUPPLEMENTAL MATERIAL
目的
目前，儿童言语运动障碍（CAS）的临床诊断标准是专家临床医生的判断。该标准的心理测量学特性尚未得到很好的理解；然而，对于改善临床诊断，这些特性非常重要。本研究的目的是通过两个患有混合性言语障碍（SSD）的儿童队列，确定专家在 CAS 临床诊断上的一致性程度。
方法
从以前和正在进行的研究中获取了患有 SSD 的儿童的语音样本，这些研究是通过对 3-8 岁儿童的视频记录（n = 36）和 8-17 岁儿童的音频记录（n = 56）获得的。国际上共招募了 23 名精通英语的专家临床医生。其中 3 名专家对每个语音样本进行评估，提供观察到的特征描述和诊断。内部评估者的可靠性可接受，一致性为 85%。
结果
专家对 CAS 存在或不存在的判断的组间可靠性较差，无论是作为分类诊断（κ =.187，95%置信区间[CI] [0.089, 0.286]）还是作为连续的“CAS 可能性”量表（0-100；组内相关系数=.183，95% CI [.037,.347]）。视频记录和仅音频样本的可靠性相似。在其他诊断（如构音障碍）上的一致性更高，而在 CAS 诊断上则较低，尽管这些诊断也未达到预定的标准。在呈现更多美国言语语言听力协会 CAS 共识特征的儿童中，CAS 的可能性更大。
结论
不同的专家评估者对应用 CAS 诊断有不同的标准。如果要使用专家临床医生的判断来诊断 CAS 或其他 SSD，需要进一步标准化和校准，以提高组间可靠性。诊断可能需要操作检查表或可靠的测量工具，这些工具沿着诊断连续体运作。
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