Cleland Joanne, Burr Sam, Harding Sam, Stringer Helen, Wren Yvonne
Psychological Sciences and Health, Graham Hills Building, University of Strathclyde, Glasgow, Scotland.
Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK.
Int J Lang Commun Disord. 2025 May-Jun;60(3):e70052. doi: 10.1111/1460-6984.70052.
There is no single classification system or diagnostic protocol for speech sound disorder (SSD). This makes it difficult to collect large-scale outcome data and determine which interventions work best for which subtypes of SSD. The United Kingdom is unique in that its publicly funded healthcare system allows the collection of such outcome data across large numbers of children; however, a necessary first step towards this is to agree on a consistent diagnostic protocol and classification system for SSD that is feasible for use in the UK healthcare system.
This study aimed to achieve an initial clinician-led UK consensus on a diagnostic protocol and classification system for SSD of unknown origin.
A mixed methods participatory design was used. Five UK health services provided SSD paperwork such as local guidelines and protocols for content analysis. Two participatory workshops were used to agree on: (1) a classification system, (2) subtype labels and definitions, and (3) a feasible diagnostic protocol for SSD. The finalised consensus was presented to a national meeting of 283 SLTs to determine the feasibility of the protocol for clinicians across the whole of the United Kingdom.
Workshop participants agreed that the Differential Diagnostic Classification System was preferred for the United Kingdom. A minimum diagnostic protocol, with additional assessment for complex SSD, was agreed. Over 90% of the national SLT meeting agreed that they could implement the definitions and protocol.
A preliminary diagnostic protocol, classification system, and subtype names and definitions were agreed upon and are broadly in line with those proposed by Dodd (2014). Future work will trial the consensus protocol and classification system in the United Kingdom to investigate treatment outcomes and refine the protocol.
What is already known on this subject There are three main classification systems for speech sound disorder (SSD) that are popular globally: the Speech Disorder Classification System (SDCS) (Shriberg et al. 2019); the Differential Diagnostic Classification System (Dodd 2014); and the Psycholinguistic Framework (Stackhouse and Wells 1993). It is not clear which of these, if any, is most used in the United Kingdom. Moreover, previous research suggests that clinicians employ a wide range of different terms for subtypes of SSD and different diagnostic methods to arrive at these subtypes. This lack of consistency, even within the United Kingdom, is confusing for parents, carers, and practitioners and makes it difficult to compare outcomes. What this study adds We showed that most clinicians in the United Kingdom use the Differential Diagnostic Classification System (Dodd 2014). We therefore suggest that this is now used consistently in the United Kingdom, with some modifications. A feasible diagnostic protocol which includes using the assessment designed specifically for this classification system, the Diagnostic Evaluation of Articulation and Phonology (Dodd et al. 2002), was agreed for clinical use. What are the clinical implications of this work? Clinicians in the United Kingdom can use the subtype labels and diagnostic protocol described here to diagnose subtypes of SSD in a consistent manner. Children with more complex SSD or concomitant disorders will require additional assessments.
目前尚无针对语音障碍（SSD）的单一分类系统或诊断方案。这使得收集大规模的疗效数据以及确定哪种干预措施对SSD的哪些亚型最有效变得困难。英国的独特之处在于其公共资助的医疗保健系统允许收集大量儿童的此类疗效数据；然而，朝着这一目标迈出的必要的第一步是就一种适用于英国医疗保健系统的SSD一致诊断方案和分类系统达成共识。
本研究旨在初步达成由临床医生主导的关于不明原因SSD诊断方案和分类系统的英国共识。
采用混合方法参与式设计。英国的五个医疗服务机构提供了SSD相关文件，如用于内容分析的当地指南和方案。举办了两次参与式研讨会，以就以下内容达成共识：（1）一个分类系统；（2）亚型标签和定义；（3）一个可行的SSD诊断方案。最终确定的共识提交给了由283名言语和语言治疗师参加的全国会议，以确定该方案对全英国临床医生的可行性。
研讨会参与者一致认为差异诊断分类系统更适合英国。商定了一个最低诊断方案，并对复杂的SSD进行额外评估。超过90%的全国言语和语言治疗师会议参与者同意他们可以实施这些定义和方案。
初步的诊断方案、分类系统以及亚型名称和定义已达成共识，并且与多德（2014年）提出的方案大致一致。未来的工作将在英国对共识方案和分类系统进行试验，以研究治疗效果并完善该方案。
关于该主题的已有知识 全球流行的语音障碍（SSD）主要有三种分类系统：言语障碍分类系统（SDCS）（施里伯格等人，2019年）；差异诊断分类系统（多德，2014年）；以及心理语言学框架（斯塔克豪斯和韦尔斯，1993年）。目前尚不清楚在英国这些系统中哪一个（如果有的话）使用最为广泛。此外，先前的研究表明，临床医生对SSD亚型使用了广泛不同的术语以及不同的诊断方法来确定这些亚型。即使在英国国内，这种缺乏一致性的情况也让家长、护理人员和从业者感到困惑，并且难以比较治疗效果。本研究的新增内容 我们表明英国的大多数临床医生使用差异诊断分类系统（多德，2014年）。因此，我们建议在英国现在应一致使用该系统，并进行一些修改。商定了一个可行的诊断方案，包括使用专门为此分类系统设计的评估工具——发音和音系诊断评估（多德等人，2002年），以供临床使用。这项工作的临床意义是什么？英国的临床医生可以使用此处描述的亚型标签和诊断方案以一致的方式诊断SSD亚型。患有更复杂SSD或伴有其他疾病的儿童将需要额外的评估。
