Really need to share this. Is this the first ever treatment study for the children with CAS in Chinese-speaking population?
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2013 年，Journal of Speech, Language, and Hearing Research 發表咗一份文章報告Dynamic Evaluation of Motor Speech Skill (DEMSS)嘅reliability 同 validity。睇完已經好興奮，因為佢算係第一個有psychometric properties，而又係針對小朋友嘅motor speech skills 嘅evaluation tool。當時我對於test 嘅認識唔係好多（宜家都唔係好多）， 所以我send 咗份article 俾研究standardized test 嘅教授睇。教授話份article 寫得好好。之後我就好期待可以見到呢個standardized test嘅真身，連喺不同大大小小嘅seminar，我都會同大家提及呢個test，一個可以診斷CAS嘅test，終於終於終於都publish 咗喇。
尋日終於收到本manual （無錯，呢個test只係得一本manual），即刻打開睇下個test 係點。睇完成本manual，又溫咗一次書，又知多咗啲新嘢。
DEMSS目的係協助治療師引發小朋友有關CAS的speech behaviours，從而思考「CAS」係唔係一個合適嘅診斷，亦可用於評估障礙嘅嚴重程度、計劃治療及決定使用那種有效的提示方法。DEMSS就係透過運用dynamic assessment嘅方法而達致其目的。
DEMSS包括8個subtest， 分別係1) Consonant-Vowel, 2) Vowel-Consonant, 3) Reduplicated Syllables, 4) CVC1, 5) CVC2, 6) Bisyllabic (one consonant, two vowels), 7) Bisyllabic (more varied syllabic shapes), 同埋 8)Multisyllabic words。總共有60條題目及需要186 judgments。DEMSS主要為小朋友嘅表現進行4項評分，包括vowel accuracy, prosodic accuracy, articulatory accuracy 同 consistency。成個test 需時大槪30分鐘。完成test 之後，會得到一個分數，呢個分數可以知道究竟「CAS」呢個名用於受試者上有幾合適。簡單啲講，個分數可以話你知以下其中一項：
1. Significant evidence for CAS 2. Some evidence for at least mild CAS 3. Little or no evidence of CAS
作者話，只憑呢個分數去決定小朋友有冇CAS係唔足夠嘅，治療師係需要參考其他資料去作differential diagnosis， 例如standardized articulation test, speech sample 等等。雖然如此，呢個test其實已經為治療師提供咗好重要嘅資料，足夠用於診斷及計劃治療。
可能你會問，呢個test係英文，咁用喺以廣東話為第一語言嘅小朋友係得唔得呢？因為個test非常之新，所以我自己都未試過。不過，test入面嘅item全部都係一啲early sounds/structures，我認為可以作參考。另外，prosodic accuracy入面會考慮stress嘅表現，呢部份就未必可以套用喺廣東話市場喇。但正如作者講，要做CAS診斷絕對唔係只用個分數，其他嘅資料亦好重要。咁呢個test嘅價值依然好高，因為佢真係反映緊小朋友嘅motor planning and programming 嘅能力。
呢個test 都唔係完美嘅。test 進行嘅過程係需要治療師運用一啲cueing methods 去協助小朋友發音，評分時亦需要運用治療師對其他構音障礙嘅認知，最後做「CAS」診斷更加需要治療師對不同speech sound disorders 及motor speech disorders 有一定程度嘅認識及經驗。所以，DEMSS係適用於有啲經驗嘅治療師嘅。
Reference: Strand, E. A. & McCauley, R. J (2019). Dynamic Evaluation of Motor Speech Skills (DEMSS) Manual. Baltimore: Paul H. Brookes Publishing Co., Inc..
Strand, E. A., McCauley, R. J., Wigan’s, S. D., Stoeckel, R. E., & Baas, B. S. (2013). A motor speech assessment for children with severe speech disorders: Reliability and validity evidence. Journal of Speech, Language, and Hearing Research, 56(2), pp. 505-520.
- eddychwong
Several CAS experts gave a 2-hour seminar on CAS treatment (PRISM, Kaufman, DTTC and PROMPT) in the 2018 National Conference. The handout has been officially posted on several apraxia FB groups. If you want a copy, please let me know~~
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