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Diagnostic Assessment of Diagnostic Assessment of Childhood Apraxia of Speech Using Childhood Apraxia of Speech Using Techniques from Automatic Speech Techniques from Automatic Speech
Recognition (ASR)Recognition (ASR)John-Paul Hosom1
Lawrence D. Shriberg2
Jordan R. Green3
1Center for Spoken Language Understanding, Oregon Health & Science University
2Waisman Center, University of Wisconsin - Madison
3Department of Special Education & Communication Disorders,University of Nebraska - Lincoln
This research is supported by NIDCD grants DC000496 and DC006722
2
Outline of TalkOutline of Talk
• Complex Disease Model for Childhood Speech-Sound Disorders of Unknown Origin
• Diagnostic Markers for suspected Apraxia of Speech (sAOS)
• Overview of Automatic Speech Recognition (ASR)
• Applying ASR to the Lexical Stress Ratio (LSR)
• Applying ASR to Coefficient of Variation Ratio (CVR)
• Summary, Current and Future Work
3
Complex Disease Model for ChildhoodComplex Disease Model for ChildhoodSpeech Sound Disorders (SSD) of Speech Sound Disorders (SSD) of
Unknown OriginUnknown OriginRisk and Protective Factors
EnvironmentalGenetic
Cognitive-Linguistic
Auditory-Perceptual
Speech Motor
Control
Psycho-social
Phonological Attunement
Speech Delay – Genetic
(SD-GEN)
Speech Delay – Otitis Media
with Effusion (SD-OME)
Speech Delay Speech Motor Involvement
(SD-SMI)
Speech Delay – Developmental Psychosocial Involvement
(SD-DPI)
Speech Errors (SE)
SD-GEN SD-OME SD-AOS SD-DPI SE-/s/ SE-/r/
I. Etiological Processes
II. Explanatory Processes
III. Nosological Entity
IV. Trait Markers (phenotypes, endophenotypes)
> Omissions< Distortions< Backing
> Omissions< Distortions< Backing
- - - -- - - - - - - -
> M1 values- - - - - - - -
- - - -- - - - - - - -
< F3–F2- - - - - - - -
- - - -- - - -- - - -
Speech markers> I-S Gap> Backing
- - - - - - - - - - - -
> Severity- - - - - - - -
SD-DYS
8 speech markersLex. Stress Ratio>Coeff. Var. Ratio
8 speech markersLex. Stress Ratio>Coeff. Var. Ratio
- - - -- - - - - - - -
- - - - - - - - - - - -
V. Diagnostic Markers
*Shriberg, Austin, et al. (1997)
4
Complex Disease Model for ChildhoodComplex Disease Model for ChildhoodSpeech Sound Disorders (SSD) of Speech Sound Disorders (SSD) of
Unknown OriginUnknown OriginRisk and Protective Factors
EnvironmentalGenetic
Cognitive-Linguistic
Auditory-Perceptual
Speech Motor
Control
Psycho-social
Phonological Attunement
Speech Delay – Genetic
(SD-GEN)
Speech Delay – Otitis Media
with Effusion (SD-OME)
Speech Delay Speech Motor Involvement
(SD-SMI)
Speech Delay – Developmental Psychosocial Involvement
(SD-DPI)
Speech Errors (SE)
SD-GEN SD-OME SD-AOS SD-DPI SE-/s/ SE-/r/
I. Etiological Processes
II. Explanatory Processes
III. Nosological Entity
IV. Trait Markers (phenotypes, endophenotypes)
SDCS*- - - -- - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
- - - - - - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
SD-DYS
SDCS- - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
V. Diagnostic Markers
*Shriberg, Austin, et al. (1997)
5
Complex Disease Model for ChildhoodComplex Disease Model for ChildhoodSpeech Sound Disorders (SSD) of Speech Sound Disorders (SSD) of
Unknown OriginUnknown OriginRisk and Protective Factors
EnvironmentalGenetic
Cognitive-Linguistic
Auditory-Perceptual
Speech Motor
Control
Psycho-social
Phonological Attunement
Speech Delay – Genetic
(SD-GEN)
Speech Delay – Otitis Media
with Effusion (SD-OME)
Speech Delay Speech Motor Involvement
(SD-SMI)
Speech Delay – Developmental Psychosocial Involvement
(SD-DPI)
Speech Errors (SE)
SD-GEN SD-AOS SD-DPI SE-/s/ SE-/r/
I. Etiological Processes
II. Explanatory Processes
III. Nosological Entity
IV. Trait Markers (phenotypes, endophenotypes)
SD-DYS
V. Diagnostic Markers
*Shriberg, Austin, et al. (1997)
SD-OME
SDCS*- - - -- - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
- - - - - - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
SDCS- - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
6
Complex Disease Model for ChildhoodComplex Disease Model for ChildhoodSpeech Sound Disorders (SSD) of Speech Sound Disorders (SSD) of
Unknown OriginUnknown OriginRisk and Protective Factors
EnvironmentalGenetic
Cognitive-Linguistic
Auditory-Perceptual
Speech Motor
Control
Psycho-social
Phonological Attunement
Speech Delay – Genetic
(SD-GEN)
Speech Delay – Otitis Media
with Effusion (SD-OME)
Speech Delay Speech Motor Involvement
(SD-SMI)
Speech Delay – Developmental Psychosocial Involvement
(SD-DPI)
Speech Errors (SE)
SD-GEN SD-OME SD-AOS SD-DPI SE-/s/ SE-/r/
I. Etiological Processes
II. Explanatory Processes
III. Nosological Entity
IV. Trait Markers (phenotypes, endophenotypes)
SD-DYS
V. Diagnostic Markers
*Shriberg, Austin, et al. (1997)
SDCS*- - - -- - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
- - - - - - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
SDCS- - - - - - - -
SDCS- - - - - - - -
- - - -- - - - - - - -
SDCS- - - - - - - -
7
Complex Disease Model for ChildhoodComplex Disease Model for ChildhoodSpeech Sound Disorders (SSD) of Speech Sound Disorders (SSD) of
Unknown OriginUnknown OriginRisk and Protective Factors
EnvironmentalGenetic
Cognitive-Linguistic
Auditory-Perceptual
Speech Motor
Control
Psycho-social
Phonological Attunement
Speech Delay – Genetic
(SD-GEN)
Speech Delay – Otitis Media
with Effusion (SD-OME)
Speech Delay Speech Motor Involvement
(SD-SMI)
Speech Delay – Developmental Psychosocial Involvement
(SD-DPI)
Speech Errors (SE)
SD-GEN SD-OME SD-AOS SD-DPI SE-/s/ SE-/r/
I. Etiological Processes
II. Explanatory Processes
III. Nosological Entity
IV. Trait Markers (phenotypes, endophenotypes)
SD-DYS
V. Diagnostic Markers
*Shriberg, Austin, et al. (1997)
> Omissions< Distortions< Backing
> Omissions< Distortions< Backing
- - - -- - - - - - - -
> M1 values- - - - - - - -
- - - -- - - - - - - -
< F3–F2- - - - - - - -
- - - -- - - -- - - -
Speech markers> I-S Gap> Backing
- - - - - - - -- - - -
> Severity- - - - - - - -
8 speech markersLex. Stress Ratio>Coeff. Var. Ratio
8 speech markersLex. Stress Ratio>Coeff. Var. Ratio
- - - -- - - - - - - -
- - - - - - - - - - - -
8
Diagnostic Markers for Diagnostic Markers for suspected Apraxia of Speech (sAOS)suspected Apraxia of Speech (sAOS)
• Childhood Apraxia of Speech is controversial disorderdue to lack of consensus on features that define it and underlying causes. (Guyette & Diedrich, 1981; Shriberg et al., 1997)
• “suspected Apraxia of Speech” (sAOS) proposed as interim term (Shriberg et al., 1997)
• Two proposed markers for sAOS: Lexical Stress Ratio (LSR) (Shriberg et al., 2003a)
Coefficient of Variation Ratio (CVR) (Shriberg et al., 2003b)
• This work: Pilot study for complete automation of these markers, to address inherent human variability. Aim was to replicate results of prior work.
• Techniques from automatic speech recognition (ASR)
9
Outline of TalkOutline of Talk
• Complex Disease Model for Childhood Speech-Sound Disorders of Unknown Origin
• Diagnostic Markers for suspected Apraxia of Speech (sAOS)
• Overview of Automatic Speech Recognition (ASR)
• Applying ASR to the Lexical Stress Ratio (LSR)
• Applying ASR to Coefficient of Variation Ratio (CVR)
• Summary, Current and Future Work
10
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
• Automatic Speech Recognition (ASR) is mapping fromrecorded speech signal to words. Words are representedas sequence of phonemes.
11
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
• Automatic Speech Recognition (ASR) is mapping fromrecorded speech signal to words. Words are representedas sequence of phonemes.
• Don’t know where phonemes begin or end, so (1) break signalinto short (10-msec) units, (2) compute the probability of eachphoneme at each unit, (3) find most likely phoneme sequence.
p(E)=.4
p(s)=.0p(^)=.2
p(i)=.1
…
12
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
• Automatic Speech Recognition (ASR) is mapping fromrecorded speech signal to words. Words are representedas sequence of phonemes.
• Don’t know where phonemes begin or end, so (1) break signalinto short (10-msec) units, (2) compute the probability of eachphoneme at each unit, (3) find most likely phoneme sequence.
f 1 n 2 tc t 8 kc k s
13
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
from Encyclopedia of Information Systems, H. Bidgoli (editor), vol. 4, pp. 155-169, 2003.
14
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
p(x)
x
• Gaussian Mixture Model (GMM) is a way of estimatingprobabilities given a feature value
= one Gaussian (Normal) distribution with mean µ and standard deviation .
µ
x
15
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
from Encyclopedia of Information Systems, H. Bidgoli (editor), vol. 4, pp. 155-169, 2003.
16
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
from Encyclopedia of Information Systems, H. Bidgoli (editor), vol. 4, pp. 155-169, 2003.
17
Overview of Overview of Automatic Speech RecognitionAutomatic Speech Recognition
• Better estimation of phoneme probabilities at each time tresults in more accurate ASR performance (correct words).
• Estimation of probabilities depends on training a phonemeclassifier on large amounts of speech data.
• If the type of data used in training is different from the typeof data seen in testing, probabilities will be low and accuracywill be poor.
• Important to match training and testing conditions as closelyas possible.
• ASR yields two results:(1) most likely word or word sequence(2) locations of each phoneme in recognized word
18
Outline of TalkOutline of Talk
• Complex Disease Model for Childhood Speech-Sound Disorders of Unknown Origin
• Diagnostic Markers for suspected Apraxia of Speech (sAOS)
• Overview of Automatic Speech Recognition (ASR)
• Applying ASR to the Lexical Stress Ratio (LSR) The Lexical Stress Ratio Measuring Fundamental Frequency Computing Probability of Lexical Stress Results
• Applying ASR to Coefficient of Variation Ratio (CVR)
• Summary, Current and Future Work
19
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:The Lexical Stress RatioThe Lexical Stress Ratio
• LSR (Shriberg et al., 2003a) measures “inappropriate lexical stress” observed in children with sAOS
• Inappropriate lexical stress:excessive stress on a syllable, orlack of stress on a syllable that is normally stressed
• Three factors used to measure lexical stress:F0, amplitude, and duration of the first and second vowels in trochaic (stress on the first syllable) words
• Due to problems reliably extracting duration, initial focusof automation on only ratio of F0 in first and second vowel
• Either high or low F0 ratios may be associated with sAOS.
“dishes,” reduced stress
“chicken,” excessive stress
“puppy,” excessive stress
20
• Data from Shriberg et al.’s 2003a study (LSR corpus):
24 children with speech delay (control data)
11 children with sAOS
Recordings of elicited samples of 8 trochaic words
Average age: 6 yrs, 4 mo. for children with speech delay, 7 yrs, 1 mo. for children with sAOS.
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:Speech DataSpeech Data
21
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:Measuring FMeasuring F00
• Fundamental frequency (F0) measured by locating peak of histogram of “strong” outputs from 32 narrow-band filters
9x4=222 Hz
Per.:F0: 889 444 296 222 111
1500 Hz
0 Hz
500 Hz
1000 Hz
889 Hz
889 Hz
889 Hz
800 Hz
727 Hz
667 Hz
444 Hz
400 Hz
444 Hz
242 Hz
228 Hz
235 Hz
222 Hz
667 Hz
889 Hz = periodicity of 9 samples
9x1=889 Hz(3 counts)
9x2=444 Hz
9x3=296 Hz
hist
ogra
m c
ount
216 Hz
9 12 15 18 21 24 27 30 33 36 39 69 72 75
9x8=111Hz
• Comparison with Kay Elemetrics’ CSL algorithm on LSR data:CSL: 30 cases of F0 error > 30 Hznew: 8 cases of F0 error > 30 Hz
22
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:Computing Probability of Lexical StressComputing Probability of Lexical Stress
• Histogram of normalized counts (probabilities) of F0 ratiosof SD subjects and sAOS subjects
Ratio of F0s in first and second vowel
prob
abili
ty g
iven
F0 r
atio
= sAOS= SD
23
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:Computing Probability of Lexical StressComputing Probability of Lexical Stress
• Probability Distribution Functions (PDFs) of F0 ratiosof SD subjects and sAOS subjects using Gamma distribution
p(SD|F0(w))
p(sAOS|F0(w))
24
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:Computing Probability of Lexical StressComputing Probability of Lexical Stress
• Probability of Lexical Stress Characteristic of sAOS:
• Use one formulation of Bayes’ Rule (only two choices):
)1)((
)()(
))(|(
))(|()(
8
1 0
0
sAOSodds
sAOSoddssAOSp
wFSDp
wFsAOSpsAOSodds
w
where w is an individual word spoken by a subject
• Decision criterion: sAOS if p(sAOS) > 0.5
25
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:Computing Probability of Lexical StressComputing Probability of Lexical Stress
• Probability of Lexical Stress:
• Example of 4 observations, equal probabilities:
• Example of 3 observations, different probabilities:
5.02
1
)11(
1)(
111115.0
5.0
5.0
5.0
5.0
5.0
5.0
5.0)(
sAOSp
sAOSodds
84.027.6
27.5
)127.5(
27.5)(
27.566.00.366.26.0
4.0
2.0
6.0
3.0
8.0)(
sAOSp
sAOSodds
26
Applying ASR to the Lexical Stress Ratio:Applying ASR to the Lexical Stress Ratio:ResultsResults
• Evaluation of method on data used to build models:• Sensitivity/Specificity: 64% / 88%• PPV/NPV: 70% / 84%
• Evaluation of method on new data:• essentially chance performance
• Conclusions:• Large difference between characteristics of training and
testing data• Need more data to develop better models
27
Outline of TalkOutline of Talk
• Complex Disease Model…
• Diagnostic Markers for suspected Apraxia of Speech (sAOS)
• Overview of Automatic Speech Recognition (ASR)
• Applying ASR to the Lexical Stress Ratio (LSR)
• Applying ASR to Coefficient of Variation Ratio (CVR) The Coefficient of Variation Ratio Identifying Speech/Pause Regions Using ASR Computing the CVR Results
• Summary, Current and Future Work
28
Applying ASR to the Coefficient of Applying ASR to the Coefficient of Variation Ratio:Variation Ratio:
The Coefficient of Variation RatioThe Coefficient of Variation Ratio• CVR (Shriberg et al., 2003b) measures reduction in normal
temporal variation of speech, as observed in children with sAOS.
• Measurement of CVR depends on duration of speech events and duration of pause events
• Because of reduced variability of speech-event durations in children with sAOS, these children have higher CVR values relative to control group
s
s
p
p
speech
pause
CV
CVCVR
p = standard deviation of pause eventsp = mean duration of pause eventss = standard deviation of speech eventss = mean duration of speech events
29
Applying ASR to the Coefficient of Applying ASR to the Coefficient of Variation Ratio:Variation Ratio:
The Coefficient of Variation RatioThe Coefficient of Variation Ratio• In Shriberg et al. 2003b, speech/pause events detected by:
(1) displaying speech amplitude envelope using Matlab software(2) human identification of pause event with largest amplitude(3) speech/pause classification using threshold from Step (2)(4) removing speech/pause regions with duration < 100 msec
• Preliminary results show good agreement between this Matlab-based algorithm and manual measurements from spectrograms (Green et al., 2004)
30
Applying ASR to the Coefficient of Applying ASR to the Coefficient of Variation Ratio:Variation Ratio:
Identifying Speech/Pause Regions Using Identifying Speech/Pause Regions Using ASRASR• Can be difficult to identify speech/pause from only energy
or amplitude envelope, so investigated speech/pausedetection using ASR
• ASR system trained using 300 utterances from 3 children with speech delay of unknown origin
• All training data phonetically labeled by hand, time-aligned at the phoneme level
• ASR system trained to classify 8 broad-phonetic classes related to speech (e.g. “nasal”), instead of specific phonemes
• State sequence used by ASR system imposed constraints onsequences of phonemic classes to be consistent withEnglish syllable structure
31
Applying ASR to the Coefficient of Applying ASR to the Coefficient of Variation Ratio:Variation Ratio:
Identifying Speech/Pause Regions Using Identifying Speech/Pause Regions Using ASRASR• ASR system recognized the following categories of speech:
• State sequence (grammar) allowed sequences such as.pau clo plo vow nas .pau (e.g. for the isolated-word utterance “can”)
but not.pau nas wfrc vow .pau(violates sonority principle)
.noise non-speech noise (e.g. door slam, breath)
.pau silence or pauseclo stop closurenas nasalplo stop burstsfrc strong fricativevow vowel, liquid, or glidewfrc weak fricative
32
Applying ASR to the Coefficient of Applying ASR to the Coefficient of Variation Ratio:Variation Ratio:
Computing the CVRComputing the CVR• ASR results (broad phonetic classes with English syllable
structure) mapped to “speech” and “pause” events
• CVR computed as in Shriberg et al. (2003b), except thatregions less than 50 msec merged with neighboring regions.
phn class:
speech/pau:
wave:
spectrogram:
33
Applying ASR to the Coefficient of Applying ASR to the Coefficient of Variation Ratio:Variation Ratio:
Speech DataSpeech Data• Data from Shriberg et al.’s 2003b study (CVR corpus):
30 children with normal speech (NS) (control data) 30 children with speech delay (SD) (control data) 15 children with sAOS Recordings of conversational speech
34
Applying ASR to the Coefficient of Applying ASR to the Coefficient of Variation Ratio:Variation Ratio:
ResultsResults
• The CV-Speech values had ES values of 0.95 and 1.04 for NS/sAOS and SD/sAOS, respectively, although there is the possibility of a confounding age effect.
• Conclusion: ASR techniques appear to be applicable to the computation of the CVR; support for the percept of isochrony in the sAOS subjects.
• Shriberg et al.’s 2003b study: mean CVR of 1.05 for NS, 1.04 for SD, and 1.36 for sAOS effect size of 0.72 for NS/sAOS, ES of 0.71 for SD/sAOS.
• ASR-based method: mean CVR of 1.24 for NS, 1.13 for SD, and 1.42 for sAOS effect size of 0.68 for NS/sAOS, ES of 1.07 for SD/sAOS.
35
Outline of TalkOutline of Talk
• Complex Disease Model…
• Diagnostic Markers for suspected Apraxia of Speech (sAOS)
• Overview of Automatic Speech Recognition (ASR)
• Applying ASR to the Lexical Stress Ratio (LSR)
• Applying ASR to Coefficient of Variation Ratio (CVR)
• Summary, Current and Future Work
36
SummarySummary
• More data necessary in order to apply statistical models incomputation for LSR. Data collection currently under wayin separate projects.
• Agreement between published results and current results indicates potential for ASR-based CVR
• Improvements necessary for automation: Train ASR system on larger amount of speech data
Improve F0 estimation for children’s speech.
37
Current and Future WorkCurrent and Future Work
• Current work focusing on:
(a) understanding differences between published CVR values and ASR-based CVR values,
(b) extension of CVR to syllable-based measure instead of speech-event-based measure, and
(c) extension of LSR to conversational speech.
38
Current and Future WorkCurrent and Future Work
• Future work will focus on:
(a) applying ASR to measurement of other prosodic factors, such as inter-stress intervals, linguistic rhythm, speaking-rate variation, and glottal-source variation
(b) multiple measures of sAOS may be combined for improved sensitivity and specificity
(c) evaluating specific factors that influence diagnosis
39
ReferencesReferences
• Green, J., Beukelman, D., Ball, L., Ullman, C., and Maassen K. (2004). “Development and Evaluation of a Computer-based System to Measure and Analyze Pause and Speech Events,” Conference on Motor Speech: Motor Speech Disorders, Speech Motor Control, Albuquerque, NM.
• Guyette, T. W. and Diedrich, W. M. (1981). "A Critical Review of Developmental Apraxia of Speech," in Speech and Language: Advances in Basic Research and Practice, 5, pp. 1-45.
• Hawley, M. (2003). “Speech Training And Recognition for Dysarthric Users of Assistive Technology (STARDUST) ”, Wales International Conference on Electronic Assistive Technology, Cardiff, Wales, July 2003.
• Hosom, J. P. (2000). Automatic Time Alignment of Phonemes Using Acoustic-Phonetic Information. Ph.D. thesis, Oregon Graduate Institute of Science and Technology, Beaverton, Oregon.
• Kasi, K. and Zahorian, S. A. (2002). “Yet Another Algorithm for Pitch Tracking,” in Proceedings of the International Conference on Acoustics, Speech, and Signal Processing (ICASSP) 2002, Orlando, FL, 1, pp. 361-364.
40
ReferencesReferences
• Marquardt, T. P., Sussman, H. M., Snow, T., and Jacks, A. (2002). "The Intelligibility of the syllable in developmental apraxia of speech," in Journal of Communication Disorders, 35, pp. 31-49.
• Shriberg, L. D., Austin, D., Lewis, B. A., McSweeny, J. L., and Wilson, D. L. (1997). "The Speech Disorders Classification System (SDCS): Extensions and Lifespan Reference Data," in Journal of Speech, Language, and Hearing Research, 40, pp. 723-740.
• Shriberg, D. L., Campbell, T. F., Karlsson, H. B., Brown, R. L., McSweeny, J. L., & Nadler, C. J. (2003a). A Diagnostic Marker for Childhood Apraxia of Speech: The Lexical Stress Ratio,” in Special Issue: Diagnostic Markers for Child Speech-Sound Disorders, Clinical Linguistics & Phonetics. 17.7, pp. 549-574.
• Shriberg, D. L., Green, J. R., Campbell, T. F., McSweeny, J. L., & Scheer, A. (2003b). “A Diagnostic Marker for Childhood Apraxia of Speech: The Coefficient of Variation Ratio,” in Special Issue: Diagnostic Markers for Child Speech-Sound Disorders, Clinical Linguistics & Phonetics, 17.7, pp. 575-595.