Behavioral Measures to Evaluate Prosodic Skills: A Review ......2000). In other words, stress and...

138 Contemporary Issues In CommunICatIon sCIenCe and dIsorders • Volume 42 • 138–154 • Spring 2015

ABSTRACT: Purpose: The aims of this review were to identify and describe the assessment tools that have been developed to assess prosodic skills in children and adults and to evaluate the clinical utility of the tools. Method: Currently available tools were identified through searching 4 online databases and bibliogra-phies of relevant articles and by contacting authors.Results: Nine assessment tools were identified. The tools were appraised for their intended purpose, tar-get population, domains of prosody assessed, validity, reliability, and normative sample data. The purpose of development and the content of the tools were well

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Contemporary Issues In CommunICatIon sCIenCe and dIsorders • Volume 42 • 138–154 • Spring 2015 © NSSLHA 1092-5171/15/4201-0138

Behavioral Measures to Evaluate Prosodic Skills: A Review of Assessment Tools for Children and Adults

Rose Thomas KalathottukarenSuzanne C. Purdy Elaine BallardThe University of Auckland, Auckland, New Zealand

ver the past few decades, there has been considerable progress in identify-ing descriptive frameworks to explain

prosody and its communicative functions. Progress has been made in the following areas: classification of prosodic disorders, acquisition of prosody, neuro-logical bases of prosodic impairments, significance of prosody in relation to language processing, and relationship between prosody and other aspects of speech (Crystal, 2009; Grigos & Patel, 2007, 2010; Patel & Brayton, 2009; Patel & Grigos, 2006; Pep-pé, 2009). However, not many studies have focused

on the areas of prosody assessment and intervention, and little consideration has been given to prosody evaluation in clinical settings (Crystal, 2009; Peppé, 2009).

Peppé (2009) reported that the lack of clar-ity regarding prosodic terminologies, problems of identifying prosody as distinct from other aspects of communication, and lack of empirical information on the acquisition of prosody makes assessment difficult in disordered populations. Crystal (2009) pointed out that there is inadequate assessment, diagnosis, and treatment of prosodic impairments and negligence

documented, but data on how feasible they were to use in practice were scarce. Each tool met some but not all of the widely accepted criteria for validity and reliability. Most have not been sufficiently well tested for use in routine clinical practice.Conclusion: This review highlights the need to continue to develop and test tools for the effective and comprehensive assessment of prosodic skills in children and adults.

KEY WORDS: PEPS–C, DANVA 2, FAB, MNTAP, Aprosodia Battery, ACS, PPAT

Kalathottukaren et al.: Prosody Assessment Tools 139

on the part of clinicians in making efforts to assess prosody in client populations.

Following Crystal (2009), we found that there are no published papers that have systematically evalu-ated and compiled the various tools that are available to assess prosodic skills in children and adults. It is surprising that this lack of literature on assessment tools exists despite the fact that prosodic difficulties extend across a wide range of communication disor-ders such as autism spectrum disorder (ASD; Green & Tobin, 2009; McCann & Peppé, 2003), specific language impairment (SLI; Marshall, Harcourt-Brown, Ramus, & van der Lely, 2009; Stojanovik, Setter, & Ewijk, 2007), Parkinson’s disease (Martens et al., 2011), apraxia (Odell & Shriberg, 2001), apha-sia (Danly & Shapiro, 1982), brain injury (Karow, Marquardt, & Marshall, 2001; Moen, 2009; Ross, Edmondson, Seibert, & Homan, 1988), and hearing loss (Nakata, Trehub, & Kanda, 2012; Peng, Tomblin, & Turner, 2008).

Theoretical approaches to explaining prosody (phonetic and phonological perspectives) and the differences in prosody error profile across clinical populations may have contributed to the development of different assessment approaches. Pitch, duration, and stress are the phonetic correlates of prosody. The physical correlates of these features are the speech’s fundamental frequency (F0), syllable duration, and intensity, respectively. Phonological correlates of prosody include the variations in pitch, length, and loudness that are produced in speech for conveying subtle changes in the meaning of spoken messages independent of words and grammatical order (Roach, 2000). In other words, stress and intonation are used to convey the grammatical, affective, and pragmatic functions of language.

Methods for assessing disordered prosody can be classified into instrumental approaches, includ-ing software applications, and approaches to measure prosodic functions. Instrumental approaches involving acoustic analysis (e.g., PRAAT, Boersma, & Weenink, 2001; EMU, Bombien, Cassidy, Harrington, John, & Palethorpe, 2006) focus on displaying and quan-tifying the relevant acoustic correlates of prosody (Shriberg, Kwiatkowski, Rasmussen, Lof, & Miller, 1992), whereas prosodic function measures assess the phonological or communicative aspects of prosody. The autosegmental metrical framework for intona-tional analysis (Pierrehumbert, 1980) and the related transcription systems such as ToBI and IViE (Grabe, Nolan, & Farrar, 1998) provide options for prosodic labeling.

Earlier studies on communication disorders have evaluated prosody in terms of its acoustic dimensions. More recently, emphasizing the role of

prosody in communicative efficiency, the assess-ment of functions of prosody has been advocated rather than quantifying F0, duration, and intensity parameters (e.g., Profiling Elements of Prosody in Speech-Communication [PEPS–C], Peppé & McCann, 2003; Diagnostic Analysis of Nonverbal Accuracy 2 [DANVA 2], Nowicki & Duke, 1994). The choice of instrumental or prosodic function measures to assess prosody should depend on the prosodic difficulties of the clinical population being assessed. Several studies have acoustically analyzed echolalia, imitative and spontaneous speech in conversation, and narratives in children, adolescents, and adults with ASD and have found important prosodic differences in the variance of F0; duration of syllables; use of prosodic contours (Diehl & Paul, 2009; Green & Tobin, 2009); and coordination of prosodic cues such as pitch, duration, and amplitude (Van Santen, Prud’hommeaux, Black, & Mitchell, 2010).

Diehl and Paul (2013) conducted acoustic and perceptual measurements of prosody production by children with ASD and reported that differences in acoustic parameters were present in the speech of the group with ASD even when the different aspects of prosody were perceived accurately. Inaccurate produc-tion of acoustic features, such as excessive or misas-signed pitch, slow syllable-timed speech, fast rate of speech, and monoloudness, have been reported in indi-viduals with apraxia of speech (Barry, 1995), PD (Pen-ner, Miller, Hertrich, Ackermann, & Schumm, 2001; Ma, Whitehill, & Cheung, 2010) and other communi-cation disorders (Shriberg et al., 2001). Darley, Aron-son, and Brown (1969, 1975) reported that prosodic deficits play a significant role in the characterization of motor speech disorders. Prosodic deficits were also re-ported as a core feature of childhood apraxia of speech by the American Speech-Language-Hearing Associa-tion (ASHA, 2007). In general, inaccurate prosody productions affect an individual’s speech intelligibility (Chin, Bergeson, & Phan, 2012; Klopfenstein, 2009; Mayo, Aubanel, & Cooke, 2012).

This review focuses on assessment tools that are used to probe for the communicative aspects of prosody. The functions of prosody are identified at the indexical, grammatical, affective, and pragmatic levels of communication. Indexical information is in-formation that is related to the age, identity, and gen-der of the speaker (Paul, Augustyn, Klin, & Volkmar, 2005; Romero-Trillo & Newell, 2012; Stojanovik, 2010). The grammatical functions of prosody include (a) determining the boundaries of phrases, clauses, or sentences, particularly when there is ambiguity (e.g., /FRUIT, SALAD and MILK/ vs. /FRUIT-SALAD and MILK/; Wells & Peppé, 2003) and (b) differentiat-ing between word classes when there are homonyms


(e.g., a noun and verb that sound the same but are differentiated by prosody; greenhouse vs. green house; Klieve & Jeanes, 2001).

The affective function of prosody is the use of prosodic features such as pitch contour, pauses, and word stress to express the speaker’s emotions and at-titudes (Peppé, 2009; Roach, 2000). Prosodic patterns convey different emotions (Banse & Scherer, 1996; Juslin & Laukka, 2003). Happiness, for example, is characterized by a fast speaking rate, rising pitch, high variability, and fast voice onsets, and sadness is nearly the opposite (Hirschberg, 2002). The use of prosodic patterns to convey discourse functions is the pragmatic aspect of prosody. Prosody is used to sig-nal to the listener what is to be taken as new infor-mation and what is already given. Prosody also helps the listener to distinguish between questions, state-ments, and commands (Roach, 2000). A variety of prosodic features are used by speakers to indicate to others that they have finished speaking, that another person is expected to speak, that a particular type of response is required, and so on. For example, a rising tone at the end of an utterance typically indicates that a response is required, and a falling tone suggests the end of a conversation (McCann & Peppé, 2003).

It is important to note that researchers have reported the overlapping functions of these different aspects of prosody. For example, the use of prosody to distinguish between question and statement was classified as a grammatical function by Paul et al. (2005), whereas Wells and Peppé (2003) described it as the pragmatic aspect of prosody. Diehl and Paul (2009) reported that the use of prosody to distinguish between question and statement can fit into both categories as it conveys the sentence type and also signals a type of mental state or intent of discourse (either the end of a conversation or a particular re-sponse is required).

Although there are differences in classification, it is widely recognized that the accurate perception and production of the ranging aspects of prosody are a significant component of successful social commu-nication (Aziz-Zadeh, Sheng, & Gheytanchi, 2010). Difficulties in perceiving the communicative aspects of prosody as well as deficits in prosody productions have been reported in children with hearing loss by several researchers (Meister, Landwehr, Pyschny, Wal-ger, and von Wedel, 2009; Nakata et al., 2012; Peng et al., 2008). Hence, the combined use of instrumen-tal techniques and prosodic function measures to as-sess prosodic skills is advised for this population.

Certain aspects of prosody are more relevant than others in specific client groups. For example, prosody evaluation in adults with neurological and psychiat-ric impairments has mainly focused on investigating

the perception and production of affective prosodic skills (Moen, 2009; Wildgruber, Ethofer, Grandjean, & Kreifelts, 2009), whereas the evaluation of gram-matical, affective, and pragmatic aspects of prosody is relevant in individuals with hearing loss, ASD, and SLI. The important communicative functions of prosody and evidence for prosodic deficits in vari-ous speech-language and hearing disorders makes it important to assess prosodic skills in both typical and clinical populations.

Diehl and Paul (2009) compared three prosody assessment measures—the Prosody Profile (PROP; Crystal, 1982), Prosody-Voice Screening Profile (PVSP; Shriberg, Kwiatkowski, & Rasmussen, 1990), and PEPS–C—to the other well-established methods of assessing language, such as the Peabody Picture Vocabulary Test—Fourth Edition (PPVT–IV; Dunn & Dunn, 2007) and the Clinical Evaluation of Language Fundamentals—Fourth Edition (CELF–1V; Semel, Wiig, & Secord, 2003). Diehl and Paul reported that there are no analogous data on the typical develop-mental sequence of prosody acquisition and adequate psychometrics derived from studies of spontaneous language use. Diehl and Paul also reported that there is a need for a prosody assessment tool that (a) has a representative normative sample and strong psycho-metric properties, (b) is based on empirical infor-mation regarding the typical sequence of prosodic acquisition and is developmentally sensitive, (c) as-sesses various domains of prosody, (d) uses tasks that have high ecological validity, and (e) has established clinical utility.

We decided to review the available published assessment tools that are used to assess prosodic skills in children and adults, explaining the different domains of prosody that can be assessed using these tools, and providing information on the normative data and psychometric properties of each tool and its clinical utility. This review provides clinicians and researchers with information that will enable them to select the appropriate tool(s) for the assessment of prosodic skills in children and adults.

METhOd

Literature Search StrategyWe conducted a review of literature to identify clini-cal and research tools that have been developed so far to assess prosodic skills in children and adults. The goal was to identify tools with established reli-ability, validity, and normative data. We entered the search terms in Table 1 in different combinations into four online databases: ScienceDirect, SCOPUS,


Web of Science, and PsycINFO. We also conducted manual searches of the bibliographies of published reviews and articles and contacted test developers to gain additional information regarding the tools. Inter-library loan facilities at the University of Auckland were used to access unpublished dissertation work.

Assessment Tool Inclusion/Exclusion CriteriaWe included assessment tools that were published in English and that were developed for use with in-dividuals with acquired neurological disorders and psychiatric disorders, even though these tend to be components of a larger test battery and thus are less comprehensive than the larger battery. Tools that were translated from English to other languages or were developed in languages other than English were excluded from this review (e.g., Foley, Gibbon, & Peppé, 2011; Ladani et al., 2012; Martînez-Cas-tilla & Peppé, 2008; Torppa et al., 2014; Van Zyl & Hanekom, 2013). Assessment tools that were out of print, such as the Right Hemisphere Language Bat-tery (Bryan, 1989), which includes a subtest to assess the production of emphatic stress, are not described in this review.

Evaluation CriteriaWe appraised each assessment tool against a range of criteria pertinent to whether a tool might be suitable for clinical use. The clinical utility of each tool was gauged through examining features such as intended purpose, target population, domains of prosody as-sessed, validity and reliability data, nature of the normative sample, time and ease of administration and scoring, availability in different formats, and administration method.

RESulTS And diSCuSSiOn

We identified nine assessment tools: PROP, PVSP, PEPS–C, Perception of Prosody Assessment Tool (PPAT; Klieve, 1998), Minnesota Tests of Affective

Processing (MNTAP; Lai, Hughes, & Shapiro, 1991), DANVA 2, Aprosodia Battery (Ross, Thompson, & Yenkoshy, 1997), Florida Affect Battery (FAB; Bowers, Blonder, & Heilman, 1999), and Advanced Clinical Solutions (ACS; Pearson, 2009). We are not aware of any additional batteries that assess prosody.

We divided the assessment tools into two sections based on the number of aspects of prosody that they assess. Table 2 shows tools with subtests that assess two or more aspects of prosody; Table 3 shows tools that involve only affective prosody. Tables 2 and 3 also summarize each tool’s target population, subtests involved, domains of prosody assessed, normative sample characteristics, and reliability and validity information available either in the literature or from the test developer. The tools differ in terms of target population, normative data, psychometric properties, and the domains of prosody assessed. The feasibility of each assessment tool is discussed based on factors such as time taken to administer, test format, appro-priateness of test items, and ease of scoring.

Intended Purpose and Target PopulationTables 2 and 3 indicate the different purposes for which the tools were developed. These include a focus on assessing (a) expressive prosodic skills, (b) perception of affective prosody in adults with neuro-logic and psychiatric disorders, (c) social and cog-nitive functioning in adults, and (d) prosodic skills in children with ASD and hearing loss. There are differences in the conceptual frameworks on which these tools are based: psycholinguistic (PEPS–C, PPAT), neurolinguistic (Aprosodia Battery), and social and cognitive functioning (DANVA 2, MNTAP, FAB, ACS), reflecting the many identified roles of prosody in social communication.

The PEPS–C has been used in a number of research studies investigating prosodic skills in typi-cally developing children and children with com-munication disorders (Catterall, Howard, Stojanovik, Szczerbinski, & Wells, 2006; Foley et al., 2011; Martínez-Castilla & Peppé, 2008; Peppé, & Mc-Cann, 2003; Peppé, McCann, Gibbon, O’Hare, &

Table 1. Search terms used to identify existing clinical and re-search tools for assessing prosodic skills in children and adults.

Concept Prosody Assess Impairment

Search words prosody assessments impairment intonation measures delay suprasegmental tests disorder evaluation difficulty tools


Tabl

e 2

(p.

1 of

2).

Feat

ures

of

the

asse

ssm

ent

tool

s th

at e

valu

ate

two

or m

ore

aspe

cts

of p

roso

dy.

Ag

e Pu

rpos

e an

d

Pros

ody

subt

ests

As

pect

s of

N

orm

ativ

e sa

mpl

e an

d

Relia

bilit

y/

Te

st

(in

year

s)

popu

latio

n Su

btes

ts

rece

ptiv

e/ex

pres

sive

pr

osod

y in

clus

ion

crite

ria

Valid

ity

Feas

ibili

ty

PRO

P C

hild

ren

& a

dults

To

obt

ain

info

rmat

ion

Four

pro

sodi

c R

ecep

tive:

Non

e Pi

tch,

tem

po,

N

o no

rmat

ive,

N

ot a

vaila

ble.

Ti

me:

dep

ends

(Cry

stal

,

ab

out

the

expr

essi

ve

patt

erns

E

xpre

ssiv

e:

stre

ss

relia

bilit

y &

val

idity

on e

xper

tise

in

1982

)

pros

odic

pat

tern

s

Into

natio

n

data

pro

vide

d.

tra

nscr

iptio

n

en

coun

tere

d in

a

(n

ucle

ar p

itch

A

ge r

ange

s,

Fo

rmat

:

sa

mpl

e of

clin

ical

dire

ctio

n),

guid

elin

es &

exa

mpl

es

m

anua

l sc

orin

g

da

ta.

Te

mpo

(ph

rasi

ng),

of i

mpa

ired

pros

ody

M

ade

for:

Stre

ss (

phra

sal)

&

ar

e pr

ovid

ed.

cl

inic

al u

se

st

rate

gies

for

prod

ucin

g st

ress

PVSP

3–

81

To a

sses

s sp

eake

rs’

7 su

pra-

R

ecep

tive:

Non

e Ph

rasi

ng,

rate

, 25

2 au

diot

aped

Pe

rcep

tual

Ti

me:

dep

ends

(Shr

iber

g

pr

osod

y an

d vo

ice

segm

enta

ls

Exp

ress

ive:

pi

tch,

stre

ss,

ex

empl

ars

from

3-

to

crite

rion

on e

xper

tise

in

et a

l., 1

990)

in c

onve

rsat

iona

l (3

pro

sody

, Ph

rasi

ng,

Rat

e,

loud

ness

,

19-y

ear-

old

child

ren

va

lidity

for

tra

nscr

iptio

n

sp

eech

. 4

voic

e)

Stre

ss,

Loud

ness

,

lary

ngea

l w

ith n

orm

al &

dis

orde

red

pitc

h, q

ualit

y Fo

rmat

: m

anua

l

Pi

tch,

Lar

ynge

al

qual

ity a

nd

spee

ch d

evel

opm

ent

& r

eson

ance

sc

orin

g

qu

ality

and

re

sona

nce

wer

e se

lect

ed &

ra

nged

bet

wee

n M

ade

for:

Res

onan

ce

co

ded

usin

g 71

%–8

4%.

cl

inic

al u

se

Dic

taph

one

2550

In

stru

men

tal

au

dioc

asse

tte p

layb

ack

crite

rion

valid

ity

de

vice

. C

Spee

ch b

y fo

r ra

te,

stre

ss,

Mile

nkov

ic (

1991

) &

pi

tch

& q

ualit

y

V

OC

AL

(Mile

nkov

ic,

ra

nged

bet

wee

n

19

89)

wer

e us

ed f

or

80%

–100

%.

inst

rum

enta

l va

lidity

st

udy.

PEPS

–C

5–14

To

ass

ess

rece

ptiv

e 12

sub

test

s (6

R

ecep

tive:

Sho

rt Pi

tch

N

orm

ativ

e da

ta o

n Te

st–r

etes

t Ti

me:

~60

min

(Pep

pé &

and

expr

essi

ve

rece

ptiv

e pr

osod

y Ite

m

dire

ctio

n,

120

stud

ents

fro

m

relia

bilit

y fo

r 30

Fo

rmat

: M

cCan

n,

pr

osod

ic s

kills

in

& 6

exp

ress

ive

Dis

crim

inat

ion,

gr

amm

atic

al,

N

orth

Lon

don

ages

pa

rtici

pant

s w

ith

elec

troni

c20

03)

ch

ildre

n. W

idel

y

pros

ody)

Tu

rn-E

nd

affe

ctiv

e 5–

14 y

ears

, En

glis

h a

6-m

onth

int

erva

l ad

min

istra

tion;

us

ed i

n ch

ildre

n

Shor

t Ite

m

Rec

eptio

n,

(like

, di

slik

e),

as f

irst

lang

uage

,

wer

e no

t au

tom

atic

with

aut

ism

D

iscr

imin

atio

n,

Aff

ect

Rec

eptio

n,

prag

mat

ic

no i

dent

ified

spe

ech

sign

ifica

ntly

sc

orin

g

sp

ectru

m d

isor

der.

Shor

t Ite

m

Long

Ite

m

&

lan

guag

e pr

oble

ms

di

ffer

ent,

the

Mad

e fo

r:

Imita

tion,

Tur

n-

Dis

crim

inat

ion,

or e

duca

tiona

l pr

oble

ms,

ra

nge

of v

aria

tion

clin

ical

&

En

d R

ecep

tion,

C

hunk

ing

&

res

iden

ts o

f

+2.0

8 to

–1.

04.

rese

arch

use

Tu

rn-E

nd

Rec

eptio

n,

En

glan

d fo

r at

lea

st 3

In

trara

ter

Ex

pres

sion

, Aff

ect

Con

trast

ive

year

s. N

orm

ativ

e da

ta

relia

bilit

y w

as

Rec

eptio

n, A

ffec

t

Stre

ss R

ecep

tion

in

clud

ing

mea

n &

SD

s ch

ecke

d by

Ex

pres

sion

, Lo

ng

Exp

ress

ive:

Sho

rt

for

ages

5;0

(ye

ars;

re

scor

ing

18/3

0

Item

Dis

crim

inat

ion,

Ite

m I

mita

tion,

mon

ths)

, 8;

0, 1

0;0,

and

pa

rtici

pant

s (3

-

Long

Ite

m I

mita

tion,

Tu

rn-E

nd

13

;0 a

re p

rovi

ded

for

m

onth

int

erva

l);

C

hunk

ing

Rec

eptio

n,

Expr

essi

on,

each

sub

test

(W

ells

,

diff

eren

ce i

n

Chu

nkin

g Ex

pres

sion

, A

ffec

t

Pepp

é, &

Gou

land

ris,

sc

ores

was

2.6

%.

C

ontra

stiv

e St

ress

Ex

pres

sion

,

20

04).

The

perf

orm

ance

In

terr

ater

R

ecep

tion,

Lo

ng I

tem

impr

oved

bet

wee

n th

e

relia

bilit

y w

as

Con

trast

ive

Stre

ss

Imita

tion,

ages

of

5;0

and

14;3

. ch

ecke

d by

Ex

pres

sion

C

hunk

ing

obta

inin

g 2


Tabl

e 2

(p.

2 of

2).

Feat

ures

of

the

asse

ssm

ent

tool

s th

at e

valu

ate

two

or m

ore

aspe

cts

of p

roso

dy.

Ag

e Pu

rpos

e an

d

Pros

ody

subt

ests

As

pect

s of

N

orm

ativ

e sa

mpl

e an

d

Relia

bilit

y/

Te

st

(in

year

s)

popu

latio

n Su

btes

ts

rece

ptiv

e/ex

pres

sive

pr

osod

y in

clus

ion

crite

ria

Valid

ity

Feas

ibili

ty

Expr

essi

on,

ju

dgm

ents

on

10%

C

ontra

stiv

e St

ress

of

the

pro

duct

ion

Expr

essi

on

task

res

ults

(N

= 3

0).

Rel

iabi

lity

of 8

0%–9

8%

re

porte

d. N

o

sign

ifica

nt d

iffer

ence

in p

erfo

rman

ce a

cros

s

gend

er &

ord

er o

f

pres

enta

tion.

PPAT

7–

12

To e

valu

ate

pros

odic

Si

x su

btes

ts

Rec

eptiv

e: A

part

Pi

tch,

dur

atio

n,

6 ch

ildre

n ag

es 7

–12

CI

parti

cipa

nts

Tim

e: ~

60 m

in(K

lieve

,

pe

rcep

tion

in c

hild

ren

Apa

rt fr

om

from

lin

guis

tic

inte

nsity

,

year

s. A

ttend

ed o

ral

perc

eive

d pr

osod

ic

Form

at:

elec

troni

c19

98)

us

ing

coch

lear

lin

guis

tic c

onte

xt,

co

ntex

t: Pi

tch,

gr

amm

atic

al,

scho

ol f

or c

hild

ren

cues

of

dura

tion,

ad

min

istra

tion;

im

plan

ts

With

in l

ingu

istic

D

urat

ion,

Int

ensi

ty

affe

ctiv

e w

ith H

L, u

sed

Nuc

leus

in

tens

ity,

&

man

ual

scor

ing

co

ntex

t, To

ne &

W

ithin

lin

guis

tic

(hap

py,

sad,

22

mul

ticha

nnel

CI

pitc

h ap

art

from

M

ade

for:

af

fect

, G

ram

mat

ical

co

ntex

t: qu

estio

n an

gry,

w

ith S

PEA

K s

trate

gy

a lin

guis

tic c

onte

xt

rese

arch

use

cl

ass,

Stre

ss,

fo

rms,

sta

tem

ent

sarc

astic

), &

mor

e th

an 1

ab

ove

chan

ce l

evel

,

Com

poun

d an

d fo

rms,

com

man

d

prag

mat

ics

year

of

expe

rienc

e 70

% o

r ab

ove.

abut

ting

wor

ds.

form

s; T

one

&

w

ith t

he i

mpl

ant.

Pe

rfor

man

ce o

n

af

fect

, G

ram

mat

ical

Parti

cipa

nts

varie

d in

pe

rcei

ving

the

clas

s, S

tress

,

ag

e of

ons

et o

f H

L,

pros

odic

cue

s m

eant

Com

poun

d &

etio

logy

of

deaf

ness

, w

ithin

a l

ingu

istic

abut

ting

wor

ds.

le

ngth

of

prof

ound

co

ntex

t w

as a

t or

Exp

ress

ive:

Non

e

deaf

ness

pre

im

plan

t &

ju

st b

elow

cha

nce

expe

rienc

e w

ith t

he

leve

l, be

twee

n

de

vice

(K

lieve

& J

eane

s,

60%

and

70%

.

20

01).

Not

e. P

RO

P =

Pros

ody

Prof

ile,

PVSP

= P

roso

dy-V

oice

Scr

eeni

ng P

rofil

e, P

EPS–

C =

Pro

filin

g El

emen

ts o

f Pr

osod

y in

Spe

ech-

Com

mun

icat

ion,

PPA

T =

Perc

eptio

n of

Pro

sody

Ass

essm

ent

Tool

.


Tabl

e 3

(p.

1 of

3).

Feat

ures

of

the

asse

ssm

ent

tool

s th

at e

valu

ate

affe

ctiv

e pr

osod

y on

ly.

Ag

e Pu

rpos

e an

d

Pros

ody

subt

ests

As

pect

s of

N

orm

ativ

e sa

mpl

e an

d

Relia

bilit

y/

Te

st

(in

year

s)

popu

latio

n Su

btes

ts

rece

ptiv

e/ex

pres

sive

pr

osod

y in

clus

ion

crite

ria

Valid

ity

Feas

ibili

ty

MN

TAP

6–11

To

ass

ess

face

16

sub

test

s R

ecep

tive:

Pro

sody

/ A

ffec

tive

–

67 c

hild

ren

with

AD

HD

M

NTA

P sc

ores

Ti

me:

~2–

3 ho

urs

(Lai

et

perc

eptio

n an

d (4

aud

itory

, co

nten

t pr

efer

ence

,

happ

y, m

ad,

and

38 c

ontro

ls

for

both

gro

ups

Form

at:

al

., 19

91)

re

cogn

ition

of

11 v

isua

l) Le

xica

l sa

d, s

care

d,

ages

6–1

1. I

nclu

sion

w

ere

com

pare

d el

ectro

nic

affe

ctiv

e st

imul

i as

Tr

aini

ng t

asks

,

com

preh

ensi

on,

ne

utra

l cr

iteria

for

AD

HD

gro

up

by s

ex &

ad

min

istra

tion;

co

nvey

ed t

hrou

gh

Inve

rted

face

s,

Pros

ody/

cont

ent

in

clud

ed 1

) a

teac

her

corr

elat

ed w

ith

man

ual

scor

ing

faci

al e

xpre

ssio

n,

Iden

tity

mat

ch

cong

ruen

ce,

Cro

ss

ra

ting

on t

he r

evis

ed

age.

No

sex

Mad

e fo

r:

la

ngua

ge,

and

pros

ody.

(1

), Id

entit

y m

atch

m

odal

mat

chin

g

Con

ners

tea

cher

rat

ing

diff

eren

ces

wer

e re

sear

ch u

se

(2),

Face

s te

achi

ng,

Exp

ress

ive:

Non

e

scal

e of

1.7

or

grea

ter

foun

d. C

orre

latio

ns

Aff

ect

mat

ch,

on

the

hyp

erac

tivity

w

ith a

ge w

ere

A

ffec

t na

min

g,

inde

x an

d 2)

dia

gnos

is

high

est

with

A

ffec

t ch

oice

,

of A

DH

D b

ased

on

Inve

rted

face

s,

G

estu

re r

ecog

nitio

n,

mee

ting

8 of

14

Face

and

Obj

ect

Lo

caliz

atio

n m

emor

y,

crite

ria s

et f

orth

in

the

reco

gniti

on m

emor

y,

Face

& o

bjec

t

DSM

III

–R.

No

& L

ocal

izat

ion

re

cogn

ition

mem

ory,

in

form

atio

n on

SES

or

mem

ory

task

s.

Se

quen

tial

face

pai

rs

ethn

icity

(Sh

apiro

,

AD

HD

gro

up

mem

ory,

and

fou

r

Hug

hes,

Aug

ust,

&

diff

ered

fro

m

au

dito

ry r

ecep

tive

B

loom

quis

t, 19

93).

cont

rol

grou

p in

su

btes

ts

ta

sks

of p

roso

dy/

co

nten

t co

ngru

ence

& c

ross

-mod

al

m

atch

ing.

DA

NVA

2

3–99

To

exa

min

e th

e 5

subt

ests

R

ecep

tive:

Adu

lt A

ffec

tive

–

Rel

iabi

lity:

Int

erna

l In

tern

al

Tim

e: ~

60 m

in

(Now

icki

&

pe

rcep

tion

of

(2 f

aces

, pa

rala

ngua

ge 2

,

happ

y, s

ad,

co

nsis

tenc

y co

nsis

tenc

y:

Form

at:

D

uke,

199

4)

fa

cial

exp

ress

ion,

2

para

lang

uage

C

hild

par

alan

guag

e an

gry,

fea

rful

D

AN

VA 2

AF-

D

AN

VA 2

AF–

el

ectro

nic

para

lang

uage

&

1 p

ostu

re)

2

158

colle

ge s

tude

nts;

α

= 0.

90 D

AN

VA

adm

inis

tratio

n;

(em

otio

nal

aspe

ct

Adu

lt fa

cial

(A

F)

Exp

ress

ive:

Non

e

DA

NVA

2 C

F-

2 C

F– α

=0.6

9–0.

81 a

utom

atic

of

pro

sody

),

expr

essi

ons

2,

acro

ss 1

0 st

udie

s w

ith

DA

NVA

2 A

P–

scor

ing

and

unde

rsta

ndin

g C

hild

fac

ial

(CF)

ch

ildre

n ag

ed 4

-16

α =

0.75

M

ade

for:

of b

ody

post

ures

ex

pres

sion

s 2,

ye

ars;

DA

NVA

2 A

P–

DA

NVA

2 C

P–

clin

ical

&

in c

hild

ren

and

Adu

lt pa

rala

ngua

ge

Mag

e 33

.5 y

ears

,

α =

0.74

re

sear

ch u

se

ad

ults

. (A

P) 2

, C

hild

N

= 2

0; D

AN

VA 2

(8

yea

r ol

d)

para

lang

uage

(C

P)

CP-

8-ye

ar-o

ld (

N =

32)

&

α =

0.7

6

2, A

dult

post

ures

&

10-

year

-old

(N

=31

); (1

0-ye

ar-o

ld).

2

DA

NVA

2 a

dult

DA

NVA

2 a

dult

post

ures

- co

llege

po

stur

es-

stud

ents

(N

= 5

4)

α =

0.75

.

Et

hnic

ity c

ompa

rabl

e to

co

mm

unity

rat

es.

Gro

ups

mat

ched

for

SES

& I

Q.

Mea

n &

SD

s of

err

ors

on

adul

t &

chi

ld f

acia

l

ex

pres

sion

s &

par

alan

guag

e

su

btes

ts a

re p

rovi

ded

for

ages

3–9

9. D

ata

for

child

po

stur

es s

ubte

st-5

–14

year

s;

adul

t po

stur

e su

btes

t-

15

–50

year

s.


Tabl

e 3

(p.

2 of

3).

Feat

ures

of

the

asse

ssm

ent

tool

s th

at e

valu

ate

affe

ctiv

e pr

osod

y on

ly.

Ag

e Pu

rpos

e an

d

Pros

ody

subt

ests

As

pect

s of

N

orm

ativ

e sa

mpl

e an

d

Relia

bilit

y/

Te

st

(in

year

s)

popu

latio

n Su

btes

ts

rece

ptiv

e/ex

pres

sive

pr

osod

y in

clus

ion

crite

ria

Valid

ity

Feas

ibili

ty

post

ures

sub

test

-5–1

4 ye

ars;

ad

ult

post

ure

subt

est-

15–5

0 ye

ars.

Apr

osod

ia

>17

To

exa

min

e Fo

ur s

ubte

sts

Rec

eptiv

e:

Aff

ectiv

e–

22 b

rain

-dam

aged

R

esul

ts

Tim

e: ~

60 m

in

batte

ry

re

cept

ion

and

(2 r

ecep

tive

Aff

ectiv

e–pr

osod

ic

happ

y, s

ad,

su

bjec

ts a

nd 1

6 co

ntro

l co

nfirm

ed t

hat

Form

at:

(Ros

s et

al.,

expr

essi

on o

f &

2 e

xpre

ssiv

e)

com

preh

ensi

on

angr

y,

subj

ects

mea

n ag

es

the

mea

n el

ectro

nic

1997

)

affe

ctiv

e pr

osod

y A

ffec

tive–

pros

odic

(w

ord,

mon

osyl

labi

c su

rpris

ed,

49

.4±

15.2

, M

/F–9

/7.

co

effic

ient

of

adm

inis

tratio

n;

in a

dults

with

re

petit

ion,

an

d as

ylla

bic

neut

ral,

Si

x w

eeks

pos

tstro

ke

varia

tion

man

ual

acqu

ired

Sp

onta

neou

s le

vels

), A

ffec

tive–

di

sint

eres

ted

patie

nts

with

ca

lcul

ated

is

scor

ing.

ne

urol

ogic

al

affe

ctiv

e–pr

osod

ic

pros

odic

unila

tera

l he

mis

pher

ic

an a

ppro

pria

te

Mad

e fo

r:

di

sord

ers.

pr

oduc

tion,

di

scrim

inat

ion

in

farc

tions

wer

e m

easu

re o

f re

sear

ch u

se

Aff

ectiv

e–pr

osod

ic

(wor

d le

vel)

in

clud

ed.

Con

trols

had

af

fect

ive

co

mpr

ehen

sion

,

Exp

ress

ive:

no h

isto

ry o

f pr

evio

us

perf

orm

ance

A

ffec

tive–

pros

odic

A

ffec

tive–

pros

odic

neur

olog

ical

pro

blem

s,

& t

hat

the

di

scrim

inat

ion

re

petit

ion

(wor

d,

st

rong

ly r

ight

han

ded

perf

orm

ance

of

mon

osyl

labi

c an

d

as

det

erm

ined

by

a co

ntro

l >

LHD

asyl

labi

c le

vels

),

sc

ore

of +

70 o

n th

e >>

RH

D

Sp

onta

neou

s

Ed

inbu

rgh

Inve

ntor

y

af

fect

ive–

pros

odic

(Old

field

, 19

71).

prod

uctio

n

Gro

ups

wer

e m

atch

ed

fo

r se

x &

edu

catio

n

(R

oss

et a

l., 1

997)

.

FAB

>1

7 To

ass

ess

10 s

ubte

sts

Rec

eptiv

e: N

on

Aff

ectiv

e–

164

parti

cipa

nts

ages

2

wee

ks

Tim

e: ~

60 m

in

(Bow

ers

et

pe

rcep

tion

of

(5 f

acia

l, em

otio

nal

pros

ody

happ

y, s

ad,

17

–85

year

s, r

ight

te

st–r

etes

t Fo

rmat

: al

., 19

99)

af

fect

ive

pros

ody

3 pr

osod

ic, &

di

scrim

inat

ion,

an

gry,

fea

rful

,

hand

ed,

prim

arily

re

liabi

lity

in

elec

troni

c

in

adu

lts w

ith

2 cr

oss

mod

al)

Em

otio

nal

pros

ody

neut

ral

Cau

casi

an,

livin

g in

yo

ung

adul

ts

adm

inis

tratio

n;

neur

olog

ic o

r

Faci

al i

dent

ity

disc

rimin

atio

n,

th

e So

uthe

aste

rn U

.S.,

(N

= 2

0, 1

8–30

m

anua

l sc

orin

g

ps

ychi

atric

di

scrim

inat

ion,

N

ame

the

no

psy

chop

atho

logy

at

year

s) &

mid

dle

Mad

e fo

r:

di

sord

ers.

Fa

cial

aff

ect

emot

iona

l pr

osod

y,

th

e tim

e of

tes

ting.

ag

e ad

ults

in

clin

ical

&

di

scrim

inat

ion,

C

onfli

ctin

g

Nor

ms

are

prov

ided

for

th

eir

early

50s

re

sear

ch u

se

Fa

cial

aff

ect

em

otio

nal

pros

ody,

youn

g ad

ults

(N

= 5

3,

(N =

12)

ran

ged

na

min

g, F

acia

l

Mat

ch e

mot

iona

l

18–3

0 ye

ars)

, m

iddl

e-

betw

een

0.89

to

af

fect

sel

ectio

n,

pros

ody

to a

n

age

adul

ts (

N =

42,

0.

97.

Fa

cial

aff

ect

em

otio

nal

face

,

31

–60

year

s),

olde

r ad

ults

m

atch

ing,

& s

ix

Mat

ch e

mot

iona

l

( N =

49,

61–

70 y

ears

) &

re

cept

ive

pros

ody

face

to

an

el

derly

adu

lts (

N=

20,

subt

ests

em

otio

nal

pros

ody

71

–84

year

s) f

or e

ach

of

E

xpre

ssiv

e: N

one

th

e 10

sub

test

s (B

ower

s

et

al.,

199

9) &

ind

ivid

uals

w

ith n

euro

logi

c di

sord

ers

(Blo

nder

, B

ower

s, &

H

eilm

an,

1991

; B

ower

s,

Blo

nder

, Sl

omin

e, &

H

eilm

an,

1996

).


Tabl

e 3

(p.

3 of

3).

Feat

ures

of

the

asse

ssm

ent

tool

s th

at e

valu

ate

affe

ctiv

e pr

osod

y on

ly.

Ag

e Pu

rpos

e an

d

Pros

ody

subt

ests

As

pect

s of

N

orm

ativ

e sa

mpl

e an

d

Relia

bilit

y/

Te

st

(in

year

s)

popu

latio

n Su

btes

ts

rece

ptiv

e/ex

pres

sive

pr

osod

y in

clus

ion

crite

ria

Valid

ity

Feas

ibili

ty

AC

S 16

–70

To a

sses

s so

cial

4

subt

ests

R

ecep

tive:

A

ffec

tive–

80

0 pa

rtici

pant

s ag

ed

Inte

rnal

Ti

me:

~30

-45

(Pea

rson

,

fu

nctio

ning

Fa

cial

aff

ect

Pros

ody–

face

ha

ppy,

sad

,

16–7

0 ye

ars,

no

cons

iste

ncy:

m

in20

09)

de

ficits

in

adul

ts.

re

cogn

ition

,

mat

chin

g,

angr

y,

hist

ory

of

soci

al p

erce

ptio

n Fo

rmat

:

Aff

ect

nam

ing,

Pr

osod

y–pa

ir su

rpris

ed,

neur

olog

ical

,

tota

l (α

= 0

.70–

el

ectro

nic

Pr

osod

y–fa

ce

mat

chin

g.

fear

ful,

ps

ychi

atric

,

0.84

), pr

osod

y ad

min

istra

tion;

mat

chin

g,

Exp

ress

ive:

di

sgus

ted,

de

velo

pmen

tal,

or

(α =

0.6

4-0.

79),

man

ual

scor

ing

Pr

osod

y–

Non

e ne

utra

l,

med

ical

con

ditio

n an

d pa

irs (

α =

Mad

e fo

r:

pair

mat

chin

g

sarc

astic

af

fect

ing

cogn

itive

0.

78-0

.85)

. cl

inic

al &

fu

nctio

ning

.

re

sear

ch u

se

D

emog

raph

ics

mat

ched

to

U.S

. 20

05 c

ensu

s

da

ta f

or e

thni

city

&

educ

atio

n le

vel.

Not

e. M

NTA

P =

Min

neso

ta T

ests

of

Aff

ectiv

e Pr

oces

sing

, D

AN

VA 2

= D

iagn

ostic

Ana

lysi

s of

Non

verb

al A

ccur

acy

2, F

AB

= F

lorid

a A

ffec

t B

atte

ry, A

CS

= A

d-va

nced

Clin

ical

Sol

utio

ns.


Rutherford, 2007; Stojanovik, 2010). The original PEPS (Profiling Elements of Prosodic Systems) test described in Peppé’s (1998) dissertation was designed for clinical use with adults; however, the present version of PEPS–C is specifically designed for use with children. Data on typical adults using PEPS are reported in Peppé, Maxim, and Wells (2000), and some clinical results for adults are reported in Peppé, Bryan, Maxim, and Wells (1997). Martinez-Castilla, Sotillo, and Campos (2011) used the Spanish ver-sion of the PEPS–C (Peppé et al., 2010) to assess the prosodic abilities of Spanish-speaking adolescents and adults with Williams syndrome. The PPAT and MNTAP have been used to assess prosodic impair-ments in children with hearing loss and attention deficit hyperactivity disorder (Klieve & Jeanes, 2001; Shapiro, Hughes, August, & Bloomquist, 1993). The Aprosodia Battery, FAB, and ACS have been used mainly to assess affective prosodic difficulties in adults with conditions such as brain injury and neurologic and psychiatric disorders. Nowicki (2006) reported that the DANVA 2, which was developed for use with children and adults, has been widely used for research purposes in various clinical groups, in-cluding hearing loss, ASD, traumatic brain injury, and learning disability.

Crystal (2009) reported that there is inadequate diagnosis in terms of identifying prosodic difficul-ties in children (mastering prosodic contrasts) and adults (managing the organizational role of prosody in speech production) and in determining the pro-sodic difficulties caused by access to limited auditory information in children and adults (e.g., due to hear-ing loss). Our review indicates that tools such as the PEPS–C, DANVA 2, PROP, and PVSP are applicable for wide age ranges (see Table 2) and diverse clinical populations. There is, in our opinion, sufficient in-formation to indicate the intended purpose and target population for these tools but a dearth of published studies exploring their clinical utility. Perhaps the best way forward is to encourage researchers to use these tools to generate evidence for clinical use.

Domains of Prosody AssessedTurk (2009) reported that an ideal prosody assess-ment tool should involve the assessment of function, phonological representation, surface-level implementa-tion, and perception of prosody (i.e., a comprehensive assessment should be able to evaluate both recep-tive and expressive skills across different aspects of prosody). An important variation among the assess-ment tools reviewed here is the attributes of prosody that they evaluate. This review reveals PEPS–C as a comprehensive tool that is useful to assess the

perception and production of different aspects of prosody. The receptive component of the PEPS–C includes subtests to assess sentence type (question vs. statement; Turn-End Reception), speaker’s attitude (liking or disliking of food items; Affect Reception), phrase boundaries (the distinction between simple and compound nouns and groupings of adjectives; Chunk-ing Reception), placement of contrastive stress/accent (Contrastive Stress Reception), and auditory discrimi-nation for long (Long item Discrimination) and short (Short item Discrimination) tones. The expressive component includes six subtests analogous to the re-ceptive subtests. The PPAT assesses the perception of phonetic features of prosody such as pitch, duration, and intensity (Apart from Linguistic Context) and grammatical (Grammatical Class and Compound and Abutting Words), emotional (Tone and Affect), and pragmatic (Stress) aspects of prosody. Thus, the PPAT is useful for the comprehensive assessment of recep-tive prosodic skills in children. However, the PPAT does not assess expressive prosody. Only the MNTAP, FAB, ACS, and DANVA 2 assess the perception of vocal emotions conveyed using prosodic cues. The Aprosodia Battery includes receptive and expres-sive subtests but assesses only affective prosody. The PROP and PVSP include only expressive prosody subtests to evaluate features such as pitch, phrasing, stress, and loudness.

The Aprosodia Battery and the FAB focus on evaluating affective prosodic deficits in neurologic or psychiatric patients. However, difficulties in affec-tive and other aspects of prosody are observed in other conditions such as hearing loss (Hopyan-Mi-sakyan, Gordon, Dennis, & Papsin, 2009; Most & Peled, 2007). Individuals with sensorineural hearing loss have difficulties perceiving subtle changes in pitch, loudness, and duration (Moore, 1987; Moore & Carlyon, 2005), which are major acoustic cues for the perception of prosody in English. Inaccurate percep-tion of these acoustic cues by individuals with hear-ing loss are manifested as difficulties in perceiving different aspects of prosody such as differentiating question from statement, word stress, distinguishing word/phrase boundaries, and vocal emotion recogni-tion (Hopyan-Misakyan et al., 2009; Meister et al., 2009; Most & Peled, 2007). The PPAT uses a phonet-ic and phonological perspective to describe receptive prosodic skills in children using cochlear implants. This is appropriate for individuals with hearing loss because it considers both acoustic factors and lin-guistic functions of prosody. Unfortunately, prospec-tive trials to evaluate the clinical utility of this tool are missing. Thus, there is a lack of comprehensive, valid, and reliable assessment tools to assess different domains of prosody in individuals with hearing loss.


Norms, Validity, and Reliability Data

Normative data. None of the tools described in this review is standardized. However, norms are provided by test developers for the PEPS–C, DANVA 2, ACS, FAB, and PVSP. Norms for the PPAT, Aprosodia Battery, and MNTAP were obtained from studies that used these measures to compare the performance of disordered populations and control groups (see Tables 2 and 3). Normative data for these tests were obtained for sample sizes ranging from 16 to 800. Diehl and Paul (2009) reported that compared to the PROP, PVSP, and PEPS–C, language assessment mea-sures such as the CELF–IV and PPVT were normed on larger normative samples with stratified norms based on gender, race, geographic location, and other factors (Dunn & Dunn, 2007; Strauss, Sherman, & Spreen, 2006). Stratified normative data are not available for the prosody assessment tools identi-fied by this review. Clinicians need to be cautious in implementing the normative scores provided by the test developers to their target clinical population. For example, the PEPS–C was normed on a sample of 120 British English-speaking children ages 5–14 years, and the DANVA 2 Child Paralanguage subtest was normed on North Americans ages 8–10 years. These norms may not be appropriate for use with children who belong to different ethnic groups as there are linguistic and cultural prosody differences even among speakers of English (Coggshall, 2008).

Validity. The PVSP test developers reported good instrumental and perceptual criterion validity (Shrib-erg et al., 1992). Instrumental procedures were used to estimate the criterion validity of more than 300 audiotaped exemplars that were selected to teach the coding procedures. Where the criterion validity of these perceptual coding decisions could not be determined by instrumental means, comparisons with the perceptual decisions of a panel of expert listeners were used. Very few studies have used the MNTAP, FAB, DANVA 2, PEPS–C, ACS, Aprosodia Battery, and PPAT tools to discriminate between typical and atypical populations (discriminant validity; Bowers et al., 1999; Klieve & Jeanes, 2001; Ross et al., 1997; Shapiro et al., 1993), which suggests a need for fur-ther validation.

One aspect of validity, face validity, can be ad-dressed by determining the relevance of test items to real-life communication. For example, the Affect and Turn-End Reception subtests of the PEPS–C use sin-gle-word test items (names of food items) rather than a sentence context. A positive feature of the ACS, DANVA 2, and FAB is that they use sentence-level stimuli, which are more naturalistic than word-level stimuli. While assessing prosodic skills, it would be

appropriate to balance the advantages of psychometric robustness (using normed tests) against the advan-tages of ecological validity (as in careful analysis and profiling of naturalistic conversational data).

Reliability. Data on the reliability of the nine assessment tools reviewed in this study are shown in Tables 2 and 3. Reliability has generally been assessed using internal consistency measures or measures that are based on the correlations between different items on the same test. For the DANVA 2 and ACS, internal consistency was demonstrated by computing Cronbach’s alpha. Further empirical confir-mation of the tool beyond its initial construction by the original developers was undertaken for DANVA 2 (Nowicki, 2006). Internal consistency was measured using the coefficient of variation for the Aprosodia Battery. Test–retest reliability data are provided for the FAB and PEPS–C. Good intrarater reliability (i.e., degree of agreement among raters) and interrater reli-ability (i.e., consistency of a measure when admin-istered by different examiners) were reported for the expressive subtests of the PEPS–C by Wells, Peppé, and Goulandris (2004). This tool has been used by an increasing number of researchers (Foley et al., 2011; Martínez-Castilla & Peppé, 2008; Stojanovik, 2010).

There is considerable difficulty in directly com-paring the different tools described in this review. For example, the sensitivity and specificity of each test varies according to the population studied and the cut-off scores that are considered abnormal (see Tables 2 and 3). Overall, this review supports the recommendation by Diehl and Paul (2009) that there is a need for a prosody assessment tool that (a) is standardized relative to a large representative norma-tive sample and (b) provides empirical data on reli-ability, validity, and other psychometric properties.

FeasibilityAs noted by Crystal (2009), prosody is often ne-glected in terms of assessment, and “it is difficult to think of another medical area where a set of poten-tially relevant symptoms would be treated with such unconcern” (p. 257). Green and Tobin (2009) reported that a phonetic (surface-level features) and phono-logical (functions) analysis of prosody is useful in both typical and atypical speech. Given the clinical relevance of prosody, clinicians should take the time to investigate prosodic skills routinely in their client groups despite time constraints. However, practical considerations are important in a clinical setting, af-fecting both clients and the professionals involved in the assessment process, especially as time is neces-sarily limited. Clinicians working in the field might need to consider having access to equipment such as


a laptop, loudspeaker, sound-level meter, and digital voice recorder that would be required to administer some of the tools (e.g., PROP, PVSP, PEPS–C, DAN-VA 2). Automatic and computerized tests such as the PEPS–C and DANVA 2 are simple, the user manuals provide clear instructions, and a minimum amount of training is required for clinicians. In contrast, the MNTAP, PROP, and PVSP require manual scoring and prosody transcription. Other factors relevant to the clinical utility of the assessment tools include the time taken to administer the test, ease of scoring (manual or computerized), appropriateness of the test stimuli for use with children (color photographs or black and white photographs), test format (comput-erized or paper pencil test), and age range. A clini-cian should consider these factors before selecting a prosody assessment tool.

Administration time. The time taken to admin-ister each test varies depending on the number of subtests involved and the population being assessed (typical or disordered population). The PEPS–C is a comprehensive test that takes approximately 45–60 min to administer both the receptive and expres-sive subtests. Wells and Local (2009) described the PEPS–C as not time consuming, whereas Diehl and Paul (2009) considered it to be very long for a clini-cal measure. Peppé (2009) reported that the PEPS–C is short compared with the process of conversa-tion analysis, and long considering that it tests only prosody. The DANVA 2, MNTAP, FAB, and ACS take relatively less time (approximately 20–30 min) compared to the PEPS–C but only assess the percep-tion of affective prosody. The PPAT and Aprosodia Battery take approximately 1 hr to administer. Longer test duration would not be appropriate for young chil-dren and some clinical populations such as attention deficit hyperactivity disorder or ASD. Tests that are in paper–pencil format and require manual scoring (MNTAP, FAB, PPAT) would take longer for the cli-nician than automatic and computerized tests (PEPS–C receptive subtests, DANVA 2). The time taken to transcribe prosodic elements (PROP, PVSP, expressive subtests of Aprosodia battery, and PEPS–C) would depend on the expertise of the clinician.

Appropriateness. The appropriateness of the test stimuli should be considered, particularly when assessing children and atypical populations. Color photographs as in the PEPS–C and DANVA 2 would appear more realistic and have higher ecological validity (Diehl & Paul, 2009) than black and white photographs (MNTAP). The color of test stimuli can have a positive effect on performance levels in chil-dren (Jeanes et al., 1997). The number of response items can affect the chance performance level and the cognitive demands of the task. The PEPS–C receptive

subtests use a simple two-alternative forced-choice format (50% chance performance level). The ACS, DANVA 2, and FAB tools have a minimum of four response options (25% or lower chance performance level), and hence may not be feasible for very young children and some clinical populations.

The version of English that is used to record the test stimuli can differ from that of the target popula-tion; hence, locally developed norms may be required for prosody assessment tools using audio-recorded material. The DANVA 2 test stimuli were recorded by native English speakers from the United States, so its suitability for assessing prosodic skills in speakers of other versions of English such as Australian or New Zealand English needs further evaluation. A positive feature of the PEPS–C tool is that the recordings are available in four different versions of English, includ-ing British, Australian, North American, and Scottish English. Clinicians need to consider the cross-dia-lect prosodic variations while assessing speakers of Afro-Caribbean, Singaporean, or Indian versions of English.

Sensitive to development. Diehl and Paul (2009) reported that there is a need for a prosody assessment tool that is developmentally sensitive and can be used with different age groups. Of the tools reviewed here, only the DANVA 2 has different forms for different ages. Tools without different age versions can have ceiling effects for older children and adults and floor effects for younger children (e.g., Wells & Peppé, 2003). Also, different subtests may not be equally difficult for the age group tested, making it difficult for the clinician to determine relative strengths and weaknesses across areas for the purpose of interven-tion unless good normative data are available (Diehl & Paul, 2009). For example, the PVSP can be used for a wide age range but does not indicate what percentage of correct prosody would be appropriate for various age groups. Few studies have reported age-related developmental changes on prosodic skills in children using the PEPS–C (Foley et al., 2011; Gibbon & Smyth, 2013; Wells et al., 2004). A sum-mary of the results and discussion section is provided in Table 4.

Conclusion SLPs frequently encounter prosodic impairments in persons with various communication disorders; hence, knowledge regarding assessment options for persons with prosodic impairments is important. The aims of this review were to identify the tools that are avail-able to assess prosodic skills in children and adults and to evaluate the clinical utility of each. In recent years, methodological paradigms such as acoustic


analysis of speech productions, direct measurement of articulatory movements, judgments and reac-tion times obtained during identification and dis-crimination tasks, measurements of brain activity, and patterns of attention in babies have been used in prosody research (Prieto, 2012). However, these techniques are time consuming and are not feasible in a clinical environment. This article described the nine behavioral assessment tools that are available to aid clinicians who wish to examine prosodic skills in typical and disordered populations. The relatively small number of tools available to evaluate prosody compared to other aspects of language indicates that, although prosody is a topic that is clinically relevant, it is often overlooked in terms of formal assessment. Clearly, there is no widespread recognition of the need for prosody assessment, as evidenced by the small number of assessment tools available.

Consistent with Diehl and Paul (2009), our lit-erature review identified very few assessment tools available to evaluate prosody compared to the large number of standardized assessment tools that are available for other aspects of language like syntax, vocabulary, and phonology. Many existing prosody tools are narrow in scope or have not been robustly validated. This is an important gap that warrants future research. Most tools have been carefully constructed but lack generalizability across prosodic disorders, and five out of the nine tools identified focus on only one particular aspect of prosody. If a clinician is working with client groups with neuro-logic impairments and psychiatric disorders in which affective prosody is the main focus, then Table 3 will be useful.

When selecting a tool, clinicians should consider the target population, time required to administer the tool, ease of administration and format of the tool,

and access to equipment, as well as normative and reliability data. The various assessment tools reported in this review have explained prosody using different perspectives; hence, clinicians should have a specific idea about which aspect of prosody they want to as-sess and on which dialects of English it can be used safely.

The assessment of prosody is currently con-strained by a lack of normative data. Three of the identified tools were devoid of norms. Only four tools are available that focus on two or more as-pects of prosody. Among these, the PROP and PVSP require a high level of expertise to transcribe pro-sodic elements and are time consuming. The PPAT was originally developed for use with children using cochlear implants and therefore focuses only on as-sessing receptive prosody skills. The PPAT may work well with children with hearing loss, but limited empirical data are available. The PEPS–C may be a good choice in clinical practice as it covers a wide age range, is easy to administer and score, provides a good user guide and manual, and has been used with a number of different clinical populations. However, its application to adults needs further investigation. A lack of knowledge of developmental norms for dif-ferent domains of prosody makes it difficult to derive standardized scores for these tools in children.

Some reasons why prosody assessment is ne-glected by clinicians may be a lack of training or awareness of existing assessments, time constraints, lack of normative data for comparison with atypical populations, lack of evidence-based studies regarding the intervention of prosodic difficulties, and lack of culturally appropriate and developmentally sensitive measures. The remarkable lack of published studies on intervention for prosodic deficits might be due to the lack of appropriate assessment tools. This review

Table 4. Summary of the features of the nine prosody assessment tools reviewed.

Target population Subtests involved Psychometric data

Tools Children Adults Receptive Expressive Norms Reliability Validity

PROP + + – + – – –PVSP + + – + + – +PEPS–C + – + + + + #PPAT + – + – * – #MNTAP + – + – * – #DANVA 2 + + + – + + #Aprosodia battery – + + + * + #FAB – + + – + + #ACS – + + – + + #

Note. * indicates that norms for control groups were derived from previous studies; # indicates that few studies have used these tools to discriminate between typical and atypical populations.


highlights the needs for prosody assessment tools that are sensitive to developmental changes in children and that comprehensively and reliably assess relevant aspects of prosody in children and adults.

It is worth mentioning here that previous research explaining the articulatory movements and acoustic features associated with various prosodic contrasts (e.g., Grigos & Patel, 2007, 2010; Patel & Grigos, 2006; Snow, 1994, 1998) are not tied to any of the assessment tools described in this review, and a good way forward is to use these theoretical data to develop future tools. Future research should gather empirical data on the acquisition of prosody using the available tools and further explore the establish-ment of standardized diagnostic measures to evaluate prosody. Validity and reliability have been addressed to varying degrees—thoroughly in some tools and not at all in others.

The effectiveness of these tools in highlight-ing specific aspects of prosody warranting clinical intervention, and then guiding the intervention ap-proach, has received little attention. Therefore, when considering these tools for the clinical assessment of prosody, caution is required to ensure that the time investment is warranted in terms of improved clinical outcomes for clients with communication difficulties. Given the considerable evidence for the importance of prosody in everyday communication, this is an important area for future work.

ACKnOwlEdgMEnT

This study was supported by the Oticon Foundation Denmark.

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Contact author: Rose Thomas Kalathottukaren, Building 721.320, Tāmaki Innovation Campus, Discipline of Speech Science, School of Psychology, The University of Auck-land, 261 Morrin Road, Private Bag 92019, Auckland, New Zealand. E-mail:[email protected]

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