Children with speech sound disorders preferred Apraxia World over traditional practice - a single-session comparison
How this was rated
Single-session within-subjects design (n=21) evaluating engagement and preference, not outcomes. No control group, no pre-post measurement of speech outcomes.
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A single-session, within-subjects study comparing two delivery conditions for Apraxia World - a tablet-based speech therapy game for children with speech sound disorders. The study assessed engagement and preferences across 21 children (14 with speech sound disorders, 7 typically developing), finding that the majority found the game enjoyable. The study is a user-experience and preference evaluation, not an efficacy trial.
A small user-experience study (n=21, single session) evaluating engagement and preference for a tablet speech therapy game. Provides feasibility and acceptability evidence only; cannot establish efficacy.
Key findings
- 19 of 21 children found the game enjoyable and wanted to continue playing.
- 13 of 21 children preferred after-game speech exercises over during-game speech exercises.
- Children particularly liked the monkey characters, fighting enemies, store features, and power-ups.
- Single-session, within-subjects randomized-order design compared two delivery conditions; not an efficacy study.
Background
Childhood apraxia of speech affects the planning and coordination of speech movements, making it difficult for children to produce speech sounds accurately and consistently. Supporting children with apraxia typically requires intensive, repetitive speech practice - often hundreds of trials per session - to build the motor plans needed for clear speech. This volume of practice can be challenging for young children, who may become frustrated or disengaged when asked to repeat the same sounds or words many times. Serious games offer a way to embed speech practice within an engaging activity, potentially increasing both the quantity and quality of practice.
What the researchers did
Hair and colleagues developed Apraxia World, a tablet-based speech therapy game for children with speech sound disorders. The game runs on a Samsung Tab A 10.1-inch Android tablet. Word prompts were drawn from the Nuffield Dyspraxia Program 3 (NDP3), a clinically established articulation assessment tool. Clinicians (using a Wizard-of-Oz keyboard interface, with no automatic speech recognition) evaluated each child’s production and controlled game progression. Parents curated individualized word lists of 5 easy and 5 hard words per child.
The study enrolled 21 children - 14 with speech sound disorders (7 with motor-speech childhood apraxia of speech and 7 with phonological disorders, ages 4-12, mean age 7.4, predominantly male) and 7 typically developing children (ages 5-12, mean age 8.7). In a single session with randomized within-subjects order (maximum 15 minutes per condition), children experienced two delivery conditions and rated their preferences and enjoyment.
What they found
19 of 21 children found the game enjoyable and expressed a wish to continue playing. When asked about their preferred timing for speech exercises, 13 of 21 children preferred performing exercises after the game rather than during it, suggesting that the game itself may be most effective as a motivational framework rather than as the direct vehicle for intensive repetition. Children responded positively to specific game elements: monkey characters, fighting enemies, the in-game store, and power-up features were the most liked aspects. No pre-post outcome measurement of speech accuracy was conducted - this was a preference and engagement evaluation, not an efficacy study.
Why this matters
The study provides useful acceptability evidence: children with both motor-speech and phonological difficulties found the game engaging and fun. The Wizard-of-Oz evaluation approach - where a clinician silently controls the system rather than relying on automatic speech recognition - may have practical implications for how technology-supported speech practice is designed and deployed in clinical settings. Clinician-curated word lists enabled individualized practice.
Limitations
This was a single-session study with no longitudinal follow-up. No pre-post measurement of speech accuracy was conducted, so no efficacy claims can be made. The Wizard-of-Oz approach requires ongoing clinician involvement and does not reflect fully autonomous technology-delivered practice. The sample was small and the within-subjects single-session design cannot establish whether engagement or preferences would be maintained across multiple sessions.
Implications for practice
Apraxia World demonstrates that tablet-based games using word prompts from established assessment tools (Nuffield Dyspraxia Program 3) can be acceptable and enjoyable for children with motor speech and phonological difficulties. Clinician-curated word lists and Wizard-of-Oz evaluation allowed individualized practice without relying on automatic speech recognition. Acceptability evidence is useful; efficacy must be established through longitudinal trials.
Where this connects to Therapy withVR
The study above is independent research and does not endorse any product. The notes below are commentary from withVR on how the themes in this research relate to features of Therapy withVR. The research findings are not claims about Therapy withVR.
AI-Generated Content
This study showed gamification sustains speech practice engagement - Therapy withVR's AI features generate contextual prompts and conversation topics, keeping practice sessions varied and motivating across high-repetition sessions.
31 Children Avatars
Create age-appropriate, engaging practice scenarios with child avatars - supporting the child-friendly environment this study found essential for sustained participation in intensive speech work.
Cite this study
If you reference this study in your work, the canonical citation formats are:
@article{hair2018,
author = {Hair, A. and Monroe, P. and Ahmed, B. and Ballard, K. J. and Gutierrez-Osuna, R.},
title = {Apraxia World: A Speech Therapy Game for Children with Speech Sound Disorders},
journal = {Proceedings of the 17th ACM Conference on Interaction Design and Children},
year = {2018},
doi = {10.1145/3202185.3202733},
url = {https://withvr.app/evidence/studies/hair-2018}
}TY - JOUR
AU - Hair, A.
AU - Monroe, P.
AU - Ahmed, B.
AU - Ballard, K. J.
AU - Gutierrez-Osuna, R.
TI - Apraxia World: A Speech Therapy Game for Children with Speech Sound Disorders
JO - Proceedings of the 17th ACM Conference on Interaction Design and Children
PY - 2018
DO - 10.1145/3202185.3202733
UR - https://withvr.app/evidence/studies/hair-2018
ER - Know of research that should be in this hub? If a relevant peer-reviewed study is not listed here, send the reference to hello@withvr.app. The hub is kept up to date as the literature grows.
Funding & independence
No withVR BV involvement in funding, study design, or authorship. Summary prepared independently by withVR using the published paper.