Development of a Child Articulation Screening Test within Digital Therapeutics Using the Delphi Method

Background Speech sound disorders (SSDs) are among the most common communication disorders in children, and are associated with an increased risk of reading disabilities and academic difficulties. The COVID-19 pandemic further highlighted the need for remote and digitalized assessment tools. In Korea, standardized instruments, such as the Urimal Test of Articulation and Phonation and Assessment of Phonology and Articulation of Children are widely used but have limitations, including reliance on face-to-face evaluation, absence of automated scoring, and limited applicability for remote assessments. This study aimed to develop and validate an articulation assessment tool that can overcome these limitations and be integrated into digital therapeutics (DTx). Methods A three-round modified Delphi survey was conducted between July and September 2025, with 23 experts (12 physiatrists and 11 speech-language pathologists). Panelists evaluated the appropriateness of word lists, phonological environments, and scoring criteria. Qualitative and quantitative analyses, including calculations of Content Validity Ratio (CVR), Content Validity Index (CVI), and median and interquartile range (IQR) were performed. Consensus thresholds were set at CVR ≥ 0.39, CVI ≥ 0.78, median ≥ 3.5, and IQR ≤ 1.0. Results In round 1, experts recommended excluding outdated or dialectal words, expanding diphthong and fricative/affricate items, and incorporating a graphical visualization of outcomes. In round 2, a revised 35-word list was established, with a strong consensus on most items. Five items failed to reach a consensus and were revised. In round 3, consensus was achieved on all remaining items, resulting in a validated 35-word articulation assessment tool with improved scoring criteria and visual reporting. Conclusion This Delphi study developed a novel articulation assessment tool that addresses the limitations of the existing instruments. This tool includes updated word stimuli, diverse analysis indices, and visualization features, thereby enhancing its clinical utility and suitability for integration into artificial intelligence-based DTx. By standardizing and digitalizing articulation assessments, this tool has the potential to support personalized and accessible interventions for children with SSDs. Future studies should focus on non-inferiority testing against existing standardized tools and clinical validation using digital therapeutic platforms.