Background: Speech sound disorders are common in children and are associated with an increased risk of academic reading difficulties. The COVID-19 pandemic further highlighted the need for remote and digitalized assessment tools. In South Korea, standardized instruments such as the Urimal Test of Articulation and Phonation and Assessment of Phonology and Articulation for children are widely used but have limitations, including reliance on face-to-face evaluation, and the absence of automated scoring. Objective: This study aimed to develop and establish the content validity of an articulation assessment tool that can overcome these limitations and be integrated into digital therapeutics (DTx). Methods: A 3-round modified Delphi survey was conducted between July and September 2025 with 92% (23/25) of the invited experts, including 52.2% (12/23) physiatrists and 47.8% (11/23) speech-language pathologists, with a mean professional experience of 10.69 (SD 5.09) years. All participants (23/23, 100%) completed all rounds. Panelists evaluated the appropriateness of word lists, phonological environments, and scoring criteria. Quantitative analyses, including calculations of content validity ratio (CVR), content validity index (CVI), and median and IQR, were performed. Consensus thresholds were set at a CVR of ≥0.39, a CVI of ≥0.78, a median of ≥3.5, and an IQR of ≤1.0. Items were retained only when all 4 criteria were satisfied. While formal qualitative analysis was not performed, the research team internally reviewed and synthesized core keywords and themes from the experts’ open-ended responses to guide the refinement of items. Results: These findings were summarized into four key areas: (1) modernization of word stimuli, (2) expansion of phonological coverage, (3) refinement of scoring criteria to reduce ambiguity, and (4) enhancement of result interpretability through visualization. In round 2, a revised 35-word list was evaluated across 25 items, of which 20 (80%) met all consensus criteria. In total, 20% (5/25) of the items failed to meet at least one threshold, including phonological environment adequacy (CVR=0.48; CVI=0.74), scoring redundancy (CVR=0.13; CVI=0.57), usefulness of proportion of whole-word correctness or percentage of word proximity (CVR=0.39; CVI=0.70), contribution of mean phonological length (CVR=0.22; CVI=0.61), and usefulness of feature-based indexes (CVR=0.30; CVI=0.65; IQR 2). Items that reached consensus showed CVR values of 0.57 to 0.91, CVI values of 0.78 to 0.96, a median score of 4, and IQR values of 0 to 1. In round 3, all remaining items achieved consensus. Conclusions: This Delphi study developed a novel articulation assessment tool with robust content validity. This tool includes updated word stimuli, diverse analysis indexes, 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 speech sound disorders.

Background/Objectives: Speech sound disorders (SSDs) are common in childhood and affect literacy and academic achievement. Standardized assessments such as the Urimal Test of Articulation and Phonology (UTAP) rely on time-intensive manual scoring. We evaluated the reliability and validity of Hi-DongDong, a Delphi-developed digital articulation assessment. Methods: This prospective multicenter study across five institutions recruited in total 931 children aged 2–13 years from outpatient clinics and community childcare facilities. Speech samples obtained with Hi-DongDong and UTAP-1 or UTAP-2 were independently evaluated by three experienced speech–language pathologists. Analyses were conducted on participants with valid paired datasets, using intraclass correlation coefficients (ICCs), Pearson correlations, Wilcoxon signed-rank tests, and Bland–Altman analyses. Results: Inter-rater reliability was excellent (ICC ≥ 0.96). Inter-instrument reliability was good to excellent for total percentage of correct consonants (PCC) and total PCC–revised. All outcomes correlated significantly with UTAP (r = 0.347–0.939, p < 0.001). Utterance-level consonant accuracy indices showed minimal mean bias, whereas phonological mean length of utterance, vowel accuracy, and word accuracy showed systematic bias or wide limits of agreement, precluding interchangeable use. Conclusions: Hi-DongDong showed excellent inter-rater reliability and concurrent validity, particularly for consonant accuracy; however, its diagnostic accuracy remains unknown, and it cannot yet replace standardized diagnostic thresholds.

Objective: This study aimed to identify caregivers’ perceptions, preferences, and intentions regarding the use of digital articulation therapy applications for children with DLD. Methods: A cross-sectional online survey was conducted between August and September 2025 among 197 caregivers of children diagnosed with DLD. A 43-item questionnaire was structured into five domains addressing demographics, therapy experience, digital-therapy exposure, and preferences for application-based articulation therapy. Constructs from the Unified Theory of Acceptance and Use of Technology 2, including performance expectancy (PE), social influence (SI), price value (PV), facilitating conditions (FC), and behavioral intention, were analyzed. Results: Most respondents were mothers (96%), and 78.7% of them resided in urban areas. Among them, 84.3% had prior speech therapy experience. Only 15.7% had used educational or therapeutic applications; the main dissatisfaction factors were lack of fun (51.6%) and feedback (19.3%). Caregivers preferred short, engaging sessions (20–40 min per day), video-based (75%) or game-based (64%) content, and feedback every 2 months, with a reasonable monthly cost (20,000–30,000 KRW). Regression analysis revealed that sex (β = −0.451, p = 0.013), PE (β = 0.381, p < 0.001), and PV (β = 0.212, p = 0.034) significantly associated with behavioral intention to use an articulation-therapy application, whereas SI and FC were not significant. Conclusions: Caregivers of children with DLD demonstrated strong willingness to adopt digital articulation therapy applications, particularly when these tools provide meaningful therapeutic outcomes at moderate cost and include motivating, interactive content. Future application design should prioritize treatment functionality, user engagement, and accessibility to enhance adoption and continuity of digital speech-language interventions.