Embodying Conversational Agents in Paediatric Speech Therapy: A systematic review

Language disorders in pediatric age affect not only linguistics, but also socio-educational dimensions. Despite its importance and advancements in using digital interventions to support speech therapy rehabilitation in its repetitive activities, there has been a knowledge gap in the systematization of the characteristics of Embodied Conversational Agents (ECAs) that make rehabilitation sessions more enjoyable and engaging for children. A systematic literature review was, therefore, conducted across PubMed, Scopus and ACM Digital Library for papers published between 2010 and 2026, following the PRISMA 2020 guidelines. A total of 200 records were identified, with 24 studies meeting the inclusion criteria. This review addresses three research questions addressing three research questions: (RQ1) which language and communication disorders are primarily addressed; (RQ2) what embodiment configurations are adopted; and (RQ3) whether ECAs improve clinical outcomes compared to standard care. The analysis reveals a limited but increasing number of studies, suggesting that ECAs are an emerging tool not yet widely adopted in clinical practice, predominantly used in speech therapy for language rehabilitation, but also applicable to social skills development. Physically embodied ECAs appear predominant, with a distinction between custom-developed systems and commercially available platforms; in both cases, a non-threatening, toy-like appearance prevails. However, longitudinal evidence is lacking on whether ECAs, whose multimodal communicative repertoire, encompassing verbal, prosodic, gestural, and facial channels, fosters a sense of social presence that approximates human interaction, can sustain a therapeutic relationship with pediatric users that supports clinical goals and maintains engagement across repeated sessions.