Introduction

• When we communicate our ideas about the world around us, we produce specific kinds of speech sounds, called phonemes that we sequence together in a variety of ways to form words

  • Phonemes - speech sounds

• Phonology - the language rules that govern how phonemes are combined to make words

  • Combine s+h and c+h but not f+h

• Articulation - the ability to produce sounds in sequence by moving the articulators

• SLPS are interested in describing, assessing, and treating children with developmental speech disorders

• Common in pediatric practice - articulation and phonology disorders

Definition and Incidence

• Articulation disorder - difficulty producing the sounds and sound sequences of their language

  • /w/ for /r/ substitution

  • /s/ distortion

  • /k/ in the final position deletion

• Phonological disorder - difficulty with understanding and implementing the underlying rules for producing sounds and sequences

  • use /sh/ and /ch/ as interchangeable

• May have difficulty with both (articulation disorder/phonological disorder)

Phonetic Science

• Production of Speech:

  • Respiratory System - lungs and diaphragm - bring air (power) to the speech system

  • Phonatory System - larynx - creates the sounds with the vocal cords

  • Resonatory System - soft pallet - allow the sounds to echo and be produced (nasal or oral sounds)

  • Articulation System - oral cavity, lips - filters the speech sounds

• Speech is served by the perceptual processes of audition and discrimination

  • Audition - hearing sounds

  • Discrimination - sorting sounds into recognizable categories

• Perception is crucially important for acquisition of speech production skills

Delay Versus Disorder

Description of articulation and phonological development as disordered of delayed is based on comparison of the child’s speech to the articulation and phonological patterns of children of a comparable age who are developing typically

• Speech Delay - speech production patterns that typically occur in children who are younger

• Speech Disorder - produce speech that is atypical of a child of any age

  

• Case Study #1

  • A child is 7 years old. He is having difficulty producing /k, g, t, d/ in the initial and final positions of words. All other phonemes are developed. His speech intelligibility is 80% accurate with careful listening in a known context. -- Speech Disorder

    • The hole in the middle is unique to him

• Case Study #2

  • A child is 4 years old. She is producing the following phonemes in all positions of words: /p, m, h, n, w, b/. Unfortunately, that is all of the sounds that she is saying spontaneously. She is stimulable with the following phonemes in isolation: /k, g, d, t, f/. -- Speech Delay

    • Looks like a 2 year old and can produce sounds of a 3 and 4 year old when focused on it

Severity of Involvement

• Severity of a speech delay or disorder is related to:

  • Accuracy of production

  • Number of sounds produced accurately

  • Produce sounds accurately in different positions

  • Produce sound sequences

  • Produce various types of words

• Severity rated by - Intelligibility and Mild/Moderate/Severe

Language and Dialect

• Children whose phonological production patterns are different because they are applying the phonological patterns of their first language to their second language are not usually placed in speech therapy

• Spanish speaking individuals learning English as a second language - may have difficulties in sufficiently distinguishing phonemes

  • jeep/sheep/cheap

Phonological Processes

• Developmental Phonological Processes:

  • Deletion of final consonants (house - hou)

  • Initial voicing (cup - gup)

  • Syllable reduction (banana - nana)

  • Palatal fronting (chase - tase)

  • Velar fronting (cake - tate)

  • Cluster simplifications (jump - jup)

• Non-Developmental Phonological Processes:

  • Deletion of initial consonants (cop - op)

  • Backing to velars (finger - ginger)

Etiology

• Etiology - the cause, set of causes, or manner of causation of a disease or condition

• Finding a cause of a developmental speech disorder in children is often quite difficult

• We do not know why a child has difficulty representing the phonology of the language

• Articulation disorder is more likely to have a known etiology or to be associated with a risk factor:

  • Perceptual Etiology - otitis media (ear infection), sensorineural loss

  • Structural Etiology - cleft lip/palate

  • Motor Etiology - dysarthria (muscles aren’t working - strength, accuracy, tone), apraxia (brain isn’t sending the right message)

Co-Occurrence

• Developmental speech disorders can co-occur with other types of speech and language problems

  • language disorder and articulation disorder

  • voice disorder and phonological impairment

  • fluency disorder and articulation disorder

  • etc.

Assessment and Treatment

• The goal of assessment is to determine the specific nature and severity of the disorder or delay

• Specific assessment procedures and materials are needed relative to the suspected etiology, the chronological and developmental age, and the primary language spoken

• Decisions regarding treatment will be based on results of the assessment and analysis

Collecting Information

• Speech Samples - Require an analysis of a spontaneous speech and language sample (play with child and record)

  • Problems with Speech Samples - time consuming, may be a privacy issue, may not have all the sounds

• Articulation Tests

  • Single word articulation test - produce consonants and vowels in various word positions

  • Traditional methods of describing articulation skills - substitution (cup - gup), omissions (cup - up or cuh), distortions (lateral s), additions (black vs. bah-lack)

  • The Goldman-Fristoe Test of Articulation - single word articulation test

• Oral-Peripheral Examination (Oral Mech Exam) - Evaluate the structure and function of the articulators (tongue, lips, palate)

• Hearing Test

• Language Tests (as appropriate)

If a child is non-verbal (not talking), how can you evaluate their communication skills?

• gesturing, vocalizing (grunting), see where their receptive language skills are, the way they eat, crying

Analyzing Speech

• Range of behaviors used for intentional communication - gestures, sign language, use of vision in gaze, body orientation

• The presence of these behaviors is important for planning where to start a treatment program designed to move toward intentional communication

Treatment/Intervention

• Centers on teaching the child to use sounds and sound sequences

• Goal of Treatment/Intervention - intelligible speech

• Articulation - repetitive motor practice with feedback

  • Production in isolation - (lah, lah, lah 10 times)

  • Beginning, middle and end of words - (lamp/light, middle, call/ball)

• Phonological approaches - emphasize the use of speech sounds and syllable sequences

  • Deemphasize repetition

  • Identify the target in the context of games/everyday sounds before turning their attention to speech

  • Metaphon approach relies on building children’s metaphonological awareness of sounds

    • Metaphonlogical - The ability to manipulate speech sounds auditorily

  • Increasing the child’s knowledge of the phonological system

  • /s, sh/ hissing sounds (high-frequency, fricative)

Service Delivery

• Seen in various settings - Early intervention (ECI) birth-3 years, public schools, medical settings, private or university clinics