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XXXXPhonologicalDis

XXXXPhonological Disorders

QuestionAnswer
Phonological disorders are more likely to occur in children than adults
ESL clients may come to you but you don’t seek them out
Articulation and Phonology used to be interchangeable
Articulation is encompassed in Phonology
Articulation is the _____ aspect the Motor Aspect = Articulation
The outer level of what you hear and how someone is producing it Articulation
The mechanics of sound production = articulation
Overt level of speech production speech sounds we hear and produce Articulation
Narrow stream continuous burst etc etc the physical movements and motor requirements Articulation Motor Aspect!
Phonology is more _____ based Language Based
The mental representation of all the sounds Phonology
The rules that govern the language system – the rules that govern the sounds Phonology = what the rules are
Sound with Contrastive Units of Speech Sounds in a Language Phonology
Mat versus Cat one phoneme makes all the difference = Phonology
Sound System and Sound Components of Language and how we use those sounds and make contrastive meaning differences Phonology
Description of systems and patterns of phonemes of a language Phonology
Patterns of sounds systems of sounds and how those patterns and sounds are used in a language to drive meaning Phonology
Use of phonemes in a language to distinguish between sounds in words Phonology
May treat one or both of these individually or simultaneously Articulation and Phonology
When a person has a problem with producing a sound (at least one sound) it is a motor production difficulty a difficulty producing a sound a problem with the actual production of a specific speech sound Articulation just can’t get the correct production of a sound or unable to produce certain sounds.
If a person has a problem with the phonemic system – when do I USE these sounds? they can PRODUCE the sounds but don’t put them in the right place = Phonological Disorder.
Phonemic Inventory = what phonemes a person HAS that they actually USE to CONTRAST MEANING.
Phonetic Inventory Think of Phonetics – more basic level – what are the speech sounds that they have OVERALL which phonemes can they SAY….
Phonological Disorder impaired phonemic system and phoneme patterns within language.
Phonetic Errors = Articulation Disorder (I can’t move my lips that way; I can’t make the airstream that way.)
Phonemic Error = Phonological Disorder (I don’t know how to use these sounds in the right place I can say the sound I can make the sound but I can’t figure out how to put them in the right place.)
Characteristics of an Articulation Disorder a couple of sounds (crummy r frontal lisp /th/ for /s/)
Articulation usually has only one or two sounds usually these are the later developing sounds – r is the hardest to correct
Phonology involves PATTERNS that extend across two or more sounds predictable patterns usually
Phonology involves errors in sound patterns like /w/ for /r/ in rabbit or /j/ for /l/ a gliding error here…
If it a predictable error type you may approach it from both articulatory and phonology perspective depending on whether or not they are able to produce the target sound.
Rule system problem = phonology
Motor production problem = articulatory
We analyze children’s sound systems differently now due to changes in theoretical beliefs that have occurred over time.
Behaviorist theory based upon stimulus-response; this is how we treated speech problems historically.
Years ago motor errors artic errors were treated with a very behaviorist approach - were only concerned about the motor aspect of production.
Since the 80’s we look at treatment more from a rule based sense of production. Less emphasis on strictly motor – we understand there are rules now that language development follows.
There are now different approaches stemming from different theoretical perspectives.
One of the earliest speech behaviorist theoreticians was Mowrer 1950s
Model/Imitation/Reinforce/Closer Approximations Mowrer 1950 Behavioral Self-Reinforcement Theory didn’t believe that there was a sequence to language acquisition all about what they randomly heard.
Mowrer stated that the Self-Reinforcement Theory (a behaviorist approach) was a classical conditioning process (Pavlov) infant needs provided by parent (food primary reinforcer) and parent vocalizations become secondary reinforcer. Child’s own speech becomes secondary reinforcer to self.
Child learns that as their vocalizations which are becoming more adult-like gets them more attention it fosters language as a secondary reinforcer.
Continuity Hypothesis relates to child learning that language is a secondary reinforcer = Early Sound Production is practice for later sound development. Still considered to be environmental and behavioral.
In Continuity Hypothesis if the child heard a lot of /s/ and /z/ they would be practicing them in babbling and those would be their first sounds mastered all based on environment and random kid to kid.
Behaviorist Theory no longer felt to be valid doesn’t account for new patterns seen in human language. Learning theory does play a part in language but it is too simplified a model.
Behaviorist Learning Theory thrown out because it doesn’t account for new patterns seen in human language and there is no evidence that sounds closer to adult models are selectively reinforced.
However imitation is VERY IMPORTANT in sound production and language learning.
STRUCTURAL theory Jakobson 1968 Kid has some innate ability to develop speech sounds; some are developed early on and others later still = there IS a universal order!
Structural Theory by Jakobson states that there is an innate an innate ability to learn language and phonological development follows universal order of development. 2 Separate Stages: Babbling and then Meaningful Speech but he had a weird CONTRASTING concept to it.
Jakobson Structural Theory 2 stages Babbling and Meaningful Speech through CONTRASTING SOUNDS.
Jakobson believed that children learned sounds in contrast 2 very diff sounds at same time like /b/ and /a/ they wouldn’t according to Jakobson be learning two bilabial stops at the same time.
According to Jakobson and the Structural Theory children learn two contrasting sounds during two stages but don’t connect the stages…and then they begin
Structural Theorists believed the Discontinuity Hypothesis = no continuity between babbling and early speech sound development thought babbling was random and early speech sounds were learned by contrasting sounds and not through practice.
Structural Theorists believed the Discontinuity Hypothesis and that speech learning was all about contrasting contrasting contrasting. They also believed the rate of language learning was variable but that the order was fixed.
Jakobson was right about two things the order of acquisition does go from stops nasals glides bilabials dentals and later fricatives affricates and liquids and there is a determined order of acquisition.
Kids do learn language at a variable rate and in a first/then order just like Structural Theory states
Discontinuity versus Continuity Continuity presents Babbling as a part of early speech.
Existing data clearly demonstrates gradual emergence of adult word shapes from babbling which supports Continuity.
Practicing /b/ /d/ /m/ in babbling according to Continuity does lead to those being the first sounds recognized in a child’s phonetic inventory.
Speech sounds preferences in Babbling are the same as in early speech.
Children also learn Singletons before Clusters more initial consonants in early babbling than final sounds also don’t have VC kinds of babbling
Kids in early speech development have more early consonant speech and more likely drop the final consonant the final consonant
Natural Theory Stampe
Generative Phonology Smith/Chomsky
Natural Theory and Generative Phonology led us to look at phonological processes and there being a universal set of them a universal set of rules for using speech sounds in our language. There is innate ability for sound and language learning.
Sound productions in a child are often simplified due to limitations in maturity of the oral motor system as they try to produce adult speech sounds they are limited in their ability to do so. They then reduce or suppress the simplifications as system becomes more adult.
Phonological Rules and Phonological Processing: as child gets closer and closer to adult speech and older they simplify speech less and less and drop these processes out. A child with a disorder does not drop those processes out they don’t suppress the simplifications. Child has an innate ability to learn language.
Optimality (see handout) a relatively new theory sees sound systems as a phonological process and not singleton sounds – looks at why certain sounds are produced ahead of others.
Distinctive Feature Theory Chomsky & Holly = stems from a lot of theoretical concepts it is a different way of categorizing sounds other than Place Manner and Voicing.
Kids do learn language at a variable rate and in a first/then order just like Structural Theory states
Discontinuity versus Continuity Continuity presents Babbling as a part of early speech.
Existing data clearly demonstrates gradual emergence of adult word shapes from babbling which supports Continuity.
Practicing /b/ /d/ /m/ in babbling according to Continuity does lead to those being the first sounds recognized in a child’s phonetic inventory.
Speech sounds preferences in Babbling are the same as in early speech.
Children also learn Singletons before Clusters more initial consonants in early babbling than final sounds also don’t have VC kinds of babbling
Kids in early speech development have more early consonant speech and more likely drop the final consonant
Natural Theory Stampe
Generative Phonology Smith/Chomsky
Natural Theory and Generative Phonology led us to look at phonological processes and there being a universal set of them a universal set of rules for using speech sounds in our language. There is innate ability for sound and language learning.
Sound productions in a child are often simplified due to limitations in maturity of the oral motor system as they try to produce adult speech sounds they are limited in their ability to do so. They then reduce or suppress the simplifications as system becomes more adult.
Phonological Rules and Phonological Processing: as child gets closer and closer to adult speech and older they simplify speech less and less and drop these processes out. A child with a disorder does not drop those processes out they don’t suppress the simplifications. Child has an innate ability to learn language.
Optimality (see handout) a relatively new theory sees sound systems as a phonological process and not singleton sounds – looks at why certain sounds are produced ahead of others.
Distinctive Feature Theory Chomsky & Holly = stems from a lot of theoretical concepts it is a different way of categorizing sounds other than Place Manner and Voicing.
Distinctive Features specific properties of a sound that signal MEANING differences – could be parts of a sound or could be an individual phoneme that makes a diff in meaning or meaning of a word (cat mat)
Distinctive Feature Analysis looks at all the different parts of all the distinctive features that make up a phoneme
Distinctive Feature Hypothesis states that there are attributes to each phoneme and show how each phoneme is different from the other ie: /t/ and /d/ are all the same except for Voicing.
Distinctive Features of Phonemes some are SOOO different and others are very similar.
The smallest indivisible units that make up phonemes are the distinctive features and are described in terms of Acoustic or Articulatory Characteristics – the sound either HAS IT or DOESN’T HAVE IT + -
Distinctive Feature Analysis uses a binary system +_- sound feature is either present or not and organizes sounds into Classes…
Sound Classes in the Distinctive Feature Analysis are Categories Place Manner and Voicing
We need to be able to look at speech from the perspective of composition of target versus error sounds - what is different between what the child produced and the target sound? If you look at it from the perspective of distinctive feature theory patterns will emerge.
Distinctive Feature Theory really brought this into the field of phonological disorders Language. Prior to this speech science was all a motor piece. Distinctive Feature Theory was the first attempt to apply linguistic theory to articulatory/phonological disorders.
+ - Nasal sound either has nasal or does not
+ - Vocalic to be + has to have Voicing and No Marked Constriction – an OPEN oral cavity
+ - Vocalic = VOWELS AND LIQUIDS ONLY
+ - Voiced ALL VOWELS ARE VOICED as well as some consonants
+ - Continuant Can the airstream be continued? For /s/ + for /w/ + Negative for stops and affricates.
+ - Consonantal Is there enough of a constriction to make it consonant-like? To be + Must have Marked Narrow or Complete Constriction in Vocal Tract. This distinguishes a ‘true consonant’ from a Vowel/Semi Vowel (semi vowels are Glides and /h/) So Vowels
+ - Rounded Are the lips Rounded?? Some vowels… and /w/ is the only rounded consonant (not /r/)
+ - Back Is the tongue back as compared to resting/neutral position? If it is pulled back from neutral than it is +back. VELARS AND BACK VOWELS ARE +BACK. /h/ is negative for back.
+ - Anterior Is the sound constriction MORE FORWARD THAN /c/ Bilabials linguadentals labiodentals and alveolars are all +anterior /ch/ is –anterior. /y / is - /r/ is negative because palatal sounds are negative (-anterior) because same place as /sh/.
+ - Continuant If a sound is continuant that means you can hang on to that sound /s/ /sh/ those are + Vowels
+ - Strident Strident sounds are NOISY sounds intense noise air being directed through narrow opening Fricatives are +strident Affricates are +strident doesn’t matter if they are voiced or voiceless still noisy
/th/s are Fricatives but are a special type of fricative Non Strident Fricatives.
Stridency can also be measured in terms of More or Less Strident /ch/ is more strident than /f/ but both meet definition of +strident.
+ - Voiced is there or is there not vocal fold vibration? Vibrating vocal folds = +voiced. VOICED: VOWELS NASALS GLIDES LIQUIDS AND VOICED COGNATES.
+ - Coronal Does the tongue BLADE OR TIP move UP Up has to be above resting/neutral state… If Up then +coronal. Dorsum doesn’t count here has to be the blade or tip part /l/ + /b/ - Several consonants including alveolar dental and palatal sounds.
Are /k/ and /g/ +or – coronal? they are negative because it is the Dorsum that moves not the blade/tip.
+ - Vocalic – constriction cannot be greater than /i/ and /u/ or /l/ and /r/ and needs to have voicing. Need to have pretty open constriction and need to have voicing to be vocalic. Vowels and Liquids are + vocalic as they have a pretty open oral cavity.
+ - Delayed Release is a slow release of total constriction as part of the same sound Affricates are + delayed release.
Babbling – preceeded by ‘cooing’ Cooing is more vowel like screeches – not formed speech as in consonants and vowels.
With Babbling we are talking more about formulating of speech sounds.
6 – 10 months of age is typical but kids vary = Babbling Stage.
6 – 10 months = beginning of babbling.
First Stage = Reduplicated (ba ba
In Reduplicated Babbling 6 – 10 month stage you might hear slight quality changes in the ‘quality’ of the vowels but the consonants will remain the same. ba
Big step in combining syllables = they are combining syllables with /ba/ /ba/ it is an initial step of bringing CV syllables together in prep for higher linguistic units later on.
Combining CV syllables in reduplicated babbling stage is a very big milestone in the first year getting first CV productions together in a repeated manner in the first year is a big deal.
As this reduplicated stage continues closer to 10 month marker you hear even more changes. Consonants and vowels start to change and become more accurate to adult production. Waegner: prior to the consonants and vowels becoming more adult like are contoids and vocoids – not quite as clear – close approximations of adult form but not quite.
In reduplicated stage consonants and vowels gradually becoming more defined over time. First true consonant articulation is forming toward end of this stage and at same time their INTONATION becomes more adult like. The intonation makes it sound like they are carrying on a conversation. Intonation starts to become more adult like.
9 – 14 Months = Variegated (Nonreduplicated Babbling Stage) Another ‘unit’ - these stages OVERLAP. One runs into another and then phase out the prior. In Variegated there are consonants and vowels are varying a lot of changing up – vary from syllable to syllable Use of JARGON may begin (made up words
In 9-14 moths Variegated Nonreduplicated Babbling Stage there are a lot of sequences of phonemes not necessarily with meaning though however theres lots of INTENTIONAL INTONATION. (at the end of the first stage this intonation thing started but NOW there is INTENTIONAL INTONATION…) Sequencing of phonemes w/o meaning which have appropriate intonation.
Intentional Intonation and Jargon in Variegated Nonreduplicated Babbling Stage develops from early babbling and continues into early words. Made up words move in and interspersed in the latter stage of JARGON real words are introduced. JARGON BABIES = BIG ON SOUND PLAY. Amount produced by each child is variable. Some are more verbal than others. This is pre-speech practice. Getting a handle on sounds to help with speech production. Pre-speech sound practice.
Jargon is part of the Variegated Nonreduplicated Babbling Stage Continued use of adult-like syllables supplemented by increased in varied consonants and vowels. Variation in pitch and volume begin stress on things SOUNDS LIKE WORDS BUT ISN’T. Doesn’t have meaning that we understand. First real words appear during this period.
Canonical Babbling is a combination of the first two stages Reduplicated and then Variegated (Non-reduplicated) ll children produce some canonical babbling by 10 months (in first year.)
Canonical Babbling is when the syllables are clear enough to be distinct syllables in adult-like syllable structure One Consonant and One Vowel with a smooth combination between the two – it is reduplicated/non-reduplicated collapsed into one state.
Canonical Babbling – well formed syllables with adult-like syllable structures at least 1C and 1V with RAPID TRANSITIONS BETWEEN THE TWO. Twins didn’t vary their C’s and V’s a lot but the little girl in the pink carseat is definitely in canonical babbling. First baby was in precanonical.
Canonical Babbling is so like speech that parents refer to it as ‘talking’ - intonation patterns are adult-like in canonical babbling. Oller is researcher who looked at this stage with deaf children.
Oller researcher who found that as it applies to canonical babbling that all hearing children produce some canonical babbling by 10 months of age but NO severe-profound HL children would begin canonical babbling by 11 months. There is a month in between there that is a red flag sign. Canonical babbling is a precursor to meaningful speech.
In summary of Oller Study Infants with severe to profound hearin gloss are delayed in the onset of canonical babbling (no canonical babbling by 11 months)
No overlap b/t the onset times of canonical babbling for hearing impaired and normal hearing infants failure of canonical babbling may signal severe-profound hearing loss – just a red flag to increase awareness but NOT diagnosis…
Attaining canonical babbling stage for HI infants correlated with age of amplification and intervention suggesting that early ID is critical to successful language acquisition.
Babbling Summary: 6 – 10 months of age babies start babbling – at 8 months more imitation of vocal play with adults – a child will repeat more of his own CV productions back and forth with adult or independently as child moves through babbling stages they get closer and closer to adult models and more adult sounds start to fall into place.
As child advances through babbling stages more adult sounds start to fall into place more adult sound prevalent and non-native sounds disappear.
Even in later babbling stages open syllables are more prevalent /ba/ /ba/ /ba/ but then the C may change and the V may change and still the CV structure is the most prevalent.
Report on which C’s are produced first most accepted first/then is labials alveolars velars early and some also say bilabials and glides.
In the Preschool age child many language milestones are taking place btw ages of 18 months to 6 years of age.
Many other language milestones are taking place in preschool age child . IE: their vocabulary goes from 50 words at 18 months to 8
Preschool age child also learns command of basic grammatical forms (verb negation question forms declarative forms) Learn to communicate effectively (pragmatics – how to use language – learning to use them effectively – do they know when to ask for something in a less direct versus more direct way
Preschool age child learns all this pragmatic and grammatical info while they are learning to master the sound system. By age 5 they should have an almost complete phonological system by age 5. . .
ACQUISITION OF SPEECH SOUNDS: AGES A lot of early research is still used today in making decisions about whether the kids have a speech problem or not particularly in a school system. There are a whole group of studies for when kids learn /t/ and /d/ etc. etc.
$50-$60 for a 30 minute session going rate for SLP.
1931-1975 were landmark studies. Very important info came from these studies but they are OLD.
Differences in ages exist between studies and acquired results probably are not in sync due to differences in studies variations in stimuli study groups etc.
We have the Sander Chart. It is SUPER IMPORTANT in the public school system – takes kids in and takes kids out of services in school districts. Sander looked at all prior studies compiled their data averaged their ages and then published these averages in his 1972 study.
Some specific problems with studies:Often didn’t test for hearing loss or language delay (might have had kids in study with some hearing loss.) Or language issues (again phonology is part of language.) Some used only middle class children. (now we look at more diverse socio economic group more diversity.)
Problems with studies Variation in cut-off criteria for age of acquisition ie: differences in ways ‘mastery’ was defined. If /t/ at age 3 and /t/ at age 4 it might have been that the person who measured used 80% and 90% in other study variation in number of children tested. If the child can make sound in ONE word does it mean that they mastered it in RUNNING SPEECH?
Problem with studies They assumed mastery in one word responses. Choices of pictures/words can affect production of sounds within words (diff pictures used some used CVC words etc. diffs in words and pics/stimuli.)
Problems with studies Variation in the number of sounds tested and how many times the sounds were tested (1x 5x etc.) Variation in type of stimuli used.
None of the studies looked at sounds acquired before 2 years of age and modeling was random Modeling was allowed but varied in frequency across studies (say Cat as opposed to just showing them a picture of a cat. Modeling was not standardized across the studies.
Sander: Reinterpreted earlier studies. We have chart now.  He used data from Wellman and Templin studies to make the chart = came up with ages of acquisition. See powerpoint K = 51% at age 2 and 90% by age 4.
We are coming up against the Sander chart want to provide services so need to refute against it when possible. Bring them in for language find informal testing to bring child in as eligible… find something.
2nd chart that is based on Goldman Fristoe took /dj/ off because it is the least frequent sound used in the language.
Sander – reinterpreted Wellman and Templin: old information but still currently used by a lot of SLPs in schools and some other places like private practices outpatient medical settings.
One of the things we need to be thinking about is the span across the range is so great that high upper age limits present sound isn’t developing till age 8 or beyond 8 you do have to think about the fact that a lot of kids will be missed when they have these sound errors – so think then about HOW THEY ARE MAKING THE SOUNDS.
If a lateralized lisp for /ch/ /j/ /s/ and /z/ these sounds typically go hand in hand when there is lateralization… If you say that I am not going to do anything with him until age 8 that child will miss out on services.
Lateralization almost NEVER goes away on its own and it is the hardest lisp to remediate. Hard to have them learn to redirect that airflow… OR if you have a kid doing something different with an /s/ (like an inhalation for /s/) that is a very very different /s/ if you said well it’s /s/ not going to see him until he’s 8 that would be wrong.
Think then about more than the chart… The clinical significance: is it something that will or will not self-remediate? High age limits for development of many sounds may allow missing some kids with delays – fall through cracks.
Although general sequence of acquisition of sounds variation in age is great. There are certain sounds that develop earlier than others. We do know that from all of these studies that there is a general age of acquisition a pattern of development to sounds but that the age range from when they develop sounds is very great. /s/ 3 – 8… wide variability across ages for development of sounds.
This means that you should interpret developmental norms CAUTIOUSLY. Remember that there is a great age span so there is a lot of room for development – be cautious in EXCLUDING kids….
Newer chart is better because it includes blends Goldman Fristoe data.
Another way is to follow kids through their own development – Longitudinal studies give better information. Generally though it is too small a sample to infer. Getting families to commit getting kids to commit to a longitudinal study people move away people drop out for various reasons longitudinal studies hard to get a good /n/ (number)
Stoel-Gammon did a 1985 longitudinal study with 34 kids. The results summarized as follows 4 things a lot more about position in word and how sounds develop in relationship to position in word
1) Stoel-Gammon early sounds that developed = stops nasals and glides.
2) Stoel-Gammon more anterior than posterior sounds produced /p/ /b/ m/ /t/ developed earlier…
3) Stoel-Gammon more sounds used in initial position than in final word position. (kids who leave sounds off a word or out of a word more apt to leave sounds of on the end of a word /ca/ for /cat/ in stead of /at/ Sounds at the beginning of words are more salient key into them better…
4) Stoel-Gammon differences in how sounds were produced in initial as opposed to final position. Voiced stops came before voiceless stops in the initial position but when kids were developing sound in final position Initial = voiced then voiceless but final = voiceless and then voiced… 5) /r/ almost always appeared first in FINAL position. Would have /r/ in car before they would have the /r/ in rabbit.
We need to have a good handle on which sounds are earlier developing versus which sounds are later developing and also IPA.
School Age Development beyond developing period: how does sound development and sound production affect kids in other ways ie: reading? pronouncedly
Metaphonology: kids being very aware of sounds in language – not just that they can produce it or have accurate or inaccurate production of sound but rather kids having good awareness of sound in language
Metaphonology (how many sounds are in the word tap the sounds in the word /cat/ - know that there are distinct phoneme boundaries in a word has good metaphonological skills. Conscious awareness of sounds within language; recognize how many sounds are in a word; identify sounds at the beginning and end.
Metaphonology Better at identifying word at beginning because it is more ‘salient’ ; high level of sound awareness. (can they separate a word can they switch sounds if this is /cat/ segmenting and replacing. /mat/ if a child can do this type of task have good metaphonological skills to identify sounds in the language and play with sounds in the language.
Metaphonology CHILD NEEDS THIS SKILL IN ORDER TO LEARN TO READ. If they cannot pull a word apart by sound properties identify sounds and syllables within words they will have difficulty reading due to poor phonemic awareness and metaphonological skills. Meta: self-referential.
Metaphonology Studies show that phonology is related to other language skills: Phonology is a part of language development of metaphonological skills helps development of other language components. Early speech development relates to early literacy development. Kids with early speech issues are more at risk for reading problems/literacy.
Metaphonology Studies show that development of phonology relates to other language skills. Research shows a strong correlation btw early speech and early literacy. Phonological development especially segmentation of sounds in words HIGHLY correlated with later reading achievement.
Metaphonology Early language development Especially phonological development one of the STRONGEST predictors of later reading skills. Children with phonological problems are at risk for developing later reading problems.
Metaphonology Phonological disorders relate to word meaning (not artic.) and when you have problems with phonological development you have to warn parents (not scare them) but let them know that it is a big deal to have phonological disorders addressed as research shows that they are at risk for later problems with reading.
Response to intervention: there might be red flagged kids that are on the fence not sure given 6 weeks of treatment and that is enough of a boost to get them going can be extended can’t stay in response to intervention all year but there are different tiers – can be moved up in tiers during the course of the year and might be enough to avoid the label and end up on an IEP.
Metaphonology If it impacts them in reading it impacts them in learning first reading to read and then reading to learn and will impact them across the curriculum.
Phonological Processes: sound difficulties that are phonemic that involve meaning and differences in words They relate back to place manner voicing and distinctive features…
Phonological processes are very systematic – NOT RANDOM – they are very systematic in nature and when you look at them and put them into processes you see the patterns. Sound ‘changes’ that can affect a whole class of sounds – sound ‘changes’ that may affect fricatives. Sound ‘changes’ that may affect sounds in the back of the mouth.
Phonological processes a systematic sound change which affects a class of sounds or a sound sequence.
Phonological processes are rules/processes used in developmental errors. Phonological processes used by both normal language learners and those with disorders. When kids drop out phonological processes well there is a certain age when kids need to stop doing certain ones like dropping the /s/
Kids with Phonological Processes Disorders hang onto the phonological processes too long…
Identification of processes not as straightforward as it may seem… different criteria suggested but no uniform guidelines adopted by profession.. How many errors make it a process? Is it a process or not? There are no set ‘number’ or ‘ratio’ to define a process – it varies across SLPs assessments measures…
ID of phonological processes You DO need to look at the percentage of the time it happens – THE PERCENT OF OCCURRENCE for any sound changes and then decide if it is ‘frequent’ enough to be a ‘process’ but that is problem as there is no ‘set’ number.
ID of Phonological Processes Some say it has to be 20% of the time in a child’s speech. In an assessment measure in conversational speech has to occur 20% of the time. Some say it just has to occur (this is not as good a way to define it.)
Phonological Processes ie: Most kids say /lello/ for yellow. If that was the ONLY error that child had that child would be labeled with a gliding error (glide for liquid) so saying it occurs once is not a good definitive criterion.
Developmental Phonological processes occur developmentally in normal children… Natural and Generative Theories: is what they are doing with developmental processes – can’t do certain things yet so they substitute in.
Phonological Processes Then there are processes which rarely or NEVER occur in normal development (called NON DEVELOPMENTAL OR UNUSUAL OR IDIOSYNCRATIC PROCESSES) this means that normal language learners DON’T DO IT.
Processes which rarely or never occur in normal development are called unusual idiosyncratic or non-developmental processes. Initial consonant deletion would be idiosyncratic… but keep in mind that you to need a pattern or a frequency to label this…
Phonological processes have 3 categories: Syllable Structure Substitution and Assimiliatory
Processes child is doing CVC might go to CV Syllable structure
Where there is one TYPE of sound (front for back) subbed or another Substitution
Where there is some SOUND IN THE WORD (velar) and it changes ANOTHER sound to a certain class (velar) of sound. – Assimilatory
SYLLABLE STRUCTURE PROCESSES: there are many types of these Reduplication Final Consonant Deletion Syllable/Weak Syllable Deletion Cluster Reduction and Epenthesis
Reduplication: first process you hear a child use. Occurs in very first words typically and usually gone by 2 ½ years of age. /ba/ /ba/ take first syllable of the word and they duplicate it for 2nd syllable. Can’t handle the adult model so they do SOMETHING to the model (take first that they CAN say and says it again..
Reduplication Water might become /wa/ /wa/ (can’t say /ter/ yet…) Frequent in first 50 words. Earliest phonological process. Early to appear but early to leave… Again if still saying it at 3 and ½ keep in mind that that thing might be still called that at home for ‘cuteness’ factor – has to not be item specific…
Final Consonant Deletion: this happens in early words and stops around 2 ½ to 3. Kid leaves off final consonant in CVC words. A lot of the child’s words are CVC words but /cat/ might become /ca/ and house might become /hou/ not a CVC word but now a CV word.
Syllable/Weak Syllable Deletion: Weak syllable impacted. By 3 ½ - 4 don’t hear it anymore but may hear it in multisyllabic words weak syllable drops out. Banana = nana. /ba/ = weak syllable. Spaghetti = sketti. Drop off of weak syllable. Pajamas = jamies. This is a little bit of a problem with the Goldman Fristoe Test when they see pajamas they often sub word in leaving off weak syllable.
Cluster Reduction: kids hang on to this longer. Can hear this up to 5 years of age and not be worried about it. Child will keep easier to produce sound – cluster is broken down and one or more members of the cluster is gone. Reducing /sk/ to /k/ /fl/ to /f/ reducing cluster by one consonant or eliminating an entire cluster. /blu/ = bu skul - /kul/ breaking the consonant clusters flower = shower (this is substitution but also reduction)
cluster reduction can occur at the end of the word too nest = net or nes but more likely nes. Cluster reduction does not typically include simplifying a cluster. If they change it to an easier sound = could become cluster simplication.
Cluster reduction Sometimes the w for l is called gliding… not a cluster error. Two components still there but something is happening with the liquid. With cluster reduction at least one sound has to be gone.
Epenthesis: usually occurs at 2 ½. When the child has two consonants together and they can’t master those so they put a schwa in the middle. Insertion of a schwa between two Cs. Functions to simplify a cluster but not part of cluster reduction because all members of cluster present. /blu/ becomes /baloo/ grass becomes /gar ass / This is the most common way to hear epenthesis.
Epenthesis Can also have it by addition of a vowel at the end of a word. Instead of /bead/ says /beada/ this is because child is trying to make the contrast between voiced and voiceless /beat/ versus /bead/ would be /beat/ and /beada/ syllable structure is different – child is trying to master voiced versus voiceless and differentiate between the production of two similar words.
Epenthesis Addition of vowel in word-final position. Occurs as first stage of voicing contrast in that position. When a child is learning to read and is sounding out a /b/ they say the schwa when they are trying to break the word down kids start to say it again when they are first learning to read if their models stress certain sounds by adding a schwa to it. Helps to cut it short cut It short when teaching a child to sound out a word…
SUBSTITUTION PROCESSES : Where one sound is substituted for another. This is an interaction of some processes – may be not just one process but another process too!
Fronting: there are TWO TYPES of fronting… Palatal and Velar
Palatal Fronting is when you front a palatal. It is usually gone by 3 ½ to 4 ½. It is when a palatal consonant is fronted to an alveolar. To be true palatal fronting has to go to alveolar. /shu/ to /bu/ is NOT palatal fronting. HAS TO GO ALVEOLAR /shoot/ to /suit/ /judge/ to /dud/
Velar Fronting: eliminated by 2 ½ to 3 ½ = Velar to Alveolar. Velar sounds fronted to alveolar. Not cat to bat but rather come to tum.. got going to dot are examples. Velar fronting is very frequent but should go away by 3 ½. If it went to LABIAL would be called LABIALIZATION…!
Stopping of Fricatives/Affricates Can be eliminated from age 2 to beyond 5. Some sounds not mastered until age 6. Stopping has a wide range during which it can continue. Should I or shouldn’t I work on stopping? You still have to look at what the stopping errors if only involve later sounds can put it off but if stopping on earlier sounds then need to start working on it. Substitute affricates or stops for fricatives.
Substituting affricates or stops for fricatives and stops for affricates. (has to be a COMPLETE STOP for affricates as affricates already have a stop component.) /fish/ to /pish/ /shu/ to /chu/ = stops and then affricate for a fricative. Jumping becoming dumping… chirp becoming tirp. Stops for affricates.
Stridency Deletion: can be eliminated up to 5+ as strident sounds develop later. Gets rid of noisiness of the sound… Strident C sounds lose its stridency lose strident feature as it gets replaced by a non-strident sound. This is one instance where a lot of interactive processes come in. /s/ replaced by /t/ is also stopping but also stridency deletion. If you have have stridency deletion always look for something else.
Deaffrication: Eliminated by age 4. It is a substitution of a fricative for an affricate. The OPPOSITE of stopping for affricates. Instead of putting a stop for an affricate put in a fricative. The affricate loses the stop feature and becomes just a fricative. May or may not be the same place of articulation. Could be both palatal or not could move from palatal to a diff place of articulation.
Gliding: eliminated later up to 5 to age 7. Substituting a glide for a liquid. Subbing something in for /l/ /r/ subbing in /j/ and /w/ instead. Ring going to wing. And lamp going to yamp.
Vocalization = Vowelization: eliminated at 5 – 6 years. A vowel is substituted for a syllabic liquid. Instead of a liquid sound that is the whole syllable such as in puzzle could be puzza. Usually hear it with syllabic /l/ and with vocalic /er/
Assimilatory Processes: another sound in the word changes something elsewhere in the word is assimilating and becoming more like something else. Process must have evidence to indicate sound change only occurs in presence of AFFECTING SOUND. Ie: Velar affecting sound = velar assimilation. Nasal = nasal assimiliation…
Consonant Harmony/Plain Assimilation: Eliminated by 2 – 3 years… One consonant is affected by another in a word; both then produced at similar place of articulation. IF THERE IS A FRONT SOUND AND IT MAKES ANOTHER SOUND TURN INTO A FRONT SOUND then they both have front production. Can either have PROGRESSIVE ASSIMILIATION where a sound in a word affects a LATER Sound or REGRESSIVE ASSIMILATION affecting sound is 2ND.
Velar Assimilation: an alveolar or palatal sound changes to a velar sound in the presence of a velar consonant. There has to be a velar consonant in the word that changes a palatal or alveolar sound to become more back and become a velar sound. Must assure presence of velar C having effect…
Labial Sound affects some other sound making it a labial sound because of its influence. Non labial sound replaced by a labial sound due to presence of a labial or labiodentals sound…
Nasal Assimilation: non-nasal sound becomes a nasal sound when influenced by a nasal sound.
Prevocalic Voicing: eliminated by age 3: a consonant that should be voiceless becomes voiced when it is before the vowel in the same syllable. All vowels are voiced it is when the vowel affects the preceding consonant. Affects OBSTRUENTS (THOSE CONSONANTS THAT HAVE A MARKED OR COMPLETE CONSTRICTION: FRICATES AFFRICATES AND STOPS)
Final Consonant Devoicing: Impacts Obstruents: Voiced sound becomes VOICELESS when it is the consonant sound at the end of a word. The sound at end should be VOICED but it becomes voiceless. It is the pause at the end of the word the anticipation of the silence/pause causes voiceless quality to ensue. Voiceless member of cognate jumps in.
Nondevelopmental Processes You see them in kids who have phonological disorders but not in kids with normal phonological development…
Deletion of Initial Consonants: deletes initial consonants (leaves sound off beginning of the word.) (unusual because first sound is most salient)
Backing is when a frontal sound (a consonant) that is somewhere more forward than velars and is moved back to a velar (if there was a velar sound in the word then it would be velar assimiliation.)
Any consonant backed to a velar when not due to assimilation backing
Favorite Sound Substitution: subbing in a sound into a LOT of places – a favorite consonant sound that they use in place of many sounds.
Glottal Replacement substituting a glottal stop and put it in for other phonemes can replace any other consonant sound – often occurs medially often difficult to hear when occurs in final position
Also called an Oral Mechanism or Speech Mechanism Exam = Oral Peripheral Exam
Oral Peripheral Exam not a standardized assessment measure there is still a sequence and specific things we do just no norms and numbers to compare to
Oral Peripheral Exam gains you loads of info but no comparative numerical scores
Oral Peripheral Exam used to describe structure/function of oral mechanism for speech purposes
Oral Peripheral Exam should be done in all cases depending on work environment and level of training but when you are a student you should do this for all clients in clinic for diagnostics even if coming for language concerns
Oral Peripheral Exam we do this in clinic to help give us training we get better by doing it a lot very different person to person do it a lot to get comfortable with it and to know what you are looking at
Once you are a certified SLP Oral Peripheral Exam might not be done because you might have an hour if they were coming only for language related purposes but this is when you are already pretty good at this.
Oral Peripheral Exam is used to look at oral cavity to describe what it looks like and how it work the Structure and the Function what the articulators look like and how they move for speech purposes something very different may impact speech production
Need to look at a lot of mouths to know what is normal do it a lot to know what you are doing
There is a range in size shape mobility of structures varies person to person in Oral Peripheral Exam
Position for Administration – a certain position for looking in a person’s mouth – have client sitting straight and their head straight sitting in a chair if able and head erect this way can see velum at rest be at eye level and right up on person
Knee to knee with adults if a child you might get down on your own knees to be on eye level or pick up a kid and stand them on table for eye to eye for Oral Mech Exam
Oral Mech Exam start at front of mouth and go back go from lips back check out articulator by articulator going back.
When talking about kids is uncomfortable and a bit scary telling them you are going to look in his or her mouth if trouble with a child try games guess what you had for breakfast they get silly and then comfortable and let you do it pretend you got it wrong and ask again
Follow the Leader works too to get in kids mouths begin with other motor movements and eventually get to mouth area Oral Mech Exam using two technicians works well too can let them look in your mouth too with gloves on
What do you need to do an Oral Mech Exam make an oral mech kit –even if you don’t think is Dx supervisor might ask (gloves latex or thicker purple and latex free individually wrapped tongue depressors wrapped and sterile in flavors flashlight/penlight/gooseneck stopwatch or watch with 2nd hand to count time for AMRs and SMRs gauze to move tongue
What do you look at and what are you looking for? Areas Lips first. Look at lips at rest and judge their appearance and their function
Lips look at appearance and function how do they look at rest and then see how they move during function do they look the same on both sides symmetry drooping on one or both sides look for any presence of scarring (repaired cleft or accident) Note anything unusual.
If you note anything unusual ask client or parent later on could ask in the presence of a child. (parent may not be there at that time.)
Scarring on lip has little to no effect on speech could be from cleft palate still generally has little if any effect on speech – still note it.
Even tight lips usually results in compensatory measures so little effect on speech speech may sound fine even if lips do not close with mouth at rest even in running speech if they don’t come together just cause something looks different doesn’t mean they don’t speak just fine.
Look for unusual movement or weakness in lips paralysis may be noted upon inspection
Dysarthria or apraxia-like behaviors might be noted on movement tasks mobility exercises like pursing/pucker the lips like they were going to kiss somebody or retract as in a smile and do back and forth purse smile purse smile so that you can see the movement.
Mobility is assessed by a series of exercises Oral Mech Exam you need to know format and what you are doing and why many different options exist for actual exercises oral mech tasks may vary and that is ok may pick and choose or make up your own because it is not standardized
Retractive and repetitive do /u/ to /i/ works too for repetitive pucker to smile Oral Mech Exam
Repetitions of /pa/ AMRs Oral Mech Exam
Tongue comes after lips The Tongue is the most important organ of articulation we use the tongue more than we use lips jaw dentition At rest first
Tongue at rest in oral cavity not the size in relation to oral cavity Oral Mech Exam
Tongue size note macroglossia or microglossia size in comparison to oral cavity Oral Mech Exam
Tongue size more often does not impact speech Oral Mech Exam
Tongue fasciculations little tremors in tongue Oral Mech Exam are there any fasciculations
Raise tongue Oral Mech Exam and assess lingual frenum is it long enough for the person to be able to raise the tongue enough to produce speech sounds in most cases this does not impact speech
There is a thing called Tongue Tied ankyloglossia where tongue is anchored to floor of mouth and they cannot move it for speech production Tongue can appear heartshaped and can’t get it out very far.
If tongue can go up to alveolar ridge even if it is a short lingual frenum it is adequate for speech Oral Mech Exam
Note with tongue lateral movements corner of mouth back and forth back and forth see if they can do that independently or if they are using their jaw (mandibular assist) the jaw could move too sometimes kids with speech sound production problems have this problem with lower jaw – no individualized movement of the tongue.
Tongue Movements that you might do raise the tongue tip can you touch your nose with your tongue see if it goes UP outside the mouth and UP against the alveolar ridge also repetitive lateral movements and can they touch their chin with it outside mouth.
Tongue Circle Tongue Movement Oral Mech Exam tell child they have icecream on their lips can they lick all around their lips be sure to do several repetitions to see if there is consistency in movement.
Oral Mech Exam If there is a person with a Unilateral Paralysis will deviate to the affected side good muscles on OTHER SIDE PUSH TOO HARD and so weak side is deviated side this usually does NOT affect articulation.
Tongue thrust during dry swallow and swallow when I tell you and pull lips back and if tongue thrust you will see it peek out and then if you see that you try some liquid small small sip of water and then see if the tongue pushes the water out see it dry and with something in their mouth you retract the lips for them. Don’t do liquid unless there is a concern.
If there are Bilateral Lesions (Neuro) to the tongue more affect on articulation imprecision on Cs and Vs and movement difficulties
Oral Apraxia may result in difficulty with execution of non-speech specific movements if you said do a circle with your tongue the oral apraxia person might evidence a lot of groping an automatic kind of task is easier for apraxia but asking them to do a specific movement results in evidence of apraxia.
Check for tongue thrust on swallow tasks in exam these kids get referred from orthodontists to correct the swallow otherwise if they push on their teeth every time they swallow they will misalign teeth. 12 weeks brief treatment done by SLP.
Jaw Oral Mech Exam look at occlusal relationship of the jaw with mouth closed. Look at upper jaw in relation to lower jaw. Is the upper jaw/Maxilla larger and wider and longer than lower jaw/Mandible.
Look at relationship of first permanent molars what you should see is upper first molar is one half a length behind the lower first molar.
Maxillary dental arch protrudes about ¼ inch over lower teeth in normal relationship Oral Mech Exam
Malocclusions may make no difference in speech production but still need to be noted Oral Mech Exam
Distocclusion Class II Malocclusion maxilla protruded anterior to mandible overbite
Mesiocclusion Class III Messy-O clussion lower jaw juts forward Underbite Oral Mech Exam Prognathic Jaw is when it is extreme (Jay Leno) (Leading with his chin)
Openbite is when the central and lateral incisors don’t close biting edges do not close open space between all of those incisors together in the back but the central and lateral incisors do not touch. Tongue thrust and thumb sucking can cause this.
Tongue Thrust often related to incisor protrusion and an open bite if it is severe There is however no predictable relationship between OVERBITE AND LISPING. NO RELATIONSHIP BETWEEN OVERBITE AND OPEN BITE THUMB SUCKING TONGUE THRUST DOES NOT EQUATE WITH A LISP.
Crooked missing and supernumerary teeth have little effect on speech production just note on eval but probably not a major contributing factor to articulation
Overall without other factors entering in changes in dentition is usually not a big deal and doesn’t result in changes in articulation deviations rarely are serious problem with articulation but should be noted.
Things taken together not in and of themselves can change speech in some individuals
Hard Palate Oral Mech Exam doesn’t move in speech production so looking at width and height structurally can see differences in them but someone with a very low palate very wide palate can sound different but still not a speech problem
Width and height of hard palate noted Oral Mech Exam
Very low narrow or very high may impede speech production here is abof tone palate sounds but not always most people just compensate just note deviations that are VERY DIFFERENT gross deviations only. All structures appear to be within normal limits.
Look for scar tissue discoloration fistulae (little holes) or unrepaired cleft Oral Mech Exam Hard palate (fistulae could be a repaired cleft or a sub mucus cleft or an accident)
Look at hard palate for pink white color if it has a blue tint on midline could suggest submucus cleft needs further investigation of integrity of bony understructure – check to see if bony structure appears to be intact feel with gloves to feel along structure for soft areas down midline.
Blue Tint could be just how the person is with regard to blood supply if the blood supply is closer to the surface in that person could be related to blood supply close to the surface in hard palate exam palpate it to check for differences in bony structure.
If there is a blueish tint on the sides of midline it may be a bony growth an extra piece of bone growth 20% of population has this Oral Mech Exam
If you suspect a submucuous cleft palpate the membrane at midline at most posterior portion of hard palate try to determine presence/absence of bony structure
Examine space between lip and alveolar ridge on individual with cleft for possible nasolabial fistula might affect nasality unlikely but possible
Soft Palate: look first at rest then have person do some specific tasks to see how it moves during phonation try to not use a tongue depressor if you don’t need to but may use tongue depressor to lower tongue.
During soft palate exam keep head in upright position if neck is extended there is restriction and limitation on velar movement. Typical mouth open to ¾ max opening.
During Soft Palate exam observe the soft palate and the uvula
Bifed uvula could exist suspect possible anatomical deviations not necessarily a bad thing 1 in 75 people has this and it is not clinically significant.
After observing the soft palate at rest observe it during a sustained /a/ note you should see upward and downward movement of velum and any lateral pharyngeal movement. “I want you to say /a/ while I look in your mouth – does the velum go up and back do the side walls coming in back wall coming in at all. Repeat 3 times because you want to get a really good look.
When looking at velar movement note whether or not the movement is symmetrical.
After long sustained /a/ 3x do short quick /a/ /a/ /a/ back down back down is what you should see do this 3x too short quick productions of /a/ it should look the same as with sustained /a/.
Is there movement is it the same on both sides and how much movement is visible looking at velar movement
Soft palate coloration should be pinky white IF YOU SEE A MIDLINE BLUISH TINT you should suspect possibility of submucous cleft.
Critical factor in velar function – effective/functional length of velum not velar length per se… you can’t decide from looking at that view because it is nearly like a sphincter closure – you can’t say for sure in a report that velar movement equated with velar closure – you CAN’T SEE THAT. You can say what you hear… can say no nasality
If person sounds kind of nasal have them do /oo/ with nose pinched and not pinched – clinician actually pinches nose back and forth to make sure it is tightly occluded
Pharynx – look for presence or absence of tonsils tonsils shrink with age they atrophy if you don’t see them don’t ask if they ever had them out they may have just shrunk the shrink during puberty.
Some kids may have enlarged tonsils and strep and otis media frequent tonsillitis get middle ear infections get background on how frequently this occurs and if child has had hearing test.
Huge tonsils can affect sound quality their resonance may sound different too cul de sac resonance where it sounds like it is all way back in the throat could be tonsils and adenoids.
VP closure occurs superior to oral cavity at the level of the nasopharynx.
Gag Reflex consider only using with adult with neurological insult that is only time when needed when lack of innervations or paresis is suspect. Many individuals have strong aversion to gag reflex.
Velar function during gagging has little relationship to velar function in speech don’t do unless you are looking for neurologic function if have to do it press with a cotton swap on back of tongue or velum to elicit that reflex.
When looking at velum check Breathing is there excessive mouth breathing excessive mouth breathing may equate with presence of enlarged adenoids or deviated septum just list for history.
Diadochokinesis DDK part of oral mech exam to look at motor coordination of the articulators rapid repetitive speech task AMR SMR in rapid repetitive CV movements
Repetition of single syllables and then multiple syllables p p p p t t t t t k k k pt pt pt pt tk tk tk tk ptk ptk ptk look at labial closure smooth opening and closing of lips on p t is there alveolar contact and c is there velar contact.
Time by Count or Count by Time Time by Count (continue till I tell you to stop but you are counting as they do it amt time for given number of syllables) or Count by Time (# syl in given time.) You are counting the number of repetitions of 1 2 or 3 syllables
Fletcher has a commercialized # per for 1 2 and 3 it is called Fletcher Time by Count for norms by age amounts of time and amounts off repetition research there are other forms like that.
You have to give a good model for 1 2 3 AMRs and SMRS if you don’t give a good model they may stop early so when you model it model it for real give a complete model.
To help you count count groups of four on your finger to look for 16 repetitions or you could record it and slow down recording later if you are timing it for 8 seconds but you are having a hard time determining the number of repetitions
Convert times in seconds to repetitions per second = divide # of reps by time also consider judgements about rhythm and accuracy of productions – listen for apraxic struggles or articulatory concerns
Can use Buttercup for SMRs for kids makes more sense than ptk and can get better sense of productions
DDK rates can give very good pieces of information however you must be careful how much you generalize from their speech production if slow cannot predict a speech disorder from just this. Doesn’t mean something neurologic is going on.
DDK rates along cannot predict speech disorders due to less experience producing sounds – may have severe phonological processing issues and may not talk as much or practice speech as much. Moreover there are not great ‘norms’ for kids for # per time.
Robinson Clee did a study that has an oral mech exam with 90 little tasks that you do that is made for kids pretty comprehensive however there is some very good info in this article and norms for kids with DDK rates.
If artic defective and client has slow irregular repetitions of single syllable and difficulty articulating bi and tri syllables sequentially might question the neuro integrity of client may have apraxia.
If normal DDK rates/rhythms it is unlikely to consider neuro as cause.
Intelligibility: we need to find out in an individual sound system what is their intelligibility level; can you understand them or not.
Subjective judgement intelligibility
Based on % of words in sample that are understood by the listener. – t his at least has ‘some’ objective value. With contextual cues/listener familiarity these are unavoidable factors.
Context can lead you to have better intelligibility – playing with child you can see all the actions the contextual cues give you more info and help you to understand what the child is saying. Another factor that can decide number of intelligible words in the sample is your familiarity as a listener.
Influencing factor in his at least has ‘some’ objective value. With contextual cues/listener familiarity these are unavoidable factors. = number of sounds in error and nature of sound errors made larger number of sounds in error is less intelligible.
Larger number of productions in error = poorer intelligibility
Nature of errors affect intelligibility
Deleting = greatest impact on intelligibility because you got rid of clues poorer intelligibility than mild distortion of sound.
Substitutions = 2nd greatest impact on intelligibility
Distortion = 3rd greatest impact attempt at sound because changed on intelligibility
Addition = least impact because sound is THERE just that there is another sound with it. least impact on intelligibility
Frequency of error sounds in language = factor if sounds are not that frequent in the language than the impact is lessened. But the very frequent sounds in the language if in error greatly impact intelligibility.
Additional extraneous factors to affect intelligibility: rate linguistic experience of the listener
Speaker’s rate inflection and stress (harder to understand when fast
Linguistic experience of listener – understanding someone with sound errors requires someone with a lot of linguistic experience like SLPs. We listen for linguistic pieces. Communication cues available to listener (context) = context helps with intelligibility.
Intelligibility is the most influencial factor in determining the severity of the disorder. Determines how severe their speech sound disorder is. That is the biggest factor. You don’t work on /s/ with a three year old but a child who had inhalation for /s/ had to work on /s/ because it was SOOOO DIFFERENT that it made him very unintelligible.
Guidelines: Important to know: A child age 2 should be 50% intelligible to familiar listeners…
A child age 3 should be 75% intelligible to strangers (don’t get nervous on the 3rd birthday – this is still relational)
A child at age 4 should be approximately 100% intelligible to strangers (even though some artic errors may be present.)
If not at these levels you may consider the fact that there is something going on that may require treatment but keep in mind that there are ‘ranges.’
How do we assess intelligibility? Word and Sentence Tests Lists that are not the same all the time…
Some that randomize tests Some intelligibility tests
Some tests claim they test intelligibility but may not really because there are too many contextual clues…
Really look for one that assesses what it says it is assessing need one without a lot of cues.
PRESCHOOL SPEECH INTELLIGIBILITY MEASURE 1995 Morris Wilcox
Led to the… CHILDREN’S SPEECH INTELLIGIBILITY MEASURE 1999 Morris and Wilcox CSIM
Word level task: single word multiple choice intelligibility measure
Single word multiple choice intelligibility measure
Adapted from assessment of intelligibility of Dysarthric Speech AIDS
Developed by Yorkston and Beukelman 1981. AIDS
CSIM: single word – e xaminer says word. Word is NOT recorded. Then child says word and then it IS recorded meaning that you only record on AUDIOTAPE what the child says… There are 50 words on the CSIM that you administer.
You count to 5 between items to standardize time of presentation just to standardize the amount of time between word presentations.
Then take unfamiliar listener and that person listens to child’s productions (only child productions) and they have a score sheet in front of them and have a choice of 12 words for EACH WORD the child says (closed set) from which to choose the target word (child’s productions.)
High inter and intra rater ability: person within or across people reliability… !? if I did this with a child today and gave it to three people they would get similar scores.. Intra rater if I did this with a child and I gave it to aketlyn to do and th reliable for kids ages 3 – 10 or 11.
CSIM: you take the list and put it down against the list that you chose
If correct = 1 1
If incorrect = 0 0
Record 0 if rater did not understand 1 if did
When you do child clinic here you will use the CSIM. for intelligibility
PCC another measure of Intelligibility ! 1982 Called Percent Consonants Correct (Shriberg & Kwiatkowski quoted in research pros and cons.sample speech in play task you get a sample of their sounds in running speech. Record sample of speech. consonants the child got correct and DIVIDE IT BY THE TOTAL NUMBER OF Cs in sample x 100 and x by 100 for %
Ch and dj - look at them as single consonants? Probably wouldn’t apply. Choo choo count /ch/ as a single consonant.
Scale for mild to severe – what percent is mild moderate and severe – there IS a scale to interpret results
Scoring Intelligibility at the Word Level – very frequently used by many.
Score = % words understood in sample. What is the best measure that will work with this person or that person.
Scoring on a 3 – 4 point scale also – used TOO OFTEN. Then the clinician would turn the sample over to another SLP and they may rate it differently. Highly subjective and reliability. Moderately intelligible (Give Billie a percent instead!) Use of such terms as mild/moderate/severe; mostly intelligible somewhat intelligible
One system may or may not be best in all situations so you need to know various ways to measure it and be adept at measuring in different ways. (you could record the speech sample and play it back to an unknown listener.) – To get rid of context don’t let them watch the video.
What is the best measure that will work with this person or that person. You need to start off with a quality speech sample. Set up a GOOD SITUATION for a speech sample.
This is part of assessment and also at the beginning at end of therapy. Go in with some ideas of how you can do this. What is the best measure that will work with this person or that person.
AIDS: dysarthria can use if for other people who who are not yet diagnosed with dysarthria this is more of an adult measure.
Before a diagnosis can begin ask two questions What information do we actually need and How should we gather that information?
Children may come from different situations different ages different degrees of impairment and differences in the information we would need to effectively evaluate the situation.
Assessment is the basis for treatment decisions – it is the clinical evaluation of a client’s disorder and can be divided into two phases APPRAISAL AND DIAGNOSIS
Appraisal is one part of Assessment where there is collection of data
Diagnosis is one part of Assessment where there is the end result of studying and interpreting collected data.
What information do we actually need and how do we gather that information is what part of Assessment Appraisal
Professional assessment demands qualified and verifiable decisions not too much and not too little data.
What are the different types of data needed for a comprehensive diagnosis? artic test including stimulability measures conversational speech assessment in varying contexts hearing testing speech mechanism exam the selection of possible additional measures such as language testing perceptual performance contextu
Data can be collected in two different ways screening or through a more comprehensive evaluation.
A screening consists of activities or tests that identify individuals who merit further evaluation.
A screening does not collect enough data to establish a diagnosis it only demonstrates the need for additional testing = screening may be formal or informal and may include elicitation procedures.
Elicitation procedures are formal measures that often have normative data and cutoff scores.
Informal measures are typically devised by the examiner and may be directed to a specific population or age group.
Screenings give an initial impression of a large group and benefit those who fail the screening and are later more comprehensively evaluated; not always reliable as some may pass but still have impairments.
Screenings are too limited in scope to serve as a database for a diagnosis but a COMPREHENSIVE EVALUATION can give a more detailed and complete collection of data.
A Comprehensive Phonetic Phonemic Evaluation is the core of the Appraisal for articulatory/phonological impairments.
A Comprehensive Phonetic Phonemic Evaluation is the core of the Appraisal for articulatory/phonological impairments and includes artic test including stimulability measures conversational speech assessment in varying contexts hearing testing speech mechanism exam the selection of possible additional measures such as language testing perceptual performance contextu
Before the formal appraisal even happens clinicians can start collecting data via initial impression using observation of speech and a simple form.
If during the initial impression the child is partly or totally unintelligible the collection of data from an artic test could be initiated if the initial impression yields an unintelligible child additional procedures for data collection should be considered especially for the spontaneous speech sample.
Who requires additional considerations very young children dialect speakers and ESL speakers = done with special guidelines.
Articulation Tests are designed to elicit spontaneous naming based upon presentation of pictures most consonants are tested in initial medial and final position in words.
Artic tests are relatively easy to give and score and time expenditure is minimal so it is a good appraisal procedure plus clinician gets a list of incorrect sound productions in diff word positions which is good to direct further assessment and planning of therapy; some provide standardized scores.
Standardized scores allow the clinician to compare the individual child’s performance with the performance of others of the same age then the scores can be used to document the client’s need for and progress in therapy.
Problems with artic tests include that they examine sounds in selected isolated words don’t give info on production in connected speech and don’t give info on production in natural speech conditions. do not give enough info on phonological system to be a comprehensive phonological analysis they only measure speech sound production.
Problems with artic tests they do not include all sounds in all contexts in which they occur in GAE and some artic tests do not even test all the sounds in GAE for example most do not test vowels and few consonant clusters sounds are not context controlled which makes production more difficult from word to word and artic tests are selected probes that only touch upon total artic abilities so are not in and of t
How do you select a test of artic? Tests appropriateness for the age or developmental level of the client the tests ability to supply a standardized score the test’s analysis of the sound errors and the test inclusion of an adequate sample of the sound(s) relevant to the individual client at hand.
Age ranges for artic tests vary but most work for children 3 and up selection becomes harder for very young and for older adolescent and adult clients.
Younger clients including 2 year olds and children who are delayed in language acquisition (3-4 years of age) may not respond well to a formal artic test. most tests not designed for kids beyond age 12.
Picture test are not appropriate for teens and adults but certain artic tests contain sentences they can read might be better for older clients.
If you need to have a test that provides a standardized score be sure to select on that does – not all artic tests have standardized scoring.
Some artic tests are labled artic tests and others are labled phonology tests same exam format (spontaneous picture naming) but the results are analyzed differently. Those test that contain categorizations of errors by phonological processes used may be time savers.
Most articulation tests do not sample the most frequently misarticulated sounds in a large number of different contexts.
How to solve shortcomings in artic tests transcribe the entire word supplement the test with additional utterances that address the noted problems of the client always sample and record continuous speech determine the stimulability of the error sounds
Scoring an artic test helps obtain info about the accuracy of the sound articulation and the position of the sound within the given word there are three different scoring systems
What are the three different scoring systems for an artic test Two Way Scoring Five Way Scoring and Phonetic Transcription
In Two Way Scoring a choice is made btw right and wrong helps document therapy progress can also be a good screening protocol but has limitations and inability to render usable info about type of aberrant artic taking place so CANNOT USE TWO WAY FOR ARTICULATION TESTS
In Five Way Scoring there is Correct and SODA Substitution Omission(deletion) Distortion and Addition
Substitution a sound is replaced by another sound - 5 Way Scoring
Omission/Deletion a sound is deleted completely – 5 Way Scoring
Distortion the target sound is approximated but not closely enough to be a norm realization
Addition a sound or sounds are added to the intended sound
Problems with 5 Way Scoring System? what is normal limits is not defined dialectal and contextual variations exist which can result in a diff but acceptable pronunciation
Deletion may include not only the omission of a sound but also a glottal stop but a glottal stop is actually a substitution of a glottal stop for a sound.
Transcription systems describe speech behavior and represent the spoken language via written symbols requires a high degree of clinical skill don’t judge best to describe the sounds you hear
Phonetic transcription if far more precise and gives more information about the misarticulation which is helpful for both assessment and intervention and is the most universally accepted way to communicate information about articulatory features.
Comprehensive Evaluations require both broad and narrow transcription and the scoring system of Phonetic Transcription will be used for
Stimulability Testing testing the client’s ability to produce a misarticulated sound in an appropriate manner when stimulated by the clinician to do so.
Clinician says “Watch and listen to what I am going to say and then you say it.” Stimulability.
In stimulability an isolated sound is often first attempted if a norm articulation is achieved the sound is placed within a syllable and subsequently into a word context Stimulability 1 – 5 modeling attempts
For many clinicians a stimulability test is a standard procedure that concludes the administration of an artic test gives a measure of consistency to naming of the picture and imitation of a speech model provided by clinician.
Articulatory stimulability used to determine therapy goals and to predict which children might benefit most from therapy; sounds that are more stimulable are easier to work on in therapy and highly stimulable sounds are targeted first.
High stimulability cross correlates with rapid therapeutic success; some research suggests that children were on the verge of acquiring those sounds and might not have needed therapy?
Contrarily treatment of non-stimulable sounds may be
Stimulability should NOT be the only source
Single word citing responses can be different from spontaneous speech samples takes a lot longer to transcribe a spontaneous speech sample so protocols continue to be based on results of citation articulation tests.
The conversational speech sample is not optional it is a basic necessity for every professional appraisal.
Complex linguistic content and low interest topics in spontaneous speech samples result in more errors.
Organizing the Continuous Speech Sample - the Continuous Speech Sample REQUIRES ORGANIZING!
Continuous Speech Sample Begin with artic test note errors decide which sounds to target provide objects or pictures with targeted sounds and make them a portion of spontaneous speech procedure compare citing and talking tasks plan the length of the sample 100 words is good can be done in 3 minutes of speech 200 to 250 = ten minutes then time to transcribe from recording = 30 minutes tops.
Continuous Speech Sample Plan Diversity into the sample = various communicative situations should be a portion of the recorded speech sample to represent the phonetic and phonemic skills of the client = talking situations picture descriptions storytelling describing the function of objects or problem solving.
Continuous Speech Sample Monitor your recording and gloss any utterances that might later be difficult or impossible to understand from the taped recording basically repeat any utterances that you understood that you realize will be difficult to comprehend later repeated with NORMAL pronunciation what the client has just said for easier identification later. Do it naturally.
Continuous Speech Sample Transcribe as much of the spontaneous speech sample as possible during the recording. Live transcriptions have the advantage of capturing phonetic detail that may be lost with a tape recording. and also reduce the subsequent transcription time. Listen to 1 to 2 minutes of conversation before transcribing due to the clinician’s adjustment to the client’s pronunciation patterns.
Continuous Speech Sample Unintelligible just mark with X and don’t go crazy trying to decipher x = unintelligible better to gloss it during the recording.
Organicity a pronounced structural or functional aberration from norm that an organic cause of speech difficulties needs to be concluded – refer to medical expert.
Micrognathia unusually small jaw
Adenoid facies chronic or repeated infections that result in enlarged adenoids mouth breathing a shortening of the upper lip and an elongated face.
Evaluation of the speech mechanism should include exam of head and facial breathing oral and pharyngeal cavity structures the tongue the hard and soft palate and functionality of the speech mechanisms
Breathing should have no clavicular movement and inhalation exhalation cycles should be about even
Oral and Pharyngeal Cavity structures include teeth tongue palate and pharyngeal areas.
Class 1 = normal bite lower molars are one half a tooth ahead of the upper molars. Class II overbite
Too big a tongue macroglossia
Microglossia small tongue
Fissures grooves cracks shrivel lesions fasciculations = deviancy.
Fistulas openings or holes in the palate that can be palpated during an oral mech exam with gloves.
A blue tint to the palate may indicate a submucuous cleft oral mech exam next feel along the midline of the hard palate to ensure that the underlying bony structure is intact.
A bifid uvula may indicate a submucuous cleft.
Swollen tonsils or adenoids medical referral.
Functionality during Oral Mech look for range smoothness and speed of movements for adequacy can tasks be adequately performed range adequate? Movements integrated and smooth? Given age of client is the speed of movement within normal limits?
Oral Mech Exam intent = to determine whether the functional integrity of the articulators appears adequate for speech purposes. Isolated functional deviancies to not necessarily translate into inability to articulate certain speech sounds. They only suggest motor problems.
Functional deviancies identified in oral mech exam should be evaluated in light of client’s articulatory performance articulatory limitations and intelligibility.
For every child who is identified as delayed speech language testing is recommended every child who has a phonetic and/or phonemic disorder has to have language testing and a hearing screening also auditory discrimination skills and cognitive abilities.
Audiologic screening includes taking a history of recent episodes of ear pain (otalgia) and ear discharge (otorrhea) a visual inspection to determine the presence of structural defects and ear canal and eardrum abnormalities identification audiometry and acoustic immittance measurements.
1/3 of the children who enrolled in SLI had a history of recurrent middle ear disease. obtain history of otitis media and tubes.
Language screening should include morphosyntactic and semantic use of language as part of the evaluation process.
If a child collapses 3 sounds w for r and l then auditory discrimination testing is needed it exemplifies the collapse of three phonemic contrasts into a single sound. Find out if the child is able to perceive the difference between these three contrasts.
Speech production perception ramp wamp lamp this is a picture of a lamp (say all three to see if child can perceive differences in speech production by clinician.)
Phonological performance analysis supplements auditory discrimination tasks to determine if child can perceive distinction between contrastive sounds. for the collapse of 2 or more phonemic contrasts.
Cognitive appraisal probs with intelligibility and verbal IQ measures
Period of emerging phonology time span in childhood in which conventional words begin to appear as a means of communication. Toddlers and older children with more sever deficits in language learning. Need special considerations in Appraisal.
Why are children referred? special risk factors such as developmental disorders Down Syndrome and other genetic disorders hearing impairments and cerebral palsy.
Why are children referred? acquired disorders secondary to diseases or trauma such as encephalitis
Why are children referred? Parents who are concerned about the child’s development differences observed btw child and child’s peers referred through various sources as ‘late talkers’ when expressive language is slow to emerge.
Special Considerations – instead of an artic test try naming objects and if that doesn’t work ask the family to get a complete sample of the words the child is using and then based on the production of those words the child’s consonant and vowel inventory and syllable shape can be determined.
Special considerations: how to get that sample of consonants and vowels the child is using have family get an audio tape saying specific words at home bring objects from home the child can name keep a lot of the intended words that the child can produce and the approximate way the words are pronounced.
Children with emerging phonological systems do not talk a lot when you need to get a spontaneous speech sample some words may be unintelligible and there may be a lot of 1 and 2 word utterances. Use Blooms or Nelsons to quantify the type of words that the child is using. Examine their emerging phonology within the broader parameter of the child’s emerging language as a whole.
To get a spontaneous speech sample with a child that doesn’t talk a lot observe them with their caregiver or parent before and after the session.
To do an oral mech exam on a Special Considerations child make it fun let them look in your mouth do fish faces etc.
Special consideration children with hearing screenings important to do but may need to refer for a comprehensive audiological evaluation.
Phonetic errors are motor production problems A Phonetic Approach is also known as a Traditional or Motor Approach.
In a Traditional or Motor Approach the client is directed to position the articulators in such a way that a speech sound within normal limits is produced.
In Traditional or Motor Approach to phonetic errors/artic errors therapy progresses from one error sound to the next and may include auditory discrimination tasks.
Auditory discrimination tasks are useful to help improve auditory discrimination skills.
In order to help a client achieve a norm production of certain speech sounds the clinician needs an understanding of how the sound is normally produced and knowledge of the misarticulation.
The most frequently misarticulated sounds are important to recognize how to treat and also the voiced or voiceless cognates are also treated.
/s/ most of the misarticulations treated are distortions
For /l/ most of the errors are substitutions
Should a traditional phonetic approach still be used to treat artic errors even though approaches are as old as 1885? Yes – there is still a place for these methods within our understanding of phonetic-phonological disorders and remediation.
In phonetic or traditional motor approaches each error is treated individually one after the other. This is in contrast to a multiple-sound approach.
Phonetic or Traditional Motor Approach is in contrast to Multiple Sound Approach in the Traditional treats one sound error at a time individually one after the other.
Omissions and substitutions of an isolated speech sound can actually be a PHONEMIC DISORDER instead of a phonetic/artic disorder.
If the error proved to be phonemic then traditional motor approach should not be used some clients have a single sound error but it is still not phonetic could be a FUNCTION error for that sound.
The question is never how many sounds are involved but rather whether the errors be they single or multiple are phonetic or phonemic in nature.
If the errors are phonetically based traditional motor phonetic approach is best therapy practice.
Sometimes phonetic treatments are used with clients with phonemic disorders too certain portions of these techniques can be beneficial when working with children.
Phonological approaches emphasise the function of sounds within a specific language and so the internalization of phonological rules and contrasts are the main goals of phonological therapies.
If a sound is not in a child’s repertoire and remains elusive in spite of phonological treatments the phonetic approach could be implemented to obtain norm articulation.
Being able to correctly produce the speech sound may be in integral part of the child’s ability to understand and utilize the phonological rules and contrasts within that particular sound.
Clients with particular pattern based errors especially if the patterns reflect motor constraints (prevocalic voicing or certain cluster simplifications) incorporate phonetic approach for clients who demonstrate linguistic or pattern based errors.
If motor constraints can be identified in the patterns of clients with phonemic disorders the traditional phonetic approach is a viable treatment option.
In the motor Training Sequence certain training items will prove unnecessary for some clients the specific client’s needs and capabilities will cause changes in the sequencing of every therapy program.
There are phases to treatment and they assume that the client enters that stage with minimal competency and moves to the next stage when a certain level of accuracy has been achieved.
The necessary level of accuracy before a client in a treatment phase may move to the next stage is relatively high at 80 – 90% in structured intervention contexts.
80 – 90% accuracy is needed to move up to next stage but not necessarily in spontaneous speech.
A dismissal criterion for spontaneous speech is at a much lower level of accuracy 50% = dismissal.
Once children use targeted behaviors in spontaneous speech the majority of the time it is probable that progress will continue toward more consistent usage.
Percentages expected for dismissal may vary according to the clinicians expectations
Sensory-Perceptual Training / Ear Training Phase: client develops ability to discriminate btw target sound and other sounds including their own irregular production that he/she uses.
In Sensory Perceptual Training / Ear Training: the client is not asked to produce the sound correctly but rather just to judge its distinctness from other sounds.
What are the STAGES of the Sensory Perceptual/Ear Training?:
In SPET describe the Identification Stage: Identification Stage is when the clinician describes and demonstrates knowledge of the sight sound and feel of the target sound – the ‘hissing snake sound.’
The hissing snake sound is a ‘name’ for the target sound of /s/ used for children. for older children and adults more complex articulatory descriptions are used inluding models and diagrams.
ID stage of Sensory Perceptual: goal is to recognize and discriminate the sound in isolation when compared to other sounds both similar and dissimilar contrasts at first should be productionally and therefore acoustically very different and later btw target and error production.
In ID stage of Sensory Perceptual arranging contrasts in a hierarchical order from dissimilar to similar is more efficient than just contrasting the error production to the target sound.
SPET describe the Isolation Stage: target is produced by the clinician in a variety of contexts that vary in word position (initial medial and final) and context complexity (words phrases sentences) the client must identify when the target sound is heard; recognize target sound in words and ID the position of the target sound within that word.
SPET describe the Stimulation Stage: variations of the target sound are produced in large quantities and the client is bombarded with them louder or softer slower or faster presentations of words containing the target sound may include longer or shorter durations of the sound in words.
SPED Stimulation Stage continued: the client should also be able to identify the target sound when various speakers (tape recorder or group setting) say words sentences and finally paragraphs that contain it. Continue to ID the target sound as context and speaker change.
SPET Discrimination/Error Detection Stage: Norm and Error Productions of target sound are presented by clinician the error should mirror those of the client misarticulations should be presented by the clinician in contexts of varying complexity words sentences tongue twisters with several of the misarticulations in one utterance.
Part two of SPET Discrimination/Error Detection Stage is the CORRECTION - Error Correction – here the client is asked to explain why the word is in error and what needs to be done to correct it. what was wrong (tongue peeking through the teeth)
Part Three of SPET Discrimination/Error Detection Stage: Emphasize the clients ongoing self-monitoring skills. Recognize an error every time it occurs in their speech when the client misarticulates the clinician should wait a few seconds and then imitate the client’s production and then clinician correctly repeating the word several times.
When to use SPET: consider two factors – the age of the client and whether specific auditory discrimination difficulties are noted for that client age is a factor due to metalinguistics.
Metalinguistics Skills require the child to think and talk about language identifying the position of a sound in a word is a metalinguistic skill.
Metalinguistics:
For younger children metalinguistic aspects may make SPET inappropriate – clinicians should carefully consider the specific auditory perceptual skills of their clients.
Specific Perceptual Skill / Define:clients abilities to differentiate between their error production and the target sound. If there are no difficulties with specific discrimination tasks SPET is unwarranted.
SPET is a phase that occurs before production training and it may or may not be implemented.
The 2nd stage for therapy of phonetic errors that occurs after SPET is Production of the Sound in Isolation goal is to elicit a norm production of the target sound alone NOT in combination with other sounds.
Easy to achieve the production of the sound in isolation except with stop/plosives and then it may be easier for children to articulate the target sound together with a central vowel or with a noticeable aspiration.
Production of the sound in isolation is often a task that can be achieved in a short time but if not achieved in five to ten minutes persisting can cause frustration for the child. Change technique!
To achieve Production of the Sound in Isolation try Phonetic Placement Method & Sound Modification Method
Phonetic Placement Method: instruct the client how to position the articulators in order to produce a typical production clinician needs to know what articulatory changes need to be initiated.
Sound Modification Method: based on deriving the target sound from a phonetically similar sound that the client can actually produce. The similar and correctly articulated sound is used as a starting point and then use specific adjustments resulting in target sound.
Once the target sound has been correctly produced in isolation using Sound Modification the next task is to STABILIZE it have the client repeat it immediately possibly in front of a mirror and with feedback from the clinician.
When the production is stabilized using Sound Modification Method the client should articulate the sound a number of times successively softer louder and with different durations do it in activities that are fun.
Softer louder and with different durations make it fun maybe diff color cards for the sound and red means loud grey means soft and an arrow card means duration clinician provides feedback and the client provides input about the accuracy of productions.
Supporting Contexts also known as Facilitating Contexts relate to Sound Modification Method: some clients can produce a sound accurately in some word contexts but not in others and coarticulatory context conditions seem to aid the clients production of a target sound.
Supporting Contexts or Facilitating Contexts a.k.a KEY WORDS are often found in the analysis of a clients conversational speech sample can be used to move directly to the production of the garget sound in isolation.
Using KEY WORDS use the target sound in the key word and isolate that sound by prolonging the sound within the word or by using the natural syllable structure of the word.
Facilitating Contexts or Key Words or Supporting Contexts are all the same thing and can be used to begin therapy at the Word Level to stabilize a production of a sound. Key words can be used as a model for the client. Point out diffs btw correct and aberrant production of the sound and when client can distinguish transition to other words.
Nonsense Syllables Goal is to maintain accuracy of the target consonant when it is embedden in varying vowel contexts order from those that are easiest to those that are hardest. Start with CV then VC then CVC vowels can be arranged with respect to coarticulation ease.
Some clinicians skip nonsense syllable phase of treatment and go right to target sound produced in words because words are more meaningful and interesting to client but some clients benefit from them. Under 50% accuracy in words means go to nonsense syllables then words later.
Years of practice mispronouncing a sound may also be remediated by use of nonsense syllables.
Word: A Therapy Phase for Phonetic Errors… Consider all of these: Word Length Position of the sound within the word the syllable structure the syllable stress coarticulation factors and familiarity.
Word Phase in Phonetic Therapy: goal is to maintain productional accuracy of the target word within the context of words. organize words from relatively easy to more difficult will prove helpful (multisyllabics with the sound appearing several times comes much later than a one syllable CV structure.)
What affects the articulatory complexity of a word: word length position of sound within word the syllable structure the syllable stress coarticulation factors and familiarity.
Word Length relevant to Word Phase of Phonetic Therapy: the fewer the number of syllables the easier the word is to produce. One syllable words should be attempted first ahead of 2 and 3 syllable words.
Position of the Sound within a Word relevant to Word Phase of Phonetic Therapy: a sound in the initial position of a word or syllable appears to be the easiest word and syllable final sounds are typically more difficult put target sounds at the beginning in early treatment.
Syllable Structure relevant to Word Phase of Phonetic Therapy Open Syllables CV are easier to produce than closed syllables CVC; considering ease of production the syllable structure may have PRECEDENCE over the length of the word.
Syllable Stress relevant to Word Phase of Phonetic Therapy a target sound is easier to produce in a stressed syllable than in an unstressed one
Coarticulation Factors relevant to Word Phase in Phonetic Therapy certain words are easier due to coarticulation factors relates to preceding and following vowels and neighboring consonants in words.
Coarticulation continued relevant to Word Phase in Phonetic Therapy: words that contain the target sound only once such as cape instead of cake are easier and singletons easier than clusters making tea easier than tree.
Familarity relevant to Word Phase in Phonetic Therapy: familiar words are easier to produce except in cases where a familiar word has been mispronounced for years those mispronounced words should be saved for later until the sound is stabilized.
STRUCTURED CONTEXTS comes after Word Phase in Phonetic Therapy = Phrases and Sentences: goal is to maintain accuracy of production of garget sound as words are placed into short phrases and sentences. phrases and sentences should be scripted though – structured and elicited – NOT spontaneous yet.
Structured Contexts often is phased in while working at the Word Level as clinicians will typically select a core set of words that can be accurately produced and then put these words into short phrases and sentences.
Structured Contexts: What is a Carrier Phrase? A Carrier Phrase is a phrase that contains a target word at the end only one word that contains the target sound per phrase in the beginning or embed one target word within the carrier phrase which can be modified for a little spontaneity. “I see a ____.”
Carrier Phrase “I see a ______.” for structured contexts could be used with objects or pictures prepared to elicit a target word containing the target sound at first do not use any s-sounds – client completes phrase. At this stage move from highly structured to less structured and begin to use more syllables and consonant clusters.
Spontaneous Speech relevant to Therapy for Phonetic Errors: goal is to maintain accuracy of production when the target sound appears spontaneously in conversation. first addressed within therapy session and then transfer to more situations outside therapy
How to you approach Spontaneous Speech relevant to Therapy for Phonetic Errors in a SYSTEMATIC MANNER? vary the length of conversation – start with five minutes and increase the time interval as client’s accuracy increases – client should know clinician is ‘listening for our sound.’
How to you step up the complexity of Spontaneous Speech relevant to Therapy for Phonetic Errors extend the time interval and specific context that trigger the production of the target sound in many different words use pictures that start with that sound for conversation starters.
With regard to Spontaneous Speech after a relatively high level of accuracy is achieved within the therapy setting the next decisive step is to correct production of the sound outside in the real world. Parents and teachers play a role here and can help with this phase of therapy; doesn’t need to be produced accurately all the time in every setting.
Home Program Assistant (parent teacher caregiver etc) should be informed of these variables: when how long how often what should be done what accuracy what if production is unacceptable what do I do and how to motivate and reward.
How to monitor a home program tape recordings can be brought from home go buy an ice cream go window shopping in a toy store clinician could drop by child’s classroom or call the child on the phone.
Dismissal and Reevaluation Criteria is the Last Phase of Therapy: 50% accuracy during natural spontaneous speech is a relatively low percentage and may be acceptable as client may become more competent on their own but must be checked by reevaluation process.
Reevaluation Process can be a simple as stepping into a child’s classroom or more structured involving an articulation test and a conversational speech sample.
Reevaluation is the only way to ensure that the therapy was indeed successful and that the client has continued to generalize across situations. Ultimate goal = norm production within all natural conversational settings and a reeval documents this.
S s ranks among the top five sounds in frequency of occurrence and the most frequent word initial clusters are st str and sp for initials and for final clusters are st ns nz ks ts rz and nts
Morthophonemic function of /s/ or /z/ can be plurality third person singular as in jumps and possessives such as mom’s also conjugations of the verb ‘to be’
Minimal pair contrasts are often used to test the perception accuracy of the error production versus the norm production of clients. Is an auditory perceptual skills also minimal pair contrast therapy both ‘th’s are contrasted to S and Z as are sh and jh and t and d.
An S problem may be indicative of a hearing loss particularly a high frequency hearing loss as both S and Z have high frequency components from 6000 to 11000 Hz could lead to a distorted perception and production. This is why we do a hearing evaluation prior to our conventional diagnostic testing.
An S problem may be related to minor structural changes due to missing teeth in a school age child or new dentures in an adult and may result in unusual production circumstances.
Tongue thrust or tongue thrust swallow also needs to be considered tongue thrust refers to excessive anterior tongue movement during swallowing and a more anterior tongue position at rest.
Oral Muscle Pattern Disorders tongue thrust.