Speech Sound Disorders

4 Causes of Speech Sound Disorders

*Exact cause is unknown, but contributing factors include: Genetics --Increased risk with family history of a speech-language disorder --Increased risk with males Hearing Loss --Ear infections, deafness, or other causes may interfere with speech perception and production --For example: Children with recurrent ear infections are at higher risk of having a speech sound disorder due to limited or modified speech input Developmental Disorders --For example: Children with Autism present with patterns of speech sound errors that are deviant for their age and interfere with oral speech Structural Anomalies --Changes in the anatomy of the articulators --For example: A child with an open bite may present with a distorted /s/ production. Or a child with down syndrome has a tongue thrust

What are treatment techniques used for?

*Methods used by SLPs to increase awareness of target sounds and provide feedback about articulatory placement and movement

Name the 3 types of treatment approaches

-Vertical -Horizontal -Cyclical

What are 5 more substitution patterns?

-affrication -deaffrication -alveolarization -depalatalization -labialization

What is: -affrication -deaffrication -alveolarization -depalatalization -labialization

-affrication: Nonaffricate is substituted with an affricate- "joor" for"door" -deaffrication: Affricate is replaced with a fricative or stop- "ships" for"chips" -alveolarization: Nonalveolar sound is substituted with alveolar sound- "tu" for"shoe" -depalatalization: Palatal sound is substituted with a non palatal sound- "fit" for"fish" -labialization: Nonlabial sound is substituted with a labial sound- "pie" for"tie"

What are 6 assimilation patterns?

-assimilation -denasalization -final consonant devoicing -prevocalic voicing -coalescence -reduplication

What is: -assimilation -denasalization -final consonant devoicing -prevocalic voicing -coalescence -reduplication

-assimilation: Consonant sounds like another sound in the word- "bub" for"bus" -denasalization: Nasal sound is substituted to a non nasal sound- "doze" for"nose" -final consonant devoicing: Final position voiced consonant is substituted with a voiceless consonant- "pick" for "pig" -prevocalic voicing: Initial position consonant is substituted with a voiced consonant- "gomb" for"comb" -coalescence: Two phonemes are substituted with a different phoneme that has similar features- "foon" for"spoon" -reduplication: Complete or incomplete syllable is repeats- "baba" for"bottle"

What are the 5 substitution patterns?

-backing -fronting -gliding -stopping -vowelization

What is: -backing -fronting -gliding -stopping -vowelization

-backing: Alveolar sounds are substituted with velar sounds- "gog" for"dog" -fronting: Velar sounds are substituted with alveolar sounds- "tootie" for"cookie" -gliding: /r/ and /l/ are substituted with /w/- "wabbit" for"rabbit" -stopping: Fricatives and affricates are substituted with stops- "pan" for"fan" -vowelization: /l/ and /er/ are replaced with a vowel- "appo" for"apple"

What are the 5 syllable structure patterns?

-cluster reduction -final consonant deletion -initial consonant deletion -weak syllable deletion -epenthesis

What is: -cluster reduction -final consonant deletion -initial consonant deletion -weak syllable deletion -epenthesis

-cluster reduction: Consonant cluster is reduced to a single consonant- "pane" for"plane" -final consonant deletion: Final consonant is omitted- "toe" for"toad" -initial consonant deletion: Initial consonant is omitted (very severe)- "unny" for"bunny" -weak syllable deletion: Weak syllable (less stress) is omitted- "nana" for"banana" -epenthesis: Sound is added between two consonants- "bu-lue" for"blue"

Vowels are all acquired by age...

3, usually easier to acquire, so babies with speech sound disorders don't have a lot of problems with vowels

All kids have phonological processing so it is not considered a disorder until...

90% of kids outgrew that problem

Normal Speech Sound Development

All children vary in their development of speech and language skills, but a natural progression exists for mastering specific skills. Several studies have been completed to establish normative data for speech sound acquisition. --Results serve as a guide for patterns of acquisition and provide insight regarding a child's development. --Normative data assists with determining whether a speech sound delay and/or disorder is present, in order to initiate therapy as soon as possible.

Articulation Disorder vs. Phonological Disorder: -difficulty with -difficulty at what level -what kind of errors?

Articulation Disorders -Difficulty producing specific speech sounds -Difficulty at the phonetic level -SODA Phonological Disorders -Difficulty organizing speech sounds into a system of sound contrasts -Difficulty at the phonemic level -Phonological processes (consistent error patterns)

Articulation Disorders vs. Dysarthria: Speech subsystem affected: What's happening with oral facial muscles? What errors occur Does anything co-occur?

Articulation disorders: - articulation affected - Intact oral facial muscles - SODA Doesn't co-occur w/ dysphagia Dysarthria: - Respiration, phonation, articulation and resonance affected - weak oral facial muscles - Mainly distortion error, but can have SOA errors - Co-occurs with dysphagia

GFTA-3

Assesses a child's articulation of the consonant and consonant cluster sounds of Standard American English --Most frequently used assessment for pre-school and young elementary ages Samples consonants and consonant clusters in multiple different positions within words Three subtests: Sounds in Words, Sounds in Sentences, and Stimulability Provides age-based normative scores separately for females and males

Treatment Structure: Begins with... Begins with...

Begin with sounds in isolation, then advance to syllables, single words, phrases, sentences, structured conversational tasks, and unstructured conversation Begin with imitation, then advance to repetition, reading, and spontaneous generation

Assessment of Speech Sound Disorders

Case History: --Chart Review: obtain medical diagnoses, determine onset and progression --Patient Interview: patient's perception of his speech, impact on communication, use of strategies to improve speech intelligibility, goal for treatment Hearing Screening: --Does the patient possess adequate hearing acuity to differentiate speech sounds? Examination of the oral mechanism at rest and/or during non speech activities Standardized and Non-standardized assessments --Determines the child's intelligibility, the severity of speech sound disorders, the child's speech perception skills, and their stimulability to produce target sounds Language Screening: --Assess auditory comprehension, verbal expression, reading, and writing ---Children with phonological disorders are at higher risk of literacy disorders

Selecting Specific Targets (6 ways to select targets)

Degree of deviance from the accurate production --Treatment typically begins with speech sounds that the child is most stimulable for, so they can be mastered and generalized more quickly Impact on intelligibility --Specific patterns contribute most to intelligibility (e.g., consonant omission) Relevance to the child and his family Age of acquisition --Speech sounds are selected with the assistance of the normative speech sound timeline. Visibility of articulators with production --Easier to teach speech sounds when the articulators can be seen by the child Stimulability --Easier to learn and generalize specific speech sounds that the child is capable of producing with SLP support

Core Vocabulary Approach

Designed for children with inconsistent speech sound production errors, slow progress with speech sounds, and/or limited attention for drill and practice. --Errors occur on multiple different sounds; no set pattern of errors --Practicing a short list provides quicker improvement with communication of functional needs The child, the child's parents, and the SLP create a list of 50 words that are meaningful for the child 10 words are selected from the list of 50 words and production of the target words is addressed in two-weekly sessions through play. At the end of the week, the child produces the 10 words three times. --The words that are produced correctly and consistently are removed from the list and replaced with new words. --If errors persist on the practiced words, they remain on the list for the next week.

Metaphon Therapy

Designed to teach children metaphonological awareness (e.g., the awareness of the phonological structure of language)- you want the kids to think about the speech sounds Assumes that children with phonological disorders have not acquired the knowledge that speech sounds contrast from one another Aims to teach children the differences between manner, placement, and voicing of speech sounds --Identifying the difference between voiced and unvoiced phonemes, front and back phonemes, stop vs fricative phonemes. --For example, a child may put a star under a word that begins with a fricative and a heart under a word that begins with a stop. *Similar to Distinctive Feature Therapy, but Metaphon Therapy helps to facilitate recognition of different features of phonemes vs addressing production of multiple phonemes at once that have the same speech features. So its important for phonological disorders

Consequences of Speech Sound Disorders

Difficulty communicating basic wants/needs and complex ideas effectively with communicative partners Difficulty acquiring reading and writing skills (mostly kids with phonlogical disorders) Higher risk of psychosocial problems --Poor confidence regarding communication skills --Anxiety and embarrassment --Social isolation Higher risk of bullying in the school-setting May interfere with friendship development Difficulty with selecting occupations

Therefore, most SLPs begin with administering the _________ If they are concerned the child is presenting with abnormal phonological process patterns, the Sounds in Words results from the _______ are transferred to the ________

GFTA-3 GFTA-3 KLPA-3 score sheet for an analysis of the phonological processes.

2 Formalized Assessments of Speech Sound Disorders

Goldman-Fristoe Test of Articulation- Third Edition (GFTA-3) --Hallmark assessment for articulation disorders Khan-Lewis Phonological Analysis- Third Edition (KLPA-3) --Hallmark assessment for phonological disorders

Vertical Approach:

Involves intense practice on one or two speech sound targets until the child reaches a specific criterion level (for a long time) before advancing to the next target speech sounds

Cyclical Approach:

Involves targeting a few speech sound targets for a predetermined period of time (for a few weeks) before moving on to other target speech sounds Incorporates elements of both horizontal and vertical structures because it "cycles" through different targets

What are phonological disorders?

Language disorder in which children have difficulty organizing speech sounds into a system of sound contrasts Involves difficulty at the phonemic level (organizational, cognitive level) Phonological processes: predictable and typical patterns of speech sound errors (ALL KIDS GO THROUGH THIS) Speech sound errors are normal at a certain age, but become a disorder if they persist beyond the age when most typically developing children have stopped using them (a speech sound disorder with language skill problems)

Lisp vs. Lateral Lisp

Lisp = produce the th instead of tongue Lateral lisp = produce th instead on s but the air comes out on the sides of the tongue

Auditory Bombardment

More done at the beginning for speech therapy sessions to get the kid ready to produce speech sounds Involves the child listening to a list of words that contains the speech sound being addressed in therapy --A type of speech sound perception training The speech sound is emphasized within the word production with increased loudness. The list is systematically read aloud multiple times for repeated exposure to the speech sound being addressed. Primes the child at the beginning of the therapy session before verbal responses are elicited --For example, if a child is working on the /r/ sound, the SLP will read a list of words beginning with the letter /r/. (e.g., ride, rise, rim, red, row, real, root) --Particularly important for the intervention of phonological disorders to facilitate with the brain's organization of specific phonemes

What are articulation disorders?

Motor production disorder in which children have difficulty producing specific speech sounds correctly beyond the age when the sound is typically learned Despite no symmetry, ROM, or weakness deficits of the articulators Involves difficulty at the phonetic level Articulation errors include: substitutions, omissions, distortions, additions Think SODA from the dysarthria lecture no neurological problem

Horizontal Approach:

Multiple speech sounds are addressed individually or simultaneously during the same therapy sessions (could be working on 5 or 6 sounds) --Involves less intensive practice on more items compared to the vertical approach --Provides exposure to more speech sounds

Speech Sound Acquisition

Nasals (e.g., /m, n/), glides (e.g., /w/), and stops (e.g., /p, b, t, d/) are mastered at the earliest ages. Bilabial stops (e.g., /p/ and /b/) are acquired before lingual stops (e.g., /t, d, k , g) due to the visual support provided from the lips. Fricatives (e.g., /f, s/), affricates (e.g., /ch/, sh/), and liquids (e.g., /l, r/) are acquired later. Clusters are acquired last.

A mom comes up to you and says, "My child, who is 4 years old, keeps messing up the /r/ sound. Is that normal? Does he need speech therapy."

No because r is one of the most complicated speech sounds to acquire

KLPA-3

Norm-referenced analysis of a child's speech development and phonological process usage Identifies the frequency of usage of the different phonological processes Groups the phonological processes into four types: manner, place, reduction, and voicing SLP administers the 60 target words of the Sounds in Words test from the GFTA-3. The target words are then analyzed for phonological processes and compared against age and gender-based norms to determine which phonological patterns are normal and which indicate a disorder. It sees if their phonological process is normal for their age You use the subtests from the goldman fristoe and then compares it with a chart of phonological process

2 Speech Sound Disorders Categories

Phonological Disorders Articulation Disorders

Phonological Disorder vs. Childhood Apraxia of Speech: -Motor control for non-speech? -Consistant/inconsistant errors? -what kind of errors? -errors and automatic output? -rate, rhythm, stress?

Phonological disorder: -Generally no difficulty with non-speech oral movements and/or dysphagia -Consistent errors that can be grouped into categories (e.g., phonological processes) -Errors are typically consistent across all linguistic material (e.g., words through sentences) -Errors persist with automatic output (e.g., counting, stating DOW) -Typically no disruption of rate, rhythm, or stress Childhood Apraxia of Speech -Difficulty with involuntary motor control for chewing and swallowing, if oral apraxia co-exists -Inconsistent articulatory errors -Frequency of errors increases as linguistic complexity increases -Less errors with automatic output due to less motor programming demands -Rate, rhythm, and stress of speech are typically disrupted (e.g., groping)

Name some treatment techniques that are used

SLP models with exaggerated stress on the target sound Visual feedback of the articulators through a mirror Tactile cues for placement accuracy --Using a tongue depressor to indicate where the alveolar ridge is in the mouth for production of /t/ Gestural cues for manner of production --Long sweeping motion up your arm to indicate frication --Tapping motion to indicate stops Amplification of speech sound during auditory bombardment

SLP Role in the Intervention of Speech Sound Disorders

SLPs play a critical role in the screening, assessment, diagnosis, and treatment of speech sound disorders in children. SLPs provide prevention information to groups known to be at higher risk of developing speech sound disorders SLPs educate professionals and families on the disparity between speech differences and speech sound disorders.

Screening of Speech Sound Disorders

Screening is conducted when a speech sound disorder is suspected or as part of a comprehensive speech and language evaluation. Purpose: identify a child for a comprehensive speech assessment and/or referral to other professional services Typically includes: Hearing Screening Oral motor examination Informal measures to assess for specific speech sounds Picture/object naming Repetition of words, phrases, and sentences Reading of words, phrases, and sentences Speech sample of spontaneous conversation

Naturalistic Speech Intelligibility Intervention

Speech therapy is addressed through play and natural activities (e.g., mealtime, class) If the child produces a speech error, the SLP recasts the correct version of the word The child is encouraged to repeat the word back correctly, but is not required. This is a treatment approach that is also helpful for children with limited attention for drill practice.

What phonological process pattern is backing? what about final consonant deletion? (look in slides for more info)

Substitution Syllable structure

SODA

Substitutions: switching a speech sound with another "Cap" with "Cat" Omissions: eliminating a speech sound within a word Common with consonant clusters "Black" with "Back" Distortions: reduced precision of a speech sound related to placement of the articulators Distortion of /s/ with a lisp and lateral lisp Additions: adding an extra speech sound within a word Can occur in initial, medial, and final positions of words Initial consonant substitution "dad" and "mad" Medial vowel substitution "mom" and "mum" Final consonant substitution "wake" and "wait"

3 Types of Phonological Processes

Syllable Structure: sound changes that modify the syllabic structure of words (ex: cvc, a speech sound is deleted and now it's a cv= syllabic structure changed) Substitution: when one class of sounds is replaced for another class of sounds Assimilation: one sound changes to become more like another sound, usually its neighboring sound

Cycles Approach

Targets phonological pattern disorders and highly unintelligible children with severe articulation disorders Specific phonological patterns and/or speech sounds are addressed within a specific cycle, or timeframe. --Cycles range from 5 to 16 weeks A new phonological pattern is introduced during the next cycle. Phonological patterns are re-cycled until the target patterns have generalized to the child's spontaneous speech production --For example, a child may address the phonological process of "backing" for 6 weeks, then switch to "fronting" for 6 weeks, then switch to "vowelization", then continue cycling through the three phonological patterns until the child has achieved the speech sounds during conversation. --These phonological patterns may be addressed through minimal pairs.

Distinctive Feature Analysis

Targets unique characteristics that distinguish one sound from other sounds Focuses on speech features that are common to several phonemes rather than addressing unrelated sounds at one time Features based on placement, manner, and voicing Used for children, who exhibit multiple articulation errors that can be grouped on the basis of distinctive feature patterns (they may have issues with all bilabials, all fricatives or all affricates- can be grouped into the placement of manner) --For example, if a child has difficulty producing voiced consonants, treatment will address multiple voiced phonemes at once (e.g., /b, d, g, v, z/) --This type of therapy may also be addressed through minimal pairs.

Symptoms of or Related to Speech Sound Disorders

Trouble making sounds Difficulty being understood May substitute sounds, leave out sounds, add sounds, or change the sound May say only one syllable in a word (e.g., "bay" instead of "baby") May simplify words by repeating two syllables (e.g., "baba" instead of "bottle") The child does not "grow out" of these sound changes

Some sound substitutions and omissions are NOT speech errors, but rather may be related to...

a dialect or accent

A person says "caffee" instead of "coffee". Is that a difference of dialect or accent?

accents

Define speech sounds disorders

an umbrella term that refers to any combination of difficulty with perception, motor production, and/or the phonological representation of speech sounds that impact speech intelligibility

Dirty for tirty = assimilation. Why?

because there is a "t" in the word dirty (so its not just considered a substitution)

Examples of place of articulation

bilabial, labiodental, lingua-alveolar, lingua-dental, lingua-palatal, glottal, velar

Dialects and accents are speech ___________ not speech _____________

differences disorders

Maximal Oppositions:

has 2 differences in the word Uses a pair of words in which ONE word differs by multiple different features (e.g., place, manner of articulation, AND voicing), which changes the word's meaning /m/ and /s/ (e.g., /m/= bilabial nasal; /s/= lingua-alveolar fricative; "May" for "Say" "Met" for "Set")

Phonological processes are hard to differentiate from....

motor planning problems (apraxia)

Minimal Oppositions (aka Minimal Pairs)-

one thing is off b/t the two Uses a pair of words in which ONE word differs by one single feature (e.g., place, manner of articulation, OR voicing), which changes the word's meaning Also important for the intervention of phonological disorders to facilitate how different phonemes create different meanings within words /p/ and /k/ are both stops, but differ by placement (e.g., /p/= bilabial; /k/- lingua-palatal; "Pup" for "Cup" and "Pool" for "Cool")

What is the focus of Contrast Therapy? What are the 2 oppositions?

producing contrasting word pairs instead of individual speech sounds to differentiate speech sounds from one another (2 words that differ by 1 speech sound) -Minimal oppositions -Maximal Oppositions

Define accent

refers to a distinct mode of pronunciation that is specific to a region or social group New England /r/ production Southern Drawl ESL (English as Second Language) speakers

Define dialect

refers to a particular form of language that is specific to a region or social group; may include differences in vocabulary and/or grammar Ebonics (African American English) British English

Examples of manner of articulation

stops, fricatives, affricates, nasal, liquid, glide

Auditory bombardment helps with...

the child being able to differentiate between speech sounds

If a child is suspected of having a speech sound disorder based on the screening results...

the child is then referred for a comprehensive speech assessment.

Define Speech and the 2 levels

the spoken medium of language; consists of an organized system of sounds (phonemes, consonants, vowels) Phonetic (Articulation) Level: refers to the motor act of producing the vowels and consonants for speech production Phonological (Phonemic) Level: refers to the brain's organization of speech sounds into specific patterns of sound contrasts, so speech sounds are different and distinct from one another

Define language

the symbolization of thought that involves a system of rules (e.g., vocabulary, grammar), which enables us to communicate meaning with others (the message behind the talk, not the actual motor production)

Can a kid have both an articulation disorders and a phonological disorder?

yes. A kid who does backing might also have a lisp