Articulation Disorders

Overview of Assessment of Speech Sound Production

-Case history -Interview (Parent, Child, Teacher) -Language Assessment -Hearing Screening -Oral Peripheral Examination -{Classroom observation, examine writing samples} -Standardized Testing -Spontaneous Speech Sample -Analysis and Integration of the Results -Differential Diagnosis -Recommendations and Suggested Prognosis

Analysis and Integration of Assessment Results

-Compile the information from case history, interview, and observations. -Analyze the effects of the child's speech sound disorder on overall communication academic achievement and socialization. -Transcribe and analyze the speech sample. -Complete a phonetic inventory analysis. --List the sounds and clusters the child produces correctly and spontaneously, those produced with modeling and instruction, and those produced incorrectly. -Look for phonologic patterns and complete distinctive feature analysis. -Analyze for speech sound patterns due to bilingualism or a dialect. -Rate overall intelligibility -Compare performance to developmental norms -Summarize the results of stimulability testing

Classification of Sound Errors based on Phonetic Principles

Another traditional approach. Errors are classified according to place and manner of production, and voicing features of each sound. Examples: /tæt/ for "cat" /t/ for /k/=Substituting a front sound for a back sound. /bæg/ for "bad" /g/ for /d/=Substituting a back sound for a front sound. /top/ for "soap" /t/ for /s/=Stopping a continuant sound. /gar/ for "car" /g/ for /k/=Substituting a voiced sound for an unvoiced sound.

Speech-Sound Disorders

Articulation was historically conceptualized as a motor act and the term "Articulation Disorder" was used. In the mid-1970's, researchers noted that linguistic activity contributes significantly to the motor process of speech. The term "Phonological Processing Disorder" came into use. The term "Speech-Sound Disorder" is inclusive of both articulation and phonological disorders.

Standardized Tests of Articulation and Phonological Skills

Can be helpful in getting an initial impression of the child's phonemic inventory and assessing error patterns. Scores are necessary for special education eligibility.

Classification of sound errors based on Phonological Patterns

Classification of errors based on phonological patterns is common for a child with a severe speech sound disorder with multiple sounds in error and significantly reduced intelligibility.

Phonological Assessment instruments

Clinical Assessment of Articulation and Phonology (CAAP) The Khan-Lewis Phonological Assessment-Second Edition Structured Photographic Articulation Test-II (SPAT-D II) Hodson Assessment of Phonological Patterns-Third Edition (HAPP-3)

Spontaneous Speech Sample

Collect a sample under naturalistic conditions. Allow for multiple opportunities to analyze the same sounds. Provide an opportunity to assess coexisting language, fluency and voice. Examine speech intelligibility and the prosodic characteristics of speech

Traditional Speech Sound (Articulation) Tests

Goldman-Fristoe Test of Articulation-Second Edition (GFTA-2) See next slide for comments from current SLP's using GFTA-3! Clinical Assessment of Articulation and Phonology (CAAP) Structured Photographic Articulation Test-II (SPAT-D II)

Stimulability Testing

Model the sound in isolation or in a CV syllable and ask the child to repeat what was modeled. Evaluate Phonetic Context Effects: Context Probe of Articulation Competence (CPAC) Secord Contextual Articulation Tests (S-CAT)

What causes speech sound disorders

Physical conditions Oral structures/dentition Developmental Disorders Genetic Syndromes Neurologic Impairments Functional articulation disorders: No known cause

Suggest Prognosis

Prognosis is better with treatment than without. A child with an articulation disorder may require fewer treatment sessions than a child with a severe phonologic disorder with extremely limited speech intelligibility. Improvement may be faster if the family can observe treatment and conduct home treatment. Maintenance and carryover are improved when caregivers and family members complete home activities and generalization procedures.

Calculating Speech Intelligibility

Record a speech sample. Calculate the following: Total number of utterances Total number of intelligible utterances (if any part of an utterance is unintelligible, the whole utterance is marked as unintelligible). Total number of words. Number of intelligible words. Calculate % intelligibility on a word-by-word basis: # of intelligible words/total # of words = __________ X 100 = __________% Calculate % intelligibility on an Utterance-by Utterance Basis # of intelligible utterances/total # of words = __________ X 100 = __________%

Calculating Rate of Speech

Record an uninterrupted speech sample. This sample can consist of conversational speech, oral reading, or both. The sample should be at least 1 minute long. Count the number of words produced in the sample and divide it by the length of the sample (number of minutes). This will give you the child's rate of speech. Example: 200 words/2 minutes=100 words per minute Purcell and Runyan (1980): Avg. speaking rates of first through fifth graders ranged from 125 to 142 words per minute. Rates vary tremendously. We measure speech rate not to compare to norms, but to evaluate the effect on intelligibility. Would a change in the speaking rate improve intelligibility?

Screening for Speech Sound Disorders

Relatively quick pass/fail that can be administered to a large number of children in a short amount of time. Nonstandard techniques: Have a brief conversation with the child. Discuss family, pets. Have the child read a short passage or describe a picture. Have a child produce a number of word, phrases, or sentences containing a representative sample of age-appropriate sounds. Standardized instruments: Fluharty Preschool Speech and Language Screening Test Preschool Language Scale

Diagnostic Criteria and Differential Diagnosis: Diagnose Phonological Disorder if:

The child exhibits multiple speech sound errors that fall into phonologic patterns. The phonologic patterns that are evident are typically absent in the speech of the child's peers. Significantly reduced speech intelligibility. The pattern of speech sound production is not due to ethnocultural factors.

Diagnose articulation disorder if:

The child's errors are limited to a few sounds that may be summarized by omissions, substitutions, and distortions. The difficulty appears phonetic. There is no obvious phonologic pattern in the few errors noted. There seems to be no neuromotor control problems. The are are no orofacial, laryngeal, and pharyngeal structural problems that need attention. The difficulty negatively impacts speech intelligibility. The child's speech pattern is not due to ethnnocultural factors.

Traditional Classification of Individual Sound Errors

The production accuracy of each phoneme is evaluated. The clinician judges the sound production as correct or incorrect. Incorrect productions are classified as distortions, substitutions, or omissions. Traditional, basic approach that is frequently used.

How long does it take to treat speech sound disorder effectively

Type and severity Existence or co-occurrence of other disorders Age of intervention Child's willingness to participate in therapy Level of support

Make Recommendations

Within normal limits: no therapy recommended. Borderline: re-evaluate in 6 months. Borderline or Mild disorder present: Diagnostic therapy period (RTI level 2) Disorder present: therapy recommended Dialect present: No therapy recommended. Family may request referral for intervention to teach speech pattern of mainstream English. Referral to another professional (audiologist, otorhinolaryngologist, neurologist, psychologist, counselor).