3/30/2014
A Late Eight Update
Ken Bleile
ICCD
March 28th, 2014
Outline
 Introduction
 Discussion
topics
Introduction
 What
are the eight and why are they late?
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Discussion Topics
 Do
speech sound disorders impact school
success?
 Should an articulatory problem be treated
using an articulation approach?
 What role does discrimination training play
in speech treatment?
 Should a clinician treat a stimulable
sound?
 What
about non-speech oral motor
approaches?
 What are effective phonetic placement
and shaping for [r] and its vocalic
sidekicks?
 Is there a best age and grade at which to
treat the late eight?
 Is there a best or standard approach?
Introduction
 What
are the eight and why are they late?
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The Late Eight
[θ]
[s]
[l]
[r]
[∫]
[t∫]
[ð]
[z]
… Plus One
Vocalic [r]
Why are the Late Eight Late?
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Short Answer
 Too
many consonants, not enough mouth
Consonants at 24 Months
 Stops
bdgptkŋ
 Affricates
 Fricatives
 Liquids
 Glides
hw
Mastery of Sound Classes
Period
Early
Sound class
Stops, nasals, glides
Mid
Affricates, liquids,
fricatives
Interdental fricatives
Late
Age
>3 years
3;0-4;0
4;6
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The Late Eight
 Difficulty
with late acquired sounds is the
world’s most frequently occurring
communication disorder, affecting both
children and adults learning English as a
second language
Demographics
 6%
of school-aged students
on caseloads
 18% not English at home
 1 in 4 adults in NYC
 92%
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Discussion Question
 Do
speech disorders impact school
success?
Short Answer
 Yes.
A student with a speech sound
disorder may be at risk for academic
failure, underachievement, and social
isolation
 The opposite is also true: speech success
contributes to school success
Academic Challenges
 Approximately 75%
to 85% of
preschoolers with speech sound disorders
also experience language disorders
 50%–70% of children with speech
disorders also experience general
academic difficulty through high school
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Studies
 Gierut,
1998
Broen, & McGue, 1994
 Overby, Carrell, & Bernthal, 2007
 Shriberg & Kwiatkowski, 1988
 Paul & Shriberg, 1982
 Ruscello, St. Louis, & Mason, 1991
 Felsenfeld,
Poor Perceptions
Even when a student does not experience
academic difficulties, at least one third of
grade school teachers perceive students
with reduced intelligibility as having less
academic potential than peers
(Overby, Carrell, & Bernthal, 2007)
Underestimate Abilities
 My
clinical impression is that statistics
underestimate academic difficulties of
students with speech sound disorders.
 The underestimation arises because a
student may still succeed at academic
work, but may do so at less than full
potential, partially because teachers may
underestimate their academic potential.
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Social Isolation
 Throughout
the school years a speech
sound disorder may result in social
isolation.
 Students with communication disorders
(including speech sound disorders) are
more likely than peers to be bullied,
experience poorer peer relationships, and
enjoy school less.
(McCormack, Harrison, McLeod, &
McAllister, 2011).
Speech Success
The opposite is also true: speech success
contributes to school success.
Iowa Core Curriculum
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Why Curriculum Matters
The curriculum impacts speech
development.
Two examples: reading and changing
speech demands during the school years
A Perspective
 Students,
teachers, and families all benefit
from linking speech services to the school
curriculum.
 In
treatment, the goal is speech, the
avenue is language, the vehicle is the
curriculum.
Discussion Question
 Should
an articulatory problem be treated
using an articulation approach?
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Short Answer
 Not
necessarily
Major Phonological Approaches
 Minimal
Pairs Approaches
 Morphosyntax Intervention
 Parents
and Children Together (PACT)
Maximal Oppositions
 Speech Assessment and Interactive
Learning System (SAILS)
 Dynamic Systems and Whole Language
 Metaphon Therapy

Major Articulation Approaches
 PROMPT
 Nuffield
Centre Dyspraxia Programme
 Van Riper approach
 Paired-stimuli (Key Word) Approach
 Sensory-motor Approach
 Motoric Automatization of Articulatory
Performance
 Motor Learning
 Five Minute Therapy
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An Observation
1. Treatment approaches typically are not
either solely “articulatory” or
“phonological.”
Example: Prompt
2. Not all articulation approaches are alike,
nor are all phonological approaches similar.
Why Both are Needed
 Attached
to every speech problem is a real
child.
 Treatment must appeal to the mind as you
practice the mouth.
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Discussion Question
 What
role does discrimination training play
in speech treatment?
Short Answer
A
misunderstood one, I believe
Idea
 Discrimination
training is based on the
observation that many children appear not
to realize they are making speech errors
 In discrimination training, generally a child
is first taught to discriminate his speech
error, and then is taught now to
pronounce the sound correctly
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The Trouble…
 The
trouble with discrimination training is
that children have mature speech
perception abilities long before they begin
school.
 ….
Actually, the following person has
mature speech perception abilities
Person with Mature
Speech Perception Abilities
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An Old Pro at Speech Perception
Development of Perception
 Auditory
Cortex
Sequences
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The King
dandy flower (for dandelion)
pin clothes (for clothes pin)
lawnmotor (for lawnmower)
el-bone (for elbow)
fire whistle (for fire siren/noon whistle)
buzzerfly (for butterfly)
little rock (for Tater Tot)
Focus on Focus
A
student’s difficulty is not in
discrimination; it is in focus and
awareness, which is a different concept
than discrimination and is executed in a
different way
 Rather than being done as a first step in
treatment, focus activities continue
throughout treatment concurrent with
work on speech production
Ways to Promote Focus and
Speech Practice
 Minimal
Pairs
 Deletion
 Self-correction
 Old
Way/New Way
Sound
 Similar
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Illustration








Clinician: What is a word for ocean that starts with the
snake sound?
Student: Sea.
Clinician: That’s right. Do you remember how you used
to say the s sound?
Student: th
Clinician: Good. Now say sea the new way, the old
way, and then the new way again.
Student: Sea. Thea. Sea.
Clinician: Great. Now say sea three times, listening to
yourself and trying to make the sound the new way.
Student: Sea. Sea. Sea.
Discussion Question
 What
about a non-speech oral motor
approach?
Short Answer
 Research
strongly suggests non-speech
oral motor approaches are based on faulty
empirical and theoretical foundations.
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Selected Studies
 Muttiah,
Georges, & Brackenbury, 2011
Strand, Lof, Schooling, &
Frymark, 2009
 Lof, 2009
 Powell, 2009
 Ruscello, 2008
 Lass & Pannbacker, 2008
 Clark, 2003
 McCauley,
Testimonials
I
don’t doubt the honesty of testimonials
that report success using non-speech
approaches
 Possibly, success has less to do with the
approach than with other variables,
perhaps the activities employed or the
clinician’s treatment skills.
Discussion Question
 Should
sound?
a clinician treat a stimulable
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Short Answer
 The
no.
answer is more complex than yes or
Stimulability Defined
A
first step in selecting a treatment sound
involves stimulability-- that is, should the
child demonstrate capacity to produce the
sound?
Stimulable Sound
The logic of selecting a stimulable
treatment sound is that a child
experiences less frustration because he or
she begins with some capacity to
pronounce it.
 Another reason to select a stimulable
sound is that, because a child can already
pronounce it correctly, during treatment a
child is practicing success.

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Non-Stimulable Sound
 Those
who argue against selecting a
stimulable treatment sound observe that a
child may acquire the sound without
treatment, since the sound already is
being pronounced correctly in some
contexts.
Get Some Religion
A
great deal of discussion, sometimes
approached with religious fervor, has been
devoted to whether a treatment sound
should be one a child or student has
limited capacity to produce (stimulable
treatment sound) vs. one that a child or
student cannot pronounce under any
circumstance (nonstimulable treatment
sound).
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Research
 Data
can be found that support both
positions-- that is, some research indicates
that a child may self-correct a stimulable
sound without treatment, and other data
suggest that a stimulable sound may not
self-correct for all children.
Selected Studies
 Dietrich,
1983
1989
 Powell, 1991
 Powell, Elbert, and Dinnsen, 1991
 Shine,
Some Thoughts
 In
the absence of research clearly
supporting one or other position on
stimulability, an alternative is not to
consider stimulability as “one size fits all”-that is, not accept either that stimuulable
sounds are right for all children or wrong
for everyone.
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A Suggestion
 Stimulability
is more a “person decision”
than a “linguistic decision.”
 That is, whether or not to select a
stimulable sound for treatment has more
to do with personality factors than
linguistic abilities.
A Perspective
I
am more likely to select a stimulable
treatment sound with a younger child with
less tolerance for failure.
 Many times, I select to first treat a
stimulable sound to build a child’s
confidence and sense of success, and later
work on non-stimulable sounds.
Capacity
 Because
capacity to produce the
treatment sound already exists, the
clinician can more quickly generalize
success to other words or phonetic
environments, rather than focusing
treatment on the often frustrating and
time-consuming task of teaching a
treatment sound that a person shows no
capacity to produce in any circumstance.
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Non-stimulable Sounds
 Selecting
a stimulable sound may not be
an option for an older school-aged student
or an adult learning a second language.
 In such situations, per force a
nonstimulable sound must be selected.
Discussion Question
 What
are some effective phonetic
placement and shaping techniques for [r]
and its vocalic sidekicks?
Making a Non-Stimulable Sound
Stimulable
 Phonetic
placement, and shaping (along
with imitation) convert a non-stimulable
sound to a stimulable sound.
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Definitions
 Phonetic placement:
Use of
articulatory postures (typically, tongue and
lip positions) for speech production.
 Shaping: Use of a sound a student can
already produce (either a speech error or
another sound) to learn a new sound.
Placement Example: [k]
1. Ask the student to place the tongue tip
behind the lower front teeth. (If needed, a
tongue depressor may be used to keep the
tongue in place.)
2. Ask the student to hump the back of the
tongue and say [ku].
Shaping Example: [ʃ] to [s]
1. Instruct the student to say [ʃ].
2. Ask the student to retract his or her lips
into a smile. Often, this results in the tongue
moving forward slightly into the position for
[s]. If needed, however, instruct the student
to move the tongue slightly forward. The
resulting sound is [s].
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The Dreaded [r]
Phonetic Placement of [ɚ]
 Instruct
the student to lie on his or her
back, relax the mouth, and say [ɚ].
Shaping of [k] to [ɚ]
1. Instruct the student to lower his or her
tongue tip.
2. Ask the student to raise up the back of
the tongue as for a silent [k].
3. Ask the student to make the sides of the
back of the tongue touch the insides of the
back teeth.
4. Ask the student to turn on the voice box,
resulting in [ɚ].
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Phonetic Placement of [r]
1.
2.
3.
4.
Tuck the chin
Make a grin.
Tongue in track.
Now curl it back.
Explanation
 The
components are a relaxed tongue
resting on the floor of the mouth (tuck the
chin), spread lips (make a grin), the
tongue positioned so its sides rest against
the insides of the lower teeth (tongue in
track), and the tongue tip curled back
(now curl it back).
For Bunched [r]
 For
bunched [r], instruct the student to
place the sides of the tongue in the track
between the upper teeth and then curve
the tongue tip down behind the lower
front teeth.
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Shaping of [ɚ] to [r]
1. Ask the student to say [ɚ].
2. Next, ask the student to say [ɚ] followed
by [i] or some other vowel.
3. Instruct the student to say [ɚi] several
times as quickly as possible, resulting in
[ɚri]. After [ɚri] is established, instruct the
student to say [ɚ] silently, resulting in [ri].
Discussion Question
 Is
there a best age and grade at which to
treat the late eight?
Short Answer
 When
it comes to speech treatment,
earlier is generally better.
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First Language
5;0 [s] and [ʃ] acquired by 75% of
students
5;6 [ð] and r-colored vowels acquired by
75% of students
6;0 [θ], [z], [ʧ], [r], and [l] acquired by
75% of students
Second Language Learning
Disability
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Down Syndrome
 Why
does a child with Down syndrome
often seem less intelligible at 12 years
than he did at 5 years?
Research Studies
 Miller,
J. (1988). The psychobiology of
Down syndrome. Cambridge, MA: MIT
Press.
 Miller,
J. (1999). Profiles of language
development in children with Down
syndrome. Baltimore, MD: Paul Brookes
Publishing.
Hemispherectomy

Stark, R., Bleile, K., Brandt, J.,
Freeman, J., & Vining, E. (1995). Speechlanguage outcomes of hemispherectomy
in children and young adults. Brain and
Language, 51, 406–421.
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A Question
 Why
is speech such an early acquisition?
A Possible Answer…
Brain Development
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Broca’s Area
 Density
of cell connections in Broca’s Area
does not peak until 15 months, and does
not reach a mature number of connections
until 6 to 8 years old.
Age and Grade
 Yes,
but….
 ….
You didn’t answer your own question.
Namely, is there a best age and grade at
which to treat the late eight?
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Best Answers
 Best:
school
Begin treatment before starting
 Next
Best: Begin treatment the second
semester of kindergarten and, if needed,
through 1st and 2nd grade
Worrisome Answers
 Worrisome:
Begin treatment after 8 years
 Very
worrisome: Begin treatment in
middle school
Question Seven
 Is
there a best approach?
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Short Answer
 It
may be the wrong question.
Diversity and Complexity
 Treatment
is more about people factors
than linguistic variables
 People are too diverse and complex to
expect one approach to provide the right
answer for everyone
 People are not so simple that you can fit
into the tenets of any single approach
An Idea
 Is
the approach the variable we should be
focusing on?
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Psychology Literature
 How
much of improvement is due to the
approach and how much is due to the
clinician?
If You believe the Approach is
Primary…
 You
ask how best to teach a clinician to
understand and execute the approach.
 The
research literature suggests this is the
dominate perspective in the profession
If You Believe the Clinician is
Primary…
 You
ask what resources does a clinician
need to deliver the best clinical services,
including:
 Continuing education?
 Size of case load?
 Support staff?
 Treatment options?
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Approaches and Judgment
 Adherence
to an approach and clinical
judgment are not in opposition
 Approaches are clinical tools and some
tools appear more useful than others
Value of Approaches
A
value of an approach –especially if it is
published-- is that it has a basis in
research and careful description makes
the results replicable
 It can be easy to carry out because you
do the same thing each time, with each
student
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Over Dependence
 The
danger sometimes is not that a
clinician fails to master the thoughts
embodied in an approach; the danger
sometimes is that the thoughts embodied
in an approach master the thoughts of the
clinician.
Example:
Articulation and Phonology
Articulation or phonology are not be the
only theoretical bases of treatment.
 Though the dichotomy between
articulation and phonology has dominated
past and present treatment approaches,
they are not necessary ways to address
speech sound disorders.
 In fact, they can be blinders, blocking
newer perspectives.
An Explanation
 Factors
related to the clinician seem to be
the major reason people improve through
treatment
 Possible explanation is that a clinician
adapts and adjusts in a way that an
approach cannot
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An Analogy
 Electronic
teachers of infants
Art and Science
 The
clinical enterprise
Return
 Returning
approach?
to the question… is there a best
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A Perspective
 Because
the clinician is the most
important factor in clinical success, the
best approach:
● May be somewhat different for each
clinician, and
● May be somewhat different for each
person receiving treatment from the
same clinician
Principles
 Principles
to promote treatment success
within a variety of successful approaches:
● Let the curriculum play a central role in
selection of activities
● Remember that speech involves both
knowing (phonology) and doing
(articulation)
Principles
● Speech practice should engage the
mind as it practices the mouth
● Include focus activities throughout the
course of treatment
● Begin treatment as young as possible
rather than after the fact
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Principles
● To encourage success, most often select
treatment sounds a student is capable
of producing under restricted conditions
● Because a high level of success is not
always possible, use techniques such as
phonetic placement and shaping to help
establish a sound in a student’s speech
Thank You!
[email protected]
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