Success with Speech Sound
Disorders
Finding the Best Fit for English and Spanish Speakers
ASHA Convention
November 16th, 2012
5:30-6:30 PM Rm : B407
Scott Prath
Ellen Kester
Financial Disclosure: The authors of this course do not have financial or
non-financial relationships to disclose.
Defining Speech Sound
Disorders(SSD)
Speech Sound
Disorders
Phonology
Definition
Articulation
Example
1.
Delayed
Phonological
2.
Consistent
Deviant
3.
Inconsistent
Deviant
4.
Articulation
Disorder
5.
Structural
Anomaly
(other)
Therapy
Defining Intelligibility
Sounds
Produced
Physical
Limitations
Intelligible
Second
Language
Influence
Speech
vs.
 Articulation
 Phonology
?
?
?
?
Language
• Receptive
• Expressive
• Syntax
• Pragmatics
• Morphology
• Semantics
Defining Speech Sound
Disorders(SSD)
Seven Subtypes of SSD
•
•
•
•
•
•
Genetic
Otitis Media
Apraxia
Dysarthria
Psychosocial Involvement
2 groups based on errors
(Shriberg)
Advantage:
Provides diagnostic markers to
categorize child
Disadvantage:
Does not differentiate between
articulation and phonology
Speech Sound
Disorders
Phonology
1.
Delayed
Phonological
2.
Consistent
Deviant
Articulation
3.
Inconsistent
Deviant
4.
Articulation
Disorder
5.
Structural
Anomaly
(Misc.)
Dodd, 1995
Defining Speech Sound
Disorders(SSD)
3. Inconsistent
Deviant
4. Articulation
Disorder
5.
Structural
Anomaly
13%
9%
21%
2.
Consistent
Deviant
Broomfield and
Dodd, 2004
57%
1. Delayed
Phonological
1.
Delayed
Phonological
Delayed Phonological Skills
• Definition:
▫ Phonological system similar to younger, typically
developing children. Most phonemes can be
articulated; however, discrepancy exists between
phonological processes observed and child’s
chronological age.
• What we see:
▫ Multiple misarticulations
▫ Errors can be classified by patterns
▫ See typical patterns that persist (e.g., stopping,
cluster reduction, liquid simplification)
1.
Delayed
Phonological
Delayed Phonological Skills
Video removed
1.
Delayed
Phonological
Delayed Phonological Skills
• Pattern-based approaches
▫ Distinctive Feature approach
▫ Phonologically-based intervention
 Cycles
 Phonological contrast therapy (Crosbie et al., 2005)
 e.g., minimal pairs, maximal oppositions, empty set, multiple
oppositions
• Example:
Phonological Contrast
Target: Stopping
▫ sun—bun
shin—pin
shoe—two
1.
Delayed
Phonological
Delayed Phonological Skills
2.
Consistent
Deviant
Consistent Deviant
Phonological Disorder
• Definition:
▫ Systemic use of deviant phonological rules (i.e.,
error patterns that are atypical of normal
phonological development).
▫ e.g., deleting all syllable-initial consonants
• What we see:
▫ Less intelligible
▫ Sound production may be age appropriate
(Difficulty producing sounds in certain contexts)
Delayed or Deviant Phonological
Patterns?
1.
Delayed
Phonological
Typical
Phonological
Patterns
•Cluster Reduction
•Liquid Simplification
•Stopping
•Velar Fronting
•Weak Syllable Deletion
•Assimilation
•Final Consonant Deletion
•Palatal Fronting
2.
Consistent
Deviant
Atypical
Phonological
Patterns
•Deaffrication
•Initial Consonant Deletion
•Backing
•Spirantization
•Denasalization
•Addition
•Palatalization
•Metathesis
•Lisping
•Nasalization
•Spirant Deletion
Goldstein and Iglesias,
2006 from CPAC-S
2.
Consistent
Deviant
Consistent Deviant
Phonological Disorder
2.
Consistent
Deviant
Consistent Deviant Phonological
Disorder
• Phonologically-Based Intervention
• Phonological Awareness
• Example:
Hodson’s Cycles Approach
Week 1: Weak syllable deletion
ma-ri-po-sa, ca-ba-llo
Week 2: Initial consonant deletion
pato, mano, bote
Week 3: Stopping (a more typical pattern)
foto, sopa
Approach includes metaphonological awareness and
auditory bombardment of sounds
2.
Consistent
Deviant
Consistent Deviant Phonological
Disorder
3.
Inconsistent
Deviant
Inconsistent Deviant
Phonological Disorder
• Definition:
▫ Variable productions of the same words or
phonological features in the same contexts and across
contexts.
• Examples:
▫ Say “butterfly”
 “Chutterdy”
▫ Again, say “butterfly”
 “sunnerny”
3.
Inconsistent
Deviant
Inconsistent Deviant
Phonological Disorder
Wait!
That sounds like apraxia!
• Both characterized by inconsistency
• Those with childhood apraxia of speech (CAS):
▫ Worse in imitation than in spontaneous production
▫ Differ in cues effective to elicit production of words
▫ Have oral-motor difficulties (e.g., groping)
3.
Inconsistent
Deviant
Inconsistent Deviant
Phonological Disorder
Goal of intervention is CONSISTENCY at the
single word level.
Example: Core Vocabulary Approach
• List of 50 target words chosen for child
• 10 words targeted during the week
• Consistent words then removed from list, and
new set of 10 words chosen randomly for
practice
• Generalization monitored through periodic
probe of untreated words
3.
Inconsistent
Deviant
Inconsistent Deviant
Phonological Disorder
• Core vocabulary approach
• This therapy approach resulted in greater
change in children with inconsistent speech
disorder compared to more traditional
approaches (Crosbie et al., 2005)
Pre
Post
3.
Inconsistent
Deviant
Inconsistent Deviant
Phonological Disorder
3.
Inconsistent
Deviant
Inconsistent Deviant
Phonological Disorder
4.
Articulation
Disorder
Articulation Disorder
• Definition:
▫ An inability to produce a perceptually acceptable
version of particular phonemes, either in isolation
or in any phonetic context.
• What we see:
▫ “/r/, /s/, and /l/ kids”—errors with a particular
sound
▫ Can be highly intelligible
4.
Articulation
Disorder
Articulation Disorder
Video removed
4.
Articulation
Disorder
Articulation Disorder
• “Traditional Artic”/motor-based approaches
▫ Teach motor behaviors associated with the
production of a particular speech sound
 Van Riper approach
 McDonald’s sensory-motor approach (use of
facilitative contexts)
 Multiple Phoneme approach
4.
Articulation
Disorder
Articulation Disorder
5.
Structural
Anomaly
Structural Anomalies
• Definition:
▫ Low intelligibility that is the result of or
compromised by atypical physical development
• Examples:
▫ Deaf Speech
▫ Cleft Lip and Palate
▫ Velo-Pharyngeal Insufficiency
VPI Pyramid
5.
Structural
Anomaly
Structural Anomalies
Video removed
5.
Structural
Anomaly
Structural Anomalies
Communication goals/ Outcomes for Structural
Anomalies
• Increase Vowel Repertoire
• Increase Consonant Inventories
• Increase Vocabulary
• Increase Oral Airflow
• Decrease use of Nasal and Glottal
Sounds
5.
Structural
Anomaly
Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation (a)
▫ In strings (a,a,a,a)
▫ In opposition (u-I, u-I a-o, a-o)
5.
Structural
Anomaly
Increase Vowel Repertoire
Video removed
5.
Structural
Anomaly
Increase Consonant Inventories
BEFORE palate repair
LOW pressure words to target
•
•
•
•
•
•
•
•
•
•
Hi
Hello
Hey
Mommy
More
Me
No
Whoa
Wow
Honey
•
•
•
•
•
•
•
•
•
Mamá
No
Mío
Niña
Niño
Ojos
En
Mano
Wawa – agua
5.
Structural
Anomaly
Increase Consonant Inventories
AFTER palate repair
HIGH pressure words to target
•
•
•
•
•
•
•
•
•
•
Baby
Boy
Pop
Pooh
Pie
Toy
Doll
Daddy
Cookie
Go
•
•
•
•
•
•
•
•
•
Papá
Bebé
Boca
Gato
Todo
Tú
Tío
Qué
Ten
5.
Structural
Anomaly
Increase Consonant Inventories
Video removed
5.
Structural
Anomaly
Increase Vocabulary
• Focus on language to give her a way to practice her
sounds
• Vocabulary development should be targeted with
sound development
▫ Choose words that:
 Are common and in their environment
 Are useful
 Are extremely fun
(read: routines-based intervention)
• Syllable should be simple CV (consonant/vowel)
• Start with stops and bilabial sounds
5.
Structural
Anomaly
Increase Vocabulary
Video removed
5.
Structural
Anomaly
Increase Oral Airflow
• A child with a cleft does not have control over the
air leaving their throat
• In typical development we stop or slowly release
this air to produce speech
• Regardless of what surgeries a child has
undergone, we need to familiarize the child with
airflow through the mouth
• Request an easy repetition (muh,muh,muh)
▫ After the child starts repeating, plug his nose
• Inhale deeply, hold your breath, and explode out
with a single sound
▫ BUH!, PUH!
5.
Structural
Anomaly
Increase Oral Airflow
Video removed
5.
Structural
Anomaly
Decrease Use of Nasal and
Glottal Sounds
• Growls and nasal sounds are typical for young infants
but children with clefts obtain these sounds later
• Parents, wanting communication, reinforce these
sounds
• Acknowledge the child’s attempt but then request
other consonants or sounds
• Pair voiceless consonants with whispered vowels
puh/tuh/ku/huh
• This keeps the glottis open and prevents the glottal
stop from occurring
Speech Sound
Disorder Tree
1. Identify which group
does the child fit
into?
Definition and
Treatment
Chart
2. Describe the
Disorder
3. Identify a course
of treatment
4. Discuss goals
that we can
focus on
Case Studies
Case Study #1
Case Study #1
• Speech sample
Production
Una
Target
Process
Luna
Initial Consonant
Deletion
Cluster reduction
Metathesis
Cluster Reduction /
Palatalization
Saltano asi alli
El nina
Domiyo
Saltando asi alli
El niño
Durmido
Mamisa
Sushasa
Camisa
Cuchara
Metathesis
?
Case Study #1
2. Describe the
Disorder
3. Identify a course
of treatment
4. Discuss goals
that we can
focus on
Case Study #2
Case Study #2
2. Describe the
Disorder
3. Identify a course
of treatment
4. Discuss goals
that we can
focus on
Case Study #3
Video removed
Case Study #3
2. Describe the
Disorder
3. Identify a course
of treatment
4. Discuss goals
that we can
focus on
Thank
you!
References
• Broomfield, J. and Dodd, B. (2004). The nature of referred subtypes
of primary speech disability. Child Language Teaching and
Therapy, 20(2), 135-151.
• Crosbie, S., Holm, A. and Dodd, B. 2005: Intervention for children
with severe speech disorder: A comparison of two approaches.
International Journal of Language and Communication Disorders
40(4), 467-91.
• Dodd, B. (1995). Differential diagnosis & treatment of children with
speech disorder. London: Whurr Publishers Ltd.
• Dodd, B. and Bradford, A. (2000). A comparison of three therapy
method for children with different types of developmental
phonological disorders. International Journal of Language and
Communication Disorders, 35, 189-209.
• Fabiano, L., & Goldstein, B. (2005). Phonological cross-linguistic
influence in sequential Spanish-English bilingual children. Journal
of Multilingual Communication Disorders, 3, 56-63.
References
• Gierut, J., Morrisette, M., Hughes, M. and Rowland, S. (1996).
Phonological treatment efficacy and developmental norms.
Language, Speech and Hearing Services in Schools, 27, 215-230.
• Goldstein, B. (2005). Substitutions in the phonology of Spanishspeaking children. Journal of Multilingual Communication
Disorders, 3, 56-63.
• Goldstein, B. (2007a). Spanish speech acquisition. In S. McLeod
(Ed.), The international guide to speech acquisition (pp. 539-553).
Clifton Park, NY: Thomson Delmar Learning.
• Goldstein, B. (2007b). Speech acquisition across the world:
Spanish Influenced English. In S. McLeod (Ed.), The international
guide to speech acquisition (pp. 345-356). Clifton Park, NY:
Thomson Delmar Learning.
References
• Goldstein, B. (2007c). Phonological skills in Puerto Rican- and
Mexican-Spanish speaking children with phonological disorders.
Clinical Linguistics and Phonetics, 21, 93-109.
• Goldstein, B., Fabiano, L., & Washington, P. (2005). Phonological
skills in predominantly English, predominantly Spanish, and
Spanish-English bilingual children. Language, Speech, and
Hearing Services in Schools, 36, 201-218.
• Holm, A. and Dodd, B. (1999). Identification and differential
diagnosis of phonological disorder in bilingual children. Language
Testing, 16(3), 271-292.
• Lewis, B., Freebairn, L., & Taylor, H. (2002). Correlates of spelling
abilities in children with early speech sound disorders. Reading
and Writing: An Interdisciplinary Journal, 15, 389–407.
References
• McIntosh, B. and Dodd, B. (2008). Evaluation of core vocabulary
intervention for treatment of inconsistent phonological disorder:
three treatment case studies. Child Language Teaching and
Therapy, 25(1), 09-30.
• Rvachew, S. and Nowak, M. (2001). The effect of target selection in
phonological learning. Journal of Speech, Language and Hearing
Research, 44, 610-623.
• Shriberg, L., & Kwiatkowski, J. (1994). Developmental
phonological disorders I: A clinical profile. Journal of Speech and
Hearing Research, 37, 1100–1126.
• Shriberg, L., & Austin, D. (1998). Comorbidity of speech-language
disorder: Implications for a phenotype marker for speech delay. In
R. Paul (Ed.), Exploring the speech/language connection (pp. 73–
118). Baltimore: Brookes.
Cleft Palate Resources
•
•
•
•
•
•
www.cleft.com
1-800-24CLEFT
www.operationsmile.org
www.widesmiles.org
The story of Lippy the Lion
The story of Thumper, the Cleft Affected
Bunny
• www.bilinguistics.com
Differentiated Treatment
Research considering the subgroups of speech disorders
found that children respond differently to therapy
approaches that target different aspects of the speechprocessing chain.
(Alcorn et al., 1995, Holm et al., 1997, Dodd and Bradford 2000)
One treatment model or structure may not fit all children
or may not fit a child throughout the course of
intervention.
Differentiated Treatment
Interventions must consider:
Target selection
Early vs. later developing sounds
Stimulability
Error consistency
Approach/Methods
Implementation structure