SPA 127 - Developmental Speech Disorders

What is a phoneme?

• Smallest unit in language that conveys meaning

• Minimal pair contrasts

  • Cat vs. bat

Where do phonemes occur in words/syllables?

• Syllables - CV, VC, CVC,… others?

• Consonants - initial, medial, final positions; in clusters

Phonology

Knowledge of the language conventions or rules for combining sounds

Articulation

The motor skills involved in producing sounds in sequence

Typical Speech Development

• May substitute difficult sounds with easier ones until they are mastered

  • E.g., a 5 year-old who says wabbit instead of rabbit

• May use phonological processes to simplify words

Developmental Speech Sound Disorder

• Errors in production of speech sounds beyond the expected age of mastery

• Classified as:

  • Articulation disorders

  • Phonological disorders

Articulation Disorder

• Incorrect production of sounds beyond expected age of mastery

• Can result from impairment with the following:

  • Breath support

  • Lips

  • Jaw

  • Tongue

  • Teeth

  • Or, coordinating of all of these together

Articulation Errors

Primary Types of Articulation Errors: SODA

1. Substitution (S): Replacement of one standard speech sound for another

   1. Ex. “wabbit” for “rabbit”

2. Omission (O): Omitting or leaving out a speech sound

   1. Ex. “cah” or “car”

3. Distortions (D): Non-standard production of speech sound

   1. Ex. /s/ produced with a lisp

4. Additions (A): Adding a speech sound

   1. Ex. “shoove” for “shoe”

Phonological Disorder

• Incorrect production of sound patterns beyond expected age of mastery

• Different from articulation disorder

  • May be able to accurately produce all of the speech sounds that are appropriate for their age in isolation

• Difficulty acquiring the phonological system of their language

  • Cannot organize the rule-based patterns that govern phonology

Cluster Reduction

• Gone by 4 yrs. without /s/

• Gone by 5 yrs. with /s/

• Ex. “pane” for “plane”

Final Consonant Deletion

• Gone by 3 yrs

• Ex. “toe” for “toad”

Weak Syllable Deletion

• Gone by 4 yrs

• Ex. “nana” for “banana”

Epenthesis

• Gone by 8 yrs

• Ex. “bu-lue” for “blue”

Severity

• Classified as mild, moderate, or severe

• Related to:

  • Number of sounds produced correctly

  • Ability to produce sounds in different positions (initial, medial, final)

  • Ability to produce various types of word forms (CCVC, CVCV, etc.)

• Closely linked to intelligibility of speech

  • Ex. Can you understand what the child is saying?

Mild

• Produce a few sounds in error

  • Usually involves a few of the “late 8” sounds

  • Generally intelligible to most speakers

Moderate

• Difficulty producing all the sounds within a single class (e.g., all velars, all fricatives)

• Intelligible to friends and family members, but not to unfamiliar listeners

Severe

• More than six sounds in error in all positions of words

• Do not sequence sounds consistently

• Unintelligible to most listeners

Bilingualism and Dialect

• Substitutions or errors may be due to phoneme differences in two or more languages

  • Differences in sound production, based on phonological inventory

    • NOT a speech sound disorder

Etiology of Speech Sound Disorders

• Functional Etiology

  • Cause can not be determined

  • Behavioral description takes place over search for cause

• Perceptual Etiology

  • Hearing impairments - otitis media, sensorineural loss

• Structural Etiology

  • Cleft lip and palate

• Motor Etiology

  • Dysarthria - neuromuscular impairment

  • Apraxia - neurological impairment

Assessment

• Goal: determine nature and severity of disorder/delay

• Describe production and compare speech patterns to others the same age

  • Speech Samples

  • Articulation Tests

  • Note presence of behaviors (gestures, pointing, visual gaze, etc.")

• Assess contributing factors

  • Hearing

  • Physical characteristics (strength and range of motion of articulators, etc.)

Order of Assessment

• Case history

• Hearing screening

• Oral peripheral examination/oral mechanism evaluation: “oral mech”

  • Exam structures (size, appearance, symmetry)

  • Exam functions (range of movement, rate of movement, strength, coordination)

• Standardized articulation test

  • Developed using a large sample of participants

  • Norm-referenced

    • Comparison to group to which child belongs

      • E.g., age-matched peers

  • Typically provides:

    • Standard score

    • Age-equivalence

    • Percentile rank

Commonly Used Articulation Tests

• Photo-Articulation Test

  • Norm-referenced: standard scores, percentiles and age equivalents

• Goldman-Fristoe Test of Articulation

  • Norm-reference; standard scores, percentiles, and age equivalents

Goldman-Fristoe Test of Articulation

• Test is administered using standard procedures

  • Follow written prompts

    • Elicited productions rather than imitation

  • Sounds-in-Words

  • Sounds-in-Sentences

  • Stimulability

Intelligibility

• Spontaneous speech sample (with at least 50-100 word utterance)

• Percentage of intelligible words

Mild

90%

Mild - Mod

65-85%

Mod - Severe

50-65%

Severe

Less than 50%

Contrast Therapy

Clients label pictures representing word pairs that differ by only one sound

• That sound only differs by one dimension (place, manner, or voicing)

Language Delay

• Delays in the development of language comprehension and/or production

• Usually temporary

Language Impairment

Significant and persistent difficulties in language comprehension and/or production that interfere with the ability to participate in and learn from everyday interaction with others

Impairments of Language Form for Infants/toddlers (0-2 yrs)

• Limited vocalization

• Restricted syllable productions during babbling

• Between 1-2 years of age: May not combine words or limited use of word combinations

Impairments of Language Form for Preschoolers (2-5 yrs)

• Delayed or disordered phonology

• Limited use of grammatical morphemes such as tense markers (e.g., walk, walked) copula forms (is, am, are)

• Produce a limited variety of sentence structures

• Difficulty comprehending complex sentences

• Have more grammatical errors than typically developing children of their same age

Impairments of Language Form for School-Age (5-18 yrs)

• Use fewer complex sentences and smaller variety of complex sentences

• Conversational speech may be noticeable ungrammatical (more than 20% in a 100 utterance sample)

• Phonological awareness may be impaired

Impairments of Language Content for Infants/toddlers (0-2 yrs)

• Understands few words in context

• Less than 50 words by age 2

Impairments of Language Content for Preschoolers (2-5 yrs)

• Restricted vocabulary size

• Reduced comprehension and production of basic concepts (temporal terms, spatial terms, kinship terms, color terms)

Impairments of Language Content for School-Age (5-18 yrs)

• Difficulty understanding and using complex terms commonly encountered in science, social studies, and other curricular contexts

Impairments of Language Use for Infants/toddlers (0-2 yrs)

• Lack of communication initiation

• Restricted range of communicative functions

Impairments of Language Use for Preschoolers (2-5 yrs)

• Restricted social initiations (e.g., making request, inform)

• Limited responsiveness (e.g., response to requests, take actions)

• Often interrupt conversations

• Conversational topics limited

Impairments of Language Use for School-Age (5-18 yrs)

• Difficulty understanding and generating coherent narratives

• Difficulty understanding and producing inferences

• Difficulty with expository texts

Primary Language Impairment

Significant impairment in language when there is no other disability

• Development language disorder (also known as specific language impairment)

Secondary Language Impairment

Language impairment that accompanies other disabilities

Developmental Language Disorder (DLD)

• Significant receptive and/or expressive language impairment

• Impairment cannot be attributed to any specific cause/condition (of unknown origin)

  • Have hearing within normal limits

  • Normal oral structure and function

  • No neurological disorder

  • Non-verbal intelligence is within normal limits

DLD Language Characteristics

• Significant late appearance of the first true word (18 months or later)

• Significant late use of two-word combinations (30 months or later)

• Restricted receptive and expressive vocabulary

• Reliances on gestures for getting needs met

• Difficulties with morphological inflections (e.g., past tense -ed, prepositions, articles)

• Difficulty with interactions with peers

Autism Spectrum Disorder

• Multi-casual neurodevelopment disorder

• Former names include: Autistic disorder, Asperger syndrome

• Related disorders: Childhood disintegrative disorder and pervasive developmental disorder-not otherwise specified (PDD-NOS)

• Prevalence: 1 in 36 children and 1 in 45 adults (US)

• More prevalent among boys (1:4), but…

• Diagnosis as early as 18 months

ASD Restricted and Repetitive Patterns of Behavior, Interests, or Activities

• Echophenomena (echolalia, palilalia, scripting)

• Topic perseveration

• Idiosyncratic phrases

• Ritualized patterns of verbal and/or non-verbal behavior (e.g., repetitive stimming)

• Difficulties with transitions, including conversational transitions

ASD Persistent Difficulties in Social Communication and Social Interaction Across Multiple Contexts:

• Failure to initiate/respond in social interaction

• Atypical conversational approach

• Poorly integrated verbal/non-verbal behavior

• Voice inflection

• Difficulties making adjustments in register

BUT, emerging research shows that these difficulties may not be present when two autistic folks are speaking with each other (the double empathy problem)

ASD Other Linguistic Features:

• Non-verbality (25-50% of those with ASD)

• Atypical pronoun usage

• Unusual word choices (e.g., happy-sad for melancholic)

Intellectual Disabilities (ID)

• Significant limitation in intellectual functioning (learning, reasoning, problem solving)

  • IQ is below 70

• Significant limitation in adaptive behavior

What are adaptive behaviors?

• Conceptual skills

• Social skills

• Practical skills

Causes of ID

• Biological Causes

  • Genetic and chromosomal abnormalities (e.g., Down Syndrome)

  • Pre-natal causes (e.g., alcohol use)

  • Perinatal causes (e.g., complications during delivery)

  • Post-natal causes (e.g., bacterial meningitis)

• Socioenvironmental Causes

  • Inadequate diet

  • Impoverished environment

General Language Characteristics in ID

• Often have both receptive and expressive language impairments

• Receptive Language

  • Difficulty understanding long sentences

  • Understand concrete information better than abstract information

• Expressive Language

  • Typically more impaired than receptive language

  • Speech intelligibility often impaired

  • Limited vocabulary

  • Depending on level of intellectual disability, may communicate using single words or simple sentence structure

ID Mild

• 85% of ID population

• Can generally learn reading, writing, and math skills between third- and sixth-grade levels. May have jobs and live independently

ID Moderate

• 10% of ID population

• May be able to learn some basic reading and writing. Also to learn functional skills such as safety and self-help. Require some type of oversight/supervision

ID Severe

• 5% of ID population

• Probably not able to read or write, although they may learn self-help skills and routines. Requite supervision in their daily activities and living environment

ID Profound

• 1% of ID population

• Require intensive support. May be able to communicate by verbal or other means. May have medical conditions that require ongoing nursing and therapy

Learning Disabilities or “Specific Learning Disability”

• Learning Disability (LD) is a heterogeneous group of disorders

• More frequent in families with a history of LD

• May involve a CNS dysfunction

Common Types of Learning Disability

• Dyslexia

• Dyscalculia

• Dysgraphia

• Processing disorders

• Nonverbal learning disability

Language Characteristics

• Deducing language rules is difficult

• Delay in acquisition of morphological rules and syntax

• Word finding problems may be present

• 80% have difficulty with reading

Assessment of Developmental Language

• Team approach

• Case history

• Standardized testing

  • Norm-referenced tests:

    • Norms enable examiners to compare a child’s performance to that of others children of the same age

  • Criterion-referenced tests:

    • Will help determine if whether a child is performing to a certain standard

• Language samples

  • Transcript and analysis

• Best attempt at non-biased assessment

  • Multicultural considerations

Intervention

• Clinician-centered approaches

  • Behavioral principles (stimulus, response, reward)

  • Structured activities

• Child-centered approaches

  • Language stimulation through play

• Hybrid approaches

Language Stimulation

• Self-talk

  • Child centered

  • Clinicians talk about what they themselves are doing, seeing, and feeling as they play with children in an unstructured setting. This technique is especially appropriate for children whose language is emerging

• Parallel talk

  • Child-centered

  • Clinicians talk about what children are doing or looking at as they play is an unstructured setting. Again, this technique is appropriate with children who are beginning to use language to communicate

• Expansion

  • Child-centered

  • Clinicians repeat the child’s utterance, adding grammatical or semantic information to make it complete. For example, the child may say “Daddy peeling orange,” and the clinician then says, “Daddy is peeling an orange”

School Based Intervention

• Literacy-based intervention

  • Pre-reading discussions, multiple readings of the books, reinforcing concepts

  • Mini lessons focusing on semantics, syntax, morphology, narration and phonological awareness

• Classroom collaboration

  • SLPs and teachers work together (co-teaching approach)

    • 1 teaches, 1 observes

    • 1 teaches, 1 assists

    • Parallel teaching

    • Station teaching

    • Alternative teaching

    • Team teaching

Service Delivery Models

• Pull-out model (traditional model)

  • Involves students leaving the classroom to receive speech-language services in a separate classroom or conference room

  • Services are delivered one-on-one or in small groups

• Push-in model

  • Classroom-based services model involves the SLP entering and delivering services in the classroom

  • Instruction focuses on the child’s IEP goals but often overlaps with classroom instruction as well

  • SLP may work supportively with just one child, or they may provide instruction to the entire classroom

  • Involves careful coordination with classroom teachers

Fluent Speech

• Ability to move the speech production apparatus in an effortless, smooth, and rapid manner

• Results in a continuous, uninterrupted forward flow of speech

Typical Disfluencies

• Children are not born as fluent speakers

• Fluency requires physical maturation and language experiences

• Children exhibit disfluencies in their utterance

Typical Disfluencies for Age 2

• Whole word repetitions

• Interjections

• Syllable repetitions

Typical Disfluencies for Age 3

• Revisions

• Disfluencies persist throughout life

• May repeat whole multisyllabic words, interject a word or phase, repeat phrases, or revise sentences

Stuttering

• Incidence

  • Estimates vary; approximately 5% of people will stutter during some part of their lives

• Age of Onset

  • 90% between 2 to 7 years; 10% after 7 years

• Male-Female Ratio

  • More in boys than in girls

  • 3-4 males to every 1 female who stutters

• Family History

  • 50% have a relative who stuttered

Stuttering Characteristics

• Audible Overt Behaviors (Primary characteristics)

  • Repetition, prolongation, blocks

• Visible Overt Behavior (Secondary characteristics)

Audible Overt Behaviors

• Part-word or sound/syllable repetition

  • Sound or syllable repetition at the beginnings of words

• Monosyllabic whole-word repetition

  • Repetition of entire word

• Prolongations of sounds and syllables

  • Inappropriate lengthening of sounds and syllables

• Blocks

  • Articulators in place but no sound is produced for 1-2 sec

• Clustered Disfluencies

  • More than one type of dysfluency

Visible Overt Behavior (Secondary Characteristics)

• Examples:

  • Blinking the eyes rapidly

  • Furrowing the forehead

  • Tensing facial muscles

  • Jerking the head

  • Shoulder/arm movements

  • Clenching fist

Developmental Stuttering

• Resolves in 60-80% of children who stutter

• Chronic stuttering: when individuals stutter into adolescence and adulthood

  • Individuals may feel frustrated and embarrassed by their stuttering

  • Avoid certain words, speaking situations

  • Difficulties with speech motor control

    • Unusual breathing patterns

    • Overly tense musculature

Effects of Stuttering

• Children may withdraw/refuse to speak

• Adults may seek professions that requite little oral communication

• Employers may view individuals with stuttering negatively (e.g., as highly anxious/nervous)

• Impacts social interaction and quality of life

Etiology of Stuttering

• Unclear

• Genetic influences

  • Family history of stuttering commonly noted

  • Stuttering is more common in identical twins

• Imbalance between environmental demand and capacity for fluency

  • Stuttering develops when demands to produce fluent speech exceed child’s physical and learned capacities

Stuttering Evaluation

• Case history

• Speech Language Assessment (when testing children)

• Obtain speech sample to estimate:

  • Total number of disfluencies

  • Average number of each type of disfluency

    • Repetitions

    • Prolongations

    • Blocks

  • Length of disfluency

  • Type and frequency of Visible Overt Behavior (Secondary Characteristics)

Stuttering Therapy: Intervention: Older Children and Adults

• Fluency Enhancing Procedures: fluent speech to replace stuttering

• Stuttering Modification Procedure: change or modify stuttering so that it is relaxed and easy