SHS 170 Exam 3: Chs. 5, 12, 13, 10
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What other conditions might coexist with an SSD?
Developmental and genetic conditions: Autism spectrum disorder (developmental), Down syndrome (genetic), Intellectual disability. Hearing impairments: Hearing loss, Recurrent ear infections (which can cause temporary hearing loss). Neurological disorders: Cerebral palsy, Apraxia of speech, and Other neurological disorders affecting the nerves involved in speech. Physical and structural issues: Cleft lip and/or palate, Other physical anomalies of the mouth, Orofacial myofunctional disorders (affecting the muscles of the face, mouth, and tongue), Issues from habits like chronic thumb-sucking or pacifier use. Other co-occurring conditions: Learning disabilities, Literacy disorders, Attention deficit disorders (ADD/ADHD). The overall prevalence of SSDs is about 8-9%.
What are the basic steps in the assessment process for SSDs?
The 1st step in the assessment process is to conduct a screening of the individual's speech and language system. Informal measures may include asking the individual to participate in a conversation, read a passage or story, or repeat words or sentences that are organized in lists based on sounds of interest. Interpretation of the results of the informal speech screening is made by the SLP and is based on years of training and experience. If the SLP decides that the individual's speech sound system is different enough, then formal screening measures are usually administered. Formal screening measures usually involve published instruments that include normative data and cut-off scores so the SLP can compare scores obtained by the individual to other children. Examples of formal screening measures include a diagnostic screening instrument that is part of a formal assessment called The Fluharty Preschool Speech and Language Screening Test 2nd Edition (Fluharty, 2001). Individuals are asked to produce selected speech sounds in isolation, in response to pictures, and/or to repeat sentences consisting of words containing specific sounds of interest. Scores are calculated and compared to standard scores and/or percentile ranks, which are then used to make a decision about whether further testing is needed. If the SLP determines that the formal screening results indicate the presence of a potential speech sound disorder, a comprehensive diagnostic assessment is undertaken.
What are the two major approaches to treatment for SSDs?
(1) Independent analyses and (2) relational analyses.
What are some basic ways in which speech sounds are characterized?
Consonants are sounds produced with a partial or complete obstruction of the vocal tract, which blocks or constricts the flow of air.
Vowels are sounds made with a relatively open vocal tract, with no significant blockage of airflow. They form the nucleus of a syllable and are typically voiced.
Classification of consonants: Consonants are described using three main articulatory criteria:
Place of articulation: Where in the vocal tract the obstruction is made. Examples include:
Bilabial: Using both lips (e.g., /p/, /b/, /m/).
Labiodental: The lower lip and upper teeth (e.g., /f/, /v/).
Dental: The tongue tip or blade and the upper teeth (e.g., /θ/ in "thin", /ð/ in "this").
Alveolar: The tongue tip or blade and the alveolar ridge, the bony ridge behind the teeth (e.g., /t/, /d/, /s/, /z/).
Velar: The back of the tongue and the soft palate (e.g., /k/, /g/, /ŋ/ in "sing").
Manner of articulation: How the airflow is obstructed. Examples include:
Stops (or plosives): Complete closure of the vocal tract, followed by a burst of air (e.g., /p/, /t/, /k/).
Fricatives: Air is forced through a narrow channel, creating a turbulent, hissing sound (e.g., /f/, /s/).
Affricates: A combination of a stop followed by a fricative release (e.g., /tʃ/ in "church").
Nasals: The air is completely blocked in the mouth but flows freely through the nasal cavity (e.g., /m/, /n/).
Approximants: A slight constriction is formed, but not enough to cause turbulence, so the sound is vowel-like (e.g., /w/, /j/).
Voicing: Whether the vocal folds vibrate during the production of the sound.
Voiced: The vocal cords vibrate (e.g., /b/, /d/, /g/).
Voiceless: The vocal cords do not vibrate (e.g., /p/, /t/, /k/).
Classification of vowels: Vowels are classified primarily by the position of the tongue and the shape of the lips.
Tongue height: How high or low the tongue is in the mouth.
High (or close): Tongue is high, near the roof of the mouth (e.g., /i/ in "beat").
Mid: Tongue is in a mid-range position (e.g., /ɛ/ in "bet").
Low (or open): Tongue is low in the mouth (e.g., /æ/ in "bat").
Tongue backness: How far forward or back the tongue is.
Front: Tongue is in the front of the mouth (e.g., /i/ in "beet").
Central: Tongue is in a central position (e.g., /ə/ in "about").
Back: Tongue is in the back of the mouth (e.g., /u/ in "boot").
Lip rounding: Whether the lips are rounded or spread.
Rounded: Lips are rounded (e.g., /u/ in "boot").
Unrounded (or spread): Lips are spread (e.g., /i/ in "beat").
Diphthongs: Some vowels are not static and involve a glide from one vowel position to another (e.g., the sound /aɪ/ in "bite").
Can you list some ways in which SLPs might gather information about a child's speech sound system as part of a comprehensive evaluation?
A comprehensive speech sound assessment involves collecting a speech sample, administering one or more formal standardized speech sound assessments, and giving any supplemental tests needed for decision-making, intervention planning, or referral for additional professional services.
Collecting a speech sample: ask the individual to participate in a conversation, to retell, create, or read a story, recite a rhyme, or describe one or more pictures. The data collected is used to make judgments of intelligibility and severity, to gather information about how speech sounds are used in authentic interactions, and to begin to characterize patterns of errors that are present and the consistency with which errors or patterns are used. The speech sample is generally audio-recorded so the SLP can accurately transcribe it later using IPA conventions to characterize errors or error patterns observed in the individual's connected speech.
The use of published, single-word, standardized tests such as The Diagnostic Evaluation of Articulation and Phonology (DEAP). The majority of these measures require individuals to look at and then state the name of a picture, after which the SLP transcribes their production for later comparison to the adult representation or model of the sound. For example, the individual may be shown a picture of a car and asked, "What is this?" If they say tar, the SLP will transcribe the production using IPA conventions and move on to the next picture. After the test is administered, the results from the speech sample and the single-word assessment are considered together to create an inventory of the speech sounds used according to their accuracy.
Can you list some ways in which SLPs might gather information about a child's speech sound system as part of a comprehensive evaluation?
Articulation tests are used when speech errors are limited to a few sounds and appear to be motoric in nature. For example, upon talking with a 2nd grader, Alex, the SLP may notice that anytime Alex attempts to produce the /s/ sound, as in sun, it is produced as /th/ as in thumb. If these kinds of errors are the only errors Alex produces, an articulation test such as the Goldman-Fristoe Test of Articulation-3 (GFTA-3) may be administered. The assessment is administered individually to those between the ages of 2 and 22. It may be administered in Spanish or English, in person or digitally, and samples sounds in spontaneous and imitative contexts in single words and sentences. Consonant sounds and clusters (eg, st, sk, bl, skr) are examined in words using picture stimuli, but also in sentences. The SLP elicits sentences by telling the individual a story (sentence by sentence with pictures) and then asking them to retell it. After the retelling, the SLP models each sentence (with pictures) and asks the individual to repeat it. The target sounds in words are transcribed onto a scoring sheet the SLP analyzes later.
The Khan-Lewis analysis. This procedure allows the SLP to categorize speech errors according to patterns involving changes in place, manner, and voicing errors using the single-word stimulus items previously administered and transcribed using the GFTA-3.
Specificity (how well the measure identifies typical speech development) and sensitivity (how well the measure identifies a speech sound disorder).
Collect a case history to examine possible causes and potential impacts of the speech sound disorder on the performance of activities of daily living, as well as the acquisition of social, cognitive, and academic skills. The case history is usually obtained first, before informal and formal assessment procedures are begun. Oral-peripheral examination to evaluate the structure and function of peripheral articulators (i.e., tongue, lips, and palate) to determine if any may be contributing to the cause or maintenance of the SSD. In general, the SLP will examine the alignment of the jaws and teeth, the integrity of the hard palate, the structure and function of the velopharyngeal port, and the strength and mobility of the tongue. A hearing screening that involves the presentation of pure tone stimuli in a limited range of frequencies using a portable audiometer to get an initial picture of an individual's hearing status. A failure to perceive sound at 1,000, 2,000, and 4,000 Hz at 20dB HL is generally used for screening purposes; however, any failure at any of these frequency levels would warrant a referral to an Audiologist for further screening.
Can you give some examples of ways in which the SLP might help a child to learn a new sound?
Articulation approaches are phoneme (sound) oriented and based on motor learning principles. Stimulable sounds that the child can imitate or produce in some contexts are trained first. The SLP may create a stimulability probe or use a published instrument to determine whether the child can produce error sounds correctly in word-initial (sun), word medial (Christmas), or word-final (ice) positions in different vowel contexts. Stimulable sounds are taught in a systematic way moving from sounds in isolation (/s/), words (sun, Ice, Christmas), phrases (The sun), sentences (The sun is shining), and structured conversation (SLP: What is happening at your house for your birthday? Child: We are celebrating with some friends and ice cream). Most articulation approaches involve some form of perception training in which children practice discriminating their errors from the correct sounds. Not all sounds are stimulable, however, so the SLP may use motor-based techniques such as phonetic placement or successive approximation to help the child produce the sound accurately. Phonetic placement involves verbal, visual, and tactile instruction about where a child should place the articulators (e.g., place your tongue on the bumpy part behind your teeth, put lips together), or how the sound is produced (e.g., leaky tire sound, buzzing sound). Successive approximation is very similar, but the SLP starts with a sound the child can produce and helps to guide the child toward producing the target sound. For example, a child with difficulty producing/s/may be able to produce /t/. Since /t/ and /s/ are both made at the alveolar ridge and both are voiceless, the SLP needs only to emphasize manner (stop versus fricative) to instruct the child on ways to gradually extend the /t/ sound until it sounds like an /s/. Then a traditional training sequence (practice in isolation, word, phrase, sentence, and conversation) is followed.
Linguistic approaches may initially involve motor-based techniques such as phonetic cueing and successive approximation; however, the goal of these approaches is to establish a child's use of sound contrasts to improve phonological knowledge. The focus of Intervention sessions under linguistic approaches is on learning the rules about how sounds are used and combined in the language and on strategies to reorganize the phonological system. Many of the procedures used in linguistic approaches involve asking the child to contrast error sounds with the adult models to realize that different sounds impact meaning
Which system shapes sounds using both active and passive articulators?
Articulatory system
Which category of speech sound disorders is characterized by inconsistent, slow, prosodically unusual speech reduction?
Childhood apraxia of speech
Which approach to intervention involves contrasting error sounds with the correct productions to highlight semantic confusion?
Linguistic Approaches
What universal symbol system is used to represent sounds and languages using phonetic symbols?
International Phonetic Alphabet (IPA)
Which assessment approach compares an individual's speech sounds to those of adults in their language community?
Cognitive analysis
The Diagnostic Evaluation of Articulation and Phonology
What does the percent consonants correct (PCC) measure?
Severity of speech sound disorders
Which of the following is not a common method for eliciting a speech sample during a comprehensive speech sound assessment?
Counting numbers
True
False
False
A congenital neurological speech disorder with words dominated by simple syllable shapes, vowel errors, and sounds that develop early. A neurological SSD is characterized by impairment in the precision and consistency of movements underlying speech production. Childhood apraxia of speech may result from a neurological impairment, may be comorbid with a known neurobehavioral disorder such as fragile X syndrome, or may occur as an idiopathic condition of unknown origin. Although many potential diagnostic markers have been proposed (eg, groping, difficulty with multisyllabic words) there is little consensus on this issue. Research suggests that slow articulatory rate, inappropriate sentential stress, and transcoding errors (establishing and executing the motor plan to produce a word) are statistically associated with suspected CAS. Because of the difficulty in agreement about what constitutes CAS, incidence and prevalence data are difficult to obtain; however, Shriberg et al. (1997) report that only 1% 2% (1-2 children in 1,000) present with this condition.
Neuromuscular speech disorder. The main problem is muscle weakness rather than production errors like substitution (saying one sound when another is expected /t/ for /k/), or omission errors (dog is said as do). In adults, dysarthria often accompanies brain damage because of a stroke or a neurological condition affecting the systems related to sound production (respiratory, phonatory, articulatory). In children, dysarthria cooccurs with known comorbid conditions such as cerebral palsy or traumatic brain injury. Diagnostic markers for dysarthric speech included slurred, imprecise speech production characterized by sound distortions.
Linguistic approaches may initially involve motor-based techniques such as phonetic cueing and successive approximation; however, the goal of these approaches is to establish a child's use of sound contrasts to improve phonological knowledge. The focus of Intervention sessions under linguistic approaches is on learning the rules about how sounds are used and combined in the language and on strategies to reorganize the phonological system. Many of the procedures used in linguistic approaches involve asking the child to contrast error sounds with the adult models to realize that different sounds impact meaning. For example, many linguistic approaches utilize minimal pair contrasts of word pairs that differ by a single phoneme (e.g., goat, coat). A child who systematically substitutes stops (p. b, t, d, k, g) for fricatives (f, v, s, z, sh, z, tch, dj) may be asked to contrast their error productions with the correct productions in ways that make it clear that the error is causing semantic confusion. A clinician may show the child pictures of a girl and a key. She would point to each picture and say She, key. Now you say what they are. The child would be likely to say, "key, key". The clinician might ask, Did you mean to say key or she (showing the picture of a girl) for this one? Then, they would work on a production that differentiates the two pictures. The clinician and child would repeat the process with picture pairs of top-shop, toe-sew, etc.
The ability to understand the words that someone else is producing. A perceptual judgment that is made by the SLP based on how well the speaker is understood. Several factors impact this judgment, including the number, type of consistency of articulation errors and/or phonological patterns errors made, and the frequency with which the errored sounds occur in a language. For example, the sounds /t/, /n/, /s/, /k/, and /d/ are the top five most frequently occurring sounds in the English language. It turns out that 61% of the most frequently occurring sounds in English are made using dental or alveolar placement.
Motor speech disorder:
Includes 3 categories, including apraxia, Dysarthria, and not otherwise understood SSDs.
Motor Speech - Childhood apraxia of speech (CAS) is a neurological SSD characterized by impairment in the precision and consistency of movements underlying speech production. Childhood apraxia of speech may result from a neurological impairment, may be comorbid with a known neurobehavioral disorder such as fragile X syndrome, or may occur as an idiopathic condition of unknown origin. Although many potential diagnostic markers have been proposed (eg, groping, difficulty with multisyllabic words), there is little consensus on this issue. Research suggests that slow articulatory rate, inappropriate sentential stress, and transcoding errors (establishing and executing the motor plan to produce a word) are statistically associated with suspected CAS. Because of the difficulty in agreement about what constitutes CAS, incidence and prevalence data are difficult to obtain; however, Shriberg et al. (1997) report that only 1% 2% (1-2 children in 1,000) present with this condition.
Motor Speech - Dysarthria. The main problem is muscle weakness rather than production errors like substitution (saying one sound when another is expected /t/ for /k/), or omission errors (dog is said as do). In adults, dysarthria often accompanies brain damage because of a stroke or a neurological condition affecting the systems related to sound production (respiratory, phonatory, articulatory). In children, dysarthria cooccurs with known comorbid conditions such as cerebral palsy or traumatic brain injury. Diagnostic markers for dysarthric speech included slurred, imprecise speech production characterized by sound distortions.
Motor Speech - Not otherwise specified is a catch-all category to describe SSDs that involve some involvement of the motor system but are not clearly differentiated as CAS or dysarthria.
Is the largest, with 56% of children representing individuals with SSDs whose family members currently experience or have been diagnosed with SSDs. The most common diagnostic marker associated with the subgroup is deletion or omission errors (i.e., dog is said as do).
Articulation approaches are phoneme (sound) oriented and based on motor learning principles. Stimulable sounds that the child can imitate or produce in some contexts are trained first. The SLP may create a stimulability probe or use a published instrument to determine whether the child can produce error sounds correctly in word-initial (sun), word medial (Christmas), or word-final (ice) positions in different vowel contexts. Stimulable sounds are taught in a systematic way moving from sounds in isolation (/s/), words (sun, ice, Christmas), phrases (The sun), sentences (The sun is shining), and structured conversation (SLP: What is happening at your house for your birthday? Child: We are celebrating with some friends and ice cream). Most articulation approaches involve some form of perception training in which children practice discriminating their errors from the correct sounds.
Symptomology:
Behavioral characteristics to differentiate subgroups. Categories do not presume A cause, but describe the speech production errors in behavioral terms. Dodd’s system consists of 5 subgroups.
Subgroup 1 is articulation disorder where children produce consistent substitutions or distortion errors on a limited number of sounds. This category is similar to Shriberg's Speech Errors subgroups in which children produce /w/ for /r/ or /th/ for /s/ or distortions of sounds such as a lateralized sh (ship for sip). According to Dodd and colleagues about 12.5% of SSD fit within this subgroup and 99 respond best to motor based, traditional or articulation-based intervention. The basics of this approach include targeting a single sound in various word positions, gradually working up to conversational speech according to a prescribed sequence.
Phonological delay (Subgroup 2) is the second and largest of the five subgroups where the speech errors of children are best described using phonological patterns. Children with phonological delay produce errors in their speech that are consistent, systematic and often observed across various languages. For example, fronting is a common pattern in which children substitute /t/ for /d/ and say fat for çat, or produce /k/ for /g/ and say doat for goat. Another common pattern is stopping, where fricatives or affricates are replaced by stops as in tat for sat, teet for teach, dat for that, or pace for face. Almost 60% of SSDs fit within this category and respond best to linguistic, phonological approaches to intervention such as the use of contrast therapy to be discussed later in this chapter.
The 3rd subgroup is called consistent atypical phonological disorder. About 21% of SSDs fall into this category and are characterized by the use of non-developmental patterns that are not typically observed in children as they acquire language. For example, children do not often omit the initial consonant in words saying at for cat; or produce velar sounds for alveolar sounds saying go for toe. Minimal pair therapy, a form of linguistic or phonologically based treatment, is recommended for SSDs that fall into this category.
The 4th subgroup is called Inconsistent phonological disorder and involves the use of non-developmental errors not unlike those in the third subgroup, however, the child's productions are inconsistent and unpredictable. About 9% of SSDs fit into this category and do not respond immediately to linguistic or motoric-based intervention approaches.
The fifth subgroup, Childhood Apraxia of Speech, is characterized by inconsistent, slow, prosodically unusual speech production.
What is a language disorder?
A persistent difficulty in the "acquisition and use” of language across spoken, written, sign language or other modalities that is due to substantial and quantifiable deficits in comprehension and production
What are the key similarities and differences between children with development language disorder, children with intellectual disabilities, children with autism spectrum disorders, and children with specific learning disorders (learning disabilities)?
The disorders in this grouping have similar genetic risk factors, shared neural substrates, and similar clinical features, such as cognitive processing problems. While children with Developmental Language Disorder (DLD) do not exhibit challenges in general intelligence, their language disorder characteristics are often similar to those with intellectual disabilities. A notable difference, however, is that children with DLD tend to show a larger gap between their language comprehension and production capabilities compared to those with intellectual disabilities.
How do you think language form, and language content interact with language use?
The interaction between language form, content, and use is a complex interplay that shapes how we think and communicate. Language form refers to the structure and rules of language, such as phonology, morphology, and syntax, which influence how we articulate ideas. Language content encompasses the vocabulary and concepts we use to describe the world, which can vary across languages and cultures. Language use involves the practical application of these elements in everyday communication, where they work together to convey meaning and facilitate understanding.
How does the setting in which SLPs work with children affect service delivery?
The setting in which SLPs work with children significantly influences their service delivery models. In clinical settings, one-on-one service is more common, while in school settings, group service is more likely. Multidisciplinary settings, such as hospitals, also affect service delivery. SLPs must adapt their approach based on the specific needs of the child and the educational environment.
What kinds of assessments are appropriate for young children?
Norm-referenced tests are administered to compare a child's skill in a given area (e.g., vocabulary development) with that of other children who are the same chronological age. Test publishers create age norms by administering a set of items to a large sample of children (usually 1,000 or more). When an SLP or an audiologist administers that test to one child, the SLP uses tables in the test manual to compare the child's raw score on the test with the distribution of scores earned by same-age children from the norming sample. This allows the clinician to determine the child's standard score, which represents how far the child's performance was from the average. Most tests provide index scores that are standardized to have a mean of 100 and a standard deviation of 15. SLPs often collect language samples, observe children interacting with others in their natural environments, and interview parents and other significant adults (such as teachers) to fully understand children's language knowledge and use. In transdisciplinary assessment, professionals from multiple disciplines collaborate in collecting and interpreting assessment data. In the multidisciplinary approach, professionals conduct their own independent evaluations and then share their results with the rest of the members of the assessment team during a meeting. Battelle Developmental Inventory, Third Edition (BDI-3) measures mastery of developmental milestones for personal social skills, adaptive behaviors, motor skills, communication, and cognition. Criterion-referenced approaches to language assessment are used to help clinicians describe the child's use of language in common speaking contexts.
What are similarities and differences between child-centered, clinician-centered and hybrid intervention approaches?
Child-centered revolves around and uses the child's conversation and play to gain more word usage. Clinician-centered is more structured by the clinician and has more specific goals. Hybrid combines the two approaches. In all three approaches, the role of the clinician is to provide models of the language skills that the child needs to learn (referred to as language targets) and to respond to the child's attempts to that inform the child of the communicate correctness/incorrectness of their communication.
What aspects of language development are especially difficult for school-age children with language disorders in the primary and secondary grades?
Early difficulties with the use of complex syntax are highly predictive of language impairment in the school-age years. Children whose conversational speech is noticeably ungrammatical (more than 20% of utterances contain grammatical errors) and does not contain a significant number of complex sentences (fewer than 20% of total utterances are complex) should be referred for a language evaluation to assess the nature of their difficulties in language form. Older school-age children with language disorders may not comprehend and use morphologically complex words, like summarization and prediction, that appear in most of the curricular materials they encounter. Children may experience difficulties understanding and creating coherent narrative and expository texts. They have trouble answering literal and inferential questions, they omit important details from stories and reports, or they have trouble specifying causal relationships or the sequential order of events. Also, the ability to make inferences. Inferences are conclusions that are made about text ideas that were not stated explicitly.
What is the difference between Section 504 and IDEA?
IDEA (Individuals with Disabilities Education Act) focuses on providing special education services, while Section 504 of the Rehabilitation Act ensures civil rights protections for individuals with disabilities in various settings, including education.
What kinds of information are part of a child's IEP?
Current Performance: Describes the child's current abilities and challenges in school and everyday life.
Learning Goals: Sets measurable annual goals based on the child's unique needs.
Progress Reporting: Details how and when progress will be reported to parents.
Special Education and Related Services: Lists all services provided, such as special education instruction, speech therapy, and occupational therapy.
Accommodations and Modifications: Describes supports provided in the general education setting to help the child be educated with nondisabled peers.
Behavior: If the child's behavior affects learning, the team may consider using positive behavioral interventions, strategies, and supports.
Limited English Proficiency: Supports provided if the child's first language is not English.
Blindness or Visual Impairment: Includes Braille instruction and accessible formats.
Deafness or Hearing Impairment: May include interpreters and amplification devices
What procedures are commonly used to assess language disorders in school-age children?
Language assessment usually includes a review of the child's records, observation of the child in the classroom setting, administration of one or two norm-referenced tests, and language sample collection and analysis. The Clinical Evaluation of Language Functions assesses multiple areas of language to provide a broad view of an individual's communication system. The Test of Narrative Language provides examiners with overall indices of language comprehension and production in textual discourse.
Significantly subaverage mental function with associated difficulties in communication, self-help skills, independence, and motor development. Significant challenges in intellectual functions, such as reasoning and problem-solving, as well as adaptive behaviors, including communication and daily living skills. Children with these disabilities display noticeable delays in motor, language, and social skills before the age of two. As they grow, they often score below 70 on IQ tests and on adaptive functioning assessments. Various factors can lead to intellectual disabilities: genetic conditions like Down syndrome or fragile X syndrome; maternal infections during pregnancy, including rubella or cytomegalovirus; birth complications like anoxia; diseases such as measles and meningitis; and environmental factors, for instance, severe neglect or malnutrition.
A significant difficulty with the acquisition and use of one or more of the following abilities: listening, speaking, reading, writing, reasoning, mathematical computation, or mathematical problem-solving.
Childhood disorders of language, speech, or learning ability resulting from impaired growth and development of the central nervous system. Ex: intellectual disability, autism, ADHD, specific learning disorder, and motor disorders.