NON-KASA EXAM #2

Phonological Analysis: preliminary analysis

• Identifies the child's inventory of speech sounds and the distribution of those sounds in different word positions. Helps determine what sounds the child can produce and where errors are.

• Distribution of speech sounds: where the misarticualtion occurs within the word)

  • Initial, medial, final vs prevocalic, post vocalic, and intervocalic

• A list of speech sounds the client can produce WNL

• What you identify first in a speech sample:

  • Inventory of speech sounds (what the child can produce)

  • Syllable/word shapes used

  • Positional constraints (where sounds do/don’t occur)

  • Phonotactic constraints (which combos occur)

• We get an idea of what should happen next.

What is the treatment for Articulation and Phonological Disorders

• Articulation

  • Problems with FORM

  • Motor Based

  • Treat with hierarchical articulation therapy

  • Ex: isolation, syllable, word, phrase, sentence, connected speech (conversastion)

• Phonological

  • Problems with the FUNCTION

  • Contrast Based

  • Treat with contrast therapy (minimal pairs, maximal pairs, multiple oppositions)

  • EXAMPLES:

    • Minimal pairs (minimal opposition): 1 feature difference

    • Maximal opposition: differ on many features

    • Multiple oppositions: for phoneme collapse

    • Cycles Approach: stimulability + patterns (for severe disorders)

    • Complexity approach: teach hardest sound first to promote system-wide growth

Prevocalic, Postvocalic, and intervocalic

• Prevocalic = before a vowel → CV (“me, to, see”)

• Postvocalic = after a vowel → VC (“up, eat, arm”)

• Intervocalic = between vowels → V C V (“baby, water”)

Phonetic Disorder

• Articulation Disorder

• motor-based production problem with difficulty producing specific speech sounds.

• Child has difficulty with placement (FORM). Errors are consistent and typically are distortions

  • errors in the physical production of sound

• of single sound (lateral /l/).

• These disorders are not cognitive-linguistic (organizational ) or perceptually base problems.

• EXAMPLES:

  • /w/ for /r/

  • /th/ for /s/

  • Lisp

  • Distortions (e.g. slushy sounding /s/)

• Preservation of phonemic contrasts

  • omission of sounds with preserved articulatory gesture for phonemic contrasts (ex. vowel duration)

Phonemic Disorder

• involves the consistent use of incorrect rules for sounds in a language

• difficulty using phonemes contrastively to differentiate meaning.

• errors in the system of the sounds a child uses (FUNCTION)

• Phonological disorder

• Language based problem, loss of phonemic contrasts. Child can produce sounds but doesn't use them to signal meaning differences.

• Pattern based and affect classes of sounds.

• Loss of contrast

• EXAMPLES: 

  • “tat” for “cat”

  • Stopping- “tip” for “ship'“

  • FCD- “ba” for “ball”

  • stopping (fricatives or affricates replaced with stops)sun → [tʌn]; shoe → [tu]

  • Backing (alveolars replaced with velars) toy → [kɔɪ]

  • fronting (velar or palatal sounds replaced with alveolars) key → [ti]

Neutralization of specific contrast/ loss of Contrast

• DEFINITION: refers to the elimination of a functional distinction between two or more linguistic sounds (phonemes) in a particular phonetic environment. The sounds become phonetically identical or very similar in that specific context, even though they remain distinct in other contexts. 

• Child collapses contrast between two or more phonemes → reduces intelligibility.

• EXAMPLE: /s, ʃ, t/ → [t]

• Neutralization of contrast is when two or more phonemes are produced as one sounds, eliminating distinction.

• EXAMPLE: /t/ used for /s/ and /sh/ toe and show sound the same

• What is loss of phonemic contrast: when a child's productions fail to preserve meaning differences that depend on distinct sounds

Beginning Therapy for Phonetic Disorderr

• Stimulability- Start by identifying which sounds are in error

• Supplement with additional words considering different contexts

  • Use word positions where the child has most success (facilitating contexts)

  • Ex: co-articulation with /r/

• High priority for sounds affecting intelligibility high frequency sounds or sounds produced with conspicuous aberrant articulation. 

  • Work on sounds affecting intelligibility the most

• Developmentally earlier sounds

  • Target developmentally earlier and frequent sounds

  • Progress systematically (isolation, syllables, words, phrases, sentences, conversation)

Analyses for Phonemic Disorder

• Phonological process analysis

• Place-manner-voicing analysis

• Distinctive features analysis

• Contrastive analysis / minimal pairs

• Stimulability testing

• Phonemic Inventory

• Use analyses that focus on patterns and contrasts

  • Phonemic inventory: which sounds are used contrastively (right sounds)

  • Syllable shapes: identifies the variety and complexity of syllables structures

  • Phonological process analysis: identify recurring error pattern (natural processes, FCD, CR)

  • Idiosyncratic processes: unusual processes not typical in development (backing of stops, ICD)

  • Vowel Errors

  • Phonemic collapse: one sound replacing several phonemes

Phonological error patterns: phonological process analysis, idiosyncratic processes

• phonological process analysis

  • Persisting normal processes: developmental patterns that continue past the typical age

  • Chronological mismatch: advanced processes alongside early one

  • Systematic sound preferences: one sound replaces many

  • Natural Processes

    • FCD, cluster reduction

    • fronting, stopping, gliding

    • weak syllable deletion, reduplication

    • deaffrication

• idiosyncratic processes

  • atypical patterns

  • Variable use of processes: inconsistent patterns

  • Idiosyncratic/atypical

    • Backing

    • Initial consonant deletion

    • Fricatives → stops in unusual places

Processes that children with phonological disorders show (examples)

• Syllable structure processes:

  • FCD: omitting final consonant at end of syllable (dog for da)

  • CR: reducing a consonant cluster to a single sound (spoon for (poo)

  • WSD: deleting unstressed syllable (banana to nana)

  • Reduplication: repeating one syllable: water to wawa

• Substitution processes

  • Stopping: replacing fricatives or affricatives with stops (sun to tun)

  • Fronting: replacing back sounds with front sounds (go to do or key to tea)

  • Gliding: liquids (l, r) with slides (w, y) (rabbit to wabbit)

  • Deaffrication: replacing affricate with fricative (chew to shoe)

  • Vowelization: replacing /l or uh with a vowel (table to tabo)

• Assimilation Processes

  • Labial Assimilation

  • Nasal Assimilation

• Idiosyncratic (atypical) processes

  • ICD: omission of initial consonant (dog to og)

  • Backing

  • Glottal replacement: target sound replaced with glottal stop (cat to tat)

Assessing Phonological knowledge

• Phonetic Inventory: all sounds produced 

• Phonemic inventory: only the sounds that are used contrastively

• Distribution of sounds in the phonemic inventory

• Use of phonological rules

Intelligibility; factors that influence intelligibility

• FACTORS - PLMBFLCFN

  • Number and types of speech sound errors 

    • omissions vs. distortions

  • consistency of sound errors

  • Frequency of occurrence of errors sounds 

  • listener’s familiarity with the speaker’s speech pattern

  • prosodic factors: speaking rate, stress patterns, voice quality, loudness, fluency, etc

  • Linguistic experience of the listener 

  • message content

  • Bilingual/ language difference

  • familiar vs. unfamiliar listeners.

• MEASURES

  • refers to a judgment made by a clinician based on how much they understood

  • subjective, perceptual judgment

  • related to the percentage of words

  • Intelligibility expectations 

    • 2yrs- 50% 

    • 3yrs- 75%

    • 4 yrs- 100% 

PCC

• Percentage of Consonant Correct

• Used to measure severity of the disorder

• ICC (incorrect consonants)

• CC (correct consonants)

• Quantitative estimates of Severity using PCC 

  • >85% mild

  • 65-85% mild-moderate

  • 50-65% moderate-severe 

  • <50% severe 

• KNOW HOW TO CALCULATE! 

  • GIVE ICC and CC for each utterance, only one final score! 

Therapy for phonetic errors; hierarchical approach (in isolation, syllables, words, phrases,

connected speech), therapy methods and coarticulatory conditions to consider

• Isolation

• Syllables

• Words

• phrases/sentences

• Connected speech

• Therapy methods used for phonetic errors:

  • Auditory stimulation/imitation: model and have the child repeat

  • Phonetic placement method: teach articulator position using mirrors, tactile cues

  • Sound modification method: shape from a known sound (t to s)

  • Facilitating contexts: use words where target sound is easier to produce correctly

• What coarticulatory conditions should be considered:

  • Choose vowels and consonants that facilitate correct placement (back vowels (k)

  • Consider syllable stress, word length, familiarity

Short-answer questions: Provide therapy method considering coarticulatory conditions or with
example of minimal pairs depending on phonetic vs. phonemic errors (e.g., Provide therapy
strategy for the error of /θ/ -> [t]

• For Phonemic Errors

  • Minimal opposition (small feature differences)

  • Maximal opposition (big feature differences)

  • Empty set (two unknown sounds contrasted)

  • Multiple

• Phonemic errors: re-establish phonemic contrasts, helping the child learn the use of the sounds, teach phonological rules and sound contrasts

• Minimal opposition (pairs):

  • Uses words that differ by only one feature (place, manner, voice)

  • Best for kids who are stimulable for the target sound and have few errors

  • Example /θ/ → [t] → Use thin vs. tin to highlight contrast.

• Maximal opposition contrast:

  • Pairs two sounds that differ by several features to teach broadest contrast

  • Promotes greater generalization and system change

  • Example: Example: Target /m/ vs. /s/ (differ in place, manner, and voicing).

• Multiple oppositions approach:

  • Used when one sound substituted for many (phonemic collapse)-

  • Targets several contrasts at once to reorganize the sound system

  • Example: /d/ used for /g/, /ʃ/, /ʧ/, /s/ → therapy includes pairs like door–shore–chore–soar.

• Cycles approach:

  • Used for highly unintelligible kids

  • Focuses on one pattern (FCD) for a few weeks then cycles to anther

  • Each sound within a pattern is targeted for a set amount of time not mastery

• Phonetic errors: phonetic placement or sound modification, teach tongue between teeth, airflow through t ongue and teeth or shaping.

• Phonetic placement method teaches how and where to place articulators.

  • Used when client cannot produce sound at all

• Sound modification (shaping) uses a sound the client already can produce to shape it into the target sound

Factors affecting the articulatory complexity

• Word length

• Sound position

• Syllable structure

• Syllable stress

• Coarticulation

• Familiarity and meaning

Misarticulation of specific sounds

S,z , lateral or dentalized production, use t-s shaping, airflow over tongue tip

ʃ/, /ʒ/ palatal or fronted, coarticulate with u, shape from /sh

K, g, fronting, use back vowels u and o, shape from ing

L, substituted with w or j, teach alveolar contact, use d to l

R, substituted or distorted, teach retroflex/bunches tongue, pair with ɚ

θ/, /ð/, replaced with f, t, d teach tongue protrusion, airflow training

F, v, replaced with p, b, teach lip teeth contact

Clusters, simplified or emphasized, teach each element separately, then blend

V oicing errors, prevocalic voicing or final devoicing, uses auditory/tactile feedback for

onset/offset

Frequency of occurrence (frequent vs infrequent)

• [s] ranks among the top five sounds in frequency of

  occurrence; [z] ranks 11 th in the 24 consonants of General American English. The

  most frequent word-initial clusters include [st], [st.I], and [sp]; the most frequent

  word-final clusters are [st], [ns], [nz], [ks], [ts], [1z], and [nts]

• [l] is a frequent sound in General American English; it

  ranks 8th in children's speech and 5th in adults' speech

• The voiceless [J] is an infrequent sound, ranking 20th

  in the 24 consonants of General American English. The voiced [3] is the most

  infrequent sound in General American English, occurring only in words of foreign

  origin, such as beige or rouge

therapy methods for voicing errors and consonant cluster errors

• For Consonant Clusters

  • Cluster reduction:

    • minimal pairs (“see” vs “snee”)

    • epenthesis (“puh-lay” → “play”)

    • cluster simplification (“pw” → “pl” → “play”)

    • Simplify cluster in early stages (work on s and t before st

    • Use empenthesis /pəliz/ for please as a bridge

    • Blend sounds slowly, then reduce the epenthetic vowel

    • Cluster hierarchy /s/ blends → reduce → full clusters

    • Epenthesis (“puh-lay”)

    • Minimal pairsTarget clusters with stimulable or familiar sounds first

• For Voicing Errors

  • Contrast training (pair /p/ vs /b/)

  • Facilitation: whisper→voice, tactile cues on larynx

  • Teach awareness of voicing contrast using tactile feedback (hand on throat)

  • Practice minimal pairs differing by voicing (pair-bear)

  • Use progressive approximation- whisper to voiced

  • Therapy with relatively high frequency

    • Auditory Discrimination exercise 

    • Tactile feedback method

    • Auditory enhancement method 

    • Whispering method for voiceless sounds

    • Singing method for voice sounds 

    • developing voiced stops productions

  • Teach “motor on/off”

  • Minimal pairs (pea/bee)

  • Tactile cues (hand on throat)

Therapy methods for phonemic errors; target selection

• Principles for the treatment of phonemic errors

  • Phoneme as a basic unit for different word meanings

    • `intervention beginning at the word level

    • use of minimal pairs

  • Analysis of the child’s phonology as an integrated
    system

    • inventory and distribution of speech sounds

    • syllable shapes and phonemic contrast

    • error patterns

  • Groups of sounds or sound classes targeted

    • generalization to other sounds or sound classes

• Choose sounds that will produce maximal change in the system (contrastive value)

• Prioritize: (TARGET SELECTION) 

  • Sounds affecting intelligibility

  • Stimulable sounds

  • Phonemes with multiple feature contrasts (maximal opposition)

  • Sounds that are least stable or least accurate across contexts

Recognize examples of minimal opposition contrast

• minimal opposition contrast 

  • Two sounds selected with many articulation similarities (manner, place, voicing features) as possible

  • Used for substitution errors (not for distortions and omissions)

  • Used most appropriately for clients who are stimulable for the target sound and when the child can produce the target sounds within the pairs

  • Might work better if combined with a traditional-motor approach

  • Selecting target sounds

    • Analysis of the norm production and substitutions

    • Considering place, manner, voicing features between the target sound and the substitution
      (e.g., [f]/[v] vs. [d]/[v])

    • Earlier sounds have priority

    • Pairs two sounds that differ by one feature (voicing). Used for kids with mild phonemic disordersand stimulable sounds

    • Sound substitutions that affect the child’s intelligibility the most have priority

    • Stimulable sounds have priority

    • Example: bee–pea (/b/ vs. /p/ differ only by voicing)

  • STEPS: 

  • Step 1: Discussion of words

  • Step 2: Discrimination testing and training

    • criterion: correct 7 consecutive responses

  • Step 3: Production training

    • Child’s production of a word → clinician’s picking up a
      picture → reinforcement for the correct sound production

    • Implementation of a traditional-motor approach at the
      word level if the child cannot produce target sound
      correctly

  • Step 4: Carryover training

    • In a situation of communication breakdown due to the
      child’s mispronunciation
      Minimal opposition contrast therapy procedures

Recognize example of maximum opposition contrast

• maximum opposition contrast

  • Sounds that have great differences in distinctive features are chosen

  • Most generalization with the order of treatment proceeded from least to most phonological
    knowledge 

  • Most beneficial for children with moderate to severe phonological disorder

  • More generalization using maximal relative to minimal contrasts

  • non-stimulable

• Example: m vs s different in all three features

  • Pairs sounds that differ by many features (place, manner, voicing)

Used for kids with severe phonological impairments

• Use of several sounds simultaneously within one phoneme collapse (e.g., /g, ð, ʃ, dʒ/ → [d])

• Target selection: maximum distinctions and maximum classification are considered – maximally different targets are selected

Treatment of phonological disorders with language problems

• Intervention for both phonology and any deficient language area

• Problematic morphemes for children with SLI Incorporated treatment of phonological and
  morphological problems: p. 379

• Treatment of phonology and semantics:targeting various verbs, expanding vocabulary with new
  words containing the target

• EXAMPLES: 

  • Cycles approach

  • Integrated language & phonology intervention

  • Morphophonemic focus (plural –s, past tense –ed

• Combine language and phonological goals within the same activity

  Work on new vocabulary containing target phonemes

  Use storytelling, sentence building, and morphological markers with target sounds

  Integrate phonological awareness activities

Treatment of a child with emerging phonological system

• Late talkers: children who have normal comprehension abilities but fail to achieve 50-word
  vocabulary and two-word combinations by age 2

• 10-15% of 2 –year-olds are late talkers

• Evaluation of phonology: inventory of speech sounds and syllable shape

• Remediation of all language areas

• Combining phonology and semantics

• Combine phonological and language stimulation

• Select words that are meaningful and function to the child

• Target expandable syllable shapes and new sound combinations

• Therapy is place-based, emphasizing communication success over accuracy

Treatment of multiple vowel errors

• The child with a very limited vowel inventory

  • use of one known and one unknown vowel in
    minimal pairs: early developing vowels targeted

  • use of two unknown vowels in minimal pair

  • The child with a high proportion of vowel substitutions

  • Target selection: 1. a vowel showing inconsistent substitutions; 2. a vowel used as a substitution for different vowels

• Use minimal pairs based on vowel contrasts 

• Use minimal pairs to contrast incorrect and correct vowels

  Use auditory auditory bombardments for vowel discrimination

  Work on high-low, front-back, and tense-lax distinctions gradually

Definition, speech characteristics, of CAS

• DEFINITION: A motor speech disorders involving difficulty in planning and sequencing the precise movements needed for speech, without muscle weakness or paralysis

  • no neurological basis verified

  • lack of sequential volitional control of the oral mechanism

• CHARACTERISTICS - Need at least 4

  • More errors with sounds involving more complex oral gestures

  • Unusual errors not typically found in children with speech sound disorders

    • e.g., sound additions, prolongations of vowels and cons., repetitions of sounds & syllables, unusual substitutions such as glottal plosives & bilabial fricatives

  • A large percentage of sound and syll. omission errors

  •  Difficulty producing and maintaining appropriate voicing

  • Vowel errors, vowel distortions

  • Sequencing errors

    • Increased error with more complexity and/or longer utterance & metathesis (e.g., telephone -> [tɛfəlon])

  • Difficulty with nasality and nasal emission

    • hyernasality: resonance occurring in the nasal cavity

    • Nasal emission: release through nasal cavity, no resonance consonants. 

  • Groping behaviors and silent posturing

  • Prosodic impairment

  • Problems with rhyming and syllabification

  • Inconsistent & variable speech sound errors

Assessment and treatment of children with childhood apraxia of speech, and the various positions concerning the etiology of this controversial disorder

• ASSESSMENT 

  • Hearing Screening 

  • Speech-motor assessment including DDK Rates

  • Language Testing

  • Articutation Test 

  • Language Sample

  • Prosody and consistency analysis

• TREATMENT

  • Intensive therapy

  • Therapy through the hierarchies of task difficulty

  • Start with a very simple structure: ex in isolation

  • Emphasize sequences of movements, tactile and kinesthetic self-monitoring

  • Drills with many repetitions of speech movements

  • Input from multiple modalities needed

  • Manipulation of prosodic features

    • Articulation doesn’t involve prosodic features

  • Compensatory strategies if needed

    • e.g., slowing down, use of pauses, vowel prolongations, intrusion of a schwa vowel in producing a consonant cluster

Speech characteristics of cerebral palsy,

• DEFINITION: A nonprogressive disorder of motor control caused by brain damage during pre-, peri-, early postnatal period

  • Most common developmental motor impairment (3 times in every 1,000 births)

  • Lack of volitional speech-motor control as well as disturbances in cognition, perception, sensation, language, hearing, emotional behavior, feeding and seizure control 

• CHARACTERISTICS: 

  • Articulatory/ Phonological Characteristics:

    • Dysfunctions in respiration, phonation, resonance (velopharyngeal inadequacies), articulation, prosody

    • Spasticity: Inadequate breath support, harsh voices, short phrases and prosodic disturbances, hypernasality, articulatory inaccuracy, slow rate of speech (Strained/ slow)

    • Athetosis: Rapid & irregular breathing, hypernasality, strained voice quality, hard global onset, reduced intensity & prosody, restricted tongue movement, distortions

    • Ataxia: Lack of expiratory control, harsh voice, reduced range of prosodic realization, speech sound distortions, inconsistent sound errors, a general dysrhythmia (irregular breakdowns)

    • Phonological processes: Voicing difficulties, CR, FCD, ST, WSD, fronting, backing, gliding, lateralization of alveolar & palatal fricatives, vowelization of [l] & [r], nasalization

Speech characteristics of cleft palate/lip (following successful primary repair),

• DEFINITION: causes by a failure of the palate to fuse during fetal development

• CHARACTERISTICS: (Articulatory/ phonological)

  • Developmental and/or compensatory articulatory and phonological disorders

  • Compensatory articulation errors: Substitutions and distortions produced by posterior positioning of the tongue, associated true and false vocal fold adduction, or abnormal
    positioning of the arytenoid cartilage and epiglottis

  • May also exhibit difficulties with organization of phonemes; a high frequency of FCD, syllable Reduction, & backing before age 4

Speech characteristics of hearing impairment, intellectual disabilities (MR)

• Hearing Impairment

  • deletions

  • voicing errors

  • substitutions of stops for fricatives and liquids

  • errors with oral vs. nasal consonants

  • errors with alveolar and palatal fricatives

  • lower accuracy word-finally

  • vowels neutralized, vowel errors

  • impaired prosody, reduced speaking rate, slow articulatory transition, poor coordination of breathing with syntactic phrasing, distorted resonance

  • Difficulty with fricatives, affricates

  • Voice quality concerns

• Intellectual Disabilities

  • indistinct, slurred, sluggish speech

  • Deletion of consonants, inconsistent errors

  • functional delay (frequent occurrence of FCD, CR)

  • Inconsistent errors

  • Slower acquisition

  • Errors influenced by cognitive level and attention

Assessment and diagnosis of speech sound production problems (with an English-speaking child and a non-English speaking child)

• English-speaking child 

  • Formal: GFTA-3, KLPA-3, PCC, hearing screening, intelligibility rating, oral-mech exam, DDK, stimulability testing.

  • Informal: Conversational samples, play-based observations, parent report (interview cx history questions)

  • Analyze patterns (place–manner–voicing, processes).

• Non-English Speaking Child

  • do all informal assessments - to avoid bias and misdiagnosis

  • obtain phonetic and phonemic inventories

    • sound inventory (consonants & vowels)

  • Analyze speech according to L1 phonological rules.

  • Identify transfer patterns (differences due to second language) vs. true disorder.

  • Use interpreters and bilingual assessment tools if available.

  • Focus on intelligibility within both language

  • Hearing Screening & Oral Mech Exam