Exam 3 - Speech Sound Disorders TCU Prahl

Speech Sound Disorder Assessment

What are the 6 types/purposes of testing?

1. Proficiency

2. Screening

3. Predictive

4. Developmental

5. Diagnostic

6. Treatment

1. Proficiency

What are all the sounds this child can produce? We are simply collecting an inventory of what sounds this child can make. We do not think about norms. (Helpful starting point with really little kids: Think of a toddler who is only producing a couple of sounds, that is concerning)

Screening

To determine whether we need to do more testing. 5-15 minutes, quick and helps us figure out if they are okay or if they have some red flag concerns.

Predictive

Administering an SSD test and using the score to tease apart if we think the child will grow out of their errors or if at that point in time we will want to do further testing.

Developmental

Compare a child’s production to their peers. Essentially, doing this in the connected speech sample based off the peer/adult model.

Diagnostic

To come up with the type and extent of errors in isolation, words, sentences, connected speech, can the child imitate

Treatment

Test errors in different conetext with various check approaches: use visual, tactile, auditory- decided which is best

What is the difference between assessment vs diagnosis

Assessment: Process and a set of procedures that Me as the SLP, am using to figure out if there is a disorder or not

Puzzle pieces to arrive to the diagnosis

The outcome of the assessment is a diagnosis: My judgment as the SLP about the absence or present of the disorder and describe the nature or characteristics of that disorder

What are the steps in making a diagnosis

1. Conduct the assessment: Collect Data

2. Scoring the tests administered

3. Analyze tests and data

4. Synthesize and interpret the results from tests and other assessment info

5. Make a clinical decision if there is a disorder present (Diagnosis)

6. Make specific recommendations

What are the general principles of assessment (Try to know early on)

1. Review the client’s background (Genetic/family history, lifestyle, medical history)

2. Plan the assessment (Wait for background info, then decide what test to administer). Arizona samples a broader range of R errors, think about that over GFTA

3. Select the appropriate test and activities

4. Prepare the testing area (eliminate any distractions/ interruptions)

5. Conduct an open interview (parent often, maybe IFSP, IEP)

6. Administer the selected tests

7. Assess related area (pragmatics, language impairment, tongue thrust/swallow, speech musculature, repaired cleft, prosody, and rate, overall intelligibility, and hearing)

8. Discuss findings and make recommendations (Make sure you are communicating in a way that a parent will understand)

9. Write the diagnostic report

Screening

A pass or fail procedure that in theory, could be conducted with a large number of students, in a relatively short period of time

If the child passes, no further assessment is needed

Fail doesn’t indicate SSD; that means we need more in-depth screening

When we approach screening, we could go in a formal, mobilized way or an informal way

(If you are on the fence, just go ahead and refer for a full assessment)

What are the 3 ways/situations to screen

1. Some schools have it set up where kinder-1st, the SLP is screening every child, good to catch early

2. Some schools believe 3rd graders are the sweet spot, by age 8, we expect children to master all sounds in the English language

3. Schools will just screen children who are referred to you

What is the primary goal of any diagnostic evaluation?

To determine if a communication disorder exists

Which of the following is the correct first step in making a diagnosis?

Conducting an assessment and gathering data

Name 3 situations or setting where speech/language screenings occur

1. Kindergarten/first grade, SLP screens every child, catch a disorder early

2. 3rd grade “sweet spot.” 8 years old, and all of their sounds should be mastered

3. Screen children who are referred to you by the teacher (less ideal)

What should an SLP do to prepare for an upcoming assessment?

Case History important pieces

Written history, written and verbal information from other professionals (OT, PT, EI) , and parent/caregiver interview

Oral Mechanism

1. Evaluation at Rest/passive

a. body movement

b. general information

2. Evaluation for voluntary movement

a. coordination of movement during speech

, phonatory/voice quality

3. evaluation of non-speech movement

a. mandible

b. lips

c. tongue

d. occlusion

e. hard palate

f. soft palate

g. diadochokinetic rates DDK - speech and regularity that the client can engage in repetitive articulatory movements, if they struggle, this gives us info on how the articulators are functioning … pu tu, ku then say fast or buttercup

h. larynx/vf

stop watch, mirror, stick/tongue depressor

Hearing Screening

To determine the client’s overall auditory functioning level to determine if there is a hearing loss related to their speech sound concerns, the best practice is to start with the hearing screening

Screening levels 5000, 2000, 3000 Hz

If a client fails - fail doesn't mean hearing loss, it can just be congestion, do not move forward with any other testing

Administration of standardized tests

aka Single word tests, the child is shown a picture and is instructed to name whatever is in the picture. Every test many vary slightly on what you do if the child cannot name the object, usually approach it in a scaffolded way . always document direct imitations on the record form

Recording responses 3 common options:

+ & - correct/incorrect: the simplest but also not as many details, best for screenings

Make notes of types of errors SODA

Whole word transcription

What are the 3 commonly used articulation tests

Test every sound and a subset of clusters,

GFTA
Arizona Test of Articulation

Bankson - Bernthal Test of Phonology

Commonly used phonological processes tests

Assessment of Phonological Processes 3-Revised

(2004)

• Bankson-Bernthal Test of Phonology -2 (BBTOP -2)

(2020)

• Diagnostic Evaluation of Articulation and Phonology

(DEAP) (2006)

• Khan-Lewis Phonological Analysis 3 (2004) similar to GFTA, another record form to transfer productions

Administration of Standardized Tests

Advantages & Disadvantages:

• Advantages: Can be done in 15-25 minutes, aka quick, provides a representative sample of sounds in English across multiple positions, we know what the child is trying to say, aka known referent

• Disadvantages: May not reflect a child’s connected speech, usually only getting one or a couple of opportunities to produce any given sound, not adequate testing of vowels, may be inappropriate for children who speak a dialect other than MAE or bilingual speakers

Standardized Tests (Speech Information)

Types of analysis (Connected Sample)

1. Looking for SODA

2. Phonological in nature (look for phonological error patterns)

3. Summarize the child’s phonetic inventory

4. Sometimes, we can also just record the word shapes, e.g., CV words and CVC words

5. Percent Intelligibility

6. Consistency of errors

7. How is the production relative/close to the complexity of the target word

Obtaining a Sample (Connected Sample)

1. Conversational (Open-ended questions)

2. Elicit connected speech from pictures

3. Books

4. Play-based sample

(All of these can be difficult to obtain, so talk to the parents and find out what the children like)

Ease the child in with parallel play and narrate what you are playing with in hopes the child will engage and narrate, and you limit the extent that you are talking… introduce a minor, aka have a toy in view but out of reach, so the child asks… be subtle about videoing

May be helpful to have a parent come in if the child is super quiet

At least 50-200 words, 20-30 minute speech sample

Recording (Connected Sample)

avoid noisy toys

HIPAA Compliant

Restate the child’s utterance, following an unintelligible utterance (Gloss)

Have a clipboard to note the errors you are observing e.g tounge protrusion, groping movements, anything not captured in broad transcription)

Transcribe (Connected Sample)

Diacritic markers

Advantages of Connected Speech

More opportunities to screen certain targets

Assess both vowels and consonants, can determine phonetic inventory, judge intelligibility, stimulability

More natural and representative

Disadvantages of Connected Speech

May take more time than a standardized test

Highly unintelligible children may find it very hard to know what their intended message is

Child may be hesitant to talk

Stimulability

Refers to a child’s ability to make correct or improved production of misarticulated sounds when given a model or additional cues

Highly stimulable means they don’t need a lot of support or may not need alot of therapy time of these sounds

Model

Model + visual

Model +Tactile ( Make k sound against hand)

Model + any combo

(Depending on how they respond is helpful to know what to use/incorporate in therapy)

Context (Facilitated Phonetic Context)

Sounds surrounding errors where the sound has a positive influence on improving the misarticulated phoneme

• deep test of articulation

• clinical probes of articulation consistency

• Spanish version of clinician probes

Speech Discrimination Testing

Research doesn’t suggest that poor auditory discrimination may contribute to speech sound

• difficulty for children who have English as a second language

• Do this after sound production errors have been identified

(Never simply work on one auditory discrimination)

What does stimulability help determine

B

Which of the follow is an advantage of standardized testing

A

which of the following is an advantage of collected a connected speech sample

B

why might a connected speech sample be difficult to analyze for highly unitellible child

Cannot tell the target word for a highly unintelligible child

Transcribing will be hard, less reliable data

What are ways we can test speech?

Connect speech sample, standardized test, stimulability testing

Analysis of Speech Sound Production (Characterizing the articulation features)

Independent: Analysis of the child’s speech production without any reference to the adult model… what the child can do regardless of accuracy, e.g., KV (upside down V) … phonetic inventory

Produce a voiceless, velar stop k in the initial position, vowel V, produce a CV word syllable shape brackets use

Relational: Compare/relate the child’s production to the adult or target // used for relation to adult target KV for cut, final consonant deletion, possible positional constraint of t in the postvocalic contexts … phonemic inventory

Be familiar with the definitions and examples in mind for the exam

Analysis of speech sound production

Traditional Analysis: consider the position of the sound and the types of errors that are made

aka SODA, appropriate for those clients who have just a few sounds in error, high intelligibility, often pretty quick to complete

Phonological Processes Analysis: Classify speech sound errors according to phonological error patterns, report the frequency that we see those error patterns within the speech sample, and the percentage of occurrence (number of times a child used the error pattern in relation to the number of opportunities (approaching 40 best to intervene)

Analysis of Related Information

Orofacial and Diadochokinetic Rates (putaku)

Medical History: known disorder? cerebral palsy, apraxia, dysarthria

Developmental: Comparing the data we gathered from the standardized test and connected speech sample to developmental norms, there is always going to be variability

Stimulability: 1 common belief: a child who is highly stimulable … all they need is a model… a better prognosis and respond really well to therapy or grow out. However, if they are developmentally behind, while they may be highly stimulable, they often do need a fair number of therapy sessions before they master sounds.

2nd common belief: For those sounds where the child is highly stimulated, those sounds should be treated first … start with the complex sound ex tS

Intelligibility: For the clients to be understood, benchmarked by age 5, the child should be 90% intelligible

Severity: Degree of impairment can be mild to profound: measure this by percent consonants correct, aka PCC

Phonemic Inventory: Summarizing what consonants and vowel sounds that the child can produce from a standardized test or a connected speech sample

Making a Diagnosis

Typical Errors: Related to second language, bilingualism, or use of a dialect, fall within WNL for age, are slight or subtle, and do not have a significant negative effect on listeners

Disordered: articulation, phonological (patterns, productions do not match adult model, limited phonetic inventory), neurological, or structural

What is the difference between phonetic disorders and phonologic diorders?

phonetic - a few single sounds… more intelligible

phonological errors are those patterns ex cluster deletion … less intelligible

Determining Prognosis for improvement

Look at prognostic variables… factors that positively or negatively impact the client’s improvement

The prognostic statement three components:

goal statement

judgement of success

prognostic variables that lead to success

variables:

1. severity - more severe SSD the poorer the prognosis

2. age - the younger the child the is when receiving the prognosis the greater chance of success

3. motivation - less motivated the poorer prognosis

4. Inconsistency - inconsistent errors is a positive prognostic variable

5. Associated conditions - ex ADHD or neurological/sensory/developmental may slow progress

6. treatment history / poor maintenance - poorer prognosis

7. family support - stronger support is better prognosis

Poorer: severity, less motivated, associated condition, treatment history with poor progress

Better: younger the better, motivated, no inconsistency in their errors, and family support