Ch. 10 -- Speech Sound Disorders

Introduction

%%Speech sound disorder%%: refers to problems in producing the sounds of a language
  * %%Articulation disorders%%: refers to process of producing speech sounds (motor)
  * %%Phonological impairment%%: challenges with the speech sound system of language (language)
  * %%Childhood Apraxia of Speech (CAS)%%: refers to problems with motor planning
    * Aka Developmental Apraxia
Articulation: mild-moderate; child is typically understood most of the time
Phonological system impairments/CAS: highly unintelligible speech; severe-profound
80% of kids with speech sound disorders need therapy
Phonology includes the study of
  * Syllables/word shapes/structures
  * Phonemes and %%allophones%% (set of multiple possible spoken sounds used to pronounce a single phoneme. For example, /p/ (as in pin) and /p/ (as in spin which is less aspirated) are allophones for the phoneme /p/)
  * Prosody/%%suprasegmentals%% (intonation and stress)
The remediation process focuses on reorganizing the child’s phonological system by helping the child learn to produce and acquire phonological patterns

The Speech Mechanism

6 major subsystems are used in the production of speech
  * Respiratory
  * Diaphragm
  * Trachea
  * Larynx
  * Velopharyngeal
  * Oral/nasal cavity

Major articulator: tongue
  * Tip (apex)
  * Blade
  * Back (dorsum)
  * Root
  * Body

Phonemes

A phoneme is the smallest arbitrary unit of sound in a given language that can be recognized as being distinct from other sounds in that language
English phonemes are divided into consonants, vowels, phonemes
Position of the consonant in the word: initial, medial, final
Consonant is described by its position in a word relative to the vowel the terms prevocalic, intervocalic, and postvocalic
Nose (CVC) (n is %%prevocalic%% – before the vowel)
Bunny (CVCV) (n is %%intervocalic%% – between the vowels)
Can (CVC) (n is %%postvocalic%% – follows the vowel)
Consonants are described by their place, manner, and voicing
%%Manner%% refers to what happens to the air flow through the resonance and articulatory systems
%%Obstruent%%: consonants that involve some type of constriction of the air flow – stops, fricative, and affricates
%%Sonorant consonants%%: (nasals, glides, liquids) are made with a relatively open vocal tract

Manner of Articulation

%%Stops%%
  * /p, b, t, d, k, g/
  * Complete closure of the vocal tract; pressure builds and then is released
  * Also called plosives or stop-plosives
%%Fricatives%%
  * Noisy sounds caused by a turbulent air flow as the air stream goes through a narrow constriction
  * Voiced: Th sound Them; V sound Vote; Zh sound Vision; Z sound Zoo
  * Unvoiced: Th sound Thin; F sound Face; Sh sound She; S sound So; H sound He
%%Affricates%%
  * Includes a stop and a fricative release
  * Voiced: J sound Joy
  * Unvoiced: Ch sound Cheese
%%Nasals%%
* /m, n, ng/
* Airflow goes through the nasal cavity
%%Glides%%
  * /w, j (like in “you”)/
  * Semivowels
  * Relatively open vocal tract during production
  * They are usually produced with the tongue moving or “gliding” to and from a position associated with a neighboring vowel sound
  * Voiced
  * Beginning of wet, we, you and yes
%%Liquids%%
  * /l, r/
  * Similar to glides, but have a bit more vocal tract obstruction than the glides or vowels
  * Examples: rain, liquid

Place

%%Bilabials%%
  * /p, b, m, w/
    * First placement of a w
  * Produced by the 2 lips coming together and with some lip rounding
%%Labiodentals%%
* /f, v/
* Lower edge of the upper incisors coming into contact with the upper edge of the lower lip creating a slight constriction in the air flow
%%Interdentals%%
* /th/ voiced and voiceless
* Tongue tip protrudes slightly and touches the edges of the upper incisors, creating a slight constriction over the tongue tip
%%Alveolars%%
  * /t, d, s, z, l, n/
  * Constriction created by the tongue tip coming into contact with the alveolar ridge
    * the part of the hard palate right behind the teeth
  * Most commonly produced in English (50%)
  * /t/ most commonly occurring of all sounds
%%Palatals%%
* /ʃ, ʒ, tʃ, dʒ, r, j/
* Some part of the tongue comes into contact with the hard palate
%%Velars%%
* /k, g, ng/
* Elevating the back of the tongue to the soft palate
%%Glottal%%
* /h/
* Air stream through a partial opening of the vocal folds

Voiced/Unvoiced

Movement of the vocal folds
%%Voiced%%: vocal folds are vibrating during a sound production
%%Voiceless%%: vocal folds are not vibrating
%%Cognates%%: sounds in English language that vary only in terms of voicing

Vowels

%%Vowels%%:
  * Voiced and are not nasalized
  * Open vocal tract
  * Sonorants
  * Described by identifying where the tongue is in relation to the palate using the terms: high, mid, low
  * Described whether the tongue is near the front, middle (central), or back of the mouth
  * Lax (shorter in duration, produced with less muscle effort) or tense (long vowels, more effort)
%%Diphthongs%%: 2 vowels are blended together, creating a change in the vocal track
2 vowels, 1 phoneme
All syllables must have a vowel, diphthong, or a vocalic/syllabic consonant to form the nucleus (ba)
%%Open syllable%%: when a syllable ends with a vowel (CV)
%%Closed syllable%%: when the syllable ends with a consonant (VC, CVC)

%%Speech Sound System%%

Nasals, stops, and glides are acquired earliest
Followed by fricatives, affricates
Lastly liquids

Acquisition

Prelinguistic Stages

Includes the time before the child’s first word
%%Reflexive vocalizations%%: cries, coughs, hiccups
Non reflexive vocalizations: sounds that eventually will be shaped into the adult form of words

Stage 1 Phonation Stage

Birth-1 month
Reflexive vocalizations
Crying, fussing
Similar to syllabic nasals and vowels

Stage 2 Coo and Goo Stage

2-3 months
Productions are acoustically similar to back vowels or to syllables consistent of back vowels and consonants
Primitive, precursors to consonants

Stage 3 Exploration and Expansion Stage

4-6 months
Vocal play
Repetitions of vowels, squeals, “raspberries”
Might produce CV syllables; marginal babbling

Stage 4 Canonical Babbling

7-9 months
%%Reduplicated babbling%%
Vocalizations become longer; CV syllables
More closer approximate adult speech
Mama
Stops, nasals, glides, short (lax) vowels

Stage 5 Variegated Babbling

10-12 months
A greater variety of CV sequences noted
Adult-like intonation patterns

Later Stages

First birthday transition from babbling to meaningful speech
First Word Stage: around 12 months
By 15 months the child has 15 words
%%Protowords%%: well-defined meaningful sound patterns produced by young children that apparently are not modeled on any adult words
* Mi for blanket
* Link between babbling and adult like speech
50 words at 18 months
1000 words by 36 months
Syllabic structures become more complex, with consonant clusters and multisyllabic productions beginning to appear

Phonological Deviations

Speech sounds can be discussed in terms of phonological patterns which are accepted groupings of sounds within an oral language
Speech pattern errors have been referred to as %%phonological processes%%

%%Omissions%%

Simplifications of the word to one syllable
* Rabbit – ra
Weak syllable deletion
* Unstressed syllable is omitted
* Banana-nana
Multi syllabicity
* Difficulty producing all the syllables and sounds in a multisyllabic word
* Ambulance-am:ance
Singleton consonant omissions
  * Bat-ba
  * Happy – ha:i
  * Pot - ot
Final consonant omissions
* Common in children with phonological process disorders
%%Consonant cluster%%: adjacent consonants in the same syllable
* Green:gr
Consonant cluster reduction: one consonant is omitted in a syllable
* Spoon-poon
Consonant cluster deletion: the omission of all consonants in the cluster
* Tree-ee
Extremely uncommon for people to delete the initial consonant sound - even with disordered language

%%Substitutions%%

Fronting: a sound made the back of the mouth is substituted by a sound produced in the front (only position switches)
* Cup-tup
Backing: is the reverse of fronting; anterior sound is replaced by a back or posterior sound (only position switches)
* Tie-kie
Stopping: refers to the use of a stop for a “nonstop” consonant (only manner switches)
* Sun-tun
Gliding: /w, j/ is used for another consonant, typically a liquids
* Light – jight
Vowelizations
* Substitution of a pure vowel for a vocalic liquid (liquid with a vowel in front of it)
* Paper- pepu
Palatalization and depalatalization
  * The palatal feature is added or omitted
  * Sheep-seep (depalatalized)
  * See-she (palatalized)
Affrication and deaffrication
  * Refers to the addition or loss of the combination of a stop and fricative
  * Chair-tair/shair (deaffricatoin)
  * She-che (affrication)

Major Assimilation

%%Assimilation%% involves a sound in a word taking on a characteristic of another sound in the same word
* Soap – poap

Glottal Stop Replacement

%%Glottal stops%% are used by some children to “mark” the final consonant in a word until the sounds are developed
Also children with repaired cleft palates and velopalatal insufficiency

Syllable-Structure/Context-Related Changes

%%Metathesis%% occurs when 2 sounds or syllables in a word change places
* Ask – aks
%%Migration%%: only one sound moves
* Snake- naks
%%Coalescence%%: 2 sounds in a word are replaced by a single sound which has the features of the 2 replaced sounds but is neither of the original sounds
  * spoon – foon
    * S: unvoiced, fricative, alveolar
    * P: unvoiced, stop, bilabial
    * F: unvoiced, fricative, labiodental (the middle of alveolar and bilabial)
%%Reduplication%%: is the repetition of phonemes or syllable
* Bottle- baba
%%Epenthesis%%: insertion of a/ sound
* /uh/ between 2 consonants in a cluster
* Black – bu:lack
%%Diminutive%%: addition of /i/ at the end of the words
* Pig-piggy

Suppression of Phonological Processes

Phonological Awareness

%%Phonological Awareness%%: refers to the child’s knowledge that words are made up of smaller, discernable units
Development of this skill indicates that the person has an awareness of the sound structure or phonological structure of spoken words independent of their meaning
Strong link between phonological awareness and literacy
Sound structure enables a child to sound out or decode a word in print
Metalinguistic knowledge: refers to the child’s ability to reflect on and discuss aspects of language separate from its meaning
%%Syllable awareness%%: requires knowledge that a word can be divided into large parts
%%Phoneme awareness%%: child is able to break a word down into its smallest parts
Factors that influence phonological awareness
  * Large vocabulary
  * Socioeconomic status
  * Print knowledge of the alphabet
Half of poor readers have an early history of spoken-language disorders

Evaluation of Children with Speech Sound Disorders

Major Etiological Factors
Hearing: adequate hearing is needed so that children are aware of the speech and langue being used in their home and surroundings
Oral Mechanism: need adequate structures used for speech production such as the lips, teeth, tongue, and palate
Personal Factors: males higher incidence than females, before the age 8, lower the IQ (under 70) the higher the prevalence and frequency of speech sound errors

Assessment: Ethnic Cultural Considerations

Need to know:
  * Which language is used and what the phonological characteristics of the other language are
  * How the first language affects the learning of the second language
  * How to determine if there is a speech sound disorder in the primary language, the second language, or both
Assessment includes:
  * Sample the speech of adults in the child’s linguistic community
  * Obtain information from interpreters/support personnel
  * Become familiar with dialectal and language features of the child’s linguistic community

Formal Evaluation

Formal evaluation
  * Case history
  * Oral peripheral exam
  * Standardized test
  * Evaluation of stimulability in differing contexts
  * Hearing screening

Tests

Most tests will assess the child’s production of the various sounds in single word production
Norm referenced tests allow for comparisons with scores of children who are the same age
Omissions, additions, substitutions and distortions are noted on the final form
  * Arizona Articulatory Proficiency Scale
  * Goldman-Fristoe Test of Articulation
  * Photo Articulation Test
Other assessment instruments focus more on phonological processes
* Hodson Assessment of Phonological Patterns
* Khan-Lewis Phonological Analysis - connected to Goldman-Fristoe (take words from GF and analyze it through KL)
Continuous Conversational speech sample
* See how single word production compares with conversation (single words are typically more intelligible than words used in conversation)
%%Stimulability%%: the degree to which a misarticulated sound can be produced correctly by imitation (model, instructions where to put the tongue, amplification)

Norms

Reporting

After the assessments, the SLP writes an evaluation report
Explained orally to the child’s parents
Summarize pertinent case history information, hearing screening results, oral mechanism examination findings, test results and recommendations

Treatment

Articulation Treatment

Phonemic-Oriented Approaches
* Some approaches emphasize articulatory placement and motor components
Traditional approach (Charles van Riper)
* Placement techniques combined with sensory-perceptual training
Stages of the traditional approach
  * Auditory training
  * Elicitation of the sound (sound, word, phrase, sentence, conversation)
  * Stabilization of the sound
  * Carry-over
  * Maintenance

Linguistic Based Approaches

Recognize phonology as a component of the child’ language system
Intelligibility is increased by helping reorganize the child’s phonological system
The processing of phonological information is enhanced
An awareness of patterns is developed
Cycles of phonological remediation approach:
* A cycle refers to the period of time required for the child to successfully focus on deficient patterns
* Each phoneme or consonant cluster is targeted for approximately 60 minutes; most patterns need to be recycled one or more times
Cycle principles
  * That phonological acquisition is a gradual process
  * That children with normal hearing typically acquire the adult sound system primarily by listening
  * That as children gain new speech patterns, they associate kinesthetic (movement) with auditory sensations
  * That phonetic environment can facilitate correct sound production
  * Children need to be actively involved in their phonological acquisition
  * Children tend to generalize new speech production skills to other targets (don’t need to train every error sound)
  * Need for an optimal match to facilitate the child’s learning
Early developing patterns are targeted first
Each session begins with a period of auditory stimulation using slight amplification
SLP reads a list of words
5 picture cards are produced with the child’s target
Experiential-play and production-practice activities follow the listening activities
Check stimulability for the next session's target patterns/phonemes
Session ends with a repeat of the listening activity
Home program is an auditory bombardment and production practice session