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