CSD 101 Exam 2 Definitive Study Guide: Speech Sound and Fluency Disorders

Exam Structure and Application Guidelines

• Assessment Modalities:

  • Multiple-choice questions.
  • Matching questions.
  • True-or-false questions.
  • Short-answer questions.

• Evaluative Expectations:

  • Direct factual recall of concepts presented during instruction.
  • Synthesis and application of combined concepts to solve novel clinical scenarios and work out responses.

Speech Sound Disorders I: Phonetic Parameters and Development

• Consonant versus Vowel Production:

  • Vowel Production:
  • Produced with an open, unobstructed vocal tract.
  • Involves no significant constriction or blockage of airflow in the oral cavity.
  • Continuants and resonant in nature; produced with vocal fold vibration (voiced).
  • Functions primarily as the nucleus of a syllable.
  • Consonant Production:
  • Produced with partial or complete constriction, obstruction, or closure along the vocal tract.
  • Modifies the vocal tract shape through active articulators (lips, tongue, teeth, palate).
  • Can be either voiced (vocal folds vibrating) or voiceless (vocal folds non-vibrating).

• Parameters for Describing Consonants:

  • Place of Articulation (location of constriction):
  • Bilabial: Both lips coming together (e.g., $/p/$, $/b/$, $/m/$).
  • Labiodental: Lower lip contacting upper incisors (e.g., $/f/$, $/v/$).
  • Interdental: Tongue tip placed between the upper and lower front teeth (e.g., $/\theta/$, $/\eth/$).
  • Alveolar: Tongue tip or blade contacting the alveolar ridge behind upper teeth (e.g., $/t/$, $/d/$, $/s/$, $/z/$, $/n/$, $/l/$).
  • Palatal: Tongue dorsum contacting or approaching the hard palate (e.g., $/\int/$, $/\mathfrak{3}/$, $/\mathrm{t}\int/$, $/\mathrm{d}\mathfrak{3}/$, $/j/$).
  • Velar: Back of tongue contacting the soft palate or velum (e.g., $/k/$, $/g/$, $/\eta/$).
  • Glottal: Constriction occurring at the level of the vocal folds or glottis (e.g., $/h/$, glottal stop /\scriptg/).
  • Manner of Articulation (how the airstream is modified):
  • Stops/Plosives: Complete closure followed by sudden release of air (e.g., $/p/$, $/b/$, $/t/$, $/d/$, $/k/$, $/g/$).
  • Fricatives: Severe constriction creating continuous turbulent airflow/friction (e.g., $/f/$, $/v/$, $/\theta/$, $/\eth/$, $/s/$, $/z/$, $/\int/$, $/\mathfrak{3}/$, $/h/$).
  • Affricates: Rapid combination of a stop closure followed immediately by a fricative release (e.g., $/\mathrm{t}\int/$, $/\mathrm{d}\mathfrak{3}/$).
  • Nasals: Complete oral closure with lowered velum, allowing airflow through the nasal cavity (e.g., $/m/$, $/n/$, $/\eta/$).
  • Liquids: Smooth airflow with vocal tract constriction slightly greater than vowels (e.g., lateral liquid $/l/$, rhotic liquid $/r/$).
  • Glides: Rapid transitioning movement of articulators into an open position (e.g., $/w/$, $/j/$).
  • Voicing (laryngeal activity):
  • Voiced: Presence of vocal fold vibration during production.
  • Voiceless: Absence of vocal fold vibration during production.

• Parameters for Describing Vowels:

  • Tongue Height: Position of the tongue along the vertical axis (High, Mid, Low).
  • Tongue Advancement (Backness): Position of the tongue along the horizontal axis (Front, Central, Back).
  • Lip Rounding: Shape of the lips during vowel production (Rounded, Unrounded/Neutral).
  • Muscle Tension and Duration: Neuromuscular effort and relative length (Tense vs. Lax).

• Characteristics of Speech Sound Development:

  • Predictable, sequential acquisition of speech sounds over time during early childhood.
  • Early-acquired sounds typically include bilabial stops, nasals, and glides (e.g., $/m/$, $/p/$, $/b/$, $/n/$, $/w/$, $/h/$).
  • Late-acquired sounds typically include fricatives, affricates, and liquids (e.g., $/r/$, $/l/$, $/s/$, $/z/$, $/\theta/$, $/\eth/$).
  • Phonological Processes: Simplified, rule-based sound changes utilized by young children as they acquire adult speech systems (e.g., cluster reduction, stopping, fronting, final consonant deletion).

• Williamson's Speech Sound Development Chart:

  • Developmental assessment reference standard outlining sound acquisition trajectories.
  • Differentiates customary production age (the age at which $50\%$ of children correctly produce a phoneme in multiple positions) from mastery age (the age at which $90\%$ of children correctly produce a phoneme).

Speech Sound Disorders II: Error Identification, Assessment, and Intervention

• Identification of Articulation Errors (SODA Framework):

  • Substitution: Replacing a target phoneme with an incorrect speech sound (e.g., producing "wabbit" instead of "rabbit").
  • Omission (Deletion): Omitting or deleting a target phoneme entirely from a word (e.g., producing "ba" instead of "ball").
  • Distortion: Producing a target phoneme with non-standard articulatory precision or unnatural resonance, though the sound remains recognizable (e.g., lateralized production of $/s/$).
  • Addition: Inserting an extraneous phoneme into a target word (e.g., producing "buhlack" instead of "black").

• Diagnostic Evaluations:

  • Speech Sound Inventory: Comprehensive cataloging of all speech sounds (consonants, consonant clusters, and vowels) an individual can correctly produce across varied contexts, independent of adult targets.
  • Syllable Structure Evaluation: Assessment of syllable shapes present in the speech inventory (e.g., CV, CVC, CCVC) and identification of structural alterations.
  • Speech Intelligibility Assessment: Quantitative percentage reflecting how well a listener understands a speaker's conversational speech across familiar versus unfamiliar listeners and known versus unknown contexts.

• General Assessment Procedure:

  • Comprehensive Case History: Review of medical, developmental, and social histories alongside client/caregiver interviews.
  • Oral Mechanism Examination: Direct structural and functional inspection of oral structures (lips, teeth, tongue, hard/soft palates) to rule out anatomical or motor deficits.
  • Standardized Articulation and Phonology Testing: Administration of formal standardized measures to evaluate phonetic errors against age-matched peers.
  • Speech Sampling and Transcription: Collection and narrow phonetic transcription of connected speech samples.
  • Hearing Screening: Audiometric pure-tone screening to rule out underlying hearing loss.
  • Analytical Integration: Synthesis of phonetic inventory, error patterns via SODA analysis, phonological process use, and intelligibility rating.

• Treatment Approaches:

  • Output-Based Feedback Approach: Motor-based articulatory intervention providing targeted sensory, auditory, visual, and tactile feedback to train precise physiological placement of articulators.
  • Minimal Pairs Contrast Approach: Linguistic/phonological intervention utilizing word pairs that differ by a single phoneme (e.g., "key" vs. "tea") to highlight semantic contrasts created by phonological error patterns.

Fluency Disorders I: Core Behaviors, Demands, and Risk Factors

• Core Behaviors of Stuttering:

  • Sound/Syllable Repetitions: Involuntary, rhythmic repetitions of individual speech sounds or single syllables (e.g., "b-b-ball").
  • Sound Prolongations: Involuntary continuous lengthening of vocalic or consonantal speech sounds (e.g., "s-s-sun").
  • Silent Blocks: Involuntary stopping or blockage of speech production due to structural fixation/closure within the vocal tract, resulting in silent struggle before sound initiation.

• Secondary Behaviors of Stuttering:

  • Escape Behaviors: Physical actions performed during a moment of disfluency to break free or escape (e.g., head nods, eye blinks, leg taps, facial grimacing).
  • Avoidance Behaviors: Tactics implemented prior to a disfluency to prevent or avoid its occurrence altogether (e.g., word substitutions, circumlocution, interjections, situational avoidance).

• Stuttering-Inducing Factors:

  • High environmental stress and time pressure.
  • Elevated emotional arousal or anxiety during communication encounters.
  • Speaking to authority figures, large audiences, or via non-face-to-face modalities (e.g., telephone calls).

• Linguistic Demands on Stuttering:

  • Increased sentence length and syntactic complexity.
  • Lower word frequency and advanced lexical/vocabulary selection.
  • Utterance-initial positions and stressed syllables within speech patterns.

• Risk Factors for Stuttering Persistence and Remission:

  • Family History: Presence of persistent stuttering within biological relatives elevates risk.
  • Gender: Males exhibit significantly higher rates of persistence, whereas females exhibit higher rates of spontaneous recovery/remission.
  • Age of Onset: Stuttering onset occurring after age $3.5$ to $4$ years correlates with higher persistence.
  • Time Elapsed Since Onset: Disfluency persisting longer than $6$ to $12$ months without improvement indicates higher risk of chronic stuttering.
  • Co-occurring Skills: Co-existing phonological or language impairments increase vulnerability to persistence.

Fluency Disorders II: Developmental vs. Acquired Stuttering, Assessment, and Interventions

• Developmental versus Acquired Stuttering:

  • Developmental Stuttering:
  • Onset during early childhood (typically between ages $2.5$ and $5$ years) coinciding with rapid language development.
  • Insidious or gradual onset with no identifiable focal neurological lesion or acute trauma.
  • Characteristic presence of secondary behaviors, variable fluency, and potential for adaptation effects.
  • Acquired Stuttering:
  • Onset later in life triggered by clear neurological injury (neurogenic stuttering, e.g., stroke, traumatic brain injury) or sudden psychological trauma (psychogenic stuttering).
  • Lacks typical adaptation effects and rarely demonstrates secondary escape/avoidance behaviors or emotional anticipation.

• Characteristics of Developmental Stuttering:

  • Marked variability in disfluencies across communication settings, time, and emotional states.
  • Adaptation Effect: Reduction in disfluency frequency upon repeated readings or recitations of the same textual material.
  • Cyclical Nature: Fluctuating periods of near-fluency alternating with periods of severe disfluency.
  • Associated Negative Attitudes: Development of communication apprehension, negative self-perception, and speaking anxiety.

• General Assessment Procedure:

  • Parent/Client Questionnaire and History: Detailed tracking of onset, family history, and perceived severity.
  • Speech Fluency Sampling: Evaluation across diverse contexts (spontaneous conversation, picture description, reading, structured interview).
  • Disfluency Quantification: Calculation of total percentage of disfluent syllables or words ($\%\,\text{disfluent syllables}$).
  • Qualitative Disfluency Analysis: Differentiation between stuttering-like disfluencies (repetitions, prolongations, blocks) and normal disfluencies (phrase repetitions, revisions, interjections).
  • Assessment of Secondary Factors and Attitudes: Administration of standardized tools measuring secondary behaviors and emotional impact.

• Treatment Approaches:

  • Direct Intervention: Focuses on active client modification of speech production mechanics.
  • Fluency Shaping: Techniques to establish seamless speech flow (e.g., easy onset, light articulatory contact, continuous phonation, prolonged speech).
  • Stuttering Modification: Techniques to reduce tension during stuttering moments (e.g., cancellations, pull-outs, preparatory sets).
  • Indirect Intervention: Modifies environmental, communicative, and interpersonal dynamics surrounding the individual without directly prompting speech mechanics changes (e.g., slowing parental speech rate, increasing pause times between turns, reducing direct questioning pressure).

School-Based Speech-Language Pathology Practice

• Professional Roles and Responsibilities:

  • Assessment, diagnosis, and provision of clinical interventions within educational settings.
  • Identification of educational impact resulting from communicative disorders.

• Educational Frameworks and Regulations:

  • Development and execution of Individualized Education Programs (IEPs) under the Individuals with Disabilities Education Act (IDEA).
  • Implementation of Multi-Tiered Systems of Support (MTSS) and Response to Intervention (RTI) frameworks for pre-referral intervention.

• Interprofessional Collaboration and Service Delivery:

  • Interdisciplinary collaboration with general education teachers, special educators, psychologists, and families.
  • Utilization of diverse service delivery models, including pull-out therapy, push-in/classroom-integrated therapy, and consultation models.
  • Management of complex school caseloads and educational compliance documentation.