Assessment

Phonological Assessment Overview

Definition of Speech Sound Disorders

  • Speech sound disorders refer to difficulties in producing sounds correctly, leading to problems with speech intelligibility.

Initial Steps in Assessment

  • Case History Collection:

    • Gather medical and speech history of the patient, whether a child or adult.

    • Important to document any relevant medical conditions, prior assessments, or treatments.

  • Speech Sample Collection:

    • Speech Sample Inventory: Analyze a speech sample to assess patterns and errors in articulation.

    • Analysis Metrics:

    • Description of speech patterns.

    • Identification of error patterns.

    • Consistency of misarticulations.

    • Assessment of stimulability.

Stimulability

  • Definition: Stimulability refers to a child's ability to accurately produce sounds or sound patterns when prompted, suggesting potential for improvement.

    • Example: A child may struggle with final consonants but produce the same sounds correctly at the beginning of words.

    • Importance: Identifies which sounds to target in therapy, focusing on those the child can produce with assistance.

Severity Level Estimation

  • Speech sound disorders are often classified as:

    • Mild

    • Moderate

    • Severe

  • Severity assessment methods include:

    • Percentage of correct consonants/productions.

    • Assessing the child's intelligibility, determined perceptually by listeners unfamiliar with the child’s speech patterns.

Oral-Peripheral Assessment

  • Purpose: To evaluate structural integrity and functioning of speech articulators (lips, tongue, teeth, etc.).

  • Assessment Elements:

    • Muscle tone, structure deviations, adequate range of motion, oral posture.

    • Assess for conditions affecting speech, such as open mouth posture or other anatomical issues.

Hearing Assessment

  • A critical step to rule out any auditory problems contributing to speech sound disorders.

Assessment Report Composition

  • Contents of Report:

    • Patient history, introduction, assessment results, and conclusion.

    • Recommendations for therapy or further evaluations.

Articulation Disorders

  • Assess via SODA Patterns:

    • Substitutions: performance of incorrect sounds (e.g. "wabbit" for "rabbit").

    • Omissions: deletion of sounds (e.g. "hat" for "hat").

    • Distortions: altered production of sounds (e.g. lateral lisp).

    • Additions: extra sounds (e.g. "green" for "green").

Examples of Substitution

  • Examples include:

    • Replacing /r/ with /w/, leading to "wabbit" for "rabbit".

    • Replacing /th/ with /d/ in production of words.

Phonological Processes and Patterns

  • Understanding that misarticulations may reflect systematic patterns.

    • Examples of Patterns:

    • Final consonant deletion: E.g., "bo" for "boat".

    • Cluster reduction: Deleting sounds in consonant clusters (e.g. "blue" to "bue").

    • Stopping of fricatives: Replacing fricatives with stops (e.g., "zoo" to "doo").

Severity Judgments Based on Criteria

  • Quantitative Criteria:

    • Number of correctly produced consonants vs. total incorrect sounds.

    • Determine percentages, such as:

    • Severe: < 50% correct.

    • Mild to moderate: 65% to 84% correct.

  • Qualitative Criteria:

    • Intelligibility: Evaluates the impact of misarticulations on overall speech understandability, typically assessed by listeners unfamiliar with the child.

Facial Assessment

  • Objective: Evaluate structure and function of articulators like lips, teeth, and tongue.

  • Critical areas to analyze include:

    • Symmetry, scarring, range of motion, and strength.

    • Posture and movement capabilities of oral structures.

Treatment Approaches

  • Types include:

    • Traditional Approach:

    • Focuses on individual sound production and teaching correct placement and auditory discrimination.

    • Involves systematic training from sound in isolation to syllables, words, and sentences.

    • Prioritizes achieving 85% accuracy at each level before progressing.

    • Emphasizes use of modeling, imitation, and feedback.

  • Additional Techniques (mentioned briefly):

    • Maximal contrast approach.

    • Cycles approach.

    • Minimal pairs approach.