Speech sound disorders
This presentation is the property of its rightful owner.
Sponsored Links
1 / 102

Speech Sound Disorders PowerPoint PPT Presentation


  • 114 Views
  • Uploaded on
  • Presentation posted in: General

Speech Sound Disorders. Peter Flipsen Jr., Ph.D., CCC-SLP University of Tennessee, Knoxville http://web.utk.edu/~pflipsen. Outline. 1. General Issues Assessment, Target Selection, Intervention, Measuring Progress 2. Articulation vs. Phonological Disorders 3. Speech Discrimination

Download Presentation

Speech Sound Disorders

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Speech sound disorders

Speech Sound Disorders

Peter Flipsen Jr., Ph.D., CCC-SLP

University of Tennessee, Knoxville

http://web.utk.edu/~pflipsen


Outline

Outline

  • 1. General Issues

    • Assessment, Target Selection, Intervention, Measuring Progress

  • 2. Articulation vs. Phonological Disorders

  • 3. Speech Discrimination

  • 4. Childhood Apraxia of Speech

  • 5. Oral-Motor Exercises

  • 6. Dialects - Appalachian English

  • 7. Approaches to Intervention

    • Articulation, phonological, discrimination, CAS


General issues assessment

General Issues - Assessment

  • The goal of every assessment is to decide if there is a problem or not.

  • When we say there is a problem, we may be right or we may be wrong.

    • Client may have had a really bad day and performed poorly.

    • Client may have been “in the zone” and did better than they usually do.


General issues assessment1

General Issues - Assessment

  • Risk of errors in our decisions greatest for borderline cases, but always a concern.

  • Given our reliance on standardized tests, we need to remember to consider “standard error of measurement” or SEM.

    • Accounts for the fact that all test scores are really just “samples” of ability and scores may vary from day to day.

    • Gives us a sense of how much they might vary.


Standard error of measurement sem

Standard Error of Measurement (SEM)

  • Allows us to see where the “true ability level” is.

  • If a child achieves a standard score (SS) of 80 and the SEM is 5, then:

    • There is a 68% probability that his actual score is really somewhere between 75 and 85.

      • We are 68% confident that his true ability is within 1 SEM of his score that day.

    • There is a 95% probability that his actual score is really somewhere between 70 and 90.

      • We are 95% confident that his true ability is within 2 SEMs of his score that day.


Speech sound disorders

SEM

  • Not always available but is generally found in most newer test manuals.

  • E.g., Photo Articulation Test – 3


Speech sound disorders

SEM

  • GFTA-2 gives us the 90% and 95% “confidence intervals” directly for every score.

  • Hodson’s new HAPP-3 does NOT provide SEM values or confidence intervals.

    • Note: The HAPP-3 allows you to calculate “Ability Scores” which look like standard scores, BUT the test manual recommends you use percentile ranks instead.


General issues assessment2

General Issues – Assessment

  • What about unusual errors?

  • We know that unusual errors such as “lateralization” of fricatives are very resistant to intervention especially if left too long.

    • Need to avoid letting them become too established.

  • We need to find a way to justify working on these errors much earlier.

  • Any ideas?


General issues diagnosis

General Issues - diagnosis

  • When we decide what the nature of the problem is, we assign a “category”.

    • Differential diagnosis.

    • Ultimately each category should mean a different approach to treatment.

  • We need to know how distinct each category is from other related categories.


General issues treatment

General Issues - treatment

  • Change happens – we see it every day.

  • Many possible reasons:

    • Our intervention resulted in the change.

    • Child “figured out” what they need to do on their own (i.e., normal development).

    • Adult relearned a skill as physiological recovery progressed (i.e., spontaneous recovery).

    • Some outside influence led to the change (e.g., parent or spouse working with them).


General issues treatment1

General Issues - treatment

  • How do we know what caused the change?

  • If we do something and change follows, did we cause the change?

    • Even if the change is almost immediate, we still CANNOT be sure!

    • Something else may have been responsible for the change.

  • Still a long way to go here.

  • See June 13/06 issue of ASHA Leader.


General issues treatment2

General Issues - treatment

  • Recommended reading:

    • Reilly, S., Douglas, J., & Oates, J. (2004). Evidence Based Practice in Speech Pathology. Philadelphia, PA: Whurr Publishers.


General issues measuring progress

General Issues - Measuring Progress

  • When we “monitor progress” we are really re-assessing skills to see if the client has learned what we’ve been teaching.

  • Re-administer a standardized test?

    • May be necessary to make decisions about whether a client is still “eligible for services”.

      • Need to consider SEM.

    • Doing this doesn’t really tell us if progress has happened.


Standardized tests and measuring progress why not

Standardized Tests and “Measuring Progress” – Why Not?

  • 1. These tests are intended for a wide range of ages.

    • Designed for efficient administration and thus don’t sample very many behaviors at any one particular age.

      • Only sample each ability level superficially.

    • For speech sounds, they don’t test enough examples of those sounds.

      • Child may have over-learned those particular words.

      • Child may have a “fossilized form” for those particular words.


Standardized tests and measuring progress why not1

Standardized Tests and “Measuring Progress” – Why Not?

  • 2. Regression to the Mean.

    • Scores at the very low end or the very high end are not very common (relative to the entire population).

    • By sheer probability, when you retest, low scores are more likely to go up and high scores are more likely to go down.

      • Remember that statistically speaking, really tall parents tend to have shorter children than themselves and really short parents tend to have taller children than themselves.


More on regression to the mean

More on Regression to the Mean

  • Every test score is a “sample” of ability and includes measurement error.

    • That’s why we consider SEM in assessments.

  • With a very low score, it means that many “sources” of measurement error were working against the child that day.

    • When we retest, it is much less likely that those “sources” will again be working against the child.

    • Scores are likely to improve just by chance.


Alternatives for measuring progress

Alternatives for measuring progress

  • 1. Conversational speech samples – for speech sound disorders the ultimate goal is performance in spontaneous speech.

    • A. For younger children (many errors) - have an unfamiliar listener transcribe (using regular spelling) and calculate % understood.

      • Track % understood over time.

      • Expectations for % understood =

        • Age in years / 4.


Alternatives for measuring progress1

Alternatives for measuring progress

  • May also do phonetic transcription.

    • Calculate Percentage of Consonants Correct (PCC) and Percentage of Vowels Correct (PVC).

  • Compare to reference data from Austin & Shriberg (1997).

    • See handout


Alternatives to measuring progress

Alternatives to measuring progress

  • Use Means (and standard deviations) to calculate z-scores.

    • Z-score = how many standard deviations from the mean a raw score is.

  • z-score = (score –mean) / std. dev.


Alternatives for measuring progress2

Alternatives for measuring progress

  • B. For older children (fewer errors)

    • Have an unfamiliar clinician transcribe phonetically and calculate % correct.

    • Probably only need to focus on the particular target sounds.

  • Clinicians can act as transcribers for each other.


Alternatives for measuring progress3

Alternatives for measuring progress

  • 2. Systematic Probes – for each target sound, set aside some (e.g., 10) words containing the target sound that you don’t use for practice in therapy.

    • Bring these out every few weeks or so and ask the child to produce them.

    • Track % correct over time.


Articulation vs phonological disorders

Articulation vs. Phonological Disorders

  • Now ASHA’s preferred term = Speech Sound Disorders.

  • Includes both “articulation disorders” and “phonological disorders”.

  • BUT is it reasonable to lump these two categories together?

    • Are they just two different names for the same thing?

    • Even if they are different, do we treat them differently?


Articulation disorders

Articulation Disorders

  • Group exercise. Answer the following:

  • What do we mean by an articulation disorder?

  • What specific behaviors do we observe?


Phonological disorders

Phonological Disorders

  • Group exercise. Answer the following:

  • What do we mean by a phonological disorder?

  • What specific behaviors do we observe?


Speech sound disorders1

Speech Sound Disorders

  • Articulation vs. Phonological Disorders

  • Are they the same thing?

  • If not, should we be doing something different for each of them?


Articulation disorders1

Articulation Disorders

  • Problems with the physical aspects of producing speech sounds.

  • Not stimulable (or very poorly so).

  • Don’t ever produce the sound correctly.

  • Don’t produce the sound accidentally in place of some other sound.

  • Sometimes called phonetic disorders.


Phonological disorders1

Phonological Disorders

  • Phonology = sub-domain of language.

  • The sound system.

  • How the phonemes and allophones are organized within a language.

  • Phonological disorder = a type of language disorder.


Phonological disorders2

Phonological Disorders

  • Not a “production” problem. Child appears capable of producing the target but isn’t using it correctly.

    • Errors are stimulable, especially to the word level or beyond,

    • Target may also be produced accidentally in place of something else.

  • Sometimes called phonemic disorders.


Natural phonological processes

Natural Phonological Processes

  • What does it really mean when we say that a child exhibited final consonant deletion?

    • Or velar fronting?

    • Or cluster reduction?

  • By themselves, do these labels really tell us what’s going on inside a child’s head?


Which process

Which Process?

  • If a child leaves off the /s/ in words like “hats” and “ducks”, what process is operating?

    • Final consonant deletion?

    • Stridency deletion?

    • Consonant sequence reduction (cluster reduction)?

    • Or is this just a failure to learn the plural morpheme?


Natural processes vs linguistic processes

Natural Processes vs. Linguistic Processes

  • The natural process labels that SLPs use are not the same as the phonological processes that linguists talk about.

  • Serious potential for confusion.


Processes vs processing

Processes vs. Processing

  • With the emergence of discussions of “phonological awareness”, we‘ve begun to look at psycholinguistic models of how the brain manages information (processing).

    • Are we talking about the same thing?


Processes vs processing1

Processes vs. Processing

  • Just because we see errors that we can label as fronting, stopping, etc., this says ABSOLUTELY NOTHING about:

    • phonological awareness skills

    • short term memory skills, or

    • how the brain “processes” linguistic information.

    • Whether the problem is phonological or articulatory.


Processes vs patterns

Processes vs. Patterns

  • There is no doubt that for many children their errors seem to follow patterns.

  • Capturing a child’s “pattern of errors” using labels such as stopping, fronting, etc. can be very useful clinically.

  • But even Barbara Hodson has suggested we call them “patterns” rather than “processes”.


What about speech discrimination

What about speech discrimination?

  • If we assume normal hearing acuity (i.e., no hearing loss):

    • Is it possible to have difficulty producing speech sounds because of difficulty with speech discrimination?

  • Even if such a problem exists, is it possible to test it?


What about speech discrimination1

What about speech discrimination?

  • If the problem were one of “general inability to discriminate speech”, then no speech would be possible.

  • We do occasionally see children who have problems with discriminating speech specific to sounds they are not producing correctly.

    • Not at all clear how common this is.

    • Probably relatively uncommon, but we can’t ignore the possibility.


Speech discrimination

Speech Discrimination

  • Two possible problems:

  • 1. Problems discriminating sounds as produced by others (external discrimination).

  • 2. Problems discriminating sounds when produced by self (internal discrimination).

    • One example of this is the “Fis” phenomenon.


Can we test speech discrimination

Can we test speech discrimination?

  • We can test external discrimination easily but ultimately we cannot ever really test internal discrimination.

    • We all hear our own speech differently than others do because of bone conduction.

    • Can’t get inside someone else’s head.


Testing speech discrimination

Testing Speech Discrimination

  • Common approach = minimal pairs test.

    • Present two words side by side (one contains the target, one contains the error).

  • Only requires comparison within working memory.

    • Doesn’t require the child to compare what they hear against their own internal representation.

  • Often present only one example – could guess.


Testing speech discrimination1

Testing Speech Discrimination

  • Need a way to allow for comparison against internal representation and to prevent guessing.

  • Locke’s (1980) “Speech Production-Perception Task” (SP-PT) does both of these things.

    • Still based on production by someone else but probably as close as we’ll get.


Sp pt

SP-PT

  • Create a unique test for each of the child’s errors.

  • Compare child’s usual error to the target.

  • Include a similar sound that child can discriminate (ensures task is understood).

  • Present multiple examples to account for possible guessing.


Sp pt1

SP-PT

  • Key = examiner presents one example at a time of a possible version of the target.

  • Child must compare what they hear with their internal representation and then decide:

    • Was it correct or not correct?

  • Record child’s responses.


Speech sound disorders

Target / / Error / / Control / /Stimulus - ClassResponse 1. / / - Control yes - NO2. / / - Error yes - NO3. / / - Target YES - no4. / / - Target YES - no5. / / - Error yes - NO6. / / - Control yes - NO7. / / - Control yes - NO8. / / - Target YES - no9. / / - Error yes - NO10. / / - Target YES - no11. / / - Error yes - NO12. / / - Control yes - NO13. / / - Error yes - NO14. / / - Target YES - no15. / / - Control yes - NO16. / / - Error yes - NO17. / / - Target YES - no18. / / - Control yes - NOCorrect response shown in uppercase letters. Misperception = 3+ mistakes on Error.Mistakes: Error ____ Control ____ Target____


Speech sound disorders

  • Target / ‘ / Error / f / Control / s /Stimulus - ClassResponse 1. / s / - Controlyes - NO2. / f / - Error yes - NO3. / ‘ / - TargetYES - no4. / ‘ / - TargetYES - no5. / f / - Error yes - NO6. / s / - Controlyes - NO7. / s / - Controlyes - NO8. / ‘ / - TargetYES - no9. / f / - Error yes - NO10. / ‘ / - Target YES - no11. / f / - Error yes - NO12. / s / - Controlyes - NO13. / f / - Error yes - NO14. / ‘ / - TargetYES - no15. / s / - Controlyes - NO16. / f / - Error yes - NO17. / ‘ / - TargetYES - no18. / s / - Controlyes - NOCorrect response shown in uppercase letters. Misperception = 3+ mistakes on Error.Mistakes: Error ____ Control ____ Target____


Testing speech discrimination2

Testing Speech Discrimination

  • Another option is the SAILS software program.

    • http://www.avaaz.com

    • Computer program that is intended to teach discrimination.

    • Includes an assessment tool.


All or none

All or None?

  • For any given child, will all of their errors fall neatly into “articulation”, “phonological” or “perceptual” categories?

    • Maybe but not necessarily.

  • Need to evaluate each error sound.

  • Treat each sound based on the type of error that it is.


Childhood apraxia of speech cas

Childhood Apraxia of Speech (CAS)

  • Now ASHA’s preferred term for “Developmental Apraxia of Speech”.

  • Group exercise. Answer the following:

  • 1. What are the core characteristics of CAS? [i.e., what behaviors set it apart from other speech sound problems?]


Childhood apraxia of speech cas1

Childhood Apraxia of Speech (CAS)

  • See handout “ASHA’s draft position statement”.

    • Based a thorough review of the available evidence.

    • Still being discussed and fine tuned (i.e., not yet the final word but close).


Speech sound disorders

CAS

  • “… (CAS) exists as a distinct diagnostic subtype of childhood (pediatric) speech sound disorder that warrants research and clinical services.”

    • Note: even with this, there may still remain some who claim it doesn’t exist.


Speech sound disorders

CAS

  • “… (CAS) is a subtype of severe childhood speech sound disorder due to unidentified neurological differences likely of genetic origin. The core deficits arise at linguistic or early speech motor processing levels. Symptomatology, which changes with age, may include age-inappropriate vowel/diphthong errors, unusual and variable errors in repeated attempts at words, increased number and severity of errors with increasing word and utterance length, and prosodic disturbances. CAS places a child at risk for persisting problems in speech, language, and literacy.”

    • ASHA Ad Hoc Committee on Childhood Apraxia of Speech, 2006


Speech sound disorders

CAS

  • “… subtype of severe speech sound disorder…”

    • Involves speech

      • Remember that “oral apraxia”, “verbal apraxia” and “limb apraxia” are independent conditions but may co-occur.

      • Feeding and drooling problems may co-exist BUT ARE NOT PART OF THE DISORDER.

    • Manifests as a very severe form

      • Helps us understand slow progress in therapy, BUT

      • SLOW PROGRESS IS NOT SUFFICIENT TO JUSTIFY THE DIAGNOSIS.


Speech sound disorders

CAS

  • “ … due to unidentified neurological differences.”

  • Unidentified – accounts for the fact that imaging studies often show nothing.

    • Personal comment: many of these kids have a history of some “event”.

  • Neurological – some deficit or difference in functioning of control over speech output.


Speech sound disorders

CAS

  • “… likely of genetic origin.”

    • Tends to run in families

      • Early genetic typing studies have suggested some possible genetic loci.

    • Takes the burden off parents (they did nothing wrong!).


Speech sound disorders

CAS

  • “The core deficits arise at linguistic or early speech motor processing levels.”

    • MY INFERENCE: As a motor speech disorder, the problem includes sequencing of speech sounds (i.e., organizing the motor program).

      • Sequencing may yet be added to the definition.

    • May see problems with prosody and sequencing of syntactic units.


Speech sound disorders

CAS

  • “Symptomatology, which changes with age, may include age-inappropriate vowel/diphthong errors …”

  • What these children present with does depend on their age.

    • See vowel errors at younger ages (persist well past age 5 in many cases).

      • One of the few disorders where vowels are an issue.

    • Problems with consonant sequences and multi-syllabic words seen early but persist longer.


Speech sound disorders

CAS

  • “… unusual and variable errors in repeated attempts at words, increased number and severity of errors with increasing word and utterance length,...”

    • Often several widely differing productions of the same word within a session.

    • Greater programming demands of longer units are often a problem.


Speech sound disorders

CAS

  • “… and prosodic disturbances.”

  • Often see atypical stress patterns.

    • Tendency by some to equally stress syllables that normally get different stress levels.

  • May see intermittent nasality.

  • May see intermittent monotone quality mixed in with normal pitch patterns.


Speech sound disorders

CAS

  • “ … places a child at risk for persisting problems in speech, language, and literacy.”

    • Often see co-existing language impairments.

    • Phonological awareness can be a problem for these children which increases risk of reading problems.

    • Often very aware of their problem – panel called this “a special form of metalinguistic awareness”.


Cas how common

CAS – how common?

  • Solid prevalence estimates not available.

  • Evidence suggests it is probably much less common than currently assumed.

  • Likely 3-4 cases per 1000 children.

  • Knox County?


Cas assessment

CAS - Assessment

  • For children under 5 years:

    • Look for vowel errors.

    • Look at sequencing of simple syllables.

      • Performance breaks down with change in place of articulation.

      • Personal comment: formal DDKs probably unnecessary. Sequencing will likely break down at normal rate.

        • Do DDK tasks but use normal rate and don’t worry about the stopwatch.

    • Try presenting word lists multiple times and watch for variability.


Cas assessment1

CAS - Assessment

  • For children over 5 years:

    • May still see vowel errors. Diphthong errors still likely.

    • Look at the nature of the consonant errors.

      • Often see multiple feature changes (e.g., both place and manner change).

    • Ask for productions in progressively longer units.


Oral motor exercises

Oral-motor exercises

  • Group exercise.

  • Answer the following:

    • What does this term mean to you?

    • What sorts of things do you do clinically that you would fit into this category?

    • Why do you use them?


Non speech oral motor exercises

Non-Speech Oral Motor Exercises

  • These are normally justified four ways:

  • 1. May help speech by breaking it down into smaller steps

    • NO. We don't learn motor activities that way. We learn motor movements by practicing the entire movement.


Non speech oral motor exercises1

Non-Speech Oral Motor Exercises

  • 2. These may help increase strength of the speech organs.

    • NO. Two problems:

    • a. Not necessary. Speech normally only requires less than 20% of our strength capacity.

    • b. Strengthening requires many repetitions against resistance. Exercises being advocated don't involve resistance and never involve enough repetitions to be useful.


Non speech oral motor exercises2

Non-Speech Oral Motor Exercises

  • 3. These may improve the connections between the nerves and muscles. NO. Research has shown that the only way to improve how the nervous system interacts with the muscles is to practice RELEVANT behaviors. Need to practice speech to improve connections for speech.


Non speech oral motor exercises3

Non-Speech Oral Motor Exercises

  • 4. But doesn't speech develop from earlier non-speech behaviors? NO. Despite what would seem obvious, research has shown that the brain organizes the movements for speech in very different ways than for non-speech movements. There are common structures, but that's all.


Non speech oral motor exercises4

Non-speechOral Motor Exercises

  • In addition to the above, clinicians say they do these “because they work”.

  • The question is “Do they?”

  • As mentioned previously, change happens and clinicians are very good observers of change.

  • But did the exercises result in the change.


Non speech oral motor exercises5

Non-SpeechOral Motor Exercises

  • Several studies have attempted to prove that they work.

  • All failed to do so.

    • Handout of recent study.

  • The only study that “appeared” to show an effect was badly flawed and thus, really didn’t show anything.


Non speech oral motor exercises6

Non-SpeechOral-motor exercises

  • Should we use these, and if so, when?

  • Ask yourself, “what is my goal?”

    • They may have some value:

      • 1. To remediate documented chewing, feeding and swallowing problems.

      • 2. As VERY BRIEF (i.e., no more than 2-3 minutes) initiating activities to heighten awareness of the articulators.


Dialects appalachian english

Dialects – Appalachian English

  • AppE is the non-standard dialect associated with the rural, working class population of the central and southern Appalachian mountains.

  • Primarily descendants of immigrants from Scotland (by way of Ireland) who arrived in the mid-late 1700s and early 1800s.

  • Mountainous region; very inaccessible until the 1940s.

  • The creation of both the Tennessee Valley Authority (1933) and the Great Smokey Mountains National Park (1934) greatly improved access.


Appe as a dialect

AppE as a Dialect

  • Some debate about whether AppE is a single dialect or many dialects.

    • “mountain talk” or

    • /d8f5nt tek 8n 2vri hel5/

  • General consensus is that it can be called a single dialect with many local variations.


Appe as a dialect1

AppE as a Dialect

  • “Characterized by distinctive sounds, syntax, and originality, Appalachian speech has long served as an emblem of the region’s natives … Appalachians have been romanticized as surviving speakers of Elizabethan English yet simultaneously ridiculed as backward users of a lower-class, substandard dialect reflecting the region’s isolation and poverty.”

    • Michael Montgomery, 2006, p. 999, Encyclopedia of Appalachia.


Appe phonology

AppE Phonology

  • As a dialect of American English, AppE includes a series of variations from General American English (GAE).

  • Includes variations in both consonants and vowels.

  • See handout for details.

  • Unfortunately we know almost nothing about how this dialect is acquired.


Acquisition of appe phonology

Acquisition of AppE Phonology

  • Two known studies.

  • Davis (1998) – unpublished MA thesis.

    • recorded conversational speech from 42 children age 5-7 years from Knox county.

    • Reported that the % of children using any of nine AppE features tended to decline with age.

      • BUT 5/9 features were still being used by half of the 7 year-olds.

    • Suggests that as the children gained more school experience, they were becoming more proficient at code-switching into GAE.


Acquisition of appe phonology1

Acquisition of AppE Phonology

  • Flipsen & Parker (2005) – unpublished paper still in process. Some preliminary results.

    • recorded conversational speech and PAT-3 from 8 children age 3;1-5;11 from Wise, VA.

    • Language analysis suggested they were “mild” dialect users (low density of AppE morpho-syntax features).

    • Calculated PCC and PVC from conversations and converted to z-scores using reference data for GAE from Austin & Shriberg (1997).


Flipsen parker 2005

Flipsen & Parker (2005)


Flipsen parker 20051

Flipsen & Parker (2005)

  • All PAT-3 standard scores were within the normal range.

  • All vowel scores (z-PVC) were outside the normal range relative to GAE.

  • 7/8 consonant scores (z-PCC) were within the normal range relative to GAE.

  • For one child, his consonant scores in conversation would identify him as disordered.

    • BUT his PAT-3 score said he was normal.

    • Produced many non-AppE errors (lateralized a lot of fricatives and affricates).


Clinical issues and appe

Clinical Issues and AppE

  • Long history of mislabeling speakers of non-standard dialects as having speech/language impairments.

  • Clinicians in the Appalachian region regularly ask about how to differentiate use of this dialect from disorder.

    • Many AppE variations resemble errors in GAE.


Clinical issues and appe1

Clinical Issues and AppE

  • Too little data available yet to really say how to make clinical decisions.

  • Available samples too small and may not be the most representative.

    • Hopefully more to come.

  • Does appear that conventional articulation tests may not be enough to catch problems (regardless of dialect).


Intervention articulation disorders

Intervention – Articulation Disorders

  • Not much new here.

  • Conventional articulation therapy is generally the way to go here.

  • Modeling, phonetic placement, sound shaping, etc.


Intervention discrimination

Intervention – Discrimination

  • For those occasions where a child is unable to hear the difference between the sound they are supposed to use and the one they actually use,

    • We need to teach them to do so.


Intervention discrimination1

Intervention – Discrimination

  • Several options:

  • 1. Traditional ear training – ala Van Riper.

    • Very involved. Not very practical in most circumstances.

  • 2. SAILS software program.

  • 3. Include Hodson’s auditory bombardment as part of other treatment.


Auditory bombardment

Auditory Bombardment

  • Hodson suggests we do this with every child that has a speech sound problem.

  • Not clear how helpful this is overall but easily warranted for children with specific discrimination problems.

  • Present word lists using SLIGHT MECHANICAL AMPLIFICATION.

    • Talking louder only distorts the signal!!!

    • See the following link for word lists:

    • http://web.utk.edu/~pflipsen/Clinical_Resources.html


Intervention phonological

Intervention – Phonological

  • Child essentially is able to produce the sound but fails to do so appropriately.

  • A number of different approaches possible.

  • All based on the idea that the child needs to learn the “function” of the sound.

    • When and where to use it to create meaning.


Intervention phonological1

Intervention - Phonological

  • Three underlying principles:

    • 1. Phonological contrasts – focus on function; teach how different sounds result in different meaning. Must use real words.

    • 2. Focus on groups of sounds - treating patterns rather than individual sounds.

    • 3. Naturalistic context – usually work with real words in meaningful contexts


Phonological intervention basic plan

Phonological Intervention – Basic Plan

  • 1. Select target words.

  • 2. Discuss target words to clarify meaning.

  • 3. Confirm discrimination between words.

  • 4. Production practice – often use role reversal; child attempts words and SLP picks up pictures (may need phonetic training here if incorrect).

  • 5. Practice in units above word level.


Phonological intervention selecting organizing targets

Phonological Intervention - Selecting / Organizing Targets

  • Several options available

    • a. Distinctive features approach

    • b. Minimal opposition approach.

    • c. Maximal opposition approach.

    • d. Multiple opposition approach

    • e. Natural patterns (processes) approach.


Not all contrasts are equal

Not all contrasts are equal

  • Consider the following contrast pairs:

    • pin – bin; pin – sin; pin – gin.

  • All differ by one phoneme so we can call them all “minimal pairs”.

  • But the pairs are different in terms of numbers of features not shared:

    • pin – bin (1; voicing).

    • pin – sin (2; place, manner).

    • pin – gin (3; place, manner & voicing).


A distinctive features approach

a. Distinctive Features Approach

  • Based on the assumption that the child has failed to learn a particular feature.

  • Really teaching features, not phonemes.

  • Usually focus on one feature at a time.

    • Select two sounds – one that includes the feature and one that does not.

    • As much as possible the two sounds should differ by as few features as possible (preferably only one).


A distinctive features approach1

a. Distinctive Features Approach

  • Video

  • Illustrates basic plan for all approaches.


B minimal opposition approach

b. Minimal Opposition Approach

  • Ultimate Targets = missing phonemes.

  • Contrast the target phoneme with another that child can produce.

    • Contrasting sound should differ from the target as little as possible.

    • Ideal = only differs on one feature.


C maximal opposition approach

c. Maximal Opposition Approach

  • Based on the idea that error sounds should be contrasted with VERY different sounds.

    • Contrasting sound differs from the target by as many features as possible.

    • Makes the error sound stand out more.

    • E.g., /s/ vs. /b/ or /k/ vs. /l/

  • Several studies have suggested that generalization may be faster with this approach.


C maximal oppositions approach

c. Maximal Oppositions Approach

  • Two versions of this now proposed:

    • 1. error sound contrasted with a sound child already has mastered.

    • 2. contrast between two different error sounds (i.e., neither currently correct).

      • Sometimes referred to as the “empty-set” approach.


D multiple oppositions approach

d. Multiple Oppositions Approach

  • Most useful when one phoneme is being used for more than one other.

    • E.g., child who uses /t/ for /k,s,c,./.

    • Called a collapse (several phonemes collapsed into one).

  • Basic idea is to create a set of contrasting words and focus on all of them at once.

    • E.g., targets for above = two, Sue, shoe, chew

    • E.g., ate, ache, ace, H (letter)

    • (note – may not be able to find words for all the targets every time; be sure to include error sound).


D multiple oppositions

d. Multiple Oppositions

  • Idea is to create maximum "cognitive" stress on the sound system and force a complete reorganization.

  • Does impose great "semantic" demands on the child.

    • Lots of different meanings to keep track of.

    • May not be appropriate for children with poor cognitive skills.


E natural patterns approach

e. Natural Patterns Approach

  • Create contrasts based on the patterns observed.

    • Patterns can be derived from Khan-lewis (after GFTA) or Hodson’s test or analysis of spontaneous speech.

  • Contrast child’s usual productions with the targets.


Intervention cas

Intervention - CAS

  • Recall – it’s a motor speech disorder with sequencing the big issue.

  • Need to train to get consistency so lots of drill and practice needed.

  • Need to train flexibility – teaching them to organize programs, not memorize particular movements.


Intervention cas1

Intervention - CAS

  • These children often have a limited number of sounds they can produce correctly.

  • Often have a limited number of syllable shapes they can handle.

  • Need to improve both.


Intervention cas2

Intervention - CAS

  • How do we:

    • Increase phonetic inventory

    • Increase syllable shape inventory

    • Improve consistency

    • Maximize flexibility

  • all at the same time?

  • AND not create demands that are too hard to manage?


Intervention cas3

Intervention - CAS

  • Three basic principles:

    • 1. Train new phonemes using syllable shapes they can already handle.

    • 2. Train new syllable shapes using phonemes they have already mastered.

    • 3. Cycle through a small number of examples randomly to maintain flexibility.


Speech sound disorders

General Q & A


  • Login