Success with Speech Sound Disorders
Finding the Best Fit for English and
Spanish Speakers
Scott Prath, M.A.
Mary Bauman, M...
Speech vs. Language
• Receptive
• Expressive
• Syntax
• Pragmatics
• Morphology
• Semantics
 Articulation
 Phonology
 ?...
Outline for today
• We are going to compare our conceptions of
“speech” disorders and “language” disorders
• We will break...
Who does this apply to?
• School-based Intervention?
• Early Childhood Intervention?
• Public / Private?
• Rural / Urban?
...
Speech Sound Disorder Tree and Comparison Chart
Click here to download this chart as a pdf.
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to listen to this course live?
Click here to visit 
the online courses.
Defining Speech Sound
Disorders(SSD)
• 40-60% Co-morbidity LI and
SSD in Pre-K
• 15% Co-morbidity LI and
SSD at age 6
Shri...
Seven Subtypes of SSD (Shriberg)
• Genetic
• Otitis Media
• Apraxia
• Dysarthria
• Psychosocial Involvement
• 2 groups bas...
Speech Sound
Disorders
Phonology
1.
Delayed
Phonological
2.
Consistent
Deviant
3.
Inconsistent
Deviant
Articulation
4.
Art...
57%
21%
9%
13%
5.  
Structural 
Anomaly
1.   Delayed 
Phonological
4.   Articulation 
Disorder
3.  Inconsistent 
Deviant
2...
All of the documents and charts in this presentation 
can be downloaded from our Free Resource Library.
Click here to visi...
Click for Audio‐over‐Powerpoint Presentation
Delayed Phonological Skills
• Definition:
▫ Phonological system similar to younger, typically
developing children. Most ph...
Consistent Deviant
Phonological Disorder
• Definition:
▫ Systemic use of deviant phonological rules (i.e.,
error patterns ...
Typical
Phonological
Patterns
Atypical
Phonological
Patterns
•Cluster Reduction
•Liquid Simplification
•Stopping
•Velar Fr...
Inconsistent Deviant
Phonological Disorder
• Definition:
▫ Variable productions of the same words or
phonological features...
Wait!
That sounds like apraxia!
• Both characterized by inconsistency
• Those with childhood apraxia of speech (CAS):
▫ Wo...
Articulation Disorder
• Definition:
▫ An inability to produce a perceptually acceptable
version of particular phonemes, ei...
Structural Anomalies
• Definition:
▫ Low intelligibility that is the result of or
compromised by atypical physical develop...
Speech Sound
Disorders
Phonology
1.
Delayed
Phonological
2.
Consistent
Deviant
3.
Inconsistent
Deviant
Articulation
4.
Art...
What types of clefts exist?
• A cleft lip (CL) is a
separation in the upper lip.
• A cleft palate (CP) is an
opening in th...
What types of cleft palates
exist?
• A cleft palate can be:
~1/750 live births
▫ unilateral 14%
▫ bilateral 37%
▫ submucou...
When does a cleft occur?
5 ½ and 6 weeks in utero
5.
Structural
Anomaly
A word on VPI
• Velo-pharyngeal Insufficiency
▫ The velum (velo) is not contacting the pharynx
(back wall of the throat)
▫...
Differentiated Treatment
• Research considering the
subgroups of speech disorders
found that children respond
differently ...
Differentiated Treatment
Interventions must consider:
• Language of the home
• Target selection
▫ Early vs. later developi...
Delayed Phonological Skills
• Pattern-based approaches
▫ Distinctive Feature approach
▫ Phonologically-based intervention
...
Delayed Phonological Skills
• Example:
Phonological Contrast
Target: Stopping
▫ sun—bun
▫ shin—pin
▫ shoe—two
▫ thick—tick...
Delayed Phonological Skills
• Example:
Minimal Pairs
Target: Stopping
▫ sun—bun
▫ shin—pin
▫ shoe—two
▫ thick—tick
1.
Dela...
Consistent Deviant Phonological
Disorder
• Example:
Hodson’s Cycles Approach
Week 1: Weak syllable deletion
ma-ri-po-sa, c...
Inconsistent Deviant
Phonological Disorder
• Goal of intervention is CONSISTENCY at the
single word level.
• Example of th...
• Core vocabulary intervention
• This therapy approach resulted in greater
change in children with inconsistent speech
dis...
Video Review
• Core vocabulary approach
• This therapy approach resulted in greater
change in children with inconsistent s...
Example:
• List of 50 target words chosen for child
• 10 words targeted during the week
• Consistent words then removed fr...
Articulation Disorder
• Traditional Artic/motor-based approaches
▫ Teach motor behaviors associated with the
production of...
Articulation Disorder
Example: misarticulation of /s/ phoneme
1. (Sensory-perceptual training) of /s/
2. Production traini...
Structural Anomalies
Communication goals/ Outcomes for Structural
Anomalies
• Increase Vowel Repertoire
• Increase Consona...
Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation (a)
▫ In strings (a,a,a,a)
▫ In opposition...
Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation
(a)
▫ In strings (a,a,a,a)
▫ In opposition...
Increase Vowel Repertoire
Video Review
• Take a vowel inventory
▫ Target vowels in isolation
(a)
▫ In strings (a,a,a,a)
▫ ...
Increase Consonant Inventories
• Hi
• Hello
• Hey
• Mommy
• More
• Me
• No
• Whoa
• Wow
• Honey
• Mamá
• No
• Mío
• Niña
•...
Increase Consonant Inventories
• Baby
• Boy
• Pop
• Pooh
• Pie
• Toy
• Doll
• Daddy
• Cookie
• Go
• Papá
• Bebé
• Boca
• G...
Increase Vocabulary
• Sounds and vocabulary develop in tandem
• Do we:
▫ Focus on articulation to give her the sounds to
p...
Increase Vocabulary
• Vocabulary development should be targeted with
sound development
▫ Choose words that:
 Are common a...
Increase Oral Airflow
• A child with a cleft does not have control over
the air leaving their throat
• In typical developm...
Video Review
• Request an easy repetition
(muh,muh,muh)
▫ After the child starts
repeating, plug his nose
• Inhale deeply,...
Decrease Use of Nasal and
Glottal Sounds
• Growls and nasal sounds are typical for young infants
but children with clefts ...
VPI Pyramid
Click here to download this chart as a pdf.
Click here to download this chart as a pdf.
Click to visit www.bilinguistics.com
Difference or Disorder? 
Understanding Speech and Language 
Patterns in Culturally and Linguistically 
Diverse Students
Ra...
Success with Speech Sound Disorders: Finding the Best Fit for English and Spanish Speakers
Success with Speech Sound Disorders: Finding the Best Fit for English and Spanish Speakers
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Success with Speech Sound Disorders: Finding the Best Fit for English and Spanish Speakers

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This presentation reviews how to better identify and treat speech disorders and evaluates existing therapy approaches and programs for addressing them. Speech sound disorders are classified into five distinct subgroups. You will learn how to determine which strategies are most appropriate for a child, depending on his/her types of errors. This presentation also describes the differences in articulatory and phonological development and error patterns in Spanish and in English.

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  • Schools have developed different speech-only programs and have shown success in English. Many are now trying to implement them in Spanish. One of the things that drove us to do this presentation is that people have been creating these intensive programs for Speech and we have been approached about how to set one up in Spanish. There was a lot of value in this exercise:Let’s take a minute and pretend that you are charged with developing a speech program for all the children your site sees. You have to come up with a way to best describe and treat the different variations on the disorder. Would you treat this new department the same way that you treat your caseload? How would you provide treatment to 30 unintelligible students? How would you divide them up? What kinds of intervention tools would you use? Today we are going to discuss:
  • Then at the end, if we have time we are going to do some case studies to try to synthesize the information into practical information for you to use at work. We are also going to Address Speech Differences with Spanish Development
  • Ellen Note: These were meant for SLP use and not for teachers.
  • There is a vast difference between how we treat language disorders and how we treat speech disorders related to the types of interventions we provide, the types of goals we write, the finite way in which we identify language abilities and how we are going to measure success. With speech we typically identify which sounds or processes are problematic, how intelligible the child is, and what the context is that the child is unintelligible (word level, running speech)The differences in intervention with Sound Disorders are often more closely related to the personality of the SLP than they are to the specific type of sound class disturbance. He’s an oral-motor guy, that’s all he does. That women is a PROMPT specialist. But what if we had a professional taxonomy for speech in our head that rivals how we break down language. If we had 4 speech categories here like we have language categories would we target the disorder differently? The research is out there. Let’s see how speech can be further understood.What we are going to do today is make an argument for approaching Speech in the same way that we approach language. If we use a more specific qualification of system for speech we can more greatly target goals and increase dismissals.
  • One clinically useful method to subtype children with SSD is to group themaccording to whether or not the SSD is accompanied by additional language impairmentThis dichotomy has the advantage from an educational standpoint because it is a good predictor of difficulty in the classroom. The authors suggest that speech sound production and spoken and written language relyon both shared and unshared processes. Therapy targets can incorporate reading strategies that are also deficientThe disadvantage to this classification is that it does not identify degree or type of unintelligibility, Either you have other difficulties and speech problems or just speech problems(LI). Shriberg, Tomblin, and McSweeny (1998) report 11–15% co-morbidity of speechdelay with LI at 6 years of age, with considerably higher co-morbidity rates estimatedfor preschool children with speech delay (40–60%; Shriberg & Kwiatkowski, 1994).Numerous studies have validated the utility of this dichotomy by demonstrating pooreroutcomes for children with combined SSD and LI than for children with isolated SSUseful in predicting deficiencies in spelling and reading decoding - Lewiset al., 2002; Young et al., 2002).D
  • The big difference between this taxonomy and the previous is that LI may be co-morbidwith any of these categories, but is not considered in defining any of the subBased on a complexdisorder framework, this classification system proposes seven subtypes of SSD: speechdelay-genetic, speech delay-otitis media with effusion, speech delay-apraxia, speechdelay-dysarthria, speech delay-developmental psychosocial involvement, and twocategories of speech errors limited to distortions of speech sound types
  • Ellen Note: These aren’t mutually exclusive. A child can share processes from across the different groups.Another classification system was proposed by Dodd (1995).***CITE THE NUMEROUS RESEARCHERS WHO’VE BEEN ABLE TO CLASSIFY INTO THESE FOUR GROUPS This system classifies SSDinto five subtypes including articulation disorder, delayed phonological acquisition,consistent deviant disorder, inconsistent disorder, and other (including dysfluency,dysarthria, and apraxia of speech). Dodd’s system is based on the types of speech sounderrors observed rather than the hypothesized etiological basis. Distinctions are madebetween delayed and deviant development, articulation and phonological errors, and theconsistency of the speech sound errors. She has an ‘‘other’’ category which is defined by an underlying basis for the errors. For the purpose of this presentation we are going to focus on unintelligibility due to structural anomalies such as VPI and CL&PDodd (1995) hasdemonstrated the prognostic utility of these subtypes in studies showing different writtenlanguage outcomes for children with speech sound delay than for children with deviantspeech sound errors.
  • Ellen Note: May have delayed phonprocessin addition to deviant processes.
  • **broader and more abstract; rule-driven (vs. artic—motor component)*Children can often produce the sounds, but prob is they don’t use right sound at the right time*Cause: Little known about the cause of phonol. delay, but present with a cognitive-linguistic deficitCommon Patterns (both groups—more than 10%) **SPANISH-SPEAKING!!! Aside: Common patterns (approx. 10%) for those w/ phon dis: 1. initial consonant deletion??? 2. Weak syllable deletion 3. Velar Fronting; Also Less Common for both (palatal fronting, assimilation, and final cons. deletion) and Uncommon (deaffrication, backing, spirantization, denasalization)…**LOOK UP! SAME PROCESSES FOR ENGLISH-SPEAKING??
  • Cause: impaired ability to abstract and/or organize knowledge about the nature of the phonological system; poor understanding of the phonemic rules of language (on legality awareness task); deficit at internal organizational level of speech-processing chain*Children in this group performed more poorly than other speech-impaired children on tasks of phonological awareness, such as recognition of alliteration and rhyme.
  • *unpredictable variation between a relatively large number of phonesCause: lack of a stable phonological system because of a deficit in phonological planning (Aside: phon. planning—process of phoneme selection and sequencing)Ellen Note: STUDY the core vocabulary in a sense stabilizes the phonological system. Core vocabulary for inconsistent deviant bilinguals?
  • *Children with inconsistent disorder are better in imitation than in spontaneous-Apraxia—disrupted speech motor controlAdd’l characteristics:1. Disturbances of prosody including overall slow rate; timing deficits in duration of sounds and pauses between and within syllables contributing to the perception of excess and/or equal stress, "choppy" and monotone speech.2. At some point in time, groping or observable physical struggle for articulatory position may be observed (possibly not present on evaluation, but observable at some point in treatment).Tx: Underlying disorder is motoric; therefore, would use a motor speech approach VS inconsistent: deficit is in phonological planning (i.e., selection and sequencing of phonemes)
  • The typical “artic” students -may consistently produce a specific distortion (e.g., lateral lisp) or substitute another phoneme (e.g., [w] for /r/)-usually more intelligibleCause: due to a peripheral problem where the wrong motor program for the production of specific speech sounds has been learned.**motor component!!
  • Clefts result from incomplete development of the lip and/or palate in the early weeks of pregnancy. During this time the face is being formed - the top and the two sides develop at the same time and grow towards each other, finally fusing in the middle.
  • submucous cleft palate is where, although the surface layers of the soft palate (mucous membrane) are complete, the underlying muscle is incomplete. A submucous cleft of the hard palate is where the bony element is incomplete.PrevalenceClefts occur in ~1/750 live birthsEstimated prevalence by type:Lip only 14%Palate only 37%Lip and Palate 49% (77% are unilateral left)Estimated data by race:Asian and Caucasian populations more susceptibleBlack populations present with ½ the rate of Asians and CaucasiansHispanic data are inconclusive
  • Week 7Upper lip joinsNose comes together
  • VPI means velo= velum pharyngeal = back wall of throat, is not coming into contact when it is supposed to. This is a term that you need to be familiar with but I am not going to go into too much detail on because it is most likely being followed by the cleft palate team.In laymen’s terms it describes why air is escaping through the nose and why the child is unable to build up pressure when making consonants. Normally, the second surgery is targeting this problem and trying to close off this gap or introduce muscle function that causes this. It can be caused by a fistula (hole), muscle function problems, too wide of a gap in the back of the mouth.Your concern with this is that if after a while after the second surgery if a child appears to be losing all of his air through his nose, you may want to recommend a check up.Some VPI is common after a surgery and it takes a while after the surgery for a child to function better both due to swelling and due to practice and strengthening his new muscle.A simple test is to ask the child to repeat buh buh buh. If they say muh muh muh, air is going out through the nose. Squeeze their nose and ask them to say buh buh buh again. If they can say buh buh buh then air is going out through the nose.
  • Researchers like Holm, Dodd, and Bradford monitored the effectiveness and efficiency of intervention approaches provided to the different groups of speech sound disorders. Approaches that were effective for a child in one or two subgroups did not result in improvement for children who made other types of errors. We’ll talk about the approaches that will be appropriate for each group and how to determine the most effective approach based on the errors and targets chosen. (FIX LAST SENTENCE!)
  • We’re going to begin discussing treatment for these various subgroups and show you how tailoring your treatment to the specific errors a child produces can result in better success for your children with speech sound disorders. Researchers like Holm, Dodd, and BradfordAll intervention plans must consider three parameters (?) based on the needs of the child. First, we must decide whether to target early-developing sounds or later-developing sounds. There is conflicting research in this area. Gierut and others (1996) found evidence that greater system-wide change occurred when targets were later developing sounds. (NOTE: LOOK UP DESCRIP. OF THEIR TWO GROUPS) On the other hand, in 2001 Rvachew and Nowak’s treatment study for children with mod. and severe speech delays revealed greater generalization when early developing sounds were targeted first. Another decision for selecting targets is whether or not we should choose sounds for which the child is stimulable or if we should work at a more difficult level to see transer to the stimulable sounds. Conflicting results also exist regarding greatest success with this factor. When looking at whether the children’s produced consistent sound substitutes in all instances or variable substitutes both within and across word positions, Forrest and colleagues (2001) reported that children with inconsistent substitutes did not benefit from traditional articulation therapy techniques. We’re going to focus on target selection for children based on their subgroup as well as the approach or method most appropriate for the types of errors produced. An additional factor of intervention that we will not go into today is how to implement the approach chosen. For example, a clinician may choose to work toward a set criterion for a single target before moving on or teaching several targets simultaneously for predetermined periods of time (such as Hodson’s cycle approach).
  • Crosbie, Holm, & Dodd (2005) compared phonological contrast therapy with another approach described later for children with phonological impairments. They found that phonological contrast therapy resulted in greater change in children with consistent speech disorder (compared to other approaches that were found more effective for children in the subgroup of inconsistent speech disorder. They made more rapid progress…… (FINISH!!!!)Using contrasting sounds that change the meaning of words
  • Aim of phonological contrast therapy is to reorganize a child’s linguistic system by teaching him to develop meaningful contrasts of words. By providing pairs of words that contrast in meaning (using the child’s error together with a target phoneme), the child will learn that his production results in a breakdown in communication and how differences in sounds change the meaning of the message.With these approaches, one particular phoneme can be targeted (assuming that generalization will occur to other phonemes that are affected by that same pattern), or a range of contrasts within an error pattern can be targeted simultaneously.
  • Aim of phonological contrast therapy is to reorganize a child’s linguistic system by teaching him to develop meaningful contrasts of words. By providing pairs of words that contrast in meaning (using the child’s error together with a target phoneme), the child will learn that his production results in a breakdown in communication and how differences in sounds change the meaning of the message.With these approaches, one particular phoneme can be targeted (assuming that generalization will occur to other phonemes that are affected by that same pattern), or a range of contrasts within an error pattern can be targeted simultaneously.
  • Aim of phonological contrast therapy is to reorganize a child’s linguistic system by teaching him to develop meaningful contrasts of words. By providing pairs of words that contrast in meaning (using the child’s error together with a target phoneme), the child will learn that his production results in a breakdown in communication and how differences in sounds change the meaning of the message.With these approaches, one particular phoneme can be targeted (assuming that generalization will occur to other phonemes that are affected by that same pattern), or a range of contrasts within an error pattern can be targeted simultaneously.
  • Depending on the phonemic structure of the language of intervention, some approaches may be easier than others to implement. In Spanish, minimal pairs are not as frequent as they are in English, making this approach more difficult. One suggestion would be to use Hodson’s Cycles Approach to target the errors. For one child, Hodson’s approach was implemented to target weak syllable deletion, initial consonant deletion, and stopping. The first two processes fall in the subgroup of deviant disorder, but this child also made errors of stopping (a more common process seen in typically-developing children as well). Even though he presented with a combination of both more- and less- common phonological processes, this pattern-based approach was very successful to remediate his use of all processes.
  • Depending on the phonemic structure of the language of intervention, some approaches may be easier than others to implement. In Spanish, minimal pairs are not as frequent as they are in English, making this approach more difficult. One suggestion would be to use Hodson’s Cycles Approach to target the errors. For one child, Hodson’s approach was implemented to target weak syllable deletion, initial consonant deletion, and stopping. The first two processes fall in the subgroup of deviant disorder, but this child also made errors of stopping (a more common process seen in typically-developing children as well). Even though he presented with a combination of both more- and less- common phonological processes, this pattern-based approach was very successful to remediate his use of all processes.
  • Core Vocabulary Intervention; targets the underlying inability to form phonological plans/templates rather than the production of certain phonemes or phoneme classes.Dodd and colleagues (2004) detail an intervention program where the child, parents and teacher selected a list of 50 words that were functionally “powerful” for the child. Words commonly included were peoples names (family, teacher), pet names, places (e.g. school, toilet, shops), function words (e.g., please, sorry, thank you), foods (water, drink, chips, Cheerios), and child’s favorite things (teddy, games, Dora). **Chosen b/c frequently used in functional comm’n—not according to word shape or segments. *Increasing intelligibility for these words motivated the use of consistent productions.*CONSISTENCY--Even if the response is incorrect (chutterdy for butterfly) you would want it to be “chutterdy” consistently. Tx: A careful inventory of the child's current consonant and vowel inventory may provide a clue as to beginning words (or approximations) that may be possible.  Word choices should take into account words and functions that a child would want to communicate.**Note: MAY also benefit from phonological contrast therapy once consistency is establishedThis supports a bilingual approach because targeting the phonological plan in either language will carry over to both languages (cite) (Because you not remediating the phoneme but you are remediating the inconsistency so this is what transfers between the languages.)
  • LOOK UP!!! *Compared to just traditional artic approaches or also compared to phonological approaches as well (Pretty sure the latter….
  • LOOK UP!!! *Compared to just traditional artic approaches or also compared to phonological approaches as well (Pretty sure the latter….
  • 10 words randomly selected from set of 50 target words. Child’s best production was achieved by teaching the word sound-by-sound, using cues such as syllable segmentation, imitation and cued articulation. Individual sounds within a syllable were also taught explicitly, and feedback was provided for each attempt. In some cases, a child’s best production still included developmental errors that were accepted, as long as the production was consistent.Daily practice is carried out by the parents and teacher, and production of those words are reinforced in everyday communication situations.
  • Compared with other groups, these kids generally have fewer phonemes to target.Van Riper (5 phases): **May not be necessary to pass through all stages of each phase1. sensory-perceptual training—includes identification, isolation, stimulation, discrimination2. Production training—sound establishment3. Production training—sound stabilization (isolation, nonsense syllables, words, phrases, sent, convo)4. Transfer and Carryover5. MaintenanceMcDonald—theoretical assumption that all sounds can be produced correctly in at least one phonetic context
  • For a child with an incorrect production/distortion of /s/ who may, for example, be able to correctly produce other fricative sounds, one might choose a more traditional motor approach for remediation of this phoneme. Based on Van Riper’s traditional approach, a sequence of steps may be used to improve production of the target. While not all of his original treatment stages are included today (e.g. sensory-perceptual/”ear training”), the progression from sound establishment and then stabilization at different complexity levels all the way to transfer in other situations and carryover to conversation is/are (?) still important _____s in intervention approaches today for articulation errors.
  • For a child with an incorrect production/distortion of /s/ who may, for example, be able to correctly produce other fricative sounds, one might choose a more traditional motor approach for remediation of this phoneme. Based on Van Riper’s traditional approach, a sequence of steps may be used to improve production of the target. While not all of his original treatment stages are included today (e.g. sensory-perceptual/”ear training”), the progression from sound establishment and then stabilization at different complexity levels all the way to transfer in other situations and carryover to conversation is/are (?) still important _____s in intervention approaches today for articulation errors.
  • So how do we address communication difficulties with the families. Here are 5 main goals and then we are going to address how to work on each one in therapy.
  • Prior to closing the palate, a child needs to focus on low pressure sounds. These are sounds that are made with the throat (h) or with the nose (m,n) and don’t depend on the child being able to build up pressure and create other sounds.Prior to their palate repair, you want to also practice high pressure sounds by asking them to repeat you and when they begin, plug their nose. Next slide You wouldn’t expect them to have much success but you are laying the groundwork for therapy after the surgery takes place.
  • Next slide You wouldn’t expect them to have much success but you are laying the groundwork for therapy after the surgery takes place.High pressure sounds consist of sounds that explode (d,t,p,b,g,k) when air leaves the mouth (not nose) only.
  • Early phonological development and lexical development are closely related. This is to say that as a child’s sounds develop, their vocabulary also expands. It goes without saying that a child with a CLP was impaired sound development and therefore may be behind on vocabulary and language development, even after the surgeries have taken place.So the question is, do you just focus on speech in order to give her the sounds in order to produce more language or do you focus on language to give them a place to practice their sounds?Data reported by Scherer suggested that “intervention that is designed to enhance general language development results in improved sound inventory as well. This is good news for all interventionists. I know that some EISs are not comfortable with articulation strategies and he we have more proof that language intervention is important.Hardin-Jones and Chapman Jan 08 LSHSS
  • Proper tX targets video
  • A child with a cleft expresses all of her air without control. The eventual stopping or slowly releasing this air is what produces speech. Independent of where they are in their surgery, we have to start familiarizing the child with an explosion and/or release of air through the mouth.
  • A child with a cleft expresses all of her air without control. The eventual stopping or slowly releasing this air is what produces speech. Independent of where they are in their surgery, we have to start familiarizing the child with an explosion and/or release of air through the mouth.
  • A child with a cleft expresses all of her air without control. The eventual stopping or slowly releasing this air is what produces speech. Independent of where they are in their surgery, we have to start familiarizing the child with an explosion and/or release of air through the mouth.
  • 13% of 63, 4-5 year olds presented with some form of voice disorderharshness, breathiness, nodulesA child with a cleft will have the greatest ability to produce sounds with the nose and throat. Parent’s, excited about communication, will reinforce growls and monster sounds. They think it can be cute. In typically developing infants they reduce the use of these sounds when more consonants come in. A child with a cleft can retain these sounds, making them habit, and then they are hard to get rid of. Hardin-Jones, chapman, scherer, June 2006 ASHA leader
  • Ellen Note: These were meant for SLP use and not for teachers.
  • Success with Speech Sound Disorders: Finding the Best Fit for English and Spanish Speakers

    1. 1. Success with Speech Sound Disorders Finding the Best Fit for English and Spanish Speakers Scott Prath, M.A. Mary Bauman, M.A. TSHA Convention: April 2011
    2. 2. Speech vs. Language • Receptive • Expressive • Syntax • Pragmatics • Morphology • Semantics  Articulation  Phonology  ?  ?  ?  ?
    3. 3. Outline for today • We are going to compare our conceptions of “speech” disorders and “language” disorders • We will break down our understanding of speech disorders into 5 distinct groups • For each speech disorder category we will provide: ▫ A description of the disorder ▫ Our caseload examples- video examples ▫ Our caseload examples- therapy techniques
    4. 4. Who does this apply to? • School-based Intervention? • Early Childhood Intervention? • Public / Private? • Rural / Urban? • Group / Individual Intervention? Dividing sound disorders into distinct classes can be implemented across all situations!
    5. 5. Speech Sound Disorder Tree and Comparison Chart Click here to download this chart as a pdf.
    6. 6. Do you need Continuing Education or want  to listen to this course live? Click here to visit  the online courses.
    7. 7. Defining Speech Sound Disorders(SSD) • 40-60% Co-morbidity LI and SSD in Pre-K • 15% Co-morbidity LI and SSD at age 6 Shriberg, Tomblin, and McSweeny (1998) Advantage: Useful in predicting deficiencies in academic outcomes (spelling, reading, decoding) Disadvantage: Does not differentiate degree or type of unintelligibility SSD and Language Impairment Dichotomy
    8. 8. Seven Subtypes of SSD (Shriberg) • Genetic • Otitis Media • Apraxia • Dysarthria • Psychosocial Involvement • 2 groups based on errors Advantage: Provides diagnostic markers to categorize child Disadvantage: Does not differentiate between articulation and phonology Defining Speech Sound Disorders(SSD)
    9. 9. Speech Sound Disorders Phonology 1. Delayed Phonological 2. Consistent Deviant 3. Inconsistent Deviant Articulation 4. Articulation Disorder 5. Structural Anomaly (other) Dodd, 1995
    10. 10. 57% 21% 9% 13% 5.   Structural  Anomaly 1.   Delayed  Phonological 4.   Articulation  Disorder 3.  Inconsistent  Deviant 2.   Consistent  Deviant Broomfield and Dodd, 2004 Defining Speech Sound Disorders(SSD)
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    12. 12. Click for Audio‐over‐Powerpoint Presentation
    13. 13. Delayed Phonological Skills • Definition: ▫ Phonological system similar to younger, typically developing children. Most phonemes can be articulated; however, discrepancy exists between phonological processes observed and child’s chronological age. • What we see: ▫ Multiple misarticulations ▫ Errors can be classified by patterns ▫ See typical patterns that persist (e.g., stopping, cluster reduction, liquid simplification) 1. Delayed Phonological
    14. 14. Consistent Deviant Phonological Disorder • Definition: ▫ Systemic use of deviant phonological rules (i.e., error patterns that are atypical of normal phonological development). ▫ E.g., deleting all syllable-initial consonants • What we see: ▫ Less intelligible ▫ Sound production may be age appropriate (Difficulty producing sounds in certain contexts) 2. Consistent Deviant
    15. 15. Typical Phonological Patterns Atypical Phonological Patterns •Cluster Reduction •Liquid Simplification •Stopping •Velar Fronting •Weak Syllable Deletion •Assimilation •Final Consonant Deletion •Palatal Fronting •Deaffrication •Initial Consonant Deletion •Backing •Spirantization •Denasalization •Addition •Palatalization •Metathesis •Lisping •Nasalization •Spirant Deletion Delayed or Deviant Phonological Patterns? 2. Consistent Deviant Goldstein and Iglesias, 2006 from CPAC-S 1. Delayed Phonological
    16. 16. Inconsistent Deviant Phonological Disorder • Definition: ▫ Variable productions of the same words or phonological features in the same contexts and across contexts. • Examples: ▫ Say “butterfly”  “Chutterdy” ▫ Again, say “butterfly”  “sunnerny” 3. Inconsistent Deviant
    17. 17. Wait! That sounds like apraxia! • Both characterized by inconsistency • Those with childhood apraxia of speech (CAS): ▫ Worse in imitation than in spontaneous production ▫ Differ in cues effective to elicit production of words ▫ Have oral-motor difficulties (e.g., groping)
    18. 18. Articulation Disorder • Definition: ▫ An inability to produce a perceptually acceptable version of particular phonemes, either in isolation or in any phonetic context. • What we see: ▫ “/r/, /s/, and /l/ kids”—errors with a particular sound ▫ Can be highly intelligible 4. Articulation Disorder
    19. 19. Structural Anomalies • Definition: ▫ Low intelligibility that is the result of or compromised by atypical physical development • Examples: ▫ Deaf Speech ▫ Cleft Lip and Palate ▫ Velo-Pharyngeal Insufficiency 5. Structural Anomaly
    20. 20. Speech Sound Disorders Phonology 1. Delayed Phonological 2. Consistent Deviant 3. Inconsistent Deviant Articulation 4. Articulation Disorder 5. Structural Anomaly (other) Dodd, 1995
    21. 21. What types of clefts exist? • A cleft lip (CL) is a separation in the upper lip. • A cleft palate (CP) is an opening in the roof of the mouth. • A cleft lip and palate (CLP) extends through both. 5. Structural Anomaly
    22. 22. What types of cleft palates exist? • A cleft palate can be: ~1/750 live births ▫ unilateral 14% ▫ bilateral 37% ▫ submucousal with bifid uvula 49% (77% are unilateral left) 5. Structural Anomaly
    23. 23. When does a cleft occur? 5 ½ and 6 weeks in utero 5. Structural Anomaly
    24. 24. A word on VPI • Velo-pharyngeal Insufficiency ▫ The velum (velo) is not contacting the pharynx (back wall of the throat) ▫ Can be caused by:  Muscle weakness  A large opening  Insufficient muscle function  Adenoids and tonsils 5. Structural Anomaly
    25. 25. Differentiated Treatment • Research considering the subgroups of speech disorders found that children respond differently to therapy approaches that target different aspects of the speech-processing chain. (Alcorn et al., 1995, Holm et al., 1997, Dodd and Bradford 2000) • One treatment model or structure may not fit all children or may not fit a child throughout the course of intervention.
    26. 26. Differentiated Treatment Interventions must consider: • Language of the home • Target selection ▫ Early vs. later developing sounds ▫ Stimulability ▫ Error consistency • Approach/Methods • Implementation structure
    27. 27. Delayed Phonological Skills • Pattern-based approaches ▫ Distinctive Feature approach ▫ Phonologically-based intervention  Cycles  Phonological contrast therapy (Crosbie et al., 2005)  minimal pairs  maximal oppositions  empty set,  multiple oppositions 1. Delayed Phonological
    28. 28. Delayed Phonological Skills • Example: Phonological Contrast Target: Stopping ▫ sun—bun ▫ shin—pin ▫ shoe—two ▫ thick—tick 1. Delayed Phonological
    29. 29. Delayed Phonological Skills • Example: Minimal Pairs Target: Stopping ▫ sun—bun ▫ shin—pin ▫ shoe—two ▫ thick—tick 1. Delayed Phonological
    30. 30. Consistent Deviant Phonological Disorder • Example: Hodson’s Cycles Approach Week 1: Weak syllable deletion ma-ri-po-sa, ca-ba-llo Week 2: Initial consonant deletion pato, mano, bote Week 3: Stopping (a more typical pattern) foto, sopa Approach includes Metaphonological awareness and auditory bombardment of sounds 2. Consistent Deviant
    31. 31. Inconsistent Deviant Phonological Disorder • Goal of intervention is CONSISTENCY at the single word level. • Example of therapy approach: ▫ Core vocabulary (that focuses on consistency of whole-word production) 3. Inconsistent Deviant
    32. 32. • Core vocabulary intervention • This therapy approach resulted in greater change in children with inconsistent speech disorder compared to more traditional approaches (Crosbie et al., 2005) Inconsistent Deviant Phonological Disorder 3. Inconsistent Deviant
    33. 33. Video Review • Core vocabulary approach • This therapy approach resulted in greater change in children with inconsistent speech disorder compared to more traditional approaches (Crosbie et al., 2005) Inconsistent Deviant Phonological Disorder 3. Inconsistent Deviant
    34. 34. Example: • List of 50 target words chosen for child • 10 words targeted during the week • Consistent words then removed from list, and new set of 10 words chosen randomly for practice • Generalization monitored through periodic probe of untreated words Inconsistent Deviant Phonological Disorder 3. Inconsistent Deviant
    35. 35. Articulation Disorder • Traditional Artic/motor-based approaches ▫ Teach motor behaviors associated with the production of a particular speech sound  Van Riper approach  McDonald’s sensory-motor approach (use of facilitative contexts)  Multiple Phoneme approach 4. Articulation Disorder
    36. 36. Articulation Disorder Example: misarticulation of /s/ phoneme 1. (Sensory-perceptual training) of /s/ 2. Production training—Sound establishment of /s/ 3. Production training—Sound stabilization of /s/ (/s/ in isolation, syllables, words, phrases, etc.) 4. Transfer and carryover 4. Articulation Disorder
    37. 37. Structural Anomalies Communication goals/ Outcomes for Structural Anomalies • Increase Vowel Repertoire • Increase Consonant Inventories • Increase Vocabulary • Increase Oral Airflow • Decrease use of Nasal and Glottal Sounds 5. Structural Anomaly
    38. 38. Increase Vowel Repertoire • Take a vowel inventory ▫ Target vowels in isolation (a) ▫ In strings (a,a,a,a) ▫ In opposition (u-I, u-I a-o, a-o) 5. Structural Anomaly
    39. 39. Increase Vowel Repertoire • Take a vowel inventory ▫ Target vowels in isolation (a) ▫ In strings (a,a,a,a) ▫ In opposition (u-I, u-I a-o, a-o) 5. Structural Anomaly
    40. 40. Increase Vowel Repertoire Video Review • Take a vowel inventory ▫ Target vowels in isolation (a) ▫ In strings (a,a,a,a) ▫ In opposition (u-I, u-I a-o, a-o) 5. Structural Anomaly
    41. 41. Increase Consonant Inventories • Hi • Hello • Hey • Mommy • More • Me • No • Whoa • Wow • Honey • Mamá • No • Mío • Niña • Niño • Ojos • En • Mano • Wawa – agua BEFORE palate repair LOW pressure words to target 5. Structural Anomaly
    42. 42. Increase Consonant Inventories • Baby • Boy • Pop • Pooh • Pie • Toy • Doll • Daddy • Cookie • Go • Papá • Bebé • Boca • Gato • Todo • Tú • Tío • Qué • Ten AFTER palate repair HIGH pressure words to target 5. Structural Anomaly
    43. 43. Increase Vocabulary • Sounds and vocabulary develop in tandem • Do we: ▫ Focus on articulation to give her the sounds to produce more language? ▫ Focus on language to give her a way to practice her sounds? 5. Structural Anomaly
    44. 44. Increase Vocabulary • Vocabulary development should be targeted with sound development ▫ Choose words that:  Are common and in their environment  Are useful  Are extremely fun (read: routines-based intervention) • Syllable should be simple CV (consonant/vowel) • Start with stops and bilabial sounds 5. Structural Anomaly
    45. 45. Increase Oral Airflow • A child with a cleft does not have control over the air leaving their throat • In typical development we stop or slowly release this air to produce speech • Regardless of what surgeries a child has undergone, we need to familiarize the child with airflow through the mouth 5. Structural Anomaly
    46. 46. Video Review • Request an easy repetition (muh,muh,muh) ▫ After the child starts repeating, plug his nose • Inhale deeply, hold your breath, and explode out with a single sound ▫ BUH!, PUH! 5. Structural Anomaly Increase Oral Airflow
    47. 47. Decrease Use of Nasal and Glottal Sounds • Growls and nasal sounds are typical for young infants but children with clefts obtain these sounds later • Parents, wanting communication, reinforce these sounds • Acknowledge the child’s attempt but then request other consonants or sounds • Pair voiceless consonants with whispered vowels puh/tuh/ku/huh • This keeps the glottis open and prevents the glottal stop from occurring 5. Structural Anomaly
    48. 48. VPI Pyramid Click here to download this chart as a pdf.
    49. 49. Click here to download this chart as a pdf.
    50. 50. Click to visit www.bilinguistics.com
    51. 51. Difference or Disorder?  Understanding Speech and Language  Patterns in Culturally and Linguistically  Diverse Students Rapidly identify speech‐language  patterns related to second language  acquisition to  distinguish difference from disorder.

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