Speech sound disorders is an umbrella term referring to any combination of difficulties with perception, motor production, and/or the phonological representation of speech sounds and speech segments that impact speech intelligibility. Known causes of speech sound disorders include motor-based disorders (apraxia and dysarthria), structurally based disorders and conditions (e.g., cleft palate and other craniofacial anomalies), syndrome/condition-related disorders (e.g., Down syndrome) and sensory-based conditions (e.g., hearing impairment. Speech sound disorders include Articulation disorder & Phonological disorder. Assessments include screening and detailed comprehensive assessment. Effective treatment of speech sound disorder include Contrast therapy, Core vocabulary approach ,Cycles Approach, Distinctive feature therapy, Naturalistic speech intelligibility intervention,Non speech oral motor therapy,Speech sound perception training.

1. EFFECTIVE INTERVENTION FOR THE
TREATMENT OF SPEECH SOUND
DISORDERS
Anshita Singh
Audiologist & speech language pathologist

2. OVERVIEW
 Speech sound disorders is an umbrella term
referring to any combination of difficulties with
perception, motor production, and/or the
phonological representation of speech sounds and
speech segments (including phonotactic rules that
govern syllable shape, structure, and stress, as well
as prosody) that impact speech intelligibility

3. CAUSES
 Known causes of speech sound disorders include
motor-based disorders (apraxia and dysarthria),
structurally based disorders and conditions (e.g.,
cleft palate and other craniofacial anomalies),
syndrome/condition-related disorders (e.g.,
Down syndrome) and sensory-based conditions
(e.g., hearing impairment).

4. CONT….
Even so, a number of studies have identified risk and
protective factors associated with speech sound disorders
in children.
Risk factors include
 pre- and perinatal problems;
 oral sucking habits (e.g., excessive sucking of pacifiers
or thumb)
 ear, nose, and throat problems;
 family history of speech and language problems;
 low parental education;
 lack of support for learning in the home.
 a more persistent and sociable temperament,
 a higher level of maternal well-being.

5. ARTICULATION DISORDER
 Speech sound disorders can impact the form of
speech sounds or the function of speech sounds
within a language. Disorders that impact the form of
speech sounds are traditionally referred to as
articulation disorders and are associated with
structural (e.g., cleft palate) and motor-based
difficulties (e.g., apraxia).

6. PHONOLOGICAL DISORDER
 Speech sound disorders that impact the way
speech sounds (phonemes) function within a
language are traditionally referred to as
phonological disorders; they result from
impairments in the phonological representation of
speech sounds and speech segments—the system
that generates and uses phonemes and phoneme
rules and patterns within the context of spoken
language.

7. INCIDENCE & PREVALENCE
 As per the country wide sample survey conducted
by Government of India in 2011, census listed
speech impairment (7.5%) as the fifth highest
disability (Males-56.25%, Females43.8%). In India,
Sreeraj, Suma, Jayaram, Sandeep, Mahima and
Shreyank (2013) found that the prevalence of
individuals at risk of communication disorders was
6.07%. the prevalence of was found to be speech
and language disorder was 9.42%.(AIISH)

8. SIGNS & SYMPTOMS
 omissions/deletions—certain sounds are not
produced but omitted or deleted (e.g., "cu" for "cup"
and "poon" for "spoon");
 substitutions—one or more sounds are
substituted, which may result in loss of phonemic
contrast (e.g., "dood" for "good" and "wabbit" for
"rabbit");
 additions—one or more extra sounds are added or
inserted into a word (e.g., "buhlack" for "black");

9. CONT….
 distortions—sounds are altered or changed (e.g.,
a lateral "s");
 whole-word/syllable-level errors—weak syllables
are deleted (e.g., "tephone" for "telephone"), a
syllable is repeated or deleted (e.g., "dada" for
"dad" or "wawa" for "water");

10. INFLUENCE OF DIALECT
 Not all sound substitutions and omissions are
speech errors. Instead, they may be related to a
feature of a speaker's dialect (a rule-governed
language system that reflects the regional and
social background of its speakers). Dialectal
variations of a language may cross all linguistic
parameters, including phonology, morphology,
syntax, semantics, and pragmatics.

11. INFLUENCE OF ACCENT
 An accent is the unique way that speech is
pronounced by a group of people speaking the
same language and is a natural part of spoken
language. Accents may be regional; for example,
someone from Kerala may sound different from
someone from Bihar. Foreign accents occur when a
set of phonetic traits of one language are carried
over when a person learns a new language.
Accents, like dialects, are not speech or language
disorders but rather only reflect differences.

12. ASSESSMENT
 Screening
 Comprehensive Assessment

13. SCREENING
 Screening is conducted whenever a speech sound
disorder is suspected or as part of a comprehensive
speech and language evaluation for a child with
communication concerns. The purpose of the
screening is to identify those who require further
speech-language/communication assessment or
referral to other professional services.

14. CONT….
 Screening may result in
 suggestions to encourage normal speech sound
development and the prevention of speech-language
impairment;
 plans to monitor speech and language development;
 referral for further speech and language assessment,
including
 a comprehensive speech sound assessment, if the
child's speech sound system is not appropriate for
his/her age and/or linguistic community,
 a comprehensive language assessment,
 a complete audiology assessment,
 a comprehensive oral motor/oral musculature
assessment;
 referral for medical or other professional services.

15. COMPREHENSIVE ASSESSMENT
 Individuals suspected of having a speech sound
disorder based on screening results are referred to
an SLP for a comprehensive assessment. The
assessment protocol may include an evaluation of
language and literacy skills
 Comprehensive assessment for speech sound
disorders typically includes
 case history;
 oral mechanism examination;
 hearing screening;

16. CONT….
 speech sound assessment (single-word testing and
connected speech sampling), including
 severity,
 intelligibility,
 stimulability,
 speech perception;
 spoken-language testing, including
 receptive and expressive language assessment,
 phonological processing;
 literacy assessment.

17. CONT….
 Assessment may result in
 diagnosis of a speech sound disorder,
 description of the characteristics and severity of the
disorder,
 recommendations for intervention targets,
 identification of factors that might contribute to the
speech sound disorder,
 diagnosis of a spoken language (listening and speaking)
disorder,
 identification of literacy problems,
 monitoring of literacy learning progress in students with
identified speech sound disorders by SLPs and other
professionals in the school setting,
 referral to other professionals as needed.

18. CASE HISTORY
 The case history typically includes gathering information
about
 family's concerns about the child's speech;
 history of middle ear infections;
 history of speech, language, and/or literacy difficulties in
the family;
 languages used in the home;
 primary language spoken by the child;
 teacher's perception of the child's intelligibility and
participation in the school setting and how the child's
speech compares with that of peers in the classroom;
 family's and other communication partners' perception of
intelligibility.

19. ORAL MECHANISM EXAMINATION
 The oral mechanism examination evaluates the
structure and function of the speech mechanism to
assess whether the system is adequate for speech
production. This examination typically
includes assessment of
 occlusion and specific tooth deviations;
 hard and soft palate (clefts, fistulas, bifid uvula);
 function (strength and range of motion) of the lips, jaw,
tongue, and velum;
 placement of the tongue at rest and during speech to
rule out tongue thrust, an oral myofunctional
phenomenon, that can affect production of some sounds
(e.g., /s/,/z/, "sh", "zh", "ch" and "j").

20. HARING SCREENING
 a hearing screening is conducted during the
comprehensive speech sound assessment. The
screening typically includes
 otoscopic inspection of the ear canal and tympanic
membrane,
 puretone audiometry,
 immittance testing to assess middle ear function.

21. SPEECH SOUND ASSESSMENT
 The acquisition of speech sounds is a
developmental process, and children often
demonstrate "typical" errors and phonological
patterns during this acquisition period. For example,
it is considered typical and acceptable for younger
children to replace later-acquired sounds, such as
/s/, with earlier-acquired sounds, such as /t/, up
until a certain age range. Developmentally
appropriate errors and patterns are taken into
consideration during assessment for speech sound
disorders in order to differentiate typical errors from
those that are unusual or not age-appropriate.

22. CONT….
 Single-Word Testing—provides identifiable units of
production and allows all sounds in the language to
be elicited in a number of contexts; however, it may
or may not accurately reflect production of the
same sounds in connected speech.
 Connected Speech Sampling—provides
information about production of sounds in
connected speech using a variety of talking tasks
(e.g., storytelling or retelling, describing pictures,
normal conversation about a topic of interest) and
communication partners (e.g., peers, siblings,
parents, clinician).

23. CONT….
 Assessment procedures typically evaluate the child's
speech sound system, including
 sounds, sound combinations, and syllable shapes
produced accurately, including
 sounds in various word positions (e.g., initial, within
word, and final word position) and indifferent phonetic
contexts,
 phoneme sequences (e.g., vowel combinations,
consonant clusters, and blends),
 syllable shapes (e.g., simple CV to complex
CCVCC);
 speech sound errors, including
 error type(s) (e.g., deletions, omissions, substitutions,
distortions, additions),
 error distribution (e.g., position of sound in word),

24. CONT….
 articulation errors—relatively consistent errors,
with preserved phonemic contrasts (e.g., /l/ and
/r/ are consistently distorted, but clearly different
from one another;
 error patterns (i.e., phonological patterns)—
systematic sound changes or simplifications that
affect a class of sounds (e.g., fricatives), sequences
of sounds (e.g., consonant clusters), or syllable
structures (e.g., complex syllable structures or
multisyllabic words.

25. SEVERITY
 Severity is a qualitative judgment made by the
clinician that indicates the significance of the
speech sound disorder on the child's
communication functioning in daily activities. It is
typically defined along a continuum from mild to
severe or profound.
 Prezas and Hodson (2010) utilize a continuum from
mild (omissions are rare; few substitutions) to
profound (extensive omissions and many
substitutions; extremely limited phonemic and
phonotactic repertoires), with distortions.

26. CONT….
 Shriberg and Kwiatkowski (1982a, 1982b) proposed
a quantitative approach in which the percentage of
consonants correct (PCC) is used to determine
severity on a continuum from mild to severe. This
type of calculation most closely aligns with the
listener's perceptions of severity. For example, a
PCC of 85-100 is considered "mild," while a PCC of
less than 50 is considered "severe."

27. INTELLIGIBILITY
 Intelligibility is a subjective, perceptual judgment,
based on how much of the child's spontaneous
speech is understood by the listener. Intelligibility
can range from "intelligible" (message is completely
understood) to "unintelligible" (message is not
understood). Intelligibility is a factor that is
frequently used when judging the severity of the
child's speech problem . The rating is on a 5-point
Likert scale: 1 = Never; 2 = Rarely; 3 = Sometimes;
4 = Usually; 5 = Always Procedures that are
“always.

28. CONT….
 A guideline for expected intelligibility can be
calculated by dividing the child's age in years by
four and converting that number into a percentage:
2-year-old: 50%; 3-year-old: 75%; 4-yearold: 100%
(Hodson, 2011)
 Articulation tests were poor predictors of connected
speech intelligibility. “Children may correctly
articulate a variety of consonants and vowels in
single words but still not have readily intelligible
connected speech.”

29. CONT….
 Several factors can influence the intelligibility of speech,
including
 level of communication (e.g., single words vs. conversation);
 listener's familiarity with the speaker's speech pattern;
 speaker's rate, inflection, stress patterns, pauses, voice
quality, loudness, and fluency;
 social environment (e.g., familiar vs. unfamiliar conversational
partners, one-on-one vs. group conversation);
 communication cues for listener (e.g., known vs. unknown
context);
 signal-to-noise ratio (e.g., amount of background noise);
 listener's skill.

30. STIMULABILITY
 Stimulability testing examines the child's ability to
produce or imitate a misarticulated sound correctly
when a model is provided by the clinician. It
provides information about how well the individual
imitates the sound in one or more contexts (e.g.,
isolation, syllable, word, phrase) and helps
determine the level of cueing necessary to achieve
the best production (e.g., auditory model; auditory
and visual model; auditory, visual, and verbal
model; tactile cues).

31. CONT….
Stimulability testing is used to
 determine if the sound(s) are likely to be acquired
without intervention,
 select appropriate therapy targets,
 predict improvement in therapy.
 attests to the child’s ability to perceive, to recognize
as different, and to produce the sound in question.
 If the child is not stimulable for a sound, then one
might question the child’s: Motoric abilities,
Perceptual abilities, Linguistic abilities, Attention
(focus), Non-compliance.

32. CONT….
 If a child is stimulable for a sound, then that sound
is likely to be added to the child’s phonetic
inventory, even without direct treatment on that
sound.
 If a child is NOT stimulable for a sound, then the
likelihood of short term gains is poor; normalization
without therapy is much poorer than normalization
for sounds that the child is stimulable for.

33. SPEECH PERCEPTION TESTING
 Speech perception testing is used to determine if a
child is able to perceive the difference between the
standard production of a sound and his/her own
error production. A number of different test
paradigms are used to assess speech sound
discrimination, including
 Auditory Discrimination
 Picture Identification
 Pronunciation Accuracy/Inaccuracy,(Speech
production–perception task, Mispronunciations
detection task, Lexical decision/judgment task)

34. SPECIAL CONSIDERATIONS
 Young children might not be able to follow
directions for standardized tests, might have limited
expressive vocabulary, and might produce words
that are unintelligible. Other children, regardless of
age, may produce less intelligible speech or be
reluctant to speak in an assessment setting.
Strategies for collecting an adequate speech
sample with these populations include

35. CONT….
 obtaining a speech sample during the assessment
session using play activities,
 involving parents/caregivers in the session to
encourage talking,
 asking parents/caregivers to supplement data from
the assessment session by recording the child's
speech at home during spontaneous conversation,
 asking parents/caregivers to keep a log of the
child's intended words and how these are
pronounced

36. SPOKEN LANGUAGE TESTING
 Language testing is included in a comprehensive
speech sound assessment because of the high
incidence of co-occurring language problems in children
with speech sound disorders. Typically, the assessment
begins with a screening of receptive language and
expressive language. A full language battery is
performed if indicated by screening results.
Phonological Processing
 Phonological processing is the use of the sounds of
one's language (i.e., phonemes) to process spoken and
written language.The broad category of phonological
processing includes phonological awareness,
phonological working memory, and phonological
retrieval

37. CONT….
 Phonological Awareness—the awareness of the
sound structure of a language and the ability to
consciously analyze and manipulate this structure
via a range of tasks, such as speech sound
segmentation and blending at the word, onset-rime,
syllable, and phonemic levels.
 Phonological Working Memory—involves storing
phoneme information in a temporary, short-term
memory as Nonword repetition (e.g., repeat /pæg/)
is one example of a phonological working memory
task.

38. CONT….
 Phonological Retrieval—the ability to recall the
phonemes associated with specific graphemes,
which can be assessed by rapid naming tasks (e.g.,
rapid naming of letters and numbers).
 All three components of phonological processing
are important for speech production as well as the
development of spoken and written language skills.

39. LITERACY ASSESSMENT [READING AND WRITING]
 Difficulties with the speech processing system (e.g.,
listening, discriminating speech sounds,
remembering speech sounds, producing speech
sounds) can lead to both speech production and
phonological awareness difficulties that can hamper
the development of literacy.
 For typically developing children, speech production
and phonological awareness develop in a mutually
supportive way
 The understanding that sounds are represented by
symbolic code (e.g., letters and letter combinations)
is essential for reading and spelling.

40. COMPONENTS OF LITERACY ASSESSMENT
 Print Awareness—recognizing that books have a front and
back and that the direction of words is from left to right and
recognizing where words on the page start and stop.
 Alphabet Knowledge—including naming/printing alphabetic
letters from A to Z.
 Sound-Symbol Correspondence—knowing that letters have
sounds and knowing the sounds for corresponding letters and
letter combinations.
 Reading Decoding—using sound-symbol knowledge to
segment and blend sounds in grade-level words.
 Spelling—using sound-symbol knowledge to spell grade-level
words.
 Reading Fluency—reading smoothly without frequent or
significant pausing.
 Reading Comprehension—understanding grade-level text,
including the ability to make inferences.

41. PERCENT OF CONSONANT CORRECT (PCC)
 An objective severity metric; The examiner makes
correct/incorrect judgments of individuals sounds
produced.
 PCC = Number of Correct Consonants/Number of
Correct + Incorrect Consonants *100
 Only evaluates consonants; Originally based only
on conversational speech;
 Efficient and valid approach for children 4 to 6
years old

42. TREATMENT
 treatment approaches have traditionally focused on
articulation production and others have been more
phonological/language-based. Articulation
approaches target each sound deviation and are
often selected by the clinician when the child's
errors are assumed to be motor-based; the aim is
correct production of the target sound(s).
Phonological approaches target a group of sounds
with similar error patterns, although the actual
treatment of exemplars of the error pattern may
target individual sounds.

43. CONT….
 The sequence of most treatment approaches for
speech sound disorders are reflected in the
following phases of therapy:
 Establishment—eliciting target behaviors and
stabilizing production on a voluntary level.
 Generalization—facilitating carry-over of sound
productions at increasingly challenging levels (e.g.,
syllables, words, phrases/sentences,
conversational speaking).
 Maintenance—stabilizing target behaviors and
making production more automatic; encouraging
self-monitoring of speech and self-correction of
errors.

44. CONT….
 Treatment selection will depend on a number of
factors, including the child's age, the type of speech
sound errors, the severity of the disorder, and the
degree to which the disorder affects overall
intelligibility

45. CONTRAST THERAPY
 Contrast therapy focuses on production using
contrasting word pairs instead of individual sounds.
This approach emphasizes sound contrasts
necessary to differentiate one word from another
 Minimal Oppositions— also known as "minimal
pairs" therapy, uses pairs of words that differ by
only one phoneme or single feature
 in an effort to establish contrasts not present in the
child's phonological system (e.g., pot vs. spot, key
vs. tea; )

46. CONT….
 Maximal Oppositions—Word pairs have multiple
feature contrasts (maximal oppositions) features can
differ on place , manner and voicing (e.g., manner of
production and place of production, such as /m/ vs. /s/,
mack/shake
 Treatment Of The Empty Set—similar to maximal
opposition contrasts, but uses pairs of words containing
two maximally opposing sounds that are unknown to the
child—ideally, an obstruent with a sonorant (e.g., /l/ vs.
/s/; Gierut, 1992).
 Multiple Oppositions—a variation of the minimal
opposition contrast approach that uses pairs of words
contrasting a child's error sound with three or four
strategically selected sounds that reflect both maximal
classification and maximal distinction (Williams, 2000a,
2000b).

47. CORE VOCABULARY APPROACH
 A core vocabulary approach focuses on whole-word
production and is used for children with inconsistent
speech sound production who may be resistant to
more traditional therapy approaches. Words
selected for practice are those that are used
frequently in the child's functional communication. A
list of frequently used words is developed (e.g.,
based on observation, parent report, and/or teacher
report), and a number of words from this list are
selected each week for treatment. The child is
taught his "best" word production, and the words
are practiced until consistently produced .

48. CYCLES APPROACH
 The cycles approach targets phonological pattern
errors and is designed for highly unintelligible
children who have extensive omissions, some
substitutions, and a restricted use of consonants.
The goal is to increase intelligibility within a short
period of time, and treatment is scheduled in cycles
ranging from 5 to 16 weeks. During each cycle, one
or more phonological patterns are targeted. After
each cycle has been completed, another cycle
begins, targeting one or more different phonological
patterns. Recycling of phonological patterns
continues until the targeted patterns are present in
the child's spontaneous speech .

49. DISTINCTIVE FEATURE THERAPY
 Distinctive feature therapy focuses on elements of
phonemes that are lacking in a child's repertoire
(e.g., frication, nasality, voicing, and place of
articulation) and is typically used for children who
primarily substitute one sound for another. This
approach uses tasks (e.g., minimal pair contrasts)
that compare the phonetic elements/features of the
target sound with those of its substitution or some
other sound contrast. Patterns of features can be
identified and targeted; producing one contrast
often generalizes to other sounds that share the
targeted feature.

50. NATURALISTIC SPEECH
INTELLIGIBILITY INTERVENTION
 Naturalist speech intelligibility intervention directs
treatment of the targeted sound in naturalistic
activities that provide the child with frequent
opportunities for the sound to occur. For example,
using a McDonald's menu, the child can be asked
questions about items that contain the targeted
sound(s). The child's error productions are recast
without the use of imitative prompts or direct motor
training. This approach is used with children who
are intelligible enough to be able to use the recasts
effectively

51. NON-SPEECH ORAL-MOTOR THERAPY
 Non-speech oral-motor therapy involves the use of
oral-motor training prior to teaching sounds or as a
supplement to speech sound instruction. The
rationale behind this approach is that immature or
deficient oral-motor control or strength may be
causing poor articulation and that it is necessary to
teach control of the articulators before working on
correct production of sounds.

52. SPEECH SOUND PERCEPTION TRAINING
 Speech perception training is a procedure used to help the child
acquire a stable perceptual representation for the target
phoneme or phonological structure. The goal is to ensure that
the child is attending to the appropriate acoustic cues (i.e., one
that ensures reliable perception of the target in a variety of
listening contexts).
 Recommended procedures include (1) auditory bombardment in
which many and varied exemplars of the target are presented to
the child, sometimes in a meaningful context such as a story and
often with amplification, and
 (2) identification tasks in which the child identifies correct and
incorrect versions of the target (e.g., "rat" is a correct exemplar of
the word corresponding to a rodent whereas "wat" is not).
Traditionally the speech stimuli used in these tasks are presented
live-voice by the speech-language therapist but more recently
computer technology has been used which has the advantage of
allowing for the presentation of more varied stimuli representing,
for example, multiple voices and a range of error types.

53. TECHNOLOGIES
 There are a number of techniques used in therapy
to increase awareness of the target sound and/or to
provide feedback about placement and movement
of the articulators. These include
 use of a mirror for visual feedback of place and
movement of articulators;
 use of gestural cueing for place or manner of
production (e.g., using a long sweeping hand
gesture for fricatives vs. a short, "chopping" gesture
for stops);

54. CONT….
 ultrasound imaging (placing an ultrasound transducer
under the chin) used as a biofeedback technique to
visualize articulatory positioning and movement for
vowel production
 palatography (using various coloring agents or a palatal
device with electrodes) to record and visualize contact
of the tongue on the palate while the child makes
different speech sounds
 amplification of target sounds to improve attention,
reduce distractibility, and increase sound awareness and
discrimination—for example, auditory bombardment with
low-level amplification is used
 spectral biofeedback through a visual representation of
the acoustic signal of speech

55. CONT….
 tactile biofeedback using tools, devices, or substances
placed within the mouth (e.g., tongue depressors,
peanut butter) to provide feedback on correct tongue
placement and coordination
 Associate Speech Sounds with Hand/Body Motions
(multi-modal input increases children’s ability to retain
newly learned speech sounds. Hand motions serve as
retrieval cues for remembering).
 Associate Speech Sounds with Alliterative Characters of
Interest to the Child. (interesting characters increase
interest in the activity and encourage full participation.
Enhances the opportunity for a child to develop
conscious awareness of the newly learned sound
segments

56. CONT….
 For example: P Putt-putt pig b Baby bear t Talkie
turkey d Dirty dog k Coughing cow g Goofy goat f
Fussy fish v Viney violet ‘ Thinking thumb s Silly
snake z Zippy zebra c Shy sheepy
 Encourage Vocal Practice (do not use drill; instead,
encourage vocal practice by including sound
elicitation activities that involve turn-taking and
requesting)

57. CHILDREN WITH PERSISTING SPEECH
DIFFICULTIES
 For some children, speech difficulties persist
throughout their school years and into adulthood.
 This is define as persisting speech difficulties (PSD)
 Difficulties in the normal development of speech
that do not resolve as the child matures or even
after they receive specific help for these problems
 The population of children with PSD is
heterogeneous, varying in etiology, severity, and the
nature of their difficulties and includes children with

58. CONT….
 speech sound disorders of unknown etiology (i.e.,
typical articulation and phonological disorders),
 motor-based speech disorders (e.g., childhood apraxia
of speech, dysarthria),
 medical conditions and sensory-based problems (e.g.,
chronic otitis media, hearing loss),
 structure-based speech disorders (e.g., cleft lip/palate,
other craniofacial anomalies).
 A child with PSD may be at risk for-
 difficulty communicating effectively when speaking,
 difficulty acquiring literacy skills,
 psychosocial problems (e.g., low self-esteem, at
increased risk of bullying).

59. INTERVENTION APPROACHES
 It depend on the child's diagnosis (e.g., structural vs.
condition-related) and his/her area(s) of difficulty (e.g.,
speaking, literacy, and/or psychosocial issues). In
designing an effective treatment protocol, the SLP
considers
 a psycholinguistic approach to identify the level at which
speech processing is disrupted, including
 input/perception (auditory discrimination of sounds
and words),
 storage (underlying lexical representation),
 speech output (planning and production of sounds
needed for speech);
 phonological (linguistic) approaches to treat the level
or levels of identified disruption, using specific
interventions and stimuli (e.g., minimal pairs, maximal
pairs, metaphon approaches);

60. CONT….
 medical and surgical intervention (e.g., for children
with cleft lip/palate or other physical conditions);
 collaboration with teachers and other school
personnel to support the child and to facilitate
his/her access to academic curriculum;
 management of psychosocial factors, including self-
esteem issues and bullying

61. REFERENCES
 Intervention of speech sound disorders (ASHA
CSC)
 Effective intervention of the treatment of the
speech sound disorder-Susan Rvachew
 Speech sound disorder (ASHA)
 What we know about children's speech sound
disorder & treatment- Children’s health Queensland
hospital and health service