Child Speech Sound Disorders

Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation and phonological processes. (ASHA)

Articulation Disorder- when someone has a structural difficulty making a sound, or a problem producing one or two sounds, not linguistically based.
Phonological Disorders- more linguistically based , and more patterns in their errors.

Traditional categories of speech sound disorders:

  • substitutions
  • omissions
  • distortions
  • additions

Most Common Phonological Processes:

  • weak syllable deletion
    • In polysyllabic words, the unstressed syllable is deleted.
      • telephone –> tephone
  • final consonant deletion
    • the final consonant of a word is deleted.
      • baet –> bae
  • reduplication
    • two syllable words are produced by repeated the first syllable
      • bottle –> baba
  • assimilation
    • the manner, place, or voice characteristics of one phoneme changes to be consistent with another phoneme in the word
      • dog –> gog
  • cluster reduction
    • consonant clusters are reduced, usually to a single phoneme.
      • stop –> top
  • stopping
    • continuant sounds (usually fricatives) are replaced by stops
      • see –> tee
  • velar fronting
    • velar sounds such as /k/ and /g/ are replaced by alveolar sounds such as /t/ and /d/.
      • go –> do
  • gliding
    • liquids such as /r/ and /l/ become glides such as /w/ and /j/
      • run –> wun
  • context-sensitive voicing
    • voiceless consonants preceding vowels are voiced, and voiced consonants at the end of words are produced as unvoiced.
      • toe –> doe
      • red –> ret

Childhood Apraxia of Speech- “A neurological childhood speech sound disorder where the precision and consistency of speech sound movements are impaired in the absence of neuromuscular deficits (motor programming issue)” (ASHA)

  • the core impairment is in the planning, programming, and sequencing of speech sound disorders
  • used to be called developmental apraxia of speech; the name was changed because insurance companies wouldn’t cover treatment of it because if it was “developmental” the child would supposedly grow out of it.
  • key characteristics:
    • inconsistent errors
    • lengthened and disrupted coarticulation
    • altered prosody (talking slower, excess stress)
    • groping/visual searching for articulatory positions
    • 2- and 3-feature articulation errors (features: voice +/-, plossives, bilabial, etc.)
    • vowel errors (as opposed to phonology where it’s mainly consonants– vowels carry so much meaning)
    • sound distortions (not substitutions or omissions)
    • sound additions (add extra sounds, especially schwas)
    • slower rate on DDK (diocokinetic)
    • syllable structure regression (difficult time maintaining syllable structure– inconsistent)
    • sometimes nasality (timing of the velopharyngeal muscles)
    • breakdown as the words get longer

ASSESSMENT:

Assessment Areas

  • family history of speech sound disorders
  • language ability
  • phonetic and phonemic inventories
  • phonological processes/characteristics and patterns
  • stimulability
  • intelligibility rating
  • effect of speech on overall communication, academic, and social success
  • performance in light of norms

Interview Questions

  • How is the client’s speech affecting his/her daily life?
  • Are there situations that are more difficult to speak than others?
  • Is there a history of speech sound disorders in the family?

Formal Tests

Depends on the questions you may have (intelligibility, patterns of errors, how is the client communicating, language vs. speech sound vs. childhood apraxia of speech, trouble sounds). A language screen may be necessary to determine the co-occurrence of apraxia/phonological disorders and language of speech disorders.

  • Kaufan Speech Praxis Test for Children (KSPT)
  • Preschool language Scale- fifth edition (PLS-5)
  • Goldman-Fristoe
  • Hodson Assessment of Phonological Patterns- third edition (HAPP-3)
  • Comprehensive Test of Phonological Processes- second edition (CTOPP-2)
  • Apraxia Profile
  • Assessment of Intelligibility of Dysarthric Speech (AIDS)

Alternative Assessment Measures

  • Speech sample
    • conversation
    • play
    • reading sample
  • pre-assessment questionnaire
  • examine stimulability

Initial Treatment Goals

  • The client will be able to produce /r/ in structured conversations with 90% accuracy.
  • The client will improve carryover of the target sound /s/ outside of the therapy setting with 90% accuracy.

CLIENT & FAMILY EDUCATION:

  • http://speech-language-therapy.com/index.php?option=com_content&view=article&id=16:ssd&catid=11:admin&Itemid=120
    • This webpage addresses questions that families of children with speech sound disorders may have. It gives basic definitions of phonology, clinical linguistics, clinical phonology, speech, speech development, intelligibility, phonological development,  phonological processes, and articulation. It addresses what a child’s typical speech development should be like, the characteristics, and when different phonological processes should stop in typically developing children. The web page describes speech sound disorders: the causes, characteristics, and treatments, as well as phonological disorders.
  • http://www.cincinnatichildrens.org/health/s/speech-disorder/
    • This website provides information about speech disorders. It describes the type of errors or speech sound disorders, the causes, and why a parent should be concerned. Treatment for speech sound disorders and ways that parents can help their children are also included in the page.
  • http://spedcd.education.nmsu.edu/cd/national-student-speech-language-hearing-association/student-presentations/articulation-and-phonology-disorders/#family
    • The webpage defines articulation and phonology disorders. It addresses possible etiologies, what developmental norms are with regards to speech, and what assessment and diagnosis are like for speech sound disorders. It also provides resources for therapy technology and activities. There is also a section about family resources  that includes more information about speech sound disorders and different techniques to help a child with speech sound disorders.

PROFESSIONAL MATERIALS & RESOURCES:

  • http://www.asha.org/Practice-Portal/Clinical-Topics/Articulation-and-Phonology/
    • The webpage is from the American Speech-Language-Hearing Association. It defines articulation and phonological disorders, addresses the incidence and prevalence of speech sound disorders, the signs and symptoms, and causes of the different speech and sound disorders. The page outlines the roles and responsibilities of the SLP, assessment for speech sound disorders, treatment, and different resources available for SLPs.
  • http://www.playingwithwords365.com/2012/11/phonological-delays-treatment-methods/
    • This blog provides different treatment methods for phonological delays. It begins by describing typical features found in speech sound disorders, as well as defining phonological processes. The different treatment methods include minimal opposition therapy, maximal opposition therapy, multiple opposition therapy, empty set, cycles therapy, metaphon approach.
  • http://speechymusings.com/2014/01/16/articulation-disorders-resource-page/
    • This blog includes therapy materials specially for articulation disorder therapy. It includes different games, activities, websites, and specific studies useful for a practicing SLP.

REFERENCES:

Haynes, W. O., & Pindzola, R. H. (2012). Diagnostics and evaluation in speech pathology (8th ed., pp 215-237). Pearson.

(1997–2014) American Speech-Language-Hearing Association (ASHA)

SPAUD 501: Diagnostics notes; Heather Koole (Calvin College)

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