Speech Sound Disorders Part 3

Front 1

Factors

Back 1

1. Psychosocial factors (not in book)
2. Motor Abilities
3. Hearing and Speech Perception
4. Oral Mechanism
5. Cognitive-Linguistic Factors

Front 2

Psychosocial Factors

Back 2

>age
>gender
>SES
>genetic factors

Front 3

Age

Back 3

Strongly correlated with speech sound production
-Older the child, better the articulation, up to 7-8 years
-Beyond 9, age does not improve articulatory performance

Front 4

Gender

Back 4

1.5:1
No strong correlations with gender

Front 5

SES

Back 5

No real correlations found although greater misarticulations in low SES

Front 6

Genetic Factors

Back 6

positive correlations, e.g., family history, identical twins

Front 7

Motor Abilities

Back 7

-Nonspeech oral motor, e.g., blowing
-Speech oral motor
-Diadochokinesis: Repeat a sequence of syllables as fast as you can, e.g., papapa or pataka
Relationship is not clear

Front 8

Childhood Apraxia of Speech (CAS)

Back 8

Overdiagnosed and misdiagnosed childhood disorder
Precision and consistency of speech movements are affected
May arise due to a known neurological impairment or may be idiopathic, i.e., no known cause

Front 9

3 primary symptons of CAS

Back 9

1. Inconsistent errors
2. Slow coarticulatory transitions between sounds and syllables
3. Inappropriate prosody

Front 10

otitis media or middle ear infections

Back 10

Chronic otitis media is no longer considered a risk factor
Language and speech outcomes were not improved with tube insertion (several studies now; anecdotes may indicate opposite)

Front 11

Hearing

Back 11

hearing sensativity is correlated with speech sound production.
-with cocheal implants, hearing aids still need to work on listening

Front 12

Hearing: Speech Perception

Back 12

Can child discriminate between target and error sound? E.g., if child is fronting, can child discriminate between [t] and [k]?
• 70% had intact perception, 30% did not (Locke, Rvachew)
• Consider it as a component of intervention only for children with perceptual deficits
• Perception does not have to precede production
• Production can however, improve without direct work on perception

Front 13

Oral Mechanism

Back 13

>dentation
>tongue
>palate

Front 14

dentation

Back 14

Open bite is associated with greater articulation errors
Missing teeth may lead to interdental productions (25%)

Front 15

tongue

Back 15

position does not matter; Tongue is remarkably versatile
Tongue-tie or ankyloglossia

Front 16

cognitive linguistic factors

Back 16

-intelligence
-language and reading

Front 17

intelligence

Back 17

Lower the IQ, greater the articulation errors but only a small correlation
Wide range of conditions with low IQ exist, e.g., Down Syndrome, Fragile X
What is true for one condition may not apply to another condition
SSD are not a core feature of autism

Front 18

language and reading

Back 18

>Children with SSD are at risk for language and reading impairments
>About 15% with SSD also have language problems at 6 years of age (Shriberg)
>Another 15% with SSD have low cognition and low linguistic abilities at 6 years of age (Shriberg)
>More linguistically complex the utterance, greater the errors

Front 19

three main phases speech sound disorders

Back 19

1) Establishment: Produce the target
2) Generalization: Make the target part of the child’s _________ repertoire
3) Maintenance: Continue to produce target even when therapy is discontinued; includes self-monitoring
(Book sometimes equates 2 and 3)

Front 20

Establishment: What Targets should one pick? Traditional and Contemporary criteria

Back 20

1.maximum interference with intelligability
2.targets occur frequently in a language
3.stimuable(traditional) nonstimuable(complex/contemporary)
4.Early acquired (default; traditional) vs late acquired (complex; contemporary)
5. Use sounds that are maximally different from existing sounds to produce system-wide change
6.o Pick sounds that are produced correctly at least some of the time (traditional)
o Pick sounds that are produced in error most or all of the time (contemporary)

Front 21

once targets are selected

Back 21

• Decide on whether to use an articulation (production-based errors) and/or phonological (cognitive-linguistic based errors) intervention approach for target sounds
• Determine treatment activities (way too much focus), reinforcement, etc.

Front 22

Articulation or Phonetic Approaches

Back 22

To be used only for mild to moderate severity and for production-based issues
1.ear-training
2.production

Front 23

ear training

Back 23

training – Objective is to get child to distinguish error from target (discrimination) - optional

Front 24

production

Back 24

• Move from 1 error sound to the next
• For each error sound, start with production of syllables or sounds  words  phrases  utterances  spontaneous speech (transfer)
(Again, refer to Table 6.5, p. 157)

Front 25

Articulation Approach Production Technique

Back 25

1. imitation
2.facilitating context
3. direct instruction
4. successive approximation
 Note: Usually in artic tx, we work on one sound at a time (except multiple phoneme approach)

Front 26

facillitating context

Back 26

Use results from stimulability testing to identify contexts and activities in which target is produced correctly
• E.g., Alicia (Table 6.1, p. 148) – “cup” /k/ was produced correctly
• E.g., velar consonants when followed by back vowels may be easier to produce than when followed by front vowels (“coo” rather than “key”)

Front 27

direct instruction

Back 27

o E.g., visual, phonetic placement, tactile cues, mirrors, analogies

Front 28

sucessive approximation

Back 28

o Shape one sound into another, e.g., gargling sound

Front 29

Phonological Approaches

Back 29

Phonological Approaches
 You are working on establishing missing feature contrasts and eliminating entire processes, not individual sounds
 You are changing the ____________ of sounds at a cognitive-linguistic level
 You target sounds at the word level
 Communicative effectiveness rather than articulatory accuracy is the goal

Front 30

Phonological Intervention

Back 30

Note: Phonological therapy does not exclude motor practice. Can still work on articulation establishment techniques, e.g., phonetic placement, successive approximation, in addition to phonological intervention techniques, esp. after child understands the need to change his/her production for communicative effectiveness.

Front 31

Two main Phonological Therapy Approaches

Back 31

Two main types
o Cycles
o Minimal Pairs and its many, many variations

Front 32

Cycles Approach

Back 32

• Hodson and Paden (1991)
• Especially useful with severely unintelligable children
• Target several phonological processes in one cycle
• Each cycle includes several sessions and lasts from 5-16 weeks

Front 33

Cycles Approach

Back 33

• Target new processes in the next cycle irrespective of progress on first cycle
• Why cycle?
o Phonological acquisition is a gradual process
o Often, once something is established, it can be consolidated without direct treatment
• Although plenty of anecdotal data, empirical evidence is meager

Front 34

Minimal Pair or Contrast Approaches (Gierut)

Back 34

1. Minimal Oppositions Approach (to be used only for mild to moderate severity; has some research support although not high quality)
2. Maximal Oppositions Approach (or Complexity Approach; used for moderate to severe cases, research is not sufficient and somewhat contradictory)
3. Multiple Oppositions Approach (used for moderate to severe cases, research is minimal)

Front 35

how do we measure change?

Back 35

• Need to probe for change on a regular basis
• Various criteria used, e.g., # correct, % correct, natural environments, # of sessions correctly produced, self-corrections
• Often criteria used is one of mastery, e.g., 90% correct
• Instead, aim for smaller change; mastery occurs on own

Front 36

2nd treatment phase generalization

Back 36

• Usually therapy moves along a continuum from clinician to caregiver, drill to ADL, and/or clinic to home
• Generalization to outside the clinic is often difficult
• Adequate generalization, e.g., 50% in spontaneous speech, is signal for dismissal, if child is typically developing in other aspects

Front 37

conclusions regarding therapy

Back 37

• Variety of Ix approaches are available for SSD
• Need to decide what is best for client based on external evidence, clinician expertise, and client values (EBP)
• Rx is not of the best quality for any approach
• So, it is imperative that the clinician maintains their own data to make sure they see changes in the child’s performance and it is the Ix alone that is making the change and not something else
• If one approach does not work, be willing to change