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37 Cards in this Set
- Front
- Back
Factors
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1. Psychosocial factors (not in book)
2. Motor Abilities 3. Hearing and Speech Perception 4. Oral Mechanism 5. Cognitive-Linguistic Factors |
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Psychosocial Factors
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>age
>gender >SES >genetic factors |
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Age
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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 |
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Gender
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1.5:1
No strong correlations with gender |
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SES
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No real correlations found although greater misarticulations in low SES
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Genetic Factors
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positive correlations, e.g., family history, identical twins
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Motor Abilities
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-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 |
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Childhood Apraxia of Speech (CAS)
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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 |
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3 primary symptons of CAS
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1. Inconsistent errors
2. Slow coarticulatory transitions between sounds and syllables 3. Inappropriate prosody |
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otitis media or middle ear infections
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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) |
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Hearing
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hearing sensativity is correlated with speech sound production.
-with cocheal implants, hearing aids still need to work on listening |
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Hearing: Speech Perception
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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 |
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Oral Mechanism
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>dentation
>tongue >palate |
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dentation
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Open bite is associated with greater articulation errors
Missing teeth may lead to interdental productions (25%) |
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tongue
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position does not matter; Tongue is remarkably versatile
Tongue-tie or ankyloglossia |
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cognitive linguistic factors
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-intelligence
-language and reading |
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intelligence
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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 |
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language and reading
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>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 |
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three main phases speech sound disorders
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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) |
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Establishment: What Targets should one pick? Traditional and Contemporary criteria
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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) |
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once targets are selected
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• 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. |
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Articulation or Phonetic Approaches
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To be used only for mild to moderate severity and for production-based issues
1.ear-training 2.production |
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ear training
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training – Objective is to get child to distinguish error from target (discrimination) - optional
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production
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• 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) |
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Articulation Approach Production Technique
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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) |
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facillitating context
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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”) |
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direct instruction
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o E.g., visual, phonetic placement, tactile cues, mirrors, analogies
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sucessive approximation
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o Shape one sound into another, e.g., gargling sound
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Phonological Approaches
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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 |
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Phonological Intervention
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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.
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Two main Phonological Therapy Approaches
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Two main types
o Cycles o Minimal Pairs and its many, many variations |
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Cycles Approach
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• 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 |
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Cycles Approach
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• 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 |
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Minimal Pair or Contrast Approaches (Gierut)
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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) |
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how do we measure change?
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• 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 |
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2nd treatment phase generalization
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• 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 |
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conclusions regarding therapy
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• 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 |