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A. Lynn Williams, Ph.D., CCC-SLPCollege of Clinical and Rehabilitative Health SciencesEast Tennessee State University
Clinical Management of Speech Sound Disorders in Children
Sound Evidence:
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Disclosure statements• Financial disclosure
– Employed at East Tennessee State University– Receive royalties from Brookes Publishing
(Interventions for Speech Sound Disorders in Children)
– Receive royalties from EBS (SCIP app)– Travel funded by UNI
• Non-Financial disclosure
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The Goal of Today’s WorkshopMake it ACAP!• Assessment
– Learn about 2 different analyses Morning
• Target Selection – Learn about 3 different approaches to target selection
• Intervention Approaches – Learn about 8 Different Interventions (match tx to dx)– Intervention Resources Afternoon– Case Examples
• Reflection
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Did you know …• Nearly 1 in 12 children 3-17 years old
have a communication disorder?– Speech sound disorders (SSD) are the
most prevalent communicative disorder– Highest among children 3-6 years– This means there are 2-3 students in every
classroom who have a communication disorder
NIH (2012)
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Did you know …• Preschool children with SSD do not perform as
well as their peers in literacy and learning during the early school years?– This continues until at least 9 years of age– Negatively impacts various aspects of children’s lives,
such as their verbal communication skills, interpersonal interactions, ability to handle stress, and participation in daily life activities with long term consequences on their educational experiences and employment outcomes
• So SSD are not confined solely to speech or to early childhood!
McCormack, McLeod, Harrison & McAllister, 2010
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Did you know …• There is a critical age hypothesis for
remediating unintelligible speech?– Unintelligible speech must be resolved by age 5;6 in
order to significantly reduce academic problems associated with speech disorders
– Given that many children do not come to SLP for treatment until age 4, there is a significant need for efficient and effective therapies to remediate the speech disorder within a short time period (e.g., 18 months!)
Bishop & Adams, 1990
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DIVERSITY AND DEFINITION OF SSD
What is the population of children with SSD?
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Defining Speech Sound Disorders• Speech Sound Disorders (SSD) in children is a
complex neurodevelopmental disorder that is quite diverse and ranges in both severity and type of disorder (Shriberg, 2010). – SSD include articulatory, phonological, and motor speech
disorders and have been identified as one of the most prevalent types of communication impairment among children.
– Further, SSD can co-occur with other impairments of communication, such as language impairment, literacy difficulties, or fluency.
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Distinction between articulation and phonology
Articulation PhonologyOrigin Errors only involve production Errors involve production + language
(linguistics)Problems are peripheral Problems are peripheral + central
Acquisition Children learn speech sounds Children learn a phonology (sound system of a language)
Symptoms DistortionsVariabilityImprecise productionsNo loss of contrasts
SubstitutionsOmissionsCollapse of contrasts
Assessment Focus on sounds Focus on phonemes Assess SODA (substitutions, omissions, distortions, additions)
Assess phonological rules
Intervention Goal is to improve speech production accuracy
Goal is to increase accuracy + “facilitate cognitive reorganization of the system and strategies” (Fey, 1992)
Focus on:PlacementsCueingPractice
Focus on:ContrastsProblem-solvingPerceptual contrastsMultiple sound errors
Williams (in press)
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Interaction of Phonetic and Phonemic Factors
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SSD: A Spectrum Approach
Articulation(Phonetic) Phonological
(Phonemic)
Ingram, Williams, & Scherer (2018)
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Question 1
• SSD are:a. Phonologicalb. Articulatoryc. Both
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Classification of SSDLinguistic Profile Characteristics Prevalence
Phonological Delay Phonological rules or processes are evident andare characteristic of younger TD children
47%
Consistent DeviantPhonological Disorder
Presence of both unusual errors and typical errors, which signal the child has impaired understanding of the ambient phonological system
30%
Inconsistent Deviant Phonological Disorder
Exhibit delayed and non-developmental error types and variability of production of single word tokens (> 40%)
12%
Articulation Disorder Unable to produce particular perceptually acceptable phones
11%
Childhood Apraxia of Speech (CAS)
Deviant surface speech production patterns that may sound similar to Incon Dev Phono Dis, but difference is the proposed level of breakdown and symptomatology
<1%
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Time: Traditional Approaches vs Phonological Approaches
Assessment and Analysis: Review
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Characteristics of a Phonological Disability
• Child’s system is smallerthan the adult system
• One-to-manycorrespondencebetweenchild:adult systems
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One To Many Correspondence
sʃkʧ
t
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Characteristics of a Phonological Disability
• Child’s system is smaller than the adult system
• One-to-many correspondencebetween child:adult systems
• Relationshipbetween thephonetic propertiesof adult target and child’s production
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Phonetic Resemblance between Targets and Child’s Production
sʃkʧ
tvoiceless
1:4 phoneme collapse
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s ʃkʧ
Phonetic Resemblance Between Targets and Child’s Production
t
fricatives
stopaffricate
voiceless obstruents
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Question 2
• Which one does not fit in describing phonological impairments?a. Logicalb. Randomc. Amazing
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GFTA-2Data Set(Adam, 4;6)
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Adam’s GFTA
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p/bl
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Question 3
• What is the predominant error pattern in Adam’s speech?
a. Backing + Stopping + Cluster Reductionb. Cluster Reduction and Stoppingc. Glottal Replacement and Gliding
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Question 4
• A PVM Analysis would be appropriate to complete on:
a. Child with several common errorsb. Child with distortionsc. Child with multiple and uncommon errors
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Phoneme Collapse
s fricativesʃk stopʧ affricate
voiceless obstruents
t
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SPACS: WI Phoneme Collapse
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SPACS: WF Phoneme Collapse
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Adam (4;6)
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Question 5
• What is the organizing principles for the [g] and [w] WI phoneme collapses?a. Fricativesb. Mannerc. Front
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What is the organizing principle?
• Manner (+ sonorant)
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Mirror Rules
SONORANT
Obstruent[-sonorant]
Sonorant[+sonorant]
Obstruents and stop clusters [g] Sonorants and continuant clusters [w]
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Adam: Comparison of PVM to SPACS
1. 1:18 phoneme collapse of obstruents and stop clusters to [g]2. 1:7 phoneme collapse of sonorants and continuant clusters to
[w]
Systemic ApproachIndependent + Relational Analysis
Phonological Processes ApproachRelational “Error” Analysis
2 complementary phoneme collapses•1:18 phoneme collapse of obstruents and stop clusters to [g]•1:7 phoneme collapse of sonorants and continuant clusters to [w]
7 unrelated phonological processes•Backing•Stopping•Voicing•Deaffrication•Cluster reduction•gliding•Idiosyncratic g/b; w/j
• Holistic • Fragmented • Systemic • Sound-based• Descriptive analysis • Error analysis• Child-based • Adult-based• Explanatory + Descriptive • Descriptive only
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Question 6
• A SPACS analysis would be appropriate to complete on all the following EXCEPT:a. Child with several common errorsb. Child with distortionsc. Child with multiple and uncommon errorsd. OGK
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Time: Traditional Approaches vs Phonological Approaches
TargetSelection
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Goals are the driving force
behind intervention.
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2Selecting Targets for Intervention• Target selection is the between
assessment and intervention• Is an important variable in treatment efficacy• The therapy goal, rather than the exact
treatment approach employed in the therapy session, may be the instrument of change (Gierut, 2005; Kamhi, 2006)(Gierut 2005; Kamhi 2006)(Gierut, 2005; Kamhi, 2006))))))))))
link
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Traditional vs PhonologicalApproaches to Target Selection
Traditional Phonological• Based on nn phonemicBased onn honemph
(superordinate)micnem
)) factors– phonological complexity– distance metric (will
discuss as third option)• Assumptions
– learnability is enhanced with the greatest amount of change occurring in the least amount of time
• Based on n phonetic Based onn honph(subordinate)
netic hon)) factors
– developmental norms– stimulability– consistency of error
•y
Assumptions– motoric basis of sound
learning– ease of acquisition– sequential order of
acquisition
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A Third Optionfor Target Selection
• The distance metric represents a different perspective to target selection that doesn’t rely on the dichotomous characterization of targets as early ~ late; stimulable ~ non-stimulable; known ~ unknown, etc.
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A Third Optionfor Target Selection
• Rather, it is based on the function a particular sound has within a given child’s system– Using phoneme collapses that represent
compensatory strategies developed by the child to accommodate a limited phonetic inventory, we can use a distance metric to select those targets that will result in the greatest amount of change in the least amount of time
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Distance MetricWilliams (2003, 2005)
• Select up to 4 different target sounds from one rule set based on two parameters:– Maximal Distinction:
select targets that are maximally different from child’s error in termsof PVM
– Maximal Classification:select targets from each of the following:
(a) different manner classes (b) different places of production (c) different voicing(d) different linguistic units
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Target Selection Using Distance Metric
dkʧfsʃstsktrkrkl
1:11 phoneme collapse
d
Maximal Distinction
clusters
fricatives
affricate
stopsMaxi
malClass
ifi
cation
t
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Practice Selecting Treatment Targetsw glidel liquidf
h s fricativesʃsw clusterssl
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Question 7
• What targets did you select?
a. A glide, a liquid, a fricative and a clusterb. A glide OR a liquid, a fricative, and a
clusterc. A glide, a liquid, a fricative, NO cluster
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Practice Selecting Treatment Targetsb d stopsg
Ø ð v fricativeszʤ affricate
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Question 8
• Which targets did you select?
a. b, v, ʤb. d, z, ʤc. g, ð, ʤ
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With the distance metric,targets are the salient
“corner puzzle pieces”that help the child
put together the big pictureof the adult sound system
Target Selection:The BIG Picture