Assessment of Articulation and Phonological Disorders

Question 1

Differential diagnosis:

Answer 1

Articulation Disorder:
Functional Etiology
Organic Etiology (CAS; Developmental
Dysarthria)
Phonological Disorder
Difference (Dialect/Bilingualism)

Question 2

Process of Assessment

Answer 2

Interview (taking a case history)
Orofacial examination and hearing screening
Select procedures to achieve goals
1. Screening procedures
2. Standardized assessment of articulation skills
3. Standardized assessment of phonological skills
4. Continuous speech sample
5. Stimulability testing
6. Contextual testing
7. Severity analysis
8. Intelligibility analysis
Analyze and organize the data
Write a report
Closing interview
Apply this assessment data to planning goals/procedures

Question 3

Taking a case history

Answer 3

Case History: Medical/developmental
information regarding possible causal
correlates and maintaining factors.
Non-organic or Functional/idiopathic
etiology:
Functional nature – not associated
with a neurological/ organic
impairment
Organic etiology:
Organic nature - underlying structural, sensory, or neurological cause or related factor

Diagnostic/Treatment
history—physician/occupational therapist,
physical therapist, previous
speech/language therapy.
Parental Information
Family history of speech problems
Cultural information

Question 4

Evaluation of Peripheral Speech Mechanism

Answer 4

Evaluation of Peripheral Speech Mechanism:
Assess structure and function of the facial muscles,
lips, tongue, palate, teeth.
Use gloves, tongue depressors, mirror, stopwatch
(Hayden, 2001) Look at:
1. tone
2. phonatory control
3. mandibular control
4. labial facial control
5. lingual control
6. sequenced movement
7. prosody
Look at structures at rest, symmetry, abnormality? Genetic
syndromes?

Question 5

Performing an Orofacial Examination cont

Answer 5

Looks at FUnction of articulators—view during movement.
How does the child integrate motor movement
Look at sensory motor mechanism (diadochokinetic rate –
rapid repetition of syllables “pataka”, p. 266)
- repeat as rapidly and accurately as possible
-significant in assessment of neuromotor
speech disorders (CAS, dysarthria etc.)
Make appropriate referrals (ENT, Orthodontist etc.)

Question 6

Conducting a hearing screening

Answer 6

To identify children with a possible hearing loss
Child who fails a hearing screening ( and a hearing loss is
suspected) is referred for a complete audiological
evaluation.
Hearing loss may have important diagnostic and treatment
implications

Question 7

1. Screening Procedures:

Answer 7

Identify if a problem exists/determine whether or not a
more complete articulation evaluation is indicated.
Short conversational sequences
Sentences designed to elicit several productions of
frequently mispronounced sounds
Use of toys/pictures of objects for younger children
Paragraph (if child reads – e.g. “Rainbow passage”)

Question 8

2. Assessment of articulation skills using Single
   Word Tests:
   Provide information about

Answer 8

provide information about child’s sound system
describe phonetic productions in terms of type of error
(SODA) and word positions (I,M, F)
Standardized Tests (most widely used):
- Goldman-Fristoe Test of Articulation (GFTA-3) -
Photo Articulation Test (PAT-3)

Single word samples should always be used along with
continuous speech samples to create a whole picture of the
child’s abilities

Question 9

Procedures used to collect data
Articulation

Answer 9

Formal Articulation Tests:
Photo Articulation Test – 3 (PAT-3)
Assesses and interprets articulation errors.
Normed on children ages 3 - 8:11 years
full-color photos used to elicit words
stimulus pictures appeal to students
Goldman-Fristoe Test of Articulation (GFTA-3)
Assessment of articulation of consonants (SODA)
Normed on children ages 2 - 21:11 years
Elicits more than one sound in one word
Targets one word productions, words in structured sentence contexts,
sound/word stimulability
Delayed imitation instructions
Arizona-4 – Arizona Articulation and Phonology Scale
All tests have: standard scores, percentiles

Question 10

Traditional format for recording errors

Answer 10

) Correct/incorrect
b) Type of error - responses are categorized by sound
substitutions, omissions, distortions and additions
c) Whole – word phonetic transcription (good in
identifying non-target errors).

Question 11

3. Assessment of phonological processes
   Function

Answer 11

. Assessment of phonological processes using
phonological tests:
Used when speech is highly unintelligible , with multiple
misarticulations
Helps analyze the error patterns across words (not
individualized phonemes in different positions)
For children with difficulty acquiring phonological rules

Question 12

Procedures used to collect data
Standardized phonological tests

Answer 12

Standardized phonological tests (most commonly
used):
1. Khan-Lewis Phonological Analysis – 2
- Uses the results of the Goldman-Fristoe test to
plot out the phonological processes used
2. Arizona Articulation and Phonology Scale
- Uses the results of the Word Articulation and
Sentence Articulation subtests (Arizona – 4) to
plot out the phonological processes used

Question 13

Vocabulary for standard test

Answer 13

Raw score: meaningless, just a number
Standard Score: converts the raw score into a different scale that can
be compared to other tests; average is usually 100
Percentile Rank: percentage of children that are functioning at the
same level
Confidence Interval: if the test was given again you were 90% sure
that the child will score within this range.
Clinician should specify whether scores fall within the “mean” or not
Most of the population will fall in the middle of a range, and not on the
extremes

Question 14

Advantages and disadvantages of standardized
tests

Answer 14

Advantages
Short administration time (15-25 min)
Representative sample of English consonants and major phonological
error types
Clinician knows the target word being evoked
Disadvantages:
Single word productions may not represent productions in connected
speech, which has implications for a diagnosis and treatment planning
Limited sampling of sounds and sound contexts (few opportunities to
produce a sound, many untested contexts)
Inadequate sampling of vowels (vowel disorders may be missed)
Test items maybe inappropriate a child who speaks a different dialect

Question 15

Continuous Speech Sample

Answer 15

dentifies overall intelligibility
Looks at sound changes, can the child hear the
mistakes?

Question 16

RECORDING A SPEECH SAMPLE

Answer 16

Audio
 Video
 Selecting the appropriate
environment

Question 17

Procedures Used to Collect Data
SPEECH SAMPLING
Number of utterance per age

Answer 17

Collect a representative sample
Sample size:
100 utterances (older children – 2 years
plus)
50 utterances (younger children)
50 utterances plus a standardized test
20 utterances for those with emerging
phonology
Why is it important?

Question 18

How to encourage a child to talk?

Answer 18

Interview parents
Use of toys that child’s likes
Structured activities
Observe child’s speech with caregivers

Question 19

Procedures Used to Collect Data
WHAT IF THE CHILD IS UNINTELLIGIBLE

Answer 19

WHAT IF THE CHILD IS UNINTELLIGIBLE
Structure the assessment as much as
possible to be able to guess the intended
utterance
Repeat the child’s utterance
Provide as much context as possible

Question 20

6. Contextual Testing

Answer 20

The identification of a facilitative phonetic context for correct
production of a specific phoneme
Example: /s/ produced correctly in the context of /sp/, but misarticulated
in other contexts

Question 21

Severity Analysis is affected by

Answer 21

Severity is affected by:
1. Speech intelligibility
2. Number of sounds in error/presence of phonological
error patterns
3. Consistency of errors
4. Child’s age
Severity categories: mild, moderate, severe, profound

Question 22

Severity Analysis
Percentage of Consonants Correct

Answer 22

Percentage of Consonants Correct (PCC) - Objective measure of
severity (Shriberg & Kwiatkowski, 1982).
Measure of articulatory accuracy in running speech
Collect a transcribe a speech sample
Score only intelligible utterances or those that can be reliably identified
Identify dialectical differences (not incorrect)
Consonants are judged as “correct” or “incorrect” (distorted/subst)
Exclude repetition of consonants in words (ba-balloon)
Exclude repetition words with target consonants
Identify incorrect consonant productions (SODA)

Question 23

Severity analysis formula

Answer 23

PCC =
# of correct cons_________________
# of total cons (correct + incorrect cons)x100
Normal speech to Mild (85% or higher accuracy)
Mild-moderate (65%-85% accuracy)
Moderate-severe (50%-65% accuracy)
severe (<50% accuracy)

Question 24

Intelligibility Analysis
Objective analysis of

Answer 24

Objective analysis of speech intelligibility:
Collect a speech sample and transcribe it
Calculate intelligibility of words
a). divide the total number of intelligible words by the total
number of words (intelligible + unintelligible)
b). (e.g. 105/250 x 100% = 42% intelligibility for words)
Calculate intelligibility of utterances
a). divide the total number of intelligible utterances by the total
number of utterances (intelligible + unintelligible)
b). (e.g. 62/200 x 100% = 31% intelligibility for utterances)

Question 25

Making a differential diagnosis
Articulation Disorder and Typical speech sound production skills:

Answer 25

Typical speech sound production skills:
If L2 interference or dialect
Errors are within normal developmental range for child’s age
Errors are mild, no significant effect on listeners
However, consider family’s /child’s reaction/opinion (effect on social life)
Articulation Disorder:
Errors are limited to a few sounds
Errors are not patterned
Intelligibility is not significantly impaired
Errors are associated with structural, sensory, or neurological deficits

Question 26

Making a differential diagnosis
Phonological disorder

Answer 26

Multiple misarticulations
Errors are patterned
Poor intelligibility
Errors do not match adult production
Limited syllable shapes
Phonetic inventory is restricted (based on child’s age)

Question 27

Articulation disorder subclassified

Answer 27

Articulation disorder subclassified :
Known organic origin: structural or sensory (HL, cleft, dental)
Neurological origin (CAS, developmental dysarthria)
Functional origin ( persistent misarticulations of /s/ or /r/)

Question 28

Phonological impairments subdivided into

Answer 28

Phonological impairments subdivided into:
Phonological delay (errors follow developmental pattern: FCD)
Phonological disorder (presence of idiosyncratic or nondevelopmental
error patterns: backing, ICD).

Question 29

Prognosis

Answer 29

Prognosis - A statement about the estimated course of the disorder
and judgment of success (excellent, good, fair, poor)
Prognostic variables:
1. Severity
2. CA
3. Motivation
4. Inconsistency (errored sounds are produced correctly some of the
time)
5. Associated conditions (attention, cooperation, neurological, sensory,
developmental deficits)
6. Treatment history (hx of limited progress)
7. Family support

Question 30

Auditory Discrimination and Perception

Answer 30

Auditory memory span, (remembering digits)
- Auditory discrimination( are two syllables the same?)
Example: Clinician repeats child’s incorrect
production (wabbit) and child
identifies an error, even if can’t
produce it correctly)
- Research has been inconclusive as to the cause-
effect relationship between auditory discrimination
abilities and articulation skills

Question 31

Independent Analysis of Data

Answer 31

More common for younger children
* Involves taking only the client’s productions into
account, without reference to the adult model
* The focus is on the child’s phonetic inventory,
syllable shape inventory , and constraints noted on
sounds or sound sequences (word positions in which
target sounds are not produced)

Question 32

Emerging Phonology

Answer 32

Covers a period of time when words begin to
appear. (late talkers may demonstrate delayed
emerging systems, small vocabularies and
reduced repertoire of sounds and syllable shapes.
Difficult to use common measures of articulation
tests, spontaneous speech sampling and speech
mechanism

Independent Analysis: only taking the
child’s productions into account. The
articulated speech sounds are NOT
compared to an adult norm model.
Three types of analysis:
inventory of speech sounds
Inventory of syllable shapes
Constraints noted on sounds or sound
sequences

Question 34

Goal of assessment

Answer 34

To identify existence of a problem
● 2. To identify the nature of the problem
● 3. To identify the factors maintaining the problem
● 4. To provide a basis for formulating goals of treatment
● 5. To provide a basis for procedural decisions

Question 35

Ways to elicit single word samples

Answer 35

Ways to elicit single word samples:
● naming
● sentence completion
● imitation

Question 36

DISADVANTAGES OF CONNECTED SPEECH

Answer 36

Some children may be reluctant to engage in
conversation with the examiner
● May not be able to target all English phonemes
● So…give a single word test and recommend a speech sample at a later date if possible.
Some children may be unintelligible

Question 37

5. Stimulability Testing:

Answer 37

Samples a child’s ability to imitate Loading…
● Encourages the individual to attempt productions based on imitation

Question 38

Final Steps of Assessment:

Answer 38

Analyze and organize the data
● Write a report
● Closing interview
● Apply this assessment data to planning goals/procedures

Question 39

Cognitive Level—if reduced can cause:

Answer 39

Reduced articulation
● Impaired memory for sound sequences
● Impaired ability to relate sound with specific movement of articulators
● Impaired understanding of generalization of syntactic and morphological rules
● Impaired ability to compare and contrast

Question 40

Language abilities (through screening):

Answer 40

Language abilities (through screening):
● Often phonological and articulation disorders co- occur with language learning difficulties

Question 41

Analysis of Speech Sound Production:

Answer 41

Independent analysis AND/OR
● Relational analysis - Traditional analysis
- Phonological error pattern analysis

Question 42

Independent Analysis:
Phonetic inventory continued

Answer 42

List the sounds the child is producing without considering the
targets being attempted;
- Sounds that occur at least three times are considered part of the child’s productive inventory
A sound is productive if it occurs in at least two different words
- Sounds that are produced one or two times only are considered marginal

Question 43

Relational Analysis:
Relational Analysis of Data

Answer 43

the most commonly used type of analysis
● Involves comparing the client’s production to the target forms seen
in the adult standard
● The focus is identification of sounds produced in error and/or error patterns based on comparison of the client’s production to the adult form
● Identifies phonemic inventory – sounds produced contrastively to distinguish word meanings

Question 44

Relational Analysis:
Traditional Analysis:

Answer 44

Traditional Analysis:
● Consideration of word positions
● Consideration of the type of errors (SODA)
● Appropriate only for children with few articulation errors and good speech intelligibility (phonetic problem)

Question 45

Relational Analysis:
Pattern Analysis:

Answer 45

Relational Analysis:
Pattern Analysis:
focus on regularities in productions rather than single behaviors
description of pattern in terms of features maintained or not maintained in production
major characteristics (place, manner, voicing)

Phonological processes: pattern of usage that reflects modifications from adult standard production
● Substitution:
● Assimilation:
● Syllable Structure