Exam 1 Flashcards
What is the need for the E & E Book?
to provide a bridge to help all clinicians better serve unique needs of these children - children with highly unintelligible speech
What is the Critical Age Hypothesis?
That children need to speak intelligibly by age 5:6 or literacy acquisition most likely will be hindered
What is Matthew Effects?
Children whose beginning reading skills are below those of their peers typically do not “catch up”, the “gap” between good and poor readers widens over the years
Define Articulation.
refers to the process of producing speech sounds, articulation can refer to mild/moderate disorders and phoneme-oriented tests and intervention
Define Apraxia.
refers to motor planning
Define Phonology.
refers to the sound system of a language that varies from language to language
What is the severity continuum?
prefer to think in terms of a continuum (Phonological Severity Continuum) this way we avoid assigning labels and dictating types of intervention to be implemented - use terms like “Expressive Phonological Impairment” or “Disordered Phonological System”
What are the upper limit in years for phonological patterns acquisition?
- 1 year - canonical babbling and vocables
- 1 1/1 years - recognizable words, CV structures; stops, nasals, glides
- 2 years - final consonants, communication w/ words, “syllableness”
- 3 years - /s/ clusters, anterior-posterior contrasts, expansion of phonemic repertoire
- 4 years - omissions rare, most “simplifications” suppressed, “adult-like” speech
- 5-6 years - liquids /l/ (5 years) and /r/ (6 years), phonemic inventory stabilized
- 7 years - sibilants and “th” perfected, “adult-like” speech
What categories of consonants (by Manner) do children acquire first (across languages)?
stops, nasals, glides
What are the major goals of a diagnostic evaluation?
- Primary goal: to determine if there is in fact a disorder/impairment
- Level of severity
- Identify possible etiological factors that may predispose, precipitate, perpetuate, or even exacerbate existing conditions
- Prognosis - potential for oral communication? AAC? Expectations of communication?
- Determining direction for intervention (synthesis and integration of outcomes of preceding goals)
What is the fundamental method?
The scientific method is an integral component of the diagnostic evaluation process. (Observations, backgrounds, info, results of formal/informal testing)
What background info is needed?
- Why and by whom the child has been referred for testing
- If child has any prior speech-language evaluations or intervention services (what type, to what extent, outcomes)
- Info about child’s birth/developmental and medical histories
What major areas need to be assessed?
- Comprehensive phonological evaluation
- Hearing testing
- Child’s language abilities (info from caregivers, observation, and then formal tests to be administered)
- Structure and function of oral mechanism
-Could consider phonological awareness testing for highly unintelligible children experiencing difficulties with literacy-
What types of Samples & Stimuli used for assessment?
- Speech sample (continuous conversational, single-word samples, etc.
- Most common method for gathering single-word is through stimuli (pictures or OBJECTS)
What is the basic info needed from a phonological evaluation?
- Child’s phonological strengths/weaknesses (phonetic/phonemic and phonotactic inventories) as well as measure of phonological deviations
- Severity level of the disorder
- Direction for intervention, including phonological patterns that need to be targeted
- Measure that can be used to document changes following intervention (dynamic assessment for EBP)
What are the pros of continuous speech/language samples?
(to be recorded during each evaluation)
- samples can be compared over time
- Pre- and post-intervention percentage measures of intelligibility can be derived from these samples
What are the cons of continuous speech/language samples?
- more time consuming to collect
- more difficult to transcribe
- unintelligible utterances cannot be analyzed
- the range of phonemes attempted may be restricted
- comparing scores can be challenging because a child may produce dissimilar sets of words during different sampling times
What major theories have influenced the HAPP-3?
-Generative phonology
-Natural phonology theory
“The culmination of some 30 years clinical research and practice involving several hundred children with highly unintelligible speech has resulted in this HAPP-3”
How to elicit “challenging” sounds - steps?
- Modeling/Imitation
- Tactile/Visual Cues
- Amplification
What is the difference between stimulability and stimulate?
Stimulability - refers to the ability to produce the sound correctly when modeling and assistance are provided
Stimulate - to provide assists to help an individual learn to produce a sound/pattern
What is the difference between Independent Analysis and Relational Analysis?
Independent: determination of the sounds and syllable structures produced independent of adult words and meaning
Relational: the act of comparing production with those of adults
Why do we do a phonological assessment/analysis?
to help SLPs obtain data as expeditiously as possible, thus providing a framework for designing efficient and effective individualized intervention plans
What are phonological deviations?
Speech sound changes (ex: omissions, substitutions) that result in production that differ from the standard
What is the most common phonological deviation for all children with highly unintelligible speech?
consonant sequences/cluster -> reductions/omissions
What are common/typical deviations for Preschoolers with intelligible speech?
Gliding, vowelization, and labial assimilation
What is the difference between “gliding” and “glide deviations/deficiencies”?
Gliding becomes a deficiency when the child is past age of 6 when their liquids are supposed to be achieved.
Gliding: the replacement of a non-glide consonant with a glide (ex: /l/ -> /j/)
Why do we score consonant category deficiencies rather than just “simplification processes” such as fronting?
Because some children totally lack a phoneme class/category (ex: velars), but do not demonstrate fronting therefore phonological processes tests are insufficient to collect data on the errors the child is actually making
What are cycles?
Time period (frequently 2-3 months) during which phonological patterns (typically 3-6) are targeted in succession for at least 2 hours each; patterns are recycled until they emerge in spontaneous speech
When is a cycle completed?
After all of the phonological patterns that need to be targeted (including liquids, if deficient) have been presented. The length of each cycle depends on the number of deficient patterns an individual child has, as well as the number of deficient sounds that are stimulable
How are target patterns selected and presented?
- A highly unintelligible child’s phonological intervention begins with facilitation of a patter for which readiness is demonstrated. The most stimulable pattern from the client’s phonological deficiencies is selected for enhancement so the child can experience immediate and tangible success.
1. Each child’s phonological system is evaluated first to determine if any of potential primary target patters are deficient
2. Secondary patterns are not targeted until certain criteria are met
3. Advanced patterns are targeted by individuals about the age of 8 years, with “intelligibility” issues who experience difficulty producing complex multi-syllabic words
What are optimal PRIMARY target patterns?
-Syllableness: for omitted vowels diphthongs, vocalic/syllabic consonants results in production limited to monosyllables
2 syllable compound words (cowboy, ice cream)
3 syllable compound words (cowboy hat, ice cream cone)
-Singleton Consonants: when consistently omitted
Prevocalic consonants: CV (word initial /p/ /b/ /m/ /w/
Postvocalic consonants: VC (voiceless final stops /p/ /t/ /k/; possibly final /m/ /n/
Pre- and post-vocalic consonants: CVC (ex: pup, pop)
Intervocalic consonants: VCV (ex: apple)
-/S/ Clusters:
Word-initial (ex: /sp/ /st/
Word-final (ex: /ts/ /ps/
-Anterior/Posterior Contrasts Word-final /k/ Word initial /k/ /g/ (for fronters) Occasionally /h/ Alveolars/labials (if backer)
-Liquid:
Word-initial /l/
Word-initial /r/ - suppress gliding initially
Word-initial /kr/ /gr/ (after the child readily produces singleton velars)
Word-initial /l/ clusters (after child readily produces prevocalic /l/)
What are the two major reasons we target /s/ clusters before singleton stridents? (ex. /f/)
- Targeting /s/ clusters increases intelligibility quickly
- Emergence of /s/ clusters serves to reduce two major deviations-strident category deficiency and consonant sequence reduction
What are potential SECONDARY target patterns?
- PALATALS*
- glide /j/
- palatal sibilants /ʃ, ʒ, ts, dʒ/
- vocalic /ɚ/, /ɝ/ (unless dialectal)
- word-medial /r/
- OTHER CONSONANTS SEQUENCES*
- word-medial and word-final /s/ plus stop (ex: basket, desk)
- CC with sonorants (glide clusters /kw/ /kj/ other liquid clusters /tr/
- CCC /skw/ /skr/
SINGLETON STRIDENTS
/f/ /s/
VOICING CONTRASTS
(prevocalic only)
VOWEL CONTRASTS
(non-dialectal)
- ASSIMILATIONS*
- Any remaining idiosyncratic deviations*
What are INAPPROPRIATE targets for preschoolers & why?
-Voiced word-final obstruents /b, d, g, v, z, ð, ʒ, dʒ/
WHY? it is common in adult speech to prolong the preceding word slightly, but not produce fully)
-Voiced word-final obstruents: postvocalic/syllable /l/ (ball)
WHY? it is common to use a slight pitch alteration for vocalic /l/ in words such as doll, candle, and milk, rather than to raise the tongue tip to the alveolar ridge
-Word-Final /ŋ/
WHY? it is common in standard conversational speech to substitute /n/ for /ŋ/, particularly in by-syllabic words
-/θ, ð/
WHY? it is common for children with typical phonological development to produce /f, v, s, z/ for /θ, ð/ and intelligibility is not affected adversely
-Unstressed (weak) syllables: saying probly for probably and member for remember
WHY? it is extremely common in conversational utterances of adult speakers
What are ADVANCED target patterns and for whom?
Advanced patterns are for some individuals (about the age of 8 years) who experience extreme difficulty producing multisyllabic words and complex consonant sequences (/kskj/, kstr/) as in excuse and extra). Many of these kids are students with language/learning disorders, who can pass standard “articulation” tests without error, but reduced intelligibility is noted in their conversational utterances
How are children helped to develop awareness of phonological patterns?
- New and accurate kinesthetic images are created by producing targets in a limited number of carefully selected words
- It is important for the children to develop auditory awareness of the pattern because unintelligible children do not seem to “hear” their own errors. Combing a limited amount of production practice with slightly amplified stimulation during each sessions helps a children improve their phonological representations of articulatory gestures and, ultimately, their self-monitoring skills
- Visual and tactile cues are incorporated as supplements when needed. They are faded as children demonstrate facility producing the target phonemes
What is the general structure of a cycles phonological treatment session?
- Review last sessions’ production practice words
- Listening Activity
- Production Practice
- Activities for Eliciting Productions
- Metaphonological Activity
- Probe for Next Session’s Target
- Repeat Listening Activity (with parent if possible)
- Home Practice
What is the home program?
The caregiver is asked to participate in a 2-minutes-per-day home (or school) program.
Each day, the week’s listening list is read to the child, and the child names picture cards containing the week’s production-practice words. The caregiver is asked to read the rhyme to the child each night (pausing allow the child to “fill in” rhyme words) to facilitate development of onset and rime awareness.
What are some motivational production-practice activities? (Appendix C)
Flashlight game Fishing Basketball, baseball, volleyball, bowling, golf Mailbox Theatre - acting out /s/ cluster words
Objects and large cards are used as stimuli to elicit naming responses. The child must say the target pattern appropriately and then “take a turn”. Typically clinicians spend 8-10 minutes on an activity.
WHEN, WHY, and HOW
do incorporation of phonological awareness activities occur?
WHEN - the last thing you do before you probe for the next session
WHY - because there is strong evidence that phonological awareness affects literacy
HOW - rhyming activities are sent home for parents to read to their children at night, syllable segmentation is facilitated by having the child hop for each syllable in a word, components from Animated Literacy, a comprehensive, multi-sensory early literacy program that blends the whole language and phonological awareness are sometimes incorporated.
WHEN, WHY, and HOW
do we incorporate focused auditory input/stimulation?
WHEN and WHY - Some children need to start one step below production practice, those who lack stimulability or who are unwilling to participate in production practice (ex. 2 years old). For these, it is recommended that focused auditory stimulation be provided for the first cycle of intervention
HOW - Deficient patterns are facilitated in succession by presenting a new phoneme (within target pattern) during each session. The child participates in activities and listens, but productions are not expected during this cycle. The clinician talks about selected objects (ex: cup, top, for final consonant stimulation) and incorporates activities (ex: jump, up) realted to the weeks’ target pattern.
How does Focused Auditory Input/Stimulation (FAI) differ from regular Auditory Bombardment?
?
What is the difference between “syllableness” and “multi-syllabicity”?
- Syllableness: is targeted for omitted vowels, diphthongs, vocalic/syllabic consonants resulting in productions limited to monosyllables. It is a primary target for children with highly unintelligible speech.
- Multi-syllabicity: is an advanced target for older children (around 8 years of age) who can pass articulation tests without error but have intelligibility issues in conversation due to difficulty saying large words. These kids commonly have language learning deficits.
What are the 7 underlying concepts that have influenced the Cycles approach? How?
- Phonological acquisition is a gradual process
- Children with “normal” hearing typically acquire the adult sound system primarily by listening (children first acquire those phonemes to which they have most frequent exposure)
- Children associated kinesthetic and auditory sensations as they acquire new patterns, enabling later self-monitoring (purpose of production practice)
- Phonetic environment can facilitate (or inhibit) correct sound production
- Children are actively involved in the phonological acquisition
- Children tend to generalize new speech production skills to other targets (critical to select target phonemes/patterns that will “trigger” the most extensive generalization)
- An optimal “match” facilitates a child’s learning. (determine at what level the child’s phonological system is breaking down so that intervention can be initiated one step above the child’s current level of functioning. This allows for the child to be optimally challenged yet experience success.)
HOW?
Why don’t we do daily “counting & charting of errors”? What do we use for accountability data?
?
Why do we incorporate amplification?
Amplification helps the child hear the correct production and recognize their errors
How do we select production-practice words? What types of words should be avoiding during beginning cycles?
Production-practice words with facilitative phonetic environments must be selected particularly during beginning cycles so that the child can experience immediate success
Words that contain phonemes produced at the same place of articulation as the substitute phoneme must be avoided during early cycles. For ex: cat, can, kiss, kite, and goat are inappropriate for children who substitute alveolars for velars (FRONTING)
Likewise: lamb, lamp, leaf, rope, robe, roof, robot, and rabbit (words containing labial consonants and/or round vowels are not used for production-practice during early cycles for children who substitute the labial glide /w/ for liquids
Words with actual objects can be used for elicitation are desirable
Why don’t we stay on a phoneme or patter until 85%/90% mastered?
Children with typical development do not learn “one phoneme at a time” to a criterion. The Cycles Approach more closely approximates the ways in which normal phonological development occur. Individual phonemes are used to facilitate the development of intelligible speech patterns.
What evidence is available for the Cycles Approach?
Almost and Rosenbaum conducted a randomized controlled intervention study in which showed that at the end of 8 months, the children who received immediate intervention scored significantly better.
A number of peer-reviewed published case studies have provided pre- and post-intervetnion data showing the effectiveness of Cycles
Which of the 7 Underlying Concepts for Phonological Cycles are the reasons for the following?
1 - Cycle of Patterns - “phonological acquisition is a gradual process”
What would be at the PRIMARY level for targeting?
/s/ clusters (initial/final)
“syllableness”
final consonants (only voiceless and possibly /m/ and /n/
Initial /r/
Final /k/
initial /l/
What would be at the SECONDARY level for targeting?
Palatal Sibilants
Medial /s/ clusters
Palatal sibilants
vowel contrasts
voicing contrasts (prevocalic only)
Initial /f/
What would be at the ADVANCED level for targeting?
Multi-syllabicity
What would be NOT APPROPRIATE levels for targeting?
Voiced final obstruents
Interdental fricatives
Final /g/
Final /l/
Children who have extensive substitutions and some omissions are in which severity level?
Moderate-Severe
Phonological Severity Continuum - table
PROFOUND: extensive omissions, many substitutions, assimilations common
SEVERE: man omissions, extensive substitutions, assimilations common
MODERATE: some omissions, some substitutions, distortions common
MILD: few omissions, few substitutions, distortions common
Consonants articulated in the back part of the oral/pharyngeal mechanism are referred to as _______________.
posterior consonants
The sequential position in a syllable (can be in the middle of a word) of a consonant that:
A) Follows a vowel _____________?
B) That precedes a vowel ____________?
A) Postvocalic
B) Prevocalic
Producing the same phonetic form for two or more adult words that normally are not produced the same is called ______________.
Homonymy
What is the major problem/limitation with using “articulation” tests?
distortions are counted as being equal to omissions, even though omissions have a more adverse effect on intelligibility than distortions
What are the general steps for eliciting sounds? (Appendix B)
- Clinician modeling a sound in monosyllabic word and having child imitate production
- Modeling/imitating sound in isolation
- Tactile/visual cues
- Slight amplification
For children unable to produce the following - what additional “tricks” would be employed for /k/ and /ʃ/?
/k/:
model and imitate velar fricative /x/, target /k/ in word-final position first
/ʃ/:
incorporate the palatal glide /j/ in models
What are some of the problems with current phoneme acquisition norms?
- Individual Differences: no two children acquire their phonological system in precisely the same manner
- Not consistent between authors
Many SLPs call children “Artic,” or “Phonological,” or “Apraxic.” What are some problems with these labels and what might you do instead?
Overlabeling and misconceptions/ misunderstandings with labels
What do we call a substitution of /w/ or /j/ for /r/?
Gliding
What is the total lacking of /w/ and /j/ (either by omission or substitution from another consonant category) Omission of glides/glottal stop replacement?
?
Is an interdental/frontal lisp a substitution of “th” for a sibilant?
Pg. 62-63. No – it’s a distortion
What are important factors to remember when selecting production-practice words?
- Monosyllabic words with facilitative phonemic environments are selected during the first few cycles so that clients can experience immediate success
- Care must be taken to reduce opportunities for assimilation effects, particularly during the first couple of cycles
What are two optimal production-practice words for word-initial /k/, /r/?
/k/ - key and cow
/r/ - rope and rock
What are two wrong production-practice words for word-initial /k/, /r/?
/k/ - kit and coat
/r/ - rabbit and ribbon
By what age [upper limit] should children?
Have suppressed most “simplification processes” and not have any omissions?
/r/? By 6 years
/s/ clusters [i.e., /s/ may be distorted, but not omitted]? By 3 years
“th”? By 7 years – perfected
Velars? By 3 years
?
