LECTURE #10 - pediatric speech sound disorders & fluency disorders Flashcards
when “diagnosing” pediatric SSDs, what is significant ?
1) is child’s speech different from their peers
2) does their speech interfere with communication ? can the child be understood ?
3) does the child avoid speaking situations ? is it impacting their engagement ?
can SLP’s in Canada diagnose ?
no
what are the 2 main assessments of speech ?
single word test and speech sample
what is the single word test ?
- is a method used to assess a person’s ability to recognize and produce speech sounds accurately. It typically involves asking the individual to repeat or identify single words spoken by a clinician. This test helps identify speech sound disorders and evaluates articulation and phonological skills.
in what assessement of speech do they :
- gather one example of each consonant sound in initial, median and final positions (I,M,F)
- standardized tests that provide an inventory of sounds child does and does not say
- give us one example
single word test
what is speech sample ?
- many examples of sounds in spontaneous conversation
- collect at least 100 different words
- percent consonants correct (PCC)
what do assessment of speech provide information on ?
1) number pf sounds produced incorrectly
2) how number of errors compares to sound production
if a child produces errors on one or two sounds what type of problem might it be ?
phonetic problem (articulation impairment)
if large numbers of sounds produced incorrectly, what do we look for ?
look for patterns of errors and phonological processes
if a child has large numbers of sounds produced incorrectly, what type of problem might they have ?
phonological (issues with the rules)
how many speech sound error patterns are there ?
4
what are the 4 speech sound error patterns ?
1) substitution errors
2) omission errors
3) distortion errors
4) addition errors
define “substitution errors” :
this is when a person replaces one sound with another. For example, saying “wabbit” instead of “rabbit.” The sound “r” is substituted with “w.”
define “omission errors” :
This occurs when a person leaves out a sound in a word. For instance, saying “ca” instead of “cat.” Here, the sound “t” is omitted, making the word shorter
define “distortion errors” :
This happens when a person produces a sound incorrectly, but it’s not completely different from the target sound. For example, saying “thun” instead of “sun,” where the “s” sound is distorted and comes out sounding like “th.”
define “additional errors” :
sound is added where it doesnt belong, often involves addition of unstressed vowel
(sound, usually a vowel,, is added where it shouldn’t be)
between the following, which is the least common ?
1) substitution errors
2) omission errors
3) distortion errors
4) addition errors
addition errors
what are two other assessment considerations not mentioned yet ?
stimulability and intelligibility
what is stimulability ?
refers to a person’s ability to correctly produce a sound when given a cue or prompt by someone else, like a speech therapist
- For example, if a child struggles to say the sound “s,” the therapist might say the sound slowly or show how to place the tongue. If the child can then repeat it correctly, they are considered “stimulable” for that sound.
what is intelligibility ?
is how well a person’s speech can be understood by others
- If someone is speaking and you can easily understand what they are saying, their speech is considered highly intelligible. If their speech is unclear or hard to follow, it has low intelligibility.
when is there a bigger impact of intelligibility ?
when large numbers of errors or omission errors
what is oral peripheral mechanism examination ?
is an assessment conducted by a speech-language pathologist (SLP) to evaluate the structure and function of the mouth, throat, and related areas involved in speech and swallowing.
what does OPE stand for ?
oral peripheral mechanism examination
what does OPE examine ?
1) structures for defects, tone, symmetry
2) function of structures for non-speech and speech movements
what is audiometric testing ?
is a procedure used to assess a person’s hearing ability. It helps determine the type and degree of hearing loss, if present.
what does SSDs stand for ?
speech sound disorder
what are the two main speech therapy approaches for intervention of SSD ?
1) articulation approach
2) phonological approach
what is “articulation approach” ?
for child who is unable to correctly say a few individual sounds (motor-based difficulty)
what is “phonological approach” ?
for child who can say sounds, but does not understand rule for saying sound in appropriate situations (rule-based difficulty)
FILL IN THE BLANK
children with physical or neurological challenges may requier _________
a team approach
what does articulation approach focus on ?
helping child to make correct productions
what does articulation approach use ?
uses sensory information to help elicit correct articulation
what approach uses “repetitive motor practice according to the principles of motor learning” ?
articulation approach
what is the traditional approach of the articulation approach ?
1) Provide auditory, visual and physical cues to help child say sound
– Child says sound after model
– Child watches and listens
2) Try to improve automaticity with which sound is said
– Provide lots of practice
– Child learns when sound feels correct or not
3) Increase length/complexity of stimulus
– syllables → words → sentences
4) Child learns to say sound outside therapy room
– Aka generalization
5) Child monitors how well they said targets
what is verbal-tactile cueing ?
is a technique used in speech and language therapy that combines verbal instructions with tactile (touch-based) prompts to help individuals improve their speech or communication skills.
what is the maximal contrast approach ?
a speech therapy technique that uses pairs of words to teach children new sounds
what is the “phonological approach” ?
- Focused on teaching the child the phonological rules they are struggling with
- Emphasizes changes in meaning caused by phonological errors, rather than teaching production of sounds
- Often uses contrastive approaches
– Use phonemic contrasts in rhyming word pairs
– e.g., Minimal Pairs Approach, Cycles Approach
what is the minimal pairs approach ?
– Child with cluster reduction
– e.g., says /pɔt/ for “spot” and “pot”
and /pi/ for “spy” and “pie”
– Therefore, child isn’t creating
meaning difference
– Present child with opportunities to
see way pair of words is different
what is the goal of the phonological approach ?
Goal = to improve intelligibility
what does therapy stimulate in the phonological approach ?
an emergence of patterns
what are the two types of cycles approach ?
vertical and horizontal
what do the cycles target selection target ?
Targets identified following a comprehensive speech
assessment
what are some cultural considerations ?
dialect and accent
define “dialect”
regional variety of particular language
define “accent” :
manner of pronunciation of a language
define Phonological Difference versus Phonological Delay or Disorder :
- Phonological Difference: Variations due to dialect or cultural background, not indicative of a disorder.
- Phonological Delay: Slower development of typical phonological skills compared to peers, expected to improve over time.
- Phonological Disorder: Persistent difficulties with phonological rules, requiring intervention to improve speech clarity.
define “Phonological Interference” :
Phonology of dominant language affects pronunciation of sounds in second language
what are “multilingual children” :
- Overall, similar rates of proficiency by age 5
- High variability in the preschool years
- Many of the same types of errors across language
define “fluency versus disfluency” :
Fluency = Fluency refers to smooth, uninterrupted, and easy speech. When a person speaks fluently, their words flow naturally without pauses, repetitions, or hesitations.
Disfluency = Disfluency refers to interruptions in speech that can include pauses, repetitions, or prolonged sounds. It can be a normal part of speaking, but when it occurs frequently or affects communication, it may indicate a speech fluency disorder, such as stuttering.
what are the 3 common characteristics of multilingual speech development ?
- distributed skills and uneven ability
- cross-linguistic associations
- individual variation
what is fluency ?
Fluency refers to smooth, uninterrupted, and easy speech. When a person speaks fluently, their words flow naturally without pauses, repetitions, or hesitations.
what is disfluency ?
Disfluency refers to interruptions in speech that can include pauses, repetitions, or prolonged sounds. It can be a normal part of speaking, but when it occurs frequently or affects communication, it may indicate a speech fluency disorder, such as stuttering.
define Normal Disfluencies :
Occasional, short, and relaxed speech interruptions
what is normal disfluency ?
- Everyone experiences minor interruptions in flow of speech at times
– Especially common in young children as they are
starting to produce sentences
How do we distinguish “normal” disfluencies from stuttering?
- Normal Disfluencies: Occasional, short, and relaxed speech interruptions.
- Stuttering: Frequent, longer interruptions with tension and impact on communication.
define stuttering :
Frequent, longer interruptions with tension and impact on communication
What is stuttering?
An interruption in the flow of speaking characterized
by specific types of disfluencies
provide characteristics of normal disfluency :
- Repetitions
– sentences
– phrases
– words - Interjections (e.g., ‘um’)
- Revisions
- Hesitations
- No awareness or frustration
- Mostly fluent
provide characteristics of possible stuttering :
- Repetitions
– syllables
– individual sounds - Sound prolongations
- Sound blocks
- Tense pauses
- Bursts of speech
- Clusters of disfluency
- Associated body movements
Distinguishing Normal Disfluency from
Possible Stuttering :
- In the first 6 months after onset, groups can look
very similar - Strong decline in disfluencies within 1st year in
- More likely to be stuttering if there is a family history
of stuttering
how many types of fluency disorders are there ?
3
what are the 3 types of fluency disorders ?
- Developmental stuttering
– vast majority of people with fluency disorders - Non-developmental stuttering
– Neurogenic stuttering
– Psychogenic stuttering - Cluttering
development stuttering is more prevalent in what gender ?
boys (3:1)
what is the typical onset age for individuals with developmental stuttering ?
typical onset between 2–5 years of age
within developmental stuttering, what does heritable mean ?
– More often in twins and runs in families
– Suggests genetic predisposition
within developmental stuttering, what does variable mean ?
– within utterances
– day-to-day
– across situations
TRUE OR FALSE
variability can decrease or increase
TRUE
describe variability decreases :
– novel speaking manner (e.g., singing)
– while alone, speaking to animals or kids
– disruptions in auditory feedback
describe variability increases :
– anticipating stuttering (e.g., waiting to respond)
– having to say specific words (e.g., your name, a joke)
– talking on the phone
what does increase variability mean ?
that a sound is produced or perceived in more diverse ways, making it less consistent. This can happen due to factors like:
- Speaking in different emotional states (e.g., excitement can make speech faster and louder)
- Different speakers (e.g., accents, voice pitch, and individual speech habits)
- Environmental conditions (e.g., background noise, echoing rooms)
what does decrease variability mean ?
Decreases in variability mean that a sound is more consistent and predictable across different contexts. This happens when:
- Speech is more controlled, such as in formal settings
- Speakers make a conscious effort to pronounce sounds clearly
what term defines :
adds diversity to sound production and perception
increased variability
what term defines :
makes sounds more uniform and easier to recognize
decreased variability
what are the 8 types of overt/primary characteristics ?
- Part-word repetition
– “mi-milk”, “d-d-d-dog” - Single syllable word repetition
– ”I…I want that” - Multi-syllabic word repetition
– “Lassie…Lassie is a good dog” - Prolongation
– “I’m Tiiiiiimy Thompson” - Silent/tense pause (block)
– “Can I have some….milk?” - Phrase repetition
– “I want a…I want a ice cream cone” - Interjection
– “He went to the …uh…circus” - Revision or incomplete phrase
– “I lost my…Where’s Mommy going?”
what are some covert/secondary behaviours ?
Bodily Movements/Struggle and psychosocial behaviours
define bodily movements/struggle :
– Facial grimaces
* e.g., blinking eyes, wrinkling forehead, distorting mouth, tongue protrusion
– Head movements
* e.g., looking away, jerking
– Loss of eye contact
– Body movements
* e.g., limb movement, foot tapping
define psychosocial behaviours :
– Avoidance
* e.g., fillers, pretending to think,
avoiding situations and people,
appearing shy and quiet
– Emotional responses before
speaking
* e.g., fear of loss of speech
control
– Emotional responses after
stuttering
* e.g., embarrassment, shame,
anger, frustration
define non-developmental stuttering :
Sudden onset of stuttering in previously
fluent adult…
A. Neurogenic
* Linked to identifiable neurological event
B. Psychogenic
* In context of psychological disturbance
explain neurogenic stuttering :
- Etiology
– Neurological damage or disease - e.g., stroke, head injury, neurosurgery, MS, Parkinson’s disease, meningitis
– Exposure to toxins - e.g., drugs, poisons
- Distinctions from stuttering
– Equally disfluent across different speaking situations
– Secondary behaviours less common
– Negative emotional response less common
explain psychogenic stuttering :
- Etiology
– e.g., psychological trauma, anxiety, depression, other psychological disorder - Distinctions from neurogenic stuttering
– May be intermittent
– Unusual or bizarre speech/language patterns
– May respond quickly to behavioural treatment
TRUE OR FALSE
cluttering is common
FALSE
cluttering is rare
what are cluttering speech characteristics :
- Frequent whole word and phrase repetitions
- Rapid rate of speech
- Irregular rate of speech
- Misarticulations
– Slurred or deleted phonemes
– Substitutions
cluttering : distinction from stuttering
- Part-word (sound or syllable) repetitions are infrequent
- Secondary behaviours (e.g., tension, struggle, avoidance) not usually present
- Lack of awareness of or negative emotional response to the problem
- Often more fluent in conditions where person who stutters is less fluent
– e.g., under stress, with authority figures, when paying attention to their own speech, when wanting to be fluent
what is the speaking rate for cluttering :
Irregular, 300+ syllables/minute
what is the speaking rate for stuttering :
Regular, 240 syllables/minute
define articulation for cluttering :
Slurred, omissions
define articulation for stuttering :
normal
define disfluencies of cluttering :
Non-stuttering disfluencies
define disfluencies of stuttering :
Stuttering-like disfluencies
define self-perception and anxiety regarding cluttering :
Unaware of disfluent speech, no anxiety
define self-perception and anxiety reguarding stuttering :
Aware of disfluent speech, anxious
define expressive language regarding cluttering :
disorganized
define expressive language for stuttering :
organized
what causes stuttering ?
we don’t know, but we have theories
what are the main type of theories to explain what causes stuttering :
- Demands & capacities theory (Starkweather, 1977)
- Covert repair theory (Postma & Kolk, 1993)
- Neuropsycholinguistic (Perkins, Kent, Curlee, 1991)
define “ Demands & capacities theory (Starkweather, 1977)” :
Intrinsic & extrinsic social demands exceed the
child’s capacities for fluent speech
define the Covert repair theory (Postma & Kolk, 1993)
According to this theory, stuttering is a result of “repairs” in speech. The idea is that, as we talk, our brain is constantly “checking” our speech plan before saying it. When it detects an error, it tries to fix it quickly, which can cause a disruption or hesitation. In people who stutter, this “repair” process may happen more frequently, causing more stops and starts in their speech.
what likely causes stuttering ?
Likely a combination of factors
– genetic predisposition
– neurological dysfunction (over-activation in right hemisphere; under-activation in left or difficulty with auditory feedback)
– Environmental stressors
define Neuropsycholinguistic (Perkins, Kent, Curlee, 1991)
This theory suggests that stuttering occurs when the timing between the brain’s language and motor systems gets out of sync. In other words, the processes for thinking of what to say (language) and actually saying it (speech movements) don’t match up perfectly, causing disruptions. When these two systems don’t align smoothly, stuttering can result because the brain struggles to coordinate both parts at the same time.
Some examples from the Communication Attitude Checklist Brutten, 1985 and Stuttering Attitudes Checklist :
- People worry about the way I talk
- I don’t talk like other children
- Some kids make fun of the way I talk
- I let others talk for me
- I sometimes feel that my stuttering is my own fault
- My teachers should not make me answer questions in class if they think I will stutter when I answer
- I feel that it is best if I do not talk about my stuttering with my friends
- My stuttering is my biggest problem
- Sometimes I feel I should be able to stop my stuttering without help
- I think stuttering makes it harder for me to make friends
- My stuttering has caused me to make poorer grades in school
- Sometimes I think my parents may have caused my stuttering
- I doubt if speech therapy can help me a whole lot
what are some assessment of fluency disorder ?
- Are speech disfluencies present?
- What is the nature of the speech disfluencies?
what are examples of treament for early stuttering ?
Uses indirect methods
- changes in environment to stabilize fluency
reinforcing fluent speech
- *family involvement (deal with anxiety)
- e.g., Lidcombe program
what are two treatment for stuttering ?
1) Fluency Shaping
2) Stuttering Modification
– Both use behaviour modification to reduce speech disfluencies
– May be used in isolation or in combination
what is the lidcome program ?
- Clinician-mediated
- Parent-implemented
Behavioural treatment (preschoolers & adapted for school age (mild-moderate stuttering)) - Goal: no stuttering
- Several outcome studies (92% achieve and maintain near zero stuttering up to 7 years post treatment)
define “fluency shaping” ?
- Designed to modify all aspects of client’s speaking behavior
- Behavioural modification
- “relearning” speech motor movements to produce fluent speech
- Goal = stutter-free speech
what do clients learn to do in stuttering modification ?
1) stutter more fluently, with less tension
2) use light articulatory contacts during speaking
3) reduce situational fears and negative associations with stuttering, feel in control of stuttering
explain stuttering modification as a treatment for stuttering :
- Designed to address individual moments of stuttering, as opposed to changing entire pattern of speaking behaviour
how to Learn new pattern of speaking in fluency shaping ?
a. Speak at reduced rate
b. Prolong vowel portions of words
c. Use slow and smooth onsets of words
d. Continuous phonation
what are some problems with stuttering modification ?
- Slower observable change
- May still have moments of stuttering
TRUE OR FALSE
most people will benefit from participating in therapy ?
TRUE
TRUE OR FALSE
there are only traditional treatment appraoches to stuttering
FALSE
there are also non-traditional treatment approaches
what are the most known non-traditional treatment approaches ?
- hypnotherapy
- drug therapy
- electronic devices
TRUE OR FALSE
hypotherapy is controversial
TRUE
what does drug therapy have some success with ?
with dopamine blockers
describe electronic devices that are used as treatment for stuttering :
- closely resemble hearing aid
- delayed auditory feedback
what should we be considering in regards to cultural consideration ?
Careful consideration required in the assessment and treatment of fluency disorders among individuals from diverse cultural backgrounds
what are some special considerations for multilingual speakers ?
- Likely to stutter in multiple languages, but more in the less proficient language
- Research is needed to support assessment and treatment in this population
how can listeners help when talking to someone with a stutter ?
- Listen to what the person is saying, not how they are saying it (Maintain natural eye contact & Wait until the person is finished (do NOT finish sentences or fill in words))
- Be especially patient on the telephone
(Don’t give advice (e.g., slow down, take a breath))
– You speak in a slow & relaxed way (modelling)
