Section 3 Flashcards
1
Q
What is phonological development?
A
The gradual acquisition of an adult-like system of speech sounds that are used to convey meaning in a language. Phonological development can be considered in terms of both perception and production of speech sounds.
Being able to perceive the differences in speech sounds is critical to comprehending and developing language and is also an essential precursor to speech production. Speech scientists have hypothesized that babies come “prewired” to perceive minimal differences in speech sounds.
2
Q
Define word awareness.
A
Tracking the words in sentences.
3
Q
What is included in phoneme awareness?
A
Identify and match the initial sounds in words, then the final and middle sounds (e.g., “Which picture begins with /m/?”; “Find another picture that ends in /r/”).
Segment and produce the initial sound, then the final and middle sounds (e.g., “What sound does zoo start with?”; “Say the last sound in milk”; “Say the vowel sound in rope”).
Blend sounds into words (e.g., “Listen: /f/ /ē/ /t/. Say it fast”).
Segment the phonemes in two- or three-sound words, moving to four- and five- sound words as the student becomes proficient (e.g., “The word is eyes. Stretch and say the sounds: /ī/ /z/”).
Manipulate phonemes by removing, adding, or substituting sounds (e.g., “Say smoke without the /m/”).
4
Q
Name the phonological skills that should be present at age 4.
A
Rote imitation and enjoyment of rhyme and alliteration.
5
Q
Name the phonological skills that should be present at age 5.
A
Rhyme recognition, odd word out
Recognition of phonemic changes in words (Hickory Dickory Clock)
Clapping, counting syllables
6
Q
Name the phonological skills that should be present at age 5.5.
A
Distinguishing and remembering separate phonemes in a series.
Blending onset and rime (ex. what word - th-umb)
Producing a rhyme
Matching initial sound, isolating initial sounds.
7
Q
Name the phonological skills that should be present at age 6.
A
Compound word deletion (Ex. say cowboy but don’t say cow)
Syllable deletion
Blending of two and three phonemes.
Phoneme segmentation of words that have simple syllables with two or three phonemes (no blends) (ex. sh-e, m-a-n)
8
Q
Name the phonological skills that should be present at age 6.5.
A
Phoneme segmentation of words that have simple syllables with two or three phonemes (with blends) (ex. b-a-ck)
Phoneme substitution to build new words that have simple syllables (no blends) (eg. change the /j/ in cage to /n/)
9
Q
Name the phonological skills that should be present at age 7.
A
Sound deletion (initial and final positions)
10
Q
Name the phonological skills that should be present at age 8.
A
Sound deletion (initial position, include blends)
11
Q
Name the phonological skills that should be present at age 9.
A
Sound deletion (medial and final blend positions)
12
Q
Describe speech sound acquisition for birth to age 1.
A
- Reflexive (0–2 months):
restricted to crying and partial vowel sounds - Control of phonation (1–4 months): “cooing”
progress to vowel-like sounds, consonant-like sounds,
combinations of vowel-like and consonant-like sounds, Anderson and Shames (2011) describe this stage as “cooing” - Expansion (3–8 months).
vocal play and exploration
begin to try new vocal postures and gain more control over their oral musculature
produce isolated vowels, vowels in sequence, glides, squeals, and the beginning of babbling sounds. - Basic canonical (C+V) syllables (5–10 months).
begin of babbling. - Advanced forms (9–18 months).
increased babbling complexity + adult-like utterances called jargon
children say first words during this stage around one year of age, and produce immature versions of adult words (e.g., “da” for “dog,” “wawa” for “water,” “di” for “drink”)
13
Q
Describe speech sound acquisition for 1-2 years.
A
Children use around 50 words (but not with 100% intelligibility) produce most (but not all) vowels reduce many adult word forms to simpler forms (e.g., “baba” for blanket, “do” for “dog,” and “kaka” for cracker) produce an average of 10 consonants (McLeod, 2013, pp. 86), often including /p m h w b n/
14
Q
Describe speech sound acquisition for 2-5 years.
A
Most English consonant sounds are acquired by the end of the third year:
plosives, nasals, and glide sounds
selected fricative and affricate sounds
Some fricative sounds (particularly /s, z, ɵ, ð, ʃ, ӡ/), affricates (ʤ, ʧ), and liquids (/r, l/) tend to be more variable in age of acquisition and may not develop until the end of the eighth year.
Acquisition of certain speech sound like /s r/ varies widely!
15
Q
Describe speech sound acquisition after 5 years.
A
As children reach school age, most begin to apply their knowledge of sounds to literacy skills.
One foundational literacy skill is the ability to understand the rules that allow sounds to be blended or taken apart, and how sounds relate to each other in words-> phonological awareness
16
Q
What purposes does the oral mechanism serve at birth?
A
- Nutrition
- Breathing
- Gaining attention via crying.
17
Q
What is a typical DDK for a 2 year old?
A
Typically developing 2 year old children can produce 3-4 syllables/second, and sustain a vowel for 5-6 seconds
18
Q
How does sound perception change after birth?
A
Babies only a few days old can perceive differences in phonemes (e.g., differences in manner & place). Vowels [i], [i], and [a] are particularly salient to infants. Infants can also differentiate between phonemes that are not contrastive in their native language.
By 12 months, the infant has the capacity to categorize only those phonemes which are in its native language.
By 2 years children’s speed and accuracy for identifying words in speech is similar to adults –but is not fully adult-like until they are 12.
19
Q
What consonant types does a child typically have in the first year of life
A
Nasals Plosives Fricatives Approximants Labials Linguals [b d m n] are the most frequently reported
20
Q
What consonants do children typically develop between 1-2 years?
A
[t] [d] and [w]
21
Q
What consonants do children typically develop between 2-2.5 years?
A
[ŋ] [k] [g] [w] [h]
22
Q
What types of consonants are generally mastered by the age of three, according to studies?
A
plosives, nasals, fricative [h] and approximant [w]
23
Q
What consonant clusters are generally predominant in 2 year olds?
A
Word-initial consonant clusters containing /w/ (e.g., [bw, kw]), where the target is [br, kl]
24
Q
What consonant clusters are common in 2-3 year old children?
A
Common final consonant clusters for 2-3 year old children contain nasals
[r] consonant clusters are rarely produced correctly by 2 year old children
25
Describe the development of vowels in children.
Low, non-rounded vowels are favoured in the first year
Front-back vowel differences appear later than height differences
^ other papers however have found that there is variability in what order vowels are acquired, but they are acquired early
Number and diversity of vowels increases as children approach their second birthdays
26
At what age should children generally be understood most of the time?
By 5 years old, typically developing children should be understood most of the time, even to unfamiliar listeners.
One study found that TD 3 year olds were 95.68% intelligible, 4 year olds were 96.82 intelligible, and 5 year olds were 98.05% intelligible to an unfamiliar listener
27
What consonants should a child between the ages of 3;6 and 4;6 have in their inventory?
[p, b, t, d, k, g, m, n, ŋ, f, v, s, z, h, w, j, l, ʃ, , tʃ, dʒ, (ɹ)]
Some studies have found that 3 year olds have acquired all major phoneme classes except for liquids
28
What consonants should a child between the ages of 4-5 have in their inventory?
[p, b, t, d, k, g, n, ŋ, f, v, s, h, w, j, l, tʃ, dʒ, ɹ, ʒ, ʃ, ð, θ]
Most studies indicate that 5 year old children produce over 90% of vowels, consonants, and consonant clusters correctly
29
Describe the changes in phonological errors in children?
Fewer occurring as children age
Some we still see b/w ages 3-5, weak syllable deletion, final consonant deletion, cluster reduction, fronting, stopping, deaffrication, and gliding (WILL see fewer as kids get older, REFER TO CHART to see when each process should outgrown)
30
What is prosody and when does it develop?
Ability to produce different stress patterns continues to develop
Age 3, typically will master trochaic stress pattern (e.g., strong-weak stress patterns such as garden, and butterfly)
Takes approximately 7 years to master words with non-final weak syllables in words (e.g., ambulance, caterpillar, computer, potato, vegetable)
31
What is the critical age hypothesis?
Children who have speech difficulties that persist to the point when they need to use phonological skills for learning to read are at a high risk for reading problems
32
What occurs to the oral cavity after the age of five?
b/w 5-7 children start to lose their primary teeth
Age 6 child’s skull reaches adult size
Lower face grows from 7-10
Lips and tongue grow from 9-13
Mandible, lips, tongue grow until age 16 for girls and 18 for boys
Throughout childhood and into adolescence refinement of movements of tongue tip, tongue body and jaw continue
33
What DDK and max phonation time should a child have after the age of 5?
5 syllables/ second on DDK task
| Sustain vowel ah for 10-11 seconds
34
Describe a child's speech development by the time they enter school.
Should be intelligible.
Typically have all consonants and vowels and most consonant clusters with 90% accuracy
Can produce all syllable shapes
May still struggle with fricatives /v/, /th/ and /z/ and approimant /r/ are acquired later.
Continuing to develop /s/ and/r/ blends.
Mastery of complex prosody (used by adults) continues to develop in school years, even beyond age 10
35
How does a child's environment effect the development of normal phonology?
Socioeconomic status:
Inconclusive evidence. Some studies have found no difference in speech acquisition between groups of varying levels of SES. Other studies have found that children from higher SES households acquire speech earlier and have better phonological awareness skills.
Maternal Education:
Higher maternal but not paternal education has been linked to more advanced speech and language skills across many studies.
Few studies however have considered this factor as it relates to speech acquisition and the results are mixed.
36
How do language skills effect the development of normal phonology?
Children’s speech and language skills are interlinked.
Generally children who have typical language skills also have typical speech skills.
Despite this, it is IMPORTANT to remember that SOME children will only have difficulties with speech and not language and vice versa.
37
How does word frequency and the age of acquisition of words effect the development of normal phonology?
Word Frequency:
Words occur in languages at different rates (i.e., high frequency or low)
High frequency words → more likely to be accurate during speech acquisition, and may be better for facilitating progress in intervention.
Age of Acquisition of Words:
Some words are acquired earlier than others. The role of the age of acquisition speech accuracy is inconclusive. E.g., some studies find that voicing is learned with earlier acquired words, and others find the opposite.
Clinical application: including later acquired words in intervention induces greater phonological generalization
38
How does vocab size effect the development of normal phonology?
Children vary in the number of words they know/use
Bidirectional relationship b/w vocab size and speech accuracy
Early speech production abilities drive word learning → as children learn more words, their speech improves. More words may mean more detailed underlying phonological representations.
39
Define neighbourhood density and how it impacts a child's phonological development.
The number of words that differ from a given word by one phoneme
E.g., dense neighbourhoods have a lot of words that differ by one phoneme (e.g., “cat” has 35 neighbours)
Words from dense neighbourhoods tend to be less variable in production in younger children
Clinically unclear how to apply findings as there are benefits to including both types of words in intervention.
40
Define phonotactic probability and how it impacts a child's phonological development.
The likelihood of occurrence of a given sound or sound pair in a given language → thought to influence phonological representation. (e.g., “ca” in cat is more common than “cu” in cup)
More common sound sequences tend to be learned more quickly and with greater accuracy during the course of typical speech development → however some contrasting evidence that this is not related with speech accuracy
41
Define functional load and how it impacts a child's phonological development.
How often a phoneme contrast with other phonemes in a language
E.g., sounds with a high functional load = w, m, b, r, h, s, k, n, t b/c there are a lot of words that begin with these sounds. “Th” contrasts b/c not many words have this sound.
Words with high functional loads tend to be acquired first.
42
Define the phonotactic structure of words and how it impacts a child's phonological development.
The length and syllabic complexity of words influences children’s accuracy of speech production → simpler =easier
Found across languages
43
Define the phoneme input frequency and how it impacts a child's phonological development.
How often a phoneme occurs in a language
Example: very few words use “th” but the ones that are, are used frequently
In general more frequently heard phonemes are learned earlier
Phoneme input frequency can be offset though by other factors. E.g., “th”, b/c it has a lower functional load, and is more complex to articulate.
44
What are some affective factors that can impact the development of normal phonology?
Pragmatic Factors:
Children might avoid saying specific words/sounds because others have found their speech difficult to understand. This can be observed in typically developing children and clinically referred children.
Might even avoid saying certain words upon Ax/Tx
Personal Factors:
Performance on a task may be impacted by the time of day, whether they are hungry, tired, bored, anxious, or disinterested in the task
45
What are some motor factors that can impact the development of normal phonology?
Phonetic/Articulatory Complexity:
How difficult a consonant is to produce from an artic perspective
Kent (1992) proposed different levels of articulatory complexity:
Level 1 (least complex/easy): [p, m, n, w, h]
Level 2: [b, d, k, g, f, j ]
Level 3: [t, r, l ]
Level 4 (most complex): s, z, sh, d3, v, th (both)
46
What are the different categories of speech sound disorders?
```
Functional (no known cause)
Organic (developmentally acquired):
- Motor/neurological
- structural
- sensory/perceptual
```
47
What are functional speech sound disorders?
Include those related to the motor production of speech sounds and those related to the linguistic aspects of speech production. Historically, these disorders are referred to as articulation disorders and phonological disorders, respectively.
48
What are articulation disorders?
Articulation disorders focus on errors (e.g., distortions, substitutions, addition or unusual idiosyncratic processes) in production of individual speech sounds
49
What are phonological disorders?
Focus on predictable, rule-based errors (e.g., fronting, stopping, and final consonant deletion) that affect more than one sound. It is often difficult to cleanly differentiate between articulation and phonological disorders; therefore, many researchers and clinicians prefer to use the broader term, "speech sound disorder," when referring to speech errors of unknown cause
50
Name and describe some common motor/neurological speech sound disorders in children.
Dysarthria (execution):
Don’t see too many of these
Weakness or paralysis of speech musculature that affect respiration, phonation, articulation, and/or resonance
Motor Speech Disorder-NOS
Mixed signs of motor planning and subtle motor control difficulties but not enough to indicate a motor planning disorder or dysarthria
Childhood Apraxia of Speech (planning):
Very rare
Difficulty executing the volitional motor plan for speech in the absence of paralysis
51
Name some structural speech sound disorders.
Cleft palate
| Structural deficits due to trauma or surgery
52
Name some sensory/perceptual speech sound disorders.
Hearing impairment.
53
Name the plosive sounds (voiceless then voiced)
Bilabial: p b
Alveolar: t d
Velar: k g
54
Name the nasal sounds.
Bilabial: m
Alveolar: n
Velar: ŋ
55
Name the fricative sounds (voiceless then voiced).
```
Labiodental: f v
Dental: θ ð
Alveolar: s z
Postalveolar: ʃ ʒ
Glottal: h (voiceless)
```
56
Name the affricate sounds (voiceless then voiced).
postalveolar: t̬ʃ dʒ
57
Name the approximate sounds.
Alveolar: r (voiced)
Palatal: j (voiced)
Velar: w (voiced)
58
Name the lateral approximate sounds.
alveolar: l (voiced)
59
What are the different types of commissions a child might have?
Simplification: rabbie to rae
Weak syllable deletion: unstressed is deleted ex. banana naene
Multisyllabicity problems: difficulty producing all the syllables and sounds in a multisyllabic word.
Singleton consonant omissions: can occurs at the end of a word or postvocalic, in the middle of a word or intervocalic, or at the beginning of a word or prevocalic (not common in english)
Consonant cluster reduction: one or more of the consonants is omitted in a syllable, often influences children's morphologies.
60
What are the different types of substitutions a child might make?
Fronting: sounds made at the back substituted by a sound produced in the front ex. tup for cup
Backing: an anterior sound (i.e., made at the front of the mouth) is replaced by a back or posterior sound (i.e., made at the back of the mouth). ex. kai to tie
Stopping: refers to the use of a stop /p, b, t, d, k, g/ for a “nonstop” consonant, such as a glide, fricative, liquid, or nasal ex. tun for sun
Gliding: where the /w/ or /j/ is used for another consonant, typically a liquid. For example, light becomes [jaɪt]
Vowelisation: is the substitution of a pure vowel for a vocalic liquid. An example would be paper→ [pepo]
Palatization:the palatal feature is added or omitted, respectively. This pattern typically occurs with sibilants. If the child says [sip] for the word sheep, the sibilant was depalatalized. If the child says [ʃi] for see, the sibilant is palatalized
Affrication: refer to addition or loss of the combination of a stop and fricative, respectively.
If chair→ [tεə] or [ʃεə], deaffrication has occurred. If she→ [ʧ], affrication occurred
61
What are assimilations?
involves a sound in a word taking on a characteristic of another sound in the same word.
This change can occur even if the sound that caused the change is omitted.
Although labial assimilation is common in young children, children with expressive phonological impairments tend to use it excessively
Labial: soap → [pop] or [po].
Velar: doggie → [gɔgi]
Alveolar: fight → [taɪt]
62
What are some syllable-structure/context related changes kids might make?
Metathesis: occurs when two sounds or syllables in a word change places (e.g., ask → [æks])
Migration: only one sound moves within the word (e.g., snake → [neks]).
Coalescence: occurs when two sounds in a word are replaced by a single sound, which has the features of the two replaced sounds but is neither of the original sounds. ex. An example is spoon → [fun]: the /f/ has the stridency of /s/ and the labial component of /p/
Reduplication: is the repetition of phonemes or syllables that young children demonstrate as a typical part of developing language (e.g., bottle → [baba]
Epenthesis: the insertion of a sound. The most common form of epenthesis is the addition of /ə/ between two consonants in a cluster, such as black → /[balæk].
63
What speech sound issues might you see with a child with a cleft lip and palate?
Tend to be less complex than TB but at a higher risk for speech delay.
Glottal stops are used by some children to “mark” the final consonant in a word until the sounds are developed and often seen after repairs.
Nasalized Vowels or ŋ/l Substitution→ Nasalized plosives or vowels can persist after surgical correction
Nasalized /ɚ/ The final /ɚ/
Phoneme-specific nasal emission (PSNE) is the result of the use of either a pharyngeal or posterior nasal fricative as a substitution for other fricatives or affricates
Pharyngeal Plosives are usually substituted for k/g
64
What speech sound issues might you see in a child with hearing loss?
Adequate hearing is needed so that children are aware of the speech and language being used in their homes and surroundings. A hearing loss can affect the child’s ability to hear, which in turn may affect the acquisition of speech. Additionally, hearing is needed so that the children can monitor their speech as it is developing.
The age of onset of a loss affects both speech and language acquisition. Children with severe/profound hearing losses since birth have a difficult time acquiring speech and language. If the hearing loss occurs later, the child may maintain some skills learned up to that point, but these skills typically deteriorate over time. Better language development is associated with early identification of hearing loss and early intervention
65
How does intelligence impact speech sound acquisition?
When intelligence falls into the cognitively delayed range (e.g., intelligence quotient [IQ] <70), however, there does tend to be a correlation: the lower the IQ, the higher the prevalence and frequency of speech sound errors
66
What are some educational impacts of speech sound disorders?
Children with SSDs are more likely to have difficulties with phonological awareness and literacy
Critical age hypothesis: children who continue to have difficulties with SSD at the beginning of literacy instruction (around 5y old) are at most risk for having later literacy difficulties
Lowered academic expectations and limitations on teacher child relationships
Difficulty with initiation and maintenance of peer relationships,
Increased parental anxiety and difficulty forming a nurturing parent child relationship
Negative impact on sibling relationships
Increased risk for reading difficulties and workplace difficulties
Children whose speech errors interact with academic performance are more severely impacted (ie. /w/ for /r/ substitution error)
67
What is cross language association?
Appears to be a transfer between phonology from L1 to L2, and from L2 to L1.
Cross-language associations among multilingual children are commonly known as cross-linguistic transfer. These effects can occur at the phonological, lexical–semantic, and morphosyntactic levels of language. Transfer effects between languages can be positive (facilitating language performance) or negative (impeding language performance), with the extent of transfer depending on how similar the languages are
68
What are some aspects of a case history that are important for children?
Demographic information: Name, DOB, age, sex, address, phone, email address
The family's needs and concerns: Reason for the referral + other areas of concern
Communication history: Babbling, first words, combining two words, current communication abilities, areas of concern, previous Ax and Tx from SLP, family Hx of speech, language, communication and academic difficulties
Cultural and Language Hx: countries family has lived in. Languages spoken, competency in each language. See comprehensive language profile below for more details.
Hearing Hx: number of ear infections & how they were treated, hearing tests, diagnoses, hearing aids, cochlear implants
Birth Hx: pregnancy, significant birth events, gestation age at birth
Developmental Hx: Milestones (sitting/walking), significant events during childhood
Feeding & Eating: difficulties with breast feeding, bottle feeding, swallowing, food preferences and allergies
The child and his/her environment: child’s interests, strengths, concerns, family members, friends, school, activities
Family preferences: for Ax and Tx (e.g., service delivery, parent-caregiver roles)
69
What types of assessments might you do to gain information about intelligibility?
Can be screened using the Intelligibility in Context Scale or rating scales provide quick screening measures of intelligibility, but there are disadvantages. Different listeners may make different judgements and specific intervention targets can’t be determined from the results.
Single word
Children produce a set of single words to assess intelligibility
Examples: children’s speech intelligibility measure (CSIM), computer mediated single word intelligibility … more examples on page 248
Connected speech measures that quantify word and syllable identification
Good face validity b/c judgements of speech intelligibility are more closely related to everyday conversational contexts
Connected speech samples have mostly relied on sentence repetition & sentence reading
Sentence reading not best measure b/c it’s dependent on how well the child can read (intelligibility can be impacted greatly --not valid)
Intelligibility index: quantifies the number of words understood by the listener. Involves transcribing utterances and determining how many syllables are understood.
70
How might you assess acceptability of a child's speech?
Example rating system:
0= within normal limits. Speech is normal
1= Mild: speech deviates from normal to a mild degree
2=Moderate: speech deviates from normal to a moderate degree.
3= Severe: speech deviates from normal to a severe degree.
71
List some possible areas of assessment for children.
```
Language profile.
Intelligibility
Acceptability
Comprehensibility
Stimulability
Oral structure and function
Hearing and speech perception
Contextual testing
Assessment of children's communication participation.
Screening of language, voice, and fluency.
```
72
How might culture impact assessment for children?
Knowledge of a family's worldview and cultural frame of reference is essential for providing speech-language pathology services that are meaningful and relevant for culturally and linguistically diverse families. Families may have multiple cultural influences upon their values, language preferences, kin structure, child rearing practices, religion, roles, responsibilities of family members (as caregivers, disciplinarians, socializers, and/or decision makers), perceptions of health, and behaviors across different domains of their life.
73
How might you adapt an assessment to account for cultural variation?
Adaptation of assessments from one language to another is not recommended, particularly for speech assessments, because phoneme inventories differ across languages.
Additional Multicultural insights (pg 230 of SSD textbook)
Make sure to get their demographic information correct such as their names and date of birth. Phonetically transcribe names so you know how to pronounce them when meeting with them again.
If a family is from a non-western culture be aware that the order in which they write their name may be different. E.g., in Vietnam many families write their surname first, then middle name, and finally first name. Don’t assume though--always clarify.
Documenting DOB also important and can vary across cultures depending on what calendar they use. Example: Lunar calendar. Some families calculate the age of a child based on the time of conception to the beginning of the lunar calendar, instead of the time of birth. Using a western calendar, the child would be 1-2 years older.
74
What assessments might you consider for a child with suspected phonological impairments?
Comprehensive single-word speech sample from a standardized phonology test
Connected speech Ax : targeting specific areas of difficulty (e.g., consonant clusters, fricatives, affricates, liquids)
Informal probes of patterns of errors (e.g., fronting, stopping, cluster reduction). Can do this with minimal pairs.
Speech perception ability (e.g., % correctly identified target sounds given array of correct, incorrect, and other sounds).
75
What assessments might you consider for a child with suspected inconsistent speech disorders?
Inconsistency assessment: sample 25 words on 3 occasions from the Diagnostic evaluation of articulation and phonology
Assessment of the same words in imitated and spontaneous speech contexts
Stimulability testing
Independent phonological analysis: inventory of phones (consonants, vowels), syllable and word shapes, stress patterns
Relational phonological analysis → calculate % inconsistency. See if there is greater than 40% variability.
76
What assessments might you consider for a child with suspected articulation impairment?
Single-word standardized articulation Ax: to determine exactly which consonants and vowels are in error, and any phonotactic constraints (e.g., whether the errors occur in all word positions, only consonant clusters, only in polysyllabic words)
Informal probes of consonant errors (e.g., s,z, r): sample 10-20 words containing the consonant errors to determine consistency of production and any phonotactic constraints that were not tested or were not apparent during single word testing.
Connected speech assessment
77
What assessments might you consider for a child with suspected CAS?
Comprehensive single-word sample from standardized phonology ax
Informal assessment of words increasing length (e.g., but, butter, butterfly)
Assessment of polysyllables (real and nonwords) reflecting varying stress patterns
Assessment of the same words in imitated and spontaneous speech contexts
Connected speech assessment: paying particular attention to intelligibility, juncture, and prosody (look for inappropriate phrasing, rate, sentinel stress, lexical stress, and emphatic stress in addition to syllable segregation)
Stimulability testing
Oral structure and function (look for slower trisyllabic reps, e.g., PTK, and slower fricative durations /f/, /s/)
Ax of views on communication, and differences b/w communication at home vs school
78
What assessments might you consider for a child with suspected childhood dysarthria?
Comprehensive single-word sample from standardized phonology test
Informal probe of specific speech sounds in error (particularly plosives, fricatives and affricates) → compare across word positions, compare singletons vs. consonant clusters, monosyllables vs. polysyllables, and single word vs connected speech
Intelligibility test (single word) → especially if the child’s speech is highly unintelligible
Connected speech Ax and/or reading passage such as “the caterpillar”: take note of respiration, phonation, prosody, voice, intelligibility, and acceptability.
Stimulability
Oral structure and fxn → look out for shorter phonation rate on prolonged /a/ and monosyllabic repetition rates on puh puh puh
Children with dysarthria are likely to have respiratory, phonatory, resonance, articulation, and prosodic difficulties in addition to increases or decreased muscle tone, uncoordinated mouth movements, and/or imprecise or weak articulation (particularly for plosives, fricatives, and affricates)
79
How might you assess a child with craniofacial anomolies for SSD?
Will benefit from having similar Ax procedures as children with suspected SSDs
Assessments to consider:
Assess consonants and vowels, paying close attention to high pressure consonants (stops) and high vowels (more susceptible to hypernasality). Assess consonants in sounds, words, and sentences -- compare children’s total inventories (including compensatory arctic) with the sounds ambient in the spoken language
Assess short sentences that are loaded with several consonants of the same type to look at hyper-nasality (e.g., /p/) and hyponasality (e.g., /m/)
Assess oral structure and fxn, include velopharyngeal function
Instrumental Ax that may be considered:
Nasometer or nasopharyngoscopy: nasal resonance and nasal escape
Videofluoroscopy: velopharyngeal competence
Note: nasal resonance + use of glottal stops can be related to velopharyngeal insufficiency or phonological learning.
Do intervention focusing on these prior to looking at velopharyngeal insufficiency.
Electropalatography (EPG): Tongue placement
80
How might you assess a child with hearing loss for SSD?
Assessments that are useful for assessing sound detection and discrimination are:
The Ling sounds /ah, i, u, s, sh, m/ can be used to determine which frequencies the child can perceive and discriminate → good quick check to test hearing aids/implant is working
The PLOTT Test, contains 9 subtests to assess children’s ability to detect a range of phonemes as well as to discriminate between phonemes based on place, manner, and voice features.
Assessments for speech perception:
Functional auditory performance index (FAPI): assesses 7 categories of auditory development: sound awareness, sound is meaningful, auditory feedback, localizing a sound source, auditory discrimination, short-term memory, and linguistic and auditory processing
The Meaningful Auditory integration Scale (MAIS)
Parent’s evaluation of Aural/Oral Performance of Children (PEACH): are parent/teacher diaries containing the listening behaviour of children in everyday life.
81
Using the referral below, name a disorder you might suspect.
Referral:
Pre-school or school aged
Difficult to understand
Having difficulty saying sounds (e.g., my child can’t say letters c, k, g)
Adding sounds to the end of words
Other patterns of error
Phonological impairments
82
Using the referral below, name a disorder you might suspect.
Referral:
Difficult to understand
Produce words differently each time
Inconsistent speech disorders
83
Using the referral below, name a disorder you might suspect.
Referral:
Child has a lisp and/or difficulty producing 1-2 sounds (usually /s,z, r/)
Articulation impairment.
84
Using the referral below, name a disorder you might suspect.
Referral:
Child is described as very difficult to understand
Has difficulty pronouncing many consonants and vowels
Problems saying long words
Unusual sounding speech
CAS
85
Using the referral below, name a disorder you might suspect.
Referral:
Described as being difficult to understand with slurred speech
Difficulty producing sounds
Childhood dysarthria.
86
What is SODA and when would you use it?
Substitution, omission, distortion, addition.
SODA is the colloquial term for traditional articulation analysis, sorting speech errors in a sample by the four categories.
87
What sound issues would a lateral lisp present with?
/s,z/ distortions with a lateral fricative across word-initial, within word, and word-final positions in both singletons and consonant clusters. Similar sounds may also be distorted.
88
What sound issues would an interdental lisp present with?
Substitution of both th sounds for /s,z/ across word-initial, within word, and word-final positions in both singletons and consonant clusters.
89
What is the benefit of a rational and independent speech sound disorder analysis?
It provides insight into what a child can produce regardless of the errors in their speech (independent analysis) and what children can correctly produce (relational analysis).
Independent analysis has 3 components:
A phonetic inventory
Syllable inventory
Shape inventory
Relational Analysis primarily looks at phonological processes analysis.
90
What are the different types of stress?
Lexical: stress paterns in words, can be Sw (eg. paper), or wS (e.g. giraffe)
Sentence: stress in connected speech
Emphatic: emphasize a point.
91
What are the different things to look at when considering intonation?
Chunking: can you perviece a difference between a child's production of compound nouns versus a list of nouns.
Affect: use prosody to communicate affective or attitudinal meaning?
Interaction: use during conversation?
Focus: draw conversation partners attention to a particular word in an utterance.
92
What are some instrumental techniques for seeing speech?
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Photography and video
Acoustic analysis: spectrogram, wave form
Ultrasound
Nasometry
MRI
Electropalatography
Speech video nasendoscopy
Electromagnetic articulography
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93
During what functions should oral structure be considered in children?
During speech,
Non-speech tasks
Feeding
94
What aspect of the lips might you look out for during an oral mech exam on a child?
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Controlled by CN VII
Structure of the lips at rest (symmetry, open/closed)
Oral function (rounding, protrusion, retraction, pucker/smile, bite lower lip, etc.)
Speech function
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95
What are some maximum performance tasks completed during an OME?
Prolongation of vowels and consonants
Repetition of syllables includes DDK
This can help differentiate speech disorders as it provides info on articulatory accuracy, breath control, speaking rate, speech fluency, and temporal variability.
ex. children with CAS are more likely to have slower trisyllabic reps (e.g., PTK) and shorter fricative consonants (/s/, /f/)
96
What are some issues related to adequate assessment of speech perception?
The process of perception is private --there is no way perception can be tested.
At best we can put a child to a task where they respond to their perceptions.
There is no agreed upon standard way to assess this skill.
2 types of tasks: 1) auditory discrimination and 2) lexical discrimination
97
What is the auditory discrimination task?
Require children to discriminate between phonemes in isolation, syllables and words (can be real or nonsense)
Auditory Discrimination same/different task: designed for CAS, where kids judge if two words sounds the same or different (e.g., lost vs lots)
Note that children with CAS do well with real words (comparable to TD) but worse on nonsense words
ABX task: listener hears 3 syllables, first 2 syllables are different, while the 3rd is identical to one of the first 2. Child picks which one they hear.
Illegal vs Legal non-words: children listen to non-words comprising of phonotactically legal (plik) and illegal (pnik) syllable sequences --judge whether possible or impossible in the language they are learning.
98
What is the lexical discrimination task?
Are designed to not only assess children’s abilities to detect differences between words but their ability to compare what they hear with their own stored representations of words.
Can be completed with or without pictures
A common example is contrastive minimal pairs
Children point to a picture of one of the word pairs
Words typically contain child’s error (e.g., ring vs. wing)
Additional examples on pg 268 (too much detail for here)
99
How does the articulation approach differ from the phonological/language-based intervention approach?
Artic: designed to target each sound deviation, and are often selected by the clinician when the child’s errors are assumed to be motor based. The aim is correct production of the target sound(s)”
Phonological: target a group of sounds with similar error patterns, although the actual treatment of examples of the error pattern may target individual sounds. elected in an effort to help the child internalize phonological rules and generalize these rules to other sounds within the pattern. Can be contrastive (uses minimal pairs) or non-contrastive.
100
What is contextual utilization?
Phonological approach
Recognizes that speech sounds are produced in syllable based contexts in connected speech, and that some (phonemic/phonetic) contexts can facilitate correct production of a particular sound. Sound is initiated in syllable context, which is used as a building block at more complex levels.
Good: helpful for child with an inconsistent sound and needs to facilitate consistent production
Bad: practicing consonant sounds with best bet vowels following may be restrictive in applicability to other vowels and words, need opportunity to practice with a variety.
Ex. Production of a /t/ may be facilitated in the context of a high front vowel (‘tea’), whereas a nasal consonant like /m/ is best produced before a low vowel, such as ‘mad’.
101
What are phonological contrast approaches and what are the various types?
This approach focuses on improving phonemic contrasts in the child’s speech by emphasizing sound contrasts necessary to differentiate one word from another. It uses contrasting word pairs as targets instead of individual sounds. Contrastive approaches are divided into:
Minimal pairs - differ by one phoneme or single feature signaling change
Maximal pairs - pairs of words that vary on multiple dimensions. Maximally opposing sound is not known or produced by child
Empty set - using maximally opposing sounds, where both are unknown to child
Multiple pairs - variation of minimal pairs, but uses 3-4 strategically selected sounds that reflect maximal classification and maximal distinction
102
What are the advantages and disadvantages to phonological contrast approaches?
Advantages: Strong evidence base, with non-english language considerations also available.
Minimal pairs are useful to help establish contrasts not currently present in the child’s system.
Multiple pairs approaches strategically selected sounds that reflect maximal classification and distinction
Disadvantages: Complex targets (use of maximal pairs and empty sets) facilitate more widespread change in children’s phonological systems relative to less complex targets (referring to minimal pairs approach)
Approach looks at word pairs as opposed to individual sounds - child must understand meaning of both words in order to distinguish difference
103
What is the complexity approach?
A speech production approach based on data supporting the idea that more complex linguistic stimuli helps promote generalization to untreated but related targets. This was developed from the maximal pairs approach. This approach does not use contrasting word pairs. Rather, there is a combination of real words and nonsense words which are not in the child’s repertoire
Advantages: determines hierarchy of complexity and stimulability, which may help goal achievement
Bad: requires detailed analysis of phonology to guide planning, more time intensive.
Ex. oiced obstruents (affricates, fricatives, stops) are considered more complex than voiceless obstruents. Thus, targeting /d/ and /g/ (a voiced stop) made greater improvements than those taught a voiceless stop (/t/ and /k/) - this leads to change in the unmarked (less complex) speech sounds
104
What is the core vocabulary approach?
Focuses on whole word production, and used with children with inconsistent speech sound production.
Short list of target words is compiled and practiced in isolation, and then the child is free to play with toys as long as he/she will continue to converse with the therapist. If words come up in conversation, they are practiced with correct production.
Good: good for children resistant to traditional approaches or with limited attention, slow progress or only say a few words due to speech issues.
Bad: relies on words coming up naturally and ability to divide attention between word practice and play, lower repetition frequency.
105
What is the cycles approach?
Targets phonological pattern errors, designed for children with highly unintelligible speech with extensive omissions, some substitutions, and restricted use of consonants. Treatment is scheduled in cycles from 5-16 weeks in length, with one or more phonological patterns targeted. To facilitate efficient change in the child’s phonological systems, phonological patterns are targeted rather than individual phonemes.
Good: better engagement due to frequent switching, used to stimulate emergence not mastery, evidence for improved intelligibility
Bad: requires errorless learning, environment is a critical component, not appropriate for children that cannot sit and practice.
Ex. Therapy may target FCD for 6 weeks, and then switch to target stopping of fricatives for the next 6 weeks, and then cycled once all phonological processes are targeted
106
What is distinctive feature therapy?
Focuses on elements of phonemes that are lacking in a child’s repertoire. It uses minimal pairs that compare the phonetic elements/features of the target sound with those of its substitution or some other sound contrast.
Good: used for children with substitution, often see generalization to other sounds that share targeted feature
Bad: lack of updated evidence
Ex. Distinctive features missing from the child’s repertoire may include frication, nasality, voicing, and place of articulation
107
What is metaphor therapy?
Designed to teach metaphonological awareness - awareness of the phonological structure of language. Focus is on sound properties that need to be contrasted.
Good: alerts to the properties of sounds, to show contrasts between sounds conveys meaning, and to facilitate knoledge of manipulating these features. Increases chance of contrastive sounds being understood.
Bad: assumes children with phonological disorders have failed to acquire rules of phonological system.
Ex. For problems with voicing, the concept of ‘noisy’ vs. ‘quiet’ is taught. Targets include processes that affect intelligibility, can be imitated, or are not seen in typically developing children of the same age.
108
What is Naturalistic Speech Intelligibility Intervention?
Addresses the targeted sound in naturalistic activities that provide the child with frequent opportunities for the sound to occur. Child’s errorless productions are recast without the use of imitative prompts or direct motor training
Good: used during everyday activities, not drill based
Bad: child must be able to use recasts effectively, less opportunity for practice as child is not required to repeat errors correctly.
Ex. using a McDonalds menu, signs at the grocery store, or favourite books to ask questions about words that contain the targeted sounds
109
What is Speech Sound Perception Training?
Used to help a child acquire stable perceptual representation of the target phoneme or phonological structure. The goal is to ensure that the child is attending to the appropriate acoustic cues and weighting them accordingly to a language specific strategy. This approach includes auditory bombardment, sometimes in the context of a story, many varied target exemplars are presented to the child with amplification; and identification tasks.
Good: computer tech has allowed for increased variability in stimuli presentation, opportunities for child to judge speech production of others.
Bad: used in or before speech production training, not appropriate to administer in isolation, child must have accurate judgement abilities of self-production of sounds.
Ex. In an identification task, the child identified correct and incorrect versions of the target (ie. ‘rat’ vs. ‘wat’) as presented by the clinician.
110
What is non-speech oral-motor therapy?
This approach involves use of oral motor training prior to teaching sounds, or as a supplement to speech sound instruction. It believes that immature or deficient oral motor control or strength may be causing poor articulation, and that it is necessary to teach control of articulators before working on correct production of sounds. This is a good approach to ensure children have efficient oral motor control before addressing articulation difficulties, however, this may not be an effective approach for treatment on its own.
111
What is the most effective intervention intensity for school aged children with SSD? What should be considered?
2-3 sessions per week with 70 or more trials (high intensity)
Balance of intervention is not overly intense and wastes resources, but also is optimal enough to produce gain.
112
Compare individual vs. group therapy for SSD.
Group therapy can limit the number of doses in each intervention session - this reduces treatment intensity
It is a poor choice for SSD unless the session length and number of sessions is increased
In school environment, this may lead to frequent amounts of time outside of the classroom
Emphasis on individual sessions so that each child can focus on their individual target sounds and spend minimal time outside of the classroom
Children do not benefit from hearing other children produce their own target, they need to do so themselves
Small group activities work for phonological awareness targets such as blending and segmenting
113
What is quick articulation?
defined as 10 minute sessions twice per week with a student clinician in the hallway. It is an 8 week program, with two targets addressed per week
114
What are some considerations when choosing an intervention approach?
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Role and preference of the family
Service setting
Frequency
Formate (individual, group, parent, tele practice)
Who is providing therapy
When is it appropriate to change goals
When is it appropriate to discharge
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115
What are the different principles of speech intervention?
Neurological experience/principles - practice must be salient, well timed, and repeated
Phonology - children need to learn the rules that govern sound use, this includes perception and meaning
Behavioural learning - as proposed by Skinner, reinforcement increases a behaviour, while punishment decreases a behaviour. Typically, SLPs use positive reinforcement, but they may also use a positive punishment (ie. a correction)
Speech perception - children need diverse opportunities to listen to sounds and judge their accuracy
Cognition and meta-awareness - phonetic awareness (what your articulators are doing), metaphonology (properties of phonological system), phonological awareness (ability to recognize and manipulate sounds)
Motor learning - practice includes amount, distribution, schedule, variability, tasks, fraction (whole or part of a word), accuracy (% of errors) and attentional focus. Further, feedback is also important to learning (frequency, type, timing)
116
What are the 5 steps to SSD intervention?
1. Senetory-perceptial (ear) training
2. Prepractice instruction: learning to articulate sound
3. Practice: isolation, nonsense syllables, words, sentences
4. Transfer and carryover
5. Maintenance
117
What are some considerations at the practice stage of SSD interventions?
Begin in imitation first → then delayed imitation → then elicit spontaneous production
The target word initially tends to be easiest in initial position (‘k’ and ‘g’ may be exceptions), then in final position, then medially
Adding a pause between the target and the rest of the syllable or word can be easier, but this needed to be blended ASAP so that pause does not become habitual
Consider carry over phrases (eg. “I see a…”), phrase length (eg. “my __”) and spontaneity
You need MANY repetitions, consider drills, games, worksheets, books. Practice with a parent helps to solidify skills and increase opportunities for practice
Concurrent treatment suggests randomizing targets**
118
What are some possible ways to select SSD targets?
Developmental - target sounds are selected based on order of acquisition in typically developing children (ie. you wouldn’t target the ‘sh’ sound before a ‘t’
Non-developmental/theoretically motivated approaches
Complexity - focussed on more complex, linguistically marked elements not in the child’s phonological system to encourage cascading, generalized learning of sounds
Dynamic systems theory - focuses on teaching and stabilizing simple target phonemes that do not introduce new feature contrasts in the child’s phonological system to assist in the acquisition of target sounds and more complex targets and features
Systemic - focuses on the function of the sound in the child’s phonological organization to achieve maximum phonological reorganization with the least amount of intervention. Based on a distance metric, meaning targets can be maximally distinct from the child’s error in terms of place, voice and manner, and can also be maximally different in terms of manner, place of production, and voicing.
Client specific - selects targets based on factors such as relevance to the child and his/her family (ie. sound is in the child’s name), stimulability, and/or visibility when produced (ie. /f/ is easier to see vs. a /k/ sound at the back of mouth
Degree of deviance and impact on intelligibility - selects targets on the basis of errors (eg. errors of omission, error patterns such as initial consonant deletion) that most affect intelligibility
119
What different tasks are included in ear training?
Identifying: did you hear the sound?
Locating: picking out of a variety of words
Stimulation: hears and tries to identify produced in a wide variety of context and forms (different rates, volumes)
Discrimination: minimal pars
120
How could you facilitate carry-over?
Increasingly challenging levels (eg. conversational speaking)
Pretend play, inclusive of a variety of objects that have the /k/ sound. Transfer may take a naturalistic approach to encourage the child to continue use of sound in conversational tasks. Opportunities for the clinician to provide ongoing feedback and correction if error is produced will be beneficial.
121
What is involved in the maintenance of a sound?
Stabilizing target sound production and making it more automatic; encouraging self monitoring of speech and self correction of errors, when applicable to the client
Depending on age, self monitoring should be introduced as early as possible, so that the child is able to judge the correctness of their productions.
122
What are some conditions of practice that need to be considered?
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Amount: Small versus Large
Distribution: Massed versus Distributed
Schedule: Blocked versus Random
Variability: Constant versus Variable
Task: Complex versus Simple
Fraction: Whole versus Part
Accuracy: Errorless versus Errorful
Learner’s attentional focus: Internal versus External
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123
What are the different types of reinforcers?
Primary – Naturally occurring (ex. Food)
Social – Verbal or nonverbal social response
Verbal praise, attention, smile, encouraging facial expression, high five
Conditioned
Tangible – stamp, sticker, check mark on chart, bead to make bracelet
Activity – using iPad, turn at game
Token – exchanged for other positive reinforcer
Informative – verbal or nonverbal information about performance
Comment about improvement, graph showing improvement, biofeedback devices
Self-reinforcement – taking pleasure in own correct or improved performance
124
What are the different schedules for reinforcers?
Continuous, fixed ratio, variable ratio, fixed interval, variable interval
125
What are the four stages fo competence?
Unconsious incompetency: doing something incorrectly but unaware
Conscious incompetency: doing something wong but not sure how to fix it
Conscious competency: consciously working on doing something correctly; requires conscious practice and repetition
Unconscious competency: mastery; doing something correctly without thinking about it
126
Why is awareness of errors important?
Crucial first step in the process. Phonological awareness/auditory discrimination/judgement activities are all necessary to help with phonological processes errors. The most common way to increase this awareness of phonological processes that a child is using is through Minimal Pair Therapy.
127
Explain the cueing hierarchy.
Imitation: Direct, delayed
Choice: of incorrect and correct (in that order and with emphasis on correct version), varied presentation
Repetition up to Error: with verbal and visual cue, with visual cue only, without verbal or visual cue
Repetition of Error: in questioning intonation, in statement intonation
’Pardon?’ (or Facial expression indicating a correction needs to be made)
