SPEECH SOUND DISORDERS Flashcards
Allophones
Variations of phonemes
Example: /p/ can be produced with or
without aspiration
Phoneme categorization
Vowel
Consonant
Distinctive features can be used to
describe vowels and consonants
Classification of Consonants
Classification of consonants by place,
manner and voice.
Can be:
Bilabial, labiodental, interdental,
alveolar, linguadental, palatal, velar,
glottal
Voiced or Voiceless
Obstruents: Stops, fricatives,
affricates
Resonants: Nasals, approximants
Approximants: Glides or liquids
Obstruents:
: Stops, fricatives,
affricates
Resonants
Nasals, approximants
Approximants: Glides or liquids
Classification of vowels
Classification of vowels by tongue and lip
position and tension
Part of Tongue Elevated
Front, Center, Back
Tongue Height
High, Mid, Low
Amount of Tension
Tense, Lax
Lips retracted or rounded
Dipthongs
Two vowels spoken in close proximity
Speech-Sound Development
Pre-Speech
Disappearance of reflexive sounds
Crying gets infant to use airflow across the vocal folds
Noncrying vocalizations with feeding or interaction
2-months: Gooing/cooing
3-months: Vocalize in response to others
5-months: Imitate pitch, babbling
6-7 months: Reduplicated babbling
8-12 months: Echolalic stage
Variegated babbling
Jargon
Phonetically consistent forms
Toddler Speech
Toddler Speech
First Word around 12-months
Phonological Processes
Example: Final Consonant Deletion
Multisyllable words may be reduced
Consonant blends may be shortened
Sound Substitutions
PreSchool Speech
PreSchool Speech
Most phonological processes disappear
by 4
Consonant blends continue to develop
Phoneme acquisition gradual
Children with phonological difficulties
Continue with phonological processes
Children with neuromuscular disorders,
sensory deficits, perceptual problems,
poor learning skills
Difficulty acquiring all phonemes
School-Age Speech
Early elementary-resembles adult
phonology
Morphophonemic contrasts
5 years-difficulty with some
consonants and blends
6-years-have acquired most speech
sounds
8-years-Acquired consonant blends
Articulation
Phone
Motor-based
Deficit refers to
difficulties in
motor production
aspects of speech
Errors are
typically
consistent
Phonology
Phonology
Phoneme
Language-based
Deficit refers
impaired system
of phonemes/
phonemic
patterns
Errors are
typically
inconsistent
Phonological Impairments
Phonological Impairments
Conceptualization of language rules;
open syllable vs closed syllable
Articulation impairments
Articulation impairments
Production
Substitutions
Omission
Addition
Distortion
May have disorders of both phonology
and articulation
Functional-
-a pattern of speech errors
in the absence of any observable
physical abnormality
Organic
attributed to physical
conditions i.e. cleft palate
Associated Disordered and
Related Causes
Correlates/related factors
Developmental impairments in
children
Language impairments
Hearing Impairments
Neuromuscular Disorders
Childhood Apraxia of Speech
Structural Functional Abnormalities
Developmental Impairments in children
Delay-not producing age-appropriate
phonemes
Disordered
-Idiosyncratic in phoneme use
Phonological Impairments
-Average age of diagnosis is 4 years, 2
months
Speech therapy can correct errors more
quickly
Errors may have a negative impact
Disordered
-Idiosyncratic in phoneme use
Phonological Impairments
-Average age of diagnosis is 4 years, 2
months
Speech therapy can correct errors more
quickly
Errors may have a negative impact
Language Impairments
Complex syllable structures are challenging
-Speech-sound errors may resolve
-Phonological errors may affect morphology
-Speech-sound errors increase with sentence
complexity
-Phonological errors affect reading and
writing
-May have poor phonological awareness
skills
Hearing Impairments
-Intelligibility decreases with more
severe hearing loss
-Frequent Otitis Media is a risk factor
-Congenital Hearing Loss leads to
more severely affected speech
-Speech deteriorates over time for
those who are profoundly deaf
Hearing aids and training can help
SPEECH PERCEPTION AND
AUDITION
Normal audition is crucial
Phonological disorders vary
depending on
the type and severity of the
hearing loss
age of hearing loss
Age at which intervention
begins
Ability to utilize residual
hearing
CHRONIC OTITIS MEDIA
Infection of the middle ear often
accompanied by fluid
Results in a conductive hearing loss
33% chance of speech delay for a 3
year old child with a history of OME
Difficulty with producing final
consonants
Impairment of plural endings
COCHLEAR IMPLANTS
Surgically implanted devices designed
to provide electrical stimulation to the
auditory nerve through the cochlea
which permits the perception of sound
Dysarthrias
Spastic: Slow rate, imprecise
articulation, harsh voice, hypernasality,
prosodic abnormalities
Speech Training or AAC
Some with CP have normal intelligence
May have accompanying deficits
Motor functioning may deteriorate over
time.
Spastic
Slow rate, imprecise
articulation, harsh voice, hypernasality,
prosodic abnormalities
Childhood Apraxia of Speech
Inconsistent Errors
Lengthened/disrupted transitions
Inappropriate prosody
Limited sound repertoires, groping,
omissions or adding sounds, difficulty
with running speech
Some may be nonverbal early on
Likely to have difficulties with
phonological awareness, reading,
writing, spelling
Prosodic abnormalities
Structural Abnormalities
Structural Functional Abnormalities
*Usually only gross abnormalities
affect speech
*Cleft Palate is detrimental to speech
**Hard Palate
**Soft Palate
CLEFT PALATE
Hypernasality
Nasal emission
Compensatory
articulation
Glottal stop
Vpi
Dentition
Ask client to bite teeth down together &
smile
Dental classification systems provide info
regarding alignment of upper & lower
teeth:
◦ Class I- normal occlusion (alignment); dental arches
close normally; but there may be crooked teeth
◦ Class II- lower molar & jaw too far back
◦ Class III- lower molar & jaw too far forward in relation
to the upper arch
◦ Look for crossbites & open bites as well
role of dentition in articulation
The role of dentition in articulation
disorders is not clear
Studies show that minor dental
abnormalities rarely cause significant
deviations in speech production
Severe dental abnormalities resulting
from malocclusion (misaligned teeth)
or deviations in jaw alignment, may
lead to speech errors
Tongue Thrust
Infants & young children swallow by
bringing tongue against hard palate and
pushing the food or liquid forward
Some believe that a persisting tongue
thrust can lead to some speech sound
errors, particularly in producing the [s]
and [z] sounds
Oral Mechanism
Adequate oral structure and physiology
are required for speech production
Some areas in addition to dentition that
SLPs examine are:
◦ lips- symmetry and range of motion
◦ Tongue- size, range of motion
◦ Jaw- opening & closing & freedom of
movement & stability is important for speech
production
◦ Hard palate must be intact for oral sounds to
be produced
◦ Soft palate must be able to close off the nasal cavity quickly & repeatedly during running speech
DOWN SYNDROME
Chronic otitis media
Dysarthria
Delayed in the onset of
babbling
READING
Phonology is the
prerequisite for reading
Need to know
phonological rules
Phonological
awareness
Dyslexia is a language
based disorder
Language and Dialect Variations
Differentiate between dialect and disordered
phonology
Characteristics of articulation and phonology
*Many variations (impossible to list)
*First language may interfere
Lifespan Issues
*Some adults choose to modify their accent
*Articulatory patterns may be firmly
established
*Goal is to increase
intelligibility/communication effectivenes
Goals of Assessment
*Describe speech-sound inventory
*Identify error patterns
*Determine impact of errors
*Identify etiological factors
*Plan treatment
*Make prognosis
*Monitor change
Screenings-
typically performed to
determine if there is a problem and if further
testing is warranted
Full evaluation:
Obtain Case History
◦ Perform Formal Assessment (standardized
testing)
◦ Obtain Spontaneous Speech Sample
◦ Perform Oral Mechanism Examination
◦ Check Stimulability
◦ Diadochokinesis
ASSESSMENT Description of phonological and
articulatory inventory
Description of phonological and
articulatory inventory
*Speech-sound inventory
*Syllable and word structure
*Sound Errors Inventory
*Phonological Process Analysis
Intelligibility
Prognostic Indicators
*Consistency, stimulability, error
sound discrimination
Case History
Developmental milestones
Prenatal/perinatal/postnatal history
Medical History
Language background
STANDARDIZED TESTS
GFTA
Assesses sound production for consonants,
consonant clusters in the word initial medial and
final positions of words
Assesses Stimulability
Limited assessment of vowels and connected
speech
Standardized Tests
Advantages
Disadvantages
Advantages: quick to administer/score;
normed; good for children that are
unintelligible
Disadvantages: Not enough info on
spontaneous speech; not
representative of all word categories;
can be morphosytactically complex
SPONTANEOUS SAMPLES
Considered the most useful source of
information for phonological analysis
and intervention planning
Child produces a range of sounds in a
variety of phonetic and communicative
contexts
100 MLU for children 3.0 or below
higher MLU 250-300 words
Spontaneous Speech Sample
Advantages
Disadvantages
- Need to carefully obtain speech
sample
Advantages: more naturalistic
Disadvantages: children may avoid
difficult words; difficult to transcribe for
highly unintelligible children
Perception testing
CAPD
CAPD
Impairments in the auditory perception
and processing of phonetic,
phonological, or linguistic information
Types of Phonological Processes
Substitutions
◦ Stopping
◦ Gliding
◦ Fronting
◦ Backing
◦ Nasalization
Syllable Structure Processes
◦ Unstressed syllable deletion
◦ Reduplication
◦ Consonant cluster reduction
◦ Final consonant deletion
Assimilation Process (Harmony Process)
◦ Progressive
◦ Regressive
Substitutions
Stopping
◦ Gliding
◦ Fronting
◦ Backing
◦ Nasalization
Syllable Structure Processes
Unstressed syllable deletion
◦ Reduplication
◦ Consonant cluster reduction
◦ Final consonant deletion
Assimilation Process (Harmony Process)
Progressive
◦ Regressive
Intervention
Establishment
Establishment- try to determine if child
is motorically able to produce forms in
error; can they perceive differences
relevant to errors
Intervention
Generalization-
- try to ensure carryover
Intervention
Target Selection
*Goal
–Make client easier to understand and
increase communication effectiveness
–Factors in target selection
*Phoneme frequency, likelihood of
success
–Difficult targets may lead to greater
generalization
INTERVENTION
Bottom-up drill approaches
Bottom-up drill approaches
*Progress from simple to more
complex
*Target one sound at a time
*Speech assignments for
generalization
Articulation Approaches
Focus on motor production
Imitation/ successive approximation
Articulation Approaches
Traditional Approach
A- Perceptual Training
(1) Identification
(2) Isolation
(3) Stimulation
(4) Discrimination
(2) Production- begins in isolation and increases to
more complex contexts
B- Sensory-Motor Approach
Language-based Approaches
Language-based Approaches
*Instruction is implicit
**Within language activities
Has proven to generalize to
conversational speech
** Follow drill-type therapy
Phonological-Based Approaches
Multiple speech-sound errors or highly
unintelligible
Cycles Approach
*Minimal pair contrasts
Multiple Opposition Approach
*Maximal Contrasts
Metaphon Approach
*Metaphonological skills
Cycles Approach
*Minimal pair contrasts
Multiple Opposition Approach
*Maximal Contrasts
Metaphon Approach
*Metaphonological skills
INTERVENTION
Complexity Approach
Complexity Approach
*Training more difficult sounds leads to
generalization of easier, untrained
sounds
*More efficient
*May take more time initially
*Success depends on
-Severity
-Frustration Level
-Overall therapy goal
Treatment of Neurologically Based Motor
Speech Disorders
Treatment of Neurologically Based Motor
Speech Disorders
*Dynamic Temporal and Tactile Cueing
**Intensive, motor-based, drill-type treatment
for severe childhood AOS
**Simultaneous productions, imitation,
delayed imitation, spontaneous production
Lee-Silverman Voice Treatment
**Designed to increase loudness in adults
with PD
**Effective with modifications for children with
CP
INTERVENTION
Computer Applications
Computer Applications
**Computer programs and games
**In conjunction with direct therapy
**Opportunity for daily practice
**Can involve family members in
treatment process
GENERALIZATION AND
MAINTENANCE
May introduce self-monitoring
activities early in treatment
Schedule follow-up sessions after
dismissal
If progress is maintain, treatment was
successful
