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Comprehensive Exam > Speech Sound Disorders > Flashcards

Speech Sound Disorders Flashcards

1
Q

Sonorant vs obstruent

A
  • Sonorant: sounds that allow for continuous airflow through vocal tract (nasals, liquids, glides)
  • Obstruents: sounds that partially or completely block airflow (stops, fricatives, affricates)
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2
Q

Functional parts of the tongue

A
  • Tip/blade
  • Dorsum (body)
  • Root
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3
Q

Bunched vs retroflex /r/

A

Retroflex: During production, the tongue forms a diagonal line pointing up towards the roof of the mouth making it easy to explain using hand gestures or imagery.

Bunched: Forms a more unique shape with the tongue, tongue tip is pointed down making it more difficult to explain and consciously execute.

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4
Q

Define speech sound disorder

A

Difficulty saying the sounds of the native language as compared to peers of same age and language/dialect background

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5
Q

Etiology of SSD (functional vs organic)

A

Functional: no known cause

Organic: developmental or acquired
- Motor/neurologic (dysarthria, apraxia)
- Structural (cleft palate)
- Sensory/perceptual (hearing impairment)

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6
Q

Articulation vs phonological disorder

A

Articulation: motoric (production based) in nature; errors are mostly distortions or substitutions

Phonological: linguistic in nature (child neutralizes phonological contrasts of language)

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7
Q

Define & describe core features of Childhood Apraxia of Speech

A

Neurological childhood SSD in which precision and consistency of movements underlying speech are impaired

Core features:
- Inappropriate prosofy
- Lengthened/disrupted transitions between sounds & syllables
- Inconsistent errors on multiple attempts of the same word

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8
Q

What is motor learning?

A
  • Retention or generalization of learning behavior
  • Relatively permanent changes
  • Occurs over time
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9
Q

What are the 3 stages of therapy?

A
  1. Elicitation: stimulability/establish sound in isolation & syllables
  2. Stablilization: words/phrases, sentences
  3. Generalization: sentences, connected speech
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10
Q

Types of feedback

A

Knowledge of performance:
- Feedback on aspects of motor movement (e.g., I saw your lips come together to make the /m/ sound)
- Acquisition

Knowledge of results:
- Feedback on accuracy (e.g., That’s right!)
- Generalization/learning

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11
Q

Strategies for motor acquisition vs learning (feedback frequency, practice amount/variability, target complexity)

A

Motor acquisition:
- High frequency feedback (90% of trials)
- High frequency, blocked practice: work on skill A for 15 minutes before moving on to skill B
- Constant practice: same target in same context
- Simple responses: early developing sounds, singletons, syllables/words

Motor learning:
- Low frequency feedback (50% of trials)
- Random practice: order of stimuli mixed up throughout session
- Variable practice: target in different contexts
- Complex responses: later deve;oping sounds, clusters, phrases/sentences

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12
Q

What are the components of an SSD evlaution

A
  • Case history
  • Hearing screening
  • Standardized test
  • Speech sample
  • Deep testing/stimulability/speech perception of **sounds in error **
  • Oral mechanism exam
  • Screen other domains (language, phonological awareness, voice, fluency)
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13
Q

What observations should SLP make from assessments (how to assess strengths/weaknesses)?

A
  • Phonetic inventory
  • Percent consonants correct
  • Most complex syllabe structures
  • Prosody
  • Error analysis: frequency, typical, age appropriateness, description, facilitating contexts
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14
Q

What information should you collect in the case history?

A

Language background: dialect, culture, age, language exposure

Medical background: syndromes, developmental concerns, hearing, known structural anomalies

Temperament, social/emotional characteristics

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15
Q

GFTA-3

A

Goldman Fristoe Test of Articulation (2;0-21;11)

SLP shows clients a series of pictures and asks, “What is this?” Pictures correspond to a list of single words that includes all phonemes in each position (initial, medial, and final.) SLP can also administer the “Sounds in Sentences” subtest to determine the client’s skills it a higher level of linguistic complexity

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16
Q

Types of speech samples

A
  • Naming
  • Imitated phrases/sentences
  • Reading
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17
Q

Deep testing

A

Assess a sound in error to determine if there are any facilitating contexts

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18
Q

Stimulability testing

A

Ability to produce sounds correctly given support

SLP instructs child to:
- Imitate sound in isolation, syllables, words
- Provide phonetic placement cues

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19
Q

Speech perception assessment

A

Assess if child can categorize phonetic information
- Categorical perception: /s/ vs /th/
- Category goodness: ability to perceitve speech and make judgements about phonetic information

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20
Q

Oral mechanism exam

A

Assess face, lips, tongue, palate/tonsils, and respiratory support during speech and nonspeech tasks

Tasks:
- Close your lips. Say /mm/ (adequate lip seal)
- Stick your tongue out. Move from side to side. (adequate protrusion & ROM)
- DDK: rapid, steady, accurate
- Say /aa/ for as long as you can (normal duration, pitch/loudness)

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21
Q

AAE considerations

A
  • Word-final cluster reduction (test → tes)
  • Vocalization (sister → sista)
  • Vocalization of /l/ in post-vocalic cluster (help → hep)
  • Deletion of word final nasal (moon → mu)
    /t/ → /k/ in /str/ cluster (street → skrit)
  • Use of f/th and v/th in intervocalic or word-final position (baf, having)
  • Use of /d/ for “voiced th” in initial position (that → dat)
  • Stopping of /v/ before syllabic nasal (seven → seben)
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22
Q

At the end of a SSD assessment you should be able to:

A
  • Establish if a speech sound disorder is present and if so, the severity
  • Differentially diagnose the type of speech problem
  • Identify etiological factors or factors that contribute to persistence of the problem
  • Identify concomitant issues (language, fluency, voice)
  • Consider prognosis, impact on social functioning
  • Identify speech targets for intervention (prioritize!)
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23
Q

Using “most knowledge” vs
“least knowledge/complexity”

A

Use “Most Knowledge” if..
- Child is stimulable & occassionally correct
- Working on early developing sounds
- Targeting singletons, clusters with large sonority differences (/kw/)

Use “Complexity” if…
- Child is not stimulable
- Sound is not produced correctly in any word position
- Working on complex/later developing sounds
- Targeting clusters with small sonority differencs (/sm/, /fr/)

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24
Q

What are 3 goal attack strategies?

A

Vertical: one target trained to criterion before moving to next

Horizontal: multiple goals assressed in a single session/goals change across sessions

Cycle: each week, (different) single target is address for single session/week

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25
What are 4 models of treatment?
Drill: clinician presents instructional event, followed by client response - Client has little control over rate and presentation of stimuli Drill play: similar to drill but includes antecedent motivational event (card game, spinner, roll dice, etc) Structured play: similar to drill play but training stimuli are presented as play activities - Less formal, more play-like. Play: child perceives it as play but clinician arranges activities that target responses in natural activities - Modeling, self-talk to elicit responses - “Naturalistic” approach.
26
What strategies should be used during the sound elicitation phase?
- Modeling - Auditory perception training - Phonetic placement cues - Motor kinesthetic training - Shaping - Successive approximation
27
Modeling
Sound eliciation Clinician models sound, child repeats (emphasize the target phoneme)
28
Auditory perception training
Sound elicitation Child identifies position of the sound in a word, discrimination (same/different), category goodness judgement
29
Phonetic placement cues
Sound elicitation Tell/show client where to place articulations, provide tactile cues & visual aids
30
Motor-kinesthetic training
Sound elicitation External manipulation of articulators (e.g., touch under chin to cue velars)
31
Shaping
Sound elicitation Start w/sound child can produce to elicit a sound child cannot produce (e.g., l → r)
32
Successive approximation
Sound elicitation Achieve a “less severe” distortion along the way to establishing a correct production
33
Define stabilization. What strategies should be used during this phase?
Once a client shows ability to produce the target sound, switch from elicitation → stabilization - Paired stimulus - Sensory motor - Speech motor chaining
34
Paired stimulus
Stabilization When child has at least one successful word, use it to facilitate other words in a word pair (e.g., red ring)
35
Sensory motor
Stabilization Utilize facilitating context (carrrrr-race)
36
Speech motor chaining
Stabilization used to progress from syllables through sentences; promotes generalization
37
What strategies are used during generalization?
- Client self-monitoring - Reduced support (less specific cues, delayed feedback) - Increased task complexity (complex/randomized targets, variable practice)
38
Explain the cycles approach
Treatment used for children w/phonological disorders (ages 3-6 w/unintelligible speech) Goal: facilitate pattern, rather than meeting set criterior before moving on Cycle: period of time to address all stimulable phonological error patterns Primary targets: - Acquiring, CVC word structures, /s/ clusters, anterior posterior contrasts, stridents, liquids Secondary targets: - Palatal obstruents, vocalic /r/, consonant sequences, assimilations/idiosyncratic patterns
39
Cycles lesson plan
- Review targets from previous session - Adutory bombardment - Play - Stimulability of next session's patterns - Phonological awareness activity - Home practice
40
What is the goal of speech perception training? Provide examples of stategies to use.
To improve ability to detect phonetic elements of sounds - Focused stimulation - Auditory bombardment - Category goodness training - Self-monitorting
41
What is focused stimulation?
Clinician talks about objects, uses them in activities, reads books with target sounds. The client not expected to respond but if they do use recasts, models, cues, etc.
42
What is auditory bombardment?
Clinician reads list of single words (not in context)
43
What is phonological awareness? What does this skill help with?
Mental-awareness of sound features in words. This skill helps with sound-symbol association
44
Phonological awareenss is a predictor of...
Reading/spelling problems
45
Examples of phonological awareness skills include...
- Syllable identification (3 yrs) - Rhyme identification/matching (4 yrs) - Initial sound identification/matching (4 yrs) - Final sound identification/matching (4-5 yrs) - Blending (4-6 yrs) - Segmenting singletons (5-6 yrs) - Elision (deletion) of sounds (5-6 yrs) - Segmenting clusters (6 yrs)
46
What are minimal pairs?
Two words that differ by one sound
47
How to conduct minimal pairs therapy:
Selecting Targets: - Use target words that differ by the sound in error - Child must be stimulable Discrimination & Production: - Set up activities so the child has to request items Teaching Procedures: - Familiarization w/pictures (this is sit, this is sick) - Perception (point to the one I say) - Production
48
Phonemic collapse
When a child produces one sound across several different target sounds (over-use of a sound)
49
What is multiple oppositions therapy? When should it be used?
Contrast the child's repeated error of one sound vs many sounds Use if the child: - Presents with multiple phoneme collapses - Is missing many sounds in their inventory
50
Multiple opposition procedures
- Map out the child's phoneme collapses - Select 4 sounds that differ the most from the collapsed sound - Create minimal pairs with the error sound & 4 maximally different sounds
51
Maximal oppositions
Contrast one sound the child has with another sound maximally different based on voice, place, and manner
52
Empty set
Contrast 2 sounds that the child doesn't have (maximally different based on voicing, place manner)
53
What is naturalistic treatment? How can an SLP plan for these sessions?
Targeting speech within a linguistic/social context Planning: - Load environment with toys & books that address the target sound - Play games/incorporate routines that elicit the target
54
What is a phonological recast?
When a child misarticulates a word and the clinician responds with the correct form of the word
55
Which children are candidates for play-based strategies?
- Young - Development disabilities - Co-occuring speech/language targets - Stuttering
56
What are some direct & indirect play-based strategies
Direct: - Mand model Indirect: - Communicative temptations - Binary choices - Cloze procedures - Preparatory sets
57
What is a mand model?
Request for imitation
58
Explain the following indirect play-based strategies: - Communicative temptations - Binary choices - Cloze procedures - Preparatory sets
Communicative temptations: - Set up environment to elicit communication - Withdraw something desirable - Violate a routine (e.g., brush a doll's feet) Binary choices: - Model appropriate choices with targets (e.g., do you want the sheep or the ship?) Cloze procedures - Fill in the blank (e.g., mary had a little _____) Preparatory sets: - Establish a predictable verbal routine/provide a sentence template (The pig licked to dog, then he licked the fish, then he licked the cat, then _______)
59
What skills should parents reinforce?
EMERGING skills
60
Dynamic Temporal and Tacticle Cueing (DTTC)
Therapy approach designed specifically for CAS based on integral stimulation - Words/short phrases repeated to improve consistency, accuracy, complexirty - Involves hierarchy and multimodal prompts - Focuses on movement of articulation gestures rather than specific sounds - Incorporates knowledge of performance feedback
61
3 population requirements for DTTC
- Moderate-severe CAS (limited syllable shapes & sound inventories) - Ability to imitate - Able to attend to face & tolerate drill/drill play
62
What should be considered during DTTC target selection?
Start with a SMALL target set Consider: - Phonetically simple targets - Phonemes and syllable shapes already in inventory - Meaningful vocabulary
63
What are the early goals of DTTC?
- Core set of 4-8 words/phrases treated at a time - Target word or movement, not just phoneme - Include variety of syllable shapes - Gradually vary place of articulation, types of sounds, number of different sounds within and across syllables, increasing length and complexity of words/phrases
64
What type of practice is implemented in DTTC?
Blocked practice - 5 words/phrases produced 15-20 times each - Up to 3 blocks per session
65
DTTC hierarchy
- Simulatenous production - Direct imitation - Delayed imitation - Spontaneous - Add prosodic variation
66
What is ReST? Targets?
Rapid Syllable Transition Training - Designed to control sounds already in inventory - Constructing individualized nonwords around sounds in inventory
67
# ReST ReST is heavily focused on...
Motor learning
68
ReST stimuli
- 20 nonsense words appropriate for client (stress patterns, phonemes) - Only sounds in inventory
69
Steps of ReST
Prepractice: performance/acquisition - Teach the difference between stressed/unstressed - KP feedback on all trials - Feedback on articulatory accuracy (sounds), syllable segregation (smooth), stress (beats) Practice: motor learning - 20 nonsense words randomized - Delayed KR feedback, reduced throughout practice
70
Dynamic Evaluation of Motor Speech Skills (DEMMS)
Dynamic motor speech exam useful in differentiation motor speech impairment (3 yrs +) Subtests assess: - Overall articulatory accuracy - Vowel accuracy - Prosodic accuracy - Consistency of speech production If child's initial attempt is incorrect, clinician offers additional cues and support to facilitate correct production

Comprehensive Exam (6 decks)

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