Speech Sound Disorders

Articulation

• can usually fix in 8 weeks
• disorder of motor learning
• the earlier you work on it, the better
• behavior pattern (behaviorist)
• have to make it worth while
• Hierarchical teaching
• help break it down, teach them 

Speech Sound Disorders

Phonology

• usualy has many different errors/omissions
• cognitive disorder
• can make the sound, but can't tell that the wrong sounds make the wrong word.
• thinks it's the other person's job to figure out they're saying
• don't know where the sound is supposed to go
• Linguistic
• considered part of language (form)
• Conceptual

• traditional articulation method was the standard practice for any speech sound disorder for many years
• single sound focus
• drill until they get it
• then move to the next sound
• start with easier ones, then move on to harder
• e.g. /p/ to /b/, etc.
• research in traditional approach dried up pretty quickly once phonological approaches gained acceptance

Baker and McLeod, 2011a

What is it?

Narrative review of the literature on SSD

• Systematic search for qualifying articles
• 1979-2009
• most studied fewer than 50 participants; between the ages of 1;11 and 10;5
• most reported on services delivered in a 1:1 context, in a university clinic
• Many different approaches were cited

Baker and McLeod, 2011a

Minimal Pairs

• single sound differences that make the words different
• can be as similar (voiced vs. voiceless) or as far apart as it is

Baker and McLeod, 2011a

Cycles

Baker and McLeod, 2011a

Core Vocabulary

Baker and McLeod, 2011a

Traditional articulatrion approach

Baker and McLeod, 2011a

Modified Cycles

cycles modified in some way. 

Some will say how and some do not

Baker and McLeod, 2011a

Speech perception focus

Baker and McLeod, 2011a

Phonological awareness

Baker and McLeod, 2011a

Psycholinguistic principles

Begin at very basic level

e.g. voicing, tongue placement

Baker and McLeod, 2011a

Constraint based - nonlinear

Baker and McLeod, 2011a

Metaphon

Baker and McLeod, 2011a

PACT

1. Parents and clinicans work together

2. works with parents to try and teach parents how to treat the child before the child can get into speech therapy

Baker and McLeod, 2011a

Strongest evidence?

• Developmental and cyclical approaches
• usually modified cycles
• both have randomized control trials (rct's) studies supporting their use
• the complexity approaches have strong level II support
• but there is very little replication within the body of literature of treatment efficacy for SSD.

1. Generate a PICO question
2. find external evidence that pertains to the question
3. critically evaluate the external evidence
4. evaluate the internal evidence from clinical practice
5. evaluate the internal evidence for client factors, values, and preferences
6. integrate the three sources of evidence
7. evaluate the outcome of the decision

P - Person/patient/problem/population

I - intervention

C - Comparision

O - Outcome

Question: Are patients with aphasia who receive group therapy more or less likely to achieve functional communication abilities than patients with aphasia who received individual therapy?

• qualitative differences between stages
• skills develop in order
• walking
• playing
• first words
• skills are universal in sequence and general timing
• with individual variation
• skills are interdependent

• before the child is producing language
• vocalizations
• largely reflexive at first
• become intentional
• then become meaningful
• Speech perception
• understanding spoken speech
• different from just being able to hear

Infant Sound Perception

How do we study it?

• Use large numbers -> assumptions re: individuals 
• mostly in typical populations ->assumptions re: clinical populations (may be a little bit different)
• infants attend to novel stimuli for longer times than to familiar stimuli

Infant Sound Perception

HAS

• High amplitude sucking
• easiest way to measure attention
• infant will suck harder/faster

Infant Sound Perception

CHT

• Conditioned head turn
• older than 2 months
• taught behavior (reward when they turn head)

Infant Sound Perception

VHP

• Visual habituation procedures
• time how long they stare at something when paired with auditory stimulation

• hearing mechanism is fully formed by 25th week of typical gestation
• infants 2-7 days old can discriminate their mothers' voices vs. other women's voices
• infants attend to suprasegmentals - intonation, tone
• infants prefer to listen to speech patterns of their home language(s) rather than to those of other languages

• paying attention to the characteristics of a child's prelinguistic productions
• crying differences
• babbling differences
• first words

Reflexive vocalizations vs. non-reflexive vocalizations

Protophones - not recognizable as adult speech sounds

be careful about ascribing meaning to the sounds a child produces (like the I love you baby at 2 months)

• Reflexive sounds
• crying, burping, sneezing, etc.
• vowel-like productions (quasivowels) indiscriminately produced
• Birth to 2 months
• no intent

• Primitive articulation
• squeals, growls, laughter
• still quasivowels
• building on the previous stage
• 1-4 months

• time overlaps with stage 2
• vocal play, marginal babbling
• full vowels
• repeated syllable shapes; quasiconsonants
• 3-8 months

• time overlaps with stage 3
• canonical babbling
• reduplicated
• variegated
• 5-10 months

Canonical Babbling

Definition

• Lots of overlap with stage 4
• produces jargon

combinations of meaningful words and canonical babbling

• things to watch for in jargon
• repeated vowels
• syllabic nasals
• syllabic fricatives
• stop+vowel or nasal+vowel productions
• in CV or VC form

• babbling often continues for 3-4 months following the onset of the first "true" word
• quantity and quality of babbling predicts later language growth

• vowel productions in babbling
• e, uh, ah, oo (phonetic symbols)
• consonants in babbling
• h d b m t g s w n k
• syllable shapes in babbling
• V, CV, VCV, CVCV

• Phonetically consistent forms (PCF)
• may not be the correct word, but the same word is used consistently

Stable phonetic form that resembles adult form

used to affect some sort of change to the environment

Development of accurate production of speech sounds is a slow process

Sequence of acquisition may be more accurately considered than age of acquisition

• cross-sectional samples yield group related findings
• longitudinal samples yield individual related findings
• what is the study's definition of mastery
• stimulus materials?
• word position
• picture/object naming

early, middle, and late construct

early-late construct

• early phonemes (before 3)
• M B J N W D P H
• middle phonemes
• t ng k g f v ch dg (like judge dz looking IPA)
• late phonemes
• sh th TH s z l r g (rouge)

• Before 5
• p b m n h d t k g f w ng j
• after 5
• sh g (rouge) l gd (dz, judge) ch s r v z th TH ng j

Helpful in illustrating gradual development

helpful in illustrating sequence rather than finite age of mastery

there will rarely be an identifiable cause of a SSD

• anatomical variations 
• neurophysiological variables

Speech can be intelligible, even in the most significant anatomical variations

some variations will result in changes to speech productions, but few will result in true SSD

• Lips
• teeth
• tongue
• hard palate
• soft palate

• cleft lip
• congenital malformation of the lip
• unilateral or bilateral
• usually corrected surgically within a few weeks of birth
• limited to no effects on speech sound learning

• teeth are not necessary for intelligible speech
• malocclusions
• class II: mandible is retracted
• class III: mandible is protruted
• open bite is the only malocclusion affecting speech production

• compensation for damaged tongue tissue results in intelligible speech
• ankyloglossia
• tongue tie
• short frenulum
• rarely causes SSD; only in extreme cases

• cleft palate
• congenital malformation of the palate
• bones of palate do not fuse during gestation, mucus membrane covering may or may not fuse
• usually corrected surgically within first 2 years
• limited to no effects on speech sound learning

• cleft palate
• congenital malformation of the soft palate
• tissues of the soft palate do not fuse during gestation
• velopharyngeal insufficiency may result
• can't produce intra-oral pressure
• hypernasality (resonanace not artic issue)
• compensatory particulation
• glottal stop substition
• pharyngeal stop
• pharyngeal fricative
• velar fricative
• mid-dental, palatal stop

• learning on impaired nerves and muscles
• tight muscles

• very specific look/needs
• hard to diagnose unless you know the child
• should really have a neurological diagnosis

1. performing the assessment
2. consolidating the gathered information
3. analyzing test data
1. includes coming up with standard scores and knowledge when to use it
4. interpreting the data
5. making clinical decision
1. may include treatment, dentists, audiologist
6. making recommendations

• screening
• case history
• oral peripheral exam
• hearing screening
• cognitive screening
• language screening
• standardized test of speech sounds
• speech/language sample

• formal or informal
• formal
• have standardized, but they're not as sensitive
• doesn't have much variation in sensitivity
• HAP-3 used at UH for adults
• Informal
• can be tailored to a particular area
• designed by the individual for a specific person

• written case histories
• information gathering from other professionals (once granted permission by parents)
• teachers - can include behaviors, such as not raising their hand or not talking in class

Oral Peripheral Exam

Tools?

Objectives?

• should never take more than 5 minutes
• incredibly unlikely to figure out a phsycial cause of speech problem
• tools
• gloves, tongue depressory, stopwatch, pen, paper
• teeth
• don't count them, just observe for dental issues
• specific objectives
• symmetry, tone, strength, coordination, ROM
• of lips tongue, palate
• diadochokinesis
• rate of speech
• time by count method

• History
• such as PE tubes, prone to ear infections etc.
• visual inspection of the ear
• 20dB across 1, 2, and 4khz
• impedance testing
• referrals
• need to find one that you trust
• not every audiologist is good with kids and vice versa

• don't have to find the pictures/words
• faster
• usually take around 20 minutes if you're goot at the test
• ability to compare
• most districts in texas require a standardized score to be eligible for therapy
• child who has articulation disorders try to find ways around the sound they have problems with, but with these they have to say the word/sound

• can't test real speech in single word fashion
• don't give very many opportunities to test the same sound
• snapshot issue
• don't really tell us a whole lot, not enough about who they are how they communicate

• 2 way scoring
• +/-
• great for during treatment, but bad for diagnostic tests
• 5 way scoring
• corrrect, addition (adding sounds), distortion (wrong sound, could be close, would use diacritics) deletion (not saying a sound) and substitution (switching a phoneme)
• Transcription
• diagnostic tests should use full transcription

• Standardized tests
• HAPP-3
• GFTA-3 (ONLY WITH KLPA-2)
• BBTOP
• ALPHA
• language samples (better option)

• production of the target sound given maximal cueing
• he can be taught how to do it
• syllable, word and sentence levels
• tests only sounds misarticulated

• Clear administreation and scoring criteria
• hard to administer/score tests are worthless
• validity
• reliability
• standardization
• sample statistics, whether its representational
• most begin in college towns
• some statistics
• should be familiar to you, don't use ones you don't know
• types of scores
• always administered the same way
• instructions must be clear enough for that to happen

• raw scores
• standard score
• standard deviation
• age equivalents
• grade equivalents
• stanines
• percentiles
• t-scores
• z-scores
• normal curve equivalents

single most important factor

• construct validity
• face validity
• concurrent validity

• means the same results are expected (or similar enough)
• interjudge
• test-retest reliability

• will different administrators get the same results?

• incomplete or ambiguous directions
• response complexity
• training and practice
• scoring practices

why - because somehow we need to differentiate between those needing services and those that don't

when - when we know the question we're asking and we understand how the test will help us determine the answer

• choose tests that meet standardization criteria
• sensitivity/specificity
• adequate standardization sample
• reliable and valid
• interpret tests accurately and carefully
• use them for ONLY what they're designed to do

• free
• story
• routines
• interview
• scripted

• as the child says something "off" make sure you repeat what they said
• do it as often as you can, but be natural

uncontrolled content

stimulus is child selected

topic can be related or unrelated to stimulu

examiner listens, takes notes, makes non-directive comments

Indirect control of content

examiner selects stimulus

topic related to materials

examiner listens, takes notes, makes non-directive comments pertaining to materials

indirect and direct control of content

examiner selected single set of materials that sample all consonant forms

topic related to materials

examiner uses questions and comments to elicit consonants

direct control of content

no stimulus materials needed

topic flows naturally

examiner asks questions to identify and build on child's interests

direct control of content

examiner selected stimulus materials designed to elecity all consonant forms

topic related only to materials

examiner script of questions and prompts designed to elicit specific responses

• connected speech is a more ecologically valid measure of true communicative abilities
• deeper phonological sampling than citation methods
• allow for more analyses and deeper analyses
• you can look beyond speech
• more sensitive to clinical change

• time limits
• transcription of continuous speech is hard
• children will avoid difficult phonetic contexts

• phonemic inventory
• phonetic inventory

comparison to adult target

• PCC
• PMLU
• PWP - phoneme for word
• phonological process analysis

• the number of sounds the child uses contrastively
• the context in which they use them
• correctly or incorrectly

use 1 phoneme for many different ones

would be considered substitution

all the sounds produced, correctly or incorrectly

1. collect the sample
2. enter data into matrices
3. summarize phonemic contrasts
1. determine consistency/inconsistency of contrast
2. look for inconsistently used contrasts
3. summarize collapses
4. look for sound preferences

• only those sounds that are used contrastively

• identify presence/absense of a speech sound disorder
• describe error productions of singleton consonants, cononant clusters in single word, citation-type utterances
• "what is that?" one word responses
• describe error productions of singleton consonants and consonant clusters in sentence productions
• determine eligibility
• identify targets for intervention

• always know your tools
• understand that if you alter the administration conventions in any way, you invalidate the scores
• that doesn't mean you don't have valuable information
• that doesn't mean the scores cannot be reported (with a clear caveat)
• safeguard the materials

Sounds in words

and

Sounds in sentences

• error analysis
• phonetic error analysis
• /r/ error analysis
• limited because /r/ is different with every vowel and it doesn't test all combinations
• vowel error analysis
• intelligibility analysis
• stimulability analysis

• standard scores
• percentile ranks
• age equivalents
• growth scale values
• males vs females (males slower to mature)
• intervals vary with age of client
• more intervals between 2 and 9 (more sensitive)
• less intervals between 9 and 21 (less sensitive)

manual

stimulus book

protocol

• new target items, more frequent opportunities to assess indvidiaul phonemes and consonant clusters
• differentiated picture stimulus for younger and older clients
• revised connected speech tasked
• used to be story retell
• now sentence repeition
• growth scale values

• quiet, non-distracting, well-lit area
• sit at a right angle to the client
• free your dominant hand for writing
• see the picture the client sees
• recorder out of the way
• make sure it's functioning correctly beforehand

• recognize that your culture may differ from your client's in a variety of ways
• be sensitive to differences even if you do not understand them fully
• commit to learning about cultures and languages represented in your practice area
• study the phonetic and phonemic effects that are possible with linguistic differences
• appendix E in the manual

• co-morbid disabilities
• out of age range administration
• can do it, but can't get standard scores
• testing for re-evaluation

• record correct respones however you want
• incorrect responses may need diacritics
• no responses usually NR but only use this as a last resort
• self-corrections as SC, but make sure they are really self-corrections

• shared variable determined by
• speaker's ability to produce the sounds accurately
• speaker's ability to discern and repair communication breakdown
• listener's ability to hear the utterance
• listener's knowledge of the speaker's topic
• listener's familiarity with the speaker and the speaker's speech patterns
• environmental factors