Articulation and Phonological Disorders

What is an Articulation and Phonological Disorder?

Articulation and Phonological Disorders = A child has difficulty expressing a sound past the intended age of development

Speech sound disorders: an umbrella term referring to any difficulty or combination of difficulties with perception, motor production, or phonological representation of speech sounds and speech segments—including phonotactic rules governing permissible speech sound sequences in a language.

ETIOLOGIES

Which children are at risk for speech sound disorders?

The cause often is not known, but children at risk for a speech sound disorder include those with:

• Developmental disorders such as autism

• Genetic disorders such as Down syndrome

• Hearing loss

• Nervous system disorders such as cerebral palsy

• Illnesses such as frequent ear infections

• Physical problems such as a cleft lip or palate

• Too much thumb-sucking or pacifier use

• Low education level of the parent

• Lack of support for learning in the home

What are the symptoms of speech sound disorders in a child?

Symptoms depend on what type of speech sound disorder the child has. He or she may have trouble forming some word sounds correctly past a certain age. This is called articulation disorder. Your child may drop, add, distort, or swap word sounds. Keep in mind that some sound changes may be part of an accent. They are not speech errors. Signs of this problem can include:

• Leaving off sounds from words (example: saying “coo” instead of “school”)

• Adding sounds to words (example: saying “puhlay” instead of “play”)

• Distorting sounds in words (example: saying “thith” instead of “this”)

• Swapping sounds in words (example: saying “wadio” instead of “radio”)

If the child often makes certain word speech mistakes, he or she may have phonological process disorder. The mistakes may be common in young children learning speech skills. But when they last past a certain age, it may be a disorder. Signs of this problem are:

• Saying only 1 syllable in a word (example: “bay” instead of “baby”)

• Simplifying a word by repeating 2 syllables (example: “baba” instead of “bottle”)

• Leaving out a consonant sound (example: “at” or “ba” instead of “bat”)

• Changing certain consonant sounds (example: “tat” instead of “cat”)

Case History: What Do We Need? How Do We Get It?

Assessing SSDs: Clinical Decision-Making

Assessment requires several steps, including:

• Identifying that an SSD is present

• Analyzing the errors or error patterns

• Differential diagnosis

A basic assessment battery includes:

• Hearing and speech mechanism assessment

• Developmental, educational, medical, and family case history

• Receptive, expressive, and literacy language skills assessment

• Speech skills (including single words, connected speech, and stimulability) and perception skills assessment

Some Questions to Ask

Assessment Information

SCREENING INFORMATION

Conducted to determine whether a more in-depth examination is needed

Involves

• Speech Analysis: word level & connected speech

• Motor Oral Sensory Examination: assesses oral structures, symmetricity, and functionality of the articulatory organs

• Hearing Examination

• Informal Assessment of Expressive and Receptive Language

• Formal/ Standardized Test Screening: Goldman & Fristoe 2000 (GFTA), Khan-Lewis Phonological Analysis (2002), Hodson Assessment of Phonological Patterns (HAPP-3)

• Informal Assessment Involves: eliciting connected speech preferably in a naturalistic setting by asking to describe an event, a movie, a game; collecting a speech sample, document sound errors

STANDARDIZED/NORM REFERENCED TESTS

• Standard Deviation, Z Score, Percentile Rank, Stanine

TESTS USED

• Goldman Fristoe Test of Articulation- 3 (GFTA): Norm referenced test, ages 2-21 years old. GFTA-3 Goldman-Fristoe Test of Articulation 3 (pearsonassessments.com)

• Hodson Assessment of Phonological Processes-3 (HAAP-3): Norm referenced test, ages 3- 8 years old. Hodson Assessment of Phonological Patterns–3rd Edition (HAPP-3) (therapro.com)

• Khan-Lewis Phonological Analysis-3 (KLPA-3): Analysis of speech sound patterns, ages 2-21 years old. KLPA-3 Khan-Lewis Phonological Analysis Third Edition (pearsonassessments.com)

• Arizona Articulation and Phonology Scale-3: Norm referenced test, ages 1.5-18 years old. Arizona Articulation and Phonology Scale | Fourth Edition | Product Info (superduperinc.com)

• Diagnostic, Evaluation of Articulation & Phonology (DEAP): Norm referenced test, ages 3-8 years old. DEAP Diagnostic Evaluation of Articulation & Phonology (pearsonassessments.com)

Table of Errors/Parameters/Skills Typically Assessed

Normative Data & Relevant Statistics

Non-standardized Assessment Procedures

Speech Sampling

Single word testing is used to analyze phonetic context

Connected speech sampling provides information about production of sounds

Vowel Analysis

Differential Diagnosis

Determining the appropriate classification or label for the speech sound disorder

Differentiating Speech Perception vs

Articulation vs. Phonology

Apraxia vs. Dysarthria

Assessment(s) Summary

Evidence-Based Treatement Approaches

Evidence-Based Treatment Approaches Cont...

Interventions for SSD:

• Vertical: repeated and focused practice on an acute number of topics, this targeted practice continues until the student reaches a specified level of skill. This is usually conversational.

• Horizontal: practitioner chooses multiple targets and weaves them into the same session. This results in exposing the client to more sounds at one time.

• Cyclical: This intervention aims to collaborate with parts of vertical and horizontal approaches where a time limit is provided for practice on a goal or multiple goals. The child graduates to another target or targets for another preset period of time.

• Contextual Utilization Approach: This intervention focuses on the notion that speech sounds are formed in syllable based context in connected speech. This is most helpful for children who have an inconsistent relationship with speech sounds and require support to produce sound routinely.

• Phonological Contrast Approach: PCA is utilized most often to address phonological patterns of error. This is important for children to develop the necessary sound patterns that help to delineate from one word to another; utilizing opposing word pairs as a target versus a solitary sound.

  • Four differing contrast approaches:

    • Minimal Oppositions: an intervention whereby the Practitioner utilizes pairs of words that are different by only one phoneme, indicating a change in meaning.

    • Maximal Oppositions: choosing pairs of words for the intervention that are the most different due to their contrastive sounds on multiple levels.

    • Treatment of the Empty Set: this approach is most alike maximal oppositions, choosing pairs of words with the most different sounds that are specifically unknown to the child.

    • Multiple Oppositions: With the goal of addressing a child’s error sounds, this intervention chooses word pairs which are different than the targeted error with 3-4 selected sounds which reflect: maximal classification and maximal distinction.

• Complexity Approach: Using more complex and difficult stimuli, this approach believes that increased complexity helps to promote generalization to other areas, yet to be treated. This approach was inspired by maximal oppositions, but instead, focuses on a hierarchy of complexity with regard to fricatives, clusters and affricates. This intervention does not focus on contrasting sound pairs but instead, on stimulability.

• Core Vocabulary Approach: CVA supports children who have difficulty with consistent speech sounds and supports them when other traditional therapies are not working.

• Cycles Approach: This approach is designed to meet the needs of children who demonstrate excessive unintelligible speech patterns.

  • This treatment is structured in a range of 5 to 16 weeks so that one or more phonological patterns can be targeted.

  • A new pattern is targeted upon the completion of the previous pattern.

  • Recycling through patterns continues until the targeted areas become present in the child’s regular speech patterns.

• Distinctive Features Approach: this approach aims to address phonemes in a child’s speech such as fricative, nasality, voicing and articulation placement. Most often, this is utilized for children who lean toward sound replacement, where one sound is used for another.

• Metaphon Therapy: Focusing on metaphonological awareness, which is the observance of the phonological foundation of language.

  • Consider the notion that children who have these disorders, failed to develop skills for the phonological system.

(ASHA, Articulation and Phonology 2021)