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Introduction to Communication Disorders: A Lifespan Evidence-Based Perspective 5th Edition

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Category: Language and Communication Studies
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Chapter 9 Lecture Notes
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CHAPTER 9: Disorders of Articulation and Phonology Introduction to Communication Disorders: A Lifespan Evidence-Based Perspective 5th Edition Owens, Farinella, & Metz Developed by Sarah A. Dachtyl, Ph.D., CCC/SLP Chapter Learning Goals Describe the nature of speech sounds and the relationship between phonology and articulation Describe the correlates and causes of disorders of articulation and phonology Explain the procedures for assessing speech sound disorders Describe the approaches and techniques for treatment of articulatory and phonological disorders, and the supporting evidence available Outline Understanding Speech Sounds Speech Sound Development Through the Lifespan Associated Disorders and Related Causes Language and Dialectal Variations Assessment Intervention Understanding Speech Sounds Phonemes are categorized as vowel or consonant Consonants are classified according to place, manner, and voicing Distinctive features are sometimes used Understanding Speech Sounds Classification of Consonants by Place and Manner The point of contact or constriction – place Bilabial, labiodental, interdental, linguadental, alveolar, palatal, velar, glottal Consonants can be voiced or voiceless Obstruents include stops, fricatives, and affricates Resonants are nasals and approximants Approximants include glides and liquids Understanding Speech Sounds Classification of Vowels by Tongue and Lip Position and Tension Vowels are produced by resonating exhaled air within the oral cavity The sound made is dependent on which part of the tongue is elevated (front, center, back), its height (high, mid, low), and amount of tension (tense, lax) Whether the lips are rounded or retracted influences the sound Diphthong: Two vowels in close proximity Understanding Speech Sounds Distinctive feature analysis Each phoneme can be identified by presence or absence of features +nasal, -nasal Helpful in Identifying patterns Facilitating correction Speech Sound Development Through the Lifespan Pre-Speech Disappearance of reflexive sounds–myelination/brain growth Crying gets infant used to air flow across vocal folds Noncrying vocalizations with feeding or interaction 2 mos: Gooing/cooing 3 mos: Vocalize in response to others 5 mos: Imitate pitch, babbling 6-7 mos: Reduplicated babbling 8-12 mos: Echolalic stage Variegated babbling Jargon, phonetically consistent forms Speech Sound Development Through the Lifespan Toddler Speech First word around 12 mos Phonological processes Example: Omit final consonants Multisyllable words may be reduced Consonant blends may be shortened Sound substitutions Speech Sound Development Through the Lifespan Preschool Speech Most phonological processes disappear by 4 Consonant blends continue to develop Phoneme acquisition is gradual Children with phonological difficulties Continue phonological processes Children with neuromuscular disorders, sensory deficits, perceptual problems, poor learning skills Difficulty acquiring all phonemes Speech Sound Development Through the Lifespan School-Age Speech Early elementary – resembles adult phonology Morphophonemic contrasts: Changes in pronunciation as a result of morphological changes 5 yrs: Difficulty with some consonants and blends 6 yrs: Have acquired most speech sounds 8 yrs: Acquired consonant blends Speech Sound Development Through the Lifespan Phonology and Articulation The correct use of speech sound requires knowledge of the sounds of the language and the rules that govern their production and combination (phonology) Speech requires neuromotor coordination to say sounds, words, and sentences (articulation) Phonological impairments: Disorders of conceptualization of language rules Open syllable vs. closed syllable Articulation impairments: Disorders of production Substitution, omission, addition, distortion Associated Disorders and Related Causes Exact cause unknown (functional) Correlates/related factors Developmental Impairment in Children With a delay, the child is not producing the phonemes expected at that age Other children may be idiosyncratic in their phoneme use (disordered) Phonological impairments Average age of diagnosis is 4 year, 2 months Associated Disorders and Related Causes Developmental Impairment in Children Lifespan Issues 75% of children outgrow speech sound errors by age 6 By age 9, most children normalize their errors Speech therapy can help children correct speech sound errors more quickly A small percentage of children will have residual sound errors May have a negative impact on academics and professional and personal relationships Change is more difficult with increased age Associated Disorders and Related Causes Language Impairments General expressive language impairment present in about 60% of children who are difficult to understand and have multiple speech sound errors Speech Characteristics Complex syllable structures are challenging More likely to exhibit phonological errors that affect morpheme production Lifespan Issues Phonological impairments have a negative effect on literacy May have poor phonological awareness skills Associated Disorders and Related Causes Hearing Impairments Phonology, voice quality, pitch, rate, and rhythm will be similarly affected Speech Characteristics Intelligibility decreases with increased severity Lifespan Issues Congenital hearing loss leads to more severely affected speech Speech deteriorates over time for those who lose their hearing after learning to talk Hearing aids and training can help Associated Disorders and Related Causes Neuromuscular Disorders Dysarthrias: Group of motor speech disorders caused by neuromuscular deficits that result in weakness or paralysis and/or poor coordination of the speech musculature 75-85% of children with cerebral palsy have impaired speech production skills Location and severity of brain damage predict dysarthria type and degree of impairment Associated Disorders and Related Causes Neuromuscular Disorders Speech Characteristics Spastic dysarthria results in slow rate, imprecise articulation of consonants, harsh voice, hypernasality, and prosodic abnormalities Speech training or the use of AAC may be required Lifespan Issues In CP, the general motor and speech signs are present from early childhood onward 1/3 of individuals with CP have normal intelligence General motor functioning may deteriorate over time Associated Disorders and Related Causes Childhood Apraxia of Speech Neurological speech sound disorder that affects the ability to plan and/or program the movement sequences necessary for accurate speech production Speech is often unintelligible, segmented/choppy, disfluent, or lacking in prosodic variation Children may be aware that speech is difficult and be unwilling to talk Associated Disorders and Related Causes Childhood Apraxia of Speech Speech Characteristics Inconsistent errors Lengthened/disrupted transitions Inappropriate prosody Limited sound repertoires, groping, omission or adding sounds, difficulty with running speech Concomitant expressive language and phonological impairments Associated Disorders and Related Causes Childhood Apraxia of Speech Lifespan Issues Can be diagnosed as early as 3 or 4 years Standardized assessments are available Children with severe CAS may be nonverbal early on Normal or near-normal cognition and receptive language are good prognostic indicators for verbal communication Likely to have difficulties with phonological awareness, reading, writing, and spelling Prosodic difficulties may persist Associated Disorders and Related Causes Structural Functional Abnormalities Usually only gross abnormalities affect speech Individuals are remarkably adept at compensating for most structural abnormalities Severe deformity of the hard and soft palates as a result of clefting is far more detrimental Language and Dialectal Variations Differentiate between dialect and disordered phonology Characteristics of Articulation and Phonology Many variations (impossible to list) First language may interfere Some language interference is neutral or positive Lifespan Issues Some adults choose to modify their accent Articulatory patterns may be firmly established Goal: Increase intelligibility/communication effectiveness Assessment Goals Describe speech-sound inventory Identify error patterns Determine impact of errors Identify etiological factors Plan treatment Make prognosis Monitor change Case history, interview, oral peripheral exam, hearing screening Collect baseline data Assessment Description of Phonological and Articulatory Status Speech Sound Inventory Appropriate for young children and for those whose speech is markedly unintelligible List phonemes by manner of production and syllable/word position Syllable and Word Structure List most common word and syllable shapes as well as reductions or simplifications Assessment Description of Phonological & Articulatory Status Sound Error Inventory Identify misarticulated phonemes Standardized assessments are available Substitutions, omissions, distortions, additions Phonological Process Analysis Targeting a process encourages generalization Standardized assessments and computerized programs can be used for analysis Assessment Prognostic Indicators Include client’s age, severity, medical and concomitant problems, family support For adults, etiology largely impacts prognosis For children, error consistency, stimulability, and the ability to discriminate errors may help Consistency Lack of consistency is a positive indicator Evaluate speech during more than one task and in more than one context Assessment Prognostic Indicators Stimulability The ability to produce the target phoneme when given focused auditory and visual cues Often a positive prognostic indicator However, children in treatment with low stimulability scores often make more progress, especially with untreated sounds Error Sound Discrimination External or interpersonal error sound discrimination Internal or intrapersonal error sound discrimination Error sound discrimination ability signals more favorable prognosis 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 Intervention Approaches Bottom-Up Drill Approaches Progress from simple to more complex Target one sound at a time Speech assignments for generalization Instruction for self-monitoring Traditional Motor Approach: Auditory discrimination, establishment of the sound, production in isolation, nonsense syllables, words, phrases, sentences, and conversation, and generalization maintenance and practice Sensory-Motor Approach: No auditory discrimination; starts at syllable level Intervention Language-Based Approaches Instruction is implicit, within language activities Not appropriate for severe speech delays Has proven to generalize to conversational speech Following drill-type therapy Intervention Phonological-Based Approaches Multiple speech-sound errors or highly unintelligible Cycles Approach: Start with most stimulable phonological process and progresses through multiple cycles Minimal pair contrasts Multiple Oppositions Approach: Children who substitute one sound for multiple sounds, uses maximal contrasts Metaphon Approach: Increase metaphonological skills Phase 1: Expanding knowledge of the sound system Phase 2: Transferring knowledge to communication situations and teaches self-monitoring and self-correction Intervention 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 Intervention Treatment of Neurologically Based Motor-Speech Disorders Dynamic Temporal and Tactile Cueing Intensive, motor-based, drill-type treatment for severe CAS Small number of functional words and phrases Practiced slowly and produced simultaneously with clinician Moves to direct imitation, delayed imitation, and spontaneous productions Home practice Lee Silverman Voice Treatment Intensive treatment designed to increase loudness in PD Effective with modifications for children with CP Intervention 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 maintained, treatment was successful Summary Producing the sounds of a language during speech is complex As children develop, they typically use phonological processes that simplify adult forms If these persist, they may present difficulties Assessment of articulation and phonology includes a detailed description of phonological output, as well as investigation of etiology and determination of prognosis The goal of intervention is to improve intelligibility in spontaneous speech Online Resources Articulation and phonological disorders: http://www.asha.org/public/speech/disorders/SpeechSoundDisorders.htm Speech sound development and disorders in children and adults: http://www.asha.org/slp/clinical/Speech Lee Silverman Voice Treatment: http://www.lsvtglobal.com/ Phonetics: http://www.uiowa.edu/~acadtech/phonetics/#

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