Transcript
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/#