Pediatric Speech Sound Disorders CSD 4411a PDF

Pediatric Speech Sound Disorders CSD 4411a Introduction to Speech and Language Disorders BJ Cunningham, PhD, SLP(C), Reg. CASLPO  Learning Objectives 1. Explain how consonant/vowel sounds are classified 2. List the major speech development milestones 3. Different...

Pediatric Speech Sound Disorders CSD 4411a Introduction to Speech and Language Disorders BJ Cunningham, PhD, SLP(C), Reg. CASLPO  Learning Objectives 1. Explain how consonant/vowel sounds are classified 2. List the major speech development milestones 3. Differentiate types of speech sound disorders 4. Explain the etiology of speech sound disorders 5. Understand procedures for the assessment and treatment of speech sound disorders 6. Describe some cultural considerations for children with speech sound disorders Consonant and Vowel Classification Systems  Speech sounds Phoneme – Smallest unit of sound in a language that conveys meaning – e.g., /p/ and /b/ are different phonemes (e.g., pat versus bat) Alphabet – English Alphabet = 26 letters Problem: No simple symbol-to-sound relationship Example: the ‘s’ sound: soup bass, base, face vs hose Example: the ‘er’ sound: jerk, fir, fur, word, butter, earth Example: the “sh” sound: ship, station, chef, moustache  Speech sounds International Phonetic Alphabet (IPA) – IPA = unambiguous system for representing sounds of speech – 42 IPA symbols (18 vowels and 24 consonants) e.g., “sh” ∫  Consonant Classification 3 dimensions along which sounds are classified 1. Place Where in vocal tract the constriction occurs as the sound is produced (e.g., /p/ = bilabial) 2. Manner How air is modified as it travels through vocal tract (e.g., /p, b, t, d, k, g/ = stops) 3. Voicing Whether vocal folds are vibrating while sound is produced (e.g., /z/ = voiced, /s/ = voiceless) Place of Articulation Some Examples: Bilabial (m, b, p) Labio-dental (f, v) Lingua-dental (th) Lingua-alveolar (t, s) Lingua-palatal (sh) Lingua-velar (k, g) Glottal (h)  Manner of articulation Examples of Energy Configuration Term Sound Sound is completely constricted and stopped before being Stop or /p/, /b/, /t/, /d/, released Plosive /k/, /g/ Sound is partially constricted, which sets up turbulence as Fricative /ʃ/, /v/, /h/ air passes through Sound is modulated by combination of complete closure following by turbulent rush of air through constricted Affricate /tʃ/, /dʒ/ opening Sound is modulated by air passing through nasal cavity Nasal /m/, /n/, /ŋ/ instead of oral cavity Tongue is shaped in various ways to either channel air Liquid /l/, /r/ blown through centre or across and along sides One articulator approaches another but does not make /j/, /w/ Glide vocal tract so narrow that turbulent airstream results  Voicing Voiced = vocal folds vibrating Voiceless = no vocal fold vibration Cognates – Speech sounds that share same manner and place of articulation, but differ along voicing dimension E.g., /d/ & /t/, /f/ & /v/  Consonant Classification Know these IPA symbols For help see: https://www.vocabulary.com/resources/ipa-pronunciation/  Vowels Characterized by positioning of the tongue within the oral cavity Variations in an open vocal tract configuration with vocal folds vibrating Vowel differentiation determined by: 1. Tongue elevation (height) Height of tongue (high, mid, low) 2. Tongue advancement Place of articulation (front, central, back) 3. Lip position Rounded or unrounded  Overall Vowel Classification concepts, not IPA symbols on exam For help see: https://www.vocabulary.com/resources/ipa-pronunciation/  For illustrative Vowel dimensions purposes only Elevation Advancement  Sample IPA questions BONUS 1. Which of the following is a 2. The place of articulation for fricative sound? /t/ is… a. bilabial a. /p/ b. labial-dental b. /f/ c. lingua-alveolar c. /w/ d. lingua-palatal d. /ŋ/ e. lingua-velar e. /tʃ/ 3. / tʃip/ is an IPA transcription of the word… a. cheap b. jeep c. sheep d. sleep e. heap Speech Development Milestones  Speech Development in the first year Over the first year, many changes move infant towards production of specific sounds 0 MOS – Reflexive, vegetative sounds (e.g., crying, grunting, sighing, lip smacking, tongue smacking) – Vowel-like and consonant-like sounds emerge – Front sounds dominate (e.g., raspberries, bilabial trills) TO – Prosodic play (altering duration and pitch, extreme pitch glides, e.g., yells, squeals, growls) – Canonical babbling – Prosody like real speech 12 MOS – Nonreduplicated/variegated babbling – Jargon – First words  Speech Development in the first year – Newborns Crying and reflexive, vegetative Birth sounds (newborn) Cooing and laughing (2-4 months) – Vocal play (4-6 months) TO Vowel-like and consonant-like sounds emerge Front sounds dominate (e.g., raspberries, bilabial trills) 6 months Prosodic play (altering duration and pitch, extreme pitch glides, e.g., yells, squeals, growls) Speech Development in the first year – Canonical babbling (6-9 months) 6 months – Variegated babbling TO (10-12 months) Prosody Jargon 1 year – First words (12 months) Speech Development beyond the first year By 18 months – Most have at least 1-2 clear vowels and approx. 4 word-initial consonants (e.g., [b, d, m, n]) 20 months  Speech Development beyond the first year By 2 years – Most vowels clearly produced – 9-10 word-initial consonants (typically [b, d, t, d, m, n, w, j, h, s, k)], clusters emerging (e.g., /bw/) – At least 70% correct in articulation of consonants – At least 50% of words are intelligible to unfamiliar listeners 29 months  Speech Development beyond the first year By 3 years – Bilabials, nasals, and glides established – Fricatives (e.g., /f/, /s/, Affricates (e.g., /tʃ/, /ʤ/) and liquids (/r/, /l/) begin to appear – At least 75% intelligible By 4 years – 90%+ intelligible, even to strangers – May have some errors on some consonants Age 3;3 Speech Development beyond the first year By 5 years – Speech is 98%+ intelligible – Phonetic inventory complete – > 90% consonants, clusters and vowels produced accurately – Can produce all word shapes When is correct articulation learned? McLeod & Crowe, 2020  When is correct articulation learned? Age 5 McLeod & Crowe, 2020  What does chart tell us? Sound development is gradual Certain groups of sounds achieved early and others at later ages Using chart to understand child’s speech development – What sounds do we expect child to be able to say well by now? – What sounds errors do we expect at the child’s age? – What errors don’t we expect at the child’s age?  Case Example 4-year-old makes errors on the following sounds: 1. /k/ Age 5 2. /d/ 3. /f/ Age 4 4. /r/ 5. /s/ 6. /ʃ/ McLeod & Crowe, 2020  Case Example 4-year-old makes errors on the following sounds 1. /k/ 2. /d/ 3. /f/ 4. /r/ 5. /s/ 6. /ʃ/ McLeod & Crowe, 2020 Speech Sound Disorder Types  Speech sound disorders in children When are speech sound errors considered an impairment? – When significant problem with production of speech sounds causes child’s speech to differ from age and cultural expectations Speech sound disorder (SSD) – aka speech sound delay or disorder – includes both rule- and motor-based impairments Speech sound disorders in children McLeod & Baker, 2018 Speech sound disorders in children Phonemic (rule-based) - Phonetic (motor-based) - Phonological Articulation Errors represent a Errors are typically pattern vs. a few sound distortions of specific errors sounds (e.g., lateral /s/) There is collapse of May discriminate phonemic contrasts between error & target – e.g., /d/ used in place of all fricative sounds sound  Articulation impairment Inability to articulate certain speech sounds Often results in phonetic error – Sound is distorted or mispronounced but is still the same phoneme e.g., the /s/ sound is produced laterally or interdentally e.g., the /r/ sound is produced as a glide  Phonological impairment Impairment in phonological system, or rules that govern sound patterns of the language – child simplifies adult rules for producing sounds Often results in phonemic error – different phoneme is substituted or sound is omitted, resulting in change of meaning  Concepts, not numbers, on Childhood SSD exam Many children have both phonemic and phonetic errors – Often difficult to determine whether child has articulation impairment, phonological impairment, or both – SSD a useful umbrella term for all of these Prevalence of SSD – 15% in 3-year-olds Campbell et al., 2003 – 6% in early school-age – Occurs more often in boys than girls Causes of Pediatric SSDs  Etiology of childhood SSD 1. Known causes – Physical or structural cause cleft lip and/or palate problems related to tongue mobility dental problems hearing impairment – Motor or neurological cause cerebral palsy childhood apraxia of speech 2. No known cause − Aka functional cause  Majority of cases  Theories of pediatric SSD Behaviourist – Acquisition of sounds is rooted in pre-linguistic behaviours (e.g., babbling) and vocal interactions – Early vocal interactions promote later development Distinctive features & natural phonology – Development affected by phonological patterns – Patterns suppressed as the child learns speech and language Optimality – Children learn constraints for possible word pronunciations – e.g., words don’t begin with /mr/ Assessment of Pediatric SSDs  “Diagnosing” pediatric SSDs What is significant? 1. Is child’s speech different from their peers? 2. Does their speech interfere with communication? Can the child be understood? 3. Does the child avoid speaking situations?  Assessment of speech 1. Single word test – Gather one example of each consonant sound in initial, medial and final positions (I, M, F) – Standardized tests that provide inventory of sounds child does and does not say 2. Speech sample – Many examples of sounds in spontaneous conversation – Collect at least 100 different words – Percent Consonants Correct (PCC)  For illustrative GFTA example purposes only  Assessment of speech (cont.) Provides information on 1. number of sounds produced incorrectly 2. how number of errors compares to sound production of peers If child produces errors on one or two sounds, likely phonetic problem (articulation impairment) If large numbers of sounds produced incorrectly, we look for patterns of errors and phonological processes  Speech sound error patterns 1. Substitution errors – One phoneme is replaced by another phoneme – Error sound is often substituted with easier, earlier developing sound E.g., /w/ for /r/ in *wabbit/rabbit E.g., /t/ for /k/ in *tee/key – Common part of normal development in young children  Speech sound error patterns 2. Omission errors – Phoneme is entirely absent – Can be one phoneme or entire class/category of phonemes e.g., just /s/, all fricatives, or all word-final consonants – Syllable simplification: when syllable is omitted – Common part of normal development in young children  Speech sound error patterns 3. Distortion errors – Phoneme misarticulated enough that sound is altered, but not enough that becomes different phoneme – Common distortions 1. Lateral lisp: air stream for /s/ or /z/ blown laterally, resulting in “slushy” sound 2. Frontal lisp: slightly interdental tongue position for /s/ or /z/ (approaching /θ/ or /ð/) – Can be seen in normal development  Speech sound error patterns 4. Addition errors – Sound is added where it doesn’t belong – Often involves addition of unstressed vowel – Not as common as other types – But addition is commonly seen in young children’s production of consonant blends E.g., /bʌlu/ for blue  Phonological Processes/Patterns Systematic sound change that affects a class of sounds Examples – Final Consonant Deletion [boat → bo] [fish → fi] [Mike → mi] – Cluster Reduction [blue → bu] [star → tar] [drink → dink] – Stopping of Fricatives [zoo → doo] [them → dem] [finger → pinger]  Other assessment considerations Stimulability – Can child imitate sounds they produce incorrectly? – If child can imitate sound after model, they are more likely to change – Gives an indication of readiness for therapy – Helps SLP choose goals  Other assessment considerations Intelligibility – What impact do errors have on our ability to understand child? – Bigger impact when large number of errors omission errors – Can be assessed reliably via parent-report (using published measures) or speech sampling  Other assessment considerations Oral peripheral mechanism examination (OPE) – To determine if structure and function of oral mechanism adequate to support speech 1. Examine structures for defects, tone, symmetry 2. Examine function of structures for non-speech and speech movements Evaluate speed, range of motion, strength, rhythm of articulators e.g., Diadochokinesis – Rapid, alternating syllable strings – /pɅtɅktɅ/  Other assessment considerations Audiometric testing – Hearing impairment can lead to articulation impairment Secondary to problems discriminating sounds Common features include – Vowel errors – Consonants: difficulties with quieter sounds, e.g., /s/, /ʃ/,/f/, /t/, /k/ – Hearing screening/test should be routine part of speech assessment Intervention for Pediatric SSDs  Intervention for SSD Main speech therapy approaches 1. Articulation approach For child who is unable to correctly say a few individual sounds (motor-based difficulty) 2. Phonological approach For child who can say sounds, but does not understand rule for saying sound in appropriate situations (rule-based difficulty) Children with physical or neurological challenges may require a team approach  1. Articulation Approach Focuses on helping child to make correct productions Uses sensory information to help elicit correct articulation Repetitive motor practice according to the principles of motor learning  1. Articulation approach Traditional Approach 1. Provide auditory, visual and physical cues to help child say sound – Child says sound after model – Child watches and listens 2. Try to improve automaticity with which sound is said – Provide lots of practice – Child learns when sound feels correct or not  1. Articulation approach 3. Increase length/complexity of stimulus – syllables → words → sentences 4. Child learns to say sound outside therapy room – Aka generalization 5. Child monitors how well they said targets  Verbal-tactile cueing https://youtu.be/SwgP5aL8Bb8 PROMPT Visual-tactile support  1. Articulation Approach Maximal contrast approach Targets later-developing sounds first Designed to elicit widespread change in the speech production system For children with severe SSD  2. Phonological Approach Focused on teaching the child the phonological rules they are struggling with Emphasizes changes in meaning caused by phonological errors, rather than teaching production of sounds Often uses contrastive approaches – Use phonemic contrasts in rhyming word pairs – e.g., Minimal Pairs Approach, Cycles Approach  2. Phonological Approach Minimal Pairs Approach, e.g., – Child with cluster reduction – e.g., says /pɔt/ for “spot” and “pot” and /pi/ for “spy” and “pie” – Therefore, child isn’t creating meaning difference – Present child with opportunities to see way pair of words is different  Minimal Pairs Minimal pairs https://youtu.be/Dy-b4gEyeJU  2. Phonological Approach Cycles Approach For children with severe phonological delay/disorder Goal = to improve intelligibility Therapy stimulates an emergence of patterns Phonological patterns are trained successively (using a horizontal approach) over pre-specified periods of time  Cycles approach Vertical Horizontal (Traditional) (Cycles) Sentences cycle 1 ---→ cycle 2----→ cycle 3 Phrases *Move from 1 cycle to the next after given time Words Syllables Isolation *Move to next level based on Performance (80-90% accuracy)  Cycles target selection Targets identified following a comprehensive speech assessment – Hodson Assessment of Phonological Patterns 3rd Edition (HAPP-3; Hodson, 2004) – Diagnostic Evaluation of Articulation and Phonology (DEAP;Dodd et al., 2002) Patterns < 40% monitored Patterns > 40% grouped into target patterns and treated for set periods of time Hodson, 2010  2. Phonological Approach Phonological Awareness Example Activities: – Phoneme detection (e.g., Does dog start with the /s/ sound?) – Phoneme categorization (e.g., Find all the pictures that start with /s/) – Initial phoneme matching (e.g., sort /s/ and /d/ cards) – Phoneme isolation (e.g., What sound does “sun” start with?) – Segmenting (e.g., How many sounds in the word /sun/?) – Blending (e.g., /s-u-n/ - what does that say?) – Rhyming – Alphabet knowledge – Emergent writing – Print awareness (discussing print) Cultural Considerations  Cultural Considerations Dialect: regional variety of particular language Accent: manner of pronunciation of a language Phonological Difference versus Phonological Delay or Disorder Elective therapy Phonological Interference: Phonology of dominant language affects pronunciation of sounds in second language  Multilingual Children Multilingualism “It is neither feasible nor ethical for SLPs to remain ignorant of basic principles of assessment and treatment of children learning more than one language, including the impact of cultural factors in the 21st century world” International Expert Panel on Multilingual Children’s Speech, 2012 Commonalities Across Languages McLeod et al., 2018 Multilingual Children 75-85% criteria 90-100% criteria McLeod et al., 2018  Multilingual Children Overall, similar rates of phoneme acquisition and proficiency by age 5 Large SDs in the acquisition of some phonemes High variability in the preschool years Many of the same types of errors across languages Goldstein & Gildersleeve-Neumann, 2015 McLeod et al., 2018  Multilingual Children Kohnert (2010) - 3 common characteristics of multilingual speech development 1. distributed skills and uneven ability 2. cross-linguistic associations 3. individual variation