Artic & Phono Disorders.pdf

ARTICULATION AND PHONOLOGICAL DISORDERS Tasks Due Date Person(s)-in-charge Status Constructing batch March 13, Chloe Marie A. Garcia COMPLETED reviewer 2024 Mykl Keith A. Hofilena...

ARTICULATION AND PHONOLOGICAL DISORDERS Tasks Due Date Person(s)-in-charge Status Constructing batch March 13, Chloe Marie A. Garcia COMPLETED reviewer 2024 Mykl Keith A. Hofilena Rejiena Simone P. Langkay Alyssandra Dominique B. Legados Leigh Andrea C. Pascua Aerrol Vincent B. Sanhi Lara Niel B. Sevilleno Frances Irah Delos Santos Marian Juliet Manrique Pauline Adriana Milan Patrizia Ann Navarro Ma. Mikaela Beatrice Quizon Julianna Santiago Elijah Mae Simeon Leeanne Frances D. Calina Alreich Millian D. Camposano Juan Paolo T. Gacis Matthew Louis D. Nillas Charlize Nicole Paredes Anne Mary Suba Andrew Jose C. Hipe Cosindad, Iceen Raya C. Santos, Reese Imogen M. Cumpas, Micah Angela L. Dela Cruz, Maria Diana S. Aguilar, Regine Clarize G. Montealto, Grace Heidi R. Padrilan, Christian Cyril A. Antonio, Fernandina F. Fernandez, Danielle Ruth D. Gonzales, Ina Louise M. Ilagan, Franchesca Beatrice N. Pablo, Christine R. Peña, Gwyneth Nicolette L. Sotto, Kristine Kamille R. Villamar, Raissa Russell R. Ariel Jienn F. Bayot Irish Faith C. Dollison Rupert Al John P. Navarro Kaileen Lois B. Quejadas Nicole Anne A. Tan Alea Clarisse T. Toledo  Clarise R. Yumol Checking of batch March 13-14 Sarah Marie Andrade COMPLETED reviewer 2024 Yannele Marie Apuada Jenneth Karylle Barba Mary Ethel Baylon Ahna Dominique Eguia Alexa Marie Elpedes Charmaine Petipit Chelsea Kristienne Villacote Revision and reviewing March 14, ALL COMPLETED of all topics 2024 Finalizing the reviewer March ALL COMPLETED 14-March 15, 2024 Anatomy and Physiology Related to Articulation ARTICULATION AND COARTICULATION (Shipley, K., 2019) Articulation pertains to the generation of clear and distinguishable sounds during speech. This process entails the coordinated action of the lips, tongue, teeth, palate, etc. As children mature, they acquire proficiency in articulation, enabling them to effectively express their wants and needs. As individuals progress into adulthood, their speech fluency typically improves gradually. This improvement is facilitated by a phenomenon known as coarticulation. Essentially, coarticulation involves adjusting mouth movements in anticipation of upcoming sounds based on preceding speech sounds. For instance, consider the words "big" and "bug." Notice how the position of your lips and tongue for the "g" sound in "big" is slightly different from that in "bug" because of the preceding vowel sound. DIFFERENCE OF ACTIVE AND PASSIVE ARTICULATORS (Wayland, R., n.d.) Articulators are simply the oral structures used to create two main types of speech sounds, namely consonants and vowels. There are two types of Articulators, which are Passive Articulators and Active Articulators. Below are the differences between the two articulators. Passive Articulators (Wayland, R., n.d.) Active Articulators (Wayland, R., n.d.) Upper surface of the oral cavity: upper lip, Lower surface of the vocal tract teeth, alveolar ridge, hard palate, soft palate Move towards passive articulators and uvula Relatively stationary PASSIVE AND ACTIVE ARTICULATORS (Seikel, et.al., 2010) ACTIVE ARTICULATORS Image Structure Physiology Lips This surrounds the oral cavity, and plays a vital role in facial expression, phonation, mastication, as well as tactile sensation and intimacy (Piccinin (Sendic, 2023) & Zito, 2023) This seals and holds foods and liquids within the mouth to prevent spilling from the oral  cavity (Piccinin and Zito, 2023). They are also a fundamental part of phonation and articulation to which almost all phonemes would have contact (Bong, 2020) with the lips (Seikel, et.al., 2010). Tongue The largest mobile articulator, which is frequently used to produce speech sounds to provide and form words clearly (Seikel, et.al., 2010; Cleveland Clinic, n.d.). This is a muscular organ used to push food to the mouth for mastication and propel it to the digestive tract (Cleveland Clinic, (Biology Easy, n.d.) n.d.). This also helps keep the airway open for proper breathing (Seikel, et.al., 2010) Jaw (Mandible) Known as the second largest articulator, and one of the largest bones in the human skull that forms the jawline and ⅓ of the face (Seikel, et.al., 2010; Aktar, Breeland & Patel, 2023) (Emin, 2022) Most movements in the articulators would connect with the mandible to produce speech sounds. This connects with different muscles (i.e. genioglossus, orbicularis oris, etc.) and nerves (i.e. Trigeminal Nerve) to provide movement for speech, mastication, and facial expression (Aktar, Breeland & Patel, 2023)  Soft Palate The soft palate makes up ⅓ of the roof of the mouth. This plays a part in producing speech, swallowing, and respiration (Caporuscio, 2019) They also play a role in (Animalia Life, n.d.) distinguishing nasal sounds (/m/, /n/) from non-nasal sounds (Seikel, et.al., 2010). Uvula They play a supporting role with the soft palate through aiding in drinking and eating through propelling. This also provides support in speech production (Cleveland Clinic, n.d.) (Christiensen, 2024) PASSIVE ARTICULATORS Image Structure Physiology Maxilla This forms the upper jaw which most articulators would also be connected (hard palate, soft palate, upper dentition, alveolar ridge (same with the lower teeth) which contributes greatly to mastication and speech production along with the (Dental Holiday, n.d.) mandible (Jewell, 2018). This also allows the person to provide facial expressions, to which it connects to different nerves (i.e. Trigeminal Nerve, Facial Nerve, Glossopharyngeal Nerve) (Seikel, et.al., 2010; Jewell, 2018)  Teeth These are the main mechanism for mastication and support articulation giving it the function of being an articulatory surface for different sounds produced (e.g. /t/, /v/, /f/) (Seikel, et.al., 2010). (Sands, n.d.) Hard Palate (white arrow behind This builds the ⅔ of the roof of the teeth and alveolar ridge) the mouth supported by the maxilla. The hard palate separates the oral cavity from the nasal cavity (Helwany & Rathee, 2023). Provides a rigid floor for the nasal cavity and prevents (Denton, n.d.) pressure changes within the mouth from closing the nasal cavity (Helwany & Rathee, 2023) This is also important for providing phonation as well as protecting the cavities during mastication and digestion (Helwany & Rathee, 2023) Alveolar ridge This is the extension of the maxilla and mandible that holds and supports the dentition structures as well as supporting speech production through production with the other articulators (International (Kadam, 2023) Congress of Oral Implantologists, n.d.)  Epiglottis (blue-coded flap) This is a flap-type structure that protects your ability to breathe by shielding the larynx from opening whenever food or liquid may enter into the respiratory system (Cleveland Clinic, n.d.), that may lead to aspiration. (Sheffield, 2022) Glottis This is a portion of the larynx that protects the true vocal cords and it is responsible for phonation of sounds (Benner, Sharma, P., & Sharma, S, 2023) (Sheffield, 2022) Pharyngeal Wall The pharyngeal walls of the pharynx would take in air from the nasal passages and food from the mouth (Travers, 2022). This also provides vibrations and resonance of sounds through moving the muscles as the air would flow through the voice box. This is a main source (Pazhaniappan, 2023) of phonation working with the vocal cords (Travers, 2022).  Placement of Consonants (Bernthal, J. E., Bankson, N. W., & Flipsen, P., 2017) Placement of How is it created Speech sounds Articulation (Bernthal et al., 2017) Bilabial Closed jaw position to /p/, /b/, /m/, /w/ assist the constriction at the lips. (Bernthal et al., 2017) Production of /p/, /b/, and /m/ Labiodental The constriction between /f/, /v/ the lower lip and the upper teeth (incisors). The jaw closes to aid the lower lip in its constricting (Bernthal et al., 2017) gesture. Production of /f/ and /v/ Interdental Contact between the /θ/ and /ð/ tongue tip and the edge of the incisors (contact behind the teeth) The jaw tends to close to aid the tongue in (Bernthal et al., 2017) making its constriction. Production of /θ/ and /ð/  Alveolar Contact between the /t/, /d/,/s/, /z/, /n/,/l/ tongue tip in the alveolar ridge Production of /t/ and /d/ An airtight chamber (Bernthal et al., 2017) is created as the tongue contacts Production of /t/ and firmly against the /d/ alveolar ridge Production of /n/ Similar position with /t/ and /d/, but the velopharyngeal port is open, which makes the /n/ nasalized. (Bernthal et al., 2017) Production of /s/ and /z/ Made when there is Production of /s/ and a narrow /z/ constriction between the tongue tip and the alveolar ridge Palatal The tip of the tongue /ʃ/, /ʒ/, /r/, /j/, /tʃ/, /dʒ/. contacts the hard palate. Production of /r/ (Bernthal et al., 2017) Contracting the tongue in the hard Production of /r/ palate Left - retroflexed /r/ Right - bunched /r/ Production of /ʃ/ and /ʒ Produced when air moves rapidly through a constriction formed between the blade of the tongue and the hard palate  (Bernthal et al., 2017) Production of /ʃ/ and /ʒ/ Velar Contact of the tongue and /k/, /g/, /ŋ/. the velum Production of /ŋ/ The tongue (Bernthal et al., 2017) constriction is Vocal tract similar to configurations for velar phonemes /k/ and consonants. /g, but the velopharyngeal port is open for nasalization. Glottal Produced when there is an /h/ opening of the vocal folds, which would generate a fricative sound, as air moves through the glottis. (Lynch P., n.d) Manner of Consonants (Bowen, 2015; Huckvale, 2018) Obstruents Image Manner Description Speech Sounds  Stops/Plosives These sounds are produced /p/, /b/, /t/, /d/, /k/, when air flow is interrupted by /g/, /ʔ/ a complete obstruction of the passage of air (Huckvale, 2018). (The Sound of English, 2022) Fricatives These sounds are produced as /f/, /v/, /θ/, /ð/ , /ʃ/, there is a severe narrowing of /ʒ/ the air passage at some place. As air escapes through this narrowed passage, fricative sounds are produced (Huckvale, 2018). (The Sound of English, 2023) Affricates These sounds are like a /tʃ/, /dʒ/ combination of plosives and fricatives characterized by a closing of the air passage followed by a fricative release of air (Huckvale, 2018). (The Sound of English, 2022) Sonorants  Nasals These sounds are produced /m/, /n/, /ŋ/ when the soft palate is lowered and air flows out through the nose instead of the mouth (Huckvale, 2018). (The Sound of English, 2022) Liquids These are sounds produced by /l/, /ɹ/ air moving continuously and smoothly while the tongue moves to its final position while producing the sound (Byrnes, 2021). (Byrnes, 2021) Approximants These sounds are produced /w/, /r/, /j/ through narrowings of the air passage at different positions, but not a complete obstruction of airflow (Huckvale, 2018). (The Sound of English, 2022) Voicing: Voiced or Voiceless (University of Manitoba, n.d.) Voicing of consonants refers to the process of the vocal folds being held against each other at just the right tension so that the air flowing past them from the lungs will cause them to vibrate against each other (University of Manitoba, n.d.). Voicing has two types: (1) Voiced sounds and (2) Voiceless sounds.  Type of Voicing Description Examples Voiced Sounds which are made with /b/, /d/, /g/, /v/, /ð/, /z/, /ʒ/, /ʤ/, vocal fold vibration. /m/, /n/, /ŋ/, /l/, /r/, /w/, /j/ Voiceless Sounds made without vocal fold /p/, /t/, /k/, /ʔ/, /f/, /θ/, /s/, /ʃ/, /h/, vibration. /ʧ/ Vowel Quadrilaterals The vowel quadrilateral or the Vowel chart is a diagram used to understand vowel sounds and tries to represent where the tongue lies in relation to the openness of the mouth when you produce a vowel sound (Trujillo, 2006). This can also be a visual representation of the side-view of your mouth since it shows where your tongue is articulating when producing a vowel sound. The location of the vowel sound on the chart matches where the tongue is positioned. There are only two dimensions of movement which affect the sound of a vowel. These are up/down movement and forward/back movement but in phonetics, these are usually known as Vowel Height and Vowel backness (The Mimic Method, 2019) ○ Vowel height (The Mimic Method, 2019) When you lower your tongue towards your lower jaw, you are making a more open vowel sound such as /a/ When you raise your tongue towards the roof of your mouth, you are making a more closed vowel sound such as /u/ ○ Vowel backness (The Mimic Method, 2019) When you extend your tongue forward towards your teeth, you are making a more front vowel sound such as /i/. When you retract your tongue backward towards your throat, you are making a more back vowel sound such as /u/. (Trujillo, 2006)  MODELS AND THEORIES RELATED TO SPEECH PRODUCTION I. Target Model (Borden et al., 1994, as cited in Ferrand, 2013; Riad, n.d.) process in which a speaker attempts to attain a sequence of targets corresponding to the speech sounds he is attempting to produce (Borden et al., 1994, as cited in Ferrand, 2013) Targets can either be spatial, auditory-acoustic, or abstract. Targets can be a combination of spatial and auditory-acoustic targets (Riad, n.d.). (1) Spatial Targets (Guntapalli, 2015; Ferrand, 2013; Guntapalli, 2015) (AnatomyZone, 2020) There is an internal spatial representation of the vocal tract (i.e. cortical homunculus) in the brain that allows a speaker to move his/her articulators (Ferrand, 2013; Riad, n.d.). This is where a series of spatial targets are specified (Guntapalli, 2015). A speaker can achieve the targets no matter from what position the articulators begin the movement (Ferrand, 2013) Movement of the articulators vary depending on the starting point (i.e. coarticulation) (Ferrand, 2013) Feedback from the articulators are provided to the brain to regulate fine movement and correct any errors (Guntapalli, 2015) (2) Auditory-Acoustic Targets (Guntapalli, 2015; Raphael, et al., 2011; Riad, n.d.) The target is the acoustic output, which refers to the perception of the listeners of the speech sound (Guntapalli, 2015; Raphael, et al., 2011) Articulatory movements to achieve a speech sound may vary (Guntapalli, 2015). This may depend on the adjacent speech sounds and the rate of speech (Riad, n.d.). II. Feedback Model (Maas et. al., 2015; Riad, n.d.) The feedback mechanism is used to detect errors such as when the actual speech sound deviates from the intended speech output and correct it by generating corrective motor commands to the motor cortex (Maas et. al., 2015)  During speech production, there are 4 main types of feedback (Riad, n.d.): 1. Auditory: it is defined as one way of assessing the plan vs. the output and it occurs through both air and bone conduction ○ Delayed Auditory Feedback (DAF): refers to the delayed timing of voice feedback when the individuals hear themselves speaking For a typical person, this may cause severe articulatory disruptions that will lead to the presence of speech disfluencies. But for an individual with stuttering, this may help him produce more fluent speech. 2. Tactile: pertains to the information received from the sense of touch ○ Examples include light touch (articulators) and deep pressure (air pressure and flow changes) ○ When the touch receptors are stimulated, the surrounding cells are inhibited which then assists in localizing and sharpening sensations 3. Proprioceptive: refers to the sense of direction of movement, velocity, and position of articulators from sensors in joints, tendons, and spindles 4. Internal: defined as the delivery of information from brain about motor commands prior to motor response itself Auditory and tactile feedback are considered as external feedback mechanisms and are slow because the output is changed after speech has already happened. On the other hand, proprioceptive and internal feedback are deemed as internal feedback mechanisms and are fast because changes to the output can be as the speech occurs (Riad, n.d.). III. Feedforward Model (Arenas, R., 2010; Goffman et al, 2008; Maas et al., 2015; Guenther, 2015; Seikel et al., 2021) In the production of speech, both feedforward and feedback systems are used synchronously. The Feedforward model indicates the use of internal representations to set up and anticipate the necessary motor sequence which allows to attain a motor goal (Arenas, R., 2010). In a study conducted by Goffman, et. al., (2008), the use of the feedforward system was evident by examining the coarticulatory movements associated with a single rounded vowel across an entire utterance. The feedforward mechanism takes past experiences from the speech target to create predictive motor commands (Maas et. al., 2015). Once we have acquired motor controls for speech through the feedback system from our personal experiences, the feedforward system comes into play. Output from the feedback system is no longer used to revise our speech time and time again because the speech target has been accurately learned (Guenther, 2016). We only return to the feedback system to correct our errors if a perturbing event disrupts our speech (e.g., anesthesia, etc.) (Seikel, Drumright, & Hudock, 2021). IV. Connectionist Models (Ferrand, 2013, Mcclelland & Cleeremans, 2009; Dell et al., 1999) Connectionist Models, or Parallel Distributed Processing Models (PDP), are derived from the manner of information processing in the brain wherein every process for speech production is performed in parallel. According to Ferrand, 2013, this model is based on computer modeling in which input and output units are linked together in various ways and with various layers of complexity. The input units are programmed to receive information, and the output units are the products generated by the system. In the brain, nodes receive stimulation and convey it to other nodes connected to it whereas in speech, there are interconnected nodes for each distinct unit of speech (e.g., phonemes, morphemes, syllables) that actively interact when producing speech. The complexity of these nodes also varies depending on the type of information it carries. For example, based on the picture below, the node for the word cat is connected to three semantic nodes (e.g., animals, mammals, or can be domesticated), which are also connected to the words “dog” and “rat” because the word can also be attributed to these semantic nodes. Therefore, words with similar meanings will be connected to a common semantic node. Looking in a different level, the Phoneme Level, the words “cat”, “rat”, and “mat” share a phoneme node of /æ/ because these words contain that same phoneme.  (Aphasia-Model-Connections-are-excitatory-and-bidirectional-From-Dell-et-al-1997_Q640.jpg (640×640), n.d.) DEVELOPMENT MILESTONES OF SPEECH PRODUCTION Phonemic acquisition refers to the use of speech sounds, which is influenced by language experience and speech sound system organization. Phonetic acquisition is the process of producing speech sounds using one's articulatory and motor skills (Post et. al., 2011). I. Age of Acquisition for Vowels (Fabus and Gironda, 2011) The three most important properties for defining vowels are height, backness, and roundness. Vowels are sounds generated with an approximation and no restriction in the air passage. The tongue is the most prominent articulator for production. All vowel sounds are voiced and all of them are 'oral' because when they are produced, the soft palate is lifted, and thus the nasal cavity is entirely blocked (Warsi, n.d.). Age of Acquisition for Consonants (Fabus and Gironda, 2011) As children develop, so does their speech. It takes time for speech sounds to be produced correctly and accurately. Because of this, incorrect productions of sounds may not be cause of concern at some ages. The table above shows at what age certain sounds are already expected. Expected Canonical Forms in Speech (Owens, 2012) Age in Months Syllable Structure Examples 24 CV, VC, CVC No, an, dog, rug, bag 36 CV, VC, CVC, No, an, dog, rug, bag, book, play, help  CCVC, CVCC 48 CV, VC, CVC, CCVC, CVCC, CCVCCC No, an, dog, rug, bag, book, play, help, brush, block 60 CV, VC, CVC, CC__, __CC, CC__CC No, an, dog, rug, bag, book, play, help, brush, block Phonological Processes TYPICAL PHONOLOGICAL PROCESSES TARGET AGE OF TYPE & DEFINITION EXAMPLE WORD DISSOLUTION WHOLE WORD PROCESSES CLUSTER REDUCTION (Bauman-Waengler, 2007), (Bernthal and Bankson, 2004), spoon /pun/ (Khan, 1982), and (Peña-Brooks and Hegde 2007). star Deletion of one or more consonants from /tar/ a two- or three-consonant cluster 4;0 UNSTRESSED SYLLABLE DELETION umbrella (Bauman-Waengler, (Bauman-Waengler, 2007), (Bernthal and Bankson, 2004), /bɹɛla/ 2007), (Bernthal and banana Bankson, 2004), (Khan, 1982), and (Peña-Brooks and Hegde 2007). /nana/ (Khan, 1982), and Unstressed or weak syllable in a word is deleted (Peña-Brooks and Hegde 2007). EPENTHESIS (Bauman-Waengler, 2007), (Bernthal and Bankson, 2004), (Khan, 1982), and (Peña-Brooks and Hegde 2007). blue /bəlu/ Insertion of a new phoneme, typically the unstressed schwa DIMINUTIZATION (Bauman-Waengler, 2007), (Bernthal and Bankson, 2004), dog /dɔgi/ (Khan, 1982), and (Peña-Brooks and Hegde 2007). cup /kʌpi/ Addition of an / i / or a consonant and / i / 3;0 REDUPLICATION (Bauman-Waengler, (Bauman-Waengler, 2007), (Bernthal and Bankson, 2004), water /wawa/ 2007), (Bernthal and Bankson, 2004), (Khan, 1982), and (Peña-Brooks and Hegde 2007). daddy /dada/ (Khan, 1982), and Repetition of an entire or partial syllable (Peña-Brooks and Hegde 2007). INITIAL CONSONANT DELETION (Bauman-Waengler, 2007), (Bernthal and Bankson, 2004), cup /ʌp/ (Khan, 1982), and (Peña-Brooks and Hegde 2007). bee /i/ Deletion of the first consonant or consonant cluster in a syllable or word SUBSTITUTION (Bauman-Waengler, 2016; Fabus and Gironda, 2011) ALVEOLARIZATION (Bauman-Waengler, 2016; Fabus and Gironda, 2011) 6:0 pan tan (Fabus and The change of non-alveolar sounds, an alveolar thumb /sʌm/ Gironda, 2011) sound is substituted for a linguadental or labial sound DEAFFRICATION /ʃu/ /tʃu/ (Bauman-Waengler, 2016; Fabus and Gironda, 2011) cheese [ʃiz] Affricates are produced as fricatives DEPALATALIZATION (Bauman-Waengler, 2016; Fabus and Gironda, 2011) /fis/ /fiʃ/ 4;0 Substitution of an alveolar fricative or affricate for a palatal fricative or affricate (Fabus and Gironda, 2011) DERHOTACIZATION (Bauman-Waengler, 2016; Fabus and Gironda, 2011) zipper The omission or loss of r-coloring for the zipp consonant /r/, and for central vowels with r-coloring GLIDING 5;0 - 7;0 run wun (Bauman-Waengler, 2016; Fabus and Gironda, 2011) (Fabus and red /wɛd/ The replacement of liquids or fricatives by glides. Gironda, 2011) LABIALIZATION bog 6;0 (Bauman-Waengler, 2016; Fabus and Gironda, 2011) dog /fʌm/ (Fabus and Substitution of a labial sound for an alveolar thumb Gironda, 2011) sound LIQUID SIMPLIFICATION 5;0 (Bauman-Waengler, 2016; Fabus and Gironda, 2011) lake take (Fabus and Substitution of another sound for a liquid Gironda, 2011) STOPPING (Bauman-Waengler, 2016; Fabus and Gironda, 2011) /catʃ/ /cat/ 3;0 - 5;0 Substitution of a stop consonant for a fricative or (Fabus and Gironda, 2011) affricate STRIDENCY DELETION (Bauman-Waengler, 2016; Fabus and Gironda, 2011) 6;0 soap oap (Fabus and Omission or substitution of another sound for a Gironda, 2011) fricative VELAR FRONTING (Bauman-Waengler, 2016; Fabus and Gironda, 2011) 3;6 candy tandy Substitution of sounds in the front of the mouth, (Fabus and key /ti/ usually alveolar sounds, for velar or palatal Gironda, 2011) sounds VOCALIZATION (Bauman-Waengler, 2016; Fabus and Gironda, 2011) 7;0 people peopo (Fabus and Substitution of a vowel for a final-position liquid Gironda, 2011) sound ASSIMILATION (Bauman-Waengler, 2016; Stein & Fabus, 2011) LABIAL ASSIMILATION cup /pʌp/ (Bauman-Waengler, 2016; Stein & Fabus, 2011) 3;6 Nonlabial sounds become labial sounds under book /bʊp/ (Stein & Fabus, the influence of neighboring labial sound bitin /bibin/ 2011) VELAR ASSIMILATION bakit /kakit/ (Bauman-Waengler, 2016; Stein & Fabus, 2011) 3;6 Nonvelar sounds become a velar sound under goat /gəʊg/ (Stein & Fabus, the influence of neighboring velar sound cup /kʌg/ 2011) NASAL ASSIMILATION (Bauman-Waengler, 2016; (Stein & Fabus, 2011) Nonnasal sounds become nasal under the bunny /nunny/ 3;6 influence of neighboring nasal sounds. ngipin /ngimin/ (Stein & Fabus, Place of articulation is retained, but the candy /nany/ 2011) manner of production is changed (Bauman-Waengler, 2016) ALVEOLAR ASSIMILATION yellow /lelo/ (Stein & Fabus, 2011) 3;6 Nonaleveolar sounds become alveolar under the bat /tæt/ (Stein & Fabus, influence of neighboring alveolar sounds ganda /danda/ 2011) FINAL DEVOICING bag 3;0 (Stein & Fabus, 2011) /beɪk/ (Stein & Fabus, Alteration in voicing affected by a nearby sound 2011) PREVOCALIC VOICING clean /dwin/ 3;0 (Stein & Fabus, 2011) car /gar/ (Stein & Fabus, Voicing of an initial voiceless consonant sound telephone /dɛləfon/ 2011) IDIOSYNCRATIC PHONOLOGICAL PROCESSES APICALIZATION (Stein & Fabus, 2011; Fabus & Gironda, 2011) /bou/ for bow /dou/ Labial /m, p, b/ is replaced by a tongue-tip consonant, such as /t/ or /d/ ATYPICAL CLUSTER REDUCTION (Stein & Fabus, 2011) The deletion of the consonant that is usually play /leɪ/ retained BACKING OF STOPS AND FRICATIVES (Fabus & Gironda, 2011) time /kimɛ/ When you move front sounds like /t/ and /d/ to zoom /gum/ the back of the mouth like /k/ and /g/ FRICATIVE REPLACING STOPS (Fabus & Gironda, 2011) sit /sis/ When there is a substitution of a fricative for a doll /zʌl/ stop GLOTTAL REPLACEMENT (Fabus & Gironda, 2011) The substitution of the glottal stop for another bat /ba?/ consonant *Typically seen in children with cleft palate MEDIAL CONSONANT DELETION /bitlɪ/ for beetle (Stein & Fabus, 2011) /bi-ou/ /spaɪdɚ/ for Deletion of intervocalic consonants /spaɪɚ/ spider MIGRATION (Stein & Fabus, 2011) Movement of a sound from one position in a soap /ɔps/ word to another SOUND PREFERENCE SUBSTITUTIONS (Stein & Fabus, 2011) Replacement of groups of consonants by one or juice /tʊs/ two particular consonants STOPS REPLACING GLIDES yes /dɛs/ (Stein & Fabus, 2011) Substitution of a stop for a glide wet /bɛt/ IDIOSYNCRATIC PHONOLOGICAL PROCESSES: VOWEL ERRORS (including feature changes in terms of tongue placement) BACKING (Stein & Fabus, 2011) /kæt/ for cat /kɪt/ Tongue retracted for a front vowel DIPHTHONGIZATION /keɪk/ for cake /ke-ek/ (Stein & Fabus, 2011) The splitting apart of the target vowel into two vowel sounds FRONTING (Stein & Fabus, 2011) /rak/ for rack /rek/ Tongue forward for a back vowel VOWEL HARMONY (Stein & Fabus, 2011) When vowels are produced like contrastive /kuki/ for cookie /ki-ki/ vowels (elsewhere in a word) SPEECH INTELLIGIBILITY MILESTONES SPEECH INTELLIGIBILITY - Refers to how clear a speaker’s speech is; determined by context and listeners (Fabus and Gironda, 2011) Age Norms, Percentage of Expected Intelligibility (Adapted from Pena-Brooks, A. & Hedge, M.) 19 - 24 months 25% – 50% intelligible 2 - 3 years old 50% – 75% intelligible 4 - 5 years old 75% – 90% intelligible 5+ years old 90% - 100% intelligible ARTICULATION PHONOLOGY Definition: Articulation encompasses all the motor Definition: Phonology refers to analyzing the actions required to produce the specific sounds of arrangements and structures of phonemes present speech (Bauman-Waengler, 2009). The acquisition in a language, along with figuring out the of articulatory abilities is a developmental language-specific phonemes and the rules progression that involves gradually gaining the skill dictating their modifications within words to move the articulators, which are crucial (Ladefoged & Johnson, 2010). Within this system, structures for forming individual sounds, with phonology revolves around identifying the precision and speed. phoneme, the most basic unit distinguished by its contrasting function within words. SPEECH SOUND DISORDERS (Lewis, et al., 2006; ASHA, n.d.; Farquharson, 2015) Term used to describe marked weakness with accurate production with age-appropriate speech sounds. It may be motoric or language-based or a combination of difficulties with perception, motor production, or  phonological representation including phonotactic rules influencing sequencing of speech sounds in a language. For some children, etiology is clear (organic) but for others, the cause of aberrant speech development is unknown (functional). ORGANIC FUNCTIONAL Organic Speech Sound Disorders are in nature Functional Speech Sound Disorders are idiopathic result from an underlying motor/neurological, or unknown. They may eventually remediate after structural, or sensory/perceptual cause (e.g. cleft a course of therapy but may also persist into palate, genetic syndrome, or hearing loss) (Lewis adolescence or adulthood (Felsenfeld et al., 1994) et., 2006). Motor/neurological disorders (ASHA, n.d.) Considering it is difficult to cleanly differentiate an Apraxia (motor planning issue) articulation disorder (motor-based deficit) from a Dysarthria (muscle weakness) phonological disorder (language-based deficit), Cerebral palsy (Garn-Nunn, 2011) researchers and clinicians prefer to use the umbrella term “Speech Sound Disorders” when the Structural abnormalities (ASHA, n.d.) cause is unknown (ASHA, n.d.; Farquharson, Orofacial anomalies 2015). ○ Cleft Lip and Palate Other structural deformities ○ Congenital defect (e.g. Pierre Robin sequence) ○ Myofunctional Disorders Patterns involving oral or orofacial musculature that interfere with normal development of structure and/or function (ASHA, n.d.; Garn-Nunn, 2011) Sensory/Perceptual Disorder (ASHA, n.d.) Hearing Loss Types of Speech Sound Disorder Articulation Disorder VS Phonological Disorder Articulation Disorder Phonological Disorder (Bauman-Waengler, 2014; Bernthal et al.,, 2017; (Bauman-Waengler, 2014; Bernthal, Bankson, & Garn-Nunn, 2011; ASHA, n.d.) Flipsen, 2017, ASHA, n.d.) Definition Garn-Nunn (2011) stated that is the It refers to the impairment in the failure to acquire a speech sound of phonemic systems in which a particular language by the individuals with phonological expected normative age due to disorders would have difficulties using  some type of motor-based issue. speech sounds contrastively to differentiate meaning. It refers to the difficulty with producing certain speech sounds Bleile (1995) stated that phonological due to structural deviations or processes are patterns of sound limited mobility, strength, and errors that typically developing endurance of the OPM structures. children use to simplify speech as they are learning to talk. The features of its errors include Substitution, Omission, Distortion, For most children, phonological and Addition (SODA), which may processes are completely normal. affect the intelligibility of one’s However, if the phonological speech. processes persist beyond the age of dissolution, it could lead to a The individual’s articulators phonological disorder. significantly deviate from the norm. Characteristics Errors are consistent in all Individuals with phonological positions. disorders have difficulty organizing the speech sounds they can produce into Structural deviations and/or a system of phonemic contrasts. limitations in an individual’s mobility, strength, and/or endurance can be Errors may have variation in positions observed. It is important to examine since individuals with phonological the articulators, their integrity, and disorders would attempt to correct how they affect phoneme their production (trial and error). production and coarticulation. Phonetic repertoire may be restricted. It is important to note that individuals with phonological disorders do not have difficulties producing speech sounds in isolation. Phonological errors may occur at the word level to the conversation level. Structural deviations and/or limitations in an individual’s mobility, strength, and/or endurance are not observed. Types of Articulation Errors (ASHA, n.d.; Wangi & Nudiya, 2020) Substitution ○ A replacement of one or more speech sounds. It could cause the phonemic contrast to become absent (e.g., "thing" for "sing" and "wabbit" for "rabbit") Omission  ○ Omission or deletion of certain speech sounds (e.g. “nake for “Snake” and “pay” for “Play”) Distortion ○ Occur when a speech sound is altered or changed (e.g. “sun” sounds like “slushy”) Addition ○ Occur when a word has one or more additional sounds added to it (e.g., "buhlack" for "black"). Diagnostic Markers/ Differential Diagnosis (ASHA, n.d.) SSD Definition Characteristics Articulation Disorder Motor-based speech Speech sound errors such sound disorder as substitution, omission, It is the atypical production distortions, or additions of speech sounds (Dodd, 2014). characterized by Reduced intelligibility of substitutions, omissions, speech due to errors distortions or additions (Dodd, 2014). (SODA) that may interfere Shows motor problems; with intelligibility (American trouble with timing and Speech-Language-Hearing coordination of the  Association,n.d.). articulatory muscles The inability to pronounce involved in speech or produce specific production (Dodd, 2014). phonemes, The child Usually has trouble with always produces the same individual/isolated sounds substitution or distortion of and consonant clusters. the target sound in words or in isolation regardless if the the sound is spontaneously produced or imitated (Dodd, 2014). In summary, the client knows the language but is unable to produce the correct sounds due to their difficulty with the motor production aspects of speech. Phonological Disorder Speech sound errors that Trouble with sound classes are rule-based/ (e.g. fricatives or bilabials) linguistically based or linguistic constraints (ASHA, n.d.). (final consonant in Phonological Disorders syllables) show deficits in the Speech is most likely to be cognitive-linguistic unintelligible. processes involved during Prevalent in younger the production of speech. children These deficits result in a Phoneme inventory may be disordered linguistic restricted. system, wherein the aim of Persisting phonological therapy is to re-organize a processes (beyond the age child’s linguistic system of dissolution). (Dodd, 2014) In summary, the client has (Dodd, 2014) problems with speech since they lack a certain knowledge about the language. Consistent Atypical All the error patterns Consistent use of one or Phonological Disorder derived to describe a child’s more unusual speech occur during normal non-developmental error development but are typical patterns; produce the error of younger children (Dodd, pattern in five different 2014) words (e.g. backing, initial  consonant deletion) (Dodd, 2005) Inconsistent Children’s phonological An individual’s phonological Phonological Disorder systems show at least 40% system shows at least 40% variability (when asked to variability (when asked to name the same 25 pictures name the same 25 pictures on three separate on 3 separate occasions occasions within one within one session). session). Multiple error forms for the (Dodd, 2005) same lexical item must be observed since correct/incorrect realizations may reflect a maturing system (Dodd, 2014). Childhood Apraxia of According to ASHA (n.d.), Articulatory groping Speech (CAS) CAS is a neurological Consonant distortions speech sound condition Vowel errors characterized by Slow speech rate inappropriate intonation and Inconsistent errors on accuracy of the movements consonants and vowels in that support speech, even repeated productions of in the absence of muscular syllables or words anomalies. Prosodic errors Voicing errors (ASHA, 2007; Iuzzini-Seigel, 2017; Strand, 2017) Phonological Disorder versus Articulation Disorder Holm, Stow, & Dodd (1997) argues the essentiality of diagnosing both articulation and phonological disorders as these two are caused by different deficits in the speech-processing chain. Moreover, clinical efficacy shows that two disorders respond best to different therapeutic approaches While articulation errors are caused from an impaired ability to program the correct motor movements for the correct “phonetic” version of a sound (e.g. lisps), phonology concerns language-specific knowledge of phonemes and how they may be combined to make up words (Holm et al., 1997). Conditions that involve/related to Speech Sound Disorders Below are the conditions that could put an individual at risk and/or could cause Speech Sound Disorders. Conditions Classification Description Autism Developmental disorder According to recent studies, children diagnosed with ASD are far more likely to experience concurrent phonological and articulation speech impairments (Broome, et al., 2017). Down Syndrome Genetic disorder Even though a large number of the DS children generated a wide range of words, their percentages of distinct words were smaller than the TD children. This may be due to smaller vocabulary sizes brought on by cognitive-linguistic deficiencies, poorer intelligibility, or increased homonymy brought on by difficulties with motor speech or both. (Rupela, et al., 2016). Hearing loss Congenital/Acquired Children who have HL are significantly more likely to have SSD, which can have an impact on their language development (St. John, et al., 2020). The most prevalent subtype of speech presentation that was discovered was phonological delay, which responds particularly well to therapy (St. John, et al., 2020). Childhood Apraxia of Speech Developmental Children with CAS + (CAS) linguistic impairment are more likely to experience motor impairments, which could have a detrimental effect on their social, academic, and professional results (Luzzine-Seigel, 2017). Cerebral Palsy Developmental Dysarthria in children with CP affects several underlying processes of speech production (i.e., respiration, phonation, and prosody). Examples of this include having nasalized speech due to a reduced control of the soft palate and having a reduced range of consonants and vowels due to an impacted control of the tongue and lip muscles (Pennington, 2012). A study examined the speech outcome of children with CP. It discovered the percentage of occurrence of common speech disorders in children with CP such as dysarthria (78%), articulation delay or disorder (54%), phonological delay or disorder (43%), and some features of CAS (17%). Children diagnosed with CP were also found to have delayed (26%) or disordered (38%) acquisition of consonants. Their  phonological disorder was also mentioned to often be disordered (27%) than delayed (17%) with fricatives and affricates often being distorted or absent. (Mei et. al., 2020) Brain Injury Acquired Children with brain injury were reported to have dysarthria or weakness in the muscles of speech and AOS/CAS or difficulty in controlling speech samples. (ASHA n.d.) Aphasia, dysarthria, and apraxia were noted to be the chief alterations in communication impacted by TBI-related disorders or neurological damage (Hora, et.al., 2014). Assessment: Data Collection and Analysis The goals of speech sound assessment include one or more of the following (Bernthal, Bankson, & Flipsen, 2017): 1. Determine whether the client’s speech sound system sufficiently varies from the normal development to warrant intervention 2. Identify factors that can be related to the presence or maintenance of phonological disability/delay 3. Determine direction of intervention (selecting target behaviors and strategies) 4. Make prognosticating statements relative to change with/without therapy 5. Monitor changes in the client’s performance across time to determine if therapy is effective and/or to decide if patient is for discharge Additionally, the goal of speech sound assessment also includes determining if the individual needs instructions to correct production of speech sounds. Assessment of other areas such as voice quality, resonance, fluency, syntax, semantics, pragmatics, discourse, prosodic aspects of language, hearing, and oral mechanism is also done when assessing an individual’s speech sound system. Speech sound assessment encompasses different processes such as obtaining a speech sample, analyzing the data gathered, interpreting, and making clinical recommendations (Bernthal, Bankson, & Flipsen, 2017). Screening for speech sound disorders (Bernthal, Bankson, & Flipsen, 2017) Considering that a comprehensive speech sound assessment cannot be done quickly, clinicians often do screening to determine if a more comprehensive/complete assessment is needed. Screening does not aim to determine the need or direction of therapy; instead, it aims to identify individuals who need further evaluation. Tools used for screening can be administered in 5 minutes or less as they consist of limited speech samples of phoneme production. Screening might be administered to: 1. Children at head-start program, preschool, or kindergarten - to determine if they possess age-appropriate skills for speech sound production 2. Older children who should have resolved most developmental speech errors 3. Individuals preparing for occupations (e.g., broadcast journalism or classroom teaching) that require specific standards of speech performance 4. Individuals referred for other speech and language impairments to identify their speech sound status Informal screening measures Formal screening measures (Bernthal, Bankson, & Flipsen, 2017) (Bernthal, Bankson, & Flipsen, 2017) Clinicians create their own informal Contain published elicitation procedures screening measures to fit the population Include normative data and/or cut off they want to screen scores Can be easily developed Formal screening measures are one of the Do not include standardized administration following: procedures or normative data 1. Related to or part of a more The clinician determines the criteria for comprehensive speech sound assessment failure. If the examiner is unsure if the 2. Screen for phonemes and other aspects of client’s speech sound system is speech and language appropriate for his/her age and/or linguistic community or not, comprehensive assessment should be referred and done. For kindergarten children: Formal screening measures that are part of a more The clinician can ask a group of children to complete and comprehensive assessment of respond to different questions/prompts speech sound systems: (e.g., What is your name? Where do you 1. Diagnostic screen (Dodd, Hua, Crosbie, live? Can you count to 10? What do you Holm, and Ozanne, 2006) watch on TV? Tell me about your favorite Includes 22 pictures games.) Client is instructed to imitate the clinician’s These questions/prompts aim to engage productions the child in conversation to obtain a typical 5 minutes to administer speech sound production from the client. Provides indication if further assessment is needed For adults: Useful for children who are shy, immature  The clinician may instruct the client to read and have short attention span sentences that contain several opportunities to produce speech sounds The following tests are part of an overall speech that are frequently misarticulated. and language screening: The clinician may instruct the client to read 1. Fluharty Preschool Speech and Language a passage that is representative of English Screening Test - 2nd edition (Fluharty, speech samples such as the Grandfather 2001) Passage and Rainbow Passage. For children aged 3-6 years old The clinician may also engage in 15 pictures of objects used to elicit 30 conversation about the client’s topic of target speech sounds interest. Includes standard scores and percentiles 2. Speech-Ease Screening Inventory (K-1) (Pigott and colleagues, 1985) For kindergarteners and first graders 7-10 minutes to administer Consists 12 items Sentence completion items screen 14 phonemes and 3 blends Includes cutoff scores that suggest if further testing/assessment is needed 3. Preschool Language Scale (Zimerman, Steiner, and Pond, 2012) For children from birth to 6 years old 20-45 minutes to administer Includes age-expected performance levels 4. Test of Language Development–Primary (Newcomer and Hammill, 2008) Includes word articulation subtest - assesses production of 25 words Includes percentile ranks and scaled scores which can be derived on the subtest for children aged 4-6 years old Scores of 1 standard deviation or more below the mean are commonly used as cutoff for further assessment. Comprehensive speech sound assessment Speech sampling protocols involved in this section are more detailed as opposed to protocols described for screening. These are facilitated as no one sampling procedure or articulation test will provide the clinician with all the data needed to diagnose a speech sound disorder and/or determine the direction of intervention for the individual. An adequate speech sample must comprise speech sound productions in varying lengths and complexities (e.g., syllables, words, phrases), phonetic contexts, and responses to various elicitation procedures (e.g., picture naming, imitation, conversation) (Bernthal, et.al., 2017). Speech Sampling ○ Connected/conversational/spontaneous speech sampling (Bernthal, et.al., 2017) It is crucial that all speech samples consist of a connected speech sample from the individual. This is due to the fact that the speech sound disorder treatment’s main objective is to re/habilitate correct productions of error sounds in spontaneous and connected speech. Therefore, the clinician must observe the client’s productions in more natural speaking contexts. Although connected speech samples are an essential part of a speech sound assessment battery, most clinicians should not rely on this type of example exclusively. However, there are shortcomings this type of speech sample poses. These are as follows: The individual’s sample may be unintelligible, in return, may be difficult to transcribe into IPA during analysis. The individual may be reluctant in engaging in discourse/ conversation, most especially with a person they do not know. This is most especially a problem with pediatric clients. It may be difficult for the clinician to elicit a speech sample with English phonemes. The error sounds lacking in this type of sample can reflect “selective avoidance” by the individual, as they may choose not to produce them. Elicitation Procedures: The preferred method to attain this type of sample is to engage in a spontaneous conversation with the client. The clinician may open up topics such as the client’s family, television shows, favorite activities, and/ or places the client has visited. These samples must be recorded for the clinician to have access to to accurately transcribe this. Some clinicians task the individual to recite a reading passage as an alternative method of attaining a connected speech sample. This procedure is not a viable option when working with young children. The clinician may also facilitate the Sounds-in-Sentences subtest in the Goldman-Fristoe Test of Articulation - Second Edition. Additionally, delayed imitation/repetition tasks are designed to elicit particular sounds in specific words. The clinician may also task the client to retell a story about a series of pictures which specifically elicit the target words and/or sounds. ○ Single-word/citation form sampling (Bernthal, et.al., 2017) Analyzing phoneme productions in single-word productions (during picture naming tasks) is also referred to as a speech sound inventory. This type of sample enables the clinician to better and quickly transcribe and analyze single-word samples as opposed to connected speech samples as this helps the clinician to better observe the production of only one or two segments (sounds) per word. In this type of sample, one or two consonants are scored in each word and typically assess sounds in the initial, middle, and final position. Elicitation Procedures: Typically, this type of sample is elicited by tasking the client to label single words in response to different picture stimuli which include the target sounds. For the pediatric population, this may be done by tasking the child to label toys or real objects. For especially young children, the clinician may transcribe single-word productions produced spontaneously. Furthermore, it is crucial for the clinician to not avoid addressing a child’s vowel productions as these are supposedly mastered at a very early age. To attain a comprehensive single-word speech sample, the clinician must consider increasing the picture stimuli with those that elicit additional vowels and diphthongs. Pollock (1991) has suggested the following approach to address this: Clients should be provided multiple opportunities to produce each vowel. Vowels should be assessed in a variety of different contexts, including (a) monosyllabic and multisyllabic words, (b) stressed and unstressed syllables, and (c) a variety of adjacent preceding and especially following consonants. Limits for the range of responses considered correct or acceptable should be established because cultural or dialect influences can affect what is considered “correct.” Recommended vowels and diphthongs to be assessed include the following: (Bernthal, et.al., 2017) However, there are shortcomings this type of speech sample poses. These are as follows: These measures do not allow children to use words from their own expressive vocabulary.  The use of multisyllabic test words can make more demands on a child’s productions and elicit more errors. Syllable shape and stress patterns of stimulus words may affect speech sound productions. Most citation tests will primarily consist of nouns; these tests do not reflect the various parts of speech in connected conversational speech. This speech sample often only elicits a single production of a given sound in each of either two or three word positions. Examples of Articulation and Phonological Tests (Bauman-Waengler, 2016) Name Age Word Scores Provided Comments Range Positions Tested Articulation Tests Arizona 3: Arizona 1;6 to Initial- and Standardized, gives standard Gives Articulation Proficiency 18;11 final-word score, Z-score, weighted Scale (3rd ed.). years positions. percentile, speech intelligibility scores for Fudala, J. (2000). Los values, and level of each Angeles: Western articulatory impairment. consonant. Psychological Tests vowels. services. A 4th edition that offers phonological process analysis is being developed. Goldman-Fristoe 2 2 to 16+ Initial-, Standardized, gives standard Can be used Test of Articulation years medial-, and score, and percentile rank; a with the (2nd ed.). Goldman, final word confidence interval can be Khan-Lewis R., & Fristoe, M. positions. calculated. test (Khan, L., (2000). Circle Pines, & Lewis N. MN: American. Circle Guidance Service Pines, MN: American Guidance Service) to assess phonological processes. Photo Articulation Test: 3 to 12 Initial-, Standardized, gives standard Uses actual PAT-3 (3rd ed.). years medial-, and scores, age equivalents, and photographs Lippke, S., Dickey, S., finalword percentiles. to test sounds Selmar, J., & Soder, A. positions. Tests vowels (1997). Danville, IL: and Interstate Printers and diphthongs. Publishers Structured 3 to 9 Initial-, Standardized scores including Uses Photographic years medial-, and standard scores, percentile photographs Articulation Test- II final word score ranks, percentile band of Dudsberry, (2nd ed.). Dawson, J. positions. scores, test-age equivalent a cute golden I., & Tattersall, P. J. scores. retriever (2001). DeKalb, IL: puppy, Janelle Publications. interacting with various objects. It does not test vowels although the manual provides a probe for imitation of each vowel in one word. The aim is to test articulation although seven common phonological processes are provided. Phonological Tests Assessment Link 3 to 8;11 Initial- and Standardized, gives standard The manual between Phonology years final-word scores, percentile ranks. provides and Articulation— positions. several Revised. Lowe, R. analyses and (1996). Mifflinville, PA: gives analysis Speech and Language forms that can Resources be used to document  phonological processes, vowel errors, and consonant clusters. Bankson Bernthal Test 3 to 6 Initial- and Standardized, gives standard Provides of Phonology. years final-word score, percentile rank, and various ways Bankson, N., & positions. standard error of to analyze Bernthal, J. (1990). measurement. results, Austin, TX: Pro- Ed. phonological processes included. Clinical Assessment of 2;6 to Pre- and Standard scores, percentile Consonant Articulation and 11;11 postvocalic rank scores, age equivalent clusters tested Phonology: CAAP (2nd years consonants. scores. are only words ed.). Secord, W. A., & containing [s], Donohue, J. S. (2002). [r], and [l] Greenville, SC: Super clusters. Duper Publications. Vowels are not tested. Sentences are provided which can be used with children who can read. Diagnostic Evaluation 3 to 8;11 Initial- and Standardized, provides Subtests of Articulation and years final-word standard scores and include Phonology (DEAP). positions. percentile ranks for several Sounds in Dodd, B., Hua, Z., measures. Words, Crosbie, S., Holm, A., Phonological & Ozanne, A. (2006). Process Use, San Antonio, TX: Single Words Pearson. vs. Connected Speech Agreement Criterion. Contains a diagnostic screen and articulation, phonology,  and oral motor screening. HAPP-3 Hodson Preschool Initial-, Standardized, gives percentile This assesses Assessment of medial-, and rank and severity rating. phonological Phonological Patterns final word processes (3rd ed.). Hodson, B. positions. Can be used (2004). Austin, TX: as a direct link Pro- Ed. to the cycles approach. Khan-Lewis 2 to 21;11 Initial-, Ten developmental