Speech Sound Assessment - PDF

1) Goals of the assessment 1. To determine if the sound system is sufficiently different from the normal development to need intervention 2. Identify factors related to the presence of phonological delay/disability. 3. Determine treatment direction. 4. Make prognostic statements. 5. Monitor change i...

1) Goals of the assessment 1. To determine if the sound system is sufficiently different from the normal development to need intervention 2. Identify factors related to the presence of phonological delay/disability. 3. Determine treatment direction. 4. Make prognostic statements. 5. Monitor change in performance. 2) Screening for speech sound disorders Informal Tailored to the population. For children: Can be in interview style question format, telling stories or describing experiences. Age appropriate topics. For adults: Reading sentences to elicit misarticulated sounds. Read a passage with a representation of the speech sounds in the language. In English: the Grandfather passage, the Rainbow Passage. Engage them in informal conversation Formal: Stand alone formal screener, such as: Diagnositic Screen of the Diagnostic Evaluation of Articulation and Phonology (DEAP) (3;0- 8,11 years) https://www.youtube.com/watch?v=bXCDmH2EU3g Part of some tests’ batteries. Cont. 2) Screening for speech sound disorders Examples of formal screening tools: Fluharty Preschool Speech and Language Test – 2nd edition (2001) Preschool Language Scale – screener (2012) Preschool Language Scale – 5 (2012) Test of Language Development – Primary (2008): supplementary subtest. More examples on p. 153. Electronic examples: Smarty Ear: http://www.smartyearsapps.com/articulation-assessmenttoolkit/ 3) Comprehensive Speech sound assessment a. Speech Sound Samples included in the assessment battery Connected / conversational speech sampling. b. Single-word/citation Form Sampling c. Stimulability Testing d. Contextual Testing e. Error Pattern Identification f. Criteria for selecting Phonological Assessment instruments g. Transcription and scoring procedures h. Accuracy of Transcriptions a. Connected / conversational speech sampling Observe speech sound production in spontaneous connected speech, since the objective of the treatment is correct production in spontaneous speech. Advantages: Information about more than just the phoneme production. Information on: Variety of phonemes, error patterns, intelligibility speech rate, intonation, stress, syllable structure, prosodic patterns. Disadvantages: People who are severe will be very unintelligible and difficult to collect. Children reluctant to participate. Spontaneous sample might not get you all sounds. “selective avoidance” not producing sounds when the person knows they make mistakes in. a. Connected / conversational speech sampling Elicitation Procedures: Conversation **Best method** Reading a passage “Delayed imitation/repetition task”: Listen to a story and retell Tell a story from pictures. b. Single-word/citation Form Sampling “Speech sound inventory”: provides discrete , identifiable units of production. Usually by naming pictures. Can include sounds in: initial, medial, final position of a word. Also includes consonant position relative to syllable: Prevocalic (/k/ in cat) Post vocalic (/t/ in cat) Intervocalic (/m/ in camel) Releaser (initiate a syllable) Arrestor (terminate a syllable) Onset (elements of a syllable before a vowel) coda(elements of a syllable after a vowel) Elicitation Procedures: naming pictures or items. Table 6.1, p.157 Standardized tests have put more emphasis on consonants than vowels. Table 6.1, p.157 c. Stimulability Testing Testing how well the child can imitate sounds in isolation, syllable, words, phrases. When provided with “stimulation”. Guides us in prognosis, if a child is more likely to self-correct or generalize more quickly. Guides us in determining stimulus items for starting interventions. Examples of stimulability testing tools: Stimulability subtest in Goldman-Fristoe Test of Articulation. Glaspey’s Dynamic Assessment of Phonology (Glaspey and McLeod, 2010) Elicitation Procedures: Ask the child to look, listen and say without pointing out placements of articulators. If the child is not successful, the clinician will engage the child in cueing, and provides instructions on how to make the sound – Appendix A, p. 325. d. Contextual Testing To identify contexts where the client’s sound productions are more or less accurate which will guide in treatment decision. The different contexts will show the influence of other sounds on the target sounds in words and connected speech. As an example: looking at sounds production in single tone (such as /s/ in sun) and in clusters (such as /s/ in stop) and in coarticulation and connected speech. Can be done informally by reviewing the connected speech sample. Can be done formally by using published tests such as: The Deep Test of Articulation (McDonald, 1964) The Contextual Test of Articulation (Aase et al., 2000) e. Error Pattern Identification This testing helps the clinician find the error patterns in sounds production, especially in children with multiple errors. Phonological pattern or Phonological Process is defined as: ”A systematic sound change or simplification that affects a class of sounds, a particular sequence of sounds, or syllable structure of words” Error pattern/Phonological processes identification can help in: Understanding the child’s overall phonological system Facilitating treatment efficacy and treatment target selection. Elicitation Procedures: Informally by recording a speech sample and conduction a pattern analysis. Using published instruments such as the Khan-Lewis Phonological Analysis (2002) https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Speech-%26Language/Khan-Lewis-Phonological-Analysis-%7C-Second-Edition/p/100000633.html Using a computer-based programs for analyzing errors. f. Considerations when selecting a Phonological Pattern Analysis instrument The material used is attractive, appropriate and organized scoring sheet. The sounds being obtained by the instrument are what is intended to test (consonants, clusters, vowels, diphthongs in syllables, words, sentences, Syllables positions, phonetic contexts). If the instrument going to give information regarding analysis of place, manner and voice. If the instrument going to give information regarding age appropriateness. If the instrument going to give information related to stimulability. g. Transcription and scoring Procedures o Recording method will determine the type of analysis and will affect recommendations. o Correct or incorrect- not recommended to use in evaluations, good for day-to-day tracking. o International Phonetic Alphabet (IPA)- also called “broad” transcription o Diacritics- provide details describing the speech sound productions, also called “close or narrow transcription”. o Diacritics are helpful in noting errors in the speech of individual with cleft palate, hearing impairment, and severe articulation errors. o They denote nasal emission, lateralization, vowel duration, dentalization and other details (Table 6.2, p. 165) h. Accuracy of Transcription Methods of judgment: Auditory perceptual judgment – The primary basis for judgment in assessment and intervention. Physiological measures – aerodynamic measures Acoustical measures – spectrographic analysis in the form of computer software. Interjudge reliability: Agreement between 2 independent clinicians. Calculate the percentage of agreement. Intrajudge reliability: Agreement by the same person, once during the data collection and once at a separate time. 4) Assessment in very young children Knowing that child’s development is part of the broader context of development; cognition, language, motor. Formal assessment is not ideal in the early ages such as infants. We look at the stages of infant vocalizations at the prelinguistic level, to the gradual shift to the linguistic behavior that occurs during the 1st year. Ages 18 – 24 months: Will look at vocabulary size (50 words) and also compare them to children their age. If the child is having low vocal repertoire, the clinician will describe the child’s use/function of sounds rather than compare them to children their age. Eliciting sounds in this population will depend on level of development. Can be done through caregiving and feeding activities, informal play, sibling interactions, structured play with clinician. Cont. 4) Assessment in very young children In this age group, we tend to do an (Independent analysis of phonological behavior) rather than a (relational analysis). Designed to describe the child’s production without reference to the adult usage. Collected through a speech sample. Elements collected: An inventory of sounds (consonants and vowels) by word position and articulatory features (manner, place and voice). An inventory of syllables and word shapes (CV, CVC, CCV, etc. ) Sequential constrains (ex. Cluster reductions) 5) Related Assessment procedures Case History Oral Cavity Examination Auditory Screening Speech sound perception/Discrimination Testing Judgment Tasks Contrast Testing Speech sound perception/Discrimination Testing It was assumed in the 1920’s- 1950’s that ALL children with speech sound errors are unable to perceive the difference between the adult production and their own error. Testing was done on all sounds and did not consider the child’s errors only. This method is not used with all children anymore and instead is only used with children who are suspected of having a generalized perceptual problem (i.e. variety of minimal pairs). NOW: Only test the child’s errors- This approach will make the testing different from one child to the other. Speech sound perception/Discrimination Testing Two approaches used to assess speech sound perception using minimal pair words: 1. Judgment Tasks: Speech errors of the client are identified and used with the adult standard (correct) forms to make the perception task. Present 3 forms to the child (error: rake → wake) Stimulus phoneme (SP) – rake (correct)- Target Response Phoneme (RP) – wake - Error Control Phoneme (CP) – fake - Control Clinician provides a picture with either 3 forms, and the child chooses which one was said. Using one form for 2 errors patterns. Speech sound perception/Discrimination Testing 2. Contrast Testing The client is shown 2 pictures and must select the one that correspond to the spoken word by the clinician. The picture contains the sound in error and another sound. Example: sea & tea some & thumb Sea & she 1. Case Selection Elements to discuss: Eligibility, Intelligibility, Severity, Pattern Analysis, Stimulability and others. Eligibility Will differ depending on the service settings. Must be consistent with the agreed upon eligibility criteria. In the school system: Scores on the standardized testing (1.5 standard deviation below the man, or the 10th percentile). Interference with academic performance The presence of social stigma. 1. Case Selection Intelligibility Speech intelligibility is a perceptual judgment made by a listener and is based on the percentage of words in a speech sample that are understood- Can also be calculated. Can described using a range from: Unintelligible – usually unintelligible- partially intelligible – Intelligible with noticeable errors- Intelligible. Can be influenced by: The number and types of errors, consistency of the errors, frequency of occurrence of the sounds being affected in the language, phonological pattern used, listener's familiarity, speaking rate, inflection, stress, pauses and voice quality. 1. Case Selection Yet, intelligibility ALONE is NOT used to determine eligibility for services because of its low correlation with percentage of consonants correct (Shriberg & Kwiatkowiski, 1982). Age of the child should be considered when intelligibility percentages are discussed. Common general accepted intelligibility percentages (Gordon-Baranna, 1994 & Bowen, 2002) - 2yrs. ~ 50% - 4 yrs. ~ 85% (100%, in Bowen) - 3 yrs. ~ 75% - 5 yrs. ~ 95% Refer back to the studies mentioned in your book in chapter 3 (Table 3.2, p. 74). 1. Case Selection Severity It is the significance of an SSD or the degree of impairment. Associated with a label: Mild, Moderate, Severe. Can guide in determining length and/or frequency of services, placement (individual vs. group). Some states combine rating for multiple factors that yields a number which then is translated into a severity rating. No standard way of assigning severity rating among states. Shriberg & Kwiatkowiski (1982) research attempted to develop a more objective way to determine severity using Percentage of Correct Consonants (PCC). 1. Case Selection Calculation the percentage of consonants correct from speech sample. PCC = Number of correct consonants X 100 number of correct + incorrect consonants Details of the sampling and the scoring rules can be found on p. 180. Based on this research, PCC percentage were recommended to correlate with these severity ratings: 85% - 100% → Mild 65% - 85% → Mild/Moderate 50% - 65% → Moderate / Severe < 50% → Severe Johnson, Weston and Bain (2004) used a sentence imitation task rather than conversational speech sample and yielded similar results, in which was more efficient and clinically more practical. --> Extra resources: (PERCENTAGE CONSONANTS CORRECT (PCC) MITATIVE SENTENCE SCORING FORM) PCC-Imitative.PDF 1. Case Selection Pattern Analysis: Several tools are used to analyze the patterns of speech errors to determine if the pattern is appropriate for the age. Standardized tools or informal connected speech sample can be used to conduct the sound error pattern analysis. Examples of some standardized tools: Hodson Assessment of Phonological patterns (Hodson, 2004) Diagnostic Evaluation of Articulation and Phonology (Dodd et. al, 2006) Khan-Lewis Phonological Analysis (Khan and Lewis, 2002) 1. Case Selection Types of Analyses: 1. Place-manner-Voicing analysis. 2. Phonological pattern/ processes Analysis (refer to the book, p. 182 – 185) Be mindful that multiple patterns of phonological processes can exist in the same child. Being able to label, describe and identify the error patterns may not provide the explanation as to WHY the child is producing the sound this way. HOWEVER, this information can help in: A. determining the child’s eligibility by comparing to phonological processes developmental norms. B. determining a treatment direction if we see a pattern reoccurring. 1. Case Selection Stimulability It can be used as ONE of factor in eligibility considerations because the research is not sufficient enough on the predictability of progress in children who are stimulable and children who are not stimulable for their errors. Some research suggests that children who are stimulable for error sounds are more likely to spontaneously correct their errors and / or more likely to make faster progress in therapy on those sounds. 1. Case Selection Causal Correlates The presence of other factors that may increase the risk for speech sounds disorders. Such as family history, documented health conditions such as accidents or trauma, or any noticeable delays in gross or find motor abilities. Outside referrals Cases where the child had failed the hearing screening and needs a full audiological evaluation. Cases where the child has significant dental issues and is referred to the dentist. These children might be put on a “monitor” list to rule out any impact on speech after the other professional referral is completed. 2. The Nature of the problem What TYPE of problem does the child have? ”Diagnosis” Is there a known cause, or is it Unknown? If Unknown, how are we going to classify? Possible : etiology, symptomology, processing? o Looking at (The Process of generating speech) from chapter 5, can guide us in figuring out where the problem occurred (specific label & possible treatment approach). o What is (The Process of generating speech)? The Process of Generating Speech Ideation Cognitive/ Psychological Encoding (language formation) Phonological Disorder Shriberg, Lohmeier, Strand, and Jakielski (2012) Transcoding (planning/prog ramming) CAS Articulation Articulation Disorder 3. Target Selection The last step in the decision-making process of the assessment is to determine the goals or targets for intervention. Here are some general ideas and considerations: (detail discussion in chapter 8) Developmental Appropriateness Complexity approach Individual Speech sounds Phonological patterns Overall Intelligibility Stimulability Frequency of occurrence Contextual Analysis 3. Target Selection Developmental Complexity approach Developmental Approach: Complexity Approach: o Therapy will mimic the normal developmental o Treat the more complex or later developing sequence. o Sounds in error, sounds first. o Research reports more generalization to other o Should they have been mastered? sounds when more complex sounds were targeted o Start with sounds that should have been (Dinnsen et. all, 1990; Tyleyr & Figruski, 1994). acquired earlier. https://www.asha.org/siteassets/practiceportal/speech-sound-disorders-articulation-andphonology/table-3-4-age-of-acquisition.jpg LinguiSystems, Inc. (2012) Crowe, K., McLoed, S., (2020) Children's English Consonant Acquisition in the United States: A Review. American Journal of Speech-Language Pathology, 1-15. July 31st. Retrieved from: https://doi.org/10.1044/2020_AJSLP-19-00168 3. Target Selection Individual Speech Sounds Individual Speech Sounds: Choosing a sound or a group of sounds that the child has errors in. Keeping in mind the developmental age expectations. Phonological Patterns Phonological Patterns: Analyze the data to focus on phonological patterns that should have disappeared by the child’s age. Refer to table 3.9 in your book or https://www.asha.org/practice-portal/clinicaltopics/articulation-and-phonology/selectedphonological-processes/ LinguiSystems, Inc. (2012) 3. Target Selection Overall Intelligibility: Focus on a more general target. SLP will use a naturalistic approach. Stimulability: Selecting targets that are more stimulable that others. Frequency of occurrence: Error sounds that have higher frequency of occurrence in the language will have a higher negative effect on intelligibility. Contextual Analysis: Start with error sounds that occur in context with greater positive influence from surrounding sounds. 4. Other Factors to consider Dialect Consider the speaker’s variation of production of sounds, placement of stress, and /or use of phonological patterns, which are considered normal in the person’s speech. They are variations and difference and NOT delays or disorders. The same considerations must be applied with bilingual speakers. ASHA’s Resources: Phonemic Inventories and Cultural and Linguistic Information Across Languages: https://www.asha.org/practice/multicultural/phono/ Social-Vocational Expectations The attitude of the client and the family. Negative experiences and reactions of others. 5. Computer-Assisted Phonological Analysis Using Computer-Assisted Phonological Analysis with save time and provide detail analysis that is harder to achieve manually. By entering the transcribed data into the software. The use of The computerized Articulation and Phonology Evaluation Systems (CAPES) will provide: Data on consonants omission, substitution and distortion errors in each of the positions; initial, medial and final. Data on vowel production. Analysis on word length, syllable stress, word shape, place –manner-voice features. Analysis of phonological patterns. 6. Sample Report The book, p. 196. On BB, under Content → Resources → Sample Assessment Report #1 Components: Identifying information Case history Oral mech hearing screening Conversational speech sample Formal Speech sounds assessment results (errors listing, patterns artic or phono, raw score, standard scores, percentile rank, severity rating, intelligibility percentage) Voice and fluency screening Language screening Summary and recommendations. 7. JISH ARTICULATION TEST- JAT JISH ARTICULATION TEST Al-Sabi, Y. and Naquawa, A. (2013) Modeled after the Goldman-Fristoe Test of Articulation Presentation on JAT by last year’s students