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Normal Development of Language
- speech sound development continues until about 9 yrs old
- allophonic and prosodic development continues until 12 yrs old
- by 7 to 8 yrs old most children have acquired normal articulation and basic phonological patterns as compared to adult standards
Deficient speech sound system
when misarticulations are regularly present after the expected age of acquisition or when phonological development is behind the expected norms
The most critical factor in determining whether articulation or phonology is deficient is the child’s speech sound production as compared to normative data relating to the age at which specific phonemes are acquired and at which phonological deviations are suppressed.
- 1.5 Standard Deviations below. 9th percentile.
- The more information that you have, the stronger the diagnosis.
additional factors in determining deficient speech
- Number of errors
- Consistency of errors
- Types of errors
- Types of phonological deviations (processes)
- Conspicuousness of errors
- Ease of imitating misarticulated sounds (stimulability)
- Speech intelligibility
- Views held by the individual and others regarding the speech problem.
Types of artic/phono disorders
- Delay- follows a normal sequence of development, but a slower rate.
- Disorder- the person is using atypical developmental pattern.
- Phonetic disorders- difficulty in producing the sounds and sound sequences of the langauge- executing motoric movements.
- Phonemic disorders- difficulty in understanding and implementing the underlying linguistic rules for producing sounds and sound sequences.
Potential Etiological Factors of Artic/Phono Disorders
- 1. Organic – known pathologies
- environmental factors, cleft palate
- 2. Nonorganic (or functional) – Cause is NOT known
- 3. Mixed
- Sometimes we simply do not know the cause.
- lips- typically they are not the most critical factor, because we are able to compensate well for this.
- teeth- missing teeth can be an issue
- tongue- tongue thrust can cause a SSD
- soft and hard palate-
- tonsils and adenoids- like talking around swollen tonsils
- General Motor Incordination – low tone children – Autism, Fetal Alcohol Syndrome,
- Cleft Lip and Palate
- Facial Clefts
- Clefting: a division of a physical structure by a cleavage
- Congenital - Failure of bones/tissue to merge/fuse
- Acquired - Trauma/accident
Sound System Impact
- 1. Nasalance issues—hypernasal
- 2. Nasal emission of air
- 3. Compensatory articulation strategies
- 4. Backing is a frequent strategy
- 5. Pressure Sounds; either episodic plosives) or maintained (fricatives) are difficult
- SLP treatment in conjunction with surgeries
- 1. Phonetic Placement to promote more forward place of articulation
- 2. Improve velopharyngeal valve function & decrease
- 3. Modify compensatory articulations
- 4. Treat phonological system as needed
Orofacial Myofunctional Disorders
- 1.Tongue thrust – we can treat this
- 2.Lip incompetence
- Tongue thrust does NOT ALWAYS cause sound system disorders.
- motor speech disorder manifested as disorders of phonation, artic, resonation, and prosody. Results from weakness, paralysis, dyscoordination, sensory deprivation, and altered tone of speech musculature.
- -can be the result of a stroke, brain injury, brain injury at birth. Can affect one, multiple, or all of: respiration, resonation, articulation or phonation
- impairment in planning, programming, and executing sequences of intentional movement for speech production. (music can be used to reteach people how to speak – Melodic Intonation Therapy (MIT))
- -this is not where the muscle has been affected, it is in the frontal lobe where our motor processing is located.
- A lot of the time we have mixed apraxia and dyspraxia.
INTENSIVE INTERVENTION. ******** MUSIC IS VERY VERY IMPORTANT FOR YOUR BRAIN **** Music has profound affects on the development of the brain.
Apraxia/Dyspraxia of Speech
- A lack of motor control of the oral mechanism for speech not attributable to other problems of muscle weakness
- -Difficulty in sequencing the MOVEMENT sequences between the sounds
- -Difficulty in sequencing the correct speech sounds
- -Acquired---Neurological trauma, disease, CVA, etc
- -Developmental—no neurological basis
Apraxia of Speech
- 1.More errors in sound classes having more complex oral gestures
- Clusters, fricatives, affricates
- 2.Unusual errors not typically found in children with other speech sound disorders
- Sound additions, prolongations (V & C), repeated sounds in syllables, and unusual substitutions (glottal plosives—bilabial fricatives)
- 3.A large percentage of omission errors-
- Sound and syllable
- 4. Difficulty producing/maintaining appropriate voicing
- 5. Vowel/Diphthong errors
- Tense/lax contrasts; diphthong reduction
- 6. Difficulty sequencing speech sounds and syllables
- Central to this disorder
- 7.Nasalance Problems
- 8.Groping behavior & silent posturing
- -groping is essentially searching for a sound because their brain is sending the wrong signals for the needed words
- 9.Prosodic impairment
- 10. Difficulty with rhyming & syllabification.
- 1. Intensive/DAILY
- 2. Use hierarchies of treatment from easiest to most difficult
- 3. Not sounds or rules
- Movement sequences
- Prosody of speech
- 4. Massed practice/ drill-oriented sessions (because you are working on muscle memory)
- 5. May need auditory discrimination training
- 6. Multiple modalities (using all of the senses to teach them the movement and retrain to motor movement part of the brain)
uses drill like therapy
- Greater the HI the more complex sound system errors.
- Sounds, stress, pitching, voicing, nasality.
- Deletions & substitutions frequent
- FCD more frequent than ICD
- Stops for fricatives and liquids
- Confusion of voiced/voiceless cognates and oral and nasal consonants
- Consonants produced with tongue blade are more likely to be in error.
- Vowels are neutralized and sound like central vowels
- Chronic Otitis Media can have a significant impact on reading ability and language.
Many children with artic/phono disorders have a history of middle ear involvement.
You must consider:
- 1.Age of onset of Otitus Media
- 2.Magnitude and duration of loss
- 3.Frequency of Otitus Media
- 4.Environmental factors
4 factors to predict the need for artic/phono intervention for young children (18 to 36 months)
- 1.Presence of velar deviations
- 2.Presence of cluster reduction
- 3.Lack of improvement in articulation 4 months after tube insertion
- 4.Time period of 6 months or more between initial diagnosis and significant remission of this condition.
- 1. Improvement of residual hearing by speech signal amplification & the methodical habituation of its application
- 2. Teach Phonetic & Phonological skills
- 3. Suprasegmentals: pitch, duration, intensity
- 4. Multisensory approach (this is needed in HI treatment)
Auditory Perception affecting artic/phono
- Auditory discrimination
- Self monitoring
- No conclusive evidence that oral/sensory function affect artic/phono.
- We should not assume that a person with a speech sound disorder must have a motor disorder, but many SLPs do so they treat the SSD with motor activities and IT DOES NOT WORK IN THESE CASES.
- More research is needed.
Research has shown that people who are blind have a higher incidence of artic/phono errors.
Cognitive factors that may affect artic/phono
- People with below the normal range IQ demonstrate a HIGHER prevalence of artic/phono errors than do people within normal range.
- People with cognitive delays usually demonstrate deficits in all areas of speech and language development.
60% of preschoolers with speech delays have unknown etiologies that are possibly genetic based.
Environmental and Psychosocial Factors
- One cause of artic/phono disorder may be inadequate speech models.
- Another factor is limited speech stimulation and motivation.
- Inadequate or inappropriate reinforcement.
- Emotional reaction to a traumatic experience may cause artic/phono disorder.
Personal Factors that may cause artic/phono disorder
- -Research has repeatedly shown girls acquire sounds earlier up to 6 years of age.
- -Males have higher prevalence of artic/phono delays/disorders.
- Sibling Status
- -Some research has shown that children without siblings, 1st borns, and children with greater spacing between siblings have better artic/phono skills.
- Socioeconomic Status
- -Some research has shown there is a higher incidence of artic errors among lower socioeconomic levels.
Linguistic and Academic Factors
There is a strong relationship between phonology, reading, spelling and educational performance.
There is an association between phonological disorders and phonological awareness skills. (Hodson, 1994) Poor phonological awareness has been linked and spelling and reading problems.