chapter 5: phonological disorders justice communication sciences and disorders: an introduction...

Chapter 5:

Phonological Disorders

JusticeCommunication Sciences and Disorders: An Introduction

Copyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Focus Questions

This chapter is designed to answer the following questions:

• What is a phonological disorder?

• How are phonological disorders classified?

• What are the defining characteristics of phonological disorders?

• How are phonological disorders identified?

• How are phonological disorders treated?

5.1




Introduction• Phonological disorder: difficulties developing

and using the sounds of one’s native language• Characterized by multiple errors in articulation

of speech sounds, resulting in mild to severe unintelligibility

• Manifests during the developmental period for speech-sound acquisition (birth-9 yrs.)

• Often accompany physical and developmental disabilities, but in majority of cases, the cause is unknown

5.2




Case Study #1: Octavio• 5-year old student with limited proficiency in

English – only Spanish spoken in home

• Does not interact at all with peers and hard to understand in both English and Spanish

• Works with an ESL teacher, but attends a regular classroom

• SLP has been requested to come and observe and Child Study meeting has been called

5.3




Case Study #1 Questions

• What strategies can be used to identify whether Octavio’s suspected phonological difficulties are the result of a speech difference or a speech disorder?

• What are some strategies Ms. Hudson might use in the classroom to promote Octavio’s success when communicating with his classmates?

5.4




Case Study #2: Emily• 9-year old child who has received speech-

language therapy for years – still has some problems producing /l/ and /r/

• Emily wants to audition for a role in the school play but wants her speech problems to be resolved in time

• She cannot receive services at the school anymore because there is no clear “educational impact”

• Would see an SLP privately, but parents cannot afford it and no insurance coverage

5.5





• What does the term “educational impact” mean to you? What are some obvious and more subtle ways that a communication disorder can impact upon a child’s educational performance?

• Emily’s parents are considering appealing to the school to pursue her right to special education services. Do you think they will be successful in their appeal? What factors might affect the likelihood of success?

5.6




Case Study #3: Barcley• 22-year old single mother attends Adult Education

Literacy Center to develop basic reading skills• Always considered herself dyslexic, has problems in

basic skills, and saw a “speech teacher” when she was younger

• New teacher in the center, formerly a reading specialist, suspects Barcley has phonological awareness problems

• Teacher has program she used with 1st graders, and wants Barcley to go through 36 lessons of phonological awareness program

5.7





• What might the connection be between Barcley’s early problems with speech production and her current problems with reading?

• What kinds of activities might be included in Barcley’s phonological awareness training program? What is the goal of such a program?

• In your opinion, how likely is it that Barcley will become a reader at age 22? What factors will most affect the likelihood of her success?

5.8




I. What is a Phonological Disorder?

• Impairment of an individual’s phonological system; onset is prior to nine years of age; cause may be known or unknown

• Two aspects of phonological development:– developing representation for each phoneme

in one’s language– developing a solid boundary around each

phoneme to make it distinct from the other phonemes

• Most common symptom: unintelligibility

5.9




Prevalence and Incidence• 4-13% of children are affected• Affects boys (4.5%) at slightly higher rate

than girls (3%)• Affects African-American children (5.3%) at

slightly higher than European-American children (3.8%)

• 60%: unknown causes40%: known causes, such as recurrent middle ear infections, motor-speech disorders, and other developmental disorders

5.10




Terminology• Phonological vs. Articulation Disorders:

• Articulation emphasized problems resulting from motor problem impacting articulators; treatment focused on “speech correction”

• Phonological emphasizes problem resulting from delays in the maturation of the underlying phonological system; treatment focuses on building and re-organizing children’s phonological representations

5.11




Shifting Perspectives• Current Preferred Terms:

Disorder:

-phonological disorder, developmental phonological disorder, phonological impairment

Assessment:

-phonological assessment, phonological analysis

Treatment:

-phonological remediation/intervention

5.12




Describing Phonology and Articulation

Key Concepts:

• Phonemes as Contrasts

• International Phonetic Alphabet

• Articulatory Phonetics

• Children’s Acquisition of Consonants

• Sounds and Syllables

• Phonology and Literacy

5.13




Phonemes as Contrasts

• Standard American English: about 40 phonemes (varies with dialects)

• Phoneme: speech sound that signals a contrast in meaning between two words of a language (pat and bat; rig and ring)

• Children develop an underlying representation (phonological representation) of each phoneme

5.14




International Phonetic Alphabet

• Most commonly-used system to represent the phonemes in the world’s languages

• Describes and classifies each speech sound on the basis of how and where it is produced in the speech mechanism

• Represents each phoneme (both vowels and consonants) as a specific symbol

5.15




Articulatory Phonetics

• Classification of speech sounds based on what the articulators are doing when a phoneme is produced

• Vowels vs. Consonants: extent of constriction in the oral cavity

• Vowels: characterized by height, frontness, and roundness

• Consonants: characterized by place, manner, and voicing

5.16




Children’s Acquisition of Consonants

Twenty-four consonant phonemes are divided into groups based on when they are acquired:

• Early 8: 3 years• Middle 8: 4 years• Late 8: 6.5 years

Children with speech delay show progress much slower

5.17




Sounds and Syllables

• Phonological context: phonological environment in which a sound is produced; describes impact of sounds in syllables, words, and sentences

• Coarticulation: individual sounds are “smeared” across the entire word

• Assimilation: one sound takes on the features of neighboring sounds

5.18




Phonology and Literacy• To read, children must “unlock” the

alphabetic code – the grapheme-phoneme correspondence

• Phonics instruction (K-1): to benefit, children must have phonological awareness and knowledge of the alphabet

• Weak phonological representations manifest as a problem with either speech-sound production or phonological awareness, or sometimes both

5.19




II. How are Phonological Disorders Classified?

Differentiating phonological disorders from other speech sound disorders:

Four Major Symptoms:1) Difficulty with expressive phonology

2) Lack of phonological awareness

3) Poor verbal working memory

4) Problems with word learning and retrieval

Children with symptom #1 and not the others may have a motor-speech or an articulation disorder, not a phonological disorder

5.20




Speech Disorders Classification System

• Developmental phonological disorder – impairment of the phonological system that impacts speech intelligibility prior to age 9

• Non-developmental phonological disorder – disorder of speech production occurring after age 9, perhaps due to illness, trauma, or accident

• Not to be confused with…speech difference – naturally-occurring speech-sound distinctions that reflect native language or a regional or cultural dialect

5.21




Three Descriptive Subtypes

• Speech delay: (2-9 yrs.) low intelligibility and high frequency of errors

• Questionable residual errors: (6-9 yrs.) continue to show subtle errors in speech production, like substitutions and omissions

• Residual errors: (9 yrs. and up) continue making errors, have history of speech delay

5.22




Five Etiology Subtypes • Phonological Disorder: Unknown Origin – 60% of

cases – no known cause• Phonological Disorder: Otitis Media with Effusion –

chronic infections of the middle ear during infancy and childhood

• Phonological Disorder: Special Populations – children with hearing impairment, Down Syndrome, or cleft palate

• Motor-Speech Disorders: motoric difficulty with planning and executing speech sounds (Ch. 6)

• Psychosocial Involvement – speech delay from psychological or social causes

5.23




III. What are the Defining Characteristics of Phonological

Disorders?Defining characteristics, causes, and risk

factors for the following:• Phonological Disorder of Unknown Origin• Phonological Disorder: Otitis Media with

Effusion• Phonological Disorder: Special

Populations (Down Syndrome, Hearing Impairment, Cleft Palate)

5.24




Unknown Origin – Characteristics- Characteristics of speech delay:• Small phonemic inventory• Phoneme collapse• Persisting errors• Reduced intelligibility- 30% of children with a speech delay also

have a significant impairment of either vocabulary and/or grammatical development, placing them at higher risk for social and academic problems

5.25




Unknown Origin – Causes and Risk Factors

• Unknown causes

• No specific risk factors

• Tendencies:

-phonological disorders run in families

-children with phonological disorders seem particularly vulnerable to dyslexia

5.26




Otitis Media – Characteristics• Same as those of the unknown type, but they

result from periods of auditory deprivation, occurring when fluid builds up in middle ear for sustained period

• Specific markers of disorder:– Delayed onset of babbling– Delayed onset of use of meaningful speech– Reduced intelligibility– Problems with specific classes of sounds– Use of “non-natural” sound changes

5.27




Otitis Media – Causes and Risk Factors

• Most common in children under 3 years• Caused by a bacterial or viral infection or

allergens• Some people can have chronic middle ear

infections and not have any negative consequences (resilience)

• Risk and resilience affected by many variables, including poverty, home language environment, genetic predispositions, and other health problems

5.28




Special Population: Down Syndrome

• Affects 1 in 700 children• Characteristics: mental retardation, small

stature, heart defects, small oral cavity, and speech/language delays

• Deficits in phonology, as well as increased risk of hearing loss and articulation difficulties

• Cause: prenatal chromosomal abnormality; cannot be prevented, but associated with increase in maternal age

5.29




Special Population: Hearing Impairment

• Transient or permanent hearing impairment can limit child’s exposure to phonology of language

• Severity of disorder reflects severity of hearing loss and extent of intervention provided

• Causes: prenatal (maternal ingestion of toxins, e.g.), perinatal (anoxia, e.g.), and postnatal (bacterial infections, e.g.)

5.30




Special Population: Cleft Palate• Congenital malformation of the palate (roof of

mouth) – 1 in 700 births• Correctional surgery is usually performed

within first year of life, but prone to phonological problems before and after surgery

• Cause: failure of fusion of palatal structures between 8th and 12th weeks of gestation

• 400 different syndromes for which cleft palate is associated

5.31




IV. How are Phonological Disorders Identified?

• Systematic and comprehensive assessment process for identification

• Speech-language pathologist consults with others to gather information:– Audiologist– Pediatrician– Psychologist– Classroom teachers– Reading specialist– Parents

5.32




The Assessment Process

• Referral

• Screening

• Comprehensive Phonological Assessment

• Diagnosis

5.33




Referral

• Typically comes from a parent, pediatrician, or early childhood educator

• Assumptions: (1) children with early phonological delays must be identified, and (2) they must be provided early intervention services to build phonological skills

• By the time the child turns two years, he/she should be intelligible at least 50% of the time, and 75% by three – if not, referral should be made

5.34




Screening• Challenging to determine difference between

phonological impairment and normally-occurring speech errors

• Screening takes a quick look to make this determination and decide whether more extensive assessment is necessary

• Can use informal measures (imitation of a specific sound target, e.g.) or formal measures (e.g., Denver Articulation Screening Test

5.35




Comprehensive Phonological Assessment

Six Goals to determine:

• General developmental history

• Status of hearing and oral structures and functions

• Phonological and language performance

• Nature and severity of disorder

• Prognosis for phonological outcomes

• Course of treatment

5.36




Phonological Assessment (cont.)

Assessment includes such activities as:• Caregiver interview and case history• Oral mechanism screening• Hearing screening• Language screening or evaluation• Phonological analysis

-standardized testing-spontaneous speech sampling-probing

5.37




Diagnosis• Consideration of the cumulative evidence

from the comprehensive evaluation• Phonological disorder is present if:

-rate of development sufficiently different from age-based expectations-differences not accounted for by cultural or linguistic factors-difference impacts upon child’s ability to effectively communicate

• Extent of disorder ranges from mild to moderate to profound

5.38




V. How are Phonology and Articulation Impairments Treated?• Recent shift in treatment paradigms from

therapies emphasizing better articulatory movements to phonologically-oriented therapies

• Governing principles:– Phonological processes or rules are treated rather

than the individual sounds themselves– Contrasts between phonemes are emphasized– Efforts to enhance language and communication

are included

5.39




Four Common Approaches1) Minimal Opposition Contrast Therapy –

recognize and produce single-phoneme contrasts between words

2) Multiple Oppositions Therapy – build phonemic contrasts within a phonemic collapse

3) Cycles Therapy – stimulate use of phonemes or patterns by treating in cycles

4) Phonological Awareness Therapy – develop child’s sensitivities to phonemic structure of language

5.40




Goals in Phonological Therapy

• Therapy goal: objective to be reached, divided into…– Short-term goals: immediate change, focuses

on eliminating broad patterns rather than training specific sounds

– Long-term goals: ultimate end goals of treatment

5.41




Targets in Phonological Therapy

• Target: phoneme or error that is addressed in a given therapy session

• Five possible approaches in selecting targets:– Target errors or patterns that most affect intelligibility– Target sounds or patterns that are stimulable– Target sounds or patterns that are not stimulable– Follow developmental norms and select early-acquired

sounds and patterns– Follow developmental norms but select later-acquired

sounds and patterns

5.42




Discharge from Treatment• Discharge occurs when child’s speech skills

have “normalized”:– 85% of consonants correct in spontaneous

speech– “adultlike” in speech production

• Short-term normalization – prior to six years of age

• Long-term normalization – after six years• Some children may normalize in speech

production, but still have phonological problems in areas associated with literacy

5.43




chapter 5: phonological disorders justice communication sciences and disorders: an introduction...

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