Speech sound disorder by Sajjal (2018)

Definition

A speech sound disorder (SSD) is a speech disorder in which some speech sounds (called

phonemes) in a child's (or, sometimes, an adult's) language are either not produced, not

produced correctly, or are not used correctly.

Diagnostic Criteria

A. Persistent difficulty with speech sound production that interferes with speech intelligibility or

prevents verbal communication of messages.

B. The disturbance causes limitations in effective communication that interfere with social

participation, academic achievement, or occupational performance, individually or in any

combination.

C. Onset of symptoms is in the early developmental period.

D. The difficulties are not attributable to congenital or acquired conditions, such as cerebral

palsy, cleft palate, deafness or hearing loss, traumatic brain injury, or other medical or

neurological conditions.

Differential Diagnosis

Normal variations in speech.

Regional, social, or cultural/ethnic variations of speech should be considered before making the

diagnosis.

Hearing or other sensory impairment.

Hearing impairment or deafness may result in abnormalities of speech. Deficits of speech

sound production may be associated with a hearing impairment, other sensory deficit, or a

speech-motor deficit.

Structural deficits.

Speech impairment may be due to structural deficits (e.g., cleft palate). Dysarthria. Speech

impairment may be attributable to a motor disorder, such as cerebral palsy. Neurological signs,

as well as distinctive features of voice, differentiate dysarthria from speech sound disorder.

Selective mutism.

Limited use of speech may be a sign of selective mutism . Selective mutism may develop in

children with a speech disorder because of embarassment about their impairments, but many

children with selective mutism exhibit normal speech in "safe" settings, such as at home or with

close friends.

Screening/assessment

Informal assessment

Case History

The case history typically includes gathering information about

Family's concerns about the child's speech;

History of middle ear infections;

History of speech, language, and/or literacy difficulties in the family;

Languages used in the home;

Primary language spoken by the child;

Teacher's perception of the child's intelligibility and participation in the school setting and how

the child's speech compares with that of peers in the classroom;

Hearing screening to rule out hearing loss as a possible contributing factor to speech difficulties,

Screening of oral motor functioning,

Facial exam to identify structural bases for speech sound disorders (e.g., sub mucous cleft

palate) and to assess facial symmetry.

Differences among speech sound disorders, accents, dialects, patterns of transfer from one

language to another, and typical developmental patterns.

Observation

Speech perception

Receptive and expressive language assessment,

Phonological processing

Sounds in various word positions (e.g., initial, within word, and final word position) and in

different phonetic contexts,

Phoneme sequences (e.g., vowel combinations, consonant clusters),

Speech sound errors, including

Error type(s) (e.g., deletions, omissions, additions),

Error distribution (e.g., position of sound in word),

Error patterns (i.e., phonological patterns)

Speech Sound Assessment/formal assessment

Portage guide to early education

The guide comes in three parts

A checklist of behavior,a card file,a manual of directions.

Areas

It comprised of five developmental areas plus a section on infant stimulation.area include self

help,motor,socialization,language and cognitive skills.

Age-birth to 6 years

Picture naming and imitation tests as tools for the diagnosis of phonological

disorder

Within the phonology tests, three types of tasks are commonly used: imitation, naming and

spontaneous speech.

METHOD: participants of this research were 50 phonologically disordered children, with no

history of prior speech-language therapy and with ages between 4:0 and 12 years.

The spontaneous speech may be elicited direct or indirectly. In direct conditions, questions are

used to evoke answers. The indirect speech collecting may be done through a free situation

(selected materials and topics; the topics may or may not be related to the materials) or

through history (use of some selected material and topics chosen by the child);

In the imitation tasks, the subject is requested to repeat a word or sentence.

In the naming task it is expected that the subject say the equivalent word to the picture or

object presented as stimulus. It's also usual to request the subject to produce the target word

in a standard sentence (Wertzner & Galea, 2002). if he/she does not recognize the

picture/object, the examiner may say the respective name and request the naming again after

showing some items.(Wertzner & Galea, 2002).

AIM: to verify the association between the phonological performance in picture naming and

imitation tasks, assessing the occurrence of phonological processes.

Published tests of articulatoin

Goldman-Fristo

Published in 2000 by Pearson Ronald Goldman and Macalyn Fristoe

Purpose-the GFTA3 is used to assess an individuals articulation of consonant sound of standard

American .

English-it samples spontaneous and imitative speech production.

Norms-2,350 examinees total

Males:1798

Females:1723

Age-2;0 to 21;11

Potensial uses-the GFTA3 can compare articulation at different levels of complexity.

It can formally observe the production of vowels and as well as note deviations.

In addition the test can screen for expressive language difficulties.

Section1:sounds in words.

Section 2:sounds in sentences.

Section 3:the ability of the examinee to produce previously misarticulated phonemes correctly

when given mximum stimulation.

Pros-the test has large colorful pictures and addresses all sounds in a concise manner.versatility

among varying developmental ages. for example.in the second part of the test ,there is a choice

of two stories that can be read to the individual .story 1 is directed towards younger patients

and story 2 can be enjoyed by older and younger clients.

Reliability

Evidence of inter rater reliability.

Evidence of test retest reliability.

Evidence of internal consistency.

Validity

Evidence of content validity

Evidence of construct validity

Arizona Articulation Proficiency scale

Developed by janet barker fudala

Ages: 1-18

Grades: Infant-Adult

Test all the major sounds in the English language including initial and final consonants and

vowels, and diphthongs.

Test Purpose

The Arizona 3 provides a quick, reliable, and well-standardized measure of articulation

proficiency in children.

Additional Assessments

Three Optional Assessment Tasks are available.

Word Reading Administration

Students read target words rather than naming objects on the Picture Cards.

Language Screening Task

On the back of almost every Picture Card is a follow-up question that can be used to elicit

information about the students' vocabulary and language-based cognitive skills.

Spontaneous Speech Task

Two additional Picture Cards encourage spontaneous conversation.

Testing Time-2-10 minutes

Test Procedure

The student names objects represented on 42 picture cards. Score each response according to

simple, quantitative rules detailed in the manual.

Examiner Qualifications

This test may be administered and interpreted by licensed and certified speech-language

pathologists or educational professionals familiar with speech sound disorders.

Components

Test Set includes: examiner's manual, picture test cards, and 25 test booklets - distributed item

Diagnostic evaluation of articulation and phonology

Author -Dodd, Barbara J. Hua, Zhu Crosbie, Sharon Holm, Alison Ozanne, Anne

Place of Publication London, England

It contains following.

How to administer the Screen:

The child names all 10 pictures, clinician phonetically transcribes each word. Imitations allowed if

semantic cue fails, but ensure an imitated word is also imitated in Any speech sound produced in

error is tested for stimulability.

Interpret

Articulation

Phonology

oromotor

Articulation Assessment:

This dynamic assessment investigates children found not to be stimulable for one or more speech

sounds they should pronounce by their age, on the Screening Assessment.

Administration time: 5 -10 minutes.

How to administer the Articulation Assessment:

i. Picture naming: What’s this? Use cues as necessary to elicit the word, if unsuccessful ask

for imitation, marking with (i). Circle any sounds produced in error.

ii. Speech Sound Stimulability: Attempt to elicit any speech sound produced incorrectly when

picture naming:

‘I am going to say a word and I want you to say it after me’ Give the child three opportunities,

getting them to watch your lips, and providing cues.

If the CV syllable is not elicited, attempt to elicit the speech sound in isolation, using cues, up to

three times. As examples, these instructions work for some children: /f/ ‘Put your top teeth on your

bottom lip, like this

The Oromotor Assessment:

Administration time: 5-10 minutes.

How to administer the Oromotor Assessment:

See the score sheet for instructions. Most children tested during normative data collection were co-

operative, but some refuse to make some oral gestures (e.g., tongue protrusion).

How to score the Oromotor Assessment:

See the score sheet for instructions. Reliability studies showed that clinicians needed practice

administering and scoring the Oromotor Assessment before they became reliable assessors.

.

The Phonological Assessment:

The assessment is scored to provide the following quantitative measures with standard scores:

Percent consonants correct (PCC)

Percent vowels correct (PVC)

Percent phonemes correct (PPC)

Single-words vs continuous speech ratio (SvsC)

The assessment also analyses error types qualitatively to identify type of phonological disorder

Administration time: 15-20 minutes.

How to administer the Phonological Assessment:

Children are asked to name 50 pictures. If the wrong word is given, or a child doesn’t know a

word, first provide a semantic cue, followed, if needed, by request for imitation.

How to score the Phonological Assessment:

1. To work out quantitative severity measures:

Percent Consonants Correct

Count the number of consonants produced correctly. Divide this number by 141 (total possible)

minus the number of consonants in any target words not attempted. Then multiply by 100.

Administration time: 5-10 minutes.

How to administer the Consistency Assessment:

i. Ask the child to name the 25 pictures one at a time.

ii. Do another activity (e.g., assessment such as oromotor test, game, read a story)

iii. Again ask the child to name the same 25 pictures one at a time, indicate same production

with ∝ or transcribe different production.

iv. Do another activity

v. Again ask the child to name the same 25 pictures one at a time, indicate same production

with ∝ or transcribe different production.

Many children protest that they have already named the pictures. Tell them they have to name

the same pictures three times before the first trial and offer a reward for each trial. Use of a

stopwatch, they can work, to measure time taken to say the words can encourage task

completion.

How to score the Consistency Assessment:

For each word that is said twice or three times, score 1 if any of the word is said differently, and 0 if

the words are produced identically. Add the scores and express as a percentage of the number of

words said on three occasions (e.g. 10 words said differently / 25 = 0.4 x 100 = 40%).

40% is the criterion for diagnosis of Inconsistent Phonological

Published Tests - Phonological Processes

Khan-lewis phonological analysis

Khan-Lewis Phonological Awareness Second Edition (KLPA-2)

Published in 2002 by Pearson Linda Khan and Nancy Lewis

Assesses the phonological processes in the speech of individuals

Latest edition

Age Range - 2:0 - 21:11

Suitable for individual administration

Takes 10-30 minutes to administer

Purpose:

• Individually-administered test of phonological process usage, designed as a “companion tool”

to the Goldman-Fristoe Test of Articulation-Second Edition (GFTA-2), to provide further

articulation and phonological diagnostic ..

Standardization Issues:

• 3,500 examinees (ages 2-21) were initially tested at 300 sites nationwide, with final norms

based on representative sampling of 2,350 individuals (1,175 males, 1,175 females). Reliability

and Validity Issues:

• Median internal, test-retest, and interrater reliabilities were all well-within acceptable limits

Hodson assessment of phonological pattern

Developed by-barbara Williams hodson

Ages: 2 years to any age (if intelligibility is an issue); Normative data provided for Ages 3-0 to 8-

0

Testing Time: 15-20 minutes (comprehensive); 2-5 minutes (screening)

Administration: Individual

The third edition (formerly APP-R) is now norm-referenced.

The HAPP-3 Comprehensive Phonological Evaluation can be administered in less than 20

minutes. Objects and a few pictures are used to elicit 50 stimulus words.

identifying major phonological patterns that need to be targeted (for goal statement), and

specifying consonant and vowel inventories,

Two screening components are included--Multisyllabic words and Preschool.

Two screening tools also are included (12 stimulus words for each). The child's productions are

transcribed, analyzed, and summarized on either the Preschool Phonological Screening Record

Form (for children 2 years of age and older) or the Multisyllabic Word Screening Record Form

(for students 8 years of age and older). The screening instruments, which can be administered

in less than 5 minutes, yield results that help the examiner determine whether further testing is

needed.

Management plan

IEP of speech sound disorder

1.Bio data

Name S.A

Age 3 years

2.Strength-Understand words

3.Weekness-Production of sound

Therapy –Oral motor exercise,blow technique

IEP

1.strength the tongue,lips,and muscles of jaws.

2.movement of tongue or lips by placing honey.

3.blow the candle

4.whistling

1.weakn

ess-

producti

on of

phonics

2.vowel

words,a,e,I,o,u

3.consonants

4.syllable ma,ma

5.words

Sessions 5

Target activity Teach phonics

Rationale Production of phonics

techniques Reinforcement Identification of reinforcement

Resources Cards,videos

Trials 5

Oral motor therapy

Oral motor therapy works on the oral skills necessary for proper speech and feeding

development. These skills include: awareness, strength, coordination, movement, and

endurance of the lips, cheeks, tongue, and jaw. .

. FOR THE LIPS:

Say "ooo" with exaggerated lip movement. Then say "eee." Combine them for "oo-ee." Really

round the lips.

Sessions 5

Target activity Strength tongue,lips,muscles of jaws(articulation)

Rationale Improve speech articulation

Techniques Oral motor exercise

Reinforcement Identification of reinforcement

Resources Cards,videos

Trials 5

Say "puh" and pop the sound with emphasis.

Make a big smile. Relax and repeat.

Puff out the cheeks while keeping the lips sealed. Relax and repeat. Puff out one cheek, then

the other, then both. Then puff out the upper lip followed by the lower lip (or vice versa).

Relax and repeat.

Purse the lips to make a kiss. Slide the kiss to the right and then to the left or vice versa.

Blow bubbles. You can also blow whistles, horns. Use these bubble straws to prevent kids

from sucking up bubble solution when they blow.

Drink through a straw rather than drinking from a cup. This is also a great activity for the

tongue and cheeks. Drinking from a straw requires a lot of oral motor work: the cheeks tighten,

the tongue tightens and retracts, and the lips purse.

FOR THE TONGUE:

Say "lalalalalalala" without moving the jaw up and down. Only move the tip of the tongue.

Rest and repeat. If the jaw is moving doing this, have the child bite down on a Probe or

Grabber to stabilize the jaw and isolate the tongue.

Place the tongue tip on the alveolar ridge just behind the upper front teeth. Hold for as long as

possible, working up to three minutes. Swallow when necessary, then get back into position.

• Practice tongue tip sounds. Say "t-t-t-t-t-t," "n-n-n-n-n-n," and "d-d-d-d-d-d." You can also

try a combination of these sounds, such at "t-d-n."

Place the tongue tip on the alveolar ridge behind the upper front teeth. Then place it behind

the bottom front teeth. Repeat several times.

Place the tongue on the roof of the mouth. Hold it there with suction for about 5-10 seconds.

Once that becomes easy, add another step: move the jaw up and down while keeping the

tongue on the roof of the mouth.

FOR THE CHEEKS:

Use straws again!

Put a prop reefer in the cheek area. Tighten the cheek around it. Relax and repeat.

Put the lips together and contract the cheeks.

Make an "o" with the lips. Then move the lips in a circle. Repeat several times and then

reverse the direction.

FOR COORDINATION:

Say "buttercup" 5 times in a row. Relax and repeat.

You can also try saying "rocket ship" instead of "buttercup." Both words work the lips, the tip

of the tongue, and the back of the tongue.

Put the tongue in the corner of the lips and trace the perimeter of the lips. When you reach the

starting point, go back the other way. Focus on stabilizing the jaw and completing the circle.

Don't allow the jaw to move at all - the tongue must do the work.

Use a mirror. Look in the mirror and instruct the individual to copy you. Make it a fun game of

"Simon Says." Mirrors are great for visual feedback as long as they aren't distracting. I have

some kids who will just play and make funny faces in the mirror!

Blowing techniques

Water flutes

. Its not often you find a resource that ticks lots of boxes – there’s a bit of science (the varying

levels of water filled tubes dictates the pitch), music, bath fun and an activity that encourages

steady blowing (to get a solid note). They even come with waterproof song/music sheets.

Balloon ball budies.

Balloon Ball Buddies are a fun way to help develop oral motor and respiration. They also

provide a constructive alternative for kids who seek oral input. The Balloon Ball Buddy is just

like a normal balloon, however it is larger and requires a bit more strength initially to inflate.

There are 6 different styles of The Balloon Ball Buddy (The Hippo, Tiger, Frog, Fish, Elephant,

Lion). The Balloon Ball Buddy is made from rubber, are more durable than a regular balloon.

They can be used and re-used many times. Initially whistle

Arks lip block

The Ark Lip straw topper is a valuable tool to add to a straw to help children learn how to suck

from a straw effectively. The Lip Block can help children develop oral motor skills such as lip

closure, tongue retraction and cheek tension.

PLAY

Alliteration. Repetition of early consonant sounds. ...

Consonance/Half-rhyme. Repetition of final consonant sounds. ...

Assonance. Repetition of the same vowel sound. ...

Rhyme. Repetition of the final vowel and the final consonant sounds. ...

Reverse Rhyme. ...

Para Rhyme. ...

Phonic education technique

Children taught to read using phonics techniques have achieved "very high" results, according

to new research, The results of the study, by the educational psychologist Marlynne Grant The

new study followed a group of 30 children who were taught using phonics for the first time

Supporting Research

According to Laura Justice (KSHA presentation, 2005), the best predictors of successful

development of decoding skills are alphabet knowledge, phonological awareness, and print-

concept knowledge. Explicit teaching is necessary to ensure that students learn necessary skills

for reading success. Only 24% of 4th grade students read proficiently and 37% do not have basic

skills for reading.A 3 year longitudinal study of 12 preschool students with speech impairments

and 19 preschool students with typically developing speech examined the effect of targeting

phonological awareness skills during the preschool years (Gillon, 2005).The study revealed that

early intervention which facilitates phoneme awareness and letter knowledge in addition to

targeting improved speech intelligibility contributed to stronger phoneme awareness skills and

eventually to improved decoding and encoding of printed words.

Augmentative and alternative communication(AAC)

Replacing natural speech and writing with aided(e:g picture communication symbols,line

drawing,speech generating devices and tangible objects)and or unaided e: g ,manual

signs,gestures and figure spelling)

Computer based instructions

Use of computer technology and computerized program for teaching language skills including

vocabulary

Contextual Utilization

Contextual utilization approaches are based on the recognition that speech sounds are

produced in syllable-based contexts in connected speech and that some contexts can facilitate

correct production of a particular sound

Contrast Therapy

Contrast therapy focuses on production using contrasting word pairs instead of individual

sounds. This approach emphasizes sound contrasts necessary to differentiate one word from

another

Cycles Approach

The cycles approach targets phonological pattern errors and is designed for highly unintelligible

children who have extensive omissions, and a restricted use of consonants. The goal is to

increase intelligibility within a short period of time, and treatment is scheduled in cycles ranging

from 5 to 16 weeks. During each cycle, one or more phonological patterns are targeted. After

each cycle has been completed, another cycle begins, targeting one or more different

phonological patterns. Recycling of phonological patterns continues until the targeted patterns

are present in the child's spontaneous speech (Hodson, 2010; Prezas & Hodson, 2010).

Distinctive Feature Therapy

Distinctive feature therapy focuses on elements of .This approach uses tasks (e.g., minimal pair

contrasts) that compare the phonetic elements/features of the target sound with those of its

substitution or some other sound contrast. (Blache & Parsons, 1980; Blache et al., 1981).

Naturalistic Speech Intelligibility Intervention

Naturalist speech intelligibility intervention directs treatment of the targeted sound in

naturalistic activities that provide the child with frequent opportunities for the sound to occur.

For example, using a McDonald's menu, the child can be asked questions about items that

contain the targeted sound(s (Camarata, 2010).

Speech Sound Perception Training

Speech perception training is a procedure used to help the child acquire a stable perceptual

representation for the target phoneme or phonological structure.

Ultrasound imaging (placing an ultrasound transducer under the chin) used as a biofeedback

technique to visualize articulatory positioning and movement for vowel production (Adler-Bock,

Bernhardt, Gick, & Bacsfalvi, 2007; Preston, Brick, & Landi, 2013);

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