Inconsistent Speech Disorder and The Core Vocabulary Approach

SPEECH DISORDER

AND THE CORE

VOCABULARY

APPROACH

Kimberly Jones

Nova Southeastern University

February 2011

Overview

Defining Inconsistent Speech Disorder (ISD)

Differentiating ISD from Childhood Apraxia of

Speech (CAS)

Existing treatment models

Defining the Core Vocabulary Approach

Review of research on the Core Vocabulary

Approach for use with ISD

Clinical Implications

Questions

References

What is Inconsistent speech

disorder (ISD)?

A sub-group of children with speech disorders characterized by inconsistent errors (McIntosh & Dodd, 2008)

Inconsistency is characterized by a high proportion of different errors upon repeated production and multiple types of errors (placement, syllables, word shape) (McIntosh & Dodd, 2008)

Generally large phonemic inventory but with unpredictable use (inconsistency score of 40% or more on the 25 word test for inconsistency); unusual phonological errors may be evident without an observable pattern (McIntosh & Dodd, 2008)

Imitated speech better than spontaneous production, no groping, no lack of diadochokinetic skills (Holm, Crosbie, & Dodd , 2005)

How is ISD different from CAS?

CAS presents with suspected impairments in

phonological planning, phonetic programming,

and motor-program implementation (Ozanne,

2005)

ISD presents with suspected impairments in

phonological assembly but intact phonological

representation, phonetic planning and motor-

speech implementation (McIntosh & Dodd,

2008)

Speech Production

Phonological Rules

Phonological plan/template

Phonetic Program Assembly

Motor Speech Program

Implementation

Execution of Motor Program

CAS:Breakdown in these areas (Orzanne 2005)

ISD :Breakdown in assembly, storage, or retrieval of phonological plan(Bradford andDodd, 1994, 1996; Dodd and McCormack, 1995 Bradford-Heit & Dodd 1998; McIntosh & Dodd 2008)

Chart adapted from Orzanne 2005

CAS ISD

CAS ISDInconsistent Errors: multiple types of errors across context;

oro-motor speech difficulties

Groping

differences in voluntary vs. involuntary movement

Unusual phonological errors with no visible pattern

Imitated speech better than spontaneous production

Diadochokinetic skills intact

Normal phonological awareness

Impaired phonological awareness, reading, and spelling

No groping

Imitation does not improve production

Limited phonemic inventory

Large phonemic Inventory

Vowel errors

(Stackhouse & Snowling, 1992b; Ozanne, 1995; Bradford-Heit & Dodd, 1998; Holm & Dodd, 1999; Moriarty & Gillon, 2006; Crosbie, Holm & Dodd, 2005; Dodd, Holm, Crosbie & McIntosh, 2006; Holm, Crosbie & Dodd, 2007; McIntosh & Dodd, 2008; Holm, Farrier & Dodd, 2007)

Current Treatment Options

PROMPT Targets phonetic programming and motor speech

implementation combined

Phonological awareness intervention: Targets accurate pronunciation and phonological

representation (phonological awareness)

Core vocabulary approach Teaches children how to assemble word phonology by

giving information about the phonological plan without providing a model for imitation and focuses on the establishment of consistent speech (as opposed to correct speech)

(McIntosh & Dodd, 2008)

What is the core vocabulary

approach?

An approach for treating highly unintelligible speech composed of many inconsistent errors due to a breakdown in phonological planning

Targets consistent production of selected high-use vocabulary words

Focus is on: Consistent “best production” instead of correct production

Gives information about the phonological plan without providing a model for imitation

(McIntosh & Dodd, 2008)

What is the core vocabulary

approach?

50 words that are functionally important are

selected with the input of the parents, teachers,

and the child

10 words are selected to target per session and

“best production” is accepted even with

developmental errors but consistency of

production is required

Parents and teachers reinforce consistent

production outside of therapy

As individual words become consistently

produced they are removed from the target list

and replaced by other words

(Dodd, Crosbie & Holm, 2004)

Core Vocabulary Approach:

What does the research show?

A comparison of three therapy methods for children with different types of developmental phonological disorder (Dodd & Bradford, 2000)

Participants: 3 boys with phonological impairment (1 with CSD and 2 with ISD)

One aim of the study was to compare the effects of the three intervention programs on the accuracy and intelligibility of the speech of three children enrolled in therapy



Measured skills pre-intervention included: PCC (percent consonants correct) from a 50 utterance

speech sample

Articulation and inconsistency tests

Phonetic inventory

Phonological analysis to evaluate use of developmental and non-developmental rules

(Dodd & Bradford, 2000)



Results for the two children with ISD attributed to the core vocabulary approach: Both children demonstrated increased consistency of word

production

Both children decreased their inconsistency scores to less than 40%

One child made gains in the core vocabulary block only (block 1)

One child made gains both in the core vocabulary block (block 1) and in the phonological block (block 2)

Consistent Phonological Errors:Best response from contrast Tx

(Dodd & Bradford, 2000)



Intervention for children with severe speech

disorder: A comparison of two approaches

(Crosbie, Holm & Dodd, 2005)

Core Vocabulary and Phonological Contrast

18 children with severe ISD or CSD (consistent

speech disorder) from ages 4:8 to 6:5 who:

PCC standard score of 3 (mean 10 and SD of 3)

Demonstrated either ISD or CSD (Consistent Speech

Disorder)

Receptive language, non-verbal skills, oro-motor structure

and function, and hearing all within normal limits

Mono-lingual speakers of English



Structure of intervention study:

Multiple baseline

All children with ISD and CSD were exposed to both phonological contrast therapy and the core vocabulary approach

ISD and CSD children were divided into four groups: one group from each diagnosis started with the phonological contrast therapy and the others started with the core vocabulary approach




Results: All children increased their percentage of consonants

correct

The core vocabulary approach resulted in greater change for children with ISD

The phonological contrast approach resulted in greater change for children with CSD

Children with ISD who received core vocabulary therapy increased their consistency on both trained and untrained words

Phonological contrast therapy resulted in suppression of patterns not just trained phonemes




An intervention case study of a bilingual child

with phonological disorder (Holm & Dodd,

1999)

Bilingual Punjabi-English speaking child (H.K.),

aged 4:6

Inconsistent errors in both languages

Core vocabulary approach provided in English

only for 8 weeks



Pre-Intervention Data

(Holm & Dodd, 1999)



Treatment

Word selection

Week 1 practice

Week 2 practice

Measurement of progress and generalization

Removal of targeted words

Results

Consistency increased on treated and untreated words

Consistency increased across languages

Consonant accuracy increased significantly in both languages

Atypical phonological processes not evident at review session (Holm & Dodd, 1999)



(Holm & Dodd, 1999)



(Holm & Dodd, 1999)



(Holm & Dodd, 1999)

Clinical Implications

Differential diagnosis allows for appropriate selection of treatment methods

Treatment selected should target the suspected area of breakdown in speech production

Some research demonstrates the effectiveness of the core vocabulary approach for children with ISD (both monolingual and bilingual) but more research is needed

Questions?

? ? ? ? ? ?

References

BRADFORD, A. and DODD, B., 1994, The motor planning abilities of phonologically

disordered children. European Journal of Disorders of Communication, 23, 349–369.

Bradford, A. and Dodd, B., 1996, Do all speech disordered children have motor de. cits?

Clinical Linguistics and Phonetics, 10, 77–101.

Bradford-Heit, A. & Dodd, B. (1998). Learning new words using imitation and additional

cues: differences between children with disordered speech. Child Language

Teaching and Therapy, 2, 159 – 179.

Crosbie, C., Holm, A., & Dodd, B. (2005). Treating inconsistent speech disorders. In B.

Dodd (Ed.), Differential diagnosis and treatment of children with speech disorder (pp.

182 – 201). London: Whurr.

References

Dodd, B. and Bradford, A., 2000, A comparison of three therapy methods for children

with different types of developmental phonological disorder. International Journal of

Language and Communication Disorders, 35, 189–209.

Dodd, B., Crosbie, S. and Holm, A., 2004, Core Vocabulary Therapy: An Intervention for

Children with Inconsistent Speech Disorder (Brisbane: Perinatal Research Centre,

Royal Brisbane & Women’s Hospital, University of Queensland).

Dodd, B, Holm, A, Crosbie, S, & McIntosh, B. (2006). A core vocabulary approach for

management of inconsistent speech disorder. Advances in Speech–Language

Pathology, 8(3), 220-230.

Dodd, B. and McCormack, P. 1995: A model of the speech processing for differential

diagnosis of phonological disorders. In B. Dodd, editor, Differential diagnosis and

treatment of children with speech disorder. London: Whurr.

References

Holm, A., Crosbie, S. and Dodd, B. 2005: Treating inconsistent speech disorders. in B.

Dodd, editor, Differential diagnosis and treatment of children with speech disorder.

London: Whurr.

Holm, A., Crosbie, S. and Dodd, B. (2007): Differentiating normal variability from

inconsistency in children’s speech: Normative data. International Journal of

Language and Communication Disorders 42(4), 467–486.

Holm, A. and Dodd, B., 1999, An intervention case study of a bilingual child with

phonological disorder. Child Language Teaching and Therapy, 15, 139–158.

Holm, A., Farrier, F. and Dodd, B., 2007, The phonological awareness, reading accuracy

and spelling ability of children with inconsistent phonological disorder. International

Journal of Language and Communication Disorders, 42, 467–486.

McIntosh, B. & Dodd, B. (2008). Evaluation of core vocabulary intervention. Child

Language Teaching and Therapy, 24(3), 307-327.

References

Moriarty, B, & Gillon, G. (2006). Phonological awareness intervention for children with

childhood apraxia of speech . International Journal of Language & Communication

Disorders, 41(6), 713-734.

Ozanne, A., 1995, The search for developmental verbal dyspraxia. In B. Dodd (ed.),

Differential Diagnosis and Treatment of Children with Speech Disorder (London:

Whurr), pp. 91–109.

Ozanne, A. 2005; Childhood apraxia of speech. In B. Dodd, editor, Differential diagnosis

and treatment of children with speech disorder. London: Whurr.

Stackhouse, J., & Snowling, M. (1992). Developmental verbal dyspraxia II: A

developmental perspective on two case studies. European Journal of Disorders of

Communication, 27, 35–54.

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Inconsistent Speech Disorder and The Core Vocabulary Approach