1. Success with Speech SoundDisordersFinding the Best Fit for Englishand Spanish SpeakersBilingual Bootcamp Summer 2011

2. Who does this apply to? School-based Intervention? Early Childhood Intervention? Public / Private? Rural / Urban? Group / Individual Intervention?Dividing sound disorders into distinct classes can be implemented across all situations! 3. Learner ObjectivesHow do we better identify and treat speechdisorders? Identify subgroups of speech sound disorders Describe differences in articulatory and phonological development and error patterns in Spanish and in English Research Evaluate existing therapy approaches and programs for addressing speech sound disorders Determine which strategies are mostappropriate for a child, depending on his/hertypes of errors 4. Outline for today Compare our conceptions of speech disordersand language disorders Break down our understanding of speechdisorders into 5 distinct groups For each speech disorder category provide: A description of the disorder Video examples Therapy techniques 5. Speech Sound Disorder Treeand Comparison Chart 6. Speechvs. Language Articulation Receptive Phonology Expressive? Syntax? Pragmatics? Morphology? Semantics 7. Defining Speech SoundDisorders(SSD) SSD and Language Impairment Dichotomy Advantage: 40-60% Co-morbidity LI and Useful in predicting deficienciesSSD in Pre-K in academic outcomes 15% Co-morbidity LI and(spelling, reading, decoding)SSD at age 6 Disadvantage: Does not differentiate degree or type of unintelligibilityShriberg, Tomblin, and McSweeny (1998) 8. Defining Speech SoundDisorders(SSD)Seven Subtypes of SSD (Shriberg) Advantage: Genetic Provides diagnostic markers to Otitis Media categorize child Apraxia Dysarthria Disadvantage: Psychosocial Involvement Does not differentiate between 2 groups based on errors articulation and phonology 9. Speech Sound Disorders Phonology Articulation1. 2.3. 4. 5.Consistent StructuralDelayedInconsistent ArticulationPhonological Deviant Deviant Disorder Anomaly (Misc.) Dodd, 1995 10. Defining Speech SoundDisorders(SSD)4. ArticulationDisorder5.3. Inconsistent StructuralDeviant 13% Anomaly9%57%21% 2. Consistent 1. DelayedDeviant Phonological Broomfield and Dodd, 2004 11. 1.DelayedPhonological Delayed Phonological Skills Definition: Phonological system similar to younger, typicallydeveloping children. Most phonemes can bearticulated; however, discrepancy exists betweenphonological processes observed and childschronological age. What we see: Multiple misarticulations Errors can be classified by patterns See typical patterns that persist(e.g., stopping, cluster reduction, liquidsimplification) 12. 2.Consistent Consistent Deviant Phonological Disorder Deviant Definition: Systemic use of deviant phonological rules (i.e., error patterns that are atypical of normal phonological development). E.g., deleting all syllable-initial consonants What we see: Less intelligible Sound production may be age appropriate (Difficulty producing sounds in certain contexts) 13. Delayed or Deviant PhonologicalPatterns?Typical Atypical 1. Phonological2.Phonological Delayed PhonologicalPatternsConsistentDeviant PatternsCluster Reduction DeaffricationLiquid Simplification Initial Consonant DeletionStoppingBackingVelar FrontingSpirantizationWeak Syllable DeletionDenasalizationAssimilationAdditionFinal Consonant DeletionPalatalizationPalatal FrontingMetathesis Lisping Nasalization Spirant DeletionGoldstein andIglesias, 2006 fromCPAC-S 14. 3.InconsistentDeviant Inconsistent Deviant Phonological Disorder Definition: Variable productions of the same words orphonological features in the same contexts and acrosscontexts. Examples: Say butterfly Chutterdy Again, say butterfly sunnerny 15. Wait! That sounds like apraxia! Both characterized by inconsistency Those with childhood apraxia of speech (CAS): Worse in imitation than in spontaneous production Differ in cues effective to elicit production of words Have oral-motor difficulties (e.g., groping) 16. 4.Articulation Disorder Articulation Disorder Definition: An inability to produce a perceptually acceptable version of particular phonemes, either in isolation or in any phonetic context. What we see: /r/, /s/, and /l/ kidserrors with a particular sound Can be highly intelligible 17. 5.Structural Anomaly Structural Anomalies Definition: Low intelligibility that is the result of or compromised by atypical physical development Examples: Deaf Speech Cleft Lip and Palate Velo-Pharyngeal Insufficiency 18. 5.Structural Anomaly Structural Anomalies Definition: Low intelligibility that is the result of or compromised by atypical physical development Examples: Deaf Speech Cleft Lip and Palate Velo-Pharyngeal Insufficiency 19. 5.Structural What types of clefts exist? Anomaly A cleft lip (CL) is aseparation in the upper lip. A cleft palate (CP) is anopening in the roof of themouth. A cleft lip and palate (CLP)extends through both. 20. 5.What types of cleft palatesStructural Anomalyexist? A cleft palate can be:~1/750 live births unilateral 14% bilateral 37% submucousal with bifid uvula 49% (77% are unilateral left) 21. 5.Structural Anomaly When does a cleft occur? 7 and 8 weeks in utero 22. 5.Structural Anomaly A word on VPI Velo-pharyngeal Insufficiency The velum (velo) is not contacting the pharynx (back wall of the throat) Can be caused by: Muscle weakness A large opening Insufficient muscle function Adenoids and tonsils 23. Differentiated Treatment Research considering thesubgroups of speech disordersfound that children responddifferently to therapyapproaches that targetdifferent aspects of thespeech-processing chain.(Alcorn et al., 1995, Holm et al., 1997, Dodd and Bradford 2000) One treatment model orstructure may not fit allchildren or may not fit a childthroughout the course ofintervention. 24. Differentiated TreatmentInterventions must consider: Target selection Early vs. later developing sounds Stimulability Error consistency Approach/Methods Implementation structure 25. 1.DelayedPhonological Delayed Phonological Skills Pattern-based approaches Distinctive Feature approach Phonologically-based intervention Cycles Phonological contrast therapy (Crosbie et al., 2005) e.g., minimal pairs, maximal oppositions, empty set, multiple oppositions 26. 1.DelayedPhonological Delayed Phonological Skills Example:Phonological ContrastTarget: Stopping sunbun shinpin shoetwo thicktick 27. 1.DelayedPhonological Delayed Phonological Skills Example:Phonological ContrastTarget: Stopping sunbun shinpin shoetwo thicktick 28. 1.DelayedPhonological Delayed Phonological Skills Example:Phonological ContrastTarget: Stopping sunbun shinpin shoetwo thicktick 29. 2. Consistent Deviant PhonologicalConsistent Deviant Disorder Phonologically Based Intervention Phonological Awareness 30. 2. Consistent Deviant PhonologicalConsistent Deviant Disorder Example:Hodsons Cycles ApproachWeek 1: Weak syllable deletion ma-ri-po-sa, ca-ba-lloWeek 2: Initial consonant deletion pato, mano, boteWeek 3: Stopping (a more typical pattern) foto, sopaApproach includes Metaphonological awareness and auditory bombardment of sounds 31. 2. Consistent Deviant PhonologicalConsistent Deviant Disorder Example:Hodsons Cycles ApproachWeek 1: Weak syllable deletion ma-ri-po-sa, ca-ba-lloWeek 2: Initial consonant deletion pato, mano, boteWeek 3: Stopping (a more typical pattern) foto, sopaApproach includes Metaphonological awareness and auditory bombardment of sounds 32. 3.Inconsistent Deviant Phonological DisorderInconsistentDeviant Goal of intervention is CONSISTENCY at thesingle word level. Example of therapy approach: Core vocabulary (that focuses on consistency ofwhole-word production) 33. 3.Inconsistent Deviant Phonological DisorderInconsistentDeviant Core vocabulary intervention This therapy approach resulted in greaterchange in children with inconsistent speechdisorder compared to more traditionalapproaches (Crosbie et al., 2005) 34. 3.Inconsistent DeviantInconsistentDeviantPhonological Disorder Core vocabulary approach This therapy approach resulted in greaterchange in children with inconsistent speechdisorder compared to more traditionalapproaches (Crosbie et al., 2005)PrePost 35. 3.Inconsistent DeviantInconsistentDeviantPhonological DisorderExample: List of 50 target words chosen for child 10 words targeted during the week Consistent words then removed from list, andnew set of 10 words chosen randomly forpractice Generalization monitored through periodicprobe of untreated words 36. 4.Articulation DisorderArticulation Disorder Traditional Artic/motor-based approaches Teach motor behaviors associated with theproduction of a particular speech sound Van Riper approach McDonalds sensory-motor approach (use offacilitative contexts) Multiple Phoneme approach 37. 4. ArticulationDisorderArticulation Disorder Example: misarticulation of /s/ phoneme1. (Sensory-perceptual training) of /s/2. Production trainingSound establishment of /s/3. Production trainingSound stabilization of /s/ (/s/ in isolation, syllables, words, phrases, etc.)4. Transfer and carryover 38. 4. ArticulationDisorderArticulation Disorder Example: misarticulation of /s/ phoneme1. (Sensory-perceptual training) of /s/2. Production trainingSound establishment of /s/3. Production trainingSound stabilization of /s/ (/s/ in isolation, syllables, words, phrases, etc.)4. Transfer and carryover 39. 5.Structural Anomaly Structural AnomaliesCommunication goals/ Outcomes for Structural Anomalies Increase Vowel Repertoire Increase Consonant Inventories Increase Vocabulary Increase Oral Airflow Decrease use of Nasal and GlottalSounds 40. 5.Structural Anomaly Increase Vowel Repertoire Take a vowel inventory Target vowels in isolation (a) In strings (a,a,a,a) In opposition (u-I, u-I a-o, a-o) 41. 5.Structural Anomaly Increase Vowel Repertoire Take a vowel inventory Target vowels in isolation (a) In strings (a,a,a,a) In opposition (u-I, u-I a-o, a-o) 42. 5.Structural Anomaly Increase Vowel Repertoire Take a vowel inventory Target vowels in isolation (a) In strings (a,a,a,a) In opposition (u-I, u-I a-o, a-o) 43. 5.Structural Anomaly Increase Consonant Inventories BEFORE palate repair LOW pressure words to target Hi Mam Hello No Hey Mo Mommy Nia More Nio Me Ojos No En Whoa Mano Wow Wawa agua Honey 44. 5.Structural Anomaly Increase Consonant Inventories AFTER palate repair HIGH pressure words to target Baby Pap Boy Beb Pop Boca Pooh Gato Pie Todo Toy T Doll To Daddy Qu Cookie Ten Go 45. 5.Structural Anomaly Increase Vocabulary Sounds and vocabulary develop in tandem Do we: Focus on articulation to give her the sounds to produce more language? Focus on language to give her a way to practice her sounds? Any ideas? 46. 5. Increase VocabularyStructural Anomaly Vocabulary development should be targeted withsound development Choose words that: Are common and in their environment Are useful Are extremely fun (read: routines-based intervention) Syllable should be simple CV (consonant/vowel) Start with stops and bilabial sounds 47. 5.Structural Anomaly Increase Oral Airflow A child with a cleft does not have control overthe air leaving their throat In typical development we stop or slowlyrelease this air to produce speech Regardless of what surgeries a child hasundergone, we need to familiarize the childwith airflow through the mouth 48. 5. Increase Oral AirflowStructural Anomaly A child with a cleft does not have control overthe air leaving their throat In typical development we stop or slowlyrelease this air to produce speech Regardless of what surgeries a child hasundergone, we need to familiarize the childwith airflow through the mouth 49. 5.Structural Anomaly Increase Oral Airflow Request an easy repetition (muh,muh,muh) After the child starts repeating, plug his nose Inhale deeply, hold your breath, and explode outwith a single sound BUH!, PUH! 50. 5.Structural Anomaly Decrease Use of Nasal and Glottal Sounds Growls and nasal sounds are typical for young infantsbut children with clefts obtain these sounds later Parents, wanting communication, reinforce thesesounds Acknowledge the childs attempt but then requestsother consonants or sounds Pair voiceless consonants with whispered vowelspuh/tuh/ku/huh This keeps the glottis open and prevents the glottalstop from occurring 51. VPI Pyramid 52. Cleft Palate Resources www.cleft.com 1-800-24CLEFT www.operationsmile.org www.widesmiles.org The story of Lippy the Lion The story of Thumper, the Cleft Affected Bunny www.bilinguistics.com 53. Identifying Speech Sound Disorders in Englishand Spanish Speakers Resources to aid in defining unintelligiblePhonological ProcessesPhoneme InventoryAge of Acquisition ofPhonemesVowel InventoryDiphthongsSyllable Structure 54. Speech Sound Disorder Tree and Comparison Chart 55. Phonological ProcessesCluster reductionSPANISH ENGLISH Stopping Fronting Flap/Trill Assimilation Vocalization DeviationGliding Final consonant deletion Deaffrication Liquid SimplificationUnstressed Syllable Deletion 56. Visit us at bilinguistics.com 57. For more great resources visit our resourcelibrary at SpeechPathologyCEUs.net 58. Thank you!