Now how’d ya say that?

Phonological Disorders

Sounds goodhttp://www.youtube.com/watch?v=aJMqHD

ynnoY&feature=relatedhttp://www.youtube.com/watch?v=TWpXaw

FFZn0http://www.youtube.com/watch?v=tBdX-

ZbDgDQ

Phonological DisorderPhonological 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

Case StudiesWhat strategies can be used to identify

whether Octavio’s suspected phonological difficulties are the result of a speech difference or a speech disorder?

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?

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?

DefinitionImpairment 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 languagedeveloping a solid boundary around each

phoneme to make it distinct from the other phonemes

Most common symptom: unintelligibility

Prevalence & Incidence4-13% of children are affectedAffects 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

Articulation versus Phonologic

Some things to know about Phonological DisordersPhonemes as Contrasts

Roughly 40 speech soundsPhoneme - allophonesUnderlying representation of each sound/phoneme

International Phonetic AlphabetEach phoneme has a representative symbol

Articulatory PhoneticsClassification of Vowels & Consonants

Children’s Acquisition of ConsonantsEarly eight – middle eight – late eight (3 yrs, 4 yrs, 6.5

yrs)Sounds and Syllables

Context in which sound is produced (sounds around)Coarticulation & assimilation

Phonology and Literacy

Classifying Phonological DisordersFour Major Symptoms:1) Difficulty with expressive phonology

1) Phoneme difficulty & phonological process reduction

2) Lack of phonological awareness (syllables & sounds change words)

3) Poor verbal working memory (processing & storing)

4) Problems with word learning and retrievalChildren with symptom #1 and not the

others may have a motor-speech or an articulation disorder, not a phonological disorder

UnintelligibilityMild – speech is understood but contains

noticeable errorshttp://www.youtube.com/watch?

v=g9Mp3hoPq5AModerate – speech is difficult to understand

http://www.youtube.com/watch?v=oaGd7M_nfEA&feature=related (close to severe)

Severe – speech cannot be understood at all

SubtypesSpeech 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 Etiology SubtypesPhonological Disorder: Unknown Origin –

60% of cases – no known causePhonological 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

Unknown OriginCharacteristics of speech delay:Small phonemic inventoryPhoneme collapsePersisting errorsReduced intelligibilityGreater risk for dyslexiaHas a tendency to run in families- 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

Otitis Media – CharacteristicsSame 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 babblingDelayed onset of use of meaningful speechReduced intelligibilityProblems with specific classes of soundsUse of “non-natural” sound changes

Otitis Media – Cause & RisksMost common in children under 3 yearsCaused by a bacterial or viral infection

or allergensSome 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

Special Populations – Down syndromeAffects 1 in 700 childrenCharacteristics: 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

http://www.youtube.com/watch?v=RwlXyoHMfYA&feature=related

Special Population: Hearing ImpairmentTransient 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.)

http://www.youtube.com/watch?v=EKNK_GOcn8w&feature=related

http://www.youtube.com/watch?v=Sq5TFk_Qc-g&feature=related

Special Population: Cleft PalateCongenital 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

400 different syndromes for which cleft palate is associated

http://www.youtube.com/watch?v=qvu5VAWcLRY

ReferralTypically 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

Phonological AssessmentSix Goals to determine:General developmental historyStatus of hearing and oral structures

and functionsPhonological and language

performanceNature and severity of disorderPrognosis for phonological outcomesCourse of treatment

More AssessmentAssessment includes such activities as:Caregiver interview and case historyOral mechanism screening (p.170)Hearing screeningLanguage screening or evaluationPhonological analysis

-standardized testing-spontaneous speech sampling-probing

DiagnosisConsideration 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

Treating Phonological DisordersGoverning 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

Categorizing SoundsVowels

Front/back, high/low, tense/lax, rounded/unrounded

ConsonantsPlace, manner, voicing

Before beginning Tx ……..sounds that are functional for the child;sounds that are stimulable;sounds that occur in key words/contexts;sounds that are more visible;sounds that occur more frequently;sounds that affect intelligibility the most; sounds least affected by physical deviationssounds inconsistently mispronounced;sounds that are acquired earlier;sounds that are part of child’s inventory;

Four Main Types of Tx1) Minimal Opposition Contrast Therapy – recognize and

produce single-phoneme contrasts between word1) Minimal pairing2) http://www.geocities.com/maximaloppositions/

minimal_pairs_vs.htm2) Multiple Oppositions Therapy – build phonemic

contrasts within a phonemic collapsephoneme collapse

3) Cycles Therapy – stimulate use of phonemes or patterns by treating in cycleschanges targets on a cycle basis

4) Phonological Awareness Therapy – develop child’s sensitivities to phonemic structure of language‘sound structures of language’words in sentences/syllables in words/intersyllabic units

http://www.asha.org/about/publications/leader-online/archives/2002/q4/021203a.htm

Target GoalsTherapy 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 treatmentFive possible approaches in selecting targets:

Target errors or patterns that most affect intelligibilityTarget sounds or patterns that are stimulableTarget sounds or patterns that are not stimulableFollow developmental norms and select early-

acquired sounds and patternsFollow developmental norms but select later-acquired

sounds and patterns

Discharge from TreatmentDischarge 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 yearsSome children may normalize in speech

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

Assessment ToolsArticulation Tests

GFTAPAT

Phonologic TestsHAPP (Hodson Assessment of Phonologic

Pattersn)CAAP (Clinical Assessment of Articulation &

Phonology)Khan-Lewis Phonological Analysis