Transcript Chapter 5: Phonological Disorders

Chapter 5:
Phonological Disorders
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.1
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?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.2
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.3
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.4
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?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.5
Case Study #2: Emily
• 9-year old child who has received speechlanguage 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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.6
Case Study #2 Questions
•
•
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?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.7
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.8
Case Study #3 Questions
•
•
•
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?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.9
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.10
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 causes
40%: known causes, such as recurrent
middle ear infections, motor-speech
disorders, and other developmental disorders
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.11
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.12
Shifting Perspectives
• Current Preferred Terms:
Disorder:
-phonological disorder, developmental
phonological disorder, phonological impairment
Assessment:
-phonological assessment, phonological
analysis
Treatment:
-phonological remediation/intervention
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.13
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.14
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.15
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.16
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.17
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.18
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.19
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.20
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.21
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.22
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.23
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.24
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)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.25
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.26
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.27
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.28
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.29
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.30
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.)
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.31
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.32
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.33
The Assessment Process
•
•
•
•
Referral
Screening
Comprehensive Phonological Assessment
Diagnosis
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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5.34
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.35
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.36
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
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5.37
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.38
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.39
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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.40
Four Common Approaches
1) 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
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Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.41
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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5.42
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
5.43
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
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.