1. Helen Grech (University of Malta)
Assessment and Diagnosis of Sub-Types of Speech Disorders in Children Sound Difficulties in the Maltese Speech Disorders in Assessment Maltese Context
Helen Grech (University of Malta)
ISHLA February 2017

2. OUTLINE Prevalence Classification of Speech Disorders
Speech Processing Model
Identified sub-groups of Speech Disorder
Deficits in the Speech Processing Chain
Characteristics of Sub-types of Speech Disorder

3. Children with Speech Sound Difficulties (SSD)
High % of SLPs case load includes children with SSD In Middlesborough, UK, around 30% of children referred for therapy were those with SSD (Broomfield & Dodd, 2004) Prevalence of SSD reported % for ‘speech delay’ only (Law et al, 2000) Mcleod & Baker (2017) report studies with diverse prevalence of children with SSD (with & without comorbidity)

4. Different approaches for describing speech difficulties exist.
There is no agreed classification to date.
The need for a harmonised classification system for developmental speech disorders is acknowledged universally e.g., Shriberg (2002); US National Institute of Health (2003); Dodd (2005).

5. Classifying by Aetiology (e.g., Shriberg, 2002; Shriberg et al, 2010)
Often no identifiable cause or difficult to establish 1 cause
Shriberg (2002) claims that speech disorder of unknown origin is possibly genetically linked
Shriberg et al (2010) reports that classification systems based on biological phenotypes is needed given the advances in genomics
Does this determine the nature/extent of the disorder & clinical management?

6. Linguistic Typology (e.g., Grunwell, 1985)
Discribes nature/extent of speech difficulties
No possible explanation to the impairment is given
Treating the symptoms & not underlying difficulties

7. Pycholinguistic Approach (e.g., Stackhouse & Wells, 1997)
Mapping interactions of input, cognitive-linguistic mental processes & output
Identifies strengths & weaknesses in speech-processing chain
Lengthy process for diagnosis; child is claimed as unique & fails to identify sub-groups

8. Sub-groups of SSD (Dodd, 1995; 2005)
Links surface error patterns with underlying deficits
Specific intervention approaches used depending on claimed deficit
Cross-linguistic case studies supporting evidence & effectiveness of therapy

9. Phonological impairment Inconsistent speech disorder
McLeod & Baker (2017)
Types of SSD
Phonological impairment
Inconsistent speech disorder
Articulation impairment
Childhood apraxia of speech
Childhood dysarthria
Base sub-grouping of SSD on the speech processing chain indicating possible difficulties at the following levels:
Perception
Articulation/Motor
Phonological representation
Organisation

10. Model of Speech-processing Chain
From Dodd B. &. McCormack, P. (1995). A model of speech processing for differential diagnosis of phonological disorders. In B. Dodd (Ed.) Differential Diagnosis and Treatment of Children with Speech Disorders (p. 65). London:Whurr Pub.

11. Model of Speech-processing Chain
From Dodd B. &. McCormack, P. (1995). A model of speech processing for differential diagnosis of phonological disorders. In B. Dodd (Ed.) Differential Diagnosis and Treatment of Children with Speech Disorders (p. 65). London:Whurr Pub.

12. What to Assess? Anatomical & physiological Phonetic Phonological
Developmental

13. Subtypes of Speech Disorder (Dodd,1995)
Articulation disorder
Delayed phonological development
Consistent deviant disorder
Inconsistent disorder
Others (such as dyspraxia) 5

14. Articulation Disorder
What to assess???
Impaired ability to pronounce any individual speech sounds in words, CV syllables or in isolation, on imitation.

15. ‘Errors’ characteristic of younger normally developing children
Delayed Phonological Development
‘Errors’ characteristic of younger normally developing children
What to assess???

16. Consistently Used Non-developmental Error Patterns
May also exhibit one or more delayed error patterns
Exhibit difficulties with phonological awareness
Associated with later literacy difficulties
What to assess???

17. Production of same lexical item inconsistently
Inconsistent Errors
Production of same lexical item inconsistently
(in absence of oro-motor difficulties such as groping or an impaired ability to imitate oral gestures and words)
What to assess???

18. Characteristics of DVD (Ozanne, 1995)
CHILDREN WHO EXHIBIT DIFFICULTIES IN:
PHONOLOGICAL PLANNING
PHONETIC PROGRAMMING
OROMOTOR & SPEECH-MOTOR PROGRAMME IMPLEMENTATION
Those exhibiting deficits at 1-2 levels should not be classified as having DVD.

19. Phonological Planning
VOWEL ERRORS
MORE ERRORS IN POLYSYLLABIC WORDS
MORE ERRORS IN PHRASES
LIMITED USE OF RULES/PROCESSES
POOR PHONOTACTICS
INCONSISTENT ARTICULATION

20. Phonetic Programming GROPING CONSONANT DELETION
VOLUNTARY VERSUS INVOLUNTARY CONTROL

21. Oro/Speech Motor Programming
DDK RATE
DDK SEQUENCES
POOR OROMOTOR SKILLS

22. Intervention Approaches
Whole language approach
Phonologically based approach
Metaphon therapy (Dean et al, 1995)
Maximal contrast approach (Gierut, 1989)
Core vocabulary approach
PROMPT therapy
Parents and children together (PACT) collaborative approach to phonological therapy 12

23. Phonological contrast
Comparison of Intervention Approaches (Dodd, 2004) S = SUCCESSFUL; US = UNSUCCESSFUL; NT = NOT TESTED
Approach
Articulation
Delay
Consistent
Inconsistent
Single speech sound S NT US
Phonological contrast
Core vocabulary
Whole language