1. Phonological Disorders
Now how’d ya say that?

2. Sounds good
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3. Phonological Disorder
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

4. Case Studies
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 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?

5. Definition
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

6. Prevalence & 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

7. Articulation versus Phonologic
Motor problem impacting articulators
‘speech correction’
Phonological
Immature phonologic system
Building/reorganizing the system.

8. Some things to know about Phonological Disorders
Phonemes as Contrasts
Roughly 40 speech sounds
Phoneme - allophones
Underlying representation of each sound/phoneme
International Phonetic Alphabet
Each phoneme has a representative symbol
Articulatory Phonetics
Classification of Vowels & Consonants
Children’s Acquisition of Consonants
Early 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

9. Classifying Phonological Disorders
Four Major Symptoms:
Difficulty with expressive phonology
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 retrieval
Children with symptom #1 and not the others may have a motor-speech or an articulation disorder, not a phonological disorder

10. Unintelligibility
Mild – speech is understood but contains noticeable errors
Moderate – speech is difficult to understand
related (close to severe)
Severe – speech cannot be understood at all

11. 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

12. 5 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

13. Unknown Origin Characteristics of speech delay:
Small phonemic inventory
Phoneme collapse
Persisting errors
Reduced intelligibility
Greater risk for dyslexia
Has 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

14. 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

15. Otitis Media – Cause & Risks
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

16. Special Populations – 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
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17. 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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18. 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
400 different syndromes for which cleft palate is associated
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19. 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

20. 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

21. More Assessment Assessment includes such activities as:
Caregiver interview and case history
Oral mechanism screening (p.170)
Hearing screening
Language screening or evaluation
Phonological analysis
-standardized testing
-spontaneous speech sampling
-probing
Most popular test of phonolgy- Goldman fristo test.

22. 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

23. Treating Phonological Disorders
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

24. Categorizing Sounds Vowels Consonants
Front/back, high/low, tense/lax, rounded/unrounded
Consonants
Place, manner, voicing

25. 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 deviations
sounds inconsistently mispronounced;
sounds that are acquired earlier;
sounds that are part of child’s inventory;

26. Four Main Types of Tx
Minimal Opposition Contrast Therapy – recognize and produce single- phoneme contrasts between word
Minimal pairing
2) Multiple Oppositions Therapy – build phonemic contrasts within a phonemic collapse
phoneme collapse
3) Cycles Therapy – stimulate use of phonemes or patterns by treating in cycles
changes 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
online/archives/2002/q4/021203a.htm

27. Target Goals Five possible approaches in selecting targets:
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
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

28. 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

29. Assessment Tools Articulation Tests Phonologic Tests GFTA PAT
HAPP (Hodson Assessment of Phonologic Pattersn)
CAAP (Clinical Assessment of Articulation & Phonology)
Khan-Lewis Phonological Analysis