1. COMD 4381: Disorders of Articulation Etiology/Prevalence/General Factors

2. Also called an idiopathic disorder When typically developing children have difficulty producing certain speech sounds Cannot be explained on the basis of neurological damage, muscle weakness, or structural problems “Functional” does not explain the disorder – only implies that an organic cause was not found Functional Articulation Disorder

3. Speech Sound Disorder (Flahive & Hodson, 2010) SSD is a term which is gaining popularity “Functional articulation disorder” is a term which has been criticized yet still widely used SSD does not explicitly imply that a person’s disordered speech can be attributed to an impairment of articulation or phonology A neutral term that does not describe the problem (Justice, 2010; Nelson, 2010)

4. Organic Disorders Arise from various physical anomalies that affect the function or structure of the speech mechanism Physical damage to the CNS or PNS, the oral mechanism, or all of these Treatment for these should be multidisiplinary and involve members of the medical community

5. Prevalence/Statistics 32% of all communication disorders are articulation and phonological disorders 10 – 15 % of preschoolers have an articulation or phonological disorder SSD in young children is 8-9% by 1 st grade – roughly 5% have noticeable speech disorders with an unknown cause (NIDCD) 80% of children with phonological disorders are severe enough to require treatment (ASHA)

6. Prevalence/Statistics In 2006, almost 91% of school-based SLPs indicated that they served children with SSD (ASHA) Children with phonological disorders often require other types of remedial services…with 50-70% exhibiting general academic difficulty through 12 th grade (ASHA)

7. Prevalence/Statistics Between 28 – 60% of children with a speech and/or language deficit have a sibling or parent also affected (2010) By the age of 8 years, all speech sounds should be produced correctly (ASHA)

8. General Factors Related to SSD Gender Some evidence that female children generally have slightly superior articulatory skills to those of male children Evidence is weak – yet more boys than girls tend to have SSD (Bernthal, Bankston, & Flipsen, 2009)

9. Intelligence Intelligence has not been shown to be related to SSD Only associated when intelligence is significantly below normal

10. Birth Order & Sibling Status Some evidence that firstborn and only children have better articulation skills than those who have older siblings (Bernthal et al., 2009) The greater the age difference between siblings, the better the articulation of the younger child Older one may be a poor speech model

11. Socioeconomic Status (SES) SES is NOT a strong factor in the etiology of articulation disorders Some studies show that children from lower SES backgrounds make more errors than children from middle- and upper-class backgrounds Hypothesize…lower SES families tend not to have health insurance (OM, dental, ortho issues)

12. Language Development & Academic Performance Younger children with severe SSDs are more likely to have language problems than children with mild-moderate language delays (Bernthal et al., 2009) Young children with SSDs may be at risk for problems with reading and spelling in the elementary school years (Justice, Gillon, & Schuele, 2009)

13. Auditory Discrimination Skills Researchers used to believe that children with SSDs had poor auditory discrimination skills, which caused the disorders Studies have had inconsistent results SLPs still conduct intensive work on auditory discrimination skills…believing it will lead to improved articulation skills EBP?

14. Articulatory Errors Phonological error patterns include final consonant deletion, cluster reduction, assimilation, and others  motoric ability is pressent These patterns underlie the lack of intelligibility Child has the motoric ability (structure and function are fine) to produce the sounds correctly  this is normal, it is a phonological process but should disappear at 3

15. Articulatory Errors Errors involve misproductions of specific phonemes Child is motorically unable to produce the erred phoneme Treatment needs to include teaching the correct production and emphasizing speech-motor control

16. Articulation Errors Substitutions Omissions (deletions) Distortions Distortions include: labialization, nasalization, pharyngeal fricative, frontal lisp, lateral lisp, stridency deletion, unaspirated, Initial/medial/final errors Prevocalic/intervocalic/ postvocalic errors

17. Organically Based Disorders Oral Structural Variables Some children have deviations of the oral structure with normal speech skills SSDs may also be present in the absence of structural anomalies

18. Oral Structural Variables Ankyloglossia “tongue tied” Lingual frenum is too short Tongue tip mobility is reduced Clipping the frenum used to be a common practice; now a rare procedure Children can compensate This becomes an issue with feeding, he can’t form a seal to pump the tongue due to the tongues restricted mobility. Oral intake first, speech second.

19. Oral Structural Variables Dental Deviations Malocclusion – deviations in the shape and dimensions of the mandible and maxilla (skeletal malocclusion) and the positioning of individual teeth (dental malocclusion) Class I-normal Class II-overbite Class III-underbite

20. Oral Structural Deviations Oral-Motor Coordination Skills Assess the functional and structural integrity of the lips, jaw, and tongue Test of diadochokinetic rate (maximum repetition rate of syllables in rapid succession) Not all children with articulation difficulties perform poorly on diadochokinetic tests Research is inconclusive

21. Oral Structural Variables Orofacial Myofunctional Disorders OMD = “tongue thrust” OMD includes any anatomical or physiological characteristic of the orofacial structures (palate, cheeks, tongue, lips, teeth, jaw) that interferes with normal speech, physical, dentofacial, or psychosocial development This includes swallow, labial and lingual rest, and speech posture differences

22. OMD Usually, a child with OMD exhibits deviant swallows – tongue tip pushes against front teeth Anterior open bite Sounds involved may include: /s/, /z/, sh, ch, /j/, /t/, /d/, /l/, /n/

23. Hearing Loss Degree of hearing loss is frequently related to the severity of the SSD Congenital, profound hearing loss – greatest challenges as they cannot monitor their speech production Errors with consonants and vowels…many sound substitutions, distortions, and omissions of phonemes

24. Hearing Loss Mild hearing loss (10 – 30 dB), especially associated with chronic OM or fluid, may have SSDs Common to omit high-frequency voiceless sounds…/s/ & /t/ Phonological processes commonly used are final consonant deletion, stridency deletion, and fronting

25. Neuropathologies Dysarthria Dysarthria is a speech-motor disorder caused by damage to the CNS or PNS Damage causes weakness, paralysis, or incoordination of the muscles of speech In children, is can be caused by Cerebral Palsy, head injury, degenerative diseases, tumors, or stroke All systems are affected: phonation, resonation, respiration, and articulation

26. Dysarthria Common articulatory error patterns: Treatment is very repetitive and structured Involves increasing muscle tone and strength, increasing rate and range of motion, and treating other parameters such as respiration that affect intelligibility AAC (augmentative alternative communication) may be an option as well as prosthetic devices  pointing to photos to get needs met

27. Neuropathologies Apraxia Apraxia of speech is caused by damage to the CNS No weakness or paralysis of muscles “motor programming disorder” Developmental apraxia of speech (DAS) has been debated; now called childhood apraxia of speech (CAS) For some, it is congenital(born with it) – others have a neurological impairment (ASHA, 2007a)

28. Apraxia These children have sensorimotor problems in the positioning and sequentially moving of muscles  groping Exhibit groping behaviors and poor intelligibility due to inconsistent and multiple errors Inconsistent errors are a hallmark of CAS (Hall, 2007) CAS common characteristics:

29. Apraxia These children may have difficulty with rhyming and with identifying syllables At risk for language, reading, and spelling problems Treatment should progress from easy to difficult tasks Including extensive drills stressing sequence of movements Gains are slow and treatment should be intensive

30. Risk Factors Chromosomal abnormalities Genetic or congenital disorders Severe sensory impairments Disturbance in CNS Intracranial hemorrhage Hyperbilirubinemia –clinically your body can’t process bilirubin through your body, there will be a yellowish tint

31. Risk Factors Major congenital anomalies Congenital infections FAS – toxic substance abuses Low birth weight-less than 3.5 lbs Respiratory distress Lack of oxygen Brain hemorrhage Nutritional deprivation