Lecture 1.

ARTICULATION AND PHONOLOGICAL DISORDERS

Phonetics vs Phonology
Phonology:
• The study of the phonological component of the language faculty: sound systems &
the rules for sound combination and pronunciation
• Study of sound patterns on a mental level
Phonetics:
• The study of speech sounds & their physical properties, how they are produced &
perceived
• Study of speech sounds on a physical level.

Symbols can represent specific sounds that are produced, with specific properties.
When we look at physical speech sounds, we look at phonetics.
Basically you think phonology & speak phonetics.

Phonetics
Notation
When we write down a phonetic representation/ phonetic transcription of a
word/sentence, we put it between […] (speaking)
3 types of Phonetics
1. Acoustic Phonetics
- The study of the physical properties of sounds
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 - E.g. frequency, amplitude, wave duration.
- A spectrogram is a visual representation of sound frequencies.
2. Auditory Phonetics
- The study of the way in which hearers perceive sounds
3. Articulatory Phonetics
- The study of the way in which the vocal tract produces sounds.
- How humans produce speech sounds using their speech organs.
- This is the one we focus on mainly.

Articulation
Articulation: The changing of the outgoing air stream and voice by modifying the size and
shape of the resonators. This refers to the action of the speech organs in the production of
speech sounds.

• Articulation has to do with the phonetic level.

• Articulation is about the pronunciation of sounds by actually forming sounds by the
movement of the articulators.
o Whereas phonology is about the rules of a language that dictate in which way
we can arrange words to communicate.
• Phonology = mental level. Articulation = physical level.

The difference between an articulation disorder and a phonological

disorder
In an articulation disorder the child’s difficulty is at a phonetic level. That is, they have
trouble making the individual speech sounds (problem with pronunciation).
In a phonological disorder the child’s difficulty is at a phonemic level (in the mind). This
“phonemic level” is sometimes referred to as “the linguistic level” or “a cognitive level”.

Articulation Disorder Phonological disorder

The child has difficulty with only one or two
sounds. The reason for this may be
unknown or known.
This usually results in incorrect production
of a number of sounds.
The child has difficulty organising speech
sounds into a system of sound contrasts
(phonemic contrasts).

Characterized by: Characterized by:

S = substitution (red – wed) Backing: (gog – dog)
O = omission (ta – take) Stoping: (dump – jump)
D = distortion (R – r) Final consonant deletion (toe – toad)
A = addition (buhlue – blue)

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To make this diagnosis, we need knowledge of:
• Phonemic inventory of child’s language
• Typical speech development
o We don’t use the word “normal”, because what is normal?
o What is typical in one language or dialect might not be typical in another.
o The “r” in Afrikaans is an example of this. To “brei” is considered abnormal is
most regions, but in the Cape it is considered normal.

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Typical Development
1. Babbling
2. Speech intelligibility
3. Phonological processes
4. Acquisition of specific sounds
Speech intelligibility: sometimes parents are able to understand their child, because they
have adapted to the child’s speech or they’ve learned certain cues.

1. Babbling and Early Words

Stages In The Development Of Pre-speech Vocalizations
Developmental stages of pre-speech vocalizations (e.g., as described by Carol Stoel-
Gammon in 1998) are not discrete, and vocalizations from previous stages continue to be
uttered subsequently. Novel emergent behaviors define the beginning of a new stage. Ages
are assigned to each stage as estimates only, because children differ greatly regarding the
timing for recording milestones of early language development.
The first stage (from zero to two months), phonation, is characterized mainly by fussing,
crying, sneezing, and burping, which bear little resemblance to adult speech. The second
stage (at two to three months), cooing, begins when back vowels and nasals appear
together with velar consonants (e.g., \gu\, \ku\). Cooing differs in its acoustic characteristics
from adult vocalizations and is recorded mainly during interactions with caregivers. In the
third stage (at four to six months), vocal play or expansion, syllable-like productions with
long vowels appear. Squeals, growls, yells, bilabial or labiodental trills, and friction noises
demonstrate infants' playful exploration of their vocal tract capabilities during this stage.
In the extremely important canonical babbling stage (at seven to ten months), two types of
productions emerge: reduplicated babbling—identical, repetitive sequences of CV syllables
(e.g., \ma\ma\, \da\da\); and variegated babbling—sequences of different consonants and
vowels (e.g., CV, V, VC, VCV = \ga\e\im\ada\). Such productions are not true words, as they
lack meaning. Canonical babbling is syllabic, containing mainly frontal stops, nasals, and
glides coupled with lax vowels (e.g., \a\, \e\, \o\). The emergence of canonical babbling is
highly important, holding predictive value for future linguistic developments. Oller and her
colleagues in 1999 argued that babies who do not produce canonical babbling on time are at
high risk for future speech and language pathology, and should be carefully evaluated by a
language clinician.
In the fifth stage (at twelve to thirteen months), jargon or intonated babble, infants produce
long strings of syllables having varied stress and intonation patterns. Jargon sounds like
whole sentences conveying the contents of statements or questions, and often co-occurs
with real words. Yet, it lacks linguistic content or grammatical structure.

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2. Speech intelligibility
The proportion of a speaker's output that a listener can readily understand
The term intelligibility refers to 'speech clarity' or the proportion of a speaker's output that a
listener can readily understand. In typical development, as children learn to talk, their
comprehensibility to those around them steadily increases. A key characteristic of children
with speech sound disorders is that they are often significantly less intelligible than non-
speech-impaired children of the same age.
In young children there is often quite a marked difference between single word (SW) and
conversational speech (CS) intelligibility; between intelligibility to their close family
members and intelligibility to unfamiliar listeners; and intelligibility in known versus
unknown conversational topics. With regard to families, siblings may sometimes be more
adept than parents in comprehending what their little brothers and sisters are saying.
Weiss (1982): 24-36 months
An early source of typical intelligibility criteria came from Weiss (1982) who suggested that
speech should be:
• 26-50% intelligible by 2;0
• 51-70% intelligible by 2;6
• 71-80% intelligible by 3;0
Intelligibility to parents: 18-36 months
Table 1, above, provides a rough guide to how clearly a child should be speaking in the age-
range 18 to 36 months. It is important to bear in mind that there is considerable individual
variation between children. If, as a parent, you are in doubt about your own child's speech
sound development or speech clarity, an assessment by a speech-language pathologist /
speech and language therapist (SLP/SLT) will quickly tell you if your child is 'on track' and
making the right combination of correct sounds and 'errors' for their age.
Intelligibility to strangers 12-48 months
A handy formula suggested by Dr Peter Flipsen Jr (see also Flipsen, 2006) and others is used
by some SLPs/SLTs as a guide to the expected conversational intelligibility levels of
preschoolers talking to unfamiliar listeners, or "strangers". The formula fits well with the
suggestions of Coplan & Gleason (1988) and is:
AGE IN YEARS / 4 x 100 = % UNDERSTOOD BY STRANGERS
Child aged 1;0 = 1/4 or 25% intelligible to strangers
Child aged 2;0 = 2/4 or 50% intelligible to strangers
Child aged 3;0 = 3/4 or 75% intelligible to strangers
Child aged 4;0 = 4/4 or 100% intelligible to strangers
Pascoe (2005) is in general agreement, and says, "By three years of age, a child's
spontaneous speech should be at least 50% intelligible to unfamiliar adults"... "By four years
of age, a child's spontaneous speech should be intelligible to unfamiliar adults, even though
some articulation and phonological differences are likely to be present."

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Less than 66% percent
In Dr Michelle Pascoe's helpful Speech Intelligibility article on the Apraxia-Kids web site she
cites Gordon-Brannan & Hodson (2000) who determined that children above the age of 4;0
with speech intelligibility score of less than 66% should be considered as candidates for
intervention. What this means is that if less than 2/3 of the utterances of a child aged 4;0 in
conversation with an unfamiliar listener can be understood by that listener, then
intervention is indicated. Unfamiliar listeners should be able to understand at least 66% of
what a child of 4;0 says.
Intelligibility Rating Scale
In the Quick Screener child speech assessment procedure is a simple, subjective,
impressionistic (so unreliable!) 5-point conversational speech intelligibility rating scale is
used. It is useful to have an intelligibility rating from a child's parent or parents, SLP and a
'stranger' (unfamiliar listener). The scale is:
1: completely intelligible in conversation
2: mostly intelligible in conversation
3: somewhat intelligible in conversation
4: mostly unintelligible in conversation
5: completely unintelligible in conversation
While these ratings are unreliable they are useful clinically as a means of comparing
impressions of intelligibility in the same child over time and between 'raters'.
Quick screener
In her doctoral research Dr Debbie James from South Australia found ten long words that
were particularly 'clinically useful' in revealing speech production difficulties in children. The
words were: ambulance, hippopotamus, computer, spaghetti, vegetables, helicopter,
animals, caravan, caterpillar and butterfly.

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3. Phonological Processes:
• An incorrect phonotactical rule that children apply in order for them to start
communicating although they haven’t mastered all the phonology and articulation
skills that they need. So they apply this simplified rule.
o Patterns that young children use to simplify adult speech.
• e.g. “wa-wa” for “water” or “tat” for “cat
• All children use them initially, but as they mature they master the real phonotactical
rules of their language.
• Should disappear at certain ages.
• Phonological processes used by isiXhosa speaking children are similar to other
languages.
• BUT the exact nature of phonological processes will be determined by the language
of the child (word structure of e.g. isiXhosa is different, so e.g. you won’t find
“cluster reduction” in isiXhosa children).
All children make predictable pronunciation errors (not really 'errors' at all, when you stop
to think about it) when they are learning to talk like adults. These 'errors' are called
phonological processes, or phonological deviations. In Table 2 are the common phonological
processes found in children's speech while they are learning the adult sound-system of
English.
Table 2: Phonological Processes in Typical Speech Development

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4. Acquisition of specific sounds:
Language differences

• isiXhosa children acquire many of their phonemes relatively early:

o 80% of isiXhosa phonemes are acquired by 3:0 years and clicks emerge
between 2;6 and 4;0 years isiXhosa speaking children –affricates and some of
the more complex clicks
• Afrikaans and English speaking children until approx. 7 years with
o /th/ only at 8;6.
• Be aware of these differences when assessing children of different languages.

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Characteristics of Disorders of Articulation and Phonology
The children that will typically be referred to you as speech therapist are typically children
with:

• Problems with pronunciation

• Problems with speech intelligibility

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 Lecture 1.2

SCREENING FOR SPEECH DEVELOPMENT

Learning outcomes for this section:
• Definition of Screening
• Purpose of Screening
• Difference between Screening and Diagnostic Assessment
• Importance of Representative Sampling during Screening
• Formal and Informal Screening Methods

How Do children End Up With You?

1. Referred 2. Screening
• Doctor / clinic sister
• Teacher
• Parents

SCREENING (general definition)

The collection of preliminary information regarding the characteristics that contribute
significantly to the health, education and wellbeing of the individual and that is relevant to
his life tasks. The method of data collection must be appropriate and reasonable with regard
to economic time investment, costs and available resources in order to handle large
numbers of people.

Screening
• A time-and cost-effective procedure to determine whether there is reason for concern
and whether there is need for a complete speech assessment.
o Speech therapists not only assess and treat patients, but they also identify at risk
children or children who already have a problem and who might need further
assessment.

Screening vs Assessment
1. SCREENING
Goal: to determine whether there is a need for further assessment. Not to determine a
diagnosis or speech problem.
2. ASSESSMENT
Goal: to determine the nature and extent of the child’s problem (diagnostic procedure).

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Speech Screening Process

FAIL or PASS

Complete speech assessment Discharged

If a child passes the speech screening it means that you feel that what you’ve seen in the
10min is evident that the child’s speech development is on the right track and there is no
reason for further investigation.
If the child fails the speech screening it means that you are concerned about the child’s
speech development and that you want to further assess the child.

Representative Sampling
Written examination example:
• Purpose of this assessment: to determine student’s knowledge regarding the
components of language.
• Topics covered in exam questions:
o Syntax
o Morphology
o Phonology
• Student’s mark: 100%
• Conclusions drawn on students’ knowledge of components of language: INVALID
o We did not assess Pragmatics and Semantics in the exam where the student had
the opportunity to express their knowledge on these two components.
o The student could have struggled with these two components, so we cannot
conclude that the student is competent in ALL the components of language.
Ensure opportunities for pronunciation of:
1. In every, or almost every sound in the language
2. in different phonetic contexts, e.g. beginning, medial and final positions in words as well
as in consonant clusters.
CHALLENGE: Screening offers a limited speech sample!

SCREENING for speech development

Formal Informal
Commercially available Self-compiled
Standardised tests Contextually-appropriate
• Templin-Darley Screening Test
• Screening Deep Test Articulation
• Fluharty Speech and Language Screening Test for Preschool Children
• Quick Screen of Phonology

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INFORMAL SCREENING for speech development
Elicited speech
✓ Naming tasks
✓ Sentence completion
✓ Retelling
✓ Imitation
o Should be the last option; your pronunciation could have had an impact on the
way that the child now pronounces the repeated word). Thus, the child could
actually be unable to pronounce the word, but can now merely pronounce it
because of your influence. You want to know if the child can spontaneously
pronounce all the sounds correctly.
Spontaneous speech
✓ Conversations over favourite TV programme
✓ Personal experience
✓ Conversations in the classroom
✓ Etc!
NB: You need to be prepared for this and you should have constructed a plan with materials
etc.

Typical Speech Development Informs Screening Protocols

Knowledge about:
• Child’s speaking context
o E.g. a “brei R” for certain Afrikaans speaking children
• Phonological processes that children typically suffer with
o E.g. consonant clusters for English speaking children (e.g. the “sp” in spider)
o Consonant clusters are mostly found in English speaking children, so know which
processes apply for which language.
• Age of acquisition of specific sounds
• Speech intelligibility

CONCLUSION
Screening is…
• Preliminary
• Should be representative
• Relies on
o data about typical speech development
o phonemic inventory of the specific language (representative sample)

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 Lecture 1.3

DIAGNOSTIC ASSESSMENT PROCEDURES

1. Case history
2. OSME (Oral Sensory Motor Examination)
3. Speech sampling (single words and continuous speech)
4. Interpretation of assessment data

1. CASE HISTORY
Learning outcomes:
• Understand the purpose of obtaining a case history
• Describe the methods to obtain a case history
• Explain and motivate the relevant areas to address when obtaining a case history

Case History Methods

1. Personal Interview
2. Questionnaire
The primary caregiver of the child is usually the preferred person to provide the information
(parent/nanny/older sibling).

Purpose:
1. Identify risk factors
2. Inform assessment & therapy
o Might inform about the probably of a speech disorder or the type of disorder.
o The caregiver could e.g. say that the child lost their front teeth a week ago, so
the “s” sound will be affected.
3. Provide information
o to caregiver whilst doing interview

INFORMATION NEEDED (WHAT DO YOU NEED TO ASK THE

CAREGIVER?)
1. Child’s age and date of birth.
• Will help you to know whether the child’s speech is typical of that age.

2. Home language and other languages exposed to.

• To determine in which language the assessment should take place.
• To assess whether speech errors are the effect of one language on another.

Language of Assessment
When a child’s home language differs from their “school language”, which language do
you assess in?
• Preferably you want to assess a child in every language that he/she is exposed to.

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 • But what if the home language is isiXhosa and the school language is English?
Consider the following:
1. Parents feedback
• What was their main concern?
2. Child’s language of learning
• Did the parents mention that the child’s teacher was concerned about the
child’s pronunciation? Then it would be priority to assess the child in this
language.
• Even if parents came in because they are concerned about the child’s
pronunciation of sounds in the home language, it is still very important to
assess the child in his/her language of learning, as it is important for a child’s
performance in school and for their development on par with his/her peers.
• Assessing in the language of learning will show how the (possible) speech
impairment impacts his/her school performance and interaction.
3. Preliminary information from the screening
• Maybe you know from the screening you already found that the child
struggles in both languages OR you’ve found that e.g. English is not the
problem, so their home language e.g. isiXhosa is where the problems are.
4. Language proficiency of the therapist
• Are you proficient in isiXhosa?

INFORMATION NEEDED (CONTINUED)

3. Primary Caregiver’s Perceptions of the Problem:
• Concerns
• Specific sounds (pay particular attention to these sounds during assessment)
• Speech intelligibility – familiar and unfamiliar listeners
o Often parents/caregivers become used to the child’s pronunciation and don’t
believe that there is something wrong with the child’s speech, but other
people who aren’t in constant contact with the child cannot understand.
Asking about this is particularly important where parents are in denial about
a problem.
• Onset of problem or changes over time
o If a specific time is mentioned, it is a cause for concern. It can also provide
information about possible causes such as trauma to the head or emotional
causes.
• Possible causes
• Family history of speech and language problems

4. Medical history:
• Otitis media
o Causes mild temporary conductive hearing loss.
o During the time of having otitis media whilst still developing speech, the child
does not have access to all the speech sounds or only to distorted speech

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 sounds. This can definitely impact speech. So very important to ask about
this.
• Chronic illnesses (specifically otitis media)
• Complications during pregnancy or birth
• Syndromes
o Such as down syndrome, which affects speech.
• Structural problems with speech mechanism
• Feeding problems
o Could be an indication of problems with the coordination of the movement of
the muscles in the face and in the jaw and mouth and overall speech
mechanism.
o Feeding and speech – same structures and muscles involved.
• Involvement of other professional persons
o E.g. does the child go to an occupational therapist? This could tell you
something about the child’s finely coordinated muscle movements.
• Ask whether a hearing loss as a possible cause for a speech impairment was ever
ruled out by means of a hearing test or a screening.

5. Personal:
• Context-specific information
o e.g. cultural background, dialects, unique linguistic characteristics of their
community
o This is important, because if a certain pronunciation is typical of the child’s
cultural background, it cannot be ruled a speech impairment.
o An example of this is the rolling “r” or “brei R” in the Cape Winelands district.
• The child’s awareness of his/her problem
o Ask the caregiver whether the child is very sensitive about the way that they
pronounce a sound differently to their pears.
o If the child is sensitive about their pronunciation, it would be important to
first try to connect with such a child and build a bond until the child feels safe
enough to show their vulnerability.
• Siblings
• School or day care
• Friends
• Interests or favourites

ALL INFORMATION SHOULD BE DEALT WITH IN STRICT CONFIDENCE.

CONCLUSION: CASE HISTORY

• Important first step
• Plan and execute thoroughly
• Sets the stage for rest of therapy process

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Case History Form Example

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QUIZ
1. View the following statement and decide whether it is true or false:
Phonology entails the rules of the sound system of a language.
• True
• False

2. View the following statement and choose whether it's true or false:
An articulation disorder occurs at phonemic level.

• True
• False

3. An articulation disorder entails a problem with the motor

production of one or two speech sounds and is characterised by
SODA (substitutions, omissions, distortions, additions).
Choose the correct articulation error for each of the following examples:

4. View the following statement and choose whether it is true or false:

All children present with phonological processes at some stage.
• True
• False

5. Which sound is the last sound to develop in English-speaking

children?
a. v as in vine
b. r as in ring
c. th as in thing
d. j as in jaw

6. View the assessment methods below and match the correct

definition with each one:

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7. Otitis Media can cause a:
A) Permanent mild hearing loss
B) Temporary mild conductive hearing loss
C) Temporary mild sensory-neuro hearing loss
D) Temporary moderate conductive hearing loss

8. A phonological disorder usually results in incorrect production of a

number of sounds. The child has difficulty organising speech sounds
into a system of sound contrasts (phonemic contrasts).
View the example of a child's results in the assessment below and identify the
phonological process that is present in the child's speech (use resources from
preliminaries to assessment and treatment lecture as reference):
• sun → tun
• foot → poot
• dress → dret
• leaf → leap
a. Weak syllable deletion
b. Stopping
c. Fronting
d. Cluster reduction

9. The purpose of a case history form is to:

A) Provide information
B) Inform therapy and assessment
C) Identify risk factors
D) Get a speech sample
E) Write a report
Select one:
a. A), B) and E) c. A), B) and C)
b. All of the above d. D) and C)

10. View the following statement and choose whether it is true or

false:
Down's Syndrome is associated with low oral muscle tone.
• True
• False

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 Lecture 2.1

DIAGNOSTIC ASSESSMENT PROCEDURES

1. Case history
2. OSME (Oral Sensory Motor Examination)
3. Speech sampling (single words and continuous speech)
4. Interpretation of assessment data

2. OSME
To test the STRUCTURAL and FUNCTIONAL adequacy for speech.

Learning outcomes:
• Identify Oral-motor structures involved in speech production.
• Explain the role of the anatomy and physiology of these structures for speech.
• Describe the aspects of function (which include strength, range, speed, coordination)
of the speech structures.
• Demonstrate the knowledge and skills with regards to the performance of OSME as a
component of speech assessment.

OSME acronym
• O ral
• S ensory
• M otor
• E xamination

Also known as…

• Oral-peripheral examination
• OPE
• Oral-facial examination
• Oral-motor examination
• Oral-mechanism exam
• Oral cavity examination
• Motor speech examination

OSME definition
Examination of the oral facial structures to assess its structural and functional
adequacy for speech production.

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Structures

Why? What? How?

WHY (RATIONALE):
Some speech errors are caused by structural or functional problems of the speech
mechanism.
Speech mechanism = oral & facial structures used for speech production.
An example of a problem with the speech mechanism:

The front upper middle teeth are missing.

This could cause problems with sounds
such as the “s” sound, a lisp could
develop, alveolar sounds could be
affected such as “t” and “d”.

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Another example of a problem with the speech mechanism that could impact speech:

A unilateral cleft of the lip.

A variety of sounds will be
impacted, especially
bilabial sounds. On right:
repaired cleft.

OSME definition
Examination of the oral facial structures to assess its structural and functional adequacy for
speech production.

STRUCTURAL ADEQUACY
To assess whether the structures are structurally adequate, observe:
• symmetry
• clefts/damage
• colour

This picture is used throughout the lecture

when referring to structural adequacy. Basically, you
have to LOOK for any adequacy problems such as
symmetry, damage and colour (hence the use of the
eyes).

FUNCTIONAL ADEQUACY (mobile articulators)

Assessing the movement:
• Range
• Speed
• Strength
• Coordination

This picture is used throughout the lecture when

referring to functional adequacy.

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HOW TO CONDUCT THE OSME
Start at the Front of the mouth and move to the Back of the mouth.

Front Back
1. Face
2. Lips
3. Dentition and
jaws
4. Tongue
5. Palatum
6. Faucial arches
7. Velum
8. Pharynx

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 1. FACE
1. Distinctive facial features
2. Symmetry
3. Anything atypical

2. LIPS
Structural adequacy:
1. Clefts:
Structurally compromised

Functional adequacy:
1. Range of movement:
• Smile (spreading the lips)
• Pucker (moving the lips forward)
• Open widely
2. Strength:
• Pursing of lips
• Puff up cheeks, hold against resistance
3. Coordination:
• Rapidly open and close lips /pa-pa-pa-pa/
• Rapidly smile-and-pucker-and-smile-and-pucker /ooh-ee-ooh-ee-ooh-eeh/

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 3. DENTITION AND JAWS
Dentition (teeth)
1. Observe:
• Spacing
• Arrangement
• Some teeth missing
• Extra teeth
• Dentures

Maxilla and mandible

Structural adequacy
1. Observe alignment:

Normal

Overbite
(malocclusion class II)

Underbite
(malocclusion class III)

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 Functional adequacy
1. Range:
• Open widely
• Moving mandible horizontally
2. Strength:
• Biting down
3. Coordination:
• Observe during movements

4. TONGUE
Structural adequacy
1. Observe size:
• Micro- and Macroglossia

2. Observe Symmetry
3. Also look for a Tongue tie
• (Ankyloglossia)

Can also impact the

Range of movement.

Functional adequacy
1. Range:
• Elevation inside and outside of mouth
• Protrusion & Retraction
• Lateral movement (side to side outside; from cheek to cheek inside)
2. Strength:
• Above movements against resistance
3. Speed & Coordination:
• Observe during movements
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 5. PALATUM (HARD PALATE)
1. Observe:
• Folds
• Wrinkles
• Growths
• Clefts

6. VELUM
Structural adequacy
1. Observe:
• Clefts

• Submucous clefts
• Uvula
o Should be in midline during rest and phonation
o Look for deviation to one side
o Bifid uvula

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 Functional adequacy
1. Velopharyngeal closure:
• During all phonemes except for 3 (/m/, /n/ & /ŋ/)

Signs of Velopharyngeal Incompetence:

• Nasal emission (air escaping through the nose during speech)

o Tests: mirror test and tissue/paper test
o Image 1 and 2
• Short utterances
• Weak or omitted consonants
• Occasional nasal grimace
o Image 3

INTEGRATED FUNCTIONS
• chewing
• blowing
• sucking
• swallowing

These processes provide info about structures’ functional adequacy that we cannot directly
observe.
Looking at these processes can assist us ingathering information about a child’s speech and
the adequacy of his/her speech structures.

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DIADOCHOKINETIC RATE (DDK)
Last part of OSME evaluation is the DDK.

• Repeat “p-p-p”
• Repeat “t-t-t”
• Repeat “k-k-k”
• Repeat “p-t-k”
The reason for using these sounds: the “p” is at the lips, the “t” is at the alveolar ridge, the
“k” is right at the back of the oral cavity. By doing this you cover the entire range of the oral
cavity.
The last step entails that the child alternately pronounce “p-t-k“ subsequently and in a rapid
manner to see whether the coordination, speed, strength etc is presenting in a adequate
manner during SPEECH. This is what we ultimately want to know.
Child will struggle with this at first, so model it for the child and then let them do it on their
own.

If the child really struggles

with “p-t-k”, let them say
caterpillar, as it contains
the same sounds.

CHILD-FRIENDLY OSME
• Simplified instructions.
o At the beginning do it yourself first, then the child can mirror.
o However, don’t do it for all the instructions. The child should be able to do it on
their own.

• Be comfortable yourself – Put the child at ease.

• Less intrusive tasks first.

• Individuals differ!

• Flashlight Fun!

• ‘Simon says’ game…

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OSME form

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 37
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 Lecture 2.2

DIAGNOSTIC ASSESSMENT PROCEDURES

1. Case history
2. OSME (Oral Sensory Motor Examination)
3. Speech sampling (single words and continuous speech)
4. Interpretation of assessment data

Outline:
• Podcast 1: Theory and basic principles about speech sampling
• Podcast 2: Compiling assessment material
• Podcast 3: Recording the child’s responses
• Podcast 4: Types of responses
• Podcast 5: Demonstration

3. SPEECH SAMPLING: THEORY AND BASIC PRINCIPLES

Acquiring a speech sample
Entails two types of samples
• Single words
• Connected speech

1. Single word productions

Rationale: single words provide a discrete, identifiable unit of production that examiners
can readily transcribe.
Collects by means of:
• Naming of pictures or objects
• Must be representative of all the speech sounds in the I, M, F (initial, medial final)
position in words.

2. Connected speech
Rationale: the ultimate objective of treatment is correct production of sounds in
spontaneous conversation! It is important to observe sound productions in as “natural” a
speaking context as possible.
When children are acquiring speech sounds it is possible that they are able to pronounce
the sounds correctly in single words when they can pay attention to it, as opposed to
spontaneous speech.
Collect by means of:
• Story retelling
o You are only testing their vocabulary, NOT their language. So it is acceptable
to provide a model story.
• Wordless picture book
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 • Picture description
• Conversation

3. Stimulability testing
• First step after diagnostic misarticulation
• Therapist models the sound
o Basically, if the child is provided with a visual or audio model of the error
sound, are they able to then pronounce it correctly.
• If child is able to pronounce correctly: easier to work with to develop sound
Test stimulability in
• Isolation
o Just the sound. “Look at my mouth, I am going to say the sound “s”. Now I
want you to say the sound “s”.”
• I, M & F positions in syllables
o Asa, isi (if “s” is the example)
• I, M & F positions in words

4. Contextual testing
In-depth testing of sound errors in different phonetic contexts.
GOAL:
• To determine phonetic contexts where error sounds are produced correctly.
• Starting points for remediation.
• Measure of consistency of misarticulation.
For example:
[r] pronounced correctly after the [t] or [d].
[t] or [d] facilitates the correct pronunciation of [r].

Phonetic Transcription
• Use phonetic alphabet
• Record form of articulation test

Hearing screening
• NB to remember this.
• Possible cause of the speech disorder.

Assess related areas

Also assess:
• Language
• Specifically: phonological awareness

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SPEECH SAMPLING: COMPILING ASSESSMENT MATERIAL
Single word speech sampling

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 • Asses spontaneous speech pronunciations, NOT imitated speech.
• The best response would be if the child immediately responds with the correct word.
This is important because a child can change their pronunciation after being exposed
to an audiological stimulus.
• We want to assess the child’s own spontaneous production in order to make a valid
judgement about his/her pronunciation.
Select words which:
• Are simple enough
• Would be part of a young child’s vocabulary
• Can be represented by means of a picture

SPEECH SAMPLING: RECORDING THE CHILD’S RESPONSES

Spontaneous production = when the child spontaneously says “tree” after seeing the
picture of the tree. Even if he/she pronounces the word wrong (e.g. “tea” instead of “tree”)
you still indicate it in this column. You just phonetically transcribe “tea”.
Delayed imitation = when the child cannot say “tree” even after you’ve given prompts, you
eventually have to give them the word. Put the card aside and come back to it again later. If
they then say “tree”, you indicate it in this column. Even if they pronounce it as “tea” and
not “tree”, you still phonetically transcribe “tea’ in this column.
Direct imitation = You want to avoid direct imitation as far as possible. Visual and auditory
model can impact the child’s pronunciation. But is all else fails (the previous 2 columns), you
have to do a direct imitation. “This is a tree, let’s say tree”.

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QUIZ
1. OSME is an acronym for:
A. Oral speech motor examination
B. Overall speech mechanism evaluation
C. Oral sensory motor examination
D. Oral sensory mechanism evaluation

2. View the picture below. What type of cleft is displayed in the

picture?

A. Unilateral incomplete cleft of the lip

B. Unilateral complete cleft of the lip
C. Bilateral complete cleft of the lip
D. Bilateral incomplete cleft of the lip

3. View the statement below. Is the statement true or false?

When assessing functional adequacy during the OSME, we specifically look at the
symmetry, colour and distinctive features of the face and articulators.
A. True
B. False

4. View the pictures of mandible/maxilla alignment (occlusion) below

and choose the correct term to describe each type of occlusion.

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5. The following are signs of Velopharyngeal Incompetence:
1. Nasal emission
2. Short utterances
3. Inability to produce vowel sounds
4. Malocclusion of the mandible
5. Weak or omitted consonants
6. Occasional nasal grimace
Select one:
a. 1 and 4
b. 1, 4, 5 and 6
c. 1, 2, 5 and 6
d. All of the above
e. 1, 2 and 3

6. The following picture evaluates the child's ability to produce which

sound in the medial word position?
The correct answer is: f

7. Delayed imitation refers to when the child...

A) Repeated the target word directly after you
B) Spontaneously responded with the target word after showing him/her the picture
C) Did not spontaneously respond with the target word and you had to say it, and
came back to that word at the end of the assessment

8. During an articulation assessment, it is important to obtain a

speech sample to evaluate the child's ability to produce sounds in
connected speech. Name one task that can be included in your
assessment battery to obtain a connected speech sample from a
child.
A connected speech sample can be obtained by making use of a variety of tasks,
including story retelling, picture descriptions, wordless picture books and
conversations.

9. View the statement below and decide whether it is true or false.

The following picture evaluates the child's ability to produce the following sounds in the
initial, medial and final word positions:
Initial position: /ch/
Medial position: /ck/
Final position: /en/

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 A. True
B. False

10. Stimulability should be tested in the following environments:

1. Isolation
2. Connected speech
3. Initial, medial and final position in syllables
4. Initial, medial and final position in words
5. Phrases and sentences
a. 1, 2 and 5
b. All of the above
c. 1, 3 and 4
d. 2 and 5

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 Lecture 3.1

DIAGNOSTIC ASSESSMENT PROCEDURES

1. Case history
2. OSME (Oral Sensory Motor Examination)
3. Speech sampling (single words and continuous speech)
4. Interpretation of assessment data

5. INTERPRETATION OF ASSESSMENT DATA

Learning Outcomes
• Knowledge about common phonological processes and articulation errors
• Approach a speech sample for analysis
• Differential diagnosis between articulation and phonological disorders

Phonological Processes
Refer to handout on Common Phonological Processes. You need to be able to recognise the
errors as possible phonological processes! And remember Articulation Errors are
characterised by SODA of sounds (i.e. substitution of sound, omission of sounds, etc.).

S – substitution

O – omission

D – distortion

A - addition

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Articulation Errors versus Phonological Processes
• Both present as pronunciation problems.
• BUT: differential diagnosis is crucial!
• BECAUSE: Underlying problems are different, thus different approaches to therapy.

Phonological Disorders
A range of sounds are usually affected.
Inappropriate application of phonotactical rules.
E.g. modifying place of articulation
posterior articulation  anterior articulation
/k/  /t/ (king  ting)
/g/  /d/ (get  det)
= Fronting
If “k” is the only sound that the child is applying this error to, then it is not a phonological
process. For this to be classified as a “process”, more sounds would have to be affected (i.e.
more sounds that are usually articulated at the front of the oral cavity is now being
articulated at the back of the oral cavity). Then it is safe to say that these errors are a result
of the phonological process fronting and not an articulation error of substitution of the “k”
sound with the “t” sound.

Articulation Disorders
Only one or two sounds are usually affected.
E.g. /k/  /t/ (king  ting)
but /g/  ✓ (get  get) and
/ŋ/  ✓ (king  king and not: kin)
= Substitution of /k/ with /t/ sounds
Articulation disorder – S ODA

Extra internet source

What is the difference between a phonological disorder and an articulation disorder?
As children mature they do not always gain the control to produce speech sounds in a clear
concise manner. Actually, along the way of mastering speech production, children often
tend to make several mistakes. Depending on their age at which they are still making these
mistakes and/or the amount of their mistakes they are making helps determine if it is truly a
disorder or not. Each individual speech sound has a different age range as to when the child
should make a particular sound correctly.
Phonological Disorder
A common speech sound disorder is a phonological disorder which is a sound pattern
problem.
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A phonological disorder or problem consists of patterns of sound errors involving altering
the structure of words and/or substituting speech sounds. This pattern of sounds may be
that the child makes all of the sounds that are supposed to be made in the back of the
mouth, in the front of the mouth. For example, saying “tup” for “cup” or “do” for “go”
involves substituting the /k/ and /g/ sounds in the back of the mouth for sounds in the front
of the mouth, /t/ and /d/. This is known as “fronting”. “Cluster reduction” is another speech
pattern problem which consists of taking a sound blend such as /gr/, /st/, /bl/, or /fl/ and
omitting one of the sounds. Some examples of this are: “green” becomes “geen”, “street”
becomes “teet”, “blue” becomes “boo” and “flag” becomes “fag”. Another pattern problem
known as “final consonant deletion” involves speech sound errors which occur in a
particular pattern, such as having a child leave off all or most of the end sounds of words
such as “ba” for “ball” leaving off the /l/, “dah” for “dog” leaving off /g/, and “ki” for “kite”
leaving off the /t/.
Articulation Disorder
An articulation disorder or problem is a speech sound problem involving not being able to
make or produce individual sounds. An articulation disorder is the substituting(child says:
/bish/ for /fish/), distorting (child says: /thpoon/ for /spoon/), omitting (child says: /cool/ for
/school/) or adding (child says: /pban/ for /pan/) of sounds. This decreases a child’s speech
clarity significantly, making it difficult to understand their speech. Children may have only a
few sounds in error or several errors. Every child is different. Those children who have
several errors are sometimes unable to be understood at all unless the subject matter which
they are talking about is known to their listener. These errors that they do make will be
consistently on the same sounds in a variety of words. For example, the /r/ sound may be
substituted for /w/ and would then be produced as “wabbit”. The /r/ sound may be in error
in the initial, medial, and final positions of words. For example, the word “race” becomes
“wace”, “carrot” becomes “cawwot”, and “car” becomes “caw”.
What do I do if I think my child has a phonological or an articulation problem?
If you suspect that your child’s speech has a phonological or articulation disorder a speech-
language pathologist (SLP) is a professional that analyzes and evaluates speech and
language difficulties. You will want to contact your pediatrician and share your concerns
with him or her. The pediatrician will provide you with a referral to a speech-language
pathologist to evaluate your child’s speech production and communication functioning.
Your pediatrician and the SLP may recommend that you have a hearing evaluation to rule
out a hearing loss which may be negatively impacting your child’s ability to perceive sound.
The SLP will conduct an evaluation of your child’s speech sound productions, the oral
mechanism, and often language development to determine their overall communication
abilities.
Depending on the severity of your child’s speech disorder, their ability to effectively
communicate their needs, wants, thoughts and ideas may be compromised. School aged
children with a speech disorder may have difficulty interacting with their peers and with
communicating information to their teachers. Children with these disorders are at an
increased risk for later reading, difficulty with spelling and learning disabilities, and they
should be treated with speech therapy once they are diagnosed.

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Differential Diagnosis

How do I approach a speech sample?

1. Identify the target and the error sounds (/s/ /t/)
– If the child pronounces “sea” as “tea” the target sound would be “s” and the
error sound would be “t”.
2. Consider how the target sound was affected:
– Place of articulation
– Manner of articulation
– Voiced or Devoiced
– Phonetic context
– Syllable structure
3. Write down all the possible diagnoses:
– Articulation: this could be an articulation error of substitution (substitution of
the “s” sound with the “t” sound).
– Phonological: this could be a phonological process of stopping.
4. Compare these possible diagnoses with other error sounds in other words to inform
final conclusions (look for similarities and patterns)
5. Make differential diagnosis between phonological processes and articulation errors.

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Speech Sample 1

Speech Sample 2

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 Lecture 3.2

FINAL THOUGHTS ON ASSESSMENT AND DIAGNOSIS

Assessment
• As therapists we owe it to our clients to show insights into the social, cultural and
linguistic characteristics of the client’s community, as we won’t be able to make a proper
diagnosis without that.
• Beware of stereotyping.

• Be able to distinguish between dialectal differences and phonological disorders.

• The effect the dialect has on the family – they can either be very sensitive about it or not
at all.

• Differentiate when speech differences are as a result of the influence of one language on
another.
If the SLPs culture, language and community differ from the client’s, he/she can:

• Familiarise themselves with the characteristics of the client’s dialect and language
• Sample speech from adults from the client’s linguistic community to enable you to
analyse his/her speech
• Obtain information from translators, interpreters or support staff
Also remember:

• Be aware of the impact of your own dialect on the assessment process, as you will
provide an auditory model about pronunciation of sounds.
• Formality of the situation can influence the extent to which the dialect occurs. The more
formal the situation, the less dense the dialect will be.

Diagnosis
Sound differences should only be diagnosed as speech errors when they are in conflict with
a client’s dialect.

When utilising translators, the SLP must ensure that…

The translators/interpreters are...

• Well trained.
• Have outstanding communication skills in both languages.
• Understand what is expected of them.
• Professional at all times.
• Can identify with the client on a cultural level.
• Only assisting the therapist and not conducting the assessment themselves.

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Reasons why family members should not be used as
translators/interpreters…
• It might become burdensome.
• They might be too emotionally involved to stay objective and unbiased.
• Might feel uncomfortable to convey information to clients that are of the opposite
sex or older.
• They might withhold some of the information.

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 Lecture 3.3

REPORT WRITING
Learning Outcomes
• Select and include appropriate information from the assessment
• Include appropriate examples to support findings
• Formulate conclusions and recommendations about the client’s speech skills
• Know the appropriate format for reporting of assessment results
• Realize the importance of professional writing style and language throughout

Remember:
• A report is an important marketing tool for your services and speech therapy as a whole.
• The “face” of your practice when you’re not there.
• Typing and spelling errors are unacceptable!

DIAGNOSTIC REPORT
• After the initial assessment
• Feedback about:
o Results
o The way forward
• Usually reports are provided to the parents and the referring agents (with the parents’
permission).

Headings
1. Biographical information
2. Problem statement
3. Background information
4. Clinical Impression
5. Assessment procedures and tests included
6. Results of assessment
7. Your recommendations

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1. BIOGRAPHICAL INFORMATION

2. PROBLEM STATEMENT
• Referring agent
• Reason for referral / concerns
o Be careful not to present it as a diagnosis.
• REMEMBER: no diagnosis

3. Background information
• Information obtained from the case history
• Information relevant to communication disorder
• Possible causes of the problem
• Known risk factors

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4. Clinical Impression
Validity and reliability of assessment results

• Self-confidence (e.g. very shy and that had an impact on the results)
• Personality
• Cooperation
• Attention and concentration (e.g. the child had a very short attention span that had an
impact on the results)
• Completion of tasks
• General health (e.g. feeling sick/fluish)

But remember:
• No sweeping statements!!!
• Instead of saying “the child never speaks”, rather say that “during the assessment it
was observed that the child is very shy”.
• You can ONLY comment on what you observed during the assessment.
• Do not make any general observation about the child.

5. Assessment procedures and tests included

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6. Results of assessment
Case history – not included here!

RESULTS: ORAL SENSORY MOTOR EXAMINATION

RESULTS: ARTICULATION AND PHONOLOGY

Requires a brief explanation (speech vs language)

1. Single word speech sample

2. Connected speech sample
3. Age appropriateness of the errors (if any)
4. Stimulability of errors (if any)

1. Single word speech sample

 Address articulation and phonology
separately
 Remember to include examples from
the speech sample!
*phonologically transcribed  use / /
*phonetically transcribed  use [ ]
It is better to use phonological
transcription, as parents and referrals
might not be able to understand
phonetical transcription (only use for other
SLPs).

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2. Connected speech sample

3. Age appropriateness of the errors (if any)

• Puts the assessment results into perspective
• Impacts conclusions about the client’s speech development
• Informs the need for intervention/therapy

4. Stimulability of errors (if any)

SUMMARISED FINDINGS
• Conclusions about the child’s articulation and phonology.
• Only make reference to reported information - no new info or results!
• BUT: Not a mere repetition.
• Short, concise and to the point.

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7. Your recommendations
• Need for therapy
• Intensity
• Referrals

REMEMBER TO PROVIDE:
• The date of the report
• Your name and contact details

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SPEECH SAMPLE EXERCISE

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QUIZ
1. View the speech sample below. Assume this is a phonological
process (articulation error has been ruled out). What process
is presented here?
• ring pronounced as wing
• rat pronounced as wat

A) Gliding
B) Consonant cluster reduction
C) Stopping
D) Fronting
E) Final consonant deletion

2. Assume this is a phonological process (articulation error has been

ruled out). What process is presented here?
• cake pronounced as ca
• fish pronounced as fi
• big pronounced as be
Answer: During the speech sample above, the final consonants in each word is left out.
This refers to the phonological process of final consonant deletion.

3. View the speech sample and diagnosis below and decide whether it
is true or false:
This speech sample is an example of deaffrication
• shoe pronounced as two
• fish pronounced as fit

A. True
B. False

4. View the speech errors below and match it with the correct
phonological process.

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5. View the speech error below. Assume this is a phonological process
(artic has been ruled out). What process is presented here?
• jump pronounced as dump
• fan pronounced as pan
A) Gliding
B) Consonant cluster reduction
C) Stopping
D) Fronting
E) Final consonant deletion

6. View the speech errors below. Assume this is a phonological

process (artic has been ruled out). What process is presented here?
• bread pronounced as bed
• crawl pronounced as call
A) Gliding
B) Consonant cluster reduction
C) Stopping
D) Fronting
E) Final consonant deletion

7. True or False: Speech differences should only be regarded as

disorders when they are in conflict with a client’s dialect.
A. True
B. False

8. View the statement below and decide whether it is true or false:

Family members can be used as translators/interpreters during the assessment.
A. True
B. False

9. In this question, you will be analysing a short speech sample.

View the speech sample below and make an appropriate diagnosis by typing the
articulation error/phonological process.
• sun pronounced as sun
• foot pronounced as poot
• leaf pronounced as leap
• shoe pronounced as shoe
• dress pronounced as dress
• elephant pronounced as elepant
Answer: Substitution of /f/ with /p/ sounds

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10. In this question, you will be analysing a short speech sample.
View the speech sample below and make an appropriate differential diagnosis by selecting
either articulation or phonological disorder from the available options. Thereafter, you must
select the name of the specific articulation error/phonological process (sound error).

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 Lecture 4

THERAPY

Target sound vs error sound

Target sound: the sound that the child pronounces wrong, e.g. if the child lisps the target
sound would be “s”, but he/she pronounces it as “th” (the error sound). You are now
targeting the target sound in therapy (because the child does not pronounce it correctly).
Error sound: the sound that the child uses instead of the target sound.

Approaches to Therapy
Articulation Disorders Phonological Disorders
MOTOR APPROACH LINGUISTIC-BASED APPROACH
Van Riper’s Traditional Approach to Minimal Pair Contrast Therapy
Articulation Therapy

HOW TO PROVIDE ARTICULATION-THERAPY?

THE TRADITIONAL APPROACH CHARLES VAN RIPER
Two components:
1. Perceptual training (ear training)
o During perceptual training we work on how the child perceives the target sound.
o The target sound is contrasted with the error sound.
o NOT pronunciation (that is production training).
2. Production training

1. Perceptual (ear) Training

Consists out of 4 stadia:
1. Identification
2. Location
3. Stimulation
4. Discrimination

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1. Identification
• Recognizing the auditory, visual and movement features of the isolated sound.
o Auditory: what does the sound sound like.
o Visual: what does the sound look like whilst pronouncing it. What is the
shape of the lips etc.
o Movement: what do you do with your articulators whilst pronouncing the
sound.
• Most patients that you will see will be preschool and thus preliterate. They will not
necessarily know what the “s sound” is.
• One way to familiarise them with a sound is to associate the target sound with a
specific character.
• E.g. Sammy Snake

• Remember we always refer to the sound as a phoneme: “sssss” not “s sound”.

o How you want the child to say the sound.

2. Locating/location
• Recognizing the sound in isolation, syllables, words and connected speech.
• Quite difficult!
• Have the picture/toy etc. which represents the sound (e.g. Sammy Snake) there
at the table and remind the child that this is the sound that you are working with.
• Tell the child that you want him/her to listen and to tell you when they hear the
target sound.
o Signal, e.g. point at the picture, with a water gun, etc. when he/she hears
the sound.
o Make it fun!

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 • Reinforce the appropriate behaviour -> saying “well done” or clapping for them
etc.
• Start in isolation, then move on to syllables, words and then connected speech.
• Remember this is therapy, not assessment. If the child does not get the sound
right, go back to the instructions to make sure the child understand, and support
the child.

3. Stimulating / Auditory Bombardment

• Flood the child’s ears with the target sound!
• Time the clinician saying the sound.
• Count the number of presentations

• Stories with the target sound.

4. Discrimination
• Contrast the target sound and the error sound.
• Error sound versus target sound (Sammy Snake vs. Theo Thin).

• Clinician imitate the error sound.

• Child becomes the teacher (you want the child to point out to you when you
are using the target sound and when you are using the error sound).
• “When do I use Sammy Snake and when do I use Theo Thin?”

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 • Remember that the child is there because he/she cannot pronounce the
target sound, so your activity should be set up so that they don’t have to
pronounce the sound (merely point etc.).
• You can have a pointing / whispering activity.
• Underlying goal of discrimination:
o Child recognizes his errors:
o After -> during
o Our goal: that he could predict his errors even before th errors are
made to prevent the error from occurring.

2. Production training
Consists out of:
1. Production in isolation
2. Production in nonsense syllables
3. Production in words
4. Production in sentences
5. Transfer and carryover (the child uses the correct sound in
all speaking instances, not just when they see you).

1. Producing the sound in isolation

Techniques:
a) Auditory stimulation
b) Phonetic placement
c) Varying and correcting
d) Progressive approximation (shaping)
e) Contextual utilization
a) Auditory Stimulation
• Relies on simple imitation, e.g:
• Now, Maria, I’m going to let you have the first chance to make the Sammy Snake
sound, sssss. Remember, we don’t want the Theo Thin sound, we want sssssss,
the Sammy Snake sound. Now, you try it.
b) Phonetic Placement
• Using a mirror.
• Tell and show the child physically how to “make” the sound.
• You will both sit in front of the mirror and you will say the target sound, drawing
the child’s attention to your articulators and what you do with them when
pronouncing the sound.
• (B, B & F: 2009 – p.287).

c) Varying and correcting

• Also in front of the mirror.
• After you’ve shown the child where to place the tongue and how the articulators
should look whilst pronouncing the target sound, the child will now try to
pronounce it themselves.

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 • You will help and guide them.
• Try new postures, new attacks and new movement patterns.
• “keep your teeth closed”
• Try and try BUT try differently every time to come closer and closer.
• Variation must precede approximation.
• (p. 244 – Van Riper).

d) Successive Approximation / Shaping

• This technique should always follow “Varying and correcting”.
• Clinician joins the client and make the same error (the starting point of this
technique is the error sound).
• Then shows client a series of transitional sounds.
• Each come a bit closer to the target sound.
• (B, B & F: 2009 – p.288).
• “T-to-S” Therapy Technique (extra resource)
o Start by having the child say some repetitions of the /t/ sound.
o Only I don’t call it the /t/ sound, I call it the “Short Ticking Sound”.
o I tell my clients that we are going to practice the short ticking sound 10
times, but on the last time we are going to make it just a little bit longer.
o Then I give them an example of what I am talking about before we begin
practicing together.
o It goes like this…
o t, t, t, t, t, t, t, t, t, ts
o The first time I only extend my /t/ slightly, making a very short /s/.
o Then we practice together, and if the client is successful we keep
practicing, but we make the last /t/ longer and longer.
o It will look something like this…
o t, t, t, t, t, t, t, t, t, tss
o t, t, t, t, t, t, t, t, t, tssss
o t, t, t, t, t, t, t, t, t, tssssss
o I keep practicing with them making the last ticking sound slightly longer
each time.
o I only increase the length of the last ticking sound if they were successful
with the previous trial.
o Then I have the client see if they can practice the “Long Ticking Sound”.
o That looks something like this…
o ts, ts, ts, ts, ts, ts, ts, ts, ts, ts
o Then tsss, tsss, tsss, tsss, tsss, tsss, tsss, tsss, tsss, tsss (accentuating the
/s/ and minimizing the /t/)
o Then I see if they can drop the /t/ sss, sss, sss, sss, sss, sss, sss, sss, sss, sss
o And before you know it – they are producing a beautiful /s/ sound all by
themselves!!!

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 e) Contextual utilisation
• Contextual testing during assessment
• /bright sun/
o Say slowly and prolong the /s/
o /bright ssssssun/
o Repeat: /bright ssssssink/
o /hot sssssea/
• Use other facilitating pairs to extend and stabilize the /s/
• Ask the client to just say /s/ without the “lead-in”
• (B, B &F: 2009 – p. 290)

2. Producing the sound in nonsense syllables

• Produces new sound in all phonetic contexts
• Any sound changes slightly when preceded or followed by other sounds
• /seeb/ & /soob/ - acoustics and tongue
4 Types of nonsense syllables:
• CV (s-a)
• VC (a-s)
• CVC (s-a-s)
• VCV (a-s-a)

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3. Production in words
Selecting a vocabulary
• What words do I use to teach the child the sound?
• Consider…
a) Word Form
b) Word Content
a) Word Form
• Always move from easy to more difficult.
• WHAT MAKES A SOUND MORE DIFFICULT TO PRONOUNCE?
o The position of the sound in the word
o The length of the word
• TREATMENT SEQUENCE:
• 1. One syllable words with target sound in prevocalic position e.g. /sun/
• 2. One syllable words with target sound in postvocalic position e.g. /bus/
• 3. Target sound in two phoneme blends e.g. /sleep/
• 4. Two and three syllable words e.g. /circus/ or /Christmas/ or /pajamas/
b) Word Content
1. Words from the child’s own vocabulary
2. Consider the child’s interests (ice, skates, stick)
3. Word families
= not always possible as the phonetic characteristics of the words should be
prioritized.

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Ideas for activities at word level

Techniques:
• See Van Riper, page 247.

4. Producing the sound in sentences

• Correct production in words
• Corrects him-/herself in words
• Meaningful (/slap your face/ vs. /thlap your fathe/)
• Statements / questions / commands

5. Generalisation / Transfer
• This refers to:
• The presence of the relevant behavior in a variety of non-training circumstances,
without the scheduling of the same events and circumstances as during the therapy
situation.

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GENERAL PRINCIPLES OF ARTICULATION THERAPY

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 74
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QUIZ
1. View the statement below. Is the statement true or false?
The traditional approach by van Riper consists of one component, namely production
training.

• True
• False

2. View the descriptions of the stages of perceptual training and

match it to the correct stage.

3. Which of the techniques below can be used to teach a child to

produce a sound in isolation?
A) Auditory stimulation and phonetic placement
B) Auditory bombardment
C) Shaping
D) Acoustics

a. A
b. A, B and D
c. A and C
d. B and D

4. Match the descriptions of the techniques for teaching the

production of a sound to its name.

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5. View the statement below and decide whether it is true or false.
It is important to target the production of the sound in syllables after targeting the
production in isolation, as all sounds change slightly when preceded or followed by other
sounds.

• True
• False

6. Name one consideration that we have to keep in mind when

selecting vocabulary for the production of the target sound in
words.
• Word form

7. When targeting the sound in words, we have to keep the length of

the word and position of the sound in the word in mind. Below are
three options of the treatment sequence when considering word
form. Which option indicates the correct sequence?
1. One syllable words with target sound in prevocalic position → One syllable words
with target sound in postvocalic position → Target sound in two phoneme blends
→ Two and three syllable words
2. One syllable words with target sound in postvocalic position → One syllable
words with target sound in prevocalic position → Target sound in two phoneme
blends → Two and three syllable words
3. One syllable words with target sound in prevocalic position → One syllable words
with target sound in postvocalic position → Two and three syllable words →
Target sound in two phoneme blends
a. 1
b. 2
c. 3

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 Lecture 5.1

APPROACHES TO THERAPY

Articulation Disorders Phonological Disorders

MOTOR APPROACH LINGUISTIC-BASED APPROACH
Van Riper’s Traditional Approach to Minimal Pair Contrast Therapy
Articulation Therapy

HOW TO PROVIDE PHONOLOGICAL-THERAPY?

When a child presents with phonological processes:
• Phonological disorder
• Linguistic-based Approach
• Minimal Word Pair Contrast Therapy

MINIMAL PAIR CONTRAST THERAPY

It is a pair of words where the only difference between the 2 words is a single phoneme,
e.g.
• key – ski
• bow – boat
• sea – she
• cat – fat
• free – three
• sing – thing

Why? (The Underlying Principle)

•We would like to teach the child that different sounds convey different meanings
•THUS: if you are using a different sound, you are saying something different.
•We want to draw their attention to how one sound difference in a word can lead to
a different meaning.
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When is Minimal Pair Contrast Therapy used?
We use Minimal Pair Contrast Therapy in the cases where a child substitutes the sound with
an error sound such as fronting (e.g. when the /k/ sound becomes a /t/ sound. So in other
words the problem lies in the stored recipe for producing the sounds towards the back of
the mouth i.e. the manner of articulation.

We also use MPC therapy when sounds are deleted such as with cluster reduction or final
consonant deletion or when syllable structures are affected (such as weak syllable deletion).

Starting point:
• Make sure the child can articulate the affected sounds.
o E.g. if the child presents with final consonant deletion, you have to make sure
that the consonants that the child should have produced at the end of the
word is actually a phoneme that they can articulate.
• If there is problems with articulation
o problems on motor level
o motor-based approach first
o Traditional Approach (Van Riper)

Example: Final consonant deletion

• Stops like /t/ produced correctly in word initial position (/table/).
• BUT deleted in word-final position.
• (/foo_/ instead of /foot/)
• In this example we have determined that the child can produce the /t/ sound, so we
don’t have to follow a motor-based approach.
• FCD in this case likely reflects problem with a conceptual rule related to syllable
structure (the child wants to produce open syllables, that’s why the leave out the
last consonant).

Treatment in this case (Final consonant deletion)

• We’re looking at treatment in the case of final consonant deletion; it’s not the same
for all cases.
• Getting the client to recognize that the presence of a consonant in word-final
position is a necessary contrast to distinguish certain word-pairs in the language.
• (e.g. two – tooth ; bee – beat)
• Recognize = conceptual change
• Articulate = motor action

Focus of Therapy
• NOT the Motor production of the target consonant, which is already within the
child’s productive repertoire.
✓ Focus IS on the development of cognitive awareness of final consonant contrasts /
syllable closure.

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COMPONENTS OF MINIMAL PAIR CONTRAST THERAPY
1. Perception of contrasts (hearing)
2. Production of contrasts (saying)

1. PERCEPTION OF CONTRASTS
How do I do perception training?
Two components:
1. Introduction of a minimal pair
2. Contrast training

Example
Jane (5 years):

Stopping of the /sh/ sound: (address each affected sound)

1. Introduction of a minimal pair

1.1 Start with shoe & boo as opposed to shoe & two.
a. Minimal pair with target sound, but not the error sound.
1.2 The child listens as the clinician points to five identical pictures of a shoe and names
each one (5 pictures for each word in the minimal pair, for both types – shoe, boo,
two):

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 1.3 NEXT: Introduce a 2nd word (with associated pictures) which contains a
contrasting sound that is very different from the target sound (/boo/).
Again, the child only listens.

1.4 THEN: the child listens as the clinician identifies the original five pictures of /shoe/
plus five pictures of /boo/.

2. Contrast Training
2.1 Ask the child to hand you the picture that you name:

• Random requests (vary between /shoo/ and /boo/).

• If the child can’t do this, this activity should be repeated, probably with different
words.
• If the child can readily do this
• he/she has established at a perceptual level the contrast between /sh/ and /b/
2.2 Repeat with the target sound and error sound:

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2.3 And other pairs with the target sound and error sound:

2. PRODUCTION OF CONTRASTS
Could be done before, after and/or during perceptual training.
• Isolation
• Nonsense syllables
• Words
• Phrases & Sentences
• Carryover

Procedures for teaching specific sounds

• Bernthal, Bankson and Flipson

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 Lecture 5.2

DETERMINING THE NEED FOR INTERVENTION

Consider the following variables:
1. Speech Intelligibility
2. Seriousness of the disorder
3. Ability to stimulate
4. Types of errors
5. Age appropriateness

VARIABLE 1: Speech Intelligibility

• Speech intelligibility refers to how much of what the child says can be understood by
someone other than the mother/caregiver.
• This does not mean that the child does not still struggle with some sounds, it just
means that they can be understood.

1 year = 25% intelligible

2 years = 50% intelligible
3 years = 75% intelligible

4 years = 100% intelligible

VARIABLE 2: Seriousness of the disorder

• PCC – Percentage Correct Consonants
• Objective method
• “Mild speech disorder” or “severe speech disorder” etc.

VARIABLE 3: Ability to stimulate

Poorer ability to stimulate → poorer prognosis → bigger the need for intervention.

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VARIABLE 4: Types of Errors
• Examine clients with multiple error patterns.
• Take into consideration whether the client’s phonological processes are in the
category of those that will disappear first or not.
o If the child still struggles with phonological processes that are in this
category, then this child is very delayed.

VARIABLE 5: Age appropriateness

Here you refer to the fact that you need to justify whether the child will benefit from
therapy or not.
Not age appropriate if:
• 70 – 90% of the child’s peers can pronounce the sound correctly.
• Compare child’s speech with developmental norms.

Also remember:
The following is enough reason for therapy:
• Teenagers and adults that feel that their speech problems interfere with their
normal functioning.
• Children’s whose parents feel that the problem should receive attention.

WHICH SOUNDS TO TARGET FIRST? (CHILDREN WITH MORE THAN

ONE ERROR SOUND)
Consider:
• Intelligibility (which sound will make the biggest difference?)
• Normal development
• Stimulability
• Success

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HOW MANY GOALS MUST I TARGET PER SESSION? (GOAL
ATTACK STRATEGIES)

1. Vertically structured therapy (in-depth training)

• One or two goals / targets are trained to a certain level according to criteria.
• A high number of responses is expected of a single target with a lot of
repetition.
• One / two phonemes are targeted in therapy and are practiced until correct
production of the phoneme is achieved on conversation level.
• For example, with a child with 5 different phonological processes, one
process is targeted and in therapy the focus is on 1 or 2 sounds related to the
process until a certain level is reached.
• Especially suited for clients with few error sounds.
2. Horizontally structured therapy
• Multiple goals are targeted per session and goals can change during the
session.
• Work on a variety of sounds at a time, less intensively on one sound; variety
sound contrasts in order to facilitate simultaneous acquisition of different
target sounds.
3. Cyclic structured therapy
• A single phoneme is targeted per session / week. The following session a
next sound / goal is targeted. Especially suitable for children with multiple
error sounds.

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HOW OFTEN MUST THERAPY TAKE PLACE? (FREQUENCY OF
THERAPY)
Consider:
• Age of the client
• Attention span
o Should maybe consider more frequent but shorter sessions.
• Severity of the disorder
• Your case load
• Child’s activities

SHOULD I TREAT THE CHILD INDIVIDUALLY OR WITHIN A

GROUP?
Research shows:
• Over 8 ½ months
• 45 min in a group = 30 min individual

Option:
• Work on production in isolation
• Once the sound/s is in child’s repertoire = group therapy
• Group therapy promotes generalization and transfer

Groups
• 3 to 4 children with similar speech problems
• Decide after considering each child’s needs and circumstances.

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EXTRA SPEECH SAMPLES

sleep /tleep/ s  th Substitution of /s/ with /θ/ (artic) ARTIC: SUBSTITUTION OF /s/ WITH /th/

bus /buth/ s  th Substitution of /s/ with /θ/ (artic) ARTIC: SUBSTITUTION OF /s/ WITH /th/

roof /root/ ft Substitution of /f/ with /t/ (artic) or Only /f/ affected in this way (stopping )?
Stopping of /f/ (phon) YES  not phonological process, rather artic.
ARTIC: SUBSTITUTION OF /f/ WITH /t/
sand /thand/ s  th Substitution of /s/ with /θ/ (artic) ARTIC: SUBSTITUTION OF /s/ WITH /th/
face /tathe/ ft Substitution of /f/ with /t/ (artic) or ARTIC: SUBSTITUTION OF /s/ WITH /th/
Stopping of /f/ (phon)
&
&
Substitution of /s/ with /θ/ (artic)
s  th
elephant /eletant/ ft Substitution of /f/ with /t/ (artic) or Only /f/ affected in this way (stopping )?
Stopping of /f/ (phon) YES  not phonological process, rather artic.
ARTIC: SUBSTITUTION OF /f/ WITH /t/

Specific speech disorders: Substitution of /s/ with /th/ and /f/ with /t/
Differential diagnosis: Articulation disorder
Approach to follow: Traditional Approach by Van Riper or any other motor-based approach

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 lie /why/ lw Substitution of /l/ with /w/ (artic) or Are there other sounds that are affected in the same
gliding of /l/ (phon) way (gliding applied)?
NO  not phonological process, rather artic.
ARTIC: SUBSTITUTION OF /l/ WITH /w/

lake /way/ lw Substitution of /l/ with /w/ (artic) or See above
gliding of /l/ (phon)
Are there other final sounds that are affected in the
same way (omitted)?
k  omitted Omission of /k/ (artic) or
Final Consonant Deletion (phon) YES  /n/ in /spoon/ and /g/ in /big/ are also affected
in the same way, so most probably a phonological
process (FINAL CONSONANT DELETION), rather than
artic.

spoon /spoo/ n  omitted Omission of /n/ (artic) or See above

Final Consonant Deletion (phon)

big /be/ g  omitted Omission of /g/ (artic) or See above

Final Consonant Deletion (phon)

Specific speech disorders: Final consonant deletion and Substitution of /l/ with /w/
Differential diagnosis: Phonological and Articulation disorder
Approach to follow: Minimal Pair Contrast Therapy or any other linguistic-based approach for final consonant deletion and Traditional Approach or
any other motor-based approach for substitution of the /l/

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 cat /tat/ kt Substitution of /k/ with /t/ (artic) or Are there other posterior sounds that are affected in
Fronting of /k/ (phon) the same way ( pronounced anterior as opposed to
posterior in the oral cavity, while other features –
voice and continuance – are consistent)?
YES  /g/ in /goal/ and /ng/ in /sing/ are also affected
in the same way, so most probably a phonological
process (FRONTING), rather than artic.

goal /doal/ gd Substitution of /g/ with /d/ (artic) or See above
Fronting of /g/ (phon)

king /tin/ kt Substitution of /k/ with /t/ (artic) or See above
Fronting of /k/ (phon)
& &

ng  n Substitution of /ng/ with /n/ (artic) or

Fronting of /ng/ (phon)

digger /didder/ gd Substitution of /g/ with /d/ (artic) or See above
Fronting of /g/ (phon)
ring /rin/ ng  n Substitution of /ng/ with /n/ (artic) or See above
Fronting of /ng/ (phon)
bake /bate/ kt Substitution of /k/ with /t/ (artic) or See above
Fronting of /k/ (phon)

Specific speech disorders: Fronting of /k/, /d/ and /ng/

Differential diagnosis: Phonological disorder
Approach to follow: Minimal Pair Contrast Therapy or any other linguistic-based approach

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