is “i'i' ■ ■ ■

DISTORM0 VE90S SOm9D0S

QEg4/9AA
(Susanibar, Dioses, & JC., 2016). : •

DEFINITION
✓ Speech Sound Disorders (SSD) are defined as an alteration in the articulatory
production of sounds (phonetics) and/or in the functional use of the contrastive
segments "phonemes" of a language (phonology) , which affects intelligibility. of
speech to different degrees and can be diagnosed at different stages of life.

YO-"-
✓ The outlined definition of TSH has significant importance for the clinician, since what he
ultimately seeks is to adapt the emission of speech sounds as much as possible to
socially acceptable standards, in such a way that the person maintains communication.
efficient.
“t2 I
____________ __“__________________________________________________________

NOMENCLATURE

✓ Over time, the nomenclature used to name children with Speech Sound Disorders –
TSH– changed according to the authorial influences of the moment and the areas to
which said researchers belonged (medicine, psychology or linguistics).
YEAR TERM USED
1920-1970 Dyslalia and functional joint disorder

1971-1980 Articulation disorder and phonological disorder

1981-1990 Articulatory-phonological disorder

1991-2005 Phonological disorder
2005 onwards Speech sound disorder
 DIAGNOSTIC CRITERIA
ACCORDING TO DSM-V

✓ In the DSM-IV, the term "phonological disorder" was used, and the term TSH replaces it in the
DSM-V.

A- There are persistent difficulties in the production of speech sounds that interfere with the
understanding of speech or prevent the messages of verbal communication
B- The disorder causes limitations in effective communication that interferes individually or
combined with social participation, academic or work achievements.
C- The onset of symptoms occurs at an early point in development
D- The difficulties are not attributable to congenital or acquired conditions such as cerebral palsy,
cleft palate, hearing loss, brain trauma, or other medical or neurological conditions

TYPES OF ALTERATIONS

I PHONETIC ALTERATIONS

• Alteration that consists of the inability to correctly produce (articulate) the sounds
expected at a certain chronological age.
• This impossibility is detected from the isolated emission of sound, as well as in syllables,
words and conversation.
• Errors are identified as distortions , substitutions or omissions, and are generally
associated with morphological (structural) deficits, neuromotor deficits, the use of
poorly adapted prostheses and piercing , among others; and even incorrect motor
learning.

PHONOLOGICAL ALTERATIONS

/
• Alteration that consists of the inappropriate use of the contrastive segments expected
for a certain chronological age.
• This is characterized because the individual manages to articulate the segment in
isolation or in syllables; but does not use them during spontaneous verbal interaction,
that is, the individual is capable of producing the segment <p> or the syllable <pa> and
even words or phrases when they are syllabled (with or without a model), but in the
Spontaneous speech says <telota> for <ball> or <maache> for <mapache>.
 Errors are identified as delayed or unusual phonological simplification processes (PSF),
as well as inappropriate use of phonotaxis. They are generally associated with a
cognitive-linguistic or auditory sensory alteration (discrimination or phonological
recognition).

ALTERATIONS
PHONETICS-PHONOLOGY

• Speech alteration in which phonetic and phonological errors coexist, although the
number of signs, severity, intensity and onset of the same varies from subject to subject, and
it may happen that there is only one phonetic error and several phonological or vice versa.
Yo---------------------------------------------------------------------------------------------------------- ➢
The previous description refers to cases in which both alterations are present
(phonetics and phonology) simultaneously. However, there are less frequent cases in
which, for the same sound, both phonetic and phonological errors can be detected, that is,
there is an inability to correctly produce the sound expected for its chronological age in
isolation or in syllables ( phonetic error), in addition to showing variability in the errors
made when said segment is found in words or spontaneous speech (phonological error).
F

PHONETIC ALTERATION PHONOLOGICAL PHONETIC-PHONOLOGICAL

ALTERATION ALTERATION
One or more sounds The error does not occur in Mistakes phonetic
expected for a chronological the emission of sound or and
age are altered. syllables, but only becomes phonological, it can be only
evident in the emission of one phonetic error and
words. several phonological ones and
The error committed is The error is vice number
unstable The versa. of errors varies.
stable (it will always issue (sometimes thephoneme is
the sound issued
incorrectly). correctly, another not.
Vowels and consonants can Both signs are present.
Mainly consonants are altered
be altered.
Guy of mistakes: Processes phonological of Both errors occur
substitution, omission, simplification (structure simultaneously.
distortion. syllabic, assimilation and
substitution.
 ETIOLOGY

✓ Some authors such as Gierut and Rucello subdivide them into two groups
1- Known or obvious causes
2- Unknown cause (idiopathic or cryptogenic) or functional
ETIOLOGY OF THE ALTERATIONS ETIOLOGY OF THE ALTERATIONS
PHONETICS PHONOLOGICAL
EVIDENT EVIDENT
AUDITORY SENSORY
MORPHOLOGIC
AL hearing loss
- Fissures
malocclusion Discrimination and/or
-

- Altered frenulum, phonological recognition

etc.
NEUROMOTOR
- Dysarthria
- Childhood apraxia of
- speech
apraxia of speech
FUNCTIONA FUNCTIONA
L L
COGNITIVE-LINGUISTICS
MOTOR LEARNING
Representation Of the
Storage Access distinctive
Retrieval features

I ➢ It is important to highlight that, although an etiology predominantly affects I plus one

component or another (phonetic or phonological), it is proven that, in many I cases, it also
affects the other component. Such is the case of lip and palate clefts;
Yo dysarthria, apraxia of speech or childhood apraxia of speech; Down syndromes, among
others.
 SEQUENCE TO DESCRIBE THE
ERRORS IN PHONETIC-PHONOLOGICAL TSH

1- Type of error 6- Articulatory mode

(substitution, 7- articulatory point
omission, 8- Sonority
assimilation, etc.) by 9- Sound used
2- Articulatory mode 10-Position where
find the error
3- articulatory point
4- Sonority
5- Altered sound

I EXAMPLE: You must say “pavo” and produce “papo”→ Inability to articulate phoneme /b/
Substitution of the voiced, bilabial, plosive /b/ with the voiceless, bilabial, plosive /p/ in
the interior syllabic I start of the word (all positions of the word)

Yo

SEVERITY

PERCENTAGE CLASSIFICATION
CORRECT CONSONANTS (PCC)

No. of correct Consonants/No.

PCC FORMULA of consonants evaluated=
Result X 100
1- speech sample
2- 200 words intelligible
3- Formula
4- Severity

MILD MILD TO MODERATE TO SEVERE

MODERATE SEVERE
PCC greater than 85 PCC between 65 to PCC between 50 to PCC less than 50
85 65
SEVERITY CHRONOLOGICAL AGE INTELLIGIBILITY
SUITABLE Emits and uses all the sounds expected for Intelligible for any
his or her chronological age, both in person
isolated words, in imitation and in
spontaneous speech.
MILD Emits and uses all the sounds His speech is intelligible to all
ALTERATION corresponding to previous ages, but fails people, although a slight effort is
in 2 sounds expected for his chronological required to understand what he
age or verbalizes the sounds of his age, but means.
fails to make a sound from previous ages.

MODERATE He presents various errors in the sounds Their speech is only intelligible to
ALTERATION expected for his chronological age and the immediate environment;
also in those expected at previous ages. outsiders must make a great effort
to understand.

SEVERE Evidence of multiple and significant errors His speech becomes unintelligible
ALTERATION in sounds expected for their age and even to the immediate
previous ages. environment.

DIAGNOSIS

“Speech sound disorder, due to phonetic alteration of morphological origin (altered

frenulum of the tongue, cleft lip and palate, maluclusion, among others)”;
“Speech sound disorder, due to phonological alteration of auditory sensory origin
(phonological perception or hearing loss)”;
“Speech sound disorder, due to phonetic-phonological alteration of morphological and
auditory sensory origin; etc
 INTERVENTION

✓ For the intervention, it is more relevant to identify and describe the symptomatology
and not the etiology, that is, to establish the profile of the phonetic and/or phonological
alterations of the individual, since this will allow us to propose the techniques and
instruments that must be used during the intervention. treatment; However, this position
does not exclude the need and importance of seeking to know and identify the etiology of
the alteration itself.

✓ Some evidence that supports this view is, for example, the fact that, in an individual whose
etiology is a cleft lip and palate, phonetic alterations will mainly be found, although
phonological errors will also be evident; A patient with dysarthria, apraxia of speech, or
childhood apraxia of speech may show both alterations, in addition to prosodic errors;
and children with some syndrome (for example Down), cognitive-linguistic,
morphological and motor alterations that trigger phonetic and phonological and even
prosodic errors.

CONSIDERATIONS
• Observe if it omits, substitutes or distorts
• Analyze what the child does when emitting the phoneme
• Record broadcasts
• Provide visual, auditory, and tactile support.
• Reinforce each attempt

HIERARCHY OF INTERVENTION

Discriminatio Speaks Generalize

n spontaneo the
n auditory us phoneme

Point and mode

articulatory
Prayers

phoneme in
initial syllable,
Phonem end and half
e of the word
isolate
 HOW TO CHOOSE THE SOUNDS TO BE WORKED WITH?

• Choose sounds that improve intelligibility, that is, they are emitted more frequently
• Choose sounds that are made at younger ages
• Choose sounds with features that are easier to articulate
• Try to group several sounds by features
• Choose sounds that are important to the user, those that cause embarrassment when
emitted incorrectly.

CONSIDERATIONS FOR
FACILITATING WORDS
• They must only contain a phonetic-
phonological difficulty
• Avoid words that have the same
articulatory point as the target sound
• Words that are easy to make, avoiding
having complex syllabic structures
• Avoid words with a large number of
syllables
• The easiest positions for the user
LEXICO CONSIDERATIONS
SEMANTICS FOR WORDS
FACILITATORS
• Meaningful words for the user (child)
• that represent real objects
• Words with communicative potential
(family names)
• That are represented in images
(verbs)
• With communicative potential, but
difficult graphic representation
• Use verbs and conjunctions

• Stress facilitates production (Easier in

stressed syllables)

STIMULUS
AUDITORY PROPRIOCEPTIVE VISUAL
Sound model Auditory Passive movements
bombardment assisted movements Sound emission model
In front of the mirror
Do them simultaneously
 OROFACIAL MOVEMENTS AND

NON-VERBAL LARYNGES (MOL-NV)

✓ Known daily as praxias , they are defined as the different motor acts executed with the
anatomical structures of speech (EAH) in an active manner and intended to achieve specific
movements or postures, but that generate little or almost no phonetically identifiable
sound, a situation that eliminates the auditory feedback.

✓ The MOL-NV do not include passive movements of the EAH, that is, those generated by an
external force, nor the responses caused by sensory stimuli

I • They are one of the most widespread strategies among speech therapists when it comes to
intervening in TSH. Despite this, its effectiveness is highly questioned and there are no I
Yo relevant empirical data on its virtue
Hmm .

WHY SHOULD NOT IT BE USED

THE MOL-NV?

(Susanibar, Dioses, & Monzó n, 2016)

1) No MOL-NV carries out phonetic-phonological feeding.

2) All of them lack the participation of the respiratory system.
3) The muscle activity recorded in the MOL-NV and sound emission is different.
4) MOL-NVs are far from being equated even with the emission of an isolated sound.
5) Training tiny parts of speech like the MOL-NVs does not transfer to speech.
6) The neurological centers for speech and MOL-NV are different.
is “i'i' ■ ■ ■ 1
DISTORM0 VE90S SOm9D0S 1
QEg4/9AA 1
DEFINITION 1
NOMENCLATURE 1
DIAGNOSTIC CRITERIA 3
ACCORDING TO DSM-V 3
TYPES OF ALTERATIONS 3
I PHONETIC ALTERATIONS 3
PHONOLOGICAL ALTERATIONS 3
ALTERATIONS 4
PHONETICS-PHONOLOGY 4
ETIOLOGY 6
SEQUENCE TO DESCRIBE THE 7
ERRORS IN PHONETIC-PHONOLOGICAL TSH 7
SEVERITY 7
PERCENTAGE CLASSIFICATION 7
CORRECT CONSONANTS (PCC) 7
DIAGNOSIS 8
INTERVENTION 9
HIERARCHY OF INTERVENTION 9
OROFACIAL MOVEMENTS AND NON-VERBAL LARYNGES (MOL-NV) 12
WHY SHOULD NOT IT BE USED THE MOL-NV? 12
References 14

References
Susanibar, Gods, & JC., &. T. (2016). Principles for the evaluation and intervention of Speech Sound
Disorders – TSH. Madrid: EOS. Retrieved from https://franklinsusanibar.com/trastorno-de-los-
sonidos-del-habla-
tsh/#:~:text=This%20%20way%2C%20se%20define,different%20degrees%20and%20p can
%20be
Susanibar, F., Dioses, A., & Monzón, K. (2016). SPEECH AND OTHER NON-VERBAL OROFACIAL MOTOR
ACTS: REVIEW PART I. EOS Peru. , 72. Obtained from https://franklinsusanibar.com/wp-
content/uploads/2019/08/Parte-I-EL-HABLA-Y-OTROS-
NON-VERBAL-OROFACIAL-MOTOR-ACTS-REVIEW%C3%93N-PART-I.pdf

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