Speech Sound Disorders
Peter Flipsen Jr., Ph.D., CCC-SLP
University of Tennessee, Knoxville
http://web.utk.edu/~pflipsen
Outline

1. General Issues

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2.
3.
4.
5.
6.
7.
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Assessment, Target Selection, Intervention,
Measuring Progress
Articulation vs. Phonological Disorders
Speech Discrimination
Childhood Apraxia of Speech
Oral-Motor Exercises
Dialects - Appalachian English
Approaches to Intervention
Articulation, phonological, discrimination, CAS
General Issues - Assessment


The goal of every assessment is to
decide if there is a problem or not.
When we say there is a problem, we
may be right or we may be wrong.


Client may have had a really bad day
and performed poorly.
Client may have been “in the zone” and
did better than they usually do.
General Issues - Assessment


Risk of errors in our decisions greatest for
borderline cases, but always a concern.
Given our reliance on standardized tests,
we need to remember to consider
“standard error of measurement” or SEM.


Accounts for the fact that all test scores are
really just “samples” of ability and scores may
vary from day to day.
Gives us a sense of how much they might
vary.
Standard Error of Measurement (SEM)


Allows us to see where the “true ability
level” is.
If a child achieves a standard score (SS)
of 80 and the SEM is 5, then:


There is a 68% probability that his actual score
is really somewhere between 75 and 85.
 We are 68% confident that his true ability is
within 1 SEM of his score that day.
There is a 95% probability that his actual score
is really somewhere between 70 and 90.
 We are 95% confident that his true ability is
within 2 SEMs of his score that day.
SEM


Not always
available but is
generally found in
most newer test
manuals.
E.g., Photo
Articulation Test –
3
Age
SEM
3 years
4
4 years
5
5 years
4
6 years
4
7 years
5
8 years
5
SEM


GFTA-2 gives us the 90% and 95%
“confidence intervals” directly for
every score.
Hodson’s new HAPP-3 does NOT
provide SEM values or confidence
intervals.

Note: The HAPP-3 allows you to
calculate “Ability Scores” which look
like standard scores, BUT the test
manual recommends you use percentile
ranks instead.
General Issues – Assessment


What about unusual errors?
We know that unusual errors such as
“lateralization” of fricatives are very
resistant to intervention especially if left
too long.



Need to avoid letting them become too
established.
We need to find a way to justify working
on these errors much earlier.
Any ideas?
General Issues - diagnosis

When we decide what the nature of
the problem is, we assign a
“category”.



Differential diagnosis.
Ultimately each category should mean
a different approach to treatment.
We need to know how distinct each
category is from other related
categories.
General Issues - treatment


Change happens – we see it every day.
Many possible reasons:




Our intervention resulted in the change.
Child “figured out” what they need to do on
their own (i.e., normal development).
Adult relearned a skill as physiological recovery
progressed (i.e., spontaneous recovery).
Some outside influence led to the change
(e.g., parent or spouse working with them).
General Issues - treatment


How do we know what caused the
change?
If we do something and change follows,
did we cause the change?




Even if the change is almost immediate, we
still CANNOT be sure!
Something else may have been responsible for
the change.
Still a long way to go here.
See June 13/06 issue of ASHA Leader.
General Issues - treatment

Recommended reading:

Reilly, S., Douglas, J., & Oates, J.
(2004). Evidence Based Practice in
Speech Pathology. Philadelphia, PA:
Whurr Publishers.
General Issues
- Measuring Progress


When we “monitor progress” we are
really re-assessing skills to see if
the client has learned what we’ve
been teaching.
Re-administer a standardized test?

May be necessary to make decisions
about whether a client is still “eligible
for services”.


Need to consider SEM.
Doing this doesn’t really tell us if
progress has happened.
Standardized Tests and “Measuring
Progress” – Why Not?

1. These tests are intended for a wide
range of ages.


Designed for efficient administration and thus
don’t sample very many behaviors at any one
particular age.
 Only sample each ability level superficially.
For speech sounds, they don’t test enough
examples of those sounds.
 Child may have over-learned those particular
words.
 Child may have a “fossilized form” for those
particular words.
Standardized Tests and “Measuring
Progress” – Why Not?

2. Regression to the Mean.


Scores at the very low end or the very high
end are not very common (relative to the
entire population).
By sheer probability, when you retest, low
scores are more likely to go up and high scores
are more likely to go down.
 Remember that statistically speaking, really
tall parents tend to have shorter children
than themselves and really short parents
tend to have taller children than
themselves.
More on Regression to the Mean

Every test score is a “sample” of ability
and includes measurement error.


That’s why we consider SEM in assessments.
With a very low score, it means that
many “sources” of measurement error
were working against the child that day.


When we retest, it is much less likely that
those “sources” will again be working against
the child.
Scores are likely to improve just by chance.
Alternatives for measuring progress

1. Conversational speech samples
– for speech sound disorders the
ultimate goal is performance in
spontaneous speech.

A. For younger children (many errors) have an unfamiliar listener transcribe
(using regular spelling) and calculate %
understood.
Track % understood over time.
 Expectations for % understood =


Age in years / 4.
Alternatives for measuring progress

May also do phonetic transcription.


Calculate Percentage of Consonants
Correct (PCC) and Percentage of
Vowels Correct (PVC).
Compare to reference data from
Austin & Shriberg (1997).

See handout
Alternatives to measuring progress

Use Means (and standard
deviations) to calculate z-scores.


Z-score = how many standard
deviations from the mean a raw score
is.
z-score = (score –mean) / std. dev.
Alternatives for measuring progress

B. For older children (fewer errors)



Have an unfamiliar clinician transcribe
phonetically and calculate % correct.
Probably only need to focus on the
particular target sounds.
Clinicians can act as transcribers for
each other.
Alternatives for measuring progress

2. Systematic Probes – for each
target sound, set aside some (e.g.,
10) words containing the target
sound that you don’t use for
practice in therapy.


Bring these out every few weeks or so
and ask the child to produce them.
Track % correct over time.
Articulation vs. Phonological
Disorders



Now ASHA’s preferred term = Speech
Sound Disorders.
Includes both “articulation disorders” and
“phonological disorders”.
BUT is it reasonable to lump these two
categories together?


Are they just two different names for the same
thing?
Even if they are different, do we treat them
differently?
Articulation Disorders



Group exercise. Answer the
following:
What do we mean by an articulation
disorder?
What specific behaviors do we
observe?
Phonological Disorders



Group exercise. Answer the
following:
What do we mean by a phonological
disorder?
What specific behaviors do we
observe?
Speech Sound Disorders



Articulation vs. Phonological
Disorders
Are they the same thing?
If not, should we be doing
something different for each of
them?
Articulation Disorders





Problems with the physical aspects of
producing speech sounds.
Not stimulable (or very poorly so).
Don’t ever produce the sound correctly.
Don’t produce the sound accidentally in
place of some other sound.
Sometimes called phonetic disorders.
Phonological Disorders




Phonology = sub-domain of
language.
The sound system.
How the phonemes and allophones
are organized within a language.
Phonological disorder = a type of
language disorder.
Phonological Disorders

Not a “production” problem. Child
appears capable of producing the
target but isn’t using it correctly.



Errors are stimulable, especially to the
word level or beyond,
Target may also be produced
accidentally in place of something else.
Sometimes called phonemic
disorders.
Natural Phonological Processes

What does it really mean when we
say that a child exhibited final
consonant deletion?



Or velar fronting?
Or cluster reduction?
By themselves, do these labels
really tell us what’s going on inside
a child’s head?
Which Process?

If a child leaves off the /s/ in words
like “hats” and “ducks”, what
process is operating?




Final consonant deletion?
Stridency deletion?
Consonant sequence reduction (cluster
reduction)?
Or is this just a failure to learn the
plural morpheme?
Natural Processes vs. Linguistic
Processes


The natural process labels that SLPs
use are not the same as the
phonological processes that
linguists talk about.
Serious potential for confusion.
Processes vs. Processing

With the emergence of discussions
of “phonological awareness”, we‘ve
begun to look at psycholinguistic
models of how the brain manages
information (processing).

Are we talking about the same thing?
Processes vs. Processing

Just because we see errors that we
can label as fronting, stopping, etc.,
this says ABSOLUTELY NOTHING
about:




phonological awareness skills
short term memory skills, or
how the brain “processes” linguistic
information.
Whether the problem is phonological or
articulatory.
Processes vs. Patterns



There is no doubt that for many
children their errors seem to follow
patterns.
Capturing a child’s “pattern of
errors” using labels such as
stopping, fronting, etc. can be very
useful clinically.
But even Barbara Hodson has
suggested we call them “patterns”
rather than “processes”.
What about speech discrimination?

If we assume normal hearing acuity
(i.e., no hearing loss):


Is it possible to have difficulty
producing speech sounds because of
difficulty with speech discrimination?
Even if such a problem exists, is it
possible to test it?
What about speech discrimination?


If the problem were one of “general
inability to discriminate speech”, then no
speech would be possible.
We do occasionally see children who have
problems with discriminating speech
specific to sounds they are not producing
correctly.


Not at all clear how common this is.
Probably relatively uncommon, but we can’t
ignore the possibility.
Speech Discrimination



Two possible problems:
1. Problems discriminating sounds
as produced by others (external
discrimination).
2. Problems discriminating sounds
when produced by self (internal
discrimination).

One example of this is the “Fis”
phenomenon.
Can we test speech discrimination?

We can test external discrimination
easily but ultimately we cannot ever
really test internal discrimination.


We all hear our own speech differently
than others do because of bone
conduction.
Can’t get inside someone else’s head.
Testing Speech Discrimination

Common approach = minimal pairs test.


Only requires comparison within working
memory.


Present two words side by side (one contains
the target, one contains the error).
Doesn’t require the child to compare what they
hear against their own internal representation.
Often present only one example – could
guess.
Testing Speech Discrimination


Need a way to allow for comparison
against internal representation and
to prevent guessing.
Locke’s (1980) “Speech ProductionPerception Task” (SP-PT) does both
of these things.

Still based on production by someone
else but probably as close as we’ll get.
SP-PT




Create a unique test for each of the
child’s errors.
Compare child’s usual error to the
target.
Include a similar sound that child
can discriminate (ensures task is
understood).
Present multiple examples to
account for possible guessing.
SP-PT


Key = examiner presents one
example at a time of a possible
version of the target.
Child must compare what they hear
with their internal representation
and then decide:


Was it correct or not correct?
Record child’s responses.
Target /
/
Error /
/
Control /
Stimulus - Class
Response
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
yes - NO
yes - NO
YES - no
YES - no
yes - NO
yes - NO
yes - NO
YES - no
yes - NO
YES - no
yes - NO
yes - NO
yes - NO
YES - no
yes - NO
yes - NO
YES - no
yes - NO
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/ - Control
/ - Error
/ - Target
/ - Target
/ - Error
/ - Control
/ - Control
/ - Target
/ - Error
/ - Target
/ - Error
/ - Control
/ - Error
/ - Target
/ - Control
/ - Error
/ - Target
/ - Control
Correct response shown in uppercase letters.
Mistakes:
Error ____
Control ____
/
Misperception = 3+ mistakes on Error.
Target____

Target / ‘ /
Error / f /
Control / s /
Stimulus - Class
Response
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
yes - NO
yes - NO
/ s / - Control
/ f / - Error
/ ‘ / - Target YES - no
/ ‘ / - Target YES - no
/ f / - Error
/ s / - Control
/ s / - Control
/ ‘ / - Target YES - no
/ f / - Error
/ ‘ / - Target
/ f / - Error
/ s / - Control yes - NO
/ f / - Error
/ ‘ / - Target YES - no
/ s / - Control
/ f / - Error
/ ‘ / - Target YES - no
/ s / - Control
yes - NO
yes - NO
yes - NO
yes - NO
YES - no
yes - NO
yes - NO
yes - NO
yes - NO
yes - NO
Correct response shown in uppercase letters.
Mistakes:
Error ____
Control ____
Misperception = 3+ mistakes on Error.
Target____
Testing Speech Discrimination

Another option is the SAILS
software program.



http://www.avaaz.com
Computer program that is intended to
teach discrimination.
Includes an assessment tool.
All or None?

For any given child, will all of their
errors fall neatly into “articulation”,
“phonological” or “perceptual”
categories?



Maybe but not necessarily.
Need to evaluate each error sound.
Treat each sound based on the
type of error that it is.
Childhood Apraxia of Speech (CAS)



Now ASHA’s preferred term for
“Developmental Apraxia of Speech”.
Group exercise. Answer the
following:
1. What are the core characteristics
of CAS? [i.e., what behaviors set it
apart from other speech sound
problems?]
Childhood Apraxia of Speech (CAS)

See handout “ASHA’s draft position
statement”.


Based a thorough review of the
available evidence.
Still being discussed and fine tuned
(i.e., not yet the final word but close).
CAS

“… (CAS) exists as a distinct
diagnostic subtype of childhood
(pediatric) speech sound disorder
that warrants research and clinical
services.”

Note: even with this, there may still
remain some who claim it doesn’t exist.
CAS

“… (CAS) is a subtype of severe childhood speech
sound disorder due to unidentified neurological
differences likely of genetic origin. The core
deficits arise at linguistic or early speech motor
processing levels. Symptomatology, which
changes with age, may include age-inappropriate
vowel/diphthong errors, unusual and variable
errors in repeated attempts at words, increased
number and severity of errors with increasing
word and utterance length, and prosodic
disturbances. CAS places a child at risk for
persisting problems in speech, language, and
literacy.”

ASHA Ad Hoc Committee on Childhood Apraxia of
Speech, 2006
CAS

“… subtype of severe speech sound
disorder…”


Involves speech
 Remember that “oral apraxia”, “verbal
apraxia” and “limb apraxia” are independent
conditions but may co-occur.
 Feeding and drooling problems may co-exist
BUT ARE NOT PART OF THE DISORDER.
Manifests as a very severe form
 Helps us understand slow progress in therapy,
BUT
 SLOW PROGRESS IS NOT SUFFICIENT TO
JUSTIFY THE DIAGNOSIS.
CAS


“ … due to unidentified neurological
differences.”
Unidentified – accounts for the fact that
imaging studies often show nothing.


Personal comment: many of these kids have a
history of some “event”.
Neurological – some deficit or difference
in functioning of control over speech
output.
CAS

“… likely of genetic origin.”

Tends to run in families


Early genetic typing studies have
suggested some possible genetic loci.
Takes the burden off parents (they did
nothing wrong!).
CAS

“The core deficits arise at linguistic
or early speech motor processing
levels.”

MY INFERENCE: As a motor speech
disorder, the problem includes
sequencing of speech sounds (i.e.,
organizing the motor program).


Sequencing may yet be added to the
definition.
May see problems with prosody and
sequencing of syntactic units.
CAS


“Symptomatology, which changes with
age, may include age-inappropriate
vowel/diphthong errors …”
What these children present with does
depend on their age.


See vowel errors at younger ages (persist well
past age 5 in many cases).
 One of the few disorders where vowels are
an issue.
Problems with consonant sequences and multisyllabic words seen early but persist longer.
CAS

“… unusual and variable errors in
repeated attempts at words,
increased number and severity of
errors with increasing word and
utterance length,...”


Often several widely differing
productions of the same word within a
session.
Greater programming demands of
longer units are often a problem.
CAS


“… and prosodic disturbances.”
Often see atypical stress patterns.



Tendency by some to equally stress
syllables that normally get different
stress levels.
May see intermittent nasality.
May see intermittent monotone
quality mixed in with normal pitch
patterns.
CAS

“ … places a child at risk for persisting
problems in speech, language, and
literacy.”



Often see co-existing language impairments.
Phonological awareness can be a problem for
these children which increases risk of reading
problems.
Often very aware of their problem – panel
called this “a special form of metalinguistic
awareness”.
CAS – how common?




Solid prevalence estimates not
available.
Evidence suggests it is probably
much less common than currently
assumed.
Likely 3-4 cases per 1000 children.
Knox County?
CAS - Assessment

For children under 5 years:


Look for vowel errors.
Look at sequencing of simple syllables.
 Performance breaks down with change in
place of articulation.
 Personal comment: formal DDKs probably
unnecessary. Sequencing will likely break
down at normal rate.


Do DDK tasks but use normal rate and don’t
worry about the stopwatch.
Try presenting word lists multiple times and
watch for variability.
CAS - Assessment

For children over 5 years:


May still see vowel errors. Diphthong
errors still likely.
Look at the nature of the consonant
errors.


Often see multiple feature changes (e.g.,
both place and manner change).
Ask for productions in progressively
longer units.
Oral-motor exercises


Group exercise.
Answer the following:



What does this term mean to you?
What sorts of things do you do clinically
that you would fit into this category?
Why do you use them?
Non-Speech
Oral Motor Exercises


These are normally justified four
ways:
1. May help speech by breaking it
down into smaller steps

NO. We don't learn motor activities
that way. We learn motor movements
by practicing the entire movement.
Non-Speech
Oral Motor Exercises

2. These may help increase strength of
the speech organs.



NO. Two problems:
a. Not necessary. Speech normally only
requires less than 20% of our strength
capacity.
b. Strengthening requires many repetitions
against resistance. Exercises being advocated
don't involve resistance and never involve
enough repetitions to be useful.
Non-Speech
Oral Motor Exercises

3. These may improve the
connections between the nerves
and muscles. NO. Research has
shown that the only way to improve
how the nervous system interacts
with the muscles is to practice
RELEVANT behaviors. Need to
practice speech to improve
connections for speech.
Non-Speech
Oral Motor Exercises

4. But doesn't speech develop from
earlier non-speech behaviors? NO.
Despite what would seem obvious,
research has shown that the brain
organizes the movements for
speech in very different ways than
for non-speech movements. There
are common structures, but that's
all.
Non-speech
Oral Motor Exercises




In addition to the above, clinicians
say they do these “because they
work”.
The question is “Do they?”
As mentioned previously, change
happens and clinicians are very
good observers of change.
But did the exercises result in the
change.
Non-Speech
Oral Motor Exercises


Several studies have attempted to
prove that they work.
All failed to do so.


Handout of recent study.
The only study that “appeared” to
show an effect was badly flawed
and thus, really didn’t show
anything.
Non-Speech
Oral-motor exercises


Should we use these, and if so,
when?
Ask yourself, “what is my goal?”

They may have some value:
1. To remediate documented chewing,
feeding and swallowing problems.
 2. As VERY BRIEF (i.e., no more than 2-3
minutes) initiating activities to heighten
awareness of the articulators.

Dialects – Appalachian English




AppE is the non-standard dialect
associated with the rural, working class
population of the central and southern
Appalachian mountains.
Primarily descendants of immigrants from
Scotland (by way of Ireland) who arrived
in the mid-late 1700s and early 1800s.
Mountainous region; very inaccessible
until the 1940s.
The creation of both the Tennessee Valley
Authority (1933) and the Great Smokey
Mountains National Park (1934) greatly
improved access.
AppE as a Dialect

Some debate about whether AppE is
a single dialect or many dialects.



“mountain talk” or
/d8f5nt tek 8n 2vri hel5/
General consensus is that it can be
called a single dialect with many
local variations.
AppE as a Dialect

“Characterized by distinctive sounds,
syntax, and originality, Appalachian
speech has long served as an emblem of
the region’s natives … Appalachians have
been romanticized as surviving speakers
of Elizabethan English yet simultaneously
ridiculed as backward users of a lowerclass, substandard dialect reflecting the
region’s isolation and poverty.”
 Michael Montgomery, 2006, p. 999,
Encyclopedia of Appalachia.
AppE Phonology




As a dialect of American English,
AppE includes a series of variations
from General American English
(GAE).
Includes variations in both
consonants and vowels.
See handout for details.
Unfortunately we know almost
nothing about how this dialect is
acquired.
Acquisition of AppE Phonology


Two known studies.
Davis (1998) – unpublished MA thesis.



recorded conversational speech from 42
children age 5-7 years from Knox county.
Reported that the % of children using any of
nine AppE features tended to decline with age.
 BUT 5/9 features were still being used by half
of the 7 year-olds.
Suggests that as the children gained more
school experience, they were becoming more
proficient at code-switching into GAE.
Acquisition of AppE Phonology

Flipsen & Parker (2005) – unpublished
paper still in process. Some preliminary
results.



recorded conversational speech and PAT-3
from 8 children age 3;1-5;11 from Wise, VA.
Language analysis suggested they were “mild”
dialect users (low density of AppE morphosyntax features).
Calculated PCC and PVC from conversations
and converted to z-scores using reference data
for GAE from Austin & Shriberg (1997).
Flipsen & Parker (2005)
ID
1
2
3
4
5
6
7
8
Gender
Male
Female
Female
Male
Female
Male
Female
Male
Age
5;11
5;3
4;4
3;4
3;1
3;4
4;10
4;0
PAT-3 ss z-PCC
87
-2.17
111
1.33
114
0.42
114
1.34
103
0.21
110
0.14
102
1.6
94
-0.78
z-PVC
-5.73
-2.73
-3.42
-4.25
-1.85
-4.85
-1.78
-6.80
Flipsen & Parker (2005)




All PAT-3 standard scores were within the
normal range.
All vowel scores (z-PVC) were outside the
normal range relative to GAE.
7/8 consonant scores (z-PCC) were within
the normal range relative to GAE.
For one child, his consonant scores in
conversation would identify him as
disordered.


BUT his PAT-3 score said he was normal.
Produced many non-AppE errors (lateralized a
lot of fricatives and affricates).
Clinical Issues and AppE


Long history of mislabeling speakers
of non-standard dialects as having
speech/language impairments.
Clinicians in the Appalachian region
regularly ask about how to
differentiate use of this dialect from
disorder.

Many AppE variations resemble errors
in GAE.
Clinical Issues and AppE


Too little data available yet to really say
how to make clinical decisions.
Available samples too small and may not
be the most representative.


Hopefully more to come.
Does appear that conventional
articulation tests may not be enough to
catch problems (regardless of dialect).
Intervention – Articulation Disorders



Not much new here.
Conventional articulation therapy is
generally the way to go here.
Modeling, phonetic placement,
sound shaping, etc.
Intervention – Discrimination

For those occasions where a child is
unable to hear the difference
between the sound they are
supposed to use and the one they
actually use,

We need to teach them to do so.
Intervention – Discrimination


Several options:
1. Traditional ear training – ala Van
Riper.



Very involved. Not very practical in
most circumstances.
2. SAILS software program.
3. Include Hodson’s auditory
bombardment as part of other
treatment.
Auditory Bombardment



Hodson suggests we do this with every
child that has a speech sound problem.
Not clear how helpful this is overall but
easily warranted for children with specific
discrimination problems.
Present word lists using SLIGHT
MECHANICAL AMPLIFICATION.



Talking louder only distorts the signal!!!
See the following link for word lists:
http://web.utk.edu/~pflipsen/Clinical_
Resources.html
Intervention – Phonological



Child essentially is able to produce
the sound but fails to do so
appropriately.
A number of different approaches
possible.
All based on the idea that the child
needs to learn the “function” of the
sound.

When and where to use it to create
meaning.
Intervention - Phonological

Three underlying principles:



1. Phonological contrasts – focus on
function; teach how different sounds
result in different meaning. Must use
real words.
2. Focus on groups of sounds - treating
patterns rather than individual sounds.
3. Naturalistic context – usually work
with real words in meaningful contexts
Phonological Intervention
– Basic Plan





1. Select target words.
2. Discuss target words to clarify
meaning.
3. Confirm discrimination between words.
4. Production practice – often use role
reversal; child attempts words and SLP
picks up pictures (may need phonetic
training here if incorrect).
5. Practice in units above word level.
Phonological Intervention
- Selecting / Organizing Targets

Several options available





a. Distinctive features approach
b. Minimal opposition approach.
c. Maximal opposition approach.
d. Multiple opposition approach
e. Natural patterns (processes)
approach.
Not all contrasts are equal

Consider the following contrast pairs:



pin – bin; pin – sin; pin – gin.
All differ by one phoneme so we can call
them all “minimal pairs”.
But the pairs are different in terms of
numbers of features not shared:



pin – bin (1; voicing).
pin – sin (2; place, manner).
pin – gin (3; place, manner & voicing).
a. Distinctive Features Approach



Based on the assumption that the child
has failed to learn a particular feature.
Really teaching features, not phonemes.
Usually focus on one feature at a time.


Select two sounds – one that includes the
feature and one that does not.
As much as possible the two sounds should
differ by as few features as possible
(preferably only one).
a. Distinctive Features Approach


Video
Illustrates basic plan for all
approaches.
b. Minimal Opposition Approach


Ultimate Targets = missing
phonemes.
Contrast the target phoneme with
another that child can produce.


Contrasting sound should differ from
the target as little as possible.
Ideal = only differs on one feature.
c. Maximal Opposition Approach

Based on the idea that error sounds
should be contrasted with VERY different
sounds.




Contrasting sound differs from the target by as
many features as possible.
Makes the error sound stand out more.
E.g., /s/ vs. /b/ or
/k/ vs. /l/
Several studies have suggested that
generalization may be faster with this
approach.
c. Maximal Oppositions Approach

Two versions of this now proposed:


1. error sound contrasted with a sound
child already has mastered.
2. contrast between two different error
sounds (i.e., neither currently correct).

Sometimes referred to as the “empty-set”
approach.
d. Multiple Oppositions Approach

Most useful when one phoneme is being
used for more than one other.



E.g., child who uses /t/ for /k,s,c,./.
Called a collapse (several phonemes collapsed
into one).
Basic idea is to create a set of contrasting
words and focus on all of them at once.



E.g., targets for above = two, Sue, shoe,
chew
E.g., ate, ache, ace, H (letter)
(note – may not be able to find words for all
the targets every time; be sure to include error
sound).
d. Multiple Oppositions


Idea is to create maximum
"cognitive" stress on the sound
system and force a complete
reorganization.
Does impose great "semantic"
demands on the child.


Lots of different meanings to keep
track of.
May not be appropriate for children
with poor cognitive skills.
e. Natural Patterns Approach

Create contrasts based on the
patterns observed.


Patterns can be derived from Khanlewis (after GFTA) or Hodson’s test or
analysis of spontaneous speech.
Contrast child’s usual productions
with the targets.
Intervention - CAS



Recall – it’s a motor speech disorder
with sequencing the big issue.
Need to train to get consistency so
lots of drill and practice needed.
Need to train flexibility – teaching
them to organize programs, not
memorize particular movements.
Intervention - CAS



These children often have a limited
number of sounds they can produce
correctly.
Often have a limited number of
syllable shapes they can handle.
Need to improve both.
Intervention - CAS

How do we:






Increase phonetic inventory
Increase syllable shape inventory
Improve consistency
Maximize flexibility
all at the same time?
AND not create demands that are
too hard to manage?
Intervention - CAS

Three basic principles:



1. Train new phonemes using syllable
shapes they can already handle.
2. Train new syllable shapes using
phonemes they have already mastered.
3. Cycle through a small number of
examples randomly to maintain
flexibility.
General Q & A