Functional Speech Sound Disorders

 Two main types:

o Articulation Disorders:

 Focus on individual sounds

 Errors like distortions or substitutions

o Phonological Disorders:

 Focus on patterns of errors

 Rules that affect multiple sounds (e.g., replacing all /k/ sounds with /t/)

 Often difficult to distinguish between the two types

  articulation errors

 omissions/deletions—certain sounds are omitted or deleted (e.g.,

"cu" for "cup" and "poon" for "spoon")
 substitutions—one or more sounds are substituted, which may result
in loss of phonemic contrast (e.g., "thing" for "sing" and "wabbit" for
"rabbit")
 additions—one or more extra sounds are added or inserted into a
word (e.g., "buhlack" for "black")
 distortions—sounds are altered or changed (e.g., a lateral "s")
 syllable-level errors—weak syllables are deleted (e.g., "tephone" for
"telephone")


 phonological errors/processes

substitution Errors:

 Backing: Replacing sounds made in the front of the mouth with sounds made in the back.
(e.g., "kog" for "dog")
 Fronting: Replacing sounds made in the back of the mouth with sounds made in the
front. (e.g., "toe" for "go")
 Gliding: Replacing /r/ with /w/ and /l/ with /w/ or /y/. (e.g., "yewow" for "yellow")

 Stopping: Replacing continuous sounds with stop sounds. (e.g., "dip" for "chip")
 Vowelization: Replacing consonants with vowels. (e.g., "papuh" for "paper")
 Affrication: Replacing stop sounds with affricate sounds. (e.g., "duice" for "juice")
 Deaffrication: Replacing affricate sounds with stop sounds. (e.g., "ships" for "chips")
 Labialization: Adding lip rounding to sounds that don't normally have it. (e.g., "pie" for
"dye")

Assimilation Errors:

 Reduplication: Repeating syllables. (e.g., "baba" for "bottle")

 Assimilation: Changing a sound to match a nearby sound. (e.g., "dod" for "dog")
 Prevocalic Voicing: Voicing voiceless consonants before vowels. (e.g., "book" becomes
"buuk")

Syllable Structure Processes:

 Cluster Reduction: Removing one or more sounds from a consonant cluster. (e.g., "tree"
becomes "tee")
 Final Consonant Deletion: Removing the final consonant of a syllable. (e.g., "dog"
becomes "do")
  Initial Consonant Deletion: Removing the initial consonant of a syllable. (e.g., "door"
becomes "oor")

So basically with phonological delays or errors,the child is able to produce individual

sounds correctly(may say /d/ right on its own) but has difficulty putting sounds together
to form words eg

/d/ replaced with /g/…. /go becomes doe//

Articulation therapy approaches

Traditional Articulation Approach

 Targets: Individual sounds, one at a time

 Progression: From simple to complex (sounds, syllables, words, phrases, sentences,
conversation)
 Techniques: Imitation, cueing, practice
 Best for: Children with mild to moderate articulation errors
 Research: Well-supported by research, but less effective for phonological errors

Traditional Articulation Approach

1. Isolation:

 Technique: The therapist isolates the target sound and has the child practice it in
isolation.
 Example: If the target sound is /s/, the therapist might have the child practice saying
"ssss" repeatedly.

2. Syllable Level:

 Technique: The therapist combines the target sound with other sounds to form syllables.
 Example: For the /s/ sound, the therapist might have the child practice saying syllables
like "sa," "si," "so," and "su."

3. Word Level:

 Technique: The therapist incorporates the target sound into words.

 Example: For the /s/ sound, the therapist might have the child practice saying words like
"sun," "sit," and "so."

4. Phrase Level:

 Technique: The therapist combines words with the target sound into phrases.
 Example: For the /s/ sound, the therapist might have the child practice saying phrases
like "See the sun."
 


 5. Sentence Level:

 Technique: The therapist has the child use the target sound in complete sentences.
 Example: For the /s/ sound, the therapist might have the child practice saying sentences
like "The sun shines bright."

6. Conversational Level:

 Technique: The therapist encourages the child to use the target sound in spontaneous
conversation.
 Example: The therapist might engage in a conversation with the child, prompting them
to use the /s/ sound naturally.

Stimulability Approach

 Targets: Increasing the range of sounds a child can produce


 Techniques: Visual cues, hand gestures, play-based activities

 Best for: Very young children with limited sound repertoires

 Research: Limited research, but promising for early intervention
 Syllables/Isolation:

First things first, a child has to be able to say the desired sound. The syllable level is

usually the first step since all other speech demands are taken away.

For example, if you are practicing /b/, start with “ba” or “ab.” Once the child can say

the sound in syllables, move on to the word level.

Words:

Next, practice saying the target sound within words.

To continue our /b/ example, practice “ball,” “able,” and “tub.” It is important to

practice saying the sound in the beginning (initial), middle (medial), and final (position)

since the tongue, teeth, jaws, lips, and vocal cords have to coordinate and move muscles

differently depending on where the sound falls within a word.

ball,” “able,” and “tub.”

Once the child can say his/her sound in words, the sentence level is next.
Sentences:

A child needs to practice the sound within sentences.

For example, “I see a ball.”

This stage can be difficult since the brain has to remember how to say the sound while

processing all those extra speech and language demands. We are making a good speech

habit here!

Conversation:

be sure to set a specified time to focus on the correct production of the target sound

during conversation. Be sure to correct any inaccurate productions of the target sound

at this time. Practicing the sound in conversation really helps with generalization. Once

the sound has been mastered in conversation the child should begin to generalize the

correct production of the sound in all conversation settings.

This last step and where home practice is very crucial aswell. A child MUST say the

target sound correctly during a conversation. I recommend short, controlled practices

for this one!

For example, tell a child, “We are going to practice /s/ while we play this

game. When we speak, we must use our good /s/ sound. "
To facilitate each level the SLP would use certain techniques like imitation, cues and obviously
practicing the learned sounds.

 Immediate Imitation:

 The clinician says a sound or word.

 The child immediately repeats it.

 Delayed Imitation: You want the child to be able to produce the word with a pause
between your production and their production.

 The clinician says a sentence or phrase.

 The child repeats the target sound or word within the sentence.

 Simultaneous Imitation:

 The clinician and child say the sound or word together.

 Mimed Imitation:

 The clinician silently mouths the sound or word.

 The child watches and then says it.

To facilitate with imitation of sounds or words the therapist may take help of cues. ALL

therapists will use cues to elicit a correct production. CORRECT use of cueing is essential

for a successful therapy program. The goal is to fade these techniques to increase

independence and generalization.

The therapist can use

Verbal cues: Cues for placement of articulators (tongue, teeth, lips, voice, jaw). this is the
easiest, listen, watch, do what I do.

Visual Cues: Visual cues such as a mirror, modeling from therapist, cue cards/reminders,
gestures.

Tactile Cues: Tactile cues such as PROMPT or devices to provide feedback on correct tongue
placement and coordination such as tongue depressors/spoons/candy.

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PRACTICE

the process of articulation therapy is all about practice and repetition. Repetition at each
level strengthens their speech muscles, improves their accuracy, and builds their
confidence which prepares them for success.
 Practice is also going to help with generalization of acquired sounds words in daily
conversation Aswell. Word lists or visual cards can be used in house settings by care giver
to maintain the successful acquisition of sounds and words.

EXAMPLE: Child working on the articulation therapy for/s/ sound may practice the

shared wordlist from the therapist at home during play activity Aswell as in daily

conversations.

Stimulability approach:

TECHNIQUES

A. VISUAL CUES
B. HAND GESTURES
C. PLAY BASED ACTIVITIES
we selected an animal or object to associate with each speech sound. A movement or gesture was also

associated to the animal or object. This gesture is made while the speech sound is modeled to assist

with eliciting the target sound. Color drawings of these characters were made on 5 × 8-in. note cards.

-At the beginning of the treatment session, the character cards are shown to the client one by one to

focus the child's attention on each character. With the clinician and client's attention jointly focused on

the character, the clinician demonstrates the character's sound and the associated movement.

e.g COUGHING COW (while tapping the throat with each syllable)

FUSSY FISH (WHILE MAING SWIMMING GESTURES WITH ARMS)

 Stimulability activities are fun, engaging ways to encourage a child to produce target

sounds

 Playful Learning: Make the activities fun and game-like.

 Model the Sound: The therapist demonstrates the sound clearly.

 Imitation: The child tries to copy the sound.

 Visual Cues: Use gestures or pictures to help the child understand the sound.

 Positive Reinforcement: Reward the child's efforts, no matter how small. Even close

approximations of target sound is accepted.

 Adjust the Difficulty: As the child improves, make the activities more challenging.

the clinician provides appropriate feedback by asking for clarification. The clinician may say, "Let's see,

do I have floppy fish /f/ (Draw's attention to teeth on lower lip.) "Here's FLOPPY FISH /f/ (with

accompanying gesture). Thus, a multimodality, auditory-visual-tactile, cue is provided.

 If the child imitates the sound, positive verbal feedback is given.

 if the child does not successfully imitate a non stimulable sound, she may next request a character

with a stimulable sound(eg /c/ coughing cow when she fails to elicit /f/ sound fussy fish

 When the clinician takes a turn, she redirects attention to the nonstimulable sounds by modeling

a nonstimulable sound as she requests a new character card.

 The child is encouraged to imitate the production. Next, when the child takes a turn and requests

a card, the child may request any character, either one that is associated with a stimulable sound

or one that is nonstimulable.

 Because both stimulable and nonstimulable sounds are targeted to expand the phonetic

inventory, the child is successful and frustration is kept at a minimum

In this way, stimulability tasks are incorporated into games and activities designed to draw attention to

speech sounds. two or three activities are used per session to maintain joint attention and interest

Other activities include-picking a card,face down.child therapist take turns picking cards

If the child picks card-therapist has to guess the associated sound to the character and vice versa.the

child can give cues of associated gestures and attempted sounds

As with the first activity, the clinician identifies the target sound by the associated gesture and either

reinforces the correct production or draws attention to the correct production through modeling and

phonetic placement cues.

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Phonological-based Interventions
understanding the phonological rules of a language that are stored in the mind and how

to apply those rules.

The goal is not to teach new sounds, as children with phonological impairments typically can produce

the sounds; the difficulty most often lies in learning to produce the correct sound in the correct context.

Contextual Utilization

 Contextual utilization recognizes that sounds of speech are produced in a context

of connected speech.

 Context itself can facilitate the correct production of a particular sound.

 EXAMPLE:A CHILD PREVIOUSLY PRODCUED THE /K/ SOUND IN THE CONTEXT OF

TAKE CARE.THE CHILD SAI TAKE CARE EARLIER WITH A GOOD ELICITION OF /K/

SOUND.the therapist can bring that up and say I really like the way you said

takecare earlier with a really good /k/ sound for care.we are gonna work on

the /k/ sound a little bit more

 Stretch it out TAAAKEE CCCAARREE

 EQUAL STRESS: TAKES CARE

 STRESS VARIATION:

 1.TAAKESS care 2. takes CAARREE

 SHORT SENTENCES DOG TAKES CARE OF BABY (you are basically probing the

generalization of the target word)

 Even in sentences you use the strategies like stress variation, stretching out can be

used to practice the target sound pattern in conversation setting

 This approach is excellent for children who are inconsistent in their speech and

need help to consistently produce a sound in multiple contexts.

Phonological contrast approaches

 These are used for the Phonological error pattern by Speech Pathologists.

 Phonemic contrasting is done to make the child aware of the differences

between different phonemes

 Types 1.minimal pair 2,multiple opposition 3. Maximal approach

 Minimal oppositions/ Minimal pairs which use a different pair of words that

differ with one phoneme but change the meaning of the word e.g. Car vs Bar

 Maximal oppositions approach uses those contrastive words that are maximally

distant and varies on the dimensions of voicing, placement and manner. . For

example, two targets with phonemes that differ in both manner and voicing

(e.g., /s/ and /d/) may be chosen as contrastive pairs.

 As another example, ‘bun’ and ‘sun’ differ in place (labial vs. alveolar (putting

the tip of tongue with the roof of mouth just behind teeth),
 manner (stop vs. fricative)).

 The pairs that are presented contain one sound with which a child is familiar to

contrast with a target sound

Multiple Opposition

 This approach uses a contrastive pair of the word that must contain a child’s

error sound and three to four contrastive words e.g. “bye”, “shy”, “ hi”, “Sky”.

 is similar to minimal pairs, though includes multiple targets that contrast (or

differ in a single feature) from the child’s production, resulting in a larger

contrastive treatment set

Cycles Phonological Pattern Approach (CPPA):

 CCPA is a combination of traditional and linguistic approaches and is effective for

those children who have highly unintelligible speech.

 Treatment consists of 5 to 16 weeks and is scheduled in cycles.

 In each cycle, phonological patterns are selected and after its completion,

another cycle begins.

 These cycles continue until the child can use these targeted sounds in his

reciprocal communication

 d. Focused auditory stimulation (previously called ‘Auditory Bombardment’) is

also used in a cycles approach at the beginning and end of a session to help the
 child to attend to the process being targeted. During this auditory stimulation,

the child listens through

 headphones to a spoken list of 15-20 words for approximately 30 seconds or less

MOTOR/NEUROLOGICAL

CHILDHOOD APRAXIA OF SPEECH

Facial and oral structures such as the lips, tongue, soft palate, jaw and vocal folds –

and the muscles that move these structures – need to be activated and move at

just the right time, in just the right order, and with just the right force so that the

words your child intends to say are produced accurately.

Practice and repetition

Parents and caregivers will be asked to help the child practice in real life, outside of

speech therapy. Intensity (practicing a lot) and frequency (practicing often) are key

concepts in speech motor learning.

It is for this reason, especially in the early phases of therapy, that children with

apraxia should have individual speech therapy.

While group speech therapy may be appropriate in addition to frequent individual

therapy, children with CAS that have little speech or significantly unclear speech

are not likely to make the gains they are capable of making with just group therapy.

USING CUES

EXAMPLE For example, a speech therapist points to his throat when the first

sound of the word which the child is going to attempt is a sound that is made in the

back of the throat (/k/ or /g/ sound). The child sees where the therapist is pointing
and it triggers her memory of the position of her tongue in the back of the throat.

The child is receiving a “visual cue” about where to start in producing the speech

target. Seeing the therapist point to his throat helps to remind the child of how to

get started with movement for the particular word. Here’s another example. The

speech therapist gently uses her fingers to press the child’s lips together when he

needs to make a “lip” sound as part of the target word (lips sounds are called

bilabial sounds and include /m/, /b/, and /p/). Feeling the touch and his lips

together, helps the child to know how to start a lip sound. This is an example of a

“touch” or tactile cue. There are many examples of cues and they take advantage

of sight, touch, or understanding in order to aid the child in achieving the speech

movement necessary.
 DYSARTHYRIA

 What is it? A chronic speech disorder caused by weakness or incoordination of speech

muscles.
 Causes: Stroke, trauma, brain damage during development or birth.
 Symptoms: Slurred speech, weak muscle control for speech.
 Treatment: Speech therapy (strengthens muscles, improves sound production).
 AAC Devices: Lingraphica AAC devices can aid communication for those with
dysarthria.