Assessment Procedures for Children with Speech Sound Disorders

• Assessment Procedures for Children with Speech Sound Disorders

For assessment and other information about speech sound diorders: • http: //www. asha. org/public/speech/disord ers/Speech. Sound. Disorders/

I. INTRODUCTION** • Assessment—set of procedures that are used to gain a clear description of the speech sound production skills of a child—goal is to determine if there is a speech sound disorder

Goals of assessment: ** • 1. Is therapy needed? • 2. What factors are related to the presence or maintenance of the SSD? (e. g. , middle ear infections) • 3. Direction of therapy • 4. Prognostic statement—what will happen with or without therapy • 5. Monitor change over time—is tx effective? Changes needed?

We can do an independent or relational analysis: ** • Relational analysis: describe the child’s productions and compare them to the adult standard of of the speaker’s linguistic community. We’re asking: does the child produce the sounds correctly? • This is what we do with most children

Independent analysis: ** • What speech sounds does the child produce? • We aren’t concerned if they are correct or not • In my experience, this is great for young, highly unintelligible young children

II. SPEECH SCREENINGS** • Screening: pass/fail procedure that can be conducted quickly with a large number of individuals in a short period of time • Id people who need further assessment • No info on test 3 re: specific screening instruments (pp. 152 -153) • Children: converse, say ABCs, count to 10 » Adults—conversation, reading

I screened Emmanuel • 5 years old, Spanish at home— difference or disorder? • Tx or no tx— give him time?

In schools in California

In the schools…** • Put the child on “monitor” status • I say to a kindergarten teacher, e. g. : • “He is still quite young, so I will re-check him again in January. If he still doesn’t technically qualify for speech, I can re-screen him in first grade. ”

III. GENERAL PRINCIPLES OF ASSESSMENT** • A. Review the Client’s Background – 1. Written case history forms – 2. Information from other professionals • 3. Conduct interview

1. Written case history forms

Written forms (continued)** • Speech, lang, developmental hx • Prenatal and birth hx • Medical hx (eating problems, ear infections) • Educational hx • Social hx (ch’s relations with others, discipline problems; is the child frustrated? )

2. Information from other professionals

3. Conduct an interview

We need to ask:

Close the interview** • Recap important points • Be sure to tell the person that you will share test findings with them • Thank them for their time

• B. Plan Assessment Session** • -select appropriate tests • -prepare bribes! (stickers, toys, games, prizes) • C. Prepare Testing Area • Clean and clutter free • Not distracting

• D. Assess Related Areas** (more later) – 1. Hearing – 2. Orofacial structures – 3. DDK syllable rate – 4. Speech rate – 5. Speech intelligibility – 6. Level of stimulability

E. Screen language

Baron et al. (2018). Children with dyslexia benefit from orthographic facilitation during word learning. Journal of Speech, Language, and Hearing Research, 61, 2002 -2014. ** • To review, children with SSD are at increased risk for having difficulty learning to read • In assessment, test phonological awareness

Test PA skills that are especially related to reading deficits (Baron et al. , 2018)

Baron et al. , 2018: ** Also test the child’s ability to repeat complex words (associated with dyslexia) like: Refrigerator Hippopotamus Aluminum Reservation

The question: ** • Does the child’s SSD have an adverse effect on their educational performance? • If not, technically they don’t qualify for speech • Farquharson, K. , & Boldini, L. (2018 October). Variability in interpreting “educational performance” for children with SSD. Language, Speech, and Hearing Services in Schools, 49, 938 -949.

Farquharson & Boldini 2018— Educational performance includes:

Farquharson & Boldini 2018—problems related to educational impact that can come from having an SSD:

• F. Administer Tests** • Get a spontaneous sample • Use standardized tests—some school districts demand norms

• G. Discuss Findings and Make Recommendations

IV. HEARING SCREENING** • SLPs can screen • In the schools, nurse usually does this • Pure tone air conduction thresholds at 20 or 25 d. B • Refer to physician, audiologist if suspect a problem

In hearing testing:

V. DIADOCHOKINETIC SYLLABLE RATES** • DDKs refer to the speed and regularity with which a person produces repetitive articulatory movements • Alternating motion—same syllable /pʌpʌ/ • Sequential motion—different syllables /pʌtʌkʌ/ • We are evaluating oral motor coordination

In evaluating oral motor coordination, we are looking for: ** • Speed • Accuracy • Sequencing problems

VI. CONDUCTING AN ORAL PERIPHERAL EXAMINATION** • A. Purpose • Helps differentiate: functional or organic • Functional: not associated with an organic or neurological impairment • Organic: some underlying structural, sensory, or neurological cause or related factor

B. Supplies** • Penlight, gloves, stopwatch (phone), tongue depressors Tasty tongue depressors are best! Dr. R’s wad ‘o gum technique

C. Assessment of Structure and Function of Facial Muscles** • 1. General symmetry of face at rest— drooping? Twitches? • 2. Facial symmetry during smiling, opening mouth • 3. Structural integrity of lips—drooping? Mouth breathing?

D. Assessment of Structure and Function of Tongue** • 1. Structural integrity—normal color? • Abnormal movements like fasciculations/tremors?

• 2. Functional integrity

• E. Assessment of Hard Palate** • Normal color? • Normal height and width? (too narrow? ) • Clefts?

Narrow, high, vaulted hard palate: (normal, thumb sucker)**

Your book recommends:

• F. Assessment of Soft Palate** • Problems VPI (velopharyngeal incompetence) • Bifid uvula submucous cleft? • Good oral-nasal resonance balance? • Prolong /a/--does velum move up and back to meet pharyngeal wall?

Confirming that velopharyngeal closure is normal…** • Requires specialized procedures • E. g. , an otolaryngologist can view closure from the top with a nasoendoscope inserted through the nose • A radiologist can use lateral fluoroscopic Xray

• G. Assessment of Teeth

watch Haberstock youtube video • Youtube channel Celeste Roseberry

VII. OBTAINING A SPONTANEOUS SAMPLE** n Ideal—most valid and representative sample of phonological performance in daily life n Time-consuming, hard with highly unintelligible children n Some children don’t want to talk with an unfamiliar adult n You may not get a sample of all English phonemes

We can get older children and adults to read a passage out loud: ** • But usually fewer errors occur in reading than in spontaneous speech • For example, in my work with adult accent clients, they use he orthography of the printed word to help them produce sounds correctly; they don’t have these visual cues in spontaneous conversation

Practical tips:

Fogle 2019—when you listen back to the spontaneous sample, you are listening for:

VIII. ADMINISTERING STANDARDIZED TESTS** • A. Introduction • Advantages • -quick (15 -20 min. ) • -sample all consonants • -you know what the highly unintelligible child should be saying

When we assess speech sounds in single words…** • We get a speech sound inventory • The speech sound inventory is phoneme productions that are gathered from a corpus of single-word productions (p. 155)

Disadvantages:

• B. Obtaining Responses** • Direct vs. delayed imitation • C. Recording Responses 1. Plus/minus technique 2. Whole word transcription

3. Record type of error: ** a. Omission (-) b. Substitution t/k, d/g, w/r c. Distortion—D or D 1 -D 3 d. Addition—transcribe whole word

D. Commonly-Used Tests: Phonological Processes** (for the exam, you only have to know the ones in orange font) • 1. Natural Process Analysis (NPA) (8 PPs) • 2. Assessment Link Between Phonology and Articulation (ALPHA) (50 words; transcribe PPs or artic)

• 3. Assessment of Phonological Processes-Revised (APPR; Hodson) 2008 March—APP: 3 (computerized version too)** Severity rating

• 4. Bankson-Bernthal Test of Phonology (BBTOP) (80 words; 9 PPs)** • 5. Khan-Lewis Phonological Analysis (first give Goldman-Fristoe) (10 PPs) • 6. Phonological Process Analysis (12 PPs) (Weiner)

Our clinic uses the CAAP: ** • Clinical Assessment of Articulation and Phonology

E. Commonly-used Tests: Articulation** • 1. Arizona Articulation Proficiency Test-3 • 2. Photo Articulation Test (PAT: 3) • 3. Goldman-Fristoe Test of Articulation: 2 (GFTA: 3 came out in November, 2016) • 4. Test of Minimal Articulation Competency (TMAC)

When you record….

Youtube • GFTA-2 • TAGroup

IX. OTHER TYPES OF ASSESSMENT** • A. Speech Discrimination Testing • Minimal pairs • B. Stimulability Testing • We are sampling the client’s ability to imitate the correct form of error sounds when provided with “stimulation” (e. g. , verbal, tactile, visual cues) • If a child is highly stimulable for a sound, he or she may outgrow their error (e. g. , w/r) without intervention

• C. Contextual Testing** • Mc. Donald’s Deep Test • Secord Contextual Articulation Tests (SCAT) • Special procedure that can help id a facilitative phonetic context for correct production of a particular phoneme—we test a sound in a variety of phonetic contexts

X. ANALYZING AND INTERPRETING ASSESSMENT INFORMATION** • A. Analysis of Speech Sound Production • Independent analysis: child’s productions transcribed without reference to adult model • Id sounds that are in the child’s phonetic inventory • **Relational analysis: compare child’s production to standard/adult form • B. Linear Phonological Error Pattern Analysis (not on test)

• C. Traditional Analysis** • 1. Errors IMF • 2. Error types—omission, distortion, substitution, addition • D. Developmental Analysis • Compare child’s production to norms for CA (**public schools)

• E. Pattern Analysis

2. Place-Voice-Manner

• 3. Phonological Process Analysis** • Analyze PPs in terms of frequency, percentage of occurrence • Total # of occurrences of final cons. deletion = 10 • Total # of opportunities for the process = 50 • Total = 20% occurrence

Review of Phonological Patterns (pp. 182 -184)** • • • 1. Final consonant deletion 2. Weak syllable deletion 3. Reduplication 4. Consonant cluster reduction 5. Epenthesis

• 6. Metathesis—transposition or reveral of** two segments/sounds in a word (baksit/basket) (p. 183) • 7. Velar assimilation (e. g. , guck/duck) • 8. Nasal assimilation (e. g. , nun/nut) • 9. Labial assimilation (e. g. , pipe/type) • 10. Fronting • 11. Backing • 12. Stopping • 13. Liquid gliding • 14. Vocalization (liquids replaced by vowels)

• 15. Deaffrication (e. g. , ship/chip)** • 16. Glottal replacement (glottal stops replace phonemes in the medial or final position of words) • 17. Prevocalic voicing (e. g. , ban/pan) • 18. Final consonant devoicing

Review of patterns disappearing and persisting after 3 years old (p. 191):

Phonological patterns persisting after age 3: • • • Cluster reduction Epenthesis Gliding Vocalization Stopping Final consonant devoicing

• F. Intelligibility Analysis** • Speech intelligibility is a perceptual judgment made by a listener based on the percentage of words in a speech sample that are understood • Usually— subjective statement “This examiner estimates that in a known context with an unfamiliar examiner, Joey is 50% intelligible in connected speech. ”

Please know intelligibility norms:

XI. MAKING A DIAGNOSIS • A. Typical Speech Skills

• B. B. Articulation Disorders— Articulation Disorder

C. Disorders—Phonological Disorder

D. Severity Estimate--Disorder is: ** • Mild-moderate • Moderate-Severe • Profound

E. Diagnostic Statement** • A summary —one of the last portions in a written report It’s very important that this be well done, because it’s all most people ever read (e. g. , parents, principals, pediatricians)

XII. DETERMINING PROGNOSIS** • Prognosis = estimated course of a disorder under specified conditions • E. g. , what will happen if tx is offered—or not? • Variables contributing to prognosis— motivation, intelligence, how much time you have

Roseberry:

3 Major components of a good prognostic statement: ** • 1) goal statement —skills ch expected to achieve—be specific • 2) judgment of success • 3) Prognostic variables that justify the judgment

XIII. MAKING THERAPY RECOMMENDATIONS

For therapy, many clinicians…

Most frequently-occurring sounds are a priority (p. 193)** • /n, t, s, r, l, d, voiced th, k, m, w, z/ • Please know these for the exam • VERY helpful with children, adult accent clients • Also good for Wheel of Fortune!

XIV. CONCLUDING THE ASSESSMENT PROCESS** • Diagnostic report • Conduct information-giving interview

Information-giving interview

Roseberry’s examples: ** • I loved working with Manuel. He is so cooperative and sweet! We will definitely need to enroll him in speech for ****. I look forward to working with him. • Jennifer is so much fun—and so motivated to improve! I am looking forward to seeing her for therapy.

XV. DIAGNOSTIC REPORT** • Legal doc—could end up in the hands of a lawyer without your permission • Typos, other errors are death • People’s first impression of you!