Sound Evidence:

Clinical Management of
Speech Sound Disorders in
Children

A. Lynn Williams, Ph.D., CCC-SLP

College of Clinical and Rehabilitative Health
Sciences
East Tennessee State University
 Disclosure statements
• Financial disclosure
– Employed at East Tennessee State University
– Receive royalties from Brookes Publishing
(Interventions for Speech Sound Disorders in
Children)
– Receive royalties from EBS (SCIP app)
– Travel funded by UNI
• Non-Financial disclosure
 The Goal of Today’s Workshop
Make it ACAP!
• Assessment
– Learn about 2 different analyses Morning
• Target Selection
– Learn about 3 different approaches to target selection
• Intervention Approaches
– Learn about 8 Different Interventions (match tx to dx)
– Intervention Resources Afternoon
– Case Examples
• Reflection
Did you know …
• Nearly 1 in 12 children 3-17 years old
have a communication disorder?
– Speech sound disorders (SSD) are the
most prevalent communicative disorder
– Highest among children 3-6 years
– This means there are 2-3 students in every
classroom who have a communication
disorder

NIH (2012)
Did you know …
• Preschool children with SSD do not perform as
well as their peers in literacy and learning during
the early school years?
– This continues until at least 9 years of age
– Negatively impacts various aspects of children’s lives,
such as their verbal communication skills,
interpersonal interactions, ability to handle stress, and
participation in daily life activities with long term
consequences on their educational experiences and
employment outcomes
• So SSD are not confined solely to speech or to
early childhood!

McCormack, McLeod, Harrison &

McAllister, 2010
Did you know …
• There is a critical age hypothesis for
remediating unintelligible speech?
– Unintelligible speech must be resolved by age 5;6 in
order to significantly reduce academic problems
associated with speech disorders
– Given that many children do not come to SLP for
treatment until age 4, there is a significant need for
efficient and effective therapies to remediate the
speech disorder within a short time period (e.g., 18
months!)

Bishop & Adams, 1990

What is the population of children with SSD?

DIVERSITY AND DEFINITION

OF SSD
 Defining Speech Sound Disorders
• Speech Sound Disorders (SSD) in children is a
complex neurodevelopmental disorder that is quite
diverse and ranges in both severity and type of
disorder (Shriberg, 2010).
– SSD include articulatory, phonological, and motor speech
disorders and have been identified as one of the most
prevalent types of communication impairment among
children.
– Further, SSD can co-occur with other impairments of
communication, such as language impairment, literacy
difficulties, or fluency.
Distinction between articulation and phonology
Articulation Phonology
Origin Errors only involve production Errors involve production + language
(linguistics)
Problems are peripheral Problems are peripheral + central
Acquisition Children learn speech sounds Children learn a phonology (sound
system of a language)
Symptoms x Distortions x Substitutions
x Variability x Omissions
x Imprecise productions x Collapse of contrasts
x No loss of contrasts
Assessment Focus on sounds Focus on phonemes
Assess SODA (substitutions, Assess phonological rules
omissions, distortions, additions)
Intervention Goal is to improve speech production Goal is to increase accuracy +
accuracy “facilitate cognitive reorganization of the
system and strategies” (Fey, 1992)
Focus on: Focus on:
x Placements x Contrasts
x Cueing x Problem-solving
x Practice x Perceptual contrasts
x Multiple sound errors

Williams (in press)

Interaction of Phonetic and Phonemic Factors
SSD: A Spectrum Approach

Articulation
(Phonetic) Phonological
(Phonemic)

Ingram, Williams, & Scherer (2018)

Question 1

• SSD are:
a. Phonological
b. Articulatory
c. Both
 Classification of SSD
Linguistic Profile Characteristics Prevalence

Phonological Delay Phonological rules or processes are evident and 47%

are characteristic of younger TD children
Consistent Deviant Presence of both unusual errors and typical 30%
Phonological Disorder errors, which signal the child has impaired
understanding of the ambient phonological
system
Inconsistent Deviant Exhibit delayed and non-developmental error 12%
Phonological Disorder types and variability of production of single word
tokens (> 40%)
Articulation Disorder Unable to produce particular perceptually 11%
acceptable phones
Childhood Apraxia of Deviant surface speech production patterns that <1%
Speech (CAS) may sound similar to Incon Dev Phono Dis, but
difference is the proposed level of breakdown
and symptomatology
Time:
Traditional Approaches vs Phonological Approaches

Assessment and
Analysis:
Review
 Characteristics of a
Phonological Disability
• Child’s system is smaller
than the adult system
• One-to-many
correspondence
between
child:
adult systems
One To Many Correspondence

s
ʃ
t k
ʧ
 Characteristics of a
Phonological Disability
• Child’s system is smaller than the adult
system
• One-to-many correspondence
between child:
adult systems
• Relationship
between the
phonetic properties
of adult target and child’s production
Phonetic Resemblance between
Targets and Child’s Production

s
ʃ voiceless
t k
ʧ

1:4 phoneme collapse

Phonetic Resemblance Between
Targets and Child’s Production

s
ʃ fricatives
t k stop
ʧ affricate

voiceless obstruents
Question 2

• Which one does not fit in describing

phonological impairments?
a. Logical
b. Random
c. Amazing
GFTA-2
Data Set
(Adam, 4;6)
Adam’s GFTA
p/bl
Question 3

• What is the predominant error pattern in

Adam’s speech?

a. Backing + Stopping + Cluster Reduction

b. Cluster Reduction and Stopping
c. Glottal Replacement and Gliding
Question 4

• A PVM Analysis would be appropriate to

complete on:

a. Child with several common errors

b. Child with distortions
c. Child with multiple and uncommon errors
 Phoneme Collapse

s fricatives
ʃ
t k stop
ʧ affricate

voiceless obstruents
SPACS: WI Phoneme Collapse
SPACS: WF Phoneme Collapse
Adam (4;6)
Question 5

• What is the organizing principles for the

[g] and [w] WI phoneme collapses?
a. Fricatives
b. Manner
c. Front
What is the organizing principle?

• Manner (+ sonorant)
Mirror Rules

SONORANT

Obstruent Sonorant
[-sonorant] [+sonorant]

Obstruents and stop clusters Æ [g] Sonorants and continuant clusters Æ [w]
 Adam: Comparison of PVM to SPACS
Systemic Approach Phonological Processes Approach
Independent + Relational Analysis Relational “Error” Analysis
2 complementary phoneme collapses 7 unrelated phonological processes
•1:18 phoneme collapse of obstruents and•Backing
stop clusters to [g] •Stopping
•1:7 phoneme collapse of sonorants and •Voicing
continuant clusters to [w] •Deaffrication
•Cluster reduction
•gliding
1. 1:18 phoneme collapse of obstruents and stop
•Idiosyncratic g/b;clusters
w/j to [g]
2. 1:7 phoneme collapse of sonorants
• Holistic and continuant clusters to
• Fragmented
[w]
• Systemic • Sound-based
• Descriptive analysis • Error analysis
• Child-based • Adult-based
• Explanatory + Descriptive • Descriptive only
Question 6
• A SPACS analysis would be appropriate
to complete on all the following
EXCEPT:
a. Child with several common errors
b. Child with distortions
c. Child with multiple and uncommon errors
d. OGK
Time:
Traditional Approaches vs Phonological Approaches

Target
Selection
Goals are the
driving force
behind
intervention.
2
Selecting Targets for Intervention
• Target selection is the link between
assessment and intervention
• Is an important variable in treatment efficacy
• The therapy goal, rather than the exact
treatment approach employed in the therapy
session, may be the instrument of change
(Gierut 2005; Kamhi,
(Gierut, Kamhi 2006))
Traditional vs Phonological
Approaches to Target Selection
Traditional Phonological
• Based onn ph
phonetic
hon netic • Based onn ph
phonemic
honem
nem mic
(subordinate)) factors (superordinate)) factors
– developmental norms – phonological complexity
– stimulability – distance metric (will
– consistencyy of error discuss as third option)
• Assumptions • Assumptions
– motoric basis of sound – learnability is enhanced
learning with the greatest
– ease of acquisition amount of change
occurring in the least
– sequential order of amount of time
acquisition
 A Third Option
for Target Selection
• The distance metric represents a
different perspective to target selection
that doesn’t rely on the dichotomous
characterization of targets as early ~ late;
stimulable ~ non-stimulable; known ~
unknown, etc.
 A Third Option
for Target Selection
• Rather, it is based on the function a
particular sound has within a given
child’s system
– Using phoneme collapses that represent
compensatory strategies developed by the
child to accommodate a limited phonetic
inventory, we can use a distance metric to
select those targets that will result in the
greatest amount of change in the least
amount of time
 Distance Metric
Williams (2003, 2005)
• Select up to 4 different target
sounds from one rule set based on
two parameters:
– Maximal Distinction:
select targets that are maximally different
from child’s error in terms
of PVM
– Maximal Classification:
select targets from each of the following:
(a) different manner classes
(b) different places of production
(c) different voicing
(d) different linguistic units
Target Selection Using Distance
Metric
Maximal Distinction

d stops
k M
a
ʧ affricate x
f i
fricatives m
s a
ʃ l
t st C
sk clusters l
a
tr s
s
kr i
kl f
i
c
a
t
1:11 phoneme collapse i
o
n
Practice Selecting Treatment Targets
w glide
l liquid
f
h s fricatives
ʃ
sw clusters
sl
Question 7

• What targets did you select?

a. A glide, a liquid, a fricative and a cluster

b. A glide OR a liquid, a fricative, and a
cluster
c. A glide, a liquid, a fricative, NO cluster
Practice Selecting Treatment Targets
b
d stops
g
Ø ð
v fricatives
z
ʤ affricate
Question 8

• Which targets did you select?

a. b, v, ʤ
b. d, z, ʤ
c. g, ð, ʤ
Target Selection:
The BIG Picture
With the distance metric,
targets are the salient
“corner puzzle pieces”
that help the child
put together the big picture
of the adult sound system