Details Created: Saturday, 12 November 2011 15:42 Updated on Saturday, 26 October 2019 12:31 Cite this article as: Show Approaches to ClassificationShriberg and colleagues' subtypes of Speech Sound Disorders (SSD) are based on genetic and environmantal risk factors (Shriberg, Potter & Strand, 2011). Dodd's approach is around linguistic profiling and linguistic subtypes. These and other classification systems are discussed by Bowen (2015) Chapter 2. Clinicians tend to use simplified, 'family friendly' terminology when explaining to families how SSDs are classified. The example of a simplified approach that is included below is the one used by the author, and modified to suit individual families, over many years of clinical practice. Note that within each classification system one or more types of SSD can co-occur (be present in the same child). Subtypes of Speech Sound Disorders (SSD) ModelShriberg, Potter & Strand (2009); Shriberg & Wren (2019)
Linguistic Profiling and Speech Subtypes ModelDodd (2005) Dodd (1995, 2005) proposed a model with psycholinguistic underpinnings that is based primarily on linguistic profiling and speech subtypes. In it, specific speech subtypes are matched to discrete areas of psycholinguistic difficulty or breakdown that are ‘testable’ or ‘differentially diagnosable’. It embraces four subtypes that can occur at any age or stage of speech development, plus CAS. They are: Phonological delay All phonological rules or processes evident in a child’s speech output are attested in typical development, but are characteristic of children younger than the child in question. Consistent deviant phonological disorder Children have co-occurring non-developmental or unusual errors and developmental rules or processes, with the presence of unusual processes signalling that the child has impaired understanding of the target phonological system. Inconsistent Speech Disorder Children exhibit delayed and non-developmental error types and variability of production of single word tokens ≥40%. Articulation disorder Children are unable to produce particular perceptually acceptable phones. Childhood Apraxia of Speech Children with CAS have ‘deviant’ surface speech production patterns that may sound similar to those of children with inconsistent speech disorder, but they are different in proposed level of breakdown and in symptomatology. Note that Dodd uses the term 'DVD' (developmental verbal dyspraxia) in the first edition of her book and 'CAS' in the 2005 (second) edition. Family Friendly Classification Articulation Disorder Phonological Disorder Motor Speech Disorders Structurally-based Speech Sound Disorders Speech Sound Disorders associated with syndromes and conditions Simple Classification System for ‘underlying levels’ of difficulty in SSD Levels and types of difficultiesEach ‘level’ of difficulty (anatomic or sensory, motoric, perceptual, phonetic, phonemic), and each type of difficulty (speech that is characterisitic of children with ankyloglossia, cleft palate, hearing inpairment, etc.; dysarthria; Childhood Apraxia of Speech (CAS); articulation disorder; phonological disorder); depicted above can co-occur in the same child. For example a child might have a primary speech diagnosis of CAS and also have some phonologically based errors and some perceptual errors. Examples John aged 4;6 had poor speech intelligibility, with his parents only understanding 75% of what he said. He appeared to have some difficulties with a sensory basis as he had a history of intermittent conductive hearing loss due to otitis media with effusion when he was between 12 and 18 months of age through to the age of four. John also had difficulties with a perceptual basis, and was unable to discriminate /l/, /ɹ/ and /w/ at word level, becoming confused with word contrasts like lip, rip and whip. As well, some of his difficulties had a phonetic basis; he was unable to articulate /k/ and /ɡ/ and /ŋ/. Furthermore, John had difficulties with a phonemic basis: while he was able to produce all the fricatives, and the stops /p/, /b/, /t/ and /d/, he was ‘stopping’: replacing all fricatives with stops, e.g., ‘dit’ for ‘sis’, 'dit' for 'fish', and 'do' for 'zoo'. Meanwhile, Shahrina, 6;0, had a repaired cleft palate (anatomic), a mild sensorineural hearing loss (sensory) and Childhood Apraxia of Speech (motoric). CitationsCite this article as: Bowen, C. (2011). Classification of children's speech sound disorders. Retrieved from https://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=45 on [insert the date that you accessed the file here]. Cite the 'SSD umbrella' illustration as: Bowen, C. (2015). Five levels of speech function with examples of difficulties that might occur at each level. Retrieved from https://www.speech-language-therapy.comhttps://www.speech-language-therapy.com/images/umbrella2015.pngon [insert the date that you accessed the file here].
These disorders impact how speech sounds are produced when talking, impacting the speaker’s intelligibility. Generally, speech sound errors are characterized based on the presence or absence of patterns within the errors (such as always leaving the ends off of words or not producing the “r” sound correctly) and then categorized as either an Articulation Disorder or Phonological Disorder. Articulation and Phonological Disorders (Speech Sound Disorders)Speech sound disorders (SSD) include articulation disorders, in which a child has trouble physically producing a sound or sounds, and phonological disorders (also known as phonological process disorders), in which the child produces set patterns of sound errors. By age five, most of a child’s speech should be understood, and by about age eight, children should be able to say all sounds correctly. There are established ages for every sound that state when most children should say that sound correctly. Mistakes are expected before that age as the child learns the sounds. But if a child still cannot correctly produce the sound(s) after that age, a speech sound disorder may be present. Sound substitutions or deletions related to a dialect or accent are not considered to be speech sound disorders. The causes of SSD are often unknown. These disorders may occur in children with developmental disorders like autism, neurological disorders like cerebral palsy, or genetic disorders like Down syndrome. Young children who have frequent ear infections that affect hearing are at an increased risk for having speech sound disorders. Symptoms of Articulation and Phonological DisordersSpeech sound disorders may be mild and affect production of only one or two sounds, or there may be so many errors that speech is not understandable. There are several different types of errors in SSD: substitutions, deletions, additions, and distortions. Examples of articulation errors include substituting one sound for another (e.g., saying wed for red), or leaving out sounds (e.g., nana instead of banana). Another type of articulation disorder is distortion of the “s” sound, also known as a lisp. Children with phonological process disorders have difficulty learning the sound systems of the language, and may not understand that changing sounds can change meanings. They produce consistent error patterns (called phonological processes). These patterns may be normal in early childhood, but should not occur past a certain age. One example of a phonological process is substituting sounds made in the back of the mouth (g, k) for sounds made in the front of the mouth (d, t) so that tab becomes cab and dot becomes got. Children may simplify consonant clusters (i.e., consecutive consonants in a word) so that string becomes sting or even sing. Another pattern is replacing sounds made without the voice (e.g., p, t, k) with voiced sounds (e.g., b, d, g), such that pie becomes bye and cat becomes gat. Assessing and Treating Articulation and Phonological DisordersThe speech-language pathologist (SLP) usually gives a formal test to check the child’s ability to say all sounds in different contexts. He will often test language skills as well, to look at overall communication abilities. He may assess the strength and coordination of speech muscles to be sure that sound errors are not caused by muscle weakness. He may also screen hearing if that has not been done recently. When treating articulation disorders, the SLP may show the child how to place and move the tongue and lips to produce sounds, and have the child imitate him. The child will practice saying the sounds in different words, and different positions in words (beginning, middle or end); eventually, practice includes phrases, sentences, and conversation. The SLP will provide feedback and teach the child to recognize when she has produced the word correctly. Phonological treatment generally involves teaching sound system rules and the link between sounds and word meanings. Children will often practice identifying and producing word pairs that differ by only one sound, in order to learn these rules. The SLP will provide a home program of speech tasks for the child to practice outside of therapy, and will educate the family about how to help the child. |
What are the 4 types of articulation disorders?
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