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Editorial
Katharine G. Butler, and Nickola Wolf Nelson
In this 25th anniversary year of Topics in Language Disorders, the
third
issue offers "Clinical Perspectives on Speech Sound Disorders." This
classical topic is addressed by a group of respected experts who
explain new
twists that hold promise for the future of both research and
practice. The
able issue editor is Ruth Huntley Bahr, PhD, Associate Professor at
the
University of South Florida and past editor of Language, Speech, and
Hearing
Services in Schools. It is due to Dr. Bahr's foresight and
leadership
(stimulated by an invitation of editorial board member Elaine
Silliman, to
whom we are grateful) that we have this issue packed full of new
ideas and
cogent explanations of complex topics with practical implications.
It is a
wonderful synopsis of current trends grounded in past understandings
of
speech sound production and disorders, opening a window to the
future...
Introduction:
Developments in treating
speech sound disorders
Ruth Huntley Bahr
Topics in Language Disorders July-Sept 2005 v25 i3 p188
Science is nothing but developed perception, interpreted intent,
common
sense rounded out and minutely articulated. --George Santayana, n.d.
Phonological knowledge in
typical
speech sound development
Benjamin Munson, Jan Edwards, and Mary E. Beckman
Topics in Language Disorders July-Sept 2005 v25 i3 p190
This article discusses 4 types of phonological knowledge: knowledge
of the
acoustic and perceptual characteristics of speech sounds (perceptual
knowledge), knowledge of the articulatory characteristics of speech
sounds
(articulatory knowledge), higher level knowledge of the ways that
words can
be divided into sounds and related phonotactic constraints on how
sounds can
be combined into words (higher level phonological knowledge), and
knowledge
of the ways that variation in pronunciation can be used to convey
social
identity (social-indexical knowledge). The first section of the
article
discusses the nature of these types of knowledge in adults. The
second
describes how they develop in children with typical language
development.
The third section outlines how different types of knowledge may be
compromised in children with functional speech-sound impairments.
Together,
these 3 sections serve as a review for practicing clinicians of the
types of
phonological knowledge that underlie accurate and fluent speech
production.
Key words: articulatory impairment, phonological impairment,
social-indexical knowledge, speech perception, speech production
Stimulability and
treatment success
Susan Rvachew
Topics in Language Disorders July-Sept 2005 v25 i3 p207
This article addresses 2 questions of importance to the treatment of
speech
sound disorders: (1) When selecting treatment targets, is it best to
begin
with the most or the least stimulable potential phoneme targets? (2)
When
treating unstimulable phonemes, which treatment procedures will
result in
the best outcome? A summary of the findings from 3 randomized
controlled
trials is provided. In these studies, outcomes were generally better
when
stimulable targets were treated; however, outcomes for unstimulable
targets
were improved by including phonemic perception training alongside
phonetic
placement procedures in the treatment program. The clinician must
take final
responsibility for judging the applicability of these research
findings to
each individual case. Clinical decisions should be made after
discussing the
known benefits and risks of any given treatment practice with the
client
and/or the client's family.
The article concludes:
'It may be frustrating to clinicians that researchers always
conclude that
"more research is required." This inevitable conclusion does not
mean that
the available research cannot support clinical decision making.
Randomized
controlled trials do provide good information about the likely
outcome of a
given treatment practice for a given population of clients. The
speech-language pathologist must make a judgment about the extent to
which
the research findings apply to a specific child in a specific
clinical
context. The clinician should also engage the child and the family
in a
discussion about the potential benefits and risks associated with
the
application of a given clinical practice. The research reviewed here
suggests that there is a very strong risk of achieving no gain after
six or
more weeks of therapy when unstimulable targets are treated using a
behaviorist approach. However, there may be many situations in which
the
potential benefits outweigh the known risk. The choice of treatment
approach
for a given child is ultimately up to the clinician.'
Key words: evidence based practice, phonological disorder, speech
perception, speech sound disorder, speech therapy, stimulability
Dynamic assessment in
phonological disorders:
The Scaffolding Scale of Stimulability
Stimulability. Amy M. Glaspey, and Carol Stoel-Gammon
Topics in Language Disorders July-Sept 2005 v25 i3 p220
Dynamic assessment is applied to phonological disorders with the
Scaffolding
Scale of Stimulability (SSS). The SSS comprises a 21-point
hierarchical
scale of cues and linguistic environments. With the SSS, clinicians
assess
stimulability as a diagnostic indicator and use the measure to
monitor
progress across treatment. Unlike other phonological measures, the
SSS is
sensitive to phonological change that occurs in relatively short
periods of
time because it measures the changes in response to cues rather than
independent productions. A case study of a 3-year-old girl with
phonological
disorder is presented to demonstrate how the SSS documented change
in
stimulability after 8 weeks of treatment. Examples of changes in
stimulability are presented at the phoneme, sound class, and
composite
levels.
Key words: dynamic assessment, phonology, scaffolding, scale,
stimulability
Assessment, target
selection, and intervention:
Dynamic interactions within a systemic perspective
A. Lynn Williams
Topics in Language Disorders July-Sept 2005 v25 i3 p231
There are a number of clinical options available for speech-language
pathologists to choose from to analyze a child's phonological
system, select
treatment targets, and design intervention. Frequently, each of
these areas
of clinical options is viewed independently of one another or
approached
within an eclectic framework. In this article, an integrated and
systemic
approach is presented which assumes that a dynamic interaction
exists among
assessment, target selection, and intervention. Systemic
Phonological
Assessment of Child Speech, the distance metric approach to target
selection, and the multiple oppositions treatment approach are
described,
with examples provided for each component. Finally, a case study is
presented that examines the systemic approach of multiple
oppositions
relative to the approach of minimal pairs.
Key words: assessment, distance metric, multiple oppositions,
phonological
restructuring, target selection
Relationships among
consistency / variability
and other phonological measures over time
Ann A. Tyler, and Kerry E. Lewis
Topics in Language Disorders July-Sept 2005 v25 i3 p243
This article explores selected phonological measures, their
relationships to
one another, and how groups differentiated by such measures change
over time
during intervention. Relationships among global quantitative
measures of
severity (percent consonants correct), measures of
variability/consistency,
and measures of whole-word complexity and syllable shape from 40
children
with speech sound disorders were examined. All relationships were
strong
prior to intervention and remained stable during the course of
intervention.
Groups of 10 were differentiated with the measure of variability so
that a
variable group had many different error substitutions and the
consistent
group had few different error substitutions across the system. For
these 2
groups, comparison of change at 3 points during the course of a
24-week
intervention showed trends that were markedly similar in their
linearity.
There was steady improvement in percent consonants correct scores
over time
and a graduated decrease in the variability of errors on target
sounds. The
lack of a discernable difference between the consistent and variable
groups
in their response to the same intervention is seen as evidence to
suggest
that such groups may not need different types of intervention.
Key words: consistency, ECI, intervention, phonology, variability
Differential diagnosis of
severe speech disorders
using speech gestures
Ruth Huntley Bahr
Topics in Language Disorders July-Sept 2005 v25 i3 p254
The differentiation of childhood apraxia of speech from severe
phonological
disorder is a common clinical problem. This article reports on an
attempt to
describe speech errors in children with childhood apraxia of speech
on the
basis of gesture use and acoustic analyses of articulatory gestures.
The
focus was on the movement of articulators and not on phoneme
accuracy
exclusively. This procedure was used to assess 15 children, who were
either
typically developing or diagnosed with either childhood apraxia of
speech or
phonological disorder (5 in each group). The results indicated that
the
groups with speech disorders performed significantly worse than did
the
typically developing group, but they did not differ from one another
in
terms of number of errors. Further analysis of the data revealed
that
differences among the groups with speech disorders were related to
the use
of the velum and the coordination between the lips and other
articulatory
gestures. The results seem to support the notion that articulatory
gesture
coordination may be more troublesome for children with childhood
apraxia of
speech. The relevance of this testing procedure for clinical use is
described and therapeutic implications from the analyses are
proposed.
Key words: articulatory gestures, articulatory phonology, childhood
apraxia
of speech, phonological disorder, speech timing
The
clinical significance of optimality theory
for phonological disorders
Judith A. Gierut, and Michele L. Morrisette.
Topics in Language Disorders July-Sept 2005 v25 i3 p266
Linguistic theory has made important contributions to the clinical
assessment and treatment of children with functional phonological
disorders.
In this article, Optimality Theory (OT) is introduced as a new
linguistic
model of grammar. Basic assumptions of the model are described and
extended
to clinical assessment and treatment. The aim is (1) to provide
basic
working knowledge of OT as germane to keeping abreast of the current
clinical literature, (2) to describe the way in which OT informs
clinical
assessment and the selection of goals for treatment, and (3) to
demonstrate
the potential that OT holds for promoting and predicting
generalization
learning in phonological treatment. The clinical significance is
that OT
analyses highlight new interactions among error patterns, which
serve to
prioritize treatment goals to promote widespread phonological
learning.
Key words: optimality theory, phonological assessment, phonological
treatment |