1. CSD 2230 HUMAN COMMUNICATION DISORDERS
Topic 7
Speech Disorders
Articulation and Phonology

2. Disorders of Articulation and Phonology
Some Definitions…
Phonemes: individual speech sounds that have meaning in a language
Consonants and vowels
Phonology: linguistic rules that govern how phonemes are combined to make words
Form
Articulation: the ability to produce sounds in sequence by moving the articulators
Disorders of Articulation and Phonology
We’ve touched on a few of the principles behind articulation and phonology in some of our previous lectures.
As review, let’s define again a few terms:
Phonemes-individual speech sounds that have meaning in a language. The two major classes of phonemes in English are consonants and vowels. Phonemes are sequenced together in a variety of ways to form words.
Phonology is the term for the language rules that govern how phonemes are combined to make words. Remember that this was one of the of the components of language form.
The ability to produce sounds in sequence by moving the articulators is known as articulation. Articulation is different from other forms of motor activity in that nearly all normal adult speakers of a language are proficient at articulation—you don’t get “better” with more practice.

3. Articulation and Phonology Disorders
People with articulation and phonological disorders produce words that sound different than the words that are produced by most other speakers
Severe articulation and phonological disorders can really affect the way linguistic knowledge (semantics, syntax, pragmatics) is expressed, and in turn can have a negative impact on communication ability
The most common communication disorder treated by SLPs of both adults and children
People with artic and phonological disorders produce words that sound different than the words that are produced by most other speakers. Severe artic and phonological disorders can really affect the way linguistice knowledge (semantics, syntax, pragmatics) is expressed, and in turn can have a negative impact on communication ability.
These are the most common comm. Disorders treated by SLPs. While it is true that much of an SLP’s caseload of artic and phonological problems will be children, there are a number of acquired causes resulting in artic disorders.

4. Definitions and Incidence
Articulation disorders involve problems producing the sounds and sound sequences of the language
Difficulty with the movements of the articulators necessary for the production of a sound
Phonological disorders involve trouble understanding and implementing the underlying rules for producing sounds and sound sequences
Deficiency in the abstract system of knowledge that forms the rule system for sounds
Inadequate mental representation of the language sound system
Definition and Incidence:
We need to talk about the difference between an articulation disorder and a phonological disorder. The difference is critical for the way speech production problems are assessed and treated.
Very simply, individuals with artic disorders have difficulty producing the sounds and sound sequences of their lang. This person has difficulty with the movements of the articulators that are necessary for the production of a sound.. A common artic disorder is substituting /w/ for /r/ in a person with CP who doesn’t have the muscle coordination and control to produce /r/
The same substitution might be made by a young child with speech delay, so the earlier appearing /w/ production is used for /r/.
Individuals with phonological disorders have trouble understanding and implementing the underlying rules for producing sounds and sound sequences. There’s a deficiency in the abstract system of knowledge that forms the rule system for sounds and sequences needed to convey a message. The individual hasn’t developed the adequate mental representation of the sound system of the native language.
An example: Child thinking that /ch/ and /sh/ are completely interchangeable. The child can produce both sounds correctly, but mistakenly uses one for the other.
Sometimes there is difficulty with artic and phonology at the same time. For example, a child w/chronic OM w/ mild HL, may not have been able to hear speech clearly. As a result, they may have not been able to develop the same mental rep of speech sounds as kids with normal hearing. At the same time, this child will not have been able to monitor her productions and may not know whether sounds are being articulated correctly.
Sometimes it’s hard to separate these disorders out, but just remember that we use the term articulation disorder when we are referring to difficulties producing speech sounds and the term phonological disorder when we are referring to difficulties with phonological rules.

5. Important Factors Delay vs disorder
We make this distinction based on comparison of the child’s speech to the articulation and phonological patterns of others of a comparable age who are developing normally
Children who are considered delayed in articulation development have speech production patterns that typically occur in children who are younger
CD-ROM Ch.10.05
Children with speech disorders do not produce speech that is like children who are developing normally
Artic and Phonological disorders:
There are a number of important factors to consider in understanding and treating artic and phonological disorders. Here they are:
1. Delay vs Disorder: It’s important in the case of children to ascertain whether the kinds of articulation behaviors the child is exhibiting is a case of delay or disorder. We make this distinction based on comparison of the child’s speech to the artic and phonological patterns of kids of a comparable age who are developing normally.
Remember that speech sound production follows a typical pattern of development in the young child. Kids who are considered delayed in artic development have speech production patterns that typically occur in kids who are younger.
Ex: a 5 y-o may produce all sounds of English but may have difficulty using them at the ends of words resulting in a production pattern like “to” for “top”, “ca” for “cat”, and “ki” for “kiss”. Normally developing kids mo often leave off the ends of words. Because this child is 5, but doing something that a normally developing 3 year old might do is considered delayed, not disordered.
In CD-ROM Ch this 5 y-o demonstrated delayed speech production abilities for his age. In talking with his SLP about the “good guy and the bad guy cars” he is difficult to understand. His most obvious error is “t” for “k”.
In contrast, kids with speech disorder do not produce speech that is like children who are developing normally.
Ex: a 10 y-o who produces speech that is whispered and contains mostly vowels with only a few consonants shows skills that aren’t like a normally developing child of any age.
Adults who have lost their speech or phonological abilities after being previously normal in those areas are always classified as being disordered.

6. Important Factors Severity of involvement Determined by:
the number of sounds produced correctly
the accuracy of the productions
the ability to produce sounds in different word positions (initial, medial, and final positions)
the ability to produce sound sequences (sound blends)
the ability to produce various types of words (multiple syllables)
Intelligibility
1. Severity of Involvement: The severity of the speech delay or disorder is determined by:
a. the number of sounds produced correctly
b. the accuracy of the productions
c. the ability to produce sounds in different word positions (ex /l/ in the initial position (like) and /l/ in the final position (bill))
d. the ability to produce sound sequences (ex sound blends)
e. the ability to produce various types of words (multisyllabic)
Each of these factors is very much ties to intelligibility. This is how understandable speech is to another person and is a crucial factor for determining the need for and the effectiveness of therapy.

7. Severity Classification
Mild impairments
Problems producing only a few sounds
Substitution errors are common
Intelligible to most listeners
Treatment is usually very successful
CD-ROM Ch is an example of a 3 year old exhibiting a mild disorder for his age
Severity of artic or phonology disorders are usually classified along a mild/moderate/severe continuum. Examples of what constitutes a mild impairment, for example, depends on the child’s age.
Mild impairments include problems producing only a few sounds. They are able to produce most of the sounds of their language and can use these sounds in sequences both within words and in varied types of words. Most of the time, the errors are substitution errors of one phoneme for another phoneme (ex /w/ for /r/ is common). These people are generally intellible to most listeners but their errors are noticeable. Treatment is usually very successful
CD-ROM Ch This 3 y-o exhibits a mild disorder for his age. His speech is intelligible, but calls attention to the way he speaks because some of the sounds are missing or incorrect. Here he is looking at a book with his clinician and says “dwaf” for “giraffe”, ‘pinwin” for “penguin”, and “teddy beo” for “teddy bear”

8. Severity Classification
Moderate impairments
More overall difficulty producing speech sounds correctly compared to people with mild impairments
May use sounds incorrectly in different word positions and often have difficulty producing all the syllables in a multisyllable word
Leaving off sounds at the ends of words
Simplifying some consonant clusters (blends)
Most intelligible to familiar listeners and oftentimes are not well understood by strangers, especially if the context of the conversation is unknown
Good prognosis for improvement, but the course of therapy may be longer than for those with mild impairments
Moderate impairments include more overall difficulty producing speech sounds correctly compared to people with mild impairments. It’s the same kind of problems, just more of them.
Ex: a 4 y-0 having difficulty producing ALL velar sounds (/k/, /g/, /ing/), not just one. These individuals may use sounds incorrectly in different word positions and often have difficulty producint all the syllables in a multisyllable word, leaving off sounds at the ends of words, and simplifying some consonant clusters (blends). These people are most intelligible to familiar listeners and oftentimes are not well understood by strangers, especially if the context of the conversation is unknown. Moderately involved clients have a good prognosis for improvement, but the course of therapy may be longer than for those with mild impairments.

9. Severity Classification
Severe artic or phonological involvement
Found in people who are unintelligible to most listeners or who can’t use speech consistently to communicate
Usually produce more that six sounds in error
Don’t sequence sounds consistently to produce intelligible words
Ability to use sounds to communicate is really limited
Kids with severe artic/phonology problems use gestures
In very severe cases an SLP may decide to use an augmentative communication system as an alternative method for communication
Usually the prognosis with these people is not very favorable.
Severe artic or phonological involvement is found in people who are unintelligible to most listeners or who can’t use speech consistently to communicate. These people usually produce more that six sounds in error, they don’t sequence sounds consistently to produce intelligible words. Their ability to use sounds to communicate is really limited. Kids with severe artic/phonology problems use gestures. In very severe cases (ex: kid with CP who doesn’t have adequate control over breathing to support speech production) an SLP may decide to use an augmentative communication system as an alternative method for comm.. Usually the prognosis with these people is not very favorable.
CD-ROM Ch is a 7 y-o who has what would be considered a severe artic/phonology impairment. He is talking to his clinician about his dog. He says that he has a new dog and his big dog knows how to swim. He is very difficult to understand.
In Ch the same kid is using gestures to supplement his comments about where he is going. This is common because it helps to convey the message to the listener, but even in this ex, his gestures aren’t enough to help the clinician understand what he’s trying to say.

10. Some Examples of A Severe Articulation/Phonology Disorder
CD-ROM Ch is a 7 year-old who has a severe artic/phonology impairment. He is talking to his clinician about his dog. He says that he has a new dog and his big dog knows how to swim. He is very difficult to understand.
In Ch the same child is using gestures to supplement his comments about where he is going. This is common because it helps to convey the message to the listener, but even in this example, his gestures aren’t enough to help the clinician understand what he’s trying to say.

11. Important Factors Language and dialect
Bilinguals are speakers who have some competence in English but have a different primary language
Ability to produce speech sounds is not impaired
Different rules for producing sounds based on their own language
Widely varying pronunciations
Children usually aren’t placed in speech therapy
Adults may choose intervention
3. Language and dialect:
We see a lot of people whose native language is not English. Their rules for producing speech sounds and sequences is not the same as English. As a result pronunciation can vary widely. Bilinguals are speakers who have some competence in English, but have a different primary lang.
These speakers have the ability to produce speech sounds, they just have different rules for how to produce them based on their own language (phonological rules). It’s important for the SLP to know the differences between these dialectical differences from true disorder. Children whose phonological production patterns are different because they are applying the phonological patterns of their first lang to English are not usually placed in speech therapy.
Adults, however, who are learning English later in life and who need to master the phonology of the lang quickly may seek therapy to improve their pronunciation and intelligibility (international students at UMD). We can’t count these as disorders, tho.

12. Important Factors Etiology Functional speech impairment
No obvious cause for the delay or disorder
Common for children with respect to phonological disorders
Articulation disorders and delays are more likely to have a known etiology or to be associated with a risk factor for developmental delay
1. Etiology
Many kids with artic or phonological impairment have what we call “functional” speech impairment. These means there is no obvious cause for the delay or disorder. Usually this isn’t a problem, because information about the possible causes of these disorders aren’t used to plan therapy or predict the child’s prognosis for improvement.
Phonological disorders are most often “functional”, especially in kids. We usually don’t know why a child has difficulty representing the phonology of lang. Phonological knowledge is based on descriptions of abstract mental representations of lang that have no literal reality in brain structures. When these descriptions are delayed or disordered, we don’t know why.
Artic disorders/delay are more likely to have a known etiology or cause, or to be associated with a risk factor for developmental delay.

13. Examples of Etiologies Associated with Articulation Disorders
Hearing loss
Reduces the exposure to the phonological rules of language and the opportunity for feedback
Cleft lip and palate
The oral-facial malformations associated with this condition can make speech very nasal and some speech sounds may be hard to produce
Dysarthria
Neuromuscular impairment
Apraxia
Neurological condition that affects motor planning and programming
Here are some examples of etiologies commonly associated with artic disorders:
Hearing loss: generally reduces the opportunity to monitor speech productions or, in the case of kids, reduces the exposure of language to develop phonological rules. All kinds of specific errors are possible with a range of severity.
Cleft lip and Palate: The oral-facial malformations associated with this condition can make a child’s speech very nasal. Kids may have difficulty producing speech sounds that require high oral pressue (ex /ch/)
Dysarthria: this is a neuromuscular impairment that causes speakers to have difficulty with respiration, phonation, artic, resonance, and prosody. Common in CP and severely affects articulation
Apraxia: this is a condition due to neurological damage and affects the speaker’s ability to plan or program speech.

14. Important Factors Co-occurrence with other types of disorders:
Articulation and phonological disorders can co-occur with other types of speech and language problems
1. Co-occurrence with other types of disorders:
Artic and phonological disorders can co-occur with other types of speech and lang problems. Kids with expressive or receptive lang problems and voice disorders often have artic or phonological impairment as well.

15. Assessment and Treatment
The goal of assessment is to determine the specific nature and severity of the disorder or delay
The specific assessment materials and procedures used depend on the suspected etiology, the chronological and developmental ages, and the primary language spoken
Analysis of the individual’s productions is done to understand the patterns of differences between the individual’s productions and the relevant comparison population
Treatment will depend on the results of this analysis
Assessment and Treatment:
The goal of assessment is to determine the specific nature and severity of the disorder or delay. The specific assessment materials and procedures used depend on the suspected etiology, the CA, the developmental age, and the primary lang spoken. After assessment, analysis of the individual’s productions is done to understand the patterns of differences between the individual’s productions and the relevant comparison population. Treatment will depend on the results of this analysis.

16. Collecting Information
Speech samples
The use and integrity of speech production skills in a spontaneous speech and language sample are evaluated
Articulation tests
There are many of these kinds of formal tests available
These tests assess the ability to produce consonants in varied word positions
Collecting information:
Speech samples: usually evaluate the use and integrity of speech production skills in a spontaneous speech and language sample. Do this by engaging the child, for ex, in conversation thru play.
Articulation tests: The test we used a few weeks ago was an example of this. There are many of these kinds of formal tests available. Usually, these tests assess the ability to produce consonants in varied word positions.

17. Analysis
The goal of speech analysis is to describe typical patterns of speech production skills and compare these skills to an appropriate group and plan treatment
Articulation analysis
The ways in which the articulators work together to produce speech sounds and sequences are recorded in detail, and patterns of differences from the comparison group are described
Substitutions, omissions, distortions
Phonological analysis
Focuses on describing how the client’s speaking reflects underlying mental reps and or rules for producing speech
Analysis
In analyzing the information collected above, the SLP is seeking to describe typical patterns of speech production skills and compare these skills to an appropriate group and plan treatment.
Artic analysis focuses on how the artic, phonatory, and respiratory systems work together to produce speech. Artic skills (artic), vocal fold coordination with articulators (phonotory), and breath support (respiratory) for speech are described. With respect to artic especially, the ways in which the articulators work together to produce speech sounds and sequences are recorded in detail, and patterns of differeneces from the comparison group are described. Common differences include substitutions (when one sound is produced or substituted for another ex /bog/ for /dog/), omissions (when one sound is left out) or distortions (sounds are produced in a recognizable but inaccurate manner).
Phonological analysis focuses on describing how the client’s speaking reflects underlying mental reps and or rules for producing speech. Emphasis is placed on the client’s knowledge of the speech sound system rather than any deficit in behavior implied by artic analysis.
Other testing would include oral-peripheral exams to rule out structural causes and hearing tests to rule out hearing loss as a cause for these problems.

18. Treatment
Emphasis on teaching the client to use sounds and sound sequences of the language like that expected of peers in the community
Approaches
Articulation based
Focus on repetitive practice of motor movements with feedback and attention to how the body is used to produce sounds
Phonological based
Emphasize the use of speech sounds to communicate ideas
Treatment
Centers on teaching the client to use sounds and sound sequences of his lang like that expected for peers in the community. The overall goal of treatment is age-appropriate intelligibility that meets community standards. The data collected are used to plan specific goals and treatment techniques for remediation.
Artic-bases approaches focus on repetitive practice of motor movements with feedback and attention to how the body is used to produce sounds. Start with words then move to longer utterances.
Phonological approaches emphasize the use of speech sounds to communicate ideas. These approaches don’t emphasize repetition and feedback on motor performance. An ex for a kid with phono problems involving /s/--might id this phoneme as the “mad cat sound”. A lot of time would be spent identifying this sound auditorily in linguistic contexts before working on production.