PHONOLOGICAL DISORDERS

I. What is a Phonological Disorder?

Impairment of an individuals phonological system;

onset is prior to nine years of age; cause may be
known or unknown
Two aspects of phonological development:
developing representation for each phoneme in ones language
developing a solid boundary around each phoneme to make it distinct
from the other phonemes

Most common symptom: unintelligibility

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Prevalence and Incidence
4-13% of children are affected
Affects boys (4.5%) at slightly higher rate than
girls (3%)
Affects African-American children (5.3%) at
slightly higher than European-American
children (3.8%)
60%: unknown causes
40%: known causes, such as recurrent middle
ear infections, motor-speech disorders, and
other developmental disorders
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Terminology
Phonological vs. Articulation Disorders:
Articulation emphasized problems resulting from motor problem
impacting articulators; treatment focused on speech correction

Phonological emphasizes problem resulting from delays in the

maturation of the underlying phonological system; treatment focuses
on building and re-organizing childrens phonological representations
Shifting Perspectives
Current Preferred Terms:
Disorder:
-phonological disorder, developmental
phonological disorder, phonological
impairment
Assessment:
-phonological assessment, phonological
analysis
Treatment:
-phonological remediation/intervention
Describing Phonology and
Articulation
Key Concepts:

1. Phonemes as Contrasts
2. International Phonetic Alphabet
3. Articulatory Phonetics
4. Childrens Acquisition of Consonants
5. Sounds and Syllables
6. Phonology and Literacy
 1-Phonemes as Contrasts
Standard American English: about 40 phonemes (varies with
dialects)
Phoneme: speech sound that signals a contrast in meaning between
two words of a language (pat and bat; rig and ring)
Children develop an underlying representation (phonological
representation) of each phoneme
 2-International Phonetic
Alphabet
Most commonly-used system to represent the phonemes in
the worlds languages
Describes and classifies each speech sound on the basis of
how and where it is produced in the speech mechanism
Represents each phoneme (both vowels and consonants) as
a specific symbol

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 3-Articulatory Phonetics

Classification of speech sounds based on what the articulators are

doing when a phoneme is produced
Vowels vs. Consonants: extent of constriction in the oral cavity
Vowels: characterized by height, frontness, and roundness
Consonants: characterized by place, manner, and voicing
 4-Childrens Acquisition of
Consonants EARLY 8=( /m/, /b/, /j/, /n/, /w/,
/d/, /p/, /h/) by age 3

Twenty-four consonant
phonemes are divided into
groups based on when they
are acquired:
Early 8 phonemesat 3 years
Middle 8 phonemesat 4
years
Late 8 phonemes at 6.5
years
Middle 8=( /t/, /ng/, /k/,/g/,/f/, /v/,
/ "tch"/,/ "dge"/ by age 4
Late 6.5="sh"/, /s/, /z/,/ "th"/ voiced
/ "th"/, /r/, /"zah" by age 6.5;
Acquisition of 3 element clusters /
spr/, /str/ up to age 9 years Some
use of phonological processes: gliding
( w/r), cluster reduction ( st/str); 97%
intelligible
.

Children with speech delay show progress much slower

 5-Sounds and Syllables

Phonological context: phonological environment in which a

sound is produced; describes impact of sounds in syllables,
words, and sentences
1-Coarticulation: individual sounds are smeared across the
entire word (TaR GeTeD)
2-Assimilation: one sound takes on the features of neighboring
sounds (comeS)

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6-Phonology and Literacy
To read, children must unlock the alphabetic code the
grapheme-phoneme correspondence
Phonics instruction (K-1):
to benefit, children must have phonological awareness and
knowledge of the alphabet
Weak phonological representations manifest as a problem with
either speech-sound production or phonological awareness, or
sometimes both
II. How are Phonological Disorders
Classified?
Differentiating phonological disorders from other
speech sound disorders:
Four Major Symptoms:
1) Difficulty with expressive phonology
2) Lack of phonological awareness
3) Poor verbal working memory
4) Problems with word learning and retrieval
Children with symptom #1 and not the others may
have a motor-speech or an articulation
disorder, not a phonological disorder
 Speech Disorders Classification
System
Developmental phonological disorder
impairment of the phonological system that
impacts speech intelligibility prior to age 9
Non-developmental phonological disorder
disorder of speech production occurring after age
9, perhaps due to illness, trauma, or accident
Not to be confused withspeech difference
naturally-occurring speech-sound distinctions
that reflect native language or a regional or
cultural dialect
 Three Descriptive Subtypes
Speech delay: (2-9 yrs.) low intelligibility and high frequency of errors

Questionable residual errors: (6-9 yrs.) continue to show subtle errors

in speech production, like substitutions and omissions

Residual errors: (9 yrs. and up) continue making errors, have history
of speech delay
Five Etiology Subtypes
Phonological Disorder: Unknown Origin 60% of
cases no known cause
Phonological Disorder: Otitis Media with Effusion
chronic infections of the middle ear during
infancy and childhood
Phonological Disorder: Special Populations
children with hearing impairment, Down
Syndrome, or cleft palate
Motor-Speech Disorders: motoric difficulty with
planning and executing speech sounds (Ch. 6)
Psychosocial Involvement speech delay from
psychological or social causes .
.
III. What are the Defining
Characteristics of Phonological
Disorders?
Defining characteristics, causes, and risk factors for the following:
1. Phonological Disorder of Unknown Origin
2. Phonological Disorder: Otitis Media with Effusion
3. Phonological Disorder: Special Populations (Down Syndrome,
Hearing Impairment, Cleft Palate)
1-Unknown Origin
Characteristics
- Characteristics of speech delay:
Small phonemic inventory
Phoneme collapse
Persisting errors
Reduced intelligibility
- 30% of children with a speech delay also have a significant
impairment of either vocabulary and/or grammatical
development, placing them at higher risk for social and academic
problems
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Unknown Origin Causes and
Risk Factors
Unknown causes
No specific risk factors
Tendencies:
-phonological disorders run in families
-children with phonological disorders seem particularly
vulnerable to dyslexia
2-Otitis Media Characteristics
Same as those of the unknown type, but
they result from periods of auditory
deprivation, occurring when fluid builds up
in middle ear for sustained period
Specific markers of disorder:
Delayed onset of babbling
Delayed onset of use of meaningful speech
Reduced intelligibility
Problems with specific classes of sounds
Use of non-natural sound changes
Otitis Media Causes and Risk
Factors
Most common in children under 3 years
Caused by a bacterial or viral infection or
allergens
Some people can have chronic middle ear
infections and not have any negative
consequences (resilience)
Risk and resilience affected by many
variables, including poverty, home language
environment, genetic predispositions, and
other health problems
3-Special Population: Down
Syndrome
Affects 1 in 700 children
Characteristics: mental retardation, small
stature, heart defects, small oral cavity, and
speech/language delays
Deficits in phonology, as well as increased
risk of hearing loss and articulation
difficulties
Cause: prenatal chromosomal abnormality;
cannot be prevented, but associated with
increase in maternal age
 Special Population: Hearing
Impairment
Transient or permanent hearing impairment
can limit childs exposure to phonology of
language
Severity of disorder reflects severity of hearing
loss and extent of intervention provided
Causes: prenatal (maternal ingestion of toxins,
e.g.), perinatal (anoxia, e.g.), and postnatal
(bacterial infections, e.g.)
Special Population: Cleft Palate
Congenital malformation of the palate (roof of
mouth) 1 in 700 births
Correctional surgery is usually performed within
first year of life, but prone to phonological
problems before and after surgery
Cause: failure of fusion of palatal structures
between 8th and 12th weeks of gestation
400 different syndromes for which cleft palate
is associated
 IV. How are Phonological
Disorders Identified?
Systematic and comprehensive assessment process for identification
Speech-language pathologist consults with others to gather information:
Audiologist
Pediatrician
Psychologist
Classroom teachers
Reading specialist
Parents

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 The Assessment Process

Referral
Screening
Comprehensive Phonological Assessment
Diagnosis

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 Referral
Typically comes from a parent, pediatrician, or early childhood educator
Assumptions: (1) children with early phonological delays must be
identified, and (2) they must be provided early intervention services to
build phonological skills
By the time the child turns two years, he/she should be intelligible at
least 50% of the time, and 75% by three if not, referral should be made
Screening
Challenging to determine difference between
phonological impairment and normally-
occurring speech errors
Screening takes a quick look to make this
determination and decide whether more
extensive assessment is necessary
Can use informal measures (imitation of a
specific sound target, e.g.) or formal measures
(e.g., Denver Articulation Screening Test
Comprehensive Phonological
Assessment
Six Goals to determine:
General developmental history
Status of hearing and oral structures and functions
Phonological and language performance
Nature and severity of disorder
Prognosis for phonological outcomes
Course of treatment
Phonological Assessment (cont.)
Assessment includes such activities as:
Caregiver interview and case history
Oral mechanism screening
Hearing screening
Language screening or evaluation
Phonological analysis
-standardized testing
-spontaneous speech sampling
-probing

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Diagnosis
Consideration of the cumulative evidence
from the comprehensive evaluation
Phonological disorder is present if:
-rate of development sufficiently different
from age-based expectations
-differences not accounted for by cultural or
linguistic factors
-difference impacts upon childs ability to
effectively communicate
Extent of disorder ranges from mild to
moderate to profound .
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V. How are Phonology and
Articulation Impairments
Treated?
Recent shift in treatment paradigms from therapies emphasizing
better articulatory movements to phonologically-oriented therapies
Governing principles:
Phonological processes or rules are treated rather than the individual
sounds themselves
Contrasts between phonemes are emphasized
Efforts to enhance language and communication are included
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Four Common Approaches

1) Minimal Opposition Contrast Therapy
recognize and produce single-phoneme
contrasts between words
2) Multiple Oppositions Therapy build
phonemic contrasts within a phonemic
collapse
3) Cycles Therapy stimulate use of phonemes
or patterns by treating in cycles
4) Phonological Awareness Therapy develop
childs sensitivities to phonemic structure of
language
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Goals in Phonological
Therapy
Therapy goal: objective to be reached, divided into

Short-term goals: immediate change, focuses on eliminating

broad patterns rather than training specific sounds

Long-term goals: ultimate end goals of treatment

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 Targets in Phonological Therapy

Target: phoneme or error that is addressed in a

given therapy session
Five possible approaches in selecting targets:
Target errors or patterns that most affect intelligibility
Target sounds or patterns that are stimulable
Target sounds or patterns that are not stimulable
Follow developmental norms and select early-acquired
sounds and patterns
Follow developmental norms but select later-acquired
sounds and patterns
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Discharge from Treatment
Discharge occurs when childs speech skills
have normalized:
85% of consonants correct in spontaneous speech
adultlike in speech production

Short-term normalization prior to six years

of age
Long-term normalization after six years
Some children may normalize in speech
production, but still have phonological
problems in areas associated with literacy
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