CLINICAL LINGUISTICS AND MULTICULTURAL ISSUES

UNIT 1.4 : PHONOLOGICAL DISABILITY

Presenters: Daliya P A, Nadwa , Vaishnavi Faculty: Dr. Brajesh

Priyadarshni

CONTENTS:

➢ Introduction

➢ Articulation vs phonological disorders

➢ Phonological disability

➢ Incidence and prevalence

➢ Signs and symptoms

➢ Etiology

➢ Features of phonological disorders

➢ Phonological processes in communication disorders

➢ Assessment and Intervention

➢ Recent study

INTRODUCTION

● Phonology is a study of the sound system of language and includes the rules that

govern its spoken form (Parker & Riley, 2010).

● Phonology is the study of sound system of a language, examines the sound units

of that particular language , how these sounds are arranged , their systematic

organization and rule system.

● The goal of phonology is to study the properties of the sound systems which

speakers must learn or internalise in order to use their language for communication

(Hyman, 1975, p, 1).

● The goal includes :-

➢ Describing the sound patterns of language

➢ Describing the organisation of speech sounds in the mind

➢ Describing how language differ from one another in this organization

➢ Discovering phonological universals (common properties shared by the

various sound systems of various languages)

● Speech sound disorders is an umbrella term referring to any difficulty or

combination of difficulties with perception, motor production, or phonological

representation of speech sounds and speech segments—including phonotactic

rules governing permissible speech sound sequences in a language.

● Articulation disorders as a subcategory of a speech disorder is the atypical

production of speech sounds characterised by substitutions, omissions, additions or

distortions that may interfere with intelligibility (ASHA,2014).

● Phonological disorders refers to impaired comprehension and/or use of the sound

system of a language and the rules that govern the sound combinations (ASHA,

2008).

● Phonological disorders focus on predictable, rule-based errors (e.g., fronting,

stopping, and final consonant deletion) that affect more than one sound. It is often

difficult to cleanly differentiate between articulation and phonological disorders;

therefore, many researchers and clinicians prefer to use the broader term, "speech

sound disorder," when referring to speech errors of unknown cause (Bernthal,

Bankson and Flipsen, 2017; Pena-Brooks and Hegde, 2015).

● Phonological disorders reflect a more central deficiency, specifically a

neurolinguistic dysfunction at the phonological level (Grunwell, 1987).

● According to DSM-V, a speech sound disorder is diagnosed when speech sound

production is not what would be expected based on the child's age and

developmental stage and the deficits are not the result of a physical, structural,

neurological or hearing impairment.

● According to the DSM-V, there are four criterions for Speech Sound Disorder:

➢ Persistent unintelligible speech consisting of phoneme addition, omission,

distortion, or substitution, which interferes with verbal communication.

➢ There is interference with either social participation, academic performance,

or occupational performance (or any combination thereof).

➢ The onset of symptoms is during childhood.

➢ The symptoms cannot be accounted for by another medical or neurological

condition, including TBI (Traumatic Brain Injury) (American Psychiatric

Association, 2013).
ARTICULATION DISORDER VS PHONOLOGICAL DISORDER

Articulation Disorder Phonological Disorder

Disturbance in the relatively peripheral Impaired comprehension of use of

speech motor process (motor-based sound system of a language. Central in
problems) nature, concerning phonological level of
organization (cognitive-linguistic
problems)

Phonetic error Phonemic error

Indicates individual’s speech sound Inventory of phonemes may be

productions vary widely from the norm restricted

Types of Error: Substitutions, Types of Error: Substitutions and

omissions, distortions, and additions omissions

Difficulty with speech sound form Difficulty with phoneme function form

Speech sound production is affected Other components of language can be

and other components of language are affected
not affected
Consistent errors Inconsistent errors

PHONOLOGICAL DISABILITY

● Phonological system refers to an orderly combination of parts forming a complex

unity.

● This system is a fundamental component of a language's overall structure and is

essential for effective communication.

● Phonetic realization of the client represents a system in themselves.

● 3 ways in which the relationship between these two levels of language organization

can be abnormal
 ● The phonological system is normal , but it’s phonetic realization is abnormal. For eg:

immature or deviant pronunciations of phonemes , but without the range and pattern

of phonemic use being affected :- Phonetic Disability.

● The phonological system is abnormal ,but the phonetic realization is normal(eg: the

range of phonemes used may be considerably delayed, but their pronunciation is

within normal limits:-Phonological Disability.

● Both the phonological system and its phonetic realization are abnormal, delay or

deviance affecting both aspects of the analysis.:Phonological Disability.

INCIDENCE AND PREVALENCE

● The incidence of speech sound disorders refers to the number of new cases

identified in a specified period.

● The prevalence of speech sound disorders refers to the number of children who

are living with speech problems in a given time period

● Overall, 2.3% to 24.6% of school-aged children were estimated to have speech

delay or speech sound disorders (Black, Vahratian, & Hoffman, 2015)

● A 2012 survey from the National Center for Health Statistics estimated that, among

children with a communication disorder, 48.1% of 3- to 10-year old children and

24.4% of 11- to 17-year old children had speech sound problems only.
SIGNS AND SYMPTOMS

Signs and symptoms of functional speech sound disorders include the following:

● Omissions/deletions—certain sounds are omitted or deleted (e.g., "cu" for "cup"

and "poon" for "spoon")

● Substitutions—one or more sounds are substituted, which may result in loss of

phonemic contrast (e.g., "thing" for "sing" and "wabbit" for "rabbit")

● Additions—one or more extra sounds are added or inserted into a word (e.g.,

"buhlack" for "black")

● Distortions—sounds are altered or changed (e.g., a lateral "s")

● Syllable-level errors—weak syllables are deleted (e.g., "tephone" for "telephone")

● Signs and symptoms may occur as independent articulation errors or as

phonological rule-based error patterns.

● In addition to these common rule-based error patterns, idiosyncratic error patterns

can also occur.

ETIOLOGY

● The reason many children have speech sound disorders is often not clear. It's

sometimes linked to language development difficulties.

● Etiologies of phonological disabilities are classified as organic, nonorganic or

mixed.

● Organic causes are those in which there is a known structural, physiologic,

neuromuscular, sensory or cognitive deficit in the vocal tract or related structures.

 ● A nonorganic cause is one in which there are no obvious signs of structural,

physiologic, neuromuscular, sensory or cognitive deficits.

● Mixed causes include both organic and nonorganic factors.

● Various factors like family history, tongue thrust, and speech sound discrimination

have been studied, but their direct connection to these disorders remains uncertain.

● Sometimes, speech sound disorders result from apparent conditions like hearing

loss or cleft palate. However, the specific disorder and treatment response can still

vary.

FEATURES OF PHONOLOGICAL DISORDERS

➢ PHONOLOGICAL PROCESSES

Phonological processes Description Example Approximate age of

elimination

Whole word (and

syllable) patterns Deletion of the final [bu] for book ~3 years
consonant in a word
1. Final consonant
deletion

2. Unstressed/weak An unstressed syllable is [teto] for ~4 years

syllable deletion deleted, often at the potato
beginning of a word,
sometimes in the middle.

3. Reduplication A syllable or a portion of a [dada] for dad ~3 years

syllable is repeated or
duplicated.

4. Consonant cluster A consonant cluster is [sti] for ski –

simplification simplified by a substitution
for one member of the
cluster

5. Consonant cluster One or more elements of a [tap] for stop

reduction consonant cluster are ~4 years;
deleted
 Including /s/,

gone by 5 years

6. Epenthesis A segment, often the [bəlæk] for ~8 years

unstressed vowel [ə], is black
inserted

7. Metathesis A transposition or reversal [bæksɪt] for –

of two segments (sounds) basket
in a word

8. Coalescence Features from two adjacent [fɪm] for swim –

sounds are combined so
that one sound replaces
two other sounds

Assimilatory (Harmony)
patterns A nonvelar sound is [gʌk] for duck ~3 years
assimilated (changed) to a
1. Velar assimilation velar sound

2. Nasal assimilation A non-nasal sound is [næni] for ~3 years

assimilated and replaced by candy
a nasal

3. Labial assimilation A nonlabial sound is bed [bɛb] ~6 years

assimilated to a labial
consonant because of the
influence of a labial
consonant

Segment change
(Substitution) patterns

1. Backing When alveolar sounds /t/ or [kæn] for tan Never typical; seen
/d/ are substituted with /k/ in more severe
or /g/ phonological
disorders

2. Fronting When sounds /k/ or /g/ are [ti] for key ~3.5 years
substituted with alveolar
sounds /t// or /d/

3. Stopping Fricatives or affricates are [pit] for peach

replaced by stops /f, v, s, z/ by 3 years

“ch” “sh” “th”

“j” by 5 years

4. Gliding of liquids [jɛwo] for

When /l/ or /r/ becomes a yellow ~6 years
 /w/ or /y/ sound

5. Affrication Fricatives are replaced by [t∫ʌn] for sun

affricates ~3 years

6. Vocalization / Liquids or nasals are [kʌo] for car

vowelization replaced by vowels [tebo] for table –

7. Denasalization When a nasal consonant [daɪs] for nice

like /n/
~2.5 years
or /m/ is substituted with a
nonnasal

sound like /d/ or /b/

8. Deaffrication Affricates are replaced by [∫ɪp] for chip

fricatives ~4 years

9. Glottal replacement Glottal stops replace [kæʔ] for cat

sounds usually in either [tuʔ] for tooth
intervocalic or final position.

10. Prevocalic voicing Voiceless consonants [bepɚ] for

(obstruents) in the paper ~6 years
prevocalic position are
voiced

11. Final consonant When a voiced consonant [dɔk] for dog ~3 years
devoicing at the end of the word, like
/d/ is produced as its
unvoiced counterpart, like
/t/

Idiosyncractic process/patterns

Phonological process Description Example

PHONOLOGICAL PROCESSES IN COMMUNICATION DISORDERS

Phonological and articulatory errors are observed in certain communication disorders and
those disorders and characteristics observed in these are listed below:

➢ Hearing impairment
➢ Cleft lip and palate
➢ Mental retardation
➢ Down syndrome
➢ Cerebral palsy
➢ Dysarthria
➢ Apraxia of speech

HEARING IMPAIRMENT:
● Consonant production in hearing impaired children is generally characterised by
deletions and substitutions, both initial and final consonant deletion occurs; however final
consonant deletion is far more prevalent (Abraham ,1989)

● Final consonant deletion were the prominent process observed in profoundly deaf cases

● Unstressed syllable deletion were seen in polysyllabic words

● Velar assimilation are also common in individuals with profound hearing loss

● Consonant substitutions frequent confusion of voiced and voiceless cognates,

substitution of stops for fricatives and liquids, confusion between oral and nasal consonants
have been reported.

● Vowels tend to be neutralised.

● As linguistic complexity increases, overall speech intelligibility reduces.

● Reduced speech rate, slow articulatory transitions with frequent pauses are also
observed.

● Poor coordination of breathing with syntactic phrasing.

● Distorted resonance also has been reported.

CLEFT LIP AND PALATE:

● Phonological processes that have been identified as being used by children with cleft
palate include final consonant deletion, initial consonant deletion, nasalization, velar
assimilation, nasal assimilation, backing, nasal preference, and glottal insertion (Chapman
and Hardin, 1992; Harding and Grunwell, 1995).

● Distortions such as glottal stops ,pharyngeal stops, mid palatal stops and pharyngeal
fricatives are common Compensatory articulation errors that have been associated with the
cleft palate speech

● Presence of hypernasal resonance of vowels, vocalic consonants, glides, and liquids.

● Reduced or diminished intraoral pressure during production of pressure consonants.

● Nasal air emission on production of pressure consonants.

● Compensatory errors such as glottal stops for stop consonants, pharyngeal fricatives for
sibilants have also been reported.
 ● Errors such as consonant cluster reductions and placement or omission errors have
been identified.

INTELLECTUAL DISABILITY

● The phonological characteristics of the population with mental disabilities can be

summarised as follows:

- Deletion of consonants is the most frequent error.

- Errors are typically inconsistent.

● The frequent processes seen are cluster reduction and final consonant deletion. Severity
of phonological problems increases with degree of retardation. Widder (1990) suggest
consonant deletions may reflect cognitive processing constraints in the motor assembly
stage of speech production.

● Fricatives are most frequently affected followed by laterals and aspirated stops.
(Shrinberg, Widder, 1990).

DOWN SYNDROME

● Stoel-Gammon (2001) lists the phonological processes seen in children with DS as

cluster reduction, final consonant deletion, stopping, prevocalic voicing, gliding,
vocalisation and final consonant devoicing.

● Lack of articulatory precision and appropriate pausing and phrasing.

●According to Van Borsel, 1996 and Cholemain ,1994 Individuals with downs syndrome will
show Word-final consonant omission, Target fricatives and affricates will be produced as
stops, aspirated voiceless stops in initial position are deaspirated ,word- initial liquids are
produced as glides and word-final liquids are produced as vowels or are omitted and word-
final voiced obstruents are devoiced.

● Vowel errors due to anatomical and/or motor limitations of the tongue (Bunton & Leddy,
2011).

● Reduction of consonant clusters and final consonant deletion are the most frequent
errors.

● Errors are typically inconsistent.

● Speech sound errors frequently result in reduced intelligibility in conversation (Kent &
Vorperian, 2013)
 MSD: CEREBRAL PALSY

● Spastic C.P.: Affects the production of fricatives and affricates

● Dyskinesia: This results in distortion of consonants as well as vowel productions.

● Ataxia: Imprecise consonants and vowel distortions, inconsistent sound substitutions and

omissions, and a general dysrhythmia. (Darley, Aronson and Brown, 1975)

Phonological Processes:

➢ Related to temporal coordination: Voicing difficulties including devoicing of initial

consonants, or voicing of unvoiced sounds, variable realisation of voiced-voiceless
cognates, prevocalic voicing, consonant

➢ cluster reductions, and final consonant deletions, stopping of fricatives or frication of

stops, weak syllable deletions.

➢ Related to motor control: Fronting, backing, stopping, gliding, lateral realisation of

apical and coronal fricatives, vowelization of /l/ and /r/, nasalization.

➢ Substitutions are observed as the prominent error in cerebral palsy

APRAXIA OF SPEECH

Several studies have reported speech characteristics of children with Childhood Apraxia of
Speech: -

● Inconsistent errors on consonants and vowels in repeated production of syllables or

words.

● Sound errors such substitutions, deletions, insertions and transpositions are seen in
apraxic individuals. A preponderance of errors on consonants rather than vowels.
 ● Unusual errors include sound additions, prolongations of vowels and consonants,
repetitions of sounds and syllables (Rosenbek and Wertz, 1983); and unusual substitutions,
such as glottal plosives and bilabial fricatives.

● A large percentage of omission errors.

● More errors in sound classes involving complex oral gestures.

● Unusual errors not typically found in children with speech sound disorders.

● A large percentage of omission errors.

● Difficulty producing and maintaining appropriate voicing

● Difficulty sequencing speech sounds and syllables.

● Difficulties with nasality and nasal emission.

● Groping behaviour and silent posturing.

● Prosodic errors.

ASSESSMENT

● Assessment of a child with phonological disorders would include gathering information

about all the phonemes that the child uses to distinguish meaning. A phonemic analysis
determines whether a child uses specific phonemes contrastively for the purpose of
differentiating between word meanings and helps in determining treatment direction,
including selecting target behaviours and strategies to be used in intervention.
Commonly administered Phonological tests:

Name of the test Age Range Word Position Scores Provided Comments
Tested

Assessment Link 3 to Initial- Standardized, The manual

between 8;11 and gives provides several
Phonology and years final- standard scores, analyses and
Articulation— word percentile ranks. gives analysis
Revised. positions. forms that can be
Lowe, R. (1996). used to document
Mifflinville, phonological
PA: Speech processes, vowel
and Language errors, and
Resources consonant
clusters.

Bankson Bernthal 3 to 6 Initial- Standardized, Provides various

Test of years and gives standard ways to analyze
Phonology. final- score, percentile results,
Bankson, N., & word rank, and phonological
Bernthal, J. positions. standard error processes
(1990). Austin, TX: of measurement. included.
Pro-Ed.

Clinical 2;6 to Pre and Standard scores, Consonant

Assessment 11;11 postvocalic percentile rank clusters tested are
of Articulation years consonants scores, only words
and age equivalent containing [s], [r],
Phonology: CAAP scores. and [l] clusters.
(2nd ed.). Secord, Vowels are not
W. A., & tested. Sentences
Donohue, J. S. are provided which
(2002). can be used with
Greenville, SC: children who can
Super read.
Duper
Publications.

HAPP-3 Preschool Initial-, Standardized, Assesses

Hodson medial-, gives phonological
Assessment of and final- percentile rank processes, can be
Phonological word and used as a direct
Patterns (3rd ed.). positions. severity rating. link to the
Hodson, B. (2004). cycles approach.
Austin,
TX: Pro-
Ed.
Diagnostic 3 to Initial- Standardized, Subtests include
Evaluation of 8;11 and provides Sounds in words,
Articulation and years final- standard scores phonological
Phonology word and process use,
(DEAP). Dodd, B., positions. percentile ranks single
Hua, Z., for words vs.
Crosbie, S., Holm, several connected speech
A., & Ozanne, A. measures. agreement
(2006). San criterion. Contains
Antonio, TX: a
Pearson. diagnostic screen
and articulation,
phonology, and
oral motor
screening.
Khan-Lewis 2 to Initial-, Ten developmental This test uses the
Phonological 21;11 medial- phonological words from the
Analysis (2nd years and processes yield Goldman-Fristoe
ed.). final- standard scores, Test of
Khan, L., & word percentile rank Articulation and
Lewis, N. (2002). positions scores, test-age translates errors
Circle Pines, equivalent scores, into more
MN: American and percentage of common
Guidance occurrence for phonological
Service. individual processes. As
processes by age. with the Goldman
Fristoe, vowels
are not tested.

INTERVENTION

All phonological treatment approaches focus on teaching children the function of sounds
and rest on the principle that, once it is introduced to a child’s system, a feature contrast
will show generalisation to other relevant phonemic pairs (Barlow and Gierut 2002).
The different approaches are:
฀ Distinctive feature therapy

฀ Metaphon therapy

฀ Cycles therapy

DISTINCTIVE FEATURE THERAPY

● Earlier distinctive feature programs were hybrids of phonological and articulatory
approaches and the activities used were motor based.
 o Costello & Onstein, 1976

o McReynolds & Engmann (1975)

o McReynolds and Bennett (1972)

● The most influential distinctive feature program is given by Blache (1989)

● In this method sounds are taught as contrastive units within words.

● There are four steps -

Step 1: Clinician assesses the client’s knowledge of the meanings of the words that are
used in treatment
Eg: If the treatment target is [p]
Pictures of ‘pan’ and ‘man’ might be shown and will ask the client to point to the one that is
used to cook and point to the one that is another word for boy.

Step 2: Client is tested to determine if he or she can discriminate between word pairs
differing by a single sound.
Eg: Pictures of ‘pan’ and ‘man’ might be shown and asked to point to the picture of ‘pan’

Step 3: Client is taught to distinguish between the word pairs in speech production.
Eg: Client might be asked to say ‘pan’ and the clinician picks up the picture card that
matches the client’s pronunciation
Step 4: After the client is able to pronounce the treatment target at the word level, the word
is place in increasingly complex linguistic contexts.

CYCLES THERAPY/PATTERNS APPROACH - Hodson & Paden (1991)

● Designed for severely unintelligible children

● Targets several phonological patterns that are lacking in client’s repertoire

● The primary concept underlying the program is the cycle, which is a time period
during which all error patterns that need remediation are facilitated in succession.

● Cycles last from 5 to 16 weeks and normally 3 to 6 cycles are usually required for a
client to become intelligible.

● Error patterns are targeted for remediation based on:

▪ Percentage of occurrence (40% or greater)

▪ Effect on intelligibility

▪ Stimulability

● Typically, each sound in an error pattern receives one hour of therapy per cycle
before the clinician goes on to the next sound
 ● All error patterns are targeted for remediation receive treatment in each cycle.

● Only one error pattern is targeted during treatment session

● Treatment activities consist of auditory bombardment, therapeutic play and drill play
to encourage production; probes to test for improvement and generalisation; and a
short home program for families

METAPHON THERAPY (Howell & Dean, 1994)

Therapy phases include:
Phase I: Developing phonological awareness
1) Concept level: – Sound characteristics are contrasted and not individual sounds
Eg: ‘long’/ ‘short’, to denote the fricative/plosive contrast;
‘noisy’/ ‘whisper’ to denote the contrast between voiced and voiceless sounds.
2) Sound level: Involves vocalization
The vocabulary child has learnt is transferred to describing non speech sounds.
Eg: Lions roaring, cars racing etc
3) Phoneme level: Sounds of one class contrasted with another class using visual
cues.
Eg. stops vs fricatives.
4) Word Level: Minimally contrasted words are introduced for listening.
Eg. pea- bee

Phase II: More realistic communicative settings

Howell & Dean (1994) targeted the preschool children because at this stage the meta
phonological knowledge is developing. It is a good method for children who have moderate
to severe phonological disorders and have at least 2 to 3 processes that predominate their
speech patterns.

RECENT STUDY : ARTICLE

Title: Advances in the treatment of children with phonological disorders (April 2013)
Journal : Int Arch Otorhinolaryngol
Authors :Marizete Ilha Ceron 1, Karina Carlesso Pagliarin 2, Márcia Keske-Soares 3
doi: https://doi.org/10.7162%2FS1809-97772013000200012
Abstract
● Introduction: Treatment of phonological disorders considering extra-linguistic and
linguistic variables are important to ensure that the alteration is resolved promptly
and in the best manner as possible.

● Aim: To analyze therapeutic advances (phonetic inventory, phonological system,

and distinctive features) in children with phonological disorders by considering the
therapeutic approach used, the severity of the phonological disorder, age, and the
number of therapeutic sessions.

● Methods: We conducted a case series study of 94 children aged 3 years, 9 months

through 8 years, 5 months. The children were divided into groups based on the
therapeutic approach used (Modified Cycles, Maximal Oppositions, ABAB-
Withdrawal, and Multiple Probes), the severity of their phonological disorder, age,
and the number of therapy sessions with each individual. Phonetic inventory, the
phonological system, and the number of altered distinctive features were analyzed.

● Results: The greater the number of therapy sessions, the greater the number of
sounds acquired. The number of sounds present in the phonetic inventory and
phonological system increased and the severity of the phonological disorder
decreased with all of the therapeutic approaches studied. There was also a
reduction in the incidence of altered distinctive features.

● Conclusion: There was a favourable evolution in phonetic inventory and

phonological system acquisitions as well as a reduction in the number of altered
distinctive features for all 3 therapeutic models regardless of the severity of the
phonological disorder, age, or number of sessions.

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