You have heard the phrase, and maybe even used the phrase, “Twelve kids on my caseload are ‘just artic’.” Certainly, compared to cases that are highly cognitively and medically complex, speech sound disorders (SSD) seem much easier to treat. However, SSDs are uniquely intricate and often underserved. In fact, the majority of pediatric speech sound disorders have an unknown etiology.7,8
Common Questions About Speech Sound Disorders
Perhaps you’ve also experienced a 5th grader who still cannot say /r/, or the 6th grader who has been on your caseload since kindergarten for “just artic.” In recent years, I have seen our field shy away from embracing the complexity of pediatric speech sound disorders, yet social media groups are bursting at the seams with questions from even seasoned clinicians.
- “What are your tips for fixing /r/?”
- “How do you motivate an 8th grader to improve a lisp?”
- “I cannot stimulate /k, g/ for the life of me!”
Tips for Treating Pediatric Speech Sound Disorders
SSDs are hard to treat, and become even harder the longer that we wait! I offer the following tips based on current research.
- There is always a connection between motor and language when it comes to speech. All phonemes that a child produces are the result of motor coordination and linguistic context. It matters less whether we label it “articulation” or “phonology” and it matters more that we evaluate how it affects the functional communication skills of the child.4
- Early speech sound disorders, regardless of severity, put a child at risk for literacy delays or deficits.1 In addition, early SSDs can be a warning sign of dyslexia – especially if the sounds in error are atypical or affect production of multisyllabic words.2
- Screenings should happen early in kindergarten and include both “expressive” use of phonological (e.g., speech sound production) and “receptive” use of phonology (e.g., phonological awareness, letter sound correspondence, phonological memory, etc.). The way children manipulate phonemes within phonological awareness tasks indicate the quality of their underlying phonological representations.2 This may be a red flag regarding a child’s ability to remedy a SSD.
- The persistence of the SSD is related to the quality and quantity of negative outcomes. At the very least, there are substantial chances of social-emotional deficits due to a persistent SSD.6
- There is evidence of lasting deficits to the phonological system even once the speech sound production skills are remediated.5
- Recent research has found additional cognitive and linguistic differences in children with speech sound disorders compared to typically developing peers. In particular, vocabulary, speech perception, working memory and nonverbal intelligence may be helpful constructs to examine during an assessment.3,5
- Developmental norms are simply one piece of data to consider when determining eligibility for services. They are not intended as the “be-all and end-all” with respect to service provision or target selection. Other things to consider include:
- The type of error – Is it a sound that is made in English? If not, it needs treatment regardless of the child’s age. An example of this is a lateral lisp.
- The intelligibility – Some children are still intelligible with a few sounds in error. Some are not. Sometimes that varies based on the teacher and the parents’ perceptions, which shouldn’t to be ignored
- The child’s confidence level – Is the child unwilling to read aloud in class? Is the child anxious about speaking to peers? Is the child being bullied?6
- The stimulability – In most cases, non-stimulable sounds should be treated before stimulable sounds.9
- The child’s “receptive” phonology skills
In summary, it is important for our field to continue to embrace all disorders within our scope of practice. Certainly, there are children who experience early SSDs who go on to be successful in and out of the classroom after remediation. However, we must not assume that all SSDs present the same way. Let us give ourselves some credit for working on a complex skill with children who are possibly less-than-willing to practice. And, for the sake of our field and for the children we serve, let us stop saying that it is “just artic.”
Coming Soon: Pediatric Offering for Speech-Language Pathologists
MedBridge is excited to announce the expansion of its pediatric course library. With a commitment to producing high-quality content, MedBridge has partnered with Dr. Edythe Strand and Dr. Rebecca McCauley to create an industry-leading offering that features courses on Language/Cognition, Speech and Sound Disorders, Motor Speech Disorders, Autism and more. Filming is already underway, with new courses launching throughout 2016.
- Anthony, J.L., Aghara, R.G., Dunkelberger, M.J., Anthony, T.L., Williams, J.M., & Zhang, Z. (2011). What factors place children with speech sound disorder at risk for reading problems? American Journal of Speech Language Pathology, 20, 146-160.
- Boada, R. & Pennington, B.F. (2006). Deficient implicit phonological representations in children with dyslexia. Journal of Experimental Child Psychology, 95, 153-193.
- Cabbage, K.L., Farquharson, K., & Hogan, T.P. (2015). Speech perception and working memory in children with residual speech errors: A case study analysis. Seminars in Speech and Language, 36, 234-246.
- Farquharson, K. (2015a). Language or motor: Reviewing categorical etiologies of speech sound disorders. Frontiers in Psychology, 6, 1-3.
- Farquharson, K. (2015b). After Dismissal: Examining the Language, Literacy, and Cognitive Skills of Children With Remediated Speech Sound Disorders. SIG 16 Perspectives on School-Based Issues, 16(2), 50-59.
- Hitchcock, E.R., Harel, D., & McAllister Byun, T. (2015). Social, emotional, and academic impact of residual speech errors in school-aged children: A survey study. Seminars in Speech and Language, 36, 283-294.
- Shriberg, L.D. (1994). Five subtypes of developmental phonological disorders. Clinics in Communication Disorders, 4, 38-53.
- Shriberg, L.D., Austin, D., & Lewis, B.A. (1997). The Speech Disorders Classification System (SDCS): Extensions and Lifespan Reference Data. Journal of Speech, Language, and Hearing Research, 40, 723-740.
- Miccio, A.W. (2002). Clinical Problem Solving: Assessment of Phonological Disorders. American Journal of Speech Language Pathology, 11, 221-229.