HISTORICAL PERSPECTIVE

The Evolution of Current Practices

Articulation Sound-by-Sound Approach

(Assessment-Target Selection-Intervention)

SPEECH DISORDERS

Historical Perspective: Historical Perspective: The Way We Were to Where We AreThe Way We Were to Where We Are

(1920’s – 1970’s)

Historical Perspective of Speech Disorders in Children

• 1960’s: Sound-by-Sound Analysis– motor problem -> intervention focused on

positioning/movement of articulators– sound-by-sound approach assessment/intervention

• 1970’s: Pattern Analyses– relationship among errors (distinctive features, PVM)– 1976: Ingram’s “Phonological Disability in Children”

1970’s – 1990’s Artic-Phonology Tree

ArticPhonology Ingram (1976)Phonological Processes

Linguistically based

Focus shifted from “mouth” to “mind”

Began to treat younger children who had more severe unintelligible speech

Order in the disorder

Shift in analysis (patterns) and intervention (generalization)

SPEECH DISORDERS

Historical Perspective (continued)

• 1980’s: Phonological Process Analysis– “Individual Differences”– Competence + Performance = Knowledge (PPK)– PPK --> treatment implications (predictions)

• 1990’s: Independent “Self-Contained” Sound Systems– treatment efficacy (variations in intervention models)– unique language systems

2010 MP

MO

MaxO

ES

MP

A

CVP

LA

STIM

PACT

Cycles

MPPA

NSIT

NLP

A

NN

INTERVENTION

PhonemicApproaches Phonetic

Approaches

PR

OM

PT

Nuffield

DT

TC

ASSESSMENT

TARGET

PhonologicalComplexity

Distance Metric(Systemic Approach)

Independent + Relational

Later sounds N

on-stimulable Markedness

Artic

PPK

PVMPPA

Optimality Theory

Con

stra

int B

ased

Early sounds

Stim

ulable

Maxim

al

Distinction

Maximal

Classification

SELECTION

SPACS

Differential Diagnosis of SSD(Diagnostic Subgroups)(cf Shriberg, 1994; Dodd, 1995)

Relational

Non-lin

ear

Lin

ear

Traditional

2000 to Today

• Learnability theory – the structure of languages that makes them “learnable”

• Teachability – the structure of input that maximizes learnability

• Evidence-Based Practice (and Practice-Based Evidence)

• International Classification of Functioning, Disability, and Health (ICF-CY; World Health Organization)

Historical and Theoretical Perspective Links

Analysis

Target Selection

Intervention

Differential Diagnosis of SSD(Shriberg, 1994; Dodd, 1995)

Complexity of Theories(Assessment, Target Selection, Intervention)

Linear(1920’s – 1970’s)

(1970’s – 1990’s)

(2011)

Traditional Perspective: Linear

10% 5%

85%

20% 10%

70%

Systemic Perspective: It’s About Time

CHILDCHILDDISCHARGDISCHARGEDED2-3 YEARS2-3 YEARS

CHILDCHILDDISCHARGDISCHARGEDED2-3 YEARS2-3 YEARS

2-3 YEARS REMAINING FOR INTERVENTION

CHILDCHILDDISCHARGDISCHARGEDED2-3 YEARS2-3 YEARS

CHILDCHILDDISCHARGDISCHARGEDED2-3 YEARS2-3 YEARS

Classification of SSD

Etiological Classification

vs

Linguistic Profiling

Etiological Classification (Shriberg, 1997; 2006)SSD Subtypes Prevalence Probable Etiology Affected Process

Speech Delay-Gen (SD-GEN)

56% Polygenic/Environmental Cognitive-Linguistic

Speech Delay-Otitis media with effusion (SD-OME)

30% Polygenic/Environmental Auditory-Perceptual

Speech Delay-Developmental Psychosocial Involvement (SD-DPI)

12% Polygenic/Environmental Affective-Temperamental(shy)

Speech Delay-Apraxia of Speech (SD-AOS)

<1% Monogenic? Oligogenic? Speech-Motor Control

Speech Delay-Dysarthria (SD-DYS)

<2% of SD population

Monogenic? Oligogenic? Speech-Motor Control

Speech Errors-Sibilants (SE-/s/)

Environmental Phonological Atunement

Speech Errors-Rhotics (SE-/r/)

Environmental Phonological Atunement

Linguistic Profiling (Dodd, 1995; 2005)

Linguistic Profile Characteristics

Phonological Delay (gliding, fronting, stopping) Phonological rules or processes are evident and are characteristic of younger TD children

Consistent Deviant Phonological Disorder(Not typical sound errers. A mix of of unusal patterns)(CONSISTANT)

Presence of both unusual errors and typical errors, which signal the child has impaired understanding of the ambient phonological system

Inconsistent Deviant Phonological Disorder(Word inconsistancy-say the word shoe different ways – sue,shue sew)

Exhibit delayed and non-developmental error types and variability of production of single word tokens (> 40%)

Articulation Disorder Unable to produce particular perceptually acceptable phones

Childhood Apraxia of Speech (CAS) Deviant surface speech production patterns that may sound similar to Incon Dev Phono Dis, but difference is the proposed level of breakdown and symptomatology