Articulation and Phonological Disorders Flashcards Preview

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Flashcards in Articulation and Phonological Disorders Deck (266):

____ is a part of articulation that is difficult to break because of habit. We do drill a lot.



_____ is part of articulation treatment that focuses on Skinner's theory.



What do you look for in sounds by word position? 2

1 produces sound incorrectly in one position, but correct in another2 produces a sound as substitution in one position but as another substitution in another


_____ is part of articulation that is based on different levels of difficulty.



What do you look for in sounds by morpheme?

correct morpheme productions


Articulation treatment involves three aspects and they are:

1 motor-learning
2 behavioral
3 hiearchical


___ is when certain sounds can be produced correctly in certain important words like a sibling's name.

Fossilized form


Phonology treatment involves three aspects and they are:

1 cognitive
2 linguistic
3 conceptual


A fossilized form is different than a ___, which does not occur in an important word, just a randomly.

inconsistent error


____ is understand how phonologically the language works.



A ___ is a phonological rule that doesn't change (never put a sound at the end of word)

static rule


____ is not hierarchical approach to treatment of phonology which focuses on ideas.



A ___ are more flowing rules that change by context or affect more than one sound.

dynamic rules


_____ address the patterns and classes of sounds rather than individual errors.

Phonological approach


What are the different static rule constraints?3

1 inventory constraints2 positional constraints3 sequence constraints


What does SSD stand for?

speech sound disorders


____ are sounds absent from phonetic and phonemic inventories.

Inventory constraints


What was Baker & McLeod 2011's main points?

It was a narrative review of the literature from 1979-2011 each study had fewer than 50 participants btw the ages of 1;11 and 10;5; if found the strongest evidence for Developmental approach and cyclical approach (there is MORE research for complexity approach)


_____ are certain sounds only occur in specific word positions, not in other word position.

Positional constraints


What are some different methods which were addressed by Baker McLeod 2011? 13

1 minimal pairs
2 complexity
3 cycles
4 morphosyntax focus
5 core vocabulary
6 traditional articulation approach
7 modified cycles
8 speech perception focus
9 phonological awareness
10 psycholinguistic principles
11 constraint based-nonlinear
12 metaphon


____ are certain sound combinations do not occur.

Sequence constraints


What are the seven steps of EBP according to Baker & McLeod 2011b? 7

1 generate a PICO question
2 find external evidence that pertains to the question
3 critically evaluate the external evidence
4 evaluate the internal evidence from clinical practice
5 evaluate the internal evidence re: client factors, values and preferences
6 integrate the three sources of evidence
7 evaluate the outcome of the decision


___ is a type of dynamic rule that must be applie regardless of word position or morpheme.



What is the difference between rote learning and cognitive learning?

rote learning is based on repetition and motor memory (habits)
cognitive learning is based on understanding fundamental idea and context (generalization)


___ is a type of dynamic rule that are applied in some cases but not all cases.



What is the difference between phonetic disorder and phonemic disorder? What do you work for on each?

phonetic is actual pronunciations - motor system or articulation disorder; working for correct production
phonemic is conceptual pronunciations - phonological disorder; working for some sort of contrast


Use a ___ to help decide what level of knowledge the child has and needs.

Decision tree for phonological knowledge


What has a child with a phonemic disorder (e.g. produces /s/, "sh", /k/, /t/, /f/ as /p/) have lost?

the phonemic contrast between those sounds


_____ is to make gross phonological change. (Gierut & Hulse 2010)

The goal of treatment of SSD


What is the difference between changing knowledge versus changing behavior?

changing a behavior isn't as difficult, we can increase consistency of a production; we increase accuracy
changing knowledge is very difficult


____ is that it doesn't matter what you do with sounds, it just matters what sounds you are working on.

Complexity research


What is the overarching goal for every child with SSD?

increase intelligibility


___ is when generalization/bootstrapping occurs through complexity theory usage of selecting targets.

Cascade effects


What are 3 things that go in to the goal of increasing intelligibility in every child with SSD?

1 produce an individual phoneme correctly and consistently
2 apply phonological rules (e.g. knowing contrasts) correctly and consistently
3 induce change in the child's knowledge of the ambient phonological system (dialect)


_____ is that complexity is system driven, number and labels of phonological processes present in a child's system and interaction of the process on one another and on the overall communicative competence of the individual affects the disorder.

epistemic perspective


What will you see if the client has an articulation disorders? 2

1 show preserved phonemic contrasts
2 show the same misarticulation regardless of position (prevocalic, postvocalic, and intervocalic; inconsistencies could be borderline or may indicate an emerging phoneme or coarticulatory effects)


_____is that there is a hierarchical relationship between the individual characteristics of the system, which allows for "cascading" of effects from tx. Treat the top of the hierarchy.

ontological perspective


How do you address an Articulation disorders? 2

Traditional Articulation method
1. Hierarchically (step by step)
2. Errorless learning (don't make crashes hard)


____ is the complexity is principle driven (like phonotactics, phonotactic probability) and there is a system.

functional perspective


How do you pick targets for Articulation disorders? 4 Which one should you ignore (more or less)?

1 stimuluable
2 emerging
3 sounds affecting intelligibility
4 earlier developing first


What IS complexity?

Epistemic, Ontological and Functional Perpsectives combined


What are the steps of the traditional approach? 7

1 ear training
2 sound in isolation
3 nonsense syllables
4 words
5 structured contexts
6 spontaneous speech
7 dismissal re-eval


____ is input that models the more advanced (adult) forms in all their mutations and derivations. Don't dumb it down!

Learnability theory


What are the steps for ear training? 4

1 identification (presence or absence)
2 isolation (where is it in the word? it's in the middle)
3 stimulation (sit there and listen to you produce the sound)
4 discrimination


Pyscholinguists with Gierut look at ___, which are linguistic rules that cross languages.

Implication laws


What are the steps in discrimination? 3

1 error detection (listen and tell me when you hear me say it wrong, "ring, real, wabbit, etc.")
2 error correction
3 self-monitoring


What are some additional system-wide implicational laws? 6

1 affricates imply fricatives2 consonants imply vowels3 liquids imply nasals4 fricatives imply stops5 clusters imply affricates6 fricative+liquid clusters imply stop+liquid clusters


How important is the ear training heirarchy?

Van Riper said you could skip steps


What are some phonological process implicational laws? 2

1 stopping implies liquid gliding2 word final velar fronting implies word initial velar fronting


What are ways to achieve sounds in isolation? 5

1 imitation of clinician
2 phonetic placement method (your tongue goes behind your teeth)
3 sound modification method (make a "th" sound and pull your tongue back)
4 stabilization (if they are producing it inconsistently
5 facilitating context


___ is when the phoneme is not represented at all in any morphemes.

inventory constraints


What are the steps in the sound modification method? 2

1 derivation of target from established sound
2 phonetically similar (don't go from voiced to voiceless)


What are the characteristics for a Phonological Disorder? 4

1 Show a reduced speech sound inventory (both in the context of a std meas and in speech sample)
2 Show syllable shape constraints
3 Show neutralization of phonemic contrasts
4 Show patterns of errors (place-voice-manner analysis; phonological process/knowledge)


How do you address Phonological Disorders? 2

1 word level (no ear training, isolation or syllables)
2 every phonological approach uses minimal pairs (except Cycle and Core Vocabulary)


What are the key factors for minimal pairs? 3

1 target phoneme contrasted with error phoneme
2 error phoneme contrasted with all the phonemes it represents (minimal oppositions)
3 two phonemes absent from phonetic inventory (least phonological knowledge)


What principles go into artic/phono therapy? 3

1 groups of sounds
2 phonological contrasts
3 naturalistic communicative context


When you are doing target selection for minimal pair, you are selecting a (phoneme/process). This is based on? 3

1 frequency
2 intelligibility
3 age & dev stage of kid


How do you use minimal pair intervention? 3

1. Familiarization
2. Listen and pick up
3. Production of minimal pair words
20 trials of each five target words.


How can you refine Traditional Approach?

go back to exposure if they are really close, phonetic placement and then go to minimal pairs


What are the steps in an articulation/phonological assessment? 6

1 performing the assessment
2 consolidating the gathered info
3 analyzing tests/data
4 interpreting the data
5 making clinical decisions
6 making recommendations


What are the parts of a speech eval? 7

1 screening - often done at a health fair, SLPAs usually do this
2 case history
3 oral peripheral exam
4 hearing screen
5 cognitive screen
6 language screen


What are standard screening stimuli? 3

1 imitation
2 picture stimuli
3 real objects


What does non-standardized screenings involve? 3

1 still planned
2 responding to questions
3 reading aloud


What do case histories involve? 3

1 written case history
2 info gathering from other professionals
3 interview


What do oral-peripheral exam? 3

1 philosophy - do it for communication -
2 tools - gloves, tongue depressors, something to chew, something to drink
3 no problems with palate, teeth


What are some specific objectives to an OPE? 5; How long does it take?

5 minutes:
1 symmetry
2 tone
3 strength
4 coordination
5 range of motion


What is diadochokinesis?

rate, rhythm, speed for syllable production. rhythm is very important


Why is a hearing screening important for artic/phon clients?

b/c they need a system of phonology and it's impossible to do that without reliable hearing screening


What goes into a hearing screening?

visual inspection, 20 dB across 1KHz, 2KHz, and 4KHz, and impedance testing:
Refer to audiologist for any failed screens (or repeated fails)


What goes into standardized articulation and phonological testing? 4

1 administration and digital recording
2 recording phonetic responses
3 normative data (as long as it is administered in a standardized way)
4 specific tests (GFTA, many are good)


____ is a single word articulation test.

Citation test


What are the advantages of standardized tests? 3
What is a disadvantage of standardized tests?

1 fast
2 know what the kid is trying to say
3 every phoneme will be sampled in every position that it is made in
only tests in single words, not fair to paragraphs


What are the ways of record keeping for artic/phono? 3

1 two-way scoring; correct incorrect
2 five-way scoring; 1. normal/correct; 2. substitution, 3. addition, 4. distortion, 5 omission
3 transcription


What standardized tests help determine if it is a phonological process? 4

1 HAPP-3
2 GFTA-2 (only with the KLPA-2)


What is a better way to determine if a client has a phonological process?

language sample


_____ helps with target selection and production of target sounds.



What goes into stimulability?

test only misarticulated sounds


What goes into evoking the sample? 4

1 keep the recorder non-distracting ("that's taking notes for me so that I can learn more later")
2 many types of speech samples
3 glossing
4 note taking


What types of speech samples are there?

1 free
2 story
3 routines
4 interview
5 scripted


_____ is uncontrolled content, where the child selects the stimulus and topic can be related or unrelated to stimulus. Examiner listens and takes notes.

Free speech sample


___ is an indirect control of content, stimulus is selected by the examiner and topic is related to the materials. Examiner listens and takes notes and makes non-directive comments pertaining to materials.

Story speech sample


___ is an indirect and direct control of content, stimulus is examiner selects a single set of materials that sample all consonant forms, and topic is related to materials. Examiner uses questions and comments to elicit consonants.

Routine speech sample


_____ is direct control of content and no materials for stimulus, topics flows naturally. Examiner asks questions to identify and build on child's interests

Interview speech sample


____ is direct control of content and the stimulus is selected materials and designed to elicit all consonant forms and topics relates only to materials. Younger kids tend to feel like they are being tested. Examiners takes notes.

Scripted speech sample


What are the pros of speech samples? 5

1 connected speech is a more ecologically valid measure of communicative abilities
2 deeper phonological sampling than citation methods
3 allow for more analyses and deeper analyses
4 you can look beyond speech ***
5 more sensitive to clinical change


What are the cons of speech samples? 3

1 time limits are hard
2 transcriptions of continuous speech is hard
3 children will avoid difficult phonetic contexts


What are different speech sample analyses? 2 (a,b,c,)

1 independent analyses (compares child to himself)
1a phonemic inventory
1b phonetic inventory
2 relational analyses - comparison to adult target
2a PCC
2b PMLU (phonetic mlu) and PWP (porportion of whole-word proximity)
2c Phonological process analysis


What are syllable structure phonological processes? (changing how the child represents syllable)6

1 reduplication "bottle" ->"baba"
2 unstressed syllable deletion (USD) banana->nana
3 final consonant deletion (FCD) "cat"-> "ca"
4 consonant cluster reduction (CCR) school -> cool
5 cluster substitution (school -> spool)
6 epenthesis (school -> sachool; blue -> balue)


What are substitution processes? 6

1 stopping (s->t, f->p)
2 deaffricatation (ch->sh)
3 velar fronting (k->t, g->d, ng->n)
4 depalatalization (sh->s, jz ->z)
5 liquid gliding (l->w,j, r->w)
6 vowelization (r->schwa, l->o)


What are assimiliation processes?

must be influencing and influenced phonemes; con affect manner voice or place


What are the TD processes disappearance rate? 8

1 reduplication - gone ~ 18months
2 final consonant deletion - gone ~36 months
3 unstressed syllable deletion - gone ~30-48 months
4 cluster reduction - gone ~5 years
5 epenthesis ~5 years
6 stopping - varies depending on phoneme
7 fronting - gone ~40months
8 gliding - gone ~ 7 years (but is imp for literacy!)


What is an inventory of speech sounds?

a count of how many sounds a child makes, the contexts in which he uses them (correctly orincorrectly), and distribution of speech sounds (prevocalic, postvocalic, intervocalic)


____ is when two phonetically different words are pronounced the same.



What are the steps to make phonetic matrices?

1 Collectthe sample
2 Enter data into matrices
3 Summarize phonemic contrasts
• Determine consistency/inconsistency of contrast
• Look forinconsistently used contrasts
• Summarize collapses
• Look for sound preferences


What was addressed in "How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems."?

comparison of Shriberg’s (2010) Speech Disorders Classification System (SDCS); Dodd’s (2005) Differential Diagnosis system; and Stackhouse and Well’s (1997) Psycholinguistic Framework


What was addressed in "Test–retest reliability of independent measures of phonology in the assessment of toddlers’ speech."? 4

1 phonetic inventory;
2 word shape;
3 syllable structure level (SSL);
4 index of phonetic complexity (IPC)


What was addressed in "Using standardized tests to inventory consonant and vowel production: A comparison of 11 tests of articulation and phonology."?

1 AAPS (Arizona Articulation Proficiency Scale)
2 BBTOP (Bankson- Bernthal Test of Phonology)
3 CAAP( Clinical Assessment of Articulation and Phonology)
4 DEAP (Diagnostic Evaluation of Articulation and Phonology)
5 FLTA (Fisher Logemann Test of Articulation)
6 GFTA- 2 (Goldman Fristoe- Test of Articulation 2nd edition)
7 HAPP-3 (Hodson Assessment of Phonological Patterns 3rd edition)
8 PAT (Photo-Atriculation Test)
9 SHAPE (Smit-Hand Articulation and Phonology Evaluation)
10 SPATT-II (Structured Photographic Articulation Test 2nd edition)
11 TDTA (Templin-Darley Test of Articulation)


What is a marked consonant?

the child marks every sound in the word with something.


What was addressed in "Relationship between speech motor control and speech intelligibility in children with speech sound disorders."?

Looked at SSD RTI with PROMPT intervention (an oral motor approach); did not use a control


What is the deal with PROMPT?

it is a specific training program that costs thousands to complete, which has some research to back it up


What was addressed in "Transcribing the Speech of Children with Cochlear Implants: Clinical Application of Narrow Phonetic Transcriptions"?

SLP's transcribe speech samples from kids with cleft palate and/or CI. Mostly b/c their consonants do not sound like SAE consonants (lots of glottal stops), recommended diacritics and narrow transcription and recording sessions


What is the the "traditional approach"?

the very first approach developed for artic tx: you need to know how a sound is produced; it is a motor approach, including a session or two on auditory discrimination skills (unless the child is totally functional with auditory discrim)


What does SDCS stand for?

Shriberg's Speech Disorder Classification System


Why do we classify SSD disorders? 2

1 So that we are all saying the same thing, common terminology
2 theory informs practice


What are the three populations of SSD? 3

1 Developmental Phono - Speech Delay
2 Developmental Phono - Residual Errors
3 Special Populations


What are the accepted developmental periods of speech delay? 5

1 Concern - 0-2yrs
2 Late talkers 2-3 yrs
3 Questionable speech delay 3-4 yrs
4 Speech delay or questionable residual errors 4-9 yrs
5 Short term or long term normalization 4-9 yrs
After 9, it's a disorder


___ are found in children whose speech system has not normalized by 9 years old.

Residual errors


What are examples of residual errors? 3

1 distortions of fricatives, 2 affricates and/or 3 liquids


What are in Shriberg's special populations? 3

1 speech hearing mechanism
2 cognitive-linguistic processes
3 psychosocial processes


What are the categories in Shriberg's Speech Disorders Classification System? 4

1 Normal or Normalized Speech Acquisition
2 Developmental Phonological Disorders
3 Non-developmental speech disorders
4 Speech differences (accent clients/ dialectal/cultural differences)


____ is anything that emerges beyond the age of typical speech development.

Non-developmental speech disorders


_____ is really a research based classifcation but almost but not quite normal by 9. between 2 and 8;11 years.

Normal/Normalized Speech Acquisition


___ is dialectal/cultural differences.

Speech differences


_______ fall into three categories: Questionable Residual Errors (QRE), Speech Delay (SD), and Residual Errors (RE).

Developmental Phonological Disorders


___ appear between 6;0 and 8;11 years and my or may not have SD history and one or more common distortions or substitutions. (COMMON).

Questionable Residual Errors (QRE)


____ is divided in 5 subtypes (unknown origin, otitis media with effusion, developmental apraxia of speech, developmental psychosocial involvement, and special population).

Speech delay


Speech delay of ________ describes 60% of SD pop and has a possible genetic link.

Unknown origin


SD with ___ describes 30% of SD pop and has at least 6 episodes of ear infections in their first 3 years.

Otitis media with Effusion (OME)


What are the diagnostic markers for SD- OME? 4

1 place/manner errors on nasals, stops and glides
2 place errors on fricatives
3 frequent rhotic errors
4 deletions of word final sounds


SD with ___ describes 3% of SD pop and have inappropriate sentential stress and excess-equal stress. Possible genetic link.

Developmental Apraxia of Speech (DAS)


SD with ___ describes 7% of SD pop (possibly Autism) who have prosody variations and situational variations in prosody.

Developmental Psychosocial Involvement (DPI)


What are the two large categories of residual errors?

Children with histories of SD = RE-A
Children with no history of SD = RE-B


What are the subcategories of RE-A and what percentage of each? 3

1 Distortions 25% of pop
2 Distortions + Imprecise Speech 50% of pop
3 Imprecise Speech 25% of pop


___ is the proportion of cases within a given population.



___ is the number of new cases identified in a particular period.



Why calculate prevalence? 3

1 helps plan for service delivery needs (who, where, and how
2 allows for efficacy studies of prevention programs
3 allows for adv of knowledge about a disorder


___ is more than one diagnosis operating concurrently.



___ is the course of a disorder over time if no treatment is provided.

Natural history


What is a natural history of SD?

a primary disorder of speech, without any other diagnosis (CP or Autism)


___ % of the general population has speech and/or language delay.



The prevalence of expressive and receptive language delay (no SD) is ___ - ____ %.

2-3%; only a little higher in expressive only or receptive only


The prevalence of speech delay only is ___ - ___%

2.3 - 24.6; using 2SD it is 4.6-6.4%


When using CA referencing prevalence of speech delay balloons to 16.5-24.6%, why does this do it?

CA doesn't always match ability


What are flaws with prevalence reporting for SD? 2

1 gender (Are we not looking closely enough at the girls or are the boys just more severe?)
2 SES (in practice we see lower SES has higher prevalence, but most studies are done in universities)


How has articulation treatment changed through history?

pre-1970 - Articulation focused and motor speech
1976 - Ingram shifted to focusing on phonological system
1979 - Stampe looked at phono patterns
Now we have 22 difference evidence-based ways to treat phonological disorders


What are service delivery factors for SD? 4

What works for your facility:
1 group vs. individual
2 drill vs. play
3 family based vs. direct
4 dosage


What is EIS?



What does EIS do? 7

U.S. Department of Education clarifies early
intervening services
1 Not to delay an evaluation
2 Recipients are not identified as students in Special Education
3 Intended for K-12
4 Emphasis on K-3
5 Cannot be used for preschool
6 May be used to purchase instructional materials to support these efforts
7 May include related service personnel in the
development and delivery of educational and
behavioral evaluations, services, and supports


Who is on an RTI intervention team? 4

1 Administrator,
2 regular education teacher,
3 counselor
4 other professionals as needed (i.e., special education, SLP, reading specialist)


What is the RtI problem solving process? 4

1. Define the problem
2. Develop a plan
3. Implement the plan
4. Evaluate


What is the role of the SLP in RtI tier 2? 4

1. More active role consulting with teachers
2. More active role providing materials for
parents and teachers to use with students
3. Co-teaching with General Education
teachers using RtI programs
4. Providing direct intervention


How do SLPs consult with teachers? 6

1. Listening to students
2. Providing developmental guidelines
3. Providing suggestions and strategies for the
teacher to implement
4. Providing materials for teachers to implement
with the student(s)
5. Monitor progress of student(s)
6. Provide recommendations on the need for
Special Education evaluation


How do SLPs consult with parents? 3

1. Provide home programs for parents to
2. Monitor student progress (in collaboration
with classroom teacher) for a specified time
3. Make recommendations regarding the need
for formal Special Education evaluation


What is ARtIc lab?

Bilingual Response to Intervention program for
elementary aged children with mild
articulation deficits.


How long does ARtIc Lab take?

20 hour evidence based program


What is targeted in ARtIc Lab?

Currently targets /r/, /s/, /l/, /sh/ and /ch/ in
English and /r/, /rr/, /s/ and /ch/.


Who is appropriate for ARtIc Lab? 9

1 English or Spanish speakers
2 1st-5th grade
3 Preferably around age 7
4 Leaves 1.5 years before the speech
normalization boundary
5 Demonstrating difficulty with one to two
6 Students who may or may not meet eligibility
criteria for Special Education speech
7 Nonstimulable for target sounds
8 Monitor students who are stimulable;
treatment probably is not warranted.
9 Research suggests that stimulable sounds will
develop without intervention (Gierut, 2007).


When does Artic Lab take place?

 3-4 sessions per week, 30 minutes each
 Scheduled first or last 30 minutes of the school
 Can schedule before or after school, depending on


What approaches are used in Artic Lab? 6

1 Traditional Model: Students progress through
the 5 phases: (1) ear training, (2) sound
establishment, (3) sound stabilization, (4)
transfer and carryover and (5) maintenance
2 Motor Learning Theory: Present sounds and
tasks in randomized order. Level of complexity
should also vary and be random.
3 Contrast Therapy Approach: Treat the more
complex sounds first and one will see
improvement in the less complex sounds
4 Sound Modification Method: Target sounds
that are phonetically similar to a sound the
student can produce.
5 Facilitated Contexts Approach: Using words
the similar sound combinations that the
student can produce correctly.
6 Nonsense Syllables: Maintains production of
targeted consonant while embedding it in a
variety of vowel contexts


What are the five placement techniques used in Artic Lab?

 Imitation
 Shaping
 Phonetic placement
 Moto-kinesthetic
 Touch cue


What goes in the Artic Lab records notebook? 6

1 Attendance
2 Consultation form
3 Parent Permission
4 Quick Screen
5 Pretest Probes
6 Sound Treatment Profile`


What do to the students for Artic Lab get? 3

 Tally counter
 Practice file folder (put in practice pages)
 Homework file folder (put in homework pages)


In Artic Lab, At the ____ the premise is to amplify student’s productions and the materials include Webber Phones, Echo Mics, etc.

Listening station


In Artic Lab at the ___the premise is motor-learning theory and the materials include Gross motor cards (printouts are provided on the ARtIC LAB CD).

Gross motor station


In Artic Lab at the ___ the premise is engaging fine motor and materials include simple games (played independently, Print Games from CD)

Games station


In Artic Lab at the ____ the premise is engaging student while using fine motor skills and materials include blocks, Legos, Lincoln Logs.

Building station


In Artic Lab at the ____ the premise is student practice of words/sentences using a variety of emotions (happy, sad, etc) and the materials include emotion cards printouts are provided on the ARtIC LAB CD.

Emotion station


In Artic Lab at the ___ the Premise: This station is used at least once a week to formally or informally monitor the child’s production and the materials include the Sound Treatment Profile and Probes

SLP monitoring station


How does Artic Lab foster self-monitoring? 4

1 Delayed feedback
2 Praise
3 Direct feedback on self-monitoring
4 Use monitoring tools (i.e. speech diary, score cards, counters)


How long does Artic Lab take?

17-20 hours of intervention should remediate
articulation deficits.


Is Artic Lab only for English speakers?

 Model can be used with Spanish speakers (or
other languages).
 Service is provided by bilingual SLPs or
through use of interpreters.
 Be sure to not use it as an ESL program.
 Be sure to not use this for accent reduction.
 We are treating potential articulation disorders.


_____ is direct addressing the collapse of multiple sounds into one sound for severe SSD only (at least 6 sounds)

Multiple oppositions


What are the 4 phases of multiple oppositions treatment?

1 familiarization and production of the constrasts
2 production of the contrasts
3 production within communicative contexts
4 conversational recasts


What takes place in phase 3 (production w/in communication contexts) of multiple oppositions?

use semantic confusion to draw attention to homonymy


____ uses more minimal pairs using real words and nonsense words, with distinctive features differences.

Complexity approaches


What are the major class features? 3

1 consonantal
2 sonorant
3 vocalic


What is the goal with complexity approaches?

pick work that differ by the most major class features do it


What are the two phases of complexity approach tx?

1 imitation
2 spontaneous


What goes into the imitation phase of complexity approach?

error free learning, until 75% over 2 consecutive session or has completed 7 sessions


What goes into the spontaneous phase of complexity approach?

client produces the word independently until 90% across 3 consecutive sessions


When choosing target opposition, it is better NOT to use ____ neighborhoods.



____ is a focus on the CONSISTENT production of a group of functionally powerful words. Not accurate productions, just consistent.

Core vocabulary


Is core vocabulary a good long term treatment?

no, it is great for making errors more consistent.


Who chooses the words for core vocab method?

the client, family, teacher and clinician; child selects first 10 words


How do you go about core vocabulary?

there are no rules re: syllable shape or sound inclusion; try to get best production; if he's not accurate go for best production with developmental errors; and 100 productions in a 30 minute session; corrective feedback and practice everyday (at home)


In ____, the clinician trains phonological patterns in specific time periods for children who have severe to profound phonological disorders.

Cycles training


In cycles approach, the focus is on ___, after which development takes over.



What are the criterion for changing targets in cycles?

There is none! Either 1-60 minute, 2-30minute or 3-20minutes


What is a cycles training session look like? 7

1 review
2 auditory bombardment w/ amplification
3 target cards
4 production practice
5 stimuluability probes
6 auditory bombardment w/ amplification
7 home program


___ is an older treatment for children 5 yrs and beyond with limited phonemic awareness, unusual or idiosyncratic processes, in an errorless learning.

Metaphon therapy


What are the two treatment phases of metaphon?

1 developing phonological awareness
2 developing commmunicative awareness


What are the levels of phase 1 of metaphon? 4

1 concept level (fast/slow, front/back)
2 sound level (long sound, leaky tire, angry cat)
3 phoneme level
4 word level


What is PACT intervention?

Parents and Children Together intervention - clinician trains child to produce sounds and parents practice at home; it is a formalized homework program


What are the different phases of PACT? 3

1 stimulability
2 meaning-based
3 homework


What goes in to PACT's stimulability phase?

teach the child how to produce his target sound; two syllable positions (syllable initial-word initial - SIWI; syllable final-word final-SFWF)


What goes in to PACT's meaning based phase?

very small number of target words (~6), mostly SIWI;SFWF (for fricatives only, since they work better at the end) and minimal pairs


What goes in to PACT's homework phase?

5-7 min practice bursts; repeat of latest formal treatment session split between talking and listening


What goes in to PACT's stimulability phase?

teach the child how to produce his target sound; two syllable positions (syllable initial-word initial - SIWI; syllable final-word final-SFWF)


What goes in to PACT's meaning based phase?

very small number of target words (~6), mostly SIWI;SFWF (for fricatives only, since they work better at the end) and minimal pairs


What goes in to PACT's homework phase?

5-7 min practice bursts; repeat of latest formal treatment session split between talking and listening


The difference between intervocalic consonants, intervocalic consonant blends and adjacent consonants?

intervocalic consonants are surrounded by vowels
intervocalic consonant blends are surrounded vowels and are blended together
adjacent consonants are consonants that end one syllable and run into the next


What is important with the inventory of speech sounds?

the # of sounds the child uses contrastively


___ is defined as a difficulty of motor planning in children. Programming their muscles is hard for them.

Developmental apraxia of speech


What is the difference between children and adults apraxia of speech? 2

1. adults have routines we can call upon
2. adults have lesions visible on MRI


What are the top characteristics of DAS? 4

1 unusual errors
2 more errors made in complex productions
3 difficulty sequencing sounds and syllables
4 groping or silent posturing


What diagnostics can you perform for DAS? 7

1 hearing screen
2 language test
3 language sample
4 motor - diadochokinetic rate
5 specific sound sequence screening
6 speech and non-speech (eating) volitional movements
7 articulation test -tests specific for DAS!


What are important treatment implications for DAS? 7

1 intensive services (difficult for ECI which is parent-tx focused)
2 begin with imitation and address tasks hierarchically
3 stress sequences/routines
4 teach self-monitoring
5 use multiple modalities (sign, AAC, gesture of some sort), functional core vocab
6 use prosodoy
7 compensatory strategies


___ is a non-progressive form of congenital brain damage (pre-,peri, or post-natal) and occurs with co-morbid physical impairment and some ID.

Cerebral Palsy


What are the 3 types of cerebral palsy?

1 spasticity
2 dyskinesia
3 ataxia


_____ is a type of cerebral palsy that is marked by too much tone/excessive rigidity.



What are the 4 types of spastic cerebral palsy?

1 hemiplegia- one side
2 paraplegia - bottom half
3 diplegia - legs, hips and pelvis
4 quadriplegia -- all 4 limbs and possibly abs


What are the speech general characteristics of Spastic CP? 4

1 harsh voice
2 short phrases with uneven voicing (difficult coordinate with breathing
3 hypernasal
4 imprecise consonants


What are the speech characteristics of spastic CP with hemiplegia? 2

1 delayed acquisition of constrasts
2 auditoryily acceptable


What are the speech characteristics of spastic CP with paraiplegia? 1

1 respiration and breath control affected by torso


What are the speech characteristics of spastic CP with diplegia? 2

1 dysprosody
2 artic disorder
3 varying degrees of severity


What are the speech characteristics of spastic CP with quadriplegia? 2

1 dysphonia - breathy and/or harsh
2 dysarthria - slurring of stops and fricatives
3 varying degrees of severity


____ is a less frequent form of CP which is the result of basal ganglia lesion and muscular involvement.



what are the speech characteristics of dyskinetic CP? 4

1 irregular respiration (forgetting to breath)
2 laryngeal spasms/freezes (very strained voice) and hard glottal attacks and loud voice
3 velopharyngeal - hypernasal
4 artic - overshooting articulators, groping


___ is the most rare form of CP, with a lesion in the cerebellum have uneven coordination/balance



What are the speech characteristics of ataxic CP? 4

1 shallow inspiration, air rushes in to catch up, uncoordinated
2 harsh voice
3 intermittent hyper- hypo nasal
4 inconsistent phonological system irregular systems


What are general considerations for CP diagnositics? 4

1 integrated system - vision and hearing
2 comorbidity - cognition (various levels of impairment), physical needs, medical needs
3 pre-speech skills -
4 team involvement - feeding/eating, use volitional skills they have (OT/PT/ST)


How do you eval a CP respiration? 4

1 s/z ratio (should be 1:1)
2 recitations
3 sustain /a/
4 phrases/sentences


How do you eval CP phonation? 3

1 pitch
2 loudness
3 quality


How do you eval CP for resonance? 2

measure nasality (gloved hand or laryngeal mirror)
pressure consonants (stops and fricatives - maintain and coordinate nasality)


How do you eval CP for artic? 2

1 standardized tests
2 intelligibility ratings (some variability by context and listener)


What are general treatment considerations for CP? 3

1 eating specialists (need nourishment to keep those muscles contracting)
2 early communication stimulation
3 older - need to work with PT on mobility/stretch possibly injections


What are traditional methods of treatment of CP? 3

1 managing breath
2 turning on/off voice
3 motor control for articulators


What are augmentative/alternative communication system uses with CP? 3

1 safety
2 for control of environment
3 for communication


What are impairment levels for cognitive levels?

Mild (90%) - 55-64
Moderate (5%) - 40-55
Severe (3.5%) - 25-39


What are patterns of SSD in cognitively impaired population? 3

consonant deletion
inconsistent errors
slowed developmental sequence


What do you do in diagnositic settings for cognitively impaired? 5

1 hearing screen, case history, DDK
2 standard artic test
3 continuous speech
4 language screen
5 functional communication assessment


What are treatment implications for cognitively impaired populations? 7

1 over-learning - lots of repetition
2 client centered
3 early intervention
4 use developmental sequences (theory of mind impaired)
5 keep functional goals - needs to be mainstreamed
6 repair strategies
7 consider AAC as necessary


What are distinguishing hearing impairment pops? 3

1 static vs. fluctuating
2 sensorineural vs. conductive
3 oral or manual


What are patterns of impairment for HI pops? 5

1 shape of audiogram and degrees of loss
2 consonant deletions & substitutions (more often in final position and back sounds)
3 overall intelligibility can be poor
4 processes persist beyond expected developmental stages
5 vowel neutralization


What should you do for diagnostics for HI pops? 4

1 case history, DDK
2 std artic test
3 continuous speech sample
4 language screen


What are treatment implications for HI pops? 4

1 Hearing aid
2 CI
3 FM system
4 signing or not


What are the different clefts that can occur? 4

1 prepalate (lip, alveolar ridge, prepalate)
2 palate (soft, hard)
3 face (lip, nasal)
4 bilateral/unilateral


What is the occurence of cleft lip/palate?



What do you have to look for with repaired cleft lip/palate?

velopharyngeal insufficiency/closure resulting in hypernasality


What are speech characteristics of clefts? 4

1 nasal emission
2 vowel distortion due to nasality
3 compensatory artic
4 atypical back artic


What are characteristics of compensatory artic for clefts? 3

1 stop-plosive to glottal stop, laryngeal stop, and pharyngeal stops
2 fricatives to laryngeal fricative, pharyngeal fricative, posterior nasal fricative, middorsoum palatal fricative
3 affricates to larngeal affricate, pharyngeal affricate, posterior nasal affricate, and middorsum palatal affricate


What are diagnostic considerations for clefts? 5

1 language
2 hearing screen and referral if necessary
3 nasal emission testing
4 sustained phonation
5 std artic test


What are tx considerations for clefts? 3

1 train and reinforce front productions
2 biofeedback and direct augmentation of VP port
3 std artic and phonological approaches


What is the first ethical principle?

Hold the welfare of those we serve paramount


What is the second ethical principle?

Achieve and maintain the highest level of competence.


What is the third ethical principle?

Represent the profession well to the public


What is the fourth ethical principle?

play nice with others (SLP, PT, OT, MD, Teachers, Administrators, Researchers)


____ is a technique that does not require speech to increase oral tone, strength and range of motion.

Non-speech oral motor exercises


What do non-speech oral motor exercises work on? 3

1 oral tone
2 oral strength
3 oral range of motion


____ of SLPs use non-speech oral motor exercises including blowing, blowing kisses, tongue push ups, tongue-to-nose-touching, pucker smile, cheek puffing, tongue wags, tongue curling, and big smile.



Why are NS-OME used in the US?

tongue elevation, drooling control, awareness of articulators, jaw stabilization, tongue strength, lip/tongue protrusion, lip strength, VP competence, lateral tongue movements, and sucking ability,


Who are NS-OME used with in the US?

dysarthria,, apraxia of speech, structural anomalies, down syndrome, enrollment in EI, late talker dx, HI, phonological impairment, functional mis-articulations


We don't need much strength to speak. T/F



____ assures changes in the neural system that supports speech. NS-OME doesn't do this.



____ _____ ensures that same structures, different functions, similar to relevance.

Task specificity


It is necessary to use warm-up/awareness of sounds. T/F



One author (Flipsen) argued that there is a difference between oral-motor and speech-motor activity, which is __ ___.

domain specificity


Some authors (McGuire) argues that famous authors (Van Riper, Bliele, and Secord) have taught using devices, such as using a straw to teach saggital grooving and focused airflow for /__/.



One author (Nunes) said must consider the _____ and ______ foundations of speech

cognitive; linguistic


_____ is an institute created to demonstrate that there is evidence for oral motor exercises.

The Oral Motor Institute


What are critiques of the Oral Motor Institute monograph? 3

1 Flipsen pointed out that peers can't work with each other
2 Bowen reviewed the errors and contacted sources which brought attention to new errors
3 Nunes peer review relies on anonynmity.


What are critiques of the Oral Motor Institute monograph? 3

1 Flipsen pointed out that peers can't work with each other
2 Bowen reviewed the errors and contacted sources which brought attention to new errors
3 Nunes peer review relies on anonynmity.


_____ is organized by phonological information and neighborhood density.

Semantic lexicon


____ is the foundation for reading. (ability to analyze sounds, foundation for alphabetic principle).

Phonological representation


____ is the foundation for reading.

Phonological representation


We cannot deny when working with multicultural clients is that there is a power ____ for people with non-mainstream ____ or ____.

differential; dialect; language


Do we fix dialects?

no, that is considered a difference not a disorder.


What is the nature of regional dialect? 2

1 mostly phonetic (vowel and consonant differences)
2 some semantic differences


What is the nature of cultural dialect? 1

people have judgements based on this (AAVE, Arabic and African Language Influences) because they believe they will be less intelligent


What are assessment considerations for dialects? 3

1 make sure you know the dialects of your region (and assessment includes identify presence/absence & frequency/occurnence of dialect and documenting that)
2 use culturally sensitive tools (pictures and language) - good ones are GFTA and Fisher-Logemann
3 gauge communicative effectiveness


What are the logistics of bilingual assessment? 2

1 bilingual SLP performs the assessment in both languages/dialects (IDEAL)
2 monolingual SLP performs assessment with some validity by using a trained/untrained interpreter and valid or translated materials.


How do you establish language dominance? Which is preferred? 3

1 structured questionnaire (may lie on form because of what they think what is expected of them)
2 observation (watch the kids reaction to teachers and on the playground)
3 should have a conversation with child/parents


What is BICS and CALP (bilingualism)?

BICS = Basic Interpersonal Communication Skills (6 months training)
CALP = Cognitive Academic Language Proficiency (4-5 years training)


What are the requirements for an interpreter? 4

1 high school education (need critical thinking)
2 some experience in communication disorders (can observe me or have had services before)
3 good language and literacy skills (duh!)
4 recognition and interpretation of cultural cues


What should the interpreter be trained in?

1 rephrasing - don't add information to make it better for student
2 familiarity with our vocab - unintelligible doesn't mean unintelligent
3 HIPAA approved (don't let them share client details! siblings are problematic about this)


What do you need to do to modify a standardized test? 8

1 delete/modify items that are likely to be unfamiliar to the child
2 check vocabulary with the interpreter
3 review pictures for cultural sensitivity
4 review and reword instructions (forms of assistance; level of complexity)
5 provide additional practice items
6 provide additional response time
7 repeat instructions as necessary
8 write everything down