Speech Sound Disorders: Let`s Get Practical Part 1 Perspectives on

Transcription

Speech Sound Disorders:
Let’s Get Practical
MYERS-BRIGGS PERSONALITY-TYPES
http://www.humanmetrics.com/cgiwin/JTypes2.asp
Wayne A. Secord
The Ohio State University
Presented for the SHAA
March 2014
1
Phonological Disorders - Final Exam
Part 1
1.
Why do children make errors in their speech?
2.
Let’s say you were asked to develop a phonological screening
instrument and you could only use 10 processes. Which ones
would you choose and why?
3.
Imagine you have just assessed a four year old
child who is almost totally unintelligible.
Describe the top 10 questions you would ask to
understand her phonological disorder.
4.
You’ve just read an article entitled Phonological Disorders:
Toward a Key Components Approach . It describes the 10
most important phonological components to be addressed in
assessment and treatment. What are they? Why are they
important?
Perspectives on Intervention
Phonological Development
•
•
•
•
•
•
•
•
Foundations of Phonological Development
Understanding Key Phonological Terms
The First Year and Beyond
Sounds, Structures, Processes
Developmental Norms and Scales
What, Where and the Problem Solving Process
Key Phonological Components
Revised Scale of Phoneme Development
3
PHONETIC
PHONOLOGICAL
Phonetic Perspective
BASICS
Phonological Perspective
ASSESSMENT
• Stresses output at the
articulators
• An Emphasis on “system”
• Motor based
• Linguistic-cognitive basis
• Heavy behavioral
influence
• Heavy pragmatics influence
• Focus on meeting a
specific criterion
• Focus on communication
success
5
• Fill in the blank
• Whole word transcription
• Simplification all-ornone scoring
• Complicated scoring
• Phonemes are correct
or incorrect
• Score broad error patterns
6
1
PHONOLOGICAL
PHONETIC
PHONETIC
PHONOLOGICAL
INTERVENTION
• Perfecting phonemes
themselves
• Phonemes are targets:
• Generally shorter
assessment
• Generally longer
assessment
• Longer remediation
• Shorter remediation
• Patterns are:
Based on normative studies
Degree of visibility
Inconsistency & Stimulability
• Phonemes are trained in
steps
TIME
• Facilitate emergence of
patterns
Phonotactic
Feature driven
Related to speech inertia
FOR WHOM
• Phonemes are a means to
an end
• Mild-Moderate
• Severe - Profound
Isolation - Conversation
7
8
Phonology
Phonological
Formal Phonological Representation
Level
• Perceptual Representation
• Production Representation
Phonetic Level
• Auditory & Visual
Mechanisms
• Neurosensory System
• Speech, Respiratory,
& Phonatory
• Mechanisms
• PERCEPTION
• PRODUCTION
Phonological Processes
•
•
•
•
Patterns of Sound Change
Usually Simplifications
Approximations of the Adult Form
A “Problem Solving” Perspective
– Features
– Phonotactics
– Contextual Influences (Inertia)
Phonological Rules
•
•
•
•
•
Describe the Sound System of a Language
Describe the Permissible Segments
Describe the Allowable Syllable Structures
Describe Allophonic Variation
Describe How Sounds Combine for Meaning
Prelinguistic (1 Month - 1 Year
• Phonation Stage (Birth - 1 Month)
– Reflexive Vocalizations (Crying, burping)
– Nonreflexive (syllabic nasals/nasalized vowels)
• Goo Stage (2- 3 Months)
– Addition of back (velarlike) sounds to form
some kind of CV sequences
–These syllables are irregular and not adult-like
2
Phonological Development Continued...
• Canonical Babling Stage
(7 to 9 Months)
• Expansion Stage (4 to 6 Months)
– Often Called Period of Vocal Play
– Addition of Fully Resonant Nuclei
•
•
•
•
•
– Change in Timing of CV’s (MoreAdultlike)
– Babbling-Reduplications Mistaken as Words
• Stops, Nasals, Lax Vowels are common
• Sharp Place Shift (Decline in Velars)
• Results in Increase in Labials & Alveolars
Vowel-like elements
Raspberries (labial trills)
Squeals (high pitched sounds)
Growls (low pitched sounds & Yells
Similar to the Goo Stage but the timing is slower
and not adult-like.
• Variegated Babbling Stage (10 Mo. - 1 Yr.)
• 1 YEAR TO 1 YEAR 6 MONTHS STAGE
(The First 50 Word Period)
– Features Non-reduplicated syllables and a
– Wider Variety of Consonants & Vowels
– Children Produce Long Strings of Syllables
– Strings Often Referred to as Gibberish
– No Real Words Yet
– [p, b, t, d, k, g] ; [m, n] ; [w, j] ; [h, s]
– Phonologically .. First Words Characterized as:
• Simple Syllable Structure CV, VC, CVCV some (CVC)
• Sound Repertoire limited usually to:
– Stops, Nasals, Glides
– These Sounds Dominated Late Babbling Period
• Place of Articulation:
– Labials and Alveolars
– Preferred Vowels are: [i, a, u]
Representative Early Words
REPRESENTATIVE EARLY WORDS
Juice
Cookie
Baby
Bye-bye
Ball
Hi
Car
Water
Eye
Nose
Mama
DaDa
Doggie
Kitty
That
Dirty
Hot
Shoe
Hat
All gone
More
No
Up
Eat
Go
Do
Milk
Cap
•
Juice /du/
•
Cookie /tuti/
•
Baby /bibi/
•
• Mama /ma ma/
•
All gone /dn/
• Dada /da da/
•
More /mo/
Bye-bye /ba ba/
• Doggie /ddi/
•
No /no/
•
Ball /b/
Up /up/
•
•
Hi /ha/
• Kitty /tdi/
•
Eat //
Car /t/
•
•
• That /dæ/
Go /do/
Water /w w/
•
•
• Dirty /dudi/
Do /du/
•
Eye /a/
Milk /m/
•
•
Nose /nou/
• Hot /ha/
•
Cap /kæ/
• Shoe /tu/
• Hat /hæ/
From Owens, 2013
3
Phoneme Acquisition (as a rule!)
Continued
• Vowels are acquired by age 3
• Diphthongs are acquired by age 3 and 1/2
• Vocalic R (rhotacity) is acquired by 6 and 1/2
• After 1 and 1/2 Yrs: (Child’s 1st 50 Words)
–
–
–
–
Things Become More Systematic, Less Variability
A Significant and Ongoing Growth in Vocabulary
Phonetic Forms Gradually Match Their Adult Targets
Increased Vocabulary Forces the Child to Create a
Rule Governed System Based on Phonemes
– By Age 4, the Child has a Phonological System in
Which Most Phonemes are Established
• Manner of Articulation
• Place of Articulation
- Affricates
- Dentals
- Liquids
- Palatals
- Fricatives
- Velars
- Stops
- Alveolars
- Nasals
- Labials
• Word Position
- Across Words - Clusters
- Final
- Initial
• Great Individual Variation
20
Profile of Phonological Development
Phoneme Acquisition (as a rule!)
• Vowels are acquired by age 3
• Diphthongs are acquired by age 3 and 1/2
• Vocalic R (rhotacity) is acquired by 6 and 1/2
• Manner of Articulation
Stage I
(0;9 – 1;6)
Speech Sound Development by Stage
Stage II
(1;6 – 2;0)
• Place of Articulation
- Affricates
- Dentals
- Liquids
- Palatals
Stage III
(2;0 – 2;6)
- Fricatives
- Velars
- Stops
- Alveolars
- Nasals
- Labials
m
p b w
m
p b w
f v
Stage VI
(3;6 – 3;4)
(4;0 – 4;6)
- Initial
m
p b w
f v
Stage VII
(4;6 +)
• Great Individual Variation
Stage I
(0;9 – 1;6)
Stage II
(1;6 – 2;0)
Stage III
(2;0 – 2;6)
Stage IV
(2;6 – 3;0)
Stage V
(3;0 – 3;6)
Stage VI
(3;6 – 3;4)
(4;0 – 4;6)
Stage VII
(4;6 + )
Speech Sound Development by Stage
m
p b w

m
p b w
f
n
t d
s
(l)

m
p b w
f v
n
t d
s z
l (r)

n
t d
s z
l r

j

t d 
l (r)
n
t d t d 
s z

l r
k g
hhH
h H

k g
j hH
hhH
 k g
j hH
hhH
22
Common Phonological Rules
– Banana > /bnæn/ -> /næn/
n
t d
m
p b w
f v
n
t d
k g
h
• Weak Syllable Deletion
n
t d
m
p b w

n
t d
s z
21
Profile of Phonological Development
n
t d
s
(l)
f
Stage V
(3;0 – 3;6)
- Across Words - Clusters
n
t d
m
p b w
Stage IV
(2;6 – 3;0)
• Word Position
- Final
m
p b w
• Final Consonant Deletion (CVC -> CV)
k g
– Dog > /d/-> /d/
h
j
t d 
t d 

– Duck > /dk/ -> /d/
k g
hhH
h H

k g
j hH
• Reduplication (CVCV)
– Same Syllable - Water > /wa wa/; Mommy > /ma ma/
– Same Consonant - Doggie > /gcgi/ (diminutive)
– CVCV Construction - Duck > /dki/; Horse > /hti/
hhH
From Owens, 1988
 k g
j hH
hhH
23
4
• Velar & Palatal Fronting
• Consonant Harmony
- Cow /kau/ -> /tau/ --- Shoe > /u/ -> /su/
– Duck > /dk/ -> /k/ --- Gun > /n/ -> /nn/
- Go /o/ -> /do/ ----- Chair > /t/ -> /ts/
• Cluster Reduction
• Gliding
– Stop > /ta/ or /tap/; Tree > /ti/
– Lamp > /læmp/ -> /wæmp/
– Scratch > /skræt/ > /kæt/ -- East -> /it/
– Right > /rat/ -> /wat
• Context Sensitive Voicing
• Stopping
– Prevocalic Voicing > /kp/ > /p/
- Shoe > /u/ -> /tu/ ---- fine > /fan/ -> /pan/
– Postvocalic Devoicing > /bd/ > /bt/
From Owens, 1988
Chronology of Phonological Processes
2;0 – 2;6
2;6 – 3;0
3;0 – 3;6
3;6 – 4;0
4;0 – 4;6
4;6 – 5;0
Syllable Structure Development
5;0 +
Weak Syllable Deletion
Final Consonant Deletion
Reduplication
Consonant Harmony
Cluster Reduction
- obstruent +
- /s/ consonant
Stopping
/
Fronting /k, g,
Gliding /r/
/f/
/v/
/ /
/ /
/s/
/z/
/ /
, /
Stage I
Stage II
CV (ma), CVCV (mama), (CVC) (mom)
Stage III
Stage IV
CV (ma), CVCV(CV) (mama), (CVC) (mom)
(CVCCV) (misty), (CVCCVC) (biscuit)
Stage V
Stage VI
CV (ma), CVCV (mama), CVC (mom),
CVCCV (misty), CVCCVC (biscuit),
CVCVCV (puppy go), etc.
Stage VII
CCV (ski), CCVC (skip), CVCC (socks),
CCVCC (spoons), etc.
/
/w/
Context-Sensitive Voicing
27
28
Representative Early Words
REPRESENTATIVE EARLY WORDS
Juice
Cookie
Baby
Bye-bye
Ball
Hi
Car
Water
Eye
Nose
Mama
DaDa
Doggie
Kitty
That
Dirty
Hot
Shoe
Hat
All gone
More
No
Up
Eat
Go
Do
Milk
Cap
•
Juice /du/
•
Cookie /tuti/
•
Baby /bibi/
•
Bye-bye /ba ba/
• Doggie /ddi/
•
Ball /b/
•
Hi /ha/
• Kitty /tdi/
•
Car /t/
•
• Mama /ma ma/
•
All gone /dn/
• Dada /da da/
•
More /mo/
•
No /no/
•
Up /up/
•
Eat //
• That /dæ/
•
Go /do/
Water /w w/
• Dirty /dudi/
•
Do /du/
•
Eye /a/
Milk /m/
•
Nose /nou/
• Hot /ha/
•
•
Cap /kæ/
• Shoe /tu/
• Hat /hæ/
29
From Owens, 2013
5
Phonological Disorders in Children
Phonological Disorders in Children
Top 10 Targets to Assess & Treat
Top 10 Things to Assess & Treat
FIRST PRIORITY COMPONENTS (1-5)
SECOND PRIORITY COMPONENTS (6-10)
•
•
•
Simple syllables (CV, VC)
Syllables with final consonants (CVC)
Front vs. back of mouth differences (Alveolars-Velars)
•
Acquisition of stridency (/s/, /f/, //, etc)
•
Glides vs. liquids (/w/ or /j/ for /r/ or /l/)
•
•
•
•
•
Syllables with initial clusters (CCV, CCVC)
Syllables with final clusters (CVCC, CCVCC)
Middle of the Mouth Productions (Palatal)
Voicing contrasts
Syllabic consonant contrasts
- “Vocalic R” and /l/ -> /o/
Assimilations – Consonant Harmony problems
31
Stages of Development
32
Stages of Development
Birth to 12 Months
2 - 5 Years
 Speech is well established
 Cooing and Babbling
 Trouble saying entire sound classes
 Vocal Practice
 Emergence of Processes
 Vocalizations Rarely Referential
 “Problem Solving” period
12 – 24 Months
> 5 Years
 Speech Replaces gestures
 Speech = Speech Community
 Vocalizations for communication
 Some sounds not developed
 Creation of early vocabulary
 Some cluster problems remain
 Emergence of first sounds/syllables
33
 Problems with unstressed syllables
34
INTERVENTION
Birth to 12 Months

Facilitate practice of vocal skills that serve as the basis for later
speech development
12 – 24 Months

Facilitate the acquisition of sounds and syllables in specific
words
2 - 5 Years

Facilitate the elimination of errors affecting whole or partial
sound classes
> 5 Years

Eliminate errors on late developing consonants, clusters, and
unstressed syllables in multisyllabic words
35
36
6
Age of Customary Production and Mastery
of Consonant Sounds
Age
Phoneme
3.0
p, m, n, , f,w, h
3.6
4.0
j
b, k, g, r, d
4.6
s, , t,
5.0
6.0
t, l, , v
7.0
, z, , d
From C. Stoel-Gammon and C. Dunn (1985)
Age of Customary Production and Mastery
of Consonant Sounds
Age
< 2.0
Customary Production
p, b, m, n, w, h
Mastery
> 2.0
t, d, k, g, 
> 3.0
f, s, l, r, j
p, m, n, w, h
> 4.0
v, z, , t, d
b, d, k, g, f, j
> 5.0
, 
> 6.0

Revised Scale of Phoneme Acquisition
Hodson (1997)
12 – 18 Months
– Recognizable Words
– Consonant-Vowel (CV) Word Structures
– Stops (/p, b, t, d, k, g/), Nasals /m, n, /
– Glides (/w/, /j/ in CV structures
18 – 24 Months
t, , r, l
> 7.0
, , t, d
> 8.0
v, , s, z
– Communication with Words
– Syllableness (CVCV and VCV)
– Word-Final Consonants (VC and CVC)
From C. Stoel-Gammon and C. Dunn (1985)
40
4 – 5 Years
2 – 3 years
– Contrasts and rapid expansion of phonemic
repertoire
– Posterior/Anterior contrasts
– (Velars - /k, g/ to alveolars - /t, d/)
– (Beginning to produce contrasts in CVC context –
more motorically correct)
– Stridents (s, z, , t, j, , f, v, s clusters)
– Approximately 80% intelligible
3 – 4 years
– “Adult like” speech
– Omissions of consonants are rare
– Simplification processes (e.g., stopping) suppressed
41
– Liquids acquired
– /l/ 3 – 5 years including l clusters
– /r/ 3 – 6 years including r clusters
5 – 6 Years
– Stabilization of phonetic/phonemic inventory
– All phones and allophones
– Produced within “intelligible" limits
6 – 7 Years
– Adult standard speech
– Sibilants perfected
• (i.e., without lisps)
42
7
Speech Sound Disorders:
Let’s Get Practical
Assessment and Intervention
Gathering a Phonetic Inventory
Assessment Procedures & Materials
Top 10 Questions?
•  Sounds used correctly
•  Sounds used correctly in some contexts
•  Sounds that appear but are never
produced correctly
•  Sounds that never appear
WAYNE A. SECORD
SHAA 2014
• 2
Top 10 questions to ask about a
phonological sample!
3. What is the child doing to the sounds he doesn’t
have (what’s the most obvious)?
-  Review the errors from question 2
1. What sounds can the child say meaningfully?
-  In most (all) contexts?
-  Consider these “in” the system
-  In some contexts inconsistently?
-  Consider these sounds “emerging”
2. What sounds are not said meaningfully in most
contexts? (What doesn’t he have?)
-  Consider these “absent” from the system
4. Does the child present deletions?
-  Initial sounds?
-  Sounds in clusters?
-  Final sounds?
-  Whole syllables?
• 3
• 4
5.
6. 
Does the child substitute sounds?
-  Do the substitutions affect whole classes
of sounds?
-  Do they affect partial classes of sounds?
Does the child have contextual errors?
-  Voicing substitutions
-  Assimilation substitutions
-  Resonance effects
• 5
7. 
ARE THERE ANY KEY COMPONENTS INVOLVED?
First Priority Components
• 
• 
• 
Front vs. back of mouth differences
(Alveolars/velars)
• 
Acquisition of stridency (/s/, /f/, /S/, etc)
• 
• 6
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©2014 Super Duper® Publications
1
7. 
ARE THERE ANY KEY COMPONENTS INVOLVED?
Second Priority Components
• 
Syllables with initial clusters (CCV, CCVC)
• 
Syllables with final clusters (CVCC, CCVCC)
• 
Front vs. back (middle) of mouth differences
(alveolars/palatals)
• 
Voicing contrasts
• 
Syllabic consonant contrasts
- “vocalic R” - /l/ -> /o/
- Consonant Harmony problems
8. Do you need additional information?
-  Phoneme probes?
-  Consistency information
-  Facilitation contexts
-  Process probes?
-  Process occurrence
-  Process differentiation
9. Fine Tuning Influences?
-  Stimulability
-  Frequency of occurrence information
-  Oral/motor considerations
• 7
• 8
• Top 10 Questions To Ask About a Phonological Sample
1. What sounds can the child say contrastively (meaningfully)?
2. What sounds are not produced meaningfully (not in the system)?
10. What does the system need the most?
THE BILLY CRYSTAL QUESTION !
-  What treatment target (s) will
energize the child’s phonological
system?
3. What’s he doing to what he doesn’t have?
4. Does the child have deletions (initial-final sounds, clusters, whole syllables)?
5. Does the child substitute sounds?
6. Does the child have contextual errors such as assimilations, voicing errors or
resonance effects?
7. Are any of the “Key” Components affected (Top-10 Components)
AND TOP-10
REVIEW ->
8. Do you need additional information from phoneme or process probes?
9. Fine Tuning Influences (stimulability, oral exam, sound frequence)?
10. The Billy Crystal Question
• 9
• 10
Top-10 Targets to Assess & Treat
FIRST PRIORITY COMPONENTS (1-5)
1.
2.
3.
4.
5.
Front vs. back of mouth (Alveolars-Velars)
Acquisition of stridency (/s/, /f/, /S/, etc)
SECOND PRIORITY COMPONENTS (6-10)
6. Syllables with initial clusters (CCV, CCVC)
7. Syllables with final clusters (CVCC, CCVCC)
8. Middle of the Mouth Productions (Palatal)
9. Voicing contrasts
10. Vocalic R - /l/ -> /o/; Consonant Harmony Issues
• 11
2
PCC
(Percentage of Consonants Correct)
Prognostic Factors
• 
• 
• 
• 
• 
• 
• 
• 
Stimulability
Consistency
Types of errors
Frequency of occurrence - See Table 1-1
Sensory – perceptual skills
% of consonants correct
Overall intelligibility
CA vs. DA
OTHER
• 
• 
• 
• 
Family income level
Intellectual ability
Motor ability
Multiple intervention agents
Formula
Total Number of
Correct Consonants
Total Number of
Intended Consonants
X 100 = PCC
Level of Severity
•  85% +
=
Normal Development
•  65-86%
=
Mild to Moderate
•  50-65%
=
Moderate to Severe
•  <50%
=
Severe
• 15
Short Term Goals
Long Term Goals
STAGES 1 - 3
• Articulation and phonological development will be
appropriate for the child’s chronological or
developmental age.
–  Norms
–  Stages of development
–  Speech intelligibility
–  Severity of involvement
STAGE 4
• Eliminate errors that adversely impact social, emotional or
educational development.
–  Observation
–  Parent interview
STAGE 1
• 
• 
Increase opportunities to vocalize
Facilitate more advanced vocalizations
STAGES 2 & 3
• 
• 
• 
• 
Reduce Homonym confusions
Reduce variability in production
Maximize established speech abilities
Eliminate errors affecting sound classes
• 
• 
• 
Facilitate late-acquired consonants
Facilitate consonant clusters
Facilitate unstressed syllables
STAGE 4
3
Sample IEP
Sample IEP Continued
Present Level of Performance
Instructional Objectives Continued
• Susan’s speech is difficult to understand in conversation having
an overall intelligibility of approximately 50%.
• Process Specific Objectives:
Annual Goals
1. 
• Susan will increase her overall intelligibility in conversation to
80% and in structured storytelling to 85%.
Instructional Objectives
2. 
• Phoneme Specific Objectives:
1. Increase accuracy and fluency of /s/ in connected speech
to 75%.
Achieve a significant reduction in the deletion of final
consonants
• 
Fricatives from 80% to 25%
• 
Affricates from 70% to 25%
Achieve a significant reduction in gliding
• 
/l/ from 90% to 30%
• 
/r/ from 88% to 30%
2. Increase accuracy and fluency of /z/ in connected speech
to 75%.
Clinical Assessment of
Articulation and Phonology
Disclosure Statements
(CAAP®-2)
The presenter is an author for Super Duper
Publications and receives royalty income from the
CAAP, CAAP-2, and CAAP-2 “APP.” He also
receives royalty income from S-CAT to be
discussed later on in this presentation.
Created by: Wayne A. Secord, Ph.D., CCC-SLP
JoAnn S. Donohue, M.A., CCC-SLP
Super Duper Publications has developed the
assessment trademarked as the CAAP-2. This part
of the presentation will focus primarily on the
CAAP-2. and the S-CAT.
Super Duper Resource:
Clint Johnson, M.A., CCC-SLP
Administer, Scoring Clinical Interpretation
Articulation/Phonology:
Impact on Education
Why Do We Assess?
Determine
Eligibility
Differential
Diagnosis
Ascertain
Progress
End
Treatment
• 
Intelligibility and speaker pitch appear to be variables
that influence a teacher’s expectations of student’s
academic, social, and behavioral performance. Overby,
Carrell, & Bernthal, 2007)
• 
Children with speech sound disorders are at risk for
having delayed phonological awareness skills if they
have poor speech perception abilities and/or relatively
poor receptive vocabulary.
(Rvachew & Grawburg, 2006)
4
Impact on Education
Impact on Education
Common Core State Standards
for English Language Arts: Speaking & Listening
Common Core State Standards for English Language Arts:
Speaking & Listening
Kindergarten: CCSS.ELA-Literacy.SL.K.6 Speak audibly and express
thoughts, feelings, and ideas clearly.
Grade 1: CCSS.ELA-Literacy.SL.1.4 Describe people, places, things,
and events with relevant details, expressing ideas and feelings clearly.
Grade 2: CCSS.ELA-Literacy.SL.2.4 Tell a story or recount an
experience with appropriate facts and relevant, descriptive details,
speaking audibly in coherent sentences.
Grade 3: CCSS.ELA-Literacy.SL.3.4 Report on a topic or text, tell a
story, or recount an experience with appropriate facts and relevant,
descriptive details, speaking clearly at an understandable pace.
Common Core State Standards English Language Arts, 2010
Grade 4: CCSS.ELA-Literacy.SL.4.4 Report on a topic or text, tell a
story, or recount an experience in an organized manner, using
appropriate facts and relevant, descriptive details to support main ideas
or themes; speak clearly at an understandable pace.
Grade 5: CCSS.ELA-Literacy.SL.5.4 Report on a topic or text or present
an opinion, sequencing ideas logically and using appropriate facts and
relevant, descriptive details to support main ideas or themes; speak
clearly at an understandable pace.
Grade 6: CCSS.ELA-Literacy.SL.6.4 Present claims and findings,
sequencing ideas logically and using pertinent descriptions, facts, and
details to accentuate main ideas or themes; use appropriate eye contact,
adequate volume, and clear pronunciation.
Common Core State Standards English Language Arts, 2010
Phonology/Articulation in the
School Setting
A Thorough and Efficient
Articulation Assessment Should:
From ASHA
“If acquisition of adequate and appropriate communication skills
are a required part of your school's academic standards and
curriculum and considered to be a basic skill necessary for all
children attending school, then children with a speech or
language impairment have a disorder that adversely affects
educational performance. Although state or local school
education agencies may apply different interpretations to
"adversely affects educational performance," they cannot deny
a child with a speech or language impairment services under
IDEA just because they do not have a discrepancy in age/grade
performance in an academic subject-matter area.”
•  Assess production of all English consonants.
•  Assess consonants in increasingly complex
contexts.
•  Differentiate an articulation impairment from a
phonological impairment.
•  Differentiate motor production from motor
planning.
Dublinske, S. “Adversely Affects Educational Performance” Policy 1980-2002;
Nothing Has Changed.”
Retrieved from: http://www.asha.org/SLP/schools/prof-consult/adverselyaffects/
Clinical Assessment of Articulation
and Phonology – 2nd Edition
(CAAP-2®)
•  Ages 2;6 – 11;11
•  Norm referenced (provides standard scores,
percentile ranks, age equivalents)
•  Assesses articulation and phonology
•  15-20 minutes to administer
•  Checklist approach to assessing phonological
processes virtually eliminates need for phonetic
transcription
•  Available in traditional print form or via iPad®
Why Develop the CAAP-2®?
• 
Re-norm the assessment to reflect current U.S.
census data.
• 
Extend the age limits of CAAP to 11;11.
• 
Discontinue the use of the error difference score.
• 
Include children with speech delays and
differences in the sample (n=7%).
• 
Update the stimulus picture “computer.”
• 
Run new validity and reliability studies.
•  Create an iPad® app that automatically
generates scores.
5
CAAP-2 Technical Characteristics
•  Sample Size: 1,486 children between the ages of
2;6 and 11;11; closely resembles 2013 U.S.
Census Data.
•  Test-retest correlations were significant beyond
p<.01 for raw scores, standard scores, and
percentile ranks.
•  Concurrent validity comparing CAAP-2 to the
GFTA-2 and the KLPA-2 were beyond p<.01 for all
raw scores, standard scores, and percentile
ranks.
•  Inter-examiner reliability coefficients were
perfect (1.00) for Articulation Inventory and
above .99 for the Phonological Process
Checklist.
What Does the CAAP-2® Assess?
Articulation Inventory (continued):
•  Most consonant sounds are tested twice – once in
initial position and once in final position; a few
sounds are tested twice in initial position or twice
in final position if the sound does not commonly
occur in both positions.
•  Three sections: Consonant Singletons,
Cluster Words, Multisyllabic Words.
•  Includes an optional introductory story to increase
attention and act as a “warm-up” activity before
beginning the actual assessment.
Articulation Inventory:
•  Pre- and postvocalic consonant singletons
•  Cluster words containing S, R, and L in the initial
position
•  Three- and four-syllable words
•  Postvocalic productions of R
•  Production of sounds in sentences
(for children 5 years and older)
Phonological Process Checklists:
•  Final Consonant
Deletion
•  Cluster Reduction
•  Syllable Reduction
•  Gliding
•  Vocalization
•  Fronting
(velar & palatal)
•  Deaffrication
•  Stopping
•  Prevocalic Voicing
•  Postvocalic Devoicing
Upgrade from CAAP
To upgrade from CAAP to CAAP-2, all you
need are:
•  New CAAP-2 Articulation Inventory Forms
CAAP®-2
• 
• 
• 
• 
• 
• 
Kit Includes
Examiner's Manual
Stimulus Easel
50 Articulation Inventory Record Forms
30 Phonological Process Record Forms
5 colorful, foam, 4” CAAP® Pals
Tote bag!
•  New CAAP-2 Phonological Process
Checklist Forms
•  New CAAP-2 Examiner’s Manual
(Use the Stimulus Easel, CAAP Pals, and
tote bag you already have!)
6
CAAP-2 App for iPad®
CAAP-2 App for iPad®
•  Purchase the app from the
•  Integrated age calculator
•  Use paper Articulation Inventory Forms:
•  Electronic stimulus pictures
- Purchase in-app & print from your iPad
or
- Purchase from Super Duper Publications
•  No need for paper Phonological Process
Checklist – the Phonological Process
Checklist is built into the CAAP-2 app!
•  Automatic calculation of Standard Scores,
Percentiles, Age Equivalents
•  Generate Phonology Scores directly from
the Articulation Inventory
•  Email or print summary reports
•  Electronic Examiner’s Manual in the app
Administering the CAAP-2
Print Edition
Consonant Inventory:
Optional Story (Print Edition)
Child looks at easel
pictures and
examiner reads the
story to the child.
Note:
Examiner says:
Examiner points to CAAP® Pals as named.
Some days, Elba and Mack look at
books together. Mack likes to point to
the pictures and say what he sees.
Elba loves to listen. Mack says, “That’s a
train, and that’s a fire truck.”
Elba and Mack want you to be their friend
and look at some pictures with them.
After you look at each picture, you say what
you see. Elba and Mack will listen to you.
Plate C
11
Consonant Inventory
(Print Edition)
(Print Edition)
Plate 4
Examiner says, “What is this?”
Dog /dͻg/
Prompt: “It says, ‘Woof, woof.’”
If pictures fails to elicit the correct response, give the prompt.
Examiner says, “It says, ‘Quack.’”
If child does not response correctly following prompt, say the target
word and have the child repeat it.
Examiner says, “Say, ‘Duck.’”
Plate 37
Dinosaur /daɪnǝsͻɚ/
Prompt: “It is a large animal
that lived a long time ago.”
7
Consonant Inventory
(Print Edition)
School-Age Sentences
(Print Edition)
•  For children ages 5;0 to 11;11.
•  Articulation accuracy in sentences that vary in
length (8 to 11 words) and complexity (number of
syllables in the word, word shape, quasi-clusters
at word junctures, later developing sounds and
frequently occurring sounds, etc.).
•  May compare to Consonant Inventory. Some
children who experience difficulty in speech
motor planning may perform poorer on the
sentences than expected.
•  Child repeats eight sentences. Examiner may
give two repetitions per sentence.
(Print Edition)
(Print Edition)
Examiner says: Say all the words I say.
“The elephant plays her favorite computer game.”
If the child does not say all of the words, say the sentence
again and have the child repeat it.
Examiner says: Remember to say all of the words. Say, “The
elephant plays her favorite computer game.”
(Print Edition)
Transfer scores to
the front of the
Response Form.
Look up Standard
Scores, Confidence
Intervals, Percentile
Ranks, and Age
Equivalents in the
Norms Tables in the
Examiner’s Manual
(pp. 76-93).
CAAP-2
Phonological Process Checklists
Uses a Checklist approach to assess occurrence of
ten common phonological processes.
Two types of scores:
•  Simple percentage of occurrence (if process is
≥ 40% then that process is “active”).
•  Standard scores (mean = 100; s.d. = 15).
Note: Only use phonology standard score if child
has at least one process with a percentage of
occurrence that is 40% or greater.
8
CAAP-2:
Phonological Process
Checklists
Ten phonological processes evaluated:
•  Final Consonant
Deletion
•  Cluster Reduction
•  Syllable Reduction
•  Gliding
•  Vocalization
•  Fronting
(Velar & Palatal)
•  Deaffrication
•  Stopping
•  Prevocalic Voicing
•  Postvocalic Devoicing
Phonological Process Checklist I
(Print Edition)
Transfer information from Articulation
Inventory to the Checklist.
CAAP-2
Phonological Process
Checklists
Checklist I used to analyze process patterns
based on child’s responses on the Articulation
Inventory. It is done after the testing is finished.
Checklist II (print version only) permits an active
assessment of child’s phonological process
patterns. Administer plates 45-69 and score the
child’s sound changes as they happen.
Phonological Process Checklist I
(Print Edition)
•  Transfer # of yes
responses and % of
occurrence to front
page of test form.
•  Total number of “yes”
responses.
•  Look up Standard
Score, Percentile rank,
and Age Equivalent in
the Norms Tables in
the Examiner’s Manual
(pp. 103-114).
Administering the CAAP-2
App Edition
(App Edition)
• Use a printed Articulation Response Form to record response.
or
• Purchase in app and print from iPad or order from Super
Duper Publications.
9
(App Edition)
Consonant Inventory
On home page, tap Consonant Inventory to begin.
Enter student’s name and birth date.
Select options (Record Audio and/or Show Story Slides).
Tap “Start” to begin.
Consonant Inventory
(App Edition)
Consonant Inventory:
Optional Story
(App Edition)
If the “Show Story Slides” option is enabled, story pictures are
presented and the prerecorded story is “read” to the student by the
iPad.
Then, Swipe to the next item.
Consonant Inventory
(App Edition)
If pictures fails to elicit the
correct response, give the
prompt or tap to have the iPad
give the prompt.
Examiner or iPad says, “A bird
can live here.”
If child does not respond
correctly following prompt, say
the target word and have the
child repeat it.
Examiner says, “Say, ‘Cage.’”
• Write responses on the record form, even if recording audio in the app.
• Tap the picture to have the additional prompt presented.
• Swipe to next item.
(App Edition)
•  Tap School-Age Sentences on home screen.
•  Enter student’s name, birth date, selection options (Record Audio, Show
Story Slides), and tap Start.
•  Picture is presented on iPad. Examiner presents sentence, and student
repeats sentence. If the child does not say all of the words, say the
sentence again and have the child repeat it.
•  Mark any words with errors on paper record form.
Scoring the CAAP-2 App Edition
• 
•  Tap “Score” on home page.
•  Tap “Load Student” to have Birth Date and Test Date entered from
saved files or tap Birth Date and Test Date to enter information.
•  Tap “Score” to enter sound errors made.
10
Scoring the Consonant Inventory
App Edition
• On Enter Results screen,
tap on the target sound that
was produced in error.
Scoring School-Age Sentences
App Edition
• Tap Score from
scoring screen.
• Tap on the word to listen to
the audio recording of child
as needed.
• Tap on words that
contained an error or
were omitted.
• Tap on substituted sound
or omission, distortion, or
other.
• Once errors are
entered, tap Submit
Score.
• Once errors are entered,
tap Submit Score.
Scoring CAAP-2 App Edition
CAAP-2 App Edition Summary Report
Chronological age, raw
score, standard score,
confidence interval,
percentile rank, and
age equivalent scores
are automatically
calculated after errors
are entered.
Tap “View/Print Summary” to view a summary of all results,
including the Phonological Process results!
Reliability of Administering
Stimulus Items Via the iPad
•  Multiple studies regarding reliability of
presenting stimulus items digitally via
iPad or computer have been conducted.
•  Study results indicate test reliability does
not change when stimulus items are
delivered electronically.
(Bowers & Husingh, 2011; Strait et al., 2013;
Waite et al., 2013)
Test Interpretation:
The Articulation Inventory
•  Step 1: Finalize All Record Form Information
and Test Scores
•  Step 2: Complete the Consonant Singleton
Summary and Consonant Singleton Index
(completed automatically in the app edition)
•  Step 3: Review the Developmental Age Norms
•  Step 4: Analyze Performance on School-Age
Sentences
•  Step 5: Other Considerations and Observations
  Rate Speech Intelligibility
  Other Observations
11
Step 8 (Details)
Phonological Process Data
First Priority
•  Simple syllables (CV, VC)
•  Syllables with final consonants (CVC)
•  Front vs. back of mouth differences (alveolars/velars)
•  Acquisition of stridency (/s/, /f/, “sh”, etc.)
•  Glides vs. liquids (/w/ or /j/ for /r/ or /l/)
•  Step 6: Finalize all checklist information and
percentages (completed automatically in app
edition)
•  Step 7: Identify active processes (identified
automatically in app edition)
•  Step 8: Focus on Phonological Processes that
may hinder the development of key contrastive
features
Second Priority
•  Syllables with initial clusters (CCV, CCVC)
•  Syllables with final clusters (CVCC, CCVCC)
•  Front vs. back (middle) of mouth differences
(alveolars/palatals)
•  Voicing contrasts
•  Syllabic consonant contrasts
  rhoticity, “vocalic R”
  /l/ vs. /o/ tied with assimilations – harmony problems
Phonological Process Data
•  Step 9: Tie up loose ends
•  Step 10: Define the big picture:
  Review all test scores and determine severity.
  Determine what speech sounds are produced
in error.
  Determine what characteristics of the child’s
speech you notice the most.
  Review error types and patterns.
  Determine if additional information is needed.
  Make recommendations.
Refer to Examiner’s Manual pp. 45-60 for details on the
authors’ Ten-Step Test Interpretation Process.
S-CAT
< C-PAC
TWCT >
Additional Resources
Additional resources in the Appendices of the
Examiner’s Manual (pp. 119-132) and at
www.superduperinc.com/CAAP/append:
• 
• 
• 
• 
• 
• 
• 
Stridency Deletion Checklist
Initial Consonant Deletion Checklist
Backing Checklist
Consonant Harmony Checklist
Stimulability Assessment
Summary Tables for /s/, /l/, /r/, and /ɚ/
Vowel Checklist
CPAC Phoneme Probes
• Consonant Sound Probes
• Pretest and Post-test
• All Consonant Sounds-Except /zh/ PostTest Only
• Vocalic /r/
• All Vowel Sounds
< S-PAC
• All Diphthongs
• 72
12
S-CAT
•  Sample Consonant Phoneme Probes
•  Summary of Contexts Assessed by S-CAT
•  What are facilitating contexts and Why?
•  Flowchart for Extension Testing
•  Process Probes
• 76
Recording Responses on the S-CAT
Traditional Scoring Notation
Error
Record
• Distortion
“x”
• Substitution
• Omission
• Addition
Substituted phone
“-”
Phonetic Contexts Assessed by CPAC
Consonant Probes - /s/ probe examples
Prevocalic Singleton
Functioning before a vowel in a syllable
seen
saw
“ + ” and added phone
13
Postvocalic Singleton
Prevocalic Cluster
Functioning after a vowel in a syllable
peace
dice
Postvocalic Cluster
Two consonants functioning primarily as one
before a vowel in a one-syllable word or
context
spoon
stamp
Prevocalic Quasi-Cluster (Syllable Juncture)
Two consonants functioning primarily as one
after a vowel in a one-syllable word or
context
wasp
lost
Functioning within a word before a vowel in the
second syllable, adjacent to a postvocalic consonant
in the first syllable of a two-syllable word
knapsack
outside
Prevocalic Quasi-Cluster (Word Juncture)
Postvocalic Quasi-Cluster (Word Juncture)
Functioning across words before a vowel in
the second word, adjacent to a postvocalic
consonant in the first word
Functioning across words after the vowel in
the first word, adjacent to a prevocalic
consonant in the second word.
rib soup
road sign
face down
toss good
14
Facilitating Contexts
WHY?
Postvocalic Quasi-Cluster (Syllable Juncture)
•  A CONTEXT may be facilitating because it minimally
interferes or competes with the error.
–  For example: /sp/ is good for /s/ because the
sounds share few features
or
•  A CONTEXT may be facilitating because it contains
similarities between the error sound and its phonetic
neighbors.
–  For example /s/ and /t/ have similar features,
hence /st/ is a facilitating context
Functioning with a word after a vowel in the
first syllable, adjacent to a prevocalic
consonant in the second syllable of a twosyllable word.
whisper
rooster
CPAC Process Probes
Type
Probe
Syllable Structure Processes
• 
• 
• 
• 
Initial Consonant Deletion (ICD)
Final Consonant Deletion (FCD)
Cluster Reduction (CR)
Syllable Reduction (SR)
CPAC Process Probes
Probe
Number
• Type
• Probe
•  Assimilation Processes
•  Prevocalic Voicing (PV)
•  Postvocalic Devoicing (PD)
•  Consonant Harmony (CH)
1
2
3
4
• Probe
Number
12
13
14
Substitution Processes
• 
• 
• 
• 
• 
• 
• 
• 
• 
Gliding (GL)
Vocalization (VO)
Fronting (FR) of Velars (FV)
Fronting (FR) of Palatals (FP)
Backing (BK)
Stopping (ST)
Stridency Deletion (SD)
Affrication (AF)
Deaffrication (DF)
5
6
7
7
8
9
10
11
11
• 87
• 88
• 89
• 90
15
• 91
• 92
• 93
• 94
• 95
• 96
16
• 97
• 98
• 99
• 100
Questions?
[email protected]
Intervention for Speech Sound Disorders
A Top-10 Approach
• 
Part 3 - Next
17

Speech Sound Disorders: Let`s Get Practical Part 1 Perspectives on

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