Assessment

When a child is referred to see a Speech Pathologist, it is typically because the parent or another important person in that child’s life (e.g. relative, educator) is concerned about the child’s communication skills.

Purpose

An assessment is conducted in order to get a comprehensive picture of a child’s communication skills and to determine the impact of any difficulties on the child’s everyday life.

If the assessment confirms a disorder in any area of communication (e.g. language, speech, voice stuttering, etc.) the assessment results will be used to guide treatment recommendations.

How we conduct assessments:

We individualise every assessment because each child is unique.

We will tailor the assessment based on factors including: your child’s age; linguistic background; any diagnoses; background history; your concerns, values and priorities, and the severity of the suspected problem.

We conduct the assessment in order to better understand your child’s:

  • strengths and abilities
  • difficulties
  • interests

These are some of the ways that we collect information as part of a comprehensive assessment:

Questionnaires and interviews

Prior to attending your first session, we will ask you to complete a questionnaire to gain background information about your child including their: developmental history; medical history; languages spoken; interests and preferences, etc.

We will discuss your answers with you during your initial visit to clarify any information.

We will ask you questions about your perception of the problem, your values and your expectations of this service.

We may request your permission to send a questionnaire or to interview your child’s teacher or educator, if this is relevant.

The information that we collect from interviews and questionnaires supplements the results of any test, which, although important, only gives us a “snapshot” of your child’s performance on one day.

Standardised testing

This is otherwise known as “formal testing”. To be valid, standardised tests must be carried out according to strict rules. Standardised tests are either:

Norm-referenced: they compare your child’s test result to the results of other children of the same age, who completed the assessment under the same conditions

or

Criterion-referenced: they compare your child’s results to certain criteria, such as: ability to use a particular grammatical form

Language sampling

We may collect a sample of your child’s language while they play or while they retell a story. These kinds of language samples are very informative because they reflect how your child normally communicates in these typical activities. Language sampling complements findings from other tests conducted.

Non-standardised testing

We may use other tests to investigate your child’s specific areas of difficulty in greater depth. This is useful for prioritising goals and it allows us to collect base-line data.

Oral Musculature Assessment (OMA)

We will evaluate the appearance and movement of your child’s oral structures (e.g. teeth, lips, tongue, hard palate, soft palate). It is important to rule out any issues with the structures we use for talking in the assessment phase.

Observation

If you are concerned about your child’s ability to participate socially or academically at their educational setting (e.g., preschool, school) we may ask your permission to observe your child in this setting. This will allow us to collect data and to see exactly how your child’s communication difficulties impact on their ability to participate in this other environment.

Client self-evaluation

This is mainly used with older children who can reflect on their difficulties and who can articulate their goals. It is important for the older child to be included in the assessment process to voice their concerns and preferences.



Assessment

When a child is referred to see a Speech Pathologist, it is typically because the parent or another important person in that child’s life (e.g. relative, educator) is concerned about the child’s communication skills.

Purpose

An assessment is conducted in order to get a comprehensive picture of a child’s communication skills and to determine the impact of any difficulties on the child’s everyday life.

If the assessment confirms a disorder in any area of communication (e.g. language, speech, voice stuttering, etc.) the assessment results will be used to guide treatment recommendations.

How we conduct assessments:

We individualise every assessment because each child is unique.

We will tailor the assessment based on factors including: your child’s age; linguistic background; any diagnoses; background history; your concerns, values and priorities, and the severity of the suspected problem.

We conduct the assessment in order to better understand your child’s:

  • strengths and abilities
  • difficulties
  • interests

These are some of the ways that we collect information as part of a comprehensive assessment:

Questionnaires and interviews

Prior to attending your first session, we will ask you to complete a questionnaire to gain background information about your child including their: developmental history; medical history; languages spoken; interests and preferences, etc.

We will discuss your answers with you during your initial visit to clarify any information.

We will ask you questions about your perception of the problem, your values and your expectations of this service.

We may request your permission to send a questionnaire or to interview your child’s teacher or educator, if this is relevant.

The information that we collect from interviews and questionnaires supplements the results of any test, which, although important, only gives us a “snapshot” of your child’s performance on one day.

Standardised testing

This is otherwise known as “formal testing”. To be valid, standardised tests must be carried out according to strict rules. Standardised tests are either:

Norm-referenced: they compare your child’s test result to the results of other children of the same age, who completed the assessment under the same conditions

or

Criterion-referenced: they compare your child’s results to certain criteria, such as: ability to use a particular grammatical form

Language sampling

We may collect a sample of your child’s language while they play or while they retell a story. These kinds of language samples are very informative because they reflect how your child normally communicates in these typical activities. Language sampling complements findings from other tests conducted.

Non-standardised testing

We may use other tests to investigate your child’s specific areas of difficulty in greater depth. This is useful for prioritising goals and it allows us to collect base-line data.

Oral Musculature Assessment (OMA)

We will evaluate the appearance and movement of your child’s oral structures (e.g. teeth, lips, tongue, hard palate, soft palate). It is important to rule out any issues with the structures we use for talking in the assessment phase.

Observation

If you are concerned about your child’s ability to participate socially or academically at their educational setting (e.g., preschool, school) we may ask your permission to observe your child in this setting. This will allow us to collect data and to see exactly how your child’s communication difficulties impact on their ability to participate in this other environment.

Client self-evaluation

This is mainly used with older children who can reflect on their difficulties and who can articulate their goals. It is important for the older child to be included in the assessment process to voice their concerns and preferences.

Therapy

When?

Depending on your child’s goals and needs, therapy can be provided on a weekly or fortnightly basis.

How long?

Sessions are typically 30 minutes, 45 minutes or 60 minutes in length. This will mainly be based on the number of goals that you would like to address during a block of therapy.

Where?

Depending on your needs, therapy can take place at your home, school, childcare or preschool.

  • Home

Home-based therapy has many advantages, especially for large families, busy families, and families who have children with special needs.

Depending on your child’s age, therapy may take place at a table or on the floor.

We may set up activities in different areas of the room to give your child an opportunity to move around and to keep them engaged and focused.

Including other siblings in therapy from time to time can be very motivating for your child! We can involve your other children in certain activities if we decide that this will be a positive experience for your child. Please note, only your referred child will receive the therapy.

It is a requirement for the parent or carer to be present at all times during the session. We encourage parents and carers to watch the therapy and to be involved in the sessions. Your child will have best outcomes when you help them to practice their new skills over the week (or two) between sessions. Also, your child will be motivated to participate if they see that you are involved, too. Speech homework will be provided at the end of each session.

  • School, day care, or preschool

This will depend on arrangements made with your school or centre.

It is ideal for children who are ‘withdrawn’ from their class or group for therapy to have their session in a quiet place with minimal distractions.

With the parent’s permission, we encourage Learning Support Teachers or educators to sit in during sessions, especially if they will be assisting the child with their goals.

Speech homework will be provided at the end of each session.

Assessment

When a child is referred to see a Speech Pathologist, it is typically because the parent or another important person in that child’s life (e.g. relative, educator) is concerned about the child’s communication skills.

Purpose

An assessment is conducted in order to get a comprehensive picture of a child’s communication skills and to determine the impact of any difficulties on the child’s everyday life.

If the assessment confirms a disorder in any area of communication (e.g. language, speech, voice stuttering, etc.) the assessment results will be used to guide treatment recommendations.

How we conduct assessments:

We individualise every assessment because each child is unique.

We will tailor the assessment based on factors including: your child’s age; linguistic background; any diagnoses; background history; your concerns, values and priorities, and the severity of the suspected problem.

We conduct the assessment in order to better understand your child’s:

  • strengths and abilities
  • difficulties
  • interests

These are some of the ways that we collect information as part of a comprehensive assessment:

Questionnaires and interviews

Prior to attending your first session, we will ask you to complete a questionnaire to gain background information about your child including their: developmental history; medical history; languages spoken; interests and preferences, etc.

We will discuss your answers with you during your initial visit to clarify any information.

We will ask you questions about your perception of the problem, your values and your expectations of this service.

We may request your permission to send a questionnaire or to interview your child’s teacher or educator, if this is relevant.

The information that we collect from interviews and questionnaires supplements the results of any test, which, although important, is only a “snapshot” of your child’s performance on one day.

Standardised testing

This is otherwise known as “formal testing”. To be valid, standardised tests must be carried out according to strict rules. Standardised tests are either:

Norm-referenced: they compare your child’s test result to the results of other children of the same age, who completed the assessment under the same conditions

or

Criterion-referenced: they compare your child’s results to certain criteria, such as: ability to use a particular grammatical form

Language sampling

We may collect a sample of your child’s language while they play or while they retell a story. These kinds of language samples are very informative because they reflect how your child normally communicates in these typical activities. Language sampling complements findings from other tests conducted.

Non-standardised testing

We may use other tests to investigate your child’s specific areas of difficulty in greater depth. This is useful for prioritising goals and it allows us to collect base-line data.

Oral Musculature Assessment (OMA)

We will evaluate the appearance and movement of your child’s oral structures (e.g. teeth, lips, tongue, hard palate, soft palate). It is important to rule out any issues with the structures we use for talking in the assessment phase.

Observation

If you are concerned about your child’s ability to make friends or to learn at their educational setting (e.g., preschool, school) we may ask your permission to observe your child. Observations allow us to see exactly how your child’s communication difficulties impact on their ability to participate in different settings.

Client self-evaluation

This is mainly used with older children who can reflect on their difficulties and who can articulate their goals. It is important for the older child to be included in the assessment process to voice their concerns and preferences.

What does it take to read and write?

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Children typically learn and develop the skills of reading, writing and spelling during their first years of primary school. However, we know that children need exposure to books and daily shared reading with an adult from even as babies to have the best start possible.

In the later years of primary school and beyond, the emphasis changes from learning to read to reading to learn.

Learning to read and write is no mean feat. Let’s look more closely to see what reading and writing involves.

What does it take to read?

Accurate and fluent reading requires the following skills and knowledge:

  1. Phonemic awareness – this refers to the knowledge that words are made up of sounds. It also refers to the ability to identify various sounds in a given word (e.g. the first, last, and middle sound) and to manipulate sounds (e.g. if you take the /s/ sound off “spin” you get “pin”). Excellent phonemic awareness skills are essential for excellent literacy skills.
  2. Letter identification – this is the ability to identify letters in both upper and lower case (e.g. a, A, B, b) and to be able to differentiate between letters and non-letters (e.g. numbers, other symbols)
  3. Knowledge of letter-sound correspondence – this is the knowledge of the sound that each letter – or a group of letters –  makes (e.g. the letter “a” makes the sound /a/ as in “apple”,  the letter “gh” makes the sound /f/ as in “laugh“, /g/ as in “ghost, or it can be silent in words like “through“). This is one of the most crucial skills to learn.
  4. Position coding – this is the ability to read letters in the correct order. (e.g. “could” is not the same as “cloud”)
  5.  Blending – this is the ability to join the sounds of a word together in order to “decode” the word (e.g. b + l + a + ck = “black”)
  6. Language skills – in order to understand what you read you must have adequate vocabulary, grammar, and verbal working memory. Your background knowledge helps with comprehension also.

Next, it is important to develop reading fluency.

In order to remember and understand what they read, children must read with automaticity. Children achieve fluency by having repeated exposure to the words they read. Once a word is very familiar to the reader, she/he no longer decodes it, but rather identifies it as a whole, making reading much faster.

This does not mean that, as accomplished readers, we always read words as a whole. Even experienced adult readers will come across words they do not know, and will have to use their letter-sound knowledge and blending skills to read these unfamiliar words.

Try it yourself! Read: hippopotamus and then read: onychocryptosis.

You should have been able to read “hippopotamus” quickly, just by looking at the word, even though it is long, whereas (unless you have a medical background), you probably had to break down “onychocryptosis” (which means ‘ingrown toenail’) into individual sounds or syllables and blend these together. Knowledge of syllables can help to chunk sounds together to read long words (e.g. “fan-tas-tic”).

Knowledge of spelling rules helps to speed up reading as it reinforces the various letter combinations that make certain sounds (e.g. the letters “f”, “ph”, “gh” all make the sound /f/). Finally, knowledge of sight words is also important for reading fluency. Sight words are the common words in English which do not follow typical spelling patterns (e.g. “could”, “who”, etc.) which are “memorised” or taught “by sight” instead of blended. It is important to note that learning letter-sound rules to decode should always be taught prior to introducing sight words.

As you can see, there are a lot of skills involved in learning to read! A breakdown in any one of these areas can cause reading failure. Most typically, it is the letter-sound correspondence rules which are most difficult for novice readers to learn. And it is no wonder why decoding is challenging – the relationship between a sound and a letter is not intuitive; it is purely arbitrary. It is simply a code.

What does it take to spell?

This answer will be shorter! Learning to spell requires all the skills necessary for reading (listed above) but instead of blending, we use segmentation.

Segmentation is the ability to break a word into its individual phonemes. It is a phonemic awareness skill.

For example, in order to spell “frog” you would have to segment this word to find that it contains 4 separate sounds /f/ + /r/ + /o/ + /g/. Your letter-sound correspondence knowledge and spelling rules would help you to write the correct letter for each phoneme: f + r + o + g = “frog”.

As with reading, a child would need to learn sight words in order to write words high frequency words with irregular spelling.

How can a Speech Pathologist help?

Reading difficulties have been shown to impact on a child’s academic progress as well as on their wellbeing. A child who struggles to read and spell may have difficulty with one or more of the skills of literacy. All the skills can be assessed during a thorough Speech Pathology assessment in order to identify the areas that require support. Scientific research has repeatedly shown that systematic synthetic phonics is the best way to teach literacy skills. Systematic synthetic phonics teaches novice and struggling readers the relationships between sounds and letters in a systematic, explicit and direct way.

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What is a speech sound disorder?

dad and daughter blog header

Speech sound disorders are common in children, making up the majority of a Speech Pathologist’s caseload. Before going into disordered speech, let’s have a glimpse at what happens in typical speech development.

Typical speech development

Speech develops gradually. Over time, children develop their:

  • Intelligibility: they speak more clearly
  • Articulation (or Phonetics): they produce increasingly complex sounds with accuracy, by making the correct oral movements.
  • Phonology: they organise the sounds of their language in a way that resembles adult speech. This involves ‘storing’ the sound correctly in their mind, and ‘saying’ the sound correctly. The way each sound is ‘stored’ and the way it is ‘said’ will correspond correctly when mastered.

So, certain speech errors are a part of typical speech development. But by the time the child is about to start school, they should be 100% intelligible, and should be making few speech errors.

Speech Pathologists refer to milestone guides to determine what is expected, developmentally, in terms of a child’s intelligibility, articulation, and phonology.

See Speech for the Early 8, Middle 8 and late 8 consonant sounds that children acquire (i.e., articulation development) and examples of phonological processes (i.e., phonological development).

What is a speech sound disorder?

Children with speech sound disorders (SSD) differ in terms of: the kinds of speech errors they produce; the severity of their errors; the cause of the disorder; the age at which the disorder appeared, and their response to therapy.

As such, children with SSDs are a heterogenous group and the term “speech sound disorder” is only an umbrella term. In order to know which treatment is best suited to each child with a SSD, researchers have tried to classify SSDs using a variety of approaches. Classification approaches were based on: why the problem exists; how children with a SSD process speech, and what the SSD looks like (Waring & Knight, 2013).

Although there is no consensus on which classification system to use, recent research has supported the third approach, which involves the precise description and analysis of the child’s speech errors and linguistic abilities. This classification system has been shown to be useful in differentially diagnosing children and selecting appropriate intervention (Crosbie, S., Holm, A., & Dodd, B., 2005)

This approach identifies 5 subgroups of SSD (Dodd, 2014). A precise description of each subgroup is too technical for the purpose of general reading, so I will describe the 5 subgroups very simply:

Articulation disorder – a child with an articulation disorder will make consistent sound substitution or distortion errors. A lisp is a common example of an articulation disorder.

Phonological delay – this is where a child continues to speak using typical error patterns (i.e., phonological processes) that are no longer age-appropriate.

Consistent atypical phonological disorder – this is where a child makes phonological errors that do not occur in typical development. For example, it is typical for a young child to say “dou” instead of “go” (this process is called “fronting”) but it is not typical for a child to say “goor” instead of “door” (this atypical phonological process is called “backing”).

Inconsistent phonological disorder – a child with an inconsistent phonological disorder will say certain sounds in words inconsistently. For example, a child may say the /k/ sound in “car” differently, calling it “car”, “tar”, and “gar” on three separate occasions.

Childhood apraxia of speech (CAS) – this is a rare SSD that affects multiple areas of difficulty (i.e., phonetic and phonemic planning as well as oral motor coordination). Inconsistency is one of the key signs as well as difficulty in imitation and “groping” (i.e., searching for the correct oral position).

How common are Speech sound disorders (SSDs)?

SSDs are very common, making up more than 70% of a Speech Pathologist’s paediatric caseload (Mullen & Schooling, 2010). SSD’s begin in childhood and may persist into adulthood if not treated.

Of the subgroups, phonological delay is the most common, followed by consistent atypical phonological disorder, articulation disorder, and least common are: inconsistent phonological disorder, and childhood apraxia of speech (Dodd, 2014).

What causes speech sound disorders?

Most developmental speech sound disorders have no known origin.

We do not know what causes phonological disorder, articulation disorder or childhood apraxia of speech. These disorders often run in families, but this is not always the case.

We do have some information on risk factors. According to an Australian study, boys with a family history of speech impairment whose mother attained a low level of education were found to be 7.71 times more likely to have a speech impairment than a child without any of these factors (Campbell et al., 2003).

The SSDs with known origins include:

Structural disorders: e.g. cleft lip and/or palate, and other craniofacial anomalies. In these cases, the speech disorder is directly caused by the structural differences of the head or face.

Hearing loss: can be present at birth or it can be acquired. It can range in severity from mild to profound. It is common in certain genetic syndromes (e.g. Down Syndrome, Treacher Collins Syndrome) and it can occur after certain diseases (e.g. meningitis, chicken pox). It can also occur due to certain kinds of noise exposure. Children with recurrent ear infections are at risk of hearing loss. Hearing loss impacts on speech directly because it prevents the child from hearing and learning speech sounds accurately.

Genetic disorders: e.g., Fragile X. Genetic disorders impact on a child’s articulation, phonology, motor coordination, etc., in different ways.

Neuromotor disorders: e.g. Cerebral palsy. Cerebral palsy affects a person’s muscle control or coordination. As a result, many people with cerebral palsy have unclear speech (dysarthria) due to impaired muscle function.

Assessment

A thorough speech assessment is necessary to correctly diagnose the SSD and to select the intervention that has been shown to be most effective for the specific deficits identified. Sometimes, there will be more than one choice and I will discuss this with you.

As there is a high co-occurrence of speech difficulties and language difficulties, assessment of both speech and language is recommended. An initial screening of speech and language can confirm whether language assessment should be conducted.

For more general information, see Assessment.

What is stuttering?

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Stuttering is a speech disorder which makes it difficult for people to talk. It involves disruptions to fluent speech characterised by the following behaviours:

  • Repetitions – this is where a sound, syllable or a word is repeated. E.g., “m-m-m-m-my tower is taller”, “can-can-can-can I go to the park?”
  • Blocks – this is where a person becomes stuck mid-speech and no sound comes out
  • Prolongations – this is where a sound is stretched out E.g., my naaaaaaaaaaaaaame is John

Stuttering is different from person to person. The severity of a person’s stuttering can range from mild to severe.  The types of stutters – repetitions, blocks and prolongations – that a person produces also vary. Stuttering can be triggered in different situations. For example, children tend to stutter more when they are talking about something very exciting. Sometimes, facial movements such as blinking or grimacing may accompany the stuttering.

What causes stuttering?

There is no known cause of stuttering.

Stuttering often runs in families – people who stutter are 60% more likely to have a family history of stuttering – but there are also cases where the person with a stutter has no known family history. No single gene causes it.

Stuttering affects more boys and men than it does girls and women. The ratio of men to women is between 3:1 and 5:1, depending on the source. Approximately 1% of the population has a stutter.

What stuttering is not

  • Stuttering is not part of a child’s typical speech development.
  • It is not an emotional disorder. That is, it is not caused by anxiety, shyness or trauma. However, people who stutter may develop anxiety disorders due to their negative experiences (e.g. bullying) and unhelpful thoughts (e.g. “they’ll laugh at me”) about their stutter.
  • It is not related to a person’s intelligence.

My child has developed a stutter. Should I contact a speech pathologist?

A stutter can emerge gradually over a period of weeks or months, or it can emerge suddenly. It typically emerges during the preschool years, before the age of 5. Some children do not appear to be concerned by their stutter, whereas others may struggle to ‘get their words out’ and become frustrated. It is recommended to contact a speech pathologist as soon as your child begins to stutter, especially if your child is displaying signs of frustration.

Stuttering treatment is most effective during the preschool years until approximately 6 years of age.  Intervention for adults who stutter is different to treatment for children. Treatments such as the Camperdown Program teach the speaker strategies to control their stutter, not to eradicate it.

Is treatment effective?

The Lidcombe Program is a safe and effective treatment for preschool-aged children. It is the only treatment for this age group with replicated Randomised Control trial evidence demonstrating that it is effective in getting rid of stuttering.

Will my child recover naturally?

Natural or spontaneous recovery is common among pre-schoolers.  However, we do not know which child will recover spontaneously and which child will not. We do know that treatment is very effective for preschool-aged children and that stuttering is more difficult to treat in adulthood. There is also a lot of research on the possible negative social and emotional consequences of stuttering in adulthood (e.g. unhelpful thoughts, social anxiety). Not many children who have been stuttering for a year will recover spontaneously.  This is why early intervention is considered best practice.

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What is speech?

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Speech is not the same thing as Language. Speech refers to the individual building blocks of language – the speech sounds that make up words, that make up sentences that make language.

Every language is made up of a specific set of speech sounds, or phonemes. Standard English has 44 phonemes. Yes, that is more phonemes than the 26 letters of our alphabet.

How do we make speech sounds?

Production of speech sounds requires accurate coordination of the body parts that we use to speak: lips, tongue, hard palate, soft palate, teeth, vocal folds (for voice), velopharyngeal port (a gateway directing the air from our lungs to go through our nose or mouth, depending on the sound) and lungs (for air).

Image source: http://bit.ly/2k0wQTk

oral-anatomy

For example, to make the “m” sound, we need to have  we need air flow from our lungs (1) to make our vocal folds (2) vibrate to make sound,  our lips (3) need to be sealed and we need our velopharyngeal port (4) to be open, allowing the air to exit through our nose (5).

Speech Pathologists should always do an evaluation of the child’s oral structures to ensure that there aren’t any physical or neurological causes for speech difficulties.

Physical causes for speech impairments may include:

  • cleft lip or palate – this is typically identified before or soon after birth
  • submucosal cleft palate – this is a concealed cleft palate, and it is often identified later, when the child is at preschool or school.
  • tight lingual frenulum – this is when the tissue under your tongue is “anchored” too tightly to the floor of the mouth restricting tongue tip movement.

Children with speech difficulties should also have their hearing tested, especially if they have a history of ear infections. Adequate hearing is essential for speech sound development.

My child doesn’t say sounds correctly. Should I contact a Speech Pathologist?

The short answer –

You should contact a Speech Pathologist if:

  • You are concerned about your child’s speech
  • You have noticed that your child makes more speech errors than his / her peers
  • Your child’s educator / teacher has approached you because they are concerned about your child’s speech
  • Your child is about to start school and unfamiliar listeners do not understand them
  • Your child is being teased / bullied about their speech
  • Your child is anxious about his / her speech

The long answer –

As we know, learning to speak doesn’t happen overnight! Certain sounds are more difficult for young children to learn to make than others. Researchers have studied the order in which children master speech sounds in order to understand what is normal articulation development. The findings vary slightly from researcher to researcher. This is in part because the criteria for the acquisition of a sound was different for different studies (e.g. in some studies, the acquisition of a sound was tested only in one-syllable-length words, in other studies the sound had to be produced correctly 90% of the time, etc.). The other reason for the differences in findings is because there is a wide range of what is “normal development”. Children develop at different rates. This is why Speech Pathologists refer to these norms as a guide only. Nevertheless, certain patterns of acquisition have been identified. Shriberg (1993) noticed the following developmental pattern:

  • Early 8 sounds: m, n, j, b, w, d, p, h
  • Middle 8 sounds: t, ng (as in ‘sing’), k, g, f, v, ch (as in ‘child’), j (as in ‘jam’)
  • Late 8 sounds:  sh, zh, l, r, s, z, th (as in ‘thing’), TH (as in ‘that’)

According to Shriberg’s findings, we would expect a 3 year old to be able to say words containing the early 8 sounds (e.g. mud, pat, bad), but we would expect this child to possibly make errors with their production of some of the middle sounds and most of the late sounds.

The typical errors that children make as they learn their speech sounds are called phonological processes. Each phonological process typically ‘goes away’ or ‘resolves’ by itself by a certain age.

Here are some examples of typical phonological processes and the age by which they should no longer be used:

Final consonant deletion

This is where the final consonant sound is left off

E.g. I have a red ball → I ha a re ba

Age eliminated by: 3 years 3 months

Fronting

This is where sounds that are normally produced further back in the mouth (e.g. k, g, sh) are produced with the tongue tip in the front of the mouth (e.g. t, d, s)

E.g. the girl cuddled the black cat → the dirl tuddled the blat tat

Age eliminated by: 3 years and 6 months

Consonant Cluster Reduction

In English, many words contain 2-3 adjacent consonants (e.g. strange). These groups of adjacent consonants are called “clusters”. This error pattern occurs when a consonant is omitted from a cluster

E.g. two blue spots and six green squares → two bu pots and sik geen quares.

Age of elimination: 4 years

Weak syllable deletion

Words can be broken up into syllables. Syllables can be strong, like “ma” in”to-ma-to” or weak, like “um” in “um-bre-lla”. Weak syllable deletion occurs when the weak syllable is omitted from the word

E.g. the elephant sat on the banana → the efent sat on the nana.

Age of elimination: 4 years

Deaffrication

This is where phonemes called “affricates” – “ch” and “j” – are produced as “fricatives” – “sh” and “zh”

E.g. The dog chewed the judge’s shoe → the dog shewed the zhuzhes shoe

Age of elimination: 5 years

Gliding

This is where “r” is pronounced as “w” and “l” is pronounced as “y” or “w”

E.g. Ronnie the lion roared at the little lamb → Wonnie the yiyon woawd at the yitu yam

Age of elimination: 5-6 years

*This list is not exhaustive.

By the time children start school, they should be saying almost all of their 44 phonemes correctly and they should be understood by an unfamiliar listener.

When phonological processes persist beyond the expected age of elimination, this then becomes a phonological disorder. Phonological disorders should be treated to prevent negative social and academic consequences such as:

  • being misunderstood by others
  • being asked to repeat themselves, which could lead to frustration or embarrassment
  • being teased by peers
  • having difficulty with literacy

References:

Bowen, C. (2011). Elimination of Phonological Processes. Retrieved from http://www.speech-language-therapy.com/ on 12/12/16.
Dodd, B., Zhu, H., Crosbie, S., Holm, A., & Ozanne, A. (2002). Diagnostic evaluation of articulation and phonology (DEAP). Psychology Corporation.
Shriberg, L.D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research, (36), 105-140.
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What is a Developmental Language Disorder (DLD)?

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Children with a developmental language disorder may have difficulties using expressive language (e.g. talking, or writing messages) or with receptive language (understanding what is said or written), or both.

A child with difficulties using language may:

  • use non-specific words, which makes it hard to know what they’re talking about
  • speak in short sentences
  • find it difficult to sequence their thoughts, ideas or stories
  • have difficulty changing their language to suit different social interactions
  • have difficulty asking questions
  • have difficulties knowing how words are related

A child with difficulties understanding language may:

  • have difficulty following instructions
  • have difficulties maintaining attention during story-time
  • provide irrelevant or strange answers when asked questions
  • have difficulty taking turns in a conversation

Children with a developmental language disorder may have difficulty with any of the following specific areas of language: phonology, morphology, syntax, semantics, and pragmatics. For more information on these areas, see Language.

These children often go on to have difficulties with reading and writing. This is an important reason why early identification and early remediation of language difficulties is recommended.

Language assessment

A Speech Pathologist should evaluate a child’s receptive and expressive language skills using a combination of different methods to get a comprehensive picture of the child’s difficulties and to determine the impact of these difficulties. See Assessment for more general information about what an assessment entails.