Faculty: Katy Cabbage

PurposeClinicians working with children who have speech sound disorders that involve multiple errors often prioritize particular errored sounds for intervention. However, this prioritization is not always an easy or clearly defined clinical decision, as there are many target selection considerations to weigh, some of which directly oppose one another. Conversely, sometimes there are multiple justified reasons to target a particular process or sound over others produced in error. Having a well-advised rationale regarding what sounds/sound classes to prioritize in treatment is a critical tenet of high-quality clinical service provision. Therefore, speech-language pathologists need to be mindful of differing rationales for prioritizing therapy targets and note that the same prioritization may not be appropriate for all children receiving therapy.
ConclusionsThis clinical focus article provides an overview of a wide variety of pediatric target selection considerations (e.g., stimulability, complexity, frequency of occurrence, and interference with intelligibility) and offers clinicians theoretical and research-based rationales for each. Limitations and/or controversies that hamper practical clinical application of each target selection consideration are noted and described. Aspects in need of further research are highlighted. Additionally, through presentation of hypothetical case studies, the authors illustrate an individualized approach to target selection appropriate for a pediatric caseload.

Clinicians providing intervention for pediatric speech sound disorders (SSDs) have many treatment approach options from which to select. Because treatment needs vary across children based on many factors including the error type(s) present and patterns of deficit noted, these factors need to be considered early in the therapeutic process to find the best-suited approach. In this article, the authors describe and contrast a traditional motor articulatory-based approach with phonologically-based approaches including cycles, contrast therapies (e.g., minimal pairs, maximal oppositions, and multiple oppositions), and complexity through presentation of hypothetical case studies, updated summaries of the evidence base for each, and a summary of current research limitations for informing clinical practice. Although children with SSDs are ubiquitous in pediatric clinical caseloads, familiarity or lack thereof with the evidence base supporting different approaches potentially limits speech production outcomes for children receiving speech services. Even so, limitations in the evidence base constrain practical application of a given approach to daily therapeutic interactions.

PurposeSpeech perception requires individuals to hear and differentiate acoustic signals integral to effective communication. Measuring speech perception in children is challenging because speech perception methodology typically requires lengthy experiments that may fatigue children, resulting in limited knowledge of developmental perceptual skills. In this study, we used an adaptive tracking measure along with a wide range of acoustic stimuli to explore how adults, typically developing (TD) children, and children with speech sound disorder (SSD) perceive small acoustic differences in synthetic speech stimuli.
MethodTwenty-four adults, 15 TD children, and 15 children with SSD between the ages of 7;0–14;0 (years;months) were administered a newly developed perceptual assessment, the Wide-Range Acoustic Accuracy Scale, to determine the just-noticeable difference in discrimination for three separate syllable contrasts. Each syllable contrast varied along a single acoustic parameter: formant transition duration for /bɑ/–/wɑ/, F3 onset frequency for /dɑ/–/ɡɑ/, and F3–F2 distance for /rɑ/–/wɑ/.
ResultsFindings revealed that adults and TD children did not differ in their discrimination of any syllable contrast, but adults significantly differed from SSD children on all syllable contrasts. TD children and children with SSD differed only on the /rɑ/–/wɑ/ contrast.
ConclusionsChildren with SSD demonstrate less accurate and more variable perception skills relative to adults and TD children for /bɑ/–/wɑ/, /dɑ/–/ɡɑ/, and /rɑ/–/wɑ/ syllable contrasts. Clinical implications of the utility of the Wide-Range Acoustic Accuracy Scale are discussed.

Purpose: Children with dyslexia have speech production deficits in a variety of spoken language contexts. In this paper, we discuss the nature of speech production errors in children with dyslexia including those who have a history of speech sound disorder, and those who do not, to familiarize speech-language pathologists with speech production-specific risk factors that may help predict or identify dyslexia in young children. Method: In this tutorial, we discuss the role of a phonological deficit in children with dyslexia and how this may manifest as speech production errors, sometimes in conjunction with a speech sound disorder but sometimes not. We also briefly review other factors outside the realm of phonology that may alert the speech-language pathologist to possible dyslexia. Results: Speech-language pathologists possess unique knowledge that directly contributes to the identification and remediation of children with dyslexia. We present several clinical recommendations related to speech production deficits in children with dyslexia. We also review what is known about how and when children with speech sound disorder are most at risk for dyslexia. Conclusion: Speech-language pathologists have a unique opportunity to assist in the identification of young children who are at risk for dyslexia.

Purpose: Orthographic facilitation describes the phenomenon in which a spoken word is produced more accurately when its corresponding written word is present during learning. We examined the orthographic facilitation effect in children with dyslexia because they have poor learning and recall of spoken words. We hypothesized that including orthography during spoken word learning would facilitate learning and recall. Method: Children with dyslexia and children with typical development ( n= 46 per group), 7 – 9 years old, were matched for grade and nonverbal intelligence. Across 4 blocks of exposure in 1 session, children learned pairings between 4 spoken pseudowords and novel semantic referents in a modified paired-associate learning task. Two of the pairings were presented with orthography present, and 2 were presented with orthography absent. Recall of newly learned spoken words was assessed using a naming task. Results: Both groups showed orthographic facilitation during learning and naming. During learning, both groups paired pseudowords and referents more accurately when orthography was present. During naming, children with typical development showed a large orthographic facilitation effect that increased across blocks. For children with dyslexia, this effect was present initially but then plateaued. Conclusions: We demonstrate for the first time that children with dyslexia benefit from orthographic facilitation during spoken word learning. These findings have direct implications for teaching spoken vocabulary to children with dyslexia.

Purpose: Childhood apraxia of speech (CAS) is hypothesized to arise from deficits in speech motor planning and programming, but the influence of abnormal speech perception in CAS on these processes is debated. This study examined speech perception abilities among children with CAS with and without language impairment compared to those with language impairment, speech delay, and typically developing peers. Method: Speech perception was measured by discrimination of synthesized speech syllable continua that varied in frequency (/dɑ/–/ɡɑ/). Groups were classified by performance on speech and language assessments and compared on syllable discrimination thresholds. Within-group variability was also evaluated. Results: Children with CAS without language impairment did not significantly differ in syllable discrimination compared to typically developing peers. In contrast, those with CAS and language impairment showed significantly poorer syllable discrimination abilities compared to children with CAS only and typically developing peers. Children with speech delay and language impairment also showed significantly poorer discrimination abilities, with appreciable within-group variability. Conclusions: These findings suggest that speech perception deficits are not a core feature of CAS but rather occur with co-occurring language impairment in a subset of children with CAS. This study establishes the significance of accounting for language ability in children with CAS.