Severity Of Phonological Disorder Research Articles

Habilidades de discriminação auditiva em crianças com desvios fonológicos evolutivos

hearing discrimination abilities in children with phonological disorders. to investigate the ability of hearing discrimination in children with Phonological Disorders who received or were receiving phonological treatment; to verify if the altered phonemes were the same as those which were not discriminated in the Picture Test for Hearing Discrimination (adapted for Portuguese language by Mota et al 2000, based on "The Boston University Speech Sound Discrimination Picture Test") and to verify if the ability of hearing discrimination is related to gender, age and the phonological disorder severity level. 41 children, 16 females and 25 males, with ages ranging between 4 and 8.2 years were evaluated. Data used for analyses were taken from the results obtained in the Picture Test for Hearing Discrimination and from the Phonological Assessment. no statistically significant difference between genders Statistical analyses also indicated that the performance in the Picture Test for Hearing Discrimination was correlated to age. The more severe the phonological disorder the higher the number of phonemes that were not discriminated. hearing discrimination inability can be a causative or aggravating factor of phonological disorder, although this rule does not apply to all cases.

Julgamento perceptivo da gravidade do desvio fonológico por três grupos distintos

OBJETIVO: comparar a gravidade do desvio fonológico a partir da análise perceptiva de três grupos distintos de julgadoras. MÉTODOS: a pesquisa foi composta de duas amostras, uma julgada, composta por 30 sujeitos com desvio fonológico com idades entre 4:1 e 7:11, e outra julgadora (cinco fonoaudiólogas, cinco leigas e cinco mães). Foi avaliada a fala espontânea das crianças através da narração de três sequências lógicas, as quais foram analisadas pelas julgadoras, acompanhadas por uma grade para marcação da gravidade. Para análise dos dados, foi realizada a Moda das 90 narrativas, possibilitando a análise estatística dos dados através da Análise de Concordância-Kappa. Determinou-se a gravidade do desvio fonológico pelo Percentual de Consoantes Corretas. RESULTADOS: a análise mostrou maior concordância entre os grupos de juízas para os extremos das possibilidades de julgamento (leve e grave), sendo mais difícil o julgamento e classificação da gravidade levemente-moderada e moderadamente-grave. CONCLUSÃO: observou-se maior facilidade dos juízes na identificação e julgamento dos sujeitos com gravidade grave (maior) e leve (menor) na fala. As leigas possuem maior dificuldade para julgar com precisão a gravidade do desvio fonológico do que as mães e fonoaudiólogas.

Análise da eficácia terapêutica em três modelos fonológicos de abordagem contrastiva

Phonological therapy in subjects with phonological disorders. To compare the efficacy of three contrastive approach models in three different severities of phonological disorder. Participants of the study were nine subjects with phonological disorders, with ages ranging between 4:2 and 6:6 years. All subjects were evaluated prior to and after phonological therapy. Three groups, with three subjects each, were determined for treatment. Each group presented one individual with severe, one with moderate-severe and one with mild-moderate phonological disorder. Each group was treated using a different therapy model--Minimal Opposition, Maximal Oppositions/Empty Set and Multiple Opposition. Results were analyzed according to the Friedman Test, considering p < 0.05; a descriptive analysis was also performed among the models. There was no statistical difference among the models considering the severity of phonological disorder. The Minimal and Maximal Oppositions/Empty Set approaches favored a greater number of sound acquisitions in the phonetic inventory of subjects with severe and moderate-severe disorder. On the other hand, the Multiple Oppositions approach favored a better performance of sound acquisition in the phonological system and a decrease in the impaired distinctive features in severe and moderate-severe disorder. The models of therapy were effective in the treatment of different severities of phonological disorders observing the best performance in children with severe and moderate-severe disorder.

Terapia fonológica: a generalização para outra posição na palavra

OBJETIVO: analisar a eficácia de três modelos de terapia com base fonológica em sujeitos com diferentes gravidades do desvio fonológico. MÉTODOS: o grupo pesquisado foi constituído de 21 crianças, 11 do sexo masculino e dez do feminino, com média de idade de 5:7 anos. Os dados da fala dos sujeitos foram analisados por meio da avaliação fonológica. Após a realização da análise contrastiva, foi calculado o Percentual de Consoantes Corretas proposto por Shriberg e Kwiatkowski (1982) e os sujeitos foram classificados em diferentes gravidades do desvio fonológico em desvio severo, moderado-severo, médio-moderado e médio. Sendo seis sujeitos submetidos ao Modelo de Ciclos Modificado, oito ao Modelo ABAB-Retirada e Provas Múltiplas, e sete ao Modelo Oposições Máximas Modificado. Fez-se uma comparação da generalização para outras posições da palavra entre os três modelos de terapia em cada gravidade. RESULTADOS: a generalização a outras posições na palavra ocorreu em todos os modelos estudados, todavia, os maiores percentuais de acertos obtidos foram no Modelo ABAB-Retirada e Provas Múltiplas, no grupo com desvio severo; no Modelo Oposições Máximas Modificado, nos grupos com desvio moderado-severo e médio-moderado; e nos Modelos Oposições Máximas Modificado e ABAB-Retirada e Provas Múltiplas, no grupo com desvio médio. CONCLUSÃO: todos os sujeitos apresentaram evoluções no sistema fonológico e quanto à generalização para outras posições na palavra, sendo em maior percentual nos modelos ABAB-Retirada e Provas Múltiplas e Oposições Máximas Modificado.

Terapia fonológica em irmãos com diferentes graus de gravidade do desvio fonológico

TEMA: terapia fonológica em irmãos com desvio fonológico. PROCEDIMENTOS: participaram da pesquisa dois irmãos, S1 e S2, do sexo masculino e feminino, respectivamente. O S1, 6:6 de idade, apresentava desvio fonológico de grau severo e foi tratado pelo modelo de Oposições Mínimas e o S2, 4:8 de idade, com desvio fonológico de grau moderado-severo foi tratado pelo Modelo de Oposições Máximas. Ambos os sujeitos realizaram 25 sessões de fonoterapia. RESULTADOS: o S2 obteve uma melhor evolução terapêutica comparado ao S1. O S1 apresentou generalização a itens não utilizados no tratamento e o S2 apresentou generalização dentro de uma classe de sons. CONCLUSÃO: os modelos utilizados são eficazes, pois proporcionaram a ocorrência de generalizações e a melhora do sistema fonológico de ambos os sujeitos. No entanto os fatores ambientais podem ter limitado a evolução do tratamento, uma vez que as crianças apresentavam substituições semelhantes na fala o que favorecia a manutenção da alteração.

Eficácia da terapia para desvios fonológicos com diferentes modelos terapêuticos

phonological therapy. to evaluate the effectiveness of three different therapy models regarding changes in the phonological system of subjects with different phonological disorder (PD) severity levels. the research group was composed by 66 subjects, 43 males and 23 females, with ages between 4:4 and 8:2 years, who were part of a school clinic database. All subjects were evaluated, before and after a period of 15 to 25 sessions of phonological therapy, using the Child's Phonological Assessment. Based on this assessment, the severity level of the PD was determined using the Percentage Consonants Correct - PCC, and by calculating the number of Non-Acquired Segments -NAS and the percentage of Acquired Segments (AS) after treatment. The subjects were treated using the following approaches: ABAB-Withdrawal and Multiple Probes, Modified Maximum Opposition and Modified Cycles Models. For the statistical analysis the T-Test was used with a significance level of 5%. the statistical analysis indicated an increase in the PCC and in the percentage of AS, as well as a reduction in the number of NAS for all groups. These results were statistically significant for the majority of the groups. the results indicate that the three therapy approaches were effective in the treatment of children with PD, and were effective in treating different severity levels. Besides that, most of the changes occurred in the phonological system of the groups with more severe PD.

Terapia fonológica: a generalização a itens não utilizados no tratamento (outras palavras)

OBJETIVO: verificar a generalização a itens não utilizados no tratamento (outras palavras) obtida em três modelos de terapia em sujeitos com diferentes graus de gravidade do desvio fonológico. MÉTODOS: o grupo pesquisado foi constituído por 21 sujeitos com desvio fonológico, 11 do sexo masculino e 10 do feminino, com média de idade no início do tratamento de 5:7 anos. Os dados da fala foram analisados por meio da avaliação fonológica. Após a realização da análise contrastiva, foi calculado o Percentual de Consoantes Correta (Shriberg e Kwiatkowski, 1982) e os sujeitos foram classificados nos diferentes graus de gravidade do desvio fonológico em: grave; moderado-grave; médio-moderado; e médio. Seis sujeitos foram submetidos ao Modelo de Ciclos Modificado, oito ao Modelo ABAB-Retirada e Provas Múltiplas, e sete ao Modelo Oposições Máximas Modificado. Fez-se uma comparação da generalização a itens não utilizados no tratamento (outras palavras) entre os três modelos de terapia para cada grau de gravidade do desvio fonológico. RESULTADOS: dos sujeitos com desvio grave, moderado-grave e médio, três apresentaram maiores generalizações a outras palavras, todos submetidos ao Modelo ABAB-Retirada e Provas Múltiplas. Dos sujeitos com desvio médio-moderado, foram os tratados pelo Modelo de Oposições Máximas Modificado que mais generalizaram. CONCLUSÃO: todos os sujeitos apresentaram evoluções no sistema fonológico e, quanto à generalização a itens utilizados no tratamento (outras palavras) observou-se maior percentual de generalização nos modelos ABAB-Retirada e Provas Múltiplas e Oposições Máximas Modificado.

Habilidades de memória de trabalho e o grau de severidade do desvio fonológico

Working memory. To verify the performance of working memory abilities and their relation with the severity of phonological disorders. 45 children, with ages between 5.0 and 7.11 years, with evolutional phonological disorders (EFD), 17 female and 18 male, were evaluated. All subjects were assessed using the Child Phonological Evaluation proposed by Yavas et al. (1991). The severity of the disorder was determined by the Percentage of Correct Consonants (PCC) proposed by Shriberg and Kwiatkowski (1982), classifying the phonological disorder as severe, moderate-severe, average-moderate and average. After that, subtest 5 of the Psycholinguistic Abilities Test (ITPA--Bogossian & Santos, 1977) and the non-word repetition test (Kessler, 1997) were applied. After analyzing the data according the statistical tests of Kruskal Wallis and Duncan, it was verified that the performance of moderate-severe and severe individuals in the non-word repetition test was inferior to that of average-moderate and average individuals. However, performance results in the digit repetition test did not present a positive correlation with severity. The performance of phonological memory has a relation with the severity of phonological disorders. This allows us to accept the idea that the phonologic memory is related to speech production. Regarding the central executor, the results indicate that the performance in digit repetition, used to assess the central executor, did not present a correlation with the severity of the disorder. This can be justified by the fact that the central executor is more directly related to vocabulary acquisition and is responsible for processing and storing information.

Metaphonological skills of children with phonological disorders before and after phonological and metaphonological intervention.

This study investigated the relationships between the phonological and metaphonological skills of 19 children aged 3-5 years with moderate to severe phonological disorders, and the effects of intervention on the children's awareness skills. Seven tasks were used which required children to produce alliterations and rhymes, to segment sentences, disyllabic and monosyllabic words, and to change the names of objects. Children's metaphonological skills were tested (a) before intervention, (b) following phonological intervention and (c) following phonological plus metaphonological intervention. Evaluation of children's segmental and syllable/wordshape profiles before intervention indicated that children with larger phonetic inventories and better word and syllable shapes tended to have higher metaphonology task scores. Individual variation, however, suggested that children's overall phonological profiles rather than particular characteristics of their speech were more important for good metaphonological task performance. Children's phonological awareness skills were also related to their morphosyntactic production skills. Intervention outcomes indicated that both phonological and metaphonological intervention may result in a significant increase in children's metaphonological task performance. It was further observed that children with more moderate phonological disorders and good morphosyntactic production skills tended to improve on the metaphonological tasks after phonological intervention alone. Children with more severe phonological and morphosyntactic disorders tended to increase their task performance only after phonological plus metaphonological intervention.

Effectiveness of speech intervention for phonological disorders: a randomized controlled trial

Thirty children of preschool age with severe phonological disorders were randomly assigned to two treatment groups. Group 1 received treatment for 4 months followed by 4 months without treatment while group 2 underwent 4 months without treatment followed by 4 months of treatment. The outcome measures used were the Assessment of Phonological Processes-Revised (APP-R), the Goldman-Fristoe Test of Articulation (GFTA), the Percentage Consonants Correct (PCC), and Mean Length of Utterance (MLU). Group 1 showed significant differences on scores of phonological measures (APP-R, GFTA, and PCC) after the first 4 months of the study. At the 8-month assessment point the measures for conversational speech intelligibility continued to be significantly different, with group 1 scores higher than those of group 2. The expressive language measure did not detect a difference between groups at any time; however group 1 scores were consistently higher than group 2 scores.

Impact of substitution patterns on phonological learning by misarticulating children

Learning and generalization of treated sounds to different word positions is a desired outcome of intervention in the phonologically disordered child's system. Unfortunately, children do not always learn the sound that is treated; nor do they always demonstrate across-word generalization. One possible explanation for differences in treatment outcome may relate to the pretreatment substitution patterns used by different disordered children. This post-hoc analysis of treatment data examines the effects on sound learning and generalization of consistent versus inconsistent substitutes. With a consistent substitute across-word position (CS), the same phone was used in initial, medial and final position for a phoneme that was not in the child's inventory. An inconsistent substitute was evidenced by a different phone for a target sound in each position of a word (InAP), or even within word position (InWP) for an error sound. Fourteen children with severe phonological disorders were treated on an obstruent in initial or final word position. Seven of these children had a consistent substitute for the treated obstruent, two children had variable substitutes across word position, and five children had variable substitutes within and across word position. The analysis revealed a tight relationship between pretreatment substitution patterns and learning. The seven children with a consistent substitute for an error sound learned the sound targeted in treatment and generalized this knowledge to other word positions. Children who had variable substitutes across word position learned the treated sound, but only in the treated word position. Four of the five children in the InWP group did not learn to produce the sound targeted in treatment in any word position. These results suggest that pretreatment substitution patterns may be a predictor of learning and generalization in phonologically disordered children.

Nonlinear Phonology

The purpose of this tutorial is to introduce a recent advance in phonological theory, "nonlinear phonology," which differs fundamentally from previous theories by focusing on the hierarchical nature of relationships among phonological units. We first introduce the basic concepts and assumptions of nonlinear phonological theory and then demonstrate clinical applications of the theory for assessment and intervention. Data from a child with a severe phonological disorder are used to illustrate aspects of nonlinear theory. The data are first analyzed in terms of phonological processes in order to provide the readers with a familiar starting point for comprehension and comparison. The nonlinear frameworks are shown to provide a deeper analysis of the child's phonological system than the phonological process analyses and to lead to a more clearly defined intervention plan.

Description and Treatment of Abnormal Vowels in a Phonologically Disordered Child

Children with difficulties in acquiring the target vowel system are undoubtedly rarer than those with disorders that primarily affect the consonant system, bat pose a considerable challenge to the speech and language therapist. At present, relatively little is known about patterns of disruption in vowel systems, and still less about effective methods of treatment. This case study describes the vowel system of a child with a severe phonological disorder. A short course of six sessions of treatment is outlined which focused on developing diphthong production. An eclectic approach was adopted, with many of the principles derived from both familiar traditional and more recently advocated approaches to the remediation of phonological disorders. Follow-up data at four and eight months post-treatment showed improvement in the vowel system. The clinical implications of the findings are discussed.

Familial Phonological Disorders

The pedigrees of 4 children with a severe phonological disorder demonstrating three generations of members with speech/language problems are presented. All 4 probands were female with two mothers, two fathers, and five out of six siblings affected. All pedigrees contained family members with dyslexia and learning disabilities as well as speech disorders. Family members varied in the type of speech problems that they demonstrated and the severity of their disorder, thus suggesting variable expressivity and incomplete penetrance. An autosomal dominant mode, a multifactorial-polygenic model, and a sex-specific threshold model for expression are discussed.

A familial study of severe phonological disorders.

The present study examined the familial basis for severe phonological disorders. Twenty children with severe phonological disorders and their siblings were compared to 20 normally developing children and their siblings on measures of phonology, language, reading, and motor ability. Results revealed that the siblings of the disordered children performed more poorly than control siblings on phonology and reading measures. Disordered subjects' phonological skills correlated significantly and positively with their siblings', whereas controls' scores did not. Families of disordered children reported significantly more members with speech and language disorders and dyslexia than did families of controls. Sex differences were reflected in the incidence but not the severity or type of disorder present. These findings suggest a familial basis for at least some forms of severe phonological disorders.

Serving Preschool Children with Severe Phonological Disorders

Preschool children with multiple articulation disorders are often referred to school speech-language clinicians to be served within the constraints of itinerant service delivery programs. Although these children would benefit from intensive phonological remediation, weekly individual therapy sessions or a self-contained class for students with severe language disorders are usually the only options available. In this study, an alternative group approach based on the procedures of Hodson and Paden (1983) was evaluated. Four of the nine preschool children with unintelligible speech in one school district were dismissed after 17 weeks of intensive intervention spread over 7 months. This alternative to preschool programming is presented here as a highly feasible and cost-accountable service delivery model, given the structure of public schools.

Structural Aspects of Phonological Development

The relationship between syllabic structure and segmental development was examined longitudinally in a child with a severe phonological disorder. Six speech samples were collected over a 4-year period (3:5 to 7:3). Analyses revealed gradual increases in the complexity and diversity of the syllable structures produced, and positional preferences for sounds within these forms. With a strong preference for [d] and [n] at the beginning of syllables, other consonants appeared first at the end of syllables. Implications for clinical management of phonological disorders include the need to consider both structural position and structural complexity in assessing segmental skills and in choosing target words for intervention.