A) Introduction to independent and Relational analysis

According to Dodd, of the five different types of described speech sound disorders, two types,
phonological delay and consistent deviant phonological disorder, comprise 77% of all SSD.
These disorders are rule governed with predictable and systemic error patterns, and they can
range in severity from mild to severe. Children who are highly unintelligible present a challenge
when it comes to identifying their predominant error patterns. As many parents have said, it’s as
if these children have a language of their own.

Models of Analysis

Fortunately, multiple models of analysis are available to help SLPs analyze moderate to severe
SSD, which leads to more effective intervention planning. The models fall under different
analysis frameworks, and clinicians can select the most appropriate one to use based on the
nature and severity of the SSD.

These analysis models provide SLPs with the tools needed to act as “linguistic detectives” and
find the order in the disorder of these complex sound systems.

Relational Analyses

The oldest and most common type of analysis, relational analyses have been used by SLPs since
the beginning of the profession. Several different analyses fall under this category, including:

 Substitution, omission, distortion, and addition analysis (SODA)

 Phonological process analysis (PPA)
 Place-voice-manner analysis (PVM)

While there are differences across these different relational analyses, they all share some
similarities:

 They compare the child’s pronunciation to an adult target.

 They only examine errors, making them specifically “error analyses.”
 They make sound-to-sound comparisons between child and adult forms.
 They use a pre-determined and finite number of categories or rules to describe the child’s
errors.

Independent Analyses

Independent analyses are newer and less commonly used methods to describe children’s
disordered sound systems. Like relational analyses, several different independent analysis
methods are available, including:
  Systemic phonological analysis of child speech (SPACS)
 Productive phonological analysis (PPK)
 Non-linear phonological analyses, such as optimality theory (OT)

Again, these analyses share a number of common features:

 They describe the sound types (phonetic inventory) and syllable structures produced by
the child independent of the adult target.
 They identify what the child does rather than what the child does not do.
 They compare child sound system to adult sound system; in other words, they are system-
to-system comparisons.

The first independent analyses were used to describe early, developing sound systems in children
under the age of 3 who had not developed a rule-based sound system. However, in the SPACS,
PPL, and OT, independent analysis is used as a first step in describing the rule-governed sound
systems of children ages 3 and over who do have rule-based sound systems.

Once the child’s sound system has been described as a unique, self-contained sound system
through independent analysis, it is then necessary to compare it to the adult system to determine
the areas of difference, or disorder, so the clinician can plan intervention. This is done through
relational analysis. This means that SPACS, PPL, and OT combine both independent and
relational analysis methods

Phonological evaluation of young children and toddlers must be accomplished within the
broader context of evaluation overall communicative behavior because phonological
development is integrally related to development of cognition language and motor skills.
Phonological development is related aspects of child development. However for propose of text
it is useful to isolate phonological from the overall communication process.
The point in the time and development of young children when clinician frequency become
involved is assisting phonology after 18 to 24 months. By this age children typically have
acquired approximately 50 words and are two words together this age clinician are usually
interested in determining how a child.
Must variability among children in of the age at which specific speech sound are acquired such
variability it difficult to development expectation and acquired for the assessment of speech
sound production in infant and toddler. Some however, can be offered. One of the first
assessments of phonological development involves determining whether the infant is progressing
normally through the stages of in fondant vocalization.
The type of phonological analysis usually employed during the early stages of sound acquisition
is termed an independent analysis of phonological behavior. An independent analysis identifies
the speech sounds produced by a child without reference to appropriateness of usage relative to
the adult standard.
 1. An inventory of sound consonants and vowels classified by word position and articulatory
features .e.g. place. Manner, voicing.
2. An inventory of syllables and word shapes produced e.g.( Cc. Cc. CCC.)
3. Sequential constraints on particular sound sequences.
The transition stage occurs between 12 to 18 months and two or three words are put together in
sequence (strings) around 24 months.
In children with speech delay these stages can occur at a later phonological age.
Children in the third group are those who should be considered for an early intervention
program.
Summary:
Phonological evaluation with infant and ate done within the context of an overall communication
assessment because phonological development is integrally related to other aspects of
development such as cognition .motor development and other aspects of linguistics development.
Once a child has a vocabulary of approximately 50 words, relational analysis typically is
employed as part of the assessment battery..
 B) INDEPENDENT ANALYSES
• Tells you what the child can do?
• Does not compare child's speech to the adult's speech.
• Not looking for errors.
• Rational analyses are tests where you compare the child's speech to adult productions and
determine there's an error.
• Both Phonetic and Phonemic inventories are independent analyses; what can the child
produce? Looks at what the child can do independently without making any comparisons.
Not accurate or inaccurate. Just what can a child do?
An independent description of phonology is typically based on a continuous speech sample
and is designed to describe a child’s production without reference to adult usage. Analysis of
a child’s production as a self-contained system i.e., independent analyses include the
following
1. An inventory of sounds (Consonants and vowels) classified by word position and
articulatory features (e.g., place, manner, voicing)
2. An inventory of syllables and word shapes produced (e.g., CVC, CV, VC, CCV)
3. Sequential constraints on particular sound sequences (e.g. /ɛfʌnt/ for /ɛləfʌnt/)
Phonetic inventory:
• A listing of the sounds a child can make Independent of the adult sound. The sound
must occur 3 times in a 100 word sample and 2 times in a 50 word sample to be counted.
• However, you can include a sound with one occurrence and circle it. You should also
keep a separate list of consonant clusters (singletons and clusters always classified as
different entities. If child can produce /s/ and /p/ it does not mean they can produce /sp /)
• Phonetics: The study of speech sounds and their properties. There are different types of
phonetics
• Phone: this is considered a speech sound.
• Phoneme: a basic speech segment.
• Allophonic variations (phonetic variations) the slight variations in production of a
phoneme that do not change the meaning.
• Phonetic inventory: an inventory of different speech sounds, or phones
Phonemic inventory:
• A listing of the phoneme a child knows.
• Done by looking for minimal pairs in a child’s speech sample
• Minimal pairs: pairs of words that differ in only one phoneme and different meanings.
• When changing one sound changes meaning, then the two sounds that were changed have
contrastive function.
• A phoneme is a phonological unit which cannot be broken down into any smaller
phonological units.
• By phonemic units should be understood each member of a phonemic contrast.
 • A phonemic contrast is any sound contrast which, in the language in question, can be
used as a means of differentiating intellectual meaning.
Phonemic inventory: an inventory of the smallest segmental unit of sounds used to form
meaningful contrasts between utterances.
● Co-articulation: the influence on one sound by a sound that precedes or follows it.
● Morphophonemic: the phonological structure of morphemes.
● Minimal pairs: pairs of words that differ by either place, manner, or voicing.
● Maximal pairs: Pairs of words that differ by multiple contrasts in place, manner, and/or
voicing.

Phonotactic inventory:
• The description of permitted phoneme combinations within a language.
 C) RELATIONAL ANALYSES
Evaluation of an individual’s speech sound status typically involves describing his or her
productions and comparing them to that of the adult standard of the speaker’s linguistic
community. We call this type of analysis a relational analysis, a procedure that is designed to
determine which sounds are produced correctly. For young children or speakers with limited
phonological repertoires, the speech sound system is sometimes described independently of the
adult standard, in which case the examiner simply wants to know what speech sounds are
produced regardless of whether they are used correctly. We call this an independent analysis.
Errors of Articulation:
There are four types of Articulation Errors which are as follows:
 Substitution
 Omission
 Distortion
 Addition

Substitutions:
Definition:
 Replace one sound with another sound.
 When one class of sounds is replaced for another class of sounds.
Example: “wed” for “red”, “thoap” for “soap”.
Omission: (Deletion)
 Omit a sound in a word.
 This error affects intelligibility the most, making speech more difficult for the listener to
understand.
Example: “tree” for “three”, “pay” for “play.”
Distortion:
Distortion occurs when the sound is not left out or substituted but does not sound right. There is
an attempt to make the sound but it is misarticulated.
Example: “kerrec” vs “correct”, “tell me” vs ”till me”.
Addition:
Addition occurs when an extra sound is added.
Definition: Insert an extra sound within a word.
Example: “buhlack horse” for “black horse”, “doguh” for “dog”.
Articulation Evaluation Steps: (Van Riper)
 Sensory Perceptual Training (hearing own mistakes).
 Producing a new sound with cuing.
 Able to make sounds correctly in isolation.
 Use the sound in syllables.
 Use the sound in words.
 Use the sound at the phrase level.
 Use the sound the sentence level.
 Carry over the sound and make it automatic.
 D) PHONOLOGICAL PROCESS ANALYSES
 Language specific issues
 Identification and classification of errors
INTRODUCTION:
 Speaking with all of the sounds of an adult is too difficult for young child’s brain. To
overcome this the child’s brain creates rules to simplify speech sounds and make words
easier to say these rules are called phonological processes. .
 For example, sounds produced in the back of the mouth ( like /k/ and /g/) are difficult for
young children to say . Many children simply this by creating a rule (phonological
process) . Therefore /k/ becomes /t/ and /g/ becomes /d/ .
Some types of phonological processes:
• Cluster reduction (pot for spot )
• Reduplication ( wawa for water )
• Weak syllable detection ( nana for banana )
• Final consonant deletion ( ca for cat )
• Velar fronting ( /t/ for /k/ and /d/ for /g/
• Stopping (replacing long sounds like /s/ with short sounds like /t/
• Assimilation (changing consonants in a word to be more like other consonants in the
word like gog for dog)
Atypical or idiosyncratic phonological processes:
 All children use some phonological processes in their speech . These are considered
natural or normal phonological processes . However in children with phonological
disorders , we sometimes see other phonological processes being used that are
atypical or abnormal .
Some of the atypical phonological processes are :-
 Initial consonant deletion ( og for dog )
 Backing (moving front sounds like /t/ and /d/ to the back of the mouth like /k/ and /g/
like
 Glottal replacement (“ ha er” for ”hammer” )
 Fricative replacing stops ( “sop” for “top” )
 Stopping of glides ( “darn” for “yarn” )
 Vowel error patterns
A phonological process analysis was
completed through the Proph program to
determine error patterns that were evidenced
in Kirk’s single-word as well as connected speech sample. This analysis revealed that the most
prevalent process was stopping, with all fricatives and affricates impacted by this pattern
(occurred in 85% of possible occasions in connected speech and had 44% occurrence in stimulus
words from the BBTOP, particularly initial position). The most prevalent example of stopping
was the use of /d/, which was substituted for initial /f/, /v/, /θ/, /d/, /s/, /z/, /∫/, /t∫/, and /dʒ/, and
the clusters /sl/, /sn/, and /fl/. Kirk used frication (e.g., /s/, /f/, although inappropriately) when
producing some single words. A diagram of his sound collapses for /d/ is as follows:

Clusters were simplified approximately 75 percent of the time in both isolated words and
connected speech samples. Less frequently occurring patterns included context-sensitive voicing
(prevocalic voicing), and initial consonant deletions. Prevocalic voicing occurred in less than 25
percent of possible instances and initial consonant deletions less than 12 percent. Process
analysis scoring on the BBTOP revealed similar error patterns.
E) ASSESMENT OF ORAL PERIPHERAL MECHANISMS
 F) SPEECH SOUND DISCRIMINATION ASSESSMENT, PHONOLOGICAL
CONTRAST TESTING
WHAT IS SPEECH SOUND DISCRIMINATION/SPEECH SOUND
PERCEPTION/AUDITORY PERCEPTION?
Children who are passing basic hearing test does not always mean having normal speech
perception skills. Acc. to Rvachew and grawburg(2006).
“Speech perception is the process of transforming a continuously changing acoustic signal
into discrete linguistic units”.
These are the necessary skills for normal speech acquisition for child:
1. Make the association between the sound of the native language and meaning that can be
expressed with those sounds.
2. Make the association between sounds of the child generates and the movements of the
vocal tract
3. Make the association between the sounds the child produces and the meaningful units of
the language, and
4. Adapt their productions to changes to their own vocal tract (e.g,adjust for their growth).
Testing speech sound discrimination:
Testing speech sound discrimination ability becomes part of the clinician assessment battery. 3
frequently used tests are ,
1. The Wepman Auditory Discrimination Test (Wepman, 1973)
2. The Templin Test of Auditory Discrimination (Templin, 1957)
3. The Goldman-Fristoe-Woodcock Test of Auditory Discrimination (Goldman, Fristoe, &
Woodcock, 1970)
The key issue in speech sound discrimination testing hinges on the nature of the stimuli material
to the subject for discrimination response.
In general, there are two types of discriminative stimuli.
1. Consists of pair of words or syllables that include a wide of stimulus sounds.
The examiner utters the pairs and the client responds by saying “same” if they are perceived as
different.
Examples
In the Wepman Auditory Discrimination Test, the subject is presented with 40 pairs of similar-
sounding words.
Examples are, tub-tug, web-wed, lag-leg, gum-dumb, coast-toast.
 2. The client to make discrimination test requires the client to make discrimination between
the correct form of this error sounds, including the incorrect form, this type of test is phoneme
specific and is called a test of internal discrimination.
Before concluding the discussion of speech sound discrimination, it seems to suggest future
directions these procedures may take.
The basic task for the children who served as subjects was to identify phonemes, as opposed to
making comparative judgements as required in discrimination tasks, the child may perceive them
as two allophones of the same phonemes between the child’s acceptable range for a given
phoneme may be different from that of adults.
Phonological contrast therapy:
A phonological distinctions or phonological contrast refers to differences between sounds of
a language that signal semantic intent.
Children with phonological disorders make speech sound errors that interfere with their
intelligibility and ability to communicate. A child with a phonological disorder might pronounce
the words ship, sip, chip and tip as the same word, tip.
The /s/ in sip and the /t/ in tip are made with the tongue tip in the same position. As a result
of simplified sound and word productions, children are unable to signal different meanings
among some similar-sounding words.
Activities for therapy:
The activities used in this therapy and its effectiveness in highly communicative, interactive
contexts, make it a widely accepted strategy when treating phonological disorders.
Two different activities are available for phonological contrast intervention:
1. Picture Naming Tasks
2. Contextualized Theme-Based Activities
PICTURE NAMING TASK:
Phonological contrast interventions expose children to contrasting words(such as cop vs.
top) in drill-like tasks. Clinicians arrange activities that produce contrasts in phonemes (e.g., /z/
vs. /d/) to convey different words (e.g., zip vs. dip)
In these activities, children encounter different word meanings as they label pairs of picture
cards. While some labelling of paired picture cards occurs in game-like tasks, the picture naming
places emphasis on production of isolated words.
Contextualized Theme-Based Activities:
Natural communicative contexts are a great therapy tool. Early on in an intervention,
clinicians can plan sessions that emphasize the need to communicate. Creating an interactive,
theme-based activity gives children reasons to make meaningful word contrasts while they talk
about their experiences.
Ship Trip:
In taking an imaginary “ship trip,” players can skip to a ship; slip getting on the ship; and feel
the ship tip, dip, and drip as it zips along. When children encounter opportunities to use certain
words in a communicative context, they realize the impact that sound contrasts make in
signalling different meanings.
Snack Shack:
Children might be placed in an imaginary context such as operating a snack shop where they
pack, sell, serve, and eat snacks. The SLP and the child converse as they take on different shop
roles and strive to achieve goals.
Depending on the error pattern(s), the child may be given the opportunity to contrast words
with and without blends (e.g., snack or smack vs. sack) or words with phonemes made in a
different place or manner (e.g., whack, rack, lack, sack, tack). The clinician and child interact as
they whack open sacks or boxes with snacks to stack on a rack, pack snacks in sacks, discover
tacks (pictured on cards) in a sack with snacks, and stack and smack on snacks that crack.
Producing Target Sounds and Meanings:
Children with phonological disorders need to learn to signal differences in meaning in
interactive contexts where words achieve communicative purposes. Interactive playful contexts
can help clinicians guide children toward this goal. Signalling differences in meaning engages
children and motivates them to produce targeted sound changes. In planning the theme-based
play contexts, clinicians can elicit targeted words and sounds in interactive exchanges even at
initial stages of intervention.13 Using conversational exchanges within meaning-based activities
can draw children’s attention to phonemic contrasts and capitalize on functions to elicit correct
pronunciation.
 G) STIMULABILITY TESTING
 Stimulability testing examines the child’s ability to produce or imitate a misarticulated
sound correctly when a model is provided be the clinician. It provides information about
how well the individual imitates the sound in one more contexts (e.g. isolation, syllable,
word, phrase) and helps determine the level of cueing necessary to achieve the best
production (e.g. auditory model; auditory & visual model; auditory, visual and verbal
model; tactile cues). There are few standardized procedures for testing stimulability
(Glaspey & Stoel- Gammon, some test batteries include stimulability subsets.
Stimulability testing is used to:
 Determine if the sounds(S) are likely to be acquired without intervention,
 Select appropriate therapy targets,
 Predict improvement in therapy.

How to conduct a Stimulability Test:

 This is a simple test which is used to determine whether or not a person may have
difficulties articulating particular speech sounds. It is quick (no more than 10 minutes) &
easy to administer, as follows:
 Choose a quiet place to work – one without any distraction (e.g. children playing nearby,
telephone that are likely to ring, too many interesting objects in the room).
 Sit opposite the person begin tested so that they can see your face clearly.
 Ask them to, “Look at me & listen carefully. I am going to say some sounds & I want
you to say them back to me.”
 Then go through the whole list of 24 English consonant sounds in table no 1, saying them
clearly one at a time. So, you would start by saying ‘p’ and have the person repeat the
sound back to you. Then you would say ‘b’ and have the person repeat the sound back to
you…and so on.
 Remember to say each consonant in isolation, i.e. do not add a vowel to the sound. For
example ‘p’ should not be said as ‘puh’, but simply as ‘p’; ‘v’ should not be said as ‘vuh’
but simply as the long sound ‘vvvvvv’.
 Make a note of whether or not the person being tested is able to imitate a sound properly
by placing a tick in the appropriate cell in Table 1.
 If a sound is not produced correctly, make a note of which sound (if any) they produced
instead.
 If the person being tested does not respond to any particular sound, gently persuade them
to repeat it by saying, “Listen again, this is the sound I want to say.” Simply record this
as ‘NR’ (no response) and move on to the next sound in the list.
How to interpret the results:
 If the person is able to articulate a particular speech sound then he or she cannot have a so
so-called phonetic disorder. Only if the person cannot articulate a sound would they be
described as potentially having an articulation disorder or articulation difficulty, i.e. a
phonetic difficulty

 Of course, the stimulability test presented above only assesses consonants. It is possible
that a person may have difficulties articulating vowels. Since vowels are open sounds that
are produced with no obstruction to the airflow from the lungs as is escapes through the
 vocal tract, such difficulties are less common. However vowel distortion can be feature of
dyspraxia (the reduced ability to perform purposeful movements of the vocal tract that
cannot be attributed to the impairments of motor or sensory functions) and dysarthria
(reduced precision, range and speed of movement of the vocal apparatus due to
neurological impairment).
Note: As dyspraxia is often characterized by a learned skill, some authorities classify oral
dyspraxia (verbal dyspraxia; developmental articulatory dyspraxia) as cognitive disorder
 H) NEED FOR INTERVENTION
(Speech Intelligibility and Speech severity Assessment)
Introduction:
 Measures of severity and intelligibility can be especially helpful in documenting the
necessity for or progress in therapy
 Measures of severity and intelligibility can be selected that meet the specific needs of the
age and the speech status of the particular client

Measures of intelligibility:
 Intelligibility refers to a judgment made by a clinician based on how much of an
utterances can be understood.
 Measurements of the degree of speech intelligibility are based on a subjective, perceptual
judgment that is generally related to the percentage of words that are understood by the
listener.
 Factors influencing speech sound intelligibility include the number , type , and
consistency of speech sound error.(Bernthal ,Bankson ,& Flipson, 2009)
 The number of errors is related to the overall intelligibility. However, just adding up the
error does not yield an adequate index of intelligibility. For Example: Shriberg and
Kwiatkowski (1982a, 1982b) reported a low correlation between the percentage of
consonants correct and the intelligibility of speech sample.

The intelligibility of an utterance is influenced by several factors. Connolly (1986) lists the
following:

Loss of phonemic contrasts.

Loss of contrasts in specific linguistic contexts.

The no. of meaning distinctions those are lost due to the lack of phonemic contrasts.

The difference between the target and its realization.

The consistency of the target – realization relationship.

The frequency of abnormality in the client’s speech.

The extent to which the listeners is familiar with the client’s speech.

The communicative context in which the message occurs

Although intelligibility remains essentially a subjective evaluation, many authors
have attempted to quantify it and to apply their results to a wide array of children and
adults with communications disorders.
MEASURES OF SEVERITY:
 Articulatory competency can be measured by different severity classifications.
 Severity measures are attempts to quantify the degree of involvement.
  Shriberg and Kwiatkowski (1982a, 1982b) originally developed a metric for
measuring the severity of involvement in children with phonological disorders. They
suggest calculating the percentage of consonants correct (PCC).
 Based on research, this type of calculation was found to correlate most closely to
listener’s perceptions of severity. This concept was later expanded to other measures.

Quantitative estimates of severity using the PCC give the clinician an objective measures to
establish the relative priority of those who might need therapy, for example.
The PCC calculations can be translated into the following severity divisions:
 #>90% Mild
 65-85% Mild- Moderate
 50-65% Moderate- Severe
 #<50% Severe
In spite of the fact that there is not a general procedure for measuring intelligibility, the
percentage of words understood in a speech sample is a common way to calculate intelligibility
(Gordon- Brannan, 1994).
Intelligibility can be categorized according to several indices. The following is based on the
frequency of occurrence of misarticulated sounds (Fudala, 2000):
 LEVEL 6- Sound errors are occasionally noticed in continuous speech.
 LEVEL 5-Speech is intelligible, although noticeably in error.
 LEVEL 4-Speech is intelligible with careful listening.
 LEVEL 3-Speech intelligible is difficult.
 LEVEL 2-Speech is usually unintelligible.
 LEVEL 1-Speech is unintelligible.

Kent, Miolo & Bloedel (1994) summarized a no. of procedures that have been used to asses
intelligibility. The following are selected for the purpose at hand.
 Procedures that emphasize phonetic contrasts analysis
 Procedures that emphasize phonological process analysis
 Procedures that emphasize word-level intelligibility.

PROCEDURES THAT EMPHASIZE PHONETIC CONTRAST ANALYSIS:

 CID Word Speech Intelligibility Evaluation (Word SPINE), for children and
adolescents with severe and profound hearing impairments, Monsen, 1981.
 CID Picture Speech Intelligibility Evaluation (Picture SPIN), for children and
adolescents with severe and profound hearing impairments, Monsen, Moog, & Grees
1981.
 Ling s Phonologic and Phonetic Level Speech Evaluation (PPLSE), for hearing –
impaired individuals, Ling, 1976.
 Children s Speech Intelligibility Test (CSIT) , for children of any age , especially for
very young children or children with cognitive or motor limitations ,Kent , Miolo , &
Blodel 1994
PROCEDURES THAT EMPHASIZES PHONOLOGICAL ANALYSIS:
 Assessment Of Phonological Processes-Revised (APP-R), for children with object –
naming competence, Hodson &Paden, 1983.
 Functional Loss (FLOSS), for children with limited phonological systems, Leinonen-
Davis 1988.
 The RULES Phonological Evaluation, for children with phonological disorders, Webb &
Ducket, 1990.
 Vihman – Greenlee Phonological Advance Measure, for children, especially those with
phonological disorders, Vihman & Greenlee, 1987.

PROCEDURES THAT EMPHASIZE WORD – LEVEL INTELLIGIBILITY:

 Assessment O Intelligibility of Dysarthria Speech, for adults & other children,
Yorkston&Beukelman1981.
 Preschool-Speech Intelligibility Measure (P-SIM), for preschool children , Wilcox ,
Schooling, & Mooris, 1991.
 *Weiss Intelligibility Test (WIT)/for children & adolescents, Weiss, 1982.
 Phonological Mean Length Of Utterances (PMLU) & the proportion of Whole-Word
Proximity(PWP), for children primarily , Ingram and Ingram , 2001

I) FACTORS AFFECTING TARGET SELECTION

CONTENTS:
 Stimulability
 Contextual Testing
 Developmental Appropriateness
 Frequency of Occurrence
 Phonological Pattern/Process Analysis.

Stimulability:
 Stimulability testing examines the child’s ability to produce or imitate a
misarticulated sound correctly when a model is provided by the clinician. It provides
information about how well the individual imitate the sound in one or more context
and helps determining the level of cueing necessary to achieve the best production.
 Stimulability testing has been used (1) to determine whether a sound is likely to be
acquired without intervention, (2) to determine the level and/or type of production at
which instruction might begin, and (3) to predict the occurrence and nature of
generalization. In other words, these data are often used when making decisions
regarding case selection and determining which speech sounds to target in treatment.
 Stimulability has also been found to be an important factor in generalization.
 Powell, Elbert, and Dinnsen (1991) reported that stimulability was the most decisive
variable they examined in explaining generalization patterns and could be used to
 explain and predict generalization patterns. They concluded that clinicians should
target non-stimulable sounds first because non-stimulable sounds are unlikely to
change, whereas children can self-correct many stimulable sounds during treatment
even without direct instruction on those stimulable sounds
Contextual Testing:
 Contextual influences are based on the concept that sound productions influence each
other in the ongoing stream of speech. McDonald (1964a) and others have suggested
that valuable clinical information can be gained by systematically examining a sound
as it is produced in varying contexts.
 An informal contextual analysis can be performed by reviewing a connected speech
sample for contexts in which a target sound is produced correctly. Occasionally,
facilitating contexts can be found in conversations that are not observed in single
words or word-pairs.
 For example, the /s/ sound might be incorrect in production of /sʌn/ but be produced
correctly when the /s/ sound is juxtaposed with /t/ as in /bæts/ or /stɔp/.
 Contextual testing is conducted to determine phonetic contexts in which a sound error
may be produced correctly. These contexts can then be used to identify a starting
point for remediation. Contextual testing is also used as a measure of consistency of
mis-articulation.
Developmental Appropriateness:
 Many clinicians follow what is sometimes called developmental logic. That means
they assume that therapy should mimic the normal developmental sequence. At some
point in development, children typically produce some errors.
 Our goal is to determine whether particular speech sounds have been mastered that
should have been mastered at the child’s current age.
 Any sounds that are deemed to be behind are then rank ordered from most to least
behind and then treated in that order. In other words, target those sounds that are
normally acquired earliest in the developmental sequence. A similar approach can be
taken with phonological patterns (i.e., treat the earliest patterns that typically
developing children no longer use).

Frequency of Occurrence:
 Another factor used in target sound selection is the frequency with which the sounds
produced in error occur in the spoken language. Obviously, the higher the frequency
of a sound in a language, the greater its potential effect on intelligibility. Thus,
treatment should have the greatest impact on a client’s overall intelligibility if
frequently occurring segments produced in error are selected for treatment.

Phonological Pattern/Process Analysis:

 phonological pattern analysis is a method for identifying commonalities among
errors. There are differences in pattern terminology & listening of phonological
patterns employed by various author. There are some most of the common patterns
 seen in normally developing children & have been commonly used in analyzing the
sound error.
Some of the patterns are:
 Whole Assimilatory (Harmony) Patterns.ord (and Syllable) Patterns, Segment Change
(Substitution) Patterns.
 Young children during the phonological acquisition stage simplify their productions
as they learn the adult phonological system. When such phonological simplifications
(processes/patterns) persist in a child’s speech sound productions,
 They can be a useful clinical tool for at least two reasons First, we can use them to
help determine whether a child is eligible for services by comparing their occurrence
to developmental norms Second, if we notice that a particular pattern such as final
consonant deletion occurs frequently and includes a variety of different final
consonants,
 Thus, identifying phonological patterns can be a useful clinical tool for both
assessment and treatment
 The first step in a phonological pattern analysis is to examine each error to determine
what pattern(s) might be present and how frequently they occur
 Next, the clinician should determine whether intervention for the pattern use is
warranted. If a formal test with normative data was used in the assessment, the scores
on the test can be compared to local eligibility criteria
J) CASE STUDY
(Documenting the assessment findings and determining the need for intervention)
The precise format, style, scope, length, and degree of detail needed for a diagnostic report varies
across settings, university programs, and even different supervisors in the same setting. In some
situations (e.g., individualized family service plans [IFSPs] and individualized education plans
[IEPs]), the structure of a report is dictated by a particular clinic or agency. In other situations,
clinicians write reports according to their own style and preferences, regardless of the style of the
report. Most assessment or diagnostic reports have a similar format and generally present the
same basic information, which includes the following components:
Identifying Information:
 Name
Date of birth/age
School/teacher/grade (if appropriate)
 Address
 Phone numbers
 Email addresses
 Physician(s)
 Billing party (if appropriate)
 Diagnostic code (if appropriate)
 Date of evaluation

Overview/Background/Presenting Complaint/Initial Status:

  Referral source
 Dates and locations of previous evaluations and treatment
 Presenting complaint (unintelligible speech, disfluency, voice problem, etc.)

Histories:
 Speech, language, and hearing
 Medical Educational
 Psychological/emotional
 Developmental/motor
 Family
 Social
 Occupational (adult)

Assessment Information:

Articulation and Phonological Processes

Phoneme productions in isolation, syllables, words, phrases, and conversational
speech
 Overall intelligibility
 Identification and analysis of sound errors
 Consistency of sound errors
 Influence of co-articulation
 Patterns of sound errors (error types, severity of errors, phonological processes)
 Stimulability for correct phoneme production
Language:
 Receptive language, including information from formal and informal evaluations,
primarily of semantics and syntax
 Expressive language, including information from formal and informal language
 samples of semantics, syntax, and morphologic features
 Pragmatics
 Literacy
 Cognition, including nonverbal cognitive abilities, use of metacognitive strategies,
 memory, and attention
Fluency:
 Types and frequencies of disfluencies
 Associated motor behaviors (hand movements, eye blinking, etc.)
 Avoidance of sounds, words, or situations, anticipation of disfluency
 Speech rates with and without disfluencies
 Stimulability for fluent speech
Voice:
 Pitch, quality, and loudness
 Resonance
 Breath support
 Muscular tension
 Stimulability for improved voice
Dysphagia:
 Feeding
 Chewing
 Deglutition
 Food textures tolerated and/or not tolerated
 Position
 Graphic assessment
 Compensation stimulability

Oro-facial Examination:
 Structures and functions that affect speech and swallowing production
 Peripheral areas (if appropriate)for example, hand and arm movements that indicate
alternative communication potential
Hearing:
 Hearing screening or summary of audiological assessment
 Middle ear status, including Otoscopic findings
Summary:
 Statement of diagnosis
 Concise statement of most significant findings
 Prognosis
Recommendations:
 Treatment (including frequency, duration, and goals), no treatment, recheck at a later
time
 Referral to other professionals
 Suggestions to the client and caregivers

Diagnostic Evaluation
Name: XXX
Date; YYY
Birthdate: 4-2-20xx Clinic File No.: 12345
Age: 7 years, 5 months
Diagnosis: Fluency Disorder
Address; ZZZ Phone:
(xxx)
Presenting Complaint: Adam, a 7-year 5-month-old male, was seen for a speech-language
evaluation at the University Clinic on September 14, 20xx. He was accompanied by his mother.
Adam attended Holt Elementary School and received speech therapy two times per week for
remediation of disfluent speech. Mrs. McCune reported that Adam began stuttering at
approximately 3 years of age. She also stated that his stuttering fluctuated and increased during
stressful situations. Mrs. McCune stated that her father also stuttered. Adam’s medical history
was unremarkable
Assessment Findings Speech: The Goldman-Fristoe Test of Articulation-2 was administered to
assess Adam’s production of consonants in fixed positions at the word level. Adam lateralized /s/
and /z/ in all positions. He substituted /nk/ for /n/ in the medial and final positions. Adam was
stimulable for /s/ and /z/ at the word level. A 384-word conversational speech sample revealed
similar errors. He also omitted /d/ and /t/ in the final position during connected speech. Adam
was 100% intelligible during
Oro-facial Examination: An oro-facial examination was administered to assess the structural
and functional integrity of the oral mechanism. Facial
features were symmetrical. Labial and lingual strength and range of motion were normal during
speech and non-speech tasks. Lingual size and shape were normal. Appropriate velar movement
was observed during productions of /a/.
Diadochokinetic syllable tasks were administered to assess rapid movements of the speech
musculature. Adam repeated /pøt´k´/ at a rate of 4.04 repetitions per second. This was within
normal limits for a child his age.
Language: The Peabody Picture Vocabulary Test-IV was administered to assess receptive
vocabulary. A raw score of 92 and a standard score of 108 were obtained. Age equivalency was
8:0 and percentile rank was 70. The results indicated average to above-average receptive
vocabulary skills. Analysis of the conversational speech-language sample revealed appropriate
expressive language skills. Syntactic, morphologic, and semantic structures of the language
were appropriate. Adam’s average length of utterance was 10.9 words. Voice: Adam exhibited a
normal vocal quality. An s/z ratio of 1.0 was obtained.

Fluency: A 384-word spontaneous sample was elicited to assess Adam’s fluency rate, and he
was 82% fluent on a word-by-word basis. Disfluencies averaged 2 seconds in duration with a
range of .8 seconds to 4 seconds. Disfluencies included: # Disfluencies Percentage Sound
Interjections 28 17.3% Word Interjections 11 10.3% Sound Repetitions 19 15.0% Word
Repetitions 18 12.1% Phrase Repetitions 18 12.1% Revisions 13 10.8% Prolongations 12 10.5%
Total 69 18.1% Adam was stimulable for fluent speech at the 3-syllable phrase level when he
was required to use an easy onset and syllable stretching
Hearing; A hearing screen was administered at 20 dB HTL for the frequencies of 250, 500,
1000, 2000, 4000, and 6000 Hz. Adam responded to all sounds bilaterally.
Summary and Recommendations; Adam exhibited moderate disfluency characterized by
sound interjections and sound, word, and phrase repetitions. He was stimulable for fluent speech,
which suggests a good prognosis for improvement with therapy. Adam also exhibited mild
articulatory errors of substitutions and additions. He was stimulable for all phonemes. Expressive
and receptive language abilities were age appropriate. It was recommended that Adam receive
speech therapy to train fluent speech and correct his articulation errors.