Deck 2: Classification, Causes, and Co-Occurrence

Question 1

Complete the following table:
$\begin{array}{|l|l|l|}\hline \text { Type of speech sound disorder } & \text { Description } & \begin{array}{l}\text { Example of a speech error } \\\text { characteristic of this type of } \\\text { speech sound disorder }\end{array} \\\hline \text { phonological impairment } & & \\\hline \text { inconsistent speech disorder } & & \\\hline \text { articulation impairment } & & \\\hline \text { childhood apraxia of speech } & & \\\hline \text { childhood dysarthria } & & \\\hline\end{array}$

Answer 1

Here is the completed table with descriptions and examples for each type of speech sound disorder:

$$\begin{array}{|l|l|l|}\hline\textbf{Type of speech sound disorder} & \textbf{Description} & \textbf{Example of a speech error characteristic of this type of speech sound disorder} \\\hline\text{Phonological impairment} & Difficulty in the sound system of a language and the rules that govern the sound combinations. & Using "tup" for "cup" (substitution of /t/ for /k/ sound). \\\hline\text{Inconsistent speech disorder} & Variability in producing the same words correctly across different attempts without a consistent pattern. & Saying "kite" as "tike," "kite," or "kide" on different occasions. \\\hline\text{Articulation impairment} & Difficulty with the physical production of specific speech sounds. & Difficulty pronouncing the "r" sound, resulting in "wabbit" for "rabbit." \\\hline\text{Childhood apraxia of speech} & A motor speech disorder where children have difficulty planning and coordinating the movements needed for speech. & Inconsistent errors, such as difficulty stringing syllables together in the correct order, resulting in "pasketti" for "spaghetti." \\\hline\text{Childhood dysarthria} & A motor speech disorder resulting from neurological damage that causes weakness, paralysis, or poor coordination of the muscles for speech. & Slurred or slow speech that can be difficult to understand, such as "shun" for "sun." \\\hline\end{array}$$

This table provides a brief overview of different speech sound disorders, their descriptions, and examples of speech errors that are characteristic of each disorder.

Question 2

List the three key features of childhood apraxia of speech in ASHA's (2007) childhood apraxia of speech position statement.

Answer 2

The American Speech-Language-Hearing Association (ASHA) released a position statement in 2007 on Childhood Apraxia of Speech (CAS), which is a motor speech disorder that makes it difficult for children to speak. According to ASHA's 2007 position statement, the three key features of childhood apraxia of speech are:

1. Inconsistent errors on consonants and vowels in repeated productions of syllables or words: Children with CAS often do not consistently produce the same speech errors. For example, they may say a word correctly once, but then have difficulty repeating it the same way subsequently, resulting in various pronunciations of the same word or sound.

2. Lengthened and disrupted coarticulatory transitions between sounds and syllables: Children with CAS may exhibit abnormal timing in the transition from one sound or syllable to another. This can result in pauses, prolongations, or disruptions in the rhythmic flow of speech, making their speech sound choppy or disjointed.

3. Inappropriate prosody, especially in the realization of lexical or phrasal stress: Prosody refers to the rhythm, stress, and intonation of speech. Children with CAS may struggle with the appropriate use of prosody, which can affect the naturalness and intelligibility of their speech. They might place stress on the wrong syllable or word, or have a monotone speech pattern, which can make it difficult for listeners to understand the intended meaning.

These features are used to help differentiate CAS from other types of speech sound disorders. It is important to note that not all children with CAS will exhibit all three features, and the presence of these features alone does not necessarily confirm a diagnosis of CAS. A comprehensive evaluation by a speech-language pathologist is necessary to accurately diagnose and treat childhood apraxia of speech.

Question 3

What is the difference between speech sound disorder and speech difference?

Answer 3

Speech sound disorder and speech difference are two distinct concepts related to the way individuals produce spoken language. Understanding the difference between the two is important for proper diagnosis and intervention.

**Speech Sound Disorder:**
A speech sound disorder occurs when a person has difficulty producing certain sounds correctly. This difficulty is not due to a physical disability, such as a cleft palate, or a neurological disorder, but rather to a problem with the perception, motor production, or phonological representation of speech sounds. Speech sound disorders can be categorized into two types:

1. Articulation Disorders: These involve problems with the physical production of sounds. The person may substitute one sound for another, omit a sound, add a sound, or distort a sound. For example, a child might say "wabbit" instead of "rabbit" or "thoap" instead of "soap."

2. Phonological Disorders: These involve patterns of sound errors. For example, a child might have trouble with all sounds that require the lips to come together, like "p," "b," and "m." They might replace these sounds with others that are produced in the back of the mouth, like "k" and "g."

Speech sound disorders can affect a person's ability to be understood, which can impact communication and social interaction. They are often identified in early childhood and can be treated with speech therapy.

**Speech Difference:**
A speech difference, on the other hand, is a variation in speech that is characteristic of a particular group of people and is not considered a disorder. Speech differences can be attributed to a person's dialect, accent, or language background. For example, someone might pronounce words differently because they are from a different region or country, or they speak a different language at home. These differences do not interfere with communication and are a natural part of linguistic diversity.

Speech differences are not indicative of a speech or language disorder and do not require intervention. However, it is important for educators and clinicians to recognize and respect speech differences to avoid misdiagnosing them as disorders.

In summary, a speech sound disorder is a difficulty with the production of speech sounds that can affect intelligibility and requires intervention, while a speech difference is a variation in speech that reflects a person's cultural or linguistic background and is considered a normal part of language diversity.

Question 4

Explain the difference between a phonological delay and phonological disorder.

Question 5

List four other terms synonymous with residual articulation errors.

Question 6

List six subtypes of childhood dysarthria.

Question 7

List the six interacting components of the Children and Youth Version of the International Classification of Functioning, Disability and Health (ICF-CY) (WHO, 2007)

Question 8

List six known origins of speech sound disorders in children.

Question 9

Describe two types of communication disorders that can co-occur with speech sound disorders.

Question 10

Explain what is meant by the critical age hypothesis.

Question 11

Discuss the difference between phonological delay, phonological disorder and inconsistent speech (phonological) disorder, and, using recent research compare and contrast the literacy outcomes for each type of phonology-based speech sound disorder.

Question 12

What is the nature of the difficulty for children with an articulation impairment involving sibilants or rhotics? Consider research literature on speech perception and speech production.

Question 13

Compare and contrast definitions and key symptoms of childhood apraxia of speech by different researchers, and the implications of the controversy around the key symptoms of childhood apraxia of speech for assessment, diagnosis and intervention.

Question 14

Discuss the similarities and differences between inconsistent speech disorder, childhood apraxia of speech, and childhood dysarthria.

Question 15

Compare and contrast the four different speech sound disorders classification systems and explain why different classification systems exist.

Question 16

Using the Children and Youth Version of the International Classification of Functioning, Disability and Health (ICF-CY) (WHO, 2007), discuss what is known from research about the impact of speech sound disorders on children's Activities and Participation.

Question 17

Explain how environmental factors (e.g., products and technology, relationships, society attitudes, in addition to speech-language pathology services) could help or hinder children with speech sound disorders.

Question 18

What do we know about genes and speech sound disorders in children?

Question 19

Select one childhood genetic disorder or syndrome that has been associated with speech sound disorder (e.g., Down syndrome, Fragile X syndrome, Velocardiofacial syndrome, and galactosemia). Describe the genetic disorder or syndrome and associated speech difficulties.

Question 20

Select one type of communication impairment (e.g., expressive language impairment, stuttering), that can co-occur with speech sound disorders, and discuss the characteristics and outcomes for children with co-occurring impairments.

Question 21

Virginia (2;4 years) has recently been diagnosed with childhood dysarthria. This means that she has:

A) an articulation impairment associated with the distortion of all speech sounds.
B) a genetic syndrome impacting her oral structure and function.
C) a motor-speech disorder due to paralysis, weakness, or incoordination of speech muscles caused by central or peripheral nerve damage.
D) spastic cerebral palsy due to anoxia at birth.

Question 22

Owen (4;5 years) pronounces the same word in different ways and can be difficult to understand. Although he has quite a good phonetic inventory, he does not have consistent error patterns in his speech. His prosody is intact, and his imitated productions of words are better than his spontaneous productions. In light of these observations, Owen most likely has:

A) inconsistent speech disorder.
B) phonological impairment.
C) articulation impairment.
D) expressive language impairment.

Question 23

Jasper (5;1 years) is monolingual and speaks English. He has a severe phonological disorder (rather than delay). Which of the following productions of the word juice most likely reflects Jasper's production?

A) juice // $\rightarrow$ [u?]
B) juice /11ee98b2_2d82_eeae_a6de_29ea8c196f60_TB9704_11/ $\rightarrow$ [3us]
C) juice /11ee98b2_2d82_eeae_a6de_29ea8c196f60_TB9704_11/ $\rightarrow$ [dzus]
D) juice /11ee98b2_2d82_eeae_a6de_29ea8c196f60_TB9704_11/ $\rightarrow$ [dus]

Question 24

Rueben (8;5 years) has difficulty clearly articulating the // in his name. He says [] instead of //. An articulation assessment revealed that Rueben derhotacized /11ee98b2_5efb_931f_a6de_437abf30e255_TB9704_11, , /. No other speech production errors were detected. Rueben has no prior history of speech, language or literacy difficulties. In light of these observations Rueben most likely has:

A) phonological impairment.
B) childhood dysarthria.
C) childhood apraxia of speech.
D) articulation impairment.

Question 25

Childhood apraxia of speech, is best characterized by:

A) inconsistent errors on consonant and vowels, syllable segregation and stress equalization.
B) consistent use of numerous substitution and syllable structure phonological processes.
C) breathy and strained voice quality.
D) distortions of sibilants and rhotics.

Question 26

Paxton (5;5 years) has inconsistent speech disorder and Jeremy (5;3 years) has childhood apraxia of speech. What speech characteristic would help separate Paxton's type of speech sound disorder from Jeremy's type of speech sound disorder?

A) Paxton would have lexical inconsistency but appropriate prosody, whereas Jeremy is likely to have lexical inconsistency and dysprosody.
B) Paxton would have vowel distortions whereas Jeremy would have sibilant distortions.
C) Paxton would have consonant omission errors whereas Jeremy would have syllable omission errors.
D) Paxton would have lexical inconsistency and dysprosody whereas Jeremy would be lexically consistency but have reversal errors in polysyllables.

Question 27

Depending on a child's symptoms, childhood dysarthria may be classified as:

A) flaccid or spastic only.
B) hyperkinetic or hypokinetic only.
C) flaccid, spastic, hyperkinetic, hypokinetic, ataxic, or mixed.
D) ataxtic or mixed only.

Question 28

Harry (10;2 years) has moderate flaccid childhood dysarthria. Symptoms you would expect to observe in Harry's speech include:

A) adequate breath control for speech but distortion of sibilants and rhotics.
B) adequate breath control for speech but syllable segregation and stress equalization.
C) inconsistent production of consonants and vowels in words.
D) breathiness, nasalized speech, monopitch, inappropriate loudness (too soft) and imprecise articulation.

Question 29

Poppy (9;3 years) has spastic childhood dysarthria. Chloe (9;5 years) has childhood apraxia of speech. In contrast with Chloe, Poppy would most likely have:

A) appropriate loudness and pitch but difficulty with lexical stress.
B) inappropriate loudness (too soft) and pitch (too low).
C) appropriate resonance but difficulty with emphatic stress.
D) inappropriate phrasing but an appropriate voice quality.

Question 30

The components of the Children and Youth Version of the International Classification of Functioning, Disability and Health (ICF-CY) (WHO, 2007) include:

A) Body Function, Body Structure, Activities, Participation, Environmental Factors and Personal Factors.
B) Impairment, Delay, Disorder, Function, Activities, Participation and Barriers.
C) Body Structure, Impairment, Activities, Participation, Barriers and Personal Factors.
D) Body Function, Body Structure, Barriers, Facilitators, Personal and Environmental Factors.

Question 31

The Body Structure component of the Children and Youth Version of the International Classification of Functioning, Disability and Health (ICF-CY) (WHO, 2007) refers to:

A) the skeletal system.
B) the organization of the body into different structures such as arms, legs and torso.
C) anatomical parts of the body (e.g., ears, eyes, lungs, liver, limbs) and their components.
D) anatomical structures of the body including bones and cartilage.

Question 32

Speech characteristics common for children with cleft lip and palate include:

A) hypernasality and abnormal nasal airflow during speech.
B) syllable segregation and stress equalization.
C) vowel distortions and dysprosody.
D) inconsistent productions of the same word.

Question 33

Children with cleft lip and palate tend to have compensatory errors in their speech such as:

A) vowel distortion and stress equalization.
B) glottal stop substitution and backing.
C) increased use of high pressure consonants.
D) increased aspiration on plosives.

Question 34

Issues that are thought to complicate the speech difficulties experienced by children with Down syndrome include:

A) increased occurrence of respiratory infections.
B) structural problems with the heart.
C) increased occurrence of otitis media, hypotonicity, and anatomical variations.
D) astigmatism and hypothyroidism.

Question 35

A sensorineural hearing loss is associated with:

A) reduced or distorted transmission of the sound in the inner ear.
B) reduced or distorted transmission of the sound in the middle ear.
C) reduced or distorted transmission of the sound through the external ear canal.
D) otitis media with effusion (glue ear).

Question 36

The link between speech sound disorders and otitis media with effusion (OME or glue ear) is:

A) unclear.
B) clear and well-established.
C) irrelevant.
D) non-existent.

Question 37

If a child has Moebius syndrome, the child may also have:

A) childhood apraxia of speech.
B) phonological impairment.
C) childhood dysarthria.
D) inconsistent speech disorder.

Question 38

Victor (7;8 years) has high functioning autism and is likely to have:

A) poorer prosodic skills compared with typically developing children.
B) prosodic skills commensurate with typically developing children.
C) an advanced ability to produce polysyllables compared with his typically developing peers.
D) slow speech rate and breathy voice compared with his typically developing peers.

Question 39

Compared with children with phonological impairment only, children with concomitant language and phonological impairment tend to have:

A) more substitution errors.
B) more atypical errors.
C) more distortion errors.
D) more omission errors.

Question 40

Santiago (3;2 years) has childhood dysarthria. Carter (3;9 years) has a phonological impairment. With regards to oral structure and function, Santiago is more likely than Carter to have difficulties with:

A) the structure of his palate.
B) oral function.
C) speech perception.
D) neither oral structure or oral function.