Linguistic-Based Treatment for Phonological Disorders

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Table of Contents

Introduction
Phonological Disorder
Classification of Phonological Disorder
Symptoms of Phonological Disorder
Treatment for Phonological Disorder
Conclusion
References

Introduction

Language development is a process that begins at a very early age. This subject has been researched by several researchers and as a result, there are several theories proposed by them. In general, a person begins to acquire language by learning it as it is spoken and by mimicry. As the development of language progresses it moves from simplicity to complexity. At the initial stage, infants start without language, however, in a few months children can read lips and discriminate speech sounds.

In general, we hear children making simple words that may not necessarily have any specific meaning. As and when they age, words acquire meaning, and connections between words are formed and then later on they begin to form simple sentences which are joined together to create logical meaning. As the child grows up, new meanings of words and sentences and new associations are created. As a result of these exercises vocabulary increases and the child is able to communicate easily.

On average a normal child becomes remarkably capable communicators during the first three years of their life. However, there can be a difference from one child to another as it invariably depends on how the parent or the caretaker interacts with them. During the first three years, children use body language, sign language, painting, drawing and mark-making, and oral expression, and sometimes a combination of these to express their needs. In fact, it can be said that child starts learning right from the womb where they have been acutely active listeners where they learned to recognize the speech patterns, tunes, and tones of the languages especially of the mother and other people in the home (The National Literacy Trust, 2007).

The concept of language development has initiated several arguments and as a result, several theories have emerged. For instance, linguists do not agree on what biological factors contribute to language development, however, most of them do agree that the ability to acquire such a complicated system is unique to the human species. Besides, the ability to learn a language may have been evolved from the ancestors through the evolutionary process.

They also assume that the foundation for language may be passed down genetically. Social interaction is a precondition for the development of language which is agreed upon by all linguists. It is important that children are allowed to interact with other people to be able to develop their basic skills with language. In other words, it is important for children to spend time and effort with other people that allow them to communicate socially in a particular language.

Between the age of two and three most of the children are able to use language to influence the people closest to them, indicating the links with brain development and they’re growing ability to attract others and gain their attention. In other words, they are beginning to understand the minds of their parents, and their siblings and express their feelings much more clearly than they used to do in the first year of their life.

While this type of development is a typical form of language development, children with impaired mental and physical status find it difficult to acquire language as fast as normal children. In the case of such speech and language disorders in children, lifelong impairments can severely impact many aspects of life such as learning, education, behavior, relationships and self-esteem. It is especially true with children born with significant biological impairments such as blindness, deafness, and severe motor deficits.

However, these children also attain a range of basic abilities, such as representational thinking and language competence, in ways different from those experienced by children without such limitations. Experience proves that a good understanding of these problems can provide guidance for interventionists in their attempts to facilitate the adaptive development of young children with a wide variety of special needs, as well as in their efforts to extend constructive support to their parents (Gleitman, 1986).

Phonological Disorder

There are many children who are not able to follow this general trend and have problems developing good communication. Children who do not succeed to use age-specific speech and sounds and language may be diagnosed with phonological disorder. Statistics suggest that phonological disorder is among the most widespread speech disorders, affecting roughly about 10% of the preschool and school-age population. It is also suggested by researchers that this disorder is more common in boys than in girls (NIDCD, 1994).

Phonological disorder is often referred to as articulation disorder, developmental articulation disorder, or speech sound production disorder. Phonological disorder is characterized by an inappropriate sound production and use. For instance, a child with such a disorder may substitute unfamiliar sounds with other similar sounds in words (e.g., wed for red). They may also sometimes exclude unfamiliar sounds in words (e.g., back for black). For a child with severe cases of phonological disorder, the articulation may be impaired to such an extent that children experience social difficulties and difficulties making basic needs known to others (Encyclopedia of Mental Disorders, 2007).

In general, it is observed that these children have normal hearing and IQ. Even after years of studies the specific cause or causes of the articulation problem is still a mystery. In some cases, an obvious organic base can be found (Gierut, 1998) whereas in others a genetic component has been suggested as an etiological variable. Other contributing factors may be low socioeconomic status or it may also be the result of a large family (NIDCD, 1994).

Classification of Phonological Disorder

Studies have come out with various classifications based on their origin. For instance, if there is no known cause, it is called “developmental phonological disorder.” If the cause is known to be of neurological origin, the names given to the disorder are “dysarthria” or “dyspraxia”. In general, it is a disorder that is characterized by a child’s helplessness to create speech at a level expected of his or her age group because of an inability to form the necessary sounds. The severity of the phonological disorder is classified into several levels and ranges from speech that is completely beyond one understanding, even to a child’s immediate family members, to speech that can be understood by the ones who listen but in which some sounds are somewhat mispronounced.

Phonological disorder is often divided into three categories, based on the cause of the disorder. The disorder is sometimes caused due to structural problems, or abnormalities in the areas necessary for speech sound production, such as the tongue or the roof of the mouth. These structural abnormalities make it difficult for children to produce certain sounds. There are severe cases where it becomes impossible for a child to produce the sounds at all. In case of such disorders, it is important to set right the structural problem causing the phonological disorder before the child goes into linguistic-based treatment. It is often observed that in many cases the correction of the structural problem results in correction of the speech sound problem.

Another category of phonological disorder is mainly due to neurological problems. As a result of such disorder, the muscles of the mouth do not allow the child sufficient fine motor control over the muscles to produce all speech sounds. It is often observed that a child with such phonological disorder is able to communicate if the child undergoes linguistic-based treatment.

The third category of phonological disorder is due to an unknown cause. This is often called “developmental phonological disorder.” Although the cause is not known, there are certain assumptions. Researchers have predicted that this disorder may result from slight brain abnormalities, a child’s learning environment, and immature development of the neurological system (Encyclopedia of Mental Disorders, 2007).

Symptoms of Phonological Disorder

Symptoms of phonological disorder depend on the age of the child and vary considerably. It is often difficult to detect this disorder, as the child with phonological disorder develops speech sounds comparatively more slowly than his or her age group children. However, though late, he or she develops them in the same order. Therefore, it can be observed that speech that may be normal for a four-year-old child may be a sign of phonological disorder in a six-year-old.

Under normal circumstances, all normal children develop speech sounds in the same sequence. These sequences of sounds are classified into three main categories groups of eight sounds each: the early eight, the middle eight, and the late night. “The early eight include consonant sounds such as “m,” “b,”, and “p.” The middle eight include sounds such as “t,” “g”, and “chi,” and the late eight include more complicated sounds such as “sh,” “th,” “z,” and “Zh.” (Encyclopedia of Mental Disorders, 2007).

In general, it is observed that as the age advances the child develops these sounds and many of them do not normally finish mastering the late eight until they are seven or eight years old. Even though they master all three levels of sound, there are some very common mistakes made by them. Some of the most common mistakes are the omission of sounds, (i.e., frequently at the end of words), the distortion of sounds, or the substitution of one sound for another. Often the substitution is of a sound that the child can more easily produce for one they find it difficult (Encyclopedia of Mental Disorders, 2007).

Treatment for Phonological Disorder

It is the job of a speech-language pathologist to diagnose, treat and provide services to children with communication disorders, including speech, language, voice, fluency, and literacy difficulties. In general, speech pathologists need to perform tasks such as identifying the exact nature and severity of each child’s communication problems, which may require the use of special equipment and test plan and carry out treatment and management taking into account the age, social environment, and physical and intellectual abilities.

A speech-language pathologist is one who helps children with phonological disorders. Though the therapy may vary from child to child depending on an individual child’s needs, it is mainly overcome by practicing sounds. These therapists demonstrate the physical ways that the sound is made. For instance, they show where to place the tongue and how to move the lips. It is often seen that repetition of the difficult sounds with the therapist produces good results.

There are serious debates among the therapists as to teach first the complex sounds or the simple sounds. Whatever the case is it is observed that when the child develops a sense of accomplishment when these sounds are mastered, and they are will more willingly continue with treatment and develops a sense of confidence (Encyclopedia of Mental Disorders, 2007).

The classic shift from articulation to linguistic and psycholinguistic research has not been accompanied by complete descriptive accounts of the distal causes or etiologies of child speech-sound disorders (Shriberg, 2003). However, today it is said that “no matter what combination of difficulties a child with a developmental phonological disorder has, appropriate speech-language pathology treatment is usually successful in eliminating or at the very least, reducing the problem” (Bowen, 1998).

It is essential that a child with speech-sound disorders is diagnosed and treated at a very early stage as the treatment for the phonological disorder is important not only for the child’s development to be able to form speech sounds but for other reasons.

For instance, children who have trouble creating speech sounds may have academic problems in subject areas such as spelling or reading. Besides, these children may also be affected psychologically as they sound themselves different than their peers. They find themselves frustrated and ridiculed, and may become less willing to participate in common activities. Even if they attempt to mingle with other children, there are times when these children are made fun of.

Stoel-Gammon and Dunn (1985) have provided a precise summation of the characteristics of phonological therapy, saying that it: “Phonological therapy is based on the systematic nature of phonology; is characterized by conceptual, rather than motoric, activities; and has generalization as its ultimate goal”.

In a similar way, Fey (1992) suggested that “phonological therapy approaches are designed to nurture the child’s system rather than simply to teach new sounds”. However, it is Grunwell (1988) who had captured the real meaning of what taking a ‘phonological’ approach to intervention for developmental phonological disorders means when she wrote that, “The defining characteristic of phonological therapy is that it is ‘in the mind’”.

If we look at the history of interventions it can be said that the traditional treatments for children with phonological disorder involved a variety of interventions, but most of them arise from a motor-oriented framework (Klein, 1996b). Some of the techniques include the use of mirrors, tongue depressors, oral-motor exercises, sensory-motor training, modeling and imitation of speech and speech sounds, shaping via successive approximations, and chaining.

Phonologically based therapy or in other words linguistic-based treatment is a more recent approach to the treatment for phonological disorder (Creaghead, 1989; Fey, 1985). Fey (1992) stated that: “phonological therapy approaches are designed to nurture the child’s system rather than simply to teach new sounds”. Researchers have noted several differences that can be noted between the traditional and linguistic-based treatment contrasts to the more traditional approaches in several ways. In fact, the traditional approaches focus on teaching the child to articulate given words or sounds correctly, the phonological approach focuses on having the child change his or her rule system, using cognitive techniques such as semantic images (Klein, 1996a).

Researchers have pointed out that phonological disorder may be characterized by poor development of the echoic repertoire that is defined by its point-to-point correspondence between the preceding verbal stimulus and the verbal response (Skinner, 1957). It is often observed that children with the phonological disorder are not able to when compared to same-age peers to display accurate point-to-point correspondence between words heard and words said. In such cases, the speech pathologist plans the treatment accordingly to focus on improving the echoic repertoire. Studies have proven that it is possible through a series of vocal imitation training (Lovaas, 2003).

In general, in vocal imitation training, children with the phonological disorder are trained to repeat sounds and words emitted by the therapist, using procedures such as shaping, chaining, and prompting. Once this step of therapy is complete and the child acquires correct articulation, the subsequent focus is made to generalize the item across personnel, stimuli, settings, and verbal classes. This is essential since the vocal imitation training only may not produce such generalization (McReynolds, 1981).

In fact, it can be seen that different therapist’s program generalizations across personnel, and teach the same label using the same training stimuli. To program generalization across stimuli, the therapist varies the stimulus materials during training, whereas to program generalization across different settings, training is carried out in different environments, such as at school, at home, and in the community (Sarokoff, Taylor, & Poulson, 2001). It should be noted that in order to optimize the effects of such training, a vital programming goal in vocal imitation training is to set up a transfer of correct articulation from trained words to untrained words and this kind of transfer may be established through further training (Osnes & Lieblein, 2002;).

Language development is part of their holistic development, emerging from cognitive, emotional, and social interactions between the child and the world around them. A question that often worries parents of children with this most severe form of articulation and Phonological impairment is, will my child ever speak? It is seen that an articulation and phonological disorder is the most commonly encountered type of communication difficulty.

These occur as either an isolated developmental problem or as part of a larger collection of difficulties such as language disorders, mental retardation, respiratory problems, neurological injuries, cerebral palsy, and orofacial anomalies. However, it should be noted that treatment can help a child with Phonological impairment to overcome the difficulties to communicate.

Conclusion

The child’s physician will usually refer the child to a variety of specialists, including a speech-language pathologist, who performs a comprehensive evaluation of his or her ability to communicate and designs and administers treatment. No single treatment method has been found to successfully improve communication in these children. The best treatment begins early, during the preschool years, is individually tailored, targets both behavior and communication, and involves parents or primary caregivers. Finally, the goal of therapy should be to improve useful communication.

References

Bowen, C. (1998). Developmental phonological disorders: A practical guide for families and teachers. Melbourne: The Australian Council for Educational Research Ltd.)

Creaghead, N. (1989). Linguistic approaches to treatment. In N. Creaghead, P. W. Newman, & W. A. Secord (Eds.), Assessment and remediation of articulatory and phonological disorders (2nd ed., pp. 193–216). Columbus, OH: Merrill.

Encyclopedia of Mental Disorders (2007) Phonological disorder. Web.

Fey, M. E. (1985). Articulation and phonology: Inextricable constructs in speech pathology. Human Communication Canada, 9, 7–16. (Reprinted in Language, Speech, and Hearing Services in Schools, 23, 225–232).

Fey, M.E. (1992). Clinical Forum: Phonological assessment and treatment. Articulation and phonology: An addendum. Language Speech and Hearing Services in Schools, 23, 277 – 282.

Geirut, J. A. (1998). Treatment efficacy: Functional phonological disorders in children. Journal of Speech, Language, and Hearing Research, 41, S85– S100.

Gleitman, L.R. 1986 Biological pre-programming for language learning. Pp. 120-151 in The Brain, Cognition, and Education. S.L. Friedman, K.A. Kilvington, and R.W. Peterson, eds. Orlando, FL: Academic Press.

Grunwell, P. (1988). Comment on ‘Helping the development of consonant contrasts’. Child Language Teaching and Therapy, 4, 57-59.

Klein, E. S. (1996a). Clinical phonology: Assessment and treatment of articulation disorders in children and adults. San Diego, CA: Singular.

Klein, E. S. (1996b). Phonological/traditional approaches to articulation therapy: A retrospective group comparison. Language, Speech, and Hearing Services in Schools, 27, 314–323.

Lovaas, O. I. (2003). Teaching individuals with developmental delays: Basic intervention techniques. Austin, TX: Pro-Ed.

McReynolds, L. V. (1981). Generalization of articulation training. Analysis and Intervention in Developmental Disabilities, 1, 245–258.

National Institute on Deafness and Other Communication Disorders. (1994). National strategic research plan. Bethesda, MD: Department of Health and Human Services.

Osnes, P. G., & Lieblein, T. (2002). An explicit technology of generalization. The Behavior Analyst Today, 4, 364–374.

Sarokoff, R. A., Taylor, B. A., & Poulson, C. L. (2001). Teaching children with autism to engage in conversational exchanges: Script fading with embedded textual stimuli. Journal of Applied Behavior Analysis, 34, 81–84.

Shriberg, L.D. (2003) Diagnostic markers for child speech-sound disorders: introductory comments, Clinical Linguistics & Phonetics, 17, 7, 501–505.

Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts.

Stoel-Gammon, C., & Dunn, C. (1985). Normal and abnormal phonology in children. Austin Texas: Pro-Ed. Inc.

The National Literacy Trust, (2007) Theories about how young children acquire and develop language. Web.

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