Speech and language development and disorders in children

Language disorders are identified when a person has difficulty with expressive language, receptive language, or pragmatic language. Speech disorders are identified when a person's voice, fluency, or articulation call attention to the speaker because his or her speech is sufficiently different from the norm. Speech and language development should be consistent with a child's overall development and can be tracked using typical milestone markers. Differential diagnosis is critical to designing appropriate intervention, which should be tailored to the parents' goals along with the child's clinical and educational needs. Early identification and intervention assist in educational planning and are often associated with better long-term outcomes. Any speech-language therapy plan should be designed with measurable goals and consistent monitoring of progress toward those goals.

Measurement of Intelligibility in Disordered Speech

Purpose

To determine empirically which of three frequently observed rules in children with phonological disorders contributes most to difficulties in speaker intelligibility.

Method

To evaluate the relative effects on intelligibility of deletion of final consonants (DFC), stopping of fricatives and affricates (SFA), and fronting of velars (FV), phonologically reduced sentences were read to groups of adult listeners at normal levels of occurrence for typical conversation and at equal levels of occurrence.

Results

DFC had a greater effect than SFA on intelligibility, which had a greater effect than FV on intelligibility, when these rules occurred at levels approximating those seen in typical conversational speech. Results differed, however, when opportunities for rule occurrence were equalized. At relatively low levels of occurrence, FV had less effect on intelligibility than did SFA and DFC, but no significant differences in intelligibility were found between the latter two rules. At relatively high levels of occurrence, no significant differences between the three rules were observed.

Implications

These findings may be important clinically for clinicians who are trying to determine which rules should be targeted first in therapy.

Análise da freqüência fundamental, jitter, shimmer e intensidade vocal em crianças com transtorno fonológico

O transtorno fonológico é uma alteração de manifestação primária de causa indefinida que torna a fala ininteligível. A análise de parâmetros vocais torna-se importante no processo do diagnóstico deste transtorno, pois distúrbios de voz poderiam interferir na produção dos sons da fala. OBJETIVO: O objetivo deste estudo foi verificar as características vocais relacionadas à intensidade e freqüência fundamental - F0 - e seus índices de perturbação - jitter e shimmer - em crianças com transtorno fonológico. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. MATERIAL E MÉTODO: Foram sujeitos 40 crianças distribuídas em dois grupos: 20 com transtorno fonológico e 20 sem alteração de fala e linguagem. Foram aplicadas provas de fonologia do Teste de Linguagem Infantil ABFW e de fala espontânea. Utilizou-se o Computer Speech Lab, para gravação e análise acústica das vogais /a/, /e/, /i/, por meio dos parâmetros vocais: freqüência fundamental, intensidade, jitter e shimmer. RESULTADOS: F0 - vogal /e/ é menor, em média, para o Grupo com Transtorno Fonológico (126Hz) e 237Hz no Grupo Controle. Para o shimmer e jitter não há evidência de que as médias do Grupo com Transtorno Fonológico sejam diferentes das do Grupo Controle (p= 0,191, p=0,865 respectivamente). Quanto à intensidade, há evidência de que a média diferencia os dois grupos (p= 0,002). CONCLUSÃO: A freqüência da vogal /e/ é menor no Grupo com Transtorno Fonológico. Existe diferença entre grupos para as médias da intensidade das vogais /a/, /e/ e /i/, sendo estas menores no Grupo com Transtorno Fonológico. Não foram encontradas diferenças entre grupos para as médias do jitter e do shimmer.

Analysis of fundamental frequency, jitter, shimmer and vocal intensity in children with phonological disorders

Phonological Disorder is a disturbance of primary manifestation of undefined causes that makes speech become unintelligible. The analysis of vocal parameters becomes important in the process of diagnosis of this disorder, since voice disorders could interfere in the production of speech sounds. Aim: The objective of this study was to verify vocal characteristics related to the intensity and fundamental frequency -F0- and their disturbance indexes - jitter and shimmer - in children with phonological disorders. Study design: clinical prospective with transversal cohort. Material and Method: There were 40 children, 20 of them with phonological disorders and 20 with no speech and language disturbances. Phonological exams with the ABFW infantile language test and spontaneous speech were applied. The Computer Speech Lab was used to record and perform acoustic analyses of the vowels /a/, /e/, /i/, through the vocal parameters: fundamental frequency, intensity, jitter and shimmer. Results: F0 - vowel /e/ was smaller, on average, in the Phonological Disorder Group and it was 126 Hz in the Control Group. To shimmer and jitter there was no evidence that the means of the Phonological Disorder Group were different from the ones of the Control Group (p= 0.191, p= 0.865, respectively). As for intensity, there was evidence that the average did not differ in the Phonological Disorder Group and the Control Group (p= 0.002). Conclusion: The frequency of the vowel /e/ was smaller in the Phonological Disorder Group. There was difference between the two groups regarding the means of intensity of vowels /a/, /e/ and /i/, smaller in the Phonological Disorder Group. No differences between the groups were found regarding the averages of jitter and shimmer.

Treatment efficacy: functional phonological disorders in children

This report addresses the efficacy of treatment for functional phonological disorders in children. The definition of phonological disorders and their incidence and prevalence are first presented. The impact of this disorder on the lives of children and the role that speech-language pathologists play in treating this disorder are then discussed. Evidence of the positive outcome of phonological treatment is reviewed, with particular emphasis on treatment procedures that have been deemed effective, the specific effects of these treatments on improving intelligibility, and comparisons between treatments in facilitating improved sound production.

Phonological/Traditional Approaches to Articulation Therapy

A retrospective design was used to compare the relative efficacy of traditional and phonological approaches in the treatment of children with multiple articulation disorders. Nineteen children received evaluation and therapy based on a traditional paradigm and 17 children received phonologically based evaluation and treatment procedures. Results indicated that children in the phonological group showed significantly greater improvement in a significantly shorter period of time than children in the traditional group.

Articulation and Phonology

In this addendum to my lead article for this forum, I will resist the temptation to reply to each point of disagreement raised by my colleagues in their commentaries or to emphasize crucial points of agreement. Instead, I will update and clarify my comments on the application of phonological principles to the treatment of children with phonological disorders, responding to their comments only where appropriate to reach these objectives.