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Speech Sound Disorders in Children
22 February 2019 (online)
One of the most commonly treated communication disorders is speech sound disorder (SSD), which is defined as persistent phoneme deletion, and/or distortion errors in speech production as compared with children of the same chronological age. Children with SSD constitute a significant percentage of caseloads for most pediatric speech-language pathologists (SLPs). According to ASHA's Schools Survey Report, ∼90% of school-based speech-language pathologists report serving children with SSDs. Relatedly, pediatric SLPs across a variety of healthcare settings report that children with SSD comprise 21% of their caseloads. Despite SSD being quite common, there remain significant questions regarding assessment and treatment of children with speech sound production deficits, such as:
How can I tell the difference between typical speech sound errors and those that indicate a full-fledged SSD, especially in very young children?
How do we help prevent the social impact/consequences of SSD?
How can a child with SSD qualify for speech services in one school district, but not in another?
I have so many kids with SSD on my caseload. Is there a way to more effectively and efficiently treat children with SSD?
Are their specific treatment factors (e.g., how often I see a child during the week? How many trials should I be expecting from a child in a session?) that can better predict treatment outcomes?
How do I maximize treatment time when a child with SSD has other comorbidities, such as language impairment?
In this special issue, we have convened several scholars in the field to tackle some of these questions.
In “Clinical challenges: assessing toddler speech sound production,” DeVeney discusses the challenges of examining speech production in very young children. Such challenges include discrepancies in speech sampling recommendations, the inherent variability across word productions that is common to toddler speech production, and limited normative data available for this particular population. DeVeney reviews the available literature, provides helpful recommendations, and highlights the need for further clinical investigation regarding speech sound production in children in the early stages of verbal development.
As children continue to develop, an estimated 16% of all young preschool-aged children exhibit errored speech patterns consistent with an SSD. The majority of research on preschool-aged children with SSD focuses on speech production behaviors relevant to assessment and intervention. An oft-overlooked, yet important, factor is the self-perception and attitude of children with SSD and how that might impact treatment outcomes. In their contribution, “What do children with speech sound disorder think about their talking?,” McCormack, McLeod, and Crowe directly investigate perceptions of preschool-aged children with SSD and correlate their perceptions with the severity of their SSD. Relatedly, the authors compare the children's responses with parental perceptions of the impact of their child's SSD. The findings highlight that child attitudes and parental attitudes do not always align, and the authors discuss the need for SLPs to take these attitudes into consideration during assessment and intervention for preschool-aged children with SSD.
In “Describing how school-based SLPs determine eligibility for children with speech sound disorders,” Farquharson and Tambyraja review the considerable variability in eligibility determination for how and whether children with SSD should receive intervention services in the schools. The authors conducted a survey of SLPs across the United States and found that, although federal guidelines broadly outline eligibility requirements for services, most SLPs are constrained by rules and regulations that may vary by state and school district. This article highlights the need for more consistency in eligibility determination across district and state lines, and suggests a call to advocacy for SLPs and their expertise when determining eligibility for services for children with SSDs.
Caseload management is a significant issue for many SLPs serving children with SSDs. In their contribution, “Innovative service delivery models for serving children with speech sound disorders,” Brosseau-Lapre and Greenwell review factors known to improve the efficiency and effectiveness of treatment outcomes for children with SSDs. They further present two innovative service delivery models, one school-based and one clinic-based, that have proven effective in a graduate training program. These practical service delivery examples provide clinicians with ideas to consider when developing and implementing sound treatment principles into their practice with children with SSD.
In “Speech sound disorder and visual biofeedback intervention: a preliminary investigation of treatment intensity,” Hitchcock, Swartz, and Lopez review literature related to treatment intensity and its effect on outcomes for children with SSDs that are resistant to treatment such as childhood apraxia of speech and/or those with residual speech errors. The authors investigate the utility of the Cumulative Intervention Index, a measure of treatment intensity, and discuss the utility of this index for clinicians when evaluating treatment outcomes in research studies. Specifically, Hitchcock and colleagues apply this investigation to treatment outcomes in biofeedback research, but suggest there is need to establish a unified measure of treatment intensity across treatment methodologies.
To conclude this issue, in her contribution “Phonological treatment options for children with expressive language impairment,” Hoover highlights that up to 50 to 75% of children with SSD of unknown origin also exhibit language deficits. She discusses the interaction between language and phonology and highlights the need to target both areas for children with deficits in both domains. In this article, Hoover describes various evidence-based treatment approaches that allow SLPs to simultaneously target the child's phonological and language deficits in a way that maximizes child outcomes.
Children with SSD constitute a significant portion of many SLP caseloads, and the challenges associated with the assessment and intervention of these children are not trivial. The primary goal of the current issue is to present current and ongoing clinically relevant research pertaining to children with SSD. We have specifically sought to provide practical suggestions that will bolster assessment practices and treatment outcomes for children with SSD and to more fully support the SLPs who serve them.
- 1 Shriberg LD, Austin D, Lewis BA, McSweeny JL, Wilson DL. The speech disorders classification system (SDCS): extensions and lifespan reference data. J Speech Lang Hear Res 1997; 40 (04) 723-740
- 2 2018 schools survey report: SLP caseload characteristics trends. Available at: https://www.asha.org/uploadedFiles/2018-Schools-Survey-Caseload-Trends.pdf . Accessed November 29, 2018
- 3 2017 SLP Health Care Survey Report: Caseload Characteristics. 2017 https: //www.asha.org/uploadedFiles/2017-SLP-Health-Care-Survey-Caseload-Characteristics.pdf . Accessed November 29, 2018.
- 4 Lewis BA, Avrich AA, Freebairn LA. , et al. Literacy outcomes of children with early childhood speech sound disorders: impact of endophenotypes. J Speech Lang Hear Res 2011; 54 (06) 1628-1643