Speech Sound Disorders
Section Editor: | Communication Sciences and Disorders McGill University 1266 Pine Avenue West, Montreal, QC H3G 1A8 Canada |
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Key Messages
What do we know?
Children with Speech Sound Disorders (SSDs) represent 91% of school-based Speech Language Pathologists’ (SLP) caseloads. Approximately 16% of all children at 3 years of age and 3.8% at 6 years of age have speech delays. Children whose speech is difficult to understand by 5 years and 6 months are likely to have difficulties in language, reading and writing, with 50-70% struggling academically through Grade 12. Thus, early assessment and intervention by an SLP are key to success for a child with an SSD.
There are generally five goals of an initial assessment:
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determine if there is a communication disorder;
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determine the level of severity (e.g., mild, moderate, severe);
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identify possible causal factors (e.g., a hearing impairment);
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determine prognosis (potential for improvement; expected outcome); and
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decide on the direction (if any) for intervention.
The SLP is interested in determining the child’s phonological strengths and weaknesses (i.e., the child’s grasp of his/her native language and the ability to accurately order and organize sounds and sound endings, stress and intonation patterns), the extent of the difficulty, and the ability to produce a specific sound, pattern or combination in any context (stimulability). The SLP is likely to use a continuous speech sample and formal and informal assessment tools to determine the child’s strengths and weaknesses, which can then be used to guide treatment.
The two types of approaches that are used in treating SSDs are: (1) traditional articulation therapy (i.e., teaching sounds one at a time) and (2) phonological (i.e, addressing the child’s phonological system as a whole). The second approach is supported by research evidence suggesting its efficiency and efficacy.
These two approaches may involve the following activities:
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speech perception intervention – teaching the child to hear the difference between the correct sound and the incorrect sound;
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phonetic placement – teaching the child how to say a new sound; and
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minimal pair activities – teaching the child to recognize the function of different speech sounds (e.g., an activity involving the words ‘bee’ and ‘beet’).
The amount of speech therapy required will vary from child to child. However, research suggests that approximately 20 hours of intervention, spread over a minimum of 15 weeks, are required to impact the child’s speech intelligibility.
SSDs might adversely affect individuals in the short and long term. Short-term effects of SSDs include academic (e.g., weak reading skills), social (e.g., being bullied) and behavioral difficulties. Long-term effects extend to educational achievement (i.e., completion of fewer years of education), occupational success (i.e., occupying jobs requiring fewer skills), and ultimately, socio-economic status.
What can be done?
Parents and Educators
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First and foremost, be an advocate for the child in your care and do not be afraid to ask questions!
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Seek the help of an SLP as soon as the child seems to have trouble with sounds that other children of the same age can produce. Early assessment and intervention are key.
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Be an active contributor to the child’s assessment:
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Provide thorough answers about any family history of speech or language disorders or delays, the child’s birthing and feeding histories, history of the child’s development of speech and language, any hearing difficulties or frequent ear infections. Your answers can help in assessing the child and determining whether intervention is needed.
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Take the child for additional testing (e.g., to an audiologist) or for possible treatment (e.g., to an otolaryngologist), if recommended.
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Ask how you can get involved in the child’s treatment:
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Learn how to provide a structured home program. Research suggests that approximately 20 hours of speech therapy, spread over a minimum of 15 weeks, are required before the child's speech becomes noticeably more intelligible; however, half as much treatment may be sufficient if the child receives a structured home program in addition to speech therapy.
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Track your child’s progress (both academic and social) by communicating regularly with the child’s teacher.
Policymakers
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Given the social and economic cost of speech difficulties for individuals with SSDs and for society at large, it is important to identify the most effective and efficient speech therapy practices for the treatment of SSDs.
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Gaps remain between what research indicates and what occurs in practice. It is important that research findings are implemented in practice and policy in a more effective and timely manner.
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Knowledge transfer is instrumental in bringing original research to practice. It may take the form of fact sheets, magazine articles, websites, web-based publications (e.g., this Encyclopedia), policy briefs, etc., depending on the audience. The materials prepared for SLPs, parents, and policymakers should be prepared in language that is easily accessible.
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Researchers, clinicians and policymakers should collaborate to improve the speed at which research can be moved into everyday practice and should help to make informed policy decisions.
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The shortage of SLPs across Canada and unmanageable caseloads can hinder the quality of therapy outcomes.
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Para-professionals deliver intervention in many clinical and school settings. These individuals often do not have adequate training and experience. It is essential to provide more intense training to these individuals focused on intervention and ongoing clinical skill development.
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The best and the most current research should be communicated to SLPs in training across Canadian programs in order to shape future practice.
