Inconsistent Speech Disorder and The Core Vocabulary Approach
- 1. SPEECH DISORDER AND THE CORE VOCABULARY APPROACH Kimberly Jones Nova Southeastern University February 2011
- 2. Overview Defining Inconsistent Speech Disorder (ISD) Differentiating ISD from Childhood Apraxia of Speech (CAS) Existing treatment models Defining the Core Vocabulary Approach Review of research on the Core Vocabulary Approach for use with ISD Clinical Implications Questions References
- 3. What is Inconsistent speech disorder (ISD)? A sub-group of children with speech disorders characterized by inconsistent errors (McIntosh & Dodd, 2008) Inconsistency is characterized by a high proportion of different errors upon repeated production and multiple types of errors (placement, syllables, word shape) (McIntosh & Dodd, 2008) Generally large phonemic inventory but with unpredictable use (inconsistency score of 40% or more on the 25 word test for inconsistency); unusual phonological errors may be evident without an observable pattern (McIntosh & Dodd, 2008) Imitated speech better than spontaneous production, no groping, no lack of diadochokinetic skills (Holm, Crosbie, & Dodd , 2005)
- 4. How is ISD different from CAS? CAS presents with suspected impairments in phonological planning, phonetic programming, and motor-program implementation (Ozanne, 2005) ISD presents with suspected impairments in phonological assembly but intact phonological representation, phonetic planning and motor- speech implementation (McIntosh & Dodd, 2008)
- 5. Speech Production Phonological Rules Phonological plan/template Phonetic Program Assembly Motor Speech Program Implementation Execution of Motor Program CAS: Breakdown in these areas (Orzanne 2005) ISD : Breakdown in assembly, storage, or retrieval of phonological plan (Bradford and Dodd, 1994, 1996; Dodd and McCormack, 1995 Bradford-Heit & Dodd 1998; McIntosh & Dodd 2008) Chart adapted from Orzanne 2005 CAS ISD
- 6. CAS ISD Inconsistent Errors: multiple types of errors across context; oro-motor speech difficulties Groping differences in voluntary vs. involuntary movement Unusual phonological errors with no visible pattern Imitated speech better than spontaneous production Diadochokinetic skills intact Normal phonological awareness Impaired phonological awareness, reading, and spelling No groping Imitation does not improve production Limited phonemic inventory Large phonemic Inventory Vowel errors (Stackhouse & Snowling, 1992b; Ozanne, 1995; Bradford-Heit & Dodd, 1998; Holm & Dodd, 1999; Moriarty & Gillon, 2006; Crosbie, Holm & Dodd, 2005; Dodd, Holm, Crosbie & McIntosh, 2006; Holm, Crosbie & Dodd, 2007; McIntosh & Dodd, 2008; Holm, Farrier & Dodd, 2007)
- 7. Current Treatment Options PROMPT Targets phonetic programming and motor speech implementation combined Phonological awareness intervention: Targets accurate pronunciation and phonological representation (phonological awareness) Core vocabulary approach Teaches children how to assemble word phonology by giving information about the phonological plan without providing a model for imitation and focuses on the establishment of consistent speech (as opposed to correct speech) (McIntosh & Dodd, 2008)
- 8. What is the core vocabulary approach? An approach for treating highly unintelligible speech composed of many inconsistent errors due to a breakdown in phonological planning Targets consistent production of selected high-use vocabulary words Focus is on: Consistent “best production” instead of correct production Gives information about the phonological plan without providing a model for imitation (McIntosh & Dodd, 2008)
- 9. What is the core vocabulary approach? 50 words that are functionally important are selected with the input of the parents, teachers, and the child 10 words are selected to target per session and “best production” is accepted even with developmental errors but consistency of production is required Parents and teachers reinforce consistent production outside of therapy As individual words become consistently produced they are removed from the target list(Dodd, Crosbie & Holm, 2004)
- 10. Core Vocabulary Approach: What does the research show? A comparison of three therapy methods for children with different types of developmental phonological disorder (Dodd & Bradford, 2000) Participants: 3 boys with phonological impairment (1 with CSD and 2 with ISD) One aim of the study was to compare the effects of the three intervention programs on the accuracy and intelligibility of the speech of three children enrolled in therapy
- 11. Core Vocabulary Approach: What does the research show? Measured skills pre-intervention included: PCC (percent consonants correct) from a 50 utterance speech sample Articulation and inconsistency tests Phonetic inventory Phonological analysis to evaluate use of developmental and non-developmental rules (Dodd & Bradford, 2000)
- 12. Core Vocabulary Approach: What does the research show? Results for the two children with ISD attributed to the core vocabulary approach: Both children demonstrated increased consistency of word production Both children decreased their inconsistency scores to less than 40% One child made gains in the core vocabulary block only (block 1) One child made gains both in the core vocabulary block (block 1) and in the phonological block (block 2) Consistent Phonological Errors:Best response from contrast Tx (Dodd & Bradford, 2000)
- 13. Core Vocabulary Approach: What does the research show? Intervention for children with severe speech disorder: A comparison of two approaches (Crosbie, Holm & Dodd, 2005) Core Vocabulary and Phonological Contrast 18 children with severe ISD or CSD (consistent speech disorder) from ages 4:8 to 6:5 who: PCC standard score of 3 (mean 10 and SD of 3) Demonstrated either ISD or CSD (Consistent Speech Disorder) Receptive language, non-verbal skills, oro-motor structure and function, and hearing all within normal limits Mono-lingual speakers of English
- 14. Core Vocabulary Approach: What does the research show? Structure of intervention study: Multiple baseline All children with ISD and CSD were exposed to both phonological contrast therapy and the core vocabulary approach ISD and CSD children were divided into four groups: one group from each diagnosis started with the phonological contrast therapy and the others started with the core vocabulary approach (Crosbie, Holm & Dodd, 2005)
- 15. Core Vocabulary Approach: What does the research show? Results: All children increased their percentage of consonants correct The core vocabulary approach resulted in greater change for children with ISD The phonological contrast approach resulted in greater change for children with CSD Children with ISD who received core vocabulary therapy increased their consistency on both trained and untrained words Phonological contrast therapy resulted in suppression of patterns not just trained phonemes (Crosbie, Holm & Dodd, 2005)
- 16. Core Vocabulary Approach: What does the research show? An intervention case study of a bilingual child with phonological disorder (Holm & Dodd, 1999) Bilingual Punjabi-English speaking child (H.K.), aged 4:6 Inconsistent errors in both languages Core vocabulary approach provided in English only for 8 weeks
- 17. Core Vocabulary Approach: What does the research show? Pre-Intervention Data (Holm & Dodd, 1999)
- 18. Core Vocabulary Approach: What does the research show? Treatment Word selection Week 1 practice Week 2 practice Measurement of progress and generalization Removal of targeted words Results Consistency increased on treated and untreated words Consistency increased across languages Consonant accuracy increased significantly in both languages Atypical phonological processes not evident at review session (Holm & Dodd, 1999)
- 19. Core Vocabulary Approach: What does the research show? (Holm & Dodd, 1999)
- 20. Core Vocabulary Approach: What does the research show? (Holm & Dodd, 1999)
- 21. Core Vocabulary Approach: What does the research show? (Holm & Dodd, 1999)
- 22. Clinical Implications Differential diagnosis allows for appropriate selection of treatment methods Treatment selected should target the suspected area of breakdown in speech production Some research demonstrates the effectiveness of the core vocabulary approach for children with ISD (both monolingual and bilingual) but more research is needed
- 23. Questions? ? ? ? ? ? ?
- 24. References BRADFORD, A. and DODD, B., 1994, The motor planning abilities of phonologically disordered children. European Journal of Disorders of Communication, 23, 349–369. Bradford, A. and Dodd, B., 1996, Do all speech disordered children have motor de. cits? Clinical Linguistics and Phonetics, 10, 77–101. Bradford-Heit, A. & Dodd, B. (1998). Learning new words using imitation and additional cues: differences between children with disordered speech. Child Language Teaching and Therapy, 2, 159 – 179. Crosbie, C., Holm, A., & Dodd, B. (2005). Treating inconsistent speech disorders. In B. Dodd (Ed.), Differential diagnosis and treatment of children with speech disorder (pp. 182 – 201). London: Whurr.
- 25. References Dodd, B. and Bradford, A., 2000, A comparison of three therapy methods for children with different types of developmental phonological disorder. International Journal of Language and Communication Disorders, 35, 189–209. Dodd, B., Crosbie, S. and Holm, A., 2004, Core Vocabulary Therapy: An Intervention for Children with Inconsistent Speech Disorder (Brisbane: Perinatal Research Centre, Royal Brisbane & Women’s Hospital, University of Queensland). Dodd, B, Holm, A, Crosbie, S, & McIntosh, B. (2006). A core vocabulary approach for management of inconsistent speech disorder. Advances in Speech–Language Pathology, 8(3), 220-230. Dodd, B. and McCormack, P. 1995: A model of the speech processing for differential diagnosis of phonological disorders. In B. Dodd, editor, Differential diagnosis and treatment of children with speech disorder. London: Whurr.
- 26. References Holm, A., Crosbie, S. and Dodd, B. 2005: Treating inconsistent speech disorders. in B. Dodd, editor, Differential diagnosis and treatment of children with speech disorder. London: Whurr. Holm, A., Crosbie, S. and Dodd, B. (2007): Differentiating normal variability from inconsistency in children’s speech: Normative data. International Journal of Language and Communication Disorders 42(4), 467–486. Holm, A. and Dodd, B., 1999, An intervention case study of a bilingual child with phonological disorder. Child Language Teaching and Therapy, 15, 139–158. Holm, A., Farrier, F. and Dodd, B., 2007, The phonological awareness, reading accuracy and spelling ability of children with inconsistent phonological disorder. International Journal of Language and Communication Disorders, 42, 467–486. McIntosh, B. & Dodd, B. (2008). Evaluation of core vocabulary intervention. Child Language Teaching and Therapy, 24(3), 307-327.
- 27. References Moriarty, B, & Gillon, G. (2006). Phonological awareness intervention for children with childhood apraxia of speech . International Journal of Language & Communication Disorders, 41(6), 713-734. Ozanne, A., 1995, The search for developmental verbal dyspraxia. In B. Dodd (ed.), Differential Diagnosis and Treatment of Children with Speech Disorder (London: Whurr), pp. 91–109. Ozanne, A. 2005; Childhood apraxia of speech. In B. Dodd, editor, Differential diagnosis and treatment of children with speech disorder. London: Whurr. Stackhouse, J., & Snowling, M. (1992). Developmental verbal dyspraxia II: A developmental perspective on two case studies. European Journal of Disorders of Communication, 27, 35–54.
Editor's Notes
- #6: Children with ISD are found to have intact Reading, awareness of phonological legality and onset rhyme, their imitated productions have less errors than their spontaneous productions, and there are no oro-motor symptoms such as groping and poor diodochokinetic skills (McIntosh & Dodd, 2008)
- #7: (Stackhouse & Snowling, 1992b; Ozanne, 1995; Bradford-Heit & Dodd, 1998; Holm & Dodd, 1999; Moriarty & Gillon, 2006; Crosbie, Holm & Dodd, 2005; Dodd, Holm, Crosbie & McIntosh, 2006; Holm, Crosbie & Dodd, 2007; McIntosh & Dodd, 2008; Holm, Farrier & Dodd, 2007)
- #8: * Refer to chart on slide 5 when describing what aspect of speech production each approach targets
- #9: Main goal is to establish CONSISTENT production as opposed to CORRECT production Accepts developmental errors as long as “best production is consistent
- #11: The methods compared included the core vocabulary approach, the PROMPT method, and a phonological contrast approach.
- #13: Both children displayed increased consistency of production even though they maintained high levels of inconsistency before treatment Both children’s inconsistency scores had decreased to less than 40% as measured by the 25 word test for inconsistency One child responded well to the 1st block of therapy (core vocabulary) but did not make any gains in the second block (PROMPT) and third block (Phonological). The other child made gains in the first block (core vocabulary) and the second block (phonological), but not the third (PROMPT) The child with consistent Phonological errors responded best to the Phonological Contrast Therapy block.
- #14: Had a standard score of 3 on the PCC portion of the DEAP (mean of 10 and normal range of 7-13) Demonstrated either inconsistent speech disorder (scored 40% or greater on the inconsistency assessment) or consistent speech disorder (scored below 40% on Inconsistency assessment and used at least 2 atypical phonological error patterns )
- #19: Treatment: 50 words were selected by H.K., his parents, and his teacher that were functionally “powerful”; 10 words were randomly chosen for each two weeks of intervention The first week’s session consisted of practicing production of the words using sound by sound connection by linking sounds to letters since H.K.’s letter awareness and sound segmentation skills were good. The n H.K. practiced those sounds on average of 5 times a day with parents and teachers and was reinforced for consistent production in everyday communication situations Finally, during the second week’s session these words were incorporated into a game At the end of the second week’s session H.K. had a “test” where he produced the practiced words 3 times each as well as 10 non-practiced words to monitor generalization Results Consistency increased on both treated and untreated words and was maintained following a two week break from therapy (see chart) Consistency increased across languages even though only English was targeted. There was a greater increase in consistency in English but both languages were less than 40% inconsistent in the final session and the review session two weeks later (see chart) Consonant accuracy increased significantly in both languages (Punjabi – 16% increase and English – 26% increase) This increase in consistency was seen both in the production of the same word in different occasion and in his substitution patterns for certain phonemes (for example: rather than fluctuating between up to 6 different phoneme substitutions for a given target he would either use the correct phoneme or one other phoneme as a substitution. Though his speech was still affected by phonological processes there were no evident atypical processes being used at the review assessment two weeks after ending treatment At the end of the 8 week study H.K.’s speech continued to be very unintelligibly but the “type” of disorder had changed from “inconsistent deviant” to “delayed”
- #23: Specifically Dodd & Bradford’s study in 2000 indicates that Phonological therapy may be more effective after consistency is established through the use of the core vocabulary approach