Yesterday, a colleague asked me to consult with her regarding a 5 year, 5 month old boy with ADHD, suspected developmental language disorder (DLD), and definitely a moderate-severe speech sound disorder (SSD). She’d administered a commonly-used phonology screener, pictured here:
As you can see, only ‘glasses’ and ‘yoyo’ were produced correctly. Every other word had at least 1 production error. But, a quick glance at the substitution patterns indicated this child was definitely demonstrating a phonological disorder. The patterns were incredibly consistent, if somewhat subtle & complex.
Newsflash ~ Kids don’t bother to read the phonology textbook you kept from grad school!
Also, not surprisingly, a phonological process analysis wasn’t capturing the patterns present in this child’s phonology. So, I pulled up a blank Place-Voice-Manner analysis form. And, here’s what the completed form looked like:
The black tallies at the top of each box are the correct productions. His error patterns are in red along with the number of times he produced each pattern – including the analysis of his very interesting cluster substitution pattern.
Let’s take a closer look at [s/z] word-finally. It looks like he has some inconsistencies in production, doesn’t it? Maybe that’s CAS? Nope, absolutely not.! If you look at the whole word productions, there’s a definite pattern to when [s, z] are produced word-finally. When /s, z/ are part of monomorphemic words like “vase” or “nose”, he at least ‘marks’ the presence of the target sound. However, when /s, z/ form a multi-morphemic word like “crayons” or “ice cubes”, they’re omitted. This is where his comorbid language impairment is ‘cross-pollenating’ his SSD. In other words, this kid knows quite a bit about the phonological and morphological systems of English.
So, back to the original question regarding where to start with treatment targets? The SLP originally wanted some help determining the phoneme collapses present in this kid’s phonological system. And, in my option, a contrastive approach based on his collapses is the right way to go. Looking at the patterns he presented, I decided to suggest she attack the [d] ~ /g, z, dʒ/ (“g”, “z”, “j”) collapse word-initially. Here’s why:
- These patterns were extremely consistent word-initially & intervocalically
- Voiced sounds are more ‘marked’ than their voiceless cognates, meaning treat the voiced cognate & you usually get the voiceless to come in ‘for free’
- Fricatives & affricates are more ‘marked’ word-initially, meaning if you treat them in word-initial position, they should emerge word-finally without direct treatment
Here are the treatment set contrasts I helped her develop. If you have questions about how to present & elicit these productions in therapy sessions, please feel free to ask. It’s definitely different than pulling the box of colorful final consonant deletion cards off the shelf!!
Here is how I would write the short & long-term goals for these contrasts:
STG: [Child’s name] will produce [g, z, dʒ] word initially with 70% accuracy imitatively across 2 consecutive sessions as measured by tracking data.
LTG: [Child’s name] will produce [g, z, dʒ] word initially with 90% accuracy spontaneously across 3 consecutive sessions as measured by tracking data.
I also suggested that the SLP target third person singular forms in a minimal pair contrast to work on the comorbid language issues. I’ll outline that process in the next post.
Thank you very much to the SLP for letting me be a part of the treatment planning for this child and for allowing me to share our collaboration process on this site! Let’s continue to think outside the box :)!
Outside The Box 