Phonological processes which characterize unintelligible

In , Hodson and Paden proposed a severity classification applying the concept that the speech disorders are part of a continuum. They considered that:. This measure is based on the frequency of occurrence of phonological processes chosen by the child and is calculated from the production of isolated words. Twenty children from 5 to 9 years of age with varying degrees of severity took part in this study. Each child was asked to tell a story based on sequenced cards and the authors used between 2 minutes, 30 seconds and 3 minutes, 30 seconds of the spontaneous speech.

The results indicated a high correlation between the listener's evaluation and the PCC and the PDS in isolated words, suggesting that the standardization of isolated words as the result of a test can be worthwhile and clinically used as an instrument in the phonological disorder evaluation.

Garret and Moran compared the severity of the phonological disorder in 20 children through five measures: the phonological disorder score PDS , the Percentage of Correct Consonant PCC in spontaneous speech and in isolated words, and the perceptive analysis of two groups of judges one of them comprised by 10 graduated in elementary education and the other by 10 speech pathologists. The judges were instructed to choose the pertinent severity degree of each child's disorder, from 1 mild to 7 severe.

Likewise in the Shriberg e Kwiatkowski's study , it was found a high correlation between the indexes and the perceptual judgment of the judges. Morrison and Shriberg , found statistical differences between the articulatory precision profiles measured with the PCC index for the articulation tests, in isolated words and in continuous speech.

All linguistic levels were analysed, including the precision, the phonological processes, the individual phonemes, the types of errors, the word positioning, and the allophones. The stable sounds were frequently produced with higher precision in spontaneous speech, while the emergential sounds presented higher precision as a response for the articulation tests' stimuli. In general, the continuous speech seemed to be more associated with elimination errors, specially of consonants in the final position of the word, and with the increase of errors involving groups and atonic syllables.

Another phonological severity measure is the "Process Density Index" PDI Edwards, , which is the mean of phonological processes in one word. Shriberg et al. Accordng to the considered type of error, they suggested: PCC - common or uncommon distortions, omissions and substitutions are considered as errors; Adjusted PCC - common distortions are not considered as errors; and Revised PCC - does not accept any type of distortion as error.

To test these indexes, the authors used tapes of subjects from 3 to 40 years of age, with normal or altered speech, aiming at a diagnostic classification based on the instrument of Speech Disorder Classification System SDCS. The study pointed that the PCC-R is the best articulatory competence measure for children from 3 to 8 years, since it provides a better separation between children with normal speech acquisition and those with late speech development, and it indicates only the omissions and substitutions errors.

In a study carried out by Wertzner et al. The severity categories of PCC mild, mild-moderate, moderate-severe, and severe proposed by Shriberg and Kwiatkowski was designed for the English languge.

For its aplication in the Portuguese language, further studies are necessary. In this regard, some studies have been carried out with normal speech development children Dias and Wertzner, ; Wertzner and Galea, and with children with phonological disorder Wertzner et al.

There are some studies in the literature about the most prevalent age or gender in phonological disorder. Among them, Shriberg et al.

Papp found higher occurrence of phonological disorder in male subjects, with age varying between and years. As demonstrated by the studies mentioned above, for a precise diagnosis, as well as for a better intervention planning, it is necessary to use severity indexes associated with the perceptual classification of the severity.

Thus, the main purpose of the present research was to use the PCC's severity index, as well as to verify the correlation between this index and the the one perceptually applied by the judges.

The research was accomplished in two parts. In a first moment the Phonology tests data were collected and analysed, and afterwards, the judges performed the perceptual judgement of the severity. All parents or legal guardians of the participants signed the informed-consent. Sixty judges, graduation and post-graduation students of the Speech and Hearing Pathology Course, also participated: 12 judges from the 1st year of the Course group J1 ; 12 judges from the 2nd year group J2 , 12 judges from the 3rd year group J3 ; 12 judges from the 4th year group J4 ; and 12 MSc students group J5.

After the diagnosis of the phonological disorder and the signing of the informed- consent, the phonology protocols of the Child Language Test ABFW Wertzner, were used to calculate the Percentage of Correct Consonant index PCC , proposed by Shriberg and Kwiatkowski , with some adaptations for the Portuguese language indicated by Wertzner Therefore, for the calculation of the PCC only the consonants that the child was intended to produce in the word must be considered.

The consonants of repeted syllables in the word, and those occured in partial words, completelly inintelligibles or unclear, must not be accounted. The addition of a consonant before a vowel must not be calculated, once only consonants are being considered. Chart 1 displays the types of changes in consonantal sounds considered as incorrect in this research. As Shriberg and Kwiatkowski stressed, for a child with speech errors, a correct sound must be accounted only when it was surely adequate produced.

Therefore, questionable sounds must be classified as errors. The regional variations, allophones, and intentional junctions performed by the child must be considered as correct. To proceed with the PCC calculation, it is necessary to compute the consonants of the words that the child really produced.

If the child fails to say any word, the consonants of this word must be deducted from the calculation. Afterwards, the video tapes with the phonology tests recordings were presented to the judges. In order to watch the videos, the goups of judges were rearranged in 3 groups, each of them with 4 judges from J1, J2, J3, J4 and J5, totalizing 20 judges per group. The video presentation order was draft for each group, so that the same subject would not be presented in the same order for the 3 groups.

The subjects' video tapes were presented to the judge groups in three sessions of one hour and thirty minutes each, in order for them to indicate the severity degree of the disorders.

Information about gender and age were given. After listening to the recordings, the judges filled out the protocol of severity degree for each subject, according to the following posibilities: mild, mild-moderate, moderate-severe, and severe.

The association between the variables was verified using the Spearman Correlation test and the Kappa test. The Kappa test measures the concordance between the variables Kappa H"1, maximum concordance. The Spearman correlation test indicates the dependency between the variables. The intensity of associaation is given by the correlation coeficient. In order to verify the equality of the judges responses for the severity judgement and for the intelligibility, the variance analysis of ANOVA was used with repeated measures in one factor there is equality between the means if pd"0.

In figures 1 and 2 it is possible to observe the number of subjects in each of the severity degrees proposed by Shriberg and Kwiatkowski , and to verify that the subjects distribution regarding the severity degree was similar in the two tests.

The judges of each group classified the severity of the subjects according to the requested degrees. Figure 3 shows the classification, considering the mode of the 60 judges' judgment. Inferential analysis of the perceptual judgements of the speech severity of the 50 subjects were performed to verify the equality of the judges' responses. In order to verify the equality of the responses given by the judges of the 5 groups, the variance analysis with repeated measures in one factor was used.

In order to verify which groups differed, the multiple comparisons of Bonferroni method were performed Table 2 , and it was possible to observe that on average the J1 differed only from the J4. The J2 on average presented different responses than J3, J4 and J5.

The J3 judges on average classified the severity the same way as the J5, and differently than J4. Finally, the J4 and J5 on average didn't present the same responses in the classification of the severity. Considering the subjects severity degree specified by the judges and the calculated value of PCC, it was obtained the mean PCC for the studied sample.

It can be seen in table 3 the mean PCC for each judge group, and in table 4 , the mean value given by the 60 judges for the studied sample.

Figures 3 to 8 show the Box plot between the PCC and the perceptual judgment of the severity chosen by the judges. It can be observed that as the severity judgment increases, the PCC decreases in all groups of judges. The Spearman Correlation test was used in order to verify the association between the PCC index and the perceptual judgment of the severity, considering the PCC values of the 50 subjects with phonological disorder and the mean scores of severity given by the judges of each group.

Thus, the higher the severity score given by the judges, the lower the PCC. Agreement between the judges for the severity judgment was studied inter and intra-groups, using the Kappa test that measures the concordance between the variables Kappa H"1, maximum concordance. The results are shown in tables 6 and 7. It can be observed that in both situations the concordance was low.

These data agree with the ones described for the English language, where the moderate-severe and severe degrees are less frequent in children with phonological disorder Shriberg et al.

Therefore, in the present research it was verified that children with phonological disorder were below the expected compared with children without phonological disorder.

Once the PCC index was studied in English speaking children and compared to the judgment of American speech pathologists, in this research, besides the application of the index, as showed above, it was observed how the Speech and Hearing Pathology Course graduation and Master students J1, J2, J3, J4 e J5 classified the phonological disorder presented by the studied subjects.

According to the judgment of the 5 groups of judges, the classifications of mild-moderate, mild, moderate-severe and severe were registered, in descending order of subjects.

Comparing the groups of judges, it was verified that, on average, the responses of the groups were different for the 50 subjects. It was noted that this difference occurred for the group J4, comprising graduation students of the 4th year of the Speech and Hearing Pathology Course. What are Phonological Processes? Phonological processes are patterns of sound errors that typically developing children use to simplify speech as they are learning to talk.

As a result they simplify complex words in predictable ways until they develop the coordination required to articulate clearly. What is a phonological disorder?

These processes are considered normal unless they persist beyond the age when most typically developing children have stopped using them. A phonological delay may also be considered if the processes the child is using are different than what would be expected. Articulation or Phonological Disorder? Since phonological disorders and articulation disorders are both speech sound disorders it can sometimes be tricky to know which speech sound disorder is present. Here are a few tips on how to tell the difference.

Children with an articulation disorder typically respond well to a traditional articulation therapy approach where one sound is targeted at a time. Treatment for Phonological Disorders: Remediation for kids with phonological disorders usually involves targeting the phonological processes in error as determined by the speech language pathologist. Targeting the phonological processes, as opposed to targeting each error sound by sound as you would in a traditional articulation approach, usually improves speech intelligibility at a faster rate for kids with phonological disorders.

As always, I wish your kids the very best in becoming successful communicators and with your help and support I know they can!

Any chance you can add at the bottom when a speech sound disorder is apraxia of speech? Great job! Thanks very much for the information. The chart was especially helpful as I have a 3 year old who is currently booked for a Furlow Palate repair surgery. This website as well as the articulation station app are essential to aid in his progress.

I was hoping you might have some suggestions on things I can work on with him until then? Anyway, any advice or exercises you can recommend would be greatly appreciated. Heidi i am curiois as my 3. She is supposed to join pre school early next month moreover whatever poems or phrases she remembered in past when she recalls them she doesnt skip or prolong any word She is kind of reserved person in front of strangers should i wait until school starts do you think she will overcome this thing OR should we consult her to a therapist immediately Please do reply Thanks.

Hi Heidi, your website is so very helpful! I have a daughter who just turned 4 in May who has been in speech therapy for about 2 years. She has some phonological delays, but is doing great! I was wondering if your articulation worksheets would be the best bet on helping her more at home? Although she sees a speech therapist through our school district, I am not confident that they are addressing the phonology more than articulation.

I just want to prepare her as much as possible for kindergarten! Thanks in advance! Hi, Great job on getting your son into speech therapy. That is a great first step.

From what you are describing, it sounds to me like your son is only producing vowel sounds and leaving the rest of the sounds off of the word. Once he is able to do that you will want to target the final consonants. Best of luck and let me know how it goes!

Hi Nauman, Sorry for the delay in response. Around the age , children should be saying the sounds: m, n, p, b, t, d, k, g, f, v, h, w, and the y sound correctly in their speech. Children at this age will still make sound errors in their speech with other speech sounds that are still developing like s, z, r, l, etc. Contact a speech therapist and they will be able to evaluate your child as to whether or not their is an articulation or phonological disorder present.