Assessment and Treatment of Speech Sound Disorders · Assessment and Treatment of Speech Sound Disorders: ... Helpful Assessment Forms • Place/Manner/Voicing forms ... • Cluster

Columbus, OH October 12, 2015

Assessment and Treatment of Speech Sound Disorders:

Rethinking Some Current Practices

Presented by

Gregory L. Lof, Ph.D. CCC-SLP

Chair/Professor ASHA Fellow Department of Communication Sciences and Disorders

Boston, MA [email protected] www.mghihp.edu

SOME THOUGHTS ON ASSESSMENT Procedures that should be accomplished… • Articulation test (52% of SLPs use Goldman-Fristoe Test of Articulation)• Continuous speech analysis (citing vs. talking; Morrison & Shriberg, 1992)• Hearing screening• Stimulability assessment

o Stimulability as a Dynamic Assessmento Teaching Stimulability: Enhancing stimulability to increase the phonetic inventory (Miccio & Elbert, 1996; Miccio,

2005), using a multi-sensory approach: Concept, Movement, Icon Use with young children with a very limited phonetic inventory. Pair consonant sounds with alliterative characters and motions. http://www.speech-language-therapy.com/awm.pdf Seven Components of Treatment to Enhance Stimulability

1. Determine Stimulability2. Directly Target Nonstimulable Sounds3. Make Targets the Focus of Joint Attention (more likely to produce a sound when they

are attending to and interested in its corresponding referent. Speech sounds may beeasier to learn when they are associated with interesting objects that have beenverbally labeled for them.)

4. Associate Speech Sounds with Hand/Body Motions (multi-modal input increaseschildren’s ability to retain newly learned speech sounds. Hand motions serve asretrieval cues for remembering).

5. Associate Speech Sounds with Alliterative Characters of Interest to the Child.(interesting characters increase interest in the activity and encourage full participation.Enhances the opportunity for a child to develop conscious awareness of the newlylearned sound segments. For example:

P Putt-putt pig b Baby bear t Talkie turkey d Dirty dog k Coughing cow g Goofy goat f Fussy fish v Viney violet ‘ Thinking thumb s Silly snake z Zippy zebra c Shy sheepy

http://speech-language-therapy.com/pdf/miccio4s.pdf 6. Encourage Vocal Practice (do not use drill; instead, encourage vocal practice by

including sound elicitation activities that involve turn-taking and requesting).7. Ensure Early Success (teach stimulable and nonstimulable sounds concurrently so they

can have success but also receive remediation for nonstimulable sounds).o Summary of Stimulability Production of a sound during stimulability testing attests to the child’s ability to perceive,

to recognize as different, and to produce the sound in question. If the child is not stimulable for a sound, then one might question the child’s: Motoric

abilities, Perceptual abilities, Linguistic abilities, Attention (focus), Non-compliance. If a child is stimulable for a sound, then that sound is likely to be added to the child’s

phonetic inventory, even without direct treatment on that sound. If a child is NOT stimulable for a sound, then the likelihood of short term gains is poor;

normalization without therapy is much poorer than normalization for sounds that the childis stimulable for.

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Training on stimulable sounds is likely to improve regardless of what is taught. Sounds that are NOT stimulable are unlikely to change without direct treatment. In therapy, we need to encourage exploratory sound productions and provide phonetic

placement or other types of cues to effect stimulability skills. Once stimulability has been achieved, generalization is more likely to occur. To avoid frustration in training nonstimulable sounds, use less directive sound play

activities (e.g., those suggested by Miccio & Elbert, 1996) to provide a nurturing andsupportive therapy environment.

• Perception/discrimination assessmento Is it still relevant? What assessment tools should be used?o Locke (1980) Speech Production/Perception Test (SPPT)

• Oral-peripheral screeningo Is it still relevant? Why? Why not? (Lof, 2002)

• Case history—Some potential question to ask parents: Describe your child’s current speechperformance; How often can your child’s speech be understood by parents, siblings, playmates,other relatives, strangers? How often does your child try to self-correct the speech errors? Howwilling is your child to repeat words after you, to try to say them correctly? How is your child’sspeech in imitation compared to when s/he says the words by him/herself? How would youdescribe your child’s willingness to repeat his/her idea if it is not understood? How would youdescribe your child’s willingness to talk? What is your estimation of severity of your child’s speechproblem? Did your child ever have ear infections or uninfected fluid in the ears? Would youconsider your child’s physical development as typical? Please comment.

• PCC: Percent of Consonants Correcto An objective severity metric; The examiner makes correct/incorrect judgments of individuals

sounds produced.

PCC = Number of Correct Consonants X 100 Number of Correct + Incorrect Consonants

o Problems with PCC: Does not take age into account; Only evaluates consonants; Originallybased only on conversational speech; Does not take into account type of errors.

o Potential solution instead of conversational speech (Johnson, Weston & Bain, 2004). Research shows the conversational speech and this imitative approach provide

comparable results. Efficient and valid approach for children 4 to 6 years old (but can be used for other

children). Uses sentence imitation. Easily scored on the form and easy PCC calculation.

o See Johnson, West, & Bain (2004)• Intelligibility

o A guideline for expected intelligibility can be calculated by dividing the child's age in years byfour and converting that number into a percentage: 2-year-old: 50%; 3-year-old: 75%; 4-year-old: 100% (Hodson, 2011)

• Intelligibility: See Ertmer, 2011o “Speech assessments that rely mainly on clinician impressions and word-based articulation

tests appear to be inadequate for monitoring the development of intelligible connectedspeech.” “Recent research has shown that word-based articulation tests are not dependableestimates of connected speech intelligibility.”

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o Words from the G-F Articulation Test had higher percentage of words identified than words inshort sentences (86.7% vs. 54.5%).

o Articulation tests were poor predictors of connected speech intelligibility. “Children maycorrectly articulate a variety of consonants and vowels in single words but still not have readilyintelligible connected speech.”

o Intelligibility Assessment: Scaling Procedures Asking listeners to rate intelligibility along a continuum (10-point equal appearing interval

scale or use descriptors: not at all, seldom, sometimes, most of the time, always). Disadvantages: Listeners have different internal criteria (pretty good for one may be not

very good to another); Numerical numbers do not have clear meaning; Scaling isinsensitive to the middle range of intelligibility (ratings may not well distinguish between30% and 60% intelligibility).

Modifications: Use clear descriptors instead of numbers: No words were understood; a fewwords were understood; approximately half of the words were understood; most of thewords were understood; almost all of the words were understood.

o Intelligibility Assessment: Item Identification Procedures Open set where listener writes down the words understood; Audio recordings of

unfamiliar sentences, listeners write words understood, place an X for words notunderstood; Scored as a percentage of the number of times there was a match

o Intelligibility Assessment: Item Identification Procedures for preschool and early elementary(4 lists, 10 sentences each) Presentation: Clinician says each sentence while using objects to act it out; Children watch

and then imitate the sentence; Presented 2x for listener to write down all words;Percentage of words correctly written

o Intelligibility Assessment : Item Identification Procedures for children who can read Presentation: Clinician shows the card and says the sentence; Card is turned over and child

is asked to say the sentences; Presented 2x for listener to write down all words;Percentage of words correctly written

• Intelligibility in Context Scale (McLeod, Harrison & McCormack, 2012)o An easy to administer, valid, and reliable estimate of preschool children’s intelligibility when

speaking with people of varying levels of familiarity and authority.o Developed as a parent-rated measure of intelligibility when speaking with people of varying

levels of familiarity and authority: Parents and 6 other types of communication partners (e.g.,“Do you understand your child?” “Do strangers understand your child?”)

o The rating is on a 5-point Likert scale: 1 = Never; 2 = Rarely; 3 = Sometimes; 4 = Usually; 5 =Always

Procedures that are “always used” in assessment (Skahan, Watson, & Lof, 2007)

76% Case History 75% Intelligibility 74% Single Word Test 71% Hearing Screening 68% Stimulability 61% Parent Interview 58% Oral Motor-Non Speech 54% Oral Motor-Speech

51% Phonological Processes 36% Connected Speech Sample 36% Phonological Inventory 31% Classroom Observation 13% Perception/Discrimination 13% Phonological Awareness 11% Contextual Testing 11% Syllable/Word Shapes

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Helpful Assessment Forms • Place/Manner/Voicing forms• Phonetic/Phonemic Inventory Forms

o Phonetic Inventory: A listing of speech sounds that are produced regardless of the target(independent analysis) (See Eisenberg & Hitchcock, 2010)

o Phonemic Inventory: A listing of the speech sounds produced in comparison to the targetsound (relational analysis)

• Cluster Analysis Forms : Powell (1995); McLeod, van Doorn, & Reed (2001); Smit (1993); McLeod& Hand (1991)

Some questions to ask about potential targets (Tyler, 2005; 2008) • How are word/syllable structures affected by error patterns?

o Frequency of different syllable structures; Match between target & structure productions;Determine affected syllable structures

• Which sound classes are proportionally more affected by error patterns?o Fricatives? Stops? Liquids? Place/Manner/Voicing analysis is helpful

• Are there positional constraints?o Do the errors occur in all positions? Is it an inventory constraint or positional constraint?

• What sounds are present/absent in the phonetic inventory?o Use a phonetic inventory form; do you expand the inventory or do you make the inventory

more useful?• What is the stimulability status of the sounds in error?

o Do you select stimulable or nonstimulable sounds?

10 Factors to Consider for Selecting Targets (based on Powell, 1991) (1) Age of Child/Age Appropriateness of Error(s): Use norms and other developmental

information (Shriberg, 1993) Order Continuous Speech Articulation Test Early 8 M b y n w d p h M b n w d p h g

Middle 8 T a k g f v . j T a k f v . j y Late 8 C ‘ ; s z l r x C ‘ ; s z l r

(2) Effect on Intelligibility--Error type: Deletions Substitutions all others (3) Effect on Intelligibility--Deviancy: Unusual, deviant, idiosyncratic (4) Frequency of Sound Occurrence (Shriberg & Kent, 2013)

/ n,t,s,r/ account for 25% of all phoneme occurrences. /1,n,t,8,s,r,I,l,d,2 / account for nearly half of all phoneme occurrences. /n,d,t,r,z/ comprise more than 69% of the final consonant occurrences in words. Order of sound occurrence:

1. n 5. l 9. m 13. p 17. g 21. j2. t 6. d 10. w 14. v 18. y 22. c3. s 7. ; 11. z 15. f 19. a 23. .4. r 8. k 12. b 16. h 20. ‘ 24. x

(5) Homonymy: The production of one phonetic form for several adult target forms (e.g., [bat] for bad, bark, bent, bite; [bi] for beach, beat, beak, bike)

(6) Markedness (a part of complexity models): The aspects that have more features are considered marked and more complex. Working on the most marked aspects can be more effective in therapy (e.g., fricatives are more marked than stops; affricates are more marked

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than fricatives; clusters are more marked than singletons; voiced is more marked than voiceless).

(7) Morphological Status: Evaluate the tense markers and language structures that mark agreement. Those complex final clusters should then be targeted (especially if client has speech AND language problems):

Morpheme Example Present Progressive “ing” barking Regular Plural “-s” dogs Possessive “’s” baby’s Regular Past “-ed jumped Regular Third Person “-s” she eats Contractable copula He’s the baby Contractable auxiliary She’s going slow

(8) Phonetic Inventory: Determine completeness of the phonetic inventory, the repertoire of speech sounds produced independent of the adult model.

(9) Relevance to Child: Select sounds/patterns important to the client. (10) Stimulability: Reasons to and not to select nonstimulable sounds.

PHONOLOGICAL THERAPY APPROACHES B a k e r ( 2 0 0 4 ) ; B a k e r a n d M c L e o d ( 2 0 1 1 ) ; W i l l i a m s , M c L e o d & M c C a u l e y ( 2 0 1 0 )

UNPROVEN Therapy Technique: Nonspeech Oral Motor Exercises • Lof (2015); Lof & Watson (2008, 2010); Watson & Lof (2008)• See handout from the morning session for more information on thisMinimal Pairs (a.k.a.: Minimal Opposition Contrast Therapy) • Use pairs of words that differ by one phoneme only; for example: bow/boat• Used to establish contrasts not present in the phonological system• Usually words are selected with one word as the target, the other the replacement• Child should be stimulable for correct sound• Have child say both words in the pair• Show a communicative confusion if both words are said the sameMaximal Pairs (a.k.a.: Maximal Oppositions Therapy) • Word pairs have multiple feature contrasts (maximal oppositions)• Features can differ on place, manner, and voicing• The oppositions contrasts only two sounds• A sound the child correctly produces is compared to a maximally different one• An example: chop/mop

o Suppose a child produces t/co Maximal Pairs: /t/ is contrasted with maximally opposed sound from /c/ (perhaps /m/); For

example: me/she; Mack/shack, my/shy• Follow the procedures for minimal pairs• Who is best to use Maximal Pairs?

o Best used for moderate/severe childreno Meant to change the child’s entire phonological system because research shows it promotes

generalization

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Multiple Oppositions • Much like minimal pairs, but pairs all or most errors simultaneously• Good approach if child substitutes a single sound for multiple sounds• Child confronts the rule from multiple contrasts• For example: /t/ for /s,k,.,tr/

Metaphonological • A subcategory of metalinguistics.• Involves child’s conscious awareness of sounds within the language.• Phonological awareness is the awareness of sound/phonological structure of spoken words in

contrast to written words.• Intervention to enhance early phoneme awareness and letter knowledge, combined with

intervention to improve speech intelligibility, may ensure that children with speech impairmentapproach literacy instruction with age-appropriate phonological awareness development and willhelp with speech sound productions.

• This combined approach has shown to work for both speech sound training and for literacydevelopment.

• Work on intelligibility, phoneme awareness, and letter-name/letter-sound knowledge.o Phoneme blending (adult says: b—a—l, child says “ball”).o Phoneme segmentation (adult says: “ball”, child says “b—a—l”).o Phoneme manipulation: Say “boat” without the “t”; What word would you make if you put

“o” before “pen”?Cyclical Approach • Cycles approach was first developed by Hodson & Paden (1983).• Typically a phoneme (or consonant cluster) is targeted one hour per week (i.e., one 60-minute

session, two 30-minute sessions, or three 20-minute sessions), with each pattern typically beingtargeted from two to five hours per cycle

• Phonological patterns are divided into primary (those targeted first and then recycled as neededuntil they began emerging in conversational speech) and secondary patterns (see Hodson, 2011).

• Remediation Structureo The child reviews production-practice picture cards from the previous session. These cards are

then set aside (and may be used again along with new, more complex words during a latercycle, depending on whether the phonological pattern needs to be recycled). The SLP thenreads a list of approximately 20 words that contain the new target pattern for the week. Thechild listens attentively, but must not repeat these words.

o The child participates in experiential-play production-practice motivational activities (e.g.,bowling, flashlight game), naming pictures and objects of four or five carefully selected targetwords with the week's pattern before taking a turn in the activity. The SLP changes activitiesevery eight to 10 minutes. Many of these activities are repeated during ensuing weeks.

o A metaphonology activity is incorporated (e.g., rhyming, segmentation) to enhance the child'sphonological awareness skills.

Sue coo

two chew true

s k

t . tr

sip kip

tip chip trip

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o The SLP probes for the optimal phoneme target for the next week (within the phonological pattern designated from phonological assessment results). For example, if the current pattern is /s/ clusters, the clinician models words with various /s/ clusters (e.g., spot, store, snow). The cluster that the child produces most successfully becomes the target for the ensuing week.

o Parents receive the listening list and the production-practice picture cards and are asked to provide two minutes of home practice every day.

o Do a web search to find many resources and information about this approach. Language-Based Intervention • Many children with speech sound disorders also have difficulties with other aspects of language. • There is an intricate web of inter-dependencies between various aspects of language. • Some studies have shown that moderately severe children may improve in phonology and other

language domains with a combined phonological/language approach. • Children who are more severe may need focused attention directly on both domains. • Cycles approach to language and phonological therapy has been shown to be effective. • Work on language for one cycle, phonology for the next cycle. • Work on morphology can also help with phonology (plural, possessives, past tense, etc.)

Other Approaches: • PACT (Parents & Children Together); Psycholinguistic (using reading methods); Nonlinear

Phonology; Core Vocabulary

SOME PRINCIPLES OF PHONOLOGICAL THERAPY • The treatment is based on a phonological assessment, and the aims are defined by the

phonological assessment. • Therapy is based on the principle that there are regularities in the child’s pronunciation patterns

(i.e., “order in disorder”). • Therapy is based on the principle that the primary function of phonological organization is

communicative (i.e., differences in sounds and sequences signal meaning differences). • Therapy aims to facilitate change in the child’s pronunciation patterns in order to build up a more

adequate system of sound contrasts and sound structures. • Therapy is designed to make maximally effective use of the organization of phonological

patterning in the target system by introducing and establishing changes in the child’s patterns through use of natural classes of contrastive phones and structures.

GENERAL COMMENTS AND SUGGESTIONS FOR THERAPY ( B a s e d o n H o d s o n , 2 0 1 1 )

• Remediating a pattern, not individual sounds; o Successive approximation; Not trained to 90% criteria

• Communication is the goal of training. o Successful communication is its own best reward; Misarticulation is miscommunication;

Internal rewards, not external rewards • Use child-led interactive activities.

o Play-like therapy; Meaningful linguistic contexts • Phonological acquisition is gradual. • Work on phonetic problems along with phonological ones. • Carefully select words and sounds for therapy. • Children generalize new skills to other targets.

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A HELPFUL RESOURCE FOR ASSESSMENT & TREATMENT C a r o l i n e B o w e n : h t t p : / / s p e e c h - l a n g u a g e - t h e r a p y . c o m /

REFERENCES Baker, E. (2004). Phonological analysis summary and management plan. Acquiring Knowledge in Speech, Language and

Hearing, 6, 14-17. Baker, E., & McLeod, S., (2011). Evidence-based practice for children with speech sound disorders: Part 1 and Part 2.

Language, Speech and Hearing Services in the Schools, 42, 102-152. Bowen, C. http://speech-language-therapy.com Eisenberg, S. & Hitchcock, E. (2010). Using standardized tests to inventory consonant and vowel production: A

comparison of 11 tests of articulation and phonology. Language, Speech and Hearing Services in the Schools, 41, 488-503.

Ertmer, D. (2011). Assessing speech intelligibility in children with hearing loss: Toward revitalizing a valuable clinical tool. Language, Speech and Hearing Services in the Schools, 42, 52-58.

Hodson, B. (2011). Enhancing phonological patterns of young children with highly unintelligible speech. ASHA Leader. http://www.asha.org/Publications/leader/2011/110405/Enhancing-Phonological-Patterns-of-Young-Children-With-Highly-Unintelligible-Speech.htm

Hodson, B., & Paden, E. (1983). Targeting intelligible speech. San Diego: College Hill Press. Johnson, C., Weston, A., & Bain, B. (2004). An objective and time efficient method for determining severity of childhood

speech delay. American Journal of Speech-Language Pathology, 13, 55-65. Locke, J. (1980). The inference of speech perception in the phonologically disordered child, Parts I and II. Journal of

Speech and Hearing Disorders, 45, 431-446. Lof, G. (2015). The nonspeech-oral motor exercise phenomenon in speech pathology practice. In C. Bowen (Ed.),

Children’s speech sound disorders (Second Ed.), 253-257. Oxford: Wiley-Blackwell. Lof, G. (2002). Two comments on this assessment series. American Journal of Speech-Language Pathology, 11, 255-256. Lof, G., & Watson, M. (2008). A nationwide survey of non-speech oral motor exercise use: Implications for evidence-

based practice. Language, Speech and Hearing Services in Schools, 39, 392-407. Lof, G., & Watson, M. (2010). Five reasons why nonspeech oral-motor exercises do not work. Perspectives in Language

and Learning, 11.109-117. McLeod, S., & Hand, L. (1991). Single word test of consonant clusters. http://athene.riv.csu.edu.au/

~smcleod/Consonantclustertest.pdf McLeod, S., Harrison, L., & McCormack, J. (2012). The intelligibility in context scale: Validity and reliability of a subjective

rating measure. Journal of Speech, Language and Hearing Research, 55, 648-656. McLeod, S., & McCauley, R. (2010). McLeod, S., van Doorn, J., & Reed, V. (2001). Normal acquisition of consonant clusters. American Journal of Speech-

Language Pathology, 10, 99-110. Miccio, A. (2005). A treatment program for enhancing stimulability. In A. Kamhi & K. Pollock (Eds.), Phonological disorders

in children: Clinical decision making in assessment and intervention. Baltimore: Brooks. Miccio, A., & Elbert, M. (1996). Enhancing stimulability: A treatment program. Journal of Communication Disorders, 29,

335-351. Morrison, J. & Shriberg, L. (1992). Articulation testing versus conversational speech sampling. Journal of Speech and

Hearing Research, 35, 259–273. Powell, T. (1991). Planning for phonological generalization: An approach to treatment target selection. American Journal

of Speech-Language Pathology, 1, 21-27. Powell. T. (1995). A clinical screening procedure for assessing consonant cluster production. American Journal of Speech-

Language Pathology, 4, 59-65.: http://ajslp.asha.org/cgi/reprint/4/1/59 Skahan, S., Watson, M., & Lof, G. (2007). Speech-language pathologists' assessment practices for children with suspected

speech sound disorders: Results of a national survey. American Journal of Speech-Language Pathology, 16, 246-259. Shriberg., L.D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in

developmental phonological disorders. Journal of Speech and Hearing Research, 36, 105-140. Shriberg, L., & Kent, R (2013). Clinical Phonetics (4th ed). Boston: Allyn & Bacon.

Smit, A. B. (1993). Phonologic error distributions in the Iowa-Nebraska articulation norms project: Word-initial consonant clusters. Journal of Speech and Hearing Research, 36, 931–947.

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Tyler, A. (2005). Promoting generalization: Selecting, scheduling, and integrating goals. In A. Kamhi & K. Pollock (Eds.), Phonological disorders in children: Clinical decision making in assessment and intervention. Baltimore: Brooks.

Tyler, A. (2008). What works: Evidence-based intervention for children with speech sound disorders. Seminars in Speech and Language, 29, 320-330.

Watson, M., & Lof, G. (2008). What we know about nonspeech oral motor exercises. Seminars in Speech and Language, 29, 320-330.

Williams, A., McLeod, S., & McCauley, R. (2010). Interventions for speech sound disorders in children. Baltimore: Brooks.

HELPFUL BOOKS

Williams, A.L., McLeod, S., & McCauley, R. (2010). Interventions for speech sound disorders in children. Brooks Publishing.

Bowen, C. (2015). Children’s speech sound disorders. (2nd ed). Wiley-Blackwell.

Bliele, K. (2014). The late eight. (2nd ed). Plural Publishing.

Secord, W., Boyce, S., Donohue, J., Fox, R., & Shine, R. (2007). Eliciting sounds: Techniques and strategies for clinicians. Thomson Delmar Learning.

Hodson, B.W. (2007). Evaluating and enhancing Children’s phonological systems: Research and theory to practice. Thinking Publications.

McLeod, S. (2007). The international guide to speech acquisition. Thomson Delmar Learning.

© 2015 Gregory L. Lof

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SPPT SCORING FORM

Client: Sound Contrast Tested:

Clinician:

Date:

Number Stimulus

Class Stimulus

Word Correct

ResponseChild’s Response

(circle)

1. CP-1 No No Yes

2. RP-1 No No Yes

3. SP-1 Yes No Yes

4. SP-2 Yes No Yes

5. RP-2 No No Yes

6. CP-2 No No Yes

7. CP-3 No No Yes

8. SP-3 Yes No Yes

9. RP-3 No No Yes

10. SP-4 Yes No Yes

11. RP-4 No No Yes

12. CP-4 No No Yes

13. RP-5 No No Yes

14. SP-5 Yes No Yes

15. CP-5 No No Yes

16. RP-6 No No Yes

17. SP-6 Yes No Yes

18. CP-6 No No Yes

Formula for misperception: RP > 3 and RP > 2(SP + CP)

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Calculating PCC Using an Informal Procedure

Child’s Name: Date Administered:

Ask the child to repeat the sentence after you. Put a line through any consonant not produced correctly: all deletions, substitutions, and distortions (no matter how subtle). Exclude all vowels, including /5,6/.

1. We see one big dog. 19. One boy went behind the balls.Wi si w4n b8g d9g W4n b9] w2nt b2he]nd ;1 belz

2. Mother talks on the new phone 20. She can’t get inside yet.M4;5 t0ks 0n ;1 nu fon Ci kqnt g2t 8nse]d y2t

3. The baby has a pretty toy. 21. I brought bugs and things.;4 b3bi hqz 1 pr8ti t9] E] br9t b4gz qn ‘8az

4. Mom says, “Sit down.” 22. Pieces are all over.M0m s2z s8t de[n Pis1z er el ov5

5. You’ll be fine with teacher 23. He got cold.Y7l bi fe]n w8’ ti.5 Hi get kold

6. Oh no, the door shut! 24. Time to clean up.O[ no[ ;1 d9r c4t Te]m t1 klin 4p

7. She looks happy. 25. Put one flower on his head.Ci l7ks hqpi P7t w4n fle[5 en h8z h2d

8. Some kids are playing. 26. We want more food.S4m k8dz er pl3]a Wi went m9r fud

9. She is looking in. 27. A lady climbed.Ci 8z l7k8a 8n 1 l3di kle]md

10. Watch them dance. 28. All kids work.We. ;2m dqns El k8dz w6k

11. Now he can read. 29. Maybe this will move now.Ne[ hi kqn rid M3bi ;8s w8l muv ne[

12. He took dinosaurs. 30. They are very tired.Hi t7k de]n1s9rz ;3] er v2ri te]5d

13. Look he can pull. 31. We’ll rest awhile.L7k hi kqn p7l Wil r2st 1we]l

14. They just made cars. 32. He can open a door.;3] j1st m3]d kerz Hi kqn op1n 1 d9r

15. Everybody goes around. 33. Come into the room.2vrib1di goz 1re[nd K7m 8ntu ;1 rum

16. Now he wants water. 34. The dog is watching.Ne[ hi wents wet5 ;1 deg 8z we.8a

17. She fell down. 35. Move the bug off.Ci f2l de[n Muv ;1 b4g ef

18. What is so funny? 36. Time to go home.W1t 8z so f4ni Te]m t1 go hom

273 consonants - errors = correct consonants /273 = PCC

Johnson, C., Weston, A., & Bain, B. (2004). An objective and time-efficient method for determining severity of childhood speech delay. American Journal of Speech-Language Pathology, 13, 55-65.

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INTELLIGIBILITY ASSESSMENT: Calculating Percentage of Intelligible Word Score

• Sitting across from the child, say a sentence from one of the lists.• After stating the sentence, ask the child to imitatively produce the same sentence. Record just the

child’s production and not the clinician’s.• After all 10 sentences are recorded, find 1-3 listeners who are not familiar with this child’s speech.• Ask the listener(s) to listen to each sentence two times in succession and write down exactly what is

heard.• Guidelines for scoring: (a) Only the words that the child actually says are used to calculate the

percentage intelligible score; (b) If more than one listener, the scores are averaged; (c) Give creditto the word if the root is understood by the listener (e.g., “swim” for “swims” is correct); (d) Donot penalize for incorrect morphology or syntax (e.g., score as correct if child says “see” insteadof target “saw”).

• Count the number of words correctly and incorrectly identified by the listener(s) to determine thePercentage of Intelligible Word Score.

List 1 List 2 1. The baby falls. 1. Daddy runs.2. Mommy walks. 2. The baby cries.3. The duck swims. 3. The dog eats.4. The boy sits. 4. The girl drinks.5. Grandma sleeps. 5. The clown falls.6. That is a little bed. 6. That is a big bed.7. The boy walked to the table. 7. The boy walked to the chair.8. My car is blue. 8. My van is green.9. He is brushing his teeth. 9. They are playing the drums.10. She is taking a bath. 10. She is talking on the phone.

List 3 List 4 1. Daddy walks. 1. The bear sleeps.2. The bunny drinks. 2. Mommy sits.3. The dog sleeps 3. The rabbit hops4. The girl jumps 4. The cowboy jumps.5. Mommy reads. 5. Grandma falls.6. That is a brown chair 6. That is a black hat.7. The boy is on the table. 7. The boy is under the table.8. My airplane is big. 8. My airplane is small9. He is tying his shoe. 9. He is painting the chair.10. She is brushing her hair. 10. She is cooking dinner.

Ertmer, D. (2011). Assessing speech intelligibility in children with hearing loss: Toward revitalizing a valuable clinical tool. Language, Speech and Hearing Services in the Schools,42, 52-58.

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v

Θ

;

s

c

m

n

a

l r

w

pr

tr

kr

pl

kw

Sing

leton

C:

Wor

d In

itial

C +

/w/

1 2

3

C +

/y/

4 5

6 7

8 9

C +

/l/

10

11

12

13

14

15

C +

/r/

16

17

18

19

20

21

22

23

24

/s/+

C

25

26

27

28

29

15

3 30

31

32

33

34

Wor

d Fi

nal

/s/

+ C

35

36

37

C +

/s,z/

38

39

40

41

42

43

44

45

46

47

48

49

50

/l/

+ C

51

52

53

54

/r/+

C

55

56

57

58

59

60

[+ na

sal] +

C

61

62

63

64

Page 14

Words for Assessing Consonant Cluster Production 1. twin tw 33. splash spl

2. queen kw 34. squirrel skw

3. sweep sw 35. wasp sp

4. pew py 36. west st

5. beauty by 37. ask sk

6. cue ky 38. caps ps

7. few fy 39. cabs bz

8. view vy 40. cats ts

9. music my 41. kids dz

10. play pl 42. box ks

11. blue bl 43. dogs gz

12. clay kl 44. caves vz

13. glue gl 45. bathes ;z

14. fly fl 46. combs mz

15. sleep sl 47. cans nz

16. pray pr 48. kings az

17. bread br 49. calls lz

18. tree tr 50. cars rz

19. drum dr 51. belt lt

20. cry kr 52. cold ld

21. grow gr 53. milk lk

22. fry fr 54. wolf lf

23. three Θr 55. sharp rp

24. shrub cr 56. cart rt

25. spy sp 57. card rd

26. stay st 58. work rk

27. sky sk 59. warm rm

28. smell sm 60. barn rn

29. snw sn 61. camp mp

30. spray spr 62. tent nt

31. stray str 63. hand nd

32. screw skr 64. ink ak

Powell, T.W. (1995). A clinical screening procedure for assessing consonant cluster production. American Journal of Speech-Language Pathology, 4, 59-65.

Page 15

PPhhoonneettiicc IInnvveennttoorryy Place-Manner-Voicing

Place a ““ in the box if the sound is ever produced in the sample. Place a ““ in the box if the sound did not have an opportunity to be produced in the sample.

Place of Articulation

Manner Bilabial Labialdental Interdental Alveolar Palatal Velar Glottal

Voicing -V +V -V +V -V +V -V +V -V +V -V +V -V

Stop

p b t d k g

Fricative

f v ‘ ; s z c x h

Affricate

. J

Nasal

m n A

Liquid

l R

Glide

w y

Page 16

Matrix for Recording Phones According to Pre-, Inter-, and Postvocalic Word Positions

Prevocalic m n

p b t d . j k g

f v θ ; c Clusters

s z

w r y h

l

Intervocalic m n a

p b t d . j k g

f v θ ; c x Clusters

s z

w r y h

l

Postvocalic m n a

p b t d . j k g

f v θ ; c x Clusters

s z

r

l

Page 17