Chapter 32 Clinical Phonology and Phonological Assessment Barbara Dodd, Barbara DoddSearch for more papers by this authorAlison Holm, Alison HolmSearch for more papers by this authorSharon Crosbie, Sharon CrosbieSearch for more papers by this author Barbara Dodd, Barbara DoddSearch for more papers by this authorAlison Holm, Alison HolmSearch for more papers by this authorSharon Crosbie, Sharon CrosbieSearch for more papers by this author Book Editor(s):Martin J. Ball, Martin J. BallSearch for more papers by this authorNicole Müller, Nicole MüllerSearch for more papers by this authorElizabeth Spencer, Elizabeth SpencerSearch for more papers by this author First published: 08 January 2024 https://doi.org/10.1002/9781119875949.ch32 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Assessment for identification of speech sound disorders (SSDs) has a descriptive purpose rather than an explanatory role. To identify children with SSD and to diagnose their type of SSD, their phonetic and phonological abilities are compared with normative data. Interpretation of data depends on clinicians' theoretical views of SSD (see Waring & Knight, 2013, for SSD classification by theoretical approach). Speech‐language pathologists (SLPs) use the data to hypothesize underlying deficits for a child's linguistic profile, designing intervention (i.e., goals and methods) to improve intelligibility. The ultimate test of this clinical process is response to intervention, measured by changes in functional communication. This chapter outlines the beginnings of clinical phonology before evaluating its role in assessment for identification, differential diagnosis, and intervention for children with suspected SSD. Early texts assumed that speech is a complex motor skill and that any difficulties affected articulation, fluency, or voice (Van Riper, 1963). However, Jakobson (1968 English translation of his 1941 monograph) raised awareness of the role of phonology in speech development and disorders. He distinguished between speech sound articulation as the surface level of a linguistic system, and the phonological system that specifies the distribution and organization of the speech sounds and syllable shapes in each language. Evidence for this clinically crucial distinction between articulation and phonology was provided by typically developing children (Smith, 1973) and children with SSD (Morley, 1972). Several people had a major influence on clinical phonology in the 1970s and 80s: Ingram (1976) reconceptualized the nature of pediatric speech impairment. He shifted the focus from individual speech sounds to patterns of errors affecting more than one sound (e.g., cluster reduction, final consonant deletion). He made direct links between theories in developmental psychology and linguistic abilities. He recognized the relevance of psycholinguistics for speech‐language pathology and provided examples of how analyses of impaired speech informed theory in linguistics and psychology. Weiner (1981) reported evidence that meaningful minimal contrasts intervention based on the principles of clinical phonology was efficient and effective. For example, two fouryear‐olds received only six intervention sessions focused on error patterns. The therapy reduced fronting, stopping and final consonant deletion errors and generalized to untaught targets. Grunwell (1982) examined how different linguistic analyses of individuals contributed to assessment, diagnosis, and treatment. She developed a linguistic framework as well as a manual for assessment practice. Locke (1983) provided a theoretical context for future research on children's speech difficulties. This context recognized the shift to describing children's patterns of speech errors using linguistic analyses rather than identifying individual children's deficits in input, cognitive and motor domains. This shift had led to a change in labeling, with phonological disorder being used instead of articulation disorder. However, Locke (1983, p. 339) lamented the missed opportunity to make a "potentially useful clinical distinction" between the two. He called for a generic label for difficulties affecting the sounds of language that emerge during children's early years that would promote research into differential diagnosis of speech disorders. Speech‐sound disorders (SSD) emerged as that term. However, Locke (1983) also proposed that clinical phonology must explain, not just describe SSD. He advocated using scientific methodology to better understand phonological processing in both typical and disordered speech development. He argued that clinical phonology should account for why a particular child exhibits specific speech behaviors to enhance theory and so guide clinical intervention. Today we know more about typical and atypical speech development in diverse language learning contexts. Measures used to describe speech behavior are more comprehensive. There is growing awareness of the heterogeneity of speech behavior of children between and within recognized subgroups of SSD, leading to evaluation of different classification systems for speech disorders (Waring & Knight, 2013). The need for differential diagnosis prompted investigation of the ability profiles associated with distinct types of SSD. The identified strengths and weaknesses of homogeneous groups of children with SSD resulted in better understanding of the need for specific types of intervention. Assessment data underpin SSD theory and inform effective clinical management decisions. Three assessment issues are crucial for research and practice: criteria for identifying children with SSD; differentiation of SSD subgroups; and intervention informed by assessment data. References Ball , M. ( 2016 ). Principles of clinical phonology . Routledge . Google Scholar Barbier , G. , Perrier , P. , Payan , Y. , Tiede , M. K. , Gerber , S. , Perkell , J. S. , & Ménard , L. ( 2020 ). What anticipatory coarticulation in children tells us about speech motor control maturity . Plos One , 15 ( 4 ), e0231484 . https://doi.org/10.1371/journal.pone.0231484 10.1371/journal.pone.0231484 CASPubMedWeb of Science®Google Scholar Bird , J. , & Bishop , D. ( 1992 ). Perception and awareness of phonemes in phonologically impaired children . European Journal of Disorders of Communication , 27 ( 4 ), 289 – 311 . https://doi.org/10.3109/13682829209012042 10.3109/13682829209012042 CASPubMedGoogle Scholar Bradford , A. , & Dodd , B. ( 1994 ). The motor planning abilities of phonologically disordered children . European Journal of Disorders of Communication , 29 ( 4 ), 349 – 369 . https://doi.org/10.3109/13682829409031288 10.3109/13682829409031288 CASPubMedWeb of Science®Google Scholar Bradford , A. , & Dodd , B. ( 1996 ). Do all speech-disordered children have motor deficits? Clinical Linguistics and Phonetics , 10 ( 2 ), 77 – 101 . https://doi.org/10.3109/02699209608985164 10.3109/02699209608985164 Web of Science®Google Scholar Broomfield , J. , & Dodd , B. ( 2004 ). The nature of referred subtypes of primary speech disability . Child Language Teaching and Therapy , 20 ( 2 ), 135 – 151 . https://doi.org/10.1191/0265659004ct267oa 10.1191/0265659004ct267oa Google Scholar Brosseau-Lapré , F. , & Schumaker , J. ( 2020 ). Perception of correctly and incorrectly produced words in children with and without phonological speech disorders . Journal of Speech Language and Hearing Research , 63 ( 12 ), 3961 – 3973 . https://doi.org/10.1044/2020_JSLHR-20-00119 10.1044/2020_JSLHR-20-00119 PubMedWeb of Science®Google Scholar Claessen , M. , Leitão , S. , & Fraser , C.-J. ( 2017 ). Intervention for a young child with atypical phonology . In B. Dodd & A. Morgan (Eds.), Intervention case studies of child speech impairment (pp. 275 – 291 ). J&R Press . Google Scholar Clausen , M. C. , & Fox-Boyer , A. V. ( 2022 ). Diagnostic validity, accuracy and inter-rater reliability of a phonological assessment for Danish-speaking children . Journal of Communication Disorders , 95 ( 1 ), 106168 . https://doi.org/10.1016/j.jcomdis.2021.106168 10.1016/j.jcomdis.2021.106168 PubMedGoogle Scholar Crockett , J. ( 2012 ). Minimal contrasts and maximal oppositions: An evidence-based practice brief [Masters thesis]. University of Texas . http://hdl.handle.net/2152/ETD-UT-2012-05-5239 . Google Scholar Crosbie , S. , & Holm , A. ( 2017 ). Phonological contrast therapy for children making consistent errors . In B. Dodd & A. Morgan (Eds.), Intervention case studies of child speech impairment (pp. 201 – 222 ). J&R Press . Google Scholar Crosbie , S. , Holm , A. , & Dodd , B. ( 2009 ). Cognitive flexibility in children with and without speech disorder . Child Language Teaching and Therapy , 25 ( 2 ), 250 – 270 . https://doi.org/10.1177/0265659009102990 10.1177/0265659009102990 Web of Science®Google Scholar Crosbie , S. , Holm , A. , & Dodd , B. 2020 . Core vocabulary intervention . In A. Williams , S. McLeod , & R. McCauley (Eds.), Intervention for speech sound disorders in children ( 2nd ed., pp. 225 – 249 ). Brookes . Google Scholar Crowe , K. , & McLeod , S. ( 2020 ). Children's English consonant acquisition in the United States: A review . American Journal of Speech-Language Pathology , 29 ( 4 ), 2155 – 2169 . https://doi.org/10.1044/2020_AJSLP-19-00168 10.1044/2020_AJSLP-19-00168 PubMedWeb of Science®Google Scholar Dodd , B. ( 1995 ). Differential diagnosis and treatment of children with speech disorders . Whurr . Google Scholar Dodd , B. ( 2011 ). Differentiating speech delay from speech disorder: Does it matter? Topics in Language Disorders , 31 ( 2 ), 96 – 111 . http://dx.doi.org/10.1097/TLD.0b013e318217b66a 10.1097/TLD.0b013e318217b66a Web of Science®Google Scholar Dodd , B. ( 2021 ). Re-evaluating evidence for best practice in pediatric speech-language pathology . Folia Phoniatrica et Logopaedica , 73 ( 2 ), 63 – 74 . https://doi.org/10.1159/000505265 10.1159/000505265 PubMedWeb of Science®Google Scholar Dodd , B. , Holm , A. , Zhu , H. , & Crosbie , S. ( 2003 ). Phonological development: A normative study of British English-speaking children . Clinical Linguistics and Phonetics , 17 ( 8 ), 617 – 643 . https://doi.org/10.1080/0269920031000111348 10.1080/0269920031000111348 PubMedWeb of Science®Google Scholar Dodd , B. , & Iacono , T. ( 1989 ). Phonological disorders in children: Changes in phonological process use during treatment . British Journal of Disorders of Communication , 24 ( 3 ), 333 – 352 . https://doi.org/10.3109/13682828909019894 10.3109/13682828909019894 CASPubMedGoogle Scholar Dodd , B. , Leahy , J. , & Hambly , G. ( 1989 ). Phonological disorders in children: Underlying cognitive deficits . British Journal of Developmental Psychology , 7 ( 1 ), 55 – 71 . https://doi.org/10.1111/j.2044-835X.1989.tb00788.x 10.1111/j.2044-835X.1989.tb00788.x Web of Science®Google Scholar Dodd , B. , & McCormack , P. ( 1995 ). A model of speech processing for differential diagnosis of phonological disorders . In B. Dodd (Ed.), Differential diagnosis and treatment of children with speech disorders (pp. 65 – 89 ). Whurr . Web of Science®Google Scholar Dodd , B. , & McIntosh , B. ( 2010 ). Two-year-old phonology: Impact of input, motor and cognitive abilities on development . Journal of Child Language , 37 ( 5 ), 1027 – 1046 . https://doi.org/10.1017/S0305000909990171 10.1017/S0305000909990171 PubMedWeb of Science®Google Scholar Dodd , B. , Mcintosh , B. , Erdener , D. , & Burnham , D. ( 2008 ). Perception of the auditory-visual illusion in speech perception by children with phonological disorders . Clinical Linguistics and Phonetics , 22 ( 1 ), 69 – 82 . https://doi.org/10.1080/02699200701660100 10.1080/02699200701660100 PubMedWeb of Science®Google Scholar Dodd , B. , Reilly , S. , Ttofari Eecen , K. , & Morgan , A. T. ( 2018 ). Articulation or phonology? Evidence from longitudinal error data . Clinical Linguistics and Phonetics , 32 ( 11 ), 1027 – 1041 . https://doi.org/10.1080/02699206.2018.1488994 10.1080/02699206.2018.1488994 PubMedWeb of Science®Google Scholar Dodd , B. , & Thompson , L. ( 2001 ). Speech disorder in children with Down's syndrome . Journal of Intellectual Disability Research , 45 ( Pt 4 ), 308 – 316 . https://doi.org/10.1046/j.1365-2788.2001.00327.x 10.1046/j.1365-2788.2001.00327.x CASPubMedGoogle Scholar Farquharson , K. , Tambyraja , S. R. , & Justice , L. M. ( 2020 ). Contributions to gain in speech sound production accuracy for children with speech sound disorders: Exploring child and therapy factors . Language, Speech and Hearing Services in Schools , 51 ( 2 ), 457 – 468 . https://doi.org/10.1044/2019_LSHSS-19-00079 10.1044/2019_LSHSS-19-00079 PubMedWeb of Science®Google Scholar Flipsen , P. ( 2015 ). Emergence and prevalence of persistent and residual speech errors . Seminars in Speech and Language , 36 ( 4 ), 217 – 223 . https://doi.org/10.1055/s-0035-1562905 10.1055/s-0035-1562905 PubMedWeb of Science®Google Scholar Garrett , K. K. , & Moran , M. J. ( 1992 ). A comparison of phonological severity measures . Language, Speech, and Hearing Services in Schools , 23 ( 1 ), 48 – 51 . https://doi.org/10.1044/0161-1461.2301.48 10.1044/0161-1461.2301.48 Google Scholar Gierut , J. A. ( 2001 ). Complexity in phonological treatment: Clinical factors . Language, Speech, and Hearing Services in Schools , 32 ( 4 ), 229 – 241 . https://doi.org/10.1044/0161-1461(2001/021) 10.1044/0161-1461(2001/021) PubMedWeb of Science®Google Scholar Gillon , G. ( 2004 ). Phonological awareness: From research to practice . Guilford . Google Scholar Goldman , R. , & Fristoe , M. ( 2015 ). Goldman-Fristoe test of articulation ( 3rd ed.). Pearson . Google Scholar Grunwell , P. ( 1982 ). Clinical phonology . Croom Helm . Google Scholar Grunwell , P. ( 1997 ). Natural phonology . In M. Ball & R. Kent (Eds.), The new phonologies: Developments in clinical linguistics (pp. 35 – 75 ). Singular . Google Scholar Günther , T. , & Nieslony , J. ( 2017 ). Traditional articulation therapy . In B. Dodd & A. Morgan (Eds.), Intervention case studies of child speech impairment (pp. 319 – 336 ). J&R Press . Google Scholar Harris , J. , Botting , N. , Myers , L. , & Dodd , B. ( 2011 ). The relationship between speech impairment, phonological awareness and early literacy development . Australian Journal of Learning Difficulties , 16 ( 2 ), 111 – 125 . https://doi.org/10.1080/19404158.2010.515379 10.1080/19404158.2010.515379 Google Scholar Holm , A. , & Dodd , B. ( 1999 ). An intervention case study of a bilingual child with phonological disorder . Child Language Teaching and Therapy , 15 ( 2 ), 139 – 158 . https://doi.org/10.1177/026565909901500203 10.1177/026565909901500203 Google Scholar Holm , A. , Dodd , B. , & Ozanne , A. ( 1997 ). Efficacy of intervention for a bilingual child making articulation and phonological errors . International Journal of Bilingualism , 1 ( 1 ), 55 – 69 . https://doi.org/10.1177/136700699700100105 10.1177/136700699700100105 Google Scholar Holm , A. , Farrier , F. , & Dodd , B. ( 2008 ). Phonological awareness, reading accuracy and spelling ability of children with inconsistent phonological disorder . International Journal of Language and Communication Disorders , 43 ( 3 ), 300 – 322 . https://doi.org/10.1080/13682820701445032 10.1080/13682820701445032 PubMedWeb of Science®Google Scholar Hua , Z. , & Dodd , B. ( 2006 ). Phonological development and disorders in children: A multilingual perspective . Multilingual Matters . 10.21832/9781853598906 Google Scholar Ingram , D. ( 1976 ). Phonological disability in children . Edward Arnold . Web of Science®Google Scholar Jakobson , R. (1941, 1968 ). Child language, aphasia and phonological universals . Mouton . 10.1515/9783111353562 Google Scholar Jerger , S. , Lewis , S. , Hawkins , J. , & Jerger , J. ( 1980 ). Pediatric speech intelligibility test. I. Generation of test materials . International Journal of Pediatric Otorhinolaryngology , 2 ( 3 ), 217 – 230 . https://doi.org/10.1016/0165-5876(80)90047-6 10.1016/0165-5876(80)90047-6 CASPubMedWeb of Science®Google Scholar Leitão , S. , & Fletcher , J. ( 2004 ). Literacy outcomes for students with speech impairment: Long-term follow-up . International Journal of Language & Communication Disorders , 39 ( 2 ), 245 – 256 . https://doi.org/10.1080/13682820310001619478 10.1080/13682820310001619478 PubMedWeb of Science®Google Scholar Leitão , S. , Hogben , J. , & Fletcher , J. ( 1997 ). Phonological processing skills in speech and language impaired children . European Journal of Disorders of Communication , 32 ( 2 ), 91 – 111 . https://doi.org/10.1111/j.1460-6984.1997.tb01626.x 10.1111/j.1460-6984.1997.tb01626.x CASPubMedGoogle Scholar Levelt , W. J. , Roelofs , A. , & Meyer , A. S. ( 1999 ). A theory of lexical access in speech production . The Behavioral and Brain Sciences , 22 ( 1 ), 1 – 75 . https://doi.org/10.1017/s0140525x99001776 10.1017/S0140525X99001776 CASPubMedWeb of Science®Google Scholar Locke , J. L. ( 1983 ). Clinical phonology: The explanation and treatment of speech sound disorders . Journal of Speech and Hearing Disorders , 48 ( 4 ), 339 – 341 . https://doi.org/10.1044/jshd.4804.339 10.1044/jshd.4804.339 CASPubMedGoogle Scholar McIntosh , B. & Dodd , B. ( 2011 ). Toddler Phonology Test . Pearson . Google Scholar McLeod , S. , & Masso , S. ( 2019 ). Speech sound disorders in children . In J. Horst & J. von Koss Torkildsen (Eds.), International handbook of language acquisition (pp. 362 – 386 ). Routledge . 10.4324/9781315110622-19 Google Scholar McNeill , B. , McIlraith , A. L. , Macrae , T. , Gath , M. , & Gillon , G. ( 2022 ). Predictors of speech severity and inconsistency over time in children with token-to-token inconsistency . Journal of Speech, Language, and Hearing Research , 65 ( 7 ), 2459 – 2473 . https://doi.org/10.1044/2022_JSLHR-21-00611 10.1044/2022_JSLHR-21-00611 PubMedWeb of Science®Google Scholar Morgan , A. , Ttofari Eecen , K. , Pezic , A. , Brommeyer , K. , Mei , C. , Eadie , P. , Reilly , S. , & Dodd , B. ( 2017 ). Who to refer for speech therapy at 4 years of age versus who to "Watch and wait"? Journal of Pediatrics , 185 ( June ), 200–204.e1 . https://doi.org/10.1016/j.jpeds.2017.02.059 . 10.1016/j.jpeds.2017.02.059 PubMedGoogle Scholar Morley , M. ( 1972 ). The development and disorders of speech in childhood . Churchill . Google Scholar Namasivayam , A. K. , Coleman , D. , O'Dwyer , A. , & van Lieshout , P. ( 2020 ). Speech sound disorders in children: An articulatory phonology perspective . Frontiers in Psychology , 10 , Article 2998 . https://doi.org/10.3389/fpsyg.2019.02998 10.3389/fpsyg.2019.02998 PubMedWeb of Science®Google Scholar Pi , M. , & Ha , S. ( 2020 ). Classification of subgroups of children with speech sound disorders: A preliminary study . Communication Sciences and Disorders , 25 ( 1 ), 113 – 125 . https://doi.org/10.12963/csd.20685 10.12963/csd.20685 Web of Science®Google Scholar Shriberg , L. D. , Fourakis , M. , Hall , S. D. , Karlsson , H. B. , Lohmeier , H. L. , McSweeny , J. L. , Potter , N. L. , Scheer-Cohen , A. R. , Strand , E. A. , Tilkens , C. M. , & Wilson , D. L. ( 2010 ). Extensions to the speech disorders classification system (SDCS) . Clinical Linguistics and Phonetics , 24 ( 10 ), 795 – 824 . https://doi.org/10.3109/02699206.2010.503006 10.3109/02699206.2010.503006 PubMedWeb of Science®Google Scholar Shriberg , L. D. , & Kwiatkowski , J. ( 1982 ). Phonological disorders III: A procedure for assessing severity of involvement . Journal of Speech and Hearing Disorders , 47 ( 3 ), 256 – 270 . https://doi.org/10.1044/jshd.4703.256 10.1044/jshd.4703.256 CASPubMedGoogle Scholar Smith , N. ( 1973 ). The acquisition of phonology . Cambridge University Press . Google Scholar Stackhouse , J. , & Wells , B. ( 1997 ). Children's speech and literacy difficulties: A psycholinguistic framework . Whurr . Google Scholar Stampe , D. ( 1973 ). A dissertation on natural phonology [Unpublished doctoral dissertation]. University of Chicago . Google Scholar Storkel , H. L. ( 2019 ). Using developmental norms for speech sounds as a means of determining treatment eligibility in schools . Perspectives of the ASHA Special Interest Groups , 4 ( 1 ), 67 – 75 . https://doi.org/10.1044/2018_PERS-SIG1-2018-0014 10.1044/2018_PERS-SIG1-2018-0014 Google Scholar Thyer , N. , & Dodd , B. ( 1996 ). Auditory processing and phonologic disorder . Audiology , 35 ( 1 ), 37 – 44 . https://doi.org/10.3109/00206099609071928 10.3109/00206099609071928 CASPubMedGoogle Scholar Ttofari Eecen , K. , Eadie , P. , Morgan , A. T. , & Reilly , S. ( 2019 ). Validation of Dodd's Model for Differential Diagnosis of childhood speech sound disorders: A longitudinal community cohort study . Developmental Medicine and Child Neurology , 61 ( 6 ), 689 – 696 . https://doi.org/10.1111/dmcn.13993 10.1111/dmcn.13993 PubMedWeb of Science®Google Scholar van de Weijer , J. ( 2019 ). Where now with optimality theory? Acta Linguistica Academica , 66 ( 1 ), 115 – 136 . https://www.jstor.org/stable/26654005 10.1556/2062.2019.66.1.5 Google Scholar Van Riper , C. ( 1963 ). Speech correction: Principles and methods . Prentice Hall . Google Scholar Waring , R. , & Knight , R. ( 2013 ). How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems . International Journal of Language and Communication Disorders , 48 ( 1 ), 25 – 40 . https://doi.org/10.1111/j.1460-6984.2012.00195.x 10.1111/j.1460-6984.2012.00195.x CASPubMedWeb of Science®Google Scholar Waring , R. , Rickard Liow , S. , Dodd , B. , & Eadie , P. ( 2022 ). Differentiating phonological delay from phonological disorder: Executive function performance in preschoolers . International Journal of Language and Communication Disorders , 57 ( 2 ), 288 – 302 . https://doi.org/10.1111/1460-6984.12694 10.1111/1460-6984.12694 PubMedWeb of Science®Google Scholar Weiner , F. ( 1981 ). Treatment of phonological disability using the method of meaningful minimal contrast: Two case studies . Journal of Speech and Hearing Disorders , 46 ( 1 ), 97 – 103 . https://doi.org/10.1044/jshd.4601.97 10.1044/jshd.4601.97 CASPubMedGoogle Scholar The Handbook of Clinical Linguistics, Second Edition, Second Edition ReferencesRelatedInformation

Studies of children's consistency of word production allow identification of speech sound disorder. Inconsistent errors are reported for two groups of children: childhood apraxia of speech (CAS) due to difficulty with the motoric precision and consistency of speech movements; and inconsistent phonological disorder (IPD) attributed to impaired phonological planning. This paper describes the inconsistent productions of children with IPD in comparison to typically developing children. In two studies of suspected SSD (N = 135), 22 children pronounced ≥40% of 25 words inconsistently on three repeated trials. No participant had symptoms of CAS. They were monolingual and spoke Australian- or Irish-English. Assessment determined the proportions of words said consistently (i.e. the same across productions: all correct or with the same error) or inconsistently (i.e. differently across productions: at least one correct and one error or different errors in productions). Qualitative analyses examined error types and explored the effect of target words' characteristics on inconsistency. Children with IPD produced 52% of words with different errors. While 56% of all phoneme errors were developmental (age appropriate or delayed), atypical errors typified inconsistency: default sounds and word structure errors. Words with more phonemes, syllables and consonant clusters were vulnerable to inconsistency, but their frequency of occurrence had no effect. TD children and those with IPD had different quantitative and qualitative error profiles, confirming IPD as a diagnostic category of SSD. Qualitative analyses supported the hypothesised deficit in phonological planning of words' production for children with IPD.

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36-60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed.

Purpose: Around 9% of children have difficulty acquiring intelligible speech despite typical sensory, neuro-motor and cognitive function. Speech-language pathologists (SLPs) rely on descriptions of children's speech errors to identify speech sound disorder (SSD) and determine intervention targets and goals. Existing normative data, however, need re-evaluation to reflect changes in populations and the language learning environment. This research evaluates whether developmental phonological patterns widely accepted as describing typical acquisition predict speech errors in a recent sample of preschool children. Method: In 2015, 99 neurotypical children aged 3;0-3;8 years;months were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP). Their performance was compared to studies describing speech development by children of the same age for phone repertoire and phonological patterns. Result: There were differences for both measures. Phone repertoire differences were marginal, but changes in phonological pattern use were unexpected. Suppression of three developmental phonological patterns (stopping of fricatives, final consonant deletion and voicing contrasts) was delayed compared to previous norms. Atypical consonant cluster reduction, sometimes considered a marker for disorder, was observed in 10% of children. Conclusion: There were qualitative differences in the speech development of the 2015 cohort of children compared to previous developmental norms. Valid and current normative data are necessary for the accurate identification of children needing intervention. The differences we found reinforce the need for regular updating of assessment tools, as well as greater understanding of how children's language learning environments are changing and potentially influencing speech development.

BACKGROUND The conversational speech of most children can be understood by people outside the family by the time they reach 4 years. However, for some children, speech sound disorders (SSDs) persist into their early school years, and beyond, despite adequate hearing, oromotor function, and language learning opportunities. One explanation for children's SSDs are domain-general cognitive-linguistic deficits that impair the child's ability to correctly derive rules governing how speech sounds legally combine to form words in a specific language. AIMS To explore whether there are differences in performance on executive function tasks between children who make speech errors characteristic of phonological delay and those who make speech errors characteristic of phonological disorder. METHODS & PROCEDURES Twenty-six children aged from 3;6 to 5;2 (13 with phonological delay and 13 with phonological disorder), matched pairwise for age and sex (nine males), were assessed on tasks measuring cognitive flexibility (rule abstraction and cognitive shift) and phonological working memory. OUTCOME & RESULTS For the cognitive flexibility tasks, the performance of children with phonological delay was significantly better than that for children with phonological disorder, but there were no group differences for the phonological working memory task. CONCLUSIONS & IMPLICATIONS Children with phonological disorders might benefit from intervention programmes that incorporate training in cognitive flexibility. WHAT IS ALREADY KNOWN ON THE SUBJECT Children with phonological delay and phonological disorder comprise the two largest SSD subgroups that present to speech-language therapy clinics. Evidence suggests domain-general cognitive processes (e.g., phonological working memory, ability to revise faulty underlying representations, rule abstraction, and cognitive shift) influence phonological development. Differences between the two subgroups in the types of speech errors, linguistic abilities, developmental trajectories, and responses to intervention have been reported, yet little is known about the underlying cognitive-linguistic deficits. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE The results of this study suggest that children with phonological delay and phonological disorder have distinct patterns of performance on executive function tasks: Children with phonological disorder showed deficits in domain general rule-abstraction and cognitive shift when compared to children with phonological delay. WHAT ARE THE POTENTIAL OR ACTUAL CLINICAL IMPLICATIONS OF THIS WORK?: The findings draw attention to: (1) the importance of differential diagnosis of phonological delay and phonological disorder; (2) the role of domain-general cognitive processes in explaining why children make particular types of errors; and (3) the need to develop innovative and tailored intervention techniques that target specific underlying deficits.

Background: Systematic reviews of treatment trials for children with speech and language difficulties often exemplify the limited clinical usefulness of the evidence base, reflecting recent literature in evidence-based medicine. Other studies report that clinicians often fail to seek information about best practice, across the health professions. Consequently, clinical researchers, including those in speech-language pathology, have sought alternative methodologies for determining best practice. Summary: Some approaches focus on “pragmatic trials,” usually as part of existing health services. Others place case management of individuals at the centre of intervention presenting studies of one or more cases, including N-of-1 randomized controlled trials and cross-over group designs. Clinical case studies can provide important theoretical data contributing to our understanding of the development of typical and atypical communication. Precision medicine (also known as personalized medicine) is an emerging approach to building the clinical evidence base that acknowledges the importance of individual genetic and environmental differences between people. With increasing knowledge of aetiological heterogeneity, even within children presenting with the same diagnosis (e.g., childhood apraxia of speech), data reinforce the edict that children are not all born equal. Key Message: This review argues that to understand response to treatment, it is critical to examine child-related factors as well as the variables of the intervention itself.

This study evaluates the ability of different measures of socioeconomic status (SES) to predict lexical outcomes for preschoolers raised in a context of nationwide bilingualism. The participants were 58 children aged 3;11-4;3 from Maltese-dominant homes who attended state preschools. Receptive picture name judgement and picture naming, in Maltese and English, were employed to measure receptive and expressive lexical abilities, respectively. Lexical outcomes for four individual SES variables and a single composite SES measure were similar but not directly interchangeable. The composite SES variable emerged as most strongly predictive of children's lexical performance. Receptive judgement of phonological accuracy improved similarly in both languages with higher composite SES. Naming skills increased significantly in English but not in Maltese, suggesting differences in English input related to parental SES. A focus on SES in relation to lexical skills in two majority languages is novel and adds to current understanding of normative bilingual acquisition.

Aims and objectives: This study measured bilingual lexical skills in children just starting preschool and in others who had been attending preschool for one year. It aimed to investigate how children’s lexical abilities were influenced by length of contact with structured bilingual input at school, in a context where two majority languages are taught through the educational system. Methodology: The participants were 72 children starting their first and second year in preschool, aged 2;11–3;4 ( N = 35) and 3;11–4;4 years ( N = 37), respectively. The children came from Maltese-dominant homes and attended the same state preschool where, in line with established bilingual educational policy, they were expected to receive systematic oral exposure to English. Receptive picture name judgement and picture naming tasks in Maltese and English were employed to measure receptive and expressive lexical abilities. Data and analysis: Correct receptive judgement and naming responses were analysed as a function of age group and language of testing. Findings: Comparison of 3- and 4-year-old performance revealed marked growth in Maltese but limited improvement in English for the older group. This profile was inconsistent with lexical outcomes expected for children receiving significant exposure to a second language (L2) in preschool. The findings call for reconsideration of the assumption that preschool entry for Maltese-dominant children and the sequential bilingual exposure associated with it bring about an improvement in L2 lexical abilities. School and home bilingual input, children’s learning demands and Malta’s sociolinguistic context were considered as possible contributing factors. Originality: To our knowledge, a focus on preschoolers’ lexical skills in two typologically distant, majority languages against a backdrop of stable bilingualism is novel. Significance: Given the bilingual stability and socio-cultural uniformity of the broader context for this study, the findings are proposed as a point of reference for evaluating preschoolers’ bilingual lexical skills.

Emerging evidence suggests domain-general processes, including working memory, may contribute to reduced speech production skills in young children. This study compared the phonological short-term (pSTM) and phonological working memory (pWM) abilities of 50 monolingual English-speaking children between 3;6 and 5;11 with typical speech production skills and percentage consonant correct (PCC) standard scores of 12 and above (n = 22) and typical speech production skills and PCC standard scores of between 8 and 11 (n = 28). A multiple hierarchical regression was also conducted to determine whether pSTM and/or pWM could predict PCC. Children with typical speech production skills and PCC standard scores of 12 and above had better pWM abilities than children with typical speech production skills and PCC standard scores of between 8 and 11. pSTM ability was similar in both groups. pWM accounted for 5.3% variance in overall phonological accuracy. Implications of phonological working memory in speech development are discussed.

Children's speech difficulties can be motor (phone misarticulation) or linguistic (impaired knowledge of phonological contrasts and constraints). These two difficulties sometimes co-occur. This paper reports longitudinal data from the Early Language in Victoria Study (ELVS) at 4 and 7 years of age. Of 1494 participants, 93 made non-age appropriate speech errors on standardised assessments at 4 years, and were able to be reassessed at 7 years. At 4 years, 85% of these children only made phonological errors, 14% made both articulation and phonological errors and one child only made articulation errors (a lateral lisp). In total, 8 of 13 children making both articulation and phonological errors at 4 years had resolved by 7 years. Unexpectedly, eight children who had demonstrated articulation of fricatives at 4 years, acquired distorted production of ≥ 50% of occurrences of/s, z/ by 7 years. In total, then, 22 children (24% of children with speech difficulties) made articulatory errors at one or both assessments. Case data for all children are presented. Theoretical and clinical implications are considered.

Cross-language McGurk Effects are used to investigate the locus of auditory-visual speech integration. Experiment 1 uses the fact that [], as in 'sing', is phonotactically legal in word-final position in English and Thai, but in word-initial position only in Thai. English and Thai language participants were tested for 'n' perception from auditory [m]/visual [] (A[m]V[]) in word-initial and -final positions. Despite English speakers' native language bias to label word-initial [] as 'n', the incidence of 'n' percepts to A[m]V[] was equivalent for English and Thai speakers in final and initial positions. Experiment 2 used the facts that (i) [ð] as in 'that' is not present in Japanese, and (ii) English speakers respond more often with 'tha' than 'da' to A[ba]V[ga], but more often with 'di' than 'thi' to A[bi]V[gi]. English and three groups of Japanese language participants (Beginner, Intermediate, Advanced English knowledge) were presented with A[ba]V[ga] and A[bi]V[gi] by an English (Experiment 2a) or a Japanese (Experiment 2b) speaker. Despite Japanese participants' native language bias to perceive 'd' more often than 'th', the four groups showed a similar phonetic level effect of [a]/[i] vowel context × 'th' vs. 'd' responses to A[b]V[g] presentations. In Experiment 2b this phonetic level interaction held, but was more one-sided as very few 'th' responses were evident, even in Australian English participants. Results are discussed in terms of a phonetic plus postcategorical model, in which incoming auditory and visual information is integrated at a phonetic level, after which there are post-categorical phonemic influences.

Previous research indicates that children with speech sound disorders (SSD) have underlying phonological memory deficits. The SSD population, however, is diverse. While children who make consistent atypical speech errors (phonological disorder/PhDis) are known to have executive function deficits in rule abstraction and cognitive flexibility, little is known about their memory profile. Sixteen monolingual preschool children with atypical speech errors (PhDis) were matched individually to age-and-gender peers with typically developing speech (TDS). The two groups were compared on forward recall of familiar words (pointing response), reverse recall of familiar words (pointing response), and reverse recall of digits (spoken response) and a receptive vocabulary task. There were no differences between children with TDS and children with PhDis on forward recall or vocabulary tasks. However, children with TDS significantly outperformed children with PhDis on the two reverse recall tasks. Findings suggest that atypical speech errors are associated with impaired phonological working memory, implicating executive function impairment in specific subtypes of SSD.

Some children’s speech impairment resolves spontaneously. Others have persistent problems affecting academic and social development. Identifying early markers that reliably predict long-term outcome would allow better prioritization for preschool intervention. This article evaluates the significance of different types of speech errors, made by 93 four-year-olds in a longitudinal population cohort study, for performance at seven years. At four years, the non-age appropriate speech errors made on standardized assessments were categorized as: phonologically delayed (error patterns typical of younger children); or, some errors atypical of normal development, including consistent errors (e.g. word initial consonant deletion), inconsistent pronunciations of the same word, or lateral distortion of /s, z/). Delayed children, some with occasional interdental /s, z/ articulation errors, were more likely to resolve (67%) than those making atypical errors (35%) by seven years. Qualitative analyses indicated that children making few atypical errors were more likely to resolve, irrespective of total number of errors or whether they received intervention. The findings’ theoretical implications relate to deficits underlying phonological disorders. Clinical implications concern assessment measures and prioritization for intervention.

A review of recent research and professional guidelines on the assessment of bilingual children with communication disorders identified some emerging themes. All the languages that a child is exposed to (including the home language/s) require assessment since proficiency across the different languages used reflects the child’s ability to maintain social contacts and access education. Language mixing is a natural, typical and fundamental aspect of bilingual discourse that has no negative effect on bilingual language acquisition. Limited data on normal bilingual language acquisition makes differential diagnosis between language disorder and language difference very difficult. Consequently, bilingual children are at risk for being misdiagnosed as having an impairment. Assessment strategies are described that provide alternative approaches to the use of normative data for the identification of communication disorders. Research is needed to determine the effect of language pair and language learning context on bilingual language acquisition and to ensure valid identification of bilingual children with communication disorder.

OBJECTIVE:To examine predictors of speech disorder resolution versus persistence at age 7 years in children with speech errors at age 4 years.STUDY DESIGN:Participants were drawn from a longitudinal, community cohort. Assessment at age 4 years (N?=?1494) identified children with speech errors. Reassessment at age 7 years allowed categorization into resolved or persistent categories. Logistic regression examined predictors of speech outcome, including family history, sex, socioeconomic status, nonverbal intelligence, and speech error type (delay vs disorder).RESULTS:At age 7 years, persistent errors were seen in over 40% of children who had errors at age 4 years. Speech symptomatology was the only significant predictor of outcome (P?=?.02). Children with disordered errors at age 4 years were twice as likely to have poor speech outcomes at age 7 years compared with those with delayed errors.CONCLUSIONS:Children with speech delay at age 4 years seem more likely to resolve, and this might justify a "watch and wait" approach. In contrast, those with speech disorder at age 4 years appear to be at greater risk for persistent difficulties, and could be prioritized for therapy to offset long-term impacts.

Early identification of phonological disorders is important for Speech Language Pathologists who assess and treat children aged under three years. Normative data justifies identification and standard scores can evaluate intervention that might prevent the negative consequences associated with phonological disorder. Two studies evaluated the reliability and predictive validity of the Toddler Phonology Test (TPT). Study 1 assessed 18 Australian toddlers, comparing their performance with normative data and reassessing them one month later to examine test-retest reliability. Study 2 assessed the predictive validity of the TPT's quantitative and qualitative normative data by reassessing 24 British children between four and nine months after their first assessment and examining number and type of errors. Study 1 found no significant difference between the first and second assessment one month later for percent consonants and vowels correct but a drop in the number of atypical errors. Positive correlations for all performance measures showed strong test-retest ranking for children. Study 2 indicated that both quantitative and qualitative TPT data predicted phonological development over 4-9 months. Case data suggested that phonological disorder was best predicted by qualitative data. The results indicated that phonological disorder can be reliably diagnosed at two years of age.

Aims and objectives: This study documents early lexical expression in children whose language input in the home was predominantly Maltese, accompanied by regular exposure to English lexical mixing. Bilingualism and language contact were also present at the societal level. The study attempts to determine whether the children’s pattern of vocabulary growth corresponded to a monolingual or bilingual mode of development. Methodology: The expressive vocabularies of 60 children aged 1;0 to 2;6 years were measured using caregiver reports and language sampling. Data and analysis: Expressive scores representing total vocabulary, Maltese and English words as well as translation equivalents were derived from the language samples and caregiver-completed vocabulary checklists. Findings and conclusions: Both Maltese and English words were identified in the children’s expressive vocabularies. Higher translation equivalent proportions were reported across daily settings than were sampled. Participants seemed to introduce new equivalents for words previously used in one language according to the needs of the communicative context. These findings demonstrate a basic level of bilingualism in the participants and suggest selective use of equivalents in response to environmental demands. The latter would imply the presence of a double lexical system, indicating a more refined bilingual status, although insufficient contextual evidence made this a tentative proposition. Fragmented exposure to English appeared unable to support the participants’ bilingual development beyond the lexical domain. Originality: While documenting lexical development in children exposed to a distinctive language-learning context that is as yet under-researched, this study adds to the limited evidence on lexical expression in young children exposed to substantial lexical mixing in their input. Significance: These findings highlight the development of bilingual proficiency as a process that spreads across linguistic levels in accordance with input variables. They also suggest that Maltese children’s bilingual lexicons may have the potential to kick-start their sequential bilingual development once systematic exposure to integral English is introduced through schooling.

A proof of concept system is developed to provide a broad assessment of speech development issues in children. It has been designed to enable non-experts to complete an initial screening of children's speech with the aim of reducing the workload on Speech Language Pathology services. The system was composed of an acoustic model trained by neural networks with split temporal context features and a constrained HMM encoded with the knowledge of Speech Language Pathologists. Results demonstrated the system was able to improve PER by 33% compared with standard HMM decoders, with a minimum PER of 19.03% achieved. Identification of Phonological Error Patterns with up to 94% accuracy was achieved despite utilizing only a small corpus of disordered speech from Australian children. These results indicate the proposed system is viable and the direction of further development are outlined in the paper.

One in twenty Australian children suffers from a speech disorder. Early detection of such problems can significantly improve literacy and academic outcomes for these children, reduce health and educational burden and ongoing social costs. Here we present the development of a prototype and feasibility tests of a screening and decision support tool to assess speech disorders in young children. The prototype incorporates speech signal processing, machine learning and expert knowledge to automatically classify phonemes of normal and disordered speech. We discuss these results and our future work towards the development of a mobile tool to facilitate broad, early speech disorder screening by non-experts.