We are pleased to announce that our SLP chat tonight on Wednesday, April 3, 2002 will be hosted by Benjamin Munson, Ph.D. Dr. Munson will address the topic of phonology and phonological disorders. Dr. Munson is an Assistant Professor in the Department of Communication Disorders at the University of Minnesota, Twin Cities Campus. Dr. Munson teaches undergraduate courses in phonetics, speech science, and speech disorders, and a graduate course in assessment and treatment of phonological disorders. His research interests include phonology and speech perception and word recognition in adults with cochlear implants. Dr. Munson's research has appeared in Journal of Speech, Language, and Hearing Research, Journal of Experimental Child Psychology, and Journal of the Acoustical Society of America. References sited in the following chat may be found at the bottom of the chat transcript. <Robin> Welcome! We are chatting tonight with Ben Munson about phonology and phonological disorders. <Robin> Well, Ben, why don't you give us an overview of phonology and phonological disorders. <Ben Munson> Gladly. The standard textbook line is that phonology is the grammatical system that relates to how sounds are represented and organized in the mind. <Ben Munson> Our knowledge of the phonology of a language includes our knowledge of the sound patterns in the ambient language, the rules that govern sound combinations, and the context-specific articulation of sounds. <Ben Munson> Children with phonological disorders/phonological impairments have difficulties with sound production that are systematic, i.e., they appear to have a system of "rules" for simplifying words. <Ben Munson> These children are highly unintelligible, and very often require speech-language intervention to achieve intelligible speech. <Robin> What is the difference between phonological disorders and articulation disorders? <Ben Munson> Robin, again, the standard textbook line is that children with articulation disorders make errors on only a small set of sounds, typically /s/, /z/, /r/, and /l/. These errors are often characterized as _distortions_, meaning that the errored sound is not a phoneme of English, like the lateralized variant of /s/ or /z/. Children with phonological disorders have many errors, which may be additions, deletions, and substitutions. <Ben Munson> While many people think of these as distinct disorders, I view them as members of a continuum of severity, where so-called 'phonological' disorders are on the severe end, and 'articulation' disorders are on the mild end. <Lori> I like that <Ben Munson> Lori, my thinking for this is partly theoretical (why should we view a deletion as a "rule" but lateralization as an "articulatory process"?) and partly pragmatic (does the diagnostic label really guide our choice of therapy?) <Robin> What assessment tools do you recommend for evaluating the phonological disorders? <Ben Munson> Robin, I hate to sound boring, but the good-ol' Goldman-Fristoe Test of Articulation, and the companion Kahn-Lewis Phonological Analysis, remain my favorites. <Ben Munson> The new Goldman-Fristoe, published in 2000, has a large, diverse normative sample. Unlike the 1986 version, it provided standard scores, which many school districts apply. The new Kahn-Lewis also provides standard scores. <Lori> But I find that PD (phonological disorders) fail to follow the rule for carryover while articulation disorders are more consistent. <Ben Munson> Lori this is the opposite of my clinical impression! I find that the kids with the label of 'articulation disorders' are often the most difficult to train to carry over correct production outside of therapy. <Ben Munson> Regardless, I think the issues of carryover/consistency/etc. need to be determined on a child-by-child basis, and not assumed based on a diagnostic label of 'phonological disorder' or 'articulation disorder.' <Lori> I use the Kahn-Lewis. I find I teach specific words and do not get generalization (not carryover). <Ben Munson> Lori, generalization to untrained words or to untrained levels of complexity? <Lori> Good question..untrained words and complexity. <Marcela> I think it depends on age and motivation. I have kids that are very motivated and do well with carry over. <Ben Munson> Marcela, I think that motivation is the KEY. If I had one piece of advice for a clinician starting with a new phonological kid, I would say pick a sound that the child will learn quickly (i.e., the most stimulable sound). <Ben Munson> Show the kids that they can be successful and get them motivated EARLY in the therapy process! You are right, motivation is key. <Marcela> I agree. What about cycles? Do you have any advice? <Ben Munson> I like the cycles approach for young children who are highly unintelligible. By cycling through goals, you end up working on more and not boring the kids. <Marcela> How do you approach cycles? <Ben Munson> A few pieces of warning, collect data frequently. If a child appears to be losing significant ground from one treatment cycle to another, then maybe this child isn't an appropriate candidate for cycles therapy. <Ben Munson> Marcela, I follow Hodson and Paden pretty closely. <Ben Munson> I do a phonological process analysis, and go through teaching the different processes in 2-3 week cycles, depending on the frequency of therapy. <Ben Munson> One piece of advice I do have about cycles relates to auditory bombardment. I really like auditory bombardment, and I think the kids benefit from it. <Ben Munson> I think that clinicians might consider making tapes/CDs for auditory bombardment that contain the target words spoken by multiple talkers, i.e., not just by the clinician and/or the mom. <Ben Munson> I think that children learning new sounds need to be exposed to sounds spoken by many different talkers. Sounds in the environment are produced by many talkers, and I think we do children a slight disservice by presenting them as produced by only one talker in therapy. <Lori> Training the ear to accept many closely produced words as the same. <Ben Munson> Lori, yes, I think that training the ear to hear variability in sound production and to accept them all as equally good tokens of a sound is important. <Ben Munson> If the only /s/ a kid learns is the clinicians hyper-articulated /s/ in therapy, then this kid isn't prepared to perceive and produce /s/ in more realistic speaking and listening situations. <Lori> As we know each sound within a word is strongly effected by the sounds following and preceeding it. <Lori> So no /s/ is the same...it depends on where it is. <Ben Munson> Absolutely. But I think we sometimes forget that sounds like /s/ are really variable across talkers. <Ben Munson> Some have a higher-frequency /s/, some have a lower-frequency /s/. Some /s/'s have more distributed energy, some have more concentrated energy. I say that, at least in auditory bombardment, kids should be exposed to different varieties of /s/, since they're correctly produced. Actually, my interest in this comes from my interest in exemplar theories of representation. I believe that individuals learning sounds store memories of most (if not all) of the tokens of sounds and words that they hear. <Ben Munson> These remembered instances of words and sound form the basis of a developing child's phonology. When a child fails to acquire phonology normally, I think that our therapy environment should mimic the 'normal' acquisition environment, in which children are given the opportunity to hear massive amounts of variable input. <jenniferslp> I am definitely interested in this area. <jenniferslp> I work with many phonologically impaired children who produce a lateral /s/ in therapy...do you recommend reinforcing this since they are making an approximation of the sound? <jenniferslp> versus stopping <Ben Munson> So, Jennifer, you're saying a child who starts out with a stopping error, then moves to lateralization? <jenniferslp> yes. <Ben Munson> I think that when the child moves to lateralization, we can introduce the concept that sounds have different parts to them. We (the SLPs) call them manner of articulation and place of articulation. <Ben Munson> With the kids, we can call them "tongue placement" and "warm air". You can reinforce the "warm air" (i.e., reinforce the continuant nature of the sound) <Ben Munson> While still calling attention to the tongue placement. <Lori> Would you work on the oral motor placement? <Ben Munson> Lori, yes. A lateralized /s/ doesn't affect intelligibility hugely, but my 'unofficial' impression is that it is easily perceptible to naive listeners, and it is generally negatively perceived. <Ben Munson> It is also (again, 'unofficially') hard to remediate in older children/adults, so I would want to address it early on with a child, to minimize the chances that the child goes on to produce a lifetime of lateral /s/'s. <jenniferslp> That's what I usually do...most of these children, however, are so unintelligible that any continuant sound is an improvement. I do agree, though, that it should be corrected early-on. Ben Munson> Jennifer, I share your intuition. Kids with phonological disorders need to increase their intelligibility. If a child had many other errors (fronting, final consonant deletion) that needed to be addressed, I would perhaps put off dealing with the lateralization until the child had reached more the 90% intelligibility level. <jenniferslp> Thank you, that definitely makes me feel better. <Lori> I work on an /s/ through an /i/ to help tongue placement into practical practice right away. How do you approach specific sound errors common to PD kids? <Ben Munson> Lori, whenever possible, I try to use metaphors to teach sounds first. In general, I like using metalinguistic approaches, because they address the issue of increasing phonological awareness which we know is important for reading, and which we know is often a hard skill for kids with phonological disorders to learn. <Marcela> Can you elaborate on the metalinguistic approach? <Ben Munson> Of course, these metalinguistic approaches don't always work, so I resort then to a variety of techniques. I am a big advocate of assessing a child's individual learning style, and tailoring my choice of elicitation techniques to that child's preferred mode of learning. <jenniferslp> That is extremely difficult to do in a group setting. <Ben Munson> (Jennifer you're darn right it is!) <Ben Munson> Marcela I'll give a concrete example with a specific error type stopping. <Ben Munson> A metalinguistic approach to treating stopping might involve first calling the child's attention not to the difference between stops and fricatives, but to the difference between SHORT and LONG. <Ben Munson> Since stops are SHORT and fricatives are LONG. You could have a couple of therapy activities focused on this difference. <Ben Munson> Then introduce the child to the two classes of sounds, the short sounds (stop), and the long sounds (fricatives). Train the child to perceive the difference between them. Bombard the child with examples of both sound types. Have the child 'find' stops and fricatives in words you produce. <Ben Munson> Then, and only then, do you work on production. By introducing the difference between stops and fricatives conceptually, before training it in production, you're calling the child's attention to a number of things. <Ben Munson> (1) words are comprised of sounds, (2) sounds have different lengths, etc. You're training the child to hear these sounds in words. These are the kinds of skills that don't just underlie sound production, they underlie phonological awareness and other pre-literacy skills. <Ben Munson> In the literature, this has been called the Metaphon approach. <Marcela> Thank you, that helps. <Lori> A child cannot correct errors until they can really identify their errors. <Lori> Teach the identification before the production. <Ben Munson> Lori, I agree that this is generally true, but it has been my experience that some children (admittedly, a minority) have a real strength in imitating sounds without overtly/consciously hearing how they are different from their own productions. <Ben Munson> For these kids, production seems to proceed perception of the contrast. (Admittedly, this is the minority.) I think this may be related to differences in learning styles; hence, the importance of doing a brief assessment of learning style as a baseline before therapy. <Lori> I think those are the apraxic children...good imitators but terrible spontaneous speakers. <Ben Munson> Lori, that very well may be so. It would be an interesting research question. <jenniferslp> We are beginning to use the LiPS (usually used for dyslexia) sound class descriptives with our PD children to increase their awareness of how the sounds are produced...for example, /t, d/ are "tongue tappers." This has really seemed to help. <Ben Munson> Jennifer, LiPS is a great example of how articulation can be used to train phonological awareness. I really like that program! <Ben Munson> Jennifer, don't underestimate how many kids with the label "dyslexia" used to have the labels "language impairment" or "phonological impairment." Again, I think we're talking highly overlapping groups. <jenniferslp> I totally agree. The facility I work at (which has a large dyslexia grant) is beginning to test children annually once they leave our PD program for dyslexia... I suspect we will find that many of these children have reading impairments, as well as auditory processing impairments. <Ben Munson> Jennifer that is supported by research by Barbara Lewis from Case Western Reserve University. Kids with a history of PD often go on to have reading problems. Also, research by Margaret Snowling shows a similar pattern for kids with language impairments. <jenniferslp> Very interesting. <Lori> What do you think about the Lindemood-Bell reading program for teaching sound identification? <Ben Munson> Lori, I think this is what Jennifer means when she says LiPS. <Ben Munson> I like it. <Ben Munson> I don't say that as an official endorsement, but my 'face-value' impression is good. It acknowledges the links between articulation and reading. I like that. <Ben Munson> Jennifer have you ever used this reading program by Maryanne Wolf? I forget its name, but it focuses on teaching the child rapid naming to facilitate reading. <Ben Munson> I've never used it, nor have I ever seen it implemented, but I have heard about it and I'm intrigued. <jenniferslp> No, I have not. I will definitely check that out. <Ben Munson> Again, a reading program that really acknowledges the links among articulation, phonology, language, phonological awareness, and reading. I like it when people see the interconnections. We give things discrete labels, but in the end we're talking about human communication, and how best to facilitate it in individuals with difficulties, right? <jenniferslp> It seems that the consensus is there is some "X" factor that is causing sets of interrelated problems for PD, language impaired, dyslexia, aud processing... <Ben Munson> Jennifer, yes, and the problem is, how do we measure this general factor AND account for the very different clinical presentations you get for kids with phonological disorder versus kids with childhood apraxia. <jenniferslp> I agree. What a puzzle! <Robin> Ben, your fingers must be TIRED!!!! <Robin> Are there any last questions? <Ben Munson> Very -| <Marcela> Do you think the PD kids benefit from oral motor exercises? <Ben Munson> Marcela, this is something best assessed on a child-by-child basis. We had a huge discussion about this on the division I listserv recently, and the facts are hard to reconcile. <Ben Munson> (1) There is no published research supporting oral-motor therapy, BUT (2) many practicing clinicians swear by it. Until the definitive clinical trial is completed, I would approach oral-motor therapy on a case-by-case basis. If a child is not responding to traditional phonological therapy, you can add an oral-motor component and monitor progress carefully. Be rigorous. Use an ABAB design, where you introduce O-M therapy, then remove it, then introduce it again, monitoring the progress at each step. <jenniferslp> Thank you for your insight. <Marcela> Thank you, this has been very interesting and informative <Robin> We will edit this transcript and add it to our online archive. <Lori> Could you include Barbara Lewis' info? <Ben Munson> Sure. I am FULL of references. I could send references on metaphon, too. Lori, you would really like Barb Lewis's recent stuff, since it's on the possible genetic basis for CAS. <Lori> Definitely. Thanks. <Robin> Ben, if you send me the references we will add it to the transcript. <jenniferslp> Thank you very much. I definitely learned a lot in a short time. <Lori> Thank you, Ben, for the very informative talk. It was a pleasure. <Ben Munson> Ditto. <Marcela> I got new ideas to try with my clients, thank you. <Robin> Ben, thanks again for sharing your expertise with us. <Robin> Goodnight all! References: Lewis, Barbara A; Freebairn, Lisa A; Taylor, H. Gerry. Academic outcomes in children with histories of speech sound disorders. [Journal Article] Journal of Communication Disorders. Vol 33(1) Jan-Feb 2000, 11-30. Elsevier Science Publishing Co Inc, US Snowling, Margaret J; Bishop, D. V. M; Stothard, Susan E. Is preschool language impairment a risk factor for dyslexia in adolescence? [Journal Article] Journal of Child Psychology & Psychiatry & Allied Disciplines. Vol 41(5) July 2000, 587-600. Cambridge Univ Press, US. |
