Case Study

Sophie: A Little Girl with an Articulation Disorder

Sophie was referred by her preschool teacher at age five years. Outside-the-family listeners were understanding about 50 per cent of what she said, well below the norm of 100 per cent understandable speech by age four years. Sophie was making mistakes on the early developing speech sounds “k, g, f, as well as others. Her mistakes were errors of substitution, so that she used a “p” for “f,” a “t” for “k,” and a “d” for “g.” Sophie was making these mistakes in all parts of words, so that “fun” was “pun,” ‘office” was ‘opice,” and “leaf” was “leap.” Early developing means these consonants are mastered in conversation by most children before the age of 4 years; speech intelligibility is adversely affected f they are in error past that age. Sophie also made mistakes on consonants “r” and “th”. These, however, are later -developing sounds and we decided not to focus on them immediately because research indicates some children at age five will learn these on their own.

I did an evaluation of Sophie’s oral structures, including her hard and soft palate, tongue, teeth, and lips. I checked structure and especially function to determine if these parts moved adequately for speech and non-speech tasks. The results of my initial evaluation revealed a mild articulation disorder. Articulation disorder refers to difficulty making a particular sound. You will also see the term phonological disorder used with children with hard-to-understand speech. Phonology is the study of a language’s sound system. Children learning to talk study their own language and may develop rules, or processes to make speech easier (like little shortcuts). If these processes persist past age five, a phonological disorder may exist.

Sophie and I began working on the early developing sounds “k, g, f.” With a visual model and cues from me (touching my lips and teeth for the “f”, for example and touching the base of my mouth for “k”), Sophie was able to produce these new sounds in isolation. We gave them names: “f” was the cat fight sound, “g” was the gurgle water jug sound, and “k” was the coughing sound. I also wrote the letter(s) associated with each sound and made them visible to Sophie as she practiced saying the sound associated with the letter. I like to get each new sound said correctly 100 times with a model (I give cues, I say the sound, Sophie copies me) before we go to the next step. Our next step for “f” was to teach the new sound in words, first with hearing the word and repeating, then just naming pictures without hearing the word, then in short sentences produced by me, then in sentences Sophie made up on her own. In Sophie’s case, with “f,” we did not have to do all the above steps with middle “f” or final “f” because she learned from practicing the beginning “f” and was able to master the middle and final “f” sounds on her own. Once all the steps for mastering a sound were accomplished, Sophie and I played the scoreboard game, where, in regular conversation using a piece of paper with a place for her name and a place for mine, we got points: Sophie for every new “f” she used in regular talking and me for every “old” “f” (“p”). Once there were no mistakes in 20 minutes of conversation, three speech visits in a row, our work on that sound was over. For me, speech therapy with a child with an articulation or phonological process disorder concludes when the child reaches age-appropriate standards with speech intelligibility (how much speech is understood by unfamiliar listeners) and when all age-appropriate sounds are mastered. When I am working on articulation, where many, many repetitions may be required, it is important to break up the relatively boring work with toys or games or another diversion. Thus we may stop every five to seven minutes to do a toy or game activity. Usually the toys or games can be chosen to produce additional practice on the particular sound without the child being directly aware that practice is occurring. I am constantly striving to get a minimum of 100 practice trials on a particular sound in any given 30 minute speech therapy visit.

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