Phonological Delays and Disorders
Description
Phonological disorder is a type of speech sound disorder. There is no known cause. Children with phonological disorder may have a family history of the same, but this is not always the case.
Children with a phonological speech disorder have phonological systems that are not developing as expected. This system is how our brains represents how speech sounds influence meaning. For example, we know that in the words ‘cat’ and ‘pat’ they differ by one phoneme (/k/ and /p/) and that this changes the word’s meaning.
Children with phonological disorders typically make predictable, rule-based speech errors. For example, they may exhibit ‘velar fronting’ in which they substitute /k/ and /g/ with /t/ and /d/ (‘cup’ to “tup”, ‘go’ to “doh”). Most often, these errors are those younger children make (‘phonological processes’), but the child did not suppress them at the age children typically do. For example, velar fronting is typically suppressed by age 3½, so a child who is fronting at age 5 is considered to have a phonological delay. Phonological errors usually involve substitutions (e.g., (‘cup’ to “tup”) or omissions (e.g., ‘star’ to “tar”).
Severity
Children with phonological disorder may range from mild to severe. Judgments of severity are based on the number of error processes the child exhibits, their overall speech intelligibility, and how typical or atypical their errors are. The more severe a child’s speech disorder, the longer treatment will take.
Severe Phonological Disorder
Children with more severe phonological disorders may exhibit ‘atypical phonological processes’ – error patterns that are not produced in typically developing children. For example, although ‘fronting’ is a typical process, ‘backing’ is not. ‘Backing’ is when a child substitutes /t/ and /d/ with /k/, /g/, or even /h/ (e.g., ‘two’ to “coo”). Young children with a severe phonological disorder may also frequently delete the first and/or last consonant sound in words, making it sound like they “talk in vowels” (e.g., ‘up’ to “uh”, ‘dada’ to “ah-ah”, ‘apple’ to “ah-oh”).
Inconsistent Phonological Disorder
For most children with phonological disorders, their errors are consistent and predictable. For example, for a child with a mild phonological delay who fronts, when they make an error on /k/, it will likely always be a /t/ substitution (before they start treatment). Some children, however, have inconsistent phonological disorder. These children make ‘inconsistent errors’ on the same word when they try to repeat it more than once. For example, when trying to say ‘spider’, on their first attempt they may say “fider”, then “sider”, then “pider”. Inconsistent phonological disorder is another more severe form of phonological disorder.
Treatment
There are many effective treatment approaches available for children with phonological disorder, and these children do indeed develop intelligible speech with appropriate and regular treatment with a speech-language pathologist.
Your child’s speech-language pathologist will discuss treatment options with you and make recommendations about how frequently your child should participate in treatment, whether it should be one-on-one or in a small group, and whether it should be provided directly with a speech-language pathologist (or an assistant) or done primarily through home programming. Such recommendations will be based on your child’s profile (e.g., age, severity, other communication disorders, ability to participate in treatment) and access to services in the public sector and/or private sector (e.g., SLP’s caseload, family’s schedule, family’s financial resources).
Generally speaking, the more severe the phonological disorder, the longer your child will require treatment. Children with very severe phonological disorders may require support for many years starting in preschool and into their school-years.
There are different models of treatment which are briefly described below. Which model is most appropriate will depend on:
-
How severe your child's phonological delay/disorder is: This is based on many factors including how many sounds they require help with, how intelligible they are overall, their age, and the type of sound errors they make. For example, if your child has a severe phonological disorder, a home program will likely not be appropriate.
-
How responsive they are to treatment / how persistent their errors are: Rate of progress is influenced by many factors within a client's control (e.g., how consistently they complete home practice) and outside of their control (e.g., severity of the phonological disorder, other demands on the child such as ADHD or anxiety). There are also other factors which are completely unpredictable - some children will just require more time to make progress regardless of all other factors.
-
The parent's comfort with doing home practice: Home programming, for example, requires that the guardian doing the practice with the child be very confident in administering treatment protocols and advancing their child's goals between sessions because they will see the SLP less often.
-
How consistent home practice is: Home practice is required to see progress regardless of how frequently your child sees their SLP. It becomes even more important, however, when you see the SLP less frequently (e.g., direct work with SLP only every 2 weeks; home programming).
-
The family's resources and distance from clinic: In most cases, it is our preference to work directly with the child every one or two weeks in person. However, a family may desire home programming due to financial constraints or telepractice to avoid travel.
Treatment Models
Frequent direct sessions with SLP one-on-one:
-
appropriate for all types and severities of phonological delays/disorders
-
30- to 45-minute sessions with the SLP delivering treatment every one or two weeks
-
daily home practice (5-10 minutes a day) must take place to ensure the child gets the minimum dosage
-
treatment sessions take place at the Dartmouth or Kentville clinic
-
if you would like your child's therapy session to take place during the school day but you are at work, ask your child's school if they would be eligible for transportation to and from the clinic through the Schools Plus program
Frequent direct sessions with the SLP in a small group:
-
sometimes siblings can do work together with the SLP if they are of a similar age, have similar goals, and are able to work together productively
-
sessions are typically 45 or 60 minutes to allow enough practice opportunities for each child
Telepractice:
-
the initial assessment would still be in person
-
appropriate for most types of phonological delays/disorders
-
30- to 45-minute sessions with the SLP delivering treatment every one or two weeks plus daily home practice (5-10 minutes a day) must take place to ensure the child gets the minimum dosage
-
appropriate for children who are able to sit relatively still in front of the computer - frequent significant movement blurs the image and impairs the SLP's ability to view the child's speech mechanism
-
can be completed from home or school - when the child connects from school, this is usually facilitated by a staff member at their school's Learning Centre or Resource Room
-
requires a stable internet connection and use of a headset (headphones AND microphone)
-
requires use of an iPad or computer
-
we use the Zoom Healthcare platform or Jane Telehealth platform, depending on the child
Home program:
-
appropriate for mild or moderate phonological delays (pending assessment with the SLP)
-
the child's guardian does treatment with them at home every day
-
example: one 30-minute practice session once a week with 5-10 minutes of practice on all other days
-
example: two 20-minute practice sessions a week plus 5-10 minutes of practice on other days
-
-
45-minute sessions once every month or other month with the SLP in which the SLP:
-
checks progress
-
advances goals
-
coaches parent in treatment techniques
-
provides new treatment and practice materials
-
-
home practice must be very consistent and the guardian must feel confident in their ability to apply their coaching from the SLP between sessions
-
appointments with the SLP take place during the day Monday to Friday - they are not eligible for scheduling in the evening or on the weekend as these times are reserved for clients receiving regular weekly or biweekly treatment sessions who are in school during the day and/or their guardian works during the day
Augmentative Communication
For children with severe speech sound disorders, an augmentative communication system may be recommended. An augmentative system is meant to supplement or augment your child’s verbal output. For example, they may have an iPad application with a display of pictures and when they select a picture or series of pictures to make a sentence, the device says the message aloud for them.
Augmentative systems do not inhibit the development of speech and expressive language. In fact, they promote this development. Furthermore, use of an augmentative system will enable a child to express their thoughts and needs while they work on their speech, thus reducing frustration and barriers to socializing.
Reading Acquisition
Since reading and writing are an extension of our speech and language skills, children with phonological disorders are at a higher risk of later having phonologically-based difficulties with reading acquisition. Not all children with phonological disorders will have trouble learning to read, and not all children with reading difficulties have had a speech sound disorder, but the risk is greater.
Your child’s speech-language pathologist will give you advice on how to promote pre-literacy skills such as print awareness, letter knowledge, and phonological awareness. Promoting the development of these skills early on will reduce your child’s risk of reading difficulties later. It will also make you more aware of the possibility so that if your child does later have trouble learning to read, you can get them appropriate support as early as possible.
