It Might Not Be “Just Artic”: The Case for the Single Sound Error
Publication: Perspectives of the ASHA Special Interest Groups
Volume 4, Number 1
Pages 76-84
Abstract
Purpose
The purpose of this article is to explore the ways in which children with mild speech sound disorders (SSDs)—that is, single sound errors—may be at risk for difficulties with phonological awareness, decoding, spelling, and social–emotional well-being.
Conclusions
SSDs comprise a group of children who have difficulty in consistently and correctly producing 1 or more phonemes in their ambient language. Presently, there is a concerning trend with respect to service provision for children who have only a few—or only 1—sounds in error. That is, these children may not receive services at all. This practice is problematic, because it assumes that children with a single sound in error are not at risk for or experiencing any related educational difficulties. However, research supports connections between SSDs, including single sound errors, and decoding, spelling, and social–emotional deficits. This article aims to make the case for the single sound error—sometimes it is not “just artic.” Clinical recommendations for assessment, treatment, and advocacy are included.
Children with speech sound disorders (SSDs) are among the largest population served by speech-language pathologists (SLPs). However, there is a trend in many states to not provide services to children with SSDs, if that is their only area of impairment (Farquharson & Boldini, 2018; Swaminathan & Farquharson, 2018; Sylvan, 2014). For some of these children, their SSD is complex and affects production of many of their phonemes. For other children, their SSD may only affect one phoneme, but that does not mean that their disorder is not complex. In this article, I will make the case that there is often more to the story for children with SSDs—even if there is only a single sound in error.
SSDs
SSDs comprise a group of children who have difficulty in producing specific phonemes in their ambient language (Lewis et al., 2006). Of particular note is that the majority of these children experience this difficulty without an overt cause. That is, SSDs are often of an unknown etiology. This is perplexing to clinicians and researchers alike. For decades, the field of speech-language pathology has attempted to understand this heterogeneous group by dichotomizing the difficulties into either “phonological disorders” or “articulation disorders.” However, some researchers have long supported that the terminology was “inextricable” (Fey, 1992). In addition, recent work suggests that SSDs are unlikely to be binary in nature and more likely to exist along a spectrum (Cabbage, Farquharson, Iuzzini-Seigel, Zuk, & Hogan, 2018; Farquharson, 2015b; Pennington, 2006). This is partially salient because some children with SSDs present with multiple sounds in error (i.e., who may appear to have a phonological disorder) but do not have any other issues with phonology (e.g., decoding words or spelling). Similarly, there are children who present with a single sound in error (i.e., who may appear to have an articulation disorder) who have concurrent deficits with other phonological skills, such as decoding and spelling. Of course, the inverse for both groups is also possible. As such, a strict dichotomy of “phonological” versus “articulation” does not seem prudent. In the present discussion, it is those children with a single sound in error that is of primary interest. Children who have one sound in error often experience difficulty in the classroom (Dodd et al., 2017; Farquharson & Boldini, 2018; Hayiou-Thomas, Carroll, Leavett, Hulme, & Snowling, 2017), with social relationships (Murphy, Pagan-Neves, Wertzner, & Schochat, 2015), literacy skills (Lewis et al., 2006, 2015; Overby, Trainen, Smit, Bernthal, & Nelson, 2012; Preston & Edwards, 2007, 2010; Preston, Hull, & Edwards, 2013; Raitano, Pennington, Tunick, Boada, & Shriberg, 2004), and vocational outcomes (Felsenfeld, Broen, & McGue, 1994; Law, Dennis, & Charlton, 2017).
SSDs and Phonological Awareness
Many children with SSDs have reported difficulties with literacy-related skills, most specifically with phonological awareness (Bishop & Adams, 1990; Catts, 1993; Felsenfeld et al., 1994; Hesketh, Adams, & Nightingale, 2000; Larrivee & Catts, 1999; Overby et al., 2012; Peterson, Pennington, Shriberg, & Boada, 2009; Raitano et al., 2004). Although severity of the SSD, the number of sounds in error, and the type of speech sound error(s) are often predictors of proficiency with phonological awareness tasks (Preston, Hull, & Edwards, 2013), that is not always the case. For instance, Gernand and Moran (2017) reported that 6- to 7-year-old children with even mild SSDs performed poorer than same-age peers on a phonological awareness task. Importantly, many of the children in this study had single sounds in error (most commonly /r/ or /l/), and all children had normal language abilities. Similarly, Farquharson, Hogan, and Bernthal (2017) reported impaired phonological working memory skills in a group of children with persistent SSDs. The children with persistent SSDs were between 8 and 11 years old, had normal vocabulary skills, and had between one and three speech sounds in error. In 10- to 14-year-old children with residual SSDs, Preston and Edwards (2007) found weak phonological processing skills when compared to typically developing peers. In this study, most children had difficulty in producing /r/ and many sibilants, which are errors commonly seen in older children with SSDs. Similar reports have shown that speech sound errors related to a developmental sequence of acquisition (e.g., early, middle, or late eight phonemes; Bleile, 2006; Shriberg, 1993) in preschool are related to performance on phonological awareness tasks (Mann & Foy, 2007). Specifically, Mann and Foy (2007) reported that children who had speech sound errors on the “early eight” phonemes (Shriberg, 1993) had weaker rhyming skills. Collectively, these studies support that persistent difficulty with speech sound production, regardless of age or the number of sounds in error, is related to weak phonological processing abilities (see also Cabbage et al., 2018). Decades of research support the connection between phonological processing abilities and word decoding (e.g., see Wagner & Torgeson, 1987). As such, children with SSDs are at high risk for deficits with decoding and other related literacy skills, such as spelling (Apel & Lawrence, 2011).
SSDs and Spelling
Spelling is a skill that, like decoding and phonological awareness, is highly dependent on an intact phonological system (Hoffman & Norris, 1989). It follows, then, that children with impaired phonological systems—like those with SSDs—would experience difficulty with spelling ability similar to their difficulties with phonological awareness and decoding (Apel & Lawrence, 2011; Bird, Bishop, & Freeman, 1995; Carroll & Snowling, 2004; Clarke-Klein & Hodson, 1995; Lewis, Freebairn, & Taylor, 2002). Children with SSDs often struggle with spelling due to the translation between phonology and orthography. That is, the mapping of speech sounds to letters—a skill necessary for both decoding and spelling—requires strong phonological and orthographic representations. These representations form in the mental lexicon and serve as the foundation for many code-based literacy skills (Sutherland & Gillon, 2007). Children with SSDs, including those with single sound errors, often have weak phonological representations (Farquharson et al., 2017), resulting in their oft-reported difficulties with phonological awareness, decoding, and spelling.
Indeed, spelling may be impaired in children who have single sound errors. For instance, Lewis et al. (2002) examined spelling ability in children with SSDs between the ages of 4 and 6 years. These researchers reported that children with isolated SSD, in the absence of a language impairment, demonstrated a weakness in spelling skills relative to their reading, language, and cognitive abilities. Children in this study were reported to have at least three phonological errors; however, their language abilities were normal. Similarly, Apel and Lawrence (2011) examined spelling ability in children between the ages of 6 and 8 years who had SSDs. Children in this study performed below the 15th percentile on the Goldman-Fristoe Test of Articulation–Second Edition (Goldman & Fristoe, 2000), but the explicit number of speech sound errors is not reported. However, these researchers concluded that their sample of children with SSDs had weak linguistic awareness, making them susceptible to deficits in both decoding and spelling. Lewis et al. (2018) longitudinally investigated the connections between early SSDs and later spelling skills. They reported that children who had a history of an SSD as a young child had poorer spelling skills in adolescence when compared to children without a history of an SSD. Although it is evident that more research is needed in this area, these reports indicate a relation between aberrant speech sound production and spelling deficits. Thus, spelling ability may be an important data point for clinicians to consider when examining the extent to which an SSD impacts educational performance (e.g., Farquharson & Boldini, 2018). Next, I will share two case examples that highlight this connection between speech sound production and spelling skills.
Application to Case Studies
Figures 1 and 2 depict the spelling skills of two different children with SSDs. Each child was enrolled in a 4-week speech sound treatment pilot study. The treatment paradigm used minimal pairs to target one speech sound for each child. Each child was asked to spell a list of 10 words that began with their target speech sound. The words were presented auditorally following the prompt “spell the word _____.” Children were encouraged to make their best guess when spelling the words, and if they responded with “I don't know,” then that item was skipped. Nathan (see Figure 1) participated in this study in the summer between first and second grades. He was age 6;9 (years;months) and exhibited only one speech sound in error—an /f/ substitution for /θ/, which was his target sound in the treatment study. Zachary (see Figure 2) participated in this study in the summer between kindergarten and first grade. He was age 5;9 and exhibited six speech sounds in error. In the treatment study, /k/ was his targeted sound. The word lists presented to Nathan and Zachary are presented in Table 1.
| Nathan | Zachary |
|---|---|
| thought | care |
| thread | kite |
| thin | cub |
| thirty | cat |
| thigh | call |
| three | comb |
| thaw | key |
| thing | came |
| throat | carrot |
| Thursday | kiss |
As can be seen from Figures 1 and 2, although Nathan had “only” one speech sound in error, it is clear that his phonological representation of the /θ/ sound is impaired to the point that it is impacting his spelling and use of the proper orthographic forms. By contrast, Zachary, albeit too young to fully engage in this spelling task, showcases the ability to properly assign a K or a C to words beginning with the /k/ sound. Of note, Zachary's speech was more severely impaired and contained several errors; however, his phonological representation for /k/ appears to be intact at the time of data collection. These two cases highlight the point that we, as clinicians, cannot make an assumption about a child's underlying phonological representation skills based on their expressive phonology. We must directly examine phonological representations using phonemic awareness, word decoding, or spelling tasks as age-appropriate for the child. In addition, although many SSDs and early language impairments resolve without treatment, children with early speech and/or language impairments often have poorer educational outcomes, even if their impairment has resolved (Farquharson, 2015a; Janus, Labonté, Kirkpatrick, Davies, & Duku, 2017; Lewis et al., 2015; Raitano et al., 2004; see also Wren, 2015, for a robust discussion of children who have not yet “grown out of” their SSDs). As such, treatment may be warranted for children with SSDs in kindergarten, with the goal of improving speech sound production and preventing poor educational performance in the future. Clinicians should also consider applying phonologically driven treatment approaches to children who may have single sound errors. In the case examples, Nathan is a child who may appear to be “just artic,” but a minimal pairs approach may be prudent to help improve his awareness of the sound contrasts in both speech and spelling. This is true, even if the current practice is to not provide services to children who have only one speech sound in error or who have errors on the “late eight” speech sounds (Shriberg, 1993).
Analysis of Cases in This Issue
Although it may seem logical to consider developmental norms during assessment, it is critical that this is not the only source of data used for clinical decision making. Take, for instance, the child profiled in Case 2 as presented earlier in this issue. This is a 6-year-old child who has the single sound of /r/ in error. On the Arizona Articulation and Phonology Scale–Fourth Edition (Fudala, 2017), this child received a score of 85, which is interpreted as “speech is intelligible, although noticeably in error” (Fudala, 2017). Although the federal law clearly indicates that eligibility for services cannot be determined using only one measure, standardized tests scores are the most common data source reportedly used by clinicians (Farquharson & Tambyraja, in press; Skahan, Watson, & Lof, 2007). As a result, it is common for children who present with a profile like the child in Case 2 to not receive timely services. However, there are a few things to consider for Case 2, which illustrates a very common issue for school-based clinicians.
First, keep in mind that the Arizona Articulation and Phonology Scale–Fourth Edition, like nearly all standardized tests of articulation, examines speech sound production at the single-word level. There are obvious reasons why single-word articulation tests are clinically useful—they are quick to administer and relatively easy to score as they inherently limit the possibilities of what the child could say. However, single-word tests of articulation are not always ecologically valid. That is, we communicate in continuous and spontaneous speech, not in single words. Although the child in Case 2 is deemed to have speech that is intelligible at the single-word level, his ability to use speech to communicate effectively in the classroom and at home is still in question.
Second, the single sound that is in error in Case 2 is /r/, which is a frequently occurring phoneme in English (Barker, 1960; Hayden, 1950; Mines, Hanson, & Shoup, 1978). For this child, then, his single sound error will be produced more frequently during spontaneous speech than if he had a different phoneme in error (e.g., / θ /). That is not to say that an error in / θ / only would not impact the child's intelligibility or his literacy skills (in fact, see the case of Nathan above); however, one important piece of data to consider during assessment is the frequency of occurrence for the phoneme(s) in error (and see Powell, 1991, for a comprehensive list of other data points to consider, such as stimulability). Phonemes that occur more frequently in conversational speech (e.g., /r, s, t, l, n/; Mines et al., 1978) are more likely to impact intelligibility—even if only one of those phonemes is in error.
Third, although this standardized test is a useful and informative piece of data, it is only one piece of data. We know that he is having difficulty producing /r/, but we do not know how this speech sound error is impacting his educational and/or social skills. We need to examine this child's expressive and receptive language, phonological awareness, and literacy skills. In addition, we should talk to the child's teacher and parent and to the child himself about the impact this seemingly minor speech sound error is having on his educational performance (see McLeod, 2004, for a freely available interview measure, discussed more below).
Finally, other factors, such as gender, are important pieces of information to consider during the assessment process. For instance, Crowe Hall (1991) found that males with SSDs were more likely to be viewed negatively by peers when compared to females with SSDs. Considering the prevalence of SSDs that occur for males (Wren, Miller, Peters, Emond, & Roulstone, 2016), it is prudent to consider the downstream social effects of the SSD. Similarly, there will be idiosyncratic reasons why a certain child, with a profile similar to the child in Case 2, may require services. If the child in Case 2 had a surname of “Roberts” or had a first name of “Ronnie” and a house full of siblings with alliterative names, then this single sound error will have a significant impact on this child's daily communication in both his home and school environments. This brings us to a very important aspect of the assessment process—the child's social–emotional well-being.
Social–Emotional Well-Being
For children with SSDs, including those with single sound errors, it is imperative to acknowledge the social–emotional experience connected to their speech. These children are at significant risk for social, emotional, and vocational difficulties in later childhood and adulthood (Felsenfeld, Broen, & McGue, 1994; Hitchcock, Harel, & McAllister, 2015; Lewis & Freebairn, 1992; Silverman, & Paulus, 1989). Research has found associations between the presence of an SSD and their own self-perception as well as the perception of their peers. For instance, McCormack, McLeod, McAllister, and Harrison (2009) interviewed 13 children between the ages of 4 and 5 years. These preschool-age participants, although quite young, expressed frustration with their inability to say their name (e.g., “Tara” for “Kara”; p. 385). However, no children in this study indicated that they felt sad about their speech. By contrast, Hitchcock et al. (2015) reported that children older than the age of 8 years experienced a significantly greater impact of their SSDs to their social–emotional well-being. Most children in the survey study had difficulty with /r/, and for the majority of those children, /r/ was their only speech sound error (Hitchcock et al., 2015). Taken together, these data suggest that children as young as age 4 are aware of the impact of their SSD (McCormack et al., 2010), and the longer that these SSDs persist, the more likely the child is to experience a social–emotional impact (Hitchcock et al., 2015). In addition to their own poor self-perceptions, children with SSDs often experience poor reactions from peers (Gertner, Rice, & Hadley, 1994). Crowe Hall (1991) reported that fourth- and sixth-grade children have more negative reactions to peers with “only” one speech sound in error compared to their reactions to the speech of typically developing peers. Silverman and Paulus (1989) and Silverman and Falk (1992) both similarly reported that teenagers with a single sound in error (most commonly /r/) were viewed negatively by peers. In fact, even classroom teachers often have negative perceptions of and lower expectations for children with SSDs, regardless of academic performance (Overby, Carrell, & Bernthal, 2007; Ruscello, Stutler, & Toth, 1983). Madison (1992) underscored the importance of these studies as they “provide empirical evidence of the negative attention and attitudes that even mild [sic] articulation disorders create for the speaker” (p. 23). For more detailed information about the connections between speech sound production and social–emotional well-being, see the article by Breanna Krueger in this issue.
Clinical Recommendations
Collectively, the information presented here highlights the importance of conducting individualized and comprehensive assessments for all children with speech sound errors, regardless of the number of sounds in error. This can be a challenge for many clinicians, especially those who are working in schools, because time pressures (Biancone, Farquharson, Justice, Schmitt, & Logan, 2014), caseload size (Katz, Maag, Fallon, Blenkarn, & Smith, 2010), and overall workload (Ehren & Ehren, 2001) make quick assessments appealing and, in many cases, necessary. See the Appendix for a list of recommendations for assessment, treatment, and advocacy.
Conclusions
In summary, children with SSDs are at risk for a host of educational difficulties, regardless of the number or kind of errors expressed. Although it is indeed the case that many children with SSDs resolve their speech production difficulties and experience no related educational issues, this is certainly not the case for all children (Janus et al., 2017). Like all other populations of individuals with communication disorders, we must apply the principles of evidence-based practice (Dollaghan, 2004). These principals command clinicians to take the client's values into consideration. Certainly, a communication impairment that impacts social–emotional well-being is worthy of treatment. It is also educationally relevant and therefore mandated under the Individuals With Disabilities Education Act (Farquharson & Boldini, 2018; Thomas, 2016). A blanket rule that automatically disqualifies children with single sound errors for services is not in alignment with the Individuals with Disabilities Education Act, nor is it ethical to make an assumption about a child's literacy or language skills without directly testing them. Notably, many of these blanket decisions are put in place in an attempt to manage the ever-expanding caseloads of school-based SLPs. Indeed, caseloads are often unmanageable (Farquharson & Boldini, 2018; Hutchins, Howard, Prelock, & Belin, 2010; Katz et al., 2010), but is denying service to a vulnerable population the answer?
In an editorial, Nippold (2012) offered some concrete suggestions regarding how the field may consider addressing the caseload issue in schools. One example is the recognition of the expanded role of the SLP (Ehren & Ehren, 2001), which might allow for SLPs to specialize in particular disorder areas instead of working as a generalist. In this example, there could be a division of labor in which one SLP provides the majority of services to the children with SSDs whereas another works with the children who have autism. The services provided to children with SSDs could take place within a multitier system of support, which has been reported to be beneficial for a quick remediation of speech sound errors (Bruce, Lynde, Weinhold, & Peter, 2018; Mire & Montgomery, 2009; Swaminathan & Farquharson, 2018; Taps, 2008). Children with SSDs require the unique and highly specialized treatment of speech-language pathologists. It is imperative to support their educational needs by intervening when necessary, regardless of the number of speech sounds in error.
Acknowledgments
The pilot study reported here was funded by a Faculty Advancement Fund Grant at Emerson College (PI: Farquharson). I am thankful for the families who volunteered their time to the pilot study. Open access fees were paid for by an award to Holly Storkel from the Friends of the Life Span Institute at the University of Kansas.
References
Apel, K., & Lawrence, J. (2011). Contributions of morphological awareness skills to word-level reading and spelling in first-grade children with and without speech sound disorder. Journal of Speech, Language, and Hearing Research, 54(5), 1312–1327.
Barker, J. O. (1960). A numerical measure of articulation. Journal of Speech and Hearing Disorders, 25(1), 79–88.
Bird, J., Bishop, D. V., & Freeman, N. H. (1995). Phonological awareness and literacy development in children with expressive phonological impairments. Journal of Speech and Hearing Research, 38(2), 446–462.
Biancone, T. L., Farquharson, K., Justice, L. M., Schmitt, M. B., & Logan, J. A. (2014). Quality of language intervention provided to primary-grade students with language impairment. Journal of Communication Disorders, 49, 13–24.
Bishop, D. V., & Adams, C. (1990). A prospective study of the relationship between specific language impairment, phonological disorders and reading retardation. Journal of Child Psychology and Psychiatry and Allied Disciplines, 31(7), 1027–1050.
Bleile, K. M. (2006). The late eight. San Diego, CA: Plural Publishing.
Brimo, D. (2013). The “how to” guide to spelling assessment. SIG 1 Perspectives on Language Learning and Education, 20(4), 129–136.
Bruce, L., Lynde, S., Weinhold, J., & Peter, B. (2018). A team approach to response to intervention for speech sound errors in the school setting. Perspectives of the ASHA Special Interest Groups, 3(16), 110–119.
Cabbage, K. L., Farquharson, K., Iuzzini-Seigel, J., Zuk, J., & Hogan, T. P. (2018). Exploring the overlap between dyslexia and speech sound production deficits. Language, Speech, and Hearing Services in Schools, 49, 774–786.
Carroll, J. M., & Snowling, M. J. (2004). Language and phonological skills in children at high risk of reading difficulties. Journal of Child Psychology and Psychiatry, 45(3), 631–640.
Catts, H. W. (1993). The relationship between speech-language impairments and reading disabilities. Journal of Speech and Hearing Research, 36(5), 948–958.
Clarke-Klein, S., & Hodson, B. W. (1995). A phonologically based analysis of misspellings by third graders with disordered-phonology histories. Journal of Speech and Hearing Research, 38(4), 839–849.
Crowe Hall, B. J. (1991). Attitudes of fourth and sixth graders toward peers with mild articulation disorders. Language, Speech, and Hearing Services in Schools, 22(1), 334–340.
Dodd, B., Ttofari-Eecen, K., Brommeyer, K., Ng, K., Reilly, S., & Morgan, A. (2017). Delayed and disordered development of articulation and phonology between four and seven years. Child Language Teaching and Therapy, 34, 87–99.
Dollaghan, C. A. (2004). Evidence-based practice in communication disorders: What do we know, and when do we know it? Journal of Communication Disorders, 37(5), 391–400.
Ehren, B. J., & Ehren, T. C. (2001). New or expanded literacy roles for speech-language pathologists: Making it happen in the schools. Seminars in Speech and Language, 22, 233–244.
Farquharson, K. (2015a). After dismissal: Examining the language, literacy and cognitive skills of children with remediated speech sound disorders. SIG 16 Perspectives on School-Based Issues, 16, 50–59.
Farquharson, K. (2015b). Language or motor: Reviewing categorical etiologies of speech sound disorders. Frontiers in Psychology, 6, 1708.
Farquharson, K., & Boldini, L. (2018). Variability in interpreting “educational performance” for children with speech sound disorders. Language, Speech, and Hearing Services in Schools, 49, 938–949.
Farquharson, K., Hogan, T. P., & Bernthal, J. E. (2017). Working memory in school-age children with and without a persistent speech sound disorder. International Journal of Speech-Language Pathology, 20(4), 422–433.
Farquharson, K., & Tambyraja, S. R. (in press). Describing how school-based SLPs determine eligibility for children with speech sound disorders. Seminars in Speech and Language, 40(2).
Felsenfeld, S., Broen, P. A., & McGue, M. (1992). A 28-year follow-up of adults with a history of moderate phonological disorder: Linguistic and personality results. Journal of Speech, and Hearing Research, 35(5), 1114–1125.
Felsenfeld, S., Broen, P. A., & McGue, M. (1994). A 28-year follow-up of adults with a history of moderate phonological disorder: Educational and occupational results. Journal of Speech and Hearing Research, 37, 1331–1353.
Fey, M. E. (1992). Articulation and phonology: Inextricable constructs in speech pathology. Language, Speech, and Hearing Services in Schools, 23(3), 225–232.
Fudala, J. B. (2017). Arizona 4: Arizona Articulation and Phonology Scale, Fourth Revision. Western Psychological Services.
Gernand, K. L., & Moran, M. J. (2017). Phonological awareness abilities of 6-year-old children with mild to moderate phonological impairments. Communication Disorders Quarterly, 28(4), 206–215.
Gertner, B. L., Rice, M. L., & Hadley, P. A. (1994). Influence of communicative competence on peer preferences in a preschool classroom. Journal of Speech and Hearing Research, 37(4), 913–923.
Gierut, J. A. (2007). Phonological complexity and language learnability. American Journal of Speech-Language Pathology, 16(1), 6–17.
Goldman, R., & Fristoe, M. (2000). Goldman-Fristoe Test of Articulation-Second Edition. Minneapolis, MN: Pearson Assessments.
Hayiou‐Thomas, M. E., Carroll, J. M., Leavett, R., Hulme, C., & Snowling, M. J. (2017). When does speech sound disorder matter for literacy? The role of disordered speech errors, co‐occurring language impairment and family risk of dyslexia. Journal of Child Psychology and Psychiatry, 58(2), 197–205.
Hayden, R. E. (1950). The relative frequency of phonemes in general-American English. Word, 6(3), 217–223.
Hesketh, A., Adams, C., & Nightingale, C. (2000). Metaphonological abilities of phonologically disordered children. Educational Psychology, 20(4), 483–498.
Hitchcock, E. R., Harel, D., & Byun, T. M. (2015, November). Social, emotional, and academic impact of residual speech errors in school-age children: A survey study. Seminars in Speech and Language, 36(4), 283–294.
Hoffman, P. R., & Norris, J. A. (1989). On the nature of phonological development: Evidence from normal children's spelling errors. Journal of Speech and Hearing Disorders, 32(4), 787–794.
Hutchins, T. L., Howard, M., Prelock, P. A., & Belin, G. (2010). Retention of school-based SLPs: Relationships among caseload size, workload satisfaction, job satisfaction, and best practice. Communication Disorders Quarterly, 31(3), 139–154.
James, D. G., van Doorn, J., & McLeod, S. M. (2008). The contribution of polysyllabic words in clinical decision making about children's speech. Clinical Linguistics & Phonetics, 22, 345–353.
Janus, M., Labonté, C., Kirkpatrick, R., Davies, S., & Duku, E. (2017). The impact of speech and language problems in kindergarten on academic learning and special education status in grade three. International Journal of Speech-Language Pathology, 1–14.
Katz, L. A., Maag, A., Fallon, K. A., Blenkarn, K., & Smith, M. K. (2010). What makes a caseload (un)manageable? School-based speech-language pathologists speak. Language, Speech, and Hearing Services in Schools, 41(2), 139–151.
Larrivee, L. S., & Catts, H. W. (1999). Early reading achievement in children with expressive phonological disorders. American Journal of Speech-Language Pathology, 8(2), 118–128.
Law, J., Dennis, J. A., & Charlton, J. J. (2017). Speech and language therapy interventions for children with primary speech and/or language disorders (Protocol). Cochrane Database of Systematic Reviews, 2017(1), 1–21.
Lewis, B. A., & Freebairn, L. (1992). Residual effects of preschool phonology disorders in grade school, adolescence, and adulthood. Journal of Speech, and Hearing Research, 35(4), 819–831.
Lewis, B. A., Freebairn, L. A., Hansen, A. J., Stein, C. M., Shriberg, L. D., Iyengar, S. K., & Taylor, H. G. (2006). Dimensions of early speech sound disorders: A factor analytic study. Journal of Communication Disorders, 39(2), 139–157.
Lewis, B. A., Freebairn, L. A., Tag, J., Benchek, P., Morris, N. J., Iyengar, S. K., … Stein, C. M. (2018). Heritability and longitudinal outcomes of spelling skills in individuals with histories of early speech and language disorders. Learning and Individual Differences, 65, 1–11.
Lewis, B. A., Freebairn, L. A., Tag, J., Ciesla, A. A., Iyengar, S. K., Stein, C. M., & Taylor, H. G. (2015). Adolescent outcomes of children with early speech sound disorders with and without language impairment. American Journal of Speech-Language Pathology, 24, 150–163.
Lewis, B. A., Freebairn, L. A., & Taylor, H. G. (2002). Correlates of spelling abilities in children with early speech sound disorders. Reading and Writing: An Interdisciplinary Journal, 15, 389–407.
Madison, C. L. (1992). Attitudes toward mild misarticulation-disordered peers. Language, Speech, and Hearing Services in Schools, 23(2), 188–188.
Mann, V. A., & Foy, J. G. (2007). Speech development patterns and phonological awareness in preschool children. Annals of Dyslexia, 57(1), 51–74.
McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2009). A systematic review of the association between childhood speech impairment and participation across the lifespan. International Journal of Speech-Language Pathology, 11(2), 155–170.
McLeod, S. (2004). Speech pathologists' application of the ICF to children with speech impairment. Advances in Speech-Language Pathology, 6(1), 75–81.
McLeod, S., & Hand, L. (1991). Single word test of consonant clusters. Retrieved from http://www.csu.edu.au/__data/assets/pdf_file/0009/227655/Consonantclustertest.pdf
McLeod, S., & Verdon, S. (2017). Tutorial: Speech assessment for multilingual children who do not speak the same language(s) as the speech-language pathologist. American Journal of Speech-Language Pathology, 26(3), 691–708.
Mines, M. A., Hanson, B. F., & Shoup, J. E. (1978). Frequency of occurrence of phonemes in conversational English. Language and Speech, 21(3), 221–241.
Mire, S. P., & Montgomery, J. K. (2009). Early intervening for students with speech sound disorders: Lessons from a school district. Communication Disorders Quarterly, 30(3), 155–166.
Murphy, C. F., Pagan-Neves, L. O., Wertzner, H. F., & Schochat, E. (2015). Children with speech sound disorder: Comparing a non-linguistic auditory approach with a phonological intervention approach to improve phonological skills. Frontiers in Psychology, 6, 64.
Nippold, M. A. (2012). Different service delivery models for different communication disorders. Language, Speech, and Hearing Services in Schools, 43(2), 117–120.
Overby, M. S., Carrell, T., & Bernthal, J. (2007). Teachers' perceptions of students with speech sound disorders: A quantitative and qualitative analysis. Language, Speech, and Hearing Services in Schools, 38, 327–341.
Overby, M. S., Trainin, G., Smit, A. B., Bernthal, J. E., & Nelson, R. (2012). Preliteracy speech sound production skill and later literacy outcomes: A study using the Templin archive. Language, Speech, and Hearing Services in Schools, 43(1), 97–115.
Pennington, B. F. (2006). From single to multiple deficit models of developmental disorders. Cognition, 101(2), 385–413.
Peterson, R. L., Pennington, B. F., Shriberg, L. D., & Boada, R. (2009). What influences literacy outcome in children with speech sound disorder? Journal of Speech, Language, and Hearing Research, 52(5), 1175–1188.
Powell, T. W. (1991). Planning for phonological generalization: An approach to treatment target selection. American Journal of Speech-Language Pathology, 1(1), 21–27.
Preston, J. L., & Edwards, M. L. (2010). Phonological awareness and types of sound errors in preschoolers with speech sound disorders. Journal of Speech, Language, and Hearing Research, 53(1), 44–60.
Preston, J. L., & Edwards, M. L. (2007). Phonological processing skills of adolescents with residual speech sound errors. Language, Speech, and Hearing Services in Schools, 38(4), 297–308.
Preston, J. L., Hull, M., & Edwards, M. L. (2013). Preschool speech error patterns predict articulation and phonological awareness outcomes in children with histories of speech sound disorders. American Journal of Speech-Language Pathology, 22(2), 173–184.
Raitano, N. A., Pennington, B. F., Tunick, R. A., Boada, R., & Shriberg, L. D. (2004). Pre‐literacy skills of subgroups of children with speech sound disorders. The Journal of Child Psychology and Psychiatry, 45(4), 821–835.
Ruscello, D. M., Stutler, S. S., & Toth, D. (1983). Classroom teachers’ attitudes toward children with articulatory disorders. Perceptual and Motor Skills, 57(2), 527–530.
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(1), 105–140.
Silverman, F. H., & Falk, S. M. (1992). Attitudes of teenagers toward peers who have a single articulation error. Language, Speech, and Hearing Services in Schools, 23(2), 187–187.
Silverman, F. H., & Paulus, P. G. (1989). Peer reactions to teenagers who substitute/w/for/r. Language, Speech, and Hearing Services in Schools, 20(2), 219–221.
Skahan, S. M., Watson, M., & Lof, G. L. (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(3), 246–259.
Soleymani, Z., & Shakeri, N. (2018). Phonological awareness in preschool Persian speaking children with speech sound disorder: Impact of comorbid language impairment. Journal of Modern Rehabilitation, 11(4), 237–244.
Sutherland, D., & Gillon, G. T. (2007). Development of phonological representations and phonological awareness in children with speech impairment. International Journal of Language & Communication Disorders, 42(2), 229–250.
Swaminathan, D., & Farquharson, K. (2018). Using response to intervention for speech sound disorders: Exploring practice characteristics and geographical differences. Perspectives of the ASHA Special Interest Groups, 3(16), 53–66.
Sylvan, L. (2014). Speech-language services in public schools: How policy ambiguity regarding eligibility criteria impacts speech language pathologists in a litigious and resource constrained environment. Journal of American Academy of Special Education Professionals, 2, 7–23.
Taps, J. (2008). RTI services for children with mild articulation needs: Four years of data. SIG 16 Perspectives on School-Based Issues, 9, 104–110.
Thomas, J. L. (2016). Decoding eligibility under the IDEA: Interpretations of “adversely affect educational performance.” Campbell Law Review, 38(1), 73–107.
Tyler, A. A., & Lewis, K. E. (2005). Relationships among consistency/variability and other phonological measures over time. Topics in Language Disorders, 25(3), 243–253.
Wagner, R. K., & Torgesen, J. K. (1987). The nature of phonological processing and its causal role in the acquisition of reading skills. Psychological Bulletin, 101(2), 192–212.
Wren, Y. (2015). “He'll grow out of it soon—won't he?”—The characteristics of older children's speech when they do—and don't—grow out of it. SIG 16 Perspectives on School-Based Issues, 16, 25–36.
Wren, Y., Miller, L. L., Peters, T. J., Emond, A., & Roulstone, S. (2016). Prevalence and predictors of persistent speech sound disorder at eight years old: Findings from a population cohort study. Journal of Speech, Language, and Hearing Research, 59(4), 647–673.
Appendix
Assessment Recommendations
•
Examine speech sound production at the conversational speech level. Single-word tests are clinically useful but cannot be used in isolation for eligibility or treatment decisions.
•
In single-word tests, include both single syllable and polysyllable words to examine how linguistic complexity contributes to speech sound production (James, van Doorn, & McLeod, 2008).
•
In single-word tests and in conversational speech, examine consonant clusters. A free single-word test of consonant clusters is available here (McLeod & Hand, 1991): http://www.csu.edu.au/__data/assets/pdf_file/0009/227655/Consonantclustertest.pdf.
•
Include formal and informal assessments of phonological awareness in younger children (Tyler & Lewis, 2005).
◦
This is important in both children with typically developing language skills and those with language delays (Soleymani & Shakeri, 2018).
◦
This is also an opportunity to collaborate with reading specialists during the assessment process. This particular kind of testing can be conducted by other specialists in a school setting.
•
Consider both number and type of errors (Dodd et al., 2017).
•
Include a measure of word-level decoding (or, if in late preschool or early kindergarten, letter identification).
◦
Also consider, again, collaboration with reading specialists or obtaining this information from the classroom teacher.
•
Examine spelling (see Brimo, 2013, for a tutorial).
•
Interview the child and his or her parents and teachers regarding the social impact of the SSD. As an example, see the Speech Participation and Activity of Children (McLeod, 2004), which is freely available online: https://arts-ed.csu.edu.au/__data/assets/pdf_file/0005/227660/SPAAC2.pdf
•
If assessing the speech sound production of bilingual children, see Wren (2015) or McLeod and Verdon (2017) for clinical recommendations.
Treatment Recommendations
•
Consider implementing a complexity approach to treatment for children with SSDs. This approach has been shown to result in faster gains in speech sound accuracy (Gierut, 2007). For resources and tutorials, see http://slpath.com/. See also this evidence-based answer from The Informed SLP: https://www.theinformedslp.com/qa_complexity_approach.html.
•
Do not limit treatment options to either “phonological” or “articulation” approaches. Consider approaches, such as minimal pairs, even if the child has a single sound error.
•
Explore different service delivery models, including a response-to-intervention type of approach (Bruce et al., 2018; Mire & Montgomery, 2009; Swaminathan & Farquharson, 2018).
Advocacy Recommendations
•
Reframe the view of children with single sound errors beginning with eliminating the phrase “just artic.” This phrase makes the assumption that this type of communication disorder is less important and less complex than others.
•
Become familiar with your state-level guidelines for eligibility and exit criteria (Farquharson & Boldini, 2018) to ensure your district is appropriately adhering to the Individuals With Disabilities Education Act.
◦
If your state-level guidelines are vague or unclear, consider volunteering with your state speech, language, and hearing association to create robust and comprehensive guidelines.
•
Start a conversation with your fellow speech-language pathologists, your special education director, or superintendent regarding the importance of individualized assessment for children with single sound errors. Implementation of the above assessment recommendations may take time to adopt, but it should begin with a data-driven discussion of the literature reviewed here.
Information & Authors
Information
Published In
Copyright
Copyright © 2019 The Authors. 
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.History
- Received: Aug 9, 2018
- Revised: Oct 31, 2018
- Accepted: Dec 6, 2018
- Published online: Feb 26, 2019
- Published in issue: Feb 26, 2019
Authors
Metrics & Citations
Metrics
Article Metrics
View all metricsCitations
Download article citation data for:
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Citing Literature
- Alexis Moser, Kelly Farquharson, Erin J. Bush, Brenda Louw, Speech-Language Pathologists' Perceptions of the Severity of Speech Sound Disorder, American Journal of Speech-Language Pathology, 10.1044/2024_AJSLP-24-00150, 34, 2, (722-738), (2025).
- Carol Westby, Changing Services for Speech Sound Disorders in Schools, Word of Mouth, 10.1177/10483950241263415, 36, 1, (1-7), (2024).
- Kathryn L. Cabbage, Dana Algeo-Nichols, Literacy-Based Intervention for Children With Speech Sound Disorders: A Review of the Literature, Perspectives of the ASHA Special Interest Groups, 10.1044/2024_PERSP-24-00025, 9, 4, (960-983), (2024).
- Françoise Brosseau-Lapré, Elizabeth Roepke, Beyond Sounds: Decoding Speech Errors and Phonological Awareness in Preschoolers, Perspectives of the ASHA Special Interest Groups, 10.1044/2024_PERSP-24-00001, 9, 4, (922-934), (2024).
- Mary Allison Moody, Catherine C. Timm-Fulkerson, Jennifer Westmoreland, Lindsay R. Dennis, Kelly Farquharson, Print-Rich Speech Sound Therapy Sessions: The Theory Behind It and Plans for Implementation, Perspectives of the ASHA Special Interest Groups, 10.1044/2024_PERSP-23-00288, 9, 4, (949-959), (2024).
- Elizabeth Roepke, Assessing Phonological Processing in Children With Speech Sound Disorders, Perspectives of the ASHA Special Interest Groups, 10.1044/2023_PERSP-23-00036, 9, 1, (14-34), (2023).
- Cara Singer, Ellianne Martin, Treating a Young Child Who Stutters' Lateral Lisp: A Case Study, Perspectives of the ASHA Special Interest Groups, 10.1044/2023_PERSP-22-00133, 8, 5, (886-896), (2023).
- Kelly Farquharson, Kathryn L. Cabbage, Anne C. Reed, Mary Allison Moody, Subtract Before You Add: Toward the Development of a De-Implementation Approach in School-Based Speech Sound Therapy, Language, Speech, and Hearing Services in Schools, 10.1044/2023_LSHSS-22-00176, 54, 4, (1052-1065), (2023).
- Elizabeth E. Ancel, Michael L. Smith, V. N. Vimal Rao, Benjamin Munson, Relating Acoustic Measures to Listener Ratings of Children's Productions of Word-Initial /ɹ/ and /w/, Journal of Speech, Language, and Hearing Research, 10.1044/2023_JSLHR-22-00713, 66, 9, (3413-3427), (2023).
- Rebecca Summy, Kelly Farquharson, Examining Graduate Training in Written Language and the Impact on Speech-Language Pathologists' Practice: Perspectives From Faculty and Clinicians, American Journal of Speech-Language Pathology, 10.1044/2023_AJSLP-22-00327, 33, 1, (189-202), (2023).
- See more
