What is a Phonological Disorder?
A phonological disorder is a type of speech disorder that affects a child's ability to produce sounds in their language correctly and use them in the appropriate places in words. Children with phonological disorders may have difficulty with certain sounds or sound patterns, which can make their speech difficult to understand or unclear. For example, a child with a phonological disorder may substitute one sound for another (e.g., saying "wabbit" instead of "rabbit") or leave out sounds altogether (e.g., saying "dah" instead of "dog").
Phonological disorders are relatively common in young children, affecting approximately 8-9% of preschool-aged children. Many require intervention to improve their speech and language skills.
What Causes Phonological Disorders?
The exact cause of phonological disorders is not fully understood, but there are several factors, including hearing loss, developmental delay, and structural abnormalities that may contribute to their development. It is important to note that phonological disorders are not caused by a lack of intelligence or motivation on the part of the child. We also know that motor patterns (the way our brains tell our muscles what to do) play a huge part in speech sound production, so "muscle memory" contributes to how long a phonological disorder may persist and how easy or difficult it is to address.
How Are Phonological Disorders Diagnosed?
If you are having difficulty understanding your child, it is important to speak with a speech-language pathologist (SLP). An SLP can evaluate your child's speech and language skills and determine if a phonological disorder is present.
During a speech and language evaluation, the SLP will likely elicit specific words or sentences in order to assess their speech production skills. The SLP may also use standardized tests or informal assessment tools to determine the best goal areas.
If a phonological disorder is diagnosed, the SLP will provide the recommended frequency and duration of intervention and work with you to identify appropriate goals.
How Are Phonological Disorders Treated?
The goal of treatment for a phonological disorder is to help your child improve their production of speech sounds and use them in the appropriate places in words. There are several different approaches that may be used to treat phonological disorders, depending on the specific needs of your child.
Some evidence-based treatment approaches for phonological disorders include:
Auditory Bombardment: Auditory bombardment is often the strategy I use to "warm up" the brain at the beginning of a therapy session. Studies have shown that when children in a quiet environment listen to a listen of words containing their target sound, they are sooner able to produce that sound during a therapy session. I often use this approach (and the following 3 approaches) when a child is not yet stimulable for the target sound.
Auditory Detection and Discrimination: These are other receptive tasks that train the brain to listen for the target sound and ultimately support the correct production of that sound. In these tasks, I often prompt the child to count the time their target sound is in a given song. I may also use this approach by practicing words with the target sound in it, and prompting the child to give me feedback on whether or not I produced the sound correctly. We might pretend they are the speech therapist, which they tend to think is pretty fun! This skill not only warms up the brain for the sound, but trains the child to then detect errors in their own speech.
Stimulability Training: Stimulability refers to whether or not a child shows that they make the sound in *any* context. For instance a child may sometimes produce the target sound in one word, but never in another, which may be due to a variety of reasons. Stimulability training then refers to exposing the child to non-stimulable sounds and emphasizing them in play, in order to develop thier stimulability. For instance, a snake toy might be used to emphasize the /s/ sound in pretend play.
Articulation Drills: Once a child is stimulable for a sound, articulation drills can be used to generalize this motor pattern to more and more new words. Depending on your child, number of repetitions can vary, but it is important to keep a high level of accuracy during articulation drill.
Minimal Pairs: Minimal pairs are words that differ by one sound/phoneme. For instance, "take" and "cake" are minimal pairs. Minimal pairs are often used to demonstrate to the child that having one incorrect sound can change the meaning of the message. Pictures of minimal pairs can be used both to practice listening for the target sound and for providing visual feedback to children for their correct and incorrect productions of a target.
Multiple Oppositions: Multiple Oppositions is an approach that uses multiple minimal pairs in one group. For instance, "cake, take, make, rake" are all minimal pairs with one another. This approach is typically best for some of the the more severe cases, when one or more phoneme collapse is present. I will write more about a phonemic collapse on another day!
Communication Breakdown Strategies: A communication breakdown refers to any instance when your little one is not understood the first time they attempt to communicate a message. Sometimes, children and parents have already developed many of these strategies. Your speech therapist can help determine what kind of strategies are best when your child is not understood, to reduce frustration.
Other Things to Keep in Mind:
Spontaneous progress: Let's say your child is making good progress on a goal. It feels like right as they start making great progress, your therapist switches it up to a new sound! Why did they do that? Well, there is evidence to suggest that your child will likely continue to improve on that original sound even when they are no longer directly practicing that sound! Typically, we will cycle right back to that sound after a set number of sessions.
Home practice: Home practice is SO CRUCIAL to progress when it comes to improved speech sounds. I would much rather my child get 5-10 minutes every day of quality intervention that a full hour once a week or every other week, because of how much a high frequency of intervention matters. Practically, this is very hard to implement from a therapy perspective, but if your therapist can provide a home program that is suited well to your child's needs this is going to boost the progress made in therapy. It is important to note that this practice should be relatively easy for the child to complete on their own.
Positive Practice: This refers to keeping the accuracy of a target in the 80-100% range. This is especially important in home practice. If a child is below this range, I typically provide additional supports to reach this level in order to strengthen the correct motor pattern. The goal of positive practice is to decrease frustration while "hard-wiring" the correct motor pattern. "Hard wiring" the correct motor pattern makes it easier for the child to produce the sound in more and more words and contexts.
Dialectal Differences: Everyone has a dialect, and having a certain dialect does NOT necessarily mean there is a disorder. English speakers can have so many different dialects. This may be influenced by the family culture or may be influenced by the speaker's first language. Dialects must be considered in the diagnosis of phonological disorders. When considering the presence of a phonological disorder of child with a different dialect than mine, it is important consider their ability to be understood by their family and community outside of the therapy environment.
If you are concerned that your child may have a phonological disorder, do not hesitate to reach out to a licensed speech-language pathologist. Early intervention is key! To schedule your free consultation, you can text (321)-209-1193 or submit a request via rachelhomza.com.
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