A Profound Phonological Disorder in a Preschooler
Children with profound phonological disorders are unintelligible to both familiar and unfamiliar listeners. These children typically produce speech containing only a few vowels and consonants. They often have difficulty producing multiple classes of sounds and regularly omit parts of syllable/word shapes.
BM was a 4-year, 2-month-old male. Pregnancy and his birth history were remarkable for delivery at 35 weeks via cesarean section. He weighed 5 lb, 5 oz, but was not hospitalized following birth. BM crawled at 5 months, walked at 11 months, and ran at 15 months. His first word was noted at 19 months. At the time of testing, BM’s parents reported that he combined words “rarely” and usually used “one word at a time.” His parents reported that BM understood “almost all” of what was said to him. He typically used gestures and “grunting” to communicate his needs and wants. He had a reported vocabulary of 15 words and he was only 50% intelligible.
Assessment was completed in a university clinic setting and conducted by graduate student clinicians under the supervision of a speech-language pathologist. The assessment included parent interview, oral-motor examination, and administration of the Preschool Language Scales-5 (PLS-5) and Hodson Assessment of Phonological Patterns-3 (HAPP-3) as well as a spontaneous language sample.
Oral-motor examination revealed no abnormalities. BM obtained an average standard score of 102 on the Auditory Comprehension subtest of the PLS-5. The Expressive Communication subtest was attempted, but aborted due to increased frustration exhibited by BM. For example, after one, typically unintelligible attempt at answering a given item, he refused to repeat his response. Testing was ceased on this subtest because the examiners felt the score would be influenced by BM’s unintelligibility; his scores would not be representative of his ability. The HAPP-3 revealed >40% occurrence in the following areas: consonant sequences/clusters (115%), postvocalic singletons (94%), liquids (100%), stridents (100%), and velars (100%). These scores were consistent with a severity rating of “profound.”
A spontaneous language sample revealed a mean length of utterance of 1.2, with an estimated 20% intelligibility to unfamiliar listeners. His phonemic inventory consisted of the vowels /i/, /o/, /ɪ/, and /ʌ/ and the consonants /h/, /m/, /t/, and /p/. He was able to follow all age-appropriate verbal directions and appeared to understand all that was said to him by both the examiners and his parents. He exhibited immediate frustration when the listener failed to understand what he said or when he was asked to repeat himself.
a is incorrect. Although an expressive language disorder cannot be ruled out at this point, there is not enough evidence to support this diagnosis. He was unable to complete the expressive portion of the PLS-4 due to frustration and unintelligibility. Expressive language should be reassessed at a later time when intelligibility has increased and frustration decreased.
Answer: a is correct. Expressive language disorder is correct because of the severity and number of potential targets. A Hodson’s cycles approach would target multiple sounds at a time by targeting the missing classes of sounds. Syllable shape would also be potential targets. Targets would be rotated on a weekly basis, which would lead to greater overall intelligibility at a more rapid pace than targeting one phoneme at a time.
b is incorrect. A traditional articulation approach would target each individual phoneme until mastery, which would be a very slow approach, given the number of potential targets and his level of frustration.
Answer: d is correct. Targeting these two first will create the greatest change in intelligibility. Since he exhibited frustration quickly, giving him success quickly is paramount. intelligibility increases the most if the word/syllable shape is correct, even if the phonemes are produced incorrectly.
Answer: c is correct. One is not more important than the other. They both give valuable information in determining the diagnosis and severity. Both scores provide a more accurate picture of actual severity. These scores also help when showing progress.
BM was found to have a profound phonological disorder characterized by difficulty in the word/syllable shapes, containing final consonants and consonant sequences/clusters as well as the classes of liquids, velars, and stridents. He was 50% intelligible to familiar listeners and 20% intelligible to unfamiliar listeners. His phonemic inventory consisted of the vowels /i/, /o/, /ɪ/, and /ʌ/ and the consonants /h/, /m/, /t/, and /p/. Frustration was high when listeners did not understand him. No evidence of receptive or expressive language disorders was observed.
BM received five cycles (10 weeks each) following a modified Hodson’s cycles approach. Every week a different target (e.g., consonant sequences/clusters, FCD, liquids, velars, and stridents) was addressed. These targets were rotated based on previous testing. On the 10th week of each cycle, the HAPP-3 was administered to assess progress and determine targets for the following cycle(see Table 39.1). The percentage of occurrence reflecting progress across the five cycles is reflected in.
At the end of therapy, at the age of 5 years, 8 months, BM was 90% intelligible to unfamiliar listeners and 100% intelligible to familiar listeners. He had no expressive or receptive language difficulties. The PLS-5 was readministered at 5 years, 6 months and BM achieved scores in the average range in auditory comprehension (standard score [SS] = 108) and expressive communication (SS = 98). At discharge from therapy, BM had residual errors on /r/ and /l/.