New School Phonology: Integrative Phonology for SLP Clinical Applications

Over the years I have noticed scholars picking up on early work we did at Kent State University in the 1970s addressing trading relationships in phonological and grammatical production as factors in clinical intervention. It is a robust factor and appears in normal language development. A primary aim of this line of investigation was to demonstrate sound-by-sound treatment is invalid for the most part. I believed we could change intervention to make it more efficient, significant and enjoyable for clinicians and children. However, when I returned to school practice for four years in Arizona schools I found that the treatment of “articulation disorders” lagged far behind. I wondered why the American Speech-Language-Hearing Association had allowed this to happen. This lead me to questions how ASHA keeps practice up-to-date through management of curriculum trends.

Definition

Integrative phonology means teaching sound structures in relation to grammar, meaning, prosody and information processing constraints. Because of integration one can expect broad generalizations across all components of expression. For example, treating articulation should improve morpho-syntactic development as well as sounds. Teaching isolated language structures out of context should be avoided and the motivation of the child should be considered. Phonology is essential to generalization of learning and academic performance.

Generalization

Integrative phonology can reduce the fragmentation of the scope of practice by mapping relationships among the different types of treatment:

“speech sound production
articulation apraxia of speech
dysarthria a
taxia
dyskinesia
phonology
morphology
syntax
semantics
pragmatics (language use, social aspects of communication)
literacy (reading, writing, spelling)”

In the area of literacy, what’s more, integrative phonology addresses methods of teaching phonological awareness within a linguistic hierarchy fostering articulation improvement charted in IEPs.

Best Practice

From the very beginning we sought to combat the teaching of isolated linguistic structures outside of the communication context. We observed some indications that children treated this way developed side effects, such as faulty generalization, disfluency and rule misapplication.

During my four years as a practicing school SLP I studied articulation / phonology practice and concluded it was out-of-date in American schools. I submitted a paper on the topic to The ASHA Leader and withdrew it after the editor said, “This wouldn’t do any good.” My impression was that this candid point of view was a public relations problem for ASHA. The paper was published elsewhere and was received favorably. I began to suspect ASHA was more concerned about image-making than improving graduate education.

I have always envisioned the simplification of developmental intervention by integrated treatment plans aimed at generalization across communication components. I imagined SLPs using their energies wisely to maximize improvement by letting generalization do the work. In school settings I saw 20 to 40 percent improvement of untreated sounds of the high functioning children.

At one of my practice sites I took on a boy with cleft palate impairment. He had been in treatment for several years for sound-by-sound treatment of affected sounds. His frustration level peaked and there was no evidence sound practice was the answer. In papers I have written I have pointed out that typical articulation treatment can be too aggressive, obliging clients to say sounds when their motor-speech systems cannot respond to the pressure. For 50 years articulation treatment have been production oriented. We know speech development is impaired but we continue to push the limits for “correct production.” I believe there are side effects if one notices.

I noticed with this boy that sound production was not the significant problem. He made sound errors because he could not produce rapid antagonistic syllable sequences using a faulty speech mechanism. The palate had been repaired but was scared and movements across syllable boundaries in words were slow and inaccurate. Of course when long words and phrases were targets, there was no chance of sustaining grammatical prosody to hit the embedded sounds accurately. Articulation errors were a symptom of syllable/morpheme production issues. I rewrote the IEP goals so rhythmic syllable production was a higher-level aim. He would have to hit sound targets in creative ways to suggest correct execution. (Many years ago a paper was published in JSHD about a client who had no tongue but intelligible speech. The acoustic effect is what is important.)

What I did was to give the boy relief from his labors of producing sounds. A “top down” and perceptual approach was adopted. The first aim was to maximize fun and success. He had had very little pleasure from speaking for therapy purposes.

My first task was simply to see if he could count the number of syllables in words. “How many syllables are in school bus?” When he said two, I was excited and he realized he got it right. No hard work. He was able to move on to find word boundaries and stress in longer words, and grammatical stress in phrases. No problem. Eventually I dropped to the lowest level of the linguistic hierarchy to see if he could perceive some of the sounds he could not produce in syllable sequences. This was more difficult but he could with extra tries. Perceptual skills seemed to be intact and available for phonological learning.

I began to read about phonological awareness for literacy training as understood in education. This method is nothing more than phonological intervention in the perceptual domain except there is a print connection.

I switched my articulation clients over to phonological awareness training and began to believe this could help production problems improve while facilitating reading development. Using prosodic contours with embedded features is a general approach with great promise to facilitate language development. When particular children have impaired speech production mechanisms, prosody intervention integrates and nurtures linguistic processing, placing less demand on brain resources for language development.

Prosody exercises are easy to design for success and fun. Music can be brought in for ear training the melody of speech. The boy had limited vocal range for speech and song could have helped him.

Diagnosis

I began to realize, as well, that SLPs misdiagnosis young children with pervasive linguistic impairments, i.e. “learning disabilities” (developmental Broca’s aphasia). By calling these children SLI and treating articulation narrowly they prevent early diagnosis of learning disability.

A child with multiple articulation errors in speech can be dismissed too early, before the learning disability comes into focus as a result of classroom instruction. SLPs take themselves out of the treatment process too early, and LD identification happens too late.

Public Policy

On the public policy level I took the position that ASHA appears to have no central curriculum process to identify, clarify and implement critical changes in school practice. This “evidence-based” approach goes a long way toward improving ASHA accreditation “standards” as promulgated by The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA). Certainly, phonology would be central to a credible accreditation system of standards.By linking communication development to learning as IDEA did one must change theory and method for graduate education. Years go by without changes in graduate education. Deflecting new and current practice into continuing education is wrong.

John M. Panagos

July 7, 2014

ASHA has used a FACEBOOK post to direct attention to the clinical summary of this new content:

http://www.asha.org/Practice-Portal/Clinical-Topics/Articulation-and-Phonology/

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