Hayo Terband

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Hayo Terband

Utrecht University

Abstract

Toward a model of speech development and disorders for diagnosis and treatment planning

Speech constitutes the primary channel of human social interaction, yet speaking can be considered the most complex skill humans perform. For most people, speech production is effortless and generally error-free, and most children acquire speech skills relatively automatically with little difficulty. However, some children struggle with the acquisition of speech production skills and require sustained and intensive treatment (Campbell, 1999). Children that suffer speech-language disorders are at increased risk for social-emotional and behavioural problems (e.g., Conti-Ramsden & Botting, 2004; Van Daal, Verhoeven, & Van Balkom, 2007), as well as for delayed development of language, literacy and other academic skills (e.g., McCormack, McLeod, McAllister, & Harrison, 2009). These issues tend to threaten employment and occupational opportunities in adulthood (e.g., Felsenfeld, Broen, & McGue, 1994; Snowling, John, Adams, Bishop, & Stothard, 2001). Accurate diagnostic methods and effective intervention programs are thus of crucial importance to limit the short- and long-term impact of speech-language disorders on the individual.

Unfortunately, the classification of paediatric speech disorders and treatment planning remains problematic. The diagnostic dilemma is that the ability to investigate the characteristics of subtypes of paediatric speech disorders requires ‘pure’ cases selected on the basis of unambiguous/clear-cut criteria. These criteria can only be defined and made available as a result of research (into a priori undefined/undetermined cases). In developmental disorders (or disorders acquired very early in life)  a high overlap in symptomatology is the rule rather than the exception as there is a gradual emergence of the adult system (e.g., Bishop, 1997; Karmiloff-Smith, 2006) and the different functions and representations develop partly simultaneously and in interaction.

In this talk, I will discuss a process-oriented approach to diagnosis and treatment planning of paediatric speech disorders that allows us to break through this circularity (Terband et al., 2016a, 2016b). The core of this approach comprises three important notions:

  1. Although the behavioural symptomatology of paediatric speech disorders is not completely clear, it is possible to precisely define a specific core problem in terms of processes. (A focus on underlying processing deficits rather than classification based on symptoms.)
  2. Developmental interaction between processes: a specific underlying impairment on one level or domain also affects the development on adjacent levels or domains. (A focus on process profiles with degrees of involvement.)
  3. The speech production system and –disorder develop/evolve in time. (A focus on changing profiles.)

Based on these three notions, a model of differential diagnosis and treatment planning for childhood speech disorders is discussed, that ─besides “fluency disorder”─ comprises two general diagnostic categories labelled “speech delay” and “developmental speech disorder”. Within these categories, treatment goals are formulated on the level of processes. This process-oriented approach to diagnosis and treatment planning holds important advantages. In contrast to diagnostic classification based on a description of behavioural symptoms, it offers direct leads for treatment aimed at the specific underlying impairment tailored to the specific needs of the individual that is evaluated, and adjusted in the course of the disorder. The approach is illustrated with an example.

References

ASHA. (2007). Childhood Apraxia of Speech [technical report]. Retrieved from www.asha.org/policy.

Bishop, D. V. M. (1997). Cognitive neuropsychology and developmental disorders: Uncomfortable bedfellows. The Quarterly Journal of Experimental Psychology, 50A, 899-923.

Campbell, T. F. (1999). Functional treatment outcomes in young children with motor speech disorders. In A. Caruso & E. Strand (Eds.), Clinical Management of Motor Speech Disorders in Children (pp. 385-396). New York: Thieme.

Conti-Ramsden, G., & Botting, N. (2004). Social difficulties and victimization in children with SLI at 11 years of age. Journal of Speech, Language, and Hearing Research, 47(1), 145-161.

Dodd, B. (2014). Differential Diagnosis of Pediatric Speech Sound Disorder. Current Developmental Disorders Reports, 1-8.

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, Language, and Hearing Research, 37(6), 1341-1353.

Karmiloff-Smith, A. (2006). The tortuous route from genes to behavior: A neuroconstructivist approach. Cognitive, Affective, & Behavioral Neuroscience, 6(1), 9-17.

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.

Snowling, J., John, W., Adams, D., Bishop, S., & Stothard, M. (2001). Educational attainments of school leavers with a preschool history of speech-language impairments. International Journal of Language & Communication Disorders, 36(2), 173-183.

Terband, H., Maassen, B., & Maas, E. (2016a). Klinisch forum: Een procesgerichte aanpak van differentiaaldiagnose en therapieplanning bij spraakontwikkelingsstoornissen. Stem-, Spraak-en Taalpathologie, 21, 1-31.

Terband, H., Maassen, B., & Maas, E. (2016b). Toward a model of pediatric speech sound disorders (SSD) for differential diagnosis and therapy planning. In P. Van Lieshout, B. Maassen, & H. Terband (Eds.), Speech Motor Control in normal and disordered speech: Future developments in theory and methodology. Rockville, MD: ASHA.

Van Daal, J., Verhoeven, L., & Van Balkom, H. (2007). Behaviour problems in children with language impairment. Journal of Child Psychology and Psychiatry, 48(11), 1139-1147.

Waring, R., & Knight, R. (2013). How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems. International Journal of Language & Communication Disorders, 48(1), 25-40.

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