Rocky Boy Health Center Prevention Department Articulation & Phonological Disorders

Today Martha Hardwick, Rocky Boy Health Center Speech-Language Pathologist discusses articulation and phonological disorders. An articulation disorder involves difficulty physically producing specific speech sounds correctly (such as substituting or distorting sounds), while a phonological disorder involves patterns of sound errors where a person simplifies speech in ways that affect entire groups of sounds (such as consistently omitting final consonants). 

Transcript

SPEAKER_00 0:01

Good morning and good afternoon to all our listeners in the area. This is Mike Gibo with the Rocky Boy Health Center Prevention Department podcast. Today our special guest is Martha Hardwick, speech language pathologist. And we are going to be talking about a topic, and I'll let her introduce herself and bring up the topic.

SPEAKER_01 0:22

Good morning. My name is Martha Hardwick, and I'm happy to be here today to discuss articulation disorders with children and also phonological process and the difference between the two and how they impact on reading and how important it is to get early intervention for the children. So here we go, Mike. So I'm sure you're wondering what is an articulation disorder? Well, that's a motor-based difficulty, and it's difficult producing sounds. I get children all the time who can't say a, instead of saying an L like little, they'll say a W, whittle, Whittle, like that. Or if they can't say the K or G sound, they say a T or D, so they'll say OT instead of OK.

SPEAKER_00 1:25

And of course now I say OT to everybody, but but so when you say uh motor base, that means like with the tongue, the teeth, the uh palate, lips, lungs and lips.

SPEAKER_01 1:38

Yes, all coordinated effort. And it's really difficult. Now I have one child that has a cleft palate, cleft lip. So she's going to have difficulty with plosives. For example, P and M. And uh some of the W sounds, it depends on where it is in the word. And also she has phonal the child has phonological process. So the child will say ote instead of okay. And in that instance, we use lollipops. It's always fun to come to my office, and then they have to learn how to push the lollipop up, and then we get the sound. So that's that's what that's all about. A phonological process really can impact on reading. And that's well, I was talking about that earlier. W for L and T and G for T and D for G and K sounds. Um with the let's go back to the articulation process. Um with a lot of children, you'll hear them say wabbit for rabbit, and that's a substitution. And some children will have it in all of those sounds. Uh, this can be a due to a variety of things, but children who have a lot of ear infections early on are going to have difficulty with speech. Some don't, but quite a few do. And that is because the Eustacean tube, which runs from the ear, the middle ear, to the nose. If a child has a runny nose that's green and goopy, odds are they have an infection. So um it's important to take them to the doctor and get them checked out. I had one recently that green, goopy nose, of course, then I got sick with a cold, which I have now, but um they um took, they took my advice, took them to the emergency, and the child had upper respiratory, so they got them on moxicillin. But if it had been an ear infection, my rule of thumb is if they have three in a year, get the tubes in the eardrum. Just do it automatically because the fluid lasts in the middle ear for up to two months. So just think of a child who's three and is just learning how to speak. They have two months where they can't hear anything. And it really impacts on their sound productions and language and sentence structure. It it all is breaks down. Some of these children appear to be autistic, but they're not. They um they don't they appear to be, but you have to kind of rule that out that they're not autistic, because that's a different category.

SPEAKER_00 4:46

Okay. And then what age would you first start seeing articulation disorders?

SPEAKER_01 4:52

I've started children as early as two and three.

SPEAKER_00 4:57

As soon as they're able to talk then?

SPEAKER_01 4:58

Yes. You can pick it out almost pretty qu quickly. And then I have children who are five, six, seven, and eight who have articulation disorders. And um, we work on reading as well. Um, other types of sound disorders are omissions. That's where we omit the sounds. So instead of cat, we might say at. So that's confusing to the listener and also to the child. So they have to learn how to put that c sound in the front. And they you usually that if the child sees how it's written, these children are generally normal and they're sometimes very bright. If they once they see it, they can go, oh, that's what that is. And then teach them how to say the sound. And another one is a distortion. So I hear this often. We don't have a lot of this here on the reservation, but I've seen it in other populations where a child has what's called a lisp, and that's sort of a mechanical problem. Um, but they'll say fip for ship. FIP for ship. So the THs are all off. Um they uh they j they and if if you can just imagine a child not being able to say a sound, and then they look at they're trying to learn to read, and they see um an S H I P, but it sounds to them like thip, they're they're gonna really have trouble. So it's important. Also, another one is an addition, and I see this a lot. I saw this a lot yesterday. So poly, polay for play, and you see a lot of an additional. I uh this one child was doing a lot of vowel sounds included in the word. So I had the listener has no idea what they're saying.

SPEAKER_00 7:10

So it's pretty many uh additional consonants?

SPEAKER_01 7:14

Yes, and so that's articulation, the phonological process I find fascinating. I always have, I've always enjoyed it. Um, and it's fun to help. There's um clusters of sounds where they'll say piter instead of spider. Again, this impacts on reading. So when we're testing a child, it's really important to figure out what they're doing. Sometimes they'll delete the final sound. So instead of cat, they'll say cat. And uh instead of spider, they'll say spida. Or sometimes just not say it at all. And then an additional one is stopping, where they will replace a long flowing sound with a stop sound. For example, pun for sun. And once they realize that pun's a totally different word, but you have to show them. Um, I actually like them to draw their ideas and sketch their ideas and play around with it a little bit so they'll see the difference between the words. Once they see it, they can do it.

SPEAKER_00 8:31

So the phonological articular phonological disorders is more of a is that language-based versus motor-based?

SPEAKER_01 8:41

It's language-based, that's right. So it's up, it's up in the brain. So the brain is giving different signals to the mouth. And the mouth just does what it wants to do. And it's not picking up on the signals. So we have to train that so that they understand what that's going to be. Um so again, remember motor and which is physical. Now, children with autism, a lot of the times we see motor planning. So they they really can't say the sound. It's very difficult for them. So it's important to kind of kind of figure out and give them give them tricks so that they can say things correctly. Um, I have one little friend that I think of often who is sound productions are so inconsistent, you never know. Sometimes you'll say ship, and sometimes you'll say say thip. It it just depends, or sometimes you'll say ship, you know. So it depends on the mood of the day, I guess.

SPEAKER_00 9:54

So your your interventions are just different ones where the like you said, you can have them draw, draw out things, and so you just have different types of uh ways to engage with them.

SPEAKER_01 10:04

Yes, and then you can work on single sounds. It's nice having the iPad in the therapy because then I can pick out stuff. And all the children love the iPad. I've got quite a few little things that they can play. One is called Reading Rainbow or Skybrary, which is La Bar Burton. I love that whole thing because it takes children right through their ages and books. And I also use the magic of stories, which is lovely because it shows the children how to what language is all about, how they can show differences in the same and do Venn diagrams, and even when they're in kindergarten, it's it's important to do some of this stuff. And then you can incorporate mathematical skills like geometry into some of this stuff too. So it's really helpful. I love the magic of stories. I use that for my dissertation. It was um really good. Uh all of my dissertation was on reading and um how we how we how we read with how how we need to read, how important it is to do narrative language and teach the children what the words really mean. Very different from when what we learned. How did you do you remember how you learned to read?

SPEAKER_00 11:28

I think just probably from being in uh class, about you know, going to Head Start and then kindergarten and you know, just all the ways that they teach. And I think like you're saying, you know, being able to see it at the same time as they're teaching it so that it's making a connection because is there like a do you have to rule out hearing issues or phonological disorder?

SPEAKER_01 11:51

That's a good question. Yes, always. And if a child has a history of ear hearing ear infections, make sure that they get seen by an audiologist that's a specialist in uh hearing. And then they can decide whether it's permanent or whether we need to intervene. What do we need to do? Do they need tubes? But I it is it's important to have the hearing checked. And they do check here. Do you remember getting your hearing checked?

SPEAKER_00 12:20

Do they do screenings?

SPEAKER_01 12:21

Yes. Yeah.

SPEAKER_00 12:22

I remember that very um I tell you when you hear the beep, you raise your hand.

SPEAKER_01 12:26

Yeah, you raise your hand. It's red, right. The the earphones are one is red and one in red is right, and the blue is left. So that's the way to remember red, right, round is how you have to rememorize it. Um it's hard to say say that altogether. Um it's a lot of these, a lot of speech therapists will see children in groups, and I think in the latter part of their treatment, once they establish the sound and they're getting it in words and then they need to go to the next level, like conversation. I think the groups are really important. But I think initially, just individually, is just the key to getting these children better, making sure it's fun. I think with the motor planning, it's important to also incorporate some of the um oral motor exercises that will help them. I have one child with a cleft palate, and we use blowing exercises a lot because it's hard for the child to get the back sound.

SPEAKER_00 13:40

And so when they have a cleft palate condition, do they eventually get surgery, or is it uh is that the solution?

SPEAKER_01 13:48

Yeah, usually by the time they're about seven, they've had maybe 30 surgeries. Um and then at seven, they have to wait for the growth plates to catch up and then they'll work on their noses, and it's very extensive. Um I I'm very fortunate I belong to the American Cleft Palette Association. And we've done a lot of work in identifying because these children, once once they got older, would have a lot of issues as far as friends, and they're so different, but they're not. They're they're usually normal and above normal. It was generally, generally, clepal cleflip is caused by lack of folic acid in the first trimester of pregnancy. Okay. So I worked on um a process on denaination. Uh, we did this study, oh gosh, it was a long time ago, maybe 20 years ago, where we met with medicine men. We wanted to make sure that the young girls got on folic acid, because many of them were getting pregnant, and we wanted it to be prior to, and they needed to take their vitamins all the way through. And so once that happened, then we were able to get rid of the the cleft palate, cleft lip. And it's I I rarely hear of any cases on denination. So maybe it's something we need to look at here.

SPEAKER_00 15:24

So is folic acid uh they would just take it as an I don't know, side effects or like as a supplement?

SPEAKER_01 15:31

Folic acid can come in food, and it can also come in in supplements. So in food, it's green chili and the uh pitto beans, the tortillas, those are loaded with folic acid corn. Um, so the three sisters, for example, the corn and the squash and the green chili. That's a real good shot of folic acid.

SPEAKER_00 16:01

Yeah, they probably get a lot of that in the southwest.

SPEAKER_01 16:03

Yeah, oh yeah, it's a big deal. Yeah, called visitus. Yeah, I make that all the time in the summer. It's so good. Yeah. I want to plant some in my I can't grow anything in the backyard, but I can get those buckets and barrels and just grow some. I'd like to try and get some corn going on and some squash, maybe. Um I don't have a green thumb, my thumb's black, but we'll give it a try. So folic acid is really important. So make sure that uh you you take your vitamins that have folic acid in them when you're going to have a baby. This the cleft palate happens in the first trimester.

SPEAKER_00 16:50

So first three months?

SPEAKER_01 16:52

Yeah, just when they're developing. And it's important not to drink alcohol or do drugs or anything. That's really critical, actually. But back to articulation uh and phonological process. This is called a speech sound disorder. And we see it a lot when the children are small. And then in adults, we'll see it with adults who have uh had a stroke, or I have adults who've who are adults but have autism, or adults who have some sort of neurological deficit of some sort. So you'll see the articulation process. In the older um the older people that I see, often we have things like cluttering or stuttering. That's another that actually is an articulation disorder, stuttering. Stuttering. And cluttering, yeah. It's motor planning and um you see the motor planning also in children with autism. Um not all of the children, but quite a few.

SPEAKER_00 18:12

So they might be affected by traumatic brain injury or stroke, you said?

SPEAKER_01 18:16

Yes, I have one adult with a traumatic brain injury uh who speaks very rapidly, and we're just trying to get slowed down a little bit so that we can understand what's going on and kind of give them things that they can use in their daily lives that will make things a little bit easier. Um, so the adults have problems as well. It's important with adults. I it's interesting. I had one of my adults that I took to division of vocational rehabilitation over at the senior center, and I just found out it was there just a couple of month uh weeks ago. So I want to get this person in to, and the um the person's family member just said he doesn't need speech, and I said, Well, it's a little more than speech, it's memory and you know how we do our day and uh showering, taking brushing your teeth and things like that. It's a little more than than just speech. Generally, when I see a child, I have I have the little ones I can see up to three times a week. And then um I do the teletherapy with them. They they love getting a phone call from me. They absolutely love it. It wasn't a while that they'll say, I'm I'm too tired, and it's okay, you know. I want to play with Pokemon or something. But generally they're pretty excited about hearing from us. So it's it's a really good impact. Um we like to emphasize that children should receive therapy before they're six and at least twice likely to if I can see them early enough, they're likely to overcome all of this by the time they start school. So I have some that I know that will be graduating this summer from speech therapy.

unknown 20:32

Oh, nice.

SPEAKER_01 20:32

Yeah, and they'll start first grade and they'll be just like everybody else. And they won't want to be pulled out. That's been another comment that the children hate to be pulled out because it it pinpoints them. It makes them stand out that they're different.

SPEAKER_00 20:49

Are the kids wonder why?

SPEAKER_01 20:51

Yes, wonder why. Want to know why? I um I used to work in the schools in Baltimore, and I always w pushed into the classroom. With ch some children, they needed individual therapy, but I like to push ins where we teach everybody. And so nobody knows who's being treated. And yeah, it's so it's it's kind of fun, and everybody gets to do the process, and it's really fun. I use the magic of stories and book literature based so that we get an example of things to do, and that the I always talk with the teachers. It's important to share that.

SPEAKER_00 21:30

That's a good way to uh make it so it's uh unobtrusive or where they don't know.

SPEAKER_01 21:35

Yes, that's right, exactly. Do you have any questions?

SPEAKER_00 21:41

Uh you know, I think um just I I know we mentioned a little bit about when a person comes in that um it's good for them to have a plan of can coming in for a certain number of sessions and to keep that going so that they could get some something out of it after their evaluation.

SPEAKER_01 21:59

But yeah, you can't I I can't do anything if I see a child every four months. And that happens sometimes. I have several that, you know, all of a sudden they'll pop up on my schedule. It's like, why weren't we bringing them in weekly? I can call you. I can do all kinds of things to help you out. We can s I can send you emails, uh all kinds of things. But um I I try everything to get people to come in. Um, but we still get a lot of the no-shows. Uh and that's pretty pervasive throughout the clinic, is a lot of the no-shows. Um I wanted to talk a little bit some percentages. Um it's estimated that 3.6% of eight-year-olds in the country have some sort of speech sound disorder. So it means what that means is that they've been having therapy. Excuse me. And uh if the younger they are, the better it is. I'm sorry, I'm getting over a cold and it hasn't been fun. Um so it's important that they get early intervention services.

SPEAKER_00 23:23

Yeah. So if they're they're not able to prevent it, you can just work with it if you with treatment to prevent it from getting worse?

SPEAKER_01 23:34

That's right. Or preventing it from not getting better. And um and the children, it's play-based therapy, a lot of play-based therapy. So a lot of the parents think that we're not really doing something, but we are. And it's important that the children um enjoy what they're doing and they're not frightened or scared. We sing a lot and make that fun. Yeah, make it fun. Um, I've got some little children I'm gonna see today, and I have puzzles and bubbles and all kinds of things.

SPEAKER_00 24:11

Nice. So articulation disorder and phonological disorder we talked about today. Yes. And and those are um, you know, for kids that are after they're developing language, uh, you can start to uh identify it and before they get to school, they can you can work with them in sessions and come to a resolution or some reach some goals where they can graduate. I heard you mention they can graduate.

SPEAKER_01 24:39

I've got several that I know are gonna graduate this summer. They're they're ready. You know, they're making extraordinary progress. These are children who couldn't say hardly anything, and um, once they figure out what that word means, they can do it. And I it's lovely when you hear a child who couldn't say anything asking you, what are we doing today? Clearly and distinctly, it's like, wow, it's time to graduate, let's go.

SPEAKER_00 25:07

Yeah, I've I haven't I'm not in the schools, and so I don't know about like all the things that you're talking about. So it's good to hear how they can get better and how they can get services and find places to get support.

SPEAKER_01 25:20

Thank you for having me today.

SPEAKER_00 25:23

Thanks for coming in.

SPEAKER_01 25:24

Okay, thank you for having me. Next week we're doing language.

SPEAKER_00 25:27

Okay.

unknown 25:28

Okay.