A recent survey of 759 UK speech and language therapists (SLTs) showed that 74.9% used transcription in their clinical role. However, 41% only used broad transcription, with those not using narrow transcription attributing this to lack of confidence. The majority (79.5%) had never attended a refresher course (Knight et al., 2018).
Why does this matter? Apart from the obvious requirements for SLTs to transcribe speech as part of their professional competency, meeting Health & Care Professional standards (HCPC, 2014), accurate diagnosis and the appropriate selection of intervention relies on accurate transcription and evidence-based decision-making (UK and Ireland’s Child Speech Disorder Research Network, 2017).
Both adult and children present with speech sound disorder (SSD). SSD may be idiopathic (no known cause), or associated with a wide range of congenital, developmental, or acquired conditions.
Adults with acquired speech disorders may present with dysarthria, dyspraxia, or voice disorders. Supra segmental features such as voice quality and intonation patterns are often disrupted. It is important to include transcription of these aspects in any assessment of speech.
For those working with children and young people, speech difficulties are the most commonly encountered problem. Broomfield and Dodd (2004) reported that 29.1% of referred children had speech difficulties.
SLTs are familiar with parent and carer interviews (“case history taking”), and carrying out single word naming assessments. How many speech and language therapists are unaware of the pitfalls of using a limited speech sample? Or that connected speech is an essential component of speech sound transcription? Or that failure to examine the vocal tract may lead to an incorrect diagnosis?
Screening assessments don’t always systematically differentiate between articulation and phonological disorders, and many fail to elicit a word list on two or more occasions, potentially misdiagnosing inconsistent phonological disorder (IPD). This is concerning, since almost one in ten referrals will present with IPD (9.4% of children, Broomfield & Dodd, 2004). Some screens don’t encourage word transcription, perhaps leading to uncertainty due to lack of transcription practise when a rare case of vowel distortion is encountered. All these shortcomings make using a screen, rather than a full assessment, a false economy.
A speech systems examination, although challenging in today’s COVID-19 world, is an essential aspect of assessment. Differentiating a sub-mucous cleft palate, or velopharnygeal dysfunction from a phonological disorder is essential for selecting the appropriate intervention.
Awareness of syllable segmentation and describing word structure is also key to planning therapy. Is it “ze-bra” or “zeb-ra”? If you acknowledge the existence of syllables, then it is contradictory to discuss “word medial” segments. Are you familiar with the maximum onset principle (Smith & Pitt, 1999) and terms such as within word, syllable final and within word, syllable initial?
Transcribing speech involves deciding if there is an error, or dialectal/accentual variation, as well as describing that error. You may be familiar with some accents that replace /t/ with a glottal stop within word, or word-final, and Liverpudlians using a voiceless palatal fricative as an allophone of /k/ word final in words such as “week”.
Each sound (phone) may be described in terms of VOICE, MANNER and PLACE. After this, the phone’s significance as a phoneme, indicating meaning within words or a distortion or error caused by the physical production process should be established. Stimulability assessment and analysis within words in different word positions is important here, as well as comparing and contrasting the phone’s distribution in the child’s speech sound system.
Co-morbidity, or co-occurrence of language disorder is very frequent. A child who cannot understand adjectives such as “loud”, “quiet” and prepositions such as “front” and “back” will find phonological awareness tasks impossible. A child who has a restricted vocabulary, possibly due to deprivation will find it difficult to trigger phoneme selection from the semantic system. Broomfield & Dodd (2004) found that over a third of children with SSD also has expressive language difficulties and over half had vocabulary difficulties. A language assessment, including vocabulary assessment, is therefore crucial for any child presenting with SSD.
Knowing the phonemes of English are not sufficient for the SLT working in the UK. For bilingual children, an articulation disorder will be evident in the child’s home language and English. However, for phonological errors, the apparently same phoneme can be affected differently in each language. This is because the two phonological systems are thought to be separate. Children must therefore be assessed in both languages, and intervention target errors in each language independently; generalisation across two or more languages is not likely (Holm & Dodd, 2001). Of course, languages have their own phonological systems and sounds produced may be unfamiliar to English speakers. Royal College of Speech and Language Therapists’ (RCSLT’s) clinical guidelines state that “Any assessment of a bilingual child’s speech must include assessment of both languages. Due to the presence of two phonological systems, one for each language, assessment of one language will not necessarily identify all the errors present in the other language.” (2019).
Transcribing speech is itself a form of analysis. This involves not only listening, but looking as well. “…auditory perception alone may be insufficient for noticing fine phonetic details.” (Stemberger, 2020: 79).
Analysis should examine the child’s phonological system of contrasts, including consideration of distribution by word position. Phonology is the interface between language and speech, and describing the child’s system is central to devising effective, evidence-based therapy.
Modern interventions differentiate between children’s presenting speech sound disorder, and target the underlying deficit. Traditional approaches build complexity, establishing competency at each level, such as blending consonants to vowels (CV) and then into consonant+vowel+consonant (CVC) proposed by Van Riper (1963, 1978). These approaches appear to be helpful for articulation errors where distortion or inability to physically produce the phone is the main feature of the speech error. However, for the vast majority of children with phonological delay or consistent disorder, other approaches are considered more effective. A sequence of interventions may be required, where a child has articulatory disorder with phonological implications.
Modern approaches often combine a range of techniques, based on meaning and mapping the child’s sound system to word meaning. Each approach has a different emphasis and have been systematically evaluated. These modern approaches have been available for many years, including the Meaningful Minimal Pairs (Weiner, 1981; Blache & Parsons, 1980), and the Cycles Approach (Hodson et al., 1983). Regardless of intervention employed, the frequency and intensity may be more important to client outcomes (Allen, 2013).
Are you aware of the range of therapy interventions available, and the impact of rationing caused by the six week block widely used in the UK, making much intervention diluted or even insignificant (Allen, 2013)?
Speech Courses Available at Course Beetle
Course Beetle offers courses to update speech and language therapists and other professionals working with speech sound disorder. They include:
- Speech Transcription Refresher Workshop
- Speech: Assessment and Therapy in Practice
- Nuffield Dyspraxia Programme
- Bilingual Children with Speech and Language Difficulties
Allen, M. M. (2013). Intervention Efficacy and Intensity for Children With Speech Sound Disorder. Journal of Speech, Language and Hearing Research 56(3), 865-877. doi:10.1044/1092-4388(2012/11-0076)
Blache, S.E. and Parsons, C.L. (1980). A linguistic approach to distinctive nature training. Language, Speech, and Hearing Services in Schools, 11, 203-207.
Broomfield, J., and Dodd, B. (2004). Children with speech and language disability: caseload characteristics. International Journal of Language & Communication Disorders, 39(3), 303-324. doi:10.1080/13682820310001625589
Health & Care Professions Council (2014). The standards of proficiency for speech and language therapists. London: Health & Care Professions Council. Retrieved from https://www.hcpc-uk.org/standards/standards-of-proficiency/speech-and-language-therapists/
Hodson, B., Chin, L., Redmond, B., and Simpson, R. (1983). Phonological evaluation and remediation of deviations of a child with a repaired cleft palate: A case study. Journal of Speech and Hearing Disorders, 48, 93–98.
Holm, A., and Dodd, B. (2001). Comparison of cross-language generalisation following speech therapy. Folia Phoniatrica et Logopaedica, 53(3), 166-172. doi:10.1159/000052671
Knight, R. A., Bandali, C., Woodhead, C., and Vansadia, P. (2018). Clinicians’ views of the training, use and maintenance of phonetic transcription in speech and language therapy. International Journal of Language & Communication Disorders, 53(4), 776-787. doi:10.1111/1460-6984.12381
Pert, S. And Bradley, B. (2019). Clinical Guidelines – Bilingualism. London: Royal College of Speech and Language Therapists. Retrieved from https://www.rcslt.org/members/clinical-guidance/bilingualism
Smith, K. L., and Pitt, M. A. (1999). Phonological and Morphological Influences in the Syllabification of Spoken Words. Journal of Memory and Language, 41(2), 199-222. doi:10.1006/jmla.1999.2646
Stemberger, J. P., and Bernhardt, B. M. (2020). Phonetic Transcription for Speech-Language Pathology in the 21st Century. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP), 72(2), 75-83. doi:10.1159/000500701
UK and Ireland’s Child Speech Disorder Research Network (authors). 2017. Good Practice Guidelines for the Analysis of Child Speech. London: Royal College of Speech and Language Therapists. Retrieved from https://www.rcslt.org/-/media/Project/RCSLT/good-practice-guidelines-for-speech-transcription-2nd-edition.pdf
Van Riper, C. (1978). Speech correction: Principles and methods. Upper Saddle River, NJ: Prentice-Hall.
Van Riper, C. (1963). Speech correction: Principles and methods. Upper Saddle River, NJ: Prentice-Hall.
Weiner, F. (1981). Treatment of phonological disability using the method of meaningful minimal contrasts: Two case studies. Journal of Speech and Hearing Disorders, 46, 97-103.