The ICF a framework for setting goals for children with speech impairment.pdf

The ICF a framework for setting goals forchildren with speech impairment

Sharynne McLeodSchool of Teacher Education Charles Sturt University Bathurst NSWAustralia

and

Ken BleileDepartment of Communicative Disorders University of Northern IowaCedar Falls Iowa USA

Abstract

The International Classification of Functioning Disability and Health (ICF)

(World Health Organization 2001) is proposed as a framework for integrative

goal setting for children with speech impairment The ICF incorporates both

impairment and social factors to consider when selecting appropriate goals to

bring about change in the lives of children with speech impairment Speech-

language therapists and teachers can work together not only to provide direct

intervention with the child but also to work in partnership with the childrsquos

family friends school and society

Children with speech impairment constitute one of the largest groups of

children with a communication difficulty (Harasty and Reed 1994) Difficulty

producing sounds as preschoolers may have influence on their subsequent

educational occupational and social opportunities throughout life (Felsenfeld

et al 1992 1994) Thus it is essential that careful planning occurs to ensure

that the goals set for these children and their families facilitate successful life-

long communication The aim of this paper is to provide speech-language

therapists (SLTs) and teachers with a meta-theory to scaffold their daily

decision making regarding children with speech impairment

Traditionally SLTs and teachers in special education have relied on an

impairment-based model of decision making The origins of the impairment

model may be attributed to the medical and behavioural origins of the professions

Address for correspondence Sharynne McLeod School of Teacher Education Charles Sturt UniversityPanorama Ave Bathurst NSW 2795 Australia E-mail smcleodcsueduau

Arnold 2004 101191=0265659004ct272oa

Child Language Teaching and Therapy 203 (2004) pp 199ndash219

According to Duchan (2001a 37) proponents of the impairment view lsquopresume

that the communication problem is in the client and that it can be remedied by

providing the client with missing knowledge or processing skillsrsquo Thus follow-

ing the impairment-based model childrenrsquos speech is assessed according to

standardized assessment tools their production of speech sounds is compared

with available norms and decisions regarding the existence and=or extent

of impairment are made Subsequent impairment-based goals could include

increasing speech sounds within a childrsquos repertoire decreasing the occurrence of

cluster reduction or expanding the syllable shapes used by the child The

impairment-based model relies heavily on the expertise of the lsquoprofessionalrsquo

(in this case the SLT) who typically conducts the assessments and analyses and

determines goals based on areas of impairment The family and teachers have less

input into the goal setting in the impairment-based model (Reynolds 1984)

Alternatively many teachers and some SLTs have adopted a social model of

decision making In the social model lsquo therapy plans centre around selected

life goals and what needs to be done to achieve them (and) emphasize the

communicative impact of the clientrsquos differences rather than the clientrsquos

deficitsrsquo (Duchan 2001a 38 39) Some proponents of the social model

also present disability as a part of life and the source of the problem as a

society that is not inclusive of people with disability (Hersh 1999 Jordan and

Kaiser 1996) A social model of goal setting validates and necessitates

extensive support from the family teachers and the children themselves as

the lsquoexpertsrsquo Thus the role of the teacher and SLT is to facilitate the dialogue

toward the development of socially appropriate goals For example the SLT

might ask about events that made the child feel lsquoparticularly good and

particularly badrsquo during the current school year (Nelson 1989 176) and use

these critical incidents as a framework for identification of relevant goals

Both impairment and social models can be valid (for an insightful debate see

the Clinical Forum led by Duchan 2001a) A meta-theory that draws on both the

impairment and social models has been developed by the World Health

Organization (WHO 2001) The initial version (WHO 1980) was grounded

in a medical (impairment) model and used the terms impairment disability and

handicap The final version integrated impairment and social models to describe

the health and health-related status of all people and is called The International

Classification of Functioning Disability and Health (ICF) (WHO 2001)

There are two parts to the ICF Table 1 illustrates the interactions between the

parts and components of the ICF Part I is titled lsquoFunctioning and disabilityrsquo and

describes health from the perspectives of the body the individual and society

and includes the components of body structures body functions activities and

participation Body structures refer to the anatomical parts of the body such as

200 Child Language Teaching and Therapy

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The ICF as a goal-setting framework 201

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mdashmdash


the nose mouth pharynx and larynx Body functions describes lsquothe physiolo-

gical functions of body systemsrsquo (WHO 2001 10) Included in the category of

body functions are lsquovoice functionsrsquo such as production and quality of voice

lsquospeech functionsrsquo including the articulation of phonemes and lsquomental func-

tions of languagersquo including expression of spoken language Activity is lsquothe

execution of a task by an individualrsquo (WHO 2001 10) and participation

describes the involvement in a life situation Thus under the heading of activity

and participation communication in its many forms is included as an entire

chapter within the ICF (chapter 3) Some of the highlighted aspects of

communication include lsquoCommunicating with ndash receiving ndash spoken messagesrsquo

lsquospeakingrsquo and lsquoconversationrsquo Other relevant categories of activity and

participation include learning and applying knowledge (chapter 1) such as

lsquolearning to readrsquo and lsquolearning to writersquo Additionally activities and participa-

tion include interpersonal interactions and relationships (chapter 7) major life

areas such as preschool education (chapter 8) and community social and civic

life (chapter 9) Finally the term disability lsquoserves as an umbrella term for

impairments activity limitation and participation restrictionsrsquo (WHO 2001 3)

Part 2 of the ICF is titled lsquoContextual factorsrsquo and includes environmental and

personal factors (see Table 1) Environmental factors lsquomake up the physical

social and attitudinal environment in which people live and conduct their livesrsquo

(WHO 2001 10) and can be facilitators or barriers Environmental factors

relevant to communication include products and technology (chapter 1) support

and relationships (chapter 3) attitudes (chapter 4) services systems and policies

(chapter 5) Personal factors include the attributes of the person and the internal

influences on functioning and disability Due to the individuality of this WHO

component personal factors are not specified as chapters within the ICF

Within the field of communication disorders there has been some use of the

ICF (and its predecessors) as a meta-theory for practice (for example American

Speech-Language-Hearing Association 2001 Threats 2000 2001 Worrall

1999 2001) The application of the ICF (and its predecessors) has particularly

occurred within the context of SLTs working with adults who have dementia

experienced a stroke or acquired brain injury (for example Bourgeois 1998

Hersh 1999 Worrall 1999) with adults who have voice disorders (Ma and Yiu

2001a 2001b) including those who use alaryngeal speech (Eadie 2003) There

have also been some descriptions of the use of a social model of interaction in

speech and language practice with children (for example Duchan 2001a 2001b

Kovarsky 2001 Locke 2000) but limited direct application of the ICF to the

consideration of the speech of children The exception is the excellent work by

Hodge (1983) who applied the original 1980 version of the WHO model to

assessment and intervention practices with a child who had a speech impairment


In order to explore the application of the ICF to child language teaching and

therapy each of the parts and components of the ICF will be discussed with

relation to childrenrsquos speech production Table 1 lists each of the parts and

components of the ICF and their application to a speech and language assess-

ment in order to inform goal setting Many of these assessments and analyses are

typically included in traditional SLT assessments (see the forum led by Williams

2002) For example oromuscular examinations and audiological assessments are

conducted to assess body structures An SLT assessment of speech sounds and

phonology are conducted to assess body functions However it is less likely that

SLTs consider activity and participation contextual and personal factors

Conversely teachers frequently consider activity and participation of children

Possible methods of evaluating activity and participation include an intelligibility

assessment or by gathering qualitative descriptions of successes and difficulties

in participation in the family school and social situations Determination of

parental wider family and school involvement support attitudes and expecta-

tions comprises evaluation of contextual factors Personal factors can include the

age of the child self-confidence motivation attention cognitive ability beliefs

learning style and experience with communication failure on intervention

Although there is close interrelationship between each of these areas goals

will be suggested for parts and components

Goals targeting functioning and disability

Body structures and functions

Children who are described as having a communication impairment of

(known) origin usually have impaired body structure(s) Impairment of body

structures can include a cleft palate anklyglossia or a malformed cochlea

among other examples Impairment-based goal setting for children with

impaired body structures often includes medical intervention such as surgical

repair of a cleft or a cochlear implant With the advancement of medical

science there is the potential for a decreasing need for extensive speech

intervention for people with impairment of body structures For example

Golding-Kushner (1995 327) has written that lsquoApproximately 80 of

children born with nonsyndromic cleft palate who undergo palate repair by

18 months of age develop speech free from compensatory errors without any

type of therapeutic interventionrsquo A social goal addressing impairment of body

structures could aim to promote societal acceptance of diversity of the

appearance of people For example a popular television show could include

a child who has a craniofacial anomaly in order to promote inclusiveness


Impaired body structure can result in impaired body function For example

a person with a cleft palate may have nasal emission during speech An

impairment-based speech goal could therefore include reduction of audible

nasal emission during the production of high-pressure consonants (stops

fricatives and affricates) (Harding and Grunwell 1998) This may have the

social advantage of being more intelligible and less different or obtrusive

Other more subtle impairments in body structure and function that

influence speech production can be detected via oromusculature examination

(for example Ozanne 1992 Robbins and Klee 1987) with examples of

impaired body structure including tongue-tie and examples of body function

impairment include difficulty on diadochokinesis (rapid speech movement)

tasks Debate exists as to the impact on speech production as a result of these

more subtle impairments of body structure and function Similarly strong

debate surrounds the use of oral-motor exercises to facilitate speech sound

acquisition in children with speech impairment Lof (2003 9) provides a

summary of this debate and concludes the lsquothere is little if any theoretical

philosophical or clinical justification for using oral motor exercises to improve

speech sound production skillsrsquo

Impairments of body structure and function relating to hearing can be

detected via audiological examination such as tympanometry An example of

impairment of body structure is otitis media (glue ear) while an example of

body function impairment is hearing loss Controversy surrounds the inter-

relationship between otitis media (impaired body structure) and speech

perception=production (body function) Shriberg et al (2000a 2000b) has

altered the debate about whether or not otitis media is the cause of speech

impairment to the notion that there is increased risk of speech impairment as a

result of occurrences of otitis media However Campbell et al (2003 353)

found that lsquopersistent otitis media in the first three years of life did not

significantly increase the risk of speech delay after controlling for relevant

covariatesrsquo A social intervention relating to aural body structure and function

differences is the Healthy Little Ears project a health promotion project with

children in Australia (Mid Western Area Health Service 1999) Within this

programme children are encouraged to blow their nose each day to increase

functioning of the eustachian tube and decrease the occurrence of otitis

media

Genetics research has opened new areas of knowledge of impairment at the

micro level of body structure It may be the case that genetic abnormality may

account for children exhibiting impaired body function but previously thought

of as having intact body structures For example Lai et al (2001) described the

FOXP2 gene chromosome 7 as relating to speech apraxia Flipsen et al (2001)


have described acoustic markers that are indicative for genetic studies of

speech impairment The influence of these genetic breakthroughs on goal

setting in speech intervention may include discussion of familial histories

(for example Lewis et al 1989 Lewis and Freebairn 1993) and genetic

counselling Early intervention opportunities may be made for younger family

members of the child referred for speech intervention Early identification

can also lead to intervention opportunities to support academic success

particularly with respect to reading and spelling (Lewis et al 2000)

To date the majority of children who are seen by SLTs have communication

impairments of unknown origin (Shriberg et al 1986) indicating that their

body structure is considered to be intact These children have difficulty with

body functions such as the production of speech sounds Traditional SLT

measures of the speech function of these children have included the array of

articulation=phonology tests such as the Edinburgh Articulation Test (Anthony

et al 1971) and the Computerized Articulation and Phonology Evaluation

System (CAPES) (Masterson and Bernhardt 2002) The range of speech

analyses includes phonological analyses [for example Profile of Phonology

(PROPHthorn ) Long et al 2002] nonlinear analyses (Bernhardt and Stemberger

2000) and psycholinguistic analyses (Stackhouse and Wells 1993) Addition-

ally objective measures including acoustic (for example spectrographic) and

physiological (for example electropalatographic Gibbon 1999) tools are

enabling more accurate description of speech (Ball et al 2001) Children

with speech impairments may receive assessment reports concluding with

impairment-based goals such as to increase the percentage of consonants

correct (PCC) decrease the occurrence of various phonological processes or to

produce a list of phonemes expected but not produced correctly by the child

For children with impaired speech function there has been extensive debate

among SLTs regarding appropriate intervention goals Two dichotomous

approaches to goal selection have been proposed First the most knowledge

method (also called the traditional or developmental approach) and second the

least knowledge method (nontraditional nondevelopmental approach) (Bleile

1995) For the most knowledge method intervention goals differ minimally

from the sounds the child already produces (Elbert and Gierut 1986) That is

sounds or phonological processes are selected as intervention goals because

they are earlier developing stimulable and produced correctly in particular

contextual environments (Bernthal and Bankson 1998) In contrast in the least

knowledge method lsquo treatment targets differ from the childrsquos existing abilities

by multiple featuresrsquo (Elbert and Gierut 1986) Therefore sounds or processes

are selected because they are nonstimulable phonetically more complex have

phonologically marked properties reflect least phonological knowledge as


categorized by inventory constraints (with respect to phonemes) and are later

acquired (Gierut et al 1996) Gierut (1998) provides evidence that treatment

goals are achieved efficiently if children are taught sounds or sound pairs that

are not in a childrsquos pretreatment repertoire and developmentally later-acquired

sounds that are phonetically more complex acoustically undifferentiated and

nonstimulable that is following the least knowledge approach In contrast

Rvachew and Nowak (2001) compared the most knowledge (traditional) and

least knowledge (nontraditional) approaches for 48 children with moderate to

severe phonological disorders The study had four major findings children

made more progress toward acquiring target sounds through a traditional

approach the approaches did not differ in generalization from treated to

untreated sounds children liked both approaches parents were more favourable

to the traditional approach These authors have debated their different inter-

pretations of the outcomes of selecting the traditional and nontraditional

approaches in Morrisette and Gierut (2003) and Rvachew and Nowak (2003)

However Williams (2003) adds another dimension to this debate in her helpful

overview and discussion of five approaches to target selection As well as

the traditional and nontraditional approaches she includes markedness the

systemic function of sounds within a given sound system contrastive sounds

and lexical properties of treatment words She concludes by advocating more

research that addresses the impact of additive relationships between these

different approaches

Some questions following on from these approaches to impairment-based

goal selection by SLTs include the following Should treatment goals include

sounds for which the child is not stimulable (Powell 2003) Do children learn

sounds that are stimulable without having to be taught (Elbert and Gierut

1986 Powell and Miccio 1996) Should treatment goals target later-acquired

sounds Does teaching later-acquired sounds facilitate linguistic generaliza-

tion more readily than teaching earlier-acquired ones (Gierut 1998 Rvachew

and Nowak 2001) Although these questions need to be asked it is not

possible to predict with certainty what the most appropriate goal is for an

individual child In order to appropriately answer questions such as these

SLTs need to add to their impairment-based approach focusing on body

structures and functions The ICF provides additional areas of consideration to

enable appropriate goal setting for each individual

Activities and participation

The ICF model specifies consideration of activities and participation in

facilitating health and well-being Some that have relevance to children with


speech impairment include speaking conversation learning and applying

knowledge interpersonal interactions and relationships community social

and civic life Each of these will be addressed with relation to children with

speech impairment

Within the last decade SLTs have appropriated measures of activity and

participation that consider (to some extent) the social impact of speaking and

conversation One measure of activity that has been formalized as an assess-

ment practice is the level of intelligibility (Bleile 1995 Kent et al 1994

Kwiatkowski and Shriberg 1992) The Childrenrsquos Speech Intelligibility

Measure (Wilcox and Morris 1999) is one commercially available sampling

tool to quantify the extent of intelligibility of individual childrenrsquos speech by

untrained listeners There are few examples of ways in which SLTs consider

participation within speaking and conversation by children with speech

impairment One example is the Therapy Outcomes Measure (Enderby and

John 1997) which includes a specific subsection on childrenrsquos speech

Consideration of activities and participation also includes the influence of

the impairment on learning and applying knowledge With the high co-

occurrence of children with speech impairments having reading and spelling

difficulties (Larrivee and Catts 1999) it is essential that goals are developed

around the facilitation of academic skills (Hodson 1994) Intervention

targeting phonological awareness should accompany speech intervention

(Gillon 2000) Partnerships between teachers and SLTs are essential for

appropriate goal setting to facilitate successful oral and literate communicative

skills throughout the lives of these children

Further SLTs and teachers can consider interpersonal interactions and

relationships in their intervention planning for children with speech impair-

ment Pertinent social assessment practices may consist of a discussion with

the child his=her parents siblings friends grandparents and other significant

people to ascertain social goals and barriers interests and hopes (Duchan

2001a) Pretty (1995) suggested a number of goals congruent with a social

model for a four-year old girl with severe speech impairment The goals

focused on the interpersonal interactions and relationships with her family

teacher friends peers and peersrsquo parents For example the teacher and SLT

collaborated to promote communicative success at preschool including

strategies to repair communication breakdowns encouraging a group of her

peers to ask for repetition when they did not understand BJ or to ask BJ to

lsquoshow mersquo BJrsquos family were encouraged to look at her when she spoke to them

use all available cues (for example maintaining a diary of significant events

that she may want to communicate) and keep a list of BJrsquos pronunciations of

important words (for example the name of her best friend) These goals based


on activity and participation can readily be adapted for any child with a speech

impairment

Finally consideration of community social and civic life of children with

speech impairment is rarely discussed However there is scope for socially

based intervention goals to facilitate activity and participation in this context

Friends can be encouraged to spend time talking and babbling with a baby

who has a craniofacial anomaly in order to develop social interactions despite

the fact that the child may look different and have reduced time for social

interaction due to the extensive amount of time spent feeding Another

example of a social goal for people with a hearing impairment would consist

of public education to decrease background noise and to encourage people to

look at a person with a hearing impairment while talking with them

When considering activity and participation the ICF allows for comparison

between performance and capacity There may be a mismatch between a

childrsquos performance within their daily lives and their communicative capacity

on standardized speech assessment tools At times children are more capable

within the confines of a standardized assessment than they demonstrate within

the complex communicative demands of the classroom At other times

children exhibit a variety of compensatory strategies to minimize commu-

nicative difficulty that is evident on standardized assessment tasks Considera-

tion of performance and capacity is an important component within the

capability focus model described by Kwiatkowski and Shriberg (1993

1998) who have successfully tested this with hundreds of children who

have received speech intervention Even while undertaking standardized

assessment tools there may be a mismatch between performance on one

versus another demonstrating the mismatch between performance and capa-

city Some areas of difference include single word versus connected speech

(McLeod et al 1994 Morrison and Shriberg 1992) imitated versus sponta-

neous speech (Leonard et al 1978) stimulable versus nonstimulable sounds

(Powell and Miccio 1996) monosyllabic versus polysyllabic words (James et

al 2002) The difference between a childrsquos communicative performance and

capacity should be considered when developing appropriate goals

Contextual factors

Environmental factors

Some of the environmental factors mentioned by WHO that relate to children

with speech impairment include products and technology support and

relationships attitudes and services systems and policies


There is a burgeoning industry of products and technology utilizing speech-

activated devices for tasks such as computer operation word processing home

banking navigation and telephone directory assistance Intelligible speech is

essential for the use of speech-activated devices and can place restrictions on

the lives of adults who have residual speech impairments (Griffin et al 2001)

While children with speech impairment currently are not affected by this

technology if intelligible speech is not achieved by adulthood incorporation

within future society may be limited Further with the advances of technology

it is possible that speech-activated devices may be a common part of living for

children and adults alike

Probably the most important environmental factor relating to children with

speech impairment is support and relationships The incorporation of parental

support into the intervention practices is frequently a key to success (see

Bowen this issue) There is some research suggesting links between inter-

vention outcomes and environmental factors such as socioeconomic status

maternal IQ and maternal educational level (Chan et al 1998) Wider

networks of family friends and teachers are also important environmental

influences

Societal attitudes towards children adolescents and adults with speech

impairments are frequently negative (Crowe Hall 1991 Madison 1992

Silverman and Falk 1992) For example Silverman and Paulus (1989)

compared childrenrsquos attitudes towards a child who uses=w=for=r=with a typical

speaker The child with the mild speech impairment was considered to be less

talkative and hear less well than his=her peers dysfluent unpleasant to listen

to soft boring dull more tense nervous afraid handicapped isolated

uncomfortable Further Anderson and Antonak (1992) found that social

acceptance of an actor with a mild speech sound impairment was less

positive than the same actor demonstrating a physical disability Research

by Felsenfeld et al (1992) adds another dimension people with speech

impairment were found to be less extroverted and socialized with fewer

people than people with typical speech development Clearly people with

speech impairment may be compromised by societal attitudes necessitating

goals directed towards society as well as working at the impairment level

The services systems and policies relating to individual children are as

varied as each individual and can influence the type of schooling the child

receives the type and amount of support the child receives at school whether

a child is eligible for SLT intervention and so forth Political factors can affect

the actuality of intervention for individual clients For example in some health

sectors within the USA the politicization of health care dictates the number of

SLT sessions a person with a particular impairment can receive Philosophical


attitudes toward the labelling of a child with a speech or language impairment

can influence the type of goals developed for a child (Christensen and Baker

2002 Green and Kostogriz 2002) For example McDermott (1993 272) has

argued that lsquothere is no such thing as LD [Learning Disability] only a social

practice of displaying noticing documenting remediating and explaining itrsquo

McLeod (2003) described the distinction between the use of the terms

lsquonormalrsquo and lsquotypicalrsquo and SLTsrsquo role in the categorization of children along

the normalndashabnormal divide Simmons-Mackie (2001) described differing

clinical assumptions leading to differing intervention approaches A childrsquos

experiences of receiving intervention from different people with differing

clinical assumptions is documented by Kovarsky (2001) Thus services

systems and policies can play a role in goal setting for children with speech

impairment

Personal factors

Attached to every lsquospeech impairmentrsquo is a real child (Bleile 1991) His or her

unique makeup must be considered within his=her cultural milieu in order to

determine the most appropriate intervention goals The ICF (WHO 2001 8)

recognizes the lsquolarge social and cultural variancersquo including gender age other

health conditions coping style social background education profession past

experience and character style Currently research into typically developing

children has demonstrated the wide range of individual differences (for

example McLeod et al 2001) For children with speech impairment there

are some case studies documenting the effect of personal factors on appro-

priate goal setting and intervention outcomes For example Kamhi (2000)

describes the progress of phonological intervention with his daughter Franne

Frannersquos lsquostubbornnessrsquo and desire to communicate with her parents led to

delineation between speech sound practice with her SLT and meaningful

communication with her parents He writes lsquoFrannersquos reluctance to practise

speech sounds was her way to let us know that we should focus on what

she said when she spoke rather than on how she said itrsquo (Kamhi 2000 183)

One important and documented factor to consider in the selection of speech

goals is the childrsquos personal ability to evaluate his=her speech Self-evaluation

occurs when the child judges the accuracy of his=her response prior to explicit

feedback from the clinician (cf Koegel et al 1986) lsquoSelf-evaluation appears

to be a central concept within diverse theoretical views of normal speech

development and within approaches to and explications of successful

interventionrsquo (Shriberg and Kwiatkowski 1987 154) Thus SLTs can incor-

porate self-evaluation within the intervention goals


Conclusion What goals are appropriate

It can be argued that the ultimate goal of speech intervention is to bring about

correct production of speech sounds resulting in intelligible conversational

speech within a childrsquos milieu (cf Kamhi 2000 Powell 1991) However

other similarly important goals may be to enhance a childrsquos participation in

social interaction to increase self-esteem or to decrease negative societal

attitudes towards people with speech impairment The ICF is a meta-theory

that allows for consideration of all these possibilities and is enhanced by

collaboration between SLTs and teachers A summary of possible goals

relating to the ICF is provided in Table 1 The most important outcome of

the present discussion is to reiterate that every child is unique requiring a

different approach to best meet their needs (Lowe 1994) Thus it is important

to consider all the factors before making a decision then to devise goals in

consultation and monitor progress (see Baker and McLeod this issue)

Continual revision and consultation will result in appropriate outcomes for

individual children as well as society

References

American Speech-Language-Hearing Association 2001 Scope of practice in

speech-language pathology Rockville MD ASHA

Anderson R J and Antonak R F 1992 The influence of attitudes and

contact on reactions to persons with physical and speech disabilities

Rehabilitation Counselling Bulletin 35 240ndash47

Anthony A Bogle D Ingram T T S and McIsaac M W 1971 The

Edinburgh articulation test Edinburgh E and S Livingstone

Baker E and McLeod S 2004 Evidence-based management of children with

phonological impairment of unknown origin Child Language Teaching

and Therapy 20 261ndash85

Ball M J Gracco V and Stone M 2001 A comparison of imaging

techniques for the investigation of normal and disordered speech produc-

tion Advances in Speech-Language Pathology 3 313ndash24

Bernhardt B H and Stemberger J P 2000 Workbook in nonlinear phonology

for clinical application Austin TX ProEd

Bernthal J E and Bankson N W 1998 Articulation and phonological

disorders 4th edition Boston Allyn and Bacon

Bleile K M 1991 Individual differences In Bleile K M editor Child

phonology a book of exercises for students San Diego CA Singular 57ndash71


Bleile K M 1995 Manual of articulation and phonological disorders San

Diego CA Singular

Bourgeois M S 1998 Functional outcome assessment of adults with

dementia Seminars in Speech and Hearing 19 261ndash75

Bowen C 2004 Child Language Teaching and Therapy 20 245ndash60

Campbell T F Dollaghan C A Rockette H E Paradise J L Feldman H

M Shriberg L D Sabo D L and Kurs-Lasky M 2003 Risk factors

for speech delay of unknown origin in 3-year-old children Child

Development 74 346ndash57

Chan A McAllister L and Wilson L 1998 An investigation of the agendash

MLU relationship and factors which predict MLU in two and three year

old Australian children Asia Pacific Journal of Speech Language and

Hearing 3 97ndash108

Christensen C A and Baker C D 2002 Pedagogy observation and

the construction of learning disability Pedagogy Culture and Society

10 73ndash93

Crowe Hall B J 1991 Attitudes of fourth and sixth graders toward peers with

mild articulation disorders Language Speech and Hearing Services in

Schools 22 334ndash40

Duchan J F 2001a Impairment and social views of speech-language

pathology clinical practices re-examined Advances in Speech-Language

Pathology 3 37ndash46

Duchan J F 2001b Social and impairment approaches viewed in a forest and

in the shadows of a city street Advances in Speech-Language Pathology

3 73ndash79

Eadie T L 2003 The ICF A proposed framework for comprehensive

rehabilitation of individuals who use alaryngeal speech American

Journal of Speech-Language Pathology 12 189ndash97

Elbert M and Gierut J A 1986 Handbook of clinical phonology

approaches to assessment and treatment London Taylor amp Francis

Enderby P and John A 1997 Therapy outcome measures speech-language

pathology technical manual London Singular

Felsenfeld S Broen P A and McGue M 1992 A 28-year follow-up of

adults with a history of moderate phonological disorder linguistic

and personality results Journal of Speech and Hearing Research 35

1114ndash25


adults with a history of moderate phonological disorder educational

and occupational results Journal of Speech and Hearing Research 37

1341ndash53


Flipsen P Shriberg L D Weismer G Karlsson H B and McSweeny J L

2001 Acoustic phenotypes for speech-genetics studies reference data for

residual =3= distortions Clinical Linguistics and Phonetics 15 603ndash30

Gibbon F E 1999 Undifferentiated lingual gestures in children with

articulation=phonological disorders Journal of Speech Language and

Hearing Research 42 382ndash97

Gierut J A 1998 Treatment efficacy functional phonological disorders in

children Journal of Speech Language Hearing Research 41 S85ndash100

Gierut J A Morrisette M L Hughes M T and Rowland S 1996

Phonological treatment efficacy and developmental norms Language

Speech and Hearing Services in Schools 27 215ndash30

Gillon G T 2000 The efficacy of phonological awareness intervention for

children with spoken language impairment Language Speech and Hear-

ing Services in Schools 31 126ndash41

Goldman R and Fristoe M 1986 Goldman Fristoe Test of Articulation

Revised Circle Pines MN American Guidance Service

Green B and Kostogriz A 2002 Learning difficulties and the new literacy

studies a socially critical perspective In Soler J Wearmouth J and

Reid G editors Contextualising difficulties in literacy development

exploring politics culture ethnicity and ethics Milton Keynes The Open

University

Griffin S Wilson L Clark L and McLeod S 2001 Speech pathology

applications of automatic speech recognition technology In Wilson L

and Hewat S editors Proceedings of the 2001 Speech Pathology

Australia National Conference Melbourne Speech Pathology Australia

293ndash99

Golding-Kushner K 1995 Treatment of articulation and resonance disorders

associated with cleft palate and VPI In Shprintzen R and Bardach J

editors Cleft palate speech management a multidisciplinary approach

St Louis Mosby 327ndash63

Harasty J and Reed V A 1994 The prevalence of speech and language

impairment in two Sydney metropolitan schools Australian Journal of

Human Communication Disorders 22 1ndash23

Harding A and Grunwell P 1998 Active versus passive cleft-type speech

characteristics International Journal of Language and Communication

Disorders 33 329ndash52

Hersh D 1999 Impairment to empowerment social model theory and

aphasia therapy In McLeod S and McAllister L editors Proceedings

of the 1999 Speech Pathology Australia National Conference Melbourne

Speech Pathology Australia 125ndash30


Hodge M 1983 Assessment and treatment of a child with a developmental

speech disorder a biological behavioural perspective Seminars in Speech

and Language 14 128ndash41

Hodson B W 1994 Helping individuals become intelligible literate and

articulate the role of phonology Topics in Language Disorders 14 1ndash16

Hodson B W and Paden E P 1981 Phonological processes which

characterize unintelligible and intelligible speech in early childhood

Journal of Speech and Hearing Disorders 46 369ndash73

James D van Doorn J and McLeod S 2002 Segment production in mono-

di- and polysyllabic words in children aged 3ndash7 years In Windsor F

Kelly L and Hewlett N editors Themes in Clinical Phonetics and

Linguistics Hillsdale NJ Lawrence Erlbaum 287ndash98

Jordan L and Kaiser W 1996 Aphasia a social approach London

Chapman and Hall

Kamhi A G 2000 Practice makes perfect the incompatibility of practicing

speech and meaningful communication Language Speech and Hearing

Services in Schools 31 182ndash85

Kent R D Miolo G and Bloedel S 1994 The intelligibility of childrenrsquos

speech a review of evaluation procedures American Journal of Speech-

Language Pathology 3 81ndash95

Koegel L K Koegel R L and Costello-Ingham J 1986 Programming

rapid generalization of correct articulation through self-monitoring proce-

dures Journal of Speech and Hearing Disorders 51 24ndash32

Kovarsky D 2001 Ruminating on impairments-based assessment and inter-

vention Advances in Speech-Language Pathology 3 59ndash62

Kwiatkowski J and Shriberg L D 1992 Intelligibility assessment in

developmental phonological disorders accuracy of caregiver gloss

Journal of Speech and Hearing Research 35 1095ndash1104

Kwiatkowski J and Shriberg L D 1993 Speech normalization in develop-

mental phonological disorders a retrospective study of capability-focus

theory Language Speech and Hearing Services in Schools 24 10ndash18

Kwiatkowski J and Shriberg L D 1998 The capability-focus treatment

framework for child speech disorders American Journal of Speech-


Lai C S L Fisher S E Hurst J A Vargha-Khadem F and Monaco A P

2001 A forkhead-domain gene is mutated in severe speech and language

disorder Nature 413 519ndash23

Larrivee L S and Catts H W 1999 Early reading achievement in children

with expressive phonological disorders American Journal of Speech-



Leonard L B Schwartz R G Folger M K and Wilcox M J 1978 Some

aspects of child phonology in imitative and spontaneous speech Journal

of Child Language 5 403ndash15

Lewis B A and Freebairn L 1993 A clinical tool for evaluating the familial

basis of speech and language disorders American Journal of Speech-

Language Pathology May 38ndash43

Lewis B A Ekelman B L and Aram D M 1989 A familial study of

severe phonological disorders Journal of Speech and Hearing Research

32 713ndash24

Lewis B A Freebairn L A and Taylor H G 2000 Academic outcomes in

children with histories of speech sound disorders Journal of Commu-

nication Disorders 33 11ndash30

Locke J L 2000 The treatment of language disordered children a potentially

helpful theory Acquiring Knowledge in Speech Language and Hearing

3 3ndash6

Lof G L 2003 Oral motor exercises and treatment outcomes Perspectives

on Language Learning and Education (ASHA Division 1) 10 7ndash11

Long S H Fey M E and Channell R W 2002 Computerized Profiling

(Version MS-DOS version 91 Cleveland OH Case Western Reserve

University

Lowe R J 1994 Phonology assessment and intervention application in

speech pathology Baltimore Williams and Wilkins

Ma E P-M and Yiu E M-L 2001a Clinical voice assessment II assessing

voice activity limitation and participant restriction Acquiring Knowledge

in Speech Language and Hearing 3 69ndash73

Ma E P-M and Yiu E M-L 2001b Voice activity and participation profile

assessing the impact of voice disorders Journal of Speech Language

and Hearing Research 44 511ndash24

Madison C L 1992 Attitudes toward mild misarticulation-disordered peers

Language Speech and Hearing Services in Schools 23 188

Masterson J and Bernhardt B H 2002 CAPES Computerized Articulation

and Phonology Evaluation System [Computer Program version 101]

San Antonio TX Psychological Corporation

McDermott R P 1993 The acquisition of a child by a learning disability In

Chaiklin S and Lave J editors Understanding practice perspectives on

activity and context Cambridge Cambridge University Press

McLeod S 2003 Normal speech development a framework for assessment

and intervention In Williams C and Leitao S editors Proceedings of

the 2003 Speech Pathology Australia National Conference Melbourne



McLeod S Hand L Rosenthal J B and Hayes B 1994 The effect of

sampling condition on childrenrsquos productions of consonant clusters


McLeod S van Doorn J and Reed V A 2001 Consonant cluster devel-

opment in two-year-olds general trends and individual difference Jour-

nal of Speech Language Hearing Research 44 1144ndash171

Mid Western Area Health Service (1999) Healthy little ears Orange

Australia printWest Western Institute of TAFE

Morrison J A and Shriberg L D 1992 Articulation testing versus

conversational speech sampling Journal of Speech and Hearing

Research 35 259ndash73

Morrisette M L and Gierut J A 2003 Unified treatment recommendations

a response to Rvachew and Nowak (2001) Journal of Speech Language


Nelson N W 1989 Curriculum-based language assessment and intervention

Language Speech and Hearing Services in Schools 20 170ndash84

Ozanne A E 1992 Normative data for sequenced oral movements and

movements in context for children aged three to five years Australian

Journal of Human Communication Disorders 20 47ndash63

Powell T W 1991 Planning for phonological generalization an approach

to treatment target selection American Journal of Speech-Language-


Powell T W and Miccio A W 1996 Stimulability a useful clinical tool

Journal of Communication Disorders 29 237ndash53

Powell T W 2003 Stimulability and treatment outcomes Perspectives on

Language Learning and Education (ASHA Division 1) 10 3ndash6

Pretty S 1995 Letter to the editor Australian Communication Quarterly

Winter 3

Reynolds M C 1984 Classification of students with handicaps In

Gordon E W editor Review of research in education Vol II

Washington DC American Educational Research Journal

Robbins J and Klee T 1987 Clinical assessment of oropharyngeal motor

development in young children Journal of Speech and Hearing


Rvachew S and Nowak M 2001 The effect of target selection strategy on

phonological learning Journal of Speech Language and Hearing


Rvachew S and Nowak M 2003 Clinical outcomes as a function of target

selection strategy a response to Morrisette and Gierut (2001) Journal of

Speech Language Hearing Research 46 382ndash89


Shriberg L D and Kwiatkowski J 1987 A retrospective study of sponta-

neous generalization in speech-delayed children Language Speech and

Hearing Services in Schools 18 144ndash57

Shriberg L D Kwiatkowski J Best S Hengst J and Terselic-Weber B

1986 Characteristics of children with phonologic disorders of unknown

origin Journal of Speech and Hearing Disorders 51 140ndash61

Shriberg L D Flipsen P Jr Thielke H Kwiatkowski J Kertoy M Nellis

R and Block M 2000a Risk for speech disorder associated with early

recurrent otitis media with effusion two retrospective studies Journal of

Speech Language and Hearing Research 43 79ndash99

Shriberg L D Friel-Patti S Flipsen P Jr and Brown R L 2000b Otitis

media fluctuant hearing loss and speech-language delay a preliminary

structural equation model Journal of Speech Language and Hearing


Silverman F H and Paulus P G 1989 Peer reactions to teenagers who

substitute =w= for =r= Language Speech and Hearing Services in


Silverman F H and Falk S M 1992 Attitudes of teenagers toward peers

who have a single articulation error Language Speech and Hearing

Services in Schools 23 187

Simmons-Mackie N 2001 Social approaches in clinical practice examining

clinical assumptions Advances in Speech-Language Pathology 3 47ndash50

Smit A B 1993 Phonologic error distributions in the IowandashNebraska

articulation norms project consonant singletons Journal of Speech and


Stackhouse J and Wells B 1993 Psycholinguistic assessment of develop-

mental speech disorders European Journal of Disorders of Communica-

tion 28 331ndash48

Threats T T 2000 The World Health Organisationrsquos revised classification

what does it mean for speech-language pathology Journal of Medical

Speech-Language Pathology 8 13ndash18

Threats T T 2001 New classifications will aid assessment and intervention

ASHA Leader 6 12ndash13

Wilcox K and Morris S 1999 Childrenrsquos speech intelligibility measure San

Antonio TX Psychological Corporation

Williams A L 2002 Prologue perspectives in the assessment of

childrenrsquos speech American Journal of Speech-Language Pathology 11

211ndash12

Williams A L 2003 Target selection and treatment outcomes Perspectives



World Health Organization 1980 ICIDH International classification of

impairment disabilities and handicaps Geneva Switzerland WHO

World Health Organization 2001 ICF International classification of func-

tioning disability and health Geneva Switzerland WHO

Worrall L 1999 Speech pathology giving people a say in life In McLeod S

and McAllister L editors Proceedings of the 1999 Speech Pathology


5ndash11

Worrall L 2001 The social approach another new fashion in speech-

language pathology Advances in Speech-Language Pathology 3 51ndash54


According to Duchan (2001a 37) proponents of the impairment view lsquopresume

that the communication problem is in the client and that it can be remedied by

providing the client with missing knowledge or processing skillsrsquo Thus follow-

ing the impairment-based model childrenrsquos speech is assessed according to

standardized assessment tools their production of speech sounds is compared

with available norms and decisions regarding the existence and=or extent

of impairment are made Subsequent impairment-based goals could include

increasing speech sounds within a childrsquos repertoire decreasing the occurrence of

cluster reduction or expanding the syllable shapes used by the child The

impairment-based model relies heavily on the expertise of the lsquoprofessionalrsquo

(in this case the SLT) who typically conducts the assessments and analyses and

determines goals based on areas of impairment The family and teachers have less

input into the goal setting in the impairment-based model (Reynolds 1984)

Alternatively many teachers and some SLTs have adopted a social model of

decision making In the social model lsquo therapy plans centre around selected

life goals and what needs to be done to achieve them (and) emphasize the

communicative impact of the clientrsquos differences rather than the clientrsquos

deficitsrsquo (Duchan 2001a 38 39) Some proponents of the social model

also present disability as a part of life and the source of the problem as a

society that is not inclusive of people with disability (Hersh 1999 Jordan and

Kaiser 1996) A social model of goal setting validates and necessitates

extensive support from the family teachers and the children themselves as

the lsquoexpertsrsquo Thus the role of the teacher and SLT is to facilitate the dialogue

toward the development of socially appropriate goals For example the SLT

might ask about events that made the child feel lsquoparticularly good and

particularly badrsquo during the current school year (Nelson 1989 176) and use

these critical incidents as a framework for identification of relevant goals

Both impairment and social models can be valid (for an insightful debate see

the Clinical Forum led by Duchan 2001a) A meta-theory that draws on both the

impairment and social models has been developed by the World Health

Organization (WHO 2001) The initial version (WHO 1980) was grounded

in a medical (impairment) model and used the terms impairment disability and

handicap The final version integrated impairment and social models to describe

the health and health-related status of all people and is called The International

Classification of Functioning Disability and Health (ICF) (WHO 2001)

There are two parts to the ICF Table 1 illustrates the interactions between the

parts and components of the ICF Part I is titled lsquoFunctioning and disabilityrsquo and

describes health from the perspectives of the body the individual and society

and includes the components of body structures body functions activities and

participation Body structures refer to the anatomical parts of the body such as


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mdashmdash



















































































































media


























































































speech impairment







































impairment































Contextual factors























influences




































impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11




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nd

ex

pe

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nce

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hco

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un

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ilu

re

mdashmdash



















































































































media


























































































speech impairment







































impairment































Contextual factors























influences




































impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11




Ta

ble

1C

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ue

d

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mm

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nit

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a

nd

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nce

wit

hco

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un

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tio

nfa

ilu

re

mdashmdash



















































































































media


























































































speech impairment







































impairment































Contextual factors























influences




































impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11





















































































































media


























































































speech impairment







































impairment































Contextual factors























influences




































impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11























































































speech impairment







































impairment































Contextual factors























influences




































impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11





impairment































Contextual factors























influences




































impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11





















influences




































impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11
















impairment

Personal factors










































References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11




















References






















Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11





Diego CA Singular














10 73ndash93









3 73ndash79











1114ndash25




1341ndash53






















University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11
























University





293ndash99





























Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11

















Chapman and Hall




































32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11












32 713ndash24






3 3ndash6





University

















































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11































Winter 3









































tion 28 331ndash48










211ndash12











5ndash11































tion 28 331ndash48










211ndash12











5ndash11











5ndash11




The ICF a framework for setting goals for children with speech impairment.pdf

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Transcript of The ICF a framework for setting goals for children with speech impairment.pdf