Wednesday, August 29, 2012

Soliciting Opinions on Age of Acquisition Guidelines

It's terribly hard to qualify a speech-only child based upon specific articulation errors because the age range for age of acquisition is so wide. However, for the sake of this discussion, let's set aside the issue of qualification and just discuss treatment. You have a (hypothetical) child enrolled in therapy. You've been treating them for some time, and the only errors they have left are "age appropriate." Do you continue to treat or discharge that client from therapy?

Or, let's say you have a child with a frontal lisp on /s/ production that is very noticeable, but they're only 4-5 years old. Do you treat the lisp? I'm inclined to treat. I feel like letting certain errors go just tends to set them in stone, so to speak. By the time the errors are finally age inappropriate, the mispronounciations are fully habituated and harder to treat than they would have been if you had addressed them earlier.

I was hoping to get some other opinions. Have any of you encountered situations where children with a history of speech errors that need treatment had "age appropriate" errors resolve on their own without treatment as the child ages? I'm prompted to ask because of Michael.

Michael had a tendency to produce a wide variety of sounds interdentally. /f/, /v/, /s/, and /z/ were all produced with significant tongue protrusion. Given his abnormal speech history (almost completely absent babbling, no vowel productions or "cooing" until over 8 months of age, no words at all until 15 months...) and his sister's more significant speech issues, I decided to treat. /s/ and /z/ are pretty much completely resolved, and /f/ and /v/ are well on their way although still problematic in conversation. At 4 1/2, problems with /f/ are now age inappropriate, but that's the only speech error he has that currently would "qualify" for treatment.

I could step back now. I could work gently, but persistently on /f/ and /v/ when they come up naturally in conversation and just take a wait and see approach on the final remaining errors (/f/ for /th-/ and /d/ for /th+/). /th/ is a sound that would never qualify for treatment at 4 1/2. Given the history, would you wait and see if the /th/ resolves on its own or would you work on it?

4 comments:

  1. My son is 8. His frontal lisp corrected without remediation between 6 and 7 (1st grade). His vocalic and prevocalic /r/ self corrected between 6-8 (was halfway though second grade). However, his /l/ will NOT generalize to his conversation, though he can easily produce in therapy.

    That is my personal experience. I do see other students who report early speech therapy, but were dismissed for age-appropriate sounds before I know them, and I have to add again for /r/.

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  2. yes, I would teach sounds when you can. I love your gentle approach to teaching sounds. We know early intervention works, as it's easier to "mold" now then later as you mentioned. Also, some kids can handle direct instruction every once in awhile. I wouldn't beat the instruction to death, just once in a while give a gentle prompt and model to see how the child tolerates it.

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  3. I have been considering a similar issue with my child's speech therapist and she believes that if it is affecting his ability to be understood by others then we should continue to treat. My son is 5 1/2 with speech sound disorder and so it is affecting literacy as well. Mind you with my 4 yr old I have done nothing and f has seemed to fix itself yet /s/ not. I am not doing anything other than modelling sounds for the 4 year old until 4 1/2 as this was when I saw the greatest development in my other son ie willingness to try to "fix" his sounds. I know that many of the 5 yrs olds friends still have /th/ as an issue and also in my daughters first year of school many had the issue and had a few sessions of therapy and "fixed" the issue - perhaps as they get older they "get it" quicker ie tongue position? really don't know.....
    Thankyou for your blog it has been a great assistance to our speech work at home each week.

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  4. Generally those age guidelines describe "mastery production" - the age at which 90% of typically developing children can produce the sound correctly in all contexts. I prefer to think about the age of "customary production" - the age at which about 1/2 of children can produce the sound.

    That being said, I often teach sounds out of the usual "developmental order". Kids with CAS follow their own sequence and I always work on what is almost stimulable.

    I do continue working with kids, especially those with apraxia, even when the only remaining errors are "developmental", That is unless they need a break from therapy. Sometimes waiting a bit until the child requests speech help results in much greater motivation, cooperation and perseverence!

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