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Library of Congress Cataloging-in-Publication Data
Names: Bauman-Waengler, Jacqueline Ann, author.
Title: Articulation and phonology in speech sound disorders : a clinical
focus I Jacqueline Bauman-Waengler.
Description: Sixth edition. I Boston : Pearson Education, [2018] I Includes
bibliographical references and indexes.
Identifiers: LCCN 2018046080 I ISBN 9780134990576 I ISBN 0134990579
Subjects: LCSH: Articulation disorders. I English language-Phonetics.
Classification: LCC RC424.7 .B378 2018 I DDC 618.92/ 855-dc23
LC record available at https://lccn.loc.gov/2018046080

1 18
ISBN 10: 0-13-499057-9
ISBN 13: 978-0-13-499057-6

@Pearson
To all the speech-language pathologists who are
working hard to make a difference to the
children and adults they serve.
About the Author

J
ACQUELINE BAUMAN-WAENGLER has been a professor for more than
25 years. Her main teaching and clinical emphases are phonetics and phonol-
ogy, including disorders of articulation and phonology in children and child
language disorders. She has published and presented widely in these areas both na-
tionally and internationally. In addition to the sixth edition of Articulation and Phonol-
ogy in Speech Sound Disorders: A Clinical Focus, Bauman-Waengler has also published
Introduction to Phonetics and Phonology: From Concepts to Transcription (2009) with
Pearson. A new book, coauthored with Diane Garcia, will be available at the end of
November from Plural Publishing, San Diego, CA. It is titled Phonological Treatment of
Speech Sound Disorders in Children: A Practical Guide.

iv
Preface

T he concept for this book grew out of a perceived need to create a bridge
between theoretical issues in speech-language pathology and their clinical
application. The goal for the sixth edition has remained the same: to tie
strong academic foundations directly to clinical applications. To this end, every
chapter contains suggestions for clinical practice as well as clinical examples and
clinical applications. These features will assist the reader in developing an under-
standing of how basic concepts and theoretical knowledge form the core for clini-
cal decision making in the assessment and remediation of speech sound disorders.
Learning aids located throughout the chapter include video clips and clinical appli-
cations. Those learning aids at the end of every chapter include case studies, criti-
cal thinking, and multiple-choice questions.

New to This Edition

With the publication of this sixth edition, this book will have been in use for 20 years.
Therefore, this edition of Articulation and Phonology in Speech Sound Disorders: A Clinical
Focus has had a serious overhaul with significant changes.
• Chapter Applications: Case Study at the beginning of each chapter. These appli-
cations focus on real-life experiences that beginning students and clinicians
will be confronted with. For example, what does a beginning clinician need
to know to be able to choose one therapy approach versus another? They
are all directly related to the content of the specific chapter.
·American Speech-Language Hearing Association's (ASHA) position statements,
definitions, and practice policies. Several of the chapters have sections de-
lineating new definitions, such as the current definition of speech sound
disorder; practice policies, such as the alignment with ASHA and the World
Health Organization's diagnostic practices; ASHA's position on dialects and
cultural competence; and specific treatment overviews, such as for dysar-
thria. This will aid students as they transition into competent clinicians.
• More user-friendly phonetic descriptors. This edition has also seen a shift from
describing and, in cases, transcribing vowels and consonants in a more user-
friendly manner. An attempt has been made to align the descriptive process
according to the International Phonetic Alphabet chart in its new 2015 revi-
sion. This will aid students in learning the specific descriptions without be-
ing unnecessarily burdened with cumbersome terminology.
·New topic: Anatomy and physiology. New to this edition is a brief overview
of the anatomy and physiology of the speech mechanism (Chapter 2). This
is applicable to the discussion of normal speech production as well as those
disorders, for example, cleft palate, cerebral palsy, and acquired dysarthria,
in which characteristic deviations of the processes underlying speech pro-
duction are a portion of the clinical picture.
• New topic: Principles of motor learning. A new section has been added
that discusses the conditions of practice and feedback for motor learning
(Chapter 9). Therapeutic applications specific to articulation disorders are
given as well as research documenting the efficacy of such principles in
childhood apraxia of speech, for example.
v
vi Preface

• New topic: Classification of speech sound disorders (Dodd, 2013). This diagnostic
classification system is now introduced (Chapter 1) and expanded upon in
several chapters. For example, in Chapter 7 the characteristics of four of the
categories-articulation disorder, phonological delay, consistent phonological
disorder, and inconsistent phonological disorder-are noted. A case study
example is given for each to provide the student with more information on
how each of these categories could look clinically. This will give students a
much needed structure of how to organize their diagnostic data. A clinical
application is also given of a child demonstrating an articulation and a
phonological disorder. This is often difficult for students to understand.
·Expanded and reorganized topics: Diagnostic protocols. Chapter 6, Assessment
and Appraisal, provides expanded information on contextual testing and the
use of multisyllabic words within the diagnostic process. Specific measures
are noted that a clinician could use to assess these variables. In addition,
updated lists of standardized speech assessment, language screening measures,
prosodic assessment protocols, the testing or screening of phonological
and phonemic awareness, and the assessment of a child's communicative
participation are given. The student or practitioner will have resources for a
large number of formal and informal measures to assess each of these areas.
• Expanded and reorganized topics: Summarizing data. The analysis of collected
data from a standardized speech assessment and spontaneous speech sample
have been completely redone for Chapter 7. Thus, the analysis of the
inventory, distribution, stimulability, and determining phonemic contrasts
has been streamlined. New analysis forms and a new case study have been
used to organize these data and demonstrate their use. Results have been tied
to the previously noted classification of speech sound disorders. This will
be especially valuable to beginning clinicians as they attempt to organize
and categorize the data they have collected. Also new to this edition are
measures of whole-word accuracy and variability. A case study is provided
so that students can understand how to apply and calculate these measures.
• Expanded and reorganized topics: Theoretical foundations and their clinical
application. Several of the theoretical constructs have been deleted from this
chapter (Chapter 4), while others, such as feature geometry and optimality
theory have been expanded to include more practical clinical applications
that the student can work through easily. Sonority theory and implicational
universals have also been included in this chapter as well as distinctive
features and their use in maximal oppositions target selection. These
principles are a major portion of specific phonological target selection and
therapies which are presented in Chapter 10.
• Expanded and reorganized topics: Treatment ofPhonological Disorders (Chapter 1OJ.
This chapter has been expanded to include more information on several of the
therapies that are considered to be phonological in respect to the target selec-
tion or treatment options. However, this chapter has also been streamlined so
that a clinician is able to obtain an overview of the treatment process. This
includes returning to the classification system noted in Chapter 1, utilizing
variables such as the age of the child and the severity of the disorder to deter-
mine who would maximally benefit from each type of treatment possibility.
Also new to this chapter is the categorization "inconsistent speech disorder."
Diagnostic criteria and the treatment process are discussed. For each of these
phonological treatment methods a case study new to this edition demonstrates
how this child's error patterns might be implemented to establish treatment
targets and goals.
 Preface vii

• Expanded and reorganized topics: Speech Sound Disorders in Selected Popula-

tions (Chapter 11). This chapter now includes a section on Down syndrome,
which contains general as well as articulatory/phonological characteristics.
In addition, when possible, the therapy section examines treatment efficacy
studies that are based on reviews of controlled studies to determine which
treatment protocols demonstrate maintenance and generalization of the
treatment effects and increased performance. This is important information
for clinicians as they are faced with a large number of treatment choices.
• Categorical learning objectives. These have been fine-tuned in each chapter so
that the reader begins each chapter with a set of easily identifiable goals for
the chapter's learning process. Each set of learning objectives provides the
scaffolding for major divisions of the chapter and leads directly to quizzes
and critical thinking components that compartmentalize key concepts.
• New clinical exercises. This text includes a number of new or revised clinical
exercises to allow the student to master theoretical concepts by applying
them to real-life situations. The eText edition of this text also contains em-
bedded videos that can be used in conjunction with these clinical exercises,
allowing for additional analysis opportunities.
• Updated references. References in each chapter have been updated to reflect
the most recent research in the field.

Instructor's Resource Manual

To help instructors in preparing their courses, we have provided an Instructor's
Resource Manual. This supplement is available online or can be obtained by con-
tacting a Pearson sales representative. To download and print the Instructor's
Resource Manual, go to www.pearsonhighered.com and then click on "Educators."

Acknowledgments
Preparing the sixth edition-as with previous editions-might appear at first to
be a simple process but it actually was a large time investment supported by
many people. I have to admit, based on past experience, I was a bit skeptical
about a "team". However, this team has been wonderful, helpful, knowledge-
able, and efficient. First, I would like to thank Aileen (Berg) Pogran, who is the
Executive Portfolio Manager of this sixth edition and relatively new to Pearson.
Her support has been amazing. Other team members include Krista (Slavicek)
viii Preface

McMurray, Development Editor, whose eye for detail has been really very helpful;
Faraz Sharique Ali, Content Producer US (Team Lead), who has been a behind the
scenes person but could be relied on for all sorts of needs, thank you; Carmina
Jimenez, Editorial Project Manager, who is so quick and efficient, great; Prince
John William Carey, Project Manager, who has been so kind and helpful in spite
of my having to change deadlines constantly; and Jon Theiss, Digital Development
Editor, always providing a top notch video. A special thanks to Deepali Malhotra,
Content Producer, who recently took a vague concept of mine and turned it into a
cover design which is so perfect: a child who is happy and hopeful, representing
to me the future and the possibilities. Thank you to Deepali and her team. All of
these amazing people have been so supportive and helpful as I proceeded through
this task.
For this edition, I would like to say a special thanks to my reviewers: Christine
Fiestas from Texas A&M -Kingsville; Carol Tessel from Florida Atlantic University;
Haralambia Kollia from William Paterson University; Maria Grigos from
New York University; Peter Richtsmeier from Oklahoma State University; Tim
Brackenbury from Bowling Green State University. I hope that you can recognize
many of the wonderful suggestions that guided me through these revisions.
Brief Contents
1 Clinical Framework: Basic Terms and Concepts 1

2 Articulatory Phonetics: Speech Sound Form 17

3 Phonetic Transcription and Diacritics 46

4 Theoretical Considerations and Practical Applications 71

5 Normal Phonological Development 114

6 Assessment and Appraisal: Collection of Data 155

7 Diagnosis: Summarizing Data and Classifying Speech

Sound Disorders 196

8 Dialects and English as a Second Language 230

9 Therapy for Articulation Disorders: Obtaining

an Accurate Production of a Speech Sound 269

10 Treatment of Phonological Disorders 342

11 Speech Sound Disorders in Selected Populations 393

Glossary 443
References 453
Index 477

ix
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Contents
About the Author iv APPENDIX 2.1 Selected Readings in Anatomy
Preface v and Physiology of the Speech and Hearing
Mechanisms 45
1 Clinical Framework: Basic Terms APPENDIX 2.2 Phonetic Symbols Used in
Current Phonetic Transcription Texts 45
and Concepts 1
Communication, Speech, and Language 1
Disorders of Communication, Speech, 3 Phonetic Transcription and
and Language 3 Diacritics 46
Articulation and Speech Sounds (Phones):
Phonology and Phonemes 4 Phonetic Transcription as a Notational System 47
Defining Speech Sound Disorders: Articulation The Use and Value of Phonetic Transcription
and Phonological Disorders 7 for Speech-Language Therapists 51
Classifying Speech Sound Disorders 10 Defining Diacrities 51
Subtypes and Etiological Factors: Speech Diacritics Used with Consonants 53
Disorders Classification System 10 Diacritics Used with Vowels 59
Examining Error Patterns: The Differential Diacritics for Stress, Duration, and Syllable
Diagnosis System 12 Boundaries 62
Summary 15 • Case Studies 15 • Think Critically 16 Additional Symbols 63
Clinical Implications 65
2 Articulatory Phonetics: Speech Summary 68 • Case Study 68 • Think Critically 69
Sound Form 17
Phonetics: Definitions and Classification 18 4 Theoretical Considerations and
Anatomical-Physiological Review of the Practical Applications 71
Foundations of Speech Production 19
The Respiratory System 19 The Evolution of the Phoneme Concept 73
The Phonatory System 22 How Did the Concept of the Phoneme Develop? 73
The Resonatory System 24 Speech Sound Versus Phoneme: Form and
Function as a Unity 74
The Articulatory System 26
Vowels Versus Consonants 27 Distinctive Feature Theories 76
How Do Distinctive Features Work? 77
General American English Vowels:
Descriptive Parameters 29 Generative Phonology 83
Front Vowels 30 How Does Generative Phonology Work? 83
Back Vowels 30 How Did Generative Phonology Develop? 84
Central Vowels 30 Naturalness, Markedness, and Implicational
Diphthongs 31 Universals 85
General American English Consonants: Natural Phonology 88
Descriptive Parameters 33 How Does Natural Phonology Work? 88
Sounds in Context: Coarticulation and How Did Natural Phonology Develop? 91
Assimilation 38 Nonlinear Phonologies: Exemplified by Feature
Syllable Structure 40 Geometry and Optimality Theory 92
Clinical Significance 41 Feature Geometry 94
Summary 43 • Case Study 43 • Think Critically 44 Optimality Theory 100

xi
xii Contents

The Sonority Theory and Sonority Sequencing Standardized Speech Assessments and
Principles 107 Supplemental Testing 165
Summary 111 • Case Study 111 • Think Critically 112 Advantages and Disadvantages of Standardized
Speech Assessments 165
Factors to Consider When Selecting a
5 Normal Phonological Standardized Speech Measure 166
Development 114 Assessment Procedures to Supplement
Standardized Speech Measures 170
Aspects of Structural and Functional
Organizing Standardized Speech Assessment
Development 116 Results: Describing the Error 170
Early Perceptual Development 118 Stimulability Testing 172
Prelinguistic Stages: Before the First Words 121 Contextual Testing 173
Vocoids: Nonphonemic Vowel-like Productions 124 Testing Multisyllabic (3-Plus Syllable) Words 173
Contoids: Nonphonemic Consonant-like Spontaneous Speech Sample 174
Productions 124
Organization of the Continuous Speech Sample 174
Syllable Shapes 125
Selection of Additional Measures
Babbling and Its Relationship to Later Language
in Other Areas 177
Development 125
Language Screening 177
Prosodic Feature Development 126
Prosodic Screening and Testing 178
Transition from Babbling to First Words
Phonological and Phonemic Awareness
and the First-SO-Word Stage 127 Screening and Testing 178
The First-SO-Word Stage 127
Cognitive Appraisal 180
Segmental Form Development 128 Assessment of a Child's Communicative
Prosodic Feature Development 133 Participation 181
Consonant, Vowel, and Prosodic Development Special Considerations: A Child with
of the Preschool-Age Child 135 Emerging Phonology 182
Segmental Form Development: Vowels 135 Special Considerations: A Child with
Segmental Form Development: Consonants 136 Unintelligible Speech 187
Phonological Processes 139 Summary 190 • Case Study 190 • Think Critically 191
Prosodic Feature Development 142
Consonants, Consonant Clusters, and Prosodic APPENDIX 6.1 Speech-Motor Assessment
Development of the School-Age Child 143 Screening Form 192
Segmental Form Development 144
Consonant Cluster Development 144 7 Diagnosis: Summarizing Data and
Prosodic Feature Development 145 Classifying Speech Sound Disorders 1 96
Phonological Awareness, Emerging Literacy, Inventory, Distribution, and Stimulability
and Phonological Disorders 146 of Speech Sounds 197
Summary 151 • Case Study 152 • Think Critically 153
Outcome Measures: Which Sounds the Child
Can Produce, Which Sounds the Child
6 Assessment and Appraisal: Cannot Produce, and Stimulability 197
What Do the Inventory, Distribution, and
Collection of Data 155 Stimulability Results Tell Us as Clinicians? 198
Guidelines for Assessment: Objectives Phonemic Contrasts: Establishing a Phonemic
of Appraisal and Diagnosis 157 Inventory 204
Initial Procedures: Hearing Evaluation and Phonemic Pattern Analysis:
Speech Mechanism Examination 159 Phonological Processes 208
Initial Impression 159 Classifying Speech Sound Disorders 211
Procedures for a Hearing Screening 160 Articulation Disorder 211
Evaluation of the Speech Mechanism 161 Phonological Delay 213
What to Look for When Evaluating the Speech Consistent Phonological Disorder 214
Mechanism 162 Inconsistent Phonological Disorder 216
 Contents xiii

Factors Affecting Intelligibility and 9 Therapy for Articulation

Measurements of Intelligibility 218
Factors Affecting Intelligibility 218
Disorders: Obtaining an Accurate
Measures of Intelligibility 219
Production of a Speech Sound 269
Measures of Severity, Whole-Word Accuracy, Defining the Traditional Motor Approach 271
and Variability 221 Guidelines for Beginning Therapy: Articulation
Measures of Whole Words 222 Disorders 272
Summary 223 • Case Study 223 • Think Critically 225 General Overview of Therapy Progression 272
APPENDIX 7.1 Transcription from Jonah, Sensory-Perceptual Training 273
Age 7 Years 4 Months, from the Goldman- Production of the Sound in Isolation 274
Fristoe Test of Articulation (Goldman & Sounds in Context 276
Fristoe, 2015) 226 Dismissal and Re-evaluation Criteria 279
APPENDIX 7 .2 Matrix for Spontaneous Speech Principles of Motor Learning and Their
Sample from Jonah, Age 7 Years 4 Months 227 Application to Therapy 281
APPENDIX 7 .3 Minimal Word-Pairs Conditions of Practice 282
Ordered by Vowel 228 Conditions of Feedback 284
APPENDIX 7 .4 Intelligibility Grid 229 The Traditional Motor Approach and
the Most Frequently Misarticulated
8 Dialects and English as a Speech Sounds 285
Misarticulations of [s] and [z] 286
Second Language 230
Misarticulations of [fl and [3] 298
Dialects 231 Misarticulations of [k] and [g] 302
Regional Dialects 232 Misarticulations of [l] 306
Characteristics of Appalachian English, Misarticulations of [1] and the Central Vowels
Ozark English, and African-American with r-Coloring 311
Vernacular English 235 Misarticulations of [9] and [c3] 319
Appalachian Versus Ozark English 235 Misarticulations of [f] and [v] 322
Ethnicity, Race, and Culture 237 Affricate Problems 325
African-American Vernacular English 238 Voicing Problems 327
ASHA's Position on Dialects 241 Consonant Cluster Problems 329
The Speaker of English as a Second Language 243 Group Therapy with the Traditional Motor
Factors to Consider in the Phonological Approach 332
Development of Children Leaming English Summary 334 • Case Study 335 • Think Critically 335
as a Second Language 243
Limited English Proficient Students 245 APPENDIX 9.1 Minimal Word-Pairs with
Speech Sound and Selected Prosodic Frequently Misarticulated Sounds 336
Characteristics of Spanish, Vietnamese,
Cantonese, Korean, Filipino, Hmong,
and Arabic American English 247 10 Treatment of Phonological
Spanish American English 247 Disorders 342
Vietnamese American English 252 Minimal Pair Therapy: Minimal Oppositions
Korean American English 255 Contrast Therapy and the Multiple
Cantonese American English 257 Oppositions Approach 344
Filipino/Tagalog American English 259 Minimal Opposition Contrast Therapy 344
Hmong American English 261 Multiple Oppositions Approach 349
Arabic American English 263 Target Selection for Minimal Pair Therapy:
Cultural Competence and Implications Maximal Oppositions and the Complexity
for Appraisal 265 Approach 353
Guidelines 266 Maximal Oppositions 353
Summary 267 • Case Study 267 • Think Critically 268 The Complexity Approach 357
xiv Contents

Cycles Phonological Remediation Approach 364 Articulatory and Phonological Characteristics 404
Inconsistent Speech Disorder and the Core Clinical Implications: Diagnostics 406
Vocabulary Approach 369 Clinical Implications: Therapeutics 407
The Metaphon Approach 373 Cleft Palate 409
Speech Sound Disorders with Concurrent Definition and General Features 409
Language Problems: The Treatment of Articulatory and Phonological Characteristics 410
Morphosyntax, Vocabulary, and the Child Clinical Implications: Diagnostic 411
with Emerging Phonology 378 Clinical Implications: Therapeutics 414
Connecting Phonology to Morphosyntax: Intellectual Disability (Intellectual
Morphosyntax Intervention 378 Developmental Disorder) 417
Connecting Phonology to Semantics: Vocabulary Definition and General Features 417
Intervention 380
Articulatory and Phonological Characteristics:
The Child with an Emerging Phonological General Information 418
System: Expanding the System and Vocabulary 381
Down Syndrome: General Information 418
Treatment of Multiple Vowel Errors 383
Down Syndrome: Articulatory and Phonological
The Child with a Very Limited Vowel Inventory: Impairments 419
Therapeutic Suggestions 384 Clinical Implications: Diagnostics 419
The Child with a High Proportion of Vowel Clinical Implications: Therapeutics 420
Substitutions: Therapeutic Suggestions 386
Summary 387 • Case Study 388 • Think Critically 389
Hearing Impairment 423
Definition and General Features 423
APPENDIX 10.1 Probes for Initial Consonant Articulatory and Phonological Characteristics 424
Clusters That Could Be Targets 389 Clinical Implications: Diagnostics 425
APPENDIX 10.2 Probes for Monitoring Clinical Implications: Therapeutics 425
Generalization or Therapy Progress 390 Motor-Speech Disorders in Adults 428
Acquired Apraxia of Speech 428
The Dysarthrias 432
11 Speech Sound Disorders in Summary 438 • Case Study 438 • Think Critically 439
Selected Populations 393
Childhood Apraxia of Speech: A Disorder APPENDIX 11.1 Protocol for Assessing
of Speech Motor Control 394 Respiration, Phonation, Resonation, and
Definition and General Features 394 Articulation of Dysarthric Speech 440
Articulatory and Phonological Characteristics 395
Clinical Implications: Diagnostics 398 Glossary 443
Clinical Implications: Therapeutics 400
References 453
Motor-Speech Disorders: Cerebral Palsy 403
Definition and General Features 403 Index 477
Chapter 1
Clinical Framework
Basic Terms and Concepts

1111 Learning Objectives

When you have fi.ni.shed thi.s chapter, you should be able to:
1.1 Define communication, speech, and language.
1.2 Define disorders of communication, speech, and language.
1.3 Distinguish between articulation and speech sounds (phones),
phonology, and phonemes.
1.4 Define speech sound disorder and understand its relationship to
articulation and phonological disorders.
1.5 Classify speech sound disorders according to specific parameters.

Communication, Speech, and Language

Communication is central to our lives. We communicate in a number of ways-
from text messaging to facial expressions. Simply defined, communication is the
process of sharing information between individuals (Pence Turnbull & Justice,
2017). When we think about the diversified population that we encounter within
the discipline of communication disorders, a broader definition might be helpful.
Communication is a process that consists of two or more people sharing informa-
tion, including facts, thoughts, ideas, and feelings. Communication includes how
to interact with other people and things, how to understand spoken language,
and how to exchange information with others using gestures or symbols. Com-
munication does not have to involve language and does not have to be vocalized
(Justice & Redle, 2014; National Joint Committee for the Communicative Needs
of Persons with Severe Disabilities, 2010). Communication refers to any way that
we convey information from one person to another. For example, we use Twitter,
Skype, and FaceTime as ways to communicate. In addition, smiling, waving, and
raising your eyebrows at a comment are all examples of nonverbal communication.
Sign languages, such as American Sign Language or Seeing Essential English, are
nonverbal conventional linguistic systems used to communicate.
However, the most widely used means of communication is speech. Speech
is the expression of thoughts in spoken words, that is, in oral, verbal commu-
nication. Speech can be further divided into articulation, the motor production
of speech sounds; fluency, the flow of speaking, including rate and rhythm; and
2 Chapter 1

voice, including vocal quality, pitch, loudness, and resonance (American Speech-
Language-Hearing Association [ASHA], 1993). The term speech is used in various ways.
Speech can be a more formal, spoken communication to an audience. For example:
Having to give a speech to her class was always frightening for Andrea. Speech can
also indicate a manner of speaking: Her speech was marked by a distinct Australian
accent. Speech is also used together with the term language to indicate the mental
faculty of verbal communication: The child's speech and language skills were tested
as a portion of the diagnostic. Based on this last example, it seems important to dif-
ferentiate between speech and language. What are the distinctions between these
two terms: speech versus language?

Figure 1.1 Subdivisions of Language

• Study of the sound system of a language; includes

arrangement, systematic organization, and rule system
Phonology of vowels and consonants (Parker & Riley, 2010).
• Example: The phonology of English contains "sh,"
If/; Spanish does not .

• Study of the structure o f words; analyzes how words

can be divided into units labeled as morphemes, which
are the smallest m eaningful units of language
Morphology (Crystal, 2010).
• Example: The word bicycle has two morphemes, "bi"
= two, and "cycle" = circular or wheel.

• Study of organizational rules denoting word, phrase, and

clause order; sentence organization; and the relationship
Syntax between sentence elements (Owens, 2016).
• Example: "I like chocolate ice cream" has appropriate
syntax, but "Ice cream I chocolate like" does not.

• Study of linguistic m eaning; includes the meaning

of words, phrases, and sentences (Parker & Riley, 2010).
Semantics • Example: Semantics includes the fact that certain words,
such as "bat," have more than one meaning and that certain
words, such as "dog" and "canine," have similar meanings.

• Study of language used to communicate within various

situational contexts; includes such things as conversational
skills and the flexibility to modify speech for different
Pragmatics listeners and social situations (Paul, Norbury, & Gosse, 2018).
• Example: Among other things, pragmatics includes facial
expressions, body gestures, and word emphases to
commun icate specific meanings.
 Clinical Framework 3

According to the American Speech-Language-Hearing Association (ASHA),

language can be defined as a complex and dynamic system of conventional sym-
bols that is used in various modes for thought and communication (American
Speech-Language-Hearing Association Committee on Language, 1983). This defi-
nition further states that language is rule governed and is described by at least
five linguistic parameters: phonological, morphological, syntactical, semantic, and
pragmatic. Language is intricate and includes variability and change. In addition,
all members of a language agree on the symbolic system that is used, and language
is used to communicate in a variety of ways.
Within our definition of language are the terms phonology, morphology,
syntax, semantics, and pragmatics. Definitions and examples of each of these
parameters are contained in Figure 1.1. One of these parameters, phonology, is of
major importance in this text.
To summarize, communication is the process of sharing information between
and among individuals. Communication can be broadly divided into speech and
language. Speech is the expression of thoughts in spoken words; it is oral, ver-
bal communication. On the other hand, language is a complex, dynamic, and
rule-based system of conventional symbols that is used in diverse modalities for
thought and communication. However, as practitioners, we deal with communi-
cation, speech, and language disorders. What characteristics would a disordered
system demonstrate?

Disorders of Communication,
Speech, and Language
According to the 1993 guidelines of ASHA, a communication disorder is the
impairment in the ability to receive, send, process, and comprehend concepts,
including verbal, nonverbal, and graphic symbol systems. Communication disor-
ders are further subdivided into speech, language, hearing, and central auditory
processing difficulties. A speech disorder is used to indicate oral, verbal com-
munication that is so deviant from the norm that it is noticeable or interferes
with communication. Speech disorders are divided into articulation, fluency, and
voice disorders. On the other hand, a language disorder involves the impaired
comprehension and/ or use of spoken, written, and/ or other symbol systems. A
language disorder may involve one or more of the following areas: phonology,
morphology, syntax, semantics, and pragmatics. Impaired auditory sensitivity
leads to a hearing impairment. Individuals with hearing impairments are typi-
cally classified as either hard of hearing or deaf. The final area within this clas-
sification system is a central auditory processing disorder. These deficits result
in difficulties with information processing of auditory signals that are not related
to impaired sensitivity of the auditory system. Thus, these difficulties are not
the result of a hearing impairment. Refer to Figure 1.2 for the subdivisions of
communication disorders.
For the purpose at hand, we are primarily interested in speech disorders
related to the impairment of the articulation of speech sounds and language dis-
orders related to the category of phonology. In this context, it is important to
examine the terms articulation and speech sounds (phones) as well as phonology and
phonemes. The following section defines and gives examples of how these words
are used in our clinical practice within communication disorders.
4 Chapter 1

Figure 1.2 Subdivisions of Communication Disorders

Impairments in one or
more of the following:
Phonology
Language Disorder Morphology
Syntax
Semantics
Pragmatics

Articulation
Speech Disorder Disorder
Voice Disorder
Fluency Disorder

Hearing Disorder Deaf

Hard of Hearing

Central Auditory
Processing Disorder

Articulation and Speech Sounds

(Phones): Phonology and Phonemes
The term articulation and its derivations are often used to describe an individual's
speech. They might appear in a referral statement or within a diagnostic report;
for example:
Sandy was referred to the clinic because her parents were concerned about
her articulation skills.
Bob could articulate the sound correctly in isolation but not in word contexts.
Joe's articulation disorder affected his speech intelligibility.
For the purpose at hand, articulation refers to the totality of motor move-
ments involved in production of the actual sounds that comprise speech (Bauman-
Waengler, 2009). The learning of articulatory skills is a developmental process
involving the gradual acquisition of the ability to move the articulators (those
structures that are important in forming the individual sounds) in a precise and
rapid manner. Thus, learning to articulate is a specific kind of motor learning. Just
as children become more adept at certain motor skills as they grow older, their
articulation skills develop as well. For example, a 2-year-old child and a 6-year-
old child differ in their articulatory abilities. Errors in articulation can result from
 Clinical Framework 5

difficulty with the motoric aspects of speech production (Small, 2020). Thus, the
peripheral motor processes involved in the planning and execution of articulation
are impaired; the central language capabilities of the individual remain intact. In
summary, articulation is a specific, gradually developing motor skill that involves
motor processes.
Speech sounds are central units in any discussion of disordered speech.
Although the human vocal tract is capable of producing a wide array of sounds,
including coughing and burping, speech sounds are special sounds because they
are associated with speech. Speech sounds, which can also be labeled as phones,
represent physical sound realities; they are end products of articulatory motor pro-
cesses. When talking about a child's s-production in the context of an articulation
test, for example, we refer to the speech sound or phone production of [s].
Speech sounds or phones are real, physical sound entities used in speech.
However, in addition to their articulatory form, they also have a linguistic function.
Linguistic function includes, for example, the rules that address how specific sound
units can be arranged to produce appropriate words and the phoneme concept.
A phoneme is the smallest linguistic unit that is able, when combined with other
such units, to distinguish meaning between words (Bauman-Waengler & Garcia,
2020). For example, "tick" has three phonemes: / t/, / r/ , and / k/ . We know that
these are phonemes of American English because the word they form is meaningful.
In contrast, / s/ is also a phoneme of American English, as can be seen in "sick,"
/ s/ , / r/ , /k/ , which differs from "tick" by one phoneme: / t/ versus / s/ . As far as
notation is concerned, speech sound (phone) productions are usually placed within
brackets in phonetic transcription, whereas phoneme values are symbolized by
slanted lines, or virgules. For example, [s] indicates that it was a sound someone
actually pronounced in a specific manner. On the other hand, / s/ signifies the
phoneme "s."
The idea of the phoneme is considered to be an abstraction. A phoneme is
not a single, concrete, unchanging entity. A phoneme as an abstraction is based on
the many variations that occur for a particular sound unit as it changes in differing
contexts of conversational speech. This does not necessarily make the phoneme
concept complex or difficult to understand. We constantly deal with abstractions.
Take, for example, the concept "cat. " A cat is not a single, unchanging entity. There
are big cats and small cats, cats that are striped or solid colored of various shades.
However, we accept certain characteristics as being typical to the concept of "cat. "
We could say that the cat concept embraces a whole family of units that are related
yet somehow distinct. Even two cats of the same size, color, and build will have
slight variations that could be detected most certainly by the owners. If we apply
this to the phoneme concept, we find a similar abstraction. So when we speak of
a particular phoneme, / t/ for example, we are referring to the typical "t" but we
also take into consideration the varieties of "t" that are used in various contexts
and by different speakers. The term allophone is used to refer to the changes that
occur in a phoneme when produced by speakers in differing contexts. Allophones
are variations in phoneme realizations, in phones, that do not change the meaning
of a word when they are produced in differing contexts. Allophones are phonetic
variations of a phoneme (Crystal, 2010). Within the phonological system of Ameri-
can English, there are many examples of allophones.
Several allophonic variations can occur with the / p/ phoneme, for example.
At the beginning of a word as a single sound unit, / p/ is typically aspirated. Aspira-
tion is that slight puff of air that you hear if you pronounce the word "pie" or "pot."
This is transcribed as [ph], the small raised h representing the puff of air or aspira-
tion in phonetic transcription. However, / p/ is typically unaspirated following "s,"
6 Chapter 1

Clinical Exercises In American English, [t] and [d] phones between two
vowels are often produced as a flap (or referred to as a tap), [r]. For exam-
ple, say the word "butter" or "ladder" casually and note the quick move-
ment of the tip of the tongue as it briefly taps the ridge on the roof of the
mouth. Sometimes this movement is so casual that the tongue does not even
touch the roof of the mouth. This is an acceptable production of [t] or [d].
It is an allophonic variation in this particular context. Does this change the
meaning of the previously noted words? What would you think if a child
said "ladder" this way on an articulation test?
Say the word "leap" and then the word "cool" slowly. Concentrate on
the production of [l]. Do you notice any differences between the first and
the second [l] productions? These two different productions are termed light
"l" (leap) and dark "l" (cool) to denote the different ways "l" is articulated.
Discuss why this would be an allophonic variation in American English. In
Russian, these two types of [l] productions have phonemic value.

as in "spy" or "spot," for example. If you pronounce these words, you will find that
the puff of air, the aspiration that you noticed in "pie," is not present. However,
these allophonic variations exemplified by aspiration or lack of aspiration do not
have phonemic value within the phonological system of American English. In other
words, we can hear these differences, but both aspirated and unaspirated p-sounds
are considered one phoneme, / p/ .
As will be noted later, a current ASHA definition of "speech sound disorder"
uses "speech sound" as an umbrella term to designate both the physical realities
or forms (phones) and the linguistic functional abstraction of the phoneme. To not
confuse this issue any further, within this text physical form realities will be referred
to as phones and linguistic functional entities will be referred to as phonemes.
Phonology is the study of how phonemes are organized and function in a lan-
guage. Phonology includes the inventory of phonemes of the language in question,
thus a list of all the vowels and consonants that function in American English to
differentiate meaning. However, phonology also focuses on how these phonemes
are organized to convey meaning within a language system. Such a description
would include how the phonemes can and cannot be arranged to form meaning-
ful words. Phonotactics refers to the description of the allowed combinations of
phonemes in a particular language.
Phonotactics of General American English includes the fact that some pho-
neme combinations do not occur in American English words. An example would be
"sh" + "v." General American English does have other "sh" combinations, such as
"sh" + "r" (e.g., shrink) or "sh" + "t" (e.g., wished). The "sh" + "v" combination
does, however, occur in the phonological system of German. Words such as Schwein
(for "pig") document this as a phonotactic possibility in German.
Phonotactics also restricts some consonant clusters in General American Eng-
lish to their use in certain word positions, for example, the clusters / ski and /ks/ .
Words or syllables can begin or end with / sk/ (e.g., skate, risk), but this is not the
case with /ks/ . This cluster can occur only at the end of a syllable or word (e.g.,
kicks). This is a phonotactic characteristic of the phonological system of General
American English. A more complete discussion of the phonotactics of American
English will be presented in Chapter 2.
 Clinical Framework 7

Table 1.1 Phoneme Versus Phone

Phoneme Phone
The smallest unit within a language that is able, when Actual realizations of phonemes; also referred to as
combined with other units, to establish word meanings allophonic variations or phonetic variations
and distinguish between them
Linguistic unit, an abstraction Concrete, produced, transmitted, and perceived
Used in reference to a particular language system Can be examined without referring to a specific language
system
Basic unit within phonology Basic unit within phonetics
Notation is within virgules (e.g., "the /s/ phoneme") Notation is within brackets (e.g., "the [f] phone")

From early to contemporary publications, phoneme realizations have also been

labeled phonetic variations. Phones or phonetic variations can be examined with-
out reference to a given language system. This is not the case with phonemes. When
using the term phoneme, we refer exclusively to the function of the sound in ques-
tion: to its ability to signify differences in word meaning within a specific language
(refer to Table 1.1). Two words that differ in only one phoneme value are called
minimal pairs. Examples of minimal pairs are dog versus log and dog versus dot
How do these terms relate to our clinical decision making? Phones as end
products of articulatory motor processes are the units we are describing when
we use phonetic transcription to capture an individual's actual productions on a
standardized speech test or a spontaneous speech sample. Phones and their errors
relate to articulatory deviations. However, what if we notice that a child's produc-
tions of swing, sing, ring, and wing all sound the same, for example, that they all
sound like wing? The child is not using the necessary phonemic contrasts to signal
differences between these words. Both listener and speaker will probably not be
able to differentiate between these words because they sound identical. Now we
are analyzing the child's phoneme system, the child's ability to use phonemes
to establish and distinguish between word meanings. If this occurs consistently
throughout the child's speech, we could conclude that the child's phoneme system
is limited-that is, restricted when compared to the norm. Difficulties when using
phonemes contrastively to distinguish meanings relate to linguistic abilities, to the
individual's phonological system as one subcategory of language.
Phones, then, are related to motor, articulatory skills. On the other hand,
phonemes represent an understanding of the phonological system of a particular
language. Table 1.1 summarizes the differences between the phoneme and the
phone. The next section will examine disorders that are related to phone produc-
tion and phonemic differentiation. Current definitions as well as clinical examples
will be provided.

Defining Speech Sound Disorders:

Articulation and Phonological Disorders
The term speech sound disorder has been defined in various ways depending
on the date and the source of the definition. To stay current with ASHA, its more
recent definition of speech sound disorder will be used. This definition is located
8 Chapter 1

Figure 1.3 Definition of Speech Sound Disorders

Speech Sound Disorder as an Umbrella Term

It refers to o ne or more of the following areas of difficulty that affect intelligibility:

(1) perception , (2) motor production , (3) the phon ological realization of speech sounds
and segm ents, and (4) p roblems with phonotactic rules and prosodic elem ents.

A speech soun d disorder can affect the form or the (unction of speech sounds
within a specific language system.

Speech sound disorders that affect the form of speech sounds are custom arily
referred to as articulation disorders and are associated with structural
(e.g., cleft palate) and motor-based (e.g., apraxia) difficulties.

Speech sound disord ers that affect the functio n of speech sou nds
(phonemes) within a language system are tradition ally referred to as phonological
disorders and are associated with difficulties in the generation and use of phon em es,
pho neme rules, and patterns within the context of spoken language.

(Based on ASHA practice portal, n.d.-b American Speech-Language-Hearing Association)

on the Practice Portal of ASHA, which is a site intended to provide audiologists

and speech-language pathologists with current information that can be used in
their daily clinical practice. The goal of this website is to offer the best available
evidence and expertise in client care by identifying resources that are relevant and
credible. A portion of the definition of speech sound disorder is adapted from the
website and contained in Figure 1.3.
First, according to this definition, a speech sound disorder is an umbrella
term. Therefore, as a label, "speech sound disorder" is not just one entity but a
term used to represent several variations of deviant "speech." Different domains
can affect intelligibility, and any one child may demonstrate difficulties in several
of these areas. For example, perceptual difficulties may affect the child's ability to
accurately perceive the distinctions between "s" and "sh," and motor production
inconsistencies may also hinder the accuracy of articulating these two phones.
Also inherent in the definition is the fact that a child could demonstrate motor
problems together with phonological realization and phonotactic, rule-based usage
problems.
An important distinction still contained within the definition is the form
and function dichotomy. Although there seems to be some argument that this is
not a valid dichotomy (Buckingham & Christman, 2006, 2008), it does provide
a framework that can be useful for practitioners. Disorders that affect the form
of speech sounds (phones) are historically referred to as articulation disorders,
whereas phonemic functional difficulties are referred to as phonological disorders.
Let's examine articulation versus phonological disorders to see how they have been
typically defined.
An articulation disorder, as a subcategory of a speech disorder, is the atypi-
cal production of phones characterized by substitutions, omissions, additions,
or distortions that may interfere with intelligibility (ASHA, 2014). Articulation
errors are typically classified relative to a child's age, which translates into stages
within this developmental process. Younger children are at an earlier stage in this
 Clinical Framework 9

development, whereas older children are at a later stage or may have completed
the process. Depending on the age of the child, certain articulation errors may be
considered to be typical (age-appropriate errors) or atypical (non-age-appropriate
errors). When assessing an individual, we often gather information on the inven-
tory of phones used. The phonetic inventory is a list of all phones, including their
variations.
On the other hand, a phonological disorder, as a subcategory of a language
disorder, refers to the impaired comprehension of the sound system of a language
and the rules that govern these sound combinations (American Speech-Language-
Hearing Association Ad Hoe Committee on Service Delivery in the Schools, 1993;
ASHA, 2008). When an individual's phonological system deviates enough from the
norm, this could lead to a phonological disorder.
Phonology is closely related to other components of the language system,
such as morphology, syntax, semantics, and pragmatics. A child's phonological sys-
tem, therefore, can never be regarded as functionally separate from these aspects
of the child's language growth. Several studies (e.g., Cummings, 2009; Edwards,
Beckman, & Munson, 2004; Krueger & Storkel, 2017; Mortimer, 2007; Munson,
Edwards, & Beckman, 2005a; Roberts, 2005) have documented that delayed pho-
nological development can occur concurrently with delayed lexical and gram-
matical development. Although the direct relationship between phonological
and grammatical acquisition remains unclear, interdependencies certainly exist
between these areas.
Assessment of a child with a phonological disorder would include gathering
information about all phonemes that the child uses to distinguish meaning-the
phonemic inventory. The phonemic inventory is the repertoire of phonemes used
by the child to contrastively differentiate meaning. When compared to the phone-
mic inventory of General American English, we might find that certain phonemes
are not used contrastively in the child's speech-that is, the child's phonemic
inventory is restricted.
In addition, we might analyze the child's phonotactics by examining the
organization of her phoneme system. Children who have difficulties with the
organization of their phoneme system might not realize the phonotactics that
are typical for American English. Their speech may demonstrate phonotactic
constraints; in other words, the phoneme use is restricted, and the phonemes
are not used in all possible word positions. Constraints are any patterns noted
that seem to limit or restrict the productional possibilities of our clients (Blache,
2000). Phonotactic constraints could be evidenced if a child uses only certain
vowels or consonants in specific word positions. Thus, [k] could be used at the
beginning of a word but not at the end: "cat" would be [k~t] , but "cake" would
be [ker]. Phonotactic limitations when producing consonant clusters could also
be a constraint. For example, consonant clusters are used occasionally by a child
at the end of a word but never at the beginning: "clown" would be [kaun], but
"trains" would be [temt]. Constraints can vary; therefore, the clinician will have
to look at the transcription and see if any patterns of restrictions or limitations
are specifically noted.
Although the distinction between an articulation disorder and a phonological
disorder is important, it is not an either/ or dichotomy. Many of the children with
speech sound disorders will evidence characteristics of both types of difficulties.
These two types of speech sound disorders should not be considered mutually
exclusive, but rather consideration should be given to the impact that both articu-
latory and phonological difficulties may have in a child's distinctive profile. A child
may demonstrate problems with physically producing phones and using phonemes
contrastively to differentiate words. Both articulatory and phonological features