The “Case”:  Boy, Grade 1, public school.  English speaking.  Let’s call him … Finnegan! (A Mr. Dress-Up shout-out).

Referral Reason:  A couple “funny” things in his speech

The Situation:  Finnegan had completed previous language assessment and all scores were in the average range.  He still demonstrated a “mild speech sound delay”.

He had received speech therapy from age three until now (Gr. 1).  Now his speech was “ok”, there were just a couple tricky sounds and certain words he had difficulty with.  He was getting a “check-in” from time to time from the Speech – Language Pathologist at school.

Finnegan’s mom wanted him to receive speech therapy to correct those “funny little spots” and “few tricky sounds”.

I of course indicated that we could do that!  When I met with Finnegan and his mom and Peppered him with words and asked him to repeat what he heard.  There were some small articulation errors, but they weren’t really a concern.  More concerning were the occasional sound errors that often occurred within consonant clusters or within multi-syllabic words.

Finnegan would say “hippotonamus”.  He would say “thermnometer”.  He would say “whikser”.  And “basetball”.

Sound substitutions, sound deletions, and something called metathesis – mixing up the order of sounds.

Immediately, I stopped worrying about Finnegan’s speech.

I asked his mom how he was doing academically.  Finnegan was a bright boy, with a big vocabulary, and could easily express himself.  He could identify all of his letters and was learning some sight words. Upon further probing, he could not “sound words out” very well, he had difficulty with spelling, and he had difficulty telling you the sound that a letter makes.

Red Flags!  Letter names are not needed for literacy task.  When’s the last time you encountered a big word and thought, “hey, there’s a “double-u” in this word!!”? Sounds, on the other hand, are super important.  We see this frequently – these students fly under the radar.  They know all the letter names, which is a large focus in gr. 1.  They are acquiring so-called “sight words”, because they have a good visual memory – they are memorizing words.  When they have decent language skills and a good vocabulary, they can get by with gr. 1 literacy tasks.

However, these “mild speech errors” provide a window into how the brain is processing sounds – and it explains why our young Finnegan has trouble providing the SOUNDS that letters make, and why he can’t spell.  (He also had poor letter formation, including some reversals or backward letters).

What we are seeing is a problem sequencing and ordering sounds in speech.  However, the culprit, the underlying problem, is the sound processing part of the brain.  It is not accurately doing its job.

Finnegan demonstrated more errors in longer, more linguistically complex words (e.g., more consonant clusters).  He also made errors on less-familiar words like “disenfranchised” but could accurately say things like “hospital” and “ambulance”.

Speach Therapy Case Study

This very quick assessment probe told me a couple things:

i.) As less-familiar words were more difficult, he was relying very heavily on the meaning processing part of the brain to process speech and language.  The brain was compensating with a skill that was a relative strength.

ii.) As longer, more complex strings were more challenging, I knew there was a problem with phonological memory.

Phonological memory, or sound memory, is the ability to remember elements and strings of speech/language.  This is a specific component of memory that relates to LANGUAGE – it is different than memory for SOUND, such as having an “ear” for music.  It is a language-specific skill.  Children that can accurately repeat multi-syllabic words or repeat longer sentences with accurate grammar and ordering of words have an advantage in language learning.

Although we hear errors in speech, the difficulty with these phonological processing disorders is a disorganized or under-developed sound representation system.  Beyond unclear speech, the sound representation area of the brain is needed for all learning that occurs in the verbal-auditory modality (most of our educational system is built around speaking and listening!)

A phonological processing disorder can impact a child’s auditory comprehension and vocabulary acquisition.  They need more repetitions of new words and information to consolidate what they are hearing.  There is also an impact in learning sound differences, sound patterns, letter-sound correspondence, phonological awareness, and letter identification.  Being able to accurately remember all of the sounds in words is an advantage in decoding longer words, learning vocabulary through reading, and contributes to auditory and reading comprehension.

In other words, a phonological processing disorder can significantly impact the development of reading, writing, and spelling skills.

As such, we may rightfully be more concerned about phonological processing disorders, and we most certainly want to be concerned about VERY EARLY intervention.

However, that very thing is what sometimes gets these children in trouble.  We must be conscious that the disorganization in the underlying brain area for sounds exists below the surface.  It manifests as speech sound errors – this is how we know it is there.

However, we often respond to that poor speech with speech therapy.  And speech therapy alone is often not enough.  Speech therapy chips away at the “visual part” of the iceberg – the speech errors that we can hear.  Once the speech is corrected, and the child sounds “ok” like our poor Finnegan, we often neglect that the disorganization in the sound system still exists beneath the surface!!

Children like Finnegan often remediate their speech, only to have trouble with reading and spelling in later grades.  A comprehensive assessment and comprehensive treatment plan is needed when a phonological processing disorder is suspected.

Children with phonological disorders are at risk for difficulty with reading, writing, and spelling years after their speech has resolved!

In our story, the sound representation part of the brain is the iceberg.  Finnegan’s reading ability is the ship – steaming along until it runs into a major problem.

Unfortunately, our story doesn’t have a happy ending.  I, obviously, was Kate Winslett in this scenario, and I was going to save the day.  I advocated for completing the assessment and moving beyond speech therapy to work on literacy development (we work on sounds and speech this way too …).  Alas, his mom wanted to fix the speech, and “wait and see” if the literacy skills filled in naturally (they won’t!!) ☹.

Don’t let go, Finnegan!!  Don’t let go!

I actually see this a fair bit.  Within our system, children can receive PUF funding up until the end of Kindergarten.  Many Speech-Language Pathologists who are working in schools are working in Pre-k and Kindergarten.  However, they have a lens of early intervention, and getting these children “ready for gr. 1”.  As such, speech therapy is the mainstay – we need to get these children saying their sounds properly!  And yes, we DO!  However, because these therapists don’t follow these children beyond Kindergarten, they don’t see how they end up, and they miss out on the “big picture” of developmental literacy.

I know, I have worked in pre-k and Kindergarten in PUF programs.  However, I have also worked in schools where I served students from pre-K to gr. 12, and I know the Big Picture – we MUST recognize certain types of speech errors as a clear WINDOW to underlying disorganization and disorder in the sound system.  It is extremely costly not to.  It leads to literacy delay, learning disabilities, even dyslexia.

MANY children come into gr. 1 with their speech “mostly fixed”.  And so, they fly under the radar.  No one suspects there is anything wrong.  So, they don’t get any help or specialized instruction.  And they find a way to compensate – usually with visual memory and memorizing.  Which works … for a while (usually until about gr. 3, when the words become too numerous and too complex to memorize, and then the rug gets swept out from under the feet of these children).

I still have hope that Finnegan will find his way back to me and we can get his sound system organized!

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