University of Sheffield

Department of Human Communication Sciences

Language and Communication Impairment in Children
Course: MSc
Student ID: 050131309

Module: Child Case Assignment

CHILD STUDY PORTFOLIO

PART ONE – BACKGROUND INFORMATION

Introduction

The affected child is a 4-year-old Greek boy, whose mother tongue is Greek. The

reason why I chose to observe this particular child is that it has received speech

therapy only for a short time (since November 2006), and it presents phonological

disorders of various types. According to the leading SLT, the processes under

investigation are assimilation, cluster simplification, deletion or substitution of final –

s and fronting. Thus, the complexity and challenging nature of the disorder prompted

me to study this child. The child study is taking place under the leading speech and

language therapist’s supervision, who is also the owner of the speech and language

centre and I act as an assistant to the sessions and supervision of the child.

My objectives at this stage are to find out more about the various underlying

phonological disorders, to assess the child, be informed about the already proposed

and implemented plan and the effects it has had on the child, and implement my own

intervention based on the literature and theoretical background of speech and

language disorders.

Background information

Family history/background:

It is a four-member family, consisting of two parents and two children. Parents are

married and the name of the younger brother is Jim, two years old. No family member

or relative has a history of epilepsy or convulsions, mental retardation, learning

difficulties, difficulty in spelling, speech impairment or hearing impairment. The

language spoken at home is Greek, which is also the child’s L1.

Education:

The child joined the nursery school at the age of three and has never repeated a class.

He is currently attending a nursery school in Athens, Greece. He comprehends,

remembers and follows oral instructions or orders. He also remembers things in the

right sequential order. He learns better by listening to the person and he can

discriminate between the left and right. He also finds the right lexis in order to express

himself, but he has difficulty in organizing his thoughts and expressing himself

correctly.

Medical history since infancy:

The child is generally in good health and is not under any medication at the present

time. He has never been checked for visual problems or hearing problems. However,

his vision and hearing appear normal and unaffected. The SLT suggested ENT check-

up, but his mother is afraid of anesthesia. The child’s tooth condition is very good. He

has never undergone any surgery or admission to hospital, accidents or illnesses and

he has never suffered any psychological disorders. The child is often affected with

frequent sore throat and laryngitis and his parents denied his having earache and otitis

(although he often has). His vaccinations are valid.

Prenatal history:

This was the mother’s first pregnancy. During pregnancy she didn’t experience or

suffer any of the following:

excess weight, hemorrhage, high blood pressure, diabetes, chickenpox or mumps,

high fever, anemia, limbs swelling, Rh negative, dietical insufficiency and renal

infections. The baby came to life via caesarian section. It was a 39week incubation

and the baby weighed 3,150kg. The baby cried by the time he came to life and he

didn’t need any oxygen supply. He didn’t receive any special medication or therapy

during birth and he didn’t stay in the maternity ward longer than his mother.

Results of previous observations/assessments

Cognitive development

Regarding the child's cognitive development, it has not been assessed, but there are no

worries. The same applies to his perceptual skills.

Motor skills

The child used the spoon in order to eat on his own when he was 7-8 months and

walked without assistance at the age of 10 ½ months. He climbed up stairs (assisted)

at the age of 11-12 months and at the age of 2 years old (unassisted). He rode a three-

wheel bicycle using the pedals when he was three years old. He is left-handed, but he

uses his right hand in activities such as playing and sometimes in his eating habits.

Regarding his body coordination (stability, graceful movements, walking), it is good.

He holds the cutlery steadily and he has a good grasp of his pencil.

Speech and language history

The child’s phonological ability as an infant was moderate. He babbled as an infant

and he expressed his first words at the end of his first year. Two-word and three-word

combinations took place quite later. He already uses words in order to express
himself. Moreover, he always maintained interest when playing games, watching TV,

looked at illustrated books and being read to by somebody else. He never turns up the

TV volume more than the usual one. His speech is comprehensible by his parents, but

with difficulty by strangers, friends and relatives.

The therapist has used various techniques in order to guide the child through the

acquisition of phonemes that were not included in his phonetic repertoire. She guided

the child to produce /θ/ (dental), for instance, by asking him to twist his tongue in a

“sandwich” position. Moreover, her use of kinesthetic and tactile approaches was

evident. She used the child’s hand on his throat in order to feel the sound for /j/. The

phonemes /θ/ and /δ/ are not yet generalised. The therapist concluded that the child is

affected by a general immaturity (behavioural, psychological) and his speech

difficulties are just part of his general immaturity.

Characteristics of the child’s behaviour:

He is not characterized by anxiousness, stress, destructiveness, hyperactivity,

insomnia, irritability, withdrawal or any other problematic and awkward kind of

behaviour. He loves playing with other children, peers, older and younger ones. He

has no difficulty in standing still for specific temporal spans in order to complete a

task.

The child’s strengths can be summarized in being smart, having a solid memory, being

outspoken, easy-going and protective. Regarding his weaknesses, parents or

specialists have to often remind him of his limits and limitations, and specific

activities cannot be planned beforehand, especially his sleep pattern.

Suggestions for Further Investigation

My suggestions rely on the hypothesis that the child may probably face phonological

immaturity, since there are not any findings in the background information and history

that justifies his impairment.

The child should be assessed related to all aspects of speech and language. An oro-

motor assessment should take place along with a phonological one and connected

speech samples should be taken, in order to investigate the articulatory or

phonological impairment this child might be affected with and in order to focus on a

specific target and achieve it through the right intervention approach.

PART TWO – ASSESSMENT

Changes to original observation/assessment plan

The child was diagnosed as having an articulation impairment, i.e. an inability to

produce a perceptually acceptable version of particular phonemes, either in

isolation or in any phonetic context. Children may consistently produce a specific

distortion or substitute another.

Regarding the definition of terms which are going to be used in this study,

segments that occurred in word-final position after a vowel will be designated

simply as final. Initial will mean word-initial and pre-vocalic, and medial will

mean intervocalic unless indicated otherwise. The term substitution will be used

to designate the replacement of a phoneme by any other class of sound, e.g., an

affricate, /t/ for the fricative /s/.

After my tutor’s guidance and a more thorough observation of the child’s type of

phonological errors, I decided that I should work on his difficulty in producing the

alveolar fricative /s/ accurately in all positions (initial, middle, final), his //

substitution- a sound that is non-existent in the Greek language for /s/ and his /t/

substitution for /s/ in final word position. Final /s/ is always substituted for /t/. The

result is producing really awkward, but intelligible words in Greek. The child had

acquired most of the phonemes in his inventory /p, t, b, d, f, v, l, n, m/, although

the fronting process ended in /k=>t/, /x=>t/, /r=>l/, /θ=>t/ and /δ=>l/. The most

interesting part of the processes was his difficulty producing the right quality of /s/

as he produced a lateral one or the // phoneme in place of /s/ and the fact that he

substituted /t/ for /s/.

An explanation for this could be that during phoneme acquisition children usually

overgeneralize the most frequent sound in their language. /t/ in Greek is acquired

before /s/. The situation in English is equivocal. Earlier studies as stated in Eblen

(1982) show that /s/ is acquired before /t/, but Ingram et al. (1980), in a study of the

acquisition of fricatives and affricates found that /t/ was mastered earlier than /s/.

Based on the principle that earlier learned sounds are substituted for those learned

later, one could find support for a phonetic basis for /s/=>/t/.

The fact that there was no other research in this field in Greek, which made it even

more challenging was another reason why I chose to resolve this specific speech

problem.

Observation/Assessment Results

Assessment was carried out to provide descriptive and quantitative information about

the integrity of the subject’s speech motor system and connected speech samples were

inspected for appropriate use of semantic, syntactic and morphological structures.

Aiming at excluding all possible articulation problems, Ι used the Nuffield Centre

Dyspraxia Programme Assessment 2004, adapted to cater for the Greek phonological

system. After testing, he did not have any feeding difficulties, he did not drool and he

had full lip mobility in speech, while vowels were fully realized. After the single

sound imitation task, it was proved that he could achieve accurate lip placements for

the following speech sounds /p, m, b, f, v, t, d, n, k, g, l, a, e, i, o, u, ai, au/, but not for

the fricatives and affricates /s, t, d/. There appeared to be no problem with his

tongue and he could blow, he did not run out of breath when speaking, he had no

problem achieving plosion, but he had a problem achieving friction. There are no

concerns about the child’s voice quality, pitch, volume, intonation or prosody. Nor are
there any worries about his palate, nasal emission on consonants and there is no

history of cleft palate or nasal regurgitation when feeding.

Common sense suggests that if a child has a well-controlled range of lip, tongue and

palatal movements, he will find it easier to work on articulatory placement for speech

sounds. In particular, he will have more knowledge of oral structures (and words used

to describe them), more control in moving these structures and heightened

kinaesthetic awareness in his mouth. Therefore, he is more likely to be able to follow

instructions for articulatory placement.

To date the only available test for speech assessment in Greece is the Assessment of

Phonetic and Phonological Development (PAL, 1995), which is an adaptation of

Grunwell’s (1985) Phonological Assessment of Child Speech (PACS). However, SLTs

in Greece also use informal/home made single word tests and conversational speech

sampling during assessment. No studies have so far documented professional

practices on speech assessment. Also, there are no additional speech sampling tools

that have been developed for use with Greek children.

Thus, I administered the only Greek phonological test, which consists of 70 pictures

depicting all kinds of words and covers all types of phonotactic structures. However, I

adapted it to my target and I had the child say the word after listening to me. In this

test, he managed to produce just one item correctly /velona/ (=needle). The rest of the

items had at least one phonetic error. Regarding the production of /s/, in the 20 words

which contained /s/ in initial, middle, final positions or clusters, he didn’t manage to

produce /s/ whatever its quality. /s/ was always substituted for /t/ in all positions, he

simplified clusters containing /s/ by omitting it or he totally deleted in some items

when in final position. According to Stephany (1997) as stated in Papadopoulou

(2000) these processes (substitutions) 'represent a strategy for reducing the overall
segmental diversity and articulatory complexity of forms, while keeping their length

unimpaired. A large proportion of the words in Greek language is composed of

disyllabic and polysyllabic words. It appears that Greek children have employed a

number of strategies in order to be able to use these multisyllabic words; they do that

by taking into consideration the phonological structure of these words. In a nutshell,

there was evidence of a generalized speech problem, which had partly resolved when

I did the evaluation in February.

He was tested for single sounds, CV, CCV and VC syllables. His oro-motor skills

were intact. This test also provided evidence for what had already been expected in

the 25 non-words (CV, CCV and VC), he achieved 40% correct. In the complex and

multisyllabic words, chosen from the inventory of PAL’s phonological assessment

test, he did really poorly achieving 0/20 words.

As far as the picture naming test was concerned, he was given items containing /s/

grouped in thematic units and depicting really familiar objects, animals and people.

He had 4/20 items correct (20%) and he constantly displayed errors identical to the

previous assessments tests.

In assessing his connected speech sample, while he was describing what he did that

day before attending the session, he was quite intelligible, presenting the common /s/

difficulties, and as far as the connected speech checklist is concerned, he joined 2+

words together and used plosives, nasals and approximants in simple and complex

syllable structures. He used a full range of vowels, clearly recognizable. He did not

use the full range of fricatives and affricates and he did not use any clusters. He

achieved normal assimilation and elision and he achieved acceptable voice quality,

volume and oral/nasal balance, rate and rhythm, as well as stress and intonation

patterns in connected speech. In connected speech, the substitution of final /s/ for /t/ is
evident (he produces /miki maut/ for /miki maus/). /s/ in initial position is deleted

before plosives such as /p/, so /spiti/ (house) becomes /piti/.

Crirical evaluation of my findings

The tests administered excluded any oro-motor difficulties and led me to the actual

problem of articulation. All the tests showed that the child had a generalized problem

with some phonemes, but regarding the phoneme /s/, his difficulty was consistent and

the processes of substitution, simplification or deletion were consistent in respective

contexts.

Regarding clusters, in her thesis, Papadopoulou (2000) states that the findings on

cluster acquisition show that cluster acquisition in Greek follows the same patterns of

acquisition with English. More particularly, initial cluster acquisition in English is

incomplete between the age of 4;0 -5;0. In fact, cluster acquisition in English is only

complete by the age of 8;0. Also, similarly to the findings in Greek, the clusters that

compose of /s /+ plosive/fricative + r/ are not acquired at the age of 4;6.

My findings are representative, since they correlate with the leading speech and

language therapist’s findings regarding /s/. However, at the time of assessment, I

should have conducted a parent interview in order to clarify questions related to the

child’s history as well as to obtain additional information. That was not feasible, as

parents were not willing to disclose information to me.

Moreover, according to Daniloff (1977) in her methodological study of factors

affecting the judgement of misarticulated /s/, one of the most important factors in

assessing a child’s speech production is repetition of phrases or sentences, something I

did not perform - except for assessment of connected speech. Furthermore, I should

probably have tested his efficiency in two word phrases, potentially the borders
between the end of the first word (-s) and the beginning of the second word which

could be /k/, /t/ or /tr/. I am not sure what he would have achieved in this way. The

sample of connected speech does not have this kind of transitions and it is difficult to

figure out what the results would be in two-word phrases and not just isolated sounds,

syllables or words.

The results confirmed my original hypothesis that the child had a generalized

phonological immaturity. /s/ was just one of the difficulties. The really low

percentages in PAL’s phonological assessment test really verified my first

expectations.

I believe that the combination of the Nuffield Centre Dyspraxia battery with PAL’s

Assessment of Phonetic and Phonological Development was crucial to the child’s

speech assessment. Some key points for intervention should be that the child needs

both articulation and phonological approach intervention.

Intervention proposal

I am planning to use traditional articulation therapy (van Riper, 1996) in combination

with minimal pair therapy (Weiner, 1981). In traditional articulation programs,

production of a target sound is taught first in isolation. This is followed by training in

initial, final, and medial positions of nonsense syllables and real words. The child’s

use of /t/ for /s/ suggests a lack of phonemic contrast. In this case and given that the

problem is mild, minimal pairs (minimal oppositions contrast therapy) would be

suitable. The use of 'sh' for /s/ in initial and final is phonetic (rather than phonological)

given that a collapse of phonemic contrast is not apparent, since the 'sh' sound is

absent from the Greek phonetic inventory. As it is a phonetic problem, then traditional

articulation therapy may be beneficial.

However, the child is stimulable for /s/ and he can produce a ‘contrast’ between real

and nonsense minimal pair words. The other approaches, cycles (Hodson) or whole

word (Dodd) would not be appropriate. Cycles approach is for child with a severe

phonological impairment and Barbara Dodd's core vocabulary approach is for

children with inconsistent deviant speech disorder, which is not the case with this

child, as he produces consistently the same speech error.

My target is to correct his lateral misarticulated /s/ or his stressed and awkward //

production and to correct his substitution process of /t/ instead of /s/ as a final

consonant of words. Whereas the traditional articulation approach is effective with

children who demonstrate difficulty with a limited number of sounds, a combination

with the phonological approach is better suited for use nowadays as whatever the

severity of the impairment is, it can always stimulate the phonological mechanism

networks and intervene in language as a whole.

The child’s problematic phonological production is due to mild phonological

acquisition difficulty and articulation difficulty. When the child first visited the SLT,

he was barely intelligible, except for his parents. In a few months he managed to

acquire and produce some consonants. However, much work and insistence is

required so as to acquire a complete phonetic repertoire. One of his major difficulties

is the lateralization of the phoneme /s/ in all word positions, producing // as in /fish/

or /shoe/. However, in the Greek language this phoneme is non-existent, and when

words are pronounced in this particular way, a special dialect is denoted (as in Crete, a

Greek island, in whose dialect/idiolect /s/ can substituted for //, without a difference

in meaning).
Moreover, the /s/ in final position is always substituted for /t/, which leads to partial

unintelligibility. For instance, /aδelfos/=(brother) becomes /aδelfot/=non-word, or his

favourite team /Olympiakos/ becomes /Olympiakot/.

I decided that three months (three blocks) with two 45-minute week sessions would

address the problem. The leading SLT would be working on the rest unresolved

phonetic immaturities or lack of specific phonemes in his phonetic inventory. The

delivery of the programme would take place in the speech and language centre in

Athens, Greece and I would use three blocks (8 sessions/month each) to deliver it.

During these sessions, the child would follow my own instructions and my own

therapy plan and the SLT would not get involved.

PART 3 INTERVENTION

Block 1 (8 sessions)

I started off with the traditional articulation therapy approach (van Riper &

Erickson,1995). Phonetic placement was the first target to achieve. It has been shown

to be effective for teaching a child how to say a new sound (Powel, Elbert, Miccio,

Strike-Roussos, & Brasseur, 1998). It helps children achieve correct placement of the

articulators for production of new speech sounds. However, phonetic placement

should not be confused with oral motor exercises that target strength, speed, and range

of motion of the articulators when producing movements outside of a speech context.

There is no evidence that these oral motor exercises are effective and some evidence

that they are unnecessary if not potentially counter-productive.

I guided the child and gave him direct instructions in the mechanism of alveolar

fricative /s/ production. I asked him to place his tongue as if touching his front teeth

and then let the airstream flow in front. I demonstrated the correct tongue position

for /s/ and compared it with what the child was doing. I referred to this tongue

position as the “butterfly position” i.e., the position for /i/ as in /tin/ and I pointed out

to the child that the lateral margins of the tongue are in contact with the teeth. I told

him this makes a “groove” for the air to “shoot down” so that when the say /s/ the air

will come straight out in front.Motor exercises and sensory-motor training

(McDonald, 1971) were implemented. I placed the child’s hand in front of his mouth

and asked him to let out a slight stream of air. The child produced a lateral /s/. As a

final exercise for /s/, I drew a snake and asked the child to track down the snake and at

the same time producing the hissing sound /s/. The /s/ was again constantly lateral.
Fortunately, the phoneme /t/ was part of his phonetic repertoire and I based my next

session on this. I had the child repeat the /t/ rapidly and say “t—t—t—t” and I

eliminated as much vowel sound as possible but if a vowel must be added it should be

/i/. The /i/ supports tighter placement of the lateral margins of the tongue against the

teeth needed to prevent lateral escape of air. When the /t/ was repeated rapidly, I

began to hear a slight /s/ between them. Then, I prompted the child to listen for it as

he says it and I had him say the /t/ sound letting a little air come out the end of the

sound. I demonstrated that for him. I did not tell him to say /s/, but only let the airflow

after the /t/. This produced the /ts/ sound. We sharpened it in a short while and then

had him practise this sound until he did it easily.

I put the sound into words (initial, middle, final). So, I had him repeat the following

words which contained /ts/ in all positions.

Table 1. /ts/ in initial, middle and final position

Initial Middle Final

/tsai/ /votsalo/ /donats/
/tsakali/ /karotsi/ /plats/
/tsekuri/ /katsariδa/ /sadwits/
/tsepi/ /katsaros/ /skets/
/tsiγaro/ /katsika/ /sorts/
/tsoas/ /koritsi/ /mats/
/tsuvali/ /paputsi/
/tsukali/ /pitsa/

Over a period of time, I had him practise other /ts/ words and I always put the words

into simple sentences without other /s/ words. I found out that if the /ts/ word was at

the end of the sentence, it was usually easier for the child. I used again discrimination

tests to establish the phonological difference between /s/ and /ts/. By the time this was

completed, the /s/ had been sharp and clear. Now is must be separated from the /t/. I

had the child say the /ts/ without moving his tongue and add the /s/ (/ts—s/). It is
better not to mention the tongue unless it is necessary. This is often difficult at first,

but if it is taken slowly with repeated encouragement, the child can learn it.

I implemented therapy in steps, with the child mastering each one before proceeding

to the next. Production started at the isolated sound level and then progressed through

syllables and higher levels of production. After the partially qualitative production

of /s/, since it was sometimes lateral and sometimes he changed his place of

articulation producing the postalveolar fricative //, I introduced syllables starting with

phoneme combinations, s+i=si, s+a=sa, s+e=se, s+o=so, s+u=su. Using verbal cues, I

tried to make him mimick the syllable /si/ at the beginning of words. I used /i/ as the

vowel initially to use the benefits of the anticipation of the sides of tongue to teeth

placement. /s/ followed by a vowel in is the hardest step, but should come easily if the

proceeding progression has been followed. Finally, I taught the medial /s/ words with

the /s/ at the beginning of the syllable and followed by a vowel. All the word items

were chosen to include front, central, and back vowels.

I used kinesthetic techniques such as joining his two hands together, his left for /s/ and

his right for/i/ and while joining, I prompted him through visual cues to produce the

syllable /si/ and so on. He produced all syllables as he had no problem with the

vowels.

Table 2. /s/ syllables in all word positions

/s/ initial /s/ middle /s/ final

/saka/ /mesa/ /aδelfos/
/salami/ /parisi/ /sismos/
/sela/ /kaseri/ /klistos/
/sedoni/ /kaseta/ /pistos/
/sikono/ /kerasi/ /teras/
/sirina/ /melisa/ /tixos/
/soma/ /kasetina/ /sovaros/
/sokaki/ /masao/ /filos/
/supa/ /masuri/ /orofos/
/suvlaki/ /musuδa/ /melos/
He needed verbal cues for the production of /s/ in initial position for quite long and

most of the time he substituted /t/ for /s/, or whenever he managed to produce it, it

was lateral. I used drills with /s/ for a better quality and I emphasized on the duration

of /s/ in final position for better quality. There was also a discrimination between the

personal pronouns (nominative) ego (I) and esy (you).

I did not involve clusters in my therapy, since there were already two really difficult

matters to deal with, and unless these were resolved, the child would not be able to

move on to the production of clusters. Even though Hodson and Paden (1991), in

treatment plans created for a 4-year-old child who had poor speech intelligibility,

recommend targeting /s/ in a consonant sequence, rather than as a singleton, especially

if the child substitutes stops in place of stridents, since the initial singleton /s/ was not

in the inventory, /s/ clusters were not considered appropriate targets.

Block 2 (8 sessions)

In this block I tried to incorporate the phonological approach. Edward Klein believes

that this child probably at one time had "Stopping of Fricatives" for all the fricatives

in Greek. However, he has "discovered" the feature of frication and is applying it (in

his clumsy way) to the sounds in the initial and middle position of words. He is not

yet doing it in the final positions - but he believes that both errors are related to each

other. Bearing in mind the fact that articulation disorders (or functional speech

disorders, Caroline Bowen, 2003) are resolved better when the linguistic part of the

language is also accessed, I designed the second and third blocks based on

phonological therapy. Klein (1996) has given us a plethora of reports supporting the
greater effectiveness and efficiency of phonologically based approaches to the

treatment of children with speech disorders.

According to Susan Rvachew (2006), it does appear that the decision to work on

patterns of speech errors is more efficient and effective than teaching sounds one at a

time. Research also suggests that it is best to begin with the easier sounds first

(Rvachew & Nowak, 2001, 2003). More recent phonological approaches address the

child's phonological system by working on patterns of pronunciation errors.

So, I tried to get him to understand the difference between the two types of sounds

(fricatives and stops) at the nonsense syllable level first and have him produce

syllables representing both classes. It seems like a straightforward phonological

problem to me - regardless of the language.

Table 3. Syllables for discrimination between fricatives and stops

Target Response
/sa/ /Isa/ 
/se/ /Ise/  The next stage of the second block of the
/si/ /Isi/ 
/so/ /Iso/  treatment was auditory discrimination in order
/su/ /Isu/ 
/tsa/ /ti/ X to remediate a supposed underlying auditory
/tse/ /te/ X
/tsi/ /ti/ X discrimination problem. The child was required
/tso/ /to/ X
/tsu/ /tu/ X to discriminate accurately (e.g. sort into words
/ta/ /ta/ 
with a final sound versus words without a final
/te/ /te/ 
/ti/ /ti/ 
sound) and recognize each pair of words. The
/to/ /to/ 
/tu/ /tu/ 
child was then required to start producing the
// /da/ X
// /de/ X minimal pairs, initially in imitation, and then
// /di/ X
// /do/ X spontaneously. Feedback was given regarding
// /du/ X
/as/ /at/ X the pattern being targeted. For example, the
/es/ /et/ X
/is/ /it/ X presence of a final sound (/kalo — no/kalos —
/os/ /ot/ X
/us/ /ut/ X Student ID: 050131309
TOTAL 10/25 Year In. Reg.: 2005
40% Course: Child Study
yes), what the final sound was (e.g. ‘kalos has an /s/ on the end… kalo — s’ and

whether or not the child had used the sound appropriately (e.g. ‘I didn’t hear an /s/ on

the end when you said /kalos/ — it sounded like /kalo/ to me’). In order to clarify this,

I should explain that /kalo/ is in accordance with neutral nouns such as /kalo peδi/

(=nice child), whereas /kalos/ is in accordance with male nouns such as /kalos andras/

(=nice man). The suffix /s/ in Greek adjectives denotes the gender of the following

noun. Similar linguistic and communicative feedback was given throughout each

stage of intervention and for each error pattern targeted. The meaning or

communicative basis for the contrast was maximized throughout intervention. The

following table depicts pairs of words for the discrimination task.

Student ID: 050131309

Year In. Reg.: 2005
Course: Child Study
Table 4. Auditory discrimination training for /s/ and /t/ in all positions and the
presence of a final sound /s/ or no sound
/saita/ - /taizo/  /pezo/ - /pezos/ 
/savato/ - /tavani/  /pezi/ - /pezis/ 
/salata/ - /taratsa/  /psito/ - /psitos/ 
/sabuan/ - /tabela/ 
/sapia/ - /tapa/ 
/sakula/ - /takuni/ 
/selini/- /tetarti/ 
/seliδa/ - /tetraδa/ 
/sedoni/ - /tedoni/ 
/siropi/ - /timoni/ 
/siδero/ - /tipota/ 
/siko/ - /tixos/ 
/supa/ - /tuba/ 
/surupo/ - /tubano/ 
/kaθaros/ - /kaθarot/ 
/aδelfot/ - /aδelfos/ 
/papus/- /paput/ 
/foret/ - /fores/ 
/stafili/ - /tsafili/ 
/trivo/ - /strivo/ 
TOTAL: 23/23 (100%)

Meaningful minimal pair activities can be used to help the child discover the

communicative function of different speech sounds. This approach was shown to be

effective in a study using a single subject research design (Weiner, 1981). However,

this procedure may not be effective unless the clinician first ensures that the child can

hear the difference between the error and the correct form and has at least some

understanding of how to produce the target sound correctly (Rvachew, 2005). There

was extensive use of modeling and subsequent requests for direct imitation on the part

of the child.

Table 3. Minimal pairs

Minimal pairs
/pali/ - /sali/ 
/jela/ - /sela/ 
/kupa/ - /supa/ 
/papia/ - /sapia/ 

Student ID: 050131309

Year In. Reg.: 2005
Course: Child Study
 /ferno/ - /serno/ 
/milo/ - /miso/ 
/trivo/ - /strivo/ 
/boro/ - /soro/ 
/krati/ - /krasi/ 
TOTAL: 10/10 (100%)

The child achieved 100% success and he managed to find out why these words were

different after listening to them by me. Thus, there was no auditory discrimination

problem.

Block 3 (8 sessions)

In the final block, he had to describe ten funny pictures which contained words having

/s/ in all positions. He did very well (88% correct, clusters considered correct). He

produced /s/ in word initial and final position, but he still produced /plaini/ and

/mea/ instead of /prasini/ and /mesa/. Some of the words contained initial clusters

which he simplified (eg /sk/ to /k/ as in /skoupizei/ which was realized as /koupizei/ or

/maska/ as /maka/). It is also interesting to note that while he produces initial /s/ in

cluster /st/, eg /stafili/ becomes /safili/, when the cluster /st/ is in middle position he

deletes /s/, eg /pirosvestis/ becomes /pirovetis/. Moreover, we can see the process of

metathesis as /stoli/ is realized as /tsoli/. His /ts/ has already been acquired as can be

seen in /tsekouli/ and /kolitsi/.

The second step involved showing flashcards containing words with /s/ in all

positions and he had to produce the word depicted. Whenever he did en error, he was

prompted by me and he gave an accurate production. He produced initial and final /s/

correctly, but he misarticulated middle /s/ substituting it for //, as in /vailias/ and

/vasilia/ achieving 87,5% correct. I continued with the task of repetition of words
Student ID: 050131309
Year In. Reg.: 2005
Course: Child Study
containing initial and final /s/, in which he achieved 50% correct and his production

was characterized by lateral initial /s/ and some final /s/substitutions for /t/.

Outcomes and influences

After the intervention I conducted, I tried to assess the benefits and results. I retested

the child for the last time in order to assess quantitative and/or qualitative learning

that has taken place so far. During May there has been an improvement of the quality

of /s/.More specifically, he managed to produce correctly the syllables /si/, /so/,

/su/, /sε/, but in /sa/, his /s/ was lateral. There was finally an improvement in the

production of /s/ in initial position, but it was a little bit lateral in middle position.

After the intervention, he could produce /s/ in words in all positions (initial, middle,

final), but with some correction in the description of pictures.

I presented him with two pages full of coloured pictures, which contained /s/ in initial,

middle and final position. Regarding the words in these pages, it was evident that he

had mastered the final /s/. Thus, there was no /s /substitution for /t/, however he

sometimes produced a lateral initial /s/. Another test I administered was the

description of the objects he could see in two pictures depicting daily activities-

watching TV and playing in the room, in which he achieved 91% of target items

correct. Some of the words contained middle /s/ and this was sometimes realized as a

lateral, but clear one.

Student ID: 050131309

Year In. Reg.: 2005
Course: Child Study
In Greek, a group of words that end in final /s/ is the ordinal numbers in masculine

gender. He was given a sheet with cats (male) in a line. There was only one red cat per

line and the rest were black. The child had to count and find the order (ordinal) of the

red cat. He produced the final /s/ correctly, but he had difficulty counting in ordinal

numbers, and that explains why he used cardinal numbers instead.

In the last part of reassessment, connected speech, he had to describe what he and his

family did yesterday. He was not always accurate and he sometimes substituted /s/

for /t/ as in /metito/ or in /balet/ which should be /bales/. So we can see some

remitting features, but with visual cueing, he was able to produce the items correctly

and he was aware of his error. We should note that the morphology of the item does

not play any role for the specific child. /s/ in Greek also denotes the plural number of

most of the masculine and feminine nouns. He seems to sometimes substitute /s/ for

/t/, no matter if the /s/ is the final consonant of a word in plural number as in /bala/

(singular), /bales/ (plural), or if it is just the last consonant of a word in singular

number as in /aδelfos/, /aδelfot/(brother,sing.).

Evaluation and Future management

I was really satisfied that the child managed to produce /s/ in final word position most

of the time. He also improved the quality of /s/ in initial and middle position with

some remissions.

During the course of this child case, I have developed crucial skills to the factors

taken into consideration before deciding on a therapy approach and I found out that no
Student ID: 050131309
Year In. Reg.: 2005
Course: Child Study
single solution is the answer. The therapist should be flexible and imaginative and

always try to achieve specific targets using a spectrum of approaches, since different

targets are achieved using different methods. I have to make a great deal of

improvements, since only by attending and working on a load of child cases and doing

a lot of personal research, will I manage to acquire the necessary experience to cope

adequately with speech and language impaired children.

(6010 words)

Student ID: 050131309

Year In. Reg.: 2005
Course: Child Study
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Student ID: 050131309

Year In. Reg.: 2005
Course: Child Study
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Student ID: 050131309

Year In. Reg.: 2005
Course: Child Study
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Student ID: 050131309

Year In. Reg.: 2005
Course: Child Study