Happy Better Hearing and Speech Month! This post has been sort of percolating for a while and with Better Hearing and Speech Month’s focus on early intervention and the recent influx of new grads it seems relevant.
Recently, while speaking with many of my SLP friends on twitter, some expressed distress that articulation norms are so often misunderstood or misused. I wanted to write a post about it a few weeks ago and prudence dictated I wait until I wasn’t quite so…frustrated.
Then, a couple days ago, I had the distinct pleasure of reading a post on the way language milestones are often misunderstood. That post, from Teach me to Talk, is available here. I have to say, I honestly hadn’t considered how language milestones are interpreted…but it’s absolutely true they are misunderstood or maybe ignored much the way articulation norms are misused.
But it really drove home how we tend to view milestones or normative charts not as how they were meant to be used – but how they best work in our favor.
Did that poke a bit? I’m sorry…Let me explain…
I recently had the joy (and it was fun) to help out at a kindergarten screening for a nearby town. The SLP in that town is experienced, knowledgeable, and competent. I was surprised to see how she interpreted the Iowa Nebraska norms that we use in our eligibility rubrics. (note: I have no data to show that her interpretation is harming or helping the kids.) When expressing my distress over this misunderstanding on twitter, I was reminded that it is not just this one SLP who misinterprets these norms.
So, for the purpose of clarity here. This is the Iowa-Nebraska norms available in many places by googing “Iowa-Nebraska artic norms.” I retrieved this from our ND Guidelines that we use for eligibility for speech and language.
When you look at this chart, it seems fairly straight forward. The ages on the chart are when 90% of kids produce the sound correctly.
Now, I have some issues with this chart in and of itself. I’ve blogged before about how it compiled information and is wrong…BUT, for better or worse, it’s the “norms” we’re stuck with using. For the record, different charts have /s/ and /r/ as developed in the majority of kids by age 4 but that’s a different rant.
When you look at the left side of the chart – you can see that /s/ is listed as developed at age 7 and /r/ is listed as age 8.
On the right hand side of this chart, there is a breakdown of “word-initial clusters.” You can see that /sp, st, sk, sm, sn, sw, sl/ are all listed as the age of acquisition to be 7 years. While /r/ blends /pr, br, tr, dr, kr, gr, fr/ are listed as developed at…you guessed it…age 8.
This chart, in and of itself, does not mention WHY it talks about /s/ blends and /r/ blends as developed at those ages, but it’s not a big leap to figure out it’s because that’s when /s/ and /r/ are developed (according to them).
HOWEVER…this is for ARTICULATION!!!
That means that the child should be able to produce a true /s/ (no lisp) in a blend at age 7. It does NOT mean that it is perfectly okay for a child to not have clusters until age 7.
Let me make sure you heard me…
This normative chart does NOT mean that the phonological process of
cluster reduction, simplification, or deletion is age appropriate until age 7.
It simply means the child may have a frontal lisp or an /r/ distortion in blends until that age (which is a no brainer because we’re not going to expect perfect in blends before we have them in singletons).
This chart is ALSO in the ND guidelines (I believe it’s taken from the Kahn Lewis information and possibly from Barbara Hodson’s book).
This chart lists when phonological processes should be eliminated. If you look closely, you will see that Consonant Cluster Reduction (top for stop) should be eliminated by age 4 and gliding (weed for read) should be eliminated by age 3-6.
So, in other words, when a child presents with a cluster reduction /top/ for /stop/ or /sop/ for /stop/ at age 5 this is an ERROR and is no longer developmental.
By the same token, if the child presents with /bed/ for “bread” this also is an error and should be eliminated by age 4…where if they say /bwed/ for “bread” this could be considered typical until age 6.
Cluster reduction is the OMISSION of one of the two sounds in a cluster. Omissions are ALWAYS bad and affect intelligibility (that’s pretty simple but true).
When we were doing screenings, the SLP (who was in charge as it was her caseload she was dealing with) considered cluster reduction to be developmentally appropriate for 5 and 6 year olds and would not consider them as candidates to be rescreened, tested, or seen for speech until that time. Conversely, she was very concerned when kids did not have “sh” and “ch” by age 5 and those students warranted rescreening and possible testing (which is weird because the norms have those sounds as in by age 6).
When I was discussing my confusion on twitter…(you know, when you have those moments where you wonder if maybe YOU’RE the one who is wrong)…I was reminded that many SLPs misinterpret the norms. I have no idea if this SLP misread the norms because she truly misread them (I’d like to believe this) or because she didn’t want to have those additional students potentially on her caseload. I have no idea what her caseload looks like although I can imagine that it’s fairly large given the size of the school. I know many SLPs refuse to adjust how they read the norms because it would potentially inflate their already over-large caseloads.
I’m surprised more SLPs don’t see that treating sound disorders early is key.
Like all early intervention, if we hit it early and hit it hard, prognosis is better.
I have to give a massive shout out to my professors at Minot State University because they absolutely drilled HOW to read norms into us until I’m fairly sure we could all recite them in our sleep.
Here’s a synopsis of common “milestones.”
- stop omitting sounds in clusters by age 4
- be 100% intelligible to strangers by age 4 (they may not have 100% articulation but should be able to be understood)
- have 50 words or more by 18 months.
- know over 1000 words by age 3.
My concern is that I already hear SLPs say “I don’t work on articulation in the schools” or “I don’t’ work on /r/ or /s/ until at least age 9 it’s not developmental until age 8 anyway.” Will I start hearing SLPs say kids don’t need language until age 3 or It’s developmental for your kid to only have 20 words when they start preschool. I am concerned that this is the direction we’re heading.
I think the question I’m afraid to ask is how many SLPs would change their practices if they read the norms correctly…or how many would be unwilling to because of the additional workload. The other question I have is where do ethics fall into it. Not just the code of ethics (although I suspect that could already be called into question)…but our personal ethics. Nope…I’m not asking. I’m pretty sure the answers will sadden me.
Hmmm. This post seems to have taken a negative turn and that was not the intent. So…In order to lighten things up a bit…and reward for reading all the way to the end.
Please leave a comment here about milestones OR an anecdote about one of your students (with names removed of course). On 5/17/15 at 9:00 PM central time, I will announce a winner. The lucky winner will will a code for their choice of one of my apps (yes, that’s a shamelss plug but you have 5 to choose from and can always gift it to someone else if you happen to have all 5 already).
Until then…Adventure on!