What’s in a name?

Françoise and I are starting to get feedback on our book and we are beginning to hear that in the Québec community we are considered to be somewhat “out there” (in the words of one reader, “those two think differently”). Having spent 928 pages expounding on the many ways in which we think differently on the topic of developmental phonological disorders we are pleased that readers are noticing this. But we are surprised to find that the evidence of our “different thinking” is apparently in the title: readers are suspicious of the content of the book because our use of the use of the term “developmental phonological disorders” diverges from ASHA’s term “speech sound disorders”. Given that the preferred descriptor for children with inaccurate or unintelligible speech in Québec is “troubles phonologiques” this is somewhat puzzling but to be sure there are a myriad of terms in use and plenty of room for confusion. In fact we do not eschew the term “speech sound disorder” but see it as a broader cover term that encompasses all of the categories of speech problems that may be observed in children while “developmental phonological disorder” is a more specific subcategory described in the Speech Disorders Classification System (Shriberg et al., 1997).

Nonexaustive list of historical and current terms used to describe children who have poor speech accuracy (all combinations of items across the three columns are possible)

Developmental

Nondevelopmental

Primary

Secondary

Functional

Specific

(null)

Speech

Speech sound

Articulation

Phonological

Delay

Disorder

Impairment

Deficiency

Difference

In reference to the 1997 Speech Disorders Classification System the term Developmental Phonological Disorder refers to children with Speech Delay (persisting substitution and deletion errors in children younger than 9 years of age), or Developmental Apraxia of Speech, or Residual Speech Errors (an update to this nosological framework is described in Shriberg et al. 2010 and in our book). Nondevelopmental Speech Disorders and Speech Differences are excluded from the category. I retain the term Developmental Phonological Disorders from the 1997 framework because, as we demonstrate in our book, children in all these categories (Speech Delay, Apraxia, Residual Errors) face developmental challenges in the acquisition and integration of knowledge at the acoustic-phonetic, articulatory-phonetic and phonological levels of representation. Furthermore and most importantly, a majority across all three subcategories have specific underlying problems with phonological processing.

Speaking for myself, I am profoundly uninterested in any arguments about what to call this particular population of children. I would not criticize anyone else’s choice anymore than I would argue about whether the four footed friend currently sleeping on the dining table should be called “that darn cat” or “le maudit chat”. Ultimately, speech-language pathologists (or speech therapists or orthophistes) are constrained by local rules and customs. In the U.S. the terms “developmental” and “delay” are both avoided because the insurance companies apparently won’t support the treatment of developmental delays regardless of whether this makes any sense at all. Some battles are not worth fighting. We can let the insurance companies tell us what to call things but we shouldn’t let insurance companies (or psychologists or psychiatrists or neurologists or anyone else) tell our profession how to think about the children that we treat. It is important to always be clear about the characteristics of the children to whom we are referring. For example, it is quite common for reviewers to suggest that my research not be funded because, after all, speech delay is not really important given that children with speech delay have good outcomes unlike children with language impairment. This is a misreading of the long term follow-up studies in which the sub-population with “speech disorder” is usually defined to cover residual errors, voice and fluency cases. In those same studies, the selection of cases called “language impaired” will include children with concomitant speech sound errors or a past history of speech delay.  And as Anne Tyler has shown in her lab and we have shown in ours, children with poor speech intelligibility inevitably have difficulties with finite verb morphology, long considered to be a primary marker for specific language impairment. In other words, speech sound disorders cannot be less important than language impairment because many times we are talking about the same kids with the same underlying neurodevelopmental disorder of phonological processing.

Reading

Beitchman, J. H., Wilson, B., Brownlie, E. B., Walters, H., & Lancee, W. (1996). Long-term consistency in speech/language profiles: I. Developmental and academic outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 35. 804-814. http://www.jaacap.com/article/S0890-8567(09)60818-2/abstract

Haskill, A. M., & Tyler, A. A. (2007). A comparison of linguistic profiles in subgroups of children with specific langauge impairment. American Journal of Speech-Language Pathology, 16, 209-221. http://www.ncbi.nlm.nih.gov/pubmed/17666547?dopt=Abstract

Mortimer, J., & Rvachew, S. (2010). A longitudinal investigation of morpho-syntax in children with Speech Sound Disorders. Journal of Communication Disorders, 43, 61-76. http://www.sciencedirect.com/science/article/pii/S0021992409000823

Shriberg, L. D., Austin, D., Lewis, B. A., McSweeny, J. L., & Wilson, D. L. (1997). The Speech Disorders Classification System (SDCS): Extensions and lifespan reference data. Journal of Speech, Language, and Hearing Research, 40(4), 723-740. http://www.ncbi.nlm.nih.gov/pubmed/9263939?dopt=Abstract

Shriberg, L. D., Fourakis, M., Hall, S. D., Karlsson, H. B., Lohmeier, H. L., McSweeny, J. L., et al. (2010). Extensions to the Speech Disorders Classification System (SDSC). Clinical Linguistics & Phonetics, 24, 795-824.http://informahealthcare.com/doi/full/10.3109/02699206.2010.503006

Advertisements
Leave a comment

3 Comments

  1. Random

     /  July 15, 2012

    ‘Given that the preferred descriptor for children with inaccurate or unintelligible speech in Québec is “troubles phonologiques”…’

    Really? I would have thought it was “troubles de la parole”, therefore cunningly avoiding any mention of phonology when it could be severe artic./’apraxia’. I know a discussion of terminology is not the point but I do find it interesting to see potential differences when they may be describing slightly different problems.

    Reply
  2. Thank you Random for your comment. I’ve seen both but the orthophonistes and étudiants and étudiantes who were working with me on our recently completed trial of speech therapy interventions (Essai Clinique Randomisé sur les Interventions Phonologiques) used “troubles phonologuique”. I think again that it is an issue of super- and sub-ordinate terms within a broader framework. As to the question of apraxia of speech, that is very complicated with many differences in terminology across countries and across time (the re-organization of the Speech Disorders Classification System that I mentioned above largely involves an evolving conceptualization of motor speech disorders by Dr. Shriberg). That need involve a whole new post since it took me months to write the chapter on this (chapter 7) in our book. Anyway, I invite orthophonistes from Québec to weigh in. What do you call “speech sound disorders” and what do you think is the fundamental underlying problem in these cases?

    Reply
  3. FBrosseauLapre

     /  July 17, 2012

    When I first started working clinically in Quebec 10 years ago in French, “troubles de la parole” was indeed often used for severe articulation difficulties and/or suspicion of apraxia of speech. However the term was also then used to refer to difficulties with fluency, resonance, voice, and articulation (lisps, and problems at the level of the nervous system, such as dysarthria). The preferred use of “troubles de la parole” in Quebec is currently to refer to the latter. Most clinicians are now using “troubles phonologiques” – as Susan, I would be interested in finding out what other SLPs in Quebec are using, and what they think the underlying problem for these children is.

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: