Speech Articulation Assessment

History

• 5yo M (Liam O'Connor, DOB: 12/05/2019, Medicare: 2948 58201 2) referred for initial ax of persistent speech sound difficulties and reduced intelligibility.
• Attended clinic on 24/10/2024 at 09:30 AWST accompanied by mother, Sarah.
• Alert, cooperative, engaged well with tabletop play-based tasks.
• Mother reports strangers understand ~60% of speech; child becoming frustrated at kindy when peers do not understand him. Nil Hx of recurrent otitis media; passed newborn hearing screen.

Physical Examination

• Oral motor exam: Anterior tongue tip elevation restricted during alveolar tasks; consistent interdental tongue protrusion observed at rest and during speech.
• Phoneme-specific findings: Consistent velar fronting (/k/ -> [t], /g/ -> [d]) across all word positions, interdental lisp on sibilants (/s/, /z/), and gliding of liquids (/r/ -> [w]).
• Connected speech: Intelligibility decreases in multi-syllabic words and rapid conversational speech; increased omissions of final consonants (/t/, /d/, /k/).
• Oral structure NAD: Hard/soft palate intact, nil submucous cleft, lingual frenulum WNL, dentition appropriate for age, bilateral diadochokinesis (DDK) rates mildly uncoordinated.

Impression

• Moderate phonological delay characterised by persistent velar fronting and final consonant deletion, alongside a phonetic articulatory error (interdental lisp) and age-appropriate liquid gliding.

Management Plan

Goals

1. Elicit accurate posterior tongue dorsum elevation for the velar plosive /k/ in isolation with 80% accuracy.
2. Produce /k/ in CV and VC syllables (e.g., "key", "ack") with 80% accuracy across 3 consecutive data sets.
3. Produce /k/ in single-syllable words (initial and final positions) with 75% accuracy during structured drill play.
4. Produce /k/ and /g/ in 2–3 word carrier phrases ("my [target]", "big [target]") with minimal cues.
5. Produce alveolar fricative /s/ in word-initial position using retracted tongue-tip placement (behind incisive papilla) with 70% accuracy.

Performance

• Goal 1: Achieved 75% accuracy (15/20 trials) for /k/ in isolation by end of session.
  • Applied tactile-kinesthetic cueing (tongue depressor to gently hold anterior tongue tip down) and metaphorical cues ("coughing sound").
  • Moderate visual (mirror) and tactile assistance required initially; faded to verbal cues only for final 5 trials.
• Goal 2: Achieved 50% accuracy in CV combinations (/kɑ/, /ki/); struggled with vowel transition without reverting to alveolar [t].
• Goal 3: Trialled briefly to establish baseline; 20% accuracy in word-initial position.
  • Targets trialled: "car", "key", "cow", "cup", "cat".
• Goal 4: Not formally targeted today due to syllable-level breakdown; baseline conversational observation conducted.
  • Spontaneous production of /k/ and /g/ in phrases remained at 0% (consistently fronted to [t] and [d]).
  • Future sessions to focus on stabilizing CV/VC transitions before advancing to carrier phrases.

Interventions

• Educated mother on the distinction between phonological processes (fronting) and articulation errors (lisp), demonstrating how to avoid reinforcing [t] for /k/.
• Supplied minimal pair picture cards (tea/key,igh/kye,art/cart) for 5 mins daily home practice focusing on auditory bombardment and isolation production only.
• Utilised auditory discrimination tasks (identifying "front" vs "back" sounds) where pt achieved 90% accuracy.

Plan

• Booked weekly 45-minute therapy blocks on Thursdays at 09:30 AWST for 8 weeks.
• Referred for formal pediatric audiological evaluation at Perth Children's Hospital to rule out mild conductive hearing loss prior to next block.
• Emailed Kindergarten teacher (Ms. Davies) the Intelligibility in Context Scale (ICS) and teacher feedback form to assess classroom functional impact.
• Review returned ICS form and audiology results to adjust therapy targets and confirm if palate/ENT review is indicated.