Speech Intelligibility Issues Related to DVD and Expressive Language Problems

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This is an interesting client and clearly you have a long and successful history with her. I would be asking two questions: (1) does she exhibit properties of developmental verbal dyspraxia (DVD) and (2) does she have an expressive language problem; language that is aggravated by word finding difficulties or sentence formulation problems or both? Answers to both of these questions may hold implications for what you might try.

If she exhibits DVD, you might want to explore DVD programs for segments that move productions from isolated words to connected speech. Children with DVD appear to have more trouble making the transition to connected speech than children whose problems are more strictly phonological. There is little evidence that oral motor exercises will facilitate this much. DVD programs often contain multiple steps to this transition process and authors usually recommend care in completing each of them. Chapter 8 in Smit's new text discusses several of these therapies [Smit, A.B. (2004), Articulation and Phonology Resource Guide, New York, NY: Thompson-Delmar].

Expressive language skills in children with severe articulation deficits are difficult to examine because poor intelligibility masks problems. It is conceivable, however, that one of the reasons the child is experiencing difficulty with the connected-speech transition is that the system into which the transition is to occur is impaired itself. This is analogous to teaching a young soccer player to kick the ball successfully and finding that he has trouble kicking the ball on the run - only to discover that running itself is a problem. So, does the child's syntax prevent her from planning and formulating sentences easily and thus present obstacles to the articulatory generalization process. Or perhaps she has difficulty finding words. In the presence of a word-finding deficit, she will have difficulty focusing on sounds she is trying to learn and use in running speech. In these cases, experimenting with intervention that targets appropriate expressive language elements may make the transition from isolated words to connected discourse smoother.

Dr. Clifford L. Highnam's interest areas are normal language acquisition and language disorders. He teaches classes in children's language disorders, language transcript analysis, communication problems of special populations and children's narrative. He conducts research in school-age language disorders. His doctoral work was completed at Bowling Green State University. He is affiliated with the Department of Communicative Disorders at the University of Northern Iowa where he serves as department head.