PHONOLOGICAL ANALYSIS OF THE SPEECH OF CHILDREN WITH CLEFT PALATE Tessa Ann Goldsmith A Dissertation Submitted to the Faculty of Arts, University of the Witxatfirsrand Johannesburg, in Partial Fulfilment of the Requirements for the Degree of Master of Arts in Speech Pathology Johannesburg 1985 DECLARATION I declare that this dissertation is my own, unaided work. It is being submitted for the degree of Master of Arts in Speech ' Pathology to the University of the Witwatersrand, Johannesburg. It has not teen submitted before for any degree or examination in any other university. Tessa Goldsmith 24th day of December, 1985. ACKNOWLEDGEMENTS I would like to express my sincere gratitude to the following people: Mrs Margaret Wahlhaus, Senior Lecturer, Department of Speech Pathologj' and Audiologj/, University of the Witwatersrand, Johannesburg, for her invaluable guidance and constant encouragement as supervisor. • Ms Lesley Wolk, Lecturer, Department of Speech Pathology and Audlology, University of the Witwatersrand, Johannesburg, for her valuable contribution in the planning of this study and her useful comments on earlier drafts of this research. Professor Anthony Traill, Associate Professor, Department of Linguistics, University of the Witwatersrand, Johannesburg for his assistance as formal consultant, particularly with regard to clarifying theoretical issues. Or Michael Saling, Senior lecturer. Department of Psychology, University of the Witwatersrand, Johannesburg for his help with aspects of research design and quantitative management of the data. Professor M.L. Aron, Director of the Speech and Hearing Clinic, University of the Witwatersrand, Johannesburg, Dr L. Kalmyn, Superintendent, Johannesburg Hospital and clinicians in private practice for granting me access to subjects. My postgraduate friends and colleagues, Marlene Carno Jacobson and Aletta Sinoff, for their unfailing support, encouragement and invaluable suggestions in all aspects of this research and for affording me the opportunity to experience true sharing of knowledge. Fellow speech therapists Marlene Sehrroann, Meryl Kobrin and Denise Anderson for their generous assistance, clear thinking and support throughout. Mrs Brenda Louw and Mrs Anita van der Merwe, Department of Speech Science, Speech Pathology and Audlology, University of Pretoria for their useful suggestions. Miss Karen Esakof for giving of her time so generously In the phonetic transcription of the speech samples. Or Laurence Chait for the Interest in cleft palate he inspired and for clarifying issues pertaining to the surgical management of children with cleft palate in Johannesburg. The subjects and their parents who willingly co-operated to make this research possible. My family, for bearing with me through the "ups and downs" of this research. My husband Clifford, to whom particular thanks are owed, for sharing my aspirations and disappointments and for his unfailing tolerance and understanding. I gratefully acknowledge South African Inherited Disorders Association - Cleft Pals for their financial assistance. ABSTRACT This study concerns the description of speech sound production errors of cleft palate children in terms of phonological processes. Eight four-year old children with repaired clefts of the palate were studied. Speech" samples were obtained from an object naming task and a structured connected speech task. Results were analysed in terms of group and individual subject performance. In the group analysis, eleven phonological processes were identified. These comprised mainly substitution processes but syllable structure processes and assimilation processes were observed. Some of these processes were considered as being typical of children with normally developing phonology, others suggested patterns of phonological delay, and still others, patterns of phonological deviance. Noteworthy was the heterogeneity of process occurrence; no two subjects showed the same sets of phonological processes. Some processes, were however, present in all eight subjects. In addition to phonological process analysis, contrastive analyses were performed on the speech samples for each subject. The results of individual analyses indicated that the subjects showed a reduction in their systems of phonemic contrasts as they were unable to make meaning differences between some classes of sounds at the level of speech output. Diagnostic and therapeutic implications of the findings of the study were considered. TABLE OF CONTENTS Chapter Page FIGURES.................................................................................................... vii TABLES......................................................................................................................vm ONE INTRODUCTION ........................................................................................ 1 I. TERMS USED IN THE STUDY ........................................................ 6 II. DESCRIPTION Of CHAPTERS .......................................................... 7 TWO ETIOLOGICAL FACTORS RELATED TO SPEECH SOUND PRODUCTION ERRORS IN CHILDREN WITH CLEFT PALATE ....................................... 9 I. FEATURES OF DISORDERED SPEECH SOUND PRODUCTION IN PRESCHOOL CLEFT PALATE CHILDREN ........................................ 9 II. FACTORS CONTRIBUTING TO DISORDERED SPEECH SOUND PRODUCTION IN CHILDREN WITH CLEFT PALATE ...................... A. Speech mechanism factors .............................................. B. Developmental factors ............................................ C. Psychosocial factors ...................................................... III. SUMMARY ......................................................................................... THREE THE APPLICATION OF PHONOLOGICAL THEORY TO DISORDERED SPEECH SOUND PRODUCTION ................................................................ I. CLASSIFICATION OF DISORDERS OF SPEECH SOUND PRODUCTION .................................................................................. II. CLINICAL APPLICATION OF PHONOLOGICAL THEORY TO THE EVALUATION AND TREATMENT OF SPEECH SOUND PRODUCTION DISORDERS ..................................................................................... A. Taxonomic phonemics ........................................................ B. Generative phonological theory .................................. C. Natural phonological theory ........................................ III. DEFINITIONS OF PHONETIC AND PHONOLOGICAL DISORDERS .. IV. SUMMARY OF THE THEORETICAL FRAMEWORK ADOPTED IN THE PRESENT STUDY ............................................................................ V. SUMMARY .......................................................................................... FOUR METHODOLOGICAL ISSUES .................................................................... I. ISSUES CONCERNING DATA COLLECTION .................................... II. ISSUES CONCERNING DATA ANALYSIS ....................................... III. PHONOLOGICAL PERCEPTION AND PHONOLOGICAL PRODUCTION . IV. SUMMARY ......................................................................................... FIVE METHODOLOGY ....................................................................................... I. AIM ............................................................................................... II. RESEARCH DESIGN ....................................................................... III. SUBJECTS ...................................................................................... A. Criteria for the selection of subjects .................. B. Description of subjects ................................................ IV. DATA COLLECTION ........................................................................ A. Assessment of speech production ................................ 1. Methods of elicitation of the speech samples 2. Recording the data .................................................. 3. Phonetic transcription .......................................... 4. Procedure for consensus ....................................... B. Assessment of phonemic perception ............................ vi. • Chapter Page V. DATA ANALYSIS ............................................................................. 98 A. Phonetic inventory .......................................................... 100 B. Percentage of consonants correct .............................. 101 C. Phonological process analysis ................................... 102 D. Contrastive analysis ..................................................... 107 VI. 'SUMMARY ........................................................................................ 109 SIX RESULTS AND DISCUSSION OF RESULTS - PHONOLOGICAL PROCESS ANALYSIS ................................................................................................ 110 I. GROUP FINDINGS .......................................................................... Ill A. Group phonetic inventory ...................................... Ill B. Group precentage of consonants correct .................... 113 C. Group phonological process occurrence ................... 114 II. DESCRIPTION OF PHONOLOGICAL PROCESSES ............................ 119 A. Substitution processes ................................... 119 B. Syllable structure processes ........................ 146 C. Assimilation processes .................... 153 III. SUMMARY OF RESULTS OF PHONOLOGICAL PROCESS ANALYSIS . 154 SEVEN RESULTS AND DISCUSSION OF RESULTS - INDIVIDUAL ANALYSES . 157 SUBJECT TJ ......................................................................................... 150 SUBJECT CS ......................................................................................... 161 SUBJECT JM ............................................................................... 164 SUBJECT BS ......................................................................................... 166 SUBJECT ChS ....................................................................................... 170 SUBJECT LC ......................................................................................... 173 SUBJECT SS ......................................................................................... 176 SUBJECT GH ......................................................................................... 178 SUMMARY OF INDIVIDUAL PHONOLOGICAL ANALYSES ....................... 180 EIGHT GENERAL DISCUSSION ............................................................................ 181 I. SUMMARY OF THE MAJOR FINDINGS OF THE PRESENT STUDY .. 181 II. JUSTIFICATION FOR DESCRIBING CERTAIN ERRORS OF SPEECH SOUND PRODUCTION AS PHONOLOGICAL ERRORS ........................ 183 III. THE POSSIBLE ROLE OF IMPAIRED ORAL STRUCTURE AND FUNCTION IN PHONOLOGICAL ERRORS ........................................ 191 IV. POSSIBLE FACTORS ACCOUNTING FOR HETEROGENEITY OF FINDINGS ...................................................................................... 194 V. GENERALISABILITY OF FINDINGS .............................................. 197 VI. CLINICAL APPLICABILITY OF PHONOLOGICAL PROCESS ANALYSIS TO THE DESCRIPTION OF DISORDERED SPEECH SOUND PRODUCTION IN CHILDREN WITH CLEFT PALATE .......... 198 VII. SUMMARY ........................................................................................ 200 NINE CONCLUSION ............................................................................................ 201 REFERENCES ............................................................................................................ 209 APPENDICES ............................................................................................................ 223 FIGURES faae 1. Major contibutory factors to disordered speech sound production in children with cleft palate .................................. 13 2. Group phonetic inventory based on naming and connected speech data ............... 112 3. Average percentage of occurrence of phonological processes affecting manner of articulation in connected speech samples .................................................................................................. 119 4. Percentage of occurrence of gliding of liquids and vocalisatTcm for each subject .......................................... 120 " Percentage of occurrence of deaffrication for each subject 124 6. Percentage of occurrence of non-sibilant replacement for each subject ......................................................................................... 126 7. Average percentage of occurrence of processes affecting place of articulation for all subjects in the connected speech samples ..................................................................................... 129 8. Percentage of occurrence of labialisation for each subject 130 9. Percentage of occurrence of palatalisation for each subject .......... 132 10. Percentage of occurrence of velarisation for each subject 134 11. Percentage of occurrence of devoicing of final consonants in naming and connected speech samples for each subject 138 12. Percentage of occurrence of glottal replacement for each subject .................................................................................................. 241 13. Average percentage of occurrence of syllable structure processes in connected speech samples ....................................... 146 14. Percentage of occurrence of cluster reduction for each subject ................................................................................................... 147 15. Percentage of occurrence of final consonant deletion for each subject .................... 152 m l. IABUS Table Page 1. Phonological contrasts expected in normally developing children aged 3.6 - 4.6 years ......................................................... 29 2. Parallels between the development of phonological theories and their impact on the management of disordered speech sound production .................................................................................. 35 3. Summary of phonological processes commonly reported in the speech of normally developing children ranging in age from 2-4 years ............................................................................................ 46 4. Advantages and disadvantages of single word tasks and connected speech samples .................................................... 59 5. Summary of description of subjects ................................................ 79 6. Sumary of the oral structural and functional characteristics for individual subjects based on the findings of the examination of the oral speech mechanism .. 81 7. Percentage of consonants correct for individual subjects and their severity ratings ..................................................... 113 8. Definitions of the 19 phonological processes observed in the naming and connected speech samples across all subjects ................................................................................................... 115 9. Average percentage of occurrence of phonological processes in naming and connected speech samples for the subjects as a group ................................................................................................... 116 10. Summary of phonetic inventory, contrastive phonemes and phonological processes for subject TO ........................................ 158 11. Summary of phonetic inventory, contrastive phonemes and phonological processes for subject CS ................ 162 12. Summary of phonetic inventory, contrastive phonemes and phonological processes for subject JM ........................................ 165 13. Summary of phonetic inventory, contrastive phonemes and phonological processes for subject BS ........................................ 167 14. Sumary of phonetic inventory, contrastive phonemes and phonological processes for subject ChS .................................. 171 15. Summary of phonetic inventory, contrastive phonemes and phonological processes for subject LC ........................... 174 16. Sumary of phonetic inventory, contrastive phonemes and phonological processes for subject SS ........................................ 177 17. Summary of phonetic inventory, contrastive phonemes and phonological processes for subject GH ......................................... 178 18. Categorisation of the phonological processes observed in the present subjects in terms of normal phonological development, philological delay and phonological deviance . 188 CHAPTER 1 INTRODUCTION The development of good communication skills is a critical consideration 'in the habilitation of children with cleft palate. For many children with cleft palate surgical management of the cleft is followed by normal development of speech. A substantial percentage of cleft palate children, however, fail to develop satisfactory speech and require further treatment. Historically, disordered speech production in cleft palate children has been primarily related' to structural inadequacies. It is widely accepted that velopharyngeal incompetence, resulting in the inability to Impound intra-ora I air pressure, is the primary causal factor of disordered speech production. Additional factors such as dental and occlusal anomalies, and the increased risk of middle ear pathology and hearing loss may also influence the production of normal speech. However, structural factors alone cannot logically account for all errors in speech production in children with cleft palate. Factors which affec- teaming may play an equally Important role in the acquisition ' ueech. Moller, Kittleson and Broen (1983) summarise the current approach cogently when they state: When children with no physical deviations have articulation problems, .e assume they are the product of faulty learning. When clefts are present, we often behave as though physical factors are the sole causes of articulation problems (p. 5). It must be appreciated that apart from having a deviant speech mechanism, the developing cleft palate child must learn the phonological system of his ambient language community. As such, he is subject to the same physiological, perceptual, cognitive and maturational constraints as are non-cleft palate children (McWilliams, Morris and Shelton, 1984/. Survey of the literature dealing with communication problems of cleft palate children reveals that a great deal of attention has been given to the structural and physiological foundations of speech production (McWilliams, 1954; Mo??, 1964; She?ton, Brooks and Youngstrom, 1965; Spriestersbach and Powers, 1959; Subtelny and Subtelny, 1959, among others). Researchers in cleft palate have paid limited attention to the description nf the phonological aspects of speech sound production, i.e. to the patterns of sound usage in langueoe. However, several authors have alluded, at least indirectly, to the possibility that children with cleft palate may display patterns of phonological development which are different from those of non-structurslly impaired children (Bzoch, 1965; Edwards, 1980; Moll, 1968; Shames and Rubin, 1979). Researchers in I phonoiogy, on the other hand, have seldom examined the errors of cleft palate children in a phonological context. Instead, the priniciples of phonological analysis have, in the main, been applied to children with functional articulation disorders. Only in the last decade, have attempts been made to examine phonological development in other clinical populations, e.g. hearing impaired (Dodd, 1976) and mentally retarded children (Stoel- Gammon, 1980); and it is only in the past three years that systematic studies have been conducted to describe the phonological patterns of cleft palate children (Hod.son, Chin, Redmond and Simpson, 1983; Lynch, Fox and Brook-cire, 1983; Moller et al., 1983). Other clinical phonologlsts do men'. cleft palate, but usually in passing, to illustrate the diff-'-.-: cp between phonetic and phonological disorders (Grunwell, 1983a; and Kwiatkowski, 1980). In the past, asses- ^ and remediation of disordered speech in cleft palate children have largely reflected the traditional approach used for children with functional articulation disorders i.e. children who nave no identifiable organic cause for their speech disorder. Speech assessment has focused predominantly on the description of errors of