SSD Approach Finder

How the Approach Finder reasons: one child, start to finish

This is a fictional child with invented assessment findings. It shows each question the Finder asks, the answer this clinician gave and why, and the full result the Finder returns, with its reasoning and caveats. Your own findings, and so your result, will differ.

The child

Assessment findings

• Hearing: pure-tone audiometry and tympanometry within normal limits at 4;5.
• Oral structure and function: typical; no cleft history; feeding typical.
• Motor speech: vowels accurate in both languages; prosody typical; repeated productions of multisyllabic words stable; no groping; accuracy didn't drop markedly as words got longer.
• Language: understanding and use of language within age expectations in both languages, by informal assessment and parent report.
• Dialect check: the clinician recorded the mother and father saying the same Arabic probe words, and compared the child's forms with theirs word by word.
• Consistency: 12% on the English DEAP inconsistency assessment; 8% on an informal Arabic repeated-naming task (25 words, three times).
• Accuracy and severity: PCC on single words 64% in Arabic and 61% in English. Severity was judged moderate to severe from PCC together with intelligibility and the extent of the errors, not from PCC thresholds alone.
• Intelligibility: on the Intelligibility in Context Scale, parents report that strangers understand him only sometimes, in both languages; nursery staff report peers often ask him to repeat himself.
• Service: the clinic can offer one session a week; parents can practise at home twice a week.
• Family priorities: being understood by his grandparents in Arabic, and at school in English when he starts KG2.

The Finder's questions, as this clinician answered them

1. 1

   Once dialect and cross-linguistic patterns are accounted for, are there differences that suggest a speech sound disorder?

   Answer Yes, differences suggest a disorder

   Why, for this child Some of his productions are dialect features and were set aside: [ʔ] for /q/ and [t] in ثلاثة matched his own caregivers' forms, word by word. His English [t] for /θ/ isn't diagnostic on its own, and his limited English exposure doesn't by itself show it's cross-linguistic influence either; it was left unresolved and not counted towards the decision. What remains does suggest a disorder, because several findings point the same way: [t] replaces /k/, /s/ and /ʃ/ in Arabic words where both his parents use the target sound; the patterns persist beyond his clinician's age expectations in each language; familiar and unfamiliar listeners struggle to understand him in both languages; and his family and nursery are concerned. That the errors occur in both languages was not, on its own, the evidence.

2. 2

   Are there signs of an underlying motor, structural or sensory basis?

   Answer No

   Why, for this child Hearing, oral structure and function were typical, with no cleft history. On motor speech assessment, vowels were accurate, prosody was typical, repeated productions of long words were stable, and there was no groping. No underlying motor, structural or sensory basis was identified.

3. 3

   Does the child say the same word differently on repeated attempts?

   Answer No, errors are consistent

   Why, for this child On the DEAP inconsistency assessment in English, 3 of 25 words varied (12%). An informal Arabic version of the same task (25 words named three times) gave 2 of 25 (8%). Both are well below 40%. The Arabic task isn't standardised, so it was read alongside the error analysis, not on its own.

4. 4

   What kind of errors are they?

   Answer Substitutions and deletions in patterns

   Why, for this child The Finder's option covers substitutions and deletions; this child shows patterned substitutions only, with no deletions and no distortions in either language. /k/ → [t] is velar fronting; /s/ and /ʃ/ → [t] are fricative substitutions (stopping). Together they collapse several targets onto [t].

5. 5

   Is the inventory very small, with many sounds the child can't imitate?

   Answer No

   Why, for this child His inventory isn't severely limited: he uses /b t d m n f h w j l r/ in both languages, /p/ in English, and /ʕ ħ/ in Arabic. With a model, he can say /k/ and /s/ in isolation; /ʃ/ isn't yet stimulable.

6. 6

   What best describes the pattern of errors?

   Answer Several targets collapse onto one sound

   Why, for this child One sound, [t], replaces several targets: /k/, /s/ and /ʃ/ in Arabic, and /k/, /s/, /ʃ/ and /tʃ/ in English. That is a phoneme collapse, not a single substitution. The clinician rated severity moderate to severe by weighing PCC (64% Arabic, 61% English, single words) together with reduced intelligibility in both languages and how many sound classes are affected, rather than applying PCC thresholds alone, which weren't developed for bilingual children.

The result the Finder returns

One possible delivery plan (fictional)

This is one way a clinician might apply the multilingual delivery considerations for this fictional child. It isn't a general recommendation for bilingual children.

• Language experience and proficiency: in this plan, home practice is in Arabic, his stronger language and the language of home, and English targets are worked on in clinic and shared with nursery staff. Other arrangements could be equally reasonable.
• Language-specific analysis: separate target sets for each language: /k/, /s/, /ʃ/ against [t] in Arabic; /k/, /s/, /ʃ/, /tʃ/ against [t] in English. Dialect forms are left as they are.
• Cross-language generalisation: untreated probe words are checked in both languages every few weeks, rather than assuming that progress in one language carries over.
• Family priorities and dose: weekly clinic sessions, with parents trained to practise twice a week and frequent contact with the clinician. Home practice isn't equivalent to more frequent clinic treatment: this is a lower dose than the main trial, the once-a-week note above applies, and the plan records that.

What the report summary would say

Speech sound intervention: clinical reasoning summary

Assessment findings that informed this decision:
- Once dialect and cross-linguistic patterns are accounted for, differences remain that suggest a speech sound disorder.
- No underlying motor, structural or sensory basis has been identified.
- Errors are consistent across repeated attempts.
- Errors are substitutions and deletions following phonological patterns, consistent with phonological delay or consistent atypical phonological disorder.
- The child's inventory is not severely limited.
- Several target phonemes collapse onto one production.

Approach that fits this profile (Phonological delay or consistent atypical phonological disorder: phoneme collapses):
- Multiple oppositions. Several targets are contrasted at once against the one sound that has replaced them, e.g. /t/ for /k, s, tʃ, tr/.
  Suited to: Phonological delay or consistent atypical phonological disorder, moderate to severe, with phoneme collapses. Studied mainly in children about 3 to 6.
  Evidence: In one RCT of 54 children aged 3 to 5, three sessions a week beat one a week for the same total of 24 planned sessions (delivered over 8 or 24 weeks), and weekly sessions didn't beat a storybook control after 8 weeks. Other evidence is mainly case series.
  Key references: Williams (2000a, 2000b, 2005); Allen (2013); Sugden et al. (2020); Tosh et al. (2017)

Session frequency: Three sessions a week beat one a week in the main trial (Allen, 2013). If weekly is all you can offer, weekly clinic sessions plus parent practice twice a week improved treated words in all 5 children in a small single-case study, with generalisation in most (Sugden et al., 2020); this is preliminary evidence. A review across speech and language therapy found home programmes worked about as well as clinic therapy when the dose was similar, parents were trained and the clinician kept in frequent contact (Tosh et al., 2017).

Multilingual delivery considerations (where the child uses more than one language):
- Language experience and proficiency in each language.
- Targets from a language-specific analysis, with the child's own dialects as the reference.
- Cross-language generalisation: monitor carry-over; the evidence is too limited to say whether shared or language-specific targets should come first.
- Family priorities, including which languages therapy and home practice use.

This plan will be reviewed if:
- The error is a single substitution (one target replaced by one sound), not several target phonemes collapsing onto one production: minimal pairs.

Also considered:
- Complexity approach: An alternative if several sounds turn out to be missing from the inventory altogether, rather than replaced by one sound.
- Minimal pairs: Not for the current profile. Minimal pairs may become appropriate if further assessment shows a simpler, isolated contrast rather than a broad collapse.

Selection reflects clinical judgement supported by the SSD Approach Finder (Bilingual SLT, bilingualslt.co). Age ranges describe the children studied, not eligibility rules.