Dr. Jennifer D. Clarke Ph.D. CCC/SLP

There are many questions that surround how speech production emerges. Is the process innate with some biological predisposition needing to be evoked? Is the emergence of a speech just one part of a more complex dynamic process? There are theoretical positions in support of these and other processes, however, the one thing that remains constant is the lack of understanding of the developmental sequence of the motor control necessary to produce speech.

Speech production is the most highly refined motor skill performed by humans requiring the activation and coordination of many muscles and body parts. In the development of spoken language, the developmental sequence of how muscles and body parts necessary for speech production have yet to be investigated nor has the impact of this process on the emergence of spoken language. Contemporary theories of language acquisition consider the development of the speech motor system as a more general biological process that occurs with growth and maturation (Kent & Miolo, 1995). The emergence of spoken language is considered rule-based with the assumption of underlying representation of words and other language elements (Vihman & Croft, 2007; Stoel-Gammon, 2011, & Menn, Schmidt, & Nicholas, 2009). A rigorous theory of the emergence of spoken language should include how the motor system necessary for producing the sounds of a language develops.

Rule based theories of speech production present a problem in developing treatment for children that do not develop speech production typically. Typical treatment plans for improving speech production skills include the imitation of target sounds as the frame from which acquisition and generalization of production are built. Depending on the severity of the production delay, therapy can address a set of speech sounds or therapy can focus on one sound a time, with treatment based on a look, listen, do model. In children who cannot produce speech and lack imitation skills, current treatment models based on phonological acquisition (Hodson, 2010) and speech sound imitation (Van Riper, 1954) are ineffective. When children lack imitation skills, alternative communicative systems (gestures, signs) are implemented rather than focusing on possible underlying cause of their inability to imitate (DeThorne, Johnson, Walder, & Mahurin-Smith).

Imitation is a neurological skill which allows that child to mimic the movements of the target model and is a crucial step in lexical development (Stoel-Gammon, 2011). Imitation requires the child to activate and coordinate the body systems necessary to produce action. Since speech models of the emergence of spoken language are rooted in the acquisition of representation and other linguistic elements, they do not typically consider the developing speech motor beyond a maturational process. Treatment based on auditory-visual cueing along with verbal instruction on how to produce target speech sounds do not help the impaired child develop the underlying motor skills necessary to imitate and produce speech sounds. A critical distinction between linguistic and speech motor control issues is necessary to development treatments for children where there are more complex considerations then phonetic and phonological impairments to production.

When a child does not produce speech sounds and cannot imitate the movements necessary for speech, the question is what happens when look, listen, do does not work? The use of oral motor organization (Beckman, 2007), moto-kinestic prompts (Hayden, 2007) and tactile-proprioceptive oral placement techniques (Bahr & Rosenfeld-Johnson, 2009) may help children with disordered speech sound production and imitation skills develop the oral motor skills

necessary to produce speech sounds. Currently the use of such therapeutic interventions to improve oral motor skills necessary for a child’s ability to produce speech have little empirical support and their use is extremely controversial (Lee & Gibbon, 2015; Lof, 2015; Alhaidary, 2019) with their application as treatment model even considered a pseudoscience (Volkers, 2019).

The use of oral motor-based therapy strategies to improve speech motor skills necessary for speech production is a highly debated topic in the remediation of speech sound disorders. The main issue with the use of oral motor-based strategies as an intervention technique is the lack of either theory or empirical evidence to support or disconfirm them. One reason for this debate, in my opinion, is the lack of understanding of the development of the speech motor system in the beginning stages of sound production in babble and words and the impact of speech motor development in the emergence of speech production. Phonological theories of the emergence of spoken language, based on linguistic principles, overlook the developing speech motor system and the physiological processes necessary for production because they are presumed to be based on a general maturational process with the specific development of the functioning of body parts necessary for sound production not examined or understood. Speech motor milestones in the emergence of spoken language have yet to be investigated in the emergence of spoken language. There currently are no empirical studies that investigate the relationship between the developing speech motor system and phonetic and phonological skills in the emergence of spoken language. The lack of understanding of the speech motor system in the emergence of spoken language hinders a robust understanding of language acquisition and prevents empirical studies aimed at improving oral motor function in the remediation of complex speech production disorders. As a result, investigations are needed to provide specific accounts of speech motor skill acquisition in the emergence of spoken language.

Thus far, theories of the emergence of spoken language have been predominately based on phonological theory. This preference has resulted from the influence of the assumption of underlying representation that include both meaning and production potential derived from rule-based theories (Vihman & Croft, 2007; Stoel-Gammon, 2011; Menn, Schmidt, & Nicholas, 2009) and explain motor development as a more general part of the maturation including anatomical changes observed in the first year (e.g., Kent & Murray, 1982). There has yet to be a thorough theory of the emergence of spoken language that combines the linguistic skill acquisition and a physiologic developmental trajectory.

At ExpressIt, we combine current theory with professional experience/training and an understanding of motor theory and neuromuscular reeducation to provide to most effective treatment plans. Our treatment considers both linguistic and physiological skill development. The goal of this treatment is to promote speech production skills in children who lack the capacity for verbal imitation as a result of poor oral motor strength, control and coordination. Each child has a unique set of skills and requires an individualized treatment plan to target their specific needs. Our goal is to help each of our patients improve their ability to verbally communicate at their highest level of functioning.

All the therapists at ExpressIt maintain the highest level of evidence-based practice by integrating clinical experience, internal and external evidence, and the interests, values, needs, and choices of the individuals we service (ASHA, 2). Each patient is evaluated to determine what treatment approach will most effectively and efficiently improve speech production skills.

References:

1. Alhaidary, A. (2019). Treatment of speech sound disorders in children: Nonspeech oral exercises. International Journal of Pediatrics and Adolescent Medicine.

2. American Speech-Language-Hearing Association. (2005). Evidence-based practice in communication disorders [Position Statement]. Available from www.asha.org/policy

3. Bahr, D. and Rosenfeld-Johnson, S. (2009). Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges. Communication Disorders Quarterly, 31(3), 131-138.

4. Beckman, D. (2007). Beckman Oral Motor Assessment and Intervention. Maitland, FL: Beckman and Associates, Inc.

5. DeThorne, L.S., Johnson, C.J., Walder, L., & Mahurin-Smith, J. (2009). When “Simon Says” doesn’t work: facilitating early speech development. American Journal of Speech-Language Pathology, 18, 133-145.

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10. Lee, ASY and Gibbon, F.E. (2015). Non-speech oral motor treatment from children with developmental speech sound disorders. Cochrane Database of Systematic Reviews 2015, 3, Art. No.:CD009383. DOI:10.1002/14651858.CD009383.pub2.

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14. Van Riper, C. (1954). Speech Correction: Principles and Methods. Englewood Cliffs: Prentice-Hall.

15. Vihman, M.M. & Croft, W. (2007). Phonological development: Toward a “radical” templatic phonology. Linguistics, 45(4), 683-725.

16. Volkers, N. (2019). Spotlight on pseudoscience: Nonspeech oral motor exercises. The ASHA Leader, 24 (7), 51.