Speech Case Study

July 22, 2018

Tanis Harty

Listening and speech are tied so closely together due to the “auditory feed back loop”

where people are “constantly comparing what we hear ourselves say with what we intend to say”

(Easterbrooks & Estes, 2007, p. 149). For children who are d/Deaf and hard of hearing (d/DHH)

this can be a difficult task as access to some sounds in any given language may be difficult to

acquire if they can’t hear it properly. While assistive listening technology may improve access to

sound and the formants of speech children with hearing loss can still struggle to develop their

auditory feedback loops which is integral to listening and speech. Even with early access to

sound and communication these children “generally exhibit expressive errors that are a function

of their auditory abilities, personal listening systems, and years of listening experience” (Erber,

2011, p. 136). This could be related to the auditory feedback loop, as it may be compromised in

children with hearing loss as they cannot hear certain speech sounds clearly, and thus may

struggle in their speech development in several ways including articulation errors, voice pitch

and quality, as well as developing normal speech patterns. This could be seen through observing

Rory during his therapy sessions, and through reviewing the Goldman Fristoe assessment. Rory

struggles to listen and monitor his own speech, and needs targeted practice so that he gains more

exposure to speech sounds he may have difficulty hearing.

When listening to Rory’s pitch it can be seen that he voices most words and sentences

with prosody and intonation that is associated with normal speech. His sentences have

appropriate speech patterns and match the correct frequencies for his age. Most of his sentences
have good intelligibility, however when he is excited or acting impulsively it can be hard to

understand him. For most words Rory’s duration is appropriate, though there are a few vowels he

draws out when he speaks. An example would be in the first video where he says “I’m the boss”

he draws out the vowel /o/. There are a few other instances where Rory extends the vowel sounds

in words like the /a/ in Alex, where he repeats what Tatum says: “next one for Alex.” Here, Rory

extended the /ah/ in Alex’s name, also his intensity in the /ah/ was too loud. In this instance it is

difficult to decipher if he said a /t/ in the beginning of her name, and the stress or syllable breath

was inaccurate. The place of his tongue for /n/ in next was in the wrong position where he has his

tongue past his teeth and lips. This is usually in spontaneous conditions where he tends to extend

the duration of the vowels, and puts too much emphasis on the sound, like when he said “it’s the

living room, not the laughing room.” The middle of both “living” and “laughing” room were

acoustically highlighted by drawing out the vowel sounds in those words. Sometimes Rory’s

intensity in his speech can be too loud when he produces speech spontaneously, or he becomes

too loud for the context of the conversation, which can also be seen in relation to his escalating

behavior. This could be due to the cognitive demand of listening and speaking which may make

it difficult for him to control how loud he is. Another possibility is because of his concurring

diagnosis with ADHD and FASD, he may raise his voice above a conversational level

impulsively. However, when prompted to listen, or when he imitates a sentence or word Rory’s

intensity is more controlled and his speech is intelligible. One example is when Rory imitates the

speech therapist Tatum after she gives the listen cue and says the word “sell.” Rory’s articulation

of “sell” improves after he is cued to listen, and imitates Tatum’s example.

 Rory has challenges with segmentals, particularly omitting sounds in the final position.

According to the Goldman Fristoe there are a few cognate pairs that Rory has difficulty with in

the final position which include /s/, /z/, /k/, /g/, /t/, /d/. He tends to omit final segmentals in his

speech like /t/ because it has less acoustic energy than in the initial position of words. This can

be seen when he discusses whose turn it is in one of the therapist’s games. Rory is able to

produce /t/ in the word “turn” but struggles to say /t/ in the final positions in words such as “not”

and “just went.” Rory also struggles with /z/ in the initial position, and /f/ in the medial position.

In the Goldman Fristoe Rory distorts several phonemes including /dw/ for /dr/, /s/ for /sh/, /s/ for

/th/, /d/ for /th/ and /sh/ for /th/. Additionally, Rory reduces blend sounds particularly those that

begin with /s/ and omits part of the blend. Examples include /sp/ with /s/ omission, /sl/ with /l/

omission, /sw/ with /s/ omission, /st/ with /s/ omission and /nt/ with /n/ omission. Monitoring his

pitch and intensity can be a difficult task for Rory, as even when he was imitating Tatum with a

scale in pitch of “la, la, la” and trying to go from loud to soft, Rory ends up yelling the words

instead. When Rory imitates Tatum in the videos during the silly sentences game his intensity

and articulation improves. Furthermore, when he is prompted to listen his intensity is much

better, and his speech is generally clearer. An example of this is when he says the word “spider.”

When spontaneously saying “spider” Rory’s “r” is distorted and he drops the initial /s/ sound.

After Tatum cues him, and says “spider,” Rory’s articulation of “spider” improves considerably.

Goal One

Rory will articulate /d/ in the final position of words spontaneously with visual aids and prompts.

Rationale

The reason why I chose this goal is because this is a cognate pair that Rory has been able to do

spontaneously in the therapy videos for the words “wide” and “shed.” He is also able to imitate
“wizard” and “lifeguard” when prompted to listen. This points to the ability that Rory is able to

reproduce /d/ but needs additional practice to be more aware of the sound. A reason as to why

this may be difficult for him in certain words is because /d/ is getting less acoustic energy in the

final position as it is a stop. It is also important to teach Rory this sound as it appears often in the

morpheme /ed/ which can affect his understanding of language in relation to syntax in his

speech. Additionally, /d/ is earlier in the developmental levels of speech compared to some other

phonemes and he has access to the first formants of /d/ when wearing his hearing assistive

technology. The second formant is in the 2000 – 2500 frequency range but with his hearing

assistive technology he may be able to discriminate the sound with the two formants, which is

why it would be important to highlight and work on this particular sound.

Activity One

Rhyme Time Game

Objective: Rory will produce words with final /d/ segmental spontaneously through a rhyme

game focusing on words he is currently struggling with like “slide.”

Description

Using a set of cards with a pair of rhyme pictures, the teacher would place most of the cards face

down on the table. Each player is dealt three cards and must flip a card over from the table to see

if they can get a match with what they have in their hand. In order to get the matching pair for a

point, Rory would have to say the word correctly before he can get it. If he doesn’t say the word

correctly the picture gets flipped back down for him to try again. At this point, the teacher can

prompt Rory to listen to the word or say it for him while using it in a sentence. The teacher
would then go and choose a different word and getting it wrong sometimes to see if Rory can

correct the word.

Materials

• Flash Cards with pictures and words

• Word list for rhyming end sounds – “Slide/Hide/Ride/Tide/Wide” &

“Bed/Shed/Red/Fed/Head.”

Activity Two

Frog Hop

Objective: Rory will work on reproducing /d/in the final position spontaneously through the

game Frog Hop.

Materials

• Green plastic protectors cut into the shape of lily pads.

• Index cards with target words could include “yelled, cheered, filled, smelled, buzzed,

begged”

Description

Using six green plastic protectors cut in the shape of a lily pad, the teacher would place the target

words inside of each of the protectors. Rory would have to hop to each lily pad and attempt to

say the word before he can jump to the next lily pad. If he has difficulties to say the word

spontaneously, the teacher can prompt him and give him the word so he may imitate it to move
on. Once he has hopped through all the lily pads, new target words can be put in place and he can

choose where he would like the lily pads to go for the next round.

Goal Two

Rory will articulate /t/ in the final position of words spontaneously with visual aids.

Rationale:

The reason why I chose this goal is because Rory has difficulty with /t/ on both the Goldman

Fristoe and in the therapy sessions. In words where /t/ is in the final position Rory tends to omit

this segmental which could be because it is the voiceless phoneme in the cognate pair /t/ & /d/

and has less acoustic energy. Another reason why this sound in the final position may be so

difficult for him is that /t/ only has one formant in the 2500-3000 frequency range and he may

not be getting as much exposure if he doesn’t use his hearing assistive technology consistently. I

would want to target this because he has /t/ in the initial position such as in “tiger” and “teacher”

and he also can spontaneously produce /d/ in certain words as shown in the therapy video.

Practice with this cognate pair in particular is important because /t/ is also used in the suffix “ed”

which would affect his understanding of syntactical structures, and when he omits this phoneme

it can compromise his intelligibility.

Activity One

Sentence Frame Activity

Objective: Rory will improve his articulation of the segmental /t/ in the final position of words

through imitation and with visual supports.

Description

This activity involves a sheet that includes a main sentence with one part blocked out for words

with pictures in it to fit into the blank space. The other picture blocks have words with the target

sound in them, and target sounds built into the sentence. The teacher would model this activity,

and offer opportunities for imitation and for spontaneous responses.

Example: I put ______ in my boat.

Key Words: a hat, a boot, a bat, a nut, a mat, an ant, meat, a cat.

Materials:

• Worksheet with key sentences and pictures of key words

Activity Two

Scoop Them Up Ice Cream Game

Description

This game involves visual support stimulus for Rory to produce target words with /t/ in the final

position. The game is about building the biggest ice cream, where scoops of ice cream have

pictures on them with target sounds like cat that are hidden in a bag. Rory would pull a scoop

from the bag, and must say the target word to get the scoop for his cone. The teacher could put in

a rule that if the word is used in a sentence the player would get bonus points. There are also

melty scoops in the bag, where if one is pulled the whole ice cream cone melts. The game ends

when all the scoops are out of the bag, and one person has the most ice cream scoops.

Materials
 • Card cut outs of ice cream scoops

• Card cut out of cone.

• Bag

• Pictures on cut outs with the target segmental /t/ in final position.

Goal Three

Rory will produce /s/ spontaneously with prompted conditions.

Rationale

In both the Goldman Fristoe and in the therapy videos Rory was able to produce /s/ even though

it is inconsistent, and in spontaneous production is distorted. Since Rory is able to produce the

sound through imitation like with Tatum’s prompt with “spider” it is reasonable to make this one

of his speech goals as it is something he is capable of, and practice will make him more aware of

saying the sound correctly. Additionally, the segmental /s/ is such an important sound in the

English language as it has so much meaning attached to it. The /s/ sound is in a significant

portion of words, and it also acts as a marker for pluralization. While /s/ is developed later in

speech, since Rory is able to imitate /s/ it is something that could be improved upon with

targeted practice.

Activity One

Sensory Box

Objective: Rory will spontaneously pronounce words with /s/ in both the final, medial and

ending positions.

Description

Fill a container with rice and place items that have /s/ segmentals in them. The teacher would

model and demonstrate how the game is played. The teacher would put her hand in the bucket,
and pick out an item, then says the word. If the word is said correctly they get to keep the item,

there are also duplicates of items to practice plurals. If it is said incorrectly, the item goes back

into the sensory container. Rory would have the opportunity to say the words spontaneously,

then can be prompted to listen and imitate before the item would go back into the container.

Materials

• Box or container

• Dollar store items that contain words with /s/ in initial or final position

o Soldier

o Sucker

o Snake

o Santa

o Princess

o Slippers

o Soap

Activity Two

Hungry Snake

Description

Using a cut-out character of a snake named Simon explain to Rory that Simon is a snake that

smells with his tongue, and is hungry for words. Using flashcards with pictures and key words,

have Rory say the word five times and feed it to Simon the snake.

Materials
 • Snake Cut Out

• Flash Cards with target words

o Grass

o Mouse

o Moose

o Moss

o House

o Lettuce

o Juice

o tacos

Goal Four

Rory will spontaneously produce /z/ with visual aids and prompts.

Rationale

The reason this would be important to work on with Rory is that /z/ is the cognate pair to /s/ and

since he is able to use /s/ inconsistently, /z/might be easier to acquire as it is the voiced

segmental of the pair. While /z/ may be more difficult to learn developmentally it is still within a

range that would be appropriate for Rory. This segmental also has two formants which include

one in the 200-300 range, and one in the 4000-5000 range. Since he is able to produce /s/ which

has one formant in the higher frequency range of 5000-6000 it is possible that /z/ may be

something he would have more access to with the low frequency formant.

Activity One

Catch a Bug Game

Objective: Rory will spontaneously produce /z/ in both the initial and final positions in words

through an interactive turn based game.

Description

Each player is given a jar template with circles drawn on it to “catch” the bugs in the game.

There is a dice with six different colours including “red, purple, green, turquoise, orange and

yellow” in which Rory would roll the dice and pick a bug with the coordinating colour. On the

other side of the bug there would be a target word with picture. Rory would have to say the word

correctly in order to get the bug. Whoever has the most bugs at the end of the game wins.

Materials

• Jar templates with different coloured lids for a player to choose which jar they would

like.

• Coloured bug cut outs with key words and pictures on the back.

• Dice with six corresponding colours to the bugs.

• Target /z/ words examples

o Zoo

o Bugs

o Pajamas

o Buzz

o Buzzer

o Bees

o Sneeze
Activity Two

I Spy Picture Game

Objective: Rory will reproduce /z/ segmental in words spontaneously through visual prompts.

Description

This game consists of a picture board with objects that have /z/ segmentals in both the initial,

final and medial positions. The goal of the game is to get points by guessing the correct item the

other person is spying in the picture. The teacher would model the questions first, and have Rory

guess what item it is.

Example: I spy with my eye something with black and white stripes. Answer: Zebra.

Materials

• Picture board with /z/ target word objects

• Zebra

• Zoo

• Pajama

• Bees

Goal Five

Rory will improve his use of the following blends: /sl/, /sp/, /st/, /sw/ through imitation and

listening prompts.

Rationale

While this would be a more difficult task for Rory, based off of the observations in the video

sessions Rory is capable of imitating blend sounds like /sp/ in “spider.” While this may be

inconsistent he has the ability to do so. This is why it would be important for him to practice

these skills using blend sounds with /s/. Additionally, this would be another way for him to
practice /s/ which is an emerging segmental for him that can be distorted sometimes. Another

reason why it would be important for him to practice blends is it would improve his

intelligibility, which would be important as he is in grade five where speech could impact his

social emotional health if there was a communication breakdown of understandability with his

peers. An example could be something like the difference between “swing” and “sing.” If Rory

meant “swing” but said “sing” instead it could cause confusion or frustration among his peers.

Given these circumstances I think it would be beneficial to target this more difficult task for

Rory as he can reproduce blends in imitative conditions.

Activity one

Roll A Blend

Objective: Rory will imitate target blend sounds through a turn based game.

Description

This game can be played with two to four people where the teacher would model the game to

show how it is played. The teacher would roll a six-sided dice, and would look at the game board

that has corresponding blend sounds at the top of the board which would include: /sl/, /sp/, /sw/,

/st/ and /sk/. After the correct blend has been match the player looks at the game board for the

picture that matches the first blend sound. The player would have to say the word before they can

move their token to the spot on the game board.

Materials

• Blend game board

• Target blends /sl/, /sp/, /sw/, /st, /sk/.

• Different coloured tokens

• Six-sided dice
Activity Two

Swat It!

Objective: Rory will practice saying blend sounds /sl/, /sp/, /sw/, /st/ and /sk/ through an

imitation game.

Description

This game can be played with two or more people. On a table, there would be fly cut outs with

pictures that have target words on it like “slippers.” Each player would have a fly swatter and

one person would say a word which the second player has to say and find on the table. Once the

correct fly is found the person who imitated can swat the fly and take it for a point.

Materials

• Fly Swatter

• Fly cut outs with object pictures of blends /sl/, /sp/,/st/, /sw/, and /sk/.
 Sources

Easterbrooks, S., & Estes, E. (2007). Helping deaf and hard of hearing students to use spoken

language. Thousands Oaks, CA: Corwin Press.

Erber, N. P. (2011). Auditory communication for deaf children: A Guide for teachers, parents

and health professionals. Victoria, Australia: ACER Press.