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I do think trying to tease out the difference is important because it leads to different treatments. With articulatory problems I might use either conventional articulatory therapy or perhaps Miccio's stimulablity therapy. With phonological problems I would use some type of contrast therapy (e.g., minimal contrast, maximal contrast, multiple oppositions). With perceptual problems (yes I believe that some children with SSD may have perceptually based problems) I would use some type of auditory training.

Like many I struggle with figuring out how to distinguish the two and that's why I asked what you do. I have developed a "decision tree" (which I believe is available in the files section for this list group) that is my attempt to do so. I make no claims that it is the final answer by any means. I welcome comments and feedback from anyone who tries it out.

I would agree that "if a child is missing a sound in all positions and is not stimulable for it, then we could think of it as being an articulatory issue" but if the sound is stimulable, I look at "how stimulable" it is. If it is only stimulable in isolation I'm not sure I would say it is phonological. If it is stimulable to the word level I'd be more certain.

I don't currently do any clinical work, so I don't have to concern myself with funding sources. I have tended to just use PCC from conversation to determine severity - No I don't just call it a SSD. I then use my decision tree to decide if the problem is articulatory, phonological, or perceptual.

- Peter Flipsen Jr

-----Original Message-----
From: Rachael Unicomb []
Sent: Thursday, July 29, 2010 5:01 PM
To: Peter Flipsen Jr

I guess I have to ask the question then, do you or should you tease out whether a SSD is articulatory or phonological? Or should we just be saying that they have a SSD in general? How do you go about the same?
I guess other observations I would make would be a thorough OME to ensure there are no structural anomolies including cleft etc. and one would be observing very closely the various features that would lend towards a suspected dx of CAS. I would be checking for stimulability for any sounds completely absent from the obtained inventory also.
One thing I do remember a lecturer saying to us was something along the lines of....if a child is missing a sound in all positions and is not stimulable for it, then we could think of it as being an articulatory issue, otherwise it was most likely phonological. What are your thoughts on the same?
I am trying to get a copy of your article via our uni search system, and may hopefully have it today.
In the meantime, how do you rate severity for either artic, phono or SSD for funding bodies that do require the same? I am sure this will become clearer once I read your article, but do you just use the PCC calculations and use the term SSD?



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