A SURVEY OF SPEECH-LANGUAGE PATHOLOGISTS APPROACHES TO ASSESSMENT AND

INTERVENTION:
INFLUENCES OF SEVERITY OF CHILDRENS SPEECH SOUND DISORDERS
Natalie Brickner, Maria Moritz, Lauren Normoyle, and Erin Rutkowsky
University of Wisconsin Whitewater
Summer 2015
Research Methods in Communication Disorders
Dr. Giuliana Miolo

Introduction
The caseloads of speech-language pathologists (SLPs) consist of high numbers of clients
with speech sound disorders (SSD). In fact, it has been suggested that as much as 75% of the
children on the SLPs caseload have SSDs (Brumbaugh & Smit, 2013). Therefore, it is critical for
SLPs to understand what qualifies as a SSD and how to assess and treat disorders of varying
severity. According to the American Speech-Language Hearing Association (2015), the general
category of SSDs encompasses a combination of difficulties with perception, motor production,
and/or the phonological representations of speech sounds and speech segments. Two examples of
SSDs in young children are articulation and phonological disorders. Because severe SSDs (S-SSD)
can lead to further difficulties with literacy, social interaction, self-esteem, and building meaningful
relationships, early assessment and intervention are critical (Brumbaugh & Smit, 2013). Early
assessment and intervention for young children with SSDs may also reduce the number of schoolaged children on SLPs caseloads. However, differentiating between articulation and phonological
disorders and identifying appropriate assessments and interventions can be difficult because a true
dichotomy between these disorders does not exist (Bauman-Waengler, 2012).
Historically, children with reduced intelligibility have been diagnosed with an articulation
disorder regardless of severity and have been treated using a traditional articulation approach to
intervention (Baker, 2006). Current textbooks and other resources describe articulation disorders as

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
difficulties with the motor production part of speech which affects a persons ability to produce
certain speech sounds (Bauman-Waengler, 2012). In general, to assess a child with a SSD, SLPs
collect a speech sample. Traditionally, these samples have been analyzed by examining the
individual phoneme errors produced (Baker, 2006). In addition to using informal assessments,
formal assessments, such as the Goldman-Fristoe Test of Articulation 2 (GFTA-2), are used to
determine the severity of the SSD compared to the childs typically developing peers (Brooks &
Hedge, 2007). Following assessment, SLPs have traditionally treated children diagnosed with a SSD
by using an articulation approach which addresses each speech sound individually using a
hierarchy from isolation to connected speech. The speech sounds are chosen based on the order of
typical developmental acquisition, stimulability, and their effects on intelligibility (Brumbaugh &
Smit, 2013). However, according to Kamhi (2006), the traditional articulation therapy approach will
be less effective than the phonological therapy approach when the child with a SSD is exhibiting a
phonological based disorder (as cited in Brumbaugh & Smit, 2013).
Diagnosis, assessment, and intervention for children with SSDs began to evolve as a result
of Ingrams (1976) publication of Phonological Disability in Children (Baker, 2006). Rather than
focusing on problems with individual speech sounds, Ingram (1976) suggested that children may
have problems organizing and using phonemes to signal meaning in linguistic contexts (Baker,
2006). This difficulty with organization and comprehension of the sound system associated with
language differentiates phonological disorders from traditional articulation disorders (BaumanWaengler, 2012). To assess a phonological disorder, SLPs still collect a speech sample, but the
analysis varies from the traditional articulation approach. Instead of examining the individual
phoneme errors, SLPs look for patterns of errors, known as phonological processes, including
multiple phonemes (Baker, 2006). In addition to this informal assessment, SLPs use formal
assessments, such as the Hodson Assessment of Phonological Patterns 3 (HAPP-3), to determine
the severity of the SSD compared to the childs typically developing peers (Brooks & Hedge, 2007).
Following assessment, SLPs must identify the most effective and efficient approach to intervention.
By remediating phonological processes using a phonological approach to intervention, the child
should be able to generalize the correct pattern to many of the associated phonemes (Baker, 2006).
While the traditional articulation approach to intervention can be used for children with S-SSDs, it is
more efficient to use a phonological approach addressing multiple phonemes simultaneously. Baker
(2006) suggested that children treated using the phonological approach had improved intelligibility
in less than two years, while treating the same child with a traditional articulation approach could
take up to six years to obtain similar results. Despite the decreased time in intervention required
before dismissal, SLPs are still reluctant to embrace phonological intervention.
Research shows that even though an abundance of phonological methods have been
published, the majority of clinicians do not implement phonological approaches. Hodson (1992)
found that less than 10% of SLPs were using phonological approaches with their clients, and Klein
(1996) suggested this may be due to the time needed to learn how to effectively use the

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
phonological approach and the lack of efficacy studies available. For example, Lousada et al. (2012)
evaluated the efficacy of an articulation approach compared to a phonological approach to
intervention for young children with phonological disorders. The participants were randomly
assigned to either an articulation approach or a phonological approach and researchers collected
pre- and post-intervention measures related to percent consonants correct (PCC) and the childrens
use of phonological processes. The researchers concluded that although the articulation and
phonological approaches were both effective, the phonological intervention was more efficient
(Lousada et al., 2012). Even so, further research is necessary to support the efficacy of the
phonological approach.
Regardless of the available research, phonological interventions for severely unintelligible
children are still not consistently implemented. Brumbaugh & Smit (2013) distributed a national
survey asking SLPs about their service delivery and intervention approaches for young children with
SSDs, and they found that SLPs were still more likely to use the traditional articulation approach
rather than a phonological intervention. However, certain phonological approaches were being used
one third of the time. Their rationale for less frequent use of phonological intervention was
confusion related to methodology and uncertainty about the appropriate technique to use for each
client (Brumbaugh & Smit, 2013). Skahan, Watson, and Lof (2007) found the majority of SLPs
learned information about SSDs and how to provide services to children with SSDs through
graduate courses, workshops, and undergraduate courses instead of through evidence-based
practice or research articles (p. 251).

Research Questions and Hypotheses

Does the severity of the childs SSD influence SLPs assessment protocols and approaches to
intervention? There does not appear to be a consensus in the assessment protocols and approaches
to intervention with children with SSDs. Evidence supporting assessment protocols and approaches
to intervention for articulation and phonological disorders are available as well as preliminary
conditions for which approach would be most appropriate. Based on these findings, we predicted
that more SLPs would use a traditional articulation assessment protocol and a traditional
articulation approach to intervention than a phonological assessment protocol and a phonological
approach to intervention regardless of the severity of the childs SSD.
Do SLPs who graduated after 1990 use a different assessment protocols and approaches to
intervention for children with SSDs of varying severity? The available research suggested that
despite the emergence of a phonological approach to assessment and intervention in the 1970s,
phonological approaches to assessment and phonological intervention may not be used by SLPs if it
was not introduced during their academic careers. Based on these findings, we predicted that SLPs
who earned their degrees after 1990 would be more likely to use different assessment protocols
and approaches to intervention depending on the severity of the SSD.

Method
Participants
3

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
The participants were 294 SLPs from the school districts within each of the twelve
Cooperative Education Service Agencies (CESAs) in Wisconsin. Participants reported on their
educational background [i.e., graduate institution (see Appendix D; Table 1 & Appendix D; Figure 1),
year of graduate degree completion (see Appendix D; Figure 2)] and their professional background
[i.e., regional CESA representation (see Appendix D; Table 2), number of years of professional
experience (see Appendix D; Table 3), age ranges of students with whom they had experience (see
Appendix D; Table 4), status of Certification of Clinical Competence (see Appendix D; Table 5)].

Participant Recruitment
Participants were recruited via: (1) a monthly electronic newsletter sent to members of the
Wisconsin Speech-Language Pathology and Audiology Association (WSHA) and (2) an email
message sent to any SLP whose email address was published on a Wisconsin school district
website. A web link to the survey was included in the electronic newsletter and in the email
message. The electronic newsletter was sent to 700 members of WSHA, and the email message
was sent to 647 SLPs from the Wisconsin school districts. Due to the two methods of recruitment, it
is not possible to determine the response rate because participants could have received the survey
link through both the WSHA newsletter and the Wisconsin school district email messages.

Materials
The survey was designed using Qualtrics, a private research software company which allows
the user to generate a survey that may be distributed electronically through email. The
Institutional Review Board (IRB) at the University of Wisconsin-Whitewater approved the survey and
research project.
The survey consisted of twelve questions (see Appendix A). Eight questions requested
information about the participants educational background and professional experience. Of those
eight questions, four questions were closed response (i.e., participants had to select the boxes
beside the responses that applied), and the remaining four questions were open response (i.e.,
participants could include their own text responses in the space provided). Four questions
addressed the participants assessment protocols and approaches to intervention with children with
SSDs. The participants were presented with two scenarios:
1. A 4K teacher tells you that a student in her class, Matt, is highly unintelligible. She also notices that
he tends to leave sounds off at the end of words. He is becoming very frustrated because others do
not understand him.
2. A 4K teacher tells you that a student in her class, Sally, is having trouble pronouncing certain
sounds. However, for the most part, the teacher can understand what Sally is trying to say.
Scenario one described Matt, a 4K student with a severe SSD (S-SSD), while scenario two
described Sally, a 4K student with a mild SSD (M-SSD). Following each scenario, the participants
were presented with two open ended questions:
1. Assuming [Matt/Sally] requires a full assessment, what would you include in your assessment
protocol?

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
2. Assuming [Matt/Sally] is eligible for services, what type of intervention approach would you use?
The participants were given unlimited space to respond to each question.

Procedures
We created an email template which included a brief explanation of the purpose of the
study, instructions to complete the survey, the web link to the survey, and researcher/faculty
supervisor contact information for receiving study results (see Appendix B). A mass email was sent
using the Wisconsin school district email addresses, and a modified version of the email template
was sent to a representative from WSHA to be included in the monthly electronic newsletter (see
Appendix C). We maintained records of the contact information for the SLPs who requested to
receive the final results for the study; however, that contact information was in no way connected
to the data collected.
The survey link remained active for approximately ten days. After closing the survey, we
downloaded the data and reviewed the information about the participants educational background
and professional experience. Because we were interested in answering questions related to the
participants year of graduate degree completion and their responses to the assessment and
intervention questions presented with each scenario, that data was coded to be analyzed using
SPSS statistical analysis software. The responses for each question were coded by two of the
researchers using consensus coding.
Coding Assessment Protocols. We reviewed the responses to the open-ended questions for
assessment following each scenario and recorded the names and frequency of the formal
articulation and phonological assessment tools being administered (e.g., GFTA-2, HAPP-3, CAAP-2).
Based on the assessment protocol, we coded the overall approach to assessment as a(n):
articulation approach, phonological approach, combination approach, assessment using the CAAP
(which could be either an articulation and/or a phonology assessment depending on how the
assessment was analyzed), or not available if the assessment protocol could not be coded in one
of these four categories. In addition to reviewing the formal articulation and phonological
assessment tools, we also recorded the names and frequency of informal assessment tools (e.g.,
speech/language sample, parent/teacher interview) and other formal assessment tools (e.g., PLS-5,
CELF-5 Preschool) used.
After coding the formal assessment tools for articulation and phonology, we excluded the
responses that could not be clearly categorized as articulation, phonology, or combination
approaches to assessment from further analysis. Therefore, those participants who reported that
they would use the CAAP-2 (n=12, M- SSD; n=14, S-SSD) but did not specify whether they used the
articulation component and/or the phonological component) were excluded from the data set. As a
result, the percentage totals reported for the approaches to assessment do not sum to 100.
Coding Intervention Approaches. We reviewed the responses to the open-ended question for
intervention following each scenario and listed all the types of intervention programs reported by
the participants. We coded each of these programs as a(n): articulation approach, phonological

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
approach, combination approach, depends on assessment results, or not available if the
approach to intervention could not be coded in one of these four categories (e.g., service delivery
model, minutes/week, pull-out/push-in therapy, individual/group therapy). For example, participants
who reported using a traditional approach to therapy would be coded as an articulation approach;
participants who reported using a Cycles approach would be coded as a phonological approach; and
participants who reported using both a traditional articulation approach and a Cycles approach
would be coded as a combination approach. Participants were coded as depends on assessment
results if they reported that their choice of intervention would depend on the results of the
assessment. Each participant, regardless of the number of different therapy programs reported,
was assigned only one code.
Coding Participants Year of Graduate Degree Completion. The participants were coded as:
graduating before 1990 (pre-1990), graduating after 1990 (post-1990), or not available if they
answered the question incorrectly (i.e., provided information other than their graduation year).

Results
Effects of Severity on Assessment Protocol
Percentages were calculated using only those participants whose responses were coded as
a(n): articulation approach, phonology approach, or combination approach.
Articulation. 66.7% of the participants included a formal test of articulation in their
assessment protocol for the child with M-SSD and 24.2% included one for the child with S-SSD (see
Appendix D; Figure 3). The most commonly reported formal assessment coded as an articulation
approach was the GFTA-2 (see Appendix D; Table 6). 59.5% included it in their protocol for the child
with M-SSD and 39.9% included it in their protocol for the child with S-SSD.
Phonology. 2.7% of the participants included a formal test of phonology in their assessment
protocol for the child with M-SSD and 28.4% of participants included one for the child with S-SSD
(see Appendix D; Figure 3). The two most-commonly reported formal assessments of phonology
were the HAPP-3 and the KLPA-2 (see Appendix D; Table 6). 11.4% of the participants included the
HAPP-3 in their assessment protocol for the child with M-SSD and 35.5% included it for the child
with S-SSD. 5.3% of the participants included the KLPA-2 in their assessment protocol for the child
with M-SSD and 14.7% included it for the child with S-SSD.
Combination. 23.5% included a combination of formal tests of articulation and phonology in
their assessment protocol for the child with M-SSD and 40.3% included a combination for the child
with S-SSD (see Appendix D; Figure 3).
Chi-Squared Test of Independence. The results of a chi-square test of independence
revealed a significant difference between the percentage of participants selecting formal tests of
articulation vs. tests of phonology based on the severity of the SSD, 2 (4, N=238) = 45.569, p <
0.001.

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
Informal Assessments. The three most commonly reported informal assessments included in
the protocols for both children were a(n): speech/language sample, parent/teacher interview, and
observation (see Appendix D; Table 7).
Other Formal Assessments. The two most-commonly reported formal assessment tools
measuring areas other than articulation or phonology were the PLS and the CELF-5 Preschool (see
Appendix D; Table 8). 10.6% included the PLS in their assessment protocol for the child with M-SSD
and 18.3% included the PLS for the child with S-SSD; and 6.1% included the CELF-5 Preschool for
the child with M-SSD and 9.2% included the CELF-5 Preschool for the child with S-SSD.

Effects of Severity on Intervention Approach

Articulation. 47.4% of the participants reported using a traditional articulation approach to
intervention with the child with M-SSD and 4.8% reported using it with the child with S-SSD (see
Appendix D; Figure 4). 60.9% of the participants reported using the Traditional Van Riper Approach
with the child with M-SSD and 21.8% reported using it with the child with S-SSD (see Appendix D;
Table 9).
Phonological. 3.8% of the participants reported using a phonological approach to
intervention with the child with M-SSD and 51.3% reported using it with the child with S-SSD (see
Appendix D; Figure 4). 7.5% of the participants used a Hodson Cycles Approach to Phonological
Remediation with the child with M-SSD and 38.7% used a Hodson Cycles Approach to Phonological
Remediation with the child with S-SSD (see Appendix D; Table 9).
Combination Approach. 1.5% of the participants reported using a combination of traditional
articulation and phonological approaches to intervention with the child with M-SSD and 11.1%
reported using one with the child with S-SSD (see Appendix D; Figure 4).
Depends on Assessment Results. 19.2% of the participants reported their approach to
intervention would depend on the assessment results for the child with M-SSD and 15.9% reported
their approach to intervention would depend on the assessment results for the child with S-SSD
(see Appendix D; Figure 4).
Chi-Squared Test of Independence. The results of a chi-square test of independence revealed
a significant difference between the percentage of participants selecting articulation approaches to
intervention vs. phonological approaches to intervention based on the severity of the SSD, 2 (9,
N=183) = 25.687, p = 0.002.
Other Types of Intervention Approaches. The three most commonly reported other types of
intervention approaches were a(n): literacy intervention, oral motor intervention, and a
phonological awareness intervention (see Appendix D; Table 9).

Effects of Year of Graduate Degree Completion

Of the 294 participants, 27.2% earned their graduate degree between 1960 and 1990 (pre1990), 67.3% earned their graduate degree between 1990 and the present (post-1990), and 5.4%
did not provide the year they earned their graduate degree (see Appendix D; Figure 2). To evaluate

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
the effect of graduation period (pre- vs. post-1990) on the participants choice of assessment tools
and intervention for both children, chi-square tests of independence were used. These analyses
revealed no significant differences between the period of graduation and choice of assessment
tools for the child with M-SSD, 2 (3, N=242) = 0.633, p = 0.889, or the child with S-SSD, 2 (3,
N=253) = 6.405, p = 0.093, or between the period of graduation and intervention approaches for
the child with M-SSD, 2 (3, N=187) = 4.779, p = 0.189 or the child with S-SSD, 2 (3, N=221) =
5.544, p = 0.136.

Discussion
One purpose of this survey was to determine if the severity of the childs SSD influenced the
participants assessment protocol or approach to intervention. We predicted that more SLPs would
use a traditional articulation assessment protocol and a traditional articulation approach to
intervention than a phonological assessment protocol and a phonological approach to intervention
regardless of the severity of the childs SSD. For the child with M-SSD, 66.7% of participants
included formal articulation tests and 2.7% included formal phonology tests in their assessment
protocol; and 47.4% of participants used a traditional articulation intervention approach and 3.8%
used a phonological intervention approach. In contrast, for the child with S-SSD, 24.2% of
participants included formal articulation tests and 28.6% included formal phonology tests in their
protocol; and 4.8% of participants used a traditional articulation intervention approach and 51.3%
used a phonological intervention approach.
When selecting an assessment protocol and intervention approach for the child with M-SSD,
participants favored an articulation assessment protocol and intervention approach, which was
consistent with our initial prediction. In contrast, when selecting an assessment protocol for the
child with S-SSD, 68.9% (i.e., the sum of phonological approach and combination approach to
assessment) of participants included a phonological assessment tool in their assessment protocol;
and when selecting an intervention approach for the child with S-SSD, 62.4% (i.e., the sum of
phonological approach and combination approach to intervention) of participants included a
phonological intervention approach, which was not consistent with our initial prediction. The
responses provided for assessment and intervention for the child with S-SSD suggested that SLPs
practices are influenced by the severity of the childs SSD, and there is an increased acceptance for
phonology.
The other purpose of this survey was to investigate if there was a difference between the
year the participants earned their graduate degree and their assessment protocol and intervention
approach with the children. We predicted that SLPs who earned their degrees after 1990 would be
more likely to use different assessment protocols and intervention approaches depending on the
severity of the SSD. Our survey data suggested that the year the participants earned their graduate
degree did not influence their approaches to assessment and intervention, which was not
consistent with our initial prediction. Graduate coursework changes from year to year, so it is
valuable to know the year SLPs earned their graduate degree. Our findings indicated that the

A Survey of Speech-Language Pathologists Approaches to Assessment and Intervention:

Influences of Severity of Childrens Speech Sound Disorders
Brickner, Moritz, Normoyle, Rutkowsky
graduation year, and the associated coursework, did not influence the SLPs decision to include
phonological or articulation approaches to assessment or intervention.

Research Implications
Although we did not find a significant difference between approaches to assessment or
intervention depending on the year the participants earned their graduate degree, there is other
data that could infer how the participants decided to use a traditional articulation approach or
phonological approach to assessment and intervention for the child with a SSD. Additionally, further
research could ask SLPs why they adopted their preferred approaches to assessment and
intervention for the child with a SSD (e.g., coursework, continuing education, clinical experience,
etc.).

Limitations
Only SLPs who were members of WSHA and/or who currently work in a Wisconsin school
district received the survey, therefore the ability to generalize the results of this study to the
practices of SLPs outside of Wisconsin may be limited.
The use of open-ended questions presented two limitations. First, these types of questions
required researchers to interpret all of the participants responses to create a code for data
analysis. Though the researchers took every precaution to use consistent coding while avoiding
researcher bias, subjective judgments were made during the interpretation process. Also, it
appeared that some of the participants misunderstood what the intervention question was asking.
The researchers intended for the participant to respond with their specific approaches to
intervention for the child with a M-SSD and a S-SSD. However, some of the responses provided were
related to the service delivery model and could not be used to draw conclusions regarding
approaches to intervention (i.e., they had to be coded as not available).

Acknowledgements
We would like to acknowledge the Wisconsin Speech-Language Pathology and Audiology
Association for distributing our survey, the speech-language pathologists who took the time to
complete it, and our faculty supervisor, Dr. Giuliana Miolo, for her guidance. We are grateful for
their contributions to our study and to the field of speech-language pathology.

References
American Speech-Language Hearing Association. (2015). Clinical topics: SSDs articulation and
phonology. Retrieved from http://www.asha.org/PRPSpecificTopic.aspx?
folderid=8589935321&section=Overview
Baker, E. (2006). Management of speech impairments in children: The journey so far and the road
ahead. Advances in
Speech-Language Pathology, 8(3), 156-163. doi: 10.1080/14417040600701951
Bauman-Waengler, J. (2012). Articulation and phonological impairments: A clinical focus (4th ed.).
Saddle River, NJ: Pearson
Education, Inc.
Brooks, A., & Hedge, M.N. (2007). Assessment and treatment of articulation and phonological
disorders in children. Austin,
TX: Pro-Ed.
Brumbaugh, K.M., & Smit, A.B. (2013). Treating children ages 3-6 who have SSD: A survey.
Language,
Speech, and Hearing Services in Schools, 44, 306-319. doi: 10.1044/0161-1461(2013/120029)
Hodson, B. (1992). CLINICAL FORUM: Phonological assessment and treatment applied phonology:
Constructs,
contributions, and issues. Language, Speech, and Hearing Services in Schools, 23, 247-253.
Klein, E. (1996). Phonological/traditional approaches to articulation therapy: A retrospective group
comparison. Language,
Speech, and Hearing Services in Schools, 27, 314-322.
Lousada, M., Jesus, L.M.T., Capelas, S., Margaca, C., Simoes, D., Valente, A., Hall, A., & Joffe, V.L.
(2012). Phonological and
articulation treatment approaches in Portuguese children with speech and language
impairments: A randomized controlled intervention study. International Journal of Language
& Communication Disorders, 48(2), 172-187. doi: 10.1111/j.1460-6984.2012.00191.x
Skahan, S.M., & Lof, G.L. (2007). Speech-language pathologists assessment practices for children
with suspected speech
sound disorders: Results of a national survey. American Journal of Speech-Language
Pathology, 16, 246259.

Appendix A
Survey
Appendix B
Email Template
Dear future colleague,

We are graduate students completing our Master's degree in speech-language pathology at the
University of Wisconsin - Whitewater. As part of our program, we are conducting a research study to
learn more about SLPs' approaches to the assessment and intervention of children with speech
sound disorders. We are contacting you, as a practicing SLP, to find out if you would be willing to
participate in our study by completing a brief survey. We would greatly appreciate your
participation, but it is completely voluntary.
By clicking the link below, you will be directed to a 10-question survey which will take
approximately 5 to 10 minutes to complete.

http://uwwhitewater.co1.qualtrics.com/SE/?SID=SV_3WTp9XeOt8wqnv7
We know how busy you are, so we greatly appreciate your support. If you would like to receive the
results of our research, or if you have any questions about this survey, please contact Erin
Rutkowsky (RutkowskE07@uww.edu) or our faculty supervisor, Dr. Giuliana Miolo
(miolog@uww.edu).
Thank you for your time,
Natalie Brickner
Maria Moritz
Lauren Normoyle
Erin Rutkowsky
Giuliana Miolo
This email and any files transmitted with it are confidential and intended solely for the use of the
individual or entity to whom they are addressed. If you have received this email in error please
notify the system manager. This message contains confidential information and is intended only for
the individual named. If you are not the named addressee you should not disseminate, distribute or
copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by
mistake and delete this e-mail from your system. If you are not the intended recipient you are
notified that disclosing, copying, distributing or taking any action in reliance on the contents of this
information is strictly prohibited.

Appendix C

Modified Version of Email Template Used in WSHA Electronic Newsletter

We are graduate students completing our Master's degree in speech-language pathology at the
University of Wisconsin - Whitewater. As part of our program, we are conducting a research study to
learn more about SLPs' approaches to the assessment and intervention of children with speech
sound disorders. By clicking the link provided, you will be directed to a 10-question survey which
will take approximately 5 to 10 minutes to complete. We would greatly appreciate your
participation, but it is completely voluntary.
http://uwwhitewater.co1.qualtrics.com/SE/?SID=SV_3WTp9XeOt8wqnv7
We know how busy you are, so we greatly appreciate your support. If you would like to receive the
results of our research, or if you have any questions about this survey, please contact Erin
Rutkowsky (RutkowskE07@uww.edu) or our faculty supervisor, Dr. Giuliana Miolo
(miolog@uww.edu).
Thank you for your time,
Natalie Brickner
Maria Moritz

Lauren Normoyle
Erin Rutkowsky

Appendix D
Tables and Figures
Table 1: Participants Graduate Institutions by Region
Percent

Graduate Institutions by

Particip

Region

Percent
Graduate Institutions by Region

Particip

Northeast

ants
1.7%

West

ants
2.0%

Colorado State University

0.3%

Eastern Washington University

0.3%

Idaho State University

0.3%

Buffalo
Towson University

San Francisco State University

0.3%

University of Maine at Orono

0.3%

University of Northern Colorado

0.3%

University of Vermont

0.3%

University of Wyoming

0.3%

South

1.7%

Midwest

9.5%

Arkansas State University

0.3%

Bowling Green State University

0.3%

0.3%

Central Michigan University

0.3%

South Florida University

Texas Tech Uni Health Science

Illinois State University

0.3%

Center
Texas University at Austin

Indiana University

0.3%

Western Carolina University

0.3%

Iowa State University

0.3%

Wisconsin

85.1%

Minnesota State University

0.3%

Marquette University

6.1%

Minot State University

0.3%

University of Wisconsin - Eau Claire

14.2%

Northwestern University

0.3%

University of Wisconsin - Madison

12.2%

St. Ambrose University

0.3%

University of Wisconsin - Milwaukee

8.8%

Truman State University

0.7%

University of Wisconsin - Oshkosh

1.7%

University of Illinois

0.3%

3.7%

University of Minnesota - Duluth

3.4%

University of Wisconsin - River Falls

University of Wisconsin - Steven's

University of Northern Iowa

1.4%

Long Island University

State Un of New York College at

Point
University of Wisconsin -

Whitewater
Western Michigan University
0.7%
Viterbo University
**n = 288; six participants did not provide a graduate institution
Table 2: Participants Regional CESA Representation
Regional CESA

Percent

Representation

Participants

0.3%
0.3%
0.3%

0.3%
0.3%

22.0%
15.9%
0.3%

North (CESA 5, 9, 12)

East (CESA 1, 7, 8)
West (CESA 4, 10, 11)
Central (CESA 2, 3, 6)
Other

17.1%
19.7%
16.9%
40.7%
5.6%

Table 3: Participants Number of Years of Professional Experience

Years of
Professional
Experience
0-4
5-9
10 - 14
15 - 19
20 - 24
25 - 29
30 - 34
35 +

Percent
Participan
ts
19.2%
15.5%
15.1%
16.2%
11.7%
6.9%
11.0%
4.5%

Table 4: Age Ranges of Students with Whom Participants Have Had Experience
Age Ranges of
Students
Early Childhood (3-6
years)
Elementary School (6-10
years)
Middle School (10-14
years)
High School (14-21 years)

Number of
Participants
236
250
164
114

Table 5: Participants Status of Certification of Clinical Competence (CCC-SLP)

Status of
Percent
Certification of
Particip
Clinical
ants
Competence (CCC)
Currently Holds
85.6%
Does Not Hold
9.9%
Expired
4.6%
Table 6: Participants Responses to Assessment Question: Formal Assessments for Articulation and
Phonology
Participants Responses to Assessment Question:
Formal Assessments of Articulation and Phonology
Articulation
Arizona Articulation Proficiency Scale 2 (AAPS-2)
Goldman Fristoe Test of Articulation 2 (GFTA-2)

Frequen Perce
cy
nt

Severe
Scenario
(n = 273)
Freque Perce
ncy
nt

8
157

4
109

Mild Scenario
(n = 264)

3.0%
59.5%

1.5%
39.9%

Photo Articulation Test 3 (PAT-3)

Structured Photographic Articulation Test II (SPAT-D II)
Phonology
ALPHA Test of Phonology
Assessment of Phonological Processes Revised (APP-R)
Bankson-Bernthal Test of Phonology (BBTOP)
Hodson Assessment of Phonological Patterns 3 (HAPP-3)
Hodson Computerized Analysis of Phonological Patterns
(HCAPP)
Khan-Lewis Phonological Analysis 2 (KLPA-2)
Both Articulation and Phonology
Clinical Assessment of Articulation and Phonology 2
(CAAP-2)

20
8

7.6%
3.0%

12
8

4.4%
2.9%

0
0
1
30

0.0%
0.0%
0.4%
11.4%

1
2
1
97

0.4%
0.7%
0.4%
35.5%

0.8%

2.2%

14

5.3%

40

14.7%

12

4.5%

14

5.1%

Table 7: Participants Responses to Assessment Question: Informal Assessments

Severe
Scenario
(n = 273)
Frequen Perce Frequen Perce
cy
nt
cy
nt
Case History
19
27
7.2%
9.9%
Parent/Teacher Interview
120
45.5% 121
44.3%
Observation
103
121
39.0%
44.3%
Hearing Screening
37
14.0% 49
17.9%
Oral Mechanism Examination
37
14.0% 39
14.3%
Speech/Language Sample
201
76.1% 220
80.6%
Speech/Language Screener
2
6
0.8%
2.2%
Speech Sound Inventory
0
1
0.0%
0.4%
Teacher Articulation Checklist
0
1
0.0%
0.4%
Stimulability
11
4
4.2%
1.5%
Table 8: Participants Responses to Assessment Question: Formal Assessments (Other Areas)
Participants Responses to
Assessment Question:
Informal Assessments

Mild Scenario
(n = 264)

Participants Responses to Assessment Question:

Formal Assessments (Other Areas)
Apraxia
Apraxia Test
Kaufman Speech Praxis Test (KSPT) or Kaufman Assessment
Battery for Children
(KABC)
Auditory Discrimination and Phonological Processing
Auditory Discrimination Test (ADT)
Phonological Processing
Cognitive Development
Battelle Developmental Inventory - 2 (BDI-2)
Developmental Assessment of Young Children 2 (DAYC-2)
Developmental Profile 3 (DP-3)
Fluency and Voice
Fluency/Voice Test

M-SSD
(n = 264)
Numb Perce
er
nt

S-SSD
(n = 273)
Numb Perc
er
ent

0.4%

0.0%

0.0%

0.7%

1
5

0.4%
1.9%

3
8

1.1%
2.9%

1
1
4

0.4%
0.4%
1.5%

1
2
4

0.4%
0.7%
1.5%

1.1%

1.8%

Language
Comprehensive Assessment of Spoken Language (CASL)
Clinical Evaluation of Language Fundamentals 5 Preschool
(CELF-5 Preschool)
Expressive One-Word Picture Vocabulary Test 4 (EOWPVT-4)
Expressive Vocabulary Test 2 (EVT-2)
Formal Receptive Vocabulary Test
Preschool Language Scale 4 (PLS-4) or Preschool Language
Scale 5 (PLS-5)
Peabody Picture Vocabulary Test 4 (PPVT-4)
Preschool Syntax Assessment
Receptive and Expressive Language Test
Receptive and Expressive Vocabulary Test
Receptive Vocabulary Test
Receptive One-Word Picture Vocabulary Test 4 (ROWPVT-4)
Structured Photographic Expressive Language Test 4 (SPELT-4)
Syntax Test
Test of Early Language Development 3 (TELD-3)
Test of Language Development 4 (TOLD-4)
Writing/Spelling Work from Classroom
Learning Achievement
Assessing Pupils Progress (APP)
Learning Accomplishment Profile 3 (LAP-3)
Literacy and Phonological Awareness
Assessment of Literacy and Language (ALL)
Phonological Awareness Literacy Screener (PALS)
School Readiness and Basic Concepts
Boehm Test of Basic Concepts 3 (Boehm-3)
Bracken School Readiness Assessment 3
Portage Guide
Wiig Assessment of Basic Concepts (WABC)
Table 9: Participants Responses to Intervention Question
Participants Responses to Intervention Question

Articulation
Five Minute Kid Articulation Approach
Lindamood Phoneme Sequencing Program for Reading,
Spelling,
and Speech (LiPS-4)
Traditional Van Riper Articulation Approach
Phonology
Hodson Cycles Approach to Phonological Remediation
Minimal Pairs Contrast Therapy
Modified Hodson Cycles Approach to Phonological
Remediation
Phonologically Impaired Classroom

0.4%

0.7%

16

6.1%

25

9.2%

7
5
0

2.7%
1.9%
0.0%

7
9
1

28

10.6%

50

11
0
9
1
1
5
3
1
1
2
1

4.2%
0.0%
3.4%
0.4%
0.4%
1.9%
1.1%
0.4%
0.4%
0.8%
0.4%

16
1
15
4
1
6
5
0
2
2
0

2.6%
3.3%
0.4%
18.3
%
5.9%
0.4%
5.5%
1.5%
0.4%
2.2%
1.8%
0.0%
0.7%
0.7%
0.0%

0
1

0.0%
0.4%

1
1

0.4%
0.4%

0
0

0.0%
0.0%

1
1

0.4%
0.4%

2
1

0.8%
0.4%
0.8%
0.4%

2
1

0.7%
0.4%
1.1%
0.0%

2
1

3
0

M-SSD
(n = 266)
Numb Perc
er
ent

S-SSD
(n = 271)
Numb Perce
er
nt

15

5.6%

1
162
20
3
2
0

2.2%

0
0.4%
60.9
%
7.5%
1.1%
0.8%
0.0%

0.0%
59
105
7
3
1

21.8%
38.7%
2.6%
1.1%
0.4%

Unspecified Phonological Approach

Other Approaches
Language Intervention
Literacy Intervention
Oral Motor Intervention
Phonological Awareness Intervention
Sign Language/Voice Output Device
Social/Pragmatic Intervention
Syntax Intervention

19%

26%

17

6.4%

104

38.4%

0
2
3
4
0
1
0

0.0%
0.8%
1.1%
1.5%
0.0%
0.4%
0.0%

2
8
9
6
2
2
1

0.7%
2.9%
3.3%
2.2%
0.7%
0.7%
0.4%

Marquette University

University of Wisconsin - Eau

Claire

University of Wisconsin - Madison

University of Wisconsin Milwaukee

University of Wisconsin Oshkosh

University of Wisconsin - River

Falls

University of Wisconsin Steven's Point

University of Wisconsin Whitewater

0% 7%
17%

14%

4% 2% 10%

Viterbo University

Figure 1: Participants Graduate Institutions in Wisconsin

Figure 2: Participants Year of Graduate Degree Completion

5%
27%
1960 - 1990
1990 - present
Not Available
67%

Figure 3: Percentage of Participants Using Articulation vs. Phonology vs. Combination Formal
Assessment Tools for Mild and Severe SSDs
100.0%

80.0%

23.5%
40.3%
2.7%

60.0%

Combination

Percentage of Participants

Phonology
40.0%

28.6%
66.7%

20.0%
24.2%

0.0%
Mild

Severe

Severity of Speech Sound Disorder

Articulation

Figure 4: Percentage of Participants Using Articulation vs. Phonology vs. Combination Approaches
to Intervention for Mild and Severe SSDs
100%

80%
15.9%

60%

19.2%11.1%
1.5%
3.8%

Percentage of Participants

Depends on Assessment
Results
Combination

40%

Phonology
51.3%
20%

0%

Articulation

47.4%

4.8%

Severity of Speech Sound Disorder