Developmental speech sound disorder (SSD) is a term that covers a wide range of problems when it comes to the production of speech for the child population. In the DSM-5, developmental speech sound disorder is defined as a persistent difficulty with sound and speech production, which inhibits speech intelligibility or prevents communication in a verbal manner (American Psychiatric Association, 2013). Developmental speech sound disorder cannot be explained through motor difficulties, sensory problems, or physical conditions. Children with this particular health concern will create systematic distortions, omissions, or substitutions of phonemes and other sounds within their speech. This phenomenon occurs even though the children are able to repeat these phonemes when they are spoken in isolation. Developmental speech sound disorder is prevalent in up to 6 per cent of the population in children below six years old (Haiyou-Thomas et al., 2016). The 6 per cent statistic varies from criterion to criterion when it comes to the specific diagnoses and the specific ages of the children. Difficulties with speech present an important area of research as they arouse parents' concern and maybe signs of developmental obstacles. Furthermore, they present a financial and time investment in the near future for such children, as guardians spend on therapy services to address their difficulties.
In the past, research has examined the links between developmental speech sound disorder and cognitive skills in isolation. There have been associations made between specific, isolated cognitive skills such as motor issues, literacy, linguistics, and social skills. However, there are few sources that take the perspective of the links between developmental speech sound disorder and the overall cognitive state. Furthermore, the fact that child cognitive development forms the foundation for several of the studied lines of research – social skills, reading, learning, and languages – means that there is a need for the link between DSS and cognitive development to be explored. In this paper, the link between DSS and the preoperational stage of child cognitive development will be investigated. The preoperational stage of child cognitive development is one of Piaget's four stages. This particular stage was chosen as the focus of this exploration, as the majority of the literature available on DSS focuses on the 4 to 6-year-old age group. The 4-6 age range falls under the preoperational child cognitive development stage.
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Speech disorders affect social work practice and policy in various ways. Although developmental speech sound disorder is considered rectifiable by working through speech therapy and other related programs, it is still considered a disability. In terms of policy, social work is impacted by SSD in the same way as all other disabilities. Disability management policy is an essential part of the social work industry, as it guides the means through which social workers apply the tenets of their practice to the unique needs of the community of people living with disabilities, as well as their support system.
This study will add to the current knowledge on children with SSD by providing information specific to the impact the disorder has on cognitive development. Current information on the effect of SSD on the value of life for children within the 4 to 6-year-old age range is limited to specific issues such as literacy and interpersonal interactions. Through this paper, the scope of SSD in the context of the preoperational stage of child cognitive development will be explored and added to existing literature.
Variables
The two main variables, in this case, are cognitive development and developmental speech sound disorder. Cognitive development is defined as the construction and creation of thought procedures. This involves problem-solving, decision making and remembering. Cognitive development is a process that is carried out from childhood until adulthood. According to the DSM-5, developmental speech sound disorder is defined as a constant difficulty with the production of sound and speech that inhibits speech intelligibility and prevents verbal communication (American Psychiatric Association, 2013). SSD is not the product of motor difficulties or other physical conditions but is instead the product of systematic distortions, omissions or substitutions of phonemes when speaking (American Psychiatric Association, 2013).
Summary
Children with developmental speech sound disorder are affected in multiple ways due to the gaps in communication that are caused by their condition. Since speech and sound formation are key elements to communication – and by extension, interacting with their immediate environment – it can be posited that SSD has an impact on the cognitive development of these children. In the paper below, the impact that SSD has on child cognitive development will be explored.
Review of the Literature
History and Background
Speech sound disorder is a broad term used to refer to a variety of complications with speech sounds, including issues with perception, phonological representation, or motor production. Researchers have identified two types of speech sound disorders, those that are organic and those that are functional. Organic speech sound disorders are the result of an underlying cause such as a structural, sensory, or neurological issue. Functional speech sound disorders have no underlying known cause and are referred to as idiopathic.
Speech sound disorders are the most common among communication conditions in the pediatric age group. They affect 10 to 15 per cent of all preschoolers and 6 per cent of older, school-aged children. As the focus of this paper will be on the preoperational cognitive development stage, the main focus will be on a segment of preschoolers. Speech sound disorders with a known cause – organic speech sound disorders – are in the minority. These are generally easily attributed to an issue such as cleft lip or sensorineural hearing loss (Waring & Knight, 2012). The majority of kids with a speech sound disorder are thus dealing with idiopathic conditions. Kids with organic SSD are generally diagnosed early, between 2 and 4 years old. However, the children that will be the focus of this paper, those at the preoperational stage, are usually past this age range. Thus, most of them have functional SSD.
Functional SSD is more likely to persist past the preschool age. This creates difficulties in the individual’s social, academic, and vocational life (Waring & Knight, 2012). Effectively handling SSD for such children is further complicated by the heterogeneity of the condition. Researchers have now achieved consensus that there is no homogeneity among children with SSD. There are not only differing underlying causes but also differing severities and speech errors. Other factors that confound the elucidation and treatment of these speech sound issues are the linguistic system, maintenance factors, and each individual child's response to the treatment.
As a result, there has been little progress in the creation of a universal system of SSD treatment. From a social work perspective, this limits the variety of basic approaches that the worker can recommend in SSD cases. Each child with speech sound disorder – and their support system – requires not only an effective solution but a highly personalized one. Furthermore, it is important for social workers to understand the underlying classifications of childhood SSD to place the child on the right path with regards to therapy. Over the course of SSD treatment in the healthcare industry, there have been a number of classification methods – each varying in terms of the theory applied to its treatment. These range from medical to processing approaches (Waring & Knight, 2012). The medical approach categorizes a speech pattern disorder according to the underlying medical issue (Waring & Knight, 2012) . This is evident from a number of different entries under SSD in the DSM-5. The descriptive-linguistic approach utilizes specific error patterns to classify the type of SSD. This type focuses on the child's developmental pattern (Waring & Knight, 2012) . The processing approach investigates the formation of speech error by investigating their psycholinguistic patterns (Waring & Knight, 2012) . Each of these approaches utilizes different recommended methods of treatment, and assisting the child’s guardians in choosing the right one is an important role for social workers in cases with SSD.
Review
Cognitive Stages in Childhood Development
Cognitive development in childhood occurs in four stages that were identified by Jean Piaget. The first is the sensorimotor stage, which arises from birth to the second year, where children learn about the world through their senses. The second is the preoperational stage, where children develop imagination and memory. This stage occurs between ages 2 and 7. During this stage, children begin to understand ideas, symbols, and time as a linear construct. The next stage is the concrete operational stage, which lasts from the ages of 7 and 11. This stage is accompanied by increased awareness of external events and feelings. Children begin to understand that their feelings and thoughts are not shared by others and begin to be less egocentric. Lastly is the formal operational stage, which happens past 11 years old. In this stage, children apply logic to solve problems and view their surroundings. The age at which SSD presents itself can be as early as two years old. It can last past preschool, but treatments seek to resolve it before entering into the school period. Thus, it affects children at the preoperational stage the most. This is the reason behind the focus on children between 2 and 7 in the literature on SSD.
Cognitive Skills and Components Involved in SSD
In the existing literature, one of the connections that have been drawn between SSD and cognitive skills centers on literacy. While developmental speech sound disorder difficulties often resolve eventually, they are commonly seen as a risk factor for other issues, such as difficulties with general literacy (Hayiou-Thomas, Carroll, Leavett, Hulme, & Snowling, 2016). Currently, there is research suggesting that there are genetic links between difficulties with speech and difficulties with literacy. While this relationship is not straightforward or causative, it still represents a significant concern that guardians may have with regards to speech disorders and the impact that it will have on the quality of their child's education, and by extension, their later life. Even indirect relationships between literacy and speech disorders can have significant effects on early education if impediments to verbal communication persist until the children are at the age for formal reading instruction. Also of note for such concerns is the particular type of errors that the child is prone to making and any other difficulties with language that may be co-occurring with their particular developmental speech sound disorder.
With cognitive skills being tied strongly to literacy, links between speech sound disorder and literacy raise concerns over child cognitive development. Cognitive skills are a key component of the reading process, and the classroom is one of the primary locations in which cognitive developmental disorders are flagged. Therefore, the links between limited literacy and a speech sound disorder highlight that cognitive development may be linked to SSD. Apart from literacy, developmental sound speech disorder has also been associated with motor and linguistic issues. These associations further highlight the need for a better understanding of the means through which SSD affects child development.
One study highlights a connection between SSD and other cognitive issues in children by studying children's social and academic lives during and after speech therapy. Farquharson (2015) finds that children with SSD often experience academic difficulties later in life as a result of the effect that their condition has on their cognitive skills. These children, even after treatment, tend to experience lingering deficits with their language as well as their cognition in the classroom. Thus, the research suggests that there is a link between SSD and cognitive development for children (Farquharson, 2015). This represents an area of study that requires more investigation and detail.
Another study by Sigurdardottir and Vik (2011) demonstrates that capacity for speech and language is determined by cognitive abilities. In conjunction with sensory and motor abilities, cognition is linked strongly to a child’s capacity for speech. Through their study, the authors determine that cognition is linked to speech difficulties in children with cerebral palsy, even after isolating the inherent motor difficulties that come with the condition (Sigurdardottir & Vik, 2011). Thus, the study confirms that speech disorders such as SSD would have an effect on cognitive development. Nevertheless, as the specific cognitive development effects fall outside the scope of this study, this is not an avenue that the authors explore.
Despite the identification of these links between SSD and cognitive development, there is a gap in the literature when it comes to a comprehensive compilation of evidence that SSD is linked to the cognitive skills of the children that have the condition. Communication with others is an essential part of the cognitive development of children, as they begin to match their world view to that of others around them. Thus, barriers to effective communication would hinder this cognitive development. SSD presents one such hindrance to effective communication. The hypothesis of this paper is that the link between communication and cognitive development indicates that SSD would have an effect on the cognitive development of children in the preoperational stage, as identified by Piaget.
Method
Purpose
The resolution of this paper will be to identify information on the effects that SSD has on the cognitive development of children and present this evidence in a comprehensive report. This report aims to bridge the gap in understanding the effect of SSD on cognition development in children, specifically those in the preoperational stage. This paper will utilize systematic review meta-analysis methods.
Paradigm
The research paradigm used in this study will be the positivist approach. The positivism paradigm relies on deduction and utilization of a priori hypothesis to determine the existence of a functional relationship between two variables (Park, Konge, & Artino, 2020). The goal of an inquiry carried out using a positivism paradigm is to find explanatory associations or relationships (Park, Konge, & Artino, 2020). These relationships can then be used to predict or control the particular phenomenon of study. The positivism paradigm is rooted in following the progression of scientific inquiry identified in ‘A System of Logic’ by Mill (Park, Konge, & Artino, 2020) –
The focus on the discovery of laws for explanation and prediction
The use of established methodologies
The application of methods to assert the existence of one true reality
Evidence derived from empirical data
Adequate sampling (Park, Konge, & Artino, 2020)
Study Design
The systematic review performed in this study will be qualitative. The goal is to explore and describe the relationship between SSD and cognitive development in children. So as to achieve this goal, data will be derived from studies utilizing observation, interviews, surveys, and verbal interactions. As a result, the study will utilize a qualitative approach. As the issue of associating SSD with cognitive development in children presents a gap in the literature, it is necessary for this first attempt in the avenue to explore and identify evidence and potential trends. Since this is a topic on which there is little to no prior information, a qualitative exploratory study is the best approach.
Sample
The sample population will be articles utilizing primary research undertaken in relatively recent periods. These will have to be relevant with regards to the topic of SSD and cognitive development, or at least a cognitive skill. Databases with social work, healthcare, and disability journals will be used for the identification of papers that will be used in the review.
Investigative Techniques
Articles will be identified through the use of formal search methods. These include electronic searching of major databases in healthcare, disability, and social work, as well as hand searching key journals. The investigation will also utilize citation tracking and reference scanning. Identification of relevant studies through the use of personal contact and snowballing will be utilized to ensure that the search is as comprehensive as possible. The specific electronic databases that have been identified for use in this investigation are PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Knowledge, JSTOR, Web of Science, and Google Scholar. Free text searches will also be used, focusing on keywords ‘speech sound disorder’ and ‘cognitive development’.
Data Collection
The inclusion criteria used will be applied in two phases – the first sift and the second sift. The first sift will utilize two main inclusion criteria. One is relevance. The relevance criterion will be concerned with whether the paper explicitly studies a speech sound disorder or the connection between communication disorders and cognitive development in children. The second criterion is specificity, which will investigate whether the study references a connection or association between these two variables. In the second sift, the articles identified in the first sift will be further examined for inclusion. Here, the articles will be included based on two criteria. The first is depth, which will be used to investigate whether the paper goes beyond a superficial or surface commentary of the issue and into specifics. This criterion will also test the empirical nature of the information within the studies. The second criterion is utility. This criterion will examine if the paper contributes to understanding the connection between SSD and cognitive development.
The exclusion criteria will be timeliness and quality of evidence. Papers published more than ten years ago will be excluded from the review. Likewise, papers that do not use primary sources of data will be excluded from the review.
Data Analysis Plan
The statistics that are planned for collection are descriptive and univariate statistics. These statistical measures will meld well with the qualitative nature of the study. Furthermore, the fact that this is a qualitative study will disqualify most inferential statistics such as ANOVA.
Ethical Consideration (Human Subject Protections)
The lack of human or animal subjects in this study means that there are no ethical considerations on subject protections to consider. The papers utilized will use anonymous data, making the identity of their participants protected.
Bias
As human subjects will not be a part of the investigation, there will be no biases on social or economic bases to consider.
Assumptions
The main assumption, in this case, is that the relationship between SSD and cognitive development in children is a singular and identifiable one rather than the product of many variables working together.
Limitations
This study is limited to the investigation of SSD and cognitive development in children from 4 and 6 years old. Therefore, SSD in children below or above this age range will fall outside of its scope. The study is also limited by time and budget, meaning that the scale will be smaller than one lasting year and a significantly larger budget.
References
Farquharson, K. (2015). After dismissal: Examining the language, literacy, and cognitive skills of children with remediated speech sound disorders. Perspectives on School-Based Issues , 16 (2), 50-59.
Hayiou‐Thomas, M. E., Carroll, J. M., Leavett, R., Hulme, C., & Snowling, M. J. (2017). When does speech sound disorder matter for literacy? The role of disordered speech errors, co‐occurring language impairment and family risk of dyslexia. Journal of Child Psychology and Psychiatry , 58 (2), 197-205.
Park, Y. S., Konge, L., & Artino, A. R. (2020). The positivism paradigm of research. Academic Medicine , 95 (5), 690-694.
Sigurdardottir, S., & Vik, T. (2011). Speech, expressive language, and verbal cognition of preschool children with cerebral palsy in Iceland. Developmental Medicine & Child Neurology , 53 (1), 74-80.
Waring, R., & Knight, R. (2012). How should children with speech sound disorders be classified? A review and critical evaluation of current classification systems. International Journal of Language & Communication Disorders 48 (1), 25–40. doi:10.1111/j.1460-6984.2012.00195.x
