Abstract
At 928 pages this is not a book for the faint hearted. The book is intended for undergraduate, graduate speech and language therapists (SLTs) and professional development. On first reading it appears more suitable for postgraduates and specialists due to the complexity of some of the speech analysis and theoretical content. Both authors are Canadian speech language pathologists (SLPs), and they research and teach at McGill University, where the book is intended as a new teaching text.
The teaching intent has influenced the layout. It has learning objectives at the start of topics, and there are frequent margin notes. The margins themselves increase the size of an already large book. However, the margin notes are very helpful in highlighting significant points. Although explanatory, I am not sure the notes obviated the need for a glossary. There were some summaries at intervals, but if studying the text it would be useful to have more didactic summaries after each topic.
The book consists of 11 chapters and is divided into three parts: Part I: ‘Phonology from a developmental perspective’; Part II: ‘A holistic approach to diagnosis and treatment planning’; Part III: ‘Intervention at multiple levels of representation’.
Part I starts with ‘describing phonological knowledge at multiple levels of representation’; the following three chapters take the reader through development of speech perception, speech motor control and phonological development, respectively. To have so much salient and well-referenced information all in one place is marvellous.
The ‘multiple levels of representation’ do stray out of the comfort zone of many SLTs/SLPs, and I suspect that they are difficult to grasp from the text alone. It is necessary to have understanding of the ‘multiple levels of representation’ to benefit fully from the analysis and intervention approaches in later chapters. Having implied it may be difficult to access parts of the book, it is nevertheless a very important contribution as to how we view speech difficulties. The authors standpoint is that widely accepted ‘natural phonology’ models (from Stampe, 1979 onwards), purporting innate phonological processes, do not give a satisfactory account of the underlying representations in the child’s lexicon, nor are the processes sufficient to explain speech development.
The authors posit that phonological structure is hierarchical and child representations may not be adult-like. They propose a nonlinear multiple layer model with interactions between the levels in a phonological hierarchy. This enables a hypothetical description of the child’s underlying knowledge against production. This model is used in Part II of the book for Chapter 5 ‘Assessment of children with developmental phonological disorders’ and Chapter 6 ‘Speech sample analysis’. However perhaps out of respect for wide current clinical practice, the authors do not totally abandon phonological processes and acknowledge that this approach is more accessible than multilinear analysis. They also acknowledge that using the more detailed development schema of phonological processes (‘phonological patterns’) can be used to give a quick analysis of children with ‘fairly consistent deviation patterns’. It has to be said that multilinear analysis is complex, requires significant phonological knowledge, and is very time consuming; it is therefore perhaps best used for severely disordered phonology in specialist situations.
It is not just undergraduates who will benefit from the detailed developmental information but experienced and specialist clinicians also. Much information that previously could only perhaps be gained by years of experience in this area is pulled together, and there is invaluable information on norms, such as for intelligibility, non-developmental errors and atypical errors.
Likewise, in the chapter on assessment there are protocols laid out in great practical detail, invaluable to the newly qualified therapist. Differential diagnosis and when/whether to offer intervention are tackled. However, the chapter on speech sample analysis is very technical and perhaps mainly useful for specialists. Chapter 7 ‘Nature of developmental phonological disorders’ and Chapter 8 ‘Treatment planning’ also receive broad, but detailed and careful attention.
Part III looks at intervention in a slightly different way, because it comes from the viewpoint of multiple levels of representation. Intervention is dealt with in Chapter 9 ‘Input-oriented approaches to intervention’, Chapter 10 ‘Output-oriented approaches to intervention’ and Chapter 11 ‘Phonological approaches to intervention’. In many ways this is a comfortable and clarifying division. They approach these chapters with evaluation of treatment procedures from a research viewpoint but, more to the point, a ‘does it work?’ attitude. However, they do also acknowledge the trial and error element that reinforces the importance of monitoring. In doing so they embrace current attention to a ‘dynamic approach’, which is a theme throughout the book.
It is good to see a whole chapter dedicated to input, as it is a step that is often overlooked. The chapter makes a case for ‘auditory bombardment’ (or ‘focused stimulation’) and ear training to establish acoustic-phonetic knowledge and underlying representations later to be relied upon. Dialogic reading is another approach explored which is worth investigating. In general the authors do not ‘throw the baby out with the bathwater’, so that frequent reference is made to traditional approaches for which there is evidence of efficacy (e.g. Van Riper, 1978). The sensitivity and very fine adjustments deemed necessary to maintain ‘optimum challenge point’, and so shape output, makes the case (intentionally or not) for highly specialist intervention. Parents are not overlooked, and their input is considered important to intervention and treatment decisions. The output chapter covers numerous techniques, specifying their appropriate application, and (as elsewhere in the book) with demonstration transcripts. Apart from their illustrative merit, they also bring the techniques to life.
The chapter on ‘Phonological approaches to intervention’, reiterates the importance of adequate acoustic-phonetic and articulatory-phonetic representations for reorganization of the phonological system. Some approaches covered and evaluated will be familiar (e.g. meta-phonological approach or minimal pairs), but approaches with a vocabulary emphasis deserve special attention. There is a catch-22 situation with intelligibility and vocabulary: insufficient vocabulary diminishes the need for phonologic contrast; but unintelligibility is a limiting factor for vocabulary development. Most children with phonological delay or disorder (chwPhonD) have poor syntactic, particularly morphological, development but many have limited vocabulary; so these approaches are particularly important. The ‘core vocabulary approach’ is particularly effective with younger children who have inconsistent phonology. The ‘phonological awareness and vocabulary enrichment’ approach (the PAVEd approach) is very broad and, with its phonological awareness component, may circumvent literacy difficulties common in chwPhonD. Also welcome, the language element is not just vocabulary, but it also deals with oracy.
There will doubtless be discussion over the book title, due to the terminology ‘phonological’ and ‘disorder’, but I think it wise to sidestep issues that could detract from what this book brings. It is using the title in a much wider sense than many would. The book does go into delay and motor difficulties, and touches on dyspraxia, but also refers to thorough assessment and individual analysis of the child’s speech sounds, before hypothesizing on the child’s sound system and therefore the intervention strategies to pursue. It also acknowledges the reality of overlap of difficulties and provides useful information for differential diagnosis.
Niggles about the book relate to the graphics, of which there is extensive and helpful use; however, many are difficult to interpret quickly, particularly plot graphs, being in black and white. There are some colour plates, hidden in the middle of the book, which would be better placed with the text they elucidate. Likewise, appendices were difficult to find and a page number reference would be useful. Additionally, after only brief use, some pages are already threatening to come away from the binding, and this is a book that one would want to come back to again and again.
The authors say that they are not attempting a review of available literature and are pursuing their own rationale; but this is an extremely well researched book (e.g. on ‘development of motor control’ there are 194 references). In fact the chapters on development in this book are extremely informative and will give invaluable insight to anyone working with chwPhonD. Also the authors do not take a narrow view but they present a very broad view posing multiple models (e.g. a biopsychosocial model), with an overall holistic approach.
The author’s viewpoint, i.e. the efficacy for multilinear analysis of multiple levels of representation, undoubtedly makes a significant contribution and advancement to the topic of phonological difficulty. It remains to be seen whether the factor of accessibility may undermine the value of their approach.
One of the things most welcome about this book is the evidence base it provides. For a profession that has difficulty supplying evidence for its practice, this is a treasure trove. Wherever possible, the authors quote research support. However this is not a book driven by purely academic interest. The subtitle of the book is ‘Foundations of clinical practice’, and this description is justified. Both authors are experienced SLTs/SLPs, and one feels that the research is not the primary interest, but a means to an end. The authors integrate evidence with clinical practice, and their experience enables them to inform practice. This book makes a huge contribution to the understanding of and the intervention for children with phonological difficulties.