Speech and language therapists' insights into severity of speech sound disorders in children for developing the speech sound disorder severity construct

What is already known on the subject Although there are several proposals aiming to define the severity of SSD, the extent to which these align with clinical practice is not well understood. In recent years, speech accuracy and other factors such as intelligibility have been suggested as possible indicators of SSD severity. Flipsen et al. (2005) concluded that experienced clinicians evaluated the number, type and consistency of speech errors as well as intelligibility, considering articulatory competence at both the segmental and whole word level when determining severity. Enderby et al. (2013) developed ICF-based Therapy Outcome Measures (TOMs), including a TOM for phonological disorder. Although there is evidence in the literature that multiple factors should be considered when determining severity, there is still no clear guidance on this. In this discussion, the perspective of SLTs is an important contribution to the development of a measure of severity, but is lacking in the known literature. What this paper adds to the existing knowledge As a first step, this study examines SLT's perspectives on how they define and measure severity of SSD, and determines how those views align with the ICF in order to develop a severity construct that can be further tested and validated. Using the views of SLTs and the ICF, this qualitative study resulted in the multifactorial SSDSC. What are the potential or actual clinical implications of this work? The practical experience of SLTs, combined with what is known from the literature, provides insight into the different factors that may contribute to severity of SSD. These factors may be considered in developing a measure of SSD severity in the future.