Naar een proces-georiënteerde, dimensionale methode voor diagnostiek en behandeling van spraakstoornissen bij kinderen. Positiebepaling en toekomstperspectieven

Background: Children with speech sound disorders (SSD) form a heterogeneous group, with respect to severity, etiology, proximal causes, speech error characteristics and response to treatment. Infants develop speech and language in interaction with neurological maturation, and general perceptual, motoric and cognitive skills in a social-emotional context. Purpose: After a brief introduction into psycholinguistic models of speech production and levels of causation, in this paper we present an in-depth overview of mechanisms and processes, and the dynamics thereof, which are crucial in typical speech development. These basic mechanisms and processes are: [1] neurophysiological motor refinement, that is, the maturational articulatory mechanisms that drive babbling and the more differentiated production of larger speech patterns; [2] sensori-motor integration, which forms the steering function from phonetics to phonology; and [3] motor hierarchy and articulatory phonology describing the gestural organization of syllables, that underlie fluent speech production. These dynamics have consequences for the diagnosis and further analysis of SSD in children. We argue that current diagnostic classification systems do not do justice to the multi-level, multi-factorial and interactive character of the underlying mechanisms and processes. This is illustrated by a recent Dutch study yielding distinct performance profiles among children with SSD, which allows for a dimensional interpretation of underlying processing deficits. Conclusions: Analyses of mainstream treatments with respect to the treatment goals and the speech mechanisms addressed, show that treatment programs are quite transparent in their aims and approach and how they contribute to remediating specific deficits or mechanisms. Recent studies into clinical reasoning reveal that the clinical challenge for SLPs is how to select the most appropriate treatment at the most appropriate time for each individual child with SSD. We argue that a process-oriented approach has merits as compared to categorical diagnostics as a toolbox to aid in the interpretation of the speech profile into underlying deficits and connect these to a specific intervention approach and treatment target.