JCPSLP Vol 21 No 2 2019 DIGITAL Edition

stop sounds. Forty-five respondents agreed that velar fronting should take priority if not eliminated by school-age with 46% saying it should be directly targeted in preschoolers. When asked which criteria for target selection guided clinical decision-making in intervention planning for /k/ and /g/, the responses were (in order): speech errors impacting intelligibility most (93%); targeting sounds or processes in developmental sequence (78%); ready stimulability (76%); social impact on the child (67%). Open-ended responses garnered other target selection rationales, including: parental concern (46%); non- developmental order (20%); sounds or processes impacting literacy development (4%). Two respondents stated that other speech errors or processes would also influence their decisions. Focus group Key themes identified in the focus group data were: (a) ‘E3BP – clinical experience’, reflecting the influence of clinical experience on evaluating, prioritising, and treating /k/ and /g/; (b) ‘Deliberating target selection’ incorporating clinical decision-making processes specific to target selection; (c) ‘The nature of velars’ connoting the complexity and variability of velar fronting as a phonological process. E3BP – clinical experience The key theme of clinical experience was a significant factor in managing /k/ and /g/. Although all participants agreed that normative data were essential when assessing and evaluating children’s speech, all identified that norms were only part of the picture. Participant 4 noted: “…you also use your clinical experience to make decisions for your targets.” When considering the available normative data for the acquisition of /k/ and /g/, participants 1, 3, and 4 all explicitly agreed they observed the sounds were acquired later than norms suggested. Participant 1 reported: “… 3 years of age, it doesn’t feel right to me anymore. I’d be thinking more three and a half to four.” Specific normative data were cited by some participants including “Grunwell” and “Kilminster and Laird”, while acknowledging that these might be outdated. Participant 1 mused: “It’s getting old now isn’t it? I think Kilminster and Laird is about 1978 so it is … you get the feeling that it needs to be updated.” Clinical experience was also a consideration in intervention for the velar stops, with the SLPs discussing specific strategies. Participant 2 reported targeting the adjunct sequence /sk/ was facilitative in remediating velar fronting and cluster reduction, noting that this may differ from empirical research findings. “I’ve recently looked at the sonority as well, but I still find that it works.” Deliberating target selection There was discussion around how participants consider /k/ and /g/ in the context of target selection. Agreeing that norms may be outdated and/or not reflecting typicality, all agreed that applying normative data in baselining speech progress was useful. Participant 4 noted: “…the norms allow you to sort of say well I’m going to check back in 3 months and see how they’re doing.” However, when considering target selection, she said: “…there are … instances where you might sort of not go along with the norms depending on the functional needs of the child”. There was discussion around application of different theories and approaches to target selection in SSD. For example, participant 2 recalled that she implemented, successfully, a complexity approach to target selection

for the velar stop sounds: “…and I trial that to work on … cluster reduction plus the fronting and sometimes that can make those big changes … yeah it can work with some kids but not all kids.” The nature of velars There was agreement that velars were difficult for children to articulate and difficult for SLPs to treat, with consensus that velar fronting was complex and could persist. Participant 1 reported: “… if at 5 years of age velar fronting is persisting, it is very, very difficult to shift.” Further discussing how at 5;0, the process progresses from an age-typical substitution error pattern to a component of SSD, the participants observed that remediation of velar fronting was influenced by other factors. For example, participant 3 suggested that, if velar fronting were present in combination with other phonological processes, it would typically decline a year or two later than if velar fronting occurred alone. Slow generalisation when targeting velar fronting was also mentioned. Participant 4 noted: “…it doesn’t generalise quickly.” Participant 3 also observed that persistent velar fronting was: “… more difficult to treat (than other processes) because … it’s not visible.” Summary of findings To summarise the key findings combining both sources of data, both survey respondents and focus group participants predominantly agreed that norms are useful in clinical practice, and many commented on the variability of the available norms. The focus group participants expanded on these findings, participant 2 stating this variability is: “…hard to communicate to parents”; and “… we need some more uniformity.” Although many survey respondents (44.4%) agreed their own clinical experience seemed to match with information provided by norms, almost 40% disagreed with this statement, suggesting the belief that the velar stop sounds may be acquired later than available norms suggest. Almost all focus group participants made comments that suggested the same, as participant 1 and participant 3 suggest (respectively): “…a lot of children don’t fit into the pattern”; “…I have wondered recently if the norms should be revised upwards.” According to 81% of survey respondents, children approaching 5 years of age who have not acquired velar sounds /k/ and /g/ most likely present with velar fronting. A similar finding emerged in the focus group discussion. One survey respondent had observed the articulatory nature of velar fronting in their clinical experience. Contrastingly, all focus group participants viewed velar fronting as an articulatory process, or having an articulatory component. Referring to both the articulatory and phonological features of the process, participant 2 suggested that: “…they kind of interplay sometimes… even if my clients can discriminate it, they’re really trying (to articulate the sound), I can see that it’s… just their tongue.” Discussion This mixed methods study canvassed the views of Australian SLPs who considered the suggestion, by SLP clinicians, that /k/ and /g/ may be acquired at a later age than available norms indicate. There were five main findings. First, and predictably, there was tension between the desirability of having adequate Australian norms to guide speech evaluation and intervention, and the reality of relying on varied, contradictory norms to inform decisions.

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JCPSLP Volume 21, Number 2 2019

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