Speech-Language Pathologists' Perceptions of the Severity of Speech Sound Disorder.

Purpose: Severity is a qualitative judgment typically made by speech-language pathologists (SLPs) to represent the impact of speech sound disorder (SSD) on a child's functional communication. Despite the influence of severity on clinical practice, there is no gold standard as to how SLPs should determine such a rating. The purpose of this study was to explore SLPs' perceptions regarding the concept of severity of SSD.

Method: An embedded mixed-methods research design was selected for this study to support the collection and analysis of both quantitative and qualitative data. An online survey of 30 closed-ended and 10 open-ended questions was created using Research Electronic Data Capture and disseminated to currently practicing SLPs across the United States. A total of 296 surveys were completed, and data were analyzed using descriptive statistics for the quantitative data and inductive content analysis for the qualitative data.

Results: The majority of SLPs reported that they determine severity when assessing children with SSD. However, the mixed-methods analysis showed that SLPs disagreed in their decision making on whether to use severity ratings. The top five factors SLPs consider when judging severity are types of errors, intelligibility, perceptual judgment, normative data for speech sound development, and standardized percentile rankings with the addition of stimulability through qualitative responses.

Conclusions: SLPs need a standard biopsychosocial model for determining severity that truly evaluates the "impact" of SSD on a child's communicative participation and attitudes. Recommendations for clinical use of holistic assessments and future research on currently established severity rating scales are discussed.