Een procesgerichte aanpak van differentiaaldiagnose en therapieplanning bij spraakontwikkelingsstoornissen

The classification and differentiation of paediatric speech sound disorders (SSD) remains a controversial issue. The definitions used in classifying childhood SSD and motor speech disorders (MSD) refer to speech production processes, and accordingly a variety of methods of intervention has been developed aiming at different parts of the speech production process. However, diagnosis in clinical practice is primarily based on behavioural speech symptoms rather than the underlying deficits. The diagnostic dilemma is that the ability to investigate the characteristics of subtypes of SSD requires ‘pure’ cases selected on the basis of unambiguous/clear-cut criteria. These criteria can only be defined and made available as a result of research (into a priori undefined/undetermined cases). In this paper we propose a process-oriented approach to diagnosis and treatment planning of paediatric SSD based on three pillars of research that will allow us to break through this circularity. The core of this approach comprises three important notions:
1. Although the behavioural symptomatology of paediatric SSD’s is not completely clear, it is possible to precisely define a specific core problem in terms of processes. (A focus on underlying processing deficits rather than classification based on symptoms.)
2. Developmental interaction between processes: a specific underlying impairment on one level or domain also affects the development on adjacent levels or domains. (A focus on process profiles with degrees of involvement.)
3. The speech production system and -disorder develop/evolve in time. (A focus on changing profiles.)
Based on these three notions, we propose a model of differential diagnosis and treatment planning for childhood speech disorders that - besides “fluency disorder” - comprises two general diagnostic categories labelled “speech delay” and “developmental speech disorder”. Within these categories, treatment goals are formulated on the level of processes. This process-oriented approach to diagnosis and treatment planning holds important advantages. In contrast to diagnostic classification based on a description of behavioural symptoms, it offers direct leads for treatment aimed at the specific underlying impairment tailored to the specific needs of the individual that is evaluated and adjusted in the course of the speech disorder. The approach is illustrated with an example.