Treatment Efficacy in Phonological Intervention

1. Treatment Efficacy in Phonological Intervention What are the variables in treatment efficacy?

2. What is treatment efficacy? Olswang (1990) discussed the “3 E’s” of treatment efficacy: 1. Efficiency 2. Effects 3. Effectiveness

3. Treatment Efficiency • How long did it take for child to achieve their goal? • Number of tx sessions • graphed data • slope (gradual or sharp?) • How much effort did it take to facilitate changes? • How long was child in each tx phase (imit vs spon)? • were branching steps included? • How much cueing did child require?

4. Treatment Effects • Was the observed change significant? • Visual inspection of the slope of the graphed data (tx and generalization) • Pre/post measures (PCC-R; PCUR; intelligibility and severity indices or rating scales; Kent measures) • was the change “clinically significiant”? • Generalization data, conversational sample, social validation

5. Treatment Effectiveness • Was therapy responsible for the observed changes? • Baseline (level and trend) • extendend baseline • control sound

6. Functional Outcomes of Phonological Treatment (Gierut, 1998) 3 questions: 1. Does treatment work? - treatment effectiveness 2. In what ways does treatment alter behavior? - treatment effects 3. Does one treatment work better than another? - treatment efficiency

7. Effectiveness: Does treatment work? • The model selected by the SLP is “a direct derivative of the diagnostic and classification framework that forms the initial phonological evaluation” • Although there are different models of treatment available, what are the 2 categories that the models can be classified in? • sensory-motor (phonetic) • cognitive-linguistic (phonemic)

8. What are the different models within each category? • Sensory-motor • Cognitive-linguistic

9. Effects: What are the types of sound change? • How do we measure sound change? • Specific: to trained sounds (narrow) • General: to untrained sounds/system-wide (broad) • On-line: change that occurs during treatment • Longitudinal: change that occurs following treatment

10. Specific sound change to treated sounds • Widespread lexical change from training a sound in a limited number of exemplars (3-5 different words) • Change across phonetic contexts • Change across linguistic units • Change across settings

11. Specific sound change to untreated sounds • Within-class generalization • Across-class generalization • broad and system-wide change • markedness

12. Efficiency: Does one treatment work better than another? 3 types of comparisons 1. Treatment models 2. Types of sounds taught 3. Modes of presentation

13. Comparison of Treatment Models - MP ~ maximal oppositions - MP ~ treatment of the empty set - MP ~ cycles - MP ~ whole language

14. Comparison of Treated Sounds - early ~ later developing sounds - phonetically complex ~ less phonetically complex - stimulable ~ non-stimulable - most knowledge ~ least knowledge

15. Comparison of Modes of Presentation - sound perception ~ sound production - drill ~ drill/play ~ play - computerized instruction ~ SLP

16. Summary of Treatment Efficiency • Teach sounds or sound pairs not in phonetic inventory • select developmentally later-acquired sounds that are also phonetically more complex, acoustically undifferentiated, and nonstimulable

17. Olswang (1990) Effectiveness: Was therapy responsible for the change Effects: Was the change significant? Efficiency: How long did it take to achieve the goal? How much effort was required? Gierut (1998) Effectiveness: Does treatment work? Effects: What is the type and extent of sound change? Efficiency: Does one treatment work better than another? Treatment Efficacy (Olswang ~ Gierut)

18. Research and Practice: Applied Phonology (Hodson, 1998) • Gap between research and practice is probably greatest in phonology • Phonetic approaches with children who have multiple sound errors take much longer (5-6 years) • However, time is a critical priority given the critical age hypothesis that reading and spelling will progress normally if the intelligibility problem has been resolved by age 5;6.

19. Phonological Impairment, Phonological Awareness, and Literacy • Compelling evidence that children with severe phonological impairments perform less well on phonological awareness tasks • Further, children with poor phonological awareness abilities experience greater difficulty learning to read • “Matthew effects” -- unless intervention is appropriate and immediate, the gap between good and poor readers widens over the years

20. Treatment Research • Critical need for more treatment outcome data • to bridge gap between research and practice • treatment studies must be “accountable” and “clinician-friendly” • Following information needed to evaluate treatment outcomes: • intelligibility • severity • stimulability • phonetic transcriptions of word productions • child’s abilities

21. Treatment Studies (con’t) • In addition, treatment studies should include: • theoretical underpinnings of the approach • explanation/rationale of specific treatment targets selected • explanation of specific procedures used • specification of contact time (exact number of contact hours); including number of sessions/wk, length of each session, period of treatment from beginning to end

22. Investment in Incorporation of Phonological Principles • Which phonological analysis model should be used? (phonological processes; PPK, non-linear; some combination?) • Do SLPs need to learn all analysis frameworks to be effective when working with children with severe PI? • These questions add to the confusion of SLPs and increase resistance to implementing phonological principles

23. Conclusions: Researcher ~ Clinician Gap Two-way responsibility • practitioners need to be involved in research at all levels • researchers need to understand the needs of clinicians as well as clients • “collaborative dialogues” between researchers and practitioners

24. Conclusions: Researcher ~ Clinician Gap • accountability and responsiveness need to be improved at all levels (including university classrooms and clinics) • SLPs need a “deep commitment to lifelong learning in order to be able to provide optimal services to children with severe phonological impairments”