Specific Treatment Approaches

1. Specific Treatment Approaches Articulation

2. Traditional Approach • Been around forever! • Early authors include S. Stinchfield and C. Van Riper • 5 basic phases • Ear training • Production Training – establishment • Production Training – stabilization • Transfer & Carryover • Maintenance

3. Ear Training • Phase 1 • Identification • Teach properties of the sound and give it a name • Ticking sound • Angry kitty sound • Phase 2 • Isolation • Identify words that contain their sound • Identify where in the word the sound is located • Phase 3 • Stimulation • Auditory bombardment of the sound • Phase 4 • Discrimination • Detection and correction • No evidence suggesting this is a necessary step

4. Production Training - establishment • Sound evoking techniques • Wayne Secord and Ken Bleile books • Imitation • Phonetic placement • Contextual cues • Motor kinesthetic cues • Sound approximation

5. Production training - stabilization • Stage 1 – isolation • Stage 2 – nonsense syllables • Stage 3 – words • Stage 4 – phrases • Stage 5 – sentences • Stage 6 - conversation

6. Transfer & Carryover • Home assignments • Self and peer monitoring • Taking the speech teacher out of the speech room • Proprioceptive awareness • Masking noise during speech work • Varying the audience and setting

7. Maintenance • Gradual dismissal from services

8. Sensori-Motor Approach • McDonald’s Sensori-motor Approach • Syllable is the basic unit of training • Facilitative contexts should be used • Three objectives • Heighten child’s awareness of motor patterns of non-error sounds (no effort to remediate error sounds at this point) • Train error sound with facilitative context • Systematically vary the context

9. Multiple Phoneme Approach • McCabe and Bradley • Designed for use with articulation disorders that have numerous errors • 3 phases • Phase 1 • Establishment (visual, auditory, tactile cues) • A=visual only (grapheme) • B=visual + auditory • C=visual + auditory + tactile • Holding

10. Multiple Phoneme Approach (continued) • Phase 2 • Transfer • Get all errors sounds to correct use in conversation • Progressively increase length of utterance • Syllable, word, phrase, story, conversation • Phase 3 • Maintenance • 90% accuracy across speaking situations without monitoring • Phone conversations • Classroom visits • Return visits to speech clinic

11. Paired Stimuli Approach • Weston and Irwin (1971) • Teaches one sound at a time • Commercially available program, Paired Stimuli Kit • Uses “key words” (words that can be produced correctly with the target sound) • 2 initial position and 2 final position “key words” • 3 levels of training: Word, Sentence, Conversation

12. Programmed Conditioning • Baker and Ryan (1971) Monterrey Program • Numerous other behavioral programs in the 1970’s • Stimulus-response-consequence • Utilizes models, pictures, graphemes, stories, etc. • Schedule of reinforcement shifts from CR to and intermittent schedule • 3 phases: Establishment, Transfer, Maintenance • Each phase has multiple substeps