Basic Principles and Procedures in Treatment of SSDs

1. Basic Principles and Procedures in Treatment of SSDs

2. Remember….** • You don’t have to read chapter 7 basic unit • PowerPoint notes only 

3. As we begin to discuss tx, remember Fogle 2019—parents report that SSDs impact their children in the following ways:

4. I. SELECTING POTENTIAL TARGET BEHAVIORS** • A. Introduction • Target behavior • We need to select short term objectives and long-term goals • In the schools, we say “benchmarks”

5. B. General Considerations** • Select tx targets that are linguistically and culturally appropriate for the client • Select targets that will make an immediate and socially significant difference in the client’s communication skills

6. Remember…** • Connect tx to classroom curriculum • Always keep Common Core State Standards in mind • I always tx speech sound errors and lang together

7. Izzy brings class reader to work on /r/

8. For Kiree, what would make an immediate difference?

9. C. Select More Readily Taught Treatment Targets** • Stimulable sounds treated before non-stimulable sounds • Teach visible sounds before non-visible sounds (e.g., /th/ before /r/) • For a phonological process to be treated, should occur at least 40% of the time

10. D. Select Targets that Affect Intelligibility the Most** • Select phonological processes that affect the most sounds; processes that contribute the most to the child’s lack of intelligibility • E.g., stopping affects many sounds

11. II. DECIDING ON THE NUMBER OF SOUNDS OR PATTERNS TO TEACH** • If the child only has 1-2 errors, the decision is easy • If the child has multiple errors, then we need to decide: do we train many sounds at once, or just a few?

12. Variables impacting this decision include child’s:

13. III. ESTABLISHING BASELINES** • A. Introduction • When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not adequately sampled • For example, an artic test may sample /r/ one time in initial, medial, final position of words

14. Because of this very limited sampling, mistakes can be made** • For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off • But later, lo and behold, the child makes the /f/ with 90% accuracy on repeated measures!

15. We counteract this problem…** • By establishing baselines of potential treatment targets before starting therapy • Baselines are measured rates of behaviors in the absence of treatment

16. Baselines in our own lives:** • How much you weigh before you start that diet  • How many pounds you can bench press when you start a new workout program • How fast you can swim a lap before you start that swim class

17. B. 3 purposes of baselines:

18. Count the # of times** • That Dr. R. makes a th/s substitution when presented with picture cards • There will be 20 opportunities for /s/--how accurate am I? What is my %age of accuracy in /s/ production?

19. C. Baseline Procedures** • Specify the treatment targets in measurable terms • For example: • -produce /r/ in word-final position with 80% accuracy • Reduce use of final consonant deletion from 70% to 20% in conversation

20. We need to be sure to specify response topography** • This refers to the linguistic level of training • For example, do we want to begin with /r/ in isolation? • Do we want to begin with /r/ in word-initial position in sentences?

21. IV. SELECTING THE INITIAL LEVEL AND SEQUENCE OF TRAINING** • Baselines help us create appropriate tx objectives • PBH: best to start tx at word level— functional words especially

22. V. DEVELOPING MEASURABLE OBJECTIVES** • Treatment or short-term objectives are the skills the clinician plans to teach on the way toward achieving the selected treatment targets or long-term goals • Appropriate long-term goals might be: • “Increase the client’s intelligibility of speech” • Improve the client’s phonological skills”

23. However, measurable short-term objectives are needed** • These objectives specify how a goal will be achieved • The objectives must be measurable so that external observers can verify the results of the clinical services provided • Many 3rd party payers like insurance companies demand detailed documentation of improvement

24. To write a good objective:** • Use observable behaviors (e.g., point to, say, write, read aloud, sing, match) • Don’t use words with non-observable behaviors (e.g., know, understand, remember, learn, perceive, memorize, think about, consider)

25. Remember that data collection** • Should be done throughout tx • A good baseline will support this

26. VI. PLANNING AND DEVELOPING A TREATMENT PROGRAM OR PLAN** • A. Introduction • Phonetic placementtechniques are direct methods to teach clients how to position the articulators and produce the sound appropriately

27. In this youtube video… • The SLP uses the direct technique of Mr. Mouth • Articulation Disorder Teaching /r/ • Ashley Mcgeehon’s channel

28. B. Successive Approximation or Shaping** • We take advantage of a sound the client can already make (e.g., /g/ if they cannot produce /r/). • We have them make the /g/, and gradually move toward /r/.

29. We can begin training the sound at one of several levels:

30. If the child cannot create a phrase or sentence with the target word…** • We can use a carrier phrase such as: • “I see______” • “Here is a ____”

31. VII. STRUCTURING TREATMENT SESSIONS** • Initial tx sessions highly structured • Tx sessions gradually loosen up to replicate natural “real world” more • Helps child generalize target sounds to spontaneous speech

32. VIII. INCREASING AND STRENGTHENING ESTABLISHED BEHAVIORS** • A. Selecting Potential Reinforcers Positive reinforcer—rewards and strengthens the behavior

35. The treasure chest rocks! 

36. Noah loves the treasure chest….

37. So does RJ!

38. IX. GENERALIZATION** • Generalization usually refers to the child’s producing learned responses in settings outside the clinic

39. Generalization across situations** • Ch uses sound in other locations with other audiences

40. X. IMPLEMENTING A MAINTENANCE PROGRAM** • A. General Considerations • Maintenance = ultimate goal • Skills sustained over time • Select stimuli from client’s natural environment • For example, classroom language arts book

41. We should vary the physical setting** • Conduct therapy in different environments

42. We Need to Teach Multiple Exemplars** • For example, “quick” children working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures • Some children may need 50 pictures, 30 objects, and 10 books with /r/-initial stimuli before they achieve 90% accuracy

43. B. Manipulation of Response Contingencies** • Most important aspect of maintenance • Move from continuous to intermittent reinforcement schedule • Fade primary reinforcers, rely more on natural reinforcers

44. We can also…** • Train parents and others to reinforce children for correct speech productions in natural environments • Teach self-monitoring/self-correcting skills (I use the terms interchangeably)

45. C. Involve Family Members and Significant Others