SPECIFIC TREATMENT PROGRAMS AND APPROACHES (chapter 8)

1. SPECIFIC TREATMENT PROGRAMS AND APPROACHES (chapter 8)

2. I. INTRODUCTION** • Intervention for speech sound disorders is very exciting • There is nothing in the world like the feeling you get when a child first says a sound correctly!!

3. These are ideas I use as an SLP in my job in the schools:

4. Using classroom language arts books for therapy—helps us help kids achieve Common Core State Standards:

7. According to our text ch. 8:** • Most tx approaches move from a simple to complex level of training (except the concurrent approach) • Some approaches do contradict each other (e.g., start w/ stimulable vs. nonstimulable sounds)

8. The point is to remain flexible…** • And do what is best for each individual client

9. Non-Speech Oral-Motor Exercises** • PBH do not believe that oral motor exercises are beneficial for anybody • They say research has not proven that oral motor exercises help • Roseberry’s position: these exercises are very helpful for children with oral motor problems

10. **Kent, R.D. (2015 November ). Nonspeech oral motor movements and disorders: A narrative review. American Journal of Speech-Language Pathology. • He said that NSOMMs can be part of practice in orofacial myology • Can be used with persons with dysarthria and dysphagia • Don’t just reject NSOMMs wholesale

11. II. TRADITIONAL APPROACH (Van Riper)** • Around since 1920s • Still popular and widely-used today • However, most SLPs really don’t do ear training any more (info on ear training on p. 402 is not on exam)

12. A. Production Training: Sound Establishment • Establish correct sound production in isolation • Use phonetic placement techniques • Successive approximation

13. B. Production Training: Sound Stabilization** • Stage 6 Conversation • ↑ • Stage 5 Sentences • ↑ • Stage 4 Phrases • ↑ • Stage 3 Words • ↑ • Stage 2 Nonsense syllables • ↑ • Stage 1 Isolation

14. 1. Isolation—use variety of fun activities** (p. 404 has some) • 2. Nonsense syllables —I don’t really use these • 3. Words —begin with words that are meaningful to the child. I work on sounds: • 1.word-initial • 2. word-final • 3. word-medial • 4. Clusters

15. For example, with /s/:** • Begin with soup, see, sun (word-initial) • Next: bus, face, piece (word-final) • Then: Classes, lesson (word-medial) • Last: Crust, stop, faster (clusters)

16. **4. Phrases – in-between stage—carrier phrases common—e.g.: • I see ____ • This is___ • 5. Sentences – various length and complexity (examples bottom of p. 405)

17. To establish sound in sentences: • Corrective set: SLP makes an error (e.g., fɪk/θɪk) and kids “catch” her) • Slow motion speech: SLP and ch say sentence together very slowly

18. 6. Conversation** • Start with structured conv.—e.g., SLP gives a topic or specific pictures to talk about • Transition to natural conv.—open ended. E.g., “Tell me what costume you wore for Halloween.’

19. C. Transfer and Carryover** • Vary the audience and settings • Speech assignments • In small groups—what are some practical strategies for implementing these ideas in a school setting?

20. D. Maintenance • Book: follow-up sessions • Dr. R.: in schools, keep on IEP, but reduce to tx once a week

21. III. CONCURRENT APPROACH (lecture notes only—not text)** • Said SLPs don’t have to use hierarchy we just described • First establish sound in isolation and CV, VC combos—80% accuracy • Then, mix it up in tx!

22. CSHA Dr. Steve Skelton • If we vary the response topography in each tx session, Ch will make  gains than if we just go up the hierarchy like a ladder

23. For example, in one session:** • 1. /r/ in final position of words • 2. /r/ in VC combos • 3. /r/ in sentences in word-initial position • 4. /r/ in word-medial position in phrases

24. Dr. Skelton: ACTIVITIES AND IDEAS FOR ELICITING AT LEAST 150 PRODUCTIONS PER GROUP SESSION • Kids take own data • Subvocalize (“say it with your voice turned off”) while other students taking their turns • Tally counters  challenge students--150+ productions

25. Post charts  individual/group competition** • Create stations--students do something different every minute or so while practicing sounds • E.g., one ch on whiteboard, one putting puzzle together, one lying on floor, one using flashcards at table

26. Then you yell “switch!” • Ask students to create cards with creative ideas for more interesting drill • They draw card, practice sound the way card says

27. E.g., “Say /r/ 10 times by itself while you are doing jumping jacks.”** • “Say at least 3 sentences with /s/ while you draw a picture on the whiteboard.” • “Say ‘the’ while you are doing hopscotch”

28. Echo microphone** • Puppets, costumes • Roll a dice or draw number from envelope to determine how many productions they have to make

29. OTHER IDEAS FOR CENTERS** • Read books or stories with target sound • Hula hoops • Jump rope

30. Create stories with flip books • Put stickers or stamps on a paper • Legos • Kick a ball

31. Blocks • Put Bingo chips into jar • Pick up sticks • Blow bubbles

32. IV. PHONOLOGICAL CONTRAST APPROACHES** • A. Introduction • These approaches have become popular and are supported by research

33. B. Minimal contrast training** • use minimal pairs which only differ by one featuresuch as • voicing (to-do, pan-ban) • Place of articulation (tea-key)

34. C. Maximal contrast training Sounds differ by at least 2 features Cane-lane: /k/ is a voiceless linguavelar stop; /l/ is a voiced lingual-alveolar glide Ten-men: /t/ is a voiceless tip-alveolar plosive; /m/ is a voiced bilabial nasal

35. I really like contrast training because: • The child sees that the sound used makes a semantic difference

37. V. COMPLEXITY APPROACH (Lecture only, not book)** • Most research done with individual children in a university setting (not tried in schools w/ diverse groups) • Best for ch with individual sound errors (e.g., w/r; j/l) • Assumes that the complex sounds are affricates, fricatives, and clusters and sounds that are not stimulable • Also assumes that later-developing sounds (e.g., /tʃ/, /r/ ) are more complex than earlier-developing sounds (e.g., /m/ and /p/)

38. Premise: • Start with hardest sounds for ch • Assumes: if train hardest sounds first, automatic generalization to easier sounds • E.g., ch produces /j/ 30% accuracy, /s/ 20% accuracy, /ð/ with 0% accuracy • Start with /ð/ and assume that /s/ and /j/ will be positively impacted

39. VI. HODSON’S CYCLES APPROACH (emphasized on exam!)** • A. Introduction • General Procedures 1. Stimulation—use of auditory, tactile, visual cues to ↑awareness of target sounds 2. Production training —produce correct sound 3. Semantic awareness contrasts —minimal pair training

40. Remediation program planned around a cycle** • Cycle: time period required for child to focus on each deficient phonological pattern for 2-6 hours • Pattern = phonological process • Focuses on teaching stimulable sounds • Early on, stick to simple CVC words

41. B. Selection of Target Patterns and Phonemes** • Top Priority: • 1. Early-developing phonological patterns: • Initial and final consonant deletion of stops, nasals, and glides • CVC and VCV word structures • Posterior-anterior contrasts (k-g, t-d, h) • /s/ clusters--word initial clusters /sp, st, sm, sn, sk/ and word-final clusters /ts, ps, ks/ • Liquids /r/ and /l/ and clusters containing these liquids

42. In order to move onto secondary patterns (next slide), the child must demo:** • Appropriate syllableness • Production of single consonants • Some emergence of velars and /s/ clusters • Productions of practice words with /l/ and /r/ without gliding (no w/r or j/l)

43. 2. Secondary Patterns (for later—see criteria bottom of p. 414) • A. /j/, sibilants /s,z/, /r/ • B. Consonant clusters • C. Singleton stridents ( e.g., /s, z, f/) • D. Multisyllabic words

44. C. Structure of Remediation Cycles** • 1. Train each phoneme exemplar within a target pattern for 60 min per cycle before going to the next phoneme • 2. Train 2 or more target phonemes in successive weeks within a pattern before changing to the next target pattern • (2+ hours on each pattern within a cycle)

45. 3. Target only one phonological pattern per session • 4. When all target patterns have been taught, a cycle is complete • 5. Initiate second cycle. Review patterns not yet corrected, intro new ones as necessary • **to become intelligible, most ch need 3-6 cycles of therapy

46. Final cons. Del. • ** Fronting Cluster reduction

47. D. Structure of Therapy Sessions • 1. Review word cards from previous session • 2. Auditory bombardment (use amplification!) SLP reads list of 12 words for about 2 min., 2x if ch paying attention. • 3. Target word cards—3-5 new target words. Ch draws, colors etc. and SLP writes name of pic on card.

48. 4. Production practice—games, shift activities every 5-7 minutes • 5. Stimulabilityprobing—check if chstimulable for phoneme planned for next session • 6. Repeat auditory bombardment w/ 12-item word list used at beginning of session

49. E. Home Program** • Caretakers are asked to read the 12-item word list once a day. • Child is asked to name the 3-5 pictures once a day (may also produce other target words)

50. VII. NATURALISTIC APPROACH** • A. Introduction • Focuses on improving child’s overall intelligibility and whole-word accuracy first, then works on individual phonemes in error • For severely involved children like preschoolers, those with Down Syndrome, autism spectrum disorder, cerebral palsy • Approximations of sounds OK