The Wonder of Cycles

1. The Wonder of Cycles Created by Barbara Hodson Shared by Anne Hasting 2013

2. Where credit is due • Created by Barbara Hodson • Evaluating and Enhancing Children’s Phonological Systems • www.phonocomp.com

3. This approach • Created for severe-profound intelligibility problems • More closely matches natural acquisition • Evidence-based • Ages 2-14 • Variety of disorders • Refined over 35 years • Works

4. Poorly intelligible kids… • Not auditory self-monitoring • Rely on inaccurate kinesthetic self-monitoring • Order in disorder • More likely to evidence certain processes • Lag behind in basic literacy and spelling later

5. What’s important? • Intelligibility! • Not number of errors • Child with /s/ lisp and /s/ omission have same number of errors on GFTA-2 • Intelligibility in connected speech – how to estimate? • Sentence imitation • HAPP-3

6. Identify errors • Tests are for identifying disability • Avoid teaching to the test • Not very helpful anyway • Play and listen, take notes • Put parents to work if kid doesn’t cooperate • Video recording, audio recording, notes • Full analysis not necessary • First look for absence of primary patterns (slide 11)

7. What do you want? • Cycles terminology focuses not on the deficits, but on what you want the child to do • Syllable reduction? Syllableness • Initial/final consonant deletion? Singleton consonants, initial and final • Fronting/backing? Anterior-posterior contrasts • Cluster reduction? /s/ clusters • Liquid gliding? Liquids • Processes? Patterns

8. Cycles has cycles • Cycle: series of target patterns • Work on each target pattern in succession • 5-20 weeks, depending on number of deficiencies and on stimulability • Then start over, add phonemes to patterns if possible • First you cycle primary patterns • When primary patterns reach accuracy criteria (3-5 cycles), begin cycling secondary patterns

9. Priorities • Omissions and additions are top • Substitutions are next critical after o & a • Distortions have much less impact on intelligibility • Structural changes • Syllable deletion • Singleton consonant deletions (initial and/or final) • Cluster reduction • Epenthesis • Syllable addition

10. What are we working on again? • Patterns NOT sounds • Need to use sounds to work on patterns • Catch-22? Just keep in mind that the sounds are a means to an end. • Do NOT work on every sound in error • Choose a few *stimulable* sounds to teach patterns • One clinical hour per target sound • Number of target sounds depends on stimulability

11. Primary Patterns • Primary patterns: • Syllableness • Singleton consonants • Initial • Final • /s/ clusters • Anterior-posterior contrasts • Liquids • Target what the child needs

12. Syllableness • Spondees (equal-stress words) • Targeting non-spondee two-syllable words results in inappropriate prosody or encourages syllable deletion • Target is producing multiple syllables • How’s he doing? • ice cream -> cream  • ice cream -> eye ee • ice cream -> ha ha 

13. Singleton consonants • Initial singleton consonants (if in error) • Choose 2-6 target phonemes • Stops /b, p/ possibly /d, t, g, k/ • Nasals /m, n/ • Glide /w/ • Always use real words, not made-up syllables • Always use words the child can say • If CVC is not stimulable, try CV

14. Singleton Consonants • Final singleton consonants • Choose 2-6 target phonemes • Voiceless stops /p, t, k/ • Nasals /m, n/ • Always use real words, not made-up syllables • Always use words the child can say • If CVC is not stimulable, try VC

15. /s/ clusters • /s/ clusters • Initial • /st, sp, sk, sm, sn/ (careful fronting/backing) • Video 1, s clusters M • Final • /ts, ps, ks/ (careful fronting/backing) • Yay for morphology: plurals, 3p singular verbs • ONLY if singleton consonants are present • If fluent words: “It’s a spoon.” “It’s a snail.” • Video 2, it’s a sk I

16. Anterior-posterior contrasts • If not stimulable, target as a secondary pattern • Most kids are fronters or velar deleters; you want velars • Final /k/ • Initial /k/, /g/ • Some kids are backers; you want alveolars • Initial /t/, /d/ • Final /t/ • Avoid words that have both front and back sounds: dog, coat, take, kiss, knock

17. Liquids • 3 y/o vs. 7 y/o working on /r/ for first time • Developmentally appropriate acquisition • Hodson’s data • “Not a glide” • Derhotacized/lax /r/ and vowels are acceptable • Data collection: • Run -> wun • Run -> oowun • Run -> oouuuun • Run -> r)un • Video 3, liquids I

18. Liquids • Target initial /l/ • Stable jaw tongue clicking for a week at home before targeting • Target initial /r/ (“er”) • Needs to be “era:k” • Jaw wide open for onset, keep it open during pause and rime (no /w/ insertion) • Target /r/ blends if stimulable for velars • /k, g/ are facilitative • Target velar and alveolar /l/ blends when /l/ is solid • /p, b, m, f, v/ encourage gliding, so rope, roof, rabbit, lamp, and leaf would be out

19. Nitty gritty, part 1 • One clinical hour per target phoneme (2-6 hours per target pattern) • Hodson recommends one hour per week total: three 20-minute, two 30-minute, one 60-minute • Double time if child has intellectual disability • MUST be stimulable • Use sounds the child can say (maybe not easily) to work on patterns the child has not mastered • Stimulable doesn’t mean easy • Focused auditory input cycle for nons (nonstimulable, nonverbal, or noncompliant) • One cycle of primary patterns: only input, no production requirements • Usually needed for children younger than 3 years • 2 weeks on each primary pattern except liquids (10 weeks)

20. Primary Pattern Graduation • Move from primary to secondary patterns when: • Initial /m, n, w/ and stops 60% correct in conversation • Final /m, n, p, t, k/ 60% correct in conversation • A-p contrasts 60% in conv. in one word position • /s/ clusters emerging in conversation • Liquid approximations at the word level • Listen during liquids • Not reached criteria? Cycle error patterns again • Severe intelligibility = 3-4 primary cycles

21. Secondary Patterns • Begin after criteria have been reached for primary pattern “graduation” • Do NOT kill yourself analyzing all patterns early • Listen during liquids

22. Possible Secondary Patterns • Some common ones: • Voicing contrasts • Vowel contrasts • *Anterior-posterior contrasts • Stridency • Palatals • Other consonant clusters • Context-related processes • Assimilations • Metathesis • Idiosyncratic rules

23. Voicing Contrasts • Errors with voiced/voiceless cognates • p/b, t/d, s/z, etc. • Prevocalic voicing • Use minimal pair words and some amplification

24. Vowel Contrasts • Usually get the vowels sorted out during the primary cycles • Use minimal pairs and some amplification

25. Anterior-Posterior Contrasts • Target in secondary cycles if not stimulable during primary cycles • See slide 16

26. Stridency • Stridents: f, v, s, z, sh, zh, ch, j • Stridency deletion: substituting non-stridents or deleting the strident altogether • Fan->pan, Sue->new, peach->pea, fishing->fitting • Stridents are often stopped but not always • Usually working on /s/ clusters generalizes but if not: • Target /f/ and /s/ first, usually in final position

27. Palatals • Palatals: y, sh, ch, j • Target y first • Then insert y after other palatals • Chyair (child will probably say tsyair) • Shyoe (syoe) • Jyump (dzyump) • Usually ch is more stimulable than sh or j

28. Other Consonant Clusters • Examples: kw, tw, sw, by, hy, fy, ky, my • /s/+stop final clusters (e.g. toast) • Medial /s/ clusters (boxes, sister) • Three consonant sequences (straw, square)

29. Context-related Processes • Assimilations: • Labial, e.g. pin -> pim • Alveolar, e.g. take -> tate • Velar, e.g. green -> gring • Nasal, e.g. mat -> man • Assimilations multiply with other errors • Pin -> im (adding initial consonant deletion) • Take -> date (adding prevocalic voicing) • Green -> wing (adding cluster reduction & gliding) • Mat -> many (adding diminutization)

30. Context-related Processes • Metathesis (switching positions) • Ask->aks, take->kate • Reduplication • Bottle->baba, TV->beebee • Idiosyncratic rules - some fun ones: • Alveolar and velar stops, and all stridents = /h/ • All fricatives, affricates, and clusters = /d/ • (except /h/ ) • Minimal pairs

31. Advanced Patterns • Upper elementary, middle (~age 9 and up) • Look fine on artic tests but have intelligibility issues in the real world • Usually have language/learning disabilities • Complex consonant sequences (extra, excuse) • Video 4, complex sequences I • Multisyllabicity (apostrophe, aluminum) • Segment phonemes syllable by syllable • Teach “phonics writing” • Once you’ve broken it up, put it all back together

32. Example: Morgan, age 4:10 • Morgan is poorly intelligible in conversation but between the GFTA and mom you get: • House -> how • Stop -> top • Big -> bid • Carson -> tawtuh • Make -> nay • Like -> wipe • Play -> pay • What will you do with her?

33. Example: Morgan • Primary patterns • Singleton consonants (final) • /s/ clusters • Anterior-posterior contrasts • Liquids

34. Example: Adam, age 6:1 • Adam’s intelligibility in conversation varies • Errors include: • Stop -> chop • Likes -> wite • Chair -> tayoh • Tree -> tee • Susannah -> Chuchannah • Skates -> chate • Christmas -> Kimuch • Shoes -> chooch • Zero -> jeewo

35. Example: Adam • Primary patterns: • /s/ clusters (avoid sk) • Anterior-posterior contrasts • Liquids

36. Example: Hannah, age 3:3 • Hannah doesn’t say much. Mom understands very little of what Hannah does say. Imitated single words include: • Drum -> uh • Mommy -> um • Me = correct • Green -> nee • Blue -> woh • Chair = refused to attempt • Baby -> bee

37. Example: Hannah • Auditory input cycle? • Primary patterns • Syllableness • Singleton consonants (initial) • Singleton consonants (final) • /s/ blends when singleton consonants emerging • Anterior-posterior contrasts • Liquids

38. Example: Nathan, age 10:6 • Nathan has had 7 years of remediation but remains unintelligible at times. You hear: • Skinny -> sinny • Color -> coloh • Electricity -> elekitsy • Christina -> wikseeta • Lightning = correct • Germany = Johmany • Mixture -> mistoh • Hopping = correct • Sneeze -> seeze • Huge = correct

39. Nathan • Primary Patterns • /s/ clusters • Liquids (/r/) • Secondary Patterns • Metathesis and migration best addressed in: • Advanced Patterns • Complex consonant sequences • Multisyllabicity

40. Whew • Enough framework for you? • It’s the most important part! • Organization of overall treatment • What does a session look like?

41. Sessions • Review • Listening words • Practice patterns • Metaphonological skills • Listening words • Stimulability

42. Session Structure • Review last week’s targets IF same pattern – 2 minutes • Listening words (amplified auditory stimulation) – 15 seconds • 12-15 words at slight amplification (6-12 dB) • Clinician reads, child listens • Speak normally • Child can attempt a few production practice words (see next slide) while wearing amplification • Try PVC piping or Whisperphone Duet • Evidence-based

43. Session Structure • Production practice – main bulk of session • Choose 2-5 target words (no nonsense syllables) • Ages 1-too immature to sit and attend: • Opportunities for targets to be produced naturally in context • Ages 3ish and up: • Create practice cards • Draw, write, color targets on index cards • Can “play and say” or produce in context or a little of both • Metaphonological skills—see next slide • Able to read: • Short oral reading period focusing on target pattern

44. Metaphonological Skills • Struggle with basic literacy and spelling • A few minutes each session targeting: • Rhyming • Segmentation and blending of: • Syllables, Video 5, syllable blending M • Onset and rime, Videos 6 & 7, blending I, seg E • Phonemes, Videos 8, 9, & 10, blending D, seg D & J • Manipulation • Send home short rhymes like Jack and Jill • Video 11 nursery thyme cloze s • Increase the time in final cycles

45. Session Structure • Listening words – 15 seconds • Same list, same amplification • Stimulability – 2 minutes • Select next session’s practice words

46. Nitty gritty, part 2 • Evidence-based but may not work if you do not follow the protocol • Quality over quantity • STIMULABLE • No data collection – measures are provided at the end of each cycle not each session • Interferes with naturalistic interactions • Mixing errors with correct leads to fuzzy phonological representation • Don’t say “good job” when you mean “good try” • Give accurate feedback and immediately try to correct the error

47. Nitty gritty, part 3 • Group therapy • FAPE, individualization • Progress is known to be slower • Listening to several targets in one session may lead to fuzzy phonological representation • Choosing targets • Listening list: anything with target pattern • Practice words: stimulable, phonetic environment, can teach semantics • Metaphonological words: child must already know • Fine if production is imperfect

48. Homework • Homework – 2 minutes per day • School age: para/aide or educator can do this • Parent reads listening words, child says each practice word once, read rhyme if applicable • Good luck • I train parents/teachers on ear training

49. Ear training • Supports Cycles • Important: limited to current target pattern • Five types: • Modeling • Auditory awareness • **Feedback** • Praise • Corrections

50. Ear training • Modeling (auditory bombardment) • Focused play, say targets often without requiring the child to imitate • Auditory awareness • “Johnny, want to go—hey, go has your /g/ sound! Want to go outside and play?” • Feedback – “Ditzy dame routine” • “The tea? Hm, I don’t see any tea out there to drink… Oh, you mean tree! Sorry, I heard tea. I do see the snow on the tree.” • “Nack? I don’t know what a nack is… Oh, snack! Sure, you can have a snack.”