Transcript Document

u SPECIFIC
TREATMENT
PROGRAMS
AND
APPROACHES
(chapter 8)
I. INTRODUCTION**
u
Intervention for speech
sound disorders is very
exciting
u
There is nothing in the world
like the feeling you get when
a child first says a sound
correctly!!
These are ideas I use as an SLP in my job
in the schools:
Using classroom language arts books for
therapy—helps us help kids achieve
Common Core State Standards:
According to our text ch. 8:**
u
Most tx approaches move from a simple
to complex level of training (except the
concurrent approach)
u
Some approaches do contradict each
other (e.g., start w/ stimulable vs.
nonstimulable sounds)
The point is to remain
flexible…**
u
And do what is
best for each
individual
client
Non-Speech Oral-Motor
Exercises**
u
PBH do not believe that oral motor
exercises are beneficial for anybody
u
They say research has not proven that oral
motor exercises help
u
Roseberry’s position: these exercises are
very helpful for children with oral motor
problems
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)
A. Production Training: Sound
Establishment
B. Production Training: Sound
Stabilization**
• Stage 6 Conversation
• ↑
• Stage 5 Sentences
• ↑
• Stage 4 Phrases
• ↑
• Stage 3 Words
• ↑
• Stage 2 Nonsense syllables
• ↑
• Stage 1 Isolation
• 1
• 2.
• 3.
For example, with /s/:**
• Begin with soup, see, sun (wordinitial)
• Next: bus, face, piece (word-final)
• Then: Classes, lesson (word-medial)
• Last: Crust, stop, faster (clusters)
• **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)
To establish sound in
sentences:
• 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.’
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?
D. Maintenance
III. CONCURRENT APPROACH
(lecture notes only—not text)
CSHA Dr. Steve
Skelton
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
Dr. Skelton: ACTIVITIES AND IDEAS FOR
ELICITING AT LEAST 150 PRODUCTIONS
PER GROUP SESSION
• 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
• 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”
• Echo microphone**
• Puppets, costumes
• Roll a dice or draw number from envelope
to determine how many productions they
have to make
OTHER IDEAS FOR CENTERS**
• Read books or stories with target sound
• Hula hoops
• Jump rope
IV. PHONOLOGICAL CONTRAST
APPROACHES**
• A. Introduction
• These approaches have become popular and
are supported by research
• B. Minimal contrast training
C. Maximal contrast training
I really like contrast training
because:
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/)
Premise:
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
• Remediation program planned around a
cycle**
• Cycle: time period required for Ch 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
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
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)
2. Secondary Patterns (for later—
see criteria bottom of p. 414)
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)
• **
D. Structure of Therapy Sessions
• 1.
• 2.
• 3.
• 4.
• 5.
• 6.
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)
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
This is what DJ and I do a lot in our
preschool SDC at Grand Oaks Elementary
Work in the child’s natural settings—
and have fun!
Speech recast:
Example of a speech recast I just did with
3-yr old Brandon (Down Syndrome):**
• Brandon (pointing to
Candyland card): “u!!”
• Dr. R.: “That’s right, Brandon!
Yay!  That is blue.”
• Brandon (Dr. R’s lucky day): “bu!” (A CV combination with lip
rounding and everything!!)
VIII. CORE VOCABULARY
APPROACH (a fave )**
• A. Introduction
• Designed for the 10% of children with functional
SSDs characterized by inconsistent errors on the
same words
• These children don’t have childhood apraxia of
speech
• Been used with 2-year olds, bilingual children, Down
Syndrome
Inconsistent SSD: assess child’s multiple
productions of the same word in the same
phonetic context**
For example: (25 pictures)
•
•
•
•
•
1. Child is asked to produce “cat”
2. Activity
3. Asked to produce “cat”
4. Activity
5. Asked to produce “cat”
Scoring:
B. Structure of Intervention
I love it!!
IX. Language Treatment for
Phonological Disorders--PBH**
• PBH: research is inconclusive re: the question: Can
language therapy improve children’s speech skills?
• Bottom line: If the child has a language and speech
disorder, best to do both language and speech
therapy simultaneously.
• In other words, don’t just do language therapy and
hope that somehow better speech sound production
will magically improve follow 
X. Combining Therapy for
Language and Speech Sound
Disorders**
• We can connect speech sound
production to children’s
morphosyntactic skills
• If children have final consonant deletion
or cluster reduction, they will have
problems with some morphemes
These morphemes include:**
• Past tense –ed (jumped, scared)
• Plural –s (pots, sidewalks)
• Regular 3rd person –s (eats, runs)
• Possessive –s (Grant’s, Bob’s)
Therapy suggestions:
For example (FCD):**
• Plurals: toe-toes key-keys
• Possessives: Joe-Joe’s
Ray-Ray’s
• Regular past tense –ed
showshowed
If the child uses cluster reduction:**
• Plurals
boat-boats
cup-cups
• Possessives
cat-cat’s Dad-Dad’s
• Regular past
walk-walked
• Irregular past
drink-drank
hold-held
We can also connect phonology to
semantics:**
• Children with language impairments often
have difficulty with verbs
• For velar fronting:
caught
tame-came; taught-
• Stopping of fricatives: tee-see, toe-sew, tipship
• Final consonant deletion: shoe-shoot, rayrake; say-sail