Additional Direct Speech Sound Production Interventions

From Stimulability to CAS

Four Non-Contrastive Direct Approaches

• Core Vocabulary

• Cycles Approach

• Nuffield Centre Dyspraxia Programme (NCDP)

• Stimulability

Core Vocabulary Approach (Dodd et al)

Developmental level Targeted stage of production

Targeted outcomes

Emerging

Developin

g

Elaborat

Key components Tech and/or materials

Specific diagnoses

Plannin

Prograing

Execution

Speech Production

Speech Perception

Phon awareness

Other oral Language

Literacy

X X *Consistent production of > 50 functionally powerful words *Sound-by-sound and syllable-by-syllable dense response drill with pictures

Picture stimuli

*Incon-sistent speech *CAS

X X X

CV: Review Case Study

• Describe the characteristics of child

• How was her speech assessed?

• Describe intervention and results

CV: Review Questions

Cycles Approach (Hodson)

Developmental level Targeted stage of production

Targeted outcomes

Emerging

Develo

Elabor

Key components

Tech and/or materials

Specific diagnoses

Planning

Programmi

Execution

Speech Production

Speech Perception

Phono awareness

Other oral Language

Literacy

X *Ordering of phonological patterns within cycles, auditory bombardment, facilitating contexts, active involvement, and self-monitoring*Home program

*Amplification device*5x8 index cards*Motivational/experiential play items

X X Xa Xa

Unique features of the Cycles approach

1. Identify Broad Phonological DEVIATION Patterns

2. Target Each Deficient PRIMARY Phonological PATTERN (e.g., /s/ clusters) 2-4 Hours (average) per CYCLE*

3. Incorporate AMPLIFICATION & METAPHONOLOGICAL Tasks During EACH Session

4. Reassess between Cycles & RECYCLE Primary PATTERNS as needed until Emerge in Conversation

5. Increase COMPLEXITY Gradually

6. Target SECONDARY PATTERNS after Specified Criteria are met (Hodson, 2007)**

• FOCUSED AUDITORY INPUT/Stimulation for Toddlers• “MULTISYLLABICITY” & Complex Consonant Sequences for older students

who have intelligibility issues*Cycle is a period of time (Varies from 5 to 15 hours. Depends on number of PATTERNS that need to be targeted. Sessions are 60 minutes per

week; Children typically require 3-4 Cycles.)

**Hodson, B. (2007). Evaluating and Enhancing Children’s Phonological Systems: Research and Theory to Practice. Wichita, KS: PhonoComp Publishing.

Cycles: Review Case Study

• Describe the characteristics of child

• How was his speech assessed?

• Describe intervention and results

Cycles: Review Questions

Nuffield Centre Dyspraxia Programme (P. Williams & Stephens)

Developmental level Targeted stage of production

Targeted outcomes

Emerging

Developi

Elaborat

Key components Tech and/or materials

Specific diagnoses

Plannin

Progra

Executio

Speech Production

Speech Perception

Phono awareness

Other oral Language

Literacy

X *Build speech processing skills from bottom up through est motor programs for single sounds in isolation & increasing phonotactic complexity*Auditory discrim and specific NSOM skills within repetitive practice

NDP3 manual + pix materials and worksheets

CAS X X X X X

Unique features of the Nuffield Centre Dyspraxia Programme

• Created in UK for children with SSD/CAS, 3-7 years• A motor and linguistic approach• Build accurate motor programs for phonemes, words and

sentences, supported by picture cues• Establish through repetitive practice• Develop a contrastive system at each phonotactic level (eg

C, V, CV, CVCV, CVC) • Work on several targets simultaneously across speech

system• Photocopiable pictures/worksheets

NCDP: Case Study

• Describe the characteristics of child

• How was his speech assessed?

• Describe intervention and results

Stimulability Intervention (Miccio)

Developmental level Targeted stage of production

Targeted outcomes

Emerging

Developi

Elab Key components

Tech and/or materials

Specific diagnoses

Plann

Programmin

Execu

Sp Prod

Sp Perc

Phon awareness

Other oral Language

Literacy

X *Stim + nonstim sds targeted*Sounds paired with alliterative characters and body motions

Alliterative sound character card illustrations (http:// www. Brookes publishing.com/williams/miccio.htm

Very young children with limited sound inventory

X X X

Unique features ofStimulability intervention

• For young children with limited phonetic inventories who are not stimulable for many or all absent sounds

• Major components– Target stimulable and non-stimulable sounds– Speech sounds are associated with

alliterative characters– Speech sounds are associated with hand/body

movements– Vocal practice encouraged through play-based turn-taking activities– Early success and successful communicative attempts ensured with

practice on both stimulable and non-stimulable sounds

Stimulability: Case Study

• Describe the characteristics of child

• How was his speech assessed?

• Describe intervention and results

Stimulability: Review Questions

Levels of Evidence (LOE)

Level Description Approach

1a Well-designed meta-analysis of >1 randomized controlled trial

None

1b Well-designed randomized controlled study CV; Cycles; Stim

2a Well-designed controlled study without randomization

Complexity; Cycles

2b Well-designed quasi-experimental study CV; Stim

3 Well-designed nonexperimental studies, i.e., correlational and case studies

CV; Cycles; NCDP; Stim

4 Expert committee report, consensus conference, clinical experience of respected authorities

Cycles