CONSIDERATIONS BEFORE STARTING...

sounds that are functional for the child; sounds that are stimulable; sounds that occur in key words/contexts; sounds that are more visible; sounds that occur more frequently; sounds that affect intelligibility the most; sounds least affected by physical deviations;

…MORE CONSIDERATIONS...

sounds inconsistently mispronounced; sounds that are acquired earlier; sounds that are part of child’s inventory; sounds that may generalize to others exemplars that are part of a rule pattern, e.g.,

P-V-M, Distinctive features, Phonoloigcal processes

Edwards (1983)Principles for selection of target sounds

•Choose target sounds that are in the child’s phonetic repertoire

•Choose sounds for which the child is stimulable.•Choose sounds that should improve intelligibility•Choose frequently occurring sounds•Choose sounds that are acquired early•Choose high-value sounds•Choose sounds that should be relatively easy to produce

Weiss, Gordon and Lillywhite (1987)Select the error phoneme that:

•is the earliest to develop•is the most stimulable•is produced correctly in a key word•occurs most frequently in speech•is most consistent•is visible•has resulted in criticism •the client most desires to correct•is least likely to be affected by physical deviations•is the same for a group of clients

Hegde and Davis (1995)Guidelines for selection of potential target behaviors:

• select behaviors that will make an immediate and socially significant difference (improves intelligibility the most);• select the most useful behaviors that may be produced and reinforced at home and in other natural settings (easily understood and reinforced by family);• select behaviors that help expand communicative skills; practice words should be meaningful and appropriate.4. select behaviors that are linguistically and culturally appropriate for the individual client; practice words and materials, suggested follow-up activities must be appropriate.

PREDICTIONS REGARDING GENERALIZATION(ELBERT AND GIERUT, 1986)

teaching one members of a cognate sounds pair will result in the use of the other sound in the pair;

teaching one allophone will result in the production of other related allophones;

teaching a distinctive feature in the context of one sound will result in the use of that feature in other untreated sounds;

teaching sounds in final position of morphemes will result in more accurate production of the sounds in inflected intervocalic contexts;

PREDICTIONS (CONTINUED)

teaching stops in word-final position will lead to more accurate production in word-initial position;

teaching fricatives in word-initial position will result in more accurate production of fricatives in word-final position;

teaching fricatives will result in more accurate production of stops;

teaching voiced obstruents (stops, fricatives, affricates) will result in accurate production of voiceless obstruents;

MORE PREDICTIONS ABOUT GENERALIZATION

teaching sounds that are stimulable results in more accurate production than teaching sounds that are not stimulable;

sounds that are phonologically “known” will be produced more accurately than sounds that are phonologically “unknown;”

teaching sounds of which a child has least phonological knowledge will result in changes across untreated aspects of the sound system.

TRADITIONAL APPROACHSensory-Perceptual (ear) Training: identification, isolation, stimulation, discriminationProduction Training – Sound EstablishmentProduction Training – Sound Stabilization isolation, nonsense syllable, words, phrases, sentences,

conversationTransfer and CarryoverMaintenance

PROBLEMS WITH INDIVIDUAL SOUNDS

WHEN ARE “ORO-MOTOR” EXERCISES APPROPRIATE?

MCDONALD’S SENSORI-MOTOR APPROACHI. Heighten child’s responsiveness to the patterns

of auditory, proprioceptive and tactile sensations associated with the overlapping ballistic movements of articulation

II. Reinforce the child’s correct articulation of his error sound

III. Facilitate the correct articulation of the error sound in systematically varied phonetic contexts.

I. Heighten awareness….a) auditory stimuli for imitation and

descriptionb) exercises for overlapping movementsc) ear trainingd) simple to complexe) listen, feel, hearf) practice with bisyllablesg) practice with trisyllables

II.REINFORCE CORRECT ARTICULATION OF ERROR SOUND

select a sound for reinforcement select a context in which error sound is correctly

articulated slow motion speech, alter stress, etc.

practice in short sentences

III. FACILITATE CORRECT ARTICULATION... change the vowel following it use other words ending in target + vowel;

change the vowel preceding target vary the stress practice in sentences if not continuant: slow motion speech/arrested

production practice with varied stressVARY THE FACILITATING CONSONANT SYSTEMATICALLY

UNIQUE FEATURES OF PHONOLOGICAL THERAPY

Works on groups or classes of sounds, not one sound

Aim is to establish phonological contrasts which have been neutralized

Works in a naturalistic context

Edwards (1983)Principles for selection of target processes

• Choose processes that result in early success or that would be relatively easy to remediate. For example, select processes that occur only in certain phonetic environments; or processes that affect sounds that are within the child’s phonetic inventory; or select processes that affect sounds for which the child is stimulable.• Choose processes that are crucial for the child, i.e., those that draw considerable attention to the child’s speech (e.g., velarization, lateralization, frication of stops, glottal replacement).• Choose early processes or processes that affect early sounds (e.g., gliding of stops).4. Choose processes that interact, i.e., involve more than one rule (e.g., stopping of fricatives in final word position, which impacts plurals, possessives, 3rd person singular.)

CYCLES APPROACH(HODSON AND PADEN (1983,1991)

designed for severely unintelligible children uses auditory, tectile, visual stimulation cues

to facilitate awareness of targets a cycle is “a period of time during which all

phonological patterns in need of remediation are facilitated in succession…

the time period required for the child to successively focus for 2 to 6 hr on each of his or her basic deficient patterns.”

CYCLES APPROACH (CONTINUED)SELECTION OF TARGET PATTERNSAdminister APP-R or HAPP-3determine which phonological patterns

are seen at least 40% of the timedetermine which one is most stimulable,

next most stimulable, etc. This determines hierarchy of tx.

Primary target patterns or phonemes:early developing phonological patterns

posterior/anterior contrasts/s/ clusters liquids

CYCLES CONTINUED

Secondary target patterns voicing contrastsvowel contrasts singleton stridents consonant clusters residual context-related processes (e.g., assimilation)

Advanced targets multisyllabic words complex consonant sequences

Inappropriate primary targets voiced-final obstruents final // weak-syllable deletion “th” phonemes

CYCLES CONTINUED:STRUCTURE OF REMEDIATION CYCLES Each phoneme exemplar within a target patterns

should be trained for approx 60 min per cycle before shifting to the next phoneme in that pattern; one 60-min session or two 30 min session or three 20-min session.

Stimulation should be provided for two or more target phonemes within a pattern before changing to the next target pattern = two hours

only one phonological pattern should be targeted during any one session

a cycle is complete when all targets have been taught a second cycle is initiated 3-6 cycles (30-40 hrs), 40-60 min per week, usually

required for a child to become intelligible

CYCLES CONTINUED:INSTRUCTIONAL SEQUENCE FOR REMEDIATION SESSIONS1. Review previous session: previous week’s production

practice word cards are reviewed2. Auditory bombardment: slight amplification, two minutes;

child only listens to 12 words, perhaps twice3. Target word cards: child draws, colors or pastes pictures of

3-5 target words on large index cards,with printed word.4. Production practice: game based repetition; practice

includes auditory, tactile, visual stimulation at word level;5. Stimulability probing: next session’s potential targets are

probed.6. Auditory bombardment - same as #27. Home program- read words to child;child imitates; 1/day.

USE OF MINIMAL PAIRS

Highlights child’s error and correct production. Target selection is crucial Train perceptual discrimination Train productive discrimination Child takes on role of ‘teacher’ and must

signal knowledge of difference between pairs.

DISTINCTIVE FEATURE THERAPY

Select the target select a sound pair contrasting this binary

feature one sound has to contain the feature and the other must not; one sound is typically in the child’s inventory and one is not

earlier developing sounds have priority

MINIMAL OPPOSITION CONTRAST THERAPY

Select two sounds with as many articulatory similarities as possible;

earlier sounds have priority; substitutions with greater impact on

intelligibility have priority stimulable sounds have priority

MAXIMAL OPPOSITION THERAPY

Choose sounds that are productionally very different in terms of P-M-V or distinctive features

sounds should not be in inventory and should be maximally different

discrimination is not trained - only imitation and spontaneous production

MULTIPLE OPPOSITION THERAPY

Used with children who are typically unintelligible and who neutralize several consonants into one;

Aims at impacting system across rule set; Choose pairs (often will result in nonsense

syllable pairings) that cut across PMV Two, three of four pairings recommended

METAPHON THERAPY

Phase One concept levelsound level

phoneme levelword level

Phase Two take turns in producing minimal pair words

COGNITIVE LEARNING AS BASIS FOR PHONOLOGICAL INTERVENTION

In contrast to traditional modes of articulation therapy, the goal of therapy from a phonological perspective is not production of target sounds, but instead involves a conceptualization or under-standing of the system or rules and regulations underlying american english phonology…once the child understands the rule-bound contrast between his production and the correct production, it will be easy to facilitate improvement.

UNDERLYING PRINCIPLES:

Emphasis is not the sound, but the rule rule is always taught in context of contrast no correct/incorrect value judgements no instructions about phonetic placement avoid direct imitation work on one rule at a time deemphasize auditory discrimination

USE OF IMAGERY

Stopping of fricatives: running vs. dripping; popping vs. blowing

fronting of velars: front vs. back; tippy vs. throaty

deletion of final consonants: open vs. closed; tail vs. no tail

cluster reduction: friendly vs. lonely

THERAPY REGIMEN STEP 1 - semantic identification STEP 2 - production in nonsense syllables STEP 3 - semantic ID in words STEP 4 - production in words STEP 5 - semantic ID in phrases STEP 6 - production in phrases STEP 7 - production in conversation

PRIORITIES FOR INTERVENTION:

Syllable structures rules first (DFC.WSD) assimilation rules manner rules (SF, gliding of liquids) placement rules (FV, backing of alveolars) late disappearing rules (CR, gliding of /r/,

stopping of “th”) voicing rules

ASSORTED ISSUES:

Age to begin: data on individual sounds does not apply. Not enough data

Well-suited for group work Exclude parents Single out a sound for state/school data Number of errors is insignificant Can be used with adults, especially FAR

ASSORTED ISSUES, CONTINUED To cycle or not to cycle choose your first client carefully bypass the child’s learned phonological

helplessness avoid wasting time on unsuccessful activities believe that the child isn’t producing, rather

than can’t produce, some sounds.

CHILD WITH AN EMERGING PHONOLOGICAL SYSTEM

Teach words that begin with sounds in inventory select words with syllable shapes that child

uses and expand to new shapes use normal developmental sequence of

consonants as a guide introduce new consonants in a babbling activity introduction new words vary their grammatical category reinforce all productions, even approximations