SPECIFIC TREATMENT PROGRAMS AND APPROACHES (chapter 8)

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!!

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:** 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)

The point is to remain flexible…**

And do what is best for each individual client

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

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, ssee, sun (word-

initial)

• 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

• A. Introduction

• These approaches have become popular and are supported by research

IV. PHONOLOGICAL CONTRAST APPROACHES**

• 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 sounds2. Production training —produce correct sound3. 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): “b-u!” (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 show-showed

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: tame-came; taught-caught

• Stopping of fricatives: tee-see, toe-sew, tip-ship

• Final consonant deletion: shoe-shoot, ray-rake; say-sail