SPECIFIC TREATMENT PROGRAMS AND APPROACHES (chapter 8)

1. SPECIFIC TREATMENT PROGRAMS AND APPROACHES (chapter 8)

2. 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!!

3. These are ideas I use as an SLP in my job in the schools:

4. Using classroom language arts books for therapy—helps us help kids achieve Common Core State Standards:

5. 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)

6. The point is to remain flexible…** • And do what is best for each individual client

7. 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

8. **Kent, R.D. (2015 November ). Nonspeech oral motor movements and disorders: A narrative review. American Journal of Speech-Language Pathology. • He said that NSOMMs can be part of practice in orofacial myology • Can be used with persons with dysarthria and dysphagia • Don’t just reject NSOMMs wholesale

9. 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)

10. A. Production Training: Sound Establishment

11. B. Production Training: Sound Stabilization** • Stage 6 Conversation • ↑ • Stage 5 Sentences • ↑ • Stage 4 Phrases • ↑ • Stage 3 Words • ↑ • Stage 2 Nonsense syllables • ↑ • Stage 1 Isolation

12. 1. Isolation—use variety of fun activities** (p. 404 has some) • 2. Nonsense syllables —I don’t really use these • 3. Words —begin with words that are meaningful to the child. I work on sounds: • 1.word-initial • 2. word-final • 3. word-medial • 4. Clusters

13. For example, with /s/:** • Begin with soup, see, sun (word-initial) • Next: bus, face, piece (word-final) • Then: Classes, lesson (word-medial) • Last: Crust, stop, faster (clusters)

14. **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)

15. To establish sound in sentences:

16. 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.’

17. 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?

18. D. Maintenance

19. III. CONCURRENT APPROACH (lecture notes only—not text)** • Said SLPs don’t have to use hierarchy we just described • First establish sound in isolation and CV, VC combos—80% accuracy • Then, mix it up in tx!

20. CSHA Dr. Steve Skelton

21. 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

22. Dr. Skelton: ACTIVITIES AND IDEAS FOR ELICITING AT LEAST 150 PRODUCTIONS PER GROUP SESSION

23. 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

25. 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”

26. Echo microphone** • Puppets, costumes • Roll a dice or draw a number from an envelope to determine how many productions they have to make

27. OTHER IDEAS FOR CENTERS** • Read books or stories with target sound • Hula hoops • Jump rope

28. Create stories with flip books • Put stickers or stamps on a paper • Legos • Kick a ball

29. Blocks • Put Bingo chips into jar • Pick up sticks • Blow bubbles

30. IV. PHONOLOGICAL CONTRAST APPROACHES** • A. Introduction • These approaches have become popular and are supported by research

31. B. Minimal contrast training** • use minimal pairs which only differ by one featuresuch as • voicing (to-do, pan-ban) • Place of articulation (tea-key)

32. C. Maximal contrast training

33. I really like contrast training because:

34. 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 children 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/)

35. Premise:

36. 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

37. Remediation program planned around a cycle** • Cycle: time period required for child 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

38. 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

39. 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)

40. 2. Secondary Patterns (for later—see criteria bottom of p. 414)

41. 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)

43. Final cons. Del. • ** Fronting Cluster reduction

44. D. Structure of Therapy Sessions

46. 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)

47. 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

48. This is what DJ and I do a lot in our preschool SDC at Grand Oaks Elementary

49. Work in the child’s natural settings—and have fun!** • Establish word and sound approximations so the listener understands the child better • Use natural recasts —corrective feedback given in naturalistic fashion—correct model given without the child being interrupted and asked to repeat

50. Working outside with RJ….