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Basic Principles and Procedures in Treatment of SSDs

This article provides an overview of the basic principles and procedures for treating speech sound disorders. It covers selecting target behaviors, considerations for selecting treatment targets, determining the number of sounds or patterns to teach, establishing baselines, developing measurable objectives, and planning a treatment program.

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Basic Principles and Procedures in Treatment of SSDs

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  1. Basic Principles and Procedures in Treatment of SSDs

  2. Remember…. • You don’t have to read chapter 7 basic unit • PowerPoint notes only 

  3. I. SELECTING POTENTIAL TARGET BEHAVIORS** • A. Introduction • Target behavior • We need to select short term objectives and long-term goals • In the schools, we say “benchmarks”

  4. B. General Considerations** • Select tx targets that are linguistically and culturally appropriate for the client • Select targets that will make an immediate and socially significant difference in the client’s communication skills

  5. Remember…** • Connect tx to classroom curriculum • Always keep Common Core State Standards in mind • I always tx speech sound errors and lang together

  6. Izzy brings class reader to work on /r/

  7. For Kiree, what would make an immediate difference? • 15 years old • FAS • Noncompliant • Highly unintelligible • Wait for it….MOOSE!

  8. C. Select More Readily Taught Treatment Targets** • Stimulable sounds treated before non-stimulable sounds • Teach visible sounds before non-visible sounds (e.g., /th/ before /r/) • For a phonological process to be treated, should occur at least 40% of the time

  9. D. Select Targets that Affect Intelligibility the Most** • Select phonological processes that affect the most sounds; processes that contribute the most to the child’s lack of intelligibility • E.g., stopping affects many sounds

  10. II. DECIDING ON THE NUMBER OF SOUNDS OR PATTERNS TO TEACH** • If the child only has 1-2 errors, the decision is easy • If the child has multiple errors, then we need to decide: do we train many sounds at once, or just a few?

  11. Variables impacting this decision include child’s:

  12. III. ESTABLISHING BASELINES** • A. Introduction • When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not adequately sampled • For example, an artic test may sample /r/ one time in initial, medial, final position of words

  13. Because of this very limited sampling, mistakes can be made** • For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off • But later, lo and behold, the child makes the /f/ with 90% accuracy on repeated measures!

  14. We counteract this problem…** • By establishing baselines of potential treatment targets before starting therapy • Baselines are measured rates of behaviors in the absence of treatment

  15. Baselines in our own lives: • How much you weigh before you start that diet  • How many pounds you can bench press when you start a new workout program • How fast you can swim a lap before you start that swim class

  16. B. 3 purposes of baselines:

  17. Count the # of times** • That Dr. R. makes a th/s substitution when presented with picture cards • There will be 20 opportunities for /s/--how accurate am I? What is my %age of accuracy in /s/ production?

  18. C. Baseline Procedures** • Specify the treatment targets in measurable terms • For example: • -produce /r/ in word-final position with 80% accuracy • Reduce use of final consonant deletion from 70% to 20% in conversation

  19. We need to be sure to specify response topography** • This refers to the linguistic level of training • For example, do we want to begin with /r/ in isolation? • Do we want to begin with /r/ in word-initial position in sentences?

  20. IV. SELECTING THE INITIAL LEVEL AND SEQUENCE OF TRAINING

  21. V. DEVELOPING MEASURABLE OBJECTIVES** • Treatment or short-term objectives are the skills the clinician plans to teach on the way toward achieving the selected treatment targets or long-term goals • Appropriate long-term goals might be: • “Increase the client’s intelligibility of speech” • Improve the client’s phonological skills”

  22. However, measurable short-term objectives are needed** • These objectives specify how a goal will be achieved • The objectives must be measurable so that external observers can verify the results of the clinical services provided • Many 3rd party payers like insurance companies demand detailed documentation of improvement

  23. To write a good objective:

  24. Remember that data collection** • Should be done throughout tx • A good baseline will support this

  25. VI. PLANNING AND DEVELOPING A TREATMENT PROGRAM OR PLAN • A. Introduction

  26. In this youtube video… • The SLP uses the direct technique of Mr. Mouth • Articulation Disorder Teaching /r/ • Ashley Mcgeehon’s channel

  27. B. Successive Approximation or Shaping** • We take advantage of a sound the client can already make (e.g., /g/ if they cannot produce /r/). • We have them make the /g/, and gradually move toward /r/.

  28. We can begin training the sound at one of several levels:

  29. If the child cannot create a phrase or sentence with the target word…** • We can use a carrier phrase such as: • “I see______” • “Here is a ____”

  30. VII. STRUCTURING TREATMENT SESSIONS** • Initial tx sessions highly structured • Tx sessions gradually loosen up to replicate natural “real world” more • Helps child generalize target sounds to spontaneous speech

  31. VIII. INCREASING AND STRENGTHENING ESTABLISHED BEHAVIORS** • A. Selecting Potential Reinforcers Positive reinforcer—rewards and strengthens the behavior

  32. Primary reinforcers—food and water

  33. The treasure chest rocks! 

  34. Noah loves the treasure chest….

  35. So does RJ!

  36. IX. GENERALIZATION** • Generalization usually refers to the child’s producing learned responses in settings outside the clinic

  37. X. IMPLEMENTING A MAINTENANCE PROGRAM** • A. General Considerations • Maintenance = ultimate goal • Skills sustained over time • Select stimuli from client’s natural environment • For example, classroom language arts book

  38. We should vary the physical setting** • Conduct therapy in different environments

  39. We Need to Teach Multiple Exemplars** • For example, “quick” children working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures • Some children may need 50 pictures, 30 objects, and 10 books with /r/-initial stimuli before they achieve 90% accuracy

  40. B. Manipulation of Response Contingencies** • Most important aspect of maintenance • Move from continuous to intermittent reinforcement schedule • Fade primary reinforcers, rely more on natural reinforcers

  41. We can also…** • Train parents and others to reinforce children for correct speech productions in natural environments • Teach self-monitoring/self-correcting skills (I use the terms interchangeably)

  42. C. Involve Family Members and Significant Others

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