SLHS 512 Unit 4 Test-Treatment

Articulation treatment

approaches target INDIVIDUAL sounds

Traditional Articulation Approach

Children with articulation (NOT phonological) errors

• Knows letter and when to use but cannot produce sound correctly 

Follows a developmental progression tacking one sound at a time through a production hierarchy (isolation, syllables, words, phrases, sentences, conversation) until mastery 

Phonological treatment

Based on approaches target a GROUP of sounds with similar error patterns

Specific treatments for CAS

Dynamic Temporal and Tactile Cueing —> motor-based approach, meaning it is designed to improve the brain’s ability to plan and program movements for speech

Treatment Sequence: Establishment

establish target sounds and have the child produce the sound by itself

Treatment Sequence: Generalization

Carry over of target sounds at more challenging levels (syllables, words, sentences, conversations)

Treatment Sequence: Maintenance

Stabilizing target sounds. Child self monitors and corrects their speech

Zone of Proximal Development(ZPD)

Sounds that are stimulable, where the child can get close to/produce sometimes

How do SLPs select what sounds to target in therapy?

-Developmental

-Client-specific

-Stimulability

-Impact on intelligibility

-Frequency

-Morphological properties

-Complexity

Developmental (target sound selection)

target sounds in order of acquisition in typically developing children typically

Client-specific (target sound selection)

target sounds that are relevant to the child (e.g. sound is in child's name)

Stimulability (target sound selection)

the child's ability to produce a sound correctly when given cues or support

Impact on intelligibility (target sound selection)

target sounds that affect intelligibility the most (e.g. initial consonant deletion)

Frequency (target sound selection)

target sounds that are highly frequent

Morphological properties (target sound selection)

•  target sounds that have more morphological properties 

  • /s/ or /z/

    • Plurals ‘cats’ /kæts/ or ‘dogs’ /dɔgz/

    • Possessives

    • Third person singular verbs (e.g he likes to run)

Complexity (target sound selection)

target sounds that are more complex to produce and may lead to broader generalization in treatment

Vertical targets

1 to 2 practice sounds until a child reaches a certain accuracy (%), then moves onto other sounds; training ‘deep’

Horizontal targets

less intense practice with multiple targets at once; ‘broad’

Cyclical target

practice targets for some pre-determined period before moving onto the other target. Cycle through targets

Cycles approach

-target phonological patterns rather than individual phonemes

-goal is to imitate typical phonological development process

-Does not need to reach a certain accuracy

-this is for children with multiple phonological errors who are highly unintelligible

WANT TO WORK ON SOUNDS THAT ARE STIMULABLE

Primary targets for cycles approach

word structures/shapes, /s/ clusters in initial or final position, fronting/backing, liquids (start with targets that are stimulable)

Secondary targets for cycles approach

palatals, /s/ clusters in medial position, singleton stridents, assimilations

Cant practice until mastered all primary

Contrastive approaches

-minimal pairs, maximal oppositions, multiple oppositions

-method of comparing 2 or more sounds that only differ by the target sounds

-this teaches kids how different sounds signal a difference in meaning

Multiple oppositions: Maximal classification

targets representing different structures (e.g., singletons vs. clusters) and different places, manners, and voicing to cover the full extent of the error pattern (different between targets selected)

USE THE GREEN AND PURPLE CHART TO FIND WHICH TARGET (LOOKING FOR HIGHER NUMBER)

Multiple oppositions: Maximal distinction

focus on high number of feature differences from the produced sound. Target sounds need to be maximally distant the errored sound

USE THE GREEN AND PURPLE CHART TO FIND WHICH TARGET (LOOKING FOR HIGHER NUMBER)

Context Utilization

Using contexts in which the child can consistently produce a phoneme(ex: word final), can facilitate consistent production of that phonemes in other contexts(ex: word initial/medial)

e.g child can produce ‘k’ word final but not word intial —> ‘duck’ to ‘ducKEY’ to ‘key’

Naturalist Intervention-

-Addresses the targeted sound in naturalistic activities that provide the child with frequent opportunities for the sound to occur (play-based)

-Best for children who have concurrent language difficulties (expressive/receptive — not just mispronouncing words but not understanding them to speak or listen)

Good for younger kids or those resistant to practicing with picture/words cards

-Ex: Using animal figurines that all have velar sounds in them

Speech Sound perception training

-The child only listens to the SLP produce the target phonemes

• The child is not producing the phonemes, only listening to the SLPs productions of the target phonemes !!

-Helps the child acquire perceptual representation of a target phoneme

-Ex: child identifies picture corresponding to the word the SLP says

Lexical diffusion

The gradual spread of a (sound) change through the vocabulary of a language

Complexity Approach

-Use of more complex linguistic stimuli helps promote generalization to untreated but related targets (DO NOT CHOOSE STIMULABLE SOUNDS FOR THIS APPROACH!!!)

-This is for children (3-5) with highly unintelligible speech that exhibit many phonological processes and reduced phonemic inventory but dont get frustrated

-Use IPA chart (affricates lead to fricatives leads to stops)

What are complex targets?

-Later acquired

-Unknown to the child

-Typologically marked

What is markedness?

Presence of more complex(marked) structure implies presence of a relatively less complex structures(unmarked)

-marked: uncommon, complex, more + features

• Unmarked → /p/ – [- continuant, -voice]

• Marked → /b/ [- continuant, + voiced]

Implicational relationships

• Liquids (marked)→ implies nasals (unmarked)

• Affricates (marked)→ implies fricatives (unmarked)

• Voiced (marked) → implies voiceless (unmarked)

Cluster Complexity and sonority difference

-The closer two sounds of a cluster are on the sonority scale, the more complex they are (choose clusters w/ small sonority difference to target)

-3-element clusters (spl) are marked relative to 2-element clusters (sp)

• Choose 3-element clusters, when child has mastered two sounds in the 2-element cluster (e.g. child can produce ‘pl’, add ‘s’ to make it a 3-element cluster ‘spl’)

Different types of syllable complexity reflect different levels of markedness

-Clusters are marked relative to singletons

-Clusters with a small sonority distance are marked relative to those with a large sonority distance

-3-element clusters (e.g., 'str') are marked relative to 2-element clusters (e.g., 'st')

Within class treatment (types of change in untrained sounds)

One sounds will affect another from the same class

-Ex: train the sound /f/ and you will get change in other fricatives

Across class treatment (types of change in untrained sounds)

Treatment on a sound will affect other sounds from a different class

-Ex: train sound /f/ and you will get change on stops

Global change

within + across class changes — affects both same class and different classes

Summary of treatment findings for clusters

-Training clusters ‘tr’ will improve singletons ‘t’

-Training small sonority distance ‘tr’ will improve large sonority distance ‘tw’

-Training 3 element clusters ‘str’ with improve 2 element clusters ‘st’

Normalization

-Refers to when child's errors become accurate

-Optimal timeframe is between 4 and 6 years of age

Considerations for treating bilingual/bidalectal children

-Remember: Assess both languages/ dialects!

-For intervention: Use a bilingual or cross-linguistic approach.

-Consider language transfer

Positive Transfer

When a child's second language shares sounds with the first language, the child can easily produce these shared sounds in their second language in the absence of an SSD

ex: english- baby and spanish-bebé

Negative Transfer

If the child's two languages do not share a sound, the child might...

• Delete the sound

• Distort the sound

• Replace the sound

THIS DOES NOT INDICATE A SPEECH SOUND DISORDER

Minimal Pairs (therapy approaches)

Children with mild-moderate, consistent phonological errors (small level of error patterns)

Contrasts a known and unknown sound differing by one distinctive feature (e.g., coat vs. goat)

-most commonly used

Maximal Oppositions (therapy approaches)

Children with consistent phonological errors who are missing 6+ phonemes in their speech sound inventory

A complexity approach similar to minimal pairs, except the known and unknown sounds differ by multiple distinctive features (e.g. meet vs. feet; /m/ and /f/ differ in place, manner, and voicing, sonorant vs obstruent).

Multiple Oppositions (therapy approaches)

Children with moderate-severe, consistent phonological errors, with a collapse to one phoneme (USE APPROACH FOR PHONEME COLLAPSE)

Contrasts the known sound with 2–4 unknown sounds (e.g. tie vs. hi, pie, and try) —> Shows up to 4 words at the same time

USE THE GREEN AND PURPLE CHART TO FIND WHICH TARGET (LOOKING FOR HIGHER NUMBER)

Core Vocabulary (therapy approaches)

Children with INCONSISTENT phonological errors — cant fix other problems until child becomes consistent in producing (transitional approach)

Choose a pool of 70 target words. Target 10 words every session, focusing on consistency of the child’s best production, rather than perfect production. Remove target words from the pool when the child can produce them consistently.

Metaphonological Approaches (therapy approaches)

Children at-risk for or diagnosed with literacy disorders (trouble reading and/or writing)

Target children’s explicit awareness of sounds’ distinctive features, and/or working on letter-sound knowledge and phonemic awareness

Stimulability approach

Young children (2–4) who aren’t yet stimulable for MANY consonant sounds (HIGHLY UNINTELLIGIBLE – transition approach)

increases the child’s phonetic inventory by reviewing sound character cards and corresponding hand motions (e.g., Coughing Cow, where you place your hand on your throat) and completing turn-taking play activities

Use for kids that cant pay attention, get frustrated easily