DLD Midterm 2

Evidence Based Practice

Integrating high quality evidence based research with practitioner expertise and client preference (cultural/personal values)

Level/Tier 1 Evidence

Meta analysis, randomized clinical trials and systematic reviews of RCT’s

External Evidence

Level/Tier 2 Evidence

Non-randomized studies, systematic reviews of non-randomized studies

External Evidence

Level/Tier 3 Evidence

Multiple case studies on the same treatment, non-experimental design

External Evidence

Level/Tier 4 Evidence

Single case studies

Internal Evidence

Level/Tier 5 Evidence

Expert opinion and consensus statements

Internal Evidence

PICO

Population

Intervention

Comparison

Outcome

Population (PICO)

Patient/client characteristics

Intervention (PICO)

What intervention/program/approach are we interested in?

Comparison (PICO)

What approaches can we compare the intervention to?

Outcome (PICO)

What is the outcome we want to measure

EBP Decision Making Process

1.) Formulate Clinical Question

2.) Identify Literature

3.) Evaluate Literature

4.) Consider Internal Evidence for Client/Family

5.) Consider Internal Evidence for Clinic/Agency Factors

6.) Answer the CLinical Question

Broad Goals of intervention

Change or eliminate the underlying problem

Change the disorder or behavior

Teach compensatory strategies

Optimize the environment

Components of Therapy

Instructional Goals

Agents of Change

Instructional Strategies

Modifying Input

Intervention Approaches

Instructional Goals

Long Term Goals

Give us direction

IEP’s require annual goals

Short Term Goals

Stepping stones or benchmarks towards completion of annual goals

Must be attainable in the Zone of Proximal Development

Zone of Proximal Development

“Sweet Spot” of what the child is able to do

Requires some scaffolding and support so the child can accomplish the goal

Levels of the Pyramid for Instructional Goals

Basic: New grammatical forms

Intermediate: Auxiliraies, articles, pronouns

Specific

Priorities for Goal Setting

Communication Effectiveness

One Aspect at a Time

Phonological Skills

Teachability

Communication Effectiveness

What is functional for the child?

One Aspect of Language at a Time

Only focus on the development of one new skill at a time

Ex: If targeting a new form, use vocab child already knows. If targeting new vocab, use a form the child already knows

Phonological Skills

Oral and Auditory abilities to discriminate and produce phonemes and letter combinations

Teachability

Better success with forms that are…

Easily demonstrated/pictured

Taught through easily organized stimulus materials

Frequent in naturally occurring every day activities/situations

Acceptable Terminology

Must be descriptive, cannot assume

Point, label, repeat, match, name, tell, say, write, count, vocalize, ask 

Unacceptable Terminology

Assumes intent or thinking

Understand, think, believe, improve, discover, know, appreciate, remember

What do all goals require?

Accuracy Criteria: 80% of the time on ¾ occassions

Treatment Stimuli: Gives guidance for when goal should be elicited. Ex “When prompted”

Setting” Where goal is taking place. Ex. When interacting with adults or in conversational settings with peers

SMART Goals

Specific

Measurable

Attainable

Relevant

Timely

Comprehension

Involves passive listening or contingent responses

Expansion, extension, recast, conversational follow

Production

Eliciting a response consistently

Imitation, Cloze procedures, WH questions

Contingent Response; Expansion

Take what the child says and add grammatical markers or semantic info that would make it an acceptable adult utterance

Ex. “The doggy walks” to “The dog is going for a walk”

Contingent Response; Extension

Adding semantic or new information that is related to the remark made by the child

Ex. “The ball” to “Thats an orange ball, a big orange ball”

Contingent Response; Recast

Restate the child’s remark into a different type of sentence, such as turning a statement into a question

Ex. “I have a dog” to “Do you have a dog?”

Contingent Response; Conversational Follow

Adding additional information to a conversation with a client

Ex. “That car is going to crash” add “They are a very bad driver”

Elicited Production; Imitation

Directly imitating what the child says

Elicited Production; Cloze Procedures

A clinician repeats the child’s utterance back to them with correct pronunciation, grammar or expanded vocab while keeping the original meaning (Wug Test)

Elicited Production: Wh Questions

Asking who, what, where, when, why

Child-Centered Approach

Content follows the child’s lead

Contingent language and natural consequences, environmental arrangements, active communication exchanges

Hybrid Approach

Interactive teaching combined with focused drill, target one or a small set of specific goals

Clinician controls selection of activities and materials, tempts the child to produce forms

Clinician-Directed Approach

Specific learning goals are selected by the clinician

Imitations and WH questions, verbal/tangible reinforcers, discourse/pragmatic context

Agents of Change

Clinician, Parents, Teachers, Peers and Siblings

Prenatal/Postnatal Risk Factors

Prenatal Factors: Fetal alcohol syndrome, exposure to toxins, dangerous substances or infection

Prematurity/low birth weight: Before 37 weeks gestation and or under 5.5 lbs

Genetic & Congenital Disorders: Craniofacial, affecting metabolism, chromosomal etc

Individualized Family Service Plan

Birth-3

Focuses on family as a unit, family determines outcomes

Present level of development & natural environments

IEP

3-21

Focuses on educational needs

Present levels of performance

IEP Team (and parents) determine goals

Focus on least restrictive environment

Roles & Responsibilities of SLP’s

Feeding and oral motor

Hearing conservation and aural rehabilitation

Promoting parent child interaction

Goals & Intervention for Preintentional Infants (1-8 months)

Vocal Development: Babbling and involving family with eliciting vocalizations from infant

Infant Behavior/Development

Parent-Child Communication: modeling adult infant communication such as turn taking and imitation, awareness of infant communication patterns and parental self monitoring

Infant Communication (9-18 months)

Increased expectations as developmental level icnreases

Follow the child’s lead

Indirect language stimulation: Self talk, parallel talk, buildups/breakdowns

Reinforce communicative intent

Red Flags in Development

Constantly making “fists” with hands

Hypertonia

Hypotonia

Hearing Loss & failure to orient towards sounds

Persistence of the Moro reflex

Neuromotor disorder

Hypertonia

Excessive/increased muscle tone and tension

Ex. Early rolling

Hypotonia

Decreased muscle tone

W sitting, bunny hopping

Area’s SLP’s Intervene On

Play and Gesture

Communicative Intentions

Comprehension

Production

Major goals for intervention

Acquire intelligible, grammatical, flexible forms of expression

Strengthen oral language to help with literacy

How do we assess progress for vocabulary development?

Criterion referenced measures such as categories of words, spatial/temporal questions, verbs

Pull Out of Classroom Therapy

Child is pulled out of the classroom to receive one-on-one or small group therapy

Evolved from the speech clinic model

Classroom Based Model (Push Into Classrooms)

SLP observes and analyzes class demands, then makes lesson plans

SLP “guest teaches” on a scheduled basis

Collaboration with teacher to create a packaged program with individual objectives for students

Indirect Language Stimulation

Child Centered

Contingent feedback

Balanced turn taking

Extension of the child’s topics

Focused Stimulation

Hybrid approach

Modeling target vocabulary

Modeling locative forms

Importance of Pre-literacy Skills

Phonological awareness

Print and alphabet knowledge

Tier 1 RTI

Traditional Classroom

SLP’s consult on oral language influencing school performance; identify evidence based practice for reading, writing, spelling

Frequent in class progress monitoring by regular teacher

Tier 2 RTI

Individualized supports for underachieving students

SLP designs procedures for small groups

Targeted short term instruction to address weakness in language or literacy

Supplement regular classroom instruction

Small groups, delivered by para, slp, special ed teacher etc

Tier 3 RTI

Intensive, individualized supports

Students who still struggle after tier 2

Intensive services and therapeutic intervention

SLP determines eligibility

SLP provides specialized language and literacy intervention in collaboration with regular and special ed

Primary Language Disorder

Disorder occurs independently and is not caused by physical, sensory, cognitive or emotional deficits

Secondary Language Disorder

Disorder that is the consequence or symptom of an underlying condition or disability

Illusory Recovery

Child appears to overcome certain language deficits around the time they begin elementary school, however improvement/recovery does not actually take place

Non-Language Impairments of DLD

Difficulty with statistical learning

Low performance on standardized tests

Difficulty with sequential learning

Impaired memory

Deficits in reading, writing, grammar

Late talkers