direct approaches

traditional approach is often called the..

motor based approach

the traditional approach has often gained its name primarily by…

the length of its existence

who came up with the traditional approach?

Van Riper

The hallmark of the traditional approach is its progression from ______________ to maintenance of the __________

sensory-perceptual training; newly acquired speech sound

five major phases of the traditional approach

1. Sensory-perceptual or ear training

2. Production training for sound establishment

3. Production training for sound stabilization

4. Transfer and carry-over training

5. Maintenance of the learned behaviors across time

traditional approach: Most clinicians write goals and use ___% correct for all levels except ______________

80-90%; spontaneous speech/conversation

traditional approach: Research suggests that once accuracy reaches at least __% in spontaneous speech, progress should continue to mastery without ________

50%; much additional help

traditional approach: what sound do you start in sensory perceptual training?

maximally different= more than 2 features are different

traditional approach: Teaching child to hear the difference between the target sound and what they usually use in its place is what stage?

stage 1: sensory perceptual training

traditional approach: which stage does not have to be mastered before moving on?

sensory perceptual training

traditional approach: what has no pressure for production?

sensory perceptual training

traditional approach: Research has not clearly shown that it is necessary to teach _____________ before moving on to ________________

auditory discrimination training; speech sound production training

traditional approach: There is no strong evidence that teaching _____________ between ________ that are in ______ will result in their correct production

auditory discrimination ; speech sounds that are in error

traditional approach: sensory perceptual components

• identification

• discrimination

traditional approach: sensory perceptual components: identification

• Recognize the target sound in isolation

• Have child practice listening to the sound by itself and compare it against other similar and dissimilar sounds

• May need simple labels (metaphors) for the sounds for very young children

• May need to begin by contrasting the sound against a very different sound (acoustically or productively very different)

traditional approach: sensory perceptual components: discrimination

• Child hears the target sound contrasted with the error they usually make in a variety of contexts

• Child is required to say whether the target sound is correct or incorrect

• Progresses to where child is asked to identify errors in their own speech

traditional approach: Goal is to evoke and establish a new sound pattern that will replace the child’s error pattern is what stage?

stage 2: production training-sound establishment

traditional approach: what are the sound evoking techniques

1. imitation-auditory stimulation

2. phonetic placement

3. contextual cues aka symbolic noise

4. motor-kinesthetic cues

5. sound approximation aka sound sounding aka sound modification

traditional approach: Simplest technique – “Do what I do”

Imitation-auditory stimulation

traditional approach

• __________ can be prolonged to heighten awareness

• ____ must be modeled in syllable

what sound evoking technique?

• continuant sounds

• stops

Imitation-auditory stimulation

Provide instruction on specifically where to put articulators and what to do with them to make the sound

phonetic placement

Elicit the target consonant as symbolic noise and then modify context and mechanics of production so that it is produced as speech

Contextual cues aka Symbolic Noise

Each sound is elicited as a part of a specified stimulus syllable, word, phrase, or sentence

Motor–kinesthetic cues

Take a similar sound and show the child how to modify it so that it becomes the target sound

Sound approximation aka Sound Shaping aka Sound modification

traditional approach: Stabilizing the child’s production of the sound at varied levels of response complexity is what stage?

stage 3: production training-sound stablization

traditional approach: Secord (1989) outlined the progression of therapy as follows:

(what stage?)

• Step1: Isolation

• Step 2: nonsense syllables

• Step 3: words

• Step 4: (structured) phrases, sentences

• Step 5: conversation (spontaneous speech)

  • Not all clinicians begin at the isolation level

stage 3: production training-sound stabilization

traditional approach: Completed at the Sound Stabilization Level

Stage 3 – Step 1: Isolation

Certain __________ have been shown to make it easier to produce certain sounds

phonetic contexts

Known as the “likely best bets” for production and can be identified for voicing, velar, alveolar, and nasal consonants

facilitating contexts

examples of facilitating contexts

• Production of a "t" may be facilitated in the context of a high front vowel

• Nasal consonants = low vowel, as in "mad" (Bleile, 2002)

traditional approach: Allows you to help establish accuracy of production of consonant – vowel combinations (CV, VC, CVC)

Stage 3 – Step 2: Nonsense Syllables

traditional approach: This step is frequently skipped

Stage 3 – Step 2: Nonsense Syllables

Some move directly to real words to make the process more meaningful

traditional approach: In Stage 3 – Step 2: Nonsense Syllables does not have to be ________ but usually starts there

strictly imitation

traditional approach: Stage 3 – Step 2: Nonsense Syllables: what can you use for each syllable during therapy?

• Can create “abstract” or nonsense shapes or drawings to use to represent each syllable

• Use colored blocks or create shapes with building blocks for each syllable

traditional approach: Stage 3 – Step 3: Words there are several levels of __________ (_________)

complexity (not all words are equal)

traditional approach: what is considered easier in Stage 3 – Step 3: Words?

• Words with fewer syllables

• Prevocalic positions easier than post vocalic easier than intervocalic

• Open syllables easier than closed syllables

• Sounds in stressed syllables easier than unstressed syllables

• Certain sound combinations easier due to co-articulatory effects

• familiar words easier than less familiar

  • Could also be impacted because of habit strength though

substage of words that are from easiest to hardest

• initial (prevocalic) words

• final (postvocalic) words

• medial (intervocalic) words

• initial clusters

• final clusters

• medial clusters

• all word positions (1-2 syllables)

• all word positions (any number of syllables)

• all word positions, multiple targets (any number of syllables)

a carrier phrase …

stays the same each time

traditional approach: Create a “carrier phrase” to practice a series of words. Ex – “I see a ____”

this is an example of?

Stage 3 – Step 4: Structured Phrases / Sentences

traditional approach: Playing games with repetitive lines such as “Go Fish” or “I Spy / See”

this is an example of?

Stage 3 – Step 4: Structured Phrases / Sentences

traditional approach: Stage 3 – Step 4: Structured Phrases / Sentences

Not always possible to go straight from _____ to __________

words to spontaneous speech

traditional approach: Ultimate goal is to have fully correct production in everyday conversation

Stage 3 – Step 5: Spontaneous Speech

traditional approach: specific time is needed to establish for this to measure production accuracy in what stage?

Stage 3 – Step 5: Spontaneous Speech

traditional approach: what can be very difficult in the spontaneous speech stage?

Self-monitoring

The following components are emphasized in transfer and carryover training in the traditional approach:

• Home based practice with caregivers

• Self and peer monitoring

• Practice in other situations

• Proprioceptive awareness exercises

• Varying the audience and setting

The ultimate goal in articulation therapy is __________ in various _____________ across _____

maintenance; natural environments across time

traditional approach: Not only is it important that the child transfer and carry over the skills learned in the clinical setting to extra-clinical situations, but also what?

that he or she maintain these skills over time

The complexity approach to intervention focuses on ________ rather than _________

what is targeted; how it is targeted

the complexity approach is considered most appropriate for children who have problems with __________ (__________ aka ____) rather than _______ (________________________)

phonological content (individual sounds aka articulation); phonological frame (syllable/word structure and shape)

The primary goal of the complexity approach is not to teach sounds in __________________, but to select _________ behaviors that could lead to _________________ based on generalization

contrasting words pair sets; complex target; wider phonological change

complexity approach: client age

2;8-7;11 – with mostly 4;0 (no meta-skills are age 4)

complexity approach: population

for children who are missing six or more sounds from their inventory, spanning at least three different types of sounds (stops, fricatives, and nasals)

complexity approach: components

________ word pairs involving one or two phonologically complex phonemes that are ______ from inventory

how many NSW pairs for ___________?

how many NSW pairs for ___________?

addressed in two phases – imitation and spontaneous

Maximally; absent

8 = Contrastive approaches

16 = complex clusters

NSW= nonsense word

complexity approach: _____, _________ generalization through ___________ units cascading to _________units

Broad system-wide; hierarchically complex; simpler linguistic units

complexity approach: target selection

Consonants and clusters that are:

• linguistically complex

• later developing

• consistently in error

• represent least knowledge within nonsense words

complexity approach: level of focus

Speech output skills; primarily at nonsense word level

complexity approach: session type

Individual sessions – 30-60 minutes/3 times weekly

what sounds are more complex than other speech sounds

clusters, fricatives, and affricates

complexity approach: Sounds with the lowest degree of _______, or the lowest level of _____________, would be considered the most complex and would make good _______________

stimulability; phonological knowledge; initial intervention targets

Other factors that can guide the clinician’s selection of complex intervention targets include:

• later developing sounds (more marked, more complex),

• consistently erred sounds (more complex sounds)

complexity approach: Contrasting phonemes within the words are presented in the _____ position

word-initial

complexity approach: The NSW pairs are assigned meaning by naming _______, _______, and _______ in stories

characters, objects and actions

complexity approach: 2 Phase Intervention

Imitation and Spontaneous

complexity approach: Child repeats the clinician’s model of each word and the clinician provides feedback regarding the accuracy. Corrective models are provided as needed

Imitation phase

complexity approach: When the child reaches ___% accuracy over ________ sessions in modeled trials or when ____ sessions have been completed, treatment shifts to the _____________ phase

75%; two consecutive; seven; spontaneous production

complexity approach: Child produces the same target words independently without a model

Spontaneous phase

complexity approach: The spontaneous phase continues until the child reaches __% accuracy over _______________ sessions

90%; three consecutive

complexity approach: in which phase of treatment activities during the sessions may include sorting, matching, and informal story-telling

spontaneous phase

core vocabulary: client age

Children across a wide age range, typically preschool to school age (at least 2 years old)

core vocabulary: population

inconsistent speech errors (dysarthria, cleft palate)

core vocabulary: components include consistent production of ≥ __ functionally powerful words supported by ____ and _____ dense response drill with pictures

50 ; sound- by-sound and syllable-by-syllable

core vocabulary: broad goals

Establish consistency of production and enhance consonant and vowel accuracy

core vocabulary: target selection

Functionally powerful words

core vocabulary: level of focus

Speech output skills via stable phonological representations at the word level

core vocabulary: session type

Individual, 30 minute, 2x/wk for approximately 8 wks

core vocabulary: materials

picture stimuli

core vocabulary: Designed to meet the needs of the approximately __% of children with functional speech sound disorders characterized by inconsistent errors on the same lexical items (words) in the absence of __________

10%; childhood apraxia of speech

core vocabulary: Ultimate goal of increasing the child’s ______

speech intelligibility

core vocabulary: Goal is for the child to produce at least ____________ vocabulary words consistently each time

70 pragmatically powerful

core vocabulary: A set of __ core vocabulary words is selected for intervention with the help of the _______(___________)

70; stakeholders (parents, teachers, etc.)

core vocabulary: ________ that the child frequently uses for names, places, function words, foods, and preferred toys or things are selected for consistency training

Functional words

core vocabulary: Target words are not selected according to _______ or ______

word shape or sound segment

core vocabulary: 1st Major Short-Term Goal

Best production possible for each target word

core vocabulary: Objective is for the child to produce the target words correctly, but if it is not possible, “________” errors are accepted

developmental

core vocabulary: 2nd Major Short-Term Goal

Consistently use the established best production, whether it is an exact match to the adult target or one that contains errors

core vocabulary: in the first weekly session, how many words are selected from the 70 set of words?

10

core vocabulary: what is KEY to this approach

Parent / Teacher Training

core vocabulary: Parent / Teacher are trained in how to ________ and how to _____________

elicit sounds; offer appropriate feedback

core vocabulary: Probes are conducted every __ days to monitor generalization of consistent whole-word production to untreated words (in sets of __).

14; 10

core vocabulary: what are measured

Consistency of production and child’s percentage of consonants correct (PCC)

core vocabulary: 1st weekly session

1. 10 target words are randomly selected from the set of 70 words

2. the clinician elicits and established the best production of the 10 target words by initially “drilling” the sound by sound then practicing the obtained best production

3. the best production of the first syllable is established and specific feedback. (once both syllables have been established, the two are combined)

4. if produced in error, the clinician imitates the child’s error production and explicitly explains that the word differed and how it differed

5. most children with inconcsistent SSD are able to imitate all sounds, but when a correct production is not evoked with cues and models, then the best production may contain “developmental” errors

6. at the end of the first session, the child’s parents and teacher are instructed to target the words directly in the child’s home and school environment until the next clinical (second) session

core vocabulary: 2nd weekly session

1. the previous 10 words are practiced and appropriate feedback when the best production is not made

2. games are used to evoke a high number of repetitions for each target core vocabulary word

3. toward the end of the 2nd session, the child is asked to produce the set of target words for the week, three times each

   • words that the child can say consistently are removed from the list of words to be learned

   • words that continue to be produced inconsistently remain on the original list. words that are not mastered are addressed in another week

stimulability intervention approach focuses on “enhancing” _______ of _________ (_____) sounds rather than their _________ (_____)

stimulability of nonstimulable (complex) sounds; full acquisition (mastery)

stimulability intervention approach: In their view, this could help alleviate the concerns expressed by some clinicians regarding:

• Time

• Level of difficulty

• Potential frustration by the child when treating nonstimulable sounds.

WHAT? stimulability intervention approach:

Program based in research shows that:

1. ________ sounds are likely to be acquired even without intervention

2. _________ sounds are not likely to change without intervention and thus should be high priority

3. Therapy outcomes could be enhanced by treating _________ sounds because of ___________ to untreated sounds or _____________ environments

4. Generalized production in the absence of direct intervention is greater on ________ than _________ sounds

1. Stimulable

2. Nonstimulable sounds

3. nonstimulable ; potential generalization ; higher linguistic

4. stimulable than nonstimulable

WHO? stimulability intervention approach:

Young children between the ages of 2 and 4

a moderate to severe functional speech sound disorder

AND a severely restricted phonetic inventory (phonological or severe artic)

stimulability intervention approach: Children considered to be good candidates for this approach show __________ for most if not all of the sounds absent from their phonetic inventory, _______, and _______________

poor stimulability; significant homonymy, and severely reduced speech intelligibility

stimulability intervention approach: Program never moves beyond the __________

syllable level

The length of the stimulability program is not based on the production of target sounds to a specified criterion, but rather on the …

delivery of services for no more than 12 weeks

stimulability intervention is a ____, __ -week program typically delivered in ____ weekly sessions, lasting ____ minutes

short-term; 12; twice; 45-50