Final notes

Remediation

The process of addressing target areas of need or weakness to improve specific skills.

Intervention

Actions taken to improve a child's speech or skills, often affecting related skills not directly addressed.

Treatment

Structured approach to help improve a child's communication skills, specifically focusing on their unique needs.

Generalization

makes sure that after practicing a sound in one situation (like with SLP), a child can say it in other situations (at home or school)

when relevant behaviors occur in conditions or contexts that have not been trained; when a behavior is facilitated and not taught

Stimulability Testing

Assessment to determine if a child can produce a sound with minimal prompting.

Severity

Evaluation of how serious a child’s articulation or phonological disorder is.

Intelligibility

How understandable a child's speech is to listeners.

Goal Attack Strategies

Approaches used to address therapy goals; includes vertical, horizontal, and cyclical strategies.

Vertical Goal Attack Strategy

Focus on one goal until specific criteria are met before moving to the next. AKA deep training, same as traditional approach

Horizontal Goal Attack Strategy

Working on multiple goals/ sounds simultaneously without needing to complete each one first. AKA training broadly

Cyclical Goal Attack Strategy

Involves addressing multiple goals across time in a rotating cycle; for children with more severe artic disorders.

ex: address M for one hour, then T for one hour, to get as high of a percentage as you can, and then move on to next sound

Play Therapy

A more naturalistic form of therapy, allowing the child to lead with minimal guidance from the clinician.

Auditory Bombardment

The technique of exposing a child to the target words through listening to enhance sound production.

phonological or articulation disorders affect what percent of the preschool and school age population?

10%

tools SLPs use to choose targets

• normative tests like the GFTA, Arizona

• stimulability testing (repeating sound w/out training)

• contextual testing (is there a context that they can produce the sound in)

• perceptual testing (can they hear SLPs error productions)

• severity (how severe is their artic problem)

• intelligibility (how well can we understand him)

• an analysis

• child’s age and maturity

• generalization research

assessing generalization is often completed through

the use of probes or pre and post analysis

types of generalization

• stimulus generalization

• response generalization

stimulus generalization

occurs when a learned response to a particular stimuli is evoked by similar but non treatment context or stimuli

ex: a child is taught to say /k/ when given a model (index card with K) and is shown a picture card of a cat and no model (you don’t say it). the child says cat. also if the child can get K words like cow, car, cub, etc. when modeled by a different SLP

response generalization

occurs when the learning of a target behavior results in the learning of a nontarget behavior

ex: matrix. if you address one sound, generalization should occur to other sounds

where can generalization occur?

1. across word position

2. across linguistic unit

3. across sound and features

4. across situation

across word position

stimulus type (not response); when I train one position, I get generalization to a non targeted position. morphosyntactical development can be impacted bc of plurals

across linguistic unit

stimulus type. when training at one linguistic level generalizes to a more complex linguistic level. linguistic level starts at word level, then we assume generalization to sentence and phrase level.

start at isolation level with what approach?

traditional

stimulus or response type of generalization? Across Word Position

stimulus

stimulus or response type of generalization? Across Linguistic Unit

stimulus

stimulus or response type of generalization? Across Sound and Feature

response

stimulus or response type of generalization? Across Situation

both

across sound and feature

occurs when the learning of a target sound generalizes to sounds that are in the same class, manner, or somehow phonetically similar.

ex: Where we are choosing sounds (PVM, phon. Process and matrix type analysis) if i teach the s, i for sure should see generalization to the z and maybe other fricatives.

across situation

once you teach them this sound in the therapy room, they can use it outside, in the hall, at home, at school, etc. Achild is taking what they have learned and is using it without your help. AKA carryover. this means that the child is starting to self monitor

self monitoring

child can hear and adjust their own errors

goal attack strategies

• vertical

• cyclical

• horizontal

intervention styles

• drill

• drill play

• structured play

• play (unstructured)

drill intervention style

clinician directed, no fun, no motivation

drill play intervention style

clinician directed, there is now motivation to increase child’s desire to work harder. ex: sticker for every one he gets right

structured play intervention style

controlled to a certain degree by SLP, but also follow what the child wants to do. We set it up in a way that we elicit responses and we want them to respond, but if they don’t, there is no correction. We should have some type of correct model. If they don't get it right they need something. Response is not required. Hard to take data.

unstructured play intervention style

purest form; we let the child take the lead; no feedback or corrections

intervention changes

changes that you should see happen in therapy

types of intervention changes

• destabilization

• inovation

• stabilization

• generalization

destabilization

disrupting their current speech pattern and disrupting or destabilizing what they know

innovation

when the child begins to use the sound appropriately, maybe 2/10 right, then 4/10, 5/10. can take a while

stabilization

where the new sound becomes more stable and automatic

generalization

where the new sound is now produced in other contexts, like words you haven’t trained, other sentences, at home, outside therapy room

reinforcement

meant to motivate a client to work hard and to get more accurate productions. leads to accuracy of the skill. know what you are reinforcing, which can be hard. ex. reinforce their ability to pay attention to keep working on S

antecedent event

sequence component. pre-response. picture card, object, verbal model. telling child what you will do before doing it

response

sequence component. child giving you their response, you hope its right but it could be wrong

consequaitng event

sequence component. follows response and makes such a huge difference as to how quickly the response gets better. the quicker you give them something, the better the next response is

ex: verbal praise, stickers, whatever they get after their response

positive reinforcement

stickers, candy, tokens

negative feedback

tells them to try something different. ex: I like your S, but let’s see if we can get rid of the T.

punishment

a delay of good stuff or taking good stuff away

ex: taking away cards he gets wring until he gets a certain number

5 components of LTOs

1. direction

2. deficit or excess

3. present level

4. expected level

5. resources

direction

increase, decrease or maintain.

Jack will increase

deficit or excess

what is the skill they are working on?

Jack will increase lexicon

present level

where is the target right now?

Jack will increase lexicon from 1 word

expected level

where do I want to take them?

Jack will increase lexicon from 1 word to 15 words

resources

setting, time period

Jack will increase lexicon from 1 word to 15 words in a language sample by the end of the semester.

3 components of STOs

1. performance

2. condition

3. standards

performance

what you want the client to do specifically to get to the LTO

Jack will practice fluency techniques

condition

the circumstances surrounding the performance. ca include spontaneously, imitatively, when given a model

Jack will practice fluency techniques with cues when reading a passage

standards

level of performance you want to get them to; not always a percentage bc they can be hard to measure

Jack will practice fluency techniques with cues when reading a passage at least 4 times, or 14/15 times.

the linguistic standpoint

is based on the standpoint that some children exhibit patterns of errors because they lack the rules of the language for appropriate sound usage rather than the inability to physically produce the sound

what do the linguistic approaches focus on

the rules of sound usage

compare the motor/traditional and the linguistic approaches

• both approaches practice target sounds through repetition and at increasingly complex levels

• they both implement perception and production phases but in different ways for different reasons

Motor based/traditional approach

• perception training

• getting the child to identify differences in sound productions and to make a judgment on these productions

• child perceives SLPs productions

• address error sounds only

• teach a child what the sound looks like when it is produced

• feedback is extremely important

• start at isolation!!!!

perception/perceptual training

ear training, speech sound discrimination

establishment

begins with elicitation or production of the target sound. includes ¾ stages of intervention: destabilization, innovation, stabilization

during establishment, movement modifications are made in 1 of 2 ways:

1. a movement is taught to replace an incorrect movement

2. movement is taught where there is an absence of sound

feedback for traditional is all about

the movement and placement of articulators

four methods to use to establish a sound

1. imitation (listen to how I make and do it)

2. phonetic placement (where we describe and show where and how to make the sound)

3. successive approximation (where you take a sound the child can produce and modify the movement to shape it for the target sound

4. contextual utilization (using context, have the child say the sound with different sounds surrounding it)

write goals for everything above

40%

Linguistic Approach

• for mild to severe children

• start at word level!!!

• goal: teach the rules of language in order to reorganize the sound system, done using minimal pairs

• always begin with perception, then production

• feedback is not as important, but it is about getting them to understand the meaning of the word they produce. example: tip for sip, if they sub t for s, they should know what tip and sip mean and that t/s is wrong

different linguistic approaches

• minimal pair approach

• minimal opposition approach

• maximal opposition approach

• empty set approach

• multiple opposition approach

• cyclical approach

minimal pair approach

• most common approach

• ok to use with mild artic disorders

• target sound: sound in error or sound we want (R)

• comparison sound: sound they are using (W)

minimal opposition approach

• for a child with a more moderate artic disorder

• look at PVM chart to see if they are the same in PVM

• eliminate the pairs with the fewest differences

• get at least 4 sound with the most generalization to work on

place

where in the mouth the sound is made. ex: bilabial, labiodental

voice

whether the consonant is voiced or voiceless. ex: th & th

manner

how the sound is made. ex: stopping, fricating, gliding, etc.

how many training words is sufficient for generalization to occur

5-10

maximal opposition approach

• the target sound is the sound in error, but the comparison sound is no longer the one they use.

• comparison sound is selected using different criteria

• comparison sound must be maximally distinct from target

criteria for choosing a comparison sound for maximal opposition approach

1. that it is not the sound they are using and is independent of the error sound

2. that it is correctly used by the child and its not another error sound

3. from a distinctive feature standpoint it is maximally distinct (eliminate homonyms like too & shoe)

empty set approach

• variation of maximal opposition

• we have a target sound and we will choose a comparison sound that is maximally distinct from the target

• however, both sounds are error sounds

• take all of the error sounds and take one or two to target. check against all others for the one that is the most maximally distinct and this is your comparison sound

• working on 2 sounds the kid cannot do

• not for the faint of hear, kid needs tenacity and motivation

multiple opposition

• goes with SPACS, mapping the sounds

• for a child who exhibits multiple collapses of sounds into one sound or nothing at all

• target sound: the several sounds they are collapsing

• comparison sound: what they are using for all targets

cyclical approach

• related to phonological processes in need of remediation

• for severe to profound artic kids

• address each process for 2 hours each, then you move to the next one

• can take up to 10 weeks

• do a phon. process analysis to see what sounds are in need of remediation (40% or more)

• make list of each sound for auditory bombardment

• can only make variations on the second cycle

auditory bobmardment

put headphones on child at beginning and at end of the session, say the sounds we are working on (targets) into his ears so he can hear and understand the correct productions

phonological awareness

the ability to constantly analyze and manipulate the structure of a word separate from its meaning

phonological awareness skills

rhyming, segmenting, blending, alliteration

good predictor of children’s learning development/ achievement

phonological awareness

conventional literacy skills begin by

6/7 years old

true or false. PA skills are on a continuum, not innate

true

awareness of words begins at what age

2-3 years old, then develops until ages 5 and 10

what age do you start to test for PA skills

4

shallow phonological awareness skills

rhyming, alliteration

deeper phonological awareness skills

segmenting, blending, manipulating

ways to integrate shallow PA skills (rhyming and alliteration)

singing, Dr Seuss books, nursery rhymes, reading to them

controversial treatment

non evidenced based. nontraditional practices that are popular but are highly debated due to lack of evidence

reasons that reduce the credibility of controversial treatment

1. Lack of evidence or not using or ignoring the evidence that is out there

2. Treatment has weak theoretical rationale. Foundation behind it is weak

3. Zero inclusion criteria. No criteria that people must meet to qualify so it “helps everyone” nobody is excluded bc it works on every disorder= Crap

4. Based on testimonials 

5. Publication in non peer reviewed journals (ASHA Leader) 

6. Potential harm by not considering evidence based practice 

7. Cost

what can you do when you are faced with someone asking you to do a controversial treatment?

1. Identify the source of controversy by analyzing the treatments theoretical rationale? What is the theory behind it

2. Analyze the outcome data. Look up research that’s been done on it

3. Examine the risks and the benefits for doing the CT

4. Compare that CT to ones that do have evidence behind them 

guidelines for using controversial treatment

1. That client should be chosen for a specific reason and not randomly. You need a clear rationale as to why you are choosing that client. You need the client or caregiver sign an informed consent for you to use that treatment with pros and cons on it. 

2. Develop very client-specific procedures with that treatment. You need a short term and long term plan so that it can be monitored.

3. Take very good data and evaluate the effectiveness of the treatment to this client. Set a time period or deadline for change. 

examples of controversial treatments

• nonspeech oral motor exercises

• tongue tied, tongue clipping

non speech oral motor exercise tools

straws, whistles, bite blocks, bubbles

tongue tied is known as

ankyloglossia