lang&phono intervention

phonological and articulation intervention

incidental teaching vs. man model

for man model, clinician initiates the interaction where incidental teaching the child initiates the interaction

milieu

based on communication temptations

PEER

Prompt-prompt child to say something specific

Evaluate-evaluate childs response

Expand-expand childs response(adding words/help build expressive language)

Repeat-make sure child has learned from expansion. repeating the prompt

CROWD

Completion prompt-have them fill in a blank

R-recall prompts

O-open ended response

W-WH prompts (who what where when why) WH questions are graduated

D-distancing prompt-help make connection between childs real life and story 

facilitative play

falls into client centered model. put out things the child likes. there is no requirement for the child to respond. opportunities are provided to allow the child many chances to produce the target. this is still skilled intervention. LEARN to wait for child to respond. some children need longer processing/formulation time. this is part of evidence based indirect language stimulation procedures

hanen programs

parent led intervention approach.

Language procedures that are used with facilitative play (FP)

simplify linguistic input(what were providing to client need only be a couple steps above their ability)

self talk

parallel talk

expansions

extensions-bear into big brown bear

expatiations-doesnt include what the child produced. models how language can be used

recasts-take what child says and then we model it in a different syntax type. child may say “bear” and i say “isnt he scary”

How do I provide language intervention for a preverbal child

determine which social, cognitive and phonological milestones have already been met

target those that need to be enhanced to move the child from the preverbal to verbal stage

heavily involve parent education

teach a functional means of communication(AAC)

does introduction of AAC inhibit childs development of verbal language

NO NO NO

scaffoling/support/cues

procedures that are implemented by adults to assist children in participating in activities. in this case, speech and language activities. there are used across clients of varied ages

some scaffolding/support/cues

close procedure

WH?s

direct/delayed models

Yes/No questions

Forced choice alternatives

Visual supports may be used as well

difference btwn cue and prompt

cue=small helper/hint to get to right answer

prompt=instructs you what to say or do to get to right answer

Cloze procedure

most useful when working with vocabulary. i.e

“a bird can ____” “An elephant is____”

WH?s

Who, what, and where questions may be asked..

DIrect models/delayed models

Often used in articulation/phonological intervention. delayed model imbeds the answer.

Yes/No questions

functionally a great skill for children to have and helps comprehension

Forced choice alternatives

works well for behavior issues. Also, can be used for vocab. “is it X or Y?” choices can be a support for positive behavior

Visual supports

a picture to serve as a reminder, or an expectant look from the clinician. 

How do SLPs in the school setting provide services to school age children with speech and language impairments

Service delivery options include:

Pull out(of class)

Push in/Classroom based intervention

Response to Intervention-important to be aware of!

-multi tiered systems of Support (MTSS)- broader framework.

MTSS

multi-tiered systems of support. broader framework a way to provide special services to all students (could be speech services, behavior literacy etc)

basic ideas for implementing language treatment for school aged LI children

may take a more clinician direct or hybrid approach with this population

materials are important(expository and narrative)

scaffolding is used

connection to the academic setting is important(using materials they’ve already been exposed to in school or home life and using it as content for therapy)

treatment methods for school age LI (not all inclusive)

Story champs (can also be used with preschoolers)

Writing lab approach

Social stories

writing lab

directly addresses macro structure of written language in a ciricular way. pro/con paper. narrative. grammar.. punctuation.

School Age LI Intervention-Social stories

Social stories are created for children and adults with ASD to assist with social interaction skills. Focusing on certain scenarios and contexts.

Social Stories

designed to help a child’s understanding of the hidden rules of social interaction with peers and in certain scenarios. This could be beneficial for any students who have significant deficits with attaining “social competence”

Story Champs

Clinician Directed/Hybrid model

this was created to remediate language dficits (FCU) through narratives.

Can be done in a classroom, small group or individually (RITI format)

Can be used for preschoolers through 3rd grade level

clinician directed-very scripted

Goals that could be addressed through STORY CHAMPS

improve narrative skill

could also target vocabulary

production of discourse level utterances (this would occur through story telling)

narrative generation

materials for story champs

Picture stimuli

script master lesson plans

story icons

(NEED TO KNOW STORY GESTURES)

optional-story games

early clinicians focused on

proper positioning

targeting a few sounds in error at a time

stressed good listening skills

traditional approach/stimulus method (charles van riper) for phonological intervention

very old method but is effective

focuses on the remediation of individual phonemes in error

targets one phoneme at a time (at most 2) vertically structured approach where a child has to reach a level of mastery in each phase before moving on to the next

factors to consider when selecting targets for remediation

chronological age vs. developmental norms for sound acquisition

stimulability

traditional/stimulus approach

1-sensory perceptual training

2-production training-sound establishment

3-production training-sound stabilization

4-transfer/carryover

5-maintenance 

1-sensory perceptual training phase (ear training)

defines the standard for the target sound

client doesnt produce the sound, but listens only to the sound being produced

develops an accurate auditory model

2-production training-sound establishment

goal is to elicit and have the client produce, and establish the new sound that will replace the childs error production. can be difficult old habits die hard.

may try the following with production training-sound establishment

auditory stimulation/imitation

phonetic placement

sound approximation

3-production training-sound stabilization

we want the client to be able to produce the sound quickly and easily

practice, progressing theough the articulation heirarchy

Articulation heirarchy

isolation

nonsense syllables

words

phrases

sentences

conversation

motor cue

producing a physical movement for each sound and syllable

tactile cues

touch cues, touch the placement for correct articulation.

sound sequencing and blending

breaking up a word into indicidual sounds or syllables and then blending together. can also be syllable sequencing.

compensatory techniques

accepting word approximations “wawa” for water

reducing speaking rate, increasing vocal intensity. particularly good with dysarthria

4-Transfer/carryover

ability to use new sound in conversational speech (important for home programming) they have to have it inside therapy and outside of the therapy room

What can transfer and carryover do

may provide structured tasks in which the child can use spontaneous speech (yet inclusive of the speech sounds as the stimuli)

homework

negative practice

negative practice

engage in producing the sound incorrectly so that the client can catch yo and identify it. or, have them go back and forth between correct and incorrect production

5-maintenance

refers to retention of the newly acquired skills after the treatment protocol is completed. often neglected but very important.

many clinicians dismiss their client before this period is completed

maintenance

maintenance phase looks like

a check in 1x/month for a few months then gradually decreases.

motokinesthetic feedback

explaining the properties of the sound

example of a concept cue

lazy T to help produce /s/ phoneme

LTO in phonological intervention

to demonstrate correct production of age appropriate phonemes at conversational level

STOs for phonological intervention

given visual/auditory and tactile (multisensory cueing) the client will produce /k/ phoneme in the initial position of words with 60% accuracy. rationale: child is not yet producing velar sounds, according to formal and informal assessments completed. this should be mastered as indicated 

linguistically based approach

target phonological processes and the child’s underlying phonological system. (cycles approach Hodson &paden) hoping to help childs phonology develop by aiding suppression of their active phonological processes that are errored.

Cycles approach

designed for the highly unintelligible child

focuses on suppression of phonological patterns that are not yet suppressed

not focused on mastery of individual phonemes

phonological patterns are targeted not just individual sounds

program is planned around cycles

what is a cycle

a period of time in which all phonological patterns in need of remediation are facilitated in succession. (a cycle does not end until i practice every sound and process pattern that the child has active)

basic info to understand about cycles approach

each errored phoneme within each pattern is “trained” for 60 minutes/cycles

stimulation should be provided for two or more target phoneme within a pattern before changing to the next pattern

1 phonological pattern per session only

cycle is completed when

all phonological patterns in error have been taught

after 1 cycle

you will repeat from the beginning using sound targets that havent emerged yet or need further instruction

typically 3-6 cycles of remediation

are usually required to see an unintelligible child become intelligible

in cycles 

mastery is not required. he focus is on training the pattern/suppression of pattern not necessarily the sound. 

Procedures for cycles approach

1-review prior session

2-auditory bombardment

3-target word cards

4-production practice

5-stimulability probing

6-auditory bombardment

7-home program

reviewing prior session

start each session with a review of the sound and pattern targeted. use the same practice cards unless a new pattern is being initiated. dont review old cards then

2-auditory bombardment

for about 2 minutes, slight amplification, child simply listens while therapist reads target words slowly, child is not allowed to repeat words. child is listening ONLY.

3-target word cards

allow child to draw, color, glue picture of the target words (3-5) on index cards. write name on the cards.

4-production practice

practice targets through drill/play model. provide auditory, tactile, and visual stim assisting the client in producing the phoneme. if child is successful in producing 3-5 targets with minimal cueing, change the targets.

stimulability probing

do some baseline collection at the end of the session to determine what sound will be targeted next(in the process pattern) check for stimulability. 

in a language based approach

we never practice at an isolation level

6-second auditory bombardment

repeat the same sound list from the beginning of the session. closing the way we open our session.

7-home program

very important to help facilitate generalization. parent is asked to read the 12 word list to child everyday. have child practice target word cards everyday. short and sweet.

phonological awareness activities are

embedded in language approach. should be incorporated in every session. like rhyming words that the child has to match. this helps with literacy. could be as simple as letter identification.

Phonological intervention Objectives example

LTOs-child will be able to produce intelligible speech at conversational discourse level. reduction of the use of phonological processes

STO examples

given visual, auditory and tactile stimulation, client will produce final consonants (p, b, t, d , m ,n) in CVC words with 80% accuracy. Rationale: Child demonstrated FCD 70% of the opportunities to produce this pattern on the HAPP-3. This will help facilitate use of closed syllables (CVC or VC)

What if the child is not stimulable for any target patterns?

Go through cycle of focused auditory stimulation

What if the child demonstrates speech and language errors?

Likely target both, may have to start with AAC depending on the intelligibility.

Why may we have to start with AAC?

So the child can communicate their needs and wants right away. This provides functionality.