SSD Treatment

Target behavior

Any skill or action that is taught to a client

Target behavior AKA….

Treatment “goals” & “objectives”

“easy to teach” target selection are based on

ideal targets

• sounds in the child’s current repertoire

• phonological processes that are unstable/inconsistent

Long term goal

• broad communication behaviors

• age appropriate artic, phonological skills, intelligibility, etc

Short term objective

• Skills that can be taught in a relatively short period of time

• Steps to achieve the LTG

• Production of specific sounds or elimination of error patterns

• 2-weeks, 1-month, 3-month

autonomy

freedom

Common approaches to target selection

• developmental norms

• “easy to teach”

• “hard to teach”

• Impact on intelligibility

Developmental norms are based on

selection of age appropriate sounds and patterns

• where the child should be performing developmentally

• age appropriate sounds are easier to teach

Target selection: developmental norms - criticism

• not challenged as an approach

• current research suggests teaching ahead of developmental norms might be beneficial

criteria for sounds (artic)

• 20%-40% accuracy - ideal target

  • 0% accuracy: wait to target when accuracy is higher

  • 60%: may not need therapy to acquire

• Sounds child is stimulable for

• Visible sounds (e.g. /p, b, f/)

Criteria for phonological processes

Error with a percentage of occurence less than 100% but more than 40%

“Hard to teach” target selection AKA…

Complexity approach

Hard to teach: ideal targets

• complex phonological patterns

  • CR, gliding, stopping

• Sounds consistently omitted

• Nonexistent sounds

• Sounds child is not stimulable for

Hard to teach: research support

• acquisition of “easier sounds/patterns” achieved with no therapy

• higher rate of generalization to settings outside of therapy

Target selection: Impact on intelligibility - ideal targets

• phonological/sound errors that occur frequently

• phonological errors that affect large numbers of sounds (e.g. stopping)

• phonological errors that are idiosyncratic (backing, glottal replacement, etc)

How many targets to select - traditional

no more than 2 targets at a time, targeting more sounds can cause confusion

How many targets to select - current

work on multiple targets (2+ sounds) at a time, targeting multiple sounds/errors yields faster progress

Establishing baseline: baseline

measured rate of behavior in the absence of treatment

Establishing baseline: main purpose

• measured the child’s performance of a skill prior to beginning treatment

• help with identifying a “starting point” for therapy

• helps set goal

Establishing baseline: other purposes

• evaluate child’s progress over time

• establish clinician accountability

• modify treatment as needed

Establishing baseline: evoked

• ask child to name pictures with target sound in all positions - no model provided

• develop list of questions/fill in the blank sentences in which answers are words that contain target sound

establishing baseline: modeled

• ask child to name pictures with target sound in all positions given a model

• develop list of words and ask child to say following a model

LTG Example

BROAD - client will improve artic skills to an age appropraite level as measured by an intelligibility rating of >/= 90% in settings outside of the clinic

LTG usually treats

• artic

• phonological skills

• intelligibility

• age appropriate speech production

STO Example

SPECIFIC - in 3 months of therapy, the client will correctly produce /r, l/ phonemes in words with 80% accuracy given minimal cues

STO usually addresses

• phonemes

• phonological processes

  • stopping, CR, FCD, etc.

Measurable behaviors

Behaviors you can observe and track

• point

• repeat

• match

• name

• tell

• ask

• count

• write

• say

• production of sound

NOT measurable behaviors

• think

• believe

• discover

• feel

• remember

• know

• understand

Approach

• general philosophies / ways of thinking

• guides entire course of treatment (selecting targets, # of targets, use of strategies, types of activities)

Strategy

specific actions implemented to facilitate execution of a desired behavior

• AKA: techniques

phonetic placement

teaching the articulatory placement of a sound

• model position (mirror)

• show picture of correct position

• use manual guidance (use hands/tongue depressor to manipulate articulators

Successive approximation: sound shaping

use of a sound the child can already make to learn a new sound

• sound can be a phoneme / another type of sound

• idea is to break down a difficult phoneme into easier steps

example of sound shaping

/t/ → /tʃ/

produce hard t with lip protrusion

maintaining lip protrusion, produce /t/ again but slowly pull tongue back

Modeling

clinician models (produces) target response

How to use modeling

can use vocal emphasis (increased intensity / duration of the sound) to highlight the sound

• child carefully watches clinician produce target and then imitates

Verbal instruction

verbal stimuli that help facilitate a clients actions

when is verbal instruction usually given

prior to model

verbal instruction example

for /k, g/ : “see the back of my tongue I’m going to make it go up really high to touch the top of my mouth in the back”

prompt

hints or cues that help facilitate an expected response

verbal prompt

use of vocal emphasis

• “remember where your tongue goes for that sound”

• “don’t forget the sound at the end of the word”

nonverbal prompt (physical prompts, visual cues, visual stimulation)

physical signs & gestures that might help the child visualize correct production of the sound

positive reinforcement

an event that follows a response that increases the response’s frequency

primary reinforcement

food & drink

secondary reinforcement

verbal praise, positive attention, smiles, tokens, stickers

fading

begin with consistency / continuous reinforcement and fad as accuracy increases

positive reinforcement

• reinforce promptly

• provide clear statements

• be positive

• vary use of phrases

corrective feedback

feedback that informs child when an error has been made

• provide feedback for ALL incorrect productions

• withdraw positive reinforcements

• ensure positive reinforcement exceeds corrective feedback

children in early stage of phonological development

• fewer than 50 words in vocab

• reduced inventory of sounds in phonetic inventory when compared to others of the same age

• reduced inventory of syllable structures when compared to others of the same age

• typically children 3 & under

Combined approach includes

vocab, phonetic inventory, syllable structures

combined approach - consideration 1

child’s current phonetic inventory

select specific word targets that contain sounds the child can already produce

• phonetic inventory: m, n, p, b, t, d, h

• possible targets: my, mine, no, puppy, baby

• GOAL: in 3 months of therapy, child will add at least 10 novel words to his expressive lexicon based on therapy data & parent report

Combined approach - consideration 2

child’s current syllable structure

select specific word targets containing syllable structures child can already produce & basic novel syllable structures that child cannot produce

• syllable structure inventory: V, CV, CVCV

• possible targets: mom, dad, baba, moo-moo, hi, bye

• GOAL: in 3 months of therapy, child will add at least 10 novel CV, CVCV, and/or CVC words to his expressive lexiconbased on therapy data & parent report.

combined approach - consideration 3

developmental sequence of sound acquisition

select word targets that contain age appropriate sounds that are not in child’s inventory

• phonetic inventory: m, n, p, b, t, d, h

• syllable structure inventory: V, CV, CVCV

• possible targets: kitty, go, whoa

• GOAL: in 3 months of therapy, the child will increase phonetic inventory to include at least 12 english phonemes within word approximations based on therapy data / parent report

combined approach - consideration 4

words that are important to the child (family names, favorite toys, food, or activities, functional words, routines)

• phonetic inventory: m, n, p, b, t, d, h

• syllable structure inventory: V, CV, CVCV

• possible targets: teddy, bubba, toe, pee-pee, poo-poo

• GOAL: in 3 months of therapy child will increase functional vocabulary to include approximations of at least 10 novel words as evidenced by therapy data & parent report

combination approach - consideration 5

word classes (nouns, verbs, prepositions)

• phonetic inventory: m, n, p, b, t, d, h

• syllable structure inventory: V, CV, CVCV

• possible targets: eat, in, out, up, down, top, hot

• GOAL: in 3 months of therapy child will increase vocab to include at least 10 novel VC and CVC action words given clinician model as needed based on therapy data / parent report

sampling activities - strategies

• model

• wait time

• sabotage

sample activities

• pretend play

• books

• songs & finger plays

• gross motor play

• sensory play

artic therapy is best for

children with articulation and/or motor based errors

main objective of artic therapy

to treat substitutions, omissions, and distortions, of each isolated error phoneme

artic therapy is also known as

phonetic / motor approach

artic therapy sequence/progression

treatment progresses in a specified sequence (isolation, words, sentences)

client does not progress to next level until mastery is achieved (80-90%)

artic therapy progression

sensory perceptual training → sound in isolation → nonsense syllables → words → phrases → sentences → spontaneous speech

purpose of sensory perceptual training (ear training)

teach auditory discrimination between correct vs incorrect forms of the target sound

build awareness of clients own correct vs incorrect productions

sensory perceptual training sample activities

client is asked to determine if a sound is a target sound or a different sound following clinician production

clinician produces words with target sounds; child is asked to detect if target sound is produced correct or incorrect

stage 1: isolation: purpose

elicit correct production of sound alone; not in combination w other sounds

*clinician uses strategies to elicit correct production

stage 1: isolation: sample activities

clinician prompts client to produce sound in isolation; client receives a sticker on a chart for each correct production

play a game that uses numbers ; client is required to say sound number of times indicated by game before taking a turn

Stage 2: nonsense syllables: purpose

elicit correct production of sound when embedded in varying vowel contexts

Step 2 : nonsense syllables: sample activities

client & clinician make artic cards with nonsense syllables child can add stickers or stamps to decorate the cards

stage 3: words: purpose & considerations

maintain production accuracy of the target sound in words

• word length: fewer syllables = easier word to produce

• sound position: initial position = easier to produce target sound

• syllable structure: open syllable structure = easier than closed syllable

• syllable stress: stressed syllable = easier to produce target sound

stage 3: words: sample activities

• card games

• gross motor

• board games

• token activity

stage 4: phrases: purpose

maintain production accuracy of the target sound in structured 2-4 word phrases

stage 4: phrases: sample activities

• client can answer basic questions that would elicit use of phrases with target sound

• can require child to use the same carrier phrase when naming pictures

stage 5: sentences: purpose & considerations

maintain production accuracy of the target sound in sentences of varying length & complexity

progress from simple/short sentences to complex sentences

progress from sentences w one instance of the target to multiple instances of the target

stage 5: sentences: sample strategies & activities

slow motion speech vs shadowing

correcting the clinician

stage 6: spontaneous speech: purpose

maintain production accuracy of the target sound in spontaneous conversation

stage 6: spontaneous speech: sample activities

• tell story using pictures w target sound

• games (table topics, would you rather)