Phonological Intervention Strategies Pt 1

Phonological Interventions, sound contrast treatments

Syllableness:

• omitted vowels and diphthongs, monosyllablic productions

• use two-syllable compound words; cowboy, hotdog

Singleton consonants in words:

• prevocalic /p,b,m,w/

• postvocalic voiceless stop

• pre & postvocalic consonant: pup, pop

• intervocalic consonants: apple

With phonological intervention, we focus on intelligibility first, and then focus on developing appropriate patterns. T/F

T

Context utilization approaches: 3

• premise; speech sounds are not produced in isolation, but in syllable based contexts

• these contexts can be used to facilitate correct sound usage

• target sound elicitation initiated in contexts in which the error can be produced correctly

Context utilization approaches sequence: 4

• /s/ error and word watch produced correctly, say target in slow motion ex) watchsun

• putting equal stress on both syllables, primary stress on first syllable and then second ex) watchsun

• say “watchs” with a prolonged /s/

• short sentences with facilitative context helps with phonological awareness, ex) watch, sun will burn you

stimulability approach def:

• stimulable therapy improves learning stimulable sounds, which is having kids repeat a sound you make

• nonstimulable sounds will likely not be learned independently and require intervention

When should we use the stimulability approach?

• young children (2-4) with functional speech sound disorders

• small phonetic inventory

• child not stimulable for many/all sounds in phonetic inventory

• appropriate for older children (5-7) with CAS

• ssd found in people with developmental disabilities, cleft lip/palate, hearing loss

How to choose targets in stimulability approach?

• broad approach - all consonants are targeted in each session (non stim and stim)

• incorporating stim sounds is done to achieve early tx success

• sounds taught in isolation or CV contexts

• stim probe is administered to determine stim/nonstim sounds

• * a sound is considered stimulable if it’s produced with at least 10% accuracy or produced correctly twice

What is the implement approach?

• teach child sound

• tx is brief at this level (12 sessions recommended)

• after 12 sessions, use a new intervention approach

• this approach is meant to be temporary

List the procedures for the stimulability approach:

• directly target nonstim sounds

• make targets the joint focus of attention

• associate speech sounds with hand/body movements

• associated speech sounds with packaged characters

• encourage vocal practice

• ensure successful communicative attempts

Core vocabulary approach def:

• looking at small list of vocabulary that is meaningful for client

• words used across different contexts

• can be used for motor speech (artic), CAS, and phonological interventions

• uses a list of functional vocab words and adds more words weekly/every two weeks

• different from core vocab, discussed in AAC as picture symbols are not required

When should we use the core vocabulary approach?

• children with severe but inconsistent speech sound productions

• speech characterized by variable in productions or phono features across contexts and in same context

• tx of choice for children with inconsistent speech sound productions that resist the traditional treatments

• diff sounds substituted across productions & less than 40% variable productions

• theory is that errors reflect deficits in phoneme selection and sequencing

• goal is to improve consistency of whole word productions while addressing speech sound deficit

What is the core vocabulary approach procedure?

• specific to child

• parents, child, SLP choose list of approx 50 “functional words” such as family names, places, foods, games, etc

• 10 words chosen weekly - clinician prompts or teaching sound by sound (devel errors are fine)

• words practiced weekly as hw

• consistency in production is more important than correct productions at this stage

• after 2 sessions, child is asked to produce entire set of words 3X

• inconsistent words stay on the list, consistent words produced are taken off

• 10 more words chosen randomly

signs of CAS:

• inconsistent errors

• inc errors with inc length

• poor sequencing

• inability to imitate sounds, better than spontaneously than in imitation

• general oromotor diff

• possible groping, silent posturing

• prolongations and repetitions of speech sounds

• inapprop prosody, slow DDK rates

signs of inconsistent phono disorder:

• inconsistent errors

• inc errors with inc length

• sub of phonemes rather than errors of order

• better in imitation than in spontaneous production

• oromotor skills WNL

• no groping or silent posturing

• no prolongations and or reps

• appropriate prosody and DDK rates

main differences with CAS and signs of inconsistent phono disorder:

what is modified feedback?

• comes from a mechanical/electronic device (not from clinician)

• spectrograms

• electropalatography

• ultrasound

modified feedback training: spectrograms

• visual feedback approach

• history

• XXXX

modified feedback training: electropalatography

• retainer looking thing

• tongue hits certain points on retainer, marks where tongue hit

• visual approach

modified training feedback: ultrasound

• ultrasound wand that is used from the outside, under chin

• tracks tongue movement in mouth

• visual approach

Why is modified feedback useful?

• could be best for clients who have residual and persistent speech sound errors

• clinician training/access to equipment is key

• some supporting evidence for approaches

difference between speech disorder (artic) and phonological disorder:

• speech disorder is motor based, focus on teaching physical aspects of producing sound, phonetically based approach

• phonological disorders are linguistically based, focused more on the rules of language, sound contrasts and patterns, treatment focuses on reorganizing child’s phonological system, multiple errors

phonological treatment tx focus:

• est of adult phono system:

• phonemic inventory (sounds used to contrast meaning)

• allophonic rules (use of different allophones in diff contexts)

• phonotactic rules (how sounds are used to form syllables and words)

phonological intervention tx targets:

• patterns reflected in sound errors

• individ sounds called exemplars are chosen to facilitate generalization to other sounds with same features

• tx designed to facilitate acquisition of appropriate sound contrasts, rules or sequences

phonological intervention tx procedures:

• est sound and feature contrasts

• replace error patterns with appropriate phono patterns

• these strategies focus on (eliminating homonyms, est new syllables and word shapes of new sounds or sound classes)

there are two branches of phonological interventions. T/F

• T

• phonological pattern interventions

• sound contrast treatment strategies

sound contrast tx strategies includes:

• distinctive feature approach

• contrast ordering

• minimal and maximal pairs

• complexity approach (type of maximal opposition contrast)

• metaphon therapy

distinctive feature approach:

• dont see much anymore

• kind of like the mother of sound contrast

• goal of tx is to est feature contrasts that are lacking in clients repertoire

• focus is est of a sound feature through teaching a sound containing that feature

distinctive feature tx strategies:

• selection of target sounds shift from isolated phonemes to sound classes

• clinician focus on features common to several phonemes and teaches a feature common to a class of sounds (not learning sounds individually at a time)

• opposite of learning unrelated sounds one at a time

• emphasis on facilitating generalization

• emphasis placed on phono contrasts as basis for acquiring

steps of distinctive feature approach:

• discussion of words

• discrimination testing and training

• production training

• carryover training

step one of distinctive feature training:

• discussion of words:

• select minimal pair: tea/key

• probe for understanding of lexical terms (which one unlocks a door, which one is a drink)

• criteria is 100% understanding of the word pair 1X

step two of distinctive feature training:

• discrimination testing and training:

• probe to see if child can perceive the feature contrast

• slp presents word pair

• child is instructed to point to the picture the clinician named

• criteria is we need 7/10 correct responses

step three of distinctive feature training:

• production training:

• child instructed to say the target word

• slp points to the picture of the word

• child should always be able to produce one word of the pair

• correct production of an error sound may not be required at the beginning of this stage

• use phoneme elicitation strategies and continue step 3 until correct production

step four of distinctive feature training:

• carryover training:

• once child is producing the target at word level, word placed in longer/complex linguistic environments

• add an article

• 2 word expression (see key)

• 3 word carrier phrase (I see key)

• criteria is that slp selected goal mastery is 80%

contrast order for stop-nasal sound class:

diagram in notes

contrast ordering for continuants:

diagram in notes

contrast ordering for semivowel sound:

diagram in notes

contrast ordering for sibilant (hissing or sharp) sounds:

diagram in notes

4 steps in paired opposition/contrast tx:

• sound/word pairs introduced through pictures/words/objects

• clinician names object, client identifies

• roles then reverse, client makes request/labels, clinician identifies

• client is rewarded by clinicians selection of the correct stimulus!

paired oppositions: minimal and maximal pairs def:

• phono approaches

• phonemic contrasts (errored vs correct) targeted that signal diff btw 2 words

• no explicit instruction on artic placement or sound production is given

• minimal opposition, differ only in one feature of sound ( tu vs du)

• maximal opposition, word pairs differ in several features (sad vs bad) → place, manner, voicing

when should i choose minimal or maximal opposition tx?

• choose minimal for more fine grained tx, client has few phono errors, primarily sound subs

• choose maximal for client with larger # of errors, omissions and distortions

minimal pair contrast therapy:

• set of words that differ by single phoneme

• tx pairs words produced as homonyms (best/vest, always best)

• word pairs differ by one phoneme with one or more feature difference

• selected pairs may also differ by the presence or absence of phonemes

target group for minimal pairs:

• child with mild-mod-severe phono pattern

• child w phono impairment and cooccuring medical condition

• phono pattern such as stopping and CS resulting in homonymy

• children should be 3+

• stimulable for target phonemes

• able to imitate verbally

• follow directions

• engage in drill play

when is minimal pairs therapy not appropriate?

• severe or profound phono impairment involving large collapses of contrasts, lots of phono processes

• diff with word structure (2, 3 word syllables)

• WSD

• assoc phono and motor speech diffs, doesnt target how to produce sound

5 word pairs are enough for minimal pairs tx. T/F

T

steps for minimal therapy:

• familiarization (showing picture card..)

• listening (listen and pick up, picture cards,)

• listening (perceptual training of minimal pair words)

• production - imitation of tx words

• production- spontaneous naming of tx words

• production- contrasting minimal pair words

• production- practice minimal pairs in phrases, sentences, conversation

maximal oppositions contrast therapy def:

• theory is making contrasts btw sounds more complex and focusing on later developing may improve learning and generalization

• word pairs teach 2 new sounds differing in place, manner, and voicing (maximal oppositions)

• 2 new sounds should also include a major class distinction (obstruents vs sonorants)

• example /s/ vs /r/

• this follows the same therapy steps as minimal pairs

target group for maximal oppositions:

• children with mild-mod-severe phono pattern disorder

• children with large number of phono errors w restricted phonemic repertoires

• phono patterns with omissions and distortions

complexity approach is a type of maximal oppositions contrast tx. T/F

• T

• it is appropriate for children with multiple errors

• treat the later and most complex sounds first

• targeting sounds with greater complexity is a more efficient way to treat generalization

• proceed with caution tho, some disagreement in literature

complexity approach tx hierarchy:

• later devel contrasted w early devel sounds

• nonstimulable contrasted w stimulable sounds

• clusters contrasted w singletons

• difficult to produce contrasted w easy to to produce

complexity approach target selection:

• phonemic target selection: teach phones (individ sounds used more that twice) that are absent from phonetic inventory

• phonemic target selection: teach phoneme contrasts that contain more complex phonemes (like teaching affricates to improve fricatives)

• syllabic target selections: complex clusters w smaller sonority differences

complexity approach therapy steps:

• pretreatment phono analysis - obtaining baselines on all singletons consonants, onset clusters, word position is single word measures

• imitation phase: train tx targets for 7 sessions or until 75% accuracy across two consecutive sessions

• monitor for generalization: monitor production of singletons and onset clusters in multiple targets and relevant word positions using single word probe measures

• spontaneous phase: elicit productions wo a SLP model until accuracy reaches 90% across three consecutive sessions or for 12 sessions total

multiple opposition contrast therapy:

• this is an extension to minimal pair contrast (like maximal opposition/complexity approach)

• designed for children with contrast collapses (children who produce multiple adult phonemes as a single sound)

• differs from minimal pairs in that multiple sounds are contrasted simultaneously in therapy with the child’s error

target group for multiple opposition:

• children 3-6

• mod-severe phono pattern disorder

• at least 6 sounds in error across 3 different manners

• children with phono impairment and co-occuring medical conditions

• phoneme collapses, syllable structure errors, and or many phono sub patterns

what are the phases of multiple oppositions?

• familiarization and production of contrasts

• production of contrasts and interactive play

• production of contrasts within communicative contexts

• conversational recasts

what is metaphon therapy?

• focuses on metaphonological awareness

• teaches children to recognize + manipulate sounds

• ability to ay attention to and reflect on the phonological structure of language

• improve cognitive awareness

• includes the minimal and maximal pairs therapy

pros and cons of metaphon therapy:

• cons

  • length of time to teach concepts or properties of sounds

  • systematic process working through phases and levels

• pros

  • raises awareness of phonological structures of a language

  • targets process interfering with intelligibility

  • est a shared vocab about characs of target sound

• awareness→apply to speech→ identification→production