Study Notes on Interventions for Speech Sound Disorders

Introduction

• Presenter: Sharon McLeod

• Seminar Title: 20 Interventions for Speech Sound Disorders: A Guide for Selection and Implementation

Overview of the Seminar

• Purpose: Introduce 20 evidence-based intervention approaches for treating speech sound disorders in children.

• Presenters: Chapter authors from Wilming's "Interventions for Speech Sound Disorders in Children, 2nd ed."

  • Authors receiving royalties vs. those with free interventions.

• Key Presenters:

  • Dr. Lynn Williams

  • Sharon McLeod

  • Rebecca Macaulay

  • Elise Baker

• Components of the Session:

  1. Overview of interventions with video demonstrations.

  2. Presentation of a clinical decision-making model by Dr. Lynn Williams.

  3. Development of a professional development program by Dr. Elise Baker.

Features of the Interventions

• Diverse range selected based on empirical evidence, efficacy, and widespread use.

• Applicable across different ages, severity levels, and populations.

• Presenters represent various countries: United States, Canada, UK, South Africa, New Zealand, and Australia.

Objectives of the Seminar

• Participants should be able to:

  • Identify unique features of at least 10 intervention approaches.

  • Select appropriate interventions using a clinical decision-making model.

  • Create a professional development plan to learn at least one new intervention.

• Definition of Childhood Speech Sound Disorders: Encompasses perception, storage, and production of speech, including:

  • Articulation

  • Phonology

  • Childhood Apraxia of Speech

  • Dysarthria

• Etiologies and Disabilities:

  • Conditions like cleft palate, cerebral palsy, and Down syndrome may co-occur.

20 Evidence-Based Intervention Approaches

Mineral Pairs Intervention (Elise Baker)

• Characteristics:

  • One of the oldest contrastive approaches.

• Involves pairing real words produced as homonyms by the child.

• Example: Child with aeropatinal venophanti mispronounces 'key' and 'tea' as 't'.

• Utilizes requests for clarification (e.g., "Did you mean nail or snail?").

• Two versions:

  1. Meaningful Minimal Pairs Intervention: Pragmatic cue introduced during the session.

  2. Perception-Production Minimal Pairs Intervention: Timing of cues differs.

• Activity Example: Children use fingers during practice to identify words.

Multiple Oppositions (Lynn Williams)

• Description:

  • Designed for children with limited sound inventories using one sound for multiple target sounds.

• Example: Child uses 't' for both 'key' and 'tea'.

• Method: Maps the child's sound system to adult phoneme system, focusing on reorganizing sound systems.

• Targets multiple sounds from a phoneme collapse to enlarge learning.

• Treatment Example: Engage children in activities distinguishing sounds (e.g., 'coo choo').

Complexity Approach (Michelle Morrissette)

• Goal: Improve intelligibility by selecting complex targets for treatment.

• Rationale: Based on observations of sound occurrences across languages; treating complex targets can lead to generalization across simpler targets.

• Example: Treating complex clusters like ‘fr’, expecting improvement in simpler sounds.

• Treatment Method: Encourage children to watch and imitate correct tongue positioning.

Cycles Phonological Pattern Approach (Raul Benezes)

• Overview:

  • Aims for intelligibility gains by targeting phonological error patterns one at a time.

• Can be used with various populations with concurrent issues.

• Combination of Targets: Focus on stimulable and non-stimulable targets based on individual needs.

• Methods: Incorporates auditory bombardment and phonological awareness activities.

• Example: Target sounds like 'hot dog', 'horse', and 'hand' during sessions.

Digital Interventions (Yvonne Ren)

• Definitions: Refers to methods of delivering interventions digitally, using apps and online tools.

• Advantages: Consistent presentation of stimuli, engaging graphics, customizable.

• Caution: Most apps lack rigorous testing; evidence for efficacy should be sought.

• Example Tools: Phoneme Factory Sound Sorter helps improve phonological awareness and phoneme representation.

Skip App (Lynn Williams)

• Development: Funded by NIH, translates research into practice.

• Functionality: Large database for generating contrastive word pairs across approaches.

• Flexibility: Works on iPads or via printout; includes numerous illustrations.

Speech Analysis and Interactive Learning System (Susan Rordashu)

• Purpose: Facilitates phonemic perception using real-world stimuli.

• Validated: Through studies, it demonstrates efficacy for improving both perception and production.

• Compatibility: Integrates with various linguistic approaches and available as an iPad app.

Stimulability Approach (Lynn Williams)

• Target Group: Young children (2-4 years) with limited phonetic inventories.

• Objective: Increase stimulability of both stimulable and non-stimulable sounds.

• Components: Uses character cards, leveraging alliterative sounds and interactive activities.

• Palindromes: Used at session end to measure generalization.

Enhanced Familiar Teaching with Phonological Emphasis Approach (Nancy Scheer)

• Focus: Combines phonological change with language for children under three.

• Components: Target words, phonetic awareness, interactive strategies for engagement.

• Goal: Promotes both language development and phonological skills through play and interaction.

Naturalistic Speech Recast Intervention (Steven Camerata)

• Method: Corrects child's speech initiations through adult modeling, reinforcing accurate productions.

• Applicability: Effective across diverse developmental contexts such as Down syndrome and autism.

• Benefit: Requires minimal direct intervention pressure; suitable for children resistant to traditional methods.

Morphosyntax Intervention and Alternating Speech Sound Intervention

• Target Group: Children with co-occurring speech sound and language impairments.

• Goals: Focus on tense and agreement markers, utilize cyclical scheduling.

• Teaching Methods: Engage through adaptive stories facilitating language and speech interaction.

Nonlinear Phonological Intervention (Unknown Presenter)

• Background: Developed in 1988, it analyzes speech at various levels from phonology to prosody.

• Policy: Individualized intervention plans based on strengths and needs assessment.

Articulation Interventions (Jonathan Preston)

• Definitions: Focus on phonetic aspects of speech with principles of motor learning.

• Instructions: Early treatment may involve auditory perception, later emphasizing generalization.

• Techniques: Include phonetic placings, imitation, and complex contexts.

Nuffield Center Dyspraxia Program (Pam Williams)

• Goal: Build speech skills targeting progressively complex sounds.

• Methodology: Engage children in drill-play activities with supportive feedback.

PROMPT (Unknown Presenter)

• Model: A sensory-motor cognitive-linguistic intervention based on dynamic systems theory.

• Discussion: Demonstrates effectiveness through studies in improving brain structure and function.

TEMPO - Rapid Syllable Transition Treatment (Unknown Presenter)

• Target: Childhood apraxia of speech focusing on articulatory features.

• Approach: Uses pseudowords to stimulate learning and research reinforces effectiveness.

Dynamic Temporal and Tactile Cueing (DTTC) (Yidi Strand)

• Goal: Improve accuracy through hierarchical modeling.

• Method: Focuses on movement rather than phonemes, involving proprioceptive strategies.

Biofeedback Interventions (Joanne Valent)

• Technology: Uses articulatory instruments like ultrasound and electropalatography for real-time feedback.

• Application: Helps children visually perceive articulation, aiding correction.

Speech Systems Approach to Dysarthria (Lindsay Pennington)

• Objective: Guide children in maintaining clarity in voice and speech rate.

• Method: Finding effective cues for each child to produce clear sounds over increasing cognitive loads.

Core Vocabulary Intervention for Inconsistent Phonological Disorder (Sharon Cosby)

• Focus: Aim for consistency rather than correctness in speech production.

• Approach: Family-centered, integrates caregiver participation to facilitate speech.

Integrated Phonological Awareness Approach (Bridget McNeil)

• Objective: Targets speech reduction, phonological awareness, and sound knowledge simultaneously.

• Goal: Use phonological awareness activities to strengthen children’s phonological representations.

Clinical Decision Making Model (Dr. Lynn Williams)

Introduction

• A framework for clinicians to assess interventions suitable for speech sound disorders.

  • Components:

  1. Child characteristics.

  2. Intervention characteristics.

  3. Clinician characteristics.

• Integration: Focus on the intersection of 3 characteristics for optimal decision-making in selecting interventions.

Child Characteristics

• Consider diversity in children with speech sound disorders.

• Use of the ICF CY framework to assess the whole child within personal contexts.

Intervention Characteristics

• Three aspects to consider:

  1. Developmental Level: Emerging, developing, or elaborating.

  2. Stage of Production: Planning, programming, or execution.

  3. Outcomes of Intervention: Speech production, perception, phonological awareness, oral language skills, literacy.

Clinician Characteristics

• Range from novice to experienced clinicians, affecting implementation fidelity and understanding of approaches.

• Therapy extenders like speech-language pathology assistants can also play a role.

Flowchart for Decision Making

• A detailed flowchart helps clinicians establish appropriate interventions based on the child's characteristics (e.g., age, phonetic inventory, stimulability).

• Examples:

  • Young child with few stimulable consonants recommended for the stimulability approach.

  • For phoneme collapses, consider multiple oppositions or the complexity approaches.

Professional Development Plan (Dr. Elise Baker)

Overview

• Focuses on empirical learning and implementation of interventions for better outcomes.

• Suggested actions for clinicians looking to learn and implement new approaches include:

  • Join seminars, observe peers, read critical literature, and utilize fidelity checklists to ensure proper implementation.

Logic Model Development

• Elements:

  • Resources: Time, motivation, and access to material; fidelity checklists are important.

  • Activities: Attending workshops, evidence-based meetings, observing practices.

  • Outputs: Quantifiable measures of activities (e.g., seminars attended, articles critiqued).

Measurable Outputs and Impacts

• The goal of a well-defined logic model translates into improved clinical outcomes, confidence, and reduced biases.

• By systematically achieving outcomes, clinicians can have a significant impact on children's speech and language development.

Conclusion

• Acknowledgment from all authors for attendance and attention.

• Reiteration of objectives and the hope that participants will make a meaningful difference for children and families facing speech sound disorders.

Introduction

• Presenter: Sharon McLeod

• Seminar Title: 20 Interventions for Speech Sound Disorders: A Guide for Selection and Implementation

Overview of the Seminar

• Purpose: Introduce 20 evidence-based intervention approaches for treating speech sound disorders in children.

• Presenters: Chapter authors from Wilming's "Interventions for Speech Sound Disorders in Children, 2nd ed."

  • Authors receiving royalties vs. those with free interventions.

• Key Presenters:

  • Dr. Lynn Williams

  • Sharon McLeod

  • Rebecca Macaulay

  • Elise Baker

• Components of the Session:

  1. Overview of interventions with video demonstrations.

  2. Presentation of a clinical decision-making model by Dr. Lynn Williams.

  3. Development of a professional development program by Dr. Elise Baker.

Features of the Interventions

• Diverse range selected based on empirical evidence, efficacy, and widespread use.

• Applicable across different ages, severity levels, and populations.

• Presenters represent various countries: United States, Canada, UK, South Africa, New Zealand, and Australia.

Objectives of the Seminar

• Participants should be able to:

  • Identify unique features of at least 10 intervention approaches.

  • Select appropriate interventions using a clinical decision-making model.

  • Create a professional development plan to learn at least one new intervention.

• Definition of Childhood Speech Sound Disorders: Encompasses perception, storage, and production of speech, including:

  • Articulation

  • Phonology

  • Childhood Apraxia of Speech

  • Dysarthria

• Etiologies and Disabilities:

  • Conditions like cleft palate, cerebral palsy, and Down syndrome may co-occur.

20 Evidence-Based Intervention Approaches

Minimal Pairs Intervention (Elise Baker)

• Characteristics: One of the oldest contrastive approaches.

• Method: Involves pairing real words produced as homonyms by the child.

• Example: A child might produce 'key' and 'tea' both as 'tea'. The clinician shows both pictures to highlight that the words have different meanings.

• Activity Example: Clinician asks, "Did you mean nail or snail?" when the child omits the $/s/$ in 'snail'.

• Two versions:

  1. Meaningful Minimal Pairs Intervention: Pragmatic cue introduced during the session.

  2. Perception-Production Minimal Pairs Intervention: Timing of cues differs.

Multiple Oppositions (Lynn Williams)

• Description: Designed for children with limited sound inventories using one sound for multiple target sounds (phoneme collapse).

• Example: If a child uses $/t/$ for 'key', 'sea', 'she', and 'tea', the clinician pairs 'tea' against 'key', 'sea', and 'she' simultaneously in therapy.

• Method: Maps the child's sound system to adult phoneme system, focusing on reorganizing sound systems.

• Treatment Example: Engaging in activities where the child distinguishes sounds in a group, such as 'coo', 'choo', and 'too'.

Complexity Approach (Michelle Morrissette)

• Goal: Improve intelligibility by selecting complex targets for treatment.

• Rationale: Based on observations of sound occurrences across languages; treating complex targets can lead to generalization across simpler targets.

• Example: Treating the complex cluster $/str/$ (as in 'string'). Success with $/str/$ often leads to the spontaneous emergence of simpler clusters like $/st/$ or $/tr/$ and singletons like $/s/$.

• Treatment Method: Encourage children to watch and imitate correct tongue positioning for these high-level sounds.

Cycles Phonological Pattern Approach (Raul Benezes)

• Overview: Aims for intelligibility gains by targeting phonological error patterns one at a time.

• Method: Can be used with various populations with concurrent issues.

• Combination of Targets: Focus on stimulable and non-stimulable targets based on individual needs.

• Example: A cycle might target Final Consonant Deletion for 2 weeks using words like 'bat', 'cup', and 'mad', followed by a cycle targeting $/s/$ clusters.

• Methods: Incorporates auditory bombardment and phonological awareness activities.

Digital Interventions (Yvonne Ren)

• Definitions: Refers to methods of delivering interventions digitally, using apps and online tools.

• Advantages: Consistent presentation of stimuli, engaging graphics, customizable.

• Caution: Most apps lack rigorous testing; evidence for efficacy should be sought.

• Example Tool: Phoneme Factory Sound Sorter, which uses games to help children categorize sounds and improve phoneme representation.

Skip App (Lynn Williams)

• Development: Funded by NIH, translates research into practice.

• Functionality: Large database for generating contrastive word pairs across approaches.

• Flexibility: Works on iPads or via printout; includes numerous illustrations.

• Example: Using the app to instantly generate a list of contrastive picture cards for a child working on $/k/$ versus $/g/$ in the final position of words.

Speech Analysis and Interactive Learning System (SAILS) (Susan Rordashu)

• Purpose: Facilitates phonemic perception using real-world stimuli.

• Validated: Through studies, it demonstrates efficacy for improving both perception and production.

• Example: A child listens to various recordings of the word 'lake' and 'wake' (some from other children, some from adults) and must correctly identify which is which.

• Compatibility: Integrates with various linguistic approaches and available as an iPad app.

Stimulability Approach (Lynn Williams)

• Target Group: Young children (2-4 years) with limited phonetic inventories.

• Objective: Increase stimulability of both stimulable and non-stimulable sounds.

• Components: Uses character cards and alliterative sounds.

• Example: Using a "Silly Snake" card for the sound $/s/$ and a "Munching Mike" card for $/m/$ to engage the child in imitating the sounds along with a specific hand gesture.

• Palindromes: Used at session end to measure generalization.

Enhanced Familiar Teaching with Phonological Emphasis Approach (Nancy Scheer)

• Focus: Combines phonological change with language for children under three.

• Components: Target words, phonetic awareness, interactive strategies for engagement.

• Goal: Promotes both language development and phonological skills through play.

• Example: While popping bubbles, the clinician emphasizes the sound $/p/$ and the word 'pop' repeatedly to encourage both language use and specific sound production.

Naturalistic Speech Recast Intervention (Steven Camerata)

• Method: Corrects child's speech initiations through adult modeling, reinforcing accurate productions without making the child repeat it.

• Applicability: Effective across diverse developmental contexts such as Down syndrome and autism.

• Example: If a child says "The tat is big," the clinician immediately responds, "Yes, the cat is very big!" emphasizing the correct $/k/$ sound.

Morphosyntax Intervention and Alternating Speech Sound Intervention

• Target Group: Children with co-occurring speech sound and language impairments.

• Goals: Focus on tense and agreement markers, utilize cyclical scheduling.

• Teaching Methods: Engage through adaptive stories facilitating language and speech interaction.

• Example: Using a story to target the plural $/s/$; the clinician points to "one cup" then "two cups," focusing on the final $/s/$ sound as both a speech and a grammar target.

Nonlinear Phonological Intervention (Unknown Presenter)

• Background: Analyzes speech at various levels from phonology to prosody (word structure).

• Policy: Individualized intervention plans based on strengths and needs assessment.

• Example: For a child who only produces single syllables (CV), the intervention might focus on expanding to two-syllable words (CVCV) like 'mummy' or 'daddy' to improve prosodic structure.

Articulation Interventions (Jonathan Preston)

• Definitions: Focus on phonetic aspects of speech (how to move the articulators).

• Instructions: Early treatment may involve auditory perception, later emphasizing generalization.

• Techniques: Include phonetic placings, imitation, and complex contexts.

• Example: Using a tongue depressor to show the child exactly where the tongue should touch the roof of the mouth to produce a $/l/$ sound.

Nuffield Center Dyspraxia Program (Pam Williams)

• Goal: Build speech skills targeting progressively complex sounds starting from single sounds.

• Methodology: Engage children in drill-play activities with supportive feedback.

• Example: A child moves from producing $/p/$ in isolation, to $/pi/$ (CV), to $/pig/$ (CVC), building the motor program step-by-step using specific picture icons.

PROMPT (Unknown Presenter)

• Model: A sensory-motor cognitive-linguistic intervention using tactile-kinesthetic cues.

• Discussion: Demonstrates effectiveness in improving brain structure and function.

• Example: The clinician uses their hands on the child's face to manually guide the jaw and lips into the correct position for the sound $/m/$ (lips closed) and $/u/$ (lips rounded).

TEMPO - Rapid Syllable Transition Treatment (ReST) (Unknown Presenter)

• Target: Childhood apraxia of speech focusing on articulatory features.

• Approach: Uses pseudowords to stimulate learning without the interference of old habits.

• Example: The child practices saying non-sense words like $/ba.da.pi/$ or $/me.ko.tu/$ while varying the stress (e.g., BA-da-pi vs ba-DA-pi).

Dynamic Temporal and Tactile Cueing (DTTC) (Yidi Strand)

• Goal: Improve accuracy through hierarchical modeling.

• Method: Focuses on movement rather than phonemes, involving proprioceptive strategies.

• Example: The clinician and child produce the word simultaneously while the child watches the clinician's mouth ("Look at me, do what I do"), slowly fading the support as the child gains independence.

Biofeedback Interventions (Joanne Valent)

• Technology: Uses articulatory instruments like ultrasound and electropalatography (EPG) for real-time feedback.

• Application: Helps children visually perceive articulation, aiding correction.

• Example: An ultrasound probe is held under the child's chin so they can see the real-time movement of their tongue on a screen while trying to produce the tricky $/r/$ sound.

Speech Systems Approach to Dysarthria (Lindsay Pennington)

• Objective: Guide children in maintaining clarity in voice and speech rate.

• Method: Finding effective cues for each child to produce clear sounds over increasing cognitive loads.

• Example: Teaching a child with dysarthria to use the cue "Big Mouth" (over-articulation) or to take a deep breath before speaking to increase loudness and clarity during a conversation.

Core Vocabulary Intervention for Inconsistent Phonological Disorder (Sharon Cosby)

• Focus: Aim for consistency rather than correctness in speech production.

• Approach: Family-centered, integrates caregiver participation.

• Example: Selecting 50 functional words (e.g., 'Mommy', 'Toilet', 'Help') and teaching the child to produce them the same way every time, even if the production isn't 100% correct.

Integrated Phonological Awareness Approach (Bridget McNeil)

• Objective: Targets speech reduction, phonological awareness, and sound knowledge simultaneously.

• Goal: Use phonological awareness activities to strengthen children’s phonological representations.

• Example: While practicing the $/b/$ sound, the child also completes an activity where they identify all the pictures on a page that start with the sound $/b/$ (e.g., 'ball', 'bat', 'bear').

Clinical Decision Making Model (Dr. Lynn Williams)

Introduction

• A framework for clinicians to assess interventions suitable for speech sound disorders.

• Components:

  1. Child characteristics.

  2. Intervention characteristics.

  3. Clinician characteristics.

• Integration: Focus on the intersection of 3 characteristics for optimal decision-making.

Child Characteristics

• Consider diversity in children with speech sound disorders.

• Use of the ICF CY framework to assess the whole child within personal contexts.

Intervention Characteristics

• Three aspects to consider:

  1. Developmental Level: Emerging, developing, or elaborating.

  2. Stage of Production: Planning, programming, or execution.

  3. Outcomes of Intervention: Speech production, perception, phonological awareness, oral language skills, literacy.

Clinician Characteristics

• Range from novice to experienced clinicians, affecting implementation fidelity.

• Therapy extenders like speech-language pathology assistants can also play a role.

Flowchart for Decision Making

• A detailed flowchart helps clinicians establish appropriate interventions.

• Examples:

  • Young child with few stimulable consonants recommended for the stimulability approach.

  • For phoneme collapses, consider multiple oppositions or the complexity approaches.

Professional Development Plan (Dr. Elise Baker)

Overview

• Focuses on empirical learning and implementation of interventions for better outcomes.

• Suggested actions: Join seminars, observe peers, read critical literature, and utilize fidelity checklists.

Logic Model Development

• Elements:

  • Resources: Time, motivation, and access to material.

  • Activities: Attending workshops, evidence-based meetings, observing practices.

  • Outputs: Quantifiable measures of activities (e.g., seminars attended).

Measurable Outputs and Impacts

• Goal: Improved clinical outcomes, confidence, and reduced biases.

Conclusion

• Acknowledgment from all authors for attendance.

• Hope that participants will make a meaningful difference for children and families.