Speech Sound Disorders Final Review Flashcards

Speech Sound Disorders Final Review

Articulation Therapy - Traditional and Behavioral

Traditional Van Riper Method

• Still used in most aspects.
• Key Points:
  • Focuses on phonetic difficulties, not phonemic. The child can’t produce specific sounds.
  • Trains only one sound at a time, not classes of sounds.
• Main Emphasis:
  • Listening skills.
  • Phonetic placement: Teaching the proper position of the articulators.
  • Drill work that builds to larger units.
• How to Select Targets (CFSIM):
  • Chronological age and sounds appropriate for that age.
  • Frequency of use of sound in the language.
  • Stimulability.
  • Inconsistency of errors.
  • Minor errors are remediated first (distortions instead of deletions).
• Procedures to Correct Sounds:
  • Ear Training (Not typically used now):
    • Listening tasks to develop an auditory model as an internal representation (identification, isolation, stimulation, discrimination).
  • Production Training (Sound Establishment):
    • The focus is to evoke the new sound pattern to replace the old pattern.
  • Stabilization of Sound:
    • Stabilize the sound that the child can produce at the easiest level.
    • Move one level at a time until consistency is achieved at that level.
    • Progress from nonsense syllables in isolation to real syllables.
  • Transfer and Carryover:
    • Taking the speech behavior from the therapy setting to outside environments.
  • Maintenance

Behavioral Methodology

• Consequence of a behavior affects the rate of the behavior.
• Antecedent, Behavior, Consequence (ABC):
  • Antecedent: Events that occur before a behavior.
    • Eliciting a response via stimuli, prompts, and cues.
  • Behavior: Anything a person does that can be observed and measured.
    • Example: Pushing a sibling.
  • Consequence: Something that follows a behavior.
    • Positive Reinforcement:
      • Adding a stimulus to increase/strengthen a behavior.
      • Example: Giving a high five or tactile object.
      • Fulfills a need of the child.
    • Negative Reinforcement:
      • Removing a stimulus to increase/strengthen a behavior.
      • Example: Removing homework after the student accomplishes a lot in class.
      • Eliminates a negative when a child produces the correct response.
• Reinforcement Schedules:
  • Variable = average, changes from time to time; fixed = not changing.
  • Ratio = count/responses; interval = time.
  • Fixed Ratio:
    • Reinforcement after a set amount of responses.
    • Example: FR3 - need 3 correct responses to get a reinforcer.
  • Variable Ratio:
    • Reinforcement after a variable amount of responses.
    • Example: Slot machines.
  • Fixed Interval:
    • Reinforcement after a set amount of time.
    • Example: Every 2 minutes, you get a reinforcer (FI2).
  • Variable Interval:
    • Reinforcement after a variable amount of time. (VI3 or VR3 but an average of 3, not every time).
• ABC principles are rooted in behaviorism; rewards like stickers are common.

Phonological Disorders Remediation

Steps to Intervention:

1. Thorough assessment of the phonological system, with well-written rules that clearly describe the sound system.
2. Identification of target processes (when appropriate) and criteria for prioritizing phonological processes for intervention. Well-written goals of intervention.
3. Identification of target sounds within a selected process, focusing on sounds likely to have the most impact and generalization.
4. Development of stimulus materials (word selection) for target sounds.
5. Development of language-based activities (treatment methodology) that use appropriate stimulus materials, emphasize generalization, are motivating, and improve speech production.

Analysis and Assessment Factors

• Questions to Ask as the SLP:
  • Is it age appropriate?
  • Are they disordered or delayed?
  • Intelligibility.
  • Parents, history, etc.
  • Does the child meet criteria?
  • Consistent patterns?
  • Structural, functional, cognitive factors.
  • Stimulability.
  • Phonetic? Phonemic? Both?

Premise of Phonological-Based Therapy

• Children developmentally organize sounds in systems of contrasts.
• There is a developmental sequence to how they organize contrasts.
• Start with phonetic techniques when a child can’t make a sound, before moving on to phonemic contrasts.
• The aim of therapy is to facilitate cognitive reorganization of the child’s phonological system.

Principles of Phonological Therapy

• Aims are defined by assessment; assessment determines what will be worked on.
• There are rule-bound (phonological processes) errors in the system.
• Communication is the most important aspect.
• Building of sound contrasts.
• Treatment is based on a phonological assessment, and the goals are defined by the phonological assessment.
• There are regularities in the child’s pronunciation patterns; there is order in the disorder.
• The function of phonological organization is communication.
• Therapy is aimed to build up a more adequate system of sound contrasts and sound structures.
• Therapy establishes changes in the child’s pattern through the use of natural classes of contrastive phonemes and structures.

3 Principles of Phonologically Based Therapy

(A test for whether a phonologically typical pattern is being followed)

1. Principle of rule-governed knowledge
   • Children’s errors are rule-bound. If children are going to learn the phonological rules of the language, they must be presented with circumstances that allow them to discover those rules.
2. Principle of communicative function
   • The child has to learn that sound production affects their communication.
   • For therapy to be successful, children must be given opportunities to see the relationship between appropriate phonological output and effective communication.
3. Principle of treatment by sound class
   • Target errors at the rule level (not single isolated words).

Difference Between Traditional and Phonological Based Therapies

• Emphasis on the phonological rule, not individual sounds.
• Rule taught in the context of contrast.
• Historically, treatments that focus on motor production of speech sounds are called articulation approaches; treatments that focus on the linguistic aspects of speech production are called phonological/language-based approaches.
• Phonological therapy emphasizes the phonological rule, not individual sound.
  • Example: the child can put something for the $/s/$ cluster reduction; it doesn’t need to be an $/s/$ at first but to break the rule by teaching them that something else needs to be there, that it needs to be a different sound to distinguish 2 words.
• Not as worried about the sound but about the rule, which will affect their perception.
• Phonological therapy teaches rules in the context of contrast.
• In both approaches, you may start by targeting sounds the child doesn’t have in their phonetic inventory.
  • Start with the sounds and then move into words (ex. /r/-“early”).

Capability-Focus; Shriberg Kwiatkowski Article

• Capability
  • Child’s potential for speech change.
    • What is their prognosis? How do we teach at the right level?
  • Cognition
    • Any intellectual disabilities can affect how successful therapy will be.
  • Motor skills/oral structures
    • Do they have a cleft palate, tongue tie, etc.
    • Do they have/need AAC devices?
  • Linguistic/language level
    • Tied to cognition.
  • Socioemotional capacity
    • What else is going on in their life?
• Focus
  • Attention, Motivation, Effort, Desire to change, Distractibility.
  • Active involvement of the child in the learning process is the single most important variable in improvement.
  • Emphasis is on the child as a learner, secondarily details of what is to be learned.
  • Must put the organism in a learning mode (happy, engaged, children and adults learn (ASHA)).
  • Must own the child for them to learn.
  • Mutual respect/compassion.
  • Emphasis is on the child as a learner; secondarily on what is being learned.
  • What do you need to change or manipulate to change the situation?
  • Increase focus by changing the task.
  • More motivating.
  • More reinforcement.

Prioritizing Phonological Processes for Remediation

• Know this, and what should be prioritized, for example, fronting over liquids, based on intelligibility and developmentally appropriate.
• Questions for Deciding What to Start With:
  • Prioritize phonological processes that should have disappeared (what is developmentally appropriate).
  • One at a time? Two at a time?
  • Target to a certain criterion? (once they get to this
    ___ then therapy is done).
  • Cycles? Do not use unless the child is unintelligible.
  • What order do you want to target processes? (for example, fronting over liquids).
• Things to Consider:
  • What is the effect on intelligibility? (phonological processes that affect intelligibility the most - think about the report, final consonant deletion affects intelligibility a TON).
  • Are they stimulable? Can they say the sounds?
  • What are the sounds in important words (like their name)?
  • What other sounds are in their repertoire?

To NSOME or Not to NSOME? (Non-speech oral motor exercises)

• What is NSOME?
  • Any technique that is supposed to influence the development of speaking, but the child isn’t required to produce actual speech sounds (tongue lifts to make the letter t).
  • Examples: blowing, tongue push-ups, pucker smile productions, tongue wags, big smiles, puffing cheeks, blowing kisses, tongue curling.
• NOT EFFECTIVE. WHY?
  • NSOME is based on strength; we use very little strength to produce speech.
    • We’re also not using these exercises in a way that would build strength anyway (not working to exhaustion) (ex: 10 tongue lifts).
  • Part to whole: you need to have context and an end goal - we can’t teach speech by breaking it into parts.
  • Not related to speech: these kids are using other parts of the brain not related to speech when they do these, so it's not relevant to the neurology, and they won’t learn speech from them.
  • No efficacy in research.

“Cookie Cutter” Hierarchies for Treatment Targets

• Target the processes that are suppressed earlier (Hodson + Paden approach).
  • Syllable reduction processes.
  • Final consonant deletion.
  • Stopping.
  • Liquids (always last).
• Target processes with extensive homonymy.
  • Ex. lots of things turn into a /t/.
• Example: Final consonant deletion + fronting + liquid gliding.
  • What is most stimulable + what affects intelligibility?
• Which sounds in the process do we target?
  • Are they stimulable for the sound?
  • Is it visible/ how easy is it to describe production?
  • How frequently does the sound occur?
  • Where is the sound in the word? - End of the word to get to the initial position in another word= facilitating environments ex. Car race - untrain the brain and retrain it.
  • What words to start with? Words are the starting point when you have the sound but don’t start with words that have the sound with more than one simple syllable shape and then increase the complexity aka words that are semantically familiar for the kids.

How to Write a Goal and Objective

Content, Behavior, Condition, and Criteria.

• Do not write methodology in objectives.
• Objective → not eliminating - what’s the positive? What are you going to do? Write down exactly what you want to see and hear.
• SMART GOALS
  • S - Specific → make sure it’s specific!
  • M - Measurable
  • A - Attainable
  • R - Relevant
  • T - Timely
• Example Goals from Scott (more on Canvas):
  • Speech and Language: Given picture prompts and phonetic cues, xxx will be able to produce age-appropriate sounds (including liquids) in words, phrases, and spontaneous speech 95% of the time.
  • By December 2019, given structured tasks and spontaneous speech, xxxx will produce all rhotic ($/r/$ and $/r/$ variants) sounds correctly in words, phrases, and sentences with 95% accuracy across 4 therapy sessions.
  • By 1/2020, Given picture prompts and phonetic cues, xxxx will produce age-appropriate speech sounds including rhotics ($/r/$, $/er/$. and all variants) with 95% accuracy in words, phrases, and spontaneous speech
  • Speech and Language: Given picture prompts and phonetic cues, xxx will be able to produce age-appropriate sounds including sibilants ($/s/$, $/z/$, $/sh/$, $/ch/$, dz) in words, phrases, and spontaneous speech 95% of the time.
  • Speech and Language: Given picture prompts and phonetic cues, xxxx will be able to produce age-appropriate sounds including liquid sounds ($/r/$, $/er/$) in words, phrases, and spontaneous speech 95% of the time.
• Condition
  • Describe the circumstance, situation, setting.
  • Ex. “Given a structured picture ask with /r/ words in a classroom setting with an AAC device”
    • AAC device list of 20 words classroom setting
    • Cards
    • Structured activities
    • Etc.
  • Content
    • Subject matter
    • What will they learn?
    • Ex. fronting, velars, FCD
    • Be very specific.
    • Written so that anyone would know what the child is working on
  • Behavior
    • Observable action (behavior).
    • Must be a behavior (What do they produce, point to, say, write, orally define, imitate).
    • Not behaviors → understand, learn, attend, comprehend (non-observable).
  • Criteria
    • Level of acceptable performance - what is the level of acceptable performance?
    • Include accuracy.
    • Obligatory contexts? (Ex. within one minute of adult prompting, in conversational speech…).
    • Measurable indication of whether the student has met the goal.
    • Ex. by Nov 15 2023, given structured activities, XX will produce velar $/k/$, $/g/$, and $/ng/$ in single words in 9 out of 10 trials over 4 sessions.

Talking with Parents About the Phono Disorder and Setting Up Home Programs

• Model after therapy.
• Good communication.
• Give updates.
• Be honest.
• Restate their words.
• General Q’s.
• Homework → Few min successful show off.
  • Only give homework that the child can do successfully.
  • If it isn’t working with the parents, give home practice the child can do independently.
  • Invite the parent to participate in a zoom session, or come to school early so you can practice together.
  • Be very specific (write scripts the parents can use for cueing).

Metaphon Therapy

• The ability to think about and reflect on the nature of phonology.
• Based on the notion that children with phonological disorders do not perform well on metaphonological tasks.
• The children fail to realize the communicative significance of the phonological rules.
• The children fail to realize that they have a phonological disorder.
• Target is preschool children, limited phonetic inventories.
• Moderate to severe phonological disorder with 2 to 3 processes.
• Selecting Targets for Metaphon Therapy
  • Age appropriateness
  • Inconsistent use of process would be given priority to target
  • Intelligibility; bigger impact on intelligibility, higher priority
  • Stimulability; if sound is stimulable, higher priority
• Prerequisites for change: Child must have:
  • Knowledge that change is required
  • Knowledge that change can be made
  • Information that can be used to assist that change
• Therapy process and methodology:
  • Therapy is program that begins at conceptual level about sounds and moves to word level
  • Phase 1
    • Conceptual level - talk about sounds and recognize classes of sounds (not specific sounds) through games and manipulatives. Noisy vs. whisper, front vs. back, matching strings and ribbons, building a house with front and back.
    • Sound Level- sounds are targeted, each sound can be described according to certain features as established in the conceptual level.
    • Phoneme level- specific phoneme are targeted and visual referents are produced to indicate phoneme. Contrasting stops vs. fricatives. Noisy vs. quiet.
    • Word level- minimal pairs are contrasted and the client is asked to make judgements about their sound properties, noisy vs. quiet.
  • Phase 2
    • Transfer of metaphonological knowledge to communicative situations
    • child should recognize when speech output and intended message are not the same
    • Awareness so that output repairs can be made and so that correct intended meaning is conveyed.
    • Draw attention to the sound differences not the child’s incorrect production. “I heard a noisy sound, should it have been a whisper sound?”
    • Main therapy methodology employs minimal contrasts in games. Have client ask for certain objects with contrast (i.e. give me the tea/key. if client says it correctly, clinician reinforces and uses already learned language “That was very good, I bet you have a lot of good words with back sounds”.

Cycle Therapy

• Methodology → do not use if the child is intelligible.
• Designed to increase intelligibility for unintelligible children.
• Goal is to stimulate emergence of sound.
• Based on natural language learning.
• Auditory bombardment is based on the concept that shows that children learn sounds that they are exposed to the most, not necessarily those that are easiest to produce.
• Method sequence
  • Aud bombardment.
  • Target word cards.
  • Production practice, etc.
• Cycle = a prescribed period of time when you’re focusing on one phonological pattern.
  • Ex. final consonant deletion → focus on one final sound at a time before moving on to another pattern, then come back to FCD later (you will move on to the next pattern based on time, not a performance criteria).
  • We’re trying to get them as many exposures as possible (bombardment), not worrying about mastery.
  • Cycles are about 2-6 tx hours (could take a few weeks to hit that time requirement).
• Each session includes:
  1. auditory bombardment
     • Two minutes of clinician reading words that contain the target sound -> children learn the sounds they are exposed to the most.
       • Use amplification (headphones).
  2. production of target words
     • Words are always the smallest unit of production.
     • Client draws/colors/pastes 3-5 words on a large index card (target words are written on the card too).
  3. production practice
     • Experiential play activities -> use the word cards to create games.
     • Shift activities every 5-7 minutes to keep their interest.
     • This part is more like traditional therapy.
  4. stimulatory probing
     • Looking at the next phoneme you’ll target within the same pattern.
     • Takes about two minutes at the end of the session.
  5. auditory bombardment again
  6. give the parents cards so they can practice at home
     • Should work for about 5 minutes.
     • Parents can do auditory bombardment at home

Using Minimal Pairs in Therapy

• Be able to create minimal pairs for different processes (e.g., final consonant deletion, stopping, fronting, etc.)
• What they say is first, what they mean is second.
  • final consonant deletion
    • tea vs. team
    • tie vs. time
    • new vs. noon
    • she vs. sheep
  • stopping
    • fit vs. pit
    • sit vs tit
    • fat vs. bat
    • fish vs. fit
  • fronting
    • tea vs. key
    • tar vs. car
    • dote vs. coat
    • dot vs. cot
  • liquid gliding
    • wed vs. red
    • wing vs. ring
    • white vs. right
    • wake vs. lake
  • deaffrication
    • chair vs. share
    • chips vs. ships
    • chop vs. shop
    • chin vs. shin
  • affrication
    • share vs. chair
    • ships vs. chips
    • shop vs. chop
    • shin vs. chin

The “Scott Method”

• The child must have: ACTS
  • Awareness - Knowledge that change is required; awareness
  • Change - Knowledge that change can be made
  • Trust - Knowledge that you are the one who can make that change
• Start by generating awareness
  • Ask them to point to the words to see if they hear the difference in sounds
    • First they point to sounds you say, then you point to sounds they say
  • You can record them during activities so you can play their own speech back to them
    • Ask them to point to the word they heard -> helps emphasize that when they say the wrong sound, you get the wrong word
  • Can create awareness through a group rating each other when they get a sound right
    • **if you have the right group dynamics, established trust, etc + when you know the kid can be successful
  • We want them to get to the 70% mastery range
  • Pay attention to resource allocation
    • If we give them too many words to practice it overwhelms their abilities
    • Start with ~2 pairs, add slowly
  • Kids learn when you make a mistake -> your counter-examples create a cognitive dissonance
  • Create a session routine
    • Pick them up from the gen ed classroom
    • Talk for a couple minutes, see how they’re doing
    • Tell them what you’ll be working on
    • always tell them how many more they will have to do of something
      • Ex. erasing words off of a whiteboard, earning a certain number of puzzle pieces
    • Start with a task they will be successful on
    • Recap at the end of the session + give reinforcement (be explicitly)
      • Reinforcement could be the prize they earned, or saying “good job”
  • Ultimate goal is to generalize sounds (Van Riper principle)
  • Always stay where you are successful
    • Ex. if you fall apart at the sentence level, go back to the word level
  • Always probe ahead of your current target
  • How is therapy for Apraxia different than for phonological process or phonetic disorder?

Phonological and Phonemic Awareness

• Read the Phonological Awareness Article in the syllabus!!
• What is the definition of Phonological and phonemic awareness?
  • Phonological Awareness (umbrella term): The ability to understand that language breaks up into words, words break into syllables, syllables are composed of phonemes, and that phonemes are distinct from each other. Onset and rime. NOT talking about SSD.
  • Phonemic Awareness: The ability to notice, think about and be able to segment the individual sounds in spoken words. The child must be able to know the first and last sound, manipulate sounds, etc.
  • Phonological and Phonemic awareness are not about letters, they are about breaking up the sound system.
• What are the components of PA?
  • Understanding that language is separate from you, it can be built and broken down
  • Knowledge of sound/syllable/word structure
• How do you recognize if a child has PA difficulties?
  • ***Difficulty rhyming
  • Difficulty learning the names of alphabet letters
  • Difficulty telling the first sounds in a word
  • Difficulty telling if two words begin with the same sound
  • Difficulty breaking words into syllables
  • Can’t change words by taking out one letter and adding another
  • Cannot identify phonemes in words/ count the number of sounds in words
  • ***Difficulty learning the alphabet
  • Difficulty telling how many sounds is in a word
  • Difficulty breaking compound words into their components (e.g. What would cowboy sound like without /cow/?)
  • Difficulty changing words by manipulating the sounds within a word
    • (E.g. what would /at/ sound like with a /k/ in the beginning? or: What word would I get if I took the /m/ out of mop and put in a /t/?)
• How is PA different than phonics? What effect does PA disorder have on reading? What does PA assessment or screening look like? What does therapy look like? Give examples of therapy.
  • Phonemic Awareness: Alphabetic Principal: The ability to map these individual sounds onto graphemes and sequence graphemes to make words.
• Phonics: The method used to teach reader about correspondence between letters and sounds. Teaching common spelling patterns, irregular spelling, clusters, silent letters, how one letter can affect the whole word (silent e), syllable rules, permissible sequences of letters, etc.

Corpus Analysis

• Determine what child’s phonological processes: write the rules in bullet and decide what phonological process to work on and why (most impact on intelligibility, stimulability, age appropriate)
• if I gave you a phonological process - fronting: give him 4 minimal pairs (one sound that child says vs. what you want them to say key, they say tee, want them to say key) -->liquid reduction there are a lot (white and right)\ stimuli - drawing, pictures, contrastive activities
• Van riper traditional therapy what do we use for those things, behavioral
• Phonemic, phonetic, definitions, rhyming alphabet knowledge (not about phonological processes). How would you teach some of this.
• Corpus (determine child’s phonological process) you will write the rules, in bullet, then you decide what you are going to work on first (stimulability, appropriate age level)
• Write a goal
• Tell a methodology you are going to use, how you are going to start, what stimuli (drawing/pictures)