Therapeutic Methods: Teaching, Cues, and Scaffolding

Therapeutic Methods: Teaching Methods, Cues, and Scaffolding

Course Objectives

• Demonstrate understanding and application of the 4 teaching theories and 4 teaching modalities.
• Demonstrate understanding of various therapeutic cues/prompts to facilitate improvement in client outcomes, including:
  • Modeling
  • Indirect and direct linguistic cues
  • Contingency cues
• Demonstrate understanding and application of scaffolding techniques to use in the therapy session.

The Therapeutic Process

• Pre-Tx Tasks
  • Gather Data
  • Choose Tx Targets
  • Write Goals
  • Determine Baseline
• Session Planning and Implementation
  • Determine Teaching Methods
  • Develop Scaffolding Strategies
  • Develop Generalization Plan
  • Create Tx Activities
• Session Documentation
  • Data Collection
  • Document SOAP Note
  • Write Progress Note

Components of the Therapy Session

• Teaching Theories and Modalities
• Cues and Prompts
• Structure and Managing Behavior
• Scaffolding and Counseling
• Collecting Data

Teaching Theories

• Behavioral
  • Repetition of target
  • Response-reward
• Cognitive
  • Showing & Explaining target
• Humanistic/Experiential
  • Experiencing
• Social Orientation
  • Using target in social context.

Case Study: Kelly

• Kelly is an autistic 3.5-year-old with limited functional communication.
• The team agreed to a new goal targeting “I want” phrases to facilitate functional requests.
• In the first session addressing this goal, the SLP displays 3 highly motivating toys with a plan to teach “I want” phrases with preferred objects.
• The SLP shows Kelly all three toys and says “wow! Toys! What do you want?” Kelly reaches for the ball.
• How does the SLP respond? It depends on the teaching theory the SLP has chosen to use in this session.

Pediatric Case Study: Behavioral

• SLP: Kelly, say “I want the-ball.”
• Kelly: Ball!
• SLP: You say: I. Want. the-Ball.
• Kelly: “I want ball.”
• SLP: Here’s the ball! (waits 3-5 seconds, then takes back the ball, places it with the 3 toys, and repeats the script again and again.)
• The behavior is verbalizing the phrase “I want ball.”
• The “reward” is getting to play with the ball.

Pediatric Case Study: Cognitive

• SLP: (puts the ball just out of reach) You reached for the ball, but you have to tell me with words: “I want the-ball.”
• Kelly: Ball!
• SLP: When you want a toy, you can tell me in a sentence:: “I.” “want.” “the ball.”
• Kelly: “I want ball.”
• SLP: You said the whole sentence! Here’s the ball! (waits briefly). Now I’ll say the sentence: I want the ball! (takes back the ball; repeats again)
• Explain the expectation
• Model/Demonstrate the response.

Pediatric Case Study: Experiential

• SLP: (holding the ball to self) “I want the-ball”
• Kelly: Ball!
• SLP: (holding the ball toward kelly) You say “I want the-ball.”
• Kelly: “I want ball.”
• SLP: Here you go! Here’s the ball! (allows time to play in Kelly’s way) It’s my turn. I want the ball! (takes back the ball and plays dramatically)
• When Kelly reaches again, SLP restarts the script.
• Planned interaction provides opportunities for hearing and using the target.

Pediatric Case Study: Social

• SLP: Oh! You reached for the ball! Do you want the ball?
• Kelly: Ball!
• SLP: Yes! It’s a ball!…Hrm, I want the-ball (Plays briefly with the ball.) Do you want the ball? (Kelly reaches and says “ball!”). Oh! “I . want. the ball!”
• Kelly: “I want ball.”
• SLP: Oh okay! Here you go, here’s the ball. (Wait as Kelly plays and joins in her play). It’s my turn, I want the ball. (Takes ball and plays in SLP’s own way).
• When Kelly reaches again, SLP restarts the script.
• The back & forth of asking and receiving demonstrates the impact of the complete 3-word request.

Teaching Modalities

• Auditory
• Visual
• Tactile
• Kinesthetic

Considerations

• Which of the 4 teaching theories should be utilized when introducing a new concept/activity to your client.
• Which of the 4 modalities of teaching can and/or should be used when teaching an new concept/activity.

Practice!

• How might you use these teaching theories to teach…
  • Teach a 5-year-old the present progressive morpheme (is + -ing)
  • Teach a 45-year-old to use easy onset for vocal abuse
• Which teaching method/modalities will you prepare for each?

Cues and Prompts

• Cues - Hints or techniques used by the clinician to elicit a desired response from the client.
• Prompts - Instruction, gesture, demonstration, touch, or other technique used by the clinician to increase the likelihood of a correct response.

Therapeutic Cueing Techniques

• Clients with little to no language ability
  • Modeling
• Clients with some language ability
  • Direct linguistic cues
  • Indirect linguistic cues
  • Contingency cues

Types of Cues: Modeling

• The clinician models the selected therapy target.
  • Expressive Language Targets
  • Receptive Language Targets
  • Articulation Targets
• Clinician verbalizes accurate language use.
• Clinician demonstrates the target.
• Clinician demonstrates articulation placement and produces the sound.

Types of Modeling:

• Immediate vs. Delayed
• Pediatric-Specific Modeling:
  • Self-Talk
  • Parallel-Talk

Language Modeling in Pediatric Intervention

• Self-Talk Modeling
  • When the therapist narrates what he/she themself is doing.
  • Eg. Therapist is pushing a car in front of the child
  • T: “Beep Beep! Mom is going to the store!”
  • T: “Mom is stopping! Now Mom is getting out of the car.”
  • T: “Mom is walking in the store”
• Parallel-Talk Modeling
  • When the therapist narrates what the child is doing.
  • Eg. The child pushes the car on the ground.

Types of Cues: Direct Linguistic

• The clinician provides a direct question or statement meant to elicit certain language forms.
• Can be used with children and adults
  • Confrontation Cue
    • “What is this?” [any direct question]
  • Semantic/Function Cue
    • “It’s something you drive to get around town.”
  • Cloze Sentence Cue
    • “We drive a … ”
  • Phonemic Cue
    • “You drive a c__ ”
  • Imitation
    • “Say ‘car’”

Confrontation Cues To Elicit…

• Verbs
  • (present progressive) - “What is [the subject] doing?”
  • (past tense) - “What did [the subject] do?”
  • (third person singular) - “What does [the subject] do?”
  • (unconjugated) - “What do you do with it?”
• Nouns
  • (people) - “Who is [verbing]?”
  • (objects) - “What is this?”
  • (locations) - “Where is this?”
• Adverbs - “How is she [verbing]?”
• Adjectives/Attributes - “What [color/size/shape/texture] is it?”

Types of Cues: Indirect Linguistic

• Uses comments, actions, or suggestions to indirectly elicit a target.
• Can be used with both children and adults.
  • Declarative Language
    • “I wonder where Potato Head is…”
  • Exaggerated/Expectant Pause
    • Clinician looks in box and gasps
  • Gesture/Point/Orthographic
    • Clinician points to Potato Head
  • Direct Suggestion (request info)
    • “Ask your friend if she knows where Potato Head is…”
  • Direct Suggestion (request objects)
    • “You can ask me for Potato Head…”
  • Negatives
    • Clinician hands client Potato Head and says “Here’s the train!”

Declarative Language

• Declarative Language: A statement or comment about an observation or thought, without explicit expectation for a response.
• Declarative Language Hacks…
  • “I wonder… ”
  • “I see that… ”
  • “I’m thinking… ”
  • “I am going to… ”

Types of Cues: Contingencies

• Cues given in response to a client’s communication attempt in which they may or may not be obligated to respond.
• Can be used with both children and adults.

Response Contingencies

• Complete Correction Model+Request
  • C: “I broked the car.”
  • T: “I broke the car. Now you say it.”
  • C: “I broke the car.
• Complete Error Repetition+Request
  • C: “I broked the car.”
  • T: “I broked the car?”
  • C: “I broke the car.
• Incomplete Correction Model+Request
  • C: “I broked the car.”
  • T: “broke.”
  • P: “I broke the car.
• Incomplete Error Repetion+Request
  • C: “I broked the car.”
  • T: “broked?”
  • P: “I broke the car.”

Response Contingencies (Continued)

• Self Correction+Request
  • C: “I broked the car.”
  • T: “Did you say that correctly?
  • C: “Oh, I broke the car.
• Repetition+Request
  • C: “I broke the car.”
  • T: “Yes! Say that again…
  • C: “I broke the car.”
• Self Correction+Confrontation cue
  • C: “I broked the car.”
  • T: “What did you do?”
  • P: “Oh, I broke the car.”
• Expansion+ Request
  • C: “I broke the car.”
  • T: “You broke the car on the road. Tell me the whole thing.”
  • P: “I broke the car on the road.”

Response Contingencies (Continued)

• Extension+ Confrontation Request
  • C: “I broke the car.”
  • T: “What did you do next?”
  • C: “I glued it.”
  • T: “Where did you glue it?”
  • C: “In my bedroom.”

Scaffolding

• Scaffolding is a temporary structure used to support a work crew and materials to aid in the construction, maintenance, and repair of buildings, bridges, and all other man-made structures.

Determine Scaffolding Strategies

Three Methods of Scaffolding

1. Adjust the condition of the session goal
2. Adjust Cues and Prompts
3. Adjust the tasks/activities

Adjusting the session goal condition

• Example:
  • Long Term Goal: By December 10, 20XX, Johnny will use is-verbing in conversation during story retell with no cues at 90% accuracy, as measured by SLP.
  • Session Goal: Johnny will use “subject + is + verb-ing” in a sentence during a picture description task, given a sentence strip and a confrontation cue “what is [the subject] doing?”.
  • To scaffold up (make it more challenging)
    • Johnny will use “subject + is + verb-ing” in a sentence during a picture description task without a sentence strip.
  • To scaffold down (make it more simple)
    • Johnny will use “subject + is + verb-ing” in a sentence during a picture description task, given the target verb and a sentence strip.

Adding/Removing Cues

• Example:
  • Long Term Goal: By December 10, 20XX, Johnny will use is-verbing in conversation during story retell with no cues at 90% accuracy, as measured by SLP.
  • Session Goal: Johnny will use “subject + is + verb-ing” in a sentence during a picture description task, given a sentence strip and a confrontation cue “what is [the subject] doing?”.
  • To scaffold up (make it more challenging)
    • Johnny will use “subject + is + verb-ing” in a sentence during a picture description task with a sentence strip with a request: “Tell me about the picture.”
  • To scaffold down (make it more simple)
    • Johnny will use “subject + is + verb-ing” in a sentence during a picture description task, given a sentence strip and verbal model.

Adjust the task/activity

• Example:
  • Session Goal: Johnny will use “subject + is + verb-ing” in a sentence during a picture description task, given a sentence strip and a confrontation cue “what is [the subject] doing?”
  • Activity: Group will play “memory” using a field of 16 action cards (8 pairs). Clinician and John will turn over 2 picture cards. If it’s a match on his turn, John will produce a present progressive sentence using the sentence strip, and take another turn. If it’s not a match, he will turn over both cards and the clinician takes a turn.
  • To scaffold up (make it more challenging)
    • 1- John will say a sentence for every card he flips over.
    • 2- John will say a sentence for the clinician’s matches
  • To scaffold down (make it more simple)
    • 1- The field of cards will be reduced to 4 pairs
    • 2- John will produce 3 sentences with the targets before playing the memory game. Only those practiced targets will be produced during the game.