Study Notes on Treatment of Speech Sound Disorders

General Principles for Treatment of Speech Sound Disorders

Overview of Speech Sound Disorders Treatment

  • This lecture will cover the principles for treating speech sound disorders, including:
    • Traditional articulation therapy
    • Phonological treatment strategies
    • Frequency, intensity, and duration of treatment
    • Carryover and principles of motor learning in treatment
    • Service delivery models
    • Long and short-term goals for treatment

Traditional Articulation Therapy vs. Phonological Treatment Strategies

  • Articulation therapy focuses on the motor aspects of sound production, while phonological approaches address the linguistic or cognitive aspects.
  • It is crucial to consider both the motor and phonological aspects in children with speech sound disorders.
    • Example of confusion: Child exhibiting gliding (e.g., substituting "w" for "r") could be seen as having a phonological process or an articulation disorder based on underlying issues.
    • Kelly Farquharson's response emphasizes that all speech production involves both motoric and linguistic components.
Discussion of Phonological and Articulation Approaches
  • Phonological interventions aim to treat children with mild to severe phonological processing disorders and address pattern-based errors that impact meaning in language.
  • Articulation approaches (e.g., Van Riper therapy) target individual sounds and follow a hierarchy from easy to complex:
    • Isolation → Syllables → Words → Phrases → Sentences → Conversational speech
  • Traditional approaches may take considerable time, so combining phonological strategies can enhance effectiveness.

Frequency, Intensity, and Duration of Therapy

  • Key terms defined:
    • Dosage: Number of teaching episodes or trial attempts during one therapy session.
    • Minimum recommendation: At least 50 trials per target in a half-hour session.
    • For children with more severe disorders, increased therapy intensity is necessary; e.g., 30 sessions recommended for childhood apraxia of speech (CAS).
    • Recent studies suggest frequent, shorter sessions may be more effective than fewer longer ones (e.g., 5-minute intense bursts).

Carryover and Generalization in Therapy

  • Carryover refers to the application of learned sounds in everyday speaking situations, leading to natural production without conscious effort.
  • Strategies to promote carryover include:
    • Enhancing self-monitoring skills in clients by helping them visualize their speech mechanics.
    • Establishing a strong rapport and motivation by highlighting how speech sound disorders affect communication.
    • Homework assignments should focus on perception and auditory discrimination when production is not yet established.
Examples of Effective Carryover Practices
  • Instead of assigning practicing incorrect sounds, use indirectly supportive tasks (e.g., auditory discrimination exercises).
  • Homework can include contexts that reinforce proper sound production and literacy skills simultaneously.

Principles of Motor Learning

  • Considerations in treatment that relate to learning motor skills:
    • Massed vs. Distributed Practice: Start with massed (blocked) practice for establishing accuracy, then shift to distributed practice for retention and variability.
    • Emphasize the importance of frequent, contextually meaningful practice to solidify new motor movements for sound production.

Service Delivery Models

  • Two primary types in school settings:
    • Pull-Out Model: Therapy conducted outside of the classroom.
    • Push-In Model: Therapy integrated into classroom activities.
  • Factors influencing effectiveness of push-in models:
    • Positive collaborative relations with classroom teachers
    • Adequate preparation time for the SLP
  • Group therapy can enhance motivation and improve social skills through peer interactions.

Long-Term Goals and Short-Term Objectives

  • Importance of creating measurable and observable objectives:
    • Long-term goals should reflect meaningful communication improvements, while short-term should specify measurable criteria.
  • Examples of Long-Term Goals:
    • "The student will improve articulation skills to 80% accuracy in conversational speech across three sessions."
    • "The client will eliminate phonological patterns and increase consonant repertoire."
Examples of Short-Term Objectives
  • Each objective should specify phonemes, word positions, and contexts. E.g.,
    • "The child will produce the /k/ sound in the initial position of words at 75% accuracy by the end of the semester."
    • Target behaviors should clearly indicate the approach used (e.g., imitate or spontaneously produce).

Considerations for Objective Writing

  • Objectives should encompass:
    • Phonemes or processes targeted
    • Contexts for practice (isolation, syllables, words)
    • Levels of support used in therapy (verbal models, tactile cues)
  • Be cautious of including unnecessary information about the therapeutic approach within the objective.
  • Clear articulation goals should specify the sound across its different forms to avoid confusion.

Conclusion

  • Addressing speech sound disorders requires both motoric and phonological interventions, a thorough understanding of treatment intensity and frequency, and a structured approach to goal setting and therapy delivery.