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The Wonder ofCycles

Created by Barbara Hodson

Shared by Anne Hasting2013

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Where credit is due

Created by Barbara

Hodson

Evaluating and

Enhancing Childrens

Phonological Systems

www.phonocomp.com

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This approach

Created for severe-profound intelligibility

problems

More closely matches natural acquisition

Evidence-based

Ages 2-14

Variety of disorders

Refined over 35 years

Works

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Poorly intelligible kids

Not auditory self-monitoring

Rely on inaccurate kinesthetic self-monitoring

Order in disorder More likely to evidence certain processes

Lag behind in basic literacy and spelling later

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Whats important?

Intelligibility! Not number of errors

Child with /s/ lisp and /s/ omission have same

number of errors on GFTA-2 Intelligibility in connected speech how to

estimate?

Sentence imitation HAPP-3

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Identify errors

Tests are for identifying disability

Avoid teaching to the test

Not very helpful anyway

Play and listen, take notes

Put parents to work if kid doesnt cooperate

Video recording, audio recording, notes

Full analysis not necessary

First look for absence of primary patterns (slide 11)

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What do you want?

Cycles terminology focuses not on the deficits,but on what you want the child to do

Syllable reduction? Syllableness

Initial/final consonant deletion? Singletonconsonants, initial and final

Fronting/backing?Anterior-posterior contrasts

Cluster reduction?/s/ clusters Liquid gliding? Liquids

Processes? Patterns

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Cycles has cycles

Cycle: series of target patterns

Work on each target pattern in succession

5-20 weeks, depending on number of deficiencies

and on stimulability

Then start over, add phonemes to patterns if

possible

First you cycle primary patterns

When primary patterns reach accuracy criteria

(3-5 cycles), begin cycling secondary patterns

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Priorities

Omissions and additions are top

Substitutions are next critical after o & a

Distortions have much less impact on intelligibility

Structural changes

Syllable deletion

Singleton consonant deletions (initial and/or final)

Cluster reduction

Epenthesis

Syllable addition

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What are we working on again?

Patterns NOT sounds

Need to use sounds to work on patterns

Catch-22? Just keep in mind that the soundsare a means to an end.

Do NOT work on every sound in error

Choose a few *stimulable* sounds to teachpatterns

One clinical hour per target sound

Number of target sounds depends on stimulability

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Primary Patterns

Primary patterns:

Syllableness

Singleton consonants

Initial

Final

/s/ clusters

Anterior-posterior contrasts Liquids

Target what the child needs

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Syllableness

Spondees (equal-stress words) Targeting non-spondee two-syllable words results

in inappropriate prosody or encourages syllable

deletion

Target is producing multiple syllables

Hows he doing?

ice cream -> cream

ice cream -> eye ee

ice cream -> ha ha

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Singleton consonants

Initial singleton consonants (if in error)

Choose 2-6 target phonemes

Stops /b, p/ possibly /d, t, g, k/

Nasals /m, n/

Glide /w/

Always use real words, not made-up syllables

Always use words the child can say If CVC is not stimulable, try CV

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Singleton Consonants

Final singleton consonants

Choose 2-6 target phonemes

Voiceless stops /p, t, k/

Nasals /m, n/

Always use real words, not made-up syllables

Always use words the child can say If CVC is not stimulable, try VC

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/s/ clusters

/s/ clusters

Initial

/st, sp, sk, sm, sn/ (careful fronting/backing)

Video 1, s clusters M

Final

/ts, ps, ks/ (careful fronting/backing)

Yay for morphology: plurals, 3p singular verbs

ONLY if singleton consonants are present

If fluent words: Its a spoon. Its a snail.

Video 2, its a sk I

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Anterior-posterior contrasts

If not stimulable, target as a secondary pattern Most kids are fronters or velar deleters; you want

velars

Final /k/ Initial /k/, /g/

Some kids are backers; you want alveolars

Initial /t/, /d/ Final /t/

Avoid words that have both front and back

sounds: dog, coat, take, kiss, knock

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Liquids

3 y/o vs. 7 y/o working on /r/ for first time Developmentally appropriate acquisition

Hodsons data

Not a glide

Derhotacized/lax /r/ and vowels are acceptable

Data collection:

Run -> wun

Run -> oowun

Run -> oo uuuun

Run -> r)un

Video 3, liquids I

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Liquids

Target initial /l/ Stable jaw tongue clicking for a week at home beforetargeting

Target initial /r/ (er) Needs to be er a:k

Jaw wide open for onset, keep it open during pauseand rime (no /w/ insertion)

Target /r/ blends if stimulable for velars /k, g/ are facilitative

Target velar and alveolar /l/ blends when /l/ issolid

/p, b, m, f, v/ encourage gliding, so rope, roof,rabbit, lamp, and leaf would be out

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Nitty gritty, part 1 One clinical hour per target phoneme (2-6 hours per

target pattern) Hodson recommends one hour per week total: three 20-

minute, two 30-minute, one 60-minute

Double time if child has intellectual disability

MUST be stimulable Use sounds the child can say (maybe not easily) to work on

patterns the child has not mastered

Stimulable doesnt mean easy

Focused auditory input cycle for nons (nonstimulable,nonverbal, or noncompliant) One cycle of primary patterns: only input, no production

requirements

Usually needed for children younger than 3 years

2 weeks on each primary pattern except liquids (10 weeks)

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Primary Pattern Graduation

Move from primary to secondary patternswhen:

Initial /m, n, w/ and stops 60% correct inconversation

Final /m, n, p, t, k/ 60% correct in conversation

A-p contrasts 60% in conv. in one word position

/s/ clusters emerging in conversation

Liquid approximations at the word level

Listen during liquids

Not reached criteria? Cycle error patterns again

Severe intelligibility = 3-4 primary cycles

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Secondary Patterns

Begin after criteria have been reached forprimary pattern graduation

Do NOT kill yourself analyzing all patterns early

Listen during liquids

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Possible Secondary Patterns

Some common ones:

Voicing contrasts

Vowel contrasts

*Anterior-posterior contrasts Stridency

Palatals

Other consonant clusters

Context-related processes Assimilations

Metathesis

Idiosyncratic rules

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Voicing Contrasts

Errors with voiced/voiceless cognates

p/b, t/d, s/z, etc.

Prevocalic voicing

Use minimal pair words and some

amplification

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Vowel Contrasts

Usually get the vowels sorted out during the

primary cycles

Use minimal pairs and some amplification

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Anterior-Posterior Contrasts

Target in secondary cycles if not stimulable

during primary cycles

See slide 16

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Stridency

Stridents: f, v, s, z, sh, zh, ch, j

Stridency deletion: substituting non-stridents

or deleting the strident altogether

Fan->pan, Sue->new, peach->pea, fishing->fitting

Stridents are often stopped but not always

Usually working on /s/ clusters generalizes but

if not:

Target /f/ and /s/ first, usually in final position

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Palatals

Palatals: y, sh, ch, j

Target y first

Then insert y after other palatals Chyair (child will probably say tsyair)

Shyoe (syoe)

Jyump (dzyump)

Usually ch is more stimulable than sh or j

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Other Consonant Clusters

Examples: kw, tw, sw, by, hy, fy, ky, my

/s/+stop final clusters (e.g. toast)

Medial /s/ clusters (boxes, sister) Three consonant sequences (straw, square)

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Context-related Processes

Assimilations: Labial, e.g. pin -> pim

Alveolar, e.g. take -> tate

Velar, e.g. green -> gring Nasal, e.g. mat -> man

Assimilations multiply with other errors

Pin -> im (adding initial consonant deletion) Take -> date (adding prevocalic voicing)

Green -> wing (adding cluster reduction & gliding)

Mat -> many (adding diminutization)

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Context-related Processes

Metathesis (switching positions)

Ask->aks, take->kate

Reduplication

Bottle->baba, TV->beebee

Idiosyncratic rules - some fun ones:

Alveolar and velar stops, and all stridents = /h/

All fricatives, affricates, and clusters = /d/

(except /h/)

Minimal pairs

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Advanced Patterns

Upper elementary, middle (~age 9 and up) Look fine on artic tests but have intelligibility

issues in the real world

Usually have language/learning disabilities Complex consonant sequences (extra, excuse)

Video 4, complex sequences I

Multisyllabicity (apostrophe, aluminum) Segment phonemes syllable by syllable

Teach phonics writing

Once youve broken it up, put it all back together

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Example: Morgan, age 4:10

Morgan is poorly intelligible in conversationbut between the GFTA and mom you get:

House -> how

Stop -> top Big -> bid

Carson -> tawtuh

Make -> nay Like -> wipe

Play -> pay

What will you do with her?

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Example: Morgan

Primary patterns

Singleton consonants (final)

/s/ clusters


Liquids

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Example: Adam, age 6:1

Adams intelligibility in conversation varies Errors include:

Stop -> chop

Likes -> wite Chair -> tayoh

Tree -> tee

Susannah -> Chuchannah

Skates -> chate

Christmas -> Kimuch

Shoes -> chooch

Zero -> jeewo

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Example: Adam

Primary patterns:

/s/ clusters (avoid sk)


Liquids

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Example: Hannah, age 3:3

Hannah doesnt say much. Mom understands

very little of what Hannah does say. Imitated

single words include:

Drum -> uh

Mommy -> um

Me = correct

Green -> nee

Blue -> woh

Chair = refused to attempt

Baby -> bee

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Example: Hannah

Auditory input cycle?

Primary patterns

Syllableness

Singleton consonants (initial)

Singleton consonants (final)

/s/ blends when singleton consonants emerging


Liquids

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Example: Nathan, age 10:6

Nathan has had 7 years of remediation butremains unintelligible at times. You hear: Skinny -> sinny

Color -> coloh

Electricity -> elekitsy Christina -> wikseeta

Lightning = correct

Germany = Johmany

Mixture -> mistoh Hopping = correct

Sneeze -> seeze

Huge = correct

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Nathan

Primary Patterns

/s/ clusters

Liquids (/r/)

Secondary Patterns

Metathesis and migration best addressed in:

Advanced Patterns

Complex consonant sequences

Multisyllabicity

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Whew

Enough framework for you?

Its the most important part!

Organization of overall treatment

What does a session look like?

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Sessions

Review

Listening words

Practice patterns

Metaphonological skills

Listening words

Stimulability

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Session Structure

Review last weeks targets IF same pattern 2minutes

Listening words (amplified auditorystimulation) 15 seconds

12-15 words at slight amplification (6-12 dB)

Clinician reads, child listens

Speak normally

Child can attempt a few production practice words(see next slide) while wearing amplification

Try PVC piping or Whisperphone Duet

Evidence-based

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Session Structure

Production practice main bulk of session Choose 2-5 target words (no nonsense syllables)

Ages 1-too immature to sit and attend:

Opportunities for targets to be produced naturally in

context Ages 3ish and up:

Create practice cards

Draw, write, color targets on index cards

Can play and say or produce in context or a little ofboth

Metaphonological skillssee next slide

Able to read:

Short oral reading period focusing on target pattern

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Metaphonological Skills

Struggle with basic literacy and spelling A few minutes each session targeting:

Rhyming

Segmentation and blending of: Syllables, Video 5, syllable blending M

Onset and rime, Videos 6 & 7, blending I, seg E

Phonemes, Videos 8, 9, & 10, blending D, seg D & J

Manipulation

Send home short rhymes like Jack and Jill

Video 11 nursery thyme cloze s

Increase the time in final cycles

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Session Structure

Listening words 15 seconds

Same list, same amplification

Stimulability 2 minutes

Select next sessions practice words

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Nitty gritty, part 2 Evidence-based but may not work if you do not

follow the protocol

Quality over quantity

STIMULABLE

No data collection measures are provided at theend of each cycle not each session

Interferes with naturalistic interactions

Mixing errors with correct leads to fuzzy phonologicalrepresentation

Dont say good job when you mean good try

Give accurate feedback and immediately try to correctthe error

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Nitty gritty, part 3

Group therapy

FAPE, individualization

Progress is known to be slower

Listening to several targets in one session maylead to fuzzy phonological representation

Choosing targets

Listening list: anything with target pattern

Practice words: stimulable, phonetic environment,can teach semantics

Metaphonological words: child must already know

Fine if production is imperfect

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Homework

Homework 2 minutes per day

School age: para/aide or educator can do this

Parent reads listening words, child says each

practice word once, read rhyme if applicable

Good luck

I train parents/teachers on ear training

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Ear training

Supports Cycles

Important: limited to current target pattern

Five types:

Modeling

Auditory awareness

**Feedback**

Praise

Corrections

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Ear training

Modeling (auditory bombardment)

Focused play, say targets often without requiring thechild to imitate

Auditory awareness Johnny, want to gohey, go has your /g/ sound!

Want to go outside and play?

FeedbackDitzy dame routine

The tea? Hm, I dont see any tea out there to drinkOh, you mean tree! Sorry, I heard tea. I do see thesnow on the tree.

Nack? I dont know what a nack is Oh, snack! Sure,

you can have a snack.

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Ear training

Praise

Nice /s/ in sit!

I heard that good /k/ sound when you said keys.

Corrections

No? Try again: snow. Thats right!

I require an equal number of praise and

corrections, max 5 corrections per day Impossible until child is generalizing

No praise = no corrections

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IEP objectives (Auditory input cycle) Will participate in activities

targeting correct speech patterns

Will produce words beginning or ending with /k/

Will produce at least two of the following at the

word level: /sp, st, sk, sm, sn/ Will produce at least two of the following at the

end of words: /p, t, k, m, n/

Will produce words with two syllables Will attempt words beginning with /l/ sound

Will produce an approximation of /r/

Will produce words ending with /s/

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Evidence

Randomized, single-blind clinical trials

Comparisons with other treatments

Hundreds of kids

Less than a year for most preschoolers to become

intelligible (30-40 clinical hours)

Closer to two years for extremely disordered

phonological systems but normal cognitive

Cleft palate, recurrent otitis media, apraxia, mild-

severe hearing impairment, cochlear implant,

cognitive delays

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My Evidence

All names are changed

Progress in a single school year

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Evidence: Hugh

Began Cycles age 3:10

No previous tx

Embarrassed, avoided speaking

Data game

Otitis media history, resolved

Poor stimulability

Fantastic follow through on ear training

Intelligibility jump after 3 months

>80% intelligible at end of school year

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Hughs progress in conversation

Target Pattern Occurrence

Final consonants 100%

A-P contrast 100%

Stridents 100%

/s/ clusters 100%Other clusters 100%

Liquid /l/ 0%

Liquid /r/ 20%


Final consonants 0%

A-P contrast 60%

Stridents 0%


Liquid /l/ 0%

Liquid /r/ 0%

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Evidence: Bella Began Cycles age 3:3

Otitis media history

Good stimulability

Resistant to practice Bribery

Intelligibility jump age 3:6, again age 3:9

Dx mild-mod conductive hearing loss, gothearing aids age 3:10

Discontinued artic age 4:1

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Bellas progress in conversation



A-P contrast 0%

Stridents 0%


Liquid /l/ 0%

Liquids /r/ 0%

Palatals 0%



A-P contrast 100%

Stridents 100%


Liquid /l/ 100%

Liquids /r/ 0%

Palatals 100%

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Evidence: David

Age 4:10

1.5 years previous tx: worked final consonants

to sentences, /k/ in isolation

Poorly intelligible, glottal stops for nearly all

medial phonemes

Poor stimulability

Very active!

Intelligibility jump age 5:3

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Davids progress in conversation



A-P contrast 0%

Stridents 40%


Liquid /l/ 0%

Liquid /r/ 0%

Voicing contrast 0%

Palatals 0%



A-P contrast 100%

Stridents 100%


Liquid /l/ 20%

Liquid /r/ 0%

Voicing contrast 100%

Palatals 80%

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Evidence: Carly


No previous tx

Selective mutism

Mom does all treatment with my guidance

Home visits to teach mom, email

Small sessions throughout the week

Pals services for personal/social

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Carlys progress in conversation



A-P contrast 0%

Stridents 40%


Liquid /l/ 0%

Liquid /r/ 0%

Voicing contrast 0%



A-P contrast 60%

Stridents 60%


Liquid /l/ 0%

Liquid /r/ 0%


Data from 5 months into tx

All at 100% except liquids after 8 months tx

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Evidence: Michael


No previous tx

Recurrent otitis media through age 3:8

Behavior, attention difficulties

Language processing

Mom sat in on sessions, good follow throughat home

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Michaels progress in conversation



A-P contrast 40%

Stridents 40%


Liquid /l/ 0%

Liquid /r/ 100%

Voicing contrast 0%



A-P contrast 60%

Stridents 60%


Liquid /l/ 0%

Liquid /r/ 100%


Data from 4 months into tx

All at 100% except other clusters after 10 months tx

Every speech sound correct including complex consonant sequences after 14 months tx

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Dismissal

All deviation percentages of occurrence

(except liquids) below 40%

TOMPD (total occurrences of major

phonological deviations) on HAPP-3 below 50

Probably need to continue phonological skills

training

Follow-up after 6 months

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The last word

3-6 months to generalize to conversation after

fluent productions at word level

Key is to KEEP MOVING ON

Dont get stuck on something they havent

generalized

Dont expect Cycles to work if you modify it

myspeechteacher.wikispaces.com

[email protected]

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Appendix A

History of Therapy Approaches

from Hodson 2010 (see note)

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Overview

Early Approaches Phoneme-Oriented Intervention

Phonetic Placement

Moto-Kinesthetic

Stimulus Approach

Sensory-Motor Approach

Discrimination Approach

Behavioristic Approaches

Linguistic-Based Approaches

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Early: Phonetic Placement

Circa 1927

Emphasis on articulators: tongue and lips

Modification of placement and airflow

Use of diagrams and demonstrations Assumption (incorrect) that phonemes are always

articulated with the same placement

Neglects coarticulatory changes

Poor efficacy

May still be useful in early phases of articulationintervention to demonstrate how a phoneme is

produced

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Early: Moto-Kinesthetic Approach

Circa 1938 Speech is a dynamic event

Involved external manipulation of the articulators

Articulatory movement must be felt anddeveloped as a muscle sense of kinesthetic image

Sounds are taught in syllables with schwa,reduplicated syllables, multisyllabic words,

phrases, then sentences Tactile cuing, such as pressing under chin to

stimulate /k/

Poor efficacy

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Early: Stimulus Approach

Van Riper 1939-1978 Aka Traditional Approach

Misarticulations are more than placement orproduction errors

Poor auditory sensory perception contributes

Auditory training prior to production practice

Only one sound targeted at a time

Five steps: sensory-perceptual training, soundelicitation, sound production stabilization (isolation tosentences), transfer, maintenance

Useful for one or two phoneme errors

Problems: insufficient for multiple errors, limitedemphasis on generalization to untargeted phonemes

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Early: Sensory-Motor Approach

McDonald 1964 Attention to position in words (init, med, fin)

Speech is a sequence of syllables rather thansounds in individual words

Recommended deep assessment to examinecoarticulatory effects

Use 2- to 3-syllable words

Correct production in varied phonetic contexts No ear training or production in isolation

Poor efficacy, though better than previous three

Useful for determining facilitative phonetic

environments

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Early: Discrimination Approach

Winitz and Bellerose 1962

Teach auditory discrimination of error soundfrom target sound

Begin with gross contrasts then finer contrasts Ship/lock before ship/chip

Controversy about whether discriminationtasks are necessary

Requires metalinguistic skills, discussion ofword structures as opposed to word meaning

Not developmentally appropriate for younger

children

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Behavioristic Approaches 1

1970s

Articulation hierarchy

Isolation, nonsense syllables (CV, VC, CVC)

All word positions, then phrases, sentences Must meet specific criterion (ex. /k/ 90% in

phrases) before moving up a level

More prompting if productions areconsistently incorrect

Test transfer or generalization to nontreatedwords to determine progress

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Behavioristic Approaches 2

Response to needs for efficiency anddocumentation

Two popular behavioristic phoneme-oriented

approaches: Programmed Instruction (1977)and Multiple Phonemic Approach (1975)

Behavioral objectives have become required

for IEPs

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Behavioristic: Programmed Instruction

Mowrer, Baker, & Schutz 1968

Reinforcement schedules: stickers, tokens

Penalties for incorrect production

Many responses required--tedious, boring (for

clinician and child)

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Behavioristic: Multiple Phonemic

McCabe & Bradley 1975 Establishment phase: all phonemes in isolation

Even correct phonemes

Every phonemes produced at least once each session

Transfer phase: similar to Stimulus Approach Articulation hierarchy

Whole word accuracy is calculated

Maintenance phase: Conversation outside the session andover time

Working on so many targets at the same time is confusingfor children with many errors

Data collection and organization cab be difficult

SLPs often modify this programseveral not all phonemes

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Linguistic: Distinctive Features

Blache 1978 Distinctive features: classification system to distinguish

phonemes across languages Place, manner, voice, etc.

Experimental, limited clinical application

Target features rather than phonemes

Subsequent substitutions that include desired features arereinforced and viewed as progression toward correctproduction

No isolated phonemes; use minimal pairs Distinctive features are helpful for classifying sounds, but this

approach does not account for omissions

Distinctive feature analysis has been subsumed under

phonological analysis

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Linguistic: Phonological Approaches

Hodson & Paden 1983, 1991; Stoel-Gammon &Dunn 1985

Goals: intelligibility, reorganized phon. System,

enhanced strategies for phon. Processing Early approaches focused on suppression of

processes through intervention of sounds

affected by the processes Cycles, Metaphon, Phonological Awareness

l

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Cycles

Um.. Go back to the beginning

i i i h

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Linguistic: Metaphon

Howell & Dean 1994 Cognitive-linguistic approach

Premise is children can change sound productions bydeveloping awareness of place, manner, voice

similarities & differences Emphasis on classification rather than production

Phase one: phonological production concepts andterms are targeted through sorting of nonspeech

sounds Phase two: judgment of minimal pair words

1995 study showed that preschoolers improvedexpressive phonological productions

Li i i Ph l i l A

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Linguistic: Phonological Awareness

Not a separate approach

Expressive phonology impacts literacy

Phonological awareness ability is highly

correlated with literacy success

Awareness of sound structure, ability to

manipulate sounds in words, etc.

Phonological awareness can be taught

Intervention can change both phonological

awareness and expressive phonology

Li i i Wh l L

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Linguistic: Whole Language

Children with expressive phon. Problems often have otherlanguage impairments

Interactive story-telling can improve phonologicaldevelopment, as well as semantic, and syntactic skills

Child describes picture, SLP scaffolds Encourage child to clarify sounds, sentence structure, semantic

relationships

Encourage to add information

Encourage to increase complexity by including relationships (ex.cause-effect) and motivation (ex. feelings)

SLP models enhanced language, children restate

Efficient and effective for children with mild impairment

Children with more severe deficits need more directphonological intervention

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Appendix B

Target Selection

from Hodson 2010

Ph O i t d A h

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Phoneme-Oriented Approaches

Chronological or developmental age

Early-developing phonemes are considered a

prerequisite for later-developing phonemes

Phoneme frequencyex. /s/

Stimulabilitystimulable before non

Visibilityex. labial consonants

Variability inconsistencysounds produced

sometimes are chosen

Utilityex. sound in the childs name

Ph O i t d A h

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Phoneme-Oriented Approaches

Elbert 1992; Gierut, Morrisette, Hughes, &Rowland 1996 suggest selection of phonemeswith least productive phonological knowledge

Nonstimulable, later developing

A series of single-subject design studies suggestedsome benefit

Rvachew and Nowak 2001 challenged this

based on results of a randomized-controlstudy

Results were poorer for children working on leastphonological knowledge targets first

7/27/2019 Cycles 2013

87/87

cycles 2013

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