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SPECIFIC TREATMENT PROGRAMS AND APPROACHES (chapter 8)
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I. INTRODUCTION** Intervention for speech
sound disorders is very exciting
There is nothing in the world like the feeling you get when a child first says a sound correctly!!
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These are ideas I use as an SLP in my job
in the schools:
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Using classroom language arts books for therapy—helps us help kids achieve
Common Core State Standards:
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According to our text ch. 8:** Most tx approaches move from a simple
to complex level of training (except the concurrent approach)
Some approaches do contradict each other (e.g., start w/ stimulable vs. nonstimulable sounds)
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The point is to remain flexible…**
And do what is best for each individual client
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Non-Speech Oral-Motor Exercises**
PBH do not believe that oral motor exercises are beneficial for anybody
They say research has not proven that oral motor exercises help
Roseberry’s position: these exercises are very helpful for children with oral motor problems
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II. TRADITIONAL APPROACH (Van Riper)**
• Around since 1920s
• Still popular and widely-used today
• However, most SLPs really don’t do ear training any more (info on ear training on p. 402 is not on exam)
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A. Production Training: Sound Establishment
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B. Production Training: Sound Stabilization**
• Stage 6 Conversation• ↑
• Stage 5 Sentences• ↑
• Stage 4 Phrases• ↑
• Stage 3 Words• ↑
• Stage 2 Nonsense syllables• ↑
• Stage 1 Isolation
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• 1
• 2.
• 3.
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For example, with /s/:**• Begin with soup, ssee, sun (word-
initial)
• Next: bus, face, piece (word-final)
• Then: Classes, lesson (word-medial)
• Last: Crust, stop, faster (clusters)
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• **4. Phrases – in-between stage—carrier phrases common—e.g.:
• I see ____
• This is___
• 5. Sentences – various length and complexity (examples bottom of p. 405)
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To establish sound in sentences:
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• 6. Conversation**
• Start with structured conv.—e.g., SLP gives a topic or specific pictures to talk about
• Transition to natural conv.—open ended. E.g., “Tell me what costume you wore for Halloween.’
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C. Transfer and Carryover**• Vary the audience and settings
• Speech assignments
• In small groups—what are some practical strategies for implementing these ideas in a school setting?
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D. Maintenance
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III. CONCURRENT APPROACH (lecture notes only—not text)
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CSHA Dr. Steve Skelton
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For example, in one session:**
• 1. /r/ in final position of words
• 2. /r/ in VC combos
• 3. /r/ in sentences in word-initial position
• 4. /r/ in word-medial position in phrases
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Dr. Skelton: ACTIVITIES AND IDEAS FOR ELICITING AT LEAST 150 PRODUCTIONS
PER GROUP SESSION
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• Post charts individual/group competition**
• Create stations--students do something different every minute or so while practicing sounds
• E.g., one ch on whiteboard, one putting puzzle together, one lying on floor, one using flashcards at table
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• E.g., “Say /r/ 10 times by itself while you are doing jumping jacks.”**
• “Say at least 3 sentences with /s/ while you draw a picture on the whiteboard.”
• “Say ‘the’ while you are doing hopscotch”
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• Echo microphone**
• Puppets, costumes
• Roll a dice or draw number from envelope to determine how many productions they have to make
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OTHER IDEAS FOR CENTERS**
• Read books or stories with target sound
• Hula hoops
• Jump rope
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• A. Introduction
• These approaches have become popular and are supported by research
IV. PHONOLOGICAL CONTRAST APPROACHES**
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• B. Minimal contrast training
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C. Maximal contrast training
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I really like contrast training because:
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V. COMPLEXITY APPROACH (Lecture only, not book)**
• Most research done with individual children in a university setting (not tried in schools w/ diverse groups)
• Best for ch with individual sound errors (e.g., w/r; j/l)
• Assumes that the complex sounds are affricates, fricatives, and clusters and sounds that are not stimulable
• Also assumes that later-developing sounds (e.g., /tʃ/, /r/ ) are more complex than earlier-developing sounds (e.g., /m/ and /p/)
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Premise:
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VI. HODSON’S CYCLES APPROACH (emphasized on
exam!)**• A. Introduction
• General Procedures
1. Stimulation—use of auditory, tactile, visual cues to ↑awareness of target sounds2. Production training —produce correct sound3. Semantic awareness contrasts —minimal pair training
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• Remediation program planned around a cycle**
• Cycle: time period required for Ch to focus on each deficient phonological pattern for 2-6 hours
• Pattern = phonological process
• Focuses on teaching stimulable sounds
• Early on, stick to simple CVC words
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B. Selection of Target Patterns and Phonemes**• Top Priority:
• 1. Early-developing phonological patterns:
• Initial and final consonant deletion of stops, nasals, and glides
• CVC and VCV word structures• Posterior-anterior contrasts (k-g, t-d, h)• /s/ clusters--word initial clusters /sp, st,
sm, sn, sk/ and word-final clusters /ts, ps, ks/
• Liquids /r/ and /l/ and clusters containing these liquids
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In order to move onto secondary patterns (next slide), the child must
demo:**• Appropriate syllableness
• Production of single consonants
• Some emergence of velars and /s/ clusters
• Productions of practice words with /l/ and /r/ without gliding (no w/r or j/l)
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2. Secondary Patterns (for later—see criteria bottom of
p. 414)
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C. Structure of Remediation Cycles**
• 1. Train each phoneme exemplar within a target pattern for 60 min per cycle before going to the next phoneme
• 2. Train 2 or more target phonemes in successive weeks within a pattern before changing to the next target pattern
• (2+ hours on each pattern within a cycle)
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• **
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D. Structure of Therapy Sessions• 1.
• 2.
• 3.
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• 4.
• 5.
• 6.
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E. Home Program**
• Caretakers are asked to read the 12-item word list once a day.
• Child is asked to name the 3-5 pictures once a day (may also produce other target words)
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VII. NATURALISTIC APPROACH**
• A. Introduction
• Focuses on improving child’s overall intelligibility and whole-word accuracy first, then works on individual phonemes in error
• For severely involved children like preschoolers, those with Down Syndrome, autism spectrum disorder, cerebral palsy
• Approximations of sounds OK
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This is what DJ and I do a lot in our preschool SDC at Grand Oaks Elementary
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Work in the child’s natural settings—and have fun!
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Speech recast:
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Example of a speech recast I just did with 3-yr old Brandon (Down Syndrome):**• Brandon (pointing to
Candyland card): “u!!”
• Dr. R.: “That’s right, Brandon! Yay! That is blue.”
• Brandon (Dr. R’s lucky day): “b-u!” (A CV combination with lip rounding and everything!!)
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VIII. CORE VOCABULARY APPROACH (a fave )**
• A. Introduction
• Designed for the 10% of children with functional SSDs characterized by inconsistent errors on the same words
• These children don’t have childhood apraxia of speech
• Been used with 2-year olds, bilingual children, Down Syndrome
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Inconsistent SSD: assess child’s multiple productions of the same word in the same
phonetic context**
For example: (25 pictures)
• 1. Child is asked to produce “cat”
• 2. Activity
• 3. Asked to produce “cat”
• 4. Activity
• 5. Asked to produce “cat”
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Scoring:
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B. Structure of Intervention
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I love it!!
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IX. Language Treatment for Phonological Disorders--PBH**
• PBH: research is inconclusive re: the question: Can language therapy improve children’s speech skills?
• Bottom line: If the child has a language and speech disorder, best to do both language and speech therapy simultaneously.
• In other words, don’t just do language therapy and hope that somehow better speech sound production will magically improve follow
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X. Combining Therapy for Language and Speech Sound
Disorders**• We can connect speech sound
production to children’s morphosyntactic skills
• If children have final consonant deletion or cluster reduction, they will have problems with some morphemes
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These morphemes include:**• Past tense –ed (jumped, scared)
• Plural –s (pots, sidewalks)
• Regular 3rd person –s (eats, runs)
• Possessive –s (Grant’s, Bob’s)
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Therapy suggestions:
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For example (FCD):**
• Plurals: toe-toes key-keys
• Possessives: Joe-Joe’s Ray-Ray’s
• Regular past tense –ed show-showed
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If the child uses cluster reduction:**
• Plurals boat-boats cup-cups
• Possessives cat-cat’s Dad-Dad’s
• Regular past walk-walked
• Irregular past drink-drank hold-held
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We can also connect phonology to semantics:**
• Children with language impairments often have difficulty with verbs
• For velar fronting: tame-came; taught-caught
• Stopping of fricatives: tee-see, toe-sew, tip-ship
• Final consonant deletion: shoe-shoot, ray-rake; say-sail