Speech Therapy in Children with Snyder-Robinson Syndrome

Angela M. Fox, Ph.D., CCC-SLP

Role of the Speech-Language Pathologist (SLP)

Assessment Intervention Augmentative and alternative communication

(AAC)

Provide: prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up.

For: speech, language (morphology, semantics, syntax, pragmatics, phonology), cognitive-communication, voice, swallowing and feeding, and fluency disorders throughout the lifespan.

(ASHA, 2001b)

Collect and then integrate information about individuals' speech, language, cognitive-communication, voice, swallowing, fluency, reading/literacy, and writing capabilities (Beukelman & Mirenda, 1998c).

Can include:◦ standardized tests

◦ criterion-referenced measures

◦ parent report formats

◦ play-based observations

◦ assessment of daily routines

◦ dynamic methods

ASHA, 2008

Federal regulations governing infant and toddler services under IDEA 2004 states that assessment should include:

a) identification of the child's unique strengths and needs

b) a family-directed assessment of the concerns, priorities, and resources of the family related to the development of the child

c) identification of the nature and extent of the early intervention services needed by the child and family

d) the identification of supports necessary to enhance the family's capacity to meet the developmental needs of the infant or toddler(§636(a)(2))

Tied directly to instructional planning◦ standardized tests

◦ qualitative analysis of student work samples

◦ observations

◦ self-report measures

ASHA, 2008

The World Health Organization (2001) definitions underscore the need for assessment to address involvement in daily life activities and social aspects of communication.

Assesses the patient in the context of the patient's education, life experience, effort, personal goals, and values (ASHA, 2003).

Involves gathering structured and systematic observations within functional context-bound activities in multiple settings (Notari-Syverson & Losardo, 1996; Olswang & Bain, 1996; Pena, 1996).

Assessment materials or strategies are selected that support observation-based assessment in natural environments within the areas found to be most challenging.

Language samples can be collected to determine the range of forms, meanings, and functions (Goldstein et al., 1996).

Needed to assess changes associated with intervention efforts and to assess changes in the individual's communication needs.

Furthermore, it is essential to determine whether intervention efforts are having the desired effect on communication skills.

• Need to monitor communication function closely when adding or changing therapy of AEDs.

Environmental arrangement (Demchak & Downing, 1996; Kaiser, Yoder, & Keetz, 1992)

1. Set up the opportunity to encourage the child to communicate.

2. Wait until the child communicates ( with sounds, gestures or words)

3. Expand child’ s communication form by modeling a target.

Milieu approach (Kaiser & Roberts, 2013)

Responsive interaction strategies ◦ language modeling

◦ expansions of child utterances

Behavioral teaching strategies◦ environmental arrangement

◦ selecting and teaching specific language targets appropriate to the child’s skill level

◦ responding to the child’s initiations with prompts for elaborated language consistent with the child’s targeted skills

Parent-implemented interventions (Arthur, Butterfield, & McKinnon, 1998; Roberts & Kaiser, 2011).

Interaction between the child and the parent occurs during play, routines, and everyday activities.

Provide opportunities for turn-taking

Use specific language through models and expansions

Prompting target production

These techniques typically include basic features of:

following the child's lead

embedding techniques throughout the child's daily routines and activities

providing caregiver support/training in multiple settings and contexts

Bricker et al., 1998; McWilliam, 1996

Increases children’s receptive and expressive language skills (Tsybina & Eriks-Brophy, 2010; van Kleeck et al., 2006).

The adult and the child switch roles so that the child learns to become the storyteller with the assistance of the adult.

The adult becomes an active listener, asks questions, adds information, and prompts the child to use more and more sophisticated responses to questions.

PEER sequence:

P= Prompt the child to say something about the book

E= Evaluate the child's response

E= Expand the child's response by rephrasing and adding information to it

R= Repeat the prompt to ensure the child has learned from the expansion

Zevenbergen & Whitehurst, 2003

Pragmatics – social language

Figurative language - nonliteral language uses such as idioms and metaphores.

Inferences - integration of meaning within text and verbal problem solving.

Written language

Polysemous vocabulary - words that have multiple meanings.

ASHA, 2001

Different disorders may result in changes in oropharyngeal muscular strength and coordination over time.

◦ Compensatory techniques are designed to help the individual swallow safely, not to alter physiology.

Position – chin tuck

◦ Habilitative techniques are designed to change swallowing physiology and can also be used as compensation.

effortful swallow

thermal-tactile stimulation

ASHA, 2001

• Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas.

• Intended primarily to maximize individuals' abilities to communicate as effectively and efficiently as possible.

• A primary purpose of AAC is often viewed as supplementing or augmenting the effectiveness with which individuals communicate through their existing methods of communication (Romski & Sevcik, 1996).

• For other individuals, the AAC system may serve an alternative function in that it becomes the primary and perhaps only means of communication. The role of AAC may vary for an individual depending on the course of the disorder (Beukelman & Mirenda, 1998b; Mathy, Yorkston, & Gutmann, 2000).

Numerous studies have demonstrated that the use of AAC does not interfere with speech development (Romski, Sevcik, & Hyatt, 2003) and actually has been shown to support such development (Charlop-Christy et al., 2002; Marckel, Neef, & Ferreri, 2006; Millar, Light, & Schlosser, 2006; Romski & Sevcik, 1996).

• Unaided communication systems – rely on the user's body to convey messages. Examples include gestures, body language, and/or sign language.

• Aided communication systems – require the use of tools or equipment in addition to the user's body. Aided communication methods can range from paper and pencil to communication books or boards to devices that produce voice output (SGD's)and/or written output. Electronic communication aids allow the user to use picture symbols, letters, and/or words and phrases to create messages. Some devices can be programmed to produce different spoken languages.

• Speech generating devices (SGDs), whether electronic or nonelectronic, is used to transmit or receive messages.

• Range from simple devices, such as a choice selection between two photographs affixed to a sheet of paper, or a single message recorded on a single switch-activated device, to relatively complex technologic presentations of numerous symbols that can be combined to convey an infinite variety of meanings.

Direct selection techniques tend to be faster (depending on the individual's motor control), and easier to learn and use, but have greater motor requirements than scanning techniques (Cook & Hussey, 1995; Dowden & Cook, 2002).

Consider alternatives to hand movements:• Motor limitations – use eye-gaze

• Dowden and Cook (2002) proposed a hierarchy of control sites (i.e., locations on the body where an individual demonstrates purposeful movements that may be used to access a switch) Fingers and hands should be considered

before head and feet. They indicated decisions must be based on

actual trials with each individual.

• Naturalistic, client- and family-centered approaches are strongly recommended when introducing AAC systems (Blacksone & Dowden, 2000; Romski & Sevcik, 1996; Sigafoos, 1999).

• Individuals should be taught to use their systems functionally with different communication partners in different settings.

CommunicationCause and effect

Choice making

Requesting

Greetings

Commenting

Initiate

It is important to base intervention decisions on what is occurring “today” as well as what is anticipated for “tomorrow.”

ChoiceBoard Creator – make a personalized grid

Yes/no – allows you to edit pages to make choices

TouchChat - Symbol-supported communication

Proloquo2Go - Symbol-supported communication

TapSpeak Choice - Symbol-supported communication

American Speech-Language-Hearing Association. (2001). Roles and responsibilities of speech language pathologists with respect to reading and writing in children and adolescents [Guidelines]. Available from www.asha.org/policy

American Speech-Language-Hearing Association. (2001). Roles of speech-language pathologists in swallowing and feeding disorders: technical report [Technical Report]. Available from www.asha.org/policy

American Speech-Language-Hearing Association. (2001b). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents (position statement). Rockville, MD: Author.

American Speech-Language-Hearing Association. (2003). Evaluating and treating communication and cognitive disorders: approaches to referral and collaboration for speech-language pathology and clinical neuropsychology [Technical Report]. Available from www.asha.org/policy

American Speech-Language-Hearing Association. (2008). Roles and responsibilities of speech-language pathologists in early intervention: technical report [Technical Report]. Available from www.asha.org/policy

Arthur, M., Butterfield, N., & McKinnon, D. H. (1998). Communication intervention for students with severe disability: Results of a partner training program. International Journal of Disability, Development and Education, 45, 97–115.

Beukelman, D., & Mirenda, P. (1998). Augmentative and alternative communication: management of severe communication impairments (2nd ed). Baltimore: Brookes.

Blackstone, S., & Dowden, P. (2000). Two to Tango: AAC users and their communication Partners. In Proceedings of the 9th Biennial Conference of the International Society for AAC (pp. 129–131). Washington, DC: ISAAC.

Bricker, D., Pretti-Frontczak, K., & McComas, N. (1998). An activity-based approach to early intervention (2nd ed.). Baltimore: Brookes.

Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35, 213-231.

Cook, A., & Hussey, S. (1995). Assistive technologies: Principles and practice. St. Louis: Mosby.

Demchak, M. A., & Downing, J. E. (1996). The preschool child. In J. E. Downing (Ed.), Including students with severe and multiple disabilities in typical classrooms: Practical strategies for teachers (pp. 63–82). Baltimore: Brookes.

Dowden, P., & Cook, A. (2002). Choosing effective selection techniques for beginning communicators. In J. Reichle, D. Beukelman, & J. Light (Eds.), Exemplary practices for beginning communicators: Implications for AAC (pp. 395–431). Baltimore: Paul H. Brookes.

Goldstein, H., Kaczmarek, L., & Hepting, N. (1996). Indicators of quality in communication intervention. In S. Odom & M. McLean (Eds.), Recommended practices in early intervention (pp. 197–221). Austin, TX: Pro-Ed.

Kaiser, A. P., & Roberts, M. Y. (2013). Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities. Journal of Speech Language and Hearing Research, 56, 295-309.

Kaiser, A. P., Yoder, P. J., & Keetz, A. (1992). Evaluating milieu therapy. In S. F. Warren & J. Reichle (Series Eds.) & S. F. Warren & J. Reichle (Vol. Eds.), Communication and language intervention series: Vol. 1. Causes and effects in communication and language intervention (pp. 9–47). Baltimore: Brookes.

Marckel, J., Neef, N. A., & Ferreri, S. J. (2006). A preliminary analysis of teaching improvisation skills with the Picture Exchange Communication System to children with autism. Journal of Applied Behavior Analysis, 39, 109-115.

Mathy, P., Yorkston, K., & Gutmann, M. (2000). AAC for individuals with amyotrophic lateral sclerosis. In D. Beukelman, K. Yorkston, & J. Reichle (Eds.), Augmentative and alternative communication for adults with acquired neurologic disorders (pp. 183–231). Baltimore: Paul H. Brookes.

McWilliam, R. A. (1996). How to provide integrated therapy. In R. A. McWilliam(Ed.), Rethinking pull-out services in early intervention: A professional resource (pp. 49–69). Baltimore: Brookes.

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The Impact of Augmentative and Alternative Communication Intervention on the Speech Production of Individuals With Developmental Disabilities: A Research Review. Journal of Speech Language and Hearing Research, 49, 248-264.

Notari, A. R., Cole, K. N., & Mills, P. W. (1992). Cognitive referencing: The (non) relationship between theory and application. Topics in Early Childhood Special Education, 11(4), 22–38.

Olswang, L., Bain, B., & Johnson, G. (1992). Using dynamic assessment with children with language disorders. In S. Warren & J. Reichle (Eds.), Causes and effects in communication and language intervention (pp. 187–215). Baltimore: Brookes.

Pena, E. D. (1996). Dynamic assessment: The model and its language applications. In K. N. Cole, P. S. Dale, & J. Thal (Eds.), Assessment of communication and language (pp. 281–307). Baltimore: Brookes.

Roberts, M. Y., & Kaiser, A. P. (2011). The effectiveness of parent-implemented language interventions: A meta-analysis. American Journal of Speech-Language Pathology, 20, 180–199.

Romski, M. A., & Sevcik, R. A. (1996). Breaking the speech barrier: Language development through augmented means. Baltimore: Brookes.

Romski, M. A., Sevcik, R. A., & Hyatt, A. (2003). Augmentative and alternative communication for persons with mental retardation. In L. Abbeduto (Ed.), International Review of Research in Mental Retardation. New York: Academic Press

Sigafoos, J. (1999). Creating opportunities for augmentative and alternative communication: Strategies for involving people with developmental disabilities. Augmentative and Alternative Communication, 15, 183–190.

Tsybina, I., & Eriks-Brophy, A. (2010). Bilingual Dialogic Book-Reading Intervention for Preschoolers with Slow Expressive Vocabulary Development. Journal of Communication Disorders, 43(6), 538-556.

van Kleeck, A., Vander Woude, J., & Hammett, L. (2006). Fostering literal and inferential language skills in Head Start preschoolers with language impairment using scripted book-sharing discussions. American Journal of Speech-Language Pathology, 15(1), 85-95.

Zevenbergen, A. A., & Whitehurst, G. J. (2003). Dialogic reading: A shared picture book reading intervention for preschoolers. In A. Van Kleeck, S. A. Stahl, & E. B. Bauer (Eds.), On reading books to children: Parents and teachers (pp. 177–200). Mahwah, NJ: Erlbaum.