1
Q
Intervention for speech sound disorders is
A
-very exciting
2
Q
There is nothing in the world like
A
the feeling you get when a child first says a sound correctly!!
3
Q
Using classroom language arts books for therapy
A
helps us help kids achieve Common Core State Standards
4
Q
According to our text:
A
- 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)
5
Q
The point is to remain flexible…
A
And do what is best for each individual client
6
Q
Non-Speech Oral-Motor Exercises
A
- PBH do not believe that oral motor exercises are beneficial for anybody
- They say research has not proven that oral motor exercises help
7
Q
What is Roseberry’s position on Non-Speech Oral-Motor Exercises?
A
Roseberry’s position: these exercises are very helpful for children with oral motor problems
8
Q
Kent, R.D. (2015 November ). Nonspeech oral motor movements and disorders: A narrative review. American Journal of Speech-Language Pathology.
A
- He said that NSOMMs can be part of practice in orofacial myology
- Can be used with persons with dysarthria and dysphagia
- Don’t just reject NSOMMs wholesale
9
Q
What is the TRADITIONAL APPROACH?
A
- (Van Riper)
- Around since 1920s
- Still popular and widely-used today
- However, most SLPs really don’t do ear training any more
10
Q
Production Training: Sound Establishment
A
- Establish correct sound production in isolation
- Use phonetic placement techniques
- Successive approximation
11
Q
Production Training: Sound Stabilization
A
Stage 6 Conversation ↑ Stage 5 Sentences ↑ Stage 4 Phrases ↑ Stage 3 Words ↑ Stage 2 Nonsense syllables ↑ Stage 1 Isolation
12
Q
- Isolation
A
—use variety of fun activities
13
Q
- Nonsense syllables
A
—I don’t really use these
14
Q
- Words
A
—begin with words that are meaningful to the child. I work on sounds:
- word-initial
- word-final
- word-medial
- Clusters
15
Q
(3. words) For example, with /s/:
A
Begin with soup, see, sun (word-initial)
Next: bus, face, piece (word-final)
Then: Classes, lesson (word-medial)
Last: Crust, stop, faster (clusters)
16
Q
- Phrases
A
– in-between stage—carrier phrases common—e.g.:
I see ____
This is___
17
Q
- Sentences
A
– various length and complexity
18
Q
To establish sound in sentences:
A
- Corrective set
- Slow motion speech
19
Q
What is Corrective Set?
A
SLP makes an error (e.g., fɪk/θɪk) and kids “catch” her)
20
Q
What is Slow Motion Speech?
A
SLP and ch say sentence together very slowly
21
Q
- Conversation
A
- 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.’
22
Q
Transfer and Carryover
A
- Vary the audience and settings
- Speech assignments
23
Q
Maintenance
A
- Book: follow-up sessions
- Dr. R.: in schools, keep on IEP, but reduce to tx once a week
24
Q
CONCURRENT APPROACH
A
- Said SLPs don’t have to use hierarchy we just described
- First establish sound in isolation and CV, VC combos—80% accuracy
- Then, mix it up in tx!
25
CSHA Dr. Steve Skelton
If we vary the response topography in each tx session, Ch will make increase gains than if we just go up the hierarchy like a ladder
26
(CSHA Dr. Steve Skelton)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
27
Dr. Skelton: ACTIVITIES AND IDEAS FOR ELICITING AT LEAST 150 PRODUCTIONS PER GROUP SESSION
-Kids take own data
-Subvocalize (“say it with your voice turned off”) while other students taking their turns
-Tally counters challenge students--150+ productions
-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
-Then you yell “switch!”
-Ask students to create cards with creative ideas for more interesting drill
-They draw card, practice sound the way card says
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”
-Echo microphone
-Puppets, costumes
-Roll a dice or draw number from envelope to determine how many productions they have to make
28
OTHER IDEAS FOR CENTERS
- Read books or stories with target sound
- Hula hoops
- Jump rope
- Create stories with flip books
- Put stickers or stamps on a paper
- Legos
- Kick a ball
- Blocks
- Put Bingo chips into jar
- Pick up sticks
- Blow bubbles
29
PHONOLOGICAL CONTRAST APPROACHES
These approaches have become popular and are supported by research
30
Minimal contrast training
- use minimal pairs which only differ by one feature such as
- voicing (to-do, pan-ban)
- Place of articulation (tea-key)
31
Maximal contrast training
- Sounds differ by at least 2 features
- Cane-lane
- Ten-men
32
What is Cane-Lane?
/k/ is a voiceless linguavelar stop; /l/ is a voiced lingual-alveolar glide
33
What is Ten-Men?
/t/ is a voiceless tip-alveolar plosive; /m/ is a voiced bilabial nasal
34
I really like contrast training because:
The child sees that the sound used makes a semantic difference
35
COMPLEXITY APPROACH
- 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/)
36
Premise:
-Start with hardest sounds for ch
-Assumes: if train hardest sounds first, automatic generalization to easier sounds
E.g., ch produces /j/ 30% accuracy, /s/ 20% accuracy, /ð/ with 0% accuracy
-Start with /ð/ and assume that /s/ and /j/ will be positively impacted
37
HODSON’S CYCLES APPROACH
- General Procedures:
1. Stimulation—use of auditory, tactile, visual cues to ↑awareness of target sounds
2. Production training —produce correct sound
3. Semantic awareness contrasts —minimal pair training
- Remediation program planned around a cycle
- Cycle: time period required for child 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
38
Selection of Target Patterns and Phonemes
Top Priority:
| 1. Early-developing phonological patterns:
39
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
40
In order to move onto secondary patterns, 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)
41
2. Secondary Patterns
A. /j/, sibilants /s,z/, /r/
B. Consonant clusters
C. Singleton stridents ( e.g., /s, z, f/)
D. Multisyllabic words
42
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)
3. Target only one phonological pattern per session
4. When all target patterns have been taught, a cycle is complete
5. Initiate second cycle. Review patterns not yet corrected, intro new ones as necessary
- to become intelligible, most ch need 3-6 cycles of therapy
43
Structure of Therapy Sessions
1. Review word cards from previous session
2. Auditory bombardment (use amplification!) SLP reads list of 12 words for about 2 min., 2x if ch paying attention.
3. Target word cards—3-5 new target words. Ch draws, colors etc. and SLP writes name of pic on card.
4. Production practice—games, shift activities every 5-7 minutes
5. Stimulability probing—check if ch stimulable for phoneme planned for next session
6. Repeat auditory bombardment w/ 12-item word list used at beginning of session
44
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)
45
NATURALISTIC APPROACH
- 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
46
Work in the child’s natural settings—and have fun!
- Establish word and sound approximations so listener understands ch better
- Use natural recasts —corrective feedback given in naturalistic fashion—correct model given without ch being interrupted and asked to repeat
47
Speech recast:
Adult feedback that immediately follows a ch’s utterance and provides an exact or reduced imitation of the ch’s words
Uses adult pronunciation
48
CORE VOCABULARY APPROACH (a fave )
- 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
49
Inconsistent SSD:
-assess child’s multiple productions of the same word in the same phonetic context
For example: (25 different pictures on 3 separate trials within one session)
1. Child is asked to produce “cat” and 24 other pictures
2. Activity
3. Asked to produce “cat” and 24 other pictures
4. Activity
5. Asked to produce “cat” and 24 other pictures
50
Scoring:
-Incorrect prod= 0
-Correct prod = 1
-Total score converted to %age—40% meets criterion for inconsistent SSD
“A word produced identically regardless of accuracy receives a score of zero”
“A word produced differently on at least one of the trials receives a score of 1.”
51
Structure of Intervention
- Ch at least 2 yrs. old
- Indiv. tx 2x/week 30 min. for 8 weeks
- Goal= increase ch’s intelligibility
- Select 70 words that are important to the individual ch
- Objective = best possible production (intelligible, not perfect) consistently
- Developmental errors accepted
- Parents and teachers must be involved—feedback
- Intended as foundation for more traditional methods
52
(Structure of Intervention)I love it!!
- Gives ch immediate ↑intelligibility
- Words are important in ch’s immediate environment
- Immediately ↓s frustration
53
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
54
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
55
Ann Tyler—ASHA 2015 (The phonology-morphology interface in children with SSD: Development, assessment, and treatment considerations.**
- Concomitant SSD and language impairment (LI) is the strongest predictor of literacy outcomes
- Children with both SSD and LI have many omissions, while children with just SSD have many more substitutions
56
Tyler 2015:
- Eliminating error patterns like final consonant deletion and cluster reduction will improve production of grammatical morphemes
- Recommends an integrated approach
- Combine therapy for speech and language
57
(Tyler)These morphemes include:
- Past tense –ed (jumped, scared)
- Plural –s (pots, sidewalks)
- Regular 3rd person –s (eats, runs)
- Possessive –s (Grant’s, Bob’s)
58
Therapy suggestions:
- If ch has final consonant deletion, use minimal pairs which include grammatical morphemes
- -For example (FCD):
- Plurals: toe-toes key-keys
- Possessives: Joe-Joe’s Ray-Ray’s
- Regular past tense –ed show- showed
59
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
60
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
Exam 4 SPHP 126
flashcards
Decks in class (5)
# Cards
