Exam 3

Question 1

Treatment is:

Answer 1

• Application of variables that change behaviors

* What the clinician does, not the client.

Question 2

Sequence of Treatment Components:

Answer 2

o Stimulus
o Response
o Reinforcement

Question 3

• Short-Term Objectives:

Answer 3

o Things that can be trained in a relatively short period of time.
o Semester, such as on our treatment plan
o Hospital setting: few days, week
o Measurable, Objective
o So that you can chart their progress in tx
o Response recording is important so that you have the data to back your goal.
o Observable behavior
o Avoid words like think, assess

Question 4

• Long-Term Goals:

Answer 4

o More broad
o What you want to achieve by the time they discharge
o Age appropriate communication skills
o Will always be changing
o Articulation or phonological skills that the child is expected to learn by the end of a specified treatment period (i.e., semester or year)
o STG help support the LTG

Question 5

o Ultimate LTG:

Answer 5

Maintenance of the trained skill in the client’s natural environment across varied settings or situations

Question 6

• Short-Term Objectives must address:

Answer 6

• Actual skill you are targeting
• Response mode: either production or discrimination
• Response level: word level, sentence level, convo level
• Quantitative criterion: 80% accuracy, etc.
• Setting: clinical, classroom, home, structured therapy setting
• Number of sessions: across three sessions

Question 7

• STG for individual sounds:

Answer 7

o The client will produce the /s/ and /z/ phonemes in single words with 90% accuracy across 3 structured clinical therapy sessions.
o The client will produce the /r/ phoneme with 85% accuracy in conversational speech at the clinic, at school and in the child’s home across three speech samples

Question 8

• In treating phonological skills, the goal may be:

Answer 8

o To eliminate certain phonological processes so that unstable word forms are eliminated
• Unstable word forms: ex: Save, sake, take, tav produces a variety of word forms for the same word.
o The child will decrease the PP velar fronting by producing k and g by with 80% accuracy across 3 structured clinical therapy sessions.
o Homonomy: Producing two words exactly the same, no contrast between the two words.

Question 9

• STG for phonological skills:

Answer 9

o The client will reduce his use of final consonant deletion by producing /p/, /k/, /t/, and /m/ in word final position at the word level with 90% accuracy measured across three clinical sessions.
o The client will establish contrast between singleton and consonant clusters by producing the following /s/ + stop clusters in the initial word position with 80% accuracy measured across three consecutive sessions: /st/, /sp/, and /sk/.

Question 10

Selecting the Initial Level and Sequence of Training:

Answer 10

• Generally, the higher the complexity you can start at, is most efficient.
• However, you don’t want to start too complex where the child will shut down and become frustrated.
• Take into consideration the child’s individual needs
• Look at each child and make sure the behaviors you are targeting are beneficial, meaningful in their home environment.

Question 11

Hegde & Davis (2005) make the following recommendations:

Answer 11

1. First, select behaviors that will make an immediate and socially significant difference in the communicative skills of the client.
   • Social communication
   • Academic achievement
   • Occupational performance
   • Includes sounds that are used highly in vocabulary first to improve speech intelligibility faster.
2. Second, select the most useful behaviors that may be produced and reinforced at home and in other natural settings
   • Reinforced in the home.
3. Third, select behaviors that help expand the communicative skills
   • Phrases and sentences that can be easily expanded.
4. Lastly, select behaviors that are linguistically and culturally appropriate for the individual client
   • Find out what vocab is used culturally, pragmatics, language structures.

Question 12

One criterion is to select treatment targets according to Developmental Norms:

Answer 12

1. Select “age-appropriate” speech and language skills
2. Target sounds that the child is misarticulating that are produced by younger, normally developing children first
3. Treatment of sounds should follow from earliest-to-latest acquired sounds
4. It is generally considered unwise to select sounds that are mastered at older ages than the child’s current age
5. It has always been believed that skills mastered chronologically earlier are simpler than those acquired late
6. Normative sequence of skills acquisition may be inviolable
7. Individual sounds expected to be mastered by the age of the child, but which the child has not mastered, are targets
8. Phonological processes that disappear by the age the child has attained but have persisted are targets for elimination

Question 13

Problems with Normative Criterion:

Answer 13

1. Children learn phonological skills at varying rates
2. Individual differences are important
3. A child’s unique and individual needs may not be met if developmental norms were used exclusively
4. It is important to remember that developmental norms are a statistical representation of the average performance of an entire age group so don’t base treatment target selection solely on age-appropriateness

Question 14

Select More Readily Taught Treatment Targets:

Answer 14

1. Initially select targets that are easier to teach
2. Treat targets that do exist, but not at the expected levels
3. Sounds that have a low base rate of correct production should be treated first (between 20% & 40%)
4. Treat sounds that are produced with visible articulatory movements (i.e., bilabials)
5. From a phonological processes standpoint, treat processes whose frequency is less than 100%, processes that only occur in certain phonetic contexts, and processes that affect sounds that the child produces correctly elsewhere; treat unstable or inconsistent processes.
6. Hodson & Paden (1991) recommend that if the frequency of a phonological process is less than 40%, it should not be treated

Question 15

Reasons for treating sounds stimulable sounds or inconsistent sound or processes is:

Answer 15

1. Initial treatment sessions may produce faster results
2. Strengthen what is already taking place in the speech of the child
3. Only problem: if the targets treated do not result in generalization to untreated error sounds

Question 16

Select Targets That Produce Extensive Generalization

Answer 16

1. Generalization is an indirect behavioral effect of tx.
2. Generalized productions are a treatment goal, and positive changes in sounds not treated save much time and training effort
3. An example: treating a few fricatives with generalization to the remaining fricatives without additional treatment

Question 17

Select Targets That Affect Intelligibility The Most

Answer 17

1. Select targets that affect speech intelligibility the most in children should be the initial treatment targets
2. Select a phonological process that occurs frequently or the one that affects a large number of sounds since they might significantly reduce a child’s intelligibility
3. Select treatment targets that result in homonymy (replacement of a single word for multiple words, resulting in loss of meaning)
4. Another recommendation is to select any unusual, deviant, or idiosyncratic process (i.e., velarization, frication of stops or glottal replacement), which result in rapid improvement in intelligibility of speech
5. Another recommendation: treatment should simultaneously target multiple sounds
6. There is some limited evidence that when the treated words are of high frequency, better generalization may be obtained as opposed to the treatment of low frequency words

Question 18

Summary of Guidelines on Target Behavior Selection

Answer 18

If immediate success in initial treatment sessions is more important than generalized effects, select as treatment targets:

1. Easier to teach
2. Stimulable
3. Visible
4. At least produced inconsistently

Question 19

If the child can tolerate a somewhat delayed success in initial treatment segment that may result in more immediate generalized productions and marked positive effects on speech intelligibility, select:

Answer 19

Complex sounds that are produce consistently in error

2. Non-existent in repertoire
3. Processes that affect a greater number of sounds
4. Processes that are idiosyncratic
5. Reduce homonomy
6. Processes that are exhibited in 100% of opportunities
7. Phonemes that contain maximal phoneme feature contrast
8. Sounds that contain multiple phoneme feature oppositions

Question 20

Regardless of the initial success or generalization considerations, select:

Answer 20

Ethnoculturally appropriate

2. Sounds that are in the child’s dialect
3. Sounds most frequently used in the child’s language or home environment

Question 21

Regardless of the target behavior selection strategy chosen, you should assess the effects of just completed treatment on untreated but potential targets

Answer 21

always be probing in therapy as they are getting success in therapy.

Question 22

Deciding the Number of Sounds or Patterns to Teach at One time

Answer 22

• Motivation
• IQ
• Home Support/family support
• More targets you can target at one time the better
• If they can handle it target 4 or 5 at one time, if overwhelming, back down.
• Also know how much time you have, individual therapy is different than group therapy at school.

Question 23

Planning & Developing a Treatment Program

Answer 23

• Prior to starting therapy
• Hospital: built into dx report
• Schools: IEP
• Clinic: actual PP

Question 24

components of a TP:

Answer 24

• Identifying Information: name age address background
• Targets you will select in therapy
• General procedures, tentative sequence of training
• Listing goals
• May include dismissal criterion possibly
• Follow up
• Will vary based on place

Question 25

Establishing Baselines

Answer 25

• Baselines: measured rates of behaviors in the absence of treatment o First session gather baseline o Will need to chart progress o Get quantitative information, what level you are looking at first. o Will help you establish accountability with yourself, with third party payers

Question 26

Baseline Procedures: change numbers

Answer 26

``` 1. Specify Treatment Targets in Measurable Terms: clinician must have a clear idea of what the intervention targets are before their baselines can be established—STG • Specify at what level (word level, etc.) 2. Prepare the Stimulus Items: • 20 items per target sound • Can also use these later in treatment • Make sure you document cues given 3.Prepare a Recording Sheet: • Record results • Good recording sheet that you can plug in whatever target you are working on 4. Administer the Baseline Trials: • Evoked procedures • Carrier phrase • Modeled trials • +/- • Gather a percentage ```

Question 27

Treatment Continuum: 3 main steps

Answer 27

• Establishment: o Teach the sound o Elicit the target behavior o Stabilize at whatever level you are at • Generalization: o Carrying over to different levels of complexity, different word positions, other situations, other sounds of the same process • Maintenance: o Stabilize or maintain retention of the behavior you taught o Frequency or duration of therapy will lessen and decrease o Client will take on self-monitoring role

Question 28

Motor Learning Principles

Answer 28

Speech is a motor skill, start at a simple level and build on that.

Question 29

Critical features in motor skill development: | 3 main areas*

Answer 29

• Cognitive analysis: o Client is able to understand mentally the placement of sounds, discriminate the right production and incorrect production. o Learner’s ability to mentally evaluate their production. • Practice: key variable thought necessary for mastery of any skilled motor behavior o Artic is all about drill o More reps the better • Feedback: of great importance in the early development of a skill; as the error response is diminished, feedback becomes less important o Tactile o Verbal o As they progress, feedback will decrease.

Question 30

Clients who enter the treatment continuum at the establishment phase include:

Answer 30

o Have in repertoire but cannot produce in convo speech o Those who do not perceive minimal pairs o Those who have trouble with discrimination o Those who produce a sound on demand but cannot produce in convo, syllable level or beyond. (Such as apraxia).

Question 31

Discrimination/perceptual training may be used prior to direct production training

Answer 31

o Controversial | o Pair with production training

Question 32

Production Training | 4 methods commonly employed to establish production:

Answer 32

Imitation Phonetic Placement Successive Approximation Contextual Utilization

Question 33

Production Training: Imitation

Answer 33

• Imitation: initial instruction method for production training o Look at you and do what you do o Sound feels, looks o Use auditory, visual and tactile cues that you can. o Incorporating a mirror is helpful. o May want to incorporate an auditory trainer o Signal-Noise Ratio increase is good o Incorporate a tape recorder to play back their production

Question 34

Production Training: Phonetic Placement

Answer 34

• Phonetic placement: o Using tactile cues, instruction to explain where to place articulators in mouth, getting in their mouth o Mirror o Mouth model o Picture of mouth o Sitting side by side o Start with mouth gymnastics-oral motor placements o Straw: Lateral lisp: move the straw around and wherever the sound is amplified is where the sound is leaking, useful for auditory feedback. Stabilizing the jaw o Tongue depressors: pointing out placement o Lemon swabs: tart swabs feedback o Kool Aid or Fun Dip: placement o Cheerio: hold it up on the alveolar ridge o Peanut butter

Question 35

Phonetic Placement: Successive Approximation

Answer 35

o Shaping a new sound from one they can already produce. o Identify a sound that is similar t and s o Graded steps: Ex: Shaping for teaching /s/: • Make [t] • Make [t] with a strong aspiration on the release • Prolong the strongly aspirated release • Remove the tip of the tongue slowly during the release from the alveolar ridge to make a [ts] cluster • Prolong the [s] portion of the [ts] cluster in a word like oats • Practice prolonging the last portion of the [ts] production • Practice “sneaking up quietly” on the /s/ (delete /t/) • Produce /s/ • Also see examples from conference: stabilizing the sides of the tongue by beginning with I

Question 36

Production Training: Contextual Utilization

Answer 36

o Deep testing o After you have done assessment o Any context that they can accurately produce the sound • Lets say the child can accurately produce /s/ in the context of the word-pair “bright-sun” where the /t/ may be a facilitative context: • Ask the client to say “bright sun” slowly and prolong the /s/ • Next ask the client to repeat “bright-ssssink, then hot-sssssea; other facilitating pairs may be used to extend and stabilize the /s/ production • Ask the client to just say /s/ without the “lead-in” • Rebecca example from conference

Question 37

Things to note:

Answer 37

* Correct consonant productions may be observed in clusters when absent in singletons * Curtis and Hardy reported that more correct responses of /r/ were elicited in consonant clusters than in consonant singletons. * Williams reported when teaching /s/ in clusters, the sound generalized to /s/ in singletons * Hodson supports this idea by suggesting the targeting of /s/ in clusters during treatment has the potential to facilitate widespread change within a child’s phonological system

Question 38

Increasing & Strengthening Established Behaviors:

Answer 38

• Select potential reinforcers in initial treatment sessions until the reinforcing value is known

Question 39

o Positive reinforcers:

Answer 39

events that increase the future probability of that response.

Question 40

o Negative reinforcers:

Answer 40

responses that remove, postpone or reduce an aversive behavior.

Question 41

o Primary Reinforcers:

Answer 41

those that do not rely on past learning. Ex: food, candy. Good initially, but not well continually and may not be preferred with the family. Works well with the beginning stages of therapy, the young, or intellectually disabled. Problem: not a natural consequence or something they will get outside of the treatment room. Should also be accompanied with a social reinforcer. Talk to the parents to find out what they like or what they are allergic to.

Question 42

o Secondary reinforcers:

Answer 42

events or actions that increase behaviors because of social or prior learning. Needs to be immediate. With speech therapy, needs to be quick reinforcement and effective, but don’t spend a lot of time with the reinforcement.

Question 43

Types include:

Answer 43

Social Reinforcers | Conditioned generalized reinforcers

Question 44

• Social reinforcers:

Answer 44

eye contact, facial expression, and verbal feedback.

Question 45

• Conditioned generalized reinforcers:

Answer 45

tokens, stickers, check marks, play money, and beads. Immediately give.

Question 46

o Informative feedback:

Answer 46

lder, motivated, girls, competitive, you can show the chart to give feedback.

Question 47

Schedules of Reinforcement

Answer 47

is the frequency with which the reinforcers will be delivered

Question 48

Two Types

Answer 48

Continuous Reinforcement | Intermittent Schedule

Question 49

1. Continuous reinforcement:

Answer 49

Primarily, initially during therapy. Every correct production is reinforced. 1:1 reinforcement schedule.

Question 50

2. Intermittent schedule:

Answer 50

Ratio schedule: b. Interval schedule: Period of time that goes by before you give reinforcement. Good for speaking rate and vocal quality, not so much speech sounds. c. Fixed ratio (FR) schedule: Every 2 correct productions or every 4. After the sound is established, the reinforcement is backed off. d. Variable ratio (VR) schedule: Constantly changing the amount of correct productions that receives a reinforcement. Can be an average of 5. e.

Question 51

Goal:

Answer 51

to wean the child off of the reinforcement. Generalization and carryover

Question 52

Considerations regarding positive reinforcers:

Answer 52

* Do not assume the same reinforcement is going to work for all children * Also do not assume that if it works one time that it will work every time. * Immediate * Eye contact don’t be looking down at your response sheet * Unambiguous manner so that they know exactly what you are reinforcing * Make sure reinforcement is very enthusiastic, they will relay on you verbal expression and gestures, keep the energy up with the child. * Be consistent, true to your word and follow up on your promises * Make sure the child knows why they are being reinforced•

Question 53

Strategies to reduce undesirable behaviors:

Answer 53

Punisher Corrective feedback • Clarification request: “Did you mean to say wabbit or rabbit?” • Mechanical feedback: using computer program or app, “Skip” program, if you say it correctly you get a happy face if you don’t you don’t get anything. • Stimulus Withdrawal: Incorrect or unacceptable response occurs, a. Time-out: Removal from what you are doing or a period where they can’t win any tokens. b. Non-exclusion time-out: stop therapy for a second to help them realize that this behavior is not acceptable. c. Response cost: Types include: i. Earn-and-lose: give for correct response, take for incorrect. ii. Lose-only: give the child so many tokens and with every incorrect response, you remove something from the child

Question 54

If response-reducing methods are being used a lot, may want to ask yourself:

Answer 54

* Targeting something that is too difficult? * Too difficult of a level? * Targeting too many sounds at once? * Does he understand the instructions and feedback? * Reinforcements positive? Reinforcing to him? * Sensory child: swinging, jumping on the trampoline before therapy, every 5-10 minutes do something active and then sit down, bear hug with deep pressure * Session may be too long? * Some of a group may not work well together in a school setting

Question 55

Structuring the treatment session: 4 different Modes of Treatment (drill and drill play used most often)

Answer 55

Drill Drill Play Structured Play Play

Question 56

Drill

Answer 56

highly structured and efficient stimulus-response mode. Goal is as many reps as possibly. Good for trying to establish the sound, motor pattern

Question 57

Drill Play

Answer 57

Add in a motivational event or activity, majority of speech therapy sessions. Incorporating a game (Chutes and Ladders), what ever number they get they have to say they word that many numbers of times, Go fish, after they ask they have to say the word so many times before getting the car.

Question 58

Structured Play

Answer 58

Training stimuli are presented in play activities but you have structured the play activity, such as words that begin with the /k/ sound, good later on in therapy, for a more natural setting.

Question 59

Play

Answer 59

free play, good for language sample, conversational therapy, good for the very end of therapy. Natural play sample,

Question 60

2 variables help the clinician determine how treatment sessions should be structured

Answer 60

1. Child or client | 2. Stage of treatment they are at

Question 61

Moving Through the Treatment Sequence

Answer 61

• When do I stop providing modeling or any other special prompting procedures? o What ever your criterion is, when they reach that, start fading the model. o Frequently probe, at least once a month with new stimulus words, or a new complexity level. If it’s a process bring out a new sound that has not been targeted in therapy. o Don’t model or cue during probe • How many target responses do I need to train before the client has learned the sound or phonological skill? o When they have reached 90% accuracy, move on to the next sound.

Question 62

Data Collection:

Answer 62

• To be completed every time because that is what is tracking progress.

Question 63

Generalization

Answer 63

• Either a temporary production of a recently learned response in different contexts and situations, or the production of new (untrained) responses based on recent or remote learning

Question 64

Types of Generalization: of Untrained Stimulus Items

Answer 64

* Learned response will evoke correct production in a target that you did not treat in therapy. * Focused on /k/, but generalized to /g/ without targeting. * Usually will happen with processes, but not all the time

Question 65

Types of Generalization: Generalization across word positions

Answer 65

* Target one word position, and it generalizes to another word position. * Probe to see after treatment of one position, if it has generalized to another word position.

Question 66

Types of Generalization: Generalization across response topographies

Answer 66

* Targeting at word, might generalize to sentences naturally. * Targeting at sentences, might generalize to conversation naturally.

Question 67

Types of Generalization: Generalization within sound classes:

Answer 67

* Place, manner, voice * Distinctive Feature * Phonological Process * Cognate Pairs

Question 68

Types of Generalization: Generalization across sound classes

Answer 68

* Targeting /m/ and /s/ improves without targeting, random but it crosses the sound classes. * Book, voiceless fricative /s/, later probed and /l/ had generalized. Same placement, but different manner and voice. * Also improved final fricatives after teaching final stops.

Question 69

Types of Generalization: Generalization across situations

Answer 69

• Target in therapy, see if it is generalizing outside of therapy.

Question 70

Assessing Generalized Responses by probing untrained words, untrained phonemes, untrained positions, and untrained linguistic levels

Answer 70

* Discrete trial probes: No modeling, probing things you have not taught in therapy. No verbal feedback, no imitation. * Conversational probe: collecting a speech sample, talking at the end of the session and listening for generalization.

Question 71

Implementing a Maintenance Program: A carefully planned maintenance program not only increases the chances that the client will produce the target sounds or phonological skills during spontaneous speech, but also that he or she will maintain the trained skills over time. Take into careful consideration:

Answer 71

Delay reinforcement Use more naturally occurring reinforcement, such as social Train the parents how to give appropriate feedback Teach self-monitoring and self-correcting. Reinforce the generalized responses that you hear that you haven’t targeted in therapy. Teach contingency priming: child is more responsible for asking if they are saying the sound correctly. Child is taking on more responsibility in the maintenance phase. Change the setting Naturally occurring stimuli Reinforce more complex productions

Question 72

* The selection and manipulation of antecedent stimuli: natural occurring * The selection of responses for training * The manipulation of treatment contingencies or reinforcement in an effort to enhance the maintenance of the trained skills***most important aspect of training

Answer 72

see slide

Question 73

Involving Others

Answer 73

• Training peers to: (good to use in group therapy to help build auditory/awareness skills) o Give feedback and help with awareness skills • Train the teachers to: especially in maintenance phase since child spends majority of day there o Appropriate feedback o Sharing any nonverbal cues you may have established with the child.

Question 74

Once the child can produce the sound consistently at least at word level, train the parents and significant others to:

Answer 74

o Non-verbal cues o Feedback o Teach how you prompt the child for correct production.

Question 75

Reasons for Discharge

Answer 75

* If the goals have been established * If insurance has stopped * If the parents cant pay anymore * If the child seems to plateaued, can take a 6 month break and come back and re-evaluate * Poor Motivation

Question 76

Performing follow-up assessments | •

Answer 76

Not always realistic • In the book • Follow up with the parents • Phone calls to check in and see how the child is doing • Speech sample, re-evaluate • Check in with the teacher in the schools • If you find out they have digressed, can see about booster treatment

Question 77

Group Therapy: | •

Answer 77

Generally, kids love therapy in the school • Want to keep the excitement and positivity • See a lot of kids • Teach the children to pass hall passes to each other to save time getting each group so that you can switch folders and prepare the next groups materials • Chart in hallway, can’t come in the room until you practice your sounds this many times • When they have a great day in therapy and follow the speech rules they get a sticker on the sticker chart and they get so many stickers they get a “cupcake party” make something special for them. • Externships will be a learning curve.

Question 78

Childhood Apraxia of Speech: To learn motor movement sequences you have to:

Answer 78

o Have a lot of repetition of the same motor sequence. o Large amounts of practice facilitate retention o Activities need to facilitate lots of repetition of the motor sequence o Start treatment by explaining what is expected and what you are targeting. o Focus on your mouth movement and what you say, “Watch and Listen”

Question 79

CAS: how many targets? Severe vs. Less Severe?

Answer 79

o Severe: 4-5 targets (vocabulary words) | o Less Severe: 10-15 targets

Question 80

CAS: THerapy tips

Answer 80

o Motor sequence, not specific sounds o Build a core, functional vocabulary for the child o Talk to the parents about some words they wish they could say o A good starter word is no and yes

Question 81

How many times a week should a child with CAS be seen?

Answer 81

3-5x a week for shorter session (30min).

Question 82

Do children with CAS need the same number of sessions as an artic child?

Answer 82

o Need 5X the number of sessions to achieve the same success as a child who has a normal artic disorder.

Question 83

Initially you should begin with..

Answer 83

o Initially have block practice: target one motor sequence with one word for a period of time and once they hit the criterion level then randomly practice those words randomly each session. o Initially practice with same intonation, rate, prosody, and stress. As they have success, change those patterns.

Question 84

What kind of feedback should you use?

Answer 84

o Movement based feedback-what you want the articulators to do o Provide lots of feedback initially and gradually fade those cues.

Question 85

Therapy techniques: Primary focus of tx

Answer 85

* Primary focus of treatment should be the movement patterns and sequence of sounds instead of drill on individual sound productions; attention to syllable structures and combinations of these syllables so that the child gains verbal building blocks for words. * Treatment may be started with vowel errors if they are dominant

Question 86

A successful program is one that will

Answer 86

facilitate correct production of varying syllable shapes and organization of these shapes into longer and increasingly complex patterns

Question 87

Initial treatment

Answer 87

o Use sounds child can already produce and change syllable shape o Not focusing just on consonant accuracy o Early phonemes: m, b, y, n, w, d, p, h o Mid phonemes: t, k, g, ng, f, v, ch, j o Late phonemes: sh, th(both), s, z, l, r, zh o Sounds that occur more frequently are better targets o Sounds may be treated in an order of increasing phonetic difficulty: vowels, plosives, nasals, laterals, fricatives, and affricates. Voiceless sounds may be treated before voiced o Sounds may be first trained in the word initial positions

Question 88

• Varied carrier phrases may be helpful in making the repeated trials more meaningful

Answer 88

I see a…. o I have a…. o I want a…

Question 89

Specific Treatment Approaches:

Answer 89

• Auditory, visual, and tactile cues are helpful and often used simultaneously o Touch/tactile cueing- Prosodic Cueing Gestural Curing: phonetic placement techniques • Can use progressive assimilation the clinician attempts to reestablish production of the target sounds from sounds that are not affected or from other non-speech gestures

Question 90

• Contrastive Stress drills:

Answer 90

used to promote articulatory proficiency and natural prosody o Especially suited to teach appropriate stresses and rhythm of spoken language

Question 91

• Dynamic Temporal and Tactile Cueing (DTTC):

Answer 91

``` o Hierarchy of temporal delay o Best and most ideal o 4 stages. o Allows for high level of success for the child, o Gradual building blocks. o A lot of repetition. ```

Question 92

DTTC: Stage 1

Answer 92

``` 1. Simultaneous production: • Simultaneous production without cues • Slow model simultaneous • Verbal cue & slow model simultaneous • Tactile cue • Tactile cue • Once child has mastered back off cueing from step 4-step 1 • Once the child can produce 25 accurate responses simultaneously without cues move to the next level: Immediate Repetition ```

Question 93

DTTC: Stage 2

Answer 93

2. Immediate repetition: • SLP provides auditory model while child watches the clinician’s face and child repeats; SLP made mouth the gesture during the response if additional support is needed; then fade

Question 94

DTTC: Stage 3

Answer 94

3. Delayed repetition • SLP says target utterance • Insert a delay of 1-3 seconds before the child imitates the response

Question 95

DTTC: Stage 4

Answer 95

4. Spontaneous Speech • Child repeats the target several times without intervening stimuli • Once target is mastered, continue to add it into the mix in functional practice • Review learned targets at beginning of each session. • Allows for use of other cueing discussed earlier as needed • Positives

Question 96

• PROMPT: Prompts for Restructuring Oral Muscular Phonetic Targets

Answer 96

uses touch pressure, kinesthetic, and proprioceptive cues to facilitate speech production o Trains finger placements on the client’s face and neck to prompt the place of articulation and manner of production for the articulatory target o Finger placements also provide information about the degree of jaw movement needed and appropriate duration of the syllable o Most appropriate for chronic severe clients in which other tx have failed o Have to be certified $650-$700 • Also may teach sign language or use augmentative communication system if their apraxia is so severe that speech is not a realistic goal. • Example CAS goal: o The client will make accurate movement gestures during speech: producing thirty 1- and 2-syllable targets words, each with 80% cumulative accuracy. An accurate production is one which achieves a score of 5/5 on the rubric below in a structured therapy setting over 3 consecutive sessions: 1. Accurate consonants 2. Accurate vowels 3. Correct sequence of sounds 4. Fluid coarticulation (no segmenting) 5. Differentiated stress

Question 97

Cerebral Palsy:

Answer 97

congenital disorder from brain damage before, during, or after birth; several types: spastic, athetoid, rigid, ataxic, mixed • Work with PT, OT, doctor, family • Early intervention with swallowing and feeding • Co-treat • Following same basic procedures as artic, but also language and feeding and swallowing and seeing child earlier than artic child.

Question 98

Treatment of children with CP

Answer 98

* With some children who may have a language delay, a home-based early language stimulation program may be necessary-Sooner Start (work more with parents than client) * A child’s articulation problems may be limited to a few sounds or they may be extensive; * If the assessment reveals specific errors or patterns, the clinician can use the procedures described in the basic unit

Question 99

Direct treatment targets include:

Answer 99

bilabial, linguavelar, lingua-alveolar, linguadental, articulatory contacts needed for various speech sound productions • Increasing the speed of the child’s articulatory movements once they have been established becomes the next goal

Question 100

Children with CP may have accompanying:

Answer 100

prosody, breathing, sustaining ah, regular breaths, interval ratio reinforcement.

Question 101

Treatment should target:

Answer 101

prosodic features including speech rate, rhythm, stress patterns, and pitch variations

Question 102

In som children, speech

Answer 102

does not become a functional mode of communication

Question 103

Children with CP may need

Answer 103

some training in voice therapy, AAC,

Question 104

Some SLP's recommend...

Answer 104

muscle strengthening exercises or methods to control interfering movements of the head, neck, jaw, and other body parts…. may consider chin strap to stabilize jaw, steady an arm

Question 105

If a home language treatment program does not produce desired effects,

Answer 105

formal language treatment may be necessary; periodic assessment is needed to make this determination

Question 106

Cleft palate treatment may begin

Answer 106

• Treatment may begin in infancy including parent education and counseling, and addressing feeding problems

Question 107

SLP's are part of the

Answer 107

craniofacial team or the cleft palate team

Question 108

Cleft palate info

Answer 108

* General behavioral treatment principles discussed previously in the basic unit would be appropriate in addressing articulation and phonological disorders * Should educate the parents * Consider an early language intervention program to stimulate language skills * Train the parents to withhold reinforcement for undesirable compensatory behaviors when the need for them has been eliminated by medical management i.e., pharyngeal fricatives * Teach … * Teach the client to breath strength orally?

Question 109

With Cleft Palate, begin treatment with

Answer 109

• Begin treatment with vowels and semi-vowels, w, y, l, r

Question 110

Teach ___1____ before ___2___ because they can't build up the ___3____ ___4____. ___5___ sounds first, move onto ___6____, ___7____ and ____8___ consonants

Answer 110

1)fricatives, 2)stops, 3)intraoral, 4)pressure, 5)visible, 6)nasals, 7)glides, 8)aspirate

Question 111

Teach accurate production of __1___ that are produced with __2___ articulatory force as this is a unique problem of children with __3__ __4___ (pressure consonants, voiceless stops)

Answer 111

1)consonants, 2)weak, 3) cleft, 4) palate

Question 112

Avoid or postpone training on __1__ and __2__ if the child's ***

Answer 112

1)/k/, 2)/g/

Question 113

Teach ___1___ sounds, ____2____ and ___3____ in that order.

Answer 113

1)lingua-palatal, 2)lingua-alveolars, 3) linguadentals

Question 114

Structure therapy so that it progresses similar to __1__. Use __2__ as needed.

Answer 114

1) arctic, 2) cueing

Question 115

Avoid ___1____ ___2___ to strengthen the __3__ or ___4__ as there is no evidence that such exercises are beneficial.

Answer 115

1) oral-motor, 2)exercises, 3)velum, 4)tongue

Question 116

Train __1__ ___2__ productions if ___3___ ___4___ are present that prevent __5___ articulation.

Answer 116

1)compensatory, 2)articulatory, 3)structural, 4)distortions, 5)normal

Question 117

Treat ___1___ also since there is a tendency for __2___ ___3___ and bad __4__ hygiene. Could be doing __5___ ___6_. Identify abusive _7___ behaviors and then target those. Teach good __8__ hygiene and ___9__ __10___.

Answer 117

1) phonation, 2)vocal, 3)nodules, 4)vocal, 5)voice 6)therapy. 7) vocal, 8)vocal, 9)breathy, 10)onsets.

Question 118

Teach the child to __1___ with __2__ ___3__ and ____4__ __5____.

Answer 118

1)articulate, 2)less, 3)effort, 4)facial, 5)grimacing

Question 119

Don't target ___1___ problems unless the child has the ability to achieve ___2____ ___3___.

Answer 119

1)resonance, 2)velopharyngeal, 3)closure

Question 120

__1___ resonance may be achieved by ____2___ the nose while making the target production, __3___ loudness or sudden __4___ of loudness, or ____5__ __6____ opening.

Answer 120

1)Oral, 2)occluding, 3)increasing, 4)bursts, 5)increasing, 6)mouth

Question 121

Hearing Impairment

Answer 121

* Start language stimulation program at an early age * Parent counseling on the effects of hearing loss and the special needs of the Deaf and HOH children will be essential * Parent training in providing language stimulation opportunities will be crucial during the infancy and preschool years that are crucial for oral language learning * Formal speech training as early as possible to get natural sounding speech * Family can be trained to conduct tx at home that parallel the clinician’s targets, objectives, and activities * Use of visual, tactile and kinesthetic cueing * Use general procedures discussed earlier * Target improved * May need to train language and pragmatics

Question 122

Pay special attention to ___1___, __2___ and __3___ because they can be some of the __4__ sounds for HI.

Answer 122

1)stops, 2)fricatives, 3)affricates, 4)harder

Question 123

Omission of ___1__ ___2___, __3____ __4___ and __5__ phoneme.

Answer 123

1)initial, 2)consonants, 3)final, 4)consonants, 5)s

Question 124

Teach ___1__ and ___2___ distinction | Target __3___ quality and reducing ___4___

Answer 124

1) voiced, 2)voiceless | 3) vocal, 4)hypernasality

Question 125

Need to constantly ___1___ to ensure that speech is an appropriate and __2___ communication choice ( __3___ _4__ sound test prior to starting) ___5__ ___6__ so that they are not focusing on __7__ __8___.

Answer 125

1)reevaluate, 2)realistic (3)Ling 4)6 5)Cover 6)mouth, 7)lip 8)reading

Question 126

Traditional Approach: Basic Information

Answer 126

* Charles van Riper * 1930s * 5 phases * Auditory Discrimination (foundation before treating) * Not producing anything * PURE ARTIC DISORDER BECAUSE YOU ARE TARGETING ONE SOUND AT A TIME (BEST WITH) * Starts in isolation and moves through to conversation * Begins with sensory-perceptual training

Question 127

Traditional Approach: Sensory Perceptual Training Phase 1 Identification

Answer 127

goal is to teach the child the auditory, visual, and tactile-kinesthetic properties of the target sound. Talking all about the sound, intro to the sound. • Client learns to recognize the target sound from among several possible sounds composed of similar and dissimilar properties • At the end of the phase the child should recognize the sound in isolation and perceive many of its important characteristics • With young children sounds may be labeled as follows: • /t/- ticking sound • /s/- snake sound • /z/- bee sound • /l/- singing sound • /k/- coughing sound • “sh”- quiet sound • /r/- lion sound; pirate sound; rooster sound • “ch”- sneezing sound • “th”- tongue sound • /f/- angry cat sound; rabbit sound

Question 128

Traditional Approach: Sensory Perceptual Training Phase 2 Isolation

Answer 128

use the newly acquired recognition skills to isolate the target sound when it is produced against a background of other speech sound • Child must be able to identify words, phrases, and sentences that contain the target sound as the clinician produces them; may point to the “happy face” if the word contains the target or “sad face” if it does not

Question 129

Traditional Approach: Sensory Perceptual Training Phase 3 Stimulation

Answer 129

clinician presents the target sound by varying its loudness and duration • Sentences loaded with the target sound and tongue twisters are produced and the child is asked to identify the target sound as it occurs in the various activities • Goal is to increase the sensitivity to the occurrence of the sound and develop an internalized model of the sound

Question 130

Traditional Approach: Sensory Perceptual Training Phase 4 discrimination

Answer 130

the child is asked to judge the clinician’s productions of the target sound as correct or incorrect

Question 131

Traditional Approach: Production Training-Sound Establishment

Answer 131

o Goal is to evoke and establish a new sound pattern that will replace the child’s error pattern o Sound-evoking techniques are used

Question 132

Traditional Approach: Production Training: Sound Stabilization

Answer 132

o Attention is shifted to stabilizing the child’s production at varied levels of response complexity o Stabilization at one level is considered pre-requisite for entry to the next level o Progression begins with isolation to conversation o 6 stages of sound stabilization

Question 133

Traditional Approach: Production Training: Sound Stabilization-1. Isolation

Answer 133

controversial as to whether this is best place to start since sounds don’t occur in isolation • Practicing prolongation of the sound (snake s-s-s-s) • Varying the number of productions emitted at any one time (incorporate a speech game, roll the dice and repeat x # of times • Varying the intensity with which the sound is produced • Whispering the sound

Question 134

Traditional Approach: Production Training: Sound Stabilization-2. Nonsense Syllables

Answer 134

* Goal is to develop a stronger and more consistently correct production of the target sound * Training can shift from nonsense syllables to nonsense words

Question 135

Traditional Approach: Production Training: Sound Stabilization-3. Words

Answer 135

* Once the child produces the target sound accurately in nonsense syllables stabilization is shifted to true words * Moving from simple mono-syllabic words to complex, multisyllabic words

Question 136

Traditional Approach: Production Training: Sound Stabilization-4. Phrases

Answer 136

* Shift from single words to two- to four-word utterances * Serves as a bridge to gap words and sentences * Carrier phrases can be used

Question 137

Traditional Approach: Production Training: Sound Stabilization-5. Sentences

Answer 137

* Goal is to stabilize production of the target sound in sentences of varying length and complexity * Techniques to help establish production: slow-motion speech, echo speech or shadowing, unison speaking, corrective set, and role-playing

Question 138

Traditional Approach: Production Training: Sound Stabilization-6. Conversation

Answer 138

* Usually progresses from structured tasks to unstructured tasks * Clinician shifts the focus of therapy to natural conversation where no restrictions are placed on the child

Question 139

Traditional Approach: Production Training: Sound Stabilization-7. Transfer and Carryover

Answer 139

* Generalization to more natural settings and other people who regularly interact with the child * Can be done through: speech assignments, self and peer monitoring, practice in other situations, proprioceptive awareness exercises, and varying the audience and setting

Question 140

Traditional Approach: Production Training: Sound Stabilization-8. Maintenance:

Answer 140

* SLP may arrange follow-up sessions * Child may be seen progressively less frequently--once a month for a few months, one every 3 months, once every 6 months, and so forth until the child is ready for dismissal

Question 141

Sensory-Motor Approach: Basic Information

Answer 141

* Mcdonald * 1964 * Goes with the Deep Test * Uses contextual facilitation to facilitate correct production * Using the context they can produce the sound correctly to produce the sound in other contexts * No auditory discrimination * No isolation * Begin at syllable level * Primary goal: increase auditory, tactile, and proprioceptive awareness of the motor patterns involved in the speech sound production through motor production oriented tasks * Begin with deep testing and start with the context that they can produce the sound in and build off of that

Question 142

Sensory-Motor Approach: 3 Primary Objectives

Answer 142

1. Heightening child’s responsiveness 2. Reinforcing Correct Articulation 3. Facilitating Correct Production in Varied Contexts

Question 143

Sensory-Motor Approach: Phase 1: heightening child’s responsiveness

Answer 143

* Production practice with sounds that the child can produce correctly * The sounds are practiced in bi-syllable reduplicated productions, combined with each of the most common vowels * Clinician instructs the client to imitate the modeled productions with primary stress on the second syllable (kiki, kIkI, kaykay, kaekae, koko, kaka * The clinician also asks the child to describe the placement of the articulators and the direction of the articulatory movements * Then move to a different bi-syllable production with the same consonant and different vowel * After the child produces one consonant with different vowels, the SLP initiates training with other non-error consonants * Then training moves to tri-syllable combinations

Question 144

Sensory-Motor Approach: Phase 2: Reinforcing Correct Articulation

Answer 144

* SLP initiates training on the sounds that are in error using the facilitative phonetic context; the phonetic context that evokes a correct production of the error sound * Child practices the target sound in the facilitative context, producing each sound deliberately and slowly * Child produces watch-sun using equal stress * Child produces watch-sun with emphasis on first syllable * Child produces watch-sun with emphasis on the second syllable * Child prolongs the target sound until a signal is given to complete the whole word * Child practices watch-sun in short sentences (i.e., “Watch sun will burn you. Watch sun is out.”) Initially without varying stress and later with varying stress patterns * Sentences used for production practice are not always meaningful because the primary goal is the practice of movement sequences * Clinician: Did you say, “Look, sun will burn you?” * Child: No, I said, “Watch, sun will burn you.” * Clinician: Did you say, “Watch, fire will burn you?” * Child: No, I said, “Watch, sun will burn you.”

Question 145

Sensory-Motor Approach:Phase 3: Facilitating Correct Production in Varied Contexts

Answer 145

* Correct production of the target sounds in a variety of facilitating contexts * Clinician changes the words in which the target sound appears (watch-sun, watch-sea, watch-sit, watch-sat) * Then shifts training to production practice in the context of different first and second words (teach-sit, reach-sun, pitch-sat) * Word combinations are practiced with varying stress and rate, and in sentence contexts * Lastly, the clinician instructs the child to practice the target sound in totally different phonetic contexts (mop-sun, book-sun, bear-sun)

Question 146

Multiple-Phoneme Approach: Basic Information

Answer 146

* Multiple mis-articulations * Unintelligible * Target 5-6 targets at once * Highly structures with specific criterion at each level * Mcabe and Bradley * Phonological kids

Question 147

Multiple-Phoneme Approach: Phase 1: Establishment

Answer 147

• Goal: the child to produce each consonant sound of English correctly when presented with a grapheme or phonetic symbol representing it

Question 148

Multiple-Phoneme Approach: Phase 1: Establishment (Steps)

Answer 148

o Step 1: Establishment of Accurate Sound Production • Correct sound production is facilitated initially by maximal stimulation through visual, auditory, and tactile cueing (Level C cueing) • Level of stimulation is then reduced to level B cueing (auditory + visual cueing) • Finally reduced to visual cueing only (level A) • May use sound production sheet as a recording system for each stimulus modality used to achieve accurate production in isolation, see page 412 o Level A #1: Visual Cueing Only: the clinician presents the child with an upper- or lowercase letter representing the target sound and evokes the sound in isolation on 5 successive trials. • The clinician records the accuracy • If the child cannot produce the sound in isolation the clinician shifts to level C, which offers maximal stimulation o Level C: Visual + Auditory + Tactile Cueing: clinician uses verbal instructions along with visual and tactile stimulation to evoke 4/5 correct productions of the target sound • SLP may use any other effective methods to achieve accuracy • Only 5 trials are provided for each sound during an individual session because several other sounds are also targeted • If successful, then treatment is shifted to the next modality • If the child fails to reach criterion in 3 sessions, then the clinician initiates a branching activity for that sound (syllable shaping, facilitative phonetic context, etc.) o Level B: Auditory + Visual Cueing: clinician shows the letter representing the sound and models the sound for the child to imitate • Auditory-visual stimulus is only modeled once and the child is asked to produce the sound on 5 consecutive trials • Accuracy criterion is 5 consecutively correct responses during one session or 4/5 correct responses for 2 consecutive sessions; once criterion is reaches, shift to level A o Level A #2 Visual Cueing Only: only visual cueing is allowed through presenting the grapheme representing the sound • May be skipped for children under 5 since they may not know grapheme-sound association • Reinforcement is provided including verbal praise and tokens as needed *The sound production sheet (SPS) is used for all English consonants during the first therapy session; non-error sounds are included in training to promote experience with the procedures and then ensure initial success. Sounds produced correctly typically reach criterion in 1 or 2 sessions and their training is omitted in subsequent steps. *List of all of the sounds (5-6), go through each sound and circle, which level they are at. *Drop the sound once they can do it at level A o Step 2: Holding Procedure • Appropriate for sounds that reach criterion on the SPS, but are not ready to progress to the syllable or word level for several sessions because of time constraints • It helps maintain correct production by requiring the child to provide one accurate response in modality A during every treatment session until the sound is ready for advancement to the next level

Question 149

Multiple-Phoneme Approach: Phase 2 Transfer

Answer 149

* Goal of this phase is that the child should use all the error sounds accurately in conversational speech * Includes 5 steps of therapy progressing from syllables to conversational speech * At least 5 or more sounds are targeted during each therapy session and each sound may be worked on at different linguistic levels of complexity—this is one of the main differences between the this approach and Traditional Approach

Question 150

Multiple-Phoneme Approach: Phase 2 Transfer (Steps)

Answer 150

o Step 1 Syllable: only used if the child fails to produce the word correctly in 6/10 monosyllabic probe words; word probe consists of 5 words with the target sound in the initial position and 5 words in final position; if child passes the syllable step is skipped and training proceeds to word level • Client practices the target sound with a variety of vowels: high front, low front, neutral, high back, and low back • Each target sound is practiced in both initial and final position of syllables • Child produces the sound 5 times after the SLP provides one auditory-visual model or one visual stimulus • Aim for 25 or more responses in a 1-2 minute task • Criterion: 80% accuracy across 2 consecutive sessions or 90% accuracy in a single session o Step 2 Words: recommended that the SLP use 25-30 varied words that may be used later in phrases and sentences • Child is presented with printed words or pictured stimuli and asked to produce the target word • Criterion: the child can produce the target sound in a given word position with 80% acc. over 2 sessions or 90% in one session *May accept erred production of non-target phonemes at this stage • If criterion is not met in a word position, training continues at the word level for that position • If training criteria are met for a word position, then training of that sound in that position progresses to the next step o Step 3 Phrases/Sentences: objective is accurate word production and improved self-monitoring skills • Response unit is the whole word, not just the target sound; so all sounds should be produced correctly • Child is asked to construct practice sentences by incorporating words trained in step 2 and adding new words as needed to complete the sentence • If child has difficulty formulating sentences on their own, you can model a target phrase or sentence and ask them to repeat it • If child can read you can use reading to facilitate production of phrases and sentences • Can use symbols or pictures to assist production • Use a variety of sentence types to set the stage for conversation • Accuracy criterion is 80% across 2 consecutive sessions or 90% in a single session o Step 4 Reading/Story: goal is accurate production of the target sounds in connected utterances containing 4-6 words • Select age-appropriate reading materials • At this stage whole-word accuracy of every word spoken is expected • Criterion is 80% across 2 consecutive sessions or 90% in one session o Step 5 Conversation: goal is accuracy in all words at conversational level • Every word spoken is counted as a response and the clinician can calculate the whole-word accuracy level; make note of any specific facilitative context in which the sound is incorrectly produced • Criterion for children 6 years and older: 80% on all words spoken during the entire session over two consecutive sessions or 90% for one entire session • Criterion for children younger then 6 should be adjusted for age

Question 151

Multiple Phonemes Approach: Phase 3 Maintenance: once every three months, or check in once every three months

Answer 151

* Goal is 90% whole-word accuracy in conversational speech across various speaking situations without direct treatment or external monitoring * A 5% accuracy loss is typical for most speakers within 3 months after the initial dismissal from therapy * The client’s skills should be monitored for 3 months * Maintenance may be accomplished by: returned clinic visits, classroom, teacher/parent reports, phones calls.

Question 152

Paired-Stimuli Approach: Basic Information

Answer 152

* Good for sound distortions, or only one error * Once sound at a time * Initial and final position if necessary if they need both * Similar to sensory motor in that you are finding 4 key words that the child can produce the sound correctly. * 1st word initial position * 2nd final position * 3rd initial position * 4th final position * if you cannot find 4 key words, you teach 4 key words, have to produce with 90% accuracy. * Example: sea, peace, sip, bus * Get 10 training words for initial and 10 training words for final position paired with a picture stimuli. * Training words they incorrectly produce 2/3 times * Create a picture board with the key word in the middle and put 10 training words around it * Have them produce the word as you point to it, 1:1 continuous reinforcement, back to the key word every time before the training word. * Make sure the target is only in the word one time

Question 153

Paired Stimuli Approach: Steps

Answer 153

o Step 1 Word Level: clinician selects the target sound and finds 4 key words (2 containing the sound in initial position and 2 in word final position) • A key word is one in which the target sound occurs only once and the child produces that sound correctly in at least 9/10 trials • If key words cannot be found in the child’s repertoire, the clinician creates key words by teaching them • Next the SLP selects training words in which the target is misarticulated in 2/3 productions • The target sound should occur only once in the training words in either initial or final position • At least 10 training words should be found for both initial and final position unless the speech sound error is limited to only one word position • Clinician then selects pictured stimuli for both the key words and the training words that will help evoke the target productions • SLP places the first key word (picture) with the target sound in the initial position onto the center of the picture board and arranges the 10 training words around it • SLP instructs the child to name the key word, then name a training word • The child continues to alternate between saying the key word and the training word until all 10 training words have been produced (training string) • SLP reinforces the child’s accurate productions in both the key word and training words by giving a token, ignores misarticulations of non-target sounds • Aim for at least 3 training strings in a 30 minute session • Criterion: 80% accuracy of training words in 2 consecutive training strings • SLP follows the same training sequence, but changes the key word and training words to word-final position • Then the 3rd key word (sound in word-initial position) is taught following the same sequence except the key word and training word are said as one response unit with only a very brief pause between the 2 • Token reinforcement is offered following accurate production of each response unit: sipseek: token, 2:1 reinforcement • Criterion at this level is 80% correct response units over 2 consecutive training strings • The 4th key word (sound in word final position) is trained as key word 3 except reinforcement schedule changes to a token given after accurate production of 2 response units successively, 4:1 reinforcement schedule • Training criterion remains the same at 80% over 2 successive training strings • Once training criterion has been reached for the 4th key word, the clinician conducts a probe to assess the child’s production accuracy in conversational speech with no reinforcement • Probe criterion: 80% accuracy of the target sounds in conversation with a minimum of 15-20 occurrences o Step 2 Sentence Level: clinician pairs the first key word with 10 selected training words, points to a training word, and asks a question that evokes the target response in a sentence • Ex: “fan” is key word & “feather” is the training word; • Clinician: “Did the fan blow the feathers?” and the client responds “Yes, the fan blew the feathers.” • Reinforcement following 3 consecutive correct sentences; child has to produce sound correctly 6x before reinforcement, 6:1 reinforcement schedule. • Correct means accurate production of the target sound in both the key word and training word in the sentences • SLP continues this sequence until a training string of 10 sentences are completed • Criterion: 80% accuracy over 2 successive training strings • Next, the clinician uses the 2nd and 3rd key words and their 10 training words to evoke sentence level production while asking 2 questions alternately, one with 2nd key word, then one with 3rd key word • Reinforcement and criterion remain the same • In the next step, the clinician asks 4 questions alternately using the 1st and 4th key words and their 10 training words • Reinforcement schedule and criterion remain the same • FR3 and 80% over 2 successive training strings o Step 3 Conversation Level: • SLP stops conversation when: the child correctly produces the target sound in 4 words or the child incorrectly produces a target sound in any word • If child produces sound incorrectly, SLP models the correct production and asks the child to repeat it • SLP reinforces with verbal praise and informative feedback (showing score sheet) • As the child meets the initial criteria, the clinician then requires the correct production of a target sound in 7 words and conducts probes when the child meets this • In subsequent stages, the child has to produce the target sound correctly in 10 and 13 words and conducts probes at each stage as the child meets the criterion • SLP provides verbal praise and visual feedback only when all productions are correct • For all probes, the clinician takes a conversational sample and does not provide any feedback during probes • SLP stops training on the target sound when the child produces the target sound correctly on 15 consecutive opportunities in conversation held on 2 successive treatment sessions separated by at least one day

Question 154

Programmed Conditioning for Articulation (PCA): Basic Information

Answer 154

* Few errors, artic client, revamped for any client * Strictly behavioral approach based on behavioral principles * Stimuli, get a response, give reinforcement * 1971 by Baker and Ryan * Continuous reinforcement initially, gradually decreasing the amount * Shift to a branching activity if the sound is in error 10x in a row or three sessions in a row and the sound is less than 80%. * Isolation

Question 155

Programmed Conditioning for Articulation (PCA): General Procedures

Answer 155

o Clinician presents stimuli--client responds--clinician reinforces the client’s accurate productions o Stimulus-response-consequence contingency paradigm o When clinician models, imitation is required o Stimuli can include modeling, pictures, questions, story-telling, and graphemes o Recommend an average of 300 responses per hour of instruction o Reinforcement is initially delivered on a continuous schedule, but shifts to an intermittent schedule (50%-10%) as the client’s productions improve o Advance to next step when the client produces 10 consecutive correct responses o Shift to branching activities if the sound is in error 10x in a row or 3 consecutive sessions with a correct response rate of less than 80%

Question 156

Programmed Conditioning for Articulation (PCA): Establishment Phase: Continuum Throughout

Answer 156

o Isolation: continuous reinforcement schedule o Nonsense syllables: target sounds are practiced in initial, medial, and final nonsense syllable positions, paired with vowels, reinforcement on a continuous schedule o Words: reinforced on an intermittent schedule (50%); trained in all word positions in following order: initial, final, then medial o Phrases: simple connected speech is evoked and correct productions are reinforced; 50% reinforcement schedule; 2-3 word phrases; initial, final, and medial positions o Sentences: correct production of target sound in 4-6 word sentences; 50% reinforcement schedule; initial position, then final, and then medial o Contextual reading: child practices the sound in contextual reading tasks; if non-reader, the clinician goes to the story narration level; continuous reinforcement o Story narration & picture description: correct production of the target sound during story narration and picture description; 50% reinforcement schedule o Conversational speech: clinician evokes conversational speech from the child; initially reinforcement is continuous, then intermittent (10% of correct responses are reinforced) o When the child achieves mastery (90%) at conversation level, the clinician stops therapy and administers the criterion test, if child is successful, therapy is shifted to the transfer phase o The establishment phase can be initiated again with a new target sound

Question 157

Programmed Conditioning for Articulation (PCA): Transfer Phase

Answer 157

• Designed to facilitate the child’s production of the target sound in natural environments o 1st step of the transfer phase actually occurs during the establishment phase when the parents are asked to train the child at home (i.e., home program) • Parents are instructed to work with the child for 5 minutes and record responses • Parents are to reinforce all correct responses and model incorrect productions • Transfer phase begins in treatment when the client has met 90% accuracy during conversational speech training • Training in different environments is the main strategy • Goal is 90% accuracy of the target sound in different physical settings with the clinician providing 100% reinforcement • 5 substeps: SLP provides reinforcement just outside tx room, down the hallway, outside the building or in another room, places away from clinic room, and outside the child’s classroom • Next step: train the target sound in the classroom with 90% acc. and continuous reinforcement • Clinician evokes conversation of the child with teacher, with SLP, small-group interactions, large-groups, and in monologues

Question 158

Programmed Conditioning for Articulation (PCA): Maintenance Phase

Answer 158

* 2-month component of the training program * Goal: correct production of the target sound in varied settings and situations and with different audiences * Clinician meets with the child once a week for the first month * Criterion: 10 consecutive correct responses with continuous reinforcement per meeting * The last step is meeting with the child once during the second month

Question 159

Distinctive Feature Approach: Basic Information

Answer 159

* Chomsky and Hally * Features that are missing, rather than the process. * DF analysis first to find missing, then target those features * Hopefully it would generalize to other sounds with those same features * Good for children with Multiple misarticulations with common missing features * If you target +continuant and you target f, it would generalize to th, v, s, etc. * Not appropriate for children who have sound distortions or children whose errors lack a definite pattern * Not popular, been overshadowed by PP * McReynolds & Colleagues Program on Distinctive Features

Question 160

Distinctive Feature Approach: Phases 1 and 2

Answer 160

o Phase 1: Nonsense Syllables (initial position) containing the target feature • Step 1: child is instructed to produce a consonant in which the feature is lacking • Step 2: child is instructed to contrastively produce 2 consonant sounds in syllables, the segment learned in step 1, and a second consonant selected to contrast with the first ex s/z only differ by one feature o Phase 2: Nonsense Syllables (final position); just like phase 1 targeting final position • Recommend training initially be limited to sound units that reflect only one contrast • As treatment progress, may want to incorporate sound units that vary by 2 or more distinctive features • There is no new treatment procedures, but rather a different method of error analysis before and after tx • Sounds are taught by behavioral methods of modeling, positive reinforcement, corrective feedback, and assessment of generalization • Find patterns in error, target exemplars for training within patterns and measures expected generalization

Question 161

Cycles Approach: Basic Information

Answer 161

• One of the most popular for PP • Hodson and Payden • To combine linguistic and motor oriented approaches • Designed for highly unintelligible children and those who have multiple processes going on. • General Procedures: o Stimulation- with the use of auditory, tactile, and visual stimulation cues, the child is made aware of the auditory, tactile, and visual characteristics of the target sound o Production Training: Offer occurrence of PP and the need for remediation. o Semantic Awareness Contrasts: minimal pairs o Remediation program is planned around cycles o Cycle: per process you target two sounds. o Another definition of a cycle: the time period required for the child to successively focus for 2-6 hours on each of his or her basic deficient patterns o Treatment cycles can range from 5-6 weeks to 15-16 weeks, depending on the client’s number of deficient patterns and the number of stimulable phonemes within each pattern o Identification & Selection of Target Patterns & Phonemes: *Only target if they have it 40%. Ex: velar fronting-k,g Stopping of fricatives-s,z,th,th,f,v Liquid gliding: r,l Only target 2: spend 60 minutes per sound you have chosen, once each sound gets 60 minutes-that is a cycle, then you begin at the beginning sound again.

Question 162

Cycles Approach: Step 1, step 2

Answer 162

* Step 1: assess the phonological performance to identify the patterns affecting the child’s intelligibility * Step 2: select target patterns and phonemes * Improved speech intelligibility is the main concern for selection * Arrange a hierarchy of phonological patterns that the child demonstrated at least 40% of the time during phonological assessment * The phonological pattern that is most stimulable is considered the optimal remediation target so that the child can achieve immediate success is therapy * Remediation then shifts to the next most stimulable pattern until all priority patterns are stimulated during one cycle

Question 163

Structure of Remediation Cycles

Answer 163

* Each phoneme exemplar within a target pattern should be trained for approximately 60 minutes per cycle before shifting to the next phoneme in that pattern and then on to other phonological patterns * Each deficient phonological pattern is stimulated for 2 hours or more within each cycle * Patterns should not be intermingled initially in the target words * A cycle is complete when … * After one cycle has been completed, a second cycle is initiated that will again cover those patterns that have not yet emerged or are in need of further instruction * At least 3-6 cycles of phonological remediation, involving 30-40 hours of instructions are usually required for a child to become intelligible

Question 164

A cycle can be one __1__ minute session, 2 __2__ minute sessions, or 3 __3__ minute sessions. Stimulation should be provided for _4__ or more target phonemes (in _5__ weeks) within a __6__ before changing to the next pattern.

Answer 164

1)60, 2) 30, 3) 20, 4) 2, 5) successive, 6)pattern

Question 165

Only _1__ pattern or ___2__ should be targeted during any one session so that the child can concentrate on it.

Answer 165

1) one, 2)process

Question 166

Instructional Sequence for a specific Remediation Session

Answer 166

* Review of Previous Session: practice word cards from previous session unless a new pattern is initiated during the cycle * Auditory Bombardment: provided with slight amplification (auditory trainer) for about 2 minutes. The child listens while the SLP slowly reads approx. 12 words containing the target sound. SLP may demonstrate the child’s error and contrast it with the target. If the client remains attentive, the SLP may repeat the 12 words a second time; child does not repeat words * Target Word Cards: the child draws, colors, or pastes pictures of 3-5 target words on large index cards. The name of the picture is written on each card. * Production Practice: child participates in game-based production practice activities, shifting activities every 5-7 minutes to help maintain the child’s interest in repetition of the target words. Child also produces the target words in conversation. * Stimulability Probing: prior to ending the session, the target phoneme for a specific pattern to be addressed during the next session is selected based on the child’s performance on stimulability testing. * Auditory Bombardment: repeated using the same 12-item word list from the beginning of the session * Home Program: parents are asked to perform the auditory bombardment with the same 12 words once a day. The parents are also instructed to review the target word list by naming the pictures once daily

Question 167

Selection of Production Practice Words

Answer 167

* Use actual words vs. nonsense syllables * Initially, use monosyllabic words with facilitative context * Avoid words that have phonemes in the same place of articulation (such as if the use t/k avoid words that have t) * Use target words that have objects that you can use * Words are appropriate for the child’s age and vocab * Incorporate minimal pairs in therapy to show distinction

Question 168

Remediation Activities

Answer 168

* Quick and fun * Still get a lot of repetition * Go fish, bowling, etc.

Question 169

Phonological Contrast Approaches: Basic Information

Answer 169

* Phonology kids with multiple mis-articulations * Remediate phonological processes * Improve speech intelligibility * Goal: improve child’s communication by establishing the lost phonemic contrasts * Goal: promote generalization to untrained phonemes * Treatment procedures are still behavioral * Looking at contrasting sound features * Scep (skip) program good with all three

Question 170

3 Phoneme Contrast Approaches

Answer 170

1. Minimal Contrast Method/Minimal Pairs Method 2. Maximal Contrast/maximal pairs 3. Multiple Oppositions/ Multiple Contrasts Approach

Question 171

Minimal Contrast Method/Minimal Pairs Method: basic information

Answer 171

* Contrasting two sounds that only differ by one feature * Phoneme contrast is limited to one or just a few features * Use of word pairs that contrast the child’s typical (error) production and the target production * Use productions that are semantically meaningful so if a nonsense word add picture to make meaning, draw a fictitious animal * Select 8-10 word pairs * Pictures with the word that hold meaning. If it is a nonsense word, create a picture with the word.

Question 172

Minimal Contrast Method/Minimal Pairs Method: Training Sequence

Answer 172

• Training sequence: o SLP places the word pairs in front of the child, models both the target and the contrast words and asks the child to imitate them o Clinician provides several opportunities for the production of the target and contrast words during imitative trials o SLP reinforces the client for correct production of the target and the contrast words o SLP asks the child to spontaneously name the pictures by asking the child to say the word she wants. The clinician gives the child the picture she names. If accurate then a reinforcement token may be given o May want to teach the production of the target sound in a more traditional manner initially before implementing the minimal pair method o After teaching a few exemplar pairs, SLP can probe for generalization to untrained phonemes

Question 173

Maximal Contrast

Answer 173

* The word pairs selected for treatment have multiple feature contrasts or maximal opposition between contrasted phonemes; may involve contrasts in place, manner, and voice * Contrast 2 sounds only * As opposed to minimal pairs, the child’s incorrect production is not used, but rather a sound the child correctly produces but is maximally different from the error sound * Treatment procedures are the same once the target words have been identified

Question 174

Multiple Oppositions/Multiple Contrasts Approach: Basic Information

Answer 174

* Creating minimal pairs for all or most of the errors simultaneously * Especially helpful for children who substitute a single sound for multiple sounds, resulting in homonymy: one sound for multiple sounds * Multiple targets may be used within each set including all 4 contrasts

Question 175

Multiple Oppositions/Multiple Contrasts Approach:

Answer 175

• Example: child produces [t] for /s/, /k/, “ch” and /tr/ o Set 1: tip-sip, tip-Kip, tip-chip, tip-trip o Set 2: tease-sees, tease-keys, tease-cheese, tease-trees o Set 3: two-Sue, two-coo, two-chew, two-true • Select up to 4 different target sounds from one rule set based on 2 parameters • Maximal distinction from error in terms of PVM • Maximal classification from each other • Differences in manner classes • Different places of production • Different voicing • Differences in linguistic unit/singletons vs clusters • Use 5 sets of different constrastive word pairs • Start at imitation level and move to spontaneous • Want to obtain a minimum of 40 responses in a 30 minute session • Probe 40 words not targeted in tx once a month • Must receive 90% acc on untrained words • Then get a conversation sample • Stop training of the pattern when the child reaches 50% acc in conversation o Phase 1: Familiarization + Production • Familiarization of the rule, sounds, and vocabulary • Production: one treatment set=20 responses (5 contrasts x 4 reps) • Provide maximum cueing o Phase 2: Contrasts + Naturalistic Activity • Imitation: comparison word then target word; slower models, feedback, gradually fade supports; switch order of presentation • Naturalistic Play Activities: sound-loaded communication-centered activities, at least 20 responses in 5-8 minutes o Phase 3: Contrasts within Communicative Contexts • Focused practice and the play are intertwined • Play games with the contrasts • Should start seeing more generalization o Phase 4: Conversational Recasts • Develop sound-loaded communicative scenarios • Variations of forming word pairs: • Target sound is paired with a correct sound from the child’s repertoire rather than the corresponding error substitute • Pair 2 target phonemes, both absent in the child’s speech; may be more efficient to select 2 error sounds that are maximally different

Question 176

Language Treatment for Phonological Disorders: Basic Information

Answer 176

• Children that have PP disorder may also have language disorder • Target language instead of phonology • Target all together • Naturalistic play, language play to incorporate language into play • Norris & Hoffman (1990) described a storytelling language-based approach to phonologic intervention based on client generation of narratives. o The goal for the child was to produce meaningful linguistic units, syllable shapes, phonemes, and gestures that are shared with a listener.

Question 177

Language Treatment for Phonological Disorders

Answer 177

o The clinician seeks to expand the child’s language-processing ability by asking children to produce utterances that exceed their current level of functioning o Motor cues are embedded within communication-based intervention with sound and production cues integrated within the constellation of language processes o Child-clinician interactions should be based on spontaneous events or utterances and communicative situations that arise in the context of daily play routines and instructional activities • Clinician can use 3 primary responses with the child: a. Clarification: when the child’s explanation is unclear, inaccurate, or poorly stated the clinician asks for a clarification. The clinician then supplies relevant info to be incorporated in the child’s response, restates the event using a variety of language forms, and asks the child to recommunicate the event. b. Adding events: if the child adequately reports the event then the clinician points out another event to incorporate in the story using a variety of language models. Then the child is asked to retell the story. c. Increasing complexity: if the child adequately reports the event, then the clinician seeks to increase the complexity of the child’s story by pointing out relationships among events such as motives of the characters, cause-effect relationships among the individual events, time and space relationships, and predictions. The child is given the opportunity again to reformulate his or her own version of the story. • May use a variety of methods including naturalistic interactions in which the child’s unclear statements are clarified, story telling or retelling, clinician’s imitation of child’s language structures, prompts, sentence completion tasks, restatements of child’s productions, and expansion of child’s telegraphic productions