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Articulation Treatment

Articulation Treatment. The Baseline Phase. Step 1. Has your client already had a recent articulation evaluation or is s/he continuing in treatment from a previous quarter? Do you know what sounds are in error?

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Articulation Treatment

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  1. Articulation Treatment The Baseline Phase

  2. Step 1 • Has your client already had a recent articulation evaluation or is s/he continuing in treatment from a previous quarter? • Do you know what sounds are in error? • Do you know what sounds are to be targeted in treatment from given recommendations? If NO, then go to Step 2 If YES, then go to Step 3

  3. Step 2 – Articulation Evaluation • Conduct an evaluation using an articulation test. • Conduct a structural-functional exam

  4. Step 2 – Articulation Test • There are many to choose from. • Some easy to administer tests include: • Goldman Fristoe Test of Articulation – 2 • Structured Photographic Articulation Test – II • Arizona Articulation Proficiency Scale

  5. Step 2 – Articulation Test • Of the errors you find on the test, choose sounds in error or patterns that are expected to be developed by the child’s age and/or affect intelligibility the most. • If there are multiple sounds in error, conduct stimulability testing first to determine which sounds you will target for treatment (see Step 4 – Stimulability).

  6. Step 2 – Structural-Functional Exam • Conduct a structural-functional exam to rule out any issues with the structure or function of the child’s articulators. • You will look at strength, range of motion, and coordination of the articulators. • You will receive instruction on this.

  7. Step 3 – Connected Speech Sample • The connected speech sample is an important component of the baseline probing process. • You need to conduct this and put your findings in the assessment section of the report. • This information is generally reported as “percent correct.”

  8. Step 3 – Connected Speech Sample • Usually having a conversation with a child is sufficient for eliciting a sample with plenty of examples of sound/s in error in multiple word positions. • There is no set time limit to the connected speech sample – the point is to obtain an adequate sample of sounds. If you can do that in a 3 minute sample, great. If you need more time, take it.

  9. Step 3 – Connected Speech Sample • If you are trying to elicit less frequently occurring sound/s you may need to try some other strategies to ensure you get an adequate sample.

  10. Step 3 – Connected Speech Sample • Possible strategies (not inclusive): • Using a story retelling task that is loaded with the target sound. For example, Storytelling Probes of Articulation Competence (SPAC) is a pre-made resource available in the Materials Room. • You might also provide the child with picture cards of words with the target sound/s in many positions and have them create a silly story for you. Note: You may have to provide an example to the child of how to create the story – use other cards.

  11. Step 3 – Connected Speech Sample • When you are recording data from the speech sample, you do not necessarily have to be careful to record by word position. • In general you record a “+” or “-” for all opportunities for the target sound and report it as a set. • (e.g., /s/ was in error in 60% of opportunities in connected speech)

  12. Step 3 – Connected Speech Sample Caveat! If, as you are analyzing your connected speech sample, you are hearing a pattern (e.g., /s/ is correct in all word final positions, but in error in all other positions), you must record and report that. That is a significant finding.

  13. Step 4 - Stimulability • Stimulability • Is trial teaching. • Is generally quick. • Informs your treatment: It tells you • what sounds (if there are multiple errors) are ready to be taught (or can be left alone to develop on their own!) • at what response level and cuing level to start in treatment for a single error sound.

  14. Step 4 - Stimulability • As with all treatment, it is important to think systematically when doing stimulability. • Different clinicians have different ways of approaching stimulability, but the next several slides will describe one way to do it.

  15. Step 4 - Stimulability • Study your Eliciting Sounds, 2E (Secord) focusing on the sounds you know to be in error. • Practice administering elicitation strategies on a peer, loved one, or child if you can. • Of course talk to your supervisor about any “tricks of the trade” s/he might have to share with you.

  16. Step 4 - Stimulability • Prepare word, phrase, and sentence lists that you will use during this trial teaching phase. • Available to you is a document to help you with this: http://courses.washington.edu/sop/ArticLang/Stimulability.pdf

  17. Step 4 - Stimulability • Start at the word level. • Try different word positions using a variety of teaching cues. • If the client is not succeeding, go down to the syllable level. • If the client is still not succeeding, try at the isolation level.

  18. Step 4 - Stimulability • Of course if the child is doing well at the word level, increase to the phrase level. • You might do short, functional phrases (e.g., “a white tooth” • You might use a “rote phrase” (e.g., I see a ___; “This is a ___”) • If the child is doing well at the phrase level, increase to the sentence level.

  19. Step 4 - Stimulability • On the following slide is an example of a chart that you might want to create for yourself to help record your data.

  20. Step 4 - Stimulability

  21. Step 5 – Baseline Word Probes • Once you have established your target sounds you will administer word probes. • In general, you will probe all word positions or contexts.

  22. Step 5 – Baseline Word Probes • Prepare probe cards. • There are many materials available in the Materials Room Articulation/Phonology cabinet. Or you can create your own. • Ideally find 10 words per position/pattern (but remember you have to have words to use in treatment as well). • If that’s not possible, see next slide for a strategy.

  23. Step 5 – Baseline Word Probes • Can’t find 10 words per position? • Try to come up with at least 3 words per position/pattern. • Then present cards 2 times (not back to back though) to get a minimum of 6 opportunities.

  24. Step 5 – Baseline Word Probes • Probe cards may be either written words or picture cards. • Use good judgment in deciding whether it is appropriate to use only written words. Consider the age/educational level of the child. • Be sure to choose words that are appropriate vocabulary (consider age and experience of child as well as family religious/cultural beliefs).

  25. Step 5 – Baseline Word Probes • When selecting words try to keep the sounds in “pure positions.” • For example, some commercial materials may use a word like “mushroom” as a medial ‘sh’ word. But technically speaking, in this case it is a syllable final sound and the /r/ may make it extra difficult. This is in contrast with “fishing” where the sound is truly intervocalic. Try the best you can.

  26. Step 5 – Baseline Word Probes • When presenting baseline word probes you will instruct the child: “I’m going to show you a card with a word on it. I want you to say the word for me. If you are not sure what the word is, I will tell you and then we’ll come back to it later to see if you remember it.”

  27. Step 5 – Baseline Word Probes • In general we obtain 2 baseline word probe data points. • If the child was seen in a previous quarter (except for Summer), you can use a data point from the previous quarter as one of your baseline data points. • Once you have collected your baseline word probe data you will put these word cards away – probably until the end of the quarter. Do NOT use your baseline word probe cards for treatment (unless there is a special circumstance).

  28. Step 6 – Begin the Treatment Phase • You now have all the information you might need to get started with treatment. • Be sure to prepare adequate treatment materials to begin your teaching.

  29. Step 6 – Begin the Treatment Phase • Begin to think about Behavioral Objectives. • Think about what you can realistically achieve by the end of the quarter (consider stimulability results). • For the purposes of this clinical experience, you probably will not be writing your BOs at the level of generalization. Read on…

  30. Step 6 – Begin the Treatment Phase • You will likely write your BOs in terms of where in treatment you will get. • So your BOs will reflect that you will use “treated” words, not “untreated.” • You could write a BO that reflects performance at the conversational level, if that is appropriate (i.e., your stimulability testing indicated the child is ready to work at a high level – like the sentence level).

  31. Step 6 – Begin the Treatment Phase • You will talk about the child’s performance on “untreated” words in the generalization section after each behavioral objective.

  32. Questions? • If you have any questions about the baseline process – Ask your supervisor!

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