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Treatment Efficacy in Phonological Intervention. What are the variables in treatment efficacy?. What is treatment efficacy?. Olswang (1990) discussed the “3 E’s” of treatment efficacy: 1. Efficiency 2. Effects 3. Effectiveness. Treatment Efficiency.

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treatment efficacy in phonological intervention

Treatment Efficacy in Phonological Intervention

What are the variables in treatment efficacy?

what is treatment efficacy
What is treatment efficacy?

Olswang (1990) discussed the “3 E’s” of treatment efficacy:

1. Efficiency

2. Effects

3. Effectiveness

treatment efficiency
Treatment Efficiency
  • How long did it take for child to achieve their goal?
    • Number of tx sessions
    • graphed data
      • slope (gradual or sharp?)
  • How much effort did it take to facilitate changes?
    • How long was child in each tx phase (imit vs spon)?
    • were branching steps included?
    • How much cueing did child require?
treatment effects
Treatment Effects
  • Was the observed change significant?
    • Visual inspection of the slope of the graphed data (tx and generalization)
    • Pre/post measures (PCC-R; PCUR; intelligibility and severity indices or rating scales; Kent measures)
    • was the change “clinically significiant”?
      • Generalization data, conversational sample, social validation
treatment effectiveness
Treatment Effectiveness
  • Was therapy responsible for the observed changes?
    • Baseline (level and trend)
    • extendend baseline
    • control sound
functional outcomes of phonological treatment gierut 1998
Functional Outcomes of Phonological Treatment (Gierut, 1998)

3 questions:

1. Does treatment work?

- treatment effectiveness

2. In what ways does treatment alter behavior?

- treatment effects

3. Does one treatment work better than another?

- treatment efficiency

effectiveness does treatment work
Effectiveness: Does treatment work?
  • The model selected by the SLP is “a direct derivative of the diagnostic and classification framework that forms the initial phonological evaluation”
  • Although there are different models of treatment available, what are the 2 categories that the models can be classified in?
    • sensory-motor (phonetic)
    • cognitive-linguistic (phonemic)
effects what are the types of sound change
Effects: What are the types of sound change?
  • How do we measure sound change?
    • Specific: to trained sounds (narrow)
    • General: to untrained sounds/system-wide (broad)
    • On-line: change that occurs during treatment
    • Longitudinal: change that occurs following treatment
specific sound change to treated sounds
Specific sound change to treated sounds
  • Widespread lexical change from training a sound in a limited number of exemplars (3-5 different words)
  • Change across phonetic contexts
  • Change across linguistic units
  • Change across settings
specific sound change to untreated sounds
Specific sound change to untreated sounds
  • Within-class generalization
  • Across-class generalization
    • broad and system-wide change
    • markedness
efficiency does one treatment work better than another
Efficiency: Does one treatment work better than another?

3 types of comparisons

1. Treatment models

2. Types of sounds taught

3. Modes of presentation

comparison of treatment models
Comparison of Treatment Models

- MP ~ maximal oppositions

- MP ~ treatment of the empty set

- MP ~ cycles

- MP ~ whole language

comparison of treated sounds
Comparison of Treated Sounds

- early ~ later developing sounds

- phonetically complex ~ less phonetically


- stimulable ~ non-stimulable

- most knowledge ~ least knowledge

comparison of modes of presentation
Comparison of Modes of Presentation

- sound perception ~ sound production

- drill ~ drill/play ~ play

- computerized instruction ~ SLP

summary of treatment efficiency
Summary of Treatment Efficiency
  • Teach sounds or sound pairs not in phonetic inventory
  • select developmentally later-acquired sounds that are also phonetically more complex, acoustically undifferentiated, and nonstimulable
treatment efficacy olswang gierut
Olswang (1990)

Effectiveness: Was therapy responsible for the change

Effects: Was the change significant?

Efficiency: How long did it take to achieve the goal? How much effort was required?

Gierut (1998)

Effectiveness: Does treatment work?

Effects: What is the type and extent of sound change?

Efficiency: Does one treatment work better than another?

Treatment Efficacy (Olswang ~ Gierut)
research and practice applied phonology hodson 1998
Research and Practice: Applied Phonology (Hodson, 1998)
  • Gap between research and practice is probably greatest in phonology
  • Phonetic approaches with children who have multiple sound errors take much longer (5-6 years)
  • However, time is a critical priority given the critical age hypothesis that reading and spelling will progress normally if the intelligibility problem has been resolved by age 5;6.
phonological impairment phonological awareness and literacy
Phonological Impairment, Phonological Awareness, and Literacy
  • Compelling evidence that children with severe phonological impairments perform less well on phonological awareness tasks
  • Further, children with poor phonological awareness abilities experience greater difficulty learning to read
  • “Matthew effects” -- unless intervention is appropriate and immediate, the gap between good and poor readers widens over the years
treatment research
Treatment Research
  • Critical need for more treatment outcome data
    • to bridge gap between research and practice
    • treatment studies must be “accountable” and “clinician-friendly”
  • Following information needed to evaluate treatment outcomes:
    • intelligibility
    • severity
    • stimulability
    • phonetic transcriptions of word productions
    • child’s abilities
treatment studies con t
Treatment Studies (con’t)
  • In addition, treatment studies should include:
    • theoretical underpinnings of the approach
    • explanation/rationale of specific treatment targets selected
    • explanation of specific procedures used
    • specification of contact time (exact number of contact hours); including number of sessions/wk, length of each session, period of treatment from beginning to end
investment in incorporation of phonological principles
Investment in Incorporation of Phonological Principles
  • Which phonological analysis model should be used? (phonological processes; PPK, non-linear; some combination?)
  • Do SLPs need to learn all analysis frameworks to be effective when working with children with severe PI?
  • These questions add to the confusion of SLPs and increase resistance to implementing phonological principles
conclusions researcher clinician gap
Conclusions: Researcher ~ Clinician Gap

Two-way responsibility

  • practitioners need to be involved in research at all levels
  • researchers need to understand the needs of clinicians as well as clients
  • “collaborative dialogues” between researchers and practitioners
conclusions researcher clinician gap1
Conclusions: Researcher ~ Clinician Gap
  • accountability and responsiveness need to be improved at all levels (including university classrooms and clinics)
  • SLPs need a “deep commitment to lifelong learning in order to be able to provide optimal services to children with severe phonological impairments”