SPECIFIC TREATMENT PROGRAMS AND APPROACHES

1. SPECIFIC TREATMENT PROGRAMS AND APPROACHES

2. I. INTRODUCTION** • “traditional and pattern-based approaches” (p. 395) • Textbook philosophy: all programs contain elements of both; regardless of what we call an approach, we are teaching motor production of phonemes • P. 396: “Children learn to produce speech sounds, not rules.” • All approaches use behavioral tx techniques

3. II. TRADITIONAL APPROACH • A. Background

4. B. Part One: Ear Training (pp. 399-400)** • Phase 1: identification • Phase 2: isolation • Phase 3: stimulation • Phase 4: discrimination

5. (p. 400)** • There are two forms of discrimination • In error detection, the child has to tell when the SLP produces the sound in error • In error correction, the child must explain why the sound was in error and how it can be corrected

6. **C.Part 2: Production Training—Sound Establishment • D. Part 3: Production Training—Sound Stabilization • (begin at the most complex level possible) • Stage 1: Isolation • Stage 2: Nonsense syllables (not functional) • Stage 3: Words • Stage 4: phrases (2-4 word phrases) • Stage 5: sentences • Stage 6: conversation

7. To help establish the production of sentences: (p. 404)** • 1. Slow-motion speech —SLP and Ch say target at the same time, using a very slow rate of speech • 2. Shadowing —SLP says the sentence first, then Ch says it immediately

8. E. Part 4: Transfer/Carryover** • (don’t worry about definitions—use them interchangeably) • Vary settings, interlocutors/audience, stimuli • Speech assignments • Follow-up (maintenance) sessions

9. CSHA Dr. Steve Skelton

11. ACTIVITIES AND IDEAS FOR ELICITING AT LEAST 150 PRODUCTIONS PER GROUP SESSION

16. OTHER IDEAS FOR CENTERS** • Read books or stories with target sound • Hula hoops • Jump rope

19. III. MULTIPLE PHONEMEAPPROACH (test 4: just lecture notes and summary on pp. 416-417)** • A. Introduction (McCabe & Bradley) • For children with 6+ errors • Highly structured • Use multimodal cues to teach multiple phonemes simultaneously

20. B. Phase 1: Establishment** • Step 1: Establishment of sound production • Step 2: Holding procedure (all sounds in isolation in each tx session)

21. C. Phase 2: Transfer** • SyllablesWords Phrases and sentencesreading/story/conversation • D. Phase 3: Maintenance • 90% accuracy across speaking situations with no external modeling

22. IV. MCDONALD’S SENSORIMOTOR APPROACH • A. Introduction—Assumptions:

23. B. Part 1: Heighten Child’s Responsiveness** • Practice syllables with nonerror sounds • Begin with CVCV syllables • Then go to trisyllables • Vary vocal emphasis on syllables

24. Bauman-Waengler CSHA:

25. C. Part 2: Reinforce Correct Articulation of Error Sound** • Use facilitative contexts: e.g. watch-sun

26. McDonald’s (Part 2 continued)** • 1. Slo-mo • 2. Equal stress on both syllables • 3. Primary stress on first syllable • 4. Primary stress on second syllable • 5. Child prolongs target until clinician signals to go on (e.g., watchsssssssssun) • 6. Practice in short sentences

27. D. Part 3: Facilitate Correct Articulation of the Target Sound in Various Contexts

28. Beach-seal

29. V. Shine & Proust’s Sensorimotor Approach** • Based on McDonald, but more structured • Emphasizes orientation to the speech helpers (articulators)

30. V. DISTINCTIVE FEATURE APPROACH (lecture only!)** • Based on distinctive feature analysis • Teach a relevant sound that is missing the feature, hope for generalization • E.g., for feature of stridency, teach /f/ and hope it will generalize to /s, z, sh/

31. VI. PAIRED-STIMULI APPROACH** • A. Introduction • Developed by Irwin & Weston, 1971 Good for children with a few sound errors Capitalizes on a key word

32. B. Step 1: Word Level** • Select a target sound for tx • Identify 4 key words: 2 with target in word-initial position and 2 with target in word-final position

33. C. Step 2: Sentence Level** • Use Key Word #1 with 10 training words, only evoke the target in a sentence • FR3 schedule of reinforcement (3 responses for 1 token) • Do 2nd, 3rd, 4th key words and then do some alternations

34. D. Step 3: Conversational Level** • Clinician and child converse • Clinician stops the conversation immediately if the child produces a sound incorrectly

35. VII. CONTRAST THERAPY APPROACH/PHONOLOGICAL CONTRAST APPROACHES (pp. 432 on)** • Minimal contrast training— use minimal pairs which only differ by one feature (tea-key) • Maximal pair training— sounds differ by at least 2 features (cane-lane; ten-men)

36. (pp. 436-437)** • Multiple oppositions/multiple contrasts approach Not on exam

37. Begin with perceptual training** • Then, go to production training where the child has to produce minimal pairs • Good for use with adults also

38. VIII. HODSON’S CYCLES APPROACH (on exam!)** • A. Introduction • General Procedures 1. Stimulation (multimodal cues) 2. Production training 3. Semantic awareness contrasts

40. B. Selection of Target Patterns and Phonemes** • Top Priority: • 1. Early-developing phonological patterns: • Initial and final consonant deletion of stops, nasals, and glides • CVC and VCV word structures • Posterior-anterior contrasts (k-g, t-d, h) • /s/ clusters--word initial clusters /sp, st, sm, sn, sk/ and word-final clusters /ts, ps, ks/ • Liquids /r/ and /l/ and clusters containing these liquids

41. 2. Secondary Patterns** • A. Voicing contrasts, vowel contrasts • B. Singleton stridents • C. Other consonant clusters • D. Other (metathesis, reduplication, multisyllabic words, complex consonant sequences)

42. C. Structure of Remediation Cycles** • 1. Train each phoneme exemplar within a target pattern for 60 min per cycle before going to the next phoneme • 2. Train 2 or more target phonemes in successive weeks within a pattern before changing to the next target pattern • (2+ hours on each pattern within a cycle)

43. **3. Target only one phonological pattern per session • 4. When all target patterns have been taught, a cycle is complete • 5. Initiate the second cycle. Review patterns not yet corrected, introduce new ones as necessary • **to become intelligible, most children need 3- 6 cycles of therapy

44. D. Structure of Therapy Sessions • 1

45. E. Home Program** • Caretakers are asked to read the 12-item word list once a day. • Child is asked to name the 3-5 pictures once a day (may also produce other target words)

46. IX. Oral-Motor Exercises** • PBH do not believe that oral motor exercises are beneficial for anybody • They say research has not proven that oral motor exercises help • Roseberry’s position: these exercises are very helpful for children with oral motor problems

47. X. Language Treatment for Phonological Disorders** • PBH: research is inconclusive re: the question: Can language therapy improve children’s artic/phono skills? • Bottom line: If the child has a language and phonological disorder, best to do both language and artic/phonology therapy simultaneously. • In other words, don’t just do language therapy and hope that somehow artic/phonological skills will magically improve too 

48. Anthony et al. 2011 American Journal of Speech-Language Pathology (4/11 issue)

49. XI. Combining Therapy for Language and Articulatory-Phonological Disorders** • We can connect phonology to children’s morphosyntactic skills • If children have final consonant deletion or cluster reduction, they will have problems with some morphemes

50. These morphemes include:** • Past tense –ed (jumped, scared) • Plural –s (pots, sidewalks) • Regular 3rd person –s (eats, runs) • Possessive –s (Grant’s, Bob’s)