Approaches to Therapy

Question 1

Describe the Traditional Approach and it’s phases

Answer 1

The hallmark of the traditional approach, established by Van Riper, is its progression from sensory-perceptual training to maintenance of the newly acquired speech sound. The 5 major phases are:

1. Sensory-perceptual or ear training
2. Production training for sound establishment
3. Production training for sound stabilization
4. Transfer and carry-over training
5. Maintenance

Question 2

In the Traditional Approach, what are the 4 phases of Sensory-Perceptual Training?

Answer 2

1. Identification- child learns to recognize the sound in isolation and perceive many of its important characteristics.
2. Isolation- child learns to recognize and isolate the target sound when it is produced against a background of other speech sounds.
3. Stimulation- “Bombardment”, increasing child’s sensitivity to the occurrence of the sound and developing an internalized auditory model of the sound.
4. Discrimination- child can judge between hte clinician’s correct and incorrect productions of the target. Error detection and error correction

Question 3

In the Traditional Approach, what are the 6 stages of Production Training- Sound Stabilization?

Answer 3

1. Isolation
2. Nonsense Syllables
3. Words
4. Phrases
5. Sentences
6. Conversation

Question 4

What are some clinical approaches in the Traditional Approach to assist in Transfer and Carryover (Generalization)?

Answer 4

• Speech assignments (homework)
• Self and peer monitoring
• Practice in other situations
• Proprioceptive awareness exercises (speaking with earplugs, speaking with masking, whispering…)
• Varying audience and setting

Question 5

Describe McDonald’s Sensorimotor Approach

Answer 5

The Sensorimotor Approach is based on the assumption that the syllable is the basic unit of training and that certain phonetic contexts can be used to facilitate correct production of an error sound.

Question 6

How does the Sensorimotor Approach differ from the Traditional Approach?

Answer 6

The Sensorimotor Approach does not include Auditory Discrimination as part of the program and production training is initiated at the syllable level rather than at isolation.

Question 7

What is a key element in successfully using the Sensorimotor Approach?

Answer 7

Finding a facilitative phonetic context in which the sound is produced correctly and can be incorporated into sound production tasks.

Question 8

What are the 3 primary objectives of the Sensorimotor Approach?

Answer 8

• Heightening the Child’s Responsiveness
• Reinforcing Correct Articulation of the Target Sound
• Facilitating Correct Production in Varied Contexts

Question 9

What are the primary features of the Multiple Phoneme Approach?

Answer 9

Established by McCabe & Bradley, the Multiple Phoneme Approach’s primary features are:

• The simultaneous teaching of multiple phonemes
• A systematic application of behavioral principles
• An analysis of sound production in conversational speech

Question 10

What kinds of children might benefit from the Multiple Phoneme Approach?

Answer 10

The Multiple Phoneme Approach can meet the needs of children with multiple articulation errors (6 or more errors)

Question 11

What are the 3 phases of the Multiple Phoneme Approach?

Answer 11

1. Establishment
2. Transfer
3. Maintenance

Question 12

Within Phase 1 of the Multiple Phoneme Approach (ESTABLISHMENT), what are the two steps?

Answer 12

Step 1: Establishment of Accurate Sound Production
Step 2: Holding Procedure- all sounds in isolation in each therapy session. This is checking in with the established phoneme to keep them at production level since you are working on multiple targets.

Question 13

Within Phase 2 of the Multiple Phoneme Approach (TRANSFER), what are the five steps?

Answer 13

Step 1: Syllable
Step 2: Words
Step 3: Phrase/Sentence
Step 4: Reading/Story
Step 5: Conversation
*important to take good notes within this Phase to keep track of where you are with each target*

Question 14

Within Phase 3 of the Multiple Phoneme Approach (MAINTENANCE), what is the goal?

Answer 14

90% whole-word accuracy in conversational speech across various speaking situations without direct treatment or external monitoring.
A 5% accuracy loss is typical within 3 months of initial dismissal- so accuracy criterion for this phase moves to 95% with maintenance accompanied by consults, follow-ups, etc.

Question 15

How is Shrine & Proust’s program different from McDonald’s Sensorimotor Approach?

Answer 15

• Based on McDonald but more structured

- Emphasizes orientation to speech helpers (articulators)

Question 16

What are the key features of the Paired-Stimuli Approach?

Answer 16

Developed by Weston & Irwin, the Paired-Stimuli Approach is highly structured and carefully sequences the progression from words to sentences to conversation. Depends on identification of a Key Word to teach correct production of a target sound in other contexts. A single speech sound is the target at any given time.

Question 17

The Paired-Stimuli Approach is a best fit for which type of client?

Answer 17

This method is most suited for children who have sound distortions or a few articulation errors.
*not a lot of evidence establishing the effectiveness of this approach

Question 18

What are the 3 steps of the Paired-Stimuli Approach?

Answer 18

Step 1: Word Level (key word = facilitative context)
Step 2: Sentence Level
Step 3: Conversation Level

Question 19

In Hodson’s Cycles Approach, what are the primary target patterns or phonemes that should be addressed early in therapy?
*good for highly unintelligible children!

Answer 19

• Initial and final consonant deletion of stops, nasals and glides
• Posterior-anterior contrasts (k-g, t-d, h)
• /s/ clusters–word initial clusters /sp, st, sm, sk/ and word-final clusters /ts, ps, ks/
• Liquids /r/ and/l/ and clusters containing those liquids

Question 20

Describe a “Cycle”

Answer 20

A time period for the child to focus on each deficient phonological process for 2-6 hours

Question 21

What are the 6 steps of a typical Cycles Approach therapy session?

Answer 21

1. Review of previous session’s word cards
2. Auditory bombardment (amplification for about 2 mins while clinician slowly reads a list of words containing target sound)
3. Target word cards (child makes cards with pictures of 3-5 target words on index cards)
4. Production practice (game-based at word level)
5. Stimulability probing for next session’s target
6. Auditory bombardment repeated
   (7. Home program)- parents read 12 word list to child once a day ie- auditory bombardment

Question 22

What did DeThorne’s studies suggest?

Answer 22

• looked at alternatives to imitation for facilitating early speech development
• Premise: when little kids won’t talk, trying to have them imitate us often does not work

Question 23

How do you structure a remediation cycle using the Cycle Approach?

Answer 23

1. Train each phoneme exemplar within a target pattern for 60 minutes per cycle before going to the next phoneme
2. Train 2 or more target phonemes in successive pattern before moving on to next pattern
3. Target only 1 phonological pattern per session
4. When all patterns are taught, the cycle is complete
5. Initiate the 2nd cycle
   * For intelligibility, most need 3-6 cycles of therapy