Chapter 7

Question 1

When selecting potential target behaviors:

Answer 1

• Target behavior
• We need to select short term objectives and long-term goals
• In the schools, we say “benchmarks”

Question 2

What are some general characteristics?

Answer 2

• Select treatment targets that are linguistically and culturally appropriate for the client
• Select targets that will make an immediate and socially significant difference in the client’s communication skills

Question 3

Remember…

Answer 3

• Connect treatment to classroom curriculum
• Always keep common core state standards in mind
• I always treat speech sound errors and language together

Question 4

Select More Readily Taught Treatment Targets

Answer 4

• Stimulable sounds treated before non-stimulable sounds
• Teach visible sounds before non-visible sounds (e.g., /th/ before /r/)
• For a phonological process to be treated, should occur at least 40% of the time

Question 5

Select Targets that Affect Intelligibility the Most

Answer 5

• Select phonological processes that affect the most sounds; processes that contribute the most to the child’s lack of intelligibility
• E.g., stopping affects many sounds

Question 6

Deciding on the number of sounds or patterns to teach

Answer 6

• If the child only has 1-2 errors, the decision is easy

- If the child has multiple errors, then we need to decide: do we train many sounds at once, or just a few?

Question 7

Variables impacting the decision on the number of patterns to teach include child’s:

Answer 7

• Motivation
  
  • Intellectual level
• Age
• Language and learning skills
• Time frame (1 year? 2 months?)

Question 8

Establishing Baselines

Answer 8

• When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not adequately sampled
• For example, an artic test may sample /r/ one time in initial, medial, final position of words

Question 9

Because of this very limited sampling (baseline), mistakes can be made

Answer 9

• For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off
• But later, lo and behold, the child makes the /f/ with 90% accuracy on repeated measures!

Question 10

We counteract this problem(baselines)…

Answer 10

By establishing baselines of potential treatment targets before starting therapy

Question 11

What are baselines?

Answer 11

Baselines are measured rates of behaviors in the absence of treatment

Question 12

3 purposes of baselines:

Answer 12

1. Establish clinician accountability (many 3rd parties want numbers or quantitative data to evaluate progress)
2. Evaluate child’s progress over time
3. Modify treatment procedure if child’s not improving expected

Question 13

What are baseline procedures?

Answer 13

• Specify the treatment targets in measurable terms
• For example:
  - produce /r/ in word-final position with 80% accuracy
  - Reduce use of final consonant deletion from 70% to 20% in conversation

Question 14

We need to be sure to specify response topography:

Answer 14

• This refers to the linguistic level of training
• For example, do we want to begin with /r/ in isolation?
• Do we want to begin with /r/ in word-initial position in sentences?

Question 15

Selecting the initial level and sequence of training

Answer 15

• Baselines help us create appropriate treatment objectives

- PBH: best to start treatment at word level- functional words especially (exam)

Question 16

DEVELOPING MEASURABLE OBJECTIVES

Answer 16

-Treatment or short-term objectives are the skills the clinician plans to teach on the way toward achieving the selected treatment targets or long-term goals

• Appropriate long-term goals might be:
  - “Increase the client’s intelligibility of speech”
  - “Improve the client’s phonological skills”

Question 17

Measurable short-term objectives are needed

Answer 17

• These objectives specify how a goal will be achieved
• The objectives must be measurable so that external observers can verify the results of the clinical services provided
• Many 3rd party payers like insurance companies demand detailed documentation of improvement

Question 18

To write a good objective:

Answer 18

• Use observable behaviors (ex: point to, say, write, read aloud, sing, match)
• Don’t use words with non-observable behaviors (ex: know, understand, remember, learn, perceive, memorize, think about, consider)

Question 19

Remember that data collection:

Answer 19

• Should be done throughout treatment

- A good baseline will support this

Question 20

What are Phonetic placement techniques?

Answer 20

Are direct methods to teach clients how to position the articulators and produce the sound appropriately

Question 21

What is Successive Approximation or Shaping?

Answer 21

• We take advantage of a sound the client can already make (e.g., /g/ if they cannot produce /r/).
• We have them make the /g/, and gradually move toward /r/.

Question 22

We can begin training the sound at one of several levels:

Answer 22

1. isolation
2. syllable
3. word
4. phrase
5. sentence

Question 23

If the child cannot create a phrase or sentence with the target word…

Answer 23

• We can use a carrier phrase such as:
• “I see______”
• “Here is a ____”

Question 24

Structuring treatment sessions

Answer 24

• Initial treatment sessions highly structured
• Treatment sessions gradually loosen up to replicate natural “real world” more
• Helps child generalize target sounds to spontaneous speech

Question 25

What is a Positive reinforce?

Answer 25

—rewards and strengthens the behavior

Question 26

What is a Primary reinforcers?

Answer 26

—food and water

Question 27

What is a Secondary reinforcers?

Answer 27

• social value::
  
  • Verbal praise
  • Tokens (ex: play money, marbles)
  • Stickers

Question 28

What is Generalization?

Answer 28

• usually refers to the child’s producing learned responses in settings outside the clinic
• Generalization across situations
• Child uses sound in other locations with other audiences

Question 29

Implementing a maintenance program

Answer 29

• Maintenance = ultimate goal
• Skills sustained over time
• Select stimuli from client’s natural environment
• For example, classroom language arts book

Question 30

We should vary the physical setting:

Answer 30

Conduct therapy in different environments

Question 31

We Need to Teach Multiple Exemplars:

Answer 31

• For example, “quick” children working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures
• Some children may need 50 pictures, 30 objects, and 10 books with /r/-initial stimuli before they achieve 90% accuracy

Question 32

Manipulation of Response Contingencies:

Answer 32

• Most important aspect of maintenance
• Move from continuous to intermittent reinforcement schedule
• Fade primary reinforcers, rely more on natural reinforcers

Question 33

We can also:

Answer 33

• Train parents and others to reinforce child for correct speech productions in natural environments
• Teach self-monitoring/self-correcting skills (I use the terms interchangeably)

Question 34

Involve Family Members and Significant Others

Answer 34

• Best maintenance- involvement of people in child’s life
• Peers can help each other, especially if they are in the same therapy group
• They love being the teacher!
• Classroom teacher can also help, especially with nonverbal signals
• Solicit the help of parents; if they refuse, discuss how this will negatively impact the child’s progress in therapy