Chapter 8 Flashcards
What are the three parts to the framework for conducting therapy?
Antecedent Events (AE)
Responses (R)
Consequent Events (CE)
What are Antecedent Events (AE)?
2
Stimulus
Events presented during or just prior to a response
What are some types of Antecedent Events (AE)?
4
Verbal model
Picture
Printed material
Verbal instructions
What might cause the Antecedent Event (AE) to vary?
The clinician’s goal (establish a motor behavior vs. teach a phonological rule vs. contrast speech sounds, etc.)
What are Responses (R)?
2
Behaviors targeted for a client
Reactions to the AE
How do Responses (R) correlate with Antecedent Events (AE)?
Why is this important?
Different stimuli will elicit the different responses
We usually need a certain number of correct responses to move forward in therapy
What is the benefit of a high rate of Responses (R)?
2
Helps the clinician monitor progression
Helps the client stabilize production
What are Consequent Events (CE)?
Reinforcement (or punishment) following a response
What is Positive Reinforcement?
What is its goal?
Giving the client a tangible or intangible “reward”
It increases a desired (or undesired) behavior
Should we reinforce wrong responses?
No
Is punishment used in therapy?
Not usually
What are the three Goal Attack Strategies?
Vertically Structured Treatment Program
Horizontally Structured Treatment Program
Cyclically Structured Treatment Program
What is the Vertically Structured Treatment Program?
2
1-2 goals are trained to a predecided level before moving on to new goals
Uses a high response rate (lots of repetition) for a single target
What is another name for the Vertically Structured Treatment Program?
Training Deep
What is the assumption behind the Vertically Structured Treatment Program?
(2)
When you practice a small number of target sound for a long period, these skills are more likely to be generalized to new targets
Some clients do better focusing on a small number of targets
What is the Horizontally Structured Treatment Program?
3
Clinician targets multiple goals in a single session
The training for each target is less intense
Focuses on the broader speech system components
What is another name for the Horizontally Structured Treatment Program?
Training broad
What is the assumption behind the Horizontally Structured Treatment Program?
The client’s phonological system will be more efficiently modified by working with a range of sounds
What is the Cyclically Structured Treatment Program?
3
Combines both the Vertical and the Horizontal
A single target is focused on for a fixed period of time (one session, a week, etc.)
Afterwards a new target is addressed no matter the mastery
What are the two types of scheduling?
Intermittent scheduling
Block scheduling
What is Intermittent Scheduling?
2-3 sessions per week for an extended period of time
What is Block Scheduling?
Daily sessions for a short period of time
Will block scheduling intervention 4-5 times a week for 8-10 weeks result in slightly higher or slightly lower dismissal rates when compared to intermittent scheduling for a longer period of time?
Higher
Use _______ scheduling only on a _________ basis. It does not appear to be as appropriate with clients who have severe articulation/phonological disorders and will need ongoing services.
Intensive/Broad
Short-term
Which tends to yield better results: scheduling a child for three 30 minutes sessions or scheduling a child for one 60 minute session?
Scheduling a child for three 30 minutes sessions
What is the difference between the pull-out model and the inclusion model?
Pull-Out - client is instructed in a treatment room
Inclusion - client is instructed in a classroom setting
What are some items a clinician can draw on when treating a school-age child using a classroom-based approach? (3)
What can be developed from these? (3)
Textbooks, homework, and classroom discourse
Goals, target words, and instructional procedures
What are some items a clinician can draw on when treating a PRESCHOOL-age child using a classroom-based approach? (3)
Crafts, snacks and toileting
What may benefit all children in the classroom when a clinician treats a preschooler using a classroom-based approach?
Phonological awareness
Which style of direction is more direct: the pull-out model and the inclusion model?
Pull-out model
What does the inclusion model require?
Collaboration from the classroom instructor
Can treatment in small groups be as effective as individual treatment?
Yes
How is are instruction groups typically designed?
By grouping 3-4 clients of similar ages working on similar targets
How does group instruction differ from individual instruction?
Groups are structured so all clients benefit from both from the activities and group interactions
Can combining group and individualized instruction be beneficial?
Yes
What are the four intervention styles?
Drill
Drill play
Structured Play
Play
What is Drill-based therapy?
2
Clinician presents a stimulus or an antecedent event
Client issues a response
What does the clinician control in Drill-based therapy?
Rate and presentation of stimuli
What is Drill-Play based therapy?
Contains the same components of Drill-based therapy but stimuli are included in a antecedent motivational event (like a game)
What is Structured Play?
2
Training stimuli are presented as play activities
Clinician moves from formal instruction to play-like activities
When is Structured Play particularly useful?
If the child becomes unresponsive to formal instruction
What is Play-based therapy?
2
Child perceives the task as play
Clinician arranges activities so that targets occur naturally within the activity.
What other techniques may be included in Play-Based Therapy?
2
Modeling
Self-Talk
What can we use to measure change?
Probe
What is the problem with issuing norm-referenced tests to measure change?
(4)
Regression to the mean
Only target a limited sample of child’s speech
Child might remember words from previous exposure
Child might be hypersensitive to a particular word and not be able to produce it on test (but may in real life)
What is a probe?
2
Several words containing the target sound that are not being practiced in therapy
Usually informal measures
How often should we probe?
2
Not every session
Every 4-5 sessions, every month, etc.
What are Extraneous Effects that might cause client improvement?
(5)
Child’s development/maturation (Natural History Effect)
Placebo effect
Hawthorn Effect
Pygmalion Effect
Regression to Mean
What are Extraneous Effects?
Events outside the clinician’s treatment
How can a child’s development/maturation cause improvement outside the treatment?
The child’s muscle control, auditory discernment, etc. may have improved by itself meaning child can now make the sound
(natural history effect)
How can the Placebo Effect cause improvement outside the treatment?
What can be the danger in the Placebo Effect?
Any attention placed on a young child’s speech can potential lead child to focus on their speech not matter the type of intervention
Therapy has not been effective but everyone is happy that the child is receiving treatment
What is the Hawthorn Effect?
Placebo-type effect where client improves because they are convinced that treatment is working
What is the Pygmalion Effect?
2
Client responds positively to interactions with the clinician putting in extra effort
Clinician/teacher might treat clients differently based on status
What is Regression to Mean?
A second testing on the same measurement will create scores closer to the mean no matter if the original score was high or low
How can parents and teachers create extraneous effects?
By providing additional therapy, correcting articulation in interactions, etc.
How can clinicians control for extraneous effects?
2
Single-subject design
Use evidence-based practices
What is Single-Subject Design?
3
Measuring change on several targets at the same time but only treating some of them
Ideally, the treated and untreated targets would not share many features
The expectation is that the untreated targets would not show the same improvement
What is another name for Single-Subject Design?
Multiple baselines within-subjects design
Is all change significant and important?
No
What is Generalization?
Applying what has been learned in therapy to to new linguistic contexts or nonclinical settings
Can generalization be taught?
No - only facilitated
What is another name for Generalization?
Transfer
What are two specific ways of facilitating Generalization?
Stimulus generalization
Response generalization
What is Stimulus Generalization?
Learned response for one stimuli is evoked by novel, but similar, stimuli
(“say kangaroo” replaced by picture of a kangaroo)
What is Response Generalization?
Taught responses carry over to new behaviors
(client learns to say /s/ correctly with a model. client automatically can use model to produce /z/ though it has not been trained)
What are some other ways speech sounds can be generalized?
6
Producing a speech sound…
- In a new position
- In a new context
- In a more complex linguistical environment
- In an untrained word
- That is novel
- In new situations
What are four specific TYPES of generalization?
Context generalization
Across-Linguistic Unit generalization
Across-Sound/Across-Feature generalization
Across-Situation generalization
What is Context Generalization?
Speech sound can be transferred to new contexts (position, blend, etc.) without direct training
(/s/ from “ask” -> “biscuit” -> “fist”)
What is Across-Linguistic Unit Generalization?
Transferring correct sound productions to more complex environments
(sounds -> syllables -> words -> phrases)
What is Across-Sound/Across-Feature?
2
Transferring correct productions of target of sounds to new sounds
Usually occurs within sound classes
(/k/ -> /g/)
What is Across-Situation Generalization?
Transfer of behaviors taught in a clinician environment to other situations (home, school, etc.)
What is another name for What is Across-Situation Generalization?
Carryover
Can parents help with generalization?
Yes
To help with generalization, should we start with stimulable or non-stimulable sounds?
Stimulable
To help with generalization in clients with multiple errors, what should we treat first: stimulable or non-stimulable sounds?
Non-stimulable
To help with generalization, when should we start incorporating sounds at the word level?
As soon as possible
To help with generalization, should we treat sounds with similar features or dissimilar ones?
Similar
Can treating a feature of a sound in one context be generalized to another context?
Yes
To help with generalization, what position should sounds be taught in first?
Whichever is easiest for the client
To help with generalization when reducing phonological patterns, should we select targets from similar classes?
No - they should be from different classes
To help with generalization, how can nonsense syllables be useful?
Production can be taught without influence by known words
When should situational generalization be facilitated?
As soon as client can say a sound in words
Do preschoolers need formal instruction to generalize instruction?
Not usually
What is the final phase of therapy often referred to as?
Maintenance Phase
What is the goal of the Maintenance Phase?
Automatization
automatic usage of standard articulation/phonologic patterns
Is self-monitoring an important component in automatization?
Yes
What is Retention?
Constant and persistent use of learned responses
What is Intersession Retention?
Ability to use correct responses from one session to the next
What is Habitual Retention?
What can this also be called?
Ability to continue using correct responses after therapy has ended
Can also be called “maintenance”
Are articulation errors susceptible to regression?
Yes
What are four factors that can affect Retention?
Meaningfulness of the material
Degree the material was learned (more trials = more retention, overlearning is helpful)
Frequency of instruction (better in several short sessions than fewer long sessions)
Individual’s motivation
What does ASHA say are the three criteria used to make dismissal decisions?
Is there a disability?
If so, does this adversely affect educational performance ?
If so, does the student need specially designed instruction and/or related services and supports to make educational progress?
What should be included when making dismissal decisions?
Monitoring phonologic behavior over time
What are two red flags that should make us err on the side of treating a client?
Backing
Not able to produce early developing sounds
What are five types of Self-Monitoring?
External monitoring
External monitoring with cues provided for revision (hand raising)
Self-revision by client
Anticipating when errors may occur
Automatic usage of correct production
How can parents help with generalization?
3
Providing auditory models for target words
Having their children practice target words
Reinforcing correct productions
Do our clients only learn from us, the clinicians?
No - they learn when they think through and apply the information in their own lives
Can reducing reinforcement help with generalization?
Yes
