Exam 4 Flashcards
phonological therapy approach is best for:
children with phonological-based error patterns
intervention begins at the WORD level - where sounds have value in “meaning” (e.g., fin vs chin, sad vs sat)
principle of phonological therapy approach
error patterns are taken into consideration when selecting targets
principle of phonological therapy approach
may address multiple targets and/or entire sound classes
principle of phonological therapy approach
minimal pair
word pair that differs by only one phoneme
target word: cool
comparison: tool
minimal pair
select two sounds that are as similar as possible
minimal contrasts/opposition (phoneme contrast (e.g., t/k, d/t, t/s, p/f))
differ by only a phoneme or single feature
minimal contrasts/opposition (phoneme contrast)
minimal contrasts/opposition examples
bat-pat: voicing
tea-key: place
toe-so: manner
minimal contrasts/opposition is best for:
children with mild to moderate phonological impairment
< 6 errors patterns; error subst. are consistent
phonological delay
minimal contrasts/opposition targets
5-10 word pairs that mirror the child’s typical errors
maximal contrasts/opposition is best for:
children with moderate to severe phonological impairment
AKA: +6 sounds missing from the phonemic inventory
maximal contrasts/opposition targets:
5-10 word pairs that do NOT mirror the child’s errors
ideally, sounds in both word pairs are not in client’s sound inventory
two sounds are selected that are different
differ by production of all phonological features if possible
the goal: teach new sounds that represent different aspects of the phonological system and highlight the diversity of the phonological system
maximal contrasts/opposition
maximal contrasts/opposition activities
speech production practice (e.g., drill-play) + sorting + matching
multiple contrasts/opposition is best for:
children with moderate to severe phonological impairment (3-6 yo)
+6 error patterns across three manner categories
multiple contrasts/opposition targets
two to four sound to be used in word pair of the error sounds vs subst. (word 1 - contains a phoneme child can produce; word 2-4 - contains subst. that are maximally distinct from the error sounds)
primary focus: to enhance speech intelligibility by selecting a phoneme collapse as the target
multiple contrasts/opposition
multiple contrasts/opposition intervention includes
drill practice -> less drill-based and with more communicative context
therapy progression for minimal contrasts: step 1
discussion of words: clinician teaches the child the concepts within the words
therapy progression for minimal contrasts: step 1 procedure
clinician asks the child questions about each picture; child is required to point to the correct picture
therapy progression for minimal contrasts: step 2
discrimination testing and training: clinician tests child’s ability to discriminate between two targets
therapy progression for minimal contrasts: step 2 procedure
clinician produces word pairs in random order while patient points to the picture the clinician names; criteria is 7 consecutive correct responses
therapy progression for minimal contrasts: step 3
production training: clinician prompts child to produce minimal word pairs; sound teaching strategies are used as needed to teach target sounds
therapy progression for minimal contrasts: step 3 activity
child acts as the “teacher” prompting clinician to point to picture he/she says; “hide the penny”
therapy progression for minimal contrasts: step 4
carryover training: clinician prompts child to produce minimal word pairs in phrases/sentences of increasing length
generalization
production of a learning response in a new context
production of an untrained response
maintenance
ability to continue producing sounds correctly over time and across situations
select targets that have functional impact on child
promotes maintenance and generalization
select treatment stimuli from child’s environment
promotes maintenance and generalization
continue treatment until mastery is achieved in conversation
promotes maintenance and generalization
use natural reinforcers
promotes maintenance and generalization
fade reinforcement
promotes maintenance and generalization
invite various people into therapy
promotes maintenance and generalization
move treatment outside of the therapy room
promotes maintenance and generalization
teach self-monitoring
promotes maintenance and generalization
work closely with families
promotes maintenance and generalization
phonetic placement
teaching the articulatory placement of a sound
how to use phonetic placement
model the position (mirror)
show pictures of the correct articulatory position
use manual guidance (hands, cotton swab, etc)
Successive Approximation: sound shaping
use of a sound the child can ALREADY make to learn a new sound
successive approximation: sound shaping example
t to sh
produce a hard t with lip protrusion
maintaining lip protrusion, produce the t again, but slowly pull the tongue back
Modeling
clinician models (produces) the target response
therapy using modeling
child carefully watches clinician produce the target and is then encouraged to repeat the production
can use VOCAL EMPHASIS to highlight the sound
modeling example
Johnny, say [rrrrrrrrred]
verbal instruction
verbal stimuli to help facilitate a client’s actions
often given prior to a model
verbal instruction example
for /k,g/ “see the back of my tongue, I’m going to make it go up really high to touch the top of my mouth in the back”
Prompt
hints or cues that help facilitate an expected response
types of prompts
verbal
nonverbal
verbal prompt
use of vocal emphasis
“remember where your tongue goes for that sound”
“don’t forget the sounda t the end of the word”
nonverbal prompt
AKA physical prompts, visual cues, visual stimulation
physical signs and gestures that might help the child visualize correct production of the sound
example of nonverbal prompt
apraxia hand signals
positive reinforcement
an event that follows a response that increases the response’s frequency
types of positive reinforcement
primary
secondary
fading
primary reinforcement
food and drink
secondary reinforcement
verbal praise, positive attention, smiles, tokens, stickers, etc.
fading reinforcement
being with consistent/continuous reinforcement and fade as accuracy increases
guidelines for positive reinforcement
Reinforce promptly
Provide clear statements
Be positive
Vary use of phrases
corrective feedback
feedback that informs the child when an error has been made
how to use corrective feedback
provide feedback for ALL incorrect productions
withdraw positive reinforcement
make sure positive reinforcement EXCEEDS corrective feedback
touch the child’s alveolar ridge with a tongue depressor to indicate the place of articulation for /l/
phonetic placement
“Rebecca, say [sssssup]
modeling
“I like how you produce /s/. Good work!”
positive reinforcement
hand gesture to facilitate /r/ production
nonverbal prompt
general philosophies or ways of thinking
approach
guides your ENTIRE course of treatment
approach
specific actions implemented to facilitate execution of a desired behavior
strategy
also known as: techniques
strategy
measured rate of behavior in the absence of treatment
baseline
MAIN purpose of establishing baseline
measure the child’s performance of a skill prior to beginning treatment
help with identifying a “starting point” for therapy
other purposes for establishing baseline
evaluate child’s progress over time
establish clinician accountability
modify treatment as needed
establishing baseline: evoked
ask child to name pictures with target sound in all positions. no model provided
develop a list of questions or fill in the blank sentences in which answers are words that contain target sounds
establishing baseline: modeled
ask child to name pictures with target sound in all positions given a model
develop a list of words and ask child to say following a model
how many targets to select with TRADITIONAL
no more than 2 targets at a time
targeting more sounds can cause confusion
how many targets to select with CURRENT
work on multiple targets (2+ sounds) at one time
targeting multiple sounds/errors yields faster progress
approaches to target selection
developmental norms
easy to teach
hard to teach
impact on intelligibility
developmental norms
based on selection of age appropriate sounds and patterns
age appropriate sounds are easier to teach
makes sense to teach sounds in the normal sequence
developmental norms examples
5 yo would work on sounds typically mastered by children 5 yo or younger
4 yo would work on error patterns typically suppressed by children 4 yo or younger
developmental norms: criticisms
not challenged as an approach
current research suggests teaching AHEAD of developmental norms might be beneficial
easy to teach
ideal targets
sounds in the child’s current repertoire
phonological processes that are unstable/inconsistent
easy to teach: criteria for SOUNDS
20-40% accuracy - IDEAL TARGET
sounds the child is stimulable for
visible sounds (p b f)
easy to teach: criteria for PHONOLOGICAL PROCESSES
error with a percentage of occurrence less than 100% (but more than 40%)
errors that occur only in certain contexts
hard to teach
ideal targets:
complex phonological patterns
sounds that are consistently omitted by the child
sounds nonexistent in child’s sound repertoire
sounds the child is NOT stimulable for
hard to teach: research support
acquisition of easier sounds and patterns achieved with no therapy
higher rate of generalization to settings outside of therapy
impact on intelligibility
ideal targets are ones that make a notable difference in intelligibility:
phonological or sound errors that occur frequently
phonological errors that affect large numbers of sounds (e.g., stopping)
phonological errors that are idiosyncratic (backing, glottal replacement)
impact on intelligibility: other considerations
address multiple sounds if needed
address sounds that occur frequently in the child’s speech (AKA high frequency words)
Client will improve articulation skills to an age-appropriate level as measured by an intelligibility rating of ≥ 90% in settings outside of the clinic.
LTG: broad (long term goal)
In 3-months of therapy, the client will correctly produce /r/, /l/ phonemes in words with 80% accuracy given minimal cues.
STO: specific (short term objective)
long term goal
broad communication behaviors
age appropriate articulation, phonological skills, intelligibility, etc.
short term objective
skills that can be taught in a relatively short period of time
steps to achieve the LTG
production of specific sounds or elimination of error patterns
2 weeks, 1 month, 3 months
target behavior
any skill or action that is taught to a client
treatment “goals” & “objectives”
Common elements of an individual treatment program
Development of follow up procedures
Involvement of child’s family in treatment
Establishment of baseline measures
Implementation of strategies to facilitate generalization
Selection of stimulus materials
use of sound evoking techniques
selection of target behaviors
best practice for approaches to speech sound disorders
take elements from well-researched approaches to develop an individualized, comprehensive treatment plan for each client
The SLP selected the /r/ phoneme as target for therapy because her client was able to produce those sounds correctly on her own on approximately 30% of opportunities in words.
easy to teach
Which one of the following minimal pair words could be the most appropriate pair of MINIMAL CONTRAST if the target was fronting of [k]?
A. cake – shake
B. key – bee
C. keep – deep
D. coast – toast
E. keep- cheap
coast - toast
An SLP using a minimal contrast approach to target stopping is using the minimal pairs “wide” and “ride” with his client. The activity he uses requires the patient to use each target within the carrier phrase, “I see
the _________”. What type of activity is the SLP using in this example?
carryover training
children in the early stage of phonological development
< 50 words in vocabulary
reduced inventory of sounds in PHONETIC INVENTORY when compared to others of the same age
reduced inventory of SYLLABLE STRUCTURES when compared to others of the same age
typically children 3 and under
a UNIFIED approach
vocabulary + phonetic inventory + syllable structures
Consideration 1: phonetic inventory
child’s current phonetic inventory
select specific WORD TARGETS that contain sounds the child can already produce
Consideration 1: phonetic inventory - GOAL
in 3 months of therapy, child will add at least 10 novel words to his expressive lexicon based on therapy data and parent report
Consideration 1: phonetic inventory - Example
phonetic inventory: m n p b t d h
possible targets: my mine no puppy baby bye bye toe happy
Consideration 2: syllable structure
child’s current syllable structure
select specific WORD TARGETS that contain syllable structures that child can already produced AND basic, novel syllable structures the child cannot produce
consideration 2: syllable structure - GOAL
in 3 months of therapy, child will add at least 10 novel CV, CVCV, and/or CVC words to his expressive lexicon based on therapy data and parent report
consideration 2: syllable structure - Example
syllable structure inventory: V CV CVCV
possible targets: mom dad baa-baa moo-moo hi bye
consideration 3 - developmental sequence
developmental sequence of sound acquisition
select WORD TARGETS that contain age appropriate sounds that are not in child’s inventory
consideration 3 - developmental sequence - GOAL
in 3 months of therapy, child will increase phonetic inventory to include at least 12 english phonemes within word approximations based on therapy data and/or parent report
consideration 3 - developmental sequence - Example
phonetic inventory: m n p b t d h
syllable structure inventory: V CV CVCV
possible targets: kitty go wagon sun
consideration 4: individual contexts to choose words
words that are important to the child
target words that are normally developing and/or that are important to the
consideration 4: individual contexts to choose words - GOAL
in 3 months of therapy, child will increase functional vocabulary to include approximations of at least 10 novel words as evidenced by therapy data and parent report
consideration 4: individual contexts to choose words - Example
phonetic inventory - m n p b t d h
syllable structure inventory - V CV CVCV
possible targets - teddy bubba tie pee pee poo poo
consideration 5: word classes
target words are from a variety of word classes
consideration 5: word classes - GOAL
in 3 months of therapy, child will increase vocabulary to include at least 10 novel VC and CVC action words given clinician model as needed based on therapy data and parent report
consideration 5: word classes - Example
phonetic inventory: m n p b t d h
syllable structure: V CV CVCV
possible targets: eat in out up down top hot
strategies
model
wait time
sabotage/communication temptation
activities
pretend play
books
songs and fingerplays
gross motor play
sensory play
parent training and education
Articulation therapy is best for:
children with ARTICULATION and/or motor based errors
Articulation therapy: main objective
treat substitutions, omissions and distortions of each isolated error phoneme
articulation therapy- sequence/progression
treatment progresses in a specified sequence
client does not progress to next level until mastery is achieved
each error sound individually one after the other
Articulation therapy progression stages
Sensory perceptual training
1. Sound in isolation
2. Nonsense syllables
3. Words
4. Phrases
5. Sentences
6. Spontaneous Speech
purpose of sensory perceptual training
(ear training)
teach AUDITORY DISCRIMINATION between correct vs incorrect forms of the target sound
build awareness of client’s own correct vs incorrect productions
sensory perceptual training - sample activities
client is asked to determine if a sound is a target sound or a different sound following clinician production
clinician produces words with target sounds; child is asked to detect if target sound is produced correct or incorrect
articulation therapy stage 1
isolation
purpose of articulation therapy stage 1
elicit correct production of sound alone; NOT in combo with other sounds
fricative and approximants can be achieved easily in isolation
stop-plosives may require central vowel or with a noticeable aspiration
articulation therapy stage 1 -sample activities
Clinician prompts client to produce sound in isolation; client receives a sticker on a chart for each correct production
Play a game that uses numbers (e.g., Chutes and Ladders, Hi Ho Cherrio); client is required to say sound number of times indicated by game before taking a turn
articulation therapy stage 2
nonsense syllables
purpose of articulation therapy stage 2
elicit correct production of sound when embedded in varying vowel contexts
common sequence: CV -> VC -> VCV -> CVC
articulation therapy stage 2 - sample activities
Client and clinician make “articulation cards” with nonsense syllables; child can add stickers or stamps to decorate the cards
Require patient to say 5 nonsense syllables from “articulation cards”; patient earns a piece to add to a puzzle.
articulation therapy stage 3
words
purpose and considerations for articulation therapy stage 3
maintain production accuracy of the target sound in words
EASIER-
word length: fewer syllables
sound position: initial
syllable structure: open
syllable stress: stressed
articulation therapy stage 3 - sample activities
Card games: Memory
Gross Motor: Crawling through a tunnel, Basketball, Egg Hunt
Board Games: Candyland, Connect 4,
Token activity: stickers on a chart, smiley faces on a white board, Bracelet
articulation therapy stage 4
phrases
purpose of articulation therapy stage 4
maintain production accuracy of the target sound in structured 2-4 word phrases
articulation therapy stage 4 - sample activities
Client can answer basic questions that would elicit use of phrases with target sound (e.g., Where does a cow live? In a farm.)
Can require child to use the same carrier phrase when naming pictures: “I see a _______”
articulation therapy stage 5
sentences
purpose & considerations articulation therapy stage 5
maintain production accuracy of the target sound in sentences of varying length and complexity
progress from simple/short sentences to complex sentences
progress from sentences with one instance of the target to multiple instances of the target
articulation therapy stage 5 - sample activities
Slow motion speech vs. shadowing
Correcting the clinician
articulation therapy stage 6
spontaneous speech
purpose of articulation therapy stage 6
maintain production accuracy of the target sound in spontaneous conversation
first addressed in therapy ut then carried over into settings outside of the clinic
progress from structured conversation to naturalistic conversation
articulation therapy stage 6 - sample activities
Tell story using pictures with target sounds
Games: Table Topics, Would You Rather
