final exam Flashcards
examples of hybrid approaches to intervention
from most child-centered to most clinician directed
- prelinguistic mileu teaching
- focused stimulation
- using narrative/convo in intervention
- script therapy
- responsivity education
- cycles approach
- structured play
- combining hybrid activities with explicit instruction
hybrid intervention approaches for younger children
(below pre-school age)
- prelinguistic mileu teaching
- responsivity education
- book reading
hybrid intervention approaches for pre-school age children
- focused stimulation
- structured play
hybrid intervention approaches for school-age children
- script therapy
- combining hybrid approaches with clinician directed activities
- using conversation in hybrid approach
- using narratives in hybrid approach
prelinguistic milieu teaching (PMT)
- goal= establish and increase nonlinguistic acts
- uses prompts/communication temptations
- giving them an opportunity to say/communicate something intentionally (ex. holding swing back & waiting for the child to ask to be pushed, holding a toy out of reach)
- clinician then imitates child’s actions/vocalizations and is responsive to the child
- intentionality (work on this at their level, but work in their zpd–you might be trying to get them to vocalize)
for younger children (below pre-school age) -> duh it’s PRE-linguistic
responsivity education
teach parents/caregivers how to respond to their child (having them practice)
for younger children (below preschool)
EX: the hannon program
- uses parent coaching–> the clinician teaches the parent the hannon program (expanding, giving child time to respond, clinician defines what things look like)
- the parent uses the strategies at home with their child
- the clinician reviews videos of the parent with them and gives feedback (very positive and helpful-> what they did right and what to improve)
book reading
hybrid intervention approach for younger children
- parents and/or clinician (can train parents how to make book reading mor interactive –> trying to make it more of a back & forth experience)
focused stimulation
focus on specific target, use multiple models, clinician uses the word/target very often
- could pretend to misunderstand, often used in play context
- clinician is talking a lot, saying similar types of utterances, lots of modeling (how you can tell the difference between focused stimulation and facilitated play)
hybrid intervention approach for preschool-aged children
focused stimulation is more child centered than structured play
structured play
- developed to use play with phonological interventions
- play is organized by the clinician (usually uses roles)
- sort of doing the same thing over and over again within some roles
- not as much practice as drill play though
hybrid intervention approach for pre-school aged children
EX: describing an order from a picture menu, writing letters to mail
script therapy
- reduces cognitive load using familiar contexts
- predictable for children; there is a structure/model/schema that the child already knows
- model the script and violate the script (you can change the script because they are familiar with it)
- culturally responsive approach (it’s within a context)
- can carry over to the home
- examples of scripts:
- event structures (an event a child is very familiar with)
- going to the doctors office, school, bedtime routines, (you can ask parents for things they are familiar with) etc
- literature-based scripts (you can pick a story, and use it over and over, then it becomes a script
- can do cloze tasks when they are familiar
- songs, rhymes, routines (mostly talking about younger kids)
- event structures (an event a child is very familiar with)
hybrid intervention approach for school age children (can also be used for pre-school aged children)
using conversation in hybrid approach
- functional (good for practicing)
- maybe show a clip and then have a conversation about it
school aged children
using narratives in hybrid approach
- functional
- can work on many goals
- retell, create stories, act out
school aged children
guiding principles of intervention for school-aged children
- use curriculum-based instruction
- use the context of their curriculum to do treatment,
- incorporate things from the curriculum
- integrate oral and written language
- they are always writing things in the classroom
- go meta
- encourage them to analyze their own performance and progress
- helps them increase their independence and be able to self advocate (by figuring out how they learn)
- participate in RTI/MTSS (response to intervention/multi tiered systems of support)
- children already on our caseload (with ieps) don’t use this
- getting kids help sooner, don’t want to heave to wait to help them
- oral language and comprehension is often missing what we worry about
- remember- we are always working on pragmatics
- there’s never a time when you aren’t doing something with pragmatics
- you want to be using language how you would do it naturally in a conversation
- we always want to have the aim that what they are working on can be used in the classroom (so don’t always do clinician directed because it can’t be generalized)
hybrid approach strategies to teaching semantics for school-age children
- visual modalities (ie. word maps, symbols/pictographs)
- so they can figure out what strategies are helpful for them
- word map: center word–> parts; function; related; appearance (to make connections between things) - semantic networks
- connect the things they learn together (group words together that relate to certain topics) - teach contextual strategies
- strategies of using clues from what is going on around the unknown word
help them create an organization of their semantic knowledge
hybrid approach strategies to teaching morphosyntax for school-age children
recognizing patterns in words
- what prefixes and suffixes can you add to a word
- how do they change the meaning of the word
complex sentences
- time words (before, after, while) [what it means when using those] or causal words (because, since, therefore, so)–> combining two sentences by using one of those words and moving it around
- practice something decontextualized and then move to a more contextualized setting/activity
what should we always be working on in treatment with school-age children
pragmatics and metaskills
- pragmatics (may be a specific target for treatment): conversational discourse [it doesn’t look very different but you provide cues]; narratives
- meta skills: phonological awareness, editing, organization, self-regulation, executive functioning
features of clinicial directed (CD) approaches
highly structured
- give them a stimulus, they are expected to provide a response, and we provide feedback/cues/prompting that is needed to get the feedback
format controlled
- can control that there is more practice
very specific linguistic stimuli
clear instructions
- if we want a specific response we need to provide clear instructions
criteria
reinforcement
maximal prompting: clinician is teaching
- cues are frequent (80% to 100% of trials)
- support is full; that is:
-complete imitative model or explicit verbal instruction (‘touch this one’)
-hand-over-hand or full physical guidance
- point or show correct target or location
- provide direct, explicit verbal instruction or metalinguistic instruction (it’s a boy; say ‘he’)
moderate prompting: client is practicing
- cues are intermittent (25–75% of trials)
- support is partial; that is:
- provide a closed set or multiple choice (do you want chips, candy, or juice?)
- provide a category for response (find the feeling words on your communication board)
- provide a semantic cue (it’s a fruit; it’s not an apple; it’s a [pear])
- provide cloze cues with expectant waiting (she’s going fast. the girl is …)
- provide phonological cues (it starts with /s/. tell me, ‘it’s a [sock]’)
- point or look in the general area of a correct response
minimal prompting
cues are occasional (5–20% of trials)
- support is subtle; that is:
- provide a light touch or tap to direct attention or remind
- provide verbal reminders (remember use your word endings. use your ipad. don’t forget your polite words)
- provide a visual cue, such as a script or picture schedule and direct attention to it if client needs support
client shows use of the skill; may self-monitor; clinician is coaching
types of CD approaches
(clinician directed)
- drill: practice over and over
- drill-play: set up a drill, but we are doing it in a play environment
- modeling: not used frequently in a clinical setting–you have to have two adults (one perons models self correcting and correct responses)
conflicting evidence for CD approaches
ie. pros and cons of CD approaches
advantages:
- greater frequency of responses
- efficient–> maximizes responses within the time
- effective–> eleiciting new forms/behaviors
disadvantages:
- not natural
- limits generalization
if you are only ever doing clinician directed, how are they ever supposed to generalize?
appropriate use of CD approaches
- useful for teaching new forms
- can be combined with other approaches (use cd for part of the session and then do hybrid after)
- plan to move along the continuum (towards more natural)
list of child centered approaches
- language facilitation
- facilitative play
- language stimulation
- developmental approaches (meeting them where they are in their development)
mostly playing and using language facilitation techniques (child isn’t just doing whatever they want)
clinician’s role in child centered intervention approaches
- choose materials (that won’t distract the child too much, but will still motivate them)
- follow the child’s lead
- respond to child’s action/productions/gestures
- ZPD (whatever you are doing is in the zpd–you are always trying to get them to the next step)
- ie. if they are using gestures you are imitating the gestures and using words with them - naturalistic (because children normally play)
language facilitation techniques for children in the emerging language stage
- self talk
- parallel talk
- imitation
- expansions
- extentions
- build-ups and breakdowns
- recasts
language facilitation for children in the developing language stage (preschoolers)
additional strategies for when they are talking a bit more
- contingent feedback
- balanced turn taking
- extend the child’s topic
- reduced rate
contingent feedback vs parallel talk
- instead of just using words to describe what they are doing, continue to respond to what they are doing and saying
- ‘i love carrots, i’m so glad that you put the carrots in, i wonder what you will put in next?’
- it’s more like a conversation
language facilitation for pre-schoolers instead of at the emerging language stage
balanced turn taking
- allow response time (if you are doing most of the responding)
- child leads with productions, clinician response
- do things that are more effective than asking questions
- say things to encourage them to have back and forth - make comments on what they are doing if they are doing most of the talking to balance it
- because pre school children can now do this better than younger kids
language facilitation for pre-schoolers instead of at the emerging language stage
facilitated play
allows for more elaborated play (providing a context for the play that allows for it to be more elaborated–by using roles)
- ex. teacher/student; doctor/patient; waitress/patron; mommy/baby-child; acting out a familiar story-book
extends the practice
- child can change roles
- child can help plan the play (early meta skills)
- a little more decontextualized
- more intentions
- more vocabulary
the child says whatever they want and the clinician uses LF techniques
things to work on with parents with child centered approaches
for young children (infants)
- help parents model interaction behaviors
- help them be aware of infant communication patterns
- help them develop monitoring skills
be sensitive while doing this
how to help parents model interaction behaviors
child-centered approaches for young children (infants)
- turn taking
- imitation
- establishing joint attention
- developing anticipatory sets
- here are ways you can encourage turn taking etc (you’re not telling them how to communicate with their kids)
- come up with ideas of what could work into their routine, ask “how do you think that would work?”
how to help parents be aware of infant communication patterns
child-centered approaches for young children (infants)
- help them recognize what their children are doing to communicate (so that they can expand on their childs communication attempts)
- respect–> tell them we know it’s hard
- and that they can enjoy their children
purposes of intervention
- change or eliminate the underlying problem
- change the nature of the disorder
- teach compensatory strategies
- change the child’s environment
we aren’t trying to cure the child
continuum of naturalness
child-centered: language facilitation -> facilitated play
hybrid:
- prelinguistic milieu teaching
- responsivity education
- focused stimulation
- cycles approach
- script therapy
- structured play
- using conversation or narratives in a hybrid approach
- combining hybrid activities with explicit instruction
clinician-directed: drill -> drill play
if you want to encourage generalization do it in a more natural setting
EBP
what is it and what does it include
it incorporates external evidence, internal evidence, & client and family preference
- ie: research evidence, clinical experience, patient preference
ebp= evidence based practice (duh)
it is descision making based on the best evidence possible
steps of EBP
- ask a question
- search for evidence
- critically appraise the evidence
- make a decision (integrate the evidence)
- evaluate performance after acting
what is communication temptation/prompting
doing something that influences the child to communicate something intentionally
what is balanced turn taking
- allow response time
- child leads with prodction; clinician responds
- more effective than asking questions
what are 2 things we are always working on during treatment?
pragmatics and metaskills
examples of meta skills
- phonological awareness
- editing
- organization
- self-regulation
- executive functioning
what intervention approaches are best for a child who can’t talk/ is 0-3/ infant/ early intervention?
- language facilitation
- prelinguistic milieu teaching
what intervention approaches are best for younger school-aged children/preschool/ early elementary who are beginning to learn language?
modeling, drill play, focused stimulation, structured play
what intervention approaches are most important for a child who has already learned the basics of language yet still struggles (older child/adolescent)
- compensatory strategies
- meta skills
- curriculum based intervention/help
continuum of discourse
- most literate: expository
- narratives are in the middle
- most oral (not literate): conversation
different types of play intervention
- drill play: doing a target activity and then they get to take a turn
- structured play: there’s a schema/structure to the activity
- facilitated play: letting the child take the lead and the clinican facilitates communication with the language facilitation techniques
service delivery models
- clinician model: therapy in the clinic room
- classroom based: therapy happens in the classroom (push in model)
- collaborative: SLP and classroom teacher work together
- consult: SLP consults the teacher on what the child might need
- RTI: tiers
what are the tiers in rti/mtts
- tier 1: child receives normal classroom instruction (teacher receives suggestions)
- tier 2: child receives instruction in small groups
- tier 3: child receives more intense instruction from SLP
(response to intervention/ multitiered support)
dimensions of culture
- uncertainty avoidance (society’s stress level in the event of an unforeseeable future (ie. how do they deal with the unknown)
- individualism vs collectivism (achievements of one person or that of a group)
- power distance (how does one person treat another– do they just completely defer to the doctor?)
continuum of cultural competence
- cultural destructiveness
- cultural incapacity
- cultural blindness
- cultural pre-competency
- advanced cultural competency
don’t ignore pink bears always
- incapable of addressing anything, you don’t udnerstand their culture
- not reflecting reality, might be invalidating the person’s experience or not recognizing it
- we want to be here
- advanced cultural competence
features of clincian directed approaches
- highly structured: give them a stimulus, they are expected to provide a response, and we provide feedback/cues/prompting that is needed to get the response
- format controlled: can control that there is more practice
- very specific linguistic stimuli
- clear instructions: if we want a specific response we need to provide clear instructions
- criteria
- reinforcement
purpose of intervention
also what are successful and ethical intervention
the goal is to stimulate overall language development and to teach language skills in an integrated fashion and in context, so as to enhance everyday communication and ensure access to academic content
- successful intervention: when the child is able to communicate better
- ethical intervention: when the outcome is better than if there had been no treatment (so ur not wasting their time or money)
products: targets/goals (of intervention)
products of intervention = goals (note: there are lots of goals that you could target -> you just need a good rational)
- use assessment data to guide goals (don’t use the same goals for all kids in an age group)
- ZPD (the correct difficulty)
- emerging vs absent forms (we want to work on emerging–most of the time)
considerations for targets/goals for preschoolers (3-5 yrs)
- characteristics of this stage: language is develop at a rapid pace–they are learning the building blocks of language
- many possible targets based on needs of the child
considerations for targets/goals for elementary kids (5-10 yrs)
- acquire needed language skills for the classroom (learning to read so they can read to learn)
- curriculum based (want to focus on the curriculum when choosing targets so that those goals help functioning)
- may address literacy and meta skills
- culturally/linguistically diverse children may need to use home language to transition to language of the school (ex. narrative langague will transfer well across languages while past tense ed won’t)
considerations for targets/goals for adolescents (11 yrs–high school)
- compensatory strategies (can’t teach them all vocab words they need; give them strategies– eg. notebook of words, how to look them up, circling unknown words)
- student-centered (use their input and work on things that they perceive are most difficult and that they want hte most help with)
- meta skills (duh)
approaches to intervention
- behaviroal interventions/techniques: increase certain behaviors and decrease others (ex. increase use of words instead of grunting)
- language intervention
- narrative interventions: ability to understand or use stories, can be targeting narratives or something else (complex sentences) within the context of narrative intervention
- parent-mediated
- pragmatics/social communication/discourse
- relationship-based in intervention (most common with oder children)
- sensory-based interventions
these are not mutually exclusive
child-centered intervention
- clinician arranges the materials and session and then follows the child’s lead (very play based)
- use language facilitation techniques based on what the child does (clinician responds to whatever the child says–expanding, etc)
- creating an environment where there’s motivating stuff for the child and you follow their lead
clincian directed intervention
clinician specifies all aspects fo the intervention (least natural)
- they choose materials, order, acceptable responses, reinforcement, etc
hybrid approaches
- target specific goal(s)-> trying to set up an activity that has communication temptations (prompts) so the child will spontaneously produce the target
- clinician has a lot of control in activity while ‘tempting’ the child to spontaneously produce target
- clinician models in addition to providing feedback (they will model what/how to say something but not directly tell the child what to do)
- trying to get the child to produce a target more spontaneously
the bulk of what we do is in this area
combination of approaches
modifying linguistic input
- therapeutic register
- repetition (not the exact same thing, but the same idea)
- slowed rate
- complexity (ZPD–grammatical forms and length)
- pragmatically appropriate responses
- are we encouraging them to have pragmatically appropriate responses (ex. they shouldn’t always be required to use a full sentence when the context doesn’t require it; don’t say ‘good talking’
- comprehension vs production (which are you targeting, need to know what you are looking for so you can count if they produce what you want them to)
- choose the right stimuli (to elicit what you want)
- AAC?
- reinforcement & feedback (do i have a plan for them. starting to evaluate their own responses
- generalization (change prompts-from visual to verbal, etc.; change environment; fade reinforcers or cues; self-monitoring
appropriate use of clinician directed intervention
- useful for teaching new forms
- can be combined with other approaches (ex. use CD for part of the session and then do hybrid after)
- plan to move along the continuum
cultural humility
understanding that one must begin with a personal examination of one’s own beliefs and cultural identities to understand the beliefs and cultural identities of others
- being aware of your own values and beliefs that influence what i do and how i interact with people
a lifelong process of self-reflection
3 things to remember about cultural competence
- everyone has a culture
- culture is as dynamic as people are
- culture incorporates implicit and explicit behaviors
many factors can be part of a person’s culture: age, disability, ancestry, dialect, ethnicity, gender, language, citizenship, sex, veteran status
cultural responsivity
- understanding and appropriately including and responding to the combination of cultural vaariables and the full range of dimensions of diversity that an individual brings to interactions
- valuing diversity; seeking to further cultural knowledge; working toward the creation of community spaces and workspaces where diversity is valued
- recognizing that something is unfamiliar to you and trying to learn more about it
diagnostic criteria of autism
and how to avoid deficit language with it
- deficits in social communication and social interactoin across multiple contexts (all 3)
a. social-emotional reciprocity
b. nonverbal communicative behaviors
c. relationships - restricted, repetitive patterns of behavior, interests, or activities (at least 2)
a. motor movements, use of objects or speech
b. adherence to routines
c. fixated interests that are abnormal in intensity
d. hyper- or hypo sensitive to sensory input - symptoms appear early in development
- symptoms impair functioning
- symptoms are not due to an intellectual disability
- c– for relationships, instead ask ‘what are their friendships like’ –> describe relationships and behaviors etc.
- b– ‘child responds well to a consistent routine’. c– ‘their fav topic is…’ or ‘they are very interested in…’
factors that result in behavioral features
which can be a language disorder i’m assuming
- genetic factors
- neurobiological factors
- environmental factors
- cognitive factors
- comorbidity
- language in the brain ; brain structure and function ; electrophysical measures
- auditory processing ; limited processing capacity ; procedural deficits
descriptive-developmental approach (tenets/assumptions)
- we don’t always know the etiology (more important to know the current language functioning
- most important is the language status in form, content, and use
- look at the normal sequence of devleopment to determine what the child should be doing (and use the ZPD)
ie: describe current language functioning and then compare to typical development to determine what to target in treatment
