SPH528 - Week 2 Paediatric Speech

Question 1

Harrison and McLeod, (2010). Risk and protective factors associated with speech and language impairment in a nationally representative sample of 4-5 year old children
- Nine factors consistently identified as having a unique effect on speech and language development

Answer 1

• being male (risk)
• having ongoing hearing problems (risk),
• having a more reactive temperament (risk),
• having a more persistent temperament (protective),
• having a more social temperament (protective),
• increased maternal well-being (protective),
• having an older sibling (risk/protective),
• parental LOTE status (risk/protective), and
• support for children’s learning in the home (risk/protective).

Question 2

Sensitivity is the proportion of children with SSD
identified correctly.
-What is specificity

Answer 2

Specificity is the proportion of typically developing children not identified as having SSD.

Question 3

This type of Ax for children with SSD gathers qualitative descriptions of success and difficulties in participation in the family, school and social situations. Assesses ICF domains of activity and participation.

(McLeod and Bleile, 2004)

Answer 3

Intelligibility Assessment

Question 4

Some contextual factors to consider when goal setting for children with SSD:

(McLeod and Bleile, 2004)

Answer 4

Parent/carer, family and school involvement, support, attitudes and expectations.

Question 5

Personal factors to consider when goal setting for a child with SSD:

(McLeod and Bleile, 2004)

Answer 5

Age of the child, self-confidence, motivation, attention, cognitive ability, beliefs, learning style, and how they deal with (or prior experiences with?) communication failure during intervention.

Question 6

What is the most knowledge method (also called the traditional, or developmental approach)

(McLeod and Bleile, 2004)

Answer 6

An approach to setting goals for children with SSD whereby sounds or phonological processes are selected as intervention goals because they are earlier developing, stimulable and (already) produced correctly in particular contextual environments (Bernthal and Bankson, 1998).

Question 7

What is the least knowledge method (nontraditional, nondevelopmental approach)

(McLeod and Bleile, 2004)

Answer 7

An approach to setting goals for children with SSD whereby Treatment targets differ from the child’s existing abilities by multiple features’ (Elbert and Gierut, 1986). Sounds or processes are selected because they are nonstimulable, phonetically more complex, have phonologically marked properties, reflect least phonological knowledge as categorized by inventory constraints (with respect to phonemes) and are later acquired (Gierut et al., 1996).

Question 8

ICF model specifies consideration of activities and participation in facilitating health and well-being. Some activities and participation are:

(McLeod and Bleile, 2004)

Answer 8

Speaking; conversation; learning and applying knowledge; interpersonal interactions and relationships; community, social and civic life.

Question 9

The influence of an SSD on learning and applying knowledge is part of the consideration of ICF activities and participation. What implications does this have for goal setting?

(McLeod and Bleile, 2004)

Answer 9

Intervention targeting phonological awareness should accompany speech intervention (Gillon, 2000). Partnerships b/n teachers and SLPs essential for appropriate goal setting to facilitate oral and literate communicative skills.

Question 10

How can SLPs consider participation within speaking and conversation by children with speech impairment, when planning for intervention?
(McLeod and Bleile, 2004)

Answer 10

Consider interpersonal interactions and relationships -social assessment practices may consist of a discussion with the child, his/her parents, siblings, friends, grandparents and other significant people to ascertain social goals and barriers, interests and hopes (Duchan, 2001a).
Consider community, social and civic life  socially based intervention goals to facilitate activity and participation (e.g., Goal: public education to decrease background noise and encourage people to look at a person with hearing impairment while talking to them).

Question 11

ICF allows for comparison between performance and capacity when considering activity and participation. How is this useful?

(McLeod and Bleile, 2004)

Answer 11

A child may be more capable within the confines of a standardized assessment than they demonstrate within the complex communicative demands of the classroom. OR a child may use compensatory strategies to minimize communicative difficulty, but the difficulty is evident on standardized assessment tasks. Mismatch between performance and capacity. –> needs to be considered when developing appropriate goals.

Question 12

ICF Environmental factors: products and technology; support and relationships; attitudes; services, systems, and policies. How do these impact appropriate goal setting for a child with SSD?

(McLeod and Bleile, 2004)

Answer 12

• Barriers/facilitators avoided/ available to be utilised need to be considered in goal setting (e.g., parental support and relationships)
• Negative judgments about people with SSD  goals directed at society may be needed.
• Products and technology e.g., future voice-activated technologies may be inaccessible.

Question 13

This ICF Personal factor is important to consider when selecting speech goals for a child with SSD, and can be improved. Perhaps incorporated into goals?

(McLeod and Bleile, 2004)

Answer 13

The child’s personal ability to evaluate their speech / self-evaluation prior to feedback from the SLP.

Question 14

Name 6 approaches to target selection for children with SSD.

McLeod & Baker, 2017. Ch 10

Answer 14

Traditional developmental
Complexity
Cycles
Systemic (functional)
Constraint-based nonlinear
Neuro-network

Question 15

Name 3 perspectives on identifying goals for children with SSD?

(McLeod & Baker, 2017. Ch 10)

Answer 15

Impairment
Social
Biopsychosocial (i.e., ICF-CY (WHO, 2007))

Question 16

• Improving a child’s speech intelligibility
• Surgical repair of a cleft palate
• Developing a child’s emergent literacy skills to ameliorate future risk of literacy difficulties
• developing a child and communication partner’s competence to use AAC
• Increasing a child’s verbal interaction with peers at preschool/school
• Reducing immediate consequences of SSD such as bullying

Answer 16

*Equipping families with strategies for resolving communication breakdowns
*Increasing family members’ and relevant professionals’ knowledge about SSD to dispel false beliefs and myths
*Improving communication partners’ abilities to listen to a child with SSD so that the child’s messages are understood.
-> Goals are not limited to the child who has the SSD - they can include others in the child’s life.
(McLeod & Baker, 2017. Ch 10)

Question 17

Some example of goals for a child with SSD, that address contextual factors:

(McLeod & Baker, 2017. Ch 10)

Answer 17

• Child’s school to develop and anti-bullying program to change the attitudes of peers.
• For the SLP to lobby relevant governing bodies about the need for SLP services in rural areas, so the child in question gets services.

Question 18

Goals must be OPERATIONALLY DEFINED to be measurable. This means include the following (specified, so as to be measurable).

(McLeod & Baker, 2017. Ch 10)

Answer 18

• Behaviour or attitude to be learned (e.g., intelligible speech during conversation)
• Task used to measure skill/behaviour/attitude (e.g., conversational speech sample.)
• WHO will conduct the measurement?
• SETTING where the measurement will take place
• Criterion (e.g., with 90% accuracy from a conversational sample containing at least 100 different words
• Expected duration of intervention (e.g., within 12 months of regular weekly SLP intervention combined with daily home practice).

Question 19

HOW TO IDENTIFY AND PRIORITISE AN INDIVIDUAL CHILD’S GOALS:

McLeod & Baker, 2017. Ch 10

Answer 19

Careful consideration of: Child’s Ax results (ALL ICF domains) + Research evidence + Child and family preferences

Question 20

Goals related to BODY STRUCTURE for a child with SSD of known origin) are likely to be…

(McLeod & Baker, 2017. Ch 10)

Answer 20

Medical intervention (e.g., eliminate repeated episodes of glue ear - ENT to prescribe antibiotics, myringotomy, pressure equalisation tube…)

Question 21

How to Ax a child’s relevant Contextual Factors (Environmental & Personal factors)?

(McLeod & Baker, 2017. Ch 10)

Answer 21

• Case Hx, intake form, interview with teacher, interview with siblings/friends…
• > SOME CONTEXTUAL FACTORS CAN BE TRANSLATED INTO GOALS. SOME MIGHT JUST BE IDENTIFIED AS BARRIERS AND FACILITATORS AND WORKED WITH OR WORKED AROUND WHEN DEVELOPING THE INTERVENTION PLAN.

Question 22

How to Ax a child’s relevant Activities and Participation?

McLeod & Baker, 2017. Ch 10

Answer 22

• information gathered from child and their family during Ax (ie case Hx, SPAA-C)

Question 23

3-level goal hierarchy (Klein & Moses, 1999)

McLeod & Baker, 2017. Ch 10

Answer 23

1. Long-term goals  (typically) summarise what needs to be achieved before discharge.
2. Short-term goals  specific skills/behaviour targeted, to achieve long-term goal.
3. Session goals  SHORT-TERM GOALS are transformed into SESSION GOALS (behaviours, skills, or knowledge taught through intervention procedures) within an activity during intervention sessions with an intervention agent

Question 24

What do session goals typically specify? (8)

NOTE: Session goals vary from one session to the next, depending on a child’s progress

(McLeod & Baker, 2017. Ch 10)

Answer 24

• Child’s observable behaviour (e.g., production of multiple opposition treatment word sets including word-initial /d/ contrast with word-initial /k, ʃ, sl, tʃ/ at word level).
• Response mode (e.g., with a model for delayed imitation),
• Response level (e.g., at word level, phrase level),
• Teaching and learning procedure(s) (e.g., metaphor, auditory models of treatment words for delayed imitation),
• Dose (e.g., two treatment sets or approximately 40 trials),
• Criterion (e.g., 70% accuracy),
• Intervention agent (e.g., the clinician, computer), and
• Context (e.g., drill- or play-based activities in the clinic).

Question 25

What does the hierarchical organisation of goals usually mean?

(McLeod & Baker, 2017. Ch 10)

Answer 25

Session goals contribute to short-term goals, and short-term goals contribute to the realisation of a long-term goal.
If the realisation of one goal facilitates realisation of a different goal, without direct intervention on that goal GENERALISATION is happening.

Question 26

What is Generalisation (transfer)?

McLeod & Baker, 2017. Ch 10

Answer 26

Desired change in a behaviour in an intervention context facilitates change in the same behaviour and/or different but related behaviours in other non-intervention contexts (Gordon-Brannan & Weiss, 2007; Stokes & Baer, 1997).

Question 27

Generalisation is one of the most important outcomes of intervention for a child with SSD (i.e., generalised acquisition of the correct production of a targeted phoneme during everyday conversational speech means intervention to target that phoneme in other contexts is not needed). So the SLP should plan for generalisation from…?

Answer 27

…from the outset of intervention - at the point where goals are being identified and prioritised.

(McLeod & Baker, 2017. Ch 10)

Question 28

What are the 2 types of generalisation?

McLeod & Baker, 2017. Ch 10

Answer 28

1. Stimulus generalisation

2. Response generalisation

Question 29

What is stimulus generalisation?

McLeod & Baker, 2017. Ch 10

Answer 29

• a trained behaviour is evoked with a different stimuli (Bernthal, Bankson, & Flipsen, 2013). Example: A child saying affricate /tʃ/ in ‘chicken’ when an SLP says “What’s this?” and presents the child with a picture of a chicken, in the clinic  Child using this affricate in the word ‘chicken’ in response to seeing a picture in a book read by his dad, when his dad asks “What kind of animal lives on this farm?”

Question 30

What is response generalisation?

McLeod & Baker, 2017. Ch 10

Answer 30

-The process in which responses carry over to other behaviours that are not taught (Bernthal, Bankson & Flipsen, 2013, p. 255).
Examples: (articulation impairment) targeted speech skill improves across untreated word positions, in untreated words during conversational speech.
(phonological impairment) increase in a child’s productive phonological knowledge generalisation to other words/word positions NOT TARGETED during intervention. E.g., child taught to say /tʃ/ in ‘chicken’ uses /tʃ/ in cheese without being taught

Question 31

Most children with SSD have more than one issue requiring intervention. How does an SLP prioritise goals to work on, in which order, or whether goals can be worked on concurrently?

(McLeod & Baker, 2017. Ch 10)

Answer 31

Consider research evidence + family preferences
**With phonological impairment, WHAT IS TREATED MAY BE MORE IMPORTANT THAN HOW IT IS TAUGHT (Gierut, 2005, p. 203). Because some intervention targets can induce more widespread and efficient change in children’s phonological systems.

Question 32

Name 6 target selection approaches reported in the literature since Elbert and McReynolds (1979) work on generalisation:

(McLeod & Baker, 2017. Ch 10)

Answer 32

1. Traditional developmental approach
2. Complexity approach
3. Cyclical approach
4. Systemic approach
5. Nonlinear approach
6. Neuro-network approach

Question 33

What is the traditional developmental approach to target selection for intervention for children with SSD? (Most knowledge)
-> Lower hanging fruit - may be helpful for a child with a reactive temperament or fear of failure. May be helpful to use these targets if a child is getting frustrated by therapy due to lack of success.

(McLeod & Baker, 2017. Ch 10)

Answer 33

Developmental norms regarding age of acquisition of speech sounds apply. Appropriate targets include phonological processes that:
• occur frequently but are optional (i.e., targets that the child has some phonological knowledge of)
• affect sounds that are stimulable or within a child’s phonetic inventory
• affect intelligibility, such as idiosyncratic processes or extensive harmony
• affect early developing sounds

Question 34

What is the complexity approach to target selection for intervention for children with SSD? (Least knowledge)

(McLeod & Baker, 2017. Ch 10)

Answer 34

Set complex intervention targets, beyond or outside their existing knowledge as it will facilitate learning of the phonological system they’re trying to learn  Evidence that it leads to greater generalisation, so fewer targets (and therefore short-term goals) are needed to achieve the long-term goal.

Question 35

What is meant by COMPLEXITY and LEARNABILITY, when using the complexity approach to setting intervention targets in a child with SSD?

(McLeod & Baker, 2017. Ch 10)

Answer 35

COMPLEXITY - fricatives in a phonological system imply the presence of plosives (but plosives don’t imply the presence of fricatives)  Fricatives are more complex than plosives.
LEARNABILITY - What a child knows about a phonological system is a subset of what an accomplished speaker of the language knows…

Question 36

What are complex intervention targets?

McLeod & Baker, 2017. Ch 10

Answer 36

Non-stimulable, phonetically more complex segments or CCs associated with least productive phonological knowledge for an individual child (consistently in error). Marked, later developing targets.

Question 37

Which children with SSD are suited to the complexity approach?

(McLeod & Baker, 2017. Ch 10)

Answer 37

Most (maybe all) children with SSD. Some believe better suited to confident risk-takers with no complicating difficulties (ie small syllable structure, word length, stress inventories, atypical receptive language etc), cognitive or attention limitations.

Question 38

What is the cycles approach to target selection for intervention for children with SSD?

(McLeod & Baker, 2017. Ch 10)

Answer 38

Patterns (or processes) evident in children’s speech are identified then targeted in a predetermined order, with primary target patterns being selected prior to secondary target patterns, which are in turn selected prior to advanced target patterns.
Criteria to move onto another target are not performance-based, but instead time-based, with most patterns being targeted for 2-6 hours (Hodson, 2007).

Question 39

What is the Systemic (Functional) approach to target selection for intervention for children with SSD?

(McLeod & Baker, 2017. Ch 10)

Answer 39

A specific sound is not targeted, rather the phonological function of a carefully selected group of sound is targeted. AIM: To reduce the homonymy of pronouncing so many different words the same, due to big collapses of contrast

Question 40

What are the intervention targets chosen, when following the systemic (functional) approach to target selection for intervention in children with SSD?

(McLeod & Baker, 2017. Ch 10)

Answer 40

Targets for intervention are chosen to be maximally distinct from the phoneme the child is using in place of a large number of phonemes not in their inventory. For example if a child is collapsing multiple phonemes into [d], a target that is maximally distinct in MOA, POA, voicing, CC vs C, from [d] would be chosen.

Question 41

What is the Constraint-Based Nonlinear Approach to target selection for intervention for children with SSD?

(McLeod & Baker, 2017. p. 360)

Answer 41

Instead of targeting sounds for intervention both content (speech sounds) and frame (word and syllable structures, timing units, stress patterns) are considered for target selection. Nonlinear theories are used to guide analysis of a child’s speech.

Question 42

What is the Neuro-Network Approach to target selection for intervention for children with SSD?

(McLeod & Baker, 2017. p. 362)

Answer 42

Instead of targeting specific sounds/sound classes, more general goals are selected, i.e., increase a child’s PCC in conversational speech, add six new phonemes to a child’s phonemic inventory EXCEPT in the case of distortions of /s, ɹ/ (Norris & Hoffman, 2005). Based on Norris & Hoffman’s (2005) constellation model of language processing, where 9 different levels of speech processing interact with each other to assimilate and accommodate new input in a self-organisation of the neural network.

Question 43

How do I know how to choose the best target selection approach for an individual child?

(McLeod & Baker, 2017. p. 363)

Answer 43

No easy answer. Integrate peer-reviewed published evidence with child characteristics and preferences. Consider the child’s personal and social contexts, language, cognitive, perceptual, and motor abilities when prioritising goals (Bernhardt, 2005).

Question 44

Goals for children with articulation impairment typically involve:

(McLeod & Baker, 2017. p. 363)

Answer 44

1. target sounds (rhotics or sibilants produced incorrectly)
2. activities and participation
   ->If more than one sound is in error select the most stimulable, correct in more contexts, earlier developing, more motivating for child to practice, more impact on intelligibility.
   Also consider family preference and impact on child’s activities and participation.

Question 45

Intervention goals for children with inconsistent speech disorder is to:

(McLeod & Baker, 2017. p. 364)

Answer 45

…Establish lexical consistency. Target will be consistent production of a core vocabulary of words (selected by the child/family in collaboration with SLP and the child’s teacher)
-> Additional goals addressing activities and participation and contextual factors on a case-by-case basis.

Question 46

Goal setting for children with CAS depends a number of factors:

(McLeod & Baker, 2017. p. 364)

Answer 46

Child’s age, nature and severity of the impairment, presence of concomitant conditions, and motivation. May be a broad range of goals addressing intelligibility in addition to activity and participation.

Question 47

A generic “pro forma” for a long-term goal for a child with phonological impairment or CAS -> Don’t use - just to help me understand the ‘format’ of this kind of goal.

(McLeod & Baker, 2017. p. 364)

Answer 47

The child will develop functional and intelligible communication based on a period of conversation with specified communication partners in specified contexts in a designated period of time, as measured by a specified functional communication outcome measurement tool

Question 48

What to work on with a child with CAS might be influenced by what the child needs to be able to say, to participate in their day-to-day. Rather than individual sounds, they need to practice…

Answer 48

…movement transitions, in the context of speech and to develop appropriate intonation and prosody.

(McLeod & Baker, 2017. p. 367)

Question 49

Some common short-term goals for children with childhood dysarthria who have the potential to use spoken communication include…

(McLeod & Baker, 2017. p. 367)

Answer 49

■■ improve articulation accuracy of problematic consonants and/or vowels, syllable shapes, or word lengths;
■■ encourage respiratory support and breath control for speech, therefore improving speech intelligibility;
■■ reduce hypernasality; and
■■ increase the naturalness of a child’s phonation through increasing a child’s awareness of and use of appropriate pitch and vocal loudness.

Question 50

Potential goals for children with highly unintelligible speech:

(McLeod & Baker, 2017. pp. 367-8)

Answer 50

Socially based goals may need to be prioritised to get the child communicating and reduce their frustration ie AAC, targeting a small vocab of meaningful words, teaching others in their environment to understand the child’s productions.
GOALS generated by the family with SLP support.

Question 51

What is a GOAL ATTACK STRATEGY in intervention for children with SSD?

(McLeod & Baker, 2017. p. 368)

Answer 51

The way in which multiples goals are scheduled.
3 contrasting goal attack strategies (Fey, 1986).
1. Vertical (training deep)
2. Horizontal (training wide)
3. Cyclical

Question 52

What is a VERTICAL goal attack strategy in intervention for children with SSD?

(McLeod & Baker, 2017. p. 368)

Answer 52

Targeting of 1-2 speech targets (e.g., phonemes, phonological processes, word shapes, stress patterns, prosodic pattern) at a time until a predetermined performance criterion
is met. RECOMMENDED for children with articulation impairment with 1-2 distorted speech sounds or children with a phonological impairment. Multiple opportunities to learn 1-2 targets over a period of time, before new targets added

Question 53

What is a HORIZONTAL goal attack strategy in intervention for children with SSD?

(McLeod & Baker, 2017. p. 368)

Answer 53

Working on several (3+) speech production targets PER SESSION. Helps children with phonological impairment see the relationship between the targets in the phonological system they’re learning. For children with MOTOR SPEECH difficulties, horizontal attack strategy may enhance motor learning.

Question 54

What is a CYCLICAL goal attack strategy in intervention for children with SSD?

(McLeod & Baker, 2017. p. 368)

Answer 54

Working on several speech production targets within a specified amount of time, regardless of accuracy. One speech production target or phonological process is targeted per session, for a certain number of hours. No predetermined performance criterion before moving on to the next one, just predetermined amount of time.

Question 55

What are 3 goal attack strategies for children with concomitant SSD and language impairment?

(McLeod & Baker, 2017. p. 368)

Answer 55

1. Block scheduling - e.g., 10 weeks of SSD intervention followed by 10 weeks of language intervention.
2. Alternating sequencing - e.g., SSD intervention on even weeks and language intervention on odd weeks.
3. Simultaneous scheduling - e.g., SSD intervention and language intervention conducted within the same session.

Question 56

List some factors that indicate risk of speech and language impairment:

Harrison & McLeod (2010)

Answer 56

Being male
Ongoing hearing problems
Having a more reactive temperament
Having an older sibling (protective for receptive language, risk for expressive)
Parental LOTE status (Risk for standardised Ax, protective for parental concerns about language).

Question 57

Plosives, nasals, nonpulmonic consonants are produced earlier than…

McLeod and Crowe (2018)

Answer 57

trills, flaps, fricatives, affricates

generally, across 27 languages studied

Question 58

MOST labial (bilabial and labiodental), pharyngeal (pharyngeal, epiglottal, and glottal), and posterior lingual (palatal, velar, and uvular) consonants are produced EARLIER than consonants with anterior tongue placement (dental, alveolar, postalveolar, and retroflex).EXCEPT…

Answer 58

…plosives and nasals with anterior tongue placement (e.g., /t, d, n/)
Which are produced EARLIER than anterior trills (e.g., /r/), liquids (e.g., /l/), fricatives (e.g., /s, z, ʃ, ʒ/), and affricates (e.g., /ʧ, ʤ/).

(McLeod and Crowe, 2018. p.1554)

Question 59

Most consonants across world languages are acquired by 5;0 (93% produced correctly). True or false?

Answer 59

True

McLeod and Crowe (2018)

Question 60

ENGLISH
Early (2;0–3;11): /p, b, m, d, n, h, t, k, ɡ, w, ŋ, f, j/
Middle (4;0–4;11): /l, ʤ, ʧ, s, v, ʃ, z/
Late?

McLeod and Crowe (2018)

Answer 60

Late (5;0–6;11): /ɹ, ʒ, ð, θ/