Treatment Strategies Flashcards
1
Q
Focused Stimulation
A
- Treatment method in which multiple examples of a specific linguistic target are modeled in an attempt to elicit spontaneous productions by taking advantage
- Basis is a naturalistic environment (conversation)
- Modeling targets in the language but you are not requiring them to elicit the target in that given session
2
Q
For Whom does Focused stimulation work best?
A
- Primary – Toddlers (early language delay), preschool and early school-age children with specific language impairment or intellectual disabilities
- Secondary – Bilingual children with language delay, children with phonological disorders with language delay
- Overall- developmental age range from toddler to elementary school
3
Q
Prerequisite Skills for FS (3)
KNOW THESE
A
- Joint Attention
- Some degree of sustained attention
- Minimal (some) level of social engagement
4
Q
How do I decide if Focused Stimulation is appropriate for the child? (4)
A
- Standardized assessment
- Parent report- ask about their perceptions (what is the major language problem) would this work?
Idea of child’s lexical ability - Language sample analysis of spontaneous speech- target driven, use it to develop treatment targets
- Phonemic inventory
5
Q
Supportive environments for FS (4)
A
- Home
- Small play groups
- Group center-based intervention
- Individual therapy sessions
6
Q
Context of FS
A
- Social context between SLP/child- Naturalistic approach
- Must be able to manipulate environment to provide opportunities for:
– Joint attention- need to be able to manipulate the environment
– Modeling target
– Tracking input
7
Q
Examples of Goals for FS
A
- Long-term goal
- Ex. Client will increase vocabulary in a variety of contexts - Short-term goal
- Client will verbalize 3 new vocabulary words in a single session within a given context after modeling provided - Strategies
- Focused stimulation - Activities
- SLP will use Fisher Price airport set to introduce following words: up, down, sky, go (keep repeating these words) - Reinforcement
- Positive verbal feedback about the play
Natural exchange resulting in continuation of play
8
Q
Conversational Recast
A
- Child’s immature or incorrect production is met with a response from the SLP that includes additional semantic, grammatical, and/or phonological information that corrects the utterance (SLP expands)
- Focus on specific developmentally appropriate skill
- If the child is not speaking the SLP can recast their own utterances
- Recast words and syntax
9
Q
Conversational Recast Sequence (7)
A
***Take what they have, keep the subject, expand to a more appropriate utterance
- Immediately follow a child utterance.
- Maintain the child’s central meaning.
- Repeat major lexical items.
- Reformulate clausal constituents.
- Add obligated grammatical forms, OR
- Correct grammatical forms, OR
- Provide alternative grammatical forms.
10
Q
Target Population for Recast
A
- Any preschool group requiring speech and language intervention
- Six-nine-year-olds functioning at pre-linguistic levels
- Children with: (best with these populations)
– Specific language impairment
– Autism
– Hearing impairment
– Intellectual disabilities
11
Q
Example of Recast for SLI
A
- The boy got on the bike. Him jump off the bike. Him fall down. Him hurt. Him cry.
- Recast:
He did jump off the bike.
He fell down
He is hurt
He did cry
12
Q
Article Recast
A
Child: That’s a orange.
Adult: That’s an orange.
Adult: That’s the orange
13
Q
Benefits of Recast (4)
A
- Gives child an opportunity to make an active and immediate comparison of their grammar with the adults
- Takes advantage of the child’s interest and focus
- Decreases the load of working memory
- Frees up processing resources so child can focus the new information
- Most parents do this naturally but they need to do it more frequently. Need to do it over and over again
14
Q
Language is the Key Model:
Constructive interactions around books
A
Model
- Primarily designed to teach parents/caregivers, you can teach it in classrooms
15
Q
Purpose of Language is the Key model
A
- Optimize language development of young children with unmet communication needs
- Optimize language development of young children with limited English proficiency
- Incorporates a lot of of child directed methods
16
Q
Target Population of Language is the key model
A
- Young children with delayed language who are functioning developmentally below 4-years old
- Children w/o speech and language issues may also benefit
- Children with specific language impairment (w/o cognitive delays)
- Children with developmental lag language impairment (cognitive delays that are equivalent to language delays)
17
Q
Target Behaviors of Language is the key model
A
- Making comments about the child’s interests
- Asking questions related to the child’s interests
- Responding to child utterances by adding more information- add wait time for child to respond
- pre-requisites- not every kid can sit still and stay near the adult
- Child has to have some level of interests
18
Q
Foundation of LIK
A
- Connectionist Model of Development- grounded in the notion that children’s interactions with their environment is critical to their development
- Constructiveness Developmental Model-
Adheres to the fact that although the adult is key to the interaction, the child has some part in guiding their own development
19
Q
What kinds of books work best for LIK?
A
- More beneficial for adults not to read during the LIK session- not about the reading
- Books are used as a point of “departure” for interaction (talking/listening)
- Appropriate books might only contain pictures (text is not as important)- you want to capture the child’s attention
- Appropriate books might contain some text but have larger focus on pictures
- Children maybe less likely to talk when presented with counting books, color books, or alphabet books
- More likely to talk with lots of lively pictures that vary
- Don’t have to go through it in the conventional manner
20
Q
Toys vs. Books LIK
A
- Following child’s lead and observation of interests assists with toy choice
- Language may be more stimulable when books vs toys are use
- Often simpler to train adults/caregivers in how to use books to stimulate language
- Adults may not be as comfortable and stimulation points may be less clear when toys are used
- Kids may talk less during building tasks because they are immersed in the fine motor skills
21
Q
Joint Attention-
A
- Joint attention is a mutual and social phenomenon in which 2 individuals are aware of their attention to a common object or event.
- Joint attention is engagement of self, other, object/event (triadic connection)
- FS, recast, LIK are all dependent on joint attention
22
Q
Response to Joint attention (RJA)
A
- RJA (response to joint attention) – individual is using nonverbal cues of another person to understand the focus of that person’s attention.
— Kid is noticing that someone is focusing on something and responds
23
Q
Initiation of Joint Attention (IJA)
A
- IJA (initiation of joint attention) – Person is intentionally using gestures and eye gaze to “direct” another person’s attention for the purpose of sharing an experience
— Kid sees a big dog, then looks at parent’s face to see if they need to be afraid
24
Q
Development of responsive joint attention
A
- 3 Months-Able to reflexively orient to sensory stimuli and control attention
- 6 Months-Use of gaze to determine where to look
- 12-15 Months – Uses the focus of another person’s gaze or pointing gesture to locate a target (Begins to “check back” and look at a person after first looking at object/even of interest.
25
Development of initiation of joint attention
- Lower-level IJA behavior – eye contact and gaze alternation (around 12-18 months)
- Higher-level IJA behavior – pointing, pointing with simultaneous eye contact, and showing (around 18-24 months)
26
Development of Joint Attention Overall
- Birth – 9 months – Joint attention skills are emerging but are not complete
- 9-18 months – infants begin to follow and direct the attention and behavior of other persons
- 18-24 months – Joint attention begins to manifest itself in many complex ways in learning and language
27
Are problems with joint attention cognitive or interpersonal-affective
- Thought (I) – JA deficits are a result of cognitive deficiency in which children lack the ability to understand another person’s attention and interest (Baron-Cohen, 1989)
- Thought (II) – Children with autism are unable to engage in appropriate affective interactions with others and unable to effectively share affective experiences or emotions (Hobson, 1993)
28
Impact of Impaired Joint Attention 1 (4)
- Diminished comprehension of one’s own social world
- Diminished ability to gather information about another person and/or the object/event he/she is referencing
- Diminished interpersonal relationships
- Diminished ability to build connections between experiences or behaviors, emotions, cognitive factors, based on ability to read another person
29
Impact of Impaired Joint Attention 2 (3)
- Associated with significant language delay/impairment
- High level social and emotional development may not be reached
- Adaptive behavioral control, social competence, and self-regulation may be improved when JA is encouraged
Kids on the spectrum don’t transition well
30
Encouraging Joint Attention
- Child-centered therapies/naturalistic teaching opportunities are helpful in creating motivation necessary for child to respond to and initiate joint attention (tools we can use, self talk, parallel talk, expansion, recast)
- Behavioral Approaches
31
Specific Approaches to Encourage JA
- ABA
- Floortime
- Pre-linguistic Milieu
- Social Skills Interventions
- Other interventions specifically designed to target joint attention (through use of behavioral techniques such as ABA)
32
Specific Strategies for Encouraging Joint Attention
- (Whelan & Schreibman, 2003) (Behavioral)
1. Coordinating gaze shifting
2. Intial prompting
3. Declarative pointing
- Coordinating gaze shifting (When a child looked at a new toy, he had to keep looking at it to keep the toy).
- Initial prompting was child’s hand were put on the toy and then prompts were faded.
- Declarative pointing (The child pointed at a photo or object. Physical prompting was used. If the child pointed within a time limit, he was allowed to keep using the toy.)
33
Specific Strategies to Encourage Joint Attention- Jones & Carr 1 (3)
- Research is limited but some procedures noted in literature:
- Introducing silly, out of place events/objects into normal routines to evoke a response
- Putting high preference item and face in line of vision to evoke gaze responses
- Teaching child to point to/show something to someone else and say “Look”
34
Specific Strategies to Encourage Joint Attention- Jones & Carr 2
Adults as reinforcers (3)
- Establishing the presence of adults as generalized reinforcers
-- Adult presents a variety of highly preferred items repeatedly over time
-- Once the child seeks proximity to the adult, the adult engages the child
35
Specific Strategies for Encouraging Joint Attention- Jones & Carr 3
Using child choice (3)
- Using child choice
- When teaching joint attention, let child choose items to be used in teaching
- Use items that are preferred and engaging (e.g., toys that move, light up)
- Use a variety of items and incorporate novel items
36
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Specific Strategies for Encouraging Joint Attention- Jones & Carr 4
Natural Consequences (3)
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- Natural consequences for joint attention initiation is a social interaction about the object
- Deliver enthusiastic, high energy attention (e.g., loud “wow”, funny face, high-volume tickles
- Social interaction about the object
37
Specific Strategies for Encouraging Joint Attention- Jones & Carr 5
Activity variety : Use the first/then approach (2)
- Interspersing easy tasks with difficult tasks has been shown to increase acquisition of difficult tasks
- They recommend using play with the preferred item as the easy task
38
Specific Strategies for Encouraging Joint Attention- Quill
| Do-Watch-Listen-Say (5)
1. Call child’s name. Pick up the item he is playing with, put in front of his face, then lead it to your face. Look for visual tracking and a transfer of his / her gaze to you.
2. Call child’s name. Take the child’s hands and touch them to your face.
3. Call the child’s name. Make a stimulating noise (finger snap, clap, etc.). When child turns to the noise, catch his gaze and reinforce.
4. Use cause and effect. Call his name during a table play activity (puzzle or pegboard). When he looks up, engage him in a reinforcing play (tickling). Re-direct back to the game, then interrupt intermittently. The real game is getting his eye gaze. Praise him for looking at you.
5. Play simple Peekabook games, using his name. (“I see ___________.”)
39
Specific Strategies for Encouraging Joint Attention 1 (2)
- Use stop and go games. Use a simply gross motor activity like hopping, crawling, or marching. Call the child’s name. Have the child stop the activity and look at you.
- Reinforce the child for stopping and looking, then direct them to the motor activity.
40
Specific Strategies for Encouraging Joint Attention 2 (4)
- Move your finger from the child’s face to the object with the direction, “Look.”
- Use a laser pointer or flashlight to direct attention to target objects.
- Have an object make physical contact with the child. Use a toy plane flying into the child’s stomach, or an Itsy Bitsy Spider game. Play “I Spy” by placing motivating objects around the room.
- Attach a silly noise to an object by always modeling it with the object.
41
Specific Strategies for Encouraging Joint Attention 3 (4)
- Slowly increase the materials for a given task. Ex. Begin with building using 5 blocks, increase to 10.
- Use sequence boards to add to the number of steps within an activity.
- Increase the number of turns in a turn-taking task.
- Use the “first/then” visual tool
42
Specific Strategies for Encouraging Joint Attention 4 (6)
- During snack time, have child share his snack.
- Have child hand you an object so you can see it, then move back.
- Create simple treasure hunt games. When the child finds a hidden object, prompt him to give it to a sibling or playmate.
- Pass a book back and forth when reading aloud.
- Ultimately these are good strategies, but they may not work for everyone
- Sometimes just getting a child into a behavioral program that helps teach joint attention may help get the child ready for the other treatment strategies
