This presentation reviews how to better identify and treat speech disorders and evaluates existing therapy approaches and programs for addressing them. Speech sound disorders are classified into five distinct subgroups. You will learn how to determine which strategies are most appropriate for a child, depending on his/her types of errors. This presentation also describes the differences in articulatory and phonological development and error patterns in Spanish and in English.
Success with Speech Sound Disorders: Finding the Best Fit for English and Spanish Speakers
1. Success with Speech Sound Disorders
Finding the Best Fit for English and
Spanish Speakers
Scott Prath, M.A.
Mary Bauman, M.A.
TSHA Convention: April 2011
3. Outline for today
• We are going to compare our conceptions of
“speech” disorders and “language” disorders
• We will break down our understanding of speech
disorders into 5 distinct groups
• For each speech disorder category we will provide:
▫ A description of the disorder
▫ Our caseload examples- video examples
▫ Our caseload examples- therapy
techniques
4. Who does this apply to?
• School-based Intervention?
• Early Childhood Intervention?
• Public / Private?
• Rural / Urban?
• Group / Individual Intervention?
Dividing sound disorders into distinct classes can
be implemented across all situations!
5. Speech Sound Disorder Tree and Comparison Chart
Click here to download this chart as a pdf.
9. Defining Speech Sound
Disorders(SSD)
• 40-60% Co-morbidity LI and
SSD in Pre-K
• 15% Co-morbidity LI and
SSD at age 6
Shriberg, Tomblin, and McSweeny (1998)
Advantage:
Useful in predicting deficiencies
in academic outcomes
(spelling, reading, decoding)
Disadvantage:
Does not differentiate degree or
type of unintelligibility
SSD and Language Impairment Dichotomy
10. Seven Subtypes of SSD (Shriberg)
• Genetic
• Otitis Media
• Apraxia
• Dysarthria
• Psychosocial Involvement
• 2 groups based on errors
Advantage:
Provides diagnostic markers to
categorize child
Disadvantage:
Does not differentiate between
articulation and phonology
Defining Speech Sound
Disorders(SSD)
15. Delayed Phonological Skills
• Definition:
▫ Phonological system similar to younger, typically
developing children. Most phonemes can be
articulated; however, discrepancy exists between
phonological processes observed and child’s
chronological age.
• What we see:
▫ Multiple misarticulations
▫ Errors can be classified by patterns
▫ See typical patterns that persist (e.g., stopping,
cluster reduction, liquid simplification)
1.
Delayed
Phonological
16. Consistent Deviant
Phonological Disorder
• Definition:
▫ Systemic use of deviant phonological rules (i.e.,
error patterns that are atypical of normal
phonological development).
▫ E.g., deleting all syllable-initial consonants
• What we see:
▫ Less intelligible
▫ Sound production may be age appropriate
(Difficulty producing sounds in certain contexts)
2.
Consistent
Deviant
18. Inconsistent Deviant
Phonological Disorder
• Definition:
▫ Variable productions of the same words or
phonological features in the same contexts and across
contexts.
• Examples:
▫ Say “butterfly”
“Chutterdy”
▫ Again, say “butterfly”
“sunnerny”
3.
Inconsistent
Deviant
19. Wait!
That sounds like apraxia!
• Both characterized by inconsistency
• Those with childhood apraxia of speech (CAS):
▫ Worse in imitation than in spontaneous production
▫ Differ in cues effective to elicit production of words
▫ Have oral-motor difficulties (e.g., groping)
20. Articulation Disorder
• Definition:
▫ An inability to produce a perceptually acceptable
version of particular phonemes, either in isolation
or in any phonetic context.
• What we see:
▫ “/r/, /s/, and /l/ kids”—errors with a particular
sound
▫ Can be highly intelligible
4.
Articulation
Disorder
21. Structural Anomalies
• Definition:
▫ Low intelligibility that is the result of or
compromised by atypical physical development
• Examples:
▫ Deaf Speech
▫ Cleft Lip and Palate
▫ Velo-Pharyngeal Insufficiency
5.
Structural
Anomaly
23. What types of clefts exist?
• A cleft lip (CL) is a
separation in the upper lip.
• A cleft palate (CP) is an
opening in the roof of the
mouth.
• A cleft lip and palate (CLP)
extends through both.
5.
Structural
Anomaly
24. What types of cleft palates
exist?
• A cleft palate can be:
~1/750 live births
▫ unilateral 14%
▫ bilateral 37%
▫ submucousal with
bifid uvula 49% (77%
are unilateral left)
5.
Structural
Anomaly
25. When does a cleft occur?
5 ½ and 6 weeks in utero
5.
Structural
Anomaly
26. A word on VPI
• Velo-pharyngeal Insufficiency
▫ The velum (velo) is not contacting the pharynx
(back wall of the throat)
▫ Can be caused by:
Muscle weakness
A large opening
Insufficient muscle function
Adenoids and tonsils
5.
Structural
Anomaly
27. Differentiated Treatment
• Research considering the
subgroups of speech disorders
found that children respond
differently to therapy
approaches that target
different aspects of the
speech-processing chain.
(Alcorn et al., 1995, Holm et al., 1997, Dodd and
Bradford 2000)
• One treatment model or
structure may not fit all
children or may not fit a child
throughout the course of
intervention.
28. Differentiated Treatment
Interventions must consider:
• Language of the home
• Target selection
▫ Early vs. later developing sounds
▫ Stimulability
▫ Error consistency
• Approach/Methods
• Implementation structure
32. Consistent Deviant Phonological
Disorder
• Example:
Hodson’s Cycles Approach
Week 1: Weak syllable deletion
ma-ri-po-sa, ca-ba-llo
Week 2: Initial consonant deletion
pato, mano, bote
Week 3: Stopping (a more typical pattern)
foto, sopa
Approach includes Metaphonological awareness and
auditory bombardment of sounds
2.
Consistent
Deviant
33. Inconsistent Deviant
Phonological Disorder
• Goal of intervention is CONSISTENCY at the
single word level.
• Example of therapy approach:
▫ Core vocabulary (that focuses on consistency of
whole-word production)
3.
Inconsistent
Deviant
34. • Core vocabulary intervention
• This therapy approach resulted in greater
change in children with inconsistent speech
disorder compared to more traditional
approaches (Crosbie et al., 2005)
Inconsistent Deviant
Phonological Disorder
3.
Inconsistent
Deviant
35. Video Review
• Core vocabulary approach
• This therapy approach resulted in greater
change in children with inconsistent speech
disorder compared to more traditional
approaches (Crosbie et al., 2005)
Inconsistent Deviant
Phonological Disorder
3.
Inconsistent
Deviant
36. Example:
• List of 50 target words chosen for child
• 10 words targeted during the week
• Consistent words then removed from list, and
new set of 10 words chosen randomly for
practice
• Generalization monitored through periodic
probe of untreated words
Inconsistent Deviant
Phonological Disorder
3.
Inconsistent
Deviant
37. Articulation Disorder
• Traditional Artic/motor-based approaches
▫ Teach motor behaviors associated with the
production of a particular speech sound
Van Riper approach
McDonald’s sensory-motor approach (use of
facilitative contexts)
Multiple Phoneme approach
4.
Articulation
Disorder
38. Articulation Disorder
Example: misarticulation of /s/ phoneme
1. (Sensory-perceptual training) of /s/
2. Production training—Sound establishment of /s/
3. Production training—Sound stabilization of /s/
(/s/ in isolation, syllables, words, phrases, etc.)
4. Transfer and carryover
4.
Articulation
Disorder
39. Structural Anomalies
Communication goals/ Outcomes for Structural
Anomalies
• Increase Vowel Repertoire
• Increase Consonant Inventories
• Increase Vocabulary
• Increase Oral Airflow
• Decrease use of Nasal and Glottal
Sounds
5.
Structural
Anomaly
40. Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation (a)
▫ In strings (a,a,a,a)
▫ In opposition (u-I, u-I a-o, a-o)
5.
Structural
Anomaly
41. Increase Vowel Repertoire
• Take a vowel inventory
▫ Target vowels in isolation
(a)
▫ In strings (a,a,a,a)
▫ In opposition (u-I, u-I a-o,
a-o)
5.
Structural
Anomaly
42. Increase Vowel Repertoire
Video Review
• Take a vowel inventory
▫ Target vowels in isolation
(a)
▫ In strings (a,a,a,a)
▫ In opposition (u-I, u-I a-o,
a-o)
5.
Structural
Anomaly
43. Increase Consonant Inventories
• Hi
• Hello
• Hey
• Mommy
• More
• Me
• No
• Whoa
• Wow
• Honey
• Mamá
• No
• Mío
• Niña
• Niño
• Ojos
• En
• Mano
• Wawa – agua
BEFORE palate repair
LOW pressure words to target
5.
Structural
Anomaly
44. Increase Consonant Inventories
• Baby
• Boy
• Pop
• Pooh
• Pie
• Toy
• Doll
• Daddy
• Cookie
• Go
• Papá
• Bebé
• Boca
• Gato
• Todo
• Tú
• Tío
• Qué
• Ten
AFTER palate repair
HIGH pressure words to target
5.
Structural
Anomaly
45. Increase Vocabulary
• Sounds and vocabulary develop in tandem
• Do we:
▫ Focus on articulation to give her the sounds to
produce more language?
▫ Focus on language to give her a way to
practice her sounds?
5.
Structural
Anomaly
46. Increase Vocabulary
• Vocabulary development should be targeted with
sound development
▫ Choose words that:
Are common and in their environment
Are useful
Are extremely fun
(read: routines-based intervention)
• Syllable should be simple CV (consonant/vowel)
• Start with stops and bilabial sounds
5.
Structural
Anomaly
47. Increase Oral Airflow
• A child with a cleft does not have control over
the air leaving their throat
• In typical development we stop or slowly
release this air to produce speech
• Regardless of what surgeries a child has
undergone, we need to familiarize the child
with airflow through the mouth
5.
Structural
Anomaly
48. Video Review
• Request an easy repetition
(muh,muh,muh)
▫ After the child starts
repeating, plug his nose
• Inhale deeply, hold your
breath, and explode out
with a single sound
▫ BUH!, PUH!
5.
Structural
Anomaly Increase Oral Airflow
49. Decrease Use of Nasal and
Glottal Sounds
• Growls and nasal sounds are typical for young infants
but children with clefts obtain these sounds later
• Parents, wanting communication, reinforce these
sounds
• Acknowledge the child’s attempt but then request
other consonants or sounds
• Pair voiceless consonants with whispered vowels
puh/tuh/ku/huh
• This keeps the glottis open and prevents the glottal
stop from occurring
5.
Structural
Anomaly
Schools have developed different speech-only programs and have shown success in English. Many are now trying to implement them in Spanish. One of the things that drove us to do this presentation is that people have been creating these intensive programs for Speech and we have been approached about how to set one up in Spanish. There was a lot of value in this exercise:Let’s take a minute and pretend that you are charged with developing a speech program for all the children your site sees. You have to come up with a way to best describe and treat the different variations on the disorder. Would you treat this new department the same way that you treat your caseload? How would you provide treatment to 30 unintelligible students? How would you divide them up? What kinds of intervention tools would you use? Today we are going to discuss:
Then at the end, if we have time we are going to do some case studies to try to synthesize the information into practical information for you to use at work. We are also going to Address Speech Differences with Spanish Development
Ellen Note: These were meant for SLP use and not for teachers.
There is a vast difference between how we treat language disorders and how we treat speech disorders related to the types of interventions we provide, the types of goals we write, the finite way in which we identify language abilities and how we are going to measure success. With speech we typically identify which sounds or processes are problematic, how intelligible the child is, and what the context is that the child is unintelligible (word level, running speech)The differences in intervention with Sound Disorders are often more closely related to the personality of the SLP than they are to the specific type of sound class disturbance. He’s an oral-motor guy, that’s all he does. That women is a PROMPT specialist. But what if we had a professional taxonomy for speech in our head that rivals how we break down language. If we had 4 speech categories here like we have language categories would we target the disorder differently? The research is out there. Let’s see how speech can be further understood.What we are going to do today is make an argument for approaching Speech in the same way that we approach language. If we use a more specific qualification of system for speech we can more greatly target goals and increase dismissals.
One clinically useful method to subtype children with SSD is to group themaccording to whether or not the SSD is accompanied by additional language impairmentThis dichotomy has the advantage from an educational standpoint because it is a good predictor of difficulty in the classroom. The authors suggest that speech sound production and spoken and written language relyon both shared and unshared processes. Therapy targets can incorporate reading strategies that are also deficientThe disadvantage to this classification is that it does not identify degree or type of unintelligibility, Either you have other difficulties and speech problems or just speech problems(LI). Shriberg, Tomblin, and McSweeny (1998) report 11–15% co-morbidity of speechdelay with LI at 6 years of age, with considerably higher co-morbidity rates estimatedfor preschool children with speech delay (40–60%; Shriberg & Kwiatkowski, 1994).Numerous studies have validated the utility of this dichotomy by demonstrating pooreroutcomes for children with combined SSD and LI than for children with isolated SSUseful in predicting deficiencies in spelling and reading decoding - Lewiset al., 2002; Young et al., 2002).D
The big difference between this taxonomy and the previous is that LI may be co-morbidwith any of these categories, but is not considered in defining any of the subBased on a complexdisorder framework, this classification system proposes seven subtypes of SSD: speechdelay-genetic, speech delay-otitis media with effusion, speech delay-apraxia, speechdelay-dysarthria, speech delay-developmental psychosocial involvement, and twocategories of speech errors limited to distortions of speech sound types
Ellen Note: These aren’t mutually exclusive. A child can share processes from across the different groups.Another classification system was proposed by Dodd (1995).***CITE THE NUMEROUS RESEARCHERS WHO’VE BEEN ABLE TO CLASSIFY INTO THESE FOUR GROUPS This system classifies SSDinto five subtypes including articulation disorder, delayed phonological acquisition,consistent deviant disorder, inconsistent disorder, and other (including dysfluency,dysarthria, and apraxia of speech). Dodd’s system is based on the types of speech sounderrors observed rather than the hypothesized etiological basis. Distinctions are madebetween delayed and deviant development, articulation and phonological errors, and theconsistency of the speech sound errors. She has an ‘‘other’’ category which is defined by an underlying basis for the errors. For the purpose of this presentation we are going to focus on unintelligibility due to structural anomalies such as VPI and CL&PDodd (1995) hasdemonstrated the prognostic utility of these subtypes in studies showing different writtenlanguage outcomes for children with speech sound delay than for children with deviantspeech sound errors.
Ellen Note: May have delayed phonprocessin addition to deviant processes.
**broader and more abstract; rule-driven (vs. artic—motor component)*Children can often produce the sounds, but prob is they don’t use right sound at the right time*Cause: Little known about the cause of phonol. delay, but present with a cognitive-linguistic deficitCommon Patterns (both groups—more than 10%) **SPANISH-SPEAKING!!! Aside: Common patterns (approx. 10%) for those w/ phon dis: 1. initial consonant deletion??? 2. Weak syllable deletion 3. Velar Fronting; Also Less Common for both (palatal fronting, assimilation, and final cons. deletion) and Uncommon (deaffrication, backing, spirantization, denasalization)…**LOOK UP! SAME PROCESSES FOR ENGLISH-SPEAKING??
Cause: impaired ability to abstract and/or organize knowledge about the nature of the phonological system; poor understanding of the phonemic rules of language (on legality awareness task); deficit at internal organizational level of speech-processing chain*Children in this group performed more poorly than other speech-impaired children on tasks of phonological awareness, such as recognition of alliteration and rhyme.
*unpredictable variation between a relatively large number of phonesCause: lack of a stable phonological system because of a deficit in phonological planning (Aside: phon. planning—process of phoneme selection and sequencing)Ellen Note: STUDY the core vocabulary in a sense stabilizes the phonological system. Core vocabulary for inconsistent deviant bilinguals?
*Children with inconsistent disorder are better in imitation than in spontaneous-Apraxia—disrupted speech motor controlAdd’l characteristics:1. Disturbances of prosody including overall slow rate; timing deficits in duration of sounds and pauses between and within syllables contributing to the perception of excess and/or equal stress, "choppy" and monotone speech.2. At some point in time, groping or observable physical struggle for articulatory position may be observed (possibly not present on evaluation, but observable at some point in treatment).Tx: Underlying disorder is motoric; therefore, would use a motor speech approach VS inconsistent: deficit is in phonological planning (i.e., selection and sequencing of phonemes)
The typical “artic” students -may consistently produce a specific distortion (e.g., lateral lisp) or substitute another phoneme (e.g., [w] for /r/)-usually more intelligibleCause: due to a peripheral problem where the wrong motor program for the production of specific speech sounds has been learned.**motor component!!
Clefts result from incomplete development of the lip and/or palate in the early weeks of pregnancy. During this time the face is being formed - the top and the two sides develop at the same time and grow towards each other, finally fusing in the middle.
submucous cleft palate is where, although the surface layers of the soft palate (mucous membrane) are complete, the underlying muscle is incomplete. A submucous cleft of the hard palate is where the bony element is incomplete.PrevalenceClefts occur in ~1/750 live birthsEstimated prevalence by type:Lip only 14%Palate only 37%Lip and Palate 49% (77% are unilateral left)Estimated data by race:Asian and Caucasian populations more susceptibleBlack populations present with ½ the rate of Asians and CaucasiansHispanic data are inconclusive
Week 7Upper lip joinsNose comes together
VPI means velo= velum pharyngeal = back wall of throat, is not coming into contact when it is supposed to. This is a term that you need to be familiar with but I am not going to go into too much detail on because it is most likely being followed by the cleft palate team.In laymen’s terms it describes why air is escaping through the nose and why the child is unable to build up pressure when making consonants. Normally, the second surgery is targeting this problem and trying to close off this gap or introduce muscle function that causes this. It can be caused by a fistula (hole), muscle function problems, too wide of a gap in the back of the mouth.Your concern with this is that if after a while after the second surgery if a child appears to be losing all of his air through his nose, you may want to recommend a check up.Some VPI is common after a surgery and it takes a while after the surgery for a child to function better both due to swelling and due to practice and strengthening his new muscle.A simple test is to ask the child to repeat buh buh buh. If they say muh muh muh, air is going out through the nose. Squeeze their nose and ask them to say buh buh buh again. If they can say buh buh buh then air is going out through the nose.
Researchers like Holm, Dodd, and Bradford monitored the effectiveness and efficiency of intervention approaches provided to the different groups of speech sound disorders. Approaches that were effective for a child in one or two subgroups did not result in improvement for children who made other types of errors. We’ll talk about the approaches that will be appropriate for each group and how to determine the most effective approach based on the errors and targets chosen. (FIX LAST SENTENCE!)
We’re going to begin discussing treatment for these various subgroups and show you how tailoring your treatment to the specific errors a child produces can result in better success for your children with speech sound disorders. Researchers like Holm, Dodd, and BradfordAll intervention plans must consider three parameters (?) based on the needs of the child. First, we must decide whether to target early-developing sounds or later-developing sounds. There is conflicting research in this area. Gierut and others (1996) found evidence that greater system-wide change occurred when targets were later developing sounds. (NOTE: LOOK UP DESCRIP. OF THEIR TWO GROUPS) On the other hand, in 2001 Rvachew and Nowak’s treatment study for children with mod. and severe speech delays revealed greater generalization when early developing sounds were targeted first. Another decision for selecting targets is whether or not we should choose sounds for which the child is stimulable or if we should work at a more difficult level to see transer to the stimulable sounds. Conflicting results also exist regarding greatest success with this factor. When looking at whether the children’s produced consistent sound substitutes in all instances or variable substitutes both within and across word positions, Forrest and colleagues (2001) reported that children with inconsistent substitutes did not benefit from traditional articulation therapy techniques. We’re going to focus on target selection for children based on their subgroup as well as the approach or method most appropriate for the types of errors produced. An additional factor of intervention that we will not go into today is how to implement the approach chosen. For example, a clinician may choose to work toward a set criterion for a single target before moving on or teaching several targets simultaneously for predetermined periods of time (such as Hodson’s cycle approach).
Crosbie, Holm, & Dodd (2005) compared phonological contrast therapy with another approach described later for children with phonological impairments. They found that phonological contrast therapy resulted in greater change in children with consistent speech disorder (compared to other approaches that were found more effective for children in the subgroup of inconsistent speech disorder. They made more rapid progress…… (FINISH!!!!)Using contrasting sounds that change the meaning of words
Aim of phonological contrast therapy is to reorganize a child’s linguistic system by teaching him to develop meaningful contrasts of words. By providing pairs of words that contrast in meaning (using the child’s error together with a target phoneme), the child will learn that his production results in a breakdown in communication and how differences in sounds change the meaning of the message.With these approaches, one particular phoneme can be targeted (assuming that generalization will occur to other phonemes that are affected by that same pattern), or a range of contrasts within an error pattern can be targeted simultaneously.
Aim of phonological contrast therapy is to reorganize a child’s linguistic system by teaching him to develop meaningful contrasts of words. By providing pairs of words that contrast in meaning (using the child’s error together with a target phoneme), the child will learn that his production results in a breakdown in communication and how differences in sounds change the meaning of the message.With these approaches, one particular phoneme can be targeted (assuming that generalization will occur to other phonemes that are affected by that same pattern), or a range of contrasts within an error pattern can be targeted simultaneously.
Aim of phonological contrast therapy is to reorganize a child’s linguistic system by teaching him to develop meaningful contrasts of words. By providing pairs of words that contrast in meaning (using the child’s error together with a target phoneme), the child will learn that his production results in a breakdown in communication and how differences in sounds change the meaning of the message.With these approaches, one particular phoneme can be targeted (assuming that generalization will occur to other phonemes that are affected by that same pattern), or a range of contrasts within an error pattern can be targeted simultaneously.
Depending on the phonemic structure of the language of intervention, some approaches may be easier than others to implement. In Spanish, minimal pairs are not as frequent as they are in English, making this approach more difficult. One suggestion would be to use Hodson’s Cycles Approach to target the errors. For one child, Hodson’s approach was implemented to target weak syllable deletion, initial consonant deletion, and stopping. The first two processes fall in the subgroup of deviant disorder, but this child also made errors of stopping (a more common process seen in typically-developing children as well). Even though he presented with a combination of both more- and less- common phonological processes, this pattern-based approach was very successful to remediate his use of all processes.
Depending on the phonemic structure of the language of intervention, some approaches may be easier than others to implement. In Spanish, minimal pairs are not as frequent as they are in English, making this approach more difficult. One suggestion would be to use Hodson’s Cycles Approach to target the errors. For one child, Hodson’s approach was implemented to target weak syllable deletion, initial consonant deletion, and stopping. The first two processes fall in the subgroup of deviant disorder, but this child also made errors of stopping (a more common process seen in typically-developing children as well). Even though he presented with a combination of both more- and less- common phonological processes, this pattern-based approach was very successful to remediate his use of all processes.
Core Vocabulary Intervention; targets the underlying inability to form phonological plans/templates rather than the production of certain phonemes or phoneme classes.Dodd and colleagues (2004) detail an intervention program where the child, parents and teacher selected a list of 50 words that were functionally “powerful” for the child. Words commonly included were peoples names (family, teacher), pet names, places (e.g. school, toilet, shops), function words (e.g., please, sorry, thank you), foods (water, drink, chips, Cheerios), and child’s favorite things (teddy, games, Dora). **Chosen b/c frequently used in functional comm’n—not according to word shape or segments. *Increasing intelligibility for these words motivated the use of consistent productions.*CONSISTENCY--Even if the response is incorrect (chutterdy for butterfly) you would want it to be “chutterdy” consistently. Tx: A careful inventory of the child's current consonant and vowel inventory may provide a clue as to beginning words (or approximations) that may be possible. Word choices should take into account words and functions that a child would want to communicate.**Note: MAY also benefit from phonological contrast therapy once consistency is establishedThis supports a bilingual approach because targeting the phonological plan in either language will carry over to both languages (cite) (Because you not remediating the phoneme but you are remediating the inconsistency so this is what transfers between the languages.)
LOOK UP!!! *Compared to just traditional artic approaches or also compared to phonological approaches as well (Pretty sure the latter….
LOOK UP!!! *Compared to just traditional artic approaches or also compared to phonological approaches as well (Pretty sure the latter….
10 words randomly selected from set of 50 target words. Child’s best production was achieved by teaching the word sound-by-sound, using cues such as syllable segmentation, imitation and cued articulation. Individual sounds within a syllable were also taught explicitly, and feedback was provided for each attempt. In some cases, a child’s best production still included developmental errors that were accepted, as long as the production was consistent.Daily practice is carried out by the parents and teacher, and production of those words are reinforced in everyday communication situations.
Compared with other groups, these kids generally have fewer phonemes to target.Van Riper (5 phases): **May not be necessary to pass through all stages of each phase1. sensory-perceptual training—includes identification, isolation, stimulation, discrimination2. Production training—sound establishment3. Production training—sound stabilization (isolation, nonsense syllables, words, phrases, sent, convo)4. Transfer and Carryover5. MaintenanceMcDonald—theoretical assumption that all sounds can be produced correctly in at least one phonetic context
For a child with an incorrect production/distortion of /s/ who may, for example, be able to correctly produce other fricative sounds, one might choose a more traditional motor approach for remediation of this phoneme. Based on Van Riper’s traditional approach, a sequence of steps may be used to improve production of the target. While not all of his original treatment stages are included today (e.g. sensory-perceptual/”ear training”), the progression from sound establishment and then stabilization at different complexity levels all the way to transfer in other situations and carryover to conversation is/are (?) still important _____s in intervention approaches today for articulation errors.
For a child with an incorrect production/distortion of /s/ who may, for example, be able to correctly produce other fricative sounds, one might choose a more traditional motor approach for remediation of this phoneme. Based on Van Riper’s traditional approach, a sequence of steps may be used to improve production of the target. While not all of his original treatment stages are included today (e.g. sensory-perceptual/”ear training”), the progression from sound establishment and then stabilization at different complexity levels all the way to transfer in other situations and carryover to conversation is/are (?) still important _____s in intervention approaches today for articulation errors.
So how do we address communication difficulties with the families. Here are 5 main goals and then we are going to address how to work on each one in therapy.
Prior to closing the palate, a child needs to focus on low pressure sounds. These are sounds that are made with the throat (h) or with the nose (m,n) and don’t depend on the child being able to build up pressure and create other sounds.Prior to their palate repair, you want to also practice high pressure sounds by asking them to repeat you and when they begin, plug their nose. Next slide You wouldn’t expect them to have much success but you are laying the groundwork for therapy after the surgery takes place.
Next slide You wouldn’t expect them to have much success but you are laying the groundwork for therapy after the surgery takes place.High pressure sounds consist of sounds that explode (d,t,p,b,g,k) when air leaves the mouth (not nose) only.
Early phonological development and lexical development are closely related. This is to say that as a child’s sounds develop, their vocabulary also expands. It goes without saying that a child with a CLP was impaired sound development and therefore may be behind on vocabulary and language development, even after the surgeries have taken place.So the question is, do you just focus on speech in order to give her the sounds in order to produce more language or do you focus on language to give them a place to practice their sounds?Data reported by Scherer suggested that “intervention that is designed to enhance general language development results in improved sound inventory as well. This is good news for all interventionists. I know that some EISs are not comfortable with articulation strategies and he we have more proof that language intervention is important.Hardin-Jones and Chapman Jan 08 LSHSS
Proper tX targets video
A child with a cleft expresses all of her air without control. The eventual stopping or slowly releasing this air is what produces speech. Independent of where they are in their surgery, we have to start familiarizing the child with an explosion and/or release of air through the mouth.
A child with a cleft expresses all of her air without control. The eventual stopping or slowly releasing this air is what produces speech. Independent of where they are in their surgery, we have to start familiarizing the child with an explosion and/or release of air through the mouth.
A child with a cleft expresses all of her air without control. The eventual stopping or slowly releasing this air is what produces speech. Independent of where they are in their surgery, we have to start familiarizing the child with an explosion and/or release of air through the mouth.
13% of 63, 4-5 year olds presented with some form of voice disorderharshness, breathiness, nodulesA child with a cleft will have the greatest ability to produce sounds with the nose and throat. Parent’s, excited about communication, will reinforce growls and monster sounds. They think it can be cute. In typically developing infants they reduce the use of these sounds when more consonants come in. A child with a cleft can retain these sounds, making them habit, and then they are hard to get rid of. Hardin-Jones, chapman, scherer, June 2006 ASHA leader
Ellen Note: These were meant for SLP use and not for teachers.