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In the Traditional Motor/Phonetic Approach:

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self-monitoring and sound discrimination are essential

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Traditional Motor/Phonetic Approach; Production of Sound in Isolation

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-auditory stimulation or imitation: if it works, it is the easiest way to achieve a target sound -phonetic placement method: clinician instructs client how to position the articulators to achieve a typical production -sound modification method: derive target sounds from a phonetically similar

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Traditional Motor/Phonetic Approach: 3 goal attack strategies

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1) Vertically Structured Treatment Program: 1 or 2 targets addressed at a time; must reach predetermined criteria before moving to new target; high rate of mass practice; preferred for kids with few errors 2) Horizontally structured treatment program: address multiple goals in same session; working on multiple sounds in each session will increase awareness of similarities and differences between sounds 3) Cyclically Structured Treatment Program: Single target addressed per session; another target addressed in next session; combination of vertical and horizontal approach; preferred for kids with multiple errors

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Traditional Motor/Phonetic Approach: Target Population

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Usually kids with articulation disorders. Can be used with kids with phonological disorders if phonological treatment attempts fail, especially if they have motor constraints

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Traditional Motor/Phonetic Approach: Therapy structure

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1.Sensory perceptual training/ear training (only necessary if SLP thinks child may not be able to identify/discriminate sounds) 2.Identification: recognize and discriminate sounds in isolation 3.Isolation: clinicians says word in initial, medial, and final position, and client must identify the position 4.Stimulation: Client hears many variations and must identify the sound 5.Discrimination: clinician makes sound errors and client must identify what is wrong

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Traditional Motor/Phonetic Approach: Treatment approach

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-focus on articulation errors -focus of therapy is to teach child how to position articulators to produce target sounds -treat each sound individually in sequence

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Traditional Motor/Phonetic Approach: selecting target sounds

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-sounds that are stimulable -sounds that develop early -phonological processes that occur in at least 40% of opportunities -ORGANIZING WORDS BY DIFFICULTY: length of word, position of sound in word, syllable structure, syllable stress, coarticulation factors, familiarity

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Traditional Motor/Phonetic Approach: accuracy level

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-85% mastery of sound must be reaches before moving to next phoneme -50% accuracy in spontaneous speech

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Traditional Motor/Phonetic Approach: Facilitating context

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coarticulation context conditions that aid in the production of target sounds

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Traditional Motor/Phonetic Approach: key words

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words in which target sound is correctly produced

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Traditional Motor/Phonetic Approach: Nonsense syllables

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maintain accuracy of target consonants in varying vowel contexts; some vowels provide favorable coarticulation conditions

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Cycles Approach: Goal Attack Strategy

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-target one phoneme pattern per week -each phoneme patterns presented for 60 minutes a week -cycle duration usually 10-15 weeks

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Cycles Approach: Goal

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to increase intelligibility of highly unintelligible children

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Cycles Approach: selecting target sounds

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1) early developing phonological patterns: -syllableness: 2 and 3 syllable equal stress word combinations -word initial singleton consonants in CV structure: /m,b,p,d,w/ -word final singleton consonants in VC structure: /p,t,k,m,n/ 2)Posterior/anterior contrasts: examine speech to see if alveolar or velar sounds are absent 3)/s/ clusters: word final /s/ clusters are the most facilitating 4) liquids: if /l/ and /r/ are absent, they should be stimulated in each session/cycle

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Cycles Approach: target population

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-highly unintelligible kids and kids with recurrent ear infections, cochlear implants, repaired cleft palate, and cognitive delays

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Cycles Approach: client criteria

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-severe to profound -20% or less intelligibility -2.5 to 14 years of age -phonological processes -group or individual therapy

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Cycles Approach: target sounds ____

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-with consistent error productions -target sounds must be stimulable so they experience early success -address non-stimulable sounds for a few minutes each session until they are stimulable

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Cycles Approach: "underlying premise"

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-phonological acquisition is gradual, so the cycles are gradual -several sounds are targeted within one cycle -some new sounds are introduced in later cycles

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Cycles Approach: session structure

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1) review preceding word cards (from last session) 2) auditory bombardment: 12 words read that contain target pattern 3) target word cards: 3-5 target word pictures 4) production practice thru experiential play: take turns naming pictures and providing cues to achieve 100% success on target patterns 5) stimulability probe: assess potential targets for next session 6) auditory bombardment repeated 7) home program - 2 minute homework per day

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Cycles Approach: accuracy level

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-no level of mastery required to move to next cycle -targeted patterns used to stimulate emergence of a sounds or pattern, not mastery -100% in the end -target sound must be @ 100% for it to no longer be a target

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Core Vocabulary: focuses on

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whole words to establish a vocab of highly functional words that are consistent but maybe not completely correct; Developed to target consistency rather than accuracy of whole word productions

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Core Vocabulary: session structure

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-Twice a week for 30- 60minutes (at least 60 minutes a week) -done for 8 weeks at least, but it can be done for another 8 weeks -100% consistency before you move on to new words -Session 1: develop best production for 10 words -Session 2: drill 100 responses in 30 minutes of those same 10 words. -Every 14 days: test 3 elicitations of 10 untreated words to assess generalization

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Core Vocabulary: session structure continued

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-70 words are identified by parents and teachers -1st session, 10 words and drilled and practiced, and also practiced at home with teachers and parents. -First 10 words are tested again in 2nd session, and 10 untreated words are tested too -1st session: elicit best production of 10-12 words -2nd weekly session: drill newly learned words -child should produce 100 words in 30 minute session -words not mastered in a week stay on the list for next week

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Core Vocabulary: target population

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-Children 2 + in age with inconsistent SSD -works with bilingual kids and Down Syndrome -best used as early intervention around age 3, but also used with school age -kids who score 40% or more on Inconsistency subtest of Diagnostic Evaluation of Articulation and Phonology (DEAP)

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Core Vocabulary: client criteria

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Minimum age: 2 Severity: moderate to profound Type of errors: inconsistent errors Exclusionary: childhood apraxia Special populations: bilingual kids and kids with intellectual disability Intervention agent: SLP with parent help Service delivery model: 2 30 minute sessions a week for 8 weeks

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Core Vocabulary: underlying concepts

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Used with kids with SSD (speech sound disorders): -inconsistent pronunciation of the same words -errors increase with increased word length -wrong choice of phoneme rather than order errors like metathesis -better at imitation than spontaneous speech -no groping or silent posturing like apraxia -normal speech and DDK rates

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Core Vocabulary: selecting target words

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-parents and teachers provide the list of 70 functional words, and they are very active in daily practice in between sessions

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Minimal Pairs Approach

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-phonologically based approach -intervention begins at the word level with no nonsense syllables

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Minimal Pairs Approach: treatment focus

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Treatment is focused on the phonological system of the child -groups of sounds or sound classes are targeted rather than individual sounds

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Meaningful minimal pair approach (FROM ARTICLE) (child produces a contrast in first session)

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1) Familiarization: clinician discusses the meaning of the words with the child 2) Listen and pick up: the clinician names the word, and the client must choose the correct picture 3) Production of minimal pair words: the child says the word, and the clinician points to the picture. Also, must point out semantic confusion if the child doesn't differentiate the words. A communication consequence must be present: you give them the picture that matches their production. Can they self correct? Note: 20 trials of each of the 5 words totaling 100 trials per session

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Perception-Production Minimal Pair Intervention (FROM ARTICLE)

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Note: 2 copies of 5 words and 2 copies of cognates equals 20 pictures total 1) Familiarization and Perception Training:Discuss words and child must sort them correctly with 90% accuracy (e.g. r words in one pile and w words in another) 2) Production-Word Imitation: child imitates 5 target words with articulation instruction if needed. This step continues until the child can imitate 5 words with 90% accuracy in 50 trials 3) Production-Independent Naming:Child independently names the pictures with 50% accuracy in 50 trials 4) Production-Minimal Pairs:Child say the word and the clinician points to the correct picture

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Minimal Pair Approach: Target Population

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-best used with kids with phonemic substitutions age 3-6 with one or two consistent errors -65%-100% on PCC with difficulties in showing phonemic contrast (best for phonological disorders not artic disorders) -Kids with unintelligible speech but normal hearing and no oral-motor difficulties -best for kids with one pervasive phonological process or a few age inappropriate phonological processes (kids with lots of phon processes errors are better suited to cycles approach) -best forkids with consistent substitutions -Article says you can also use it with kids with hearing loss, developmental difficulties and cleft palate

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Minimal Pair Approach: Client Criteria

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Minimal age: 3-6 years of age Severity: mild to moderate (PCC 65-85%) Types of errors: substitutions, 2-3 error patterns only Exclusionary: sound distortions or assimilations Special population: bilingual, cleft palate, mild hearing loss

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Minimal Pair Approach: Selecting Target Sounds

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1) phonemic substitutions vs. norm productions 2) place/manner/voicing should be considered 3) choose substitutions with least # of differences in production features 4) early sounds have priority 5) substitutions that affect intelligibility have priority 6) stimulable sounds have priority Article states that nonstimulable sounds should be targeted

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Minimal Pair Approach: structure of sessions

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1) Discussion of words: child must understand the words 2) Discrimination Testing and training: the child must point to the correct picture 7 times to make sure they can differentiate sounds 3) Production Training: child says words and clinician points to pictures 4) Carryover training: -a + word -the + word -touch the + word -point to the + word -longer expressions + word *Need 5 words for each target!

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Minimal Pair Approach: delivery model

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-there is a wide variety of service delivery models -Usually one phoneme or pattern is address at a time Service delivery model: individual or group therapy, 30-45 minute sessions Intervention agent: SLP -usually 60 minutes a week

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Minimal Pair Approach: Goal Attack

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vertical, horizontal, or cycles approach

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Minimal Pair Approach: Nature of sessions

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-Number of Trials per session: 20 per target to 5 pairs: 100 trials and 3 pairs: 60 targets -Progress monitoring: treatment data and generalization to conversational speech -If no progress after 4-6 weeks, reevaluate and change! -Dismissal criteria:50-70% in connected speech

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Minimal Pair Approach: Minimal pairs

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pairs of words that differ by only one phoneme (think/sink, hog/dog)

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Minimal Pair Approach: Near Minimal Pairs

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pairs of words that differ by more than one phoneme, but the vowel preceding or following the target sounds remains constant in both words (sir/third)

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Maximal oppositions Approach

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-part of multiple oppositions -better to teach sound pairs that involve maximal opposition and major class distinctions b/c greater improvement is expected when trained sounds differ by many features -indirectly affects homonymy

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Maximal oppositions Approach continued

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-sounds are chosen that demonstrate diff in all 3 production features -treatment focused on sounds the child can't produce(consistent error productions) and later targeted sounds that appeared in some contexts (inconsistent productions) -you select sounds that are maximally different so they can generalize that info later

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Maximal oppositions Approach: goal attack

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-start with vertical: use 1-2 sounds to start 1) pair a consonant the child can produce with a consonant the child cannot produce 2) select consonants that differ by as many distinctive features/class distinctions as possible 3) chart on pg. 333

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Maximal Oppositions Approach: target

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-1-2 sounds -8 minimal pairs (nonsense or real) -contrast in the initial position -use chart on p. 333

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Maximal Oppositions Approach: target population

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-moderate to severe phonological disorders with at least 6 sounds missing across 3 manner categories -36-72 months of age -exclusionary: N/A -special populations: hearing impairment, apraxia, and intellectual disabilities

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Maximal Oppositions Approach: selecting targets

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-1-2 sounds not in the child's inventory are selected that are maximally different (includes number of distinctive features and major class features) Select: -non-stimulable sounds -later developing sounds -more complex sounds -pair an error sound that is maximally diff in distinctive features/class from a sound that the child can produce

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Maximal Oppositions Approach: service delivery

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2 phases: 1) imitation phase (continues until 75% imitative accuracy occurs over 2-7 consecutive sessions) 2) spontaneous phase(continues until 90% accuracy occurs without a model over 3-12 consecutive sessions) -service delivery: 30-45 minutes 2-3 times a week

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Complexity Approach: Empty set

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-similar to maximal opposition except you use 2 unknown consonants they cannot produce -select consonants that differ by as many distinctive features/class distinctions as possible -use same chart on p.333

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Multiple Opposition Approach:

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-directly affects homonymy and uses maximal oppositions Note: learnability of multiple sounds contrasts made it easier for the child to systematically reorganize the sounds system; it directs the child's attention to the entire rule rather than just one minimal pair

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Multiple Opposition Approach: Assessment methods to determine intervention relevance

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-single word sample -20 minute conversational speech sample -stimulability testing

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Multiple Opposition Approach: target populations

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-Severe speech disorders -moderate to profound phonological impairments -exclusion of at least 6 sounds across 3 manner categories -children who use sound substitutions that result in multiple phoneme collapses to a single error production -children with speech delay and comorbid issues with speech, language and/or reading impairments -kids 36-72(3-6 years) months of age Kids with typical hearing, intelligence and oral mech structures -can be used with kids with receptive lang delay, but not as effective as kids without receptive delays -also could be used with kids whose speech delays are related to otitis media, apraxia, and Down Syndrome

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Multiple Opposition Approach: Selecting targets

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-targets that are maximally different are targeted -sounds that affect phonological reorganization the most are targeted *Sounds are targeted across the rule set or phoneme collapse rather than looking at early sounds, stimulable sounds, etc 1) Substitution errors a. consonant production b. vowel production 2)Syllable structure errors a. cluster reduction b. word initial deletion c. word final deletion

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Multiple Opposition Approach: two theoretical constructs

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1) signal diff in meaning thru contrastive phonemes in order to avoid homonymy 2) selection of intervention targets across a rule set that represent the phoneme collapse and are maximally distinct from each other and the child's substitution

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Multiple Opposition Approach: Goal attack

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-Use horizontal, vertical, and cycles approach. -Usually do vertical strategy first to get greater focus, then switch to horizontal or cyclical

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Multiple Opposition Approach: 4 phases of treatment

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1) familiarization and production of the contrasts 2) production of the contrasts (focused practice) + interactive play (naturalistic activities) 3) production of contrasts with communicative contexts 4) conversational recasts

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Stimulability Intervention: Target population

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-Very young children -Children with small phonetic inventories -Not stimulable for a number of sounds -Moderate to severe phonological delay

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Stimulability Intervention: Goal

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-increase stimulability of error sounds -Encourage more verbalization -When a child can produce a sound with 30% accuracy, you no longer address it -Can be used to increase stimulability in order to use another approach that uses sounds that are stimulable -Increase child's overall phonetic inventory

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Stimulability Intervention: target sounds

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-Target nonstimulable sounds; more complex sounds -Incorporate stimulable sounds to give client early success

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timulability Intervention: treatment structure

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-short-term approach; 12 sessions, no more than 12 weeks 1) Elicit 1/3 of stimulability probe (phonemes the child is not stimulable for) 2) Review sounds (and motions) (specific picture cards → on blackboard) 3) Play-based stimulability activities 4) Administer palindrome generalization probe

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Naturalistic speech intelligibility training: goal

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•Speech accuracy - how well the child can produce the sound accurately •Speech intelligibility - how well you can understand what the child is saying •Shifts focus from individual speech sounds to a whole-word approach •Production of speech sounds is not the same as overall intelligibility

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Naturalistic speech intelligibility training: target populations

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•Any child with severe SSD •Children at risk for difficulty with intelligibility: Down syndrome, Autism, etc.

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