question

*a crucial consideration in programming involves a client's ability* to

answer

transfer newly mastered communicative behaviors from the clinical setting to the everyday environment -*generalization is enhanced when intervention is provided in the most authentic, realistic contexts possible*

question

*Generalization should not* be

answer

viewed as a distinct event that occurs only in the final phase of the therapy process -*rather, it is an integral part of programming that requires attention from the very beginning*

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*three main factors can influence the degree to which generalization occurs*:

answer

stimuli physical environment audience

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*a variety* of *stimuli*

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objects, pictures, questions should be used during therapy activities to avoid tying learning to only a small set of specific stimulus items

question

similarly, *the clinician should vary the physical environment*

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location in room, location in building, real-world locations in which therapy occurs as soon as a new target behavior has been established this will minimize a client's natural tendency to associate target behaviors with a particular setting

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finally, *clinicians should bear in mind that target behaviors*

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frequently become attached to the individual who consistently reinforces them i.e., the clinician

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therefore *it is important to vary the audience*

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familiar adult, sibling, unfamiliar adult with whom therapy targets are practiced, to maximize the likelihood of successful generalization

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*termination* of *therapy*

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it is difficult to definitely state the point at which intervention services are no longer warranted

question

*at the current time*, *there are no*

answer

valid empirical data that can be used to determine appropriate dismissal criteria for any particular communicative disorder

question

*general discharge guidelines used by many clinicians* include

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1. *attainment of communication skills that are commensurate with a client's chronological/developmental communication skills age or premorbid status* 2. *attainment of functional communication skills that permit a client to operate in the daily environment without significant handicap*

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*general discharge guidelines used by many clinicians* include

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3. *lack of discernible progress persisting beyond a predetermined time period* -establishment of reliable treatment outcome measures in critical in the current climate of professional accountability in both the public and private sectors

question

within the last few years, the

answer

availability of efficacy data has increased significantly for a variety of communication disorders

question

*once long term goals and initial treatment has been identified*, the clinician develops

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short-term objectives designed to culminate in the achievement of the selected long term goals -*in education settings, student progress is measured through benchmarks which are sets of skills required to achieve specific learning standards*

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*these objectives must be clearly *

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delineated to ensure appropriate and effective intervention programming - *a widely used approach to task design in the formulation of behavioral objectives*

question

*a behavioral objective is* a

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statement that describes a specific target behavior in observable and measurable terms

question

there are *three main components of a behavioral objective*

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1. *"do" (action) statement* 2. *condition* 3. *criteria*

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the *"do" statement*

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identifies the specific action the client is expected to perform -*thus, behavioral objectives should contain verbs that denote observable activity* -*non action verbs should be avoided*

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*verbs that are appropriate for inclusion* in behavioral objectives

answer

point label repeat match name tell say write count vocalize ask elevate

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*verbs that are unacceptable because they refer to behaviors that cannot be observed*

answer

understand think learn believe improve discover know appreciate remember apply comprehend feel

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*what* is *an easy way to check the appropriateness of a verb*?

answer

*is to ask yourself* *"will I be able to count (tally) how many times this behavior occurs?* e.g., 1. "to repeat single syllable words" and 2. "to learn single syllable words" -*only the first is an appropriate "do" statement * -*number of repetitions can be easily counted, whereas "learning" is a behavior that cannot be directly observed*

question

*the condition portion* of a behavioral objective

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identifies the situation in which the target behavior is to be performed -*it specifies one or more of the following when the behavior will occur, where it will be performed, in whose presence, or what materials and cues will be used to elicit the target*

question

following are *common examples of condition statements*

answer

given the clinician's model in response to a question from the teacher in the presence of three classmates during book report presentation given a list of written words

question

following are *common examples of condition statements*

answer

in the home environment during a job interview using pictures during free play in the presence of other group therapy members during storybook reading time

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*condition statements* are

answer

critical parts of behavioral objectives because clients may demonstrate adequate mastery of a communicative behavior in one situation and yet be completely unable to perform the same behavior under different conditions

question

*example* of *condition statements*

answer

a client's ability to perform a "do" statement such as "produce 1 minute of connected speech without disfluency," is likely to be quite different if the condition statement specifies "while talking to a familiar clinician" versus "while talking to a potential date."

question

*the criterion* specifies

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how well the target behavior must be performed for the objective to be achieved -*it can be expressed in several ways, including percent correct, within a given time period, minimum number of correct responses, a maximum number of error responses*

question

*a list of criterion measures typically used in speech-language therapy follows*:

answer

90% accuracy 8 correct out of 10 trials less than four errors over three consecutive sessions 80% accuracy over two consecutive sessions 90% agreement between clinician and client judgments continuously over a 2 minute period

question

*a well-formulated behavioral objective allows a client, as well as the clinician*, to

answer

*know exactly what the therapy target is, how it is to be accomplished, and what constitutes successful performance* -examples of how to formulate behavioral objectives page 14 R&W

question

*the fundamental purpose of intervention* is to

answer

either increase desired behavior or decreased unwanted behavior -*the term behavior refers to communication targets as well as a patient's degree of cooperation and attentiveness* -*this is accomplished through application of the principles of behavior modification*

question

behavior modification

answer

is based on the therapy of operant conditioning and involves the relationship among a stimulus, a response, and a consequent event

question

a *stimulus*

answer

or antecedent is an event that precedes and elicits a response

question

a *response*

answer

is the behavior exhibited by an individual on presentation of the stimulus

question

a *consequence*

answer

is an event that is contingent on and immediately follows the response

question

*there* are *different types of consequent events*

answer

reinforcement punishment

question

reinforcement

answer

*consequences* that *increase the probability that a particular behavior will recur*

question

punishment

answer

*consequences* that are designed *to decrease the frequency of a behavior*

question

*types of reinforcement* are

answer

positive reinforcement and negative reinforcement -*both types are used to increase the frequency of a target responses*

question

*positive* reinforcement

answer

*is a rewarding event or condition that is presented contingent on the performance of a desired behavior* -primary and secondary positive reinforcements

question

*primary positive* reinforcement

answer

*these are contingent events to which a client reacts favorably due to the biological makeup or physiologic predisposition of the individual* -*food is the most common example* of primary reinforcer -*this type of reinforcer is very powerful and is used most effectively to establish new communicative behaviors* i.e., behaviors not previously present in the client's reperotire

question

*low functioning clients often respond well to the basic nature* of

answer

primary reinforcement

question

*disadvantages* of *primary reinforcement*

answer

1. *it can be difficult to present the reinforcement immediately after every occurrence of the target behavior* 2. *this type of reinforcement is susceptible to satiation- that is, it loses its appeal as a reward if presented too often* 3. *skills that are taught using these contingent events are often difficult to generalize outside the therapy setting, because primary reinforcers do not occur naturally in the real world*

question

*secondary positive* reinforcement

answer

these are contingent events that a client must be taught to perceive as rewarding

question

*secondary positive reinforcement* includes the following *subtypes of reinforcers*

answer

social token performance feedback

question

*social secondary positive* reinforcement

answer

consists of events such as *smiling, eye contact, and verbal praise* *it is the most commonly used type of reinforcement in speech language remediation programs*

question

*social secondary positive* reinforcement

answer

are extremely easy to administer after each target response and generally do not disrupt the flow of a therapy session

question

*social secondary positive* reinforcement

answer

in addition, this type of contingent response is not very susceptible to satiation (although it is not totally immune) and does occur in a client's natural daily environment

question

*token secondary positive* reinforcement

answer

consists of symbols or objects that are not perceived as valuable in and of themselves -*however, the accrual of a specific number of these tokens will permit a client to obtain a previously agreed on reward*

question

*examples* of *token secondary positive reinforcement*

answer

stickers, checkmarks, chips and point scores -*are generally regarded as very powerful because they are easy to administer contingent on each occurrence of a target behavior and are relatively resistant to satiation*

question

*performance feedback secondary positive* reinforcement

answer

involves information that is given to a client regarding therapy performance and progress -*many individuals find it rewarding to receive information about the quality of their performance* -*it is not intended to function as praise and need not be presented verbally*

question

feedback regarding client performance can be delivered in various formats including

answer

percentage data frequency of occurrence graphs numerical ratings and biofeedback devices

question

provision of this type of contingent event decreases a client's reliance on

answer

external sources of reinforcement by encouraging the development of intrinsic rewards i.e., internal satisfaction and motivation for mastering and maintaining a target behavior

question

*negative* reinforcement

answer

an unpleasant event/condition is removed contingent on the performance of desired behavior

question

*negative reinforcements* are

answer

escape avoidance

question

*escape negative* reinforcements

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requires the presence of a condition that the client perceives as aversive -*each performance of the target behavior relieves or terminates this aversive condition, thus increasing the probability that the specified behavior will recur*

question

*example* of *negative reinforcements*

answer

a clinician might place her hands firmly on a child's hands and remove them only when the child exhibits the target behavior of imitatively producing /s/

question

*avoidance negative* reinforcements

answer

each performance of a target behavior prevent the occurrence of an anticipated aversive condition -*this contingent event results in increased rates of performance of the desired response on subsequent occasions*

question

*example* of *avoidance negative reinforcements*

answer

a clinician might inform a child that each imitative production of the target /s/ will prevent the imposition of hand restraint

question

*use of negative reinforcement is relatively uncommon in the treatment of communication disorders* because it

answer

repeatedly exposes clients to unpleasant or aversive situations

question

*use of positive reinforcement is the preferred method for increasing the frequency* of

answer

desired responses -*also can improve a client's motivational level and foster an effective interpersonal relationship between clinician and client*

question

punishment

answer

an event is presented contingent on the performance of an undesired behavior to decrease the likelihood that the behavior will recur

question

*punishments* are

answer

Type I Type II

question

*Type I* Punishment

answer

this involves the *prompt presentation of an aversive consequence after each demonstration of an unwanted behavior*

question

*examples of this consequence type that might be used in speech-language remediation programming* include

answer

verbal utterances such as "No!", frowning, or the presentation of bursts of white noise

question

*Type II* Punishment

answer

requires *withdrawal of a pleasant condition contingent on the demonstration of an unwanted behavior* -*time-out and response cost are the two most common forms used in speech-language intervention*

question

*time-out procedures* involve

answer

the temporary isolation or removal of a client to an environment with limited or no opportunity to receive positive reinforcement -*a modified version can be accomplished by turning the client's chair toward a blank wall in the therapy room or simply withholding direct eye contact from the client for short periods of time*

question

*response-cost contingencies* occur when

answer

previously earned positive reinforcers are deducted or taken back each time the undesirable behavior is demonstrated

question

*this type of punishment can take various forms* including

answer

removal of stickers earned for previous correct responses or the partial subtraction of points already accrued by the client earlier in a therapy session -*sometimes the clinician may choose to give a client several unearned tokens at the beginning of a session or task to institute response cost procedures*

question

several factors influence the effectiveness of punishment procedures

answer

punishment should be* delivered after every instance of the unwanted behavior* punishment should be *presented immediately following the undesirable behavior* punishment should *occur at the earliest signs of the unwanted behavior rather than waiting until the behavior is full-blown*

question

several factors influence the effectiveness of punishment procedures

answer

punishment should not be *programmed in graduated levels of intensity; this creates the potential for client habituation to the punishing stimulus, thus reducing its effectiveness* punishment *duration should be brief as possible; lengthy periods of punishment call into question the strength of the chosen punishing stimulus*

question

*punishment procedures should be employed with caution in therapy setting* because there are

answer

undesirable effects associated with their use -*these may include client anger, aggression, a reluctance to engage in any communicative behavior with the therapist, and the avoidance or actual termination of treatment*

question

if no contingent consequences occur following a targeted behavior, the frequency of that behavior will

answer

gradually decrease and ultimately disappear from a client's repertoire -*this phenomenon is known as extinction and is used in therapy to eliminate behaviors that interfere with effective communication*

question

*extinction* does not occur

answer

immediately

question

*behaviors that receive reinforcement on a continuous basis are most vulnerable* to

answer

extinction, -*whereas those that are only periodically reinforced over a long period of time are least susceptible to this procedure*

question

*it is recommended that extinction procedures* that are

answer

*implemented for an undesired behavior* e.g., ignoring crying behavior *be combined with positive reinforcement for the converse behavior* e.g., rewarding noncrying behavior

question

t/f: application of all the principles just discussed does not guarantee that a therapy session will run smootly

answer

true -*the clinician should anticipate the possibility that a patient may not pay attention or cooperate with the session plan*

question

why may this occur?

answer

due to a patient's developmental level of attention, boredom, frustration, lack of self-motivation, or a neurological behavior disorder

question

*what must* the *clinician now focus on in addition to behavior modification*?

answer

behavior management

question

currently, a system of

answer

positive behavioral supports (PBS) is recommended for dealing with challenging behaviors -*is a proactive approach that uses interpersonal and environmental strategies to minimize opportunities for problematic behavior and encourages more socially use behaviors*

question

thus, positive behavioral supports (PBS) shifts the emphasis of behavior management from a

answer

reactive, aversive approach to one that is more preventative and positive in nature

question

a positive behavior support plan (see Appendix 1-H) generally identifies the following information:

answer

a description of the problematic behavior(s), an explanation of why it impedes learning, and an estimate of its severity (frequency, intensity, duration) antecedent events that appear to trigger the behavior(s)

question

a positive behavior support plan (see Appendix 1-H) generally identifies the following information:

answer

the desired or alternative behavior(s) the supports (teaching strategies or environmental modifications) that will help the client achieve the desired behavior(s)

question

*from the SLP's perspective, most behavior problems can be prevented if* the

answer

therapy materials are creative, the activities are interesting, and the session is well paced

question

once the appropriate type of reinforcer has been selected for a given client,

answer

the clinician must decide how often the reinforcer will be delivered -*the two main schedules of reinforcement are continuous and intermittent*

question

*continuous* reinforcement

answer

a reinforcer is presented after every correct performance of a target behavior -*this schedule, sometimes characterized as "dense," tends to generate a very high rate of response*

question

*continuous* reinforcement

answer

it is most commonly used to shape and establish new communication behaviors it also can be used when transitioning an already established skill from one level of difficulty to the next e.g., from word to sentence level

question

*use* of a *continuous schedule*

answer

reduces the risk that a client's production of a target behavior will "drift" from the intended response

question

*the primary disadvantage of this schedule* is that

answer

behaviors reinforced at such a high density level are very susceptible to extinction -*it also may interfere with a client's production of a steady flow of responses*

question

*intermittent* reinforcement

answer

with this schedule, only some occurrences of a correct response are followed by a reinforcer

question

*intermittent reinforcement*, often termed

answer

lower density *is most effective in strengthening responses that have been previously established*

question

*this reinforcement schedule reduces* the

answer

probability of satiation during treatment and results in behaviors that are extremely resistant to extinction

question

*the four types of intermittent schedules* are:

answer

fixed ratio fixed interval variable ratio (VR) variable interval (VI)

question

fixed *ratio*

answer

*a specific number of correct responses must be exhibited before a reinforcer is delivered* e.g., every two responses, every 10 responses, every 35 responses

question

fixed *ratio*

answer

*the required number is determined by the clinician and remains unchanged throughout a therapy tasks* -this reinforcement schedule generally elicits a high rate of response

question

fixed *interval*

answer

reinforcement is delivered for the first correct response made after a predetermined time period has elapsed e.g., every 3 minutes, every 50 seconds

question

*the main disadvantage of fixed interval schedule* is that

answer

response rate tends to decline dramatically immediately following presentation of the reinforcer, and therefore a fixed interval schedule may be an inefficient use of therapy time

question

variable *ratio* (VR)

answer

the number of correct responses required for the delivery of a reinforcer varies from trial to trial according to a predetermined pattern set by the clinician

question

*example* of variable *ratio* (VR)

answer

the pattern might be as follows: after the third response; then after the tenth response; then after the fourth response; then after the seventh response this ratio, represented as VR 3, 10, 4, 7 would be repeated throughout a therapy task

question

*this schedule tends to be more effective than a fixed ratio schedule* because the

answer

client cannot predict the seemingly random pattern of delivery and anticipates that every response has an equal chance of being reinforced

question

variable *interval* (VI)

answer

this schedule is similar to a variable ratio except that the clinician varies the time period required for reinforcement delivery rather than the number of responses

question

*example* of *variable interval* (VI)

answer

one interval pattern might be as follows: after 3 minutes then after 10 minutes then after 1 minute then after 4 minutes -this pattern, represented as VI: 3, 10, 1,4 would repeated throughout a therapy task

question

*in general practice, continuous reinforcement is used to establish* a

answer

new target behavior -*intermittent schedules are introduced is subsequent stages of therapy to promote maintenance and generalization*

question

one rule of thumb is to

answer

switch to lower-density intermittent schedules when the target response increases 30% to 50% over the original baselines measures

question

several basic training techniques are commonly used in intervention to

answer

facilitate the acquisition of communication behaviors

question

the following *strategies are used for a variety or purposes and are implemented at different points throughout the remediation process*:

answer

direct modeling indirect modeling shaping by successive approximation prompts fading

question

the following *strategies are used for a variety or purposes and are implemented at different points throughout the remediation process*:

answer

expansion recast negative practice target-specific feedback

question

direct modeling

answer

clinician demonstrates a specific behavior to provide an exemplar for the client to imitate

question

indirect modeling

answer

clinician demonstrates a specific behavior frequently to expose a client to numerous well-formed examples of the target behavior

question

shaping by successive approximation

answer

a target behavior is broken down into small components and taught in an ascending sequence of difficulty

question

prompts

answer

clinician provides additional verbal or nonverbal cues to facilitate a client's production of a correct response

question

fading

answer

stimulus or consequence manipulations e.g., modeling, prompting, reinforcement are reduced in gradual steps while maintaining the target response

question

expansion

answer

clinician reformulates a client's utterance into a more mature or complete version

question

recast

answer

clinician reformulates a client's utterance into a different sentence type

question

negative practice

answer

the client is required to intentionally produce a target behavior using a habitual error pattern -*this procedure is generally employed to facilitate learning by highlighting the contrast between the error pattern and the desired response*

question

target-specific feedback

answer

the clinician provides information regarding the accuracy or inaccuracy of a client's response relative to the specific target behavior -*this type of feedback contrasts with generalized feedback or consequences*

question

*direct modeling* is the

answer

teaching techniques most frequently used in the early stages of therapy -*it is also employed whenever a target behavior is shifted to a higher level of response difficulty because this type of modeling provides the maximum amount of clinician support*

question

direct modeling

answer

typically, clinicians augment direct models with a variety of visual and verbal cues to establish correct responses at the level of imitation -*also minimizes the likelihood that a client will produce his or her customary error response* -*initially a direct model is provided before each client response*

question

*once a target behavior is established, continuous modeling should be eliminated* because

answer

it does not facilitate strengthening or maintaining a target response

question

*direct modeling* can be *terminated*

answer

abruptly or faded gradually

question

*gradual fading* can be *accomplished in at least two ways*:

answer

*one requires a client to produce multiple imitations for each model demonstrated by the clinician* e.g., three imitative responses are required after each direct model

question

*gradual fading* can be *accomplished in at least two ways*:

answer

*the second method involves the progressive reduction of the length of the behavior modeled by the clinician* e.g., the direct model of the "the boy is running" is shortened first to "the boy is....." and then to "the boy...." while the client's imitative response in all three cases is the production of the complete target sentence, "the boy is running."

question

in general, *fading procedures can be initiated once a client is able to produce*

answer

at least five consecutive correct imitative responses

question

in some cases, the stimulus alone is not sufficient to

answer

elicit the desire response

question

*prompts* are

answer

extra verbal and nonverbal cues designed to help a client produce the target behavior

question

*prompts* can be *categorized as*

answer

attentional or instructional

question

*attentional* cues

answer

improve performance by focusing a client's concentration on the task at hand -*clinicians also can draw attention to a target by modeling the behavior with exaggerated loudness and duration*

question

*examples* of *attentional cues* include

answer

"look at me" "watch my mouth" "remember to pay attention" and "are you ready?"

question

*instructional* cues

answer

can provide information that is directly related to the specific target behavior being attempted -*this may include verbal prompts and instructional prompts*

question

*verbal prompts* such as

answer

"remember to elevate your tongue tip at the beginning of each word" "don't forget to segment your words into syllables if you get stuck" or "be sure that your answer has at least three words in it"

question

*instructional* cues also can be

answer

nonverbal -*such as an index card with the name of the targeted fluency techniques written on it, a gesture to indicate that voice loudness should be increased or drawings the represent the grammatical categories of subject, verb, and object*

question

t/f: some target behaviors are too complex for a client to perform successfully and even the provision of a direct model accompanied by prompts may not elicit a correct imitative response

answer

true -*in such instances procedures for shaping by successive approximation are usually instituted*

question

shaping by successive approximation

answer

the simplification of a difficult target into a series of more manageable tasks fosters client success at each step -*each successive step moves progressively closer to the final form of the desired response*

question

target specific feedback

answer

is a technique that is useful throughout all phases of therapy process

question

*it serves three main functions*:

answer

first, *clients benefit from feedback that consists of more than simple accuracy judgements regarding their responses*

question

*target specific feedback* provides

answer

*precise information about why responses are correct or incorrect* e.g., "Good, I didn't see your tongue peeking out when you said, "Soup," rather than simply "Good job")

question

*it serves three main functions*:

answer

second, *use of this strategy tends to maintain a client's awareness of the exact response being targeted without the need for continuous reinstruction during a therapy activity*

question

*it serves three main functions*:

answer

finally, this type of feedback assists clinicians in maintaining client focus on the communication behavior being targeted by a given therapy activity -*it is a particularly helpful strategy for beginning clinicians who may get too involved in the details or rules of an activity and lose sight of the true purpose of the therapy task*

question

*negative practice is a strategy intended* to

answer

enhance a client's awareness of the salient characteristics of his or her error pattern -*it is used primarily to illustrate the differences between an "old" response and the intended target*

question

*negative practice* is

answer

generally implemented only after a client demonstrates the ability to produce a given target consistently at the level of imitation

question

*negative practice* is a

answer

powerful technique that is best used on a short-term basis -*devoting a significant amount of therapy to client practice on incorrect responses is of questionable value*

question

*clinicians frequently use the general stimulation procedures* of

answer

*indirect modeling*, *expansion* and *recasting* -*these strategies can be employed at any stage in the therapy process*

question

indirect modeling, expansion and recasting

answer

they provide a client with increased exposure to instances of desirable speech, language, or communication behaviors but are not intended to elicit immediate specific responses

question

indirect modeling

answer

for example a clinician working with a client on the production of /s/ may implement indirect modeling by including a significant number of /s/ initial words in her off-task comments throughout a session

question

*expansions are used almost exclusively* in

answer

*language therapy programs and may involve the clinician's interpretation of the client's intentended meaning* e.g.., client: "Daddy cookie" clinician: "Yes, Daddy is eating the cookie"

question

*an example* of *recasting* is

answer

*changing the the client's declarative statement to an interrogative form* e.g., client: "Doggie is barking" clinician: "is the doggie barking?"

Chapter 1: The Essential Ingredients of Good Therapy: Basic Skills – Flashcards

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