Basic Principles and Procedures in Treatment of SSDs

Remember….** You don’t have to read chapter 7 basic unit PowerPoint notes only 

As we begin to discuss tx, remember Fogle 2019—parents report that SSDs impact their children in the following ways:

I. SELECTING POTENTIAL TARGET BEHAVIORS** A. Introduction Target behavior We need to select short term objectives and long-term goals In the schools, we say “benchmarks”

B. General Considerations** Select tx targets that are linguistically and culturally appropriate for the client Select targets that will make an immediate and socially significant difference in the client’s communication skills

Remember…** Connect tx to classroom curriculum Always keep Common Core State Standards in mind I always tx speech sound errors and lang together

Izzy brings class reader to work on /r/

For Kiree, what would make an immediate difference?

C. Select More Readily Taught Treatment Targets** Stimulable sounds treated before non-stimulable sounds Teach visible sounds before non-visible sounds (e.g., /th/ before /r/) For a phonological process to be treated, should occur at least 40% of the time

D. Select Targets that Affect Intelligibility the Most** Select phonological processes that affect the most sounds; processes that contribute the most to the child’s lack of intelligibility E.g., stopping affects many sounds

II. DECIDING ON THE NUMBER OF SOUNDS OR PATTERNS TO TEACH** If the child only has 1-2 errors, the decision is easy If the child has multiple errors, then we need to decide: do we train many sounds at once, or just a few?

Variables impacting this decision include child’s:

III. ESTABLISHING BASELINES** A. Introduction When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not adequately sampled For example, an artic test may sample /r/ one time in initial, medial, final position of words

Because of this very limited sampling, mistakes can be made** For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off But later, lo and behold, the child makes the /f/ with 90% accuracy on repeated measures!

We counteract this problem…** By establishing baselines of potential treatment targets before starting therapy Baselines are measured rates of behaviors in the absence of treatment

Baselines in our own lives:** How much you weigh before you start that diet  How many pounds you can bench press when you start a new workout program How fast you can swim a lap before you start that swim class

B. 3 purposes of baselines:

Count the # of times** That Dr. R. makes a th/s substitution when presented with picture cards There will be 20 opportunities for /s/--how accurate am I? What is my %age of accuracy in /s/ production?

C. Baseline Procedures** Specify the treatment targets in measurable terms For example: -produce /r/ in word-final position with 80% accuracy Reduce use of final consonant deletion from 70% to 20% in conversation

We need to be sure to specify response topography** This refers to the linguistic level of training For example, do we want to begin with /r/ in isolation? Do we want to begin with /r/ in word-initial position in sentences?

IV. SELECTING THE INITIAL LEVEL AND SEQUENCE OF TRAINING** Baselines help us create appropriate tx objectives PBH: best to start tx at word level— functional words especially

V. DEVELOPING MEASURABLE OBJECTIVES** Treatment or short-term objectives are the skills the clinician plans to teach on the way toward achieving the selected treatment targets or long-term goals Appropriate long-term goals might be: “Increase the client’s intelligibility of speech” Improve the client’s phonological skills”

However, measurable short-term objectives are needed** These objectives specify how a goal will be achieved The objectives must be measurable so that external observers can verify the results of the clinical services provided Many 3rd party payers like insurance companies demand detailed documentation of improvement

To write a good objective:** Use observable behaviors (e.g., point to, say, write, read aloud, sing, match) Don’t use words with non-observable behaviors (e.g., know, understand, remember, learn, perceive, memorize, think about, consider)

Remember that data collection** Should be done throughout tx A good baseline will support this

VI. PLANNING AND DEVELOPING A TREATMENT PROGRAM OR PLAN** A. Introduction Phonetic placement techniques are direct methods to teach clients how to position the articulators and produce the sound appropriately

In this youtube video… The SLP uses the direct technique of Mr. Mouth Articulation Disorder Teaching /r/ Ashley Mcgeehon’s channel

B. Successive Approximation or Shaping** We take advantage of a sound the client can already make (e.g., /g/ if they cannot produce /r/). We have them make the /g/, and gradually move toward /r/.

We can begin training the sound at one of several levels:

If the child cannot create a phrase or sentence with the target word…** We can use a carrier phrase such as: “I see______” “Here is a ____”

VII. STRUCTURING TREATMENT SESSIONS** Initial tx sessions highly structured Tx sessions gradually loosen up to replicate natural “real world” more Helps child generalize target sounds to spontaneous speech

VIII. INCREASING AND STRENGTHENING ESTABLISHED BEHAVIORS** A. Selecting Potential Reinforcers Positive reinforcer—rewards and strengthens the behavior

The treasure chest rocks! 

Noah loves the treasure chest….

So does RJ!

IX. GENERALIZATION** Generalization usually refers to the child’s producing learned responses in settings outside the clinic

Generalization across situations** Ch uses sound in other locations with other audiences

X. IMPLEMENTING A MAINTENANCE PROGRAM** A. General Considerations Maintenance = ultimate goal Skills sustained over time Select stimuli from client’s natural environment For example, classroom language arts book

We should vary the physical setting** Conduct therapy in different environments

We Need to Teach Multiple Exemplars** For example, “quick” children working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures Some children may need 50 pictures, 30 objects, and 10 books with /r/-initial stimuli before they achieve 90% accuracy

B. Manipulation of Response Contingencies** Most important aspect of maintenance Move from continuous to intermittent reinforcement schedule Fade primary reinforcers, rely more on natural reinforcers

We can also…** Train parents and others to reinforce children for correct speech productions in natural environments Teach self-monitoring/self-correcting skills (I use the terms interchangeably)

C. Involve Family Members and Significant Others