Bootstrap Turner Jr. Laura Stidham, Mickey Harrison, Nathan Webb

Background Information 6 years 2 month old male Born 32 weeks gestation aboard the Black Pearl Due to forceps delivery his left eye was gauged and rendered unusable

Symptoms Referred by his first grade teacher Jack Sparrow due to speech sound concerns Evaluation date: February 19, 2010 Bootstrap is blind in his left eye but unremarkable in his right eye Pure Tone Audiometry was administered which resulted in his hearing being within normal limits

Speech Concerns Low speech production in a natural environment Main speech concerns include /s/, /l/, /f/, /sh/, /ch/, /j/, /z/, and /r/. Also has increased difficulty with plurals and word endings related to past tenses such –ing, and –ed Receptive speech is normal Expressive language concerns

Phonological Disorder Failure to use speech sounds appropriate for the individual's age and dialect Levels of severity range from completely unintelligible, to speech that can be understood by everyone with just slight mispronunciations Treatment is important for the child's development and is best treated as early as possible Children who have problems with speech will likely have problems in their class rooms in subjects such as reading and writing.

Phonological Disorder Symptoms Failure to produce and use sound appropriately Substituting one sound for another Omitting sounds

Assessments

Goldman- Fristoe Test of Articulation- Second Edition Ronald Goldman & Macalyne Fristoe Assesses individual’s articulation of consonant sounds Samples spontaneous and imitative sounds Contains three sections: Sounds-in-Words, Sounds- in-Sentences, and Stimulability Tests individual’s 2-21 years of age An untimed assessment – Sections can be completed in 5-15 minutes, however this estimated time is dependent upon the individual

GFTA-2 Scoring Using the individual’s age (year and month) find the section that corresponds in Appendix B Find the raw score (equal to total number of errors individual made) down the list and go across the columns to find the standard score Be sure to record the correct gender score! Bootstrap displayed 36 errors out of 77 when given the Sounds-in-Words subtest of the GFTA-2. His raw score of 36 translates into a standard score of 52 which shows that Bootstrap has fallen below the average range which denotes a moderate articulation disorder The average range is His dominant errors were created when he produced consonant clusters in the initial word position and deletion of final consonants.

GFTA-2 Pros New artwork Racial and gender balanced Widely used for over 30 years Response form Allows examiner to compare responses simultaneously Cons Vowels are not assessed Is not printed in all other languages

Hodson Assessment of Phonological Patters (HAPP-3) Author : Barbara Williams Hodson The HAPP-3 is a test designed for children with highly unintelligible speech. The age range is for children 2 years old and up and there is normative data for children between the ages of 3 and 8. Testing time is 15 to 20 minutes for the comprehensive assessment and 2 to 5 minutes for the screening.

HAPP-3 continued The HAPP-3 kit includes: Examiners Manual, Comprehensive Phonological Evaluation Record Forms, Major Phonological Deviations Analysis Forms, Substitutions and Other Strategies Analysis Forms, Preschool Phonological Screening Record Forms, Multisyllabic Word Screening Record Forms, Multisyllabic Word Screening Picture Sheet, 30-piece object kit, and 13 picture cards.

HAPP-3 screening Bootstrap was administered the 5 minute screening of 12 stimulus words: boats, fork, glasses, gum, leaf, rock, soap, spoon, star, watch, zip, and nose. To pass the screening he would have to meet 5 of the 6 criteria questions. Unfortunately Bootstrap only met 2 of the 6 criteria Because he did not pass the screening, I administered the full comprehensive phonological evaluation.

HAPP-3 Comprehensive Phonological Evaluation The full evaluation is scored by a raw number score that fits into four categories: mild, moderate, severe, and profound mild moderate severe >150 Profound Bootstrap was tested on 50 words similar to the screening words and scored a raw score of 68 which labeled him as having a moderate phonological disorder.

HAPP-3 Pros: Use of three dimensional objects. (Children are more apt to pay attention to objects than pictures). Can be administered in 20 minutes or less. Has a pre-screen assessment. Cons: For English speaking children only. Only tests for highly unintelligible speech.

Test of Early Language Development TELD-3 Wayne P. Hreskd, P. Kim Reid, Donald D. Hammill Norm Referenced; Standard scores, percentiles, and age equivalents Area of Assessment: Receptive, Expressive and overall spoken language in children Age Range: 2 years – 7 years 11 months Specific Skill areas assessed Typically test is administered between minutes depending on the child’s age and ability

TELD-3 Scoring Bootstrap revealed a raw score of 30 for the receptive language subtest yielding a quotient score of 100 and raw score of 32 for expressive language yielding a 94 from the quotient score. Sum of quotient score was 194. Spoken language Quotient score was 96 Receptive subtest revealed that Bootstrap falls in his age category of 6 years 2 months Expressive subtest revealed that Bootstrap fell in the 5 year 2 month range displaying a mild to moderate expressive language delay

TELD-3 Advantages and Disadvantages Advantages Disadvantages Contains Receptive and Expressive Subtests New colored pictures Adequately evaluates children at upper and lower age ranges by using new items that are age appropriate Useful in targeting children who may be prone to later academic failure Complicated to Score Bias on test items relative to gender, disability, racial, socioeconomic, or ethnic groups Could not find percentiles from subtests

Bootstrap’s Score GFTA-2Raw score: 36Standard score: 52 HAPP-3 Score 68Moderate Phonological disorder TELD-3 Receptive: 3o Raw score; 100 quotient score Expressive: 32 Raw score; 94 quotient score Spoken Language Quotient: 96 Mild to Moderate expressive language delay; fell in 5 year 2 months age category; Normal Receptive language abilities

Treatments

Parents and Children Together (PACT) Designed for 3-6 year olds who are unintelligible and have delayed and/or disordered speech Focuses on phonemes at word level or above in order to expand child’s accuracy with regard to consonants, vowels, syllable shape and stress Sessions are individual in nature 50 minutes Parents/ Caregivers play an extremely important role According to McCleod and Bleile, “The incorporation of parental support into the intervention practices is frequently a key to success.” (2004, p. 210) Use of Quick Screener is available online

PACT Great choice for Bootstrap because: Incorporates parents Targets intelligibility Falls within age range for which it was designed for

PACT Pros Family centered Cost efficient Used with other client populations Incorporates technology Cons Some questions cannot be answered (i.e. effectiveness, efficiency, and validity) Relies on individual and family to overall success Individual will and materials (internet)

Minimal Pairs Minimal pair consists of two monosyllabic words that differ in sound by only one feature (e.g., key – pea, big – bug) Closed-set test of speech feature discrimination Target items were presented in a live-voice auditory- format Bootstrap was asked to point to only one of the two pictures corresponding to what he perceived

Minimal Pairs Advantages Disadvantages Improves client‘s understanding of word meanings Oldest, most well-known, and widely used treatment Served as basis from which other intervention approaches have developed It is suggested that minimal pair research needs to better establish the effectiveness of the approach, beginning with children with a mild or mild to moderate phonological impairment without any associated difficulties

Minimal Pair Treatment Great for Bootstrap because: Treats mild or mild- moderate phonological impairment Helps client see a need to produce a contrast between word pairs Increases vocabulary Decreases final consonant omissions

Multiple Oppositions Is a variation of the minimal pars contrastive approach that takes a holistic approach and addresses moderate to severe speech disorders in children with highly unintelligible speech. Focuses on system wide change. Addressing child's error rule as a whole unit Targets multiple substitutions at the same time. (Phoneme Collapse) Used for children who have multiple sound errors

Multiple Oppositions Substitution errors Consonant production: tea: key, see, she Vowel production : eat: it, at Syllable structure errors Cluster reduction: tuck: stuck, truck, cluck Word-initial deletion: eat: Pete, feet, wheat, meat Word- final deletion: bee: beat, beef, bees, beach Time frame: 30 to 45 minutes twice a week for a minimum of 21 weeks.

Multiple oppositions Intervention works for Bootstrap because: He fit the age recommendation. He struggles with multiple sound errors It has shown to be effective for children with a moderate to profound phonological disorder Is thought to decrease the amount of time a child a child needs treatment.

Plan of Action Goals: Increase expressive language by producing one word utterances by targeting FCD Reduce production of Gliding

Plan of Action Cont’d Objectives: Bootstrap will duplicate one word utterances 4 out of 5 attempts over 3 consecutive sessions He will instinctively produce one word utterances 3 out of 5 attempts over 3 sessions Bootstrap will both imitate and spontaneously include deleted sounds in final word positions 3 out 5 attempts He will imitate and spontaneously reduce production of gliding

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