Treatment Principles and Children's Speech Sound Disorders
- Created on Thursday, 24 November 2011 11:15
- Updated on Friday, 02 March 2012 13:29
Treatment Principles: Phonological Disorder, CAS, and The Principles of Motor Learning - ppsx - 20 slides - opens in a new window
Phonological Disorder - Treatment Principles
- Intervention is based on the systematic nature of phonology.
- Intervention is characterised by conceptual activities rather than motor activities.
- Intervention has generalisation as its ultimate goal, promoting intelligibility.
Ten Points to Consider in Intervention
- Work at word (meaning) level.
- Work towards functional generalization.
- Treat a pattern or patterns of errors.
- If using a 3-position SODA test transcribe entire words in order to see error patterns
- Teach appropriate contrasts.
- Direct the child’s attention to the way that different sounds make different meanings. Make this apparent to parents too, e.g., give examples of their own child’s homonymy.
- Use naturalistic contexts that have meaning (hold interest) for the child, because this helps demonstrate to the child that the function of phonology is to make meaning.
- Stack the ‘therapy environment’ with several exemplars of each individual target word so the child can self-selects activities, e.g., for work on eliminating Velar Fronting, for the target words: car, key, core, cow, have available several different cars, car keys, etc.
- Select targets with an eye to their potential impact on the child’s system.
- Carefully select exemplars of an error pattern / phonological rule.
With clever exemplar-choices, the rule is learned, and carries over to the other targets. In explicitly targeted therapy it should be unnecessary to work on all possible targets.
CAS - Treatment Principles
- Intervention is based on the principles of motor learning (see below).
- Intervention is characterised by motor activities rather than conceptual activities.
- Intervention has habituation and then automaticity as its ultimate goal, promoting intelligibility.
Fifteen Points to Consider in Intervention
- Use paired auditory and visual stimuli in intensive practice trials.
- Train sound combinations (CV VC CVC …) rather than isolated phones.
- Keep the focus in therapy (and at home) on movement performance drill.
- Use repetitive production trials / systematic drill as intensively as possible.
- Carefully construct hierarchies of stimuli, using small steps.
- Use reduced production rate with proprioceptive monitoring (child’s self-monitoring).
- Use simple carrier phrases and simple cloze tasks.
- Pair movement sequences with suprasegmental facilitators: including stress, intonation and rhythm. Be thinking ‘prosodic contour’ of the utterance all the time!
- Use singing, whispering and loudness judiciously.
- Establish a core vocabulary or a small number ‘power words’ (that make things happen) early in therapy, especially for non-verbal or minimally verbal children.
- Use sign / AAC to facilitate communication, intelligibility and language development, and to reduce frustration. Reassure families.
- Be flexible. Treatment changes over time.
- Present regular, consistent, effective homework as a ‘given’, within reason.
- Expect ‘good days and bad days’ in terms of the child’s performance.
The principles of motor learning apply to CAS dynamic assessment and therapy.
The Principles of Motor Learning
‘A set of processes associated withpractice or experience leading torelatively permanent changes in thecapability for movement.’Schmidt & Lee, 2000
Precursors to Motor Learning
- Focused attention
- Pre-practice (phonetic placement training prior to entering the practice phase)
Consider a behaviour management plan for children who have motivation / attention / difficulties.
Conditions of Practice
- Goal / target setting (what, and how many times)
- Setting and with whom
- etc (many factors)
Repetitive drill (‘motor drill’)
Massed vs. distributed practice
Blocked vs. random practice.
- There must be sufficient trials (MANY REPEATS of the target behaviour) within a practice session for any motor learning to take place, and for it to become habituated (a step towards more automatic speech output processing).
- Reinforcement (praise) used should not take up too much time, or make too much noise, ‘interrupt’ or distract. Guide parents; model how to do it.
- Choose and develop appealing activities that will facilitate / invite repeated opportunities for production of target behaviour / utterance.
Massed vs. distributed practice
Massed practice involves fewer but longer sessions. This promotes quick development of skills, but poor generalisation. Distributed practice involves the same duration of practice, distributed across more sessions. It takes longer, but achieves better motor learning.
Blocked vs. Random Practice
In blocked practice all practice trials (‘repeats’) of a stimulus (‘target’) are done in one time block before moving to the next target. This tends to lead to better performance. In random practice the order of presentation of all stimuli is random through the session. This tends to lead to better retention, so better motor learning.
Feedback to the child (knowledge of ‘movement performance’)
It is essential to give a child frequent information about his or her movement performance. The cognitive motor literature reports that adults benefit from finely specified feedback. Conversely, if feedback is too specific children’s performance can decrease. Tailor the frequency of feedback to suit the child (it can distract).
Rate of Production Trials
There is usually a trade-off between rate and accuracy. A slower rate will, up to a point, increase accuracy. Varying the expected rate of production can be an effective technique to incorporate into repetitive “motor drill” practice of targeted utterances. It encourages habituation of articulatory movement accuracy while working towards “automaticity”, a natural rate, and natural prosody.
Recall that the precursors to motor learning are (1) motivation (2) focused attention (3) pre-practice. Pre-practice involves phonetic placement training prior to entering the practice phase, so for many clients it is inextricably bound up with stimulability training.