Articulation disorders

• Stimuli designed to elicit a response.
• Auditory, visual, Kinesthetic

Consequent Events

Discrete trial

Evoked Trial

modeled trials

postitive reinforcement

negative reinforcement (not the same as "punishment"

primary reinforcer

Secondary reinforcer

Conditioned generalized reinforcers

Verbal

Nonverbal

Multiple reinforcement contingencies

Mechanical feedback

• Token Economy
• 1. Present reward immediatly following the behavi or
• 2. Agreement concerning how the tokens can be exchanged for prizes.
• 3. Reinforcement Menu- indicates how many tokens it takes to buy each prize.

Reinforcement menu

Self reinforcement

1. Clients can't take the reward until after the behavior is demonstrated.

2. Client has control over the rewards.

3. Standards are set before the rewards can be given.

Continuous

Intermittent

Ratio Schedule

Interval

Fixed Ratio and Variable ratio

Fixed Ratio

Variable Ratio

Inappropriate Communication Behaviors

Interfering behaviors

Extinction

make sure that what we are doing is resistant to extinction

Punishment

Ratio-Strain

Make them attainable/reachable quickly

Response-Cost

Non-exclusion time out

Corrective Feedback

• Verbal
• Nonverbal
• Mechanical

Stimulus Withdrawl

Leveling

• Probe
• - do after you've done your tx.
• - no reinfrocements during probes(similar to baserating)

(Ex./k/ sound-going well so will do a probe of the /g/sound to see if it has generalized to this sound)

• (Do) Max will produce /s/ in isolation.
• (Conditions) in respose to visual and a model
• (Accuracy)- with 70% Accuracy

• Instructional Objectives
• - tends to be stock phrases that are used in making objective statements.
• - Anytime writing a goal for a client, they need to be able to produce with at least 60-70% accuracy or task needs to be leveled back(may need to work on tongue placement or comparision to other phoneme sounds)
• - Looking for duplication...if I couldn't be there could someone pick up my treat/lesson plan and know what i had planned to do.
• Include these types of statements.pg. 465 in text

• Terminal Objectives
• - Ex. (Do) Max will produce /s/
• (conditions) - In conversaitional speech
• (Accuracy) - with 90% Accuracy

Short Term Objectives

• Ex. (Do) Max will produce /s/ in all postitions
• (conditions) - in response to visual cues
• (Accuracy) With 90% accuracy

Weekly Objectives

• Ex. (Do) Max will produce /s/ in isolation
• (Conditions) in conversational speech
• (Accuracy) with 90% accuracy

Traditional Approach

• - Chronological Age
• - Frequency of occurrence
• - Stimulability
• - Extent to which errors are produced
• - Severity of error

• - Least=Distortion
• - Middle = substitution
• - Most= Omission

• 1. Sensory Perceptual training
• 2. Production Training
• 3. Stabilization
• 4. Phrases
• 5. Sentences

• 1. Sensory Perceptual training
• 2. Production training
• 3. Stabilization
• 4. Transfer and Carry over
• 5. maintenance

Sensory perceptual training

Identification

Isolation

Stimulation

Discrimination

• 1. Imitation/ Auditory stimulations
• 2. Use of facilitating Contexts- if these don't work the next prodecures are more direct
• 3. Phonetic Placement
• - Articulator placement
• - Modification of breathstream
• - Appropriate voicing
• 4.Motokinesthetic - stresses pattern of movement from one to the other
• 5. Sound approximation (Shaping)- progressive approximation and sound modification

Motokinesthetic

Stabilization

• Productions are "stabilized" at each level before moving on to the next
• **Be sure steps are very small**

Reconfiguration

Simultaneous Talking and Writing

Signaling techniques

Carryover

Speech Assignments

Self and peer monitoring

Nucleus Situations

Ex. show and tell or somone monitor adult during coffee break.

Proprioceptive Awareness

Use the sound in various types of speaking

This was the 5th Activity listed under carryover activities. Really not a definition, just a statement. So there was no answer.

Retention of a learned skill after the therapy is complete (mastery of skill should be retained)

- client seen less freq. to start(2x's a week to once a week)

• - Ready for dismissal
• *if they slip too far back, bring them back in and work on transfer and carry over**

1. Heighten responsiveness to patterns of speech movements.

2. Reinforce correct production of the error sound.

3. Facilitate correct production in systematically varied contexts.

Baseline

Baseline data describes the current state of the behavior

Behavior must be measureable, have a difinite beginning and end (this is one of the most important but often most difficult in writing goals.) Jimmy will improve his speech is "No Bueno"!!

-Immediately follows a response

-There are many types of reinforcers

-Satisfies a need of the organism-need of approval

-Increases the probability of a response recurring.

• Positive Reinforcement
• Negative reinforcement

Target Behavior

1. Important to change (age appropriate?, developmentally appropriate ?, will it make a difference in the clients social interaction?)

2 May be reinforced in other settings

3. Expand communication skills

4. Linguistically and culturally appropriate.

• Antecedent
• Behavior
• Consequence

Antecedent Events

Can be auditory, visual, or Kinesthetic

Consequent Events

• Discrete Trial
• Evoked Trial
• Modeled Trial
• *may use other stimulus methods(visual, cueing,etc)**

Discrete Trial

Evoked Trial

Modeled Trial

Verbal, nonverbal, multiple reinforcement contingencies, and mechanical feedback.

- State of need exists

- Experimenter controls the presentation of the stimulus

- Reinforcer is positive only if the behavior increases.

- Choose reinforcers that will not wear out or have no undesirable side effects.

- Don't assume a consequence is a reinforcer.

- Present reinforcer immediately after behavior

- dont use monotonous delivery

- Be sure the client knows why the reinforcer is being given

- Eye contact is important

- Consistency!!

Non-Reinforcement

- Is this activity to difficult?

-Were my instructions clear?

- Was the reinforcement appropriate? Did they like it, did it work?

- Were sessions too structured to meet the client's needs?

- Did I target the appropriate target behaviors?

• Establishment Phase
• Level A
• Level B
• Level C

• Establishment Phase
• - sound production sheet (SPS)

• Level A
• Children under 5 skip

Level B

• Level C
• *start at level C and move toward level A
• Holding procedure

• 1. May work on 5 or more sounds during a session
• 2. Syllable-use only if the client fails a word probe.. so usually don't use syllables.
• 3. At word level, use a variety of words with a variety of vowels- when we work on articulation we train a lot of nouns because we can picture them in our head
• 4. Phrases or sentences- self monitoring begins
• 5. Reading or Story passages (WWA)-whole word accuracy
• 6. Conversation level

90% whole word accuracy in various speaking situations without any external support. May monitor for about 3 months May lose about 5%

• Return Visits, Clinician visits class, telephone conversations, reports and others
• - Value of this approach is the speed of remediation

• - designed for children with few errors or sound distortions
• - operant principles- only one sound is trained at a time
• - uses a key word to train production
• - 4 keywords (keywords are words in which the client says correctly), 2 initial, and 2 final
• - Key Word: target occurs only once, target produced correctly 9 of 10 times. (ex. Word List)
• - training words: 10 initial, 10 final, unless errors occurs in only one position.
• -Use of a picture board P.419
• - alternate between a key word and a training word=training string
• -

• word
• sentence
• conversation

• - first train the initial position, then final
• - Third word (target in initial position), produce both key and training words with a breif pause=response unit
• - Fourth word(target in final postition), produce both key and training word with a brief pause=response unit
• -Probe for generalization to conversational speech.

• - Ask a question to elicit the key word and a training word in a sentence.
• - Reinforcement varies
• - ask a question to elicit the second and third key words(alternate the key word and the training words)
• - Ask a question to elicit the first and fourth training words.

• - Asks open ended questions
• - Stop if the child uses the sound correctly in 4 words or there are errors.
• - Increase level of the #of productions needed for reinforcement. (maybe start with 7, then 10, 13, 15)
• - Probe after each level
• -

Training String

Key word, 9 out of 10

• - Target sound occurs only once(for this example the target sounds is./r/
• - the child says the sound correctly 9 of 10 times.
• -2 with the sound in the initial position:(rat, rope)
• -2 with the sound in the final position:(car, bear)

• - the target sound is misarticulated 2 of 3 times.
• - Target sound occurs only once
• - 10 initial: rake, rot, room, rabbit, rice, read, roll, rocks, rattle, rip
• - 10 final; ear, four, door, pour, hair, star, deer, snore, chair, jar

Training String

True

• 1. Isolation
• 2. Nonsense Syllables
• 3. Word level
• 4. Phrases
• 5. Sentences

• - goal is to develop more consistent correct productions
• - Characteristics
• - Where is the tongue, what does it look like in the mirror
• - prolonging, changing intensity, varying the umber of productions
• - Variety of speech activities (text p.401-402

• - uses a variety of contexts
• - Reduces interference from old error
• - prevocalic CV
• - postvocalic VC
• - Intervocalic VCV
• - Initial CVC
• - Final CVC
• *may be used as a basis for consonant clusters later*

• - moves from single syllable words to multisyllabic words.
• -If client cannot produce words, even though stabel at syllable level.
• -Reconfiguration- words are made up of sound sequences
• - Simultaneous talking and writing- client says and writes the sound; 1 syllable words, multisyllable words, whole words.
• - Signaling techniques- client prolong the sound, then on a signal clinician produces the rest.
• - if the sound is correct, but an error appears before the rest of the word
• preform the mouth- (control of context) Create simple words from complex contexts- especially when working with consonant blends Ex. "st" blend as in best. "nice tie", "gr"-great, "big rat"

• -Provide numerous opportunites for practice in a variety of increasingly complex utterances
• - to stablize correct production at each substage (initial, medial, final)
• - Develop the ability to self correct(self monitor)

• - think small
• - Try "slot fillers" or carrier phrases

• - Start 1st with structured sentences(what we want to get)
• - level of complexity must be sequenced and controlled
• - Phonetic context must be controlled
• - Ex. p.403
• - Establishing Productions in sentences
• -slow motion speech
• -Shadow or echo speech
• -Corrective set- some sentences are correct and some are not-client must guess
• -Role Playing

Move from structured to unstrucured(conversation)

• Speech assignment
• Self and peer monitoring
• Nucleus Situations-practice in other situ.
• Proprioceptive awareness
• Use the sound in various types of speaking

• - often uses the minimal pair approach, but not necessarily.
• - choose an approach based on what is best for the client

• - (after you've done some kind of analysis)
• -Look at target phonemes and substitutions
• - distinctive features representing substitutions - Summary of feature changes and number of affected Phonemes.
• (you want to look at the dist.features that are involved in the phonemes, such as labial,nonlabial, stops,voice, voiceless etc. and see what features are present in the phoneme you want and the phonemes they are producing, then figure out the difference between the two, then decide what is missing and what phonemes they affect. (this is straight from the tape)

• - Identify features that neutralize contrast
• - Consider the frequency with which features occur
• - Ex. continuance, Stopping
• - Preferably on that affects the whole group of sounds
• - Establish one contrast that will generalize.

• - teach motor acoustic patterns
• - teach the linguistic importance of each sound pair contrast. - sometimes called a linguistic approach
• - Words should have an equal # of segments. Ex. CVC, VCV
• - Equal # of phonemes
• - contrast may be ina a position, but other segments must be identical.

• 1. Teach motor acoustic patterns
• 2.Teach the linguistic importance of each sound pair contrast
• 3.Words should have an equal number of segements
• 4. Equal number of phonemes
• 5. Contrast may be in any position but other segments must be identical.

• 1. Perceptual Training- "point to the_______"
• 2. Production- the child is required to produce the minimal pairs

minimal pair

Broader defn- word pairs that differ by one phoneme

• - The child must have the concept that is being labeled: use words from the childs' lexicon.
• Discussion of the words
• - There must be a need to make the word different.
• - Ask a question that requires a pointing response.

• - clinican says the two words in random order, and the child identifies which word was said
• -possible modifications- if the child can not get 7 consecutive correct responses, try a diffeent pair or other discrimination tasks.
• - Poor auditory memory-
• - try saying the word then delay showing the picture-
• at this point, the feature is perceived, discriminated, retained.

• Demonstrate use and control of the feature and control of the feature.
• - child becomes the teacher
• - work at word level
• - reinforce correct articulation
• - think in terms of features, not sounds.

• Move to phase, keeping both words-negative practice
• - make the 2 word utterance as natural as possible
• - Reinforce the feature in the target word
• - three word carries phrases, "touch the _______. sometimes called slot filler.
• - Begin home practice

• A. Goals- to eliminate instablility, eliminate homonyms, and establish contrasts.
• B. Natural Processes
• 1. Final consonant deletion
• 2. Velar Fronting
• 3. Stopping
• 4. palatal fronting
• 5. Liquid simplification
• 6. Assimilation
• 7. Cluster Reduction
• 8. unstressted syllable deletion

• 1. Early developing
• 2. Posterior/anterior
• 3. /s/ clusters
• 4. Liquids

• 1. Voiced final obstruents
• 2 Final "ng"
• 3. Post vocalic syllabic [l]
• 4. Weak syllable deletion
• 5. Voiced and voiceless "th" phonemes

• - Frequency of occurrence
• - Effect on intelligibility
• - Chronological Age: age appropriate
• - See p. 280
• The goal is to eliminate instability, eliminate homonyms and establish contrasts.

• - final consonant Deletion
• - Velar fronting; t for K
• - Stopping: t for S
• - Palatal fronting: S instead of Sh
• - Liquid simplification: W for R or L
• - Assimilation: puts a sound that already occurs in the words somewhere else.
• - Cluster reduction
• - Unstressd syllable deletion

• -Syllable is the basic unit of training
• - Use of facilitating contexts)some phonetic contexts that allow for a sound to occur)

• -No auditory discrimination training
• - training begins at the syllable level

Goal- increase auditory, tactile and proprioceptive awareness of the motor patterns of speech.

Approach- find a phonetic context with accurate prodution of the target sound (McDonald Deep)

• 1. Discussion of the words
• 2. Receptive training (perception training) descrimination testing and training)
• 3. Production training: demonstrate use and control of the feature
• 4. Carry over

• 1. Heighten responsiveness to patterns of speech movements
• 2. Reinforce correct production of the error sound
• 3. Facilitate correct production in systematically varied contexts

- goal- To establish contrasts

• - perceptual training
• - Production: the child is required to produce the minimal pairs.

• 1. manner
• 2. Place
• 3. voice
• - Maximal oppostions really are differences in distinctive features
• - Most generalization occurs when focusing on sounds that client consistently produces in error, then move to inconsistent errors.
• - Use when there are at least 6 error sounds (moderate to severe)

• - Select 2 sounds not in the childs inventory
• - Select class features (see p.80)
• - Don't train driscrimination

• 1. Imitation
• 2. Spontaneous

Picture cards are presented and the client reaches 75% accuracy in 2 sessions.

Produce word pairs without the clinician model(no model)- continue to 90% accuracy in 3-12 sessions

- treat a large number of contrasts

• - Shortened length of time to improve intelligbility
• - Useful for a child who substitutes one sound for multiple phonemes (Ex. h/t, h/k, h/d,h/g.)
• - Uses minimal pairs for the entire set of errors.(going to do all of the errors)
• - Efficient intervention

*multiple and Maximal kinda overlap a little bit, Multiple uses some of the principles of maximal contrast.

• *use Maximal contrasts to select targets*
• - Use imitation until the client reaches 70% in 2 sessions
• - Use spontaneous until the client reases 90% in 2 sessions
• - Spontaneous contrast and generalization in untrained words until it reaches 90% accuracy
• - Conversation with natural intervention (mostly monitoring vs. TX)

• - Language and phonology may be related (differing opinions)
• - Children with phono. disorders also have language disorders
• - Intervention needs to target both.

• - word pairs that show the constrastive morphemes(plurals, past tense)
• - use clusters when possible ("cats"
• - Sentence level- build structures needed: copula "he is mad...." "he is sad...." (targeting both articulation and language at the same time)

- Conversation Level: subjective and objective pronouns (he/she vs. him/her)

• - Inventory speech sound they produce and in what position.
• - Syllable Shapes that they produce.
• Goal is to expand vocabulary that is also intelligible (intelligible core vocab)
• Especially function words that express needs and wants.

• Not very common but is challenging to train because you can't see them.
• - vowel inventory
• - Accuracy of productions
• - Error pattern
• - use one known and one unknown vowel in minimal pairs (difficult in comparision to /i/.

• - do not include speech attempts
• - controversial: no speech production, used with children with no evidence of neuromotor disorders.
• - Would time be better spent in training articulation
• - No evidence the exerices help improve speech production.