Sound Reasoning 1 - Speech

Treatment Principles Contrasted
Phonological Disorder
 Childhood Apraxia of Speech
 Principles of Motor Learning
Copyright © 2011 Caroline Bowen
Treatment Principles
Phonological Disorder
Phonological 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.
Copyright © 2011 Caroline Bowen
10 Points to Consider in Intervention
If using a 3-position SODA test transcribe
entire words in order to see error patterns.
Work at word (meaning) level.
Work towards functional generalisation.
Treat a pattern, or patterns, of errors.
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
them examples of their own child’s homonymy.
Copyright © 2011 Caroline Bowen
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.
8. Stack the ‘therapy environment’ with several
exemplars of each individual target word so the
child can self-select activities, e.g., for work on
eliminating Velar Fronting, for the target words:
car, key, core, cow, have available several
different cars, car keys, car books, etc.
9. Select targets with an eye to their potential
impact on the child’s system.
10. Carefully select exemplars of an error pattern /
phonological rule. With clever exemplar-choices,
the rule is learned, and carries over to the other
Copyright © 2011 Caroline Bowen
3-to-5 minimal pairs!
Elbert, Powell and Swartzlander found that they
could teach as few as 3 to 5 minimal pairs, and
their participants showed spontaneous
generalisation to other words containing the
target sounds.
Elbert, M., Powell, T. W., & Swartzlander, P.
(1991). Toward a technology of generalization:
How many exemplars are sufficient? Journal of
Speech and Hearing Research, 34, 81-87.
Copyright © 2011 Caroline Bowen
Treatment Principles
Childhood Apraxia of Speech
‘CAS Therapy’ Principles
Intervention is based on the principles of
motor learning.
Intervention is characterised by motor
activities rather than conceptual activities.
Intervention has habituation and then
automaticity as its ultimate goal, promoting
Copyright © 2011 Caroline Bowen
15 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. Not p-b-p-b; f-f-f!
Keep the focus in therapy (and at home) on
movement performance drill. Feedback to the
child should reflect this.
Use repetitive production trials / systematic drill
as intensively as possible.
Carefully construct hierarchies of stimuli, using
small steps.
Copyright © 2011 Caroline Bowen
Use reduced production rate with proprioceptive
monitoring (child’s self-monitoring). Prolong vowels.
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! No . No? No! No . No . NO!!!
Me . Me? Me! Me . Me . ME!!!
Use singing, whispering and loudness judiciously.
Establish a core vocabulary or a small number
functional ‘power words’ (that make things happen)
early in therapy, especially for non-verbal or
minimally verbal children. BRAG BOOK.
Copyright © 2011 Caroline Bowen
Use sign / AAC to facilitate communication,
intelligibility and language development, and to
reduce frustration. Reassure families that AAC
won’t get in the way of learning to speak.
12. Be flexible. Treatment changes over time.
Signal changes and explain them to parents.
Changes may be misconstrued.
13. Present regular, consistent, effective homework
as a ‘given’, within reason.
14. Expect ‘good days and bad days’ in terms of the
child’s performance.
15. The principles of motor learning apply to CAS
dynamic assessment and therapy.
Copyright © 2011 Caroline Bowen
Motor Learning
“A set of processes associated with
practice or experience leading to
relatively permanent changes in the
capability for movement.”
Schmidt, R.A., & Lee, T.D. (2000). Motor
control and learning: A behavioral emphasis
(3rd ed.). Champaign, IL: Human Kinetics.
Copyright © 2011 Caroline Bowen
Motor learning principles apply to
CAS assessment and therapy
Precursors to Motor Learning
1) Motivation
2) Focused attention
3) Pre-practice
phonetic placement training prior
to entering the practice phase
Behaviour management plan
for children who are ‘difficult’
Copyright © 2011 Caroline Bowen
Conditions of Practice
Goal / target setting
what, how many times
Setting and with whom
many factors, very ‘individual’
Copyright © 2011 Caroline Bowen
Practice Schedules
Repetitive drill
Massed vs. distributed practice
Random vs. blocked practice.
Copyright © 2011 Caroline Bowen
Repetitive motor drill
There must be sufficient trials
(“repeats” of the target behaviour)
within a practice session for any
motor learning to take place, and for
it to become habituated.
 Habituation is a step towards more
automatic speech output processing
Copyright © 2011 Caroline Bowen
Reinforcements (praise) should not take up
too much time, or make too much noise, or
“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.
Copyright © 2011 Caroline Bowen
Massed vs. distributed practice
Fewer but longer sessions.
Quick development of skills.
poor generalisation.
 Distributed:
The same duration of practice,
distributed across more sessions.
Takes longer.
better motor learning.
Copyright © 2011 Caroline Bowen
In the ‘real world’ we may not HAVE
a choice regarding practice distribution.
But we must decide
which targets
to select and
how many targets
to address concurrently…
…ensuring “homework implementers”
know what to do, and how to do it,
and are aware of any changes.
Copyright © 2011 Caroline Bowen
Blocked vs. Random Practice
Blocked practice
All practice trials (“repeats”) of a stimulus
(“target”) are done in one time block before
moving to the next target.
Tends to lead to better performance.
Random practice
The order of presentation of all stimuli is
random through the session.
Tends to lead to better retention,
and hence better motor learning.
Copyright © 2011 Caroline Bowen
Feedback to the child:
knowledge of ‘movement performance’
Essential to give a child frequent information
about his/her movement performance.
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 some children).
Copyright © 2011 Caroline Bowen
Rate of production trials
Usually a trade-off between rate and
 Slower rate will, up to a point, increase
 Varying the expected rate of production
can be effective.
 It encourages habituation of articulatory
movement accuracy while working
towards “automaticity”, a natural rate,
and natural prosody.
Copyright © 2011 Caroline Bowen
Recall that the Precursors to Motor Learning are
a) Motivation b) Focused attention c) Pre-practice
Pre-practice involves phonetic
placement training prior to entering
the practice phase.
 For many clients it is inextricably
bound up with stimulability training.
Copyright © 2011 Caroline Bowen