Treatment Principles Contrasted Phonological Disorder Childhood Apraxia of

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

PHONOLOGICAL DISORDER 10 Points to Consider in Intervention 1. 2. 3. 4. 5. 6. 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 targets. 7. 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 intelligibility. § Copyright © 2011 Caroline Bowen

CHILDHOOD APRAXIA OF SPEECH 15 Points to Consider in Intervention 1. 2. 3. 4. 5. 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

6. 7. 8. 9. 10. 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!!! 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

11. 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 (3 rd 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 § § § Motivation Goal / target setting what, how many times Instructions Modelling Setting and with whom etc 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 (automaticity). § 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 Massed: 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 accuracy. § Slower rate will, up to a point, increase accuracy. § 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

Pre-practice Recall that the Precursors to Motor Learning are a) Motivation b) Focused attention c) 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