Core vocab - Coggle Diagram
Maintaining auditory attention-focus on sounds generally
When you put same sounds tgt each time you get the same word
Provide as much info as possible about word to child about words w/i word cueing
Facilitate consistent production! But unds that 3 years old, mean inconsistency is 13%, 4 years old, mean inconsistency is 6%.
Step 1: choosing words
Choose 50-70 functionally powerful words that child uses often
Not chosen on basis of word shape, length or sounds
Negotiate w someone in env (parent, teacher) to find impt words for child
Eg. name of family, friends, pets, places, thank you, sorry,toilet, fave foods, toys, TV shows
Research shows generalisation increases after 50 words, vocalisations increase in consistency
For ourselves, write in phonemic transcription, for parent spell it out
Step 2: first session
choose a set of words to work on (10 words)
Elicit child's best production of these words. Does not need to be the correct one
Give cues: no. of syllables, starting, ending sounds, number of sounds, imitation, cued articulation, linking sounds to letters (BUT THIS IS RARE)
Eg. popcorn has 2 popping sounds, talk about where sound is produced in the word sock- back sound. Limit modelling, you want to find out the child's best production
Provide specific, clear feedback on error
Emphasise to child that word must be produced w best production each time. Shaping towards approx target.
Step 3: parental invl
Parents work w child twice per day, integral to therapy approach
Encourage parents to elicit, accept child's best production using cues from session
Reinforce aim to parent: regardless whether it is right or wrong. Need to keep reassuring parents
Ask parent (have a key role, monitor, tells you what change happens across that time) --> to change expected production of that word. Both parent and child need to know what the best production is
Step 4: further sessions
Ongoing discussion w parents
Once 1 word produced consistently, replace w another one
Work towards consistency on all 50 words
Once child becomes consistent on approx 50 words, consistency achieved- then start regular phon Tx-do DEAP Ax again, parent can do intelligibility context scale.
To check for generalisation: untreated vs. treated words- meaningful and child should know. Ask teacher about child's progress. Record child before and after Tx. How parents think of child's clarity of sounds
Example of 2nd session: elicit a high number of productions of target words (each word approx 20 times in 30 min session). Games used to elicit numerous productions. Provide feedback to explain why word was in error and how to correct production. Aim for child to produce word spontaneously. New target words- at end of each session check consistency of target words (child produces words three times), any word produced consistently is removed from list, replaced w new word.If they are ok, give parents new words for them to prac with child.
Step 5: Generalisation
To monitor generalisation, a set of untreated items (10 words) should be tested, for example 10 words from DEAP. Response generalisation probe.
When child's speech is consistent, move onto phon Tx eg. min pair Tx, metaphon, cycles
Service delivery options
How often? Two 30 min sessions per week recommended. But once per week can be successful
Length of Tx block: 6-8 weeks of 6-8 hours enough for most chn
Agent of Tx: SLP as primary agent, parental invl impt also. Teachers should also be involved
Why is there a difference in responses?
Andrew (56% to 10%): Influence of previous Tx- already had artic and min contrast therapy
Ben (64% to 10%): Default word plans-FCD, adding schwa
Cameron (64% to 40% which is borderline): Behvaioural problems, limited production of words in Tx, home. But actually can shift into phon Tx bcos he is at borderline, very gradual but at least Tx is working. Might need a break, consider behaviour mgm from OT, psychologist.
Client group that benefits
Inconsistent speech disorder 40% inconsistent on Ax
Chn around 3;0 makes most progress using this Tx- words that child is familiar w, can play games, can unds the cueing you provide.