intervention approaches i.overview of approaches (23) ii.direct speech sound production approaches...

Intervention Approaches

I. Overview of Approaches (23)

II. Direct Speech Sound

Production Approaches (7)

III. Contrastive approaches (4)

I. AN OVERVIEW23 Intervention Approaches

Overview of 23 Interventions

Different ways to organize approaches

1. 23 approaches categorized according to:a. Direct Speech Production Intervention (7)

• TONIGHT: Only Contrastive Approaches (4 of the 7)

b. Interventions within a Broader Context (12)

c. Interventions for Achieving Speech Movements (4)

2. Intervention Options Decision Tree (next figure)

– Series of tables (only 1st table discussed tonight)– Follows Phonological Analysis Summary and

Management Plan (handout)

Intervention Options Decision Tree

Comparison of Contrastive Intervention Approaches

Comparison of Intervention Approaches for Young Children

Comparison of Intervention Approaches AddressingPhonological Awareness/Literacy

Approach Classification Characteristics Population

Metaphonological Approach

Unintelligible Speech

Includes phonological awareness activities in addition to production activities

Preschool-aged children with moderate tosevere SSDs

Psycholinguistic Approach

Unintelligible Speech

Addresses links between speechand literacy

Preschool and School-aged children with moderate tosevere SSDs

Comparison of Integrated Intervention Approaches

Comparison of Phonetic Intervention Approaches

II. DIRECT SPEECH SOUND INTERVENTION APPROACHES

Overview of 7 Approaches

Direct Speech Production Interventions• Approaches that directly and explicitly

address goals of speech sound production– Minimal pairs– Multiple oppositions– Complexity approaches

• Maximal oppositions• Empty set

– Core vocabulary– Cycles approach– Nuffield Centre Dyspraxia Programme– Stimulability Approach

Direct Speech Production Interventions• Approaches that directly and explicitly

address goals of speech sound production– Minimal pairs– Multiple oppositions– Complexity approaches

• Maximal oppositions• Empty set

– Core vocabulary– Cycles approach– Nuffield Centre Dyspraxia Programme

Current best evidence

Clinician factors Client factorsKey components age

Broad goals type of SSD

Level of focus

Session type

Technology/materials

Levels of Evidence (LOE)

Level Description Approach

1a Well-designed meta-analysis of >1 randomized controlled trial

None

1b Well-designed randomized controlled study Complexity; CV; Cycles; Stim

2a Well-designed controlled study without randomization

MO; Complexity; Cycles

2b Well-designed quasi-experimental study MP; MO; Complexity; CV; Stim

3 Well-designed nonexperimental studies, i.e., correlational and case studies

MP; MO; Complexity; CV; Cycles; NCDP; Stim

4 Expert committee report, consensus conference, clinical experience of respected authorities

Cycles

3 Stages of Research

Stages of Research LOE Number of Studies

Exploratory Studies 3 32

Efficacy Studies 2b

2a

55

3

Effectiveness Studies 1b 5

LOE: Promising Interventions with Probable Efficacy

Stages of Research LOE Number of Studies

Exploratory Studies 3 32

Efficacy Studies 2b

2a

55

3

Effectiveness Studies 1b 5

Characteristics of InterventionsComparative Factors

Specifications

Age 3;0-6;0 • down to 2;0-Stim; up to 7;0-Complexity, Cycles, CV, NCDP

Population Multiple speech errors and unintelligible speech• Inconsistent speech errors (CV)• CAS (NCDP, Cycles)

Intervention Agents SLP• Supplemental assistants:- Parents/caregivers (Cycles, Stim, CV, NCDP)- Paraprofessionals (Cycles)- Teachers (Stim, CV)

Key Components Direct and focused intervention using meaningful words• NSW (Complexity)• Sound (NCDP)

Characteristics of Interventions: con’t

Comparative Factors

Specifications

Broad Goals Increase speech intelligibility• Reduce homonymy• increase stimulable sounds (Stim)• increase consistent productions (CV)• establish accurate motor programs/planning (NCDP)

Target Selection Varied (developmental-linguistic-distance metric-stim/nonstim; functional words)

Level of Focus Speech output (representation + planning – CV; NCDP)

Session Type Individual (30-60 min 2x/wk)

Technology Illustrations; SCIP; NCDP-3 pictures; Alliterative sound character cards (Stim)

ICF-CY Codes Primarily b320: Functions of productions of speech sounds

III. FOUR CONTRASTIVE APPROACHES

Direct Speech Sound Intervention Approaches

Homonymous or Non-homonymous?• Homonymous approaches directly

confront child’s rule by contrasting his/her error with the new target sound(s) to be learned.

• Non-homonymous approaches indirectly address child’s rule with assumption that greater contrastive distinction of word pairs facilitates learning.

- Minimal Pairs and Multiple Oppositions

- Maximal Oppositions and Empty Set (Complexity Approaches)

Non-Homonymous (Complexity) Approaches: MaxO and ES

• Ideally, the target sound(s) for MaxO (one target) and ES (two targets) are:– Missing from child’s inventory– Marked (phonologically complex)– Non-stimulable– Later developing

• The comparison sound (MaxO) should be:– Known, Independent of error, and Maximally Different

• The second target sound (ES) should be:– Unknown, Independent, and Maximally Different

Non-Homonymous (Complexity) Approaches: MaxO and ES

Target contrasted with known sound (MaxO)- nonmajor feature distinction

Target 1 contrasted with Target 2 (ES)- nonmajor feature distinction

Target contrasted with known sound (MaxO)- major feature distinction

Target 1 contrasted with Target 2 (ES)- major feature distinction

Least Change

Most Change

Minimal Pairs: contrasts the child’s error with the target sound

Designing Treatment for Adam

error ~ target

example: g ~ d / #____

go ~ doe

gate ~ date

gown ~ down

Guy ~ dye

game ~ dame

Designing Treatment for Adam

Maximal Oppositions: Contrasts a “known”, independent, and maximally different sound with the target sound

correct ~ target

Example: m ~ d / #

moo ~ dewmore ~ doormate ~ dateMay ~ dayme ~ Dee

Empty Set: Contrasts two target sounds that are unknown, independent, and maximally different from each other

Designing Treatment for Adam

Target 1 ~ Target 2

Example: r ~ d / # ____

row ~ doe

ray ~ day

rye ~ dye

ran ~ Dan

ram ~ dam

Designing Treatment for AdamMultiple Oppositions: Contrasts child’s error with several target sounds from across an entire rule set.

error ~ targets

d

f

g t # _____

st

dew dill deer

Fu fill fear

goo chew gill chill gear cheer

stew still steer

daze Danefaze feign

gaze chaise gain chainstays stain

Multiple OppositionsAssumes learning is facilitated by the size and nature of linguistic “chunks” presented to the child (learning of the whole is greater than the sum of its parts)

Assumes learning is a dynamic interaction between child’s unique sound system and intervention

Predicts learning will be generalized across a rule set (i.e., learning will generalize to obstruents and clusters collapsed to [g] in the 1:17 phoneme collapse) and result in system-wide restructuring.

• Minimal Pairs • Multiple Oppositions • Maximal Oppositions • Empty Set

Video Examplesof 4 Contrastive Approaches