“using the building speech™ system in the treatment of cas

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“Using The Building Speech™ System in the Treatment of CAS and Other Speech Sound Disorders,” Presented by: Kathy Jakielski, PhD, CCC-SLP and Lisa Mitchell, MS, CCC-SLP, March 7, 2017, Sponsored by CASANA

Kathy J. Jakielski, Ph.D., CCC‐SLPAugustana CollegeRock Island, IL

Lisa B. Mitchell, M.S., CCC‐SLPHampton Falls, NH

WebinarCASANA

March 7, 2017

Building Speech

in Children with CAS and Other Speech Sound Disorders

FinancialInstructor for CASANA’s Intensive CAS Training Institute.Author of Building Speech & Quantifying Complexity

—an assessment and intervention toolkit published by CASANA—for which I receive royalties.

NonfinancialProfessional Advisory Board Member for CASANA

Disclosures: Kathy Jakielski

Financial – CASANA webinar presenter‐ Will receive a stipend for this presentation

Nonfinancial – Lisa is a graduate of the 2011 CASANA intensive CAS training instituteShe is the owner of a private SLP practice in New Hampshire

Disclosures: Lisa Mitchell

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Building Speech is a new approach for selecting & constructing targets in speech intervention based on articulatory movements & movement sequences that progress from basic to more complex.

Based on the premise that children with motor speech disorders benefit from speech intervention that begins by teaching the child how to articulate words & phrases that are constructed of speech movement patterns that follow the early acquisition exhibited by typically‐developing children.

Those basic speech movement patterns then serve as the foundation for the child’s production of more complex articulations.

There are 8 speech movement patterns targeted in Building Speech that broadly follow early typical babbling & speech development.

Building Speech of Increasing Phonetic Complexity

The general early patterns that the Building Speech patterns are based on include typical child mastery of:

• stops, nasals, & glides prior to fricatives, affricates, & liquids• monophthongs prior to diphthongs & diphthongs prior to rhotics• open word shapes prior to closed word shapes• reduplicated syllables prior to variegated syllables• homorganic consonant + vowel syllables & homorganic consonant + consonant

sequences prior to heterorganic constructions• voiced consonants in word‐initial position prior to voiced consonants in word‐final

position• voiceless consonants in word‐final position prior to voiceless consonants in word‐

initial position

Early Speech Acquisition Findings

IPC Terminology: Consonant Place Classes

Labials• produced using one or both lips• p, b, m, w, f, v

Coronals• produced with the tongue tip on or near the alveolar ridge• t, d, n, j, θ, ð, s, z, ʃ, ʒ, ʧ, ʤ, l, r

Dorsals• produced with the tongue body at the velum• k, g, ŋ

Glottals• produced at the level of the vocal folds, without supralaryngeal articulation• ʔ, h

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IPC Terminology: Consonant Manner Classes

Stops p, b, t, d, k, g

Nasals m, n, ŋ

Glides w, j

Fricatives f, v, θ, ð, s, z, ʃ, ʒ, h

Affricates ʧ, ʤ

Liquids l, ɹ

IPC Terminology: Vowel Manner Classes

Monophthongs i, ɪ, e, ɛ, æ, ə, a, u, ʊ, o, ɔ

Diphthongs aɪ, aʊ, ɔɪnon‐phonemic ij, ej, oʊ

Rhotics ɚ, ɪr, ɛr, ar, ur, ɔr, aɪr, aʊr

IPC Terminology: Place Variegation

Homorganic Sounds• sound sequences produced in the same place

• coronal consonants + front vowelst, d, n, j, s, z, ʃ, ʒ, ʧ, ʤ, l + i, ɪ, e, ɛ, æ

• dorsal consonants + back vowelsk, g, ŋ + u, ʊ, o, ɔ

• clustersbw, st, ŋk, etc.

Heterorganic Sounds• sound sequences produced in different places

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IPC Terminology: Word Shape

Open Word Shapes• words that end with a vowel sound

• V, CV, CVCV, CCV, CVCVCV, etc.

Closed Word Shapes• words that end with a consonant sound

• VC, CVC, CVCVC, CCVC, CVCC, etc.

IPC Terminology: Phonotactics

Reduplications• syllables repeated

o C1V1C1V1

o C1V1C1V1C1V1

o etc.

Variegations• syllables containing consonants &/or vowels that vary

o C1V1C2V1

o C1V1C1V2,

o C1V1C2V2

o etc.

As you get started, have a child in mind and think about:

• application of the principles of motor learning (practice schedule, etc.)• customizing the condition and criteria when setting your goals• your child’s current sound repertoire• weaving in variability from the start• utilizing items you already have in your toy closet

Let’s Start Building Speech!

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CV+CV(C)

syllable‐2 static

CV+CV(C)

syllable‐2 static

CvoicedVCvoicelessCvoicedVCvoiceless

CvoicedVCnasalCvoicedVCnasal

CVCV

heterorganic consonants

CVCV

heterorganic consonants

CVCVC

homorganic consonants

CVCVC


CVCV


CVCV


CVCV

reduplicated CV (from Pattern 1)

CVCV

reduplicated CV (from Pattern 1)

CV

voiced stop or nasal consonant

CV

voiced stop or nasal consonant

The 8 Patterns of Building Speech

Customizing Building Speech

Please refer to the worksheet provided

Selecting Child‐specific Functional Vocabulary

For a comprehensive list of vocabulary that an individual child uses, use the Functional Communication Parent Questionnaire developed by Wilson and Gildersleeve‐Neumann.

A completed questionnaire provides information about the following vocabulary:o nameso activitieso placeso requests & needso emotions & feelingso toys & materialso food & drinko household items & placeso clothingo question wordso yes & no responseso social language

The questionnaire can be accessed at:https://www.pdx.edu/sphr/clinical‐resources‐0

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The 8 Patterns Explained & Demonstrated:

Intervention‐in‐Action

Pattern 1

CV

CV

Words with• voiced stop & nasal consonants

b, d, g, m, n

• monophthong & diphthong vowelsi, ɪ, e, ɛ, æ, ə, a, u, ʊ, o, ɔaɪ, aʊ, ɔɪ

Let’s construct some examples!

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CV

Words with• voiced stop & nasal consonants

b, d, g, m, n

• monophthong & diphthong vowelsi, ɪ, e, ɛ, æ, ə, a, u, ʊ, o, ɔaɪ, aʊ, ɔɪ

Examples

• bee, bye

• D, day

• goo, go

• me, moo

• new, no

Pattern 1: CV

General:Susie Speech will accurately produce 10 different CV word shapes that include a voiced stop or nasal combined with a monophthong or diphthongindependently over 3 consecutive sessions.

Specific:Susie Speech will produce 5 different CV word shapes that include a voiced stop combined with a monophthong or diphthong independentlyover 3 consecutive sessions.

Cumulative: Susie Speech will produce CV word shapes that include a voiced stop + monophthong or diphthong with 80% cumulative accuracy.

4/10 5/10 8/10 8/10 9/10 9/10 = 43/60 71.6% KEEP GOING!

Examples of Goals for Pattern 1

Literature: Repetitive stories like Brown Bear <me>/ (Carle), yes/no book , <no> (Patricelli)

Activities: wind up bee <bee>, car ramp <go>, farm <moo>, <neigh>phonological awareness b/d <B>, <D>

Games: go away monster <go> Honeybee tree <bee>

Therapy Ideas for Pattern 1

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Weave in Language & Phonological Awareness Early On

Multiple meanings

Use different pictures to teach different meanings

Phonological Awareness: labeling letter names

Power Words & Phrases for Pattern 1

BOO!

GO!

ME

NO!

MA

BYE

When choosing “power words” – consider including nouns, verbs and words that carry social power.

Video 1A

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Video 1B

Pattern 2

C1V1 + C1V1

C1V1 + C1V1

Words that are• reduplicated CV words

• Pattern 1 words repeated


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C1V1 + C1V1

Words that are• reduplicated CV words

• Pattern 1 words repeated

Examples

• boo‐boo, bye‐bye

• dada, day‐day

• goo‐goo, go‐go

• me‐me, moo‐moo

• new‐new, no‐no


General:Fanny Phoneme will accurately produce 10 different disyllable words with reduplicated syllables that include a voiced stop or nasal combined with a monophthong or diphthong (C1V1+C1V1) independently.

Specific:Fanny Phoneme will accurately produce 5 different disyllable words with reduplicated syllables that include a nasal + diphthong/monophthong over 3 consecutive sessions independently.

Cumulative:Fanny Phoneme will produce disyllable words with reduplicated syllables that include voiced stop or nasal + diphthong/monophthong with 80% cumulative accuracy.

1/10 3/10 6/10 4/10 4/10 7/10 8/10 8/10 = 41/80 = 51% cumulative accuracy –KEEP GOING!


Boo Boo

Bye Bye!

No No

Go Go (Not the boots, the action! Think functionally!)

Mama

Mimi (grandma)

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Literature: yes/no book <no‐no>, Didi the Dodo (Salole) <didi, dodo>, boo boo book <boo‐boo>Activities: hunt for cards/matching, highway strip, do’s and don’ts (label the no‐no’s)Games: races <go‐go>, Howie’s owie <boo‐boo>

More Therapy Ideas for Pattern 2

Video 2

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Pattern 3

ChomVChomV

ChomVChomV

Homorganic Consonants in an Open Word Shape

• consonants produced in the same articulatory place

• places collapsed into four categories: labial, coronal, dorsal, glottal


ChomVChomV

Homorganic Consonants in an Open Word Shape



Examples

• PB, peewee, maybe

• bye + ______ pa, boy, ma

• today, tiny, naughty

• no + ______ tea, doll, knee

• cookie, cougar

• go + ______ cow, car, guy

• ha‐ha

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General:Patty Patient will independently produce 10 different CVCV word structures with homorganic consonants from her existing repertoire in 3/3 trials.

Specific:Patty Patient will produce 3‐5 different CVCV word structures with labial consonants in 5/5 trials when provided with visual or verbal cues.

Cumulative: Patty Patient will produce 5 different CVCV word structures with homorganic consonants with 80% cumulative accuracy.

5/10, 7/10, 8/10, 9/10/, 9/10, 9/10 , 9/10 = 56/70 GOAL MET!


PoopyPeepeeWeeweeCookiePow‐powDaddyMommy

No, Now!Bye Ma!

Tattoo (think about what words would be powerful for that specific child)

Literature: Where’s Baby’s Puppy (Kratz), The Mommy Book &The Daddy Book (Parr)Activities: label daddy/mommy (sharing photos), puppy/moo‐moo ball pop, superhero games <pow‐pow>,Cookie jarGames: puppy bingo, baby animal bingo


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Video 3A

Video 3B

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Pattern 4

ChomVChomVChom

ChomVChomVChom

Homorganic Consonants in a Closed Word Shape




ChomVChomVChom

Homorganic Consonants in a Closed Word Shape



Examples

• peep‐peep, pop‐pop, bebop

• boy + ______ (pop, beep, burp, mop)

• my + ______ (pop, mop, map, mom)

• me + ______ (pop, poop, bop, mop)

• toilet, doughnut, noodle

• not it!

• cooking, kicking

• (cake, coke, cookie) ______ + ick!

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General:Sammy Speechie will produce 3 different CVCVC with homorganic consonants indisyllabic words and/or phrases in 4/5 trials independently.

Specific:Sammy Speechie will produce a CVCVC word structure with coronal consonants in disyllabic words and/or phrases in 4/5 trials with verbal and/or visual cues.


Whoa, poop!

Pow, boom!

My mom

Donut

No, dad

Not it!


Literature: The Donut Chef <donut> (Staake), K is for Kick<go, kick!> (Herzog), Let’s talk about tattling <tattle> (Berry), Noodle (Leaf)

Activities: stacking pup (pup up), cooking <whip up, cooking, donut, go, cook! >

Games: donuts!, turtle shellsAlfred’s Food Fight <noodle>

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Video 4

Pattern 5

ChetVChetV

ChetVChetV

Heterorganic Consonants in an Open Word Shape

• produced in different articulatory places

o labial‐coronal, labial‐dorsal, labial‐glottal

o coronal‐labial, coronal‐dorsal, coronal‐glottal

o dorsal‐labial, dorsal‐coronal, dorsal‐glottal

o glottal‐labial, glottal‐coronal, glottal‐dorsal


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ChetVChetV

Heterorganic Consonants in an Open Word Shape

• produced in different articulatory placeso labial‐coronal, labial‐dorsal, labial‐glottalo coronal‐labial, coronal‐dorsal, coronal‐glottalo dorsal‐labial, dorsal‐coronal, dorsal‐glottalo glottal‐labial, glottal‐coronal, glottal‐dorsal

Examples

• potty, body, messy

• me too!

• picky, pokey, Mickey

• me go, moo cow

• doggie, nicke(l), yucky

• you ‘kay?, no key


General:Patty will produce CVCV word structures with heterorganic consonants in9/10 trials independently.

Specific:Patty will produce CVCV word structures with labial‐dorsal consonants in 9/10trials when provided with a visual and/or verbal prompt.


Potty

Me Too!

No Way

Minnie & Mickey

Woody (Buzz’s best friend)

No, Ma!

Hi, Ma!

Hey, Ma!

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Literature: Baby Happy Baby Sad (Patricelli)

Activities: hanging bunnies <bunny>, piggy bank <piggy, penny,money, nicke(l)>

Games: funny bunny, toy story Matching game <Woody>

Video 5A

Video 5B

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Pattern 6

CvdVCnas

CvdVCnas

Words with:

• voiced stop, nasal, glide, & fricative consonants in initial position

• nasals in final position


CvdVCnas

Words with:

• voiced stop, nasal, glide, & fricative consonants in initial position

• nasals in final position

Examples

• boom, bone, bang

• mom, name, none

• wham, won, wing

• van, zoom, zing

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General: Al Velar will accurately produce CVC word structures with initial voicedconsonant and final nasal in 4/5 trials independently over 3 consecutive sessions.

Specific: Al Velar will accurately produce CVC word structures with initial voiced stop and a final nasal when provided with verbal and/or visual cues in 9/10 trials.

Note:For this goal, you could change the manner to be more specific. You could write this goal to target initial voiced nasal, glide or fricative and/or specify the nasalyou are targeting in final position.

Power Words for Pattern 6

Actions: bam!, yawn, whine, gone, boom, bang

High Frequency: nine, yum, win, down, man, done, mom, mean


Literature: The Doorbell Rang (Hutchins) <ding‐dong>, Yummy/yucky <yum, yuk>

Activity: Young or old? <young>, hammer/peg toy <bang, bam>, Would you like…Nine or none?, yum/yuk sorting

Games: Feed the dog <bone>, inch worms, wiggly worms, Don’t spill the beans <bean>

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Video 6


Even More Therapy Ideas for Pattern 6

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Pattern 7

CvdVCvl

CvdVCvl

Words with:

• voiced stops, nasals, glides, & fricatives in initial position

• voiceless stops or fricatives in final position


CvdVCvl

Words with:

• voiced stops, nasals, glides, & fricatives in initial position

• voiceless stops or fricatives in final position

Examples

• beep, boot, book, beef, bus

• deep, dot, duck, deaf, dice

• goop, goat, goof, goose

• map, meat, make, moose

• nope, night, knock, knife, nice

• whoop, wait, walk, yup, yuck, yes

• vote, vase, zip

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General:Joey will accurate produce CVC word structures with an initial voicedconsonant and final voiceless stop or fricative in 4/5 trials independently.

Specific:Joey will accurate produce CVC word structures with initial voiced stop and final voiceless stop in 4/5 trials with visual and/or verbal cues.

Power Words for Pattern 7

Actions: whip, use, weep, woke, walk, wait, bake, beat, bite, burp, get, whack, wash, wish, got

High frequency:duck, bike, book, nice, bus, yes, yup, yuck, night, white, wet, what, nap


Literature: Five little ducks, The Napping House (Wood), 10 Little Rubber Ducks (Carle)

Activities: bus or boat?, bathing a baby <wash, wet>

Games: whack a mole, Ned’s head <yuk!>

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Video 7

Pattern 8

CV + CV(C)

CV + CV(C)

Words with:

• a variable first syllable

• + the same second syllable


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CV + CV(C)

Words with:

• a variable first syllable

• + the same second syllable

Examples

• TEA words: potty, mighty, nightie, etc.

• KING words: peeking, baking, kicking, etc.

• ME words: tummy, mommy, gimme, etc.

• KNEE words: penny, bunny, shiny, etc.


Sally will accurately produce 5 disyllable words with a CVCV structure, /ni/ being the second syllable, in 4/5 trials when provided with a model.

Sally will expand production of disyllable words in a CVCV word shape by producing 5 different final syllable combinations in 4/5 trials independently.


Literature: Benny’s chocolate bunny (Trasler)Henny Penny <Henny Penny, Cocky Locky>(Galdone)

Activities: hokey pokey, bubblevs. double (stackable bubbles), cookie picnic for turkey, monkey and Mickey!

Games: Funny Bunny

Carryover: Make some muddy buddies!,Mickey hockey coloring page

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Therapy Ideas for Patter 8 “bull words”


Video 8

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Video 8B

Carryover Activity for Pattern 8

Another Carryover Activity for Pattern 8

MUDDY BUDDY RECIPE

Serves: 9 servings

INGREDIENTS•4½ cups any flavor of Chex cereal•½ cup chocolate chips (semi-sweet or regular)•¼ Cup peanut butter•⅛ cup butter or margarine•½ tsp vanilla•¾ cup powdered sugar

INSTRUCTIONS1Pour cereal into a large bowl and set bowl aside.2 Add chocolate chips to a microwave safe bowl and add peanut butter and butter.3 Put the bowl in the microwave and microwave for one minute. Add ½ teaspoon of vanilla and microwave for 20 more seconds.4 Stir until smooth.5 Pour chocolate mixture of the cereal in large bowl.6 Mix together, making sure to coat all the cereal with the chocolate.7 Place the coated cereal into a large zippered bag and add ¾ cup of powdered sugar.8 Zip bag and shake to coat the cereal.9 Place on a sheet of wax paper to cool and after they will be ready in 15 minutes.

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1. Collect a spontaneous speech sample from the child with CAS

2. Analyze the speech sample to derive the child’s phonetic & error inventories

3. Considering articulatory complexity, determine the sounds & sound sequences that are difficult for the child to produce

4. Select the Patterns to target as speech based on your analyses, & write the goals, for example:

“Jasper correctly will produce ChomVChomV syllable shapes, in which the consonants are homorganic, in spontaneously‐produced disyllabic words & phrases…"

5. Develop a list of words & phrases that are meaningful to the child & that fit the target patterns; use a family questionnaire to obtain this important information

6. Have fun designing creative intervention activities!

Recap: Designing Intervention Using this Approach

Have Fun Building Speech

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“using the building speech™ system in the treatment of cas

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