Practicing Clinicians Need Practical Ideas

Phonological Treatment of Speech Sound Disorders in Children: A Practical Guide

Jackie Bauman-Waengler, Ph.D., CCC-SLP and Diane Garcia, MS, CCC-SLP

Why should I buy this book? What is unique about it?

The first unique feature of this workbook is that it is intended for practicing clinicians who work with children with speech sound disorders. From this workbook’s inception, the goal was to make something user-friendly that clinicians could use in various ways with a limited investment of time.  Another distinguishing feature is its summary of several of the most frequently used approaches for treating phonological disorders in children. While there are other textbooks that give a broad-based understanding of treatment of phonological disorders, this workbook offers a more in-depth discussion of eight different approaches. It describes the type of children this therapy would be optimally suited for, the diagnostic information needed, how to select targets for treatment, how to structure therapy, how to monitor progress, examples of intervention goals, and group therapy ideas. And, for every therapy concept, it provides examples of research which support evidence-based practice with this treatment protocol.

What are the strengths of this book?

This workbook has several areas of strength. First, its structure is a strength. Every therapy chapter offers a brief overview of the method, examples of supporting research, target selection procedures, sample goals, data collection strategies, treatment guidelines, and group therapy ideas. This structure provides the clinician with an easy to follow process from beginning implementation to monitoring therapy progress. Second, many worksheets are offered which can be tailored to meet the needs of individual children. This saves the clinician time during the assessment and intervention process. Third, case studies are offered in each of the chapters to demonstrate the concepts. There is also a separate chapter at the end of the book which is devoted to four children of different ages with varying degrees of severity. Assessment data for each child are given as well as a brief glimpse of a portion of therapy. Fourth, group therapy ideas are included in many of the chapters. To account for increased caseloads, many clinicians must often structure therapy within a group. These ideas offer group application possibilities for children with speech sound disorders and possibly language impairments.

How will this book help me practically in my job setting?

Many clinicians in a variety of settings are working with children with phonological disorders. With caseloads increasing, we often do not have a large amount of time to become experts in the various treatment options available, nor to decide which treatment protocol might be the most effective for an individual child. This workbook gives clinicians a streamlined version which is easy to use while offering specific data collection forms and protocols which assist and guide the therapist throughout the entire process. It also offers a large quantity of practical information that can be immediately used in therapy. Clinicians will find the progression through each of the treatment options easy to follow and practical to implement. In addition, every chapter contains two case studies that demonstrate the application of assessment information to structuring therapy. These case studies will give clinicians further support in developing appropriate intervention plans for their own clients.

What phonological intervention approaches are addressed in this workbook and how were they chosen?

The eight approaches in this book are: Minimal Pair Therapy; Multiple Oppositions; Maximal Oppositions; Complexity Approaches; Phonotactic Therapy; Core Vocabulary Intervention; Cycles Approach; and Phonological/Phonemic Awareness.  These eight were selected based upon several factors: research demonstrating positive evidence-based practice, frequent use of the method, ease of implementation, and availability of resources to support application.  Some of the approaches included represent comprehensive therapeutic protocols, while others primarily describe a specific target selection strategy.  All are designed to remediate phonological difficulties, yet do not necessarily exclude the principles which govern a traditional sound-by-sound approach.

What are the characteristics of children who would most benefit from phonological intervention?

As the name implies, phonological intervention approaches are designed for children with phonological disorders.  That said, all children who demonstrate a speech sound disorder, regardless of etiology, may potentially benefit from the principles of phonological therapy.  Appropriate recipients typically demonstrate more than one or two speech sound errors. They may demonstrate pervasive sound error patterns and exhibit highly unintelligible speech. With specific methods it is important that the child demonstrates a collapse of phonemic contrasts. In other words, one phoneme replaces many other phonemes. For example, the child uses “t” for “s”, “z”, and both the voiceless and voiced “th” sounds.  With other therapy protocols the child fits best if a very restricted phonemic inventory is noted.  Specific characteristics of children who would benefit from each therapy approach, such as age, severity, and types of errors, are provided in this workbook.  This information gives clinicians concrete and verifiable guidelines for selection of appropriate intervention methods for individual children.

What are the advantages of using a phonological intervention approach, as opposed to a traditional motor approach?

There are many advantages!  Phonological intervention targets often include patterns or groups of phonemes, rather than individual sounds.  This results in broader change across a child’s entire phonological system.  Phonological approaches have successfully demonstrated generalization to other sounds or patterns through careful selection of targets according to specific guidelines (Gierut, 2007). On the other hand, the traditional motor approach focuses on correct remediation of the physical production of individual sounds in a sound-by-sound manner. The traditional approach can take a much longer therapy time and generalization to other sounds does not seem to occur (e.g., Bowen, 2011; Dinnsen, Chin, & Elbert, 1992). In addition, phonological therapy targets the linguistic function of sounds, that is, the use of phonemes to create meaningful words.  This shift in focus allows clinicians to facilitate functional communication in natural contexts, thus improving children’s ability to communicate during daily interactions.

I have just been using the traditional-motor approach. Is that wrong?

The traditional motor approach, sometimes called the phonetic approach, is not intended for every child with a speech sound disorder. Decades of research have documented that some children make faster, and more broad-based progress with some of the phonological treatment options (Gierut, Elbert, & Dinnsen, 1987; Gierut, Morrisette, Hughes, & Rowland, 1996; Tyler & Figurski, 1994 ). If you have children on your caseload with multiple errors, then the traditional approach, going sound-by-sound through the child’s errors, can take an enormous amount of time. This is time they are spending in speech therapy and not within the classroom. The goal is to get these children out of therapy as soon as possible. Phonological treatment methods are one very successful way to do this.

 

Bowen, C. (2011). Target selection in phonological intervention. Retrieved from http://www.speech-language-therapy.com/ on 8/12/2018.

Dinnsen, D. A., Chin, S. B., & Elbert, M. (1992). On the lawfulness of change in phonetic inventories. Lingua, 86, 207–222.

Gierut, J. A. (2007). Phonological complexity and language learnability. American Journal of Speech-Language Pathology, 16, 6–17.

Gierut, J. A., Elbert, M., & Dinnsen, D. A. (1987). A functional analysis of phonological knowledge and generalization learning in misarticulating children. Journal of Speech and Hearing Research, 30, 462–479.

Gierut, J. A., Morrisette, M. L., Hughes, M. T., & Rowland, S. (1996). Phonological treatment efficacy and developmental norms. Language, Speech and Hearing Services in Schools, 27, 215–230.

Tyler, A. A., & Figurski, G. R. (1994). Phonetic inventory changes after treating distinctions along an implicational hierarchy. Clinical Linguistics & Phonetics, 8, 91–107.

Love, Talk, Read: Early Intervention Strategies for Infants and Toddlers At Risk for Language Impairment

Celeste_Roseberry-McKibbinRoseberry-McKibbin_ILSSLIB_2e

By Celeste Roseberry-McKibbin
Author of Increasing Language Skills of Students From Low-Income Backgrounds: Practical Strategies for Professionals, Second Edition
and co-author of the forthcoming Comprehensive Intervention for Children with Developmental Delays and Disorders Practical Strategies (10 book set)

Statistics have documented the precipitous rise of children diagnosed with Autism Spectrum Disorder (ASD), language impairment, and other atypical developmental profiles. For example, according to the Centers for Disease Control and Prevention (2016), 1 in 68 children today is diagnosed with ASD. Many times, these children do not receive intervention until they are 4 years old or even older. Recent research has documented very exciting outcomes that can occur when these at-risk children receive early intervention, which can start as early as 6 months of age. Speech-language pathologists can help caregivers begin, very early in their children’s lives, to implement strategies that improve their language outcomes. The strategies can be summed up in three words:  love, talk, read. Let’s start with love.

Love

Relationships are the cradle of all learning. Babies and young children above all must feel attached to their caregivers through love, attention, and bonding. It is critical, in the early weeks and months of life, for caregivers to respond immediately and with love when a baby cries. Immediate responses help infants to bond with caregivers and trust their world. Leaving babies to “cry it out” teaches them that the world is not a safe place, and can create a shaky foundation upon which to build later language interaction. Thus, immediate responsiveness to a baby’s cries is a foundational building block of later language.

Talk

We have all heard the oft-repeated advice, “Talk to your baby.” This is true, and talking to babies and young children is crucial to their developing language. However, research has shown that it is actually parent responsiveness to the baby’s initiations that is even more predictive of early language development (Center on the Developing Child at Harvard University, 2016; Ozonoff et al., 2009; Tamis-LeMonda et al., 2001). When a baby looks at something, for example, the parent can follow his “line of regard” and establish joint attention, where the parent and baby are focusing on the same thing. So when the dog walks into the room and the baby’s eyes land on the dog, the parent can say, “Oh, you see Angel. (pointing to dog) That’s right, Angel just came in.” When the baby points, the parent can look at what the baby is pointing to and comment—“Oh, you are pointing at the red balloon. The balloon is pretty!” When babies make sounds, the parents can respond with immediate imitation and add new sounds as well.

Ozonoff et al. (2009) conducted a study with parents of infants (6–15 months of age) suspected of having ASD. Parents were coached to create pleasurable social routines to increase their children’s opportunities for interaction. Parents used toys and words to attract their babies’ attention, and also imitated their babies’ sounds and intentional actions. The treatment consisted of 12 one-hour sessions with the infant and parent, followed by a six-week maintenance period with biweekly visits and follow-up assessments at 24 and 36 months of age. The study’s results showed that in contrast to a control group whose parents did not receive coaching, the children who received the intervention had significantly more ASD symptoms at 9 months of age, but significantly lower autism severity scores at 18 and 36 months of age. By age 3, the group that received the intervention had neither ASD nor developmental delay.

When the baby begins to say words at around 12 months of age, parents can extend their utterances. Extensions have proven to be some of the most powerful ways to increase children’s language skills.  So, for example, if the child points to the dog and says “doggy!” the parent can say, “Yes, our doggy Angel just came into the room and she is wagging her tail.” If the child says “more juice,” the parent can say, “You are thirsty, and more juice is available. Here you go!” When parents add words and new meaning to children’s utterances, semantic and syntactic skills grow. The best part is that this can be done in any language, even if the caregiver is nonliterate and has little extra time. Extensions can easily be added to families’ daily routines with no extra expenditure of time or money.

Read

Parents can share books even with babies, reading and pointing out pictures. Simple books with colorful pictures are ideal. If parents do not read, they can talk about pictures on the pages. Parents can label pictures and actions in the pictures, saying things like, “Look—there is Thomas the Tank Engine! (pointing to Thomas). Why is he happy? (pause) Oh, he is happy because Percy the Train just came up to him and wants to play.” Babies and some young children will not answer questions, but parents can ask the questions, pause for a few seconds, and then answer the question themselves. This shows the developing child that, eventually, turn-taking is expected. Routines such as this help establish joint attention, reciprocity, and eventually conversational turn-taking. Daily sharing of books with babies and young children establishes pre-literacy skills, which are critical building blocks for later literacy.

Summary

For infants and young children who are at risk for language impairment and other developmental issues, caregivers can focus on three simple strategies: love, talk, read. Research shows that early intervention, beginning in infancy, can have exciting and dramatic results in terms of helping children achieve successful language and life outcomes.

For more information, visit http://lovetalkread.com.

 

References

Center on the Developing Child at Harvard University. (2016). Serve and return. Available at http://developingchild.harvard.edu/science/key-concepts/serve-and-return/

Centers for Disease Control and Prevention. (2016). Autism spectrum disorder. Available from https://www.cdc.gov/features/new-autism-data/index.html

Ozonoff, S. et al. (2009). How early do parent concerns predict later autism diagnosis? Journal of Developmental and Behavioral Pediatrics, 30(5), 367–375.

Roseberry-McKibbin, C. (2013). Increasing language skills of students from low-income backgrounds: Practical strategies for professionals (2nd  ed). San Diego, CA: Plural Publishing, Inc.

Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 72(3), 748–767.