Articulation Treatment

Posted by | December 14, 2010 | Articulation Treatment, Treatment

The speech-language pathologists assesses an individuals speech for errors in pronouncing the word. It may be normal for a child to pronounce a sound wrong. A child’s speech sounds must be compared to norms for his or her age group. The child may have an articulation disorder if the sound errors occur past the expected age. Only if the child If the child is supposed to have a sound, but pronounces it incorrectly, speech therapy should utilized.  Individuals with dialects do not have an articulation disorder.  Students in school are expected to learn Standard English, but are not penalized for having a dialect.

Based on the results of the articulation assessment, the child may need speech intervention.  In a school setting, an Individualized Education Plan (IEP) may be needed if the student has poor intelligibility, attracts significant attention, and affects the students education.

General Strategies for Parents to Facilitate Speech Acquisition

Parents and caregivers can promote speech and language acquisition in a variety of ways that can be easily integrated into the daily routine. The best strategies are to talk and read to the child often. Listen attentively. Describe daily events in vivid detail.  Encourage all attempts at speaking. Read together often. The amount of early exposure to books and reading is the greatest predictor of educational success

Children may mispronounce sounds until the age of eight years. Parents can facilitate pronunciation of speech sounds by providing many opportunities for the child to hear and say the sound correctly. Since hearing affects sound acquisition, be sure to have your child’s hearing screened regularly.

  • Use speech that is clear and easy for your child to follow.
  • Repeat what your child says, using correct sounds. Never imitate incorrect speech.
  • Avoid baby talk that uses sounds incorrectly.
  • Make a picture book of interesting pictures containing a misarticulated sound. Have fun perusing the book and talking about the pictures. Be sure to say the words with the target sound frequently. Stress the sound ever so slightly, but keep your production natural.
  • Sing songs and recite poems and nursery rhymes that contain the target sounds.
  • Select four or five common household words containing the target sound and use them frequently during the day.
  • Show your child how to make the sound, especially if it is a visible sound like l, s, ch, j, or th. Use this methodsparingly to avoid frustration.
  • Encourage talking. If the child is unintelligible, try to determine the meaning from context. Whenever possible, avoid asking the child to repeat what he or she has just said. This will reduce frustration.
  • If your child has many misarticulations, focus on one or two sounds for a few weeks at a time.

Report Writing

The SLP records the evaluation findings and outcomes in the Assessment Report. In the report the SLP:

  • Gives pertinent background information, including information about hearing.
  • Describes the student’s speech production strengths and weaknesses and explains the causes and effects of the weaknesses. Includes information about developmental level, dialect, second language learning, intelligibility, severity, stimulability, adverse attention, attempts by teacher to correct the misarticulation, and effects on educational progress.
  • Determines whether or not a disorder exists.  If it does exist, describes its impact on intelligibility, adverse attention, and educational progress.
  • Makes recommendations about eligibility, placement, intervention goals, and strategies.

The IEP team determines the frequency and amount of special education and related services that a student requires to make progress toward achieving the IEP goals.   In an educational setting, the average intervention time is set within one schoolyear.  This does not include the extended school year.  If an extended school year is indicated, the frequency and amount of services, as well as a justification should be written into the IEP.  Students with IEPs for single articulation errors rarelyrequire an extended school year.

Services must be specified on page 1 of the IEP.  IEP teams are free to select a service delivery model that is most suitable for the student’s needs.  Consider the following options:

SLP writes the number of minutes per session, the number of sessions per week and the number of weeks on the first page of the IEP (ex. 2, 30-minute sessions per week for 30 weeks).  If the number of weeks is omitted, it is assumed that services will extend for 36 instructional weeks.

SLP writes the number of hours or sessions per year on the first page of the IEP.

Examples:

# Sessions per semester or year (30, 30-minute sessions per year)

# Hours per semester or year (20 hours per year)

Sample Articulation Assessment

Traditional Articulation Approach

The most well-know spokesperson for the traditional articulation approach was Charles Van Riper. Van Riper outlined the basic steps in 1978. The SLP helps the individual who produces an erred sound achieve correct production by:

Identifying the Standard English sound and discriminating it from the erred sound.

Approximating and refining the approximation until correct production is achieved.

Practicing the new sound in language segments of increasing length and complexity (sounds, syllables, words, phrases, sentences, and conversation).

Generalizing the sound to all speaking situations.

The Sequence for Articulation Intervention, Elements of a Traditional Articulation Lesson, and Facilitative

Complexity Approach

The nonlinear phonology approach is guided by linguistic laws and sound features. Assessment yields information about the child’s phonetic and phonemic inventories as well as stimulability. Treatment targets the sounds that are nonstimulable, phonetically complex, and later developing. Frequently, a minimal pair approach is employed to contrast two new sounds that differ by major class features (nasal vs. liquid vs. obstruent) and to maximize feature differences (place, voice, manner). In general, nonlinear treatment teaches the most difficult aspects of production to facilitate an overall change in intelligibility.

For additional information, read Judith Gierut’s Clinical Application of Phonological Complexity (CSHA Magazine, Vol. 34,No. 1, Summer 2004, p 6).

Principles of Motor Learning

New research into motor learning affords SLPs with better, more effective techniques to use during intervention. Researchers emphasize the importance of motivation, task understanding, random practice, the amount of practice, and the type of feedback to learning and acquiring motor skills. For additional information, read Steven Skelton’s Motor-skill Learning

Approach to the Treatment of Speech-Sound Disorders (CSHA Magazine, Vol. 34, No. 1, Summer 2004, p 8).

Articulation Activities

  • Use the attached practice chart to have children take own data (they create own key for a sense of ownership). This could draw random lines throughout the chart for home practice and speech practice to ensure that they are practicing random numbers of items.
  • Have students subvocalize (say it with their “voices turned off”) during other students’ turns to increase the motor practice and number of repetitions. (You might have to monitor this initially, but they should become independent in their subvocalization.)
  • Use tally counters to challenge students to produce 150 more items or more.
  • Have students track their totals using the practice charts and/or the counters. (You could add up the group total and have contests across groups to see who can produce the most.  Also, you could multiply the group total by the number of students if they are subvocalizing.  Example: Group total (710) X students in group (4) = 2,840 items for a 30-minute session.)
  • Post a grid chart in the room with individual totals for each student and/or group total.
  • Have students make cards with different levels (or make your own and put them in a jar) to ensure that they are getting mixed practice within a given session – sounds, syllables, words, phrases, sentences,conversation/stories. (They would draw a card for every turn.) You could further randomize this by specifying different word positions on each card and/or clusters.  For instance, cards might say, “medial sound in sentence,” “final sound in phrase,” “initial cluster in single word,” etc.
  • Have students spread out in the room (if possible) and work independently to produce more items.
  • Create “stations” where students have to do something different every minute or so while practicing sounds. For instance, four stations could include the following: one child at the board practicing at various levels while drawing, one child at the table practicing while putting a puzzle together, one child lying on the floor while practicing and one child typing on the computer while practicing.  This encourages them to use good sounds ina variety of contexts.  You can yell “switch” at random times for them to move to a new station.  On the board, you could write the sequence, such as board  table  computer  floor  board.
  • The students can practice saying sounds, words, sentences, etc. while being given directions by other students (provided they can do so without interrupting the feedback loop too much).  For instance, while saying a sentence with the target sound, one student could walk around the classroom and do whatever the other children suggest.  This could include walking around the table, touching a picture, doing jumping jacks, closing their eyes, etc.  You might have to model this for a session, but the kids will want to take over giving directions quickly.  Each turn lasts a random amount of time and each student should have several turns in a given 30-minute session.
  • Ask the students to help you create cards to “mix it up” in other ways.  For their turns, they could choose one of these cards (in addition to the practice word and level) and practice it as suggested.  These could include whispering, singing, stretching, saying something with different emotions, alternating between loud and quiet or high and low, while laughing, saying the words slowly, saying the words quickly, saying and spelling the target word, while dancing, while doing pushups, while walking, etc.
  • Have the students go around the table and say the same thing (one at a time).  This will cue them into monitoring their speech as well as others.  You could also have them provide delayed feedback to each other.
  • To emphasize the feedback loop, ask the students to cover their ears and close their eyes.  They will practice a given target (random words and levels) while doing so.  This blocks out all other stimuli and helps them concentrate on the motoric requirements for the target sounds and the resulting accuracy of production.
  • Another way to emphasize the feedback loop is to use an echo microphone for each student’s turn.
  • If you are using nonsense word stories, you can create cards with characters to color and label.  During turns,students could switch colors as they switch levels and target words.
  • Manipulatives can be used for random activities.  For example, you could give each student counting bears ofvarious colors and numbers (perhaps 25 total).  (Go tohttp://www.officedepot.com/txtSearchDD.do?uniqueSearchFlag=true&searchTxt=counting+bears.) On a given turn, they could put all of the yellow and blue ones into a cup while saying the practice items.  During the next turn, they could do something different and on and on.  This ensures that they will practice different numbers. You could also have them create patterns with the colors or put the manipulatives into shapes (all of the bears into a circle, etc.).
  • Have the students draw a number from an envelope to determine the random number of items to say.  A sheet ofnumbers is attached to this for you to cut apart.
  • Have the students add the number of items practiced on the board.  The first will write the number on the board,the second will add his/her total to the first’s total.  The third will add his/her number to the total and on and on.

Sequence for Traditional Articulation Intervention

This sequence combines principles from both the traditional articulation and behavioral approaches.

I. Is Motivated.

A. Is aware of problem and wants to eliminate or modify it.

II. Discriminates the Target Sound: Ear Training.

A. Identifies target sound’s auditory characteristics.

B. Is bombarded with sound to ensure recognition.

C. Discriminates target sound from other sounds.

D. Discriminates target sound in minimally paired words.

E. Discriminates target sound from incorrect production.

F. Discriminates correct/incorrect production in own speech.

III. Produces the Sound In Isolation: Production Methods.

A.  Progressive approximation

1. Intervention begins with erred placement.

2. Client makes transitional sounds, shifting gradually closer to correct production.

3. Client learns to vary degree of error.

4. Outcome is to improve production by reducing amount of deviation.

B. Auditory stimulation

1. Intervention depends on quality of initial ear training.

2. Clinician models target sound.

3. Client imitates target sound.

4. Both evaluate correctness of production.

5. Outcome is to achieve correct production by imitation.

C. Phonetic placement

1. Clinician teaches discrete placement of sound using descriptions, visual, and moto-kinesthetic

methods.

2. Outcome is to achieve production of target sound by assuming correct placement.

D. Modification of other sounds

1. Client makes the first sound.

2. Clinician directs client to move articulators to target sound while making first sound.

3. Outcome is to achieve production of target sound by modifying another sound that is correctly

produced.

4. Example: t to s. Client makes /t/, then slowly withdraws and elevates tongue tip until /s/ is produced.

E. Key word

1. Clinician determines words in which client makes target sound correctly by writing words containing

target sound in different phonetic contexts and directing client to say each one 10 times.

2. Client says correct word 100 times.

3.  Client says correct word and tries to prolong target sound for increasing counts up to 20.

4. Outcome is to generalize correct production of target sound to all phonetic environments.

IV. Stabilizes the Correct Sound.

A. Produces the target sound in nonsense syllables.

1. Sequence

a. target + vowel

b. vowel + target

c. target + vowel + (front, mid, back) consonant

d. (front, mid, back) consonant + vowel + target

2. Sample word list for /s/:

3. If client’s articulation error is a substitution, do not include substituted sound in practice words.

Example: If th/s, then omit /th/ from practice material.

B. Produces the target sound in the initial position of words.

1. Begin with key words determined by using Key Word Method or noted during nonsense syllable

stage.

2. Use pictures beginning with target sound.

3. Use Van Riper’s Reconfiguration Technique (not commonly used).

a. Client reads or talks substituting non-errored sounds.

1. Example: A student with lisp is asked to substitute b/f while reading “Sammy caught a bish

with his hook and line.”

2. Purpose is to train client to substitution task.

b. Client substitutes target sound for other sounds but not for itself.

1. Example: A student with a lisp reads, “Sammy sssaught a fish with his hook and line.”

c. Client substitutes another sound for the target sound in the same material

1. Example: A student with a lisp reads, “Bammy caught a fish with his hook and line.”

d. Client omits target sound when it begins a word.

1. Example: A student reads, “-ammy caught a fish with his hook and line.”

e. Client substitutes target sound for erred sound.

1. Example: A student reads “Sssammy caught a fish with his hook and line.”

4. Use Van Riper’s Talking/Writing Method.

a. Client says any word containing target sound while writing its symbol for specified number of

lines.

5. Use Van Riper’s Signaling Techniques.

a. Client prolongs or repeats the target sound. Clinician signals using finger snap or hand drop.

Client immediately says a predesignated vowel or word part, then repeats whole word.

1. Example: sssss (signal) un; sun

6. Develop and practice word lists following sequence noted in IV.A.

C. Produces the target sound in the final position of words.

1. Use methods 1, 3–5 recommended in IV.B.

D. Produces the target sound in the medial positions of words.

1. Use methods 1, 3–5 recommended in IV.B.

E. Produces the target sound in multisyllabic words.

1. Use methods 1, 3–5 recommended in IV.B.

F. Produces the target sound in clusters in all positions.

1. Sequence

a. Target + vowel + consonant cluster

b. Consonant cluster + vowel + target

c. Target in initial consonant cluster

d. Target in final consonant cluster

e. Target in IMF positions in multisyllabic words

G. Produces the target sound in singleton and clusters in I, M, F position of phrases.

1. Practice target words in carrier phrases.

2. Practice phrases with contextual variety.

H. Produces the target sound in sentences.

1. Reads key words in sentences or talks about pictures that elicit target sound.

2. Practices sentences with contextual variety.

3. Formulates own sentences using key words.

4. Client concentrates on monitoring and evaluating own production.

a. Have client tally the number of times the target sound is produced.

b. Tape-record and play back to evaluate production.

5. Begins carry-over assignments.

a. Have client request object (has target sound) from another person.

b. Have client deliberately use key word in speech to specified others.

c. Have client carry card and tally number of correct productions during a specified time period.

I. Produces the target sound in controlled conversation.

1. Reads key words and sentences in passages.

2. Role-plays situations using key words and sentences.

3. Creates and recites dialogue using key words and sentences.

4. Talks about topics using key words and sentences.

J. Produces the target sound in spontaneous conversation.

1. Self-evaluates production in a variety of speaking situations.

Sources: Baker and Ryan (1971), Van Riper (1984), Winitz (1975)

Teaching Placement of the Articulators

When beginning at the placement level, first model the correct placement.  Use phonetic placement, approximation, auditory stimulation or shaping.  Then lead the students by performing the exercise with them.  Lead the students by performing the exercise with them. Initially do this with the whole group. Divide into small groups or work with individual students as needed. Direct the students to watch your model, each other, or themselves. Give specific, corrective feedback. Return to Step 1 if students are unable to find correct placement. Test the students by asking them to perform the target behavior independently. Give corrective feedback. Return to Step 1 or 2 if students are unable to find correct placement. Once the students produce the target behavior independently, begin mass practice. Corrective feedback should be specific, immediate and multisensory. Use a 100% reinforcement schedule at this level. Multisensory feedback includes giving verbal cues, drawing pictures and diagrams, marking plus and minus, using a token system, and working with a mirror and tape recorder.  Mastery is usually set at 70–80%.

Teaching Producing Sounds at the Word Level

First model the activity. Then, lead the students as a group through a few items to make sure that they understand the task. Test the students individually. Ask them to perform the target behavior independently. Give specific, corrective feedback. Once the students produce the target behavior independently, begin mass practice. Corrective feedback should be specific, immediate, and multisensory. Use a 100% reinforcement schedule at this level. Multisensory feedback includes giving verbal cues, drawing pictures and diagrams, marking plus and minus, using a token system, and working with a mirror and tape recorder.  Students should begin intensive self-monitoring and self-correction at this level.  Mastery is usually set at 70–80%.

Teaching at the Sentence Level

First model the activity. Then, lead the students as a group through a few items to make sure that they understand the task. Test the students individually. Ask them to perform the target behavior independently. Give corrective feedback.  Once the students produce the target behavior independently, begin mass practice.  Corrective feedback should be specific, immediate and multisensory. Use a 100% reinforcement schedule at this level. Multisensory feedback includes giving verbal cues, drawing pictures and diagrams, marking plus and minus, using a token system, and working with a mirror and tape recorder. Students should begin intensive self-monitoring at this level.  Mastery is usually set at 70–80%.

Teaching at the Controlled or Spontaneous Conversation Level

Again, the first step is to model the activity. Lead the students as a group through a few items to make sure that they understand the task.  Test the students individually. Ask them to perform the target behavior independently. Give corrective feedback. Once the students produce the target behavior independently, begin mass practice.  Corrective feedback should be specific, immediate or delayed, and multisensory. Use a 50–60% reinforcement schedule at this level. Multisensory feedback includes giving verbal cues, drawing pictures and diagrams, marking plus and minus, using a token system, and working with a mirror and tape recorder. Mastery is usually set at 70–80%. Students with multiple articulation errors who are able to correctly produce their first target sound in controlled conversations are ready for placement work on their second misarticulated sound.

20999 total views, 2 today

Tags: ,

Leave a Reply

Your email address will not be published.