Articulation Treatment

The Baseline Phase

Step 1

Has your client already had a recent articulation evaluation or is s/he continuing in treatment from a previous quarter?– Do you know what sounds are in error?– Do you know what sounds are to be targeted in

treatment from given recommendations?

If NO, then go to Step 2If YES, then go to Step 3

Step 2 – Articulation Evaluation

Conduct an evaluation using an articulation test.

Conduct a structural-functional exam

Step 2 – Articulation Test

There are many to choose from.

Some easy to administer tests include:– Goldman Fristoe Test of Articulation – 2– Structured Photographic Articulation

Test – II– Arizona Articulation Proficiency Scale

Step 2 – Articulation Test

Of the errors you find on the test, choose sounds in error or patterns that are expected to be developed by the child’s age and/or affect intelligibility the most.

If there are multiple sounds in error, conduct stimulability testing first to determine which sounds you will target for treatment (see Step 4 – Stimulability).

Step 2 – Structural-Functional Exam

Conduct a structural-functional exam to rule out any issues with the structure or function of the child’s articulators.

You will look at strength, range of motion, and coordination of the articulators.

You will receive instruction on this.

Step 3 – Connected Speech Sample

The connected speech sample is an important component of the baseline probing process.

You need to conduct this and put your findings in the assessment section of the report.

This information is generally reported as “percent correct.”

Step 3 – Connected Speech Sample

Usually having a conversation with a child is sufficient for eliciting a sample with plenty of examples of sound/s in error in multiple word positions.

There is no set time limit to the connected speech sample – the point is to obtain an adequate sample of sounds. If you can do that in a 3 minute sample, great. If you need more time, take it.

Step 3 – Connected Speech Sample

If you are trying to elicit less frequently occurring sound/s you may need to try some other strategies to ensure you get an adequate sample.

Step 3 – Connected Speech Sample

Possible strategies (not inclusive):– Using a story retelling task that is

loaded with the target sound. For example, Storytelling Probes of Articulation Competence (SPAC) is a pre-made resource available in the Materials Room.

– You might also provide the child with picture cards of words with the target sound/s in many positions and have them create a silly story for you.

Note: You may have to provide an example to the child of how to create the story – use other cards.

Step 3 – Connected Speech Sample

When you are recording data from the speech sample, you do not necessarily have to be careful to record by word position.

In general you record a “+” or “-” for all opportunities for the target sound and report it as a set. – (e.g., /s/ was in error in 60% of opportunities in connected

speech)

Step 3 – Connected Speech Sample

Caveat!If, as you are analyzing your connected

speech sample, you are hearing a pattern (e.g., /s/ is correct in all word final positions, but in error in all other positions), you must record and report that. That is a significant finding.

Step 4 - Stimulability

Stimulability– Is trial teaching.– Is generally quick.– Informs your treatment: It tells you

what sounds (if there are multiple errors) are ready to be taught (or can be left alone to develop on their own!)

at what response level and cuing level to start in treatment for a single error sound.

Step 4 - Stimulability

As with all treatment, it is important to think systematically when doing stimulability.

Different clinicians have different ways of approaching stimulability, but the next several slides will describe one way to do it.

Step 4 - Stimulability

Study your Eliciting Sounds, 2E (Secord) focusing on the sounds you know to be in error.

Practice administering elicitation strategies on a peer, loved one, or child if you can.

Of course talk to your supervisor about any “tricks of the trade” s/he might have to share with you.

Step 4 - Stimulability

Prepare word, phrase, and sentence lists that you will use during this trial teaching phase.

Available to you is a document to help you with this: http://courses.washington.edu/sop/ArticLang/Stimulability.pdf

Step 4 - Stimulability

Start at the word level. Try different word positions using a

variety of teaching cues. If the client is not succeeding, go

down to the syllable level. If the client is still not succeeding, try

at the isolation level.

Step 4 - Stimulability

Of course if the child is doing well at the word level, increase to the phrase level.– You might do short, functional phrases

(e.g., “a white tooth”– You might use a “rote phrase” (e.g., I

see a ___; “This is a ___”) If the child is doing well at the phrase

level, increase to the sentence level.

Step 4 - Stimulability

On the following slide is an example of a chart that you might want to create for yourself to help record your data.

Step 4 - Stimulability

Step 5 – Baseline Word Probes

Once you have established your target sounds you will administer word probes.

In general, you will probe all word positions or contexts.

Step 5 – Baseline Word Probes

Prepare probe cards. There are many materials available

in the Materials Room Articulation/Phonology cabinet. Or you can create your own.

Ideally find 10 words per position/pattern (but remember you have to have words to use in treatment as well).

If that’s not possible, see next slide for a strategy.

Step 5 – Baseline Word Probes

Can’t find 10 words per position?

– Try to come up with at least 3 words per position/pattern.

– Then present cards 2 times (not back to back though) to get a minimum of 6 opportunities.

Step 5 – Baseline Word Probes

Probe cards may be either written words or picture cards.

Use good judgment in deciding whether it is appropriate to use only written words. Consider the age/educational level of the child.

Be sure to choose words that are appropriate vocabulary (consider age and experience of child as well as family religious/cultural beliefs).

Step 5 – Baseline Word Probes

When selecting words try to keep the sounds in “pure positions.”

For example, some commercial materials may use a word like “mushroom” as a medial ‘sh’ word. But technically speaking, in this case it is a syllable final sound and the /r/ may make it extra difficult. This is in contrast with “fishing” where the sound is truly intervocalic. Try the best you can.

Step 5 – Baseline Word Probes

When presenting baseline word probes you will instruct the child:

“I’m going to show you a card with a word on it. I want you to say the word for me. If you are not sure what the word is, I will tell you and then we’ll come back to it later to see if you remember it.”

Step 5 – Baseline Word Probes

In general we obtain 2 baseline word probe data points. – If the child was seen in a previous quarter

(except for Summer), you can use a data point from the previous quarter as one of your baseline data points.

Once you have collected your baseline word probe data you will put these word cards away – probably until the end of the quarter.

Do NOT use your baseline word probe cards for treatment (unless there is a special circumstance).

Step 6 – Begin the Treatment Phase

You now have all the information you might need to get started with treatment.

Be sure to prepare adequate treatment materials to begin your teaching.

Step 6 – Begin the Treatment Phase

Begin to think about Behavioral Objectives.

Think about what you can realistically achieve by the end of the quarter (consider stimulability results).

For the purposes of this clinical experience, you probably will not be writing your BOs at the level of generalization. Read on…

Step 6 – Begin the Treatment Phase

You will likely write your BOs in terms of where in treatment you will get.

So your BOs will reflect that you will use “treated” words, not “untreated.”

You could write a BO that reflects performance at the conversational level, if that is appropriate (i.e., your stimulability testing indicated the child is ready to work at a high level – like the sentence level).

Step 6 – Begin the Treatment Phase

You will talk about the child’s performance on “untreated” words in the generalization section after each behavioral objective.

Questions?

If you have any questions about the baseline process –

Ask your supervisor!