Treatment Principles Contrasted Phonological Disorder Childhood Apraxia of Speech Principles of...

Copyright © 2011 Caroline Bowen

Treatment Principles Contrasted

Phonological Disorder Childhood Apraxia of Speech

Principles of Motor Learning


Treatment PrinciplesPhonological Disorder

Phonological Principles Intervention is based on the systematic

nature of phonology. Intervention is characterised by conceptual

activities rather than motor activities. Intervention has generalisation as its

ultimate goal, promoting intelligibility.


1. If using a 3-position SODA test transcribe entire words in order to see error patterns.

2. Work at word (meaning) level.

3. Work towards functional generalisation.

4. Treat a pattern, or patterns, of errors.

5. Teach appropriate contrasts.

6. Direct the child’s attention to the way that different sounds make different meanings. Make this apparent to parents too, e.g., give them examples of their own child’s homonymy.

PHONOLOGICAL DISORDER10 Points to Consider in Intervention


7. Use naturalistic contexts that have meaning (hold interest) for the child, because this helps demonstrate to the child that the function of phonology is to make meaning.

8. Stack the ‘therapy environment’ with several exemplars of each individual target word so the child can self-select activities, e.g., for work on eliminating Velar Fronting, for the target words: car, key, core, cow, have available several different cars, car keys, car books, etc.

9. Select targets with an eye to their potential impact on the child’s system.

10. Carefully select exemplars of an error pattern / phonological rule. With clever exemplar-choices, the rule is learned, and carries over to the other targets.


3-to-5 minimal pairs!

Elbert, Powell and Swartzlander found that they could teach as few as 3 to 5 minimal pairs, and their participants showed spontaneous generalisation to other words containing the target sounds.

Elbert, M., Powell, T. W., & Swartzlander, P. (1991). Toward a technology of generalization: How many exemplars are sufficient? Journal of Speech and Hearing Research, 34, 81-87.


Treatment PrinciplesChildhood Apraxia of Speech

‘CAS Therapy’ Principles Intervention is based on the principles of

motor learning. Intervention is characterised by motor

activities rather than conceptual activities. Intervention has habituation and then

automaticity as its ultimate goal, promoting intelligibility.


1. Use paired auditory and visual stimuli in intensive practice trials.

2. Train sound combinations (CV VC CVC …) rather than isolated phones. Not p-b-p-b; f-f-f!

3. Keep the focus in therapy (and at home) on movement performance drill. Feedback to the child should reflect this.

4. Use repetitive production trials / systematic drill as intensively as possible.

5. Carefully construct hierarchies of stimuli, using small steps.

CHILDHOOD APRAXIA OF SPEECH15 Points to Consider in Intervention


6. Use reduced production rate with proprioceptive monitoring (child’s self-monitoring). Prolong vowels.

7. Use simple carrier phrases and simple cloze tasks.

8. Pair movement sequences with suprasegmental facilitators: including stress, intonation and rhythm. Be thinking ‘prosodic contour’ of the utterance all the time! No . No? No! No . No . NO!!! Me . Me? Me! Me . Me . ME!!!

9. Use singing, whispering and loudness judiciously.

10. Establish a core vocabulary or a small number functional ‘power words’ (that make things happen) early in therapy, especially for non-verbal or minimally verbal children. BRAG BOOK.


11. Use sign / AAC to facilitate communication, intelligibility and language development, and to reduce frustration. Reassure families that AAC won’t get in the way of learning to speak.

12. Be flexible. Treatment changes over time. Signal changes and explain them to parents.Changes may be misconstrued.

13. Present regular, consistent, effective homework as a ‘given’, within reason.

14. Expect ‘good days and bad days’ in terms of the child’s performance.

15. The principles of motor learning apply to CAS dynamic assessment and therapy.


Motor Learning “A set of processes associated with

practice or experience leading to relatively permanent changes in the capability for movement.”

Schmidt, R.A., & Lee, T.D. (2000). Motor control and learning: A behavioral emphasis (3rd ed.). Champaign, IL: Human Kinetics.

Motor learning principles apply to CAS assessment and therapy

Precursors to Motor Learning1) Motivation2) Focused attention3) Pre-practice

phonetic placement training prior to entering the practice phase

Behaviour management plan for children who are ‘difficult’


Conditions of Practice Motivation Goal / target setting

what, how many times Instructions Modelling Setting and with whom etc

many factors, very ‘individual’


Practice Schedules

Repetitive drill

Massed vs. distributed practice

Random vs. blocked practice.


Repetitive motor drill There must be sufficient trials

(“repeats” of the target behaviour) within a practice session for any motor learning to take place, and for it to become habituated.

Habituation is a step towards more automatic speech output processing (automaticity).


Reinforcements (praise) should not take up too much time, or make too much noise, or “interrupt”, or distract.

Guide parents; model how to do it. Choose and develop appealing activities that

will facilitate / invite repeated opportunities for production of target behaviour / utterance.


Massed vs. distributed practice Massed:

Fewer but longer sessions.Quick development of skills.poor generalisation.

Distributed: The same duration of practice, distributed across more sessions. Takes longer. better motor learning.


In the ‘real world’ we may not HAVE a choice regarding practice distribution.

But we must decide which targetsto select and

how many targets to address concurrently…


…ensuring “homework implementers” know what to do, and how to do it,

and are aware of any changes.

Blocked vs. Random Practice Blocked practice

All practice trials (“repeats”) of a stimulus (“target”) are done in one time block before moving to the next target. Tends to lead to better performance.

Random practice The order of presentation of all stimuli is random through the session.Tends to lead to better retention,and hence better motor learning.


Feedback to the child: knowledge of ‘movement performance’ Essential to give a child frequent information

about his/her movement performance. Cognitive-motor literature reports that adults

benefit from finely specified feedback. Conversely, if feedback is too specific

children’s performance can decrease. Tailor the frequency of feedback to suit the

child (it can distract some children).


Rate of production trials Usually a trade-off between rate and

accuracy. Slower rate will, up to a point, increase

accuracy. Varying the expected rate of production

can be effective. It encourages habituation of articulatory

movement accuracy while working towards “automaticity”, a natural rate, and natural prosody.


Pre-practiceRecall that the Precursors to Motor Learning area) Motivation b) Focused attention c) Pre-practice Pre-practice involves phonetic

placement training prior to entering the practice phase.

For many clients it is inextricably bound up with stimulability training.


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