Innovations For Four Innovations

Addressing Single Sound 1. Shift to General Education (through

Articulation Errors In Speech Improvement Class)
2. Articulation Resource Center (ARC)
School Settings 3. Research-
Research-Based Methods
4. Required Home Practice
Jennifer Taps, M.A., CCC-
CCC-SLP
San Diego Unified School District
2007 ASHA Conference Boston, MA
November 15, 2007

Why Reform Social Ramifications

Crowe-
Crowe-Hall (1991)
„ 2004 Survey of 178 SDUSD SLPs „ Videos of kids with mild speech disorders and
„ 821 IEPs for SSADD only typical speech
„ 14 full-
full-time SLPs „ Interviewed 4th and 6th graders about their

„ Average length of treatment: 3 years

perceptions of these peer groups
„ Children with mild speech errors viewed more
„ Average amount of service: 30 min a wk
negatively than peers with typical speech
„ Most SLPs used traditional approach
„ Encouraged school districts to intervene because
of possible social and emotional impact
„ Compliance Review by CDE
„ Failed to establish educational need

The Reform
Innovation 1 – „ Shift speech service to students with single
sound articulation differences from special
Shift to General education to general education

Education
„ Offer students with single sound articulation
differences intensive short term high quality
services within general education

„ Provide intensive professional development and

support to district SLPs

Taps, San Diego Unified School District ASHA 2007

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Single Sound Cases Over Time Critical Reform Features
SSADD = Single Sound Artic. Differences and Disorders
Staskowski, M., & Rivera, E. (2005)
„ Well-
Well-organized set of procedures
„ Prioritizing time for SLPs
„ Buy-
Buy-In from Administration, Staff & Community
„ Proposal: Benefits and Phase-
Phase-In Implementation Plan
„ Meetings and workshops with stakeholders

„ Adherence to Special Education Eligibility Criteria

„ Articulation Resource Center & Articulation
Differences and Disorders Manual (and many
other resources)
„ Speech Improvement Class at Every Site
(gradually implemented)

Eligibility Requirements
„ In California Ed Code, student must meet ALL
three criteria to qualify for IEP services:
Significantly interferes with communication
AND
Attracts adverse attention
Articulation Differences
& Disorders Manual
(Dunaway, 2004)
http://csha.org/ResourceCenter/resourcecentermain.htm
(or csha.org Æ Resource Center Æ San Diego City Schools Manual)
„ Overview of Service Delivery Approaches
„ Performance-
Performance-Based Assessment Procedures
„ Screening, Full Assessment, IEP, 504
„ Protocols, Checklists, Rating Scales

AND „
„ Sample Report – section at beginning with IEP criteria
Speech Improvement Class
Adversely affects educational performance „ Description, Permission and Record Forms, Inventories
„ Intervention Approaches

SLP Benefits Student Benefits

„ Gradual implementation of SI class „ Access to high quality services
„ More technical support
„ Increased ability to manage workload „ Accurate diagnosis/identification
„ More latitude to decide who needs help & when „ Less treatment time
„ Programs allocates .5 day a week for Speech
Improvement: Counts 5 students toward „ Flexible scheduling
caseload total
„ Flexible scheduling „ Increased practice in classroom and
„ Wait list at home
„ Less paperwork
„ Introduce RTI to sites

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 ARC Coordinator
Innovation 2 – „ Two-
Two-day assignment

The Articulation „ Works from central location

„ Opportunities to educate, consult,

Resource Center model and coach

„ Service to staff not to individual
students
„ Cost-
Cost-effective

The ARC Provides... The ARC Provides...

„ Consultation (visits, e-
e-mails, phone calls) about „ Resources for and information about the
students with phonological or articulation needs Speech Improvement Class
„ Current research in assessment and intervention „ Library of resources, including research
„ ARC News articles, current phonological textbooks
„ Opportunity for observation and some materials
„ Therapy materials created for specific methods „ Handouts on placement techniques,
„ Workshops regarding current techniques for randomized treatment, ways to generate
SLPs and SLPAs mass practice

Speech Differences
Speech „ Neutral term that refers to sound
production that does not match Standard
Differences and American English
Developmental
Disorders
„

„ Dialect
„ Second language acquisition

„ Idiosyncratic (mild distortion)

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Speech Deficit or Disorder
„ Atypical sound production that may
or may not Response to
„ affect
communication
„ drawadverse attention Intervention
„ impact educational performance

„ Phonological disorder, childhood

apraxia of speech or articulation
deficit

Tiers of Intervention Tier I Intervention

for Single Sounds
„ Layers of intervention
responding to student
TIER I: Core
needs „ Developmental information shared with
Each tier provides more
„
intense intervention teachers and parents (Tier I power point)
„ Aimed at preventing „ Teachers determine stimulability (given
TIER II: reading difficulties
Supplemental coaching)
TIER „ Teacher and family provide extra models
for target sounds & monitor progress
adapted from Vaughn, 2003, RtI Symposium
III
Intensive

Tier I Intervention Tier I Intervention -

for Single Sounds Recasts (Camarata, 1993)
„ Consistent visual cue given to child across „ “A critical element of naturalistic
environments (e.g., /s/ - running finger conversation training is that the clinician
down the arm) (Miccio & Elbert, 1996) maintains the integrity of the interaction
while providing the model.”
model.”
„ More time to respond
„ Conclusion: kids with sound errors may
„ If you cannot understand what the child require more relevant models of correct
says, say “I need help. Please help me productions than other children
understand…”
understand…” (take the communicative „ Other research bears this out –
burden off of the child) grammatical recasts, etc.

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 Tier II Intervention
for Single Sounds Who is the
Speech Improvement Class – twice a week for
Speech
„
30 minutes (intensive treatment)
„ Child given sufficient time for development
„ Ideally, extra services provided if sound not
acquired by age 7-7-7 ½
Improvement
„
„
Most treatment complete in 20 hours or fewer
Progress monitoring through conversation
Class for?
samples and Speech Improvement Sound
Inventory – samples target sounds in isolation,
words (singletons and clusters), sentences

Sound Acquisition Normative Data

„ A social interactive process that isn’
isn’t „ Unreliable
complete for some children until the age 8 „ Depends on the sample population
years, 5 months (speech normalization „ Children develop their sound repertoires
boundary – Shriberg et al, 1994) individually
„ Speech normalization boundary metric for „ Can provide general information about
SDUSD Speech Improvement Class sound development
„ Each child follows a unique developmental
timetable

Smit et al (1990) &

Smit (1993) Other
„

„
New data for Iowa and Nebraska
Cautioned against strict use of norms to
Considerations
guide treatment
„ New data about typical vs. atypical error „Typical or atypical patterns
patterns „Dialectical pattern

„Stimulable or nonstimulable sound

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 English Learner or
Atypical Patterns
Dialectical Patterns
„ Lateral /s/ and /z/ (and other sounds)
production not developmental (intervene „ Determine if difference is due to first
at any time) (Smit, 1993a) language pattern or dialect
„ Consider other atypical patterns „ e.g., child who speaks Spanish says [tʃ
[tʃ] for
/ʃ/
„ Treat atypical patterns first
„ e.g., child who speaks African-
African-American
English says [f] for /θ
/θ/

Ideal Candidates for

Stimulability
„ Stimulability for target sound
„ Research suggests that children who are
stimulable for target sounds will acquire
them without intervention (Gierut, 2007)
„ Monitor children in K and 1st grade –
intervention may not be warranted if child
is stimulable
the SI Class
„ 2nd or 3rd grade (ideally around age 7 - leaves
1.5 years before the speech normalization
boundary) (except for lateralized productions)
„ One sound/cognate (or two sounds)
„ Three IEP criteria not met - intelligibility,
adverse attention AND educational impact
„ Nonstimulable for target sounds (monitor kids
who are stimulable)
„ Motivated and willing to practice at home

SI Classes At Every Site Routes to Speech

„ Open to any grade level if the student is
motivated and will complete homework Improvement
May take a little longer at middle and high
Class &
„
school levels (past the speech
normalization boundary)
Procedures

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 1.Child Has Existing IEP –
Existing IEP Æ SIC
Student has IEP (from any district) Speech Improvement or
1. IEP Æ Dismiss from IEP Æ Consider Waitlist More Appropriate
SIC (often residual errors)
„ Ask teacher to complete Describing Speech
Misarticulations prior to meeting
„ Review progress at the annual IEP
„ If three criteria not met, consider dismissal
(following performance-
performance-based assessment)
„ Students may enroll in SIC

2. Child Has Existing IEP –

Existing IEP Æ IEP Stays on IEP (rare)
2. IEP Æ (Rarely) Keep on IEP
„ If only 30 minutes per week on IEP, consider
adding additional 30 minutes to accelerate
intervention

„ SLPs can do this in one of two ways:

1. Convene IEP to add 30 minutes (60 min/wk)
2. Add 30 minutes as a general education
service (30 minutes on IEP, 30 minutes SIC)

3. New Consultation –
New Student SIC or Waitlist
3. New student
Enroll in SI class
„ Teacher completes Describing Speech
Misarticulations
„ If three criteria not met and good
candidate for SI class, enroll in class

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 Procedures for SI Class
„ After parents sign and return, work with
teacher to schedule class time
„ Administer Speech Improvement Sound
Inventory for target sound prior class for
baseline
„ Provide daily home practice opportunities
„ Periodically check on progress and
communicate with parents and teacher
Procedures for Completion
„ Document attendance and homework
completion (on back of sound inventory)
„ Readminister Speech Improvement Sound
Inventory to compare with baseline
„ Conversation sample
„ Researchers have suggested 80% accuracy
in conversation adequate for dismissal
„ Award Certificate of Completion

Continuation of Services Other Odds & Ends

„ With proper techniques, most kids will fully „ Students not billed for MediCal
acquire and generalize the sound in ~20 hours
„ SLPs can mix students with and
„ Services can carry over to next school year without IEPs in a Speech
„ SLP’
SLP’s discretion about whether to continue for Improvement Class
others beyond 20 hours
„ Funding source – 15% of IDEA funds
„ Students past speech normalization boundary
may take longer for early intervening services
„ 71 students randomly selected – 76% finished „ SLPAs can implement class with
in 17 hours or fewer, other 24% required 25-
25-30 training
hours

File Contents Innovation 3 –

„

„
Signed Permission to Enroll
Describing Speech Misarticulations Form
Evidence-Based
„

„
Entry/Completion Form/Attendance
Speech Improvement Sound Inventory
Intervention
(before and after class) •Complexity Approaches (Phonemic)
„ Homework Contract/Documentation of
homework completion •Motor Learning Approach (Phonetic)

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A. Lynn Williams: Complexity
„ “Regardless of the placement on the
phonetic-
phonetic-phonemic continuum, children Approach
with speech disorders require aspects of
each in remediating their sound (What to Teach)
disorders.”
disorders.”
„Language
Laws
„Clusters

„Phonemic Targets

Complexity Approach
Principles (Phonemic)
Language Laws
„ Universals - implicational relationships
„ Guided by language laws and sound found across languages
features „ Laws can be used to guide treatment
„ Some laws applicable to SIC students
„ Treatment targets sounds - nonstimulable, „ Treating marked structures creates change
phonetically-
phonetically-complex and later-
later-developing in unmarked structures (Marked implies
unmarked)
„ Results in generalization to untreated
sounds and contexts

Phonemic Inventory Laws Phonemic Laws

„ Velars Æ Coronals (Stoel-
(Stoel-Gammon, 1996) „ Affricates Æ Fricatives (Gierut, 1990)
„ Teach affricates to create change in the
system

„ Fricatives Æ Stops (Dinnsen & Elbert, 1984)

„ Liquids Æ Nasals (Tyler & Figurski, 1994)
„ Voiced obstruents Æ Voiceless obstruents
(McReynolds & Jetzke, 1986)

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Distributional Laws
„ Stops in final position Æ Stops in initial
position (Rockman, 1983)
Clusters
„ Fricatives in initial position Æ Fricatives
in final position (Smith, 1973)

Syllable Structure Laws Syllable Structure Laws

„ Clusters Æ Singletons (Gallagher & Shriner, 1975) „ 3- element clusters Æ 2-element /s/ and non /s/
clusters (Gierut & Champion, 2001)*

„ Clusters Æ Affricates (Gierut & O’

O’Connor, 2002) „ 3-element clusters typically last sequences to be
acquired; therefore, complex targets
„ Fricative + Liquid Clusters Æ Stop + Liquid Clusters
(Elbert et al, 1984) *Caveat: 3-
3-element clusters impact both cluster
types and promote system-
system-wide change;
however, results significant only if consonant 2
„ Liquid-
Liquid-onset Clusters Æ Liquids in Coda Position and consonant 3 already in system (i.e. teach
/skr/ only if /k/ and /r/ already in inventory)
(Baertsch, 2002; Fikkert, 1994)

Clusters Probe
„ Independent probe (Taps, 2005)
„ Each cluster targeted 2-
2-3 times
„ Untreated words to measure progress
„ May need to provide cues to elicit target
words
„ Some pictures include more than one
target word (e.g. “spider”
spider” and “smile”
smile” for
the same picture)
„ Identify which clusters are in the system

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 Other Complex
Adjunct Clusters
Clusters
„ /sp/, /sk/, /st/
„ Refer to handout – Sonority Sequencing
„ SSP does not apply (Perhaps due to
Principle for Clusters
difference of -2)
„ Clusters from most complex (sm-(sm-, sn-
sn-) to least
„ Treating these may inhibit generalization
complex (tw-
(tw-, kw-
kw-)
to other clusters
„ If several clusters missing from repertoire,
„ Led to overgeneralization of /s/ onset
treat more complex clusters to create change
clusters
„ Ideally, three-
three-element clusters or other
complex clusters (if consonant 2 and
consonant 3 not in phonetic inventory)

Phonological and
Lexical Learning
Phonemic Targets „ Research positing interaction
between the two
„ Complex interaction between
Real or Nonsense phonology and lexicon
Words?
„ New area of focus

High Frequency vs.

Real Words Low Frequency Words
Current research suggests (see Morrisette & Gierut
(2005) and Storkel & Morrisette (2002)): „ High-
High-frequency words impacted treated
„ High-
High-frequency words have greater impact than sounds
treating low-
low-frequency words (treating real, „ Also within and across class generalization
common words)
„ Frequency – number of occurrences of given
word in a language (Morrisette, 1999) Æ high-
high- „ Low frequency words generalized across
frequency words recognized faster and are class only
therefore more resistant to slips of the tongue

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Neighborhood Density Low Density vs.
„ Neighborhood density – number of High Density Words
phonetically similar counterparts that
„ Both types of words yield change in child’
child’s
exist for a word based on one system
substitution, one deletion or addition
„ Choose words balanced in density (i.e. five
„ E.g. “feet”
feet” – fleet, meet, fee, eat, fit, high density and five low density)
fate, fete, etc. – 10
neighbors/counterparts
„ high-
high-density Æ 11 or more neighbors
„ low-
low-density Æ 10 or fewer neighbors

Combining Principles Web site

of High Frequency and http://128.252.27.56/Neighborhood/Home.asp
Density (Storkel, 2004) „ Identifies targets based on frequency and
density
„ Low-
Low-density „ High-
High-density „ Washington University in St. Louis

/r/ words /r/ words

„ “radio”
radio” „ “run”
run” „ Handout with high frequency words available
„ “read”
read” on web site – http://slpath.com
„ “river”
river”

Nonsense Words
„ Frequently utilized because these words are novel
and therefore not “frozen”
frozen” in a child’
child’s system
Motor Learning
„

„
May break into old pattern
Nonsense word stories give nonsense words a
Strategies
(How to Teach It)
sense of meaning (therefore phonemic value)
„ Nonsense words – character names and places
„ Can use nonsense words at different levels (single
words, conversation, story telling) •Three phases of motor learning
„ Picturable •Randomization

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 Traditional Approach vs.
Specificity of Learning Motor Learning Approach
„ “Specificity of learning”
learning” stipulates that the „ Both acknowledge different levels of
“most closely related movement/activity difficulty
creates most improvement in overall skill”
skill” „ Traditional – gradually gets more difficult
(Skelton, 2004) Æ 80% at the sound level, 80% at the
„ Practice connected, meaningful speech for syllable level, 80% at the word level, etc.
the most effective approach „ Motor learning – once sound established
„ Oral-
Oral-motor exercises less related and do in isolation/syllables Æ mix up levels
not create improvement in overall speech (move between various levels in given
intelligibility session)

Traditional Motor Learning Motor Learning Skill

conversation
Acquisition - Three
sentences
syllables

sentences
phrases
Phases (Phonetic)
(Skelton, 2004)
stories
words

sounds
phrases words

1. Pre-
Pre-practice/placement
stories

sentences
sounds
phrases
words syllables
2. Practice
syllables
Sound 80% accuracy in 3. Generalization
isolation and syllables
isolation

Motor Learning Skill Pre-Practice/Placement

Acquisition – Phase I Strategies
(Skelton, 2004)
„ What works for one child may not for
Pre-practice: Brief
1. Pre- another
placement/production phase (OK to
return to this phase at any time) „ Many SLPs not trained in this area

„ Teach target sound in isolation and „ Critical to have a variety of resources

syllables until 80% accurate „ Bauman-
Bauman-Waengler chapter
„ May need to teach new strategies or
„ Dr. Bleile’
Bleile’s book: Late Eight (Plural)
make phonetic adjustments in how
student produces the sound(s) „ Dr. Secord’
Secord’s book: Eliciting Sounds (rev.)

Taps, San Diego Unified School District ASHA 2007

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 Five Placement
Techniques
(Flipsen, 2002)
„ Imitation - visual or verbal cue
„ Shaping - shape from one sound to another (also
called sound modification)
„ Phonetic placement - describe how to make sound
by talking about articulators or through metaphors
„ Moto-
Moto-kinesthetic - stimulating sounds through use
of tongue depressors, etc.
„ Touch cues (e.g., PROMPT)

Motor Learning Skill Blocked vs. Random Practice

Acquisition – Phase II (Skelton, 2004)
(Skelton, 2004) „ Blocked practice (all practice
items of target stimulus practiced
2. Practice: Randomized variable
sequence of tasks together before moving on) Æ
„ Schema theory predicts greater transfer Better performance in given
and retention because “rules”
rules” are flexible sessions
„ Student practices at different levels or „ Randomized practice Æ Better
different numbers during each session
(more than one context - not “fixed”
fixed” at a
retention/motor learning
particular level as in traditional treatment)

Motor Learning Skill

Acquisition – Phase III
(Skelton, 2004)
3. Generalization: Practice skills in more Letting kids be kids
representative contexts of communication
„ Provides natural consequences of
performance, including a listener’
listener’s
reaction

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 Randomization Can Be Randomization Can
Accomplished By: Be Accomplished By:
„ Switching levels (words, „ Changing body position
sentences, conversation) (different actions) – standing,
sitting, jumping jacks, etc.
„ Switching the order of target
„ Self-monitoring while doing a
words
million things (as kids do)
„ Switching number of
„ Have kids brainstorm ideas
responses
„ Video

Randomization Can Be
Accomplished By Changing:
„ Stress
Feedback That
„ Intonation Fosters
„ Prosody

„ Rate of speech
Self-Monitoring
„ Emotional context - Video

„ Have kids brainstorm ideas

Delayed Feedback Kind of Feedback/Praise

„ Offer delayed feedback by waiting 5 seconds „ Praise that is nonspecific (“
(“Good job,”
job,”
„ More feedback during the pre-
pre-practice stage “Excellent”
Excellent”) can be viewed as insincere
than practice (the more specific to the process, „ Praise can undermine a child’
child’s self-
self-
the better) monitoring and self-
self-correction skills
„ Provides opportunity for child to assemble and (Donahue et al, 2004)
retrieve motor plans (Yorkston et al, 1999) „ Some children become so dependent on
„ Offers child more self-
self-monitoring opportunities praise that they lose ability to evaluate
own performance and fail to take pleasure
in own success (Burnett, 1991; Good, 1987)

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 Generalization Generalization
Koegel, Koegel, Voy & Ingram (1988) Koegel, Koegel, Voy & Ingram (1988)

„ Evaluated necessary conditions for „ Increased self-

self-monitoring led to
generalization to occur accuracy of production in all situations
„ Children taught self-
self-monitoring skills „ % of correct responses within clinic
within clinic (children become own unrelated to generalization
clinicians) „ Accuracy of self-
self-monitoring unrelated
„ Monitored own productions on wrist to generalization (kids who self-
self-
counters outside of clinic monitor correctly even intermittently
generalize)

Constructivist
Self-Monitoring
Strategies
„ Rating productions each day while talking
with family for five minutes (fridge log)
(Ertmer & Ertmer, 1998)
„ Encouraged child to employ metacognitive
„ Speech diary strategies (similar to those children who
„ Buzzing watches easily carried over learning)
„ Score caddy counters „ Ideas: child is the “leader”
leader” in authentic
www.outabounds.com/golf-
www.outabounds.com/golf-score-
score- situations to practice speech
counters-
counters-caddy-
caddy-golf-
golf-score-
score-counter.htm „ Student reflection during all aspects of the
„ Knitting counters process

Ways to Elicit
Mass Practice
Mass Practice „ Use tally counters to challenge students for
multiple productions (Go to
www.tallycounterstore.com)
www.tallycounterstore.com)
„ Have students subvocalize (“(“voices turned
off”
off”) during other students’
students’ turns to increase
the motor practice and number of practice
opportunities (may have to monitor initially)

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 Ways to Elicit
Mass Practice
„ Students track their totals using counters
„ Add up group total and have contests
across groups to see who produces the most
„ Multiply the group total by the number of
students if subvocalizing
„ E.g.: Group total (710) X students in group
(4) = 2,840 items for a 30 min. group
Ways to Elicit
Mass Practice
„ Manipulatives can be used for random activities
„ E.g., counting bears of various colors and
numbers (perhaps 25 total)
„ First turn: put all yellow bears in cup while
saying the practice items
„ Next turn: all the blue bears
„ Ensures randomized practice by doing
something different each turn

Centers
Centers „ Create centers like those in general
education
„ Students do something different every
(Taps, 2005) minute or so while practicing sounds

„ Three centers could include the following:

1. one child at the board saying words
2. one child telling SLP a story
3. one child lying on the floor while
practicing sentence

Centers
„ Encourages students to use good
sounds in variety of contexts and to
become own clinicians Activities
„ Say “switch”
switch” at random times for
them to move to a new station
„ Write the sequence for kids to follow,
such as
board Æ SLP Æ floor Æ board

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 Meaningful Contexts
(Hoffman & Norris, 2005) Treat Like Fluency
„ Provide multiple opportunities to produce Multiple, meaningful contexts
words in a range of simple to complex contexts „ Speech room
(repetitive modeling, redundancy, immediate „ Classroom
recasting all facilitate generalization) „ Playground
„ Intervention independent of communication „ Media center
(i.e. drill only) Æ child defaults to old motor „ Phone calls
pattern of speech used in communicative „ Front office
situation (generalization may take years) „ Recess

Sample Activities More Activities

„ Barrier games „ Role playing

„ Shopping for items with target „ Puppet shows

sounds „ Operator
„ Hide and seek „ Old way/New way
„ Guessing targets „ Guess Who
„ Retelling stories „ Fishing pond
„ What’
What’s in Ned’
Ned’s head?

Home Practice – A
Innovation 4 – Critical Component
Required Home „ General education Æ can require homework

ASHA NOMS – children who practiced at

Practice
„
home significantly more likely to generalize
than children who did not

„ Letter provided to SLPs to send to families

about the importance of home practice

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 Child with Limited
Homework Policy
Home Support
„ Initial letter home
„ SLP can arrange something creative for
extra practice in another environment
„ One homework assignment not
(speech buddy in class, practice in library
completed – courtesy call home
(explain policy again) during recess, etc.)

„ Second homework assignment – „ Something that promotes thinking and

move to next child on wait list practice outside of the speech room
(enough to motivate most families)

Home Practice Options

„ ARC open to SLPs and visitors by
Applying the
appointment for treatment materials
(homework practice sheets organized by
Four Innovations
„
target sound available)
Make sure that homework consistent with in Your District
practice during sessions (do not switch to
blocked practice if randomizing)
„ May need to modify existing sheets – ask
the kids for ideas

Four Innovations –
What You Can Do
1. Shift to General Education Services Æ
Implement process over time
THANK
2.

3.
Articulation Resource Center Æ Develop
a support within your district
Research-
Research-Based Methods Æ Apply in
YOU!
treatment jtaps@sandi.net
4. Home Practice Æ Require it to facilitate Resources available at
generalization http://slpath.com

Taps, San Diego Unified School District ASHA 2007

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 Best Practices
for SI Class
Summary of „ Consider whether or not differences are
developmental or dialect
Best Practices „

„
Treat lateral /s/ and /z/ as soon as possible
Treat around ages 7/7 ½ (time before speech
normalization boundary)
„ Intensity of service critical
„ Treat nonstimulable sounds
„ Use three stages of motor learning – pre-
pre-
practice, practice and generalization

Best Practices Best Practices

for SI Class for SI Class
„ Treat real words (high-
(high-frequency/low-
frequency/low-
density) Randomized tasks
„ Lots of opportunities in natural
communication
„ Conversational recasts
„ Delayed, occasional feedback (but specific
to problem-
problem-solving or effort)
„ Build self-
self-monitoring from beginning
„ Home practice

Data from SLPs for Single Sound

Students (July 04, July 05, November
05, June 06, July 07, October 07)

Further July 2004

Sample size 178

Evidence
Total SSADD cases w/IEP 821
Total SSADD cases w/o IEP 0

July 2005
Sample size 159/203 (78% response rate)
Total SSADD cases w/IEP 560
Total SSADD cases w/out IEP 322

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 Data from SLPs for Single Sound Data from SLPs for Single Sound
Students (July 04, July 05, November Students (July 04, July 05, November
05, June 06, July 07, October 07) 05, June 06, July 07, October 07)
November 2005 July 2007
Sample size 199/207 (96% response rate) Sample size 199/207 (92% response rate)
Total SSADD cases w/IEP 147 Total SSADD cases w/IEP data unavailable
Total SSADD cases w/out IEP 273 Total SSADD cases w/out IEP 569

June 2006 October 2007

Sample size 195/223 (88% response rate) Sample size 240/255 (94% response rate)
Total SSADD cases w/IEP 46 Total SSADD cases w/IEP 95
Total SSADD cases w/out IEP 415 Total SSADD cases w/out IEP 470

Matched Pairs Analysis Matched Pairs Analysis

July 04, July 05, November 05, July 04, July 05, November 05,
June 06, October 2007 June 06, October 2007
July 2004 Nov 2005
Total cases SSADD w/IEP 101
Total cases SSADD w/IEP 573
Average # per SLP 1.3
Average # per SLP 7.2
Total cases SSADD w/o IEP 162
July 2005 Average # per SLP 2.0
Total cases SSADD w/IEP 395
June 2006
Average # per SLP 4.9
Total cases SSADD w/IEP 32
Average # per SLP 0.4
Total cases SSADD w/o IEP 208
Average # per SLP 2.6 Total cases SSADD w/o IEP 225
Average # per SLP 3.4

Matched Pairs Analysis

Matched Pairs Average Over Time
July 04, July 05, November 05,
June 06, October 2007
October 2007
Total cases SSADD w/IEP 25
Average # per SLP 0.5

Total cases SSADD w/o IEP 156

Average # per SLP 2.8

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 Bibliography Bibliography
American Speech-
Speech-Language Hearing Association (n.d.) National Bauman-
Bauman-Waengler, J. (2004). Articulatory and phonological
Outcome Measurement System. Retrieved August 1, 2004, from impairments: A clinical focus. Needham Heights, MA: Allyn &
http://www.asha.org/members/research/NOMS/noms_data.htm Bacon.
Baertsch, K. (2002). An optimality theoretic approach to syllable
syllable Bernthal, J. & Bankson, N. (2003). Articulation and Phonological
structure: The split margin hierarchy. Unpublished doctoral Disorders. Needham Heights, MA: Allyn & Bacon.
dissertation, Indiana University, Bloomington. Bleile, K. (2004). Manual of Articulation and Phonological Disorders.
Barlow, J. (2004). Consonant clusters in phonological acquisition:
acquisition: San Diego, CA: Singular Publishing Group.
Applications to assessment and treatment. CSHA Magazine, Bleile, K. (2005). Late Eight. San Diego, CA: Plural Publishing.
Summer, 10-10-12. Camarata, S. (1993). The application of naturalistic conversation
conversation
Barlow, J. (2001). Recent advances in phonological theory and training to speech production in children with speech disabilities.
disabilities.
treatment. Language, Speech, and Hearing in the Schools, 32 (3), Journal of Applied Behavior Analysis 26(2):173–
26(2):173–182.
295 – 297. Crowe-
Crowe-Hall, B. (1991). Attitudes of fourth and sixth graders toward
peers with mild articulation disorders. Language, Speech, and
Barlow, J. A. (2001). The structure of /s/ sequences: Evidence from a Hearing Services in Schools, 22, 334-
334-340.
disordered system. Journal of Child Language,
Language, 28,
28, 291-
291-324.
Dinnsen, D. A., & O'Connor, K. M. (2001). Implicationally related
related error
Barlow, J. A., & Gierut, J. A. (2002). Minimal pair approaches toto patterns and the selection of treatment targets. Language, Speech
phonological remediation. Seminars in Speech and Language,
Language, 23,
23, Schools, 32,
and Hearing Services in Schools, 32, 257-
257-270.
57-
57-68.

Bibliography Bibliography
Dinnsen, D. A., & O’
O’Connor, K. M. (2001). Typological predictions in Elbert, M., Dinnsen, D. A., & Powell, T. W. (1984). On the prediction
prediction of
developmental phonology. Journal of Child Language,
Language, 28,
28, 597-
597-618. phonologic generalization learning patterns. Journal of Speech and
Dinnsen, D.A., Chin, S.B., Elbert, M. & Powell, T.W. (1990). Some
Some Disorders, 49,
Hearing Disorders, 49, 309–
309–317.
constraints on functionally disordered phonologies. Journal of Ertmer, D. J., & Ertmer, P. A. (1998). Constructivist strategies
strategies in
Speech and Hearing Research, 33, 33, 28-
28-37. phonological intervention: Facilitating self-
self-regulation for carryover.
Dinnsen, D. & Elbert, M. (1984). On the relationship between Schools, 29,
Language, Speech, and Hearing Services in Schools, 29, 67-
67-75.
phonology and learning. In M. Elbert, D. Dinnsen & G. Weismer Fikkert, P. (1994). On the acquisition of prosodic structure. Dordrecht,
Dordrecht,
(Eds.), Phonological theory and the misarticulating child (ASHA the Netherlands: ICG.
Monographs, No. 22) (p. 5 -17) Rockville, MD: ASHA. Flipsen, P. (2002). http://web.utk.edu/~pflipsen/555-
http://web.utk.edu/~pflipsen/555-therapy.PDF
Dunaway, C. (2004). Articulation differences and disorders manual. Gallagher, R. & Shriner, T. (1975). Contextual variables related
related to
San Diego: San Diego City Schools Office of Instructional Support.
Support. inconsistent /s/ and /z/ productions in the spontaneous speech of of
Dweck, C. (1999). Self theories: Their role in motivation, personality children. Journal of Speech and Hearing Association Research, 18,
development. Philadelphia, PA: Psychology Press.
and development. 623 – 633.
Dyson, A.T. & Robinson, T.W. (1987). The effect of phonological Gierut, J.A. (2007). Phonological complexity and language learnability.
learnability.
analysis procedure on the selection of potential remediation targets.
targets. Speech-Language Pathology, 16, 6 – 17.
American Journal of Speech-
Language, Speech and Hearing Services in Schools, 18, 364-364-377. Gierut, J.A. (2004). Clinical application of phonological complexity.
complexity.
Elbert, M. & Gierut, J. (1986). Handbook of Clinical Phonology: CSHA Magazine, Summer, 7- 7-8.
Treatment. Boston: College-
Approaches to Assessment and Treatment. College-Hill
Press.

Bibliography Bibliography
Gierut, J. A. (2001). Complexity in phonological treatment: Clinical
Clinical Gierut, J.A. & Morrisette, M. (2005). The clinical significance of
factors. Language, Speech, and Hearing Services in Schools,
Schools, 32,
32, optimality theory for phonological disorders. Topics in Language
229-
229-241. Disorders. Clinical Perspectives on Speech Sound Disorders.
25(3):266 - 280.
25(3):266
Gierut, J.A. (1999). Syllable onsets: Clusters and adjuncts in
acquisition. Journal of Speech, Language and Hearing Gierut, J.A., Elbert, M., & Dinnsen, D.A. (1987). A functional analysis
Research, 42, 708 - 726. of phonological knowledge and generalization learning in
misarticulating children. Journal of Speech and Hearing Research,
Gierut, J.A. (1998). Treatment efficacy: Functional phonological
phonological 30, 462-479.
disorders in children. Journal of Speech, Language and Hearing
Research, 41, S85 – S100. Gierut, J.A. (1989). Maximal opposition approach to phonological
treatment. Journal of Speech and Hearing Disorders, 51, 324-336.
Gierut, J.A. (1990). Differential learning of phonological
oppositions. Journal of Speech and Hearing Research, 33, 540- 540- Glaspey, A. & Stoel-Gammon, C. (2005). Dynamic assessment in
549. phonological disorders. Topics in Language Disorders. Clinical
Perspectives on Speech Sound Disorders. 25(3):220 - 230.
Gierut, J. A., & O’
O’Connor, K. M. (2002). Precursors to onset clusters
in acquisition. Journal of Child Language,
Language, 29,
29, 495–
495–517. Green, J., Moore, M., Higashikawa, M., & Steeve, R. (2000). The
physiologic development of speechmotor control: Lip and jaw
Gierut, J.A. & Champion, A.H. (2001). Syllable onsets II: Three
Three- coordination. Journal of Speech, Language, and Hearing
element clusters in phonological treatment. Journal of Speech, Research, 43, 239–256.
Language and Hearing Research, 44, 886 -904.

Taps, San Diego Unified School District ASHA 2007

22
 Bibliography Bibliography
Jacoby, G., Lee, L., Kummer, A.W., Levin, L., Creaghead, N. (2002). The number Masterson, J. & Apel, K. (2006). Optimal Phonology Assessment: Making
of individual treatment units necessary to facilitate functional communication Sound Decisions. National CEU, Portland.
improvements in the speech and language of young children. American
Journal of Speech-Language Pathology, 370-380. Masterson, J., Bernhardt, B., & Hofheinz, M. (2005). A comparison
comparison of
Kamhi, A.G. & Pollock, K.E. (Eds.) (2005). Phonological Disorders in Children.
single word and conversational speech in phonological evaluation.
evaluation.
Baltimore: Brookes Publishing Co. American Journal of Speech-
Speech-Language Pathology, 14 (3), (3), 229 – 241.
Kamhi, A. G. (2006). Treatment decisions for children with speech-sound McReynolds, L. & Jetzke, E. (1986). Articulation generalization
generalization of voiced-
voiced-
disorders. Language, Speech & Hearing in Schools, 37, 280 – 283. voiceless sounds in hearing-
hearing-impaired children. Journal of Speech and
Kamhi, A. G. (2000). Practice makes perfect: The incompatibility of practicing Hearing Disorders, 51, 348 – 355.
speech and meaningful communication. Language, Speech, and Hearing Miccio, A. W. & Elbert, M. (1996). Enhancing stimulability: A treatment
Schools, 31,
Services in Schools, 31, 182–
182–186. program. Journal of Communication Disorders: Clinics Issue, 29,
Kehoe, M.M. (2001). Prosodic patterns in children’
children’s multisyllabic word 335 - 351.
productions. Language, Speech and Hearing Services in Schools, 32, 32, 284-
284- Miccio, A. W., Elbert, M., & Forrest, K. (1999). The relationship
295. relationship between
stimulability and phonological acquisition in children with normally
normally
Kollia, B. & Eisenberg, S. (2005, November). Children’
Children’s performance on five tests developing and disordered phonologies. American Journal of Speech-Speech-
of articulation and phonology. Poster presented at the American Speech-
Speech-
Language Hearing Association Convention, San Diego, CA. Pathology, 8, 347-
Language Pathology, 347-363.
Lof, G. (2006). Logic, Theory and Evidence Against the Use of Oral Motor Morrisette, M. L., & Gierut, J. A. (2002). Lexical organization and
Productions. Paper presented at the
Exercises to Change Speech Sound Productions. phonological change in treatment. Journal of Speech, Language and
American Speech-
Speech-Language Hearing Association Convention, Miami, FL. Research, 45,
Hearing Research, 45, 143-
143-159.

Bibliography Bibliography
Morrisette, M. L. (1999). Lexical characteristics of sound change. Clinical Rvachew, S. (2005). Stimulability and treatment success. Topics in Language
13, 219–
Linguistics & Phonetics, 13, 219–238. Disorders. Clinical Perspectives on Speech Sound Disorders. 25(3): 207 - 219.
25(3):207
Munson, B., Edwards, J. & Beckman, M.E. (2005). Phonological knowledge in Secord, W. (2007). Eliciting Sounds. Florence, KY: Thomson Delmar Learning.
typical and atypical speech-
speech-sound development. Topics in Language
Disorders. Clinical Perspectives on Speech Sound Disorders. 25(3): 190--206.
25(3):190 Shriberg, L. D., Gruber, F. A., & Kwiatkowski, J. (1994). Developmental
Developmental phonological
disorders III: Long-
Long-term speech-
speech-sound normalization. Journal of Speech and
Powell, T. W., Elbert, M. and Dinnsen, D.A. (1991) Stimulability
Stimulability as a factor in the Research, 37,
Hearing Research, 37, 1151–
1151–1177.
phonological generalization of misarticulating preschool children.
children. Journal of
Speech and Hearing Research, 34, 1318-
1318-28. Shriberg, L., & Kwiatkowski, J. (1982). Phonological disorders II:
II: A conceptual
framework for management. Journal of Speech and Hearing Disorders,
Disorders, 47,
47, 242–
242–
Ristuccia, C. (2000). Entire World of R. Tybee Island, GA: Say It Right. 256.
Ristuccia, C. (2004). Entire World of S & Z. Tybee Island, GA: Say It Right.
Skelton, S. & Kerber, J.R. (2005, November). Using concurrent treatment
treatment to teach
Ristuccia, C. (2004). Entire World of Sh and Ch. Tybee Island, GA: Say It Right . multiple phonemes to phonologically-
phonologically-disordered children. Poster presented at the
Ristuccia, C. & Ristuccia, J. (2006). The Entire World of R Book of Elicitation American Speech-
Speech-Language Hearing Association Convention, San Diego, CA.
Techniques. Tybee Island, GA: Say It Right. Skelton, S. (2004). Motor-
Motor-skill learning approach to the treatment of speech-
speech-sound
Rockman, B. (1983). An experimental investigation of generalization and disorders. CSHA Magazine, Summer, 8- 8-9.
individual differences in phonological training. Unpublished doctoral Skelton, S. (2004). Concurrent task sequencing in single-
single-phoneme phonologic
dissertation, Indiana University, Bloomington. treatment and generalization. Journal of Communication Disorders, 37, 131 –
155.

Bibliography Bibliography
Smit, A. (1993a). Phonologic error distributions in the Iowa-
Iowa-Nebraska Storkel, H. L., Hoover, J. R., & Young, J. M. (2004). Evidence-
Evidence-Based
articulation norms project: consonant singletons. Journal of Speech and Practice in Treatment of Preschool Children with Speech Delays:
Hearing Research, 36 (3), 533 – 547. What is the Evidence? [Handout]. Lawrence, Kansas: University of
Smit, A. (1993b). Phonologic error distributions in the Iowa-
Iowa-Nebraska Kansas.
articulation norms project: word-
word-initial consonant clusters. Journal of
Speech and Hearing Research, 36 (5), 931 - 947. Storkel H.L. & Morrisette, M. L. (2002). The lexicon and phonology:
phonology:
Smith, N. (1973). The Acquisition of Phonology. Cambridge: Cambridge
Interactions in language acquisition. Language, Speech and
University Press. Hearing Sciences in Schools, 33, 24 – 37.
Staskowski, M., & Rivera, E. (2005). Speech–
Speech–language pathologists’
pathologists’ Strand, E. & Kent, R. (2005). Treatment of Motor Speech Disorders
Disorders in
involvement in responsiveness to intervention activities: A complement
complement to Children: Dilemmas and Solutions. Presentation at the American
curriculum-
curriculum-relevant practice. Topics in Language Disorders, 25(2),
25(2), 132–
132– Speech-
Speech-Language Hearing Association Convention, San Diego, CA.
147. Taps, J. L. (2005). Randomized Principles and Practice. [Handout].
[Handout].
Steriade, D. (1990). Greek prosodies and the nature of syllabification.
syllabification. New San Diego, CA: San Diego Unified School District.
York: Garland Press.
Taps, J. L. (2005). Clusters Probe. [Handout]. San Diego, CA: San
Stoel-
Stoel-Gammon, C. (1996). On the acquisition of velars in English. In B.
B. Diego Unified School District.
Bernhardt, J. Gilbert, & D. Ingram ( Eds.), Proceedings of the UBC
UBC
International Conference on Phonological Acquisition ( pp. 201–
201–214). Tyler, A. A. and Figurski, G. R. (1994). Phonetic inventory changes
changes after
Somerville, MA: Cascadilla Press. treating distinctions along an implicational hierarchy. Clinical
Phonetics, 8, 91-
Linguistics & Phonetics, 91-107.

Taps, San Diego Unified School District ASHA 2007

23
 Bibliography
Weston, A., & Bain, B. (2003, November). Current v. evidenced-
evidenced-based
practice in phonological intervention: A dilemma. Poster session
presented at the Annual Convention of the American Speech-
Speech-
Language-
Language-Hearing Association, Chicago.
Williams, A. (2005). From developmental norms to distance metrics:
metrics:
Past, present, and future directions for target selection practices.
practices. In
A. Kamhi & K. Pollock ( Eds.), Phonological disorders in children:
children:
Clinical decision making in assessment and intervention (pp. 101–101–
108). Baltimore: Brookes.
Williams, A.L. (2005). Assessment, target Selection and intervention.
intervention.
Topics in Language Disorders. Clinical Perspectives on Speech
25(3):207 - 219.
Sound Disorders. 25(3):207
Yorkston, K.M., Beukelman, D.R., Strand, E.A. & Bell, K.R. (1999).
(1999).
Management of Motor Speech Disorders in Children and Adults.
Austin, TX: Pro-
Pro-Ed.

Taps, San Diego Unified School District ASHA 2007

24