childhood apraxia of speech: disclosure the k-slp · pdf fileactivities, people/pet’s...
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
NancyR.Kaufman,M.A.,CCC/SLPKaufmanChildren’sCenterforSpeech,Language,
Sensory-Motor,AndSocialConnections,Inc.WestBloomfield,Michigan48322
Phone(248)737-3430• [email protected]
ChildhoodApraxiaofSpeech:TheK-SLPMethods&BehavioralStrategiestoBuildSuccessful
VocalCommunicationTheKaufmanChildren’sCenterforSpeech,Language,Sensory-Motor,&SocialConnections,Inc.isownedandoperatedbyNancyKaufman,MA,CCC-SLP.NancyhasdevelopedaspeechpraxistreatmentprogramknownastheKaufmanSpeechtoLanguageProtocol(K-SLP).SheistheauthoroftheK-SLPTreatmentKitsforChildren,theK-SLPWorkoutBook,theKaufmanMuttFamilyTotalLanguageBuilder,theK-SLPInstructionalDVD,andtheKaufmanSpeechPraxisTest.Nancyistheco-author,withTamaraS.Kasper,MS,CCC-SLP,BCBA,oftheK&KSigntoTalkNouns&Verbsprogram.Shebenefitsfromthesalesoftheseproducts,publishedbyNorthernSpeechServices.
Disclosure
TheKaufmanSpeechtoLanguageProtocolAmethodofpracticingsyllableshapegestures
andwordapproximationstowardtargetvocabularytobemoveddirectlyinto
functionalexpressivelanguage.
Typicaldevelopingtoddlerswhoarejustlearningtospeakrarelybegintospeakusingwholewords.Forexample,thewordbottle mightbeproducedinthissequence:
ba
baba
bado
bottle
Childrenwhostruggletospeakdonotgothroughthisprocessormaybestuckonapproximationsmuchlowerthantheircapability.
Continuouslyaskingthemtorepeatwholewordsissettingthemupforfailure!
Thehelpschildrenwhostruggletocombineconsonantsandvowelsto:
• Practice combining the consonantsandvowelswithintheirrepertoiretoformsyllableshapesofVV,CV,VC,CVCV,CV1CV2,CVC,C1V1C2V2,etc.usingrealwords.
• Practice simplenounstospontaneouslynamethem,developingvocabulary,andtoeventuallyaddaverbforatwo-wordutterance(eatapple).
• Practice functionalrequests(mands):on,off,out,open,come,go,watch,don’t,help,etc.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
The helpschildrenwhostruggletocombineconsonantsandvowelsto:
• Practice successiveapproximationstoward“favorites”andhigh-frequencywordsforrequestingandcommenting.
• Practice pivot(carrier)phrasestoimplementforexpressivelanguageformulation.
• Practice buildingsyntax,morphology,andgeneralexpressiveformulationtosociallanguagedevelopment.
Thewasestablishedwithrootsin…
• Appliedbehavioranalysis(ABA),andinparticularappliedverbalbehavior(AVB)
• Phonology/phonologicalprocesses• Acquiredapraxiaofspeech(literatureandresearch)especiallytheuseofmelodyandgesturestofacilitatecommunication
• Sensoryintegrationandpraxis• Currentneuroscience• Currentresearchinchildhoodapraxiaofspeech,especiallyprinciplesofmotorlearning
• ThoughABAisknowntoteachskillstothosewithautismspectrumdisorders,ithasafar-reachingcapacitytoteachanyskills/behaviors.
• The behavior terminABAisoftenassociatedwithextinguishingnegativebehaviorsthatcanbeinterferingtothelearningandsocialprocess.
AppliedVerbalBehavior&the
• However,ABAprinciplesareexcellentandhighlyresearchedteachingstrategiestoestablishorimproveuponbehaviors.
• Inthiscase,thebehaviorswewishtoestablishorimproveuponarethatofspeech-motorandexpressivelanguage (andlanguageprocessing/receptivelanguage).
• Appliedverbalbehavior(AVB)wouldbeamorespecificapproach,especiallywhenteachingthebehaviorofcommunication.
AppliedVerbalBehavior&the
Hereisanewbookonthisverysubject!
AppliedVerbalBehavior&theWhyShouldSLPsLearnthePrinciplesofBehaviorismandHowtoApplyThem?
Direct excerpt from Behavioral Principles in Communicative Disorders: Applications to Assessment and Treatment (Maul, Findlay, Adams)
Speech-language pathologists (SLPs) are in the business of changing communicative behaviors in the clients they serve. SLPs seek to establish new communicative behaviors in their clients, rehabilitate communicative behaviors that may have been lost, strengthen and maintain existing behaviors, and, often simultaneously, decrease communicative behaviors that are undesirable.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
WhyShouldSLPsLearnthePrinciplesofBehaviorismandHowtoApplyThem?
...The well researched principles of behaviorism, therefore, are highly relevant to the field of speech-language pathology because it is a science that has resulted in an evidence-based, systematic set of methods applied to modify the behaviors of others.
• AsSLPs,wewouldneedanadditionalmaster’sdegreetofullyunderstandAVB,withmanyhoursofsupervisedinstruction.Thoughthiswouldbeawonderfulidea,itwouldnotbefeasibleformostofus.
• Therefore,ageneralunderstandingofsometeachingstrategiesofABA,andspecificallyverbalbehavior(AVB)wouldhelpustobebetterclinicians.
• Hereare8AVBteachingstrategiestoimplementforCAS(orotherspeechandlanguagebehaviors).
AppliedVerbalBehavior&the
1. Pairing&establishingmotivation2. Definingthebehavior&datacollection3. Implementingshapingtechniques4. Errorlessteaching5. Implementingandfadingcues6. Differentialreinforcementanderrorcorrection7. Practiceschedulesforthenewbehavior8. Practicingnewskillsinthenatural
environment(coachingparents)
8TeachingStrategies 1• Weshouldneverunderestimatethepowerofmotivation!
• Determinethechild’shighlypreferred toys,activities,themes,characters,places(orfoods/drinksifunmotivatedbytheothers),andhavethemreadilyavailable.
• Afavoriteslistcanbeobtainedfromparentsandcaregivers.
• Ifthechildhasunusualinterests,roundtheseup(examples:surgicalgloves,eyeglasses,phones).
Pairing&EstablishingMotivation
TeachingStrategy
• Pairyourselfwiththechild’shighlypreferreditemsandactivitiesbybeing“theGiverofGoodThings.”
• Givethoseitemsorprovidethoseactivitiesfreely withoutexpectationofperformance.
• Graduallybegintoaskforasimpleperformancetask,suchasagross-motorimitation,orplacingapuzzleinoneavailableopening.
• Ifthechildunderstandsthetaskofimitation,attempttogainsimplegross-motormovementsorsimplevowels/consonants.
PairYourself
• Pairthechild’shighlypreferreditemsandactivitieswiththerapymaterialsorstimulusitems
• Whentheycomeout,sodotheirfavorites
PairItems&Activities
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Whenthereisanabsenceofimitationskills,consider:
• RapidMotorImitationAntecedentTraining
• SigntoTalk(Kasper&Kaufman)
• TamaraKasper’se-course,“ProgressiveandSystematicSpeechandLanguageTrainingforchildrenontheAutismSpectrum”(northernspeech.com)providesthespecificsaboutimplementingtheK-SLPwithspecialpopulationslikeASD.
• Definethebehaviortobeestablished,improvedupon,orextinguishedandreplaced.
• InCAS,theinitialbehavioristhatofspeech-motorplanningandprogrammingandeventuallyexpressivelanguagedevelopment.
• Thisisdonethroughtestingandobservation.
DefiningtheBehaviorTeachingStrategy2
DefinitionofCASpertheAmericanSpeechLanguageHearingAssociation’s(ASHA)AdHocCommitteeonChildhoodApraxiaofSpeech(2007):Childhoodapraxiaofspeech(CAS)isaneurologicalchildhood(pediatric)speechsounddisorderinwhichtheprecisionandconsistencyofmovementsunderlyingspeechareimpairedintheabsenceofneuromusculardeficits(e.g.,abnormalreflexes,abnormaltone).CASmayoccurasaresultofknownneurologicalimpairment,inassociationwithcomplexneurobehavioraldisordersofknownorunknownorigin,orasanidiopathicneurogenicspeechsounddisorder.Thecoreimpairmentinplanningand/orprogrammingspatiotemporalparametersofmovementsequencesresultsinerrorsinspeechsoundproductionandprosody.
Childhoodapraxiaofspeechcan andoftendoesco-existwithotherspeechandlanguagechallenges.Weneedtoconsiderthenatureoftheprimary interferingfactortosuccessfulvocallanguagedevelopment.
Signs&SymptomsofApraxiaofSpeechSource:CASANA/Apraxia-Kids.org
• Limitedrepertoireofvowels;lessdifferentiationbetweenvowelproductions;andvowelerrors,especiallydistortions.
• Variabilityoferrors(inconsistenterrorsonrepeatedtrials).
• Unusual,idiosyncraticerrorpatterns(sometimesdefyingtranscription).
• Errorsincreasewithlengthorcomplexityofutterances,suchasinmulti-syllabicorphoneticallychallengingwords.
Signs&SymptomsofApraxiaofSpeechSource:CASANA/Apraxia-Kids.org
• Dependingonlevelofseverity,achildmaybeabletoaccuratelyproducethetargetutteranceinonecontextbutisunabletoproducethesametargetaccuratelyinadifferentcontext.
• Moredifficultywithvolitional,self-initiatedutterancesascomparedtoover-learned,automatic,ormodeledutterances.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Signs&SymptomsofApraxiaofSpeechSource:CASANA/Apraxia-Kids.org
• Impairedrate/accuracyondiadochokinetictasks(alternatingmovementaccuracyormaximumrepetitionrateofsamesequencessuchas/pa/,/pa/,/pa/andmultiplephonemesequencessuchas“puhtuh kuh”)“DifferentialDiagnosisofChildrenwithSuspectedChildhoodApraxiaofSpeech.”(Murray,McCabe,Heard,&Ballard,2015)
Signs&SymptomsofApraxiaofSpeechSource:CASANA/Apraxia-Kids.org
• Disturbancesofprosodyincludingoverallslowrate;timingdeficitsindurationofsoundsandpausesbetweenandwithinsyllablescontributingtotheperceptionofexcessand/orequalstress,“choppy”andmonotonespeech.
• Atsomepointintime,gropingorobservablephysicalstruggleforarticulatorypositionmaybeobserved(possiblynotpresentonevaluation,butobservableatsomepointintreatment).
• Mayalsodemonstrateimpairedvolitionalnon-speechmovements(oralapraxia).
Signs&SymptomsofApraxiaofSpeechSource:CASANA/Apraxia-Kids.org
Nancy’sobservation:Verbalmotorperseveration:getting“stuck”onapreviouslyutteredword,anautomaticoroverusedword,orbringingspeech-motorelementsfromapreviouswordintothenextworduttered.
Signs&SymptomsofApraxiaofSpeechSource:CASANA/Apraxia-Kids.org
OthercharacteristicsthatmaydescribechildrenwithCAS,butarelesslikelytocontributetoadifferentialdiagnosisinclude:
• Poorspeechintelligibility• Delayedonsetofspeech• Limitedbabblingasaninfant• Restrictedsoundinventory• Lossofapparentlypreviouslyspokenwords
EarlyspeechsoundcharacteristicsofCAS:“Volubility,consonant,andsyllablecharacteristicsininfantsandtoddlerslaterdiagnosedwithchildhoodapraxiaofspeech:Apilotstudy.”(Overby &Caspari,2015).
• TheKaufmanSpeechPraxisTest(K-SPT)(WayneStateUniversityPress,1995)isatestthatprovidesuswithinformationaboutwhatvowels,consonants,andsyllableshapesarewithinthechild’srepertoire,andifcoreCAScharacteristicsareobservedinthechild’sresponses.
• Observation wouldprovideuswithspeechandlanguagebehaviorsthatmaybeidiosyncraticorhabituatedthatwouldneedtobeextinguishedandreplaced.
TheKaufmanSpeechPraxisTest
UsingtheKaufmanSpeechPraxisTestforChildren(KSPT),wecandetermineatwhatlevelachild’sspeech-motorskillsarecompromised,andwecantargetthoselevelsintreatment.
TheKSPThierarchyincludesthefollowing:
I.Grossoral-motormovements
TheKaufmanSpeechPraxisTest
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
II.SimpleLevel
1. Isolatedvowels– / a,E,�,I,Ã,u,i/
2. Voweltovowelmovement–/aI,oU,eI,aU,�I/(diphthongs)
3. CSimple– /m,b,p,t,d,n,h/
4. CVCV(reduplicatedsyllables)–mama,papa,dada
5. VCV– opa,ah-po,oh-bow
6. CV– da,me,bay,do
7. CV1CV2(repetitiveconsonantswithvowelchange)– mommy,daddy,puppy
8. CVC (assimilatedinitialandfinalconsonants)–pop,mom,bib
9. CVCCVC (initialandfinalconsonantinclusion)–man,home
10. C1V1C2V2(simplebisyllabics)–happy,tummy,bunny
11. CVCVCV(simplepolysyllabics)–banana,potato,tomato
III.ComplexLevel
ComplexC–/k,g,f,s,z,l,r,w,v,j,S,tS,dZ,P,D/
CVCCVC – complexinitialandfinalconsonantinclusion
Complexbisyllabics– candle,chicken,machine
Consonantblends– / r ,s ,l /
fàb (t,dàk,g)andbàf (k,gàt,d)words(alveolartovelarandvelartoalveolar)
Lengthandcomplexitywords:win,window,windowsill
IV.SpontaneousLengthandComplexity
Alex:Evaluation(age3.11)
• Grossoralmovementintact.• Awareofmoisturearoundmouth.• “Mommy”verbalperseveration(gettingstuckonanautomaticword)
• Deliberateproduction(evidenceofearlyprosodyissues).• NeedsbombardmentcuesforsimpleCVforaccuracy.• Overgeneralizationof“y”endingswhenaskedtoimitateCVCVsyllableshapes(baby,puppy,mommy,daddy).*Thisiswhyitisimportanttomixandvaryourtasks.
• Oralgropingtomaintainpositioning.• Voicingerrors.
Alex:Summary
• Canproduce/E/and/i/butcannotcombineintodiphthong/eI/asin“day.”
• VCVassimilation.
• Disintegrationwithextendedsyllabiclength.
• Receptivelanguagemoreadvancedthanexpressive.
• Stimulable forreducingcuestooralpostures.
• Distortedvowelsinconnectedspeech.
• Appearstobeawareofhiserrors.
Alex:Summary
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Tommy:KSPTEvaluation(age4.10)
• Grossoralmotorskillsaregenerallyintact
• Additions(initialconsonantspriortosomeisolatedvowels,addinga/t/,/d/,/h/
• Diphthongreductions/�I/asinboy
• Canproducesimpleconsonantsaccurately(tensevowelsareaccurate,justhaveprevocalicadditions)butstrugglestocombinethesemovements
• Vowelinaccuraciesincontext
Tommy:Summary
• Devoicing/b//z/• Voicinginitial/t/• Deletionofinitialconsonants• Deletionfinalconsonants(inconsistent)• Deletionmedialconsonants• Replacementsofmedialandfinalconsonants• Someinitial/h/wordsintact• Narrowrepertoireofcomplexconsonantsinisolation• Inaccuracyofcomplexconsonants
Tommy:Summary
• Inconsistencyonrepeatedtrials• Hassomeautowordsintact• Verbalmotorperseveration(getsstuckonapreviouslysuccessfulword,"hot/hop“)
• Difficultywithsyllablelength(evenwithCVCV)• Unintelligiblelengthofutterance• Unusualphonologicalprocesses(devoicing,nasalreplacements,initialconsonantdeletion)
• Receptivelanguagesuperiortohisspeech-motorandexpressivelanguageskills
Tommy:Summary
Speech-MotorBehaviors1. Syllableshapes(singlewordsfromK-SLPKit1)
NeedsallsyllableshapesfromCVCVtosimplemultisyllabics.
2. Namecommonnounswithbestapproximationstothetargetadultwordforms.
3. Favoriteslist:bestapproximationstowardtargetadultwordforms.
4. High-frequencywordstobeestablished.5. Producesimplemanding(requesting)words:
in,on,off,up,open,help,come,go,don’t,etc.
Tommy’sBehaviorstoEstablish,ImproveUpon,orExtinguish
ExpressiveLanguageBehaviors1. Usetheabovesinglewordsfunctionally.2. Learnpivotwordsandphrases(tobediscussed).3. Namethefunctionofobjectswithtwoandthree-
wordcombinations(subject-verb-object)4. Nameactionwithtwoandthree-word
combinations(S-V-O)5. Re-scripthisspontaneouscommunicative
attempts6. Moveaheadongrammaticalskillacquisition.
Tommy’sBehaviorstoEstablish,ImproveUpon,orExtinguish
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Tommy:Progress&CoachingMom Amber:Evaluation(age3.3)
Amber:Summary
• Struggle(headnodding)oninitiationofutterances.• Oralgroping,movementinsidetheoralcavity.• /n/in“no”asanautomaticbutunabletoproduce/n/ inothercontexts.
• CVCVbestskilleventhoughshehasCs&Vs,can’tcombine.
• Unintelligibleattemptsatspeaking.• Initialconsonantdeletionandfinalconsonantdeletion.
• Distractible,needstobeinmovement.• Needsvisualcuesforsuccess.
Amber:Progress(age3.6)
• Childrenwhocanproduceconsonantsandvowelsbutstruggletocombinethem.
• Childrenwhostruggletomaintainarticulatoryaccuracywhencombiningconsonantsandvowelsinconnectedspeech.
• Childrenwhounderstandthetaskandcanimitatevocal/verbalbehavior.
Candidatesforthe
1. Determinewhichvowels,consonantsandsyllableshapegestures thechildhasinhis/herrepertoireviatheKaufmanSpeechPraxisTestforChildren.
2. Establishfirstwords(consideringevaluationfindings),andbeginworkingonsyllableshapegestures,andcommonnouns,simplifyingthemotorplansifnecessary.
3. Establishalist offunctionalmands(requests)suchas,on,off,open,out,up,down,andhelp,includingalistoffavoritefoods,drinks,toys,activities,people/pet’snamesplaces,andhigh-frequencywords,establishingbestapproximationsforrequestingandcommenting.
SixStepsofthe
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
4. Helpthechildtocombinewordsthroughpivotwordsand(carrier)phrases,aswellastelegraphiclanguagestructures,toincludescriptingfunctionallanguage.Moveaheadonexpressivelanguage(combiningwords),andbackuponspeech-motor(clarity).
5. Refineandintegratecomplexconsonantsandsyllableshapegestures.Continuetobuildexpressivelanguagebyaddinginsyntaxandmorphology.
6. Establishahomeprogram.
SixStepsofthe 3• Shapingisamethodoftrainingabehaviorbywhichsuccessiveapproximationstowardatargetbehaviorarereinforced(PsychologyEncyclopedia).
• Understandingthebasicsofshaping,wecannarrowdownthebehaviorofspeechintocomponentparts(simplifythebehaviorormotorplan)andbuilditbackupbyusingcues,fadingcues,andimplementingreinforcementstrategically.
Shaping(B.F.Skinner)TeachingStrategy
Wecanimplementnaturalphonologicalprocesses tohelpchildrensimplifymotorplanswithbestapproximations…
Aphonologicalprocessisdefinedasasimplifyingdevice.Itisthewaythatadultphonologyissimplified,eitherlinguisticallyormotorically,basedontheprincipaloftheleastphysiologicaleffort.(Weiner,1979)
HowDoWeSimplifytheMotorPlansofWords?
AsSLPswecansimplifywordsfortemporaryfunctionallanguagebyteachingnaturalphonologicalprocesses
• Childrenwhostruggletospeakmaynotfollownaturalphonologicalprocessestosimplifytheirownspeakingattempts.
• Achildmaysimplifythemotorplanofawordmuchlowerthantheirmotoriccapability.
• Ifonlyacceptingthechild’s approximation,theywon’tprogresstowardtargetwords.
• ExposuretogoodspeechandlanguagerolemodelsisnotenoughtohelpthechildwithCAStosucceed.
• Speechmustbepracticedtobemastered.(Strand,2005;Maas,2008)
TheSLPcanimplementphonologicalprocessesasamethodofsimplifyingthemotorplanofwordsonamotorbasisclosertotheadultformofthewordgainingcloserapproximationsjustshortoffailuretosuccessfullyimitate.
ShapingWordApproximationsClinicalImplications
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Eachwordtaughtcanbesimplifiedbyreducingclusters,deletingfinalconsonants,voicingdevoicedconsonants...(naturalphonologicalprocessesemployedabovethelevelofthechild’sbestapproximationconsideringstimulability andcoarticulation).Wecancontinuetoassistthechildrentowardtheadultformofthewordasweprogressintherapy.
ShapingWordApproximationsClinicalImplications Theultimategoalistheabilityto
producewordsperfectly.
Teachingsuccessiveapproximationsofwordsisonly implementedwhenthechildisnotstimulable toaccuratelyproduceconsonants,vowels,orsyllableswithinwordsthatareimportanttothechild’scommunication.
SuccessiveapproximationsarerootedinthebehavioralprocessofSHAPING,originalprinciplesofB.F.Skinnerfromthe50’sand60’s(Skinner,1957).
TeachingSuccessiveApproximationstoSimplifytheMotorPlansofWords
• Whenchildrenareunabletoaccuratelyproduceasign,weoftenteachthemanapproximationasatemporarycommunication.Thisshouldholdtrueforspeechaswell.
• ThinkabouthowANYmotorskillistaught,suchashowtoplaytennisorshootabasket.Smallstepsarepracticeduntiltheycanbecoordinatedintotheentireskill.
• Thechildislikelycapableofabetterorcloserapproximationofawordthantheirownsimplification.
WhyTeachApproximations?(Ratherthantosimplyacceptthechild’sattempt)
• Approximationsgivethechildtheopportunitytouseawordtheywouldotherwisemaynothaveattempted.
• Thechildmaynotbestimulablefortheaccuracyofavowel,consonant,orsyllable,nomatterwhattechniqueswehaveimplement-ed.Wethereforecannotaffordtowaituntilthechildisstimulableforproductionofadifficultphonemetothenworkonwordsthatcontainthem,especiallyforhighlypreferreditemandactivityvocabulary.
Wordapproximationsaretemporaryandfunctional.Asthechildprogressesthroughtherapy,lesserapproximations(motorplans)arereplacedwithhigherapproximationsandultimatelyperfectionofwords.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Anywordcanbebrokendownintoalevelthatachildcanimitate
Nancy = complextwo-syllableword
Nan-tee = stoppingthe/s/
Nan-dee = stoppingthe/s/(andvoicing)Nae-nee = repetitiveconsonantswith
vowelchange
Nae-nae = reduplication
Nah-nah = vowelneutralization
Nae = syllabicreduction
spaghettiss-puh-geh-ti(segmentingsyllables)
puh-geh-tee(blendreduction)
puh-deh-tee(fronting)
buh-deh-dee(voicing)
__deh-dee(syllabicreduction)
Wecanuseourknowledgeofphonologicalprocessestohelpchildrenwithapraxiaofspeechsimplifywordsintobestapproximations:
Finalconsonantdeletion bafor ballInitialconsonantdeletion ine for mineMaynotbeanaturalprocessbutstillmayservetobethebestapproximation
Medialconsonantdeletion buh-ee for bunny
Clusterreduction top for stop
Reduplication wawa for water
Deaffrication ticken for chickenVowelneutralization nem for name
Stopping tum for thumb
Devoicing bik for big
Fronting tootie for cookie
Voicing doo for too
*Donotteachbacking,asitisnotanaturalprocess.
Example:
water = complexbisyllabicwa-tuh = simplebisyllabic
wa-duh = voicingandvowelneutralization
wa-wa = reduplication
wa = singlesyllable(CV)
oo-awoo-aw = simplifythemovementwithinadiphthong
Teachingwordapproximationsorsimplifyingthemotorplanhelpschildrenwhostruggletospeaktopracticefirstwordswithoutfailure.Thegoalistocontinuouslymoveapproximationstoward perfection.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Compensatoryplacements(simplifications)forisolatedconsonantsofwhichtheyarenotstimulable
• /t,d,n,l/dentalizetheseconsonants(tonguebetweenteeth)asamoregross-motorandvisibleproduction
• /p,t,k,s/orothervoicelessconsonantsfollowedbyvowels,allowerroneousvoicing/t/=/d//p/=/b//k/=/g//s/=/z/etc.
• /k,g/(initialandmedial)replacewith/t,d/frontingcut=tut
• /l/(initialandmedial)replacewith/w/or/j/look=wook
• /l/(final)replacewith/ou/asinbubbo/bubble
/� r/(final)replacewith/�/asinwatuh/water (vocalization)/S/replacewith/s/ shoe = soo (deaffrication)/tS/replacewith/t/ chair = tair (deaffrication)/dZ/replacewith/d/ jump = dump (deaffrication)/s/replacewith/t/or/d/ soup = toup (stopping)/z/replacewith/d/or/s/ zoo = doo (stopping)
= soo/f/replacewith/p/ fun = pun (labialization)/v/replacewith/b/ very = bery (labialization)
Oncethechildisstimulable foreachvowelandconsonant,extinguish thecompensatoryplacementandreplacewiththeaccurate phonemes.
• Segmentawayfinalconsonantsifinfluencinganerrorontheinitialconsonant.Thisshouldbedonewithoutavocalbreak,ifpossible.Prolongthevowelorusemelodytoavoidthevocalbreak.
• Avoidtheadditionofaschwa vowel,postfinalconsonant.
• Afteremphasizingsyllablestocorrecterrors(makingthemlouder),ensurethatappropriatestresspatternsarethenpracticed.(happyforacquisitiontohappyforretention)
MoreTipsinChoosingSuccessiveWordApproximationsTowardTargetVocabulary
• Continuetofocusuponconsonants,vowels,andsyllableshapesthatareinerrorbyreplacinglesserapproximationswithhigherapproximationstowardperfection.
• Implementingcues,andfadingcues,aswellaserrorlessteachingmethods(cueingbeforefailure)areparamounttotheK-SLPmethods.
EvaluationandTreatmentofChildhoodApraxiaofSpeech– availableintwoformats:• E-course(northernspeech.com)• K-SLPInstructionalDVD(kidspeech.com/dvd)
EightBehavioralTeachingStrategiesForTreatingChildhoodApraxiaOfSpeech(e-course,northernspeech.com)
LearnMore
TheApplicationoftheK-SLPforCAS&ASD
• “Apraxiaofspeechinchildrenandadolescents:Applicationsofneurosciencetodifferentialdiagnosisandintervention.”(Burns,2011)
• “Effectoftutor-modeledsuccessiveapproximationsversustutor-modeledadultformstoimprovetopographyoftacts.”(Eldridge,Kasper&Goodwin,2006)
• “EfficacyoftheKaufmanApproachinIncreasingSpeechOutputwithaLow-VerbalChildwithAutismSpectrumDisorder.”(Holbrook&Pelayo,2013)
• “Improvingthespeechproductionofchildrenwithautism.”(Sweeney-Kerwin,Carbone,etal,2006)
• “Improvingvocalverbalbehaviorviatutor-modeledsuccessiveapproximations.”(Kasper&Goodwin,2003)
Evidence-BasedPractice
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
TheApplicationoftheK-SLPforCAS&ASD
• “Increasingthevocalresponsesofchildrenwithautismanddevelopmentaldisabilitiesusingmanualsignmandtrainingandpromptdelay.”(Carboneetal,2010)
• “IntensiveCASsummerprogram:Boostorbust?”(Nancarrow,Kaufman,&Ficker,2013)
• “Shapingwordapproximationsforspeechintelligibility:Effectonlanguage.”(Nancarrow,Kaufman,&Burns,2009)
• “Treatingchildhoodapraxiaofspeech:EvaluatingtheKaufmanSpeechtoLanguageProtocol.”(Gomez,etal,2016)
Evidence-BasedPractice KaufmanSpeechtoLanguageProtocolTreatmentKitsforChildren:BasicLevel(kit1)andAdvanceLevel(kit2)
• TheK-SLPkitsprovideuswithstimuluspictureswhicharepracticedthroughsuccessiveapproximationstowardperfecttargetvocabulary.
• Kit1followsthesimplesyllableshapeswiththeearliestandeasiestconsonant-vowelcombinations.Itincludes/m,b,p,t,d,n,h,w/withvowelstoformsimplesyllableshapeswhichconstitutewholewords.
• Kit2helpswithmorecomplexconsonantandvowelcombinations andtoworkmorespecificallyonphonemesynthesis(consonantsthatareproducedaccuratelyinisolationthroughreplacedordeletedinconnectedspeech).
Thebacksofthecardsareonlysuggestions.Therearemanywaystosimplifywords,dependinguponthechild’sconsonantsandvowels.TheseshouldbepracticedwiththeguidanceofanSLP.
ballba-llbaw
wateroo-aterwa-tuhwawaaw-tuh
wa
• TheK-SLPkitsandSigntoTalkpicturesarejustone easywaytoprovidestimulusitemsrapidlyforpractice!
• Yes!Objectsandnaturalenvironmenttrainingareultimatelyhowtopracticeandretainfunctionalskills.
• But,picturesareinitiallymoreeasilyaccessibleandallowustochoosestimulusitemsefficiently.
AbouttheUseoftheK-SLPKitPictures… • Inadditiontotheuseofpicturesinitially,thereisalwaystheelementofplay,andthewordsassociatedwiththereinforcingtoysandactivities!
• TheapproximationsonthebacksofK-SLPkitsareonlymeanttobesuggestions andfollowtypicalphonologicaldevelopment.
• Approximationsaredeterminedonthebasisofwhatvowelsandconsonantsarewithinachild’srepertoire.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
• Theyaresimplifications ofthemotorplansofwordsorcompensatoryplacementsfordifficultphonemes.
• Ifyouareonlyusingthekitpicturesduringasession,youarenot implementingtheK-SLPthewayitisintended!
• ParentsandcaregiversshouldnotbeusingkitpicturesforhomepracticeunlesstheyareadvisedbytheirSLPastobestapproximationsandcuesforthatparticularchild,and thatthepicturesarepairedwithahighlypreferredtoyoractivity!
• TheK-SLPkitpicturesarejustoneofthefivelistsofsinglewordstopractice.
• Simultaneously,alongwithKit1syllableshapes,othersinglewordsarefocusedupon.
1. Simplesyllableshapes2. Simplecommonnouns3. Simplemands(requestingwords)4. Favorites5. High-frequencywords
GettingStarted:Single-WordLists
Syllableshapesforspeech-motorcoordination/planning(Kit1)CVCV,CV,VCV,CV1CV2,C1V1C2V2,etc.Forthosewithalimitedvowelandconsonantrepertoire.Makealistofthevowelsandconsonantsatthetopofyourpage.Pullthemdownintosimplewords.Havevisualreferencesofthewords.
List1:SyllableShapesPracticeWordsIftheyonlyhaveah,uh,eh,m,b,t,n,wecanestablishwordssuchas:mama
baba
nana=banana
mop
knot
knob
ten
ton
net
on
Exampleofachild’slimitedrepertoire:
Commonnounsofdifferentcategoriesthatlendthemselvestotheabilitytothennametheirfunction.
bubbles(blow) apple(eat)water(drink) ball(throw,kick,bounce)shoes(puton,wear) bike(ride)
List2:SimpleCommonNouns
Functionalwordswhichservetomanipulatetheenvironment.Thesecanbepairedwithagesture.Theyareoftenreferredtoas“powerwords.”
openonoffinouteat
updownyesnodon’tcatch
herethere/dehthis/disthat/datgodraw
comemamadadawatchlookread
List3:FunctionalMandingWords
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Veryoften,thefirstwordsorsignsSLPsandparentstendtoteachare:• more• want• please• help• (all)done• again
Althoughtheseareinitially effective,theybegintolosetheirpower.
Wordsthatbecomelesseffectivesingle-wordmands(requests)ifoverdone
• more
• want
• please
• help• alldone
• again
Unless theyareapivotwordinatwo-wordphrase.Why?
**Oncethesewordsaretaught,theremaybelessmotivationtolearnadditionalvocabulary
***Thechildmayonlylearnthatwhenusingthesesinglewords,goodthingswillprobablyhappen
Listoffavoritefoods,drinks,toys,activities,places,peopleandpetsnames,andfavoritecharacters.
Ifcolors,letters,ornumbersareofhighinterest,addthemtothefavoriteslist.
Thisiswheresimplificationofwordsismostnecessary
List4:FavoritesforMandingWords
Thesearewordsthatareoftensaidbutdon’tfittheothercategories,suchas:
please get byethankyou have awesomesee hi wow
Descriptivewordssuchas:colors,numbers,sizeandshape
Smalllinkingwordssuchasarticlesorauxiliaryverbssuchas:
a,an,the,is,to,are,was
List5:High-FrequencyWords
ListenerResponding(LR)=ReceptiveLanguageShowmeanapple.Showmesomethingweeat.Showmethestemoftheapple.Showmeafruit.
Echoic=VocalimitationSayapple.
Tact=LabelNamethis:apple.
TeachSingleWordsAcrossAllOperants Mand=RequestSayingthewordtogainaccesstoit.
Intraverbal=Fill-ins,answeringquestionsSomethingweeatisan____.Whatisthefruitthatgrowsontrees?
LiteracyWhichwordsaysapple?(pointresponse)Whatdoesthiswordsay?(apple)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
TreatmentTipsforEstablishingFirstWordsVocabulary
a. Gettheconsonantvowelpatternsthechildhasspontaneously,uponimitation.
b. Maketheconsonantsorvowelsmoregross-motorandvisible byexaggeratingthem–dentalizing/t,d,n.,l/orgutteral,openmouthed/k/
c. UsethepicturesinKit1forestablishingeasysyllableshapegesturesandforbestwordapproximationstothenbecomeavisualreferentforeventualspontaneousnaming.
d. Useconsonantsand/orvowelsthatarealreadyinthechild’srepertoire toformearlyvocabulary.
e. Reduplication isanearlyprocessandalsodoesnotincludefinalconsonants.Ifthechildonlyproducesasinglesyllable,bombardwithmorethantwo,andtheymightproducetwo:
mama dada papamoomoo baabaa hoohoo
booboo byebye wawa
nono
f. Finalconsonantsaredifficult.Choosewordsthatdonothavefinalconsonants:
(CVpatternsfromKit1):
me hi bye dough
two bee tea pea
no new now
CVCV,VCV,CV1CV2 andC1V1C2V2 alsodonothavefinalconsonants.Wecanachieveagreatdealofprogressbeforeevenmovingtowardfinalconsonantinclusion.
g. Initialconsonantsmaybedifficult,sochoosewordswithoutthem:
(VCofKit1):
up on in outoat eat ouch arm
h. Assimilation isaneasysimplificationofmanyCVCortwo-syllablewordswithbilabialtobilabialortipalveolartotipalveolar,sochoosewordslike:
pop mom bib dadpup toot mop mapboom mob tin tanknot dot den teddypuppy peppy dirty nuttywhoa wow
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
i. Itiseasiertovoiceintheinitialandmedialpositionsandtodevoiceinthefinalposition.Sochoosewordsthatstartwith/b,d,g/ andendwith/p,t,k/ (wheninKit1)
j. Tense vowels and diphthongs are difficultespecially if the child cannot produce /i/ as ineat or /u/ as in boo. We can neutralize thesevowels in a word to help the child produce aword approximation.
Tensevowels: Canbereplacedwith:/u/ asinboo /U/ asinbook/i/ asineat /I/ asinbit
Diphthongs: Canbereplacedwith:/oU/ asinoat /Ã/ asinnut/aI/ asinhigh /A/ asinhot/eI/ asinday /E/ asinbet/�I/ asinboy /�/ asinbought/j/ asinyesand /i/ plusnextvowelinword/w/ asinwant /u/ plusnextvowelinword
k. Considerco-articulation
/t,d/co-articulatebestwith/i/asinteaordeep.
/k,g/co-articulatebestwithneutralvowelssuchas/Ã,«/asincup,come,gum,andgutor/A/asincob,cot,orgob.
/m,p,b/co-articulatebestwith/Ã,«/ or/A/
l. Voiced,nasalcontinuants maybetheeasiestinitialconsonantstotargetastheycanbeprolongedbeforethevowel.
/m/
/n/
m. Tohelpwithinitialconsonantinclusion,keeptheinitialconsonantpairedwiththevowel,prolongthevowelandsegmentawaythefinalconsonantbyjustalittlebit.
ifboot=doot,tryboo-t
n. Ifboththeinitialandfinalconsonantarevoicelessconsonantssuchas/p,t,k/, practicethemwithoutthevowelinthemiddle.
Baeden:FirstWords
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Baeden:Progress(age2.9)
Hereisayoungchild(age2years,3months)whohascharacteristicsofCASbutnoformaldiagnosis.
ThegoalofstartingtheK-SLPistogainimitationofvowels,consonants,orsyllableshapes,andmakeitfunwhilecontinuingtoevaluateforCAS.
*Asyoucansee,nopicturesarenecessary.
Video:Knox’sFirstWords
Knox:FirstWords Hannah:Favorites
1. Imitationpluscues(auditory,visual,andtactilecuesifnecessary)
2. Imitationonlywithminimalcues(visualonly)
3. Spontaneouswithminimalcues(visualonly,suchasoralposturalorgestural)
4. Spontaneous
FourLevelsofChartingSyllableShapeGoals
Example:Thechildwillbeabletoproducesimplebisyllabicsinsuchwordsashappy,bunny,tuna,with(90%)accuracy.
Subgoals:a. Uponimitationwithcuesb. Uponimitationwithminimalcues(visualonly)c. Spontaneouslywithminimalcues(visualonly)d. Spontaneously
SettingIndividualEducationPlanning(IEP)Goals
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
James:FirstWords(age2.10)
James:SimpleBisyllabics(age3.5) James:GroupScripting
James:ExpressiveLanguage(age3.8) James:Progress(age5.3)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
James:Progress(age8) James:Progress(age11)
4• Errorlessteaching(orerrorlesslearning)isamethodofcueingbeforefailure.
• Errorlessteachingisatechniquethathelpschildrentoemitsuccessfulresponsesonagivengoal.Thereisanimmediatepromptorcuethatpreventsthechildfromemittingamistakeorerror,andthushelpsthemtopracticecorrectresponsesratherthanerrors.
• Childrenwillbemoreinclinedtocooperatewitherrorlessteaching.
ErrorlessTeaching/LearningTeachingStrategy
Whileestablishinga“core”vocabulary,cueswillbenecessarytoremindthechildofanewmotorsequenceforeachword(picture).Useasmanycuesasnecessaryforthechildtoreachhis/herbestwordapproximation(orwholeword),thenreduceeachcuesystematicallyuntilthechildcannamethepicturesspontaneouslyormandfortheirfavorites,usingtheirbestwordapproximationorwholetargetword.
1. Explanationcues“biteyourlipandblow”(for/f/)“openyourmouth”(for/k/ and/g/)
5 ImplementCuesTeachingStrategy
2.Visual/tactilephonetichandcuesforVOWELS(onoraroundtheclinician’sownmouth)
Visual/tactilephonetichandcuesforVOWELS(onoraroundtheclinician’sownmouth)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Visual/tactilephonetichandcuesforSIMPLECONSONANTS(onoraroundtheclinician’sownmouth)
3.Visual/tactilephonetichandcuesforSIMPLECONSONANTS(onoraroundtheclinician’sownmouth)
For/k/:Placeyourthumbunderneathyourchinandmakethemotionofpushingup(asinpushingupunderthetongue)withanopenmouthposition.
For/g/:Cupyourhandjustunderyourchinaroundtheneck.
For/S/:Placeyourindexfingeracrossthelipsverticallytomakethe“bequiet”signal(shhhh)orpinchthelateralportionofthelipstogether(forcingthelipstopucker).
For /tS/:Placethethumb,forefinger,andmiddlefingerabovetheupperlip.
For/dZ/:Placethethumb,middlefinger,andforefingerbelowthelowerlip.
For/s/:Putteethtogetherandshowthemwithopenedlipswhilemakingtheletter/s/intheair.
Forvoicing:Placeyourhandonyourthroat(asin“feeling”thevibrationofthevocalfolds).
Youcanalwayscreateyourownhandsignalsaslongastheyareconsistentforthechild.
(Carahaly,Speech-EZ)
4. ConcurrentcuesSaythewordtogetherwiththechild.
5. OralposturalcuesPlacingyourownarticulatorsvisiblyfortheinitial,medial,orfinalconsonantwithoutvoicing.
6. FirstconsonantorsyllablecuesSay,whisper,ororalposturethefirstconsonantorsyllableofawordorsubsequentwordsinaphrasesentence.
7. Contextualcues“Fillins”tosongs,books,andrhymes.
Fillintheblank:“Idrivethe_______.”“Thewheelsonthe________.”“Twinkletwinkle,little________.”
8. TouchcuesPhysicallytouchingyourbodyorthechild’sbodyforsyllabicemphasis(kneetoknee,handtohand,etc.)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
9. Alternatenamingforverbalmotormemory(breakingperseveration)Using2newwordapproximationsandhavingthechildnamethem,alternatingbetweenoneandanother.Often,thewordsmaybesimilar,andtriggersperseveration.Alternatingnamingbetweenthemwithcuesmayhelp,i.e.butter andbunny.
10. Pivotsyllables
ny:bunny,money,honey,Barney,Winnie,Ernie,beanie
ter:water,batter,meter,matter,Peter,butter
dle=/do/:puddle,needle,noodle,poodle,beetle
ble:bubble,marble,table,hobble,pebble
dy:muddy,body,Daddy,handy,candy,Heidi,Paddy
ty:potty,party,beauty,nutty,putty,Betty
*ty canbepronounceddy
11. Signlanguage/gesturalcuesUsesignsoruniversalgestures(Rosenbek,1984)SigntoTalkisawaytobridgesignlanguagetovocalcommunication(Kasper&Kaufman,2009)
12. WrittencuesHighlightingerrorssochildcanreadcues.
13. Answer-firstcuesGivetheanswerfirst.“Lookatherpainting.Whatisshedoing?”
14. DeletionofvowelinmonosyllabicwordsMovingfromtheinitialconsonantdirectlytothefinalconsonantwithoutthevowel,thenaddingthevowelbackin.
15. Backwardchainingontwoandthree-syllablewordsor“chunking”syllablesImitatingthelastvowelorconsonant-vowelofaword,andmovingbackwardorforwardlittlebylittle.
cookie bananaee nanakee ba-nanauh-keecookie
16. PictoralcuesRealpicturesorpictureswhichrepresentconsonants,i.e.clock =t-t-tEasyDoesItForApraxia(Strode&Chamberlain,1994)
17. IntensityPresentingthetarget(errored)syllablelouderinintensitythantheothersyllable.
18. MelodyUsingpitchvariationora“singsong”qualitytothestimulustargetword.MelodicIntonationTherapy(Sparks&Helm,1978)
19.AuditorycontrastcuesExample:pottyChildsays,teeteeClinicianshouldaskthechildtoproducetheirerroragainonimitation:Say,“teetee.”Nowtellthechildtosaypottywhileemphasizingthefirstsyllablelouderandwithadifferentpitchtodrawchild’sattentiontothesyllableinerror.
20.AuditorybombardmentcuesSaythesyllableinerrorthreetimes
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
21. WhispercuesWhisperthewordwhilethechildisattemptingit.
22. Automatic/familiarcontextasabridge(usingacontextalreadyinthechild’srepertoire)Ifthechildcannotsaytheworddown,havehimsay,dada (orawordthatstartswith/d/thatiseasilyintheirrepertoire)thenhavehimsay,down.
23. Phonicscues(sounds/letterassociation)ShowthealphabetletterofwhichthechildhasbeentaughttheassociatedphonicsExample:ShowtheletterSandthechildknowstosay,sss.
24. VisualhandcuesCanbeimplementedforarticlesandauxiliaryverbs.Examples:a,the,to,is
25. BreakingupdiphthongsintocomponentpartsExamples: bikewouldbebah-eek
namewouldbeneh-eemhomewouldbeho-oomhousewouldbeha-ooseboywouldbebaw-ee
(Avoidmakingavocalbreakbykeepingvoicingongoing)
26. TalkTools™(Rosenfeld-Johnson,TalkTools.com)
27. PROMPTsystem(Hayden)
28. Speech-EZ(Carahaly)
29. EasyDoesItforApraxiaandMotorPlanning(Strode&Chamberlain)
• Cuesareessentialforinitialsupport,but…THEYNEEDTOBEFADED.
• Theverylastutteranceachievedshouldbethechild’sbestapproximationorwholewordproducedwiththemostminimalcuesnecessary,ideallywithnocuesatall…spontaneousproductions!Andtheyshouldberepeatedafewtimesaswell.
FadingCues
1. Concurrent:Saythewholewordorphrasewiththechild.
2. Whisper:Whisperthewholewordorphrasewiththechild.
3. Provideoralposturalcueswithgestures.
4. Providegesturesonly.
5. Say,“useyourwords.”
ExamplesofFadingCues Emma:FirstWords(age4)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Emma:FadingOutMelodyforNamingSkills
Emma:Summary
1. Emmawasseatedatthetableforstructuralnaming.
2. ShethencontinuedinourABAprogramtolearnmorerequestinginthenaturalenvironment(andreceptivelanguageaswell)
3. Result:HandingabooktoDadandrequesting,readbook.
Group:ScriptingThroughMusic
Theincredibleprogressyouseeisduetotheteameffortbetweenmyselfandeachchild’sSLPs,parents,familymembers,andcaregivers…aswellasthechild’shardwork!
TreatmentisaCollaborativeEffort!
Olivia:TheK-SLPApproach(age6) Olivia:Progress(age8)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Jason:Bisyllabic&ExpressiveLanguage
AsdefinedbyAmyMeredith,PhD.CCC-SLP(apraxia-kids.org)
“Prosodyreferstointonation,stresspattern,loudnessvariations,pausing,andrhythm.Weexpressprosodymainlybyvaryingpitch,loudness,andduration.Wealsomayusegreaterarticulatoryforcetoemphasizeawordorphrase…”
• IntheK-SLPandanyCAStherapy,secondsyllablesorfinalsoundsoftenneedtobeemphasized.
Prosody
• InJason’scase,hewasmakingerrorsonsecondsyllables.
• Oncehewasabletoproducethesimplebisyllabicssuchas,muddy,table,happy, itwouldbeimportanttothenchangetheemphasistothefirstsyllablewhereitbelongs.
• Sooncehecouldsaytummy,Ishouldhavegonebackandhadhimproducethosewordswiththepropersyllablestress,tummy
• Asyoucanseeonhisprogressvideo,hisprosodyissuesarereduced,thoughcouldbeimproved.
Jason:Syntax&Morphology/Progress
Jordan:DownSyndrome(age7.4) 6
• Howreinforcementisprovidedalsofollowstheprinciplesofmotorlearning(Skinner,1957;Cooper,Heron&Heward,2007;Maas2008)
• Havethechild’shighlypreferredtoysandactivitiesavailableandreadytouse.
• Thesemightincludeless-ordinaryitemstogather(surgicalgloves,eyeglasses,phones,stimulatingitems).
DifferentialReinforcementAndErrorCorrection
TeachingStrategy
DifferentialReinforcement
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
• Thechild’shighlypreferredtoysandactivitiesmightincludeaneaselforpainting,playdough,trampoline,spraybottles,swing,slime,shavingcream,tobeusedforreinforcement.
• Thesemightalsoincludefoods(suppliedbyparentsduetodietsandallergies)
• Praisemaybeallthechildneeds,butagain,let’snotunderestimatethepoweroftangiblereinforcement!
• Foryoungchildren,feedbackmaybeabouthowmuchorhowlittlereinforcementisoffered.
• Forexample,smalleramountsoffoodforsmallerattemptsatthetask,largerforcloserattemptsorforgainingthetargetinfull.
• Forolderchildren,feedbackwouldbemoreexplanationastowhatwaspositiveornegativeregardingtheirattempt,andhowtoimproveuponthedesiredtargetresponse.
• Childmakesanerror(noreinforcement)
• Providecuesandsupportforsuccessfulutterance(giveasmallamountofreinforcementforthatutterance)
• Askagain,withfadedcuesthatwilllikelyresultinthedesiredutterance(givemorereinforcement)
• Gaintheutteranceoneortwomoretimes(givefullreinforcement)
Makethereinforcementreflectthelevelofindependence
ErrorCorrection Josie:FirstWords&UnusualReinforcers(age4)
Josie:Progress(age7)
27
K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Movingintowordcombinationstovaryinwithspeechtasksandpreparingforfunctionalpractice.
CombiningWords • CombiningwordsforfunctionalexpressivelanguageisanothergoaloftheK-SLP.Expressivelanguagetaskscanbemixedinwithspeech-motortasks.
• Helpthechildtocombinewordsthroughpivotwordsandphrases,aswellastelegraphiclanguagestructures,toincludescriptingfunctionallanguage.
• Moveaheadonexpressivelanguage(combiningwords),andbackuponspeech-motor(clarity)
Oncethechildhassomeconsistentwordapproximations,addwordsforatwo-wordphrase,suchaspivotwords(wordswhichremainconstant):my______open______help______want______no______on______tie______
move______more______hi______bye______red______big______hold______
draw/paint______tickle______push______take______wash______don’t______eat_______
*Addaperson’snamebeforeorafterthephrasetoengagethem.Mommyopen.
PivotWords
Iwant__________.
Ineed__________.
Iwantto__________.
Can(may)Ihave______?
Letme__________.
Putaway__________.
Puton__________.
Takeoff__________.
Pickup__________.
Watchme__________.
Drawa_________.
Ticklemy_________.
Come________withme.
CanIhavea_________?
Whereisthe_________?
ScriptFunctionalLanguagewithThree-WordPivotPhrases(ormore)
Sam:PivotPhrases
*withNicoleDevens,CarruthCenterHouston,TX
Sam:Progress
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Namingfunctionofobjects(S-V-O)Foreachconsistentwordapproximationorwholeword,ask…“whatdoyoudowitha…ball?”Helpthechildtorespond“Ithrowball.”Thismayevenbe“/A//to//b�/,”eachwordbeinganapproximation.
*Forsomechildrenwithautismspectrumdisorderswewouldnotworkonnamingfunctionbecauseitwouldnotnecessarilybeabridgetotheuseofthisstructure.
TelegraphicNamingofFunction&Action Hannah:S-V-ONamingFunction
Namingaction(S-V-O)
Presentanactionverbpictureandaskthechild“whatistheboydoing?”Patterntheresponse“boyeatapple.”Thismayhavetobe“/b�/ /i/ /Apo/,”eachwordbeinganapproximation.
*Age-appropriatesyntaxandmorphologywillbebuilt-inlater(pronouns,functionwords).
TelegraphicNamingofFunction&Action Kai:S-V-OAction
Braden:S-V-OPuzzle(age4.9) Alexine:RescriptingPivotPhrases(age3)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Alexine:Progress(age10)
“Girlpaintwater” “Boycutpaper”
K&KSigntoTalk– northernspeech.com
Presentasimple3-5picturesequencestory.AssistthechildwithanS-V-Oresponseforeach:
“Paddywakeup” “Paddygopotty”“Paddywashhands” “Paddybrushteeth”“Paddyputonclothes” “Paddyeatfood”
• Again,eachwordoftheS-V-Opatternmaystillhavetobeanapproximation.
• Moveaheadonexpressivelanguagewhilealwaysworkingonextinguishinglowerapproximationsandreplacingwithhigherapproximationstowardperfectarticulation.
SimpleSequenceStoriesforS-V-OStructures
KaufmanSpeechtoLanguageProtocolWorkoutBook
KaufmanSpeechtoLanguageProtocolWorkoutBook
Example:Thechildturnsthedoorknobandisunabletoopenthedoor.
Say: “Doyouwantmetoopenthedoor?”(usetheanswerwordswithinyourquestion)
GetbestapproximationforyesSay:“Tellmeyouwanttoopenthedoor.”Helpthechildtosay:“opuh do”or “Iwao-puh”or “o-puhpeez”or “o”(opendoor)(Iwantopen)(openplease)(open)*Eventuallyfadecues
ScriptingFunctionalLanguage
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Avoid askingopen-endedquestionssuchas:Whatdoyouwant?Whatdoyouwanttodo?Whathappened?Canyouuseyourwords?
HelpfulTipsforScriptingLanguage
Instead…
• Trytoanticipatewhatyourchildmightliketosayandputtheanswerin yourquestion:Doyouwanttogooutside?Tellmeyouwanttogooutside (thechildhearstheanswertwice).
• Helpthechildtoproducebestapproximationsandwordcombinationsfortheanswer.
HelpfulTipsforScriptingLanguage
Ethan:Rescripting Lizzie:SyllableShapes
Lizzie:Scripting Refinementandintegration(backuponspecificphonemesynthesis)
Begintobackuponspecificphonemesynthesis,wordinitial,medial,orfinal.Onceanewphonemeisproducedsuccessfullyinsynthesisatthewordlevel,youwillextinguishatemporaryphonemeorapproximationwiththisnewcorrectpattern.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Jason:Syntax&Morphology/Progress Tessa:SequenceStories
Inadvanceofthegame,knowhisgoals:• Final/s,z/inplurals,auxiliaryverbs(is,was)
andpossessivepronouns(his,hers),andininitialandfinalwordpositions(house,see)
• Velartoalveolarwords(got,get)• Initial/f/(found)
Alexander:TargetingSpeech&ExpressiveLanguageGoalswiththe“What’sinYourDoghouse?”TherapyTool
Alexander:TargetingSpeech&ExpressiveLanguageGoalswiththe“What’sinYourDoghouse?”TherapyTool
Try:
• RapidMotorImitationAntecedentTraining(Tsiouri,Paul,Simmons,Lewis,2012)
• SigntoTalk(Kasper&Kaufman,2009,2012)
WhatAboutChildrenWhoAreNotYetVocalCommunicators?
• RootedintheprinciplesofABA,butextensiveapplicationswithspeech-languagepathology
• RapidMotorImitationAntecedent(Tsiouri,Paul,Simmons,Lewis,2012)
• Focusesonestablishingstrongmotorimitationskills (rapid,fluentandgeneralized)toimproveattending,respondingandbehavioralmomentumtogetchildimitatingsoundsand/orwordstorequestpreferreditems
RapidMotorImitationTraining
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Sophie:RapidMotorImitationtoVocalImitation
Sophie:VocalImitation
Sophie:MandGo
Thefollowingisabrief,summarizeddescription.SigntoTalk takesagreatdealofexpertiseandtechniqueandisbestdonewithinanABAverbalbehaviorprogramwiththeguidanceofanSLP.
ThereisafullmanualwiththeK&KSigntoTalkkits.
SigntoTalk(Kasper&Kaufman,2009,2012)
Amethodtobridgesignlanguagetovocal/verbalcommunication(especiallyinASD)
1. Followthechild’sleadanddiscovertheirhighlypreferreditemsandactivities.
2. Whilethechildisshowingmotivationfortheitemoractivity,playfullyblockthemfromobtainingit,andhelptoshapetheirhandstomakethesignforit.
3. Saythewordfortheobjectoractivitythreetimes(inanaturalvoice).
SigntoTalk(Kasper&Kaufman,2009,2012) 4. Deliverasmallquantityoftheitem(ifpossible)orallowforshortaccesstotheactivity.
5. Thismayhavetobedonemanytimesuntilyourhandsarecomingtowardthechildtohelpthemtosignandtheyproducethesignwithouthelp.
6. Wewouldthenprovidemoreoftheitemoractivity(i.e.abiggerchunkofcookieormoretimetojumponthetrampoline).
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
7. Eventually,ifthechildneverattemptsthewordtheyhaveheardpairedwiththesign,stopreinforcingthesignonly– thechildmustvocalizewiththesign.
8. Shapethevocalizationtowardthewordthroughsuccessiveapproximations.
9. Ifthechilddoesnotvocalize,attemptRapidMotorImitationAntecedentTraining.
Kasper,T.&Kaufman,N.(kits2009,app2012).K&KSigntoTalk:ShapingVerbalLanguageforIndividualswithAutismandOtherDevelopmentalChallenges.Gaylord,MI:NorthernSpeechServices.
Somechildrenstruggletoproduceisolatedvowelsandconsonants.Acombinationofthefollowingmaybehelpful:
• OralPlacementTherapy(OPT)(ToincludeReneeRoyHill’sApraxiaShapes)
• Tactilecues(PROMPT)
• KaufmanSpeechtoLanguageProtocol(K-SLP)
• First,signlanguagewastaughtsohecouldrequesthighlypreferreditemsandactivities(Kasper&Kaufman,2009).
• Togainisolatedvowelsandconsonants,TalkTools™wereused.Thesearetoolsusedinsidetheoralcavitytoprovidetactile/proprioceptivecues.
üMickeyMouseearsusedfor/m/.ü Apraxiatactiletubefor/ou/asin“no”and
smalleronefor/u/asin“boot”(ReneeRoyHill)ü Bitestickswereusedfor/i/asin“eat.”
• TheseTalkTools™werethenfadedsothatthephonemeswereperformedwithnoassistance.
EstablishingFirstWordswithaMinimallyVocalChildwithASD TalkTools™for/m/and/i/
BiteSticksFadedfor/i/&TactileTubefor/oU/
EchoictoTactTransfer(ImitationtoNaming)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
PromptedMand(RequesttoReadBook)
PromptedTact(LabelingHisOwnActionWalkBaby)
Jayden:SigntoTalk Jayden:SigntoTalk
Jayden:VocalSkillProgress
• K&KSigntoTalk:ShapingVerbalLanguageforIndividualswithAutismandOtherDevelopmentalChallenges.(Kasper&Kaufman,2009,2011)
• ProgressiveandSystematicSpeechandLanguageTrainingforChildrenontheAutismSpectrum.(Kasper,2015)
• ASystematicApproachtoTeachingSpeechtoNon-VocalIndividualswithAutism(Roy-Hill&Solomon)
• RapidMotorImitationAntecedent(Tsiouri,Paul,Simmons,Lewis,2012)
MoreInformation…
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
7• Understandhowtoprovidefeedbackforretentiontooccurforthosewhounderstandlanguage.
• Mixandvarytaskstoavoidactuallyteachingovergeneralization.
• Understandtheprinciplesofmotorlearning.
PracticeSchedulesTeachingStrategy
Principlesofmotorlearningteachushowtoprovidefeedbacksothat:
• Thechildprogressesrapidlyintheacquisitionstageoflearning.
• Thechildretainsthenewmotor(speech)skills.
Moreonmotorlearningprinciples:
“Demystifyingtheprinciplesofmotorlearninginspeechtherapy.”(Maas,2013- webinar)
“Principlesofmotorlearningintreatmentofmotorspeechdisorders.“(Maas,2008)
The&MotorLearningPrinciples
• Providingtimely,powerful,andstrategicreinforcementorfeedbackisimportantwhenattemptingtochangeanygivenbehavior.ThisisacoreprincipleofABA.
• Feedback involvesprovidinglearnerswithinformationabouttheirresponses.
• Reinforcement affectsthetendencytomakeaspecificresponseagain.Usereinforcementespeciallyifthechilddoesnoteasilyunderstandlanguage(highlypreferredtoysoractivities/motivators).
Itisimportanttomovefromblockedpracticetomixingandvaryingtaskstoavoidteaching overgeneralization!
• Blockedpracticeiswhenalearnerperformsasingleskillrepetitiously.
• Randompracticeisworkingonanumberofdifficultskillsincombinationwitheachother…“Soone’scognitivesystemmustadapt,rethink,andsolvetheproblemofchoosingandexecutingappropriatemotorpatterns.”(Dr.AllisonBelger,athleteandPhDclinicalpsychologist)
Afterblockedpractice,randomizethepractice:
• MixtheorderofonesectionofKitpictures(shufflethedeckJ )
• VaryinanothersectionofKitpictures(shufflethedeckstogether)
• Varyinotherexpressivelanguagetasks
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
GenerallyforACQUISITION•Morefrequenttrials•Morefrequentreinforcement(mayhavetoreinforceforeachutterance)
•Keepstimulusitemsinpredictableandconsistentorder(easytargets)withsmallincrementstowarddifferenttargets•Provideasmanycues/supportsasnecessaryforsuccess.
GenerallyforRETENTION• Movetolessfrequenttrials(moretimeinbetween)
• Lessfrequentreinforcement(moreresponsesbeforereinforcement)
• Mixandvarystimulusitems(lessordered,morerandom,unpredictable,mixeasyanddifficult)
• Minimaltonocues/support
Gainingasmuchrepetitiononagoalaspossiblefollowscurrentneuroscienceonneuroplasticity.
Neuroplasticityisthebrain'samazingcapacitytochangeandadapt.Itreferstothephysiologicalchangesinthebrainthathappenastheresultofourinteractionswithourenvironment.Fromthetimethebrainbeginstodevelopinuterountilthedaywedie,theconnectionsamongthecellsinourbrainsreorganizeinresponsetoourchangingneeds.Thisdynamicprocessallowsustolearnfromandadapttodifferentexperiences.Huttenlocher(2002),Lomber&Eggermont(2006),Kadis,etal(2013),Sowell,etal(2004)
Neuroplasticity
• Repetition iskeyforCAS.
• Gain asmanyresponsesaspossibleinaplayfulwaywithstrategicreinforcementforretentionskills.Edeal,Gildersleeve-Neumann,2011Strand,2005Burns&Kaufman,2013
8• NET=NaturalEnvironmentTeaching
• Beawareoftheskillareasthathavebeenfocuseduponinstructure.
• Listsomeofthecorevocabularysinglewords,syllableshapewords,specificphonemesynthesisgoals,pivotphrases,andcues.
• Practicethesethroughplay.
NaturalEnvironmentTraining:PracticingNewSkillsintheNaturalEnvironment&CoachingParents
TeachingStrategy
Kiara:SeaWorldToy
• Personalizednotebooks/binders,iPadapps
• TheKaufmanSpeechtoLanguageProtocolWorkoutBook(canbeduplicated)
• TheK-SLPMuttFamilyPracticePuzzle
• Scriptfunctionalsingle-wordmands(requests)orpivotphrases
• Canusepictures,books,magnetics
• Andreal-lifeexperiences
HomeProgramSuggestions
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
• Canuserealphotostotellastoryaboutachild’sexperiences,example:goingtothezoo.(“Pictello”iPadappworkswellforthis.)
• iPadapps(seeapraxia-kids.org)
HomeProgramSuggestions
• Startwithmakingcomments
• Askquestionswiththeanswerembedded
• Scriptorre-scriptwithcuesandfadingcues
• Slidebackandforthbetweencommenting(andbeingquiet)toquestions
• Befun,silly,andabsurd
CoachingParents&CaregiversThroughPlay
• Noteinadvance:speech&languagegoals.Makenotesandfocusonthesewithallowingothererrorsgounnoticed.
• Establishpatterns:are/not,will/won’t,do/don’t,can/can’t,does/doesn’tor,why/because
• Possessives:Sheiswearingherdress.Heiseatinghiscake.
Oncechildrenareabletofirstberesponders,thentousevocallanguagefunctionally(pivotphrases),stopaskingquestionsandsimplymakestatementsand…wait.Maybe thebunnywantstohop.Iwonderifthezebraishungry.Look,thislionisnapping.Wow,thiscatislicking thebowl!Hey,therearenohippos.Or,makeanabsurdcommentlike:Iwonderwhatwouldhappenif thedogclimbedonthetable.
*Thechildwillnowenjoyopportunitiestocreatelanguageandtochimeinspontaneously!
Jayden&Parents Whenwecananticipatewhatachildistryingtoconvey(throughtheirnon-verbalorunintelligibleattempts):
• Helpthemtosayitwiththeirbestsingle-wordapproximations,phrases,orfullsentences!
• Don’tforgettofadeyourcues,orthechildrenwillsimplywaitforeachwordandnotmoveaheadtowardspontaneousspeechandlanguageskills!
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Pivotphrasenarrativescanbedoneusingreal-lifeactivities!
• Gettingreadyforschool
• Gettingreadyforbed• Settingorclearingthetable
• Takingouttoys,playingwiththem,andputtingthemaway
• Goinggroceryshoppingandalsobackathome:takingeachitemoutofthebagandputtingaway
• Games
• Playground
• School
• Holidays
• Birthdayparties
• …andmore!
ScripttheLanguageof:
• Allfamilymemberscanplaytogether,promotingturntakingandgoodsportsmanship.
• Scriptingthelanguageofgames.
• Practicingthe/g/ingo andthe/n/inno.
• Vowelaccuracy.
• Scriptingnegatives.
Sanders&theLanguageofGames Sanders:KSPTEvaluation
Sanders:WithFamily Sanders:Progress
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
CommonTherapyMistakes• Continuouslyandtirelesslyworkingonvocalimitationwhenitisunsuccessful(tryrapidmotorimitationantecedenttrainingorsignlanguageasabridge).
• Not pairingyourselfwithpleasurabletoysandactivities.
• BringingoutKitpictureswithoutpairingthemwithpleasurabletoysandactivities.
• Usingtoysandmaterialsthatarenotpreferredbythechild(buttheSLPsureenjoysthem)!
• Notprovidingpleasurablemotivatorsforchildrenwhoareusuallycompliantwithoutthem(orforolderchildren)whocouldalluseamotivator!
• Notprovidingtimelyreinforcementforthosewhomayneedamotivatoraftereachresponse.
• Havingthechildpracticerandomwordsthatarenotwithinthelistsofsyllableshapes,functionalwords,orlistoffavorites.
• Accepting thechild'sapproximationandmovingontoanotherwordwithoutattemptingtogainabetterapproximation,withcontinuouspractice.
CommonTherapyMistakes
• StickingonlywithKitpicturesandnotmovingaheadonotherpertinentvocabularylistsorfunctionalexpressivelanguage.
• Givingfullimitationandcuesandnotmovingthemastepfurther togainingthelastresponsetobeasspontaneousaspossible,withcontinuouspractice.
• Forgettingtofadecuesorscriptingeachandeverywordwithoutfadingtoinitialconsonantcues,whispers,oralposturesorgestures.
• Addingaschwa"uh"afterafinalconsonant.
CommonTherapyMistakes
• Forgettingtomodelcorrectly,butwhenhelpingthechildtorespond,gainingthebestapproximation.
• Promotingovergeneralizationduetolackofmixingorvaryingtasks.
• Notgainingenoughresponseswithinasessionforcarryovertotakeplace.
• Waiting forthechildtohaveperfectarticulationofasignificantnumberofsinglewordsbefore assistingthemtocombinetwoandthree-wordphrases.
CommonTherapyMistakes• Scriptingtoomanywords(orhighlevelsofsyntaxandmorphology)beforethechildisready.
• Segmentinginitialconsonants.Shouldkeepthempaired(glued)tothevowelifpossible.
CommonTherapyMistakes
40
K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Andrea:Pre(age3) Andrea:Progress(age13)
Drew:Pre(age3) Drew:Progress(age4)
Drew:Progress(age10) Stephen:Pre(age3)
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Stephen:Post(age18)
PraxisRequiresPractice
Nancy’sFavoritesK-SLPKits1and2,WorkoutBook,MuttFamilyPracticePuzzle,K&KSigntoTalk,
Nancy’sFavorites• InadditiontotheK-SLPmaterials:
• Trainsetswithmanylarge,easypieces
• Windups,smallandlarge
• Push-downorpull-backtoysthatshootforward
• Largeslidewithabucketreadytocatchitems
• Means-endscausalitytoys
Nancy’sFavorites• Binofcharacters(stuffedanimalspreferred):• Winnie,Barney,Minnie,BugsBunny,Ernie(nypivotsyllables)
• SesameStreet,FindingNemo,ToyStory,Frozen,andPawPatrolcharacters
• Familycharactersofdifferentethnicgroups• Animals,oceancharacters
Nancy’sFavorites• Toyhouseholdfurnitureandplaygroundequipment(slide,swing,chairs,tables,beds,potty,cars,etc)
• Bookswithoutwords,orwithasimplesequencestory
• Musicaltoysthatonlyplayforabriefmoment• Magnetics,Colorformsorreusablestickers
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
Nancy’sFavorites• Stim Toys.(Koosh balls,wandsthatspin,squishytoys,playdough,lightups,fidgets)
• Blocks
• Simpleboardgames
• DVDplayerwithremote
• Puzzlesthat“talk”
• iPad• Balltoys
• AmericanSpeech-Language-HearingAssociation.(2007).Childhoodapraxiaofspeech(positionstatement).asha.org/policy
• Barbera,M.L.,&Rasmussen,T.(2007). TheVerbalBehaviorApproach:HowtoTeachChildrenwithAutismandRelatedDisorders.London:JessicaKingsleyPublishers.
• Burns,M.&Kaufman,N.(2013).BridgingneurosciencetoclinicalskillsinCASandotherspeechsounddisorders.PresentedattheAmericanSpeech-Language-HearingConvention,ChicagoIL.
• Carahaly,Lynn.TheSpeech-EZApraxiaProgram.speech-ez.com
• Carbone,V.J.,Sweeney-Kerwin,E.J.,Attanasio,V.,Kasper,T.Increasingthevocalresponsesofchildrenwithautismanddevelopmentaldisabilitiesusingmanualsignmandtrainingandpromptdelay.JournalofAppliedBehaviorAnalysis,43, 4,705-9.
• Caspari,S.&Overby,M.(2012).Earlyphoneticandphonologicalcharacteristicsofchildhoodapraxiaofspeech.PresentedattheAmericanSpeech-Language-HearingAssociationNationalConvention,Atlanta,GA.,SanDiego,CA.
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K-SLP Methods & Behavioral Strategies to Build Successful Vocal CommunicationNancy R. Kaufman, MA, CCC-SLP
GO SSLP Best Practices ConferenceAtlanta, GA – March 9, 2018
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