Update on T...

I only have four more sessions with T, and I am happy to say that he has made some major progress in the last several weeks. His articulation is slowly improving, as well as his ability to answer questions appropriately. One thing he always gets stuck on is his age. When I ask him how old he is, he tells me his name. I have tried many times to explain that the answer to this questions is a number. If anyone else has suggestions, I welcome them!

We have been working with a lot of minimal pairs in the last few weeks. Sometimes when I ask T to "point to hall; point to call" he points to the correct one, but sometimes he does not. I don't know if he is guessing, but he seems to know the more common words. Some of the words in my list may be a little unfamiliar to him, which could certainly cause some confusion.

I have read that it is best to use minimal pair treatment when the target phoneme is completely absent from the child's phonological index (Barlow and Gierut, 2002). However, T's articulation is so inconsistent that I thought I would give it a try. It seems to be working, slowly.

My supervisor and I have also questioned if T may have a little bit of apraxia because of his inconsistencies. He can say a word one minute, and the next time he can't. Maybe this should be an area to investigate further in the next couple of weeks.

That's about all - I hope everyone enjoys the last two weeks of clinic!

Reference:
Barlow, Jessica A. and Gierut, Judith A. (2002) Minimal pair approaches to phonological remediation. Seminars in Speech and Language (23) 1; 57-67.

Second Semester

The second semester is almost halfway over already! I can not believe how quickly grad school is going. My new client this semester, T, is a VERY cute 3 year old with delayed speech and language. Last semester his goals were mostly focused on language: WH questions, yes/no questions, increasing MLU, etc. Apparently, he had a huge language "growth spurt" over the last several months, and his MLU seems to be right on target now. He still has some trouble with WH questions, especially "when" and "how." Right now I give him two choices while working on those questions, and he seems to be improving.

T's main problem, in my opinion, is not his language but his speech. He demonstrates everything that Dr. Ruscello taught us were red flags: initial consonant deletion, glottal stopping, and the occasional backing of sounds. He is stimulable for almost every sound, but his phonological rules are incomplete. For example: Last week we were working on the initial /p/ in /pIg/, and he would say /p....p....kIg/. I read a book of rhyming words to him (AKA minimal pairs), and this week I am going to include many more minimal pairs in the sessions. My goal is to teach him that he needs to make his sounds in the right places for people to understand him (Geirut, 1998). The challenge will be keeping his attention and finding fun activities to do while motivating him to improve his speech. He is extremely active and loves to change tasks often before we are really finished!

Reference:
Geirut, Judith A (1998). Treatment efficacy: Functional phonological disorders in children. Journal of Speech, Language, and Hearing Research, 41 (S85-S100).

Semester Wrap-up

D, the client I described in the previous post, has been progressing very well this semester. He has almost mastered the "sh" sound. When he is concentrating, he remembers to use "th" instead of "f," but he is having trouble generalizing to conversation.

Along with using minimal pairs, I have started working with his reading skills. D has trouble reading. When I realized this, I immediately began having a reading section in each therapy section. Because he gets frustrated easily, I try to make it fun and short.

I can tell that D is starting to recognize the phoneme-grapheme relationships. He sounds out words, and even though it takes him a while, he can usually figure out what each word says. This confirms what I read in the article, that reading improves with articulation therapy!

Stewart, Sharton R., Gonzalez, Lori S., Page, Judith L. (1997). Incidental learning of sight words during articulation training. Language, Speech, and Hearing Services in Schools (28) 115-126.

D is a very well-behaved 6-year-old who has several articulation problems. He has been receiving services at the WVU speech clinic since February 2006. He also goes to speech therapy in the schools. In the past, clinicians have worked on articulations of consonant clusters such as /gl, pl, kl, bl, and fl/.

D can make the voiceless “th” sound, but he substitutes /f/ in most cases. I decided to take a minimal pairs approach. I had flashcards of several examples, such as thread vs. Fred and free vs. three. I explained to D that if he says “free” when he means “three,” that people may be confused about what he is saying. Three and free have different meanings, and he has to use the “th” sound so that people will be able to understand him. We just learned about using the minimal pairs technique in one of our classes, and that is where I first got the idea to use it. I found a case study of two children having the same problem as D. In the study, the children corrected the substitution in targeted words, but did not generalize to words not used in therapy (Saben and Ingham, 1991).

D seemed to understand the concept that he needs to use “th” to be an accurate speaker of the language. When he is doing therapy activities, he concentrates on his speech and is over 90% accurate. However, when he is taking a small break, he reverts back to using the substitution. Hopefully he will begin to generalize soon!

References:

Saben, Cari B. and Ingham, Janis Costello (1991). The effects of minimal pairs treatment on the speech-sound production of two children with phonologic disorders. Journal of Speech and Hearing Research, 34, 1023-1040.