Here are some of the basic of the basic considerations for the SLPs for Speech Therapy

1. Presented By – Piyush Malviya
Topic – Basic Considerations In Speech Therapy

2. Contents
• Target selection
• Basic framework for therapy
• Goal attack strategies
• Organizing group therapies
• Individual vs. group therapies

3. Target Selection
• The first step in programming is identification of the communication behaviors to be
acquired over the course of the treatment program.
• These therapy targets are often referred to as long-term goals.
• Initial information about potential therapy targets should be obtained by reviewing the
results of previous diagnostic findings.
• In addition, it is essential that a clinician consider the client’s cultural and linguistic
background when identifying potential therapy targets.
• Speech and language differences arising from dialect usage or a non-English native
language do not constitute a communicative disorder.
• This sampling is accomplished through the administration of pretreatment baselines.
• Baselines are clinician-designed measures that provide multiple opportunities for a
client to demonstrate a given communicative behavior.

4. • A good rule of thumb is to include a minimum of 20 stimuli on each pretreatment
baseline.
• The ratio of correct versus incorrect responses is calculated; the resulting percentage is
used to determine whether the behavior should be selected as a therapy target.
• Many clinicians view a performance level of 75% accuracy or higher as an indication
that the communication skill in question is not in need of remediation.
• Baseline measures that fall below the 75% accuracy level represent potential
intervention targets.
• Ultimately, however, the selection of appropriate therapy targets relies heavily on
clinical judgment. Some clinicians believe that behaviors that occur with at least 50%
accuracy represent targets with the best potential for improvement.
• Other clinicians argue strongly that behaviors with much lower baseline rates of
accuracy may be the most appropriate choices based on individual client
characteristics (e.g., intelligibility level, age, and so on).

5. • Often, clients present with several behaviors that qualify as candidates for
remediation.
• For individuals who demonstrate a large number of errors, clinicians may choose a
broad programming strategy that attacks as many targets as possible in a given time
frame.
• Alternatively, clinicians may select a deep programming strategy for clients who
demonstrate either relatively few or highly atypical errors. In addition, clinicians
typically employ one of two basic approaches for choosing among potential targets:
developmental/normative or client-specific.

6. The developmental/normative strategies
• This strategy is based on known normative sequences of communicative
behaviors in typically achieving individuals.
• Therapy targets are taught in the same general order as they emerge
developmentally. When two or more potential targets are identified from
baseline procedures, the earliest emerging behaviors are selected as the
first therapy objectives.
• For example - A 5-year-old child with an articulation disorder produces
the following speech sound errors on baseline procedures:
1. /p/ for /f/ as in pinger for f inger
2. /t/ for /ʃ/ as in tip for ship
3. /d/ for /dʒ/ as in duice for juice
4. /d/ for /b/ as in doat for boat

7. • Use of the developmental strategy guides the clinician to select /b/ as the initial therapy
target because typically developing children demonstrate mastery of this sound earlier
than the others.
• According to a developmental progression, /f/ is the next logical target, followed by /ʃ/
and /dʒ/.
• The developmental strategy tends to be most effective for articulation and language
intervention with children.
• This strategy has less application for adults and disorders of voice and fluency.
• A developmental strategy for target selection should be implemented with careful
consideration of at least two factors.
• The sample population from which the norms were derived may have been too small to
permit valid generalization of the findings to other populations.

8. Client specific strategy
• Using the client-specific strategy, therapy targets are chosen based on an individual’s
specific needs rather than according to developmental norms.
• Relevant factors in the selection of treatment objectives include:
(1) the frequency with which a specific communicative behavior occurs in a client’s daily
activities;
(2) the relative importance of a specific communicative behavior to the client, regardless of
how often it occurs; and
(3) the client’s potential for mastery of a given communication skill.
• This last factor addresses the notion of stimulability, which is typically defined as the degree
to which a client can approximate the correct production of an error pattern on imitation.

9. • Mr. Max Asquith, a 52-year-old computer programmer, demonstrates the following
speech and language characteristics on pretreatment baseline procedures:
1. Omission of final consonants such as /s/, /k/, and /θ/
2. Distortion of vowels in all word positions
3. Misarticulation of consonant blends such as /br/, /pl/, /fl/, /ks/, and /skw/
4. Omission of the copula forms (is and are) as in “He sad” for “He is sad”
5. Difficulty with the accurate use of spatial, temporal, and numerical vocabulary
6. Difficulty with subject-verb agreement, especially third-person singular constructions,
as in “He drink milk” for “He drinks milk”
• From the client-specific perspective, initial speech intervention targets could consist of
/ks/ and /skw/ because these blends occur in the client’s name and therefore constitute
a high priority for him.

10. Basic framework for therapy
• Speech therapy is the assessment and treatment of communication problems and
speech disorders. It is performed by speech-language pathologists (SLPs), which are
often referred to as speech therapists.
• Speech therapy techniques are used to improve communication.
• These include articulation therapy, language intervention activities, and others
depending on the type of speech or language disorder.
• Speech therapy may be needed for speech disorders that develop in childhood or
speech impairments in adults caused by an injury or illness, such as stroke or brain
injury.

11. Long term goals & Short Term Goals
• It is vital for the SLP to create long-term goals that will result in achievement of the
language disorder skills within a year.
• These goals are not designed in terms of what would be expected in language
production at your child's age.
• Long-term goals are written according to your child's language disorder.
• If your child has a receptive or expressive language disorder this means that he has the
inability to process language correctly during communication with others.
• The teacher may say "please sit down at your desk," but your child may interpret what
she heard as sit down.

12. • She may not process "at your desk."
• She may just sit down on the floor.
• An example of a long-term goal for a receptive disorder is "Christy will
understand and process others' speech, at an age-appropriate level as
compared to her peers within this school year."
• An expressive language disorder is the inability to express language
appropriately.
• A child with this type of disorder is unable to use correct word order. For
instance a child may say "swim water" for "I want to go swimming."

13. • Also, the child will misuse or not use the rules of proper grammar. A short-term
goal may be stated as "Christy will build her vocabulary by identifying picture
vocabulary in categories such as animals, school items and clothing in order to
increase her expressive language three to four months developmentally, as
measured by an age appropriate assessment."
• Building Christy's vocabulary and learning correct grammar are the short-term
objectives or goals, to reach the long-term goals of correcting the expressive
language disorder.

14. Treatment Approaches
• There are a variety of phonetic (i.e., articulation) and phonological (i.e., linguistic
rules) approaches to intervention.
• Williams, McLeod, and McCauley (2010) identified 23 approaches that have
been utilized in the treatment of speech sound disorders.
• Selected examples of classic and more recent remediation approaches are
described in the following sections.
1 - Traditional (Van Riper, 1978)
• This phonetic approach to intervention is also known as the sensory-perceptual
or motor- based approach.

15. • It relies on sensory training (i.e., auditory discrimination or “ear- training”)
either before or concurrently with speech production training to provide
the client with an internal standard with which to compare correct versus
incorrect productions of sounds.
2 - Motor-Kinesthetic (Stinchfield-Hawk & Young, 1938)
• This phonetic approach emphasizes development of correct movement
patterns and requires the clinician to manipulate the articulators to
facilitate sound production.
• This method is based on the assumption that it is possible to establish
positive kinesthetic and tactile feedback patterns through direct
manipulation of the client’s articulators.
• As a result of the feedback, the client is helped to recognize and then to
produce the movements of speech.
• In this approach, the basic unit of therapy is the isolated sound; only later
are words and sentence patterns introduced and established

16. 3 - Distinctive Features (McReynolds & Bennett, 1972)
• Distinctive feature therapy is a phonological approach based on the theory that
speech sounds can be defined in terms of articulatory patterns and acoustic
properties.
• Each phoneme in a language consists of a bundle of binary features, in which
the presence or absence of these features is specified (e.g., +voicing/−voicing,
+nasal/−nasal, +continuancy/− continuancy; Jakobson, 1968).
• Some phonemes, such as /t/ and /d/, differ by only one feature contrast, in this
case, voicing.
• Other phonemes, such as /s/ and /g/, differ by many feature contrasts, including
voicing, continuancy, placement, and stridency.

18. 4 - Paired Oppositions—Minimal and Maximal (Weiner, 1981)
• These phonologically based approaches target phonemic contrasts (errored
versus correct) that signal differences in meaning between two words.
• No explicit instruction on articulatory placement or sound production is given.
• Instead, this approach emphasizes the use of the child’s communication success
or breakdown to teach target sound productions.
5 - Phonological Processes (Oller, 1975)
• This phonological approach to intervention is based on the strategies used by
young, typically developing children between 1½ and 4 years of age to simplify
the production of an entire class of adult speech sounds (Hodson & Paden,
1981; Khan & Lewis, 2002).

19. • For example, young children frequently omit weakly stressed
syllables in multisyllabic words (e.g., ephant/elephant,
jamas/pajamas), reduce consonant clusters (e.g., bue/blue,
dek/desk), assimilate consonants in words (e.g., goggie/doggie,
chichen/chicken), and delete final consonants (e.g., ba/ball,
hou/house).

21. 6 - Cycles Approach
• One of the better-known phonological process intervention programs is the
“cycles” approach developed by Hodson and Paden (1983) that is intended for
children with highly unintelligible speech.
• The clinician identifies phonological patterns that are targeted for a designated
amount of time (i.e., cycles lasting 5–16 weeks).
• A typical session sequence includes:
(1) auditory bombardment,
(2) production training,
(3) stimulability probes, and
(4) take-home activities for generalization.

22. 7 - Core Vocabulary (Dodd, Holm, Crosbie, & McIntosh, 2010)
• This approach focuses on functional outcomes in which consistency, as opposed
to accuracy, is targeted.
• The SLP selects 50 to 70 “functionally powerful” words and targets up to 10 at
once.
• Children learn to produce their best pronunciation of the words consistently,
both in isolation and connected speech.
• It targets the ability to generate consistent plans for words; the ability to create
a phonological plan is improved by providing detailed, specific feedback about a
limited number of words.
• This approach relies heavily on systematic practice in a drill-like format.

23. 8 - Metaphon
• Developed by Howell and Dean (1994), this approach is more accurately labeled
a “philosophy” rather than a program; it is designed to provide children with
explicit information that will enable them to consciously reflect on the
phonemic structure of language.
• Heavy emphasis is placed on the child’s awareness/understanding of the
detailed aspects of speech sounds (separately from word meaning) to facilitate
accurate sound production.

24. Goal attack strategies
• A goal attack strategy refers to the way in which multiple goals are approached
or scheduled within an intervention session (Cirrin & Gillam, 2008).
• Three strategies have been identified:
• (a) a vertical goal attack strategy in which one goal at a time is targeted until a
predetermined level of accuracy is achieved,
• (b) a horizontal goal attack strategy in which several goals are targeted within
every session, and
• (c) a cyclic goal attack strategy in which several goals are targeted with a
repeating sequence, each for a specified time period independent of accuracy
(Cirrin & Gillam, 2008; Fey, 1986; Tyler et al., 2003).

25. • Each goal structuring method has advantages and disadvantages.
• Vertical structuring allows a practitioner to work on one goal at a time and a
child to achieve a high response rate for a single target in each session.
• The one-​goal strategy may help the child focus attention on the targeted skill.
However, vertical structuring may lead to a repetitious and potentially boring
intervention.
• In a horizontal structure, the practitioner presents two or more goals in the
same intervention session.
• The goals may target related behaviors (e.g., use of the be verb as a copula
[“The boy is a baseball player”] with a be verb as an auxiliary [“The boy is
throwing the ball”] or unrelated behaviors (e.g., a goal targeting syntax and a
goal targeting semantics).

26. • New goals are added as the child reaches predetermined criteria on each goal.
The amount of time to reach criteria will vary from goal to goal.
• One advantage of horizontal structuring is that the intervention session is not
too repetitive, and the child is less likely to be bored.
• Another advantage of a horizontal strategy is that as a primary goal is achieved
in a structured intervention context, the adult can relegate a primary goal to
secondary status.
• The interventionist regularly monitors a student’s use of secondary goals during
natural, spontaneous speech.
• In this way, newly learned communication behaviors are generalized to everyday
interactions.

27. • A disadvantage of horizontal structuring is that presenting multiple intervention
targets may cause confusion for children who are easily distracted or more
severely impaired.
• In a cyclic goal attack strategy, an interventionist moves through a series of
targeted goals using a predetermined schedule.
• For example, in the cyclic approach, Goal 1 is introduced during Week 1 and
Goal 2 during Week 2. The interventionist then cycles back to Goal 1 in Week 3
and Goal 2 during Week 4.
• The cyclic approach has features of both vertical and horizontal attack
strategies. When implementing the cyclic attack strategy, a practitioner
introduces a different goal each week and then moves from one goal to the
next, regardless of the child’s progress, or lack of progress, on a particular goal
(Williams, 2000).

28. • Over time, as the cycle is repeated, the child develops increased competency on
individual goals.
• Consider the following example of an intervention program that uses the cyclic
approach.
• The interventionist develops three goals for Macauley, a student who has
deficits in three areas: (1) third-​person verb errors (e.g., “He walk to
school,”“She drive the car”);
• (2) limited use of conjunctions, such as so and but (e.g., “The man wants a new
car, but he doesn’t have enough money”); and
• (3) poor comprehension of why questions. The interventionist writes a goal for
each of the targets:

29. 1. Macauley will produce third-​person regular verbs with 70% accuracy in focused
stimulation activities in which third-​person verbs are contrasted with regular
present progressive verbs (e.g., “What is the girl doing? She is walking her dog.
What does she like to do? She likes to walk her dog? Does she do it every day? Yes,
she walks her dog every day.”
2. Macauley will produce four to six sentences using coordinating conjunctions
during a retelling of a familiar fairy tale, with access to a written list of
coordinating conjunctions.
3. Macauley will produce three different why questions and answer at least three
different why questions during a shared book reading interaction using a first-
​grade-​level book.
• The three goals are targeted on a rotating basis, and the interventionist records
the child’s accuracy for each session.

30. • If a child reaches the criteria for a goal, a new goal is brought into the cycle, or
the goal is modified to elicit more independent and complex productions.
• Goals for which the child does not reach criteria continue to be targeted in the
cycle. The child learns some skills in a period of a few weeks, but other skills take
longer.
• The cyclic approach has been shown to be effective in teaching morphosyntax
skills to preschoolers (Tyler et al., 2003) and in teaching phonological skills
(Williams, 2000).
• A rationale for the cyclic approach is that goal mastery is developmental, and
children require varying levels of exposure to meet criteria (i.e., some targets
may be acquired with little stimulation, while others take more time).
• The disadvantage is that generally professionals need more skill and experience
to organize and maintain a cyclic intervention schedule.

31. Organizing therapy sessions
1. Organize your digital materials, so you can easily access them in a session.
Create Youtube Playlists for certain types of videos that you use most often.
Organize your no print or PDFs that you like to use digitally on your iPad by
folders in your Google drive.
2. Make copies of all those IEP forms, checklists, Health and Developmental, etc.
so you have a copy handy when you need to quickly put together a packet for
a family. Have extra copies of homework sheets, graphic organizers you use
often, or parent handouts.
3. Make a binder for something you have to reference often like your speech
referrals. When everything is in one place, it is easier to put speech referrals
or give forms to parents and teachers.

32. • Include parent consent forms, a log to list when you screened a student, developmental
norms, and whatever else you might need.
• Put helpful developmental milestones, parent permission slips and anything else I need
to store a hard copy of for teachers and parents. Here are some links to organizational
forms that have helped me or I stick in my binder for reference:
• Data Binder Forms that include parent permission slips for RTI intervention from
The Speech Bubble SLP (My district has their own template, so if you don’t have a
template, I recommend using these).
• Articulation & Language Flipbook Screeners that I tuck in the back flap of the binder
by The Dabbling Speechie (ME)
• Dual Language Cheat Sheet Guide to reference when getting a speech
referral/assessment for a student that has a primary language other than English by
The Dabbling Speechie

33. • Speech Sound Development Norms shown in the picture above by Rosie
Prehoda (FREE printable on TPT)
• Speech Sound Development Norms by Mommy Speech Therapy (FREE
download)
• Make a binder or therapy resource box filled with all the materials you need
for a certain skill.
• You have those students/groups where you have a plan in mind for therapy, but
prepping items for them each week is time consuming.
• So, make an /r/ and /s,z/ carryover binder filled with all the resources that I
need to treat that sound at the sentence, reading and conversation level. It has
books, reading passages, homework sheets, conversation starters, etc.

34. 4. Block out time in your week that is devoted to preparing materials that will
help reduce lesson planning time all year long.
• If you don’t dedicate and schedule in that time, it will either never get done or
you will stress doing it at home after a long day.
• Only prep those materials you need right now, or will be grab n’ go materials for
future sessions.
• If you are limited on time, don’t prep the WHOLE resource if you only need part
of it for the week.

35. Individual Therapy vs. group therapy
Individual Speech-Language Therapy
• Professional speech-language pathologists work with children individually to
provide intensive, one-on-one, family-centered therapeutic intervention.
• In conjunction with parents and caregivers, our speech-language pathologists
will develop an individualized therapy plan with short- and long-term goals
addressing specific areas of need.
• Therapy activities center on functional, contextual activities to improve skills, as
well as incorporate parent/caregiver training.

36. Group Therapy
• The use of a group therapy model requires attention to several unique aspects
of session design that are not pertinent to individual treatment.
• Unfortunately, there is a paucity of information on group intervention and even
less empirical study of this process in the field of speech-language pathology.
• However, group therapy is critical to any discussion of session design, because it
is a frequently used service delivery mode—in fact, it is becoming the dominant
model in many therapeutic settings (such as the public schools).
• Clinicians implement a group intervention model for a variety of purposes. Some
groups are intended to teach new communication skills at introductory levels.
• Others are designed primarily to provide clients with practice on skills previously
established in individual sessions.
• Still others have socialization, self help, or counseling as their main purpose.

37. • Group Size - The size of a group will vary depending on its purpose, the setting,
and client age.
• Groups whose primary purpose is to teach new skills tend to be smaller than
those geared for the generalization of previously mastered skills.
• Group size is also determined by the availability of clients in different service
delivery settings.
• Institutions such as metropolitan hospitals and public schools lend themselves
more readily to the formation of larger therapy groups than do private practices
or small clinics.

38. • Group Composition - The primary client characteristics to be considered in the
formation of a group are age, gender, disorder type, and disorder severity.
• Other factors that may be relevant to some groups include intelligence,
socioeconomic status, education level, and personality type.
• As a general rule, the two most important factors are client age and disorder
type.
• Effective groups tend to be relatively homogeneous with respect to one or both
of these variables. Clinicians may choose to organize groups in either a closed or
open format.
• Closed groups frequently operate for predetermined time periods and maintain
the same membership throughout.
• In contrast, open groups have revolving membership and accept new individuals
whenever space becomes available.

39. • Clinician’s Role. The role of the clinician is to function as group leader.
• Leadership style can be directive or nondirective.
• A directive style is typically used with groups composed of young children.
• In addition, it is more common in the early stages of therapy when a group
model is being used to teach new communication behaviors.
• In this role, the clinician sets the agenda, chooses the materials and activities,
provides specific instruction, and gives corrective feedback.
• A nondirective approach is more commonly used in the carryover stages of
therapy and with self-help groups.

40. • Procedures - Several procedures can be used in group settings to maintain the
active participation of all members throughout the entire session.
• In one method, the clinician presents a stimulus and pauses before choosing a
particular group member to respond.
• This strategy increases the likelihood that all members will pay attention and
prepare answers to every stimulus in anticipation of being called on.
• In another strategy, clients can take turns modeling target behaviors for other
group members to repeat in unison.
• Finally, clients can be required to listen, watch, and evaluate the performance of
a target behavior by fellow group members.
• Clinicians can use a variety of techniques to facilitate group interaction.

41. • The following examples are applicable to any type of communicative disorder:
■■ Reinforce client behaviors and comments that are consistent with treatment
goals.
■■ Model the target behaviors or techniques group members are attempting to
develop.
■■ Focus attention and group time on members who are making progress toward
established goals.
■■ Encourage interaction within the group by asking one member to demonstrate
a target behavior for the other members.
■■ Ask open-ended questions that require longer than one- or two-word
responses.
■■ Cue a group member to focus on a particular therapy target before she or he
begins speaking.

42. • ■■ Restructure comments or topics so they have appeal for all
members of the group. ■■ Use behaviors of individual members to
form generalizations that are applicable to the group as a whole.

43. References
• Language Disorders in Children Fundamental Concepts of
Assessment and Intervention – Joan N. Kaderavaek (2nd Edition)
• Treatment resource manual for speech language pathology – Froma
p Roth (5th Edition)
• Assessment and treatment of articulation & phonological disorders
In children M.N. Hegde (2nd Edition)

44. The end