Language Disorders: Chapter 3

Discuss the uses of computers in language intervention (2)

USE OF COMPUTERS: (1) as a context in treatment: Computer games/programs function as a topic of conversation - clinician and client can generate a story etc. (2) as a word processer to facilitate the dev't of written lang skills; "talking" word processors can also provide aud feedback that helps clients develop better sense of audience, as well as i.d. grammatical errors

Define and give examples of the zone of proximal development

ZPD = the distance between child's current level of independent functioning and potential level of performance; defines what child is ready to learn with some help of a competent adult. EXAMPLE: Goal of production of the plural morpheme is performed at 80% correct, then this is within child's current knowledge base; at 40% this may be within the ZPD).

How can functional use of communication be evaluated? (4 tasks)

- Communicative behaviours can be assessed in a core set of salient contexts: i.e.: -role-playing tasks - narrative tasks - structured peer interactions - natural observation in real settings

Define and discuss levels of prevention identified by ASHA

- Primary - Secondary - Tertiary

What primary intervention strategies are appropriate for disorders of genetic and chromosomal origin?

1. Proper health and medical care including immunizations and prenatal care 2. Public education 3. Genetic Counseling. 4. Mass screening and early identification 5. Environmental quality control 6. Governmental action 7. Elimination of poverty

What kinds of primary prevention efforts are appropriate for SLPs?

1. Wellness promotion - Optimizing Psychological, Physical and Behavioral well being 2. Family - Centered intervention

Name the three basic approaches to intervention discussed in this chapter. Give an example activity for teaching "is (verb)ing" as it might be done in each approach.

3 BASIC APPROACHES TO INTERVENTION: (1) Client-Directed Approach = clinician specifies all aspects of the intervention ; less naturalistic ; allow clinicians to max the opportunities for child ; using "Drill", "Drill Play", "Modeling". (2) Child-Centred Approach = (aka indirect lang stimulation); from child's POV the intervention is just play/conversation ; no tangible R+; follow child's lead, only feedback ; using "self talk / parallel talk", "Imitations", "Expansions", "Extensions", "Buildups&Breakdowns", "Recast Sentences". (3) Hybrid Approach = target small set of specific lang goals ; clinician maintains some control in selecting activities by tempting child; using ling stimuli to respond and model forms being targeted ; using "Focused Stim", "Vertical Structuring", "Milieu Comm Training", "Script Therapy".

What are the three basic purposes of intervention?

3 BASIC PURPOSES OF INTERVENTION & EXAMPLE: (1) To change/eliminate the underlying problem (2) To change the disorder; improve the child's discrete aspects of language function by teaching specific behaviors; *make child better communicator (3) To teach compensatory strategies - not specific language behaviors; clinician gives tools so client can function better with the deficits

What are three ways that intervention can change language behavior?

3 WAYS: (1) Facilitation = accelerating the rate of growth/learning of a final outcome that would have naturally happened bring language to a higher level of awareness thus influencing other areas of dev't. (i.e. facilitating correction of articulating errors greater self esteem etc) (2) Maintenance = preserving a behavior that would otherwise decrease/disappear ; keeping an immature sys intact so that it can reach full dev't at later stage (i.e. maintaining babbling) (3) Induction = reaching an endpoint which without intervention, could not be achieved; (i.e. client learns sign language

Prevalence

Tota rate or proportion of cases in a population at, or during a specified time period. Prevalence is the actual number of cases alive, with the disease either during a period of time (period prevalence) or at a particular date in time (point prevalence).

Name and define the four models of contexts for language intervention. Give situations in which each one would be the best choice for teaching use of the conjunctions "because", "unless", and "although".

4 MODELS OF CONTEXTS: (1) Clinical = "pull out" ; students are pulled out of the classroom to a private clinic room where one-to-one intervention can take place. (2) Consultative = determines all the intervention targets/procedures/contexts, but there is another agent of intervention so that SLP does not relate directly to client SLPA, classroom teacher, parent. (3) Language-based Classroom = SLP is a classroom teacher for a group of students with lang disorders (resource room). (4) Collaborative = SLP works with a student within the mainstream classroom, collaborating with the classroom teacher.

Describe five activities for promoting generalization of plural forms

5 ACTIVITIES: (1) Use many exemplars (2) Use sequential modification (practicing it in multiple settings) (3) Make treatment materials similar to things used in the natural environment (4) Intermittent/delayed R+ (fading out) (5) Introducing distracter items (semantically relevant but not direct targets of intervention to resemble natural conversation)

Why is it suggested that intervention focus on selecting production as a target response rather than comprehension?

BECAUSE: - Especially if the child already comprehends the form, then production training is indicated. If comprehension and production is not there yet for new forms, then guided production activities appear to facilitate both comprehension and production of new forms in children. *Behaviorists stress that production (by imitation) is the first step in lang learning to learn, the behavior must be reinforced, and to be reinforced, it must be produced.

Why is it important to evaluate the effectiveness of intervention (2)

BECAUSE: - it gives us the opportunity to show that the behavior we targeted in intervention improved more than other language behaviors that were not subjected to intervention. - ensure that time/money spent on intervention was worthwhile.

Discuss the considerations involved in determining the modality of language for the client to use. (AAC) (4)

CONSIDERATIONS INVOLVED in choosing AAC system: (1) Consider the choice of symbols: - Moving towards less iconicity with dev't (the degree to which the symbol visually resembles the referent). (2) Consider the choice of the interface: - with whatever motor abilities the client can muster. (3) Consider the ease, accuracy, efficiency with which client can use the sys. (4) Consider the client's comm partners

What is meant by the continuum of naturalness in intervention? Give examples of three activities and settings at different points along this continuum.

CONTINUUM OF NATURALNESS = the extent to which the settings and activities in intervention resemble "real life" or the world outside the clinic room. (1) Clinician-directed approach with massed discrete trial intervention and with R+ in clinic room. (2) Hybrid Approach with interactive activities that have been carefully arranged by clinician to elicit child initiations (Milieu Comm Training - incidental teaching method where child needs to initiate a request for objects arranged in the setting) (3) Child-centered approach with playing blocks with a child at their home; waiting and responding to child's leads; doing self-talk/parallel-talk.

What criteria are used to decide which goals identified in the assessment will be targeted in the intervention program? (4)

CRITERIA FOR DECIDING GOALS: (1) Communicative effectiveness = target behaviors that will increase a child's ability to comm; choose skills that readily accomplish social goals as highest priority. (2) Ensure that child is doing only one new thing at a time (3) Choose targets that fall within the phonological abilities of the client (i.e no words with 'esh' if it is not in the inventory yet. (4) Choose forms that are more teachable (i.e. 1. Easily demonstrated/pictured; 2. Taught through stimulus materials easily accessed ; 3. Used freq in naturally occurring activities. )

What is the role of the SLP in secondary prevention of communicative disorders?

Can and should be active participants, including early identification and treatment efforts, as well as in research programs to identify risk factors and preventative intervention methods.

Discuss the essential ingredients in successful intervention, and give examples of incorporating each into a therapy program (10)

ESSENTIAL INGREDIENTS: 1) Intensity = Daily/ 1.5 hours/ for 5-8 weeks (i.e. use intensive cycle scheduling) 2) Active engagement = sustaining client's active involvement (maintenance cueing, choosing activities that appeal) (i.e. provide pre-attentive stimulus "look at this") 3) Feedback = Info about accuracy of response (i.e. Give midly unpleasant response for incorrect answers - "clunk" computer noise. 4) REINFORCEMENT (R+) = Delivering a reward following a correct response (i.e. social praise/ extrinsic rewards) 5) Repetition = providing many opportunities for the clients to use new target (i.e. Drill play activities) (6) Use distributed practice = provide short intense periods of practice for new forms (i.e. structure sessions to include 5-10 min drill-play) (7) Specificity = children learn what they are taught (i.e. provide clear examples of their referents to teach lang comprehension) (8) control complexity = teach in the ZPD (i.e. provide lang that is a few morphemes longer than client's MLU) (9) Minimize error responses = provide adequate cueing and scaffolding (10) Work within schemas = embed practice of new forms within familiar sequences of actions. (i.e. yes/no questions within "Go Fish" game)

Give an example of a client for whom each would be used?

EXAMPLE: 1. Young child with brain injury -neural plasticity may lead to language learning proceeding normally again 2. Teach expanding number of words/grammatical morphemes in sentence, produce broader range of semantic relations; use language more flexible/appropriately 3. Teach strategy to aid recall of vocab in conversational tasks; use phonetic features of a target word to help recall word.

Describe and give examples of both extrinsic and intrinsic reinforcement.

EXTRINSIC REINFORCEMENT (R+) =R+ that do not contribute to the interaction itself / outside of the interactive frame. (i.e. Tangible - Raisin/sticker/token ; Social - Praise) INTRINSIC REINFORCEMENT (R+) = R+ that is part of the interactive frame. (i.e. naturalistic social reward - giving obj that is verbally requested/ getting clinician's attention through speech/action "see!")

Secondary

Early detection and treatment are used to eliminate the disorders or retard its progress, thereby preventing further complications EXAMPLE: Newborn hearing screenings to detect hearing loss and provide early amplification or cochlear implantation

Primary

Elimination or inhibition of the onset and development of a disorder by altering susceptibility or reducing exposing for susceptible persons. EXAMPLE: Inoculation to prevent rubella

Describe how to implement a multiple-baseline study of lang intervention. (4)

HOW TO IMPLEMENT: 1) I.d several intervention objectives, based on assess data. (setting control goals, generalization goals, and target goals.) (2) Gather baseline data on the target, generalization, and control goals so we know that baseline is a reliable reflection of child's ordinary use of the form. (3) Institute intervention for the target, but not the control/generalization goals. (4) Evaluate the child's use of the target and control goals. if target and generalization goals show sig increase over baseline, whereas use of the control goals remain unchanged, then our intervention has made the difference in client's target form. *RE: Our real objective is improved fxn'al comm, not meeting goals.

Tertiary

Intervention is used to reduce a disability by attempting to restore effective functioning. EXAMPLE: Providing rehabilitation and special services to a child with down syndrome.

Discuss the role of perceptual salience and pragmatic appropriateness in determining the linguistic stimuli to be used in intervention

ROLE OF PERCEPTUAL SALIENCE: - May help young listener direct attn to the auditory signal and highlight segments containing the most salient info; intonational highlighting helps get children to produce new structures ("therapeutic register") ROLE OF PRAGMATIC APPROPRIATENESS: - i.e. without providing a context for an elliptical sentence in the response, we have the client produce the whole sentence as a response.

Discuss the difference between short- and long-term goals.

SHORT VS. LONG TERM GOALS: Short term goals = are specific goals (specific instances of language form/content/use identified as intermediate goals; based on child's functional readiness) Long-term goals = basic goals that areas selected because of the importance for functionality/severity of deficit; general goals.

Discuss the criteria you would use for evaluating a new technique to decide whether it is evidence-based. (6)

STEPS TO EVALUATE EVIDENCE-BASED NEW TECHNIQUE: (1) Formulate clinical question using PICO elements (2) Use internal evidence (clinical experience and family preference) (3) Find external research evidence base (4) Grade the studies according to levels of evidence (5) Integrate internal & external evidence (6) Evaluate the decision multiple times by documenting outcomes

Define termination criteria, and discuss the guidelines suggested in the text.

TERMINATION CRITERIA = the criterion used to decide that a goal has been achieved. GUIDELINES SUGGESTED - when one or more conditions met: (1) comm is now within normal limits (2) All goals/objectives have been met (3) client's comm is comparable to those of same peer group (4) Indiv's speech/lang skills no longer adversely affecting social/emo/educ status (5) Indiv's AAC use has achieved optimal comm across partners and setting. (6) The client has attained the desired level of comm skills.

Incidence

The rate of new occurrences of a condition in a population free of the disorder within a specific time period. Incidence is the rate of new (or newly diagnosed) cases of the disease. It is generally reported as the number of new cases occurring within a period of time (e.g., per month, per year).