خدمة تلخيص النصوص العربية أونلاين،قم بتلخيص نصوصك بضغطة واحدة من خلال هذه الخدمة
In the field of communication disorders, the domains of research and clinical practice are frequently regarded as distinctly separate entities.Mr. Max Asquith, a 52-year-old computer programmer, demonstrates the following speech and language characteristics on pretreatment baseline procedures: ?Omission of final consonants such as /s/, /k/, and /?/ ?Distortion of vowels in all word positions ?Misarticulation of consonant blends, such as /br/, /pl/, /fl/, /ks/, and /skw/ ?Omission of the copula forms (is and are) as in "He sad" for "He is sad" ?Difficulty with the accurate use of spatial, temporal, and numerical vocabulary ?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. An appropriate initial language target for this client would be vocabulary words that convey number concepts, because his position as a computer programmer relies heavily on the use of this terminology. Chapter 1 The Essential Ingredients of Good Therapy: Basic Skills A 6-year-old child with an articulation disorder exhibits the following speech sound errors on baseline procedures: ? /?/ for /s/ as in thun for sun ? /g/ for /d/ as in guck for duck ? /w/ for /l/ as in wight for l ight ? /?/ for /t?/ as in shew for chew Using the client-specific strategy, the initial therapy target would be /s/, regardless of developmental considerations. The results of stimulability testing conducted during the diagnostic test indicated that this child's ability to imitate /s/ was superior to performance on the other error sounds. In addition, /s/ occurs far more frequently in English than /l/, /w/, and /t?/. Unlike the developmental approach, a client-specific strategy can be implemented across a wide range of communication disorders with both pediatric and adult populations. In addition, a combina tion of the two strategies is often an effective way to approach therapy target selection for children with speech and language impairments. Sequencing of Therapy Targets Following therapy target selection and prioritization, programming involves the development of a logical sequence of steps that will be implemented to accomplish each objective. Three major factors determine the progression of the therapy sequence: stimulus type, task mode, and response level. The following outline presents a hierarchy of complexity for each of these factors. Stimulus Type (Nature of Input Used to Elicit Target Responses) ?Direct physical manipulation ?Concrete symbols ? Objects ?Photographs/color pictures ?Black-and-white line drawings ?Abstract symbols ?Oral language ?Written language Task Mode (Type of Clinician Support/Scaffolding Provided to Obtain Desired Responses) ? Imitation ? Cue/prompt 9 ? Spontaneous 10 Preparing for Effective Intervention Response Level (Degree of Difficulty of Target Responses)1 ? Increase length and complexity of desired response ? Isolation ? Syllable ? Word ?Carrier phrase (e.g., "I see a ______.") ?(In educa tion settings, student progress is measured through benchmarks, which are sets of skills required to achieve specific learning standards.) These objectives must be clearly delineated to ensure appropriate and effective intervention programming. A widely used approach to task design is the formulation of behavioral objectives. A behavioral objective is a statement that describes a specific target behavior in observable and measurable terms. There are three main components of a behavioral objective: 11 12 Preparing for Effective Intervention
In the field of communication disorders, the domains of research and clinical practice are frequently
regarded as distinctly separate entities. It is true that the aims of the two activities are very different.
The main purpose of research is to add to the existing knowledge base in a given area, whereas the
ultimate goal of clinical work is to change behavior. However, the two activities also share many
common characteristics, and these similarities outweigh the differences. The most fundamental simi
larity is that both research and clinical practice are scientific processes based on the highest quality
of evidence available (often referred to as evidence-based practice). Therefore, it is our view that
intervention, like research, should be based on the principles of the scientific method. Both research
and intervention involve the following:
● identification of a problem
● review of existing knowledge regarding the problem area
● formulation of hypotheses about how to solve the problem
●manipulation of the independent variable(s)
● collection and analysis of data
● formulation of conclusions about the validity of the original hypotheses
Based on the authors’ experiences, an essential ingredient to successful intervention is critical
thinking. Critical thinking is the objective analysis and evaluation of an issue to form a judgment,
which goes beyond memorization/recall of information and is free from feelings or personal biases.
Teaching beginning clinicians critical-thinking skills supports their ability to manage complex issues
inherent in clinical work. This important topic is discussed more extensively in Chapter 13.
Speech and language intervention is a dynamic process that follows a systematic progression. It
begins with the diagnosis of a communication disorder and is followed by the selection of appropri
ate therapy targets. Training procedures are then implemented to facilitate the acquisition of the
target behaviors. The intervention process is complete when mastery of these behaviors is achieved.
Periodic follow-up is performed to monitor retention and stability of the newly acquired behaviors.
Throughout all stages of therapy, advocacy is an important role for the speech-language pathologist
(SLP). All clinicians should be aware of the Americans with Disabilities Act (1990). This federal
legislation (Public Law 101-336) and its amendments (Public Law 110-325) prohibit discrimination
and ensure equal opportunity in public accommodations, employment, transportation, government
services, and telecommunications (see https://www.ada.gov for more specific information). Speech
language pathology is a dynamic profession that is continually evolving. The scope of practice in
3
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Preparing for Effective Intervention
Part One
speech-language pathology is delineated by the American Speech-Language-Hearing Association,
or ASHA (ASHA, 2007b). SLPs are responsible for fully understanding the areas of communica
tion and swallowing that they are qualified to address (e.g., voice, language, fluency) as well as the
range of services that they are eligible to deliver (e.g., screening, consultation, treatment). A related
document of major importance to all SLPs is the 2023 ASHA Code of Ethics (see Appendix A on
the companion website). This document outlines standards for professional behavior with regard
to several areas (e.g., client welfare, SLP competence level, public understanding of the profession).
Universal Design Principles for Learning:
An Overarching Framework
In 2000, Rose and Meyer put forth a framework based on the premise that every individual — regard
less of physical, cognitive, sensory, learning, or other type of disability — is entitled to universal access
to information and to learning. Their model is characterized by three universal design for learning
(UDL) principles: multiple means of representation, multiple means of expression, and multiple means
of engagement. As applied to educational and clinical settings, it is meant to be a theoretical framework
for providing the most appropriate supports for children and adults and includes the following:
●Multiple means of representation: There must be multiple methods available by which
individuals can access and learn important information and skills (e.g., traditional textbook
augmented by supplemental internet resources, speech-to-text media).
●Multiple means of expression: Various methods and modalities must be available for individuals
to demonstrate their mastery of information and skills.
●Multiple means of engagement: Individuals must be provided with enough successful learning
opportunities and meaningful interactions to maintain adequate motivation for learning.
The crux of UDLs is instructional flexibility to provide the most suitable options for different
learners. For individuals with disabilities, UDLs include accommodations, modifications, and assistive
technology. Accommodations are changes that help clients overcome or compensate for their disabil
ity, such as preferential seating or allowing written rather than spoken communication. Modifications
are changes in informational content or expectations of an individual’s performance. Examples include
a decreased amount of classwork/homework or reduced goals for productivity or learning.
Also inherent in UDLs is the use of assistive technology (AT) as support for students and
adults with disabilities (Dalton et al., 2002; Hall et al., 2012; Ralabate, 2011; Strangman, 2003). AT
may include speech-to-text software that converts speech into text documents, translation software
for English-language learners, and internet access as a means of information gathering. In all cases,
adequate training must be provided so that individuals can use the AT successfully and reliably. We
must emphasize that these technologies are supportive and do not replace direct instruction.
General Principles of Intervention
The basic principles of effective intervention are consistent with a UDL framework and apply to
clients of all ages and disorders. These include the following:
● Intervention is a dynamic rather than static process in which the clinician continuously
assesses a client’s progress toward established goals and modifies them as necessary.
Chapter 1
The Essential Ingredients of Good Therapy: Basic Skills
● Intervention programs should be designed with careful consideration of a client’s verbal
and nonverbal cognitive abilities. Knowledge of a client’s level of cognitive functioning
is critical to making decisions about eligibility for treatment and selecting appropriate
therapy objectives.
●The ultimate goal of intervention is to teach strategies for facilitating the communication
process rather than teaching isolated skills or behaviors (to the extent possible). Whereas
skills are required to achieve specific outcomes in given situations, strategies enable the
individual to know when and how to use these skills in new and varied learning contexts.
●Speech and language abilities are acquired and used primarily for the purpose of communica
tion and therefore should be taught in a communicative context. To the extent possible,
therapy should occur in realistic situations and provide a client with opportunities to engage
in meaningful communicative interactions.
● Intervention should be individually oriented, based on the nature of a client’s specific deficits
and individual learning style.
● Intervention should be designed to ensure that a client experiences consistent success
throughout all stages of the therapy program.
● Intervention is most effective when therapy goals are tailored to promote a client’s knowledge
one step beyond the current level.
● Intervention should be terminated once goals are achieved or the client is no longer making
demonstrable progress.
● Intervention practices must be based on the best scientific evidence available.
● Intervention should be sensitive to a client’s values and beliefs as well as cultural and
linguistic background.
To provide effective intervention for any type of communication disorder, SLPs must acquire
certain essential clinical skills. These skills are based on fundamental principles of human behavior
and learning theory. The following categories of clinical skills are the building blocks of therapy and
serve as the foundation for all disorder-specific treatment approaches:
●Programming: Selection, sequencing, and generalization of therapy targets
●Behavior modification: Systematic use of specific stimulus-response-consequence procedures
●Key teaching strategies: Use of basic training techniques to facilitate learning
●Session design: Organization and implementation of therapy sessions, including interpersonal
dynamics
●Data collection: Systematic measurement of client performance and treatment efficacy
Successful intervention requires the ability to effectively integrate these five parameters into a
treatment program. Appendix 1–A, listed on the companion website, provides a checklist of clinician
behaviors that correspond to each of the parameters. This checklist can be used by students as a guide
for observing therapy sessions or by supervisors for evaluating student clinician performance. The
remainder of this chapter is devoted to a detailed discussion of each basic skill area.
5
6
Preparing for Effective Intervention
Programming
Part One
Programming involves the selection and sequencing of specific communicative behaviors. New behav
iors are introduced and taught in highly structured situations with multiple prompts and maximal
support provided by the clinician. Subsequent activities progress through a hierarchy of difficulty
and complexity, with decreasing support from the clinician. The client demonstrates generalization
of each newly learned behavior by using it in novel situations or contexts. The programming process
culminates with a client’s habitual and spontaneous use of a behavior in everyday speaking and
listening situations.
In recent literature (e.g., DeThorne & Gerlach-Houck, 2023), there is a growing call for inter
vention that is based on a social model of intervention. This approach does not focus on how to
bring the client up to typical societal expectations. Instead, it identifies ways to modify the attitudes
and structures of society to accommodate the client’s communication profile. Rather than target
ing specific skill deficits demonstrated by the client, a social model focuses on reducing barriers to
successful communication found within the individual’s environment or interpersonal relationships.
This framework focuses on enhancing communicative daily function in society by providing supports,
accommodations, and modifications that address physical, environmental, and sensory barriers expe
rienced by the client.
Selection of Therapy Targets
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. Frequently, assessment data are based, in part, on the administration
of standardized tests. These tests typically are designed to sample only one or two exemplars of a
given communication behavior. However, a single incorrect response does not constitute a sufficient
basis for the inclusion of a behavior as a target in a treatment program. It indicates only a potential
area of weakness, which then must be sampled more extensively to determine whether a genuine
deficit exists. 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. Refer to
Chapter 12 for common characteristics of African American English, Spanish-influenced English,
and Asian-influenced English.
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. 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 communica
tion 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).
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
Chapter 1
The Essential Ingredients of Good Therapy: Basic Skills
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.
The Developmental/Normative Strategy
This strategy is based on known normative sequences of communicative behaviors in typically achiev
ing 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. Following are two examples that illustrate use
of the developmental strategy.
A 5-year-old child with an articulation disorder produces the following
speech sound errors on baseline procedures:
● /p/ for /f/ as in pinger for f inger
● /t/ for /ʃ/ as in tip for ship
● /d/ for /dʒ/ as in duice for juice
● /d/ for /b/ as in doat for boat
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/.
A 4-year-old child with a language disorder exhibits the following
grammatical errors on baseline procedures:
●Omission of present progressive tense, as in “The boy play” for “The boy is
playing”
●Omission of the plural marker on regular nouns, as in “I see two bike” for
“I see two bikes”
●Overgeneralization of regular past tense, as in “He runned down the street”
for “He ran down the street”
Use of the developmental strategy dictates that the first target for therapy is the
present progressive form (is + verb + -ing), because it is the earliest of the three
structures to emerge. The plural marker is the next behavior to be targeted, followed
by the regular past-tense form.
Note: With clients from different cultural/linguistic backgrounds, these grammatical
forms may reflect a language difference rather than a language disorder. Therefore,
intervention may not be warranted.
7
8
Preparing for Effective Intervention
Part One
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. Moreover, the characteristics
of the standardization sample (e.g., ethnicity, gender, socioeconomic status) may differ significantly
from those of an individual client. Consequently, it may be difficult to draw direct comparisons
between the client’s performance and the group norms.
For clinicians who choose to approach therapy from a social model of intervention, potential
goals might include training peers to initiate communication with an autistic child, encouraging
teachers to provide written as well oral instructions in the classroom, or educating coworkers on best
practices for conversational interactions with a colleague who stutters.
The 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 objec
tives include (a) the frequency with which a specific communicative behavior occurs in a client’s daily
activities; (b) the relative importance of a specific communicative behavior to the client, regardless of
how often it occurs; and (c) 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. Following are two examples
that illustrate the use of the client-specific strategy.
Mr. Max Asquith, a 52-year-old computer programmer, demonstrates the
following speech and language characteristics on pretreatment baseline
procedures:
●Omission of final consonants such as /s/, /k/, and /θ/
●Distortion of vowels in all word positions
●Misarticulation of consonant blends, such as /br/, /pl/, /fl/, /ks/, and /skw/
●Omission of the copula forms (is and are) as in “He sad” for “He is sad”
●Difficulty with the accurate use of spatial, temporal, and numerical
vocabulary
●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. An appropriate initial language target for this client
would be vocabulary words that convey number concepts, because his position as a
computer programmer relies heavily on the use of this terminology.
Chapter 1
The Essential Ingredients of Good Therapy: Basic Skills
A 6-year-old child with an articulation disorder exhibits the following
speech sound errors on baseline procedures:
● /θ/ for /s/ as in thun for sun
● /g/ for /d/ as in guck for duck
● /w/ for /l/ as in wight for l ight
● /ʃ/ for /tʃ/ as in shew for chew
Using the client-specific strategy, the initial therapy target would be /s/, regardless of
developmental considerations. The results of stimulability testing conducted during
the diagnostic test indicated that this child’s ability to imitate /s/ was superior to
performance on the other error sounds. In addition, /s/ occurs far more frequently in
English than /l/, /w/, and /tʃ/.
Unlike the developmental approach, a client-specific strategy can be implemented across a wide
range of communication disorders with both pediatric and adult populations. In addition, a combina
tion of the two strategies is often an effective way to approach therapy target selection for children
with speech and language impairments.
Sequencing of Therapy Targets
Following therapy target selection and prioritization, programming involves the development of a
logical sequence of steps that will be implemented to accomplish each objective. Three major factors
determine the progression of the therapy sequence: stimulus type, task mode, and response level. The
following outline presents a hierarchy of complexity for each of these factors.
Stimulus Type (Nature of Input Used to Elicit Target Responses)
●Direct physical manipulation
●Concrete symbols
● Objects
●Photographs/color pictures
●Black-and-white line drawings
●Abstract symbols
●Oral language
●Written language
Task Mode (Type of Clinician Support/Scaffolding
Provided to Obtain Desired Responses)
● Imitation
● Cue/prompt
9
● Spontaneous
10
Preparing for Effective Intervention
Response Level (Degree of Difficulty of Target Responses)1
● Increase length and complexity of desired response
● Isolation
● Syllable
● Word
●Carrier phrase (e.g., “I see a ______.”)
● Phrase
● Sentence
●Text (conversation, narration)
●Decrease latency (actual time) between stimulus presentation and client response
Part One
The sequencing process starts with a decision regarding the most appropriate level to begin
training on each target behavior. Pretreatment baseline data for a given target are analyzed to deter
mine the entry training level. Rules of thumb that can be used are as follows:
● If a client obtained a baseline score lower than 50% accuracy, training on that behavior should
begin just below the level of difficulty of the baseline stimulus items.
● If the score was between 50% and 75% accuracy, training can begin at the same difficulty level
as the baseline stimuli.
For example, a 5-year-old client scored the following on baseline measures for initial /s/: word level
= 65%; carrier phrase level = 40%; and sentence level = 30%. In this example, therapy would begin at
the word level of difficulty.
Adherence to these procedures generally will result in a progression of targets at the appropriate
levels of difficulty. However, there may be occasions when a client does not perform as predicted; a
chosen task turns out to be too difficult or too easy for the individual at this time. The clinician must
recognize this situation when it occurs and immediately modify the task rather than persist with the
original plan. This modification is known as branching and is achieved by increasing or decreasing
the difficulty level by one step according to the therapy sequence hierarchies listed previously.
As the client’s performance improves and initial training objectives are mastered, the stimulus
type, task mode, and response level should be manipulated systematically to gradually increase the
difficulty of therapy tasks until the final criterion is met for a given target. This criterion level is
generally set at 90% accuracy or higher in everyday conversational interactions.
The following sample behavioral objectives illustrate the manipulation of each of the three
factors:
Behavioral objective: The client will imitatively produce /s/ in the initial position of single
words with 90% accuracy while naming 20 photographs.
Modified stimulus type: The client will imitatively produce /s/ in the initial position of single
words with 90% accuracy while naming 20 written words.
1This response-level hierarchy pertains to oral responses only. Other response types—such as gesture, sign, and writing—may
require alternative hierarchies of difficulty.
Chapter 1
The Essential Ingredients of Good Therapy: Basic Skills
Modified task mode: The client will spontaneously produce /s/ in the initial position of single
words with 90% accuracy while naming 20 photographs.
Modified response level: The client will imitatively produce /s/ in the initial position of words
in carrier phrases with 90% accuracy in response to 20 photographs.
Generalization/Carryover
A crucial consideration in programming involves a client’s ability to transfer newly mastered commu
nicative behaviors from the clinical setting to the everyday environment. Generalization is enhanced
when intervention is provided in the most authentic, realistic contexts possible. Generalization
should not be viewed as a distinct event that occurs only in the final phase of the therapy process.
Rather, it is an integral part of programming that requires attention from the very beginning. Three
main factors can influence the degree to which successful generalization occurs. A variety of stimuli
(objects, pictures, questions) should be used during therapy activities to avoid tying learning to only
a small set of specific stimulus items. Similarly, the clinician should vary the physical environment
(location in room, location in building, real-world locations) in which therapy occurs as soon as a
new target behavior has been established. This will minimize a client’s natural tendency to associate
target behaviors with a particular setting. Finally, clinicians should bear in mind that target behaviors
frequently become attached to the individual who consistently reinforces them (i.e., the clinician).
Therefore, it is important to vary the audience (familiar adult, sibling, unfamiliar adult) with whom
therapy targets are practiced, to maximize the likelihood of successful generalization.
Termination of Therapy
It is difficult to definitively state the point at which intervention services are no longer warranted. At
the current time, there are no valid empirical data that can be used to determine appropriate dismissal
criteria for any particular communicative disorder. Therefore, it is beyond the scope of this book to
indicate realistic time frames for the duration of intervention. General discharge guidelines used by
many clinicians include (a) attainment of communication skills that are commensurate with a client’s
chronological/developmental age or premorbid status, (b) attainment of functional communication
skills that permit a client to operate in the daily environment without significant handicap, and
(c) lack of discernible progress persisting beyond a predetermined time period. The authors strongly
believe that the establishment of reliable treatment outcome measures is critical in the current climate
of professional accountability in both the public and private sectors. Within the past few years, the
availability of efficacy data has increased significantly for a variety of communication disorders. This
information is presented throughout the book in pertinent chapters.
Formulation of Behavioral Objectives
Once long-term goals and initial treatment levels have been identified, the clinician develops short
term objectives designed to culminate in the achievement of the selected long-term goals. (In educa
tion settings, student progress is measured through benchmarks, which are sets of skills required to
achieve specific learning standards.) These objectives must be clearly delineated to ensure appropriate
and effective intervention programming. A widely used approach to task design is the formulation of
behavioral objectives. A behavioral objective is a statement that describes a specific target behavior
in observable and measurable terms. There are three main components of a behavioral objective:
11
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Preparing for Effective Intervention
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