What Works in Speech Sound Disorders Therapy: A Review of the Evidence

 Communication Access Real-time Translation (CART) is provided in order to facilitate communication accessibility and may not be totally verbatim.  The consumer should check with the moderator for any clarifications of the material.  This text-based course is a written transcript of the live event, “What Works in Speech Sound Disorders Therapy, a Review of the Evidence,” presented by Dr. Elise Baker, on March 5, 2012. >> Amy Hansen:  Welcome to today’s expert seminar.  I am very pleased to introduce Dr. Elise Baker who is presenting, “What Works in Speech Sound Disorders Therapy, a Review of the Evidence.”  Dr. Elise Baker is a speech‑language pathologist and academic with discipline of speech pathology at the University of Sydney, Australia.  She is recognized for her knowledge and expertise on the management of speech sound disorders (SSD) in children, SLPs methods of practice with children who have SSD and the conduct of evidence‑based practice.  Dr. Baker has been an invited speaker at ASHA and has presented workshops on the topic of SSD in children.  In 2011, Dr. Baker co‑authored companion papers on the evidence-based management on SSD in children, in the journal Language, Speech, and Hearing Services in Schools.  As a Steering Committee member of an innovative speech-language pathology EBP network in Australia, Dr. Baker has a keen interest in the application of research to practice.  Dr. Baker, thank you for joining us today.  We are honored to have you with us. >> Dr. Baker:  Thank you, Amy.  When Gregory Lof invited me to present the seminar today, I did not think twice about it because I really enjoy the opportunity to share with clinicians ideas and strategies from the latest research evidence that can help guide clinical practice.  Course Objectives·        List and match six different approaches to target selection to a range of evidence-based phonological intervention approaches.·        Identify and describe intervention approaches suited to different children with SSD, given case-based data.·         Compare and contrast the intensity of your own SLP services for children with SSD (including dose, dose frequency, and intervention duration) with evidence-based recommendations. First you will learn to list and match at least six different approaches to target selection to a range of evidence‑based phonological intervention approaches.  Secondly, you will identify and describe intervention approaches suited to different children that have a speech sound disorder using some case-based data.  Thirdly, you will compare and contrast the intensity of your own SLP services for children who have a speech sound disorder, thinking particularly about the dose in your clinical sessions, the dose frequency, and total intervention duration (or how long it takes from that point of referral to dismissal) and comparing that with evidence‑based recommendations.  This portion is more for your own knowledge over the coming weeks and months.   Where Do I Start?I will begin with a statement from a child that perhaps may not be that unfamiliar.  In thinking about preschool children who have a speech sound disorder, consider these utterances from this child. This child, like many on your caseloads, has unintelligible speech.  Where do you start with a child like this?  How do you think about their speech?  Do you typically look for phonological processes or do you identify collapses of contrast?  Do you list consonants that are within or excluded from their phonetic inventory?  Think for a moment, assuming that you will actually collect a much larger sample than just this utterance, the types of analysis that you do, and think about what targets you are picking with these children and why.  What factors influence the types of targets that you prioritize for therapy?  For example, are you influenced by your past experience that you have had with other children?  Are you influenced by the types of groups you could form with other children on your caseload, for example, having a velar fronting group or a group working on clusters?  Alternately, are you influenced by what the child would like to work on or the child's caregiver or the child's teacher?  There are a lot of factors that go through our heads when we are thinking through the types of targets to pick.  According to Tom Powell (1991, p.21), “To develop an efficient treatment program” …“clinicians must have some means of prioritizing possible treatment targets.”  That is, as evidence‑based clinicians you use evidence to guide your decision.  A number of researchers have been thinking about this issue for decades.  Evidence-Based Target Selection Approaches for SSD  As represented in the image above, across the literature there are seven different approaches to target selection.  We will focus on four of the more common approaches primarily because there is comparatively more peer-review published evidence associated with each of these.  Of the three other approaches, the constraint-based nonlinear phonology approach has the potential to offer insight into quite complicated phonological systems that we might see in children, for example, children who have problems with speech sounds, syllable structure, and stress.  Psycholinguistic also has potential to provide insight into the difficulties children may be having with both speech and literacy.  It would take much more than just a one hour seminar to try to scratch the surface on those two particular approaches.  In the Neuro-network approach, this particular approach is rather unique in that it actually sees phonology as integral and inseparable from the language system.  One of the principles of this approach, according to Norris and Hoffman (2005), it is not necessary to pick a particular target per se in your intervention, but work on the whole language system.  Given the big picture of those target selection approaches, we will focus on the four more common approaches. Developmental ApproachThe Developmental Approach is perhaps the approach that is most familiar.  From surveys of clinicians and clinical practice both in the US and in Australia, this approach is the one that clinicians tend to use more frequently.  It involves identifying specific problematic speech sounds or processes or patterns, and then intuitively prioritizing targets that are considered easy for children, such as stimulable targets and early developing targets.  It is based on two underlying assumptions.  Firstly, that children should not be discouraged or frustrated...