Monday, November 5, 2012

Phonological Disorders: Dx, Goals, Tx

One of my favorite things about this blog is the way I get to share information with fellow SLP's. Today I asked my colleagues, Jacqueline Whitney, to share her POV on phonological disorders. If you're brand new or getting back into preschool after a break you're going to love this post! 

Phonological Disorders: How to diagnose, write goals, and treat

Jacqueline Whitney, M.A., CCC-SLP
Public School Based and Home Health Pediatric Speech-Language Pathologist
#1 fan of Speech Room News and colleague of Jenna Rayburn

I’m sure many of you, just like me, learned about phonology for about 30 minutes in grad school. Under the huge umbrella of the “Articulation/Phonology” course, phonology was breezed over. I never even had a phonology client as a grad student. I was on a hearing impairment grant so most of my students were hearing impaired. I did my student teaching at the high school level with included mostly low incidence disorders. I can say with honesty that when I left graduate school I could probably only tell you what “fronting” and “stopping” are. I really didn’t know how to evaluate and diagnose a child with a phonological disorder, determine what to target first, or even how to write goals. It wasn’t until my clinical fellowship that I learned SO much about phonology (shout out to Jen S. who had quite a bit to do with my phonology education). I now know how to evaluate, diagnose, write goals, treat, and remediate phonological disorders with a modified version of Barbara Hodson’s Cycles Approach. I say that it’s modified because in the school setting, things can’t always be textbook. Am I right??

Last year I did play-based assessments at the preschool level, I basically salivated when the school psych told me it was a potential “speech only” evaluation. I’m kind of like the surgeons on Grey’s Anatomy when they get a really exciting surgery, except that’s how I get with phonology evaluations. So what I would like to share is a Goldman-Fristoe-2 with my “client,” Freddy Phonology, who presents with severe, but very common phonological processing errors. Also, I will explain how I organize myself to begin therapy and how to WRITE GOALS based on the assessment. How many of you are now being told to write goals with 6 components? Here in Ohio we are now required to do that. I’ll give you some templates to be able to write your goals according to the Ohio Department of Education and your school district.

Client Background Information
Name: Freddy Phonology
Chronological Age: 4;0
Developmental Summary: No pre-academic, social emotional, fine motor, or cognitive impairments suspected. The only area of concern is speech and language skills
Based on observations, Freddy presents with age appropriate receptive language skills. His MLU is 3.6 (0.4 below average).

Results of the Evaluation
Freddy presents with a significant speech sound disorder. He achieved a standard score of 48 on the GFTA-2 (average 85-115) indicating significantly delayed phonological skills when compared to his same aged peers. He presents with the following phonological processes (or simplification patterns):

·      Final Consonant Deletion: Final consonant deletion is described as deleting the final sound off of a word. For example, Freddy produced “hou/house” and “du/drum.” He did produce some final consonants in words, which indicates that his final consonant production is emerging; however it is still significantly delayed.

·      Cluster Reduction: Cluster reduction is described as deleting a sound from a consonant cluster. For example, Freddy produced “pun/spoon,” “ta/star” and “bu/blue.”

·      Velar Fronting: Velar fronting is described as substituting t/k and d/g such as “dirl/girl” and “tup/cup.” Freddy is demonstrating velar fronting in both the initial and medial positions. Final positions were not observed as he deleted final consonants in these contexts.

·      Stopping of Fricatives: Stopping of fricatives is described as producing a stop sound for a continuant. For example, t/sh, t/s, d/z, p/f, and b/v. Freddy produced “tubuh/shovel” and “piti/fishing.”

·      Gliding: Gliding is described as substituting w/l and w/r. Examples include “wam/lamp” and “tewi/carrot.” Gliding is considered developmental until between the ages of 7-8.

·      Substitutions of /f/ for voiceless “th” (fum/thumb) and /d/ for voiced “th” (feader/feather). This is considered developmental until between the ages of 7-8. (I think this is technically stopping, but of course I would not work on these sounds with a 4 year old)

IEP Goals and Objectives
So, now that we have found the error patterns, what goals am I going to write? I put the processes in the order that I would target them. So, I will write an objective for each process. ODE is requiring Who, Will do what?, to what level or degree?, under what conditions?, in what length of time?, and How will progress be measured?

·      IEP Goal: By the IEP review date, in a small group setting, Freddywill reduce the occurrence of deviant phonological processes by producing targeted phonemes at the word level with 80% accuracy, 4/5 data collections. (Through observations and anecdotal records)
o   ***Only target word level if you are just beginning the Cycles Approach

·      Objective 1.1: By the IEP review date, in a small group setting, Freddy will reduce final consonant deletion by producing final consonants in CVC wordswith 80% accuracy, 4/5 data collections.  

o   Target final /t/ for 60 minutes (in the schools that’s 3 weeks if you do 20 minute sessions 1x/wk)
o   Target final /d/ for 60 minutes
o   Target final /p/ for 60 minutes
o   Target final /b/ for 60 minutes
o   Even if they don’t have final consonants in their conversational speech at this point (which is unlikely), move on. This is a total of 12 weeks. Sometimes I will cut this short and only work on it for a quarter, but still enforce it while I focus on another process.
o   Probe for velars during these sessions. Some kids take a long time to become stimulable for /k/ and /g/.

·      Objective 1.2: By the IEP review date, in a small group setting, Freddy will reduce cluster reduction by producing 2 sounds in a consonant cluster (focus on S-blends) at the word level with 80% accuracy, 4/5 data collections
o   I target S-blends before I target velars because I think it’s easier to teach, plus kids get the idea of fricatives. Then, when you start to remediate stopping they have some prior knowledge.
o   Target whichever blends they are stimulable for first.
o   Target SP for 60 minutes
o   Target ST for 60 minutes
o   Target SM for 60 minutes
o   Target SN for 60 minutes
o   Probe for velars

·      Objective 1.3: By the IEP review date, in a small group setting, Freddy will reduce velar fronting by producing /k/ and /g/ in the initial and final positions of words with 80% accuracy, 4/5 data collections.
o   Target final /k/ for 60 minutes
o   Target initial /k/ for 60 minutes
o   Target initial /k/ for 60 minutes
o   Do NOT target final /g/. When you put emphasis on this word, a vowel is typically put on the end. The final /g/ should emerge on it’s own.

·      Objective 1.4 By the IEP review date, in a small group setting, Freddy will reduce stopping by producing fricatives [/f/, /v/, /s/, /z/, and/or “sh”] in the initial position of words with 80% accuracy, 4/5 data collections.
o   (This way you can leave it open to which sound he will be most successful with. There is no way that you will have enough time to target each sound in 5 different sessions during one IEP year, but you are always targeting a fricative. **the underlying goal is to remediate the PHONOLOGICAL PROCESS).
o   You can also target the final position, but you might run out of time by the IEP. Save it for next year!

My typical phonology sessions:
·      Start with auditory bombardment
·      Auditory discrimination (not every session, but I like to check and make sure they can hear the difference before I ask them to produce. I used to write a goal on auditory discrimination, but I don’t anymore. I just make sure I target it.)
·      Word drill embedded with fun activities:
o   Reading a book with high occurrence of target phoneme
o   Articulation Station
o   Articulation Scenes
o   Coloring activity (e.g., have them color their homework)
o   Memory
o   Go fish
o   Board games
o   Puzzles with high occurrence of target phoneme
o   Jenna’s Candyland Phonology
o   I Spy (a fav for S-blends)
o   Bury cards in a tub of dried rice and beans and unbury them!
o   MUCH more!
·      End with auditory bombardment

·      I also like to end the session with the student producing some of their best productions for their teacher. That way the teacher knows what sound I am targeting and the student feels proud of themselves.

Again, this is what I do. This is not to say that this is the only way to do phonology therapy. Last year my success rate with exiting “speech only” students was pretty high using this method and these goals. I had a personal goal for myself that no student should enter Kindergarten without being able to produce final consonants, S-blends, /g/, /k/, and at LEAST one fricative in the initial position at the word level. Of course those extremely unintelligible students are an exception to this.

I hope these goals and therapy targets will be helpful for at least some of you!
Enjoy J

Jacqueline Whitney 

Thank you Jacqueline! Jacqueline is the person I can text at 11pm to ask her opinion about a therapy idea. So happy she moved to my district this year! You can become a follower of her brand new TPT store. Click 'follow me' and you will get updates when she posts new content.