COMBINATION OF TRADITIONAL, PHONOLOGICAL AND PHONEMIC AWARENESS INTERVENTION IN CAS

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COMBINATION OF TRADITIONAL, PHONOLOGICAL AND
PHONEMIC AWARENESS INTERVENTION IN CAS

• LILA J. CARSON, M.S., CCC-SLP ASHLEY GARLAND,
  LAUREN KICKLIGHTER, AND TRACEY SAMUELS, GRADUATE
  STUDENTS

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ABSTRACT

• THIS PRESENTATION WILL INCLUDE A CASE OF A 5
  YEAR OLD MALE WITH CHILDHOOD APRAXIA OF SPEECH.
  IT IS THE THIRD CASE IN WHICH A COMBINATION OF
  ARTICULATION, PHONOLOGICAL, AND PHONEMIC
  AWARENESS INTERVENTION RESULTED IN IMPROVEMENT IN
  ARTICULATION SKILLS. THE PREVIOUS TWO CASES WERE
  PRESENTED AT THE 2006 AND 2007 ASHA CONVENTIONS.

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ABSTRACT (Continued)

• THE FIRST CASE CAN ALSO BE FOUND IN ADVANCE for
  SPEECH LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS,
  Vol. 16 No. 12, March 20, 2006.
• NOTE IDEAS FOR INCORPORATING PHONEMIC
  AWARENESS ACTIVITIES INTO THERAPY FOR CHILDREN
  WITH DEVELOPMENTAL APRAXIA (OR OTHER MODERATE TO
  SEVERE ARTICULATION DISORDERS/DELAYS) WHO MAY BE
  AT PARTICULAR RISK FOR READING DIFFICULTY CAN BE
  FOUND IN THAT ARTICLE.

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BACKGROUND INFORMATION

• PATRICIA AND PHYLLIS LINDAMOOD, AUTHORS OF THE
  LINDAMOOD PHONEME SEQUENCING PROGRAM FOR READING,
  SPELLING, AND SPEECH (THE LIPS PROGRAM) REPORTED
  THERE IS A DIRECT LINK BETWEEN SPEECH AND
  SPELLING AND READING, BECAUSE SPEECH CONSISTS OF
  SEQUENCES OF SOUNDS, AND PRINTED WORDS ARE A
  VISUAL SYSTEM FOR REPRESENTING SEQUENCES OF
  SOUNDS.

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• A DECISIVE FACTOR COMMON TO ALL THREE THUS
  CONCEIVABLY COULD BE FACILITY IN PHONEME
  AWARENESS. THE IDENTITIES OF THE SOUNDS IN THE
  SEQUENCES MUST BE PERCEIVED AND ORDERED
  ACCURATELY IN ALL THREE PROCESSES.

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• IN RECENT YEARS, RESEARCH HAS BEEN CONCLUSIVE IN
  SUPPORTING THIS POSITIVE RELATIONSHIP BETWEEN
  PHONEMIC AWARENESS AND CERTAIN ASPECTS OF SPEECH
  AND READING/SPELLING (P. LINDAMOOD, 1993 WINGERT
  KANTROWITZ, 1997.)

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• GILLON, G. (2000) (2005) FOUND THAT THE
  INCLUSION OF PHONOLOGICAL AWARENESS ACTIVITIES
  INTO THERAPY SESSIONS DIDNT DETRACT FROM A CHILD
  MAKING GAINS IN SPEECH ARTICULATION. SHE
  SUGGESTED THAT PHONOLOGICAL AWARENESS AND
  KNOWLEDGE OF HOW SPEECH AND PRINT ARE RELATED MAY
  HELP ESTABLISH MORE FULLY SPECIFIED UNDERLYING
  PHONOLOGICAL REPRESENTATIONS AND THUS MAY
  FACILITATE ACCURATE SPEECH PRODUCTION.

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CASE BACKGROUND

• CLIENTS DAYCARE PROVIDER REFERRED HIM FOR SPEECH
  EVALUATION DUE TO CONCERN ABOUT POOR SPEECH
  INTELLIGIBILITY
• CLIENT WAS EVALUATED AT AGE 3 YEARS, 6 MONTHS AND
  BEGAN RECEIVING SERVICES IN SPRING 2006

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ORIGINAL EVALUATION

• JANUARY 2006
• GFTA2 RAW SCORE -61
• STANDARD SCORE 67
• PERCENTILE RANK 4
• KLPA-2 RAW SCORE 126
• STANDARD SCORE - lt40
• PERCENTILE RANK - lt1
• NOTE NEARLY ALL OF THE WORDS HAD TO BE PRODUCED
  IMITATIVELY, THEREFORE THESE RESULTS DO NOT
  REFLECT SPONTANEOUS SPEECH PRODUCTION.

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RE-EVALUATION

• MARCH 2008
• GFTA-2 RAW SCORE 27
• STANDARD SCORE 76
• PERCENTILE RANK 9
• KLPA-2 RAW SCORE
• STANDARD SCORE 44
• PERCENTILE RANK 4
• NOTE ALL OF THE WORDS WERE PRODUCED
  SPONTANEOUSLY

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KAUFMAN SPEECH PRAXIS TEST FOR CHILDREN

• JANUARY 2007
• PART 1 (ORAL MOVEMENT LEVEL)
• STANDARD SCORE (NORMALS) 106
• PERCENTILE RANKING (NORMALS) 28
• STANDARD SCORE (DISORDERED) 111
• PERCENTILE RANKING (DISORDERED) 54

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• MARCH 2008
• PART 1 (ORAL MOVEMENT LEVEL)
• STANDARD SCORE (NORMALS) 108
• PERCENTILE RANKING 25
• STANDARD SCORE (DISORDERED) 111
• PERCENTILE RANKING - 54

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• JANUARY 2007
• PART 2 (SIMPLE PHONEMIC/SYLLABIC LEVEL)
• STANDARD SCORE (NORMALS) BELOW NORMS
• PERCENTILE RANKING (NORMALS) N/A
• STANDARD SCORE (DISORDERED) 62 PERCENTILE
  RANKING (DISORDERED) 6

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• MARCH 2008
• PART 2 (SIMPLE PHONEMIC/SYLLABIC LEVEL)
• STANDARD SCORE (NORMALS) 3
• PERCENTILE RANKING (NORMALS) lt2
• STANDARD SCORE(DISORDERED)98 PERCENTILE RANKING
  (DISORDERED)26

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• JANUARY 2007
• PART 3 (COMPLEX PHONEMIC/SYLLABIC LEVEL)
• STANDARD SCORE (NORMALS) BELOW NORMS
• PERCENTILE RANKING (NORMALS) N/A
• STANDARD SCORE (DISORDERED) 77
• PERCENTILE RANKING (DISORDERED) 10

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• MARCH 2008
• PART 3 (COMPLEX PHONEMIC/SYLLABIC LEVEL)
• STANDARD SCORE (NORMALS) 38
• PERCENTILE RANKING (NORMALS) lt2
• STANDARD SCORE (DISORDERED) 108
• PERCENTILE RANKING (DISORDERED) 58

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• JANUARY 2007
• PART 4 SPONTANEOUS LENGTH AND COMPLEXITY
  INTELLIGIBILITY RATING - 2
• STANDARD SCORE (NORMALS) BELOW NORMS
• PERCENTILE RANK (NORMALS) N/A
• STANDARD SCORE (DISORDERED) 87
• PERCENTILE RANK (DISORDERED) - 22

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• MARCH 2008
• PART 4 SPONTANEOUS LENGTH AND COMPLEXITY
  INTELLIGIBILITY RATING - 2
• STANDARD SCORE (NORMALS) BELOW NORMS
• PERCENTILE RANK (NORMALS) N/A
• STANDARD SCORE (DISORDERED) 104
• PERCENTILE RANK (DISORDERED) - 45

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THERAPY

• SPRING AND SUMMER SEMESTER 2006, HODSONS
  PADENS CYCLES APPROACH WAS USED IN THERAPY,
  ALONG WITH A TRADITIONAL APPROACH TO TARGET
  VOWELS IN ISOLATION.
• FALL 2006, SINCE HE COULD NOT PRODUCE A LOT OF
  THE PHONEMES AT ALL, THE SOUND BOOK FROM THE
  PROGRAM OF AUDITORY ARTICULATION THERAPY FOR
  CHILDREN BY DIANE PAGNOTTO HILL WAS PRACTICED IN
  EVERY SESSION. THIS PROGRAM TARGETS INDIVIDUAL
  SOUNDS AND ASSOCIATES THEM WITH A PICTURE AND A
  NAME (E.G., /SH/ IS THE QUIET SOUND.) BY THE
  END OF FALL, HE COULD PRODUCE EVERY SOUND IN THE
  BOOK (HOWEVER SOME WERE NOT AS CONSISTENT AS
  OTHERS)
• WE ALSO USED A TRADITIONAL APPROACH FOR /K/ IN
  ISOLATION /S/ IN ISOLATION /l/ IN SYLLABLES AND
  /k/ IN VC COMBINATIONS.

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• PHONEMIC AWARENESS ACTIVITIES WERE INCORPORATED
  BEGINNING SPRING 2007, AND THE KAUFMAN SPEECH
  PRAXIS KIT WAS UTILIZED TO TARGET VC AND VCV
  WORDS. PHONEMIC AWARENESS INTERVENTION
• CONTINUED UNTIL THE CLIENT STARTED PRE-SCHOOL
  IN FALL 2007
• BY THE TIME THE CLIENT STARTED PRE-SCHOOL, HE
  KNEW LABELS FOR NEARLY ALL OF THE GRAPHEMES,
  COULD PROVIDE THE PHONEME ASSOCIATED WITH THEM,
  AND PROVIDE WORDS BEGINNING WITH ALL OF THE
  PHONEMES EXCEPT 5!! HE HAD ALREADY BEGUN TO
  READ SOME WORDS!! HE HAD THE MOST ADVANCED
  PHONEMIC AWARENESS SKILLS IN HIS CLASS WHEN HE
  ENTERED PRE-SCHOOL!!

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• LABELING OF UPPER AND LOWER-CASE GRAPHEMES
• PRODUCTION OF PHONEMES WHEN PROVIDED WITH
  GRAPHEMES
• CLIENT LEARNED TO PROVIDE 2 OR 3 WORDS THAT
  BEGIN WITH EACH PHONEME
• WHEN PRESENTED WITH 3 PICTURED WORDS AT A TIME
  AND PROVIDED WITH A PHONEME, THE CLIENT WOULD
  SELECT THE WORD THAT BEGINS WITH THAT SOUND
• LATER, WRITTEN WORDS WERE USED WHEN PRACTICING
  ARTICULATION, EVEN WHEN CLIENT WAS AT IMITATIVE
  LEVEL BEFORE HE COULD READ

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• FALL SEMESTER, 2007, THERAPY CONSISTED OF A
  TRADITIONAL APPROACH WHERE WORDS WERE CAREFULLY
  SELECTED TO TARGET ALL OF THE VOWELS IN CV
  SYLLABLES AND CV WORDS. IN ADDITION, MINIMAL
  PAIRS WERE USED FOR AUDITORY DISCRIMINATION OF
  /p/ VS. /b/ /d/ VS./g/ AND /t/ VS./d/. AND THE
  BROTHER PAIRS FROM THE Lindamood Phoneme
  Sequencing Program for Reading, Spelling, and
  Speech (LiPS Program) WAS USED TO ADDRESS
  DISCRIMINATION AND PRODUCTION OF /p/ vs. /b/.

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• SPRING 2008, A TRADITIONAL APPROACH WAS USED WITH
  WORDS CAREFULLY SELECTED USING ALL VOWELS IN THE
  QUADILATERAL FOR /G/ /K/ /M/ /T/ /B/ AND /D/
  IN CVC AND CVCC WORDS (SOME OF THE WORDS WERE
  MOVED TO PHRASE LEVEL.) IN ADDITION, VOWEL
  SEQUENCING EXERCISES WERE ADDED TO HELP PREPARE
  THE CLIENT FOR /r/ PRODUCTION.

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CONCLUSIONS

• CLIENTS PRE-SCHOOL TEACHER, WHO HAD KNOW HIM FOR
  SEVERAL YEARS, COMMENTED THAT SHE HAD SEEN A
  DRAMATIC IMPROVEMENT IN THE CLIENTS SPEECH
  INTELLIGIBILITY, AND SHE WAS VERY IMPRESSED WITH
  PHONEMIC AWARENESS SKILLS
• THIS CLIENT SEEMED TO BENEFIT GREATLY FROM THE
  INCORPORATION OF THE GRAPHEMES AND WORDS INTO
  ARTICULATION THERAPY

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• FOR EXAMPLE, IF THE CLIENT PRODUCED THE WORD
  CARP AND THE WORD WAS CARB IT COULD BE USED
  AS AN ERROR STRATEGY I HEARD /P/ AT THE END OF
  THAT WORD LOOK AT IT AGAIN, AND THE CLIENT
  EVENTUALLY BECAME ABLE TO CORRECT HIMSELF BY
  LOOKING AT THE LETTER

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RECOMMENDATIONS

• ADDITIONAL CLIENTS MAY BENEFIT FROM PHONEMIC
  AWARENESS ACTIVITIES INCORPORATED INTO
  ARTICULATION TREATMENT TO PREVENT LATER READING
  DIFFICULTY, AND HELP IMPROVE ARTICULATION
• THIS APPROACH NEEDS TO BE TRIED WITH ADDITIONAL
  CLIENTS

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REFERENCES

• GILLON, G., (2000). The efficacy of Phonological
  awareness intervention for children with spoken
  language impairment. Language, Speech, and
  Hearing Services in Schools, 31 126-41.

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REFERENCES (Continued)

• Gillon, G., (2005). Facilitating phoneme
  awareness development in 3- and 4-year-old
  children with speech impairment. Language,
  Speech, and Hearing Services in Schools, 12
  463-471.
• Lindamood, P. and P. (l998). The Lindamood
  Phoneme Sequencing Program for Reading, Spelling,
  and Speech, 3rd ed.
• Rvachew, S., Ohberg, A., Grawburg, M., Heyding,
  J. (2003). Phonological awareness and phonemic
  perception in 4-year old children with delayed
  expressive phonology skills. Language, Speech,
  and Hearing Services in Schools, 12 463-471.