Storybook Reading Approach:
Outcomes With Two Children
With Language and Phonological
Impairments Exhibiting Different
Levels of Phonological Consistency
Monica Bellon-Harn
Lamar University, Beaumont, TX
Maggie Credeur-Pampolina
Evadale Independent School District, Evadale, TX
I
mpairments of phonology coexist with other
language impairments (Bishop & Edmundson,
1987; Shriberg & Kwiatowski, 1994; Shriberg, Kwiatkowski, Best, Hengst, & Terselic-Weber,
1986). However, the nature of the interaction between
language and phonology has not been established,
spurring many treatment considerations for children
with impairment in both domains (Baker & McLeod,
ABSTRACT: Purpose: This study examined how 2
children with language and phonological impairments
exhibiting different levels of phonological consistency
responded to a storybook reading approach. In particular, within-treatment response to contrastive word
pairs was examined.
Method: The following questions were asked: (a) Does
a child with phonological inconsistency respond differently than a child with phonological consistency to
use of a CCVC/CVCC contrastive word pair strategy
during treatment? (b) Does a child with phonological
inconsistency exhibit a similar phonological response
to treatment as a child with phonological consistency?
Results: Treatment effects supported a storybook
Contemporary Issues
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and
2011; Kamhi, 2006). One line of inquiry has examined
the effects of broad-based language treatments, such as
storybook reading, on phonology. These treatments are
based on the view that language and phonology are interdependent parts of a dynamic communication system
(Stoel-Gammon, 1991). Therefore, it is expected that
change or ability in one domain may trigger change or
ability in the other (Hoffman, 1992; Tyler, 2002).
reading approach with children possessing different
levels of phonological consistency. However, differential responses were identified. The child with phonological inconsistency responded to contrastive word
pairs with revised productions, whereas the child with
phonological consistency responded to contrastive
word pairs with both revised and accurate productions. A similar treatment effect was noted on the
percentage of consonant correct—revised measures.
However, effects on the proportion of errors, consistency measures, and occurrence of cluster errors were
different. Implications for treatment are discussed.
KEY WORDS: phonology, language, intervention
Bellon-Harn
Credeur-Pampolina:
Contrastive
Disorders
• Volume 43 &
• 1–10
• Spring 2016 © NSSLHA
1092-5171/16/4301-0001
Word Pairs
Single-subject and small-group studies have
pointed to gains in phonology following various
storybook reading approaches (Hoffman, 1997). For
example, children with mild language and phonological impairments experienced gains in phonology
following an indirect storybook approach (Hoffman,
Norris, & Monjure, 1990). On the other hand, children with moderate-to-severe impairments benefited
from direct phonological approaches in addition to
storybook reading approaches (Friberg & Lund, 2010;
Hart & Gonzalez, 2009; Tyler & Sandoval, 1994).
Bellon-Harn, Hoffman, and Harn (2004) suggested
that the use of direct phonological strategies during
storybook reading may be beneficial to children with
mild, moderate, or severe impairments.
Although studies have supported the use of storybook reading approaches in children with co-occurring
impairments at differing levels of severity, previous
studies have not considered phonological consistency
as a factor in treatment outcomes. Our study contributes to existing studies by examining how two
children with language and phonological impairments
exhibiting different levels of phonological consistency responded to a storybook reading approach. In
particular, we examined within-treatment response to
a direct phonological strategy (i.e., contrastive word
pairs).
Treatment Approach
Treatment in this study included the repetition of
storybooks and clinical presentation of cloze procedures, expansions, models, and contrastive word
pairs, which we refer to as RSR-CWP (i.e., repeated
storybook reading—contrastive word pair). A cloze
procedure provides a linguistic context in which a
child fills in specific information signaled by an adult
pause (Bradshaw, Hoffman, & Norris, 1998). Expansion refers to adult repetition of a child’s utterance
using more mature language. One or more morphosyntactic elements is added, and the central meaning is expanded (Proctor-Williams, 2009). Modeling
refers to an adult production of appropriate semantic,
syntactic, and phonologic aspects of language (Camarata, 1993; Fey et al., 1994). A contrastive word pair
provides a contrast between the child’s error production and his or her correct production (Gierut, 1989;
Weiner, 1981; Williams, 2000).
In our treatment approach, the strategies were
presented in a scaffolded structure and the targets were not preselected. Rather, we presented the
strategies based on the child’s initiation or response.
Applying strategies in this structure is considered
scaffolding because the clinician supports the child’s
use of complex phonology and language with each
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and
subsequent production (Bornstein & Bruner, 1989;
Bruner, 1978; Kirchner & Skarakis-Doyle, 1983).
As the child’s language and phonology increases in
complexity, the linguistic complexity of the clinician gradually increases (Ukrainetz, 2006). Multiple
repetitions of a storybook provide context for strategy
presentation with redundant linguistic and phonological elements.
The following is an example of a scaffolded
structure during RSR-CWP using the book Mrs.
Wishy Washy (Cowley, 1990).
Adult: And that cow is ________ (cloze
procedure)
Child: Looking at the mud
Pho: /wʊkɪn æt ðə mØd/
Adult: /wʊkɪn/ or /lʊkɪn/? (contrastive word pair)
Child: Looking
Pho: /lʊkɪŋ/
Adult: He’s looking at that mud. Because he wants ________ (expansion and cloze procedure)
Child: To jump in the mud
Pho: /tu dZəmp ɪn ðə mØd/
Bellon-Harn et al. (2004) reported that the
elicitation of specific phonological forms through
a contrastive word pair followed by cloze procedure and expansion during repeated storybook reading increased the phonological accuracy of children
with speech and language impairments. Bellon-Harn,
Credeur-Pampolina, and LeBoeuf (2013) corroborated
these results and further clarified the role of contrastive word pairs. Greater speech production accuracy
was related to redundant, massed presentation of contrastive word pairs, which included bisyllabic, CVCC,
CCVC, and CVC structures. Additionally, contrastive word pairs with greater phonological complexity
positively impacted the speech-sound production of
children with speech and language impairments. Our
study extends this research by examining how two
children with language and phonological impairments
exhibiting different levels of phonological consistency
responded to RSR-CWP.
Phonological Consistency
Inconsistent speech productions in typically developing children are well documented. Inconsistency
can occur when a child has different productions of
a particular speech sound for different lexical items
(e.g., /s/ produced as /s/ in sea but not sun) or different word positions (e.g., /s/ produced as /s/ in
initial but not final positions). This may be related
to incomplete underlying representations of words,
Disorders • Volume 43 • 1–10 • Spring 2016 misperception, or immature articulatory abilities
(Holm, Crosbie, & Dodd, 2007). Variable production
of speech sounds is indicative of ongoing phonological reorganization, and inconsistency decreases as
a child masters the sounds of language (Forrest &
Elbert, 2001).
The speech of children with impaired phonological systems may be characterized by inconsistency
as well (Broomfield & Dodd, 2004). These children
often have variable productions of the same words or
phonemes within and across word positions (Crosbie,
Holm, & Dodd, 2005; Tyler, Lewis, & Welch, 2003).
The underlying cause of inconsistency in children
with phonological disorders has not been determined
(Betz & Stoel-Gammon, 2005). Dodd (1995) suggested that these children may have a degraded phonological plan. In other words, they may have difficulty
selecting and sequencing phonemes for the production
of a word or utterance. Through treatment, children
with phonological disorders may begin to stabilize
their phonological plan for word production, thereby
decreasing their variable production.
According to Forrest, Elbert, and Dinnsen (2000),
treating children with inconsistent speech patterns
may be difficult because the clinician may not know
the appropriate sound to contrast with the error production. McIntosh and Dodd (2008) documented positive outcomes using an approach to assist children
in assembling a phonological plan online via modeling and stabilizing the child’s best error production
(i.e., core vocabulary approach). They suggested that
intervention should target sequences of phonemes in
whole words. Tyler et al. (2003) found that children
with language and phonological impairments who
were characterized with a highly inconsistent system made greater phonological changes following
a morphosyntax treatment than those with a highly
consistent system. The authors suggested that the
more diversified stimuli and varied opportunities for
production in the language approach may have contributed to more widespread change than an approach
focused on particular phonemes.
We suggest that RSR-CWP may be a viable option for the treatment of children with phonological
inconsistency. To examine this possibility, we asked
the following research questions:
• Does a child with phonological inconsistency respond differently than a child with phonological
consistency to use of a CCVC/CVCC contrastive
word pair strategy during treatment?
• Does a child with phonological inconsistency
exhibit a similar phonological response to treatment as a child with phonological consistency?
We hypothesized that the child with phonological inconsistency would be likely to produce revised
responses, albeit not fully accurate responses, following CCVC/CVCC contrastive word pairs because
the child is working toward a gestural match with
the adult target and is developing a more efficient
phonological plan. On the other hand, we hypothesized that the child with phonological consistency
would be likely to produce accurate responses following CCVC/CVCC contrastive word pairs because
the child has a stable phonological system and is able
to select and sequence the correct phoneme for the
production of a word.
We also hypothesized that both children would
improve their phonological performance because
of the clinical strategies used within the storybook
reading interaction. Storybook repetition allows the
child to focus on complex lexical and phonological
relationships. Clinical strategies presented in a scaffolded structure provide multiple opportunities to hear
and produce lexical items in varied linguistic units.
In RSR-CWP, clinicians do not predetermine stimuli;
rather, the strategies are applied as a consequence of
the child’s initiation or response. As a result, there
are many words used in contrastive word pairs, with
various lexical and phonological characteristics. Lexical items are not tightly controlled, ensuring diversified stimuli.
We used a case study design (Yin, 2003) whereby
we examined clinician–child treatment interactions
to answer the first question, and we evaluated the
children’s baseline, treatment, and posttreatment performance to answer the second question.
Method
Participants
We recruited two children via the speech-language
pathologist (SLP) at a local public school. Beth was
a female, age 5;7 (years;months), and Diane, also a
female, was age 5;4. Their language and phonological abilities are shown in Table 1. Both children
exhibited impaired language based on scores at least
1 SD below the mean on the Structured Photographic
Expressive Language Test—Third Edition (Dawson
& Stout, 2003) and/or the Preschool Language Assessment Instrument–Second Edition (Blank, Rose,
& Berlin, 2004). The children’s ognitive abilities
were within normal limits based on scores within 1
SD from the mean on the Columbia Mental Maturity
Scale—Revised (Burgemeister, Blum, & Lorge, 1972).
Neither child presented with gross oral-motor,
Bellon-Harn & Credeur-Pampolina: Contrastive Word Pairs
Table 1. Results of the two children’s language, cognitive, and speech assessments.
Assessment
SPELT–3
PLAI–2
CMMS–R
W.I.
C.I.
P.I.
Consistency index
Beth
Diane
74
82
95
65
65
65
25
74
94
102
76
72
80
5
Note. SPELT–3 = Structured Photographic Expressive Language Test—Third Edition, PLAI–2 = Preschool Language
Assessment Instrument—Second Edition, CMMS–R =
Columbia Mental Maturity Scale—Revised, W.I. = Bankson-Bernthal Test of Phonology word inventory, C.I. =
Bankson-Bernthal Test of Phonology consonant inventory,
P.I. = Bankson-Bernthal Test of Phonology phonological
process inventory.
hearing, emotional, or neurological impairments based
on school documentation and screenings.
Phonological impairment was based on the
children’s scores of at least 1 SD below the mean on
the word, consonant, and phonological process inventories of the Bankson-Bernthal Test of Phonology
(Bankson & Bernthal, 1990). The scores indicated
that Beth demonstrated a more severe phonological impairment than Diane. The phonetic inventories demonstrated that both children produced most
sounds expected for children between 5 and 6 years
of age (Grunwell, 1987). However, the children’s
production of clusters was limited. The consistency
index is defined as a raw number that reflects the
total number of different errors occurring across the
23 phonemes of the language (Tyler et al., 2003). A
low consistency index score reflects fewer errors per
phoneme; a high score reflects a lack of consistency
in the child’s production. Beth presented with phonological inconsistency; Diane did not.
Treatment Procedure
A second-year graduate student clinician conducted
the baseline, treatment, and posttreatment sessions.
Baseline measures were obtained 1 week before the
treatment; the posttreatment measures were obtained 1
week following the treatment. The baseline and posttreatment sessions lasted as long as needed to obtain
a representative sample, which was approximately 15
min. The clinician presented a storybook, asked broad
wh-questions (e.g., “What’s happening?”), and used
general prompts (e.g., “Tell me the story”). No
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and
strategies were presented at the baseline or posttreatment session.
Each child completed 12 treatment sessions,
three times per week for 4 weeks. Treatment was
conducted in 20-min sessions. The books selected
for repeated reading contained narrative structures
that were characterized as reactive or abbreviated
sequences and were approximately 15 pages in
length, including the cover and title page (Applebee,
1978). At the first session, the initial five pages
of a book were introduced. Each subsequent session reviewed the previous set of five pages and
introduced the next set of five pages. Each book
was completed in three sessions. Cloze procedures,
expansions, models, and contrastive word pairs were
applied. Following treatment, five posttreatment
measures were obtained following procedures used
in the baseline phase.
To ensure uniform treatment, the first author
recorded and reviewed each session. Clinician utterances across eight treatment sessions were coded as
either cloze procedure, expansion, model, or contrastive word pair. Clinician productions that included
nonstorybook-related utterances and utterances for
behavior regulation (e.g., “Sit in your seat”) were
removed from the sample. Next, the number of total
strategies and number of contrastive word pairs were
calculated (see Figure 1). The frequency of each
was determined using the FREQ program from the
Child Language Analysis (CLAN) computer program
(MacWhinney, 2010). Strategies occurred at a rate of
139–180 per session (i.e., 7–9 per min) for Beth and
at a rate of 123–180 (i.e., 6–9 per min) per session
for Diane. Contrastive word pairs occurred at a rate
of 53–75 per session (i.e., 3–4 per minute) for Beth
and at a rate of 37–61 per session (i.e., 2–3 per min)
for Diane.
Treatment Outcome Measures
To answer the question of whether or not a child
with phonological inconsistency responds differently
than a child with phonological consistency to CCVC/
CVCC contrastive word pairs, we examined eight
treatment sessions. We decided to examine CCVC/
CVCC contrastive word pairs because both children
had limited production of clusters in the pretreatment assessment, and the production of clusters is
considered a complex phonological task (McLeod,
Van Doorn, & Reed, 2001). Within each session,
clinician–child exchanges that included CCVC/CVCC
contrastive word pairs were selected for analysis.
The following is an example of a clinician–child
exchange.
Disorders • Volume 43 • 1–10 • Spring 2016 Figure 1. Total number of strategies and total number
of contrastive word pairs used by the clinician during
treatment.
Adult: So he’s flying in the . (cloze
procedure)
Child: Sky
Pho: /kaɪ/
Adult: The /kaɪ/ or /skaɪ/? (contrastive word pair)
Child: Sky
Pho: /skaɪ/
Each child production following a CCVC/CVCC
contrastive word pair was coded according to whether
or not the cluster (a) was revised to approximate the
adult form, (b) accurately matched the adult form, or
(c) did not change. The following is an example of a
revised production.
Adult: She wants the cow to be . (cloze procedure)
Child: clean
Pho: /hin/
Adult: /hin / or /klin/? (contrastive word pair)
Child: clean
Pho: /kin/
The following is an example of a cluster production that did not change.
Adult: It made a . (cloze procedure)
Child: splash
Pho: /fwæ∫/
Adult: /fwæ∫/ or /splæ∫/? (contrastive word pair)
Child: splash
Pho: /fwæ∫/
To answer the question of whether or not a child
with phonological inconsistency has a similar phonological response to treatment as a child with phonological consistency, we examined the speech samples
at baseline, treatment, and posttreatment. The speech
samples consisted of 60–70 child utterances based on
complete, intelligible child utterances taken from the
start of each session. Utterances consisted of child
initiations and responses to strategies. Spontaneous
speech not related to the storybook interaction was
not included. To provide a global measure of speechsound change that accounts for uncommon and common clinical distortions, we calculated the percentage
of consonants correct–revised (PCC–R; Shriberg,
Austin, Lewis, McSweeny, & Wilson, 1997). PCC–R
is calculated using the following formula: (# consonants correct ÷ # consonant targets) × 100.
The proportion of errors (POE) provides a measure of articulatory accuracy in whole word production using the following formula: # error/# total
productions × 100 (Betz & Stoel-Gammon, 2005).
A POE score of 0% means that there were no errors made on any of the words in the sample; a POE
score of 100% means that all attempts at the words
comprising the sample were incorrectly produced.
This measure is a percentage, allowing the results to
be compared between children (Betz & Stoel-Gammon, 2005).
Because both children presented a limited production of clusters, we also calculated the percentage
of occurrence of errors on consonant clusters. All
clusters in syllable-initial and syllable-final position,
excluding those that marked morphological relationships, were counted. A cluster was considered to be
in error if one or more elements was omitted, if one
or more elements included a phoneme substitution, or
if one or more elements was added.
A consistency index score was calculated to
examine changes in phonological consistency (Tyler, 2002). Within each sample, the total number of
different sound substitutions/omissions for each of
Bellon-Harn & Credeur-Pampolina: Contrastive Word Pairs
the 23 phonemes made across word positions was
summed.
97% and for child production coding (i.e., revised,
accurate, no change) was 99%.
Data: Transcription, Coding, Reliability
Data: Analysis
All baseline, treatment, and posttreatment data were
recorded using digital flash audio recorders. Sessions
occurred in speech therapy rooms in the children’s
public school. Sessions were individual and occurred
at the same time in the same room each week. Two
graduate students in a program of speech-language
pathology completed the transcription. First, they
phonetically transcribed the samples individually. Then,
they compared the samples. If agreement could not be
reached on all utterances, the second author listened
and transcribed the utterances in question to make the
final decision. To establish transcript reliability, 20%
of the baseline, treatment, and posttreatment speech
samples were phonetically transcribed by the second
author. Transcriptions were compared using verbatim agreement in that every phoneme had to be the
same. Agreement was calculated using the following
formula: (agreements/agreements + disagreements) ×
100. Transcript reliability of the child utterances during the baseline, treatment, and posttreatment speech
samples ranged from 90% to 94%. The same process
was completed for transcript reliability of the clinician’s utterances during the treatment phase. However, these utterances were not phonetically transcribed.
Agreement ranged between 92% and 95%.
The second author completed PCC–R, POE, occurrence of consonant cluster error, and consistency
index scores on all of the speech samples. A graduate student completed these measures on 20% of the
baseline, treatment, and posttreatment speech samples.
Point-by-point comparison of child utterances was
completed. For PCC–R, phonemes correct and incorrect per utterance were counted; for POE, whole word
accuracy per utterance was counted; and for occurrence of consonant cluster error, accuracy on clusters
per utterance was counted. For consistency index,
phonemes produced differently in different word positions were counted. Agreement was calculated using
the following formula: (agreements/agreements + disagreements) × 100. Agreement for PCC–R was 96%,
POE was 95%, occurrence of consonant cluster error
was 91%, and consistency index was 90%.
The first author identified clinical strategies and
coded child productions as revised, accurate, or no
change. A graduate student in the program of speechlanguage pathology completed these measures on 20%
of the treatment samples. Agreement was calculated
using point-by-point comparison and the following
formula: (agreements/agreements + disagreements) ×
100. Agreement for clinical strategy identification was
In order to identify the presence of trends, we plotted
the frequency of child responses to CCVC/CVCC contrastive word pairs (i.e., revised, accurate, no change)
across sessions and examined them. We also plotted
the treatment outcome measures across sessions and
examined them to identify trends of changes during
the baseline, treatment, and posttreatment sessions.
To compare baseline and posttreatment performance,
we used Busk and Serlin’s (1992) d1 statistic (Beeson
& Robey, 2006). This statistic is a reliable estimator
of the effect size when the pretreatment variance is a
nonzero value. Although effect size measurements in
single-subject studies do not test the null hypothesis,
they do yield a measure of the magnitude of change
(Meline, 2010). Law, Garrett, and Nye (2004) analyzed
five clinician-administered treatments for expressive
phonology and reported an effect size range from
0.96 to 2.86 when the outcome measure was PCC–R
in conversation.
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Results
Within-Treatment Response
to Contrastive Word Pairs
Responses to CCVC/CVCC contrastive word pairs
primarily consisted of revised productions for Beth
(see Figure 2). Transcripts 3 and 4 contained the
greatest level of accurate responses (i.e., 28% and
41%, respectively). Each transcript included responses
in which Beth’s production did not change. Diane’s
revised productions and responses in which production did not change decreased, whereas her accurate
responses increased (see Figure 2).
Treatment Outcomes
A divergence of data points was apparent toward
the end of the treatment phase for Beth (see Figure
3). Her PCC–R increased, and her POE decreased.
A slight upward slope in PCC–R occurred across
Diane’s treatment phase. Her POE increased slightly
during her initial treatment sessions, followed by a
slight downward slope. The pre–post PCC–R comparison indicated differences with moderate effect sizes
for both children when compared to the range reported in Law et al. (2004; see Table 2). Pre–post POE
comparison indicated differences with a large effect
size for Beth and a minimal effect size for Diane.
Disorders • Volume 43 • 1–10 • Spring 2016 Figure 2. Response type to CCVC/CVCC contrastive
word pairs.
Visual inspection of the consonant cluster errors suggested that both children improved in their production
(see Figure 4). The treatment had a greater effect on
Diane than on Beth. Visual inspection of the changes
in consistency index scores suggested a treatment effect for Beth. The pre–post consistency index comparison indicated a large effect size.
Discussion
We examined how two children with language and
phonological impairments exhibiting different levels
of phonological consistency responded to a storybook reading approach. One child presented with a
mild–moderate, consistent phonological impairment
and the other with a moderate–severe, inconsistent
phonological impairment. The treatment protocol
included the use of cloze procedures, expansions,
models, and contrastive word pairs. Collectively,
clinical strategies were massed so that they occurred
Figure 3. Percentage of consonants correct—revised
(PCC–R) and percentage of errors (POE) during baseline, treatment, and posttreatment for both children.
at a high frequency per minute. The use of contrastive word pairs occurred at comparable rates for
both children. As with Bellon-Harn et al. (2004), the
child with a mild–moderate phonological impairment
required contrastive word pairs with slightly less
frequency than did the child with a moderate–severe
phonological impairment.
The first research question asked whether or not
a child with phonological inconsistency responds differently than a child with phonological consistency
to CCVC/CVCC contrastive word pairs. We hypothesized that the child with phonological inconsistency
would be likely to produce revised, albeit not fully
accurate, responses following contrastive word pairs
as she worked toward a gestural match with the adult
target and developed a more efficient phonological
plan. This hypothesis was supported. Beth revised her
productions following contrastive word pair strategies
and approximated the adult form more often than accurately matching the adult form.
We expected that the child with phonological
consistency would be more likely to produce accurate
responses than revised responses following contrastive word pairs because she had a stable phonological system and was able to select and sequence a
correct phoneme for the production of a word. This
hypothesis was not fully supported. During the initial
treatment sessions, Diane’s responses were revised.
Bellon-Harn & Credeur-Pampolina: Contrastive Word Pairs
Table 2. Effect size measurements for dependent variables.
Baseline
Posttreatment
Participant
M
M
SD
d1
SD
PCC-R
Beth
Diane
66.40 3.20
81.00 3.53
72.80
86.40 4.49
3.13
2.00
1.52
POE
Beth
Diane
63.60 2.30
32.40 3.64
53.40
29.80
3.78
7.25
–4.43
–0.71
Consonant cluster errors
Beth
74.00 7.77
Diane
60.8 16.61
65.00
29.80
8.94
7.25
–0.49
–1.86
Consistency index score
Beth
19.8 3.89
Diane
5.4
2.07
11.2
3.2
1.92
.83
6.11
0.59
Figure 4. Percentage occurrence of consonant cluster
errors and consistency index scores during baseline,
treatment, and posttreatment.
Note. PCC–R = percentage of consonants correct—revised;
POE = proportion of errors.
Analysis of subsequent transcripts suggested that this
behavior decreased and Diane’s accurate productions
increased. Initially, the CCVC/CVCC contrastive
word pairs may have included more difficult or novel
words than Diane produced during her pretreatment
speech samples. As such, during treatment, Diane
made multiple revised productions in order to more
closely resemble the clinician’s production. She produced the same word in several different ways as she
worked toward a gestural match with the adult target.
To answer the second question of whether or not
a child with phonological inconsistency has a similar
phonological response to treatment as a child with
phonological consistency, we obtained measures of
PCC–R, POE, percentage of occurrence of consonant cluster errors, and consistency index scores. We
hypothesized that the phonological performance of
both children would improve because of the clinical
strategies used and the nature of the storybook repetition. However, the results do not fully support this
hypothesis. For both children, similar effects were
noted on PCC–R in that both children increased their
correct production of phonemes. On the other hand,
treatment effects on Beth’s POE and consistency
index were large, whereas Diane’s were minimal.
During baseline, the children had control of the book
and the interaction. For Beth, once treatment began,
the clinician’s use of repeated lexical items within
a controlled interaction resulted in increased consistency. Massed application of the strategies may have
contributed to consistency because Beth had multiple
attempts to hear her error production contrasted with
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the adult target. Although speculative, it may be that
Beth had less entrenched errors than Diane, which
resulted in greater flexibility during treatment. Conversely, Diane’s stable system was thrown into flux
following the introduction of complex and/or unfamiliar contrastive word pairs, resulting in more revised
than accurate responses and greater POE at initial
treatment sessions. Overall, both children worked
toward a more efficient phonological plan.
The occurrence of cluster errors in Diane’s
speech decreased at a greater rate than in Beth’s
speech. When a contrastive word pair strategy was
triggered, Beth’s responses typically remained incorrect, albeit revised and stabilized. It may be
that Beth’s accurate production of clusters required
phonemic placement and/or other cues as described in
Friberg and Lund (2010), Hart and Gonzalez (2009),
and Tyler and Sandoval (1994). Further, when using
RSR-CWP, more sessions may be required to reach
accurate production for a child with moderate–severe,
inconsistent speech impairment. Thus, an extension of
the total treatment time may be needed.
Conclusion
Overall, treatment effects on phonological consistency and speech-sound accuracy provide data to
Disorders • Volume 43 • 1–10 • Spring 2016 support using RSR-CWP with children with either
phonological consistency or inconsistency and corroborate outcomes from previous studies (Bellon-Harn
et al., 2004, 2013). Results lend support to Tyler et
al. (2003), who suggested that a language-based approach to treatment may be appropriate for a child
with phonological inconsistency.
Limitations and Future Research
We speculate that this treatment could be appropriate
for children with language and phonological impairments exhibiting different levels of phonological
consistency. To fully consider the viability of this
treatment, group comparison studies with various subgroups of children are needed. Additionally, treatment
time with greater duration may have revealed patterns
that were not noted in this examination.
Previous examinations of RSR-CWP with children with co-occurring impairments have suggested
that the children’s level of language impairment plays
a role in the outcomes. Although both children in this
study exhibited language impairment, Diane performed better on semantic language assessment than
did Beth. This study did not parse out cognitive–
linguistic abilities as contributing factors to treatment responses. Further, this study did not examine
morphophonemic relationships. Future research on
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Full word type analysis within storybooks and
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phonological consistency because the children differed in severity at the outset of the study. The child
with a more severe disorder received more strategies
than the child with a milder disorder.
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Contact author: Monica Bellon-Harn, P.O. Box 10076,
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10
Contemporary Issues
in
Communication Science
and
Disorders • Volume 43 • 1–10 • Spring 2016