Skelton and Taps ASHA (2008)
Concurrent Treatment in the Speech‐
Improvement Class: A motor‐skill‐based treatment for speech‐sound disorders Steven L. Skelton, Ph.D. Jennifer Taps, M.A.
Dept. of Communicative Dept
of Communicative
Disorders & Deaf Studies Articulation Resource Articulation
Resource
Center
California State University, Fresno
San Diego Unified School District
Motor skill learning consists of “performance” and “learning”
● Performance – skill use during practice
● Learning – skill retention and transfer
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● The extent of learning is effected by the nature of the practice tasks used. This concept is call “specificity of practice.”
What are we learning when we practice? ● From practice, we learn a rule for a relationship between actions and their outcomes. In motor skill terminology this is a motor schema for the skill (Schmidt & Lee, 2005).
● However, to use a skill effectively we must also learn . . .
○ Variations of these actions and the resulting variations in their outcomes.
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○ The stimulus conditions under which to perform.
● And we learn the inherent sensory consequences of actions.
Where we are going?
● Basic concepts of motor learning
● Conditions of practice
● Concurrent Treatment research into the effects of variable practice
● Integrated treatment framework (based on the San Diego Unified School District study)
Specificity of Learning
● Motor learning (transfer) tends to be highest to contexts that are similar to the original practice.
● Best learning experiences are those that most closely approximate the movement components and environmental conditions of the target.
● Practice of motor behaviors that are outside of a context typical for speech would violate “specificity of learning” (as is done in most nonspeech oral motor approaches).
● So if we want our clients to practice speech we give them speech tasks to practice.
Conditions of Practice
The saying “practice make perfect” is central to motor learning approaches to treatment.
● We must practice a skill to acquire it. ○ ASHA NOMS Project (ASHA, n.d.) – Children who practiced at home significantly more likely to generalize than those who did not.
○ The conditions under which a person practices influences the learning outcomes
learning outcomes. ● Conditions of practice are the variables we manipulate to create a practice session.
○ What skill will we practice? ○ What if a skill is too difficult?
○ What variations of the tasks need to be practiced?
○ What is the order in which we will practice the tasks?
○ How will we schedule practice?
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Skelton and Taps ASHA (2008)
Conditions of Practice
Blocked
● Constant vs. Variable practice (task variation)
● Block vs. Random practice (task order)
● Massed vs. Distributed practice (practice & rest)
Massed vs Distributed practice (practice & rest)
● Part vs. Whole practice (simplifying practice tasks and integrating them into the final skill)
Constant
Variable
Random
Blocked
Acquisition
Concurrent Treatment
Constant
Variable
Random
A motor learning treatment with random‐variable task sequencing
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Transfer & Retention
Treatment Key Ideas
The treatment design included the following elements: ● Establish sound(s) in several (two to four) syllables or words using blocked, consistent practice
● Then, use randomized variable practice to enhance transfer and retention by . . .
○ Teaching the full range of practice tasks within each treatment session, and
○ Presenting the teaching tasks intermixed in random order. Skelton (2004)
● Establish the target sound in isolation (if applicable) and one CV and VC syllable (criterion 8 correct out of 10 attempts).
● Variable Practice of the full range of tasks. ○ Randomized sequence
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○ Practice all tasks within each session ○ Stop when performance is 80% correct across all types of tasks.
● Probing for generalization to untaught tasks across the range taught, and to within‐clinic and beyond‐clinic conversational settings.
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Skelton and Taps ASHA (2008)
The Heart of the Matter
● What is the defining characteristic of Concurrent Treatment?
Concurrent and “Traditional” Treatments
Component
“Traditional”
Concurrent
Placement teaching to establish the target sound
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Reinforcement and punishment consequences
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Many responses per session
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High mastery criterion 9
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Various practice tasks (“easier” and “harder” tasks)
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Blocked constant sequence of practice tasks in incremental steps
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Randomized variable sequence of practice tasks
Skelton (2004)
The Heart of the Matter
● What is the defining characteristic of Concurrent Treatment? Randomized variable practice is the defining characteristic of this approach.
● After each completed treatment task, you have another that differs in response length, mode, position, or any combination.
● The changes are determined randomly.
Where have we been?
Previous Research on Concurrent Treatment
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Replication Study
Skelton and Funk (2004)
● Four children, age 7 years received treatment / /
for /s/.
● Rapid sound acquisition.
● Generalization to untaught tasks.
● Generalization across settings.
● Three children, ages 4:8 to 5:11, with multiple sound errors.
● Received treatment, one for /k/ and two for /s/ speech sounds
and two for /s/ speech sounds.
● Acquisition for taught sounds.
● Generalization to untaught tasks.
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Skelton and Taps ASHA (2008)
Treatment of Multiple Sounds
Skelton & Kerber (2005)
● Four children with phonologic disorder.
● Each taught 4 sounds related to a Each taught 4 sounds related to a
phonologic pattern.
● All children acquired targets.
● Across‐phoneme generalization to untaught sounds in the pattern.
Speech Improvement Class
●General education services for children who do not IEP criteria. In California, must meet all three criteria –
○ 1. significant impact on intelligibility AND ○ 2. attracts adverse attention AND The Current Study
What is the San Diego Study About?
● Providing greater generality of previous findings.
● Evaluating the use of Concurrent Treatment in a typical public school setting.
● Evaluating if Concurrent Treatment can be adapted to a group therapy setting.
● Evaluating the efficacy this form of group therapy.
● Treatment was administered in the context of the “Speech Improvement Classes” at San Diego Unified School District
Speech Improvement Class
●Around age seven ‐ leaves 1.5 years before the speech normalization boundary of 8;5 (Shriberg et al, 1994) (Two exceptions for atypical patterns – lateral patterns and cluster reduction after age 5;6 (Smit, 1993a and 1993b))
○ 3. adversely affects educational performance.
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●Nonstimulable for target sounds (monitor and watch kids who are stimulable)
●RtI Tier II Intervention – 08‐09 fifth year of implementation
●Motivated and willing to practice at home
●Children with mild articulation errors – could be any number of sounds in error (including clusters)
●Speech Improvement Class – twice a week for 30 minutes (intensive treatment)
The participants
● At start of study, 34 children children, ages 5 ‐ 8 years, were randomly assigned to a control or experimental group (17 per group). ● One to three speech sound errors not typical of their chronological age. ● Children requiring special education services for other Child
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disabilities excluded from this project.
● The participants did not have other speech services during the time of the study – including the control group.
● At end of study (posttests), there were 27 children (15 experimental and 12 control). Attrition was due to children moving out of the district.
Assessment of participants
●CASL: Comprehensive Assessment of Spoken Language
●Goldman‐Fristoe Test of Articulation – 2 (PCC Calculated)
●Oral Mechanism Exam (ALL were within normal limits).
●Hearing Screening (ALL passed at 20dB for 500, 1000, 2000, 4000, and 6000 Hz bilaterally )
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Skelton and Taps ASHA (2008)
The Participants
The participants
CASL: Comprehensive Assessment of Spoken Language
Experimental Group
Control Group
●Age
•Mean: 7 yrs, 2mos.
•SD: 14.08 mos.
●Males: 59%
●Age
•Mean: 7 yrs. 2 mos.
•SD: 10.44 mos.
●Males: 47%
●Females: 41% ●Females: 53%
●White: 59%
●White: 47%
●African‐American: 0%
●African‐American : 6%
●Hispanic: 35%
●Hispanic: 47%
●Asian: 12%
●Asian: 0%
The participants
Goldman‐Fristoe Test of Articulation – 2 (Percent Consonants Correct)
Experimental Group
●MEAN
●SD 4.89%
4 89%
91.70%
Experimental Group
Control Group
●Mean Standard Score: 99.00
●Mean Standard Score: 105.57
●Standard Deviation: 24.87
●Standard Deviation: 12.90
The Speech‐Language Pathologists
Control Group
●MEAN
94.27%
●SD 4.94%
●Eight Speech‐Language Pathologists employed by the San Diego Unified School District, San Diego, California
●These SLPs volunteered to participate.
●Before the beginning of the study, all were trained in the treatment methodology by the authors.
●All assessment and treatment sessions were held at each SLP’s assigned school site.
Informed Consent
Pretest‐Posttest Control Group Design
● Consent must be signed
● No one denied services for not signing the consent
● Any parent was able to withdraw their child from the study without being removed from the SI class.
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Skelton and Taps ASHA (2008)
Dependent Variables
●Dependent Variable was the child’s production of the target sound.
●Sounds taught in the study /g/, /k/, /r/, /s/, /z/, /ʃ/, /tʃ/, /dʒ/.
●Only perceptually and cosmetically correct productions of all target sounds were scored as correct. All other productions were scored as incorrect. Measures ● PRETEST and POSTEST – Speech Improvement Sound Inventory
● Target sound measured in words and sentences. ● Singletons in initial and final word positions; clusters in initial word
positions; clusters in initial word position.
● Children named pictures for the singletons and clusters in words
● Children read the sentences aloud.
● Reliability: r = 0.94
Speech Improvement Sound Inventories (SISI)
Establishment
●Administer Speech Improvement Sound Inventory for target sound before and after class ● Teach placement in four words (two initial and two final position) per target sound.
● Practice was in blocked constant practice condition
Practice was in blocked constant practice condition
● Use of “segmentation” (additive practice) instead of “fractionalization” (interrupted practice) to teach use of target sound in the words.
●Singletons, clusters, stimulability, quick oral‐peripheral ●Singletons
clusters stimulability quick oral peripheral
screen
●For later‐developing sounds – k, g, s, z, r, ʃ, tʃ, ʤ, l, θ, ð ●Clip art or words
●Available for download at http://slpath.com
Segmentation Practice
Sequentially practice a target part and then sequentially add the other parts to it.
● Start with segment needing practice, then build the word from that point.
● Whole word Whole word – “Say
Say skip.
skip ”
● Segmentation (in either direction) –
○ “Say /s/” OR “Say /ɪp/”
○ “Say /sk/” “Say /kɪp/”
○ “Say /skɪ/” “Say /skɪp/”
○ “Say /skɪp/”
Another Segmentation Example
Practice from a motor behavior to the target in a word.
● “Do ‘tongue up to the bumps’”
● “Do ‘tongue up to the bumps and drop it’”
● “Do
Do ‘tongue
tongue up to the bumps and drop it with up to the bumps and drop it with ‘Mr
Mr. voicebox voicebox
on’”
● “Do /le/”
● “Do /lek/”
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Skelton and Taps ASHA (2008)
Variable Practice
Practice Tasks
These were range of tasks included in the random‐variable practice.
●Practice the full range of tasks.
●Change a task after each completed treatment trial. ●Randomize the sequence of tasks.
●Practice all tasks within each session
●Practice all tasks within each session ●Criteria for training: when performance is 80% correct across all types of tasks.
●There were 30‐40 stimulus items per sound representing all applicable word positions (and, if applicable, initial clusters).
●Imitative
○Syllables
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○Single words
○Phrases
○Sentences
●Nonimitative (Spontaneous)
○ Single words
Single words
○ Phrases
○ Sentences
○ Conversational or Storytelling
All relevant word positions were represented and if relevant, initial clusters were included. These were randomly intermixed.
How to Randomize Tasks
● Spinner + Card deck with target sound across word positions
● Cards + Card deck with target sound across word positions
An example of a randomized variable task sequence
house
straight
sink
sled
castle
etc.
Consequences
● Correct responses – token or verbal reinforcement on a continuous schedule followed by intermittent reinforcement.
● Errors – each error received the following correct sequence
○ 1. Brief verbal instruction; child repeats trial.
○ 2. Imitation of the response.
2 Imitation of the response
○ 3. If there is still no correct response task is discontinued and precede to the next task.
Home practice
● In the establishment phase – practice of establishment tasks in blocks.
● In the variable practice phase – practice of variable tasks.
○ Modified
Modified existing homework sheet with ten target existing homework sheet with ten target
words. ○ After spinning the spinner, the child wrote the result as “SY” (“syllable”), “W” (“word”), “P” (“phrase”), “SE” (“sentence”) or “ST” (“story”) next to each word. go - P
legos – ST
game – W
ladybug – SE
guessing - ST
spaghetti – W
egg – SY
green - P
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Skelton and Taps ASHA (2008)
Treatment in groups of four children
● Children in the experimental group received Concurrent Treatment in sessions of no more than four children at a time. ● The task spinner was spun and a child had a practice (treatment) trial
(treatment) trial.
● After the completion of that trial, the next child had a practice trial.
● Treatment over an average of forty 30 minute sessions.
Conclusions
Contacts
Steven L. Skelton, Ph.D.
●As was seen in earlier studies, treatment with randomized variable practice of the full range of practice tasks (Concurrent Treatment) can result in rapid acquisition of a target sound.
Dept. of Communicative Disorders and Deaf Studies
California State University, Fresno
[email protected]
Jennifer Taps
San Diego Unified School District
http://slpath.com
[email protected].
●This treatment can be adapted for use with groups of 4 h
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children, seen in typical public school settings.
●The results show the efficacy of the treatment of single sounds in an intervention class (Speech Improvement Class)
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