For the second blog I decided to focus on the second client I am working with. J is a 23 year old female who is diagnosed with a syndrome called Cavum Septum Pellicidum and delayed speech and language. She was in therapy from 1989-1996 and then returned in 2001 until the present.
I have 3 goals with J. For the first 2 goals, I use J’s personal communication notebooks to enhance receptive language. Our third and main goal is to work with the Vantage (AAC device) and a program called Literacy Through Unity.
With J’s notebooks I ask her to point to words or Velcro words in the front of the notebook to make phrases and I try to use as many different words in her notebook as possible. When using the Vantage, I present word cards to J that show the word spelled out and a picture of the icon. I then read J the directions and a sentence using that word.
In a presentation from the ASHA Convention 2007, the presenters support the literacy based technique I use with J. The recommendations for individuals with use AAC are that they have knowledge of letter-sound correspondences and sight word recognition skills. The instructor should also demonstrate the skill, provide support and cues, have the individual rehearse the word in their head and provide feedback when the individual performs the skill independently.
These are all techniques I use with J. I show J each word multiple times and she points to the word when I am saying it. Some lessons I use the individual speech sounds and J seems to respond better when the sound is made and not just the letter read. When I read the directions, J rehearses the word in her head, then points to the word, and spells it on her device. When she is incorrect, I model the correct sequence and provide verbal and visual cues. I am always giving J feedback on her performance.
J has really been progressing through the lessons this semester. Each lesson gets a little harder and J has been doing really well. A few seem to confuse her but usually we try it again another day and she does better. All of the cues, models, and reinforcement I have given her have really seemed to help her learn how to use the Vantage. Some days you can even tell that she is enjoying looking at the new words and learning how to produce them on her device.
Light, J. & McNaughton, D. (2007). Evidence-based literacy intervention for individuals who require AAC. Retrieved April 13, 2008, from www.asha.org.
Sunday, April 13, 2008
Wednesday, February 27, 2008
First Blog about N
My client, N, is 6 years old and has been in therapy for a year. His diagnosis is fluency. Last semester, N, used the Shine approach to treat his stuttering but since he got bored with it, my supervisor wanted to try something different with N this semester. We are using a contingent management and fluency shaping approach. All we do is play the whole session. There's a 5 minute non-treamtent probe where I talk normally, then we have 20 minutes of treatment. During those 20 minutes, I’m using slow and easy speech. N is supposed to imitate me and every time I hear him use his easy voice, I drop a bean in a container. N earns something at the end of the session according to the amount of beans he earns. We then have another 5 minute non-treatment probe and then while I talk to his dad, he plays with my assistant and his sisters for a maintenance phase.
There are many operant stuttering treatment programs and operant conditioning has been proven to work for children who stutter. In the article, Contingency Management and Stuttering in Children by Ryan, the author states that stuttering is an operant behavior controlled by its consequences. The frequency of stuttering, when followed by aversive events, decreased and when followed by positive events, increased. All of these contingent programs have an acquisition, generalization, and maintenance phase. All of these programs have been proven to also reduce stuttering.
Our program sometimes works for N. He has his days where he won’t use his easy voice at all. Some days you have to bribe him and he’ll only say a certain number of things with his easy voice because he knows he only has to earn that many beans. Or he won't even earn all of this beans and just say a few things in his easy voice. Other days he sees that he’s earning them and he’ll think of things to say just to earn beans. He has had some decrease in his stuttering but it hasn’t always correlated with days he has used his easy voice. His dad even says his stuttering is decreasing at home. It's almost like some days we are pushing his easy voice on him when he's not even stuttering. He just has his good days and bad days. Some days he will have a lot to say and other days he won’t really feel like talking much. At least he’s participating so far and he likes this approach much better than the Shine.
Ryan, B.P. (2004). Contingency management and stuttering in children. The Behavioral Analyst Today, 5(2), 144-150.
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There are many operant stuttering treatment programs and operant conditioning has been proven to work for children who stutter. In the article, Contingency Management and Stuttering in Children by Ryan, the author states that stuttering is an operant behavior controlled by its consequences. The frequency of stuttering, when followed by aversive events, decreased and when followed by positive events, increased. All of these contingent programs have an acquisition, generalization, and maintenance phase. All of these programs have been proven to also reduce stuttering.
Our program sometimes works for N. He has his days where he won’t use his easy voice at all. Some days you have to bribe him and he’ll only say a certain number of things with his easy voice because he knows he only has to earn that many beans. Or he won't even earn all of this beans and just say a few things in his easy voice. Other days he sees that he’s earning them and he’ll think of things to say just to earn beans. He has had some decrease in his stuttering but it hasn’t always correlated with days he has used his easy voice. His dad even says his stuttering is decreasing at home. It's almost like some days we are pushing his easy voice on him when he's not even stuttering. He just has his good days and bad days. Some days he will have a lot to say and other days he won’t really feel like talking much. At least he’s participating so far and he likes this approach much better than the Shine.
Ryan, B.P. (2004). Contingency management and stuttering in children. The Behavioral Analyst Today, 5(2), 144-150.
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Sunday, November 25, 2007
Second Blog About M
My client, M, is a 14 year old female with a diagnosis of delayed speech and language and auditory processing disorder. She has been in treatment for 9 years at the speech clinic.
Right now, a couple of the goals we are working on are improving reading comprehension and memory skills. With reading, I usually read to M and then she reads back to me. Then I have her answer questions about what she has read. We do a variety of different things for memory skills. In the beginning of the semester we started with 3 word phrases. M does really well with those but when I tried 4 word phrases she did poorly. We moved on to pictures and games. When she met the accuracy criterion for pictures, we moved on to the ABC game. We are now trying a board game where she has to listen to phrases.
The one thing both of these goals and what I am doing have in common are the strategies M uses to remember things. Categorization really helps her and she can use rehearsal up to a point. What really seems to help her though is mental imagery. If she can see a picture and then remember it in her mind or create mental images from what is being said it helps her remember.
In the article Comprehension problems in children with specific language impairment: does mental imagery training help? by Joffe, Cain, and Maric (2007), the use of mental imagery in children with specific language impairment greatly helped improve their reading comprehension. Mental imagery training enhanced the story comprehension of children with specific language impairment and helped them answer questions about short narratives.
M enjoys games where we use pictures to help her remember. She also really responds to pictures better than words. So when we work with words and remembering things from her reading, I have her make mental pictures. This helps her focus and really pay attention to what I am reading. Then when she reads she is familiarized to what is going on in the story and the words. By using mental pictures, she is able to answer questions in great detail. I have made my questions I ask her more detailed because she just keeps improving on her reading comprehension.
Mental pictures have really helped M in remembering sequences of words too. Her accuracy rate for 3 word phrases always now meets 90% or above. She is using the strategies she learned and during our last session she finally started to correctly remember 4 word phrases.
Joffe, V, Cain, K, & Maric, N. (2007). Comprehension problems in children with specific language impairment: does mental imagery training help. International Journal of Language & Communication Disorders, 42(6), 648-664.
Right now, a couple of the goals we are working on are improving reading comprehension and memory skills. With reading, I usually read to M and then she reads back to me. Then I have her answer questions about what she has read. We do a variety of different things for memory skills. In the beginning of the semester we started with 3 word phrases. M does really well with those but when I tried 4 word phrases she did poorly. We moved on to pictures and games. When she met the accuracy criterion for pictures, we moved on to the ABC game. We are now trying a board game where she has to listen to phrases.
The one thing both of these goals and what I am doing have in common are the strategies M uses to remember things. Categorization really helps her and she can use rehearsal up to a point. What really seems to help her though is mental imagery. If she can see a picture and then remember it in her mind or create mental images from what is being said it helps her remember.
In the article Comprehension problems in children with specific language impairment: does mental imagery training help? by Joffe, Cain, and Maric (2007), the use of mental imagery in children with specific language impairment greatly helped improve their reading comprehension. Mental imagery training enhanced the story comprehension of children with specific language impairment and helped them answer questions about short narratives.
M enjoys games where we use pictures to help her remember. She also really responds to pictures better than words. So when we work with words and remembering things from her reading, I have her make mental pictures. This helps her focus and really pay attention to what I am reading. Then when she reads she is familiarized to what is going on in the story and the words. By using mental pictures, she is able to answer questions in great detail. I have made my questions I ask her more detailed because she just keeps improving on her reading comprehension.
Mental pictures have really helped M in remembering sequences of words too. Her accuracy rate for 3 word phrases always now meets 90% or above. She is using the strategies she learned and during our last session she finally started to correctly remember 4 word phrases.
Joffe, V, Cain, K, & Maric, N. (2007). Comprehension problems in children with specific language impairment: does mental imagery training help. International Journal of Language & Communication Disorders, 42(6), 648-664.
Wednesday, October 17, 2007
All about M
My client, M, is a 14 year old female. M is diagnosed with delayed speech and language and an auditory processing disorder. She has been coming to the speech clinic since September 1998. In the past, M has worked on the sounds \th\ and \ch\, memory skills, multi step directions, counting money, telling time, constructing sentences, learning the parts of speech, increasing vocabulary, wh questions, and the sequencing of events in the correct order.
In therapy now, I work with M on the same goals. We have added some new ones this semester including orienting M to the calendar, months, and seasons, identifying common "survival" signs, social interactions, distinguishing between left and right, reading, and we are trying to improve her writing skills even if we aren't writing therapists.
With M I use alot of worksheets and actitivies that either my assistant or myself have made up. We use alot of games and pictures with M because she responds better to pictures. One method in particular that I am using involves reading. I read aloud first to M and then she reads for me. I ask her questions before she begins reading or after she has read. I help her with difficult words and she asks me about any words she is having trouble with.
In the article Read aloud and learn by Hannaford (Hannaford, C. (2003). Read aloud and learn. Literacy Today, 35. ), the author discusses how children learn better by reading aloud. Research has shown that by listening, children on average retain 5% of the information delivered; reading, 10%; and audio-visual techniques, 20%. By contrast, discussion (50%), practice by doing (75%) and explaining to others (90%) show significant improvements in the amount of knowledge retained. So by reading and explaining what they have read, children learn more.
I have seen this with M. When I read aloud to her, she is familiarized with the story. She reads words that you would never think she would be able to read. Then she reads the story and we discuss what happened and the difficult words for her. She can remember in detail what happened in the story which shows she is learning. She has trouble remembering 4 word phrases but after reading aloud and being familiarized with a story, she can answer your questions in great detail.
M also really responds to high praise and motivation. We provide alot of motivation for her and rewards. Sometimes she can get frustrated if she has to read alot, but she is motivated to complete the reading. She really enjoys the book she is reading right now and really gets into it. If I read with alot of inflection, she will too.
M has vastly improved in her reading this semester. When we started out, she had alot of trouble. Now when I read aloud to her and familiarize her with the story, she has alot less trouble. When she has to read directions or sentences in some of her other activities, she reads them really well too. At first, because she knew she had trouble reading, she was really hard on herself. But now she is seeing that she is making improvement and when she can read almost the whole page without my help she is really proud of herself. She is becoming a better reader with this method.
In therapy now, I work with M on the same goals. We have added some new ones this semester including orienting M to the calendar, months, and seasons, identifying common "survival" signs, social interactions, distinguishing between left and right, reading, and we are trying to improve her writing skills even if we aren't writing therapists.
With M I use alot of worksheets and actitivies that either my assistant or myself have made up. We use alot of games and pictures with M because she responds better to pictures. One method in particular that I am using involves reading. I read aloud first to M and then she reads for me. I ask her questions before she begins reading or after she has read. I help her with difficult words and she asks me about any words she is having trouble with.
In the article Read aloud and learn by Hannaford (Hannaford, C. (2003). Read aloud and learn. Literacy Today, 35. ), the author discusses how children learn better by reading aloud. Research has shown that by listening, children on average retain 5% of the information delivered; reading, 10%; and audio-visual techniques, 20%. By contrast, discussion (50%), practice by doing (75%) and explaining to others (90%) show significant improvements in the amount of knowledge retained. So by reading and explaining what they have read, children learn more.
I have seen this with M. When I read aloud to her, she is familiarized with the story. She reads words that you would never think she would be able to read. Then she reads the story and we discuss what happened and the difficult words for her. She can remember in detail what happened in the story which shows she is learning. She has trouble remembering 4 word phrases but after reading aloud and being familiarized with a story, she can answer your questions in great detail.
M also really responds to high praise and motivation. We provide alot of motivation for her and rewards. Sometimes she can get frustrated if she has to read alot, but she is motivated to complete the reading. She really enjoys the book she is reading right now and really gets into it. If I read with alot of inflection, she will too.
M has vastly improved in her reading this semester. When we started out, she had alot of trouble. Now when I read aloud to her and familiarize her with the story, she has alot less trouble. When she has to read directions or sentences in some of her other activities, she reads them really well too. At first, because she knew she had trouble reading, she was really hard on herself. But now she is seeing that she is making improvement and when she can read almost the whole page without my help she is really proud of herself. She is becoming a better reader with this method.
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