Miss J

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.

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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