Is your child preverbal? Does your child have difficulties articulating sounds and words? Or does your child just have a specific articulation difficulty? At Skybound we utilise a range of different techniques/programmes to develop speech, or to correct any errors included within your child’s speech.
So, what programmes do we use?
Talk Tools is an oral placement therapy treatment plan based on the Occupational Therapy and Physiotherapy model where therapy is focussed on the tactile and proprioceptive sensory systems. Oral placement therapy techniques involve a hierarchy of tactile proprioceptive therapeutic activities using a vast range of tools to teach targeted oral movements that are needed for speech. These oral movements are immediately transitioned in to speech (Bahr & Rosenfeld-Johnson, 2010).
The long term aims of Talk Tools are:
• To improve feeding skills.
• To improve speech sound production and increase intelligibility.
If a child is preverbal, Talk Tools along with ABA techniques (see below) is used to encourage the child to, initially produce a sound on demand. Once voicing on demand is established, Talk Tools can be used to shape the mouth into the correct position to produce various speech sounds. The programme may also be used for increasing muscle strength and stability in preparation for speech and feeding.
If a child requires intervention to work on only one sound or a handful of sounds then the Apraxia Kit included within the Talk Tools programme may be used to show the child where they need to place their articulators (jaw, lips, cheeks and tongue) in order to successfully produce the sound.
PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a tactile kinaesthetic approach, which was designed with the aim to help organise, plan and execute speech sounds. Deborah Hayden (1984), the founder of PROMPT, describes the programme as a method of supporting the child’s speech by providing a vocal model and specific tactile cues to evoke a word approximation. As the child’s success at producing a range of sounds increases, the aim would be to fade the PROMPTs, giving visual cues as opposed to using touch (Hayden, 1984).
We find PROMPT to be most useful to help a child blend the individual sounds which they have learned into words. The child is taught a number of tactile cues, with each cue corresponding to a sound. These cues provide the child with tactile input to show them which sound (as well as where the sound is produced) is required next within a word. Once the child is able to blend, these cues are then systematically faded so that he child is communicating independently.
Specific behavioural programs can be effective in addressing this issue and evoking speech sounds in non-vocal individuals. These procedures are often used alongside the Talk Tools oral placement and feeding exercises. The behavioural programs include Stimulus-Stimulus Pairing (Sundberg et al, 1996; Ward et al, 2007), Rapid Motor Imitation Antecedent (Ross & Greer, 2003), Direct Reinforcement of Vocalisations (Drash, High & Tudor, 1999; Ward et al, 2007) and the use of Extinction to occasion a sound.
Stimulus-Stimulus Pairing – This procedure aims to increase the frequency of specific speech sounds during vocal play. The therapist pairs a specific speech sound (usually a sound that is already present in the child’s repertoire during babbling) with a preferred activity (reinforcer).
Direct reinforcement of vocalizations – This procedure is used to increase the frequency of babble (vocal play). The therapist is required to deliver reinforcement every time the child emits a targeted speech sound.
Rapid Motor Imitation Antecedent (RMIA) – This procedure involves asking the child to produce a speech sound immediately following the imitation of gross, fine and oral motor movements. This procedure is effective due to the use of behavioural momentum – the child is already imitating movements, therefore when a speech sound is modelled, the child will continue to imitate and therefore produce the speech sound. The child will need good imitation skills prior to using this procedure.
Extinction to occasion a sound – Using extinction involves providing the child with all the support needed to produce the sound accurately and then waiting for them to ‘turn on’ their voice. Reinforcement (preferred item/activity) is not delivered until the child has produced the sound.
Once a number of sounds have been learned, other programs may be introduced to provide the child with additional support to form words. These programmes include:
The Nuffield Dyspraxia Programme – NDP3 provides the child with visual support to blend sounds into words.
We also use the programme to encourage the child to switch between different motor plans quickly and smoothly using their visual tools.
The Kaufman Kits – This programme teaches words following a developmental sequence. The programme breaks each word down into wordshells (simple versions of a word which takes into account how a baby would first learn these words). The child can then build on their ability to produce complex blends using this structured approach.
Carys Jenkins, SLT