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301 Cards in this Set

  • Front
  • Back
Language Disorder
an impairment in comprehension and/or use of spoken, written and/or other symbol system; disorder may include form, content or function
Form
phonology, morphology, syntax
Content
semantics
Function
pragmatics
Significant
a deficit big enough to be noticed by ordinary people; causes an adaptive consequences (e.g., performing in school, social communication); deficit on testing
Mental Age
age equivalent score from a standardized test of cognitive ability (developmental level); indicates that language keeps pace with cognitive development in individuals with mental retardation
Disadvantages of intelligence tests
They are language loaded; language potential can exceed IQ; gaps may not be large enough for serveices until a later age
To meet the diagnostic criteria both ________ and ______ information must be documented
perceptual; diagnostic
Examples of diagnostic criteria/tests
DSM-IV; ICD-10
Problems with tests
No always available (age dependent; language function dependent); quality (construction; fairness; accuracy)
Fairness
level of reliability and validity
Accuracy
sensitivity and specificity
WHO - Body structures/functions
loss or abnormality of psychological, physical or anatomical structure or function
WHO - Activities & Participation
Any reduction in ability to address needs of daily living
WHO - Contextual factors
Phycial, social, and attitudinal environments
WHO Terminology
is Holistic; moves ways from labels and considers strengths and needs
Language disorders in a preschool child persists ___________ in adulthood
as a more subtle form
Children with a language disorder resemble _________ spekaers in order of language acquisition.
younger
T/F: There is no one true definition of a language disorder.
True
Specific language impairments
Pure language disabilities uncontaminated by mental retardation or other kinds of deficits; rare
In the Systems Model, the communication problem is or is not "in" the child?
It is NOT "in" the child.
Systems model involves the relationship between ________. Form example, either __________ or _________ differences or _________ __________ disability
speakers
cultural; dialectical
severe communication
T/F: In the Systems Model, the goal is 'normal' speech-language.
False (e.g., PECS, AAC, etc. may be goal)
A clinician with a Systems Model believes that the environment must be...
responsive for communication to be rewarding for the child
The Systems Model views the importance of what 3 aspects of language?
(1) context (2) training of people in environment (3) adaptations to environment
The Categorical Model is considered to be a _______ model.
medical
The Categorical Model is based on ______ labels, and has an ________ base of problem.
Diagnostic; causal/etiological
T/F: Categorical Models lead to specific treatment ideas.
False (differential diagnosis)
T/F: The Categorical Model is concerned with quantitative and qualitative information.
True
Limitation of the Categorical Model...
Not all kids with same cause have the same level of functioning or abilities
The Specific Disabilities Model is based on how speech-language impairments differ from _________ _______ of the child.
cognitive abilities
Specific Disabilities Model uses a profile of score that identifies __________ and ___________.
strengths and weaknesses
The Specific Disabilities Model teaches to ________ and remediates or works around __________.
strengths; weaknesses
T/F: The Specific Disabilties Model include the Auditory Perceptual Deficit Approach.
True
The Auditory Perceptual Deficit Approach is a "bottom-up" model that focuses on _____ level processes such as discrimination and percpetion. to provide input for ________ level processes such as comprehension.
lower; higher
T/F: Under the Auditory Perceptual Deficit Approach, poor performance on auditory tests is an indicator of poor language performance and vice versa.
False.
Poor performance on auditory tests is highly related to _________ problems.
attention
Define bottom-up language processing models
Lower level/peripheral processes such as perception and discrimination provide information for high level processes; analysis of features to a meaningful representation
Definte top-down language processing models
Concept-drive higher level processes (prior to knowledge, concepts, and expectations) influence treatment of lower level processes; developing expectations of what will occur and comparing features of stimuli to expectations to confirm or disconfirm one's expectations
Define interactive/parallel processing
bottom-up and top-down processes interact when engaged in language
The Specific Disabilities Model involves limited processing capacity due to problems in _________ memory and _________ _______ _____ memory.
working memory (ability to listen and write/respond); phonological short term (non word repetition)
The Descriptive-Developmental Model is a _________ _______ approach.
communicative language
The Descriptive-Developmental Model measures _______ level of functioning in all language areas (_____, ______, ____).
current; content, form, use
The Descriptive-Developmental Model follows _________ language development.
normal
Which of the language models collects a detailed profile for treatment and is the most current model being used today?
The Descriptive-Developmental Model
The Descriptive-Developmental Model makes what assumptions?
not always possible to know the cause;
descriptive profile leads to treatment ideas;
determining where the child is in the developmental sequence also leads to treatment;
evidence-based
Normative
Language impairment in a child that is noticeable to the general population; also called adaptive dysfunction criterion.
Neutralist
Standardized criterion; a child must score below expectations on a standardized or norm referenced test in order to be given a language disorder diagnosis.
Ecological validity
A study is ecologically valid if it represents actual behaviors of the test subject.
Dynamic Assessment
Changes the context of assessment to support the performance of the child; involves pretest, intervention and post-test.
Linguistic
Refers to the study of the nature, structure and variation of language.
Psychometric
Psychometric tests measure psychological variables such as behavior, intelligence and emotion.
Reliability
efers to the ability of the test or measuring method to produce data that is reproducible.
Validity
The degree to which test results are correct or true.
Specificity
The ability of a test to correctly identify children as NOT having a disorder; rate of false positive results.
Sensitivity
The degree to which a test accurately identifies a child as having a language disorder.
Accurate
How accurately a certain langauge test assign subjects to diagnostic categories. It includes sensitivity and specificity.
Syntax
The organization of words to make meaningful sentences; grammar.
Semantics
Vocabulary.
Pragmatics
The social and conversational aspects of speech.
Phonology
The science of the production of speech.
Percentile
Scores that tell us what percentage of the population scored lower than the test taker.
Standard deviation
The measure of dispersion or variability in a distribution. On a bell curve, 68% of scores would be expected to be within 1 SD (on either side) of the mean.
Differential diagnosis
Weighing the probability of one diagnosis vs another; identification of a disorder by comparing it to two or more similar disorders.
The Descriptive-Developmental Approach has ______ distinct phases.
less
What's the goal of the diagnostic process?
To decide whether there is a significant communication problem, and if so, to describe the deficit in as much detail as possible, relative to the normal sequence of language acquisition
The Descriptive-Developmental approach has less _______, and more ________.
diagnosis; description
What are the 6 purposes of assessment?
Screening, diagnosis/differential diagnosis, determine eligibility of service, establish baseline(s), develop intervention targets, and track and document progress
Some clinicians divide assessment into 2 phases - ________ and _________.
appraisal; diagnosis
Appraisal
Involves collecting data (existing records, case history; interviews and questionnaires direct examination of child)
Diagnosis
Made through stud and interpretation of appraisal information (identify & label problem and move toward treatment goal)
Under PL106-466 (IDEA) evaluation involves _______ while assessment _______________________________________.
eligibility;
describe communication function and needs & how to meet them
Who/what is the assessment team?
It consists of professionals from a variety of disciplines and background who contribute their expertise to provide a full picture of the child's strengths & needs (includes parents)
What different models can the assessment team operate under?
Multidisciplinary; interdisciplinary; transdisciplinary
Multidisciplinary
Team made up of professionals from different disciplines. Each completes an independent evaluation of the client and comes up with a separate set of recommendations, which are reported to the team and the client's family.
Interdisciplinary
Team consists of professionals from different disciplines, but formal communication channels are established between them. A case manager coordinates services among all disciplines. Some professionals may be involved in the assessment on a consultant basis, providing suggestions to those who work directly with the child, but do not interact directly themselves.
Transdisciplinary
Team members are encouraged to share information and skills across disciplines. Assessment is collaborative in that one individual may do all or most of the interaction with the child, whereas others observe or make suggestions for the interactor to use during the assessment process. Team members work together whenever possible. They train and receive training frome ach other in reciprocal interactions. Role release employed.
What are the steps in developing an assessment plan
(1) Determine child's general developmental/cognitive ability
(2) Decide what areas to assess
(3) Decide what methods to use to assess each area
(4) Think about the order in which assessment tasks will be done
(5) Write out your plan (+ plan B)
What does it mean to say that an assessment plan should be comprehensive?
It should cover aspects of hearing oral-motor function, comprehension and production of language
Should treatment start with high or low structure activities?
low
Why do we assess?
screening;
establishing baseline function;
establishing goals for intervention;
measuring change in intervention
T/F: 85-115 with a mean of 100 is in the "normal" range on a bell-curve.
True
What do we assess?
Language function, Domains of language, Collateral areas
Language function
Comprehension (process of), production
Domains of language
Form, content, use
Collateral areas
Hearing, motor functioning, speech-motor ability, nonverbal cognition, social/emotional/behavioral functioning, and cognitive status
Decontextualized tasks
Less than ideal; artificial; high stress
Contextualized tasks
familiar; non-linguistic cues; benefit of in-home treatment
How do we assess?
standardized tests, developmental scales, criterion-referenced procedures, behavioral observations
Standardized tests are ______ structure.
high
In standardized testing the child is compared to ______ on specific, pre-determined test items.
peers
Standardized tests should be...
psychometrically sound, interpreted properly and judiciously, used to show whether a child differs significantly from a normal population
3 Criteria for Discharge
(1) reached goal (2) plateau (3) progress not related to treatment
Ecological validity
Spontaneous vs. imitation production must match up
Standardized tests should NOT be...
Used to establish baseline;
Used to identify intervention goals;
Used to measure progress in an intervention program
T/F: A clinician should use "teaching to the test" by setting goals based on standardized testing
FALSE
Developmental Scales
Interview or observational instruments that sample behaviors from a particular developmental period
Are developmental scales standardized and used to decide whether a child has a deficit?
NO!
Developmental scales have clearly stated ________ for administration, provide some type of ___________ score, and are helpful for establishing __________ _____________.
guides;
equivalent;
baseline function
Criterion-Referenced procedures determine...
if a child can attain a certain level of performance
Criterion-Referenced Procedures are used to establish __________ ________ and identify _________ for intervention by finding out precisely what the child can or cannot do with language.
baseline;
targets
What are Criterion-Reference Procedures useful for?
Evaluating whether intervention goals have been met
Under what contexts can Criterion-Referenced Procedures be used to assess comprehension?
Structured & Natural contexts / Contextualized & Decontexualized situations
When using Criterion-Referenced Procedures for assessing comprehension what 3 considerations should be use?
avoiding over-interpretation;
controlling linguistic stimuli;
specifying an appropriate response
What are the 3 major response approaches for assessing production under Criterion-Referenced Procedures?
elicited imitation;
elicited production;
structural analysis
What are behavioral observations useful for?
charting progress over the course of an intervention program
T/F: Behavioral observations are subjective.
True
What format does Dynamic Assessment use?
Test-Teach-Test format
What 3 questions does Dynamic Assessment ask?
How child approaches tasks (error patterns & self-monitoring);
degree to which child's behavior is modifiable;
intervention styles and methods most useful
Functional Assessment is beyond identifying deficits, it evaluates _____ on ability to communicate.
effects
A "hard-to-assess child" may be...
shy & quiet;
noncompliant;
hyperactive & impulsive;
physically disabled
T/F: Some children are simply untestable.
False
Name severity level:
Some impact on child's ability to perform in social or academic situations, but would not preclude participation in normal age-appropriate placements
mild
Name severity level:
A significant degree of impairment that would probably necessitate some special accommodations for the child to function in mainstream settings
moderate
Name severity level:
Can not function in a normative setting without extensive support services
severe
Name severity level:
very little functional communication at time of assessment
profound
Prognosis
Clinician's prediction about what communicative outcome can be reasonably expected at some future time, in light of current level of functioning
T/F: Prognosis should always be stated in positive term (i.e., talk about what the child will be able to do over a specific period, rather than what he or she won't be able to do)
True
Recommendations
General statements about the need, directions, and approach to intervention that would be most appropriate for a particular child
Recommendations contain these 3 parts:
Whether intervention by SLP is needed and whether it will be helpful;
Goal of intervention based on assessment;
Suggestions of methods, approaches, reinforcers, etc. that might maximize chances for success in intervention
Descriptive Language of Assessment
Language reflects information coming int through the senses or technology (i.e. hearing test)
Inferential Language of Assessment
Language reflects professional's conclusions based on data obtained. Use "seems/appears" to describe.
Evaluative Language of Assessment
Language only reflects professional's feels/interpretations without data to support
A report should include the following 6 areas:
(1) statement of problem
(2) background info
(3) test results
(4) impressions/assessment
(5) summary and prognosis
(6) recommendations
Norm-referenced testing compares...
a child to other children on specific language behaviors
Norm-referenced testing measure _______ and/or ______, not __________.
content;
form;
use
Norm-referenced testing may need to be used to determine...
whether a child differs significantly from average child on set of tasks
What size groups are norm-referenced tests administered to?
large groups of randomly selected children
T/F: Norm-referenced tests contain many tests and subtests to measure different skills.
True
Standardized tests should always be ______ the same way and ______ scored the same way no matter who ______ it or ______ it.
given;
scored;
scores;
takes
If you have questions about a standardized test you should refer to what?
the manual
T/F: Standardized test should be used to check or measure progress.
False
3 types of reliability
test-retest;
inter/intra-examiner;
split-half
3 types of validity
content;
criterion-related;
construct/concurrent
A test is reliable if its measures are ________ and _______ (i.e., amount of random error should be small).
Consistent & accurate
Test-retest reliability
Give the test 2 different times to the same person and compute the correlation of the two scores. High correlation means test is stable.
Inter-rater reliability
Two different examiners give test to same person or score the same person's test. High correlation = smaller examiner influence on outcome.
Test-retest and inter-rater reliability must have a correlation coefficient of _____ (or better) with a _____ confidence interval to be reliable.
.90;
95%
Internal consistency reliability
Subtests of the test rank subjects similarly OR parts of test measure something similar to what is being measured by the whole
Split-half reliability
Scores on first half compared with scores on second half
Odd-even reliability
Scores on odd items compared to scored on even items
Equivalent forms reliability
2 forms of a test measure essentially the same thing
Test that are valid measure....
what it purports to measure
A test is valid if it's systematic error is ______.
small
Face validity
The common sense match between test's intended purpose and its actual content.
Content validity
Concerns whether the test measures all the relevant attributes of the construct. Evaluated by having experts in the field judge the test as a whole.
Construct validity
Concerns whether it measures the theoretical construct it was designed to measure. Experts judge how well content matches author's definition of the construct.
Criterion-related validity
Concerns whether the test has strong correlations with other tests that measure the same thing.
2 types of criterion-related validity
(1) Concurrent
(2) Predicitive
Concurrent validity
Test agrees with other valid instruments in categorizing children as normal or disorderd
Predictive validity
Test predicts how well child will perform later on another valid measure of speech or language
What are scores of relative standing?
Percentile rank and standard score (t-score, z-score)
What are developmental scores?
Grade equivalent and age equivalent scores
Raw score
number of items client gets correct on a test
What must one do to interpret a raw score on a standardized test?
Refer to the norms provided in the test manual w
What two types of comparisons can be made from norm-referenced scores?
Standard and equivalent
Name the measures of central tendency
Mean;
Median;
Mode;
Bell-shaped curve
Mean
average score
Median
middle score
Mode
Most commonly occurring score
Bell-shaped curve
represents the range of normalcy and points after which children are no longer considered normal
Standard deviation
represents the average difference from the mean score
Standard error of measurement
standard deviation of error around a person's score
A large test population should form a normal distribution known as a ________________.
bell-shaped curve
When using standardized tests, we _________ that scores in the normative population were normally distributed.
assume
The mean of test scores is a measure of ________ _________.
central tendency
T/F: Standardized tests allow us to see deficits and then use other methods to determine goals.
True
In the normal curve, we expect __% of scores to fall within 1SD on either side of the mean, and ___% of the scores to fall withing 2SDs of the mean.
68; 96
Usually you will have an SD of +/- ____ on a mean of 100, or a +/-____ on a mean of 10.
15; 3
T/F: Since any score we obtain from a client is only an estimate of their "true" score, there is always some measurement of error involved.
True
A well-constructed test must take human variability into account by reporting a _________ _______ of _______.
standard error of measure (SEM)
A standard error of measure (SEM) represents...
the SD that would be obtained if a person of average ability took a test a large number of times and a distribution of scores was obtained
SEM is used to determine a _______ around the observed score (e.g., observed score +/- SEM)
confidence band or interval
Standard comparisons
Compare a raw score with the score of others of the same age, mental age, or grade
Types of standard comparisons:
Percentile ranks;
Z-scores;
T-scores;
Scaled scores;
Stanines
Percentile ranks
tells what proportion of the norming population scored lower than the client
Z-scores
the number of SD units that the score falls from the mean score for that population; have a mean of 0 and an SD of 1, so a score of -2 means the score is 2 SDs from the mean of the reference population
T-scores
like Z-scores; mean is 50 and SD is 10; a client with a T-score of 35 would be 1.5 SDs below mean, equivalent to a z-score of -1.5
Scaled scores
On a test with this form of scoring, 100 represents the mean with an SD of 15; a score between 85-100 is normal
Stanines
Normalized standard scores with a mean of 5 and an SD of 2; except for 2 extremes of 1 & 9 each stanine represents a range of 1/2 SD
Sensitivity
identifies disorder accurately
Specificity
identifies not having a disorder accurately
Positive/negative likelihood ratio
confidence of having/not having a disorder
Positive/negative predictive value
probability of having/not having a disorder
Diagnostic accuracy is related to _______ ______ ________.
evidence based assessment
Mild/borderline/below average is located ___ SD below norm of the -1SD range.
1/2
Moderate/significantly below average is located ___ SD below norm of -1SD range.
1 1/2
Severe/profound is located ___ SD below norm of -1SD range.
3+
Equivalent Scores
Classify raw scores according to a level such as age (age-equivalent scores) or grade (grade equivalent scores)
An equivalent score cannot determine whether a child has a significant deficit, only a ______ score can be used in this way.
standard (e.g., can be 1.5 years delayed and be in normative range)
T/F: When standardized tests are well-constructed they provide the only valid, reliable and fair way to establish that a child is significantly different from other children.
True
A clinician should interpret results both ______ and ________.
properly and judiciously
One should use _________ forms of testing to establish baseline function, choose goals for intervention and measure progress.
other (NOT standardized)
A clinician should develop a treatment plan by identifying a child's current level of language use in areas of ________, _______, _________, _________, and __________.
semantics;
morphology;
phonology;
pragmatics;
syntax
Goals should be selected that would be _____ in the developmental sequence.
next
The purpose of intervention is to...
teach language behaviors to help a child become a better communicator, and to show intervention was conducive to change that would not have occurred without treatment
The 3-4 major purposes of intervention are:
change/eliminate problem;
change the disorder;
compensatory strategies (required metacognition);
focus on environment
What is the most common purpose of intervention?
to change the disorder and make the child more typical on aspects of language by teaching specific behaviors
What are 3 alternatives to how treatment can change language behavior?
(1) facilitation
(2) maintenance
(3) induction
Facilitation
rate of growth accelerated, but final outcome not changed
Maintenance
Preserves communication skill that would otherwise decrease or disappear
Induction
With treatment, outcome would never have been achieved
What two alternative to treatment often cannot be predicted?
Facilitation and induction
Which is the most dramatic and cost-effective alternative in treatment to change language behavior?
Induction
What are the 4 aspects of the Treatment Plan?
(1) Evidence-based practice
(2) Products of intervention: setting goals
(3) Processes used to achieve objective: teaching strategies/methods
(4) Contexts for intervention: environments
Evidence-based practice
The conscientious, explicit, and unbiased use of current best research results in making decisions about the care individual of clients by integrating clinical expertise with the best available external clinical evidence from systematic research
External evidence
published research
External evidence should be approach with these 3 principles:
(1) opinions of experts should be viewed with skepticism (should be proved with data)
(2) all research is not created equal
(3) clinicians must be critical of evidence we use in decision-making
Internal evidence
characteristics, culture of family/client, willingness to participate, and preference; Clinician preferences, professional competencies & values; Values, policies and cultures of the institutions in which we work
To incorporate EBP into Practice one must do these 5 things...
(1) Formulate clinical equestions using PICO
(2) Use internal evidence to determine 1st approach
(3) Find external evidence based
(4) Integrate internal and external evidence
(5) Evaluate the decision by documenting outcomes
What are the PICO elements
Patient/problem;
Intervention being considered;
Comparision Tx (or no Tx);
Outcome desired
Basic goals
Identify areas based on importance for functionality or because of severity of disorder; general; E.g. increase vocab
Intermediate goals
Specific; Several levels; E.g. Work on new vocab within specific categories utilized in theme-based activities
Specific goals
Instances of language form, content or use identified; Steps to basic; Based on functional readiness; E.g. Vocab on farm, tools, etc.
Highest priority goals
Forms and functions client uses in 10-50% of required contexts
High priority goals
Forms and functions used in 1-10% of required contexts, but understood in receptive task formats
Lower priority goals
Forms and functions used in 50-90% of required contexts. Forms the client does not sue at all and does not demonstrate understanding of in receptive task formats
What is the Zone of Proximal Development (ZPD)?
What the child is ready to learn with help from competent adult
T/F: Teachability is always the primary criterion in goal setting.
False - NEVER!
When setting goals the following things must be considered:
Priority;
Communicative effectiveness;
Teachability;
Phonological abilities;
New forms/Old functions (vice versa)
In order to achieve effective communication assume that intervention is based on:
Interaction of content, form & use;
Emphasis on language regardless of etiology;
Typical language development guides Tx;
Production will be targeted;
Goals set based NOT what missing in adult model but rather on what child produces and where developmentally
Long-term goals (and example)
Broad changes in communicative behavior;
Ex. Increase client's MLU to express a variety of age-appropriate semantic relations.
Short-term goals (and example)
Do statement + condition component + criterion;
Ex. Client will produce the action semantic relation using 2-3 constituents 85% of the time in obligatory communicative contexts
List the verbal hierarchy of complexity
Imitation/complete model;
Delayed imitation/delayed model;
Partial imitation; partial cues & prompts;
Elicitation;
Spontaneous
List nonverbal hierarchy of complexity
Manipulated movement;
Imitated movement;
Elicited movement;
Spontaneous movement
__% accuracy denotes an emerging level of learning.
60
__% accuracy denotes learning level of learning.
70
__% accuracy denotes a mastery level of learning.
80-90
To determine goals for therapy one must...
Pretest to determine initial baseline of % correct;
Determine task complexity;
Start where child is stimulable/capable;
Conduct treatment at a learning level;
Decide what is developmentally appropriate;
Never teach to standardized test
What is the 1st lexicon?
1st 50 words
If a child is a referential learner there lexicon consists mainly of?
nouns
If a child is an expressive learner their vocab consists mainly of?
social words ("hi" "bye")
What 3 factors affect naturalness?
(1) Intervention activity
(2) Physical context
(3) Interacting individuals
What are the 3 approaches to intervention?
Clinician-Directed (CD) Approach;
Client-Center (CC) Approach;
Hybrid Approach
Clinician-Directed (CD) Approach
Trainer-Oriented; clinician specifies materials, how client will use them, type and frequency of R+, form of responses that are acceptable, and order of activities
The CD Approach is traditional _______ approach.
Behaviorist
What is the advantage of CD Approach?
Lots of practice/efficient for production in clinic; child has failed to learn through natural interactions
What is the disadvantage of the CD Approach?
Not effective for generalizing to natural conversation
What's the most effective way to use the CD Approach?
Use in initial phases of Tx to elicit forms; once stabilized, use naturalistic approaches to generalize
3 varieties of CD Approach
(1) Drill
(2) Drill-play
(3) Modeling
Drill
Different level of prompts; fading R+; motivating event; shaping (efficient but clinicians don't like)
Drill-play
motivation built into drill structure
Modeling
confederate models expected response; child's job is to listen, not imitate)
Which is the most naturalist intervention approach?
Child-Centered Approach
Child-Centered Approach is best for...
the noncompliant or unassertive child with an MLU <3.0 and as an adjunct to the CD approach
Child-Centered Approach
Indirect language stimulation (facilitative play), clinician may choose the materials but does not direct the activity
T/F: In the CC Approach the clinician is trying to elicit specific structures not react to the child's behavior.
False
Language is mapped by what approaches under CC Approach?
(1) Self-talk/parallel-talk
(2) Imitations
(3) Expansions
(4) Extensions
(5) Buildups and breakdowns
(6) Recast sentences
CC Approaches deal with ______ language including all language modalities and cannot be reduced to components.
whole
In the CC Approach, ____ should be the natural reward of conveying meaning.
R+
What is the goal of a CC Approach?
the general level of communication (not any specific language form)
Under what setting is CC Approach used?
In group or classroom with high integrated (theme-based) activities
What are the characteristics of Hybrid Approaches?
Target one or a small set of specific language goals (identified through Dx);
Clinician maintains good deal of control in selecting activities and materials, but does so to tempt the child to make spontaneous use of target utterances;
Clinician uses linguistic stimuli not just to respond to child, but to model and highlight forms being targeted
What are the 4 approaches of the Hybrid Approaches?
(1) Focused stimulation
(2) Vertical structuring
(3) Milieu Teaching
(4) Script Therapy
Focused stimulation
Clinician arranges context so child is tempted to produce utterances with obligatory contexts for targeted form
In focused stimulation, the child is not required to produce the target, only ________.
tempted
Focused stimulation improves __________ of the form and __________.
comprehension;
production
Vertical structuring is used for...
early developing forms.
Vertical structuring
particular form of expansion used to highlight target structures
Vertical structuring description
(1) Clinician responds to incomplete utterance with contingent question
(2) Child responds to question with fragment
(3) Clinician takes the two pieces and expands into more complete utterance
(4) Wait for possible imitation (not required)
(5) Clinician elicits another set of related utterances and provides vertically structured expansion again
T/F: Imitation is required in vertical structuring.
False, but we hope for it!
Milieu teaching
Application of operant principles to naturalistic settings; imitative prompts, cues, and extrinsic R+ in interactive activities carefully arranged by clinician to encourage communication
The goal of milieu teaching is the increase the frequency of _________.
assertations
Milieu teaching is best in a ________ or ________ setting.
small-group; classroom
The 3 components to milieu teaching are:
(1) environmental arrangement
(2) responsive interaction of clinician
(3) conversation-based context that uses child's communicative interest
What are the 4 types of Milieu teaching?
(1) Incidental Teaching (IT)
(2) Mand-Model
(3) Prelinguistic Milieu Teaching
(4) Enhanced Milieu Teaching
Incidental Teaching (IT)
Arrange setting so desirable objects are out of reach, child makes gestural + vocal request, clinician responds with focused attention; if child does not elaborate request, clinician asks a question; if question fails, clinician prompts; one more prompt if fails; child gets what requests
Mand-Model
Same as IT, but clinician does not wait for child to initiate; also goals stated generally (e.g., 1-2 word utterances or complete sentences)
Prelinguistic Milieu Teaching
For children at 9-15 month levels (but up to 6 years chronological age); goal is to develop basic intentional communication skills; good for severe disabilities like ASD
Enhanced Milieu Teaching
For children who imitate with MLU of 1-3.5; focus on parent-delivered Tx; incorporates methods from IT and Mand-Model
Prompt
a way of providing varying levels of help for child to achieve desired level target
Script Therapy
Embed therapy in familiar routine to lessen the cognitive load on child; use a known script, then violate/disrupt the routine, tempting child to communicate
Literature-based scripts and Interactive book reading
Involves scripted based on pictures and story books read to child; critical pieces of this method include commenting, asking questions, responding by adding a little more, and giving time to respond.
For forms & functions a child comprehends, the target is ___________. For forms & functions child does not comprehend, the target should include ________ + _________.
production (within ZPD);
input component (focused stimulation);
elicited production
The disadvantage of iconic systems is that they are limited in ...
novel generative sentence generation
R+ _________ frequency of behavior.
increases
Extrinsic R+
Used in CD Approach;
Tangible;
Token;
Social
Intrinsic R+
Natural communication consequence;
Achievement of intended goal of a request
Control of clinician's attention
Feedback
Give information about communicative value or accuracy;
Used in CC Approach;
Should not repeat or focus on child's error
T/F: Generalization should should be incorporated into every session (not every activity).
True
6 Guidelines for Generalization
(1) Provide many examples of target forms/functions
(2) Sequential modification - multiple settings
(3) Intermittent or delay R+
(4) Distracter items
(5) Self-monitoring
(6) Take advantage of models in environments
T/F: There is no evidence that using the computer in independent practice results in functional use outside Tx.
True
What service delivery model is the most common?
Pull-out
Clinical delivery model
pull-out
Consultant delivery model
Clinician determines targets, procedures, & contexts; gives info to another person; observes periodically; responsible for evaluating; troubleshoots
Language-based classroom delivery model
Clinician as classroom teacher; continuous Tx within day-to-day activities
Collaborative delivery model
Clinician works with children in mainstream classroom in collaboration with regular teacher
6 Discharge Criteria
(1) Communication within normal limits
(2) Goals of intervention met
(3) Communication is comparable to peers
(4) Speech or language skills no longer adversely affect social, emotional, or educational status
(5) Uses AAC and has achieved optimal communication
(6) Attained the desired level of communication skills
2 termination criteria for individual objects
(1) 80-90% correct usage in structured setting
(2) 50% correct in natural contexts
Multiple-baseline evaluation
Identify target goals, generalization goals, and control goals;
Gather baseline data &amp; establish stable baseline;
Institute Tx for the target;
Evaluate

TARGET + GENERALIZATION GOALS IMPROVE: CONTROL DOES NOT CHANGE
Functional use of communication should be assessed in these 4 areas:
(1) Role-playing
(2) Narrative
(3) Structured peer interaction
(4) Natural setting observation
Responsiveness to Intervention (RTI)
Designed to overcome identifying children with language disorders based on discrepancy scores
Tier I of RTI
Classroom instruction + SLP adaptation; used before the identification of Tx needs
Tier II of RTI
Targeted, short-term, reach-based instruction; small groups with aid + SLP input
Tier III of RTI
Intensive therapeutic instruction; individualized IEPs
3 Reasons why must we evaluate
(1) Respect we command as a professional
(2) Results sometime are hard to see\
(3) Be able to advocate for our services
Primary Prevention (and example)
Elimination of inhibition of the onset and development of a disorder by altering suscpetibility or reducing exposure for susceptible person
Ex. Inoculation to prevent rubella
Incidence
# of new cases of a disorder that appear
Prevalence
# of cases of a disorder at any given time
Secondary Prevention (and example)
Early detection and Tx are used to eliminate the disorder or retard its progress, thereby preventing further complications
Ex. Newborn hearing screening
Tertiary Prevention (and example)
Intervention used to reduce a disability by attempting to restore effective functioning
Ex. Providing special educational and rehabilitation services to a child with Down Syndrome