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Speech-Language Intervention in the Schools

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Speech-Language Intervention in the Schools Powered By Docstoc
					 Speech-Language
Intervention in the
     Schools
An overview of what to expect from your
     child and your school system.
          Stephanie Bailey, M.A., CCC-SLP
           Stephanie Lucy, M.S., CCC-SLP
    Understanding Normal Speech and
        Language Development
   Parents should discuss early
    speech and language
    development, as well as
    other developmental
    concerns, with their child's
    doctor at every routine well-
    child visit. Developmental
    norms help guide parents
    and doctors to determine if
    speech and language are
    developing as expected.
            Before 12 months
 Cooing
 Babbling

Babies are using their voices to relate to their
  environment.
At about 9 months of age, they begin to string
  sounds together, incorporate the different tones
  of speech, and say words like "mama" and
  "dada" (without really understanding what
  those words mean).
    What if my child doesn’t attend to
                sound?
   If a baby is attentive to
    you but doesn‘t seem to
    be startled by loud
    noises, he may be
    demonstrating a hearing
    loss.
   Hearing screen.
                     12-15 months
   Wide range of speech
    sounds in their babbling.
   At least one or more true
    words.
   Nouns are usually first.
   Should also be able to
    understand and follow
    single directions ("Please
    give me the toy‖)
                18-24 months
   Vocabulary of about 20 words by 18 months.
    50 or more partial words by the time they turn
    2.
   Combine two words, such as "baby crying" or
    "Daddy big."
   A 2-year-old should also be able to follow
    two-step commands (such as "Please pick up
    the toy and bring me your cup").
                 2-3 years of age
   An "explosion" in their
    child's speech occurs at
    this time.
   Expressively:
-Large vocabulary
-Routinely combine three
  or more words into
  sentences.
              2-3 years of age
 Receptively:
- Should begin to understand what it means to
  "put it on the table" or "put it under the bed."
- Should also begin to identify colors and
  comprehend descriptive concepts (big versus
  little, for example).
              Speech sound development
                                          Iowa-Nebraska Articulation Norms
       Smit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798.


   Phoneme                  Age of Acquisition Age of Acquisition
                                  Females          Males
/m/                              3.0             3.0
/n/                              3.6             3.0
/ng/                             7.0             7.0
/h-/                             3.0             3.0
/w-/                             3.0             3.0
/j-/                             4.0             5.0
/p/                              3.0             3.0
/b/                              3.0             3.0
            Speech sound development
                                        Iowa-Nebraska Articulation Norms
     Smit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798.



   Phoneme            Age of Acquisition Age of Acquisition
                       females            males
/t/                           4.0                3.6
/d/                           3.0                3.6
/k/                           3.6                3.6
/g/                           3.6                4.0
/f-/                          3.6                3.6
/-f/                          5.6                5.6
/v/                           5.6                5.6
Voiceless th                  6.0                8.0
Voiced th                     4.6                7.0
            Speech sound development
                                        Iowa-Nebraska Articulation Norms
     Smit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798.



   Phoneme            Age of Acquisition Age of Acquisition
                       females            males
/s/                           7.0                7.0
/z/                           7.0                7.0
/sh/                          6.0                7.0
/ch/                          6.0                7.0
/dg/ (j)                      6.0                7.0
/l-/                          5.0                6.0
/-l/                          6.0                7.0
/r-/                          8.0                8.0
/er/                          8.0                8.0
            Speech sound development
                                        Iowa-Nebraska Articulation Norms
     Smit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798.


   Phoneme      Age of Acquisition Age of Acquisition
                            females        males
/tw kw/                       4.0                  5.6
/sp st sk/                    7.0                  7.0
/sm sn/                       7.0                  7.0
/sw/                          7.0                  7.0
/sl/                          7.0                  7.0
/pl bl kl gl fl/              5.6                  6.0
/pr br tr dr kr gr fr/        8.0                  8.0
/thr/                         9.0                  9.0
/skw spl/                     7.0                  7.0
/spr str skr/                 9.0                  9.0
    Mom and Dad’s role in all of
             this:
STIMULATE STIMULATE
       STIMULATE
TALK TO YOUR CHILD
LABEL OBJECTS AND ACTIONS
READ TO YOUR CHILD
PLAY GAMES WITH YOUR CHILD
    Mom and Dad’s role in all of
             this:
   Consistency is key—read the same books over and
    over, play with the same toys and use the same words
    or phrases over and over. This will help your child to
    know the ―routine.‖
   Once the child knows the routine, then you can leave
    out the word that goes with a particular action. The
    goal is for the child to begin to add to the activity by
    saying a word or by participating in the activity at a
    different level—adding to an activity or expanding on
    an activity.
    What Are Some Warning Signs of a Possible
                  Problem?

  An infant who isn't responding to sound or
   who isn't vocalizing is of particular concern.
   Between 12 and 24 months, reasons for
   concern include a child who:
-isn't using gestures, such as pointing or waving
   bye-bye by 12 months
-prefers gestures over vocalizations to
   communicate by 18 months
-has trouble imitating sounds by 18 months
For the child over 2 years, you should seek an
            evaluation if he or she:
   Doesn't produce words or phrases spontaneously – only imitates.
   Only certain sounds or words repeatedly.
   Can't use oral language to communicate more than his or her immediate
    needs
   Can't follow simple directions
   Has an unusual tone of voice (such as raspy or nasal sounding)
   Is more difficult to understand than expected for his or her age.

    Parents and regular caregivers should understand about half of your child's
    speech at 2 years and about three quarters of your child's speech at 3 years.
    By 4 years old, your child should be mostly understood, even by people
    whom your child doesn't know.
      What if I suspect difficulties in
          speech or language?
   Anyone can refer a child for speech and
    language services:
   Parents
   Teachers
   Speech Pathologist
   Other supporting staff
              Screening process
   All children are screened at the Pre-K or
    Kindergarten level for speech and language
    development.
   This can be done by the teachers or the school speech
    pathologist.
   A child who does not ―pass‖ the screen may be
    referred for evaluation or another course of action
    may be pursued (i.e., offer guidance to parents or
    refer to teacher assistance team).
                    Referral
   Designee – records the date, reason for
    referral, and name of person making referral.
   Procedural safeguards notice
   Confidentiality
   Child Study Team meets.
                       Child Study
   Child Study team members:
       Parent
       Speech Pathologist
       Classroom teacher
       Designee (principal, asst principal, other)

    Reviews information the school already has:
      classroom test scores, observations by school staff,
      previous evaluation reports, classroom performance as
      reported by teacher, etc.
                    TIMELINE
   Evaluation must be completed and the child‘s
    eligibility determine within 65 business days of the
    date the referral is received.
            Evaluation Report
   Analysis of child‘s strengths and weaknesses.
   Assessment results fully explained.
   Indicates the existing and predicted impact of
    any speech-language impairment on the child‘s
    ability to access and progress in the general
    educational curriculum.
                ELIGIBILITY
   Based on the presence of a disability that
    results in the child‘s need for special education
    and related services,
   Not the potential benefit from speech-language
    services.
   The team must be able to document the
    adverse educational impact of a student‘s
    speech and language skills on performance.
   Is there a need for specially designed services
                   The bottom line…
A student can demonstrate communication
 differences, delays, or even impairments,
 without demonstrating an adverse affect on
 educational performance.
 Virginia Dept of Education (2005). Speech Language Pathology Services in Schools:
 Guidelines for Best Practice, p.15.
    Educational Impact Of a Speech-
        Language Impairment
   How does the disability affect the progress and
    involvement of the student in the general
    curriculum; for preschoolers, the effect on
    their ability to participate in appropriate
    activities.
   Academic
   Social
   Vocational
                  Academic
   Reading
   Math
   Language Arts
   Difficulty with language-based activities
   Difficulty comprehending orally presented
    information and/or difficulty conveying
    information orally.
                      Social
   Interference with the ability of others to
    understand the student
   Peers teasing the student about his/her speech-
    language disability
   The student having difficulty maintaining and
    terminating verbal interactions
   The student demonstrating embarrassment
    and/or frustration regarding his speech-
    language skills.
                      Vocational
   Job-related skills that the student cannot
    demonstrate due to speech-language
    impairment
       Inability to understand/follow oral directions
       Inappropriate responses to coworkers‘ or
        supervisors‘ comments
       Inability to answer and ask questions in a coherent
        and concise manner
       Children not eligible for Special
                 Education
   ―The Virginia Special Education Regulations
    require whenever a child is found ineligible for
    services, the eligibility committee should
    prepare useful information for the classroom
    teacher and the parent about steps they can
    take to facilitate the child‘s development.‖
    Virginia Dept of Education (2005). Speech Language Pathology Services in Schools:
    Guidelines for Best Practice, p.18.
    When a child is found eligible
   IEP (individualized education program)
   Within 30 calendar days of the eligibility date.
   Describes the services necessary to meet the unique
    educational needs of the child, as identified by the
    assessment.

   Consider: strengths, parental concerns, results of most
    recent evaluations, performance on any state or
    division-wide assessments.
          Addresses 3 questions:
   Where are we now?
   Where are we going?
   How will we get there?
                                                    PLOP
   Present Level of Performance

   What would I want to know about this student
    if he or she were going to be in my classroom
    next year?
    (Virginia Institute for Developmental Disabilities, 2001)
         Annual Measurable Goals
   What do we want the child to be able to do in a
    year?
   Be realistic
   Prioritize
   Measurable terms:
       Who will achieve?    -- What is the skill or
                                   behavior to be achieved?
     How can the skill be     -- Where will the student
       measured?                  use the behavior?
    -- When will the skill be used or goal be accomplished?
                    Service Delivery
   Direct services
   When speech and language services are
    indicated, the service delivery and clinical
    methods must focus on achieving the goals in
    the child‘s IEP.

       Pull-out therapy (individual or small group)
            provided in an individual or small group setting (speech
             therapy room, classroom, cafeteria, or other school
             setting)
                    Service Delivery
   Integrated Therapy
        Individualized service in a least restrictive setting and does not
         remove the child from the general or special ed. Classroom.
        Direct services while continuing to receive classroom instruction.
         Classroom teachers are an integral part of the process.
         Collaborative effort.
              Paraphrases information,
              creates graphic organizers,
              teaches strategies for vocabulary learning,
              teaches strategies for sequencing,
              teaches strategies for developing a narrative,
              cues and prompt the student,
              modifies the language level of instruction to meet students‘ needs.
                Indirect Services
   Consultative
   Specifies support for school personnel as a part of the
    accommodations, modifications, or supplemental
    support services provided to a teacher on behalf of
    the student.
   Include providing information and demonstrating
    effective instructional and facilitation procedures.
   SLP monitors student‘s progress.
   Appropriate for students nearing dismissal from
    speech-language services or students whose teachers
    require additional support to create materials,
    implement specific communication strategies, or
    modify AAC equipment.
        Indirect Services continued
   Indirect services include:
       Providing information and demonstrating effective
        instructional materials and facilitative procedures.
       While providing consultative services on behalf of
        a child, the speech-language pathologist will
        monitor the student‘s progress.
       Consultative services usually do not involve the
        direct provision of therapy to the student.
      Services Available at School
   Effective service delivery is dynamic and
    changes with the needs of the student.
   Services may be provided directly to the
    student or indirectly through consultation with
    educators and families.
   Decisions are based upon the child‘s present
    level of performance, progress made in
    services received to date, assessment results,
    IEP goals, and any objectives/benchmarks.
        Speech Language Intervention
                 includes:
   Articulation / phonology
       Increase Intelligibility of child‘s speech.
       Reduce use of phonological processes.
       Stimulability of sound production.
        Speech Language Intervention
                 includes:
   Expressive and Receptive Language
       Syntax
       Morphology
       Organization
       Vocabulary
       Pragmatics
       Semantics
       Verbal comprehension
       Figurative Language skills
        Speech Language Intervention
                 includes:
   Fluency
       Repetitions (sounds, syllables, part words, whole
        words, phrases)
       Pauses
       Prolongations

    Differ in number and severity from those of
     normally fluent individuals.
        Speech Language Intervention
                 includes:
   Voice
       Pitch
       Loudness
       Quality

    Calls attention to itself rather than to what the speaker is
      saying.
    Before a child may be found eligible for services for a voice
      impairment, the child should receive a medical examination
      from an otolaryngologist (ENT), clearing the child for
      intervention.
What Can Parents Do at Home?
   For mild developmental errors try these:
       Repeat the sound slowly and correctly over and
        over in lots of natural conversations while facing
        your child directly.
       Work on one sound at a time for no more than 15
        minutes at least three times a week.
            Five trials at a time. Parent model and child tries to
             match it. Give praise – positive reinforcement.
            Make it a game, color something together.
            Stickers!
         Quick Communications, P.O. Box 27891, St.Louis, MO 63146
    Suggestions that Parents Can Do at
                  Home.
   For mild developmental errors try these:
        Model proper grammar during conversation
        Correct a child‘s grammar during spontaneous speech no
         more than once a day. We want enthusiasm for natural
         speech.
        Respond with lots of encouragement and praise for trying.
        Refer your child to the word in which he can produce the
         sound correctly. (i.e., I like your /r/ in ‗run‘.)
          Quick Communications, P.O. Box 27891, St.Louis, MO 63146
    Suggestions that Parents Can Do at
                  Home.
   Aiding your child‘s language development.
        Read longer and longer stories and see if he/she
         can remember what happened first, second, third,
         etc. Have him tell the story back to you. This
         promotes memory improvement.
        Make category scrapbooks – select categories for
         each page. Have child find and glue magazine
         pictures for each category. This promotes logic
         and logical language.
          Quick Communications, P.O. Box 27891, St.Louis, MO 63146
    Suggestions that Parents Can Do at
                  Home.
   Aiding your child‘s language development.
        Encourage complete sentences. When your child
         uses just a few words, repeat them and put them
         into a short sentence. Provide sentences with
         additional phrases as your child grows older.
         This expands sentence length naturally.
        Embrace opportunities to incorporate language
         concepts: descriptive (big); spatial (under) ,etc..
          Quick Communications, P.O. Box 27891, St.Louis, MO 63146
    Suggestions that Parents Can Do at
                  Home.
   Aiding your child‘s language development.
        Play ―what if-‖ games:
           ―What if we ran out of gas, what would you do?‖
           Ask questions of why, what, how & where.

           Use riddles.

          This promotes problem solving skills.
          Quick Communications, P.O. Box 27891, St.Louis, MO 63146
    Suggestions that Parents Can Do at
                  Home.
   Language is best learned while doing, so let
    your child participate in household and
    neighborhood routines whenever possible.
    Describe what you are doing and what will
    happen next.
   Give him/her a chance to ask questions.
       Quick Communications, P.O. Box 27891, St.Louis, MO 63146
    Suggestions that Parents Can Do at
                  Home.
   What if my child stutters?
     Start with improving your own listening skills.
      What is your child really trying to tell you?

        Provide an appropriate speech model for you child.
             Make efforts to talk a little more slowly.
             Try using simpler and shorter sentences at times.
             Give your child time to talk without interruption.
             Act and speak patiently.

          Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America
    Suggestions that Parents Can Do at
                  Home.
   What if my child stutters?
        Provide pleasurable and rewarding speech
         experiences.
             Singing
             Word games
             Teach riddles and jokes
             Read or tell stories

             Speech is not always for scolding and reprimanding.
          Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America
    Suggestions that Parents Can Do at
                  Home.
   What if my child stutters?
        Help him/her to express feelings verbally.
             Model verbalizing and showing love.
             Talk about things that are funny and make him/her
              laugh. The child should also learn that something that
              harms others is not funny.
             Talk about what is making him/her angry. Talk about
              ways he/she could express their feelings.

          Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America
    Suggestions that Parents Can Do at
                  Home.
   What if my child stutters?

   Accept the Disfluencies
   Express acceptance
        It may help you to remember that he/she is doing the best
         he can at the moment he speaks. If you react emotionally,
         you make him struggle harder to stop, avoid, or conceal
         what he is doing to distort his speech.

          Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America
    Suggestions that Parents Can Do at
                  Home.
   What if my child stutters?
        Talk to him about his stuttering – Sometimes we all get
         tangled up or stuck. Some of us do it more than others.
         Describe to him what he doing and that it‘s alright to talk
         this way as long as he has to do so.
             Tell him to talk as easily as he can at the moment. – One parent
              taught this by showing the child what he meant: He squeezed his
              fist and gradually relaxed it while he let a sound ―leak out.‖
             Let him know he can take all the time he needs.


          Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America
    Suggestions that Parents Can Do at
                  Home.
   What if my child stutters?
       Reduce fears, anxieties and frustrations about speech.
            Encourage him to talk about his fears, anxieties and frustrations and
             accept what he says without criticism or disapproval.

            Do not attempt to overprotect (i.e., don‘t try to arrange his life so he
             doesn‘t have to talk.)

            ―Successive approximation‖ process- Encourage him to overcome his
             barriers and fears gradually.

            Help him to release the destructive feelings of frustration. (i.e.,
             encourage him to hit a stuffed animal or clown as hard as he can until he
             feels better; allow the child to have a period of saying anything he wants
             without disapproval, only assurance that that you understand his
             feelings; have child to talk into a wastebasket and throw out the
             metaphoric poison, outdoor exercise-take a long walk.)
         Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America
 Speech and Language Development
  is a journey we all make together.
The world cannot function without communication. We
  make bridges with our ability to communicate.

				
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