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Clinical Issues Exam Review


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Which of the following is a step in developing an effective and safe time-out?

(a) allow the child to have a toy to make the time pass quickly for them

(b) allow the child to sit on your lap, but don't talk to them

Before the evaluation Cultural sensitive planning is needed to conduct assessment that is appropriate for the client of cultural diversity. What steps in planning your session might you take?

a.) Figure out what the population of the cultural
c.) Choose material that is culturally appropriate and know the cultural background.
You can use extinction to help control undesirable behaviours by:

a) lecturing the child.

b) giving a reward.

c) withdrawing attention (avoiding eye contact and sitting motionless)..

d) telling the child &q
The answer is c.
Reference is on p. 334 How to use extinction #3
Here is my submission for the exam questions.

In a variable-ratio schedule reinforcement is given:
a) around an invariable amount of time.
*b) around an average number of correct responses.
c) around a variable predetermined a
To select target behaviours, which of the following guidelines apply to various disorders of communication:

a) Select behaviours that will not make an immediate and socially significant difference in the communicative skills of
the cli
What is the definition of the client specific approach?

A. Targets behaviours which are appropriate for the client’s age group.

B. Targets behaviours which the client requests be worked on in therapy

C. Targets those
When treating a multicultural client an etnographic interview should be
conducted. This type of interview is one that:

a) focuses on the true ethnicity of your client

b) focuses on the holidays the client's family celebrates
The definition for Negative Reinforcement is:

A: Verbally or gesturally conveying “no”, “incorrect” or “wrong” immediately after correct response in a non-angry tone in varied ways.
B: Withdraw a stimulus that maintains or i
Selecting target behaviours that are relevant and useful for the individual client, is considered what type of Target Behaviour Selection Method?

a). Functional Approach

b). Normative Approach

c). Preferred-Practice Appro
Prompting" is:
a) The clinician's production of the client's target response.
b) Is when there is a progressive withdraw of additional parts of the modelled stimulus and the correct response remains.
c) A method of teaching non-exsist
If you were to work with an interpreter which of the following is NOT true:

a) Use the same interpreter as much as possible.

b) Use an interpreter from the same ethnic background as you.

c) Use what you want the interpret
Which of the following is an example of a primary reinforcer?

a. Food and drink
b. Saying "good job"
c. Stickers
d. Tokens that can be exchanged for a prize
The advantages of Time-Out are:
a) it is only mildly aversive
b) it is not a difficult procedure to learn and use
c) do not waste much teaching time
d) all of the above
Prompts are indirect stimuli because
a) They are done quietly
b) They only suggest the target response instead of displaying it
c) They show the client exactly how to respond
d) They are non-verbal
To baserate target behaviours you must:

A) Write instructions to the S-LP to evoke target responses.
B) Transcribe everything the child says into the IPA.
C) Use the SPAT test.
D) Write at least 20 responses during discrete tria
Shaping is an example of:

a) positive reinforcement

b) physical stimuli

c) creating new responses

d) evoking communicative behaviours
Which of the following is not a method of treating communication disorders?

a) Model communicative behaviors

b) Create non-existent communicative behaviors

c) Increase existing communicative behaviors

d) Contr
Implementing therapy that will make an immediate and significant difference in a clinent's communication is considered (choose the best answer):

a. behaviour targeting

b. the client-centred approach

c. the
What are 4 communicative behaviors that need to be reduced while working with your clients?
1) disorders of language

2) articulation and phonological disorders

3) voice disorders

4) disorders of fluency
What are 6 undesirable general behaviors that interfere with treatment?
1) inattention
2) crying, fussing, etc
3) out-of-seat and other uncooperative behaviors
4) absenteeism
5)general unresponsitivy
6) distracting verbal behaviors
What is a functional analysis baseline?
Baselines that also are used to find out the maintaining causes of behaviors being measured ex: finding the reason a child is getting out of their seat
Most often, ____ is the positive reinforcer that maintains undesirable behaviors
what is automatic reinforcement?
when behaviors don't have environmentally generated maintining cuases; the undesirable behaviors are presumed to generate neutral or sensory consequences that reinforce behaviors.

- lack of stimulatino is one reason for undesirable behaviors maintained by automatic reinforcment; these kids need opportunities to play and explore to reduce bad behavior
What is a direct response reduction strategy?
-concentation on undesirable behavior

The treatment contingency is placed on the behavior to be reduced - meaning you take an immedicate action (ex: saying no) followed by a behavior that needs to be decreased
Indirect response reduction strategy
you take the contingency on a desirable behavior whose increase will have an indirect effect on decreasing an undesirable behavior

- increasing desirable behaviors

- isn't considered a 'punishment'
2 direct stategies for decreasing behavior
1) stimulus presentation
- presenting a stimuls immediately after a response is made ex: 'no','wrong' (helps when paired with strong reinforcers for desirable behaviors)

2) stimulus withdrawal
- immediately after a response is made, withdraw a stimulus that presumably maintans that response
how to reduce behaviors by stimulus presentation
1) present verbal stimulus soon after response is made

2) preent the verbal stimulus in a firm and objective manner

3) use and objective tone devoid of emotionality

4) vary the words you use
3 procedures for stimulus withdrawal
1) time-out
2) response cost
3) extinction
1) timeout
2) exclusion timeout
3) nonexclusion timeout
1) timeout is a period of time during which all reinforcing events are suspended onctingent on response and typically is a decrease in the rate of that response

2) exclusion time-out --> child is excluded from the current setting and activities
3) non-exclusion --> an undesirable behavior is followed immediately by termination of all activity
Ex: after stuttering, tell client to stop talking for 5 seconds, avoid eyecontact, then signal them to continue talking
avoid the following 2 conditions under which time-out may increase the undesirable behavior...
1)providing unintended negative reinforcement
(ex: time out ends the difficult task of therapy, so it increases bad behavior)

2) time out provides unintendend positive reinforcement (ex: child gets to play with a toy in time out, so it reinforces bad behavior)
8 points for using time-outs
1) avoid too brief or too long durations of timeout

2) avoid exclusion time-out

3) signal the beginning of the nonexclusion timeout with a stimuls ex: raising index finger
4)avoid physcial contact in admistering exclusion timeout
5) use time-out on a continuous schedule (use it every time behavior is bad)
6) remove all reinforcers from the time-out area
7) release the clien from timeout only when the undesirable behavior has been stopped
8) enrich the treatment situation with powerful and varied reinforcers
What is response cost?

* token
* backup reinforcer
* lose-only type
* earn and lose type
The client must give up a reinforcer every time an undesirable response is made

- may be used with token system...tokens are presented and withdrawn depending on behaviior
- at the end tokens are exchanged for a backup reinforcer, usually a small gift
- in the lose-only type, you give the client a certain number of tokens at hte beginning of a session; unlike in the 'earn-and-lose' type, they aren't dependent on behavior during the session
What problems should you avoid in designing response cost systems?
1) low token los preceded by high loss may be ineffective (Ex: first take away 5 tokens per error, then only 2)

2) the client may run out of tokens and have nothing to lose

3) loss of tokens may cause an emotional response

4) the undesirable behavior may increase because of attention
6 tips for using response cost
1) prefer the earn-and-lose method to lose only

2) give more tokens than you take back

3) withdraw tokens promptly

4) increase the number of tokens withdrawn per response only if necessary...don't decrease #

5) avoid client indebtedness

6) control potential emotional problems - for example, if child starts crying, let them play the clinician for a while and take tokens from you

*escape extinction
- a do-nothing procedure

the procedure of witholding the consequences that reinforce a behavior

- not a punishment

- ex: a child who keeps saying 'you know what?' is actually reinforced when the clinician acknowledges this...should ignore it

* escape extinction - can't always ignore it - must prevent their escape - for example, if child tries to leave room

* behaviros that are reinforced automatically adn those that are destructive or aggressive are NOT candidates for extinction
7 tips for using extinction
1) discuss the problem and the extinction procedure with the parents

2) find out what reinforces the undesirable behavior

3) remove positive reinforcers inherent to your actions promptly and fully (ex: no eye contact, sit still, no lecturing, etc)

4) remove positive reinforcers that are unrelated to your actions (ex: toys on the floor the child begins to play with)

5) remove negative reinforcers as promptly and fully as possible

6) don't terminate the extinction procedure when you see an extinction burst (temporary increase in rate of response when extinction initiated)

7) reinforce desirable behaviors promply and lavishly
5 types of INDIRECT strategies for decreasing behaviors

(remember, indirect means reinforncing positive behaviors, which in turn eliminates negative ones)
1)Differential reinforcement

2) behavioral momentum

3) suprising stimulus presentation
what is differnetial reinforment

- of other behavior
-of incompatible behavior
- of alternative behavior
- of low rates of responding
* The use of reinforcement to increase some behaviors while other behaviors decrease as a result

DRO = you reinforce a child for not exhibiting a specified undesirable behavior for a particular duration (ex: get a token for not squirming for 2 minutes)

DRI - reinforce behaviros that are incompatible with the undesirable behavior (ex: a child who is verbally abusive is reinforced for using socially acceptable language)

DRA - specify and reinforce a behavior that is an alternative to teh undesirable behavior

DRL - reinforce the child when the frequency of undesirable behaviro is below the baseline level
behavioral momentum
a procedure in which the force of a behavior in progress causes another behavior that may not otherwise be exhibited

Ex: if a child won't look at a picture, but WILL clap their hands, ask them to clap their hands and immediately after, to look at the picture
Suprising Stimulus Presentation
a sudden noise can terminate undesirable behavior

ex: right before a child is about to cry, dramatically pull out a toy, which is a positive reinforcer

- must be presented BEFORE the undesirable behavior
What is generalization?
It is a declining rate of response when untrained stimuli are presented and reinforcers are withheld

If a child doesn't continue to produce /s/ at home, we'd say that the correct production didn't generalize

- in order for behaviors to generalize, they need to be reinforced
The final treatment goal is...
- maintenance of target behaviors

- clinically established communicative behaviors must be produced in conversational speech, in the natural environment, and mustbe sustained over time
What is a maintenance strategy?
It is an extension of treatment to natural settings. The main task is to teach people in the client's life to support target behaviors...but also to teach the client to maintain their own behaviors.
What are the steps in a comprehensive maintenance strategy??
1) select useful behaviors
2) reinforce target responses in conversational speech
3) shift reinforcement schedule (move from continuous reinforcement to intermittent)
4) Use social reinforcers (ex: verbal praise) and conditioned generalized reinforcers (ex: token system)

continued on next slides...
Step 5) Spread the discriminative stimulus control
A discriminative Stimulus is a stimulus in whose presense a response has been reinforced. SO...the response is likely in the presense of that stimulus

- the most important discriminative stimuli are people, physical stimuli and physical settings, so the task is to spread the discriminative stimulus control exerted by the clinicial to otehr people in non-clinical settings
How do you spread the discriminative stimulus control?
1) ask the family members to sit in the treatment room

2) move treatment to outside the treatment room
a) take the client to less-threatening situations
b) let the client rehearse what he or she will tell a stranger in a new setting
c) the first few times, stay close to the client
d) take note of correct and incorrect production
e) gradually increase the distance b/w you and your client
f) take the client to progressively more difficult situations
Step 6: Teach others to evoke and consequate target behaviors
Significant others need to know a) the exact target behaviors b) how to evoke them and c) how to enhance them... for this to happen...

A) Describe and demonstrate the target behaviors to others

B) Demonstrate how to evoke target behaviors

C) Teach family members the subtle ways of prompting target behaviors (ex: a small hand movement to tell a child to slow down their speech) For each target response, devise a specific, brief signal

D)Teach family members how to create opportunities for the client to produce the target behaviors

E) Teach how to reinforce the target behaviors

F) Teach how to provide corrective feedback, but only minimally (ex: use a prompt like a hand gesture for 'slow down' rather than saying 'no')

G) Train family members to stop reinforcign inappropriate behaviors

H) Assess whether family members and others are prompting and reinforcing target behaviors (ex: ask them to taperecord a conversation)

I) Train family members to conduct home treatment programs

Step 7: Teach the client Self Control
* teach the client to judge the accuracy of their behaviors

* Train clients in target behavior charting (ex: let a child put a chip in one cup for correct production and in another for incorrect and have them tally it up_

* Teach clients to implant signals that remind them of the target behaviors in tehir everyday lives (ex: a person who stutters may draw downward pointing arrows near phones, on desk, etc)
Step 8: Teach the Client to Prime others to Administer Cosequences

* Define 'priming'
Priming = a special way of prompting others to reinforce; it is done by those who wish to recieve reinforcement

- teach clients to draw attention to their target behavior productions and ask the family to reinforce immediately

-'vocal emphasis' on a target language fature maay be another way of drawing attention (example: a boy who has learnd to produce the regular plural morpheme slighly emphasizes it in his words, phrases, etc)
Step 9: Give Sufficient Treatment
* when clients are dismissed prematurely, either the target responses haven't been trained sufficiently in conversational speech or no maintenance procedures have been implemented
Step 10: Give Booster Treatment
* Treatment resumed for a client after dismissal is called booster treatment

* a relapse can occur after successful treatment; you should inform clients of this and tell them that it can be handled successfuly and they should contact you immediately if relapse occurs

*booster treatment needed most for those who stutter
* it is usually the same treatment that was successful initially
How are Home Treatment Programs Different from Maintenance Programs?
In home maintenacne programs, families strengthen behaviors the clinician has already established. But in a HOME treatment program, the parents may have to establish at least some of the behaviors.
Home Treatment Programs (HTP) are especially recommended for ___
* infancts at risk for developing communicative disorders (who show early signs of mental retardation, heranig probs, neuro impairments, etc)

* in cases where clients receive limited treatment from a professional with the understanding that the fam members will continue some systematic treatment at home
The clinician should never simply give a written home program and ask the parents to follow it. HTP should be recommended only after the clinician has... (4)
1) thoroughly assessed a client

2) developed and tried an intervention program that works

3) trained the parents in a home treatment program, including objective record keeping procedures

4) developed plans to make her/himself available to supervise the fam members' work, assess the data supplied by them, modify the treatment program, and retrain family when necessary
What is a Follow-up Assessment?
It is an assessment of response maintenance over time. It is a 'conversational probe' of communicative behaviors.

Typically, the first follow-up should be scheduled 3 months after dismissal.

A 3-4 year follow-up is needed for stuttering and voice clients

* determine the need for booster treatment by taking an extended conversational speech sample
Chapter 6 - Multicultural Issues

ASHA has had policies regarding nondiscrimination based on ...
on gender, race, linguistic background, and other factors. This policy also includes nondiscrimination towards students and professionals who speech English with nonstandard dialects or accents.
In general, as a student clinician you should:
1. Develop a thorough knowledge of normal and disordered communication and communication development.
2. Acquire effective diagnostic and intervention skills.
3. Learn to effectively communicate with clients from a variety of cultural, ethnic, racial, and linguistic backgrounds.
4. Develop the skill to model all target behaviors required of your clients. For example, for articulation therapy, you will need to be able to model each of the English phonemes or allophones.
5. Learn to write clearly and concisely, using correct grammar.

Recommendation that clinicians should study and understand the cultural and linguistic background of clients they serve applies to all clinicians.
A bilingual speech-language pathologist is one who...
speaks his or her own language proficiently and speaks (or signs) at least one other language with native or near native proficiency.
ASHA- Suggested Competencies Required of Bilingual Clinicians
1. The ability to describe the development of speech and oral (or manual) and written language for both bilingual and monolingual individuals.
2. The skill to differentiate communication differences from communication disorders in oral (or manual) and written language through the use of both formal and informal evaluation.
3. The ability to provide treatment in the client’s primary language.
4. Knowledge of various cultural factors related to service delivery.
5 AHSA Guidelines for Serving Minority Language Populations
1. Contracting with a bilingual speech-language pathologist or audiologist to serve as a consultant.
2. Employment an itinerant bilingual speech-language pathologist or audiologist to provide services for a specific language population.
3. Collaborating with university bilingual speech-language pathology and audiology program.
4. Developing an interdisciplinary team that consists of at least one bilingual professional who also is proficient in language development and nonbiased assessment procedures.
5. Creating SLPCF and practicum sites for individuals from bilingual speech-language pathology and audiology programs.

Guidelines for the use of interpreters include training the interpreter, planning assessment sessions, using the same interpreter, and using natural assessment measures.

You can only recommend speech therapy for those individuals who exhibit a language disorder, not a language difference.
3 ASHA Guidelines for Collaborating in ESL Instruction
1. Before an assessment, discuss with the ESL teacher such issues as language development and code switching during second language use in the classroom and community.
2. As part of an assessment, discuss with the ESL teacher such issues as the student’s test performance, specific test results, and methods and strategies for maximizing the student’s learning.
3. During intervention, continue to collaborate with the ESL teacher, discussing ideas and resources, and coordinating goals, objectives, and activities related to the communicative disorder connected to those of developing proficiency in English.

AHSA suggests that the speech-language pathologist act as a consultant to the teachers and other professionals and advocate for the child.
It is important that a communicative disorder not be misinterpreted as acquisition of a second language, and that second language acquisition is not diagnosed as a communication disorder.
Assessment Issues
Assessment Issues
Evaluation, or assessment, is a multifaceted process that involves interactions between the examiner, the client, the client’s family, and various educators, physicians and allied professionals. To make comprehensive and accurate evaluations, the speech-language pathologist should possess knowledge of normal and abnormal communication development, knowledge of standardized tests, effective test administration skills, good observation skills and interviewing skills.
Before the Evaluation (These are the following steps we should use when working for clients of cultural diversity)
1. Know the cultural background of your clients. Try to understand the client’s disposition, values and expectation regarding communication and its disorders.
2. Understand how your life experience may influence your attitude towards a client.
3. Know the beliefs and behaviors dispositions toward communicative disorders. Know your clients’ beliefs regarding the origin if a communication disorder.
4. Know phonological and linguistic differences. Study the phonological and linguistic characteristics of your client’s native language or dialectal variation.
5. Know health statistics. The prevalence of certain diseases varies across race and culture.
6. Select standardized test that is appropriate to the client.
7. Choose material that is culturally appropriate.
8. Determine if you will need to use the service of an interpreter.
9. Train the interpreter. After you have selected an interpreter discuss the evaluation session with him or her.
19 points to remember during assessments

1. Be sensitive to cultural issues. For example, in the client’s cultural it may not be acceptable to touch the top of an individual’s head. Know what behaviors are considered rude and which are considered polite.
2. Talk to the client, not the interpreter.
3. Explain why you will be asking question.
4. Use the appropriate title of the cultural group. If an Asian boy is accompanied to the clinic by his uncle and you are talking to the child, it is preferable to use the phrase “Your uncle,” and not “Mr. Kapoor”.
5. Find out the clients primary language.
6. Conduct an ethnographic interview. An ethnographic interview is one that focuses on the client and his or her interactions within the family. The ethnographic interview is directed by the responses a family member provides to such questions as: who is the primary person whom children talk to in your family? Basically, you are trying to learn about the dynamics of the culture and the particular family and how your client fits within the culture and family.
7. In a naturalistic context, obtain an adequate sample of your client’s speech. Obtain sample from home and work or school, this is the best source of information.
8. Sample social cognitively demanding language. People discuss familiar events, share personal experiences, and answer simple questions about stories to which they have listened.
9. Use standardized tests that are culturally relevant and contain appropriate norms. For example, some children of migrant farm workers may never have seen an elevator or an escalator. A child’s inability to identify one of these on a test may lead to inaccurate conclusion regarding the child’s vocabulary.
10. Administer a test in one language at a time. Completely administer the test in one language before administering the test in a second language.
11. Be aware of individual differences within each culture. Do not stereotype your client based on information you have about his or her background.
12. Use a variety of methods to evaluate performances. Do not only rely on test scores, interview the family members, speech samples audiotapes in the home.
13. Obtain case history information orally.
14. When assessing a child, ask parents to compare the performance of that child with that of other children who are at home.
15. When assessing a school-age child, ask teachers to compare the performance of that child with that of other children in the same classroom.
16. If necessary, train test-tasking skills. Most tests provide opportunity to practice required responses (e.g., pointing to a picture. When you have gathered background information on your client’s typical communicative behaviors prior to assessment session, you will have an idea of what types of responses will be easier to evoke and which will require additional time to practice.
17. If necessary, complete the evaluation during subsequent visit or visits. As they meet with you on repeated occasions, your clients will begin to feel more comfortable with you.
18. Find out what the home and school environments are like. Observe what types of toys are available at home and what types of play activities are attractive to him or her.
19. Conduct treatment on a trial basis. Conduct some trial speech therapy. This will help you understand the client’s learning strategies. This gives you information about how quickly your client learns new task.
After the evaluation
1. Talk with your interpreter.
2. Analyze your results.
3. Schedule a follow up session.
4. Understand how what you are saying may be interpreted by your clients and their family member.
Is essence, flexibility, knowledge and sensitivity are the key concepts in assessing clients of multicultural backgrounds
Treatment Issues

(1-5 of 12)
There is very little research on treatment efficacy for multicultural populations.

1. Ask parents if selected communication skills are acceptable. Children of Asian background do not maintain eye contact with such authority figures as clinicians and teachers during conversation. Should the clinician teach or not teach eye contact as an accepted conversational skill? Do not teach skills that clients or their families do not want.
2. Note that some multicultural questions relevant to assessment may not be relevant to treatment. For instance, if a recent immigrant child from a tropical country did not name ski lift, you should not conclude that the child is deficient is some aspect of language.
3. Initially, use culturally appropriate stimulus materials. For example, if your child is a vegetarian Hindu, you may want to omit stimulus pictures that show an individual eating meat.
4. Use activities that reflect your client’s environment .Use activities that are culturally relevant.
5. Provide treatment in the client’s natural environment. Duplicate your client’s natural environment as much as possible use using language, activities and materials.
6. Note that there exists very little treatment research suggesting that people of different ethnocultural background react differently to the same treatment procedures.
7. Modify treatment procedures to suit the client. Some methods might have to be changed because of cultural of the linguistic background of the client.
8. Keep accurate and detailed records of treatment methods and their outcomes. You may have to make constant modifications in treatment methods.
9. Do not schedule appointments on religious or cultural holidays.
10. Collaborate with family members and other professionals. Engage other people in your client’s treatment.
11. Learn to appreciate your client’s culture and language differences.
12. Share your experiences with clients of differing cultural backgrounds with other clinicians.
Define the 2 types of interpreting...
* Consecutive interpreting
* Simultaneous interpreting
Consecutive interpreting which is when an individual talks, pauses, and then the interpreter translates. Simultaneous interpreting, the interpreter translates as the individual talks.
16 things to remember when working with an interpreter
Working with an Interpreter
The interpreter helps obtain information, assist with evaluation and helps report information to clients and family members.
1. Use the interpreter as much as possible.
2. Use an interpreter from the same ethic background as the client, of possible.
3. Meet with the interpreter in advance.
4. Train the interpreter to administer any new tests you will be using.
5. Discuss the testing format with the interpreter. Give the interpreter an overview of the session.
6. Describe what you want the interpreter to do in clear and simple language.
7. Let the interpreter ask questions or make comments before meeting with the client.
8. Arrange a comfortable environment.
9. When you meet with the client, introduce yourself and the interpreter to the client.
10. Describe your role and that of the interpreter to the client. Do not assume that the client will automatically distinguish your role from that of the interpreter.
11. Talk to and look at the client, not the interpreter.
12. Use brief sentences or paragraphs. Keep your utterances short.
13. Use a normal rate of speech and allow sufficient pauses.
14. Do not allow other to talking during the interpreting process.
15. After the session, discuss the session with the interpreter.
16. Thank the interpreter for assisting and pay for the service.
Social Dialects of English
Social Dialects of English
- Dialectal differences in English are not disorder and should not be treated as such
- Clinician needs to be aware of linguistic variation because of differences in dialect vs. linguistic variation because of a communication disorders.
- Clinicians may work on linguistic variations based on dialectal differences if requested by the client, e.g., accent reduction or code-switching between dialect and standers English.
- This must be the choice of the client though.
Chapter 7 'Target Behaviors across Disorders'

What is a target behavior?
A target behaviour is a generic term that means any skill or action you teach a client or a student. The term is applicable to educational and medical settings. Anything the clinician teaches regardless of the professional setting is a target behaviour.
Why must you select target behaviours?
1. you need to teach multiple targets to most clients.
2. most clients cannot learn multiple targets at once
3. multiple targets should be sequenced
4. some behaviours need to be taught before others
What is the client specific approach to target behavior selection?
The targets in the client specific approach make an immediate and significant difference in the clients communication are selected regardless of the norms(you do not necessarily have to follow the table of norms for this approach) You teach the client things that would best serve the clients environment, educational, and social needs. This approach is suitable for choosing targets that are culturally and linguistically appropriate.

Other facts!
The normative and the client-specific approaches may suggest the same target behaviours for a given client. ALTHOUGH the targets may be different.
4 guidelines for selecting target behaviors
1. Select behaviours that will make an immediate and socially significant difference in the communicative skills of the client. i.e. functional targets
2. Select the most useful behaviours that may be produced and reinforced at home and in other natural settings.
3. Select behaviours that help expand communicative skills.
4. Select behaviour that is linguistically and culturally appropriate for the individual client.
Treatment Targets Based on the Sound by Sound Analysis
1. Find out if each phoneme is produced correctly or not.
2. Classify errors as substitutions, distortions, or omissions.
3. Find out the word positions in which the sounds are misarticulated.
4. Select the initial target sounds for training, and write you target behaviour statements in objective and quantitative terms.
5. In the case of a child who is bilingual or multicultural, or both, select the phonemes based on a clear understanding of the phoneme us in the clients language.
Target Patterns Based on the Place-Manner-Voice Analysis
1. Find out all substitution errors of the client.
2. Group substitutions that are based on place of articulation
3. Group substitutions that are based on manner of production. (sounds produced in one manner may be substituted for sounds produced in another manner.
4. Group substitutions that are based on voicing features
5. Teach one or mare sounds from each group. Probe to find out if untrained sounds in the group are produced.
6. Clients who are bilingual-bicultural, make this analysis with a firm knowledge of the phonolgy of the clients language.
Target Patterns Based on Distinctive Features
1. Find out all the errors of your client.
2. Determine the distinctive features shard by the phonemes in error
3. Group misarticulated sounds on the basis of shared (common) distinctive features.
4. Teach a few sounds from each group. Probe to see if untrained sounds within the group are produced without training. If they are, reinforce them and implement a maintenance procedure.
5. Make a distinctive feature analysis of a bilingual clients misarticulations with a firm knowledge of the linguistic and phonological features of the relevant language.
Patterns based on Phonological Processes include the following...
Final consonant deletion
Syllable Structure Processes

*full list on page 230-232
Target Phonological Processes:
1. Select on phonological analysis procedure because there are several somewhat incompatible approaches.
2. Following the procedure prescribed by the selected approach, record continues speech sample, transcribe the samples and make a process analysis.
3. Select processes and the involved target sounds for intervention Take not the you teach specific sounds to eliminate a process.
4. In the case of a client who is bilingual, make phonological process analyses only with a firm knowledge of the client’s language and phonological features.
Basic Target Words Are:
1. Concrete words that name specific things or actions.
2. Names of manipulable objects.
3. Names of animal and pets.
4. Verbs
5. Adjective to describe objects and people.
6. Culturally and linguistically relevant words.
Target Phrases:
1. Simple phrases
2. Two-word utterances.
3. Two or three word utterances.
Morphologic Treatment Targets:
1. Morphologic features that help build a language repertoire.
2. The present progressive ing.
3. other morphologic features ie prepositions.
4. Morphologic features that help expand the multiword utterances into syntactically more correct utterances or complete sentences.
5. Pronouns
6. Additional grammatical morphemes and syntactic structures.
7. Grammatical morphemes and syntactic structures that are culturally and linguistically relevant.
Pragmatic Language Treatment Targets
1. Requests or mands
2. Tacts or descriptive statements
3. Topic initiation
4. Topic maintenance
5. Turn taking in conversation
6. Conversational repair
7. Narrative skill
8. Culturally appropriate pragmatic communicative behaviours.
4 Treatment Targets in Literacy Intervention
1) oral language skills

2) parental behaviours that promote literacy skills in preschoolers
3) reading skills
4) writing skills
parental behaviours that promote literacy skills in preschoolers
a. Storybook reading to children
b. Literacy –rich home environment
c. Modelling literacy skills at home
d. Getting children involved in literacy skill practice
Reading Skills
a. Integrating printed letters of the alphabet in all oral speech and language training.
b. Integrating printed word stimuli during oral speech and language training.
c. Integrating printed phrases and sentences into oral speech and language training.
d. Reading the letters of the alphabet, simple and functional words, phrases and sentence selected from the child’s family environment and academic curricula.
e. Reading during advance language training.
f. Reading as independent target.
Writing Skills
a. Writing the letter of the alphabet during oral speech and language training.
b. Writing words during oral speech and language training.
c. Writing phrases and sentences during speech and language training
d. Writing during advanced language training
e. Writing as independent target
Treatment Targets in Treating Disorders of Phonation
1. Respiration training
2. Muscular Effort
3. Esophageal speech
4. Phonation with artificial larynx
5. Relaxation
6. Vocal Rest
7. Altered head positions
8. Elimination of vocally abusive behaviours.
9. Elimination of vocal misuse.
10. Culturally appropriate vocal behaviours
Treatment Targets in Treating Loudness and Pitch Disorder:
1.Increased loudness
2.Decreased loudness
3.Higher Pitch
4.Lower Pitch
Treatment Targets in Treating Resonance Disorders
1. Reduced nasal resonance on nonasal speech sounds
2. Increased nasal resonance on nasal speech sounds
3. Increased oral resonance
Treatment Targets in Fluency Shaping.
1. Management of airflow
2. Gentle onset of phonation
3. Reduced rate of speech through syllable prolongation
4. Normal prosody
5. Maintenance of fluent conversational speech in natural settings
Treatment Targets with Direct Stuttering Reductions Strategy
-All forms of dysfluencies or stuttering as defined by the clinician
-Any associated motor behaviours if they need to be specifically manipulated, normally they do not.

Treatment Targets with Fluency Reinforcement Strategy
-Fluently produced words, phrase and sentences
-Fluent conversational speech
Treatment Targets in Treating Stuttering
1. Slower rate of speech
2. Slight syllable prolongation
3. Pauses between phrases and sentences
4. Deliberate stress on syllables
5. Reduced dysfluency rate
6. Language skills
7. Increased awareness of the problem
8. Self-monitoring skills
Treatment Targets for Patients with Aphasia
Treatment Targets for Patients with Aphasia

1. Auditory comprehension of spoken language.
2. Naming responses
3. Phrases and Sentences
4. Pragmatic aspects of language
5. Gestures paired with verbal expressions
6. Writing
7. Reading Skills
Treatment Targets for Patients with the Right Hemisphere Syndrome
Treatment Targets for Patients with the Right Hemisphere Syndrome

1. Denial of illness and deficits
2. Impaired attention
3. Visual neglect
4. Abstract reasoning
5. Pragmatic communication skills
Treatment Targets for patients with verbal Apraxia
Treatment Targets for patients with verbal Apraxia

1. nonspeech movements
2. misarticulated but correctly imitated speech sounds
3. Sounds that are produced with visible movements of the articulators
4. Singletons and clusters.
5. Most frequently occurring sounds.
6. Stressed Syllables
7. Gesturing and writing
8. Rhythm
9. Normal Prosody
Treatment Targets for Patients with Dysarthria
Treatment Targets for Patients with Dysarthria

1. Appropriate posture and tone and improved strength of muscles
2. Improved respiratory management for speech

Treatment Targets for Patients with Dysarthria con’t

1. Improved phonatory behaviours
2. Improved articulatory behaviours
3. Improved resonance characteristics
4. Improved prosody
5. Nonverbal or augmentative means of communication
Treatment Targets for Patients with Dementia
Treatment Targets for Patients with Dementia

1. Memory Skills
2. Orientation
3. Maintenance of communications skills
Treatment Targets for Family Members and Other Caregivers of Patients with Dementia
1. Understanding Dementia
2. Understanding the particular patient
3. Understanding community resources
4. Structuring the living environment
5. Sustaining the patients personal care habits
6. Exhibiting nonprovoking behaviours
7. Minimizing effects of negative factors
8. Reducing the demands made of the patient
9. Providing respite care
10. Effective ways of communicating with the patient
Treatment Targets for Patients with Traumatic Brain Injury
1. Orientation
2. Attention
3. Use of augmentative and alternative communication devices
4. Memory for daily routines
5. Improved naming skills
6. Comprehension of spoken language
7. Reduction in inappropriate, irrelevant or tangential responses
8. Improved pragmatic language skills
9. Self-monitoring skills
10. Compensatory strategies
11. Compensatory strategies
12. Family support
Treatment Targets for Children with Neuropathologies
Treatment Targets for Children with Neuropathologies

1. Respiratory management for speech
2. Appropriate phonatory behaviours
3. Improved resonance with or without surgical or prosthetic treatment
4. Improved articulation and intelligibility
5. Improved prosody
Treatment Targets for Children with Developmental Apraxia
Treatment Targets for Children with Developmental Apraxia

1. Nonspeech movements of oral structures
2. Imitation of speech sounds
3. Syllables and words in which the articulatory breakdowns occur
4. Reduced rate of speech
Treatment Targets for Persons with Hearing Impairment
1. Oral Language
2. Speech production and improved articulation
3. Improved voice quality
4. Improved prosody
5. Nonoral means of communication
Unadied Systems of Communication for the Nonverbal
1. American Sign Language (ASL)
2. Signed English
3. Signed Exact English
4. Amer-Ind Gestural Code
5. Fingerspelling
Aided Systems of Communication for the Nonverbal
1. Object display
2. Pictures, photographs and line drawings
3. Traditional orhtography
4. Blissymbolics
5. Rebuses
6. Abstract symbol systems
7. Braille and International Morse code
8. Speech generators or synthesizers
9. Neuro-assisted devices

Deck Info