case study presentation -...
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Case Study PresentationMegan Brey, Anna Fishlove, Maren Johnson, and Kelsie Quinn
Case Overview: Jaedyn
• Four-year-old male
• Third child in the family
• Preschool teacher noted that his speech seemed immature
• SLP recommended “language-focused” preschool
Impacts of Communication Delay
● He is difficult to understand
● He is frustrated with not being understood by his peers and teachers
● His frustration has resulted in aggressive behavior towards peers
Why should we care about impacts to the child in his/her environment?
● IDEA disability definition
● A speech or language delay must adversely affect a child’s educational performance
● Impacts eligibility for services
Characteristics of his speech/languageExamples:
● Syntax and morphology
“Me a big boy,” “I want two cracker(_)”
● Phonological processes
“mato” for “tomato” and “buh” for bug (i.
e., stressed syllable deletion, final
consonant deletion)
● Semantics
“spiky” for “pineapple”
● Pragmatics
communication breakdowns lead to
aggressive behavior in place of words
Jaedyn exhibits errors in:
Language Modalities
● Expressive Language
Language Domains
● Form: phonology, syntax, morphology
● Content: semantics (lexical knowledge)
● Use: pragmatics
Assessment Assessment Measure (standardized/norm-referenced)
Language Domain/Modality Results
TOLD-P:4(Test of Language Development-Primary: 4th Edition)
Form● Grammar Composite● Organizing Composite
Content● Semantics Composite● Speaking Composite
Modalities Receptive Language
● Listening Composite Expressive Language
● Spoken Language
*below average*below average
average*below average
average
*below average
*Index Score=80-89 is -1.00 SD
Paul & Norbury, 2012
AssessmentAssessment Measure (criterion-referenced)
Language Domain/Modalities
Results
Speech Sample Analysis(SALT)+/- 6 mo
FormSyntax/Morphology MLU in Words -2.72 SD
MLU in morphemes -2.74 SD
ContentSemantics No. Diff Word roots -3.16 SD
Type Token Ratio -1.60 SD
UseDiscourse Mean Turn Length -2.09 SD
AssessmentAssessment Measure (criterion-referenced)
Language Domain/Modalities
Results
Language-Sample Analysis Form: syntax limited use of verb phrase elaboration, use of negative and question forms, and advanced sentence structures
Phonetic Inventory/Phonological Analysis
Form: phonology -delayed speech sound development-Middle 8 speech-sound group not present (typical for 4-year-old)
“Peanut butter protocol” Use: pragmatics adequate for expressing communicative intentions and social engagement
Hallmarks of Specific Language Impairment (SLI)National Institutes of Deafness and other Communication Disorders (NIDCD)
● Late talkers without a hearing loss or other developmental delay
● Difficult to understand
● Struggles to learn new words
● Difficulty with discourse skills
● Difficulty using verbs
● Dropping tense markers○ “s” from end of present-tense
verbs“she ride_”
○ dropping past-tense markers“he ate(eat) the cookie”
○ asking questions without verbs “to be” or “do”“why _ he like me?”
Final Diagnosis: SLI
Jaedyn’s communication profile:
• TOLD-P:4 shows below average expressive language composite• SALT analysis shows significant differences (i.e., greater than -2.00 SD below the mean)
• syntax• morphology• semantics• discourse
• Based on the assessment results, Jaedyn could benefit from speech-language interventions• Jaedyn is in a “high risk” category for literacy delays
Other Considerations:
• Children with SLI are four times more likely to have reading difficulties compared with their typically developing peers
Group Activity From the results of the assessment and the information from the parents and his teacher, what are two areas that you might target?
Determining Intervention Objectives
• Phonological Awareness• Overall self-confidence/ behavior• Spoken vocabulary • Increasing length and complexity of
utterances
Choosing an Intervention Approach and Targets
Efficacy- Building vocabulary knowledge and phonological awareness skills in children with specific language impairment through hybrid language intervention: a feasibility study
● Munro, Natalie, Lee, Kerrie, and Baker, Elise, 2008. ● Hybrid approach to specific language intervention approach● Targets:
○ Vocabulary knowledge○ Phonological awareness
● Using:○ Oral narratives○ Storybook reading○ Drill-based games
Efficacy-Ten Principles of Grammar Facilitation for Children with Specific Language Impairments
● Fey, Marc, Long, Steven, and Finestack, Lizbeth, 2003. ● Principle 7-manipulate the discourse so that targeted features are
rendered more salient in pragmatically felicitous contexts. ○ Parents can stress targets by making them longer and louder
and producing them with more dynamic pitch changes. ● Principle 8-Systematically contrast forms used by the child with
more mature forms from the adult grammar, using sentence recasts.
Efficacy - Language Impairment- Shared Reading, and Phonological Awareness: A Feasibility Study
● Justice, Kaderavek, Bowles, Grimm, 2005● Parent-directed training in book reading and implementation of
intervention by having parents ask questions to their children to promote more awareness of rhyme and alliteration.
● Correlation to our intervention plan: ○ Parent training in joint book reading to raise phonological awareness○ Parent satisfaction from involvement in therapy.
Efficacy - Effective Interventions for Specific Language Impairment
● Elin Thordardottir, 2007● Hybrid approach integrates aspects from the entire continuum of
naturalness in order to create an approach that is more salient than one of the approaches on their own.
● Some methods focus on the explicit teaching of rule-based aspects of language whereas other methods emphasize the meaning of language without an explicit focus on formal aspects, under the assumption that the underlying rules will emerge with meaningful use.
● There is little clear-cut evidence that one method is better than the other; however, several studies concluded that interventions that emphasize learning in meaningful contexts do result in better generalization.
Efficacy- A Phonologically Based Intervention for School-Age Children With Language Impairment: Implications for Reading Achievement
● Ritter, Micheala, Park, Jungjun, Saxon, Terrill, and Colson, Karen. 2013● Used storybook intervention to increase child’s interest and engagement in therapy and to
create a link between print and spoken language and foster child’s alphabetic knowledge.● Intervention focused on four areas:
○ syllable tasks- example-child segments syllables in words verbally pronounced by SLP, working from compound words to multisyllabic.
○ phoneme tasks- example- child blends individual phonemes pronounced by SLP 1-s intervals to form target word/nonword, child asked to count number of phonemes and verbalize individual sounds.
○ scaffolding-examples- slow speech rate, visual prompts, manipulatives, stressing individual sounds, and repetition of stimuli.
Efficacy-Outcomes of an Emergent Literacy Intervention From Head Start Through Second Grade
● Whitehurst, Grover, Zevenbergen, Andrea, Schultz, Margaret, Velting, Olivia, Fischel, Janet. 1999.
● Parent and teacher training program used (20 min. video) on dialogic reading
● Dialogic reading- reading program implemented with teachers and parents where they ask questions about the story. ○ Different levels of questions are given for different aged children.
● Sound Foundations- phonemic awareness tasks in classroom, teacher will introduce seven consonant sounds corresponding to (s, m, p, g, l, t and sh) in different word positions.
Overview of Intervention ApproachApproach: hybrid intervention with emphasis on oral narrative, storybook reading, and drill-based
games -Meaning-based approach
Method: clinician-delivered and parent/teacher-implemented intervention
Outcome/Target: increase Jaedyn’s...• overall self-confidence • phonological awareness • spoken vocabulary• oral narrative ability
Setting: preschool, home and clinic
Implementation: As an SLP...
One-hour intervention sessions on a weekly basis
• Final 10 minutes for discussion of home follow-up activities with parents
Session Outline
1. Scripted Oral-Narrative / Storybook Reading 2. Drill-Based Games 3. Parent discussion of home activities
Rhyme
Words into syllables
Alliteration
Onset-rime
segment.
Segment initial & final
sounds
Blends sounds
into words
Segment words into
sounds
Delete, manipulate phonemesMore Complexity
Less Complexity
Phonological Awareness
Phonemic Awareness
Paul, 2012
Scripted Oral-Narrative / Storybook Reading
• Using a picture-based storybook • Mainly pictures with very limited written text
• Offer multiple discussion points for: • Phonological awareness features such as rhyme and alliteration
• E.g., ‘Sheep and shrug both start with the sound /sh/.’• E.g., ‘Leap and jeep, these words rhyme. They both end in -eep.”
• Semantic features • Semantic Elaborations
• E.g., ‘Shove means that the sheep were pushing the the jeep.’• Semantic Networks
• E.g., including lexical items such as ‘dog’, ‘paws’ and ‘dig’ being located within the same utterance
• Grammar
Drill-Based Games
• Card or board game • Odd-one out format
• Assists child to identify words or parts of words that vary • Snap format
• Matching game• External reinforcement board games (e.g., Don’t Break the Ice)
• Features some of the same lexical items from within the scripted oral narrative
Implementation: As a parent and/or teacher
• “Story-Pack”• Contains therapy materials including...
• A simple story book featuring the same PA target(s) and game ideas for follow-up home activities
• Explicit written instructions in a handout
Group Activity
Final Thoughts / Wrap-Up
• Questions?• Comments?