It is the second Tuesday of the month, which means it’s time for Research Tuesday. As always the interpretation of the research is mine and side comments are placed in [brackets].
Today’s post is brought to you by the letter I… errr…. the Language, Speech, and Hearing Services in Schools journal.
Title: Treating Children Ages 3-6 Who Have Speech Sound Disorder: A Survey
Authors: Brumbaugh, K. and Smit, A. B., (2013)
Background: Do we treat articulation disorders and sound-system disorders (aka phonological disorders) with the same interventions? They are different disorders, and according to many, it is possible to have both disorders occur concomitantly. Preschool children who have SSD make up approximately 75% of the population receiving speech services in preschools. Effective therapy is critical to making sure to have the highest impact possible for these students. The authors state there has been no comparable research discussing the types of interventions that SLPs routinely use with Speech Sound Disorders (SSD).
Purpose: The purpose of the research was to determine which treatment and service delivery methods were used with children between the ages of 3 – 6 years of age and exhibiting a speech-sound disorder.
Questions: The survey had several questions. The service delivery questions included: 1) where services took place, 2) time/length and frequency of sessions, and 3) group/individual sessions. The Interventions questions included: 1) Frequency of use of named interventions (the survey included many options including: traditional, cycles, whole language, minimal pairs, PROMPT, NSOME, and Phonological Awareness to name a few) , 2) Elicitation Techniques (traditional, phonological, NSOME), and 3) Models, Inputs, and Contingencies.
What they Did: The Authors sent a survey out to 2,084 SLPs working in preschools across the United States. Approximately 18% of those surveyed completed the entire survey and an additional 6% completed a portion of the survey. [Not great numbers there…I wonder why so few SLPs completed the survey…I’d offer to poll SLPs about how they complete surveys, but I doubt I’d get much response.] The survey asked about service delivery and interventions.
Results: The first question was the service delivery question. There were 464 respondents and 52% responded that half or more of their caseload included children aged 3-6. The locations of services varied: 67% preschool, 48% early childhood center, 35% walk in or bus, 31% home, 21% kindergarten classroom, 11% private practice, and 2% university clinic. Scheduling was the second question. Of the 389 SLPs who saw preschoolers in individual session, the most common time was 30 minute session twice weekly. Only 28% indicated one-30 minute or two 15-minute sessions, and 30% responded to “other.” Of the SLPs responding, 382 reported individual sessions only, 352 reported a mix of individual/group sessions and 190 reported group sessions only.
The second section of the survey included the intervention questions. Of those responding 49% reported using Traditional artic therapy the majority of the time (70-100% of the time), 36% reported using Phonological Awareness techniques, 33% reported using Minimal Pairs, and 32% reported using Cycles. NSOME were used by 14% of SLPs followed closely by PROMPT with 12%.
[Note: There are many tables in the article – and each one is really interesting to read. In the interest of brevity here (and because I am not re-writing the entire article for your reading) I am not going to report on all the questions…Go read the article! It’s worth it…really!]
Real Results – AKA – Summary: Preschool children typically received 30-60 minutes of therapy a week. Traditional intervention was most frequently used. Approximately 33% of the SLPs reported using minimal pairs and cycles approaches most often. Behavioral techniques were used by half or more of the SLPs. The majority of people were familiar with NSOME and 30% of SLPs reported never using them [oh oh…that means 70% DID use them for speech purposes. That’s better than Lof’s survey showing 85+%!].
Real Life Applications: The article has good discussions. 1) if the majority of preschool kids receive 30-60 minutes/week regardless of individual or group sessions and treatment areas – can we truly say service is based on individual need? 2) There’s little research to show the efficacy of group vs individual sessions for children with SSD. There has been research to show effectiveness in school-aged children with language disorders (no difference between group/individual) but no research for preschoolers and SSD. 3) The authors stated: “Based on the data from this survey, it is possible that SLPs who treated preschoolers were using hybrid interventions…” [Uhm…I could have told them that.]
Thoughts: The survey was interesting. One of the things that really came to mind is that regardless of when we graduated or how experienced we are, we all need to keep learning. There have been many new techniques that have come out recently (and I’m sure there will be more). To keep up-to-date in the field, we need to keep expanding our horizons and keep seeking new information.
As I said earlier, the research was interesting. It made me think about my own clinical practices and what I’ve seen or done.
What are your thoughts? Do you do a set 30/2xweek for preschool kids or do you tailor it? Do you do cycles? PROMPT? Let me know…
Until then…Adventure on!
Mary
Speech Adventures 
For a true speech sound disorder, I’d do a hybrid approach of traditional, minimal pairs (more likely if error is “big” like a /t/ for /k/), possibly some phonemic awareness or PROMPT /visual cue system. I only do cycles for phonological disorders. I most often see kids 2x/week for 30 min. Frequency and length of time can be difficult to modify in my setting. Would I like to see some kids every day for 10-15 min? Probably. But the reality is the disruption to the classroom, inefficinecy of my time/set up, not to mention the billing difficulty it would cause keeps me in a traditional model most often. And since most of my kids make rapid gains with it, the motivation to change is low. Of course, it helps greatly that most of my parents and teachers are willing to help on a daily basis. Thanks for bringing this to my attention, Mary!
Thanks for the comment. What is your definition of speech-sound disorder? Like you, I typically see my “typical” pre-school kids two sessions for about 30 minutes each simply because it’s easier scheduling and parents bring them in…I have had some that I see just once a week and a couple I’ve seen more often that are profoundly impacted and their parents were willing to bring them in…But typically when they’re that bad, they qualify for ECSE preschool and are bused out of district (we don’t have an ECSE preschool here in town). The article definitely made me think about WHY I schedule the amount of time I do (60 minutes is too long for littles to sit, time constraints for parents, etc.). I’d like to think that I am individualizing (I KNOW the goals are) but now I find myself questioning that.
What I meant was a true articulation disorder as opposed to phonological processing issues 🙂
LOL! That makes sense. I treat pure artic different than phono as well.
Pingback: Research Tuesday Roundup - June 2014 - Gray Matter Therapy
Curious if you have ever used the Speak for Yourself App with a preschooler who is exhibiting strong evidence of Childhood Apraxia of Speech and what you would do if a parent entered your care already using this app with her 3 year old.
I’m not familiar with that app.
As far as what I’d do? It would depend on the success the child is having with it. I find that so many parents (and a few SLPs) pick an app and that’s what the kid is stuck with until something else comes along without taking the time to truly see what works best for the child. If the child is able to use the app well and is having success, I’d be willing to work with it to figure out if it’s right for that child or until we find something that will work better.
Personally I think that we have a tendency to jump to high-tech AAC when often a low-tech AAC is the better choice until the child is just a tad older…or at the very least, capable of using a high-tech device that will grow with the child.