Wrapping up Spring '08

My client D is a 6 year old boy diagnosed with autism since age 2. This is D’s first time at the WVU clinic. He has been receiving speech therapy at elementary school since age 5, and his parent’s felt that he needed the extra one on one time at our clinic in order to further his communication progress. I have only seen D for four sessions this semester due to illness and family traveling, but I feel as though I have already learned a lot from him.

D is a very passive and friendly child. He has no speech other than random noises and babbling. On occasion he produces a single word but completely out of context. At this point, the main goal is to enable D to communicate his basic wants and needs with those around him.

In order to elicit communication, I have been using the Picture Exchange Communication System with him. D had previously been working with PECS some at school, so he already had some experience with it and the supplies needed. He has his own book of velcro pictures from which he chooses a picture and hands it to me indicating what he wants. I then give D the item he requested (such as bubbles, rings, blocks, food, drink, etc), and he is allotted time to play with and enjoy the item. I also say the name of the item as I hand it to D and help him learn to play with and use the item correctly. D is currently in the beginning stages of the program in which few item choices are placed on a page at a single time. The main focus is on being sure that D can distinguish between the pictures to indicate his wants/needs. That is accomplished by using a more aversive item with a desired item so that D can learn what picture he needs to choose in order to get what he wants.

My supervisor recommended that I use PECS. She specializes in working with children with autism, and in addition to offering a great deal of knowledge of the program, she has found it to be very effective for other children in the past.

A study by Charlop-Christy et al. (2002) examined the acquisition and communication effects of PECS on 3 children with autism. The results of the study showed increases in verbal speech for all 3 children and overall improved communication over time.

In addition to using the PECS, I have addressed play goals with D. We sing songs and I attempt to get him to enjoy structured play with various toys.

In the short amount of time I have been with D, I feel as though he has made some progress. He already seems to be improving on discriminating between the different items. I think the one on one undistracted time in clinic is just what he needed. He has shown good potential for future sessions and will be a joy for any clinician to work with.

Reference:

Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with children with autism: assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis. 35 (3), 213-231.

A new semester, A new client

My client , N, is a 7 year old boy with an articulation disorder. He has been in therapy since 2004. He has worked on numerous sounds throughout his time at the clinic. His past sessions with other clinicians included the mastery of sounds such as /k, g, n, l, s, t, f, th/. More recent therapy left off with the sounds /sh, ch, j/. Beginning this semester with N, it was recommended to continue work on the /ch, sh, j/ sounds until mastery, and then to begin the /r/ sound.

We began therapy working with a traditional phonetic approach. N was able to quickly progress through the /ch, sh, j/ sounds from sentences to reading to conversation. N does well with the target sounds, but occasionally still makes mistakes in casual conversation when he is not self monitoring; therefore, we are still addressing the sounds during the sessions in hopes to achieve transfer/carry-over of training. An article by Mowrer (1971), supports the way that I have been conducting therapy to lead toward positive transfer of sounds. For example, I have been using both pictures and written words to support stimulus similarity. I also read that it is important to use a large amount of training which I have done by getting a large number of responses from N each session. Finally, as recommended in the article, I have been using reinforcement variability and mild punishment (Mowrer, 1971). For example, in the beginning, I provided immediate verbal feedback for correct or incorrect sounds, and then I gradually cued N less and less. I now use a marker board to mark N’s correctly or incorrectly articulated responses under a smiling or frowning face. This helps N because he can participate in natural conversation without interruption and can still be made aware when he has made an occasional sound mistake and should self correct.

In addition to conversation with the /sh, ch, j/, I have began working with N on the vocalic /er/ sound in isolation.

It should be noted that throughout the sessions, I also provide reinforcers for N such as short games after working on a sound for a given amount of time. I also give N a small treat at the end of the session.

I feel that my supervisor has provided good expertise because she has supervised N for several years and feels that this method of therapy has worked well for him thus far. I feel that she has also offered good suggestions in promoting carryover; for example, she suggested the nonverbal reinforcement through the marker board.

N and his family have proven to be very dedicated to improving N’s articulation based on their attendance the past several years. N himself shows concern when he is not making the sounds correctly and has verbally expressed interest in improving his speech. N improves day to day in therapy, and I feel that he is progressing at a good level, based his current and past achievements.

Reference:
Mowrer, D. E. (1971). Transfer of training in articulation therapy. Journal of Speech, Language, and Hearing Association, 36, 427-446.