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.