Can you suggest criteria or guidelines for a speech-language pathologist in deciding amount and type of articulation services for an 11 year old, with a cochlear implant and with a cognitive disability (FS IQ 67)? He can produce all the phonemes in isolation but has many errors, deletions, and substitutions in connected speech. This student’s many needs all require large amounts of time and repetition (sometimes years) in order to develop, though we do see progress. In part the slow progress is because the student is complex (history, etiology, needs). In addition however, the student’s services and placement are not adequate to meet his complex needs; we work with it as best we can. The good news: I hope he will receive an evaluation at the Clarke School this spring. Meanwhile another year is ticking away.
My suggestion to the SLP was to embed articulation work within the pragmatic, social communication we will be focusing on this year. Suggestions or examples of what this more specifically might look like would be welcome since she is not trained in working with deaf and hard-of-hearing children.
In looking at your description of this child, his cognitive skills, age and current articulation skills, my first inclination is to ask whether a phonological analysis has been done on his speech production patterns? I ask this because you say that he can produce all phonemes in isolation, (this is great!!!), yet he has errors in connected speech. A phonological disorder is characterized by difficulty acquiring the rules that underlie the sound system. A child with a hearing loss and cognitive issues would be at risk for this. For example he may be producing phonological processes that are characteristic of a younger child, such as deleting final consonants (“home” is pronounced “ho”) or fronting velar sounds (“Kiss” is pronounced Tiss), or he could be displaying the process of stopping (substituting a stop sound for a fricative or affricate sound, so “Funny” is pronounced “Punny”). There are several tests that can assess whether the child is producing phonological processes – you might want to look into having an assessment done.
• Bankson-Bernthal Test of Phonology
• Clinical Assessment of Articulation and Phonology (CAPP)
• Computerized Articulation and PhonoEval System
• Hodson Assessment of Phono Patterns (Happ-3)
• Kahn-Lewis Phonological Analysis (KLPA-2)
• Phonological Process Analysis
• Smit-Hand Articulation and Phono Eval (1997)!
• Structured Photographic Articulation Test
The other issue I wonder about given your description is whether he has apraxia, a motor programming issue, and a good test that checks for apraxia is called the Kaufman Speech Praxis test. The website provides other tests http://www.apraxia-kids.org/site/apps/nl/content3.asp?c=chKMI0PIIsE&b=788447&ct=464141
I see that he has an evaluation coming up at Clarke and that will be great, but in the meantime, it would be valuable to know whether he has characteristics of either apraxia or a phonological disorder. I say that because these types of disorders do not respond well to traditional therapy methods, and for these he will need direct targeting. It would be important to begin adapting his therapy plan accordingly. The “Cycles” method can be very effective in treating either issue and even for children with hearing loss. A typical session in the “Cycles” method goes like this:
• Review past session
• Auditory bombardment
• Target word cards (adapt with photos, or photos with words printed under them and take vocabulary from his units in school )
• Production Practice with different activities every 5-7 minutes
• Stimulability probes
• Auditory bombardment
• Home Program
Best of luck!