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- 1700 Lomas Suite 1300
- The University of New Mexico Speech, Language, and Hearing Center
Assessment drives the treatment plan, as always. Targets should fall within the range of stimulability. It is important to get a list of functional words and potential words with high impact at home and possibly school to create "word shells," which are targets that approximate important, functional words. For example, brother might become "bubu" if in the child's zone of proximal development. I typically use tactile cues, as long a the child will allow it. The prompt for jaw opening has been particularly helpful. I very seldom teach a sound in isolation. Rather, I like to use the Kaufman cards or similar incremental stimuli to practice sequencing patterns (Example, open-close-open OR Front, back, front).
If the child has sensory defensiveness, I make sure I provide clear visual cues, with tactile cues on myself. Sometimes the child will imitate the tactile cues on themselves. A key strategy is to make sure the child is paying full attention with reinforcement in between speech attempts. I also explain that AAC can be a key part of the child's overall communication repertoire as verbal speech develops. I try to pack in as many opportunities to practice the speech target (a good goal is 60 opportunities within a 30 minute session) As the child progresses in speech therapy, I try to reduce my feedback regarding speech accuracy and, if the child is old enough and cognitively able to do so, ask the child to self-assess. As the child progresses, I increase the complexity of the target movement in terms of length of target (e.g., with a carrier phrase).
I volunteered to host a PROMPT workshop here at the University of New Mexico Clinic and marketed the training (and participated in it). More broadly, I am a board member of our state professional organization NMSHA. I provide direct treatment to clients, adults and children, and also supervise graduate students in our clinic, as they deliver services.
Parents are encouraged to participate directly in treatment, especially if the child is preschool age. I encourage parents to reward these word approximations and not require 100% correct articulation in order get the desired item requested by the child. PROMPT allows parents to use parameter prompts if appropriate and in line with family goals
Our clinic has many low and high tech AAC options to trial with families. I am familiar with many ASL early vocabulary signs/bab sign and sometimes incorporate signs into the communication repertoire. An interview-based needs assessment is conducted to help determine which system/s is the best fit. I introduce AAC in a fun way by modeling and using a most to least hierarchy at first until the child understand the purpose and process of the target AAC. It is key to make accessible vocabulary functional and personally relevant to help with contexts of communication break down at home or at school. One of my former clients, for example, was not sharing a circle time in preschool, although she is an outgoing girl in general. Her mother and I programmed her speech-generating app on the tablet to allow her to share emotions and highs/lows with a frequency phrases. I was not able to go to the school in this case but did talk with her teachers and send a graduate student under my supervision to demonstrate and explain the use of AAC.
A good way to marry AAC development and speech therapy is to have the child request reinforcers and activities that go along with the motor speech therapy.