New Client, Mr. "J"

Blog #2

Background:

Mid-semester I was assigned a 5 year old boy, (J), who was initially referred by his school to the WVU Speech and Hearing Center for a diagnostic evaluation. After the diagnostic was administered, speech therapy was recommended to work on articulation and to evaluate language.
During the first few sessions with J, I administered the Goldman Fristoe Test of Articulation, Khan-Lewis Phonological Analysis, and the Preschool Language Scale 4. Test results revealed J’s language to be within normal limits. However, his articulation score put him in the moderate to severe category making his speech unintelligible to an unfamiliar listener. At first, I did have trouble understanding what J was telling me. Now I can understand what J says most of the time.

Technique:

I have been using the phonetic approach with J and we practice, practice, and practice! The main thing I use in therapy is articulation cards. (stimulus) However, since J is only 5 cards get boring real fast. Therefore, I plan camping trips, scavenger hunts, and variety of games using these articulation cards to make therapy more enjoyable.
Also, I always make sure to give a lot of reinforcement (knowledge of response). For example, whenever J can put an ending on a word I say enthusiastically “good job” or when he does not get something quite right I might say “Good try, remember to close to word.”
J has made quite a bit of progress in a short amount of time. Now whenever you remind him to put endings on words he usually gets it for that sessions. J still displays problems with transferring to spontaneous speech.

Goals:

The main goal for therapy has been working on final consonant deletion. Starting out, I tested auditory discrimination and he displayed 90% accuracy in three consecutive sessions which allowed us to move forward to another goal. Recently, initial consonant deletion was added.

Clinicial Expertise:

Since I am still new at being a clinician, my supervisor, Mrs. Graebe directed me as to where to begin. Mrs. Graebe has given me a lot of ideas and I have taken those ideas and have tried different things with each session. J also likes to spontaneity.

Patient Values:

J’s mother has been very supportive. While, J and I go on our scavenger hunt in the hallway, J’s mother comes along as well to see what we are doing. She also participates. For example, J finds the card “soap” and he doesn’t close the word she says “J close it”. She sometimes appears frustrated whenever J was not closing to word with the right sound, so I had to reassure her he was doing a great job and right now we just want him to add any type of closing to words.

Effectiveness:

I feel this technique has been effective. Data collected in therapy supports J is definitely improving.

Supporting Evidence / Reference:

Williams,A.L. (2003). Speech disorders resource guide for preschool children. Singular Resource Guide Series. Thomson: Delmar Learning.

I was very excited when I found this article. It supported what I have been doing with J. The techniques talked about in this article were the same strategies in which I have been doing with J. Listed below are the strategies in which I am talking about.
1. Treatment occurs 2x/week.
2. Analyze child’s errors
3. Select Treatment Targets
4. Begin with imitation until 90% accuracy is reached in three consecutive therapy sessions
5. Progress to spontaneous speech