MSHA 2016 Handout Slides

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Changes in Articulation and PerceivedResilience in Children with ChildhoodApraxia of Speech (CAS) Following

Multisensory Intervention

Mississippi Speech-Language-Hearing Association

Annual Continuing Education Conference

Jackson, Mississippi

March 3, 2016

DuBard School for Language Disorders

Maureen K. Martin, Ph.D.,CCC-SLP, CALT, QI

Daphne Cornett, M.S.,CCC-SLP, CALT, QI

Missy Schraeder, M.S.,CCC-SLP, CALT, QI

Susan Perry, M.S.,CCC-SLP, CALT

Department of Child andFamily Studies

Lindsay Wright, Ph.D.

Center for ResearchSupport

J. T. Johnson, Ph.D.

Disclosure Statements

Financial:

Susan Perry – Employed by the DuBardSchool for Language Disorders, TheUniversity of Southern Mississippi

Presentations are included in salaried duties.

Nonfinancial:No relevant nonfinancial relationship exists.

Founded in 1962 by Etoile DuBard

Clinical division of the Department of Speechand Hearing Sciences

Serves as the full-time public school placementfor 80 students with severe speech, oral orwritten language (including dyslexia), and/orhearing disabilities

DuBard School for Language DisordersThe University of Southern Mississippi

Outclient therapy services provided forindividuals with less severe disabilities

Evaluation services

DuBard School is a national training site for theDuBard Association Method®

DuBard School for Language DisordersThe University of Southern Mississippi

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DuBard Association Method®

A phonetic, multisensory structured languageapproach

Systematically organized; Instruction consists ofincremental units of language/speech

Student experiences more success than failure

Martin, M.K. (2012). Oral and written communication disorders. Arlington,TX: The Fowler Group


As skills are mastered at each level,material is organized into larger and,gradually, more complex units related tocommunication until the child no longerexperiences multiple uncertainties aboutlanguage, speech, and reading.

Martin, M.K. (2012). Oral and written communication disorders. Arlington,TX: The Fowler Group

Components of Multisensory Interventionusing the


Visual

Auditory

Tactile

Motor-Kinesthetic

Phonetic

Linguistic

Structured

Systematic

Incremental

Cumulative

DistinctiveFeatures of the

DuBardAssociation

Method®

1. No program to buy or sell; however,professional training is required for maximumsuccess.

2. Use of Northampton symbols, which are highlycorrelated to written English. Northamptonsymbols are organized into primary andsecondary spellings.

Distinctive Features of theDuBard Association Method®

As part of theNorthampton symbolsystem, 1’s and 2’s

are used todifferentiate betweengraphemes that are

written the same waybut are saiddifferently.


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3. Precise articulation is required from thebeginning.

4. Cursive script is used

o More visual differences are present vsmanuscript

o Letters in words are connected so wordsare seen as units

o Easier motorically


5. The use of colordifferentiation.


6. Teaching begins at the level of thephoneme

7. Modification of temporal rate

8. Individual student’s book made as studentprogresses through the method

9. Instruction in phonetic rules is delayed untilupper levels of the method.


The DuBard Association Method® is

appropriate for children who have a

developmental age of 3 years on a

nonverbal cognitive basis.

For an individual to make the most progress,

the intensity of intervention

must correspond to the

severity of the disability.

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• Receptive and/or expressive language disorder

• Auditory processing disorder

• Deaf/hard-of-hearing

• Dyslexia/Specific Learning Disability in Reading

• Adults

• English language learners (ELL)

• General education

• Childhood Apraxia of Speech (CAS)

Who can benefit from theDuBard Association Method®?

• Neurological speech sound disorder

• Precision and consistency of movements underlyingspeech are impaired

• Absence of neuromuscular deficits

• Core impairment in planning and/or programmingmovement sequences

• Results in errors in speech sound production andprosody

Childhood Apraxia of Speech (CAS)

ASHA Position Statement on CAS, Retrieved from www.ASHA.org/policy

Few studies of intervention for CAS

Yoss and Darley (1974) – long period of therapyoften resulted in minimal improvement

Blakely (1983) – estimated therapy would lastfrom three to ten years, depending on severity

Moriarty and Gillon (2006) – slow progressusually associated with CAS


Murray, McCabe, & Ballard, 2014 –Reviewedsingle-case studies (n=23), or case series ordescription studies (n=19)

Found 3 treatments to have enough evidenceto support efficacy: Integral Stimulation/DTTC,ReST, and Integrated PhonologicalAwareness Intervention


Twelve students, ages 3-8 to 10-3, diagnosedwith CAS were enrolled in the DuBard Schoolfor Language Disorders at The University ofSouthern Mississippi.

Most students presented with significantcomorbid conditions.

One student had no comorbid conditions.

CAS and Phonetic, MultisensoryStructured Intervention

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Professional staff consisted of six ASHA-certifiedspeech-language pathologists, one of whom wasalso a master’s level educator of the deaf.

All professional staff met the requirements for beingHighly Qualified for K-4 as outlined by NCLB, 2001.

All staff (including teacher assistants) wereextensively trained in the DuBard AssociationMethod®


DuBard Association Method® wasimplemented daily in the classroom.

This approach included both reading andwriting components simultaneously with thedevelopment of articulation skills.


Articulation, mean length of utterance(MLU), and speech intelligibility weremeasured using the ArizonaArticulation Proficiency Scale – ThirdRevision (AAPS-3)

CAS and Phonetic, MultisensoryStructured Intervention Maximum Total Score = 100

Not simply a count of accurate productions,as 67 sounds are tested

Each sound given a weighted value from0.5 to 7.0 reflecting how frequently it occursin American speech

Sum of all values = 100

AAPS-3 Total Score

Because Total Scores are linked to the actual rateof speech sound occurrence, these scores“express a real sense of how often distortedsounds are likely to occur in the examinee’severyday speech” (Fudala, 2000, p. 13).

Incorrect phoneme with value of 2.0 wouldindicate that 2% of speech would be incorrect.

AAPS-3 Total Score

ə (schwa) = 7.0

ɪ (-i-) = 6.0

t = 4.5

n = 3.5

eɪ (a-e) = 2.0

AAPS-3 Total Score

ð (th) = 2.0

m = 1.5

f- = 1.0

-f = 0.5

ɵ (th) = 0.51

2

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AAPS-3 Total Score

Mean Range

Pre-test 56.38 45.5 - 75.5

Post-test 91.08 73.0 - 100.0

F(1,11)=85.39, p<.001

95.0-100.0: Sound errors are occasionallynoticed in continuous speech

85.0-94.5: Speech is intelligible, althoughnoticeably in error

70.0-84.5: Speech is intelligible with carefullistening

60.0-69.5: Speech intelligibility is difficult

45.5-59.5: Speech usually is unintelligible

0-44.5: Speech is unintelligible

AAPS-3 Speech Intelligibility Values

Used to compare results to others of thesame age (and gender, for young children)

Mean = 100, Standard Deviation = 15

AAPS-3 Standard Score AAPS-3 Standard Score

Mean Range

Pre-test 64.75 <55 - 75

Post-test 85.83 67 - 100

F(1,11)=41.35, p<.001

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Mean Length of Utterance (MLU)

Mean Range

Pre-test 3.8 1.2 – 6.7

Post-test 7.0 2.9 – 10.3

F(1,11)=25.98, p<.001

Pre-Intervention Gain =

Developmental Age

CA


18 months

66 months= 0.273

Gain Made During Therapy orIntervention Efficiency Index (IEI) =

Age equivalency (post) – Age equivalency (pre)

Length of therapy

IEI =24 months - 18 months

19 months= 0.316

Proportional Change Index (PCI)

IEI (Gain made during therapy)

Pre-Intervention Gain

PCI =0.3160.273

= 1.159

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Developmental Age

CA


18 months

49 months= .367

Gain Made During Therapy orIntervention Efficiency Index (IEI) =

Age equivalency (post) – Age equivalency (pre)

Length of therapy

IEI =72 months - 18 months

23 months= 2.347

Proportional Change Index (PCI)

IEI (Gain made during therapy)

Pre-Intervention Gain

PCI =2.347.367

= 6.395

ProportionalChange IndexStudent

1

2

3

4

.

10

.

12

1.159

1.889

2.367

3.106

.

10.648

.

18.000

Ability to adapt to, and overcome, a challengingsituation

Relationship between individual and theenvironment

Changes over time; can vary based on differentstressors during a person’s life

No correlation between resilience and maturationfound in the literature

Resilience

1. Child has to be “doing okay” in terms ofbehavioral expectations

2. Child must have significant exposure to risk oradversity that poses a serious threat topositive outcomes

Resilience – Two Major Judgments

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• Social and academic achievements

• Happiness or life satisfaction

• Normative mental health and conduct

• Overall absence of undesirable behavior

Resilience – Criteria forGood Adaptation

• Positive attachments with caregivers orother adults

• Intellectual skills

• Self-regulation

• Positive perception of self

• Faith, hope, and a sense of meaning

Resilience – Protective Factors

• Supportive and prosocial friends

• Bonds to effective schools and otherprosocial organizations

• Communities with positive services

• Cultures that provide positive standards,rituals, relationships, and supports

Resilience – Protective FactorsResilience Assessment of ExceptionalStudents (RAES) (Perry & Bard, 2001)

• Teacher Rating Form (completed by SLP)

• Parent Rating Form

• Three broad constructs measured:o Exceptionality Problem-Solvingo Social Supporto Resilience Behaviors

Resilience – Data Collection

1. Exceptionality Problem-Solving

• Planning for needs

• Knowledge of exceptionality

• Alternative thinking

Resilience Assessment ofExceptional Students (RAES)

2. Social Support

• Mother/Teacher

• Immediate Family

• Extended Family

• Community/School

Resilience Assessment ofExceptional Students (RAES)

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3. Resilience

• Positive peer relations

• Self-efficacy/Locus of control

• Positive adult relations

• Modeling/Active social skills

Resilience Assessment ofExceptional Students (RAES) Positive Peer Relations

• Starts conversations with peers

• Stands up to bullies

• Shows others how to do things

• Shows leadership with peers

• Able to introduce people to each other

• Attends social events such as parties

• Popular with peers due to friendliness

RAES: Resilience

Self-efficacy/Locus of Control

• Completes homework independently

• Seeks help only when needed

• Shows enthusiasm for learning

• Attributes grades to ability

• Attempts new tasks without feat

• Self-reliant in carrying out tasks

• Self-confident about ability to learn

RAES: Resilience

Positive Adult Relations

• Helps family with daily living tasks

• Volunteers to help parents and teachers

• Follows parents’ and teachers’ rules

• Will attempt work such as runningerrands

• Responsible for personal belongings athome

RAES: Resilience

Modeling/Active Social Skills

• Acts as a model of helpful behavior

• Attempts to compensate for learningproblems

• Tries to stop arguments

• Models or imitates positive behavior of others

• Strives for perfection when completing tasks

• Understands how others feel

RAES: Resilience

Parent Rating Form and Teacher Rating Form

• Parents and SLPs/Teachers rated each child’slevel of success in basic subject areas and/orIndividual Education Plan (IEP) goals.

• Items rated in terms of Frequency and Need toImprove

RAES: Resilience

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RAES: Resilience

Frequency scale:

0 = Never

1 = Sometimes

2 = Often

3 = Very Often

Need to Improve scale:

0 = Strongly Agree

1 = Agree

2 = Disagree

3 = Strongly Disagree

RAES: Resilience - Frequency

Rater Time Interaction

Positive PeerRelations

Parent >SLP

Time 2 >Time 1

NS

Self-Eff./Locusof Control

Parent >SLP

Time 2 >Time 1

NS

Positive AdultRelations

NSTime 2 >Time 1

NS

Modeling/ActiveSocial Skills

Parent >SLP

NS NS

RAES: Resilience – Need to Improve

Rater Time Interaction

Positive PeerRelations

NSTime 2 >Time 1

ParentSLP

Self-Eff./Locusof Control

NS NSParentSLP

Positive AdultRelations

NSTime 2 >Time 1

NS

Modeling/ActiveSocial Skills

NSTime 2 >Time 1

ParentSLP

Articulation and Resilience

Study limitations:

1. Small sample size

2. Heterogeneous sample

3. Lack of a true comparison group

4. More intensive intervention thantypical settings

DuBard School for Language Disorders

The University of Southern Mississippiwww.usm.edu/dubard

MSHA 2016 Handout Slides

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