Therapy

 

 

 

 

 

 

 

 

 

RCSLT guidelines (2007) - updated 2018

The decision about the language/s of therapy must be influenced by the nature of the client's linguistic repertoire, which may be monolingual other than English, bilingual or have the sociolinguistic expectation of being bilingual. Therefore, it is strongly recommended that SLTs try to offer therapy and intervention in the languages used by the client in her/ his daily repertoire, particularly the client's home language. 

Where possible use bilingual co-workers (https://www.rcslt.org/members/welcome/support_worker_faq). In many settings and situations this is not possible.

When this is not achievable, here are some ideas and suggestions:

  • Therapy is often provided in English in the UK but the SLT can support and encourage the family they are working with to continue to communicate in their home language/s by including discussions about the home language/s from the very beginning, e.g. at the time of assessment. Show that you value and respect the home language and you are interested in it. Talk to parents openly about generalising strategies and advice you have provided in English to other languages used at home (where appropriate).

  • By completing a language map with the family/client you work with will assist you in clearly understanding the role of and interaction between all languages used at home and allow you to talk to parents/carers about appropriately embedding some of the SLT targets into the home environment to improve overall communication in all languages.

  • It is not uncommon that children resist speaking their native language in settings where the dominant language is English. You can help by creating an environment where the home language is encouraged and respected. Truly encouraging a child/student to use and communicate in their home language and praise the student for his/her bilingual skills.

  • Think practically about the activities you provide. Some activities and strategies you carry out in English will be more natural for the parent to do at home in their home langauge, e.g. PCI, vocab therapy, phonologial awareness etc.

Speech sound therapy

For summaries of the research for use of specific therapy approaches for children with more than one sound system. All research taken from ‘Interventions for Speech Sound Disorders in Children.’ A. Williams, S. McLeod, R. McCauley (2011). See the reference list for full articles and details about research findings discussed.

Please see the summaries below of the research for use of specific therapy approaches for children with more than one sound system. All research taken from ‘Interventions for Speech Sound Disorders in Children.’ A. Williams, S. McLeod, R. McCauley (2011). See the reference list for full details.

 

 

Minimal Pair Intervention

 

Reported to be used in: American, British, Canadian English, Finnish, German, Greek, Israeli Hebrew, Japanese, Korean, Maltese and Turkish. Research also reports success using the approach for speakers who use a language in addition to English, e.g. Ray 2002 with English, Hindi and Gujerati. Improvements were noted in the target language (English) and other 2 languages not targeted. Research by Holm & Dodd, 2001 found only effects on target English and not on Cantonese. Conflicting results mean that there is no conclusive evidence at this time that working in one language will generalize  to other language/s. It is therefore possible that there are 2/3 separate phonological systems that will both require targeting separately.

 

 

Multiple Oppositions Intervention

This has been used with American English speaking children mostly. Also with Brazilian Portuguese speaking children. The nature of the therapy means that the constructive contrasts could be developed for any language. No research about generalisation from one language to the next.

Complexity Approach (Maximal opposition and empty set)

The maximal opposition approach has been used internationally in: American, British, Australian English and Brazilian Portuguese. Intervention targeting complex clusters for the purpose of facilitating wide spread phonological change has been used with; American & Australian English and Spanish. There are theoretically no limits to the languages this approach can be applied to, if you speak the language fluently that is!  No research about generalisation from one language to the next.

Core Vocab

 

This approach is suitable for children from all backgrounds. Words are chosen by the family so could easily be selected in their home language. There is some evidence to show that working in one of the child’s language could generalize to the other language/s (Holm & Dodd, 1999). The Child is the mentioned study was treated in English and consistency of productions increased in both English and Punjabi.

 

 

The Cycles Approach

 

The 7 underlying concepts that serve the foundation of the cycles approach are highly universal.  More research is needed to determine appropriate targets for approach in other languages based on when sounds and rules develop. An assessment of Phonological patterns in Spanish is underway (Hodson & Prezas, 2009).  More data is needed to determine the efficacy of a cyclical intervention model for bilingual children.

 

 

The Nuffield Centre Dyspraxia Programme

 

This is a language specific tool that cannot be translated into another language. Careful adaptations need to be made to reflect phoneme inventories and phonotactic structures of a specific language. Such adaptations have been carried out in Dutch, Swedish and work in progress in Danish and Greek.

Psycholinguistic Intervention

 

The framework can be used to work with children with Speech Sound Disorder who speak more than one language.  There is a specific level in the speech processing profile that looks at whether the child has language specific representations of word structures (see Stackhouse and Wells, 1993. Psycholinguistic assessment of speech sound disorders book). The framework has been translated and adapted for use in different language and cultures; German, Danish, French and Portuguese. The framework has also been used in South Africa to understand the speech and literacy difficulties of multilingual school age children and for training teachers and assistants to promote word learning in English speaking children with delayed SLT. 

Presenters of the assessment and intervention tasks need to be aware of how variation of in accents between themselves and their client can affect not only a child’s interpretation of the task but also how performance on the task is scored. 

 

 

Metaphonological Intervention

 

Phonological Awareness (PA) is not language specific. There is evidence of transferability of PS skills across languages. PA tested in child’s first language predicts literacy achievement in first and second language (Lafrance & Gottardo, 2005). The sequence of development of PA from smaller to larger units is common across languages however detailed patterns of development are not due to variety in phoneme boundaries, stress versus syllable timings etc. Learning to read is also influenced by language’s orthography and correspondence between phonemes and letters.  PA is a universal skill therefore an increased awareness of the individual phonemes of a word should generalise bidirectional among language in multilingual children.

 

 

Speech Perception Intervention

 

Administered through SAILS computer program with SLT feedback. This is currently only available in Canadian English. This would not be appropriate to use in other dialects or languages unless you develop stimuli appropriate to this different dialect or language.

 

Non- Linear Phonological Intervention

 

It is first necessary to determine the phonological aspects of the language through literature searches and work with native therapists. See book for more details about what would need to be collected.  There are currently word lists available in German, Kuwaiti Arabic, Iclandic Slovene and Spanish and Mandarin.  The computer program (CAPES) used for analysis is able to analyse data in any language through it’s connected speech module.  Much knowledge and thought is required to use this approach to match with cultural expectations.

 

 

Dynamic Systems and Whole Language Intervention

 

The processors in the model of language use and development that underlie this intervention are meant to represent general processes that would be active in the language learning of all children. The details of the pattern developed within and across processors would depend on the structure of the language inputs that the child’s system receives. Therapy would need to be delivered in the language the child learns. There is currently no research to support this apart from in English speaking countries. Considerations regarding adult-child interactions patterns, socioeconomic factors, cultural background and the use of Western storybooks of the family you work with need to be taken into account.

Naturalistic Intervention for Speech Intelligibility and Speech Accuracy

This intervention has been developed in light of typical interactions between parents and children across cultures. Other than considering the appropriate speech targets for the given language this approach can readily be applied to different cultures and linguistically diverse individuals. Rhymes, books, stories, play objects, photos etc. from the home or school environment are utilised in therapy which makes the therapy very flexible and individual to the child and family.

 

Morphosyntax Intervention

 

The majority of morphosyntax –based studies reflects Standard American English Speakers. The interaction between speech and morphosyntax varies cross-linguistically, making goal selection a challenge unless you speak the child’s home language fluently!

 

Parents and Children Together (PACT)

 

This has been effective in English learning children from various cultural backgrounds including: Chinese, Fijian, Indonesian, Japanese, Korean, Lebanese, Sri Lankan, Tongan and Thai. The slideshows and books have been used in many languages and information about this is available on Caroline Bowen’s website. The form of PACT has varied depending on the learning or teaching style of the parent, e.g. didactic or directive.

 

 

PROMPT

 

Fundamental principles underlying PROMPT mean that it is inherently flexible and easily adaptable across speech and language systems internationally. The manual has been translated into: German, French, Dutch, Spanish, Cantonese and English. PROMPT can be used by clinicians working with children who speak other languages, who have a speech sound disorder, as well as with bilingual children who have either a speech disorder or difficulty with sounds present in their new, not but not first language. Therapist has to receive PROMPT training before they are able to deliver this programme in any language.

 

 

Family - Friendly Intervention

 

This approach focuses on adapting intervention for individual families, it is therefore well suited to use with children and families from different cultural and cultural backgrounds.

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