If our clients were typically developing, they wouldn’t need therapy. So, why should therapy follow a ‘typical’ developmental progression?
Consider Letting “Learnable” Guide Your Treatment Target Selection
Imagine the following: You get a referral on a 3 year old with concerns about speech intelligibility. You evaluated the client. You identified the characteristics of the speech sound disorder and determined the severity level. The client presents with a severe-profound phonological disorder characterized by a very limited phonetic inventory resulting in a lot of sound omissions and substitutions. The good news is the client’s errors are extremely consistent and predictable.
Now, you need to develop the plan of care and/or long- and short-term goals. What’s an SLP to do?
Do you remember the Choose Your Own Adventure Series? (BTW, it’s back in print and available on Amazon)
Let’s choose our phonology adventure. You could take the ‘traditional’ developmental route. That is, start with sounds the child is stimulable for, teaching the (supposedly) earliest acquired sounds first, use a cycles approach, etc. But, you know what will happen if you choose this route. Progress will be slow and word by word and generalization will be even slower. That’s because this adventure is like the shallow end of the kiddie pool. It will let you get your feet wet, but you won’t learn to swim. This approach’s ‘learnable‘ factor is near zero.
What if you chose a different phonology adventure? What if you chose your treatment targets from sounds excluded from the child’s system? In other words, what if you chose to start with treatment targets that are the most learnable for your client? Before you think this is too challenging for your clients, remember that kids do challenging things all the time. They fall when they learn to walk and get right back up. They fall off their bikes and try again. They learn to swim. They want to learn to do these things. Let’s use their motivation to learn to our advantage.
If something is learnable for a person, then there is a lot of room for growth. For example, as a mature, skilled reader (and hopefully writer) of English, there isn’t much that’s learnable for me. I can learn some additional writing conventions to make the revision/editing process smoother, but I don’t have a lot to learn about how to use or understand English. Spanish, however, is a different story. My expressive conversational Spanish skills are at the 2-3 word stage. I understand much more than that, but Spanish is most definitely still learnable for me. But, I’m not going to benefit from adults or kids speaking Spanish at my current expressive level. I’ll benefit from fluent Spanish speakers giving me the opportunity to make mistakes and provide (appropriate) corrective feedback at the conversational level. While my comprehension of conversational Spanish definitely has room to grow, it’s the expressive piece that is the most learnable currently.
Let’s get back to the 3 year old with the severe-profound SSD. What if you took a risk and focused on what’s most learnable for each of your clients? Yes, it’s more work on your part to figure out what’s most learnable for each client. But, one tool that makes this easier has been available for nearly 40 years – PVM Analysis Form. As summer approaches and my schedule settles down, I hope to have a tutorial video available on how to use this form soon.
If you use learnable as a guide for treatment target selection, you would look first to the individual sounds/phones that are excluded from the child’s system. That includes consonant clusters. (Yes, really, for a 3 year old!) Why? Because you want to select treatment targets that are the most learnable for the client – that is, the treatment targets where they have the most room for growth. When you choose treatment targets that are the most learnable, your client will make more progress more quickly. That progress may not be immediately apparent in the specific sounds you chose for treatment targets. You may first see acquisition of sounds/sound classes you’re not directly targeting – that is, your client is acquiring sounds ‘for free’ you’re not going to have to teach. (How awesome is that??!!) Here again, you may find yourself asking why would I do this? The answer has to do with a concept from linguistics called ‘markedness.’ If you’ve read this far and ‘markedness’ is a learnable concept for you, please feel free to message me privately. In a nutshell however, markedness means some sounds/sound classes are more ‘marked’ than others, resulting in omission of more marked sounds from some language systems or later acquisition of these sounds/sound classes in language systems where they are present. As quick examples, voiced consonants are ‘marked’ relative to voiceless consonants; affricates are ‘marked’ relative to fricatives and stops; and clusters are ‘marked’ in relation to singletons. Basically, the more ‘marked’ a sound/sound class is, the more ‘learnable’ it is. Sometimes, kids have to acquire some of the less marked features, sounds, or sound classes before you see change in the most learnable treatment targets you selected.
What’s learnable will vary from client to client. I see this as a professional challenge that keeps me on my toes and keeps me on my A game in therapy. The next time you receive a referral on a young child with a severe-profound phonological disorder, take a page from the child’s play book. Don’t be afraid to ‘go there’ with your treatment target selection and choose targets that will promote the greatest amount of change in the child’s system in the shortest amount of time – in other words, treatment targets that are the most learnable.
If you would like some help with using the PVM analysis and in selecting learnable treatment targets from it, please feel free to message me privately. Currently, I do not charge for these services.
If you’re curious as to why learnable is presented in bold italics each time I’ve used the word, it’s because I used the principles of Robust Vocabulary Instruction to introduce the word and teach the concept behind it. I plan to address teaching vocabulary and the SLP’s role therein in future posts.
As always, dear reader, thank you for reading.