Or, How Did I Decide to “Go Big or Go Home” When It Comes to Intervention Targets?
First, I need to take a moment to thank the people who came before me and who helped me on my own path. I was incredibly fortunate enough to have the opportunity to learn directly from two outstanding women researchers in phonology, Dr. Judy Gierut and Dr. Lynn Williams. Both of these researchers pioneered what we now call the complexity approaches in phonology. Dr. Gierut, especially, helped plant the seeds of what I call the CLOUDS Approach in an undergraduate SPHS student’s head.
Dr. Lori Swanson was willing to take on an overeager Master’s student who was determined to complete a thesis project. She knew I needed to fall down and scrape my knees so I could learn to pick myself back up again. She also read untold rounds of revisions of the document and helped me learn to provide constructive feedback. I am eternally grateful to her.
Finally, Dr. Howard Goldstein shared his extensive knowledge of both single subject design and grant writing with me. He further encouraged my already (over-)developed sense of asking, “but why?” and “what if…” and helped me develop more systematic ways of answering my own questions.
Reaching for the CLOUDS
The research in support of the complexity approaches in phonology is pretty clear: If you challenge children, they will rise to the occasion. By focusing on what’s learnable for each client, they will make more progress in a shorter amount of time. For a review of what’s learnable, click here.
Sweet. Cool. Got it & bought the t-shirt very early on in my clinical & research career.
But, what about those kids with DLD/SLI/PLI/whatever we’re calling it this week? To be clear, we’re talking about children who perform at least -1.25 standard deviations below the norm on standardized language tests and whose productive morphosyntax makes them sound about 2 years younger than their chronological age (in English, at least). These are the kids who substitute the objective for the subjective pronouns (e.g., Him eating) and use filler words like “it” or “that” it conversation. Many of these kids also have comorbid speech sound disorders.
The traditional intervention path with these kids has been to work on their receptive language skills by making them follow multi-step directions and answer multiple choice questions. Expressive language intervention often consists of wasting everyone’s time by treating the pronoun errors without addressing the underlying lack of verb phrase tensing. Nothing ever changes for individual kids and SLPs just get accused of sitting in the boiler room playing games all day.
Let’s change things up and let’s change the perception of the profession during Better Hearing & Speech Month. Let’s ask kids to do more with the time we have with them.
Here’s an example of the CLOUDS Approach. This set is designed for the Little Critter book, Just Me and My Dad. Because of copyright issues, I can’t post actual images of the book. These materials are meant to be printed out, then affixed to the appropriate pages in the book as prompts for you while you read the storybook. Also included in the packet is a data sheet which will allow you to track progress over time along with a coding scheme that isn’t immediately obvious to prying eyes. I’m in the process of making these materials more widely available through Boom Cards (search for loribslp) and/or TpT.
The CLOUDS Approach focuses on features of English morphosyntax which are learnable for most children with DLD. It focuses primarily on Wh-question formation, negation, third person singular, and regular past tense forms. The CLOUDS Approach is based on a technique called Structural Priming (Leonard et al., 2000, 2002). With Structural Priming, you provide an example of the structure you are trying to elicit, then immediately provide an opportunity for the individual to generate their own novel utterance using the same structure. “Go Fish” is an excellent example of an easy way for families to implement Structural Priming. You start the game by saying, “Do you have any 4’s?” – that is, you provide the structural prime (Aux DO yes/no questions in this case). The individual has the opportunity to answer yes/no in a functional setting, then generate their own “Do you have…” question.
The CLOUDS Approach also relies on errorless learning. While your client should be given the opportunity to generate their own novel utterance(s), if they make an error you should provide feedback in the form of morphosyntactic prompting (e.g., “No, he [did]…) or provide the opportunity for the client to repeat a grammatically correct response either ‘with’ you or immediately after you. Because you are working on structures that are learnable (and by definition not known to the client), errorless learning is critical to everyone’s success – including yours as an SLP!
Success Breeds Success
In both research and clinical settings, the children with whom I have used the CLOUDS Approach have never appeared to be distracted by the embedded Structural Priming questions and elicitation opportunities. In fact, the opposite is true. Very positive changes in the complexity of children’s narrative retelling of the storybooks were found and were found to be statistically significant.
If it’s possible to get changes in morphosytactic and narrative complexity by embedded Structural Priming into children’s storybooks, then is it possible this is a worthy multipurpose tool in your SLP toolbox?
As always, thank you for reading. Please feel free to share your thoughts, questions, or concerns. I’m especially interested to hear from you if you try the CLOUDS Approach in your own clinical practice.