An alternative to phonological therapy: Core Vocabulary Therapy with Inconsistent Speech Disorder.
Welcome Back! I will try not to make all my blog entries so “dry” and research-oriented but I have found success with this approach with a kindergartner with severe speech disorder and I really want to share it with my fellow SLP’s or with parents who feel their child is not making enough progress in speech therapy and want to talk to their SLP’s about trying an alternative therapy approach.
First, let talk about “Inconsistent Speech Disorder” not to be confused with apraxia of speech! Inconsistent speech disorder is characterized by variable productions of the same sounds, not only from context to context but within the SAME context. Although inconsistency is the hallmark of Childhood apraxia of speech (CAS) as well, children with CAS do worse in imitation compared to spontaneous speech while children with Inconsistent Speech Disorder do BETTER perform better in imitation than in spontaneous production. It accounts for approximately 9% of speech disorders. Check out the following link for the pdf of an article by Crosbie et al that explains Inconsistent speech disorder and contrasts it with other types of speech disorders: “Intervention for children with severe speech disorder: A comparison of two approaches. If you have a student that you suspect has apraxia of speech or a phonological disorder but they have not responded to traditional intervention methods for these disorders, you might consider the diagnosis of “Inconsistent Speech Disorder” and institute a trial of the core vocabulary therapy approach. You can also try having your student name 25 pictures on three occasions within one session. Transcribe their responses phonetically. Multiple error forms for the same sound must be observed to consider inconsistent speech disorder.
Core Vocabulary Therapy differs from other types of intervention approaches for speech disorders. The aim of therapy is NOT to contrast phonemes (using minimal or maximal pairs). Nor is the goal to teach individual speech sounds in isolation as you might with a child with an articulation disorder. The aim of therapy is consistent (not necessarily accurate at first) word production. The following link does an excellent job of outlining the goals and therapy session structure of core vocabulary therapy: “A core vocabulary approach for management of inconsistent speech disorder.” For my student, I gathered a list of 50 target words by collaborating with her general education teacher and parents. The words must be both functional and powerful to the child. We used names of peers at her table, family names, favorite toys and games. WORDS ARE NOT SELECTED ACCORDING TO SOUND OR SOUND PATTERN!. Choose powerful and functional words that the child has a difficult time producing in their speech. The words are often chosen because the child uses them frequently. We practiced 10 words every 1-2 weeks. Don’t just ask the child to imitate the words each session. Rather, dissect them! For example, if a child says “hout” for “house,” explain that they made the word with a t sound at the end which is a short burst of air. We want to make it with an s sound at the end where we use a long stream of air.” Try showing the correct production of the word in graphic form. My student progressed quickly and we extended our word list to over 100 in the course of the school year. Words were chosen from the her day (lunch, rest time) her favorite color (pink) and from the kindergarten curriculum. One word list was counting by tens to 100, (ten, twenty, thirty etc). At the end of the school year, I noticed a few remaining phonemes were tricky for her and now that her phonological system had stabilized to having more consistent errors, I did introduce some minimal pairs therapy. It’s important to remember that our therapy approach should change as the child’s needs change!
Thank-you for your interest in this post. If you have other thoughts, comments or questions, please use the comments section. I’d love to hear from you!!