Cycles Therapy (Patterns Intervention)

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Created on Wednesday, 30 January 2013 12:57

Updated on Tuesday, 19 March 2013 16:27

Patterns / Cycles Therapy

This approach combines traditional and linguistic approaches and was devised for SLPs/SLTs working with highly unintelligible children. Although Cycles is a word-based approach, it does not include contrastive pairs until late in therapy when secondary patterns are targeted. There is a full description of the approach in Hodson (2006) listed below in the references section with a link to the article.

Assessment

The HAPP-3 (Hodson, 2004) is administered, before beginning treatment, to determine which patterns need to be targeted. Deviations are analysed in order to select optimal (for the individual child) target phonological patterns.

Background

This approach combines traditional and linguistic approaches and was devised for speech-language clinicians working with highly unintelligible children (Hodson & Paden, 1983, 1991; Hodson 2007). The seven underlying concepts of the Cycles approach (Hodson, 2007 p. 109) are:

1.     Phonological acquisition is a gradual process.

2.     Children with normal hearing typically acquire the adult sound system primarily by listening.

3.     Children associate kinaesthetic and auditory sensations as they acquire new patterns, enabling later self-monitoring.

4.     Phonetic environment can facilitate (or inhibit) later self-monitoring.

5.     Children are actively involved in their phonological acquisition.

6.     Children tend to generalise new speech production skills to other targets.

7.     An optimal “match” facilitates a child’s learning.

Target Selection

Phonological patterns analysis (Hodson, 2004) is performed to identify treatment targets. Targets are consistent phonological deviations or patterns occurring 40% or greater. Targets are stimulable.

Primary patterns are targeted first: early syllable structure patterns, anterior-posterior contrasts, /s/ clusters and liquids; then secondary patterns: palatals, other consonant sequences, singleton stridents, prevocalic voicing contrasts, vowel contrasts, assimilations and any remaining idiosyncratic deviations. Note particularly that phonemic contrasts (minimal pairs) are not included in therapy until secondary target patterns are introduced.

Hodson (2004) writes, 'Potential secondary target patterns need to be reviewed to ascertain if any of these need to be targeted after the following three criteria are reached: (a) All early developing patterns (e.g., syllableness) are established; (b) /s/ clusters are emerging in conversation; and (c) anterior and posterior consonants are used contrastively. Although a number of these secondary patterns may have been evidenced during the initial evaluation, many will have "normalized" during the time that the client was working on the Primary patterns'.

Some children above the age of 8;0 require help with “advanced target patterns”: multisyllabic words such as “aluminium” and “thermometer” and complex consonant sequences as in “excuse” and “extra” (Hodson, 2007 p.100).

Intervention Procedures

1.     Cycles

Rationale
Normal phonological acquisition is gradual.

Implementation
A phoneme within a pattern is presented/stimulated/targeted for 1 hour (sometimes 2); then another phoneme for that same pattern (always at least 2 phonemes per pattern; then the next pattern, etc. The patterns are recycled, adding complexity with each ensuing cycle. One cycle is 6-18 hours. Phonological assessment (Hodson, 2004) is performed at the end of each cycle. Typically 3 or 4 cycles (requiring approximately 30-40 hours) are required for clients with extremely disordered phonological systems to become intelligible.

A cycle is not complete until all of the deficient Patterns [primary; then secondary] that have been identified/specified have been targeted. For example, Cycle One for most children with highly unintelligible speech involves at least 2 hours for each of the following patterns: “syllableness,” final “consonantness,” /s/clusters, velars, liquids. Typically syllableness and final consonantness do not need to be “recycled,” but /s/ clusters, velars, and liquids virtually always need to be recycled 2 or 3 times. Also /s/ clusters are often targeted for 4-5 hours for each early cycle. And then more complex [internal] /s/ sequences are targeted under Secondary patterns.

2.     Focused Auditory Input

Rationale
Speech acquisition occurs through listening. Focused input ‘tunes up’ the child’s sound system in order to maximise the effect of production practice.

Implementation
The child listens for <30 seconds to 15-20 words, spoken by an adult, through headphones at the beginning and end of each session and once daily at home without amplification.

3.     Facilitative Contexts, Active Involvement, Self-monitoring and Generalisation

Rationale
This promotes the development of new kinaesthetic and auditory. These are internalised through practice, so facilitating the child’s self-monitoring skills.

Implementation
In a drill-play format the child does production practice of individual words, carefully selected for optimal phonetic environment (Kent, 1982), involving that is, facilitative phonetic contexts.

A small set of production practice words (target words) is included in each session. Models and tactile cues are used to help the child consistently produce the targets correctly, to facilitate new auditory and kinaestheticimages. Four or five words with captions are drawn on index cards. The child actively participates in drill-play for 7 to 8 minutes. At home, the caregiver reads the ‘AB’ words once daily to the child, and the child names the words on the cards in a 2-minute a day homework activity.

4.     Optimal Match

Rationale
Matching the child’s current 'phonological level' with a corresponding treatment level facilitates allows the child to be optimally challenged and yet experience success.

Implementation
When it is initiated, treatment is geared to ‘one step higher’ than the child’s current phonological level to (1) challenge the child, and (2) facilitate success.

References

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Hodson, B. (2004).Hodson Assessment of Phonological Patterns, 3rd Ed. Austin, TX: Pro-Ed.

Hodson, B. (2006). Identifying phonological patterns and projecting remediation cycles: Expediting intelligibility gains of a 7 year old Australian child. Advances in Speech-Language Pathology, 8(3), 257-264. Click here

Hodson, B. (2007). Evaluating and enhancing children’s phonological systems: Research and theory to practice. Greenville, SC: PhonoComp Publishing.

Hodson, B. W. (2009). Enhancing phonological patterns to expedite intelligibility gains. In C. Bowen, Children's speech sound disorders. Oxford: Wiley-Blackwell, pp. 19-21.

Hodson, B. W. (2011, 4/5/2011). Enhancing phonological patterns of young children with highly unintelligible speech. The ASHA Leader.

Hodson, B.W., Chin, L., Redmond, B., & Simpson, R. (1983). Phonological evaluation and remediation of speech deviations of a child with a repaired cleft palate: A case study. Journal of Speech and Hearing Disorders, 48, 93-98.

Hodson, B.W., & Paden, E.P. (1981). Phonological processes which characterize unintelligible and intelligible speech in early childhood. Journal of Speech and Hearing Disorders, 46, 369-373.

Hodson, B. W., & Paden, E. (1983). Targeting intelligible speech: A phonological approach to remediation. San Diego, CA: College-Hill Press.

Hodson, B.W., & Paden, E. P. (1991). Targeting intelligible speech: A phonological approach to remediation, 2nd Ed. Austin, TX: Pro-Ed.

Hodson, B.W., Scherz, J.A., & Strattman, K.H. (2002). Evaluating communicative abilities of a highly unintelligible child.American Journal of Speech-Language Pathology, 11, 236-242.