language intervention and the true believer. Journal of Medical Speech-Language

Pathology, 11, 95-104.

TAP

The topics of the reading are the five “extraneous effects” the article lists that can cause the changes seen in patients instead of the actual treatment that has been given.  The audience of this article is any researcher or practicing clinician in the field of communication disorders.  The purpose is to inform these people of the “extraneous effects” so that they are aware of all the variables involved in their research and treatment.  This way they do not rely on clinical judgment alone to make decisions regarding treatment.  They must decide which approaches are best and why.  This way the can improve and maintain high quality services for their patients.        

Claim

• Many variables affect therapy outcomes and they should be taken into consideration when judging the cause of change in our patients.  Clinicians must take precautions to keep these variables from impeding the best quality of service possible.   
• The Placebo Effect has a strong influence on results, and all treatments in our field are probably effected by placebo. 
• A participant’s outcome may be affected simply because they are involved in a study, treatment, etc.  Any of the interventions and techniques we use such as, transcribing, scoring, and interpreting scores could be influenced by the Hawthorne Effect.    
• Diseases and conditions have a Natural History that can affect the outcome of treatment instead of the specific treatment rendered.
• Results from a certain treatment or therapy could be due to the fact that we as clinicians believed that the treatment or therapy would work.  Not controlling the effect a clinician’s previous expectation on outcomes is a real problem in speech-pathology because it is difficult to apply the controls to all parties involved.
• A measured score has the tendency to move towards the mean of the scores upon successive measurement.  The farther from the mean, the greater the move towards the mean.  This is due to real changes in behaviors and does not just refer to statistics. 

Evidence

• Emotions, expectations, pre-existing knowledge, and many other things could change patient outcomes, as shown in the five “extraneous events”.  They must decide if it was the therapy approach that was responsible for the improvement that the clinician witnessed.
• The Placebo Effect has been shown to be the sole cause of improvement in cases involving unknowing participants, such as babies.  It also has been shown to cause documented side effects.  Specific responses to placebos have been discovered.  For example, the color of pill predicts its expected function and the number of pills has been shown to change dosage expectations. 
• The Hawthorne Effect has been shown to have a greater effect on outcome than the Placebo Effect.  It is a psychological effect shown when improvements are seen because the subject knows they are being monitored.  It can also occur when they are simply given the extra attention involved in a study or therapy. 
• Dysfluency has been shown to sometimes have a natural history that spontaneously recovers.  Therefore, when a patient’s treatment is successful, we must ask if it was the treatment that was successful or if the natural history played a role.  The same can be said for a child in speech therapy correcting stimulable sounds first.  Gains from therapy could simply be due to natural development. 
• Many pre-existing beliefs and paradigms we hold on to make us act a certain way, even if it is subtle and without our knowledge.  Studies have shown that students that are labeled as intelligent are, over time, somehow more successful.  Even if they were incorrectly labeled to begin with.  The teachers said they had no memory of treating them differently than students without the label. They simply expected these students to do better and that allowed it to happen. Double-blind methods are used in medicine and psychology to avoid this.  But, in communication disorders, it is hard to avoid.  Studies on the efficacy of speech therapy are usually done by someone who promotes and believes in the techniques being used.       
• Scores and outcomes are dictated by a multitude of different variables; especially in speech and language scores.  When a score is extreme in either direction is it due to a combination of variables that is extreme and unlikely to happen again.  Therefore, the next time the score is measured that combination of variables will have changed and the score will be closer to the average.  The actual measured behaviors are different than before.  Maybe the client is having a better day, or is not hungry today.  This can also skew our judgment of the outcomes of treatment because when studies are conducted, usually the population who is most delayed or extreme is studied.  This means that regression to the mean alone will cause scores to improve.        

Connections

            Text-to-self-  I have learned before in Diagnostics that there are many different variables involved in speech and language scores.  We also talked about how important what the client does outside of treatment is.  We also learned this in Neuro because those patients especially, must have treatment in mind outside of the therapy hours.  But, I have never realized until now all the different ways scores and outcomes can be affected.

            Text-to-text-  In several of the psychology classes I have taken in the past, the text book describes placebo effect.  It discussed how it has been shown to make changes even in cases where one would not assume placebo could work due to the patient or subject.  It has been shown to work in animals and in babies.  Also, I never realized that we were learning the Natural History of child development from our CD 325 textbooks when we studied norms.    

            Text-to-world-  As the article states, a clinician must not simply rely on the fact that a techniques works to claim its usefulness.  We must always be aware of the “extraneous” events and effects upon what we do.  This allows us to understand what is actually useful to our patients and imply the most effective treatment. 

Communication Disorders:  An introduction [Technical Report]. Available from www.asha.org/policy.

Progress Memo #2

            Since my last progress memo I have learned to do a few more things.  I have learned a lot about how to do good research.  I have not had research class yet, so all that we do is fairly new to me.  I have learned some good ways to retrieve information that pertains to what I am looking for.  I am better now at maneuvering through Academic Search Premier and coming up with useful keyword and search strings.  This way I do not have to just take a shot in the dark.  I have also learned how to more efficiently organize my papers.  I have learned that I need to plan them a little better instead of just writing what comes out of my head.  From reading the many articles that were assigned I have learned lots of information about several different things.  I learned what issues surround phonological assessment in our field today.  Many people do not agree upon how a phonological assessment should be completed.  There is no set or prescribed way to assess a child for a phonological disorder.  The clinician uses current research and experience to make the best decisions for their client.  From listening to charetttes I found out that the information found in most of my classmates’ research used Evidence Based Practice to make decisions.  The treatment articles I am currently reading have informed me of different treatment techniques that I was not previously aware of.  For example, I now understand a little bit about minimal-pairs and cycles therapy.  All I knew before were the names.  I hope that we hash these out further in class so I can feel more prepared for clients this summer.

            All of this new knowledge about phonological treatment means that I can feel just a little bit better about having my own clients.  I will at least know what approach I need to research more to be able to use in therapy.  This also means that I will be able to do research more efficiently than before; and maybe the time I spend on writing papers will decrease because these skills have improved.  Some of the different approaches to phonological treatment still don’t make sense to me.  I believe that this is because I do not feel like I have a good knowledge base about phonology in general.  I am still unsure as to how to go about deciding which method will be best for a client.  I am sure that this somehow depends upon what processes are being used and to what degree as well as the etiology (if available).  But, I do not know how to use this information to make the best decisions when it comes to target selection and many other crucial decisions.  I am also confused about generalization.  What I know about it I have taken from CD 468.  The articles we read in this class make it seem like it is something that we just wait and hope for as a result of the treatment approach used.  It doesn’t seem like something a clinician has good control over.  What I have learned so far, and what still confuses me means that I have a long way to go before I have learned what I need to know about phonology.    

I learned what the concepts behind the different methods are and some tips to implement them.  I will know what treatments I need to research further.  I also learned which treatments are best suited for which type of client (mild/severe).  This will allow me to have a starting place if I get a child with a phonological disorder in therapy.  I learned how many concepts regarding treatment are debated.  It seems that not much is known about our field compared to other professions.  But, I never realized how much about phonology is up in the air and being currently researched.  This is especially true when it comes to efficacious target selection.  Most of the authors I read about have different ideas, opinions, and research, when it comes to target selection.   

TAP            

            The topic of this reading the different kinds of journals that can be implemented when conducting research.  The intended audience is Naturalists and Ecologists or anyone conducting research.  The purpose is to describe the types of journals so that the reader can begin to use them and benefit from them. 

Claim

• Journals are written for the writer.  They are not written for others to enjoy or understand.  There are a few different types of journals.
• There are different options when it comes to organizing journals.  

Evidence

• Personal journals are records of someone’s life.  They can be used to document thoughts and what happens every day.  Everyday writing is usually used.  Dedicated journals document particular projects or journeys.  These focus on a single project or trip.  All types of data collection, methodology, insights, doubts, and interpretations are used.  There are brief notes about other aspects of the writer’s life.  This type of journal keeps all thoughts and data related to the project together.  It will be a useful resource later if it is properly labeled or indexed.  Field journals are constantly with a naturalist.  They contain a mixture of personal and professional notes.  This takes observation, reflection, and interpretation.  The style of a journal is up to the author because it is only for them. 
• Using straight chronology when writing in a journal has some advantages.  The ideas and events are integrated according to time.  However, this means that related ideas are not grouped together, but spread out.  To do lists may be included because there are always things to remember.  A daily log is a good habit if it seems important when you are doing it.  Also, include natural history notes.  This is observations of behaviors or anything else that interests you.  It will be suited to your own interests and needs.  Sketch what is seen to use for visual memory.  They can do things words cannot do.  Use a double entry format to separate observations and interpretations.  Divide them with a vertical line down the middle of the page.  Save the last few pages of a journal to record important information such as titles, articles, people, or anything else pertinent that should be remembered.     

Connections

Text-to-self – This reading reminds me of some techniques I learned in my stress management class in Counseling.  We learned that keeping a journal is a good way to get thoughts out and deal with problems by writing them on paper.  Of course, this type of journal would be very different from the kind discussed in this reading.  But it just goes to show that journals can be helpful in many different ways.

Text-to-text – I have never read anything about how to make a journal before.  In fact I never really knew that there were set ways to organize one.  What should be included is left up to the author though. 

Text-to-world – I am having a lot of trouble understanding how this relates to our broader clinical world at all.  I do see where observations and interpretations are recorded.  In our field observation is very important and a organized and efficient way to document would be very important to develop.

Barlow, J. (2001). Recent advances in phonological theory and treatment. Language, Speech, and Hearing Services in Schools, 32, 295-297.

Barlow, J. (2002). Recent advances in phonological theory and treatment: Part II. Language, Speech, and Hearing Services in Schools, 33, 4-8.

TAP

            The topic of these articles is the connections in phonological theory and treatment and their importance.  The intended audience is the student of Communication Disorders of the practicing clinician.  The purpose of these articles was to introduce research that will be discussed in the later forum.

Claim

• Phonological treatment has a goal.  That goal is to make the most maximal changes possible in the child’s sound system in the least amount of time possible. 
• Acquiring phonological knowledge is developmental.  Disorders can exist within phonology as well as language because phonology is part of language development.  Therefore, phonology should not be treated alone, but with language.  The child’s language abilities should be taken into consideration when planning therapy. 
• The most global change can be brought about by targeting the most difficult (most complex) sounds in treatment.

Evidence

• The author used many different types of evidence in these articles.  She used studies done by others.  These studies were related to target selection, procedures, and even focus in therapy.  No new evidence in used in these articles.  Barlow cites other articles in the forum.  She states that, markedness is the same as complexity.  Sounds that are more marked are more complex.  Also, the optimality theory is constraint-based and has a different view of markedness.  It says that high-ranking marked constraints cause the simplified productions we see in our children with phonological disorders. 

Connections

Text-to-self – These articles reminds me of a theory class I took in my Counseling program.  Theory seems to be so abstract that it is hard to understand.  I guess that is true no matter what discipline the theory belongs to.  I remember that class was hard for me and these articles were equally as hard for me to understand.

Text-to-text – These articles remind me a little bit of our textbook for CD 325.  In it I read about language theories.  These theories are similar because they say that phonological knowledge is developmental just like language is.  Both sets of theories try to shed some light on how these skills are learned and developed by children. 

Text-to-world – There is a connection to the broader clinical world because theory drives treatment and just about everything that we do.  Whether we know it or not we are prescribing to a certain theory when we use or agree with a type of treatment.  They were developed in accordance with a theory of how a child learns or changes or thinks, etc. 

TAP

            The topic of this article is multiple oppositions therapy and a case study exploring it further.  The intended audience is the student of Communication Disorders or the practicing SLP.  The purpose of the article is to convince the reader that multiple oppositions therapy is more efficacious for some clients depending on the type and number of errors they have. 

Claim

• Treatment intervention will have the most impact on the child’s sound system when the child’s phonological system and it’s organization is described and when phonological learning is directed across the phonological rule or strategy systematically.  Therefore, minimal pair therapy may not assist in eliminating the pattern in the child’s speech.  Multiple opposition approach is unique.  
• There are many different variables in determining what has actually caused the change in a child’s sound system. 

Evidence

• Multiple opposition approach is unique because it is specific to each child and focuses on the child’s unique needs and phonological strategies.  Broad training is better because intervention is distributed across a large and varied treatment set.  The child is exposed to the extent and range of training applicable to a particular rule.  This is also called deep training.  In children with severe phonological disorders, broad training causes significantly greater generalization.  In a moderate phonological disorder, outcomes for broad training and deep training.  Single oppositions are more difficult to learn and integrate phonemically for children.  It also presents the child with a range and diversity of all the new contrasts that they would not otherwise get.  This will increase generalization.  Learning a single contrast at a time may limit the child’s ability to integrate this into a system and reorganizing an entire rule set.  But, multiple oppositions may require greater focus and attention from the child.  Multiple oppositions encompasses larger treatment sets of contrasts and provides the child with intervention across a much broader spectrum of a child’s error pattern or rules.
• A researcher must decide what information is important in their study and what information has no relevance to the treatment outcomes.  This is a limitation to any case study where treatment outcomes are measured.  The child’s pretreatment functioning, prognosis, level of severity, are some things that must be taken into consideration when looking at the results of a case study.   

Connections

Text-to-self – This article reminds me of a case study I just completed for 527L.  There is a lot of information needed to complete a case study.  I had never realized how much information that may not seem that important at first it actually important for treatment.  However, it can make a real person seem like a statistic or a study guide. 

Text-to-text – I have never read another text that discusses this material.  I read the handout we had in class about the different types of therapy.  But, this was the first time I had even heard of most of them.  Therefore, it is all new territory and I have nothing to compare it to. 

Text-to-world – This article relates to the broader clinical world because it looks at a real client.  It is not just some research that was done to many different people.  This makes results seem very far away to me.  This article looks at one client who was treated with multiple oppositions.  This is more like what we will be doing in real life after we begin practicing.  It is like a client that could be on anyone’s case load.

TAP

            The topic of this article is the predictors of phonological change that follow intervention.  The intended audience is the student of Communication Disorders or the practicing SLP.  The purpose of the study is to find the best predictor of change as a result of speech language intervention.

Claim

• No one predictor was found that is associated with phonological change.  Nor was a combination of predictors found to have an impact as a predictor of phonological change.  

Evidence

• By itself, FMC cannot clearly predict PCC change.  Two thirds of PCC change could not be accounted for by the variables that were examined by the researchers.  Error consistency accounted for one third of the overall change in the children studied.  There were two combination intervention strategies used in this study.  They were randomly assigned to the children in the study.  The first was an alternating strategy in which phonology and morphosyntactic goals alternated on a weekly basis for 24 weeks.  The second, was a simultaneous strategy in which phonology and morphosyntactic goals were integrated within activities in every session.  There were four predictor variables examined in this study; the error consistency index (CI), finite morpheme composite (FMC), CA, and IS.  There was not a significant difference in PCC change between any of these different strategies.  Previous research in this area of phonology has focused on identifying variables associated with children who will normalize than on variables that could predict change as a result of intervention.  There are too many variables involved for this type of research to be effective.   

Connections

Text-to-self – This article reminds me of the articles I have read about generalization.  In these articles the researchers seem to be trying to find the most efficacious way to cause generalization in a child’s speech.  This is hard to do because of all of the variables involved in generalization.  That is why the results are often unreliable.  It seems like the results of this study are not reliable because it is impossible to control all of the variables involved in a study such as this.  The researcher could never really know exactly what is causing the change they are studying. 

Text-to-text – This article was hard for me to read because of all of the technical terms and abbreviations that were used throughout.  It made reading it not very fluid so the overall concepts were hard to grasp.  I cannot think of a text I have ever read that would relate to this article in some way.  All of the information in these articles is completely new to me.  As I stated above, it reminds me of the generalization articles that we read in this treatment section because of all of the variables. 

Text-to-world – This article has an impact on the broader clinical world because it is trying to find predictors.  Even though these authors were fairly unsuccessful in finding predictors, their efforts are still important.  Finding a predictor for phonological change would help plan therapy to be more effective for our clients.  If we could predict what may happen to the child’s sound system, then we could manage it better and more effectively. 

TAP

            The topic of this article is the response to studies done by Gierut and Morrisette.  The intended audience for this article is the student of Communication Disorders or the practicing SLP.  The purpose of this article is to compare and contrast these two studies and relate the clinical outcomes as a function of target selection strategy. 

Claim

• Children made significantly greater progress toward mastery of target phonemes when treatment progressed from easier to more difficult targets than when treatment progressed from the most difficult to easier targets.  Superior performance was achieved by the ME group for treated sounds both during treatment sessions and on the posttreatment generalization probe.  The advantage to the ME groups is maintained even after controlling for pretreatment differences in target phoneme probe score.
• Morrisette and Geirut’s findings converge on parallel sets of findings with the authors of this article.   

Evidence

• Children in the ME group clearly achieved higher post-treatment probe performance that children in the LL group.  Children in the ME groups also had a higher posttreatment performance which means that they had better generalization than did the children in the LL group.  Therefore the children in the ME group benefited from easier targets.  But treatment of more difficult sounds benefited the LL groups but generalization was not as good.  Therefore the better progress by the ME group’s means the traditional target selection used on them was effective.  There success was not due to an extraneous effect of between-group differences in pretreatment production accuracy.  The ME groups had an advantage over the LL group.  Their progress was superior regardless of if they children were stimulable for the target phoneme before treatment.  

• Any such studies must employ a randomized group design and an untreated control groups because of the difficulty of distinguishing generalization from maturation effects that occur regardless of whether or not treatment is provided.  There is no other means of ensuring that performance improvements for untreated sounds are due to the treatment approach employed with the participants.  Morrisette and Gierut tacitly acknowledge that single subject designs are not appropriate for this research question when they describe their previous studies as employing a multiple baseline across subjects design, in which the relative effectiveness of different target selection strategies is compared across groups.  However, Morrisette and Gierut disagree with these authors and state that when treatment targets are selected on the basis of a child’s productive knowledge, normative sequence does not seem to differentially impact how the subject learns the treated sound.  It is concluded that when treatment of more difficult sounds produces a greater sound change in the child’s sound system.    

Connections

Text-to-self – This article reminds me of some of the therapy sessions that I watched while observing this semester.  It reminds me of this because I don’t think I saw it when I was observing.  It seemed like more complex targets were not used by most.  I am unaware of how the student clinicians go about target selection, but it does not seem like they use the same kind of thinking that is addressed in these articles. 

Text-to-text – This article is similar to the article I previously read on complexity.  This article talks a lot about sounds that are more difficult; therefore more complex.  This article has helped me further understand the idea of complexity and its many aspects.  The conclusion is that more complex (more difficult) sounds are more efficacious in therapy.  These sounds produce a greater change in the child’s sound system. 

Text-to-world – This article affects the broader clinical world in many ways.  It is always useful to pull the most important parts from a study and put them all together to be able to see them more clearly.  You can get even more information by taking using facts from two studies to put them together to see how they compare or contrast.  This is what allows connections to be made in meaningful way.  Even knowing about this way of looking at things will allow me to better understand articles I read in the future.