Speech Practicum: Programming & Behavior Modification

Programming in Speech Therapy

• Involves the selection and sequencing of specific communicative behaviors
• New behaviors are introduced and taught in highly structured situations with multiple prompts and maximal support
• Subsequent activities progress through a hierarchy of difficulty and complexity, with decreasing support from the clinician
• The client demonstrates generalization of each newly learned behavior by using it in novel situations or contexts

Selection of Therapy Targets

• The first step in programming is identification of the communication behaviors to be acquired over the course of the treatment program
• These therapy targets are often referred to as long-term goals
• Initial information about potential therapy targets should be obtained by reviewing the results of previous diagnostic findings
• Baseline measures that fall below the 75% accuracy level represent potential intervention targets
• Clinicians typically employ one of two basic approaches for choosing among potential targets:
  • Developmental/Normative Strategy: based on known normative sequences of communicative behaviors in typically achieving individuals
  • Client-Specific Strategy: based on an individual’s specific needs rather than according to developmental norms

Sequencing of Therapy Targets

• Three major factors determine the progression of the therapy sequence:
  • Stimulus type (nature of input used to elicit target responses)
  • Task mode (type of clinician support/scaffolding provided to obtain desired responses)
  • Response level (degree of difficulty of target responses)
• The sequencing process starts with a decision regarding the most appropriate level to begin training on each target behavior
• Pretreatment baseline data for a given target are analyzed to determine the entry training level
• A rule of thumb is to start training at a level just below the difficulty of the baseline stimulus items if the client obtained a baseline score lower than 50% accuracy

Generalization/Carryover

• A crucial consideration in programming involves a client’s ability to transfer newly mastered communicative behaviors from the clinical setting to the everyday environment
• Three main factors can influence the degree to which successful generalization occurs:
  • Variety of stimuli used during therapy activities
  • Variation in the physical environment in which therapy occurs
  • Variation in the audience with whom therapy targets are practiced

Behavior Modification

• Based on the theory of operant conditioning and involves the relationship among a stimulus, a response, and a consequent event
• A stimulus (or antecedent event) is an event that precedes and elicits a response
• A response is the behavior exhibited by an individual on presentation of the stimulus
• A consequence is an event that is contingent on and immediately follows the response
• Types of reinforcement:
  • Positive reinforcement: a rewarding event or condition that is presented contingent on the performance of a desired behavior
  • Negative reinforcement: an unpleasant event/condition is removed contingent on the performance of a desired behavior
• Types of punishment:
  • Type I: prompt presentation of an aversive consequence after each demonstration of an unwanted behavior
  • Type II: withdrawal of a pleasant condition contingent on the demonstration of an unwanted behavior
• Schedules of reinforcement:
  • Continuous reinforcement: a reinforcer is presented after every correct performance of a target behavior
  • Intermittent reinforcement: only some occurrences of a correct response are followed by a reinforcer