URGENT!!! Anyone know of a study to prove 1:1 is better than group speech

[Guest guest]

I am negotiating with my school district to get my son 1:1 speech. He

is 4.5 and severely apraxic with only 9mth old level of speech and all

he gets is 1 hour of group speech per week from school. When he

started we were told by the school that he did not need any additional

speech therapy outside of school and so I stopped it....stupid me!

Within 6 months he had gone from a -2SD to a -3SD and is less than 1

percentile for his age group. I feel he needs a 1:1 aid and 1:1

speech as he is currently not pushed to speak at school.

The ASHA website says that " children seen alone for treatment do

better than children seen in groups " but I need more amunition than

this.

Anyone know of any studies that prove 1:1 is better???? Sorry for the

urgency but I need it for an IEP meeting tomorrow.

Thanks

FD

[Guest guest]

Hi FD!

There's lots more in the archives -but The Late Talker book together

with some of the following (can't recall if all is in there) should

be enough. Of course I'd always bring private evaluations from your

child's private SLP as well as the 1:1 therapy appropriate

recommendation from either a pediatric neurologist or developmental

pediatrician as well. Remember to always use the word " appropriate "

vs " best " The school is not required to provide the best therapy and

placement for your child -just what is appropriate.

And this is in The Late Talker but just in case you don't have that

http://www.cherab.org/information/speechlanguage/therapymatrix.html

(have the private professionals put in writing severity level)

One on One Therapy

A Review of Apraxia Remediation

The Cherab Foundation gratefully acknowledges permission to print the

following, cited by Hecker, a parent advocate for her

apraxic son, .

" The type of treatment appeared to influence whether patients

improved. More patients improved and improvement was greater in Group

A, individual stimulus-response treatment, than in Group B, group

treatment. These result imply the way to treat AOS (Apraxia Of

Speech) is to treat is aggressively by direct manipulation and not by

general group discussion. This is consistent with what has been

recommended (Rosenbek, 1978).

The type of treatment appeared to influence whether improvement

occurred or not. Four of the five patients who did not improve

received group treatment with no direct manipulation of their motor

speech deficit. " Apraxia of Speech: Physiology, Acoustics,

Linguistics, Management. Rosenbek et al. 1984

" The frequency of professional speech assistance is critical in the

habilitation of children with developmental apraxia of speech. This

disability call for all-out attention and deserve serious instruction

to the limits of the child's attention and motivation. When normal

children begin their formal education, they do not go to school two

or three times a week for just a half-hour at a time, even in

kindergarten. Thus, I do no expect to provide special education for

children with developmental apraxia of speech on a cursory basis, for

it may be the most important part of the entire education. " Current

Therapy of Communication Disorders, Dysarthria and Apraxia.

H. Perkins 1984

" They use the term developmental apraxia to describe a disorder that

is not confined to the phonologic and motoric aspects of speech

production, but includes difficulty in selection and sequencing of

syntactic and lexical units during utterance productions. Most

clinicians agree that planning the appropriate treatment approach and

methods is crucial to the efficacy of intervention. A variety of

factors can facilitate treatment of DAS. DAS is often characterized

as being resistant to traditional methods of treatment. Group

therapy decreases the potential of responses per session for each

child and therefore, the motor practice needed by children with

apraxia and dysarthria. " Treatment of Motor Speech Disorders in

Children by Edythe Strand in " Seminars of Speech and Language " Vol.

16, No. 2. May 1995

" Early stages of treatment need to be carried out on a one-to-one

basis for it is only in this way that the patient can learn to

develop his own particular strengths and adopt compensatory measures

for weaknesses. " Disorders of Articulation, Aspects of Dysarthria and

Verbal Apraxia. Margaret 1984 " These children do not seem to

make good progress with the usual approaches to clinical treatment of

articulation problems. Carefully structures programs that combine

muscle movement, speech sound production, and sometimes even work on

grammar seem to get better results. " " Developmental Verbal Dyspraxia "

on Healthtouch Online, ASHA website

" Children must be seen one-on-one, at least in the early stages of

treatment. " Kaufman, author of the Kaufman Speech Praxis Test

and expert on Apraxia, on The Kaufman Children's Center for Speech

and Language Disorders website .

" However, many of the theories, principles, and hierarchies described

for adult apraxics are potentially helpful to the clinician designing

motor-programming remedial program for an individual child. (We

stress the word individual since the program development for children

with DAS must meet the individual, and often unique, needs of each

child.) " " Intensive services are needed for the child with DAS.

Children with DAS are reported to make slow progress in the

remediation of their speech problems. They seem to require a great

deal of professional service, typically done on an individual basis.

Therefore, clinicians working with DAS must accommodate this need and

schedule as much intervention time with the child as the child and/or

his/her schedule can allow. The definition " intensive " varies from

clinician to clinician and from work setting to work setting.

Rosenbek (1985), when discussing therapy with adult apraxics, defines

the word as meaning that the patient and the clinician should have

daily sessions: Macaluso Haynes (1978), Haynes (1985), and Blakeley

(1983) also advocate daily remediation sessions. " Also, " our

experience has been that the overall outcome has been best for those

children with DAS who were identified as possibly exhibiting DAS and

received services as very young children. " Developmental Apraxia of

Speech, Theory and Clinical Practice. Penelope Hall et al. 1994

" We recommend therapy as intensively and as often as possible. Five

short sessions (e.g., 30 minutes) a week is better than two 90 minute

sessions. Regression will occur if the therapy is discontinued for a

long-time (e.g. over the summer). Most of the therapy (2-3/week) must

be provided individually. If group therapy is provided, it will not

help unless the other children in the group have the same diagnoses

and are at the same level phonologically. " Velleman,

authority and published author on Apraxia, on her website

(velleman.html). " Our clinic has had tremendous success with the half-

hour format, we find these session to be very intense, packed with

therapy, and have little

down time. The earlier and more intensive the intervention, the more

successful the therapy. Group therapy can be effective for

articulation disorders and some phonological processing disorder, but

children with Apraxia really need intensive individual therapy. "

Lucker-Lazerson, MA, CCC-SLP, and Clinic Coordinator for the

ish Rite Clinic for Childhood Language Disorders San Diego, on

the Apraxia Kids website.

" A few major principles in particular have direct relevance to the

treatment of motor speech disorders. The most obvious, yet

surprisingly often disregarded, is that of repetitive practice.

Pairing of auditory and visual stimuli is included in most

approaches, and intensive, frequent, and systematic practice toward

habituation of a particular movement pattern is suggested instead of

teaching isolated phonemes. It is important to

consider the treatment needs of each child and attempt to find

creative solutions that

> allow frequent individual treatment for children that will most

benefit. "

Childhood Motor Speech Disorders Edythe Strand

" Given the controlled conditions stipulated in the studies..., it is

clear that speech dyspraxia can respond to therapy. All approaches

involved an intensive pattern of therapy. Even if not seen daily by a

therapist, patients carried out daily practice. " Acquired Speech

Dyspraxia, Disorders of Communication: The Science of Intervention.

Margaret M. Leahy 1989

" Consistent and frequent therapy sessions are recommended. The

intensity and duration of each session will depend on the child. At

least three sessions per week are recommended for the child to make

consistent progress. " Easy Does it for Apraxia-Preschool, Materials

Book. Robin Strode and Chamberlain

" In stark contrast, the children with apraxia of speech whose parent

stated that three quarters of their child's speech could be

understood following treatment, required 151 individual sessions

(ranging from 144-168). In other words, the children with apraxia of

speech required 81% more individual treatment sessions than the

children with severe phonological disorders in order to achieve a

similar function outcome. " Functional treatment outcomes for young

children with motor-speech disorders by in Clinical

Management of Motor Speech Disorders A.J. Caruso and E.A. Strand

1999.

(In addition to the information on this page, a great page on 1:1

therapy is at Apraxia-Kids)

1:1 Therapy Question Sent To Children's Apraxia Network:

Advice From our nonprofit's SLS/MA/ EDUCATIONAL CONSULTANT, Cheryl

-

It is interesting to note that when a child is receiving Early

Intervention services in the home, therapy is 1:1. It is also

interesting to note that children as young as 6 months of age have

received 1:1 services. Every apraxic child is different, with a

diagnosis of severe apraxia, the child would benefit from 1:1

therapy. What data is the school SLP (Speech Language Pathologist)

presenting indicating that the age of 5 is too young for 1:1

services?

Remember when a request for services is not given as requested, the

denying party must give a written rationale as to why. The IEP

(Individualized Education Program) is an individualized Education

Program. How will the SLP (Speech & Language Pathologist) address the

severe oral motor needs of the child within the group setting? What

are the short and long term goals and objectives that are specific to

the nature of this child's severe apraxia? Does the SLP plan to

devote x amount of minutes providing 1:1 therapy to your child within

the group setting? Your child's disability of apraxia affects his

involvement and progress in the general curriculum and access to

nonacademic and extra curricular activities due to the fact that he

is not able to communicate appropriately to school personnel when

needed and communicate effectively through speech and/or writing to

class- mates and teachers. The severity of his disability warrants

1:1 speech therapy intervention. Your child's disability of apraxia

of speech affects his ability to engage in age relevant behaviors

that typical students of the same age would be expected to be

performing or would have achieved {IDEA-Code of Federal Regulations

(C.F.R.): 34 C.F R.300.347 (a)(1)(i) Statue 20 United State Code

(U.S.C.) 1414 (d)(1)(A)(i)(1).

I am requesting that the parent draft a letter to the Dr. of the

Child Study Team including the information listed above. Indicate

that you are not in agreement with the type /amount/duration of the

speech therapy services that will be provided to your child. State

that you are seeking 1:1 therapy services for your child because...

Send the letter certified receipt return requested. Send a copy to

the SLP, the District Superintendent of Schools, and Board of

Education President. Severe Apraxia requires the parent to advocate

for 1:1 services in the area of speech therapy.

http://www.cherab.org/information/speechlanguage/therapyintensity.html

Inclusive therapy archive

Re: Classroom teacher a SLP and " language based preschool " vs SLP

Shilo perhaps the teacher 'can' be an SLP, a " Sweet Likable Person " -

but what does that have to do with appropriate professional speech

therapy?

And Kim -you mean to tell me they are 'still' saying that same old

line, don't tell me let me guess something like:

" It's a language based program so it's hard to say just how much

speech therapy he will be receiving per day or week because (insert

wool over eyes here) he will be receiving therapy throughout the day

incorporated and reinforced in all activities all day long by the

teacher and aids in the classroom... so... in fact it's actually if

you think about it more speech therapy than what you were asking us

for because since the therapy is all day long incorporated and

carried out by the teacher and aids in the classroom and because the

SLP is there to oversee and show the teacher what needs to be done

speech therapy outside of this program by the SLP is no longer

necessary

because again the speech therapy is all day long and incorporated

into all we do which is why this program is called a language based

program "

Don't confuse the words language based, inclusive and group

therapy since they all 'can' be different -but in most preschools in

most cases they all mean the same thing -less or no one on one

appropriate therapy when appropriate. Don't let the school get away

with talking

you into something that is not appropriate for your child. Ten

years from now you may never see them again -ten years from now

however your child will still be your child -stand up and fight to

secure appropriate therapy now for his/her future.

A language based classroom also referred to by some as an inclusive

classroom is typically wonderful, inclusive therapy is different.

Inclusive (group) therapy does not replace individual therapy, and a

teacher's follow through does not replace an SLP working with your

child anymore than you doing follow through at home does. Neither

alone is appropriate for children that require 'individual' or 'one on

one' speech and/or occupational therapy.

Best possible world is when the school offers both the inclusive

classroom together with the individual therapy if that is

appropriate for the child. The Summit Speech School for the hearing

impaired and deaf is a perfect example of such a preschool. It's

where my son Tanner, and many other's children here went to preschool.

In general inclusive therapy (again not to be confused with an

inclusive classroom which could be great for almost all) is wonderful

only for

those children with mild or simple delays in speech. As far as I

know to date there are no experts who will recommend inclusive

therapy 'alone' for a child with moderate to especially severe

impairments of speech that require individual therapy (such as

apraxic children) at best they will say " it's yet to be determined " -

and many others state that inclusive therapy for a child with a

severe impairment of speech 'can' be detrimental. All this can be

found under lock and key at the ASHA site. This article on

inclusive therapy used to be available to the public to help the

children and the families and back when I needed it to help advocate

for my son Tanner I printed it out -and was able to use that to help

secure out of district placement (which is why he is excelling today)

http://www.cherab.org/information/familiesrelate/letter.html

In a quick search for a website that appreciates that information out

there helps the children -I found these quotes on inclusive therapy:

" With more children in inclusive settings, we are finding ourselves

with more training of regular education /paraprofessional staff

needed and less time to manage it. I feel important carry-over is

neglected due to our lack of time to contact parents, support staff,

etc. This has been professionally very frustrating for me. "

" It is difficult to develop necessary time to consult with teachers

on work more inclusively when running to three buildings a day. "

" My caseload for 98-99 was great. I was primarily at 1 school. I did

not have a COTA and saw approximately 20 students. Had excellent

inclusive therapy with time to discuss weekly inclusive therapy, so,

when I was in the classroom I was NOT an aide. Was able to carryout

ALL IEP objectives as time was allotted for collaboration and travel

time was minimal. Not the case this year! At 4 schools and have a

COTA. Have noticed a significant decrease in ability to carryout IEP

objectives, not in 1 place long enough to be part of collaborative

meetings - miss all my schools scheduled collaboration meetings

which are critical to attend to get carryover of goals - In and out

method of therapy - not good. Need to limit amount of travel and

allow time at each school to become " part " of the program. 94 - The

98-99 school year was somewhat atypical with a caseload of 45.

Typically I am over but last year was excessive. At 45 it is

impossible to do more than the basics. I may have met the IEP but

not in a way that was most beneficial to the child. For example, if

I missed a child due to a meeting I would try to make up the time

but the child would be often inappropriately grouped. The high

numbers also affected my ability to consult with

teachers/staff/parents. There were several children on my caseload

whose time could have been cut down this year if I could have spent

more 1:1 time with them in and out of the classroom last year. "

http://idea.uwosh.edu/sped/yeartwo/surveys/occ/returns/therapy.pdf

And...just to show you as well that you are not the only one in this

situation -here is another off the web which was from a thread you

may find interesting with comments from Kathleen Whitmire PhD, an ASHA

professional (and with her email address):

" I am in a situation where the principal has decided that ALL

special education classes including speech therapy to be performed

in the classroom. Although inclusion has it's merit,and ultimately

you want your student/client to generalize in the community setting,

inclusion may not be appropriate. How would you suggest to approach

this individual, who by the way, refuses to listen to any and all

recommendations that pull-out is necessary, including quoting

the " law " . Thank you for your response. "

http://cahn.mnsu.edu/5whitmire/_disc25/0000001b.htm

" Although " quoting the law " hasn't been too helpful in the past, this

will be your best approach. IDEA does require that a full continuum of

services be considered for each child. You may want to mention that

individual services may result in faster progress for some kids,

allowing you to dismiss those kids earlier and thus save the district

money in the long run. It sounds as though the administrator is

concerned about budget, so try to come from that perspective. Good

luck. "

http://cahn.mnsu.edu/5whitmire/_disc25/00000025.htm

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