Marisha: Hello there and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode. Welcome back to the SLP Now podcast. We're continuing this series with Lindsey from Speechy Things. If you don't follow her on Instagram already you should definitely go check her out. Just search Speechy Things. She's got lots of great content. But we are continuing our conversation about speech sound disorders assessment and specifically focusing on perception tasks and trial therapy today. So, Lindsey, should we start off with perception tasks?

Lindsey: Let's do that. I think that sounds great.

Marisha: You gave us a little bit of an overview of what perception tasks are in the first episode this month but can you give us a reminder of what a perception task is and then why do you use them and what does that look like? Spill all the beans.

Lindsey: I will spill the beans. So a perception task is basically something that helps you tease out whether a student's... I hope I'm saying this right, okay, but whether their inner voice matches what the word should sound like. Does that make sense?

Marisha: It does make sense.

Lindsey: Okay, so if you can think about a student, think about any phono kid you've ever had and they're like, "It's a tat." And you're like, "What, is this a tat?" And they're like, "No, it's a tat." Right? They're so convinced that they're saying it correctly. They would not do well on perception tasks. Their awareness is just not there.

So, I got to point out, there is an ASHA Evidence Map about this, in the Speech Sound Disorders section, called Speech Perception Skills of Children with Speech Sound Disorders, and it's really helpful. I love the ASHA Evidence Maps. I feel like I have not been utilizing them enough. I just love the summaries. Between that and The Informed SLP I'm set.

There is a correlation absolutely between speech sound disorders and children not doing well on speech perception tasks and I've been digging more into the research behind this and I've seen some varying reports on how important it is for kids to be able to discriminate errors in other people versus themselves. But, I think, no matter what in an assessment, it's valuable information for you to know. Typically, I mean, I always look at it in the assessment and I'll get more into what that actually looks like but I just want to throw out there I think it's okay to spend some time on this in early therapy. There's mixed reports on whether or not you have to get perception down before you could even work on elicitation or working up the articulation hierarchy or vice versa if they're not going to get perception until they know how to produce the sound. I just think it's so interesting. Would you like some examples of what you would do to look at this?

Marisha: Yes, let's do it.

Lindsey: I feel like this is much more in the phonology wheelhouse and can help you tease apart what's articulation, right? So what is the difficulty producing the sound and what is phonology? And that is much more about their awareness and their linguistic skills. Is that accurate? Sounds fancy. I don't know if that's actually right. But anyway, their understanding of the sound and its job in their speech.

So my examples would be judging if someone else produces a sound correctly, judging if they said a sound correctly, saying the same word twice and them telling you if it sounded the same or if it sounded different, bringing in some minimal pairs. It's a great opportunity to bring in minimal pairs and really look at phonology. So, just in case, minimal pairs would be a word that differs by one phoneme like tat and cat, those would be minimal pairs. Not a great example. I don't know how many kids know what tatting is, even though that is a real word. But if you have pictures of both words and you say one of them, can they point to the picture that you just said? Can they hear the difference between those two words? Those are some examples that I try to include in my assessments and there are things that I'm building into the R assessment that I've been working on that I was telling you about because I think it's so important.

Marisha: That is amazing because I feel like having an assessment that gives you some resources to navigate that would be so helpful. A lot of this we can just take it and run with it but sometimes having it in a little bit of a informal protocol or whatever can make a huge difference. So I'm excited to see that.

Lindsey: Thanks.

Marisha: If your assessment is ready it'll be linked in the show notes. No, that's so exciting to see that come together. Are we good to talk about trial therapy?

Lindsey: Yeah, let's do it.

Marisha: Okay. So, I think it makes sense, but tell us what trial therapy might look like, why you use it, how you approach that?

Lindsey: Okay. So in the textbooks that I peruse from time to time they talk about dynamic assessment and I'm assuming those people know what they're talking about, they're professors and stuff, smart people. To me, as a clinician, the benefit of a dynamic assessment, meaning you assess, then you teach, then you reassess, basically, so you're figuring out what cues might be helpful. You're figuring out at what level, for example, in the articulation hierarchy are they at? Because, as I mentioned in the first episode of this series, I think, formal assessments often fall short here, right? They don't give you necessarily an insight into how easy or difficult it's going to be for a student to achieve a particular speech sound or to eliminate a particular phonological process. So I think that doing trial therapy is crucial for knowing how to write your care plan. You can't just write the care plan based on the formal assessment, in my opinion. Not that I haven't done that before but I don't think it's the best way.

Marisha: Yeah, I think that makes a lot of sense. Would you mind giving us an example or two of what an activity might look like or how we might do that?

Lindsey: So basically I would just think about... So this is towards the end of the assessment, so, knowing what you know now about this kid, what would be one of the first therapy activities you did with them in your first official session? And bring that out. So if it's a phonology kid then maybe bringing out some minimal pairs and probing there, similar to the perception tasks, but can they produce whatever sound is an error or whatever phonological process that they're doing, can they fix it? And then, for articulation, maybe bringing out a couple of... a little word list or something and seeing, okay, can they imitate it? Can they make the sound at all? Or what kind of cues do they need from me in order to fix it? I mean, really you're just trying to figure out, in that assessment, "Can I get them to do what they need to do with whatever phonologic process for a speech sound?" I think it's just a little bit more of a fine tune dive into what the issue is and how easy or difficult it's going to be to get them where they need to go.

Marisha: And I've done this before where in the clinic where I'm at, I administer formal assessments in addition to all the informal stuff but [inaudible 00:08:30] SLP could also, if they give the Goldman and Fristoe, for example, you can pull the words from there, the ones that they produced in error, and then see what do they need to produce that word? Is it just another, typically, not just repetition, but do they need just a visual cue, a model, or do they need placement cues, whatever that looks like? And, I think, that's a lot of times parents will ask, "How long is this going to take?"

Lindsey: Oh my god.

Marisha: And that's like the worst question ever to answer. But if we can do some of that, if we have some of that trial therapy, that can make such a world of a difference in being like, "Well, they just needed this type of support." And just in terms of writing goals too.

Lindsey: Absolutely.

Marisha: Because if it's super-easy to cue them we can be very ambitious with our goals. A lot of times we can't get the correct production in our first session but that gives us information that we can use in considering our goals too.

Lindsey: For sure because there's just a million different ways you can write goals. I feel like the most important thing you get from your assessment is the care plan. And I feel like goals are tricky to write and I think it's easy for us to be so exhausted with writing up our report that that's almost like an afterthought and I think that's backwards. Your goals guide treatment and I think they deserve so much love and attention and you just can't write good goals without trial therapy.

Marisha: Yeah, I love it. So I think that's a really awesome note to end this episode on because the next episode is talking all about making recommendations and maybe we can tie together some cool stuff in that episode.

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