Speech-LanguagePathologist.org

We are pleased to welcome Dawn Moore, MA, CCC-SLP, as our guest 

host for the SLP chat tonight, Monday, October 25, 2004. She will

be addressing the topic of The Cycles Approach to Phonological

Remediation.

Ms. Moore received her undergraduate and graduate degrees at the

University of Pittsburgh. Immediately after graduation, she moved

to North Carolina where she currently owns a contracting practice. 

Ms. Moore has contracted with the same North Carolina county for

the last five years and holds the position of Lead Speech-Language

Pathologist.  During this time, she became very frustrated with her

clients with phonological disorders and began to look for another

approach to help them have more success in a shorter amount of time. 

Ms. Moore taught herself the Cycles Approach by Barbara Hodson and

is now committed to teaching others through workshops and presentations. 

She is a frequent contributor to the message board on

www.speech-languagepathologist.org, sharing her expertise in therapy

approaches and techniques.

For a copy of Dawn's outline on the Cycles Approach, please email

her at dawnmooreslp@earthlink.net.

<Robin> Welcome!  We are chatting tonight with guest host Dawn Moore, MA, CCC-SLP about

The Cycles Approach to Phonological Remediation.

<Adrienne_FSU> Great to see everyone here tonight!

<jasper> I just went to a conference where Dr. Hodson presented the Cycles approach.

<Dawn Moore, SLP> I bet that was interesting

<Dawn Moore, SLP> I would love to meet her.

<msdeb> Practicing I'm a practicing SLP in the schools - very little experience (read that

almost none) with Cycles.

<Dawn Moore, SLP> I didn't have any experience either...had to teach myself.

<Dawn Moore, SLP> I was not happy with a traditional approach to phonology.

<June> I am an SLP practicing in a rural district, with several severe artic kids.

<jasper> I am very interested in trying the Cycles approach after hearing Dr. Hodson.

<Robin> Dawn, please give us some background information on this topic.

<Dawn Moore, SLP> What is Cycles?  Time periods during which all primary phonological

patterns that need remediation are facilitated in succession.  Why target patterns?

How many of you have tried to target the individual sound only to have the child

exhibit another error pattern somewhere else in the word?  If a child fails to

produce /s/, this may be the result of different circumstances in different words.

It may be omitted at the end because the child deletes all final consonants, or it

may be omitted preceding another consonant because of omission of stridents in

consonant clusters.  It may also be replaced by /t/ in the initial position because

the child exhibits stopping.  So, teaching /s/ as an isolated unit when one or more

of these conditions exist, does not ensure its correct use in all of these situations

and does not facilitate broader learning that results from targeting a pattern.

<Robin> Dawn, please tell us about assessment.

<Dawn Moore, SLP> Anyone using the Assessment of Phonological Processes (APP-R)?

<Dawn Moore, SLP> The Assessment of Phonological Processes-Revised (APP-R) is a test designed

by Hodson to go along with Cycles.  It tests the child on 50 words analyzing errors on

the primary patterns (You can also score the secondary patterns, but it does not affect

the child's score).  It is from this you can design your treatment and use it again to

assess progress.

<Dawn Moore, SLP> The one I just mentioned (Assessment of Phonological Processes) or the new one

Hodson just came out with, Hodson Assessment of Phonological Patterns (HAPP-3).  It is

the new version of the APP-R and measures the same primary patterns.  I have never used

it personally, nor have I talked to anyone that has.  However, I'm sure it's a good test

given that I really like the APP-R.

<jasper> My main question is what diagnostic tool to use to best identify phonological patterns?

<June> I use the Goldman-Fristoe and the Hodson analysis.

<jasper> Do they go hand in hand?

<June> Yes, but you look for patterns.

<jasper> I have used the Goldman-Fristoe but it does not identify patterns, just errors.

<Dawn Moore, SLP> I don't like the GFTA for phonology...not enough information.

<Dawn Moore, SLP> The GFTA goes with the Kahn-Lewis, but they don't give you the targets you will

use in Cycles.

<June> ok

<Adrienne_FSU> Dawn, you mention the Kahn Lewis will not give you the same info, or the info you

need for Cycles approach...

<Dawn Moore, SLP> I recognize some people that are here already have it.

<Adrienne_FSU> What info do you need to get from an assessment to use the Cycles?

<Dawn Moore, SLP> You need to target patterns like Stridency Deletion.

<Dawn Moore, SLP> The Kahn-Lewis goes more with Consonant Harmony and Deaffrication, things you do

not target with Cycles....at the beginning.

<Dawn Moore, SLP> That's why I use Hodson's test since I use her program.

<Adrienne_FSU> So the (HAPP-3) is the assessment that corresponds with Cycles approach to remediation?

<Dawn Moore, SLP> Yes, it's the new version of the APP-R

<Dawn Moore, SLP> I haven't used it yet.

<Adrienne_FSU> Ok, thanks

<Dawn Moore, SLP> I am used to the APP-R so I use it.

<June> Tell us a brief overview of Cycles.

<jasper> Can you discuss early pattern targets?

<Dawn Moore, SLP> The primary patterns...according to Hodson include Syllables, Consonant Sequence,

Velars, Alveolars and Liquids.

<Dawn Moore, SLP> The difference between Cycles and Traditional Articulation therapy is that you target

the pattern, not the individual sound.

<jasper> final consonants?

<Dawn Moore, SLP> Final Consonants are targeted through consonant sequences where you are targeting the

structure of the word, not the individual phoneme.

<jasper> She mentioned final consonant deletion as a primary pattern.

<msdeb> Is there a hierarchy for consonant sequences?

<Dawn Moore, SLP> Not really a hierarchy.

<Dawn Moore, SLP> You just target what they need.

<Dawn Moore, SLP> If they don't have final consonants, you can start with VC words.

<Dawn Moore, SLP> Then add in CVC

<msdeb> Then, do you target initial consonant sequences, final, medial, or doesn't it matter?

<Dawn Moore, SLP> Initial is always tried first.  Children should not be deleting initial consonants.

<Dawn Moore, SLP> Targeting patterns enables the child to target every primary pattern they need within

each cycle.

<Dawn Moore, SLP> A cycle is the period of time that all primary phonological patterns that need

remediated are targeted in succession.

<Dawn Moore, SLP> So if you have a child that is fronting, has liquid simplification, cluster reduction

etc., you will need to target every one of those patterns in Cycle.

<crystal> how much time is alloted each pattern?

<jasper> can you discuss choosing targets and what to work on first if a child displays mulitple error

patterns?

<Dawn Moore, SLP> You may try to start with final /k/ as your first target phoneme of the Velar Pattern.

<Dawn Moore, SLP> If the child is stimulable (and most will not be!) you would do final /k/ for two

sessions of 30 minutes each.

<Dawn Moore, SLP> This means you practice final k with 5 target words per session.

<crystal> and then go on to another final consonant for 2 sessions?

<Dawn Moore, SLP> No, you stick with your pattern

<jasper> I have a child who can do final /t/ but not final /k/ or final /p/ consistently.

<Dawn Moore, SLP> You're working on velars, so you try to do initial /k/ and /g/ next again for 30 minutes...

two sessions.

<jasper> But if the pattern is final consonant deletions then keep on with finals?

<Dawn Moore, SLP> If the pattern is final consonant deletion (FCD), yes you keep on with final consonants.

<jasper> Dr. Hodson said to target voiceless final consonants and not worry about voiced ones.

<Adrienne_FSU> So you target every incorrect pattern with a certain phoneme, then move on to cycle two where

the same patterns may be targeted again but with a new phoneme?

<Dawn Moore, SLP> No, a cycle targets EVERY pattern and every phoneme within a pattern that the child can do.

<Dawn Moore, SLP> Your first cycle may be very long.

<Adrienne_FSU> I'm unclear on the difference between the first and subsequent cycles.

<msdeb> If a student is severely apraxic and can't get the final velars, ignore them and move to the next

pattern?

<June> What do you do about the child that voices unvoiced phonemes?

<Dawn Moore, SLP> all except voiced final stops.  Hodson says NEVER target those.

<Dawn Moore, SLP> Cycles is not for apraxic children

<jasper> What are the voiced final stops?

<Dawn Moore, SLP> /b/, /d/, /g/.

<jasper> So we do not target final g?

<Dawn Moore, SLP> Example of Cycle

<Dawn Moore, SLP> Final /k/, initial /k, g/, CVC targeting final /m, n, p, t/, clusters targeting /sp, sn,

sm, st/, then liquids initial /r/, initial /l/.

<Dawn Moore, SLP> That would be just one cycle.

<Dawn Moore, SLP> Each phoneme I listed would be targeted 60 minutes.

<Dawn Moore, SLP> You can see that would take a while

<Adrienne_FSU> definitely!

<Dawn Moore, SLP> The next cycle would contain the same targets because the child has not mastered them.

<Dawn Moore, SLP> Mastery means they are using them in conversation.

<Dawn Moore, SLP> The great thing about Cycles is that you only use words.

<Dawn Moore, SLP> You never move beyond that, but they do.

<Dawn Moore, SLP> They will start to use the pattern you are teaching them in conversation.

<Dawn Moore, SLP> I didn't believe it until I saw it happen.

<Adrienne_FSU> Is there a theoretical explanation?

<Dawn Moore, SLP> Yes, it's in Hodson's book and it's too long to explain here

<Dawn Moore, SLP> So, Cycle 2 would contain everything Cycle 1 did and you could add in more when they

become stimulable.

<Dawn Moore, SLP> Targeting patterns facilitates broader acquisition.

<Adrienne_FSU> Thanks Dawn, that helped. Does anyone have any questions about the premise of this appraoch

before we move to specific applications?

<Dawn Moore, SLP> Most chidren are not stimulable for /k, g/ at the beginning and those sounds can be added

in during Cycle 2 or Cycle 3.

<Dawn Moore, SLP> I have a child that could not do them until Cycle 4, because all she could produce was /h/

for all initial sounds.

<msdeb> Since you are moving from pattern to pattern are there any suggestions about goal writing than covers

what you are actually doing?

<Dawn Moore, SLP> I write the actual level the child is using that process on the IEP.  So if cluster reduction

is at 80%, I write that in present level of performance.

<Dawn Moore, SLP> Then I write the goal, Brittany will decrease the use of Cluster Reduction to 60% in words.

<June> So the child must be stimulable for the sound in words...not in isolation?

<Dawn Moore, SLP> Yes, they need to produce it in isolation first, except for /r/

<Dawn Moore, SLP> That is sometimes easier elicited in words...only working on suppressing gliding.

<Dawn Moore, SLP> Remember goals are written for a year only so I try to write them so they are attainable.

<June> Dawn do you work in a school?

<Dawn Moore, SLP> Yes, I have for 7 years.

<Dawn Moore, SLP> I have 10 children that have phonological delays on my caseload of 45.

<June> I have so many kids, I don't have the luxury of 30 minute sessions.

<Dawn Moore, SLP> I'm sorry to hear that.

<Dawn Moore, SLP> How long do you see your kids?

<June> 20 minutes

<jasper> How many do you put in a group for Cycles?

<Dawn Moore, SLP> I don't like to have more than two, but I do have a group of three that I see three times a

week.  They are all in the profound range.

<Dawn Moore, SLP> I had to put them together to see them 3x a weeek

<Dawn Moore, SLP> One important thing to remember about Cycles is the need for Auditory Bombardment.

<Adrienne_FSU> Do you see the same peer-learning effects in Cycles as you sometimes do in traditional?

<Dawn Moore, SLP> To be honest, I never really thought about it.

<jasper> Is Cycles only for unintelligible students?

<Dawn Moore, SLP> Yes, but the level of unintelligibility varies.

<Dawn Moore, SLP> Some children are mild, some moderate and so on.

<jasper> Mildly unintelligible? how so?

<Dawn Moore, SLP> The APP_R will actually tell you when you score it if the child needs a Cycles approach.

<Dawn Moore, SLP> It's also a great tool to use if you're trying to differentially diagnose apraxia.

<Dawn Moore, SLP> Most will show up in the mild range on the APP-R.

<Adrienne_FSU> You said Cycles should NOT be used with apraxia right?

<Dawn Moore, SLP> That is my understanding.

<jasper> Dr. Hodson didn't seem to get too caught up on the apraxia label.  She said just that if they were

unintelligible it would work.

<Dawn Moore, SLP> I don't know about that.  I had a child whose errors constantly changed and he made no

progress with Cycles. I then realized he was apraxic. I was getting ready to start apraxia therapy

with him, but he left my school.

<liz> I'm having a hard time going along with one sound in one position for an hour.

<Dawn Moore, SLP> Liz, why is that?

<Dawn Moore, SLP> You have to remember you're targeting a pattern, not one sound.

<Dawn Moore, SLP> You will be amazed how it will help the other sounds in the pattern.

<Dawn Moore, SLP> For example, targeting s-blends facilitates stridency to /f, v, z/ "ch", "sh" and "dz" and

it works!

<liz> It seems that the child might make more progress by targeting say final /p,t/ in the same session.

<Dawn Moore, SLP> You do target both of those sound when you target VC or CVC words.

<liz> I thought you would target only one per therapy session?

<Dawn Moore, SLP> You are only targeting one Pattern per therapy session.

<liz> Thank you for clarifying that!

<Dawn Moore, SLP> The Pattern in that case would be Consonant Singletons in which you target the structure of

the word thereby targeting all the final consonants and medial consonants needed.

<June> So give us an overview of a typical 30 minute session.

<June> Pick something you'd work on in cycle 1 and examples of words.

<Robin> June, Dawn's outline on Cycles will be added to our chat archive where you can see a detailed sample.

<Adrienne_FSU> The main thing about Cycles is the intense focus on patterns, as opposed to particular sounds.

<Dawn Moore, SLP> I can't stress the importance of auditory bombardment enough.

<Dawn Moore, SLP> I use a digital recorder and read the child's sentences into it using their name whenever

I can and they love it!

<Dawn Moore, SLP> It is then saved for later cycles, so I don't have to record it again.

<Adrienne_FSU> So they are to listen to the tapes at home?

<Dawn Moore, SLP> No, that's for therapy.

<Adrienne_FSU> You record your voice or theirs?

<Dawn Moore, SLP> Mine

<msdeb> Is the recording for bombardment purposes?

<Dawn Moore, SLP> yes

<Dawn Moore, SLP> You can give them the sentence list for the parents to read to them. I haven't had much

luck parent participation, but it really helps.

<msdeb> Why use a recording as opposed to your live voice?

<Dawn Moore, SLP> I use headphones and it takes 40 seconds for each child to listen to it at the beginning

and then again at the end.

<Dawn Moore, SLP> Because it's recorded and I can be getting set up while they listen...frees up more time

for therapy.

<msdeb> If you have 2 children in a group, do you have 2 recorders going?

<Dawn Moore, SLP> No, they take turns.

<Dawn Moore, SLP> So, Brittany's SP words are #12.

<Dawn Moore, SLP> I scan to those and she listens, then CJ listens to his #14.

<Dawn Moore, SLP> I don't make anything up...never reinvent the wheel.

<crystal> Are they listening to sentences you have made up with their target words for the purpose of auditory

bombardment, is that it?

<Dawn Moore, SLP> I read sentence from the Easy Does it Books. They are in the therapy manual.

<crystal> But do the sentences you read have their target words, according to the patterns they need work on?

<Dawn Moore, SLP> Some of them do, but you're not really trying to bombard them with the words you're working on.

<msdeb> I have a crummy old tape player - what sort of digital recorder do you have?

<Dawn Moore, SLP> A Walmart one for $40.

<msdeb> excellent!

<Dawn Moore, SLP> It has 4 folders and can hold up to 200 files in each one.

<Adrienne_FSU> Dawn, you mentioned you haven't had luck with parent help, what about teachers... how do they

respond to this approach?

<Dawn Moore, SLP> Not a lot of help there either.

<Dawn Moore, SLP> It's a difficult approach for most SLPs, I don't try to explain it to teachers.

<Dawn Moore, SLP> However, I do sit in on testing so the children are not marked wrong for errors for sounds

they cannot say correctly.

<Adrienne_FSU> Assuming you had a wiling teacher, what would you like them to do in the classroom (or parents

at home?)

<Dawn Moore, SLP> Giving them the correct model is key.  And auditory bombardment with the sentences provided,

then practice the target words when the child can say them well enough.

<Dawn Moore, SLP> It was amazing to me how easy it is to get children as young at three to produce sm, sn etc.

<Adrienne_FSU> Could you provide a few target words each week for the teacher to try to use?

<Dawn Moore, SLP> My teachers are so overwhelmed, I haven't tried it.

<<Dawn Moore, SLP> Since most of my kids are learning to read in Kindergarten now, they are getting exposure.

<Dawn Moore, SLP> I have seen improvements in both traditional articulation and phonology.

<Dawn Moore, SLP> I know when I have presented this approach that a lot of the attendees were using a modified

version of it and didn't even know it!

<Dawn Moore, SLP> It's a program that needs to be explained so that it can be put into practice.

<Dawn Moore, SLP> We barely touched on it in grad school.

<Adrienne_FSU> You said you taught yourself... do they offer CEU or workshops for this?

<Dawn Moore, SLP> I don't know.  I have presented it for local counties in NC.

<Robin> Dawn, you have been chatting for close to an hour....is there anything else about the Cycles Approach

to Phonological Remediation that you would like to add?

<Dawn Moore, SLP> It's overwhelming at first, but if you try it, stick with it.

<Dawn Moore, SLP> You will begin to see amazing progress.

<Robin> Any final questions for Dawn?

<Dawn Moore, SLP> I have my /h/ girl that is on her 4th Cycle and I am so excited about where she is now

when a year ago she could only produce /h/.

<Lekha> How old is she?

<Dawn Moore, SLP> She turned 6 this week. She now uses all final consonants.

<Dawn Moore, SLP> Brittany also has /f/ in all positions and can produce final -ts, ps, initial sp, st, sn,

sm in words as well as initial /r/ and /l/.

<Dawn Moore, SLP> You can actually understand her now out of context.  I believe she will be making excellent

progress over the next couple of months as she carries these skills over to conversation.

<Lekha> Did she receive traditional oral motor instruction?

<Dawn Moore, SLP> No, I didn't do oral motor, just placement work.

<June> This explains some of the objectives I got on some kids at a new school for me. I thought the therapist

was really over enthusiastic about progress.

<Dawn Moore, SLP> I have had children in the severe range in August dismiss in March of the following year

using this approach.

<June> What reading do you recommend to introduce this concept?

<Dawn Moore, SLP> Hodson's book "Targeting Intelligible Speech" and the manual from the APP-R.  It has a lot

of great info in it.

<June> Thanks

<Adrienne_FSU> Thanks Dawn!  It's a tough one to explain, but you sound like a believer!

<Robin> Thank you Dawn, for sharing your expertise with us! 

<msdeb> Thank you so much for clarifying a bit more.  I'm getting ready to start...

<Adrienne_FSU> Thank you for joining us!  Great questions.

<Dawn Moore, SLP> Thanks to Speech-LanguagePathologist.org.  Such a great site!

<Dawn Moore, SLP> Goodnight everyone.

<Robin> For a copy of Dawn's outline on the Cycles Approach, you may email her at dawnmooreslp@earthlink.net.