How Nicole Organizes Her DTTC Sessions

Full transcript

Nicole, from the Motor Speech Lab, coming in live to talk about a question I got asked last week: "Nicole, how do you organize your DTTC treatment sessions?"

Before I begin, I wanted to see if you have all seen the new infographic the practice team has come up with. Can you see that? I printed it out in color. It's the DTTC hierarchy. This is the NYU Motor Speech Lab in collaboration with the Case Speech Lab, Marquette Lab, and also Childhood Apraxia Treatment, and it's really awesome. We have it in our stories. If you have any questions about the hierarchy and how to implement it, this is really helpful.

So, that being said, the question was, how do you organize your DTTC motor speech sessions? What I do first is think about the words I'm going to target. I've created this; it's just a treatment session document. You'll notice I have the words I'm targeting here, and I have these little boxes so I can note how many blocks I'm doing of each treated word. Then I have space on the side so I can make a note to myself about where I got in the hierarchy that day with that target word or movement gesture. Did I get to direct with varied prosody? Did I make it to spontaneous? Or were we still in slow simultaneous production? That's where I put those notes.

The bottom is a little bit different, because there I have the words that are in spontaneous. What we do with spontaneous productions, and I talked about this a little while ago, is sprinkle them into the session. You're not targeting them repetitively in a block; you're sprinkling them in between blocks. Your goal is to get 10 solid productions per session, across three treatment days, and then you'd say, "You know what, this word is golden. I'm going to take it out of the rotation." So I just make a long space where I can mark that I got the 10 productions, so I can see it visually. I'm fortunate enough to have a research assistant who watches my sessions and tallies the number of productions, so I have that information on the back end, but this is helpful for me.

The tricky thing is when you have a word you just put into spontaneous yesterday, and you come in today thinking it's spontaneous, and you start, and it's not. This is the amazing thing about this dynamic treatment: in the moment, we are making decisions about where this child is. If I could go back to the hierarchy: you think you're in spontaneous so they can just say it, and they can't, so you're able to move down the hierarchy, start with direct, and then work back up to spontaneous. For that type of word, I'm going to have it on the top with the blocks and also on the bottom, so I have a clear visual of how many blocks I did of that word and how many times I got it spontaneously. I'm very visual, and I'm taking notes quickly in the session. It's not easy to do, and this has really helped me.

The things to think about: if it's a really challenging target, you're going to have fewer repetitions of that word. You don't want to engage in negative practice, so think of it as, "Let me get in and out." I might be doing a mime or a whisper at that point if it's really hard. If it's a word you're really getting traction with, you're definitely going to have more repetitions of it as you start to test the waters of the hierarchy. Maybe you have a really good direct production and you want to see how the delayed is looking. Sometimes you do this and they can't get it with delayed, and that's okay, because you go back. But with those types of targets, you're going to have a lot more repetitions.

So again, check out this infographic. It's super helpful, and it goes through everything. This is just my personal note-taking system, but if you're interested in seeing what it looks like, I will happily share it with you. You can DM me here, or you can email me at [email protected]. And if you have a question you'd like me to answer, you can also DM me. I hope everybody is well. Have a wonderful, wonderful night. Take care, everybody.