Beathard & Krout (2008)

April 14, 2017

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

  • The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.

 

Key:

 

ASL = American Sign Language

C = Clinician

CAS = Childhood Apraxia of Speech

EBP = evidence-based practice

f = female

MT = music therapist

NA = not applicable

P = Patient or Participant

PEC Picture Exchange Communication

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Bearthard, B., & Krout, R. E. (2008). A music therapy clinical case study of a girl with childhood apraxia of speech. The Arts in Psychotherapy, 35, 107-126.

 

REVIEWER(S): pmh

 

DATE: March 30, 2017

 

ASSIGNED OVERALL GRADE: D- (Based on the design of the investigation, the highest possible grade was D+. This overall grade ranks the quality of the evidence and does not reflect a judgment on the value of the intervention.)

 

TAKE AWAY: This case study describes music therapy designed for a child with Childhood Apraxia of Speech. Descriptions of the therapy and its results suggest improvement in some aspects of communication, literacy, and music.

                                                                                                           

 

  1. What was the focus of the research? Clinical Research

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Study

                                                                                                           

  • What was the level of support associated with the type of evidence?

Level = D+    

                                                                                                           

 

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No

from data analyzers? No

 

 

  1. Was the participant (P) adequately described? Yes

 

– How many Ps were involved in the study? List here: 1     

 

– DESCRIBED Characteristics:

  • age: 3 years
  • gender: f
  • cognitive skills: at 20 months knew shapes, colors, and numbers 1-10
  • expressive language: did not use speech to communicate but used American Sign Language (ASL)
  • hearing: within normal limits
  • literacy: by 20 months could identify at least ½ of all capital letters
  • sensory skills: some issues including sensitivity to some food
  • previous therapy: at 18 months initiated speech, physical, occupational, and play therapy
  • motor skills: diagnosed with hypotonia
  • neurological status: MRI was within normal limits

                                                 

– Were the communication problems adequately described? No

  • List the disorder type(s): nonverbal, Childhood Apraxia of Speech (CAS); hypotonia
  • List other aspects of communication that were described:

no words were reported prior to interventions described in the case study

before intervention began and after speech therapy had begun at the age of 18 months, P produced the following syllables

  • bah
  • da
  • uh
  • oh
  • puh

– used American Sign Language (ASL)

     – before intervention began, the mother noted the participant (P) loved music

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, this was a single case study.

                

  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, this was a case study.

                                                                      

  • Were baseline/preintervention data collected on all behaviors? No

 

  • Did probes/intervention data include untrained stimuli? No Data were Provided

 

  • Did probes/intervention data include trained stimuli? No Data were Provided

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– OUTCOME MEASURES

 

  • OUTCOME #1: Communication Skills: Nonverbal and Verbal Skills (comprehension and production)
  • OUTCOME #2: Socialization
  • OUTCOME #3: Cognitive Skills
  • OUTCOME #4: Emotional Status
  • OUTCOME #5: Motor skills
  • OUTCOME #6: Sensory Status
  • OUTCOME #7: Perception and Spatial Skills
  • OUTCOME #8: Responsiveness to Music

 

ALL the outcomes were subjective.

 

NONE of the outcomes were objective.

 

No outcome measures were associated with reliability data.

 

 

  1. Results:

 

Did the target behavior(s) improve when treated? Yes, for the most part.

 

– Quality of improvement associated with the Outcomes was

 

  • OUTCOME #1: Communication Skills: Nonverbal and Verbal Skills (comprehension and production): moderate
  • OUTCOME #2: Socialization: limited
  • OUTCOME #3: Cognitive Skills: moderate
  • OUTCOME #4: Emotional Status: limited
  • OUTCOME #5: Motor skills: insufficient data to make decision
  • OUTCOME #6: Sensory Status: : insufficient data to make decision
  • OUTCOME #7: Perception and Spatial Skills: insufficient data to make decision
  • OUTCOME #8: Responsiveness to Music: moderate

 

 

NOTE: All the results were descriptive and were only provided in the description of each session. Summaries of descriptions of progress for each session are provide below.

 

DURING SESSION 1

 

  • OUTCOME #1: Communication Skills:

– P produced “uh” as a request and produced some ASL signs

– the Clinician (C) describe P as nonverbal

 

  • OUTCOME #2: Socialization

– C noted P gradually became open to engagement

 

  • OUTCOME #3: Cognitive Status

– C noted P was very active throughout the session

 

  • OUTCOME #6: Sensory Status

– C noted P had auditory sensory sensitivity

  • OUTCOME #8: Responsiveness to Music

– C noted P enjoyed music

 

 

SESSION #2

 

  • OUTCOME #1: Communication Skills

– C reported that

  • P’s eye contact and interactions increased
  • P produced /b/ several times
  • used ASL especially for colors

 

  • OUTCOME #3: Cognitive Skills

– C reported that P seemed aware of the relationship between /b/ and the letter “B”

 

  • OUTCOME #4: /Emotional Status

– C reported P

  • was happy throughout the session
  • was eager to attend
  • displayed an increase in eye contact and interactions

 

  • OUTCOME #8: Responsiveness to Music

– C reported P preferred the piano and guitar

 

 

SESSION #3

 

  • OUTCOME #1: Communication Skills:

– P was beginning to use vocalizations when she wanted to play an instrument

– C was able to prompt P to use selected consonants to signal desire to play an instrument

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • enjoyed music
  • preferred the piano over other instruments
  • also liked the Q Chord

 

 

SESSION #4

 

  • OUTCOME #1: Communication Skills

– P used “buh” and “pah” to request musical instruments beginning with the sound.

 

  • OUTCOME #3: Cognitive Skills

– P’s attention span was very short during this session .

 

  • OUTCOME #8: Responsiveness to Music

– P preferred the drum and C used it as a reward during the session

 

 

SESSION #5

 

  • OUTCOME #1: Communication Skills

– P continued to use the initial sound of an instrument to request access to items

 

  • OUTCOME #2: Socialization

– P’s interactions with C continued to improve

 

  • OUTCOME #3: Cognitive Skills

– P’s attention improved.

 

  • OUTCOME #8: Responsiveness to Music

– P preferred the piano. C and P began to take “conversational” turns with instruments.

 

 

SESSION #6

 

  • OUTCOME #2: Socialization

– P’s interactions with C became increasingly playful.

 

  • OUTCOME #3: Cognitive Skills

– Attention continued to improve.

 

  • OUTCOME #8: Responsiveness to Music

– P preferred the Q-Chord and showed a preference to a Beatles song (“Michelle.”)

 

 

SESSION #7

 

  • OUTCOME #3: Cognitive Skills

– Attention level decreased, even for items/activities that previously were of interest.

 

  • OUTCOME #4: Emotional Status

– Some behavioral challenges were noted by the C.

 

  • OUTCOME #8: Responsiveness to Music

– P smiled and giggled to the “Hello” song.

 

 

SESSION #8

 

  • OUTCOME #1: Communication Skills:

– C reported that P increased

  • vocalizations
  • general communication skills (particularly during piano activities)
  • turn taking
  • imitation of syllables from words and portions of the Goodbye song.

 

  • OUTCOME #3: Cognitive Skills

– C reported that P increased attending behaviors

 

  • OUTCOME #8: Responsiveness to Music
  • C reported that P

– increased general communication skills (particularly during piano activities

– increased imitation of syllables from words and portions of the Goodbye song.

 

 

SESSION #9

 

  • OUTCOME #1: Communication Skills:

– C reported the following increases

  • interaction with C
  • turn taking
  • communicating needs with ASL and other gestures

 

  • OUTCOME #2: Socialization

– C reported the following increase: socialization skills

 

  • OUTCOME #3: Cognitive Skills

– C reported the following increase: attentiveness

 

  • OUTCOME #5: Motor skills

– P attempted to draw a face on the dry ease board (which had been modeled in previous sessions.)

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following increase: interest in musical instruments

 

– P continued to prefer the piano.

 

 

SESSION #10

 

  • OUTCOME #1: Communication Skills:

– During the drawing activity P

  • with a single prompt vocalized individual syllables, markers, and blue marker.

– C reported that P demonstrated the following improvements:

  • imitating with mouth and lips syllables during the “Hello” song
  • vocalizing the initial syllable of instruments to signal that she wanted the instrument
  • turn taking
  • imitating mouth and lips for /i/, /e/,and /o/ during the “Old MacDonald” song.

 

  • OUTCOME #2: Socialization

– C reported that P demonstrated the following improvements:

  • turn taking
  • socializing
  • sustaining appropriate eye contact

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P demonstrated the following improvements:

  • imitating with mouth and lips syllables during the “Hello” song
  • imitating mouth and lips for /i/, /e/, and /o/ during the “Old MacDonald” song.

 

 

SESSION #11

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

  • increased communication skills with PEC symbols
  • independently vocalizing an initial sound when requesting an instrument
  • increased turn taking
  • vocalizing the letters of P’s name during the “Whose Name is This?” song

 

  • OUTCOME #2: Socialization

– C reported the following improvements:

  • increased socialization with the PEC symbols
  • increased turn taking

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following improvement: vocalizing the letters of P’s name during the “Whose Name is This?” song

 

SESSION #12

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

  • increased mouthing of the “Hello” song
  • apparent linking of words to parts of the face during the drawing activity

 

  • OUTCOME #2: Socialization

– C reported the following improvement: increased playfulness with the balloons (which later in the session served as a distraction)

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvements:

  • increased attention
  • apparent linking of words to parts of the face during the drawing activity

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following improvement: increased mouthing of the “Hello” song

 

 

SESSION #13

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvement: increased mouthing of words during the “Hello” song

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvement: increased attention during the “Hello” song

 

SESSION #14

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

  • increased interactions
  • increased communication during the “Old MacDonald” song
  • increased vocalizations during the “Old MacDonald” song
  • increased following directions during the “Old MacDonald” song

 

  • OUTCOME #2: Socialization

– C reported the following improvements:

  • increased interactions
  • increased enjoyment (such as smiling and laugher) during the “Old MacDonald” song

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvement: increased attention

 

  • OUTCOME #4: Emotional Status

– C reported the following improvement: increased enjoyment (such as smiling and laugher) during the “Old MacDonald” song

 

  • OUTCOME #5: Motor skills

– C reported the following improvement: increased sitting time

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following improvements:

  • increased enjoyment (such as smiling and laugher) during the “Old MacDonald” song
  • increased communication during the “Old MacDonald” song
  • increased vocalizations during the “Old MacDonald” song
  • increased following direction during the “Old MacDonald” song

 

 

SESSION #15

 

  • OUTCOME #1: Communication Skills

– C reported that P

  • communicated with C upon initially seeing her
  • had increased her verbal ability dramatically over the break
  • vocalized and verbalized sounds and words during the “Old MacDonald” song and other interactions

 

  • OUTCOME #2: Socialization

– C reported that P appeared to be happy to return

 

  • OUTCOME #3: Cognitive Skills

– C reported that P sounded out letters

 

  • OUTCOME #4: Emotional Status

– C reported that P appeared to be happy to return

  • communicated with C upon initially seeing her

 

  • OUTCOME #7: Perception and Spatial Skills

– C reported that appeared to enjoy tasks that included visual aids

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P vocalized and verbalized sounds and words during the “Old MacDonald” song

 

 

SESSION #16

 

  • OUTCOME #1: Communication Skills:

– C reported that

  • vocalization of letter sounds and syllables increased
  • verbalization of words increased
  • P’s responses to questions were more accurate
  • P was more likely to respond at the appropriate time during songs
  • P said “more” when she wanted more music

 

  • OUTCOME #3: Cognitive Skills

– C reported that

  • on-task behavior increased
  • cognitive skills increased
  • P’s responses to questions were more accurate

 

  • OUTCOME #8: Responsiveness to Music

– C reported that

  • P was more likely to respond at the appropriate time during songs
  • P said “more” when she wanted more music

 

 

 

SESSION #17

 

  • Progress was not noted on any of the outcomes for this session.

 

 

SESSION #18

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • increased vocalizations of sound combinations and parts of words
  • increased overall vocalization attempts

 

  • OUTCOME #3: Cognitive Skills

– C reported that P displayed interest in pairing musical note names with letters

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • displayed interest in the old “Hello” song.
  • displayed interest in the “Letter Tree” song
  • displayed interest in pairing musical note names with letters

 

 

SESSION #19

 

  • OUTCOME #1: Communication Skills:

– C reported that

  • P displayed a preference for the Letter Tree, Name, and Button Song interventions.
  • P increased vocalizations of letter, sound combinations, and parts of words.

 

  • OUTCOME #3: Cognitive Skills

– C reported that

  • P matched a picture of a piano with the piano in the room.
  • P matched verbal and written letters with the names of the musical notes.
  • P displayed a preference for the Letter Tree, Name, and Button Song interventions.

 

  • OUTCOME #8: Responsiveness to Music

– C reported that

  • P matched verbal and written letters with the names of the musical notes.
  • P displayed a preference for the Letter Tree, Name, and Button Song interventions.

 

SESSION #20

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • increased vocalizations and verbalizations during the “Button” song.
  • counted every ant on every page by vocalizing for each number.
  • while playing the piano, she used hand signals to represent “loud” and “soft.”
  • without models produced vocalizations for several words and sounds.
  • produced babbling/singing

 

  • OUTCOME #3: Cognitive Skills

– C reported that P counted every ant on every page by vocalizing for each number.

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • increased vocalizations and verbalizations during the “Button” song.
  • enjoyed the “Ants Go Marching In” board book/song activity.
  • showed a preference for the piano
  • while playing the piano, she used hand signals to represent “loud” and “soft.

 

 

SESSION #21

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.
  • indicated that she wanted to play an instrument by herself by producing a 3 word phrase
  • when playing with the bubbles attempted to say “pop.”

 

  • OUTCOME #3: Cognitive Skills

– C reported that P displayed decreased attention

 

  • OUTCOME #4: Emotional Status

– C reported that P

  • was excited to return to therapy after a 1 month hiatus
  • displayed decreased attention, perhaps due to her excitement
  • enjoyed playing with the bubbles
  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.
  • indicated that she wanted to play an instrument by herself by producing a 3 word phrase

 

 

SESSION #22

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • vocalized letter combinations during the “Name” and “Button” songs.
  • vocalized indicated appropriate letters during the “Name” and “Button” songs.
  • drew the letter ‘b’ and produced the sound

 

  • OUTCOME #2: Socialization

– C reported that P displayed increased “participation, energy, smiles, and excited flapping of hands” (p. 114)

 

  • OUTCOME #3: Cognitive Skills

– C reported that P

  • vocalized indicated appropriate letters during the “Name” and “Button” songs.
  • preferred visual and interactive aids
  • drew the letter ‘b’ and produced the sound

 

  • OUTCOME #4: Emotional Status

– C reported that P

  • enjoyed the session
  • displayed increased “participation, energy, smiles, and excited flapping of hands” (p. 114)

 

  • OUTCOME #6: Sensory Status

– C reported that P preferred visual and interactive aids

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • vocalized letter combinations during the “Name” and “Button” songs.
  • vocalized indicated appropriate letters during the “Name” and “Button” songs.

 

 

SESSION #23

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • displayed improved direction following during the “Bubbles” song
  • increased vocalization skills.

 

  • OUTCOME #3: Cognitive Skills

– C reported that P

  • displayed improved direction following during the “Bubbles” song
  • displayed increased cognitive skills

 

  • OUTCOME #4: Emotional Status

– C reported that P improved her self-control during the “Bubbles” song

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • improved her self-control during the “Bubbles” song
  • displayed improved direction following during the “Bubbles” song

 

 

SESSION #24

 

  • OUTCOME #1: Communication Skills:

– C reported that P did not follow directions

 

  • OUTCOME #2: Socialization

– C reported that P

  • displayed several behavioral challenges during the session

 

  • OUTCOME #3: Cognitive Skills

– C reported that P did not follow directions

 

  • OUTCOME #4: Emotional Status

– C reported that P

  • displayed several behavioral challenges during the session
  • appeared to enjoy the bubble activity

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P played inappropriately with the musical instruments

 

 

OVERALL PROGRESS

 

In the summary of P’s treatment, the investigator noted that P moved from being almost entirely nonverbal to vocalizing (sounds and sound combinations) and verbalizing (i.e., words and a phrase.) She also displayed knowledge of some letter and their associated sounds.

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

                                               

 

  1. What is the clinical significance? NA, data were not provided.

 

 

  1. 11. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:
  • Under the supervision of the second investigator, the first investigator provided music therapy to a child who had been diagnosed with CAS.

 

  • The music therapy treatment approach was described as “data-driven” which the authors described as a combination of “behavioral, improvisational, and creative approaches” (p. 107) including “musical interventions, visual, and interactive aids…as well as engaging, playful dialogue” (p. 107.)

 

  • Supporting data consisted of session notes in which judgments about improvement were noted.

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to describe a course of music therapy

 

POPULATION: Childhood Apraxia of Speech; Children

 

MODALITY TARGETED: production, comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: music (pitch, rhythm, timing)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: overall communication skills, literacy

 

OTHER TARGETS: socialization, cognition, attention, emotional status, motor skills, sensory status, perception and spatial skills, responsiveness to music

 

DOSAGE: 1 hours a week, over 9 months (24 sessions dues to breaks)

 

ADMINISTRATOR: music therapist graduate student (MT)

 

MAJOR COMPONENTS:

 

  • The stages of treatment were (p. 109)

– referring the participant (P)

– building rapport

– assessing the P

– determining goals, objectives, targets

– identifying intervention strategies

– developing the intervention plan

– administering the intervention plan

– evaluating P’s progress

– terminating the intervention

 

NOTE: When the authors did not describe the procedure, the sessions are NOT listed below.

 

DEVELOPING RAPPORT AND ASSESSING THE P (Sessions 1-3)

 

SESSION 1:

  • C played musical instruments to get P’s attention and observed her

– likes and dislikes

– communicative strategies

– activity level

 

 

SESSION 2:

  • This was the first session in which the parents observed from outside the room.

 

  • C oriented P to the physical set up.

 

  • C made observations about P’s communication, literacy, and music [reference

 

 

SESSION 3:

  • C continued to observe P during this final session.

 

  • As the result of the observations of during Sessions 1-3, C described the following characteristics of P:

– P was nonverbal

– P had a short attention span

– P’s gross motor development was delayed (e.g., unsteady gait, sitting at the piano was a challenge)

– P displayed sensory sensitivity problems

– P enjoyed music

– P used some ASL signs

– P produced “uh”

 

TREATMENT SESSIONS (SESSIONS 4 -7): EXPLORATION

 

  • C rearranged the room, placing instruments within sight but out of reach.

 

  • Each instrument was labeled with a letter indicating its first sound. The purpose of this was to encourage P to produce the initial sound on an instrument to gain access to it

 

  • C also introduced Picture Exchange Communication (PEC) symbols and a communication board to facilitate requesting.

 

  • Sessions were structured around play and play activities using toys, books, and so forth to encourage sound production and engagement.

 

  • Each week the session involved a theme which included the music therapy activities, the beginning and end of the session were marked by “Hello” and “Goodbye” songs.

 

  • Each session included at least one theme-based new song with visual aids. The songs and added were placed in the P’s songbook.

 

  • Intervention involved a number of treatment approaches.

 

  • C allowed P to explore the therapy room.

 

 

TREATMENT SESSIONS (SESSIONS 8 -14): INTRODUCING

VISUAL AND INTERACTIVE AIDS

 

  • C began to include sound-based activities. Specifically, she used “Sound Box Songs” and “Easy Does It for Apraxia-Preschool Series.”

 

SESSION 8:

  • C increased focus on facilitating interactions (e.g., using toys, visual aids, and bubble.)

 

 

SESSION 9:

  • C focused on drawing on a dry erase board due to P’s interest in the task. The drawing activity was regularly used in subsequent sessions.

 

 

SESSION 11:

  • C continued to add new songs. In this session, she added “Whose Name is This?” which appeared to be of interest to P.

 

 

SESSION 12:

  • C provided several balloon to the session

 

 

SESSION 13:

  • C moved introduction of the balloons to the end of the session.

 

  • C noted that pauses in the music helped to elicit mouthing or vocalizing

 

  • C changed “Welcome” to “Hello” during to drawing activity.

 

 

SESSION 14:

  • The furniture in the therapy room was changed to include child-sized chairs and tables.

 

  • Hand motions used during speech therapy were added to the sessions to facilitate mouthing and vocalizing.

 

  • This was the last session of the Fall Term. Therapy would resume 8 weeks later.

 

 

TREATMENT SESSIONS (SESSIONS 15 -21): VERBALIZATION AND DRAWING

 

  • Therapy was re-initiated after an 8 week winter break. However, there was an additional hiatus between Sessions 20 and 21.

 

SESSION 16:

  • New farm animals were added to the “Old MacDonald” song.

 

 

SESSION 17:

  • C introduced a new “Hello” song.

 

  • Several factors (P’s fatigue, the new song, physical issues) contributed to confusion and limited attention during the session.

 

SESSION 18:

  • C returned to the old “Hello” song.

 

 

SESSION 19:

  • C used flash cards during this session. From the prose, it could be assumed that this intervention had been used previously.

 

 

SESSION 20:

  • C introduced “Ants Go Marching In” board book/song intervention.

 

  • C assisted P in sounding out words of items she wanted.

 

 

SESSION 21:

  • There was a break of 1 month between Session 20 and 21.

 

  • The following changes in intervention plans had been made noted for Session 21 in Session 20 notes.

– include word music in interventions

– include numbers and words for the numbers in modeling

– include written words on Flash Cards

 

– C reported that P

  • was excited to return to therapy after a 1 month hiatus
  • displayed decreased attention, perhaps due to her excitement
  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.
  • indicated that she wanted to play an instrument by herself by producing a 3 word phrase
  • enjoyed playing with the bubbles

¶ when playing with the bubbles attempted to say “pop.”

 

 

TREATMENT SESSIONS (SESSIONS 22-24): TERMINATION

 

 

SESSION 22:

  • C added a new song: the “Easter” song that was paired “with interactive aids” (p. 114.)

 

 

SESSION 23

  • C used the bubble activity as a reward.

 

 

SESSION 24:

  • This was the final session

 

 

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