The late eight [Third edition.] 9781944883034, 1944883037

Citation preview

The Late Eight Third Edition

The Late Eight Third Edition

Ken M. Bleile, PhD

5521 Ruffin Road San Diego, CA 92123 e-mail: [email protected] website: http://www.pluralpublishing.com

Copyright © 2018 by Plural Publishing, Inc. Typeset in 11/13 Garamond by Flanagan’s Publishing Services, Inc. Printed in the United States of America by McNaughton & Gunn All rights, including that of translation, reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, including photocopying, recording, taping, Web distribution, or information storage and retrieval systems without the prior written consent of the publisher. For permission to use material from this text, contact us by Telephone:  (866) 758-7251 Fax:  (888) 758-7255 e-mail: [email protected] Every attempt has been made to contact the copyright holders for material originally printed in another source. If any have been inadvertently overlooked, the publishers will gladly make the necessary arrangements at the first opportunity.

Library of Congress Cataloging-in-Publication Data Names: Bleile, Ken Mitchell, author. Title: The late eight / Ken M. Bleile. Description: Third edition. | San Diego, CA : Plural Publishing, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2017030954| ISBN 9781944883034 (alk. paper) | ISBN 1944883037 (alk. paper) Subjects: | MESH: Articulation Disorders — diagnosis | Articulation Disorders — therapy | Speech Articulation Tests | Language Development Classification: LCC RC424.7 | NLM WL 340.2 | DDC 616.85/5 — dc23 LC record available at https://lccn.loc.gov/2017030954

Contents Preface vii Contributors ix

Part I.  New Essentials Chapter One A Late 8 Update

3

Ken M. Bleile Chapter Two

Using Evidence to Guide Clinical Practice: Considerations for the Late Eight

37

Lauren K. Nelson Chapter Three

The Late Eight en español

59

Lindsey R. Leacox Chapter Four

Speech Sound Disorders, Literacy, and Curriculum

93

Jennifer Walz Garrett Chapter Five

Motor Learning Guided Therapy

107

Carlin Hageman

Part II.  Clinical Resources Chapter Six Overview 131 Chapter Seven [θ] 153 Chapter Eight [ð] 179 Chapter Nine [s] 197 Chapter Ten [z] 255 Chapter Eleven [l] 277 Chapter Twelve Vocalic [r] 319 Chapter Thirteen

Consonantal [r]

345 Chapter Fourteen [ ʃ ] 393 Chapter Fifteen [tʃ ] 417 Chapter Sixteen Evaluation and Treatment: An Illustration 439 v

vi

The late eight

Appendix A. Language Activities 453 Appendix B. Quick Guide to Resources 457 Index 459

Preface The first edition of The Late Eight provided clinical resources to help clinicians and students evaluate and treat late-acquired sounds. I likened the resources to all-purpose tools —  the clinical equivalents of a carpenter’s hammers, screwdrivers, bolts, paintbrushes, and ladder. The third edition keeps (and slightly modifies) the clinical resources while expanding the tool kit to include new essential clinical concepts, including evidence-based practice, Spanish-influenced English, the curriculum, and a new treatment model. Chapter 1, A Late 8 Update, offers short question-and-answer sections on 18 clinical topics, ranging from practical issues (Any suggestions for practicing speech?) to thoughts on current controversies (Do the Late 8 belong in school? Is there a best age to begin speech treatment?). Chapter 2, Using Evidence to Guide Clinical Practice, describes tools to discover the evidence base for evaluating and treating late-acquired sounds. Chapter 3, Late Eight en español, is the first chapter in our professional literature to focus exclusively on late-acquired sounds in Spanish-speaking students. Chapter 4, Speech Sound Disorders, Literacy, and Curriculum, demonstrates the importance of speech treatment in school settings. Chapter 5, Motor Learning Guided Therapy, which appeared in the second edition, shows principles that underlie decisions within an exciting new clinical approach. Along with the new chapters, the third edition replaces the CD of previous editions with an expanded and flexible interactive companion website. The authors of the third edition hope you find these changes beneficial in your clinical work with your students. Ken M. Bleile April 2017

vii

Contributors Ken M. Bleile, PhD Professor Communication Sciences and Disorders University of Northern Iowa Cedar Falls, Iowa Chapter 1 and Part II Jennifer Walz Garrett, PhD Associate Professor Communication Sciences and Disorders University of Northern Iowa Cedar Falls, Iowa Chapter 4 Carlin Hageman, PhD Professor Emeritus ASHA Fellow Communication Sciences and Disorders University of Northern Iowa Cedar Falls, Iowa Chapter 5 Lindsey R. Leacox, PhD Assistant Professor Communication Sciences and Disorders University of Northern Iowa Cedar Falls, Iowa Chapter 3 Lauren K. Nelson, PhD Associate Professor and Head Communication Sciences and Disorders University of Northern Iowa Cedar Falls, Iowa Chapter 2

ix

Part I

New Essentials

Chapter One

A Late 8 Update Ken M. Bleile

This chapter discusses frequently asked questions about the Late 8. Topics range from practical concerns (What are good phonetic placement and shaping techniques for [r]?) to theoretical issues (Do the Late 8 belong in school?). You can read the questions either in sequence or individually. The format for discussion of each topic is the same: question, short answer, discussion — sometimes brief, other times longer — followed by a brief summary. Questions: n What are the Late 8? n Why are the Late 8 late? n Do the Late 8 belong in school? n Should a clinician treat the Late 8 using an articulation approach? n What major speech errors affect the Late 8? n Any suggestions for practicing speech? n What if a production is not quite right? n Is there a best age to begin speech treatment? n What are key environments? n Should a student with good speech perception receive discrimination

training? n What are phonetic placement and shaping techniques? n What are good phonetic placement and shaping techniques for [r]? n Are non-speech oral motor exercises different than phonetic place-

ment and shaping? n How many sounds can I treat in a session? n Should a clinician provide treatment for a stimulable

3

sound?

4

The late eight n What if you hear n Any therapy tips

something but aren’t sure how to transcribe it? for a speech-language pathologist (SLP) student or

a new clinician? is the most important reason a person improves in treatment?

n What

For convenience, here is the same list divided by the nature of the question: practical or conceptual. Primarily Practical Questions: n What major speech errors affect the Late 8? n Any suggestions for practicing speech? n What if a production is not quite right? n What are key environments? n What are good phonetic placement and shaping techniques for [r]? n How many sounds can I treat in a session? n What about if you hear something but aren’t sure how to transcribe it? n Any therapy tips for an SLP student or a new clinician?

Primarily Conceptual Questions: n What are the Late 8? n Why are the Late 8 late? n Do the Late 8 belong in school? n Should a clinician treat the Late 8 using an articulation approach? n Is there a best age to begin speech treatment? n Should a student with good speech perception receive discrimination

training? n What are phonetic placement and shaping techniques? n Are non-speech oral motor exercises different than phonetic

place-

ment and shaping? n Should a clinician provide treatment for a stimulable sound? n What is the most important reason a person improves in treatment?

What are the Late 8? Short Answer [θ ð s z l r S tS ]. The Late 8 are the last eight English consonants acquired by first language learners, and among the consonants most likely to present challenges to second language learners. Discussion The above list is a reanalysis of the Iowa articulation norms project and its Nebraska replication (Smit, Hand, Frelinger, Bernthal, & Byrd, 1990). Within

5

CHAPTER 1: A Late 8 Update

this reanalysis, Late 8 consonants are those acquired by 50% of students at 5 years or older. More technically, Late 8 consonants are those acquired by 50% of subjects of both genders at an age (and never by less than 50% of subjects at a later age). The results are similar, though not identical, to those found in studies of other varieties of English (McLeod, 2002) and in languages other than English (McLeod, 2011). This book also discusses vocalic [r], which, of course (as the word vocalic suggests). is not a consonant. Vocalic [r] is included because, like the Late 8, students sometimes acquire vocalic [r] during the school years. A more accurate title for this book is The Late 8 + 1. Summary In this book the Late 8 are [θ ð s z l r S tS ]. Information on vocalic [r] is included because clinicians frequently teach that sound alongside the Late 8.

Why are the Late 8 late? Short Answer Too many consonants, not enough mouth. Discussion A table and a concept help explain why these eight consonants are late. Table 1–1 shows English consonants typically acquired by children 24 months or younger. The table lists sound classes from most closed (no distance between articulators) to most open (the most distance between articulators). Table 1–1.  Early Acquired Consonants Arranged by Degree of Closure Most Closed Stops

b  d  g  p  t  k  m  n  ŋ

Affricates Fricatives Liquids Glides

h  w  j Most Open

6

The late eight

Viewed this way, children prefer (or at least acquire at an earlier age) consonants with complete closure of the articulators (stops) or with the articulators spread as wide as possible (glides). That is, if consonant classes are viewed as falling on a continuum from most closed to most open, children’s early consonants occur at the ends of the continuum. Midpoint consonant classes (affricates, fricatives, liquids) are later acquisitions. In all the languages with which I am familiar, children typically acquire endpoints (stops and glides) before midpoints (McLeod, 2007, 2011). What is striking is that the Late 8 are all “midway” sounds — that is, they are consonants produced midway from most closed (stops) to most open (glides). [tS ] begins as a stop and ends with friction. [θ ð s z S ] are made with friction throughout, and [l r] are made with less closure than fricatives, resulting in a kind of liquid turbulence in the air. As Table 1–2 shows, being a midway sound is not sufficient to make a sound a late acquisition (for example, [f] is a relatively early acquisition in English). In other words, the pattern is that all the Late 8 are midway sounds but that being a midway sound is not sufficient to make a consonant a late acquisition. Summary The Late 8 are midway consonants made with the mouth with the articulators either farther apart (glides) or entirely touching (oral and nasal stops).

Do the Late 8 belong in school? Short Answer Yes, because treatment of the Late 8 is important educationally, socially, and economically. Table 1–2.  Consonants Arranged by Degree of Closure (Late 8 Underlined) Most Closed Stops

b  d  g  p  t  k  m  n  ŋ

Affricates

tS  dZ

Fricatives

f  v  θ  ð  s  z S

Liquids

l  r

Glides

h  w  j Most Open

CHAPTER 1: A Late 8 Update

7

Discussion Speech sound disorders are frequently occurring, which makes their care expensive and time-consuming. A generation ago, school districts often asked, why treat speech sound disorders when other children have broader developmental needs? A question being asked more frequently today is, why treat speech when schools struggle to meet new curriculum standards? Questions such as these often pit one group of children with developmental difficulties against other groups, while also pitting a family’s legal right to developmental services against the need of society to pay for services. Six Reasons At least six reasons support why we should not let the Late 8 become school dropouts: 1. Speech sound disorders are the world’s most frequently occurring communication disorder.  Speech sound disorders account for 32% of all communication disorders (Slater, 1992). For 80% of children with speech disorders, the impairment is sufficiently severe to require clinical treatment (Gierut, 1998). Approximately 6% of students in grades 1 to 12 experience speech sound disorders (American Speech-LanguageHearing Association, 2006; Law, Boyle, Harris, Harkness, & Nye, 2000). The disorder appears to be approximately 1.5 times more prevalent in boys (4.5%) than in girls (3.8%) (Shriberg & Tomblin, 1999). As discussed in Chapter 3, the Late 8 also may pose special difficulties for those learning English as a non-native language. Fully 20% of school-aged students speak a language other than English at home, the largest group being Spanish speakers (National Center for Educational Statistics, 2002). To illustrate, in Des Moines, the capital of a largely agricultural state in the Midwestern U.S., approximately 16% of students are non-English speakers, and speak 80 different languages (Iowa Department of Education, 2011b). 2. Speech sound disorders affect a student’s education.  Speech sound disorders may affect a student’s ability to communicate with peers and teachers. Additionally, even single sound errors, which may not interfere with intelligibility or reading success, gain in importance as a student transitions through school and, after completing school, seeks employment (Felsenfeld, Broen, & McGue, 1994; Van Dyke & Holte, 2003). 3. Speech contributes to school success. Success in treating speech sound disorders contributes to school success in the following areas of a core curriculum: speaking and listening, language and reading, science, and social interactions (Iowa Department of Education, 2011a). Chapter 4 on language contains more information on the link between speech and the curriculum.

8

The late eight

4. Students with speech sound disorders are at risk for educational failure. Approximately 11 to 15% of 6-year-old students with speech sound disorders also experience specific language impairment (Shriberg & Tomblin, 1999) — 50 to 70% of students with speech disorders experience general academic difficulty through high school (Felsenfeld, Broen, & McGue, 1994; Gierut, 1998; Lewis, Freebairn, & Taylor, 2000; Pennington & Bishop, 2009; Shriberg & Austin, 1998). 5. Teachers may view students with speech disorders negatively. Even when students with speech sound disorders are without academic difficulties, at least one third of grade school teachers perceive them as having less academic potential (Overby, Carrell, & Bernthal, 2007). 6. Students with speech sound disorders may be bullied and enjoy school less.  Students with communication disorders (including speech sound disorders) are more likely than other students to be bullied, experience poorer peer relationships, and enjoy school less (McCormack, Harrison, McLeod, & McAllister, 2011). Summary Difficulty with late acquired sounds is the world’s most frequently occurring communication disorder, affecting both children and adults learning English as a non-native language. The school is the natural habitat for the treatment of the Late 8 because speech contributes to school success and problems in speech may result in school difficulties, both academically and socially. Because of the close relationship between speech sound disorders and educational success, in treating the Late 8 the goal is speech, the avenue is language, and the vehicle is the curriculum.

Should a clinician treat the Late 8 using an articulation approach? Short Answer Not necessarily. Discussion On first consideration, it may seem that treatment of the Late 8 lends itself to an articulatory approach, since midpoint sounds appear harder for children to pronounce than those on either end of the continuum (see question Why are the Late 8 late?). However, this view does not do justice to the complexity of treating a person with a developmental difficulty, including those in the speech area.

CHAPTER 1: A Late 8 Update

9

The difficulty with providing articulatory treatment for an articulation problem is that it requires a clinician to think of speech treatment as a type of pill. With a pill, a clinician diagnoses a problem and gives a pill to fix the difficulty. If a clinician considers speech treatment this way, a student with an articulation problem receives an articulation approach pill. Alternatively, a student with a phonological problem receives a phonological approach pill. The trouble is that many times treatment does not act like a pill. For example: n A

student experiences an articulation problem but improves because she finds the language activities engaging. n A student experiences a phonological problem but improves because he wants to impress the clinician (or maybe a girl). n A student improves because she is ready to work on speech issues. These examples suggest that speech treatment requires a clinician to consider more than the cause of a student’s speech problem. At least three variables affect a clinician’s decision regarding a treatment approach: C (cause), C (communication), and P (person). Cause This is the pill-like aspect of speech treatment: diagnosing a student’s speech difficulty and developing a treatment approach designed to remediate the deficit area. To illustrate, based on a careful assessment, a clinician may diagnose that a student’s difficulty with [s] arises because he produces the sound by creating a constriction with the tongue blade instead of the tongue tip. The treatment approach might have as its goal to help a student pronounce [s] with the tongue tip. Communication Speech treatment entails not simply knowing a problem’s cause, but also understanding how the difficulty affects communication. Speech for communication requires both language knowledge (phonology) and production ability (articulation). To give just one illustration, a student who communicates through speech needs to know the role of [s] in language as well as how to perceive and move the articulators in such a way to produce [s]. Because the ultimate goal of speech treatment is to improve communication, speech treatment benefits from inclusion of both speech components, articulation and phonology. Articulation provides the motor practice necessary for speech to occur; phonology provides the links from the articulatory system to the language system, which in turn makes it possible for a student to function socially and educationally. To give an analogy: without language, speech is like a train that travels fast but has no place of arrival; speech

10

The late eight

without the articulation component is like knowing the destination you want to reach but not having a vehicle to get there. Person Attached to every speech difficulty is a real person. Along with cause and communication, success or failure in speech treatment also depends on person variables, including a student’s interests, motivation, language abilities, views about speech therapy, peer relations, and personality. And, of course, along with the student comes family, the school, and race/ethnicity. Summary Speech treatment is more complex than selecting to administer either an articulation or a phonology pill. Because speech is a motor skill, speech treatment typically benefits from extensive opportunities to practice speech. Because speech is also part of language, speech treatment benefits from opportunities to develop language and literacy. And because a real person is attached to the speech disorder, speech treatment benefits from lessons that students find motivating and interesting. Practically, this means a clinician needs to consider not only the reason(s) a student experiences a speech problem, but also ways to motivate and generalize speech change. Sometimes the cause of the speech difficulty and the approach that motivates change may be one and the same, as when — for example — a student with articulation difficulty is motivated and is able to generalize success through drills. Many other times, however, treatment achieves great success when a clinician includes language and ties it to the school curriculum.

What major speech errors affect the Late 8? Short Answer The major errors are lip rounding, lisping, blading, and lateralization. Discussion Early speech errors tend to (though not always, of course) replace mid sounds with sounds on either end of the openness continuum (see question Why are the Late 8 late?). To illustrate, stops may replace [s] and other affricates, and glides may replace liquids. Later in development, even when students may produce midpoint sounds, they often produce them in differ-

CHAPTER 1: A Late 8 Update

11

ent ways, prominent productions being lip rounding, lisping, blading, and lateralization. Lip Rounding [r] is prone to being pronounced with lip rounding, sometimes called [w] coloring because it may sound like a cross between [r] and [w]. The usual transcription of lip rounding on [r] is a small w under the [r], like this: [ r ] Lisping [s] and [z] (and to a lesser extent other of the Late 8 as well) are prone to being pronounced with the tongue tip between the front teeth, similar or identical to [θ] or [ð]. The usual symbol for lisping is a small tooth under the sound, like this: [  ] Blading [s] and [z] (and to a lesser extent other of the Late 8 as well) are prone to being pronounced with the blade of the tongue body raised toward the roof of the mouth, giving it a [s] quality. The symbol for bladed is a small half circle (representing the roof of the mouth) under the sound, like this: [ ] Lateralization [s] and [z] (and, as above, to a lesser extent many other of the Late 8) are prone to being pronounced with the air flowing over the sides of the tongue rather than over its top. Lateralized sounds have an [l]-like quality, though the lateralization can sound bladed, especially if the lateralized sound is unvoiced. The symbol for lateralization is an [l] placed before the sound, like this: [ls] [] Summary The Late 8 are affected by many different speech errors. Highly frequent errors include lip rounding, lisping, blading, and lateralization.

Any suggestions for practicing speech? Short Answer A major challenge in practicing speech is to do it in a way to promote generalization to language, the curriculum, and other settings.

12

The late eight

Discussion Chapter 5 on motor learning contains excellent principles for helping students practice speech, and the Appendix contains a long list of language activities. Here are some additional commonsense speech practice principles: Speed Avoid having a student practice speech by saying sounds and words very slowly. Extremely slow speech employs feedback mechanisms not typically used in speech. Vowels Whenever possible, practice consonants in the context of vowels. People seldom speak consonants in isolation in everyday conversations. Dual Nature of Speech Speech is both a motor activity (articulation) and an aspect of language (phonology). Practice the mouth while you engage the mind. A good way to do this is through lots of speech practice during a session using languageand curriculum-based activities whenever possible. From Words to Conversation When possible, work on a treatment sound from the level of words to conversation. Those levels have functional value to a student; they promote generalization because students speak them outside of therapy, and they appear to be units of motor planning. Self-Monitoring Promote self-monitoring by not providing constant feedback. Rather than being the monitoring system, encourage a student to monitor his or her own speech. Self-Correction Provide opportunities for self-correction. Help students become aware of and practice techniques to correct their own speech. Introduce Distractions A student must learn to manage distractions when speaking, which can be challenging for any newly acquired skill. Ways to introduce distractions

CHAPTER 1: A Late 8 Update

13

range from throwing a ball back and forth while practicing speech, holding group treatment, having the student make oral reports to you containing the treatment sound, and providing treatment or generalization in the classroom. Communicative Value Help a student learn about the communicative value of a treatment sound through frequent use of minimal pairs, deletions, self-corrections, old way/ new, and similar sounds. Functional Activities Base treatment activities on a student’s interests, including, when appropriate, books, magazines, hobbies, and school or work assignments. People of Importance Keep people of importance in a student’s life informed about therapy and, if appropriate, provide them simple therapy activities in which they can participate. When to Dismiss Typically, a student should pronounce a treatment sound 90% correctly in short phrases and in conversation before dismissal. Follow-Up Whenever possible follow up after dismissal to make sure a student has not regressed in his or her speech. Summary The primary goal of speech practice is to bring students to a point where they no longer need speech practice. Students obtain this goal most readily with practice that actively promotes generalization to language, curriculum, and other settings.

What if a production is not quite right? Short Answer Think of “right” as being just one end of a scale.

14

The late eight

Discussion Whenever possible, treatment should avoid practicing a speech error — something the student probably already has lots of practice doing! Ideally, a sound should be entirely correct during practice. An analogy might be to suppose a coach wanted to teach a student a new tennis stroke. Ideally, the coach wants to establish the stroke perfectly and then engage in perfect practice. However, in both speech-language pathology and tennis, sometimes something less than ideal is accepted, and both a clinician and a coach may need to practice a skill that is better than before but still not perfect. For this reason, a “3,” “2,” “1” rather than a “correct/incorrect” system often proves useful. A student’s old speech pattern is a “3,” and the goal is to establish it as a “1” (perfect). However, in many instances a “3” does not automatically become “1,” and instead the student produces something like a “2” — a more correct version of the old pattern, but still not perfect. Speech treatment often contains many more “2”s than “1”s. While practicing a less than perfect sound, the student learns to make it a “1” through self-reflection activities and prompts. Summary A simple 1-2-3 scale usually is sufficient to describe clinical progress that has not yet reached the point where a production sounds entirely “right.”

Is there a best age to begin speech treatment? Short Answer When it comes to treating speech, earlier is generally better. Discussion Many factors contribute to a clinician’s decision regarding at which age or grade to begin speech treatment. To name just a few, these include caseload, needs of other clients, treatment philosophy, and school district rules. The present discussion focuses on linguistic and neurological variables. Evidence from at least five sources suggests that children acquire speech early and that the window of opportunity to treat speech disorders may be more open early in life: 1. Brain development 2. First language 3. Second language

CHAPTER 1: A Late 8 Update

15

4. Disability 5. Brain injury 1.  Brain Development Many essential aspects of brain development are “front loaded” to occur early in life, including: n Brain

weight, important for numerous brain functions, at birth is about 25% of adult brain weight and achieves 85% of its growth during the first three years (Dekaban & Sadowsky, 1978; Kretschmann, Kammradt, Krauthausen, Sauer, & Wingert, 1986). n Myelin sheaths, critical for motor movements, is 90% complete by one year, the remainder occurring up to young adulthood (Evans & Hutchins, 2002). n The hippocampus, an essential system for laying down new memories, achieves a mature number of synapses during the second year (Liston & Kagan, 2002). n The primary auditory cortex, essential for speech perception, is mature months before a child’s first birthday (Maurer, 2005; Pascallis, de Hann, & Nelson, 2002; Werker & Tees, 2005). n Broca’s area, centrally important to speech production, begins development during the second year and matures by 6 to 8 years of age (Schade & van Groenigen, 1961; Simonds & Scheibel, 1989). 2.  First Language Speech (even the Late 8) is the earliest acquired language area. These are the ages at which the Late 8 are acquired by fully 75% of students (Smit, Hand, Frelinger, Bernthal, & Byrd, 1990): n 5;0:  [s] and [S ] n 5;6: [ð] n 6;0: [θ], [z], [tS ],

[r], and [l]

Children acquire other areas of language form (morphology and syntax) several years later than speech, while semantics, pragmatics, and discourse are lifelong acquisitions. 3.  Second Language As a famous study of second language learning indicates (and as many adult second language learners will sadly attest), second languages are better learned younger than older ( Johnson & Newport, 1989). Grammatical proficiency begins high and remains so until around 7 years, when proficiency begins to decrease through the teenage years and into adulthood.

16

The late eight

4. Disability Studies of children with Down syndrome offer further evidence of the early acquisition of speech. As noted in several studies, children with Down syndrome may appear less intelligible at 10 years than when they were 5 (Miller, 1988, 1999). The explanation is that speech stops or slows in development around 5 years, while other areas of language continue to develop. As other areas develop — for example, a child develops a larger vocabulary and speaks in longer sentences — speech remains relatively unchanged, resulting in a child who sounds less intelligible when older than younger. 5.  Brain Injury Studies of language outcome in a severe form of injury highlights the great plasticity of the neocortex at younger ages. The surgery is hemispherectomy, which is removal of one hemisphere of the brain. The surgery is performed to alleviate otherwise intractable seizures. The classic condition for a hemispherectomy is Rasmussen encephalitis, an autoimmune disease that begins in one hemisphere before moving to the other hemisphere (Stark, Bleile, Brandt, Freeman, & Vining, 1995). Research suggests that outcome improves when children are younger (Stark, Bleile, Brandt, Freeman, & Vining, 1995). To illustrate, all other things being equal (though they seldom are), a child of 3 years who has his left hemisphere removed will have significantly better language outcome than a child of 7 or 8 years who has the same hemisphere removed. The child of 7 or 8 years will in turn likely have a better language outcome than a child who receives the surgery as an adolescent. Summary Evidence from many sources suggests that speech is an early developing system. As summarized in Table 1–3, because speech is an early acquisition, treatment begun as early as possible is likely to be more successful, suggesting the following general guidelines for when to begin speech treatment. The “best” is to begin treatment when the brain is engaged in that type of learning. The “next best” (and many times the more realistic) is to begin speech treatment close to the age at which speech slows in development. The second semester of kindergarten is a starting point to allow the new school social environment to impact speech. The “worrisome” age to begin is near 8, years after speech development has leveled off for many children and getting closer to adolescence, when development slows further. The “very worrisome” age to begin is adolescence, when speech and language development slow considerably. For some students, perforce speech treatment must wait until that age due to factors

CHAPTER 1: A Late 8 Update

17

Table 1–3.  Preferred Ages to Begin Treatment Best

Begin treatment before starting school

Next best

Begin treatment the second semester of kindergarten and, if needed, through first and second grades

Worrisome

Begin treatment after 8 years of age

Very worrisome

Begin treatment in middle school

such as availability of services, willingness to receive treatment, or maturity. Speech can still be learned at such an age (or at any age, for that matter), but the work can be more challenging.

What are key environments? Short Answer A key environment is a phonetic context that may increase the likelihood of pronouncing a sound correctly. Discussion Key environments are the mirror image of phonological processes. Phonological processes, derived originally from the cross-linguistic work of David Stampe and expanded through extensive research in child language, enumerate the phonetic “pitfalls” into which a child’s speech tends to fall. To illustrate, the processes of prevocalic voicing and final consonant deletion describe the phonetic tendency for consonants to be voiced before a vowel and voiceless at the end of a syllable, respectively. Another way to describe these phonetic tendencies (the mirror image of phonological processes) is this: vowels facilitate the voiced consonants that follow, and the end of syllables facilitates voiceless consonants. That is, if a student experiences difficulties producing a voiced consonant, it may facilitate treatment to introduce the voiced consonant before a vowel in the same syllable. Similarly, if a student experiences difficulties pronouncing a voiceless consonant, it may facilitate treatment to introduce it at the end of a syllable. In these and other key environments, the operative word is may. Like phonological processes, key environments describe phonetic tendencies, not rules that every student must follow. As such, key environments offer a phonetic context in which to introduce a treatment sound. The following show key environments for the Late 8 by syllable position and vowel influence.

18

The late eight

Syllable Position Beginning of Syllables.  The beginning of syllables and between vowels may

facilitate voiced Late 8 consonants. n [l] as in lake and alone n [r] as in run and around n [ð] as in those and weather n [z] as in zee and a zee

End of Syllables. The end of a syllable may facilitate voiceless Late 8

consonants. n [s] as in bus n [tò] as in batch n [s] as in fish n [θ] as in teeth

Consonant Clusters.  Consonant clusters may facilitate at least three Late 8

consonants. n [s] next to [t] as in steep, pizza, beats n [z] after [d] as in beads n [r] after [t] or [k] as in tree or creek

Ambisyllabic.  A two-syllable sequence in which the first syllable ends with

the late consonant and the second syllable begins with a vowel may facilitate all Late 8 consonants. For example, n [s] n [z]

as in this is as in buzz it

Vowel Influences High Front Vowels.  Production of Late 8 consonants produced near the alveolar area is facilitated by high front vowels. n [θ] as in thin n [ð] as in these n [s] as in see n [z] as in zip n [r] as in read n Light [l] as in leaf

High Back Vowels.  Production of Late 8 consonants produced in the back of the mouth is facilitated by high back vowels.

CHAPTER 1: A Late 8 Update

19

n [tS ] as in chew n [ S ] as in shoe n Dark [l] as in cool

Summary Key environments are the mirror image of phonological processes. Key environments derive from the same cross-linguistic and child language research as phonological processes, differing from phonological processes only in that their focus is phonetic contexts that may facilitate, rather than hinder, speech production. Table 1–4 summarizes key environments for the Late 8, organized by individual sound.

Table 1–4.  Key Environments for Individual Consonants

[θ]

End of a syllable, as in teeth Before a high front vowel, as in thin

[ð]

Beginning of syllable and between vowels, as in the and weather Before a high front vowel, as in these

[s]

End of syllables, as in bus Next to [t], as in steep, pizza, beats Next to high front vowels, as in see

[z]

Beginning of syllable and between vowels, as in zee and a zee Before a high front vowel, as in zip In consonant clusters after [d], as in beads

[l]

Beginning of syllable and between vowels, as in lake and alone Light [l] before a high front vowel, as in leaf Dark [l] after a high back vowel at the end of a syllable, as in cool

[r]

Before a high front vowel, as in read Beginning of syllable and between vowels, as in row and teary In a consonant cluster with [t] or [k], as in tree or creek

[tS ]

End of a syllable, as in batch By a high back vowel, as in chew

[ S ]

End of a syllable, as in fish By a high back vowel, as in shoe

20

The late eight

Should a student with good speech perception receive discrimination training? Short Answer Yes, because speech discrimination and speech perception are unrelated. Discussion Discrimination training derives from the observation that many children appear not to realize they are making speech errors. A classic illustration is a student who says rabbit as wabbit. The speech pathologist asks, do you know you said rabbit as wabbit? And the student answers, No I didn’t. I said wabbit as wabbit. Traditional Approach Traditionally, researchers believed problems in the speech perception system caused discrimination difficulties, suggesting a student’s discrimination difficulty lies in the auditory system’s inability to distinguish between sounds. Within a traditional approach, the goal of traditional discrimination training is to train the auditory system to hear a difference between sounds, after which production training can commence. Traditional techniques to improve discrimination include ear training (“raise your hand when you hear our treatment sound”), sometimes accompanied by mirror work, descriptions of the speech sound, and speech demonstrations. Researchers have learned a great deal about the development of the speech perception system since the 1930s through 1950s, casting doubt on the traditional perspective. Current research strongly suggests that the auditory system, in common with other sensory systems, matures early and has adultlike capacities very early in life — before the end of a child’s first year (Casey, Gledd, & Thomas, 2000; Maurer, 2005; Pascallis, de Haan, & Nelson, 2002; Werker & Tees, 2005). The early maturity of the primary auditory cortex provides a reliable means through which information about speech and language reaches the higher cognitive areas of an infant’s brain. If primary auditory cortex sustained damage sufficient to disrupt this function, the resulting difficulties would be far more extensive and disruptive than, for example, an isolated difficulty distinguishing between [w] and [r]. A Cognitive Explanation If a student has a normal speech perception system, why would he or she fail to perceive that he or she pronounces, for example, rabbit as wabbit?

CHAPTER 1: A Late 8 Update

21

The answer may be that students both with and without speech difficulties typically give little attention to their speech. The only difference between the two is that we notice the lack of attention in students with speech difficulties because their speech problem shines a light on their inattention. Attention Not paying attention to our speech is normal. To give just a few illustrations, few people (other than speech-language pathologists) are aware that when someone says [p] in consonant clusters, such as in spy, the sound is voiceless and unaspirated, similar to a sound in Thai, while [p] beginning words such as pie is aspirated. Similarly, few people realize that they pronounce [r] in pride with little or no voicing, and typically pronounce [r] in bride with voicing throughout. We fail to perceive these speech variations not because our auditory mechanism is broken, but because we focus our attention on communication. Considered in this way, students’ “discrimination problems” may be difficulty with awareness, implying that the therapeutic challenge is to focus a student’s attention on the difference between an intended pronunciation and the actual sound that comes out of the mouth. An awareness exercise is a little verbal tap on the shoulder to say, “Remember what sound you are working on. Focus on what you are doing.” Clinical Differences This difference in perspective between a traditional and a cognitive approach to discrimination leads to at least three differences in treatment. 1. A Population Difference.  Within a traditional perspective, treatment of discrimination typically is restricted to students who demonstrate discrimination difficulties — that is, the wabbit students who, for example, pronounce rabbit as wabbit without realizing they are pronouncing [r] as [w]. Within a cognitive perspective, the expectation is that people experience difficulties focusing on speech. For this reason, almost all students with speech problems may benefit from little reminders that say, in effect, “Yo, pay attention: this is what we’re working on.” 2. A When Difference.  Within a traditional perspective, a clinician undertakes discrimination activities at the beginning of treatment prior to working on speech production. Within a cognitive perspective, discrimination training occurs throughout treatment, concurrent with practicing speech production. 3. A How Difference.  Within a traditional perspective, identification activities are the most common way to help a student learn to discriminate between sounds, perhaps supplemented or expanded on through activities that draw a student’s attention to his/her speech, including:

22

The late eight n Metaphors n

Touch cues

n Mirrors n Descriptions n Demonstrations n

Phonetic placement and shaping

These are also excellent tools within a cognitive perspective and have wide uses in many activities in this book. Less traditionally, activities that promote language and reading also help focus a student on speech, including: n Minimal pairs n Deletions n Self-correction n Old way/new way n Similar sound

The Appendix contains a lengthy list of language-based activities to promote speech awareness. Lastly, distraction tasks can introduce a student to the challenge of keeping a focus on newly acquired speech skills outside of the treatment room. Numerous types of distractions are possible; several that come readily to mind are: n Standing on one foot while talking n Talking while throwing a ball back n Practicing a speech

and forth

Summary Discrimination problems arise from a normal cognitive process, not a broken speech perception system. The challenge of awareness training is to help students recognize that what they intend to say differs from what comes out of their mouths.

What are phonetic placement and shaping techniques? Short Answer Phonetic placement and shaping techniques convert a non-stimulable sound into a stimulable sound. Phonetic placement uses articulatory postures (typically, tongue and lip positions). Shaping relies on a sound a student can already produce (either a speech error or another sound).

CHAPTER 1: A Late 8 Update

23

Discussion The following examples illustrate a phonetic placement technique for [k] followed by a shaping technique for [s]. Placement Example:  [k] This (or one of its many variants) is a popular technique to establish [k]. 1. Ask the student to place the tongue tip behind the lower front teeth. (If needed, a clinician can use a tongue depressor to keep the tongue in place.) 2. Ask the student to hump the back of the tongue and say [ku]. Shaping [ S ] to [s] This phonetically clever shaping technique shows that sometimes a smile is all you need. 1. Instruct the student to say [S]. 2. Ask the student to retract his or her lips into a smile. Often, this results in the tongue moving forward slightly into the position for [s]. If needed, however, instruct the student to move the tongue slightly forward. The resulting sound is [s]. Summary Phonetic placement and shaping are techniques to convert a non-stimulable sound into a stimulable sound.

What are good phonetic placement and shaping techniques for [r]? Short Answer Many good techniques exist. The website for this book lists over one hundred phonetic placement and shaping techniques, including dozens for [r] and vocalic [r]. Discussion I receive more questions about phonetic placement and shaping of [r] than any other sound. I do not believe one single best technique exists: there exist

24

The late eight

multiple ways to produce a sound and there are too many different studentlearning portraits for there to be “a best technique for everyone.” Here is my personal list of favorite techniques: Shaping of [k] to [2] Based on my very informal polling of clinicians, this is the most widely used technique to establish vocalic [r]. 1. Instruct the student to lower the tongue tip. 2. Ask the student to raise up the back of the tongue as for a silent [k]. 3. Ask the student to make the sides of the back of the tongue touch the insides of the back teeth. 4. Ask the student to turn on the voice box, resulting in [2] or another vocalic [r]. Phonetic Placement of Vocalic [r] This technique is simple and clever. 1. Instruct the student to lie on his/her back, relax the mouth, and say [2] or another vocalic [r]. Shaping [2] to [r] This technique relies on the phonetic tendency in two syllable sequences such as it is for the final consonant in the first syllable to migrate to begin the second syllable, if the second syllable begins with a vowel. This tendency explains why a phrase such as it is is often pronounced i tis. The technique is useful because it provides a clever way to help a student convert the ability to make a syllable final sound into a syllable initial one. 1. Ask the student to say [2]. 2. Next, ask the student to say [2] followed by [i] or some other vowel. 3. Instruct the student to say [2i] several times as quickly as possible, resulting in [2ri]. After [2ri] is established, instruct the student to say [2] silently, resulting in [ri]. Phonetic Placement of [r] The first technique is for retroflex [r] and the second for bunched [r]. Both variants contain the following steps: 1. Tuck the chin 2. Make a grin

CHAPTER 1: A Late 8 Update

25

3. Tongue in track 4. Curl it back The components are: n A relaxed tongue resting on the floor of the mouth (tuck the chin) n Spread lips (make a grin) n Position the tongue so its sides rest against the insides of the lower

teeth (tongue in track) n Curl the tongue tip back (curl it back) For bunched [r], instruct the student to place the sides of the tongue in the track between the upper teeth and then curve the tongue tip down behind the lower front teeth. Summary Dozens of techniques exist to place or shape [r]. There is no “best” technique for everyone. Instead, clinicians find techniques that fit their clinical style and training and that work for clients.

Are non-speech oral motor approaches the same as phonetic placement and shaping? Short Answer The two are not the same. Discussion Non-speech oral motor approaches attempt to strengthen and improve flexibility of articulators, the idea being that such exercises will result in improved speech. Sometimes such approaches cite phonetic placement and shaping as support. Differences Though superficially similar, phonetic placement and shaping techniques and non-speech oral motor approaches are unrelated. Phonetic placement shaping converts a non-stimulable sound into a stimulable one; non-speech oral motor approaches replace speech treatment with exercises to strengthen and improve flexibility of the articulators. Phonetic placement and shaping

26

The late eight

techniques have a long clinical history of helping clinicians. On the other hand, clinical testimonials to the utility of non-speech oral motor approaches aside, multiple research studies strongly suggest that non-speech oral motor approaches are based on faulty empirical and theoretical foundations (Clark, 2003; Lass & Pannback, 2008; Lof, 2009; Muttiah, Georges, & Brackenbury, 2011; Powell, 2009; Ruscello, 2008). Testimonials How can clinical testimonials exist that attest that students improve in speech using non-speech oral motor approaches if clinical research strongly suggests that non-speech oral motor approaches rely on faulty empirical and theoretical foundations? The answer may lie in testimonials, which highlight an important truth about treatment: when a student improves, it is notoriously difficult to determine why he or she improved. Any treatment approach contains multiple components, including the theory behind the approach, the student, the setting, the clinician’s treatment skills, time of day, etc. Careful research is required to determine how the many components in any given approach alone or in conjunction with each other result in treatment change. For this reason, testimonials are better at telling you “a student got better” than telling you why a student got better. Summary Phonetic placement and shaping do not strengthen or improve muscle tone, and they do not lend support to non-speech oral motor approaches. Research supports the position that non-speech oral motor approaches have faulty theoretical and research foundations. The topic of non-speech oral motor approaches highlights the idea that testimonials are better at telling you a student got better than telling you why a student got better.

How many sounds can I treat in a session? Short Answer As in many treatment areas, the answer depends in large measure on whom you are treating. Discussion An assessment typically yields one or more possible treatment sounds, which raises the following questions:

CHAPTER 1: A Late 8 Update

27

n If

a student’s speech contains more than one possibility, which sound to select? n Should one sound be worked on to completion and then another? n Should a clinician work on two sounds simultaneously, changing from one to another in the same treatment session or in alternate sessions? n Does working on two or more treatment sounds confuse a student? My view is that answers to these questions have more to do with human variables than linguistic ones. Some students — especially older ones — can work on a sound from beginning to completion, while others benefit from alternating between sounds, sometimes within a single treatment session or in alternate sessions. A useful dynamic assessment is to initially select several treatment sounds, alternating between them either in a single session or in alternate sessions, and then reevaluate the choice after several treatment sessions. Summary No single answer holds for everyone. As with many aspects of the clinical enterprise, clinical judgment is (and should be) the final arbitrator of how many sounds to treat.

Should a clinician provide treatment for a stimulable sound? Short Answer Importantly (though not surprisingly), it depends on the student. Discussion Stimulability is an old word — circa 1930s — that means capacity. If a student is stimulable for a sound, he or she demonstrates capacity to pronounce it. Debate exists (sometimes carried out with something approaching religious intensity) concerning whether a clinician should select a treatment sound for which a student is stimulable — that is, whether to select to treat a sound for which a student already shows some capacity to produce in limited circumstances. The Positions The logic of selecting a stimulable treatment sound is that a student experiences less frustration because he or she begins with some capacity to pronounce it. Another reason to select a stimulable sound is that a student is

28

The late eight

practicing success during treatment because he or she can already pronounce it correctly. The logic for selecting a non-stimulable sound for treatment is that the student learns more by selecting treatment sounds different from those sounds the student can produce. Also, a student may acquire a stimulable sound without treatment, since the sound already is being pronounced correctly in some contexts. What the Research Says Research does not offer an unequivocal resolution to the stimulability question. Studies exist that support both positions (Dietrich, 1983; Gierut, 1998; Powell, 1991; Powell, Elbert, & Dinnsen, 1991; Shine, 1989). Often, in the same study some students appear to self-correct a stimulable sound without treatment, while others require speech treatment. A Hypothesis My hypothesis (and I believe that of many clinicians) is that stimulability is more a “person decision” than a “linguistic decision.” That is, person factors may be the most important variable in deciding whether to treat a stimulable sound, including a student’s age, maturity, attention, cognitive skills, and ability to tolerate failure. In tacit recognition of the importance of human variables, most clinicians select a stimulable sound with a younger student with less tolerance for failure. They may first treat a stimulable sound to build a student’s confidence and sense of success, and later work on non-stimulable sounds. Selecting a stimulable sound may not be an option for an older school-aged student or an adult learning a second language. In such situations, perforce a clinician must select a non-stimulable sound. An alternative to accepting one or the other position is to be your own researcher, experimenting with different perspectives. Perhaps you will find that you have more success with non-stimulable sounds than reported by some, or perhaps you will have less. Or maybe you will discover which students on your caseload seem to require a treatment sound that is stimulable and which do not. No matter what you discover, experimenting with different approaches may yield important insights about what works best for you and the students you serve. Summary The stimulability question highlights the difficulty in analyzing speech without also considering the person who has the speech problem. One size does not fit all when it comes to stimulability: not all students with stimulable sounds improve without treatment.

CHAPTER 1: A Late 8 Update

29

What if you hear something but aren’t sure how to transcribe it? Short Answer Welcome to my life. Discussion Sometimes a clinician hears a sound in a student’s speech but isn’t sure how to transcribe it. This may happen particularly often with a new student, leading a clinician to listen and wonder, What is going on? It doesn’t quite sound lateral and it’s not quite bladed. Is it both bladed and lateralized or something else altogether? In this situation, the first task is to attune yourself to the speech error. A quick review of the errors often affecting the Late 8 may help. Deciding what symbol or diacritic to address is a secondary problem after you determine how the student is producing the sound. Until then, a simple technique is to place an X under the sound the student is attempting. For example, if the student produces the first sound in sun in a difficult-to-determine-exactlywhat-he’s-doing way, transcribe the [s] with a small X underneath. At this point the X simply means that the student is saying [s] in a way you haven’t yet identified. Basically, X = I’m not sure how the student is producing the [s]. During treatment, as you become more familiar with the student, you are likely to figure out what the student is doing to make [s] sound the way it does. For example, you may think to yourself, Oh. [s] is kind of lateral on the left side of the tongue, and it sounds wet because of excess saliva. At this point, you define X, maybe placing at the top of your transcription, X = left side tongue lateral, wet. Summary X is a very useful diacritic in situations in which a clinician is not quite certain how to transcribe a student’s speech.

Any therapy tips for an SLP student or a new clinician? Short Answer Over the years, I have had the pleasure to supervise many students and new clinicians. The following distills what I have learned from watching the progression of their clinical skills.

30

The late eight

Discussion Here are general principles that I follow in clinical work: Recipes No single therapy technique is right for everyone. Instead of having “one recipe for all occasions,” think of therapy techniques as an index box filled with ideas that you select from, add to, and modify to fit the needs of an individual student. To continue the cooking analogy maybe a little too far, a newer chef is likely to reply on one or a few basic recipes, since that is a quick way to become competent. With experience, a chef relies on more and varied recipes, as he or she becomes more flexible with experience. Functional Activities One functional activity is worth a hundred games. Books, class assignments, and newspapers are just a few materials that facilitate learning while facilitating speech. Let a student know why he or she is there Talk openly and respectfully to a student about his or her speech. A student needs to understand why he or she is in therapy to improve. Don’t let a student’s speech difficulty become “the elephant in the room” that no one mentions. Success A student needs to feel success. In general, if a student is not successful from 50 to 70% on an activity, consider changing the activity. Keep It Fun Be interesting and energetic in therapy. If you have fun, a student is more apt to have fun, too. But while having fun, remember that games and entertaining activities are tools and that the purpose of therapy is to improve a student’s speech. Summary In summary, these are my suggestions to new clinicians: n Move

from reliance on one or a few recipes to flexible approaches as soon as you feel comfortable.

31

CHAPTER 1: A Late 8 Update n Make activities functional whenever possible. n Work to improve your student’s speech awareness. n Maintain a high level of success. n Make therapy fun, while keeping in mind that the

purpose of treat-

ment is to improve speech..

What is the most important reason a person improves in treatment? Short Answer One factor stands out above the others. Discussion One of the most essential clinical questions is, why do people improve in treatment? Though recognizing that a student’s improvement in treatment probably depends on multiple interacting factors (including motivation, a clinician’s skills, the treatment approach, family involvement, treatment frequency, etc.), several researchers in psychology have focused on two variables, asking, what is the major driver of clinical success, the clinician or the approach? (Lambert, 2004; Staines, 2008). Approach or Clinician? The question of clinician or approach is important, because, depending on how you answer it, a profession does very different things. If the approach is primary, a profession asks how best to teach a student or clinician to understand and execute the approach. The research literature suggests that this is the dominant perspective in our profession. Alternatively, if a profession believes the clinician is primary, it asks different questions, including: n What is the clinician doing to result in clinical n What motivates students to learn? n How does a clinician develop, maintain, and

success?

expand good clinical judgment? n What role does size of caseload play? Experience? Personality? Research A general finding from Beutler, Malik, Alimohamed, Harwood, Talebi, Noble, and Wong in Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (Lambert, 2004) and Staines (Staines, 2008, in Review of General

32

The late eight

Psychology) is that the “individual therapists’ personal skills rather than their theoretical orientation” make the most difference in effectiveness of treatment. Importantly, both the approach and the clinician contribute to clinical success — that is, both the approach the clinician uses and the clinician’s clinical skills are important. The approach contributes approximately 25% to success and the clinician contributes the other 75%. A Hypothesis The reason a clinician is primary to clinical success is that both the student and the clinician share the same neurological wiring for learning in a social context. The reason a clinician is primary to treatment success — and it is only my hypothesis — is that social relations play the same central role in the treatment of speech sound disorders as they do in other types of clinical treatment. In the treatment of speech sound disorders, approaches are important tools, just like a painter’s brushes, pigments, and canvases. But mastery of the tools will not result in a masterpiece. To achieve art, you need a clinician. Summary Clinicians are more central to treatment success than the treatment approach. Social relations may be crucial to treatment success because the student and the clinician share the same neurological wiring for learning in a social context.

Conclusions This chapter discussed 18 questions related to current issues affecting the treatment of the Late 8. Some questions addressed conceptual issues, while others focused on practical matters. In important respects, the other chapters in this section also provide Late 8 updates. The topics of those updates are current research, the curriculum, a speech motor approach, and the Late 8 en español.

References American Speech-Language-Hearing Association. (2006). 2006 schools survey report: Caseload characteristics. Rockville, MD: Author. Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., & Wong, E. (2004). Therapist effects. Bergin and Garfield’s handbook of psychotherapy and behavior change, 5, 227–306. Casey, B., Gledd, J., & Thomas, K. (2000). Structural and functional brain development and its relation to cognitive development. Biological Psychology, 54, 241–257.

CHAPTER 1: A Late 8 Update

33

Clark, H. M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial. American Journal of Speech-Language Pathology, 12, 400–415. Dekaban, A. S., & Sadowsky, D. (1978). Changes in brain weights during the span of human life: Relation of brain weights to body heights and body weight. Annals of Neurology, 4, 345–356. Diedrich, W. (1983). Stimulability and articulation disorders. In J. Locke (Ed.), Seminars in Speech and Language, 4. Evans, O. B., & Hutchins, J. B. (2002). Development of the nervous system. In Duane E. Haines (Ed.), Fundamental neuroscience (pp. 71–89). New York, NY: Churchhill Livingstone. Felsenfeld, S., Broen, P., & McGue, M. (1994). A 28-year follow-up of adults with a history of moderate phonological disorder: Educational and functional results. Journal of Speech and Hearing Research, 37(6), 1341–1353. Gierut, J. A. (1998). Treatment efficacy: Functional phonological disorders in children. Journal of Speech, Language, and Hearing Research, 41, S85–S100. Hayden, D., Eigen, J., Walker, A., & Olsen, L. (2010). PROMPT: A tactually grounded model. In A. L. Williams, S. McLeod, & R. J. McCauley (Eds.), Interventions for speech sound disorders in children (pp. 453–474). Baltimore, MD: Paul H. Brookes. Iowa Department of Education. (2011a). Iowa core. Retrieved from http://www .educateiowa.gov Iowa Department of Education. (2011b). Statistics. Retrieved from http://www.educateiowa​.gov Johnson, J., & Newport, E. (1989). Critical period effects in second language learning: The influence of maturational state on the acquisition of English as a second language. Cognitive Psychology, 21, 60–99. Kretschmann, H., Kammradt, G., Krauthausen, I., Sauer, B., & Wingert, F. (1986). Brain growth in man. Bibliography of Anatomy, 28, 1–26. Lambert, M. (2004). Bergin and Garfield’s handbook of psychotherapy and behavior change. New York, NY: John Wiley. Lass, N., & Pannbacker, M. (2008). The application of evidence-based practice to nonspeech oral motor treatments. Language, Speech, and Hearing Services in Schools, 39, 408–421. Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (2000). Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature. International Journal of Language and Communication Disorders, 35(2), 165–188. Liston, C., & Kagan, J. (2002). Memory enhancement in early childhood. Nature, 419, 896. Lof, G. L. (2009). The nonspeech-oral motor exercise phenomenon in speech pathology practice. In C. Bowen, Children’s speech sound disorders (pp. 181–184). Oxford, UK: Wiley-Blackwell. Maurer, D. (Ed.) (2005). Special issue: Critical periods re-examined: Evidence from human sensory development. Developmental Psychobiology, 46(3), 155–292. McCauley R. J., Strand E., Lof, G. L., Schooling T., & Frymark, T. (2009). Evidencebased systematic review: Effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology, 18, 343–360. McCormack, J., McLeod, S., McAllister, L. & Harrison, L. J. (2010). My speech problem, your listening problem, and my frustration: The experience of living with childhood speech impairment. Language, Speech, and Hearing Services in Schools, 41(4), 379–392.

34

The late eight

McLeod, S. (2002). Part I: The plethora of available data on children's speech development ACQuiring Knowledge in Speech, Language and Hearing, 4, 141–147. McLeod, S. (Ed.). (2007). The international guide to speech acquisition. Clifton Park, NY: Thomson Delmar Learning. McLeod, S. (2011). Laying the foundations for multilingual acquisition: An international overview of speech acquisition. Journal of Linguistics and Language Teaching, 2, 53–71. Pascallis, O., de Haan, M., & Nelson, C. (2002). Is face processing species specific during the first year of life? Science, 296, 1321–1323. Miller, J. (1988). The psychobiology of Down syndrome. Cambridge, MA: MIT Press. Miller, J. (1999). Profiles of language development in children with Down syndrome. Baltimore, MD: Paul Brookes. Muttiah, N., Georges, K., & Brackenbury, T. (2011). Clinical and research perspectives on nonspeech oral motor treatments and evidence-based practice. American Journal of Speech Language Pathology, 20(1), 47–59. National Center for Education Statistics. (2002). Digest for education statistics. U.S. Department of Education, Institute of Education Sciences. Overby, M., Carrell, T., & Bernthal, J. (2007). Teachers’ perceptions of students with speech sound disorders: A quantitative and qualitative analysis. Language, Speech, and Hearing in Schools, 38(4), 327–341. Paul, R., & Shriberg, L. (1982). Associations between phonology and syntax in speech-delayed children. Journal of Speech and Hearing Research, 25, 536–547. Powell, T. (1991). Planning for phonological generalization: An approach to treatment target selection. American Journal of Speech-Language Pathology, 1, 21–27. Powell, T. W. (2009). Non-speech oral motor exercises: An ethical challenge. In C. Bowen, Children’s speech sound disorders (pp. 199–202). Oxford, UK: Wiley-Blackwell. Powell, T., Elbert, M., & Dinnsen, D. (1991). Stimulability as a factor in phonological generalization of misarticulating preschool children. Journal of Speech and Hearing Research, 34, 1318–1328. Ruscello, D. M. (2008). Nonspeech oral motor treatment issues in children with developmental speech sound disorders. Language, Speech, and Hearing Services in Schools, 39, 380–391. Ruscello, D. M., St. Louis, K., & Mason, N. (1991). School-aged children with phonologic disorders: Coexistence with other speech/language disorders. Journal of Speech and Hearing Research, 34, 236–242. Schade, J. P., & van Groenigen, W. B. (1961). Structural organization of the human cerebral cortex. I. Maturation of the middle frontal gyrus. Acta Anatomica, 47, 72–111. Shine, R. (1989). Articulatory production training: A sensory-motor approach. In N. Creaghead, P. Newman, & W. Secord (Eds.), Assessment and remediation of articulatory and phonological disorders (pp. 355–359). Columbus, OH: Charles Merrill. Shriberg, L. D., & Austin, D. (1998). The speech-language connection. Baltimore, MD: Paul H. Brookes. Shriberg, L., & Kwiatkowski, J. (1988). A follow-up study of children with phonologic disorders of unknown origin. Journal of Speech and Hearing Disorders, 53, 144–155. Shriberg, L., & Tomblin, B. (1999). Prevalence of speech delay in 6-year-old children and comorbidity with language impairment. Journal of Speech, Language, and Hearing Research, 42, 1461–1481.

CHAPTER 1: A Late 8 Update

35

Simonds, R. J., & Scheibel, A. B. (1989). The postnatal development of the motor speech area: A preliminary study. Brain and Language, 37, 42–58. Slater, S. (1992). Portrait of the professions. Asha, 34, 61–65. Smit, A., Hand, L., Frelinger, J., Bernthal, J., & Byrd, A. (1990). The Iowa articulation norms project and its Nebraska replication. Journal of Speech and Hearing Disorders, 55, 779–798. Staines, G. (2008). The relative efficacy of psychotherapy: Reassessing the methodsbased paradigm. Review of General Psychology, 12(4), 330–343. Stark, R., Bleile, K., Brandt, J., Freeman, J., & Vining, E. (1995). Speech-language outcomes of hemispherectomy in children and young adults. Brain and Language, 51, 406–421. Tyler, A., & Haskill, A. (2010). Morphosyntax intervention. In A. Williams, S. McLeod, & R. McCauley, (Eds.). Interventions for speech sound disorders in children (pp. 355– 380). Baltimore, MA: Brookes. Van Dyke, D. C., & Holte, L. (2003). Communication disorders in children. Pediatric Annals, 32(7), 436. Werker, J., & Tees, R. (2005). Speech perception as a window for understanding plasticity and commitment in language systems of the brain. Developmental Psychobiology, 46(3), 233–251.

Chapter Two

Using Evidence to Guide Clinical Practice: Considerations for the Late Eight Lauren K. Nelson

Introduction Using evidence to guide practice has been a part of academic and clinical education in speech-language pathology for many years. The need for an evidence-based approach to decision making became even more prominent in the mid-2000s (American Speech-Language-Hearing Association [ASHA], 2004, 2005). This greater emphasis occurred in part because of increased reliance on evidence in the field of medicine (ASHA, 2004). These changes in the field of medicine have carried over to other health care fields. The greater emphasis on evidence also occurred because of input from speech-language pathologists (SLPs) in clinical practice. SLPs in both health care and school settings experienced increased pressure to document that the services they provided had supporting evidence. When you consider the term “evidence,” perhaps the first thing that comes to mind is research evidence. The use of reliable research evidence is an important component of evidence-based practice (EBP). However, you might better think of EBP as a decision-making process that incorporates the best available research evidence, the SLPs’ own expertise, gained through 37

38

The late eight

both their educational and clinical experiences, and the input from the client and/or his/her family (ASHA, 2004; Fey, Justice, & Schmitt, 2014). Dollaghan (2007) used the phrase “external evidence” to refer to research evidence and noted that the other sources, the SLP, client, and family, provided valuable evidence as well. The focus of this chapter is on finding, evaluating, and using external evidence, but we will keep in mind the equal importance of evidence from clinical practice, the client, and family.

The Phrase “Evidence-Based Practice” You might have noticed I avoided the phrase “evidencebased practice” (EBP) in my opening paragraph. That was deliberate. EBP is a decision-making process that encompasses using research evidence, but also using SLPs’ knowledge and experience, as well as the client’s and/or family’s input. The phrase “evidence-based practice” tends to highlight the research evidence and obscures the importance of the SLP, client, and family in making decisions about clinical services.

Speech-language pathologists generally agree that using research evidence to support their clinical decisions is a reasonable idea. They also generally agree that finding time to engage in EBP is a significant challenge (O’Connor & Pettigrew, 2009). Thus, our first consideration in looking at EBP for the Late Eight consonants is to identify approaches that yield meaningful results in a time-efficient way. Our second consideration is to accept the fact that the research base in speech-language pathology has limitations. You rarely find research evidence that exactly matches the characteristics of your client or clinical setting. To test this statement, I conducted a search using the term evidence combined with “late 8” or “late eight” using a few of the most popular search engines for the field of speech-language pathology. This search yielded one published article (Shriberg et al., 2005). This implies that to find research evidence that supports clinical decision making for children with errors on the Late Eight consonants, we need to dig a little deeper into the research literature.

EBP Resources One option for identifying research evidence in an efficient way is to utilize evidence reviews developed and distributed by another person or group. One such group is the ASHA’s National Center for Evidence-Based Practice in Communication Disorders (N-CEP). Groups such as N-CEP search the research literature in a systematic way, carefully critique the studies they find,

CHAPTER 2:  Using Evidence to Guide Clinical Practice

39

and publish the results for others to use in the form of an “Evidence-Based Systematic Review.” You can find a list of N-CEP’s systematic reviews at the following website: http://www.asha.org/Research/EBP/EBSRs/. Unfortunately, N-CEP had not published any systematic reviews that address children with speech sound disorders (SSDs) at the time this chapter was written. Evidence Maps A second option from the ASHA website was more helpful. ASHA’s Evidence Maps included the topic “Speech Sound Disorders” (http://www.asha.org/ Evidence-Maps/). These evidence maps comprised information for all three components of EBP: research evidence, clinician expertise, and the client and family perspective. If you go to this website and select the topic “Speech Sound Disorders” and then select “External Scientific Evidence,” you will find at least 20 sources, most of which are systematic reviews. Two articles from this list stood out, a narrative review of research evidence for treatment of children with SSDs (Baker & McLeod, 2011a) and a systematic review on the topic of treatment intensity for children with SSDs (Kaipa & Peterson, 2016). We will explore the Baker and McLeod article in greater depth in a later section of this chapter. If your client with an SSD had a specific diagnosis, you might consider another topic, such as “Apraxia of Speech (Childhood),” “Cerebral Palsy,” or “Cleft Lip and Palate” (http://www.asha​ .org/Evidence-Maps). Speech Pathology Database A second tool for efficiently identifying research evidence in the field of speech-language pathology is the Speech Pathology Database for Best Interventions and Treatment Efficacy (speechBITE). The speechBITE database has a specific focus on intervention studies in speech-language pathology. Speech-language pathologists at the University of Sydney started this database and their effort has ongoing support from many organizations (http:// speechbite.com). A unique feature of speechBITE is that all the research articles, except systematic reviews, undergo a rigorous review before they appear in the database. A review of a research article includes such information as the description of participant eligibility, assignment of participants to groups (random or nonrandom), participant follow-up, the quality of the data analysis and report, and whether or not participants, therapists, or those administering pretests and posttests were aware of group membership (i.e., blinding). Another feature of speechBITE is that articles with the best available evidence appear first on the list. One of the primary factors in critiquing research articles is the level of evidence of the study. For treatment studies, levels of evidence from highest to lowest are: (1) systematic reviews and metaanalyses, (2) randomized control trials, quasi-experimental group studies, and

40

The late eight

quasi-experimental single subject experimental designs, (3) nonexperimental designs including nonexperimental case studies, and (4) expert opinion. If you are already familiar with the differences among these kinds of studies, you can skip the next paragraph. A systematic review is a special type of literature review based on a carefully defined search and critique of research articles. Authors of systematic reviews conduct a thorough search of the literature and filter and critique the articles, using a predefined set of criteria. A meta-analysis is similar to a systematic review but also employs statistical tools to analyze the data from the studies in a collective way. A randomized control trial is a group study with comparisons of treatment and no-treatment groups, or with comparisons of two different treatments. As the name implies, another feature of randomized control trials is that participants are assigned to their groups in a random manner. Quasi-experimental design studies involve comparisons of treatment and no-treatment conditions or comparisons of alternative treatments. In a quasi-experimental group design, the researchers study different treatment conditions using preexisting groups. An example of this would be comparing two different classrooms, one that receives an experimental treatment and one that receives a control treatment. In single subject experimental designs, the person receiving treatment participates in both the treatment and control or baseline conditions. Sometimes single subject experimental designs have replications across several participants, so the term does not literally mean a study has just one participant. In nonexperimental studies, researchers carefully observe and gather data in naturally occurring circumstances. One example of a nonexperimental study is a case study during which the researchers observe and gather data from a What Articles Should I Read First? As students, many of us wrote lengthy papers on topics related to speech-language pathology. Often our goal was a thorough and somewhat lengthy review of the literature. Practicing speech-language pathologists seldom have time to read and synthesize all of the research literature on a topic. SLPs need a strategy for prioritizing their reading. Once you identify relevant articles, you might use the “level of evidence” for the articles to prioritize your reading. Using this strategy, your highest priority would be systematic reviews and meta-analyses. For treatment research, your second priority would be a randomized control study. If you cannot find any articles at this level, research from lower levels of evidence — such as single subject experimental studies or treatment comparisons without random assignment to groups — is still useful.

CHAPTER 2:  Using Evidence to Guide Clinical Practice

41

single person. The lowest level of evidence occurs when empirical evidence on a topic is lacking and individuals with strong credentials related to the topic generate guidelines based on their collective expertise. SpeechBITE Search Strategies When you search for research evidence using speechBITE, I suggest you try the easy to use advanced search option. Using this advanced search option, you can specify the area of practice (e.g., speech, language, swallowing); the type of intervention (e.g., speech/articulation/phonological therapy, language therapy, fluency/stuttering therapy), population (e.g., autism spectrum disorder, speech sound disorder [developmental], traumatic brain injury), age group, and service delivery method (e.g., individual, group, parent). You also have the option of skipping some of the options. For an initial search on our topic of SSDs and the Late Eight consonants, you could try speech/articulation/phonological therapy and speech sound disorder (developmental) and children. This search turned up 105 articles and that would be an overwhelming number to read through. Seven of those articles were systematic reviews, so a good starting place would be to focus just on those seven articles. This search yielded the same 2 articles we identified from the ASHA evidence maps search: Baker and McLeod (2011a) and Kaipa and Peterson (2016). Among the randomized control trials, two somewhat recent studies stood out, a treatment study in which intelligibility was an outcome measure (Lousada, Jesus, Hall, & Joffe, 2014) and a study of the effectiveness of treatment delivered in a typical clinical setting (Broomfield & Dodd, 2011). These latter two studies were of interest because they were relatively recent and were not included in the Baker and McLeod narrative review. Learn by Doing If you have waited to try some of the searches covered in the previous section, now would be a good time to stop reading, get out your favorite device for browsing the Internet, and try a search. First, type “http://speechbite.com” to get to the speechBITE website. Then, just under the search box, select the advanced search option. You should see a series of drop-down boxes. Let’s try the following options: (1) for Type of Intervention select Speech/Articulation/ Phonological Therapy; (2) for Within This Population, select Hearing and Visual Impairment; and (3) for Age Group. select Children. This search yielded 17 articles, 2 of which were systematic reviews.

42

The late eight

From our initial search, we identified two promising articles at the highest level of evidence, a broad, carefully constructed narrative review by Baker and McLeod (2011a) and a more focused systematic review on the topic of treatment efficacy by Kaipa and Peterson (2016). Baker and McLeod identified 134 intervention studies from 1979 to 2009. These studies covered the full range of evidence from systematic reviews/meta-analyses, to randomized control trials, to quasi-experimental studies, to nonexperimental studies including case studies. These authors found that the majority of studies were at lower levels of evidence; 56 were single subject experimental designs (level IIb) and 43 were nonexperimental case studies. Baker and McLeod did find studies at the highest levels of evidence, including 2 systematic reviews as well as randomized control trials (19 studies) and quasi-experimental control trials without random assignment (13 studies). As Baker and McLeod (2011a) noted, the body of evidence largely supported the effectiveness of treatment for children with speech sound disorders. The authors also noted some limitations in the available evidence. The vast majority of studies were conducted in university or other research settings and only a few studies took place in a typical clinical environment such as a school or a treatment center. Researchers in our field have investigated many different treatment approaches, meaning that the research evidence in support of any one approach often is limited. Only a few approaches had supporting evidence from multiple researchers working in different research settings (Baker & McLeod, 2011a). Baker and McLeod concluded that the field of speech-language pathology needs “to encourage greater collaboration and the publication of replication intervention research by investigators other than and/or in addition to the proponents of a particular approach” (p. 116).

Clinical vs. Research Settings Baker and McLeod (2011a) reported that the typical treatment schedule across the 134 research studies they reviewed consisted of 30- to 60-minute sessions, occurring two to three times per week. In regular school settings or other treatment centers the typical treatment schedule may be less than this. One of the challenges in using research evidence to support clinical decision making is that the parameters for treatment in research studies are not always a good match for clinical settings.

Kaipa and Peterson (2016) conducted a focused systematic review to identify evidence about treatment intensity. The authors identified seven

CHAPTER 2:  Using Evidence to Guide Clinical Practice

43

studies that compared different treatment intensities. Only one of these studies focused on treatment of SSDs. The other studies included participants with dysarthria (n = 2), acquired apraxia of speech (n = 1), and childhood apraxia of speech (n = 3). Overall Kaipa and Peterson determined that four of the seven studies showed that treatment outcomes improved with greater treatment intensity. The research of most interest for treatment of SSDs was a study by Allen (2013). Allen identified children with SSDs and randomly assigned them to a 1× per week treatment group, a 3× per week treatment group, and a control group. This study showed that children who received more treatment performed significantly better at 8- and 24-week posttests, and both the 1× and 3× per week treatment groups made gains over a 6-week follow-up period after treatment was discontinued. Our search of ASHA’s evidence maps website and speechBITE yielded two additional articles of interest. Broomfield and Dodd (2011) investigated the effectiveness of speech and language treatment in a typical clinical setting that served preschool and school-age children. These researchers conducted a randomized treatment and control group study to determine the effectiveness of the speech and language services that children usually receive. Broomfield and Dodd included 730 total participants in their study. Of these children, 220 were preschool children with speech disorders and 100 were school-age children with speech disorders. The other participants had receptive and expressive language disorders. Broomfield and Dodd randomly assigned their participants to one of three groups: (1) one group that received intervention in the first 6 months of the study and no intervention in the next 6 months; (2) a second group that received no intervention in the first 6 months but did receive intervention in the next 6 months; and (3) a third group that received intervention for all 12 months. All of the participants completed a pretest and a posttest at the midpoint of the study. Broomfield and Dodd compared the performance of the two groups that received treatment during the first 6 months to that of the group that did not receive treatment until the second half of the study, i.e., a no-treatment control. The children in the treatment groups received the amount and type of therapy that SLPs in the agency usually recommended. These researchers found significant differences between the treatment and control group for children with receptive and expressive language disorders, as well as children with speech disorders (Broomfield & Dodd, 2011). The study by Lousada et al. (2014) was interesting because the researchers used an outcome measure, speech intelligibility, that has functional significance for children. Further investigation of this article indicated that the study would not provide relevant evidence for children whose primary language was English. The study was conducted in Portugal and the children who participated in the study spoke Portuguese. The consonant system in Portuguese includes only four of the Late Eight: /s, z, l, ʃ/ (International Phonetic Association, 1999), making this study less useful for our purposes.

44

The late eight

EBP for the Late Eight Thus far our search for research evidence to support clinical decision making for children with SSDs has yielded research that reflects the highest levels of evidence, including systematic reviews and randomized treatment and control group studies. This body of evidence showed that treatment for SSDs was efficacious under the controlled conditions of research studies, and in some cases, under the conditions present in typical clinical settings (Broomfield & Dodd, 2013; McCleod & Baker, 2011a). What is less clear is the extent to which the existing research studies included children with speech errors on the Late Eight consonants. One approach to address this issue would be to filter the studies we discovered through our previous searches according to the age of the participants. The rationale for filtering by age is that research with older children, ages 5 and above, is more likely to include participants with errors on the Late Eight Admittedly, this is a somewhat arbitrary assumption, but information about age is often available in the article abstracts or in the summaries from the systematic reviews. Our search for the best available evidence yielded systematic reviews as well as a variety of research studies that included children ages 5 and above. The best research evidence for our purposes would be studies that included the Late Eight consonants among the participants’ treatment targets. For the most part, the only way to identify this detail about a study is to read the full research report. The evidence we discovered is listed in Table 2–1. The table includes information, when available, about the extent to which the study addressed treatment for errors on the Late Eight. One thing apparent in Table 2–1 was that research articles covering treatment of SSDs do not always include information about the specific speech sounds targeted in treatment. Nevertheless, the research evidence provided some guidance regarding treatment of the Late Eight consonants. If children have errors on multiple consonants, clinicians should consider multiple oppositions treatment (Williams, 2000). This approach was effective and comparatively efficient for children in more than one study (Allen, 2013; Williams, 2000, 2005). Including either phonological awareness activities or well-designed speech sound discrimination training in treatment appeared to enhance treatment outcomes (Denne, Langdown, Pring, & Roy, 2005; Rvachew, Nowak, & Cloutier, 2004). For children with both morphosyntactic and phonological errors, either alternating treatment between morphosyntactic and phoneme targets or targeting morphosyntactic errors first led to greater overall improvement (Tyler, Lewis, Haskill, & Tolbert, 2002, 2003). As noted in other reviews (Baker & McLeod, 2011b; Sugden, Baker, Munro, & Williams, 2016), the considerable variability among studies and the many different approaches to delivering treatment and selecting target sounds made it difficult to draw definitive conclusions about the best approaches to treatment.

45

Narrative review/Ia

Systematic review/Ia

Metaanalysis/ Ia

Systematic review/Ia

Systematic review/Ia

Baker & McLeod (2011a)

Kaipa & Peterson (2016)

Law, Garrett, & Nye (2004)

McCauley et al. (2009)

Sugden et al. (2016)

Source

Research Design/Level of Evidence

Multiple studies

Ages 1;6 to 9;6 across 61 studies

Ages 1;3 to 16;11 across 5 studies

Mean age 2;10 to 6;10 across 6 studies

Multiple studies

Multiple studies

Ages 2;6 to 8;2 across 7 studies

Ages 1;6 to 10;5 across 134 studies

Participants (# and age)

Multiple studies

Multiple studies

Treatment Approach

NA

NA

NA

NA

NA

Target Sounds

continues

Evidence suggests that parents can be effective intervention agents, but the evidence covers many different approaches and the description of these approaches lacks detail

No clear-cut evidence supporting the use of nonspeech oral motor exercises to improve speech production

Intervention effect was significant for children with expressive phonological disorders

Higher treatment intensity led to better outcomes

Children with SSDs benefited from treatment

Outcomes

Table 2–1.  Identified Sources of Evidence from 2000 to 2016 that Included Children Ages 5 and Above with Speech Sound Disorders and/or Specified Target Sounds Among the Late Eight

46

Randomized control trial/Ib

Randomized control trial/Ib

Rvachew & Nowak (2001)

Randomized control trial/Ib

Broomfield & Dodd (2011)

Denne et al. (2005)

Randomized control trial/Ib

Allen (2013)

Source

Research Design/Level of Evidence

Table 2–1.  continued

48 children in two different groups with mean ages of 51.5 and 49.6 months

20 children ages 5 to 7 randomly assigned to treatment or control group

730 children ages 0–16; including 100 with speech disorders ages 5–11+

55 children ages 3;0 to 5;5

Treatment Approach

NA

Later acquired/ least known (e.g., /r, l, θ, S/ and earlier acquired and most known (e.g., /t, k, l, v/

Seven step TX from imitated syllable to spontaneous sentences

NA

Phoneme collapse (e.g., /g, dZ, z, ð, dr, gr/)

Target Sounds

Phonological awareness treatment (TX) in typical clinical setting (i.e., 12 hours total)

Usual speech and language services averaging 5½ hours in the 6 months following the initial assessment

Multiple oppositions; treatment frequency 1× or 3× per week, and control

Participants (# and age)

Children treated on earlier acquired sounds made significantly greater gains, but children treated on later acquired sounds did make gains; authors reported no differences in generalization

Children receiving treatment scored significantly higher on phonological awareness after treatment, but not on literacy or speech production tests

Children with language and speech disorders who received treatment made significantly greater gains than no treatment control group

Children improved more when receiving treatment 3× per week compared with 1× and when cumulative intervention was the same

Outcomes

47

Rvachew et al. (2004)

Randomized control trial/Ib

Randomized control trial/Ib

Source

Tyler et al. (2002)

Research Design/Level of Evidence

27 children ages 3;0 to 5;11

34 children in two different groups with mean ages of 52.9 and 50.3 months

Treatment Approach Target Sounds

Compared 2 TX orders: morphosyntax then phonological vs. phonological, then morphosyntax

/k, g, f, s, S, tS, l/

Individually reported for each child and included consonant clusters and sounds such as

One outcome Control group measure was received TX percent correct determined by for “difficult” the clinician (e.g., consonants: /ŋ, k, cycles, tradition); experimental g, v, S, tS, dZ, ð, θ, group received s, z, l, r/ similar TX plus 15 added minutes of computerized speech perception treatment

Participants (# and age)

continues

Phonological treatment led to significantly greater improvement in phonology compared with no treatment; morphosyntax treatment led to significantly greater improvement in morphosyntax than no treatment; additionally, cross-domain improvement occurred from morphosyntax treatment, leading to improvement in phonology as well, but not for phonology treatment

Experimental groups, receiving speech perception training, made significantly greater gains in perception of speech sounds and in accuracy of speech sound production compared with the control group; no differences were found for phonological awareness

Outcomes

48

Research Design/Level of Evidence

Randomized control trial/Ib

Source

Tyler et al. (2003)

Table 2–1.  continued

47 children ages 3;0 to 5;11 with 7 children serving as no-treatment controls and the other 40 randomly divided among four different TX groups

Treatment Approach Four goal attack strategies compared: blocks of morphosyntax followed by phonological TX, blocks of phonological followed by morphosyntax TX, alternating morphosyntax and phonological TX, alternating morph-syntax and phonological TX, and simultaneous morphosyntax and phonological TX

Participants (# and age)

Outcomes For morphosyntax, both the morphosyntax first TX and the alternating TX led to significantly greater gains compared with the control group; for phonology, morphosyntax TX first, phonological TX first, and alternating TX all led to significantly greater gains compared with the control group

Target Sounds Three target sounds for each participant, such as /f, s, tS/; /l, S, k/; /k, f, tS/; and /s, S, l/

49

Crosbie et al. (2005)

Gillon (2000)

Source

Nonrandomized groups/ IIa with baseline/ treatment and group comparisons

Nonrandomized groups/ IIa

Research Design/Level of Evidence

18 children ages 4;8 to 6;5 with either consistent (n = 8 ) or inconsistent (n = 10) speech sound disorders

91 children ages 5;6 to 7;6 with spoken language impairment

Treatment Approach

8 week block of contrast TX (minimal pairs) and 8 week block of core vocabulary TX

23 children received phonological awareness (PA) TX, 23 children received typical speech and language TX, 15 children received minimal TX, and 30 children were typically developing as a comparison

Participants (# and age)

continues

For inconsistency, children with inconsistent speech sound disorders made significantly more improvement in core vocabulary TX; for percent consonants correct, contrast TX led to significantly greater gains and gains were greatest for children with consistent speech sound disorders

Post-treatment assessment revealed the children receiving PA treatment scored significantly higher on PA tests and on several reading measures compared with the traditional TX and minimal TX groups; children in the PA group also made significantly greater gains in consonants correct, but the authors stated they needed a larger sample for a meaningful effect size for this difference Not specifically targeted but report pretreatment and post-treatment percent consonants correct scores and use of phonological processes

NA

Outcomes

Target Sounds

50

Gierut & Champion (2001)

Forrest & Elbert (2001)

Source

Single subject experimental/ IIb

Single subject experimental/ IIb

Research Design/Level of Evidence

Table 2–1.  continued

Treatment focusing on one fricative at the word level, first with modeled and then unmodeled productions of words with the target sounds in final position Treatment of 3-element s-clusters, in made up (nonsense) words

7 children ages 3;4 to 6;3 who scored below the 6th percentile on an articulation test, who otherwise had normal hearing and nonspeech oral motor skills, and age-appropriate language skills

Participants (# and age)

Four male children ages 4;11 to 5;3 with inconsistent speech sound production errors and multiple consonants missing from their phonetic inventories

Treatment Approach

spl, spr/

3-element clusters /skw, skr,

Targeted one fricative per child /­S, θ, s/ that was missing from the child’s phonetic inventory

Target Sounds

During TX the children improved their accuracy in producing nonsense words with 3-element clusters; post-treatment assessment showed little generalization to real words with 3-element clusters; the authors identified generalization to single consonants (e.g., /g, f, θ, ð, s, z, S, l, r, tS, dZ/) and some 2-element clusters

Participants mastered the target sound in word final position and generalized to untreated words with the sound in word final position; only one child met the criterion for generalization to other word positions (68%+)

Outcomes

51

Miccio & Ingrisano (2000)

Single subject experimental/ IIb

Single subject experimental/ IIb

Source

Morrisette & Gierut (2002)

Research Design/Level of Evidence

8 children ages 3;10 to 5:4 with phonological delays; scored at or below 5th percentile on an articulation test

Female child age 5;3 with history of otitis media; pure tone thresholds were 20 to 30 dB in the right and left ears; receiving special education services for additional developmental delays included problems with fine motor skills

Treatment Approach

Four different TX based on lexical properties of target words: high frequency words, low frequency words, words from high density “neighborhoods” and words from low density “neighborhoods”

Treatment in two phases with the initial phase focusing on acquisition and imitation of the target and the second phase on production of minimal pair words with the target and error phonemes

Participants (# and age)

continues

Children in all four conditions acquired their target sounds in treated words; treating high frequency words led to more generalization to untreated words and sounds than the other conditions

Child’s production of /v/ and /z/ improved with treatment and the authors noted generalization in different degrees to untreated sounds /f, θ, ð, tS, dZ/ after starting treatment on /v/ and additional generalization to /s, S/ after starting treatment on /z/

/v, z/ in word initial position

One target sound for each child from the following set: /f, s, l, r/

Outcomes

Target Sounds

52

Jacoby et al. (2002)

Williams (2005)

Source

Retrospective, nonrandomized groups/III

Single subject experimental/ IIb

Research Design/Level of Evidence

Table 2–1.  continued

234 children, ages 3 to 6, who had received speech and language treatment from a university clinic

Female child age 6;5 with moderate phonological impairment

Treatment Approach

Usual TX approaches; all participants received functional communication ratings on National Outcome Measurement System

Multiple oppositions TX follow by minimal contrast TX

Participants (# and age)

Three multiple oppositions targets /f, θ, gl/ were acquired in spontaneous words and generalized to conversational speech; one minimal pair target /r/ was acquired in spontaneous words and conversational speech Found a statistically significant relationship between amount of TX and improvement in functional communication rating for children with articulation disorders (intelligibility), and expressive language disorders; older children (ages 5 & 6) needed more TX to make functional improvements than younger children (ages 3 & 4)

NA

Outcomes

Multiple oppositions targets were word initial /f, θ, gl, fr/; minimal pair targets were word initial /r, S/ and word final /θ/

Target Sounds

53

Nonexperimental case study/III

Williams (2000)

10 children ages 4;0 to 6;5 with multiple speech sound production errors

Female child age 6;5 with severe speech sound disorder

Treatment Approach

TX yielded improvements in CVC words productions, spelling, and connected speech; improvements maintained at a 7-month follow-up Reported amount of time in TX; maximum amount was 5 semesters and 105 sessions; average was 3.4 semesters and 60.3 sessions; 2 of the 10 children only required multiple oppositions TX; remaining children required addition TX – minimal pairs and/or naturalistic TX

Targets varied from 4 to 16 depending on the child and included different places of production and manners of production

Multiple oppositions, minimal pair, and naturalistic speech intelligibility TX; all children started with multiple oppositions approach

Outcomes

Multiple final consonants in CVC words and eventually connected speech

Target Sounds

Speech only and speech-spelling TX with CVC words as the targets

Participants (# and age)

Note. This table only includes research evidence for children with speech sound disorders not related to specific diagnoses such as childhood apraxia of speech, cleft of the lip and palate, or dysarthria. Some high-level sources were omitted for this reason, such as the systematic review on treatment for childhood apraxia of speech by Murray, McCabe, and Ballard (2014). Additionally, the table only includes studies in which the participants spoke English.

Nonexperimental case study/III

Pascoe et al. (2005)

Source

Research Design/Level of Evidence

54

The late eight

Conducting EBP Searches Perhaps the most efficient way to approach an evidence search is to identify sources of information that already have been filtered and critiqued, such as the evidence available from ASHA’s evidence maps, speechBITE, or published systematic reviews (Baker & McLeod, 2011a; Kaipa & Peterson, 2016; McCauley, Strand, Lof, Schooling, & Frymark, 2009; Sugden et al., 2016). Still, completing your own search for literature and review articles will be necessary at times. Fortunately, free tools are available to help you conduct these searches efficiently: Google Scholar (https://scholar.google.com/), Education Resources Information Center (ERIC; https://eric.ed.gov/), and PubMed (https://www.ncbi.nlm.nih.gov/pubmed/). One reason to conduct your own search is to update literature searches from other authors. Through our evidence search we found the narrative review by Baker and McLeod (2011a). The publication date of this article was 2011, so it would be important to find any additional relevant studies published after 2011. Google Scholar has a tool for conducting such a search in a time-efficient way. At the Google Scholar website, hold down the small arrow to the right of the search box to bring up the advanced search options. Type the title of the Baker and McLeod article in the box following the phrase “with the exact phrase.” This search will retrieve the Baker and McLeod article. At the bottom of the entry you will see the phrase “Cited by,” which lets you quickly identify more recent articles that include Baker and McLeod in their reference lists. Selecting the “Cited by” link will bring up a list of articles (71 when this chapter was written).

Identifying Current Findings The narrative review article by Baker and McLeod (2011a) illustrated one issue with research evidence that may be unavoidable: the lag between the time authors complete their work and the time of publication of an article. Baker and McLeod reported searching for articles through 2009, but the publication date of their article is 2011. Journal editors and reviewers need this time to complete a careful review of submitted articles. Even when authors approach their review in a very thorough and systematic way, clinicians should consider updating the literature search due to this publication lag.

Another reason you might want to conduct your own literature search is that your client has unique characteristics, suggesting that a client-specific evidence search would be helpful (Gallagher, 2002). Let’s consider the possibility of a 6-year-old child with Down syndrome, an SSD, and reduced speech

CHAPTER 2:  Using Evidence to Guide Clinical Practice

55

intelligibility. What, if any, treatment modifications should you consider for this child? You could use a search engine such as ERIC or PubMed to look into this question. For this particular search, you might go to the PubMed website. My personal preference is to use the advanced search option: https:// www.ncbi.nlm.nih.gov/pubmed/advanced. Here are some suggested strategies to try: (1) in the advanced search option, change “All Fields” to “Title/ Abstract” and type Down syndrome in the first row; (2) again change “All Fields” to “Title/Abstract” and type articulation or phonological OR speech in the second row; and (3) add a third row, change “All Fields” to “Title/ Abstract” and type treatment OR intervention OR therapy in this row. Note a couple of features of this search. First, we used synonyms for our terms. One challenge for evidence searches in speech-language pathology is that authors use different terms to refer to similar concepts, e.g., articulation disorder or phonological disorder; treatment, intervention, or therapy. Another feature is that we limited the search to the title/abstract. This is a way to limit the articles you review to the ones that have substantial content on your topic. This search yielded 66 articles and some of them looked promising. An article by Yoder, Camarata, and Woynaroski (2016) included children with Down syndrome ages 5 to 12. These researchers compared two different treatment approaches, a recast approach and a contrast approach, to determine which led to greater gains in “speech comprehensibility.” Websites such as speechBITE and ASHA’s evidence maps focus on providing straightforward access to evidence about treatment of communication disorders, including SSDs. If you have evidence questions about other areas of clinical practice, such as assessment or evaluation, conducting your own evidence search may be necessary. You might have a question similar to the following: “What are the best tests for assessing speech sound disorders in children?” To investigate this question, you might use the ERIC website at https://eric.ed.gov/. To find the most relevant articles you might limit your search to just article titles. Try typing the following in the search box: title:test AND title:(articulation OR speech sound OR phonology). This search yielded 139 articles and 19 published in the last 10 years. Two of these were directly related to tests of children’s speech sound production (Eisenberg & Hitchcock, 2010; Flipsen & Ogiela, 2015). If your interests were in approaches to assessingt comprehensibility or intelligibility or uses of conversational speech samples, you would find some of those articles with this search. You also could modify the search by adding different terms to better reflect your interests.

Summary In this chapter we covered three strategies to identify research evidence to support clinical decision making. A less time-consuming starting point is to use databases that were developed specifically for our field, such as

56

The late eight

ASHA’s evidence maps or speechBITE. If your focus is more specific, such as looking for research related to treating the Late Eight consonants, you could further screen research articles to identify those that included the Late Eight consonants as treatment targets (i.e., Table 2–1). Finally, you might need to conduct your own search and review of articles for areas of practice other than treatment or if your client has unique characteristics that make treatment decisions more difficult. Fortunately, SLPs have access to free search engines that allow them to efficiently conduct such searches.

References Allen, M. M. (2013). Intervention efficacy and intensity for children with speech sound disorder. Journal of Speech, Language, and Hearing Research, 56, 865–877. doi:10.1044/1092-4388(2012/11-0076) American Speech-Language-Hearing Association. (1997–2016). Evidence maps. Retrieved from http://www.asha.org/Evidence-Maps/ American Speech-Language-Hearing Association. (2004). Evidence-based practice in communication disorders: An introduction [Technical report]. Retrieved from http://www.asha.org/policy American Speech-Language Hearing Association. (2005). Evidence-based practice in communication disorders [Position statement]. Retrieved http://www.asha.org/policy Baker, E., & McLeod, S. (2011a). Evidence-based practice for children with speech sound disorders: Part 1 narrative review. Language, Speech, and Hearing Services in Schools, 42, 102–139. doi:10.1044/0161-1461(2010/09-0075) Baker, E., & McLeod, S. (2011b). Evidence-based practice for children with speech sound disorders: Part 2 application to clinical practice. Language, Speech, and Hearing Services in Schools, 42, 140–151. doi:10.1044/0161-1461(2010/10-0023) Broomfield, J., & Dodd, B. (2011). Is speech and language therapy effective for children with primary speech and language impairment? Report of a randomized control trial. International Journal of Language and Communication Disorders, 46, 628–640. doi:10.1111/j.1460-6984.2011.00039.x Crosbie, S., Holm, A., & Dodd, B. (2005). Intervention for children with severe speech disorder: A comparison of two approaches. International Journal of Language and Communication Disorders, 40(4), 467–491. Retrieved from http://www.tandf​ online.com/toc/ilcd20/current Denne, M., Langdown, N., Pring, T., & Roy, P. (2005). Treating children with expressive phonological disorders: Does phonological awareness therapy work in the clinic? International Journal of Language and Communication Disorders, 40(4), 493–504. Dollaghan, C. A. (2007). The handbook for evidence-based practice in communication disorders. Baltimore, MD: Paul H. Brookes. Eisenberg, S. L., & Hitchcock, E. R. (2010). Using standardized tests to inventory consonant and vowel production: A comparison of 11 tests of articulation and phonology. Language, Speech, and Hearing Services in Schools, 41, 488–503. doi:10.1044/0161-1461(2009/08-0125) Fey, M. E., Justice, L. M., & Schmitt, M. B. (2014). Evidence-based decision making in communication intervention. In R. Paul (Ed.), Introduction to clinical methods in communication disorders (3rd ed., pp. 55–79). Baltimore, MD: Paul H. Brookes.

CHAPTER 2:  Using Evidence to Guide Clinical Practice

57

Flipsen, P., Jr., & Ogiela, D. A. (2015). Psychometric characteristics of single-word tests of children’s speech sound production. Language, Speech, and Hearing Services in Schools, 46, 166–178. doi:10.1044/2015_LSHSS-14-0055 Forrest, K., & Elbert, M. (2001). Treatment for phonologically disordered children with variable substitution patterns. Clinical Linguistics and Phonetics, 15(1), 41–45. Gallagher, T. M. (2002). Evidence-based practice: Applications to speech-language pathology. Perspectives on Language Learning and Education, 9(1), 2–5. Gierut, J. A., & Champion, A. H. (2001). Syllable onsets II: Three-element clusters in phonological treatment. Journal of Speech, Language, and Hearing Research, 44, 886–904. Gillon, G. (2000). The efficacy of phonological awareness intervention for children with spoken language impairments. Language, Speech, and Hearing Services in Schools, 31, 26–41. International Phonetic Association. (1999). Handbook of the International Phonetic Association. Cambridge, UK: Cambridge University Press. Jacoby, G. P., Lee, L., Kummer, A. W., Levin, L., & Creaghead, N. A. (2002). The number of individual treatment units necessary to facilitate functional communication improvements in the speech and language of young children. American Journal of Speech-Language Pathology, 11, 370–380. doi:10.1044/1058-0360(2002/041) Johnson, C. J. (2006). Getting started in evidence-based practice for childhood speech-language disorders. American Journal of Speech-Language Pathology, 15, 20–35. Kaderavek, J. N., & Justice, L. M. (2010). Fidelity: An essential component of evidencebased practice in speech-language pathology. American Journal of Speech-Language Pathology, 19, 369–379. doi:10.1044/1058-0360(2010/09-0097) Kaipa, R., & Peterson, A. M. (2016). A systematic review of treatment intensity in speech disorders. International Journal of Speech-Language Pathology, 18(6), 507–520. doi:10.3109/17549507.2015.1126640 Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (1998). Screening for primary speech and language delay: A systematic review of the literature. International Journal of Language and Communication Disorders, 33(Suppl.), 1–23. Law, J., Garrett, Z., & Nye, C. (2004). The efficacy of treatment or children with developmental speech and language delay/disorder: A meta-analysis. Journal of Speech, Language, and Hearing Research, 47, 924–943. doi:10.1044/1092-4388(2004/069) Lousada, M., Jesus, L. M. T., Hall, A., & Joffe, V. (2014). Intelligibility as a clinical outcome measure following intervention with children with phonologically based speech–sound disorders. International Journal of Language and Communication Disorders, 49, 584–601. doi:10.1111/1460-6984.12095 McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Evidencebased systematic review: Effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology, 18, 343–360. McCauley, R. J., Weston, A., Rvachew, S., Williams, L., & Weiss, A. (2004). Evidencebased practice and speech sound disorders: The why? And the how? Paper presented at the annual convention of the American Speech-Language Hearing Association, Philadelphia, PA. Miccio, A. W., & Ingrisano, D. R. (2000). The acquisition of fricatives and affricates: Evidence from a disordered phonological system. American Journal of SpeechLanguage Pathology, 9, 214–229. doi:10.1044/1058-0360.0903.214

58

The late eight

Morrisette, M. L., & Gierut, J. (2002). Lexical organization and phonological change in treatment. Journal of Speech, Language, and Hearing Research, 45, 143–159. Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23, 486-504. doi:10.1044/2014_AJSLP-13-0035 O’Connor, S., & Pettigrew, C. M. (2009). The barriers perceived to prevent the successful implementation of evidence-based practice by speech and language therapists. International Journal of Language and Communication Disorders, 44, 1018–1035. doi:10.3109/13682820802585967 Pascoe, M., Stackhouse, J., & Wells, B. (2005). Phonological therapy within a psycholinguistic framework: Promoting change in a child with persisting speech difficulties. International Journal of Language and Communication Disorders, 40(2), 189–220. Rvachew, S., & Nowak, M. (2001). The effect of target-selection strategy of phonological learning. Journal of Speech, Language, and Hearing Research, 44, 610–623. Rvachew, S., Nowak, M., & Cloutier, G. A. (2004). Effect of phonemic perception training on the speech production and phonological awareness skills of children with expressive phonological delay. American Journal of Speech-Language Pathology, 13, 250–263. Shriberg, L. D., Lewis, B. A., Tomblin, J. B., McSweeny, J. L., Karlsson, H. B., & Scheer, A. R. (2005). Toward diagnostic and phenotype markers for genetically transmitted speech delay. Journal of Speech, Language, and Hearing Research, 48, 834–852. doi:10.1044/1092-4388(2005/058) Speech Pathology Database for Best Interventions and Treatment Efficacy. (n.d.). About. Retrieved from http://speechbite.com/about/ Speech Pathology Database for Best Interventions and Treatment Efficacy (n.d.). Group comparison studies. Retrieved from http://speechbite.com/rating-research-quality/ group-comparison/ Sugden, E., Baker, E., Munro, N., & Williams, A. L. (2016). Involvement of parents in intervention for childhood speech sound disorders: A review of the evidence. International Journal of Language & Communication Disorders, 51(6), 597–625. doi:10.1111/1460-6984.12247 Tyler, A. A., Lewis, K. E., Haskill, A., & Tolbert, L. C. (2002). Efficacy and cross-domain effects of a morpho-syntax and a phonology intervention. Language, Speech, and Hearing Services in Schools, 33, 52–66. Tyler, A. A., Lewis, K. E., Haskill, A., & Tolbert, L. C. (2003). Outcomes of different speech and language goal attack strategies. Journal of Speech, Language, and Hearing Research, 46, 1077–1094. Williams, A. L. (2000). Multiple oppositions: Case studies of variables in phonological intervention. American Journal of Speech-Language Pathology, 9, 289–299. Williams, A. L. (2005). Assessment, target selection, and intervention: Dynamic interactions within a systemic perspective. Topics in Language Disorders, 25(3), 231–242. Yoder, P. J., Camarata, S., & Woynaroski, T. (2016). Treating speech comprehensibility in students with Down syndrome. Journal of Speech, Language, and Hearing Research, 59, 446–459. doi:10.1044/2015_JSLHR-S-15-0148

Chapter Three

The Late Eight en español Lindsey R. Leacox

Introduction In the United States, 13.0% of the population 5 years and older (38.4 million residents) speak Spanish in the home (U.S. Census Bureau, 2013). In contrast, approximately 94% of speech-language pathologists (SLPs) are monolingual English speakers. Of the 6% who are bilingual SLPs, the largest group (approximately 65%) self-identify as bilingual in Spanish and English (ASHA, 2016). Although more bilingual SLP programs are emerging (Crowley et al., 2014), for the present and into the near future, Spanish-speaking students are more likely to receive speech treatment from monolingual English-speaking clinicians. The International Expert Panel on Multilingual Children’s Speech has emphasized the need for monolingual and bilingual SLPs around the world to address the speech needs of multilingual children (International Expert Panel on Multilingual Children’s Speech, 2012). Essential areas include distinguishing a speech difference from a disorder and overcoming linguistic and cultural barriers that may limit overall school-to-home communication (Kohnert, Yim, Nett, Kan, & Duran, 2005; Williams & McLeod, 2012). This chapter focuses on treatment of late acquired sounds in bilingual Spanish-English children. The intended audience includes monolingual English-speaking SLPs, English-speaking SLPs with some “preschool” Spanish, and bilingual SLPs. The chapter proceeds in the following steps: n Differences and similarities in the phonologies of English and Spanish n Late-developing sounds in Spanish n Treatment strategies for late sounds en español

59

60

The late eight

When I began as a bilingual SLP and recent PhD graduate, I was astonished to find only five articles on bilingual speech sound disorder (SSD) treatment. The studies described treatment only in English, and not all the studies focused on Spanish-English children! At the time of this writing, we now have six published treatment articles for multilingual children, but this number remains scarce compared with the 130 studies for monolingual English-speaking children (Baker & McLeod, 2011).

Differences and Similarities in the Phonologies of English and Spanish Clinicians working with Spanish-English bilingual children with SSDs need knowledge of the phonology of English and Spanish to appropriately assess and provide treatment (Yavas & Goldstein, 1998). Yavas and Goldstein (1998) suggest that SLPs should possess knowledge of the language, interference or transfer patterns, and dialect. This section provides a quick reference for these three topics. The discussion focuses on similarities and differences between English and Spanish. This knowledge contributes to a clinician’s cultural and linguistic competence, helps writing appropriate goals, and facilitates choosing meaningful words and exercises for therapy.

The Language English and Spanish share both linguistic similarities and differences. The historical connection between these two languages appears in their shared Roman alphabet (Langdon, 2008). The historical connection between the two languages also appears in shared overlapping sound-meaning word pairs (cognates). Examples of English-Spanish cognates include rose-rosa and lemon-limón. In any given linguistic area, linguistic features in the two languages may be the same, share a partial overlap, or be different. Further, just as in English, there may also be variations within Spanish phonology (Goldstein, 2001). Phonemes and word structure are especially important to clinical care of Spanish-speaking students. The discussion of phonemes focuses on sound classes and consonant clusters. The discussion of word structure focuses on word length and syllable structure. Phonemes Spanish and English phonology share 15 consonants, with 9 consonants unique to English and 5 consonants unique to Spanish (Goldstein, 2000).

CHAPTER 3:  The Late Eight en español

61

Spanish has fewer consonants than English does, Spanish having 18 consonants and English possessing 24 (Acevedo, 1993; Jiménez, 1987; Gorman & Kester, 2003). Figure 3–1 shows a Venn diagram of sounds that are shared in Spanish and English, sounds unique to Spanish, and sounds unique to English. Major differences between Spanish and English occur in the fricative and liquid sound classes (Morrow, Goldstein, Gilhool, & Paradis, 2014). Fricatives Spanish does not contain the following English fricatives: [z, Z, ʃ, v], except perhaps in particular dialects. Without these phonemes, Spanish-influenced English may result in the following productions. n /z/ → /s/ in maze [mes] n /Z/ → /tʃ/ in measure [metʃ2] n /v/ → /b/ in vase [bes] n /ʃ/ → /tʃ/ in sheet [tʃit]

Additionally, the English voiced stops [b, d, g] have allophones in Spanish that provide more of a voiced spirant production: [β, ð, ] (Bedore, 1999). These spirant allophones typically occur in the medial position of words and/ or between vowels; for example, “dedo” (finger) = /deðo/ or “cada” (each) = /kaða/ (Face & Menke, 2009; Goldstein, 2001, p. 55).

Figure 3–1.  Venn diagram of shared and unique consonants in English and Spanish.

62

The late eight

Liquids Spanish and English share the [l] phoneme, but Spanish does not contain the English [ɹ]. Instead, Spanish has a vibrant trill /r/, where the tongue vibrates against the alveolar ridge (e.g., “perro” = dog), and a tap /ɾ/ which is produced with a quick touch to the alveolar ridge (e.g., “pero” = but), similar to the flap in English (/bɾ2/ for butter) (Morrow et al., 2014). In this chapter, the phonetic transcriptions will be: English [ɹ] (in “rabbit”) represented upside down, the Spanish trill [r] right-side up, and the Spanish tap [ɾ] as such. Consonant Clusters Spanish has consonant clusters in word-initial and word-medial position, such as /tɾen/ (train). Consonant clusters do not occur in word-final position in Spanish (Bedore, 1999). R-clusters in Spanish include [pr br tr dr kr gr fr]. L-clusters in Spanish include: [pl, bl, kl, gl, fl]. Spanish has different word initial s-clusters than English (Yavas, 2010). In Spanish, a vowel precedes all s-clusters: sp/esp → espejo (mirror), sc/esc → escuela (school). Clusters with /es/ + consonant in Spanish include: [esk-, esp-, est-]. Spanish-influenced English might result in a comment like, “I will estay at my abuela’s (grandma’s) house.” Word Structure Differences between English and Spanish occur in relation to word structure. Kohnert and Derr (2004) identified that on average there are longer words in Spanish (2.76 syllables/word) than in English (1.74 syllables/word) (p. 330). This linguistic difference is why a colleague questioned (somewhat teasingly), “Why would I teach the word ‘pelota’ (3 syllables), when I can teach the word ‘ball’? (1 syllable).” English relies heavily on consonant-vowel-consonant (CVC) or postvocalic consonants in word structure, while Spanish has more consonant-vowel (CV) combinations. Therefore, we see English has more final sound endings. In contrast, Spanish words primarily end in vowels, with only five final consonants: [d, n, s, ɾ, l], with some sources highlighting /x/ as a final Spanish sound, as seen in the word “reloj” (clock) (Bedore, 1999; Goldstein, 2000). Here are a few examples showing final consonants in Spanish: n pared (wall) n pan (bread) n arroz (/aros/ = rice) n flor (/floɾ/ = flower) n sol (sun)

It is important to note that final consonant deletion may influence English more than Spanish because English has more final consonants. At the same

CHAPTER 3:  The Late Eight en español

63

time, a kindergartener with a phonological disorder may still need to work on final consonant deletion in both languages (Gildersleeve-Neumann & Goldstein, 2015). I once consulted with a monolingual English-speaking SLP who had a bilingual child on her caseload. I offered to put together a list of the student’s treatment sounds in Spanish. The clinician requested Spanish targets for initial /s/ and /f/ words, as well as final /s/ and /f/ words. However, as reviewed, final /f/ words do not exist in Spanish. As in this anecdote, not all SLPs may be aware of the phonological characteristics of a child’s home language. To aid phoneme selection, bilingual SLPs or trained monolingual SLPs may need to coach professionals on the linguistic differences between English and Spanish. Notably, not all sounds occur in the same positions between English and Spanish.

Interference or Transfer Patterns In the past, researchers debated whether bilinguals had one or two separate phonological systems (see Ray, 2002 for a review). Grosjean (1989) furthered the discussion by sharing that “the bilingual is NOT the sum of two complete or incomplete monolinguals; rather, he or she has a unique specific linguistic configuration” (p. 3). Presently, the commonly accepted perspective suggests that bilinguals have two phonological systems which overlap and interact (Gildersleeve-Neumann & Goldstein, 2015; Hambly, Wren, McLeod, & Roulstone, 2013; Prezas et al., 2014). Some researchers refer to this dual language model as the Interactional Dual Systems Model (Paradis, 2001). Based on current research, SLPs can share that a child’s first language (L1) may influence or interfere with his or her second language (L2) and vice versa (Hambly et al., 2013). Thus, it is important to know the linguistic differences between languages. These differences may be a source of cross-linguistic interference or transfer. In practical terms, what this means is that bilingual children have separate phonological systems that overlap and interact with each other (Hambly et al., 2013). A child’s exposure to his or her home language may influence the child’s pronunciation of a second or third language (referred to as interference or transfer). For example, a school-age child may use the Spanish tap /ɾ/ to pronounce the English word /fɹut/ as /fɾut/, or produce the English word “shoes” as /tSus/ because the /S/ sound (and /z/ sound) are not present in Spanish. Additionally, a Spanish-speaking school-age child who has not mastered the trill /r/ may use the English /ɹ/ for the Spanish trill /r/ to say the Spanish word “dog” as “pay-ro” for perro (Prezas et al., 2014).

64

The late eight

As a quick self-test, look at the following productions made by a Spanish-speaking school-age child learning English. Which errors represent Spanish-influenced English? Or, in other words, does each example represent a speech difference or a concern for a SSD? n “choose” for shoes n “eschool” for school n “wabbit” for rabbit

In the first item, the initial /S/ changed to /tS/, and in the second item, a vowel was added before the s-cluster. These first two items are examples of Spanish-influenced English. In the third item, the /w/ for /ɹ/ substitution is a phonological process not resulting from Spanish influence (Goldstein, 2001). For this reason, the clinician needs to perform further assessment to evaluate an SSD, depending on the child’s age.

Dialects The world is home to 21 Spanish-speaking countries. Most phonological research focuses on two Spanish dialects, Mexican and Puerto Rican (Bedore, 1999). These two dialects happen to be the largest dialects in the U.S. (Taveras, Namazi, Pazuelo, & Casado, 2015). Dialectal differences obviously influence pronunciation but also may lead to vocabulary differences with significant clinical impact. To illustrate, different Spanish assessment measures may include items that are unfamiliar to a bilingual child’s unique dialectal background. These vocabulary differences make it difficult when testing specific sounds in different word positions. For example, on the Contextual Probes of Articulation Competence–Spanish (a Spanish articulation test; Goldstein & Iglesias, 2006), the Spanish word for “belt” has the Spanish target “correa” to test the phonemes [k] and [r]. However, some dialectal speakers may label the picture of a “belt” as “cinturón.” Thus, these unfamiliar words require a direct imitation or delayed model, which may not provide an accurate representation of a child’s phonological skills due to unfamiliarity (Acevedo, 1993). In two different groups of 120 three- to five-year-old Spanish-speaking children, certain articulation test items were less familiar for children from Texas (Acevedo, 1993) compared with children from California’s Sacramento Valley ( Jiménez, 1987). When given the same test items, nine words required a direct imitation for over half of the children from Texas (Acevedo, 1993); these words were: “nido (nest), nube (cloud), jirafa (giraffe), bigote (mus-

CHAPTER 3:  The Late Eight en español

65

tache), vela (candle), bañera (bathroom), rey (king), lluvia (rain), and burro (donkey)” (p. 11). As seen in these examples, even common objects and foods may have increased variation to a specific dialect. As a bilingual SLP learning Spanish as a second language, I sometimes just ask the child. One joyful kindergarten boy from Guatemala once laughed at me in disbelief, “Qué es esto? No es un chango. Es un mono” (What is this? it’s not a chango. It’s a monkey). Sometimes children like to be the experts, too.

Conservation and Radical Dialects Researchers classify Spanish dialects as either conservative or radical (Anderson & Smith, 1987; Bedore, 1999; Goldstein & Washington, 2001; Guitart, 2005). Mexican Spanish is an example of a conservative dialect, while Puerto Rican and Dominican Spanish are examples of radical dialects. SLPs must be mindful of dialects for accurate decision making to distinguish difference from disorder (Goldstein & Iglesias, 2001; Yavas & Goldstein, 1998). This section focuses on two clinically important aspects of radical dialects: final consonant deletion and substitution of /ɾ/ for /l/. Radical Dialect:  Final Consonant Deletion One main difference between conservative and radical dialects is the presence or omission of final consonants (Bedore, 1999). Depending on the speaker’s dialectal origin, the Spanish word for “more” could be pronounced as más (México) or má’ (Puerto Rico). A preschool teacher who spoke with a Puerto Rican Spanish dialect once shared with me “comemo’ la’ palabra’” [comemos las palabras = we eat our words], referring to the final consonant [s] omissions common in a Puerto Rican dialect. Based on socioeconomic and/or social status, some Puerto Rican Spanish dialect speakers substitute the syllable-final [s] with an [h] (“lah cosah” for “las cosas”) (Poplack, 1980). Whether omitted or substituted, the [s] omissions occur only in syllable final position; therefore, initial [s] omissions ([ol] for “sol” = sun) or final [r] substitutions ([flo] for “flor” = flower) are indicators of further investigation needed to determine an SSD. Radical Dialect:  Substitutions of /ɾ/ for /l/ Another notable difference for Puerto Rican Spanish speakers is the substitution of the tap /ɾ/ for /l/ in syllable-final position. For example, a child may pronounce the target word /kaɾta/ (“letter”) as /kalta/ with a Puerto

66

The late eight

Rican influenced Spanish (Yavas & Goldstein, 1998, p. 51). See Goldstein and Iglesias (2001) and Martinez (2011) for a more in-depth review of the phonological influence of Spanish dialects.

Late-Developing Sounds in Spanish As in English, children acquire certain Spanish sounds later than other sounds (Carballo & Mendoza, 2000). Table 3–1 presents findings from several frequently referenced studies on the most common later-developing sounds for Spanish-speaking children. Most of the studies highlight children who speak a Mexican dialect of Spanish. Although this table is not all-inclusive, findings highlight the most frequent later-developing sounds in Spanish. These later-developing Spanish phonemes appear to be /s, r, ɾ, l/. Other Late-Developing Sounds in Spanish Spanish /s, r, ɾ, l/ appear to be the more common later-developing sounds, particularly in Mexican Spanish dialects; however, additional sounds may also present as a challenge in pronunciation. Based on previous research, Goldstein (1995) initially summarized that school-age children may present with some infrequent errors on [x, s, tS, r, ɾ, l] and consonant clusters. Later, Fabiano-Smith and Goldstein (2010) assessed 24 children (ages 3;0 to 4;0) who spoke Puerto Rican or Dominican dialects and divided children into three groups: 8 bilingual Spanish-English–speaking children, 8 monolingual Spanish-speaking children, and 8 monolingual English-speaking children. Categories for Spanish sound acquisition were as follows: The Late 4:  [l ð r ɾ] The Middle 6:  [s f p tS β ] The Early 6:  [ t m n k x] An interesting finding from Fabiano-Smith and Goldstein’s study was the inclusion of the [ð] as a later-developing sound. English-speaking learners of Spanish demonstrate difficulty with the Spanish allophones [d] and [ð], such as in the Spanish word for the game piece “dice” = /daðo/. The interdental tongue placement of the Spanish [d] compared with [ð] may need closer assessment from both monolingual and bilingual SLPs (Face & Menke, 2009). Perhaps the pronunciation of the Spanish [ð] is a sound with underidentification (Fabiano-Smith & Goldstein, 2010). More recently, Prezas, Hodson, and Schommer-Aikins (2014) found that the most common phonological patterns of 56 four- and five-year-old bilingual children (speaking a Mexican dialect) were consonant cluster omissions and

67

Participants

Mexican children in CA (ages 4–9; n = 424) Sounds mastered later than 5 years of age

Venezuela (2;10–5;5; n = 64) Monolingual Spanish

Mexican American children in CA (3–5;7; n = 120)

Mexican American in TX (3–5;11; n = 120)

(see above)

Puerto Rican & Dominican Spanish speakers (8 bilingual, 8 monolingual)

Studies

Mason, Smith, and Hinshaw (1976) replicated Medida Española de Articulación (as cited in Jiménez, 1987)

Terrero (1979) (as cited in Acevedo, 1993)

Jiménez (1987)

Acevedo (1993)

Goldstein, Fabiano, & Washington (2005) derived from Acevedo (1993)

Fabiano-Smith & Goldstein (2010)

X

f

Xa

g

x

xprex xpost

Table 3–1. Late Developing Spanish Sounds Identified Across Studies

X

n X

d

X

ð

X

tS

X

X

X

X

X

xpost

xpost

ɾ

xpost

l X

b

X

ñ

X

X

X

X

xpre

X

r

continues

X

X

X

xprex xpost

X

s

68

ð tS

ñ

b

Midwest, USA (K–5th grade; n = 100) 1

1

1

1

1

1

1

1

1

1

1

1

2

2

2

2

3

3

4

X

3

l

6

X

5

X

ɾ

8

X

7

X

X

s

9

X

8

X

X

r

Note.  aNo other studies cite /g/ as late developing; may have been influenced by unfamiliar target ‘bigote’ (mustache) (Acevedo, 1993, p. 13).

New Totals

Leacox (2016) clinical estimate

Totals

X

X

d

New Mexico (5–8 years; n = 148)

n X

x

Chihuahua, Mexico (3–6 years; n = 97) sounds after 5

g

Linares (1981) (as cited in Jiménez, 1987)

f

Participants

Studies

Table 3–1.  continued

CHAPTER 3:  The Late Eight en español

69

liquid deviations. Although clinicians may overlook consonant clusters when identifying late acquired sounds, we expect the blending of two adjacent phonemes may be more difficult for children to produce, as seen with English monolingual children (Smit, Hand, Freilinger, Bernthal, & Bird, 1990).

Variation and Dialect Variation regarding which sounds are late acquisitions in Spanish may at least in part reflect dialectal or regional influences. For example, both Jiménez (1987) and Acevedo (1993) assessed 120 Mexican American children (ages 3–5) with the same articulation test items but found differences in which sounds were late acquisitions. Jiménez (1987) studied children from California and found that most children aged 3 to 5 years had not yet acquired /s/ and trilled /r/. In contrast, Acevedo (1993) studied children from Texas using the same articulation test items but found children of the same age had not acquired /g/ and trilled /r/. It is possible the /g/ phoneme influenced the target item “bigote” (mustache), as it was dialectally less familiar to the students in Texas.

Treatment Strategies for Late Sounds en español This section describes treatment strategies for late-developing sounds for Spanish-speaking children. The information focuses primarily on Spanishspeaking students with SSDs. You may also find the information beneficial for adults who speak Spanish-influenced English and receive accent modification services. The topics are: n Education n Treatment n Treatment n Treatment

programs approaches sounds techniques

Education Programs Clinical care for late sounds in Spanish is best undertaken with awareness of and contributing to a student’s education. Dual language (DL) programs provide educational instruction in more than one language (Thomas & Collier, 2002). Although a variety of programs exist in the United States and around the globe, DL programs use different methods to group or “chunk” language instruction. This “grouping” or “chunking” of language provides opportunities for children to learn language in predictable ways.

70

The late eight

One-Way or Two-Way DL programs may have a wide variation but may include either one-way or two-way DL classrooms (Langdon, 2008). A one-way DL classroom means the classroom includes only children whose home language includes exposure to Spanish. To contrast, a two-way DL program means the classroom includes children whose home language has Spanish as well as children whose home language does not include Spanish (i.e., English-speaking children who are learning Spanish). Two-way refers to the two different groups of children with different home languages learning two languages (Gómez, Freeman, & Freeman, 2005). Language Ratio The language of instruction is another way to group or “chunk” language learning. Many DL programs transition to a specified ratio or percent of language exposure (Gómez et al., 2005). Children may start kindergarten with instruction in Spanish 80 to 90% of the time and English 10 to 20% of the time and then move to first grade with 70% Spanish and 30% English. The language ratio may continue to shift until third grade, when language exposure is about a 50 to 50% equal ratio. In an 80-20 Spanish-English kindergarten classroom, English instruction may include reading a familiar Spanish story in English, singing the English alphabet and child-friendly songs in English, and structured language-literacy activities for children to participate in. For example, a snack time might focus on opportunities to learn specific English vocabulary and pragmatic functions during snack time (e.g., commenting “this is yummy,” “do you like it?,” “who wants more?”) (Ballantyne, Sanderman, & McLaughlin, 2008). From a clinical perspective, SLPs may decide to match the language of therapy to the language ratio of the classroom. If a child is in an 80-20 Spanish-English classroom, a clinician may structure speech therapy with eight sessions in Spanish and then two sessions in English with familiar vocabulary words. Or bilingual SLPs may decide to split a 30-minute session with approximately 25 minutes in Spanish and the last 5 minutes in English (Leacox, 2016). We know this language ratio may depend on the child’s personal language proficiency and exposure to other DL speaking peers or English-speaking siblings (Rojas, Iglesias, Bunta, Goldstein, Goldenberg, & Reese, 2016). To illustrate, Gildersleeve-Neumann and Goldstein (2015) investigated an eight-week bilingual treatment for two 5-year-old males (one with an SSD, one with childhood apraxia of speech). The treatment language ratio emphasized Spanish over English, where at least two of every three days of treatment focused on Spanish. Gildersleeve-Neumann and Goldstein (2015) found that both children made gains in both languages, with improvements made on untreated errors.

CHAPTER 3:  The Late Eight en español

71

Bilingual Resources Depending on the number of trained bilingual educators, other DL programs may group language instruction based on the teachers’ language proficiency. Children can rotate between Spanish-speaking bilingual teachers and English monolingual teachers throughout the day to provide exposure to both languages (Gómez et al., 2005). Or specific subjects may be taught in a predetermined language. To illustrate, a DL program may decide to teach math in Spanish until fourth grade, because educators believe that children in that approach outperform other students on math tests, hypothesizing that high math scores result from the strong foundation of math education provided in the home language.

Treatment Approaches for Multilingual Students Treatment of SSDs in bilingual children lags behind that of monolingual children both in its evidence base and in practitioners’ clinical competence (Verdon, McLeod, & Wong, 2015; Williams & McLeod, 2012). Since 1994, only 6 peer-reviewed published studies have appeared on treatment for multilingual children with SSDs, compared with 130 studies with English monolingual children (Baker & McLeod, 2011). The multilingual treatment studies published between 1994 and 2015 described multilingual children speaking a variety of languages, including French, Cantonese, Punjabi, Gujarati, Hindi, and Spanish. As depicted in Table 3–2, five studies provided therapy with English-only interventions, and only one study incorporated both languages in treatment (Gildersleeve-Neumann & Goldstein, 2015). The six treatment approaches described in these studies are all familiar to clinicians who treat English-speaking students. They include: 1. Traditional articulation 2. Minimal pairs 3. Core vocabulary 4. Perceptual and metalinguistic 5. Cuing for motor plan (for childhood apraxia of speech) 6. Home practice

Cognate Intervention Researchers are developing an approach called cognate intervention to focus specifically on treating multilingual English-Spanish–speaking students (Kohnert & Derr, 2004; Leacox, 2013). As background, cognates are words with similar overlapping sounds between two languages, with the same meaning (Harley, 2008). For example,

72

“JL” n = 1 (5;2) Cantonese-Eng

“HK” n = 1 (4;6) English-Punjabi

n = 2 (4;8, 5;2) Cantonese at birth, Eng preK

“MC” n = 1 (5 yrs) English, Hindi, Gujarati

n=2 (5;8, 5;6 males) Spanish & Eng

Holm, Ozanne, & Dodd (1997)

Holm & Dodd (1999)

Holm & Dodd (2001)

Ray (2002)

GildersleeveNeumann & Goldstein (2015)

SSD, CAS

Mild SSD

Phonological (4;8) Artic & phonological (5;2)

Phonological

Perceptual, drill, minimal pairs, functional vocabulary, cueing motor plan

Cognitive-linguistic = auditory bombardment, minimal pairs therapies, perceive and produce

Traditional artic, minimal pairs, core vocabulary, home practice

Core vocabulary

Traditional artic, minimal pairs

Mild artic: /s/ Phonological: gliding & cluster reduction

Traditional artic, motor based articulation program

Treatment Approach(es)

Interdental /s, z/ (phonetic errors in both languages)

Diagnosis

English and Spanish

English-only

English-only

English-only

English-only

English-only

English-only or Bilingual TX

Note.  *Children treated in both Spanish and English. CAS = childhood apraxia of speech; SSD = speech sound disorder; TX = treatment.

n = 7 (7;0–8;3) French-English

Child(ren) and Languages

McNutt (1994)

Study

Table 3–2.  Treatment Studies with Multilingual Children

CHAPTER 3:  The Late Eight en español

73

the translation equivalents plate-plato and lion-león are both cognate pairs. As Kohnert and Derr (2004) mentioned, cognates are appropriate targets for a bilingual approach. These cognate pairs may be appropriate targets whether the SLP knows little or no Spanish or is bilingual. Choosing these target words potentially creates a bridge between the home and school languages. Recent research has established that even younger children are sensitive to cognates in vocabulary (Leacox, Wood, Sunderman, & Schatschneider, 2016; Pérez, Peña, & Bedore, 2010; Simpson Baird, Palacios, & Kibler, 2016). However, to date no one has presented the empirical evidence of cognates for phonological therapy. Nonetheless, “Words Their Way” for Spanish-English DL learners provides phonological awareness activities, where the initial sound pictures are cognates (Helman, Bear, Invernizzi, Templeton, & Johnston, 2009). The images share the same first sound between English and Spanish (examples below in Figure 3–2). Although cognates need further research, it is an interesting strategy to consider for DL learners.

Treatment Sounds The topic of treatment sounds appears in two sections: selection of goals and selection of sounds. Goal Selection If a disorder is determined, how do we choose an intervention approach and specific goals to target? Two key clinical recommendations on treatment continue to guide clinical practice (Table 3–3). First, Yavas and Goldstein (1998) recommended treating phonological patterns by first targeting

Figure 3–2.  Example of cognate words, which share [s] sound similarity between English and Spanish.

74

The late eight

Table 3–3.  Clinical Recommendations to Guide Clinical Practice with Multilingual Speakers Yavas ¸ & Goldstein (1998, pp. 57–58)

Kohnert & Derr (2004, pp. 325–332)

Treat phonological patterns:

Bilingual targets:

1.  Similar rates in L1 and L2 (frequently occurring) 2.  Unequal frequency between L1 and L2 3. Only in one language

A. Choose target phonemes which are shared across the two languages Cross-linguistic targets: B. Intervention on the unshared features between the two languages

Source:  Kohnert, K., & Derr, A. (2004). Language intervention with bilingual children. In B. Goldstein (Ed.), Bilingual language development and disorders in Spanish-English speakers (pp. 311–338). Baltimore, MD: Paul H. Brookes; Yavas¸, M., & Goldstein, B. (1998). Phonological assessment and treatment of bilingual speakers. American Journal of Speech-Language Pathology, 7, 49–60. doi:10.1044/1058-0360.0702.49

sounds in error that exist in both languages, then targeting sounds unique to Spanish or unique to English (Perez, 1994 as cited in Yavas & Goldstein, 1998). Children with difficulties in production of late-developing sounds may struggle with only one or a few articulation sounds in error. However, we can apply Yavas and Goldstein’s (1998) phonological principles to latedeveloping articulatory productions. Second, Kohnert and Derr (2004) describe two broad bilingual treatment perspectives to encourage gains in both languages: a bilingual approach and a cross-linguistic approach. A bilingual approach focuses on the shared skills in both languages, such as cognate words (English-Spanish translation equivalents: salt/sal) and shared phonemes (e.g., [s], [l]). Kohnert and Derr’s bilingual approach corresponds to Yavas and Goldstein’s (1998) primary recommendation to target shared error patterns that have similar impact on a child’s L1 and L2. Additionally, monolingual English SLPs can still choose a bilingual approach by selecting phonemes that overlap between English and Spanish. Prezas et al.’s (2014) findings align with the bilingual approach, as bilingual 5-year-old children demonstrated equal error frequency on consonant cluster deletion and liquid deviation errors between English and Spanish. To provide services, an SLP would need knowledge of the child’s L1: Spanish. Kohnert and Derr’s cross-linguistic approach supports an intervention on the unshared features between the two languages, similar to that of Yavas and Goldstein’s (1998) third recommendation to target error patterns unique to one language.

CHAPTER 3:  The Late Eight en español

75

In 2002, Ray published the first study with a trilingual student with English-only treatment and found that generalization occurred on untreated sounds in both Hindi and Gujarati. Then, there was a 13-year gap in the bilingual SSD research literature until Gildersleeve-Neumann and Goldstein’s (2015) study with the language of instruction including both English and Spanish. It goes without saying that more evidence and clinical tools are needed to guide SLPs to serve Spanish-English DL learners. Sound Selection As depicted in Figure 3–3, late sounds divide into three categories: (1) treatment of sounds found in both English and Spanish, (2) treatment of sounds unique to Spanish, and (3) treatment of sounds unique to English. Based on Figure 3–3, [s] and [l] are late sounds found in both English and Spanish, tap [r] and trill [ɾ] are late sounds unique to Spanish, and SH, Z, V, and English-R are late sounds unique to English. Sounds in the first two groups are candidates for treatment. But what about sounds in the third group, which occur in English but not in Spanish? To treat or not to treat? Spanish-speaking children may have difficulty producing the English [ʃ z v]. These sounds do not exist in the child’s home language and result in a speech difference but not disorder. Therefore, a Spanish-speaking student with only these sound errors would not typically qualify for speech services (Yavas & Goldstein, 1998). Keep in mind, a child with difficulty in pronunciation of Spanish trill [r] and/or tap [ɾ] may also have difficulty with the English [ɹ], and in that case, may qualify for therapy to remediate speech productions in the language of the classroom. Parents

Figure 3–3.  Venn diagram of unique and overlapping late acquired sounds.

76

The late eight

or adults may request services for accent addition or accent modification; however, this type of therapy support is not necessarily the purpose of the individualized education plan (IEP).

Frequency of Sounds on a Caseload Clinical expertise contributes to the decision-making process for evidencebased practice (see Chapter 2 of this book). Clinical experiences can verify research findings. Additionally, the clinical world can inform research. In this spirit, I calculated a quick retrospective snapshot of the most common speech goals from part of my time as a bilingual SLP. Figure 3–4 contains this informal calculation from my clinical experience. Notably, this information is an estimate and only one expert opinion (ASHA, 2004). At the time, I was working outside of Chicago in a district with EnglishSpanish dual language programs. The children were Spanish-English bilinguals instructed in general education classrooms. The figure includes ~100 bilingual children with IEPs across two different school years (grades K–6). Preschool students were not included for this snapshot. Illinois had a case­ load capacity of 60 students at the time. From this sample, approximately 87% of children had articulation or phonological goals for sounds in Spanish (see Figure 3–4). Some children had concomitant language, fluency, voice, and augmentative-alternative communication goals. Some children had more than one sound in error. For example, one child had goals to remediate trill [r], tap [ɾ], and [ɾ]-blends.

Figure 3–4. Clinical experience estimate: Common Spanish speech sound goals for school-age bilingual children.

CHAPTER 3:  The Late Eight en español

77

In this retrospective anecdote, the sounds with speech goals from most common to less common sounds were: 1. tap [ɾ] and [ɾ]-blends (27%) 2. [s] and [s]-blends (interdental errors more common than lateralized) (21%) 3. trill [r] (20%) 4. [l] and [l]-blends (8%) 5. Less frequent sound errors were [k g tS ] and more complex phonological difficulties.

Treatment Techniques Treatment techniques are “tools of the trade” for treating Spanish-speaking children with SSDs. As expected, treatment tool techniques for Spanishspeaking children overlap extensively with tools for English-speaking children. As elsewhere in this book, the discussion of each sound includes the following information: 1. Relative frequency 2. Expected errors 3. Shaping and elicitation techniques 4. Minimal pairs Each subsection concludes with suggestions for practice. In addition to these techniques, the University of Iowa provides an interactive website to demonstrate production of all Spanish and English phonemes: http://soundsofspeech.uiowa.edu/spanish/spanish.html (also are available with an app). Sometimes this visual can be helpful for students to have increased awareness about correct placement of Spanish phonemes. [s] and [l] These are late sounds found in both English and Spanish. [s] Relative Frequency In Spanish, [s] ranks first in relative frequency compared with all other Spanish consonants, and its percentage of occurrence compared with all Spanish phonemes is 9.4% (Guirao & Jurado, 1990).

78

The late eight

Expected Errors Similar to English, a common error for [s] is lisping, with interdental tongue placement [θ]. However, some dialects of Spanish may produce the interdental “θeta” as a typical dialectal production (Martinez, 2011). Lateralizing [s] with airflow escaping on each side of the tongue occurs but is less common than interdental productions. Spanish-speaking children with SSDs are likely to experience difficulties with [s] in consonant clusters (Gildersleeve-Neumann & Goldstein, 2015; Yavas, 2010). Phonetic Placement and Shaping Techniques In my clinical experience, strategies similar to those for English-only–speaking children in this book’s English resources are applicable. A key environment for [s] productions is before the [i] vowel to retract the tongue. Two words to elicit trials of Spanish [s] productions are sí (yes) and silla (chair). Additionally, Spanish materials designed for Spanish-speaking children with cleft palate are available through the Leaders Project site. The site provides clinical videos of Dr. Crowley and Spanish-speaking SLPs eliciting Spanish sounds for the late-developing sound [s] and middle-developing sounds [k g]: http://www.leadersproject.org/2013/03/13/las-estrategias-paraproducir-la-s/. The [s] shaping strategies focus on cleft palate repair but include strategies that would work for children with SSDs as well. Minimal Pairs It is a myth that there are “no rhyming words in Spanish.” Because Spanish has fewer final sounds and a more syllabic CV word structure, there are fewer minimal pair combinations compared with English, but minimal pairs are still used in research and clinical practice as an appropriate tool for therapy (Gildersleeve-Neumann & Goldstein, 2015) and with several languages (Holm & Dodd, 2001; Holm, Ozanne, & Dodd, 1997). For Spanish speakers with a conservative dialect, such as Mexican Spanish, you might consider working on minimal pairs with final [s]. Final [s] occurs in both English and Spanish. The phoneme [s] is only one of five final sounds in Spanish. Examples with plurality include: n Pato-Patos (duck-ducks) n Dedo-dedos (finger-fingers) n Mano-manos (hand-hands)

Or simple CV-CVC minimal pairs with a final [s] phoneme may be another option: n Pe-Pez (letter p, fish) n Ve-Vez (see [third person singular ver], n Me-Mes (reflexive pronoun, month)

time)

CHAPTER 3:  The Late Eight en español

79

Suggestions for Practice For younger children, choosing one treatment word for home practice may be a relevant strategy. One bilingual SLP colleague I worked with gave each of her students a notebook for speech therapy. As her students became successful with a sound, she would give them just one word to take home and practice ( J. Leautaud, personal communication, December 22, 2016). The child could color the notebook assignment with the one target word, if he or she chose. The homework drawing could be artistic or simple, depending on the age of the student (see Figure 3–5 for an example). Although these children may have had consistent phonological or articulation disorders, this type of homework assignment may align with principles of a core vocabulary approach (Holm & Dodd, 1999). Clinically, this assignment increased home-to-school communication and provided a feasible method for the bilingual SLP to share treatment information with the child’s family. [l] Relative Frequency In Spanish, [l] ranks seventh in relative frequency compared with all other Spanish consonants, and its percentage of occurrence compared with all Spanish phonemes is 3.9% (Guirao & Jurado, 1990). Expected Errors Similar to English, a common error is gliding, substituting a [w] or [ j ] for an [l] consonant. Examples in Spanish are: [pjato] for “plato” (plate), [ja] for “la” (Spanish for “the,” a Spanish feminine article). Liquid omission may also occur in consonant clusters: banco for “blanco” (white) (Prezas et al., 2014). The primary difference between the English and Spanish [l] is the

Figure 3–5.  Therapy homework example for isolated [s] productions. (Practice the “s” sound and draw the rays of the sun.)

80

The late eight

markedness, which relates to sound complexity in relation to the world’s languages (Fabiano-Smith & Barlow, 2010). The [l] is unmarked in Spanish but marked in English (Cataño, Barlow, & Moyna, 2009). Based on treatment in English (Dinnsen, Chin, Elbert, & Powell, 1990), perhaps targeting [l] in English (marked) would lead to more accurate productions of [l] in Spanish (unmarked). This hypothesis requires further research. Phonetic Placement and Shaping Techniques As [l] is an overlapping sound in English and Spanish, strategies to elicit [l] production may be similar to elicitation strategies in English. Minimal Pairs As stated in the discussion of [s], Spanish has fewer final consonants than English, which limits the number of minimal pairs. Nonetheless, minimal pairs remains a useful treatment tool. Here are a few examples of minimal pairs: English n fawn-flan n pain-plane Spanish n luego-fuego (then-fire) n puma-pluma (puma-feather) n lobo-globo (wolf-balloon) Combined English and Spanish Spanish Spanish-English English Pan (bread) Plan Pan Suggestions for Practice High-frequency words can be beneficial to target in Spanish. The most common Spanish word is the word meaning “the,” with over 909,735 occurrences in a word frequency count examining newspaper samples; this number is almost 10% of the total (Thomas, Nash, Thomas, & Richmond, 2005). Spanish articles can be either feminine or masculine, singular or plural. All definite articles include the [l] phoneme in productions, which makes them appropriate targets for [l] practice: “The” Targets

Singular

Plural

Feminine

la playa = the beach

las niñas = the girls

Masculine

el león = the lion el lobo = the wolf

los niños = the boys los gatos = the cats

CHAPTER 3:  The Late Eight en español

81

These practice targets may be beneficial, as children with language impairment may also have grammar difficulty in accurate production or matching correct article-noun agreement in Spanish. These targets will be helpful if intervention groups have children with and without language impairment. Additionally, Spanish short stories or Madlib stories have several opportunities for older children to practice this sound in article productions: el, la, los, las. Tap [r] and Trill [ɾ] These are late sounds unique to Spanish. Frequency In Spanish, the tap [ɾ] ranks third in relative frequency compared with all other Spanish consonants, and its percentage of occurrence compared with all Spanish phonemes is 5.4% (Guirao & Jurado, 1990). This higher ranked frequency may be because the tap [ɾ] is one of the few consonants that occur in the final position of Spanish words. Additionally, tap [ɾ] occurs in the Spanish initial and medial ɾ-blends. The trill [r] ranks sixteenth in relative frequency, with its percentage of occurrence at only 0.4% (Guirao & Jurado, 1990). Expected Errors Similar to English, a common error is gliding, substituting a [ j ] for an [r] consonant; [w] for [r] substitutions are less common in Spanish, unless the child has substantial exposure to English. Another developmental error is to substitute a /ð/ for /ɾ/ (Prezas et al., 2014). Table 3–4 provides examples of the substitutions, omissions, and distortions that Spanish-speaking children may produce. Bilingual children have more substitution errors than Spanish monolinguals (Goldstein & Washington, 2001). For example, monolingual Spanish-speaking children may only substitute tap and trill sounds with [l ɾ j], while bilingual children may present with more possible substitutions: [l ɾ j s t tj dr ld] (Goldstein & Washington, 2001). Phonetic Placement and Shaping Techniques Although many Spanish speakers may be able to trill the Spanish /r/, teaching someone to produce this vibrant sound is much different. Here are a few techniques I have learned over the years: Shaping: “Engine lips”— bilabial trill to alveolar trill. If a child does not produce any type of “r” in either language and if the trill [r] is a phoneme in the child’s dialect, then I may start with this strategy. I start here in part

82

The late eight

Table 3–4.  Error Patterns for the Spanish tap [ɾ] and trill [r] Spanish Error Profiles for Tap r / Trill r

Error

Example (target → child’s production)

Substitution

Bilabial trill for alveolar

/pero/ → /peBo/  (dog)

Uvular trill // for alveolar

/pero/ → /peo/

Tap /ɾ/ for trill /r/

/fɾuta/ → /fruta/  (fruit)

English /ɹ/ for Spanish /r/

/aros/ → /aɹos/ (rice)

/j/ for trill /r/

/pero/ → /pejo/ 

Trill /r/ for tap /ɾ/

/raɾo/ → “rrarro”  (rare)

/l/ for tap /ɾ/

/fɾuta/ → /fluta/

Omission

Omit final /ɾ/

maɾ → “ma”  (sea)

Distortion

Distorted production

flip-flop tongue with attempt to approximate sound

Sources: Goldstein & Washington, 2001; González-Bueno, 2005.

because it can be a fun way to try making different sounds. Additionally, this strategy provides tiered levels of support. Tiered levels benefit group therapy when working with children at different levels of approximating accuracy of the trilled /r/ sound. The “Engine lips” strategy was inspired from a comical Youtube video with “Mr. Ugly Teeth” that progresses from the trill [r] sound in isolation, to syllables, words, and sentences. The video presentation ends with a wellknown Spanish tongue twister to practice the trill [r]: “erre con erre cigarro, erre con erre barril, rápido corren los carros del ferrocarril” (an R with an R cigar, an R with an R barrel, rapidly running the cars to the railroad) (Terrell, 1989, p. 17). http://www.youtube.com/watch?v=P9mMvuRGKY8 Here are the individual steps: 1. “Engine lips”:  Ask the student to place lips together gently, keep lips relaxed, and puff air through the closed lips. Repeat until you achieve a bilabial trill. Cues at step 1 or 2 may include, “haz el sonido cómo un barco a motor, un carro, bichos, a roncar” (make the sound like a motor boat, car, bugs, snoring). 2. Tongue and lip:  Ask the student to place tongue between upper lip and front teeth. The tongue is in front of the teeth but behind the upper lip. Again, ask the child to puff air through gently closed teeth-tongue-lip placement. Modeling this placement and providing a mirror are helpful.

CHAPTER 3:  The Late Eight en español

83

After several vibrant puffs, now the child’s tongue also has a sense of vibrant movement. 3. Shape to alveolar trill:  Ask the student to repeat step 2 and then slide the tongue from between the upper lip and front teeth, back toward the alveolar ridge. Repeat front-to-back tongue movements with sustained puffs of air, until resulting in an alveolar trill.

Have you ever seen or heard a bilabial trill? A bilabial trill is a unique substitution error for the trill /r/. You produce a bilabial trill by vibrating the lips together to create a sound like a raspberry sound or a motor boat imitation. These productions may “sound” adequate in the trill quality — if you’re not looking directly at the child and just listening — but are not accurate productions. However, bilingual children may benefit from remediation, as the inaccurate placement may bring unwanted social attention to the speaker. The bilabial trill can be distracting for a listener, as you can see the lip vibrations. I worked with one third-grade boy who occasionally turned his head to hide his lips when he produced the bilabial trill. He knew his pronunciation was different but he still preferred the bilabial trill over the alternate /r/ for /d/ substitution when saying the word “dog” in Spanish (“perro”), which resulted in producing the word: “pedo” . . . you’ll have to Google-translate that one. Thankfully, the child had the concept of a vibrant sound — just the wrong placement. From there, shape these bilabial substitution errors to the correct alveolar placement.

Phonetic placement: Muerde-mueve-respira (bite-move-breathe). This technique has been used successfully to help fourth-grade bilingual students with residual [r] difficulties in Spanish. I like this technique because it only has three steps. Simple instructions may be at your advantage when a student also has language difficulties. You may consider priming this technique by first identifying speech articulators: tongue sides, alveolar ridge. Using a mirror may be beneficial also.

1. Ask the student to bite (gently!) the sides of tongue (to close airflow from escaping). 2. Ask the student to move tongue tip behind the front teeth. 3. Ask the student to take a deep breath and puff strong air (breathe) out.

84

The late eight

Shaping: Uvular trill to alveolar trill. Some children may produce or approximate an uvular trill to substitute for the alveolar placement of the trill [r]. A trill [r] produced in a posterior position may be a sign of dialectal variations, such as in a Puerto Rican or Dominican dialect (see Appendix in Goldstein & Iglesias, 2001; Goldstein & Washington, 2001). Alternatively, children with SSDs may initially produce or approximate an uvular trill when first learning the alveolar trill. No matter the source, velar trills have an advantage of vibratory movement already occurring in the speech system. The clinician’s job is to shift that vibratory element to the alveolar ridge, if dialectally appropriate (e.g., Mexican Spanish).

1. Ask the student to produce the vibrant sound. 2. Ask the student to put the tongue behind the front teeth (and place hands on cheeks to keep airflow from redirecting, if needed). 3. Ask the student to take a deep breath and puff strong air toward front of mouth. Shaping: Final [l] to trill [r] or tap [ɾ]. This technique is based on the coarticulation and phonetic similarity among [l], [r], and [ɾ]. This strategy may be the phonetic contrast needed to eliminate [l] substitutions.

1. Ask the child to say “el” (masculine definite article in Spanish for word “the”). 2. Then name picture of “el río” (the river), but flip tongue back quickly between words. 3. Ask the student to try again but flip the tongue forcefully for the [r] or [ɾ], depending on target approximation. 4. Can also try with the Spanish words for “the king”: el rey. Minimal Pairs Similar to English monolingual children with SSDs, bilingual children may also have difficulties perceiving the difference between the trill /r/ and tap /ɾ/. Complete an auditory discrimination task to see if a child distinguishes the difference and/or use minimal pairs in therapy to practice productions (see González-Bueno, 2005 for picture prompts). Minimal pair auditory discrimination (perception).  Instructions for this task may be something similar to: “Sólo levante la mano cuando lo oigas la doble rr . . . perro – pero” [“Only raise your hand when you hear the trilled rr . . . perro (dog) . . . pero (but)”] (González-Bueno, 2005).

Minimal pair examples of tap [ɾ] and trill [r]: n pero

– perro

(but – dog)

CHAPTER 3:  The Late Eight en español n cero n coro

– cerro – corro

85

(zero – hill) (choir – I run)

Minimal pair examples of [r] and [l]: n rata – lata n río – lío n rey – ley

(rat – can) (river – mess) (king – law)

Minimal pair verbal practice (production).  González-Bueno (2005) presented a case study of a bilingual child and focused on three sets of minimal pairs: trill /r/ versus /l/, trill /r/ versus tap /ɾ/, and tap /ɾ/ versus /l/. The conference proceeding includes pictures and words that can be used in therapy (available in González-Bueno’s appendices) — or as a model to make your own materials.

Suggestions for Practice Simple activities to send home can increase repetitions and possible generalization. I found these activities as suitable to practice during group therapy or for home therapy, relying on an element of independence and/ or self-monitoring. 1. Online audio flashcards.  Online flashcards provide the written Spanish word and audio examples of native speakers producing the Spanish target. I add a self-monitoring tally sheet to allow the child to track accurate and inaccurate productions. I primarily used this website for the trill [r]: http://www.studyspanish.com 2. Question-Answer. To practice the tap [ɾ], clinician or peers take turns asking what you’d like to do during the weekend, offering two choices. The choices need to include two infinitives (i.e., unconjugated, to-___ verbs). Child needs to self-monitor and monitor the peer. For example, “quieres nadar en la piscina o jugar al tenis con Alison?” (Do you want to swim in the pool or play tennis with Alison?) (Terrell, 1989, p. 17). This activity works well in pair or group therapy but may also be appropriate if family support (by a sibling or parent) is available. 3. Simple picture treatment materials.  Simple books or picture cards are helpful to send home. Given the lack of treatment materials in Spanish, Dr. Kohnert and colleagues Scarry-Larkin and Price (2000) published clinician-friendly materials that are economically priced through Learning Fundamentals: Fonología en Español: Dibujos y Actividades [Spanish Phonology: Picture Cards and Activities], published by LocuTour. These treatment materials focus on early-, middle-, and late-developing sounds. Additionally, the word targets are divided into varied syllable length, which allows the clinician to control for difficulty level (2-syllable targets vs. 3-4-5-syllable targets).

86

The late eight

Sample Lesson Plan To summarize the use of tools described in this section, here is a sample lesson plan for the trill [r]. This lesson plan is for the end of assessment and/or early in treatment. It incorporates multiple strategies for the trill /r/ (Table 3–5).

Table 3–5.  Example Lesson Plan for Early Treatment Elicitation of the Spanish Trill /r/ Pretest probe (words from Spanish Articulation Measure; Mattes, 1995 or CPAC-S; Goldstein & Iglesias, 2006)

Baseline 20 words: 10 words for tap /ɾ/ 10 words for trill /r/

Teach oral mechanism and demonstrate trill production

Observe trill /r/ demonstrations from University of Iowa website:  http://www.uiowa​ .edu/~acadtech/phonetics/#

Auditory discrimination (see González-Bueno, 2005)

Child given pictures of minimal pair sets. Child should be able to identify correct target with trill /r/ (when listening to clinician): Cerro-cero, carro-caro, perro-pero

Elicitation strategies

Cycle through strategies to elicit the correct production: •  Engine lips • Muerde, mueve, respira (bite sides of tongue, move tip behind front teeth, breathe)

If correct production elicited, then practice with these motivating game options

1.  Shoot hoops

Posttest probe

Same 20 words

Home practice

Listen to correct trill /r/ productions and trial trill /r/ productions in isolation or words. http://www.studyspanish.com/pronunciation/ letter_rr.htm

_________________, CCC-SLP Terapista del habla y lenguaje

2. Bingo 3.  Soccer goal game 4. Dice game

CHAPTER 3:  The Late Eight en español

87

Conclusions The focus of this chapter was to review the knowledge SLPs need to treat SSDs for Spanish-speaking learners of English. Essential to service provision, the key areas highlighted were the differences and similarities between English and Spanish phonological systems, later acquired sounds in Spanish, and specific treatment strategies for remediation. Presently, there are a mere six studies on treatment with only one research study providing treatment in Spanish and English (Gildersleeve-Neumann & Goldstein, 2015), emphasizing the necessity of further bilingual research guided by clinical insight. Given the increase of multilingual speakers, clinical researchers and SLPs need to continue to investigate strategies for multilingual children with SSDs.

References Acevedo, M. A. (1993). Development of Spanish consonants in preschool children. Communication Disorders Quarterly, 15(2), 9–15. American Speech-Language-Hearing Association. (2004). Evidence-based practice in communication disorders: An introduction [Technical report]. Available from http://www.asha.org/policy American Speech-Language-Hearing Association. (2016). Demographic profile of ASHA members providing bilingual services [PDF document]. Retrieved from http://www.asha.org Anderson, R., & Smith, B. (1987). Phonological development of two-year-old monolingual Puerto Rican Spanish-speaking children. Journal of Child Language, 14, 57–78. Baker, E., & McLeod, S. (2011). Evidence-based practice for children with SSDs: Part 1 narrative review. Language, Speech, and Hearing Services in Schools, 42(2), 102–139. doi:10.1044/0161-1461(2010/09-0075) Ballantyne, K. G., Sanderman, A. R., & McLaughlin, N. (2008). Dual language learners in the early years: Getting ready to succeed in school. Washington, DC: National Clearinghouse for English Language Acquisition. Available at http://www.ncela​ .gwu.edu/resabout/ecell/earlyyears.pdf Bedore, L. (1999). The acquisition of Spanish. In O. Taylor & L. Leonard (Eds.), Language acquisition across North America: Cross-cultural and cross-linguistic perspectives (pp. 157–208). San Diego, CA: Singular. Carballo, G., & Mendoza, E. (2000). Acoustic characteristics of trill productions by groups of Spanish children. Clinical Linguistics and Phonetics, 14(8), 587–601. doi:10.1080/026992000750048125 Cataño, L., Barlow, J. A., & Moyna, I. M. (2009). A retrospective study of phonetic inventory complexity in acquisition of Spanish: Implications for phonological universals. Clinical Linguistics and Phonetics, 23(6), 446–472. doi:10.1080/02699200902839818 Crowley, C., Gildersleeve-Neumann, C., Peña, E., Restrepo, M. A., Rhein, D., & Rodriguez, B. (2014, November). How they work: Graduate SLP programs with bilingual/multicultural concentrations. Presentation at the American SpeechLanguage-Hearing Association Convention, Orlando, FL.

88

The late eight

Dinnsen, D., Chin, S., Elbert, M., & T. Powell. (1990). Some constraints on functionally disordered phonologies. Journal of Speech, Language, and Hearing Research 33, 28–37. Fabiano-Smith, L., & Barlow, J. A. (2010). Interaction in bilingual phonological acquisition: Evidence from phonetic inventories. International Journal of Bilingual Education and Bilingualism, 13(1), 81–97. Fabiano-Smith, L., & Goldstein, B. (2010). Early-, middle-, and late-developing sounds in monolingual and bilingual children: An exploratory investigation. American Journal of Speech-Language Pathology, 19, 66–77. Face, T. L., & Menke, M. R. (2009). Acquisition of the Spanish voiced spirants by second language learners. In Selected Proceedings of the 11th Hispanic Linguistics Symposium (pp. 39–52). Somerville, MA: Cascadilla Proceedings Project. Gildersleeve-Neumann, C., & Goldstein, B. (2015). Cross-linguistic generalization in the treatment of two sequential Spanish-English bilingual children with speech sound disorders. International Journal of Speech Language Pathology, 17(1), 26–40. doi:10.3109/17549507.2014.898093 Goldstein, B.A. (1995). Spanish phonological development. In Kayser, H. (Ed.), Bilingual speech-language pathology: An Hispanic focus (pp. 17–39). San Diego, CA: Singular. Goldstein, B. (2000). Cultural & linguistic diversity resource guide for speech-language pathologists. San Diego, CA: Singular. Goldstein, B. (2001). The effect of dialect on phonological analysis: Evidence from Spanish-speaking children. American Journal of Speech-Language Pathology, 10, 394–406. Goldstein, B., & Iglesias, A. (2001). The effect of dialect on phonological analysis: Evidence from Spanish-speaking children. American Journal of Speech-Language Pathology, 10, 394–406. doi:10.1044/1058-0360(2001/034) Goldstein, B., & Iglesias, A. (2006). Contextual probes of articulation competenceSpanish. Greenville, SC: Super Duper Publications. Goldstein, B., & Washington, P. (2001). An initial investigation of phonological patterns in 4-year-old typically developing Spanish-English bilingual children. Language, Speech, and Hearing Services in Schools, 32, 153–164. doi:10.1044/0161-1461​ (2001/014) Gómez, L., Freeman, D., & Freeman, Y. (2005). Dual language education: A promising 50-50 model. Bilingual Journal Research, 29, 145–164. González-Bueno, M. (2005). Articulatory difficulties in the acquisition of Spanish /r/ in the bilingual context. In J. Cohen, K. T. McAlister, K. Rolstad, & J. MacSwan (Eds.), ISB4: Proceedings of the 4th International Symposium on Bilingualism (pp. 914–934). Somerville, MA: Cascadilla Press. Gorman, B., & Kester, E. S. (2003). Spanish-influenced English: Typical phonological patterns in the English language learner. Austin, TX: Bilinguistics. Retrieved from http://bilinguistics.com/wp-content/uploads/2013/01/abad_1001.pdf Grosjean, F. (1989). Neurolinguists, beware! The bilingual is not two monolinguals in one person. Brain and Language, 36(1), 3–15. Guirao, M., & García Jurado, M. A. (1990). Frequency of occurrence of phonemes in American Spanish. Revue québécoise de linguistique, 19(2), 135–149. doi:10.7202/​ 602680ar Guitart, J. M. (2005). Sociophonetic knowledge of Spanish and control of style. In L. Sayahi & M. Westmoreland (Eds.), Selected proceedings of the Second Workshop

CHAPTER 3:  The Late Eight en español

89

on Spanish Sociolinguistics (pp. 16–23). Somerville, MA: Cascadilla Proceedings Project. Hambly, H., Wren, Y., McLeod, S., & Roulstone, S. (2013). The influence of bilingualism on speech production: A systematic review. International Journal of Language and Communication Disorders, 48(1), 1–24. doi:10.1111/j.1460-6984.2012.00178.x Harley, T. (2008). The psychology of language: From data to theory. Sussex, UK: Psychology Press. Helman, L., Bear, D. R., Invernizzi, M., Templeton, S., & Johnston, F. (2009). Words their way: Emergent sorts for Spanish-speaking English learners. Boston, MA: Pearson. Holm, A., & Dodd, B. (1999). An intervention case study of a bilingual child with a phonological disorder. Child Language Teaching and Therapy, 15, 139–158. doi:10.1177/ 026565909901500203 Holm, A., & Dodd, B. (2001). Comparison of cross language generalisation following speech therapy. Folia Phoniatrica et Logopaedica, 53, 166–172. doi:10.1159/​ 000052671 Holm, A., Ozanne, A., & Dodd, B. (1997). Efficacy of intervention for a bilingual making articulation and phonological errors. International Journal of Bilingualism, 1, 55– 69. doi:10.1177/136700699700100105 International Expert Panel on Multilingual Children’s Speech. (2012). Multilingual children with SSDs: Position paper. Bathurst, NSW, Australia: Research Institute for Professional Practice, Learning and Education (RIPPLE), Charles Sturt University. Retrieved from http://www.csu.edu.au/research/multilingual-speech/ position-paper Jimenez, B. C. (1987). Acquisition of Spanish consonants in children aged 3–5 years, 7 months. Language, Speech, and Hearing Services in Schools, 18, 357–363. doi:10.1044/0161-1461.1804.357 Kohnert, K., & Derr, A. (2004). Language intervention with bilingual children. In B. Goldstein (Ed.), Bilingual language development and disorders in SpanishEnglish speakers (pp. 311–338). Baltimore, MD: Paul H. Brookes. Kohnert, K., Scarry-Larkin, M., & Price, E. (2000). Fonología en español: Dibujos y actividades [Spanish phonology: Picture cards and carryover activities]. San Luis Obispo, CA: LocuTour Multimedia. Kohnert, K., Yim, D., Nett, K., Kan, P. F., & Duran, L. (2005). Intervention with linguistically diverse preschool children: A focus on developing home language(s). Language, Speech, and Hearing Services in Schools, 36(3), 251–263. doi:10.1044/​ 0161-1461(2005/025) Langdon, H. (2008). Assessment & intervention for communication disorders in culturally and linguistically diverse populations. Clifton Park, NY: Thomson Delmar. Leacox, L. R. (2013, November). Spanish-English phonological overlap: Children’s cognate assessment and facilitation in speech therapy. Poster presented at the annual convention American Speech-Language-Hearing Association, Atlanta, GA. Leacox, L. R. (2016, October). Late-acquired sounds for Spanish-English dual language speakers. Paper presented at the annual convention of the Oregon SpeechLanguage and Hearing State Conference, Salem, OR. Leacox, L., Wood, C., Sunderman, G., & Schatschneider, C. (2016). Young SpanishEnglish language learners’ cognate facilitation on picture naming. Contemporary Issues in Communication Science and Disorders, 43, 115–128.

90

The late eight

Martinez, S. (2011). Dialectal variations in Spanish phonology: A literature review. Echo, 6(1), 7–14. Mattes, L. J. (1995). Spanish articulation measures. Oceanside, CA: Academic Communication Associates. McNutt, J. C. (1994). Generalization of /S/ from English to French as a result of phonological remediation. Journal of Speech Language Pathology and Audiology, 18, 109–114. Morrow, A., Goldstein, B. A., Gilhool, A., & Paradis, J. (2014). Phonological skills in English language learners. Language, Speech, and Hearing Services in Schools, 45(1), 26–39. doi:10.1044/2013_LSHSS-13-0009 Paradis, J. (2001). Do bilingual two-year-olds have separate phonological systems? International Journal of Bilingualism, 5(1), 19–38. doi:10.1177/1367006901005 0010201 Pérez, A. M., Peña, E. D., & Bedore, L. M. (2010). Cognates facilitate word recognition in young Spanish-English bilinguals’ test performance. Early Childhood Services Journal, 4(1), 55–67. Perez, E. (1994). Phonological differences among speakers of Spanish-influenced English. In J. Bernthal & N. Bankson (Eds.), Child phonology: Characteristics, assessment, and intervention with special populations (pp. 245–254). New York, NY: Thieme Medical. Poplack, S. (1980). The notion of the plural in Puerto Rican Spanish: Competing constraints on (s) deletion. In W. Labov (Ed.), Locating language in time and space (pp. 55–67). New York, NY: Academic Press. Prezas, R. F., Hodson, B. W., & Schommer-Aikins, M. (2014). Phonological assessment and analysis of bilingual preschoolers’ Spanish and English word productions. American Journal of Speech-Language Pathology, 23(2), 176–185. doi:10.1044/​ 2013_AJSLP-12-0132 Ray, J. (2002). Treating Phonological disorders in a multi-lingual child: A case study. American Journal of Speech-Language Pathology, 11, 305–315. doi:10.1044/10580360​(2002/035) Rojas, R., Iglesias, A., Bunta, F., Goldstein, B., Goldenberg, C., & Reese, L. (2016). Interlocutor differential effects on the expressive language skills of Spanishspeaking English learners. International Journal of Speech-Language Pathology, 18(2), 166–177. doi:10.3109/17549507.2015.1081290 Smit, A. B., Hand, L., Freilinger, J. J., Bernthal, J. E., & Bird, A. (1990). The Iowa articulation norms project and its Nebraska replication. Journal of Speech and Hearing Disorders, 55(4), 779–798. Taveras, M., Namazi, M., Pazuelo, L., & Casado, L. (2015). Phonological patterns in Dominican Spanish-English bilingual preschoolers: Implications for assessment. SIG 16 Perspectives on School-Based Issues, 16(3), 87–98. Terrell, T. D. (1989). Teaching Spanish pronunciation in a communicative approach. In P. C. Bjarkman & R. M. Hammond (Eds.), American Spanish pronunciation: Theoretical and applied perspectives (pp. 196–214). Washington, DC: Georgetown University Press. Thomas, S., Nash, R., Thomas, G., & Richmond, D. (2005). The big red book of Spanish vocabulary. New York, NY: McGraw-Hill. Thomas, W. P., & Collier, V. P. (2002). A national study of school effectiveness for language minority students’ long-term academic achievement. Washington, DC: Center for Research on Education, Diversity and Excellence.

CHAPTER 3:  The Late Eight en español

91

U.S. Census Bureau. (2013). American Community Survey (American FactFinder). Verdon, S., McLeod, S., & Wong, S. (2015). Reconceptualizing practice with multilingual children with speech sound disorders: people, practicalities and policy. International Journal of Language and Communication Disorders, 50(1), 48–62. Williams, C. J., & McLeod, S. (2012). Speech-language pathologists’ assessment and intervention practices with multilingual children. International Journal of SpeechLanguage Pathology, 14(3), 292–305. Yavas¸, M. (2010). Acquisition of /s/-clusters in Spanish–English bilingual children with phonological disorders. Clinical Linguistics and Phonetics, 24(3), 188–198. doi:10.3109/02699200903362919 Yavas¸, M., & Goldstein, B. (1998). Phonological Assessment and treatment of bilingual speakers. American Journal of Speech-Language Pathology, 7, 49–60. doi:10.1044/​ 1058-0360.0702.49

Chapter Four

Speech Sound Disorders, Literacy, and Curriculum Jennifer Walz Garrett

Introduction The use of evidence-based interventions for speech sound disorders that relate to the curriculum should be a priority of all SLPs working with schoolaged students. This chapter addresses essential educational topics for schoolbased SLPs who treat students with speech sound disorders. The two sections of the chapters are: n Eligibility n Linking Interventions

with the Curriculum

Eligibility Before treatment can begin, an SLP must qualify a student for school-based service. Topics in this section include: n The Individuals with Disability Education Act n Compliance Plans and Assessment Frameworks n Impact on Education n Frequently Asked Questions

93

94

The late eight

The Individuals with Disability Education Act For many children in the United States between ages 3 and 21, eligibility for speech-language services are determined through regulations under the Individuals with Disability Education Act (2004). The IDEA regulations define speech sound disorders within the speech or language impairment category with the following eligibility definition: Speech or language impairment means a communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance. (Sec. 300.8, IDEA)

The statement means that to qualify for services under IDEA a child must have an educational disability. “An educational disability requiring the services of Special Education is a skills deficit, a health or physical condition, a functional limitation, or a pattern of behavior that adversely affects educational performance” (IDEA, 2004). The following rules guide the eligibility process: 1. Parents, teachers or other members of an agency can start the process by requesting an evaluation. 2. Parental consent is required prior to the evaluation being started. 3. Multiple individuals, including a variety of school personnel, may collect and analyze data as part of the evaluation team. 4. Evaluations may consist of formal and/or informal assessments, but cannot solely rely on one measure. 5. Evaluations should include a review of existing data and any classroombased or state assessments that might yield relevant information. 6. All evaluations must include an observation by the teacher and/or related services provider (Sec. 300.305, IDEA 2004). Many SLPs use tests such as the Goldman-Fristoe 3 Test of Articulation (Goldman & Fristoe, 2015), Arizona Articulation Proficiency Scale, 3rd revision (Fudala, 2000), Bankson-Bernthal Test of Phonology (Bankson & Bernthal, 1990), or others to collect information in a formal way. In addition, an SLP should collect a speech-language sample to analyze for errors to rule out any language components.

Compliance Plans and Assessment Frameworks States, districts, or agencies may interpret federal regulations as part of their compliance plans. These guidelines may include characteristics that the

CHAPTER 4:  Speech Sound Disorders, Literacy, and Curriculum

95

student must meet to qualify as having a disability. Educational judgement is also included to allow flexibility. Additional criteria may include speech errors expected of children at least one year younger than the student based on normative data, existence of multiple sound errors, and speech deficits that impact specific academic subject areas. These additional criteria must be considered cautiously and carefully. States may also decide to determine eligibility within an assessment framework. (Newer school SLPs should consult with their district or agency administrators about the use of alternative assessment frameworks as part of state compliance with federal regulations.) To illustrate, some states use a matrix of Reviews, Interviews, Observations and Tests (RIOT) and Instruction, Curriculum, Environment and Learner (ICEL) as part of their Response to Intervention (RtI) or Multi-Tier System of Supports (MTSS) framework. Within this system, the domains of ICEL are considered, using RIOT to determine where intervention is needed and if it will be successful. This type of framework allows for a multidimensional assessment with a focus on relevancy and functionality. An advantage of an RtI or MTSS model is that it may allow an SLP to try a short-term small group or individual intervention to address speech sound disorders before initiating a formal evaluation. If the intervention proves promising but more intensive services are needed, the clinician can utilize the data collected within the individualized education program (IEP) as part of the evaluation to determine if the child has a disability. Speech-language pathologists must carefully consider if additional criteria are in the spirit of the federal regulations and the impact they may have on students qualifying for services. State speech-language-hearing associations and the American Speech-Language-Hearing Association can be valuable resources to advocate for change if professionals find criteria to be overly restrictive.

Impact on Education Eligibility guidelines often have gray areas regarding what constitutes educational impact. Multiple times, the American Speech-Language-Hearing Association has requested clarification from the Department of Education regarding the educational justification of speech services. The Office of Special Education Programs (OSEP) first responded to concerns about eligibility of services in 1980 (Martin, 1980). At that time, some states or local education agencies were narrowly defining eligibility as academic failure instead of considering the impact of oral communication more broadly on educational performance.

96

The late eight

After IDEA was updated in 2004, ASHA again asked for clarification from the OSEP about eligibility for services. Posny (2007) stated: “it remains the Department’s position that the term ‘educational performance’ is not limited to academic performance. The determination that a speech and language impairment adversely affects a child’s educational performance must be determined on a case-by-case basis, depending on the unique needs of the child, not based on discrepancies in age or grade performance in academic subject areas” (Posny, 2007, p. 1). Recent updates to IDEA expand considerations to include implications for nonacademic and extracurricular activities which may include clubs, recess, and mealtime. The following research describes the connection between speech sound disorders and disorders of language and literacy: n A

significant number of students experience speech sound disorders that negatively impact their school success. Shriberg, Tomblin, and McSweeny (1999) have conservatively estimated that 3.8% of children who are 6 years old exhibit speech sound disorders, with another 2% of 6 year olds having a co-occurrence of a speech sound disorder along with a language impairment and/or cognitive impairment. n Many studies document the connection between a history of speech sound disorders and later language and literacy disabilities, including children who might remediate an articulation or phonology disorder by age 6, but present with a language or literacy delay in later years (Catts, 1993; Ehri, Cardoso-Martins, & Carroll, 2014; Farquharson, 2015; McCormack, McLeod, McAlliser, & Harrison, 2009; Nathan, Stackhouse, Goulandris, & Snowling, 2004; Peterson, Pennington, Shriberg, & Boada, 2009). Farquharson (2015) conducted a preliminary study of outcomes for children with remediated speech sound disorders which appeared to show they were at increased risk for later literacy delays. n Several researchers have found that the long-term communication and literacy outcomes of students with only speech sound disorders are more favorable compared with those with language impairments only or those exhibiting both language and speech errors (Catts, 1993). For example, Catts (1993) found correlations between speech ability and reading achievement to be non-significant based on results of tests of children in first and second grade; however, an increased risk for later reading difficulties was found in children with speech and language impairments. n Speech sound disorders may impact later domains related to activity limitation and participation restrictions (McCormack, McLeod, McAlliser, & Harrison, 2009). Research indicates that SLPs and educators at minimum should monitor the language and literacy skills of students who have speech sound disorders

CHAPTER 4:  Speech Sound Disorders, Literacy, and Curriculum

97

or who previously received services. Research also provides some level of justification of embedding literacy instruction within our speech sound disorder interventions. Frequently Asked Questions How do we know which kids will struggle with literacy? Some SLPs may wonder how we know which kids may continue to struggle with academics after remediation for a speech sound disorder. Under IDEA, once a speech-language disorder has been remediated, a child no longer has a disability and is dismissed from services. Farquharson (2015) states, “for a puzzling group of students, even after services are rendered and the speech sound disorder has remediated, academic difficulties persist. These academic difficulties are often in the areas of reading, writing, and spoken language” (p. 1). Unfortunately, we don’t have a crystal ball to predict. Using research studies as guidance, we should carefully consider the following potential areas as being red flags for later academic difficulties: n Students who have both speech and language impairment, n Students with long-term speech sound disorders, and n Students who show difficulty in both oral language skills and

reading

comprehension. Do we keep children who have remediated on our caseload just in case or dismiss them? Children with speech sound disorders may receive services from multiple providers across their childhood. Speech-language pathologists billing insurance or Medicare must document a speech-language disability. School-based SLPs must also make sure the child meets the definition of being speech or language impaired under IDEA. Speech-language pathologists receiving private pay could initially see a client for a speech sound disorder and continue to work with that child, with parental understanding, in a preventive manner knowing that some children are at risk for later literacy difficulties. If an SLP dismisses these students, how does the school monitor make sure they don’t fall through the cracks? Professionals should make parents aware that if later concerns develop related to language or learning skills, they should refer for an evaluation. School personnel can also conduct file reviews of students who appear to be struggling academically to determine if they have previously received speech-language services. Within the RtI or MTSS framework, small-group or individual instruction can be implemented to determine if a short-term explicit intervention is needed to catch-up the student or more intensive services are necessary indicating a need for a reevaluation and development of a new IEP.

98

The late eight

How do decisions impact our caseload or workload? School-based SLPs may worry about issues of caseload and workload when qualifying speech and language impaired students. Although caseload numbers, minutes of services, or location of services cannot be a decision-making point for qualifying a student, it is sometimes the elephant in the room. The American Speech-Language-Hearing Association has stated that SLPs have a role in working across all levels, serving a range of disorders, ensuring educational relevance, providing unique contributions to curriculum, highlighting language/literacy, and providing culturally competent services. These services may include prevention, assessment, intervention, program design, data collection and analysis, and compliance (ASHA, 2010). There are no easy solutions to caseload and workload but SLPs must be advocates for themselves, schools, and ultimately the students they service. The American Speech-Language-Hearing Association has resources available to help address concerns and provide advocacy.

Linking Interventions with the Curriculum The following guidelines link interventions for speech sound disorders to the curriculum: 1. Students who have a speech disorder as determined by an evaluation that indicates educational relevancy are eligible to receive speech services. 2. Appropriate interventions should be individualized to the client but rely on sound clinical judgement and a scholarly foundation (Baker & McLeod, 2011a, 2011b). 3. Interventions should link to the curriculum as much as possible. 4. States may be aligned to the National Common Core (National Governors Association Center for Best Practices & Council of Chief State School Officers, 2010) or have their own set of standards. English Language Arts or 21st Century Skills Standards Most often, speech sound disorders affect a students’ ability to present information or their self-confidence in sharing with teachers and peers. It may also impact their long-term success in securing a job of their choice. To justify treatment or to link interventions to content standards, SLPs may look toward English Language Arts (ELA) or 21st Century Skills standards. In the Speaking and Listening Strand, a professional may find a standard worded similarly to the Common Core Standard of “Speak audibly and express thoughts, feelings, and ideas clearly” (CCSS.ELA-LITERACY.SL.K.6). In the Language Strand, a statement similar to the Common Core Standard of “Acquire and use accurately grade-appropriate conversational, general aca-

CHAPTER 4:  Speech Sound Disorders, Literacy, and Curriculum

99

demic, and domain-specific words and phrases” (CCSS.ELA-LITERACY.L.3.6) could also be used to justify services for a speech sound disorder. While the selection of content standards and sound intervention techniques is necessary, the specific materials an SLP uses can also make a difference in remediation within a school setting. Materials Many intervention techniques require SLPs to select materials or targets to address articulation and phonological areas of deficits. School SLPs should strongly consider using literature and curricular materials in interventions. Commercially available guides like Once Upon a Sound: Literature-Based Phonological Activities (Smith-Kiewel & Claeys, 1998), Artic and Lit: Materials for Articulation Carryover Using Children’s Literature (Borsch, 1994), and others cross-reference target sounds or words within books and stories. Similar resources can also be found or purchased online through websites like Teachers-Pay-Teachers and TheraSimplicity. In addition, SLPs or other educators may have blogs where free or low-cost materials that cross-reference word lists and activities to literature. It is important to remember that these materials are only as good as the SLP who adapts them to meet a student’s needs. A sound teaching instructional model instead of a “quiz-show format” of drilling is necessary if improvement is to occur. Specific Language Areas Students experiencing both speech and language or learning disabilities need very thoughtful instruction to maximize their intervention. This means considering how to address speech sound disorders while also meeting students’ language or learning skills. Early in speech or phonology intervention, placement for correct production might be emphasized, but as soon as word level work is utilized, the SLP should make every effort to select words from the curriculum or words that would benefit students’ long-term outcomes. Students who present with language or learning disabilities should require interventions targeting multiple skills. Although this chapter cannot address all areas of literacy, several examples will be provided along with word lists, lessons, and additional resources. The following language, reading, and writing areas are discussed in this subsection: n Semantics n Syntax n Morphology n Reading fluency n Spelling

100

The late eight

Semantics Vocabulary is an important part of school learning. Much focus has been placed on Tier I, Tier II, and Tier III vocabulary in recent years (Beck, McKeown, & Kucan, 2002). Tier I vocabulary is often described as common words. Tier II vocabulary is academic vocabulary that goes across content areas. Tier III vocabulary is often specific to content areas. As SLPs are considering words to use to address speech sound disorders, they should consider selecting Tier II vocabulary. Although there are several vocabulary interventions that an SLP can consider, using the Tier II words provides more bang for your buck. A six-step process for teaching vocabulary has been described by Marzano and Simms (2013) which could be implemented by educators as well as the SLP. The steps include: 1. Provide a description, explanation, or example of the new term. 2. Ask students to restate the description, explanation, or example in their own words. 3. Ask students to construct a picture, symbol, or graphic representing the term or phrase. 4. Engage students periodically in activities that help them add to their knowledge of the terms in their vocabulary notebooks. 5. Periodically ask students to discuss the terms with one another. 6. Involve students periodically in games that allow them to play with the terms (Marzano & Simms, p. 14). These authors provide a list of words that are linked to standards in the common core and might also be addressed in state standards. Words are defined in a student-friendly way and cross-referenced with ELA and Math Standards. Educators could cross-reference a list from this resource or similar resources by targeted speech sound that would also go across content areas (Table 4–1). Table 4–1.  Tier II Vocabulary Targeting /r/ Sounds

Initial /r/

Initial /s/

Report

Sort

Respond

Select

Reason

State

Resolve

Summarize

Repeat

Solve

Source:  Modified from Marzano & Simms, 2013.

CHAPTER 4:  Speech Sound Disorders, Literacy, and Curriculum

101

Using curricular material can be a good starting point for selecting vocabulary. In additional, other resources are available for educators to narrow down academic vocabulary. Coxhead (2000) conducted research and created an extensive academic word list made up of 570 word families. Sublists of words were created based on their frequency of use in English. Reviewing the sublists, an SLP may select target articulation words that address the student’s speech sound disorder. An example is provided in Table 4–2. Finally, resources in books or on websites may provide vocabulary lists that are linked to popular fiction and nonfiction books. Speech-language pathologists should be critical consumers of these materials. Justice, Schmitt, Murphy, Pratt, and Biancone (2014) found that SLPs often selected basic vocabulary to target instead of academic rich vocabulary even though basic vocabulary is often learned in context. Beck, McKeown, and Kucan (2002) outline common books used by grade levels and the Tier II vocabulary that could be targeted by educators. Even a classic story that might be considered easy for children like Caps for Sale (Slobodkina, 2015), first published in 1940, has complex vocabulary like “ordinary,” “refreshed,” and “imitate” (Beck, McKeown, & Kucan, 2002). If a child was working on /r/ targets, teaching the words “ordinary” and “refreshed” would have more academic carryover than selecting the words “street,” “red,” “gray,” “under,” and “tree,” which most students would already have been exposed to in everyday conversations. SLPs, along with other educational team members, need to use their best judgment in selecting academic targets. Even though there are resources available, there is no exact criteria or recommended sequence to decide if a word is Tier I, Tier II, or Tier III and the order or grade level that words should be targeted. Syntax As students improve their speech sound production, often SLPs will ask them to use words in sentences. If syntax is an issue for students, treatment Table 4–2.  Target Academic Words a Speech-Language Pathologist Might Select by Speech Sound Initial [r]

Final [r]

Initial [s]

Final [s]

1. Respond

1. Consumer

1. Site

1. Benefits

2. Range

2. Legislator

2. Seek

2. Economics

3. Regulate

3. Labor

3. Similar

3. Equates

4. Region

4. Computer

4. Select

4. Obvious

5. Retain

5. Culture

5. Summary

5. Refocus

Note.  Words selected from http://www.victoria.ac.nz/lals/resources/academic​ wordlist/sublists

102

The late eight

words can be selected to both address speech production and teach specific syntactic structures. Eisenberg (2007) provides an in-depth look at laterdeveloping grammatical structures, including noun phrase expansions, verb form expansions, predicate expansions, conjunctions, complement clauses, adverbial constructions, and other sentence constructions. These advanced grammatical structures may be overlooked as students remediate the most basic syntactic skills. Using a discrete skills approach, an SLP may select target words to address speech and model, drill, or sentence-combine with students to work on syntax. Mini and micro lessons embedded in writing can strengthen and assist with carryover of skills. An example of sentence expanding is provided in Table 4­–3. Morphology An SLP can address morphology and speech sound disorders concurrently. For example, a student may need instruction about marking plurals and have errors on /s/ and /z/. The SLP can teach the student that “more than one” is often marked by adding an “s” or “es” to the end of words. Sometimes that “s” sounds like an /s/ but it can also sound like /z/ and /Iz/. Voiceless final sounds in words result in the voiceless /s/ being added to indicate plurals. Voiced final sounds in words result in the voiced /z/ being added to the end to indicate plurals. For words that end in /ʃ/, /tʃ/, /dZ/, /s/, and /z/, the /Iz/ is the final sound. Table 4–4 provides select target plurals. Similar lessons could be created to teach other morphology, including third person singular and possessives.

Table 4–3. Instructional Sequence for Sentence Expanding Targeting /r/ Words The speech-language pathologist introduces the concept of sentences while reminding students that they are working on the /r/ sound.

Simple sentences that target /r/: The car is ready. The car is in the race. The car is red.

The speech-language pathologist talks about how to combine sentences. First, the student might learn to identify a describing word and combine it into a longer sentence.

Combined sentence: The red car is ready.

As the student becomes competent in initial lessons, combining multiple sentences can be targeted.

Sentence combining three simple sentences that target /r/: The red car is ready to race.

CHAPTER 4:  Speech Sound Disorders, Literacy, and Curriculum

103

Table 4–4.  Target Words by /s/, /z/, and /Iz/ Sound Indicating Plural

/s/

/z/

/Iz/

cats hats socks blankets lamps coats disks lights books chips

dogs frogs cars bowls games bananas bands beads eggs cubs

beaches couches stitches boxes badges lunches sandwiches judges buses quizzes

Reading Fluency Educators often use short passage or grade level readers to target and measure reading fluency. Reading fluency has been defined as reading accurately, quickly, and with expression. After the National Reading Panel report was released (National Institute of Child Health and Human Development, 2000), assessments and instruction around reading fluency has increased. Reading fluency improves through treating decoding skills and comprehension. One popular intervention that can improve reading fluency while also addressing motivation is Reader’s Theatre (Leahy & Justice, 2007). Reader’s Theatre combines reading aloud for guided reading practice, supported reading to help target decoding skills, repeated reading to improve fluency, and performance reading to practice strategies. The ultimate goal is to perform for an audience. Students who have reading disabilities along with a speech sound disorder can identify words with treatment sounds within a Reader’s Theatre script. This also allows multiple educational professionals to be involved in using the same script for multiple purposes but providing repeated readings to improve reading fluency. Below is an example script that might be used to address reading fluency, motivation, and speech sound targets. The SLP should read the script and select or modify the parts to treat speech sounds. In the example in Table 4–5, the SLP has underlined target /r/ words for the students to practice. Spelling Spelling is an area of instruction that relates to vocabulary, reading, and writing. Within a spelling focus, spellers are taught that the sounds of speech,

104

The late eight

Table 4–5.  Three Billy Goats Gruff Script with /r/ Words Underlined Three Billy Goats Gruff Reader’s Theatre Script Narrator 1:  Welcome to our show. Today’s play is The Three Billy Goats Gruff. Narrator 2: As Little Billy Goat Gruff strolls through the fields he sees a rickety, old bridge. On the other side of the bridge is a meadow with green, green grass and apple trees. Little BGG: I’m the littlest billy goat. I have two big brothers. I want to go across this bridge to eat some green, green grass and apples so that I can be big like my two brothers. Source: https://www.aea267.k12.ia.us/system/assets/uploads/files/25/three_billy_ goats_readers_theatre_script.pdf

i.e., phonemes, are related to letters, i.e., graphemes. This phonological perspective of spelling is only one part of learning to spell; other sources of knowledge include graphotactic (what words look like) and morphological knowledge (understanding the relationship of roots to prefixes and suffixes) (Bourassa & Treiman, 2014). Wolter and Squires (2014) discuss a multilinguistic approach that integrates phonological awareness, orthographic knowledge, and morphological knowledge using explicit instruction. Another program that SLPs and other educators could consider would be the SPELL-Links to Reading & Writing: A Word Study Curriculum (Wasowicz, Apel, Masterson, & Whitney, 2004). For students with speech sound disorders, lessons could incorporate linguistic areas of deficit along with target words that include speech errors. For example, Lesson 3 of the SPELL-Links program assists students in developing the “ability to segment phonemes and map letters to the pre-vowel consonant /r, l/ sounds” (Wasowicz, Apel, Masterson, & Whitney, 2014, pp. 1–26). The starter word list includes words like red, lip, let, and ran, which are words also commonly targeted by children working on /r/ and /l/ in articulation therapy. This targeted area includes three lesson plans for students to be taught and practice the skills. Overall, the SPELL-Links program provides 73 lesson topics with three to five plans for each area. The SPELL-Links program is just one example of a commercially available program that can be used to target spelling in a systematic way but also provide students the opportunity to practice improving their articulation and phonology skills.

Conclusion School SLPs play a vital role in remediating speech sound disorder. The use of evidence-based interventions for speech sound disorders that relate to curriculum should be a priority of all SLPs working with school-age students.

CHAPTER 4:  Speech Sound Disorders, Literacy, and Curriculum

105

Resources are available in the form of state standards, classroom curricular materials, and specialized programs. It is important for school-based SLPs to understand qualification for services under IDEA as well as consider additional criteria proposed by states, districts, and agencies in interpreting those regulations. Some students may have additional communication or literacy disorders that need to be addressed. Ultimately, the SLP is part of an educational team and collaboration is necessary to improve the long-term outcomes of all students. Addressing curricular needs in speech-language therapy and closely monitoring their future outcomes will allow each child to achieve his or her educational potential.

References American Speech-Language-Hearing Association. (2010). Roles and responsibilities of speech-language pathologists in schools [Professional issues statement]. Available from http://www.asha.org/policy Baker, E., & McLeod, S. (2011a). Evidence-based practice for children with speech sound disorders: Part 1 narrative review. Language, Speech, and Hearing Services in Schools, 42(2), 102–139. Baker, E., & McLeod, S. (2011b). Evidence-based practice for children with speech sound disorders: Part 2 application to clinical practice. Language, Speech, and Hearing Services in Schools, 42(2), 140–151. Bankson, N. W., & Bernthal, J. E. (1990). Bankson-Bernthal Test of Phonology. Austin, TX: Pro-Ed. Beck, I., McKeown, M., & Kuckan, L. (2002). Bringing words to life: Robust vocabulary instruction. New York, NY: Guilford Press. Borsch, J. C. (1994). Artic and Lit: Materials for articulation carryover using children’s literature. Youngtown, AZ: ECL Publications. Bourassa, D., & Treiman, R. (2014). Spelling development and disability in English. In C. A. Stone, E. Sillman, B. Ehren, & G. Wallach (Eds.), Handbook of language and literacy (pp. 569–583). New York, NY: Guilford Press. Catts, H. W. (1993). The relationship between speech-language impairments and reading disabilities. Journal of Speech, Language, and Hearing Research, 36(5), 948–958. Coxhead, A. (2000). The Academic Word List. Retrieved from http://www.victoria.ac .nz/lals/resources/academicwordlist/ Ehri, L., Cardoso-Martins, C., & Carroll, J. (2014). Developmental Variation in Reading Words. In C. A. Stone, E. Sillman, B. Ehren, & G. Wallach (Eds.), Handbook of language and literacy (pp. 385–407). New York, NY: Guilford Press. Eisenberg, S. (2007). Grammar: How can I say that better? In T. Ukrainetz (Ed.), Contextualized language intervention (pp. 145–194). Greenville, SC: Thinking Publications. Farquharson, K. (2015). After dismissal: Examining the language, literacy, and cognitive skills of children with remediated speech sound disorders. Perspectives in School-Based Issues, 16(2), 50–59. doi:10.1044/sbi16.2.50 Fudala, J. B. (2000). Arizona Articulation Proficiency Scale, 3rd revision. Torrance, CA: Western Psychological Services.

106

The late eight

Goldman, R., & Fristoe, M. (2015). Goldman-Fristoe 3 Test of Articulation. Minneapolis, MN: Pearson Assessments. Individuals With Disabilities Education Act, 20 U.S.C. § 1400 (2004). Justice, L. M., Schmitt, M. B., Murphy, K. A., Pratt, A., & Biancone, T. (2014). The ‘robustness’ of vocabulary intervention in the public schools: Targets and techniques employed in speech-language therapy. International Journal of Language and Communication Disorders, 49(3), 288–303. Leahy, S., & Justice, L. (2007). Promoting reading fluency and motivation through readers theatre. In T. Ukrainetz (Ed.), Contextualized language intervention (pp. 469– 502). Greenville, SC: Thinking Publications. Martin, E. (1980). Letter to Stan Dublinske, American Speech-Language Hearing Association from E. Martin at Office of Special Education Programs. Marzano, R., & Simms, J. (2013). Vocabulary for the Common Core. Bloomington, IN: Marzano Research Laboratory. McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2009). A systematic review of the association between childhood speech impairment and participation across the lifespan. International Journal of Speech-Language Pathology, 11(2), 155–170. Nathan, L., Stackhouse, J., Goulandris, N., & Snowling, M. J. (2004). The development of early literacy skills among children with speech difficulties: A test of the critical age hypothesis. Journal of Speech, Language, and Hearing Research, 47(2), 377–391. National Governors Association Center for Best Practices & Council of Chief State School Officers. (2010). Common Core State Standards (CCSS). Retrieved from http://www.corestandards.org/ELA-Literacy/ National Institute of Child Health and Human Development (2000). Report of the National Reading Panel. Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction. NIH Publication No. 00–4769. Peterson, R. L., Pennington, B. F., Shriberg, L. D., & Boada, R. (2009). What influences literacy outcome in children with speech sound disorder? Journal of Speech, Language, and Hearing Research, 52(5), 1175–1188. Posny, A. (2007). Letter to Catherine Clark, American Speech-Language Hearing Association from A. Posny at Office of Special Education Programs. Shriberg, L. D., Tomblin, J. B., & McSweeny, J. L. (1999). Prevalence of speech delay in 6-year-old children and comorbidity with language impairment. Journal of Speech, Language, and Hearing Research, 42(6), 1461–1481. doi:10.1044/jslhr.4206.1461 Slobodkina, E. (2015). Caps for sale. New York, NY: HarperCollins. Smith-Kiewel, L., & Claeys, T. M. (1998). Once upon a sound: Literature-based phonological activities. Eau Claire, WI: Thinking Publications. Wasowicz, J., Apel, K., Masterson, J., & Whitney, A. (2004). SPELL-Links to reading & writing. Evanston, IL: Learning By Design. Wolter, J., & Squires, K. (2014). Spelling instructional and intervention frameworks. In C. A. Stone, E. Sillman, B. Ehren, & G. Wallach (Eds.), Handbook of language and literacy (pp. 602–618). New York, NY: Guilford Press.

Chapter Five

Motor Learning Guided Therapy Carlin Hageman

Introduction Teaching a young child to produce speech to match the culturally accepted norm is no easy feat. True, some children seem to be natural pleasers who will do anything that you suggest. Others tend to go along with you when there seems to be a good reason to do it. Finally, there are children who actively resist practicing new ways of talking, perhaps because they cannot see the point or because they just do not place practicing speech at a higher priority than fooling around. This chapter is not going to provide you with a magic bullet to reach all of those children, but it may provide you with the tools to modify your therapy so that the child learns the most he or she can in the few minutes you have for practice. That is important because we are under great pressure to produce better results, in a shorter time, using fewer resources. Therefore, the goal of this chapter is to help you plan therapy that has the potential to address those demands. Many of us have attempted to learn a new motor skill or one that was difficult. Some of us have tried to teach or coach young learners to play a musical instrument or master an athletic skill. As speech-language pathologists, we are concerned about teaching articulatory skills (motor skills) to young children who have failed to learn how to articulate the sounds of the language. This chapter will address the motor learning components of articulation while fully realizing that articulation is just one component of the complicated system of linguistic and motor competences. 107

108

The late eight

Much of what is known about motor learning arises from disciplines other than speech pathology, and little literature exists that examines the principles of motor learning in speech. In my opinion, it is crucial that speech-language pathologists explore new ways of thinking about therapy to make our therapy more efficient and more likely to engender carryover to real world communication. Thus, I have chosen to utilize the principles of motor learning — Motor Learning Guided (MLG) — to structure practice, knowing full well that all of the principles are not yet delineated in their relative efficiencies and inefficiencies with respect to articulation.

Thinking About It Have we ever delineated all of the procedures and processes that we currently use (e.g., immediate or constant feedback)? Have we considered if behavior modification is the correct model for practice of a motor skill? Do our traditional methods work? Of course they do for many learners, but are they suitable for everyone and the most efficient and cost effective?

Motor Skill Motor Control Clearly all of us have learned motor skills in a variety of domains to greater and lesser degrees. Some of us have amazing aptitudes for certain motor skills — the athlete or musician who seems to be able to accomplish any complex feat of athletic skill or perform the most complex musical pieces. On the other hand, most of us are able to accomplish the most amazing athletic feat of all — we talk. For example, Netsell (1991) noted that speech required a minimum of 140,000 neuromuscular events per second (14 phonemes per second × 100 muscles × 100 motor units per muscle). It is a remarkable achievement that most of us attain. Why do some children find talking so difficult and some find it almost impossible to acquire? For example, the causes are relatively apparent in children with motor speech disorders and hearing loss. In others, the underlying causes are not obvious. Recently, Redle and colleagues (2015) demonstrated fine motor praxis in children with persistent speech disorders. For the present discussion, we are going to consider that the process of motor learning is disrupted, and discuss the variables that we, as speech-language pathologists, can control in the context of practice for learning to speak.

CHAPTER 5:  Motor Learning Guided Therapy

109

Thinking About It What could disrupt motor learning of articulation? What are the necessary capabilities for learning the skill of speaking?

Although it is not certain that learning to talk is affected by the same principles that have been shown to be effective for motor learning in other domains, it is certain that speech is a highly complex motor skill and that we can speak “automatically” with little effort or attention directed to the motor control aspects of speaking. Since the effort is low to control the motor aspect of speech for most of us, we can attend to the social context, linguistic structure, and communicative intent. Controlling complex motor activities with low effort suggests that speech may be controlled by motor programs, which are automatic mechanisms of motor control. Is there evidence for programmatic control of speech? One example was provided by Robin et al. (2008), who demonstrated that normal speakers and speakers with apraxia of speech or dysarthria differ in their ability to track a moving target with their jaw, lips, and voice. Essentially, apraxic speakers could not track a predictable target as well as normal or dysarthric speakers. On the other hand, the apraxic speakers could track an unpredictable signal as well as the normal or dysarthric speakers because all three groups used closed-loop control (nonprogrammatic) for unpredictable targets. The findings were interpreted as evidence for motor programming in the control of speech. Backlin et al. (2008) and Gaughan, Howard, and Hageman (2009), using a speech inhibition task, found evidence of programmatic or automatic control of speech in adults and children. Closed Loop and Open Loop Schmidt and Wrisberg (2008) described two methods of motor control — closedloop and open-loop control. Closed loop is characterized by slow movements because the movements are constantly modified by sensory feedback about the movement and the environment. Closed-loop control is slow and the effort is intensive; consequently, it’s too slow to control the fast movements of speech. In contrast, during open-loop control, the performer recalls a set of instructions (or programs) for controlling muscle movements that, once initiated, are completed without modification. Open-loop control systems are fast because the movements (instructions) are completed without modification. The disadvantage of open-loop control is that when the environment changes, the performer is unable to change the movement once it has been initiated. If the wrong movement is planned, it is likely to be executed before the performer can stop it. Since the open-loop control system demands low

110

The late eight

effort or attention, the performer can pay attention to the environmental demand (e.g., listeners) and plan subsequent movements. Because nearly all movements occur within unique contexts, do skilled performers remember all possible movements or programs? Schmidt and Wrisberg (2008) pointed out that memory limitations preclude that possibility and developed schema theory to complement the notion of general motor programs. Although this is not a suitable venue for a lengthy discussion of their model, a basic understanding of the principles of motor learning is necessary. The reader is referred to Maas et al. (2008) for a detailed review of schema theory and to Schmidt and Wrisberg (2008) for complete explanation. Schema Theory Underlying schema theory is an assumption that there are units of motor activity (motor programs) and that these motor programs (MPs) are stored and retrieved from memory and adapted to the specific requirements of the moment (Schmidt, 1988; Schmidt & Wrisberg, 2008). These MPs have invariant and variant features. The invariant features include the temporal relationships between components (timing) and order of events. The variant features consist of elements of a movement that can vary (e.g., absolute speed, loudness). The size of the unit in speech has not been specified for certain, but Stetson (1951) hypothesized that it was the syllable. Carr (2004) demonstrated that invariant feature control across at least three syllables was present in young children as early as 5 years (i.e., the children maintained relative timing and order across rates of speech). Although the syllable may be a core feature of speech, it would seem that speech motor programs can be longer than one syllable. Backlin et al. (2008) and Gaughan, Howard, and Hageman (2009) found that program length was at least two to three syllables in adults using a refractory time test. Because speech consists of nearly an infinite variety of phoneme and syllable combinations and given the infinite array of initial conditions, goals, and motor modalities, it is not possible to remember all programs. Schmidt (1988) proposed that the programs are generalized and then organized for the specific act needed. Once the intent to speak has arisen, schema theory suggests that certain processes must occur (Figure 5–1). The motor control system of the performer must be aware of initial conditions, both internal and external (e.g., the structures involved in the movement and the characteristics of the environment relevant to the goal). For example, in golf, the player is knowledgeable (though not necessarily cognitively aware) of the muscular system status, joint positions (internal), and target place (external), and the recall schema uses this information to recall a generalized motor program (GMP) and to predict the outcome of the movement. Once the movement is generated, the information is stored in the recognition schema where the outcome of the movements, the prediction of the movements, and the consequences (both

CHAPTER 5:  Motor Learning Guided Therapy

111

Figure 5–1.  Processes hypothesized to occur when intent to speak is formed.

internal and external) are compared with the actual outcomes (internal and external). When there is a mismatch between the predicted external (desired) outcomes, the learner can tweak the GMP to attempt to make the next movement more accurate or examine the intended internal sensations to ensure that the intended movement was actually completed. In a sense, the learner uses the errors to create a better GMP for the next attempt, either for the specification of the invariant features of the plan (stay the same across many different iterations of the movement) or the variant features of the plan (vary

112

The late eight

with specifics of the target [e.g., greater force]). From this writer’s perspective, we can hypothesize potential influences that may create problems for the learner. First, if the learner does not have an idea of the correct target, practice attempts are not modifiable. For example, a deaf child or a child with auditory processing problems may not have a clear notion of speech targets. Second, the learner must be aware of the initial conditions. For example, the learner must “know” the internal conditions (e.g., the position of the tongue, jaw position, muscle tone, and respiratory system status). Further, even if the learner knows the initial conditions, the learner must have feedback about the dynamic changes that occur during the movements. If the learner does not receive accurate feedback or no feedback at all, then the next attempt will not be corrected in any systematic way — resulting in nearly random trials. Finally, the learner must be aware of the external conditions, meaning whether the movement had intended consequences on or for the target (e.g., did I make the correct phoneme or did the listener get the message?). Schema theory suggests that all of this information is held in memory and compared with the outcome of the movement. Thus, the learner must be able to hold in memory the initial condition information long enough to compare it (which also takes time and mental effort) to the outcome. Hence, the comparison is dependent upon accurate and timely internal and external feedback as well as the ability to remember and process the information. Factors that have been shown to interfere with mental processing may include distraction and arousal levels that are too high or too low (Kahneman, 1973). The sections that follow are this author’s attempts to utilize this information to construct therapy practice.

Thinking About It Do we have diagnostic tests for these variables? Hearing — certainly, tests are available for hearing across the frequency spectrum but maybe not for dynamic hearing. Internal conditions — no, for ability to know tactically, kinesthetically, etc., the conditions of the speech production mechanism. What does that mean? Perhaps for some learners, we can be making serious errors assuming that they know “articulatory movements.” And no, for testing the ability to hold in working memory the motor plan and compare it with results. What about attention? Do we measure the learner’s ability to attend to information about a movement long enough to make adjustments to the plan and commit the adjustments to memory?

CHAPTER 5:  Motor Learning Guided Therapy

113

Principles of Motor Learning Learning Versus Acquisition Before we delve into the specifics of motor learning applied to speech practice, we need to make the distinction between acquisition performance and learning. Acquisition performance refers to the momentary strength of a pattern (skill) during practice, whereas learning refers to what the learner remembers at a point remote from the practice. This can be measured as retention, generalization, and spread. The important point for this discussion is that during acquisition (practice), both the learner and the therapist will do things to improve performance during practice that will be detrimental to retention or generalization (e.g., constant feedback with description and cuing). More will be said about this in the feedback section. Learning can also be inhibited during practice by constant evaluation, which may affect arousal levels. Many of us have seen the anxious child looking over our shoulder trying to catch a glimpse of the scores (Hageman, Mueller, Burda, & Bleile, 2004; Maas et al., 2008; Schmidt & Wrisberg, 2008).

Thinking About It What is the purpose of saying “good job” after each trial? What are the consequences of praise after each trial? When is the learner allowed to make the internal comparisons about the adequacy of the movement? How much time is necessary to make that comparison? What capabilities does the learner need to have to make those comparisons and use them? How or when does clinician behavior interfere with learning?

Prepractice Before practice begins, the learner should be prepared for practice (Schmidt & Lee, 2005). Maas et al. (2008) suggested three goals of prepractice, including: (a) motivation to learn, (b) adequate understanding of the task, including a basic knowledge of correct, and (c) stimulability for acceptable responses to avoid frustration. Although I think these are worthy goals, in my experience, it is important not to expect prepractice attempts to be accurate before practice begins. For me, it is more important that the learner is able to vary the productions. As a clinician, one must broaden acceptable responses to include the ability to systematically vary movements even when they are incorrect with respect to the “correct” response. This is a difficult task for

114

The late eight

the clinician because as mature language users, we listen categorically to speech production. Hence, we can easily miss productions that are closer to the target but not yet crossing the categorical boundary into the correct sound. We have to listen phonetically rather than phonemically, especially for early learners. As part of the prepractice time, it is important to gather information about the invariant and variant features of the learner’s speech. The invariant features include the rhythm or prosody of the utterances, including the relative durations of segments and the order of the movements. Several researchers, including Schmidt and Wrisberg (2008) and Schmidt and Lee (2005) have observed that practice addressing the invariant features should precede the practice with the variant features (i.e., articulation of individual sounds).

Thinking About It To learn to throw a baseball or softball, it is necessary to learn the order of movements before worrying about accuracy of the throw (e.g., correct starting point, opposite leg motion, rotation of the hips, then rotation of shoulders, then the arm forward motion and then the wrist snap). What about speech? What are the correct starting positions? What is the first movement, the second, and so on? How much relative time should those movements consume? Do we test or observe these events?

Selecting goals is another important aspect of prepractice. In my approach to motor learning guided practice, I try to keep it simple and designate the learner as on a continuum from an early learner to an advanced learner. The point is that goals for early learners should be more performance oriented (e.g., better lip position) and advanced learners should be more results oriented (e.g., correct phoneme). Above all, the goals should be within reach of the learner. Understanding the task is an element of prepractice that has several dimensions. For an adult with a motor speech disorder, Maas et al. (2008) recommends that the learner be provided with a reference of correctness and explanations of why it is correct or not. From my perspective, explanations using details about the error, the nature of the error, or mechanism of the error add too much cognitive load to the learning process, especially for children. Most of us have probably experienced the zealous coach or instructor who overwhelmed us with detail until we were paralyzed by analysis. One common trick to play on a fellow golfer is to ask: “Do you always hold your fingers that way?” Maas et al. (2008) cautioned us to avoid complex, lengthy

CHAPTER 5:  Motor Learning Guided Therapy

115

explanations and to use instructions that match the comprehension abilities of the learner. Most of us probably could recall providing instructions and feedback that were more complex than the task the learner was practicing. Practice Maas et al. (2008) provided an outstanding breakdown of the different ways that practice can be addressed, and it is beyond the scope of this chapter to go into detail about each one. Figure 5–2 shows many elements that may influence motor learning. In general, the more practice, the better; but you must take into account fatigue, which detracts from the benefit of practice. In addition, large amounts of constant practice are contraindicated. Consequently, practice distribution is an important consideration, especially in early learners for whom fatigue or motivation may be a problem. Thinking About It Why does fatigue affect practice? Does it affect attention through low arousal, which means that focused attention is difficult? Does it mean the learner loses interest and does not “tweak” the motor plan after a trial using mental effort? Variable practice has been shown to be superior for enhancing learning during practice. In a sense, the less predictable the practice items are, the more challenging the task. Guadagnoli and Lee reported that increased difficulty during practice enhances learning (Guadagnoli & Lee, 2004). Other research has shown that forcing the learner to generate a plan for each practice attempt has positive effects on learning. Schmidt and Wrisberg (2008) have reported that even imaging (visualizing) the movement has positive effects on learning. Mass and Mailend (2012) demonstrated that motor speech planning takes place before speech execution. It is my belief that imagining performance is a powerful technique to enhance practice. Thinking About It We defined motor learning as what the learner remembers how to do at a time remote from the practice. If you score acquisition behavior (i.e., during practice), the tendency is to simplify practice and provide more feedback and cuing to achieve higher acquisition scores, but that comes at the price of poorer retention.

116 Figure 5–2.  Principles of motor learning.

CHAPTER 5:  Motor Learning Guided Therapy

117

Using random practice can be more beneficial for learning than blocked practice. In our experience, blocked practice may be more effective for the early learners, whereas random practice is more effective for the advanced learner. However, when we use blocked practice, we must allow for learning from each repetition of the production. Therefore, we impose delays of up to 5 seconds between reiterations of the practice item. During the pause, we do not allow the learner to talk, play games, or fidget or the clinician to speak because we have hypothesized that one variable underlying the poor learning of speech is a lack of attention devoted to the recognition schema and modification of the GMP. Focus Where should the learner focus his/her attention during practice? The learner has two options in that he/she can focus on the internal aspects of the movement (e.g., kinesthetic, kinematic, and somatosensory, as in the feel of the tongue during the production of the /r/) or the external aspects (e.g., how does the /r/ sound or how does the listener respond?). The evidence is very strong that an external focus produces a strong advantage for learning in the nonspeech motor domain. The movements tend to be more accurate and less variable, but even so, there may be some interaction between the level of performance (new or more experienced learner) and the task (Wulf, Shea, & McNevin, 2003).

Thinking About It This issue may lie at the heart of some children trying to learn to speak. When clinicians suggest that attention be directed to the feel of the act, they assume that the mechanisms of perception are normal. Our current state of the art does not allow us to test those senses. Because the movements of the pharynx, velum, and tongue essentially are invisible to the learner, poor sensory ability to detect, identify, and remember sensations of speech may make internal focus of feedback and instruction frustrating. On the other hand, some ability to know what the structures are doing is necessary (not necessarily at the conscious awareness level) or the next try is essentially random.

External focus is thought to enhance learning because the learner is not encouraged to constrain the motor system through conscious control, and the more automatic motor response is encouraged (e.g., Lisman & Sadagopan, 2013). One could also think of this as a conflict of open- versus closed-loop

118

The late eight

control. Paying attention to internal characteristics is effort intensive and slow, thus encouraging the use of a closed-loop control system, which is neurophysiologically different from open-loop control. Consequently, one would not expect a great deal of learning or generalization to automatic performance from closed-loop practice. However, since external versus internal control of speech movements has not been investigated up to this point, we will have to make some assumptions. First, we know that speech movements are highly complex and fast. Second, we know that speakers proceed with talking with little effort allocated to the internal aspects of speech. Consequently, at present, I am willing to assume that speech learning has more in common with rapid, complex nonspeech movement learning than not. I am going to suggest that we stress external focus to our clients (Lisman & Sadagopan, 2013). Thus, what does the speech sound like and what is the effect on the environment? Turning our clients into “mini” SLPs with complicated explanations is counterproductive because it directs their attention to internal factors, which require too much effort to utilize during speech production. This advice is not pervasive, because a learner who did not know how to start producing a sound may need some advice about the starting position and the first articulatory movement.

Thinking About It But here we are, right back at the point at which we need to know, what are the sensory capabilities of the learning with respect to movements of the oral structures? Indeed, another assumption we often make is that if the hearing sensation levels are adequate, then the learner can hear the sounds. Is that always true?

Feedback From my perspective, traditional articulation therapy mixes up feedback with reinforcement. Operant reinforcement strategies are utilized to increase or decrease behaviors by providing immediate reinforcement or punishment. Operant techniques clearly have a role in therapy, especially behavioral management, but they should not be confused with feedback. Feedback is information about the performance or the outcome of the performance. Two sources of feedback are possible (see Figure 5–2). Internal or intrinsic feedback is what the performer can discern from his/her own senses about the results of the movement and about the movement itself. External feedback is information supplied to the performer by a coach or therapist. Schmidt and Wrisberg (2008) were emphatic that external feedback

CHAPTER 5:  Motor Learning Guided Therapy

119

that duplicates that which the performer can perceive has a neutral effect at best and more commonly is detrimental to learning. Consider how irritating it would be for a coach to keep telling you that you made the basket when you can see that you did (literature is clear that arousal levels that are too high interfere with learning). In addition, Schmidt and Wrisberg (2008) reported that excessive feedback contributes to dependency upon the coach or therapist for correct performance rather than internal direction or evaluation.

Thinking About It The key word about feedback is duplication. How do we know when we duplicate the intrinsic feedback of the learner? Because we cannot measure internal feedback, in which direction should we err? In my opinion, we should err on the side that the learner can do it — albeit with communication that focuses his or her attention on it and the learner is provided with plenty of time to use it. How much time is plenty? Note that focusing attention on internal feedback is not the same as giving feedback. Using cognitive “questioning,” like how did that feel? etc., is counterproductive because it misdirects attention and effort involved in evaluating performance and is a difficult cognitive task (e.g., can you put into words how it feels to elevate your velum during speech?).

On the other hand, when internal feedback mechanisms are absent or deficient, then the coach or therapist must provide the information or direct the learner’s attention to the variable. Schmidt and Wrisberg (2008) described two types of external feedback: knowledge of results (KR) and knowledge of performance (KP). KR is information about the result of the movement in the world (e.g., that sound was correct). KP is information about the performance of movement (e.g., your lips were too rounded). My experience with traditional practice structure has led me to believe that KP and KR are used much too frequently and that little consideration is given to whether the learner can discern the information without feedback. So, where does that leave the clinician? The principles of motor learning have not yet been investigated to the point where specific rules and guidelines can be proposed for the use of feedback for speech practice. Following Schmidt and Wrisberg (2008), with respect to feedback, less is more and delayed is better. In other words, the clinician should strive to use only the feedback that the learner needs and make the learner wait for it. The clinician must use his/her best clinical judgment to determine the needs of the learner.

120

The late eight

Thinking About It Why make the learner wait for it? From my perspective, I am hypothesizing that with practice the learner may begin to be able to use internal feedback. Forcing him or her to wait for KR or KP may provide an opportunity to use that internal feedback and give the learner time to compare the actual movement/result with what was intended. Of course, with this model you run the risk of duplication of what the learner can do. Limiting the frequency of feedback may address that issue.

For example, it is obvious that the deaf child needs KR; however, it is not so obvious that the deaf child needs KP. The deaf child would need KP providing that he/she could not perceive the movements that led to the KR received. Further, even KR would not be needed provided the child could discern the reaction of the environment to the attempted production. In other words, when the child can determine whether the production resulted in the desired effect in the real world, then he/she would not need to be told. Of course, during practice, it might take considerable ingenuity by the clinician to create communication interactions that lead to independent judgments by the learner rather than just direct feedback from the clinician. At this point, the clinician should use every tool available to determine what the learner can perceive. Since few, if any, tools are available to the clinician to measure a child’s ability to perceive the position and movement of the articulators, we need to go back to the model of the schema whereby the learner modifies behavior by comparing what he/she intended to do with what actually occurred and then evaluating the effect on the environment. If the learner — in our case, the child — is unable to acquire and remember internal and accurate feedback about the results and the movement, then the comparison cannot be made in order to adjust the next trial. External feedback is then required. How frequent should the feedback be? A few investigations have examined the frequency of feedback in speech (e.g., Kim, LaPointe, & Stierwalt, 2012; Steinhauer & Preston Grayhack, 2000; Wambaugh, Kalinyak-Flizzar, West, & Doyle, 1998). Consistently, they have demonstrated that feedback of between 20% and 60% is more effective for retention than 100% percent feedback. However, for the tasks they examined, they did not control for learner experience. In other words, in keeping with Schmidt and Wrisberg’s (2008) notions, if the learners were just beginning, 100% feedback might be appropriate for a few trials. How precise should the feedback be? Schmidt and Wrisberg (2008) described several types of feedback; among them are summary feedback, average feedback, and bandwidth feedback. Their guiding principle was that

CHAPTER 5:  Motor Learning Guided Therapy

121

feedback should be as vague as possible so that the learner is forced to figure it out. An example of bandwidth feedback might be that the production of /l/ fell between an /r/ and /w/ sounds. Average feedback is also quite vague. The therapist might describe a set of five practice trials as on the whole being pretty good. In summary mode, the therapist might report that the first two were accurate, the third and fourth were inaccurate, and the fifth one was inaccurate. The size of the set about which to give feedback is dependent upon the learner’s experience. However, Hageman et al. (2004) described a therapy trial in which the feedback was provided to an apraxic child about vowels and consonants; however, the child was not told which she was receiving, that is, vowel or consonant feedback. The child was able to figure it out and had remarkable improvement in her speech accuracy. Another important variable to control during practice is the post-KR delay interval (Hall, Jordan, & Robin, 1993). Hageman et al. (2004) expanded on the post-KR delay interval notion to include postproduction delay interval. The purpose of these delays was to provide time for the learner to process the internal feedback (postproduction) and then to process the external feedback (post-KR or KP). The assumption being made was that the learner needed that time to compare the intended movement with the actual movement and then with the consequences of the movement in the environment (internal and external feedback). In some investigations we have used as much as 5 seconds of delay and as little as 1 second. The entire range has been shown to produce learning; however, we do not know the optimum time. In fact, it may not be the delay that is critical but rather the enforced “quiet time” that allows for attention to be allocated to the comparison task, followed by GMP tweaking. It is not necessarily externally directed attention but rather a period of time in which the neurological processes of recalling a program, remembering the program, and comparing the program with the results of the movement can occur. For example, in one study, the learner was consistently vocally rehearsing (groping) an incorrect production during the postproduction interval, which we interpreted to show that he was not making the necessary comparisons but was engaging in rapid trial and error experimentation. When we enforced the quiet delay postproduction, he began to show improvement (Hageman, 2005 [clinical observation]; Hageman, Stierwalt, & Burda, 2004). Measurement Every day in my clinic, I hear supervisors and students interacting about “taking data.” Since I was in graduate school, “taking data” has meant judging each performance as it is made and entering the “score” on a variety of forms. However, Schmidt and Wrisberg (2008) and others have described in depth the problems with this approach to measuring learning. These problems are serious and interfere with learning and our interpretation of what the learner actually knows.

122

The late eight

We must make a distinction between the momentary strength of a behavior (acquisition) versus the permanent memory (retention) of a behavior. This distinction is important because both the clinician and the learner will do things that improve acquisition scores but reduce retention. We have worried about this issue for years, calling it carryover. There are at least three aspects of permanent learning that we should consider. Retention is measured by performance on the practiced tasks at some time remote from the practice (e.g., at the next session). Generalization is measured by performance on tasks that are closely related to the practiced task (e.g., unpracticed words with the targeted sounds). Social validation is determined by measuring the use of the learning targets in normal day-to-day activities. The key element is that none of these measures is completed during practice. Why is measurement remote in time necessary? First, measurement during practice typically increases arousal and anxiety. Increased arousal levels are detrimental to learning, particularly in new or sensitive learners. (Importantly, I think it also detracts from the clinician’s ability to manage the therapeutic milieu as it is a divided attention task.) Second, measurement during practice encourages clinicians to use strategies that increase practice scores (e.g., blocked practice, constant feedback, etc.) but negatively impact retention. Third, learners will attempt to use as little variability as possible to maintain accuracy, which does increase acquisition scores but decreases retention score. Consequently, I recommend that retention testing be completed periodically. How often is that? Well, it depends. One should consider the learning level of the client. More experienced learners could be measured less frequently, whereas new learners could be measured once each session. For generalization and social validation, perhaps even longer time intervals would be more appropriate. The intervals are unique to individuals and depend on rate of learning and the demands of third-party interests. Movement Complexity Because we already have established that speech is a remarkably complex and rapid set of movements, what is there about speech complexity that can be managed to promote learning? Let’s examine rate. It is possible to slow speech and perhaps simplify the task. We know that we should not slow below three movements per second, as that will move into closed-loop control (Schmidt & Wrisberg, 2008). In addition, numerous researchers have shown that temporal errors (variability) increase with slow movements and that place (spatial target) error increases with faster movements. So whether you slow speech practice depends upon the type of error the learner is making. I would use slow speech practice when the child is having trouble hitting targets but not necessarily when the child is having timing or order errors. BUT, I would not slow to fewer than three movements per second because it uses a different control mechanism (closed loop).

CHAPTER 5:  Motor Learning Guided Therapy

123

Thinking About It How do you define the speed of movements in speech? Stetson said that the fundamental unit of speech is the syllable. We know that the temporal relationships between transitions and the vowel, voice onset time, the relative lengths of sounds within syllables, and the relative lengths of syllables are critical components of speech perception and prosody. Therefore, I would not practice at a speech rate that is so low that it changes any of those aspects. Another area of complexity is the length of the practice stimulus. Thus, perhaps we can break down longer motor tasks into shorter ones. Research has consistently shown that the more loosely coupled movements are, the easier it is to break them apart and practice them in isolation. For example, in tennis the serving ball toss is coupled to the actual serving motion but not so tightly that it is unreasonable to practice tossing. On the other hand, the hip rotation and arm swing of the serve are closely coupled during serving and not easily practiced separately. In speech, we have sentences, phrases, words, syllables, and phonemes. Starting with Stetson (1951), many researchers have proposed that the syllable is the fundamental unit of speech. In fact, it is clearly observable that stop consonants do not exist outside the transitions within the preceding or following vowel. In my opinion, speech sounds (phonemes) are so tightly coupled within syllables that they do really exist outside of a syllable. The coupling becomes less across syllables and even less across words and phrases. Consequently, all MLG speech practice takes place at least at the syllable level. Thinking About It The notion of coupling has clear implications for clinicians trying to figure out the length of a motor program — for speech I would say at minimum a syllable. However, there is considerable evidence that speech motor programming can be in elements considerably longer than a syllable. For example, two investigations of the effect on phrase length of inhibition of short and longer phrases clearly demonstrated that speakers, including young children, program across several syllables (Anderson, Meuting, Woolston, & Hageman, 2011; Backlin et al., 2008). Carr (2004) also demonstrated open- and closed-loop control differences across syllables in speech rate tasks.

124

The late eight

Although not necessarily directly related to simplification, during prepractice, imagining the movement is useful. Experts in golf and many other sports have reported that visualization of the motor act promotes better performance. Schmidt and Wrisberg (2008) reported research which suggests that the act of calling up the program is beneficial to learning even when the act is not completed. When the child is old enough, we begin using “imagination” or covert auditorization of (covert imagination of saying) a production of the target before random practice trials. We have not explored this technique systematically, but we anticipate that speech motor control is similar enough to nonspeech motor control to have positive consequences. Clearly there is more work to do.

Summary Several variables have been described that are known to affect motor learning for nonspeech activities and some speech activities. We have also proposed certain other aspects of motor practice that improve nonspeech motor control and extrapolated them to speech motor practice. Figure 5–3 shows a sample therapy hierarchy with explanations.

125

For creating unpredictable practice sequences

Client attempts utterance 2 times without feedback-waiting 3 seconds after each production.

Pre-performance time can be filled with movement rehearsal such as imagining saying the target. Time to wait is adaptable to the client.

After two attempts, clinician repeats the same utterance, waits 3 seconds, then has client judge the productions which allowed time for learner to process intrinsic feedback and adjust motor program.

Figure 5–3. A sample therapy hierarchy with explanation.  continues

Important – this step is optional. Judgments vary from correct/incorrect or closer/further from target (or other notions governing understanding of the effort). In Step 4 the client actually indicates the judgment. (Preference should be given to broad focus on production – how it sounds versus how is made).

Step 3

Post performance reflection-internal comparison of intent with movement allowing time to process internal feedback and adjust motor program. The time may be too long for some and too short for others. No talking by either person. Minimize motor activity and excitement (e.g., game anticipation)

Step 2

Note the pool contains items of various complexities, which can be controlled by the clinician. Challenging stimuli are better.

Clinician produces utterance depicted on stimulus card and then waits 3 seconds.

For learners who are showing some mastery of the target, omit step 1 randomly (50%)

Step 1

Clinician draws a set of words to use as a generalization measure (not practiced)

Pre-practice set up: From a previously collected pool of practice items, the client randomly draws five words, phrases, and/or sentences to use during steps 1–5.

Contains personalized practice materials representing universe of targets

126

Clinician provides feedback (KR-verbal or nonverbal) A. Outcome: 100% -Nonverbal, value chips returned to child if judged correctly (or according to the extension) B. Prescriptive: 50% -Location of articulation placements given every other error C. Post KR delay of 3 seconds.

Figure 5–3.  continued

Five items in a set is arbitrary – could be more or less depending upon the client’s ability to attend. KR or KP could be provided across the entire set; thus, the learner should show evidence that they can integrate more general feedback such as summary. Note that the evidence is not overt (asking client to tell you); rather it is shown by changing performance.

Repeat steps 1-5 with a new set of randomly drawn stimulus cards and continue until session ends.

The outcome feedback can be 100% early but should be reduced quickly. As learner shows movement toward more correct, I would reduce feedback systematically to as little as 25%. Similarly, prescriptive feedback should be reduced as well to zero as learner shows the ability to change productions closer to correct. The post KR delay time can be shortened or lengthened. Important thing is to keep the post KR time quiet (no talking by either person. Motivational feedback should be given when needed but definitely not during post KR time or every time.

Step 5

An extension could be that the client receives more value for a correct production judged as correct compared to a wrong production judged as wrong though the “wrong/wrong” act would still have value. The learner should not fear error. No value for correct/wrong or a wrong/correct judgments. However feedback could be delivered as summary or average feedback across the set of productions with motor learning suggesting that the less precise the feedback the better. Summary or average feedback is best with learners who have made some progress.

Step 4 Client judges correct versus incorrect production by correctly placing plastic chips in “happy/sad face” cups.

CHAPTER 5:  Motor Learning Guided Therapy

127

References Anderson, K., Mueting, E., Woolston, L., & Hageman, C. (2011). Reliability, accuracy and refractoriness of a transit reaction reaction: Replication with speech in children. Presentation at the Annual Meeting of the American Speech-LanguageHearing Association, San Diego, CA. Backlin, J., Corbett, A., Halbur, T., Gaughan, L., Howard, L., Williamson, C., et al. (2008). Reliability, accuracy and refractoriness of a transit reaction: Replication with speech. Presentation at the Annual Meeting of the American Speech-LanguageHearing Association, Chicago, IL. Carr, L. (2004). Temporal stability of speech motor programs in young children (Unpublished master’s research). University of Northern Iowa, Cedar Falls, IA. Gaughan, L., Howard, L., & Hageman, C. F. (2009). Speech inhibition in aphasia: A measure of motor speech programs. Presentation at the Annual Meeting of the American Speech-Language-Hearing Association, New Orleans, LA. Guadagnoli, M. A., & Lee, T. D. (2004). Challenge point: A framework for conceptualizing the effects of various practice conditions in motor learning. Journal of Motor Behavior, 36(2), 212–224. Hageman, C. F., Meuller, M., Burda, A., & Bleile, K. (2004). A motor learning guided approach to the treatment of developmental apraxia of speech. Presentation at the 10th Symposium of the International Clinical Phonetics and Linguistics Association, Lafayette, LA. Hageman, C., Stierwalt, J., & Burda, A. N. (2004). A motor learning guided approach to the treatment of nonfluent aphasia. The 10th Symposium of the International Clinical Phonetics and Linguistics Association, Lafayette, LA. Hall, P. K., Jordan, L. S., & Robin, D. A. (1993). Developmental apraxia of speech: Theory and clinical practice. Austin, TX: Pro-Ed. Kahneman, D. (1973). Attention and effort. Englewood Cliffs, NJ: Prentice-Hall. Kim, I., LaPointe, L. L., & Stierwalt, J. A. (2012). The effect of feedback and practice on the acquisition of novel speech behaviors. American Journal of Speech-Language Pathology, 21, 89–100. Lisman, A. L., & Sadagopan, N., (2013). Focus of attention and speech motor performance. Journal of Communication Disorders, 46, 281–293. Maas, E., & Farinella, K. A. (2012). Random versus blocked treatment for childhood apraxia of speech. Journal of Speech, Language and Hearing Research, 55, 561–578. Maas, E., & Mailend, M.-L. (2012). Speech planning happens before speech execution: Online reaction time methods in study of apraxia of speech. Journal of Speech, Language, and Hearing Research, 55, 1423–1534. Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K. J., Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17, 277–298. Netsell, R. (1991). A neurobiologic view of speech production and the dysarthrias. San Diego, CA: Singular. Redle. E., Vannesi, J., Maloney, T., Tseval, R. K., Eikenberry, S., Lewis, B., Shriberg, L. D., Tkach, J., & Holland, S. (2015). Functional MRI evidence for fine motor praxis dysfunction in children with persistent speech disorders. Brain Research, 1597, 47–56.

128

The late eight

Robin, D. A., Jacks, A., Hageman, C., Clark, H. M., & Woodworth, G. (2008). Visuomotor tracking abilities of speakers with apraxia of speech or conduction aphasia. Brain and Language, 106(2), 98–106. Schmidt, R. A. (1988). Motor control and learning: A behavioral emphasis. Champaign, IL: Human Kinetic. Schmidt, R. A., & Wrisberg, C. A. (2008). Motor learning and performance: A problembased learning approach (3rd ed.). Champaign, IL: Human Kinetics. Stetson, R. H. (1951). Motor phonetics: A study of speech movements in action (2nd ed.). Amsterdam, Netherlands: North-Holland. Steinhauer, K., & Preston Grayhack, J. (2000). The role of knowledge of results in performance and learning of a voice motor task. Journal of Voice, 14(2), 137–145. Wambaugh, J. L., Kalinyak-Flizzar, M. M., West, J. E., & Doyle, P. J. (1998). Effects of treatment for sound errors in apraxia of speech and aphasia. Journal of Speech, Language, and Hearing Research, 41, 725–743. Wulf, G., Shea, C. H., & McNevin, N. H. (2003). Increasing the distance of an external focus of attention enhances learning. Psychological Research, 67, 22–29. doi:10.1007/ s00426-002-0093-6

Part II

Clinical Resources

Chapter Six

Overview

This chapter provides an overview of the resources in the second half of the book and on the accompanying companion website. Resources described in the first half of this chapter include 14 “tools of the trade” to evaluate and treat late-acquired sounds. The second half of the chapter offers an illustration showing how a clinician might use the resources in evaluations and treatment. The chapter concludes with a description of resources on the accompanying companion website. The 14 resources include: 1. Definition 2. Acquisition 3. Relative frequency 4. Errors 5. Key environments 6. Metaphors 7. Touch cues 8. Initial screening 9. Screening for stimulability 10. Demonstrations 11. Phonetic placement and shaping techniques 12. Exercises 13. Language activities 14. Word lists

131

132

The late eight

Warning! This chapter provides necessary background for using the resources. Most of the information, though important, is fairly dry to read.

Resources for the Late Eight 1. Definition What It Is:  The definition is a prose description showing how a sound is

produced, or, as in the case of a sound such as [s], [z], or [r], the several different ways it may be produced. Its Uses:  Typical uses of the definition include: n Making an n Explaining

informed decision about how to teach a sound to a student and family how a sound is produced

Illustration:  This is the definition of [s]:

[s] is made in either of two ways. Some people produce [s] with the tongue tip up behind the upper front teeth, others say it with the tongue tip down behind the lower front teeth. Neither one is the “right way.” Follow a student’s lead in deciding which way to teach [s]. If a student appears to find it easier to say [s] with the tongue tip up, teach the sound that way; if a student appears to find it easier to say [s] with the tongue tip down, teach the sound that way. For both varieties of [s], the airstream is continuous and the vocal folds are apart. A brief technical definition of the sound is also provided. This is the technical definition of [s]: [s] is a voiceless alveolar fricative. 2. Acquisition What It Is:  Acquisition data show the ages at which 50% and 75% of children

acquire a sound. Its Uses:  Acquisition data are widely used for two purposes:

CHAPTER 6:  Overview

133

n Deciding

if a student’s delay in acquisition of a sound is sufficient to warrant therapy n Selecting between possible treatment sounds (some clinicians choose to treat earlier acquired sounds before treating later acquired ones) Illustration:  This is the acquisition data for [tʃ ]:

Fifty percent of children acquire [tʃ ] by 4;6 and 75% of children acquire [tʃ ] by 5;6. 3.  Relative Frequency What It Is:  Relative frequency is the level of repetitiveness in the occurrence

of a sound in the language. The data source for relative frequency is Shriberg and Kwiatkowski (1983). The information is for consonants; vocalic [r] is excluded from the calculations. Its Use:  A typical use of information on relative frequency includes: n Evaluating

the contribution of a possible treatment sound on intelligibility (sounds with higher relative frequency are presumed to have greater influence on intelligibility than those that occur less frequently)

Illustration:  This is the relative frequency for [z]:

[z] is ranked fifth in relative frequency compared with the other late acquired consonants. It ranks fifteenth in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 3.0%. 4. Error What It Is:  This resource shows the speech errors a student is likely to make when unable to pronounce a sound. Its Uses:  Knowledge of speech errors is widely used for at least two reasons: n Identifying errors that n Determining possible

may lead the student to be stigmatized socially influence of an error on intelligibility. (Errors with a relatively large effect on intelligibility include those found in the beginning of words, changes in place of pronunciation, and those involving sound deletions.)

134

The late eight

Illustration:  These are common [r] errors among students with errors affect-

ing late-acquired sounds: The most common error is gliding — that is, [w] for [r]. Deletion of [r] after vowels and in consonant clusters also is a common error. 5.  Key Environment What It Is:  A key environment describes the phonetic position or context

in which a student is likely to pronounce a sound correctly. As discussed in Chapter 1, key environments are the mirror image of phonological processes. While phonological processes describe the “phonetic pitfalls” into which a student may fall, key environments show phonetic contexts that assist rather than hinder. Key environments are “best bets” rather than absolute laws. Stated differently, a best bet is that a student will learn to pronounce a sound in a key environment rather than in another environment. Importantly, key environments for sounds overlap with similarly pronounced sounds sharing similar key environments and less similarly pronounced sounds possessing fewer common key environments. Its Use:  A key environment is widely used for one important purpose: n Helping

decide in which phonetic environments to establish a treatment sound

Illustration:  These are the key environments for [θ]

1. End of a syllable or word, as in teeth 2. Before a high front vowel, as in thin 6. Metaphor What It Is:  A metaphor provides a means to describe a sound. Its Use:  A metaphor is widely used for: n Providing

the clinician and student a handy way to refer to a treatment sound n Helping a student focus on speech Illustration:  These are possible metaphors for [z]:

135

CHAPTER 6:  Overview

Tongue placement: Tongue tip sound Bump sound little Hill sound bottom Teeth sound

(tongue (tongue (tongue (tongue

tip tip tip tip

up or down) up) up) down)

Fricative: Snake sound Long sound Hissing sound Voicing: Motor-on sound Voice box on Voice-on sound Buzzing sound Word position:

Starting sound End sound Sound friends

Beginning of word End of word Consonant cluster

7.  Touch Cue What It Is:  A touch cue draws attention to an aspect of a sound’s production, typically the place of production. Its Use:  Typical uses of this resource include: n Referring

to a treatment sound through modalities (touch and sight) other than hearing n Reminding a student how a treatment sound is produced Illustration:  This is the touch cue for [l]:

Tip of finger on the middle of the upper lip. 8.  Initial Screening What It Is:  An initial screening helps determine if a student may experience difficulty pronouncing a late-acquired sound. It typically includes a spontaneous speech sample and a short screening test that assesses possible errors at the word level in selected major phonetic contexts. Its Use:  Typical uses of this resource include: n Helping

decide if a student is a candidate for treatment

136

The late eight

n Developing

an initial hypothesis regarding types of errors made by a

student n Pretesting

a student’s ability to pronounce a sound

Illustration:  This is the initial screening test for [S ]:

Instructions:  I’m going to say some words. Please say the word after me. Example:  “Dog. Now you say it.” Word Beginning

Student*

1. Shell

_____________

2. Shutter

_____________

3. Show

_____________

4. Shrug

_____________

5. Shrimp

_____________

6. Shred

_____________

Medial 7. Wishing

_____________

8. Ocean

_____________

9. Washer

_____________

Final 10. Dish

_____________

11. Crush

_____________

12. Irish

_____________

13. Mars

_____________

14. Marsh

_____________

15. Borscht

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

137

CHAPTER 6:  Overview

9.  Screening for Stimulability What It Is:  A screening test for stimulability helps determine if a student is capable of pronouncing a sound. Stimulability is assessed in imitation, key environments, and favorite words and through phonetic placement and shaping. A sound may also be stimulable if it occurs in low frequency across a number of words; this is typically assessed through a spontaneous speech sample or through asking someone who knows the student well, perhaps a teacher or family member. Its Use:  The most typical use of this resource includes: n Selecting

between possible treatment sounds. (Note: Stimulability is a controversial topic. Some clinicians prefer to select a sound for which a student is stimulable, others prefer to select nonstimulable sounds. The topic is discussed in Chapters 1 and 16 of this book.)

Illustration:  This is the stimulability screening test for [tʃ ]:

Imitation 1. chip _____________ 2. catch

_____________

Best Bet Environments End of a syllable or word 1. [tʃ ] _____________ 2. watch

_____________

After a high front vowel 1. beach

_____________

2. itch

_____________

Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement 1. Ask the student to make the train sound “choo choo.”

138

The late eight

Shaping 1. Instruct student to say “Bet you” slowly. 2. Next, instruct student to say “Bet you” fast, resulting in the production of “Betcha.” 3. If “betcha” doesn’t work, repeat with “Got you.” 10. Demonstration What It Is:  Demonstration is a formalized explanation showing how a sound

is produced. Demonstrations can be simple or involved, some requiring no implements and others making use of a mirror and other tools. In general, simple demonstrations work best. If a clinician is going to put a hand in the student’s mouth, all universal health care precautions should be followed. Its Use:  Typical uses of this resource include: n Helping explain to a student how to pronounce n Focusing a student’s attention on aspects of a

a sound sound pronounced

incorrectly Illustration:  This is a simple demonstration of [s]:

Objects:  Q-tip and peanut butter or other favored food. Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food on alveolar ridge (for tongue tip raised [s]) or behind lower front teeth (for tongue tip lowered [s]). 3. Ask the student to touch the food with the tongue tip. 11.  Phonetic Placement and Shaping Techniques What They Are:  Phonetic placement and shaping techniques are procedures

to teach sounds. Phonetic placement techniques entail instructing a student how to place the articulators to make a sound. Phonetic placement techniques are similar to demonstrations, the difference being that phonetic placement techniques require a production from a student and demonstrations do not. Shaping techniques rely on similarities between sounds to shape a sound a student can pronounce into one he or she cannot pronounce. Techniques presented in this book were culled from many sources, published and unpublished. The main published sources were books long out of print, most especially Nemoy and Davis (1954). Unpublished sources include many talented

139

CHAPTER 6:  Overview

and creative clinicians that the author has had the pleasure to interact with over the years. What Phonetic Placement and Shaping Techniques Do In essence, phonetic placement and shaping techniques make an unstimulable sound stimulable. Once stimulable, treatment then expands use of the sound in a student’s speech.

Their Use:  Typical uses of this resource include:

Establishing a sound in a student’s speech Illustration:  This is a phonetic placement technique for [θ], followed by tech-

nique for shaping vocalic [r] into consonantal [r]: Phonetic Placement Technique for [θ] Objects:  Feather or small piece of paper Instructions: 1. Place a feather or small piece of paper in front of the student’s mouth, about a half-inch to an inch from the tongue. 2. Instruct the student to blow air over the tongue to move the feather or paper, resulting in [θ]. Shaping Technique for [r] Objects:  None Instructions: 1. Ask the student to say vocalic [r]. 2. Next, ask the student to say vocalic [r] followed by [i] or some other vowel. 3. Instruct the student to say [i] several times as quickly as possible, resulting in vocalic [r] becoming [ri]. After [ri] is established, instruct the student to say vocalic [r] silently, resulting in [ri]. 12.  Speech Exercise What It Is:  A speech exercise helps a student to gain experience pronouncing or focusing on a treatment sound (see the discussion of speech discrimination in Chapter 1). Six different types of speech exercises are provided:

140

The late eight

Imitation:  The student repeats the word after you. Minimal Pairs: The student says a word that contains the treatment sound, replaces the treatment sound to create a rhyming word, and then again says the word with the treatment sound. Deletion:  The student says a word that contains the treatment sound, says the same word with the treatment sound deleted, and then again says the word with the treatment sound added. Self-Correction:  The student says a word containing the treatment sound three times, self-correcting if errors in the treatment sound occur. Old Way/New Way:  The student says a word containing the treatment sound, pronouncing the treatment sound the new way, the old way, and then the new way again. Similar Sound: The student says a word containing the treatment sound, replaces the treatment sound with the most similar sound the student can make, and then again says the word with the treatment sound. Its Use:  Typical uses of this resource include: n Helping a student to master pronunciation of a late-acquired sound n Helping a student learn to self-monitor and self-correct speech errors n Focusing a student on the communication value of a late-acquired

sound Illustration:  This is a possible use of two speech exercises in a treatment

session. Clinician:  What is a word for ocean that starts with the snake sound? Student: Sea. Clinician:  That’s right. Do you remember how you used to say the s sound? Student: th Clinician:  Good. Now say sea the new way, the old way, and then the new way again. Student:  Sea. Thea. Sea. Clinician:  Great. Now say sea three times, listening to yourself and trying to make the sound the new way. Student:  Sea. Sea. Sea.

141

CHAPTER 6:  Overview

13.  Language Activity What It Is:  A language activity lets a student practice a treatment sound in

conversation and in school projects. Its Use:  Typical uses of this resource include: n Promoting generalization of a treatment sound to settings and persons

outside the treatment session n Helping to make a treatment sound a student’s regular n Practicing a treatment sound in linguistic contexts n Promoting success on school assignments

way of talking

Illustration:  This is an awareness activity for [z] and a speech activity for [r],

followed by an example showing ways in which an activity might be varied. Awareness Activity for [z] Ask a student to silently read a newspaper or story and then circle or write down words that contain [z]. Speech Activity for [r] Give the student a printed story that has a sticker over words that contain [r]. Ask the student to read the story aloud and “to guess” at the words under the stickers. An easy alternative is to ask the student to say each stickered word the new way, the old way, and then the new way again. 14.  Word List What It Is:  This book contains a list of approximately 4,000 different com-

monly found words containing late-acquired sounds. With very few exceptions, the words are short (one to two syllables) and easily pictured. The word lists for each sound are divided into major phonetic environments in which the sound occurs. Included in the word lists are lists of minimal pairs, deletions, and themes. Its Use:  This resource is used in many different ways, including: n Developing pre- and posttests n Practicing treatment sounds in isolated words n Focusing a student on the linguistic role of a treatment n Developing language-based activities

sound

142

The late eight

A Good Question Someone may ask: Yes, but how do these word lists differ from those in the 40,000 words book — in addition to that book having 40,000 words and this book having only 4,000? An Answer The author has a well-worn copy of 40,000 Selected Words (Blockcolsky, Frazer, & Frazer, 1987). The major differences between the word lists in that fine book and those in this book include: n The Late Eight contains

more than twice the number of words containing late-acquired sounds. n The present book contains more short (one to three syllables), easily pictured words. n Word lists in the present book are organized into minimal pairs, deletions, and themes. n Word lists in the present book are organized according to phonetic environments frequently useful in treatment.

Illustration:  The following is a sample of the entry for [s] at the beginning

of words, followed by a theme for [l]: Word List for [s] Beginning of Words Single Consonants Deletions Minimal Pairs Sat at bat, mat, hat, cat, rat, pat Salmon Sail ale, ail tail, pail, nail, veil, rail, whale, mail, jail Salad ballad Sailboat Socks fox, rocks, box Soap rope Sew O, oh  toe, row, hoe, no, bow, mow, go Sun fun, run, one, bun, gun Sally alley tally Silk ilk Seagull eagle

143

CHAPTER 6:  Overview

Theme for [l] Northern Places Deletions Minimal Pairs Chilly hilly Willy, silly, Billy Elk Rudolph Sled said fled Sled dog Sleigh bells Sleet seat fleet Glacier Blizzard North Pole Cool fool, tool, pool Wolf woof Wolves Sledding Sleigh say Snowflake

Companion Website The accompanying companion website offers maximum portability and flexibility. Information on the website replicates much of the book, but in formats to download, print out, make into exercises, and adapt as a clinician deems most suitable. The accompanying website includes the following printable materials for each late-acquired sound: n A “cheat sheet” n Initial screening form n Initial stimulability testing form n Demonstrations n Phonetic placement and shaping n Shells for speech exercises n Shells for language activities n Complete word list n Minimal pairs n Deletions n Themes

exercises

Illustration of Clinical Resources The order in which resources are described in the following sections is to better approximate their use with a hypothetical student from the evaluation through conclusion of treatment. The sequence is indicated in Table 6–1.

144

The late eight

Table 6–1.  Clinical Resources Used in Evaluation and Treatment Assessment

Initial screening Screening for stimulability Definition Acquisition Relative frequency Errors

Treatment

Metaphors Touch cues Demonstrations Phonetic placement and shaping techniques Key environments Word lists Speech and awareness exercises Language activities

Evaluation The following resources are used primarily in assessment: n Initial screening n Screening for stimulability n Definition n Acquisition n Relative frequency n Errors

Guide to Resources Evaluation n An initial screening helps indicate if a student has a speech difficulty. n Screening for stimulability helps determine if a student has the

capacity to pronounce a sound. n Definition helps decide how a sound should be produced. n Age of acquisition helps in making a decision regarding

sound to teach.

which

145

CHAPTER 6:  Overview n Relative

frequency helps in making a decision regarding which sound to teach. n Errors help in making a decision regarding which sound to teach. Treatment n Metaphors help label n Touch cues help label

a treatment sound. a treatment sound through modalities of touch

and sight. n Demonstrations show a student how a treatment sound is produced. n Phonetic placement and shaping help establish a sound in a stu-

dent’s speech repertoire. n Key environments suggest which phonetic positions may facilitate pronunciation of a treatment sound. n Word lists are a basis for activities involving words, minimal pairs, deletions, and themes. n Speech exercises help a student to gain experience pronouncing a treatment sound. n Language activities help a student practice a treatment sound using real world activities and resources. Initial Screening, Screening for Stimulability The most typical referral source for a student is a parent or teacher. A student may then be observed in a classroom or playground before receiving an initial speech screening and a screening test for stimulability. Initial Screening An initial screening helps determine if a student experiences difficulty pronouncing a late-acquired sound. An initial screening assesses a treatment sound at the word level in a variety of phonetic contexts. In addition to determining if a problem with a sound exists, an initial screening often serves as a pretest against which treatment progress is measured. If a student’s speech is found to contain speech errors, a screening test for stimulability typically is administered. Screening for Stimulability Screening for stimulability helps determine if a student can pronounce a possible treatment sound. Information on stimulability is helpful in predicting how rapidly treatment is likely to proceed. In general, if a student has some initial capacity to pronounce a sound, treatment proceeds more rapidly than if such a capacity must first be established.

146

The late eight

Definition, Acquisition, Relative Frequency, and Errors These resources bundle together after stimulability testing is completed and as a clinician decides between possible treatment sounds. Typically, deciding which sound to select is based on weighing multiple factors, personal and linguistic. Personal factors include a clinician’s judgment about a student’s attention span, interests, and concerns. The linguistic aspect of sound selection includes stimulability, definition, acquisition, relative frequency, and errors. No single variable trumps the others. Rather, a clinician weighs multiple considerations to reach a balanced decision. Definition The definition is a prose description showing how a sound is produced. The definition contributes to treatment decisions because understanding how a sound is made suggests which resources may be needed to teach it. To illustrate, for [l] a clinician thinks about where the tongue is, how easily it might be to teach a student this tongue position, what types of demonstrations might be needed, what phonetic placement and shaping technique to use, and the types of exercises available. Alternatively, for [s] an additional consideration might be to develop short probes to determine which [s] is easier for a student — tongue tip raised or lowered? Typically, a clinician follows the student’s lead — that is, if a student already makes [s] with the tongue tip lowered, the clinician teaches [s] with a lowered tongue. If a student does not have a preferred way, a clinician may feel freer to select an appropriate variant. Acquisition Acquisition data indicate the age at which 50% and 75% of children acquire a sound. If all other things are equal (they seldom are), a clinician may decide to first treat an earlier acquired sound. Indeed, for some clinicians the importance of acquisition data is the primary criterion used in the selection process. Relative Frequency Relative frequency is the level of repetitiveness in the occurrence of a sound. Typically, remediation of a sound with a higher frequency of occurrence has greater impact on intelligibility than one with lower frequency. For this reason, a clinician may incline to first teach more frequently occurring treatment sounds. To illustrate, if a clinician is deciding between [s] and [z], [s] might be selected because of its higher frequency of occurrence.

147

CHAPTER 6:  Overview

Errors A sound may be susceptible to a number of major errors. This information weighs in sound selection in at least two respects: 1. Some errors may be socially stigmatized. 2. Errors have varying effect on intelligibility. In general, errors that may lead to a student being stigmatized socially are a high treatment priority. To illustrate, a lisp and [w] for [r] are often early treatment sounds because they may provoke teasing. Impact of an error on intelligibility also influences sound selection. Errors that negatively affect intelligibility are good candidates for treatment. These include deletions, changes in place of production, and substitutions in the beginning of words.

Treatment Once a sound or sounds have been selected for treatment, the following resources are used: n Metaphors n Touch cues n Demonstrations n Phonetic placement and shaping n Key environments n Word lists n Awareness and speech exercises n Language activities

techniques

Metaphors, Touch Cues, and Demonstrations Metaphors, touch cues, and demonstrations all provide useful ways to refer to treatment sounds, and especially during early treatment phases may help focus a student on the task at hand. As treatment progresses, they serve as reminders and prompts. Metaphors Metaphors provide useful analogies for a treatment sound. Typically, a clinician presents several possible metaphors, allowing a student to select between them. With a younger student, the metaphors make analogy with something familiar — perhaps an engine starting, a hissing snake, or a leaky tire. With

148

The late eight

an older student, the metaphors often refer to an aspect of the treatment sound — that is, an interdental may be the tongue-out sound, [s] with a lowered tongue tip may be the tongue-down sound, or [l] may be the pointy sound. For a student who is a teenager or an adult, many times a treatment sound is called by its technical name. To illustrate, with an adult student a clinician may decide to call [s] “a fricative sound” or “a fricative made at the alveolar ridge.” Often, a metaphor proves more successful when a student helps select it. Typically, a clinician presents several options and asks the student to select one. Allowing a student to help select a metaphor entails the clinician giving up a measure of control — after all, a student is not obliged to select the metaphor that the clinician thinks best captures the nature of the speech problem. A clinician weighs selection of the most appropriate metaphor against a student’s need for involvement. In the author’s experience, most often the issue does not arise and selection of a metaphor presents few problems. If a question of appropriateness versus student involvement arises, most clinicians give up the best, most appropriate metaphor in favor of student involvement. Touch Cues Touch cues are finger positions that represent a treatment sound, allowing a clinician to refer to a treatment sound using modalities other than speech. Touch cues grossly mimic speech movements. An older student understands that, for example, the touch cue for velar consonants is made parallel to the back of the mouth, representing where the tongue is raised. A younger student may benefit from a touch cue without realizing its mimicking quality. For such a student, a touch cue is a visual and tactile reminder, a way to say, “Remember: this is the sound we are working on.” Demonstrations Demonstrations show a student how a treatment sound is produced. By drawing attention to such aspects of speech as tongue position and airflow, a student may better understand how to pronounce a treatment sound. Older students often find demonstrations intellectually engaging and interesting. Others, especially those under 7 years, may find demonstrations more confusing than helpful. Demonstrations find their most use early in treatment. Later in treatment, an occasional demonstration may serve as a reminder about how a treatment sound is produced. Phonetic Placement and Shaping Techniques Phonetic placement techniques show a student how to place the articulators to pronounce a sound, and shaping techniques show a student how to convert

CHAPTER 6:  Overview

149

one sound into another. These techniques are used when a nonstimulable sound is selected for treatment. Students 7 years or older typically possess sufficient attention and language skills to benefit from these techniques. With a younger student, success with these techniques is more hit-or-miss. The techniques are typically inappropriate (and ineffective) with a child under 4 years. Though every clinician has favorite phonetic placement and shaping techniques, no single technique works for every student. In general, a clinician selects one that makes intuitive sense and then engages in trial-and-error dynamic assessment. Often, from a few to 5 to 10 minutes is sufficient to determine if a particular technique will prove successful. In general, when selecting a technique, most clinicians prefer those that are simpler and have shorter instructions. Longer techniques are turned to when the shorter, simpler ones do not yield results. The phonetic placement and shaping techniques listed in this book are “bare bones recipes” to expand and modify as a clinician desires. Often, the actual phonetic placement or shaping technique used with a student contains the following elements: 1. An initial self-demonstration by the clinician. 2. The student practices the steps in the technique. Use of a touch cue and metaphors focus the student and help remind him or her about how the sound is pronounced. 3. The student attempts to make the sound. 4. The clinician gives feedback about the success of the attempt. The following illustrates one possible way to fully expand a bare bones phonetic placement technique:

Phonetic Placement Technique for [θ] Objects:  Feather or small piece of paper Instructions: 1. First demonstrate the method on yourself. 2. To begin, place your tongue between your upper and lower front teeth. 3. Place a feather or small piece of paper in front of your mouth, about a half inch to an inch from your tongue. 4. Blow air over your tongue to move the feather or paper. 5. Explain, “That’s how you make the leaking tire sound. Now it’s your turn.” 6. Instruct the student to stick out his or her tongue just as you did. 7. When the tongue is out, place the feather or paper before the mouth.

150

The late eight

8. Explain, “Now blow to make it move.” 9. If the sound is made correctly, say, “That’s right. You did it. You made [θ] ​ — the leaky tire sound.” If the sound is made incorrectly, say something like, “Good try. Let’s try again.” Key Environments Key environments describe phonetic environments in which a student is likely to pronounce a sound correctly. In addition to being used during the evaluation to determine if a student has the capacity to make a sound, key environments find good use after a treatment sound (or sounds) is selected, providing a possible succession of environments in which to treat a sound. The following illustrates how key environments might be used to establish [s], [l], and [r] at the beginning of words and end of words, between vowels, and in consonant clusters. Beginning of Word Establish [s], [l], and [r] before a high front vowel. Once established, expand the number of different vowels that follow. For a student who is strongly affected by the adjacent vowel, back high vowels are likely to be more challenging than front ones. End of Word [s] is more likely to be established here than [l] and [r]. Establish after a high front vowel. Next, to make word-initial sounds, have the word-final sounds be followed by a word beginning with a vowel, such as “bus and.” This encourages the sound to “migrate” to start the following word, resulting in, for example, “bu sand.” Between Vowels [l] and [r] are more likely to be established here than [s], though some students find [s] easier to make here, too. For all three consonants, establish between two high front vowels, as in ili. Once established, add different adjacent vowels. To expand to word-initial position, have the student drop the first vowel, resulting in, for example, [li]. To expand to word-final position, follow the same procedure, resulting in, for example, [il]. Consonant Clusters For [s], establish after [t] as in “pizza” or the nonsense word [tsi]. To expand the environments in which [s] occurs, have [ts] be followed by different

CHAPTER 6:  Overview

151

vowels. To help expand [s] to syllable-initial position, encourage the student to drop the [t]. For [l] and [r], establish after a consonant with a different place of production than [l] and [r] (most often, select [p] or [b]) followed by a high front vowel. Next, to help expand [l] and [r], ask the student to drop the initial consonant in the consonant cluster. Word Lists Word lists are used to generate stimuli to help establish a sound in a student’s speech, and then to practice it. Words, rather than nonsense syllables, are the vehicle for teaching a treatment sound for two reasons: 1. Words, carefully selected, offer relatively simple phonetic contexts in which to teach a sound, and 2. Words, being a student’s everyday means of communication, are used both in and outside of treatment, making them a critical bridge to generalization. Word lists in this book are divided by phonetic environment; on the accompanying companion website, lists of minimal pairs, deletions, and themes also are included. Word lists are therapeutic building blocks for many different exercises and activities. The value of using isolated words diminishes as treatment proceeds and the clinician shifts to more naturalistic activities. Awareness and Speech Exercises Awareness exercises focus a student’s attention on the treatment sound. They are used frequently early in therapy to orient a student, and later in therapy primarily as prompts and reminders. Speech exercises help a student to gain experience with a treatment sound, providing practice in pronouncing, self-monitoring, and self-correcting speech. The most frequently used exercises are imitation, minimal pairs, deletions, multiple productions, old way/new way, and similar sounds. Speech exercises are used most often in language activities and, less frequently, as a list of words. Many times a mix of exercises is used. For example, a student may be asked to delete the treatment sound and then say the word with the treatment sound three times. Language Activities Language activities use school books and other outside materials, including stories a student is reading, favorite stories from home, and articles from

152

The late eight

newspapers and magazines. These materials, because they are familiar and widely used, are easy to adapt by families, aides, and teachers. Many times their use also has the practical advantage of improving a student’s academic skills. Though the purpose of therapy is speech, much is gained if in the process of learning speech a student also does better on classroom assignments or gives a better oral report.

Summary Resources contained in the first half of this book are “tools of the trade” to assist a clinician in evaluating and treating such speech disorders. The discussion in the second half of the chapter illustrates one way care might be conceptualized and carried out. The resources are flexible and can be used within a wide variety of therapeutic approaches and with a range of students, including children and adults and both first and second language learners. The hope in assembling these resources is to help provide clinical care to the many students with this highly prevalent developmental difficulty.

References Bernstein, N. (2005, January 19). Proficiency in English decreases over a decade. New York Times. Blockcolsky, V., Frazer, J., & Frazer, D. (1987). 40,000 selected words. San Antonio, TX: Communication Skills Builder. McDonald, E. (1964). A deep test of articulation. Pittsburgh, PA: Stanwix House. Nemoy, E., & Davis, S. (1954). The correction of defective consonant sound. Magnolia, MS: Expression. Shewan, C. (1988). 1988 omnibus survey: Adaptation and progress in times of change. Asha, 30, 27–30. Shriberg, L., & Kwiatkowski, J. (1983). Computer-assisted natural process analysis (NPA): Recent issues and data. In J. Locke (Ed.), Seminars in Speech and Language, 4, 397. Van Riper, C. (1978). Speech correction: Principles and methods (6th ed.). Englewood Cliffs, NJ: Prentice-Hall.

Chapter Seven

[θ] Definition

[θ] is made with the tongue tip between the upper and lower front teeth. The airstream is a continuous hiss between the upper tongue and the upper teeth. The vocal folds are apart. The technical definition of [θ] is voiceless interdental fricative.

Acquisition Fifty percent of children acquire [θ] by 4;6 and 75% of children acquire [θ] by 6;0.

Relative Frequency [θ] is ranked seventh in relative frequency compared with the other late-acquired consonants. It ranks twenty-first in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 0.9%.

Errors [s] for [θ] is a common error, as is [f] for [θ]. A less common error for [θ] among school-aged students is [t] or [p] for [θ]. 153

154

The late eight

Key Environments End of a syllable or word, as in teeth Before a high front vowel, as in thin

Possible Metaphors Select metaphors based on the aspect of speech that is the focus of therapy. Tongue placement: Tongue tip sound Fricative: Leaky tire sound Long sound Hissing sound Voicing: Motor off Voice off Not a buzzing sound Voice box off

Touch Cue Finger in front of lips. Instructions Place the student’s finger in the middle of the front of the lips.

Initial Screening Test for [θ] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example:  “Dog. Now you say it.” Word Student* Beginning 1. Thigh

_____________

2. Thunder

_____________

3. Thorn

_____________

4. Threw

_____________

5. Thriller

_____________

6. Throne

_____________

Medial 7. Nothing

_____________

8. Python

_____________

9. Without

_____________

Final 10. Bath

_____________

11. Oath

_____________

12. Teeth

_____________

13. Sixth

_____________

14. Ninth

_____________

15. North

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

155

Stimulability Tests for [θ] Student’s Name: Date: __________________ Referral: Imitation 1. Thumb _____________ 2. Tooth

_____________

Key Environments End of a syllable or word 1. teeth

_____________

2. [iθ] _____________ Before a high front vowel 1. thin _____________ 2. [θi] _____________ Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement  _____________ 1. Ask the student to place the tongue between the upper and lower teeth. 2. Instruct the student to put his or her hand in front of the mouth, and blow through the teeth to feel the airflow. Shaping [θ] from [s]  _____________ 1. Demonstrate the difference between the place of production for [s] and the place of production for [θ]. 2. Next, instruct the student to say /s/ while moving his or her tongue to rest between the upper and lower teeth, resulting in [θ]. Notes/Comments:

156

157

CHAPTER 7:  [T]

Demonstrations for [θ] Place: Interdental First Method   Object:  Tongue depressor Instructions: 1. Instruct the student, “Please stick out your tongue.” 2. Once the tongue is out, gently close the student’s mouth. If the tongue is sticking out too far, gently push it back with a tongue depressor. Second Method   Objects:  Tongue depressor or stick of candy or other favored food Instructions: 1. Place a tongue depressor or piece of food in front of the student’s mouth, about half an inch before the lips. 2. Instruct the student, “Please touch it with your tongue.” 3. While the student touches the tongue depressor or food with the tongue tip, gently close the student’s mouth. 4. Instruct the student, “Now pull your tongue back just a little until I say stop.”

Manner: Fricative First Method   Objects:  Strip of paper or a feather Instructions: 1. Place a strip of paper, a feather, or the student’s hand held in front of your mouth while you produce several long voiceless fricatives. 2. Draw attention to the “hissing” quality and continuous nature of the sounds.

158

The late eight

Second Method   Objects:  A small paper flower on end of a pencil Instructions: Tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind. Third Method   Objects:  None Instructions: Run your finger or the student’s finger down the student’s arm while making several long voiceless fricatives to demonstrate the “hissing” quality and length of fricatives.

Voicing: Voiceless First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and voiced [a]. Second Method   Objects: None Instructions: Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration.

CHAPTER 7:  [T]

159

Third Method   Objects: None Instructions: If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, ask the student to make [h] and [a]. Fourth Method   Objects: None Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off. Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions: If the student is able to produce a pair of voiced and voiceless oral stops, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

160

The late eight

Placement and Shaping Techniques for [θ] Phonetic Placement Techniques Both these simple phonetic placement methods focus on tongue placement (tongue between the teeth) and airflow (air over the tongue). First Method   Objects:  Feather or small piece of paper Instructions: 1. Place a feather or small piece of paper in front of the student’s mouth, about one-half inch to an inch from the tongue. 2. Ask the student to blow air over the tongue to move the feather or paper, resulting in [θ]. Second Method   Objects:  Tongue depressor and Q-tip Instructions: 1. Place a tongue depressor in front of the student’s mouth, instructing the student to touch the depressor with his or her tongue tip. 2. When the student’s tongue is out, gently push up the student’s lower jaw so that his or her teeth and tongue come into contact. 3. Instruct the student to blow air over the tongue. If the student produces an interdental [t], gently insert a Q-tip between the student’s tongue tip and upper teeth to create a sufficiently broad opening to allow continuous airflow, resulting in [θ].

Shaping Exercises [θ] from [f]   This method is for a student with a well-established [f]. Objects: None

CHAPTER 7:  [T]

161

Instructions: 1. Demonstrate the difference between the places of production for [f] and [θ]. 2. Ask the student to say [f] while moving the tongue to lie between the upper and lower front teeth, resulting in [θ]. (Note: To facilitate [ð], develop from [v].) [θ] from [s]   This method approaches [θ] from the opposite direction as the first method: rather than from slightly anterior [f], this method approaches [θ] from slightly posterior [s]. Objects: None Instructions: 1. Demonstrate the difference between the place of production for [s] and the place of production for [θ]. 2. Next, instruct the student to say [s] while moving the tongue to lie between the upper and lower front teeth, resulting in [θ]. (Note: To facilitate the [ð], develop from [z].)

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct:  ________ / ________ Comments:

162

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student:  “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Thin

1. __________________

Thumper

2. __________________

Thick

3. __________________

Thief

4. __________________

Thumb

5. __________________

Thank you

6. __________________

Thigh

7. __________________

Thunder

8. __________________

Thorn

9. __________________

Thumbtack

10. __________________

Total Correct:  ________ / ________ Comments:

163

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:

Thin

Chin

1. __________________

Thor

Soar

2. __________________

Third

Word

3. __________________

Thumper

Jumper

4. __________________

Thatch

Hatch

5. __________________

Think

Pink

6. __________________

Thick

Sick

7. __________________

Thief

Chief

8. __________________

Thumb

Gum

9. __________________

Thigh

Bye

10. __________________

Total Correct: ________ / ________ Comments:

164

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Thin

In

1. __________________

Thick

Ick

2. __________________

Thumb

Um

3. __________________

Thigh

I, eye

4. __________________

Thug

Ugh

5. __________________

Thor

Or

6. __________________

Thaw

Awe

7. __________________

Thought

Ought

8. __________________

Think

Ink

9. __________________

Theory

Eerie

10. __________________

Total Correct: ________ / ________ Comments:

165

166

The late eight

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Thin

1. __________________

Thumper

2. __________________

Thick

3. __________________

Thief

4. __________________

Thumb

5. __________________

Thank you

6. __________________

Thigh

7. __________________

Thunder

8. __________________

Thorn

9. __________________

Thumbtack

10. __________________

Total Correct: ________ / ________ Comments:

167

CHAPTER 7:  [T]

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note.  Replace * with the way the student used to say the sound. Word List:

Student Responses:

Thin

1. __________________

Thumper

2. __________________

Thick

3. __________________

Thief

4. __________________

Thumb

5. __________________

Thank you

6. __________________

Thigh

7. __________________

Thunder

8. __________________

Thorn

9. __________________

Thumbtack

10. __________________

Total Correct: ________ / ________ Comments:

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with * and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note.  Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Thin

1. __________________

Thumper

2. __________________

Thick

3. __________________

Thief

4. __________________

Thumb

5. __________________

Thank you

6. __________________

Thigh

7. __________________

Thunder

8. __________________

Thorn

9. __________________

Thumbtack

10. __________________

Total Correct: ________ / ________ Comments:

168

169

CHAPTER 7:  [T]

Complete Word List for [θ] Beginning of Words Single Consonants

Deletions

Minimal Pairs

Thin in chin, pin Thumper jumper, bumper Thick ick sick, kick, tick, pick, wick, lick Thief chief, beef, leaf Thumb um gum Thank you Thigh I, eye bye, high, pie, tie Thunder sunder Thorn corn, torn, horn, worn Thumbtack Thong long, song Thighbone my bone Thimble nimble, cymbal Thug ugh bug, hug Thelma Selma Thebes dweebs Thorny corny Thorax Borax Third bird, word, nerd, heard Thor or soar, core, shore, floor Thanks banks Thursday Third base Thirty dirty Thoreau Thaw awe paw, saw Things Thinnest Thought ought caught, bought Thousand Thirteen Third world Thermal Thirsty Thicket picket, wicket Think ink rink, wink, pink

170

Single Consonants

The late eight

Deletions

Minimal Pairs

Thermos Theme song Thebe dweeb Thoughtful Thatch batch, hatch Theory eerie dearie Thorough burrow Thirst burst, nursed Thistle missile Consonant Clusters

Deletions

Minimal Pairs

Three tree Throw row Thrill rill Throttle Thrift shop Thread read tread Throat wrote Threw rue true, crew Throw rug Thriller Throne roan grown, prone Thrifty Throwing rowing Threshold Throng wrong prong Thirsty Thrive Thrash rash crash, brash, lash Through rue grew, true, crew Thrush rush brush, crush Threat Thrust rust crust Throb rob

171

CHAPTER 7:  [T]

Medial Single Consonants Nothing Toothpick Author South Seas Martha Nathan Something Toothpaste Kathy Playthings Bathroom Athens Earthquake Toothless Carthage Athlete Bathmat Earthling Mouthwash Toothbrush Gothic Panther Python Fifth grade Playthings Without Bathtub Southpaw Toothache Mathew Consonant Clusters Heartthrob Fourth grade Monthly Jethro Swarthmore Darth Mal North Pole Darth Vader Bathrobe Bathroom

North Star Anthrax Cutthroat

All Environments Mouthwash Earthquake Athens Heartthrob Athlete Fourth grade Nothing North Star Toothless Darth Mal Something North Pole Panther Author Bathmat Jethro Cutthroat Monthly Bathroom Nathan Fifth grade Playthings Kathy Bathtub Toothpick South Seas Toothache Anthrax Darth Vader Gothic Python Carthage Mathew Martha Earthling Toothbrush Swarthmore Toothpaste Bathrobe

172

The late eight

Ends of Words Single Consonants

Deletions

Mammoth Bath baa Oath oh Dishcloth Ruth rue Teeth tea Babe Ruth Steam bath Macbeth Sith Goldsmith Sloth slaw Keith key Sweet tooth Bike path Swath Birdbath Tooth two Sleuth slew Math Phone booth Kenneth Plymouth Faith fey, Fay South sow Blacksmith Sheath she Path Faith Fay, fey Mouth Mao Cheesecloth Beth Breath Myth Broth braw Booth boo Death Wreath

173

CHAPTER 7:  [T]

Consonant Clusters

Deletions

Fourth four Fifth Sixth six Seventh seven Eighth eight Ninth nine Tenth ten Eleventh eleven Twelfth North nor Warmth warm

Themes for [θ] Themes Teeth Brushing Bath Time Star Wars Villains Around the Home It’s a Job Nature

Actions Numbers and Days Days of Christmas Directions People and Places

Teeth Brushing

Deletions

Toothache Toothless Teeth T, tea Mouth Mao Breath Thirst Sweet tooth Tooth two Toothbrush Thirsty Mouthwash Toothpick Toothpaste

Minimal Pairs

wreath, Keith burst, nursed

174

Bath Time

The late eight

Deletions

Minimal Pairs

Thumb gum Thigh I, eye bye, high, pie, tie Mouth Throat wrote Bathmat Bathtub Bathrobe Bathroom Bath baa Playthings Star Wars Villains Sith Darth Mal Darth Vader Throne Threat Around the Home

Deletions

Minimal Pairs

roan

grown, prone

Deletions

Minimal Pairs

Bathmat Bathtub Thermos Threshold Bathrobe Bathroom Thimble nimble, cymbal Throw rug Thumbtack Mouthwash Playthings Toothpick Broth bra Thread read tread Toothpaste Thong long, song

175

CHAPTER 7:  [T]

It’s a Job

Deletions

Minimal Pairs

Athlete Author Sleuth slew Blacksmith Cutthroat Thief Thug

chief, beef, leaf bug, hug

Nature

Minimal Pairs

Deletions

Path Thistle missile Thatch batch, hatch Thrush rush brush, crush Thicket picket Mammoth Sloth slaw Bike path Thaw awe saw, paw Panther Earthquake Python Thorny corny Thunder Thorn corn, torn, horn, worn Actions

Deletions

Minimal Pairs

Throwing rowing Thrive Think ink rink, wink, pink Thrash rash crash, brash, lash Threaten Thrust rust crust Throb rob Throw row crow, pro Threw rue true

176

Numbers and Days

The late eight

Deletions

Minimal Pairs

Three tree Fourth four Fourth grade Tenth ten Monthly Thursday Third bird, word, nerd, heard Third base Thirty dirty Thousand Sixth grade Fifth grade Thirteen Third world Days of Christmas

Deletions

Minimal Pairs

Third Fourth four Fifth Sixth six Seventh seven Eighth eight Ninth nine Tenth ten Eleventh eleven Twelfth

bird, word, nerd, heard

Directions

Minimal Pairs

Deletions

North nor South sow

177

CHAPTER 7:  [T]

People and Places

Deletions

Minimal Pairs

North Star Jethro Thumper jumper, bumper Swarthmore North Pole South Seas Faith fey, Fay Babe Ruth Ruth rue Thebe dweeb Mathew Thebes dweebs Beth Athens Nathan Kathy Carthage Martha Nathan Macbeth Goldsmith Keith Kenneth Plymouth Thelma Selma Thor or soar, core, shore, floor Thoreau

Chapter Eight

[ð] Definition

[ð] is made with the tongue tip between the upper and lower front teeth. The airstream is a continuous hiss between the upper tongue and the upper teeth. The vocal folds are together. The technical definition of [ð] is voiced interdental fricative.

Acquisition Fifty percent of children acquire [ð] by 4;6 and 75% of children acquire [ð] by 5;6.

Relative Frequency [ð] is ranked fourth in relative frequency compared with the other lateacquired consonants. It ranks eleventh in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 4.1%.

Errors [d] for [ð] is a common error. A less common error among school-aged students is [b] for [ð]. 179

180

The late eight

Key Environments Beginning of syllable and between vowels, as in weather Before a high front vowel, as in these

Possible Metaphors Select metaphors based on the aspect of speech that is the focus of therapy. Tongue placement: Tongue tip sound Fricative:

Leaky tire sound Long sound Hissing sound

Voicing:

Motor on Buzzing sound Voice box on sound



Touch Cue Finger in front of lips. Instructions Place the student’s finger in the middle of the front of the lips.

Initial Screening Test for [ð] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example:  “Dog. Now you say it.” Word Student* Beginning 1. This

_____________

2. Them

_____________

3. Then

_____________

4. The

_____________

Medial 5. Clothing

_____________

6. Weather

_____________

7. Father

_____________

8. Feather

_____________

Final 9. Breathe

_____________

10. Teethe

_____________

11. Sheathe

_____________

12. Soothe

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

181

Stimulability Tests for [ð] Student’s Name: Date: __________________ Referral: Imitation 1. the _____________ 2. mother _____________ Key Environments Between vowels 1. weather _____________ 2. either _____________ Before a high front vowel 1. these _____________ 2. this _____________ Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement _____________ 1. Demonstrate placing the tongue between the upper and lower teeth. 2. Instruct the student to put his or her hand in front of the mouth and blow through the teeth to feel the airflow with the voice box turned on. Shaping [ð] from [z] _____________ 1. Demonstrate the difference between the place of production for [z] and the place of production for [ð]. 2. Next, instruct the student to say [z] while moving his or her tongue to rest between his or her upper and lower teeth, resulting in [ð]. Notes/Comments:

182

183

CHAPTER 8:  [D]

Demonstrations for [ð] Place: Interdental First Method   Object:  Tongue depressor Instructions: 1. Instruct the student, “Please stick out your tongue.” 2. Once the tongue is out, gently close the student’s mouth. If the tongue is sticking out too far, gently push it back with a tongue depressor. Second Method   Objects:  Tongue depressor or stick of candy or other favored food. Instructions: 1. Place a tongue depressor or piece of food in front of the student’s mouth, about half an inch before the lips. 2. Instruct the student, “Please touch it with your tongue.” 3. While the student touches the tongue depressor or food with the tongue tip, gently close the student’s mouth. 4. Instruct the student, “Now pull your tongue back just a little until I say stop.”

Manner: Fricative First Method   Objects:  Strip of paper or a feather Instructions: 1. Place a strip of paper, a feather, or the student’s hand held in front of your mouth while you produce several long voiceless fricatives. 2. Draw attention to the “hissing” quality and continuous nature of the sounds.

184

The late eight

Second Method   Objects:  A small paper flower on end of a pencil Instructions:  Tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind. Third Method   Objects: None Instructions:  Run your finger or the student’s finger down the student’s arm while making several long voiceless fricatives to demonstrate the “hissing” quality and length of fricatives.

Voicing: Voiced First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and voiced [a]. Second Method   Objects: None Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects: None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, the student is asked to make [h] and [a].

CHAPTER 8:  [D]

185

Fourth Method   Objects: None Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off. Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a pair of voiced and voiceless oral stops, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

Phonetic Placement and Shaping Techniques for [ð] To facilitate [ð], follow the steps for [θ] but also use demonstrations to instruct the student to turn on the voice box.

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

186

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student: “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

That

1. __________________

This

2. __________________

Them

3. __________________

Then

4. __________________

The Hague

5. __________________

Their

6. __________________

Those

7. __________________

These

8. __________________

They

9. __________________

There

10. __________________

Total Correct: ________ / ________ Comments:

187

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:

They

hay

1. __________________

Than

can

2. __________________

Though

toe

3. __________________

Their

bear

4. __________________

Those

nose

5. __________________

These

bees

6. __________________

There

bear

7. __________________

That

sat

8. __________________

Then

Ben

9. __________________

They

bay

10. __________________

Total Correct: ________ / ________ Comments:

188

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

They

A

1. __________________

Than

Ann

2. __________________

Though

O

3. __________________

Their

air

4. __________________

Those

Os

5. __________________

These

ease

6. __________________

There

air

7. __________________

That

at

8. __________________

Then

N

9. __________________

They

A

10. __________________

Total Correct: ________ / ________ Comments:

189

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

That

1. __________________

This

2. __________________

Them

3. __________________

Then

4. __________________

The Hague

5. __________________

Their

6. __________________

Those

7. __________________

These

8. __________________

They

9. __________________

There

10. __________________

Total Correct: ________ / ________ Comments:

190

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note:  Replace * with the way the student used to say the sound. Word List:

Student Responses:

That

1. __________________

This

2. __________________

Them

3. __________________

Then

4. __________________

The Hague

5. __________________

Their

6. __________________

Those

7. __________________

These

8. __________________

They

9. __________________

There

10. __________________

Total Correct: ________ / ________ Comments:

191

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with _____*, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note:  Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

That

1. __________________

This

2. __________________

Them

3. __________________

Then

4. __________________

The Hague

5. __________________

Their

6. __________________

Those

7. __________________

These

8. __________________

They

9. __________________

There

10. __________________

Total Correct: ________ / ________ Comments:

192

193

CHAPTER 8:  [D]

Complete Word List for [ð] Beginning of Words Single Consonants

Deletions

Minimal Pairs

That at sat, mat, cat, fat, bat This kiss, hiss Them M REM Then N Ben, hen, pen, men The Hague Their air bear, share, care, fair Those Os nose, toes, bows These ease bees, cheese, knees They A hay, bay, say, day, gray There air bear, share, care, fair The a Than Ann can, man, fan, ran Though O, oh toe, bow, go, show, no

Medial Single Consonants Clothing Slither Northern Weather Mother Earthquake Father Leather Brother Heather Breathing Bathrobe Teething Arthur Bathing Bather Feather Smoothest Consonant Clusters — 

194

The late eight

End of Words Single Consonants

Deletions

Breathe Bree Teethe Tea Sheathe She Soothe Sue Bathe Bay Unsheathe Smooth Clothe Scythe Sun bathe

Themes for [ð] Themes Nature People and Places Bath Time

The Body Grammatical Words Family

Nature

Deletions

Earthquake Slither Sun bathe Leather Weather Feather Heather Northern People and Places

Deletions

The Hague Arthur Heather

Minimal Pairs

feather, weather, heather feather, leather weather, heather, leather feather, weather, leather

Minimal Pairs

feather, weather, leather

195

CHAPTER 8:  [D]

Bath Time

Deletions

Minimal Pairs

Bather Bay Bathing Bathrobe Clothe Clothing Bather Bayer The Body

Deletions

Minimal Pairs

Breathe Bree Breathing Teethe T, tea Teething Grammatical Words

Deletions

Minimal Pairs

That At This Them M Then N Their Air Those These Ease They A The a Than Ann Though O, oh

sat, mat, cat, fat, bat kiss, hiss

Family

Minimal Pairs

Deletions

Ben, hen, pen, men bear, air, share, care, fair nose, toes, bows bees, cheese, knees hay, bay, say, day, gray can, man, fan, ran toe, bow, go, show, no

Brother mother, other Father brother Mother other, mother

Chapter Nine

[s] Definition

[s] is made in either of two ways. Some people produce [s] with the tongue tip up behind the upper front teeth, others say [s] with the tongue tip down behind the lower front teeth. Neither one is the “right way.” Follow the student’s lead in deciding which way to teach [s]. If a student appears to find it easier to say [s] with the tongue tip up, teach the sound that way; if the student appears to find it easier to say [s] with the tongue tip down, teach the sound that way. For both varieties of [s], the airstream is continuous and the vocal folds are apart. The technical definition of [s] is voiceless alveolar fricative.

Acquisition Fifty percent of children acquire [s] by 3;6 and 75% of children acquire [s] by 6;0.

Relative Frequency [s] is ranked first in relative frequency compared with the other lateacquired consonants. It ranks 3rd in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 7.1%.

197

198

The late eight

Errors A common error for [s] is lisping. During lisping, [s] is pronounced with the tongue tip between the teeth, as for [θ]. Another common error for [s] is using the tongue blade instead of the tongue tip, which is sometimes called bladed [s]. A third common error is lateralizing, in which instead of air flowing over the top of the tongue, it flows over the sides of the tongue, as for an [l].

Key Environments End of syllables, as in bus Next to [t], as in steep, pizza, beats Next to high front vowels, as in see

Possible Metaphors Select metaphors based on the aspect of speech that is the focus of therapy.

Tongue placement: Tongue tip sound Bump sound (tongue tip up) Little hill sound (tongue tip up) Lower teeth sound (tongue tip down) Fricative:

Snake sound Long sound Hissing sound

Voicing:

Motor off Voice off Not a buzzing sound Voice box off



Touch Cue Finger on the corner of the mouth (finger up for tongue tip raised sound or finger down for tongue tip down sound). Instructions Place the student’s finger in the corner of the lips, and remind the student to keep upper and lower teeth close together.

Initial Screening Test for [s] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example:  “Dog. Now you say it.” Word Student* Word

Student*

Beginning 1. Soap

_____________

6. Skirt

_____________

2. Sew

_____________

7. Smell

_____________

3. Sun

_____________

8. Slap

_____________

4. Sting

_____________

9. Strap

_____________

5. Spicy

_____________

Medial 10. Acid

_____________

11. Messy

_____________

12. Icing

_____________

Final 13. Dice

_____________

17. Husk

_____________

14. Moose

_____________

18. Toast

_____________

15. House

_____________

19. Fierce

_____________

16. Wasp

_____________

20. Wince

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

199

Stimulability Tests for [s] Student’s Name: Date: __________________ Referral: Imitation 1. sun _____________ 2. bus

_____________

Key Environments End of a syllable or word 1. kiss

_____________

2. [is] _____________ Before a high front vowel 1. See _____________ 2. Seat _____________ After [t] and before [i] 1. [tsi] _____________ 2. pizza _____________ After a [t] occurring in the same syllable 1. beats

_____________

2. [its] _____________ Favorite Words Names of family members:  Favorite people, heroes, and activities: 

200

Phonetic Placement _____________ 1. Place a tongue depressor just behind the student’s upper or lower front teeth, depending on which variety of [s] is being taught, and ask him or her to use the tongue tip to hold it there. 2. Next, ask the student to keep the tongue tip still while you carefully remove the tongue depressor. 3. Ask the student to breathe out, resulting in [s]. Shaping [s] from [θ] _____________ 1. Ask the student to place the tongue tip between the front teeth and then gently close the teeth together. 2. Ask the student to draw back the tongue tip behind the teeth. If needed, gently push the tongue tip inward with a tongue depressor. 3. Ask the student to either raise or lower the tongue tip slightly, depending on which type of [s] is being taught, and to blow air out through the mouth, resulting in [s]. Notes/Comments:

201

202

The late eight

Demonstrations for [s] Place: Alveolar First Method   Objects: None Instructions: 1. Instruct the student, “Please stick out your tongue.” 2. Once the tongue is out, for [s] with the tongue tip raised ask the student to pull the tongue back to feel the bump on the roof of the mouth behind the two front teeth. For [s] with the tongue tip down, ask the student to pull the tongue back to feel the little bump behind the two lower teeth. Second Method   Objects:  Q-tip and peanut butter or other favored food Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food on the alveolar ridge (for tongue tip raised [s]) or behind lower front teeth (for tongue tip lowered [s]). 3. Ask the student to touch the food with the tongue tip.

Manner: Fricative First Method   Object:  Strip of paper or a feather Instructions: 1. Place a strip of paper, a feather, or the student’s hand held in front of your mouth while you produce several long voiceless fricatives. 2. Draw attention to the “hissing” quality and continuous nature of the sounds.

203

CHAPTER 9:  [s]

Second Method   Objects:  A small paper flower on the end of a pencil Instructions:  Tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind. Third Method   Objects: None Instructions:  Run your finger or the student’s finger down the student’s arm while making several long voiceless fricatives to demonstrate the “hissing” quality and length of fricatives.

Voicing: Voiceless First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and a voiced [a]. Second Method   Objects: None Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects: None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, ask the student to make [h] and [a].

204

The late eight

Fourth Method   Objects: None Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off. Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a voiced and voiceless oral stop, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

205

CHAPTER 9:  [s]

Phonetic Placement and Shaping Techniques for [s] Phonetic Placement Techniques A key to making [s] is correct tongue tip placement. To make [s] the tongue tip is behind either the upper or lower front teeth, the upper and lower teeth are relatively close, and a narrow stream of air hisses between the tongue tip and the teeth. Once this is achieved, the hiss of air is achieved simply by breathing out, and getting the jaw relatively closed so the upper and lower teeth nearly touch is usually achieved with a few simple instructions. All the following phonetic placement techniques focus on placing the tongue tip for [s]. The first two methods are used either for [s] with the tongue tip raised or lowered, the third and fourth are for [s] with the tongue tip raised, and the fifth is for [s] with the tongue tip lowered. First Method (tongue tip up or down)   This method and the following method work whether the tongue tip is up or down. Objects: None Instructions: 1. Ask the student to place the tongue tip behind either the upper or lower front teeth and then to pull the tongue back a little bit. 2. Close the student’s teeth so the teeth barely touch. 3. Place your finger in front of the center of the student’s mouth, and say, “Breathe slowly over your tongue toward my finger.” The sound produced by the student when breathing out approximates [s]. Second Method (tongue tip up or down)   Object:  Tongue depressor (or Q-tip) Instructions: 1. Place a tongue depressor just behind the student’s upper or lower front teeth and ask the student to use the tongue tip to hold it there. 2. Ask the student to keep the tongue still while you carefully remove the tongue depressor. 3. Ask the student to breathe out, resulting in [s].

206

The late eight

Third Method (tongue tip up)   This method is a little more involved than the previous two. It is useful for a student who really doesn’t seem to “get” the idea that the tongue tip must be raised. Object:  Tongue depressor Instructions: 1. Make a shelf by placing a tongue depressor against the lower edges of the student’s upper teeth. 2. Next, ask the student to place the tongue on the shelf. If needed, place a tongue depressor under the student’s tongue tip to bring the “elevator up” so that the tongue depressor touches the lower front teeth. 3. Ask the student to breathe out through the mouth. The resulting sound approximates [s]. Fourth Method (tongue tip up)   This somewhat involved method is for a student whose difficulty is raising the tongue and who may also experience difficulty grooving the tongue. Differing from previous methods, this one utilizes the fact that the sides of the tongue touch the inside of the teeth when making an [s]. Some children find “anchoring” the tongue sides to the teeth a helpful strategy when attempting to raise the tongue tip for [s]. Object:  Drinking straw Instructions: 1. Ask the student to raise his or her tongue so that the sides are firmly in contact with the inner surface of the upper back teeth. (An alternative method is to instruct the student to stick out the tongue slightly, lower the upper teeth to come into contact with the sides of the tongue, and then pull the tongue inside the mouth.) 2. Ask the student to groove the tongue slightly along the midline. (If needed, ask the student to protrude the tongue and place a clean object such as a drinking straw along the midline of the tongue. Then ask the student to raise the sides of the tongue slightly around the straw.) 3. Carefully withdraw the straw. 4. Ask the student to place the tongue tip about a quarter of an inch behind the upper teeth and then ask the student to bring the teeth together.

207

CHAPTER 9:  [s]

5. Instruct the student to blow air along the groove of the tongue toward the lower teeth. If the student has difficulty directing the air along the tongue groove, insert a drinking straw into the student’s mouth and instruct the student to blow through the straw, which often results in [s]. Fifth Method (tongue tip down)   This method works surprisingly well with some students. It can be tried for [s] with the tongue tip raised, though my clinical experience is that it is usually more effective for the tongue tip-lowered variety of [s]. Objects: None Instructions: 1. Ask the student to brush his or her lower gums with the tongue while attempting to say [s]. 2. Ask the student to stop moving the tongue and to bring the upper and lower teeth close together, but not touching. 3. Instruct the student to breathe out through the mouth, resulting in [s].

Shaping Techniques [s] from [z]   If a student can make a [z], he or she can usually be taught to make an [s] fairly easily. Objects: None Instructions: Instruct the student to say [z] and then to turn off the voice box. For some students, this is sufficient to result in [s]. (Note: To facilitate [z], instruct the student to turn on the voice box while saying [s].) [s] from [θ]   This method works well either for a student who lisps or for one who otherwise has a well-established interdental consonant.

208

The late eight

Object:  Tongue depressor Instructions: 1. Instruct the student to protrude the tongue between the teeth and to say [θ]. 2. As the student says [θ], instruct him or her to bring the tongue back into the mouth and behind the upper or lower front teeth, depending on which variety of [s] is being facilitated. An alternative method is to ask the student to scrape the tongue tip back along the back of the front teeth. (If needed, the tip of the student’s tongue can be pushed inward with a tongue depressor.) 3. Next, ask the student to either raise or lower the tongue tip slightly, depending on which type of [s] is being taught. 4. Ask the student to blow air through the mouth. The sound produced approximates [s]. (Note: To facilitate [z], develop from [ð].) [s] from [ls]   These four methods help a student to convert a lateral [s] into [s]. First Method (tongue tip raised) The following description of the useful butterfly technique is a condensed version of a Web page provided by Caroline Bowen at: http://members.tripod​ .com/CarolineBowen/fsd-butterfly-procedure.htm. The technique can be applied to lateral or palatal alveolar fricatives and requires a student to be able to pronounce a correct [t] and [d]. Objects: None Instructions: 1. Talk about the “butterfly position” for the tongue, or the position the tongue is in when you prolong the i in pip or the ee in peep. Point out to the student that the lateral margins of the tongue are in contact with the teeth: like a butterfly with its wings up. Older students sometimes like and are amused by the imagery of a butterfly assuming the “bracing position.” 2. Draw the student’s attention to the way the tongue edges (wings) press quite firmly on their teeth. You might mention that “floppy edges” or “floppy wings” let the air out sideways, while “strong edges” or “strong

CHAPTER 9:  [s]

209

wings” do not. Help the student imagine the midline of the tongue as the butterfly’s body, visualizing the groove that forms along its center. 3. Tell the student the groove is there for her/him to “shoot” the air down, straight out in front. It is there specially to guide the air in the right direction for a super sounding ess. Use your hands to convey the idea of “wings up,” “wings firmly tucked in against the teeth,” and language such as, “a nice little groove where the butterfly’s body sits,” and a “straight shot” of air. Employ imagery to talk about “shooting straight” and “shooting sideways.” 4. Next, model [t] and have the student imitate your production. Do the same with [t-t], then [t-t-t] and then [t-t-t-t]. If the student is producing a schwa or other vowel between the consonants, eliminate it if possible. Aim for a “pure” sounding sequence of consonants. If the student needs a vowel to get from one [t] to the next, use i as in pip (ti- ti- ti-) or ee as in peep (tee- tee- tee-). Some clinicians prefer ee because it creates a firmer “seal” between the tongue margins and the teeth, and, potentially anyway, this discourages lateral airflow. 5. Increase the rate at which the student repeats [t-t-t-t]. Notice the subtle [s] that starts occurring between the t’s. Point this out to the student in your speech and in his/her speech. The sequence is now starting to sound like [ts-ts-ts-ts]. 6. The student will probably be unaware at this stage that the little “underarticulated” [s] is there. In this step, tell the student to produce the [t] and to let a little air come out at the end of the sound. Demonstrate what you mean, without actually instructing the student to produce “t and then s.” Just emphasize that you want to have “air happening” after the [t]. Gradually “sharpen” the [ts] thus produced, so that it becomes obvious that there are two sounds, [t] and [s], being articulated clearly. Once it’s perfect, have the student practice saying [ts] until he or she can do it very easily. It is a good idea to stay on this level for several days. 7. Now put the [ts] combination into real words. Again using the vowels ee as in feet or i as in fit to facilitate correct placement, present the student with a practice list. For example, “He eats meat, she eats candy, it eats grain,” and so forth; or, “It’s a boy, it’s a man, it’s a cow,” and so forth or, “It’s good, it’s bad, it’s tall,” etc. In making up the phrases or sentences, do not include other words containing [s] or [z]. This means don’t have items such as, “He eats pasta” or “It’s a zoo” or “It’s silly.” Once [ts] is established in words, practice [ts] in simple sentences that do not contain other s-words. 8. When the [s] the student is producing sounds clear and “adultlike,” it is ready to separate from the [t]. Without mentioning the tongue too often, instruct the student to say [ts] without moving the tongue, and then add an ess, like this: [ts-s]. This may be difficult for the student at first, so take it slowly and quietly and give plenty of support and encouragement. 9. Next, instruct the student to make the [ts] silent, resulting in [s].

210

The late eight

Second Method (tongue tip raised or lowered) Object:  Drinking straw Instructions: 1. Demonstrate air flowing through a straw protruding from the side of the mouth when a lateral [s] is made and air flowing through a straw placed in the front of the mouth when a correct [s] is made. 2. Encourage the student to close the teeth and to direct the airflow through a straw placed in front of the mouth. This typically results in [s]. (Note: To facilitate [z], develop from lateral [z].) Third Method (tongue tip raised or lowered) Objects:  Q-tip and picture of a small circle on a piece of paper Instructions: 1. Instruct the student to produce a lateral [s] ([ls]). 2. Draw imaginary circles with a Q-tip where the groove should occur in the center of the tongue to indicate to the student where the air should flow during [s]. 3. Next, draw a small circle on a piece of paper and hold it in front of the student’s mouth at the point where air should be emitted if the air flows over the top of the tongue. 4. Instruct the student to direct the air through the circle while saying [s]. An alternative method is to instruct the student to use the fingers instead of paper. If the student’s fingers are used, the sensation of air is felt more keenly if the fingers are wet. (Note: To facilitate [z], develop from lateral [z].) Fourth Method (tongue tip raised or lowered) Objects: None Instructions: 1. Ask the student to gently bite the sides of the tongue, drop the tongue tip, and put it behind the front teeth. 2. Ask the student to smile and blow air out the front of the mouth, resulting in [s].

CHAPTER 9:  [s]

211

[s] from [t]   These methods rely on the fact that [t] and [s] are made in the same place of production. It is extremely helpful for the many students who have a wellestablished [t]. A limitation on its utility is that it requires the student to follow steps which some students find challenging. First Method Objects: None Instructions: 1. Instruct the student to say [t] in tea with strong aspiration. If said quickly and forcefully, [tsi] results. An alternative to this procedure is to ask the student to say [tsi] instead of tea. 2. Instruct the student to say [tsi] without the vowel, resulting in [ts]. 3. Ask the student to prolong the [s] portion of [ts], resulting in tsss. 4. Ask the student to make [t] silent, resulting in [s]. Second Method Objects: None Instructions: 1. Ask the student to open the mouth and to put the tongue in position for [t]. 2. Instruct the student to lower the tongue slightly and to send the air over the tongue. 3. Place the student’s finger in front of the mouth to feel the emission of air, which typically results in [s]. Third Method This is a clever variation of the [s] from [t] method that was developed by Gillian Fleming of Dunedin, New Zealand, who kindly consented to let it be placed in this book. It works especially well for establishing [s] at the end of words. Gillian writes, “I feel that by the time a child reaches school age, he/ she is very aware of the [s] sound. People have been trying to correct it for ages, saying things like, ‘Put your tongue in’ or ‘It’s not [θ], it’s [s]’ and other

212

The late eight

unhelpful comments. Children are programmed to use their lateral sound or their lisp as soon as they see or think about [s]. So, when they first present for therapy, I tell them we are not going to work on [s] — we are going to work on making good clear [t] sounds.” Objects: None Instructions: 1. Instruct the student to place the tongue tip on the ridge behind the top teeth, resulting in a series of short [t] sounds (t — t — t — t — t). 2. Next, instruct the student to make [t] a little longer (ttt ttt ttt). 3. Next, make [t] a little longer still (ttttttt — tttttttt — ttttttt). 4. Lastly, put the long ttttttt on the end of a word (catttt — big cattttt — fluffy cattttt — etc.), resulting in word final [ts]. 5. Once clear [s] is established, practice final [ts] in other words (bats, boats, kites, etc.). 6. When the clinician believes the time is right, point out that the student is now making a correct [s] sound. [s] from [ ʃ ]   As this method attests, sometimes the only thing that is needed to succeed is a good smile. Retracting the lips to smile pulls the tongue forward into an [s]. Objects: None Instructions: 1. Ask the student to say [ ʃ ]. 2. Ask the student to retract the lips into a smile. Often, this moves the tongue forward slightly into the position for [s]. If needed, however, ask the student to move the tongue slightly forward, resulting in [s]. (Note: To facilitate [z], develop from [ Z ] or instruct the student to turn on the voice box.) [s] from [f] This method, like the one above, converts one fricative into another. The difference is that it approaches [s] from an anterior position rather than a posterior one. I have found it a little less successful than the previous method. Objects: None

CHAPTER 9:  [s]

213

Instructions: 1. Ask the student to lift the tongue tip slowly while making a prolonged [f]. 2. Ask the student to bring the front teeth close together but not quite touching. If needed, gently pull out the student’s lower lip slightly. 3. Ask the student to smile while making the sound, which often results in [s]. (Note: To facilitate [z], develop from [v] or use [s] and instruct the student to turn on his or her voice box.) [s] from [i] Admittedly, this and the method that follows are a somewhat far stretch. This method relies on the similarity in the place of production of [i] and [s], and the following method relies on similarity in the frication created by [s] and [h]. Neither would be my first choice for a method to remediate [s], but each has a place in the clinical repertoire. Objects: None Instructions: 1. Instruct the student to say [i]. 2. Ask the student to turn off the voice box and gradually close the teeth until [s] results (Note: To facilitate [z], instruct the student to keep the voice box on.) [s] from [h] Objects: None Instructions: 1. Ask the student to gradually close the teeth while saying [h]. 2. Ask the student to raise the tongue tip gradually while producing a prolonged [h] until the resulting sound is [s]. (Note: To facilitate [z], instruct the student to turn on the voice box.)

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

214

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student: “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Sat

1. __________________

Salmon

2. __________________

Sail

3. __________________

Salad

4. __________________

Sailboat

5. __________________

Socks

6. __________________

Soap

7. __________________

Sew

8. __________________

Sun

9. __________________

Sally

10. ________________

Total Correct: ________ / ________ Comments:

215

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:

Sink

think

1. __________________

Ceiling

peeling

2. __________________

Sip

whip

3. __________________

Soak

poke

4. __________________

Sea

me

5. __________________

Son

fun

6. __________________

Sad

mad

7. __________________

Sack

back

8. __________________

Sun

fun

9. __________________

Sick

tick

10. ________________

Total Correct: ________ / ________ Comments:

216

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Sat

at

1. __________________

Sail

ale, ail

2. __________________

Sew

O, oh

3. __________________

Sally

alley

4. __________________

Silk

ilk

5. __________________

Seagull

eagle

6. __________________

Sick

ick

7. __________________

Sole

ole

8. __________________

Sink

ink

9. __________________

Sea

E

10. ________________

Total Correct: ________ / ________ Comments:

217

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Sat

1. __________________

Salmon

2. __________________

Sail

3. __________________

Salad

4. __________________

Sailboat

5. __________________

Socks

6. __________________

Soap

7. __________________

Sew

8. __________________

Sun

9. __________________

Sally

10. ________________

Total Correct: ________ / ________ Comments:

218

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note.  Replace * with the way the student used to say the sound. Word List:

Student Responses:

Sat

1. __________________

Salmon

2. __________________

Sail

3. __________________

Salad

4. __________________

Sailboat

5. __________________

Socks

6. __________________

Soap

7. __________________

Sew

8. __________________

Sun

9. __________________

Sally

10. ________________

Total Correct: ________ / ________ Comments:

219

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with _____*, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note:  Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Sat

1. __________________

Salmon

2. __________________

Sail

3. __________________

Salad

4. __________________

Sailboat

5. __________________

Socks

6. __________________

Soap

7. __________________

Sew

8. __________________

Sun

9. __________________

Sally

10. ________________

Total Correct: ________ / ________ Comments:

220

221

CHAPTER 9:  [s]

Complete Word List for [s] Beginning of Words Single Consonants

Deletions

Minimal Pairs

Sat Salmon Sail

at

bat, mat, hat, cat, rat, pat

ale, ail  tail, pail, nail, veil, rail,   whale, mail, jail ballad

Salad Sailboat Socks fox, rocks, box Soap rope Sew O, oh  toe, row, hoe, no, bow,   mow, go Sun fun, run, one, bun, gun Sally alley tally Silk ilk Seagull eagle Sick Ick Sole ole mole, goal, hole Saber Sink Ink think, pink, rink, wink Surgeon Sea E me, bee, key, knee, pea Cellar teller Sioux oo dew, coo Saddle addle paddle Surfboard Sailboat Son fun, run, bun, gun, one Sidewalk Sand and band, fanned, tanned, hand Surfer Sunrise Sad add mad, bad, dad Sundae fun day Sydney kidney Sunday fun day Sunburn Susan Cycle Michael

222

Single Consonants

The late eight

Deletions

Minimal Pairs

Circle Sit it hit, mit, kit, knit, bit Soldier Sam am ham, lamb Salesclerk Six wicks, mix Seaweed Suit cute, hoot, boot Cindy Indy windy Soar or, oar four, more, tore, bore, core Ceiling peeling, reeling, kneeling Sub hub, cub Sunlight Saint ain’t paint, faint Subway Seal eel Neil, heel Cement Sour hour tower, shower, cower Sunny honey, money, funny,  bunny Suck uck buck, luck, shuck, muck City kitty, witty Soup loop, poop Salt ought malt Sign nine, fine, shine Sandal handle Sid id hid, kid, bid, lid Song thong, long Sank rank, lank, bank Suds duds, cuds Soak oak poke, choke, yolk, joke,  woke Serve Merv, curve Sound round, pound Sue ooh boo, who, due Soot foot Sing wing, thing, king, ring Sip whip, rip, lip, hip, dip Cell L fell, dell, Mel Sack back, rack, hack, pack, tack Surf turf Soil oil boil, coil Sock lock, mock

223

CHAPTER 9:  [s]

Consonant Clusters

Deletions

[sp] Spot pot Spell Spicy Spout pout Spanish Space pace Spill pill Spit pit Spokes pokes Spider Sponge Spear peer Spark park Spank Spoon Spareribs Spin pin Spy pie Spade paid Spooky Pooky Spy pie Spaceship Spike pike Spirit Speak peak Special Spear peer Speed peed [st] Stop top Sting ting Stoplight Stink Story Tory Stack tack Stork torque Stagecoach Steak take Stick tick

224

Consonant Clusters

The late eight

Deletions

Storm Stairs tears Stone Age Stalk talk Stool tool Stallion Staff Steam team Steal teal Starfish Stamp Stale tale, tail Stock car Stand Stub tub Star tar Stew two Staff Stag Stake take Standard Statue Steady Teddy [sk] School cool Ski key, C Skin kin Scale kale Skinny Skirt Kurt Skier Scarf School bus cool bus Scar car Skate Kate Scotland Skunk Skip Kip Sky Skillful

225

CHAPTER 9:  [s]

Consonant Clusters

Deletions

Sketch Skew Q Skim Kim Skull cull Skid kid Skill kill [sf] Sphinx finks Sphere ear Sphincter [sl] Slip lip Sleigh lay Slide lied Sleep leap Sled dog Slug lug Sling Sled led Slimy limey Sleepy Sleeve leave Slippers Sliver liver Slime lime Sloth Slab lab Slang Slick lick Slump lump Slow low Slash lash Slink link Slate late Slave Slop Slay lay Sleek leak

226

Consonant Clusters

The late eight

Deletions

[sw] Swing wing Swimmer Sweater wetter Sweatshirt Sweet tooth Sweat wet Swiss Sweet wheat Switch witch Swamp Swim whim Swan wan Swelter welter Swerve Swear wear Sweden Swat watt Sweep weep Sway way Swap Swallow wallow Swarm warm Swift wift [sm] Small mall Smell Mel Smile mile Smelly Smog Smoke Smack Mack Smoky Smooth Smallest Smock mock Smart mart Smoky Smash mash

227

CHAPTER 9:  [s]

Consonant Clusters

Deletions

Smother mother Smudge Smite mite [sn] Snack knack Snail nail Snout Snorkel Snap nap Snake bite Snow no, know Snarl gnarl Snack bar Snow bank no bank Snow White no white Sneakers Snoopy Snake Sneeze knees Snore nor Sneer near Snug Sniff Snippy nippy Sniffle Snub nub Sneak Snatch Snob knob Snort [spr] Spring Spray pray Sprite (soda) Sprinkle Spry pry Spray gun Sprint print Sprinkles

228

Consonant Clusters

The late eight

Deletions

Springboard Sprinkling Springtime Sprain Spread Sprig prig Spree Spruce Sprout [str] Struck truck Strum Strike out Strong Stroller troller Street treat Stranger Straw Stronghold Stripe tripe String Strike zone Streetcar Stream Strap trap Strike trike Stretcher Strict tricked Stroke Struggle Strum Strut [skr] Screen Scribble Scream cream Scratch Scrapper

229

CHAPTER 9:  [s]

Consonant Clusters

Deletions

Scrooge Screenplay Scrub Screw crew Screen Script crypt Scramble Scribe Scrap crap Scroll Scrimp crimp Scrabble Screech [skw] Square Squash Squeal keel Squeak Squad quad Squirt Squaw Squalid Squirm Squeeze Squall Squint Squadron [spl] Splashdown Splinter Split Splash Splint Spleen Splat Splice Splurge

230

[s] + Stops [p t k]

The late eight

Deletions

Sting ting Spicy Skirt Kurt Steak take Spanish Staff Skull cull Steady Teddy Skinny Spill pill Spider Sponge Sketch Skew Q Skim Kim Spear peer Scotland Spark park Skid kid Spareribs Steal teal Spin pin Staff Spy pie Skill kill Spade paid Stoplight top light Spooky Pooky Spy lie Stone Age Stallion Starfish Spaceship Stop top Spot pot Stag Stake take Spit pit Story Tory Spirit Stack tack

231

CHAPTER 9:  [s]

[s] + Stops [p t k]

Deletions

Spoon Stork Stagecoach Space pace Stick tick Storm Stairs tears Spank Stalk talk Sky Stool tool Special Skip Kip Stamp Spike pike Speed peed Stock car Spokes pokes Stand Stub tub Star tar Stew two School cool Standard Ski key Speak peak Skin kin Spout pout Scale kale Spell Skier Scarf Spear peer School bus cool bus Stink Scar car Steam team Skate Kate Statue Skunk Stale tale, tail

232

[s] + Nasals [m n]

The late eight

Deletions

Small mall Snarl gnarl Sneeze knees Smell Snail nail Smock mock Sneer near Snort Smile mile Snoopy Smog Snow White no white Smoke Snug Snob knob Smart mart Smite mite Snack bar Smooth Snoopy Smoky Smudge Snake Smallest Snack knack Snub nub Sneak Smother mother Snout Smack Mack Snorkel Snap nap Smash mash Snake bite Smelly Snow no, know Smoky Sniff Snippy nippy Sniffle Snatch Snow bank no bank Sneakers Snore nor

233

CHAPTER 9:  [s]

[s] + Two Consonants

Deletions

Squeal keel Strike trike Stretcher Screw crew Spread Squeak Spray pray Squalid Strap trap Screen Screech Sprinkle Sprinkles Scrimp crimp Scrabble Street treat Squash Squirm Sprinkling Struck truck Script crypt Scramble Scribe Sprain Squint Squadron Strum Squall Splash Strike out Squeeze Springtime Scrap crap Scroll Strong Spray gun Strict tricked Stroke Spruce Stroller Splint Scream cream Stranger Sprig prig

234

[s] + Two Consonants

The late eight

Deletions

Straw Sprint print Stronghold Squad quad Spree Stripe tripe Split String Strike zone Squash Struggle Strum Scrooge Streetcar Square Scrapper Splurge Squirt Stream Splashdown Spring Sprite (soda) Strut Splinter Screen Spruce Sprout Scribble Splat Splice Scratch Screenplay Scrub Spleen Squeak Springboard Squaw

235

CHAPTER 9:  [s]

Medial Single Consonants Icy Racer Jason Dress up Russell Glasses Muscle Castle Lucy Acid Fossil Mossy Messy Grassy Posse Icing Brussels Peso Possum Bossy Kissing Bison Tracy Bessie Lassie Racing Casey Faucet Listen Tracing Dissect Tucson Consonant Clusters Hopscotch Shoe store Einstein Ice skate Explore Casper Crystal Pretzel Hairspray Oscar Eskimo Bus stop Costume Shakespeare Explode Expressway Dog sled Pizza Diskette Cub Scout Asleep Ski slope Basking Baseman Basement Shoestring Whisker Whisper Postman Hot spring Sixty Locksmith Houston Chopsticks Escape Casket Teaspoon Betsy Bracelet All Environments Shakespeare Dissect Costume Icy Asleep Tucson Dress up Racer Diskette Sixty Postman Ski slope Dog sled Russell Basement Muscle Castle Whisker Teaspoon Betsy Jason

236

The late eight

All Environments Explore Hairspray Pizza Acid Fossil Glasses Basking Escape Hopscotch Messy Grassy Lucy Cub Scout Casper Mossy Pretzel Bracelet Ice skate Icing Brussels Posse Shoe store Einstein Houston Possum Locksmith Baseman Chopsticks Bossy Peso Oscar Whisper Kissing Bison Expressway Crystal Hot springs Shoestring Bessie Lassie Tracy Bus stop Eskimo Explode Casey Faucet Racing Tracing Casket Listen

End of Words Single Consonants

Deletions

Toss White house Dice die Goose goo Moose moo Courthouse Ice eye, I Noose new Nervous Famous Trace tray Gas Red Cross Race ray Lighthouse Glass Fireplace Mace May Janis

237

CHAPTER 9:  [s]

Single Consonants

Deletions

Greece Kansas Bruce brew Porpoise Press Grass Police Gross grow Palace Grease Air base Lewis Louie Cross Mattress Paris Pass Geese Gee Necklace Carlos Carlo Rice rye Dress Alice alley Blouse Yes Mouse Mao Bus Briefcase Chris Kiss Congress Class Vase Face Fay, fey Bernice Ace A Hiss Horse Mice my Bus Boss Moss

238

Consonant Clusters

The late eight

Deletions

[sp] Wasp Lisp lip Grasp Crisp Gasp gap [st] Waist wait Chest Chet Frost fraught Signpost Fast fat Midwest Crust Rust rut Artist Post Fist fit Breakfast Mist mitt August Feast feet Toast tote Twist twit Chemist Most moat Nest net Forest Gust gut Signpost Toothpaste West wet Typist Vest vet Conquest Priest August Gymnast Ghost goat Wrist writ Last Slowest

239

CHAPTER 9:  [s]

Consonant Clusters

Deletions

Key West Lost East eat [sk] Desk deck Mask Mack Disk Dick Corn husk Tusk tuck Mollusk Gas mask Husk Huck Ask School desk Face mask Whisk wick Task tack Mosque mock [sl] Missile Axle Fossil Muscle Wrestle [ls] Convulse Pulse Paul [ns] Fence fen Dance Dan Defense Florence Wince win Immense

240

Consonant Clusters

The late eight

Deletions

France Fran Balance Science Pounce Tense ten Prince Bounce License Rinse Lance Entrance [rs] Force four Divorce Pierce peer Golf course Fierce fear Hoarse whore Horse whore Air Force Sawhorse [ks] Ax Alex Fox Smallpox Comics comic Larynx Phoenix Mailbox Box Bach Tax tack [s] + Consonant Fast fat Wasp Waist wait

241

CHAPTER 9:  [s]

Consonant Clusters

Deletions

Mosque mock Chest Chet Frost fraught Signpost Midwest Crust Lisp lip Rust rut Artist Gasp gap Fist fit Crisp Breakfast Mist mitt School desk August Feast feet Facemask Husk Huck Toast tote Twist twit Mollusk Chemist Most moat Gas mask Nest net Forest Wrestle Gust gut Signpost Toothpaste West wet Corn husk Typist Fossil Tusk Frost Vest Conquest Priest Muscle Gymnast

242

Consonant Clusters

The late eight

Deletions

Wrist writ Last Grasp Slowest Key West East eat Desk deck Post Mask Mack Ghost goat Disk Dick August Axle Ask Whisk wick Lost Task tack Missile Consonant + [s] Convulse Rinse Fence fen Comics comic Larynx Florence Fierce fear Wince win Box Immense Air Force Dance Dan Horse whore Sawhorse France Fran Ax Balance Fox Smallpox Science Force four

243

CHAPTER 9:  [s]

Consonant Clusters

Deletions

Pounce Hoarse whore Tense ten Defense Prince Phoenix Bounce Pulse Paul License Prince Alex Lance Entrance Divorce Tax tack Pierce peer Golf course Mailbox Plural Markers

Deletions

Bucks buck Cats cat Tops top Punks punk Picks pick Spots spot Pops pop Shops shop Tips tip Carts cart Skunks skunk Sharks shark Pops pop Droughts drought Types type Spouts spout Embarks embark Plops plop Sinks sink Shouts shout

244

The late eight

Themes for [s] Themes Snack Time Let’s Bake Field and Forest Horseback Riding At the Beach People to See Places to Go

The Body Speech Bath time Clothes to Wear Medieval Fun Bus Ride Around Town

Snack Time

Deletions

Minimal Pairs

Messy Toast tote Swallow wallow Spare ribs Soup loop, poop Salt ought malt Sip whip, rip, lip, hip, dip Rice rye mice, lice Salad ballad Sundae fun day Steak take Sub hub, cub Sour hour tower, shower, cower Icy Sprout Icing Squirm Sprouts sprout Squeeze Squash Skim Kim Splurge Spread Spicy Spree Stew two Sprinkle wrinkle Snack bar Snack knack

245

CHAPTER 9:  [s]

Snack Time

Deletions

Minimal Pairs

Smell Mel Sweet wheat Sprinkles Chopsticks Pizza pita Crust Crisp Frosting Let’s Bake

Deletions

Minimal Pairs

Snack knack Icing Grease Feast feet Crust Swallow wallow Crisp Frost fraught Snack knack Smell Mel Sweet wheat Sprinkles Whisk wick Teaspoon Frosting Spoon Skim Kim Splurge Spread Field and Forest

Deletions

Minimal Pairs

Fox Fence fen Corn husk Tusk tuck Sprig prig Spruce Husk Huck

246

Field and Forest

The late eight

Deletions

Minimal Pairs

Sliver liver Ax Salmon Sun fun, run, one, bun, gun Mouse Mao Saddle addle Sleek leak Swerve Swan wan Swallow wallow Sailboat Sand and band, fanned, tanned, hand Sunrise Swarm warm Swift wift Sunlight Sunny honey, money, funny,  bunny Soil oil boil, coil Possum Stag Moose moo Bison Grassy Skunk Skip Kip Mossy Moss Stork Sky Slug lug Stallion Stick tick Storm Horse whore Mice my Grass Goose goo Geese gee Stream Splash Cycle Michael Forest

247

CHAPTER 9:  [s]

Horseback Riding

Deletions

Minimal Pairs

Fence fen Sun fun, run, one, bun, gun Saddle addle Sunlight Sunny honey, money, funny, bunny Grassy Swift wift Stallion Storm Sleek leak Swerve Swelter welter Horse whore Grass Stream Splash Forest At the Beach

Deletions

Minimal Pairs

Mollusk Salmon Sail ale, ail tail, pail, nail, veil, rail, whale, mail, jail Sailboat Sun fun, run, one, bun, gun Seagull eagle Sole ole mole, goal, coal Sea E pea, me, key Surfboard Sailboat Sand and band, fanned, tanned, hand Sunburn Surfer Sunrise Squall Sharks shark Seaweed Sunlight Seal eel Neil, heel Sunny honey, money, funny, bunny Sandal handle

248

At the Beach

The late eight

Deletions

Minimal Pairs

Surf turf Lighthouse Porpoise Sky Stallion Stick tick Storm Starfish Splash People to See

Deletions

Minimal Pairs

Alex Lance Sally alley tally Sioux oo dew, coo Lucy Louie Susan Russell Sam am Pam, ram, lamb Cindy Indy windy Sid id hid, kid, bid, Sid Sue ooh boo, who, due Lassie Tracy Jason Bessie Casey Janis Bruce brew Lewis Carlos Carlo Alice Chris Smoky Snow White no white Oscar Shakespeare Betsy Betty Einstein Casper Snoopy

249

CHAPTER 9:  [s]

Places to Go

Deletions

Minimal Pairs

Phoenix France Fran Florence Sphinx Sweden Key West Sydney Tucson White House Greece Kansas Scotland Houston

kidney

The Body

Minimal Pairs

Deletions

Larynx Smallpox Skin kin Smile mile Sniffle Splint Spleen Sprain Stretcher Stroke Skull cull Sneeze knees Snore nor Gasp gap Lisp lip Waist wait Chest Chet Wrist writ Muscle Pulse Paul Fist fit Sick ick tick, thick, kick, pick, lick,  wick Snort Speak peak Squint

250

The Body

The late eight

Deletions

Minimal Pairs

Sniff Slump lump Speech

Deletions

Minimal Pairs

Slang Speak peak Lisp lip Smile mile Larynx Swear wear Bath Time

Deletions

Minimal Pairs

Splash Steam team Sting ting Sponge Spout pout Spill pill Face fay, fey ace Faucet Sing wing, thing, king, ring Suds duds, cuds Soak oak poke, choke, yolk, joke,  woke Soap rope, pope Sink ink think, pink, rink, wink Clothes to Wear

Deletions

Minimal Pairs

Socks fox, rocks, box Sew ooh toe, row, hoe, no, bow,   mow, go Suit cute, hoot, boot Sock lock, mock Sneakers Slip lip Skirt Kurt

251

CHAPTER 9:  [s]

Clothes to Wear

Deletions

Minimal Pairs

Dress up Glasses Necklace Dress Blouse Scarf Slippers Strap trap Costume Silk ilk Shoestring Bracelet Vest vet

Medieval Fun

Deletions

Saber Soldier Spell Story Tory Saint ain’t Cellar Sad add Cell L Sack Casket Sneak Locksmith Slave Squalid Stake take Slay lay Escape Crystal Straw Swing wing Scar car Staff Struggle Spike pike

Minimal Pairs

paint, faint teller mad, bad, dad fell, dell, Mel back, rack, hack, pack, tack

252

Medieval Fun

The late eight

Deletions

Spirit Splat Strike trike Spear peer Speed peed Scribe Scroll Sneer near Slash lash Slink link Stairs tears Spy pie Spade paid Spooky Pooky Spider Spear peer Castle Fireplace Mace May Palace Cross Spark park Stalk talk Swamp Smoke Stronghold Squad quad Conquest Priest Nest net Forest Mist mitt Gust gut Ghost goat Lost Mask Mack Wrestle Defense Prince Entrance Force four Pierce peer

Minimal Pairs

253

CHAPTER 9:  [s]

Medieval Fun

Deletions

Minimal Pairs

Fierce fear Horse whore Feast feet Bus Ride Around Town

Deletions

Sat at Sit it Subway City Cement Sign Sidewalk Salesclerk Postman Stroller Street treat Stand Stop top Pass Courthouse Police Bus Briefcase Stoplight top light School bus cool bus Switch witch Shoe store Bus stop

Minimal Pairs bat, mat, hat, cat, rat, pat hit, mit, kit, knit, bit witty, kitty nine, fine, shine

Chapter Ten

[z] Definition

[z] is made in either of two ways. As with [s], some people produce [z] with the tongue tip up behind the upper front teeth, others say it with the tongue tip down behind the lower front teeth. Neither one is the “right way.” Follow the student’s lead in deciding which way to teach [z]. If the student appears to find it easier to say [z] with the tongue tip up, teach the sound that way; if the student appears to find it easier to say [z] with the tongue tip down, teach the sound that way. For both varieties of [z], the airstream is continuous and the vocal folds are together. The technical definition of [z] is voiced alveolar fricative.

Acquisition Fifty percent of children acquire [s] by 4;0 and 75% of children acquire [s] by 6;0.

Relative Frequency [z] is ranked fifth in relative frequency compared with the other lateacquired consonants. It ranks fifteenth in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 3.0%.

255

256

The late eight

Errors [z] is affected by many of the same errors as [s] — lisping, bladed productions, and lateralizing are all common errors for [z]. Additionally, at the end of words, [z] may be produced with little or no voicing, resulting in an [s]-like sound.

Key Environments Beginning of syllable and between vowels, as in zee and a zee Before a high front vowel, as in zip In consonant clusters after [d], as in beads

Possible Metaphors Select metaphors based on the aspect of speech that is the focus of therapy. Tongue placement: Tongue tip sound Bump sound (tongue tip up) Little hill sound (tongue tip up) Lower teeth sound (tongue tip down) Fricative:

Snake sound Long sound Hissing sound

Voicing:

Motor on Buzzing sound Voice box on sound



Touch Cue Finger on the corner of the mouth (finger up for tongue tip raised sound or finger down for tongue tip down sound). Instructions Place the student’s finger in the corner of the lips, and remind the student to keep upper and lower teeth close together.

Initial Screening Test for [z] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example:  “Dog. Now you say it.” Word Student* Beginning 1. Zen

_____________

2. Zone

_____________

3. Zombie

_____________

Medial 4. Daisy

_____________

5. Rosa

_____________

6. Moses

_____________

Final 7. Nose

_____________

8. Buzz

_____________

9. Hose

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

257

Stimulability Tests for [z] Student’s Name: Date: __________________ Referral: Imitation 1. zoo _____________ 2. buzz

_____________

Key Environments End of a syllable or word 1. fizz

_____________

2. [iz] _____________ Before a high front vowel 1. zip _____________ 2. zero _____________ After [d] and before [i] 1. [dzi] _____________ After a [d] occurring in the same syllable 1. beads

_____________

2. ads

_____________

Favorite Words Names of family members:  Favorite people, heroes, and activities: 

258

Phonetic Placement _____________ 1. Place a tongue depressor just behind the student’s upper or lower front teeth, depending on which variety of /z/ is being taught, and ask him or her to use the tongue tip to hold it there. 2. Next, ask the student to keep the tongue tip still while you carefully remove the tongue depressor. 3. Ask the student to breathe out, resulting in [s]. 4. Ask student to turn voice box on, resulting in [z]. Shaping [z] from [s] _____________ Instruct the student to say [s] and then to turn on the voice box. Notes/Comments:

259

260

The late eight

Demonstrations for [z] Place: Alveolar First Method   Objects: None Instructions: 1. Instruct the student, “Please stick out your tongue.” 2. Once the tongue is out, for [s] with the tongue tip raised ask the student to pull the tongue back to feel the bump on the roof of the mouth behind the two front teeth. For [s] with the tongue tip down, ask the student to pull the tongue back to feel the little bump behind the two lower teeth. Second Method   Objects:  Q-tip and peanut butter or other favored food Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food on alveolar ridge (for tongue tip raised [s]) or behind lower front teeth (for tongue tip lowered [s]). 3. Ask the student to touch the food with the tongue tip.

Manner: Fricative First Method   Object:  Strip of paper or a feather Instructions: 1. Place a strip of paper, a feather, or the student’s hand held in front of your mouth while you produce several long voiceless fricatives. 2. Draw attention to the “hissing” quality and continuous nature of the sounds.

261

CHAPTER 10:  [z]

Second Method   Objects:  A small paper flower on the end of a pencil Instructions:  Tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind. Third Method   Objects: None Instructions:  Run your finger or the student’s finger down the student’s arm while making several long voiceless fricatives to demonstrate the “hissing” quality and length of fricatives.

Voicing: Voiced First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and a voiced [a]. Second Method   Objects: None Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects: None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, the student is asked to make [h] and [a].

262

The late eight

Fourth Method   Objects: None Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off. Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a voiced and voiceless oral stop, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

Phonetic Placement and Shaping Techniques for [z] To facilitate [z], follow the steps for [s] but also use demonstrations to instruct the student to turn on the voice box.

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

263

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student: “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Zoo

1. __________________

Zip

2. __________________

Zero

3. __________________

Zigzag

4. __________________

Zipper

5. __________________

Zach

6. __________________

Zest

7. __________________

Czar

8. __________________

Zip code

9. __________________

Zoom

10. __________________

Total Correct: ________ / ________ Comments:

264

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:

Zoo

new

1. __________________

Zap

tap

2. __________________

Zipper

ripper

3. __________________

Zen

hen

4. __________________

Zeal

meal

5. __________________

Zip

hip

6. __________________

Zapped

tapped

7. __________________

Z

pea

8. __________________

Zinc

pink

9. __________________

Zest

best

10. __________________

Total Correct: ________ / ________ Comments:

265

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Zoo

oo

1. __________________

Czar

R

2. __________________

Z

E

3. __________________

Zen

N

4. __________________

Zone

own

5. __________________

Zinc

ink

6. __________________

Zeal

eel

7. __________________

Zion

ion

8. __________________

Total Correct: ________ / ________ Comments:

266

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Zoo

1. __________________

Zip

2. __________________

Zero

3. __________________

Zigzag

4. __________________

Zipper

5. __________________

Zach

6. __________________

Zest

7. __________________

Czar

8. __________________

Zip code

9. __________________

Zoom

10. __________________

Total Correct: ________ / ________ Comments:

267

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note:  Replace * with the way the student used to say the sound. Word List:

Student Responses:

Zoo

1. __________________

Zip

2. __________________

Zero

3. __________________

Zigzag

4. __________________

Zipper

5. __________________

Zach

6. __________________

Zest

7. __________________

Czar

8. __________________

Zip code

9. __________________

Zoom

10. __________________

Total Correct: ________ / ________ Comments:

268

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with _____*, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note:  Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Zoo

1. __________________

Zip

2. __________________

Zero

3. __________________

Zigzag

4. __________________

Zipper

5. __________________

Zach

6. __________________

Zest

7. __________________

Czar

8. __________________

Zip code

9. __________________

Zoom

10. __________________

Total Correct: ________ / ________ Comments:

269

270

The late eight

Complete Word List for [z] Beginning of Words Single Consonants Zoo

Deletions

Minimal Pairs

oo new, shoe, two, moo, goo,   boo, chew Zip hip, chip, ship, whip, rip,   sip, lip Zero hero Zigzag Zipper ripper, nipper Zach sack, rack, Mack Zest Czar R tar, car, far Zip code Zoom room, boom, doom Z E pea, me, key, D, tea Zorro Zap tap, rap, map Zapped tapped, rapped,  mapped Zulu Zoe Zebra Zany Zen N hen, men, Ben, Ken Zone own moan, tone, bone Zombie Zealot Zuni loony, goony Zephyr heifer Zinc ink pink, wink, sink, link Zeal eel meal, peel, kneel Zither Zeppelin Zing sing, wing, ping Zeus moose, noose Zurich Zion ion tie on Zenith Zest best, west, pest

271

CHAPTER 10:  [z]

Consonant Clusters —

Medial Single Consonants Thousand Freezer Susan Daisy Pisa Blizzard Dozen Tuesday Zigzag Rosa Brazil Scissors Muzzle Pheasant Busy Moses Dessert Aztec Rosie Raisin Caesar Wizard Buzzer Kansas Busy Cheesecake Prison Freezing Daisy Visor Boise Trouser Puzzle Muslim Suzanne Kansas Desert Lizard Crazy Nazgul Music Thursday Grizzly Houses Closet Husband Consonant Clusters Bronze Age Thumbs up

Eavesdrop Thumbs down

Wednesday

All Environments Thousand Wizard Freezer Daisy Busy Pisa Wednesday Freezing Tuesday Dozen Boise Brazil Rosa Muslim Pheasant Muzzle Desert Eavesdrop Moses Nazgul Dessert Rosie Grizzly Raisin Thumbs up Closet Buzzer Cheesecake Susan Kansas

272

The late eight

All Environments Daisy Bronze Age Prison Trouser Blizzard Thumbs down Suzanne Zigzag Visor Lizard Scissors Puzzle Music Busy Kansas Houses Aztec Crazy Husband Caesar Thursday

End of Words Single Consonants

Deletions

Nose no, know Buzz Rose row Cruise crew Hose hoe Jazz Maze May Liz Samwise Snooze Graze gray Cheese Sneeze Please plea Oz News new Noise Louise Louie Consonant Clusters (Plural markers)

Deletion

Tribes tribe Bugs bug Kings king Dimes dime Tadpoles tadpole Bells bell

273

CHAPTER 10:  [z]

Consonant Clusters (Plural markers)

Deletion

Dwarves Seashells seashell Crabs crab Weeds weed Balls ball Wolves Sandals sandal Nails nail Waves wave Ears ear Lions lion Wings wing Drums drum Claws claw Seagulls seagull Eggs egg Roars roar Leopards leopard Rinds rind Sneakers sneaker Ponds pond Trolls troll Ribbons ribbon Whales whale Elves Crowns crown Spareribs sparerib Stars star Goblins goblin Birds bird Thumbs thumb Tails tail Wheels wheel Kids kid Baggins Blackbirds blackbird Worlds world Dogs dog Tears tear Hands hand Camels camel Rugs rug

274

The late eight

Consonant Clusters (Plural markers)

Deletion

Mountains mountain Coins coin Schoolrooms schoolroom Pools pool Skateboards skateboard

Themes for [z] Themes Animals Frodo’s Journey to Moria New Oz Stories

People and Places Weekdays

Animals

Deletions

Zoo

ooh new, shoe, two, moo, goo,   boo, chew

Zebra Tadpoles tadpole Muzzle Pheasant Bugs bug Seals seal Lizard Buzz Crabs crab Wolves Lions lion Wings wing Claws claw Tails tail Eggs egg Roars roar Leopards leopard Seagull seagull Whales whale Birds bird Camels camel Dogs dog Blackbirds blackbird

Minimal Pairs

275

CHAPTER 10:  [z]

Frodo’s Journey to Moria

Deletions

Minimal Pairs

Wizard Samwise Nazgul Baggins Rosie Dwarves Rings ring Blizzard Freezing Elves Pools pool Mountains mountain Drums drum Crowns crown Kings king Music Roars roar Claws claw Maze May Crazy Goblins Goblin New Oz Stories

Deletions

Kansas Oz Tribes tribe Zombie Worlds world Stars star Dreams dream Bells bell Prison Desert Wolves Lions lion Wings wing Leopards leopard

Minimal Pairs

276

People and Places

The late eight

Deletions

Minimal Pairs

Zach Zorro Czar R Daisy Baggins Rosa Moses Louise Louie Aztec Suzanne Sue Ann Liz Samwise Susan Caesar Rose row Zulu Pisa Brazil Boise Kansas Oz Zeus Zurich Zion ion

pack, rack, knack

Weekdays

Minimal Pairs

Tuesday Wednesday Thursday

Deletions

car, tar, mar

moose, noose tie on

Chapter Eleven

[l] Definition

[l] is made with the tongue tip raised and touching the mouth roof. Air flows over the sides of the tongue, and the larynx vibrates. The technical definition of [l] is voiced alveolar lateral. Two varieties of [l] exist in English: “light [l],” which occurs at the beginning of syllables, as in leak [lik], and “dark [l],” which occurs at the end of syllables, as in cool [kul]. In “dark [l]” the back of the tongue is raised in the velar region.

Acquisition Fifty percent of children acquire [l] by 3;6 and 75% of children acquire [l] by 6;0.

Relative Frequency [l] is ranked second in relative frequency compared with the other lateacquired consonants. It ranks seventh in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 5.6%.

277

278

The late eight

Errors A common error for [l] is called gliding — that is, [w] or [j] (glide consonants) substitute for [l] (a liquid consonant). Another common error for [l] is to produce the sound with a wet, slushy quality. Often, a wet, slushy sound occurs when [s] is made with the tongue blade raised instead of the tongue tip.

Key Environments Beginning of syllable and between vowels, as in lake and alone Light [l] before a high front vowel, as in leaf Dark [l] after a high back vowel at the end of a syllable, as in cool

Possible Metaphors Select metaphors based on the aspect of speech that is the focus of therapy. Tongue placement: Singing sound (la-la-la) Pointy sound (tongue tip pointing to   alveolar ridge) Bump sound Little hill sound Lateral:

Side sound

Liquid:

Flowing sound

Voicing:

Motor on Buzzing sound Voice box on sound



Touch Cue Tip of finger on the middle of the upper lip. Instructions Place the student’s finger on the middle of the upper lip.

Initial Screening Test for [l] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example: “Dog. Now you say it.” Word Student* Beginning 1. Lamp

_____________

2. Light

_____________

3. Leg

_____________

4. Plane

_____________

5. Sleep

_____________

6. Clip

_____________

Medial 7. Sailor

_____________

8. Billy

_____________

9. Olive

_____________

Final 10. Skull

_____________

11. Mail

_____________

12. Bell

_____________

13. Apple

_____________

14. Model

_____________

15. Muscle

_____________

*Suggestion: Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

279

Stimulability Tests for [l] Student’s Name: Date: __________________ Referral:  Imitation 1. lie _____________ 2. low _____________ 3. all

_____________

4. ill

_____________

Key Environments Light [l]: 1. leaf _____________ 2. leap _____________ Dark [l]: After a high back vowel at the end of a syllable 1. cool

_____________

2. bull

_____________

Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement _____________ 1. Touch the student’s alveolar ridge with a tongue depressor, peanut butter, or lollipop to indicate the place of production for [l]. 2. Ask the student to place his or her tongue tip in the place indicated, to relax and to let air flow out from the sides of the tongue. The resulting sound is voiceless [l]. 3. Instruct the student to turn on the voice box, resulting in [l].

280

Shaping [l] from Interdental [t] _____________ 1. Ask the student to place the tongue tip between the teeth as for an interdental [t]. 2. Lower the student’s jaw. 3. Ask the student to slowly draw the tongue tip backward but to keep the tongue tip in contact with the back of the teeth and the ridge behind the two front teeth. 4. Ask the student to say [l], being sure that contact between the tongue and the roof of the mouth is maintained. Notes/Comments:

281

282

The late eight

Demonstrations for [l] Place: Alveolar First Method   Objects:  None Instructions: 1. Instruct the student, “Please stick out your tongue.” 2. Once the tongue is out, ask the student to pull the tongue back to feel bump on the roof of the mouth behind the two front teeth. Second Method   Objects:  Q-tip and peanut butter or other favored food Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food on alveolar ridge. 3. Ask the student to touch the food with the tongue tip.

Manner: Liquid First Method   Objects:  None Instructions:  Run your or the student’s finger down the student’s arm while making several long glides or liquids to demonstrate the “flowing” quality and length of this sound. Second Method   Objects:  Strip of paper, a feather, or a small paper flower taped on the end of a pencil

283

CHAPTER 11:  [l]

Instructions:  Use a strip of paper, a feather, or the hand held in front of the student’s mouth while you produce several glides or liquids to draw attention to the “flowing” quality and continuous nature of the sounds. Alternatively, tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind.

Special Demonstration:  Lateral Airflow First Method   Object:  Drinking straw Instructions:  Place a straw on the groove of the tongue and blow out to demonstrate central emission of air. Second Method   Object:  Drinking straw Instructions:  Ask the student to breathe in with the tongue as for [s]. Cool air is felt at the central groove. Alternatively, perform the straw technique above, remove the straw, and ask the student to breathe in with the tongue in position for [l]. Cool air should be felt on the sides of the tongue over which the air was emitted. An alternative method is to perform the straw technique above, remove the straw, and ask the student to breathe in.

Voicing: Voiced First Method   Objects:  None Instructions:  Instruct the student to listen to and identify the difference between a voiceless and voiced [a]. Second Method   Objects:  None

284

The late eight

Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects:  None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, the student is asked to make [h] and [a]. Fourth Method   Objects:  None Instructions:  You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off. Fifth Method   Objects:  Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a voiced and voiceless oral stop, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

285

CHAPTER 11:  [l]

Phonetic Placement and Shaping Techniques for [l] Phonetic Placement Techniques Most often, the challenge with [l] is to help the student direct the airflow over the sides of the tongue. These four methods each focus on helping the student achieve lateral airflow. The first three methods focus on [l] in isolation and the fourth focuses on [l] in consonant clusters. First Method   Object:  Tongue depressor Instructions: 1. Place a tongue depressor under the student’s tongue tip and then raise the tongue tip behind the upper front teeth. 2. Ask the student to say [l] while maintaining contact between the tongue tip and the roof of the mouth. The resulting sound is [l]. Second Method   Objects:  Tongue depressor, small dab of peanut butter, or lollipop Instructions: 1. Touch the student’s alveolar ridge with a tongue depressor, peanut butter, or lollipop to indicate the place of production for [l]. 2. Ask the student to place the tongue tip in the place indicated, to relax, and to let air flow out from the sides of the tongue. The resulting sound is voiceless [l]. 3. Instruct the student to turn on the voice box, resulting in [l]. Third Method   This method works, though the number of steps limits its effectiveness, unless the student has good motivation and attention. Objects:  Small piece of paper and two drinking straws

286

The late eight

Instructions: 1. Place a straw midline on the student’s tongue groove to demonstrate central air emission. Ask the student to blow out onto an open hand or piece of paper. An alternative (or additional) demonstration of central air emission is to ask the student to prepare the mouth to say [s] but to breathe in. Cool air is felt midline on the upper tongue surface. 2. Next, place a straw in each corner of the student’s mouth. Ask the student to breathe out into his or her open hand or on a piece of paper. If an additional demonstration is needed, remove the straws and ask the student to breathe in and to feel the cool air on the sides of the tongue over which the air is emitted. To demonstrate the feel of the air more vividly, ask the student to suck on a piece of peppermint candy for a few minutes before performing the demonstration. 3. After lateral emission of air is obtained, ask the student to place the tongue tip in contact with the roof of the mouth behind the upper front teeth and to blow out over the sides of the tongue. If needed, place straws in the side of the student’s mouth while the tongue tip is held in contact with the roof of the mouth. 4. Ask the student to blow air out the side straws, which results in the voiceless [l]. 5. Voicing is obtained by asking the student to turn on the voice box. The resulting sound is [l]. Fourth Method   This method is for a student who needs to learn to pronounce [l] in consonant clusters. The method works for consonant clusters in which the other consonant in the cluster is not alveolar — for example, a velar or labial stop. Objects:  None Instructions: 1. Instruct the student to place the tongue in the position for /l/. 2. Instruct the student to say “blue,” resulting in a [bl] consonant cluster.

287

CHAPTER 11:  [l]

Shaping Techniques [l] from [θ] or [ð]   If a student’s speech contains a well-established interdental, this can be converted into [l]. Instead of an interdental, [s] or [z] can be used, though the task is more difficult for most students, because [s] and [z] are harder to see move than the interdental fricatives. Objects:  None Instructions: 1. Ask the student to place the tongue tip between the teeth as for [ð]. 2. Lower the student’s jaw. 3. Ask the student to slowly draw the tongue tip backward but to keep the tongue tip in contact with the back of the teeth and the ridge behind the two front teeth. 4. Next, instruct the student to say [l], being sure that contact between the tongue and the roof of the mouth is maintained. If [θ] is used, instruct the student to turn on the voice box. [l] from [i] or [u]   This method sounds tricky. It works, though, with selected students. Objects:  None Instructions: 1. Ask the student to open the mouth as wide as for [a] but to raise the tongue tip as for [i]. 2. Ask the student to keep the tongue up as for [i] but to say [a], resulting in a light (alveolar) [l]. Note. For a dark (velar) [l], follow the same steps but ask the student to say [u] instead of [i].

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

288

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student:  “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Log

1. __________________

Leather

2. __________________

Lick

3. __________________

Lock

4. __________________

Lake

5. __________________

Litter

6. __________________

Lump

7. __________________

Look

8. __________________

Low

9. __________________

Lip

10. __________________

Total Correct: ________ / ________ Comments:

289

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student:  “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:

Low

bow

1. __________________

Larry

berry

2. __________________

Lair

fair

3. __________________

Lock

sock

4. __________________

Lamp

ramp

5. __________________

Look

book

6. __________________

Log

dog

7. __________________

Lump

dump

8. __________________

Leg

beg

9. __________________

Ladder

sadder

10. __________________

Total Correct: ________ / ________ Comments:

290

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student:  “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Lick

ick

1. __________________

Lake

ache

2. __________________

Low

O, oh

3. __________________

Lion

ion

4. __________________

Lair

air

5. __________________

Lamp

amp

6. __________________

Leg

egg

7. __________________

Ladder

adder

8. __________________

Larry

airy

9. __________________

Lou

ooh

10. __________________

Total Correct: ________ / ________ Comments:

291

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student:  “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Log

1. __________________

Leather

2. __________________

Lick

3. __________________

Lock

4. __________________

Lake

5. __________________

Litter

6. __________________

Lump

7. __________________

Look

8. __________________

Low

9. __________________

Lip

10. __________________

Total Correct: ________ / ________ Comments:

292

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student:  “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note:  Replace * with the way the student used to say the sound. Word List:

Student Responses:

Log

1. __________________

Leather

2. __________________

Lick

3. __________________

Lock

4. __________________

Lake

5. __________________

Litter

6. __________________

Lump

7. __________________

Look

8. __________________

Low

9. __________________

Lip

10. __________________

Total Correct: ________ / ________ Comments:

293

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student:  “You are going to hear a word with our sound. Please say the word, then replace our sound with _____*, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note:  Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Log

1. __________________

Leather

2. __________________

Lick

3. __________________

Lock

4. __________________

Lake

5. __________________

Litter

6. __________________

Lump

7. __________________

Look

8. __________________

Low

9. __________________

Lip

10. __________________

Total Correct: ________ / ________ Comments:

294

295

CHAPTER 11:  [l]

Complete Word List for [l] Beginning of Words Single Consonants

Deletions

Minimal Pairs

Log dog, hog, bog Leather feather, heather, weather Lick ick sick, tick, wick, pick, kick,  thick Lock sock, knock, rock Lake ache bake, cake Litter sitter Lump dump, pump Look book, cook, hook Low O, oh bow, sew, foe, no, know Lip  zip, rip, dip, whip, sip,   chip, ship, hip Lettuce bet us Lagoon Lion ion Legolas Lair air fair, hair, mare, tear, chair Lamp amp ramp, camp, damp Light night, write, white, bite,   fight, kite Leg egg beg, Meg, Ladder adder sadder, madder Line sign, mine, line, pine, nine List mist, wrist, kissed, hissed Letter better, setter Lantern Larry airy berry, Barry, merry, cherry Lou oo new, chew, Sue, Rue, two Leech each beech, reach Ladies Lemon Lei A day, bay, say, gray, hay Lime I’m dime, rhyme, mime Lie I, eye buy, guy, sigh, rye, die, fly,   sigh, pie Leopard Lawrence Long song, wrong

296

Single Consonants

The late eight

Deletions

Minimal Pairs

Late ate date, rate, gate, hate, bait Leonard Lava Java Lawn awn Shawn Leak eek beak, meek, peak Llama Lois Lobster Luke nuke, kook Leap peep, reap, seep Laugh calf, half Leash Lisp wisp Limp imp wimp, gimp Lynn in win, sin, tin Lincoln Love dove, shove Lumber number Life knife Leaf chief, thief Lung sung, rung, hung Lamb am Sam, ram, ham Lace ace race, chase, face Loaf oaf Land and sand, band Limb gym, Jim, him, rim Lance dance, chance Lucy juicy Luggage Lad add bad, mad, sad Load ode code, node, bode Lazy daisy Lunch bunch, munch, hunch Link ink sink, rink, mink Lid id hid, bid, mid Least east beast Like Ike Mike, bike, pike London Lane mane, sane, bane Lone own tone, moan Label able sable, Mabel Lap nap, cap Locker succor

297

CHAPTER 11:  [l]

Single Consonants

Deletions

Minimal Pairs

Lame aim game, same, name Lace ace race, case, base Lady Sadie Lye I, eye tie, die, sigh Consonant Clusters

Deletions

Minimal Pairs

[pl] Plane pain, pane Plywood Plants pants Plant food Play pay pray Pluto Planet Plank prank Plato Platoon Plowed proud Please peas Plastic Plaza Plymouth Pliers Plate pate Playground Plum Placard [kl] Clark quark Clip Kip quip Club cub Classroom Class Clock cock crock Clipper Clap cap crap Clifford Clay K Kray

298

Consonant Clusters

The late eight

Deletions

Minimal Pairs

Clamshell Clerk Kirk quirk Cliff Clever Cluck Cloud cowed crowd Clippers kippers Clam cam cram Clover Clown crown Claw caw craw Climb crime [bl] Black back Blue boo brew Blind bind Blizzard Blossom Bleed bead breed Blackbird Block Brock Blindfold Blender bender Blank bank Bloodhound Blackmail Blood bud [gl] Glove grove Glass gas grass Glacier Glenn Glad grad Glitter Globe Glider Glow go grow Glue goo grew

299

CHAPTER 11:  [l]

Consonant Clusters

Deletions

Minimal Pairs

Gloomy Glasses

gasses grasses

[fl] Floor four Flashbulb Flag Fly fie fry Flood food Flight fight fright Flagstaff Flat fat frat Flipper Flash Flea fee free Flour Florist forest Flab fab Flame frame Flip Flower [sl] Slip sip skip Slaw saw Sledding Slide side spied Slap sap Sleigh bells Sleet seat skeet, sweet Slug Sleep seep steep, sweep Slop sop stop, swap Sleeve sieve Steve Slicing spicing Slipper sipper skipper Sled dog Slum sum scum Sled said sped Sloth

300

The late eight

Consonant Clusters

Deletions

Minimal Pairs

Sleigh Sling Sleepy Slurp

say sing

stay, spay, sway sting, swing

[spl] Splash Splinter sprinter Splendid Splay play Splashdown Splatter Splurge Splice Spleen Splat Split Splutter Splint sprint Splotchy Splashy Splendor All Consonant Clusters

Deletions

Minimal Pairs

Plane pain, pane Glasses gasses grasses Plants pants Sleep seep sweep, steep Pluto Slicing spicing Plank prank Platoon Clip Kip quip Plywood Plowed proud Clark quark Play pray, prey Clipper kipper

301

CHAPTER 11:  [l]

All Consonant Clusters

Deletions

Minimal Pairs

Slop sop stop, swap Club cub Classroom Plastic Class Cass crass Clock cock crock Plant food Clap cap crap Glue goo grew Globe Clifford Clay Slipper sipper skipper Clamshell Slap sap Flab fab Sleigh bells Planet Sled dog Slum sum scum Clever Blossom Cluck Cloud cowed Sleeve sieve Steve Clippers kippers Clam cam cram Sleet seat skeet, sweet Clover Gloomy Slug Clown crown Plato Claw Playground Climb Black Sled said sped Blue boo brew Plymouth Blind bind

302

All Consonant Clusters

The late eight

Deletions

Minimal Pairs

Clerk Kirk Flip Pliers Flower Blizzard Plate pate Bleed bead breed Glass gas grass Block Brock Flood food Florist forest Slide side spied Cliff Sliver Blood bud Fly fie fry Plaza Glove Bloodhound Glacier Flight fight fright Glenn Splashdown Glitter Blank bank Globe Blackbird Glider Blender bender Glow go grow Splash Floor four Splinter Flashbulb Glad Flag Splendid Sleigh say stray, stay, sway Sleepy Blindfold Flagstaff

303

CHAPTER 11:  [l]

All Consonant Clusters

Deletions

Minimal Pairs

Sling sing sting, swing Flat fat frat Flipper Blackmail Flash Slurp Flea fee free Flour Plum Flame fame frame Slip sip skip Slaw saw Sledding Please peas Sloth Placard

Medial Single Consonants Sailor Ireland Dallas Billy Chile Sailor Olive Kelly Pillow Smiling Cellar Aileen Ceylon Julie Eyelash Ballet Toilet Bowling Valley Jailer Albert Eyelid Zulu Boulder Galleon Cello Melbourne Boiling Shelley Gallon Chilly Collar Jello Gimli Children Chilly Collar Alley Police Ruler Island Ceiling Palace Balloon Hilly Delhi Salad Dallas

304

The late eight

Consonant Clusters Airplane Milkshake Burglar Apply School bus Cornflake Applaud Wobbling Snowflake Cobbler Giggling Goblin Douglas England Stiffly Duckling Wildfire Wrestler Ticklish Gobbler Asleep Weekly Cornflakes Nicely Bubbling Ugly Album Toddler All Environments Cobbler Chile Wrestler Sailor Weekly Island Bubbling Kelly Cornflake Billy Cellar Balloon Olive Gobbler Apply Smiling Julie Salad Album Toilet Dallas Applaud Jailer Burglar Ceylon Duckling Sailor Ballet Zulu Pillow Valley Cello Aileen Eyelid Ticklish Stiffly Galleon Shelley Eyelash Boiling Collar Bowling Chilly Children Albert Airplane Alley Boulder Gimli Wobbling Nicely Douglas Giggling Melbourne Collar England Gallon Ruler Wildfire Jello Milkshake Cornflakes Asleep Palace Ugly Chilly School bus Toddler Police Delhi Snowflake Ceiling Ireland Goblin Hilly

305

CHAPTER 11:  [l]

End of Words Single Consonants

Deletions

Roll row Wheel whee Rail ray Tile tie Skull Mail may Towel Bell Dial die Seal sea, see Boil boy Mall Snail Seashell Hole ho Veil Pile pie Mole Peel pea Spool Cell School Cool Bowl bow Nail Drill Troll toll Pail pay Mel Bill Goal go Eel E Gail gay Bull Baseball Coal Pill Ball Churchill Steal

306

Single Consonants

The late eight

Deletions

Fall April Drool Doll Daniel Jail J Phil Carol Yell Steel Cheryl Hall Beach ball Seagull Brazil Wall Tadpole Hotel Oatmeal Jackal Whale way Cartwheel North Pole Consonant Clusters [pl] Apple People Scalpel Steeple Maple People [bl] Cable Bible Fable Hubble Bubble

Deletions

307

CHAPTER 11:  [l]

Consonant Clusters Scrabble Pebble [dl] Model Pedal Candle Cradle [gl] Eagle Beagle Bugle [fl] Cheerful Eiffel Sniffle Velar Nasal [l] Jungle Bungle [nl] Funnel Colonel Tunnel Kernel [kl] Jackal Ankle Buckle Knuckle Snorkel

Deletions

308

Consonant Clusters

The late eight

Deletions

[dl] Devil [sl] Missile Castle Fossil Pencil Muscle Capsule [ ʃ ] + [ l ] Marshal [lv] Twelve [lt] Salt sought Belt bet Vault Bolt Bank vault [ld] Child chide Donald World word Old ode Gold goad Stronghold Bald Field feed Windshield Arnold

309

CHAPTER 11:  [l]

Consonant Clusters

Deletions

[lf] Elf F Werewolf Golf Wolf woof Shelf chef Rudolph Gandolf [lb] Light bulb DeKalb [lm] Elm M Helm hem [lp] Kelp Alp Scalp [lk] Milk Silk Elk Hulk Consonant + Syllabic [l] Apple Model Muscle People Beagle Steeple Bugle

310

Consonant Clusters

The late eight

Deletions

Maple People Fossil Cable Scalpel Bible Pencil Hubble Snorkel Bubble Ankle Pedal Candle Knuckle Cradle Eagle Cheerful Buckle Eiffel Sniffle Jungle Fable Bungle Funnel Pebble Colonel Missile Tunnel Kernel Jackal Scrabble Devil Castle Capsule Marshal [l] + Consonant Stronghold Twelve Salt sought Hulk

311

CHAPTER 11:  [l]

Consonant Clusters

Deletions

Vault Light bulb Bolt Bank vault Child chide Shelf chef Donald Bald World word Belt bet Gold goad Windshield Arnold Gandolf Elk Alp Elf F Werewolf Silk Wolf woof Rudolph Old ode DeKalb Golf Elm M Field feed Scalp Helm hem Kelp Milk

Themes for [l] Themes Northern Places Day at the Beach Sea Voyage to Old Hawaii Let’s Cook Lord of the Rings

Make a Healthy Lunch People to See Places to Go Animals Make Up a Fairy Tale

312

Northern Places

The late eight

Deletions

Minimal Pairs

Chilly Elk Rudolph Sled said sped Sled dog Sleigh bells Sleet seat skeet, sweet Glacier Blizzard North Pole Cool coo Wolf woof Wolves Sledding Sleigh say stay, spay, spray Snowflake Day at the Beach

Deletions

Lobster Salt Snorkel Pebble Splash Flipper Clamshell Beach ball Seagull Pail pay Towel Seal sea, see Snail Seashell Kelp Whale way Eel E

Minimal Pairs bought, taught

feel, meal

313

CHAPTER 11:  [l]

Sea Voyage to Old Hawaii

Deletions

Minimal Pairs

Sailor Galleon Clipper kipper Lei A say, pay, may Boil boy Lava Java Hilly Island Boiling Let’s Cook

Deletions

Minimal Pairs

Lettuce Lemon Lime I’m dime, rhyme, mime Milk Apple Bubbling Cobbler Boil boy Slicing spicing Slaw saw Flour Glass gas grass Blender bender Clam cam cram Plate pate Plum Lunch bunch, munch, hunch Lid id hid, bid, mid Like Ike Mike, bike, pike Peel pea Loaf oaf Olive Bowl bow Chili Salad Jello Roll row Oatmeal

314

Let’s Cook

The late eight

Deletions

Minimal Pairs

Deletions

Minimal Pairs

Duckling Cornflakes Lord of the Rings

Gandolf Elrond Gimli Legolas Gollum Elf F Wolf woof Wolves Eagle Troll stroll Trolls Goblins Lady Sadie Lad add bad, mad, sad Make a Healthy Lunch

Deletions

Minimal Pairs

Lettuce Lemon Milk Apple Slicing spicing Glass gas grass Plate pate Plum slum Peel pea Loaf oaf Olive Bowl bow Salad Roll row

315

CHAPTER 11:  [l]

People to See

Deletions

Minimal Pairs

Kelly Gimli Lance dance, chance Lucy juicy Gandolf Lynn in win, sin, tin Billy Lincoln Leonard Larry airy berry, Barry, merry, cherry Lou oo two, new, boo, goo, new,   chew, Sue, Rue, two Gail gay Julie Legolas Lawrence Gollum Lois Luke nuke, kook Elrond Zulu Shelley Aileen Arnold Donald Albert Glenn Cliff Clifford Clark quark Plato Douglas (The) Hulk Kelly (The) Devil Billy Mel Bill Churchill April Daniel Phil Carol Cheryl

316

Places to Go

The late eight

Deletions

Minimal Pairs

Deletions

Minimal Pairs

Ceylon Ireland Dallas England Delhi London Ireland Chile Dallas Brazil Pluto (The) Hubble Plymouth Flagstaff Boulder Melbourne Eiffel (Tower) DeKalb Animals

Leech each beach, reach Lair air fair, hair, mare, tear, chair Lion ion Leopard Lick ick sick, tick, wick, pick, kick,  thick Llama Lamb Sam, ram, ham Eel E Eagle Beagle Gobbler Sloth Flea fee free Claw caw Tadpole Jackal Blackbird Slug Wolf woof Wolves

317

CHAPTER 11:  [l]

Make Up a Fairy Tale

Deletions

Minimal Pairs

Valley Lake ache bake, cake Lock sock, knock, rock Lamp amp ramp, camp, damp Light night, write, white, bite,   fight, kite Lawn Shawn Elf F Castle Tunnel Werewolf Steeple Ugly Goblin Lame aim game, same, name Lace ace race, case, base Lazy daisy Lye I, eye tie, die, sigh England Flower Flame fame frame Jail J Cell Lady Sadie Lad add bad, mad, sad Veil Slipper sipper Fable Lagoon

Chapter Twelve

Vocalic

[r] Definition

Vocalic [r] is a vowel rather than a consonant, and is included in this book because often the road to a good [r] leads through first learning to make vocalic [r]. Vocalic [r] is heard in the words heard, butter, and girl. As with its consonant counterpart (called consonantal [r] or simply [r]), it is produced in either of two ways. In the first way, called bunched, the lips are rounded slightly, the tongue tip lowered, and the tongue body bunched up near the area of the palate. In the second way, called retroflex, the lips are rounded slightly and the tongue tip is raised either toward the alveolar ridge or curled back toward the alveolar ridge. In both varieties of vocalic [r], the sides of the tongue touch the insides of the teeth about halfway back. Both bunched and retroflex types of vocalic [r] can result in a good sound, though the author’s clinical experience is that more students find the bunched variation somewhat easier to learn than the retroflex one. For both types of vocalic [r], the vocal folds are vibrating and the tongue root is retracted, creating a contraction in the pharynx. The technical definition of vocalic [r] is a mid-central rounded rhoticized vowel.

Acquisition Vocalic [r] is acquired by 50% of children by 3;6 and 75% of children by 5;6. 319

320

The late eight

Relative Frequency —

Errors The most common error is deleting the [r] part of the vowel, resulting in words such as fur, fare, and fear being pronounced fu, fa, fe, respectively.

Key Environments In a word consisting of a single stressed syllable, as in girl

Possible Metaphors The best metaphor usually focuses on the way vocalic [r] closes (ends) the vowel. [r] quality:

Mad dog or growling-tiger sound (grr) Arm-wrestling sound (errr) Pirate sound (aar)

Tongue placement: Tongue-tip flat sound (bunched) Tongue-tip up sound (retroflex) Voicing:



Motor on Buzzing sound Voice box on sound

Touch Cue Palm down and finger tips curled down (bunched) or palm up and finger tips curled up (retroflex). Instructions Place the student’s hand beside the mouth.

Initial Screening Test for Vocalic [r] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example:  “Dog. Now you say it.” Word Student* Open 1. Grocer

_______________

2. Racer

_______________

3. Sister

_______________

4. Monster

_______________

5. Chester

_______________

Closed 6. Bird

_______________

7. Shirt

_______________

8. Burn

_______________

9. Hurl

_______________

10. Nurse

_______________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

321

Stimulability Tests for Vocalic [r] Student’s Name: Date: __________________ Referral: Imitation 1. her

_______________

2. curl _______________ Key Environments In a word consisting of a single stressed syllable 1. her

_______________

2. girl _______________ Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement _____________ Instruct the student to growl like a tiger (grrr). Alternatively, ask the student to make the “arm wrestling sound” ([rrr]) while arm wrestling with the clinician. Vocalic [r] (retroflex) from [ð] 1. Ask the student to place the tongue as for [ð]. 2. Ask the student to quickly draw the tongue tip back and slightly up, resulting in vocalic [r]. Notes/Comments:

322

323

CHAPTER 12:  [r]

Demonstrations for Vocalic [r] Place: Alveolar First Method   Objects: None Instructions: 1. Instruct the student, “Please stick out your tongue.” 2. Once the tongue is out, for vocalic [r] with the tongue tip lowered, ask the student to pull the tongue back and touch the gums below the two lower front teeth. For vocalic [r] with the tongue tip raised, ask the student to pull back the tongue to feel the bump on the roof of the mouth behind the two upper front teeth. Second Method   Objects:  Q-tip and peanut butter or other favored food Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food on alveolar ridge (for tongue tip raised vocalic [r]) or behind lower front teeth (for tongue tip lowered vocalic [r]). 3. Ask the student to touch the food with the tongue tip.

Manner: Liquid First Method   Objects: None Instructions:  Run your or the student’s finger down the student’s arm while making several long glides or liquids to demonstrate the “flowing” quality and length of this sound.

324

The late eight

Second Method   Objects:  Strip of paper, a feather, or a small paper flower taped on the end of a pencil Instructions:  Use a strip of paper, a feather, or the hand held in front of the student’s mouth while you produce several glides or liquids to draw attention to the “flowing” quality and continuous nature of the sounds. Alternatively, tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind.

Special Demonstration:  Bunched A Q-tip, small piece of candy, or other favored food sometimes is helpful in demonstrating where to place the tongue tip. First Method   Objects: None Instructions:  Ask the student to place the tongue tip behind the lower front teeth and to raise the body of the tongue toward the mouth roof. Second Method   Objects:  Q-tip or small piece of candy or other favored food Instructions: 1. Touch behind the student’s lower front teeth with a Q-tip to demonstrate where the tongue tip should be placed. Alternatively, place a small piece of candy or other favored food behind the lower front teeth and ask the student to hold it there with the tongue tip. 2. Once this is achieved, ask the student to raise the tongue body toward the mouth roof.

325

CHAPTER 12:  [r]

Special Demonstration:  Retroflex A Q-tip, small piece of candy, or other favored food sometimes is helpful in demonstrating where to place the tongue tip. Method   Objects: None Instructions: 1. Ask the student to place the tongue tip behind the upper front teeth. 2. Ask the student to curl the tongue backward without touching the roof of the mouth until it cannot go back farther.

Sides of Tongue (Bunched and Retroflex): Vocalic and Consonantal [r] A good [r] often is more easily achieved if the student is encouraged to say the sound while keeping the sides of the tongue touching the insides of the teeth. The following simple demonstration can be practiced in isolation or as part of the bunched and retroflex demonstrations. First Method   Objects: None Instructions: 1. Tell the student that his or her tongue is sleepy and wants to rest. 2. Instruct the student to let the tongue spread out in “its bed” until it is touching the insides of the teeth. Second Method   Objects:  Q-tip, candy, or other favored food

326

The late eight

Instructions: 1. Touch the inside teeth with a Q-tip or some favored food to demonstrate where the tongue should go. 2. Tell the student that his or her tongue is sleepy and wants to rest. 3. Instruct the student to let the tongue spread out in “its bed” until it is touching the insides of the teeth.

Voicing: Voiced First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and voiced [a]. Second Method   Objects: None Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects: None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, the student is asked to make [h] and [a]. Fourth Method   Objects: None Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off.

CHAPTER 12:  [r]

327

Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a voiced and voiceless oral stop, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

328

The late eight

Phonetic Placement and Shaping Techniques for Vocalic [r] Phonetic Placement Techniques The first three techniques are simple and quick. If they don’t work, try the fourth or fifth methods. First Method (retroflex or bunched)   Objects: None Instructions:  Ask the student to growl like a tiger (grrr). Alternatively, ask the student to make the “arm-wrestling sound” (rrr) while you and the student arm wrestle. Second Method (retroflex)   I like this method — it is simple and quick, needs no objects, and is good both for vocalic [r] and for shaping vocalic [r] into consonant [r]. It comes from Gillian Fleming of Dunedin, New Zealand, who posted it on Caroline Bowen’s website and kindly consented for it to be presented in this book. Objects: None Instructions: 1. Instruct the student that for this sound it is the tongue that does the work and that the lips need to be “out of the road” in a half-smile so that the upper and lower teeth can be seen. 2. Model a long vocalic [r], and then ask the student to curl the tongue back to copy your model. Allow the student to move the tongue around until a perfect production is reached. If the student has difficulty, liken the sound to “a car starting on a frosty morning” to elicit a growly rrrrr sound. 3. Once vocalic [r] is produced, ask the student to “feel” where the tongue is. 4. Once established in isolation, practice vocalic [r] in syllables, such as rrah and rrye. 5. Once rrah and rrye have been achieved, instruct the student to place the tongue tip up and back until the correct [r] is achieved and then have the student say ring.

CHAPTER 12:  [r]

329

Third Method (retroflex or bunched)   This method works by stretching and spreading the sides of the mouth. Somewhat surprisingly, for some students it places the tongue in just the right position to make vocalic [r]. Object:  Thin drinking straw Instructions: 1. Ask the student to “make a face” by hooking the first finger of each hand in the corner of the mouth and stretching the mouth apart and back. The same result can be achieved by placing a thin straw horizontally in the student’s mouth. 2. With the mouth stretched, ask the student to say vocalic [r]. Fourth Method (retroflex or bunched)   This method works because if a student lies back and relaxes, the tongue “bunches” and falls into the position for vocalic [r]. Though it seems funny, sometimes after establishing vocalic [r] flat on the back, you need to work for the student to say the sound when not reclining. Objects: None Instructions:  Instruct the student to lie on his or her back, relax the mouth, and say vocalic [r]. Fifth Method (bunched)   Objects: None Instructions: 1. Ask the student to lower the tongue tip. 2. Next, ask the student to hump up the back of the tongue as for “a silent [k].” 3. Ask the student to make the sides of the back of the tongue touch the insides of the back teeth. 4. Lastly, ask the student to turn on the voice box, resulting in vocalic [r].

330

The late eight

Shaping Techniques For many students, it is easier to shape vocalic [r] from another sound than it is to teach it using phonetic placement techniques. Vocalic [r] (bunched) from [w]   This method requires a number of steps, but is effective with the right student. Object:  Tongue depressor (optional) Instructions: 1. Lower the student’s jaw slightly. 2. Ask the student to say [w]. 3. Next, ask the student to make the tongue position for [d]. 4. Lastly, ask the student to retract the tongue slightly while lowering the tongue tip and to say vocalic [r]. Vocalic [r] (retroflex) from [n], [d], or [l]   This “stretching” technique is very similar to the third vocalic [r] phonetic placement technique. Object:  Thin drinking straw Instructions: 1. Ask the student to “make a face” by hooking the first finger of each hand in the corner of the mouth and stretching the mouth apart and back. The same result can be achieved by placing a thin straw horizontally in the student’s mouth. 2. With the mouth stretched, ask the student to say a prolonged [n], [d], or [l]. 3. As the student says the prolonged [n], [d], or [l], ask him or her to curl the tongue backward, resulting in ner, der, or ler. 4. Have the student delete the consonant, resulting in vocalic [r].

CHAPTER 12:  [r]

331

Vocalic [r] (bunched) from [d]   Objects: None Instructions:  Lower the student’s jaw slightly as for [d]. While the student’s jaw is lowered, ask the student to pull back the tongue slightly, to lower the tongue tip, and to say vocalic [r]. Vocalic [r] (retroflex) from [ð]   Objects: None Instructions: 1. Ask the student to place his or her tongue as for [ð]. 2. Ask the student to quickly draw the tongue tip back and slightly up, which typically results in vocalic [r]. Vocalic [r] (retroflex) from Alveolar Trill   The trick of this method is to get a student to make an alveolar trill. Objects: None Instructions: 1. Instruct the student to trill the tongue tip at the alveolar ridge. 2. Ask the student to stop the trill but to continue vocalizing, resulting in vocalic [r]. Vocalic [r] (retroflex) from [l]   The authors of almost all phonetic placement and shaping techniques are unknown. The exception is the first technique for shaping vocalic [r] from [l], described by Shriberg (1975). The technique works well with a student who can pronounce [l]. The other two techniques offer additional possibilities for shaping [l] into vocalic [r].

332

The late eight

First Method (retroflex) Objects: None Instructions: 1. Instruct the student to place the tongue tip on the alveolar ridge in the position for [l]. 2. Ask the student to say [l] several times. 3. Ask the student to say [l] for 5 seconds. 4. Next, ask the student to say a long [l] but to drag the tongue tip slowly back along the roof of the mouth until it is so far back that the student has to drop it, resulting in vocalic [r]. Second Method (retroflex) Objects: None Instructions: 1. Ask the student to say [l]. 2. While the student says [l], gently pull down the student’s jaw until the position for vocalic [r] is reached, resulting in vocalic [r]. (Alternatively, instead of lowering the student’s jaw, ask the student to lower his or her jaw.) Third Method (retroflex) Objects:  Tongue depressor or lollipop stick Instructions: 1. Ask the student to say [l]. 2. Using either a tongue depressor or lollipop stick, gently push back the tongue tip until there is enough space between the tongue tip and roof of the mouth to insert the tongue depressor or lollipop stick, resulting in vocalic [r]. Vocalic [r] (retroflex) from [ ʃ ]   This clever technique relies on the surprising similarities between vocalic [r] and [ ʃ ], both of which involve slightly rounded lips, raising of the tongue

CHAPTER 12:  [r]

333

blade, and contact between the tongue sides and the insides of the teeth. Anne Hommes of Corvalis, Oregon contributed to this technique. Objects: None Instructions: 1. Ask the student to say [ ʃ ], and then ask him or her to turn on the voice box, resulting in [3]. 2. Next, ask the student to curl the tongue tip back while keeping contact with the insides of the back teeth, resulting in vocalic [r]. Vocalic [r] from ah   Here are two simple methods for converting ah into vocalic [r], For both, watch carefully that the student does not round the lips, which results in a vocalic [r] with [w] qualities. If need be, ask the student to hold down the lower lip while practicing. First Method (retroflex) Objects: None Instructions: 1. Ask the student to sweep the roof of the mouth with the tongue tip while saying ah. 2. Tell the student to stop, but to keep vocalizing ah. 3. Instruct the student to lower the tongue tip slightly, which often results in vocalic [r]. Second Method (retroflex) Objects: None Instructions: 1. Ask the student to say a long ahhhhhh. 2. As the student says ahhhh, instruct him or her to raise and curl back the tongue tip, resulting in ahhhhrrr (vocalic [r]).

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

334

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student: “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Sir

1. __________________

Dagger

2. __________________

Finger

3. __________________

Singer

4. __________________

Bur

5. __________________

Winner

6. __________________

Glacier

7. __________________

Whisper

8. __________________

Fir

9. __________________

Author

10. __________________

Total Correct: ________ / ________ Comments:

335

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

336

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Singer

sing

1. __________________

Winner

win

2. __________________

Spider

spied

3. __________________

Trailer

trail

4. __________________

Steamer

steam

5. __________________

Racer

race

6. __________________

Chester

chest

7. __________________

Cellar

cell

8. __________________

Rooster

roost

9. __________________

Dancer

dance

10. __________________

Total Correct: ________ / ________ Comments:

337

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Sir

1. __________________

Dagger

2. __________________

Finger

3. __________________

Singer

4. __________________

Bur

5. __________________

Winner

6. __________________

Glacier

7. __________________

Whisper

8. __________________

Fir

9. __________________

Author

10. __________________

Total Correct: ________ / ________ Comments:

338

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note:  Replace * with the way the student used to say the sound. Word List:

Student Responses:

Sir

1. __________________

Dagger

2. __________________

Finger

3. __________________

Singer

4. __________________

Bur

5. __________________

Winner

6. __________________

Glacier

7. __________________

Whisper

8. __________________

Fir

9. __________________

Author

10. __________________

Total Correct: ________ / ________ Comments:

339

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with _____*, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. **un. Sun.” Note:  Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Sir

1. __________________

Dagger

2. __________________

Finger

3. __________________

Singer

4. __________________

Bur

5. __________________

Winner

6. __________________

Glacier

7. __________________

Whisper

8. __________________

Fir

9. __________________

Author

10. __________________

Total Correct: ________ / ________ Comments:

340

341

CHAPTER 12:  [r]

Complete Word List Vocalic [r] Open Deletions Sir Dagger Finger Singer sing Bur Winner win Glacier Whisper Fir Author Spider spied Barber Trailer trail Summer Steamer steam Grocer Racer race Sister Monster Chester chest Cellar cell Rooster roost Dancer dance Easter east Hamster Master mast Thriller thrill Dollar doll Endure Rider ride Spencer Spence Caesar seize Plaster Lobster Toaster toast Cancer Freezer freeze

342

The late eight

Open Deletions Satyr Fur Her Over Pepper pep Closed Lizard Burst Turk Sneakers Sure Curve Orchard Pearl Thunder Songbird Girl Yogurt Worm Curb Self-serve Bird Herb T-shirt Shirt Suburb Work Burn Birch Nerve Hurl Church Girl Nurse Bird Squirrel Purse Herd Germ Hearse Leonard Cavern Burst Mustard Dirt Thirst Wizard Shirt Bur Pittsburgh

Themes for Vocalic [r] Themes Creatures It’s a Job People to See Creatures Deletions Spider spied Rooster roost Hamster Monster Lobster

343

CHAPTER 12:  [r]

Creatures Deletions Songbird Worm Satyr Lizard Squirrel Bird Germ It’s a Job

Deletions

Author Barber barb Singer sing Racer race Dancer dance Rider ride Wizard Nurse People to See

Deletions

Chester chest Spencer Spence Caesar seize Pittsburgh Turk Herb Leonard

344

The late eight

Reference Shriberg, L. (1975). A response evocation program for vocalic [r]. Journal of Speech and Hearing Disorders, 40, 92–105.

Chapter Thirteen

Consonantal

[r] Definition

Consonantal [r] (henceforth simply called [r]) is the consonant counterpart of vocalic [r]. [r] occurs before vowels in read, red, and three, and after vowels in beard, hear, far, and four. In common with vocalic [r], the consonantal [r] has two variations, the first (bunched) in which the lips are rounded slightly, the tongue tip lowered, and the tongue body bunched up near the area of the palate, and the second (retroflex) in which the lips are rounded slightly and tongue tip is raised to the alveolar ridge or curled back toward the alveolar ridge. In both varieties, the sides of the tongue touch the insides of the teeth about halfway back. As mentioned in the description of vocalic [r], both the bunched and retroflex variations can produce an acceptable [r], though the author’s clinical experience is that more students find the bunched variation somewhat easier to learn than the retroflex one.

Acquisition [r] is acquired by 50% of children by 5;0 and by 75% of children by 6;0.

345

346

The late eight

Relative Frequency [r] is ranked third in relative frequency compared with the other lateacquired consonants. It ranks eighth in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 5.2%.

Errors The most common error is gliding — typically, [w] for [r], though [j] also occurs. Deletion of [r] after a vowel and in consonant clusters also is common.

Key Environments Before a high front vowel, as in read Beginning of syllable and between vowels, as in row and teary In a consonant cluster with [t] or [k], as in tree or creek

Possible Metaphors The metaphors for [r] are the same as for vocalic [r]. [r] quality:

Mad dog or growling tiger sound (grr) Arm wrestling sound (errr) Pirate sound (aar)

Tongue placement: Tongue tip flat sound (bunched) Tongue tip up sound (retroflex) Voicing:



Motor on Buzzing sound Voice box on sound

Touch Cue The same touch cue is used for [r] as for vocalic [r]. Palm down and finger tips curled down (bunched) or palm up and finger tips curled up (retroflex). Instructions Place the student’s hand beside the mouth.

Initial Screening Test for [r] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example: “Dog. Now you say it.” Word Student* Word

Student*

Beginning 1. Rain

_____________

6. Crayon

_____________

2. Root

_____________

7. Sprinkle

_____________

3. Rat

_____________

8. Stream

_____________

4. Priest

_____________

9. Scream

_____________

5. Tribe

_____________

Medial 10. Story

_____________

11. Gary

_____________

12. Earning

_____________

Final 13. Oar

_____________

16. Airport

_____________

14. Stair

_____________

17. Starve

_____________

15. Spear

_____________

18. Mark

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

347

Stimulability Tests for [r] Student’s Name: Date: __________________ Referral: Imitation 1. Rain

_____________

3. bear _____________

2. road

_____________

4. deer _____________

Key Environments Before a high front vowel 1. read

_____________ 2. reek _____________

Between vowels 1. eery

_____________

2. teary _____________

In a syllable-initial consonant velar cluster 1. Creek

_____________

2. Gray _____________

Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement ___________ Instruct the student to make a sound like a motor starting up, rerrrr. Shaping [r] from Vocalic [r] ___________ 1. Ask the student to say vocalic [r] (as in girl). 2. Next, ask the student to say vocalic [r] followed by [i] or some other vowel. 3. Instruct the student to say vocalic [r] + [i] several times as quickly as possible. Notes/Comments:

348

CHAPTER 13:  Consonantal [r]

349

Demonstrations for Consonantal [r] Place: Alveolar First Method   Objects: None Instructions: 1. Instruct the student, “Please stick out your tongue.” 2. Once the tongue is out, for [r] with the tongue tip raised ask the student to pull the tongue back to feel the bump on the roof of the mouth behind the two front teeth. For [r] with the tongue tip down, ask the student to pull the tongue back to feel the little bump behind the two lower teeth. Second Method   Objects:  Q-tip and peanut butter or other favored food Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food on alveolar ridge (for tongue tip raised [r]) or behind lower front teeth (for tongue tip lowered [r]). 3. Ask the student to touch the food with the tongue tip.

Manner: Liquid First Method   Objects: None Instructions:  Run your or the student’s finger down the student’s arm while making several long glides or liquids to demonstrate the “flowing” quality and length of this sound.

350

The late eight

Second Method   Objects:  Strip of paper, a feather, or a small paper flower taped on the end of a pencil Instructions:  Use a strip of paper, a feather, or the hand held in front of the student’s mouth while you produce several glides or liquids to draw attention to the “flowing” quality and continuous nature of the sounds. Alternatively, tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind.

Special Demonstration:  Bunched A Q-tip, small piece of candy, or other favored food sometimes is helpful in demonstrating where to place the tongue tip. First Method   Objects: None Instructions:  Ask the student to place the tongue tip behind the lower front teeth and to raise the body of the tongue toward the mouth roof. Second Method   Objects:  Q-tip or small piece of candy or other favored food Instructions: 1. Touch behind the student’s lower front teeth with a Q-tip to demonstrate where the tongue tip should be placed. Alternatively, place a small piece of candy or other favored food behind the lower front teeth and ask the student to hold it there with the tongue tip. 2. Once this is achieved, ask the student to raise the tongue body toward the mouth roof.

CHAPTER 13:  Consonantal [r]

351

Special Demonstration: Retroflex A Q-tip, small piece of candy, or other favored food sometimes is helpful in demonstrating where to place the tongue tip. Method   Objects: None Instructions: 1. Ask the student to place the tongue tip behind the upper front teeth. 2. Ask the student to curl the tongue backward without touching the roof of the mouth until it cannot go back farther.

Sides of Tongue (Bunched and Retroflex): Vocalic and Consonantal [r] A good [r] often is more easily achieved if the student is encouraged to say the sound while keeping the sides of the tongue touching the insides of the teeth. The following simple demonstration can be practiced in isolation or as part of the bunched and retroflex demonstrations. First Method   Objects: None Instructions: 1. Tell the student that his or her tongue is sleepy and wants to rest. 2. Instruct the student to let the tongue spread out in “its bed” until it is touching the insides of the teeth. Second Method   Objects:  Q-tip, candy, or other favored food

352

The late eight

Instructions: 1. Touch the inside teeth with a Q-tip or some favored food to demonstrate where the tongue should go. 2. Tell the student that his or her tongue is sleepy and wants to rest. 3. Instruct the student to let the tongue spread out in “its bed” until it is touching the insides of the teeth.

Voicing: Voiced First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and voiced [a]. Second Method   Objects: None Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects: None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, the student is asked to make [h] and [a]. Fourth Method   Objects: None Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off.

CHAPTER 13:  Consonantal [r]

353

Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a voiced and voiceless oral stop, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

354

The late eight

Phonetic Placement and Shaping Techniques for [r] Phonetic Placement Techniques First Method   Objects: None Instructions: Ask the student to make a sound like a motor starting up (ruh). Second Method   Object:  Tongue depressor (optional) Instructions: 1. Ask the student to place the tongue tip behind the upper front teeth. (If needed, place the student’s tongue tip on a shelf made with a tongue depressor.) 2. Next, ask the student to curl the tongue backward without touching the roof of the mouth until it cannot go back farther. 3. Lower the student’s jaw slightly and ask the student to say [ru].

Shaping Techniques [r] from vocalic [r]   These two methods are for a student who has mastered vocalic [r]. They are the methods the author uses most often to teach [r]. First Method Objects: None Instructions: 1. Ask the student to say vocalic [r]. 2. Next, ask the student to say vocalic [r] before a word beginning with [r]. For example, say read as vocalic [r] + [rid].

CHAPTER 13:  Consonantal [r]

355

3. After the student pronounces the words with vocalic [r] followed by consonantal [r], instruct him or her to say the vocalic [r] silently, which typically results in initial [r]. Second Method This method relies on the fact that a syllable that ends in vocalic [r] and is followed by a syllable beginning with a vowel will often result in a syllableinitial [r] as a type of transition between vocalic [r] and the vowel that follows. Objects: None Instructions: 1. Ask the student to say vocalic [r]. 2. Next, ask the student to say vocalic [r] followed by [i] or some other vowel. 3. Instruct the student to say vocalic [r] + [i] several times as quickly as possible, resulting in vocalic [r] + [ri]. After [ri] is established, instruct the student to say vocalic [r] silently. The resulting sound is [ri]. [r] from [w]   This method is for a student who substitutes [w] for [r] (gliding), but whose tongue is in the correct position for [r]. Such a student may need to be taught to reduce lip rounding. Object:  Tongue depressor (optional) Instructions: 1. Lower the student’s jaw slightly. 2. Ask the student to say [w] but to “let the lips go to sleep” or “make it with a little smile.” An alternative method is to tell the student, “No kissing frogs” to prompt an unround lip position. If needed, gently push the student’s lips back with a tongue depressor to an unrounded lip position. [r] from [a]   This and the following method are for students for whom you wish to establish [r] at the end of syllables. The methods demonstrate the technique for [ar] as

356

The late eight

in car and [ir] as in hear. The same technique works for all other vowels. To illustrate, to teach [or] simply replace [a] or [i] with [o]. When teaching [r] in this position, a useful trick is to have the student keep contact between the sides of the tongue and the inner teeth. Objects: None Instructions: 1. Ask the student to say ah. 2. Next, ask the student to raise the tongue slightly toward the roof of the mouth and say [ar]. (If needed, instruct the student to raise the tongue tip or to raise the tongue slightly and to say [a] forcibly.) The resulting sound is [ar]. [r] from [i]   Objects: None Instructions: 1. Ask the student to say [i]. 2. While the student says [i], ask him or her to lift the tongue and curl back the tongue tip to say [ir].

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

357

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student: “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Rain

1. __________________

Root

2. __________________

Relaxed

3. __________________

Rat

4. __________________

Rattle

5. __________________

Robot

6. __________________

Rug

7. __________________

Rainy

8. __________________

Red Sea

9. __________________

Raven

10. __________________

Total Correct: ________ / ________ Comments:

358

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:

Rat

sat

1. __________________

Rug

bug

2. __________________

Root

toot

3. __________________

Rattle

saddle

4. __________________

Reach

beach

5. __________________

Read

bead

6. __________________

Rocks

socks

7. __________________

Roast

toast

8. __________________

Run

sun

9. __________________

Rink

sink

10. __________________

Total Correct: ________ / ________ Comments:

359

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Rat

at

1. __________________

Rattle

addle

2. __________________

Read

Ed

3. __________________

Rocks

ox

4. __________________

Rhino

I know

5. __________________

Red

Ed

6. __________________

Reach

each

7. __________________

Rose

owes

8. __________________

Rita

eat a

9. __________________

Rome

om

10. __________________

Total Correct: ________ / ________ Comments:

360

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Rain

1. __________________

Root

2. __________________

Relaxed

3. __________________

Rat

4. __________________

Rattle

5. __________________

Robot

6. __________________

Rug

7. __________________

Rainy

8. __________________

Red Sea

9. __________________

Raven

10. __________________

Total Correct: ________ / ________ Comments:

361

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note: Replace * with the way the student used to say the sound. Word List:

Student Responses:

Rain

1. __________________

Root

2. __________________

Relaxed

3. __________________

Rat

4. __________________

Rattle

5. __________________

Robot

6. __________________

Rug

7. __________________

Rainy

8. __________________

Red Sea

9. __________________

Raven

10. __________________

Total Correct: ________ / ________ Comments:

362

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with _____ *, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note: Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Rain

1. __________________

Root

2. __________________

Relaxed

3. __________________

Rat

4. __________________

Rattle

5. __________________

Robot

6. __________________

Rug

7. __________________

Rainy

8. __________________

Red Sea

9. __________________

Raven

10. __________________

Total Correct: ________ / ________ Comments:

363

364

The late eight

Complete Word List for Consonantal [r] Beginning of Words Single Consonants

Deletions

Minimal Pairs

Rain vein, mane, pane, pain Root toot, moot Relaxed Rat at sat, mat, bat, pat, fat, hat,  cat Rattle addle saddle, battle, cattle Robot Rug bug, mug, jug, hug Rainy Red Sea Raven cave-in, maven Read bead, seed, weed Rabbit habit Roast toast, coast, most Rocks ox socks, box, fox Rhino I know Red Ed bed, wed, head Reach each beach, teach, leech Rowboat Russia Rose owes toes, mows Richard Reptile Railroad Ring sing, wing, king Rita eat a pita Rome om home, gnome Raccoon Rice ice mice, nice Rope soap, hope Row owe mow, no, know, sow, go Rugby Run sun, bun, one, gun, fun Rachel Road ode, owed toad, mowed Rink ink sink, wink, pink, link Room tomb

365

CHAPTER 13:  Consonantal [r]

Single Consonants

Deletions

Minimal Pairs

Wrestle trestle Ron on gone Roof goof Rainbow Realm elm helm Rake ache bake, make, lake, shake Race ace face, chase, lace Reef leaf Ruth Rust dust, bust Ram am Sam, Pam, lamb Raisin lazin’ Rod odd mod, sod, nod, god Roll bowl, goal Raincoat Roar oar, or tore, soar Rip whip, lip, hip Rinse mince Racket Write night, light, fight Ran an can, man, pan Reel eel kneel, feel, deal, Neal Robed Ripe pipe, type Rail ale nail, whale, mail, jail, veil,   tail, pail Rind mind, signed, bind Roy oi boy, toy Ray bay, say, May Ranch Rip tip, lip, whip, ship Rag bag, sag, nag Rebel Raid aid maid, jade Rhine mine, fine, sign Rend end bend, send, mend Ramon Rake ache bake, take, lake Rich itch witch, hitch

366

Consonant Clusters

The late eight

Deletions

[pr] Prize pies Price Prince Preschool Preach peach Prairie Perry Prowl Powell Pray pay Proof poof Prison Press Princess Prune Priest pieced Prick pick Pretzel Pray pay Pro [tr] Trip tip Track tack Train Trent tent Tractor Tree tea, T Trunk Tray Travel Tribe Tragic Trick tick Tramp Traffic Trap tap Trail tail Trash can Truck tuck Troll toll Tree house

CHAPTER 13:  Consonantal [r]

Consonant Clusters

Deletions

Trouble Treat teat Trailer tailor Trash Tracy Trish Tish [kr] Crab cab Crib Cradle Crown Crawl Crayon Crumbs comes Crow Crash cash Cricket Crete Christmas Chris kiss Croak Coke Creak Crossbow Crutch Crust cussed Crisp Cry [br] Bread bed Broom boom Brownie Brian Braces bases Britain Brick Bic Broken Bridge Branch

367

368

Consonant Clusters

The late eight

Deletions

Brake bake Broomstick Brazil Brain bane Bronze Age Brush Break bake [dr] Drink dink Driftwood Drive dive Driver diver Drill dill Dry die Drugstore Drag race Dragon Drum dumb Drawer Driveway Drag Dreaming deeming Drip dip Drizzle Dress Drain Dane Drummer dumber [gr] Grass gas Grease geese Great gate Grapefruit Grant Grave gave Grover Grizzly Group Grouchy

CHAPTER 13:  Consonantal [r]

Consonant Clusters

Deletions

Grapes gapes Ground Greece geese Great Dane Gray gay Green Grow go Grill gill Grocer [fr] Front Frown Fruit French fries Friday Fry fie Francis Frank Freeze fees Franklin Frog fog Frosting Friend fend Friar fire France [θr] Three thee Throw though Thrill Throttle Thrift shop Thread Throat Threw Throw rug Thriller Throne Thrifty

369

370

Consonant Clusters

The late eight

Deletions

Throwing Threshold Throng thong Thrive Thrash Through Thrush Threat Thrust Throb [Sr] Shrew rue Shredded Shrug rug Shrimp Shrub rub Shroud Shreveport Shrivel Shriek reek Shred red Shrill rill Shrink rink Shrine Rhine Shrewd rude [spr] Spring Spray spay Sprite (soda) spite Sprinkles Spray gun Spruce Spry spy Sprint Sprinkle Springboard Sprinkling Springtime

CHAPTER 13:  Consonantal [r]

Consonant Clusters

Deletions

Sprain Spain Sprinkler Spread sped Spring Sprig Spree Spruce Sprout Sprawl [str] Struck stuck Strum Strike out Strong Stroller Street Stranger Straw Stronghold Stripe String sting Strike zone Streetcar Stream steam Strap Strike Stretcher Strict sticked Stroke stoke Struggle Strut [skr] Screen Scribble Scream scheme Scratch Scrapper Scrooge

371

372

Consonant Clusters

The late eight

Deletions

Screenplay Scrub Screw Script skipped Scramble Scribe Scrap Scroll Scrimp skimp Scrabble Screech Consonant + [r]

Deletions

Britain Prize pies Trap tap Price Prince Throat Preschool Bridge Prairie Perry Frosting Prowl Pray pay Grease geese Prison Trouble Priest pieced Trip tip Crayon Travel Drummer dumber Tribe Drip dip Trick tick Prune Tramp Traffic Grow go

CHAPTER 13:  Consonantal [r]

Consonant + [r]

Deletions

Truck tuck Frog fog Troll toll Driver diver Trailer tailor Trish Tish Crib Trash can Crown Prick pick Crawl Thrill Crow Track tack Crash cash Drugstore Cricket Trail tail Crete Dress Croak Coke Friar fire Creak Tree house Crutch Preach peach Crust cussed Princess Crisp Bronze Age Cry Bread bed Tracy Brownie Tree tea, T Brian Tragic Brake bake Green Broomstick Crumbs comes Brazil

373

374

Consonant + [r]

The late eight

Deletions

Crab cab Brain bane Shriveled Brush Pro Break bake Train Crossbow Trunk Press Tray Drink Friday Driftwood Throttle Drive dive Broken Drill dill Christmas Dry die Brick Drag race Friend fend Drawer Driveway Trash Drag Tractor Drizzle Broom boom Drain Dane Grass gas Prof Great gate Grapefruit Grant French fries Grave gave Freeze fees Grizzly Group Grouchy

CHAPTER 13:  Consonantal [r]

Consonant + [r]

Deletions

Drum dumb Grapes gapes Braces bases Gray gay Shroud Grill gill Branch Grocer Front Frown Pray pay Fruit Dreaming deeming Fry fie Trent tent Francis Chris kiss Frank Thriller Franklin France Three Shriek sheik Throw Thrush Cradle Thread Dragon Throw rug Grover Thrum thumb Greece geese Thrift shop Shrimp Pretzel Shrub Great Dane Shrew shoe Ground Shrink

375

376

Consonant + Consonant + [r]

The late eight

Deletions

Scribe Spring Scrooge Strike out Sprint Sprawl String bean Sprinkle Stream steam Scream scheme Straight state Spray spay Straw stall Sprinkler Strut Spry spy Scrawny Sprinkling Stride Sprig Street Spruce Stretcher Springboard Strudel Stripe Spread sped Strap Scratchy Spree Stretch Scribble Strange Scrub Stroller Sprinkles Screw Springtime Strong Scrapbook Spray gun String sting

377

CHAPTER 13:  Consonantal [r]

Consonant + Consonant + [r]

Deletions

Sprout Screech Sprain Spain Scratch Sprite spite

Medial Single Consonants Story Garage Tourist Gary Berry Beret Earring Forest Syringe Marry Laura Eric Barrel Zero Arrow Europe Merry Peru Harry Sheriff Cairo Arrest Burro Ferry Irish Weary Sarah Zorro Very Terry Hero Carol Far East Consonant Clusters [pr] Surprise Apron Depressed Supreme Blueprint Cypress Footprint Soundproof Shipwreck April [tr] Country Portrait Mattress Subtract Actress Pine tree Pantry Waitress Subtract Fire truck Race track Entrance Matrix Detroit Patrick

378

The late eight

Consonant Clusters [kr] Secret Concrete King crab Aircraft Witchcraft Akron Across Red Cross Pie crust Red Crescent Recruit Cockroach Scarecrow Spacecraft [br] Umbrella Toothbrush Hairbrush Fabric Hebrew Zebra Cornbread Library Cambridge [dr] Laundry Gumdrop Hydrant Address Bedroom Ear drop Hundred Madrid Raindrop Children Soft drink [gr] Regret Pilgrim School grounds Hungry Bridegroom Background Agree Photograph Congress Angry [fr] Defrost Deep freeze French fries Afraid Bullfrog Grapefruit Cold front Boyfriend [ðr] Bathrobe

Drive through

Heart throb

[ʃr] Mushroom

Washrag Washroom

379

CHAPTER 13:  Consonantal [r]

Consonant Clusters [spr] Hot springs Hair spray Bedspread Offspring [str] Bloodstream Shoestring High-strung Construct Backstroke Nostril Monstrous Nostril Pastry [skr] Ice cream Corkscrew Describe Muskrat

Subscribe

All Consonant Clusters Subscribe Ear drop Soft drink Portrait Witchcraft Akron Subtract Fire truck Regret Construct Red Cross Hungry Surprise Afraid Hundred Depressed Recruit Agree Cypress Pie crust Spacecraft Country Gumdrop Congress Cold front Bloodstream Deep freeze Monstrous Cockroach Pilgrim Entrance Umbrella Bedspread Patrick Corkscrew Bridegroom Secret Fabric April Blueprint Hydrant Photograph Muskrat Cornbread Hot springs Aircraft Address School grounds Raindrop Toothbrush Children Across Hebrew Background Red Crescent Pantry Apron Shipwreck Defrost Angry Scarecrow Bedroom Bullfrog Matrix Hairbrush Library Concrete Madrid Boyfriend

380

The late eight

All Consonant Clusters King crab Heart throb Shoestring Subtract Mushroom Backstroke French fries Footprint Mattress Supreme Washrag Nostril Grapefruit Zebra High-strung Bathrobe Laundry Nostril Actress Washroom Pastry Waitress Detroit Ice cream Race track Hair spray Pine tree Drive through Offspring Describe Cambridge Soundproof Shoestring All Environments Subscribe Red Crescent Address Portrait Shipwreck Toothbrush Weary Carol Hebrew Subtract Scarecrow Forest Construct Matrix Pantry Surprise Marry Defrost Depressed Barrel Bedroom Cypress Concrete Beret Country Ear drop Hairbrush Garage Witchcraft Madrid Zero Fire truck Soft drink Cold front Red Cross Akron Monstrous Tourist Harry Entrance Afraid Regret Story Recruit Syringe Gary Pie crust Hungry Earring Gumdrop Hundred Irish Laura Agree Patrick Bloodstream Hero Secret Cockroach Spacecraft Very Umbrella Congress Blueprint Arrest Arrow Muskrat Corkscrew Deep freeze Berry Fabric Pilgrim Aircraft Hydrant Bedspread Raindrop Cornbread Bridegroom Across Europe April

CHAPTER 13:  Consonantal [r]

381

All Environments Photograph Bathrobe Sheriff Hot springs Actress Hair spray School grounds Waitress Offspring Eric Zorro Ferry Children Race track Soundproof Background Drive through Shoestring Apron Cambridge Terry Angry Cairo Backstroke Bullfrog Heart throb Mattress Library Mushroom Nostril Peru Sarah High-strung Boyfriend Footprint Burro King crab Washrag Nostril Subtract Zebra Pastry French fries Far East Ice cream Supreme Laundry Pine tree Merry Washroom Describe Grapefruit Detroit Hair spray Sheriff

End of Words End of Words* *Deletions are not included for [r] at the end of words. The [r] lowers the preceding vowel, making the deletions task for this sound less useful for most students. Car Guitar Oar Stair Spear Door Poor Jar Seashore Tear Year Bazaar Bar

382

End of Words Ore Pier Software Soar Share Hear Ear Space bar Bookstore Pour Air Snack bar Stare Frontier War Pear Nightmare Cheer New Year Star Scar Swear Scare North Star Chair Downpour Steer Senor Mare Shore Air Bear Boar Square Hair Éclair Four Floor Boar Store

The late eight

CHAPTER 13:  Consonantal [r]

Consonant Clusters [rt] Art Airport Court Port Head Start Heart Tart Starve [rk] Arc Mark Bark Pitchfork Denmark Ark Dark New York Pork Fork [rb] Rhubarb Barb [rd] Beard Blackboard Lord Flashcard Hard Bored Hoard Award

Deletions

383

384

Consonant Clusters [rg] Morgue Borg [rm] Arm Farm Storm Snowstorm [rn] Born Corn Horn Thorn Torn Popcorn Acorn [rs] Horse [rʃ ] Borscht [rtʃ ] Arch March Porch Starch Torch Research

The late eight

Deletions

CHAPTER 13:  Consonantal [r]

Consonant Clusters [rd] Barge Large Forge George [r] + consonant Snowstorm Art Denmark Airport Starve Mark George Acorn Bark Torn Pitchfork Farm Dark Popcorn Fork Rhubarb Port Beard Pork Blackboard Borg Lord Barb Flashcard Court Hard Tart Bored Arc Hoard New York

Deletions

385

386

The late eight

Consonant Clusters

Deletions

Award Morgue Arm Porch Storm Born Forge Horn Torch Thorn Horse Borscht Arch Heart March Corn starch Research Barge Ark Large Head Start

Themes for Consonantal [r] Themes Around the Home Food Animals Scary Noises

Halloween Stories People to See Places to Go

Around the Home

Deletions

Rug ugh Trash Floor flow Chair Stair Rake ache Rag

Minimal Pairs bug, mug, jug, hug

bake, take, lake bag, sag, nag

387

CHAPTER 13:  Consonantal [r]

Around the Home

Deletions

Minimal Pairs

Garage Roof goof Room tomb Door Broom Food

Deletions

Minimal Pairs

Roast toast, most, coast Sprinkles Strudel String bean Rice ice mice, nice Rich itch witch, hitch Fruit French fries Pear Frosting Snack bar Éclair Prune Sprite spite Cornbread Raisin lazin’ Pretzel Crab cab Crumbs comes Crust cussed Bread bed Brownie Grapefruit Grapes gapes Shrimp King crab Pie crust Gumdrop Soft drink Pastry pasty Mushroom Ice cream Popcorn

388

Food

The late eight

Deletions

Minimal Pairs

Deletions

Minimal Pairs

Corn Rhubarb Pork Tart Borscht Animals

Rat at Dragon Burro Raven Rabbit Rhino Reptile Frog fog Raccoon Ram am Great Dane Shrew Cockroach Crow Roar oar Steer Mare May Bear bay Boar Grizzly Shrimp Bullfrog Muskrat Horse Zebra Cricket Scary Noises

Deletions

Hear he Ear E Croak Coke

sat, mat, bat, pat, fat, hat, cat cave-in, maven habit

Sam, Pam, lamb

tore, soar, more, boar

Minimal Pairs

389

CHAPTER 13:  Consonantal [r]

Scary Noises

Deletions

Minimal Pairs

Creak Scratchy Screech Shriek sheik Drip dip Cry Bark Roar oar

tore, soar, more, boar

Halloween Stories

Minimal Pairs

Deletions

Trick tick Treat teat Hoard hoed Heart Rend end Afraid Witchcraft Strange Shroud Shriveled Thriller Thrill Friar fire Grave gave Dreaming Broomstick Crossbow Crown Tree tea, T Trunk Princess Scare Nightmare Spear Arrow Forest Hero Ring Rain Story

bend, send, mend

sing, wing, king vein, mane, pane, pain

390

Halloween Stories

The late eight

Deletions

Minimal Pairs

Downpour Hair hay, hey Priest pieced Secret Children Dark Morgue Storm Thorn Torch People to See

Deletions

Rose owes Richard Rita eat a Rachel Ron on Ruth Rod odd Roy Oi Ramon Ray A Gary Harry Zorro Laura Sarah Terry Carol Eric Tracy Trish Tish Brian Patrick April Scrooge Franklin Grover Francis Frank

Minimal Pairs toes, mows pita

mod, sod, nod, god boy, toy bay, say, May

391

CHAPTER 13:  Consonantal [r]

People to See

Deletions

Minimal Pairs

George Barb Bob Mark Chris kiss Places to Go

Deletions

Red Sea Russia Rome om Europe Far East Peru Cairo North Star Rhine Crete Brazil Britain Detroit Greece geese France (The) Matrix Akron New York Denmark Madrid

Minimal Pairs

home, gnome, roam

mine, fine, sign

Chapter Fourteen

[ ʃ ] Definition

[ ʃ ] is made behind the alveolar ridge, a little behind the position for [s]. The tongue blade is raised, and the lips are rounded. The airstream is continuous and the vocal folds are apart. The technical definition of [ ʃ ] is voiceless postalveolar fricative.

Acquisition [ ʃ ] is acquired by 50% of children by 3;6 and by 75% of children by 5;0.

Relative Frequency [ ʃ ] is ranked sixth in relative frequency compared with the other lateacquired consonants. It ranks nineteenth in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 1.5%.

Errors [s] for [ ʃ ] is a common error. A younger student may pronounce [ ʃ ] as [t] or [d]. A less common, though not rare error, is pronouncing [ ʃ ] as [tʃ ].

393

394

The late eight

Key Environments End of a syllable, as in fish By a high back vowel, as in shoe

Possible Metaphors The best metaphors for [ ʃ ] typically focus on the fricative nature of the sound. Tongue placement: Back of the hill sound Fricative:

Hushing sound Shhh! sound Quiet sound Long sound

Voicing:

Motor on Buzzing sound Voice box on sound



Touch Cue Finger in front of lips and use the metaphor “quiet sound.” Instructions Place the student’s finger in the corner of the lips, and remind the student that this is the quiet sound.

Initial Screening Test for [ ʃ ] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example: “Dog. Now you say it.” Word Student* Beginning 1. Shell

_____________

2. Shutter

_____________

3. Show

_____________

4. Shrug

_____________

5. Shrimp

_____________

6. Shred

_____________

Medial 7. Wishing

_____________

8. Ocean

_____________

9. Washer

_____________

Final 10. Dish

_____________

11. Crush

_____________

12. Irish

_____________

13. Harsh

_____________

14. Marsh

_____________

15. Borscht

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

395

Stimulability Tests for [ ʃ ] Student’s Name: Date: __________________ Referral: Imitation 1. shoe _____________ 2. bush

_____________

Key Environments End of a syllable or word 1. fish

_____________

2. [ish] _____________ Before a high front vowel 1. she _____________ 2. shy _____________ Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement ___________ 1. Ask the student to hiss like a snake. 2. While the student hisses, ask him or her to purse the lips. Shaping [ ʃ ] from [s] _______________ 1. Ask the student to say [s]. 2. Instruct him or her to pucker the lips slightly and to draw the tongue back a little until [ʃ] results. Notes/Comments:

396

397

CHAPTER 14:  [ S ]

Demonstrations for [ ʃ ] Place: Postalveolar First Method   Objects: None Instructions:  Ask the student to run the tongue to where the bump on the mouth roof just begins to go down toward the back of the mouth, using an analogy of a “hill and valley.” Second Method   Objects:  Q-tip and peanut butter or other favored food Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food behind the alveolar ridge. 3. Ask the student to touch the food with the tongue blade.

Manner: Fricative First Method   Objects:  Strip of paper or a feather Instructions: 1. Place a strip of paper, a feather, or the student’s hand held in front of your mouth while you produce several long voiceless fricatives. 2. Draw attention to the “hissing” quality and continuous nature of the sounds. Second Method   Objects:  A small paper flower on end of a pencil

398

The late eight

Instructions:  Tape a small paper flower on the end of a pencil and encourage the student to move the flower in the wind. Third Method   Objects: None Instructions:  Run your finger or the student’s finger down the student’s arm while making several long voiceless fricatives to demonstrate the “hissing” quality and length of fricatives.

Voicing: Voiceless First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and voiced [a]. Second Method   Objects: None Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects: None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, the student is asked to make [h] and [a]. Fourth Method   Objects: None

CHAPTER 14:  [ S ]

399

Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off. Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a voiced and voiceless oral stop, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

400

The late eight

Phonetic Placement and Shaping Techniques for [ ʃ ] Phonetic Placement Technique Method   In this book there is only a single phonetic placement exercise for [ ʃ ]. Most often, the sound is easily established through a demonstration or a shaping exercise. Objects:  Tongue depressor (optional) Instructions: 1. Ask the student to part the teeth and lips. 2. Touch the student’s tongue just behind the tip with a tongue depressor. Ask the student to move the place just touched to the roof of the mouth behind the “bumpy part.” (If needed, a tongue depressor may be used to push the tongue back from the upper front teeth.) 3. Next, ask the student to lower the tongue slightly. (If needed, direct the tongue down slightly with a tongue depressor.) 4. Ask the student to hold this position, pucker the lips slightly, and breathe out through the mouth, resulting in [ ʃ ].

Shaping Techniques [ ʃ ] from [s]   This is a good, efficient method for a student with a well-established [s]. Objects: None Instructions: Ask the student to say [s]. While the student is saying [s], instruct him or her to pucker the lips slightly and to draw the tongue back a little until [ ʃ ] results. [ ʃ ] from [Z]   Most students do not have a well-established [ Z ] before having a well-established [ ʃ ]. For those who do, however, this method works well.

CHAPTER 14:  [ S ]

401

Objects: None Instructions:  Ask the student to say [Z] and then turn off the voice, which often results in [ ʃ ]. [ ʃ ] from [i]   As for the [ ʃ ] from [i] shaping technique, this technique relies on the fact that [ ʃ ] and [i] are made near the same place of production. Objects: None Instructions: 1. Ask the student to say [i], first with the voice on and then with the voice off. 2. Next, ask the student to pucker the lips slightly. 3. Raise the student’s lower jaw slightly. 4. Ask the student to breathe out silently while raising the tongue. The sound produced is [ ʃ ].

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

402

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student: “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Shoe

1. __________________

Sheep

2. __________________

Shiny

3. __________________

Shut

4. __________________

Sharon

5. __________________

Shovel

6. __________________

Shell

7. __________________

Shutter

8. __________________

Show

9. __________________

Shannon

10. __________________

Total Correct: ________ / ________ Comments:

403

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student responses:

Shoe

goo

1. __________________

Ship

chip

2. __________________

Sheet

feet

3. __________________

Show

row

4. __________________

Shoe

two

5. __________________

Shake

lake

6. __________________

Shy

hi

7. __________________

Shore

tore

8. __________________

Shear

tear

9. __________________

Shock

knock

10. __________________

Total Correct: ________ / ________ Comments:

404

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Shoe

ooh

1. __________________

Sharon

Aaron

2. __________________

Shell

L

3. __________________

Shutter

utter

4. __________________

Show

o, owe

5. __________________

Sheet

eat

6. __________________

Shade

aid

7. __________________

Shy

I, eye

8. __________________

Sheik

eek

9. __________________

Shower

hour

10. __________________

Total Correct: ________ / ________ Comments:

405

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Shoe

1. __________________

Sheep

2. __________________

Shiny

3. __________________

Shut

4. __________________

Sharon

5. __________________

Shovel

6. __________________

Shell

7. __________________

Shutter

8. __________________

Show

9. __________________

Shannon

10. __________________

Total Correct: ________ / ________ Comments:

406

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note:  Replace * with the way the student used to say the sound. Word List:

Student Responses:

Shoe

1. __________________

Sheep

2. __________________

Shiny

3. __________________

Shut

4. __________________

Sharon

5. __________________

Shovel

6. __________________

Shell

7. __________________

Shutter

8. __________________

Show

9. __________________

Shannon

10. __________________

Total Correct: ________ / ________ Comments:

407

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with _____ *, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note:  Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Shoe

1. __________________

Sheep

2. __________________

Shiny

3. __________________

Shut

4. __________________

Sharon

5. __________________

Shovel

6. __________________

Shell

7. __________________

Shutter

8. __________________

Show

9. __________________

Shannon

10. __________________

Total Correct: ________ / ________ Comments:

408

409

CHAPTER 14:  [ S ]

Complete Word List for [ ʃ ] Beginning of Words Single Consonants

Deletions

Minimal Pairs

Shoe oo goo, boo, new, dew, Sue Sheep cheep, keep, peep, jeep,   deep, leap Shiny Shut mutt, gut Sharon Aaron Shovel hovel Shell L bell, fell Shutter utter gutter, butter Show o, owe bow, go, toe, mow Shannon cannon Sheet eat feet, meat, neat, beet, beat Shade aid paid, raid, wade Shortcake Shield field, kneeled Sugar bugger Cheryl barrel, Carol Shock knock, rock, sock, lock Shy I, eye hi, lie, die, buy, cry Shellfish Shine vine, sign, nine, line Sherlock Sheik eek beak, meek, seek, peek Shower hour tower, power, cower Shortcut Shaw awe law, saw Shed Ed dead, said, wed, head Shout out pout Shady Shane pain, sane, bane, mane Sherbet Shamrock Shore or, ore tore, more, core, chore Shoelace Shortbread Shadow Shirt hurt, dirt

410

Single Consonants

The late eight

Deletions

Minimal Pairs

Shepherd Shape ape cape, nape, tape Shakespeare Shark arc, ark dark, bark, lark Sheriff Ship chip, sip, hip, zip, whip,   rip, lip Shampoo Shush hush, mush Shake ache lake, bake, make, rake Short court Shaft aft raft, laughed Shuffle ruffle Shoe oo two, new, boo, dew Shadow Shear ear tear, near, beer, seer Shop hop, pop, mop Sharp tarp, carp Sham aim came, tame, same Shed Ed bed, Ned, red Shaggy Aggie baggy Shift gift, lift Shave pave, knave Shanty ante Shiver liver, giver Shade aid laid, maid, paid Shelter Shabby abbey cabbie, tabby Shape tape, nape Shot hot, got, pot, rot Shock rock, sock, knock Shaking aching baking, making Shower hour power, tower, bower Shoulder older colder, bolder Shelob Shale ail, ale mail, nail, pail, tail Shallow aloe callow, tallow Shelf elf Sham am ram, Pam, Sam, ham Show O row, tow, mow, go Share air, heir care, mare, tear Shuttle

411

CHAPTER 14:  [ S ]

Consonant Clusters

Deletions

Minimal Pairs

Shrew rue grew, true, brew Shredded breaded Shrug rug drug Shrimp crimp Shrub rub grub Shroud crowd Shreveport Shrug rug Shrivel drivel Shriek reek creek Shred red tread, bread Shrill rill trill, krill Shrink rink brink Shrine Rhine Shrewd rude crewed, brewed

Medial Single Consonants Wishing Washcloth Woodshed Ocean Bushes Fractions Washer Dishes Flash card Banshee Windshield Nashville Fishing Ashes Dishcloth Rickshaw Flashlight Push-ups Sunshine Dashboard Seashore Glacier Snowshoe Washtub Handshake Washing Fishy Steamship Consonant Clusters —

412

The late eight

End of Words Single Consonants

Deletions

Mustache Trash Dash Goldfish Irish Dish Crush British Crawfish Mash Crash Toothbrush Fish Cash Catfish Hush Spanish Ash Wash Welsh well Paintbrush Leash Lee Clash Trish Push Nailbrush Flush Wish Splash Car wash Bush Josh Rubbish Smash Danish Mouthwash

413

CHAPTER 14:  [ S ]

Consonant Clusters

Deletions

Harsh Marsh mar Borscht bore

Themes for [ ʃ ] Themes People to See Places to Go Animals Things That Go Bump in the Night People to See

Watery Places Things to Eat Washing Dishes

Deletions

Minimal Pairs

Sharon Shannon cannon Cheryl barrel, Carol Sherlock Shaw awe Shane cane, bane, mane Shakespeare Irish Ash Wash Welsh well Spanish British Shaggy Aggie baggy Shelob Trish Josh Danish Places to Go Nashville Shreveport

Deletions

Minimal Pairs

414

Animals

The late eight

Deletions

Minimal Pairs

Sheep cheep, keep, peep, jeep,   deep, leap Shark dark, bark, lark Goldfish Fish Crawfish Catfish Shrew rue true, brew, grew Shrimp Things That Go Bump

Deletions

Minimal Pairs

Banshee Shelob Shape tape, nape Shiver liver, giver Shade aid laid, maid, paid Sharp tarp, carp Shadow Shock rock, sock, knock Shaking aching baking, making Shrivel drivel Shriek reek creek Watery Places

Deletions

Shale ail, ale Shallow aloe Ocean Fishing Seashore Shelf elf Fishy Shark Shore or, ore Ship Splash Shell L Goldfish

Minimal Pairs mail, nail, pail, tail callow, tallow

dark, bark, lark tore, more, core, chore chip, sip, hip, zip, whip, rip, lip bell, fell

415

CHAPTER 14:  [ S ]

Watery Places

Deletions

Minimal Pairs

Shower Crawfish Catfish Shrimp Steamship

hour

power, tower, bower

Things to Eat

Deletions

Minimal Pairs

Shortcake Sugar Shellfish Fish Crawfish Catfish Shrimp Shake ache Sherbet Shortbread Borscht bore Washing Dishes

Deletions

Dish Rubbish Splash Trash Dishes Washcloth Washing Washer Shine

lake, bake, make, rake

Minimal Pairs

vine, sign, nine, line

Chapter Fifteen

[tʃ ] Definition

[tʃ ] is made with the body of the tongue touching the mouth roof behind the bumpy ridge (alveolar ridge). The lips are slightly puckered. The airstream is stopped and then becomes continuous, making it a short stop ([t]) followed by a fricative ([tʃ ]). The vocal folds are apart. The technical definition of [tʃ ] is voiceless postalveolar affricate.

Acquisition [tʃ ] is acquired by 50% of children by 4;6 and by 75% of children by 5;6.

Relative Frequency [tʃ ] is ranked eighth in relative frequency compared with the other late-acquired consonants. It ranks twenty-second in relative frequency compared with all other English consonants, and its percentage of occurrence compared with all English consonants is 0.7%.

Errors Errors for [tʃ ] typically keep either the stop or fricative component of the sound. Both [t] for [tʃ ] and [s] for [ʃ ] are common. 417

418

The late eight

Key Environments End of a syllable, as in batch By a high back vowel, as in chew

Possible Metaphors The best metaphors for [tʃ ] typically focus on the affricate (stop-fricative) quality of the sound. Affricate quality:

Choo-choo sound Sneezing sound (choo!) Engine-chugging sound

Tongue placement: Back of the hill sound Voicing:

Motor on Buzzing sound Voice box on sound

Touch Cue None

Initial Screening Test for [tʃ ] Student’s Name: Date: __________________ Referral: Instructions:  Say to the student, “I’m going to say some words. Please say the words after me.” Example:  “Dog. Now you say it.” Word Student* Beginning 1. Chain

_____________

2. Chip

_____________

3. Chunk

_____________

Medial 4. Peaches

_____________

5. Itchy

_____________

6. Teacher

_____________

Final 7. Witch

_____________

8. Sketch

_____________

9. Itch

_____________

10. Porch

_____________

11. Starch

_____________

12. Punch

_____________

*Suggestion:  Transcribe an X if the sound is correct or, if incorrect, phonetically transcribe the error. Ignore errors produced elsewhere in the word.

Comments/Notes:

419

Stimulability Tests for [tʃ ] Student’s Name: Date: __________________ Referral: Imitation 1. chip _____________ 2. catch

_____________

Key Environments End of a syllable or word 1. [Itʃ ]

_____________

2. watch

_____________

After a high front vowel 1. beach

_____________

2. itch

_____________

Favorite Words Names of family members:  Favorite people, heroes, and activities:  Phonetic Placement _____________ 1. Ask the student to make the train sound, “choo choo.” Shaping _____________ 1. Instruct student to say “Bet you” slowly. 2. Next, instruct student to say “Bet you” fast, resulting in the production of “Betcha.” 3. If “betcha” doesn’t work, repeat with “Got you.” Notes/Comments:

420

421

CHAPTER 15:  [tS ]

Demonstrations for [tʃ ] Place: Postalveolar First Method   Objects: None Instructions:  Ask the student to run the tongue to where the bump on the mouth roof just begins to go down toward the back of the mouth, using an analogy of a “hill and valley.” Second Method   Objects:  Q-tip and peanut butter or other favored food Instructions: 1. Instruct the student, “Please open your mouth.” 2. Once the mouth is open, with Q-tip dab a little peanut butter or other favorite food behind the alveolar ridge. 3. Ask the student to touch the food with the tongue blade.

Manner: Affricate Method   Objects: None Instructions:  Have the student hold his or her hands together tightly and then separate them quickly to indicate the stop onset and fricative release of affricates.

Voicing: Voiceless First Method   Objects: None Instructions: Instruct the student to listen to and identify the difference between a voiceless and voiced [a].

422

The late eight

Second Method   Objects: None Instructions:  Place the student’s hands over the ears and instruct him or her to hum, which heightens the sensation of vocal cord vibration. Third Method   Objects: None Instructions:  If the student is able to produce a voiced and voiceless fricative, ask him or her to cover the ears and make these sounds. Alternatively, the student is asked to make [h] and [a]. Fourth Method   Objects: None Instructions: You and the student place one hand on your throat and the other on the student’s throat while making voiced and voiceless sounds together, telling each other when the voicing goes on and off. Fifth Method   Objects: Pencil or tongue depressor and small piece of paper or small paper flower Instructions:  If the student is able to produce a voiced and voiceless oral stop, attach a small piece of paper or a paper flower to the end of a tongue depressor or pencil and ask the student to “make the paper (or flower) move.” The paper is more likely to move when a voiceless consonant is produced than when a voiced consonant is produced (be careful in providing instructions to the student, however, because a strongly articulated voiced oral stop will also move the flower).

423

CHAPTER 15:  [tS ]

Phonetic Placement and Shaping Techniques for [tʃ ] Phonetic Placement Technique Method   Objects: None Instructions: 1. Ask the student to pucker the lips slightly. 2. Ask the student to make the tongue tip touch “the bump” behind the two upper front teeth. 3. Next, instruct the student to make the sneezing sound (choo!) while keeping the lips slightly puckered and the tongue tip on the alveolar ridge. If [ts] results, ask the student to move the tongue tip back slightly while maintaining contact with the roof of the mouth. The resulting sound is [tʃ ].

Shaping Technique [tʃ ] from [ ʃ ]   Objects: None Instructions:  Ask the student to say a quick [ ʃ ] with the tongue tip touching “the bump,” resulting in [tʃ ]. (Note: To facilitate [dZ], develop from [d].) [tʃ ] from [t] and [ S ]   Objects: None Instructions: 1. Explain that [tʃ ] is [t] and [ʃ ] said together very quickly. 2. Next, ask the student to say [ʃ ]. 3. Instruct the student to say [t] and then to draw the tongue tip back a little and say [t] again. 4. With the student’s tongue tip in the position for the “back” [t], instruct the student to quickly say [t] followed by [ʃ ], which typically results in [tʃ ]. (Note: To facilitate [dZ], develop from [d] and [dZ].)

424

The late eight

[tʃ ] from [ts]   This method modifies [ts], as in pizza into [tʃ ] Objects: None Instructions: 1. Instruct the student to say pizza. 2. Next, ask the student to say only the [ts] in pizza. (If needed, have the student divide pizza into two parts — pizza — and then ask the student to say only the second part — zza. 3. Next, ask the student to say [ts] farther back in the mouth, resulting in [tʃ ].

Shell for Speech Exercises Student’s Name: Date: __________________ Treatment Sound: __________________ Word List:

Student Responses:



1. __________________



2. __________________



3. __________________



4. __________________



5. __________________



6. __________________



7. __________________



8. __________________



9. __________________



10. __________________

Total Correct: ________ / ________ Comments:

425

Imitation Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student repeat the word after you. Instructions to Student: “You are going to hear a word with our sound. Please say it after me. Here’s an example. I say sat, and then you say sat.” Word List:

Student Responses:

Cheese

1. __________________

Chicken

2. __________________

Chief

3. __________________

Cheat

4. __________________

Chain

5. __________________

Chip

6. __________________

Chunk

7. __________________

Church

8. __________________

Chuck

9. __________________

Chop

10. __________________

Total Correct: ________ / ________ Comments:

426

Minimal Pairs Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. Instructions to Student: “You are going to hear a word that begins with our sound. Please say the word, then replace our sound with another sound to make the word have a different meaning, and then say the word with our sound again. Here’s an example. I say seal. You say seal, then change [s] to [w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.” Word List:

Student Responses:

Chore

boar

1. __________________

Chill

pill

2. __________________

Charge

barge

3. __________________

Chunk

skunk

4. __________________

Cheese

peas

5. __________________

Cheep

sheep

6. __________________

Chum

mum

7. __________________

Chop

shop

8. __________________

Chest

test

9. __________________

Cheer

fear

10. __________________

Total Correct: ________ / ________ Comments:

427

Deletion Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. Instructions to Student: “You are going to hear a word with our sound. Please say the word, and then say it with our sound deleted, and then say it with our sound included. Here’s an example. I say red. You say red, then Ed, then red. Like this: Red. Ed. Red.” Word List:

Student Responses:

Cheese

ease

1. __________________

Cheat

eat

2. __________________

Chew

oo

3. __________________

Chase

ace

4. __________________

Chin

in

5. __________________

Cheek

eek

6. __________________

Chicks

icks

7. __________________

Chess

S

8. __________________

Chill

ill

9. __________________

Cherry

airy

10. __________________

Total Correct: ________ / ________ Comments:

428

Self-Correction Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word three times, self-correcting if errors in the treatment sound occur. Instructions to Student: “You are going to hear a word with our sound. Please say the word three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Here’s an example. I say cheese, and then you say cheese three times, listening to how you say our sound and changing it to make it correctly if you say it incorrectly. Like this: Cheese. Cheese. Cheese.” Word List:

Student Responses:

Cheese

1. __________________

Chicken

2. __________________

Chief

3. __________________

Cheat

4. __________________

Chain

5. __________________

Chip

6. __________________

Chunk

7. __________________

Church

8. __________________

Chuck

9. __________________

Chop

10. __________________

Total Correct: ________ / ________ Comments:

429

Old Way/New Way Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student say the word the new way, the old way, and then the new way again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then say it the old way you used to say our sound, and then say it the new way you say our sound. Here’s an example. I say thin. You say thin, then *in, and then thin. Like this: Thin. *in. Thin.” Note:  Replace * with the way the student used to say the sound. Word List:

Student Responses:

Cheese

1. __________________

Chicken

2. __________________

Chief

3. __________________

Cheat

4. __________________

Chain

5. __________________

Chip

6. __________________

Chunk

7. __________________

Church

8. __________________

Chuck

9. __________________

Chop

10. __________________

Total Correct: ________ / ________ Comments:

430

Similar Sound Student’s Name: Date: __________________ Treatment Sound: __________________ Goal:  Have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again. Instructions to Student: “You are going to hear a word with our sound. Please say the word, then replace our sound with _____*, and then say the word with our sound. Here’s an example. I say sun. You say sun, then *un, and then sun again. Like this: Sun. *un. Sun.” Note: Replace * with a sound the student can pronounce that is phonetically similar to the treatment sound. Word List:

Student Responses:

Cheese

1. __________________

Chicken

2. __________________

Chief

3. __________________

Cheat

4. __________________

Chain

5. __________________

Chip

6. __________________

Chunk

7. __________________

Church

8. __________________

Chuck

9. __________________

Chop

10. __________________

Total Correct: ________ / ________ Comments:

431

432

The late eight

Complete Word List for [tʃ ] Beginning of Words Single Consonants

Deletions

Minimal Pairs

Cheese ease peas, keys, knees Chicken sicken Chief thief, beef, leaf Cheat eat seat, meat, heat, wheat Chain Spain, gain, lane, pain Chip ship, hip, sip, rip, lip, whip,   zip, dip Chunk skunk, junk Church Chuck luck, buck, tuck Chop shop, cop, pop, top, hop,  mop Chew oo zoo, moo, two, shoe, new, boo Chase ace pace, race, case Chapter raptor Charge barge, large, Marge Chirp Chin in pin, thin Checkers Charles Cheek eek peek, seek, week, leak Cheetah Chicks eek six, mix Chess S Wes, mess, less Chill ill pill, gill, Bill, mill Chest test, pest, vest, nest, west Cherry airy Sherry, merry, berry Chilly Willy, Billy, hilly Champ amp ramp, lamp, damp Chalk balk, talk Chick ick lick, sick, wick Child tiled, piled Chili Willy, Billy, hilly Cheer ear fear, hear, deer, near, year Cheep sheep, jeep, deep, leap Choke oak soak, poke

433

CHAPTER 15:  [tS ]

Single Consonants

Deletions

Minimal Pairs

Chair air mare, care, fair, hair China Choice Chad add mad, sad, bad, cad Chore ore, or boar, core, more, tore Chafe safe Cheat eat beat, meet, seat Chatter matter, tatter, batter Chain mail Chat at cat, rat, mat, pat Chug bug, hug, mug Chair air tear, wear, care Choose ooze news, lose Charcoal Challenge Chamber Cherish perish Chum um mum, hum, sum, come Chief beef Chopstick Chance dance Champagne Church Check peck, neck Change mange, range Channel panel Chant ant can’t, rant, pant Chap tap, map, cap Chapel apple Charm arm harm Checkers Charter barter, martyr Churn earn burn, turn Chase ace face, case, pace Cheap peep, keep, deep Consonant Clusters —

434

The late eight

Medial Single Consonants Peaches Stitches Nature Itchy Future Pitcher Rachel Nachos Ketchup Richard Rancher Vulture Picture Inches Pitching Teacher Roaches Watching Matches Preacher Benches Witches Gretchen Preacher Pitchfork Question Torture Consonant Clusters Archway Lunchtime Lunches Torchlight Parchment Lunchroom Finches All Environments Archway Pitchfork Lunchtime Peaches Stitches Pitcher Itchy Future Ketchup Finches Nachos Vulture Rachel Lunchroom Pitching Richard Rancher Parchment Picture Inches Watching Torchlight Roaches Benches Teacher Preacher Preacher Matches Gretchen Torture Witches Question Lunches Nature

End of Words Single Consonants

Deletions

Teach Witch

tea, T

435

CHAPTER 15:  [tS ]

Single Consonants

Deletions

Peach pea, P Sketch Roach row Coach Ouch ow Speech Track coach Watch Ski coach Wristwatch Beach bee, B Catch Couch cow Sandwich Watch Cockroach Scratch Ostrich Fetch Consonant Clusters

Deletions

[rtʃ ] Arch R Scorch score March mar Porch poor, pour Starch star [ntʃ ] Trench Punch pun Branch French Bunch bun Lunch Bench Ben Wrench wren

436

The late eight

Themes for [tʃ ] Themes Actions Around the Home The Body Nature

It’s a Job People and Places Lunch

Actions

Deletions

Minimal Pairs

Cheat eat seat, meat, heat, wheat Chased aced paste, taste, raced, waist Sketch Watch Teach tea, T Catch Fetch Scratch March mar Matches Pitching Watching Choke oak soak, poke Cheer ear fear, hear, deer, near, year Chain Spain, gain, lane, pain Charge barge, large, Marge Cheek eek peek, seek, week, leak Chip ship, hip, sip, rip, lip, whip,   zip, dip Chop shop, cop, pop, top, hop,  mop Chew oo zoo, moo, two, shoe Chill ill pill, gill, Bill, mill Scorch score Choose ooze news, lose Check peck, neck Change mange, range Chant ant can’t, rant, pant Chase ace face, case, pace Chat at cat, rat, mat, pat Cheat eat beat, meet, seat Chatter matter, tatter, batter Charm arm harm

437

CHAPTER 15:  [tS ]

Around the Home

Deletions

Minimal Pairs

Porch pour, poor Starch star Arch R Archway Couch cow Wrench wren Watch Wristwatch Picture Checkers Chess Chalk Chopstick Chair air Chore ore, or

mare, tear, wear, care boar, core, more, tore

The Body

Minimal Pairs

Deletions

Wes, mess, less balk, talk

Chin in Chest Cheek eek

pin, thin test, pest, vest, nest, west leak, beak, meek

Nature

Minimal Pairs

Deletions

Roach row Cockroach Ostrich Branch Roaches Nature Vulture Beach bee, B Itchy Cheetah Chicks Cherry airy

six, mix Sherry, merry, scary

438

It’s a Job

The late eight

Deletions

Minimal Pairs

Deletions

Minimal Pairs

Preacher Teacher Ski coach Rancher Track coach Coach People and Places

Chuck Gretchen Rachel Richard China Charles

luck, buck, tuck

Lunch

Minimal Pairs

Deletions

Peaches Lunch Chew oo zoo, moo, two, shoe Chill ill pill, gill, Bill, mill Lunchtime Chip ship, hip, sip, rip, lip, whip,   zip, dip Scorch score Lunchroom Cheese ease peas, keys, knees Chicken sicken Chili hilly, Willy, Billy Nachos Ketchup Chop shop, cop, pop, top, hop, mop Sandwich Punch pun Bunch bun Peaches Peach pea, P Cherry airy Sherry, merry, scary Pitcher Lunches

Chapter Sixteen

Evaluation and Treatment: An Illustration Introduction Resources in this book may be used in diverse ways within many different approaches. This chapter illustrates how they are employed to evaluate and treat students in one school setting. The illustration is descriptive rather than prescriptive, suggesting how the resources might be used rather than indicating how they should be used.

Clinical Orientation Use of resources described in this chapter is based on three ideas: 1. Treatment of late-acquired sounds reflects the dual nature of speech. 2. Treatment success depends as much on human variables as linguistic ones. 3. Treatment activities are functional. The Dual Nature of Speech Speech has a dual nature: it is both a channel of communication and a part of language (Bleile, 2004). The dual nature of speech is the basis of the conceptual distinction between an articulation disorder (disorder arising in the channel of communication) and a phonologic disorder (a disorder in the language component). 439

440

The late eight

Articulation A primary reason the 8 are acquired late is that they are hard to pronounce. What late-acquired sounds share is that none are made with the articulators touching throughout (as stop consonants and nasals are) or with the articulators relatively far apart (as glides and vowels are). Instead, late-acquired sounds require a student to position the articulators not touching, not far apart, but somewhere in the middle, making the airflow variously stop and start (affricates), hiss (fricatives), flow over the sides of the tongue (lateral), or flow around and over an atypical tongue configuration ([r]). Examples of resources focusing primarily on the articulation aspect of speech include definitions, metaphors, demonstrations, phonetic placement and shaping techniques, and key environments. Phonology Being a skilled motor movement is only half of speech’s dual nature. Speech also is an aspect of language, requiring language knowledge similar to but distinct from knowledge that underlies syntax, morphology, semantics, and discourse. A critical aspect of treating late-acquired sounds entails drawing a student’s attention to the communication value of speech. In addition to learning how to pronounce a sound, a student must also learn how sound affects meaning, how a sound is similar to and different from other sounds, and how to self-monitor and self-correct to ensure that communication occurs. Examples of resources focusing primarily on the phonologic aspect of speech include speech exercises, language activities, and word lists. Human Variables A speech problem does not exist independently from the person who has the problem. Factors such as motivation, intelligence, family support, attention, and desire to learn are equally as important for clinical success as are linguistic ones. To give just one illustration of the diversity of the people attached to speech problems, one recent morning three students in the same grade and school received speech therapy, one after the other. The first was embarrassed by his speech problem, the second thought his speech problem sounded pretty cool, and the third didn’t know he had a speech problem. Later that same day another student was treated — a teenager with a severe [r] difficulty who desperately wanted speech help for an upcoming radio presentation with his class. He promised to do anything to have better speech — except give up basketball practice for speech therapy. Radio address or not, basketball had a higher priority. The point is not to criticize this priority — only to emphasize that students bring far more than their linguistic system to the therapy setting. Examples of resources focusing primarily on human variables arising in the treatment of late-acquired sounds include acquisition, relative frequencies, and errors.

CHAPTER 16:  Evaluation and Treatment: An Illustration

441

Human Variables What is more trite and less controversial than the assertion that treatment success depends as much on human variables as linguistic ones? Nonetheless, considering that most clinicians believe such variables are important, it is amazing how poor our knowledge base is about human variables compared with our knowledge of linguistic factors. Far more research is needed before we understand how learner attributes interact with speech factors to influence treatment outcome.

Functional Activities All students, children, and adults, gifted or delayed, learn and grow throughout their lives. Time devoted to treatment of late-acquired sounds should further this learning whenever possible. In practice, this entails using activities that encourage learning and personal growth. Class materials, books, and projects are excellent sources of activities for school-aged students, as newspapers and movies and upcoming social events are for older schoolaged students and adults. In addition to providing support for learning, a critical benefit of treatment relying on such activities is that it encourages use of a treatment sound in contexts that matter to a student. Examples of resources that most directly support classroom and life-based activities are the speech exercises and language activities.

Clinical Resources The order in which resources are described in the following sections approximate their use with a hypothetical student from the evaluation through conclusion of treatment. The sequence is indicated in Table 16–1.

Evaluation The following resources are used primarily in assessment: n Initial screening n Screening for stimulability n Definition n Acquisition n Relative frequency n Errors

442

The late eight

Table 16–1.  Clinical Resources Used in Evaluation and Treatment Assessment

Initial screening Screening for stimulability Definition Acquisition Relative frequency Errors

Treatment

Metaphors Touch cues Demonstrations Phonetic placement and shaping techniques Key environments Word lists Speech and awareness exercises Language activities

Initial Screening, Screening for Stimulability The most typical referral source for a student is a parent or teacher. A student may then be observed in a classroom or playground before receiving an initial speech screening and a screening test for stimulability. Initial Screening An initial screening helps determine if a student experiences difficulty pronouncing a late-acquired sound. An initial screening assesses a treatment sound at the word level in a variety of phonetic contexts. In addition to determining if a problem with a sound exists, an initial screening often serves as a pretest against which treatment progress is measured. If a student’s speech is found to contain speech errors, a screening test for stimulability typically is administered. Screening for Stimulability Screening for stimulability helps determine if a student can pronounce a possible treatment sound. Information on stimulability is helpful in predicting how rapidly treatment is likely to proceed. In general, if a student has some initial capacity to pronounce a sound, treatment proceeds more rapidly than if such a capacity must first be established.

CHAPTER 16:  Evaluation and Treatment: An Illustration

443

Definition, Acquisition, Relative Frequency, and Errors These resources bundle together after stimulability testing is completed and as a clinician decides between possible treatment sounds. Typically, deciding which sound to select is based on weighing multiple factors, personal and linguistic. Personal factors include a clinician’s judgment about a student’s attention span, interests, and concerns. The linguistic aspect of sound selection includes stimulability, definition, acquisition, relative frequency, and errors. No single variable trumps the others. Rather, a clinician weighs multiple considerations to reach a balanced decision. Definition The definition is a prose description showing how a sound is produced. The definition contributes to treatment decisions because understanding how a sound is made suggests which resources may be needed to teach it. To illustrate, for [l] a clinician thinks about where the tongue is, how easily it might be to teach a student this tongue position, what types of demonstrations might be needed, what phonetic placement and shaping technique to use, and the types of exercises available. Alternatively, for [s] an additional consideration might be to develop short probes to determine which [s] is easier for a student — tongue tip raised or lowered? Typically, a clinician follows the student’s lead — that is, if a student already makes [s] with the tongue tip lowered, the clinician teaches [s] with a lowered tongue. If a student does not have a preferred way, a clinician may feel freer to select an appropriate variant. Acquisition Acquisition data indicate the age at which 50% and 75% of children acquire a sound. If all other things are equal (they seldom are), a clinician may decide to first treat an earlier acquired sound. Indeed, for some clinicians the importance of acquisition data is the primary criterion used in the selection process. Relative Frequency Relative frequency is the frequency of occurrence of a sound. Typically, remediation of a sound with a higher frequency of occurrence has greater impact on intelligibility than one with lower frequency. For this reason, a clinician may incline to first teach more frequently occurring treatment sounds. To illustrate, if a clinician is deciding between [s] and [z], [s] might be selected because of its higher frequency of occurrence.

444

The late eight

Errors Errors are the major errors to which a sound is susceptible. This information weighs in sound selection in at least two respects: 1. Some errors may be socially stigmatized. 2. Errors have varying effect on intelligibility. In general, errors that may lead to a student being stigmatized socially are a high treatment priority. To illustrate, a lisp and [w] for [r] are often early treatment sounds because they may provoke teasing. Impact of an error on intelligibility also influences sound selection. Errors that negatively affect intelligibility are good candidates for treatment. These include deletions, changes in place of production, and substitutions in the beginning of words.

Treatment Three Questions Before selecting treatment resources, at least three questions must be resolved: n How many sounds should be treated? n What constitutes a correct production of a treatment sound? n Should a student be stimulable for a treatment sound?

How Many Sounds to Treat? The assessment typically yields one or more possible treatment sounds. This raises the following questions: n If

a student’s speech contains more than one possibility, which sound to select? n Should one sound be worked on to completion and then another? n Should two be worked on simultaneously, changing from one to another in the same treatment session or in alternate sessions? n Does working on two or more treatment sounds confuse a student? The author’s view is that answers to these questions have more to do with human variables than linguistic factors. Some students — especially older ones — can work on a sound from beginning to completion, while others benefit from alternating between sounds, sometimes within a single treatment session, sometimes in alternate sessions. A useful dynamic assessment

CHAPTER 16:  Evaluation and Treatment: An Illustration

445

is to initially select several treatment sounds, alternating between them either in a single session or in alternate sessions, and then reevaluate the choice after several treatment sessions. What Constitutes a Correct Production of a Treatment Sound? Whenever possible, treatment should avoid practicing a speech error — something the student probably already has lots of practice doing! Ideally, a sound should be entirely correct during practice. An analogy might be: suppose a coach wanted to teach a student a new tennis stroke. Ideally, the coach wants to establish the stroke perfectly and then engage in perfect practice. However, in both speech-language pathology and tennis, sometimes something less than ideal is accepted, and both a clinician and a coach may need to practice a skill that is better than before, but still not perfect. For this reason, a “3,” “2,” “1” rather than a “correct/incorrect” system often proves useful (Highnam, 2004). A student’s old speech pattern is a “3,” and the goal is to establish it as a “1” (perfect). However, in many instances a “3” does not automatically become “1,” and, instead, the student produces something like a “2”— a more correct version of the old pattern, but one still not perfect. Speech treatment often contains many more “2”s than “1”s. While practicing a less than perfect sound, the student learns to make it a “1” through selfreflection activities and prompts. Should a Student Be Stimulable for a Treatment Sound? An important, much debated question is: will a student self-correct stimulable sounds without treatment (Dietrich, 1983; Powell, 1991; Powell, Elbert, & Dinnsen, 1991; Shine, 1989)? Research suggests extensive individual variation, with some students self-correcting and others not. Some clinicians choose to work with only stimulable sounds and others select only to treat nonstimulable ones. Many other clinicians fall in the middle, working first on a stimulable sound to build a student’s confidence before tackling more difficult nonstimulable sounds. In general, the author prefers to teach stimulable sounds. A useful “trick of the trade,” especially with a younger or less motivated student, is to first treat a stimulable sound to help build confidence before attempting the more challenging nonstimulable sounds. However, selecting a stimulable sound often is not an option for an older school-aged student (typically, preteens and teenagers) or an adult nonnative speaker. In this situation, a nonstimulable sound is selected for treatment. A challenging situation can arise if a preteen or teenager with a nonstimulable sound is an unwilling participant in therapy, “forced” to receive treatment by parents or teachers. In this situation, after an initial period of therapy a student may be placed on a semester by semester contract in

446

The late eight

which continued treatment is dependent on a student’s effort and success. The purpose of the contract is to avoid a difficult situation in which an unmotivated student continues in therapy semester after semester, bored, demoralized, and unsuccessful. Better a therapeutic break than a broken spirit!

Stimulability and Religion In the absence of research clearly supporting one position or the other, the discussion of stimulability at times almost seems religious, some fervently asserting this and others just as fervently asserting that. An alternative to accepting one or the other position is to be your own researcher, experimenting with different perspectives. Perhaps you will find that you have more success with nonstimulable sounds than reported by some, or perhaps you will have less. Or perhaps you will discover which students on your caseload seem to require a treatment sound that is stimulable and which do not. No matter what you discover, experimenting with different approaches may yield important insights about what works best for you and the students you serve.

Once a sound or sounds have been selected for treatment, the following resources are used: n Metaphors n Touch cues n Demonstrations n Phonetic placement and shaping n Key environments n Word lists n Awareness and speech exercises n Language activities

techniques

Metaphors, Touch Cues, and Demonstrations Metaphors, touch cues, and demonstrations all provide useful ways to refer to treatment sounds, and especially during early treatment phases may help focus a student on the task at hand. As treatment progresses, they serve as reminders and prompts.

CHAPTER 16:  Evaluation and Treatment: An Illustration

447

Metaphors Metaphors provide useful analogies for a treatment sound. Typically, a clinician presents several possible metaphors, allowing a student to select among them. With a younger student, the metaphors make analogy with something familiar — perhaps an engine starting, a hissing snake, or a leaky tire. With an older student the metaphors often refer to an aspect of the treatment sound — that is, an interdental may be the tongue-out sound, [s] with a lowered tongue tip may be the tongue-down sound, or [l] may be the pointy sound. For a student who is a teenager or an adult, many times a treatment sound is called by its technical name. To illustrate, with an adult student a clinician may decide to call [s] “a fricative sound” or “a fricative made at the alveolar ridge.” Often, a metaphor proves more successful when a student helps select it. Typically, a clinician presents several options and asks the student to select one. Allowing a student to help select a metaphor entails the clinician giving up a measure of control — after all, a student is not obliged to select the metaphor that the clinician thinks best captures the nature of the speech problem. A clinician weighs selection of the most appropriate metaphor against a student’s need for involvement. In the author’s experience, most often the issue does not arise and selection of a metaphor presents few problems. If a question of appropriateness versus student involvement arises, most clinicians give up the best, most appropriate metaphor in favor of student involvement. Touch Cues Touch cues are finger positions that represent a treatment sound, allowing a clinician to refer to a treatment sound using modalities other than speech. Touch cues grossly mimic speech movements. An older student understands that, for example, the touch cue for velar consonants is made parallel to the back of the mouth, representing where the tongue is raised. A younger student may benefit from a touch cue without realizing its mimicking quality. For such a student, a touch cue is a visual and tactile reminder, a way to say, “Remember: this is the sound we are working on.” Demonstrations Demonstrations show a student how a treatment sound is produced. By drawing attention to such aspects of speech as tongue position and airflow, a student may better understand how to pronounce a treatment sound. Older students often find demonstrations intellectually engaging and interesting. Others, especially those under 7 years, may find demonstrations more confusing than helpful. Demonstrations find their most use early in treatment.

448

The late eight

Later in treatment, an occasional demonstration may serve as a reminder about how a treatment sound is produced. Phonetic Placement and Shaping Techniques Phonetic placement techniques show a student how to place the articulators to pronounce a sound, and shaping techniques show a student how to convert one sound into another. These techniques are used when a nonstimulable sound is selected for treatment. Students 7 years or older typically possess sufficient attention and language skills to benefit from these techniques. With a younger student, success with these techniques is more hit-or-miss. The techniques are typically inappropriate (and ineffective) with a child under 4 years. Though every clinician has favorite phonetic placement and shaping techniques, no single technique works for every student. In general, a clinician selects one that makes intuitive sense and then engages in trial-and-error dynamic assessment. Often, from a few to 5 to 10 minutes is sufficient to determine if a particular technique will prove successful. In general, when selecting a technique, most clinicians prefer those that are simpler and have shorter instructions. Longer techniques are turned to when the shorter, simpler ones do not yield results. The phonetic placement and shaping techniques listed in this book are “bare bones recipes” to expand and modify as a clinician desires. Often, the actual phonetic placement or shaping technique used with a student contains the following elements: 1. An initial self-demonstration by the clinician. 2. The student practices the steps in the technique. Use of a touch cue and metaphors focus the student and help remind him or her about how the sound is pronounced. 3. The student attempts to make the sound. 4. The clinician gives feedback about the success of the attempt. The following illustrates one possible way to fully expand a bare bones phonetic placement technique:

Phonetic Placement Technique for [θ] Objects:  Feather or small piece of paper Instructions: 1. First demonstrate the method on yourself.

CHAPTER 16:  Evaluation and Treatment: An Illustration

449

2. To begin, place your tongue between your upper and lower front teeth. 3. Place a feather or small piece of paper in front of your mouth, about a half-inch to an inch from your tongue. 4. Blow air over your tongue to move the feather or paper. 5. Explain, “That’s how you make the leaking tire sound. Now it’s your turn.” 6. Instruct the student to stick out his or her tongue just as you did. 7. When the tongue is out, place the feather or paper before the mouth. 8. Explain, “Now blow to make it move.” 9. If the sound is made correctly, say, “That’s right. You did it. You made [θ] ​ — the leaky tire sound.” If the sound is made incorrectly, say something like, “Good try. Let’s try again.” Key Environments Key environments describe phonetic environments in which a student is likely to pronounce a sound correctly. In addition to being used during the evaluation to determine if a student has the capacity to make a sound, key environments find good use after a treatment sound (or sounds) is selected, providing a possible succession of environments in which to treat a sound. The following illustrates how key environments might be used to establish [s], [l], and [r] in the beginning of words, end of words, between vowels, and in consonant clusters. Beginning of Word Establish [s], [l], and [r] before a high front vowel. Once established, expand the number of different vowels that follow. For a student that is strongly affected by the adjacent vowel, back high vowels are likely to be more challenging than front ones. End of Word [s] is more likely to be established here than [l] and [r]. Establish after a high front vowel. Next, to make word-initial sounds, have the word-final sounds be followed by a word beginning with a vowel, such as “bus and.” This encourages the sound to “migrate” to start the following word, resulting in, for example, “bu sand.” Between Vowels [l] and [r] are more likely to be established here than [s], though some students find [s] easier to make here, too. For all three consonants, establish between two high front vowels, as in ili. Once established, add different adjacent vowels. To expand to word-initial position, have the student drop

450

The late eight

the first vowel, resulting in, for example, [li]. To expand to word-final position, follow the same procedure, resulting in, for example, [il]. Consonant Clusters For [s], establish after [t] as in “pizza” or the nonsense word [tsi]. To expand the environments in which [s] occurs, have [ts] be followed by different vowels. To help expand [s] to syllable-initial position, encourage the student to drop the [t]. For [l] and [r], establish after a consonant with a different place of production than [l] and [r] (most often, select [p] or [b]) followed by a high front vowel. Next, to help expand [l] and [r], ask the student to drop the initial consonant in the consonant cluster. Word Lists Word lists are used to generate stimuli to help establish a sound in a student’s speech, and then to practice it. Words, rather than nonsense syllables, are the vehicle for teaching a treatment sound for two reasons: 1. Words, carefully selected, offer relatively simple phonetic contexts in which to teach a sound, and 2. Words, being a student’s everyday means of communication, are used both in and outside of treatment, making them a critical bridge to generalization. Word lists in this book are divided by phonetic environment; on the accompanying companion website lists of minimal pairs, deletions, and themes also are included. Word lists are therapeutic building blocks for many different exercises and activities. The value of using isolated words diminishes as treatment proceeds and the clinician shifts to more naturalistic activities. Awareness and Speech Exercises Awareness exercises focus a student’s attention on the treatment sound. They are used frequently early in therapy to orient a student, and later in therapy may be used primarily as prompts and reminders. Speech exercises help a student to gain experience with a treatment sound, providing practice in pronouncing, self-monitoring, and self-correcting speech. The most frequently used exercises are imitation, minimal pairs, deletions, multiple productions, old way/new way, and similar sounds. Speech exercises are used most often in language activities and, less frequently, as a list of words. Many times a mix of exercises is used. For example, a student may be asked to delete the treatment sound and then say the word with the treatment sound three times.

CHAPTER 16:  Evaluation and Treatment: An Illustration

451

Discrimination Versus Awareness The difference between discrimination exercises and awareness exercises lies in conception, not actual practice. If a reader prefers, awareness exercises described in this book may be used as and called discrimination exercises. However, within the author’s perspective the conceptual distinction between discrimination and awareness is important. The term discrimination implies that a student’s difficulty lies in the auditory system’s inability to distinguish between sounds; however, research strongly suggests that the auditory system, in common with other sensory systems, matures early and has adultlike capacities near the end of a child’s first year (Pascallis, de Haan, & Nelson, 2002). The term awareness implies the therapeutic challenge is to focus a student’s attention on the difference between an intended pronunciation and what comes out of the mouth. A student with a speech problem, like most other persons, is not likely to closely monitor his or her speech even when what comes out of the mouth differs considerably from the speech of the community. An awareness exercise is a little verbal tap on the shoulder, saying, “Remember what sound you are working on. Focus on what you are doing.”

Language Activities Language activities use school books and other outside materials, including stories a student is reading, favorite stories from home, and articles from newspapers and magazines. These materials, because they are familiar and widely used, are easy to adapt by families, aides, and teachers. Many times their use also has the practical advantage of improving a student’s academic skills. Though the purpose of therapy is speech, much is gained if in the process of learning speech a student also does better on classroom assignments or gives a better oral report.

Summary The discussion in this chapter illustrates that one way care might be conceptualized and carried out. Within this perspective, treatment for late-acquired sounds is conceptualized as helping a student learn new ways of speaking and to unlearn old ones. This requires a treatment approach focusing on

452

The late eight

both the articulation and phonologic aspects of speech. Within this view, a treatment program focused solely on articulation is like building a train that doesn’t go anywhere, while a treatment program focused solely on phonology is like a destination without a vehicle to get there. Treatment of late-acquired sounds requires careful attention to building a good train to reach a worthwhile travel destination. An additional characteristic of this framework is that human variables such as motivation, intelligence, family support, attention, and desire to learn are recognized as being at least equally important for clinical success as linguistic ones. Lastly, the framework emphasizes the importance of using functional activities that contribute to the advancement of a student’s education and social development.

References Bleile, K. (2004). A manual of articulation and phonological disorders (2nd ed.). Clifton Park, NY: Delmar Thomson. Diedrich, W. (1983). Stimulability and articulation disorders. In J. Locke (Ed.), Seminars in Speech and Language, 4. Highnam, D. (2004). Personal communication. Pascallis, O., de Haan, M., & Nelson, C. (2002). Is face processing species-specific during the first year of life? Science, 296, 1321–1323. Powell, T. (1991). Planning for phonological generalization: An approach to treatment target selection. American Journal of Speech Language Pathology, 1, 21–27. Powell, T., Elbert, M., & Dinnsen, D. (1991). Stimulability as a factor in the phonological generalization of misarticulating preschool children. Journal of Speech and Hearing Research, 34, 1318–1328. Shine, R. (1989). Articulatory production training: A sensory-motor approach. In N. Creaghead, P. Newman, & W. Secord (Eds.), Assessment and remediation of articulatory and phonological disorders (pp. 355–359). Columbus, OH: Charles E. Merrill.

Appendix A

Language Activities

Therapy seeks to make a treatment sound into a student’s regular way of talking. Language and school-based activities help ensure that what is learned in therapy is used in the “real world.” This appendix lists 35 language activities. Language activity forms are contained on the accompanying companion website. Language activities are divided according to whether their primary focus is to facilitate awareness or to practice speech production. The list of activities is illustrative and should be modified, added to, and deleted based on a clinician’s interests and philosophy. Most language activities can be carried out either by clinicians, aides, or families. The following speech activity illustrates some possible ways an activity might be varied. The activity is: Have the student make a book of words or pictures, each containing the treatment sound, and then say each word to you. A few of many possible variations include: 1. Make it an awareness activity by removing the speech component and having the student make a book of words or pictures containing the treatment sound. 2. Make it a group activity in which the student shows the book to other students, or make a home activity in which the student and a family member make the book and practice the words. 3. For a younger student, instead of a book of words or pictures, find objects whose names contain the treatment sound, and then hide them around a room for the student to find and name. For an older student, 453

454

The late eight

replace the book with stories, homework assignments, magazine articles, or newspaper articles. Language activities for speech may be easily modified by changing the instructions in the following ways: 1. Imitation:  To create an imitation exercise, have the student repeat the word after you. 2. Minimal Pairs:  To create a minimal pairs exercise, have the student first say the word with the treatment sound, then say the rhyming word, and then say the word with the treatment sound. 3. Deletion: To create a deletion exercise, have the student first say the word with the treatment sound, then without the treatment sound, and then with the treatment sound. 4. Self-Correction: To create a self-correction exercise, have the student say the word three times, self-correcting if errors in the treatment sound occur. 5. Old Way/New Way: To create an old way/new way exercise, have the student say the word the new way, the old way, and then the new way again. 6. Similar Sound:  To create a similar sound exercise, have the student first say the word with the treatment sound, then with the most similar sound the student can make, and then with the treatment sound again.

Awareness Activities 1. Read aloud from a book, having the student listen and raise a hand, clap, or ring a bell whenever a word containing the treatment sound is heard. An easy variation is to tell a story aloud rather than read aloud from a book. 2. Ask a student to silently read a newspaper or story and then circle or write down words that contain the treatment sound. 3. Read a story to a therapy group, having the students compete to be the first to raise their hand when they hear the treatment sound. 4. Read a story to the student and a stuffed animal, having the two “compete” for who raises a hand first when a treatment sound is heard. Let the stuffed animal often give the wrong answer and have the student correct it. 5. Create minimal pairs using household objects or school materials (e.g., wing/ring, light/write). Then say a minimal pair and ask the student which word (first or second) contains the treatment sound. 6. Tape-record several word lists and ask the student to rate them as being either the new way or the old way of producing the treatment sound. 7. Read paragraphs from stories to the student and occasionally mispronounce the treatment sound (e.g., “Once upon a time there was a print-

Appendix A: Language Activities

455

heth who lived in a cathle”). Have the student raise a hand whenever the treatment sound is mispronounced. 8. Make up and read silly stories/sentences that contain the treatment sound produced the “old” way (e.g., “He gave her a diamond wing”). Draw silly pictures to match the silly sentences. 9. In a therapy group, have a student who can pronounce the treatment sound read sentences aloud, sometimes saying the treatment sound correctly and other times incorrectly. The student with difficulty on the treatment sound does a thumb up/thumb down, depending on whether the treatment sound is correct or not. 10. Work with the student to make a book of words, each containing the treatment sound. An easy variation is to have the student find pictures depicting objects that contain the treatment sound and then have the student paste the pictures into the book.

Speech Activities 1. Ask the student to read a story or article and to say each word that contains the treatment sound. 2. Create a therapy group containing some students who can pronounce a treatment sound and others who cannot. Either read aloud or tell a story to the group, asking the students to listen for the treatment sound and having a student who can pronounce it do so every time it occurs. Ask the student who cannot pronounce it to say it after the student who can. 3. Give the student a printed story that has a sticker over words that contain the treatment sound. Ask the student to read the story aloud and “to guess” at the words under the stickers. 4. Read the student a story, stopping at words that contain the treatment sound. The student then says the word. For younger students, have a puppet or stuffed animal tell the story. 5. For a younger student, find cards or objects that contain the treatment sound. Place them around a room, turn off the lights, and give the student a flashlight. The student then finds the cards or objects and says them as they are found. 6. Have the student make a book of words or pictures, each containing the treatment sound, and then say each word to you. 7. Play a board game and adapt the rules to make it a therapy tool (e.g., move ahead two spaces with an accurate production; go back one space with an “old way” production). 8. Use checkers with words containing the treatment sound attached to the back. Have the student say the word taped on the back before moving a piece. 9. Adapt familiar song tunes to include treatment sounds and words (e.g., Larry had a little lamb).

456

The late eight

10. Have the student make a collage with pictures containing the treatment sound and then name the pictures. 11. Have the student collect and name pictures of friends/teachers who have the treatment sound in their names. 12. Have the student write a letter to someone (family/friends) using words with the treatment sounds as many times as possible. 13. Ask the student to list all the toys, animals, foods, and so forth that contain the treatment sound. 14. Have the student look through spelling words, classroom vocabulary words, and reading group books to find as many words as possible that contain the treatment sound. 15. Have the student substitute the treatment sound for another sound in words in stories or books (e.g., pronounce polled as rolled). 16. Ask the student to fill in the correct treatment word in sentences from a bank of words or have the student choose his or her own words. 17. Make up sentences for the student containing words with the treatment sounds for the student to say. Alternatively, ask the student to make up the sentences. 18. Place a word or picture containing the treatment sound on a card, make two copies of each card, and play “Go Fish.” 19. Tell the student a story containing words with the treatment sound, and then have the student retell the story to you. 20. For a student who likes jokes, you and the student develop tongue twisters containing the treatment sound. 21. Create a scavenger hunt using words containing the treatment sound. 22. Have the student say a word in a book with the treatment sound, then say it without it, then with it again (e.g., rain, -ain, rain). 23. For a younger student, set toys containing the treatment sound around the room. Blindfold a stuffed animal and have the student tell it the name of the toys. 24. Lay out picture sequence cards that contain the treatment sound and ask the student to tell you the story. 25. Adapt a song to make a silly version containing the treatment sound (e.g., “Christmas is coming, a rooster ate a rat”). Acknowledgment.  The following clinicians and students kindly contributed ideas to this appendix: Diane Highnam, Lindsay Deitloff, Jill Jensen, Kayla Jiskoot, and Abby Sievers.

Appendix B

Quick Guide to Resources

Evaluation n An initial screening helps indicate if a student has a speech difficulty

affecting a late-acquired sound. n Screening for stimulability helps determine if a student has the capacity to pronounce a sound. n The definition helps decide how a sound should be produced. n Age of acquisition helps in making a decision regarding which sound to teach. n Relative frequency helps in making a decision regarding which sound to teach. n Errors help in making a decision regarding which sound to teach.

Treatment n Metaphors help label n Touch cues help label

a treatment sound. a treatment sound through modalities of touch

and sight. n Demonstrations show a student how a treatment sound is produced. n Phonetic placement and shaping techniques help establish a sound

in a student’s speech repertoire. environments suggest which phonetic positions may facilitate pronunciation of a treatment sound. n Word lists are a basis for activities involving words, minimal pairs, deletions, and themes. n Key

457

458 n Speech

The late eight

exercises help a student to gain experience pronouncing a treatment sound. n Language activities help a student practice a treatment sound using real world activities and resources.

Index Note:  Page numbers in bold reference non-text material.

A Acquisition as Late 8 resource, 132 learning versus, 113 Acquisition performance, 113, 146 Activities, language, 141 of awareness, 141 of speech, 141 Arizona Articulation Proficiency Scale, 3rd revision, 94 Assessment. See also Evaluation frameworks for, 94–95 resources for, 144

B Bankson-Bernthal Test of Phonology, 94 Bilabial trial, 83 Bilingual children. See Multilingual students; Spanish-English children Bilingual speech sound disorder (SSD) treatment, 60 Blading, 11 Brain development, 15 Brain injury, 6

C Clinical vs. research settings, 42 Cognate intervention, 71–74 Complexity, movement, 122–124 Compliance plans, 94–95 Conservative dialects, 65

Consonant clusters, Spanish, 62 Consonants, key environments for individual, 19t Coupling, 123, 123 Curriculum, guidelines for linking interventions to, 98

D Definition, 4–5, 132, 146d Demonstrations, 138, 148 Dialects, 64–66 conservative, 65 radical, 65–66 variation and, 69 Disability, 16 Discrimination training, 20–22 DL. See Dual language programs Dual language (DL) programs, 69 one-way, 70 two-way, 70

E EBP. See Evidence-based practice Education impact, gray areas of, 95–96 ELA. See English Language Arts Eligibility compliance plans and, 94–95 rules, 94 “Engine lips” strategy, 81–82 English language consonants in, 60–61, 61f fricatives, 61 liquids, 62 [l] phoneme in, 62 459

460 English language  (continued) phonemes, 60–61 word structure, 62–63 English Language Arts (ELA), 98 Environments, key, 134 definition of, 17–19 for individual consonants, 19 Errors, 133–134, 147 Evaluation. See also Assessment; Treatment activities, functional, 441 articulation, 440 clinical orientation, 439–441 clinical resources, 441–444 phonology, 440 speech, dual nature of, 439 variable, human, 440, 440 Evidence-based practice (EBP), 37–38, 38 conducting searches for, 54–55 for Late Eight, 44–53 resources, 38–39 evidence maps, 39 SpeechBITE search strategies, 41–43 speech pathology databases, 39–41 sources for, 2000–2016, 44–53t Evidence maps, 39 searching with, 55 Experimental designs nonexperimental, 40–41 quasi, 40 single subject, 40 External feedback, 118–119 knowledge of performance (KP) type of, 119 knowledge of results (KR) type of, 119 External focus, 117–118

F Feedback defined, 118 excessive, 119 external, 118–119 internal, 118 motor learning and, 118–121 Focus, external, 117–118

The late eight

Frequency, relative, 133, 146 Fricatives, Spanish/English, 61

G Glides, 6 Gliding, 278 Goal selection, 73–75, 76f Goldman-Fristoe 3 Test of Articulation, 94

I ICEL. See Instruction, Curriculum, Environment and Learner IDEA. See Individualized education programs Individualized education programs (IEPs), 95 Individuals with Disability Education Act (IDEA, 2004), 94 compliance plans and assessment frameworks for, 94–95 Initial screening, 135–136, 144 Instruction, Curriculum, Environment and Learner (ICEL), 95 Interactional Dual Systems Model, 63 Interference, 63 Internal feedback, 118 Interventions guidelines for linking curriculum to, 98 materials for, 99

K Key environments, 134 definition of, 17–19 for individual consonants, 19t Knowledge of performance (KP), 119 Knowledge of results (KR), 119 post-, delay interval, 121

L [l] acquisition, 277 definition, 277

461

Index

demonstrations for alveolar, 282 lateral airflow, 283 liquid, 282–283 voiced, 283–284 environments, key, 278 errors, 278 exercises deletion, 291 imitation, 289 minimal pairs, 290 old way/new way, 293 self-correction, 292 shell for, 288 similar sound, 294 expected errors, 79–80 metaphors, possible, 278 minimal pairs, 80 phonetic placement, 80 phonetic placement techniques, 285–286 relative frequency, 79, 277 shaping techniques, 80, 287 suggestions for practice, 80–81 tests initial screening, 279 stimulability, 280–281 touch cue, 278 touch cues, 135 word lists animals, 316 beginning of words, 295–303 day at beach, 312 end of words, 305–311 fairy tale, making up, 317 healthy, lunch, making, 314 let’s cook, 313–314 Lord of the Rings, 178 medial, 303–304 northern places, 312 Old Hawaii, sea voyage to, 313 people, 315 places, 316 themes, northern places, 143 [l] phoneme, in Spanish and English, 62 Language/literacy disorders, research on speech sound disorders and, 96–97

Language ratios, 70 Late 8. See also Spanish-English children articulation approach for, 8–10 evidence-based practice (EBP) for, 44–53 reasons for, 5–6 resources for acquisition, 132–133 definition, 132 demonstration, 138 error, 133–134 key environment, 134 language activity, 141 metaphor, 134–135 phonetic placement/shaping techniques, 138–139 relative frequency, 133 speech exercise, 139–140 stimulability, 137–138 tests initial screening, 135–137 stimulability, 137–138 touch cue, 135 word list, 141–143 schools and, 6–8 speech errors affecting, 10–11 Lateralization, 11 Lip rounding, 11 Lisping, 11, 78 Literacy, identifying students struggling with, 97

M Measurement, of motor learning, 121–122 Meta-analysis, 40 Metaphors, 134–135, 147–148 Midway sounds, 6 Morphology, 102–103 Motor control, 108–109 closed-loop control method, 109 open-loop control method, 109–110 Motor learning, 113 acquisition vs., 113 defined, 115 feedback, 118–121

462 Motor learning  (continued) focus, 117–118 measurement, 121–122 movement complexity and, 122–124, 123 practice, 115–117 prepractice and, 113–115 principles of, 113–124, 116f feedback, 118–121 focus, 117–118 learning versus acquisition, 113 measurement, 121–122 movement complexity, 122–124 practice, 115–117 prepractice, 113–115 Movement complexity, 122–124 MTSS model. See Multi-Tier System of Supports model Multilingual students. see also SpanishEnglish children clinical recommendations to guide clinical practice with, 74t treatment approaches for, 71 treatment studies with, 72t Multi-Tier System of Supports (MTSS) model, 95

N National Center for Evidence-Based Practice in Communication Disorders (N-CEP), 38–39 Nonexperimental designs, 40–41 Non-speech oral motor approaches, 25–26

O One-way dual language programs, 70 Open-loop motor control, 109–110

P Phonemes, Spanish/English, 60–61 Phonetic placement definition of, 22–23 examples of good, 23–25 versus non-speech oral approaches, 25–26

The late eight

non-speech oral motor approaches and, 25–26 Phonetic placement techniques, 138–139, 148–149 Phonological systems, of bilingual children, 63 Practice, 115–117 fatigue and, 115 Prepractice, 113–115 PubMed website, searches on

Q Quasi-experimental design studies, 40

R [r]: consonantal acquisition, 345 definition, 345 demonstrations alveolar, 349 bunched, 350 liquid, 349–350 retroflex, 351 sides of tongue (bunched and retroflex), 351–352 voiced, 352–353 environments, key, 346 errors, 346 exercises deletion, 360 imitation, 358 minimal pairs, 359 old way/new way, 362 self-correction, 361 shell for, 357 similar sound, 363 metaphors, possible, 346 phonetic placement techniques, 354 relative frequency, 346 shaping techniques, 354–356 tests initial screening, 347 stimulability, 348 themes animals, 388 around the home, 386–387

463

Index

food, 387–388 Halloween stories, 389–390 people, 390–391 places, 391 scary noises, 388–389 touch cue, 346 word lists beginning of words, 364–377 end of words, 381–386 media, 377–381 [r]: tap error patterns for, 82t expected errors, 81 frequency, 81 minimal pairs, 84–85 phonetic placement, 81–83 shaping techniques, 81–85 suggestions for practice, 85 [r]: trill error patterns for, 82t expected errors, 81 frequency, 81 minimal pairs, 84–85 phonetic placement, 81–83 sample lesson plan, 86t shaping techniques, 81–85 suggestions for practice, 85 [r]: vocalic, 5. acquisition, 319 definition, 319 demonstrations alveolar, 323 bunched, 324 liquid, 323–324 retroflex, 325 side of tongue (bunched and retroflex), 325–326 voiced, 326–327 environments, key, 320 errors, 320 exercises deletion, 337 imitation, 335 minimal pairs, 336 old way/new way, 339 self-correction, 338 shell for, 334 similar sound, 340 metaphors, possible, 320

phonetic placement techniques, 328–329 relative frequency, 320 shaping techniques, 330–333 technique for shaping, into consonantal [r], 139 tests initial screening, 321 stimulability, 322 themes creatures, 342–343 it’s a job, 343 people, 343 touch cue, 320 word lists, 341–342 Radical dialects, 65–66 Randomized control trials, 40 Reading fluency, 103 Relative frequency, 133, 146 Research versus clinical settings, 42 Resources for assessment, 144 guide to, 144–147 illustration of clinical, 143, 144t for treatment, 147–149 Response to Intervention (RtI) model, 95 Reviews, Interviews, Observations and Tests (RIOT), 95 Radical dialects, 65–66 Randomized control trials, 40 Reading fluency, 103 Relative frequency, 133, 146 Research versus clinical settings, 42 Resources for assessment, 144 guide to, 144–147 illustration of clinical, 143, 144t for treatment, 147–149 Response to Intervention (RtI) model, 95 Reviews, Interviews, Observations and Tests (RIOT), 95

S [s] acquisition, 197 definition, 197

464 [s]  (continued) demonstrations for, 138 alveolar, 202 fricative, 202–203 voiceless, 203–204 environments, key, 198 errors, 198 exercises deletion, 217 imitation, 215 minimal pairs, 216 old way/new way, 219 self-correction, 218 shell for, 214 similar sound, 220 expected errors, 78 metaphors, possible, 198 minimal pairs, 78 phonetic placement, 78 phonetic placement techniques, 205–207 relative frequency, 77, 197 shaping techniques, 78, 207–213 suggestions for practice, 79, 79f tests initial screening, 199 stimulability for, 200 themes baking, 245 bath time, 250 beach, 247–248 body, 249–250 bus ride, 253 clothes, 250–251 field and forest, 245246 horseback riding, 247 medieval fun, 251–253 people, 248 places, 249 snack time, 224–245 speech, 250 touch cue, 198 word lists beginning of words, 221–234 beginning words, 142 end of words, 236–243 medial, 235–236 [ʃ ] acquisition, 393 definition, 393

The late eight

demonstrations fricative, 397–398 postalveolar, 397 voiceless, 398–399 environments, key, 394 errors, 393 exercises deletion, 405 imitation, 403 medial, 411 minimal pairs, 404 old way/new way, 407 self-correction, 406 shell for, 402 similar sound, 408 metaphors, possible, 394 phonetic placement technique, 400 relative frequency, 393 shaping techniques, 400–401 tests initial screening, 136, 395 stimulability, 396 themes animals, 414 people, 413 places, 413 things that go bump, 414 things to eat, 415 washing dishes, 415 watery places, 414–415 touch cue, 394 word lists beginning of words, 409–411 end of words, 412–413 Schema theory, 11–112 Semantics, 100–101 Shaping techniques, 138–139, 149 definition of, 22–23 examples of good, 23–25 versus non-speech oral approaches, 25–26 non-speech oral motor approaches and, 25–26 Single subject experimental designs, 40 SLPs. See Speech language pathologists (SLPs) Sounds determining number of, for treatment sessions, 26–27

465

Index

providing treatment for stimulable, 27–28 Sound selection, 75–76 Spanish, consonant clusters, 6 Spanish-English children. See also Late 8 cognate intervention for, 71–73 dialects and, 64–66 education programs for, 69–71 late developing sounds for, 66–69, 67–68 phonological systems of, 63 sample lesson plan, 86, 86t treatment sounds, 73–76 treatment techniques, 77–85 Spanish language consonant clusters in, 62 consonants in, 60–61, 61f fricatives, 61 late developing sounds in, 66–69, 67–68t liquids, 62 [l] phoneme in, 62 phonemes, 60–61 word structure, 62–63 Speech best age beginning treatment of, 14–17 suggestions for practicing, 11–14 SpeechBITE database accessing, 41 features of, 39–41 searching with, 55 search strategies, 41–43 Speech discrimination, 20 Speech errors, 10–11 Speech exercises deletion, 140 illustration, 140 imitation, 140 minimal pairs, 140 old way/new way, 140 self-correction, 140 similar sound, 140 Speech language pathologists (SLPs) bilingual children with speech sound disorders, 60 dismissing students on caseloads, 97

frequently asked questions by, 97–98 identifying students struggling with literacy, 97 issues of workloads and determining eligibility, 98 research strategies for, 40 Speech perception, 20 Speech sound disorders (SSDs) bilingual, treatment of, 60 guidelines for linking interventions to curriculum, 98 IDEA regulations definition of, 94 reasons for treating, in schools, 7–8 research on language/literacy disorders and, 96–97 Speech treatment. See Treatment Spelling, 103–104 SSD. See Speech sound disorders Stimulability screening, 137–138, 145 Stops, 6 Syntax, 101–102 Systematic reviews, 40

T [tS ] acquisition, 417 definition, 417 demonstrations affricate, 421 postalveolar, 421 voiceless, 421–422 environments, key, 418 errors, 417 exercises deletion, 428 imitation, 426 minimal pairs, 427 old way/new way, 430 self-correction, 429 shell for, 425 similar sound, 431 metaphors, possible, 418 phonetic placement techniques, 423 relative frequency, 417 shaping techniques, 423–424 tests initial screening, 419 stimulability, 137–138, 420

466 [tS ]  (continued) themes actions, 436 around the home, 437 body, 437 it’s a job, 438 lunch, 438 nature, 437 people, 438 places, 438 touch cue, 418 word lists beginning of words, 432–433 end of words, 434–435 medial, 434 Therapy tips, 29–31 [T] acquisition, 153 awareness exercises, 151 consonant clusters, 150–151 definition, 153 demonstrations fricative, 157–158 interdental, 157 voiceless, 158–159 environments, key, 150–151, 154 errors, 153 exercises deletion, 165 imitation, 163 minimal pairs, 164 old way/new way, 167 self-correction, 166 shell for, 162 similar sound, 168 language activities, 151–152 metaphors, possible, 154 phonetic placement for, 139 phonetic placement techniques, 149–152, 160 relative frequency, 153 shaping exercises, 160–161 speech exercises, 151 tests initial screening, 155 stimulability, 156 themes actions, 175 bath time, 174

The late eight

Christmas, 176 days, 176 directions, 176 home things, 174 job words, 175 nature, 175 numbers, 176 people, 177 places, 177 Star Wars villains, 174 teeth brushing, 173 touch cue, 154 word lists, 151 beginning of words, 169–170 ends of words, 172–173 medial position, 171 [ð] acquisition, 179 definition, 179 demonstrations fricative, 183–184 interdental, 183 voiced, 184–185 end of words, 194 environments, key, 180 errors, 179 exercises deletion, 189 imitation, 187 minimal pairs, 188 old way/new way, 191 self-correction, 190 shell for, 186 similar sound, 192 metaphors, possible, 180 phonetic placement techniques, 185 (See also [T]) relative frequency, 179 tests initial screening, 181 stimulability, 182 themes bath time, 195 family, 195 grammatical words, 195 nature, 194 people, 194 places, 194 body, 195

467

Index

touch cue, 180 word lists beginning of words, 193 medial, 193 Touch cues, 135, 148 Transcribing, for problem sounds, 29 Transfer patterns, 63 Treatment. See also Evaluation best age for, 14–17 correct production of treatment sounds, 445 demonstrations, 447–448 discrimination versus awareness, 451 language activities, 451 metaphors, 447 most important reason for success, 31–32 phonetic placement technique for [T], 448–450 phonetic placement techniques for, 448 sample hierarchy of, 125–126f sounds to treat, 444–445 stimulable for treatment sounds, 445–446, 446 tips for, 29–31 touch cues, 447 Treatment sounds correct production of, 445 goal selection, 73–75, 76f sound selection, 75–76 stimulable for, 445–446 Treatment techniques, 77–85 21st Century Skills standards, 98–99 Two-way dual language programs, 70

V Variation, dialects and, 69 Vocabulary, teaching, 100–101 Vocalic [r]. See [r]: vocalic

W Word lists, 141–145 Word structure, English/Spanish, 62–63

Z [z] acquisition, 255 definition, 255 demonstrations alveolar, 260 fricative, 260261 voiced, 261–262 environments, key, 256 errors, 256 exercises deletion, 266 imitation, 264 minimal pairs, 265 old way/new way, 268 self-correction, 267 shell for, 263 similar sound, 269 metaphors, possible, 256 relative frequency, 255 tests initial screening, 257 stimulability, 258–259 themes animals, 274 Frodo’s journey to Moria, 275 Oz stories, new, 275 people, 276 places, 276 weekdays, 276 touch cue, 256 word lists beginning of words, 270–271 end of words, 272–274 medial, 271–272