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If you want a child you are working with to make progress in his/her articulation goals, you have to inspire them to practice between sessions. Make some fun stationery to list their practice words or sentences on and encourage parents to post it in a prominent place. Have parents and kids post stickers or write stars after each practice so they can “show off” their hard work the next time the therapist sees them. One Mom added “Speech” to her child’s responsibility chart and it became part of her daily routine.
Often I tell parents to keep practice sessions short, fun and frequent. It can be helpful to “warm up” a child’s speech before they head off to school. A reminder of using that /s/ or /r/ sound while talking at the breakfast table helps a child key into their sound. Let them listen to you and point out good and bad productions of their sound. They love to catch adults doing it wrong and it builds their auditory discrimination skills to monitor their own speech.
I realize I have an advantage over a school therapist in that I see parents during or after each speech therapy session AND they are paying for my services so I tell them, “If you want to spend less and finish speech faster, make sure your child practices!” It seems to work. They are anxious to get “new words” for practice after each session and the parents get more invested in the process. If kids are older, let them take responsibility for practice. I have some 7 year-olds who are working on /r/. They are motivated to practice simply by my offering to bring a special game of toy if they comply. One mom was to e-mail me the night before to tell me if her son practiced that week and I would bring the Playmobil Egyptian pyramid. Certain toys are reserved for good speech behavior:)
I notice that a number of people who come to my site are searching for and interested in information on apraxia and speech therapy for apraxia. Parents want to know when and how it is diagnosed and what kinds of therapy they should be looking for to help their child.
I have blogged on this topic a number of times, often related to my view that children are often diagnosed too early or misdiagnosed in this area. I ran across a helpful interview that addresses this issue as well as appropriate therapy approaches, feedback and practice. In the professional magazine, www.advance.com., blogger and speech language pathologist Stephanie Bruno Dowling, interviews Sharon Gretz, MEd., founder and current executive director of CASANA, the Childhood Apraxia of Speech Association of North America. Her interview is very informative and helpful to parents as well as therapists. Several points are emphasized that I agree with:
- Effective apraxia therapy must be approached from a motor planning and programming approach, understanding that children with CAS practice movements that lead to permanent change in their motor system.
- Effective therapy is delivered individually and in short, frequent sessions. I have had parents call me, telling me that their child was diagnosed with Childhood Apraxia of Speech and they were getting therapy in a group, once or twice a week for an hour. Therapy needs to be very specific for a child and include repeated execution of motor movements which is not conducive to group therapy. Several shorter sessions per week have been found to be more effective. In fact, the American Speech and Hearing Association recommends therapy 3-5 times per week for children who are diagnosed with severe to moderate CAS.
- Effective practice by the therapist and parents as well as feedback is important for progress with CAS
- Effective speech therapy for apraxia appears “to include multi-sensory feedback in the form of visual, verbal, or even tactile/touch cues to help guide the child’s speech movements.” Unfortunately there isn’t one method that is right for each child so it is necessary to try different approaches that involve strengthening the child’s internal sensory systems, while giving feedback for correct motor movements. I have blogged in the past about success I have found in using the Kauffman approach as well as PROMPT.
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I just got a note from Marshalla Speech and Language, pointing me to Pam Marshalla’s new free videos on YouTube, demonstrating her cues for consonants. She has developed a helpful system of hand cues to focus a child on placement of sounds. I watched her video and tried them out with a few of my 3 year-olds who keep confusing /k/ and /t/. They were helpful and the kids started to use the cues themselves! Try them out.
What cues do you find helpful in articulation therapy? Share with us in the comments below.
Today I was called in to consult on a little 2 year-old girl who has been receiving services from a Birth-3 provider. I usually ask parents to have all the reports and current goals for me to get an idea of the background on their child. Once again, a child had been labelled “apraxia” and the parents wanted to know what I thought. Personally, I have seen very few children who truly have apraxia in the 35 years that I have been in practice. I have seen many that initially I thought had motor planning difficulties but they settled into therapy and began to show progress and were eventually dismissed.
This little girl was using some 3 word sentences, imitating what I was saying and also had the advantage of just getting tubes put in her ears a few weeks earlier. The parents noticed a dramatic improvement in her speech and ability to imitate. Fluid in the ears and temporary hearing loss can contribute to slow progress and a need for medical intervention.
I gave the parents several suggestions for how they were to respond and talk to their child–not a lot of questions or requests for her to say words, but modelling the words and phrases for her, turn off background music and tapes during your talking play time and talk in 2-3 word phrases during your play time. I offered some suggestions for therapy as well as increasing her frequency of sessions. I am careful not to be invasive when recommending ideas to other therapists because I know that they are doing their best and usually a very good job as in this case. But, sometimes it is helpful to take a step back and view the child through different eyes.
I watched a wonderful interaction between mother and child today during our speech therapy session. It is exciting for me to see my little clients improve, but just as satisfying to watch parents learn how to encourage speech and language.
Little two-year-old Sean loves my three dollar plastic pretend microphone. He selected it out of my bag and started to make sounds into it. Mom held the mike and began to imitate Sean. Much to his delight he continued in their “conversation,” offering up new sounds and syllables, waiting for Mom to imitate. Ever so gradually, Mom began to slightly change what Sean was saying. He said “ba” and she replied “ba ba.” Slowly the roles reversed and Sean started to imitate mom so now he was having to match what mom was saying. He was learning the fun of producing sounds, having a conversation and imitating sounds all at once. By the way, Mom was having fun too!
Whenever we teach parents how to stimulate speech and language, they become a big part of their child’s progress.
As I have said before, I think many children are labeled apraxic prematurely. Often I will say to a parent that their child is apraxic-like, meaning he or she appears to be having some motor programming difficulty with speech and finds it difficult to imitate at the appropriate age.
With the 2 year-olds that are referred to me who have very few words that might appear and then be gone, I have found an effective way to “get them going” in a therapy session. If they have a word or two that seem easy for them to produce such as “ball” or “dog,” then begin with those words. Plan an activity where you can use the word in many different ways through play so the child has an opportunity to be successful and get his vocal mechanism going. I even tell parents to help “warm up” their child in the morning before they are going off to preschool and they seem to talk more and be more successful.
Yesterday I used a little push-activated toy, a dump truck, that we kept making and putting play-doh balls into as we made it go across the table. Every little activity with a ball was an opportunity for success.
Many speech delayed children have apraxia of speech or apraxic-like characteristics: inability to consistently repeat speech models, difficulty with the motor programming for speech,
In my work with preschoolers who have these characteristics, I have found several materials valuable, one of which are the Speech-Language-Reading Connection Books pictured on the left. Each book features a consonant, vowel, or vowel-consonant combination that is highlighted and repeated throughout the simple silly story. These goofy tales appeal to kids. In Bunny Bop, the bunny “bippity bop, bop. bops” to various bushes–a berry bush, banana bush, green bean bush and even a bagel bush. Today, my little student who is finally repeating single words, attempted “bippety bop bop” with several syllables. Another favorite is Hanna Hippo who laughs with a “ha ha ha,” “hee hee hee,” and a “ho ho ho.” Timmy the Turtle is too slow for the race and lamented “Tut, tut, tut,” he’s too slow. A wizard showed up to fix Timmy’s feet until he had “magic feet” that could not be beat.
Let me know what materials you find helpful in working with kids who exhibit apraxic-like characteristics.
Any speech therapy practice is constantly changing–clients are being dismissed and new ones are beginning therapy for the first time. It occurred to me that I should blog about some of the expectations that parents have who are new to the preschool therapy process.
- The speech therapist has all the answers. We don’t know all the answers immediately. I am often asked, “How long will this take?” Will he learn to talk?” I tell parents that I don’t have a crystal ball and can’t answer those questions. Certainly, after I have seen a child for several weeks or months, I have a better idea of whether they are responding quickly to therapy or if they are progressing more slowly, whether it is a simple delay or might involve a disorder. This can be shared with parents although kids are always surprising me and they may take a jump in their progress at any time.
- Things should go smoothly from the start. Kids need to adjust to the therapy process. Even though preschool therapy should be provided through play so kids love it, it is still an adjustment for a 2 or 3 year-old to pay attention to an adult for 45 minutes to an hour. It is up to the therpist to change activities often enough to keep a child’s interest, but intially you might be just teaching that the child has to say something to get something (Isn’t that the jist of communication?) Up until now, a language delayed preschooler has developed their own tactics for getting what they want–ranging from screaming, grunting, pointing etc. Now they are being rewarded for verbalizing, even if it isn’t clear, to get what they want, which is the beginning of successful communication.
- I want to be involved but how? Parents need to be educated too. Parents should be an integral part of preschool speech therapy. Hopefully they can be sitting in on the sessions, learning how to encourage specific speech and language progress. I always share exactly what I am working on, how I am doing it, and how much to push without ever frustrating a child. Give a list of words, phrases or concepts for the parent to reinforce until you see the child the next time.
- If my child said it once, he should be able to do it again. Not so. Some kids can consistently repeat a new sound or word, but often they need prompting to say it again. If they can’t repeat the sound or word after the therapist is gone, simply keep modeling it in your own speech with no expectations put on them, “Here comes the car. The car is turning, Stop the car.” Your child might repeat “car” after all that modeling by you, or you might hear it later on. Some preschoolers are late in talking because they have difficulty motor planning the speech sounds (apraxia). In that case, it will take a lot of practice before they can easily say sounds and words.
Don’t we all want to get the most out of our therapy sessions while having fun?? I find it challenging to find fun activities that don’t monopolize the session, but leave room for plenty of responses by the child. Therefore, games that have quick uncomplicated turns are best.
Lately I have been using puzzles to great advantage with my kids from 2-4 years of age. They provide quick reinforcing turns, and are interesting to the kids. If you pick the right puzzle by ability and interest, the kids can’t wait to give your several attempts at their articulation or language target to get a reinforcing piece. Some of my favorites are:
- Lauri puzzles are made from crepe foam rubber so they are easy to grip and fun to push into the cut-outs. There is a variety of amusing subjects like construction, transportation, nature and castles. With the large assembly piece around the puzzle, and guide beneath, kids can see where the pieces go.
- Melissa and Doug chunky wooden puzzles are winners with preschoolers. I can’t tell you how many kids will attempt to communicate just to get the chunky wooden train or boat cut-out. An advantage of these puzzles is that they become pretend play pieces outside of the puzzle as you stand them up on the table. Duncan made a parade of boats and trains as he said his sounds and collected a puzzle piece. My favorites are “Vehicles” and “Safari.”
- Infantino’s “My First Puzzles” are a first introduction to a multi-piece puzzle. There are 2, 4 and 6 piece puzzles to put together and feel accomplished at completion!
- Frank Schaffer’s “Giant Fire Engine Floor Puzzle“ has 24 jumbo pieces to construct the fire truck which stretches four feet long. Kids hardly know they are practicing their speech and language targets as they’re anxious to receive a piece and make this puzzle.
- Shure’s “Chunky World Magnetic Tow Truck” has thick, easy to grab vehicles with bright engaging pictures on each side. The powerful magnetic tow truck (that even hung on to my clothes dryer!) picks up the cars, trucks, buses and campers to kids’ delight.
