Archive for the ‘Speech Disorders’ Category

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Ideas for the fast talker

Tuesday, January 12th, 2010

Problem: You are working with a child who is hard to understand because he speaks too quickly.

Generally, my focus will be on clarity rather than rate. I’ll say, “It is important that you say all your sounds when you speak.” Then, I’ll demonstrate clear speech and unclear speech. Often, the rate automatically reduces when the child focuses on clearly articulating all sounds.

If you feel focusing on rate is what you would like to do, you can give out “speeding tickets” when he speaks too quickly. His goal will be to not get more than x number of tickets in a session in order to get a sticker or candy treat.

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An 8 year old still in therapy poses special problems.

Thursday, October 22nd, 2009

Problem: I have a student who is nearly 8 years old. This little boy stops all /s/, /sh/ and /s/ blends. He is able to produce the /s/ sound and is able to produce the sound in words when segmented from the vowel. However, whenever it gets close to a vowel, he inserts a /d/, i.e. sdo/so. He is able to produce /s/ blends in words in targeted structured tasks but I see little to no carryover. He can produce /s/ final in words with ease, but, again, has no transition to spontaneous speech. He also has no /r/or /r/ blends and when not in targeted tasks, can intermittently front /k/ and /g/.

I feel like I am at my wit’s end. I’m sure you get emails like this all the time, but I HAVE NO IDEA HOW TO STOP HIM FROM INJECTING THE D! If you have any suggestions, I will try anything. Thank you for any time or suggestions you are willing to offer.

An 8 year old child who’s still in speech poses problems to all of us. They are habituated to their errors and are very sensitive about changing their speech patterns. Among the children I’ve spoken to, most are concerned that the new way of saying the sound feels odd and they worry that they will sound strange to their friends if they change their pattern. Some don’t realize that they sound different than their peers. For these reasons I usually talk to children this age and older about how their new sound sounds to them, how they produce it that makes them sound different than their peers, and finally, how others will really think they sound when they produce the new sound in speech.

Regarding /k/ and /g/: Write down the words that he mispronounces and practice them with him during each therapy session. Make him a list of the words and ask him to practice them at home.

Since /s/ and “sh” are stopped, I would try to tackle both at once. You are on the right track by having him a pause between the consonant and vowel sounds. Gradually reduce the pause in your production when giving the model. Once he can produce CV with barely a pause, tell him that he needs to now slide the sounds into the next sound. Raise your arm to prepare for a visual sliding motion as you say the CV combo. In other words, as you say /s/ or “sh” you’ll motion a slide with your arm and end with the vowel. You can also preface by telling him he is inserting a /d/ after the /s/ or “sh” and he needs to work on sliding the /s/ or “sh” into the next sound without the /d/. If he must have a slight pause with CV, I would still move him on to words, initial position and do the same as you did for CV.

I would hold off on /r/ for now.

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Posted in Articulation Disorders, Behavioral issues in therapy, Communication Disorders, Phonological Disorders, Special Education, Speech Disorders, speech therapy | Comments Off

Child Who Says /t/ for /l/ In Some Words

Tuesday, September 15th, 2009

Problem: I’m working with a 4yrs old. who substitutes a “l” for “t’ and “th” e.g he will say “le” for “the”, “male” for “matter”, but it is not consistent across all word positions and words. What would you suggest?

Since he does use /l/, although inconsistently, I would recommend writing a list of /l/ words for him to practice. Practice these words daily. You can add to the list whenever another mispronounced words comes up.

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Spontaneous language sample: the speech pathologists stethoscope

Saturday, August 29th, 2009

When I test a child, I do a battery of formal tests and a spontaneous language sample. For an spontaneous language sample, I audiotape a conversational sample of a child’s speech (50 to 100 utterances) and analyze it. It offers a lot information about grammar, syntax, semantics, pragmatics and and overall conversational skills.

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Posted in Articulation Disorders, Communication Disorders, Language Disorders, Language Therapy, Language problems, Special Education, Speech Disorders, Speech and Language Evaluation, Speech and Language Testing, speech therapy | Comments Off

Consonant devoicing

Tuesday, August 18th, 2009

Problem: I have a 4 1/2 year child who devoices /b/ and /d/ and produces them as /p/ and /t/ respectively. What should I do?

I would work on getting this child to understand the concept of voicing. If he is at least 4, I would talk about the voice box and that we can feel it work (If he is closer to 3 years, don’t bother talking about the voice box). Have him cover his throat with the palm of his hand as he feels it work when he hums and coughs. Compare this feeling to what happens when it doesn’t work—blowing air and whispering. Next compare the feeling for voiced and unvoiced sounds that he is able to produce ( I guess I am assuming that there are voiced sounds he is able to produce). Try giving him a string of voiced sounds, randomly throwing in /b/ and /d/ without warning. Gradually increase the occurrence of /b/ and /d/ in the sequence until production becomes consistent.

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Is the child talking too quickly or not speaking clearly?

Thursday, August 13th, 2009

Problem: The child talks too quickly and is hard to understand in conversations.

Some children do not clearly articulate consonant sounds in conversation. This can make their speech sound excessively fast. In such a case, I would encourage clarity by telling her to, “Say all your sounds.” When a child focuses on saying sounds clearly, she will generally slow her speech down to do so. On the other hand, she may be talking too fast and, as a result, drops consonant or compromises consonant sounds. In this case, I would make some “speeding tickets.” I would tell her that when she talks too fast she is speeding. Explain that when cars go too fast, people get speeding tickets. When she speeds, she will get a speeding ticket. I like to have treats or stickers ready. If they stay under a certain number of speeding tickets, they get ___________ as a reward at the end of the session. If they go over, no reward.

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What do to if the child has dysarthria

Tuesday, July 21st, 2009

Would you recommend working at sound level at all? What about oral strengthening exercises for the dysarthric features?

If the child has a large enough repertoire of sounds there is no need to work at the sound level. Take him to the next challenging level. If I am assuming correctly, that “oral strengthening” exercises are the same as oral motor therapy, then there is no evidence that “oral strenthening” exercises are of any benefit. Rather, I would observe and note which sound transitions are challenging for him and then work on those transitions. For instance, let’s say that he has difficulty transitioning from /k/ to /t/ as in “back to” I would start out asking him to repeat /k/ — /t/ one right after the other. If this is easy, move him on to two word combos: take to, make time, etc. Short sentences would be the next step. The idea is to determine the level of breakdown and work from there.

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Posted in Articulation Disorders, Communication Disorders, Dysarthria, Phonological Disorders, Speech Disorders, speech therapy | Comments Off

30 Minutes of Therapy a Week!

Monday, July 20th, 2009

Re: I see Ben once per week for 30 minutes, usually at his school.He has made progress in therapy, but it has been slow and limited and his speech remains very inconsistent.

What can be done to help a child on a 1/2 hour schedule once a week? Very little to nothing, unfortunately. I say this because your heart and mind are in the right place in trying to help this child. He is severe so I hope you are keeping your expectations in check. The good news is that his mom sounds as if she is involved.

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Posted in Articulation Disorders, Communication Disorders, Parent Involvement in Therapy, Phonological Disorders, Special Education, Speech Disorders, speech therapy | Comments Off

Does this 5 year old have dysarthria?

Tuesday, July 14th, 2009

I recently started working with Ben (age: 5;3) who is in Kindergarten.
-His prosody is close to monotone
-His speech sounds and looks effortful. It is slow and he over- articulates his sounds (e.g. his mouth opens wide). His mother and teacher report that his clarity drops significantly with fatigue. His
performance varies from session to session (e.g. /ch/ isolation 100% one week, 60% the next „³ /sh/)
- He appears to be simplifying his syntax not just because of his language delay but also due to the limitations of his articulation (he can say grammatically correct sentences when prompted to, but generally sticks )
- Feeding: Ben takes a very long time to chew hard/chewy foods (e.g. a carrot). I am planning to look at his feeding when I see him next.

I am wondering if this child has dysarthria. I would recommend that you speak with the parents about having a pediatric neurologist see their son.

Re: Previous goals have included- phonological awareness skills (e.g. syllabifying words- if he has trouble saying a word now his mother prompts him to clap it out & he is generally successful at saying it- e.g. spaghetti) & /l/ clusters. He can syllabify words with up to 4 syllables by clapping and imitating. He can say /l/ clusters at
word level, but sometimes breaks down at higher levels. When he says /l/ clusters at word level he segments the sounds a little (e.g. b-lue) like he is trying really hard to make all the sounds. He had also been working on rhyme identification but with little success (I have abandoned this goal). Mum reports that he has improved a lot since the beginning of the year (meaning that his speech is easier to understand).
- He has inconsistent processes (deaffrication tch„³ts, consonant
harmony dog„³gog, WSD, CR). When asked to copy an adult model at single word level, Ben can do so accurately (although at a slower rate). At phrase & sentence level, Ben distorts and omits sounds and syllables including vowels.

I think at this point I would focus on consistent sound production at the phrase level in repetition tasks. I would focus on all sounds in his repertoire. I would also compose a list of words in which consonant harmony occurs and work on correct production of those words. Identifying a pattern, such as consonant harmony in words beginning in /d/ followed by /g/ (as in your example), will help narrow down the word list possibilities. Using the /d/-/g/ example, a sample of appropriate words would include: dig, dug, dagger, drag.

I agree with your decision to abandon the previous focus on phonological awareness and focus instead on helping this child communicate more effectively.

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Speech Therapy for a Two-Year-Old

Tuesday, July 14th, 2009

I am seeing a 27 month old boy who started out pretty much non-verbal (except for ‘uh-uh’). I’ve been seeing him for about 3 months. He tries to imitate words during play, but only produces the initial sounds (m, p, b, d, t,). He has responded very nicely to touch cues and grossly imitates them as well. While I celebrate this accomplishment, I’m not sure how to move him beyond this. No matter how much I exaggerate the vowels and try to elicit imitative play, I just get the initial sound. He will imitate ‘o’ for open; ‘ah’ for up; I used to get a ‘pah’ for push as he knocked me down with a pillow. I also used to get a ‘ch’ for choo choo. Lately, he’s very whiny, and uses only ‘uh-uh’ to try to communicate his needs. He does, with prompts use some signs: help, please, more. In response to my model, he is beginning to the gesture ‘come’, instead of just taking your hand to lead you to what he wants. I should let you know that he has been in a day care setting where the provider reportedly is very demanding, resulting in some power struggles; parents also have some unrealistic expectations in terms of thinking that because they showed him once, he should just do it now. So we spend a lot of time talking about the fact that children need to see and hear models repeatedly, within daily routines before they begin just doing things. I’ve been working in early intervention for 8 months now, and I guess I am looking for feedback in terms of expectations with regard to time frame…..is this all I should be expecting at this point; and also, suggestions for how to move him along into CV, VC, and CVC. Follow through at home is not the greatest….they’re stating that “once he is in preschool, he’ll begin to do more.” I just want to make sure I’m on the right track, and looking ahead appropriately in terms of the direction of my sessions.

With children in this age group, I try to get across the message that verbal communication is rewarding. Being understood and responded to is rewarding. So when he uses verbal communication that even approximates the real word ( “He will imitate ‘o’ for open; ‘ah’ for up; I used to get a ‘pah’ for push as he knocked me down with a pillow. I also used to get a ‘ch’ for choo choo” ) that is a great starting point. When he makes these approximations, one should acknowledge and reward what he has said, by either repeating the word (said correctly by you) or acting on it, such as opening whatever, when he says, “O.” Right now I would not worry about CV, VC, or CVC. I’d just focus on making talking fun.

It sounds to me as if his parents and caretakers need help in making communication rewarding for this child, reducing demands, and maintaining realistic expectations. Also, I would focus on training these significant others in using the techniques of parallel play, self-talk, modeling, repetition, and expansion.

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