Archive for the ‘Behavioral issues in therapy’ Category

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.

Motivation comes in different forms for different kids

Tuesday, August 18th, 2009

Problem: I am working with a child who is not motivated to do anything during the session. The only thing he enjoys doing is spinning in my chair, which he does immediately upon entering the room.

Since spinning in the chair is motivating, I would use it as a reward for cooperating and doing what is asked of him. Seat him in a stationary chair. When he successfully accomplishes the task at hand, he gets to spin in the chair. I would limit the spinning to one or two spins. Then he returns to the other chair and to his work. You can up the ante a bit too. If he does _________, he gets to do one spin. But if he does ___________, he can spin two times.

Rewarding good behavior during therapy

Friday, July 10th, 2009

Re: He is 3 years 3 months old and an only child. His teachers report that he never accomplishes his schoolwork, painting etc. His parents report that they play and paint with him and they read stories to him at home. I think that his parents haven’t set any limits on his behavior. Thus, he is not pushed to do things and he does and has whatever he wants just by starting crying. I should mention that when I asked him to imitate sounds and syllables(he seems to realize his difficulty), he started sniveling. When he plays with me, he follows the rules and he tries to imitate my gestures. He really enjoys clapping my hands when he does sth right.

It’s very important for the child to understand that there are rewards for cooperating and consequences for noncompliance. I always play games with the children. I select fun turn-taking games that I know the child enjoys and wants to play. Cooperation earns turns. I also have treats that children earn for good work once the session is over.