How do you say, “Squirrel”? Does your pronunciation truly match the spelling of “squirrel”?
A bright student and I were practicing the postvocalic /r/ sound in “first”. I re-spelled the word (incorrectly) as “ferr—st” to show how it’s pronounced with an emphasis on the underlying vowel and a prolongation of the /r/. “Even though it has an ‘i’ in it, we say, ‘er’, like in ‘her’, or ‘fur’.” We began to generate a list of others words that had the “er” sound, which led to an interesting discussion about /r/ and spelling.
This student has been working on the vowel /r/ sound for “er” for a little while. The “er” sound is often difficult for clients to produce because the underlying vowel is “uh”, like the two vowel sounds in the word “above”. This “uh” vowel, like in “duh”, is produced with the articulators (lips, tongue, and jaw) in a relatively neutral position – almost like your mouth at rest. If you just open your mouth slightly and make a sound, you’ll probably get “uh”. To make “er”, we have to add /r/ to a relaxed mouth position.
We started a list of words that rhyme with “er” and were astonished at the spelling variations.
• “er” sound with “ir”: stir, girl, chirp, first, etc.
• “er” sound with “er”: her, paper, dinner, etc.
• “er” sound with “ere”: were
• “er” sound with “ear”: pearl, earth, heard, etc.
• “er” sound with “or”: worst, worry, world, doctor, etc.
• “er” sound with “our”: journey, courage, etc.
• “er” sound with “ur”: fur, nurse, purse, turn, etc.
If clients rely on spelling, it may be difficult for them to determine the underlying vowel for postvocalic /r/ words. Our orthographical system does not directly correspond to our phonological system. Approximately 44 phonemes (sounds) are represented with 26 graphemes (letters) combined in various ways.
Sometimes there are letters that we don’t even say. We tried the word, “February”.
“Do you know that most people don’t say ‘brew’ in the middle of ‘February’? They just say, ‘you’.” I explained. We then re-spelled “February” as “feb—u—air—ree”.
Articulation therapy may benefit from a focused exploration of sound-letter correspondence for /r/ and /r/ influenced vowels. We know that we don’t produce a /w/ sound for “write”. For conscientious, older students who are strong readers, their ability to use spelling to help them produce /r/ words may be highly misleading. Our spelling system does not consistently indicate which one of the underlying /r/ vowel sounds will be used. Generally, we have six /r/ influenced vowels: fear, fair, fur, far, four, fire. The “er” sound alone can be represented with seven different spelling combinations.
The student told me that “squirrel” is hard for him to say. We re-spelled the word as “sk—werr—ul”.
“I wish it was spelled that way,” he said.
“So do I,” I concurred.
Did you ever catch your friend’s eye from across the room at a crowded event and let her know that you were ready to leave? Briefly tilting your head to the side and a quick glance toward the door can represent an entire sentence.
We exchange thoughts and ideas through gestures, facial expressions, body postures, and physical proximity. Non-linguistic communication may often be just as important as spoken words.
We use conventional gestures to share familiar ideas, such as pointing or rolling one’s eyes. Coding and transmitting ideas non-verbally is actually a complex process. Communicating an intention with gestures and facial expressions, without speaking at all, requires multiple steps:
Generate an intention: decide what you want to communicate
Plan: decide how you will communicate your message
- You can watch your partner until they look at you
- You can wave at your partner
- You can move a little closer to your partner (lean forward)
- You can tap your partner lightly on the shoulder
Give your message: combine your gestures and facial expression to convey your intention and share your message
Check for understanding: watch for your partner’s response
- If your partner doesn’t understand you, you can repeat the gesture or try a new gesture
- Validate your partner’s correct understanding of your message: nod, smile, etc.
We can teach the sequential steps involved in a non-verbal communicative exchange as a game. We can model and demonstrate the multiple steps required for each stage of the interaction with cue cards that use words and/or pictures.
Each card has the command “No talking” and/or an icon of an X across the mouth to remind players that the message has to be shared non-verbally. The entire exchange will take place without talking at all:
- Let your partner know that you think it’s hot in here
- Let your partner know that you think it’s cold in here
- Let your partner know that you are hungry
- Let your partner know that you are thirsty
- Let your partner know that you like their shoes
- Let your partner know that you like their shirt
- Let your partner know that you need a pencil
- Let your partner know that you want to play a game (like Rock, Paper, Scissors)
- Let your partner know that you want to know what time it is
When we communicate, we observe the behaviors of our partner to gauge their understanding of our message and if there is a communication breakdown. Individuals with speech and language disorders may have difficulty with pragmatic judgments of listener responsiveness, and limited perseverance to overcome misunderstandings.
Showing the turn-taking steps in an interaction without using spoken language may provide a fun way to recognize the roles and responsibilities of both the sender and the receiver.
Do you have an emotional response to consonant mastery charts for age
of acquisition for speech sounds? I do. Just the mere mention of late mastery
of sounds makes me bristle.
Do you use the Poole study from 1934 or the Templin study from 1957 as
a means to determine whether or not a child is demonstrating an articulation
delay? The 1934 Poole study examined 65 children ages 2;6-8;6 at the University
of Michigan, and mastery was defined at 100% accuracy for consonants in
initial, medial, and final position in words. The 1957 Templin tested 480
children ages 3-8, and mastery was defined at 75% accuracy for consonants in
initial, medial, and final position in words.
In the Poole study, /r/ and /s/ were not considered mastered until 7; 6.
In the Templin study, both were considered mastered by ages 4;6. There is a three-year difference in mastery between
these two studies. (Neither of these studies was specifically designed to
serve as a form of eligibility criteria for the provision or the denial of
special education services and therapeutic intervention.)
This past week I met with a new student and his family. The student was
a second grader, age 7;8. He had recently transitioned from another school
district. He had difficulty producing /l/ and /r/. His mother shared that she
had advocated for services at his prior school and was told that his errors
were typical. She had become concerned and had sought a medical evaluation for
I tested the student and found him eligible for services. He was
friendly and eager, and readily attempted all tasks presented. When his mother
asked me why no one had helped her son before, I said, “Everyone has different
opinions.” There was nothing else I could say, because educational agencies
form “opinions” by extrapolating certain elements of data for specific purposes
that are then used to determine policy.
What if we conducted action-based developmental research on other
- Age at which beginning intervention requires the least amount of
services in order for child to achieve goals
- Age at which child is most stimulable to intervention (modifying
- Age at which maladaptive compensatory patterns become fossilized
(highly resistant to intervention)
- Age at which speech articulation affects perceptual skills (ability to
differentiate between targets, approximations, and errors)
- Age at which speech sound disorders affect socialization and peer
- Age at which speech sound disorders affect literacy development
- Age at which family, staff, or student are initially concerned about
In this case, the student presented with a mild restricted lingual
frenulum (tongue tie), an anatomical and structural difference that may affect
his development of speech production for /l/ and /r/. Waiting for a normative
age of mastery may not have been appropriate, as underlying lingual range of
motion was atypical, but we can talk more about tongue tie later…
Question mastery charts and their appropriateness to policy.
1. Prather, E.M., Hedrick, D.L. & Kern, C.A. (1975). Articulation
Development in Children Aged Two to Four Year. Journal of Speech and
Hearing Disorders, 40, 179-191
2. Bauman-Waengler, J. (2016). Articulation and phonology in speech
sound disorders: A clinical focus (5th ed.). Boston, MA: Pearson.
Confidence is widely regarded as an important trait for success, and insecurity is often considered a liability.
Recently, a colleague who is transitioning to a new team shared her fears with me about her position change. She will soon be working alongside Occupational Therapists and Physical Therapists to serve children who use Augmentative and Alternative Communication. Many of the children have complex medical needs and the position requires coordinating services across multiple professionals.
“I feel like an imposter,” she confided to me, implying that she didn’t feel qualified for the job. The imposter syndrome describes when people with strong skills do not appear to believe in their own abilities. I know her and I know her work. She is qualified for the position, and it will also require her to expand her knowledge base.
After reassuring her that most professionals feel uneasy when they change settings and begin working with new clients, I told her that a little insecurity is actually a good thing. Insecurity can make us better clinicians. Insecurity often occurs when we are not sure how to proceed. When we are unsure, we may take deliberate steps to increase our understanding.
Self-doubt may be a form of self-reflection. If we entered every clinical situation with such a heightened sense of confidence, that we didn't question our own decision-making, then how would we learn new things? We might even inadvertently make incorrect assumptions about the course of treatment. Obviously, too much insecurity can be debilitating, but too much confidence can be detrimental. A balance of just enough insecurity to recognize our current limits may prompt self-improvement.
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When we have moments where we feel like an imposter, we may be recognizing that we have areas that need growth. We are acknowledging that we have more to learn. Our field encourages life-long learning, which is another way of saying that we have a life-long lack of knowledge. The manifestation of disorders, disabilities, and constellations of needs in communication and swallowing that exist within the entire human condition is too broad for any one person to ever reach expertise.
Insecurity is a shadow form of humility, which may be an asset as we interact with clients and families. Self-improvement may come from recognizing present limitations, followed by a purposeful plan of action for positive change. We can welcome threads of insecurity to enter our practice in the form of functional questions:
• How was I prepared for this client’s needs?
• How was I unprepared for this client’s needs?
• How did I interact with the family?
• How could I change my interaction style to foster improved rapport?
• What additional information do I need to access?
• What resources could help me?
• What is the expertise of the other professionals around me?
• How can I learn more about the scope of related professionals?
• What new research is available pertaining to this client’s needs?
Skilled services may include the instability that comes from seeing strengths along with current weaknesses. Insecurity can be a force that challenges us to be better.
A child who is substituting /w/ for /r/ makes progress producing /r/. He is now using /r/ in initial position in words. Surprisingly, he is also now substituting /r/ for /w/. He is producing “right” correctly, but now he is no longer saying “white”.
My colleague shared this story with me and explained how she needed to provide specific directions to the child, e.g., “It’s OK for you to still say /w/. ‘Wing’ starts with the /w/ sound. You can still pucker your lips for the /w/.”
What happened? We could simply assume that the child overgeneralized production of /r/. Perhaps it is much more complicated. Substitution of the /w/ phoneme for the /r/ phoneme may have altered his phonemic inventory. One sound, /w/, represented two distinct phonemes /w/ and /r/. Untreated speech sound errors may have the ability to affect a child’s phonological understanding.
We each have a phonemic inventory, which is the total number of phonemes that we use contrastively. This means that we recognize that when one phoneme changes, the meaning of the word changes. “Rich” is not the same as “which”. One phoneme change in the minimal pair means that we have said two different words. For a child who is using one sound for two phonemes, this contrast may be lost.
A teacher shared that one of the students was writing “thun” for “sun”. She was concerned that articulation had affected spelling. Speech sound production had likely affected more than spelling, it may have altered the child’s phonological development.
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In articulation therapy, we often begin with ear training to help the child differentiate between target sounds and substitutions or distortions. Children often have difficulty recognizing when they have produced the target sound correctly and the closeness of their approximations.
Parents and caregivers may also report that they are unable to hear the difference between their child’s errors, approximations, and correct productions, e.g., “It’s just how he talks. I don't hear it anymore. ”How many years of substituted productions would it take for a child to become unable to hear the difference between phonemes? How many years of substituted productions would it take for a parent/caregiver to become unable to hear the difference in their child’s speech?
We listen for meaning. As typical communicators, the message is more important than how the speech sounds were produced. We generally focus on the content of what was said, instead of how it was said. Children with articulation disorders and their families are likely listening for meaning to the extent that they may lose the ability to hear production.
Extended ear training exercises and contrastive pairs may be essential for many more children with articulation errors than we realize. We could question if more years of inaccurate production leads to increased risk of phonological involvement. We can advocate for children by sharing the benefits of initiating articulation therapy with young children to prevent possible phonological disorders, which could, in turn, affect literacy development.
Speech sound production and articulation are often treated casually in comparison to their fancy partner, language. The complexity of language and the mysterious relationship between language and cognition tend to overshadow the finely timed coordination of motor movements for speech clarity. Speech, however, isn’t an unimportant subdomain of communication.
Speech, itself, is incredibly powerful. We live in societies that use spoken language as the primary communicative modality.
Speech is socialization. Speech enables us to communicate with others. We establish emotional bonds, engage in reciprocal conversation, share knowledge, and express emotions.
Speech is acceptance. There are societal expectation for speech clarity and intelligibility. Clear speaking skills may provide a speaker with opportunities, advantages, and privileges (social, academic, employment, etc.). People who have significant speech sound disorders may be mistakenly perceived to be of lower intelligence. The original meaning of “dumb” was “mute” (unable to speak). Teasing and bullying may exist. Microagressions may be present in the form of potentially offensive questions, e.g.:
“What’s wrong?”, “What happened to you?”, or even “Where are you from?” when your speech production makes it sound like you have an accent from another region.
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Speech is identity. Our speaking styles mark our allegiance to our communities. We use our speaking styles to show elements of who we are:
• Regional and dialectal affiliation: geographically-based accents
• Gender-coded speech of societally-determined binary male/female traits
• Generational speaking styles: age of group belonging
• Prestige: societally-coded styles indicating affluence and education
Speech is control. Using words to communicate allows for agency – the ability to exert influence on other people.
• By speaking, we define traits and characteristics that shape another person’s thoughts and perceptions.
• Our requests for assistance prompt others to come to our aid.
• Verbal orders and demands prompt others do things for us.
The ability to speak the way that you want to speak, and to sound the way that you want to sound, shouldn’t be taken for granted. As clinicians, we may not necessarily understand the fundamental connection between speech and identity, as our speech typically matches our self-identity.
Experiential and simulation activities may help build our awareness and a renewed sense of value to speech. Try this: hold your tongue tip behind your lower front teeth and don’t move it. Start to talk. Your tongue range of motion has been limited and you are likely using the blade (flat, mid-section of your tongue) to produce sounds. You may even have saliva starting to pool on the interior sides of your mouth. Your speech will sound different. Now use this speaking style in public, ordering at a restaurant, meeting a new person, etc. Let me know how it goes and how you felt.
I would like to award you an honorary degree in professionalism. You worked hard for this degree. You studied and learned every day of your career, gaining insight from daily clinical, family, and staff interactions. You have specialized skills specific to clinical practice that you acquired through hard work and dedication.
As practitioners, we have obtained high levels of achievement both clinically and interpersonally. Perhaps it’s time that we acknowledge our own merits and expertise. If there were a higher education degree in professionalism, it could encompass the following knowledge, content, and skills areas:.
• Child and family studies
o Operate as change agents regarding issues, polices, and needs that affect children, adolescents, and families
• Intercultural communication studies
o Theories and applications in cultural and linguistic diversity
Data analysis and documentation management
• Educational measurement and performance standards
o Norm referenced and criterion referenced measures
• Methodological issues
o Programmatic evaluation of service delivery
Clinical research and application
• Theories and application of efficacious intervention
o Clinical topics and issues across disorders, developmental stages, and needs
• Evidence-based practice
o Peer-reviewed research, client values, and clinical skills
• Professional and staff knowledge of quality services
o Design and implementation of inter-professional teams
• Cross-disciplinary intervention systems
o Coaching and mentoring
• Organizational behavior and strategic communication
o Ethical and legal considerations
• Educational psychology
o Theories and initiatives in teaching and learning
Learning exists in formal academic settings and in professional work settings. The role of professional requires study, observation, reflection, application, and self-evaluation. Each day that we work, we are increasing our clinical and professional understanding. The ability to serve as a positive influence supporting children, families, and staff, within a larger organizational structure, is deserving of recognition. There is pride and value in clinical practice.
Imagine your own commencement ceremony in your own work setting as you and your colleagues recognize the power of professional expertise.
“I hereby confer the honorary degree of professionalism with all the rights, honors, and privileges, which throughout the world pertain to that degree.”
“And Congratulations! You earned it.”
I received an unfriendly email message from a colleague. The message started nicely with kind words, but ended with criticism and complaints. I felt stung. The whole situation was a misunderstanding and I had not even caused the problem.
“I’m innocent,” I wanted to proclaim. “It wasn’t my fault. We didn’t even know that there could be a problem.” Multiple emotions confused my thinking in a mixture of sadness and indignation. We didn’t have all of the information at the time and were acting with the best intentions.
As adults, the playground refrain “words will never hurt me” has a new significance. Instead of becoming immune to insult, we know that words have power and are capable of causing emotional distress. Our words affect the trajectories of our personal and professional relationships.
I emailed back a short and polite apology. I said that I was sorry and made assurances that the team understood the factors, and that the situation would not be repeated.
It takes time to process and recover from difficult interactions. An initial human response is to interpret events personally, although most of the time, they aren’t personal. We have hectic days, extensive obligations, and on-going demands. We’re all doing the best that we can to keep up with the pace of work.
• Sometimes when people are mean, it is because they are experiencing their own emotional states (tired, overworked, frustrated, etc.) and it truly has nothing to do with you.
• Being unkind may indicate a measure of trust because it may show that a person has enough faith in the relationship to be a little bit rude without fear of rejection.
• Rudeness may come from a perception of lack of control. People may feel powerless about other factors in their lives. A moment of emphatic, direct, and insensitive language may be a way for them to experience a sense of autonomy.
• Some people have difficulty expressing what they need. They may find it hard to say “no” initially, and then find it easy to protest after they are overextended.
• Sometimes anger is displaced. You may not be the actual target. A person may be upset by another party, such as a parent/caregiver, administrator, etc., and be unable to show it.
If you have been treated insensitively, I’m sorry. I understand that it feels bad. We all deserve better. When there are repeated patterns of inconsideration, we may need to change our work environment and/or self-advocate. We work on teams providing services and supports for clients with complex needs. We partner with families who are experiencing significant stress regarding the growth and development of their children. It’s our job to care for each other, too. In our daily work we can be role models of respectful interactions. We can sincerely thank each other for the hard work that we do, and we can forgive those occasional times when we are less than polite.
“There’s a zombie on your lawn.” This catchy refrain is from the theme song for the video game “Plants vs. Zombies.” Even though I’m not personally a fan of zombies, it’s easy to see how zombies have become part of the current cultural landscape for children. I held out as long as I could before I finally invited zombies into therapy using pictures from the video game.
In “Plants vs. Zombies”, animated smiling sunflowers, pea plants, corn, and other vegetables fight zombies who are heading across the front lawn toward your house. The drawings in the video game are relatively cute and the zombies don’t look too scary. I haven’t played the game, but I learned about the premise, the rules, and the characters from the students.
We co-created our own zombie games using Google images for the different characters, which we printed and laminated:
• Zombie/plant barrier game: Students colored checkerboard patterns on green paper to make lawn game boards. Each student was given a lawn game board and a small set of zombies and plants. We used tri-fold presentation displays as barriers so that we couldn’t see each other’s game boards. Students would take turns designing the layout and giving specific directions to the group, e.g., “Put the zombie with the brown jacket in the top right corner of the lawn.”
• Zombie/plant bingo: We made four different nine square bingo/lotto boards with matching cards. The students took turns drawing a card and describing it to the group, e.g., “It’s a sunflower with two heads and three leaves.”
• Zombie/plant 20 questions: One student picks a character card and we take turns asking questions to guess which character it is, e.g., “Is it a plant?”, “Is it a flower?”, “Is it winking?”
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There are discrete attributes for each character based on their appearance and their actions:
• Zombies: color and state of articles of clothing, accessories, and uniforms denoting occupations and preferred hobbies, e.g., “The zombie who is wearing a red and white football jersey and a helmet,” or “The zombie who is jogging and has shorts on.”
• Sunflowers: color of face, facial expression, number of faces, petals, and leaves, e.g., “The sunflower with two faces that are both light brown,” or “The sunflower that has three leaves.”
• Plants: type of vegetable, color, size, facial expression, trait/power, number of leaves, e.g., “The small frozen blue pea plant with four leaves”
Our games addressed multiple goals:
• Semantics: descriptors/attributes, categories, comparatives, basic concepts (directions/locations)
• Syntax: elaborated noun phrases, question forms
• Pragmatics: turn-taking, asking questions, providing information
And the reason that I finally agreed to use zombies in the first place was because of the /s/ and /z/ sounds in the words “plants” and “zombies”, as the student who liked to sing the theme song was working on tongue tip alveolar placement for /s/ and /z/.
A few years ago, I attended a restorative listening community event, which brought together parents/caregivers, general education teachers, special education service providers, and administrators. I wasn’t sure what to expect as I entered a large hall filled with round tables. Seating was organized so that each table contained members of the different constituent groups. Restorative listening is part of restorative justice, designed to unite disparate parties through the sharing of perspectives. Each person is encouraged to speak their truth while everyone listens.
At my table, a parent spoke first. She had a young daughter who had Autism Spectrum Disorder and behavioral challenges. She talked about how her daughter’s kindergarten teacher “really got it” and understood the supports that her daughter needed, but subsequent teachers had not connected with her daughter and didn’t support her. She commented that the special education team didn’t do nearly enough for her daughter. She listed the things that they should have done and should be doing right now.
A general education teacher shared next. She described her classroom and how she supported students with special needs. I couldn’t focus. My mind was still processing everything the mother had said. I was thinking about how I might try to collaborate with her if her child was on my caseload. I was also worried about the special education team that did serve her child and wondered if I might know any of them.
I wanted to explain that we wanted to do more. We all wanted to do more, but there were many constraints (time and staffing, competing responsibilities, district policies and mandates), and that as human beings with busy lives, we simply couldn’t work every evening and every weekend. I tried to organize my thoughts to show that we did care and that it was never that we didn’t care.
Suddenly, it was my turn, and everyone at the table was staring at me. To my shock and surprise, I didn’t speak at all but began to cry – not like crying in the movies where an actress sheds a solitary tear that slowly slides down her cheek. This was real life blubbering with my nose running and gulping breaths of air. I stopped eventually, after other people at the table had found a box of tissues and somebody had offered to hug me.
When I finally could speak, I said, “You have no idea how hard it is to know what you want to do and to be unable to do it because of the constraints of the system. I am not allowed to recommend a single thing to you for your daughter because anything I suggest could make the district liable to provide it. I want to do more, but sometimes it’s not allowed and sometimes there is not administrative support to provide more. We do care and we are trying.”
As speech Language Pathologists, we care about the students we serve. We work hard to support students, families, and staff. We can all take opportunities to advocate and to let everyone know our truth, even when it hurts.
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Spelling is misleading. The orthographic system does not reflect all aspects of pronunciation. Word stress, syllable breaks, articulatory placement, and co-articulatory processes affect speech production. In General American English, 80% of words in conversation have stress on the initial syllable. Stressed syllables are typically produced more loudly, with a higher pitch, and held for a longer period of time. Unstressed vowels may be reduced or neutralized to the “uh” sound (called “schwa” in phonetics).
Producing a word with more than one syllable requires recognizing syllable breaks and the relative level of stress of each syllable. Sound production is shaped by the surrounding sounds in co-articulation. Each word can be analyzed at syllable and speech sound level. The words “dinner” and “dessert” show the contrast of stress.
“dinner”: Stress is on the first syllable, like “DINN-er”. Even though it is spelled with two middle consonants, we only say one consonant, “DIN-er”, as opposed to “DIN-ner”
The underlying vowel in the first syllable is the same vowel as in the word “it”. The lips are in a slightly spread position.
• “DIN”: Lips are slightly spread throughout the entire first syllable because of the underlying vowel. Tongue lifts to the alveolar ridge for /d/, drops momentarily, and then lifts again to the alveolar ridge for /n/.
The second syllable is unstressed.
• “er”: Lips return to a neutral and relaxed position. Underlying vowel is “uh”, as in “duh” with r-coloring added. This sound may be especially difficult because the /r/ is more subtle (less emphasized) in the unstressed position.
“dessert”: Stress is on the second syllable, like “de-SERT”, which is a less common stress pattern. Spelling does not match the sounds, because /s/ is pronounced as /z/, and the first vowel may be reduced.
Two different vowels are acceptable in the first syllable:
• “di-ZURT”: “di” sounds like the start of “dip”, and vowel rhymes with the vowel in “it”
• “duh-ZURT”: “duh” sounds like “uh”, and vowel rhymes with the vowel at the end of “llama”
The second syllable carries stress.
• “ZURT”: Underlying vowel is “uh”, like in “dug”. It is the same vowel /r/ as in “fur”, with the lips in a neutral (relaxed position). You can hear how “fur” rhymes with “zur”.
The second syllable ends with a consonant cluster blend. To produce “dessert” as “duh-ZURT”, the lips remain in a neutral (natural) state throughout the entire word. Both vowels have relaxed lip positioning. The tongue does the majority of the work:
• “duh”: Tongue tip elevates to the alveolar ridge for /d/, and then returns rapidly to a mid-level position for the vowel “uh”.
• “ZURT”: Tongue tip elevates to the alveolar ridge for /z/. Tongue returns to mid-level position for “uh” and is retracted as r-coloring is added. Tongue produces final /t/ with slightly retracted placement (just a tiny bit behind the alveolar ridge) based on the retraction from the preceding “er” sound.
Word and sound level analyses allow us to monitor client lip positioning to ensure that it matches the underlying vowel. Understanding stress helps us explain and model where emphasis is placed within a word. As speakers we are continually preparing for the next sound we will say, while our articulators are finishing the current sound. Appreciating the complexity of articulation fosters focused instruction.
In the early days of my career, I was at an IEP meeting waiting to present goals for a kindergarten student with multiple needs. He was an enthusiastic young boy with mild coordination difficulties, who frequently bumped into furniture and other children. He had language and learning delays, and slightly imprecise articulation. His grandmother was his legal guardian and she was at the meeting to discuss goals for his kindergarten year.
The grandmother appeared wary and distrustful; as she grilled the teacher on how many years of experience she had teaching. She drummed her long nails on the table during breaks in the conversation. I was nervous. This was one of many meetings with the families of students who attended a specialized kindergarten program.
When it was my turn to present, I launched into an explanation of how speech and language goals aligned with classroom curriculum. I described sequencing goals by using the caterpillar to butterfly metamorphosis from the classroom. There were colored pictures of cocoons and butterflies on the walls of the classroom because this was the current classroom theme.
The grandmother looked at me and said, “My family doesn’t care about butterflies.” I was shocked and startled. A series of thoughts entered my head: “Who doesn’t care about butterflies?” “Why wouldn’t you care about butterflies?” “I like butterflies.” Suddenly, in a moment of clarity I realized that it had nothing to do with butterflies. In her own way, the grandmother was saying to me, that I hadn’t recognized what was important to her and her grandson. When I spoke again, I floundered. I thought about how the student loved to wear sports shirts and talked about sports. I amended my example and described sequencing goals for sports and outdoor activities. It wasn’t a lot better, but I had made an attempt.
This event changed my practice because I no longer present any information without asking the family about their own concerns and preferences first:
• How is your child’s speech and language at home? How does your child sound to you?
• What are some of your child’s favorite activities? What are some of your family’s favorite activities?
• What do you think would help your child to be able to express himself better?
• I’m thinking of goals around X, how does this sound to you?
• In the classroom we are doing X, how does this sound to you?
I neglected to tell you something. The grandmother and her grandson self-identified as African-American. What she actually said to me was dialectal: “What do a Black family care about butterflies?” She wasn’t just telling me that I hadn’t taken the time to personalize the treatment for her grandson. I also hadn’t taken the time to collaborate with the family, and to honor and respect them. Sometimes the clinical drive to share our own ideas of what we think will help a child causes us to overlook the fundamental need to connect with the family first.
Vowels have lip, tongue, and jaw positions. Lip positions vary from highly spread (almost smiling) to rounded (puckered) positions. When you say “cheese” for a photo, you are producing the “ee” vowel, which puts your lips in the most spread position.
Many children master consonant /r/ (pre-vocalic, e.g., “run”, “right”, etc.) before r-colored vowels (post-vocalic /r/). Producing the glide /w/ with puckered lips, in place of the liquid /r/ with neutral lips, is a common early phonological process. Residual lip rounding may continue when producing rhotic vowels.
Rhotic vowels follow the same lip, tongue, and jaw positions as their underlying vowels. There are typically six rhotic vowels: fear, fair, fur, four, far, fire. In speech sound disorders, residual lip tensing and puckering may be visible in both the top and bottom lip, or just the top lip. Any lip rounding will change the resonating and acoustic properties of the underlying vowel – it will sound slightly distorted.
When eliciting vowel /r/ sounds, watch the client’s lip and jaw movements to see if they match the underlying vowel. In 5/6 rhotic vowels, there should not be any added tensing, puckering, rounding, or mouth opening. We can teach our clients the underlying lip and jaw shape of each vowel, so that they can monitor their articulators using a mirror.
Fear: Underlying vowel is close to “ee”, as in “see”. Lips should be spread (light, friendly smile). Jaw is nearly closed with only a minimal opening. Tongue is a in a high position in the mouth. As we move from “ee” to “ear”, our lips may stay slightly spread or return to a neutral (relaxed) position.
Fair: Underlying vowel is close to “ay”, as in “hay”. Lips are slightly spread (light, friendly smile). Jaw opens midway. Tongue is in a mid-position in the mouth. As we move from “ay” to “air”, our lips may remain slightly spread or return to a neutral (relaxed) position.
Fur: Underlying vowel is close to “uh”, like “duh”, or “duck”. Lips are in the most relaxed position (resting position when lips are closed). Lips open slightly without changing position. Lips and tongue primarily remain passive while the mouth opens midway. This is a challenging sound because you maintain neutrality of the lips and tongue, and then use only the tongue to add the rhotic element. Many clients use excessive lip movement for the “er” sound, which distorts the production. Watch how the lips are frozen in place in “uh, uh, uh”, and sliding from “uhhhh” to “er”
Four: Underlying vowel is like in the East Coast dialect “coffee”. This vowel is round! This is the only vocalic /r/ with a rounded lip shape. Mouth is open midway, tongue is in mid-position in the mouth, and lips are puckered.
Far: Underlying vowel is “ahh”, like “hot”, or when the doctor says, “say ‘ah’”. Mouth is in its most open position; lips are typically in a neutral or slightly spread position while jaw lowers. Tongue is in the lowest position in the mouth. Tongue moves from “ah” to “are”, while the lips remain neutral or spread lightly.
Fire: Underlying vowel is a diphthong with two sounds, like “eye”, that ends with an “ee” sound. Mouth starts in an open position and moves to near closed position. Tongue starts in a low position and moves toward a high position. Lips are spread (smiling).
Isolating and maintaining the underlying lip, tongue, and jaw positions will help our clients recognize when residual, early patterns of lip rounding are still occurring.
Clinicians typically rely heavily on the phrases “say it again” and the mind-numbing “one more time” in articulation therapy. Intervention for speech sound disorders generally includes repeated trials of target words to facilitate auditory discrimination of correct/incorrect productions, self-monitoring of accuracy, and the formation of a new pattern of motor planning and execution for the articulators. Students may be instructed to repeat target productions multiple times in formalized tasks.
Adding naturalistic conversational, teaching, and pretend play strategies helps encourage repetition in a less formal manner, which may increase generalization. Conversational strategies may be common requests for clarification. Teaching strategies involve independent practice and showing others what to do. Pretend play adds varied paralinguistic elements, including intonation patterns. We can use engaging and interactive ways to elicit repetition:
• Appear to become distracted by other tasks and pretend that you didn’t hear the student’s production: “Sorry I missed that. I’m ready. Let’s hear it. I’m watching now.”
• Mock (and genuine) surprise with praise: “What just happened? That sounded amazing! I can’t believe it. Let’s hear it again.”
• Give the student a few moments of independent practice: “This is a tricky word. Practice it by yourself for a couple minutes and then tell me when your ready.” (Pretend to work on other tasks and look away from the student.)
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• Ask for self-monitoring while giving praise: “Did you hear how you said that? It was awesome! I want to hear it again. Listen to how you do it.”
• Praise and request to watch for understanding: “That was incredible. Do it again so I can watch and figure out just how you did it.”
• Praise and ask for self-report: “It was amazing when you said, (target word). Do it again so you can tell us how you did it.”
• Praise and watch self: “That sounded so clear. Look in the mirror and do it again so you can see how great that was.”
• Praise and show peer: “You did awesome! Show (peer name) what you just did.”
• Role-play: “Ready, pretend you are the movie announcer at the theater. Say it again, like the announcer says it.” (Vary situations for different settings). “Now pretend you are the waiter at a restaurant offering dessert.”
• Praise and add pretend emotion: “That sounded great. Pretend that there are no desserts and say it in a sad way.” (Vary situations for different emotions.) “Now pretend that there are lots of desserts and say it in an excited way.”
• Ask a question that requires the use of the word that the student has just produced: “Dessert. Hmm, is your favorite dessert a baked dessert or a frozen dessert?” or “Dessert. Do you like chocolate desserts or fruit desserts?”
There are many ways to embed requests for repetition. We can help give each repetition a specific goal and communicative purpose beyond “say it again.”
I almost got in an argument with a five-year-old.
We were working on describing skills and taking turns providing descriptors for familiar objects. We were looking at a picture of a car. I attempted to give him a clue. I whispered that a car needs a key. He shook his head, “no”. He said that a car didn’t need a key. I looked at him questioningly, but he was adamant. I started to explain how you used a key to start a car and make it go. He didn’t agree with me. I was about to protest when I finally had the good sense to stop telling him how a car worked and asked him instead, “How does it go?”
“Like this,” he said and gestured as if he had a toy car in his hand and was dragging it backwards. Many toy cars have a pullback clockwork motor so that when you release them, they accelerate forward. We were both right, but we weren’t talking about the same type of car.
Developmental Psychologist Piaget described the cognitive process of learning. As young learners, we form internal schemes for concepts through our interactions with our environment. We are continually gaining new information. With each new bit of information about a concept, we will either assimilate the knowledge into an already existing scheme about that concept, or adapt and create a whole new scheme. We are continually arranging and rearranging our schemes in an interconnected organizational system. Schemes may be the basis for taxonomic knowledge, the ability to store and retrieve words by category.
In the describing lesson, I had been attempting to help the child establish a set of characteristics or semantic features, which represented the concept of “car”. Early definitions rely on use and how we interact with an object. An early definition of “chair” might be “sit on it”. We gradually expand our definitions to include descriptors (color, size, shape, part/whole, etc.), and context (where you find it). Fully formed definitions include superordinate categories, such as defining “chair” with the category title “furniture”.
Although we had both described how we interacted with a car, our world knowledge didn’t match. I hadn’t taken the time to understand his scheme for “car” before superimposing my scheme of “car”. If I had learned about his perspective first, we could have started by comparing and contrasting toy cars and adult cars. I could have asked:
• “What do you do with it?
• “Where do you find it?”
• “How big is it?”
• “How does it work?”
We all have our own unique life experiences that shape our definitions of shared concepts. When we learn about our clients’ schemes, we may be able to understand how they view the world. We will be able to find commonalities and recognize the differences that exist.