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.)
SEE ALSO iPad Use for Children With Apraxia
• 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.
Do you know future Speech Language Pathologists who are applying to graduate school? Here are some tips to share with them about graduate school interviews.
Many university programs use interviews to learn about a candidate’s experiences, interests, and personality.
Think about the following types of questions:
• What interested you in Speech Language Pathology? Concisely share your background and meaningful life decisions that have led you to this point.
• Why are you interested in attending this university? Review the values and mission of the university, along with the expertise of the faculty before the interview.
• What are your strengths? Think about strengths that are unique to you, along with a short example of when you used one of your strengths to support others.
• What are your challenges? Think about how you have come to understand your struggles, and how you have established ways to ensure that you are successful, e.g., “I know that I like to observe before I jump in, so I make sure to let people know that I learn best by example."
• What hobbies do you have? Your creativity and life interests help people see your personality. Share a vignette from one of your favorite recent pastimes.
• What is a time that you have handled a difficult interpersonal situation? Describe how you work with others and how you consider other people’s perspectives.
• What are your clinical interests? Share your enthusiasm and excitement about specific aspects of this field. Additionally, remember to show that you are open-minded in your learning and that you have an appreciation of the complexity of disorder types and clinical populations.
An interview is a form of ritualized and scripted interaction. There are expected ways of responding that reflect your ability to organize and present information.
• Practice answering sample questions before the actual interview. Have a supportive friend listen to your responses. Record yourself answering questions. You are practicing composing and expressing your thoughts for an audience.
• Practice answering with a summary statement, two or three main points, and a short example, e.g., “I am interested in how Autism Spectrum Disorder affects learning opportunities. ASD affects social interaction, which reduces access to incidental learning in daily family routines. When children have less early learning opportunities, this could impact their language development. I’ve read how Early Intervention can change access to social opportunities through parent training models. When I watched (add example from an observation or video from class).”
• Don’t rush to answer a question. You can restate the question, pause, and then answer, e.g., “…My clinical interests... I have many clinical interests (and then start your answer)”
• Think about ways to personalize the exchange. Make a genuine positive comment about new information provided by the interviewers. Share a meaningful and emotional (happy, funny, sad, surprising) learning moment from your coursework or clinical work.
An interview provides a special opportunity to reflect on your emerging professional identity. Let the interviewers see your commitment and dedication. Our profession needs your fresh insight and energy!
I was working with a bright student who has difficulty producing /r/ and consonant clusters. He was explaining about writing computer code in Java script. The word “script” was challenging for him. We stopped the conversation to practice it.
“Did you know that script is ‘crypt’ with an ‘s’ at the beginning?” I asked, while writing ‘script’ and ‘crypt’ on a piece of paper. “And ‘crypt’ is actually ‘ripped’ with a ‘k’ sound at the beginning,” I continued while writing ‘k + ripped.’ “In fact, ‘ripped’ is ‘rip’ with a ‘t’ sound added at the very end,” I concluded. We now had a list of words of increasing complexity to practice. We analyzed articulatory movement within each word.
• “rip”: Your tongue starts in the back for /r/. Pull your tongue to the back of your mouth and have the sides of your tongue slide up to your back molars for /r/. Then your tongue zooms to the middle of your mouth for “i”, like in the word “it”, and you smile a little bit (spread your lips). Then your lips jump in and close for /p/.
• “ripped” or “rip+t”: Now we have to get ready for the /p/ and the /t/ sound to come out together. When you close your lips for /p/, make sure your tongue tip is up high behind your front teeth for /t/. When you open your lips, the /p/ and the /t/ come out at the same time.
• “crypt” or “k+rip+t: Your tongue starts way in the back for /k/. From the /k/ spot, lift the sides of your tongue up to your molars to make a valley for the /r/ sound to come through.
• “script” or “s+k+rip+t: Here’s the tricky part. Your tongue starts up high behind the front teeth for /s/, and then it has to zoom back for /k/ and /r/.
We found smaller words within the target word. We described tongue movement and presence/absence of lip involvement. Each phoneme has a different profile. We described why some transitions are easier than others, e.g., front to back tongue excursion and lip/tongue involvement.
Having the student increase his awareness of his articulators, using a mirror, and analyzing placement sound-by-sound gave us the opportunity to discuss motor muscle movements. Speech is the finely coordinated timing of articulatory contacts. We can help students recognize why certain words are more challenging than others.
What will the future bring? As we enter a new time period, a new calendar year, school year, month, or even week, we can help students make predictions about upcoming events. Asking questions about factual and hypothetical events may build metacognitive and syntactic skills:
• What do you know will happen? When we know something will happen, we express certainty. We have factual information, e.g., “I know that we will have no school on (date) because it is a (reason: holiday or planning day),” while showing the calendar.
• What do you think might happen? When we think something might happen, we show a degree of uncertainty, which expresses a possibility. We have probable information, e.g., “I think that there might be a (event: field trip, book fair, other school event) in (month).”
• What do you hope might happen? When we hope something might happen, we highlight uncertainty and express desire. We have hopes and dreams, e.g., “I hope that we have cheesy breadsticks for lunch this week,” or “I hope that I win the track race”.
We can extend the concept of “hope” to discuss agency, or personal control, e.g., “When we hope for something, sometimes what we do makes a difference, and sometimes it doesn’t. We don’t control school lunches, but we do have some control over other things. If I hoped that I would win the track race next month, I could practice a lot. Even if I practiced a whole lot I might not win, but I would be working toward my dream. Sometimes we can do things that might help our dreams come true.”
Metacognitive verbs refer to acts of thinking. “Meta” is self-referential. We use an abstraction (a part) of a concept to talk about that same concept. “Know”, “think”, and “hope” reflect an awareness of substantially different likelihoods of occurrence. Modal verbs, e.g., “will” and “might”, represent probability of future events. Verbs for mental states are foundational for academic tasks, including evaluating events/concepts (scientific experiments) and understanding literature (book reports and character analyses). The ability to discern a person’s mental state of certainty within a conversation is integral in social interaction.
Syntactically, at the sentence level, metacognitive verbs require a dependent clause. When we use “know” for a person or an activity, e.g., “I know Sam”, or “I know karate”, the noun is one word: “Sam” or “karate”. When we use “know” for an event, e.g., “I know (that) we will go to the movies on Friday”, we have created a complex sentence with a subordinate clause used as a noun phrase. The embedded nominal clause “that we will go to the movies on Friday” has a modal (auxiliary) verb, and acts like a noun in the sentence.
Looking into the future and making predictions involves planning, evaluating probability, and generating complex syntactical forms. We can help students visualize upcoming events, and determine their likelihood of occurrence, and their role in the outcome, while expanding their verb phrase and sentence length.
With speech sound therapy, guided questions may help children recognize which words to practice and allow for visualization of a semi-independent practice routine.
Co-create a list of practice words:
• Which of these words did you think were your star words – your best words?
• Which of these words do you want to practice more?
• Do you think that you should practice three words or five words? Five words or ten words?
Highlighting successful productions during the treatment session helps students recognize which productions were the clearest, e.g., “that’s your star word”, “that’s your show-off word”, “that’s your rock star word”. When students choose their practice words from a small set of acceptable options, we may gain insight into their self-awareness of their own performance and their level of desired challenge.
Co-create a practice card with instructions:
• What directions do we need to give your mouth? What do we need to tell your tongue to do? What do we need to tell your lips to do?
• What should we tell your tongue to do if it has trouble? What reminders should we give it?
Separating and personifying the articulators may help students form a sense of control by reminding them that they may direct their own motor movements. Expecting that the articulators (not the student) occasionally make mistakes may depersonalize possible feelings of self-judgment or concerns around perfectionism.
Co-design a plan for practice:
• Do you think that you should practice for five minutes, or for ten minutes?
• Where will you practice?
• What materials do you need?
• Who will be with you? Who will listen to you? If you are by yourself, what will you look for and listen for?
• How will you know if your tongue is doing what you want it to do? What will you feel? What will you hear?
• If your mouth isn’t doing what you want it to do, how will you fix it?
• How will you reward yourself for doing a good job? What will you say to yourself when you’re finished? What do you usually say to yourself when you are proud of what you’ve done?
Describing and visualizing how, where, and when practice will be completed in another setting may help students develop a mental image of specific behavior patterns. Including self-evaluative and self-repair strategies may help students understand that practice is about self-monitoring and making continual adjustments. Success is noticing and altering movement patterns. Positive self-talk and providing one’s own internal reinforcement may help foster a sense of pride and accomplishment. Questions can be simplified and shortened for younger students with an emphasis on being proud of sharing your words with others.
Sometimes students practice at home and sometimes they don’t. There are many internal and external factors that affect everyone’s lives, however, scripting a routine for practice may help many students see themselves as capable of establishing new patterns.
“What day is it today?”
I ask students this question at the beginning of every session. It started as strategy of modeling self-talk, showing students my thought processes as I recorded the session data in the data log. Thinking aloud highlights internal steps of planning and information seeking. With busy schedules, often across multiple sites, it’s easy to become confused about the day/date. I needed to check a calendar! I quickly realized the benefit of two separate calendars: one for me, and one for the students. My calendar is electronic and full of meetings, notes, and responsibilities.
The student calendar is a traditional paper calendar with an engaging theme (e.g., baby animals, underwater dog photos, wild weather, etc.). When I travel from place to place, without a dedicated clinical space, I use a 7”x7” mini-calendar. Calendar referencing is built into the beginning of each session. Students find the day’s date. For younger students, this involves guided questions, and prompts, e.g., “What month is it? It’s cold outside and winter break is coming soon. It’s De…”
Students write their birthdays on the calendar, as appropriate (I verify the dates of their birthdays and research family backgrounds before asking them). We record school events, field trips, assemblies, half-days, etc., using child-focused interpretations, e.g., “No School” instead of “Teacher In-Service Day”. Students decorate the date squares for events with a tiny drawing or writing in fancy lettering. We discuss holidays listed on the calendar, e.g., “Some people celebrate (holiday). Does your family celebrate (holiday)?”
Calendars let us predict upcoming events, reflect on prior events, and recognize the passage of time. We cross out days that are finished and we count down days until fun events. Calendars involve specific vocabulary for past, present, and future:
• “Yesterday was (day) and today is (day).”
• “Last week (point to date) we (describe past activity). Today (point to date), we are going to (describe upcoming activity).”
• “How many days until (activity)? Let’s count. Start here because this is today.”
• “We have no school next week (point to date). What are you going to do? (Model future tense options)”
• “We had a break last week (point to date). What did you do? (Model past tense options)”
Learning about the calendar initially involved free exploration of the pages and pictures, and labeling/reciting days of the week, and months of the year. Students shared and took turns looking through the months. They had time to feel comfortable with the contents before we learned about the day/date. Calendar activities in small groups expand on the classroom calendar routine and allow for extended practice.
When the year changes, we celebrate having a new calendar. We model two important time markers: the end of the calendar year (December/January), and the end of the school year (May/June). Calendars reflect daily routines and events. Early calendar interactions may lay a foundation for goal-directed planning behaviors, based on anticipating events, which is a valuable skill as students mature.
Many students have describing goals. Describing is the ability to provide details and specific information about a person, place, object, or concept. Descriptors allow a listener to create a mental picture of a shared idea. Descriptors help differentiate between different possible interpretations of an entity, e.g., for “dog”, “the small dog” versus “the big dog”.
Adding descriptors elaborates the noun phrase. A simple noun phrase is often a determiner (the, a/an) + a noun, such “the bear”. Adding adjectives before the noun provides information about the bear, e.g., “the big bear”, “the big, brown bear”, and “the big, brown, furry bear”. Notice the specific order of the adjectives of size/shape, color, and texture/composition. We wouldn’t say, “the furry, brown, big bear”. We can teach sequences of adjectives by asking a series of questions that replicate the expected order:
• What size is it?
• What color is it?
• What does it feel like? What is it made of?
Describing is more than adding adjectives. Interesting descriptors come after the noun, as post-noun modifiers. Adjectival phrases add information about characteristics or location. An adjectival phrase may be a prepositional phrase introduced with a preposition (in, on, at, with, by, etc.).
• Characteristics: “the kitten with the white paws”, “the shirt with the red stripes ”
• Location: “the kitten in the tree”, “the girl in my class”
Teach characteristics by asking about distinguishing traits and modeling adding detail into the sentence:
• What color is the cat? What color are the cat’s paws? That’s right, it’s an orange cat with white paws. I see the orange cat with white paws. The orange cat with white paws is cute.
Teach location with guided questions using locational prepositions and modeling adding location into the sentence:
• Where is the kitten? What is it next to? What is it on? Etc.
• “That's right, the kitten is in the tree. I see the kitten in the tree. The kitten in the tree is meowing!”
Relative clauses add details and increase clausal density (create sentences with more than one verb). A relative clause is introduced with a relative pronoun (that, who, which, etc.), e.g., “the boy who has a red shirt is next”. The relative clause, “who has a red shirt”, adds descriptive information within the simple sentence, “the boy is next”.
Teach relative clauses with a series of action pictures, guided questions, and modeling embedding of information:
• Where is he sitting? What is he doing? That’s right, he’s sitting at the table. He’s sitting at the table and he’s eating. The boy is sitting at the table and eating. The boy who is sitting at the table is eating.
• What is she doing? How is she feeling? That's right, she’s playing on the swings. She’s playing on the swings and she’s happy. The girl is playing on the swings and she’s happy. The girl who is playing on the swings is happy.
Elaborated noun phrases have more details and increased sentence length and complexity. They allow us to express more than one idea within a sentence and represent higher-level syntax (sentence form) skills.
A colleague asked about ways to analyze a language sample:
Consider cultural and linguistic factors: dialect/language differences, linguistic community, etc.
Highlight conjunctions: compare compound and complex sentences
• Coordinating conjunctions: and, but, or, etc.
• Subordinating conjunctions: before/after, because, until, where, etc.
• Examine use of simple coordinating conjunctions for overreliance on forms
o “and then… and then… and then…”
• Look for sentence complexity: cause/effect, rationale, temporal relationships
o “We were last because there was a long line”
• Find the longest grammatically correct sentence as a sample to share with family
Highlight morphological errors
• Subject-verb agreement: “she play”
• Past tense forms: “it costed(-ed)”, “he catched it”, “I drawed”
• Plurals: “two cat”, “two teeths”
• Comparatives and superlatives: “more funner”, “goodest”
SEE ALSO: Interactive Patient Education
Highlight syntactical errors
• Declaratives: “going up kitty”
• Interrogatives: “why he come here?”
• Negative: “we not go to the park”
Consider noun and verb specificity: level of semantic meaning
• Non-specific nouns: “that guy”, “the thing”, “there”, “it”
• Generic nouns: girl, dog, store, park, ball
o “the kids went to the park”
• Specific nouns: proper nouns, descriptive elements, character names, location names
o “my sister Briana, she goes to South City High School”, “My friend Ethan caught the baseball.”
• Non-specific verbs: go/went, have/had, do/did, get/got
o “that boy went ‘hi’”, “they do it”
• Generic verbs: play/played, ran/run, says/said, etc.
o “they ran outside”
• Specific verbs: describes action and gives detail, yell, ask, race, jump, write, etc.
o “the tall boy grabbed the ball”, “he won the game”
• Look for metacognitive verbs for mental processes: thought, remember, forgot, etc.
o “and then I ‘membered what to do”
• Look for modal verbs for ability, obligation, or likelihood: can/could, have to, might, will, etc.
o “I had to go outside”, “he couldn’t play”
• Look for adverbial forms: manner (slowly), location (here/there), time (first/last), extent (only/almost), and intensity (very/really) for actions
o “we always walk real slow”, “he ran out so fast’, “I literally laughed”
• Consider any non-words (created forms): “he tornating the other boy”, “she swipt the floor”
• Consider repetition: same concepts/terms used multiple times, overuse of routinized/ritualized phrases, e.g., “and it was fun”, “and I liked it”
Descriptors/adjectives: details, perception/opinion, and specificity
• Unelaborated noun: “the bear”
• Elaborated with adjectives: “the big, fuzzy teddy bear”
• Elaborated with prepositional phrase: “the bear on the shelf”
• Elaborated with relative clause: “the bear that my sister gave me”
Narrative conventions: stylistic elements and story grammar
• Introduction/conclusion, time elements, etc.
o “Once there was”, “for a long time”, “and it was all better”
• Complexity of episodes (events – actions/attempts – consequences, etc.)
• Characters: dialog, feelings, motivations, responses
o “he was excited because he found the treasure”
• Coherence: referents, introduction of characters, noun/pronoun agreement
o “this girl, he had a cat”
• Topic maintenance: tangential or off-topic, multiple topics
Sequencing: presence and order of events/steps
• All steps present: in chronological order or out of order
o “My sister got a new doll. We had a party. It was her birthday”
• Not all steps are present
o “It was her birthday. She like her doll.”
Pragmatics: attempts to engage listener and emphasize information
• Paralinguistic: pitch, stress, rate, pauses/hesitations, etc.
o Delayed responses, asking for help, persistence, self-cueing, mazing (mid-sentence revisions)
o Look for clues about planning and formulation of ideas
• Nonlinguistic: gestures, body posture, facial expression, etc.
Listener response: listener’s ability to understand and retell story
• Level of communicative competence
• Presupposition: understand when listener doesn’t know background information
o Listener able or unable to determine who did what, what happened, where/when/why something happened
o Determine which elements are missing and why listener would be confused
In-depth analysis may guide language goals. Noticing areas of difficulty provides information about skill development across language domains.
Feeling thankful is recognizing the good things in one’s life, whether they are big things or little things. During clinical sessions, we can help students recognize the significance of everyday events, and the value of the people in their lives. As clinicians, we are role models for our students. We teach through our own values and behaviors. We may foster skills with social reciprocity, empathy, and resilience by helping students to identify positive relationships and caring gestures. Thankfulness can be expanded throughout the year:
Thank students at each session: Take a moment to thank your students for a specific behavior, e.g., “thank you for walking so quietly in the hallway”, “thank you for taking-turns during the game”, “thank you for thinking about your sounds”, etc.
Guide students to thank each other: Help students recognize the moment that a peer has done something kind, e.g., “Sam let you pick the game today. That was really nice of him. Let’s make sure we thank him.”
Thank the prior clinician: Whenever you begin at a new site, or are replacing another clinician, or you have students who are new to your caseload from another location, have students write ‘thank-you’ cards to the previous clinician. Model ideas for the students, e.g., “thank you for helping me with my (insert speech sound, skills, or activities)”. This may ease closure and transition, along with validating the importance of the therapeutic relationship.
'Thank-you' cards: Have students create ‘thank-you’ cards at periodic intervals, such as holidays, school breaks, or transition times. Have students think about which one person they want to thank and the reason why they want to thank that person. Add perspective-taking skills by asking the student to think about what kind of picture the person receiving the card would like to see. Customizing a card for a specific recipient requires you to reflect on another person’s interests. You can use art supplies, stickers, clipart, etc.
Thank colleagues: At the end of the school year, and/or at holiday times, have students sign their name to cards to key staff in the school building, e.g., school secretary, principal, custodian, etc.
Email notes: Show that you appreciate your team by thanking staff for their contributions and support after important meetings, e.g., “Thank you for coming to the meeting and sharing how well (student name) is participating in group activities in science. This is great news!”
Gratitude wall: Designate a wall, board, or location in the clinic room for students to share what they are grateful for. Use post-its to have students write what makes them feel grateful. Guide students in recognizing positive events in their lives and noticing how people help each other to be successful.
Thanking someone shows that you appreciate their actions and efforts. Thankfulness honors and increases the strength of the positive relationships in our lives.
“Do you think that the teacher is a racist?”
Does this question offend you? Does it depend on the context? Does the context matter?
Here is the actual situation: the special education team is reviewing referrals from general education staff. One teacher (not present) has referred a fourth grade student for concerns about his reading and math skills. The student is identified as African-American in a school where the majority of students and staff are identified as Caucasian. This student would be considered a minority at his school and within the greater society. The administrator asks the team, “Do you think that the teacher is a racist?”
What would have prompted this question?
• District sanctions for disproportion: Perhaps the district had faced fines for having too many students from culturally and linguistically diverse backgrounds receiving special education services, as compared to the general population.
• Referral rates: Perhaps the school had a history of referring many children from culturally and linguistically diverse backgrounds for special education services.
• Over-identification: Perhaps the school had a history of inappropriately identifying students from culturally and linguistically diverse backgrounds as having a delay or disorder.
• Cultural sensitivity training: Perhaps the administrator had recently completed a cultural sensitivity training and considered this to be a reasonable question.
• School culture: Perhaps there were concerns about school climate and inclusive practice within the school community.
All of these issues are serious concerns. An entire discussion about institutional biases within educational systems is valid, as schools have a symbiotic relationship with society. It is appropriate to ask about the role of cultural and linguistic factors in the classroom. It is not appropriate to ask one staff member if another staff member is a racist.
SEE ALSO: American Disabilities Act at 25
‘Racist’ is a dichotomous term reflecting identity. It is often used to imply an inherent trait within a person and presupposes a permanent mindset of ‘racism’ consistent across all settings and contexts. ‘Racist’ may be used as an accusation.
Yes, people may demonstrate behaviors that are (or appear) racially biased. It’s likely that all of us have inadvertently, or even purposefully, demonstrated negative racially biased behaviors. We live within a complex society, which grants hierarchical levels of privileges to different groups based on racial/ethnic identity, among many other variables. We are all affected by pervasive, systemic issues across media, business, policy, law, infrastructure, etc. It is essential to question these issues, however, we can explore the role of cultural and linguistic factors without using accusatory language:
• “I would like to hear more about cultural factors in the classroom.”
• “I’m wondering about the role of racial and ethnic communication characteristics for the student and the teacher.”
• “Let’s talk about diversity in the classroom and how it may be affecting student performance.”
There are no simple solutions to entrenched societal challenges. We can advocate for thoughtful consideration of the issues. We can find safe and respectful ways to start these discussions.
Do you know anyone applying to graduate school? Here are some tips to share:
Writer’s block: Fight the freeze by starting in the middle of the essay. Sometimes we discover introductions through conclusions. Return to the opening lines only after you’ve reached the end.
Answer simple questions: Unsure what to say? Start with everyday, plain language. Writing is about sharing your ideas. Editing is about refining them.
• Why do you want to be a Speech Language Pathologist?
• How did you hear about this field?
• How have you worked with clients?
• What classes have you taken?
• What are your favorite classes?
• What are your areas of interest?
• What inspires you?
• What do you like about Speech Language Pathology?
• Why do you think that you will be good at it?
Overwrite: Write long answers to simple questions. Words are like clay and we need a lot of clay to create a sculpture – the more words, the better. Overwriting is free expression without judgment. Don’t delete during this stage – just keep writing.
Ask “why?” again and again: Every time you answer a simple question, ask yourself “why?” If you think, “I want to be a Speech Language Pathologist to help people communicate,” then answer the questions “why do I want to help people communicate?” and “why is communication important?” Find the underlying reasons for every statement you make. If you think, “I like neurology,” then ask yourself “why?” again and again to discover your values.
Value statements: Explain the origin of your values and beliefs. People come to this profession for different reasons. Find your reasons by asking yourself what matters and why it matters.
Learning examples: Reflect on times that you’ve had an emotional response to learning. Describe these pivotal moments in your understanding. Include course material, meaningful observations, positive interactions with clients, etc.
Credit others: Who has helped you? Describe support and mentoring in your life. When you credit others, you share the knowledge that you gained while honoring the expertise of others.
Recognize uniqueness: What can you say that no one else can say? Find the truths about your experiences, skills, commitment, and interests that are not the same as other peoples.
Cultural and Linguistic Diversity: Reflect on your personal and professional experiences understanding the role of language and culture in communication and social interaction.
Check the basics: A personal statement is a persuasive essay. Build evidence showing that you are prepared for graduate school. Make sure that you have information about your experiences, employment, volunteer work, skills, academic coursework, etc.
Graduate programs need to know: (1) why you are interested in the field, (2) the experiences and skills you bring, and (3) your readiness for high-level academic coursework. Tell everyone why you want to be a clinician. Our profession needs the new ideas and enthusiasm that you will bring!
Last week you told me about a recent leadership meeting: participants, proposed initiatives, attempted negotiations, and post-meeting allegiances. I didn’t hear what you needed, but I should have. I tried to dissuade you from higher-level politics. I don’t know if I felt jaded, or if I was trying to protect you. I care about you a lot. I don’t want you hurt by the system, or transformed into something that you are not.
I’ll tell you what I did, but you are your own person, so your course will be different:
Solidify values and vision: Reflect on characteristics and traits linked to your professional vision. Chose adjectives, e.g., “informed”, “resourceful”, etc. Use belief statements and inclusive language to form goals, e.g., “All practitioners have the right to access current research in the field,” “All clients have the right to culturally sensitive services,” etc.
Determine needs and strengths: Interview clinicians across levels of experience. Make calls and visit people. Ask new clinicians what would help them the most. Ask experienced clinicians what system changes they recommend. Use open-ended questions. Act as an unbiased reporter taking notes. Thank people for their time and ideas. Remember each person’s unique insights and strengths.
Learn organizational history: Interview long-time employees. Find out about prior influential leadership, times of major policy changes, previous programs and teams, etc. Trace funding streams of financial allocations.
Review policy: Learn basic fundamentals of federal law, state law, and district policies. Refer to ASHA policy statements. Evaluate how Special Education legislation was interpreted locally. Remember that working within an organization does not negate your clinical judgment.
Organizational initiatives: Track local and regional philosophical shifts and projected program adoptions.
Prepare for negativity: Some people have limited understanding of daily issues and say dismissive and inaccurate things. When this happens, listen impartially to gather more information: “I hadn’t heard about that. Where is this happening?” Provide an alternate interpretation or counter example. Remind everyone that there are multiple ways to view any given situation and one solitary exemplar is not a trend.
Manage feelings: Suppress instinctive emotional reactions. Conversations provide data for planning and progressive steps toward goals. View people as uninformed, not malicious.
Craft recommendations: Combine and synthesize information to form possible steps, e.g., policy changes, committees, trainings, guidelines, etc.
Plant seeds: Start to share small pieces of your ideas with everyone. Pique others’ interest in moving toward positive shared goals. Shape aspects of goals to align with others’ strengths. Let people create meaningful roles for themselves.
Discover solutions collaboratively: Solutions may appear after sufficient foundational information has been shared by all parties. Balance patience with activism. Understanding fosters receptiveness to recommendations. Prepare three possible mutually beneficial solutions with varied levels of implementation to present to administration.
I know that you are incredibly intelligent, creative, and caring. I have watched you consider leadership roles and I’ve encouraged you in the past. You have the potential to initiate changes that will support students and staff now, and in the future. I believe in you and I am prepared to help.
Clients working on cluster blends, /pl/, /bl/, /fl/, /kl/, /gl/, and /sl/, may initially demonstrate vowel epenthesis, inserting a schwa between two consonants, e.g., “puh-lay” for “play”, and altering the syllable shape from CCV to CVCV. We can directly teach how to blend consonants to produce near simultaneous release of sound – and lose the schwa (“uh”).
After a client has mastered placement for alveolar /l/, blends may be challenging. Make sure the client is familiar with the parts of the mouth and how sounds are produced, e.g., identification of articulators (tongue, lips, jaw), tongue tip placement, lip sounds (/p/ and /b/) versus tongue sounds (/k/ and /g/), etc. A basic understanding of speech sound production lets us describe how /l/ blends involve anticipation and preparation. Speakers are generally already in position for the next sound in a sequence, before they have even started to speak.
“When you say two sounds together at the start of word, you say them at almost the exact same time. Our mouth is actually ready to say two sounds together.”
/pl/ and /bl/: “Open your mouth wide and lift your tongue tip to the bumps right behind your front teeth (alveolar ridge) for /l/. Now freeze your tongue there. Don’t move it. Ready? Close your lips and keep you tongue tip high. Is your tongue tip still behind your teeth? Great! Ready? When you open your lips for the /p/ sound, then say the /l/ sound, too. Your lips will say /p/ while your tongue says /l/. They will both be saying sounds at the same time.”
/fl/: Follow the same directions for /l/ placement at the alveolar ridge. “Keep your tongue tip up high for /l/. Now lightly bite your lower lip to get ready for /f/. Is your tongue tip still touching the top of your mouth? Great! Ready? Just as soon as you start making the ‘ffff’ sound for /f/, start make your /l/ sound. They can come out together.”
SEE ALSO: It's All About That Alveolar Ridge
/kl/ and /gl/: The back of the tongue and the tip of tongue are both active. Production of /l/ is slightly retracted from the alveolar ridge because of the velar production of /k/ or /g/. “Let’s make a /k/ sound.” (Have client look in a mirror with a flashlight to see tongue retraction.) “The back of your tongue is doing the work. See how far it pulled back in your mouth? Now we’re going to see if we can make the tip of your tongue work too. Freeze the back of your tongue for /k/ and see if you can point your tongue tip up toward the roof of your mouth. Let’s see if the back of your tongue can make a /k/, while the front of your tongue makes an /l/.”
/sl/: “Your tongue stays up high for /s/ and never drops. Start your /s/ sound with your tongue tip up, and as soon as you start it, tap your tongue to the top of your mouth for /l/. The /s/ is really fast because your tongue is starting the /l/ as soon as it can.”
Some clients benefit from specific explanations of placement and movement to sequence sound combinations. Our knowledge of speech science lets us describe the co-articulatory process.