An excited student (working on generalizing /r/) recently told me all about an upcoming summer blockbuster dinosaur movie. He wanted us to watch the movie trailer (and he was highly motivated to talk about the movie). We made a list of /r/ words from the film clips and our own articulation cards using index cards and markers. We highlighted where the /r/ sound appeared in the words and sorted the words by their underlying vowels. We practiced the words in isolation, in short phrases, and combined into silly sentences.
Rhotic vowels vary by the stress and syllable breaks within a word, and by their underlying vowel. Intervocalic /r/ sounds are often easier to produce because a stress break within a word makes it like a prevocalic /r/. For example, “Jurassic”, is often produced as “ju-RASS-ic” with the main stress on “RASS” and a syllable break (millisecond pause) before /r/. We don’t have to add /r/ coloring to the first syllable, e.g., either “jur-RASS-ic” or “ju-RASS-ic” is acceptable. Intervocalic /r/ sounds, like “Jurassic”, or “T-Rex” (“t-REX”), encourage /r/ within a word without requiring r-coloring.
Postvocalic /r/ words may be challenging because rhoticism is fundamental. In “dinosaur”, the postvocalic /r/ alters the vowel. We can add a prevocalic /r/ word after a postvocalic /r/ word, such as “dinosaur run”. We can blend the words together, “dinosaurrun” to encourage a close juncture with less separation (no pause) between words, and sounds crossing word boundaries, to encourage /r/ production in both words. As the student progresses, we can slowly fade the second word, e.g., “Say ‘dinosaurrun’, but just whisper the ‘run’ part.”
SEE ALSO Identifying Learning Styles
Syllable breaks can change intervocalic /r/. An intervocalic /r/ can be like a postvocalic /r/, such as “scary”, “SCAR-y”, which has the underlying stressed vowel “ay”, like in “hay”. We can practice it as “SCAR-ry” and add a helping prevocalic /r/ onto the second syllable. Intervocalic /r/ can either start or end a syllable.
Underlying vowels may be deceptive because rhoticism changes how they are realized. Practicing identifying underlying vowels and then adding r-coloring may help production. Dinosaurs and dinosaur actions combine to make interesting phrases and sentences:
vowel “ah”, like in “hot”
vowel, “ah”, like in “hot”
vowel “uh”, like “cut”
vowel “aw” (like in East Coast dialect “coffee” with lip rounding)
stressed vowel “ah”, like in “hot”
vowel “aw”, like “coffee” (see above)
vowel “uh”, like “cut”
Many dinosaur names have multiple/r/ sounds, such as “velociraptor”, e.g., “ve-LOC-i-rap-tor”, with an intervocalic /r/ and a postvocalic /r/ in “raptor”. We can even try challenging words with /w/, /r/, /l/ together, such as “world”, which requires multiple steps:
• Quick initial lip rounding for /w/
• Neutral (no strong lip rounding) for the rhotic vowel and consonant cluster
• Tongue retraction for the underlying vowel “uh” with added rhoticism
• Tongue tip alveolar placement for the /ld/ blend.
Dinosaur vocabulary provides a naturalistic method to form lists of /r/ words. Using promotional materials from a movie release, we can prepare students to talk about the actions and characters in advance. This student’s favorite phrase was about the “army of trained velociraptors”. Practicing words that children will likely use in conversation, with peers and family, may have the potential to foster carryover from structured settings to everyday life.
Once upon a time, not so long ago, I was testing a second-grade boy who is African-American. The student was bright and engaging, and I was beginning to wonder about the validity of the initial referral for evaluation. I was administering a comprehensive standardized language assessment.
One of the subtests required the student to provide a definition, such as responding to the question “What’s a dog?” with a set of descriptors: “It’s an animal. It barks. It wears a collar.”
The student was performing well and we were quickly advancing through the subtest. I asked him, “What’s a king?” He launched into details about castles, princesses, knights horses, and so on. I marked his response as correct and was about to present the next item. Suddenly, he froze for a moment, and then said, “Wait, I forgot something!” I nodded and waited.
“They’re White,” he added, appearing proud of his depth of understanding and the details that he’d shared. We finished the test and I praised him for his hard work. His response has haunted me for years. Kings are White in so many children’s picture books, stories, movies, and fairy tales that for a smart child, this trait would seem to be an obvious and important characteristic to include in a standard definition.
SEE ALSO: Language Barriers and Dysphagia
Providing a definition of an object, item, or concept, is generally accomplished through listing a variety of relationships including category, part/whole, location, and function, along with physical descriptors. When we define something we label its key characteristics. Our definitions themselves show us what elements within our society we value to differentiate between related items. They are a reflection of the values of our culture. The student’s definition that kings are White was directly related to the cumulative cultural exposure of the presentation of the concept of a king that he had received.
What definitions are we providing our students today? We may need to continually evaluate our therapeutic environments to determine what messages we are giving children. Do our materials visibly show various groups in positions of power? The societal construct of race, the sorting of people into particular groups and assigning meaning to these groups, based on a predetermined set of physical characteristics, changes generationally. All of us have the ability to redefine the concepts we present to include minoritized groups by race/ethnicity, and all of the other traits that society uses to separate, instead of unify people.
Invisibility is a form of microaggression, an unintended insult with far-reaching, systemic, negative effects. When kings are only presented as White, all other racial and ethnic groups are invisible in the definition of kings. We can evaluate all of the images within our clinical spaces – every poster, sticker, card, book, toy, etc. Every clinical material we use, from a storybook to deck of cards, reflects cultural values and teaches children cultural knowledge. We can take the perspective of different minoritized groups and consider what definitions these images are teaching. We can avoid unintentional micro-aggressions by fostering an inclusive environment. Through conscientious and deliberate actions, we have the ability to open up the concept of “king”, and much more.
Early in my career, I was completing what I expected to be a routine oral mechanism examination for a shy girl in the 4th grade. She opened her mouth wide and I shined my flashlight into her mouth. She had two complete sets of teeth, side-by-side – like a shark’s mouth. I was shocked. I had never seen anything like that, nor imagined that children could have two sets of teeth. I attempted to suppress the physical manifestations of my surprise.
In actuality, hyperdontia, having supernumerary and extra teeth, is not uncommon. Sometimes deciduous (baby) teeth do not fall out as expected, and the permanent, (adult) teeth erupt alongside them. When I told the classroom teacher, she was rightfully unconcerned, and apparently had a greater knowledge of childhood oral health and structure than I did at that time. The family was aware and saving/planning for oral surgery and orthodontia.
This girl taught me an important lesson and I am continually thankful for the experience. Ever since that day, before I look in anyone’s mouth, I ask a few questions. We often focus on our own perceptive abilities as the most important source of information, which may inadvertently cause us to ignore or devalue knowledge that clients offer.
SEE ALSO: Summer Camps Address Speech & Hearing
In a typical school setting, there may be children with hypodontia (almost no teeth), open bite (top and bottom teeth don’t meet), baby bottle caries (bottle rot), cavities, orthodontia, craniofacial disorders, velopharyngeal insufficiency, and a variety of malocclusions. Some children may have severely swollen adenoids, or infections. There are children who can curl, roll, and make their tongues into a clover shape.
Over the years, I expanded my initial interview questions to encourage clients to share more information:
• “Is there anything special about your mouth?”
• “Do you have any loose teeth?”
• “Did you ever have braces? or “Do you think that you will have braces?”
• “Does your mouth ever hurt?”
• “Do you know if you snore?”
• “Do you know if you are allergic to anything?”
• “Can you breath through your nose? Do you get colds a lot?”
• “Can you do any tricks with your mouth? Curl your tongue? Make funny sounds?”
• “Sometimes when kids are little, they might suck on their thumb or their fingers. Did you ever do anything like that when you were little?” (If yes, then, “Sometimes people will suck their thumb when they are relaxing, like going to sleep or watching TV. Do you do that sometimes?”)
• “We use our mouths to talk. We are going to look into your mouth to see what your mouth is doing. Do you want to see?” (Offer the client a mirror to watch the entire oral mechanism examination while you provide a friendly narration.)
There is something special about each person’s mouth and we are experts of our own mouths. Our clients know their oral structural and functional history from a personal perspective. Young children are often able to report on the state of their mouths when we give them the opportunity. Conducting an interview prior to an oral examination allows us to tap into our client’s knowledge and insight.
May is Better Speech and Hearing Month and a wonderful opportunity to increase awareness of every individual’s fundamental right to communication. Communication allows us to make social connections, develop emotional bonds with others, and have a sense of agency - to be active in the daily decisions of our lives.
Visible markers, from a poster, a button, a flyer, a coffee mug, or child-created art about talking, all serve as reminders to others about the value of communication. Often we take for granted skills that appear to come naturally (innately). Communication impairments have far-reaching effects for clients. If you have typical communication abilities and have not been exposed to communication disorders, then you have the privilege of not needing to understand the difficulties that others face. As clinicians we are ambassadors. We help others recognize that communication truly is a gift, and we can increase understanding for individuals with communication disorders.
SEE ALSO: Better Hearing in the Classroom
We can offer to lead classroom lessons on:
• Hearing conservation and ear protection
• Strategies to increase active listening
• Social skills and pro-social language
• Disability awareness and the idea that fairness is ensuring that people have the tools that they need to succeed
• Categorization and sorting as a method to learn new vocabulary
• Organization and time management
• Turn-taking, speaking and listening, and conversational skills
• And much more
Better Speech and Hearing Month is also a unique opportunity to teach other people about our work and the positive effects we have in the lives of our clients. Many clinicians may initially feel reluctant about self-promotion, or consider talking about achievements as bragging or boastful. There are many ways to inform, enlighten, enrich, and inspire others by sharing stories in humble and meaningful ways.
Do you think that the building staff and your colleagues understand what you do and all of the facets of your daily job? Are they able to see the progress that your clients are making?
Preparing and sharing short and simple vignettes may help others recognize how small changes are meaningful. A clinical vignette that focuses on the success of the client enables another person to recognize that positive gains have been made. Start noticing little differences. Watch what makes your clients smile. Watch what makes them proud. Sharing client achievements, which were accomplished in the therapeutic setting through your guidance, reinforces the importance of our work.
Reflect on your last few weeks of work and how your clients’ lives are changing. We do amazing work every day. Share an inspiring story or two with staff and colleagues, and they will see the power of communication, too!
Meetings with families may occur annually, monthly or even weekly. People respond to their physical environment and to the communication styles of those around them. We can show our care and our understanding for parents/caregivers by how we arrange the materials and our interactions. The items that are on the table and within reach reflect our values and our desire to collaborate. Our speaking style can show respect and collegiality.
• A box of tissue: for emotional responses and for colds/allergies
• Extra pens: lots of extra pens so that anyone can use them
• Post-It notes: to encourage others to use for quick reminders
• Extra blank notepads: to allow others to take their own notes
• Large mailiing envelope: to be offered to the famiy at the end of the meeting to carry all of the paperwork that they have been given
• Paperclips/binder clips: if multiple providers will be sharing documents, a binder clip can be used to hold papers together
Most of these materials may be stored in a prepared basket or small tote bin, that you restock regularly, and then have available and unpack at every meeting.
• Blank goal pages: show that the team is always ready to add/change/modify any of the goals
• Release of Information Form: to encourage communication with outside providers and agencies
• Multiple copies of the IEP: have multiple copes available and give each parent/caregiver a copy (especially when parents/caregivers are separated/divorced), provide teachers and other services providers with copies as needed
You can have a folder where you keep blank goal pages, forms, and any other agency specific paperwork stored in your tote bin.
• Introductions: begin with team member introductions and repeat these same introductions with descriptions, when each team member presents information, e.g., “The Occupational Therapist, (insert name), who works on self-regulation and sensory needs, will share her recommendations.”
• Positive Attribute: share a positive attribute about the client and possibly a recent event that highlights this unique trait
• Pause Regularly: after you share information, pause (count silently in your head for 10 seconds) to encourage family members and other staff members to comment
• Solicit Feedback: specifically ask others, “Does that feel right to you?”, “Have you seen anything similar at home or in the classroom?”, “What other areas are important?”
• Translate Jargon: explain every bit of jargon (even the terms that seem basic to you)
• Reframe: reframe difficulties as “areas for growth”, “current challenges”, “areas for improvement” to promote the idea of positive change
• Listen: when family members and staff share information, stop and listen to them
• Honor: honor and recognize the contribution of each team member, e.g., “Our special education teacher, (insert name), has created a variety of high interest activities to engage him in writing activities”, or “As a family, you have encouraged his creativity and his love of listening to stories.”
Sometimes meetings can be stressful and we have tools which may help encourage everyone to participate and to feel welcome.
Many children with articulation disorders may have difficulty with consonant clusters (two sounds together), possibly inserting a sound such as “puh-lay” for “play”. As we produce intricately timed sequences of speech sounds, we are simultaneously completing one sound while we are preparing for the next sound. Our primary active articulators (lips and tongue) are in constant motion while speaking. This is coarticulation.
Say the word, “pay”.
Now say, “play”.
Get ready to say, “pay” again, but don’t actually say it – just get your mouth ready to say “pay”. Freeze your mouth and focus entirely on your tongue position. Your lips should be together and closed tightly as you are building up air pressure to release the /p/ sound.
Where is your tongue in your mouth?
It is probably lying flat against the bottom of your mouth with the tongue tip touching the inside of your lower teeth.
Get ready to say, “play” again, but don’t actually say it – just get your mouth ready. Freeze your mouth and focus entirely on your tongue position.
Where is your tongue in your mouth?
Your tongue tip is probably raised and approaching the alveolar ridge.
When you say, “pay”, you tongue is getting ready for the vowel “ay”. When you say, “play”, your tongue is getting ready for the consonant, /l/. Your tongue is already in position for /l/ before you release the air for /p/ for a near simultaneous production. The air for /p/ comes out while the tongue is shaped for the /l/ sound.
Now say, “pray”.
Freeze your mouth as you prepare for each word. Did you feel the sides of your tongue elevate to come into contact with your back molars and your tongue retract slightly as you prepared to say, “pray”? (Or, your tongue tip and sides may have both elevated if you use a retroflex alveolar placement for “r”.)
SEE ALSO iPad Use for Children With Apraxia
We can teach our clients about coarticulation to facilitate smooth transitions between sound combinations. After a client is able to produce a target sound, such as /l/, we can explain the process:
• Did you know your tongue is always ready for the next sound you say? Your tongue gets ready to say, /l/ before you even open your mouth. Your tongue tip is up high behind your teeth getting ready for /l/. When we say, “play”, our tongue tip knows what to do before we start to talk.
• Let’s try it. We’re going to say, “play”, but we’re going to say two sounds, “p” and “l” at the same time.
• Close your lips and get ready to say, “p”. Freeze your lips. Now feel inside your mouth and lift your tongue tip behind your top teeth.
• We’re going to say both “p” and “l” together.
The first few attempts may have an over exaggerated explosive air release for /p/ and forward tongue position for the transition between the /l/ and the vowel. Multiple practice opportunities with cues to monitor tip placement may improve fluidity and reduce the addition of the vowel between the consonants. Teaching the tricks of motor timing may also increase self-awareness and feelings of agency (active participation) in the learning process.
Daily conversation unites individuals and groups. We establish social bonding and friendships through every day, seemingly trivial, exchanges. Many children with pragmatic challenges (impairments in social language) may have difficulty joining a conversation. Sometimes children have an underlying pragmatic deficit, such as Autism Spectrum Disorder, which affects perspective-taking (understanding others’ thoughts/feelings). requiring specialized treatments. Sometimes children have intact (unimpaired, neurotypical) social perspective-taking, however, they may have social-emotional behavioral disorders and limited experiences navigating positive interactions.
Some children with behavioral disorders habituate to negative, maladaptive interaction patterns, (negative attention seeking). For example, if two peers are talking about a ball game they played at recess, the child might do one of the following:
• Interrupt with a comment: “I played tag at recess!”
• Change the topic abruptly, “I got a new videogame.”
• Make a negative comment about the speaker, “You can’t catch the ball.”
• Making a negative comment about the topic, “Four Square is a stupid game.”
• Make a positive comment about oneself, “I can throw the ball really high!”
• Make a positive statement about oneself with a negative comparison, “I can play ball better than you.”
When a comment is pro-social, the speaker may be invited to join in the conversation, however, pro-social comments carry significant socio-emotional risks, because they show a desire to engage. Pro-social comments could be ignored. The visible manifestation of longing to be part of a group is a sign of vulnerability. These feelings are part of humanity and exist for children and adults. Think about whether or not you would approach an unfamiliar person at a social event. You might think: What if my greeting is ignored? Maybe it's better not to say anything at all.
When a comment is negative, responses may appear more predictable. People tend to react in expected ways (getting angry/defending oneself). A child might respond, “Four Square is not stupid,” or “I can to catch the ball.” Negative conversational initiations tend to elicit a response more frequently, which reduces the risk of being ignored. Making a negative comment may help a child feel in control of a situation. In some cases, watching others’ strong emotional reactions may be stimulating to a child. Negative comments involve a person in a conversation, though not usually as a new friend.
Intervention may include activities to increase resiliency and the ability to manage frustration, along with teaching specific pro-social language. Partnering with counselors, occupational therapists, teachers, families, and others may help foster a child’s emotional self-regulatory growth. Providing role modeling, scaffolding interactions with supportive peers, and facilitating positive “natural” consequences through environmental changes may increase a child’s ability to take risks. As clinicians, we can teach vocabulary for pro-social comments. A positive strategy with a high response rate is asking specific, related questions that show interest:
• “Who won the game?”
• “What happened after that?”
• “Did you play with the red ball?”
• “Did (insert peer name) play, too?”
Changing pre-existing patterns may require multidisciplinary support. As a team, we can help children experience the rewards of collaborative peer partnerships and strong social bonds, and manage the fears related to belonging.
Speech language pathologists use an impressive amount of technical terminology, also known as jargon. This is to be expected within any professional discipline, however, clinicians are regularly required to code-switch between high-level terminology and plain language.
Back in my early days, I was presenting to a teacher and a young child’s family on the results of standardized testing, which indicated a mild language delay. I thoroughly explained the child’s performance, and areas of strengths and challenges. After I had finished speaking, the kindergarten teacher turned to me and responded with, “I have no idea what you just said.” Apparently my comprehensive explanation was not accessible to her and the family, which meant that I had made a critical mistake by not using friendly and understandable language.
Transferring complex concepts into plain language is a skill. Using shorter and more familiar words allows everyone to understand what we are saying, and does not diminish the value of our knowledge. We can seamlessly combine terminology with plain language descriptions to use every information exchange as a learning opportunity.
Every time you hear yourself uttering a word that you think would be unfamiliar to the general public (someone at the grocery store, your grandmother, a neighbor, etc.), add a short description of its meaning. The technical term for this technique is an appositive, the addition of a subsequent noun phrase that defines or identifies the noun, and it is frequently used in textbooks to teach new vocabulary. We can call it adding a mini-definition. Since our primary goal is for people to understand us, we can put the emphasis on the appositive (the definition), instead of on the technical term. You can even expand with a quick example:
Language, the ways that we share ideas with each other, …
Semantics, what words mean and how they relate to each other, …
Syntax, how we put words together to make sentences, …
Morphology, word parts, and how we add little pieces to change words, like happy/unhappy, …
Pragmatics, the ways that we talk to each other in different social situations, like in the classroom, or at the playground, …
Articulation, how we make the individual sounds that form words, like c-a-t, …
Voice, our daily speaking voice and how our voice sounds, …
Fluency, how fast or slow, and how smoothly we talk, and when we stutter or repeat ourselves, …
Hearing, how our ears work to hear sounds, …
A simple description has the ability to establish the topic so that listeners will have a general idea. It will not encompass all of the important aspects of a given concept, but it allows for a shared understanding of foundational knowledge before more information is added. Collaboration and partnerships with clients, families, colleagues, staff, community partners, and more, rely on mutual understanding. We can combine technical and plain language to unite everyone.
lives are filled with a combination of both obligations and opportunities. Sometimes
we may even have difficulty distinguishing between the two. Having the chance
to work hard, to push oneself to accomplish tasks, and to learn new things is
an opportunity. Access to education is not universal – learning is in many ways
still a privilege, regionally and globally.
There is a
unique balance within each of us, of demands that are within our capacities,
and complexity that is within our proximal zone of development. We may have
personal limits at any given time and our understanding is continually
expanding, however, we are often stronger than we know. This may mean that we
thrive when we work just a little harder than we think we can. We grow when we
appreciate the moments that challenge us.
We have the
ability to change the perception of any given task or event with only one word.
Verb choices carry more semantic meaning than we often expect. The verb choice
may show either obligation or opportunity. Consider the following two
“We have to
read this book today.”
to read this book today.”
statement makes you more interested in reading the book? The first sentence is
about obligation and the second sentence is about opportunity. When we use the
verb “have to”, we automatically demote the task to something that is
undesirable. When we “get to” do something, we elevate it by adding excitement,
eagerness, and adventure. We are affected by our word choices and our own
self-talk. Think about what you will gain from your accomplishments and how
lucky you are to “get to” to do things.
are affected by our word choices and how we present tasks to them. They can
often read our moods, and their own responses to the activities may be
predetermined simply by how we introduce them. We can entice through verb choices,
highlighting newness, curiosity, and interest. Think about what you and your
client will “get to” do at your next session.
our colleagues are affected by our word choice. Consider these two statements:
to go to a training session on behavioral intervention yesterday.”
to go to go to a training session on behavioral intervention yesterday.”
statement might elicit a response of sympathy or commiseration, while the
second statement has the potential to pique someone’s interest, e.g., “Really,
how was it? What did they say?”
remember that learning is a gift, we can present the acquisition of knowledge
and the practice of skills as the opportunities that they are. We can let our
words entice others to participate.
Children with language disorders may have difficulty with subjective
personal pronouns “he/she”. They may use only “he”, only “she”, or appear to
alternate between the two terms indiscriminately. They may even use objective
personal pronouns “him/her” instead.
We can analyze what we hear and what we see with “he/she”.
Auditory/acoustic and perceptual/visual information shape our understanding of
these terms. “He” and “she” are short, consonant-vowel (CV) words that rhyme
(share the same syllable nucleus, i.e., same vowel or same rime). The initial
phonemes of /h/ and /sh/ are both low amplitude (quiet) sounds with minimal
resonance (in relation to other consonants). The sibilant “sh” is comprised of
turbulent airflow at high frequencies. The glottal fricative /h/ has noise
produced by turbulent airflow throughout the entire open vocal tract, and takes
on the characteristics of the following vowel.
Acoustically, “he” and “she” are words that sound similar.
In sentences, “he” and “she” are affected by intonation and tonal units
(sentence-level stress patterns). As the tonic syllable (the loudest and most
emphasized syllable) is often placed on the word with the most semantic
importance, “he” and “she” are rarely prominent. In natural conversation, when
we say, “he is going to the store,” both the verb “going” and the location
“store” are more acoustically salient (louder and clearer) than the pronoun
“he”. Even when we deliberately try to
highlight the pronoun in intervention settings, we are likely still
highlighting “going” and “store” to some extent, e.g., “HE is GOING to the
STORE.” We don't automatically and artificially change our rhythm pattern
throughout the remainder of the phase, just because we said “he” louder.
“He” and “she” are naturally emphasized in contrastive and
informational settings, e.g., “Did he go to the store? No, SHE did,” and “Who
has the ball? HE does.” Contrastive and informational stress point out the
differences between people, and call specific attention to the correct pronoun.
If we designed therapeutic activities that focused on “he/she” in contrastive
and informational positions, we could increase the acoustic salience of these
terms. Our natural intonation patterns would emphasize the target pronouns.
Perceptually and visually, gender is often delineated by an arbitrary
set of societal markers for binary traits, e.g., male (pants, short hair, blue)
and female (dress, long hair, pink). These markers are often exaggerated in
cartoon drawings to the point of caricatures. Within society, we have fluidity
in color choices and styles for our clothing, hairstyles, and other features.
Using photographs, instead of cartoons, may give clients more realistic
examples of gender and encourage generalization of the pronouns into their
daily conversation. We can introduce “he/she” (using informational stress) when
we show the photographs to the client for the activity.
Using sets of contrastive photographs with actions (running, jumping,
swimming, etc.), states of being (tall, wet, sleepy, etc.), and possession (has
a book, has a ball, etc.) allow us to design activities that mirror the stress
markers in our natural speaking patterns:
• “She is a girl. She
is jumping.” (Show matching photograph)
• “He is a boy. He is
standing.” (Show matching photograph)
• “Who is jumping?”
• “She is!” (Show
We can make “he/she” sound and look clearer to our clients.
In our practice we recognize differing communication and learning
abilities. As clinicians, we work to increase our clients’ access to social
opportunities and interactions. We understand that all people have a unique way
of expressing their thoughts and ideas.
Within the nature of the human condition, skills vary across domains,
and throughout an individual’s lifetime and circumstances.
In Cynthia Lord’s Newbery Honor Book, “Rules”, a young girl describes
her life with her brother with Autism Spectrum Disorder (ASD). Although this
book is acclaimed for the narrator’s perspective of having a sibling with ASD,
a second plot exists within the story of the girl’s emerging friendship with
another child who uses Augmentative and Alternative Communication (AAC). Peer
pressure affects this relationship and the author highlights the courage it
takes to advocate for acceptance.
Many of us may not have a personal sense of having a socially perceived
disability, or having a relative or close friend with a socially perceived disability.
We may benefit from increasing our own awareness:
- Read books and articles which share the perspectives of both
individuals with communication challenges and their family and friends.
- Watch films which feature the feelings and events which may reflect
individuals with differing abilities, their loved ones, and roles in society.
- Attend community events sponsored by agencies which support individuals
- Talk with clients and their families about their personal experiences.
- Seek out simulation activities, such as learning differences
simulations, in which you are placed in situations that mirror experiences
(check your local dyslexia association, other non-profit agencies for
disability services, and understood.org).
Awareness is a fundamental step to increase understanding of the
privileges that exist within a culture that sorts individuals by ability, and
empowers us to advocate.
- Display books about individuals with disabilities in your office and
- Share children’s books about acceptance and understanding with your
clients and their families.
- Track current terminology to describe different conditions or
states-of-being (e.g., person-first language, “contemporary” versus “archaic”
- Adopt the new terms (times change and words change their meanings).
- Recognize that wording mistakes are common (wrong words, saying
something inappropriate, etc.) and that we have the power to correct ourselves.
- Focus on the positive intent of each communicative interaction.
- Politely and subtly re-state and re-frame another person’s use of
terminology, if they are not using appropriate terms, to model respectful
- Offer to lead a lesson or training on differing abilities with staff,
colleagues, and students.
- Understand the pervasive effects of societal collective forces for
conformity to a pre-established “normative” set of skills.
- Continue to question your own behavior and how you confront bias within
your own life.
As clinicians, our daily work is founded on accepting people and
partnering with them to address communication goals. We support them when we
advocate for a broader understanding of abilities, and we increase everyone’s
people on social media and later mainstream media recently viewed a photo of a particular
dress that stirred a national debate. Due to the background lighting and
photographic exposure, people saw the two colors of the dress differently.
For all of us
who debated the colors of that dress (blue/black or white/gold),
we had a personally relevant mini-lesson on qualia. The philosophical terms quale/qualia encompass the concept that sensory
experience is subjective. People have their own individual responses with unique
perceptual properties for a given stimulus item or event.
We don’t have a universally
shared sensory system. We don’t
experience the same things when presented with an identical stimulus. We are
neurologically diverse. As clinicians, much of our daily work is with
individuals who have a range of mild to profound differences in neurological
profiles. The color of that dress, and the disparate views, continued to
surprise us, even though our work gives us an advanced understanding of sensory
responses. We are reminded that our perception is only our own – and not necessarily
that of our clients, and those around us.
valuable information when we ask direct questions about sensory perception. A
few years ago, I watched a skilled teacher show a drawing of stick figures
standing in a row on a blank background as a visual reminder for a child to
stay in line in the hallway. Depth and directionality may be challenging to
achieve in simple line drawings. As adults, we saw the vertically placed stick
figures as children standing in a line. The teacher asked the child what he saw.
She expected him to say something about standing in line, instead he said, “All
of the kids are standing on my head.” This drawing represented an entirely
different concept to him. He saw the directionality differently.
sensory experiences vary. Many clients with articulation disorders may have different
perceptions of speech sounds, e.g., possibly unable to differentiate
maladaptive productions from target productions. Ear training helps establish a shared
perception of distinctive speech sounds. Clients with behavioral concerns may
perceive the relative safety of a given situation differently, based on
possible earlier life circumstances, which required hyper-vigilance for
survival. Clients with Autism Spectrum Disorder frequently report painful
responses to certain sounds.
The photo of
the dress showed us the neurological variation in visual discrimination that exists
for all of us. Taking time to ask our clients how they perceive the situation
(setting, context, etc.) and the stimuli (materials, activities, etc.) gives us
insight into their experiences.
What did you
hear? What does it sound like to you?
What did you
see? What does it look like to you?
What did you
smell? What does it smell like to you?
What does it
taste like to you?
What do you
feel? What does it feel like to you?
How does it
make your body feel?
Emotional and regulatory system
How does it
make you feel?
Compensatory articulation means that we
can produce a sound in more than one way. We can use different configurations
of our tongue, jaw, lips, etc. to form a target sound. This target sound is
perceived to be the same sound by a listener regardless of which mouth posture
we are using.
Compensatory articulation guides /r/ production. In the United
States, in General American English, there are two basic mouth postures for
Bunched /r/: the tongue is retracted to the back
of the mouth and forms a “hump”, the sides of the tongue elevate and may touch
the back molars, the tongue shape is like a valley (high on the sides and lower
in the middle)
· Retroflex /r/: the tip of the tongue touches the
alveolar ridge in the front of the mouth and the sides of the tongue are
slightly curved inward (like a scoop)
Understanding which way you make /r/
and learning the other way to make /r/ allows you flexibility in designing an
articulation plan and modeling production to meet clients’ needs based on their
Which way do you typically make an /r/?
· Look in the mirror with a flashlight. Shine the flashlight into
· Open your mouth wide and while keeping your mouth open the whole
time, slowly say, “ray”. (It will sound a little distorted because we
don’t usually talk with our mouths wide open.) Pay specific attention to your
tongue position for /r/.
· Did you see your tongue retracted to the back of your mouth and
tensed to form a compact structure? You are making a bunched /r/.
· Did you see the underside of your tongue (maybe even part of the
lingual frenulum) as it lifted to the roof of your mouth? You are making a
Our tongues are hydrostatic (like an
elephant’s trunk), which means they maintain a constant volume that can be
shaped (extension makes our tongues skinnier, and retraction makes them
fatter). The bunched /r/ uses a fatter tongue shape.
Can you make the other type of /r/?
· If you make the bunched /r/, try making the retroflex /r/. Start with the /l/ sound, “la, la, la”. With /l/, your
tongue tip is on the alveolar ridge. Hold the /l/ starting position and curve
the sides of your tongue inward (to make a scoop shape) and slightly retract
the tongue while phonating.
· If you make the retroflex /r/, try making the bunched /r/. Start with the /k/ sound. Hold the /k/ starting position
with you tongue in the back of your mouth. Elevate the sides of the tongue so
that they start to press on your upper molars (forming a valley) and phonate.
· Practice making this different /r/ in a variety of words. See
if you can blend it into vowels.
Examine and analyze the /r/ production
of your friends and family. See if you can teach them to make /r/ with a
different mouth posture than the one that they are currently using. With
friends and family, it is likely that you will be able to practice teaching the
two types of /r/ to people who do not have any underlying articulatory/muscle
weaknesses or coordination/timing challenges. This is a great way to have an
accelerated view of learning production.
Vowel /r/ distortions are common and often challenging to
remediate. We may benefit from starting with the underlying vowel and then
re-introducing the /r/. In the United States, we generally have a rhotic /r/,
where the vowel is “colored” (changed) by the /r/. Many children recognize this change in the
state of the vowel, and when they are not able to produce the target, they may
substitute another vowel, a common diphthong, or even an idiosyncratic diphthong.
For example: “I dug dowd” represented “I dug dirt” for a
child with an /r/ distortion (and mild voicing errors). Her production showed
an underlying change to the vowel. “I dug duh-d” would have been a closer
approximation. In recognizing the vowel /r/ difference, she attempted to change
her vowel, too. She substituted a diphthong that is produced in a different
part of the mouth from the original vowel. The “ir” sound in “dirt” is produced
in the middle of your mouth. She used “ow”, a diphthong of two vowels, with lip
rounding, made toward the back of the mouth.
What if children have lost a sense of the original vowel in
their attempts to find a substitution for vowel /r/? Think of “caw-uh” for
“car”, where there is added lip rounding (both changing the original vowel and
adding a second vowel), forming a diphthong of vowels that may not be in the
original target word at all. (Remember lip rounding for “ah/aw” and full
realization of /r/ varies by regional dialect.)
Let’s start with the vowels.
Sample /r/ word
Sample vowel word
lips spread, no lip rounding, tongue high and forward
mouth open, jaw lowered, no lip rounding, tongue low and
slight mouth opening, no lip rounding, tongue slightly low
lips rounded, tongue high and back
East Coast style
lips rounded, sides of tongue raised and curved (like the
tongue makes a valley), tongue back
mouth open, jaw lowered, no lip rounding, tongue low and
One way to start vowel-r treatment is by checking the
accuracy of each of the vowels before we introduce the r-coloring.
Have the child say each sample vowel word (without
r-coloring) while watching in the mirror.
Point out the different lip, jaw, and tongue positions for
Show that some vowels have lip rounding and some do not
Practice making the vowel sounds in isolation
Slowly add r-coloring (with retroflex /r/): “Say the vowel.
Hold it. Now lift up the tip of your tongue and curve it backward.”
Continue to practice blending the original vowel with the
/r/ to smooth the process of change
Remember to reinforce lip rounding that should be present
and reduce lip rounding that should not be present by returning to practice the
Each time we work with a client, we are learning about
successful intervention and so are our clients. When a target is met, a good
idea has been implemented – and when we share credit for these ideas, everyone
blooms. Developing a generous and giving mindset toward ideas and reducing
instinctive proprietary reactions, may help us to empower others.
Let’s help everyone recognize the power of sharing ideas.
Clients: Helping clients recognize the facilitating contexts
for their own successes may foster ownership. Even for young children, you can
show the connection between an action and an outcome; “I heard /k/. You pulled
your tongue back – that was a great idea you had.” You can help students believe
that they have generated solutions, because, in partnering with you, they have.
Families: Many families know what works best for them.
Present a couple of possible strategies to implement at home. Solicit feedback on
integrating one of the strategies into daily life. Wait. Let the family come up
with the idea of how it will work. Praise the family for their great idea,
because it is now their idea.
Staff: Teachers and staff members understand classroom
routines and have an incredible sense of the patterns of behavior for students.
Share a student’s goals and ask staff members for their ideas about practicing these
goals. Before you offer suggestions, wait, and it’s likely that teachers will
have their own ideas of ways to support them.
Colleagues: Remember all of those great ideas you have about
therapy and intervention. Your colleagues have great ideas, too. Start sharing
ideas, and soliciting ideas from your colleagues, e.g., “I tried these
strategies with this client, and this was the outcome. What ideas do you have?”
Administration: Tell your administrators about one small
aspect of a successful therapy session. Wait. Perhaps this will prompt them to
share their own memories of positive gains with clients. Many administrators
have wisdom and ideas to share; yet they may rarely be asked to share them.
Community: Friends, family members, neighbors, and
acquaintances are seeking solutions to minor communication and learning
challenges all of the time. We know how people communicate and how people learn.
You can politely offer to share your expertise, e.g., “As a Speech Language
Pathologist, I help children and adolescents with organizing and sequencing
information every day. Do you want to brainstorm some ideas about how to work
on that project together?”
A magical aspect of any idea is how it is changed and shaped
by the various people who implement it. Ideas take on the nature of the
individual and the situation in which they exist. When we share ideas with
others to be continually re-created, we may foster everyone’s personal growth
and their self-esteem.