“You know where it ends, Yo it usually depends, On where you start” – from “What It’s Like” by Everclear
There seems to be a 90’s music theme building here this week, but I digress…
This question was posed to me this week – How do I teach /r/?
And, my response was, “it depends on where you need to start.” (Suddenly, the lyric from Everclear’s “What It’s Like” popped in my head.)
Please note, dear reader, this post is a work in progress and I’ll add to it as time allows:
Let’s take a moment to make sure we all have the same definitions of speech sound disorders in children (SSD)…
- Articulation disorders – distortions and/or substitutions related to the motoric aspects of production; generally restricted to one or a few closely related sounds
- Phonological disorders – pattern-based substitution and/or omission errors based upon the child’s underlying knowledge of the phonology of the ambient language and which often affect more than one sound
The take-home message here: If you can predict how a child will say a word, then it’s a phonological error pattern.
Can a single sound error pattern be phonological in nature? I’m extremely glad to see a recent return to this question in the literature. Yes, it can. And, a phonological error pattern requires a different type of intervention than an articulation disorder.
To successfully treat any SSD, you have to correctly identify the problem. If a child’s phonological disorder has resolved to the point where the liquids or /r/ alone are the only sounds still affected, the child still has a phonological disorder. It didn’t suddenly become an articulation disorder.
/r, l/ in English are tricky. They are true consonants at the beginning of the syllable and become more sonorant or vowel-like at the end of the syllable. Notice I said at the beginning and end of the *syllable*, not word. English phonology really happens at the syllable level rather than at the word level. It helps to remember that as we talk through the scenarios.
Remember, a phoneme is a phoneme because it indicates a change in word meaning. If you treat individual sounds at the sound level, that’s artic therapy and you’re doing phonological intervention wrong. Always, always treat at the word level to help your clients make the most change in the shortest amount of time!
That doesn’t mean you won’t need to explain the correct placement in isolation. You may need to. But, you immediately – immediately – put the phoneme back in the context of the target word.
Scenario 1 – the child who presents with a consistent [w] for /r/ pattern syllable-initially
- The vowel nucleus of the syllable will either be your best friend or your worst enemy. When developing treatment word sets, make sure you use front vowels to the greatest extent possible. Why? They all require you to produce them with a ‘smile’ and smiling is incompatible with lip rounding. If you don’t round your lips, you can’t produce [w]. Work smarter, not harder applies here, too!
- There is considerable evidence for using non-sense words in phonological therapy. From a purely practical standpoint, creating your own nonsense words definitely makes it easier to come up with contrasts using the front vowels. For an example of nonsense words in phonological therapy, see here. Some word pairs you might use could be /wibu/ – /ribu/ (weeboo-reeboo), /waIdo/ – /raIdo/ (waydoe-raydoe), /wImi/ – /rImi/ (wimmy-rimmy). You’re going to introduce these words as the names of characters to create new lexcial/semantic or vocab entries (I’ll explain the theory and research behind this in a later post on lexical development).
- If you’re using these contrast sets appropriately, you really do only need 3-5 word sets. As with the other NSW, word sets when you start out, the only demand you place on the child is to ‘make them sound different.’ Once the child is able to consistently differentiate between each member of the word pairs, then you begin shaping /r/ as needed
Elicitation strategies for w/r syllable initially
- Mirror/camera work – have the child observe their face in a mirror or cell phone camera while attempting to say each member of the word pairs. Recording the correct lip placement & attempts for the child to view at home (on the family’s device, of course) is priceless! You also can record elicitation techniques for practice at home…I’m just saying…
- Eliciting /r/ from the velar stops – For some children, differentiating between the members of the word pairs and watching themselves in the mirror just won’t be enough to help them approximate the correct placement. Both /r/ and /w/ really have 2 points of articulatory contact – the lips (which are easy to visualize) and the posterior portion of the tongue which ‘bunches’ against the back of the hard palate (and which is not so easy to visualize). Fortunately, the velars are more posterior than /r/ and clusters can be formed with both /k/ and /g/. Try having the child ‘growl’ – grrrr – to get a feeling for the correct tongue placement. This type of growling is incompatible with lip rounding so you get the correct lip placement as an added bonus.
- Mouth Puppets are still available here. They can work wonders.
- Whatever you do, DO NOT TEACH A RETROFLEX POSITION TO ELICIT A “GOOD” /r/. For those of you who don’t know, this is when the SLP teaches the child to flip their tongue tip back against the hard palate to produce /r/ in isolation. As someone who specializes in cleaning up other SLPs’ mistakes with SSD, do have any idea how hard this is to ‘fix’ later? To me, intentionally teaching a child to produce /r/ like this in English is bordering on unethical.
- I have a few other tricks for eliciting /r/ when the first 3 don’t work. However, I should state I don’t have to use them with children who have been working with me from the beginning. I only need to use them to help children ‘unlearn’ what other SLPs have taught them. If you need to know more, please feel free to contact me.
I’ll tackle vocalic /r/ in Part 2. Thank you for understanding that while this site and the idea behind it are a labor of love, my day job demands my dedication, too!