TheSpeechPathWay.com

Articulation Therapy Goals – Add a Qualitative Element

Marcus Little — Tue, 10 May 2011 17:12:47 +0000

I am not a fan of typical articulation therapy goals. To me they are missing a main ingredient. They usually contain a quantitative element but almost never identify the “qualitative”, and by this I mean how the target is being produced. Let’s look at the following goals for articulation therapy. These will probably look familiar.

1. CLIENT X will produce /target/ in isolation with 90% accuracy.

2. CLIENT X will produce /target/ in syllables with 90% accuracy.

3. CLIENT X will produce /target/ in all positions of words with 90% accuracy.

4. CLIENT X will produce /target/ in sentences with 90% accuracy.

5. CLIENT X will produce /target/ in oral reading tasks with 90% accuracy.

6. CLIENT X will produce /target/ in structured conversation with 90% accuracy

7. CLIENT X will produce /target/ in spontaneous speech with 90% accuracy.

8. CLIENT X will improve carry-over of the target sound /target/ outside of therapy setting with 90% accuracy.

These goals are too vague to be meaningful. The quality of the target production is assumed. This is a problem. A goal needs to speak to the quality of the production as well. I used to celebrate my clients achievement of 100 % accuracy at the word level and sentence level and then would have to wait for endless periods for them to achieve their sound in conversation. This was because my clients could only produce their targets if they “emphasized” their sounds or were “pausing” before their target sounds. If I change the goal to address the qualitative issue of removing pausing and emphasis it becomes much more powerful.

CLIENT X will produce /target/ in spontaneous speech without pausing before target or emphasizing of target with 90% accuracy.

This simple shift in my speech therapy goal setting allowed for my clients to drastically reduce the amount of time before acquiring their sound in conversation. This was due to adjusting the client’s therapy focus to address how to eliminate “pausing” and “emphasis” of speech targets.

By adding the qualitative dimension of “pausing” and “emphasis” to your speech therapy goals you will not only be creating more powerful goals but doing your clients a great service as well.

A Parent from New Zealand Shares her Experiences

Marcus Little — Wed, 21 Jul 2010 03:16:06 +0000

Sometimes I get some really great-emails from parents sharing how they are working with their kids speech at home. This is one of them. Thank you Pam from New Zealand.

Thanks for your reply. I would like to say first of all that because we are so remote and because my son absolutely hates any away from home, after school activity except soccer training and playing with friends I am the sole speech therapist for him. In NZ the government does not provide speech therapy at school except to those very disabled students. I find Ben very easy to work with because he enjoys his speech work with me and willingly does it each day. ( We do take some breaks.)

I have read your posts and boy, does what you say make sense to me. It all just sounds so logical and although I have no speech therapy training at all nor any experience in speech therapy of any kind, I now feel perfectly confident to work with Ben. I have carefully analyzed his difficulties and at the beginning quickly whipped out a pencil and took note of his errors when he was not aware of it during normal daily conversations. I put these into categoreies,e.g. sound troubles and the position of these sound troubles in relation to other sounds and then grammar troubles and habitual left off word parts and etc. Once I had these all written up and this took several days of careful observation, I then invented drills. I am not as fast as you are, Marcus. I have not reached 4 to 5 hundred drills per session yet, but we do go fast and we do cover a lot of ground in one session. He actually loves this. Of course as you could predict he likes the drills he is most familiar with and it is hard introducing new ones although he likes new things too. So where does the innovative bit come it? Well, we don't just sit and drill, we get on the mini trampoline and the balance board and we pass bean bags back and forth. We use sticks that twirl and small balls and slightly bigger balls that are one kilogram each. We also sit for a time and we do reading of the drills together. He loves the rhythm of the drills. So for example I say "go" and he says "went". I say "do" and he says "did". We do this really fast and we reverse roles.. I ask him questions like " Did you go to the movies last night?" then he must answer saying "No. I went to the races." the target is proper use of the past tense of irregular verbs. I have a series of 20 such questions using different irregular verbs that he got wrong often but is now getting correct more often in ordinary speech. He never used to use the auxiliary verbs, do/does, was/wasn't, have/haven't and others. The negative from of these expressions was simply "not" plus the present tense of the verb for all conjugations. He has vastly improved in this area over the past 2 months. We don't correct him much in everyday speech and never did but now he will self-correct at times and makes most of his errors when tired or upset.

I am having so much fun making up these drills and doing them with Ben. I colour code the drills where we ask each other questions or have dialogue. This means we can easily find our place. I also use headings at the top of pages or at the beginning of drills that name the target. He does not drill this but I read it to him so he knows why he is doing each drill.

I had been racking my brain thinking "Where do I start?" before stumbling onto your website. I knew correcting him was not the answer but how to help him??? Well, you have answered that question for me and I have been going to town. The drills (inspired by you) have not only helped him to speak more clearly and smoothly, but they have also been an enjoyable activity for us both. I have read a lot of research regarding the fact that physical activity stimulates the brain and increases recall of information ( Such as Braingym and Vis-a-Ball) and it is on this account that I have included physical movement with the speech drills. He can do the two at once though with new drills it seems best to start out seated on the couch. I sometimes get him to read the drills from a large format spiral drawing book (I also use what we call A4 size spiral lined notebook which is your sort of equivalent of 8×11 inch) which I flip as he finishes each page. He just bounces lightly as he goes. Sometimes he simply holds a beanbag in each hand as he does the drills or holds these as he stands on the tramp just lightly bouncing so as not to even lift his feet off the trampoline. We make up the physical movements as we go and do what seems to work best.

So that is me for now. Kind regards, Pam from Wellington region, Wainuiomata, New Zealand

Articulation Therapy-A Clinicians Responsibility.

Marcus Little — Fri, 05 Mar 2010 17:08:11 +0000

In my last post we looked at a Henry Ford quote and used it as an inspiration for developing the proper mindset for articulation success. The focus was on the individual who was taking on doing speech therapy drills at home for themselves or their child. In today’s post we will consider the clinicians perspective towards a caregiver or parent as agent of speech therapy homework. I have modified the Henry Ford quote to suit this purpose. I have changed the word “you” to the word “they” to reflect how a Speech Language Pathologist looks at a potential agent of a home speech therapy program.

“If you think they can do a thing or think they can’t do a thing, you’re right.”

If a Speech Pathologist “thinks” that parents can be of little or limited help in their child’s speech remediation it will dramatically increase the “likelihood” that the parents involvement will be of little value. It becomes a self fulfilling prophecy. Why? A Speech Pathologist with this mindset will not spend the time and effort educating a parent to be effective at home. They may believe it is a waste of time and that they could be spending on their client directly. If this is their belief, whether conscious or not, it will shape how they implement their therapy program and ultimately how quickly progress will be made.

Having parents be effective with a home program starts with the fundamental belief that it is possible. When a Speech Pathologist “thinks” a parent or caregiver can be an effective agent of a home speech therapy program, their actions will be inline with supporting those individuals in being effective. It is at this point that a clinician will realize the value of putting the time and effort into training an individual to be effective with the drills they are doing at home. Training parents is not a little task that can be done in five minutes. It takes a big commitment on the Speech Pathologists part to step up to the task of training parents. It is much, much, much easier to take on the commitment of training parents to be effective if you actually believe they can be effective.

I am a firm believer that when a parent is actively involved and trained to be effective, the whole remediation process goes much quicker. This fact is reinforced every week I work with clients who attend an evening speech clinic I work at. Clients I see in the evening clinic setting must have their parents in attendance. By working with both client and parents simultaneously the progress of clients seen in the clinic is significantly faster than clients I see during the school day without their parents present. The bottom line is kids working on a home therapy program progress significantly faster when a parent is trained to be effective and is being supported on an ongoing basis.

I believe whole heartedly that parents and caregivers can be extremely effective in working on speech therapy programs. I know this to be true. Do you?

Yours in making a difference,

Marcus Little

Articulation Therapy-Mentally Preparing for Success.

Marcus Little — Tue, 23 Feb 2010 03:45:13 +0000

“If you think you can do a thing or think you can’t do a thing, you’re right.”

Henry Ford

I absolutely love this quote. Simple yet powerful. To me it illustrates why having a proper mindset is critical for success. It makes success appear as a choice. If you think you can achieve success you are halfway to succeeding. If you think you cannot succeed, you have failed before starting. You have to be responsible for your thinking in the matter of success and “own it”, or it will “own you”. This is especially the case when working on articulation with your child. You have to actively manage your attitude and believe in your ability to make a difference.

Parents of children with speech difficulties need to believe they can make a difference in their child’s speech therapy. They need to “Know” in the very core of their being that they hold the key to unlocking incredible results. Parents/caregivers have the most access to their children and as a result are in a position to make a significant difference in speech remediation. Parents need to acquire and execute a plan for helping their children work on their speech development at home. Ideally, a parent needs to be working with a Speech Language Pathologist who see’s the parent/caregiver as an extremely valuable resource that is integral to the therapy process. It is amazing how much a difference it makes when someone believes in you and is supporting you in your success. When this occurs, what is possible greatly expands.

Doubt happens! Parents need to actively manage their doubts. When an inner conversation arises that is preventing you from moving ahead and is causing you to stop pushing on, you need to acknowledge this negative self talk push on in the face of it. The conversation might look like:

· I am not a professional

· Am I doing this right

· I am not making a difference

· My child will get this on their own

· I am leaving all the work to the Speech Language Pathologist.

If you start believing in why you can not help the situation, you will be stuck there until your thinking changes. The best way of getting past this is having a conversation with your Speech Language Pathologist. They are your coach and need to be helping you “get unstuck” when doubt sets in. Additionally, you should only work on speech drills that your child already knows how to do and focus on doing them quicker and with less effort.

In closing, I want to leave you with a couple of tips. When you get frustrated or are hitting your limit you need to stop and take a break. Use this time to regroup and adjust your thinking. Adjust your expectations and work on an easier task to develop success again. Secondly, find some support. You need someone who believes in your goals and can support you in achieving them. You need someone to listen to you and answer your questions. Ideally, this should be your Speech Language Pathologist. If you do not have this type of relationship with your SLP then ask for it. Tell them what you need.

Yours in making a difference,

Marcus Little

Avoid Over Correcting Articulation Errors at All Costs

Marcus Little — Mon, 15 Feb 2010 02:50:39 +0000

During my last post I revealed how the frequency in which I correct a child has gone down greatly over the years. The rational for limiting how much I correct a client is pretty simple. No one enjoys being corrected. So the question we raise is how much is too much when correcting a client. There is no set number or formula for this, rather this is where a clinician needs to use their powers of perception and intuition. Some clients can be very resilient and can take being corrected and pushed. Other clients can have a “low failure threshold “and literally shut down after getting one or two trials wrong. A clinician needs to develop the ability to read their clients and sense when they are hitting their limits. Knowing when to back off is critical.

The best practice when working with a client is to focus on what the client can already do well, and strive to do it better and quicker. You would be surprised how much a client can improve their productions which may initially appear very strong. With practice and continued repetition, you will notice that the amount of focus and effort it takes to make rapid productions, greatly reduces. The problem lies in the fact that it is counterintuitive to focus our time working on what the client can already do. We would rather work on the specific level they are having difficulty with in order to see what difference we can make. I always make a quick trip to this level during every session only to see where it is, but I do not dwell there. I only need to know where the breakdown is the most pronounced and then I will fall back a level or two and focus my efforts at that specific level.

The time for intensive correcting of a client is during the process of developing consistent stimulability. It is at this stage that the client may need constant reminding to adjust what is occurring in their mouth in order to produce their sounds accurately. Once consistently stimulable, it becomes much easier to work with your client without constant correcting. At this time, the purpose of the drills provided is to maintain and reinforce accuracy while developing the ability to produce the sounds quicker. If mistakes start occurring than the client needs to slow down and back off to reconnect with their accuracy.

Lastly, when providing homework to your clients, you want them to be working on drills that they can do well. You do not want them to be reinforcing any inaccurate productions. Getting your clients to practice drills that they can easily do with you, allows you to send the homework drills home with the confidence that they will be practiced accurately and effectively.

What Does High Rep Articulation Therapy Look Like?

Marcus Little — Sat, 13 Feb 2010 05:52:45 +0000

I thought many of you might find some value in me breaking down what one of my therapy sessions looks like. I will give you an overview of a session I did this past week. The session was with a newly acquired private client who I did a session with at their school with her mother in attendance. It was her second session following her initial assessment which revealed fronting on her /z/ and /s/ sounds, plus misarticulation of the /l/ sound. The 6 year old client was found to be stimulable for all sounds up to the word level. The 20 minute session was timed on my iphone and went as follows:

1. Discuss homework from previous session and get a sense of how it went. If they had trouble maintaining homework schedule we discuss structures to put in place to support their commitment to homework. I ask for only 5 mins a day of homework to be done preferably at the same time in the same place everyday. The idea is to build a habit like brushing the teeth. I am always a stand for homework. In the 10080 minutes available in a week, we need 35 minutes spread across 7 days. It is doable when it is made a priority.

2. /s/ target sound warm-up 40 sets of 5. (200 reps in total) I go fast with these. I push the speed to see if I can get the sound to breakdown then back off to re establish accuracy.

3. /s/ target sound plus vowels AEIOU in the initial and final positions. I do 5 sets of 5. That makes 125 reps for initial targets and 125 reps for final targets. I always go slow for the first set of five then gradually increase the speed keeping the accuracy.

4. Lastly we ventured into double syllable level drills. Here we put 2 syllables together then do one set of 10 for each combination. I tracked these individually to get a percent at the end. This was 100 reps in total. All combinations were 100% except for one which was 90%.

5. Lastly we discussed homework expectation and basically prescribed a scaled down version of what we did during our session. I always send homework home that I know the client can do.

Notice that I did not start at word level drills even though my client is stimulable to word level. In Graduate School I was taught to work on the word level as soon as possible. I have since learned that to not work on phoneme, syllable and double syllable level drills will ultimately slow me down in the end due to carry over into conversation taking far too long.

In the end my client performed 550 reps in this 20 minute session. It has taken me many years to get to the point that I can do this. The big shift came in my relationship to correcting the clients. The bulk of the correcting takes place early on when we are developing consistent stimulability. Once stimulable, the goal of my drillwork with the clients is to get them to progress through the various levels up into conversation while maintaining their accuracy and at the same time pushing their speed. For the most part clients know when they make a mistake and will correct themselves on subsequent trials even when they have not been told. You will only get a chance to witness and appreciate this when doing sets of five rapidly with your client. Because of the speed of the drill you are not able to correct every production. You just need to watch to see if your client is correcting themselves. If they are not correcting themselves and getting entire set of 5 wrong then this is where I intervene and have the client try again slower. This is usually enough to get them back on track. As a clinician, there is no cooler feeling then watching your client motor through sets of five correcting their own errors as they go.

Just recently, it really struck me how little I correct my clients during our sessions compared to when I started. I still do it when absolutely necessary but find if I am correcting them too much, I am working on too high/hard of a level for them. Is anyone a fan of someone constantly correcting them. I am definitely not. As a result of this shift in how I conduct my therapy sessions, they have become much more productive and enjoyable for both me and my clients.

If you are a fellow SLP, feel free to contact me with any questions regarding integrating high repetition therapy into your offerings as a clinician.

Yours in making a difference,

Marcus Little

Speech Pathology-3 Key Elements of Impactful Speech Therapy.

Marcus Little — Fri, 22 Jan 2010 20:41:39 +0000

Over the past eleven years I have worked in speech pathology, I have always pondered the question, "what does a Speech Pathologist do that is most impactful and really makes a difference during therapy?". After much thought I have boiled it down to 3 key elements. Therapy method must:

1. Provide high repetition.

2. Drill for speed while maintaining accuracy.

3. Be easy to train parents and Educational Assistants.

Both speed and high repetition have been discussed in earlier posts. Today I want to focus on the third point above. Therapy must be easy for parents and caregivers to understand and follow. From experience I have learned that if there is any doubt or question in the minds of the individuals you provide your home program to, the likelihood of them not doing it increases dramatically! It is easy for them to feel overwhelmed and start to question whether they are doing the drills properly. They must be given a simple roadmap to follow and time needs to be spent explaining the “how” and the “why” your homework drills need to be done in a specific way.

It is critical to design therapy homework that is easily carried out and performed by someone other than the clinician. Doing so makes a world of difference in your client’s progress. The ability to easily train and empower others into providing exceptional support and followthrough on homework is critical to success. The ability to duplicate a small part of what you do as a speech pathologist in others is a worthwhile goal with a huge payoff. For me, this is what speech pathology is about.

/S/ Homework Drill Sheets Available for Download.

Marcus Little — Sun, 13 Dec 2009 20:40:19 +0000

Greetings Subscribers to the SpeechPathway.com,

In keeping with the Christmas Spirit, I am giving all of you a taste of what I have been working on. I am in the process of putting together a Speech Sound Workbook that can be used with “The SpeechPathway” system of developing stimulable sounds through the various levels of sound production up into conversation. The /s/ sound drill component of the workbook is complete and I am giving it away free. It compliments the /s/ sound stimulability video as well as the online course. If you have not watched the Online Course that describes the “SpeechPathway” method, you can gain free access to it by signing up in the top right hand corner of this page. I highly recommend you watch the overview of the “SpeechPathway” method. Understanding the method is essential to being able to use the drill sheets effectively.

This Online Course is roughly eight minutes long. It is an overview of the approach I use to develop speech sounds progressively into conversation. This is the same information I present to each of my clients parents and caregivers prior to beginning therapy. This training helps ensure the homework drills are being done properly. It is important that caregivers understand not only how to do the drills, but why they are done in such a specific manner. To practice the drillsheets without clearly understanding how to use them would be a mistake.

Access to the /s/ drill sheets is also gained through the same “access password” as the “online course”. The link to the drill sheets can be found below the “online course.

Enjoy my latest offering. Feel free to contact me if you have any questions about using the drill sheets. I will do my best to answer them in a timely fashion. If you are Speech Pathologist feel free to use the sheets with your clients. As for the entire workbook of sounds, I am committed to having it available by January 1, 2010.

Yours in Making a Difference,

Marcus Little

M.Sc-SLP Reg. CASLPO # 3526

Automaticity – The Key to Articulation Therapy

Marcus Little — Tue, 27 Oct 2009 03:10:00 +0000

When reflecting on the many courses I took in my academic career, there is one course that stands above the rest in terms of shaping me as a Speech Language Pathologist. Ironicaly it isn’t even a SLP specific course. Go figure. It was a course I took in “Cognitive Psychology” that had me write a paper on the concept of “attention and automaticity”. It was this paper above all else that has had the most influence on the articulation therapy that I do today.

What is the concept of “attention and automaticity”. Automatic processes are tasks that people do without conscious control, like writing or tying shoelaces. Once a person has decided to write something, they no longer need to visualize and consciously control each motion. Automatic processes ultimately require little attention or awareness and can be done simultaneously with other processes once learned or internalized. The key to the internalization of the process is repetition. Practicing the task over and over again until it becomes fluid, seemless and effortless. I remember struggling to write in the primary grades and hated doing it. Daily, I find myself writing homework notes by hand to parents and it is no longer a struggle (but I still hate doing it:). Another example would be learning to drive a car. I remember learning to drive was overwhelming. This was especially true for learning to drive standard. Trying to keep track of the gas, brake and clutch coupled with rules of the road was initially quite a challenge. Now I find myself doing many things at once in car effortlessly. Automaticity is a beautiful thing.

What does “attention and automaticity” have to do with articulation therapy? Everything! Each and every client I work with goes through a phase of being in their head and focusing on proper articulator placement during production of their target sound. Success does not occur until they can demonstrate the ability to produce their sound effortlessly in all contexts leading up to and including conversation. The “pathway” to success is repetition coupled with speed. I like the music analogy the best. Anyone who has tried to learn the piano has been instructed to practice musical scales over and over in order to develop the motor planning necessary to play the music effectively. Automaticity is the key to success.

We have established that highly repetitive drills are critical in developing the automaticity of speech sound production. What exactly is high repetition therapy? When I first started treating clients ten years ago I thought that getting over a hundred repetitions during a half hour session was stellar. Two years ago I adjusted my therapy technique to maximize repetitions and can easily produce between four and five hundred repetitions in 15 minutes. I discovered I could get quicker results and be more effective by actually spending less time with the clients if the therapy was highly condensed and focused.

In closing high repetition drills in my opinion are the number one thing you can do to accelerate the results of speech therapy. Learning how to ramp up the number of targeted repetitions will have a huge impact on the speed of your success.

Marcus Little

Stimulability – The Foundation for Success.

Marcus Little — Fri, 02 Oct 2009 02:12:31 +0000

In the world of Speech Pathology, stimulability is a key concept. It is one of the first things a Speech-Language Pathologist will look for once identifying the existence of a misarticulation. So what is stimulability? It is simply the client demonstrating the ability to accurately produce a target sound when given a model for that sound. Stimulability is typically achieved at the sound level first but can be identified at each of the sound production levels leading up to conversation. These include the syllable level, double syllable level, word and sentence levels. Once a sound is identified as being stimulable, it signals to the SLP that this sound may be ready to be targeted specifically to be developed through the levels into conversation. Stimulable sounds display a readiness for therapy.

The extent to which a sound is stimulable is a key factor in target selection. I would not necessarily choose the most stimulable target as my therapy target. For instance a sound which is stimulable in sentence level drills with multiple target sounds in multiple positions, I may choose to overlook. A sound at this level is on the verge of emerging into conversation and I may choose to monitor this sound while choosing a lesser stimulable target to focus on.

Early on in my career as a Speech Pathologist I imagined I would be spending the majority of my time developing stimulability in clients. I was amazed that this simply was not the case. Clients with multiple speech errors usually had a mix of stimulable and non stimulable sounds. Quite often when working on the stimulable targets, the non stimulable sounds would develop stimulability on their own. In the instances of having no sounds that are stimulable, it usually does not take multiple sessions to develop stimulability. I have encountered sounds that were highly resistant to developing stimulability but these cases have always been the exception. I strongly believe that once a client becomes stimulable for a sound it is simply a matter of doing the work to get the sound to ultimately emerge into conversation.

I have put together a training video covering the concept of stimulability. This video also provides some techniques to develop stimulability of the /s/ sound as well. I am very pleased with the production quality considering this is our first video offering. I encourage you to leave questions and comments. I am here to serve you.

Marcus Little

httpvhd://www.youtube.com/watch?v=Jc8jEvC7jHs