Errors in the production of /r/ sounds in children are very common. It can be a tricky sound to correct, and intervention is harder as children get older, but it can be corrected. I use a combination of the “Say it Right” program and the PROMPT approach. The Say it Right program helps organize the treatment in terms of which /r/ to intervene first. There are in fact several /r/ productions- initial /r/ (e.g., rat, road, rain), and several vocalic /r/- (e.g. -er, -ar, -or, -air) and r-blends (e.g. br, kr, tr, fr, etc). There is a systematic approach to determine which /r/ should be targeted first for the intervention to be effective. In addition, I also use the PROMPT approach which is a tactile approach. The PROMPT approach provides the necessary sensory feedback by showing the child exactly what he or she needs to do to produce the /r/ sound. These PROMPTs are gradually faded until the child can produce the sound without the PROMPT. You can read more about the PROMPT approach on my website.
The Use of Oral-Motor Techniques to Improve Speech Production
Using oral-motor techniques to work on articulation continues to be controversial in the field of speech-language pathology. Recent research appears to indicate that use of oral motor techniques do not in fact demonstrate better outcomes in terms of speech production. However, when reviewing any research it is important to understand that the study was carried out on a small group of participants. As parents and professionals we know that no two children are alike in terms of their deficits or their strengths. Techniques and treatment methods that work for one child may prove to be ineffective for another and vice versa. It is therefore my opinion that each child must be evaluated as an individual with unique needs and abilities. Techniques that work on building lip strength in a child with poor lip seal resulting in drooling and errors in production of bilabial sounds “p,” “b,” “w,” and “m” may in fact be effective.
I believe a detailed evaluation that includes an assessment of a child’s jaw, tongue and lips: their strength, coordination and dissociation (i.e. the ability to move independently of the other) is key to determining their effect on speech production. However, I cannot emphasize how important it is to always use oral motor techniques in conjunction with direct speech production therapy. It may not result in the desired articulation changes if used in isolation.
Cycles Approach
Cycles Approach to treating multiple articulation errors in children with poor speech intelligibility
Children often demonstrate errors in the production of sounds like /s/, /r/ and /l/. When a child presents with a few specific sound errors, a traditional articulation treatment is warranted. However, for some children the sound error includes a wide range of sounds and severely impacts their speech intelligibility. Their errors often follow patterns such as omission of final sounds in words (e.g. saying “ca” for “cat.”). Hodson and Paden (1991) proposed the “Cycles Approach” in which these patters are targeted in a specific sequence. The treatment includes specific treatment strategies used in each session such as auditory bombardment, a communication activity, drills and a generalization activity. Evidence suggests that treatment approaches that target patterns of sounds rather than each specific misarticulated sound for children with multiple errors are more efficient thereby reducing the overall treatment time. The more dramatic impact of using an approach such as the Cycles Approach is a significant impact in the child’s speech intelligibility. This video (Thank You, Sonali!) is a “Before and After Cycles Program” of a child (age 3 years). The little girl demonstrated multiple sound errors using essentially vowels to communicate. Following several months of intervention, she could produce complete sentences that are intelligible even to unfamiliar persons. The remarkable difference in her speech is impressive evidence of the overall effectiveness of the program.
What’s In It For Me?
I believe that a great place to begin speech therapy, no matter what your child’s diagnosis, is figuring out what’s in it for him. Therapy cannot work until we find out what motivates your child. It could be as simple as bubbles or stickers. It doesn’t really matter what it is. The important thing to remember is that that’s where therapy begins. Using a portion (or sometimes all) of my first session to build trust and a relationship with your child has proved invaluable time and time again.
Many parents will tell me that their child is very reserved and will not speak to strangers. This may be true. But even the most reserved child knows a good deal when he sees it. His favorite toy, fun activities and games are a few of the things that first greet him when he visits the clinic. My goal is not only to ensure that your child makes significant progress in his communication skills, but also to ensure that he has a fun time doing it!
