5-Minute Therapy for /r/

If I was asked to list my top three challenges as a school-based SLP, correcting /r/ would top the list in terms of difficulty and high incidence.  (The other two challenges are laterals and dysfluency.  Fortunately, these have been very low incidence on my caseload).

If I was asked to list the top three benefits that have come out of my website, Speaking of Speech.com,  and this blog, the answer would be:

  1. Materials!  Through the vast Materials Exchange on my site, I’ve been able to build up my “bag of tricks,” by either using the free materials “as is” or by using them as a guide to create materials specific to student needs.
  2. New therapy techniques!  Through product reviews I’ve done on the site, I’ve increasingly expanded and refined my speech and language therapy.  I’ve also learned a lot from the generous SLPs who answer questions, give advice, and share tips on the various message boards in the SLP Message Center.
  3. The growth of the Speaking of Speech.com community!  So many SLPs have contributed to the growth of the site by sharing materials, participating on the message boards, and spreading the word about the site to colleagues, SLPs in training, teachers and parents.  I have personally developed close relationships with so many SLPs around the world through Speaking of Speech.com and related social media.  Even though I haven’t met all of these SLPs face-to-face, we recognize each other as kindred spirits in support of children with communication challenges.  And I’m not the only one who has forged close relationships because of the site!  Susan Sexton and Linda Seth met through my site and — wow! — what a productive relationship that has been!

Linda Seth has more than 30 years’ experience as a school-based SLP and 5 years as a classroom teacher.  Her varied experiences range from inner city schools in New Jersey to the last one-room schoolhouse in West Virginia.  She has achieved national recognition as an outstanding (and one of my very favorite!) presenter across the country.  Linda is the author of numerous volumes of therapy materials that seek to actively engage students (individually, in small groups, and in classrooms) in fun and meaningful learning. Great examples are the books in the G.R.O.W. series, which stands for Get Rid of Worksheets.  See what I mean?  Active learning is what Linda is all about, and she has an unlimited wealth of ideas toward that goal.  If Linda is ever presenting in your area, DO NOT miss the opportunity to attend!  To see and purchase all of Linda’s materials, visit Great Ideas for Teaching.

Susan Sexton is a retired school-based SLP from Michigan.  Susan broke away from traditional 30-minute small group therapy and pioneered the idea of short, frequent, intensive therapy sessions that became the basis of her very popular “5 Minute Kids” therapy plan and materials.  Research and anecdotal evidence shows that students make measurable progress and the length of time in therapy is reduced, using this approach.  Be sure to visit Susan’s website for details, samples, and purchase of her must-have materials.

5-minute-kids-logoIt was through Speaking of Speech.com that Linda and Susan connected — and, boy, did they ever!  Putting their two very creative heads together, they produced the fabulous series of books:  “5-Minute Kids Therapy,” “5-Minute Games,” and “5-Minute Verbs.”  As soon as I saw these books, I knew they were going to my all-time favorite “go to” materials.  And now — oh, joy! — a new volume has just been published!  While the other “5-Minute Kids Therapy” books address all of the consonant sounds that are frequently addressed in therapy, this new one is all about vocalic /r/!!  The book follows the same format as the predecessors:  repetition lists at the word/phrase/sentence levels, data charts, pages for independent practice, quick games to keep kids motivated, and homework and carryover activities.  Really, what more could you want??

Check out this new book (special new release price of $22!)from Susan Sexton and Linda Seth, and then check out all of their other gems.  In addition to using these books for short, frequent, intensive therapy, I’ve used them for group therapy, homework, and for establishing baseline and progress monitoring.  Every time I use them, I am so glad that Speaking of Speech.com brought these SLPs together!

 

Make Social Learning Stick!

When I was getting my Bachelor’s and Master’s degrees in Speech/Language Pathology, social skills were not mentioned in the context of young children, only in terms of functional life skills for adults with aphasia.  Of course, that predates the rise of autism spectrum disorders.

Early in my career, students with social skills issues were referred to the guidance counselor or school psychologist.  Gradually, students with these needs were moved to the SLP, which left some of us scrambling for materials and strategies to use in therapy.  Enter Michelle Garcia Winner with her books and presentations on “Social Thinking” and Carol Gray’s introduction of “Social Stories.”  Whew!  Now we had published materials to guide us into this new phase of therapy.

Since then, a great deal of research has been done in the areas of social skills, executive functioning, and behavior.  In common use in schools today are “the Incredible 5-Point Scale” (Kari Dunn Buron), “Zones of Regulation” (Leah Kuypers), the “SCERTS Model” (Emily Rubin), and “Integrated Play Groups” (Pamela Wolfberg), to name a handful of research- and evidence-based resources available to SLPs, teachers, and parents.  Still, we recognize that our students have very complex and diverse needs.  We can’t count on a “one size fits all” approach;  therefore, we often find ourselves cobbling together elements of various strategies and that, in itself, can be daunting.  After all, social skills don’t only happen in the therapy room.  Students need to be able to apply learned skills in a wide variety of settings, with a wide variety of social communication partners.  This generalization requires educators and caregivers to work closely together in support of the student.  And while SLPs and teachers now receive training in social skills, parents do not.

Screen Shot 2019-02-24 at 11.45.07 AMTo answer this need, Elizabeth A. Sautter, M.A., CCC-SLP, pulled together the best practices outlined by the above-mentioned authors to create an amazing resource for educators and caregivers to support social and emotional competence and participation by simplifying targeted needs of “following directions, thinking about others, being flexible, reading nonverbal social cues, working in small groups, participating in conversation, advocating for themselves, seeing the ‘big picture,’ and making friends.”  Her book, “Make Social Learning Stick! How to Guide and Nurture Social Competence through Everyday Routines and Activities,” is a must-have for anyone supporting young children with these needs.  This well-organized and illustrated book is divided into three sections:  At Home, In the Community, and Holidays and Special Events.  Each of the nearly 200 daily routines is distilled onto a single page to help the adult guide the child through observation, critical thinking and decision-making, recognizing social cues, understanding expected behavior, and active participation and interaction with adults and peers.

IMG_1187Each page presents “Hidden Rules”:  those unstated social contracts and expectations that are often missed by students on the spectrum. Scattered throughout are examples of “job talk,” modifications in how adults speak to children that result in more active participation.  Additionally, social learning vocabulary is italicized;  this helps all adults to be consistent in the words they use with the student.  The book ends with an extensive resource list, visual supports, sample narratives, and a great list of recommended games and social activities for after school and weekend play dates and family interactions.  At $21.95, this comprehensive book from AAPC Publishing is an affordable resource for all team members, and that is the key to carryover.

Be sure to visit Elizabeth A. Sautter’s website.  There you will find two children’s books about Whole Body Listening Larry, her blog, her events/presentations schedule, and additional resources.  Sign up for her free e-newsletter to keep abreast of useful information in the field of social learning.

 

A Plethora of Resources from One Dynamic SLP

The most memorable moment of graduate school, way back when at Trenton State College, was when the 8 or so students from our program exited the hall after taking the ASHA exam.  We gathered in the parking lot to seek assurance from one another that we hadn’t bombed the test. “What did you put for this question?  What did you put for that one?”  Buoyed by the knowledge that we had pretty much all selected the same answers on the trickiest questions, we were about to part with a sense of cautious optimism about our future careers.  Then, one of my classmates asked, “So, how DO you correct an /r/?” There was stunned silence, then a ripple of laughter that built into full-blown hysterics.  Yes, leaning across cars for support, we laughed until we cried, because not one of us could answer that question.

The first fifteen years of my career were spent with students who had moderate to severe disabilities, so fixing an /r/ was the least of my concern. Therapy was all about functional communication and assistive technology, and I was good at that.  Then I transferred to a new school with caseload of kiddos in regular education for whom improved articulation was their goal.  Oh, dear! I was suddenly confronted with errors on “k, g, th, and l” which I felt I could handle, but predominant on the caseload were frontal lisps, lateral lisps, and the dreaded /r/ distortion.  I had to do some very serious professional development very quickly.  That’s when I had the great good fortune of attending my first of several trainings with Char Boshart, creator of Speech Dynamics, and my entire approach to artic therapy changed.

Screen Shot 2018-09-30 at 12.06.09 PMIf I could only choose one word to describe Char, “dynamic” would be it! (“Delightful, insightful, funny, creative, generous, and awesome” also spring to mind, as you’ll see as you read on).  Here’s just a bit from her bio:

Char Boshart, M.A., CCC-SLP is a therapist, seminar presenter, writer, interviewer on The Speech Link podcast, and is president of Speech Dynamics, Inc.

She graduated with her MA from Western Michigan University (she took a class from the esteemed Dr. Charles Van Riper) and began her career in the public schools with over a hundred on her caseload. Since that time, she’s worked several years in the public schools in southern California, Maryland, and Georgia, in the clinical setting, private practice, and as an Assistant Professor and Department Chair at Loma Linda University.

Since the ‘90s, she has presented numerous well-received articulation and language seminars through Speech Dynamics, as well as through the Bureau of Education and Research (BER). She has also created several practical CEU videos through SpeechTherapypd.com, and now hosts a podcast, The Speech Link. She is a consummate speaker with an organized, infectious and exhilarating presentation-style.

Her interest in creating effective therapy techniques and efficient caseload management has evolved into the development of many practical resources. Her most current books are The Easy R, The Key to Carryover, 22 of My Favorite Tools and How to Use Them, Demystify the Tongue Tie, and others.

In addition, Char writes, and thousands of SLPs read, her weekly blog, Therapy Matters. She is dedicated to sharing practical information and ideas to therapists that work with children.

That’s the formal Char Boshart. Then, there’s the day-to-day reality of being a school SLP, to which I’m sure we can all relate.

“I’ve been in schools with no phones and had to hunt down every single kid, every time, every day. I’ve been up-chucked on (I’ll never forget it; Waterloo Elementary….). I’ve double booked parent meetings. I’ve judged the Spelling Bee (I have no recollection of that on my Job Description; oh wait, I didn’t have one). I participated in the talent show (as a performer—talk about a train wreck). I’ve had 10 minutes to get a report done, and did, somehow. I’ve sat down at the therapy table with four kids and panicked because I had absolutely no idea what I was going to do with them. I’ve forgotten kid’s names. A drop of a child’s saliva actually landed on my lip (eeek!). I’ve worked (or tried to) with toddlers and pre-schoolers who wouldn’t engage no matter what, and I felt guilty cause I wasn’t helping them. I’ve had over 110 on my caseload with four schools and no life.

Crazy? Yes. Fast-paced? Wouldn’t have it any other way. Helpful to kids? Boy, I sure hope so. It’s been great, and I wouldn’t change a thing.”

If you EVER have the opportunity to attend one of Char’s presentations, DO IT!  I have attended multiple presentations and have learned so much each time.  And while you are waiting for that opportunity to see Char live and in-person, you MUST check out the plethora of resources mentioned in this post.  Books, videos, podcasts, her quick-read but chock-full blog posts, and all of the freebies she generously posts on her site:  WOW!!  If you are looking for the perfect way to spend a professional development day, this would be it.  Gather your SLP colleagues and dig into all that Char has to offer.  Your head will be spinning, but I guarantee, if one of your colleagues asks, “So, how do you correct an /r/?,” you will be able to answer that question with many new and effective tools and techniques to supplement what you are already doing.

You can hear Char interview me on how to increase communication opportunities for students with complex needs on The Speech Link podcast, hosted by SpeechTherapyPD.com, on October 4, 7 PM Eastern.  This will include a live Q&A period following the broadcast.  You can read about the resources I recommend in my September 19, 2018 post.

Tackling /r/ with Technology

A /t/ is a /t/ and a /k/ is a /k/. But, oh, that vocalic /r/ – the most complicated phoneme in the English language! Volumes have been written about how to fix an /r/ distortion. My go-to bag of tricks includes Char Boshart’s “The Easy R Therapy Program” and “The Entire World of R” books and cards. I’ve learned so much from Char’s books and presentations about how to facilitate tongue movement and tension; her website is a treasure-trove of great information, including free materials, videos, books, and blog posts.  Char Boshart’s “The Easy R Therapy Program” comes in hardcopy and digital versions, and there is even a condensed version for quick reference.   From “The Entire World of R” I learned that there are more than 20 allophones of /r/, each depending on the vowel context and position in the word, and that students can have some of these /r/ sounds perfected, while others remain stubbornly distorted.   Indeed, as part of my own /r/ remediation packet, I developed “Hit the Mark with /r/,” a quick screener to help me determine the vowels and positions in which the student can produce a good vocalic /r/ and those in which production breaks down.   “Hit the Mark with /r/” presents three words for each of the vocalic /r/ sounds (initial, medial, final) and a rating scale that breaks down production into 3 categories: “vowel and /r/ are distorted,” “vowel is OK but the /r/ is distorted,” and “acceptable vowel and /r/.” I follow this up with more in-depth probes, using Artic-U-Checks, which uses a similar rating scale of “incorrect,” “close,” and “acceptable.” A pattern I see over and over in my students: most initial and medial vocalic /r/ sounds are acceptable, but /er/ in all contexts is distorted, and so are all final /r/ sounds.

So, once I have assessed the type, place, and severity of a student’s /r/ distortion, therapy begins. In my experience, there is no one-size-fits-all approach to /r/ that will work for every student. Therefore, I am constantly expanding my bag of tricks, searching for that one cue, one technique that will flip the switch for each student. Multimodality instruction is key.

Screen Shot 2018-06-03 at 12.43.09 PMBecause vowel context is so critical to producing acceptable /r/ sounds, my favorite app is Vowel Viz Pro by Complete Speech. This awesome app analyzes vowel production in real time. As the student produces words with vocalic /r/, the spaceship zooms to and hovers over high, middle, or low planets, representing the various vowels. The visual feedback is very reinforcing to the students and is definitely a motivator. The effort I’ve seen students expend in achieving the goal with this app is amazing – far more than I could ever get with flashcards or word lists. You can read more about Vowel Viz Pro in my blog post, “Apps for Vocalic /r/.” If you use an iPad in therapy, you definitely want this app.  Another app from Complete Speech that you might find useful is “Speech Racer.”

smartpalate_system-1Another very useful piece of technology, also by Complete Speech, is a palatometer, called the SmartPalate System. A custom-built mouthpiece shows students exactly where their tongue is touching the palate (or not). I wrote about my experience with the palatometer in my post, “Watch that Tongue: A Trial with a Palatometer.” This tool is not only very useful for /r/, but was also great for lateral and frontal distortions of /s, z, sh, ch, j/. The downsides for school use: (1) the software is expensive, and (2) each student has to have a mouth mold made by a dentist, then a custom-built palate with sensors – also expensive. The best approach is to see the students every day for short periods of time. Research done by Complete Speech indicates that 20 sessions is the average for fixing a speech sound error. Imagine cycling students through 4 weeks of intense therapy with the palatometer, and it could actually mean a cost-savings or break-even, compared to traditional weekly therapy that could go on for months or years. Still, it could be a tough sell to most school districts.  A new product by CompleteSpeech is the TargetPalate:  a custom-made plastic palate that has bumps where the tongue should be touching for sounds that the student is making in error.  I haven’t yet tried this with my students, but imagine the tactile feedback could be very helpful.  Please leave a comment if you have already had experience with the TargetPalate.

Students can get good information from seeing and hearing themselves on video, using a free program like PhotoBooth on my Mac. I just had a fourth grade boy who was convinced his /er/ was pretty good, until he heard the playback on PhotoBooth. The look on his face when he heard the distortion reflected an important “aha” moment for him. Another student with a wicked /r/ distortion heard the app, “Talking Tom,” repeating the /r/ words spoken by him and other, more advanced, students. I’ll never forget the puzzled look on his face when he asked, “Why is Tom saying their words correctly and my words wrong?” (Note: Talking Tom apps are available for iOS and Android, but I caution their use as they have gotten to be a bit raunchy for school use).

In my next post, I’ll share my no-tech tricks for working on /r/. By combining these “tried and true” old school techniques with new technology, students remain motivated and make measurable progress.

Preventing Screen Addiction

A recent article in The Telegraph describes a very scary trend: “Children as young as four are becoming so addicted to smartphones and iPads that they require psychological treatment.”  Popular and professional literature are full of such warnings, yet parents continue to use digital devices to keep their babies, toddlers, and young children occupied.  One in seven parents polled in a study admitted their children used digital gadgets for four or more hours a day!  Although 81% of the parents surveyed expressed a concern that their children were spending too much time with digital devices, this hasn’t stopped them from allowing their children to have this access.  Indeed, the article states that according to psychiatrists, “digital dependency” in  adults and children has grown 30% in recent years. This addiction in young children is evident by obsession with devices and uncontrollable tantrums when the devices are removed, and leads to difficulties with social interaction as the children get older.

With so many warnings about the potential detriments of excessive screen time, why do parents still allow their infants, toddlers, and even older children have so much access to digital devices?  One reason might be that parents are discounting these warnings as an overblown extension of warnings in the past about letting children watch too much TV.  After all, generations of kids dating back to the 1950s watched hours of TV each day and they didn’t grow up to be TV addicts, right?  While it’s a fact that when people are home, the TV is more likely to be on than off, most people don’t go through withdrawal when the electricity goes out or the TV is on the fritz and they are unable to watch TV for any length of time.  But have digital devices go dark and there is very clearly a visceral reaction. I’m not a neuroscientist, but I’m guessing that the major difference is the way we engage with digital gadgets vs. TV screens.  Unless we are binge-watching the latest Netflix series, engagement with the TV is much less intense.  We move around, get something to eat, page through a magazine, cook dinner, fold laundry, knit, and engage with others while the TV is on;  the TV does not capture and hold our undivided attention.  In many cases, it is simply background noise to other activities in the home.  Engagement with handheld devices is much more intense;  it is the primary focus of attention, often to the exclusion of all other activities and interactions. This releases endorphins that excite the pleasure centers in our brains, which feeds the addiction.

Another reason for parents to rely on digital devices to occupy their children — and this one horrifies me — is that parents themselves are hooked into devices, so keeping the kids quiet with device use allows the parents uninterrupted time on their own handheld screens.  As an article in Huffington Post states, over 70% of children surveyed feel their parents spend too much time on mobile devices.  Remember, parents of infants and young children are themselves “digital natives,” meaning they grew up with technology and don’t know life without it.

As SLPs, we see the effects on language and pragmatic skill development caused by  overexposure to screens, be it smartphones, tablets, or video games — not to mention the effects on attention, executive functioning, fine and gross motors skills, imagination, and higher level thinking.  The question is: how can we help parents understand the critical importance of hands-on experiences and interpersonal engagement and how to incorporate these experiences and engagement in everyday life?  Ironically enough, there’s an app for that!

Screen Shot 2016-03-24 at 5.11.48 AMJoinvroom.org is a website, app, and e-newsletter that encourages parents to be “brain builders” through simple activities already occurring in the home:  mealtime, bath time, daily errands and chores, etc.  Downloadable activity cards and daily videos teach parents how to engage their infants and children using eye contact, chatting, taking the child’s lead, expanding on the child’s language, and turn-taking, all in the context of daily living.  No special equipment or skills are needed.  Joinvroom.org is really all about being a fully present, hands-on parent.  I heartily recommend this resource to all parents of infants and young children. Although geared toward children ages 5 and younger, parents of older children who have special needs will be able to use many of these ideas to stimulate growth and engagement in their children, too.

The kind of parenting encouraged by Joinvroom.org will seem intuitive to most SLPs and reflects the kind of parenting that was common before the digital age.  I encourage every SLP working in early intervention and preschool to share this with parents on their caseload. And, for the rest of us, consider recommending this site to all new parents and others who would benefit from these back-to-basics parenting tips.  Share this post on your social media for May is Better Hearing and Speech Month.   Keeping parents and children engaged in these hands-on and interactive activities just might prevent the need for “digital detox” in their future.