Intervention for /r/ errors

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.

Toys, Books and Games that Promote Language Development

There are many toys and games available at your local toys store. For some parents the choices and variety can be overwhelming. Parents often ask me “Which toys should I purchase?” “Which toys will help my child develop speech and language skills?” The important thing to remember with regards to developing speech and language skills with toys is that the adult model and the actual interaction are more critical than the toy you use. Fancy toys can never replace an interactive, engaged and responsive adult partner. Having said that, some toys and books lend themselves to building specific speech and language skills.

  1. Developing basic joint attention skills in young children or children with moderate to severe cognitive delays.
    • Bubbles – Most children love to watch, pop and blow bubbles. Bubbles are perfect to draw a child’s attention. They also help with building oral motor skills, and sensory awareness when popped on their bodies. I often use bubbles to teach body parts. I will pop bubbles on a child’s nose, ears, mouth, cheeks, fingers and toes while labeling the body parts.
    • Wind-up toys – These are wonderful attention grabbers because of the movement and noise. They can be used as reinforcements. I will often use the wind-up toys to teach basic speech imitation skills such as animal sounds. Children will often imitate sound effects before real words.
    • Pop-up toys – Toys that open when buttons are pressed or dials are turned not only teach joint attention, but also develop cause and effect relationships. Certain cognitive theories state the development of cause-effect and object permanence as a precursor to language development.
  2. Developing vocabulary skills in children.
    • Mr. Potato Head – I especially love this toy for building basic vocabulary skills such as body parts and clothing. However, you can also use it to teach verbs such as walking, sleeping, eating, jumping and running. In addition, since there are a wide variety of accessories, you can also use the pieces to teach describing words such as big, small, long and short.
    • Puzzles – Some of the new wooden puzzles are wonderful in terms of quality and durability. They also make a wide variety of puzzles ranging from animals to vehicles. Most of their pieces are chunky and ideal for little hands. Some puzzles also include sound effects and are interactive.
  3. Developing pretend play skills and social interaction.
    • Tea set – A tea set works well to teach turn taking, pretend play, and pronouns (e.g., I, you, my, your).
    • Little People farm/ zoo – I like using these toys for younger children. Pretending to make the animals walk, run, jump, eat, and sleep are early pretend play skills. You can also teach simple sentence formation (e.g Here is the cow; The horse in eating). In addition, they can be used to build prepositions such as “in,” “out,” and “next to.”
    • Doll house/ Kitchen set – A doll house or kitchen set can be used to teach more elaborate play sequences such as “First the doll wakes up, then gets dressed, then eats breakfast and then goes to school.” These interactions not only teach pretend play, but are also rich in language and provide lots of language stimulation.
  4. Children’s books that build language and speech skills.
    While there are a plethora of children’s books at your local book store, I wanted to list some of my favorites. I especially like books that are repetitive in nature and therefore are predictable. Children love the repetitions and will quickly learn to imitate the familiar words and phrases.

    • The Very Hungry Caterpillar
    • Brown Bear, Brown Bear
    • Polar Bear, Polar Bear
    • The Very Busy Spider
    • Go Away Big, Green Monster
    • Glad Monster, Sad Monster
    • Seals on the Bus
    • It looked like Spilled Milk.
    • If you give a Mouse a Cookie
    • If you give a Moose a Muffin
    • We’re Going on A Bear Hunt
    • Five Little Monkeys Jumping on the Bed
    • The Three Little Pigs
    • There was an Old Lady who Swallowed a Shell

    Parents and caregivers can also find pictures and activities online that are based on the books. A website I often use is .

Remember to keep your interactions fun and animated. The key to using these books and toys effectively is “Repetition! Repetition! Repetition!”

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!

Hello world!

I am so excited to finally launch my website. I want to officially thank everyone who helped make my vision a reality. I thought I’d write this blog to share ideas and techniques with parents and other speech language therapists. Thank you for reading and I can’t wait to hear your comments.