Articulation Therapy

Speech therapy, more specifically articulation therapy, is intervention provided by a speech-language pathologist to help a person produce the sounds of his/her language correctly. 

Everything from therapy techniques to goal writing to cueing techniques to home practice exercises is individualized and differs quite a bit depending on a child's speech disorder evaluation.

It is crucial for SLPs and parents to understand this process thoroughly before beginning any treatment plan.

Overview of Articulation Therapy

Each articulation therapy program USUALLY follows the following protocol:

1. First: Establish a volitional production of a target sound (usually at syllable or word level)
2. Next: Generalize production from syllables to words to phrases and finally to connected speech at the conversational level
3. Last: Maintain progress over time

Detailed Description of Each "Level "

Children usually begin at the syllable level and work up to the connected speech level. Below is a detailed description of each level.

Syllables/Isolation:

First things first, a child has to be able to say the desired sound. The syllable level is usually the first step since all other speech demands are taken away. For example, if you are practicing /b/, start with “ba” or “ab.” Once the child can say the sound in syllables, move on to the word level.

Words:

Next, practice saying the target sound within words. To continue our /b/ example, practice “ball,” “able,” and “tub.” It is important to practice saying the sound in the beginning (initial), middle (medial), and final (position) since the tongue, teeth, jaws, lips, and vocal cords have to coordinate and move muscles differently depending on where the sound falls within a word. Once the child can say his/her sound in words, the sentence level is next. 

Sentences:

A child needs to practice the sound within sentences. For example, “I see a ball.” This stage can be difficult since the brain has to remember how to say the sound while processing all those extra speech and language demands.  We are making a good speech habit here!

Conversation:

This is the last step and where home practice is the most crucial. A child MUST say the target sound correctly during a conversation. I recommend short, controlled practices for this one!

For example, tell a child, “we are going to practice /s/ while we play this game. When we speak, we must use our good /s/ sound. "

Goal Writing: Which Sounds To Target

It can be a difficult task to decide which sounds to work on first, next, etc...

Different approaches will be utilized for different children based on the evaluation results, learning styles, and much more!

• Developmental Approach: Chose target sounds based on developmental norms for sound acquisition. 
• Intelligibility Approach: Chose speech sounds that affect intelligibility the most.
• Complexity Approach  (Gierut, 2007): This is a top-down approach. Start with a later developing sound. Progress generalizes to earlier developing sounds.

When creating goals, don't forget to fill out your Voice Place Manner chart! Find out why and see how I updated them nicely for you!

Treatment Planning:

Choosing how to move through chosen targets also takes some consideration. Below are common, research-based treatment plans for articulation disorders.

• Vertical (Fey 1986): Work on 1-2 sounds until the child reaches mastery (usually 80% at the sentence level). Once mastered, new targets are chosen. Intense/focused practice.
• Horizontal (Fey 1986): Multiple sounds are chosen to be targeted at once. All sounds may or may not be worked on during each session. More exposure to all necessary sounds.
• Cycles Approach (e.g., Hodson, 2010): A combination of both vertical and horizontal approaches. Child cycles through chosen targets. 

Treatment Techniques

Below are different articulation interventions. Many therapists will use a combination of approaches.

• Contextual Utilization: Surrounding sounds in a word are used to help elicit a target sound. (McDonald, 1964), (Bernthal et al., 2013), (Bleile, 2002)
• Contrast Therapy/Minimal Pairs Minimal pairs are 2 words that differ only by one sound or feature (i.e., back vs rack). 
• Naturalistic Speech Intelligibility Intervention: Therapy occurs during a natural activity that a child typically plays. There is no direct teaching or cueing. A child's errors are recasted by the SLP (Camarata, 2010).
• Auditory Bombardment: Auditory bombardment is a type of speech sound perception training. This involves exposing a child to the target sounds through multiple repetitions across varied contexts. 
• Identification tasks: This is also a type of speech sound perception training. The child is presented with correct and incorrect productions of the target sound and the child identifies which are correct and incorrect. 
• Phonological Approach: Read more here!
• Complexity Approach: This relatively new approach targets complex sounds first. If you need some more tips on how to target clusters, click here.

Cueing Techniques

ALL therapists will use cues to elicit a correct production. CORRECT use of cueing is essential for a successful therapy program. The goal is to fade these techniques to increase independence and generalization. Below are common cues.

• Verbal cues: Cues for placement of articulators (tongue, teeth, lips, voice, jaw)
• Visual Cues: Visual cues such as a mirror, modeling from therapist, cue cards/reminders, gestures. Read about my favorite visual cues and how to use them here. 
• Tactile Cues: Tactile cues such as PROMPT or devices to provide feedback on correct tongue placement and coordination such as tongue depressors/spoons/candy.

What To Avoid:

For articulation therapy, there are no quick fixes. I wish there were! It takes work and lots of practice to learn a motor habit.

There are a lot of expensive programs out there that want to sell you tools which promise fast results. If there was a program out there that worked, I WOULD USE IT!!!!  So far, the research and personal experience have taught me, the best way to improve articulation is to do what I described above. If things change, I'll let you know. 

Avoid: 

1. Any quick fixes

Home Practice

There are a lot of FREE and paid options for home practice at Speech Therapy Talk Services. There is something for everyone.

1. Words Lists: The word lists have FREE games ideas, common cues, and a quick tutorial for each sound
2. Free household therapy page gives suggestions on how to target sounds using things found around the house.
3. Watch videos on how to use my favorite therapy toys to target speech goals
4. Check out our Articulation Materials and Guide eBook for a step-by-step guide for each sound, functional games, flashcards, and more!
5. Join us! Become a member and have instant access to hundreds of pages of materials for each possible sound in English and Spanish and step-by-step guides on how to teach and practice each sound.