Articulation Therapy Tips
Whether you are a veteran SLP or new to the field, please read my top 10 tips for designing and implementing a successful articulation therapy program.
Share your own ideas or leave a note if you would change something!
1. A GOOD evaluation!!!
This one may seem obvious to all you as you read this; however, I feel that clients with articulation disorders don't always receive a high quality, full evaluation.
Now, by full evaluation, I don't just mean a standardized test. To be honest, even though I highly recommended that you complete a standardized test, I don't love them and they are not all-encompassing.
So what is a good evaluation then? I'm so glad you asked 🙂
First: Complete a standardized test. Lately, I have been loving the Clinical Assessment of Articulation and Phonology - 2nd edition (CAAP-2). It is quick, easy, and screens for phonological processing disorders too.
Second: Complete an oral mech exam (actually do this before the standardized test). I will get to more on this next.
Third: Take a language sample during play or while talking about something of interest to the child. Make sure to get at least 20 utterances or more. Transcribe your sample and take data on errors in connected speech.
Fourth: Stimulability testing. Take a quick glance at the child's errors and see if you can cue/prompt for a correct production in isolation or at the word level. This will help with goal planning. I like to always include a goal that the child can achieve rather quickly to build self-esteem and confidence (that hard work does pay off).
Fifth: Take an "interest inventory." This is CRUCIAL!! Ask the parents or the child about what activities he/she finds most interesting. Therapy must revolve around this.
See which toys the child gravitates towards during the eval and take note. I actually jot down an inventory of the child's toys (since I go into the home) and then design therapy activities that use the child's own toys. That way the child is not only motivated but will most likely repeat the words practiced during therapy throughout the week with his/her parents.
For example, if you use "telephone" during a therapy activity to target initial /t/, think...will that child ever say "telephone" again throughout the week? Probably not. If the child is interested in building with blocks, the word "top" might come up more often as he/she puts a block on "top."
Phew...that was a lot. Please keeping reading though. We are just getting started.
2. Oral Mechanism Examination
I feel that this is skipped a lot and that should not be happening. Speech-language pathologists are medical professionals and need to assess structure and function.
If the child's structure has something wrong, you don't want to be the one to miss it. But, more importantly, there might be something wrong structurally that is causing a speech disorder. This may need to be taken care of first before therapy can start such as a cleft palate.
Just do a good oral mech exam and make referrals if needed.
3. Throw Away The Laminator
I know this may be a controversial tip but stick with me.
Personally, I feel that materials sometimes receive the most attention instead of therapy techniques. Now, I do own a laminator and do use it from time to time (especially at the beginning of each session to review goals and "warm-up" the muscles); however, I don't use pre-made materials very often. It is time-consuming, expensive, and not nearly as effective as other techniques.
What to do instead:
- If you are working with a younger child, get out some of his/her favorite toys and target articulation during play.
- If you are working with an older child. Run through some drill activities for a few rounds and then target articulation using materials pulled from the curriculum.
- Make a list of words that naturally occur during a game/play and pull out that game for therapy (not fancy worksheets)!
I have an entire packet of FUNCTIONAL speech therapy games to be used that don't require flashcards (there are flashcards for drill practice included as well). Click here to access them.
4. Put Effort Into Which Targets You are Choosing and Why!
Think through which sounds you are going to target and WHY!
Create purposeful goals that are individualized for the child. This means, every child on your caseload will have different goals for different reasons.
For picking which sounds to work on...are you going to...
- use the developmental approach which means you chose target sounds based on developmental norms for sound acquisition?
- select sounds or patterns that affect intelligibility the most?
- use the complexity approach (Gierut, 2007) which means you target complex phonological process/later developing sounds first with the hope that progress will generalize down?
For treatment planning, are you going to use...
- a vertical approach (Fey) which works on 1-2 sounds until the child reaches mastery (usually 80% at the conversation level). Once mastered, new targets are chosen.
- a horizontal approach (Fey) where multiple sounds are chosen to be targeted all at once. All sounds may or may not be worked on during each session. This treatment provides more exposure to all sounds.
- a cyclical approach (Hodson) which is a combination of both vertical and horizontal approaches. A child cycles through chosen targets, usually targeting a new sound each week.
Know what you are doing and WHY!
For more info on treatment for speech disorders, click here.
5. Plan for discharge at the evaluation
Yep...you read that correctly! You need to plan for your child's discharge at the evaluation.
Now, you can't possibly know how many sessions a child will require before discharge, but you do know what you except the child to be able to do before discharging (in a perfect world).
Make a note of the expectations in the report and discuss it with the child's parents/teachers.
5. It's All About Cueing
Articulation therapy is all about teaching a new motor pattern and then having the child use this new motor pattern in conversational speech.
Besides completing the diagnosis section of the evaluation, the main purpose of the speech-language pathologist is to teach the child how to produce certain sounds correctly in isolation, words, phrases, sentences, and connected speech. Easy, right?! No!
Since you have already pushed your laminator to the side and given your printer a break, therapy now can be all about cueing!! THIS is the most important part in my book. You want the child to produce his/her target sounds correctly (a lot). To do this, you will have to teach and cue at different levels, but the ultimate goal is to fade your cues and have the child produce sounds independently.
This is the delicate balance. You want to provide enough support so the child is able to say the sound correctly but not too much that he/she is depending on you and not moving his/her new motor habit to procedural memory. THIS is what makes speech therapy a skilled practice and makes you a good speech pathologist (not how cute your game was).
For more info on cues and a FREE parent handout, click here.
7. Don't Fall For the "it" Program
There are many "it" programs out there that promise to change your professional life and "fix" all your students. I'll save you money....they don't work!
Now, they aren't all terrible by any means. However, there can't possibly be one program that will work for every child. Every child is very different with very different needs.
Personally, I piecemeal tools, programs, and prompts together to help a child. Many times I do this within one activity! Remember, it is all about getting them to produce target sounds with most independence at the highest level (conversation) possible.
8. Focus On Anatomy
Many times, I see speech pathologists not introduce the anatomy of speech production and how the muscles function to parents and children. This is a mistake!
As young as 2, I start teaching my clients about how each sound is made and what he/she has to do to say sounds correctly. I make sure parents are in the loop as well.
I find by taking this motor/anatomy approach, you take the pressure off your clients. They don't feel like something is innately wrong with them. Instead, they have to teach their muscles to move correctly (like a sport).
Also, it stresses the medical importance of speech therapy. It isn't all about fun and games 🙂
9. Get Parents and Teachers Involved
It is your job to get the parents and teachers involved in treatment. This process is not cookie cutter either.
You need to learn and understand what the parents need to be successful at home.
- Do they need more information?
- Do they need easier activities?
- Do they need handouts/reminders?
- Do they need a refresher on how to perform needed cues?
- Do they need more functional activities?
This is an ESSENTIAL part of the job. This packet provides all the teaching materials needed.
10. REVIEW, REVIEW, REVIEW
Even the perfect plan will have faults. Make sure to review how treatment is going and adjust.
In private practice, I can change goals as needed to fit the child's progress. If things aren't going well, change it. There are many resources out there for you and your client.
It is as simple as that!