As Speech Pathologists we are all aware of the hierarchies we work through when working with speech and language tasks and with fluency. But are we good at explaining these to parents and … do you stick to them?
I have had parents who return after the first therapy session and when I ask how practice has been, they respond “well, they are ok when they are practicing but they aren’t saying it all the time”. Sound familiar? This is when I realise that I haven’t explained the hierarchy. The hierarchy we follow doesn’t just support our therapy outcomes but also helps us talk to parents about expectations, about results and how this will occur.
Generally, it is the articulation hierarchy that is the first to come to mind. This is where we start with a sound in isolation then move through to words, phrases, sentences, stories, conversation and finally generalisation. Through this process we gradually add in more complexity and challenge without overwhelming the student. We use this hierarchical structure with many things we do. We start with the simplest unit – whether a grammatical unit or fluent speech and build in complexity by adding more words or external distractors.
So hierarchies are always on my mind. They help me to chart the child’s progress, keeping an eye on what they have established, while still providing a challenge by presenting work at the next level. While providing challenges is important, it is also important to recognise that sometimes clients need more time at a particular level to consolidate skills. So we mustn’t forget to explain this process to parents. It also provides them with a guide for home practice and increases their awareness of what they are working on.
And now to my second question – Do you stick to them? What happens if you don’t?
Confession time. While I love the structure provided by hierarchies I also deviate. There are times when I want to see what a child can do, or sometimes I have a child who doesn’t seem to follow the hierarchy. There are other times when I am half way through a hierarchy and I will start on the sound in a different position. So while the hierarchy is in the back of my mind, I adjust to the child’s needs. I also talk to parents about working on generalising once working at sentence level. While generalisation happens at the end, it is something which we need to start working on early in the process.
Hierarchies are an important part of our practice and should be shared with parents to achieve great outcomes for our students.