Isolation to conversation
We are all aware of the hierarchies we work through when working with speech and language tasks, 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.
Let’s review the Articulation Hierarchy
Auditory Discrimination – hearing when it is right and when it is not
To be able to produce a sound correctly you need to be able to hear the sound, so that you know when you are right as well as when you are wrong. This is achieved with word pairs – most of the time minimal pairs. e.g. tar and car.
The only difference between these words is the target sound and the sound made in error. The adult says the words randomly, e.g. tar tar car tar car car tar and the student points to the word (picture) produced. The aim is 100% accuracy.
I always start my articulation therapy at this level and revisit as a warm-up at the start of the next few sessions. When the child is comfortable I swap the talking role around and get them to produce the words while I listen. I usually only let them do four or five (it’s tricky). This builds their awareness quickly about how they need to move their tongue or mouth in different ways to produce the words. I watch out for that look of awareness but always stop before frustration kicks in.
Auditory discrimination tasks can also occur with sounds but I find that this is difficult when kids don’t have a solid understanding of sounds and letters.
Here is an example from our Isolation to Conversation series. I use stamps, mini erasers, counters for them to show what they have heard.
This means producing the sound by itself. It is the sound in its purest form. For example, if you are practicing the /k/ sound say /k/, /k/, /k/ multiple times in a row. When you are able to produce the sound accurately 80% of the time you move up the hierarchy onto syllables. I like to get a high number of clear repetitions before moving on.
Kids need to be confident in their ability to produce the target sound. Again, I love stamps, tokens and counters. Active kids love throwing ping pong balls in a bucket or jumping around the room. I use masking tape (cheap and efficient) on the floor in the shape of the sound.
Syllables – consonants plus vowel
To practice the target sound in syllables, add a vowel to the target sound. They may be real words but most will be nonsense words. To practice a sound in the initial position of syllables, add a vowel sound after the target sounds like “ka”. To practice a sound in the medial position of syllables, add a vowel before and after the target sound like “oku”. To practice a sound in the final position of syllables, add a vowel before the target sound like “ik”.
Be sure to practice the target sound with lots of different vowels. Note abilities with different vowels. There may be differences. Some combinations are more tricky. When the target sound is mastered in syllables move on to words. Here are some of my favourite tabletop syllable activities.
The first step in practicing the target sound at the word level is to determine which position of the word (initial, medial or final) you want to target. If all positions are affected we normally practice initial, then final with medial targeted last. There are heaps of activities ideas for word level. There is so much you can do with just a pack of articulation cards.
- Grab a game and say a word before your go.
- Play snap, memory or card games.
- Grab some Lego and ‘buy’ each piece by saying a word.
- Hide cards around the room and say the words when you find them.
When working in sentences I love to start with a repetitive sentence (carrier phrase) of 2-3 words (e.g. can of peas, can of corn) before moving on to more complex/unique sentences. In a carrier phrase, the sentence stays the same while only the target word changes. For instance, your sentence might read, “Mikey dropped his cup, Mikey dropped his corn”. Then you move all your target words through the sentence. Some of the sentences might be crazy, but that the fun of it.
Kids often need to start with sentences where the first word contains the target sound. This provides high success and confidence to move forward.
Unique sentences are harder but can be more creative. The next step is using multiple targets in one sentence.
I love interactive and flexible activities. They are the basis of our practice and can be changed and modified to suit.
When practicing story level, select a story which contains a high repetition of the target. Read and practice the target words in sentences. You will need to read the story a few times (that’s ok with a good book – right!) before the student is ready to retell the story.
Once the target sound is produced accurately while reading or retelling the story in their own words move onto conversation.
Practicing the target sound in conversation can be tricky. Consider centring conversation topics around some of the target words practiced through your activities. Another good idea is making a specified time to focus on the correct production of the target. Self-awareness and the ability to self-correct should be a focus at each step of the hierarchy. You will see the pay off now when children can self correct their productions.
A game we love to play in the clinic is talking towers (with blocks) or counter catch. Give everyone 5 counters and have a pile of blocks or counters to win. Have a conversation – you win another block or counter for each correct production and lose one for every incorrect production. The tallest tower – or biggest catch wins.
Once the sound has been mastered in words, sentences, stories and in conversation you want to work on generalisation across all the contexts. Make sure you continue to provide specific feedback and reinforcement throughout the day in different contexts.
Hierarchies are an important part of our practice and should be shared with parents to achieve great outcomes for our children.
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 halfway 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.
And now to my second question – Do you stick to them? What happens if you don’t?
Hierarchies should always be on your mind. They help 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. Whilst 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.