Speech Therapy: Intentional Practice Matters
You know the familiar phrase "Practice makes perfect"? Unfortunately, in the world of speech therapy, that isn't always true. Practice is important-very important. In fact, practice makes permanent. If your child's speech is difficult to understand, the first step in helping them is to find a speech-language pathologist who specializes in the differential diagnosis of speech sound and motor speech disorders.
In my private practice, I frequently provide therapy for children who present with articulation disorders, phonological disorders, and Childhood Apraxia of Speech (CAS). Some children do not fit into a perfect diagnostic "box" of solely an articulation or phonological disorder; however, it is crucial to be able to distinguish what type of speech sound errors are occurring and why in order to provide effective treatment.
Did you know there are different types of speech sound disorders?
Articulation disorders are defined as distortions (e.g. a lateral lisp) and/or single sound substitutions (e.g. difficulty producing the "r" sound). See the infographic below from the Crowe, K., & McLeod, S. (2020) study to learn more about the ages at which children typically acquire consonants.
Phonological disorders are present when a child demonstrates predictable error patterns, which indicates a breakdown in the underlying sound system. For example, a child with a phonological disorder may present with several phonological processes, such as fronting (e.g. producing /t/ for /k/ and /d/ for /g/ (e.g. tar for car), gliding (wed for red, wion for lion), or final consonant deletion (e.g. my for mine, boo for boom).
Wait. What are phonological processes?
Phonological processes are shortcuts that children use in order to simplify their speech while their language and speaking skills are rapidly expanding. That's right- all children use phonological processes! However, when these processes do not go away on their own, it is very likely that a child now has a phonological disorder. Check out this great reference guide from Caroline Bowen to learn more about at what age certain phonological processes are expected to be eliminated.
Childhood Apraxia of Speech (CAS) is a speech sound disorder that results from motor planning difficulties. Children with CAS may demonstrate vowel distortions, inconsistent productions of words, and/or groping of the lips, jaw, or tongue when trying to speak.
A licensed speech-language pathologist is trained to differentiate between the above diagnoses. As an SLP who specializes in speech sound disorders, I have taken additional continuing education courses in order to learn more about evidence-based treatment approaches to help clients improve their speech intelligibility.
Why does any of this matter?
If practice makes permanent, then we need to be intentional in our practice. If your child has a motor planning component to their speech sound disorder, therapy must incorporate the principles of motor learning. The focus of therapy, therefore, is not on specific speech sounds, but on the movements needed to successfully coarticulate and move across various consonants, vowels, and syllable shapes. I implement Dynamic Tactile and Temporal Cueing (DTTC) in my practice for this very reason.
Back to being intentional in our practice.
If a child has a phonological disorder, treating individual speech sounds from a traditional articulation therapy hierarchy approach (e.g. sound level, syllable level, word level, short phrase level, etc.) will not be the most efficient or effective route. Sure, you may see progress, but it would likely be slow progress. Treatment methods, such as Hodson's Cycles, Minimal Pairs, and Multiple Oppositions, are evidence-based treatments for phonological disorders and more likely to produce better client outcomes for those with phonological disorders.
Even when working with a child who presents with a traditional articulation error, we can be intentional in our practice by choosing high frequency words or words that matter to the child. Is their error sound in their name? If so, let's work on that right away to help improve their confidence when introducing themselves to others. I'll admit, straight out of graduate school, I didn't put much thought into my "target" words. I cringe looking back, but you live and you learn, right? Now, I am constantly asking myself how I can make articulation therapy more functional and meaningful for my clients.
Practice makes permanent and intentional evidence-based practice truly makes all the difference!
If you're concerned about your child's speech, search for an SLP in your area who specializes in speech sound disorders.
Want to learn more? Check out this informative page from the American Speech-Language Hearing Association.
Lindsey O'Neill MA, CCC-SLP is the owner of Cultivating Communication LLC, a pediatric private speech therapy practice located in Lebanon, Ohio.