Apraxia Therapy: Articulation Practice

What is Articulation Practice?

Articulation practice is practicing making specific sounds. Children with all types of speech sound disorders have to practice making sounds.

• Children with a simple articulation disorder only have trouble with one or two sounds and they practice those sounds first in isolation, then at the beginning, middle, and ends of words, then in phrases and sentences, and finally in conversation.
• Children with phonological disorders have trouble with groups of sounds or patterns of sounds and their speech therapist chooses words in those groups or words that have those patterns to practice.
• Children with Childhood Apraxia of Speech have trouble with the motor planning of speech movements. They need to practice all possible combinations of sounds in as many contexts as possible as often as possible to try to make that motor planning smooth and automatic.

How does Articulation Practice need to be different for children with Childhood Apraxia of Speech?

1. Children with Childhood Apraxia of Speech need many more repetitions than children with other types of speech disorders in order to show improvement. It takes a lot of practice to improve motor planning.
2. Children with Childhood Apraxia of Speech need to practice speech in a way that builds complexity much more gradually than children with other types of speech disorders. Instead of working with words as the smallest unit of complexity, they will look at specific types of syllables and work their way up from the simplest syllable shapes to more complex ones. For example, a Consonant-Vowel (CV) syllable shape such as the word "boo" is a very simple syllable shape. Another very simple syllable shape is Vowel-Consonant (VC) such as "at". A complex syllable shape is CCVCC such as "blast". Yes, boo and blast are both one-syllable words that start with B, but one is much simpler than the other.
3. Children with Childhood Apraxia of Speech need to practice consonant sounds paired with as many vowels as possible. For children who do not have difficulty with motor planning, it is enough to simply practice beginning, middle, and ending consonants without thinking about the vowels in between. Children with motor planning problems have to practice each consonant with each vowel because a consonant paired with one vowel requires different motor planning than that same consonant paired with a different vowel.
   
   Here is an example: Say "bee, bee, bee" and then pause before making the next /b/ sound. Your lips are pressed together. Now say "boo, boo, boo" and then pause before making the next /b/ sound. Your lips are pursed as if you're about to blow a kiss. The motor planning for a /b/ paired with the "ee" is different than the motor planning for a /b/ paired with the "oo".

What are some speech therapy materials that can be used to practice articulation in a way that is best for children with Childhood Apraxia of Speech?

• The only formal speech therapy materials that I know of that addresses syllable shapes is the Kaufman Kits (level one and level 2). The Kaufman Kit is designed to work systematically through the simplest syllable shapes in approximate order of difficulty. Alternately, you can simply take free word lists you find online and sort them by syllable shape and start with the simplest ones first gradually working your way up to harder syllable shapes.
• I am not aware of any articulation picture sets that make a deliberate effort to include all vowels. I am currently creating my own picture sets to try to address this issue. The sets are designed as much as possible to include words that are familiar to young children or that are easily taught. The sets will include only one-syllable words and will include at least one example of all possible vowel pairings. Eventually I would like to create multi-syllable words lists as well but that will not happen for quite some time. Look for the sets to begin to appear on this site shortly.

Key Points to Remember about Articulation Practice for Childhood Apraxia of Speech

1. Many, many repetitions.
2. Move from simple syllable shapes to more complicated syllable shapes.
3. Pair each consonant with as many different vowels as possible. Some pairings will be easier than others. Practice them until they become automatic.

Note: Remember that your child's production does not have to be perfect. For example, say you are practicing "spoon" because it has the "ooh" vowel paired with a final /n/. Your child says "soon". Great! They may have left out the /p/ in "spoon", but they correctly pronounced the vowel and final /n/ that you were looking for. Treat that as correct (for now - until you start working on the /sp/ blend) and heap on the praise.

You might also be interested in the following articles:

Apraxia Therapy: Communication Boards

Apraxia Therapy: Gestural Prompts

Apraxia Therapy: Two-Word Combinations