Apraxia Therapy: Early Apraxia Therapy (Where to Begin) Part 3

I frequently receive requests for information from parents or therapists of very young children - usually between the ages of 18 and 30 months. The children have very few, if any, words. They make few sounds. They have a history of reduced or absent babbling. They have difficulty imitating and difficulty making volitional utterances. They are beginning to become aware that they are different. They want to communicate and yet struggle. Frustration is increasing on the part of both parents and children. The child may begin to act out in negative ways. What do you do? Where do you start?

You have three immediate goals:

1. Reduce frustration.
2. Establish and increase frequency of volitional utterances.
3. Increase number of daily speech utterances through structured practice.

Early Apraxia Treatment - Reducing frustration.

Read about how to address this goal in part one of my Early Apraxia Therapy (Where to Begin) series.

Early Apraxia Treatment - Establishing and increasing frequency of volitional utterances.

Read about how to address this goal in part two of my Early Apraxia Therapy (Where to Begin) series.

Early Apraxia Treatment - Increase number of daily speech utterances through structured practice.

Childhood Apraxia of Speech is a disorder of the motor planning of speech movements. The brain knows what the child wants to say. The mouth is capable of making the movements necessary. The planning of those movements gets jumbled in between. Children with apraxia need repetition, repetition, repetition in order to establish proper motor planning routines and make those routines smooth and automatic. One of the most efficient ways to increase the sheer number of repetitions your child makes is through drill. You can do drill activities with very young children, but first you need to figure out what to drill. I will outline a sequence of steps that will show you how to determine which sounds to target first for a specific child and help you find the resources and methods for doing those drill activities with young children.

1. Take a speech sound inventory - Young children with apraxia often have a “limited phonemic repertoire”. This is just a fancy way of saying that they can’t make very many sounds. Even if they are trying to mimic a wide variety of words, the sounds they are actually producing often are not the sounds that should be in the words they are trying to imitate. Listen carefully to your child when they are verbalizing. Take videos of several times when your child is “chatty”. Then go back and really listen to those utterances. Transcribe them if you can. What sounds do you hear? What vowels? What consonants? Write those down. For example, check out this speech sample of a child with apraxia at 23 months of age. You can see the transcript of the words Ava was saying and the actual sounds she produced. You'll want to do this several times so that you can be sure that you have a fairly complete collection of the types of utterances your child can make.
2. Analyze the speech sound data you collected - Take your lists of the transcribed words your child makes (if you are a parent, you don't have to use fancy transcription symbols like I did -just note vowels and consonants as best you can). From those lists, make a final list of all the consonant sounds your child can produce. If you can, note next to each consonant whether you heard it at the beginning of the word (in initial position) or at the end of the word (in final position) or both. Your list of consonants may be very small. When I started working with Ava, her only consonant was /d/. You may hear several consonants. If so, try to identify the one or two consonants your child uses most often. Or, the one or two consonants they can imitate best.
3. Choose speech practice target sounds - This may seem counterintuitive, but you want to begin by working with the sounds your child is most successful with. You are going to begin practicing with the one or two sounds that they already use the most and/or that they can imitate the best. You are going to do this for two reasons. First, you want them to experience success. Early apraxia therapy is all about turning speech from a frustrating activity the child feels like a failure at to a fun activity they can enjoy and consistently participate in at some level. Second, it is likely that they are only using those "best" consonants in a single word, or that they cannot produce them at will in many situations. You want to take that sound that they are currently only using in one word, at home, with you and turn it into a sound they can use in many words (with different vowels to mean different things) in many different situations (school, with other family members, at the park, etc.).
4. Make therapy practice materials - Go to my free speech articulation materials page and download a free card set or two. Choose a card set that features the sounds you identified in the previous step. If your child uses the sound at the beginning of their words, download the initial card set for that sound. If your child uses the sound at the end of their words, download the final card set for that sound. The card set is designed to pair that consonant your child can produce successfully with multiple vowels. If they leave off a sound (for example, "pah" for "pop"), accept that as correct and move on. If there are cards in the set that your child cannot produce because they can't imitate that vowel sound at all, don’t use them. Right now you want your child to think that this game is fun. You want them to experience success.
   
   Scroll down to the bottom of the free card set page for some tips on doing speech practice with young children and 30 ideas of games and activities to do with those cards.
5. Practice, practice, practice - Keep practice sessions short. Treat it as play. Tell your child that you're going to play a speech game and then follow through with making it fun. If your child is struggling, ask for just one more, and then put it aside and come back to it later, with a different game. Remember that all of these speech repetitions are cumulative. You are using a variety of strategies throughout the child's entire day to increase the number of speech utterances they produce. Structured practice with picture cards can easily double a the number of speech utterances a child produces in a day in a very short amount of time. It is a valuable tool. It also allows your child to practice using very simple combinations of sounds to produce a wide variety of words that they will hopefully begin to be able to incorporate into their own spontaneous use.

If you found this article useful, check out other articles I've written about Childhood Apraxia of Speech.

Apraxia Therapy: Early Apraxia Therapy (Where to Begin) Part 2

I frequently receive requests for information from parents or therapists of very young children - usually between the ages of 18 and 30 months. The children have very few, if any, words. They make few sounds. They have a history of reduced or absent babbling. They have difficulty imitating and difficulty making volitional utterances. They are beginning to become aware that they are different. They want to communicate and yet struggle. Frustration is increasing on the part of both parents and children. The child may begin to act out in negative ways. What do you do? Where do you start?

You have three immediate goals:

1. Reduce frustration.
2. Establish and increase frequency of volitional utterances.
3. Increase number of daily speech utterances through structured practice.

Early Apraxia Treatment - Reducing frustration.

Read about how to address this goal in part one of my Early Apraxia Therapy (Where to Begin) series.

Early Apraxia Treatment - Establishing and increasing frequency of volitional utterances.

Typically, very young children with apraxia have difficulty producing sounds when they want to. You want to help them be able to intentionally vocalize. If they already can vocalize at will, you want to increase the number of those utterances and the contexts in which they can produce those utterances. Note that for the purpose of this goal, you should not care if the utterance is phonetically accurate. For example, if the child is trying to say, “baby”, and the utterance they make doesn’t sound anything like “baby,” that is all right. If they produce something different each time, that is all right too. You simply want them to be able to reliably produce an utterance in response to a stimulus.

Every time a child with apraxia makes a vocalization (any vocalization) on purpose they are practicing formulating a message in their mind, creating a motor-speech plan, and successfully coordinating breath, phonation, and movement of the speech articulators to produce sound. For these children, that sequence of events is a huge success and a necessary beginning. You need this to happen before you can begin to fine tune the specific sounds that emerge. There are many ways to establish and increase practice opportunities for volitional utterances. I will describe four methods below.

1. Echoing - One of the simplest ways to establish or increase the number of volitional utterances is to echo any utterances your child does make back at them. Remember that every single time your child deliberately makes a sound to communicate they are coordinating intent with breath, phonation, and movement of speech muscles and structures. This is essential practice in early apraxia therapy. So, if your child happens to make a sound (not a frustration sound, but any other sound) echo it back at them. You want to try to create a fun feedback loop or simple game out of bouncing that word/sound/exclamation/utterance back and forth. For example, there was a time when my daughter's only word was "da?" (for "that?"). She would use it to label items she already knew the name for, to request the name for unknown items, and to request items she couldn't reach. She and I could have an entire conversation consisting of bouncing that one word back and forth. She would point to an unknown item (let's say... a marble, just for the sake of this example). The conversation would unfold as follows:
   • Ava: "Da?" (What's that?)
   • Mama: "Da?" (You mean this?)
   • Ava: "Da!" (Yep!)
   • Mama: "Da?" (You sure you mean this?)
   • Ava: "Da!" (Yep mama. Tell me already!)
   • Mama: "Marble."
   
   So, instead of her making a single utterance and then receiving either the marble or the label for the marble and being done, Ava practiced making an utterance three times in the context of a true, turn-taking conversation. Over time, this simple technique can result in dozens, or hundreds of extra utterances a day. You can listen to an example of a father using this technique with his 21 month old daughter in the first apraxia speech sample audio clip of this post.
2. Interactive book reading - Sit down with your child and a picture book. Your goal is to use the book interactively to elicit speech from your child. Read the same book each night so that the child sees the book as a familiar and fun activity. You do not want to read the book to your child, although you can make reading the text on each page part of what you do. You want to engage your child in commenting on the action in the pictures by pointing and asking questions. For example, if a story involves a character who falls, every time you read that page, point to the character and say, “Uh oh!” Then encourage your child to mimic you. Go back and forth several times. Have fun with it. Other utterances that can be worked into reading many children’s books include “hi,” “oh no,” “shhhh,” “bye bye,” “mama,” “daddy,” etc. Again, it doesn’t matter so much that your child mimics those words correctly. You simply want them to experience the turn taking and joint attention that comes with playing the game.
   
   You can watch a video of this type of interaction in my Case Study of Apraxia – Audio Samples from 21-30 months post. I am reading a book with my 21 month old daughter with apraxia. I also highly recommend the Big Book of Exclamations by Teri K. Peterson. The author is a speech pathologist who designed the book to provide many, many opportunities for interactions and vocalizations. Read my review of The Big Book of Exclamations for more information on this great book.
3. Pair actions and vocalizations - Often children with apraxia find vocalizing easier when their efforts are paired with motion. Encourage your child to say “whee” while sliding down a slide or swinging on a swing. Play horsie and bounce them on your knee or on an exercise ball while saying “ba bump, ba bump, ba bump”. Blow bubbles and encourage them to say “pop” as they pop each one with their finger. Crash cars together and have them mimic “bam!” Give them a ball of play dough and let them poke holes in it imitating “squish” each time. Line up blocks along the end of a table and have them say “uh oh” each time they push one off. Then they can say “up” each time they put one back up setting up for the next round. Possibilities are endless. Again, it doesn’t so much matter what sound they make. What matters is that they do make a sound. You want them to enjoy making the sound. Making a sound is part of the game. Without a sound, the game isn’t as much fun.
4. Strategic Withholding - Create speech opportunities in daily life. Structure interactions to require speech. It is so easy with a minimally verbal child to start anticipating their needs and eliminate the need for them to even try to vocalize. Instead, deliberately place a few favorite things out of reach so they have to ask for your help to reach them. Give them a small serving of their favorite food so they’ll need to ask for more. If you are coloring with them, deliberately place the colors just a little out of their reach so they’ll have to ask you to hand them the crayons. These are just a few simple examples, but extend the concept as much as possible during the day. Through this simple technique you can create dozens of opportunities for your child to verbalize each day. Every single utterance adds up to extra practice. A child with apraxia needs as much practice as you can possible squeeze in.
   
   Do not take this to extremes. You are not trying to be mean, or to deliberately frustrate the child. You are simply intentionally creating opportunities for requests. You want the process to feel natural and not forced. If the child is not able to vocalize a request, respond to nonverbal requests (and signs) as well. You want to avoid increasing frustration. Think “create opportunities” rather than “force practice.”

Trying to write this as one continuous post was simply too long. Look for the continuation of this series the rest of the week. In the meantime, if you need more general information about Childhood Apraxia of Speech, the following posts may be useful:

1. What is Childhood Apraxia of Speech and How Is It Diagnosed?
2. What makes Childhood Apraxia of Speech different from other speech disorders?
3. Childhood Apraxia of Speech Therapy Fundamentals: Part 1 - How Much and How Often?
4. Childhood Apraxia of Speech Therapy Fundamentals: Part 2 - Types and Variability of Practice
5. Childhood Apraxia of Speech Therapy Fundamentals: Part 3 - Methods and Content

Apraxia Therapy: Early Apraxia Therapy (Where to Begin) Part 1

I frequently receive requests for information from parents or therapists of very young children - usually between the ages of 18 and 30 months. The children have very few, if any, words. They make few sounds. They have a history of reduced or absent babbling. They have difficulty imitating and difficulty making volitional utterances. They are beginning to become aware that they are different. They want to communicate and yet struggle. Frustration is increasing on the part of both parents and children. The child may begin to act out in negative ways. What do you do? Where do you start?

You have three immediate goals:

1. Reduce frustration.
2. Establish and increase frequency of volitional utterances.
3. Increase number of daily speech utterances through structured practice.

Early Apraxia Treatment - Reducing frustration.

Both child and parents experience increasing frustration. The child has the cognition and underlying receptive and expressive language skills to want to communicate and yet the child is unable to talk. The child wants to initiate simple requests - they want attention, food, help, an item out of reach, etc. When they are unable to make those requests they are frustrated and act out in frustration. They also resort to grabbing, pulling, pointing, crying, and grunting as they attempt to communicate. You need to reduce all of this frustration to improve the quality of life for the child and everyone around him or her. The child needs to be able to communicate their basic needs. You need to teach temporary ways for the child to communicate effectively.

1. Teach simple signs - Teach the child simple signs such as "no, stop, more, help, eat, drink," etc. Teach the same signs to any adults and other children who regularly spend time with the child. Incorporate the use of these signs into daily routines and encourage the child to use them as well. Adults and other children should pair the use of the sign with the matching spoken word, but do not push the child with apraxia to vocalize. The purpose of using the signs at this point is to allow the child to communicate functionally when their voice fails them. This will result in a happier child who will be able to better understand the underlying give-and-take nature of communication when you are ready to bridge to verbal communication. Here's a visual guide to 21 signs useful with young children.
2. Create communication boards - Create communication boards and post them in key areas of the child's home. Make a simple chart of food and drink items to put on the wall in the kitchen (at a height the child can reach). Post another chart with characters from their favorite TV shows near the television. A third chart might include pictures of the toys they request most often posted near the place toys are put away. This gives the child a way to request specific things without needing to be able to verbalize complex sounds.
   
   Think about the things the child most often struggles to communicate and create boards that feature those things. For more in depth information, read about why and how to make and use communication boards in my Apraxia Therapy: Communication Boards post.

Trying to write this as one continuous post was simply too long. Look for the continuation of this series the rest of the week. In the meantime, if you need more general information about Childhood Apraxia of Speech, the following posts may be useful:

1. What is Childhood Apraxia of Speech and How Is It Diagnosed?
2. What makes Childhood Apraxia of Speech different from other speech disorders?
3. Childhood Apraxia of Speech Therapy Fundamentals: Part 1 - How Much and How Often?
4. Childhood Apraxia of Speech Therapy Fundamentals: Part 2 - Types and Variability of Practice
5. Childhood Apraxia of Speech Therapy Fundamentals: Part 3 - Methods and Content

Language Explosion = Speech Intelligibility Issues

As I mentioned, almost in passing, Ava was discharged from speech therapy at the end of the school year. I was fine with that. She had achieved all of her goals working on specific age-appropriate sound targets. We finally got the /k/ and /g/ sounds even at the conversational level and the only sounds she makes errors with at the word level aren't eligible for therapy until she's much older. Besides, we were beginning homeschooling, and as a SLP myself, I'd rather do therapy here at home from here on out.

I've taken a more laid back approach with Ava at home. Once she started making progress and her intelligibility was no longer an issue, I decided to let structured therapy happen with her therapists and let her time at home with Mama just be Mama time. And it has been fine. She's doing so well. Most people can understand her most of the time. You would no longer pick her out from a crowd of her peers and notice her speech. All of these things are wonderful and amazing and facts I wish I could have known about two or three years ago. It would have saved me so much worry.

However... She's 4. She has so much to say. Her language skills are perfectly normal and so her sentence length and grammatical complexity are shooting up. She want to tell stories and participate in active conversations and is competing with an extremely verbal older brother. And we're starting to have trouble understanding her again. It certainly isn't all the time, but several times a week she'll say something and we won't have any idea what a couple of key words are. We'll ask her to repeat herself, and that doesn't help. I'm finding myself asking questions like, "Can you tell me something else about it?", or "What does it do?" in order to try to figure out what she's trying to tell me.

Some of that is specific sound errors. She has a consistent /v/ for voiced /th/ and /f/ for voiceless /th/ substitution. /w/ and /r/ are weak. But some of it is the mild apraxia rearing it's head as utterance length and complexity increases. Soon it will be time to incorporate some structured speech therapy into our homeschooling routine. If it weren't affecting her intelligibility, I would wait. But it is. So, soon...

Free Simple Articulation Screening Tool

For those of you who are new, I'm a Speech-Language Pathologist. I also have a daughter with Childhood Apraxia of Speech who wasn't talking at the age of two. Look back in the archives for the full journey, but to simplify things a lot, she made a great deal of progress once we began intensive therapy. Several months later she had enough speech to attempt an articulation test. Hahahaha. I'm sure some of you have tried a GFTA with an apraxic two year old so you know where I'm coming from here. It took us three sessions. And it was a mess. Think about the stimuli on a GFTA. There are so many of them. They are multisyllablic. The problems with the instrument in the context of severe apraxia with a young child are purely practical.

I just needed a quick, simple, way to gather data about the phonemic inventory of a young child with a severe speech delay while maximizing their chances of success. That meant I needed simple stimuli (CVC words) and a short test (appropriate for short attention spans). So I made my own. And I used it and found it useful. Then it sat in a folder on my computer for two years.

Recently I decided I wanted to re-screen Ava's speech. Now, of course, she could participate in a standardized articulation assessment without a problem, but I don't own one, so I dug out the screening I made two years ago to use again. All of the reasons it worked then make it an extremely easy instrument to readminister now. I thought I would share the instrument with all of you.

If you like this free articulation screener, you might want to check out the premium speech therapy kits now available in the Testy Shop. Kits include expanded speech sound card sets, illustrated minimal pairs, homework sheets and more in a single download.

Simple Articulation Screening

Description

This is a tool designed to screen the phonetic inventory and articulation errors of young children with severe speech delays. The screening is comprised of picture stimuli of 22 CVC words. Prompts are provided on the back of each stimulus card. Results can be analyzed for individual articulation errors and for patterns of phonological processing errors.

Permissions

I give permission to copy, print, or distribute this articulation screening provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

To download click on each image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock or laminate for durability.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

Speech therapy picture card sets are on my Download/Print Free Speech Articulation Materials page. Other card sets include /p, b, t, d, m, n, h, f, v, k, g, w, j, s, z, l, r, th, ch, sh, ʤ, s-blends, and l-blends/. More sets are being added regularly.

Silence

We found some old home videos tucked away in a folder we had lost track of. Ava was about 4-5 months old when the videos were taken. What struck me as I watched was how smiley she was. I remember very few smiles, and yet while watching these videos, she responded with a huge toothless grin every time I smiled at her. Her eyes would light up and there was this huge smile. And yet she was wrapped in a huge bubble of silence.

I listen to babies coo and babble all the time. I play with those sounds in waiting rooms, babbling back and forth with any infant who will play the game with me. Ava was silent. It's a little creepy - all the talking around her and this completely silent little baby. She didn't seem unhappy, she was just silent. She was silent in the bouncer, on the playmat, and in the arms of loved ones. We have some videos of me trying to make her laugh - tossing her gently in the air or creeping tickle fingers up her leg towards her neck. The vast majority of the time I was unsuccessful. The once or twice she managed to giggle, it looked and sounded effortful. And yet, somehow, even as a speech pathologist I managed to miss how exactly abnormal it all was. I was a sleep-deprived mother of a 4 and 19 month old. My professional experience was with preschoolers and school-aged children. At the time, I wasn't getting out much and didn't realize how much noise babies should be making.

There was a video where... well, I have no idea exactly what I was trying to capture in the video, but Ava was laying on her back on the floor. She couldn't roll over yet and looked a lot like a turtle stuck on her back. She was obviously frustrated. She was lifting her head and shoulders and waving her arms and staring straight at me. And there were no sounds. None at all. No grunting, no fussing, no crying even. Just silence in the presence of frustration and physical effort. And why exactly did it take me 18 more months to start assessment?

Has anyone had similar experiences with their apraxic children? If you go back and watch videos when they were babies are they silent? I know that "abnormal history of babbling" is a red flag for apraxia, but this complete silence... Anyone?

Initial Z Printable Speech Activity: Color By Word

Practice /z/ in Initial Position

Click on the image to open it to full size and then right click to save it to your computer.

Enjoy! If you like this activity, look for other free printables and therapy ideas or my comprehensive speech therapy kits.

Final G Printable Speech Game: Finish First Game Board

Practice /g/ in Final Position

Click on the image to open it to full size and then right click to save it to your computer.

Print the game board and gather a die and a small game piece for each player. Put the game pieces on the start box, decide who will go first, and let that person begin by rolling the die and moving that number of squares on the game board.

You can have the players practice the words in isolation, in pairs, in phrases, or in sentences. You can provide models and cues if necessary. Adapt the stimuli to the level your student needs to work at.

When you're done, review the words for additional simple drill practice. Then send the game board home or to the classroom for extra practice.

If you are a parent practicing at home, save the game board in a binder to play again another time. You could also have your child play with a younger or older sibling or send it to an aunt or grandparent's house for extra practice.

This worksheet was adapted from the medial /f/ version of the game board included in the /f/ Speech Kit that will be available soon in the Testy Shop.

Enjoy!

Ava Speech Update - Winter 2013

Birthdays, holidays, trips, surgeries, and reduced childcare have been conspiring to decimate my previously immaculate record of regular posting. Bear with me please, I'm working on it.

We just had Ava's second IEP meeting. She's come such a long way.

(Brief review for those who aren't caught up.

We began almost exactly two years ago with her early intervention evaluation. At that time she was barely talking at all even though she was almost two years old. Even more concerning was that she only had a few speech sounds she could make and she couldn't imitate. She was also giving up - beginning to turn to rudimentary gestures instead of even trying to talk.

Over the next several months we started using communication boards and sign language which gave her some tools to communicate and made her much happier. She began receiving services and working with me intensively at home. We all worked hard, and we saw a great deal of progress. She learned new sounds and started using words along with her signs. She made the jump to two-word utterances. Steadily we saw progress.

Six months after her initial IFSP meeting the second one was held and the team identified an additional area of need. Ava had sensory issues that were affecting basic life skills like dressing, bathing, feeding, and socializing. She began to receive occupational therapy in addition to her speech therapy. She continued to make progress in both areas.

Another six months crept by as she approached the age of three where children transition from early intervention to services provided by the schools. We needed to have her reevaluated to see if she would continue to qualify for services. Fortunately, she did and so her first IEP meeting was held. On her third birthday she joined a speech group using the cycles approach. It has served her well and over the next year we have seen so much progress.)

At this point Ava is speaking in full sentences using age-appropriate vocabulary and morphology. She is not at all hesitant to communicate and is usually intelligible. She continues to exhibit many speech errors but the only ones that are age-inappropriate at this point are /k/ and /g/. If you've been following me for a while, you'll know that we've been working on /k/ and /g/ for something like 18 months. I am happy to report that they are finally starting to come in. She can produce velar sounds now. She can do it almost all the time when imitating words in medial and final position and at least 85-90% of the time when imitating initial position. I even hear it pop in occasionally in spontaneous speech. (Okay, very occasionally, but that is huge!) So, finally we are on our way with the velars. Now it is just a matter of time.

At her IEP meeting we decided that the speech group using the cycles approach was no longer the most appropriate setting for her given that she's only working on velars. We are reducing her minutes to 30 minutes a week and she will receive those services via a traditional pull-out method. Her therapist will pull her out of her preschool room for 15 minutes twice a week to work with her on her velars.

I know there is more to work on than the velars, but I am so much more relaxed about it. The other sounds come in later anyway (/th/, /r/, etc.). She's mostly intelligible. I'm going to start homeschooling in the summer, and I think I'll sneak speech work into pre-reading phonics lessons rather than addressing it completely separately during "speech time". She's really have a phonemic awareness explosion enjoying playing with syllables, beginning and ending sounds, rhyming, and alliteration and so working on the speech covertly through a related area of strength makes more sense to me.

In summary, things are good. Progress over the past two years has been phenomenal and I anticipate that she will continue to improve. As I look back and remember how devastated and worried I was two years ago I wish I could travel back in time and provide a glimpse of the future. We are fine. Ava is fine. It has been a lot of work, and a huge commitment. However, even the work has often been fun. Ava enjoys her speech therapy and the friends she makes there. She’s been doing it so long, it is just a part of her life – no different than preschool or gymnastics. It is just an activity for her. I’d say the turning point is when the speech improves just enough that you can understand her most of the time. When everyone is frustrated and in tears because you just can’t understand what they are trying to say on a daily or hourly basis, things are awful. After that, it is so much easier.

Mixed V Printable Speech Worksheet: Color a Position

Practice /v/ in Initial, Medial, and Final Position

Click on the image to open it to full size and then right click to save it to your computer. Print the sheet in color or black and white.

If the child you are working with doesn't have the fine motor control to color in the entire balloon you could color it for them. Another option is to have them put an "X" or check in the balloon in the appropriate color. (An X or checkmark also has the side benefit of speeding up the rate of practice and the consequential number of repetitions.)

You can practice the words in isolation, in pairs, in phrases, or in sentences. You can use the words with or without cues. Adapt the stimuli to the level your student needs to work at.

When you're done, review the words sorted by position for additional simple drill practice. Or, review the words in the order they appear in the balloons (the word positions mixed up) for harder drill practice. Then send the worksheet home for practice.

If you are a parent practicing at home, save the worksheet in a binder to review again another time. You could also hang it on the wall, pin it on the refrigerator, have your child "read" it to a younger or older sibling, or send it to an aunt or grandparent's house for extra practice.

This worksheet was inspired by this free sight word coloring worksheet.

Enjoy!

Initial R: Free Speech Therapy Articulation Picture Cards

If you like this free card set, you might want to check out the premium speech therapy kits now available in the Testy Shop. Kits include expanded card sets, illustrated minimal pairs, homework sheets and more in a single download.

Initial /r/ Card Set

(Initial /r/ is also referred to as consonantal /r/ and pre-vocalic /r/.)

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Description

This articulation picture card set is designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for this set is young children or children with more severe speech delays that need intensive practice with initial /r/ at a simple, one-syllable level. No blends or vocalic /r/ sounds are included in this set. The set pairs the initial /r/ with as many different vowel sounds as possible to maximize co-articulation variety.

Key Features

• This set includes 30 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all CV or CVC in syllable shape.
• The words are easily understood by or easily taught to young children.
• Combines the target sound with a variety of vowel sounds.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Download/Print Free Speech Articulation Materials page. Other card sets include /p, b, t, d, m, n, h, f, v, k, g, w, j, s, z, l, r, th, ch, sh, ʤ, s-blends, and l-blends/ and more sets are being added regularly.

What kinds of activities can I do with this cardset?

1. 10 Card Set Game and Activity Ideas
   
2. Simple Speech Card Puzzles
   
3. Speech Card Stories
   
4. Speech Card Caterpillar
   
5. Speech Card Game: What's Hiding?
   
6. Speech Card Game: Speech Switcheroo (An Uno-Style Game)
   
7. Speech Card Set Activity: Magnetic Speech Cards
   
8. Speech Card Game: Speech Fours
   
9. Speech Card Game: Old Maid
   
10. Speech Card Set Activity: Bang!
    
11. Speech Card Set Activity: What's Hiding Behind Door Number...?
    
12. Speech Card Set Activity: Customizing a Homework Sheet
    
13. Speech Card Set Activity: Making a Simple Sentence Flipbook
    
14. Speech Game: Find-It
    
15. Speech Card Set Activity: Speech Art Collage
    
16. Speech Card Set Activity: Speech Crowns
    
17. Speech Card Set Activity: Simple Treasure Hunt
    
18. Speech Card Set Activity: Speech for Beads
    
19. Speech Card Set Activity: Easy Speech Sort
    

Back to Basics: Syllable Shape in One-Syllable Words

Learn why it is necessary to control syllable shape in your target words and how.

Why does syllable shape matter when choosing words for speech therapy?

Childhood Apraxia of Speech (CAS) is a neurological speech disorder that disrupts the sequencing, transmission, and execution of the motor-planning commands of speech. For most people, this process is automatic and effortless, but for children with CAS, each sequence must be taught and then practiced over and over again until it becomes automatic.

Think of it this way. Pretend that children with motor-planning problems have a circuit breaker somewhere in their system between their brain and their mouth. If the demands on the circuit are low, the breaker does not trip and the word is produced correctly. If the demands are high, the circuit breaker is overloaded and word production fails.

Words with many sounds are more demanding than words with fewer sounds. Consonants put more stress on the system than vowels. A new sound or sound combination takes more effort (putting more demand on the system) than one that has been practiced many times. As a therapist, you always want to find that balance between stimuli that are demanding enough to teach new skills, but not so demanding that the circuit breaker trips and the student only experiences repeated failure. Controlling syllable shape is one way to create an appropriate list of target words for children with CAS and other children with a motor-planning component to their speech problem.

Children who have no motor-planning problems can learn a new sound like /p/, practice it at the beginning and ends of words, practice it in phrases and sentences, and then use it in conversation. Once taught a /p/, children with a motor-planning component to their speech disorder can say the /p/ in some one-syllable words, but not others. Why? Not all one syllable words are the same.

Understanding Syllable Shape

One-syllable words are words that contain only one vowel. "A" is a one-syllable word. "Springs" is also a one-syllable word. "A" is a one-syllable word comprised of just one vowel sound - /eI/. "Springs" is a one-syllable word comprised of six sounds (five consonants and one vowel) - /s/, /p/, /r/, /I/, /ng/, /z/. One-syllable words are not all created equal. A one-syllable word with 6 sounds has motor-planning requirements that are significantly more demanding than a one-syllable word comprised of only one or two sounds.

One-syllable words can have a variety of syllable shapes. Typically more sounds = more difficult. More consonant blends = more difficult. You can break down the sounds in the words into consonants (C) and vowels (V). There are also R-colored vowels or vocalic R sounds (like in the words car, fur, and air), but we will save discussing those for another time. If there is a vocalic R in your word list and you are working with a child with a severe speech disorder, discard that word for now.

The simplest one-syllable words have a vowel-consonant (VC) or consonant-vowel (CV) shape. Whether you are targeting a consonant or vowel, it is interesting to note that some children may find production easier in a CV context and other children will have an easier time with VC. Experiment to find out which is easier for the child you're working with. Remember that you're working with sounds - not letters. "bee" and "she" are both CV words even though the first is spelled with one consonant and two vowels and the second is spelled with two consonants and one vowel. You are looking for words that are pronounced with only two sounds regardless of how they are spelled.

In terms of complexity of syllable shape, consonant-vowel-consonant (CVC) words are next. To keep things simple, you want to choose CVC words that include two sounds your child can make and only one target sound. For example, if your child has trouble with /k/ and /n/, and you're targeting /k/, do not choose the word "can". Choose "cab" instead. Another thing to remember when creating a CVC word list is word position. Again, the child may find words with the targeted sound at the beginning of the word more difficult or they may find words with the targeted sound at the end of the word more difficult. Adjust your word list accordingly. Remember to keep your focus on sounds. Words like "ship", "with", "cheat", and "those" are all CVC words.

One-syllable words with consonant blends come next in terms of complexity. If you're working with children who have a severe speech delay I would avoid these for now. Consonant blends are two or more consecutive consonants in the same syllable that are produced in a blended fashion. Your one-syllable word could have one or two consonant blends. CCVC, CVCC, CCVCC, CCCVC, CVCCC, CCCVCC, CCVCCC, and CCCVCCC are all potential one-syllable syllable shapes.

Guidelines for Creating Word Lists by Syllable Shape

1. Include only one target sound in each word. Make sure all the other sounds in the word are in the child's phonemic inventory. (Alternately, accept approximations of the other sounds in the target word.)
2. CV and VC words are the simplest. CVC words are more complex. Work at the highest level of complexity the child can handle to maximize speed of progress and generalization.
3. Avoid words with vocalic /r/ and consonant blends.
4. Experiment with words that include your target sound in initial position and words that include your target sound in final position. A child may find one position easier than the other giving you a starting point for therapy. As soon as possible, mix the word positions together to increase difficulty and improve generalization.
5. Remember to focus on sounds, not letters when searching for words to include in your list. All of your words will be two or three sounds, but may be spelled with more letters.

Moving Beyond CVC Words

If your child has mastered production of your target sound in one-syllable CVC words move to simple two-syllable words or focus on the CVC words in short phrases before trying to work on the sound in consonant blends. The simplest two-syllable syllable shapes are VCV, CVCV, and VCVC.

A useful technique when moving past CVC words is to introduce a simple carrier phrase that is used over and over again with the target words. ("Give me the _____." or "That is my _____.") Another strategy is to find a nursery rhyme, children's song, or children's book that contains some of your target words and use them with the child pausing to let the child fill in the target words at the appropriate times.

Motor-Speech Articulation Method (MSAM)

Controlling syllable shape is one of the fundamental underlying strategies I use when designing the illustrated card sets that are the core of my free and premium speech materials. Other strategies involved in target word selection in the MSAM method include controlling the phonemic complexity of the individual sounds that are the building blocks of the target words and maximizing co-articulation variety.

Mixed V Printable Speech Fishing Activity

Practice V in Initial and Final Position While Playing with Speech Fish

Click on the image to open it to full size and then right click to save it to your computer. Print the sheet with a program of your choice on cardstock for durability. You might even want to laminate these. Put a few heavy-duty staples in each fish or put paper clips on them to use them in a fishing game with a magnetic wand.

Children might also enjoy lining the fish up, pretending to feed the fish or feed the fish to another stuffed animal, sorting the fish by color, using the fish to make patterns, or tossing the fish into a pond (small bowl, bucket, or blue piece of paper).

You can practice the words in isolation, in pairs, in phrases, or in sentences. You can use the words with or without cues. Adapt the stimuli to the level your student needs to work at.

This worksheet is modeled after Speech Fish worksheets included in the Simple Vowels Speech Kit and the /S/- Blends Speech Kit.

Enjoy!

Review: VAST iPhone / iPad Therapy Apps by Speak in Motion

Speak in Motion provided me with complementary copies of the VAST Songs 1 - Intro app and the VAST Autism 1 - Core app for review.

The VAST Song 1 - Intro app and the VAST Autism 1 - Core app are very different from the typical speech therapy apps. They do not focus on specific sounds. Their target audience is functioning at a nonverbal or minimally verbal level. These are the apps you're going to want to reach for when you have a student who is not responding to traditional speech therapy methods. Specific populations that come to mind are children with Autism, children with severe Childhood Apraxia of Speech, and children with TBI affecting speech.

VAST Autism 1 - Core iPhone / iPad App

The VAST Autism app is focused on practicing functional spoken scripts at syllable, simple word, multi-syllable word, phrase, and sentence levels. Once you choose the level appropriate for the child you are working with, you choose the specific script you want the child to learn. Then the child begins by simply watching and listening to a close-up video of an adult speaking that script slowly and clearly (yet with fairly natural intonation).

The videos stimulate both auditory and visual pathways in the brain. They also allow for simultaneous production which is known to stimulate speech production. The slightly slower production paired with relatively natural intonation also helps facilitate success. The app includes good choices of stimuli. For example, the syllable level includes: mama, papa, moo moo, boo boo, baa baa, beep beep, peep peep, da da, pop pop, la la, Weeee, and Ooooo. These are nice, simple reduplicated syllables using simple consonants and vowels. The levels progess logically from simple reduplicated syllables, to one-syllable words, multi-syllable words, phrases, and then sentences. As the productions get more complex, the stimuli choices focus on functional scripts. For example, some of the sentence level stimuli are: " I need to use the bathroom.", "I am thirsty.", "I am hungry.", and "I need a break.".

Bottom Line

This is an app that consists entirely of carefully chosen stimulus videos. It is accessibly priced at $4.99. If you work with students who are minimally verbal and are not yet responding to therapy targeting specific phonemes this app might be very useful for you. If you do not have any non-verbal or minimally verbal children on your caseload you would probably find little use for this app.

VAST Songs 1 - Intro iPhone / iPad App

The VAST Songs app is a set of videos that show a close-up of either a male of female singer singing one of 10 songs. These videos are useful during therapy because they provide both auditory and visual stimuli and they also stimulate the pathways in the brain involved in music. Research has shown that the rhythm and melody involved in music can often help stimulate speech production. Alternately, they could be used during carryover practice in more traditional articulation therapy (Yankee Doodle for /k/, for example.)

Bottom Line

This is an app that consists entirely of carefully chosen stimulus videos. It is accessibly priced at $4.99. If you work with students who are minimally verbal and are not yet responding to therapy targeting specific phonemes this app might be very useful for you. It might also provide a creative way of working on specific phoneme carryover with other young clients. If you are not working with severely speech delayed children, you might be better off finding a different app for your needs.

Review: Speech Therapy for Apraxia by NACD - iPad App

Speech Therapy for Apraxia iPad App by NACD and Blue Whale App Development: A Review

I purchased this app in order to evaluate it. It is very reasonably priced in the app store for only $4.99.

Detailed Description

Blue Whale is offering their Speech Therapy for Apraxia iPad app for $4.99 at the app store. I find the app to be rather soothing and visually appealing as did my children. The pictures are sweet and the interface is simple. Let's look at what the app does in more detail.

This app allows you to work with one group of phonemes at a time. /b/, /p/, and /m/ are grouped together. /d/, /n/, and /t/ are grouped together. /g/, /k/, and /h/ are grouped together. /w/ is on its own. /f/ and /v/ are grouped. /s/ and /z/ are grouped. /sh/, /ch/, and /J/ are grouped. Finally,, /l/ and /r/ are grouped. They are grouped roughly by developmental sequence and place of articulation. I particularly like the simple, just thorough enough, and easily understandable explanations on the options screens.

Once you've chosen your phoneme set, you are taken to a screen that lets you choose a difficulty level. There are eight difficulty levels that progress in a very logical manner from level one (still CV syllables, but presented in groups of five with a variety of vowels and pulling from two sets of consonants rather than one).

That's it. Once you've made those two choices (consonant group and initial difficulty level) the practice session begins. The stimuli appear on the page. They are a mix of nonsense syllables and real words.

Very young children will have trouble learning the nonsense CV combinations even though the developers make each two letter combination a unique font/color which is a nice touch. However, if the child cannot say the syllable spontaneously, all they have to do is tap on it to hear a model. The child repeats all the syllables and then swipes their finger to move to a new page of randomly chosen (within the structure of the difficulty level) stimuli. When they reach the end of the stimuli the final page allows the therapist to choose to repeat the same difficulty level or to move on to the next.

The program does not track data at all. There is no mechanism for data tracking and therefore keeping track of separate students is unnecessary. It is purely a simple, elegant method of practicing at the syllable level with severely apraxic children.

My 3 1/2 year old daughter was easily able to "play" this speech game independently. I see it as having a place in a therapy room. It would allow you to have one child happily drilling productions while you work with another child individually before switching. At $4.99 it is a very reasonable program to recommend to parents as well

Pros, Cons, and Bottom Line

If you have any children at all on your caseload who need drill at the CV level, this app is a great deal. It is perfect for introducing a new phoneme to apraxic children. It would be great practice for a phonological process or artic child who is struggling to learn a new consonant in initial position.

This app is extremely comprehensive in what it does: CV syllables in an increasing hierarchy of difficulty. They've included pictures of real words where possible and made the visual cues unique when a real picture did not apply.

Here's my bottom line. If you ever need to drill at the syllable level and you like incorporating iPad work into your speech room grab this app. At the price, it will be worth every penny. If you rarely work at the CV level and prefer to skip straight to simple CV, VC, and CVC real words than you won't find anything useful in this app.

Case Study of Apraxia - Audio Samples from 21 - 30 months

About a year ago I pulled a bunch of speech samples from home videos and posted them on the website. A lot of people had trouble making the audio links work so I'm reposting them now in a single post for anyone who is interested in hearing what Ava sounded like just before starting therapy and through the first few months of progress. These samples begin with a short video taken at 21 months of age just before she started therapy. There is a monthly audio sample between 21-26 months and then a final sample at 30 months.

Let's begin with a frame of reference for this age group. Even dated research used a cutoff criteria of not having a spoken vocabulary of at least 50 words by the age of two to qualify children as "late talkers". More current research shows that the average number of words girls produce at 24 months is 346 and boys produce 252. A vocabulary of below 92 for girls and 63 for boys puts a 24 month old at the 10th percentile.

This is one speech delayed child with suspected Childhood Apraxia of Speech. As I know now, Ava's apraxia is mild and she made (and is continuing to make) swift progress in therapy. Do not listen to these samples and think that your student/child should sound just like Ava at the same age. All children are different. Their speech problems are different and their responses to therapy are different. I'm reposting these because I remember searching for some examples when Ava was first being diagnosed and wanting to hear some examples of other children who were struggling with severe speech delay. This is just one example of what a speech delay sounds like and the way the speech changed over time with excellent therapy. She went from almost no sounds/words at 21 months to singing a fairly recognizable rendition of a nursery rhyme at 30 months. I wanted to document that progress.

It has come to my attention that Blogger posts these videos/audios in flash format which does not play in Safari (on the iPad/iPhone) so you'll need to view/listen to these on a PC. Sorry!

Speech Sample - Ava - 21 months old - Childhood Apraxia of Speech before therapy

This is a video I took while reading a book with a 21 month old Ava before bed. At this time she had about four consonants, three vowels, and four "words" in her spoken repertoire. It was fairly obvious that she would be getting anywhere near 46-342 more words in the next three months. This is a good example of how to use picture books to encourage a speech delayed child to vocalize. Turn the book reading into a "conversation" by asking questions and pausing for a contribution from your child.

Speech Sample - Ava - 21 months old

Here's something from about three weeks later. Ava has found something interesting on the floor. It looks like a sticker of an eye that has fallen off of something and she is pointing to it and "talking" to her Daddy about it.

This was taken about two weeks before she was evaluated by early intervention, about four weeks before a private SLP and I began speech therapy, and about six weeks before she began receiving speech services through early intervention.

It was however, after I had accepted that there was a significant delay and that I needed to schedule evaluations. I began to consciously try to encourage more vocalizations and one method of doing that is to "echo" back what you hear from your child. You hear my husband doing that with Ava during this clip.

Speech Sample - Ava - 22 months old

Here's something from about one month after the last sample. At this point Ava had qualified for early intervention services, but hadn't begun receiving them yet. I was not yet doing structured speech therapy with her at home, but she had seen a private speech therapist for a few sessions.

Ava was laying on a blanket and I put my head beside her. She was quite offended that I was trying to share her blanket and was trying to persuade me to move off. She keeps pointing to a spot off of the blanket and telling me to move "there" while I keep pointing to a spot on the blanket and insisting that I stay. After quite a bit of back and forth I tell her I'll get off if she says "please" (we had taught her the sign for please and I'm actually asking her to use the sign). She uses the sign and I move.

During this interaction I am focusing on getting as many conversational turns in as possible without frustrating her. I've made the situation into a game where she is vocalizing over and over for me. In this one minute interaction I get 10 utterances and a sign. There -may- have even been one two-word utterance of "No, there!", but I can't swear that she really intended two words of if her Daddy and I were reading too much into that one.

Speech Sample - Ava - 23 months old

Again, this is about one month after the last sample. At this point Ava was about six weeks into receiving speech services. Ava and I were laying on the floor and she was making some observations about the striped shirt I was wearing.

This speech sample shows a great deal of change. At 22 months, Ava produced 10 utterances in a little under a minute. Those utterances included four different words. She used one consonant (/d/) and three vowels (/Ɛ/, /Λ/, /OƱ/). In the 23 month sample she produces 13 utterances total in just over a minute. Two of them are two-word utterances. Nine different words are used. She went from using one consonant to using seven. In the last sample she used three vowel sounds and in this one she uses six vowel sounds.

Speech Sample - Ava - 25 months old

This is about six weeks after the last sample. It is a bit of a therapy session I was doing with Ava. We were using a few of the Kaufman Cards. She had just turned 25 months old.

In the previous sample, Ava used the following consonants: /b, d, t, m, n, w, j/. All but one of those (mama) were used in one-syllable CV words.

In this sample Ava produces five different two-syllable words. Four of them were imitated correctly and one was imitated incorrectly, but still with a two-syllable non-reduplicated word. She uses /b, d t, p, m, n, h/ in this sample. She has added the /p/ and /h/ syllables in the six weeks since the last sample. She has also moved from productions that were primarily the CV syllable shape to productions that are non-reduplicated CVCV in syllable shape which is much more complex.

Speech Sample - Ava - 25 months old

This sample was taken three weeks after the last one. Ava is almost 26 months old. The most striking thing to notice here is how Ava moved to using multi-word utterances. In this sample she produces 10 utterances. 2 of those are one word (both two-syllable). 5 of those are three words (4 syllables per utterance). One utterance was four words long (5 syllables)! This is a huge increase in average sentence length in three weeks.

Speech Sample - Ava - 26 months old

This is the last monthly sample I have. It was taken about three weeks after the last one and Ava is 26 months old. At this point Ava was about four months into receiving speech services. Ava was asking me to get something down from a shelf.

In the last audio sample Ava produced 10 utterances in a little under half a minute. Those utterances included seven different words and ranged from 1 word (two syllable) utterances to 4 word (five syllable utterances). In this sample, Ava produces 13 utterances in a little under 30 seconds. These utterances include 12 different words and range from on word (one syllable) utterances to 5 word (5 syllable)utterances. The average number of words per utterance in the last sample was 2.2. In this sample it increased to 2.42. More importantly, there was significantly more diversity to the utterances in this sample.

Speech Sample - Ava - 30 months old

This is a short audio clip I pulled from a home video of Ava singing to me as we were swing on a deck swing. I was using the front facing camera on my phone and Ava was entranced at watching herself sing. First I got her version of the ABC song twice. Then I asked for the Itsy Bitsy Spider, then Row, Row, Row Your Boat, and finally Hush Little Baby. It was so adorable.

Here is a small audio clip from the concert. She decided to sing the Itsy Bitsy Spider as the Itsy Bitsy Butterfly instead, as she explains at the end.

Thank You Volunteers (A Sneak Preview Thank You)

I wanted to sincerely thank everyone who commented or emailed me offering to help proofread my new book. I got far more offers than I needed. I've already contacted the people who sent in the first few offers and I don't need any more volunteers for now.

Here's a sneak preview of just a few of the 53 reproducible /s/ resources you'll find in the book.

Once I get some feedback, I'll make any corrections necessary and make the book available. I'll be sure to keep everyone updated.

Ava Speech Update: Fall 2012

It's been a long time since I've talked about Ava's speech in more than a passing manner. Fall seems like as good a time as any to check in. It's been a long time and many of you started reading between my last update and this one so I'll begin with some background so you can understand how far she's come.

Ava was not talking at 22 months. She had a history of reduced babbling and an extremely limited phonemic repertoire (d, m, h and a couple of vowels). The only syllable shape she produced was CV. She used the word approximation "da" with an upward inflection for almost everything accompanied by pointing to the object she wanted. She could not imitate. She was beginning to give up on trying to talk at all turning to gestures instead.

At that point I abandoned the wait-and-hope-she-miraculously-catches-up approach and began to make phone calls. We briefly saw a local SLP who had put a flyer in the daycare who agreed that Ava's speech was significantly delayed and that she had many of the red flags for Childhood Apraxia of Speech. I called around and discovered that one of the national experts on CAS lives in our area and set up an appointment with her. We've been seeing her twice a month for well over a year and she's wonderful. We also had Ava assessed by early intervention, wrote an IFSP, and began receiving services. Finally I set up a program of home therapy with her.

At that point I knew Ava was delayed - really delayed. What I couldn't yet anticipate was prognosis. It would depend on how well she responded to therapy. Some children respond well to therapy and make progress quickly. In those cases, prognosis is pretty good. In other cases the children, parents, and therapists work hard, frequently and intensely and progress is still slow. In those cases, prognosis is poorer. You know you're going to have to work harder and longer. You know progress will be slower and that the child may not ever have typical speech. I didn't know which category Ava would fall into, but I feared, based upon how delayed she was that she would fall into the second category.

We were so lucky. Ava responded well to therapy. Really well. I was doing updates on the blog every 2-3 weeks and it was like I was describing a completely different child. First she was learning to produce new consonants and vowels. Then she added more complex syllable shapes. She went from one syllable to two and from one-word utterances to multi-word utterances. We went from almost no speech to lots of speech that was extremely difficult to understand because there were multiple errors in every utterance.

Slowly we worked on speech errors. Some sounds and categories of sounds she learned quickly and easily. /s/ and /l/ came relatively quickly even in blends. Now she uses them conversationally with no problem. Other sounds we've worked on for well over a year and they're still a struggle (/k/, /g/). As more sounds came in and fewer sounds are left that are in error she became easier to understand.

Right now she's intelligible most of the time. She struggles most with sounds produced in the back of the mouth. She fronts /k/ and /g/ producing /t/ and /d/ instead. She also fronts /ch/ and /J/. /th/ is produced as an /f/. There are plenty targets left to work on. The almost complete absence of back sounds certainly impacts her speech in a noticeable way. Her language helps her though. She's using long sentences in conversation. You usually have enough context from the conversation and from the rest of the words in the sentence to figure out the one or two words that would have been unintelligible in isolation. You can ask her to tell you a different way or give you a clue and she is able to rephrase her message to help you.

Ms. J (our local apraxia expert) has even suggested we take a hiatus from visiting her because Ava has made such great progress. We're stuck working on trying to break through on those back sounds and I can do that myself with her at home.

Ava is heading off to preschool next week and I am not worried about her speech significantly impacting her experience there. Yes, her speech is not typical, but she is understandable. I am so grateful that all her hard work has paid off. Prognosis is good. If we keep working, I expect that the remaining speech errors will be corrected in time. At some point, I truly think her speech will be typical. Until then, we'll keep working at it.

Save, Print, and Use Free Articulation Materials - A New Look

I've completely redone my free articulation resources page. You can always find the page when you need it by clicking on the "Download/Print Free Speech Articulation Materials" link at the top of any page on my blog. I hope the new format is a little easier on the eye and will make it easier to find what you need.

For those of you who haven't visited that page, here is a brief summary of the free speech materials and resources you can find there:

• Speech Articulation Cards with pictures for a wide variety of sounds. The target words in these cards sets are kept simple (CV, VC, and CVC) in order to be useful with young children, children with severe speech delays, children with childhood apraxia of speech, hearing imparied children, and other populations with similar needs. So far there are over 840 cards available for over 20 target sounds. I add more regularly as I make them.
  
  
• There are a handful of speech homework booklets (six and counting). These are booklets printed on a single sheet of paper and then folded into booklet form. They tell simple stories in a format where young children can participate by "reading" their target word from pictures inserted into parts of the story. Send them home as homework. If you're a parent, print them and keep them in your child's room and read them with your child at bedtime.
  
  
• There are a few other printable resources like some minimal pairs sets, pivot phrase worksheets, and other assorted worksheets.
  
  
  
  
• There's a section of tips for parents doing home therapy or home practice sessions with their children.
• There is also a growing list (15 and counting) of speech games and activities you can do using the free articulation picture cards.
  
  

If you like the resources, please consider sending me an email and sharing your experiences using them at testyyettrying(at)gmail(dot)com. Be sure not to miss future cardsets or activity suggestions by subscribing to my blog through email or a feed reader in the upper left hand corner of the page.

Thanks for reading!