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.

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!

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!

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 K Speech Song: Mucky Mucky Hockey Puck

Somewhere I came across an adorable book of word family songs. They were a collection of songs someone had written to the tune of familiar children's songs designed to work on word families. (Please don't ask me where I found the book. Or when. Or how. As I approach the grand old age of 40 I'm finding these sorts of details more and more difficult to hang on to.) Anyway, the point of this rather tangential story is that I was inspired to create a speech song. This is where you promise to not laugh!

Given that /k/ is apparently the target sound that will never go away in our household, I decided to make a mixed /k/ song my guinea pig. Here you go. It won't be winning a Grammy I suspect, but it should be amusing to little ones while providing a whole new way to work on the /k/ sound in initial, medial, and final position.

You sing the song to the tune of Twinkle Twinkle Little Star. I've provided the printable with a cute blue background and with a more practical white background (below - to save printer ink). Choose whichever you prefer.

Let me know what you think of the idea. Do you like it? Would you enjoy using speech songs during articulation therapy? Would it be worth my time to make some more?

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!

Initial H Speech Worksheet

Make classroom teachers happy, reinforce phonics and handwriting, and practice speech all at the same time.

This worksheet is pretty self-explanatory. You might enjoy sliding it into a sheet protector and using dry-erase markers during your session. Then you can use this same sheet all day long. Alternately, at the end of the session, slide it out and let the child take it home for homework.

Younger children will just enjoy identifying the pictures and working on clear initial /h/ sounds while letting you fill in the letter "h" for them. Slightly older students can work on their handwriting and fine motor skills by writing in the letter themselves.

As always, you can practice these words in isolation, in repetitions of two or three, with carrier phrases, or in short sentences. If you're sending the sheet home for homework, write in extra directions if you want the parents to practice at a particular level.

This worksheet is modeled after The Missing Vowel worksheets included in the Simple Vowels Speech Kit.

Enjoy!

Places to Get Free ASHA CEUs Online: Part 1

ASHA requires 3.0 Continuing Education Units every three years. That is the equivalent of 30 contact hours. The state of Missouri requires 30 hours of continuing education every two years. (Check your state's SLP continuing education requirements.) If I get 15 hours every year (or one every 3.5 weeks) I should be covered. Of course, last year I only got 10. That means I need 20 more by December 31st. Next year, I'm setting a reminder on my calendar. Every three weeks I'm going to spend an hour working on continuing education. That will put me a little ahead by the end of the year so I can take the holidays off. Or, alternately, being slightly ahead will make up for the occasional time I can't actually keep my self-imposed CEU appointment. However, next year's responsible plan does not save me from this year's last-minute mess. I went searching online for sources of free SLP CEUs. Here's the first place I found and tried.

Places to Earn Free Speech-Pathology CEUs Online: LinguiSystems

LinguiSystems
First, you have to sign up for a free LinguiList account in order to take their free courses (sign up). The plus side is that if you provide them with your ASHA account number, they'll report your continuing credits to the ASHA registry for you as you earn them. Their FAQ states that it can take up to six weeks for the courses to show up in your ASHA CEU registry. If you're not participating in the ASHA CEU Registry and keeping track of your CEUs yourself, you can also print a certificate to keep for your records to send to ASHA or your state if you get randomly audited. (As a complete aside, getting chosen for a random audit one month after the birth of your first, constantly screaming, child and four months after moving into a new home was soooo much fun.)

1. LinguiSystems has three ways to earn credits. You can take one of 19 short courses that range from .15 to .3 CEUs each. You read the contents of the course presented in slideshow format and then take a written exam. You can keep the course up in another window while you take the exam so that you can refer back to the content when choosing your answers. One small tip. Use the search function (ctrl-F) to search for a key phrase in the course quickly when taking the exam. Some exams are simple multiple choice (the two I took were 20 questions) and you get your results (and your CEUs) immediately. You need 80% to pass.
   
   Some exams are a mix of multiple choice and paragraph-style responses to open-ended questions and you have to wait up to 24 hours to find out if you passed and earned your CEU. They say you may re-take a course you fail. Unfortunately, you can't tell which style exam a course will have until you click on that exam to take it. However, you can save a half-finished exam and come back to it later. I have taken three of their short courses and I thought they were all nicely presented with good information.
   
   The courses cover a wide variety of topics including attention disorders, AAC, typical development, counseling skills, dysarthria, evidence-based practice, and more. I took the Developing Communication Skills in Young Children and Communication Milestones courses (multiple choice exam) and the Changing Behavior to Change the Child's Voice course (multiple choice and short-answer exam).
   
   I particularly liked the Communication Milestones course and intend to print it out and keep it handy for easy reference. I also thought the voice course was well-done and well worth reading if you have a voice client. However, the short-answer exam took me a long time and if you're looking to get a lot of CEUs done quickly, save the voice one for later.
   
   I intend to take several more of these courses and will update in the comments if there are any I thought were particularly well done or particularly poor.
2. If you own any of LinguiSystems "Source" books (I have the Source for Apraxia Therapy, for example.) you might be able to take a free online assessment about the contents of the book and earn anywhere from 0.4-0.8 CEUs if you pass. (Not all of the Source books have an online test available.) The test for the Source for Apraxia was a 20 question multiple choice exam. I was already intimately familiar with the contents of the book so it didn't take me long to complete. I earned 0.4 ASHA CEUs for taking the exam. I know this post is about earning free CEUs, but purchasing a source book (some of which can be purchased on CD and therefore would be a searchable PDF), is a pretty price efficient way of getting CEUs and you are left with a well-written reference book on a topic that interests you.
3. The third way to earn free CEU's from Linguisystems requires that you have 5 SLPs in the same place and must be registered 30 days ahead of time. If so, you can request a DVD course. There are currently 14 to choose from although two are being discontinued at the end of the year.

I took three short courses and one test on a LinguiSystems Source book I already owned and earned 1.0 CEUs in one (admittedly long) morning. That is half of the total number of CEUs I needed to earn between now and the end of the year. And that was my experience earning free CEUs with LinguiSystems. In the next installment of this blog series on earning free ASHA CEUs online I'll talk about the next place I found to earn free ASHA CEUs online. If anyone has tried any of the other LinguiSystems short courses and wants to share their favorites or mention which ones had which types of exams, please share with us in the comments. I'll be taking some more shortly and I'd love to know which ones you liked. Also, if anyone has seen one of the LinguiSystems DVD courses, I'd be interested to know what you thought of that method of earning free CEUs.

Move It! - A Printable Final N Speech Game

The simple vowels speech kit is done except for final edits. Expect to see it in the Testy Shop Monday morning. This kit is a monstrosity. It is 168 pages with a section for each simple vowel. You are provided with a visual / gestural cue for each vowel. There is a discussion of the characteristics of vowels and consonants and why understanding those characteristics is so important to planning speech therapy from a motor-planing perspective. The vast majority of the kit is, as usual, printable resources to use in your therapy sessions. Each vowel has syllable level worksheets, an illustrated card deck, illustrated minimal pairs, homework sheets at three difficulty levels, a story booklet, and a unique game or activity.

Here is a sneak peek of the game I made for the /u/ section modified for Final /n/.

Final /n/ Speech game: Move It!

Setup

This game comes with four mini card decks (red, blue, green, and yellow). You only need two decks at a time. Choose two decks and place one deck face down on the table. Give a game card to each child. Distribute the other deck between two children and have them place those cards face up on the game board. Tell the children the first person who helps the movers move the cards into the house wins the game. (If you need to play with four children, print an extra copy of the game board page and then use the extra two card sets with another pair of children. After both pairs of children play, have them switch cards for another game with an entirely new set of words.)

Gameplay

The first child chooses a game card from the table and says the word out loud. They then say all the words on their game board looking for the rhyming word. If they find the rhyming pair they move both cards onto the house. If not, they return the card to the table. Then the other child takes a turn. Play continues in this manner until one child moves all their cards into the house.

Roll It!: Printable Initial M Speech Activity

Thanks to the generosity of my parents and my husband, who are doing extra childcare duty, I have been working pretty intensely on preparing a vowel speech kit. One of the activities I created for that kit is a set of printable speech dice. Roll multiple dice at the same time to work on simple phrases or one at a time to work on single words. Here is an Initial M version I modified for you guys to check out.

Initial M Printable Speech Activity: Roll-It!

(Click to open image to full-size then right-click to save to your computer. Then print using a program of your choice.)

Gather some glue and scissors and print this activity on cardstock. Cut out the two dice templates. Fold on the solid lines, glue where indicated, and assemble the dice.

Race to the Top Speech Game - Mixed /d/ Version

I was playing around with the Race to the Top game concept for the new /k/ therapy kit and came up with a picture version of the game. The /k/ therapy kit contains a version of this game that incorporates initial, medial, and final /k/ words.

Here is a free downloadable version of the Race to the Top game that incorporates both initial and final /d/ words. (Click to open image to full-size then right-click to save to your computer. Then print using a program of your choice.)

If you're playing with one child, use tokens or chips to cover words from the bottom up on the towers (as that tower's number is rolled on the die) until one tower reaches the top. Then the child can color that flag. Play again to see if they can color a different flag. When you run out of time, send it home so they can play at home until all the flags have been colored.

If you're playing with a group, give each child a small game piece to put at the bottom of the tower of their choice. They take turns rolling the die, moving their pieces, and practicing the words until one player reaches the top. Then you can clear the game board and play again. Happy Halloween!

Simple Communication With Teachers and Parents

Rebecca at Adventures in Speech Pathology designed simple reminder strips to communicate with classroom teachers and parents. Simply download the free template and print the strips in advance. Then, at the end of each session fill out the strips with the students and send them back to the classroom. Tell the child to either give the strip to their teacher or to put it in their cubby/school bag. Or, give the child two strips and have them do both. It is a great way to communicate what you're working on to other adults in the child's life and perhaps recruit some helpers for additional speech practice.

Another Simple DIY Speech Warm-up Teachers Will Thank You For

Here's another perfect blend of phonics and speech that is a great activity for working on final consonants and word families at the same time. (See the last one here.) This will only take you 5-10 minutes to make from materials you'll already have around.

Gather

1 piece of cardstock or construction paper
1 piece of regular copy/printer paper
marker or sharpie
stapler
craft tape (optional)

Assemble

Quarter-fold the cardstock and paper and cut into fourths. Decide if you want your mini flipbook to have six or eight pages. If you want six pages, put three pieces of paper on top of one piece of cardstock. If you want eight pages, put four pieces of paper on top of one piece of cardstock. Then fold that pile in half and put three staples in the fold line to hold it together. If you like, put a piece of craft tape over the outer fold to cover the staples and make your mini flipbook look "bound". Next, cut the inner pages once so that the right half is 2/3 of the book's length and the left half is 1/3 of the book's length.

Now you have a blank flipbook to fill out. Choose 6-8 word families that have your target sound as their final sound. For final /k/ I used: -ack, -ake, -ick, -ock, -oke, and -uck. Write these on the right-hand pages of your flipbook. Then write 6-8 beginning consonant sounds on the left-hand pages of your flipbook. I chose six early emerging sounds to keep the focus on the more difficult, targeted, final sound. My six initial consonants were: /p, b, t, d, m, n/. As you use the flipbook, some combinations will make real words and others will make nonsense words. That is fine. Now write your target sound on the cover and you're ready to go.

Inspiration found here. Follow the link for 10 different games to play with phonics flipbooks.

Speech and Language Roundup: List 1

Occasionally I come across activities on the web that I think would be great in a speech and language room, but they really aren't full-post material. Whenever I put together five such resources I'll share them with you in a "roundup".

1. I found a post that has a great worksheet on homophones. Each pair of homophones is illustrated and used in a sentence example. The worksheet has 20 pairs of homophones. The full post gives some additional homophone resources.
   


2. This youtube video has a series of adorable, catchy songs - one for each letter of the alphabet. Find the sound you're working on and show the video to the kids for a musical video introduction to your speech sound.
   


3. Susie Q at Learning with Susie Q has an I Have...Who Has? free printable game for irregular plural nouns that is exceptional. The full (free) game has 23 irregular plural nouns.
   
   


4. Smile Play Learn has a very sweet graphic/Simon Says activity based on the book Kitten's First Full Moon by Kevin Henkes. The book has an engaging story with exquisite black and white illustrations. This activity is perfect if you're working on action words with a language group. The post also has an art activity for making a soft kitty.
   
   


5. Digitprop has a set of super cute downloadable .pdf files. Cut them out, fold and tape and you end up with 3-D letters. They would look nice on a desk or bulletin board, or simply as an activity to get kids excited about their target sound.
   
   

Isolation "Race to the Top" Game: Simple DIY

Race to the Top Game - Simple Isolation Practice

Preparation

Take a piece of paper, marker, die, and some stickers. Download and print my sample below if you happen to want to practice /t/ and /k/. (I have a child who substitutes /t/ for /k/ and so practicing those two sounds together is a great exercise.) Otherwise, use the paper and marker to make your own game sheet with whatever sounds you need to practice. Write one sound on three stickers and the other sound on three more stickers and stick onto a die. Put the die into a small container with a lid to allow kids to shake without chasing it all over the room.

Play

Have the child shake the die. Mark whichever letter comes up after the child makes the sound. If you have a young child, have them color the letter or place a sticker on it. An older child can trace the letter. Then roll again. Whichever "tower" is completed first "wins" the game.

Variations

• Have the child make the sound 3-5 times in succession before marking that sound off in the tower.
• Have the child think of a word that starts with the sound.
• Have the child think of a word that ends with the sound.
• Provide the child with an initial or final word and have them use it in a phrase or sentence.

(Inspired by this post.)

Simple DIY Speech Warm-up Teacher Will Thank You For

Grab a piece of cardstock, a sharpie, a few jumbo craft sticks, and some tape. In about five minutes you'll have a speech warm-up that classroom teachers will thank you for.

Fold the cardstock to make a sleeve for the craft stick and tape together. For your initial sound warm-ups, position the sleeve to the left and write your initial phoneme on the end of the sleeve that you'll insert the stick into. Then write several word endings on the stick. As the child moves the stick back and forth they'll create several target words to practice and at the same time they're getting some phonics practice in as well.

For the final phonemes, position the sleeve to the right. Feel free to use the back of the same stick you just used for an initial phoneme. Write a word ending that ends with your target sound on the edge of the sleeve closest to the end in which the stick is placed. Then write several initial sounds that work with that ending to make a word. Now the child is practicing several words that end with your target sound and practicing word families at the same time.

It took me less than five minutes to make these. You could easily make a small set of these for each group you work with by taking just a few minutes before your session. Alternately, make them as a group project and send them home for practice. Children would have a lot of fun making these if you gave them several colors of papers and pens to choose from when making them.

Great Source of Free Speech and Language Worksheets

Heather's Speech Therapy has an amazing list of free speech and language worksheets to download. She has syllable wheels, most consonants in multiple positions in words and phrases, grammar and vocabulary worksheets, and some reward charts. All worksheets include color pictures of the target words. Most target words are 1-2 syllables and vary from simple syllable shapes and phonemes to complex ones. You should definitely check these out!

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.

Data and Diagnosis

Let's take some snapshots.

Ava just shy of two years old. No words. Three consonants and one vowel in her phonemic inventory. Not able to imitate. History of reduced babbling. Lots of red flags for Childhood Apraxia of Speech.

Ava at three. Decent phonetic inventory. Speaking in multi-word sentences. Significantly reduced intelligibility. Exhibiting many age inappropriate phonological processes. Diagnosis would look a lot like a phonological processing disorder with a motor-planning (apraxic) component.

Ava at 3 1/2. Intelligibility is improving. Many phonological processes are resolving - even the ones that are still age appropriate (cluster reduction, stopping of stridents, etc.). It would be difficult to describe Ava's speech problems as a phonological processing disorder at this point. She has numerous speech errors which are resistant to intervention due to the underlying motor planning component (stubborn, stubborn velars).

Same kid. Same neurology. The "diagnosis" looks different at different points. We get so hung up on a label. We need them for insurance and schools. Parents and SLP's tend to like them too. It is more important to understand the characteristics of the speech at that point in time and to have a plan to remediate the current spectrum of problems. Then you have to periodically re-evaluate with an open mind and be responsive to change.

Fascinating stuff.

(Typically, you'd never administrate the same instrument three times in five months. In this particular case it was done because of the timing of Ava's IEP. They assessed her at intake, at the end of the school year, and then at the beginning of this school year. The results are not simply an artifact of retesting though. She has indeed made progress in the areas noted. It's pretty amazing actually.)