Speech Card Set Activity: What's Hiding?

Game: What's hiding?
Description: Set 3-5 cards out in front of children. Have children identify each word. Hide one card. Have children identify the missing card. Repeat.
Object: Child who has the most cards at the end of the game wins.
Materials: One piece of paper and a free card set.
Setup: Fold paper into thirds. Unfold and set upright to form barrier between yourself and children. Lay 3-5 cards in front of the barrier facing the children.

Directions:

1. Tell children (for example), "Fan, food, and feet came out to play. Say, "Hi fan!" Say, "Hi food!" Say, "Hi feet!"
2. Wait for children to produce target words in imitation, threes, phrases, sentences, etc.
3. Say, "Now, one of the cards is going to hide from you. Close your eyes and don't open them until I tell you to. (Hide one of the cards behind the barrier.) Now open your eyes and tell me who went hiding."
4. The child who identifies the missing card first and pronounces it correctly gets to keep the card.
5. Set out a new group of cards and repeat. The child with the most cards at the end of the game wins.

Card Set Activity: Speech Caterpillar

This idea is super simple. I cut out 8 circles that were 3.75 inches in diameter each. That made the circles just big enough for my free printable speech cards. Then add a slightly bigger head with antennae, eyes and a mouth and laminate (or stick together with contact paper) and you have a speech caterpillar. It is inexpensive, easy to make, travels well, and makes artic drill a little more interesting.

You place a card on each body segment and then one prize per child (treat, sticker, token, etc.) on the last segment. They get the prize when they reach the last word on the caterpillar. You can easily modify difficulty. One child might simply imitate the word while another might say it three times in a row. A third child might use it with a carrier phrase and a fourth child might be using it in a sentence.

It rolls up easily for storage and or transport. You could keep it in a pencil box along with several card decks. You could also make a train, snake, racetrack, chain of boats, etc and keep them rolled up in the same box and then the children can choose the one they want to use that day.

If you liked this activity idea you might also be interested in top-bottom puzzles, or this activity and game list.

How many words does it take to be a late talker?

The Twenty-Five Words Every Toddler Needs to Know is getting a lot of press. This article is pretty much a fluff news piece with very little substantive content and no references. It was a written summary of someone's take home message from a talk a researcher did at a conference. I am not at all criticizing the researcher / presenter. I wasn't there. I have no idea of the quality of the research or presentation. I am questioning the "factual" information presented in this news article and the potential impact on parents who read it.

There are two concrete bits of information printed in the article.

1. A late talker is a child who is using fewer than 25 words at age 2.
2. When helping late talkers build their vocabulary, the 25 words that should form the building blocks of that vocabulary are: all gone, baby, ball, banana, bath, bye bye, book, car, cat, cookie, daddy, dog, eye, hat, hello/hi, hot, juice, milk, mommy, more, no, nose, shoe, thank you, and yes.

Now I have no major objections to the 25 words listed as good building blocks of an early vocabulary with one caveat. The caveat is that when working with children with a severe speech delay, sometimes you have to take whatever you can get and build from there rather than holding out for specific words you got from a list. You might have to start with exclamations, sound effects, or animal sounds before moving on to other words. You might have to kick start expressive language with a communication board or signs. A parent and therapist of a child with severely delayed speech need to be flexible rather than focused on any one ideal list.

I do have a major issue with the accuracy of the first statement: a late talker is a child who is using fewer than 25 words at age 2. Older research in the area of speech and communication disorders often defined "late talkers" as children who were using fewer than 50 words or lacked two-word combinations at age two. Even dated research wanted two year old children to be using at least 50 words at age two, not 25. More recent 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. I'm taking this data from the introductory section of Language Outcomes of Late Talking Toddlers at Preschool and Beyond which is an excellent article.

The popularity of the Twenty-Five Words Every Toddler Needs to Know article concerns me because it may persuade parents that they can wait to have their child evaluated by a professional. In fact, children with a vocabulary of 25-50 words who are not using two-word combinations at 24 months should probably be evaluated by a professional.

On a personal note, reading the criterion for concern as a 92, 50, or even 25 word expressive vocabulary were all depressing. Ava had 3-5 words at that age. My worries at that time were completely valid and I certainly do not regret seeking a professional evaluation (other than my own) and early intervention. In fact, I credit intensive early intervention by excellent professionals and the work we do here at home for all the progress she has made in the past year.

Rory's Story Cubes - Action Version: A Mini-Review

Last year I did a review of Rory's Story Cubes. It is a simple, yet amazing game that consists of nine dice. Each die has a different picture on each side. Most of the pictures are of things (lock, phone, flower, castle, apple, etc.). You take turns rolling the die and making up a story. I think the game is wonderful. It is small and compact. It is great for either speech or language therapy. It is very reasonably priced on Amazon.

I recently discovered that there is a new Rory's Story Cubes game - the Action Edition. The game is still nine dice. There is still a different picture on each side of each die. This time the pictures depict actions (build, play, kick, jump, read, dig, etc.). Combine these die with the original set and your stories become even more complex. Again, it is a small, compact, reasonably priced therapy tool to address either speech or language goals.

Help me tell a story. - A Speech Card Set Activity

I had 15 cards left over from my Initial /s/ card set after making some top-bottom puzzles yesterday. I was trying to think of an activity to do with the remaining cards.

I decided to try to come up with a story to tell about the cards. I told the story and paused to let Ava fill in the words prompted by the appropriate cards during the storytelling. The story is pretty silly, but it works fairly well given it was just made up to include 15 random initial /s/ words.

Here are the words I was trying to include: suck, seed, saw, soup, soap, sock, sick, seek, seal, sack, soil, side, sell, sub, and same.

Here is the story I used. It isn't exactly great fiction, but it includes all the words and Ava thought making up a story was fun. I thought of the story ahead of time and put the cards in the order they would appear in the story. Then, I just told the story off the top of my head as prompted by the cards.

Mommy was trying to suck some juice out of her juice box. It was all empty though. She decided to make some more from this watermelon. First she had to take out this seed and all the others. She was having some trouble so she cut it with a saw. Then she made her juice and drank all of it. When she was done she was still hungry so she decided to eat some soup. Her hands were all sticky from the watermelon, so first she had to wash her hands with some soap. Mommy didn't have a towel, so she dried her hands on a sock. How silly! Then she ate her soup. After she finished all her soup, she felt a little sick so she laid down and took a nap. After her nap she decided to go for a walk. While she was on her walk she saw some children playing hide and seek. She walked by the zoo and saw a mama seal and a baby seal. She saw a sack full of soil that had fallen on its side. All the soil fell out and made a big mess. Then mommy saw a man trying to sell a hot dog and realized that all that walking had made her hungry so she bought one and ate it. Next she walked by the lake and was surprised to see a sub. Finally, mommy decided it was time to go home. She was thirsty, so she went back to the same table to drink some more juice. The end.

Ava enjoyed the story and being able to help out by adding words to my story. I'd pretend that I had forgotten the next part of the story and she was helping me by telling me the word on the card.

Again, this isn't the most intense type of articulation drill, but taking five minutes out of a session to do this type of activity works on language skills, and teaches a story that you can use later to work on generalization to the phrase or sentence level. You could do this type of activity with any of the card sets.

Card Set Game: Top-Bottom Puzzles

Usually I just do drill with Ava. She tolerates it fairly well if I bribe her with a treat (I use the Gerber Graduates Yogurt Melts so I don't even feel guilty). I give her one treat for every set (15-30 repetitions or so) and two treats when we're all done.

For variety, I decided to try the top-bottom puzzle idea from the card set game and activity ideas list I posted a while back.

I printed a fresh copy of the fronts of my Initial /s/ set. First I cut them out using a paper cutter. Then I chose 15 out of the 30 cards that I thought would divide well into top and bottom halves and cut those in half. (I'll save the other half of the cards for a different game another time.)

I shuffled the half-cards and started setting them out on the table. I separated the tops from the bottoms to make it a little easier this first time. Every time Ava saw a match, she said the word and set the match aside.

She really enjoyed the activity. I thought it was fun, but the actual speech practice was much less intense than our usual therapy session. It sounds terrible to admit that I prefer drill, but speech therapy for motor planning problems needs to be heavy on repetitions. The child cannot automatize motor sequences without actually talking, and talking a lot.

Using a game instead of drill significantly reduced our number of repetitions. Perhaps a compromise would be to do drill for the first 2/3 of a session, and bring a game out at the end of the session for extra motivation when the child is getting fatigued.

Free Speech Therapy Articulation Cards: Game and Activity Ideas

Speech Therapy Card Activities and Games

Here are some suggestions for fun activities to do and games to play using the free speech therapy articulation card sets (or any other card sets you might be using with young children). They're great for speech therapy, but could also be used for flash cards while studying for a grade school test.

1. Play a matching game. This requires two copies of a set.
2. Play go fish card game. This requires two copies of a set.
3. Play a fishing game. Put a paper clip or a couple of heavy duty staples in each card. Make a fishing pole with a magnet on the end of the line. Turn the cards upside down and have the child "fish" for the cards. Alternately, you could leave the cards face up and ask them to fish out the card you prompt them to find (see levels of prompting).
4. Play bowling. Put cards in clothespins you can stand on end. Line up 3-5 clothespins in a row and have the child say the words pictured on the cards before attempting to "bowl" them down with a small ball.
5. Build a train. Make a train engine and caboose and laminate for durability. Line the cards up in between to build a train. Put a small prize on the caboose like a sticker or cheerio. The child receives the prize when they finish saying all the words pictured on the train.
6. Put cards in a mailbox. Cut a slit in the top of a box or other container to make a "mailbox". Let the children "mail" the cards after completing each card.
7. Play top-bottom puzzles. Cut each card in a card set in half and have the children match the top of each picture to the bottom saying the words as they complete the mini puzzles.
8. Play speech uno. This requires four copies of a set. Take foil stars in four colors (red, green, blue, gold) and put a star of each color on the four cards for each word. (You could also use smiley stickers in four colors, or simply color dots with crayons or markers.) Then play a card game uno-style matching either color or word. The child says the word each time a card is played.
9. Play flashlight hunt. Tape the cards on the wall and turn off the lights. The adult or child shines a flashlight on each card in turn saying the word when the card is illuminated.
10. Play stepping stones. This is recommended only if your cards have been laminated and you have a large space to work in. Place the cards on the floor making a trail. Space the cards so the child has to take a large step to move from one to the next. The child can only move to the next "stone" once they've said the word on their current card.

Note: Keep in mind, you're making a trade off. The more game-like the activity is, the fewer repetitions the child will produce. Particularly with a child who has motor-planning problems, you want to get in as many repetitions as possible in each session. Strike a balance between fun and productivity and try to keep things moving quickly with the focus on many productions no matter which activity you are using. One way to increase the number of productions during an activity is to require multiple repetitions instead of a single production if the child is capable of doing so accurately. So ask for chains of two, three, four, or even five if you can get them. (ex. "pay, pay, pay)

Does anyone have any other games or activities they play while using articulation cards? I'd love to add more ideas to this list. Please leave suggestions in the comments.

Research Article: Toddlers Don't Modify Speech Production Based on the Auditory Feedback of Their Own Voice

Research of the Week

I read this research summary and thought the findings were interesting. I got my hands on the original journal article and thought the research methodology and conclusions were well thought out and seemed sound.

Essentially, research shows that adults and preschoolers listen to the sound of their own voice and modify their speech based upon what they hear. If you put headphones on an adult or 4 year old child and feed a slightly modified version of their own voice back to them, the speech they produce changes as they try to "fix" the productions they are hearing.

If you do the same thing to a two year old, they do not modify their productions. Toddlers do not appear to monitor the sound of their own voices and adjust their speech production according to the auditory feedback provided by their own voice.

This has rather significant implications for therapy with toddlers. If you're expecting them to hear the difference between their own correct and incorrect productions that probably won't happen without some sort of additional feedback.

This study was done with typically developing two and four year old children and showed that adjusting speech due to auditory feedback develops between the ages of two and four. I wonder if you took a group of speech delayed children and conducted the same experiment, would you find that it takes even longer for self-monitoring to develop in these children? And further, would you find a difference between articulation, phonological, and apraxic children?

Final F: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 20 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 VC or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• 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 Free Speech Therapy Articulation Cards page.

Card Sets

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.

Initial F: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

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 simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• 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 Free Speech Therapy Articulation Cards page.

Card Sets

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.

Our Special Education Eligibility Evaluation

Ava's eligibility evaluation was Thursday morning. The family was up and my husband took care of feeding and dressing the children while I sneaked in a shower. I was about to pull on my usual jeans and a t-shirt when this article popped into my head. Essentially it says that women are judged to be more competent when wearing makeup. I realized that I wanted to be seen as a professional SLP today in addition to simply Ava's mother. So, I dug out my dusty professional clothes from the closet and slapped on a little makeup. I also made sure that Ava was dressed nicely and I fixed her hair. First impressions can be important.

We left early and got there in plenty of time. We were at least 20 minutes early for our appointment. That gave me time to take Ava to the bathroom before we got started. (And yet she asked to be taken back to the bathroom three more times during the evaluation!) They took us back into their examination room which was a room set up almost like a preschool classroom. It had a small child-sized table and chairs and shelves of toys. It had a kitchen play area, block play area, doll play area, etc. It also had an adult-sized table and chairs set up along one wall and a large closet with an open door with another child-sized table in it.

Ava and I were allowed to play by ourselves in the room for at least 10 minutes before the first examiner (case manager) came in. She integrated herself into our play for about 10 minutes before another examiner (the child psychologist) came in. At that point, the case manager and I went over to the adult table to do a case history while the child psychologist played with Ava. The SLP came in shortly after that and joined Ava's play while I did a behavioral evaluation with the child psychologist. During that time, the SLP took Ava into the closet to do a formal speech test. At that point, the evaluation team left the room to score their tests and presumably discuss eligibility while I played with Ava some more.

During that time I spoke briefly with an OT, but most of Ava's sensory issues have responded very well to our First Steps therapy and it is no longer a significant area of concern although we will continue to monitor the situation.

The team was super efficient. All of this had taken only about an hour and a half. The team was good at what they did. They were respectful, and listened carefully to everything I had to say. They asked good questions. They were great with Ava and I felt like they got an accurate idea of her current level of performance. I thought their setup and organization was excellent and a wonderful way of conducting a comprehensive evaluation. Ava and I were never separated so they did not need to deal with anxiety issues, and yet they managed to get what they needed from both of us.

Although I was impressed with the team's competence, interest, concern, and friendliness and felt like they had gotten a comprehensive and accurate assessment of Ava and a comprehensive interview with me, I was not optimistic when they left to score and discuss. I honestly felt like Ava had done too well. The SLP commented in amazement multiple times during the session that Ava's sentences were at least 5-7 words in length. The team members didn't have much trouble understanding her because everything they were discussing with her was in context and the only formal speech test they gave her was at the single-word level.

I wished I had emphasized more that Ava's intelligibility tanks when we don't have context. I wished I had remembered to mention how I struggle to understand her when we're in the car and I can't see her face and have no idea what she's talking about. I wished I had mentioned how much we had worked for all the progress she had made so far. It isn't like she just magically improved over the year since she qualified for early intervention. She worked hard to improve. I worked hard to help her. She worked with a lot of therapists. There is no reason to expect her to continue to make progress if therapy suddenly stops on her third birthday (not that I would let that happen.)

After perhaps a 15 or 20 minute wait, the team came back into the room. They didn't make me wait. They told me right away that they did decide to qualify her. I appreciated that. Not only that she qualified after all, but that they told me right away. Then we discussed the results of the evaluation. She no longer has any other areas of concerns besides speech. It is difficult to qualify a young child on speech alone. They made that determination on "professional judgement". Apparently during the interview I had mentioned that I had concerns about her intelligibility and that she experienced frustration when she was unable to communicate. I think the obvious discrepancy between her high pre-academic and receptive and expressive language skills and her delayed speech was helpful too. So, she qualified for services as a "Young Child with a Developmental Delay."

I don't have the official evaluation report yet, but I did manage to see the results of her articulation assessment. 15th percentile. I suppose that's better than the 7th percentile we got 7 months ago it was still disappointing. Even with all the progress she has made, her speech intelligibility at the single word level is still worse that 85% of children her age. And that's at the single word level. It would be even worse in connected speech.

I spent months, MONTHS worrying about this one day. I was so anxious about this evaluation. I built it up in my mind to be a huge deal. Ultimately it was a couple of hours of something Ava thought was pretty fun. And in the end, the evaluation went well.

And because my daughter comes by her contrary nature honestly, I now have somewhat mixed feelings about her qualifying. Do I really want her to be officially labeled? Would we perhaps have been better off just treating her here at home and avoiding the label? I don't think so. The help is valuable. I can only make the best decisions possible at any given time with the information currently available.

IEP (date to be determined) will be held within 30 days. Guess I need to start thinking about what I want, and how best to advocate for it.

Preparing for an Evaluation?

Ava's evaluation is less than a week away. I'm beginning to think about how I need to prepare, if I need to prepare.

Some things are mundane. I need directions. I need to know what parking will be like. I need to figure out how long the drive will take given that I will be fighting rush hour traffic. I need to make sure someone can pick up Michael from school because Ava and I won't be done in time to get him. I need to pack a snack for her because we are supposed to be there all morning.

It is silly, but I want her to look nice. I need to pick a nice, but comfortable outfit. I need to allow enough time in the morning to feed her a good breakfast, dress her, and fix her hair.

And then there are the other considerations. Here in our state, in this district I've been told that the decision will be made that morning as to whether she qualifies. If she does, we will set up an IEP date that same day. I guess that means they plan to score all their tests and come to some kind of decision that same morning while Ava and I wait. If I want to be prepared to advocate for her, I need to be prepared to do so that same morning as the testing.

I'm not sure what that means exactly. I am going to write down my observations of her speech challenges at this time. I don't want to have to think under pressure. I want to be able to read off a list. Or perhaps just share that list with the team. I am thinking I should bring the ASHA position statement on Childhood Apraxia of Speech just in case. Oddly enough, I am having trouble thinking of other things that might be useful.

Does anyone have any suggestions? What should I bring with me to this evaluation/meeting? What should I be sure to think through ahead of time? What should I say/share? What should I not say/share? Any thoughts or comments would be appreciated.

Our first try with the final /k/ pivot phrase pages

I made the final /k/ pivot phrase pages a few days ago for Ava (and shared them with you). We sat down during our after dinner at home therapy session to try them. It looked like it was going to go well. She was excited about the new pages. They were bright, colorful, and looked new. She was excited about the treat she was going to earn. A necessity, as I've discussed. Things all went downhill from there.

Here was my reasoning for trying the pivot phrases. First, she was blasting through the pivot phrase exercises in the Kaufman Speech to Language Protocol Workout Book. All of those use early emerging sounds and she's pretty much got those now. She's even starting to add final consonants on the medial words in therapy without prompting. So, doing those exercises is good practice and review, but not challenging any more. Second, she was starting to get that final /k/ in single word practice at least 60-80% of the time. I really thought we might be successful at moving up to the pivot phrase level.

Well... not so much. I don't know if she was just having an off night, but she could hardly produce the final /k/ sound at the single-word level. The pivot phrases were a complete bust. I should have taped it. It was prototypical motor planning problems. No two attempts were the same. One time the /k/ would pop in at the beginning of the phrase even though she can't actually produce initial /k/ sounds. Another time, the /k/ would pop in in the middle of the word and then there would be random /t/ sounds thrown in for fun. Everything was disjointed and there would be long pauses while her system just struggled to sequence.

After trying for several minutes unsuccessfully to get some /k/ productions at the single-word level and watching her frustration increase exponentially I shifted gears. I simply used the picture prompts on the pages and made up 2-3 word phrases with them working on getting all the final consonants in the short phrases. At that point we were in familiar territory using all early emerging sounds and she was able to experience some success. Every so often I would probe the /k/ again, but without success.

I guess I'll try again in a few days. I hope someone else had more luck with these.

Final /k/: Free Pivot Phrase Picture Prompts

Description

This is a set of four pages of picture prompts. Each page uses a different pivot phrase that targets the final /k/ sound. The first page uses "I like the...". The second page uses "I pick the..." The third page uses "I take the...". The last page uses "Look at the...". The picture prompts are designed to be simple and varied. The picture words are CV, VC, or CVC in syllable shape and include mostly early emerging consonants. The vowel sounds are varied to improve carryover.(Scroll down to preview pages.)

How to use these prompts:

Use these prompts if your client is ready to practice final /k/ in multi-word utterances. Start with two words (Look top.). Then move to three words (Look at top.). Then do all four (Look at the top.). Skip any of the prompt pictures that your client is unable to produce. For example, if your client is not yet producing /w/, skip the prompt picture "wood".

Deliberately break up the flow of practice after every line. Stop briefly and ask your client to repeat something entirely unrelated to /k/. Then go back to the page. This will briefly disrupt motor memory and improve generalization in the long run.

Permissions

I give permission to copy, print, or distribute these pivot phrase picture prompt pages 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 these. Let me know if 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?

This is the only set of pivot phrase picture prompt pages I have so far. I do have free articulation therapy card sets on my Free Speech Therapy Articulation Cards page.

Pivot Phrase Picture Prompt Pages

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.

Speech Therapy Update: Speech vs. Language

We saw Ms. J for therapy yesterday. It was the first time in about three months. Ms. J had some issues with her office space and wasn't seeing clients for a while and then we had some scheduling conflicts. It is amazing how time can just slip away.

Three months is a long time at this age. Ms. J was amazed at Ava's language. She's talking in full sentences. For her age, her sentences are complex and she is also doing well with grammar. To be honest, even when she had no words, I wan't super concerned about her language skills. She always understood exactly what was being said around her and was managing to be pretty expressive through body language and other non-verbal communication. Now that she's talking she has a lot to say.

Her speech, on the other hand, hasn't progressed a lot. After working with her for an hour, we were sent home working on mostly the same things. We're still working on that final /k/ sound. I think I hate /k/. Never once, did I imagine working on the same sound for months and months and months on end. However, I should note that it is finally coming in. It is guttural, but with prompting and multiple cues we can get a back sound instead of a front one. So now we're going to try to stimulate /k/ in medial and front positions as well.

So, in summary, language is great, intelligibility is moderate (pretty good in context to a familiar listener, but iffy under other circumstances), and speech is still our biggest area of concern.

Stimulability from a New Perspective

As I was taking a course dutifully working towards earning my 15 continuing education credits for this year I came across an interesting article that reminded me of several concepts in articulation/phonology treatment that I hadn't had time to think about recently.

In a nutshell, I was taught to address the error sounds a child is stimulable for first. That seems to make sense. In theory they would make progress faster and with less frustration than with sounds that are harder for them.

The article I read claimed that more recent research (I have not had time to look up the source articles yet, so take this with a grain of salt until I can confirm.) shows that often, children will acquire the sounds they are stimulable for on their own given time. Therefore, time in therapy should be spent on the sounds they are least stimulable for. If you spend 3 months establishing and working on /k/ and in the meantime, the /t/ which they were stimulable for pops in on its own, the child now has some mastery of two sounds at the end of that time period instead of just one.

This therapist chooses two targets to work on with a child at any given time. She chooses the two most complex sounds the child is not stimulable for that have the most contrast (voicing, manner, place). This is an entirely different model of choosing targets than I was taught to use, but the idea is intriguing.

I have two questions for any readers that might want to discuss this:

1. Have you encountered this approach to articulation/phonology therapy before, and what do you think?
2. If you agree that this approach has merit, do you think that this approach also applies to children with motor planning problems (apraxia)?

The problem with making assumptions about therapy materials.

I bought a therapy resource that was designed specifically to target early emerging sounds. Even better, the resource stated that it included 100 words per phoneme (20 one-syllable initial, 20 two-syllable initial, 20 two-syllable medial, 20 one-syllable final, and 20 two-syllable final). I thought to myself, "Why did I spend all that time designing my own early-emerging sounds card sets? There was already something out there!"

Well, I pulled it out the other day and excitedly flipped to the one-syllable final /p/ words to use with Ava. It was new. It was colorful. It was a spiral bound book that stands up like an easel. It was new and shiny. I had high hopes. There were 20 one-syllable final /p/ words. They were easy to find, and Ava was interested. However, I was able to use only 8 of those. I was so disappointed. Let's take a look at why.

First I had to eliminate all the words with blends (CCVC). That eliminated 6 words (stop, sweep, clap, step, scope, and grape). Then I had to eliminate the 6 words that began with phonemes that were too difficult for her (cup, cap, chip, drape, cop, and rope). That left me with 8 (soap, type, ape, top, shop, ship, map, and soup).

Of those 8 words, two began with /s/ and two began with /sh/. If your client is having difficulty with those phonemes you would be left with only 4 words to work on.

(If I apply these same criteria to my own final /p/ card set I am able to use 24 of the 30 picture cards in the set. I have to eliminate the 4 that begin with /k/ and the 1 /l/ and the 1 /r/.)

I encountered similar problems with the other one-syllable words. If you are going to design a set of cards designed to target early emerging sounds, it is not actually helpful to have so many of the words include sounds that emerge late or words that include more complex syllable shapes.

I suppose the moral of the story is to try to get a good look at the actual word lists in the materials you are about to spend your limited resources on. It is definitely possible that when you get a good look at what is included the set may not meet your needs.

Visual Aid:

1. cup
2. soap
3. cap
4. stop
5. type
6. chip
7. sweep
8. clap
9. step
10. scope
11. ape
12. drape
13. top
14. cop
15. shop
16. rope
17. ship
18. map
19. grape
20. soup

Try it for yourself. How many of these words would you actually be able to expect your child/client to produce accurately?

Simple Homemade Therapy Reinforcer

Ava has an expressive speech delay (definitely a strong motor speech component and a significant phonological processing component). She sees an early intervention therapist weekly and we also see a local apraxia expert a little less often (once or twice a month on average).

(I'm getting to the therapy reinforcer, I promise.)

Even though I'm a certified speech therapist myself we don't do enough therapy at home. The therapist/client dynamic is hard between mother and daughter and I find her difficult to positively reinforce. Ava does respond well to froot loops. Froot loops aren't great for therapy rhythm though. It seems to take forever to chew one and she can't talk while chewing. Kind of counterproductive don't you think?

Then I had a great idea. It just popped into my head. The brilliant idea came as I was lying in bed. Working out the details in my mind stole at least half an hour of sleep, but it was worth it. So, the next day I made this:

I call it the Froot Loop Therapy Reinforcer. :-)

I pull a random froot loop from a bag after several repetitions (5-10 on an easy item, 1-2 on a harder one). She threads the froot loop on the matching color pipe cleaner. When she gets three of any one color she gets to eat them. It worked beautifully. It only takes a moment to pull one out of the bag and thread it but she likes that part so it is motivating. Then, every so often she ends up with three and gets to eat them (very motivating) and I can use those moments to mentally review what I want to do next or take a few notes.

It also has the benefit of working on color identification, color matching, and fine motor skills.

An alternative to froot loops would be threading color coordinated pony beads onto the pipe cleaners, but you just wouldn't eat them when the pipe cleaner was full. You'd need some other higher level reward (perhaps you could then thread three at a time onto yarn to make a bracelet for them to take with them at the end of the session).

Another advantage is that it is lightweight and can be folded flat for storage so if you travel for private practice or early intervention therapy, you could take it with you in a bag easily.

Here's how I made it.

1. Gather materials.
• Piece of cardboard.
• Piece of cardstock.
• Glue.
• Colored duct tape (optional).
• Pipe cleaners (red, yellow, blue, orange, green, purple).
• Tool to poke small holes in cardboard (I used a sewing pin).
2. Poke holes about one inch apart in a line across cardboard.

3. Cut pipe cleaners to about 2-3 inches long and feed them halfway through holes in cardboard.
   
   
4. Twist them together on bottom to hold them to the right length.
   
   
   
5. Cut cardstock to the same size as cardboard and glue cardstock to bottom of cardboard to hide the pipecleaners.
6. (Optional) Put colored duct tape along sides to make a pretty border and help prevent your edges from separating.
   
   

Apraxia Therapy Materials: Turn & Talk Early Sounds

Therapy Materials Review: Turn & Talk Early Sounds - Fun Practice with P, B, M, T, D, and N in Initial, Medial, and Final Positions of Words

This is a review of Turn & Talk Early Sounds. This easel book is published by Super Duper Publications. The book contains 600 illustrated words addressing the early emerging phonemes (p, b, m, t, d, n) in initial, medial, and final positions of one and two syllable words.

Target Audience

The publishers state that the target audience for the Turn & Talk Early Sounds book will be children from PreK-3rd grade. The pictures on the cards are appealing to children. I could see using selected sections with younger children who need practice on early emerging sounds as well.

Description of Turn & Talk Early Sounds

This product is a 11 inch by 4.5 inch spiral bound book with hard covers. The book has a built in easel so you can stand it upright. Inside you'll find an introductory section describing the contents of the book and giving tips for eliciting correct production of the target sounds. This section also includes a blank card you can use to write in the sounds in isolation or in VC or CV syllables with a dry erase marker if you want to work on the sounds at that level.

Phonemic Breakdown

The book has a tabbed section for each of the six phonemes: P, B, M, T, D, N.

Each section includes 100 words divided as follows:

• 20 Initial One-Syllable
• 20 Initial Two-Syllable
• 20 Medial Two-Syllable
• 20 Final One-Syllable
• 20 Final Two-Syllable

How to Use the Turn & Talk Early Sounds book

This book is going to be most appropriate for intense drill on these phonemes. Choose the section that addresses your goals and objectives for a child and use that section to drill. The pictures are fairly engaging, but you will probably need some motivational tool such as a turn at a game, sticker, or token.

Pros and Cons of the Turn & Talk Early Sounds book

• Pros:
• The Turn & Talk Early Sounds book is compact and easy to carry around.
• AT 100 words per phoneme, the Turn & Talk Early Sounds book includes a pretty good number of stimuli per phoneme.
• The five picture spread format allows you to do many repetitions easily. This is a great format for approaching therapy with apraxic children from a motor planning standpoint.
  
• The book is sturdy and has a built in easel.
• The illustrations are well done and appealing to children at a wide variety of ages.
• Cons:
• Although there are 100 words per phoneme, there are only 20 one syllable initial and 20 one syllable final pictures for each phoneme. Most of those 20 one syllable words are fairly complex including later emerging phonemes, vocalic /r/ sounds, and even blends. Therefore, if you are working with a child with a severe speech delay you may find this book to include stimuli that is mostly too difficult. My free articulation picture cards target these same phonemes at a simpler motor planning level, so if you need simpler look there.
• This book will work best for children needing a simple articulation approach to speech remediation. Most children with simple articulation errors are making errors with later emerging phonemes. This book may not address the phonemes you need most.

Bottom Line:

The Turn & Talk Early Sounds book is a good purchase if you need stimuli that address these early emerging phonemes. Just think carefully about whether the stimuli included here are actually going to be too difficult given that often children who need drill on early emerging phonemes are severely delayed and may have difficulty producing many of these stimuli because of the other phonemes included in the target words.

You might also be interested in the following products:

Apraxia Therapy Materials: Free Speech Therapy Articulation Cards

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Apraxia Therapy Materials: Word Flips

Apraxia Therapy Materials: Phrase Flips

Apraxia Therapy Materials: Word Flips

Therapy Materials Review: Word Flips - Flips for Learning Intelligible Production of Speech

This is a review of Word Flips. This flip book is published by Super Duper Publications. The flip book contains three identical 40-word card sets divided into sections by consonant placement (bilabial, alveolar, velar, and palatal). All 40 words are CV words.

Target Audience

The target audience for the Word Flips will usually be children with severely delayed expressive language typically between the ages of 2-5. The pictures on the cards are appealing to children. This book is ideal for children working on early emerging sounds in CV syllable structure.

Description of Word Flips

This product is a 11 inch by 4.5 inch spiral bound book with hard covers. The book has a built in easel so you can stand it upright. Inside you'll find three identical sets of picture cards divided by tabs into sections according to place of articulation (bilabial, alveolar, velar, and palatal). 40 words are included and they are all CV syllable structure.

Phonemic Breakdown

• Bilabial: /b/-4, /p/-3, /m/-4, /w/-4
• Alveolar: /t/-4, /d/-3, /n/-4, /s/-3, /z/-2
• Velar: /k/-2, /g/-2
• Palatal: /sh/-4, /ch/-1

How to Use the Word Flips book

• Simple repetitions. Choose target sounds that are appropriate for the child and practice them in repetitions of three. Work on sounds that share articulatory placement, or if increased difficulty is appropriate, alternate between different areas of placement.
• Alternating sets of three.
  
  • Same consonant, different vowel. Ex. "boo, bee, bee; boo, boo, bee; bee, bee, boo; boo, bee, boo; boo, bee, bye; etc..."
  • Same vowel, different consonant (same placement). Ex. "bye, bye, pie; bye, pie, bye; pie, bye, bye; bye, pie, bye; etc..."
  • Same vowel, different consonant (different placement). Ex. "pay, pay, day; pay, day, pay; day, day, pay, etc..."
• Random variation. Ex. "pay, key, show"
• Combine CV words to make CVCV words. Ex. "sew + pea = soapy" The book includes a list of CVCV words you can make this way from the CV words in the book.
  
  
  
• Combine CV words into short phrases. Ex. "Go zoo." The book also includes a list of phrase suggestions.
  
  
  

Pros and Cons of the Word Flips book

• Pros:
• The Word Flips book is compact and easy to carry around.
• The Word Flips book includes a fair amount of variety using real words at a very simple, CV level. You get 13 phonemes. All phonemes except /ch/ are paired with multiple vowels. This makes it a great book for working with apraxic children.
• The flip book format allows you to do many repetitions of the same CV syllable or many repetitions of alternating syllables. Again, this is a great format for approaching therapy with apraxic children from a motor planning standpoint.
  
• The book is sturdy and has a built in easel.
• The illustrations are well done and appealing to children at a wide variety of ages.
• Cons:
I really only see one con here. Overall, I like this resource a lot for children with a severe delay. The Word Flips book does not go into any one phoneme at great depth. So, for example, if you have a child who can only produce one or two phonemes, this book may not provide enough stimuli for an entire session of work. You might look into my free articulation cards which include 30 CV or CVC words for each phoneme if you need additional depth for a specific early emerging phoneme.

Bottom Line:

This book is great for children with a severe expressive delay who need work at the CV syllable level. The only caveat is that you don't get a lot of depth with any one phoneme.

You might also be interested in the following products:

Apraxia Therapy Materials: Free Speech Therapy Articulation Cards

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Apraxia Therapy Materials: Phrase Flips