Initial P: Free Speech Therapy Articulation Picture Cards

The Initial /p/ set is finished and it is a significant upgrade over the previous sets (I will be updating those to the new format soon.) Here are the features of the new card sets. For those of you who read this blog regularly, I apologize in advance for the fact that this introductory section will be exactly the same for each new set posted. It is the only way to be sure that someone who finds this website by searching for a specific set gets the full set of information. In the future feel free to skip down to the actual pictures and skip the introduction.

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 or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets.

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• 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.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets 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 the word sets. Let me know if there is anything you would change.

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.

Instructions for printing and using the cards are included in the set.

Free Speech Therapy Articulation Picture Cards: Final T

This version is out of date. Go here for new, easy to download, version and additional sets.

There are a lot of articulation cards available for working on just about any sound for your child. There are many commercial sets that you can buy and there are many that you can find for free online. I've done both. I was frustrated that most of those sets did not meet our needs very well.

When you are working with a young child who has Childhood Apraxia of Speech you need the words to be relatively simple in structure. Many of the lists were half full of two and three syllable words that are way too complicated for a young apraxic child to imitate. Also, children with apraxia need to practice their target sound paired with as many vowels as possible, and most sets are not designed with that goal in mind. Also, if you are working with a toddler, the words need to be relatively easily understood concepts for a young child. A word like "beg" is harder to understand and make a picture for than a word like "bed."

I have complied a set of 40 one-syllable words that I feel are easily understood or taught to a young child and I have made picture cards for them. I also have written out some directions for making the cards and some ideas for activities to do with the cards. The words are divided into levels by difficulty. I suggest you begin with the easiest cards and include the harder levels as your child is able to practice them too. I also describe the different levels of cueing you can use and provide suggestions for very simple one word carrier phrases you can use when you want to move to a two word level.

You are welcome to download the set for use with your child. I will be posting sets as I complete them.

For an easy to print version, download a .pdf of the five-page One-Syllable Final T Articulation Picture Cards file.

This is an old version of the card set. You can find the new version and additional sets in an easy to download format here: Free Speech Therapy Articulation Cards

Apraxia Therapy Materials: Kaufman Speech Praxis Kit 1 (Basic Level)

Therapy Materials Review: Kaufman Kit 1 (Basic Level)

This is a review of the Kaufman Speech Praxis Treatment Kit for Children (Basic Level). The kit was developed by Nancy Kaufman, MA, CCC-SLP. Nancy Kaufman is a nationally acclaimed expert in apraxia who has developed assessment and treatment materials in the area of apraxia. This kit contains a small manual that explains the treatment methods recommended and 201 picture cards sorted into category by syllable shape. The back of each card shows a hierarchy of acceptable responses for the picture on the card depending on the current performance level of the child.

Target Audience

The target audience for the Kaufman Kit Basic Level will usually be children between the ages of two and six. The pictures on the cards were designed with those ages in mind. These cards will be most useful for children who are struggling with producing simple syllable shapes and need to focus on the early emerging consonants /p, b, m, t, d, n, h/.

Description of the Kaufman Kit (Basic Level)

This kit is a boxed set of treatment materials including a 52 page manual and 201 stimulus cards sorted by type.

• Manual
  The manual is the same for both the Basic Level Kit 1 and the Advanced Level Kit 2 so some of the pages in the manual do not apply to Kit 1. The manual begins with a note to parents that describes Childhood Apraxia of Speech, gives an overview of the Kaufman Speech to Language Protocol approach to treating Childhood Apraxia of Speech, and briefly describes some things parents can do at home. The rest of the manual is pretty technical and written with a Speech-Language Pathologist in mind as the target audience for the manual. The rest of the manual describes the Kaufman evaluation hierarchy, treatment hairarchy, describes cueing techniques, gives examples of goals for IEPs and describes general treatment considerations.
  
  
• Stimulus Cards
  The cards consist of 201 full color 5" by 7" cards. The cards are seperated into sections that are color coded so that you can easily pull the cards, use them in therapy, and then sort them back into their sections. The early emerging consonants are included in kit one. Those consonants are /p, b, m, t, d, n, h/. Syllable shapes include CVCV, VC, CV, VCV, CV1CV2, C1V1C2V2, CVC, and CVCVCV. There are also more complex versions of some of those basic syllable shapes.
  
  

How to Use the Kaufman Kit Cards

Through formal or informal assessment, determine which syllable shapes are missing and which of the missing ones the child is stimulable for. Then work with the card sets for the missing syllable shapes that are easiest for the child. Remember that any of the responses on the back of the card can be considered to be correct. The responses on the back of the card are all acceptable, but get closer to the actual production of the word as you move from bottom to top. When you start working with a particular card, figure out which is the highest production the child can successfully imitate and start there gradually working your way up by using the cueing techniques described in the manual.

Therapy Activity Suggestions for Kaufman Kit Cards

• You can always simply drill the words offering a verbal reward, sticker, or turn at a game after every 5-10 responses.
• Make a laminated train engine and caboose. Line your cards up in between the engine and caboose making a word train and place a small reward (sticker, cheerio, etc.) on the caboose. Have the child say each word 1-5 times and when they reach the end of the train they get the reward. Then set up a new train.
• Tape the cards in a line on the wall. Make the room as dark as possible and let the child light up each card with a flashlight. They must say the word 1-5 times before they can light up the next word.
• Hide the cards around the room. Tell the child that you are playing hide and seek with the words and that they need to find 10 (or however many you hid) words. As they bring each word to you they need to say it 1-5 times before going to find the next word. Once they find all the cards they get a small reward. Then they cover their eyes while you hide a new set of cards. Or, you can trade and let them hide the words for you to find. They still have to say each word 1-5 times when you bring the card to them before you go find another.
• Lay the cards on the floor in some kind of pattern and play a beanbag toss game. They say the word the beanbag lands on 1-5 times before getting to throw the next beanbag.

Pros and Cons of the Kaufman Speech Praxis Kit 1 (Basic Level)

Pros: This kit provides materials for systematically building speech from least difficult to most difficult in terms of syllable structure. Within each syllable structure, there is also a hierarchy of acceptable responses from the least motorically complex to most motorically complex (and accurate). That makes this kit ideal for working with children who have Childhood Apraxia of Speech particularly those children who are minimally verbal.

Cons: This kit is very expensive. It is only Kit 1. There is another kit that includes the later developing consonants and more complex syllable structures that you might want when a child outgrows Kit 1. That kit is also very expensive. There are only a few words (usually 6-12) in each category so if you are looking for a wide variety of words to increase generalization, that is not the purpose of this kit. Also, if your child needs practice with a wider variety of consonants, they will not be included in this kit.

For the price, I expected a big manual that was designed to educate a parent or novice SLP with little apraxia experience about the disorder itself. Then I would would like for the manual to explain in an accessible way the theory behind the Kaufman method and why it is so appropriate for treating the disorder. The manual should make it very easy to understand how to use the materials with children and give concrete examples of therapy activity ideas. To put it simply, I was underwhelmed with the manual.

Bottom Line:

If you already have the knowledge and expertise to understand how to best use these materials and you have several minimally verbal children on your caseload, this kit would be well worth the purchase price. If you do not meet both of those criteria, I believe the price is prohibitive.

You might also be interested in the following articles:

Apraxia Therapy Materials: The Big Book of Exclamations

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Free Speech Therapy Articulation Picture Cards: Final N

This version is out of date. Go here for new, easy to download, version and additional sets.

There are a lot of articulation cards available for working on just about any sound for your child. There are many commercial sets that you can buy and there are many that you can find for free online. I've done both. I was frustrated that most of those sets did not meet our needs very well.

When you are working with a young child who has Childhood Apraxia of Speech you need the words to be relatively simple in structure. Many of the lists were half full of two and three syllable words that are way too complicated for a young apraxic child to imitate. Also, children with apraxia need to practice their target sound paired with as many vowels as possible, and most sets are not designed with that goal in mind. Also, if you are working with a toddler, the words need to be relatively easily understood concepts for a young child. A word like "beg" is harder to understand and make a picture for than a word like "bed."

I have complied a set of 40 one-syllable words that I feel are easily understood or taught to a young child and I have made picture cards for them. I also have written out some directions for making the cards and some ideas for activities to do with the cards. You are welcome to download the pictures for use with your child. I will be posting sets as I complete them.

For an easy to print version, download a .pdf of the four-page One-Syllable Final N Articulation Picture Cards file.

This is an old version of the card set. You can find the new version and additional sets in an easy to download format here: Free Speech Therapy Articulation Cards

Free Speech Therapy Articulation Picture Cards: Initial B

This version is out of date. Go here for new, easy to download, version and additional sets.

There are a lot of articulation cards available for working on just about any sound for your child. There are many commercial sets that you can buy and there are many that you can find for free online. I've done both. I was frustrated that most of those sets did not meet our needs very well.

When you are working with a young child who has Childhood Apraxia of Speech you need the words to be relatively simple in structure. Many of the lists were half full of two and three syllable words that are way too complicated for a young apraxic child to imitate. Also, children with apraxia need to practice their target sound paired with as many vowels as possible, and most sets are not designed with that goal in mind. Also, if you are working with a toddler, the words need to be relatively easily understood concepts for a young child. A word like "beg" is harder to understand and make a picture for than a word like "bed."

I have complied a set of 40 one-syllable words that I feel are easily understood or taught to a young child and I have made picture cards for them. I also have written out some directions for making the cards and some ideas for activities to do with the cards. You are welcome to download the pictures for use with your child. I will be posting initial sets as I complete them.

For an easy to print version, download a .pdf of the four-page One-Syllable Initial B Articulation Picture Cards file.

This is an old version of the card set. You can find the new version and additional sets in an easy to download format here: Free Speech Therapy Articulation Cards

Apraxia Therapy: Articulation Practice

What is Articulation Practice?

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

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

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

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

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

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

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

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

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

You might also be interested in the following articles:

Apraxia Therapy: Communication Boards

Apraxia Therapy: Gestural Prompts

Apraxia Therapy: Two-Word Combinations

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Book Review: Webber Jumbo Articulation Drill Book

This is a review of the Webber Jumbo Articulation Drill Book by Sharon Webber, M.S. and M. Thomas Webber, Jr. The book is designed to be a resource for Speech-Language Pathologists that offers a kind of dictionary of words, phrases, and sentences that can be used in therapy for the most common consonant sounds in the English language.

Target Audience

This resource is useful for Speech-Language Pathologists working with all ages. If you need to target specific speech sounds, this book is a wonderful resource for you. The pictures are essentials with young children and the word, phrase, and sentences lists work well with older children and even adults.

How to use the Webber Jumbo Articulation Drill Book

You need to know what sounds you are going to target and in what context (Do you need to target the sound at the beginning, middle, or ends of words? Do you need to target the sound in words, phrases, or sentences?) Once you know what you need to work on, you simply turn to the appropriate section of the book, copy the page, and use it in therapy.

What is inside the Webber Jumbo Articulation Drill Book?

You can view sample pages of the book.

The book has word lists, pictures, phrase lists, and sentences in initial, medial, and final positions for the following sounds: R, S, L, (Initial R, S, and L Blends), Z, SH, CH, TH (voiced and voiceless), F, V, K, G, P, B, T, D, J, H, M, N, and Y. It also includes an articulation drill record form, progress chart, homework helper note, and awards. There are a total of 6,420 target words, 3,120 phrases, 3,120 sentences, and 1,710 pictures.

Therapy Ideas using the Webber Jumbo Articulation Drill Book

• You can practice the words in drill format by simply going through one at a time. Each picture card has boxes at the bottom for you to keep track of correct and incorrect productions if you like.)
• You can make two copies of each page, cut the individual pictures out, and play a matching game or Go Fish style game with the pictures.
• You can cut out the pictures and glue them onto a piece of cardboard in a kind of snake and make a game board. Have the children spin a spinner or roll dice and say the words they land on the number of times that they rolled in order to move forward.
• You can cut out the pictures, glue them onto fish cut out of construction paper and then laminate the fish. Glue a small magnet on the back of each fish. Then make a fishing pole with a magnet on the end of the line and go fishing for the words.
• If you have a small bowling pin game, you can glue or tape words to each pin. The child knocks down the pins and then has to say each word before they can set each pin back up for the new try.
• Form a long train from the pictures. You can put an engine at the front and a caboose at the end. Put a small prize on the caboose like a sticker or piece of candy. When the child finishes saying each word that forms the train, they get the prize on the caboose.
• You can let the children color the black and white line drawing pictures.

Pros and Cons of the Webber Jumbo Articulation Drill Book

Pros: This book can be very useful. It gives you some words to use in therapy for all common consonants in all three word positions. If you use the words and pictures creatively, they can make articulation therapy fun and productive. It is also great to have phrases and sentences included as well.

Cons: Young children often need practice with simple, one-syllable words. Often, there are only a small number of simple one-syllable words included for each phoneme in each position. You may not find a lot of exactly what you are looking for. Also, some of the pictures are hard to interpret for little ones or may not be the best illustration for the word.

Bottom Line

If you are looking for a single resource that will have at least a few stimulus words for almost any sound in any context, this is a hard book to beat.

You might also be interested in the following articles:

Apraxia Therapy Materials: The Big Book of Exclamations

Apraxia Therapy Materials: Talking Carl iPhone / iPad App

Apraxia Therapy Materials: Doodle Buddy iPhone / iPad App

Home Therapy Plan - Rough Draft

Here's my first attempt (this time around) at structuring therapy sessions here at home.

1. I made Ava a speech bag to store her speech materials in. Since we're really fancy around here, her bag is a ziploc decorated with stickers.
   
2. I printed some very nice articulation cards I found at mommyspeechtherapy.com. I cut those out, paperclipped the different targets, and stuck them in the bag. Note: I printed these on cardstock at high quality to make the cards more durable and prettier.
   
3. I found a site with some free printable reward charts and printed a butterfly one for Ava.
   

Now, my original idea was that Ava and I would sit down together and my charisma and enthusiasm would result in her wanting to practice speech sounds with me in exchange for the pleasure of putting stickers on the chart after each set of cards.

Hahahahahaha.

After that complete failure, I offered her two froot loops of her choice after doing each stack of cards. ("Two pink mommy." Hmm... what will we do when we run out of red froot loops?) That worked much better. We ended up with only one sticker on the chart. So I stuck the chart up on the wall and now we'll put a sticker up on the chart after each session.

My goal is to try to get in four or five 10-20 minute sessions per week. We'll see how it goes.

Therapy Progress - Small Details Add Up to Big Picture Progress (At least, that's the plan.)

I realized that I haven't done a real update on Ava's therapy progress and speech in quite a while.

Here are her previous updates, in order, for anyone who is just tuning in and is interested in the background:

• Speech Therapy Progress: January 27, 2011
• Therapy Progress - Speed of Light: February 17, 2011
• Two-word combinations begin: March 5, 2011
• Therapy Progress - Practice and Generalization: March 21, 2011
• Therapy Progress - Steady Progress and Subtle Change: April 12, 2011

It has become much more difficult to track Ava's progress. The difference between "My baby isn't talking!" and "My baby is starting to use words!" is pretty clear and exciting. The difference between, "She can't even imitate." and "She can imitate." is also pretty clear cut. The increase from single words to two-word phrases was obvious as well as was the increase to 3-4 word sentences. Getting a new sound is another simple, observable change. Well, we went through all of those easy to track changes and they were wonderful and I was feeling great. Then there was the reality check of a standardized articulation test. Overall, things are getting harder to track now, but I'll try.

Big Picture

Ava is certainly talking a lot. She pretty much never uses a single word utterance any more. She's rarely uses a two-word phrase. Oddly enough, now that she is more ambitious in her speech she is actually harder to understand. When her sentences are longer and particularly when I have no context, I have a lot of trouble understanding her. It is frustrating for me and for her. I can handle my frustration, but watching her get upset when I don't understand just kills me.

So, I suppose the good part of the "big picture" is that Ava's gained enough confidence to try more. In terms of the length of her sentences, she's pretty much age appropriate. Also, the more she talks the more opportunities you have to practice, refine, and correct. The challenging part of the "big picture" is that the more she tries to say the harder she is to understand.

Details

Specifically, we are working on two main areas. We are trying to add final consonants (only the ones she can actually make) to her words. She does best with /t/ and /p/. Those sounds are easier for her because they are voiceless. She can imitate a final /t/ (like in hat) and a final /p/ (like in up) pretty much 100% of the time. She's also using them on her own when talking roughly 30% of the time. We're trying to work on final /d/, /b/, /s/, /n/, and /m/ as well, but those are all harder for her. She can imitate some better than others, and pretty much never uses them on her own.

The other thing we're working on is trying to get some new consonants. Specifically we are trying to get the /k/ sound. Ms. J says that she has gotten Ava to make a /k/ sound in isolation during her therapy sessions, but I just cannot get her to do it here at home. I even tried bribing her with M&M's, but still no luck.

Why these specific targets? Well, adding final consonants is huge. Leaving those sounds out makes her much harder to understand and as she starts to add those sounds back in, that should improve her intelligibility. Improving intelligibility (how well she is understood) is the reason for trying to get her to make the /k/ sound. /k/ will be the gateway sound for /g/ because they are a voicing pair. There are a lot of words out there that use the /k/ and /g/ sounds and right now she either leaves the sound out or substitutes a /t/ or /d/. If we can introduce the /k/ and eventually the /g/ she should get a big boost in her ability to make herself understood.

And so we march forward. We choose targets that we hope will get us that much closer to our overall goal of helping Ava express herself in a way that can be understood.

My goal for the next few weeks is to reintroduce structured home practice. She needs more repetitions. That is the core of apraxia therapy. Even if I have to resort to bribing the girl with candy, we will somehow get it done.

Apraxia Therapy Materials: Doodle Buddy iPhone / iPad App

Doodle Buddy is another iPhone / iPad app that can be a wonderful way to elicit speech or sound effects from your child. The program is free, but is overrun with really obtrusive ads. You can choose to pay $0.99 to remove the ads from the application.

This program does many things all of which can be used as a therapy activity.

• It is a drawing program. (Please don't laugh at my lack of artistic skills.) You can draw things for your child to label. Alternately, you can follow their instructions and draw what they tell you to. If they say "car," you do your best to draw one.
  
  
  
• The program has "stamps". There are tons of little pictures that your child can transfer to the screen just by choosing the one they want and then tapping as many times as they like. Even better, each stamp has a sound effect. So the frog croaks, the crying face cries, the dog barks, and so on. Your child can label the stamp or imitate the sound effect. Even if they are non-verbal and using signs, you can wait until they make the sign for "more" before you let them put more stamps on the page. Here is a sampling of the stamps available. There are many more than would fit on one page.
  
  
  
• There are backgrounds and themed stamps to go along with them. Some come with the program. Some you have to "buy" with points. If you are willing to install a few free programs on your machine you can get more points for free to get additional themes.
  
  So you pull up a background. Backgrounds (themes) include dinosaurs, cars, beach, farmyard, lake, princess, space, underwater, winter, spooky house, doghouse in backyard, desert, and more. You make up a story about the picture adding stamps as you go along. You get your child to repeat words that are part of the story. Here are some examples.
  
  Farm: Mama chicken was at the farm today. (insert chicken, have child say, "chicken"). She had three baby chicks with her. (insert three baby chicks counting, "one, two, three") They were lonely! They wanted to play with some friends. (toss in a couple of sheep and practice saying, "baa") I could continue, but you get the idea.
  
  
  
  
  Here are examples of the lake and princess themes as well.
  
  
  
  
  
  
My kids particularly enjoy the haunted house theme, the cars theme, and the farm theme. I'm sure your kids will have their favorites too. Really, the possibilities for using this program as a therapy tool are only limited by your imagination. (I make up really boring stories when put on the spot, but the kids don't seem to care. I get lots of speech and vocabulary practice in and that is all that really matters.)

You might also be interested in the following articles:

Apraxia Therapy Materials: Talking Carl iPhone / iPad App

Apraxia Therapy Materials: The Big Book of Exclamations

Apraxia Therapy Materials: Talking Carl iPhone / iPad App

If you have access to an iPhone or iPad there are a lot of apps that can be used to elicit speech from your little one. One in particular that can work well with a child at any stage is Talking Carl. (Note: There are other "talking" apps as well. Most are free or 99 cents. Just be sure to try a couple and choose the one you like best before you try it with your child. Some of them are not appropriate for children.)

Talking Carl is an interactive little monster with big eyes and a big mouth. He will giggle when tickled, and complain when poked. Children almost always crack up laughing themselves when they tickle or poke Carl. If you have a nonverbal child, just being able to get a giggle or an "ouch" in sympathy is good speech practice.

The other key thing Carl does is listen to what your child says when they talk into your phone and then repeat their words back to them. So if your child says, "Hi!" Carl will repeat, "Hi!" Carl will repeat anything the child says. If you are looking for a fun way to get your child to talk, this might do the trick for you. Check it out.

Here is a short YouTube video that demonstrates most of the things Talking Carl does (except the giggling). I chose this one because it was short, but did a nice demonstration of the speech repetition (not in English, but still a good demonstration).

You might also be interested in the following articles:

Apraxia Therapy Materials: Doodle Buddy iPhone / iPad App

Apraxia Therapy Materials: The Big Book of Exclamations

Ms. J and Magic

I haven't spoken much about Ms. J recently. She's the local apraxia expert we're fortunate enough to be seeing twice a month. We saw her again yesterday morning. She is so good. She has amazing one-on-one sessions with Ava. I shamelessly eavesdrop through the door. She takes my 26 month old little girl and gets her to work on her speech for 50 minutes straight and enjoy it the whole time.

She's also magical. I will go and she will tell me work on something (the one I remember most is "work on two-word phrases"). I will tell her, "Sure!" while thinking to myself, "Yeah, right! There's no way Ava will be doing that in the next two weeks, she isn't even close." Every single time, Ms. J has been right. Every single time. She was right about the two word phrases. She was right when Ava first started being able to imitate final consonants. She was right about using the hand signals.

Well, this time she told me to work on the /k/ sound. I've been trying off and on to stimulate a /k/ production from Ava. I'll say, "Say /k/." Ava will respond, "/t/". Every time. She just can't make a /k/ or /g/ in the back of her mouth. Think about it for a second. Try to explain how to make the /k/ sound. It would go something like this:

1. Bring the back of the tongue up to the roof of your mouth so that you completely block all air flow from your mouth. Leave the front of your tongue down.
2. Build up air pressure behind your tongue.
3. Now, let the air out in a little explosion by dropping the back of your tongue down. If you do it right, it will make a /k/ sound.

Ok. Now imagine trying to explain that to a two year old. Just not possible. So, when we're trying to stimulate a sound a child isn't making we have to use indirect methods. Sometimes you're lucky and the child can imitate the sound even though they aren't using it on their own. Or sometimes it is a sound that is easy to see, like /m/, because you make the sound with your lips. Then you might be able to help the child make the sound by showing them how. But /k/ is made in the back of the mouth. You can't just have the child watch you.

Ms. J took an indirect approach to getting Ava to make a sound in the back of her mouth. Essentially she had Ava open her mouth wide. Then she used a tongue depressor to hold down the tongue tip which will often force the back of the tongue up. Ava hated the tongue depressor and was happy to open her mouth wide if only the tongue depressor stayed put away. Then Ms. J had Ava imitate a kind of growling, "scary" sound. With the mouth wide open and the head tilted slightly back, making that noise is a giant step towards making a /k/ sound because you're making a sound way in the back of the mouth by moving the back of the tongue up. That's the first step we needed. Hopefully over the next two weeks I will be able to use that technique to shape a true /k/ sound from Ava.

If you had asked me two days ago if I thought there was even a possibility of getting a /k/ out of Ava in the next couple of weeks I would have said, "No way, absolutely not." One visit with Ms. J later and I think there's a distinct possibility. Magic I tell you. Magic.

Free kindergarten.com iPhone/iPad apps

If you search kindergarten.com in the app store, you will find 24 programs that are flash card style programs. All of them are free in April in honor of Autism Awareness Month. That gives you a few more days to check them out if you are interested. I haven't tried them all yet, but there are three main kinds: flash cards, receptive identification, and problem solving. The pictures are very nice and you might be able to use the flash card programs to try to get your little ones to say some words. Michael enjoyed the one problem solving program I let him try, so if you have older children the more advanced programs might be nice too.

Apraxia Therapy: Gestural Prompts

What are Gestural Prompts?

Gestural prompts (sometimes referred to as hand signals or visual cues) are hand signals made by the adult or child as cues to help the child try to make certain target sounds. Using these prompts or cues paired with specific speech sounds has been very successful at helping children with Childhood Apraxia of Speech learn and use the target sounds. Every professional book I have read about Childhood Apraxia of Speech has a section on this technique. Every Speech-Language Pathologist I know who works with children with Childhood Apraxia of Speech uses gestural prompts.

How do I use Gestural Prompts?

Using gestural prompts is a straightforward technique. Make sure your child is watching you (otherwise they will not see the prompt). Use the signal as you make the sound. If you are trying to cue a sound in a word, make the hand signal when you say the target sound. So if you are cueing a /p/ at the end of a word, make the /p/ prompt when you say the /p/ at the end of the word.

For example, let's say you're working on the /t/ sound. The gestural prompt for /t/ is tapping your index finger on your upper lip right under your nose. If your child says "ha" instead of "hat", ask him/her to look at you. Then repeat the word "hat" and make the /t/ gestural prompt as you emphasize the /t/ sound at the end of the word. You can also use the cue to emphasize a sound in the middle of a word. Let's say your child leaves the middle /p/ out of the word "puppy." You can pair the gestural prompt for /p/ (close your fist and then pop it open) paired with emphasizing the /p/ sound in the middle of the word "puppy".

Why do Gestural Prompts work?

Children with Childhood Apraxia of Speech respond well to being cued in multiple ways. Emphasizing the /t/ sound is an auditory cue. Using the /t/ gestural prompt is a visual cue. If they mimic the gestural prompt, it is also a movement or tactile cue as well. It grabs their attention and stimulates multiple pathways in the brain at the same time. This is what makes the technique so effective.

What are some common Gestural Prompts?

These are some commonly used gestures. You can use a different hand signal, it just needs to be consistent.

• T - tap the index finger on the upper lip right under the nose
• D - tap the index finger on the lower lip above the middle of the chin
• P - close your fist and pop it open (into a "5" position)
• B - use the ASL sign for /b/ and tap the hand gently against the side of your chin
• M - gently pretend to pinch both lips closed together with your index finger and thumb
• N - push index finger against one side of your nose as if you're trying to close one nostril
• SH - finger across your lips like you're shushing a child

There are more. You can find a hand signal (or make one up) for any sound you might be working on. Here is a link to a great video of a woman demonstrating a hand signal for almost every sound. Some of her signals are different from what I described above and that’s fine. You can use any signal you’re comfortable with as long as that symbol is consistent. Also, don't feel like you need to learn all of these at once. Pick one or two to start with and if that goes well you can always learn more. Be sure to choose a sound that your child is currently working on and check with your SLP. She or he may already be using a hand signal for that sound. You would want to use the same gestural prompt in order to be consistent.

Other than tapping, this is one of the techniques I find to be most effective.

Note: You may have found this web page searching for information on PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) therapy. PROMPT is a formal therapy technique conducted by PROMPT certified Speech-Language Pathologists that uses tactile cues (the therapist places his/her hands on the child in specific ways to try to stimulate sound production). If you're looking for more information on PROMPT, start here.

You might also be interested in the following articles:

Apraxia Therapy: Communication Boards

Apraxia Therapy: Two-Word Combinations

Ava's Speech - What next?

Ava's speech continues to improve in subtle ways. She's talking all the time. Her sentences are often multi-word sentences. She's a full conversational partner in the household. She listens to the conversations around her and tries to participate. She initiates new conversations. She is trying to sing songs. Slowly she's starting to use consonants in the middle of words and put some on the ends of words. Her vowels are usually correct now. The consonants that are missing are still missing, but they are consonants you wouldn't necessarily expect a young two year old to be using like /f, v, k, g, r, l, ch, J, s/. She still has difficulty with more complex syllable structures like C1V1C2V2, but those would be difficult for many typically developing early two year old children too.

She looks so different from the child who less than four months ago had only three "words", very few sounds, couldn't imitate, and scored at the 4 month old level on the early intervention speech and language assessment. She had so many of the items on the checklist for early red flags for Childhood Apraxia of Speech.

Now her therapists are starting to hint that she's looking more and more age appropriate. They're starting to say that the remaining issues she has look more like articulation or phonological issues than apraxic issues. This is exactly why Speech-Language Pathologists are reluctant to diagnose Childhood Apraxia of Speech this early.

If Ava had/has Childhood Apraxia of Speech it is mild. Anyone with moderate or severe CAS would have improved much more slowly. She's in an odd place. She's outgrown many of those "early red flag" signs (although her history of those red flags will never change). She's not quite old enough for the classic signs of Childhood Apraxia of Speech to show up yet.

We're in an odd limbo place. She's made great strides that have brought her to a place that is almost age appropriate. You could argue that we could stop therapy or go to therapy fewer times a week. After all, I am a speech therapist and I'm working with her at home too. I'm also able to monitor her for signs of backsliding. However, it took therapy multiple times a week over several months (and possibly multiple kinds of supplements) to achieve those improvements. I don't want to stop too early. She wasn't making any improvements before the therapy (and supplements).

I'm just not sure what to do. Continue therapy for now? Reduce therapy and see if she's still improving or at least maintaining her skills? Stop therapy for a while and wait to see if she falls behind again?

What do you guys think?

Apraxia Therapy: Communication Boards

Young children with Childhood Apraxia of Speech are often very frustrated, have very few words, and are resorting to gestures to try to get what they want. Often those gestures are not effective and their frustration just continues to increase. They can begin to give up trying to communicate. You want to give them some success at communicating and reduce their frustration. Communication boards are a great way to achieve these goals.

What are Communication Boards?

A communication board for a young child is simply a set of pictures placed in an area accessible to the child. The purpose of the communication board is to allow the child to communicate successfully without needing speech. Communication boards are considered to be a low technology form of augmentative and alternative communication.

Why would I give my child a Communication Board? Don't I want him/her to talk?

Yes, you absolutely want your child to learn to talk. Teaching your child with apraxia to talk is your long term goal. Communication boards can solve several problems in the meantime and get you closer to that goal.

• Communication boards reduce frustration. When your child can successfully communicate with you they will be less frustrated and happier.
• Communication boards teach your child about language and communication. If your child has no words, or very few words, they have not had the opportunity to learn how powerful and easy communication can be. Once they get a taste of successfully and easily communicating, they will want to learn more.
• Communication boards increase vocabulary. Every picture you include on your communication boards is a word you are hoping they will eventually learn.
• Communication boards encourage speech. Over time, your child may naturally try to vocalize the word as they point to a picture. Research has shown that this often happens. Therefore your communication boards can be a gateway to speech.

How are Communication Boards used?

Place the communication board on the wall in an appropriate area of your home at a height that is easy for your child to see and point to. You want them to actually be able to run over to the wall and touch the picture of the item or activity they want on the board.

For example, let's take snack time. You can't ask your child, "What would you like to have for snack today?" They don't have the words to answer you. So you put a snack time communication board up on the wall in the kitchen. The communication board has pictures of all of your child's favorite drinks and snacks. At snack time, you can now ask them, "What would you like to have for snack today? Go show me." Your child simply walks over to the board, enjoys looking at all the options, and points to what he or she wants.

How do I design and make a Communication Board?

First you need to identify topics your child would want to communicate about. Be creative in thinking about possible topics for communication boards. Possibilities include:

• Food and drink items posted in the kitchen.
• Television shows they can choose from posted in the living room near the television.
• Table activities they can choose from (coloring, painting, puzzles, games, etc.) posted near the kitchen table or a play table if they have one.
• Favorite toys posted in their play area.
• Items of clothing, hair accessories, etc. posted in their bedroom.

Now you're ready to plan your communication boards. Write out a list of the specific items you want to include on each board. I would put no more than six to eight pictures per board for a young child. So, for example, on a snack time board you might include milk, juice, animal crackers, grapes, banana, and cheerios. Pick items you actually use in your household. No two communication boards are ever the same because they are customized for your household and your child.

Once you have your list, you can make your board using one of several methods.

1. You can take pictures of your household items, have the pictures developed, and cut them out and glue them to a backing (construction paper, posterboard, cardstock, even regular printer paper).
2. You can cut pictures out of magazines and then glue them onto a backing.
3. You can use a computer program like Microsoft Word and import pictures you've taken digitally or pictures you've found online to make your board and then print it.

Can you give me some examples of Communication Boards?

Here are a couple of communication boards we used in our house. I made both of them on the computer. The kitchen communication board I made with pictures I took of actual items in the house with my camera phone. The television communication board I made with images I found in Google image search.

You might also be interested in the following articles:

Apraxia Therapy: Gestural Prompts

Apraxia Therapy: Two-Word Combinations

Apraxia Therapy Materials: The Big Book of Exclamations

Book Review: The Big Book of Exclamations

This is a review of The Big Book of Exclamations by Teri K. Peterson with illustrations by Chris McAllister. The author is a Speech Language Pathologist and designed the book as a combination of a tutorial to teach parents how to use a picture book to elicit utterances from their young children and a picture book designed to appeal to young children.

Target audience.

I'd say this book would be most appropriate for children between the ages of 12 months and 3 years of age. There are always exceptions where the book might be appropriate for older children. The book is designed to be used by a parent and child together and to leave the parent with some skills that they can then apply to reading other picture books with their children. The book is particularly useful for "late talkers" and children with Childhood Apraxia of Speech becuase it is designed to teach short phrases to children and provide many opportunites to practice those phrases in a fun context.

How to use The Big Book of Exclamations

This book is meant to be "read" with your child. I put the word "read" in quotes because the book is not a storybook with a typical story. It is designed to be interactive. It is designed to teach you how to use a picture book to prompt speech, and lots of it, from your child. The Big Book of Exclamations teaches you to interact with a child and a book the same way I was taught to do it as a Speech-Language Pathologist during a therapy session.

You can then apply the same concepts to any other picture books you are reading with your child. The idea is to spend five or ten minutes (or even longer) on each two-page spread. You don't need to read the entire book in one sitting. The activity is about the two of you enjoying the book, pictures, and conversation. It is about your child having fun talking about the book. Literally - talking about the book! How often does your child get to do that?

You can easily adjust the difficulty level up or down just by modifying what you say from two words at a time to one word at a time. Or, if your child can't say "bottle", change it to "ba ba." You want to model the exclamations yourself and then pause to let your child participate too. Encourage their participation. Enjoy it. Play with the exclamations and the pictures. Laugh at the silly things they see in the pictures and the silly things your child gets to say. Have fun telling the dog, No, no!" over and over again.

What is inside the Big Book of Exclamations?

This book is dense. Each two-page spread if full of tons of things to talk to your child about. The pictures and concepts covered in the book are perfect for an emergent talker. The illustrations are complex and beautifully done. You can see a sample page at the book's website. The book begins with two two-page spreads on how to use the book. The true beauty of the book emerges in the following six two-page spreads.

• Wake Up! Good Morning!
  This scene has a mommy and daddy entering a nursery with a toddler aged boy and toddler aged girl to wake them up in the morning. There’s a pet dog and cat in the scene along with lots of nursery toys including cars, blocks, planes, and farm animals. The pictures have captions in key areas prompting you (the parent) to use key words like, “Hi, baby”, “beep, beep”, “uh-oh,” and “no no”.
• Eat! Eat!
  This scene is of the family getting ready for breakfast. You have the mama, daddy, children and pets again and now you add a grandma. Again, there is lots going on here. You have all the items typically present in a kitchen, some playground equipment out a window, fruit on the counter, and much more. Captions include, “hot, hot”, “all done”, please”, and “dirty”.
• Ready to Go!
  This scene shows the family in the foyer getting ready to go out. All of the previously introduced family members are present and now we add grandpa. In addition to the typical things you’d see in such a scene like a door, stroller, stairway, side table, phone, pictures in frames you have lots of action. Captions include, “bye, bye”, “wait, wait”, Dada help”, and “run, run”.
• The Park!
  This scene shows the entire family at the playground. You have a slide, swing, bubbles, people playing ball and Frisbee, and even a birthday party going on in the background. Captions include, “swing, swing”, “up up up”, “pop pop pop”, and “weeeeee”.
• Bath Time! Wash! Wash!
  This scene shows the mama and daddy giving the children a bubble bath. It’s a great bathroom scene. Captions include, “oh, oh, duckie”, “owie, “no bite”, “pop”, and “sh- sh- shhh”.
• Bedtime – Goodnight
  This scene shows the entire extended family again in the nursery getting the children ready for bed. You’ve got a bedtime story, dim lights and the moon shining in through the window. Captions include, “shhhh- papa stay”, “stop”, “look, my book”, and “ni ni dada”.
• The final page is a picture of the family waving good-bye to the readers and the page opposite is full of captions about being all done and wanting to read again.

At the end of the book the author includes two additional two-page informational spreads. The first is about typical language development and the second is about what to do if you have concerns about your child's speech development.

Our experience using The Big Book of Exclamations

We used this book with Ava when she was just starting to verbalize. When we got the book she wasn't even imitating reliably. She was engaged as soon as I pulled out the book and we spent several minutes just talking about the cover. The book worked exactly as intended. We spent half an hour or so on the first three two-page spreads. She did get antsy after the first couple. It is not like a storybook that holds their attention because they like the story itself. It is more of an interactive activity. I would plan on using the book for no more than 15-20 minutes at a time. It would certainly be worth it even if you were only using it 5-10 minutes at a time. Pick it up, talk about a couple of pages and then put it away and save the next set of pages for another day.

Even though the book is a bit expensive at $20, I feel the price is worth it for the experience. You can get hours of entertaining speech practice out of this book if used properly.

I do have one small criticism though. This book is designed to be read with a very young child cuddled in your lap engaging with the book. Yet it is a hardback book with paper pages and is rather large and unwieldy. Also, some of the illustrations disappear into the binding. I found it a little difficult and uncomfortable to hold when reading it with Ava. I wish the book were available in a ¾-size board book form. I would actually pay $5 or $10 additional dollars to get the book in that format and consider it an investment.

This book was not available through my local library system. I’ll admit that I did not check out local bookstores. Amazon does however, carry the book and so you can find it there for sure if you are interested. I believe the book can also be purchased through the book's website.

Bottom line: Highly recommended.

You might also be interested in the following articles:

Apraxia Therapy Materials: Talking Carl iPhone / iPad App

Apraxia Therapy Materials: Doodle Buddy iPhone / iPad App

Therapy Progress - Steady Progress and Subtle Change

I was looking back at all of Ava’s progress reports and I realized that her progress has been very steady. Every 3 weeks or so, significant progress has been made. Here’s a quick summary.

• Beginning of January – Ava had only three “words” and very few consonants and vowels.  She couldn’t imitate.  She was starting to use gestures instead of even trying to communicate verbally.  We began therapy and Omega 3 supplementation in January.
• End of January -  At this point Ava would imitate when bribed with food.  She had learned several new consonant sounds and was using 15-20 words spontaneously.
• Middle of February - Ava was spontaneously trying to label things.  She had started two syllable words like “nanuh” for banana and “baby”.  She was making further progress on consonants and some progress on vowels.
• First Week of March - She started putting two words together make short phrases and sentences.  It was a huge step.  We were getting 3-4 syllables strung together at a time.  
• End of March -  Ava was continuing to practice multi-word utterances.  She was using them more frequently and would often use three word sentences.  Occasionally we would even hear a four word sentence.  We started using Nutriiveda.

 

At the moment, we’re trying to add a little clarity to Ava’s words.  Before, her words had no final consonants (“ha” for hat) and no medial consonants (“pu-ee” for puppy).  We’re using gestural cues to help her add those back in.  It’s working.  She’s occasionally doing it spontaneously (she’ll add the /t/ in the middle of turtle), but most of the time we have to remind her (using the cues).  When she’s imitating I’d say she’s successful about half the time.  It depends on the sound.  She does a great job with /t/ and /p/, but /d/, /b/, /n/ and /m/ are harder.  She doesn’t have /k/, /g/, /f/, or /v/ at all, so we aren’t even trying with those. 

All of these things are very concrete.  These are the kinds of things that speech pathologists choose as goals and can collect data on to track change.  I talk about this kind of progress because I am a speech pathologist and these changes make sense to me.  I’m proud of them.

There has also been a more subtle kind of change.  This is the change that my husband and parents notice.  It’s less about specific sounds, utterance length, and data and more about Ava as a person.  There’s been a change in her confidence.  She’s talking more.  She’s talking when she’s by herself in another room.  She’s chattering away in the back seat of the car.  She’s trying to sing, laugh, and make jokes.  She has conversations with her parents, grandparents, and brother.  She is no longer the baby who had to grab my hand and drag me to the refrigerator, pound on the door to get me to open it, and point to ask me for milk.  Now she can just ask, “Mi pea!” (Milk, please!)   It’s been a wonderful change to watch.

How do you measure progress in your little ones?

Gestural Prompts for Apraxia – Therapy Techniques

Using hand signals (sometimes referred to as gestural prompts or visual cues) paired with specific speech sounds has been very successful at helping children with apraxia learn and use those sounds. Every professional book I have read about apraxia has a section on this technique. Every speech pathologist I’ve been working with uses gestural cues. It has worked exceptionally well with Ava. I’m going to explain the therapy technique, give you a specific example of how we’re using the technique with Ava right now, and then give you descriptions of several of the prompts we’re using right now.

Using hand signals is very simple actually. You just make sure your child is actually watching you, and then use the signal as you say the word. For example, right now we’re trying to get Ava to use the /t/ sound at the ends of words. She’ll say “ha” instead of “hat.” I will repeat the word emphasizing the /t/ sound at the end and at the same time I make the hand signal for /t/ (tapping the index finger on your upper lip right under the nose). The visual cue in addition to the auditory cue really seems to help her focus on that missing sound. Almost all the time now, she’ll then repeat the word adding the missing sound. She often uses the gestural cue herself when she repeats the word correctly. We’re also using the technique in the middle of words. Ava will say “tu uh” for “turtle”. If I use the hand signal for /t/ while emphasizing the /t/ sound that should be in the middle of the word, she will repeat, “tu tuh.” She still can’t make the /r/ or /l/ sound in that word, but she can add the /t/ in the middle.

These are the gestures we are using as our hand signals. You can use a different signal, it just needs to be consistent.

• T - tap the index finger on the upper lip right under the nose
• D - tap the index finger on the lower lip above the middle of the chin
• P - close your fist and pop it open (into a "5" position)
• B - use the ASL sign for /b/ and tap the hand gently against the side of your chin
• M - gently pretend to pinch both lips closed together with your index finger and thumb
• N - push index finger against one side of your nose as if you're trying to close one nostril
• SH - finger across your lips like you're shushing a child

There are more. You can find a hand signal (or make one up) for any sound you might be working on. Here is a link to a great video of a woman demonstrating a hand signal for almost every sound. Some of her signals are different from what I described above and that’s ok. You can use any signal you’re comfortable with as long as that symbol is consistent. Also, don't feel like you need to learn all of these at once. Pick one or two to start with and if that goes well you can always learn more. Be sure to choose a sound that your child is currently working on and check with your SLP. She or he may already be using a hand signal for that sound.

Other than tapping, this is the technique that has been the most successful with Ava. I highly recommend it.

Songs and Rhymes – Therapy Techniques

Songs and nursery rhymes can be powerful tools for getting little ones with apraxia to verbalize. The singing activates different areas in the brain than those typically used in speech production and that often helps children successfully produce words.

I’ve been singing to my children since before they were born. I love singing. I enjoy it. I happen to like kids’ songs. What can I say? I’m an educator. So I usually sing kids’ songs to my children. I sing nursery rhymes like “Jack and Jill” and “Baa, Baa, Black Sheep.” I sing lullabies like, “Rock-a-Bye Baby,” and “Hush Little Baby.” I sing classic kids songs like, “Sing a Song of Sixpence” and “This Old Man.” We do preschool fingerplays like “The Itsy Bitsy Spider,” and “Twinkle, Twinkle Little Star.” The beautiful things about these songs are that they are predictable. They fascinate children. Rarely do I encounter a child that does not enjoy participating in a performance of kids’ songs. Ava knows almost all of these songs.

For the past few weeks I’ve been using the cloze technique (reading, or in this case singing, the first part of the sentence and then pausing to let the child fill in the next word) when singing songs with Ava and she has been filling in the missing words. So when we do, “Baa, Baa Black Sheep,” she fills in the words I’ve bolded.

Baa, baa, black sheep,

Have you any wool?

Yes sir, yes sir,

Three bags full.

One for the master,

One for the dame,

And one for the little boy
Who lives down the lane.

And so in the 30-45 seconds it takes to sing this little song, she’s produced eight words. If you spend ten minutes singing songs from a nursery rhymes book (as we do every time we have an extended visit to the potty), you can get productions of 70-100 words. And they’re having fun the entire time. They don’t even know it’s therapy. You can incorporate this into reading time before nap and bedtime. You can do it any time really, just for fun. During car rides is another fun time to do this activity.

This activity isn’t about how perfect the production is. Obviously you’re not expecting to get perfect production of such a wide variety of words. It’s about making talking fun. It’s about them getting to participate in a fun verbal activity in a way they can be successful. It’s about just getting them to try. For example, Ava’s “lane” is pretty much just a long /a/ with no /l/ or /n/. But that isn’t the point. The point is the participation, attempts, and fun.