Articulation Therapy: Why Is The SLP Working On That Sound?

Target Selection

Hello to part 2 of this week's topic of articulation therapy. Yesterday, we talked about building rapport to begin working on speech therapy. Today, we will be discussing why and how your SLP chooses which sounds to work on.

So, this can get very clinical, but I am not going to “go there” within this blog post. I am just geeky enough that I will talk to anyone about how much the Cycles Approach has been helping out my therapies, and how I prefer many words to just a few personally in my practice, but that’s just too much. What I will do in this section is explain what speech “targets” are and explain a little but about how you can become an active member in helping your SLP determine what sounds would be most beneficial for your child first.

So, first, there are a few different ways that speech therapists can determine what sounds to work on first. If your child only has 1-2 sounds in error, it is much easier to decide which sounds to work on. Otherwise, an SLP can choose first sounds to work on based on:

• Sounds errors that are no longer age-appropriate. For example, a 4 year old who has /k, g, and r/ in error would work on the /k and g/ first as those sounds are no longer age-appropriate to be in error, but the /r/ still is.
• Complexity Approach: this means that the SLP is targeting a sound that is not in the child’s repertoire (or list of sounds that they can make) to allow a cascading effect to generalize sounds that are in their repertoire. For example, let’s say that a child is substituting /t/ for different “noisy” sounds, like, /s, z, sh/. Now, let’s say that the child can make the /s and z/ sounds, but not /sh/. The SLP would target the /sh/ sound, with the theory that by targeting the harder sound for the child, they will naturally apply this strategy to the sounds that are in their repertoire.
• Dynamic Systems Approach: This is when the SLP targets the sounds that are in the child’s repertoire and makes sure they are solid before moving on to more complex sounds. If given the example directly above, the SLP would choose to work on /s/ or /z/, whichever was easier for the child, before moving on to the other sounds.
• Systematic Approach: This applies to when a child has several sound errors across many types of sound placements within the mouth. I explain that sound classes can be organized into “file folders” within the motor areas of the brain. We train the child on one of these “file folders” at a time, showing them where in the mouth these sounds should be made. So, for example, /b, p, and m/ are all made by pressing our lips together. I may work on this sound class, or bilabial sounds, before moving onto another class of sounds. 
• Selecting targets based on the significance of the sound in the child’s life. For example, my son’s name is “Finn.” Let’s pretend that when he is 4, he cannot say /t, d, f, l, and s/. Although /t, d, and s/ are all produced in the front of the mouth and have the same “file folder” of motor planning, and although /t and d/ are earlier developing sounds, I may work on /f/ first as the sound is in his name and is important for him to be able to produce.
• Selecting targets based on how poorly it affects intelligibility, or how easily the child is understood. In this example, perhaps a child is 5 and has errors on /l/ and leaves off the /s/ sound every time it is at the end of a word. Although the child can make the /l/ sound and it is developed before /s/, I may work on the /s/ because people have a really hard time understanding what she is saying because she omits that sound at the ends of words.

In addition to target selection, an SLP may have different approaches for when to move on from those target sounds. They include:

• Vertical Approach: Intense practice working on 1-2 sounds until they are mastered before moving onto another sound. A lot of times this includes “drill practice” of a couple sounds within a session; this means lots of words and less variability in the different sounds worked upon.
• Example: A 5 year old child has errors on /k, g, sh, and l/. I decide to work on /k/ before moving on to any other sound. I have the child practice 50-100 words in our session with /k/ at the beginning of the word.
• Horizontal Approach: Less intense practice on a fewer target words. This means less target words but allows for a larger variety of target sounds. 
• Example: Using the same example above, I may have the child work on 5 high-frequency words in her language with /k/ and /g/ sounds in different positions of the word. This may include, “kitty, dog, gaga, go, bike”. 
• Cyclical Approach: This is a combination of the two approaches listed above. A child works on a particular sound for a predetermined amount of time before moving onto another sound(s). The theory behind this approach is that it encourages natural generalization. 
• Example: Again, given the example from above, I may work on 10-20 targets of the /k/ and /g/ sounds for 3-4 sessions before moving on to the /sh/ sound for 3-4 sessions then the /l/ sound for 3-4 sessions. I cycle through these sounds, increasing/decreasing the difficulty and number of target words as appropriate.

Talking with our Director here at Rehab Specialists, she also reminded me that it is important to note that we have to consider a child's other speech goals. If the child is also working on language, fluency, voice, or swallowing goals, the session may look very different from just working on articulation goals. The target and number of target words may differ if we are working on more than one goal. Again, this is something you can discuss with your SLP in further detail.

I know that was a lot of information, especially for someone who has no knowledge of the speech and language world! But, hopefully for a few of you parents, you are better prepared to ask questions about the approach your child’s SLP is using, you can help your SLP come up with appropriate targets in therapy, and you can understand why the SLP may be working on certain sounds. If you have any questions or concerns, leave a comment below or contact us (info in the bio).

Until next time!

Kathleen