I have recently read some posts about SLPs and parents who are struggling with their children's habitualized the use of misarticulations for various commonly used words. I thought I'd just share what has worked for me in the past. I use these techniques for ALL disorders relating to articulation deficits (including but not limited to apraxia, dysarthria, use of phonological processes, articulation disorders of varying severity etc.).
3 Simple Steps to Reducing Habitualized Use of Misproductions!
1. Segment, Segment, Segment: The first thing I do is have the child segment the target sound in syllables or words (depending on child's ability to imitate and segment). Why segment? The purpose is to REPLACE the use of ingrained misarticulated sound with CONSCIOUS production of correct sound in order to train the child's brain to sequence the correct sounds together for target words. Segmenting means to produce the target sound separately from rest of syllable or word. For example, if I am working on initial /s/ in the word "sock" I will have the child imitate "s" after me first, pause, then imitate "ock" ("s" pause "ock"). I use hand and other placement cues, models and a mirror to achieve successful production. We would practice this until the child no longer needed my model for EVERY trial (this usually occurs very quickly, within the first 2-3 trials). Once the child can do this, we move to step 2.
2. Repeat, Repeat, Repeat: Once the child can segment words with only one of my models, I quickly begin to have them repeat the segmented production 5-10 times in a row. I usually begin with 5xs in a row for young children (PK kiddos), and 10xs in a row for older children. For severely apraxic or dysarthric children, 5 repetitions may be too many...then I reduce to 3 repetitions initially and move up to 10 repetitions for these kiddos. I explain to ALL children the rationale for repetition. "We are teaching our brain, how to say this word the right way. Just like we exercise our muscles we need to exercise our brain over and over so our brain learns how to say these words." I then send a few words the child can segment and repeat home to parents for practice in front of a mirror. Once the child can segment these words independently I immediately move to step 3.
3. Fluent production in words: It usually takes a week or two of daily home practice for a child to be able to exhibit repeated segmented production of ingrained words successfully without relying on me for additional assistance. Once this happens I begin to have the child move into fluent word production. If the child resorts back to ingrained misproductions I (of course continue use of hand and placement cues and mirror as needed) move to simultaneous production of fluent word. Simultaneous production means I sit side by side with the child both of us looking in the mirror, using our cues, and producing elongated form of target word. By elongating the sounds in the word and using continuous voicing, the child is not able to add misarticulated sound in target word. We do this with my rules of repetition (5-10xs) then move to child's own fluent production of words. Once the child can do this at word level, we begin to practice at more complex levels (phrases, sentences, reading, conversation).
That's it...three simple steps to reduce habitualized use of misarticulations. Happy Talking!
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