Making informed decisions at the start of articulation treatment can help make speech therapy as successful as possible. Here's how.
There is so much variation in the cases that fall under the umbrella of speech sound disorders (SSDs). School-based SLPs may come across:
a preschooler who is barely intelligible because she is substituting /d/ for most consonants
a first grader who is having difficulty developing his spelling skills because his spelled words are reflecting his speech sound errors
a fifth grader who refuses to speak in class because she is embarrassed about not being able to produce /ɹ/
a kindergartener who gets so frustrated when his teachers and peers don't understand him that he cries multiple times a day
These hypothetical cases illustrate how wide the SSD spectrum can be, and school-based SLPs are tasked with treating all of them.
Once a thorough assessment has been done (likely including a standardized measure, and the ruling out of any oral-motor anomalies, apraxia, hearing impairment, or influence from another language), we have some important decisions to make. And the more up-to-date information and resources we have at our disposal, the better equipped we'll be to both treat and advocate for these children.
Here are 4 considerations to help you make the most out of your articulation goals in speech therapy:
Developmental Norms:
It may be counter-intuitive, but developmental norms aren't the be-all and end-all when it comes to eligibility criteria for speech therapy in schools. Using them on their own as a way to make black-and-white decisions about who qualifies for therapy and who doesn't is not ideal.
But they're still an inevitable component.
Over the years, there have been various sets of developmental norms for speech sound acquisition used to make determinations about when specific speech sounds should be acquired (Smit or Sander, anyone?), as well as when phonological processes should disappear. These are the most up-to-date norms that I know of:
- For individual speech sounds for kids in the United States: Crowe & McLeod, 2020 (direct link to the chart is here)
- For sounds in connected speech: Glaspey et al., 2022
- For phonological processes: ASHA.org
Therapy Dosage:
It's important to think about "dosage" when scheduling treatment sessions. "Dose" simply means the number of trials a child gets in a given session, and "dose frequency" means how many times per week a child receives treatment.
There is an increasing amount of literature suggesting that short, individual sessions 2-4 times per week is the ideal therapy dosage for kids with SSDs. Within these short, drill-type sessions (which can even occur in the school hallway or in the back of a classroom for 5 minutes), the child should get the opportunity for 50-100 trials of their target sound.
This can be a time-saver for school-based SLPs for two reasons: this therapy setup can actually take less time than seeing kids in a more standard group mandate dosage (i.e., 2x30); and research has shown that kids who participate in what's known as the Quick Articulation! model progress more quickly, and can be dismissed earlier from speech therapy -- yes please!
If you need research to support this service delivery model, in case you need to convince administrators to let you try it, you can use this excellent article here.
Generalization and Carryover:
I recently took a continuing education webinar called Elicitation Strategies for Speech Sound Disorders by Amy Graham. In it, Graham stated that, for phonological errors, "generalization typically occurs with therapy at the word level." By contrast, for articulation errors, Graham stated that therapy should follow a more traditional hierarchy by progressing through isolation, syllable, word, and sentence levels, etc.
This blew my mind. And ever since I've been aware of this distinction, I've seen it play out in my own therapy; I typically start to see kids carry over new speech patterns more quickly into their spontaneous speech if we've been working on phonological processes, while my artic kids usually need to progress through increasing levels of complexity step-by-step before they are able to use their new speech sounds in their spontaneous language.
(Okay - I feel a responsibility at this moment to also share this excellent article by Kelly Farquharson that warns against making clear distinctions between "artic" and phonological cases. As with most everything in our field, arm yourself with knowledge and keep your eyes open; each case is unique.)
So now, when I write goals and plan therapy, I do keep this artic/phonological idea in mind; I'll usually pair word-level practice with phonological awareness work for my phonological-seeming kids, and I'll do more drills around a traditional hierarchy for my articulation-seeming kids. Then I watch how they progress and stay ready to pivot, based on what I see.
I also came across this quick-to-read and informative list from Pam Marshalla on some principles and ideas for carryover. I recommend taking a quick peek at it; there are some good ideas for activities.
And here is a great list of generalization and carryover activities from SLP Fiona Balfe.
Treatment Techniques:
There will always be cases where a traditional artic approach makes the most sense. But for cases where the cause of the speech sound errors appears to be more phonological, we have some great options that are both evidence-based and have been shown to help kids progress more quickly:
And my post on how to get started with the complexity approach here. For more artic-based cases, I think you can still apply complexity concepts when choosing treatment targets.
And if you want to tie your articulation work with spelling skills, read this post.
LEVEL UP YOUR SPEECH THERAPY ACTIVITIES WITH STORYWHYS
Did you find this blog post helpful? Subscribe below to get the latest blog posts, which feature lots of speech therapy ideas for busy SLPs who want to provide fun, impactful, and meaningful speech-language therapy.
Have you heard? StoryWhys now offers the Speech and Spell series of resources. I am always trying to tie articulation work and spelling together in my therapy and I've never found any good resources out there to help me do this. So I made my own! Many more speech sounds and spelling rules to come. They'll be 50% off for 48 hrs when new resources are added to the StoryWhys store. Find them here.
Did you know book companions can be among the best speech therapy materials for elementary students? Explore all of the StoryWhys book companions for speech therapy in my store. You'll find comprehensive book companions that target many different language skills or Spotlight Series book companions that focus on one type of skill, all using high-quality, beloved storybooks.
Enjoy!
