Therapy for Speech Sound Disorders (SSD)
Addressing the level of breakdown in the Speech Sound System
ARTICULATION THERAPY
Placement, Mirror and Drill Work
Articulation is the realisation of sounds caused by the actions of articulators on the airstream.
Children who cannot imitate or say a single sound on request are said to be not stimulable for X (where X is the phone in question).
To correct this, the child must be facilitated to produce the phone (sound) on target.
Articulation is the realisation of sounds caused by the actions of articulators on the airstream.
Children who cannot imitate or say a single sound on request are said to be not stimulable for X (where X is the phone in question).
To correct this, the child must be facilitated to produce the phone (sound) on target.
Placement of articulators
Articulation might be thought of as 'mini-physiotherapy' focused on the vocal tract. This is a hands-on task and should not be taught by listening skills only! Before commencing any hands-on therapy, discuss what you plan to do with both the parent(s)/carer and the child. Verbal consent should be noted in the client's records.
Training a parent or carer to carry out the activities is helpful, as the exercises will need to be carried out many times before the sound is successfully
Placement can be indicated to the child by:
- Model the sound. Showing the child how to make the sound (watching an adult), highlighting the articulators and lip/mouth/mandible (jaw) placement. For example, using an open mouthed position and tapping the velum with a sterile spatula to model [g].
- Using a therapy mirror to help the chid to check that their articulator movements and lip/mouth position and shape match the adult's. Therapy mirrors are made of plastic or other unbreakable material(s). A therapy mirror should ideally be landscape orientation and allow the child to see their own face and the adult's face comfortably when seated side-by-side.
- Spatulas to highlight the alveolar ridge, or palate. Wooden or soft plastic, single use and sterile. Ask about gag reflex first before attempting to use with a child (and consider desensitisation work if the child has a strong reflex). It often helps to give the child a spatula and encourage them to explore your mouth before moving onto them so that they know what to expect.
- Model of the mouth. Using a model will allow the child to explore the structures and for the Speech and Language Therapist to check that the child knows names of structures involved in producing the sound.
- Encouraging the child to use their thumb and forefinger on the top of the larynx (voice box) to develop an aware of loud sounds (voice on) and quiet sounds (voice off) sounds. I use homorganic pairs such as [f, v], [s, z], as they can be extended and reflected on.
- Use an articulogram scheme rather than other sound or letter scheme that has no image to help the child know how to make the sound. I use the Bigmouth Sound Scheme which, although currently out of print, is available as an app for iOS devices.
- Use a sign for each sound. The Cued Articulation system by Jane Passy was re-published in 2010, and the original video is available on YouTube here.
- Help the child to shape the sound. For example, gently tucking the child's lower lip under their top incisors and then asking the child to blow will produce the voiceless labio-dental fricative [f]. For example, using a clean drinking straw placed centrally may be used to encourage central airflow for the production of [s].
Please note that good hand hygiene is required when carrying out articulation therapy, and the use of gloves and/or PPE is recommended. Adults planning a family should note that Cytomegalovirus (CMV) may be present in saliva and may be harmful to unborn children and young children. See NHS advice here. COIVID-19 and other respiratory diseases, as well as parasites such as Threadworms may be present in saliva.
PHONOLOGY THERAPY
Phonology therapy uses meaning to help the child to understand that a change in sound is needed to get the right message over to the listener.
Phonology therapy (usually) assumes that the child is stimulable for both the target sound (and the sound the child uses in error).
There is debate about the most effective phonology therapy, and research is on-going.
Phonology therapy (usually) assumes that the child is stimulable for both the target sound (and the sound the child uses in error).
There is debate about the most effective phonology therapy, and research is on-going.
Theoretical approaches
Phonological Delay and Consistent Phonological Disorder
Inconsistent Phonological Disorder: Establishing word production consistency
- Developmental approach
- Complexity approach
Inconsistent Phonological Disorder: Establishing word production consistency
- Core Vocabulary
Delivering therapy: Therapy packages
- Minimal Pairs
- Maximal Pairs
- Multiple Oppositions