First, see if you can identify any context in which -r- is produced correctly. To do this, assess the child’s production of vocalic and consonant r forms, including the stressed vocalic-er, the unstressed vocalic-er, the –r- in ‘are’ ‘ear’ ‘air’ ‘or’ (be this the consonant or the vocalic-r) , the consonant r as a singleton, and the consonant r as a cluster.

If you identify a context in which the -r- is correct, try to shape ‘er’ from that context.

1) If the child’s production of r is correct in the r-initial position cluster, you can use that r to get to ‘er’
I suggest you use /tr/ or /dr/ cluster. To get ‘er’ from an r-cluster use the following sequential steps; first, have the child produce the r-cluster in a word in a natural manner (e.g., drip). Then have him briefly extend the first part of the word as he says it (e.g., derrip), and then drag it out even more as he says it (e.g., derrrrip). The next step is to insert a brief pause in between the first part (e.g., der) and the rest of the word (e.g., rip) [here, derrip]. Then increase the duration of the pause before saying the rest of the word (e.g., der< long pause >rip). Then the child is directed to repeatedly produce only the first part and drop off the rest of the word (e.g., der).

At this point, you have two possible strategies, one is to have the child repeatedly say that first part (e.g., der, der, der) and then build nonsense and real words on the first part by adding final consonants (e.g., derk, dirt). The other strategy is to separate out the ‘er’ by having the child say the first part, freeze the position of the ending for that first part, and then say er repeatedly— (e.g., der er, er, er, er).

2) If the child’s production of r is correct in the vowel + r-contexts, you can use that to get production of er.
Here you will evoke production from the words are, ear, air, or or. Have the child produce a context that he can produce correctly in a natural way (e.g., or), then have the child extend the duration of the production (demonstrate e.g., orrrrrr—hear the sound of er emerge); tell the child to listen carefully to the sound he is making at the end. Then have him freeze the position for that sound he is making at the end and repeat only that last sound, first only once (e.g., orrrr er, -er, er, er, er.)

3) If the child’s production of the vocalic er is correct, you can use that to get the consonant-r
First have the child ‘read’ a card that contains ‘er’ repeatedly, followed by reading repeatedly a card that contains all but the r- of a word that with the addition of r- becomes an r word (e.g, ed for the word red) At this first step he would be saying er,er,er and ed, ed, ed. Then have the child read the two cards in succession, as you gradually reduce the pause time between the presentation of the two cards, until the child is reading the two parts as a single word. (This would sound like er ed, er ed, even shorter pause, until the child is reading erred.) The next step will be to separate out the er from the r-word: to do this have the child, continue to read the entire word (here erred), and each time he does it to say the er part more and more quietly, until he is only thinking it. (e.g., erred, er[quieter]red, er[thinking it]red). This would be followed by repeatedly saying the r-initial position word that he was saying (in this case red red red red)

4) If the child’s production of er is correct, you can use that to get the vowel +r as in are, or, ear, air
In this case, write ‘er’ on one card, write a vowel (e.g., the vowel in or ) on another card. Have the child produce the er repeatedly when told to read the er card; have him read the vowel repeatedly when told to read the vowel card. The have him read the cards in succession, gradually reducing the pause time between each card, (eg. Ow er…… etc., until both parts are combined into the vowel + r form (here —or). Have the child then produce the combined parts repeatedly, (here, or, or, or) The next step is to try to build nonsense words, and possibly real words by placing a consonant before the vowel+er (e.g., d—for door) and after the vowel _ er (e.g., b—for orb)

If, however, the child is never producing the –r- correctly
Begin with evoking ‘er’—with the er-evoke procedure, described by Shriberg. The procedure is straightforward and has you work for er from the /l/—as in look (not the velar l—as in ball)—this is important, as the er you will get with the velar –l is distorted

Some general guidelines for working for –r – whatever the form, and whatever the approach you use:

1) Routinely remind the child to listen to the sound he is producing and to notice the feel of the production, when he is producing the target correctly. To facilitate focused listening, use some for of amplification —-one possibility is the use of earphones that contain plastic deflectors that slightly amplify production by directing the child’s production back towards him———the advertisement said these were originally designed for singers to get feedback on their singing as they practiced.

2) Routinely provide explicit evaluative feedback so the child knows if he is or is not producing the desired behavior. It is useful to provide visual and verbal feedback. Recently one of the clinicians in the Phonology Clinic provided visual feedback by using a continuum-line that contained the words Got it! (correct production) at the far left, Didn’t get it. (incorrect production) at the far right, and Almost, at the center. After each production the clinician would make a mark with a colored marker to indicate where on the continuum the child’s production had been. For verbal feedback, it is important to explicitly praise the child’s successes—which include correct production, and movement in the direction of correct, and to also identify what the child is doing that is interfering with getting correct production, such as tense productions, and extraneous lip and mouth movements—and, after identifying the interfering behavior, to tell him what he needs to change and help him change it, so that he resolves the interfering behaviors.

3) It is also useful to have the child do some self evaluation, periodically, at first, and then more and more often. For self evaluation, do the following. After the child’s response, ask him to self evaluate in the same way that you the clinician was evaluating his production attempts—namely using the same kinds of verbal feedback and the same visual feedback system that you were using. After the child has self-evaluated, give him feedback on both his production and his self-evaluation, also using the same verbal and visual feedback.

4) Use a mirror to draw the child’s attention to any extraneous mouth movements and tenseness in the his face, while also having him notice what he is hearing and feeling, so that he can identify the interfering behaviors, even when a mirror is not being used.

5) Always manipulate the teaching tasks to provide the child with maximal success — do this by returning to a level at which the child was successful, when he is repeatedly unsuccessful at the current level, change teaching strategies and techniques when the ones you are using in the moment are not being successful, always end each practice with success, repeatedly remind the child of improvements he is making and summarize those improvements at the end of each treatment session. Also acknowledge that you recognize that the child is working hard. It would also be a good idea to include a token reinforcer during your sessions; we find it useful to have the child earn game pieces, like the chips for connect-four, and then after he has earned all the pieces, we play a short game, as a short break from the work. Keep in mind that as you continue to work on the target, you can motivate a child to a higher level performance, discourage an extraneous oral behavior, etc. by changing what will receive a token reinforcer, and how many tokens the behavior will earn.

6) As the child’s skills are improving, periodically invite the child to try to ‘figure out’ how to say an r-form that he can successfully produce in some words, in the new words that you present for him to practice.

7) An important thing to keep in mind, is that the ‘er’ is a vowel, and vowels must be learned auditorily—therefore, it is useful to also include Listening tasks in your practices when you are finding it challenging to evoke the ‘er’. You could provide auditory bombardment during the treatment session by repeating stimuli in the context of a simple game such as a memory game, using minimally contrasted CV real and nonsense words (eg., her, burr, ter, ger ). The parents could also provide bombardment in the context of a similar game at home. You could also create a 4 to 5 minute CD for the child to listen to for auditory bombardment. Whenever you provide auditory bombardment, vary the pause time between presentations.

This information was provided courtesy of Joan Kwiatkowski, Clinical Professor at UW-Madison’s Department of Communicative Disorders.

Educational-based speech language pathology is playing a bigger role in the literacy success of children and adolescents. Related professions and teachers are starting to become more aware of our unique skill set and how we play a critical role in education.

The following document is posted on the American Speech Hearing Association’s website, Literacy Gateway.

Speech-language pathologists (SLPs) have the specialized knowledge and experience needed to identify communication problems and to provide the help that children need to build critical language and literacy skills. SLPs are often the first professionals to identify the root cause of reading and writing problems through a child’s difficulty with language. SLPs help children to build the skills they need to succeed in school and in life.

The American Speech-Language-Hearing Association’s (ASHA) National Outcome Measurement System (NOMS) data indicates that more than 70% of teachers who responded to a survey believed that students who received SLP services demonstrated improved pre-reading, reading or reading comprehension skills. A majority of teachers also cited improvements in the student’s listening and written language skills and ability to communicate in socially-appropriate ways (pragmatics).

Key elements of a speech-language pathologist’s academic training relating to early language and literacy development include skills to:

* Build and reinforce relationships between early spoken language and early pre-literacy abilities and consider influences of parent-child interactions in early shared storybook interactions;
* Address difficulties involving phonological awareness, memory, and retrieval;
* Teach children to use tactile-kinesthetic and auditory cues in reading and writing;
* Analyze how the language demands of textbooks, academic talk, and curriculum may stress a student’s capabilities at different age and grade levels; and
* Conduct fine-grain analyses of written language, including spelling, to generate intervention that matches the needs of individual students.

How Speech-Language Pathologists Can Contribute

Speech-language pathologists (SLPs) are key members of the team responsible for helping students learn to read and write. SLP’s contribute in the areas of:

1. Prevention—Communicating risk factors to teachers and parents, and working with them to develop programs to help children acquire explicit, age-appropriate knowledge, skills and strategies of the components of language that contribute to reading and writing development.
2. Identifying At-Risk Children—assisting in development and implementation of screening (e.g., instruments and teacher observation checklists) and referral procedures for very young children as well as older school-age children, including modifying procedures to reduce bias (e.g., dynamic assessment techniques and criterion referenced tasks) for culturally and linguistically diverse populations.
3. Assessing—selecting, implementing, adapting, and interpreting assessment tools and methods to evaluate skills in spoken language, reading, writing and spelling.
4. Providing Intervention—collaborating with teachers and families to plan intervention goals and activities, as well as modifying curricula to keep students progressing in the general education curriculum.
5. Documenting Outcomes—establishing a tracking system for identifying new or re-emerging literacy deficits and documenting outcomes of intervention goals and plans.
6. Program Development—directing or participating in teams to develop school or system-wide strategic approaches to early identification and intervention for children with reading deficits.
7. Advocating for Effective Literacy Practices—providing information about literacy development to state and local agencies that plan and evaluate curricula, establish comprehensive assessments and set related policies; educating them about relationships between spoken language and written language (i.e., reading, writing and spelling) and the benefits of collaborative instructional approaches.
8. Advancing the Knowledge Base—conducting scientifically-based research on early literacy development.

The scope of speech language pathology is diverse and one of my goals for the Brooklyn Letters website is to educate others about my profession. When I meet new people and we discuss what I do professionally, I find it difficult to give a brief explanation about language pathology and its treatment.

“Reading and writing? What does that have to do with speech?” Is a common reaction from those inquiring about what I do. Unlike language pathology, speech pathology is more straightforward to explain to others, e.g. child has difficultly enunciating the “r” sound.

I recently read an article from a journal that I find very helpful for those interested in learning more about how language pathology connects with literacy and learning.

The following excerpt is from the article “Back to School: Why the Speech-Language Pathologist Belongs in the Classroom,” by Dr. Marilyn A. Nippold. Marilyn A. Nippold, Ph.D., holds an Endowed Professorship at the University of Oregon where she has worked since 1982, teaching and conducting research in later language development, literacy, language disorders, and stuttering.

Back to School: Why the Speech-Language Pathologist Belongs in the Classroom

Sam is a 12-year-old boy who recently began the sixth grade at a rural middle school. Like many of his classmates, Sam spent a relaxing summer playing baseball, fishing, and swimming at a nearby lake. However, now that the school year is underway, he is experiencing increasing frustration in the classroom. Unlike most of his classmates, Sam has a language disorder.

If a sixth-grade child such as Sam has deficits in syntax (grammar), the lexicon (vocabulary), word decoding, and reading comprehension, those deficits are likely to continue into adulthood if left untreated by qualified professionals (Nippold & Tomblin, 2010). Moreover, Sam’s frustration in the classroom is likely to increase as the language demands become even greater during middle school and high school, resulting in a diminishing sense of confidence, optimism, and enjoyment of academic pursuits.

On the other hand, if Sam’s language deficits are promptly identified by a speech-language pathologist (SLP), they can be addressed through an intervention program that targets practical aspects of spoken and written communication, focusing on the language demands of the classroom.

In science, Sam’s class is studying coral reefs, and students are expected to read and understand the following passage:

Like rain forests, coral reefs contain many animals and plants that produce potentially valuable chemicals. For this reason, it is important to protect the reefs from damage from many sources. Unfortunately, reefs are in danger from natural disasters and from humans. Natural forces, such as water that is too warm, can kill corals and produce a phenomenon called coral bleaching. Organisms that eat living corals, such as the crown-of-thorns sea star, can greatly damage reefs. (Coolidge-Stoltz, Padilla, Miaoulis, & Cry, 2002, p. 326)

Notably, this passage contains several features that often prove challenging to older children with language disorders. Syntactically, the sentences are long and complex, and several of them contain relative clauses (that produce potentially valuable chemicals, that is too warm, that eat living corals) that may tax a child’s working memory. The passage also contains literate vocabulary in the form of adverbial conjuncts (for this reason, unfortunately), abstract nouns (sources, phenomenon), and technical terms (coral bleaching, organisms, crown-of-thorns sea star).

After reading about coral reefs and listening to the teacher’s lectures, students are expected to demonstrate their knowledge of the topic by answering questions on an essay exam. They are also asked to make individual and group oral presentations to the class on the topic.

By spending time in a middle school classroom, we realize that to succeed in school, a sixth-grade child with a language disorder must be assisted to use and understand complex syntax and literate vocabulary; to learn new information through listening and reading; and to demonstrate knowledge through speaking and writing. Practical information such as this is invaluable in establishing functional goals for language intervention, thereby helping the child to realize his academic potential and to have reasonable options in life. Assisting children in this way also offers long-term benefits to society, helping to build a workforce of competent young adults who can give back to their communities through productive and stable employment.

The full article can be accessed, for free, at http://lshss.asha.org/cgi/content/full/41/4/377?etoc and it was published in Language, Speech, and Hearing Services in Schools, Vol.41, 377-378, October 2010.

Craig Selinger is a pediatric speech language therapist with a private practice in Park Slope, Brooklyn. He works with babies and pre-adolescents with speech, language, feeding delays and difficulties. In addition, he provides specialize tutoring services (reading, writing, speaking, and listening) for struggling learners and those with unique differences. His speech, language, literacy, and feeding team travels to your home and your child’s school throughout Brooklyn, Manhattan, and Queens. Contact: craig@brooklynlearning.com, 347-394-3485, www.brooklynlearning.com.

My name is Craig Selinger, and I am a speech language pathologist, also known as a speech therapist, who lives in Park Slope, Brooklyn. Starting in September, I will work full-time in the area; no more back and forth Manhattan commuting. My services include child speech, language, and feeding therapy and language remediation, e.g. reading and writing.

I am very excited to launch Brooklyn Letters! Seven months of steady work on the website and now it is live. Brooklyn Letters will be a dynamic forum: updated blogs, articles, and resources. We want to create services based upon your needs. Here are some future ideas/plans:

UPDATES

BROOKLYN Letters TEAM

Dr. Annette Hernandez and I will soon be adding more professionals to our team.

BLOG

Every member of the Brooklyn Letters team will contribute to our interdisciplinary blog. Check-in monthly for new entries.

Other ideas about the blog:
1) Contacting professors/researchers to make research more accessible to the public.
2) Extending our interdisciplinary blog to other pediatric professionals in the New York City area. If you would like to contribute to our blog, please email me your name, phone number, area of expertise, and the topic you would like to write about. I am limiting blog entries to one page and one per month. Each month will have a different professional contributor.

RESOURCES

Did I miss an important resource? Please email me the link, and I will consider adding it.

LOCAL

We have a FREE Brooklyn (Park Slope and nearby neighborhoods) private business and local pediatric professional (for those offering unique services) directory.

GROUP SERVICES

If you are interested in small group services (3 children) please fill out this form and email it back to me. I teach language learning, literacy, and social skills to small groups. Creating these groups is cumbersome due to the difficultly coordinating schedules and matching learning needs. My goal is to organize compatible small learning groups.

HIRING PROFESSIONALS

If you are a pediatric professional interested in home-based services in the Park Slope and/or and nearby communities, please email me your résumé.

FEEDBACK FROM YOU

How can we improve this site? Email me your ideas.

FUTURE

I am very excited to see how Brooklyn Letters will help contribute to Brooklyn, and watch it help parents from around the world learn more about their child’s development.

THANKS

Many thanks to Brent and Teresa (my amazing website designers), Amy Way (photographer), the families that allowed me to be photographed with their children, Evan, Noreen, Chino, and Maryam. It was a team effort and I appreciate everyone’s important contributions and endeavors!

RECENT NEWS

We are now offering speech, language, and feeding services/therapy in Bay Ridge, Dyker Park and Dyker Heights, and Bensonhurst! If you are interested in Kristi, a speech language pathologist, coming to your home, contact Craig at craig@brooklynlearning.com

We will be expanding our speech, language, and literacy services to your home in Queens- Sunnyside, Woodside, Long Island City, Astoria, and we will be expanding our speech and language services to your home in Williamsburg, Greenpoint, Bushwick.

We welcome Emily Harms, M.S. CCC-SLP- a speech language pathologist that comes to your Manhattan home. She travels to Gramercy Park, Midtown, Murray Hill, Flatiron District, Chelsea, Nolita, Soho, Greenwich Village, West Village, Battery Park City, Financial District, Lower East Side, East Village, Williamsburg

Please contact Craig for more information craig@brooklynlearning.com

11215 11217 ABA Applied Behavioral Analysis apraxia Apraxia of speech articulation articulation delay asperger aspergers auditory processing autism autism spectrum bay ridge bensonhurst Bilingualism Boerum Hill Brooklyn brooklyn heights CAPD Carrol Gardens Center central auditory processing disorder Cobble Hill Communication Communication Center disorder dyker heights dyker park dyslexia Dyspraxia early childhood eating therapist enunciation ESL evaluation expressive language delay feeding delay feeding therapist floor time fluency Fort Greene language based learning disability language delay language pathology language processing late talker Learning lisp literacy literacy specialist Manhattan mixed expressive receptive language delay New York New York City NYC oral motor parent training Park Slope park slope communication PDD-NOS pervasive development disorder PDD phonological delay phonological disorder picky eater pragmatic language Private Private Speech Language Pathologist Private Speech Therapist private therapist PROMPT reading reading specialist receptive language delay Red Hook remediation school age SEIT social language delays social skills specialist speech delay Speech Language Pathologist speech language pathology speech pathologist speech pathology speech techniques speech therapist speech therapy stuttering therapist therapy treatment Windsor Terrace writing program speech therapy program preschool infant elementary student child baby Kensington Sunset Park Ditmas Park Flatbush Gramercy Park, Midtown, Murray Hill, Flatiron District, Chelsea, Nolita, Soho, Greenwich Village, West Village, Battery Park City, Financial District, Lower East Side, East Village, Williamsburg

Craig Selinger is a pediatric speech language therapist with a private practice in Park Slope, Brooklyn. He works with babies and pre-adolescents with speech, language, feeding delays and difficulties. In addition, he provides specialize tutoring services (reading, writing, speaking, and listening) for struggling learners and those with unique differences. His speech, language, literacy, and feeding team travels to your home and your child’s school throughout Brooklyn, Manhattan, and Queens. Contact: craig@brooklynlearning.com, 347-394-3485, www.brooklynlearning.com.