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.

If you are interested in a licensed speech language therapist (pathologist) coming to your home, please contact us, craig@brooklynletters.com or call us at 347-394-3485.

We work with all ages (babies-adolescents) and all types of speech and language delays and concerns. We service many neighborhoods in Manhattan, Brooklyn, and Queens. We travel to the following neighborhoods:

Manhattan- Upper East Side, Midtown East, Murray Hill, Gramercy, Union Square, East Village, Soho, Upper West Side, Midtown, Chelsea, West Village, Chinatown, Lower East Side.

Brooklyn- Kensington, Midwood, Windsor Terrace, Park Slope, Ditmas Park, Boro Park, Clinton Hill, Fort Greene, Prospect Heights, Carroll Gardens, Cobble Hill, Boerum Hill, Brooklyn Heights, Downtown Brooklyn, DUMBO, Ditmas Park, Kensington, Prospect Park South, Midwood, Canarsie, Flatbush, Crown Heights, Greenpoint, Williamsburg, Prospect Heights, Bay Ridge, and Dyker Heights.

Queens-- Sunnyside, Woodside, Long Island City, Astoria

We look forward to working with you!

AAC is used when speech is not an adequate means of functional communication. The “augmentative” refers to any devices, methods, or systems that are used in addition to speech. This can be necessary when someone’s speech is not clear due to low volume, low tone, or articulation errors, or when someone requires vocal rest. The “alternative” refers to any device, method, or system used for communication when speech has not developed or has been lost. Many devices or systems can be both. AAC devices are used by many individuals, including those with autism spectrum disorders, cerebral palsy, dysarthria, aphasia.

Like our clients, AAC devices come in all shapes and sizes! Low or no-tech systems include the Picture Exchange Communication System (PECS), single cell switch devices (e.g. Big Red Switch, Jelly Beamer, Big Mac), or multi switch devices (e.g. Step-by-Step, Multi-Step Big Mac) or static communication devices (e.g. GoTalk devices). Hi-tech devices include Dynavox products (e.g. Tango, Maestro, V), Tobii software and devices, PRC Unity devices (e.g. ECO, Vantage Lite), and iPad applications (e.g. TouchChat, SceneSpeak, Look2Learn, Sonoflex, Proloquo2Go).

The aim of all of AAC devices is to increase functional communication. Whether this means requesting with one word for a desired item or commenting on your surroundings, AAC devices help individuals get their needs met and allow them to be participants in social situations.

EVERYONE is a candidate for AAC. There is no cognitive prerequisite, and accommodations can be made to all systems and devices.

Brooklyn Letters evaluates individuals to determine if there is a need for AAC, and which device or system would best suit that individual. Our specialists work with families to help individuals develop independence and work towards overcoming their particular difficulties. They are available to review, augment and implement assistive technology recommendations made as a result of an evaluation. They also conduct AAC therapy which works on familiarizing clients with their AAC device or system, and provide communicative partner training to ensure generalization. In addition, they are available to consult with schools about adapting curriculum, integrating assistive technology, and training teaching staff on how to work with assistive technology tools.

Join South Slope resident Dr. Michelle MacRoy-Higgins, Assistant Professor in the Communication Sciences program at Hunter College (CUNY) and a speech therapist with over 15 years of experience, for a parent-friendly discussion on speech and language development and delays in toddlers and preschoolers. Dr. MacRoy-Higgins will debunk common myths about speech and language delays, inform you on the current best practices for speech and language therapy, and provide you with practical and effective strategies to incorporate at home to help your child’s communication development; question and answer will follow.

When: Wed. February 29th, 6:45pm to 8:15pm.

Where: 435 15th St. #1 between 8th Ave and Prospect Park West in Park Slope, Brooklyn. One block from the F and G subway- 15th St. stop. *Please note the Brooklyn bound F subway does not stop at 15th St. Please exit at the 7th Ave stop (when exiting the subway station, walk up the stairs to 8th Ave).

Cost: $15 per person. No refund, unless event is canceled. Spots limited to 12 people.

Interested?
Email Craig at craig@brooklynlearning.com to RSVP.

Once confirmed, please mail a check for $15, written out to Craig Selinger, and mail it to:

Craig Selinger
435 15th St. #1,
Brooklyn, NY 11215

Now is the time to contact us, if you are interested in summer speech language therapy & reading remediation services. Once summer arrives, we will plan our fall schedules.

If your child is currently receiving school speech language therapy services, we will connect with your school therapist and carry over his or her speech and language goals this summer.

If you are interested in literacy help, summer is a great time for your child to continue to develop and nurture their reading and writing skills. Particularly for children with literacy delays, don’t let your child’s literacy gap widen. Our language specialists work with a reading intervention teacher, local learning specialists, and a psychologist trained in evaluating reading and writing disorders. Our reading interventionist, Jo-Ann Kalb, is trained in Orton-Gillingham (PAF), Wilson Reading, Sounds in Motion (a phonemic awareness program that gets kids moving and learning consonant and vowel sounds) and Great Leaps.

Jo-Ann Kalb is a certified NY State and NYC Teacher and Reading Tutor. After a 30 year career teaching grades 1, 2 & 5 in Park Slope, including 10 years as a school librarian, she became a Reading Intervention teacher in 2003. She uses a combination of programs and strategies gleaned from her long professional career to work with students who struggle with reading, phonemic awareness or dyslexia. Jo-Ann is currently a Reading Intervention teacher at PS 10 in Park Slope and she provides group work as well as one on one tutoring.

Jo-Ann travels to your home!
Hours: Mon, Wed-Fri 3:30-7PM
Sat & Sun 10 AM-3 PM

Location: Park Slope, Windsor Terrace, Prospect Heights, Bay Ridge, Ditmas Park, Cobble Hill, Boerum Hill, Brooklyn Heights, Fort Greene

Types of Services: Initial reading evaluation, reading intervention using research based reading programs.

Expertise: working with children (5-10 years old) who have problems with phonemic awareness and decoding, and/or dyslexia.

She will run a summer group in August for struggling readers (kindergarten-third grade).

Contact Jo-Ann for more information at joann@brooklylearning.com or 347.470.4406

Thanks!
Craig
craig@brooklynletters.com