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, 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
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
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
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
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.
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