Language and Communication Skills (SPED 3164)

Chapter 4
4. Management of Communication Disorders
4.1. Language Stimulation in early childhood
4.2. Language stimulation for school aged children
4.3. Speech Correction
4.4. Alternative augmentative communication

Language Stimulation: Infants and toddlers generally develop communication skills in a

reasonably predictable way. We see infants cooing and gurgling around 4 months, babbling with the
same sound around 7 months (e.g. bababa, dadada), babbling with varied sounds around 9 months (e.g.
bagagada), first words emerging around 12 months, and simple word combinations around 24 months
(e.g. Daddy go, no ball, more milk Mummy).Often parents are concerned that their child is not meeting
these language milestones, and that they are ‘behind’ other children their age. It is important that these
language milestones be taken as rough guidelines as children develop at different rates, and there is a
wide scope of ‘normal’ when it comes to language development. Even so, many parents find it difficult
not to worry about their child’s language development. This is where ‘Early Language Stimulation’
can be of assistance.

Early Language Stimulation refers to a range of techniques that parents/carers can use to encourage
their child to use language. Language stimulation is a set of interaction strategies that can be used in
any context with young children. Language stimulation is particularly useful for early communicators,
and early language users.
Teaching and learning practice encourage the emergence of verbal communication. Also, for early
language users who are already using language to communicate, language stimulation can support
children to:
• Engage in back-and-forth communication
• Use/understand more words
• Start to say longer sentences
• Use language for a range of social purposes.
Language stimulation is a great way of building upon children’s communication attempts and
modelling how children can use more language.
Language stimulation strategies can also be used with Language and Emergent Literacy Learners to
further extend upon their oral language, and as ways of repeating and validating their contributions to
conversations/discussions.
Language stimulation strategies can be used during any interaction with children including in everyday
situations, storytelling, reading/writing with children, during discussions, and performing arts/fine arts
experiences.
Benefits of Language Stimulation: Supportive language learning environments are created when
educators have high expectations for every child and interact with children in respectful and responsive
ways. When adults use language to respond to (and build upon) children’s communication attempts,
this provides them with a logical way of extending their own language capacities.
Learning occurs in many different contexts and social environments when children watch others, talk
with others and participate in routines and everyday experiences. Children also learn on their own and
this learning can be stimulated and extended by the involvement of responsive adults.
When children are engaged in responsive, language-rich experiences, they are supported to continue
building upon the language they can use and understand. It is important to uphold the idea of the child
as a competent learner from birth when interacting with children.
The image of the child as a competent learner from birth drives professionals to provide a safe and
stimulating environment and encourage children to expand their capacities and deepen their knowledge
and understandings of the world.
Therefore, language stimulation is aimed at using language that is appropriate to the child’s current
level of language learning, and within their ‘zone of proximal development’ (Vygotsky, 1967). This
allows educators to consistently provide an intellectually stimulating environment that fosters optimal
development.

Language Stimulation in Early Childhood

Imitation: Imitation is one of the earliest language stimulation techniques that you can start using with
your infant. Your baby will develop simple actions before he develops sounds, so make sure you copy
these actions at every opportunity. As soon as your baby starts making noises (gurgling, squealing,
cooing) you can start imitating them. By simply copying your baby’s sounds, you are teaching the
basics of conversation skills- taking turns. Your baby is learning that he says something, and then you
say something. You are also reinforcing your baby’s vocalisations. In other words, your baby will
come to expect you to copy him when he makes a sound, and when you do copy him he will be happy
about it. This simple reinforcement will encourage him to vocalise more and more. Soon your child
will be imitating you, which is how he will begin to learn words.
Running Commentary: Children learn language (words and sentences) through listening to others.
The more language they are hearing, the more readily they are able to pick up new words and phrases.
Often children have to hear a word many times before they will attempt to say it, which suggests that
Mums and Dads need to do a lot of talking to encourage their children to learn new words. A simple
way to do this is by providing a ‘running commentary’ throughout the day. In other words, describe all
the things that your child is doing as they are doing them. Use simple language and repeat the main
words. For example, if your child is engaging in pretend play with cups and spoons, your commentary
might sound something like this:
“Pick up the cup, oops! Dropped it! Pick it up again. Big drink. Yum, yum, yum! Yummy drink! More
drink please! Yum. Hmm, where’s the spoon? Here’s the spoon. Stir the drink. Stir, stir, stir. Big drink.
Yummy drink! More please.”
Don’t talk too quickly, make your voice animated, and make sure you are commenting specifically on
your child’s actions and interests. If your child is extremely interested in banging the spoons rather
than stirring, make sure your commentary focuses on this, for example:
“Bang, bang, bang! Bang the spoon. Very noisy! Wow! Banging the cup! Bang, bang, bang! Uh-oh,
dropped the spoon. Come back here, spoon. Got you! Bang, bang! Bang more spoons. Lots of spoons.
Very noisy!”
By commenting on your child’s immediate interests and actions, you are providing them with words
and sounds that are motivating in that moment, and it is these words and sounds that they will be more
likely to say.
Labelling: When your child begins to use single words, you will most likely hear a lot of labels (nouns)
such as kitty, puppy, milk, ball. Right now, these are the most useful words for your child as these are
the things that he can see and touch. At this stage it is important for you to encourage your child’s
vocabulary by labelling other things in your environment. Your child does not know all of the words
yet and may be simply pointing to different things and looking at you questioningly. When this
happens, give your child the word.
It is important for you to focus on things that your child is already interested in. For example, if your
child sees a cat and says ‘kitty’ you can begin to label other parts such as nose, feet, tail, whiskers, eyes,
fur. Choose one new label to begin with, such as whiskers, and whenever your child points to a cat and
says ‘kitty’, help him find the whiskers and say ‘whiskers’. Before long, your child will be labelling
‘whiskers’ independently.
This simple technique allows parents to build their child’s vocabulary by extending on their current
interests.
Build on your Child’s Words: Once your child is using lots of single words (50+ words, around 18-
24 months of age) it is time for you to start speaking in 2-3 word sentences. Children learn how to
construct sentences from Mum and Dad, so why not simplify your language and show them exactly
how to combine 2-3 words?
As with the previous techniques, you should aim to build on your child’s interests at the time. The
technique of ‘building on your child’s words’ simply means taking your child’s single word and
adding a bit more information. For example, if your child points to a cat and says ‘kitty’, you could
respond with ‘Oh! White kitty. Kitty is sleeping.’ In this instance you have given your child a few
more words that they can use to talk about the cat: a colour (white) and an action (sleeping). These
words will be interesting to your child in this moment, because he has shown interest in the cat. You
have also shown your child how to combine these words to make a short sentence.
It is a good idea for you to incorporate lots of different types of words when using this technique. In
other words, don’t only use colour words or size words when building on your child’s single words. To
follow on from the cat example, you could use labels (whiskers, claws, fur), size words (little, big,
long), colour words (black, white, brown), action words (pat, jump, sleep, purr), emotive words (angry,
happy), location words (in, off, under), texture words (furry, soft, wet), etc. By using a wide variety of
word types you are encouraging your child’s development of sentences and vocabulary.
Once your child is a bit older and using 3+ word sentences, it is time for you to start demonstrating
appropriate grammar and sentence structure. At this stage your child’s sentences contain mostly
content and not a lot of grammar or joining words. For example, your child might say ‘no park, raining,
cold’. To teach the appropriate sentence structure you could say ‘Yes, we can’t go to the park because
it’s raining and cold. We would get wet.’ Try to stay one step ahead of your child, in terms of the
language you are using.
Self-Talk and Parallel Talk: An important way of stimulating language development is modelling
language during interactions with children. Educators can talk about:
• what they’re doing (self-talk)
• what the child is doing (parallel talk).
When modelling language for young children it is best to talk about people, objects, places and events
that are in the immediate context (talking about what we are doing here and now).
Using self-talk and parallel talk allows educators to engage children in an interaction, providing
multiple examples of a particular vocabulary word or aspect of grammar in context, without requiring
the child to respond.
When using these strategies, educators can provide opportunities for the child to say the word, word
ending, or sentence structure, but they are not required or requested to do so.
Self-Talk: The educator describes and comments on what he/she is doing. Language is provided to
describe one’s own actions, when interacting and playing alongside children.
• e.g. “I’m sitting down next to Ahmed. I want to see what Ahmed is doing with his play dough.”
• e.g. “Look at all of this tasty fruit! I’m going to choose watermelon. I love watermelon. It’s my
favourite fruit!”
• e.g. “I’m digging in the sandpit! Digging deeper and deeper. I wonder where the digger is? I
think Danika has it!”
Parallel Talk
• the educator commentates or narrates what a child is doing
• language is provided to describe the child’s actions
• educators use purposeful pauses, eye contact and gestures to allow children opportunities to
communicate with words, sounds or gestures
• educator: “You’re building a tower! You’ve got the blue block, and it’s going on the long red
block. [pause] What is coming next? [pause] Now you’ve found the biggest green block!
You’re sliding it in between the blue and red blocks. [pause] Wow the tower is getting taller
and taller!”
Example with target vocabulary: eat and orange; context: teddy bear, toy animals, and toy fruit:
• educator: "Teddy is hungry. Let’s find some food for the teddy bear. Here’s an orange. [pause]
Do you want an orange? [pause] Teddy eats an orange. Doggy eats an orange."
[pause]
• child: [picks up orange and pretends to eat]
• educator: "you eat an orange too. Orange yum…" [pause]
• child: "orange" (approximation of word)
• educator: "everyone likes to eat orange."
Child-Directed Speech: When speaking with infants and toddlers we often change how we speak, in a
way often called child-directed speech. Child directed speech has been shown to be important for
developing speech and language especially for early communicators and early language users (Birth –
30 months)
Child-directed speech usually has:
• a higher pitch
• greater changes (fluctuations) in pitch, sounding a bit like singing than talking
• a slower rate
 • more fluent and clear pronunciation
• more frequent and longer pauses
• a smaller and more restricted set of words used in utterances
• a focus on objects or events happening now.
Child-directed speech should not be confused with talking as a young child would (e.g. “baby talk”). It
is a way of interacting that adults use with young children but does not involve simplifying language to
a great extent, nor introducing speech errors.
Expansions: This strategy is best used for early language users who are starting to use single words to
communicate. When a child says a word (or word approximation) or two-word phrase, educators
expand on the word(s) to make it into a short phrase or sentence. See examples below:
• child: "drink"
• educator: "Drink water" "Dog is drinking" "Teddy wants a drink"
• child: "up!" (with request gesture)
• educator: "Let me up please!" "Let’s go up!"
• child: "doggy run"
• educator "yes, the doggy is running. Look at the dog run!"
• child: "him hurt? "
• educator: "Is he hurt?"
Expansions are a great way to model how to combine words into short phrases and sentences, using the
words that children are already saying in context.
Expansions can help to keep interactions going and to tell children you are listening and that you
understand them.
Extensions: Extensions are useful language stimulation strategies for children who are combining
some words together (e.g. ‘big ball’, ‘go car’). We can use extensions to:
• show how to add more information to children’s language
• model how to communicate messages using a variety of different sentences.
See the following examples where educators are adding more information to extend upon children’s
language:
• child: "dog drink"
• educator: "Dog is thirsty. Dog drinks water."
• child: "car go"
• educator: "It's a red car. The fast car is going! The car goes… and stops."
• child: "baby cry"
• educator: "The baby is hungry. Oh no, the crying baby! The baby is sad."
Extensions allow us to respond to what children say and stay in their ‘zone of proximal development’
(Vygotsky, 1967).
By providing language modelling that is more complex than what they are already saying, we can
support children’s ability to process new information and learn new vocabulary and grammar. See the
following examples where educators show how an idea can be extended and built upon using a variety
of sentences:
• child: "dog drink"
• educator: "Is the dog drinking?" "Dog isn’t drinking." "Isn’t the dog drinking? "
• child: "car go"
• educator: "Is the car going fast? Look at the car go! When will the car stop?"
• child: "him sleepy?"
• educator: "Is he sleepy?" "The teddy bear is sleepy!" "Is it time for teddy’s bedtime?" "Go to
sleep teddy!"
• child: "I *buyed a orange"
• educator: "Wow, you bought an orange." "Did you buy a big orange?" "Let’s eat the orange!"
By using extensions, we can avoid explicitly correcting children when they make grammatical errors
(e.g. 'buyed' instead of 'bought', ‘her is hungry’, instead of ‘she is hungry’). Instead, we can use an
extension or recast to model and let children hear how an adult would express that idea or build upon it.

Language Stimulation for School Aged Children

The ability to produce what we think, in speech requires choosing the right word and
making sense to the other person. Communication is of great importance when it comes
to making decisions and acquiring knowledge. Students need to develop these skills as
early as possible and the best way to catch hold of such a skill will be to learn it from
their teachers. Students spend a long time of the day with their teachers. In this time, if
the teacher can focus on developing language and communications, it will do wonders
for the student in future. Having a strong grip over language and communication will
help the student become confident. The teachers are the ones, along with the parents
who can make sure that their students achieve in the development of language and
Communication.
Be Attentive and Listen: The first step to develop the communication skills is to listen.
You will need your students to understand this. To do so, you will have to set the
example first. Whenever they tell you something or come forward to talk to you, you
should be listening to them with full attention. Do not ignore or hush them away,
because you are not interested. The students will reciprocate in similar manner when
you want them to listen to you.
Talk and Discuss: Have group discussions and debates in classroom about relevant
topics. Even while you are teaching, ask questions and wait for students to take the first
step and reply back to you. Though some teachers may not encourage the talking of
students with each other, but during discussions, let them have a chat about the topic.
The teacher must take the role of the moderator. Make sure the point of discussion
doesn't get lost.
Use new Words: While you are taking a class, or just having a chat with your students,
make sure you use new words in your sentences. Make sure the students get the context,
and if it looks like they don't then explain the meaning to them. But while you are at it,
don't fill up all your sentences with just new words. Doing this might cause the students
problem in understanding what you are trying to convey, especially when you are
teaching a new concept.
Use Signs: While teaching complex concepts, include gestures and signs. This will help
the students to provide a meaning to the word, the sentence and the concept while
making things easier for them to understand. You can even draw on the board, and if
you aren't that great at drawing, use a projector and show images or videos. This will get
the students' attention, and you will find it that they understand the concept in a much
better way.
Read Aloud Every Day: Reading aloud and its follow-up conversation allows teachers
the opportunity to help students increase vocabulary, create a shared literary experience,
evoke discussion, and model fluency.
Reading: Reading to your child daily helps him or her to develop speech and language
skills. Reading together also offers a time of quiet comfort and bonding.
Use Word Walls: Word walls are another key component of a language-rich
environment. These organized displays of words provide an always-available visual
reference for students.
Create a Diverse Classroom Library: Fill your libraries with a variety of picture and
chapter books, magazines, graphic novels, travelogues. The more materials students
have available, the more likely they are to read, thereby increasing the amount of
language they are exposed to.
Put Language in Unexpected Places: Exposing students to language frequently and
systematically is important in a language-rich environment. Inspirational quotes that
have been painted all around the building, Students often stop to read the wording.
Because of daily exposure to the words, they have become normal part of the everyday
language.
Engage Your Students in Daily Conversations: Talk to students. Interpersonal
communication requires students to use all the language that have been working to help
them acquire in a natural, unstructured manner.
Homonyms. Promote listening and comprehension skills by playing with words that
sound the same but have different meanings. Allow your children to think of words that
sound alike and let them try to define each one. This is also a good gauge of how much
your children’s vocabulary has expanded and if their understanding of the words is
correct.
Storytelling. While storybooks provide ample entertainment, sharing stories – whether
real or make-believe – can provide a good bonding time with your children while
helping develop their communication skills. Exchange stories about daily events.
Broaden their imagination with fantastical stories and let their creativity grow as you
make up stories about anything and everything around them.
Tongue Twisters. Tongue twisters are an excellent and fun way to teach children
correct pronunciation and enunciation of words. It is a fun way to train their tongue to
pronounce words. Start with simple ones and work your way up.
Rhymes: The repetitive chanting, reading, writing, or hearing of rhymes promotes good
listening skills and memory retention, aside from developing speech. You can also
narrate what you do at home with rhyming words or let your children tell you about
their favorite toys using rhyming words.

Words can be a lot of fun if we know how to maximize their use. Together, they can be
made up into stories, songs, and a whole lot of other things that will help your children
be more eloquent. Continue to encourage your children to speak well by constructing a
healthy and fun learning environment where they can unleash their creativity and
broaden their linguistic skills. Guide them on how to express their thoughts, feelings and
actions better through the use of words

Speech Correction
The sequence of most treatment approaches for speech sound disorders are reflected in the following
phases of therapy:
Acquisition Training of speech / Establishment: Select number of sounds will be taught intensively.
Eliciting target behaviors and stabilizing production on a voluntary level goes through the steps of
teaching the target sound (the sound you want to teach) in isolation, syllables, words, sentences, stories,
conversation and finally generalizing the target sound in all contexts of language. Teach correct
placement and production (sometimes the hardest part of therapy). Some items used for stimulability
are Mirror, diagrams, tissues, gloves, See-scape Video Articulator, Sound-Level Meter, Spectrographs,
Straw, Tube from mouth to ear, FM system, Tongue Depressor.
There are four stimulability approaches.
➢ Auditory Stiumlation/ Imitation: this approach is the easiest; merely listen/watch, so what I
do
➢ Use of context: pair target sound with sounds that make it easier to produce
➢ Moto-Kinesthetic: move articulators with gloved fingers, tongue depressors, etc
➢ Sound Approximation: Shaping; go from a /t/ to an /s/ by holding out the /t/, an /s/ to a /th/,
etc
Generalization of Speech
Use the sound in spontaneous speech in all situations by enlarging treatment situation (activities,
conversational partners, settings etc.) with the incorporation of self-evaluation and self-monitoring but
Self-monitoring can be very difficult at this level. For example, Role playing in clinical setting, Speech
assignment to use /f/ at dinner table at home. The goal is to have fully correct production in everyday
conversation. Probably need specific time for this to at least measure production accuracy.
Generalization occurs when there are no more errors associated with target sound. generate more
natural practice situations to make production more natural and automatic (use outside the therapy
room). facilitating carry-over of sound productions at increasingly challenging levels (e.g., syllables,
words, phrases/sentences, conversational speaking). Thin is not uncommon to see mostly correct
productions in the clinic room but the errors return in other settings. May need to plan conversations in
other places. Setting up a home program often helpful (ask parents / older siblings to monitor speech).
May be done by a speech assistant. Once the sound has been mastered in words, sentences, stories and
in conversation you want to watch for generalization across all the contexts of language. If there seems
to be difficulty in generalizing the target sound go back and practice the words, sentences and stories
again until the sound is produced correctly in daily speech.
Maintenance: Progressive check-up of client to see that productions remain correct 1 month, 3 months,
6 months. Stabilizing target behaviors and making production more automatic; encouraging self-
monitoring of speech and self-correction of errors.

What Is Articulation Therapy: When a child has difficulty forming sounds it may affect their
development and other aspects of their lives. For example, a child with an articulation error may have
difficulty completing schoolwork or interacting socially with their peers. This is where articulation
therapy comes into play. The goal of articulation therapy is to help a child produce challenging sounds
and achieve age-appropriate speech. A key point in understanding articulation errors is their
relationship to physiological, rather than psychological, issues. A child who has a rhotacism, or the
inability to pronounce the letter /r/, understands how to pronounce the letter and sound, but has a
physical impairment that prevents him or her from producing them correctly.
Initially, a speech-language pathologist will determine which sounds will be most beneficial to target
in terms of generalizing to other sounds and overall speech intelligibility. The process of therapy will
begin by teaching the sound or sounds in isolation. This isolation process will be able to teach the
accurate production in terms of placement in the mouth and movement of the articulators. Once
production of the sound is mastered, the speech pathologist will follow a hierarchy of more complex
language targets to generalize the sound to words, phrases, sentences, and, eventually, conversational
speech. A hierarchy of speech levels includes mastering the production of the sound in that context at
80% accuracy or higher across a number of sessions.
 The Process of Articulation Therapy
Target Sound
The Process of Articulation Therapy goes through the steps of teaching the target sound (the sound you
want to teach) in isolation, syllables, words, sentences, stories, conversation and finally generalizing
the target sound in all contexts of language

Isolation
To practice the target sound in “isolation” just say the sound all by itself without adding a vowel. For
example, if you are practicing the /t/ sound say /t/, /t/, /t/ multiple times in a row. When the target
sound is said accurately in isolation move on to syllables.
If you are unable to get an accurate production of the target sound in isolation you may want to
reference a “Speech Sound Development” chart to make sure the sound is developmentally
appropriate. If it appears the target sound is in fact delayed and you still cannot get an accurate
production of the sound contacts a Speech-Language Pathologist for some guidance.
Syllables
To practice the target sound in “syllables” simply add a vowel to the target sound. To practice a sound
in the initial position of syllables add a vowel after the target sound like “to”. To practice a sound in
the medial position of syllables add a vowel before and after the target sound like “otu”. To practice a
sound in the final position of syllables add a vowel before the target sound like “it”. Be sure to practice
the target sound with all the different vowel variations. When the target sound is mastered in syllables
move on to words.
Words
To practice the target sound at the word level start by determining which position of the word (initial,
medial or final) you want to target first. Begin with the sound position that the target sound was
produced the most accurately in at the syllable level. For example, let’s say the target sound was
produced the most accurately in the initial sound position. In this case you would then practice the
target sound in the initial position of words until the target sound is said correctly at least 80% of the
time. Once the target sound is said correctly in the initial position of words move on to practicing the
target sound in the initial position of sentences. You will want to practice this sound in the initial
position of words, sentences and stories before you switch sound positions and start practicing the
target sound in another sound position like the final or medial sound positions.
Sentences
To practice the target sound in sentences, start with a “rotating sentence” or a carrier phrase. In a
rotating sentence or a carrier phrase the sentence stays the same while only the target word changes.
For example, your sentence might read, “The teacher taught about the toy.” or “The teacher taught
about the toad.” Then you rotate all your target words through the sentence. This is an especially great
way to practice sentences for young children who can’t read yet. They are able to memorize the
sentence or use visual cues to help them read it aloud. You are also able to maximize the production of
your target sound when you use a sentence with two or three target words in it.
Once rotating sentences are mastered unique sentences that change every time offer even more
opportunities to practice the target sound in the specified sound position. When the target sound is
produced correctly at least 80% of the time move on to stories.
Stories
To practice the target sound in stories, select a story with the target sound appearing frequently. Read
the story through multiple times until the target sound is produced accurately at least 80% of the time.
Once the target sound is produced accurately while reading aloud move on to retelling the story in their
own words. If the target sound is produced correctly while retelling a story and has been mastered in
all the sound positions (initial, medial and final) of words, sentences and stories move on to
conversation.
Conversation
To practice the target sound in conversation takes some creativity. You may want to try to center
conversation topics around some of the target words they have mastered or you may just want to set a
specified time to focus on the correct production of the target sound during conversation. Be sure to
correct any inaccurate productions of the target sound during the conversation.
Generalization
Once the sound has been mastered in words, sentences, stories and in conversation you want to watch
for generalization across all the contexts of language. If there seems to be difficulty in generalizing the
target sound go back and practice the words, sentences and stories again until the sound is produced
correctly in daily speech.

Traditional Articulation Therapy

The most well-known spokesperson for the traditional articulation approach was Charles Van Riper.
Van Riper outlined the basic steps in 1978. A Traditional Articulation Therapy approach also goes by
several other names
• Motor approach
 • Traditional approach
• Articulation approach
• Sensorimotor approach
• Phonetic Therapy
It is applied to phonetic errors. It may also be appropriate in some case with phonemic problems. Child
may be quite stimulable for the error in a particular context but not in others. Child may need some
"motor practice" to establish the sound. In these cases, not all of the steps in a phonetic approach may
be necessary.
"The Traditional Approach is a clinician-driven approach that uses a hierarchical progression
(vertical approach) to correct speech sound errors. It targets a single sound/phoneme at a time.
Main goal of traditional articulation therapy is to help improve the client's intelligibility by
correcting speech sound errors/misarticulations".
The Traditional Approach Consists of five intervention phases:
Therapy Sequence
1. Sensory-perceptual training: also called auditory training or ear training/ Discrimination
2. Stimulabilty: Also known as Sound Elicitation; teaches correct placement and production
(sometimes the hardest part of therapy)
3. Production / Stabilization: Teaching the child to produce the sound in isolation, nonsense
syllables, in words, phrases / sentences, spontaneous speech
4. Transfer and Carry over / Generaliztion
5. Maintenance
To move from one level to the next, we set some criterion for "mastery". Most clinicians use 80-90%
correct for all levels except spontaneous speech. Research suggests that once accuracy reaches at least
50% in spontaneous speech, progress should continue to mastery without much additional help.
Phase 1. Sensory Perceptual Training / Auditory Training
• Also called auditory training or ear training. Only needed if discrimination is a problem.
Teaching child to hear the difference between the target sound and what they usually use in its
place. Several steps (clinicians don't always use every step)
Step 1. Identification
➢ Give sound its vivid characteristics, for example is /f/ is angry cat sound.
➢ Want child to be able to recognize the target sound in isolation.
➢ Have child practice listening to the sound by itself and compare it against other similar
and dissimilar sounds.
 ➢ May need simple labels (metaphors) for the sounds for very young children.
➢ May need to begin by contrasting the sound against a very different sound (acoustically
or productively very different).
Step 2. Isolation
➢ Child's goal is to be able identify sounds in series of phonemes. For example, when
you hear the sound /f/ tap table.
➢ Sound is produced in a variety of word positions and in a variety of material words,
phrases, sentences, narrative.
Step 3. Stimulation
➢ Child hears and tries to identify the sound produced in a wide variety of contexts and
forms for example, Listen to the story with "f" words
➢ Practice with different speakers, different rates, different volumes, different types of
material. This step is frequently omitted (difficult to organize the material)
Discrimination
➢ Also called error detection and error correction
➢ Child hears the target sound contrasted with the error they usually make in a variety of
contexts. Child is required to say whether the target sound is correct or incorrect
➢ Second stage where child is asked to identify errors in their own speech
Special Considerations
➢ Younger children may have difficulty with identifying where a sound is in the
word.This is a "phonological awareness" task (a type of metalinguistic task).
➢ Must be able to appreciate that words consist of smaller units (sounds) that can be
separated. Most preschool children have trouble with this.
Self-Monitoring
➢ During the early phases of phonetic therapy, we need to help the child pay attention to
their own productions (self-monitor).
➢ They need to be able to judge the correctness of their productions.
It has been suggested that for some children simply training them to hear the sounds may result in
correct production. There is no solid evidence either way. Certainly, would only apply in those
situations where discrimination is a problem.
Phase 2. Stimulability
➢ Also known as Sound Elicitation; teaches correct placement and production (sometimes the
hardest part of therapy).
 ➢ Some items used if stimulability are Mirror, diagrams, tissues, gloves, See-scape Video
Articulator, Sound-Level Meter, Spectrographs, Straw, Tube from mouth to ear, FM system,
Tongue Depressor
➢ There are four stimulability approaches.
➢ Auditory Stiumlation/ Imitation: this approach is the easiest; merely listen/watch, so what I
do
➢ Use of context: pair target sound with sounds that make it easier to produce
➢ Moto-Kinesthetic: move articulators with gloved fingers, tongue depressors, etc
➢ Sound Approximation: Shaping; go from a /t/ to an /s/ by holding out the /t/, an /s/ to a /th/,
etc
Phase 3. Production / Stabilization
Step 1. Production in isolation
➢ Trying to teach the child the specific physical movements required to produce the sound by
itself. For example, watch me in the mirror and say /f/ just like I do.
➢ In most cases you should be able to get a few good productions within 5-10 minutes. If not,
switch to another target sound to avoid having the child become frustrated.
➢ Always try imitation – simplest technique is to ask the child to listen to you and "try to do what
you do". Continuant sounds (fricatives, liquids, glides, nasals) can be prolonged to heighten
awareness (hear and feel it more). With stops, you must model in a syllable
➢ Phonetic placement: Tell the child specifically where to put the articulators and what to do with
them to make the sound.
➢ Sound modification: Also called sound shaping. Take a similar sound and show the child how
to modify it so that it becomes the target sound.
➢ Symbolic noise: A variant of sound shaping. Elicit the target consonant as symbolic noise (hiss,
growl, machine noise, etc.) and then modify context and mechanics of production so that it is
produced as speech.
Certain phonetic contexts have been shown to make it easier to produce certain sounds (for some
children). Almost always real words. Called 'facilitating contexts'. May explain why some children can
produce the sound in only some contexts but not others.
Step 2. Stabilization in isolation
➢ Practice the sound in various ways, (softly, quickly, whispered). For example say /f/
every time I ring the bell.
Step 3. Production in Nonsense Syllables
 ➢ Allows you to help establish accuracy of production of consonant-vowel combinations
(CV, VC, CVC). For example, /fi/, /if/, /ifi/
➢ This step is frequently skipped; move directly to real words to make the process more
meaningful. May be a very necessary step for some children (real words may trigger old
habits).
Does not have to be strictly imitation though it often starts with that. Can create "abstract" or nonsense
shapes or drawings to use to represent each syllable. Could use colored blocks or create shapes with
building blocks for each syllable.
Step 4. Production in Words
➢ It includes several levels of complexity that you may need to work through in sequence. Words
with fewer syllables usually easier.
➢ Vary, correct and stabilize monosyllabic and multi syllabic words in the initial, middle and
final positions. For example, /fit/ (model and then no model), /lif/ (model and then no model)
then /fit/ and /lif/ (no model).
➢ Prevocalic position tends to be easier than postvocalic which may be easier than intervocalic.
Open syllables easier than closed syllables.
Sounds are usually easier to produce in stressed syllables than unstressed syllables. Certain sound
combinations may be easier due to coarticulatory effects (recall facilitating contexts). Very familiar
words may be easier than less familiar ones (but may be more difficult for some because of "habit
strength").
Step 5. Structured Phrases / Sentences
➢ Vary, correct and stabilize in sentences in all positions.for example, the shoe did not /fit/, A
/calf/ is a baby cow, she is /laughing/ (model then no model).
➢ Not always possible to go straight from words to spontaneous speech.
➢ Create a "carrier phrase" to practice a series of words in (e.g., "I see a ________.").
➢ Playing "go fish" can be helpful here "Do you have a ________?" (or other games that require
frequent use of phrase like that).
Phase 4. Transfer and Carry Over/ Generalization
Spontaneous Speech
➢ Use the sound in spontaneous speech in all situations by enlarging treatment situation
(activities, conversational partners, settings etc.) with the incorporation of self-evaluation and
self-monitoring but Self-monitoring can be very difficult at this level. For example, Role
playing in clinical setting, Speech assignment to use /f/ at dinner table at home.
 ➢ The goal is to have fully correct production in everyday conversation. Probably need specific
time for this to at least measure production accuracy.
Generalization occurs when there are no more errors associated with target sound. generate more
natural practice situations to make production more natural and automatic (use outside the therapy
room). facilitating carry-over of sound productions at increasingly challenging levels (e.g.,
syllables, words, phrases/sentences, conversational speaking). A big issue in therapy. Not
uncommon to see mostly correct productions in the clinic room but the errors return in other
settings. May need to plan conversations in other places. Setting up a home program often helpful
(ask parents / older siblings to monitor speech). May be done by a speech assistant.
Phase 5. Maintenance
Progressive check-up of client to see that productions remain correct 1 month, 3 month, 6 month.
stabilizing target behaviors and making production more automatic; encouraging self-monitoring of
speech and self-correction of errors.

Augmentative and Alternative Communication (AAC): Augmentative and alternative

communication (AAC) describes multiple ways to communicate that can supplement or compensate
(either temporarily or permanently) for the impairment and disability patterns of individuals with
severe expressive communication disorders.
AAC is a range of strategies and tools from simple letter or picture boards to sophisticated computer
technologies. AAC helps someone to communicate as effectively as possible, in as many situations as
possible.
AAC stands for ‘Augmented and Alternative Communication and it’s a method of communicating
without speech (alternative) or where speech is used together with another form of communication
(augmentative).
Augmentative and Alternative Communication (AAC) includes all forms of communication (other
than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we
make facial expressions or gestures, use symbols or pictures, or write.
People with severe speech or language problems rely on AAC to supplement existing speech or replace
speech that is not functional. Special augmentative aids, such as picture and symbol communication
boards and electronic devices, are available to help people express themselves. This may increase
social interaction, school performance, and feelings of self-worth.
AAC users should not stop using speech if they are able to do so. The AAC aids and devices are used
to enhance their communication.
Types of AAC Systems: When children or adults cannot use speech to communicate effectively in all
situations, there are options.
• Unaided communication systems: Unaided modes of communication include non-spoken
means of natural communication (including gestures and facial expressions) as well as manual
signs and American Sign Language (ASL). These modes of communication often require
adequate motor control and communication partners who can interpret the intended message.
• Aided communication systems: Aided modes of communication include those approaches that
require some form of external support or the use of tools or equipment in addition to the user’s
body, such as a communication boards with symbols (e.g., objects, pictures, photographs, line
drawings, visual-graphic symbols, printed words, traditional orthography) or computers,
handheld devices, or tablet devices with symbols that generate speech through synthetically
produced or recorded natural (digitized) means.

AAC can also be divided into ‘low-tech’ and ‘high-tech’.

• Low-tech requires the person to use something external to them, either non-electronic or a
simple electronic device.
• High-tech types of AAC use electronic devices similar to computers. The table below provided
examples for each system:
For individuals with severe disabilities, it can be helpful to encourage (and teach) both unaided and
aided modes of communication. Individuals may need to be taught when it is appropriate to use
different modes of communication. For example, the individual may sign when interacting with
parents at home but may use a picture-based system or speech generating device (SGD) with other
communication partners. Individuals with very complex needs and a limited communication repertoire
can learn to use different systems in different contexts.
Speech Pathologists are able to assess and provide treatment for children with varied diagnoses who
may benefit from the use of augmentative communication which will provide them with or improve
their communication. Our Speech Pathologists are experienced at using a variety of augmentative and
alternate communication devices and methods. Using augmentative or alternative communication can
often be an exciting time for children/adolescents and their families as it can decrease frustration
resulting for difficult or no speech and improve the child/adolescent’s sense of independence and self-
worth, opening up pathways for self-expression, socialization, learning and function.
The use of AAC does not mean that speech will cease, or stop being encouraged but rather enhances
the child/adolescent’s communication and in some cases allows for speech to begin. Augmentative and
alternative communication includes all forms of communication (other than oral speech) that are used
to express thoughts, needs, wants, and ideas.
Speech pathology intervention may include the development of unaided communication systems,
which include gesturing, sign language and body language, or aided communication systems which
involves the use of a tool such as books, boards, devices, and iPads.
Speech Pathologist may be able to assist with the implementation of an AAC program within the home,
community, preschool/school, and other therapy sessions. Practicing these skills intensively in other
settings, assists them to develop their communication skills within a functional context.
Decision About AAC Systems and Interventions: The currently accepted evidence suggests that
there are no specific prerequisites (e.g., age, cognitive, linguistic, motor) for getting started with AAC.
A number of AAC options are available to begin the intervention process. Ideally, the decision to
introduce AAC should be made in consultation with the consumer, family, and a team of professionals.
However, no individual should go without communication, and all individuals should have access to
AAC systems that promote effective communication.
AAC should also be considered for individuals who have some speech or speech that is unintelligible
to unfamiliar listeners. These individuals may use AAC to augment their communication. Other
individuals may use speech in low-demand contexts but choose to use AAC to augment their
communication in high-demand contexts. The presence of speech should not preclude the
consideration of AAC as a support.
Decisions When Choosing Aided AAC: A speech pathologist will help you decide which AAC
system best suits your needs. They will take the following factors into account:
• Age
• Physical skills
• Family & culture
• Level of development
• Individual interests
• Personality
• Communication skills of the individual
• Level of assistance required
• Environment/context
• Cost
Choosing an aided AAC system requires careful consideration of an individual’s current skills,
strengths, and needs, but it is important not to restrict the individual’s potential. Assessment strategies
can lead to an understanding of:
• Options for different symbols, systems, and access modes
• The contexts where the individual must communicate
• The skills and supports available to partners
• The profile of the individual including vision, hearing, sensory-motor, motivation, cognitive,
linguistic, literacy skills, and current modes of communication