In English, prosody (intonation and word stress) is affected by what happens at the end of the word, phrase, or sentence. For example, yes/no questions are marked by pitch going up at the end of the sentence; statements have a pitch fall on the last word or phrase. Also, adding an ending to a word can change the stress pattern. For instance, the stress in the word “eLECtric” shifts from “lec” to “tri” when we add “ity” to the end: “ElecTRIcity”. For these reasons, it is easier to learn to pronounce an English word or sentence with natural prosody if you start from the end and work forward. This is called a “backward build-up”. Because children with CAS are at risk for prosody problems as well as having difficulty with longer or more complex utterances, backward build-ups are an important strategy to use with them.

Heres the procedure:

First, model the last syllable or two (depending on how much difficulty the person is having saying the utterance). Its somewhat easier if the part youre modeling starts with a stressed syllable, if possible, but adding two syllables at a time may be too difficult for some children.

DOcious

Be sure that both the modeler and the child are stressing the correct syllables, and raising or lowering their pitch in the right places. The fragment should sound natural, as if it was spliced out of a tape of the whole word or sentence.

When the child can say that part fairly easily, add another syllable or two:

AliDOcious

Dont move on until the portion that youve already done can be produced pretty automatically. If the person stumbles, remove a syllable and practice that shorter version until it becomes easy, then try moving on again. Continue in that manner, until the person has mastered the whole word or sentence.

EXpiAliDOcious

LISticEXpiAliDOcious

FRAgiLISticEXpiAliDOcious

CAliFRAgiLISticEXpiAliDOcious

SUperCAliFRAgiLISticEXpiAliDOcious.

Tip: Its often helpful to both the SLP/teacher/parent and the child to write down the word or phrase, covering up the beginning part of it with a piece of paper and only revealing it gradually as you get there.

This technique works for anyone who is having trouble learning to say a difficult word or phrase. It is often used by teachers of English as a Second Language. I used it to try to learn the word that Welsh children love to challenge foreigners with, the name of a town in the middle of Wales that made itself a famous tourist destination via its long name: Llanfairpwllgwyngyllgogerychwyrndrobwllllantysiliogogogoch! With the added difficulty of very un-English-like Welsh stress patterns and consonant sounds, I only made it about halfway through the word, though, I must confess.

[Dr. Shelley Velleman is Associate Professor of Communication Disorders at the University of Massachusetts – Amherst. She has conducted research and written numerous journal articles about childhood apraxia of speech, its diagnosis and treatment in addition to presenting conferences and workshops on apraxia across the country. Dr. Velleman’s research interests include: early phonology; babble; developmental verbal dyspraxia; phonological disorders; and the relationship between phonological disorders, language disorders, and learning disorders/differences. She is also on the Apraxia Kids Professional Advisory Board.]