We believe in making speech practice fun and play-like whenever possible. One way to do this is to think about what types of activities your child enjoys and how to incorporate speech practice into those activities. This encourages your child to be emotionally invested in the practice and more “in control”. You’ll get better cooperation this way and find practicing a lot less stressful. Below are some examples of different activities for speech practice. Keep practice sessions short and fun when possible. As much as possible, do what fits into your lifestyle and daily schedule. Let siblings and friends participate in the activities with everyone practicing the speech targets. You don’t have to use the practice sheet the therapist gave you. Write the words on 3 x 5 cards and have your child draw a picture on each (they don’t have to be great), or you do this. Then use these in fun activities or games during the day.

Get on the Move: Use Movement Activities to Encourage Speech Practice.

• For example, write or draw pictures of the speech sounds, syllables or words on 3 x 5 cards. Scatter these around a room or outside. Have your child run or hop or skip to a card (let your child pick what type of physical movement he/she wants to do to go get the cards). The child says the word on the card three times, then runs, hops or skips back to you. He/she says the word three more times, then can put the card into a basket or small paper bag. Do this for all the cards.
• Do the same in a hide-and-seek activity. “Hide” the cards and let your child search for one at a time. When he finds one, he says the word three times, then brings it back to home base (you). He tells you the word three times, then goes to find another card. Play again, but this time let him hide the cards and you search for them. When you bring a card back to him you both must say the word three times.
• Throw or bounce a ball back and forth, practicing a word each time before the ball is thrown. Do the same for throwing a basketball through the hoop.
• Go to the playground or park. Push your child several times on a swing, catch the swing, have your child say a word three times, then resume pushing. Play on the slide. When your child is sitting at the top of the slide put your arm across the top of the slide in front of him to make a barrier and say “stop”. Have him say a practice word after you three times. Lift your arm and cheerfully say “go” and let him slide down.
• Play “Red Light-Green Light”. This is a fun game to play with several children. The children line up across the lawn from you. The object is to be the first one to arrive at the base (you) without getting caught. You turn your back and say “green light,” at which time the children can take big steps toward you. When you say “red light” they must stop moving completely before you turn around. Anyone caught moving has to go back to the starting line. Each person must say a speech practice word before you can turn around to say “green light” to resume the game.
• Make an obstacle course with a word card in front of each obstacle. For example: have a large cardboard box laying on its side that is open on both ends that the child can climb through, a pillow she can roll over, a chair she can crawl under, a wrapping paper roll she can jump over, etc. She has to say the word on the card before attempting each obstacle. This is great for motor planning also.
• Write a movement activity on each card below the practice word. Put all the cards in a paper bag. The child reaches in and pulls one out, says the word several times, then performs the activity (e.g., “say your practice word 2 times, then turn in a circle 2 times). You take a turn too.

Use Pretend Play Activities to Encourage Speech Practice.

• Do you have left over party bags or boxes? Hide a practice card in each one and play birthday party. Use a dialogue thats appropriate for a pretend party. Make a cake out of playdoh, letting your child practice a word in order to put a candle on the cake. Then let him/her open one present at a time. He says the practice word 3 times to put it in his present pile.
• Set up a play scenarios such as, Lets pretend Barbie is going to the beach. Lets pack a suitcase for her. (This can be a small suitcase or a shoe box). Get out a bunch of Barbie clothes and equipment. The game goes this way. Each person gets a turn – on your turn you pick a speech word, say it 3 times, then you get to put something in the suitcase. Each player does this multiple times. You can use 2 suitcases and see what the other one packs. You can make this funny, I think Barbie would want to swim in this long ball gown, so Im going to pack that.

Use Board Games or Building with Blocks to Encourage Speech Practice.

• Play Hi-Ho Cherry-O, Shoots and Ladders, Bingo, any child board game. Each player picks a speech card or points to a speech word on the practice sheet, says the word, then gets to roll the dice, pick a game card, do the spinner, etc.
• Blocks, Legos and Duplos are great for this – you take turns saying words to get to add another piece onto the structure. You can also do this with puzzles.

Preacademics

• Buy a book with simple coloring and preschool activities. These are available at Wal-Mart, K-Mart, or the grocery store. Let your child pick a picture in the book. When she says a word 3 times she can color one part of the picture. Then you take a turn to say a speech word and color a section of the picture. Take turns until the picture is completed. Hang proudly on the refrigerator. This is fun to do with dot-to-dot pages also.
• Make an alphabet book. Write an alphabet letter at the top of each page of a spiral notebook. Add pictures (clip art, cut from magazines, hand drawn) with a written word under each for each speech practice word. This is cumulative – you keep adding new words to the book each week. This is a great way to review speech words and build literacy early skills.

Use the Computer

• Help your child type a speech practice sound, syllable, or word on the computer using a fun, large font. Have her say the word 3 times, then copy and paste it on the computer. She can do this multiple times, saying the word each time its pasted. Print this out and mail it to Grandma. You can use different fonts, different colors, or print it on colored paper to add interest.
• Use a clip art program to print multiple copies of a picture of a target word on a page. Each time he pastes a picture on the page he has to say the word 3 times.

Make a Photo Album

• Use a small photo album that holds single pictures on each page. Take pictures that represent speech targets, using the child in as many of the pictures as possible. Write the target sound, syllable, word, or phrase on a file folder label and put it on the bottom of each picture. That way everyone who looks at the book with the child will know what word to practice. This also encourages early literacy skills. For syllables you could have pictures to represent mo for more, wa for want, ba for ball. For reduplicated syllables have a picture of 2 balls for ba-ba, people (mama, dada, nana), or animals (moo-moo, woof-woof, neigh-neigh). If child is practicing initial /b/ words for example, take a picture of a big ball with a friend whos a boythere you have words such as big, ball, boy, and bye. Our children love looking through their picture books and showing them to friends and family. This is a great way to build a core vocabulary and to practice repeatedly on words that are important to your child such as his name, his friends names, or his favorite activities, toys and foods.

Make it Predictable: some children like to know their practice schedule and how long they will spend practicing.

• Set up a routine practice time each day. Draw boxes on a piece of paper, one for each word the child will practice. Tell him the rules”I’ll put a star in a box each time you practice one of your words. When you have 3 stars in a box, well color that box. When all the boxes are colored, we’re finished!”

Reward System: Set up a reward system. All of us enjoy a reward for a job well done.

• Use the box system above, but now draw a happy face when your child has finished practicing his words for the day. When he has 5 to 7 happy faces he can pick a prize from a special toy box. Have a variety of small prizestoys from McDonalds, a matchbox car, a coupon for lunch out, a piece of Barbie clothes, a coupon for a trip to the park or library, sunglasses, toy jewelry, crafts activities, stickers, markers, etc., etc. One child I worked with loved tools so I bought a set of toy tools and tool belt for the toy box. Every time he earned a trip to the toy box he could pick any one of the tools he wanted. He became excited about practicing his “speech homework” because he was working toward something meaningful and fun for him.
• This system works well when your time for practicing is limited or your child is reluctant to practice.

Practice in New Places: you can practice anywhere.

• The car is a great place to practice. Put the speech words on 3 x 5 cards, punch a hole in one corner of each card and put them a special key ring for your child. Every time you stop at a red light see if you and your child can say one of the words 3 times before the light changes. Make it into a game called “Beat the Light.”
• Mealtime is a great way to incorporate the whole family into practice. Have your child “hide” a card under napkins as you set the table. She has to say the word 3 times to hide the card. When everyone sits down to eat, each person lifts their napkin to find a card. Your child tells them what the word is and they must repeat it after her one to 3 times before they can eat dinner.
• Put practice cards on doorways around the house. To go through the doorway each person must say the “magic” word 3 times.

Truly respect that speech is difficult for him, but that you have faith in his abilities. Let him know you will help him through any difficulties. For example, tell him you will write down any “hard” words to give to the therapist to come up with special tricks to make them easier. Always praise your child for attempting speech targets, even when he wasn’t fully correct. You can tell him “good try,” “I like the way you were watching me,” or “Wow, you got really close that time.” Then model (say) the word again using helpers such as touch cues and have him try again.

Just remember that if we make practicing fun, playful and rewarding both you and your child will enjoy it.

(Robin Strode, M.A., CCC-SLP, has been a practicing speech-language pathologist for 28 years, currently specializing in serving preschool children with a large variety of special needs. She and her partner, Catherine Chamberlain, have presented numerous workshops throughout the United States on the topics of Developmental Verbal Apraxia and Oral-Motor Facilitation of Speech Skills. They also serve as consultants to speech-language pathologists, teachers, schools, and families. She and Ms. Chamberlain have written seven joint publications for LinguiSystems, including three best sellers: Easy Does It for Apraxia and Motor Planning, Easy Does It for Apraxia: Preschool, and Easy Does It for Articulation: An Oral-Motor Approach. Additionally, Ms. Strode is a member of the Childhood Apraxia of Speech Association’s Professional Advisory Board.)

(Note: Apraxia-KIDS thanks the author and Pediastaff, where this article originally appeared, for permission to reprint.)

Young children with suspected childhood apraxia of speech (CAS) and children with very severe CAS present unique challenges to speech-language pathologists. When children begin to develop some volitional control over the production of syllables, the speech-language pathologist can help to shape increasingly complex speech movement sequences and support the child’s acquisition of a complete phonemic repertoire. For children who do not imitate speech reliably, however, other treatment strategies need to be utilized. Following are several strategies to support the development of more reliable volitional imitation and early speech in children who are nonverbal or minimally verbal.

Support Attainment of the Precursors of Motor Learning

The lack of speech imitation in children past the age of two years creates a great deal of anxiety for parents and caregivers. We as SLPs want to see those first words emerge, too; however, when children have not developed precursors to motor learning (Strand & Skinder, 1999), including (a) trust and motivation; (b) focused attention and effort; (c) an understanding that the goal of treatment is the practice of movement, and (d) an understanding of the tasks at hand, our efforts to elicit speech imitation may be futile. This does not mean that children need to be able to sit quietly and attentively in a chair for a period of several minutes before attempts to elicit speech are introduced. It does mean that the SLP needs to be sensitive to where the child is developmentally, and work to support the child’s focus, attention, direction following, simple imitation, and motivation to try challenging things. Speech therapy becomes much more productive if time is taken earlier on and throughout the treatment process to facilitate these precursors to motor learning.

Reinforce Vocalizations and Oral Movements

Before children begin to imitate vocalizations, they vocalize by cooing and babbling. It is important to provide positive reinforcement for children’s vocal productions, even when these productions are not volitional or imitative. Telling a child, “I love all those lip sounds you’re making!” may lead to an increase in babbling, and these sounds gradually can be shaped into volitionally produced, meaningful words.

Attach Meaning to Vocalizations

When we attach a meaning to a child’s sound productions, we help the child learn that their verbal behavior elicits certain responses. The child who says, “ma,” in the context of playing with a ball may be babbling, or may be trying to say, “ball” or “more.” By treating the vocalization as a meaningful word, the therapist links the child’s speech with a favorable response of receiving a desired toy. We can respond to the child’s production by enthusiastically saying, “Oh, you want the ball. Here you go!” thereby increasing the likelihood that the child will produce the same utterance again in hope of a similar response. Teaching parents and caregivers to begin to recognize their child’s sounds as meaningful is equally important to the therapy process.

Talk About Speech Movements

Children need to understand that the purpose of their therapy visits is to work on movement and sounds. When children stick out their tongues, talk about it; bring it to their attention and make movement and sound become the forefront of the sessions. Comments by the parents and clinician, such as, “Wow, I see your tongue,” “I love to hear all your noisy sounds,” or “I see you smacking your lips. You’re a great lip smacker,” help the child to recognize the importance of sounds and oral movement. Bringing movement to the forefront helps set the stage for what the speech therapy is all about, thus supporting attempts at further speech movements.

Facilitate Imitation

Prior to speech imitation readiness, children need to develop other types of motor imitation skills. When children engage in back and forth imitation, they are learning the important skill of “you do what I do,” an essential skill in the process of speech praxis treatment. Rather than pushing imitation of sounds and words, determine what types of movements the child is able to imitate and work from there. Refinement of imitation is a gradual process, and can be facilitated by beginning with whole body movement (rocking back and forth), imitation of actions during play (banging a drum, stacking blocks), smaller movement imitation (clapping, wiggling fingers, shaking head), imitation of oral/facial movements (sticking out tongue, smacking lips), vocal imitation (basic sound and syllable play), and, finally, imitation of true words. Although parents may be eager for their children to begin saying real words, it is important to help them understand the importance of developing a strong base of imitation prior to asking the child to say words, and to have them engage in these types of imitation routines at home.

If the child does not readily imitate body or vocal movements, one way to get the imitation turn-taking routine going is to imitate what the child is doing. When the child bangs on a table, makes tongue-clicking sounds, or vocalizes a neutral vowel, the therapist and parent can match the movement or sound, usually to the delight of the child. After the turn-taking routine is established with the child in the lead, the therapist or parent can change it by doing something a little different. If the child is banging on the floor, the therapist may bang on a chair instead. If the child is making tongue clicks, the therapist may, instead, make lip-smacking sounds. Praising the child for these imitative attempts is equally important to support the establishment of purposeful, volitional imitation skills upon which speech praxis treatment is based.

Use Toys That Reinforce Early Sound Effects and Simple Exclamations

Prior to the development of “true words,” children typically produce silly sounds and sounds effects, such as coughing, grunting, chewing noises, raspberries, and snoring. Animal and vehicle noises also are among the sounds children master in the context of play and book reading. Encourage production of these sounds by incorporating toys and activities that elicit these sounds. Toy animals, animal puzzles, vehicles, foods, cooking gadgets, and building tools, all serve to elicit repetitive modeling of playful sounds that the child can be encouraged to imitate. Linking a movement to a sound offers an additional cueing mechanism for the child. For example, each time the buttons on the microwave are pushed when “making” playdough cookies, the therapist or parent can say, “beep, beep, beep.”

Pause with Expectation

For children who are quite delayed in babbling and sound imitation, lack of vocal responsiveness becomes an expectation. After children have begun to develop some ability to imitate some vocalizations, a shift should occur on the part of the therapist and family that helps the child recognize that being passive during turn-taking routines is no longer the expected response. Pausing and looking at a child expectantly lets the child know that some response is expected. Offering positive reinforcement when the child takes the risk of making a vocal response further solidifies shared enjoyment in the turn-taking process, paving the road to continued effort and continued success.

It is beneficial to model the target sound effects and target words during therapy using a focused stimulation approach (Ellis Weismer & Robertson, 2006). During focused stimulation, the therapist or parent produces the target sound or word frequently and in a way that brings a heightened awareness of specific phonemes or sounds. Treatment targets can be emphasized by (a) pausing just before the target word is produced (e.g., “Here’s a … ball, and here’s another … ball … and here’s another …ball”); (b) increasing the duration of the vowel of the target word or prolonging a consonant (e.g., “Yummy banana. Mmmmmmm” or “The airplane is going higher. It goes uuuuup, uuuuup, uuuuup.”); and (c) securing the child’s visual attention prior to modeling the target word or sound. Using amplification tools, such as an echo microphone, Toobaloo®, or even a paper towel or wrapping paper roll, may help to focus the child’s attention and generate interest in repetition of sounds and words.

Reduce the Number of Target Utterances Per Session

Strand and Skinder (1999) recommend limiting the number of target utterances in the stimulus set introduced during a therapy session to no more than five or six utterances. In this way, blocked practice of a small number of treatment targets could be accomplished. This repetitive practice of a small number of targets supports the child’s ability to master new movement plans in the earlier stages of learning.

Use Tactile and Proprioceptive Input

Ayres (2005) suggests that many children with apraxia demonstrate reduced tactile and proprioceptive processing. By providing additional tactile and proprioceptive cues, the child’s ability to make sense of the somatosensory input is enhanced. PROMPT® treatment, described by Hayden (2008), incorporates specific tactile cues that offer the child a more salient way of sensing what a movement sequence should feel like, thus helping the child to connect the feeling of the movement gesture with the accompanying acoustic information. Strand and Skinder (1999) also recommend incorporating tactile cues as needed to support imitation when visual and verbal cues alone are not enough to help the child perform the targeted speech movements. In addition, body movements, gestures, and manual signs can be associated with speech movement gestures to create associations between speech movements and other movement cues.

Practice Skill Refinement

It is important to help children move from broad to more narrow distinctions between sounds. For children who do not reliably turn on their voice to produce sounds, praise will be provided when a child produces an undifferentiated vowel sound volitionally. As treatment progresses, purposeful movement of the lips or tongue will be facilitated, and then gradually building up to making distinctions between lip versus tongue sounds, nasals versus non-nasals, stops versus continuents, one versus two syllables, and voiced versus voiceless phonemes. Grading and differentiating of vowels based on tongue position (high/low/mid; front/central/back) and lip shape (open/round/retracted) also should be facilitated. These distinctions are gradual and take time, and children’s achievement of these motor speech skill refinements should be praised each step of the way.

Incorporate Music, and Books into Treatment

Music and carefully chosen books support attainment of speech in children with severe CAS, because they offer opportunities for repetitive practice of target utterances. Music also provides opportunities to practice varied and exaggerated intonation patterns, simple sound effects, and early developing sounds and words. Reduction of rate during songs offers the child the time to achieve initial articulatory configurations of target sounds and words. Making up little tunes with repetition of simple treatment target sounds and words to accompany the activities in the speech session can help to engage the child in the repetitive practice necessary for initial learning of treatment targets. Creation of simple, personalized books can support opportunities for repetitive practice of a simple sound effect or a small number of target utterances. For example, a book with pictures of people or things dropping, falling, and crashing, could be the perfect tool for practice of the exclamation, “uh oh.” Fish (2010) provides several book and song lists, including lists of books to target sound effects and early word production.

Provide Access to AAC

Children need a means of communication. When speech is slow in coming, the use of manual signs and gestures, low tech picture boards, and/or voice output communication devices will help support a child’s ability to express a wider range of ideas, and to establish greater social communication skills. Parents may need to be reassured that the verbal mode of communication will continue to be addressed, but that helping children find a way to establish positive communication patterns is very important for overall development.

References:

Ayres, A. J. (2005). Sensory integration and the child: Understanding hidden sensory challenges. Los Angeles, CA: Western Psychological Services.

Ellis Weismer, S., & Robertson, S. (2006). Focused stimulation approach to language intervention. In R. McCauley and M. Fey (Eds.), Treatment of language disorders in children (pp. 175-201). Baltimore, MD: Paul H. Brookes.

Fish, M. (2010). Here’s how to treat childhood apraxia of speech. San Diego, CA: Plural Publishing.

Hayden, D. A. (2008). P.R.O.M.P.T. prompts for restructuring oral muscular phonetic targets, introduction to technique: A manual (2nd ed.). Santa Fe, NM: The PROMPT Institute.

Strand, E. A., & Skinder, A. (1999). Treatment of development apraxia of speech: Integral stimulation methods, In A. Caruso & E. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 109-148). New York, NY: Thieme.

Featured Author: Margaret A. Fish, M.S., CCC-SLP

Margaret Fish is a speech-language pathologist working in private practice in Highland Park, Illinois. She has 30 years of clinical experience working with children with severe speech-sound disorders, language impairments, and social language challenges. Her primary professional interest is in the evaluation and treatment of children with childhood apraxia of speech (CAS). Margaret is the author of the recently released book, Here’s How to Treat Childhood Apraxia of Speech by Plural Publishing. Her workshops and writing focus on providing practical, evidence-based evaluation and treatment ideas to support children with CAS.