It seems like being a speech pathologist is kind of like being on a roller coaster.
We have some days we’re ready to tackle the trickiest cases and are determined to change the world…but then there are other days we’re limping along just trying to get through the day…wondering if we’re ever going to actually help our students.
There are always those nagging cases that don’t get better no matter what we seem to try, and it can feel like the outcomes our out of our control.
We can’t help that some of our students have poor language skills because they have no exposure to good language models outside of school, or live in home environments that don’t provide a lot of support.
We can’t help that some of our students come to therapy with emotional baggage that hinders their motivation and attitude toward learning.
We can’t help that our schedule is so jam-packed that our therapy groupings look like a random mix-and-match, with language cases sometimes coming with articulation cases or fluency cases.
And we can’t help that some of these students are working on so many different things that we can’t quite seem to find time to work on all of the different goals they have.
We can’t do anything about any of these things.
Or can we?
Well…that depends. In truth, you can only do so much about what goes on in our students’ home environments, and we can’t control what’s happened to them in the past. These things are all out of our hands.
But, while we do have limitations to our schedules do to logistics or time-constraints, we actually have more control than we think when it comes to prioritizing our therapy and getting more out of the time we have with our students.
This past summer, I asked some of my readers about some of the challenges they face; and there was one repeat problem that kept coming up time and time again.
You see, many of my articles focus on treating language; but here’s the thing…many of the students we treat might need work on sound errors too. This means we need to become therapy ninjas and figure out how treat BOTH in one handy-dandy treatment plan or IEP…and do it with way less time than is ideal.
Not to mention, we have to do this with groups of students. This means that we not only have to treat students with multiple issues…but we also need to figure out how to do it while we are treating multiple students within the same session.
This can make for watered-down therapy sessions that jump around from one skill to another as we try to hit all of the goals we need to target. It’s stressful, it’s frustrating, and it can make us feel like we’re swimming upstream; never seeing tangible results from our efforts.
These “combination” cases can be some of the most challenging cases to treat.
The combination that seems to pop up most often in the school-aged population is language and articulation issues.
You might get a referral for a student who has delayed vocabulary skills, weak grammar and auditory processing, is struggling across the board academically…and on top of all of that they also can’t say their R. Or L, or TH, or S/Z…you get the picture.
This combination can be a bear to tackle, because we know that students with articulation issues need drill and practice to develop motor memory; but sometimes this can take so much time that we don’t have time to get to the language goals.
Yet, if we take time to work on language at the same time-the progress on sound errors moves at a snail’s pace or not at all.
I’ve contemplated this dilemma many times, and tried a number of different “combination approaches”, and I’ve finally come up with some guidelines I use for treating both articulation and language.
When and How to Focus on Articulation
When we treat sound errors, many times we are setting our students up for failure without even realizing it. There are certain factors that must be present for a student to benefit; otherwise we’ll see students sit in therapy for ages without making progress.
We can identify the students who have potential to benefit from articulation therapy by using the following four criteria:
The student has the auditory skills to discriminate correct vs. incorrect productions
The structural requirements to physically create the sounds are present
The student has the cognitive abilities to fully participate in articulation therapy
The student is motivated to work on the sounds.
There are some cases that I have stopped working on articulation all together if the student didn’t care to work on it, had plateaued, and could communicate “good enough” to get by in the schools.
There have been other times I’ve dropped it because there were too many structural issues impacting their ability to say sounds, and I knew it was beyond my scope to address them all.
I’ve also stopped working on articulation with students with poor attention or cognitive skills, because working on functional language skills was more of a priority and because they weren’t able to fully benefit from articulation drills.
The main thing to ask yourself is if the student has the ability and willingness to work on sound errors, and if it is a high priority based on the overall adverse impact.
There are some times when these rules don’t apply for sound errors. For example, a very young child with a severe to profound phonological impairment obviously needs therapy to address it, and we should try to intervene regardless of these factors.
For a child in elementary school or older with one or two sound errors; I’d recommend using the criteria I just described above (i.e., auditory skills, structural requirements, cognitive skills, motivation) to decide if it’s something you should address in therapy.
If you determine that your student should work on articulation, I recommend working on sound errors first and holding off on the language goals initially.
I like to get them to the point that they have enough motor control that they are ready to start working on their sounds at the sentence level. This means they are between 80-90% accurate with their sound in words, across different positives (e.g., initial, medial, final), and across different phonetic environments (e.g., words that are “highly stimuable”, and words that are more challenged).
The key reason I wait on language goals for some of my language/articulation cases is because students with sound errors need structured drill and practice to develop motor memory when they are first learning their target sounds. Some students need a lot of cuing to say their target sound correct in isolation. Your goal at this stage to create as much structure as you can so that they can learn how a good production feels.
This means eliminating all other distractions. You don’t want to overload them by asking them to think about a language task on top of it. Doing too much at once can result in breakdown and sloppy practice with target sounds. This will only delay progress. Your main priority at this is lots of practice with “good” productions of sounds.
Once you get students to the point that they are accurate in structured contexts (e.g., isolation, syllables, words), you want to make it more challenging by increasing the cognitive load. Typically, this is when we move to working on sounds at the sentence level and beyond.
This is the perfect time to start integrating language tasks if the student also has language goals.
Once you get students to the point that they can say their target sound pretty consistently in words, your options for scheduling, grouping, and therapy activities increase substantially.
When you’re targeting articulation alone, that student should probably come with other students who are only working on articulation so that you can keep your sessions focused on getting good sound productions.
After you get them through this initial stage, you can group them with students who are working with either articulation or language, and you can move to less repetitive tasks and add more variety.
The “secret sauce” for these “mix-and-match” groups is to have an inventory of staple therapy activities you’ve strategically designed that address both language and articulation goals.
Stay tuned for the next post, where I share one of my therapy protocols that targets language and articulation using a new app called What’s the Pic Articulation by Luke Barber from Home Speech Home.
If you liked this article, you may also like this free guide for SLPs.
It’s called The Ultimate Guide to Sentence Structure.
Inside you’ll learn exactly how to focus your language therapy. Including:
- The hidden culprit behind unexplained “processing problems” that’s often overlooked.
- The deceptively simple way to write language goals; so you’re not spending hours on paperwork (goal bank included).
- The 4 sentence types often behind comprehension and expression issues and why they’re so difficult.
- An easy-to-implement “low-prep” strategy proven to boost sentence structure, comprehension, and written language (conjunctions flashcards included).
