We’ve all been there…a new student on the caseload who is maybe 25% intelligible…if that. They have so much to say, but also so many errors. Where do we even begin? It can be overwhelming at first, but there are things you can do that will ensure your child makes excellent progress in the shortest amount of time.
First, you absolutely MUST conduct a thorough evaluation. I’m talking more than just a quick administration of the Goldman Fristoe. Make sure you have as much data and information as you can to determine the best type of treatment for your student. When I have a child who is highly unintelligible, I immediately start by looking for error patterns. It’s important to note what sounds are being deleted, distorted, or substituted. If there are substitutions, what are they? Where are the errors occurring – initial, medial, or final position? Are errors consistent across words, phrases, sentences, and conversation? Your formal assessment (i.e. Goldman Fristoe or other articulation test) will provide some data, but I recommend going beyond that. If possible, record a speech sample. You can use sound loaded articulation scenes to help with this.
Once you have a good amount of data, start looking for phonological processes in the child’s speech. These are error patterns that occur across a wide variety of words. Examples include deletion of final consonants (saying “ba” instead of “bat”), stopping of fricatives (saying /p/ instead of /f/), or gliding (saying /w/ instead of /l/). The ASHA website has a summary of different phonological processes with examples. Click HERE to see it. I also love this chart from Little Bee Speech. It’s important to note which phonological processes are still being used that should have resolved by now (according to the child’s age).
If your student is indeed demonstrating some of the phonological processes listed on these charts beyond the age that is considered typical, you know you can proceed with the cycles approach. Using the cycles approach allows your student to make faster progress than they would with traditional articulation therapy. Rather than focusing on one sound error, treatment cycles through the error patterns focusing on one phonological process at a time and cycling through the others. This allows you to work on many targets in a short amount of time. You can read more about the cycles approach on Caroline Bowen’s website by clicking HERE. She has a great list of references and information on how to implement the cycles approach.
Here are my personal tips for implementing the cycles approach (please refer back to the websites I mentioned earlier for more specific information on the cycles approach):
1. Identify the phonological processes that may be impacting intelligibility the most. Start with the earlier developing patterns and make a list of all the deficient patterns. It’s also a good idea to list which targets the child is stimulable for. This will be your road map as you work through your cycles. I usually focus on 2-3 main phonological processes at a time.
2. Keep a cheat sheet handy to help you as you go through each session. In the Cycles Approach, each session follows the same structure. Having a cheat sheet handy will help you as you get started, so you don’t miss any steps. You can download my free Cycles Session Structure handout HERE.
3. Select 4-5 target words to focus on for each session. I use the same 4-5 target words for a total of 60 minutes (either 2 30-minute sessions, or 3 20-minute sessions) before moving on to a new set of targets. For example, if a student is deleting final consonants and fronting, I may work on words with final /p/ for a total of 60 minutes, then move on to words with final /m/. I would then move on to target fronting with initial /k/ for a total of 60 minutes, then initial /g/. I would then go back to final consonants.
4. Use familiar and/or frequently occurring words. In my experience, using familiar words helps reduce the amount of time spent teaching a new word. When the child is already familiar with the target words, they tend to be able to auditorily discriminate correct vs. incorrect productions faster. This helps them as they move through their cycles. If I have to use a target word that is unfamiliar to the student, I make sure to spend sufficient time making sure they really understand the word and what it is. I also often select target words from my minimal pairs bundle. I know many SLPs do not like to mix approaches, but this set of cards provides many different target words to choose from. While working through cycles, we won’t focus on minimal pairs, but I do like to use words that are part of a minimal pair so I can use the contrast approach if needed.
5. Encourage home practice. I always include parents and teachers in my treatment. It is so important to provide parents and teachers with the list of target words a child is working on. If I see the child for 20 minutes, 3x per week, they also should be practicing the target words in between sessions. You can jot down the target words on a sticky note for parents/teachers, or send a copy of your target word cards home for them to play memory or even just drill for a couple of minutes. I also demonstrate what a short practice session might look like to show them how quick and easy it can be. The easier it is, the more likely it is going to be done.
This may sound like a lot and be a little overwhelming, but I promise, once you get going, it becomes second nature and you will see so much progress!
Be sure to check out my Phonology on the Go resource, and feel free to contact me if you have any questions!