Debra Goshulak, Speech-Language Pathologist at The Speech & Stuttering Institute, has trained hundreds of clinicians to support children with motor speech disorders. We asked Deb about the most common mistakes she sees when clinicians are learning to do motor speech therapy. Here are her top 4:
1. Talking TOO FAST
We know – slowing down our own speaking rate is hard work! But it is vital if we want to help children learn how to move from one speech gesture to the next. They need to see, hear, and feel these transitions in slow(er) motion.
Tip: When you are asking a child to watch and copy your model, make sure the child is watching your face. Then, say the word or phrase slowly and smoothly. Think about stretching out the vowels and linking the sounds together, as if you’d turned down the playback speed on a recording.
2. Working TOO HIGH on the motor speech hierarchy
We all want our young clients to improve their speech as fast as possible. But sometimes this means we jump ahead and work on higher-level skills before the basic foundations are in place. For example, if we ask a child to work on back tongue control for /k/ before they have developed basic jaw and labial-facial control, they will likely struggle with this higher-level skill.
But beware: it is equally frustrating for a child when we continue to work at a level that is too low when they are ready to move on to something more difficult! They do not need to completely master one ‘level’ before moving on to the next. We can help them to continue to refine their skills throughout their therapy program.
3. Not stabilizing the jaw when working on tongue control: SLIPPING & SLIDING!
Many children with motor speech disorders have difficulty with jaw control. We help them learn to stabilize their jaw when speaking: opening just enough without overextending, limiting side-to-side or back-to-front ‘sliding’, and moving with control between ‘open’ and ‘closed’ positions. Then, as soon as they can demonstrate good jaw control, about 60% of the time, in structured practice, we move on to another level of the motor speech hierarchy.
Later, we might introduce a new tongue movement (for example, for /k/, /s/, /l/, or /r/) and – surprise! – the jaw instability suddenly returns! Slipping and sliding all over the place! What happened?
By asking the child to put their tongue in a new position (for a new sound), we challenged their developing motor system, which is still relying quite heavily on the jaw to ‘push’ the tongue into position.
This is much more than a cosmetic problem. It may show that the child does not yet know how to move their tongue independently (without the jaw). An unsteady jaw may also lead to distortions or inconsistent productions of the sound and can make it hard for the child to move smoothly into and out of the new sound so they can use it in conversational speech.
Luckily, we can help!
Tip: When you are helping a child work on lingual consonants, watch for signs of jaw instability, such as:
- overextending the jaw
- clenching the jaw or ‘fixing’ the corners of the lips into a tight ‘smile’
- side-to-side or back-to-front movements of the jaw
If you see any of these signs, stabilize the jaw by offering physical support.
And take note – when working on /s/ or /z/ (or any other sound) we wouldn’t want to ask a child to put their “teeth together” or “bite” on something. While biting does stabilize the jaw, it does so in a different way than is needed for speaking fluently and accurately. Instead, offer physical jaw support to help the child get a feel for the mature movement patterns of speech, and fade this support as the child’s jaw control improves. For speech, we need jaw stability while still being flexible for speech movement.
4. Working on segments that are TOO LONG
Sometimes, a child’s speech accuracy breaks down in a multisyllabic word or phrase. It can be tempting to ask them to repeat it a few times in the hopes that it will improve. Unfortunately, this often leads to rehearsing errors rather than to developing new speech movement patterns.
Instead:
- Determine if the word or phrase is an appropriate target for your client. Consider their current level of motor speech control. If the word is well beyond the child’s skills, but important to them (such as, a friend’s name), could you help them get a better approximation?
- Identify the specific place(s) of breakdown in the sequence.
- Work on the smallest unit of the breakdown first.
- Then gradually build up the segment, one transition at a time, slowly and smoothly. It can be helpful to start with the last word or syllable, and work towards the beginning of the word or phrase. Stretch out the vowels in your models, and maintain the prosody of the word or phrase. Have them increase their rate to a more natural prosody as soon as they can.
The best way for clinicians to learn to do motor speech therapy is to do motor speech therapy! Mistakes are going to happen. Hopefully, hearing about others’ mistakes can help you notice and learn from your own.
Be kind to yourself, and ask for help when you need it. Remember, we’re here to help motor speech-trained clinicians who see clients through Ontario’s publicly funded PSL and SBRS services. Email us or set up a video or phone chat today!
And if you haven’t yet taken SSI’s motor speech e-learning course, you can learn more about it here.