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R can be a challenging sound to treat. We SLPs know R is a tricky sound, we know it involves complex oral motor skill, and we don’t want to forget phonological awareness. But how do all of these skills fit together? What are the first and next steps?
This episode continues a conversation on a balanced approach to R therapy, and is part two of a two part discussion.
Check out the vocalic R freebie at https://speechumbrella.com/product/free-resource-library!
— Useful Links —
Digging Into Stability and Mobility with Char Boshart
Phonological Awareness Tracking Tool
Phonemic Awareness for Parents video
Under the Umbrella of Phonological Awareness
Developmental Sequence of Phonemic Awareness
Tracking Phonological Awareness
Music: Simple Gifts performed by Ted Yoder, used with permission
Denise: Welcome to The Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech language pathologist of 30 plus years. I’m closer to the end of my career than the beginning, and along the way, I’ve worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness.
Hello. Welcome to episode 81 of The Speech Umbrella podcast. I’ve been doing this podcast for two and a half years, and I am so excited to announce that I have reached 10,000 downloads.
As of now, my top three listening areas are Los Angeles, Salt Lake City, and Sydney, Australia. Now, I’ve been to LA because my daughter lives there. I live in Salt Lake City, basically. So obviously I need to go to Sydney, Australia, so whoever’s listening there, can I come visit you? I’ve always wanted to go to Australia.
Thank you so much for helping me get to this milestone of 10,000 downloads. And because of that, I have a special giveaway, but you’ve got to listen to the whole podcast because I’m not gonna tell you about it until the end. This month I’m focusing on one of my favorite topics, R therapy. Today’s episode is a continuation of the last episode, which I call A Balanced Approach To R Therapy. So this is just part two. If you’re new to this podcast, you may not have heard about my video course called Impossible R Made Possible. I struggled with R for many years and when I cracked the code, I couldn’t wait to share the good news. Those kids who couldn’t seem to say R no matter what I did, I found out that their case isn’t impossible, and my course shows you how you can crack the code too.
In episode 79, I had a wonderful guest, Char Boshart. She’s the president of Speech Dynamics and author and a presenter, a podcaster, you name it, and she has. Char is just a vast well of knowledge and if you haven’t listened to episode 79, check it out. She has a particular focus on the motor aspects of speech and the importance of building motor capability for speech.
Since my R course also has a heavy emphasis on the motor aspects of R and building a foundation for R, I’m discussing the main points of Impossible R Made Possible in relation to what Char said, the basis of Impossible R rests on three pillars, stability and mobility, precise production and relaxed practice.
In the last episode, I talked about stability mobility, and precise placement. Today I’m talking about the third pillar, relaxed production, and I’ll also be addressing phonemic awareness, because when all is said and done regarding motor skills, some clients will still need to have work in phonemic awareness too.
It’s important to look at all of these areas to have a balanced approach to R. Here’s a problem I often see when I begin working with a pre-teen or teen with a lingering R issue. Usually they’ve had years of therapy working on R, but they can’t make the leap to mastery. What’s the holdup? Well, there’s more than one possibility, but if it’s not difficulties with stability mobility, or precise placement, it could be related to unneeded tension.
So let me illustrate. If the client is saying R in such a way that it stands out or calls attention to itself, it’s in a manner over-emphasized and they’re headed for trouble if not now, then in the future, that’s simply not how competent speakers speak. It’s not efficient and they won’t be able to keep up this inefficient way of speaking outside of the therapy room.
For example, I just worked with a client today who is saying rrrrrraccoon instead of raccoon. Okay? So until he can soften and slide into that R as easily as he slides into any other sound, that is not going to lead to his being able to generalize. So what’s the way you can tease out this unnecessary tension? Here’s one thing I like to do. I have a client say an R syllable, a pre-vocalic R syllable, usually like ra. And they need to be able to say it in a really relaxed way. Like that, not ra. And one way I teach them to get it relaxed is to compare it to a really easy sound like ma and we can go ma, ma, ma, ma, ma, and just connect all of those M syllables.
And I want them to fill how easy it is for their jaw to just open and close and just, I compare the sound coming out of their mouth to water running down a stream and nothing interferes with it. And then once we do that, and once they can get a really easy ruhh, we’re gonna try and get two ruhs connected like this ruh ruh.
Now the client might do this. They might go rah wah. Okay, so the easiness is there, but the second syllable turned into a W because they don’t have that transition from an R to a vowel back to an R. So you’re going to work to getting a correct R the second syllable, and they might do this, rah rah. So now they left a breath break because I still haven’t got that technique down of connecting it. So you’re gonna help them connect it again, but this might happen, rah rah, rah-rah rah. So they’re kind of connecting it, but it’s like a dog barking, it’s just shooting out of their mouth like bullets. So you just work with them and work with them until you get a connected rah-rah, and then you go for three, rah, rah, rah.
And I try to go to five or six, connect it, rah, rah, rah, rah, rah. And that is really the secret for generalization because that is how we speak. We don’t take breath breaks except rarely, for sentences. And we connect our words and we’re able to transition smoothly between sounds. Here’s another way to tease out, if unneeded tension is a problem.
If it sounds like their R is standing out a little bit like it’s calling attention to itself, ask them to lower their voice and just see what happens. Sometimes magic happens when they simply lower their pitch. If you want to hear more about this, tune into episode 19, it’s called Peaceful Speech, to hear a firsthand account about the differences made for a client.
Okay. So let’s talk about what does this have to do with what Char talked about? Well, she talked about the need for stillness so that clients can achieve intraoral focus, and you need to have that same kind of stillness in order for them to even begin to be aware that they are carrying extra tension. So I really have them focused. They can’t be moving their bodies around. They can’t be flapping all over the place, flipping backwards in the chair. I mean, a lot of these clients have some sensory needs and they’re sometimes all over the place. No, they’ve got to be still, they’ve got to be focused, pay attention to what their bodies are doing so they can feel and hear that that tension is extra and that they don’t need it.
Now, with Char we talked about how these are kids and they need to move. Yeah, but you need at least 50% stillness. The way I do this is to intersperse the moments of stillness with moments of movement. For example, we might do some pre-practice of syllables or words or phrases, wherever they’re at, and they’re being really still in focus.
And then we’ll stand up and we’ll shoot some hoops with my basketball. And the child will again be still while they’re standing waiting at the basket, I’ll have them practice some targets, however many times I want them to say it, and then I’ll throw them the basketball and they gonna make a basket and move around again. And then I take the ball again and I have them practice again, and I throw the ball. So that way they get to move, they get to be still in focus, and they get to go back and forth. If you’re wondering what stillness looks like when they’re standing up, it looks a lot like the mountain pose in yoga. Again, not flopping all over with their body, and that’s just one example.
There’s a lot of ways to get the stillness that you need in order to focus on relaxed productions. . I have seen a lot of talk in the SLP world on the need for tension in the tongue in order to say R. Now, while that’s true, I rarely teach my clients that they need to have tension in their tongue in therapy.
In fact, I stay as far away from it as I can, and here are two reasons why. Tension radiates much like pain radiates, and we end up with a bigger problem. The tension radiates to their necks or their jaw or their lips or their vocal chords, and you’ll end up with an R that is over-emphasized.
Over-emphasized means it won’t generalize. Hey, that kind of rhymes. So I have found that instructing clients on precise placement to get the perfect R is a much more effective way than instructing them to tighten their tongue. For example, if I can teach them to make a tongue bowl, and if they’re able to do that without also rounding their lips or doing other unnecessary movements, then that contraction in the middle of their tongue accomplishes the needed tension, and automatically allows for the front of the tongue to move upward as it does with R. And one of the great things Char talked about was that speech is vertical. All sounds, except those strange th sounds involve front tongue vertical movement clients making a retroflex R will have more front tongue vertical movement, but it also happens with the bunched R.
Sometimes it’s hard to see, but I swear to you it happens with a bunched R too. Some clients have a tendency to roll the tip of their tongue way too far back in the oral cavity if they’re trying to make a retroflex R. And I know that’s why some speech therapists stay away from it. But you can teach a good retroflex R if you know what’s happening and you know how to instruct them not to move the tongue too far back.
And these clients are just lacking the small, refined, differentiated movements that are needed for R. Okay, so that’s the third pillar of impossible R Made Possible, relaxed practice. If you will teach relaxed practice from the get-go, from the very first R syllable you elicit, your clients will sail into generalization usually with very little work on your part.
The bottom line is our clients must learn to say R with the same minimal effort as other sounds. Here’s a story to illustrate. I just got a new client, he’s a teenager. When I evaluated him, he had sporadic pre-vocalic R and R blends all over the place, but he had quite a few Rs that could be a springboard for all other R sounds.
His mom brought him to me because he was stagnating, just not getting it with the previous R therapies that he had had. Well, why was he stagnating with so many good Rs to springboard from? My thought was that he wasn’t a particularly challenging case. I mean, his oral resting posture was good. His stability and mobility were good, and he could say quite a few spot-on Rs.
It was the way he was saying R, with way more effort than he needed. He was really over-emphasizing his Rs and that just made it so his vocalic Rs sound so, so bad. Sometimes I can’t even understand what he says when he says a volcanic R word. I’m like, what did you say? And I’m a speech therapist because he’s lacking that easy movement. Well, once I helped him shape a relaxed production, he was able to move from words to phrases with just the ree syllable in his first session, and his mother kept nodding her head every time she heard this new R commenting on how much better it sounded. That’s because it was finally sounding like his peers, and that’s the R he needs for carryover. I mean, it’s brand new. We’re still working on pre-vocalic R. Haven’t even gotten to vocalic R, I won’t go there yet. At a second appointment his mother commented how she was starting to hear R at home. How easy was that? I just tell him to relax his R.
Now let’s talk about phonemic awareness. Suppose a client has all of the above and is still not getting R without constant queuing. It’s time to look at phonemic awareness if you haven’t already. Some clients don’t have the ability to monitor the sounds they’ve been working on because they simply can’t process the sounds in words as quickly as they need to. I haven’t found anything better than the PAST assessment, which was created by Dr. David Kilpatrick. It’s free, I’ll link to that in my show notes. It’s a rigorous assessment of phonologic and phonemic awareness for pinpointing problems. And if I find a problem, I use, again, Dr. Kirkpatrick’s program, Equipped For Reading Success. I use his drills for part of the session and it really, really helps.
And one thing I found is, expect this work on phonemic awareness to take longer than you think it will. I have found in many cases it takes longer to change the auditory channel, that’s the processing of these sounds, than the motor channel. And it really surprised me at first because I thought that changing the motoric system and building that motor capability to say R would be the hardest piece, but for a lot of my clients, I would say it’s really the phonemic awareness. If they have that problem, it takes longer than changing their motor capabilities.
Sometimes I get a client with such poor phonological awareness that I need to start at a more basic level than what Equipped For Reading Success offers, and in these cases I turn to my phonological awareness tracking tool, and you can find that at thespeechumbrella.com at my store. Or you can also find it on TPT. Just find my store, the speech umbrella on TPT. Let me take a little minute here and explain about phonological awareness and phonemic awareness, because it used to really, really confuse me and it’s still kind of confusing.
Phonological awareness is an umbrella term for all of the sound processing we do, and phonemic awareness is for the individual sounds in words, but we don’t really have a separate term for the earlier phonological awareness stuff that we do. So that’s when we can separate syllables and we can separate separate words and we can count words.
So some of my clients really don’t have like syllable awareness and they’re trying to work on R but they can’t separate like a word into three syllables and take off one syllable. So you’ve got to find out where they’re at and start from there. I do have a whole bunch of podcasts on phonological awareness and phonemic awareness, and I will link those in the show notes.
And here’s a story that illustrates how important this piece is to a balanced approach. I have a teen client who has been in therapy for years working on R, but he also lisps sometimes intermittently, which was kind of strange. And his speech sounded sort of generally imprecise at times. However, his R misarticulations overshadowed these other areas, so I didn’t pick up on their importance, although they were in fact a big clue.
He was so steamable for R, I mistakenly thought he progressed quickly and that I could clear these other things up kind of at the end. Let’s get a big handle on the R and clear up this other stuff when we were further down the road. But that was not the case. He simply could not discriminate between his accurate and inaccurate productions.
Because his mother had reported no academic issues and he had a pretty good vocabulary. I didn’t initially give him the PAST assessment because I usually look for a parent saying something about a reading disorder to cue me to do that. But here’s a warning. Give the Past anyway. When I gave him that assessment, oh my word, he was so delayed in phonemic awareness, so, so delayed in phonemic awareness for a junior high child. That was a huge piece of his puzzle. And once I started doing the Equipped For Reading Success drills with him, guess what changed first, his on and off again lisp was corrected and his sort of general imprecision around speech, and now we just have R to deal with and bringing his phonemic awareness up to speed.
And by the way, he has got a little bit of that relaxed production stuff to work on too. He’s got a little bit of unnecessary tension. So here we are taking a balanced approach. He’s progressing in all areas, but I just know that this phonemic awareness piece is going to take the longest because it is so difficult for him.
It’s not a super fast process, but it is a really, really powerful remediation tool, and I’ve seen that, but you just need to be patient. It’s rather like rebuilding a house from the ground up that was built rather poorly. And, oh, we gotta take this door off. It won’t even close. It’s crooked. There’s air coming through the crack. Well, why won’t it? Well, the walls are crooked. Well, the foundation’s crooked. It’s rather like the therapy that he’d had before was built on this not really great foundation, and we’re taking some things down and rebuilding. It’s slow, but it’s going to be thorough and when he is done, it will be a thorough job and he’ll finally be able to graduate.
Now because it is so slow to work on this when phonemic awareness, I have a parent video that demonstrates how parents can also do Equipped for Reading Success at home under the guidance of a speech therapist. And most parents aren’t confident to take it up on their own, which is why I made this video. And they really do need your guidance as SLPs to figure out how to do it. But these kids just need practice, practice, practice. And if you invite them into your session, show them how you do it, show them the video, they can really help just give this repeated practice at home because the more practice they get, the faster they will improve.
That video is called Phonemic Awareness for Parents, and you can find it on thespeechumbrella.com/blog/pa-for-parents. And you can also find it on my YouTube channel. Just look for The Speech Umbrella on YouTube. There’s one more thing that I did to help this particular client with his auditory channel, and that was to have him slow down while he was speaking. Say one target word, one time, record it, and have him listen to it twice. So that old adage about measure twice, cut once before he made a decision about whether he was right or wrong, because I was having him judge himself, listen twice, then make your decision, and that was a huge help to him. This was really, really key for him to determine his own accuracy. This was the only way that he was able to finally hear what he said and decide if it was correct or not, and begin to correct himself.
Well, that’s all for today’s podcast. So let me recap. A balanced approach for R therapy will include looking at both motor and phonological awareness. Looking at motor skills includes looking at stability and mobility. That includes the oral resting posture, precise placement, and relaxed production. Phonological and phonemic awareness includes finding the client’s starting point, whether it be a basic syllable level, word level phonological awareness, or the more advanced individual sounds at the phonemic awareness level. Or you may even have to go back to early listening skills, which you can find on my tracking chart that I talked about. I have lots of tools for working on both the motor skills and the phonological awareness piece at my store on TPT and in my free resource library, which you can get at thespeechumbrella.com/free, and I’ll link all of that below.
So when clients master these fundamental skills, guess what? The complex skills take care of themselves. And if you do it right the first time, you don’t have to take the house down and rebuild the foundation. But if you do have a client who needs that, now you know what to do. And guess what? These clients finally graduate.
Now for the fun stuff. Thanks for listening to the end. In celebration of 10,000 downloads, I am giving away one copy of my online course and my workbook for Impossible R Made Possible. This course is awesome. It has two and a half hours of instruction and that includes client videos. So these client videos show you how to get stability and mobility, they show you how to elicit R, they show you how to get a precise production and how to get that relaxed practice. All the stuff I’ve talked about in the last two podcasts, it’s got 60 plus worksheets. All of these worksheets are downloadable and PDF format, so you can send ’em home for homework. It’s a grab and go resource, and it’s really almost all I use for R therapy.
To enter for your chance to win this free course, go to my website and sign up for the Free Resource Library so that I have a way to contact you, plus you get all my awesome free materials. Then go to the page for this episode, thespeechumbrella.com/blog/81, and leave me a comment letting me know what you like about the podcast, what keeps you coming back. I want to hear from you. Now, if you’ve already signed up for the Free Resource Library, you can still enter. Just go to the episode page and leave me a comment. Now, I know some of you are going to be eager to get started right away on the R course. Go ahead and buy it, and if you are the lucky winner, I’ll just refund you or give you some other great tools. Don’t worry, we’ll talk.
The important thing is you get the help you need to move those challenging R clients forward, right now. Remember, sign up for the Free Resource Library at thespeechumbrella.com/free and comment on the episode, thespeechumbrella.com/blog/81. The entry window will be open for two weeks from today, March 22nd through April 5th, so don’t delay. Good luck and thanks for listening and getting me to 10,000 downloads.
Thanks for listening to The Speech Umbrella. We invite you to sign up for the Free Resource Library at thespeechumbrella.com. You’ll get access to some of Denise’s best tracking tools, mindfulness activities, and other great resources to take your therapy to the next level. All this is for free at thespeechumbrella.com. If you’ve enjoyed this podcast, subscribe and please leave us a review on Apple Podcasts and other podcast directories.
I am a therapist and entrepreneur, clinic owner, published author, and creator of speech therapy materials.
The Speech Umbrella is run by Denise Stratton, Reach out with any questions.