Q: I have a four-year-old male client whose only consonant is D. He says “telephone” as “Deh-duh-doh.” How do I teach him other phonemes?

Therapists use a wide variety of methods to stimulate new phonemes.  I have summarized them in an article published by the Oral Motor Institute (Marshalla, 2008).  I also have put this information into my newest seminar, titled “21^st Century Articulation Therapy.”  It also will appear in my next book to be called “The Marshalla Guide to 21^st Century Articulation Therapy” (to be out in 2013-14).

In sum, there seem to be at least 22 fundamental ways therapists have developed to stimulate new phonemes.  Here is the list with a sample activity for each ––

• Assist– Press his lips together to get him to say B instead of D.
• Associate– Use his D to teach him to say T by teaching him how to turn off his voice.
• Contrast– Help him understand that he is sending sound out the mouth for D, and help him learn to send sound out the nose for N.
• Cue – Use a cue to teach him another feature (like “stridency”), and help him learn to produce stridency on any sound.
• Describe– Use descriptions he can understand to try new phonemes.  For example, “Poke out your lips” or “Make a sound in the back.”
• Develop sensory awareness and discrimination– Help him wake up his mouth to learn other sounds by sucking on ice cubes or by brushing his tongue or lips.
• Direct– Point to the back of the tongue moving upward to help him learn to lift the back for K or G.
• Dissociate– Help him learn to move his tongue independently from his jaw so that it moves more independently for other phoneme productions.
• Exaggerate– Super-exaggerate your production of P or L or Ng to see if he can imitate them.
• Increase/decrease muscle tone– Perhaps that child has very few phonemes because his overall oral tone is too low. Help him increase it.
• Increase range of motion– Perhaps this client had D only because he doesn’t move the tongue or lips to their full range. Teach him gross oral movements.
• Inhibit– Perhaps this child cannot move the back of the tongue for a [+Back] phoneme because the tongue-tip does all the moving. Hold the tip down with a tongue depressor and see if that stimulates him to move the back instead.
• Maintain positions– If he can press his lips together to blow through a straw, have him maintain lip closure on the straw to become aware of lip closure. Then use that movement to teach a labial sound.
• Mark the target– Have him put lip gloss on his lips to learn bi-labial contact for a labial sound
• Model– Show him how to make other sounds. Use your mouth, hands, pictures, and other 3-D models.
• Normalize tactile sensitivity– Maybe this child does not make any other sounds because it is uncomfortable for him to do so. Help him normalize his oral-tactile sensitivity so he can explore more oral movement.
• Practice– Have him practice any new sounds that happen to come along, whether taught or spontaneous. Notice them, make a big deal about them, spell them, repeat them, and practice them.
• Resist– Use resistance to get the lips and tongue to move more for more phonemes. For example, press downward on the lower lip to get it to elevate to the top lip for the bi-labials.
• Speed up / Slow down– Maybe this child cannot process your models. Slow your models so the client has more time to hear and see what you are producing.
• Stabilize– Maybe the jaw is banging up-and-down and only D is used as a result. Stabilize the jaw to force more variety of lip and tongue movement.
• Stimulate reflexes– Consider using the oral reflexes to stimulate new movement. For example, stimulate the cough reflex to encourage [+Back] sounds.
• Vivify– The client may not produce many consonants because the oral mechanism simply has not learned to move enough in gross ways. Have the client move in any and all ways to cause new phonemes to emerge by chance. Van Riper said that any new movement was a step in the right direction.  For example, teach the client to produce labial and lingual raspberries to get the lips and tongue moving.

References

• Marshalla, P. (2008) Oral motor Treatment vs. Non-speech oral motor exercises: Historical clinical evidence of 22 fundamental methods.” Oral Motor Institute, Monograph No. 2 http://www.oralmotorinstitute.org/mons/v2n2_marshalla.html
• Marshalla, P. (unpublished manuscript) The Marshalla Guide to 21^st Century Articulation Therapy. Mill Creek: MSL. [Scheduled for publication in 2013-14.]