Q: I have a 3rd grader I have worked with since the age of 3. He has worked on a wide variety of phonemes through the years. I am ready to dismiss because I have been unable to make a difference recently. I have used all tricks in the book, yet his tongue still moves very poorly. Without full mobility of the tongue, I am beside myself. He speaks fast and is a smart boy however he is persistently unintelligible in conversation.

He sounds like he has dysarthria. This means that he will struggle with speech forever. This is a motor speech disorder for which a different strategy is needed because the inherent poor oral control probably will not go away. Charles Van Riper called these kids “clumsy-tongued individuals” and “the slow of tongue.”

This is not a phoneme-by-phoneme fix like a regular articulation case.

Working with dysarthria is a matter of teaching the client to speak up, speak out, over-articulation, pace himself, over-articulate syllables, over-articulate vowels, produce round and resonant vowels, produce both parts of diphthongs, produce crisp consonants, watch others to make sure he is being understood, deciding when and where he needs to do this (because it will be too exhausting to do all the time).

You also can consider teaching him to use substitutions that improve intelligibility. For example, if he substitutes m/p, teach him to use b/p instead.

Also, focus on clean, clear, crisp CV syllables, and don’t worry about the final consonants or clusters. For example, if he says poo/spoon, let him. Reward him for making intelligible errors. Just make sure the CV syllable is clean, clear, and correct. This will boost his intelligibility.

All this needs to be done in conversational speech so that it makes sense in conversation and he knows how to do it in conversation.

The focus needs to switch from correct pronunciation of individual phonemes, to becoming intelligible when necessary — like when answering questions in class, giving an oral report, etc..

This type of therapy also requires talking openly about being understood. You have to be able to say to him, “I didn’t understand you” or “Tell me again in a way that I can get it” and so forth. He needs to learn that he only will get his message across when he is intelligible. Therefore you cannot let him get his message across to you when he is not stepping up to the plate in therapy.