Q: I have a 1st grade student with moderate to severe apraxia who can make the /h/ sound in isolation but cannot co-articulate it. I’ve written the letter /h/ on an index card, and a vowel on another card. I have had him touch the H card and make /h/, and then touch the vowel card and make it. And we have increased the speed as we go but he ends up dropping the /h/ every time. Is there another way I can teach him to co-articulate the /h/ and the rest of the word?

A few thoughts…

• If you are working on words with initial /h/, then don’t forget that he has an auditory and motor memory for these words. He may need to be told, for example, “Don’t say, “hat.” Just do what I do. You are trying to break his connection to his old memories, and to create a new one.
• He may not be able to sequence from [-Voice] to [+Voice] within a single syllable. Stretch out the /h/, and slow down the transition from /h/ to the vowel so he has time to hear how the voice comes on. He probably drops /h/ because he cannot do this transition.
• Can he tell when you say the words right and wrong? If not, he is not paying good enough auditory attention, and is not discriminating between /h/ that is present and /h/ that is absent.
• Consider using minimal pairs: hat/at, hit/it, hum/um, hi/I. That way the phonology changes and the meaning changes simultaneously. The meaning change might help him hear and remember to do the sound change.
• And, I usually do exercises where the client learns to turn his voice on and off in sequence — He says Ah-H-Ah-H-AH-H… in sequences without stopping the airflow between the two sounds. That was he is learning to turn his voice on and off at will and in sequence. Make sure he keeps the airflow going and does not stop. That is the key. Again, the focus is on the transition between the sounds because that is where his real problem probably is. Do these slowly so he can hear and make the transitions between voice off and voice on. Also do F-V, S-Z, Sh-Zh in sequences just to work on turning voice on and off at will while keeping the airflow going.