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SLP Corner: Choosing Words and Building Language for Children with Childhood Apraxia of Speech (CAS) and other Severe Speech Sound Disorders

All material Copyright © 2010, Nancy Kaufman, CCC-SLP and
Published with the express permission of the author.
When children present with severe speech sound disorders, our focus is understandably upon the child’s ability to produce vowels and consonants that are not within their repertoire. Another area of therapy focus is usually upon helping the children to say full words with accuracy. Many children with restricted phoneme repertoires or difficulty coordinating vowel and consonant movement patterns employ phonological processes as a simplifying device. In fact, a “phonological process is defined as a simplifying device. It is the way that adult phonology is simplified, either linguistically or motorically, based on the principal of the least physiological effort” (Weiner, 1979). We can make better decisions about what words to choose for children who struggle to speak by thinking about phonological processes. These are such terms as final consonant deletion, cluster reduction, fronting, voicing, devoicing, gliding, etc. If we choose words that are already simplified by taking these processes into consideration, we will help children who struggle to speak with more rapid and successful vocabulary development.
Words of choice for children who struggle to speak should not be chosen randomly. There are many reasons for specific word choices. Specific words are chosen so that the child can practice the vowels and consonants already within their repertoire or a new phoneme in synthesis in differing word positions. Other words should be chosen for the opportunity to practice different syllable shapes. A third reason for specific word choices is about motivation for use. We want to choose words that are important to the child’s particular interests so that their requests are met with success by the listener.
Children who struggle to speak would most likely have more success when choosing words that only contain the earliest and easiest phonemes to produce. These include, /m,b,p,t,d,n,h/. The easiest vowels are usually open and lax such as “uh, eh, ah.” Other consonants that are easy include /w/ and /j/ which are really diphthong vowels. Now that we know what phonemes to choose, we want to find the easiest contexts for which to include them. These would include reduplication, CVCV (mama, dada, papa, moo moo, neigh neigh), CV or VC, VCV and CV1CV2 (mommy, baby, puppy). These syllable shapes could also include simple bisyllabics, C1V1C2V2 (happy, tummy, muddy). Notice that these are also open syllable words. Children with severe speech sound disorders often speak in open syllables. So, final consonants must pose some difficulty to the motor speech system. Once we begin to choose words that do contain final consonants, increased motor-speech coordination and thus increased difficulty in pronunciation is imposed. So, if we choose the above-mentioned phonemes and include them within the easiest open syllable shapes, the child will have some initial success with vocabulary development.
Once we do move into a CVC, we should consider the motor movements involved in these monosyllabic words. Assimilation is an easy process and one that children with severe speech sound disorders typically fall into erroneously. They might produce the word “cup” as bup, or “put” as dut. Knowing that assimilation is easiest when it comes to final consonants, we should consider choosing words that are already assimilated. These are words that start and end with the same phoneme such as “pop, peep, mom, dad, bib, none, noon.” They can also be words that start and end with a bilabial such as “mop, map, boom, bam, beep.” They can also be words that start and end with a tip alveolar placement such as “tin, knit, knot, tan, neat, teen.” Starting with words that begin and end with a back velar placement (if the child has /k,g/ within their repertoire) would be good choices as well such as “kick, cook, coke, or gag.” Two-syllable words can also be assimilated such as “puppy, daddy, mommy, baby, teddy, nutty, cookie, goggle.”
It is often easier to voice phonemes in the initial and medial positions of words, as they then precede a vowel and vowels are always voiced. It is often easier to produce devoiced phonemes in the final position of words as they are not followed by a vowel. So when choosing words for practice we would consider choosing those with voiced initial (and medial consonants) such as those beginning with /m,n,b,d,g/ and those ending with /p,t,k,s/ for example.
We would also want to make a list of the child’s favorite foods, drinks, toys and activities and help them to produce these with best approximations. This is also where knowledge about phonological processes comes into play. Each word that is important to the child may contain difficult motor-speech movements. We would want to listen to the child’s pronunciation of the words, and help them to produce the word as accurately as possible. In order to help the child with their best approximation, we would employ phonological processes for them to simplify a difficult word until the time that they have increased motor-speech proficiency. We would then extinguish the lower approximation with a higher one. Some isolated phonemes are difficult and may not even be within the child’s repertoire. So, if a word starts with /dz/ as in “jump” and the child is deleting the initial consonant all together, we might help the child to say this as “dump” as younger children would replace /dz/ with /d/ as this is part of this affricate and the process is called deaffrication. If the child does not have a /k/ in their repertoire and deletes the /k/ in the word “cookie” for example, we would help the child to use a /t/ instead. This process is called fronting. Once the child practiced and acquired a /k/, then we would extinguish this “fronting” pattern and replace it with the /k/. If the child cannot produce the “st” blend in the word “stop,” we would help them to produce this word as “top” (cluster reduction) or “dop” (cluster reduction and voicing) as a temporary way to produce “stop” until they were able to master this blend. A word such as “water” could be reduced to watuh (final consonant deletion), then to waduh (final consonant deletion and voicing), to wawa (reduplication) to wa (syllabic deletion). In therapy, we would work on extinguishing temporary patterns to the highest approximation we can obtain, by using cues, fading cues and using powerful motivational toys and materials. So, knowing natural phonological processes like reduplication, stopping, fronting, voicing, devoicing, deaffrication, gliding, etc. will help us to help children to make their best approximations giving them functional vocabulary toward total word accuracy!
*To understand more about word choices and shaping approximations using phonological processes, see Nancy’s K-SLP Instructional DVD or the manuals to the Kaufman Speech Praxis Treatment Kits, the Kaufman Speech Praxis Workout Book or the K&K Sign to Talk kits!
Featured Organization and Author:   Nancy Kaufman, CCC-SLP and The Childhood Apraxia of Speech Association of North America (CASANA)
Nancy R. Kaufman, M.A., CCC/SLP is the owner and Director of the Kaufman Children’s Center for Speech, Language, Sensory-Motor, and Social Connections, Inc. (KCC), located in West Bloomfield, Michigan. She received her B.A. at Michigan State University and M.A. at Wayne State University, having been awarded a graduate assistantship. Nancy has dedicated herself to establishing a treatment approach to help children to become effective vocal communicators since 1979. She is the author of the Kaufman Speech Praxis Test for Children, (Wayne State University Press, 1995), the Kaufman Speech Praxis Treatment Kits for Children (Northern Speech Services, 1998, 2001), the Kaufman Speech Praxis Workout Book (Northern Speech Services, 2005), and co-author of the K&K Sign to Talk: Nouns (Northern Speech Services, 2005) and the K&K Sign to Talk: Verbs (Northern Speech Services, 2009). She lectures locally, nationally, and internationally on the subject of childhood apraxia of speech and other speech sound disorders in children. Families from around the country and the world travel to the KCC to participate in intensive and specialized programs created to meet the needs of their children. Nancy is highly regarded as an expert in her specialized field, and consults with parents and professionals across the globe. Nancy also serves on the Professional Advisory Board of the The Childhood Apraxia of Speech Association of North America (CASANA), and is the recipient of the 2010 Michigan State University College of Communication Arts & Sciences Outstanding Alumni Award. Many specialists in the field of Applied Verbal Behavior (AVB) have adopted the Kaufman Speech to Language Protocol (K-SLP) for children with autism spectrum disorders. A recipient of the Clinical Service Award from the Michigan Speech-Language-Hearing Association, the KCC continues to grow and has earned a reputation for excellence, warmth, and successful outcomes. Nancy has three grown children and resides with her husband in West Bloomfield, Michigan.

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