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#099: Phonological Awareness: Assessment + Goals

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This month, Monica and I are talking about phonological awareness. 🎉

Last week we did a quick review of phonological awareness and why is it is so important. We learned PA is very important for future reading skills and all students can benefit from phonological awareness intervention.

This week we will focus on PA assessment and how to create goals to target PA.

Phonological awareness is your ability to “identify and manipulate units of oral language: words, syllables, onsets (beginning sound c in cat) & rimes (end sounds -at in cat)”. 

Let’s get to it!

Assessments and Tips discussed

– You can find screeners on PTP to see where students are with PA
– If a teacher or RTI instructed has already done a screener, collaborate with them and review their notes. Work smarter not harder!
– Reach out to parents to see if they have any concerns

Example Goals Discussed

– When given a CVC word orally as a prompt and asked to identify which position a particular sound (initial. medial, final) in the word is in (example: “Say the word tap. What is the medial sound in “tap”?”), STUDENT will identify the sound being requested for each prompt with 80% accuracy in 2 out of 2 trials as measured by teacher-made assessment.

– When given the onset and rime (/b/ + /at/ , /h/+/ot/) for 10 different 3-letter short vowel words (CVC words), STUDENT will blend those sounds (onset and rimes) into words with 100% accuracy in 2 out of 2 trials as measured by teacher-made assessment.

– When given 3 phonemes as a prompt (example: /c/ /a/ /t/ or /p/ /i/ /g/), STUDENT will orally blend those phonemes into words with 80% accuracy in 2 out of 2 consecutive trials as measured by teacher made assessments.

Links Mentioned and Additional Research

–  FREE: The PAST Test Screener : David A. Kilpatrickby
Basic Syllable
Onset-Rime
Basic Phoneme
Advanced Phoneme
–  Hello Two Peas In A Pod (TPT): Free PA Assessment
– Cabbage Et al article (Decision Tree + Sample Assessment Checklist)
– Test for multisyllabic words! Can they blend them together?

 

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Transcript

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Marisha: Hello there, and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hey, there SLP. This month, Monica and I are diving into all things phonological awareness. So in Episode 98, we did a quick review of what phonological awareness is. We're going to spend the rest of the month talking about assessment, goals, treatment ideas, all sorts of good stuff. So, without further ado, let's dive in to this week's episode.

Marisha: Let's spend a little bit of time talking about assessment and goals and what that might look like. Like you said, in California, things are a little bit different. So can you tell us a little bit about what that looks like for you?

Monica: Yeah. So, specifically in my district, SLPs don't really do the formal assessment or write the goals or provide the services because we have either reading specialists for RTI, or our classroom teachers who provide that specialized academic support do that. Either pulling from the gen-ed classroom, or for students who are either in our co-teach classes or separate classrooms, they all do that. So, I do a lot of collaborating.

Monica: But, we do have a state dyslexia guideline and it says that SLPs can play a role in the dyslexia intervention. So, they have a description of what SLPs can do, and then ASHA also says that we have a major role and responsibility to play in this, to support spoken language skills and written language skills as well. But I feel like that probably also if you are going to become a dyslexia specialist, you have a full lot of different CPU's to do, I feel like to specialize. But I feel like, there are a lot of things that we already do in speech-sound disorder intervention, that we just can add a couple of things in to be able to target that.

Monica: But for right now, my role in my particular school is really just to make sure I screen those speech-only students, kind of looks like checking back with the teacher, checking to make sure if they're getting RTI for reading, to make sure I'm talking to that teacher, asking the parents if they have any concerns for that. And then, I just do a little bit of informal assessment with it. And then during intervention I include a little bit of phonological awareness in that. I'm not doing that whole long list, I'm not hitting every single one of those, I just do the ones that are really easy to incorporate. And then if the teacher or the RTI person, or whoever it is that's working with that student, they'll email me and say, "They're having a really hard time with this specific area." Maybe the carry over from blending their words, or something isn't happening over in the classroom, so they'll give me a couple words. They'll say, "They're having a really hard time with these sounds." And so that's what role I play within my school.

Monica: And, I think that I probably also focus on it a little bit more because I have mainly kindergarten to second grade. So, it's really those grades where they're focusing on it, so I might be focusing on it more so than another SLP.

Marisha: That makes a lot of sense because every state will have a different setup, but especially in California where they have those specialists, and it sounds like your district has awesome RTI supports and everything too, but just keeping an eye out for things. So, like if we get that speech-only student, maybe we can run through a quick screener. There's a bunch of screeners available on Teachers Pay Teachers, or if you just search Phonological Awareness, basically just need to run through the activities and see where students are with that. And then just collaborating with the team to see, we'll use their expertise and do the legwork and just do what we can to support. I think that's a really awesome approach.

Marisha: And then if we happen to do a quick screening and that student, for some reason, isn't getting RTI yet, we could also refer out and help with that identification so students don't get missed.

Monica: For sure. And then we'll have linked, it's called the PAST test. This is by David Kilpatrick, and then it's a free screener. And on there is basic syllable, onset-rhyme, basic phoneme, and then advanced phoneme, if you just want something that's free and already put together.

Monica: And then the Cabbage et al. article has a sample assessment checklist in the appendix of their article as well, for things that you could include in your assessment if you just want a more in depth guideline to go through, if you really, really think that this is an area that you want to focus on for that student. Their article also has a decision tree for referral for your Student Support Teams or extra intervention, if this is something that you would like a decision tree for, and a little bit of extra support with that.

Marisha: That's some really good resources, definitely have to highlight those in the show notes.

Monica: For sure.

Monica: But, I think similar to what you were talking about, I definitely pull from the classroom teacher or RTI instruction, like our classroom teachers do the DIBELS. And so there's a lot of information in there, so a lot of times you don't have to do extra screening. I'll just take from whatever they do in the classroom. And then if we're doing a full evaluation, the psychologist or the academic specialist, they're usually doing a lot of phonological awareness testing, and so then I'll just pull from that and then I don't have to do my own.

Marisha: Yes, work smarter, not harder. Awesome.

Marisha: We talked about some different informal assessment options. Was there anything else that you wanted to point out?

Monica: So in that Cabbage article for the effectiveness of early phonological awareness interventions, they talked about different articles and different research for where you could focus your testing on. And then they showed that rhyming, blending, and segmentation tasks, especially rhyming and the ability to identify phonemes, were the most important meta-phonological skills for preschoolers to have that predicted reading and spelling abilities in first graders.

Monica: And then they talked about including receptive tasks for children who can't respond verbally. And so for students who might have a more severe phonological disorder, to be able to see if they, you know, if you want to know if they have some sort of knowledge for clusters, to have "Which one is spoon?" It has the sp- blend and then have three different pictures. And then to test for multi-syllabic words to see if they can blend them together, have non-word repetition tasks to test for phonological awareness, and then to do it for your initials as well as exiting, just to make sure. And not necessarily to keep them, you could be exiting a student, but then just to make sure that you refer them to the appropriate services.

Marisha: Awesome. Is that our list of informal assessment?

Monica: Yeah, I think that pretty much covers it.

Marisha: This is always a super common question, but what about goals?

Monica: Yeah.

Marisha: I know it's a little different with what you're working on in California.

Monica: It for sure is. So, I'm never specifically on those goals, just because ed code doesn't list out reading for SLPs, but it could be different for your state. You could be in private practice. I have some example goals, but also, I don't think that you need a goal to work on this. You just need to incorporate it into speech-sound disorder treatment, which we can talk about in a little bit. But one example goal is when given a CVC word, they'll be able to identify which position a particular sound is in the word. So initial, medial, or final. So, if you have to say the word tap, what's the medial sound? What's the middle sound? Or if given the onset and rhyme for 10 different CVC words, that they'll blend the onset and rhyme. So it's like, "What word is this? B-at." And they have to say bat.

Monica: Or another one could be the almost opposite of that. So if I say, "C-at, what word is that?" And for them to blend it. Or you can have the opposite, "what are the three sounds?" So they have to segment it as well.

Marisha: And we'll put some example goals in the show notes, if you're looking for some inspiration.

Marisha: I love what you were saying, because we might not have an actual phonological awareness goal, but if we have a goal for a student to reduce cluster reduction or to reduce fronting, or if they're learning a specific sound, we can incorporate this approach as a means to get towards that goal. Because there's plenty of evidence to show that that works. I like that perspective, that's helpful. Anything else you wanted to talk about when it comes to goals?

Monica: No, I don't think so. This is definitely where I end up working with the reading specialists, we call them RSP teachers in my district. But we'll share materials, or if there's a student with a severe phonological disorder, they'll be like, "Where can I start working first? What sound are you working on? So that I can make sure that I'm targeting that extra." Or they'll say, "This student says this phrase a lot in my classroom and I can't understand them when they're saying this." So, I can pull that and make some of those the target words, and then do phonological awareness with that, because sometimes they'll have a book or sight words or something that they're testing all the time. And it's something that the student has to do frequently. That's a good way. I feel like for me, that's worked to be able to work together with them.

Marisha: Awesome. So I think that's a wrap on our mini list through assessment and goals. So yeah, that was super helpful, and hopefully everyone feels like they've got a good grasp on where they can get started with that.

Marisha: Thanks for listening to the SLP Now podcast, this podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEU's for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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The SLP’s Guide to Treating Childhood Apraxia of Speech

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This is a guest blog post by Monica, a school-based SLP, all about treating childhood apraxia of speech (CAS). 

Childhood Apraxia of Speech (CAS)

Treating childhood apraxia of speech (CAS) can feel overwhelming. There is a lot to know, but there is a wealth of information available.

When it comes down to it, CAS is a motor speech disorder that’s under the umbrella of speech sound disorders (SSD), so we have to treat it differently than other speech sound disorders by concentrating on motor planning. You’ll hear motor planning a lot when you look up information about CAS, and you’ll have to shift your thinking from working on individual “speech sounds” to working on “speech movements.” CAS requires frequent sessions with a lot of trials to remediate. During those sessions, you’ll use principles of motor learning and an approach that’s the right fit for your student.

This post will give you an overview of the resources available to SLP Now members.
> If you’re a member, click here to access the materials!
> If you’re not a member yet, click here to sign up for a free trial. The trial includes 5 free downloads, and it’s totally risk-free! No credit card required. 🙂

Keep in mind that this is a very simplified version of treatment for childhood apraxia of speech, and I encourage you to seek out additional training if you are going to be treating students with CAS.

Dynamic Assessment

Dynamic assessment is a crucial first step to treatment because you’ll figure out what stimulus set to start with, as well as what type of cueing and feedback work for your student.

This assessment will include a variety of syllable shapes to see what movements are difficult for your student. Think CV, VC, CVC, CVCV, and multisyllabic words. The emphasis isn’t on what sounds are being produced but where the breakdown is happening in your student’s motor plan. They may produce a CV, but not a CVC. That lets us know that adding that extra consonant is difficult.

During the assessment, you’ll also be looking out for ten different characteristics of CAS. Strand and McCauley (2018) state that having four characteristics over three assessment tasks indicates CAS.

Here’s a preview of our informal CAS dynamic assessment that’s a part of our CAS skill pack available to SLP Now members. The assessment is based on Dr. Strand’s work through the Callier Center for Communication Disorders at UT Dallas. The free training is available at this link.

Apraxia Assessment

We’ve included a page for differential diagnosis with other speech sound disorders, a research summary with all of the important terms, and apraxia “do’s and don’ts.”

Apraxia Do’s and Don’ts

Here are a few examples:

>> Do suggest AAC if your student has a severe speech sound disorder and has difficulty communicating.

>> Do collaborate with the student and parents to pick meaningful stimuli words.

xx Don’t forget about co-occurring diagnoses and take that into account when you are planning treatment (a phonological disorder is most likely going to be co-occurring).

xx Don’t segment sounds as you say them (e.g., break up bat into /b/ /at/). This will disrupt the motor plan. You want the student to learn to make a continuous motor movement.

How to Choose Your Initial Stimulus Set for CAS

Use your clinical skills to choose your first set.

In her training, Dr. Strand walks you through how to use your clinical skills to choose your first set. There are no easy, ready-made sets because they need to be individualized for each student. For students with severe CAS, you’ll pick a small stimulus set that includes difficult movements for them to produce. In the beginning, you’ll use very specific feedback about how to make the movements (knowledge of performance), and feedback will be very frequent.

Later, you’ll move to a larger stimulus set once students are more successful and have more feedback about if their production was correct (knowledge of results) and also have less feedback overall. I like to incorporate a lot of self-monitoring in the later stages for generalization.

Going through the dynamic assessment will help you choose your initial stimulus set based on what movements students were successful with and what type of cueing helped them produce movements that they could not do on their own.

It’s also crucial to choose words that are important to your student and their family to get early success and buy-in.

Before Your Sessions Start

Figure out what type of method you’re going to use with your students.

Here are moderately strong to very strong evidence-backed treatment methods with free training or information available:

Dynamic Temporal and Tactile Cueing DTTC (Developed by Edythe Strand) → Moderate severe CAS (ages two and up)

ReSt/TEMPO (Developed by Speech Pathology in the Sydney School of Health Sciences at the University of Sydney headed by Professor Tricia McCabe) → CAS and ataxic dysarthria (ages 4-12)

Integrated Phonological Awareness Training (Moriarty & Gillon, 2006) → Speech-language impairment (ages 4-12)

The NDP3 program (Williams & Stephens, 2004) is also evidence-backed but not free. Students must have attention skills, the ability to imitate (look at the clinician’s face), and knowledge of cues before they can begin CAS treatment.

I love using DTTC and have had a lot of great success with it over the years. It utilizes principles of motor learning that I honestly use with all of my speech sound disorder students.

We’ve got a great guide with activities to help gauge your student’s skills. You can use play-based sessions to gauge these skills and use that opportunity to build a relationship. You can also introduce words you’ll be using for cueing and feedback. Also, make sure your students are ready for your sessions by taking an inventory of their attention and imitation skills.

It’s also an opportunity to see if the method you chose is a great fit. DTTC works well, but it requires a lot of sustained attention to look at the SLPs face. DTTC may not be the best choice for autistic students if you can’t find a workaround.

Ideas for Sessions

If you’re using DTTC, we (SLP Now) have a guide in our skill pack to help!

The quick rundown is that it’s a cueing system to start with the most help for your student’s motor plan (saying the stimulus simultaneously) and then move to the least support for their motor planning (spontaneous). It’s easy once you get the hang of it. You’ll most likely find that it’s helpful for your entire speech sound disorder caseload.

“Principles of motor learning” is another term that you’ll hear a lot about with CAS.

The best way to summarize it is that they are principles that, when followed, improve a student’s motor plan in efficiency and flexibility. Some of the significant points are:

1. Practice as much as you can.
2. Build a relationship with the student.
3. The student should have clear instructions and know what to expect.
4. Vary distribution of practice with the child’s progress and severity.
5. Work on prosody.
6. Use a slow rate to help with motor planning.
7. Vary feedback based on the student’s performance.

In this podcast episode, Amy Graham of Graham Speech Therapy talks about treating CAS and the principles of motor learning. She also talks about how you don’t need anything fancy for therapy sessions to work on CAS.

Her Instagram account has lots of videos of her doing therapy, which are helpful to watch! She likes quick games that get a lot of trials.

Dr. Strand also notes that pictures and cards should not be used when you are first starting treatment because you want the emphasis to be on your face so that the student can get that input for their motor planning.

As long as you can get a lot of trials, anything can work! Here are some other ideas for sessions that I pulled from our skill pack:

1. Use a racetrack and send a car down for every ten trials.
2. Have mystery paper bags that students get to open after ten trials.
3. Have plastic eggs that students get to open after ten trials.

Resources

Here are some other resources that I’ve found to be helpful:

Instagram
Carie Ebert – SLP Apraxia Specialist
SLP Mommy of Apraxia – SLP Apraxia Specialist

Free Training
Presented by Edythe Strand in partnership with Callier Center for Communication Disorders UT Dallas
YouTube videos on assessment, treatment, and DTTC
ReST
Integrated Phonological Awareness Training

Free Resources about CAS for Parents and Clinicians
Apraxia Kids
Child Apraxia Treatment
Evidence Map from ASHA for CAS

References

Apraxia of Speech (Childhood). American Speech-Language-Hearing Association; ASHA. Retrieved October 1, 2021, from

Childhood Apraxia of Speech by Edythe Strand. (2018). Childhood Apraxia of Speech by Edythe Strand. (Free training presented by: Callier Center for Communication Disorders UT Dallas)

Moriarty, B. C., & Gillon, G. T. (2006). Phonological awareness intervention for children with childhood apraxia of speech. International Journal of Language & Communication Disorders, 41(6), 713–734.

Murray, E., McCabe, P., & Ballard, K. J. (2015). A randomized controlled trial for children with Childhood Apraxia of Speech: Comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme. Journal of Speech, Language, and Hearing Research, 58(3), 669–686.

Strand, E. A. (2020). Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech. American Journal of Speech-Language Pathology, 29(1), 30–48.

Strand, E. A., & McCauley, R. J. (2018, 34-12 01:34:48). Differential Diagnosis of Severe Speech Impairment in Young Children (world) [Review-article]. The ASHA Leader; American Speech-Language-Hearing Association.

Williams, P., & Stephens, H. (2004). Nuffield Dyspraxia Programme. Windsor, England: The Miracle Factory.

#098: A Quick Review of Phonological Awareness

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This month, Monica and I are talking about phonological awareness. 🎉

It’s something that a lot of SLP Now members have been asking about and what it would look like in therapy.  Thank you for your requests!  Today we will discuss a brief overview of Phonological Awareness, what is it and what is it so important?

The rest of the month we will dive in deeper with episodes 99, 100, and 101 and discuss goals and therapy ideas for PA. 🤓

The first thing is first, what is phonological awareness and why is it important?

Phonological awareness is your ability to “identify and manipulate units of oral language: words, syllables, onsets (beginning sound c in cat) & rimes (end sounds -at in cat)”.

PA is very important for future reading skills and all students can benefit from phonological awareness intervention. Research shows that all students may not need small group intervention, but students who struggle will have positive outcomes from targeted practice. Some research we looked at showed that students with learning disabilities in early education settings and students with speech impairments would benefit. You can start as early as a preschool with phonemic tasks. 

And guess who is the perfect person to do a quick assessment of phonological awareness and to incorporate simple strategies in your intervention? That’s right. You are, my friend! 

Let’s get to it!

Strategies + Tips Discussed:

–Gillon, 2000. This study compared traditional articulation to phonological awareness intervention. The children who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development than the children receiving the other types of speech and language intervention. The phonological awareness intervention also improved the children’s speech articulation.

– Phonological and Phonemic Awareness

Screen Shot 2021 09 13 at 1.58.26 PM

A Quick Review of the Parts of Phonological Awareness

Syllable awareness
Rhyme awareness and production
Alliteration
Onset-rime segmentation
Initial and final sound segmentation
Blending sounds into words
Segmenting words into sounds
Deleting and manipulating sounds

Links Mentioned and Additional Research

– Kelly Farquharson, PhD, CCC-SLP Instagram: @classlab_fsu
– ASHA Evidence Map: Systematic Review: Effectiveness of Early Phonological Awareness Interventions for Students with Speech or Language Impairments
– ASHA Evidence Map: Early Childhood Education Interventions for Children With Disabilities Intervention Report: Phonological Awareness Training
–Article: Al Otaiba, S., Puranik, C., et al. (2009). Across the eight studies investigating the effects of phonological awareness training in students with speech impairments, all studies indicated improvement of the trained phonological skills.
– Ukrainetz Pearson EBP brief
–EBP brief on phonemic awareness efficacy
–Do Phonemic Awareness Interventions Improve Speech in Preschool Children with Speech Sound Disorders?

 

Subscribe & Review in iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you! Click here to make your listening experience auto-magic and as easy as possible.

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Thanks so much!

Transcript

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Marisha: Hello there, and welcome to the SLP Now podcast where we share practical therapy tips and ideas for busy speech language pathologists.

Marisha: Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLP Now podcast. This month, Monica and I are talking about phonological awareness. It's something that a lot of SLP Now members have been asking about. They've been requesting activities and just asking about what that would look like in therapy.

Marisha: And then I also had a little experience that I wanted to share real quick before we dive into all of the nitty-gritty details that Monica did a fabulous job digging up and putting together for us. And so my first experience with phonological awareness was when I was working at a school and there was a student, he had a couple speech errors. We just had articulation goals. It was a student that I inherited, so I just started down that route. But after communicating with the teacher, I realized that there was a lot more going on. The student was really struggling with reading, among other things.

Marisha: So I started digging through the research, trying to figure out what my role would be and what I could do to better support. And there was one article that really stood out and got me excited, and it just made a lot of sense for this student. And this is just one article that I'm pulling out that just stood out to me, but we will go through a lot of different types of articles and research that has a higher quality of evidence, but this is just what got me started.

Marisha: But it was Guillen 2000. The article compared traditional articulation therapy to a phonological awareness intervention. Check out the article for the full details on their approach. But we will share some of the activities throughout the podcast today, just some ideas. What was really interesting was that these children with SLI who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development, which makes sense because that's what they're targeting and they saw improvement, but it also improved the children's speech articulation.

Marisha: So they weren't doing direct speech activities. They were doing all of this phonological awareness, but they also saw an improvement in the speech articulation which was really interesting to me. And I was able to implement some of these approaches with this student, and I saw some similar approaches.

Marisha: But that was just my intro to it, and I'm really curious, Monica, to hear about what your experience was like because your school or district sets things up a little bit differently. [inaudible 00:03:03] you started with it and what have you seen?

Monica: I had preschool to junior high at one point, so I was kind of seeing the different spectrum of it.

Monica: So for my preschool students, we were just really using it a lot for that contrast for them to even hear the sound and do that auditory discrimination. And I was like, "This is really making a difference," so then I really looked into it, and I was like, "There is so much research behind this" because it's just one of those things where you're fresh out of grad school, and they might've touched on it, but then you look into it on your own and you're like, "Wow. I need to like really digest this."

Monica: So I started incorporating it and with my preschoolers because even if we weren't at a really high level, they could still do it receptively, so I feel like that was really great for them, and they felt great because they could be successful with something.

Monica: And then for my elementary students, it was a great way to be able to collaborate with the teachers. And so it was just kind of a natural way to do that, so that was really nice. And they were all just really happy that I was doing something with reading and speech as well because they saw the results. So I was like, "Well, if it's generalizing, there's a big light bulb right there."

Monica: And then for my junior high students, the ones that still kind of had residual speech sound errors, I found that doing those things really helped them, and it wasn't necessarily something that they had done, but just doing a lot of that and concentrating on that because they also were struggling readers as well. They were still going to get help with reading. So it was kind of like, "Maybe that's the missing piece for them to do that in speech as well."

Monica: So for one kid, he didn't have his R in, I think, it was seventh grade, but he had the motivation and he was like, "You know what? I want to get this." And I was like, "Well, we're going to get it" and building in some of those really helped him. I think it just felt like a new way for him to do speech because he had done speech for so long that I think it was just different, and so I got a little bit more buy-in.

Marisha: That is so interesting. I loved your range of experience with that too, and I think that'll resonate with people listening because we have SLPs working with all sorts of age groups, so that's awesome.

Marisha: And so what is phonological awareness, actually, because we've been sharing all of these cool little stories, but what is it? Phonological awareness is just your ability to, and I'm quoting, "identify and manipulate units of oral language," so words, syllables and onset and rime. so rimes is R-I-M-E-S, not like rhyming words. So the onset would be the beginning sound and then the rime would be the end sound.

Marisha: And then under that is also phonemic awareness. So that's your ability to manipulate individual sounds and words, and I feel like a lot of SLPs are probably doing a lot of phonological awareness, but you're just not calling it phonological awareness.

Monica: That's super interesting. And so what are some of the types of activities that we might be doing that fit under phonological overtness?

Monica: So some of the things could be syllable awareness, rime awareness and production, alliteration, onset and rime segmentation, initial and final sound segmentation, blending sounds into words, segmenting words into sounds, and then deleting and manipulating sounds.

Monica: And so we can do a quick example, so syllable awareness would be saying, "How many syllables are in awareness" and then they would get to clap them out.

Monica: Then rime awareness is that, "Do cat and dog rime," or for rime production, it would be, "What rimes with cat?"

Monica: And then for alliteration, it would just be saying words that start with the same sound.

Monica: Then onset rime segmentation would be splitting those words from the beginning sound and the end sound.

Monica: Initial and final sound segmentation is what it sounds like, is being able to segment those. All of that segmentation [inaudible 00:07:19].

Monica: And then blending sounds into words. So that's when we say, "C, A, T. What does that make?"

Monica: And it's so interesting. It feels like I've done some phonological awareness testing, and it's always fascinating that some of our students can't put that together. It seems like, "I'm giving you the answer," but, no. It's super interesting how that works.

Monica: And then the reverse of segmenting words into sounds like, "Tell me the sounds in 'cat' and then the student would have to do that."

Monica: And then the higher level with that is also deleting and manipulating sounds so, "Say 'cat' without the c-." That's how that works.

Monica: So why is all of this important? Why would we be targeting this with our students?

Marisha: It's important at every level, but I feel like maybe the most important is that early intervention where we can really make the biggest difference, especially with some kids who might come to us first just for speech because we all know that is definitely the case sometimes. But when I highlight how important it is for future reading skills and that we can incorporate it into things that we're already doing because I feel like sometimes, we hear like, "You need to do this. You need to do this. You need to do this," but you can incorporate it pretty quickly into something that you're already doing. So a quick phonological awareness check during an assessment and then when you're doing intervention with speech sound disorders, you can kind of put these into things that you're already doing.

Marisha: The kids who are at risk for dyslexia, we have so much overlap with kids who have speech sound disorders. So we're almost like the frontline of catching that and to be able to help with that intervention.

Monica: And it's not hard to incorporate. If we're doing articulation practice, we can do some of those. We can identify the syllables. We can identify the initial sound, the final sound. It's just a matter of knowing which questions to ask and could even have a little cheat sheet of like, "We're going to try this." And so it doesn't involve a lot of extra materials. We're just using words. And then we'll talk a little bit more about activities later, but I love that you pointed that out.

Marisha: I think that's important too is that it's you don't need extra materials or extra supplies. You can just kind of use what you already have.

Monica: Do we want to talk about who could benefit from this, or did you want to talk a little bit more about the importance?

Marisha: There are a couple articles that I looked at. So there was one by [inaudible 00:09:55] et al., and it said that children with a history of speech language impairment are four to five times more likely to have reading difficulties than children from the general education population, so that one definitely stood out to me.

Marisha: And then there is an article that I pulled a lot of this from. So it's from [inaudible 00:10:16] et al. which also includes Kelly Farquharson who is on Instagram, and she's classlab_FSU, and she has a lot on all sorts of things. But this article was exploring the overlap between dyslexia and speech sound disorder, speech sound production deficits. In that article, they just said one-quarter of kids with speech sound disorders who are receiving school-based speech therapy have decoding deficit. So I think she just really wanted to go over the importance that SLPs could play with the role they could play in schools and the best intervention is early.

Marisha: And then it kind of touched on that. It's our speech-only kids. They come in, and you think it's just a speech sound disorder, but I think we're now starting to realize that it's not ever just a speech sound disorder.

Marisha: And in our district, we're really trying to push for full assessments when they have that because you might have a kid who just has a lisp once in a blue moon, but most of the time, they're going to have a lot of other things that go along with that, and I think it's just the importance of also working with other members of the team, just to make sure things are covered. And if I get interns or CS and they'll be like, "Well, this kid just has a speech sound disorder. Do I need to do language testing too?" And I'm like, "Well, here's the thing" and then we kind of go into the importance of you have the opportunity to chat. You might as well just do it. If it's an extra hour or so of testing, you could make a difference in this kid's life for them to be able to get early intervention and to prevent reading difficulties that they have later on.

Monica: No, that can have a huge impact. If it's not super apparent right away, it will become very apparent. And if we lose that time, then that one hour, is it really that bad if we avoid that impact.

Marisha: And then in California, I think we'll talk about it a little bit later too, but in California, it's kind of a tricky area with our ED code. SLPs aren't covering reading skills. That's our other reading specialists, and we have RTI for that too in some districts. But a lot of times, they can't get that intervention until they're 1.5 standard deviations or 2 grade levels below or whatever the qualifier is. So that student might not get intervention until first or second grade which is too late. It's just kind of looking at the big picture sometimes helps to sacrifice that extra little bit of testing.

Monica: So who can benefit from this approach?

Marisha: Going through the research, all students can benefit. So I think all classrooms have it, but if we're looking at who needs that really targeted practice, it's the students that have these phonological awareness difficulties. That's really going to be some of the first indicators that they're going to have difficulty with future reading skills.

Monica: So it's students who have learning disabilities can benefit, students in early education settings, students with speech impairments would all benefit. There was even an article specifically mentioning apraxia. So it's all these different students can benefit it, and you can start as early as preschool.

Marisha: Did you want me to go through some of the articles that I found?

Monica: Maybe you pick one or two to talk about, and we can link in the show notes to the rest of the articles if people want to dig in more, but these are super interesting.

Marisha: Yeah. I, of course, went to the ASHA Evidence maps. It's the easiest place to go if you want a really good quality article. So I'm going to go over two more systematic review type ones.

Marisha: So the first one is a systematic review, and it's called, "The Effectiveness of Early Phonological Awareness Interventions for Students with Speech or Language Impairments." This one is by Otaiba et al. It's 2009. And so across eight studies, they just showed that phonological awareness training showed improvement in phonological skills kind of across the board. So that was awesome to see.

Marisha: And then the other one was [inaudible 00:14:42], and it was a Pearson EBP brief. And this one talked about how you can start as early as preschool and in those early years that you don't have to start with the super easy tasks where it's like, "Which one is a dog barking? Which one is a bell? Put sunset into sunset." You can start with the phoneme deletion. You can start with segmenting. You can start with blending. And that might not necessarily be for every student that we have. We [inaudible 00:15:12] different levels of support that we need to provide for students, but if they're able to and that seems like a good fit for your student, that you can start those as early as preschool.

Monica: That's awesome.

Monica: We have some additional articles that we'll share in the show notes related to the impact on articulation, but that was so cool how we can target, and it makes so much sense that targeting phonological awareness can impact articulation as well. Even if we don't do actual articulation practice, that's so interesting.

Monica: [inaudible 00:15:45] phonological patterns? What does the research show on that?

Marisha: We all know that if there is a phonological pattern in there, that there is going to be a weakness in their whole phonological system. So the research shows that if you do not target phonological awareness, it's not going to generalize to reading and writing skills.

Marisha: Also, if you don't dismiss the kids until you check for those phonological awareness skills because just because the speech sound errors are gone, it doesn't mean necessarily that their whole phonological system is intact. So that Guillen article that you were talking about, as well as the [inaudible 00:16:29] one, was just talking about how this phonological awareness training definitely improves their reading skills, but children who were in the control group... so it's children who received this controlled treatment made significant improvement, but made remarkably little progress in their phonological awareness and written language skills development over time.

Marisha: So I think it just kind of is highlighting the importance again of being able to just include those phonological awareness skills during the treatment.

Monica: That's super interesting, and the progress wasn't significantly slower by adding in the phonological awareness, just in terms of the progress on articulation. So there's not a huge... but we really want them to get their sounds and be able to graduate and all of that. Just targeting that helps the progress towards that, plus it looks at the whole child perspective. So I think I'm convinced.

Marisha: And we have all of the articles in the show notes if you want to dive in more.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through Speech Therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast.

Marisha: If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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Neurodiversity-Affirming Practices: How to Support Sensory Needs

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This is a guest blog post by Monica, a school-based SLP, all about how to support Sensory Needs.

Part of being neurodiversity affirming is recognizing that students who have sensory needs may not be able to regulate themselves or identify what their sensory needs are. What may have been traditionally seen as “noncompliance” can now be viewed through this lens. We can help support our students instead of requiring them to mask their needs. One thing to keep in mind is that students don’t know what they don’t know. It’s one of my favorite phrases that I learned from a fellow SLP. Students may not be aware that they have sensory preferences or how to advocate for themselves. They may not know that they are dysregulated or what would help. Even as adults, we have a hard time listening to our bodies, for example, sometimes remembering to eat or drink. I can’t imagine how hard it is for a neurodivergent child!

It is crucial to create an environment where students can be themselves and get their needs met. Masking and unmet support needs are highly correlated with higher rates of suicide and later mental health issues (Cassidy et al., 2018).

Jessie Ginsburg on Instagram is an excellent resource for what to look out for and tips for working with our students.

When talking about sensory needs and stimming, it’s easier to explain to others as if you were the student. Think about the itchiest bug bite you’ve ever had and how much you felt like you needed to scratch it. You can’t think about anything else because it’s so itchy. Sometimes that’s what having a sensory need feels like, and itching it would be stimming. When you ask students not to stim, or don’t give them an alternative, what you’re asking them to do is listen to you and follow your directions while all they can think about is how uncomfortable they feel. Just like how scratching a bug bite is the only thing that would make you feel better, the way a student prefers to stim may be the only thing that would help them self-regulate. Keep that in mind when alternatives to stimming are suggested. Listening to my students and their sensory needs is essential to building trust because most of my caseload is autistic or has sensory needs.

Quick Ways to Adjust Your Sessions

Give students a choice to sit or stand, as long as they are being safe.

Put a band on the chair legs so that they can move their legs while they sit.

Have an inflated wobble cushion.

Give movement breaks if they are sitting for a long time. Have them stretch in place or give themselves a hug.

Movement breaks with a preferred activity. A lot of my students love dancing to songs. I keep in mind what may be too much sensory input.

Practicing asking for accommodations during a session is a great way to practice self-advocacy skills as well! I start by experimenting with the different supports, then give them a choice of 2-3, tell them they need to ask, then wait for them to ask independently.

Other Things to Keep in Mind

Smells: If I could suggest one easy thing, it would be to not have any strong scents in the classroom and speech room.

Lighting: Is your speech space too bright? Some students may do better without bright overhead lighting. Try turning the lights off (if you can!) or adjusting the lighting to see if it makes a difference.

Sounds: I ask students if the music is too loud, and we adjust as needed. It’s also a great opportunity to practice self-advocacy.

References

Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9, 42.

Neurodiversity-Affirming Practices: How to Support Executive Functioning

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This is a guest blog post by Monica, a school-based SLP, all about how to support Executive Functioning. 

I always tell my interns that the SLP is sometimes going to function as a student’s executive functioning outside of their body until they can do it themselves. Realizing that many of our students struggle with executive functioning is a great way of problem-solving and collaborating with teachers.

Carie Ebert is a great overall resource for early intervention therapy and working with autistic students.

Tera Sumpter has great posts on executive functioning as well. Lots of students struggle with executive functioning, not just students with ADHD or that are autistic.

Here’s a great example of the executive functioning skills involved in a neurotypical conversation. This would be a great resource for talking about how neurotypical and neurodivergent communication styles are different.

 

View this post on Instagram

 

A post shared by Tera Sumpter, SLP (@terasumpter_slp)

Let’s dive into a few examples!

1. The student doesn’t “listen” to directions.

This student may be overwhelmed by multi-step directions and has difficulty with working memory.

Recommended Support

Give one step at a time and show the student visually how it is done. Having an example of what the finished task looks like and having clear steps about the task helps. Having the student imagine what each step looks like will help them towards independence with future tasks.

2. The student is impulsive in class.

This student may struggle with executive functioning and may not prioritize or start more challenging tasks. They may only want to do tasks that feel easy to them, but to others, it looks like they are off task and impulsively doing only preferred tasks.

Recommended Support

Helping the student estimate how much time the task will take and how to start it often helps with how overwhelming it can feel to start and finish tasks.

This post in the ASHA Leader, by Scott Prath, summarizes the SLPs role with executive functioning.

References

Prath, S. (2019). Helping Students With Executive Functions—What Is Our Role as SLPs? The ASHA Leader; American Speech-Language-Hearing Association.

Building Relationships with Students: How to Incorporate Trauma-Informed Practices

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This is a guest blog post by Monica, a school-based SLP, all about how to incorporate trauma-informed practices while building relationships with students.

This post by The Informed SLP talks about the effects of trauma on language development, and if you haven’t read it, you should! They, of course, go over a lot of research, including a 40-year meta-analysis by Sylvestre et al. (2015) that highlights that abuse and neglect lead to delayed language skills. Their post also provides many resources and a reminder that you are almost always a mandated reporter.

I will be honest and say that I take a trauma-informed approach with all of my students. I don’t want to assume that they have not experienced trauma because there may not be outward signs of it. Sometimes we find out later that our students are in foster care or have a difficult family situation. I would rather take a universal approach and have students feel safe rather than find out later that one of my students needed extra support. Here are some supports that I have found to be helpful:

1. Don’t use hand over hand. 

If students need extra support, they can put their hand on top of yours, but ask for consent first.

2. Tell students the plan for your lesson. 

I tell my students what the plan is each time we have a session. If we are going to have a change in our regular routine, I’ll also let them know in advance.

I also do my best to tell students what goal they are working on that day, and we occasionally review why it’s important to work on that goal. Knowing what they’re working on also gets a lot of buy-in from students at any age.

For younger students, I ask them if (their goal area) is really hard to do. They typically say yes, and I tell them that I will be working with them to make it easier. I talk about related activities and how they’ll be easier after we work on them. I also talk about how there will be times when they feel frustrated working on their goals and talk about how they can self-advocate for themselves.

The more reluctant students are typically older. With these students, we work together to choose goals, and we also talk about what it would take to be in speech for less time or to possibly exit.

Overall, these strategies help students feel like their voices are being heard.

3. Be predictable.

My students are the most comfortable when my expectations are very clear, and the consequences are very predictable. Allow time for transitions and give ample warning time for when an activity is going to end.

4. Don’t base your rules on compliance.

I only have a couple of true “rules” in speech. We need to stay safe, and we need to be kind to each other. If I ask a student to change their behavior, I will relate to safety or kindness. For example, if a student is leaning back on their chair, I will say, “We need to be safe. You can either sit all the way in your chair or stand if you need to move around. I don’t want you to get hurt.” That way, I have recognized that they aren’t intentionally breaking “rules”. They may just need movement to keep regulated, and they are having a hard time sitting in their chair.

5. Recognize emotions and feel emotions.

Don’t be quick to have students quickly recover from strong emotions to continue the session. You can work with the school counselor to see what would be appropriate to work on. Autistic students may also have alexithymia and have difficulty recognizing and labeling their emotions (Poquérusse et al., 2018).

6. Be flexible.

Sometimes you won’t get the activity that you planned done if a student is having a rough day. Communicating how they are feeling and working on a less structured activity still works on a student’s access to the school environment/curriculum and their ability to succeed at school. It only takes one adult at school that has the time to listen to them to make a difference.

If your student has a behavior that breaks a “rule” that you have, but you weren’t clear about your expectation for that rule and the consequences, then you have to be flexible about what happens. Admit that adults make mistakes too and that now that we know what the expectation is, we are going to enforce what the consequences are.

Rachel “The PTSD SLP” also shares some great content on Instagram.

References

Poquérusse, J., Pastore, L., Dellantonio, S., & Esposito, G. (2018). Alexithymia and Autism Spectrum Disorder: A Complex Relationship. Frontiers in Psychology, 9, 1196.

Sylvestre, A., Bussières, È.-L., & Bouchard, C. (2016). Language Problems Among Abused and Neglected Children: A Meta-Analytic Review. Child Maltreatment, 21(1), 47–58.

Building Relationships with Students: Anxiety and Other Mental Health Needs

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This is a guest blog post by Monica, a school-based SLP, all about how to build relationships with students while taking into consideration anxiety and other mental health needs!

When our students have anxiety or other mental health needs, we can collaborate with the school psychologist or counselor on goals. We can ask them about how to best support our students.

Another option is to work with the classroom teacher! The SLP is often the best person to collaborate with the classroom teacher if the student doesn’t have academic support services. Being able to suggest accommodations in the classroom could improve a student’s quality of life at school.

Examples of Accommodations

– To be able to present alone and not in front of the class for a student that stutters.
– To be able to ask a teacher to explain directions on a test if they are unclear without fear of being told no.
– To have a discrete signal with the teacher to communicate that they need help.
– To be referred to a peer mentor for classes they are struggling with.
– To have graphic organizers to help them plan assignments.

Push-In Lesson Ideas

– Talk about different styles of communication with neurotypical and neurodivergent students, also known as the double empathy problem (Mitchell et al., 2021).
– Talk about recognizing feelings and dysregulation in your body and have students try out different coping mechanisms to see what works for them.
– Talk about different ways to self-advocate when you are not feeling regulated. (Working in the classroom is also a great way to model for teachers and collaborate without adding it to your workload.)

My favorite Instagram account for school counseling resources and information is WholeHearted School Counseling.

Rachel Dorsey is an autistic SLP that is also one of my favorite accounts. She has a lot of amazing posts on working with autistic clients. I love this post on not labeling autistic student’s emotions:

 

View this post on Instagram

 

A post shared by Rachel Dorsey (@rdorseyslp)

References

Mitchell, P., Sheppard, E., & Cassidy, S. (2021). Autism and the double empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39(1), 1–18.

How to Use Neurodiversity-Affirming Practices to Build Relationships with Students

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This is a guest blog post by Monica, a school-based SLP, all about how to use neurodiversity-affirming practices to build relationships with students!

If you’ve ever wondered how to build a relationship during speech sessions, I’m here to help! I’ve been using neurodiversity-affirming practices for a long time and am constantly shifting and changing. I’ll outline my approach and share what I’ve learned from autistic adults and other essential voices in the disability community. There will also be a lot of links to resources.

As a person of color and a neurodivergent SLP, my therapy approach has always been different. With more people talking about the neurodiversity-affirming movement, I have words to label what I’ve been doing. I have a neurodiversity-affirming, trauma-informed, and culturally responsive approach. It’s a mouthful, but I think it works wonders! I acknowledge that it is a unique time, where there are a lot of shifts happening in society which can be really overwhelming! Providing support communicates to our students that they are welcome as they are, and we will provide the tools to help them succeed. We’ll dig into some basic principles with some real-life examples, and by the end, I’m hoping that you’ll feel comfortable enough to incorporate some of them into your own practice.

First things first, a straightforward way to define a neurodiversity-affirming approach is to think of it as modifying the environment and providing supports, instead of expecting children to change themselves.

Ross Greene (2019) states that children do well when they can and that behind every challenging behavior is an unsolved problem or lagging skill.

In the article Collaborative & Proactive Solutions (CPS): A Review of Research Findings in Families, Schools, and Treatment Facilities, the CPS model is outlined, and a checklist of “lagging skills” to lead discussions for “unsolved problems” is included (Green and Winkler, 2019). In this list are executive functioning needs, sensory/motor difficulties, difficulties with transitions, and mental health needs–just to name a few. This article would be great when discussing making changes with other team members and administration.

This website by AutisticSLT (Emily Lees) in the UK is a fantastic resource on a neurodiversity-affirming approach.

We owe it to our students to learn about self-regulation skills and how to modify environments to help them succeed. By providing support to our students, we build trust and a relationship with them by communicating that we see their struggles and will help shape their environment, rather than putting the burden on them to change. I’ll go over a couple of different support areas for you to individualize for your students, keep in mind that this is not an exhaustive list.

If you want to learn more, check out these blog posts:

– How to Support Sensory Needs

– How to Support Executive Functioning

– How to Support Anxiety and Other Mental Health Needs

– How to Incorporate Trauma-Informed Practices

– How to Be Culturally Responsive

References

Greene, R., & Winkler, J. (2019). Collaborative & Proactive Solutions (CPS): A Review of Research Findings in Families, Schools, and Treatment Facilities. Clinical Child and Family Psychology Review, 22(4).

Building Relationships with Students: How to Be Culturally Responsive

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This is a guest blog post by Monica, a school-based SLP, all about how to be culturally responsive and why it matters!

Representation matters!

An easy way to keep that trust going with students is to have them feel like they are included and represented.

The account Books for Diversity on Instagram is an easy way to find culturally diverse books.

I love this ASHA post, “Why Use Literary Interventions for Diverse Populations” by Phuong Palafox (2018), as well as her Instagram for information about cultural responsiveness.

In her post, Phuong talks about “three ways to incorporate literacy to support the diverse needs of your students and clients”. They are: connect to experience, represent diverse narratives, and value home language. It’s a great way to build rapport and trust when your students’ culture is respected and included in your sessions.

I also love JRC the SLP and her anti-racism work.

Want more information on diversifying your therapy materials? Check out this SLP Now podcast with Liliana from The Bilingual Speechie.

Nina and Scott from Stuttering Therapy Resources also have so much great information on how stuttering is verbal diversity. They also talk about different paradigm shifts around thinking about stuttering in another way.

Here’s a great post about how we should use the word “stuttering” and drop the word “fluency”, as fluency should not be the end goal of therapy.

Keep in mind that it took me years to include all of this in my sessions! It may take some time if you choose to adopt any of these in your sessions and some shifts in thinking, but they are some of the most significant changes that you can make in your therapy room.

Planning Evidence-Based Treatment Plans in Speech Therapy

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This is a guest post by Holly, a school-based SLP, all about planning evidence-based interventions for speech-language therapy.

Planning Evidence-Based Treatment Plans in Speech Therapy

During my first year as a school-based SLP, I was just trying to keep my head above water. I was taking my therapy sessions day-by-day, treading IEP deadlines, and trying not to drown in paperwork. I felt like I was managing, but I imagine I was really just treading water.

With spur-of-the-moment therapy plans, it seemed like I was starting from scratch every day. Plus, if I’m being honest, seeking out EBP- aligned intervention wasn’t a high priority. I just graduated — surely my training was fresh and comprehensive enough to help me serve my caseload of elementary through high school students, right? It turned out, I had a lot of digging to do… which led me to find resources from SLP Now!

If you’ve been tuning into these blog posts and podcasts for a while, you’ve probably heard the SLP Now team talk about the power of planning (here’s a flashback to our Therapy Planning Bootcamp) and the merits of evidence-based intervention (here’s our current podcast series on EBP). That’s because these habits and processes are ways we can #WorkSmarterNotHarder.

No surprise here: the things we think we don’t have time for often end up being the things that save us the most time.

When we reframe evidence-based practice as a process that is embedded into our clinical decision-making (rather than a stack of dusty journal articles you’ve been meaning to get to), it makes a lot of sense to use a plan in therapy.

EBP process

In this EBP process, once we’ve asked our clinical question and gathered/assessed the evidence, we can develop a plan that goes hand-in-hand with our clinical decisions (source: ASHA, accessed 2021).

Based on this framework, I’ll be outlining the workflow that I use for decision making and planning. Once I have gathered evidence-based approaches for treatment, there are some things I do in order to connect the dots between the evidence and actionable therapy plans. With some of these tips and tools, I hope you’ll notice a difference in your work and your students’ communication outcomes!

Step 1: Compile your sources for decision-making.

What kind of internal/external evidence and family values will you reference when planning your therapy sessions?

Here are just a few examples of how I might gather my sources:

Types of Sources
Student assessment data
Family questionnaires
Student interviews
Journal articles
Therapy ideas on the web
ASHAPractice Portal
SLP Now Research Summaries

Organization Ideas
Physical folders for each student or binders for each therapy approach
Digital storage for documents or links (e.g., bookmark lists, Google Drive folders, Trello boards)
Family contact log (the SLP Now notes section is great for this!)

All of this information helps guide your treatment decisions by mapping out the rationale, benefits, and potential harms — plus it can also be shared with members of your IEP team or administration.

Step 2: Decide on your approach and methods of measuring communication objectives.

How are you going to implement and adapt a therapy approach for a student or group?

This is where I typically map out how an IEP goal will be targeted and monitored in the context of my therapy activities.

The SLP Now Paperwork Binder (included in the SLP Now Membership) is a gold-mine of resources — definitely check out the treatment plans across communication domains! Or check out our free treatment plan template to get you started!

Step 3: Outline your logistics.

Once the big picture is formed, it’s time to figure out the practical details.

This can include the topic/theme of activities, therapy planner for a given week or month, teaching visuals, therapy materials, and data-taking tools. There may also be other things to consider: school protocols, location of services, feasibility of implementation, therapy routines, etc. Lastly, it’s up to us to evaluate the effectiveness of our approach as we deliver services. This step of evidence-based practice is what sets us apart as clinicians!

Here’s an example of how I might use this workflow in my role as a school-based SLP.

Step 1: Compile Sources

I work with an autistic student in third grade (you’ll see identity-first language in this example — of course, use whatever terminology your student/family prefers). This student loves outer space, uses grammar/syntax effectively, and has strengths in vocabulary. The student exhibits some signs of hyperlexia and loves reading books aloud, but has trouble with comprehension. As a result, summarizing stories can be challenging. In conversation, their speech pattern is consistent with cluttering (quick rate of speech, collapsing of syllables/words, excessive revisions), plus they are having trouble navigating social situations with peers.

This student and their family are on board with a neurodiversity-affirming approach; based on our conversations, we will shift away from teaching social skills and masking, and move towards perspective taking, problem solving, and self-advocacy skills.

Parent Communication

Sources: Family/student interview, baseline progress monitoring data and student ratings, ASHA Practice Portal page on Fluency Disorders and Spoken Language Disorders, the Therapist Neurodiversity Collective education page, “Systematic Individualized Narrative Language Intervention on the Personal Narratives of Children With Autism” (Peterson et al., 2014), and SLP Now’s Narrative Research Summary (Included in the SLP Now Membership).

Step 2: Decide on Approach/ Methods

I’ll use treatment plan templates from the SLP Now Paperwork Binder, especially the pages related to Stuttering, Language, and Autism/Social Communication.

 

Social Language Treatment Plan

For the cluttering treatment approach, I’ve decided to explicitly teach strategies related to self-monitoring (rate, clarity of speech) and communication repair. For this goal, I’ll use student self-ratings to measure their awareness and speech satisfaction in structured conversation.

When using narratives to target story grammar elements, the student will focus on problems/actions/consequences and internal responses of characters throughout the story. I’ll measure the student’s progress by taking data on the student’s ability to retell a story with visual support, including these elements.

Per decision making with the IEP team (Brandel, 2020), the student will receive 45 minutes of direct therapy per week (a 30 minute small group session primarily using Literacy-Based Therapy, plus a 15 minute individual session to work on cluttering awareness and strategies).

Step 3: Outline Logistics

Topic/theme: My third graders are learning about the solar system in science, which pairs well with my student’s space interests! My library has a copy of “Mousetranaut” that I’ll be using in therapy.

Therapy activity planner (week/month at a glance): I love using the SLP Now One Page Literacy-Based Therapy Planner worksheet in order to set up plans based on a theme or book for multiple weeks at a time. If you’re using another approach, you can create your own outline for assessing, teaching and practicing skills.

Literacy-Based Therapy Planner

Prep your teaching visuals: I have a set of materials for supporting student narratives, including story grammar icons. For recognizing characters’ thoughts and feelings, SLP Now’s Perspective Taking Bundles are great to keep on hand. I also have a set of visuals to use as reminders for cluttering strategies. It can be helpful for my students when I keep these teaching tools consistent, even as my themes change throughout the year!

Gather materials: I’ll get a copy of the book and add Mousetronaut-themed materials to “My Materials” in SLP Now (book guide, book activity, no print activity, and smart deck). Think about how you’ll organize physical materials while you’re actively using them (here are more tips on Speech Room Organization!)

Set up your data collection tools: I take data on pen and paper, then plug it into my SLP Now planner to keep track of student progress over time. I also have a self-monitoring scale that the student can use throughout our activities.

Provide intervention → evaluate & adjust as needed: I’ll adjust the plan and task complexity to account for the student engagement/progress. I’ll also follow up the student’s teacher and family members to measure how these skills are carrying over beyond our sessions.

Mousetronaut

Narrative Visuals

 

That’s a run-down of how I embed the process of evidence-based practice into my therapy plans! I normally think through Steps 1 & 2 near the beginning of the year, then I update Step 3 as we progress through different therapy activities/themes. It takes time up front, but using a long-term plan ends up saving so much time and stress compared to reinventing the wheel every morning.

What does your therapy planning look like? We’d love to hear what tools and strategies you use to set yourself up for success! Feel free to drop any questions you have below, too ⬇️

 

 

References

American Speech-Language-Hearing Association. (n.d.). EBP Process – Step 4: Make your clinical decision. Retrieved September 2021, from https://www.asha.org/research/ebp/make-your-clinical-decision/. 

Brandel, J. (2020). SLP Service Delivery Decisions: How Are They Made?. Communication Disorders Quarterly, 1525740120951185.

Johnson, C. (2008). Evidence-based practice in 5 simple steps. Journal of Manipulative & Physiological Therapeutics, 31(3), 169-170.

Petersen, D. B., Brown, C. L., Ukrainetz, T. A., Wise, C., Spencer, T. D., & Zebre, J. (2014). Systematic individualized narrative language intervention on the personal narratives of children with autism. Language, Speech, and Hearing Services in Schools, 45(1), 67-86.

Ukrainetz, T. A., & Gillam, R. B. (2009). The expressive elaboration of imaginative narratives by children with specific language impairment.

#097: How We Approach Client Perspectives

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This Week’s Episode: How We Approach Client Perspectives:

This month is coming to an end and so is our podcast series on EBP. Today we will be finishing up by discussing the last part of the EBP Triangle: Client Perspectives.

Why are client perspectives important?

✨ Because lived experience matters.✨

Since starting the podcast, I’ve spoken with so many SLPs who have landed in a speciality or area of expertise because of their experience living with a condition.

Stephen Groner is a great example of this — his personal struggles with fluency as a child led him to develop a very real understanding of how stuttering can impact your life on a social or emotional level.

That experience is part of why he’s so effective in his work today!

But we don’t always share the same conditions as our students, and pathology isn’t the only experience that influences the client perspective; it’s just one example.

Linguistic diversity is another example of something to consider when it comes to client perspectives, so we spent some time discussing that — and if you want to learn more (specifically as linguistic diversity relates to narratives) check out this episode from last month.

Effective therapy is about so much more than laying out the material and following a plan.

Taking client perspectives into consideration allows us to get a full picture of what’s really going on with our students so that we can use our clinical judgment and meet them where they’re at.

We want to set our students up for success, and this helps us do that! 🚀

Of course, client perspectives is also about more than just the student — especially if they’re too young to provide meaningful information during an intake.

Figuring out what kind of support is available outside of the speech room is so important because if there isn’t buy-in from the student, their family, or teacher…well, you probably won’t see much progress.

Okay! There’s so much more that I could tell you about, but this is an email not a novella. 😂

If you’d like to catch up on this month’s podcast series, you can do so by visiting these links below:

A Quick Review of the EBP Triangle
Evidence (Internal & External)
Clinical Expertise

Let’s get to it!

Evidence-Based Practice Triangle (EBP):

In this episode of the SLP Now podcast, Marisha and Monica break down their process on how they approach clinical perspectives.

Important Take-Aways

– Get to know your student
– Take an inventory of your student’s thoughts and feelings
– Are there any cultural differences?
– Get client and family buy-in
– Send the family a language use questionnaire (linked below)
– Find out who the client’s main caregivers are
– Use the ASHA Evidence Maps
–  Reflect on your internal evidence, is it working?
– Reflect on your external evidence, do you need to make adjustments?
– Pair it all up with what works best for your client and boom, you’ve got yourselves EBP with a pretty bow on top! 🎁

Links Mentioned

– ASHA: Evidence Maps
– Podcast: Considerations for Linguistic Diversity When Assessing Narratives
– Cornell University: The Multilingual Language Use Questionnaire
– Adventures in Speech Pathology

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Thanks so much!

Transcript

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Marisha: Hello there and welcome to the SLP Now podcast, where we share practical therapy, tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there and welcome to the SLP Now podcast. I'm your host Marisha. And this month we have Monica Lynn joining us to talk about all things evidence-based practice. So in episode 95, we did a review of the EBP triangle, just some of our initial thoughts. And then for the rest of the month, we are going to be diving into the different parts of the triangle. So without further ado, let's dive into this week's episode.

Marisha: Now, let's tackle all things client perspectives, at least as much as we can. Where should we start when we're thinking about client perspectives?

Monica Lynn: You know what I think the ASHA Evidence Maps is probably the best place to start just because I've got a whole tab for it. A lot of times there might only be one or two, but it doesn't have to just be from the client perspective tab, I feel like sometimes just in the regular tab. For example, if you go to the cultural and linguistic diversity one for external evidence and clinical judgment, that's it, just thinking about the cultural linguistic diversity is taking the client's background into account. So you're already kind of doing it. So the one that I looked at is the use of dynamic assessment. So even doing that, doing a dynamic assessment, you're taking into account that your student is bilingual in being able to do that.

Monica Lynn: So then there was a meta analysis right there. It says that is a great way for diagnostic accuracy for that. That's a great way to be able to take that into account, that client perspective ones. There was one on telepractice and outcomes for speech-sound disorders. We definitely had our fair share of telepractice this year, but this one study listed under client perspectives said that all studies included high levels of participant satisfaction with tele-health delivered speech and language interventions. This is for the study, I am sure that those of us that weren't able to do telepractice in the way that it was meant to be might have some differing opinions, but at least you would have kind of some place to go from in general that it is possible for this type of service delivery model to be successful. And then there was one on fluency and stuttering and the lived experience of stuttering.

Monica Lynn: And this one was like implications for rehab. So this was for adults, I believe, but just like how we're listening to autistic adults to learn from adults who stutter like SLP [inaudible 00:03:08]. But this study included five themes of lived experience of adults who stutter. So like avoidance is used to manage stuttering that stuttering unfavorably impacts employment experiences. It shapes your self identity. What kind of negative reactions there are. So some of these things that might even be like social, emotional things that we need to keep in mind even for when we have them when they're children, because that can shape the therapy that they have and their perspective about it can shape their thoughts about themselves, their self identity, their self-esteem, and then that can bleed into so many areas of their life that if we didn't consider those things, when we're doing therapy as children, that it might affect the way that they are as adults.

Monica Lynn: And those are kind of like important things to think about and part of the EBP triangle where it really might be just taking like an inventory of their thoughts and feelings about something. Like I know in my sessions we're always talking about how we feel about things and doing a lot of self regulation type stuff. And I think the lesson probably is, don't be scared to do it during your session. Therapy does not have to just be like, "Here's our material, here's our plan," black and white. We can include a lot of this stuff to be a whole picture of the student, just to make sure that we're having the best outcome that we could.

Marisha: Yeah, absolutely. It's interesting too, because last month when we were talking about narratives, we were talking about linguistic diversity. So I feel like our whole last episode last month was talking about how this could be implemented with narratives.

Marisha: And I'm curious if you have any, just more general suggestions in terms of that domain.

Monica Lynn: So I think for cultural staff, during your interview with the family, asking who the caregivers are at home, who's helping with homework, do the tips and the recommendations that you're giving align with their family values or their culture. So like a lot of the common things like reading books at home that might not be a cultural practice that they do at home. So that might be really difficult for them to incorporate at home. Or for a lot of my families the grandparents or the caregivers while parents are working, so they were helping a lot with schooling and they weren't very comfortable in English. So it might've been the older brother and sister who also had to do school at the same time. So they might not be able to do any of these things at home because parents are at work.

Monica Lynn: I also had a parent who uses ASL. So it's like asking them, "You should provide whatever you want at home, what you're comfortable with in the language that you are comfortable in." So it's like, "If you want to practice this, practice it in ASL. Do it in a way that is feasible for you." And I think it's just like being flexible with that because I know a lot of the external evidence is going to say that the practice has to happen at home for generalization to happen, but real life, that may not happen. So then you might have to work with the teacher to make sure that happens in the classroom, just because of the way that your population is and just to be sensitive to that. I think another one could be, are your materials diverse?

Monica Lynn: Is your population represented in your materials? Like if your students need more support in language, are you giving your directions in a way that they can understand? All of these things together it is a lot, but I feel like after you do it a lot, it just kind of becomes routine and then you don't have to think about it so much. But in the end, this might be some of the most important stuff too, just because it makes the family feel included.

Marisha: Yeah. If we don't have the student buy-in, or the family buy-in, or teacher buy-in too, we're not going to make much progress. We could be the most experienced SLP, totally dialed in on all of the research and all of our data collection have the best system ever, if we're not taking this into consideration, we could still have students that make minimal progress.

Marisha: I'm curious too, obviously we want to get the buy-in from the student and the family and the teacher, last time we talked about the language use questionnaire to just kind of understand where they're coming from and I think that can sometimes bring things to light, but what other things could we be considering when we're having those conversations? Is there anything that we can listen for or something that we can ask?

Monica Lynn: I think generally when we're using like that questionnaire, I use a general questionnaire about what the family feels like are the student's strengths, what they're doing well with, what helps them succeed, what they think the challenges are for them. And what is one thing that you would love to see your child succeed with? And maybe like, what are things that help with that?

Monica Lynn: If they have found that repeating directions, or having a visual, or something especially if you have a new student that you're assessing, all of that could be really valuable information. And we touched on it a little bit too with the teacher that you could ask the same sort of things in the classroom. But I think that it doesn't just go for narrative, I think that it goes for everything that, do you notice that if you have it projected up on the TV... our classrooms have TVs, we're really lucky and the teachers can project it and show an example of how you're supposed to do it. Does that visual help a lot or do you have to come over to the student's desk and repeat the verbal instructions when you're closer and you know that they have their attention?

Monica Lynn: So some of those things and kind of narrowing down what type of support that that student might need and really considering that student's individual support needs, I think can help. Also, the student's social, emotional situation. So if you're doing like a multi-disciplinary team approach, did anything else come up with the other people who are doing the assessment? IF you're picking a goal for stuttering is that going to be something that you're taking the student's social, emotional situation into account? For autism, are you incorporating methods that aren't going to make the student uncomfortable? Like making sure you're not using eye contact goals or preventing them from moving their body in a way that they need to? So those might be embedded support. So in my thing, I have embedded supports for... they can sit or stand if they need to, or if they need a movement break.

Monica Lynn: So those are all some things that you can look at for supports that you need to have a successful session that aren't necessarily based in, you're not going to read like a whole article on it, or you might not have internal data for it, but it's just kind of something that you're considering about the client as you get to know them to think about the best way to support them.

Marisha: Absolutely. And I think now would be a good time to tie all the pieces together. One example that stands out to me, and this was from Dr. Strand's seminar too, I think it's important just to listen and have an open perspective as to what is important too, because that's what this boils down to. What's important to our students and parents and teachers? She's got all of her clinical experience or expertise, and she definitely knows all of the research and she knows what progression of words is the most evidence-based.

Marisha: But this student really, really wanted to learn to say his name, it was not in the protocol, it didn't make sense in terms of where the student was, but that is what he really wanted to do. So they took some time every session to work on learning his name. So she incorporated all of those different parts of the triangle, that motivation I think really contributed and the student felt seen and heard, and it all went together. So I'm curious if you have one other example to wrap this up.

Monica Lynn: I do have a specific example, but that also made me think about using a student's special interest in the session. And it's like, sometimes if they are not in the mood, they're not super regulated, we will throw everything out the window and talk about trains for half an hour. But you know what? We still get the work done and they're still making progress.

Monica Lynn: So I think that's just something to keep in mind. But for pulling it all together, I think we could talk about... like a student you have with a phonological disorder, they're not making much progress, you learned about minimal pairs that seem like the easiest. There's a little bit of rhyming in there for phonological awareness, you feel like you're doing okay, but then you look at your internal evidence and you're like, "You know what? I feel like maybe we would've made a little bit more progress now." So then you look into other treatment methods. So you were looking into external evidence. So you see that from your assessment that student had phoneme collapsed. So then you could look into multiple oppositions and from also different external evidence research articles that you want to add some more phonological awareness activities as well.

Monica Lynn: So then you're going to use your clinical judgment to then put that together and try this new method, which Rebecca from [inaudible 00:13:08] and speech pathology has amazing stuff for that. And put that together, [inaudible 00:13:12], the phonological awareness, switch it up with the student, that the student has low frustration during sessions. So they're going to be able to try that when they're making new sounds. So you've thought about that student's social, emotional reaction that they might have to try a different method that might be a little bit more difficult. So that client perspective comes in there. The family at home has been asking for homework and they said they will practice because the student is really unintelligible. So now you've got that client and family perspective. So now you know that they are going to do some practice at home.

Monica Lynn: With really unintelligible students, I also do what you were talking about. I'll ask families to send me like 5 or 10 words that are really important for them that they struggle with and are frustrated at home with so that we can practice, or I might even teach the classroom aid after we've gotten it pretty good. We'll have like maybe a classroom aid if there is one. Just practice that list with them a couple of times every day. So I have that [inaudible 00:14:22], and then you wrap that all together and now you've got an EBP treatment plan.

Marisha: Oh, I love it. It's like a nice little bow.

Monica Lynn: Right?

Marisha: Wrapping it all together. That is the perfect way to wrap up the series all on EBP. Thank you for sharing all of your experience and research with us, Monica. It was super helpful.

Monica Lynn: Yeah. This has been fun.

Marisha: And yeah, we'll see you all next month.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through SpeechTherapyPD. So yes, you can earn ASHA CEUs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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7 Phonological Awareness Strategies in Speech Therapy

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This is a guest blog post by Monica, a school-based spech-language pathologist, all about Phonological Awareness Activitiesin school-aged speech therapy!

What is Phonological Awareness?

Phonological awareness is “the ability to identify, process, and manipulate phonological units that compose spoken words of different complexity and size” (Milankov, Golubović, Krstić, & Golubović, 2021). 

In other words, phonological awareness is the ability to break down and manipulate spoken words into different parts.

Phonological awareness includes the awareness of words, sentences, syllables, onsets (first sound in a word), rimes (sounds that follow the first sound in a word), and individual sounds in syllables and words (Harbers, 2003). 

Some examples of phonological awareness are:

Rhyming: identifying words that rhyme

Counting syllables: identifying how many syllables are in a word 

Alliteration: identifying words that begin with the same sound

Phonological Awareness and Phonemic Awareness: What’s the difference?

Before working on phonological awareness and phonemic awareness in your speech therapy sessions, it is important to note the difference between phonological awareness and phonemic awareness.

Picture phonological awareness as an umbrella, with phonemic awareness falling underneath of it. Phonological awareness is the ability to break down and manipulate spoken words and sentences into different parts using larger chunks (think rhyming and counting syllables), whereas phonemic awareness is the ability to manipulate smaller pieces, such as individual phonemes in spoken syllables and words (Harbers, 2003). 

Some examples of phonemic awareness are: 

Segmenting phonemes: “map” = /m/ + /a/ + /p/”

Substituting phonemes: “say map, what is the word if we switch /m/ with /t/?”

Isolating phonemes: “What is the first sound in map?”

Why is Phonological Awareness important?

Making the jump from research to practice can sometimes feel overwhelming. Working on phonological awareness with students who are already at risk of developing dyslexia is one that translates pretty painlessly. This post will quickly cover why we should target phonological awareness in our sessions and then discuss speech therapy ideas. The activities will focus on preschool to 1st grade, but you could easily adapt them for any age group.

If you follow Dr. Farquarson on Instagram, you know that including phonological awareness activities during speech sound sessions is a must!

The article, Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits, by Cabbage et al. (2018) is a must-read on the connection between dyslexia and speech sound disorders. The article states that, “Approximately 18% of preschool-age children with isolated speech sound disorder (absent of a co-occurring language impairment) have reading difficulty in mid-elementary school” (Cabbage et al., 2018) (Lewis, Freebairn, & Taylor, 2000). “In a separate line of work, an estimated 25% of school-age children with a family history of dyslexia have a history of speech sound disorder in early childhood (Pennington & Lefly, 2001). Thus, speech sound disorder and dyslexia are highly comorbid.”

Long story short, students with speech sound disorders are at a higher risk for developing dyslexia later in life, so including phonological awareness activities is an easy way to introduce reading skills early on (Tambyraja, Farquharson & Justice 2020).

If you want to know more about phonological awareness, check out the podcast episode on Where to Start With Phonological Awareness.

What is the Phonological Awareness Hierarchy?

Now that we have a better idea of what phonological awareness is, let’s take a look at the phonological awareness skills based on complexity. According to Moats & Tolman (n.d.), the following is a list of phonological awareness skills, ranging from the most basic phonological awareness skills to the most advanced phonological awareness skills:

Word awareness: tracking words in sentences

Rhyme and alliteration during word play: enjoying and reciting rhymes and alliterations (not producing)

Syllable awareness: counting, tapping, blending, or segmenting words into syllables

Onset and rime manipulation: producing rhyming words

Phoneme awareness: identifying and matching the sound in words (e.g. “which picture begins with /p/?”, segmenting and producing sounds (e.g. what sound does map start with?”), blending sounds (e.g. /m/ /a/ /p/ = map), segmenting phonemes in words (e.g. map = /m/ /a/ /p/”, and manipulating phonemes by removing, adding or substituting sounds (e.g. “say stop without the /s/”). 

Teaching Phonological Awareness Skills using the General Education Curriculum

I typically incorporate phonological awareness into my sessions based on the Preschool Learning Foundations (PLF) and Common Core Standards (CCS).

Here’s a quick snapshot of the PLF and CCS if you need them as a reference:

Preschool Learning Foundations:

Preschool Learning Foundations

Common Core Standards for Phonological Awareness (Kindergarten and 1st Grade)

CCS for Kindergarten + 1st Grade

How to Write Speech Therapy Goals for Phonological Awareness Skills & Phonological Awareness Goal Bank

Like any speech language goals we write, we want to make sure our phonological awareness goals are SMART, meaning our goals are Specific, Measurable, Attainable, Realistic, and Timely.

A great place to start to get ideas for phonological awareness goals is the SLP Now Goal Bank. There are several examples of phonological awareness goals to get inspiration from. Remember, it is important to make goals individualized yo your students!

5 Examples of Speech Therapy Goal Targets For Phonological Awareness Skills:

Listen to a word and identify the first/middle/last phoneme.

Listen to individual sounds and blend them to form a word.

Produce the individual sounds in a stimulus word (e.g. /k/ + /a/ + /t/ for”cat”).

Delete phonemes in a word to form a new word.

Phonological Awareness Skill Building Activities

Now on to the phonological awareness activities! I’m going to cover my favorite ones and how to use them during speech sessions. I weave phonological awareness into my speech therapy activities. They aren’t separate tasks that take a lot of planning or prep. It’s part of the teaching process and works well with auditory discrimination.

Manipulating Individual Syllables

I use small dry-erase boards the most for this activity since it would be a lot of prep work to print and cut out words by syllables for all of my students. They also get practice writing out the words when we use dry erase boards, which teachers love anyways! I try to get a list of sight words from teachers and pick out words that have my student’s sounds.

Write out a target word on the students’ dry erase boards at the top to leave room for them to copy it on the bottom. Draw lines between the syllables and erase syllables, so students practice manipulating words.

Here’s what it might look like if you had a student working on multisyllabic words:

SLP: I’m going to write strawberry on the top. Let’s clap that out and see how many syllables it has. Straw/ber/ry. Did you hear 3? Let’s do it again. Straw/ber/ry. Let’s draw lines between the syllables, and then I’ll have you copy it down at the bottom. We heard 3 syllables, right? So every time you say the word, it should have 3 syllables. Let’s try!

*A prompt to build self-awareness could be, “did that have 3 syllables?”. Students would be able to say yes or no and then try their words again.

SLP: If I take out the first syllable “straw,” what’s left? Ber-ry. If I take out “berry,” what’s left? Straw. If a student can’t get this, I’ll use the dry erase board and cover the syllables to match what I’m saying. Let’s make sure we get all of the syllables when we say our words.

Rhyming Words

Using minimal pairs is an easy way to work on rhyming! I usually use a small set of words (no more than 5) and ask my students if the ending sounds the same. I mix in random words that sound really silly to make it fun when we’re contrasting sounds that don’t rhyme.

Here’s what it might sound like in a session if you were working on fronting:

SLP: Let’s look at these pictures. This person is tall (gesture for tall), and this person is making a call (gesture making a call). Let’s say those words. Tall. Call. Did you hear how both of the words have “all” at the end? Let’s just say “all”. Now let’s add our /t/ sound. Tall. Let’s say “all” again. Let’s add our “c” sound. Sometimes our “c” sound is just like our /k/ sound. Call. Did you hear how they both have the same sound at the end? That means they rhyme. What if I say call/oink. Did those two rhyme? No! That has a different sound at the end.

Other Phonological Awareness Ideas

Go through the minimal pairs and ask students to jump or do some movement or gesture every time the pairs rhyme, then sit down if they don’t.

Have the words separated into onset and rime. Have your students say what you hold up so that they have a visual of the rime being the same. Write the “c” and /t/ on their own and then have /all/ on its own and then put them all together to make words and also say /all/ by itself to build awareness. This is also a great way to work on blending.

Add some fun to repetitions by varying the speed of combining and deleting the onset and rime as they repeat them. Verbal instructions for this one could be, “Let’s put this one together fast” or “Let’s put this one together super slow”.

You could also put the pictures down and have students pick up matching rhyming pairs. You could modify this to add movement by sticking your pairs on the wall with some sticky tack and standing for parts of your session. You could make a scavenger hunt for the rhyming word after you’ve gone over all of the pairs. The ideas are endless!

Isolating Sounds

I use isolating sounds the most out of all of the phonological awareness tasks. It also really helps my deaf and hard of hearing (D/HH) students. If you have any students with initial or final consonant deletion, you’re probably already including it in your sessions. I love that it’s auditory discrimination and phonological awareness all rolled into one.

I mainly use gestures as we talk about our sounds and go through repetitions.

If a student is working on /s/ blends, I will ask them if the /s/ sound is in the front of the back. I put my hand on my heart for the “front” sound and point to my back for the “back” sound.

SLP: Our word is “spot”. Did you hear the /s/ sound in the front (hand to your heart) or in the back (point to your back)? Spot. I heard that in the front (hand to your heart). I want you to try the next word. Spill. Did you hear the /s/ sound in the front or the back? Yes! The front. What’s our back sound? Spill. It’s an /l/ sound! I will say the sound for new words and ask, “What sound did you hear in the front?” and “What sound did you hear in the back?”.

When a Student Responds Incorrectly

I ask, “Where is the /s/ sound? Front or back?”

Then I say, “You’re right! It’s in the front, try your word again.”

After enough times, if I ask “front or back,” they can correct their sound by themselves.

It works really well with initial /s/ blends and leads to less prompting pretty fast. I love that it builds self-awareness and self-correction quickly too.

Deleting and Manipulating Sounds

Here’s another activity that’s perfect for working on blends. Let’s say a student was working on /l/ blends. I use a dry erase board, or we make it a listening/auditory discrimination activity.

SLP: We’re going to work on the word “flip”. What’s the first sound we hear in “flip”? That’s right, an /f/ sound. What happens if I take the /f/ sound off? It becomes “lip”! Let’s try with some more words.

It also works well with final and initial consonant deletion.

SLP: Let’s work on the word “cat”. I’m going to write it out. If I cover up the “c” what do we have? At! Let’s try to say all the sounds by themselves “C-A-T”. If we put those all together, what does it make?

I often mix and match phonological awareness activities and put a couple of them together depending on what process we’re working on. I also adjust based on how much support my students need. Tambyraja, Farquharson & Justice (2020) highlight the unique skill and importance SLPs have in developing early reading skills with our students during speech therapy sessions. I love that I’m helping my students work on their reading skills, and it doesn’t take a lot of effort on my part.

I also love this resource from Reading Rockets. They partnered with the National Education Association and Colorín Colorado to make a guide for parents. It’s great for educators too. They have lots of activities for phonological awareness. It’s a great place to look if you want more ideas.

 

References

Cabbage, K. L., Farquharson, K., Iuzzini, -Seigel Jenya, Zuk, J., & Hogan, T. P. (2018). Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits. Language, Speech, and Hearing Services in Schools, 49(4), 774–786.

Harbers, Heidi. (2003). Phonological Awareness and Treatment Outcomes. Perspectives on Language Learning and Education 10, 21-26. 

Lewis, B. A., Freebairn, L. A., & Taylor, H. G. (2000). Academic outcomes in children with histories of speech sound disorders. Journal of Communication Disorders, 33(1), 11–30.

Pennington, B. F., & Lefly, D. L. (2001). Early Reading Development in Children at Family Risk for Dyslexia. Child Development, 72(3), 816–833. 

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