Marisha

Marisha (host): Welcome to the podcast. SLPs have submitted questions about the complexity approach, and I am so incredibly excited to tackle some of those questions with our guest today. I knew she would be able to break down the complexity approach for us, probably better than anyone else, because I've learned all of the practical implementation tips from her, I've been able to implement this with my caseload, and it's been an absolute game changer. And I learned all of this through her amazing site called SLPath, and it includes comprehensive courses as well as so many free resources that make the complexity approach totally doable and approachable, no matter what your caseload looks like. So I can't wait to hear all of her practical tips and strategies. So without further ado, I'm going to go through her bio real quick because it's absolutely amazing.

Marisha (host): But Jennifer Taps Richard is a speech language pathologist in the San Diego Unified School District, and an Indiana University graduate. She provides small group and classroom intervention to caseload and at risk students. And so she's in the trenches with us, but she's also a coordinator for the Phonology and Articulation Resource Center. She applies research and supports SLPs in articulation and phonological intervention through staff development, consultation and coaching. She also owns SLPath, like I said, a private company committed to promoting best practices and speech sound disorder intervention through online courses and intensive workshops. And I am so incredibly excited that she's here with us today. So let's dive in. And before we get into all of the juicy content, I'm curious because you're clearly a very busy person, very, very smart with free resources and ideas for all of this. But I'd love to hear a little about you and what led you to do so much work in this area.

Jennifer: Well, thank you. It's a pleasure to join you on the podcast today. I've just always found linguistics to be fascinating. I'm kind of a nerd where [inaudible 00:02:15]that's concerned, and it's just from the time I was in undergrad, when I first kind of learned the beginning of these principles, I was just kind of blown away by how impactful it can be to teach complex sounds to kids with speech sound disorders. And I remember the first time I heard about it, I was a junior in college in Indiana and by chance my father was in town visiting and he was picking me up after the class and, when I walked out he said that he thought I met like Bono or some other rock stars something because I was so excited about the potential for pursuing this kind of work and what it can do for kids to have them become more intelligible and therefore more successful in communicating. That's what kind of led me to be interested in this from the time I was 19.

Marisha (host): Yeah, that's such a great story. I love that. And I got a little bit of chills hearing it. Because you can totally see your enthusiasm for that topic. Help us understand a little bit. What is the complexity approach?

Jennifer: Well, I think most SLPs are familiar with the normative approach. The idea that we teach sounds and developmental sequence. That's been a historical practice in our field since really the beginning. Complexity takes this idea and completely turns it on its head. Instead, it advocates teaching phonetically complex non-stimulable and later mastered sounds. So this is a very different way of approaching helping kids to learn more probably about the sound system as opposed to one sound at a time. And, it's really based on about more than 30 years of research studies, and it applies linguistic principles to help SLPs re-target for action. So Judith Garrett, who's at Indiana University, my Alma Mater, was really the first proponents of this approach and other investigators have looked at this at other universities since then. And if people are interested in reading an excellent article that it provides an overview of the complexity approach, Garret's 2007 article is fantastic. And it'll give you a much bigger sense than I could give. It's due, during this session.

Jennifer: But essentially the idea is that we teach complex targets, especially complex clusters like /spl/ as in splat or /thr/ as in throw. And this helps kids to win more rapidly about the sound system, thereby helping them become more intelligible, more quickly. And essentially it's not just about the treat to targets, it's about the entire sound system. So it's really remarkable still after doing this for 20 plus years, I still get a thrill to see what kind of changes occur in a child's sound system after a few months of working on particular targets. But one other thing that I thought might be helpful when talking about what is the complexity approach is just to kind of share, the general findings of the body of work of complexity and then also how we've applied it in San Diego Unified in the trenches basically. So, the original research, it's all received, just like most biological research, individual services and the university clinic, the kids were around age four.

Jennifer: These are kids who only presented with phonological disorders. And that's to keep research more controlled and have fewer variables. Just like we often see with phonological research. So these are not kids who also have language disorders or other kinds of learning issues or behavioral issues. And that's pretty much the case with phonological research. But in looking at the original complexity studies, most kids received about 20 to 25 hours of intervention over 10 weeks and they increased an average of 20 to 25% in their consonance correct, which is a huge gain in a short amount of time. And that's because of these complex targets. But even with those original studies, Garrett and others, positive that these principles may apply to other populations as well, that we could potentially apply them to kids with concomitant language disorder, kids with autism, kids with down syndrome, kids with mild articulation disorders.

Jennifer: And in particular I wanted to highlight kids with concomitant language disorders, because researchers have estimated that as many as 60% in children with phonological disorder also present with expressive language disorder. That's a huge percentage of the population. And we of course want to consider that. But in our district we've had SLPs applying these principles for more than 15 years. And what we've really strived to do is go across populations and not only children with phonological disorders, but the kids we see in the real world. So the kids who also have language impairments, kids with autism, down syndrome, kids who stutter, I mean you name it, to anybody who needs to learn more about the sound system. And so what we've done is we've collected several case studies that have been submitted by various SLPs and not just students that I work with.

Jennifer: And I partnered with Jessica Barlow and Phillip Combats from San Diego State University. We took 32 of those case studies from this heterogeneous groups. So these again are kids, it's a very mixed group. So some kids had only phonological disorders, some kids had co-occurring language impairments. We had some bilingual kids, we had a child who stutters. And these kids all received group intervention in the schools just like we typically do. We typically provide and all 32 of these kids received treatment on complex two element clusters such as /fl/ or complex three element clusters such as /skr/. And so what we did with this data is, we had probe data before or at the beginning of the school year versus the end of the school year. And so we analyzed this data to look at a number of measures. And what we found was the children received about 20 to 25 hours on average of intervention, well in groups.

Jennifer: And each group had an average of 25% increase in consonance correct. So just like the original complexities studies. And this is different conditions. Because with the original studies, there was a very strict protocol. It was individual and so very controlled, which is what research needs to do, but the schools are messy. We have a million interruptions, but we can still achieve a very high level of increase despite that. And we even broke it down to different groups. So we found a comparable increased for kids who only had phonological disorder versus kids who had phonological disorder and language impairment. We had the same kind of increase for kids under five versus over five. Yeah. And he also had the scene changes for bilingual versus monolingual kids. And so essentially all this tells us that it's possible in the trenches to help kids rapidly increase their intelligibility when we teach them complex down.

Marisha (host): Oh, that's amazing. And I love the comparison of like the clean research and then the research in the trenches. That's amazing and so helpful.

Jennifer: Yes. Yes. And we were heartened just to see that we've had so many SLPs in our district applying these principles and people kind of apply it in their own way. And the way I also think of it is the target selection, which we'll talk about a little bit later, is kind of the science of it, but how an SLP actually goes about teaching is more the art. So that's the how. And so many people have creative ways of doing that, that I would have never thought of and vice versa. But what matters ultimately is as we'll talk about, is the target itself. That the target we select is everything.

Marisha (host): Yeah, now that's amazing. So helpful too. So why would you ... Because you've kind of talked about it a little bit, but why would you choose this approach over another approach?

Jennifer: Well, first I recommend applying these principles if we want kids to finish intervention as soon as possible and reduce our case load or maybe not reduce it but manage it a bit more effectively. But the way I always think about different methodologies for phonological intervention is that all methodologies work. But the difference is the treatment efficiency. So it's more efficient to teach kids, broadly about the sound system and deeply given complex targets rather than starting with early sounds and then building and teaching every early sound. If we were to teach every sound and then cluster and sequence that would take years and years. And kids really don't have that kind of time because we need them to be able to access the curriculum, we need them in the classroom and, if they have curriculum language impairment, we need just to support them with that rather than always working on sounds. And so, those are some really important considerations.

Jennifer: But another thing that I think is persuasive is, there is a very strong evidence base to support complexity. And so, inaudible did a paper in 2006, and he identified five major theoretical perspectives with regard to my biological intervention, including complexity as one of the five. And he found that there's almost more research on complexity than the other four major methodologies combined. So this is a significant body of evidence that's been amassed over more than 30 years. And so I feel like that's very persuasive as well. And then one other bit of information from research that I found compelling is a Baker and McLeod also did a review and they were trying to identify the number of studies that have been done for different methodologies. So they found that there was an eight to one ratio for complexity studies as compared to normative studies.

Jennifer: Even though the normative approach of teaching sounds in developmental sequence has been a historical practice, it really is very limited evidence to support its efficacy. I think those are important reasons we'd want to consider that. But, the other thing we want to think about is any target we select, we want that target to have maximum impact on the system. And so of course we want kids to learn dealers, like Angie, we want them to have those sounds. But if they learned those sounds in the midst of being highly an intelligible, that's not going to make a huge difference in terms of their overall intelligibility. So instead we want to consider different linguistic principles. So I'll just highlight briefly two language universals that are often highlighted with regard to complexity target correction.

Jennifer: So, basically, complexity is based on language universals, our laws. And what's so powerful about This is, not only do they apply across all languages of the world, they also apply to every individual speaker. And so, here's one example. So there's a universal that's been identified across languages that stipulates that affricates imply fricatives. And so that has two different meanings. So first, if we think of it from the perspective of an entire language, that means if a language has affricates, it also has fricatives. So one implies the presence of the other, but it doesn't go on both directions because a language could have fricatives but it could also not have affricates. So, the affricates are more complex and that they are implying the presence of the fricatives. We can also think of that regarding an individual speaker. So that means if a speaker produces an affricate in his or her system that speaker also has at least one fricative.

Jennifer: And so if a speaker potentially have difficulty with both of these sound classes by targeting affricates, we can predict change in fricatives as well. That's what makes it more efficient than teaching all the fricatives and then getting to the affricates. So, that's one language universal. And then one other I just wanted to share briefly, there's also universal that has shown there are three element clusters, and what I mean by that is a cluster like /spl/, /skr/ and those kinds of things. They implied both two element clusters that do not have /s/ such as /f/, /l/, /t/, /h/, /r/, and /w/, et Cetera, as well as two element clusters that include /s/, such as /st/, /sp/, /sm/ and so on and so forth. So essentially this tells us that by teaching a three element cluster, we can also help kids to improve two element clusters with /s/ and without /s/. So you can see that/ that would have a pretty big impact on the sound system.

Marisha (host): That has been magical. I feel like it's magic in my own practice, like I started working on /skw/ with a student, like that was one of our first targets. And then just watching the progress, it's magic! It's like raising arms, yeah.

Jennifer: It absolutely feels that way. And I mean, what you've done is great, and you could probably come up with a very creative way of doing stuff.

Marisha (host): We'll see about that. But yeah, it's been so amazing, and I'm just so excited to hear it broken down in a way, because it's not an approach that we hear about as much despite all of that evidence, which is really interesting.

Jennifer: Yeah. And I think, just from traveling around and meeting SLPs around the country, a lot of people have shared that in their graduate programs. A lot of programs are doing kind of a surface overview of many methodologies rather than going deeply into one or two. And, I kind of understand that impulse on one hand because you want people to be aware of these different methodologies, but then it really doesn't help us to be truly prepared or master them in order to apply them in the way that they need to be applied. And so I think, many people are exposed to it just like in a textbook as one out of 20 methodologies, when in fact I think it would be better to prepare people for our profession to go deeply into at least a few, be aware of them.

Marisha (host): Yeah. Like the top three with the most evidence. Then how to do it would be helpful too, just some idea.

Jennifer: Absolutely. Absolutely.

Marisha (host): Yeah, I agree. It's so amazing. And then so what types of students would benefit from this approach or who might not be a good fit?

Jennifer: Sure. Well, I think really the principles apply to all children with phonological disorders. And so that could be kids who are monolingual, multilingual, kids with concomitant language impairment, but as I shared earlier, SLPs in our district, not just me, but multiple people have applied this with kids with autism, with down syndrome, kids who stutter. Because, essentially every speaker has a real governance sound system. So we all have these linguistic roles that are applying in our systems. And so we can leverage that to help us to identify ideal targets for each speaker. And the other thing I wanted to mention about that is, I think normative studies give us good information about which sounds are relatively early mastered versus later mastered. But I also think that some of the study data could be unintentionally misleading in that, I think it's led us to kind of underestimate kids in terms of what they're prepared and what they're ready to learn, because their young children produce clusters.

Jennifer: So, there have been studies that show that two year olds produced clusters 50% of the time and three and a half year olds produced 75% of clusters accurately. So their young children are ready and it's within the zone of proximal development for even young kids. And there was also a really cool cross linguistics study from the McLeod and Crowe that just came out in the last six months. And they looked across 27 languages and they found that by age five children produce 93% of consonants correctly. So that's a lot. And so that means young kids are able to do that. But essentially the sooner we can introduce complex clusters into the system, the better. And kids can really learn these targets with the right support. Now one thing I didn't mention earlier when I was talking about three element clusters, there is one caveat that research studies have identified, is that to teach a three element cluster, the child already needs to have both the second and third sounds in the phonemic inventory.

Jennifer: So, for instance, if we're going to teach /spl/, both /p/ and /l/ need to be in the child's phonemic inventory, which means that the child not only produces this sounds but can use them contrastibly to help the listener understand. So like if a child said pink and think, that /p/ and the /th/ sound are being used contrastibly to help the listener understand the difference between a color and what we do with our brains. And so we would need to make sure that /p/ is a singleton and /l/ is singleton ran in the phonemic inventory. If not, that's a little too complex for that individual child. And we go to the next best thing, which is a complex two element cluster. But even if kids are not good candidates for three element clusters, they are still good candidates for complex two element clusters.

Jennifer: And there's no prior knowledge necessary for complex two element clusters. That's good news. But the one population, I am more conservative with applying these principles forward, are kids with childhood apraxia of speech. So at this point, there are preliminary studies that show that it can be effective, but we need more evidence. And because this population needs such individualized and intensive support, I think we should go with kind of what the the standard is at this point. But essentially we know even for kids with apraxia that the intervention is all about moving through sounds. And so when you're teaching a cluster, it's about moving through consonant sounds or into the vowel. So it's still kind of in the same vein. I would feel better if there were a little more evidence at this point. But I have applied it with a couple of my students with apraxia and they've had good outcomes as well.

Marisha (host): Wow, that's amazing. That's good stuff. So what are ... Because, in your course you go into a lot of detail, and I know this is another kind of big question, but what are your best practices for like getting started with an evaluation?

Jennifer: Sure. Well, I could probably talk for five hours just about this alone, but I'll try to focus on what really matters, kind of the big picture. So first of all, we need an in depth sample of those singletons and clusters in the target system. And, I want to highlight standardized test have a place. They do provide us a snapshot of the child with a snapshot of the child system, but they're not comprehensive enough to be the only evaluation tool. Because usually they only sample sounds once in each word position, and they usually don't cover all of the cluster, mainly half of the clusters. And so they really don't support strategic target selection. So we can think of them as a piece of the puzzle, but we need other tests or probes to supplement it to really be able to characterize a child's sound system.

Jennifer: So what I would suggest, there are several in depth independent samples that people could access. One is a probe that I created, it's called the In Depth Phonological Assessment, the IPA for short. And probably the IPA gives me yet another [inaudible 00:23:35], because we use IPA transcription when we're transcribing and then we can celebrate with an IPA inaudible factor. It's all over everyone's [inaudible 00:23:46]. But at this point the IPA, the target words, so the transcription firms are on SLPath for people to freely download the pictures but the target words are not there. And it's just kind of a long story. But, why not? But, I do want to tell you about two other probes that are available, where the pictures are available.

Jennifer: So, Jessica Barlow from San Diego State has allowed me to offer an SLPath, it's called the little PEEP and PEEP stands for Protocol for the Evaluation of English Phonotactics. And it is a pretty in depth probe and it might be ... And I know that it's longer than the IPA, but it provides really in depth information about child sound system. One other freely available probe is from how historical she created a cluster's probe and a probe for singletons that focus on complex singletons. So what she wanted to do was focus on the sounds that kids are most likely to have an air. So like her sample is not heavy on /p/, /b/, /t/, /v/, but it is heavy on /k/, /g/, /l/, /r/ and some of those later master type sound. So that would be a great supplement to a Goldman Fristoe or another kind of standardized test. But of course I do want to highlight if a child is bilingual, we do want a sample across both languages whenever possible.

Jennifer: Unfortunately, these days there are many free probes available online, including Doctor Barlow's Spanish probe, which is on his SLPath. But there are also several clubs available through Sharynne McLeod websites. She likes to stumble three probes and I just discovered a few months ago, there's a new website, it's called speakaboo.io, and they have ... I have lost the exact number in my brain, but it's something like 20 free probes of other languages. And they also have it where they have a video of the native speaker producing the words. So, I would feel comfortable as a monolingual SLP recording a child and then comparing it to see if it's the same or different from the adult model. And so it really could empower us to look at that as the child's other language. So some really cool things are available for those purposes. And, I can tell you about a few other things if you'd like?

Marisha (host): Yeah, go for it. Cheer up.

Jennifer: Okay, thanks. Okay. So, we also want to consider stimulability. And so a common phrase that is used in phonological analysis is in or out sounds. So in being sounds that either singletons or clusters a child produced at least twice independently. So for stimulability tasks we won't be sampling the end sounds, because obviously they're already stimulable, because they're in. So what we would focus on for stimulability task would be out singletons and out clusters, first specifically out singletons for this example. But Glaspey & Stoel-Gammon really came up with a cool way to look at stimulability, and it's really changed how I view things because when I was in graduate school, if a child didn't produce a sound, the way that I was training to elicit the sound is let's say that they don't produce ash in a sample.

Jennifer: So I'd say to the child, can you say, /sh/, and if the child said, /sh/, I would consider it to be stimulable. Glaspey & Stoel-Gammon take it a little bit further because they want to see not only can the child produced the sound in isolation, but also in syllables with the /e/, /a/ and /u/ vowels. And the idea behind that is /e/, /a/ and /u/ are different places. So front, back, high, low, and you can also see that if a child pairs one back vowel with a back sound, does that facilitate? So you can get a better sample of what the child can control and do. Furthermore, you are allowed to provide help. So you can say to them like, if you're trying to elicit /l/, you want to put your tongue up on the bumps and let it drop.

Jennifer: You know, so you can see what they can do with just a tiny bit of support. And if they can respond to that in the midst of this dynamic task, that says that they have a lot more potential, a lot more stimulability than a child who even given that wouldn't be able to produce it. So it tells us a lot more about what stimulable versus what is not stimulable. And so it's basically giving us a richer picture of modifyability and just seeing what a child could do with just a little bit of help. And so if you wanted to see the examples of these stimulability tasks, they are SLPath, there's one in English and one in Spanish. And so of course when in Spanish only has Spanish sounds. But I also want to highlight a few other tasks that I think are important.

Jennifer: We will definitely want a conversation sample as well as a single word test, because in a conversation sample, it gives us a better sense of overall intelligibility vowels, [inaudible 00:29:04], rate, those kinds of things that we wouldn't be able to pick up on it in single words. Because you were just saying one word at a time, you're not going to really be able to hear kind of the cadence of the child's productions. So that would give us a sense of that. And usually what I do in the conversation sample is I usually just describe it or just use it for, just a baseline to kind of hear a sample of where the child is in conversation. And only educationally do I actually go through and do a 50 inaudible sample where I score the percentage of intelligibility.

Jennifer: I do think that's valuable sometimes, but, I don't know that it's going to yield us information that's going to help us with target selection, which is the ultimate goal of a good assessment. But some examples of helpful tasks for conversation samples, as we know, we've all probably encountered kids who are telling us something and we want for the world to understand what they're saying and we just can't catch it for whatever reason because we don't have any shared context. So it's helpful to set ourselves up. So we have that shared contexts. So wordless books like the Frog, Mercer Mayer books, we're also ... This beautiful black dog called Carl. So there's a bunch of ... Where those books so the child could tell the story about Carl and his adventures or we could have toys with different target sounds, so that way we know kind of what the child is talking about. So I think those are some of the things that we want to consider, but then just a few more tasks if that's all right. Yeah?

Marisha (host): Okay.

Jennifer: So, there are three more tasks that I like to highly recommend because they can really help us with differential diagnosis. So a study from 2015 from Marie and her colleagues, they looked at ... I don't remember at multiple tasks, that would help to differentiate between kids with apraxia versus kids with phonological disorders only. So they wanted to see which tasks could help really to differentiate the two groups. And there were two tasks in particular that stood out. The first was a polysyllable task. So, they elicited, I think it was 25 different polysyllable words and they were not only looking at the accuracy of the sounds and the polysyllable, but they were also looking at stress patterns.

Jennifer: They were looking to see if kids deleted syllables or not and different kinds of things like that, that would be more enlightening for kids with apraxia and to have those prosodic kind of bears versus kids with a final manageable pattern. So that was a very, valuable task. The other one they found to be most informative was an oral mechanism exam. So looking at non speech movements including Dido kinetic tasks even though that's not really non speech. But there was a big difference in the performance between on the non speech and Dido kinetic tasks for kids with apraxia versus kids with monological disorders only. But one other tasks that I'd like to throw in to help with differential diagnosis is we know that kids with apraxia do better with well-rehearsed sequences. So things they've said a lot are usually a lot clearer than things are saying spontaneously.

Jennifer: So what I'd like to ask is to produce automatic sequences like the alphabet or count or a song and hear what it sounds like. To have them do that versus a spontaneous conversation. And it's been remarkable because I've only had maybe five kids in my whole career with apraxia. But one in particular, when she was in fourth grade, when I was doing her triennial, she had made a ton of progress. She was maybe 80 to 90% intelligible in conversation, but still definitely having some motor planning issues. But the clarity of her counting from one to a hundred versus having a spontaneous conversation was remarkable. I mean it just really jumped out and it's not that I needed that for deferential diagnosis at that point, but it was just really interesting to kind of see that.

Jennifer: But the last thing I wanted to highlight is we also want to consider the impact of this speech sound disorder on the child and his or her life. And so there's some really valuable tools that we can look out for this as well. This is another one is from Sharon McLeod and by the way, Sharynne McLeod's one of my phonology heroes. That's why you hear me saying her name so frequently, but one, it's called the Speech Participation Assessment of Activity of Children. She calls it the SPAAC for short and it's a series of questions for the child, the parent teacher, sibling friends. And so that way you can have some sense of what the child thinks about his or her own speech, how he or she feels about different talking situations with the parent observes in terms of confidence or frustration or strengths in general.

Jennifer: And so it can be really beneficial to gather that information. And then Sharynne McLeod also has a tool, it's called the Intelligibility and Context Scale. It's called the ICS. Yeah. It's a very elegant, simple tool. It asks the parent seven questions on a Likert scale. So one being never, five being always. So, the first question is how much do you understand your child? And then the next one is how much do immediate family members understand? How much to extended family? So it goes through seven different listening groups and, Sharynne McLeod and her colleagues have looked at this across different languages and cultures and they found that the parent reports are pretty accurate. Now, it doesn't allow us to calculate a percentage of intelligibility.

Jennifer: So if they're, getting three, which is an average of three which corresponds to sometimes being understood across different groups. It doesn't mean that it's 50% intelligibility, but it does give us some sense of how much the child is understood and how this might be impacting the child's life. But, I do want to mention that all of the tasks that I have described here, there is a report template on SLPath, a phonological report template, and all of the tasks are included in there. So if you wanted to see an example of a writeup, it's available for people to download.

Marisha (host): That is amazing. Like you just planned out my whole evaluation.

Jennifer: It's all good.

Marisha (host): And then I'll link to all of these different resources and show notes. So it's easy to find them.

Jennifer: Great.

Marisha (host): So helpful. And so, and I know this question is pretty much an entire course as well, but can you give us some initial tips on identifying targets for intervention?

Jennifer: Sure. Well, it all starts with this in depth assessment. So we need all that rich data, but looking at singletons and clusters. And so then what we want to do is an independent analysis. So looking at what sounds the child produced to communicate. Now, this is different than the kind of relational analysis approach, which is kind of comparing the child's production to the adult targets. And I understand, I mean there is a reason to do that. We do want to identify different patterns and things like that more for descriptive reasons, and just because if we can tell parents or let's say a teacher of this child is deleting, /s/ from words that might help them figure out what the child's trying to say in the moment versus, not sharing this kind of information. But the tricky thing with the patterns or the process analyzes is that they don't really tell us what to target, and they can sometimes send us in the wrong direction.

Jennifer: So for instance, a very common example is, let's say a child demonstrates fronting even a lot of the time they'd be not all the time, but the child produces /k/ and /g/ in a few words. So if we were to then target /krg/ to address the fronting, we do want the child to learn /krg/, but that's not going to have a big impact on the system. And so the patterns I think are more for descriptive purposes than for identifying targets. But the bigger picture is we want to look at the information we have from the probe data and identify the child's phonetic inventory. So that's, which sounds a child independently produced, just which sounds the child produced. And one thing that's important to consider, his kids do not restrict themselves to the target language sounds. And a good example of that and I think many of us have encountered kids with this, is like for instance, if a child is trying to say beach and the child says /b/, that's an affricate, it's just an alveolar affricate.

Jennifer: So we'd want to give credit to that child for producing that, because that child knows something about affricates. He or she doesn't yet know about the English affricate. But still we want to get credit for that. And so that's one thing we want to keep in mind. We also want to see if the child, or we want to identify the child's phonemic inventory. So which sounds a child is using contrastably? The earlier, I use the example of pink versus think that means the child is using the /p/ sound versus the /th/ sound to show the listener the difference in meaning. So you want to look at that. We also want to identify a cluster in mentoring, a stimulability like we talked about earlier. But once we have that information, we can utilize this to select targets. And so, really what we want to do is introduce these complex structures into the system to support intelligibility.

Jennifer: And so I'd really like to encourage SLPs to not be cluster-phobic because clusters are great targets and there are many ways to go about addressing this. So, essentially, and there's a document on SLPath that we can link to. It's called a cluster target selection document. The first choice to help kids learn broadly about the sound system is three element clusters such as /spl/, /skw/, /str/, /spr/, and /skr/. I think I've ... I don't know if I got everyone of those right there. And so that's our first choice. But again, the caveat is the child must already have both the second and third sounds in the phonemic inventory. And that's true for a lot of kids. And the two, three element clusters that are most likely to be viable targets are /skw/, because kids will often have /k/ and /w/ in their phonemic inventories or /spl/ because /p/ and /l/ might be, or often in a child's phonemic inventory.

Jennifer: Of course our beloveth friend inaudible prohibits many kids from working on /skr/, /str/, et cetera. But, more often than not, and I've been able to choose /skr/ several times in the last few years, and I love /skr/. So it does happen even in kids with highly unintelligible speech. So it is out there. There are some great /skr/ activities and books that I don't want to overlook. So that's really kind of our first choice, if that's viable for kids. But if they do not have the second and third sounds in their phonemic inventory, then we go onto the next best thing, which is a complex two element cluster. And essentially linguistic principles, I won't go into all the background, have identified five complex new element clusters that we want to highlight. So that would be /fl/, /fr/, /thr/, /sl/ and /sr/ and it's ideal, according to research that we choose among those two element complex clusters. It's ideal if the child does not yet produce either of the two sounds in the cluster.

Jennifer: So for instance, if /fl/ is a good target or for /fl/ to be an ideal target, both /f/ and /l/ should be out of the system in non-stimulable. Because not only are you going to teach kids new sounds, you're also going to teach them the sequence and how to put them together. But of course we always want to consider the child in front of us in different characteristics. So, sometimes when I've had kids who get easily frustrated or kind of shut down, if something's a little more challenging, what I might choose is, let's say that the child is stimulable for /f/, but non-stimulable for /l/. Then I'll teach an /fl/ cluster. And so the /f/ will give them a sense of success. And the /l/ will be a little more challenging and then I'm going to support them a lot. One other thing that I want to highlight about this target selection is teaching complex clusters, we're giving kids a lot of support.

Jennifer: This isn't about frustrating kids by any means. And there are a lot of ways we can teach kids how to blend sounds together. We could use principles from reading. So like when kids are learning how to blend sounds in words, we can use similar kind of strategies to teach them how to produce them as well. But by using those principles ... So again, first tries three element clusters, second choice, complex two element clusters. What I usually recommend is choosing multiple targets so that way we have different options, because we usually see kids in groups, and it's nice to have some different options. Maybe you start all the kids, maybe they all have a common /skw/ cluster, but then their second cluster is different. So you start them all together with the first one and then maybe you do different ones, once they kind of know how speech services work, that kind of thing. So, that's the gist of how target selection works.

Marisha (host): Yeah. So helpful. And I know that starting with those clusters can be a little scary, but it totally works. Like people around the world are doing it. There's lots of good evidence for taking that step into the unknown. So thanks for walking us through that.

Jennifer: And I do want to mention one other thing. The way we can use teaching three element clusters as a strength is because the child already has both the second and third sounds in their phonemic inventory. They already have at least some knowledge of the sounds. So you can take that as a strength and then build on that. And the other cool thing is to teach /skw/ they just need to have /k/ and /w/ in their phonemic inventory, they did not already need to have the /kw/ cluster. But again, you can use ... They already have some knowledge of /k/ and /w/, use that build on and say, "Look, you can already say the south and I'm going to help you to say them together." And so I think that's a way to approach it using that as a strength.

Marisha (host): Yeah, for sure. And then this is again another huge question, but do you have suggestions in getting started with goal writing if you're using this approach?

Jennifer: Sure, absolutely. And there's another document on SLPath. It's called sample phonological goals. But the tricky thing about this kind of methodology in terms of goal writing is the nature of language universals. So early I talked about how working on affricates can help kids to also improve fricatives. The tricky thing is we can make that prediction. So we can say that teaching affricates will help kids learn fricatives, but we can't predict which specific fricatives they're going to improve. And so I wouldn't want us to write a goal predicting that these fricatives will prove when in fact other fricatives improved. And so then it's looking like they didn't achieve the goal. So we need another way to kind of approach this. So, what I would recommend would be a few different ways of thinking. So we wanted to recommend goals that kind of capture learning across the system.

Jennifer: So not just about the treated but more importantly about the system. Because the end goal of treatment is to help kids become more intelligible, not to learn individual sounds or clusters. We can think of the cluster target as the vehicle for driving the change. But it's not the ultimate goal that, that's all we want the child to learn. But some examples of ways to approach this is we could write first a goal to add new singletons or clusters. So, you could say something like the child will produce, and I often will write eight or 10 new singletons or clusters in single words on probes and administer three times per year. And the exact number of singletons or clusters that identified depends on different factors. And this is in the document as well. If you have kids who have more non for more stimulable out sounds you're going to go higher.

Jennifer: If you have kids who have around more robust inventory, you're going to go higher. If we had kids who have other disabilities. So let's say kids are working on speech and language, it might go a little bit lower because we're going to need be targeting both at the same time. We also want to consider social emotional factors or motivations. So, all of those are going to be important considerations. So that's the first one is adding new singletons or clusters. The next one could be to just increase accuracy. So what we can do is calculate present consonants correct across the entire probe sample and let's say a baseline, it's 40% and then the next time it's 55% then the next time it's 70%. So you could say that the child will increase his or her present consonants correct to. ... I don't remember 75 to 80%.

Jennifer: It just depends on where the child starts, of course, in single words on this probe. And if the percent consonants correct is increasing, that means the child is learning more broadly about the sound system. So that will kind of capture that. But one last option could be to use a visual analog scale. So this is a new way of taking data for months and from colleagues. And this gets away from the historical practice in our field of just doing plus or minus for a target sound. So what he and his colleague suggested was to do more of a scale from one to five. And the example I like to start with is looking at /r/. So if we are trying to work with the child on /r/, rather than doing plus, minus because with, especially with /r/, everything is a minus until it's a plus.

Jennifer: And so it's not really capturing the progress of the child is making versus a one, two, three, four, five, of one would be a child who says wab for wrap. So it's a /w/ for /r/, it's a pure substitution and then a five would be wrup for wrap. But then two, three, and four are that in between. And I think we've all heard those kids who are like so close. It's like right there and that's a four probably. Or if you can tell it's got a little bit of our coloring, but it's not a true art that's number three. And so we could use this visual analog scale data also from old writing. So we can say, you know, at baseline, because a lot of kids at baseline for /spl/ for instance, will produce a /w/ and so for that scale, and we might do one through seven.

Jennifer: So you know, they're starting with an average of one out of seven. And so we'd say, by this time next year they're going to do six and a half out of seven ... So, which is essentially, I don't know, like in the 90 percentile or 98-90% area. So that way we can really see some change over time. But a couple of other little things, that I wanted to highlight about, writing goals and just what we might see as a result of that is the kids in the original complexity studies as well as the kids in our district, just with our anecdotal data, many of them did not generalize the treated target to untreated words on the probes. That's just a very common phenomenon. But as I shared earlier, the target is kind of the vehicle that drives the change, it's not the ultimate goal to.

Jennifer: I mean, we want them to learn /spl/ of course, but not every child will generalize, but if they learn more broadly about the sound system, that's a much bigger goal in learning /spl/. But in the one other phenomenon that commonly occurred in both the studies, and our data is kids will often improve singletons and clusters, but not necessarily at the same time. So if we re-administer probes every three to four months, it might be the first time through they are like, "I'm going to pay attention to the singletons and I had a bunch of them in my system." But then the next round they're going to be like, "No. And now I'm more interested in clusters. I'm going to add some questions this time." So if you see that kind of thing occur, it's nothing to be discouraged from.

Marisha (host): Yeah. So helpful. So many good tips. Do you have any suggestions because I feel like I'm ready, I've got my evaluation, I know what my targets are. I'm going to write some good goals. Do you have any tips for getting started with treatment and getting organized there?

Jennifer: Sure. I think as I shared earlier, we can choose multiple clusters for kids in a group, that's going to give us some flexibility in terms of maybe you start everybody with /spl/ or everybody with /skw/ before you would move on to another cluster. And that's going to make it easier for choosing books that feature complex clusters or activities that feature different complex clusters. I also like to make sure that kids have their own cards with the target. So either ones that, I have from other sources or where ones that they draw themselves because then they kind of own those cards and there's some ownership there as opposed to hear, just the words over here and they're just on these cards. I want them to be their cards. And so that way it's more meaningful to them, especially if kids like to draw, I love to have them draw it because then their version of splash is going to be different than another kid's version of splash and they're really entertaining little pictures too.

Jennifer: But the other thing is I tend to stay away from games just because the focus goes on the game rather than what they're actually trying to learn. But instead I try to focus on fun books and activities and that way we're getting some meaningful practice. So I've become kind of obsessed with books that feature complex clusters. So, I got my own group of clusters collection. And so two of my favorite books, one is from Mo Willems who does the Pinion Elephant Books. And there's one called Watching You Throw the Ball and has a lot of /thr/ words and it's the delight. And the nice thing about that book is you could also change ... So let's say you have a group where none of the kids are working on /thr/, some are working on /fl/, for the /thr/ kids, they can say throw, through, et Cetera. But the /fl/ kids could say fling or flung ... So you can always kind of modify it for an individual within the group.

Jennifer: And another favorite book of mine is Mr. Strong from the Mr. Man series, those little square books for the different characters. In Mr. Strong, I know they use the word strong 37 times. So there's a lot of meaningful models of it. And then the book is hilarious and there's a video on youtube. It's a married video by his great British broadcaster. And it's just hilarious. I have to confess, I've watched the video on my own, without kids sometimes. It is really funny. But there are also many activities that feature complex clusters. So, and if you've seen slap of before, but you can throw them against the whiteboard or like more metallic type of door, and they just really splat against it. And kids were kind of /spl/ forever with that, or those little mind-up animals where you wind it up and then they flip, like little flipping frogs. They've got pretty much every animal. You could do that for /fl/ for flip, flop, fly ...

Jennifer: There's so many different ways you could apply that. But the other thing I would really recommend is we want to make sure there's a solid foundation at the word level and make sure that kids are producing strong production of whatever the target is as soon as possible. Before we would jump into kind of mixed practice where we're using it in a sentence or in a story or during a game or ... I am not playing gamed. But during like a more fun kind of movement type of activity. But once kids have that strong foundation at the word level, I kind of have this mantra that I like to follow, that I want kids practicing in different places with different people for different purposes. So not just the SLP room, even though there it is a magical place, we want them practicing outside.

Jennifer: We want if we can go in the classroom and have them show off for a friend or for their teacher or make a little video of them that then we send the link to their parents. So they can see. Because we don't want it to just be, but what we're saying, we want them to use it with different people. But then, we can also play around with other conditions that kids will encounter in daily communication. So we know that kids aren't just sitting straight up in a chair with a piece of paper when they're talking. So we need to kind of create conditions that are more like what Golan counters. So that means for instance, we might have been doing different actions while they practice, like doing jumping jacks while they're saying a sentence or dancing while they're saying a phrase or something like that where they still have to self monitor the accuracy of their production, or you can have them play around with different emotions.

Jennifer: So, I guess this is my long way of saying I think we can have a core kind of group of activities that help kids to really focus on their target sounds, and then get into the more meaningful production like with these different movement activities and things like that. That can go a long way. And I don't think we need a ton of different activities and kids are just so thrilled to do a lot of things over and over again, especially if we find the right activity.

Marisha (host): Especially if we're having fun with it, I think they can do the same thing over and over again. And there'll be totally happy. I'm curious too, how do you move through the target? So like if you're starting with /spl/, do you stick with that for a long time, or do you move between different ones? How does that look?

Jennifer: Sure. Well, there's more of an art to this than like an exact amount of time. But, I typically stay with a target cluster, until the child can do it pretty easily in sentences or conversation, where you can just tell that it's mostly automatic. I want it to become essentially pretty easy or just fluent for them. And, again, that means not only in my room but also walking to and from their classroom, at the lunch area, other places like that. So I would say at a minimum I'd want them to be strong in words and sentences to 80% or higher just so we've got that foundation. Because that's what's really going to kind of induce that big change. But I do want to mention any original complexity studies. They are only taught at the word level. And again, that was to control for variables because it gets a lot crazier when you get up the sentence and conversation, but just studying that kind of thing.

Jennifer: But, word level was sufficient to create these significant changes in their systems. So some of our SLPs feel more comfortable just staying with the word level and, that's fine. But I think we can still expose kids to books and other things that model these words at a higher level. And, so I would kind of do that before I would move on to the next cluster.

Marisha (host): Okay. Awesome. And then do you have it ... I know it varies depending on each student, but I think that making progress on a cluster can sometimes take a little bit longer than a singleton. So do you have like a range of how much time you typically spend on ... Like if you're starting with the three element, and I know there's lots and lots of variables here-

Jennifer: Sure, of course. Of course. Well, I would say, some kids will get it within a session or two and that's not as common. But I would say it's not uncommon to take four to five weeks to really become solid and some kids really need kind of baby steps. So what I often do if I'm teaching at three element cluster, is because they already have the second and third sounds in there, at least some knowledge of them. I start by having them blend those two sounds and it makes sure that is really strong and automatic before I ever start to add /s/ into the mix. So if I am teaching /skw/, we make sure /kw/ is completely solid before we start adding /s/ into it. And so I think there are different ways like that, that we can scaffold that will make them successful and have that strong foundation.

Jennifer: And if we jump straight into all three sounds at the same time, it may not help them to pay attention to all the different sounds or be as precise with the different sounds. So, I think it's just a matter of being creative with different things. I've also just through trial and error, figured out that a lot of times we want to get help the kids get ready for the second sound before they even say the first sound. So like for instance, if you're teaching /fl/. I had a kid who, like a lot of kids would say and sort of fly was [inaudible 00:59:37], like insert that very well. And they are not very, very common. And so what we figured out together was I could have him put his tongue up in his mouth, getting ready for /l/, freeze it and then his teeth on his lip and then say fluff.

Jennifer: So that way he was already set up for the second sound and my core articulation was already kind of half in process before you even began the /f/. I also learned through trial and error that I'm way too verbose as you probably already heard today. But, I realized with some kids I was giving them this full blown explanation and what I realized I needed to do is just break it down. So now it's more like hung up, freeze it, teeth on lip, inaudible ... Even just a picture like I'll just even point and stop talking, just so the kid can focus on what he or she is trying to accomplish.

Marisha (host): Yeah. I love those treks. So good. Then the last piece, any tips for monitoring progress?

Jennifer: In terms of monitoring progress, I look for kind of three types of data. The first is how is the child doing with the treated words and targets? Like is the child getting to the point or from where you know there's a lot of limitation, there's a lot of placement, there's a lot of queuing to independence, either at the word level, sentence level or higher. And so this is where we could use the visual analog scale again. And so what I like to try to do, and I don't always do this with complete fidelity just because of the chaos that is working in the school. But if, let's say I've worked with a group of four kids, and so I see them twice a week. What I try to do is at the beginning of a session, each time is I just have one kid come over and then I use a visual analog scale. So I see how the child does with producing his words independently, and I score it and then we go into intervention.

Jennifer: And so the next session, the second child comes up, I was in his eight words, so each basically every two weeks I have this really rich data for each child, and it ends up taking a minute or two at the beginning of the session. And then over time I've got a lot of data, and we see this progression from ones to threes or fives or whatever the target number is. So that could be very rich information to either include in a goal that we've written or to share with parents and an IEP or, just to show some change over time. But then the other big piece of data that you referenced was, I like to be a minister of the probes every three times a year. Because that's really looking at the untreated sounds that the child sound system, so to see what kind of changes occurred and that's going to give us a sense of what singletons and clusters had been added.

Jennifer: That's going to help us to understand why the intelligibility is increasing and so on. And then the third type of data, it's just more observations, is the child showing more confidence, more independence, does the child understand how the sessions kind of work to go get? Like I always have kids get their folders, and they get warmed up right away when they get there. So they know that they're working or doing something from the moment we eat, we get there. I also, of course will check in with parents just to see, how's your child doing with talking, is your child showing more confidence or any frustration or anything else like that. I also talked with teachers, just in passing, nothing formal but just in passing. But, one of my favorite indicators of progress is when kids start getting in trouble in class for talking too much. And so that to me is the most robust kind of outcome. But those are some of the things that I'm looking at in terms of progress monitoring.

Marisha (host): Yeah. Thank you for that. And thank you so much for all of your time. I feel like we just got so much helpful information. If SLPs are wanting to learn more, where can they go?

Jennifer: So they can go to my website, SLPath.com and we do have over 250 free resources, many of which I've referenced during the podcast. And then we do offer free online courses for anxious CEOs, and then one additional course on a service delivery model. So there's a lot of learning that we can do in our pajamas and spread it out rather than everything at the same time, 10 hours or six hours at a time. So it's a lot nicer to kind of spread out the learning of it.

Marisha: Welcome to the podcast, SLPs have submitted a lot of questions about speech sound disorders and some specifically asking about the cycles approach. I'm so excited to tackle some of those questions with our guest today. I knew our guest would be able to break down the cycles approach for us because she's a little bit of a research nerd like me and she's incredibly talented when it comes to creating practical speech therapy resources and materials. In particular, she created a resource to make the cycles approach incredibly easy for SLPs and she'll mention this during her presentation. I know you're going to love all of the practical tips and strategies she has for us today. Without further ado, let's introduce Shannon Werbeckes, she's a rockstar SLP, she's worked in outpatient pediatric clinics and in the schools, particularly, in preschool and middle school. She also shares practical tips and resources and creates materials, and you can find her on her blog at speechymusings.com and on social media. Welcome, Shannon.

Shannon: Hello, thank you. I'm excited to be here.

Marisha: Yeah, and like we were just talking before we went live, I'm so incredibly excited to hear your answers to these questions because you have such amazing resources. I know you'll have lots of great tips for us. But before we dive into all of the nerdy stuff, I'm really curious about how you got to learn about the cycles approach and what led you to create a resource to help us with the cycles approach?

Shannon: Yeah, it's a good question. The first couple years after I graduated, I worked in an outpatient clinic, and there I saw mostly students or children with autism. I was doing a lot of AAC, and then when I switched mid-school year, I switched into a school contract job and it was mostly preschool. I had never done cycles, I had actually I don't think I'd worked with someone with a phonological disorder since grad school so I just dove in and realized I think it was like 50% of my caseload had phonological goals. Shortly after starting my job, me and my husband went on a vacation and I was just ranting about how confused I was about cycles. I just started jotting in my notebook all my thoughts about it, trying to figure out what I was going to do when I got back. When you're contracted into a school, at least, I was just thrown in, I had a whole caseload.

Shannon: They were missing minutes from earlier in the year, so I didn't have a whole lot of time to be reading research and organizing this all during the school hours. That's when I dove into cycles and tried to figure out an easy way that I could get everything set up for the whole school year for a lot of my caseload.

Marisha: That's amazing.

Shannon: Yeah, it worked out great.

Marisha: Yeah, and I know it's an incredibly popular resource that people love so it works.

Shannon: Yeah, it did and it helped me so much. I was so drowning, like I said, it was just a whole different population when I switched so it was from a need from myself too.

Marisha: Yeah, awesome. Now we'll get to dive into the nitty gritty pieces of it. What is the cycles approach for those of us who are [inaudible 00:03:16]?

Shannon: Yeah, so the cycles approach, just as a basic, is an evidenced way to treat phonological disorders in children. It was developed by Barbara Hodson, I think, maybe in the '70s. It was a long time ago, and it's just recently, I think, in since maybe 2010, actually, started posting about it, doing a lot of research on it. What makes it different than an articulation approach is that it treats sound patterns and processes instead of individual sounds. What makes it different than maybe a traditional phonological approach is that you cycle through sounds even before a child might have mastery on a sound, you keep moving. An example of the cycles would be you might do final consonant deletion first, and you target each sound for 60 minutes. I can talk more later how I organize this all, but you might do final consonant deletion first and target Final M, then Final P, then Final F, then you might move on to cluster reduction.

Shannon: And then target SM, SP, SK, and then you keep cycling through processes and sounds. I have an analogy that I give to parents because sometimes I think the hard thing for me, and I think parents, when trying to understand the cycles was like when do I move on to a different sound? When do I switch processes? Am I cycling through sounds or am I cycling through processes? It gets confusing what you're actually cycling through, so I did the analogy of if you're doing a physical body workout, cycles style, you would have your arms, your legs, your abs, those would be your processes. Then within those are specific muscle groups, that would be like your sound. Within arms, you'd have your biceps and your triceps. If you're doing a cycle based workout, you would do arms for a week and you'd do biceps for 60 minutes, then triceps for 60 minutes. Then the next week you'd move on to legs and you'd do different leg groups broken up like that.

Shannon: The perk of cycles is that when you're working on the different body groups, let's say you move on to legs, your arms are given time to recover and you might actually see growth even when you're not targeting it. Because you just keep moving along, which is really nice. I try to give parents that analogy because I think it helps them understand what's working on these big groups that have separate small things within them and then cycling through to give those body parts arrest, so you're not just doing arms nonstop and working to the point of fatigue. They appoint a break to build up and see growth when you're not just directly targeting it.

Marisha: That is an amazing analogy, I've never heard that and I love it. So good.

Shannon: Yeah, that helped my brain, I think the hardest part about cycles, like I said, is just imagining when am I moving on? What groups are we moving between? There's just a lot of moving pieces, so for some reason thinking about a physical workout makes a lot more sense to me. Because, I don't know, you don't want to just do arms all the time or your arms would just be jello and never have recovery time. It's you don't have to be able to do a push up before you can move on two legs, for example. You'll just keep on chugging, so that helped my mind visualize what I was doing.

Marisha: Yeah, I love that, so helpful. You touched on this already, but why would you choose this over another approach? Like the traditional approach to articulation or complexity or whatever else is out there?

Shannon: For students of phonological, like if you have an articulation disorder, I wouldn't choose this, but for students that have phonological disorders, I like it in the school setting because it's super, super structured. Once you're set up, it takes very little work to keep going, and it has a really good carryover piece. I found it really easy to implement, I've seen good growth. I do use other approaches, I'll be honest that most of my preschoolers we start on cycles, and then if it's not appropriate, we move on to something else. I think I just like it because it's structured, it's been really effective, and when you're really busy, it's a really easy way to implement an evidence based structured approach to your phonological therapy.

Marisha: Yeah, that makes sense. Then so you touched a little bit on the types of students who would benefit. Do you have any more on that, or are there students who definitely wouldn't benefit from cycles?

Shannon: Yeah, students that have severe phonological disorders, that are hard to understand, that have significantly lowered intelligibility to me are like perfect for cycles. It's best if they can sit and attend to activities because you got to get really high drill work in, this is really drill based. I've had some success doing a play-based method, but they still have to be able to play and get that drill in. If I'm chasing the kid around and they're not repeating any words and I'm getting five repetitions a note a session, which does happen, I might work on something like the core word approach. Just to where you're focused on intelligibility on a smaller set of functional words, and then sometimes I'm able to move back into cycles. But that would be the type of kid where I might question. I might start with cycles and then realize we're just not getting in the repetitions and they're not adhering to, "I have a really rigid session schedule and I go through this thing."

Shannon: If they're not able to do that, then I might shift approaches. Again, sometimes I would shift back into cycles, so it's not just like a pick one and that's it for the next three years, I might move back. But if I'm having trouble getting that drill in, sometimes another approach makes more sense.

Marisha: That sounds good. I assume you use a different approach for your older students? Maybe like they have less sounds, when would you decide in asking?

Shannon: Yeah, I have done zero cycles since going to middle school. To me, they're just more, if my kids are... by the time we get to middle school, either kids are on an AAC device because of lowered intelligibility. We're working on just core functional words and that. To me, I mean, I haven't done, honestly, I haven't done a lot of upper elementary, I switched straight from the real lowers to the middle. But, middle, I'm doing no cycles at all. Preschool, I think it's super, super awesome, and then either you're going to start to see progress in a year or two of cycles or your approach should just be shifted into the upper years anyways.

Marisha: That makes sense, that's super helpful. Before we dive into all of the treatment stuff, we want to start with an evaluation. Do you have any tips or strategies on doing an evaluation that will set us up for success and give us what we need inaudible to the cycles approach?

Shannon: Yeah, so when I evaluated in preschool, I usually did a complete standardized assessment that specifically looked at phonology skills. I've heard good things about the HAPP, it's Hodson's Assessment of Phonological Processes. That one is strictly from Hodson who's the creator of cycles. I haven't used that one myself, but I think that's probably a pretty gold standard for this. I've heard good things about the DEAP as well, the Diagnostic Evaluation of Articulation and Phonology. The one I'm most familiar with is the KLPA, the Khan-Lewis, and because you can use that one with the Goldman-Fristoe, so it just analyzes the errors in the Goldman-Fristoe. I'll tell you what phonological processes are happening, if any. Once you do that, I would really spend time analyzing the years, and I think that's a huge part of these tests. You're looking at not just what processes you're seeing, but are they getting vowels correct, are their errors consistent throughout the test.

Shannon: You might look at the types of errors, they might have omissions, substitutions or distortions, so you're seeing are they all omissions? A lot of my phono kids are a lot of omissions, so they're just not saying any sound there at all. Then I'll also do something informal, I usually do a specific informal measure that I just made because I use that throughout the cycles, so just to measure progress. I like to do that right at the beginning just so I have a good baseline on the informal thing that I'll be doing. That's to look at the phonological disorder, there's also lots of other parts that I usually add on for these students like an oral motor evaluation. I would recommend ruling out hearing, I've caught a lot of hearing impairments from these types of students. I would strongly, I wrote like seven exclamation points after this, strongly recommend looking at language because phonological disorders are language based.

Shannon: A lot of my students end up in the getting special ed services for reading or pre-literacy skills, so just looking at a lot of the language skills as well. Again, look at consistency of productions, stimuli ability. I usually spend a long time assessing stimuli ability for what they missed on the phonological assessment because, actually, a lot of the students I've worked with, with phonological disorders have really good stimuli ability, which is really helpful in the cycles approach. When I note that like, "Oh, they're actually really stimulable for a lot of these sounds," to me that's a really good indicator that the cycles approach might be really, really appropriate. If they have low stimuli ability, it's trickier to do cycles because they have to be... you're only practicing stimulable sounds and words, so if they're not stimulable for very much, I would, again, maybe resort to something like core vocabulary.

Shannon: Then I always do a connected speech sample. I read recently on the informed SLP that the percent consonants correct, the PCC, so you're looking at how many consonants are correct in a connected speech sample or in a word list. I usually look at PCC, again, just as a way to measure overall progress, overall intelligibility. That might be like a good long term goal, so that's a lot, but that's all the different parts that I might do in an assessment, an initial assessment.

Marisha: Awesome, that's so helpful. Then so you've got all of this information, all of the data, how do you make sense of it and how do you start identifying treatment or treatment targets?

Shannon: Yeah, so that it is a lot of information and I think this is the step that gets really tricky. A lot of people I think know how to do these assessments, and then when you're actually moving into an approach, it's like how do I organize all that information? As a general rule of thumb, I target sounds and processes that are stimulable, like I mentioned. During this eval process, I'm trying to keep track of they can say Esplen, they're just not in their speech, that would be a great target. I assess each process on that informal screener. I usually just do 10 words in each process, and then words that were produced or, yeah, sounds that were produced correctly between 40 and 70% of the time are usually my initial targets. If final consonant deletion, if they were stimulable between 40 and 70%, I'd throw that right into my list. If they were able to produce clusters with 50% accuracy, I'd throw that in. I try to jot down anything they're stimulable for and producing 40 plus percent of the time. Those are great first targets.

Shannon: If they're only struggling with a sounder process in a specific position, which I'll be honest, was rare for me, usually, it's just like a complete mess. There's lots of things going on, but then you just target that, that specific position or sound. Generally, the first four that I work on are syllable reduction, syllable structure, cluster reduction, and final consonant deletion. I'll say that, not 100% of the time, but that's pretty consistent. Then I usually do those four processes first and then I add in other ones like stopping, fronting, or gliding as they're demonstrating mastery on those first four. I only target four processes at a time in one cycle, so starting with those four is usually just a good general rule of thumb. It also gives my students a lot of success, so syllable reduction, you're not even looking for sounds in that, you're just trying to get those marked syllables.

Shannon: Usually, I can get that pretty quick and then my students are excited and it's a good way to start. Then within each session, I usually only use five words. I try to get 100 correct productions. Again, just target all the stimulable sounds within a process. That sounds like a lot but what I always remind myself is four processes, five words, 100 productions. Then, again, all that should just be stimulable, if they can't say it, exclude it for now, and stick to the things that are stimulable, that they can say in a rapid 100 correct productions a session. If they're not stimulable enough to get 100 correct productions, that's not a good target at that time. Again, like this might lead us to say you might start cycles and you're not able to get 100 correct productions because they're just not stimulable for really anything. Then, again, I might back up, do the core word approach, introducing AAC and then maybe come back to cycles until they're stimulable for enough to cycle through.

Marisha: I think that's super helpful. Four cycles, five words, and 100 productions.

Shannon: Yeah, 100 productions.

Marisha: Then with those five words, are you targeting like do you have a mix of different sounds, or do you do one day you're just doing?

Shannon: Yeah, so each sound should be targeted for 60 minutes. I like to write minutes for 60 minutes a week, if you can, if not, it's fine. It's just easier in my mind to separate it week to week, but you might target final consonant deletion first, then you're going to do Final P for 60 minutes, then Final M, 60 minutes, Final whatever, 60 minutes and then move on. You're targeting all the final sounds they're stimulable for 60 minutes at a time. The cycles, I'll say, when you're doing it in real life feels that it moves very slowly because it takes a long time to get 60 minutes. One week, you might, work Final P, the next week Final M, then the next week final something else, then cluster reduction. You might do 60 minutes of SM, 60 minutes of SK, 60 minutes of SN, and then keep cycling through that. Then move on to a different, then you might do stopping, for example. You're doing 60 minutes of each sound, if that makes sense.

Marisha: Okay, cool. That's super helpful. Then so that is a long time, what strategies do you use to keep that, to keep it moving and to keep it fun and engaging? Because you use five words for those 60 minutes, so what's your assumption?

Shannon: For each session, honestly, I probably do, do five words for 60 minutes, but in the school setting, I'm often not doing 60 minutes, they're broken up 2 times 30, 3 times 20, or 4 times even 15 for our movers. I try to do shorter sessions whenever appropriate. I've seen progress on 30 minute sessions, I've never done the 60 where you do a full thing, but I do have a really structured session schedule that I mentioned earlier. I have a visual schedule, it says listen, practice, listen, check. At the beginning in the listening portions is that auditory piece, so I actually do amplified me, we're just reading a word list. I recorded those on my computer so that my kids just sit hooked up to my computer right at the beginning and they just listened to me reading the word list. That way I can amplify it as needed, they love it because they get their little headphones on. I liked it because I could get my session setup while they were listening. The listen, practice, listen, check system works really well.

Shannon: It keeps, in 15 minutes that's a lot to get in, so it keeps things moving really fast. In the practice section for the longer sessions I do drill, and then I might do a game like bowling with the same five words but just to give it some difference so we're not just sitting at the table. But even the drill, we'll do coloring, we glue them into books, we do dubbers, the classic speech motivators. But I keep it really simple because those sessions with those four parts, sessions go really fast. That's part of the reason I like it too is that it's really structured and there's four parts to each session, my kids like the routine of it, and it does, it goes very, very quickly once you're trying to get those 100 Productions. Then the check is checking for stimulability at the end, and that's where I get all my data and I just do 10 words to gather data right at the end.

Shannon: I might check to see where we're going next and write it down because I tend to forget things between sessions so I'll be like, "Oh, we're going to do this next time." And then I get to see them next time and like, "Oh, my gosh, what did I..." I can't remember what I wanted to do anymore, so I do right at the end that check time. I'll usually write a little note to myself like, "Do stopping, target the F next time or something, whatever." That check at the end is a nice time to wrap up and see where I'm going next.

Marisha: Awesome, super helpful.

Shannon: Thanks.

Marisha: I'm not disappointed at all, so good. Okay, and then we always get this question about any topic we talk about, but how do you tackle writing goals for these types of [crosstalk 00:20:34]?

Shannon: Yeah, so I have a goal written that I use for each process. My final consonant deletion goal is will reduce final consonant deletion by producing final consonants in CVC words with 80% accuracy. Obviously, I can alter that, if a kid is making slow progress, I might isolate one final consonant that I'm assessing instead of in all of them. If I want to look at more big picture gains, I might write a goal for... I know some districts have to do long-term and short-term and all that, my district's they just write straight goals. Like mine, that would be perfect for my district because it's easy. I know some people have to write a big one and then little objective, so a big one might be, again, the percent consonants correct measure or an intelligibility measure. Then I write specific goals for each process. I usually only write two processes because they're not going to be able to correct. Actually, some kids do but you don't want that to be the expectation, but you don't want to write six processes.

Shannon: Even if you're cycling through them, I tend to not write a goal for everyone I'm cycling through because that's just a lot. Usually, I stick to the hierarchy like syllable reduction, syllable structure, cluster reduction in a specific order. Then I write goals for the lower ones that they haven't yet mastered. I might just write two goals for two different processes that they can't yet get rid of. My goal writing is a little bit easier, and I usually use word level too when I do cycles. Cycles really does stick to the word level, they don't do a lot of phrases. Sometimes I use phrases with the cluster reduction, but other than that, most of my goals are pretty much word level as well.

Marisha: Awesome, and then do you have any other tips for organizing the actual treatment piece of it?

Shannon: Yeah.

Marisha: I think there's a lot but-

Shannon: It is, I feel like organization is 75% of the battle with cycles. It's like once you're in it, it's so good but it's, I don't know, I'm really a messy, pretty tight B SLP, which I know might be rare in the world. But I feel like for some reason the organization is clutch for me. I have a spreadsheet for each student that's doing cycles, I print it because I like writing, and it has a column for the process that I targeted, the specific sound I targeted. And then I have the dates that I write down when I did them and then an accuracy that I take every day. That helps me keep track, so then if the student has 20 minutes sessions, for example, I might have three columns because that would total to the 60 minutes. Then I have to write, "I saw them on September 9th, then September 10th, then September 12th." Then I know, "Okay, we're moving on to another sound because I've filled up my three columns."

Shannon: Then that also gives me the data, so then I can write data each time a quick percentage as well. I like having this spreadsheet printed to just keep track of all of my dates because I think that's the trickiest thing. You need to target each sound for 60 minutes, so unless you're having 60 minutes sessions, you got to have a way to keep track of how many minutes you've targeted each sound. Those forms work really well for me but I know people who have little check boxes or some system. But I think that's the trickiest part is getting the dates and the sounds or the minutes to total up for each sound.

Marisha: Nice, and then you do, you collect your data at the end during the check?

Shannon: I do, yeah, and I know people who do it different. Some people do it right when the kid walks in, they just do 10 quick ones. I feel like the beginning of sessions for me is really chaotic, kids are coming in, and I liked the routine of them getting their headphones on and getting settled in my room. Then I liked just doing it at the end before they left just like a checkout, "Oh, you got to do this before you can leave." But I know a lot of people when they walk in, they do the quick checks so that they're not... that might lower their accuracy a little too and be more accurate because they're not thinking about all of their sounds. If you're having trouble like I'm assessing at the end and they're getting them all right, at the beginning might make more sense to but depending on what works for you. I like the structure that I have, and I saw mostly preschoolers too where they still have a lot to work on, so assessing at the end, they're not getting all of them right all the time.

Marisha: I think as long as you're consistent, your rate is going to be interesting across that.

Shannon: Exactly, it is what it is and you're hearing it apples to apples [crosstalk 00:25:06].

Marisha: That's awesome. Yeah, and whatever works best for the structure is that makes total sense. I had another question but I can't remember. Oh, so in terms of your target list, do you have the list of the 10 words for the different processes just ready to go, or how do you choose which words you're going to-

Shannon: I have it ready to go, so it's in a binder. I have a page for each process that list. It might say like cluster reduction at the top and then it has each cluster and then a word list underneath it. I keep that in a binder, I keep my assessment pages in there, I keep the little assessment pictures that kids label in there, I keep my parent letters in there. I send home a lot of home carry over for cycles, so I keep that on there.

Marisha: This is all part of your toolkit, right?

Shannon: It is, yeah, this is the part that I... this is what I put all together was wordless session notes, flashcards, just so it's all self-contained, I suppose. But, yeah, you could use... I know a lot of people who do cycles with no materials as well or they have the materials, like they have our tick cards and stuff already so they don't need. A lot of SLPs might have everything that they need already but, yeah, that's what I put together for my own ease.

Marisha: Yeah, and so you also mentioned the home carry over piece, what does that look like?

Shannon: Yeah, so I send home a little letter that just says... Well, so when I did preschool, I had a lot of itinerant students which was actually really great. The parents would come into my sessions, and then there's very little to explain because they're seeing what I'm doing. Again, I usually use that home workout analogy that seems to help them understand when we're moving between muscle groups or processes and when we're switching muscle groups or processes. I usually just explain the general, I usually explain with that analogy what cycles is, and then I send home a little note that says, "Practice these 10 words this week." Again, that's why it's sometimes easier if you can write minutes for 60 minutes a week, I find it easier for family to understand, "This week is this, is SM words. Next week will be SK words, the following week will be..." But that's a little bit easier, but I literally send home black and white flashcards.

Shannon: I make little paper envelope, so I just fold a piece of paper in half and I staple the outside edges, fold that in half, paper clip it closed, and just keep black and white. Usually, they're colored because my students color them during our sessions, send them home. It's usually like five to 10 words, like I said, I try to keep the words that really small and then I just say drill them, I don't know, for a really, really good student. I actually worked with a mom that was a speech pathologist and I worked with her daughter. She was drilling like two or three times a day, but for most families I just say if you can read them through once a day, have the student produce them once a day every day. That's what I ask parents to do.

Marisha: Awesome, and so they're doing the same practice that you're doing in the sessions?

Shannon: Exactly, yep, and because I'm only doing stimulable words, it works, and I don't send anything home that the student isn't stimulable for but the cycles approach is all based on they should be stimulable for this. It actually makes, again, the parent carry over piece easier because they're not struggling through sounds that you have to use specific elicitation techniques to produce, it's just the kids should be able to say it given a focused, structured setting. Yeah, it's a pretty easy home carry over because it's literally just practicing five words repeatedly throughout the child's day.

Marisha: Awesome, that's such a good system. I like that a lot.

Shannon: Yeah, that's why I like cycles, it's a system. I think I like systems, it's when you're busy and if this can take off 20% of your caseload, or it's just done you, because they're doing cycles and you know what you're doing next session. To me, that's like where that the time saving comes in because it is a system.

Marisha: Yeah, and it takes a little bit of time to wrap your head around it and get it set up. But you could get these materials set up, and if you have the card decks or whatever, you could do it in an hour or so.

Shannon: Yep, exactly, I say the card decks, getting the card decks is the part where my hands starts to cramp and I'm cutting them. That's the laborious part, but beyond that, this is really just getting spreadsheets, getting a whole system where you do this, then this, then this, and then you're good for your career as long as you want to do cycles. That just then the kid just starts in to the whole system and it's pretty easy.

Marisha: Yeah, and I know now is a little bit of a crazy time. When this comes out, some SLPs might already be on summer break. It's the perfect time to assemble some of those materials. If you're listening to this in the middle of the school year and like, "I want to start it now." Yeah, do all the things, like you can totally just print the fine black line versions to print and go.

Shannon: I say even mommy speech therapy has those printable free cards online and just go on there, print those, and you can implement this with anything. It's easy, once you get something that's consistent, it's just done for you. There's no secret to this, it's just it's a complex system of funnels that you're putting this student through. But once you have that done, you can do that pretty much with any materials with the spreadsheets and you can make in Google or Excel or something. It's all pretty easy once you get that setup, so yeah. The summer I set mine up in the summer, I actually went over, I think we were watching The Bachelorette or something. Me and a bunch of friends cut apart the whole toolbox in one night, and since then... I don't know how long ago I even made that, five years, and it's still perfect. You can just pull it out and use it. It totally takes upfront work to get everything together, but once it's there, then you're good. You don't have to prep every week for those students anymore.

Marisha: Yeah, working smarter.

Shannon: Yes, working smarter, exactly.

Marisha: Doing a little bit of work ahead of time and then reaping the benefits four years to come, which is so neat.

Shannon: Exactly.

Marisha: I love that idea of making it into a party or just a prepping party. Well, if you have friends that aren't SLPs, they can do some of the work for you or-

Shannon: My mom laminates a lot.

Marisha: My mom does too. There are parent volunteers too. Like you can totally just print those out and have them cut for you. When I was in the elementary school and working in the preschool, there was a mom who really wanted to help out, but she couldn't come in during the school day because she was asking, "I really want to help, what can I do?" I just found home stuff for her to cut it and she was really happy and it's just amazing. We can get really creative in making things happen.

Shannon: That's true.

Marisha: Even if we don't have an hour to put aside now, we can get creative and make this happen.

Shannon: I had my itinerant parents, like I said, I saw a lot of itinerant that came in and some of them were so bored during the sessions, while I'm working, that they were like, "Can I just cut this pile?" I'm like, "Sure." They would just be cutting in the corner and I'm like working. It works so nicely, and then I had my next week done for me.

Marisha: That's right.

Shannon: Yeah, and the nice thing about cycles or any reusable material is, again, it just takes that upfront time and then you're ready to go forever. There's I don't do themes when I do cycles, I don't do anything that's different throughout the whole school year. Every single it's the same, and that keeps kids from being bored inherently just because they're constantly moving through different targets. To me cycles is one of those things that's really super time consuming in the beginning but, again, really super good once it's set up. Because you're not switching through themes or different... The timing of the school year doesn't really matter once it's set up.

Marisha: Yeah, perfect.

Shannon: Yeah, it's a perfect summer project if you're in the summer listening to this.

Marisha: I love it. Given us some homework.

Shannon: Yes.

Marisha: Then I'm curious too because you mentioned that a lot of times these students will have like they'll also have language delays and other things going on. Oftentimes, I assume we won't just have the goal for the process, or for those few processes that we're doing. How do you manage that then? Does that just determine their treatment minutes or?

Shannon: For what I did personally, which I don't know is doable in all settings, I separated out their minutes so we would do cycles for certain sessions and then we would do their language based goals in a totally separate session. Because, like I said, I think have the structure down. It really does take a full session for me to do the listen, practice, listen, check schedule. For my students that I could write increased minutes for, I might write 80 minutes a week and then use 60 for cycles, 20 for a language school. For students where that's not possible or districts or SLPs where that's not possible, that's when you might spread a cycle or targeting a sound across two weeks, for example. You might do 30 minutes one week, 30 minutes the next week, and then the other session do a language, a language target. I try not to mix them just because, honestly, cycles is it's so much work.

Shannon: Like these little kids are such hard workers, they're really, really, really in it, they're so focused and it's like I just feel like switching all the targets on them, "Okay, we're going to do this for 15 minutes. Oh, and now we're doing something that feels totally different, feels a little bit, I don't know, confusing I guess and a little bit overwhelming." I would try to separate out, even if you have to do cycles slower, like I said, across two weeks, I would just separate the sessions if possible. That's nice, too, because I try to keep my cycles groups only cycles groups as well. Then your other group can be more of a mixed group, you can always put them into a mixed group to do more language objectives another session.

Marisha: Yeah, that makes a lot of sense, that's perfect. Then in terms of the mixed groups then too, that's all the good stuff. Kids are usually working on different words in the... They might be working on the same process or they might not, they might have the same words or they might not, so do you round robin through their sounds?

Shannon: Yeah, I do you them in my cycles, like a cycles group where they're working on different projects. Yeah, so then I'm round robining through. Like I said, we do a lot of book... Honestly, my favorite activity is taking black and white flashcards, cutting them apart, and gluing them on the index cards and then putting a hole punch through the index cards, putting a binder ring because then they can take that home. Well, as I'm round robining, they're gluing, they're coloring, they're whole punching, they're doing all the assembly part and then I just work through. I usually try to get five or 10 productions while I'm working with them before I move on to the next student. I'm not like, "Say one word, say one word," across the group. Because that takes forever to get their attention. I might work with a student for a minute and have them get 10 productions and then they color and work on those cards then to the next student.

Shannon: It's okay if they're working on different processes. If you can get them in line, that would be great. Like I said, there's, usually, in preschool to me there is like the four heavy hitter processes. Some of the time it is possible to get them in the same routine in order, although, it's just with absences and all sorts of stuff. It's definitely not possible all of the time.

Marisha: Yeah, and that's cool when that lines because then they get additional auditory development too.

Shannon: Exactly, so they're listening to me say it over and over. I even had a girl she was working on a different process than her group mate and she then she was always wanting to work on their sound because she was like, "Oh, I know that one." Then we're like, "No, no, stick to this one." But it is really good because they're hearing it, there's hearing the same processes, the same wording, the same queuing over and over so that works nice.

Marisha: Yeah, and do you ever use the auditory bombardment, the headphones piece, as an alternating thing, too?

Shannon: Yeah, I've done stations like centers, and I did that with my groups that were really like we had a high energy, high energy bunch. But then I would literally have like a station for doing jumping jacks and squats, and then a station for listening, and then a station for working with me. That works too if you have a lot of movers, and just all sitting at a table coloring their cards is not the reality. Centers worked really well for me, too. I literally had posters that just said center one, center two, center three. I usually only have three kids in preschool in a group together, so one's working with me, one's literally like I'm a drill sergeant and I'm like, "Do push ups, keep jumping, keep your body moving." I have little pictures that they have to follow, yoga works great, and then the other one is sitting at my laptop doing the headphones. I have the big noise canceling ones too, so they think they're the coolest. These tiny little kids with these huge headphones is always sweet.

Marisha: Oh, I love it. That's cool because then each of the centers is exciting in its own way. They get to work with you or they get to move around or they get to wear the cool headphones.

Shannon: I think some like the time away from me because when you're working one on one with an adult, you get a lot of feedback. You get a lot of, "Try that again, nope, that's not quite right." Then they're like, "I just need like a breather break." It's nice to just go do something the teacher is not necessarily monitoring what you're doing. Just go get your energy out for minutes, you can calm and have a focused, productive drill based time with me.

Marisha: Yeah, it's so good. Then one other question too about just... because you talked about this a little bit but in terms of what to expect for progress because you said you typically expect about two processes in a IEP period.

Shannon: Mm-hmm (affirmative), it just it varies so much, and I'll say like I'm only, I don't know, five years out of grad school so I think that this just comes maybe with time is knowing how fast kids are expected to demonstrate progress versus other students. I know there's diagnostic, there's indicators of good progress. Like I said earlier, really solid stimulability for a large amount of processes to me means faster progress. I see those kids just zoom through cycles. The tricky thing with cycles too is I do see it, I've seen almost in all of my kids who do cycles, correction of processes that we didn't even target. They have vowel errors and then we work through their primary processes and we fix them and their vowel errors self correct, or they have voicing errors that are really unusual and those correct through a couple of cycles.

Shannon: Predicting progress has been challenging for me, and usually, honestly, in a good way where I'm like, "Oh, they're going to... we're going to work on final consonant deletion." Then the next year they're not voicing errors, they don't have vowel errors. That's a bit tricky. For collecting the progress I usually just focus on, yeah, one or two different processes. Usually, for real little, it's cluster reduction and final consonant deletion because I just find that those impact intelligibility so much. They're easy for parents to understand, they're easy for teachers to understand progress on. Some words like fronting, stopping, backing, I find those things sometimes a little bit confusing for teachers to really understand. I actually do, I should mention this too instead of just a home carry over, I do classroom carry over too. A lot of my preschoolers do centers in their classrooms, where they're practicing sight words.

Marisha: Genius.

Shannon: Yeah, so then I put their cycles cards in their sight word bin and they practice them in the classroom as well. That's why I love that index card ring, that thing is like their words, and then I go into their classroom each week and I swap them for the next process we're working on and then swap them. They might have three card decks of the same words, one at home, one in the classroom, one with me. But then I find teachers, when I'm sending these things into the classroom for something like fronting, I find that they're a little bit more confused just as what is fronting? What kinds of words are we working on? What do all these things have in common? Versus cluster reduction, final consonant deletion to me make a little bit more sense to anybody. Yeah, so progress is tricky to predict but I just feel like most of my students who are really eligible for cycles where they're stimulable, they can sit and do drill.

Shannon: We make really fast, huge gains, which is awesome. But then, yeah, every caseload has those kids too that are totally they feel idiosyncratic, you're not sure what errors they're making, there's so much going on. Those ones I'll admit to having a hard time predicting what they're going to improve on or how fast.

Marisha: Yeah, and I know that was the tricky question. It's one that parents always ask, and so sometimes it's like, "No, what do I say?" I knew that.

Shannon: Yeah, oh, every time, I swear, every preschool or parent is like, "So when is this going to be corrected?" I'm like, "I don't know."

Marisha: There's not, I've tried looking for the research on this is what you can expect if you see these kinds of things, but it's not out there.

Shannon: It's not out there, and the things that I find are the obvious things, if they're more stimulable, obviously, they're going to make faster progress. If you have better attention, they can drill, they're going to make faster progress. But it's still what is faster progress? What is expected within a certain amount of time is still just totally tricky. I know therapists, I hear therapists talk about expected rate of progress, and I just think it might just take more years of experience doing something over and over to really see what average looks like.

Marisha: Yeah, for sure. If there's any researchers listening-

Shannon: Yes, tell us. Yeah, and definitely a struggle. I have that with my late talkers a lot too, they're like, "When are they going to talk?" I'm like, "Oh, I don't know."

Marisha: Yeah, and we can just talk about the factors that we're seeing and those things tell us that they're going to make more progress but it's just really hard to put a specific timeline on it.

Shannon: Yes.

Marisha: Even though we would all, like everyone would love to have that timeline.

Shannon: I know, or even just like a trajectory of... the tricky thing is typical development just doesn't really apply in a lot of these situations. That's what we have a lot of information on, and once a child is having a phonological disorder, it'd be so nice to have some sort of development or trajectory for that subgroup of students. But I have yet to find a lot of info on that.

Marisha: Yeah, well, I know we'll both keep looking and we'll share if we find anything else.

Shannon: Yes, put the informed SLP on that.

Marisha: Yeah, come on. She's got us covered in so many ways, though.

Shannon: Yeah, she does.

Marisha: Okay, cool. Then just one last question too, well, two more I guess. Do you have any other tips in terms of what to do if a student isn't quite ready for the cycles? Because you talked about the core word approach, is there anything that you can do? Do you ever see it where you use that approach and then you're able to switch into cycles, or what does that look like?

Shannon: Yeah, so usually, the core word is usually my favorite one to go to because I find that with kids like that, especially, when I'm feeling like progress in cycles might be slow. You have frustrated parents, you have frustrated kids, you have you just want to show something that. I want my students to feel successful in therapy like, "Oh, now I can do this thing I couldn't do before." Core word to me has been the best backup step down from cycles. I usually pick like 10 words that are really meaningful like mom or their own name and I work on those. After they might demonstrate some progress on core words, I might introduce that schedule, the listen, practice, listen, check, and do it with core words. I literally just make a voice recording of their core words, they listen to it, then we practice and we move into that session schedule.

Shannon: Then I can always swap out less motivating cycles based words later, once that attention is... it's usually attention or behavior that's the tricky piece there. Then once that attention and behavior improves, then we can... they're already in the right schedule, we just swap out those motivating words and introduce more cycles based words. That's the progression I usually take for a student that just can't sit for cycles. I think maybe I had thinking it's got to be less than 10% of the kids that I've introduced cycles to that I've had to backup or had to do something because, I don't know, I call it putting on my dog and pony show. I am very animated in therapy, it is like cycles is the most fun thing in the whole world. I do think students like it too because we're only working on stimulable sounds, you're not stuck just like make the K sound, hey, go... For like 20 minutes where they're just not getting it.

Shannon: They're always saying words successfully, so usually cycles is pretty good, but the core word pushed into the cycles is the route that I would take if they just can't attend to that drill based.

Marisha: Awesome, and then any other tips or strategies or things that we left out that you think would be really helpful, or just for us to think about?

Shannon: I don't think. The one thing that maybe I haven't talked a little bit about is activities that I do. Which is probably really standard preschool activities, but I guess if you're listening and you are just starting to do cycles, usually, my practice sessions don't just do drill. I do, do drill but once they get to 100, then usually I do bowling. I like to put the cards under bowling pins. I can't think of the name of the house but it's a classic speech toy with little doors and doorbells on the different sides. There's four doors, which works really well when you only have like five words, I'll shove one in each door. I usually do, you have to get 100 and I use a clicker, and once we get to 100, we can play a game with these words or something to increase the motivation. Within that practice part, it's not just drill always, I usually incorporate some movement thing towards the end before they have to listen and check again.

Shannon: You can pretty much use any of your classic preschool activities even on train railroad pieces. I'll put the card on each track, for example, so you have to get 100 and then we're going to get your tracks out and we can build with this. That's how I used to increase that motivation piece for the little is I usually just say we just got to get to 100 and then we can do a scavenger hunt. It's just another common one, I'll hide them, close your eyes, and we go find these five words or whatever. I think that's the only thing that I had jotted down that we didn't get to, that felt really... that was a lot of info.

Marisha: Yeah, so much good stuff it's like, "I'm going to go to cycles now."

Shannon: Cycles for everyone.

Marisha: No, this is so helpful and it just makes so much sense.

Shannon: It does.

Marisha: But it's a little bit of work up front but once you do it like you're five years out and you're still using this and that, the same classes. Essentially, your whole therapy for the year is planned.

Shannon: Exactly, my big thing for saving time, for me, has been isolating a group of students on your caseload that you can get everything done for, and then you're always going to have tricky kids, you're always going to have ones that don't fall into what prescribed programs say that students should look like. Then those ones you can dedicate a lot of time to, but I like getting rid of huge subgroups of my caseload to really systematic therapy and then you just don't think about it. I really think kids prefer this over a lot of other things because, like I said, the workout thing. Well, if you're just working on arms 24/7 until you can do a pull up, I'm going to hate working out because that pull up seems really elusive and you're working and working and working and working and you're not getting anywhere and your arms are fatiguing and everything's frustrating. Versus saying, "We're gonna do this for a week and then we're going to move on to something else and maybe your arms will strengthen up while we're doing something."

Shannon: You just feel a lot more successful with the constant moving, "So you didn't get it, all right, no worries. Next week, we're doing a different sound or..." It just I feel like the frustration in preschool is so decreased doing cycles, so that's been really, really nice as well.

Marisha: Awesome. Well, thank you so, so much. This was incredibly helpful and I know people are going to love this. If they want to find out more about what you do and get more of your awesome tips, where can they find you?

Shannon: You can find me Speechy Musings anywhere, Instagram, Facebook, Pinterest, email, it's S-P-E-E-C-H-Y Musings, it's plural. Then I share daily on Instagram, I share lots of pictures of my products and different ideas of how to use them and different carry over ideas and things like that too.

Marisha: Awesome, and then you also have the cycles kit, where can they find that?

Shannon: Yeah, that's in my Teachers Pay Teachers store. Again, that's under Speechy Musings, it's my best seller. It's like the top one right when you click in, you can find it there. If you have any questions about cycles, you can feel free to email me. I'm pretty available via email, but that's where to find all the cycles. I think I have a blog post too about how I set it up with lots of photos and stuff as well. That's on my blog speechymusings.com.

Marisha: Yeah, and I'll share those links, all of those links in the show notes too. You'll be able to see, because I think you had a blog post explaining how you set it up and then you have different ideas on how to organize them.

Shannon: Yeah, so my original idea was in like a toolbox that I bought at a home improvement store. But I know a lot of people are itinerant or might move around a lot, so I have just different ideas of how to store all the flashcards and stuff you need for cycles for people who might move between schools and such. Again, like you can use those ideas with any flashcards, that's not necessarily... Mine makes it easy, if you're starting from scratch, mine makes it super easy. But if you have stuff already, you can just read through the information and organize your own materials in that way too.

Marisha: Awesome. Well, thank you and-

Shannon: Yeah, thank you.

Marisha: Yeah, check out these show notes for all of the other links and we'll see you next time. That's a wrap. What an incredibly helpful episode and I'm so grateful to Shannon for sharing all of her knowledge on this topic. If you want to check out the show notes and find all of the links that we mentioned, head to slpnow.com/five and that's where you can find all the good stuff. That's also where you can find information about earning ASHA's CEUs for listening to this podcast. Thanks for joining us and we'll see you soon.