Practical Tips SLPs will Love for Speech Therapy: Unintelligibility
Are your students impossible to understand? Improve their intelligibility in functional communication after reading these practical tips and help them communicate more clearly.
When preschoolers have unintelligible speech, they often get frustrated easily since they aren’t understood. They don’t understand why their needs aren’t being met. And usually, they don’t have the language skills to reword or otherwise clarify their message.
The good news is that your students can learn to speak understandably when you use the correct approach. Working on a single sound at a time just doesn’t cut it. But these tips will help you get started using a broader approach to make a bigger impact earlier in therapy.
1. Look for sound error patterns in their speech.
Often students who are highly unintelligible have patterns of speech errors going on, so working on one sound at a time is a drop in the bucket!
- Analyze the errors for problems with phonological processes or errors in sound movement patterns based on place or manner.
- Work on these error patterns using multiple sound targets and a variety of words. If the students are making progress, keep it up! If they aren’t, move on to another error pattern and see if it is more stimulable.
- Continue to check back on previous sounds to see if there have been any changes in the students’ stimulability. There are no clear-cut guidelines from research for how to proceed with this, although the ASHA website has a good overview.
2. Choose your therapy targets carefully.
Clinically speaking, I’ve found a few tips to be useful.
- Error patterns that have more visible sounds are often easier to elicit.
- Complete omissions of sounds, unusual phonological patterns, and unusual prosody make students very difficult to understand.
- Close substitutions, such as ‘s’ for ‘sh’, impact intelligibility less than a pattern of substitutions that have very little in common with the error sound.
- For unintelligible students, practice words they already use. This is not the time to teach new vocabulary containing their speech targets.
- While we usually aim for 100+ productions of the sound, highly unintelligible children with motor planning issues need the first emphasis to be on maintaining correct productions.
3. Use language samples to help determine target words and phrases.
It is not possible to practice all of the words! Especially with more impaired students who have multiple issues and need more repetition to make improvements, we really need to focus on the most vital and functional skills to have an impact in daily life.
- Have conversations when walking to the therapy room and pay attention to words and phrases the students use the most often.
- These become the target list to practice every session as a warm-up activity.
- When they can say the words correctly, have them practice in the conversational phrases they use.
The rest of the session can include practice with words that tie into the language activities for the day, but the frequently used word list gets lots of practice and review!
4. Pay attention to communication needs throughout the child’s day.
If your student has to practice many times to gain the skill, be sure to start with some words or phrases that are functional!
- Drill target words that serve a communicative function, like getting a need met.
- Make sure that the words are easy to elicit multiple times by all staff during a typical day. Use language from routines, like the classroom circle time opening, rather than specific words from the day’s topic.
- Include words that have easy to produce sounds along with the more difficult ones. Build in some success!
- It’s best of all when the words can be combined to produce functional phrases after the child can say the words!
5. Watch for extraneous movements during speech production.
Be sure to watch your students as they attempt new sounds or new words! Some behaviors to notice include:
- Moving their head when attempting to move their tongue
- Smiling all the time (even when not happy)
- Adding additional vowel sounds
These signals indicate that they could be having problems with jaw stability or grading and moving their articulators independently. Practicing speech production with some extra stability support is sometimes all that a student needs to get better sound production.
I learned so much working jointly with my students’ OTs and PTs. Together, we make a terrific team! If you suspect problems with motor planning or stability issues, these are the people you need to speak to first!
If you are interested in reading more about the development of disassociated jaw, lip, and tongue movements for speech production, check out these resources. (Please note that I am not a proponent of using non-speech exercises, but I have found touch and placement cues to be very useful for eliciting sound productions.)
- Bahr D., & Rosenfeld-Johnson S. (2010). Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges. Communication Disorders Quarterly, 31, 131–138.
- Ray D Kent, Research on speech motor control and its disorders: A review and prospective, Journal of Communication Disorders, Volume 33, Issue 5, 2000.
- Jordan R. Green, Christopher A. Moore and Kevin J. Reilly. The Sequential Development of Jaw and Lip Control for Speech, Journal of Speech. Language, and Hearing Research, Volume 45, Issue 1, 2002.
5. Immediately apply the sound practice to functional or linguistic contexts.
After practicing the motor skills of sound production, be sure to use the same sounds in a context that will help your students retain and use the newly learned skill. This can be done in a few ways.
- Read! Simple books with repetitive refrains that include your students’ target sound combinations are a wonderful way to get lots of practice! Many unintelligible students also have language needs, so this is a great way to target multiple skills.
- Play! Pair a movement used for a toy with a CV, VC, or CVC that approximates a word that naturally goes with the toy. A bang-a-ball toy was one of my favorites to use this way.
- Sing! Use a song with a repetitive refrain that incorporates the sounds. Sing the first few yourself and then pause to see if the child joins in. If you can’t find a song, pick a simple tune, like Twinkle Twinkle, and make up your own words about something your student enjoys.
Simple artic errors? No problem! But when a child is unintelligible and has multiple needs, it can be overwhelming trying to decide the best way to start therapy. Try out these tips and comment on what worked for you!