Bleile, Ken Mitchell - The Late Eight-Plural Publishing (2018)

The Late Eight
Third Edition
The Late Eight
Third Edition
Ken M. Bleile, PhD

5521 Ruffin Road
San Diego, CA 92123
e-mail: [email protected]
website: http://www.pluralpublishing.com
Copyright © 2018 by Plural Publishing, Inc.
Typeset in 11/13 Garamond by Flanagan’s Publishing Services, Inc.

Printed in the United States of America by McNaughton & Gunn
All rights, including that of translation, reserved. No part of this publication

may be reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, recording, or otherwise, including
photocopying, recording, taping, Web distribution, or information storage
and retrieval systems without the prior written consent of the publisher.
For permission to use material from this text, contact us by

Telephone: (866) 758-7251
Fax: (888) 758-7255
e-mail: [email protected]
Every attempt has been made to contact the copyright holders for material
originally printed in another source. If any have been inadvertently over-
looked, the publishers will gladly make the necessary arrangements at the
first opportunity.
Library of Congress Cataloging-in-Publication Data
Names: Bleile, Ken Mitchell, author.

Title: The late eight / Ken M. Bleile.
Description: Third edition. | San Diego, CA : Plural Publishing, [2018] |
Includes bibliographical references and index.
Identifiers: LCCN 2017030954| ISBN 9781944883034 (alk. paper) | ISBN
1944883037 (alk. paper)
Subjects: | MESH: Articulation Disorders — diagnosis | Articulation
Disorders — therapy | Speech Articulation Tests | Language Development
Classification: LCC RC424.7 | NLM WL 340.2 | DDC 616.85/5 — dc23
LC record available at https://lccn.loc.gov/2017030954
Contents
Preface vii
Contributors ix
Part I. New Essentials

Chapter One A Late 8 Update 3
Ken M. Bleile
Chapter Two Using Evidence to Guide Clinical Practice: 37
Considerations for the Late Eight
Lauren K. Nelson
Chapter Three The Late Eight en español 59
Lindsey R. Leacox
Chapter Four Speech Sound Disorders, Literacy, 93
and Curriculum
Jennifer Walz Garrett
Chapter Five Motor Learning Guided Therapy 107
Carlin Hageman
Part II. Clinical Resources

Chapter Six Overview 131
Chapter Seven [θ] 153
Chapter Eight [ð] 179
Chapter Nine [s] 197
Chapter Ten [z] 255
Chapter Eleven [l] 277
Chapter Twelve Vocalic [r] 319
Chapter Thirteen Consonantal [r] 345
Chapter Fourteen [ ʃ ] 393
Chapter Fifteen [tʃ ] 417
Chapter Sixteen Evaluation and Treatment: An Illustration 439
v
vi The late eight
Appendix A. Language Activities 453

Appendix B. Quick Guide to Resources 457
Index 459
Preface
The first edition of The Late Eight provided clinical resources to help clini-
cians and students evaluate and treat late-acquired sounds. I likened the
resources to all-purpose tools — the clinical equivalents of a carpenter’s
hammers, screwdrivers, bolts, paintbrushes, and ladder. The third edition
keeps (and slightly modifies) the clinical resources while expanding the
tool kit to include new essential clinical concepts, including evidence-based
practice, Spanish-influenced English, the curriculum, and a new treatment
model. Chapter 1, A Late 8 Update, offers short question-and-answer sec-
tions on 18 clinical topics, ranging from practical issues (Any suggestions
for practicing speech?) to thoughts on current controversies (Do the Late 8
belong in school? Is there a best age to begin speech treatment?). Chapter 2,
Using Evidence to Guide Clinical Practice, describes tools to discover the
evidence base for evaluating and treating late-acquired sounds. Chapter 3,
Late Eight en español, is the first chapter in our professional literature to
focus exclusively on late-acquired sounds in Spanish-speaking students.
Chapter 4, Speech Sound Disorders, Literacy, and Curriculum, demonstrates
the importance of speech treatment in school settings. Chapter 5, Motor
Learning Guided Therapy, which appeared in the second edition, shows
principles that underlie decisions within an exciting new clinical approach.
Along with the new chapters, the third edition replaces the CD of previous
editions with an expanded and flexible interactive companion website. The
authors of the third edition hope you find these changes beneficial in your
clinical work with your students.
Ken M. Bleile
April 2017
vii
Contributors
Ken M. Bleile, PhD

Professor
Communication Sciences and Disorders
University of Northern Iowa
Cedar Falls, Iowa
Chapter 1 and Part II
Jennifer Walz Garrett, PhD

Associate Professor
Cedar Falls, Iowa
Chapter 4
Carlin Hageman, PhD

Professor Emeritus
ASHA Fellow
Cedar Falls, Iowa
Chapter 5
Lindsey R. Leacox, PhD

Assistant Professor
Cedar Falls, Iowa
Chapter 3
Lauren K. Nelson, PhD

Associate Professor and Head
Cedar Falls, Iowa
Chapter 2
ix
Part I
New Essentials
Chapter One
A Late 8 Update
Ken M. Bleile
This chapter discusses frequently asked questions about the Late 8. Topics
range from practical concerns (What are good phonetic placement and
shaping techniques for [r]?) to theoretical issues (Do the Late 8 belong in
school?). You can read the questions either in sequence or individually. The
format for discussion of each topic is the same: question, short answer, dis-
cussion — sometimes brief, other times longer — followed by a brief summary.
Questions:
n What are the Late 8?
n Why are the Late 8 late?
n Do the Late 8 belong in school?
n Should a clinician treat the Late 8 using an articulation approach?
n What major speech errors affect the Late 8?
n Any suggestions for practicing speech?
n What if a production is not quite right?
n Is there a best age to begin speech treatment?
n What are key environments?
n Should a student with good speech perception receive discrimination
training?
n What are phonetic placement and shaping techniques?
n What are good phonetic placement and shaping techniques for [r]?
n Are non-speech oral motor exercises different than phonetic place-
ment and shaping?
n How many sounds can I treat in a session?
n Should a clinician provide treatment for a stimulable sound?
3
4 The late eight
n What if you hear something but aren’t sure how to transcribe it?
n Any therapy tips for a speech-language pathologist (SLP) student or
a new clinician?
n What is the most important reason a person improves in treatment?
For convenience, here is the same list divided by the nature of the question:
practical or conceptual.
Primarily Practical Questions:

n What major speech errors affect the Late 8?
n Any suggestions for practicing speech?
n What if a production is not quite right?
n What are key environments?
n What are good phonetic placement and shaping techniques for [r]?
n How many sounds can I treat in a session?
n What about if you hear something but aren’t sure how to transcribe it?
n Any therapy tips for an SLP student or a new clinician?
Primarily Conceptual Questions:

n What are the Late 8?
n Why are the Late 8 late?
n Do the Late 8 belong in school?
n Should a clinician treat the Late 8 using an articulation approach?
n Is there a best age to begin speech treatment?
n Should a student with good speech perception receive discrimination
training?
n What are phonetic placement and shaping techniques?
n Are non-speech oral motor exercises different than phonetic place-
ment and shaping?
n Should a clinician provide treatment for a stimulable sound?
n What is the most important reason a person improves in treatment?
What are the Late 8?
Short Answer
[θ ð s z l r S tS ]. The Late 8 are the last eight English consonants acquired by

first language learners, and among the consonants most likely to present
challenges to second language learners.
Discussion
The above list is a reanalysis of the Iowa articulation norms project and its
Nebraska replication (Smit, Hand, Frelinger, Bernthal, & Byrd, 1990). Within
CHAPTER 1: A Late 8 Update 5
this reanalysis, Late 8 consonants are those acquired by 50% of students

at 5 years or older. More technically, Late 8 consonants are those acquired
by 50% of subjects of both genders at an age (and never by less than 50%
of subjects at a later age). The results are similar, though not identical, to
those found in studies of other varieties of English (McLeod, 2002) and in
languages other than English (McLeod, 2011).
This book also discusses vocalic [r], which, of course (as the word vocalic
suggests). is not a consonant. Vocalic [r] is included because, like the Late 8,
students sometimes acquire vocalic [r] during the school years. A more accu-
rate title for this book is The Late 8 + 1.
Summary
In this book the Late 8 are [θ ð s z l r S tS ]. Information on vocalic [r] is included

because clinicians frequently teach that sound alongside the Late 8.
Why are the Late 8 late?
Short Answer
Too many consonants, not enough mouth.
Discussion
A table and a concept help explain why these eight consonants are late.
Table 1–1 shows English consonants typically acquired by children 24 months
or younger. The table lists sound classes from most closed (no distance
between articulators) to most open (the most distance between articulators).
Table 1–1. Early Acquired Consonants

Arranged by Degree of Closure
Most Closed
Stops b d g p t k m n ŋ
Affricates
Fricatives
Liquids
Glides h w j
Most Open
6 The late eight
Viewed this way, children prefer (or at least acquire at an earlier age) conso-
nants with complete closure of the articulators (stops) or with the articulators
spread as wide as possible (glides). That is, if consonant classes are viewed
as falling on a continuum from most closed to most open, children’s early
consonants occur at the ends of the continuum. Midpoint consonant classes
(affricates, fricatives, liquids) are later acquisitions. In all the languages with
which I am familiar, children typically acquire endpoints (stops and glides)
before midpoints (McLeod, 2007, 2011).
What is striking is that the Late 8 are all “midway” sounds — that is, they
are consonants produced midway from most closed (stops) to most open
(glides). [tS ] begins as a stop and ends with friction. [θ ð s z S ] are made
with friction throughout, and [l r] are made with less closure than fricatives,
resulting in a kind of liquid turbulence in the air. As Table 1–2 shows, being
a midway sound is not sufficient to make a sound a late acquisition (for
example, [f] is a relatively early acquisition in English). In other words, the
pattern is that all the Late 8 are midway sounds but that being a midway
sound is not sufficient to make a consonant a late acquisition.
Summary
The Late 8 are midway consonants made with the mouth with the articulators
either farther apart (glides) or entirely touching (oral and nasal stops).
Do the Late 8 belong in school?
Short Answer
Yes, because treatment of the Late 8 is important educationally, socially, and

economically.
Table 1–2. Consonants Arranged by

Degree of Closure (Late 8 Underlined)
Most Closed
Stops b d g p t k m n ŋ
Affricates tS dZ
Fricatives f v θ ð s z S
Liquids l r
Glides h w j
Most Open
Discussion
Speech sound disorders are frequently occurring, which makes their care
expensive and time-consuming. A generation ago, school districts often
asked, why treat speech sound disorders when other children have broader
developmental needs? A question being asked more frequently today is,
why treat speech when schools struggle to meet new curriculum standards?
Questions such as these often pit one group of children with developmental
difficulties against other groups, while also pitting a family’s legal right to
developmental services against the need of society to pay for services.
Six Reasons
At least six reasons support why we should not let the Late 8 become school
dropouts:
1. Speech sound disorders are the world’s most frequently occurring

communication disorder. Speech sound disorders account for 32% of
all communication disorders (Slater, 1992). For 80% of children with
speech disorders, the impairment is sufficiently severe to require clini-
cal treatment (Gierut, 1998). Approximately 6% of students in grades
1 to 12 experience speech sound disorders (American Speech-Language-
Hearing Association, 2006; Law, Boyle, Harris, Harkness, & Nye, 2000).
The disorder appears to be approximately 1.5 times more prevalent in
boys (4.5%) than in girls (3.8%) (Shriberg & Tomblin, 1999).
As discussed in Chapter 3, the Late 8 also may pose special difficul-
ties for those learning English as a non-native language. Fully 20% of
school-aged students speak a language other than English at home, the
largest group being Spanish speakers (National Center for Educational
Statistics, 2002). To illustrate, in Des Moines, the capital of a largely agri-
cultural state in the Midwestern U.S., approximately 16% of students are
non-English speakers, and speak 80 different languages (Iowa Depart-
ment of Education, 2011b).
2. Speech sound disorders affect a student’s education. Speech sound
disorders may affect a student’s ability to communicate with peers and
teachers. Additionally, even single sound errors, which may not interfere
with intelligibility or reading success, gain in importance as a student
transitions through school and, after completing school, seeks employ-
ment (Felsenfeld, Broen, & McGue, 1994; Van Dyke & Holte, 2003).
3. Speech contributes to school success. Success in treating speech
sound disorders contributes to school success in the following areas of
a core curriculum: speaking and listening, language and reading, science,
and social interactions (Iowa Department of Education, 2011a). Chapter 4
on language contains more information on the link between speech and
the curriculum.
8 The late eight
4. Students with speech sound disorders are at risk for educational

failure. Approximately 11 to 15% of 6-year-old students with speech
sound disorders also experience specific language impairment (Shri-
berg & Tomblin, 1999) — 50 to 70% of students with speech disorders
experience general academic difficulty through high school (Felsenfeld,
Broen, & McGue, 1994; Gierut, 1998; Lewis, Freebairn, & Taylor, 2000;
Pennington & Bishop, 2009; Shriberg & Austin, 1998).
5. Teachers may view students with speech disorders negatively. Even
when students with speech sound disorders are without academic dif-
ficulties, at least one third of grade school teachers perceive them as
having less academic potential (Overby, Carrell, & Bernthal, 2007).
6. Students with speech sound disorders may be bullied and enjoy
school less. Students with communication disorders (including speech
sound disorders) are more likely than other students to be bullied, expe-
rience poorer peer relationships, and enjoy school less (McCormack,
Harrison, McLeod, & McAllister, 2011).
Summary
Difficulty with late acquired sounds is the world’s most frequently occur-
ring communication disorder, affecting both children and adults learning
English as a non-native language. The school is the natural habitat for the
treatment of the Late 8 because speech contributes to school success and
problems in speech may result in school difficulties, both academically and
socially. Because of the close relationship between speech sound disorders
and educational success, in treating the Late 8 the goal is speech, the avenue
is language, and the vehicle is the curriculum.
Should a clinician treat the Late 8 using

an articulation approach?
Short Answer
Not necessarily.
Discussion
On first consideration, it may seem that treatment of the Late 8 lends itself to
an articulatory approach, since midpoint sounds appear harder for children to
pronounce than those on either end of the continuum (see question Why are the
Late 8 late?). However, this view does not do justice to the complexity of treating
a person with a developmental difficulty, including those in the speech area.
The difficulty with providing articulatory treatment for an articulation

problem is that it requires a clinician to think of speech treatment as a type
of pill. With a pill, a clinician diagnoses a problem and gives a pill to fix the
difficulty. If a clinician considers speech treatment this way, a student with
an articulation problem receives an articulation approach pill. Alternatively, a
student with a phonological problem receives a phonological approach pill.
The trouble is that many times treatment does not act like a pill. For
example:
n A student experiences an articulation problem but improves because

she finds the language activities engaging.
n A student experiences a phonological problem but improves because
he wants to impress the clinician (or maybe a girl).
n A student improves because she is ready to work on speech issues.
These examples suggest that speech treatment requires a clinician to

consider more than the cause of a student’s speech problem. At least three
variables affect a clinician’s decision regarding a treatment approach: C
(cause), C (communication), and P (person).
Cause
This is the pill-like aspect of speech treatment: diagnosing a student’s speech

difficulty and developing a treatment approach designed to remediate the
deficit area. To illustrate, based on a careful assessment, a clinician may diag-
nose that a student’s difficulty with [s] arises because he produces the sound
by creating a constriction with the tongue blade instead of the tongue tip.
The treatment approach might have as its goal to help a student pronounce
[s] with the tongue tip.
Communication
Speech treatment entails not simply knowing a problem’s cause, but also
understanding how the difficulty affects communication. Speech for com-
munication requires both language knowledge (phonology) and production
ability (articulation). To give just one illustration, a student who communi-
cates through speech needs to know the role of [s] in language as well as
how to perceive and move the articulators in such a way to produce [s].
Because the ultimate goal of speech treatment is to improve communica-
tion, speech treatment benefits from inclusion of both speech components,
articulation and phonology. Articulation provides the motor practice neces-
sary for speech to occur; phonology provides the links from the articulatory
system to the language system, which in turn makes it possible for a student
to function socially and educationally. To give an analogy: without language,
speech is like a train that travels fast but has no place of arrival; speech
10 The late eight
without the articulation component is like knowing the destination you want
to reach but not having a vehicle to get there.
Person
Attached to every speech difficulty is a real person. Along with cause and com-
munication, success or failure in speech treatment also depends on person
variables, including a student’s interests, motivation, language abilities, views
about speech therapy, peer relations, and personality. And, of course, along
with the student comes family, the school, and race/ethnicity.
Summary
Speech treatment is more complex than selecting to administer either an

articulation or a phonology pill. Because speech is a motor skill, speech
treatment typically benefits from extensive opportunities to practice speech.
Because speech is also part of language, speech treatment benefits from
opportunities to develop language and literacy. And because a real person
is attached to the speech disorder, speech treatment benefits from lessons
that students find motivating and interesting.
Practically, this means a clinician needs to consider not only the reason(s)
a student experiences a speech problem, but also ways to motivate and
generalize speech change. Sometimes the cause of the speech difficulty and
the approach that motivates change may be one and the same, as when — for
example — a student with articulation difficulty is motivated and is able to
generalize success through drills. Many other times, however, treatment
achieves great success when a clinician includes language and ties it to the
school curriculum.
What major speech errors affect the Late 8?
Short Answer
The major errors are lip rounding, lisping, blading, and lateralization.
Discussion
Early speech errors tend to (though not always, of course) replace mid
sounds with sounds on either end of the openness continuum (see ques-
tion Why are the Late 8 late?). To illustrate, stops may replace [s] and other
affricates, and glides may replace liquids. Later in development, even when
students may produce midpoint sounds, they often produce them in differ-
ent ways, prominent productions being lip rounding, lisping, blading, and
lateralization.
Lip Rounding
[r] is prone to being pronounced with lip rounding, sometimes called [w]
coloring because it may sound like a cross between [r] and [w]. The usual
transcription of lip rounding on [r] is a small w under the [r], like this: [ r ]
Lisping
[s] and [z] (and to a lesser extent other of the Late 8 as well) are prone to
being pronounced with the tongue tip between the front teeth, similar or
identical to [θ] or [ð]. The usual symbol for lisping is a small tooth under the
sound, like this: [  ]
Blading
[s] and [z] (and to a lesser extent other of the Late 8 as well) are prone to
being pronounced with the blade of the tongue body raised toward the roof
of the mouth, giving it a [s] quality. The symbol for bladed is a small half
circle (representing the roof of the mouth) under the sound, like this: [ ]
Lateralization
[s] and [z] (and, as above, to a lesser extent many other of the Late 8) are
prone to being pronounced with the air flowing over the sides of the tongue
rather than over its top. Lateralized sounds have an [l]-like quality, though
the lateralization can sound bladed, especially if the lateralized sound is
unvoiced. The symbol for lateralization is an [l] placed before the sound,
like this: [ls] []
Summary
The Late 8 are affected by many different speech errors. Highly frequent
errors include lip rounding, lisping, blading, and lateralization.
Any suggestions for practicing speech?
Short Answer
A major challenge in practicing speech is to do it in a way to promote

generalization to language, the curriculum, and other settings.
12 The late eight
Discussion
Chapter 5 on motor learning contains excellent principles for helping students

practice speech, and the Appendix contains a long list of language activities.
Here are some additional commonsense speech practice principles:
Speed
Avoid having a student practice speech by saying sounds and words very
slowly. Extremely slow speech employs feedback mechanisms not typically
used in speech.
Vowels
Whenever possible, practice consonants in the context of vowels. People

seldom speak consonants in isolation in everyday conversations.
Dual Nature of Speech
Speech is both a motor activity (articulation) and an aspect of language

(phonology). Practice the mouth while you engage the mind. A good way to
do this is through lots of speech practice during a session using language-
and curriculum-based activities whenever possible.
From Words to Conversation
When possible, work on a treatment sound from the level of words to con-
versation. Those levels have functional value to a student; they promote
generalization because students speak them outside of therapy, and they
appear to be units of motor planning.
Self-Monitoring
Promote self-monitoring by not providing constant feedback. Rather than being

the monitoring system, encourage a student to monitor his or her own speech.
Self-Correction
Provide opportunities for self-correction. Help students become aware of and

practice techniques to correct their own speech.
Introduce Distractions
A student must learn to manage distractions when speaking, which can

be challenging for any newly acquired skill. Ways to introduce distractions
range from throwing a ball back and forth while practicing speech, holding
group treatment, having the student make oral reports to you containing the
treatment sound, and providing treatment or generalization in the classroom.
Communicative Value
Help a student learn about the communicative value of a treatment sound

through frequent use of minimal pairs, deletions, self-corrections, old way/
new, and similar sounds.
Functional Activities
Base treatment activities on a student’s interests, including, when appropri-

ate, books, magazines, hobbies, and school or work assignments.
People of Importance
Keep people of importance in a student’s life informed about therapy and,

if appropriate, provide them simple therapy activities in which they can
participate.
When to Dismiss
Typically, a student should pronounce a treatment sound 90% correctly in

short phrases and in conversation before dismissal.
Follow-Up
Whenever possible follow up after dismissal to make sure a student has not
regressed in his or her speech.
Summary
The primary goal of speech practice is to bring students to a point where

they no longer need speech practice. Students obtain this goal most readily
with practice that actively promotes generalization to language, curriculum,
and other settings.
What if a production is not quite right?
Short Answer
Think of “right” as being just one end of a scale.

14 The late eight
Discussion
Whenever possible, treatment should avoid practicing a speech error — some-

thing the student probably already has lots of practice doing! Ideally, a
sound should be entirely correct during practice. An analogy might be to
suppose a coach wanted to teach a student a new tennis stroke. Ideally, the
coach wants to establish the stroke perfectly and then engage in perfect
practice. However, in both speech-language pathology and tennis, sometimes
something less than ideal is accepted, and both a clinician and a coach may
need to practice a skill that is better than before but still not perfect. For this
reason, a “3,” “2,” “1” rather than a “correct/incorrect” system often proves
useful. A student’s old speech pattern is a “3,” and the goal is to establish it
as a “1” (perfect). However, in many instances a “3” does not automatically
become “1,” and instead the student produces something like a “2” — a more
correct version of the old pattern, but still not perfect. Speech treatment
often contains many more “2”s than “1”s. While practicing a less than perfect
sound, the student learns to make it a “1” through self-reflection activities
and prompts.
Summary
A simple 1-2-3 scale usually is sufficient to describe clinical progress that has
not yet reached the point where a production sounds entirely “right.”
Is there a best age to begin speech treatment?
Short Answer
When it comes to treating speech, earlier is generally better.
Discussion
Many factors contribute to a clinician’s decision regarding at which age or

grade to begin speech treatment. To name just a few, these include caseload,
needs of other clients, treatment philosophy, and school district rules. The
present discussion focuses on linguistic and neurological variables.
Evidence from at least five sources suggests that children acquire speech
early and that the window of opportunity to treat speech disorders may be
more open early in life:
1. Brain development
2. First language
3. Second language
4. Disability
5. Brain injury
1. Brain Development
Many essential aspects of brain development are “front loaded” to occur early
in life, including:
n Brain weight, important for numerous brain functions, at birth is

about 25% of adult brain weight and achieves 85% of its growth
during the first three years (Dekaban & Sadowsky, 1978; Kretschmann,
Kammradt, Krauthausen, Sauer, & Wingert, 1986).
n Myelin sheaths, critical for motor movements, is 90% complete by
one year, the remainder occurring up to young adulthood (Evans &
Hutchins, 2002).
n The hippocampus, an essential system for laying down new memo-
ries, achieves a mature number of synapses during the second year
(Liston & Kagan, 2002).
n The primary auditory cortex, essential for speech perception, is
mature months before a child’s first birthday (Maurer, 2005; Pascallis,
de Hann, & Nelson, 2002; Werker & Tees, 2005).
n Broca’s area, centrally important to speech production, begins devel-
opment during the second year and matures by 6 to 8 years of age
(Schade & van Groenigen, 1961; Simonds & Scheibel, 1989).
2. First Language
Speech (even the Late 8) is the earliest acquired language area. These are the
ages at which the Late 8 are acquired by fully 75% of students (Smit, Hand,
Frelinger, Bernthal, & Byrd, 1990):
n 5;0: [s] and [S ]

n 5;6: [ð]
n 6;0: [θ], [z], [tS ], [r], and [l]
Children acquire other areas of language form (morphology and syntax)

several years later than speech, while semantics, pragmatics, and discourse
are lifelong acquisitions.
3. Second Language
As a famous study of second language learning indicates (and as many adult

second language learners will sadly attest), second languages are better
learned younger than older ( Johnson & Newport, 1989). Grammatical pro-
ficiency begins high and remains so until around 7 years, when proficiency
begins to decrease through the teenage years and into adulthood.
16 The late eight
4. Disability
Studies of children with Down syndrome offer further evidence of the early
acquisition of speech. As noted in several studies, children with Down syn-
drome may appear less intelligible at 10 years than when they were 5 (Miller,
1988, 1999). The explanation is that speech stops or slows in development
around 5 years, while other areas of language continue to develop. As other
areas develop — for example, a child develops a larger vocabulary and speaks
in longer sentences — speech remains relatively unchanged, resulting in a
child who sounds less intelligible when older than younger.
5. Brain Injury
Studies of language outcome in a severe form of injury highlights the great

plasticity of the neocortex at younger ages. The surgery is hemispherectomy,
which is removal of one hemisphere of the brain. The surgery is performed
to alleviate otherwise intractable seizures. The classic condition for a hemi-
spherectomy is Rasmussen encephalitis, an autoimmune disease that begins
in one hemisphere before moving to the other hemisphere (Stark, Bleile,
Brandt, Freeman, & Vining, 1995).
Research suggests that outcome improves when children are younger
(Stark, Bleile, Brandt, Freeman, & Vining, 1995). To illustrate, all other things
being equal (though they seldom are), a child of 3 years who has his left
hemisphere removed will have significantly better language outcome than
a child of 7 or 8 years who has the same hemisphere removed. The child of
7 or 8 years will in turn likely have a better language outcome than a child
who receives the surgery as an adolescent.
Summary
Evidence from many sources suggests that speech is an early developing

system. As summarized in Table 1–3, because speech is an early acquisition,
treatment begun as early as possible is likely to be more successful, suggest-
ing the following general guidelines for when to begin speech treatment.
The “best” is to begin treatment when the brain is engaged in that type
of learning. The “next best” (and many times the more realistic) is to begin
speech treatment close to the age at which speech slows in development. The
second semester of kindergarten is a starting point to allow the new school
social environment to impact speech.
The “worrisome” age to begin is near 8, years after speech development
has leveled off for many children and getting closer to adolescence, when
development slows further. The “very worrisome” age to begin is adoles-
cence, when speech and language development slow considerably. For some
students, perforce speech treatment must wait until that age due to factors
Table 1–3. Preferred Ages to Begin Treatment
Best Begin treatment before starting school

Next best Begin treatment the second semester of kindergarten
and, if needed, through first and second grades
Worrisome Begin treatment after 8 years of age
Very worrisome Begin treatment in middle school
such as availability of services, willingness to receive treatment, or maturity.

Speech can still be learned at such an age (or at any age, for that matter),
but the work can be more challenging.
What are key environments?
Short Answer
A key environment is a phonetic context that may increase the likelihood of

pronouncing a sound correctly.
Discussion
Key environments are the mirror image of phonological processes. Phono-

logical processes, derived originally from the cross-linguistic work of David
Stampe and expanded through extensive research in child language, enu-
merate the phonetic “pitfalls” into which a child’s speech tends to fall. To
illustrate, the processes of prevocalic voicing and final consonant deletion
describe the phonetic tendency for consonants to be voiced before a vowel
and voiceless at the end of a syllable, respectively.
Another way to describe these phonetic tendencies (the mirror image
of phonological processes) is this: vowels facilitate the voiced consonants
that follow, and the end of syllables facilitates voiceless consonants. That is,
if a student experiences difficulties producing a voiced consonant, it may
facilitate treatment to introduce the voiced consonant before a vowel in the
same syllable. Similarly, if a student experiences difficulties pronouncing a
voiceless consonant, it may facilitate treatment to introduce it at the end of
a syllable. In these and other key environments, the operative word is may.
Like phonological processes, key environments describe phonetic tenden-
cies, not rules that every student must follow. As such, key environments
offer a phonetic context in which to introduce a treatment sound.
The following show key environments for the Late 8 by syllable position
and vowel influence.
18 The late eight
Syllable Position
Beginning of Syllables. The beginning of syllables and between vowels may

facilitate voiced Late 8 consonants.
n [l] as in lake and alone
n [r] as in run and around
n [ð] as in those and weather
n [z] as in zee and a zee
End of Syllables. The end of a syllable may facilitate voiceless Late 8

consonants.
n [s] as in bus
n [tò] as in batch
n [s] as in fish
n [θ] as in teeth
Consonant Clusters. Consonant clusters may facilitate at least three Late 8

consonants.
n [s] next to [t] as in steep, pizza, beats
n [z] after [d] as in beads
n [r] after [t] or [k] as in tree or creek
Ambisyllabic. A two-syllable sequence in which the first syllable ends with

the late consonant and the second syllable begins with a vowel may facilitate
all Late 8 consonants. For example,
n [s] as in this is
n [z] as in buzz it
Vowel Influences
High Front Vowels. Production of Late 8 consonants produced near the alveo-
lar area is facilitated by high front vowels.
n [θ] as in thin
n [ð] as in these
n [s] as in see
n [z] as in zip
n [r] as in read
n Light [l] as in leaf
High Back Vowels. Production of Late 8 consonants produced in the back of

the mouth is facilitated by high back vowels.
n [tS ] as in chew
n [ S ] as in shoe
n Dark [l] as in cool
Summary
Key environments are the mirror image of phonological processes. Key envi-
ronments derive from the same cross-linguistic and child language research
as phonological processes, differing from phonological processes only in
that their focus is phonetic contexts that may facilitate, rather than hinder,
speech production. Table 1–4 summarizes key environments for the Late 8,
organized by individual sound.
Table 1–4. Key Environments for Individual Consonants
[θ] End of a syllable, as in teeth

Before a high front vowel, as in thin
[ð] Beginning of syllable and between vowels, as in the and weather

Before a high front vowel, as in these
[s] End of syllables, as in bus

Next to [t], as in steep, pizza, beats
Next to high front vowels, as in see
[z] Beginning of syllable and between vowels, as in zee and a zee

Before a high front vowel, as in zip
In consonant clusters after [d], as in beads
[l] Beginning of syllable and between vowels, as in lake and alone

Light [l] before a high front vowel, as in leaf
Dark [l] after a high back vowel at the end of a syllable, as in cool
[r] Before a high front vowel, as in read

Beginning of syllable and between vowels, as in row and teary
In a consonant cluster with [t] or [k], as in tree or creek
[tS ] End of a syllable, as in batch

By a high back vowel, as in chew
[S] End of a syllable, as in fish

By a high back vowel, as in shoe
20 The late eight
Should a student with good speech perception

receive discrimination training?
Short Answer
Yes, because speech discrimination and speech perception are unrelated.
Discussion
Discrimination training derives from the observation that many children

appear not to realize they are making speech errors. A classic illustration is
a student who says rabbit as wabbit. The speech pathologist asks, do you
know you said rabbit as wabbit? And the student answers, No I didn’t. I said
wabbit as wabbit.
Traditional Approach
Traditionally, researchers believed problems in the speech perception system

caused discrimination difficulties, suggesting a student’s discrimination dif-
ficulty lies in the auditory system’s inability to distinguish between sounds.
Within a traditional approach, the goal of traditional discrimination training
is to train the auditory system to hear a difference between sounds, after
which production training can commence. Traditional techniques to improve
discrimination include ear training (“raise your hand when you hear our
treatment sound”), sometimes accompanied by mirror work, descriptions of
the speech sound, and speech demonstrations.
Researchers have learned a great deal about the development of the
speech perception system since the 1930s through 1950s, casting doubt on
the traditional perspective. Current research strongly suggests that the audi-
tory system, in common with other sensory systems, matures early and has
adultlike capacities very early in life — before the end of a child’s first year
(Casey, Gledd, & Thomas, 2000; Maurer, 2005; Pascallis, de Haan, & Nelson,
2002; Werker & Tees, 2005). The early maturity of the primary auditory cortex
provides a reliable means through which information about speech and
language reaches the higher cognitive areas of an infant’s brain. If primary
auditory cortex sustained damage sufficient to disrupt this function, the
resulting difficulties would be far more extensive and disruptive than, for
example, an isolated difficulty distinguishing between [w] and [r].
A Cognitive Explanation
If a student has a normal speech perception system, why would he or she

fail to perceive that he or she pronounces, for example, rabbit as wabbit?
The answer may be that students both with and without speech difficul-
ties typically give little attention to their speech. The only difference between
the two is that we notice the lack of attention in students with speech
difficulties because their speech problem shines a light on their inattention.
Attention
Not paying attention to our speech is normal. To give just a few illustrations,
few people (other than speech-language pathologists) are aware that when
someone says [p] in consonant clusters, such as in spy, the sound is voice-
less and unaspirated, similar to a sound in Thai, while [p] beginning words
such as pie is aspirated. Similarly, few people realize that they pronounce [r]
in pride with little or no voicing, and typically pronounce [r] in bride with
voicing throughout. We fail to perceive these speech variations not because
our auditory mechanism is broken, but because we focus our attention on
communication.
Considered in this way, students’ “discrimination problems” may be dif-
ficulty with awareness, implying that the therapeutic challenge is to focus
a student’s attention on the difference between an intended pronunciation
and the actual sound that comes out of the mouth. An awareness exercise
is a little verbal tap on the shoulder to say, “Remember what sound you are
working on. Focus on what you are doing.”
Clinical Differences
This difference in perspective between a traditional and a cognitive approach

to discrimination leads to at least three differences in treatment.
1. A Population Difference. Within a traditional perspective, treatment of

discrimination typically is restricted to students who demonstrate dis-
crimination difficulties — that is, the wabbit students who, for example,
pronounce rabbit as wabbit without realizing they are pronouncing [r]
as [w]. Within a cognitive perspective, the expectation is that people
experience difficulties focusing on speech. For this reason, almost all
students with speech problems may benefit from little reminders that
say, in effect, “Yo, pay attention: this is what we’re working on.”
2. A When Difference. Within a traditional perspective, a clinician undertakes
discrimination activities at the beginning of treatment prior to working on
speech production. Within a cognitive perspective, discrimination training
occurs throughout treatment, concurrent with practicing speech production.
3. A How Difference. Within a traditional perspective, identification activi-
ties are the most common way to help a student learn to discriminate
between sounds, perhaps supplemented or expanded on through activi-
ties that draw a student’s attention to his/her speech, including:
22 The late eight
n Metaphors
n Touch cues
n Mirrors
n Descriptions
n Demonstrations
n Phonetic placement and shaping
These are also excellent tools within a cognitive perspective and have wide
uses in many activities in this book. Less traditionally, activities that promote
language and reading also help focus a student on speech, including:
n Minimal pairs
n Deletions
n Self-correction
n Old way/new way
n Similar sound
The Appendix contains a lengthy list of language-based activities to promote

speech awareness.
Lastly, distraction tasks can introduce a student to the challenge of
keeping a focus on newly acquired speech skills outside of the treatment
room. Numerous types of distractions are possible; several that come readily
to mind are:
n Standing on one foot while talking

n Talking while throwing a ball back and forth
n Practicing a speech
Summary
Discrimination problems arise from a normal cognitive process, not a broken

speech perception system. The challenge of awareness training is to help
students recognize that what they intend to say differs from what comes out
of their mouths.
What are phonetic placement and shaping techniques?
Short Answer
Phonetic placement and shaping techniques convert a non-stimulable sound

into a stimulable sound. Phonetic placement uses articulatory postures (typi-
cally, tongue and lip positions). Shaping relies on a sound a student can
already produce (either a speech error or another sound).
Discussion
The following examples illustrate a phonetic placement technique for [k]

followed by a shaping technique for [s].
Placement Example: [k]
This (or one of its many variants) is a popular technique to establish [k].
1. Ask the student to place the tongue tip behind the lower front teeth. (If
needed, a clinician can use a tongue depressor to keep the tongue in place.)
2. Ask the student to hump the back of the tongue and say [ku].
Shaping [ S ] to [s]
This phonetically clever shaping technique shows that sometimes a smile is
all you need.
1. Instruct the student to say [S].

2. Ask the student to retract his or her lips into a smile. Often, this results
in the tongue moving forward slightly into the position for [s]. If needed,
however, instruct the student to move the tongue slightly forward. The
resulting sound is [s].
Summary
Phonetic placement and shaping are techniques to convert a non-stimulable

sound into a stimulable sound.
What are good phonetic placement

and shaping techniques for [r]?
Short Answer
Many good techniques exist. The website for this book lists over one hundred
phonetic placement and shaping techniques, including dozens for [r] and
vocalic [r].
Discussion
I receive more questions about phonetic placement and shaping of [r] than
any other sound. I do not believe one single best technique exists: there exist
24 The late eight
multiple ways to produce a sound and there are too many different student-
learning portraits for there to be “a best technique for everyone.” Here is my
personal list of favorite techniques:
Shaping of [k] to [2]

Based on my very informal polling of clinicians, this is the most widely used
technique to establish vocalic [r].
1. Instruct the student to lower the tongue tip.

2. Ask the student to raise up the back of the tongue as for a silent [k].
3. Ask the student to make the sides of the back of the tongue touch the
insides of the back teeth.
4. Ask the student to turn on the voice box, resulting in [2] or another
vocalic [r].
Phonetic Placement of Vocalic [r]
This technique is simple and clever.
1. Instruct the student to lie on his/her back, relax the mouth, and say [2]
or another vocalic [r].
Shaping [2] to [r]
This technique relies on the phonetic tendency in two syllable sequences

such as it is for the final consonant in the first syllable to migrate to begin
the second syllable, if the second syllable begins with a vowel. This tendency
explains why a phrase such as it is is often pronounced i tis. The technique is
useful because it provides a clever way to help a student convert the ability
to make a syllable final sound into a syllable initial one.
1. Ask the student to say [2].

2. Next, ask the student to say [2] followed by [i] or some other vowel.
3. Instruct the student to say [2i] several times as quickly as possible,
resulting in [2ri]. After [2ri] is established, instruct the student to say [2]
silently, resulting in [ri].
Phonetic Placement of [r]
The first technique is for retroflex [r] and the second for bunched [r]. Both
variants contain the following steps:
1. Tuck the chin

2. Make a grin
3. Tongue in track
4. Curl it back
The components are:
n A relaxed tongue resting on the floor of the mouth (tuck the chin)
n Spread lips (make a grin)
n Position the tongue so its sides rest against the insides of the lower
teeth (tongue in track)
n Curl the tongue tip back (curl it back)
For bunched [r], instruct the student to place the sides of the tongue in the
track between the upper teeth and then curve the tongue tip down behind
the lower front teeth.
Summary
Dozens of techniques exist to place or shape [r]. There is no “best” technique

for everyone. Instead, clinicians find techniques that fit their clinical style
and training and that work for clients.
Are non-speech oral motor approaches the same

as phonetic placement and shaping?
Short Answer
The two are not the same.
Discussion
Non-speech oral motor approaches attempt to strengthen and improve

flexibility of articulators, the idea being that such exercises will result in
improved speech. Sometimes such approaches cite phonetic placement and
shaping as support.
Differences
Though superficially similar, phonetic placement and shaping techniques

and non-speech oral motor approaches are unrelated. Phonetic placement
shaping converts a non-stimulable sound into a stimulable one; non-speech
oral motor approaches replace speech treatment with exercises to strengthen
and improve flexibility of the articulators. Phonetic placement and shaping
26 The late eight
techniques have a long clinical history of helping clinicians. On the other

hand, clinical testimonials to the utility of non-speech oral motor approaches
aside, multiple research studies strongly suggest that non-speech oral motor
approaches are based on faulty empirical and theoretical foundations (Clark,
2003; Lass & Pannback, 2008; Lof, 2009; Muttiah, Georges, & Brackenbury,
2011; Powell, 2009; Ruscello, 2008).
Testimonials
How can clinical testimonials exist that attest that students improve in speech
using non-speech oral motor approaches if clinical research strongly sug-
gests that non-speech oral motor approaches rely on faulty empirical and
theoretical foundations?
The answer may lie in testimonials, which highlight an important truth
about treatment: when a student improves, it is notoriously difficult to deter-
mine why he or she improved. Any treatment approach contains multiple
components, including the theory behind the approach, the student, the
setting, the clinician’s treatment skills, time of day, etc. Careful research is
required to determine how the many components in any given approach
alone or in conjunction with each other result in treatment change. For this
reason, testimonials are better at telling you “a student got better” than telling
you why a student got better.
Summary
Phonetic placement and shaping do not strengthen or improve muscle tone,

and they do not lend support to non-speech oral motor approaches. Research
supports the position that non-speech oral motor approaches have faulty
theoretical and research foundations. The topic of non-speech oral motor
approaches highlights the idea that testimonials are better at telling you a
student got better than telling you why a student got better.
How many sounds can I treat in a session?
Short Answer
As in many treatment areas, the answer depends in large measure on whom

you are treating.
Discussion
An assessment typically yields one or more possible treatment sounds, which

raises the following questions:
n If a student’s speech contains more than one possibility, which sound

to select?
n Should one sound be worked on to completion and then another?
n Should a clinician work on two sounds simultaneously, changing from
one to another in the same treatment session or in alternate sessions?
n Does working on two or more treatment sounds confuse a student?
My view is that answers to these questions have more to do with human

variables than linguistic ones. Some students — especially older ones — can
work on a sound from beginning to completion, while others benefit from
alternating between sounds, sometimes within a single treatment session or
in alternate sessions. A useful dynamic assessment is to initially select several
treatment sounds, alternating between them either in a single session or in
alternate sessions, and then reevaluate the choice after several treatment
sessions.
Summary
No single answer holds for everyone. As with many aspects of the clinical
enterprise, clinical judgment is (and should be) the final arbitrator of how
many sounds to treat.
Should a clinician provide treatment for a stimulable sound?
Short Answer
Importantly (though not surprisingly), it depends on the student.
Discussion
Stimulability is an old word — circa 1930s — that means capacity. If a student

is stimulable for a sound, he or she demonstrates capacity to pronounce it.
Debate exists (sometimes carried out with something approaching religious
intensity) concerning whether a clinician should select a treatment sound
for which a student is stimulable — that is, whether to select to treat a sound
for which a student already shows some capacity to produce in limited
circumstances.
The Positions
The logic of selecting a stimulable treatment sound is that a student expe-

riences less frustration because he or she begins with some capacity to
pronounce it. Another reason to select a stimulable sound is that a student is
28 The late eight
practicing success during treatment because he or she can already pronounce

it correctly.
The logic for selecting a non-stimulable sound for treatment is that
the student learns more by selecting treatment sounds different from those
sounds the student can produce. Also, a student may acquire a stimulable
sound without treatment, since the sound already is being pronounced cor-
rectly in some contexts.
What the Research Says
Research does not offer an unequivocal resolution to the stimulability ques-

tion. Studies exist that support both positions (Dietrich, 1983; Gierut, 1998;
Powell, 1991; Powell, Elbert, & Dinnsen, 1991; Shine, 1989). Often, in the
same study some students appear to self-correct a stimulable sound without
treatment, while others require speech treatment.
A Hypothesis
My hypothesis (and I believe that of many clinicians) is that stimulability is

more a “person decision” than a “linguistic decision.” That is, person factors
may be the most important variable in deciding whether to treat a stimulable
sound, including a student’s age, maturity, attention, cognitive skills, and
ability to tolerate failure.
In tacit recognition of the importance of human variables, most clini-
cians select a stimulable sound with a younger student with less tolerance for
failure. They may first treat a stimulable sound to build a student’s confidence
and sense of success, and later work on non-stimulable sounds. Selecting a
stimulable sound may not be an option for an older school-aged student or
an adult learning a second language. In such situations, perforce a clinician
must select a non-stimulable sound.
An alternative to accepting one or the other position is to be your own
researcher, experimenting with different perspectives. Perhaps you will find
that you have more success with non-stimulable sounds than reported by
some, or perhaps you will have less. Or maybe you will discover which stu-
dents on your caseload seem to require a treatment sound that is stimulable
and which do not. No matter what you discover, experimenting with different
approaches may yield important insights about what works best for you and
the students you serve.
Summary
The stimulability question highlights the difficulty in analyzing speech

without also considering the person who has the speech problem. One size
does not fit all when it comes to stimulability: not all students with stimulable
sounds improve without treatment.
What if you hear something but aren’t

sure how to transcribe it?
Short Answer
Welcome to my life.
Discussion
Sometimes a clinician hears a sound in a student’s speech but isn’t sure

how to transcribe it. This may happen particularly often with a new student,
leading a clinician to listen and wonder, What is going on? It doesn’t quite
sound lateral and it’s not quite bladed. Is it both bladed and lateralized or
something else altogether?
In this situation, the first task is to attune yourself to the speech error.
A quick review of the errors often affecting the Late 8 may help. Deciding
what symbol or diacritic to address is a secondary problem after you deter-
mine how the student is producing the sound. Until then, a simple technique
is to place an X under the sound the student is attempting. For example, if the
student produces the first sound in sun in a difficult-to-determine-exactly-
what-he’s-doing way, transcribe the [s] with a small X underneath.
At this point the X simply means that the student is saying [s] in a way
you haven’t yet identified. Basically, X = I’m not sure how the student is
producing the [s]. During treatment, as you become more familiar with the
student, you are likely to figure out what the student is doing to make [s]
sound the way it does. For example, you may think to yourself, Oh. [s] is
kind of lateral on the left side of the tongue, and it sounds wet because of
excess saliva. At this point, you define X, maybe placing at the top of your
transcription, X = left side tongue lateral, wet.
Summary
X is a very useful diacritic in situations in which a clinician is not quite certain

how to transcribe a student’s speech.
Any therapy tips for an SLP student or a new clinician?
Short Answer
Over the years, I have had the pleasure to supervise many students and
new clinicians. The following distills what I have learned from watching the
progression of their clinical skills.
30 The late eight
Discussion
Here are general principles that I follow in clinical work:
Recipes
No single therapy technique is right for everyone. Instead of having “one

recipe for all occasions,” think of therapy techniques as an index box filled
with ideas that you select from, add to, and modify to fit the needs of an
individual student. To continue the cooking analogy maybe a little too far,
a newer chef is likely to reply on one or a few basic recipes, since that is a
quick way to become competent. With experience, a chef relies on more and
varied recipes, as he or she becomes more flexible with experience.
One functional activity is worth a hundred games. Books, class assignments,

and newspapers are just a few materials that facilitate learning while facilitat-
ing speech.
Let a student know why he or she is there
Talk openly and respectfully to a student about his or her speech. A student
needs to understand why he or she is in therapy to improve. Don’t let a
student’s speech difficulty become “the elephant in the room” that no one
mentions.
Success
A student needs to feel success. In general, if a student is not successful from

50 to 70% on an activity, consider changing the activity.
Keep It Fun
Be interesting and energetic in therapy. If you have fun, a student is more apt
to have fun, too. But while having fun, remember that games and entertaining
activities are tools and that the purpose of therapy is to improve a student’s
speech.
Summary
In summary, these are my suggestions to new clinicians:
n Move from reliance on one or a few recipes to flexible approaches as

soon as you feel comfortable.
n Make activities functional whenever possible.

n Work to improve your student’s speech awareness.
n Maintain a high level of success.
n Make therapy fun, while keeping in mind that the purpose of treat-
ment is to improve speech..
What is the most important reason a

person improves in treatment?
Short Answer
One factor stands out above the others.
Discussion
One of the most essential clinical questions is, why do people improve in
treatment? Though recognizing that a student’s improvement in treatment
probably depends on multiple interacting factors (including motivation,
a clinician’s skills, the treatment approach, family involvement, treatment
frequency, etc.), several researchers in psychology have focused on two vari-
ables, asking, what is the major driver of clinical success, the clinician or the
approach? (Lambert, 2004; Staines, 2008).
Approach or Clinician?
The question of clinician or approach is important, because, depending on

how you answer it, a profession does very different things. If the approach
is primary, a profession asks how best to teach a student or clinician to
understand and execute the approach. The research literature suggests that
this is the dominant perspective in our profession.
Alternatively, if a profession believes the clinician is primary, it asks
different questions, including:
n What is the clinician doing to result in clinical success?

n What motivates students to learn?
n How does a clinician develop, maintain, and expand good clinical
judgment?
n What role does size of caseload play? Experience? Personality?
Research
A general finding from Beutler, Malik, Alimohamed, Harwood, Talebi, Noble,

and Wong in Bergin and Garfield’s Handbook of Psychotherapy and Behav-
ior Change (Lambert, 2004) and Staines (Staines, 2008, in Review of General
32 The late eight
Psychology) is that the “individual therapists’ personal skills rather than their
theoretical orientation” make the most difference in effectiveness of treat-
ment. Importantly, both the approach and the clinician contribute to clinical
success — that is, both the approach the clinician uses and the clinician’s
clinical skills are important. The approach contributes approximately 25% to
success and the clinician contributes the other 75%.
A Hypothesis
The reason a clinician is primary to clinical success is that both the student
and the clinician share the same neurological wiring for learning in a social
context. The reason a clinician is primary to treatment success— and it is
only my hypothesis — is that social relations play the same central role in
the treatment of speech sound disorders as they do in other types of clini-
cal treatment. In the treatment of speech sound disorders, approaches are
important tools, just like a painter’s brushes, pigments, and canvases. But
mastery of the tools will not result in a masterpiece. To achieve art, you need
a clinician.
Summary
Clinicians are more central to treatment success than the treatment approach.
Social relations may be crucial to treatment success because the student and
the clinician share the same neurological wiring for learning in a social context.
Conclusions
This chapter discussed 18 questions related to current issues affecting the

treatment of the Late 8. Some questions addressed conceptual issues, while
others focused on practical matters. In important respects, the other chapters
in this section also provide Late 8 updates. The topics of those updates are
current research, the curriculum, a speech motor approach, and the Late 8
en español.
References
American Speech-Language-Hearing Association. (2006). 2006 schools survey report:

Caseload characteristics. Rockville, MD: Author.
Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., &
Wong, E. (2004). Therapist effects. Bergin and Garfield’s handbook of psycho-
therapy and behavior change, 5, 227–306.
Casey, B., Gledd, J., & Thomas, K. (2000). Structural and functional brain development
and its relation to cognitive development. Biological Psychology, 54, 241–257.
Clark, H. M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial.

American Journal of Speech-Language Pathology, 12, 400–415.
Dekaban, A. S., & Sadowsky, D. (1978). Changes in brain weights during the span of
human life: Relation of brain weights to body heights and body weight. Annals
of Neurology, 4, 345–356.
Diedrich, W. (1983). Stimulability and articulation disorders. In J. Locke (Ed.), Semi-
nars in Speech and Language, 4.
Evans, O. B., & Hutchins, J. B. (2002). Development of the nervous system. In Duane
E. Haines (Ed.), Fundamental neuroscience (pp. 71–89). New York, NY: Churchhill
Livingstone.
Felsenfeld, S., Broen, P., & McGue, M. (1994). A 28-year follow-up of adults with a
history of moderate phonological disorder: Educational and functional results.
Journal of Speech and Hearing Research, 37(6), 1341–1353.
Gierut, J. A. (1998). Treatment efficacy: Functional phonological disorders in chil-
dren. Journal of Speech, Language, and Hearing Research, 41, S85–S100.
Hayden, D., Eigen, J., Walker, A., & Olsen, L. (2010). PROMPT: A tactually grounded
model. In A. L. Williams, S. McLeod, & R. J. McCauley (Eds.), Interventions for
speech sound disorders in children (pp. 453–474). Baltimore, MD: Paul H. Brookes.
Iowa Department of Education. (2011a). Iowa core. Retrieved from http://www
.educateiowa.gov
Iowa Department of Education. (2011b). Statistics. Retrieved from http://www.educa-
teiowa.gov
Johnson, J., & Newport, E. (1989). Critical period effects in second language learn-
ing: The influence of maturational state on the acquisition of English as a second
language. Cognitive Psychology, 21, 60–99.
Kretschmann, H., Kammradt, G., Krauthausen, I., Sauer, B., & Wingert, F. (1986).
Brain growth in man. Bibliography of Anatomy, 28, 1–26.
Lambert, M. (2004). Bergin and Garfield’s handbook of psychotherapy and behavior
change. New York, NY: John Wiley.
Lass, N., & Pannbacker, M. (2008). The application of evidence-based practice to
nonspeech oral motor treatments. Language, Speech, and Hearing Services in
Schools, 39, 408–421.
Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (2000). Prevalence and natural
history of primary speech and language delay: Findings from a systematic review
of the literature. International Journal of Language and Communication Disor-
ders, 35(2), 165–188.
Liston, C., & Kagan, J. (2002). Memory enhancement in early childhood. Nature, 419, 896.
Lof, G. L. (2009). The nonspeech-oral motor exercise phenomenon in speech pathol-
ogy practice. In C. Bowen, Children’s speech sound disorders (pp. 181–184).
Oxford, UK: Wiley-Blackwell.
Maurer, D. (Ed.) (2005). Special issue: Critical periods re-examined: Evidence from
human sensory development. Developmental Psychobiology, 46(3), 155–292.
McCauley R. J., Strand E., Lof, G. L., Schooling T., & Frymark, T. (2009). Evidence-
based systematic review: Effects of nonspeech oral motor exercises on speech.
McCormack, J., McLeod, S., McAllister, L. & Harrison, L. J. (2010). My speech problem,
your listening problem, and my frustration: The experience of living with child-
hood speech impairment. Language, Speech, and Hearing Services in Schools,
41(4), 379–392.
34 The late eight
McLeod, S. (2002). Part I: The plethora of available data on children's speech devel-
opment ACQuiring Knowledge in Speech, Language and Hearing, 4, 141–147.
McLeod, S. (Ed.). (2007). The international guide to speech acquisition. Clifton Park,
NY: Thomson Delmar Learning.
McLeod, S. (2011). Laying the foundations for multilingual acquisition: An inter-
national overview of speech acquisition. Journal of Linguistics and Language
Teaching, 2, 53–71.
Pascallis, O., de Haan, M., & Nelson, C. (2002). Is face processing species specific
during the first year of life? Science, 296, 1321–1323.
Miller, J. (1988). The psychobiology of Down syndrome. Cambridge, MA: MIT Press.
Miller, J. (1999). Profiles of language development in children with Down syndrome.
Baltimore, MD: Paul Brookes.
Muttiah, N., Georges, K., & Brackenbury, T. (2011). Clinical and research perspec-
tives on nonspeech oral motor treatments and evidence-based practice. American
Journal of Speech Language Pathology, 20(1), 47–59.
National Center for Education Statistics. (2002). Digest for education statistics. U.S.
Department of Education, Institute of Education Sciences.
Overby, M., Carrell, T., & Bernthal, J. (2007). Teachers’ perceptions of students with
speech sound disorders: A quantitative and qualitative analysis. Language, Speech,
and Hearing in Schools, 38(4), 327–341.
Paul, R., & Shriberg, L. (1982). Associations between phonology and syntax in
speech-delayed children. Journal of Speech and Hearing Research, 25, 536–547.
Powell, T. (1991). Planning for phonological generalization: An approach to treat-
ment target selection. American Journal of Speech-Language Pathology, 1, 21–27.
Powell, T. W. (2009). Non-speech oral motor exercises: An ethical challenge. In
C. Bowen, Children’s speech sound disorders (pp. 199–202). Oxford, UK:
Wiley-Blackwell.
Powell, T., Elbert, M., & Dinnsen, D. (1991). Stimulability as a factor in phonologi-
cal generalization of misarticulating preschool children. Journal of Speech and
Hearing Research, 34, 1318–1328.
Ruscello, D. M. (2008). Nonspeech oral motor treatment issues in children with
developmental speech sound disorders. Language, Speech, and Hearing Services
in Schools, 39, 380–391.
Ruscello, D. M., St. Louis, K., & Mason, N. (1991). School-aged children with pho-
nologic disorders: Coexistence with other speech/language disorders. Journal of
Speech and Hearing Research, 34, 236–242.
Schade, J. P., & van Groenigen, W. B. (1961). Structural organization of the human cere-
bral cortex. I. Maturation of the middle frontal gyrus. Acta Anatomica, 47, 72–111.
Shine, R. (1989). Articulatory production training: A sensory-motor approach. In N.
Creaghead, P. Newman, & W. Secord (Eds.), Assessment and remediation of articu-
latory and phonological disorders (pp. 355–359). Columbus, OH: Charles Merrill.
Shriberg, L. D., & Austin, D. (1998). The speech-language connection. Baltimore, MD:
Paul H. Brookes.
Shriberg, L., & Kwiatkowski, J. (1988). A follow-up study of children with phono-
logic disorders of unknown origin. Journal of Speech and Hearing Disorders, 53,
144–155.
Shriberg, L., & Tomblin, B. (1999). Prevalence of speech delay in 6-year-old children
and comorbidity with language impairment. Journal of Speech, Language, and
Simonds, R. J., & Scheibel, A. B. (1989). The postnatal development of the motor
speech area: A preliminary study. Brain and Language, 37, 42–58.
Slater, S. (1992). Portrait of the professions. Asha, 34, 61–65.
Smit, A., Hand, L., Frelinger, J., Bernthal, J., & Byrd, A. (1990). The Iowa articula-
tion norms project and its Nebraska replication. Journal of Speech and Hearing
Disorders, 55, 779–798.
Staines, G. (2008). The relative efficacy of psychotherapy: Reassessing the methods-
based paradigm. Review of General Psychology, 12(4), 330–343.
Stark, R., Bleile, K., Brandt, J., Freeman, J., & Vining, E. (1995). Speech-language out-
comes of hemispherectomy in children and young adults. Brain and Language,
51, 406–421.
Tyler, A., & Haskill, A. (2010). Morphosyntax intervention. In A. Williams, S. McLeod, &
R. McCauley, (Eds.). Interventions for speech sound disorders in children (pp. 355–
380). Baltimore, MA: Brookes.
Van Dyke, D. C., & Holte, L. (2003). Communication disorders in children. Pediatric
Annals, 32(7), 436.
Werker, J., & Tees, R. (2005). Speech perception as a window for understanding
plasticity and commitment in language systems of the brain. Developmental Psy-
chobiology, 46(3), 233–251.
Chapter Two
Using Evidence to
Guide Clinical Practice:
Considerations for
the Late Eight
Lauren K. Nelson
Introduction
Using evidence to guide practice has been a part of academic and clinical
education in speech-language pathology for many years. The need for an
evidence-based approach to decision making became even more prominent
in the mid-2000s (American Speech-Language-Hearing Association [ASHA],
2004, 2005). This greater emphasis occurred in part because of increased
reliance on evidence in the field of medicine (ASHA, 2004). These changes in
the field of medicine have carried over to other health care fields. The greater
emphasis on evidence also occurred because of input from speech-language
pathologists (SLPs) in clinical practice. SLPs in both health care and school
settings experienced increased pressure to document that the services they
provided had supporting evidence.
When you consider the term “evidence,” perhaps the first thing that
comes to mind is research evidence. The use of reliable research evidence
is an important component of evidence-based practice (EBP). However, you
might better think of EBP as a decision-making process that incorporates the
best available research evidence, the SLPs’ own expertise, gained through
37
38 The late eight
both their educational and clinical experiences, and the input from the client
and/or his/her family (ASHA, 2004; Fey, Justice, & Schmitt, 2014). Dollaghan
(2007) used the phrase “external evidence” to refer to research evidence and
noted that the other sources, the SLP, client, and family, provided valuable
evidence as well. The focus of this chapter is on finding, evaluating, and
using external evidence, but we will keep in mind the equal importance of
evidence from clinical practice, the client, and family.
The Phrase “Evidence-Based Practice”

You might have noticed I avoided the phrase “evidence-
based practice” (EBP) in my opening paragraph. That was
deliberate. EBP is a decision-making process that encom-
passes using research evidence, but also using SLPs’ knowl-
edge and experience, as well as the client’s and/or family’s
input. The phrase “evidence-based practice” tends to high-
light the research evidence and obscures the importance
of the SLP, client, and family in making decisions about
clinical services.
Speech-language pathologists generally agree that using research evi-

dence to support their clinical decisions is a reasonable idea. They also
generally agree that finding time to engage in EBP is a significant challenge
(O’Connor & Pettigrew, 2009). Thus, our first consideration in looking at EBP
for the Late Eight consonants is to identify approaches that yield meaningful
results in a time-efficient way. Our second consideration is to accept the fact
that the research base in speech-language pathology has limitations. You
rarely find research evidence that exactly matches the characteristics of your
client or clinical setting. To test this statement, I conducted a search using
the term evidence combined with “late 8” or “late eight” using a few of the
most popular search engines for the field of speech-language pathology. This
search yielded one published article (Shriberg et al., 2005). This implies that
to find research evidence that supports clinical decision making for children
with errors on the Late Eight consonants, we need to dig a little deeper into
the research literature.
EBP Resources
One option for identifying research evidence in an efficient way is to utilize

evidence reviews developed and distributed by another person or group.
One such group is the ASHA’s National Center for Evidence-Based Practice
in Communication Disorders (N-CEP). Groups such as N-CEP search the
research literature in a systematic way, carefully critique the studies they find,
CHAPTER 2: Using Evidence to Guide Clinical Practice 39
and publish the results for others to use in the form of an “Evidence-Based
Systematic Review.” You can find a list of N-CEP’s systematic reviews at
the following website: http://www.asha.org/Research/EBP/EBSRs/. Unfortu-
nately, N-CEP had not published any systematic reviews that address children
with speech sound disorders (SSDs) at the time this chapter was written.
Evidence Maps
A second option from the ASHA website was more helpful. ASHA’s Evidence
Maps included the topic “Speech Sound Disorders” (http://www.asha.org/
Evidence-Maps/). These evidence maps comprised information for all three
components of EBP: research evidence, clinician expertise, and the client
and family perspective. If you go to this website and select the topic “Speech
Sound Disorders” and then select “External Scientific Evidence,” you will find
at least 20 sources, most of which are systematic reviews. Two articles from
this list stood out, a narrative review of research evidence for treatment of
children with SSDs (Baker & McLeod, 2011a) and a systematic review on
the topic of treatment intensity for children with SSDs (Kaipa & Peterson,
2016). We will explore the Baker and McLeod article in greater depth in
a later section of this chapter. If your client with an SSD had a specific
diagnosis, you might consider another topic, such as “Apraxia of Speech
(Childhood),” “Cerebral Palsy,” or “Cleft Lip and Palate” (http://www.asha
.org/Evidence-Maps).
Speech Pathology Database
A second tool for efficiently identifying research evidence in the field of

speech-language pathology is the Speech Pathology Database for Best Inter-
ventions and Treatment Efficacy (speechBITE). The speechBITE database
has a specific focus on intervention studies in speech-language pathology.
Speech-language pathologists at the University of Sydney started this data-
base and their effort has ongoing support from many organizations (http://
speechbite.com). A unique feature of speechBITE is that all the research
articles, except systematic reviews, undergo a rigorous review before they
appear in the database. A review of a research article includes such information
as the description of participant eligibility, assignment of participants to groups
(random or nonrandom), participant follow-up, the quality of the data analysis
and report, and whether or not participants, therapists, or those administering
pretests and posttests were aware of group membership (i.e., blinding).
Another feature of speechBITE is that articles with the best available
evidence appear first on the list. One of the primary factors in critiquing
research articles is the level of evidence of the study. For treatment studies,
levels of evidence from highest to lowest are: (1) systematic reviews and meta-
analyses, (2) randomized control trials, quasi-experimental group studies, and
40 The late eight
quasi-experimental single subject experimental designs, (3) nonexperimental

designs including nonexperimental case studies, and (4) expert opinion. If
you are already familiar with the differences among these kinds of studies,
you can skip the next paragraph.
A systematic review is a special type of literature review based on a
carefully defined search and critique of research articles. Authors of sys-
tematic reviews conduct a thorough search of the literature and filter and
critique the articles, using a predefined set of criteria. A meta-analysis is
similar to a systematic review but also employs statistical tools to analyze
the data from the studies in a collective way. A randomized control trial is
a group study with comparisons of treatment and no-treatment groups, or
with comparisons of two different treatments. As the name implies, another
feature of randomized control trials is that participants are assigned to their
groups in a random manner. Quasi-experimental design studies involve
comparisons of treatment and no-treatment conditions or comparisons of
alternative treatments. In a quasi-experimental group design, the researchers
study different treatment conditions using preexisting groups. An example
of this would be comparing two different classrooms, one that receives an
experimental treatment and one that receives a control treatment. In single
subject experimental designs, the person receiving treatment participates
in both the treatment and control or baseline conditions. Sometimes single
subject experimental designs have replications across several participants,
so the term does not literally mean a study has just one participant. In
nonexperimental studies, researchers carefully observe and gather data in
naturally occurring circumstances. One example of a nonexperimental study
is a case study during which the researchers observe and gather data from a
What Articles Should I Read First?

As students, many of us wrote lengthy papers on topics
related to speech-language pathology. Often our goal was
a thorough and somewhat lengthy review of the literature.
Practicing speech-language pathologists seldom have time
to read and synthesize all of the research literature on a
topic. SLPs need a strategy for prioritizing their reading.
Once you identify relevant articles, you might use the “level
of evidence” for the articles to prioritize your reading. Using
this strategy, your highest priority would be systematic
reviews and meta-analyses. For treatment research, your
second priority would be a randomized control study. If you
cannot find any articles at this level, research from lower
levels of evidence — such as single subject experimental
studies or treatment comparisons without random assign-
ment to groups — is still useful.
single person. The lowest level of evidence occurs when empirical evidence
on a topic is lacking and individuals with strong credentials related to the
topic generate guidelines based on their collective expertise.
SpeechBITE Search Strategies
When you search for research evidence using speechBITE, I suggest you try
the easy to use advanced search option. Using this advanced search option,
you can specify the area of practice (e.g., speech, language, swallowing);
the type of intervention (e.g., speech/articulation/phonological therapy, lan-
guage therapy, fluency/stuttering therapy), population (e.g., autism spectrum
disorder, speech sound disorder [developmental], traumatic brain injury),
age group, and service delivery method (e.g., individual, group, parent).
You also have the option of skipping some of the options. For an initial
search on our topic of SSDs and the Late Eight consonants, you could try
speech/articulation/phonological therapy and speech sound disorder (devel-
opmental) and children. This search turned up 105 articles and that would
be an overwhelming number to read through. Seven of those articles were
systematic reviews, so a good starting place would be to focus just on those
seven articles. This search yielded the same 2 articles we identified from
the ASHA evidence maps search: Baker and McLeod (2011a) and Kaipa and
Peterson (2016).
Among the randomized control trials, two somewhat recent studies
stood out, a treatment study in which intelligibility was an outcome measure
(Lousada, Jesus, Hall, & Joffe, 2014) and a study of the effectiveness of treat-
ment delivered in a typical clinical setting (Broomfield & Dodd, 2011). These
latter two studies were of interest because they were relatively recent and
were not included in the Baker and McLeod narrative review.
Learn by Doing
If you have waited to try some of the searches covered in
the previous section, now would be a good time to stop
reading, get out your favorite device for browsing the Inter-
net, and try a search. First, type “http://speechbite.com” to
get to the speechBITE website. Then, just under the search
box, select the advanced search option. You should see a
series of drop-down boxes. Let’s try the following options:
(1) for Type of Intervention select Speech/Articulation/
Phonological Therapy; (2) for Within This Population, select
Hearing and Visual Impairment; and (3) for Age Group.
select Children. This search yielded 17 articles, 2 of which
were systematic reviews.
42 The late eight
From our initial search, we identified two promising articles at the

highest level of evidence, a broad, carefully constructed narrative review by
Baker and McLeod (2011a) and a more focused systematic review on the
topic of treatment efficacy by Kaipa and Peterson (2016). Baker and McLeod
identified 134 intervention studies from 1979 to 2009. These studies covered
the full range of evidence from systematic reviews/meta-analyses, to random-
ized control trials, to quasi-experimental studies, to nonexperimental studies
including case studies. These authors found that the majority of studies were
at lower levels of evidence; 56 were single subject experimental designs
(level IIb) and 43 were nonexperimental case studies. Baker and McLeod did
find studies at the highest levels of evidence, including 2 systematic reviews
as well as randomized control trials (19 studies) and quasi-experimental
control trials without random assignment (13 studies).
As Baker and McLeod (2011a) noted, the body of evidence largely sup-
ported the effectiveness of treatment for children with speech sound disor-
ders. The authors also noted some limitations in the available evidence. The
vast majority of studies were conducted in university or other research set-
tings and only a few studies took place in a typical clinical environment such
as a school or a treatment center. Researchers in our field have investigated
many different treatment approaches, meaning that the research evidence in
support of any one approach often is limited. Only a few approaches had
supporting evidence from multiple researchers working in different research
settings (Baker & McLeod, 2011a). Baker and McLeod concluded that the
field of speech-language pathology needs “to encourage greater collabora-
tion and the publication of replication intervention research by investigators
other than and/or in addition to the proponents of a particular approach”
(p. 116).
Clinical vs. Research Settings

Baker and McLeod (2011a) reported that the typical
treatment schedule across the 134 research studies they
reviewed consisted of 30- to 60-minute sessions, occurring
two to three times per week. In regular school settings or
other treatment centers the typical treatment schedule may
be less than this. One of the challenges in using research
evidence to support clinical decision making is that the
parameters for treatment in research studies are not always
a good match for clinical settings.
Kaipa and Peterson (2016) conducted a focused systematic review to

identify evidence about treatment intensity. The authors identified seven
studies that compared different treatment intensities. Only one of these

studies focused on treatment of SSDs. The other studies included participants
with dysarthria (n = 2), acquired apraxia of speech (n = 1), and childhood
apraxia of speech (n = 3). Overall Kaipa and Peterson determined that four
of the seven studies showed that treatment outcomes improved with greater
treatment intensity. The research of most interest for treatment of SSDs was
a study by Allen (2013). Allen identified children with SSDs and randomly
assigned them to a 1× per week treatment group, a 3× per week treatment
group, and a control group. This study showed that children who received
more treatment performed significantly better at 8- and 24-week posttests,
and both the 1× and 3× per week treatment groups made gains over a 6-week
follow-up period after treatment was discontinued.
Our search of ASHA’s evidence maps website and speechBITE yielded
two additional articles of interest. Broomfield and Dodd (2011) investigated
the effectiveness of speech and language treatment in a typical clinical
setting that served preschool and school-age children. These researchers
conducted a randomized treatment and control group study to determine
the effectiveness of the speech and language services that children usually
receive. Broomfield and Dodd included 730 total participants in their study.
Of these children, 220 were preschool children with speech disorders and
100 were school-age children with speech disorders. The other participants
had receptive and expressive language disorders. Broomfield and Dodd ran-
domly assigned their participants to one of three groups: (1) one group that
received intervention in the first 6 months of the study and no intervention
in the next 6 months; (2) a second group that received no intervention in
the first 6 months but did receive intervention in the next 6 months; and
(3) a third group that received intervention for all 12 months. All of the
participants completed a pretest and a posttest at the midpoint of the study.
Broomfield and Dodd compared the performance of the two groups that
received treatment during the first 6 months to that of the group that did
not receive treatment until the second half of the study, i.e., a no-treatment
control. The children in the treatment groups received the amount and type
of therapy that SLPs in the agency usually recommended. These research-
ers found significant differences between the treatment and control group
for children with receptive and expressive language disorders, as well as
children with speech disorders (Broomfield & Dodd, 2011).
The study by Lousada et al. (2014) was interesting because the research-
ers used an outcome measure, speech intelligibility, that has functional
significance for children. Further investigation of this article indicated that
the study would not provide relevant evidence for children whose primary
language was English. The study was conducted in Portugal and the children
who participated in the study spoke Portuguese. The consonant system in
Portuguese includes only four of the Late Eight: /s, z, l, ʃ/ (International
Phonetic Association, 1999), making this study less useful for our purposes.
44 The late eight
EBP for the Late Eight
Thus far our search for research evidence to support clinical decision making
for children with SSDs has yielded research that reflects the highest levels
of evidence, including systematic reviews and randomized treatment and
control group studies. This body of evidence showed that treatment for
SSDs was efficacious under the controlled conditions of research studies,
and in some cases, under the conditions present in typical clinical settings
(Broomfield & Dodd, 2013; McCleod & Baker, 2011a). What is less clear is
the extent to which the existing research studies included children with
speech errors on the Late Eight consonants. One approach to address
this issue would be to filter the studies we discovered through our previ-
ous searches according to the age of the participants. The rationale for
filtering by age is that research with older children, ages 5 and above, is
more likely to include participants with errors on the Late Eight Admittedly,
this is a somewhat arbitrary assumption, but information about age is
often available in the article abstracts or in the summaries from the sys-
tematic reviews. Our search for the best available evidence yielded system-
atic reviews as well as a variety of research studies that included children
ages 5 and above. The best research evidence for our purposes would
be studies that included the Late Eight consonants among the participants’
treatment targets. For the most part, the only way to identify this detail
about a study is to read the full research report. The evidence we discovered
is listed in Table 2–1. The table includes information, when available, about
the extent to which the study addressed treatment for errors on the Late
Eight.
One thing apparent in Table 2–1 was that research articles covering
treatment of SSDs do not always include information about the specific
speech sounds targeted in treatment. Nevertheless, the research evidence
provided some guidance regarding treatment of the Late Eight consonants.
If children have errors on multiple consonants, clinicians should consider
multiple oppositions treatment (Williams, 2000). This approach was effective
and comparatively efficient for children in more than one study (Allen, 2013;
Williams, 2000, 2005). Including either phonological awareness activities or
well-designed speech sound discrimination training in treatment appeared
to enhance treatment outcomes (Denne, Langdown, Pring, & Roy, 2005;
Rvachew, Nowak, & Cloutier, 2004). For children with both morphosyntactic
and phonological errors, either alternating treatment between morphosyn-
tactic and phoneme targets or targeting morphosyntactic errors first led to
greater overall improvement (Tyler, Lewis, Haskill, & Tolbert, 2002, 2003).
As noted in other reviews (Baker & McLeod, 2011b; Sugden, Baker, Munro,
& Williams, 2016), the considerable variability among studies and the many
different approaches to delivering treatment and selecting target sounds
made it difficult to draw definitive conclusions about the best approaches
to treatment.
Table 2–1. Identified Sources of Evidence from 2000 to 2016 that Included Children Ages 5 and Above with Speech Sound
Disorders and/or Specified Target Sounds Among the Late Eight
Research
Design/Level Treatment Participants
Source of Evidence Approach (# and age) Target Sounds Outcomes
Baker & Narrative Multiple studies Ages 1;6 to 10;5 NA Children with SSDs
McLeod review/Ia across 134 studies benefited from treatment
(2011a)
Kaipa & Systematic Multiple studies Ages 2;6 to 8;2 NA Higher treatment intensity
Peterson review/Ia across 7 studies led to better outcomes
(2016)
Law, Garrett, Meta- Multiple studies Mean age 2;10 to NA Intervention effect was
& Nye (2004) analysis/ 6;10 across 6 studies significant for children with
45
Ia expressive phonological
disorders
McCauley Systematic Multiple studies Ages 1;3 to 16;11 NA No clear-cut evidence
et al. (2009) review/Ia across 5 studies supporting the use of
nonspeech oral motor
exercises to improve
speech production
Sugden et al. Systematic Multiple studies Ages 1;6 to 9;6 NA Evidence suggests that
(2016) review/Ia across 61 studies parents can be effective
intervention agents, but
the evidence covers many
different approaches and
the description of these
approaches lacks detail
continues
Table 2–1. continued
Research
Allen (2013) Randomized 55 children ages Multiple oppositions; Phoneme Children improved more
control trial/Ib 3;0 to 5;5 treatment frequency collapse (e.g., /g, when receiving treatment
1× or 3× per week, dZ, z, ð, dr, gr/) 3× per week compared with
and control 1× and when cumulative
intervention was the same
Broomfield & Randomized 730 children ages Usual speech and NA Children with language
Dodd (2011) control trial/Ib 0–16; including language services and speech disorders who
100 with speech averaging 5½ hours received treatment made
disorders ages in the 6 months significantly greater gains
5–11+ following the initial than no treatment control
46
assessment group
Denne et al. Randomized 20 children ages Phonological NA Children receiving treatment
(2005) control trial/Ib 5 to 7 randomly awareness scored significantly
assigned to treatment (TX) higher on phonological
treatment or in typical clinical awareness after treatment,
control group setting (i.e., 12 hours but not on literacy or
total) speech production tests
Rvachew Randomized 48 children in two Seven step TX from Later acquired/ Children treated on earlier
& Nowak control trial/Ib different groups imitated syllable least known (e.g., acquired sounds made
(2001) with mean ages to spontaneous /r, l, θ, S/ and significantly greater gains,
of 51.5 and 49.6 sentences earlier acquired but children treated on
months and most known later acquired sounds
(e.g., /t, k, l, v/ did make gains; authors
reported no differences in
generalization
Research
Rvachew Randomized 34 children in two Control group One outcome Experimental groups,
et al. (2004) control trial/Ib different groups received TX measure was receiving speech
with mean ages determined by percent correct perception training, made
of 52.9 and 50.3 the clinician (e.g., for “difficult” significantly greater gains
months cycles, tradition); consonants: /ŋ, k, in perception of speech
experimental g, v, S, tS, dZ, ð, θ, sounds and in accuracy of
group received s, z, l, r/ speech sound production
similar TX plus 15 compared with the control
added minutes of group; no differences were
computerized speech found for phonological
perception treatment awareness
47
Tyler et al. Randomized 27 children ages Compared Individually Phonological treatment
(2002) control trial/Ib 3;0 to 5;11 2 TX orders: reported for led to significantly greater
morphosyntax then each child improvement in phonology
phonological vs. and included compared with no
phonological, then consonant treatment; morphosyntax
morphosyntax clusters and treatment led to significantly
sounds such as greater improvement in
/k, g, f, s, S, tS, l/ morphosyntax than no
treatment; additionally,
cross-domain improvement
occurred from
morphosyntax treatment,
leading to improvement in
phonology as well, but not
for phonology treatment
continues
Research
Tyler et al. Randomized 47 children ages Four goal attack Three target For morphosyntax, both the
(2003) control trial/Ib 3;0 to 5;11 with 7 strategies sounds for each morphosyntax first TX and
children serving compared: blocks participant, such the alternating TX led to
as no-treatment of morphosyntax as /f, s, tS/; /l, S, k/; significantly greater gains
controls and the followed by /k, f, tS/; and compared with the control
other 40 randomly phonological /s, S, l/ group; for phonology,
divided among TX, blocks of morphosyntax TX first,
48
four different TX phonological phonological TX first, and
groups followed by alternating TX all led to
morphosyntax significantly greater gains
TX, alternating compared with the control
morphosyntax group
and phonological
TX, alternating
morph-syntax and
phonological TX,
and simultaneous
morphosyntax and
phonological TX
Research
Gillon (2000) Nonrandom- 91 children ages 23 children received Not specifically Post-treatment assessment
ized groups/ 5;6 to 7;6 with phonological targeted but revealed the children receiv-
IIa spoken language awareness (PA) TX, report pre- ing PA treatment scored
impairment 23 children received treatment and significantly higher on PA
typical speech and post-treatment tests and on several read-
language TX, 15 percent ing measures compared
children received consonants with the traditional TX and
minimal TX, and correct scores minimal TX groups; children
30 children were and use of in the PA group also made
typically developing phonological significantly greater gains
as a comparison processes in consonants correct, but
the authors stated they
49
needed a larger sample for
a meaningful effect size for
this difference
Crosbie et al. Nonrandom- 18 children ages 8 week block of NA For inconsistency,
(2005) ized groups/ 4;8 to 6;5 with contrast TX (minimal children with inconsistent
IIa with either consistent pairs) and 8 week speech sound disorders
baseline/ (n = 8 ) or block of core made significantly
treatment inconsistent vocabulary TX more improvement in
and group (n = 10) speech core vocabulary TX; for
comparisons sound disorders percent consonants
correct, contrast TX led to
significantly greater gains
and gains were greatest
for children with consistent
speech sound disorders
continues
Research
Forrest & Single subject Four male children Treatment focusing Targeted one Participants mastered the
Elbert (2001) experimental/ ages 4;11 to 5;3 on one fricative at fricative per child target sound in word final
IIb with inconsistent the word level, first /S, θ, s/ that was position and generalized
speech sound with modeled and missing from the to untreated words with the
production errors then unmodeled child’s phonetic sound in word final position;
and multiple productions of inventory only one child met the
consonants words with the criterion for generalization
missing from target sounds in final to other word positions
their phonetic position (68%+)
50
inventories
Gierut & Single subject 7 children ages Treatment of 3-element During TX the children
Champion experimental/ 3;4 to 6;3 who 3-element s-clusters, clusters /skw, skr, improved their accuracy
(2001) IIb scored below the in made up spl, spr/ in producing nonsense
6th percentile on (nonsense) words words with 3-element
an articulation clusters; post-treatment
test, who otherwise assessment showed little
had normal generalization to real words
hearing and with 3-element clusters;
nonspeech oral the authors identified
motor skills, and generalization to single
age-appropriate consonants (e.g., /g, f, θ, ð,
language skills s, z, S, l, r, tS, dZ/) and some
2-element clusters
Research
Miccio & Single subject Female child age Treatment in /v, z/ in word Child’s production of /v/
Ingrisano experimental/ 5;3 with history of two phases with initial position and /z/ improved with
(2000) IIb otitis media; pure the initial phase treatment and the authors
tone thresholds focusing on noted generalization
were 20 to 30 dB in acquisition and in different degrees to
the right and left imitation of the untreated sounds /f, θ, ð, tS,
ears; receiving target and the dZ/ after starting treatment
special education second phase on /v/ and additional
services for addi- on production of generalization to /s, S/ after
tional developmen- minimal pair words starting treatment on /z/
tal delays included with the target and
51
problems with fine error phonemes
motor skills
Morrisette & Single subject 8 children ages Four different TX One target sound Children in all four
Gierut (2002) experimental/ 3;10 to 5:4 with based on lexical for each child conditions acquired
IIb phonological properties of from the following their target sounds in
delays; scored target words: high set: /f, s, l, r/ treated words; treating
at or below 5th frequency words, high frequency words led
percentile on an low frequency to more generalization
articulation test words, words to untreated words and
from high density sounds than the other
“neighborhoods” conditions
and words from
low density
“neighborhoods”
continues
Research
Williams Single subject Female child age Multiple oppositions Multiple Three multiple oppositions
(2005) experimental/ 6;5 with moderate TX follow by minimal oppositions targets /f, θ, gl/ were
IIb phonological contrast TX targets were word acquired in spontaneous
impairment initial /f, θ, gl, words and generalized to
fr/; minimal pair conversational speech; one
targets were word minimal pair target /r/ was
initial /r, S/ and acquired in spontaneous
word final /θ/ words and conversational
speech
52
Jacoby et al. Retrospective, 234 children, ages Usual TX NA Found a statistically
(2002) nonrandom- 3 to 6, who had approaches; significant relationship
ized groups/III received speech all participants between amount of TX and
and language received functional improvement in functional
treatment from a communication communication rating for
university clinic ratings on children with articulation
National Outcome disorders (intelligibility),
Measurement and expressive language
System disorders; older children
(ages 5 & 6) needed more
TX to make functional
improvements than
younger children (ages 3
& 4)
Research
Pascoe et al. Nonexperi- Female child age Speech only and Multiple final TX yielded improvements
(2005) mental case 6;5 with severe speech-spelling TX consonants in CVC words productions,
study/III speech sound with CVC words as in CVC words spelling, and connected
disorder the targets and eventually speech; improvements
connected maintained at a 7-month
speech follow-up
Williams Nonexperi- 10 children ages Multiple oppositions, Targets varied Reported amount of time
(2000) mental case 4;0 to 6;5 with minimal pair, and from 4 to 16 in TX; maximum amount
53
study/III multiple speech naturalistic speech depending was 5 semesters and
sound production intelligibility TX; all on the child 105 sessions; average
errors children started with and included was 3.4 semesters and
multiple oppositions different places 60.3 sessions; 2 of the 10
approach of production children only required
and manners of multiple oppositions TX;
production remaining children required
addition TX – minimal pairs
and/or naturalistic TX
Note. This table only includes research evidence for children with speech sound disorders not related to specific diagnoses such as child-
hood apraxia of speech, cleft of the lip and palate, or dysarthria. Some high-level sources were omitted for this reason, such as the systematic
review on treatment for childhood apraxia of speech by Murray, McCabe, and Ballard (2014). Additionally, the table only includes studies in
which the participants spoke English.
54 The late eight
Conducting EBP Searches
Perhaps the most efficient way to approach an evidence search is to identify

sources of information that already have been filtered and critiqued, such
as the evidence available from ASHA’s evidence maps, speechBITE, or pub-
lished systematic reviews (Baker & McLeod, 2011a; Kaipa & Peterson, 2016;
McCauley, Strand, Lof, Schooling, & Frymark, 2009; Sugden et al., 2016). Still,
completing your own search for literature and review articles will be neces-
sary at times. Fortunately, free tools are available to help you conduct these
searches efficiently: Google Scholar (https://scholar.google.com/), Educa-
tion Resources Information Center (ERIC; https://eric.ed.gov/), and PubMed
(https://www.ncbi.nlm.nih.gov/pubmed/). One reason to conduct your own
search is to update literature searches from other authors. Through our
evidence search we found the narrative review by Baker and McLeod (2011a).
The publication date of this article was 2011, so it would be important to
find any additional relevant studies published after 2011. Google Scholar has
a tool for conducting such a search in a time-efficient way. At the Google
Scholar website, hold down the small arrow to the right of the search box to
bring up the advanced search options. Type the title of the Baker and McLeod
article in the box following the phrase “with the exact phrase.” This search
will retrieve the Baker and McLeod article. At the bottom of the entry you will
see the phrase “Cited by,” which lets you quickly identify more recent articles
that include Baker and McLeod in their reference lists. Selecting the “Cited
by” link will bring up a list of articles (71 when this chapter was written).
Identifying Current Findings

The narrative review article by Baker and McLeod (2011a)
illustrated one issue with research evidence that may be
unavoidable: the lag between the time authors complete
their work and the time of publication of an article. Baker
and McLeod reported searching for articles through 2009,
but the publication date of their article is 2011. Journal
editors and reviewers need this time to complete a careful
review of submitted articles. Even when authors approach
their review in a very thorough and systematic way, clini-
cians should consider updating the literature search due to
this publication lag.
Another reason you might want to conduct your own literature search
is that your client has unique characteristics, suggesting that a client-specific
evidence search would be helpful (Gallagher, 2002). Let’s consider the possi-
bility of a 6-year-old child with Down syndrome, an SSD, and reduced speech
intelligibility. What, if any, treatment modifications should you consider for

this child? You could use a search engine such as ERIC or PubMed to look
into this question. For this particular search, you might go to the PubMed
website. My personal preference is to use the advanced search option: https://
www.ncbi.nlm.nih.gov/pubmed/advanced. Here are some suggested strate-
gies to try: (1) in the advanced search option, change “All Fields” to “Title/
Abstract” and type Down syndrome in the first row; (2) again change “All
Fields” to “Title/Abstract” and type articulation or phonological OR speech
in the second row; and (3) add a third row, change “All Fields” to “Title/
Abstract” and type treatment OR intervention OR therapy in this row. Note a
couple of features of this search. First, we used synonyms for our terms. One
challenge for evidence searches in speech-language pathology is that authors
use different terms to refer to similar concepts, e.g., articulation disorder or
phonological disorder; treatment, intervention, or therapy. Another feature
is that we limited the search to the title/abstract. This is a way to limit the
articles you review to the ones that have substantial content on your topic.
This search yielded 66 articles and some of them looked promising. An article
by Yoder, Camarata, and Woynaroski (2016) included children with Down
syndrome ages 5 to 12. These researchers compared two different treatment
approaches, a recast approach and a contrast approach, to determine which
led to greater gains in “speech comprehensibility.”
Websites such as speechBITE and ASHA’s evidence maps focus on pro-
viding straightforward access to evidence about treatment of communication
disorders, including SSDs. If you have evidence questions about other areas
of clinical practice, such as assessment or evaluation, conducting your own
evidence search may be necessary. You might have a question similar to the
following: “What are the best tests for assessing speech sound disorders in
children?” To investigate this question, you might use the ERIC website at
https://eric.ed.gov/. To find the most relevant articles you might limit your
search to just article titles. Try typing the following in the search box: title:test
AND title:(articulation OR speech sound OR phonology). This search yielded
139 articles and 19 published in the last 10 years. Two of these were directly
related to tests of children’s speech sound production (Eisenberg & Hitch-
cock, 2010; Flipsen & Ogiela, 2015). If your interests were in approaches
to assessingt comprehensibility or intelligibility or uses of conversational
speech samples, you would find some of those articles with this search.
You also could modify the search by adding different terms to better reflect
your interests.
Summary
In this chapter we covered three strategies to identify research evidence

to support clinical decision making. A less time-consuming starting point
is to use databases that were developed specifically for our field, such as
56 The late eight
ASHA’s evidence maps or speechBITE. If your focus is more specific, such as

looking for research related to treating the Late Eight consonants, you could
further screen research articles to identify those that included the Late Eight
consonants as treatment targets (i.e., Table 2–1). Finally, you might need to
conduct your own search and review of articles for areas of practice other
than treatment or if your client has unique characteristics that make treat-
ment decisions more difficult. Fortunately, SLPs have access to free search
engines that allow them to efficiently conduct such searches.
References
Allen, M. M. (2013). Intervention efficacy and intensity for children with speech
sound disorder. Journal of Speech, Language, and Hearing Research, 56, 865–877.
doi:10.1044/1092-4388(2012/11-0076)
American Speech-Language-Hearing Association. (1997–2016). Evidence maps.
Retrieved from http://www.asha.org/Evidence-Maps/
American Speech-Language-Hearing Association. (2004). Evidence-based practice
in communication disorders: An introduction [Technical report]. Retrieved from
http://www.asha.org/policy
American Speech-Language Hearing Association. (2005). Evidence-based practice in
communication disorders [Position statement]. Retrieved http://www.asha.org/policy
Baker, E., & McLeod, S. (2011a). Evidence-based practice for children with speech
sound disorders: Part 1 narrative review. Language, Speech, and Hearing Services
in Schools, 42, 102–139. doi:10.1044/0161-1461(2010/09-0075)
Baker, E., & McLeod, S. (2011b). Evidence-based practice for children with speech
sound disorders: Part 2 application to clinical practice. Language, Speech, and
Hearing Services in Schools, 42, 140–151. doi:10.1044/0161-1461(2010/10-0023)
Broomfield, J., & Dodd, B. (2011). Is speech and language therapy effective for
children with primary speech and language impairment? Report of a randomized
control trial. International Journal of Language and Communication Disorders,
46, 628–640. doi:10.1111/j.1460-6984.2011.00039.x
Crosbie, S., Holm, A., & Dodd, B. (2005). Intervention for children with severe speech
disorder: A comparison of two approaches. International Journal of Language
and Communication Disorders, 40(4), 467–491. Retrieved from http://www.tandf
online.com/toc/ilcd20/current
Denne, M., Langdown, N., Pring, T., & Roy, P. (2005). Treating children with expressive
phonological disorders: Does phonological awareness therapy work in the clinic?
International Journal of Language and Communication Disorders, 40(4), 493–504.
Dollaghan, C. A. (2007). The handbook for evidence-based practice in communica-
tion disorders. Baltimore, MD: Paul H. Brookes.
Eisenberg, S. L., & Hitchcock, E. R. (2010). Using standardized tests to inventory
consonant and vowel production: A comparison of 11 tests of articulation and
phonology. Language, Speech, and Hearing Services in Schools, 41, 488–503.
doi:10.1044/0161-1461(2009/08-0125)
Fey, M. E., Justice, L. M., & Schmitt, M. B. (2014). Evidence-based decision making in
communication intervention. In R. Paul (Ed.), Introduction to clinical methods in
communication disorders (3rd ed., pp. 55–79). Baltimore, MD: Paul H. Brookes.
Flipsen, P., Jr., & Ogiela, D. A. (2015). Psychometric characteristics of single-word

tests of children’s speech sound production. Language, Speech, and Hearing
Services in Schools, 46, 166–178. doi:10.1044/2015_LSHSS-14-0055
Forrest, K., & Elbert, M. (2001). Treatment for phonologically disordered children
with variable substitution patterns. Clinical Linguistics and Phonetics, 15(1),
41–45.
Gallagher, T. M. (2002). Evidence-based practice: Applications to speech-language
pathology. Perspectives on Language Learning and Education, 9(1), 2–5.
Gierut, J. A., & Champion, A. H. (2001). Syllable onsets II: Three-element clusters
in phonological treatment. Journal of Speech, Language, and Hearing Research,
44, 886–904.
Gillon, G. (2000). The efficacy of phonological awareness intervention for children
with spoken language impairments. Language, Speech, and Hearing Services in
Schools, 31, 26–41.
International Phonetic Association. (1999). Handbook of the International Phonetic
Association. Cambridge, UK: Cambridge University Press.
Jacoby, G. P., Lee, L., Kummer, A. W., Levin, L., & Creaghead, N. A. (2002). The number
of individual treatment units necessary to facilitate functional communication
improvements in the speech and language of young children. American Journal
of Speech-Language Pathology, 11, 370–380. doi:10.1044/1058-0360(2002/041)
Johnson, C. J. (2006). Getting started in evidence-based practice for childhood
speech-language disorders. American Journal of Speech-Language Pathology, 15,
20–35.
Kaderavek, J. N., & Justice, L. M. (2010). Fidelity: An essential component of evidence-
based practice in speech-language pathology. American Journal of Speech-Language
Pathology, 19, 369–379. doi:10.1044/1058-0360(2010/09-0097)
Kaipa, R., & Peterson, A. M. (2016). A systematic review of treatment intensity in
speech disorders. International Journal of Speech-Language Pathology, 18(6),
507–520. doi:10.3109/17549507.2015.1126640
Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (1998). Screening for primary
speech and language delay: A systematic review of the literature. International
Journal of Language and Communication Disorders, 33(Suppl.), 1–23.
Law, J., Garrett, Z., & Nye, C. (2004). The efficacy of treatment or children with devel-
opmental speech and language delay/disorder: A meta-analysis. Journal of Speech,
Language, and Hearing Research, 47, 924–943. doi:10.1044/1092-4388(2004/069)
Lousada, M., Jesus, L. M. T., Hall, A., & Joffe, V. (2014). Intelligibility as a clinical
outcome measure following intervention with children with phonologically based
speech–sound disorders. International Journal of Language and Communication
Disorders, 49, 584–601. doi:10.1111/1460-6984.12095
McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Evidence-
based systematic review: Effects of nonspeech oral motor exercises on speech.
McCauley, R. J., Weston, A., Rvachew, S., Williams, L., & Weiss, A. (2004). Evidence-
based practice and speech sound disorders: The why? And the how? Paper presented
at the annual convention of the American Speech-Language Hearing Association,
Philadelphia, PA.
Miccio, A. W., & Ingrisano, D. R. (2000). The acquisition of fricatives and affricates:
Evidence from a disordered phonological system. American Journal of Speech-
Language Pathology, 9, 214–229. doi:10.1044/1058-0360.0903.214
58 The late eight
Morrisette, M. L., & Gierut, J. (2002). Lexical organization and phonological change
in treatment. Journal of Speech, Language, and Hearing Research, 45, 143–159.
Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment
outcomes for children with childhood apraxia of speech. American Journal of
Speech-Language Pathology, 23, 486-504. doi:10.1044/2014_AJSLP-13-0035
O’Connor, S., & Pettigrew, C. M. (2009). The barriers perceived to prevent the suc-
cessful implementation of evidence-based practice by speech and language
therapists. International Journal of Language and Communication Disorders,
44, 1018–1035. doi:10.3109/13682820802585967
Pascoe, M., Stackhouse, J., & Wells, B. (2005). Phonological therapy within a psy-
cholinguistic framework: Promoting change in a child with persisting speech
difficulties. International Journal of Language and Communication Disorders,
40(2), 189–220.
Rvachew, S., & Nowak, M. (2001). The effect of target-selection strategy of phonological
learning. Journal of Speech, Language, and Hearing Research, 44, 610–623.
Rvachew, S., Nowak, M., & Cloutier, G. A. (2004). Effect of phonemic perception
training on the speech production and phonological awareness skills of children
with expressive phonological delay. American Journal of Speech-Language Pathol-
ogy, 13, 250–263.
Shriberg, L. D., Lewis, B. A., Tomblin, J. B., McSweeny, J. L., Karlsson, H. B., & Scheer,
A. R. (2005). Toward diagnostic and phenotype markers for genetically transmitted
speech delay. Journal of Speech, Language, and Hearing Research, 48, 834–852.
doi:10.1044/1092-4388(2005/058)
Speech Pathology Database for Best Interventions and Treatment Efficacy. (n.d.).
About. Retrieved from http://speechbite.com/about/
Speech Pathology Database for Best Interventions and Treatment Efficacy (n.d.). Group
comparison studies. Retrieved from http://speechbite.com/rating-research-quality/
group-comparison/
Sugden, E., Baker, E., Munro, N., & Williams, A. L. (2016). Involvement of parents
in intervention for childhood speech sound disorders: A review of the evidence.
International Journal of Language & Communication Disorders, 51(6), 597–625.
doi:10.1111/1460-6984.12247
Tyler, A. A., Lewis, K. E., Haskill, A., & Tolbert, L. C. (2002). Efficacy and cross-domain
effects of a morpho-syntax and a phonology intervention. Language, Speech, and
Hearing Services in Schools, 33, 52–66.
Tyler, A. A., Lewis, K. E., Haskill, A., & Tolbert, L. C. (2003). Outcomes of different
speech and language goal attack strategies. Journal of Speech, Language, and
Williams, A. L. (2000). Multiple oppositions: Case studies of variables in phonological
intervention. American Journal of Speech-Language Pathology, 9, 289–299.
Williams, A. L. (2005). Assessment, target selection, and intervention: Dynamic interac-
tions within a systemic perspective. Topics in Language Disorders, 25(3), 231–242.
Yoder, P. J., Camarata, S., & Woynaroski, T. (2016). Treating speech comprehensibility
in students with Down syndrome. Journal of Speech, Language, and Hearing
Research, 59, 446–459. doi:10.1044/2015_JSLHR-S-15-0148
Chapter Three
The Late Eight en español

Lindsey R. Leacox
Introduction
In the United States, 13.0% of the population 5 years and older (38.4 million
residents) speak Spanish in the home (U.S. Census Bureau, 2013). In contrast,
approximately 94% of speech-language pathologists (SLPs) are monolingual
English speakers. Of the 6% who are bilingual SLPs, the largest group (approxi-
mately 65%) self-identify as bilingual in Spanish and English (ASHA, 2016).
Although more bilingual SLP programs are emerging (Crowley et al., 2014), for
the present and into the near future, Spanish-speaking students are more likely
to receive speech treatment from monolingual English-speaking clinicians.
The International Expert Panel on Multilingual Children’s Speech has
emphasized the need for monolingual and bilingual SLPs around the world
to address the speech needs of multilingual children (International Expert
Panel on Multilingual Children’s Speech, 2012). Essential areas include dis-
tinguishing a speech difference from a disorder and overcoming linguistic
and cultural barriers that may limit overall school-to-home communication
(Kohnert, Yim, Nett, Kan, & Duran, 2005; Williams & McLeod, 2012).
This chapter focuses on treatment of late acquired sounds in bilingual
Spanish-English children. The intended audience includes monolingual Eng-
lish-speaking SLPs, English-speaking SLPs with some “preschool” Spanish,
and bilingual SLPs. The chapter proceeds in the following steps:
n Differences and similarities in the phonologies of English and Spanish

n Late-developing sounds in Spanish
n Treatment strategies for late sounds en español
59
60 The late eight
When I began as a bilingual SLP and recent PhD graduate,

I was astonished to find only five articles on bilingual speech
sound disorder (SSD) treatment. The studies described
treatment only in English, and not all the studies focused
on Spanish-English children! At the time of this writing, we
now have six published treatment articles for multilingual
children, but this number remains scarce compared with
the 130 studies for monolingual English-speaking children
(Baker & McLeod, 2011).
Differences and Similarities in the

Phonologies of English and Spanish
Clinicians working with Spanish-English bilingual children with SSDs need

knowledge of the phonology of English and Spanish to appropriately assess
and provide treatment (Yavas & Goldstein, 1998). Yavas and Goldstein (1998)
suggest that SLPs should possess knowledge of the language, interference
or transfer patterns, and dialect. This section provides a quick reference for
these three topics. The discussion focuses on similarities and differences
between English and Spanish. This knowledge contributes to a clinician’s
cultural and linguistic competence, helps writing appropriate goals, and
facilitates choosing meaningful words and exercises for therapy.
The Language
English and Spanish share both linguistic similarities and differences. The
historical connection between these two languages appears in their shared
Roman alphabet (Langdon, 2008). The historical connection between the
two languages also appears in shared overlapping sound-meaning word
pairs (cognates). Examples of English-Spanish cognates include rose-rosa
and lemon-limón. In any given linguistic area, linguistic features in the two
languages may be the same, share a partial overlap, or be different.
Further, just as in English, there may also be variations within Spanish
phonology (Goldstein, 2001). Phonemes and word structure are especially
important to clinical care of Spanish-speaking students. The discussion of
phonemes focuses on sound classes and consonant clusters. The discussion
of word structure focuses on word length and syllable structure.
Phonemes
Spanish and English phonology share 15 consonants, with 9 consonants

unique to English and 5 consonants unique to Spanish (Goldstein, 2000).
CHAPTER 3: The Late Eight en español 61
Spanish has fewer consonants than English does, Spanish having 18 conso-
nants and English possessing 24 (Acevedo, 1993; Jiménez, 1987; Gorman &
Kester, 2003). Figure 3–1 shows a Venn diagram of sounds that are shared
in Spanish and English, sounds unique to Spanish, and sounds unique to
English. Major differences between Spanish and English occur in the fricative
and liquid sound classes (Morrow, Goldstein, Gilhool, & Paradis, 2014).
Fricatives
Spanish does not contain the following English fricatives: [z, Z, ʃ, v], except
perhaps in particular dialects. Without these phonemes, Spanish-influenced
English may result in the following productions.
n /z/ → /s/ in maze [mes]

n /Z/ → /tʃ/ in measure [metʃ2]
n /v/ → /b/ in vase [bes]
n /ʃ/ → /tʃ/ in sheet [tʃit]
Additionally, the English voiced stops [b, d, g] have allophones in Spanish

that provide more of a voiced spirant production: [β, ð, ] (Bedore, 1999).
These spirant allophones typically occur in the medial position of words and/
or between vowels; for example, “dedo” (finger) = /deðo/ or “cada” (each) =
/kaða/ (Face & Menke, 2009; Goldstein, 2001, p. 55).
Figure 3–1. Venn diagram of shared and unique consonants in

English and Spanish.
62 The late eight
Liquids
Spanish and English share the [l] phoneme, but Spanish does not contain the
English [ɹ]. Instead, Spanish has a vibrant trill /r/, where the tongue vibrates
against the alveolar ridge (e.g., “perro” = dog), and a tap /ɾ/ which is produced
with a quick touch to the alveolar ridge (e.g., “pero” = but), similar to the
flap in English (/bɾ2/ for butter) (Morrow et al., 2014). In this chapter, the
phonetic transcriptions will be: English [ɹ] (in “rabbit”) represented upside
down, the Spanish trill [r] right-side up, and the Spanish tap [ɾ] as such.
Consonant Clusters
Spanish has consonant clusters in word-initial and word-medial position,

such as /tɾen/ (train). Consonant clusters do not occur in word-final position
in Spanish (Bedore, 1999).
R-clusters in Spanish include [pr br tr dr kr gr fr]. L-clusters in Spanish
include: [pl, bl, kl, gl, fl]. Spanish has different word initial s-clusters than
English (Yavas, 2010). In Spanish, a vowel precedes all s-clusters: sp/esp →
espejo (mirror), sc/esc → escuela (school). Clusters with /es/ + consonant in
Spanish include: [esk-, esp-, est-]. Spanish-influenced English might result in
a comment like, “I will estay at my abuela’s (grandma’s) house.”
Word Structure
Differences between English and Spanish occur in relation to word structure.

Kohnert and Derr (2004) identified that on average there are longer words in
Spanish (2.76 syllables/word) than in English (1.74 syllables/word) (p. 330).
This linguistic difference is why a colleague questioned (somewhat teasingly),
“Why would I teach the word ‘pelota’ (3 syllables), when I can teach the
word ‘ball’? (1 syllable).” English relies heavily on consonant-vowel-consonant
(CVC) or postvocalic consonants in word structure, while Spanish has more
consonant-vowel (CV) combinations. Therefore, we see English has more final
sound endings. In contrast, Spanish words primarily end in vowels, with only
five final consonants: [d, n, s, ɾ, l], with some sources highlighting /x/ as a final
Spanish sound, as seen in the word “reloj” (clock) (Bedore, 1999; Goldstein,
2000). Here are a few examples showing final consonants in Spanish:
n pared (wall)
n pan (bread)
n arroz (/aros/ = rice)
n flor (/floɾ/ = flower)
n sol (sun)
It is important to note that final consonant deletion may influence English

more than Spanish because English has more final consonants. At the same
time, a kindergartener with a phonological disorder may still need to work

on final consonant deletion in both languages (Gildersleeve-Neumann &
Goldstein, 2015).
I once consulted with a monolingual English-speaking SLP

who had a bilingual child on her caseload. I offered to put
together a list of the student’s treatment sounds in Spanish.
The clinician requested Spanish targets for initial /s/ and
/f/ words, as well as final /s/ and /f/ words. However, as
reviewed, final /f/ words do not exist in Spanish. As in this
anecdote, not all SLPs may be aware of the phonological
characteristics of a child’s home language. To aid phoneme
selection, bilingual SLPs or trained monolingual SLPs may
need to coach professionals on the linguistic differences
between English and Spanish. Notably, not all sounds occur
in the same positions between English and Spanish.
Interference or Transfer Patterns
In the past, researchers debated whether bilinguals had one or two sepa-
rate phonological systems (see Ray, 2002 for a review). Grosjean (1989)
furthered the discussion by sharing that “the bilingual is NOT the sum of
two complete or incomplete monolinguals; rather, he or she has a unique
specific linguistic configuration” (p. 3). Presently, the commonly accepted
perspective suggests that bilinguals have two phonological systems which
overlap and interact (Gildersleeve-Neumann & Goldstein, 2015; Hambly,
Wren, McLeod, & Roulstone, 2013; Prezas et al., 2014). Some researchers
refer to this dual language model as the Interactional Dual Systems Model
(Paradis, 2001). Based on current research, SLPs can share that a child’s first
language (L1) may influence or interfere with his or her second language
(L2) and vice versa (Hambly et al., 2013). Thus, it is important to know the
linguistic differences between languages. These differences may be a source
of cross-linguistic interference or transfer.
In practical terms, what this means is that bilingual children have sepa-
rate phonological systems that overlap and interact with each other (Hambly
et al., 2013). A child’s exposure to his or her home language may influence
the child’s pronunciation of a second or third language (referred to as inter-
ference or transfer). For example, a school-age child may use the Spanish
tap /ɾ/ to pronounce the English word /fɹut/ as /fɾut/, or produce the English
word “shoes” as /tSus/ because the /S/ sound (and /z/ sound) are not present
in Spanish. Additionally, a Spanish-speaking school-age child who has not
mastered the trill /r/ may use the English /ɹ/ for the Spanish trill /r/ to say
the Spanish word “dog” as “pay-ro” for perro (Prezas et al., 2014).
64 The late eight
As a quick self-test, look at the following productions made

by a Spanish-speaking school-age child learning English.
Which errors represent Spanish-influenced English? Or, in
other words, does each example represent a speech differ-
ence or a concern for a SSD?
n “choose” for shoes

n “eschool” for school
n “wabbit” for rabbit
In the first item, the initial /S/ changed to /tS/, and in

the second item, a vowel was added before the s-cluster.
These first two items are examples of Spanish-influenced
English. In the third item, the /w/ for /ɹ/ substitution is a
phonological process not resulting from Spanish influence
(Goldstein, 2001). For this reason, the clinician needs to
perform further assessment to evaluate an SSD, depending
on the child’s age.
Dialects
The world is home to 21 Spanish-speaking countries. Most phonological

research focuses on two Spanish dialects, Mexican and Puerto Rican (Bedore,
1999). These two dialects happen to be the largest dialects in the U.S. (Taveras,
Namazi, Pazuelo, & Casado, 2015).
Dialectal differences obviously influence pronunciation but also may
lead to vocabulary differences with significant clinical impact. To illustrate,
different Spanish assessment measures may include items that are unfamiliar
to a bilingual child’s unique dialectal background. These vocabulary dif-
ferences make it difficult when testing specific sounds in different word
positions. For example, on the Contextual Probes of Articulation Compe-
tence–Spanish (a Spanish articulation test; Goldstein & Iglesias, 2006), the
Spanish word for “belt” has the Spanish target “correa” to test the phonemes
[k] and [r]. However, some dialectal speakers may label the picture of a
“belt” as “cinturón.” Thus, these unfamiliar words require a direct imitation
or delayed model, which may not provide an accurate representation of a
child’s phonological skills due to unfamiliarity (Acevedo, 1993).
In two different groups of 120 three- to five-year-old Spanish-speaking
children, certain articulation test items were less familiar for children from
Texas (Acevedo, 1993) compared with children from California’s Sacramento
Valley ( Jiménez, 1987). When given the same test items, nine words required
a direct imitation for over half of the children from Texas (Acevedo, 1993);
these words were: “nido (nest), nube (cloud), jirafa (giraffe), bigote (mus-
tache), vela (candle), bañera (bathroom), rey (king), lluvia (rain), and burro
(donkey)” (p. 11). As seen in these examples, even common objects and foods
may have increased variation to a specific dialect.
As a bilingual SLP learning Spanish as a second language,

I sometimes just ask the child. One joyful kindergarten
boy from Guatemala once laughed at me in disbelief,
“Qué es esto? No es un chango. Es un mono” (What is this?
it’s not a chango. It’s a monkey). Sometimes children like
to be the experts, too.
Conservation and Radical Dialects
Researchers classify Spanish dialects as either conservative or radical (Ander-

son & Smith, 1987; Bedore, 1999; Goldstein & Washington, 2001; Guitart,
2005). Mexican Spanish is an example of a conservative dialect, while Puerto
Rican and Dominican Spanish are examples of radical dialects. SLPs must
be mindful of dialects for accurate decision making to distinguish difference
from disorder (Goldstein & Iglesias, 2001; Yavas & Goldstein, 1998). This
section focuses on two clinically important aspects of radical dialects: final
consonant deletion and substitution of /ɾ/ for /l/.
Radical Dialect: Final Consonant Deletion
One main difference between conservative and radical dialects is the pres-
ence or omission of final consonants (Bedore, 1999). Depending on the
speaker’s dialectal origin, the Spanish word for “more” could be pronounced
as más (México) or má’ (Puerto Rico). A preschool teacher who spoke with
a Puerto Rican Spanish dialect once shared with me “comemo’ la’ palabra’”
[comemos las palabras = we eat our words], referring to the final consonant
[s] omissions common in a Puerto Rican dialect. Based on socioeconomic
and/or social status, some Puerto Rican Spanish dialect speakers substitute
the syllable-final [s] with an [h] (“lah cosah” for “las cosas”) (Poplack, 1980).
Whether omitted or substituted, the [s] omissions occur only in syllable
final position; therefore, initial [s] omissions ([ol] for “sol” = sun) or final [r]
substitutions ([flo] for “flor” = flower) are indicators of further investigation
needed to determine an SSD.
Radical Dialect: Substitutions of /ɾ/ for /l/

Another notable difference for Puerto Rican Spanish speakers is the substi-
tution of the tap /ɾ/ for /l/ in syllable-final position. For example, a child
may pronounce the target word /kaɾta/ (“letter”) as /kalta/ with a Puerto
66 The late eight
Rican influenced Spanish (Yavas & Goldstein, 1998, p. 51). See Goldstein
and Iglesias (2001) and Martinez (2011) for a more in-depth review of the
phonological influence of Spanish dialects.
Late-Developing Sounds in Spanish
As in English, children acquire certain Spanish sounds later than other

sounds (Carballo & Mendoza, 2000). Table 3–1 presents findings from several
frequently referenced studies on the most common later-developing sounds
for Spanish-speaking children. Most of the studies highlight children who
speak a Mexican dialect of Spanish. Although this table is not all-inclusive,
findings highlight the most frequent later-developing sounds in Spanish.
These later-developing Spanish phonemes appear to be /s, r, ɾ, l/.
Other Late-Developing Sounds in Spanish
Spanish /s, r, ɾ, l/ appear to be the more common later-developing sounds,

particularly in Mexican Spanish dialects; however, additional sounds may
also present as a challenge in pronunciation. Based on previous research,
Goldstein (1995) initially summarized that school-age children may present
with some infrequent errors on [x, s, tS, r, ɾ, l] and consonant clusters. Later,
Fabiano-Smith and Goldstein (2010) assessed 24 children (ages 3;0 to 4;0)
who spoke Puerto Rican or Dominican dialects and divided children into
three groups: 8 bilingual Spanish-English–speaking children, 8 monolingual
Spanish-speaking children, and 8 monolingual English-speaking children.
Categories for Spanish sound acquisition were as follows:
The Late 4: [l ð r ɾ]
The Middle 6: [s f p tS β ]
The Early 6: [ t m n k x]
An interesting finding from Fabiano-Smith and Goldstein’s study was the

inclusion of the [ð] as a later-developing sound. English-speaking learners of
Spanish demonstrate difficulty with the Spanish allophones [d] and [ð], such
as in the Spanish word for the game piece “dice” = /daðo/. The interdental
tongue placement of the Spanish [d] compared with [ð] may need closer
assessment from both monolingual and bilingual SLPs (Face & Menke, 2009).
Perhaps the pronunciation of the Spanish [ð] is a sound with underidentifica-
tion (Fabiano-Smith & Goldstein, 2010).
More recently, Prezas, Hodson, and Schommer-Aikins (2014) found that
the most common phonological patterns of 56 four- and five-year-old bilingual
children (speaking a Mexican dialect) were consonant cluster omissions and
Table 3–1. Late Developing Spanish Sounds Identified Across Studies
Studies Participants f g x n d ð tS ñ b l ɾ s r
Mason, Smith, and Hinshaw Mexican children in CA X X X X X X X
(1976) replicated Medida (ages 4–9; n = 424)
Española de Articulación Sounds mastered later
(as cited in Jiménez, 1987) than 5 years of age
Terrero (1979) (as cited in Venezuela xprex xpost xpost xpost xprex xpre
Acevedo, 1993) (2;10–5;5; n = 64) xpost xpost
Monolingual Spanish
Jiménez (1987) Mexican American X X
children in CA
67
(3–5;7; n = 120)
Acevedo (1993) Mexican American in TX Xa X X
(3–5;11; n = 120)
Goldstein, Fabiano, & (see above) X X X X X X
Washington (2005) derived
from Acevedo (1993)
Fabiano-Smith & Goldstein Puerto Rican & X X X X
(2010) Dominican Spanish
speakers (8 bilingual,
8 monolingual)
continues
Studies Participants f g x n d ð tS ñ b l ɾ s r
Linares (1981) (as cited in Chihuahua, Mexico (3–6 X X X
Jiménez, 1987) years; n = 97) sounds
after 5
New Mexico X X X X X
68
(5–8 years; n = 148)
Totals 1 1 1 1 1 1 2 2 3 3 5 7 8
Leacox (2016) clinical Midwest, USA X X X X
estimate (K–5th grade; n = 100)
New Totals 1 1 1 1 1 1 2 2 3 4 6 8 9
Note. aNo other studies cite /g/ as late developing; may have been influenced by unfamiliar target ‘bigote’ (mustache) (Acevedo, 1993, p. 13).
liquid deviations. Although clinicians may overlook consonant clusters when

identifying late acquired sounds, we expect the blending of two adjacent
phonemes may be more difficult for children to produce, as seen with English
monolingual children (Smit, Hand, Freilinger, Bernthal, & Bird, 1990).
Variation and Dialect
Variation regarding which sounds are late acquisitions in Spanish may at least
in part reflect dialectal or regional influences. For example, both Jiménez
(1987) and Acevedo (1993) assessed 120 Mexican American children (ages
3–5) with the same articulation test items but found differences in which
sounds were late acquisitions. Jiménez (1987) studied children from Cali-
fornia and found that most children aged 3 to 5 years had not yet acquired
/s/ and trilled /r/. In contrast, Acevedo (1993) studied children from Texas
using the same articulation test items but found children of the same age had
not acquired /g/ and trilled /r/. It is possible the /g/ phoneme influenced
the target item “bigote” (mustache), as it was dialectally less familiar to the
students in Texas.
Treatment Strategies for Late Sounds en español
This section describes treatment strategies for late-developing sounds for

Spanish-speaking children. The information focuses primarily on Spanish-
speaking students with SSDs. You may also find the information beneficial for
adults who speak Spanish-influenced English and receive accent modifica-
tion services. The topics are:
n Education programs
n Treatment approaches
n Treatment sounds
n Treatment techniques
Education Programs
Clinical care for late sounds in Spanish is best undertaken with awareness
of and contributing to a student’s education. Dual language (DL) programs
provide educational instruction in more than one language (Thomas &
Collier, 2002). Although a variety of programs exist in the United States and
around the globe, DL programs use different methods to group or “chunk”
language instruction. This “grouping” or “chunking” of language provides
opportunities for children to learn language in predictable ways.
70 The late eight
One-Way or Two-Way
DL programs may have a wide variation but may include either one-way or
two-way DL classrooms (Langdon, 2008). A one-way DL classroom means the
classroom includes only children whose home language includes exposure to
Spanish. To contrast, a two-way DL program means the classroom includes
children whose home language has Spanish as well as children whose home
language does not include Spanish (i.e., English-speaking children who are
learning Spanish). Two-way refers to the two different groups of children
with different home languages learning two languages (Gómez, Freeman, &
Freeman, 2005).
Language Ratio
The language of instruction is another way to group or “chunk” language

learning. Many DL programs transition to a specified ratio or percent of
language exposure (Gómez et al., 2005). Children may start kindergarten
with instruction in Spanish 80 to 90% of the time and English 10 to 20% of
the time and then move to first grade with 70% Spanish and 30% English.
The language ratio may continue to shift until third grade, when language
exposure is about a 50 to 50% equal ratio.
In an 80-20 Spanish-English kindergarten classroom, English instruction
may include reading a familiar Spanish story in English, singing the English
alphabet and child-friendly songs in English, and structured language-literacy
activities for children to participate in. For example, a snack time might
focus on opportunities to learn specific English vocabulary and pragmatic
functions during snack time (e.g., commenting “this is yummy,” “do you like
it?,” “who wants more?”) (Ballantyne, Sanderman, & McLaughlin, 2008).
From a clinical perspective, SLPs may decide to match the language
of therapy to the language ratio of the classroom. If a child is in an 80-20
Spanish-English classroom, a clinician may structure speech therapy with
eight sessions in Spanish and then two sessions in English with familiar
vocabulary words. Or bilingual SLPs may decide to split a 30-minute session
with approximately 25 minutes in Spanish and the last 5 minutes in English
(Leacox, 2016). We know this language ratio may depend on the child’s
personal language proficiency and exposure to other DL speaking peers
or English-speaking siblings (Rojas, Iglesias, Bunta, Goldstein, Goldenberg,
& Reese, 2016). To illustrate, Gildersleeve-Neumann and Goldstein (2015)
investigated an eight-week bilingual treatment for two 5-year-old males (one
with an SSD, one with childhood apraxia of speech). The treatment language
ratio emphasized Spanish over English, where at least two of every three
days of treatment focused on Spanish. Gildersleeve-Neumann and Goldstein
(2015) found that both children made gains in both languages, with improve-
ments made on untreated errors.
Bilingual Resources
Depending on the number of trained bilingual educators, other DL programs

may group language instruction based on the teachers’ language proficiency.
Children can rotate between Spanish-speaking bilingual teachers and English
monolingual teachers throughout the day to provide exposure to both lan-
guages (Gómez et al., 2005). Or specific subjects may be taught in a prede-
termined language. To illustrate, a DL program may decide to teach math in
Spanish until fourth grade, because educators believe that children in that
approach outperform other students on math tests, hypothesizing that high
math scores result from the strong foundation of math education provided
in the home language.
Treatment Approaches for Multilingual Students
Treatment of SSDs in bilingual children lags behind that of monolingual

children both in its evidence base and in practitioners’ clinical competence
(Verdon, McLeod, & Wong, 2015; Williams & McLeod, 2012). Since 1994, only 6
peer-reviewed published studies have appeared on treatment for multilingual
children with SSDs, compared with 130 studies with English monolingual
children (Baker & McLeod, 2011). The multilingual treatment studies pub-
lished between 1994 and 2015 described multilingual children speaking a
variety of languages, including French, Cantonese, Punjabi, Gujarati, Hindi,
and Spanish. As depicted in Table 3–2, five studies provided therapy with
English-only interventions, and only one study incorporated both languages
in treatment (Gildersleeve-Neumann & Goldstein, 2015).
The six treatment approaches described in these studies are all familiar
to clinicians who treat English-speaking students. They include:
1. Traditional articulation
2. Minimal pairs
3. Core vocabulary
4. Perceptual and metalinguistic
5. Cuing for motor plan (for childhood apraxia of speech)
6. Home practice
Cognate Intervention
Researchers are developing an approach called cognate intervention to

focus specifically on treating multilingual English-Spanish–speaking students
(Kohnert & Derr, 2004; Leacox, 2013).
As background, cognates are words with similar overlapping sounds
between two languages, with the same meaning (Harley, 2008). For example,
Table 3–2. Treatment Studies with Multilingual Children
Child(ren) and English-only or

Study Languages Diagnosis Treatment Approach(es) Bilingual TX
McNutt (1994) n = 7 (7;0–8;3) Interdental /s, z/ Traditional artic, motor English-only
French-English (phonetic errors in based articulation program
both languages)
Holm, Ozanne, & “JL” Mild artic: /s/ Traditional artic, minimal English-only
Dodd (1997) n = 1 (5;2) Phonological: pairs
Cantonese-Eng gliding & cluster
reduction
Holm & Dodd “HK” Phonological Core vocabulary English-only
(1999) n = 1 (4;6)
72
English-Punjabi
Holm & Dodd n = 2 (4;8, 5;2) Phonological (4;8) Traditional artic, minimal English-only
(2001) Cantonese at birth, Artic & pairs, core vocabulary,
Eng preK phonological (5;2) home practice
Ray (2002) “MC” Mild SSD Cognitive-linguistic = English-only

n = 1 (5 yrs) English, auditory bombardment,
Hindi, Gujarati minimal pairs therapies,
perceive and produce
Gildersleeve- n=2 SSD, CAS Perceptual, drill, minimal English and
Neumann & (5;8, 5;6 males) pairs, functional vocabulary, Spanish
Goldstein (2015) cueing motor plan
Spanish & Eng
Note. *Children treated in both Spanish and English. CAS = childhood apraxia of speech; SSD = speech sound disorder;
TX = treatment.
the translation equivalents plate-plato and lion-león are both cognate pairs.
As Kohnert and Derr (2004) mentioned, cognates are appropriate targets
for a bilingual approach. These cognate pairs may be appropriate targets
whether the SLP knows little or no Spanish or is bilingual. Choosing these
target words potentially creates a bridge between the home and school
languages.
Recent research has established that even younger children are sensitive
to cognates in vocabulary (Leacox, Wood, Sunderman, & Schatschneider,
2016; Pérez, Peña, & Bedore, 2010; Simpson Baird, Palacios, & Kibler, 2016).
However, to date no one has presented the empirical evidence of cognates for
phonological therapy. Nonetheless, “Words Their Way” for Spanish-English
DL learners provides phonological awareness activities, where the initial
sound pictures are cognates (Helman, Bear, Invernizzi, Templeton, & John-
ston, 2009). The images share the same first sound between English and
Spanish (examples below in Figure 3–2). Although cognates need further
research, it is an interesting strategy to consider for DL learners.
Treatment Sounds
The topic of treatment sounds appears in two sections: selection of goals

and selection of sounds.
Goal Selection
If a disorder is determined, how do we choose an intervention approach

and specific goals to target? Two key clinical recommendations on treat-
ment continue to guide clinical practice (Table 3–3). First, Yavas and Gold-
stein (1998) recommended treating phonological patterns by first targeting
Figure 3–2. Example of cognate words,

which share [s] sound similarity between
English and Spanish.
74 The late eight
Table 3–3. Clinical Recommendations to Guide Clinical Practice with

Multilingual Speakers
Yavaş & Goldstein (1998, pp. 57–58) Kohnert & Derr (2004, pp. 325–332)
Treat phonological patterns: Bilingual targets:
Similar rates in L1 and L2
1. A. Choose target phonemes
(frequently occurring) which are shared across the
two languages
Unequal frequency between
2.
L1 and L2 Cross-linguistic targets:
B. Intervention on the unshared
3. Only in one language features between the two
languages
Source: Kohnert, K., & Derr, A. (2004). Language intervention with bilingual children. In
B. Goldstein (Ed.), Bilingual language development and disorders in Spanish-English
speakers (pp. 311–338). Baltimore, MD: Paul H. Brookes; Yavaş, M., & Goldstein, B. (1998).
Phonological assessment and treatment of bilingual speakers. American Journal of
Speech-Language Pathology, 7, 49–60. doi:10.1044/1058-0360.0702.49
sounds in error that exist in both languages, then targeting sounds unique
to Spanish or unique to English (Perez, 1994 as cited in Yavas & Goldstein,
1998). Children with difficulties in production of late-developing sounds
may struggle with only one or a few articulation sounds in error. However,
we can apply Yavas and Goldstein’s (1998) phonological principles to late-
developing articulatory productions.
Second, Kohnert and Derr (2004) describe two broad bilingual treatment
perspectives to encourage gains in both languages: a bilingual approach
and a cross-linguistic approach. A bilingual approach focuses on the shared
skills in both languages, such as cognate words (English-Spanish translation
equivalents: salt/sal) and shared phonemes (e.g., [s], [l]). Kohnert and Derr’s
bilingual approach corresponds to Yavas and Goldstein’s (1998) primary
recommendation to target shared error patterns that have similar impact on
a child’s L1 and L2. Additionally, monolingual English SLPs can still choose a
bilingual approach by selecting phonemes that overlap between English and
Spanish. Prezas et al.’s (2014) findings align with the bilingual approach, as
bilingual 5-year-old children demonstrated equal error frequency on con-
sonant cluster deletion and liquid deviation errors between English and
Spanish. To provide services, an SLP would need knowledge of the child’s L1:
Spanish. Kohnert and Derr’s cross-linguistic approach supports an interven-
tion on the unshared features between the two languages, similar to that of
Yavas and Goldstein’s (1998) third recommendation to target error patterns
unique to one language.
In 2002, Ray published the first study with a trilingual student with
English-only treatment and found that generalization occurred on untreated
sounds in both Hindi and Gujarati. Then, there was a 13-year gap in the
bilingual SSD research literature until Gildersleeve-Neumann and Goldstein’s
(2015) study with the language of instruction including both English and
Spanish. It goes without saying that more evidence and clinical tools are
needed to guide SLPs to serve Spanish-English DL learners.
Sound Selection
As depicted in Figure 3–3, late sounds divide into three categories: (1) treat-
ment of sounds found in both English and Spanish, (2) treatment of sounds
unique to Spanish, and (3) treatment of sounds unique to English.
Based on Figure 3–3, [s] and [l] are late sounds found in both English
and Spanish, tap [r] and trill [ɾ] are late sounds unique to Spanish, and SH,
Z, V, and English-R are late sounds unique to English.
Sounds in the first two groups are candidates for treatment. But what
about sounds in the third group, which occur in English but not in Spanish?
To treat or not to treat? Spanish-speaking children may have difficulty pro-
ducing the English [ʃ z v]. These sounds do not exist in the child’s home
language and result in a speech difference but not disorder. Therefore, a
Spanish-speaking student with only these sound errors would not typically
qualify for speech services (Yavas & Goldstein, 1998). Keep in mind, a child
with difficulty in pronunciation of Spanish trill [r] and/or tap [ɾ] may also
have difficulty with the English [ɹ], and in that case, may qualify for therapy
to remediate speech productions in the language of the classroom. Parents
Figure 3–3. Venn diagram of unique and overlapping

late acquired sounds.
76 The late eight
or adults may request services for accent addition or accent modification;

however, this type of therapy support is not necessarily the purpose of the
individualized education plan (IEP).
Frequency of Sounds on a Caseload
Clinical expertise contributes to the decision-making process for evidence-

based practice (see Chapter 2 of this book). Clinical experiences can verify
research findings. Additionally, the clinical world can inform research. In
this spirit, I calculated a quick retrospective snapshot of the most common
speech goals from part of my time as a bilingual SLP. Figure 3–4 contains this
informal calculation from my clinical experience. Notably, this information is
an estimate and only one expert opinion (ASHA, 2004).
At the time, I was working outside of Chicago in a district with English-
Spanish dual language programs. The children were Spanish-English bilin-
guals instructed in general education classrooms. The figure includes ~100
bilingual children with IEPs across two different school years (grades K–6).
Preschool students were not included for this snapshot. Illinois had a case
load capacity of 60 students at the time.
From this sample, approximately 87% of children had articulation or
phonological goals for sounds in Spanish (see Figure 3–4). Some children
had concomitant language, fluency, voice, and augmentative-alternative com-
munication goals. Some children had more than one sound in error. For
example, one child had goals to remediate trill [r], tap [ɾ], and [ɾ]-blends.
Figure 3–4. Clinical experience estimate: Common

Spanish speech sound goals for school-age bilingual
children.
In this retrospective anecdote, the sounds with speech goals from most
common to less common sounds were:
1. tap [ɾ] and [ɾ]-blends (27%)

2. [s] and [s]-blends (interdental errors more common than lateralized)
(21%)
3. trill [r] (20%)
4. [l] and [l]-blends (8%)
5. Less frequent sound errors were [k g tS ] and more complex phonologi-
cal difficulties.
Treatment Techniques
Treatment techniques are “tools of the trade” for treating Spanish-speaking

children with SSDs. As expected, treatment tool techniques for Spanish-
speaking children overlap extensively with tools for English-speaking chil-
dren. As elsewhere in this book, the discussion of each sound includes the
following information:
1. Relative frequency
2. Expected errors
3. Shaping and elicitation techniques
4. Minimal pairs
Each subsection concludes with suggestions for practice.

In addition to these techniques, the University of Iowa provides an
interactive website to demonstrate production of all Spanish and English
phonemes: http://soundsofspeech.uiowa.edu/spanish/spanish.html (also are
available with an app). Sometimes this visual can be helpful for students to
have increased awareness about correct placement of Spanish phonemes.
[s] and [l]
These are late sounds found in both English and Spanish.
[s]
Relative Frequency
In Spanish, [s] ranks first in relative frequency compared with all other
Spanish consonants, and its percentage of occurrence compared with all
Spanish phonemes is 9.4% (Guirao & Jurado, 1990).
78 The late eight
Expected Errors
Similar to English, a common error for [s] is lisping, with interdental tongue
placement [θ]. However, some dialects of Spanish may produce the interdental
“θeta” as a typical dialectal production (Martinez, 2011). Lateralizing [s] with
airflow escaping on each side of the tongue occurs but is less common than
interdental productions. Spanish-speaking children with SSDs are likely to
experience difficulties with [s] in consonant clusters (Gildersleeve-Neumann
& Goldstein, 2015; Yavas, 2010).
Phonetic Placement and Shaping Techniques
In my clinical experience, strategies similar to those for English-only–speaking

children in this book’s English resources are applicable. A key environment
for [s] productions is before the [i] vowel to retract the tongue. Two words to
elicit trials of Spanish [s] productions are sí (yes) and silla (chair).
Additionally, Spanish materials designed for Spanish-speaking children
with cleft palate are available through the Leaders Project site. The site
provides clinical videos of Dr. Crowley and Spanish-speaking SLPs eliciting
Spanish sounds for the late-developing sound [s] and middle-developing
sounds [k g]: http://www.leadersproject.org/2013/03/13/las-estrategias-para-
producir-la-s/. The [s] shaping strategies focus on cleft palate repair but
include strategies that would work for children with SSDs as well.
Minimal Pairs
It is a myth that there are “no rhyming words in Spanish.” Because Spanish
has fewer final sounds and a more syllabic CV word structure, there are fewer
minimal pair combinations compared with English, but minimal pairs are
still used in research and clinical practice as an appropriate tool for therapy
(Gildersleeve-Neumann & Goldstein, 2015) and with several languages (Holm
& Dodd, 2001; Holm, Ozanne, & Dodd, 1997).
For Spanish speakers with a conservative dialect, such as Mexican
Spanish, you might consider working on minimal pairs with final [s]. Final
[s] occurs in both English and Spanish. The phoneme [s] is only one of five
final sounds in Spanish. Examples with plurality include:
n Pato-Patos (duck-ducks)
n Dedo-dedos (finger-fingers)
n Mano-manos (hand-hands)
Or simple CV-CVC minimal pairs with a final [s] phoneme may be another
option:
n Pe-Pez (letter p, fish)

n Ve-Vez (see [third person singular ver], time)
n Me-Mes (reflexive pronoun, month)
Suggestions for Practice
For younger children, choosing one treatment word for home practice may
be a relevant strategy. One bilingual SLP colleague I worked with gave each
of her students a notebook for speech therapy. As her students became suc-
cessful with a sound, she would give them just one word to take home and
practice ( J. Leautaud, personal communication, December 22, 2016). The
child could color the notebook assignment with the one target word, if he
or she chose. The homework drawing could be artistic or simple, depending
on the age of the student (see Figure 3–5 for an example).
Although these children may have had consistent phonological or articula-
tion disorders, this type of homework assignment may align with principles of
a core vocabulary approach (Holm & Dodd, 1999). Clinically, this assignment
increased home-to-school communication and provided a feasible method
for the bilingual SLP to share treatment information with the child’s family.
[l]
Relative Frequency
In Spanish, [l] ranks seventh in relative frequency compared with all other
Spanish consonants, and its percentage of occurrence compared with all
Spanish phonemes is 3.9% (Guirao & Jurado, 1990).
Expected Errors
Similar to English, a common error is gliding, substituting a [w] or [ j ] for

an [l] consonant. Examples in Spanish are: [pjato] for “plato” (plate), [ja] for
“la” (Spanish for “the,” a Spanish feminine article). Liquid omission may
also occur in consonant clusters: banco for “blanco” (white) (Prezas et al.,
2014). The primary difference between the English and Spanish [l] is the
Figure 3–5. Therapy homework example for isolated [s] productions. (Practice
the “s” sound and draw the rays of the sun.)
80 The late eight
markedness, which relates to sound complexity in relation to the world’s

languages (Fabiano-Smith & Barlow, 2010). The [l] is unmarked in Spanish
but marked in English (Cataño, Barlow, & Moyna, 2009). Based on treatment
in English (Dinnsen, Chin, Elbert, & Powell, 1990), perhaps targeting [l] in
English (marked) would lead to more accurate productions of [l] in Spanish
(unmarked). This hypothesis requires further research.
As [l] is an overlapping sound in English and Spanish, strategies to elicit [l]

production may be similar to elicitation strategies in English.
Minimal Pairs
As stated in the discussion of [s], Spanish has fewer final consonants than
English, which limits the number of minimal pairs. Nonetheless, minimal pairs
remains a useful treatment tool. Here are a few examples of minimal pairs:
English
n fawn-flan
n pain-plane
Spanish
n luego-fuego (then-fire)
n puma-pluma (puma-feather)
n lobo-globo (wolf-balloon)
Combined English and Spanish

Spanish Spanish-English English
Pan (bread) Plan Pan
High-frequency words can be beneficial to target in Spanish. The most

common Spanish word is the word meaning “the,” with over 909,735 occur-
rences in a word frequency count examining newspaper samples; this number
is almost 10% of the total (Thomas, Nash, Thomas, & Richmond, 2005).
Spanish articles can be either feminine or masculine, singular or plural. All
definite articles include the [l] phoneme in productions, which makes them
appropriate targets for [l] practice:
“The” Targets Singular Plural

Feminine la playa = the beach las niñas = the girls
Masculine el león = the lion los niños = the boys
el lobo = the wolf los gatos = the cats
These practice targets may be beneficial, as children with language

impairment may also have grammar difficulty in accurate production or
matching correct article-noun agreement in Spanish. These targets will be
helpful if intervention groups have children with and without language
impairment. Additionally, Spanish short stories or Madlib stories have several
opportunities for older children to practice this sound in article productions:
el, la, los, las.
Tap [r] and Trill [ɾ]
These are late sounds unique to Spanish.
Frequency
In Spanish, the tap [ɾ] ranks third in relative frequency compared with all
other Spanish consonants, and its percentage of occurrence compared with
all Spanish phonemes is 5.4% (Guirao & Jurado, 1990). This higher ranked
frequency may be because the tap [ɾ] is one of the few consonants that
occur in the final position of Spanish words. Additionally, tap [ɾ] occurs
in the Spanish initial and medial ɾ-blends. The trill [r] ranks sixteenth in
relative frequency, with its percentage of occurrence at only 0.4% (Guirao
& Jurado, 1990).
Expected Errors
Similar to English, a common error is gliding, substituting a [ j ] for an [r]
consonant; [w] for [r] substitutions are less common in Spanish, unless the
child has substantial exposure to English. Another developmental error is to
substitute a /ð/ for /ɾ/ (Prezas et al., 2014). Table 3–4 provides examples of
the substitutions, omissions, and distortions that Spanish-speaking children
may produce. Bilingual children have more substitution errors than Spanish
monolinguals (Goldstein & Washington, 2001). For example, monolingual
Spanish-speaking children may only substitute tap and trill sounds with
[l ɾ j], while bilingual children may present with more possible substitutions:
[l ɾ j s t tj dr ld] (Goldstein & Washington, 2001).

Although many Spanish speakers may be able to trill the Spanish /r/, teaching
someone to produce this vibrant sound is much different. Here are a few
techniques I have learned over the years:
Shaping: “Engine lips”— bilabial trill to alveolar trill. If a child does not
produce any type of “r” in either language and if the trill [r] is a phoneme
in the child’s dialect, then I may start with this strategy. I start here in part
82 The late eight
Table 3–4. Error Patterns for the Spanish tap [ɾ] and trill [r]
Spanish Error
Profiles for Example
Tap r / Trill r Error (target → child’s production)
Substitution Bilabial trill for alveolar /pero/ → /peBo/ (dog)
Uvular trill // for alveolar /pero/ → /peo/
Tap /ɾ/ for trill /r/ /fɾuta/ → /fruta/ (fruit)
English /ɹ/ for Spanish /r/ /aros/ → /aɹos/ (rice)
/j/ for trill /r/ /pero/ → /pejo/
Trill /r/ for tap /ɾ/ /raɾo/ → “rrarro” (rare)
/l/ for tap /ɾ/ /fɾuta/ → /fluta/
Omission Omit final /ɾ/ maɾ → “ma” (sea)
Distortion Distorted production flip-flop tongue with attempt

to approximate sound
Sources: Goldstein & Washington, 2001; González-Bueno, 2005.
because it can be a fun way to try making different sounds. Additionally, this
strategy provides tiered levels of support. Tiered levels benefit group therapy
when working with children at different levels of approximating accuracy of
the trilled /r/ sound.
The “Engine lips” strategy was inspired from a comical Youtube video
with “Mr. Ugly Teeth” that progresses from the trill [r] sound in isolation, to
syllables, words, and sentences. The video presentation ends with a well-
known Spanish tongue twister to practice the trill [r]: “erre con erre cigarro,
erre con erre barril, rápido corren los carros del ferrocarril” (an R with an R
cigar, an R with an R barrel, rapidly running the cars to the railroad) (Terrell,
1989, p. 17). http://www.youtube.com/watch?v=P9mMvuRGKY8
Here are the individual steps:
1. “Engine lips”: Ask the student to place lips together gently, keep lips
relaxed, and puff air through the closed lips. Repeat until you achieve
a bilabial trill. Cues at step 1 or 2 may include, “haz el sonido cómo un
barco a motor, un carro, bichos, a roncar” (make the sound like a motor
boat, car, bugs, snoring).
2. Tongue and lip: Ask the student to place tongue between upper lip and
front teeth. The tongue is in front of the teeth but behind the upper lip.
Again, ask the child to puff air through gently closed teeth-tongue-lip
placement. Modeling this placement and providing a mirror are helpful.
After several vibrant puffs, now the child’s tongue also has a sense of
vibrant movement.
3. Shape to alveolar trill: Ask the student to repeat step 2 and then slide
the tongue from between the upper lip and front teeth, back toward the
alveolar ridge. Repeat front-to-back tongue movements with sustained
puffs of air, until resulting in an alveolar trill.
Have you ever seen or heard a bilabial trill?

A bilabial trill is a unique substitution error for the trill /r/.
You produce a bilabial trill by vibrating the lips together
to create a sound like a raspberry sound or a motor boat
imitation. These productions may “sound” adequate in the
trill quality — if you’re not looking directly at the child and
just listening — but are not accurate productions. However,
bilingual children may benefit from remediation, as the
inaccurate placement may bring unwanted social attention
to the speaker. The bilabial trill can be distracting for a
listener, as you can see the lip vibrations.
I worked with one third-grade boy who occasionally
turned his head to hide his lips when he produced the
bilabial trill. He knew his pronunciation was different but
he still preferred the bilabial trill over the alternate /r/ for
/d/ substitution when saying the word “dog” in Spanish
(“perro”), which resulted in producing the word: “pedo”
. . . you’ll have to Google-translate that one. Thankfully, the
child had the concept of a vibrant sound — just the wrong
placement. From there, shape these bilabial substitution
errors to the correct alveolar placement.
Phonetic placement: Muerde-mueve-respira (bite-move-breathe). This

technique has been used successfully to help fourth-grade bilingual students
with residual [r] difficulties in Spanish. I like this technique because it only
has three steps. Simple instructions may be at your advantage when a student
also has language difficulties. You may consider priming this technique by
first identifying speech articulators: tongue sides, alveolar ridge. Using a
mirror may be beneficial also.
1. Ask the student to bite (gently!) the sides of tongue (to close airflow
from escaping).
2. Ask the student to move tongue tip behind the front teeth.
3. Ask the student to take a deep breath and puff strong air (breathe) out.
84 The late eight
Shaping: Uvular trill to alveolar trill. Some children may produce or

approximate an uvular trill to substitute for the alveolar placement of the
trill [r]. A trill [r] produced in a posterior position may be a sign of dialectal
variations, such as in a Puerto Rican or Dominican dialect (see Appendix
in Goldstein & Iglesias, 2001; Goldstein & Washington, 2001). Alternatively,
children with SSDs may initially produce or approximate an uvular trill when
first learning the alveolar trill. No matter the source, velar trills have an
advantage of vibratory movement already occurring in the speech system.
The clinician’s job is to shift that vibratory element to the alveolar ridge, if
dialectally appropriate (e.g., Mexican Spanish).
1. Ask the student to produce the vibrant sound.

2. Ask the student to put the tongue behind the front teeth (and place
hands on cheeks to keep airflow from redirecting, if needed).
3. Ask the student to take a deep breath and puff strong air toward front
of mouth.
Shaping: Final [l] to trill [r] or tap [ɾ]. This technique is based on the
coarticulation and phonetic similarity among [l], [r], and [ɾ]. This strategy may
be the phonetic contrast needed to eliminate [l] substitutions.
1. Ask the child to say “el” (masculine definite article in Spanish for word
“the”).
2. Then name picture of “el río” (the river), but flip tongue back quickly
between words.
3. Ask the student to try again but flip the tongue forcefully for the [r] or
[ɾ], depending on target approximation.
4. Can also try with the Spanish words for “the king”: el rey.
Minimal Pairs
Similar to English monolingual children with SSDs, bilingual children may

also have difficulties perceiving the difference between the trill /r/ and tap
/ɾ/. Complete an auditory discrimination task to see if a child distinguishes
the difference and/or use minimal pairs in therapy to practice productions
(see González-Bueno, 2005 for picture prompts).
Minimal pair auditory discrimination (perception). Instructions for this

task may be something similar to: “Sólo levante la mano cuando lo oigas la
doble rr . . . perro – pero” [“Only raise your hand when you hear the trilled
rr . . . perro (dog) . . . pero (but)”] (González-Bueno, 2005).
Minimal pair examples of tap [ɾ] and trill [r]:

n pero – perro (but – dog)
n cero – cerro (zero – hill)

n coro – corro (choir – I run)
Minimal pair examples of [r] and [l]:

n rata – lata (rat – can)
n río – lío (river – mess)
n rey – ley (king – law)
Minimal pair verbal practice (production). González-Bueno (2005) pre-

sented a case study of a bilingual child and focused on three sets of minimal
pairs: trill /r/ versus /l/, trill /r/ versus tap /ɾ/, and tap /ɾ/ versus /l/. The
conference proceeding includes pictures and words that can be used in
therapy (available in González-Bueno’s appendices) — or as a model to make
your own materials.
Simple activities to send home can increase repetitions and possible gen-
eralization. I found these activities as suitable to practice during group
therapy or for home therapy, relying on an element of independence and/
or self-monitoring.
1. Online audio flashcards. Online flashcards provide the written Spanish

word and audio examples of native speakers producing the Spanish
target. I add a self-monitoring tally sheet to allow the child to track
accurate and inaccurate productions. I primarily used this website for
the trill [r]: http://www.studyspanish.com
2. Question-Answer. To practice the tap [ɾ], clinician or peers take turns
asking what you’d like to do during the weekend, offering two choices.
The choices need to include two infinitives (i.e., unconjugated, to-___
verbs). Child needs to self-monitor and monitor the peer. For example,
“quieres nadar en la piscina o jugar al tenis con Alison?” (Do you want
to swim in the pool or play tennis with Alison?) (Terrell, 1989, p. 17). This
activity works well in pair or group therapy but may also be appropriate
if family support (by a sibling or parent) is available.
3. Simple picture treatment materials. Simple books or picture cards are
helpful to send home. Given the lack of treatment materials in Spanish,
Dr. Kohnert and colleagues Scarry-Larkin and Price (2000) published
clinician-friendly materials that are economically priced through Learn-
ing Fundamentals: Fonología en Español: Dibujos y Actividades [Spanish
Phonology: Picture Cards and Activities], published by LocuTour. These
treatment materials focus on early-, middle-, and late-developing sounds.
Additionally, the word targets are divided into varied syllable length,
which allows the clinician to control for difficulty level (2-syllable targets
vs. 3-4-5-syllable targets).
86 The late eight
Sample Lesson Plan
To summarize the use of tools described in this section, here is a sample

lesson plan for the trill [r]. This lesson plan is for the end of assessment
and/or early in treatment. It incorporates multiple strategies for the trill /r/
(Table 3–5).
Table 3–5. Example Lesson Plan for Early Treatment Elicitation of the
Spanish Trill /r/
Pretest probe Baseline 20 words:

(words from Spanish 10 words for tap /ɾ/
Articulation Measure;
Mattes, 1995 or CPAC-S; 10 words for trill /r/
Goldstein & Iglesias, 2006)
Teach oral mechanism Observe trill /r/ demonstrations from

and demonstrate trill University of Iowa website: http://www.uiowa
production .edu/~acadtech/phonetics/#
Auditory discrimination Child given pictures of minimal pair sets. Child

(see González-Bueno, should be able to identify correct target with trill
2005) /r/ (when listening to clinician):
Cerro-cero, carro-caro, perro-pero
Elicitation strategies Cycle through strategies to elicit the correct

production:
• Engine lips
• Muerde, mueve, respira (bite sides of tongue,
move tip behind front teeth, breathe)
If correct production 1. Shoot hoops

elicited, then practice with 2. Bingo
these motivating game
3. Soccer goal game
options
4. Dice game
Posttest probe Same 20 words
Home practice Listen to correct trill /r/ productions and trial trill
/r/ productions in isolation or words.
http://www.studyspanish.com/pronunciation/
letter_rr.htm
_________________, CCC-SLP
Terapista del habla y lenguaje
Conclusions
The focus of this chapter was to review the knowledge SLPs need to treat
SSDs for Spanish-speaking learners of English. Essential to service provi-
sion, the key areas highlighted were the differences and similarities between
English and Spanish phonological systems, later acquired sounds in Spanish,
and specific treatment strategies for remediation. Presently, there are a mere
six studies on treatment with only one research study providing treatment
in Spanish and English (Gildersleeve-Neumann & Goldstein, 2015), empha-
sizing the necessity of further bilingual research guided by clinical insight.
Given the increase of multilingual speakers, clinical researchers and SLPs
need to continue to investigate strategies for multilingual children with SSDs.
References
Acevedo, M. A. (1993). Development of Spanish consonants in preschool children.

Communication Disorders Quarterly, 15(2), 9–15.
American Speech-Language-Hearing Association. (2004). Evidence-based practice
in communication disorders: An introduction [Technical report]. Available from
http://www.asha.org/policy
American Speech-Language-Hearing Association. (2016). Demographic profile of
ASHA members providing bilingual services [PDF document]. Retrieved from
http://www.asha.org
Anderson, R., & Smith, B. (1987). Phonological development of two-year-old mono-
lingual Puerto Rican Spanish-speaking children. Journal of Child Language, 14,
57–78.
Baker, E., & McLeod, S. (2011). Evidence-based practice for children with SSDs: Part
1 narrative review. Language, Speech, and Hearing Services in Schools, 42(2),
102–139. doi:10.1044/0161-1461(2010/09-0075)
Ballantyne, K. G., Sanderman, A. R., & McLaughlin, N. (2008). Dual language learn-
ers in the early years: Getting ready to succeed in school. Washington, DC: National
Clearinghouse for English Language Acquisition. Available at http://www.ncela
.gwu.edu/resabout/ecell/earlyyears.pdf
Bedore, L. (1999). The acquisition of Spanish. In O. Taylor & L. Leonard (Eds.),
Language acquisition across North America: Cross-cultural and cross-linguistic
perspectives (pp. 157–208). San Diego, CA: Singular.
Carballo, G., & Mendoza, E. (2000). Acoustic characteristics of trill productions by
groups of Spanish children. Clinical Linguistics and Phonetics, 14(8), 587–601.
doi:10.1080/026992000750048125
Cataño, L., Barlow, J. A., & Moyna, I. M. (2009). A retrospective study of phonetic inven-
tory complexity in acquisition of Spanish: Implications for phonological universals.
Clinical Linguistics and Phonetics, 23(6), 446–472. doi:10.1080/02699200902839818
Crowley, C., Gildersleeve-Neumann, C., Peña, E., Restrepo, M. A., Rhein, D., &
Rodriguez, B. (2014, November). How they work: Graduate SLP programs with
bilingual/multicultural concentrations. Presentation at the American Speech-
Language-Hearing Association Convention, Orlando, FL.
88 The late eight
Dinnsen, D., Chin, S., Elbert, M., & T. Powell. (1990). Some constraints on functionally
disordered phonologies. Journal of Speech, Language, and Hearing Research 33,
28–37.
Fabiano-Smith, L., & Barlow, J. A. (2010). Interaction in bilingual phonological acqui-
sition: Evidence from phonetic inventories. International Journal of Bilingual
Education and Bilingualism, 13(1), 81–97.
Fabiano-Smith, L., & Goldstein, B. (2010). Early-, middle-, and late-developing sounds
in monolingual and bilingual children: An exploratory investigation. American
Journal of Speech-Language Pathology, 19, 66–77.
Face, T. L., & Menke, M. R. (2009). Acquisition of the Spanish voiced spirants by
second language learners. In Selected Proceedings of the 11th Hispanic Linguistics
Symposium (pp. 39–52). Somerville, MA: Cascadilla Proceedings Project.
Gildersleeve-Neumann, C., & Goldstein, B. (2015). Cross-linguistic generalization in
the treatment of two sequential Spanish-English bilingual children with speech
sound disorders. International Journal of Speech Language Pathology, 17(1),
26–40. doi:10.3109/17549507.2014.898093
Goldstein, B.A. (1995). Spanish phonological development. In Kayser, H. (Ed.), Bilingual
speech-language pathology: An Hispanic focus (pp. 17–39). San Diego, CA: Singular.
Goldstein, B. (2000). Cultural & linguistic diversity resource guide for speech-language
pathologists. San Diego, CA: Singular.
Goldstein, B. (2001). The effect of dialect on phonological analysis: Evidence from
Spanish-speaking children. American Journal of Speech-Language Pathology, 10,
394–406.
Goldstein, B., & Iglesias, A. (2001). The effect of dialect on phonological analysis:
Evidence from Spanish-speaking children. American Journal of Speech-Language
Pathology, 10, 394–406. doi:10.1044/1058-0360(2001/034)
Goldstein, B., & Iglesias, A. (2006). Contextual probes of articulation competence-
Spanish. Greenville, SC: Super Duper Publications.
Goldstein, B., & Washington, P. (2001). An initial investigation of phonological patterns
in 4-year-old typically developing Spanish-English bilingual children. Language,
Speech, and Hearing Services in Schools, 32, 153–164. doi:10.1044/0161-1461
(2001/014)
Gómez, L., Freeman, D., & Freeman, Y. (2005). Dual language education: A promising
50-50 model. Bilingual Journal Research, 29, 145–164.
González-Bueno, M. (2005). Articulatory difficulties in the acquisition of Spanish
/r/ in the bilingual context. In J. Cohen, K. T. McAlister, K. Rolstad, & J. MacSwan
(Eds.), ISB4: Proceedings of the 4th International Symposium on Bilingualism (pp.
914–934). Somerville, MA: Cascadilla Press.
Gorman, B., & Kester, E. S. (2003). Spanish-influenced English: Typical phonological
patterns in the English language learner. Austin, TX: Bilinguistics. Retrieved from
http://bilinguistics.com/wp-content/uploads/2013/01/abad_1001.pdf
Grosjean, F. (1989). Neurolinguists, beware! The bilingual is not two monolinguals
in one person. Brain and Language, 36(1), 3–15.
Guirao, M., & García Jurado, M. A. (1990). Frequency of occurrence of phonemes in
American Spanish. Revue québécoise de linguistique, 19(2), 135–149. doi:10.7202/
602680ar
Guitart, J. M. (2005). Sociophonetic knowledge of Spanish and control of style. In L.
Sayahi & M. Westmoreland (Eds.), Selected proceedings of the Second Workshop
on Spanish Sociolinguistics (pp. 16–23). Somerville, MA: Cascadilla Proceedings

Project.
Hambly, H., Wren, Y., McLeod, S., & Roulstone, S. (2013). The influence of bilingual-
ism on speech production: A systematic review. International Journal of Language
and Communication Disorders, 48(1), 1–24. doi:10.1111/j.1460-6984.2012.00178.x
Harley, T. (2008). The psychology of language: From data to theory. Sussex, UK:
Psychology Press.
Helman, L., Bear, D. R., Invernizzi, M., Templeton, S., & Johnston, F. (2009). Words
their way: Emergent sorts for Spanish-speaking English learners. Boston, MA:
Pearson.
Holm, A., & Dodd, B. (1999). An intervention case study of a bilingual child with a phono-
logical disorder. Child Language Teaching and Therapy, 15, 139–158. doi:10.1177/
026565909901500203
Holm, A., & Dodd, B. (2001). Comparison of cross language generalisation follow-
ing speech therapy. Folia Phoniatrica et Logopaedica, 53, 166–172. doi:10.1159/
000052671
Holm, A., Ozanne, A., & Dodd, B. (1997). Efficacy of intervention for a bilingual
making articulation and phonological errors. International Journal of Bilingual-
ism, 1, 55– 69. doi:10.1177/136700699700100105
International Expert Panel on Multilingual Children’s Speech. (2012). Multilingual
children with SSDs: Position paper. Bathurst, NSW, Australia: Research Institute
for Professional Practice, Learning and Education (RIPPLE), Charles Sturt Uni-
versity. Retrieved from http://www.csu.edu.au/research/multilingual-speech/
position-paper
Jimenez, B. C. (1987). Acquisition of Spanish consonants in children aged 3–5 years,
7 months. Language, Speech, and Hearing Services in Schools, 18, 357–363.
doi:10.1044/0161-1461.1804.357
Kohnert, K., & Derr, A. (2004). Language intervention with bilingual children. In
B. Goldstein (Ed.), Bilingual language development and disorders in Spanish-
English speakers (pp. 311–338). Baltimore, MD: Paul H. Brookes.
Kohnert, K., Scarry-Larkin, M., & Price, E. (2000). Fonología en español: Dibujos y
actividades [Spanish phonology: Picture cards and carryover activities]. San Luis
Obispo, CA: LocuTour Multimedia.
Kohnert, K., Yim, D., Nett, K., Kan, P. F., & Duran, L. (2005). Intervention with lin-
guistically diverse preschool children: A focus on developing home language(s).
Language, Speech, and Hearing Services in Schools, 36(3), 251–263. doi:10.1044/
0161-1461(2005/025)
Langdon, H. (2008). Assessment & intervention for communication disorders in cul-
turally and linguistically diverse populations. Clifton Park, NY: Thomson Delmar.
Leacox, L. R. (2013, November). Spanish-English phonological overlap: Children’s
cognate assessment and facilitation in speech therapy. Poster presented at the
annual convention American Speech-Language-Hearing Association, Atlanta, GA.
Leacox, L. R. (2016, October). Late-acquired sounds for Spanish-English dual lan-
guage speakers. Paper presented at the annual convention of the Oregon Speech-
Language and Hearing State Conference, Salem, OR.
Leacox, L., Wood, C., Sunderman, G., & Schatschneider, C. (2016). Young Spanish-
English language learners’ cognate facilitation on picture naming. Contemporary
Issues in Communication Science and Disorders, 43, 115–128.
90 The late eight
Martinez, S. (2011). Dialectal variations in Spanish phonology: A literature review.

Echo, 6(1), 7–14.
Mattes, L. J. (1995). Spanish articulation measures. Oceanside, CA: Academic Com-
munication Associates.
McNutt, J. C. (1994). Generalization of /S/ from English to French as a result of
phonological remediation. Journal of Speech Language Pathology and Audiology,
18, 109–114.
Morrow, A., Goldstein, B. A., Gilhool, A., & Paradis, J. (2014). Phonological skills in
English language learners. Language, Speech, and Hearing Services in Schools,
45(1), 26–39. doi:10.1044/2013_LSHSS-13-0009
Paradis, J. (2001). Do bilingual two-year-olds have separate phonological systems?
International Journal of Bilingualism, 5(1), 19–38. doi:10.1177/1367006901005
0010201
Pérez, A. M., Peña, E. D., & Bedore, L. M. (2010). Cognates facilitate word recognition
in young Spanish-English bilinguals’ test performance. Early Childhood Services
Journal, 4(1), 55–67.
Perez, E. (1994). Phonological differences among speakers of Spanish-influenced
English. In J. Bernthal & N. Bankson (Eds.), Child phonology: Characteristics,
assessment, and intervention with special populations (pp. 245–254). New York,
NY: Thieme Medical.
Poplack, S. (1980). The notion of the plural in Puerto Rican Spanish: Competing
constraints on (s) deletion. In W. Labov (Ed.), Locating language in time and space
(pp. 55–67). New York, NY: Academic Press.
Prezas, R. F., Hodson, B. W., & Schommer-Aikins, M. (2014). Phonological assessment
and analysis of bilingual preschoolers’ Spanish and English word productions.
American Journal of Speech-Language Pathology, 23(2), 176–185. doi:10.1044/
2013_AJSLP-12-0132
Ray, J. (2002). Treating Phonological disorders in a multi-lingual child: A case study.
American Journal of Speech-Language Pathology, 11, 305–315. doi:10.1044/1058-
0360(2002/035)
Rojas, R., Iglesias, A., Bunta, F., Goldstein, B., Goldenberg, C., & Reese, L. (2016).
Interlocutor differential effects on the expressive language skills of Spanish-
speaking English learners. International Journal of Speech-Language Pathology,
18(2), 166–177. doi:10.3109/17549507.2015.1081290
Smit, A. B., Hand, L., Freilinger, J. J., Bernthal, J. E., & Bird, A. (1990). The Iowa
articulation norms project and its Nebraska replication. Journal of Speech and
Hearing Disorders, 55(4), 779–798.
Taveras, M., Namazi, M., Pazuelo, L., & Casado, L. (2015). Phonological patterns in
Dominican Spanish-English bilingual preschoolers: Implications for assessment.
SIG 16 Perspectives on School-Based Issues, 16(3), 87–98.
Terrell, T. D. (1989). Teaching Spanish pronunciation in a communicative approach.
In P. C. Bjarkman & R. M. Hammond (Eds.), American Spanish pronunciation:
Theoretical and applied perspectives (pp. 196–214). Washington, DC: Georgetown
University Press.
Thomas, S., Nash, R., Thomas, G., & Richmond, D. (2005). The big red book of Spanish
vocabulary. New York, NY: McGraw-Hill.
Thomas, W. P., & Collier, V. P. (2002). A national study of school effectiveness for
language minority students’ long-term academic achievement. Washington, DC:
Center for Research on Education, Diversity and Excellence.
U.S. Census Bureau. (2013). American Community Survey (American FactFinder).

Verdon, S., McLeod, S., & Wong, S. (2015). Reconceptualizing practice with multi-
lingual children with speech sound disorders: people, practicalities and policy.
International Journal of Language and Communication Disorders, 50(1), 48–62.
Williams, C. J., & McLeod, S. (2012). Speech-language pathologists’ assessment and
intervention practices with multilingual children. International Journal of Speech-
Language Pathology, 14(3), 292–305.
Yavaş, M. (2010). Acquisition of /s/-clusters in Spanish–English bilingual children
with phonological disorders. Clinical Linguistics and Phonetics, 24(3), 188–198.
doi:10.3109/02699200903362919
Yavaş, M., & Goldstein, B. (1998). Phonological Assessment and treatment of bilingual
speakers. American Journal of Speech-Language Pathology, 7, 49–60. doi:10.1044/
1058-0360.0702.49
Chapter Four
Speech Sound Disorders,

Literacy, and Curriculum
Jennifer Walz Garrett
Introduction
The use of evidence-based interventions for speech sound disorders that

relate to the curriculum should be a priority of all SLPs working with school-
aged students. This chapter addresses essential educational topics for school-
based SLPs who treat students with speech sound disorders. The two sections
of the chapters are:
n Eligibility
n Linking Interventions with the Curriculum
Eligibility
Before treatment can begin, an SLP must qualify a student for school-based
service. Topics in this section include:
n The Individuals with Disability Education Act

n Compliance Plans and Assessment Frameworks
n Impact on Education
n Frequently Asked Questions
93
94 The late eight
The Individuals with Disability Education Act
For many children in the United States between ages 3 and 21, eligibility
for speech-language services are determined through regulations under the
Individuals with Disability Education Act (2004). The IDEA regulations define
speech sound disorders within the speech or language impairment category
with the following eligibility definition:
Speech or language impairment means a communication disorder, such

as stuttering, impaired articulation, a language impairment, or a voice
impairment, that adversely affects a child’s educational performance.
(Sec. 300.8, IDEA)
The statement means that to qualify for services under IDEA a child must
have an educational disability. “An educational disability requiring the ser-
vices of Special Education is a skills deficit, a health or physical condition,
a functional limitation, or a pattern of behavior that adversely affects educa-
tional performance” (IDEA, 2004).
The following rules guide the eligibility process:
1. Parents, teachers or other members of an agency can start the process

by requesting an evaluation.
2. Parental consent is required prior to the evaluation being started.
3. Multiple individuals, including a variety of school personnel, may collect
and analyze data as part of the evaluation team.
4. Evaluations may consist of formal and/or informal assessments, but
cannot solely rely on one measure.
5. Evaluations should include a review of existing data and any classroom-
based or state assessments that might yield relevant information.
6. All evaluations must include an observation by the teacher and/or related
services provider (Sec. 300.305, IDEA 2004).
Many SLPs use tests such as the Goldman-Fristoe 3 Test of

Articulation (Goldman & Fristoe, 2015), Arizona Articula-
tion Proficiency Scale, 3rd revision (Fudala, 2000), Bank-
son-Bernthal Test of Phonology (Bankson & Bernthal, 1990),
or others to collect information in a formal way. In addition,
an SLP should collect a speech-language sample to analyze
for errors to rule out any language components.
Compliance Plans and Assessment Frameworks
States, districts, or agencies may interpret federal regulations as part of their

compliance plans. These guidelines may include characteristics that the
CHAPTER 4: Speech Sound Disorders, Literacy, and Curriculum 95
student must meet to qualify as having a disability. Educational judgement

is also included to allow flexibility. Additional criteria may include speech
errors expected of children at least one year younger than the student based
on normative data, existence of multiple sound errors, and speech deficits
that impact specific academic subject areas. These additional criteria must
be considered cautiously and carefully.
States may also decide to determine eligibility within an assessment
framework. (Newer school SLPs should consult with their district or agency
administrators about the use of alternative assessment frameworks as part
of state compliance with federal regulations.) To illustrate, some states use
a matrix of Reviews, Interviews, Observations and Tests (RIOT) and Instruc-
tion, Curriculum, Environment and Learner (ICEL) as part of their Response
to Intervention (RtI) or Multi-Tier System of Supports (MTSS) framework.
Within this system, the domains of ICEL are considered, using RIOT to deter-
mine where intervention is needed and if it will be successful. This type
of framework allows for a multidimensional assessment with a focus on
relevancy and functionality. An advantage of an RtI or MTSS model is that it
may allow an SLP to try a short-term small group or individual intervention
to address speech sound disorders before initiating a formal evaluation. If
the intervention proves promising but more intensive services are needed,
the clinician can utilize the data collected within the individualized educa-
tion program (IEP) as part of the evaluation to determine if the child has
a disability.
Speech-language pathologists must carefully consider if

additional criteria are in the spirit of the federal regulations
and the impact they may have on students qualifying for
services. State speech-language-hearing associations and
the American Speech-Language-Hearing Association can be
valuable resources to advocate for change if professionals
find criteria to be overly restrictive.
Impact on Education
Eligibility guidelines often have gray areas regarding what constitutes edu-
cational impact. Multiple times, the American Speech-Language-Hearing
Association has requested clarification from the Department of Education
regarding the educational justification of speech services. The Office of
Special Education Programs (OSEP) first responded to concerns about eli-
gibility of services in 1980 (Martin, 1980). At that time, some states or local
education agencies were narrowly defining eligibility as academic failure
instead of considering the impact of oral communication more broadly on
educational performance.
96 The late eight
After IDEA was updated in 2004, ASHA again asked for clarification from
the OSEP about eligibility for services. Posny (2007) stated: “it remains the
Department’s position that the term ‘educational performance’ is not limited
to academic performance. The determination that a speech and language
impairment adversely affects a child’s educational performance must be
determined on a case-by-case basis, depending on the unique needs of the
child, not based on discrepancies in age or grade performance in academic
subject areas” (Posny, 2007, p. 1). Recent updates to IDEA expand consider-
ations to include implications for nonacademic and extracurricular activities
which may include clubs, recess, and mealtime.
The following research describes the connection between speech sound
disorders and disorders of language and literacy:
n A significant number of students experience speech sound disorders

that negatively impact their school success. Shriberg, Tomblin, and
McSweeny (1999) have conservatively estimated that 3.8% of children
who are 6 years old exhibit speech sound disorders, with another
2% of 6 year olds having a co-occurrence of a speech sound disorder
along with a language impairment and/or cognitive impairment.
n Many studies document the connection between a history of speech
sound disorders and later language and literacy disabilities, including
children who might remediate an articulation or phonology disorder
by age 6, but present with a language or literacy delay in later years
(Catts, 1993; Ehri, Cardoso-Martins, & Carroll, 2014; Farquharson,
2015; McCormack, McLeod, McAlliser, & Harrison, 2009; Nathan,
Stackhouse, Goulandris, & Snowling, 2004; Peterson, Pennington,
Shriberg, & Boada, 2009). Farquharson (2015) conducted a prelimi-
nary study of outcomes for children with remediated speech sound
disorders which appeared to show they were at increased risk for
later literacy delays.
n Several researchers have found that the long-term communication and
literacy outcomes of students with only speech sound disorders are
more favorable compared with those with language impairments only
or those exhibiting both language and speech errors (Catts, 1993).
For example, Catts (1993) found correlations between speech ability
and reading achievement to be non-significant based on results of
tests of children in first and second grade; however, an increased risk
for later reading difficulties was found in children with speech and
language impairments.
n Speech sound disorders may impact later domains related to activity
limitation and participation restrictions (McCormack, McLeod, McAl-
liser, & Harrison, 2009).
Research indicates that SLPs and educators at minimum should monitor the
language and literacy skills of students who have speech sound disorders
or who previously received services. Research also provides some level of

justification of embedding literacy instruction within our speech sound dis-
order interventions.
Frequently Asked Questions
How do we know which kids will struggle with literacy?
Some SLPs may wonder how we know which kids may continue to struggle
with academics after remediation for a speech sound disorder. Under IDEA,
once a speech-language disorder has been remediated, a child no longer has
a disability and is dismissed from services. Farquharson (2015) states, “for a
puzzling group of students, even after services are rendered and the speech
sound disorder has remediated, academic difficulties persist. These academic
difficulties are often in the areas of reading, writing, and spoken language”
(p. 1). Unfortunately, we don’t have a crystal ball to predict. Using research
studies as guidance, we should carefully consider the following potential
areas as being red flags for later academic difficulties:
n Students who have both speech and language impairment,

n Students with long-term speech sound disorders, and
n Students who show difficulty in both oral language skills and reading
comprehension.
Do we keep children who have remediated on

our caseload just in case or dismiss them?
Children with speech sound disorders may receive services from multiple
providers across their childhood. Speech-language pathologists billing insur-
ance or Medicare must document a speech-language disability. School-based
SLPs must also make sure the child meets the definition of being speech
or language impaired under IDEA. Speech-language pathologists receiving
private pay could initially see a client for a speech sound disorder and con-
tinue to work with that child, with parental understanding, in a preventive
manner knowing that some children are at risk for later literacy difficulties.
If an SLP dismisses these students, how does the school monitor make
sure they don’t fall through the cracks? Professionals should make parents
aware that if later concerns develop related to language or learning skills,
they should refer for an evaluation. School personnel can also conduct file
reviews of students who appear to be struggling academically to determine
if they have previously received speech-language services. Within the RtI or
MTSS framework, small-group or individual instruction can be implemented
to determine if a short-term explicit intervention is needed to catch-up the
student or more intensive services are necessary indicating a need for a re-
evaluation and development of a new IEP.
98 The late eight
How do decisions impact our caseload or workload?
School-based SLPs may worry about issues of caseload and workload when
qualifying speech and language impaired students. Although caseload numbers,
minutes of services, or location of services cannot be a decision-making point
for qualifying a student, it is sometimes the elephant in the room.
The American Speech-Language-Hearing Association has stated that SLPs
have a role in working across all levels, serving a range of disorders, ensur-
ing educational relevance, providing unique contributions to curriculum,
highlighting language/literacy, and providing culturally competent services.
These services may include prevention, assessment, intervention, program
design, data collection and analysis, and compliance (ASHA, 2010). There
are no easy solutions to caseload and workload but SLPs must be advocates
for themselves, schools, and ultimately the students they service. The Ameri-
can Speech-Language-Hearing Association has resources available to help
address concerns and provide advocacy.
Linking Interventions with the Curriculum
The following guidelines link interventions for speech sound disorders to

the curriculum:
1. Students who have a speech disorder as determined by an evaluation that

indicates educational relevancy are eligible to receive speech services.
2. Appropriate interventions should be individualized to the client but
rely on sound clinical judgement and a scholarly foundation (Baker &
McLeod, 2011a, 2011b).
3. Interventions should link to the curriculum as much as possible.
4. States may be aligned to the National Common Core (National Governors
Association Center for Best Practices & Council of Chief State School
Officers, 2010) or have their own set of standards.
English Language Arts or 21st Century Skills Standards
Most often, speech sound disorders affect a students’ ability to present infor-
mation or their self-confidence in sharing with teachers and peers. It may
also impact their long-term success in securing a job of their choice.
To justify treatment or to link interventions to content standards, SLPs
may look toward English Language Arts (ELA) or 21st Century Skills stan-
dards. In the Speaking and Listening Strand, a professional may find a stan-
dard worded similarly to the Common Core Standard of “Speak audibly and
express thoughts, feelings, and ideas clearly” (CCSS.ELA-LITERACY.SL.K.6).
In the Language Strand, a statement similar to the Common Core Standard of
“Acquire and use accurately grade-appropriate conversational, general aca-
demic, and domain-specific words and phrases” (CCSS.ELA-LITERACY.L.3.6)

could also be used to justify services for a speech sound disorder. While
the selection of content standards and sound intervention techniques is
necessary, the specific materials an SLP uses can also make a difference in
remediation within a school setting.
Materials
Many intervention techniques require SLPs to select materials or targets to

address articulation and phonological areas of deficits. School SLPs should
strongly consider using literature and curricular materials in interventions.
Commercially available guides like Once Upon a Sound: Literature-Based
Phonological Activities (Smith-Kiewel & Claeys, 1998), Artic and Lit: Materi-
als for Articulation Carryover Using Children’s Literature (Borsch, 1994),
and others cross-reference target sounds or words within books and stories.
Similar resources can also be found or purchased online through websites like
Teachers-Pay-Teachers and TheraSimplicity. In addition, SLPs or other educa-
tors may have blogs where free or low-cost materials that cross-reference
word lists and activities to literature. It is important to remember that these
materials are only as good as the SLP who adapts them to meet a student’s
needs. A sound teaching instructional model instead of a “quiz-show format”
of drilling is necessary if improvement is to occur.
Specific Language Areas
Students experiencing both speech and language or learning disabilities

need very thoughtful instruction to maximize their intervention. This means
considering how to address speech sound disorders while also meeting stu-
dents’ language or learning skills. Early in speech or phonology intervention,
placement for correct production might be emphasized, but as soon as word
level work is utilized, the SLP should make every effort to select words from
the curriculum or words that would benefit students’ long-term outcomes.
Students who present with language or learning disabilities should require
interventions targeting multiple skills. Although this chapter cannot address
all areas of literacy, several examples will be provided along with word lists,
lessons, and additional resources.
The following language, reading, and writing areas are discussed in this
subsection:
n Semantics
n Syntax
n Morphology
n Reading fluency
n Spelling
100 The late eight
Semantics
Vocabulary is an important part of school learning. Much focus has been

placed on Tier I, Tier II, and Tier III vocabulary in recent years (Beck,
McKeown, & Kucan, 2002). Tier I vocabulary is often described as common
words. Tier II vocabulary is academic vocabulary that goes across content
areas. Tier III vocabulary is often specific to content areas. As SLPs are
considering words to use to address speech sound disorders, they should
consider selecting Tier II vocabulary. Although there are several vocabulary
interventions that an SLP can consider, using the Tier II words provides more
bang for your buck.
A six-step process for teaching vocabulary has been described by
Marzano and Simms (2013) which could be implemented by educators as
well as the SLP. The steps include:
1. Provide a description, explanation, or example of the new term.

2. Ask students to restate the description, explanation, or example in their
own words.
3. Ask students to construct a picture, symbol, or graphic representing the
term or phrase.
4. Engage students periodically in activities that help them add to their
knowledge of the terms in their vocabulary notebooks.
5. Periodically ask students to discuss the terms with one another.
6. Involve students periodically in games that allow them to play with the
terms (Marzano & Simms, p. 14).
These authors provide a list of words that are linked to standards in the
common core and might also be addressed in state standards. Words are
defined in a student-friendly way and cross-referenced with ELA and Math
Standards. Educators could cross-reference a list from this resource or similar
resources by targeted speech sound that would also go across content areas
(Table 4–1).
Table 4–1. Tier II Vocabulary Targeting /r/
Sounds Initial /r/ Initial /s/

Report Sort
Respond Select
Reason State
Resolve Summarize
Repeat Solve
Source: Modified from Marzano & Simms, 2013.
Using curricular material can be a good starting point for selecting vocab-
ulary. In additional, other resources are available for educators to narrow
down academic vocabulary. Coxhead (2000) conducted research and created
an extensive academic word list made up of 570 word families. Sublists of
words were created based on their frequency of use in English. Reviewing the
sublists, an SLP may select target articulation words that address the student’s
speech sound disorder. An example is provided in Table 4–2.
Finally, resources in books or on websites may provide vocabulary lists
that are linked to popular fiction and nonfiction books. Speech-language
pathologists should be critical consumers of these materials. Justice, Schmitt,
Murphy, Pratt, and Biancone (2014) found that SLPs often selected basic
vocabulary to target instead of academic rich vocabulary even though basic
vocabulary is often learned in context. Beck, McKeown, and Kucan (2002)
outline common books used by grade levels and the Tier II vocabulary that
could be targeted by educators. Even a classic story that might be considered
easy for children like Caps for Sale (Slobodkina, 2015), first published in
1940, has complex vocabulary like “ordinary,” “refreshed,” and “imitate” (Beck,
McKeown, & Kucan, 2002). If a child was working on /r/ targets, teaching
the words “ordinary” and “refreshed” would have more academic carryover
than selecting the words “street,” “red,” “gray,” “under,” and “tree,” which most
students would already have been exposed to in everyday conversations. SLPs,
along with other educational team members, need to use their best judgment
in selecting academic targets. Even though there are resources available, there
is no exact criteria or recommended sequence to decide if a word is Tier I,
Tier II, or Tier III and the order or grade level that words should be targeted.
Syntax
As students improve their speech sound production, often SLPs will ask
them to use words in sentences. If syntax is an issue for students, treatment
Table 4–2. Target Academic Words a Speech-Language Pathologist

Might Select by Speech Sound
Initial [r] Final [r] Initial [s] Final [s]

1. Respond 1. Consumer 1. Site 1. Benefits
2. Range 2. Legislator 2. Seek 2. Economics
3. Regulate 3. Labor 3. Similar 3. Equates
4. Region 4. Computer 4. Select 4. Obvious
5. Retain 5. Culture 5. Summary 5. Refocus
Note. Words selected from http://www.victoria.ac.nz/lals/resources/academic
wordlist/sublists
102 The late eight
words can be selected to both address speech production and teach specific
syntactic structures. Eisenberg (2007) provides an in-depth look at later-
developing grammatical structures, including noun phrase expansions, verb
form expansions, predicate expansions, conjunctions, complement clauses,
adverbial constructions, and other sentence constructions. These advanced
grammatical structures may be overlooked as students remediate the most
basic syntactic skills. Using a discrete skills approach, an SLP may select
target words to address speech and model, drill, or sentence-combine with
students to work on syntax. Mini and micro lessons embedded in writing
can strengthen and assist with carryover of skills. An example of sentence
expanding is provided in Table 4–3.
Morphology
An SLP can address morphology and speech sound disorders concurrently.

For example, a student may need instruction about marking plurals and have
errors on /s/ and /z/. The SLP can teach the student that “more than one” is
often marked by adding an “s” or “es” to the end of words. Sometimes that
“s” sounds like an /s/ but it can also sound like /z/ and /Iz/. Voiceless final
sounds in words result in the voiceless /s/ being added to indicate plurals.
Voiced final sounds in words result in the voiced /z/ being added to the end
to indicate plurals. For words that end in /ʃ/, /tʃ/, /dZ/, /s/, and /z/, the /Iz/
is the final sound. Table 4–4 provides select target plurals. Similar lessons
could be created to teach other morphology, including third person singular
and possessives.
Table 4–3. Instructional Sequence for Sentence Expanding Targeting

/r/ Words
The speech-language pathologist Simple sentences that target /r/:

introduces the concept of sentences The car is ready.
while reminding students that they
The car is in the race.
are working on the /r/ sound.
The car is red.
The speech-language pathologist Combined sentence:
talks about how to combine The red car is ready.
sentences. First, the student might
learn to identify a describing word
and combine it into a longer
sentence.
As the student becomes competent Sentence combining three simple
in initial lessons, combining multiple sentences that target /r/:
sentences can be targeted. The red car is ready to race.
Table 4–4. Target Words by /s/, /z/, and /Iz/
Sound Indicating
Plural /s/ /z/ /Iz/
cats dogs beaches
hats frogs couches
socks cars stitches
blankets bowls boxes
lamps games badges
coats bananas lunches
disks bands sandwiches
lights beads judges
books eggs buses
chips cubs quizzes
Reading Fluency
Educators often use short passage or grade level readers to target and measure
reading fluency. Reading fluency has been defined as reading accurately,
quickly, and with expression. After the National Reading Panel report was
released (National Institute of Child Health and Human Development, 2000),
assessments and instruction around reading fluency has increased. Reading
fluency improves through treating decoding skills and comprehension.
One popular intervention that can improve reading fluency while also
addressing motivation is Reader’s Theatre (Leahy & Justice, 2007). Reader’s
Theatre combines reading aloud for guided reading practice, supported
reading to help target decoding skills, repeated reading to improve fluency,
and performance reading to practice strategies. The ultimate goal is to
perform for an audience. Students who have reading disabilities along with
a speech sound disorder can identify words with treatment sounds within a
Reader’s Theatre script. This also allows multiple educational professionals
to be involved in using the same script for multiple purposes but providing
repeated readings to improve reading fluency. Below is an example script
that might be used to address reading fluency, motivation, and speech sound
targets. The SLP should read the script and select or modify the parts to treat
speech sounds. In the example in Table 4–5, the SLP has underlined target
/r/ words for the students to practice.
Spelling
Spelling is an area of instruction that relates to vocabulary, reading, and

writing. Within a spelling focus, spellers are taught that the sounds of speech,
104 The late eight
Table 4–5. Three Billy Goats Gruff Script with /r/ Words Underlined
Three Billy Goats Gruff Reader’s Theatre Script

Narrator 1: Welcome to our show. Today’s play is The Three Billy Goats Gruff.
Narrator 2: As Little Billy Goat Gruff strolls through the fields he sees a rickety,
old bridge. On the other side of the bridge is a meadow with green, green
grass and apple trees.
Little BGG: I’m the littlest billy goat. I have two big brothers. I want to go
across this bridge to eat some green, green grass and apples so that I can
be big like my two brothers.
Source: https://www.aea267.k12.ia.us/system/assets/uploads/files/25/three_billy_
goats_readers_theatre_script.pdf
i.e., phonemes, are related to letters, i.e., graphemes. This phonological per-
spective of spelling is only one part of learning to spell; other sources of
knowledge include graphotactic (what words look like) and morphological
knowledge (understanding the relationship of roots to prefixes and suffixes)
(Bourassa & Treiman, 2014).
Wolter and Squires (2014) discuss a multilinguistic approach that inte-
grates phonological awareness, orthographic knowledge, and morphological
knowledge using explicit instruction. Another program that SLPs and other
educators could consider would be the SPELL-Links to Reading & Writing: A
Word Study Curriculum (Wasowicz, Apel, Masterson, & Whitney, 2004). For
students with speech sound disorders, lessons could incorporate linguis-
tic areas of deficit along with target words that include speech errors. For
example, Lesson 3 of the SPELL-Links program assists students in developing
the “ability to segment phonemes and map letters to the pre-vowel consonant
/r, l/ sounds” (Wasowicz, Apel, Masterson, & Whitney, 2014, pp. 1–26). The
starter word list includes words like red, lip, let, and ran, which are words
also commonly targeted by children working on /r/ and /l/ in articulation
therapy. This targeted area includes three lesson plans for students to be
taught and practice the skills. Overall, the SPELL-Links program provides 73
lesson topics with three to five plans for each area. The SPELL-Links program
is just one example of a commercially available program that can be used to
target spelling in a systematic way but also provide students the opportunity
to practice improving their articulation and phonology skills.
Conclusion
School SLPs play a vital role in remediating speech sound disorder. The use
of evidence-based interventions for speech sound disorders that relate to
curriculum should be a priority of all SLPs working with school-age students.
Resources are available in the form of state standards, classroom curricular

materials, and specialized programs. It is important for school-based SLPs
to understand qualification for services under IDEA as well as consider
additional criteria proposed by states, districts, and agencies in interpreting
those regulations. Some students may have additional communication or
literacy disorders that need to be addressed. Ultimately, the SLP is part of an
educational team and collaboration is necessary to improve the long-term
outcomes of all students. Addressing curricular needs in speech-language
therapy and closely monitoring their future outcomes will allow each child
to achieve his or her educational potential.
References
American Speech-Language-Hearing Association. (2010). Roles and responsibilities of

speech-language pathologists in schools [Professional issues statement]. Available
from http://www.asha.org/policy
Baker, E., & McLeod, S. (2011a). Evidence-based practice for children with speech
sound disorders: Part 1 narrative review. Language, Speech, and Hearing Services
in Schools, 42(2), 102–139.
Baker, E., & McLeod, S. (2011b). Evidence-based practice for children with speech
sound disorders: Part 2 application to clinical practice. Language, Speech, and
Hearing Services in Schools, 42(2), 140–151.
Bankson, N. W., & Bernthal, J. E. (1990). Bankson-Bernthal Test of Phonology. Austin,
TX: Pro-Ed.
Beck, I., McKeown, M., & Kuckan, L. (2002). Bringing words to life: Robust vocabu-
lary instruction. New York, NY: Guilford Press.
Borsch, J. C. (1994). Artic and Lit: Materials for articulation carryover using chil-
dren’s literature. Youngtown, AZ: ECL Publications.
Bourassa, D., & Treiman, R. (2014). Spelling development and disability in English.
In C. A. Stone, E. Sillman, B. Ehren, & G. Wallach (Eds.), Handbook of language
and literacy (pp. 569–583). New York, NY: Guilford Press.
Catts, H. W. (1993). The relationship between speech-language impairments and
reading disabilities. Journal of Speech, Language, and Hearing Research, 36(5),
948–958.
Coxhead, A. (2000). The Academic Word List. Retrieved from http://www.victoria.ac
.nz/lals/resources/academicwordlist/
Ehri, L., Cardoso-Martins, C., & Carroll, J. (2014). Developmental Variation in Reading
Words. In C. A. Stone, E. Sillman, B. Ehren, & G. Wallach (Eds.), Handbook of
language and literacy (pp. 385–407). New York, NY: Guilford Press.
Eisenberg, S. (2007). Grammar: How can I say that better? In T. Ukrainetz (Ed.),
Contextualized language intervention (pp. 145–194). Greenville, SC: Thinking
Publications.
Farquharson, K. (2015). After dismissal: Examining the language, literacy, and cogni-
tive skills of children with remediated speech sound disorders. Perspectives in
School-Based Issues, 16(2), 50–59. doi:10.1044/sbi16.2.50
Fudala, J. B. (2000). Arizona Articulation Proficiency Scale, 3rd revision. Torrance,
CA: Western Psychological Services.
106 The late eight
Goldman, R., & Fristoe, M. (2015). Goldman-Fristoe 3 Test of Articulation. Min-

neapolis, MN: Pearson Assessments.
Individuals With Disabilities Education Act, 20 U.S.C. § 1400 (2004).
Justice, L. M., Schmitt, M. B., Murphy, K. A., Pratt, A., & Biancone, T. (2014). The
‘robustness’ of vocabulary intervention in the public schools: Targets and tech-
niques employed in speech-language therapy. International Journal of Language
and Communication Disorders, 49(3), 288–303.
Leahy, S., & Justice, L. (2007). Promoting reading fluency and motivation through readers
theatre. In T. Ukrainetz (Ed.), Contextualized language intervention (pp. 469–
502). Greenville, SC: Thinking Publications.
Martin, E. (1980). Letter to Stan Dublinske, American Speech-Language Hearing
Association from E. Martin at Office of Special Education Programs.
Marzano, R., & Simms, J. (2013). Vocabulary for the Common Core. Bloomington, IN:
Marzano Research Laboratory.
McCormack, J., McLeod, S., McAllister, L., & Harrison, L. J. (2009). A systematic review
of the association between childhood speech impairment and participation across
the lifespan. International Journal of Speech-Language Pathology, 11(2), 155–170.
Nathan, L., Stackhouse, J., Goulandris, N., & Snowling, M. J. (2004). The development
of early literacy skills among children with speech difficulties: A test of the criti-
cal age hypothesis. Journal of Speech, Language, and Hearing Research, 47(2),
377–391.
National Governors Association Center for Best Practices & Council of Chief State
School Officers. (2010). Common Core State Standards (CCSS). Retrieved from
http://www.corestandards.org/ELA-Literacy/
National Institute of Child Health and Human Development (2000). Report of the
National Reading Panel. Teaching children to read: An evidence-based assessment
of the scientific research literature on reading and its implications for reading
instruction. NIH Publication No. 00–4769.
Peterson, R. L., Pennington, B. F., Shriberg, L. D., & Boada, R. (2009). What influences
literacy outcome in children with speech sound disorder? Journal of Speech,
Language, and Hearing Research, 52(5), 1175–1188.
Posny, A. (2007). Letter to Catherine Clark, American Speech-Language Hearing
Association from A. Posny at Office of Special Education Programs.
Shriberg, L. D., Tomblin, J. B., & McSweeny, J. L. (1999). Prevalence of speech delay in
6-year-old children and comorbidity with language impairment. Journal of Speech,
Language, and Hearing Research, 42(6), 1461–1481. doi:10.1044/jslhr.4206.1461
Slobodkina, E. (2015). Caps for sale. New York, NY: HarperCollins.
Smith-Kiewel, L., & Claeys, T. M. (1998). Once upon a sound: Literature-based pho-
nological activities. Eau Claire, WI: Thinking Publications.
Wasowicz, J., Apel, K., Masterson, J., & Whitney, A. (2004). SPELL-Links to reading &
writing. Evanston, IL: Learning By Design.
Wolter, J., & Squires, K. (2014). Spelling instructional and intervention frameworks.
In C. A. Stone, E. Sillman, B. Ehren, & G. Wallach (Eds.), Handbook of language
and literacy (pp. 602–618). New York, NY: Guilford Press.
Chapter Five
Motor Learning
Guided Therapy
Carlin Hageman
Introduction
Teaching a young child to produce speech to match the culturally accepted

norm is no easy feat. True, some children seem to be natural pleasers who
will do anything that you suggest. Others tend to go along with you when
there seems to be a good reason to do it. Finally, there are children who
actively resist practicing new ways of talking, perhaps because they cannot
see the point or because they just do not place practicing speech at a higher
priority than fooling around. This chapter is not going to provide you with a
magic bullet to reach all of those children, but it may provide you with the
tools to modify your therapy so that the child learns the most he or she can
in the few minutes you have for practice. That is important because we are
under great pressure to produce better results, in a shorter time, using fewer
resources. Therefore, the goal of this chapter is to help you plan therapy that
has the potential to address those demands.
Many of us have attempted to learn a new motor skill or one that was
difficult. Some of us have tried to teach or coach young learners to play a
musical instrument or master an athletic skill. As speech-language patholo-
gists, we are concerned about teaching articulatory skills (motor skills) to
young children who have failed to learn how to articulate the sounds of the
language. This chapter will address the motor learning components of articu-
lation while fully realizing that articulation is just one component of the
complicated system of linguistic and motor competences.
107
108 The late eight
Much of what is known about motor learning arises from disciplines

other than speech pathology, and little literature exists that examines the
principles of motor learning in speech. In my opinion, it is crucial that
speech-language pathologists explore new ways of thinking about therapy
to make our therapy more efficient and more likely to engender carryover
to real world communication. Thus, I have chosen to utilize the principles
of motor learning — Motor Learning Guided (MLG) — to structure practice,
knowing full well that all of the principles are not yet delineated in their
relative efficiencies and inefficiencies with respect to articulation.
Thinking About It
Have we ever delineated all of the procedures and pro-
cesses that we currently use (e.g., immediate or constant
feedback)? Have we considered if behavior modification is
the correct model for practice of a motor skill? Do our tradi-
tional methods work? Of course they do for many learners,
but are they suitable for everyone and the most efficient
and cost effective?
Motor Skill
Motor Control
Clearly all of us have learned motor skills in a variety of domains to greater

and lesser degrees. Some of us have amazing aptitudes for certain motor
skills — the athlete or musician who seems to be able to accomplish any
complex feat of athletic skill or perform the most complex musical pieces. On
the other hand, most of us are able to accomplish the most amazing athletic
feat of all — we talk. For example, Netsell (1991) noted that speech required
a minimum of 140,000 neuromuscular events per second (14 phonemes
per second × 100 muscles × 100 motor units per muscle). It is a remarkable
achievement that most of us attain. Why do some children find talking so dif-
ficult and some find it almost impossible to acquire? For example, the causes
are relatively apparent in children with motor speech disorders and hearing
loss. In others, the underlying causes are not obvious. Recently, Redle and
colleagues (2015) demonstrated fine motor praxis in children with persistent
speech disorders. For the present discussion, we are going to consider that
the process of motor learning is disrupted, and discuss the variables that we,
as speech-language pathologists, can control in the context of practice for
learning to speak.
CHAPTER 5: Motor Learning Guided Therapy 109
Thinking About It
What could disrupt motor learning of articulation? What are
the necessary capabilities for learning the skill of speaking?
Although it is not certain that learning to talk is affected by the same

principles that have been shown to be effective for motor learning in other
domains, it is certain that speech is a highly complex motor skill and that
we can speak “automatically” with little effort or attention directed to the
motor control aspects of speaking. Since the effort is low to control the motor
aspect of speech for most of us, we can attend to the social context, linguistic
structure, and communicative intent. Controlling complex motor activities
with low effort suggests that speech may be controlled by motor programs,
which are automatic mechanisms of motor control. Is there evidence for
programmatic control of speech? One example was provided by Robin et al.
(2008), who demonstrated that normal speakers and speakers with apraxia of
speech or dysarthria differ in their ability to track a moving target with their
jaw, lips, and voice. Essentially, apraxic speakers could not track a predict-
able target as well as normal or dysarthric speakers. On the other hand, the
apraxic speakers could track an unpredictable signal as well as the normal
or dysarthric speakers because all three groups used closed-loop control
(nonprogrammatic) for unpredictable targets. The findings were interpreted
as evidence for motor programming in the control of speech. Backlin et al.
(2008) and Gaughan, Howard, and Hageman (2009), using a speech inhibi-
tion task, found evidence of programmatic or automatic control of speech
in adults and children.
Closed Loop and Open Loop
Schmidt and Wrisberg (2008) described two methods of motor control —closed-
loop and open-loop control. Closed loop is characterized by slow movements
because the movements are constantly modified by sensory feedback about
the movement and the environment. Closed-loop control is slow and the
effort is intensive; consequently, it’s too slow to control the fast movements
of speech. In contrast, during open-loop control, the performer recalls a set
of instructions (or programs) for controlling muscle movements that, once
initiated, are completed without modification. Open-loop control systems are
fast because the movements (instructions) are completed without modifica-
tion. The disadvantage of open-loop control is that when the environment
changes, the performer is unable to change the movement once it has been
initiated. If the wrong movement is planned, it is likely to be executed before
the performer can stop it. Since the open-loop control system demands low
110 The late eight
effort or attention, the performer can pay attention to the environmental

demand (e.g., listeners) and plan subsequent movements.
Because nearly all movements occur within unique contexts, do skilled
performers remember all possible movements or programs? Schmidt and
Wrisberg (2008) pointed out that memory limitations preclude that possibility
and developed schema theory to complement the notion of general motor
programs. Although this is not a suitable venue for a lengthy discussion of
their model, a basic understanding of the principles of motor learning is
necessary. The reader is referred to Maas et al. (2008) for a detailed review of
schema theory and to Schmidt and Wrisberg (2008) for complete explanation.
Schema Theory
Underlying schema theory is an assumption that there are units of motor

activity (motor programs) and that these motor programs (MPs) are stored
and retrieved from memory and adapted to the specific requirements of
the moment (Schmidt, 1988; Schmidt & Wrisberg, 2008). These MPs have
invariant and variant features. The invariant features include the temporal
relationships between components (timing) and order of events. The variant
features consist of elements of a movement that can vary (e.g., absolute
speed, loudness). The size of the unit in speech has not been specified for
certain, but Stetson (1951) hypothesized that it was the syllable. Carr (2004)
demonstrated that invariant feature control across at least three syllables was
present in young children as early as 5 years (i.e., the children maintained
relative timing and order across rates of speech). Although the syllable may
be a core feature of speech, it would seem that speech motor programs can
be longer than one syllable. Backlin et al. (2008) and Gaughan, Howard,
and Hageman (2009) found that program length was at least two to three
syllables in adults using a refractory time test. Because speech consists of
nearly an infinite variety of phoneme and syllable combinations and given
the infinite array of initial conditions, goals, and motor modalities, it is not
possible to remember all programs. Schmidt (1988) proposed that the pro-
grams are generalized and then organized for the specific act needed.
Once the intent to speak has arisen, schema theory suggests that certain
processes must occur (Figure 5–1). The motor control system of the performer
must be aware of initial conditions, both internal and external (e.g., the
structures involved in the movement and the characteristics of the environ-
ment relevant to the goal). For example, in golf, the player is knowledgeable
(though not necessarily cognitively aware) of the muscular system status,
joint positions (internal), and target place (external), and the recall schema
uses this information to recall a generalized motor program (GMP) and to
predict the outcome of the movement. Once the movement is generated, the
information is stored in the recognition schema where the outcome of the
movements, the prediction of the movements, and the consequences (both
Figure 5–1. Processes hypothesized to occur when intent to speak is formed.
internal and external) are compared with the actual outcomes (internal and
external). When there is a mismatch between the predicted external (desired)
outcomes, the learner can tweak the GMP to attempt to make the next move-
ment more accurate or examine the intended internal sensations to ensure
that the intended movement was actually completed. In a sense, the learner
uses the errors to create a better GMP for the next attempt, either for the
specification of the invariant features of the plan (stay the same across many
different iterations of the movement) or the variant features of the plan (vary
112 The late eight
with specifics of the target [e.g., greater force]). From this writer’s perspec-
tive, we can hypothesize potential influences that may create problems for
the learner.
First, if the learner does not have an idea of the correct target, practice
attempts are not modifiable. For example, a deaf child or a child with audi-
tory processing problems may not have a clear notion of speech targets.
Second, the learner must be aware of the initial conditions. For example, the
learner must “know” the internal conditions (e.g., the position of the tongue,
jaw position, muscle tone, and respiratory system status). Further, even if the
learner knows the initial conditions, the learner must have feedback about
the dynamic changes that occur during the movements. If the learner does
not receive accurate feedback or no feedback at all, then the next attempt
will not be corrected in any systematic way — resulting in nearly random
trials. Finally, the learner must be aware of the external conditions, meaning
whether the movement had intended consequences on or for the target (e.g.,
did I make the correct phoneme or did the listener get the message?). Schema
theory suggests that all of this information is held in memory and compared
with the outcome of the movement. Thus, the learner must be able to hold in
memory the initial condition information long enough to compare it (which
also takes time and mental effort) to the outcome. Hence, the comparison is
dependent upon accurate and timely internal and external feedback as well
as the ability to remember and process the information. Factors that have
been shown to interfere with mental processing may include distraction and
arousal levels that are too high or too low (Kahneman, 1973). The sections
that follow are this author’s attempts to utilize this information to construct
therapy practice.
Thinking About It
Do we have diagnostic tests for these variables? Hearing—cer-
tainly, tests are available for hearing across the frequency
spectrum but maybe not for dynamic hearing. Internal con-
ditions — no, for ability to know tactically, kinesthetically,
etc., the conditions of the speech production mechanism.
What does that mean? Perhaps for some learners, we can be
making serious errors assuming that they know “articula-
tory movements.” And no, for testing the ability to hold
in working memory the motor plan and compare it with
results. What about attention? Do we measure the learner’s
ability to attend to information about a movement long
enough to make adjustments to the plan and commit the
adjustments to memory?
Principles of Motor Learning
Learning Versus Acquisition
Before we delve into the specifics of motor learning applied to speech prac-
tice, we need to make the distinction between acquisition performance and
learning. Acquisition performance refers to the momentary strength of a
pattern (skill) during practice, whereas learning refers to what the learner
remembers at a point remote from the practice. This can be measured as
retention, generalization, and spread. The important point for this discussion
is that during acquisition (practice), both the learner and the therapist will
do things to improve performance during practice that will be detrimental
to retention or generalization (e.g., constant feedback with description and
cuing). More will be said about this in the feedback section. Learning can also
be inhibited during practice by constant evaluation, which may affect arousal
levels. Many of us have seen the anxious child looking over our shoulder
trying to catch a glimpse of the scores (Hageman, Mueller, Burda, & Bleile,
2004; Maas et al., 2008; Schmidt & Wrisberg, 2008).
Thinking About It
What is the purpose of saying “good job” after each trial?
What are the consequences of praise after each trial? When
is the learner allowed to make the internal comparisons
about the adequacy of the movement? How much time is
necessary to make that comparison? What capabilities does
the learner need to have to make those comparisons and
use them? How or when does clinician behavior interfere
with learning?
Prepractice
Before practice begins, the learner should be prepared for practice (Schmidt
& Lee, 2005). Maas et al. (2008) suggested three goals of prepractice, includ-
ing: (a) motivation to learn, (b) adequate understanding of the task, including
a basic knowledge of correct, and (c) stimulability for acceptable responses
to avoid frustration. Although I think these are worthy goals, in my experi-
ence, it is important not to expect prepractice attempts to be accurate before
practice begins. For me, it is more important that the learner is able to vary
the productions. As a clinician, one must broaden acceptable responses to
include the ability to systematically vary movements even when they are
incorrect with respect to the “correct” response. This is a difficult task for
114 The late eight
the clinician because as mature language users, we listen categorically to

speech production. Hence, we can easily miss productions that are closer
to the target but not yet crossing the categorical boundary into the correct
sound. We have to listen phonetically rather than phonemically, especially
for early learners.
As part of the prepractice time, it is important to gather information
about the invariant and variant features of the learner’s speech. The invariant
features include the rhythm or prosody of the utterances, including the rela-
tive durations of segments and the order of the movements. Several research-
ers, including Schmidt and Wrisberg (2008) and Schmidt and Lee (2005) have
observed that practice addressing the invariant features should precede the
practice with the variant features (i.e., articulation of individual sounds).
Thinking About It
To learn to throw a baseball or softball, it is necessary
to learn the order of movements before worrying about
accuracy of the throw (e.g., correct starting point, opposite
leg motion, rotation of the hips, then rotation of shoulders,
then the arm forward motion and then the wrist snap).
What about speech? What are the correct starting positions?
What is the first movement, the second, and so on? How
much relative time should those movements consume? Do
we test or observe these events?
Selecting goals is another important aspect of prepractice. In my approach

to motor learning guided practice, I try to keep it simple and designate the
learner as on a continuum from an early learner to an advanced learner. The
point is that goals for early learners should be more performance oriented
(e.g., better lip position) and advanced learners should be more results
oriented (e.g., correct phoneme). Above all, the goals should be within reach
of the learner.
Understanding the task is an element of prepractice that has several
dimensions. For an adult with a motor speech disorder, Maas et al. (2008)
recommends that the learner be provided with a reference of correctness and
explanations of why it is correct or not. From my perspective, explanations
using details about the error, the nature of the error, or mechanism of the
error add too much cognitive load to the learning process, especially for chil-
dren. Most of us have probably experienced the zealous coach or instructor
who overwhelmed us with detail until we were paralyzed by analysis. One
common trick to play on a fellow golfer is to ask: “Do you always hold your
fingers that way?” Maas et al. (2008) cautioned us to avoid complex, lengthy
explanations and to use instructions that match the comprehension abilities

of the learner. Most of us probably could recall providing instructions and
feedback that were more complex than the task the learner was practicing.
Practice
Maas et al. (2008) provided an outstanding breakdown of the different ways

that practice can be addressed, and it is beyond the scope of this chapter
to go into detail about each one. Figure 5–2 shows many elements that may
influence motor learning. In general, the more practice, the better; but you
must take into account fatigue, which detracts from the benefit of practice.
In addition, large amounts of constant practice are contraindicated. Conse-
quently, practice distribution is an important consideration, especially in
early learners for whom fatigue or motivation may be a problem.
Thinking About It
Why does fatigue affect practice? Does it affect attention
through low arousal, which means that focused attention is
difficult? Does it mean the learner loses interest and does
not “tweak” the motor plan after a trial using mental effort?
Variable practice has been shown to be superior for enhancing learning

during practice. In a sense, the less predictable the practice items are, the
more challenging the task. Guadagnoli and Lee reported that increased dif-
ficulty during practice enhances learning (Guadagnoli & Lee, 2004). Other
research has shown that forcing the learner to generate a plan for each prac-
tice attempt has positive effects on learning. Schmidt and Wrisberg (2008)
have reported that even imaging (visualizing) the movement has positive
effects on learning. Mass and Mailend (2012) demonstrated that motor speech
planning takes place before speech execution. It is my belief that imagining
performance is a powerful technique to enhance practice.
Thinking About It
We defined motor learning as what the learner remembers
how to do at a time remote from the practice. If you score
acquisition behavior (i.e., during practice), the tendency is
to simplify practice and provide more feedback and cuing
to achieve higher acquisition scores, but that comes at the
price of poorer retention.
116
Figure 5–2. Principles of motor learning.
Using random practice can be more beneficial for learning than blocked
practice. In our experience, blocked practice may be more effective for the
early learners, whereas random practice is more effective for the advanced
learner. However, when we use blocked practice, we must allow for learning
from each repetition of the production. Therefore, we impose delays of up
to 5 seconds between reiterations of the practice item. During the pause,
we do not allow the learner to talk, play games, or fidget or the clinician to
speak because we have hypothesized that one variable underlying the poor
learning of speech is a lack of attention devoted to the recognition schema
and modification of the GMP.
Focus
Where should the learner focus his/her attention during practice? The learner
has two options in that he/she can focus on the internal aspects of the
movement (e.g., kinesthetic, kinematic, and somatosensory, as in the feel of
the tongue during the production of the /r/) or the external aspects (e.g.,
how does the /r/ sound or how does the listener respond?). The evidence is
very strong that an external focus produces a strong advantage for learning
in the nonspeech motor domain. The movements tend to be more accurate
and less variable, but even so, there may be some interaction between the
level of performance (new or more experienced learner) and the task (Wulf,
Shea, & McNevin, 2003).
Thinking About It
This issue may lie at the heart of some children trying
to learn to speak. When clinicians suggest that attention
be directed to the feel of the act, they assume that the
mechanisms of perception are normal. Our current state of
the art does not allow us to test those senses. Because the
movements of the pharynx, velum, and tongue essentially
are invisible to the learner, poor sensory ability to detect,
identify, and remember sensations of speech may make
internal focus of feedback and instruction frustrating. On
the other hand, some ability to know what the structures
are doing is necessary (not necessarily at the conscious
awareness level) or the next try is essentially random.
External focus is thought to enhance learning because the learner is not

encouraged to constrain the motor system through conscious control, and the
more automatic motor response is encouraged (e.g., Lisman & Sadagopan,
2013). One could also think of this as a conflict of open- versus closed-loop
118 The late eight
control. Paying attention to internal characteristics is effort intensive and

slow, thus encouraging the use of a closed-loop control system, which is
neurophysiologically different from open-loop control. Consequently, one
would not expect a great deal of learning or generalization to automatic
performance from closed-loop practice.
However, since external versus internal control of speech movements
has not been investigated up to this point, we will have to make some
assumptions. First, we know that speech movements are highly complex and
fast. Second, we know that speakers proceed with talking with little effort
allocated to the internal aspects of speech. Consequently, at present, I am
willing to assume that speech learning has more in common with rapid,
complex nonspeech movement learning than not. I am going to suggest that
we stress external focus to our clients (Lisman & Sadagopan, 2013). Thus,
what does the speech sound like and what is the effect on the environ-
ment? Turning our clients into “mini” SLPs with complicated explanations is
counterproductive because it directs their attention to internal factors, which
require too much effort to utilize during speech production. This advice is
not pervasive, because a learner who did not know how to start producing
a sound may need some advice about the starting position and the first
articulatory movement.
Thinking About It
But here we are, right back at the point at which we need
to know, what are the sensory capabilities of the learning
with respect to movements of the oral structures? Indeed,
another assumption we often make is that if the hearing
sensation levels are adequate, then the learner can hear the
sounds. Is that always true?
Feedback
From my perspective, traditional articulation therapy mixes up feedback with

reinforcement. Operant reinforcement strategies are utilized to increase or
decrease behaviors by providing immediate reinforcement or punishment.
Operant techniques clearly have a role in therapy, especially behavioral
management, but they should not be confused with feedback.
Feedback is information about the performance or the outcome of the
performance. Two sources of feedback are possible (see Figure 5–2). Internal
or intrinsic feedback is what the performer can discern from his/her own
senses about the results of the movement and about the movement itself.
External feedback is information supplied to the performer by a coach or
therapist. Schmidt and Wrisberg (2008) were emphatic that external feedback
that duplicates that which the performer can perceive has a neutral effect at
best and more commonly is detrimental to learning. Consider how irritating it
would be for a coach to keep telling you that you made the basket when you
can see that you did (literature is clear that arousal levels that are too high
interfere with learning). In addition, Schmidt and Wrisberg (2008) reported
that excessive feedback contributes to dependency upon the coach or thera-
pist for correct performance rather than internal direction or evaluation.
Thinking About It
The key word about feedback is duplication. How do we
know when we duplicate the intrinsic feedback of the
learner? Because we cannot measure internal feedback, in
which direction should we err? In my opinion, we should
err on the side that the learner can do it — albeit with com-
munication that focuses his or her attention on it and the
learner is provided with plenty of time to use it. How much
time is plenty? Note that focusing attention on internal feed-
back is not the same as giving feedback. Using cognitive
“questioning,” like how did that feel? etc., is counterpro-
ductive because it misdirects attention and effort involved
in evaluating performance and is a difficult cognitive task
(e.g., can you put into words how it feels to elevate your
velum during speech?).
On the other hand, when internal feedback mechanisms are absent or

deficient, then the coach or therapist must provide the information or direct
the learner’s attention to the variable. Schmidt and Wrisberg (2008) described
two types of external feedback: knowledge of results (KR) and knowledge
of performance (KP). KR is information about the result of the movement
in the world (e.g., that sound was correct). KP is information about the
performance of movement (e.g., your lips were too rounded). My experience
with traditional practice structure has led me to believe that KP and KR are
used much too frequently and that little consideration is given to whether
the learner can discern the information without feedback. So, where does
that leave the clinician?
The principles of motor learning have not yet been investigated to the
point where specific rules and guidelines can be proposed for the use of
feedback for speech practice. Following Schmidt and Wrisberg (2008), with
respect to feedback, less is more and delayed is better. In other words, the
clinician should strive to use only the feedback that the learner needs and
make the learner wait for it. The clinician must use his/her best clinical
judgment to determine the needs of the learner.
120 The late eight
Thinking About It
Why make the learner wait for it? From my perspective, I am
hypothesizing that with practice the learner may begin to be
able to use internal feedback. Forcing him or her to wait for
KR or KP may provide an opportunity to use that internal
feedback and give the learner time to compare the actual
movement/result with what was intended. Of course, with this
model you run the risk of duplication of what the learner can
do. Limiting the frequency of feedback may address that issue.
For example, it is obvious that the deaf child needs KR; however, it is
not so obvious that the deaf child needs KP. The deaf child would need KP
providing that he/she could not perceive the movements that led to the KR
received. Further, even KR would not be needed provided the child could
discern the reaction of the environment to the attempted production. In other
words, when the child can determine whether the production resulted in the
desired effect in the real world, then he/she would not need to be told. Of
course, during practice, it might take considerable ingenuity by the clinician
to create communication interactions that lead to independent judgments
by the learner rather than just direct feedback from the clinician. At this
point, the clinician should use every tool available to determine what the
learner can perceive.
Since few, if any, tools are available to the clinician to measure a child’s
ability to perceive the position and movement of the articulators, we need to
go back to the model of the schema whereby the learner modifies behavior
by comparing what he/she intended to do with what actually occurred and
then evaluating the effect on the environment. If the learner — in our case,
the child — is unable to acquire and remember internal and accurate feedback
about the results and the movement, then the comparison cannot be made
in order to adjust the next trial. External feedback is then required.
How frequent should the feedback be? A few investigations have exam-
ined the frequency of feedback in speech (e.g., Kim, LaPointe, & Stierwalt,
2012; Steinhauer & Preston Grayhack, 2000; Wambaugh, Kalinyak-Flizzar,
West, & Doyle, 1998). Consistently, they have demonstrated that feedback
of between 20% and 60% is more effective for retention than 100% percent
feedback. However, for the tasks they examined, they did not control for
learner experience. In other words, in keeping with Schmidt and Wrisberg’s
(2008) notions, if the learners were just beginning, 100% feedback might be
appropriate for a few trials.
How precise should the feedback be? Schmidt and Wrisberg (2008)
described several types of feedback; among them are summary feedback,
average feedback, and bandwidth feedback. Their guiding principle was that
feedback should be as vague as possible so that the learner is forced to figure

it out. An example of bandwidth feedback might be that the production of
/l/ fell between an /r/ and /w/ sounds. Average feedback is also quite vague.
The therapist might describe a set of five practice trials as on the whole being
pretty good. In summary mode, the therapist might report that the first two
were accurate, the third and fourth were inaccurate, and the fifth one was
inaccurate. The size of the set about which to give feedback is dependent
upon the learner’s experience. However, Hageman et al. (2004) described a
therapy trial in which the feedback was provided to an apraxic child about
vowels and consonants; however, the child was not told which she was
receiving, that is, vowel or consonant feedback. The child was able to figure
it out and had remarkable improvement in her speech accuracy.
Another important variable to control during practice is the post-KR
delay interval (Hall, Jordan, & Robin, 1993). Hageman et al. (2004) expanded
on the post-KR delay interval notion to include postproduction delay interval.
The purpose of these delays was to provide time for the learner to process
the internal feedback (postproduction) and then to process the external
feedback (post-KR or KP). The assumption being made was that the learner
needed that time to compare the intended movement with the actual move-
ment and then with the consequences of the movement in the environment
(internal and external feedback).
In some investigations we have used as much as 5 seconds of delay and
as little as 1 second. The entire range has been shown to produce learning;
however, we do not know the optimum time. In fact, it may not be the delay
that is critical but rather the enforced “quiet time” that allows for attention
to be allocated to the comparison task, followed by GMP tweaking. It is not
necessarily externally directed attention but rather a period of time in which
the neurological processes of recalling a program, remembering the program,
and comparing the program with the results of the movement can occur.
For example, in one study, the learner was consistently vocally rehearsing
(groping) an incorrect production during the postproduction interval, which
we interpreted to show that he was not making the necessary comparisons
but was engaging in rapid trial and error experimentation. When we enforced
the quiet delay postproduction, he began to show improvement (Hageman,
2005 [clinical observation]; Hageman, Stierwalt, & Burda, 2004).
Measurement
Every day in my clinic, I hear supervisors and students interacting about

“taking data.” Since I was in graduate school, “taking data” has meant judging
each performance as it is made and entering the “score” on a variety of forms.
However, Schmidt and Wrisberg (2008) and others have described in depth
the problems with this approach to measuring learning. These problems are
serious and interfere with learning and our interpretation of what the learner
actually knows.
122 The late eight
We must make a distinction between the momentary strength of a behav-

ior (acquisition) versus the permanent memory (retention) of a behavior. This
distinction is important because both the clinician and the learner will do
things that improve acquisition scores but reduce retention. We have worried
about this issue for years, calling it carryover. There are at least three aspects
of permanent learning that we should consider. Retention is measured by
performance on the practiced tasks at some time remote from the practice
(e.g., at the next session). Generalization is measured by performance on
tasks that are closely related to the practiced task (e.g., unpracticed words
with the targeted sounds). Social validation is determined by measuring the
use of the learning targets in normal day-to-day activities. The key element
is that none of these measures is completed during practice.
Why is measurement remote in time necessary? First, measurement
during practice typically increases arousal and anxiety. Increased arousal
levels are detrimental to learning, particularly in new or sensitive learners.
(Importantly, I think it also detracts from the clinician’s ability to manage the
therapeutic milieu as it is a divided attention task.) Second, measurement
during practice encourages clinicians to use strategies that increase practice
scores (e.g., blocked practice, constant feedback, etc.) but negatively impact
retention. Third, learners will attempt to use as little variability as possible
to maintain accuracy, which does increase acquisition scores but decreases
retention score.
Consequently, I recommend that retention testing be completed periodi-
cally. How often is that? Well, it depends. One should consider the learn-
ing level of the client. More experienced learners could be measured less
frequently, whereas new learners could be measured once each session.
For generalization and social validation, perhaps even longer time intervals
would be more appropriate. The intervals are unique to individuals and
depend on rate of learning and the demands of third-party interests.
Movement Complexity
Because we already have established that speech is a remarkably complex

and rapid set of movements, what is there about speech complexity that
can be managed to promote learning? Let’s examine rate. It is possible to
slow speech and perhaps simplify the task. We know that we should not
slow below three movements per second, as that will move into closed-loop
control (Schmidt & Wrisberg, 2008). In addition, numerous researchers have
shown that temporal errors (variability) increase with slow movements and
that place (spatial target) error increases with faster movements. So whether
you slow speech practice depends upon the type of error the learner is
making. I would use slow speech practice when the child is having trouble
hitting targets but not necessarily when the child is having timing or order
errors. BUT, I would not slow to fewer than three movements per second
because it uses a different control mechanism (closed loop).
Thinking About It
How do you define the speed of movements in speech?
Stetson said that the fundamental unit of speech is the
syllable. We know that the temporal relationships between
transitions and the vowel, voice onset time, the relative
lengths of sounds within syllables, and the relative lengths
of syllables are critical components of speech perception
and prosody. Therefore, I would not practice at a speech
rate that is so low that it changes any of those aspects.
Another area of complexity is the length of the practice stimulus. Thus,

perhaps we can break down longer motor tasks into shorter ones. Research
has consistently shown that the more loosely coupled movements are, the
easier it is to break them apart and practice them in isolation. For example,
in tennis the serving ball toss is coupled to the actual serving motion but not
so tightly that it is unreasonable to practice tossing. On the other hand, the
hip rotation and arm swing of the serve are closely coupled during serving
and not easily practiced separately. In speech, we have sentences, phrases,
words, syllables, and phonemes. Starting with Stetson (1951), many research-
ers have proposed that the syllable is the fundamental unit of speech. In
fact, it is clearly observable that stop consonants do not exist outside the
transitions within the preceding or following vowel. In my opinion, speech
sounds (phonemes) are so tightly coupled within syllables that they do really
exist outside of a syllable. The coupling becomes less across syllables and
even less across words and phrases. Consequently, all MLG speech practice
takes place at least at the syllable level.
Thinking About It
The notion of coupling has clear implications for clinicians
trying to figure out the length of a motor program — for
speech I would say at minimum a syllable. However, there
is considerable evidence that speech motor programming
can be in elements considerably longer than a syllable. For
example, two investigations of the effect on phrase length
of inhibition of short and longer phrases clearly demon-
strated that speakers, including young children, program
across several syllables (Anderson, Meuting, Woolston, &
Hageman, 2011; Backlin et al., 2008). Carr (2004) also dem-
onstrated open- and closed-loop control differences across
syllables in speech rate tasks.
124 The late eight
Although not necessarily directly related to simplification, during pre-

practice, imagining the movement is useful. Experts in golf and many other
sports have reported that visualization of the motor act promotes better
performance. Schmidt and Wrisberg (2008) reported research which suggests
that the act of calling up the program is beneficial to learning even when
the act is not completed. When the child is old enough, we begin using
“imagination” or covert auditorization of (covert imagination of saying) a
production of the target before random practice trials. We have not explored
this technique systematically, but we anticipate that speech motor control is
similar enough to nonspeech motor control to have positive consequences.
Clearly there is more work to do.
Summary
Several variables have been described that are known to affect motor learn-
ing for nonspeech activities and some speech activities. We have also pro-
posed certain other aspects of motor practice that improve nonspeech motor
control and extrapolated them to speech motor practice. Figure 5–3 shows
a sample therapy hierarchy with explanations.
Contains personalized practice materials representing For creating unpredictable practice
universe of targets sequences
Pre-practice set up: From a previously collected pool of practice items, the client randomly draws five words, phrases, and/or
sentences to use during steps 1–5.
Clinician draws a set of words to use as a generalization measure (not Note the pool contains items of various complexities, which can be
practiced) controlled by the clinician. Challenging stimuli are better.
Step 1 Clinician produces utterance depicted on stimulus card and then waits 3 seconds.
For learners who are showing some mastery of the target, omit step 1 Pre-performance time can be filled with movement rehearsal
randomly (50%) such as imagining saying the target. Time to wait is
adaptable to the client.
125
Step 2 Client attempts utterance 2 times without feedback-waiting 3 seconds after each production.
Post performance reflection-internal comparison of intent with movement allowing time to process internal feedback and adjust motor program.
The time may be too long for some and too short for others. No talking by either person. Minimize motor activity and excitement (e.g., game
anticipation)
Step 3 After two attempts, clinician repeats the same utterance, waits 3 seconds, then has client judge the productions which
allowed time for learner to process intrinsic feedback and adjust motor program.
Important – this step is optional. Judgments vary from correct/incorrect or closer/further from target (or other notions governing understanding of the effort). In Step 4
the client actually indicates the judgment. (Preference should be given to broad focus on production – how it sounds versus how is made).
Figure 5–3. A sample therapy hierarchy with explanation. continues

Step 4 Client judges correct versus incorrect production by correctly placing plastic chips in “happy/sad face” cups.
An extension could be that the client receives more value for a correct production judged as correct compared to a wrong production judged as wrong
though the “wrong/wrong” act would still have value. The learner should not fear error. No value for correct/wrong or a wrong/correct judgments.
However feedback could be delivered as summary or average feedback across the set of productions with motor learning suggesting that the less precise
the feedback the better. Summary or average feedback is best with learners who have made some progress.
Step 5 Clinician provides feedback (KR-verbal or nonverbal)

A. Outcome: 100%
-Nonverbal, value chips returned to child if judged correctly (or according to the extension)
B. Prescriptive: 50%
-Location of articulation placements given every other error
C. Post KR delay of 3 seconds.
126
The outcome feedback can be 100% early but should be reduced quickly. As learner shows movement toward more correct, I would reduce feedback
systematically to as little as 25%. Similarly, prescriptive feedback should be reduced as well to zero as learner shows the ability to change productions
closer to correct. The post KR delay time can be shortened or lengthened. Important thing is to keep the post KR time quiet (no talking by either person.
Motivational feedback should be given when needed but definitely not during post KR time or every time.
Repeat steps 1-5 with a new set of randomly drawn stimulus cards and continue until session ends.
Five items in a set is arbitrary – could be more or less depending upon the client’s ability to attend. KR or KP could be provided across the entire set; thus,
the learner should show evidence that they can integrate more general feedback such as summary. Note that the evidence is not overt (asking client to tell
you); rather it is shown by changing performance.
Figure 5–3. continued

References
Anderson, K., Mueting, E., Woolston, L., & Hageman, C. (2011). Reliability, accu-
racy and refractoriness of a transit reaction reaction: Replication with speech in
children. Presentation at the Annual Meeting of the American Speech-Language-
Hearing Association, San Diego, CA.
Backlin, J., Corbett, A., Halbur, T., Gaughan, L., Howard, L., Williamson, C., et al.
(2008). Reliability, accuracy and refractoriness of a transit reaction: Replication
with speech. Presentation at the Annual Meeting of the American Speech-Language-
Hearing Association, Chicago, IL.
Carr, L. (2004). Temporal stability of speech motor programs in young children
(Unpublished master’s research). University of Northern Iowa, Cedar Falls, IA.
Gaughan, L., Howard, L., & Hageman, C. F. (2009). Speech inhibition in aphasia:
A measure of motor speech programs. Presentation at the Annual Meeting of the
American Speech-Language-Hearing Association, New Orleans, LA.
Guadagnoli, M. A., & Lee, T. D. (2004). Challenge point: A framework for conceptual-
izing the effects of various practice conditions in motor learning. Journal of Motor
Behavior, 36(2), 212–224.
Hageman, C. F., Meuller, M., Burda, A., & Bleile, K. (2004). A motor learning guided
approach to the treatment of developmental apraxia of speech. Presentation at the
10th Symposium of the International Clinical Phonetics and Linguistics Associa-
tion, Lafayette, LA.
Hageman, C., Stierwalt, J., & Burda, A. N. (2004). A motor learning guided approach
to the treatment of nonfluent aphasia. The 10th Symposium of the International
Clinical Phonetics and Linguistics Association, Lafayette, LA.
Hall, P. K., Jordan, L. S., & Robin, D. A. (1993). Developmental apraxia of speech:
Theory and clinical practice. Austin, TX: Pro-Ed.
Kahneman, D. (1973). Attention and effort. Englewood Cliffs, NJ: Prentice-Hall.
Kim, I., LaPointe, L. L., & Stierwalt, J. A. (2012). The effect of feedback and practice on
the acquisition of novel speech behaviors. American Journal of Speech-Language
Pathology, 21, 89–100.
Lisman, A. L., & Sadagopan, N., (2013). Focus of attention and speech motor perfor-
mance. Journal of Communication Disorders, 46, 281–293.
Maas, E., & Farinella, K. A. (2012). Random versus blocked treatment for child-
hood apraxia of speech. Journal of Speech, Language and Hearing Research, 55,
561–578.
Maas, E., & Mailend, M.-L. (2012). Speech planning happens before speech execution:
Online reaction time methods in study of apraxia of speech. Journal of Speech,
Language, and Hearing Research, 55, 1423–1534.
Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard,
K. J., Schmidt, R. A. (2008). Principles of motor learning in treatment of motor
speech disorders. American Journal of Speech-Language Pathology, 17, 277–298.
Netsell, R. (1991). A neurobiologic view of speech production and the dysarthrias.
San Diego, CA: Singular.
Redle. E., Vannesi, J., Maloney, T., Tseval, R. K., Eikenberry, S., Lewis, B., Shriberg, L.
D., Tkach, J., & Holland, S. (2015). Functional MRI evidence for fine motor praxis
dysfunction in children with persistent speech disorders. Brain Research, 1597,
47–56.
128 The late eight
Robin, D. A., Jacks, A., Hageman, C., Clark, H. M., & Woodworth, G. (2008). Visuomo-
tor tracking abilities of speakers with apraxia of speech or conduction aphasia.
Brain and Language, 106(2), 98–106.
Schmidt, R. A. (1988). Motor control and learning: A behavioral emphasis. Cham-
paign, IL: Human Kinetic.
Schmidt, R. A., & Wrisberg, C. A. (2008). Motor learning and performance: A problem-
based learning approach (3rd ed.). Champaign, IL: Human Kinetics.
Stetson, R. H. (1951). Motor phonetics: A study of speech movements in action (2nd
ed.). Amsterdam, Netherlands: North-Holland.
Steinhauer, K., & Preston Grayhack, J. (2000). The role of knowledge of results in
performance and learning of a voice motor task. Journal of Voice, 14(2), 137–145.
Wambaugh, J. L., Kalinyak-Flizzar, M. M., West, J. E., & Doyle, P. J. (1998). Effects of
treatment for sound errors in apraxia of speech and aphasia. Journal of Speech,
Language, and Hearing Research, 41, 725–743.
Wulf, G., Shea, C. H., & McNevin, N. H. (2003). Increasing the distance of an external
focus of attention enhances learning. Psychological Research, 67, 22–29. doi:10.1007/
s00426-002-0093-6
Part II
Clinical Resources
Chapter Six
Overview
This chapter provides an overview of the resources in the second half of the
book and on the accompanying companion website. Resources described
in the first half of this chapter include 14 “tools of the trade” to evaluate
and treat late-acquired sounds. The second half of the chapter offers an
illustration showing how a clinician might use the resources in evaluations
and treatment. The chapter concludes with a description of resources on the
accompanying companion website.
The 14 resources include:
1. Definition
2. Acquisition
3. Relative frequency
4. Errors
5. Key environments
6. Metaphors
7. Touch cues
8. Initial screening
9. Screening for stimulability
10. Demonstrations
11. Phonetic placement and shaping techniques
12. Exercises
13. Language activities
14. Word lists
131
132 The late eight
Warning!
This chapter provides necessary background for using the
resources. Most of the information, though important, is
fairly dry to read.
Resources for the Late Eight
1. Definition
What It Is: The definition is a prose description showing how a sound is

produced, or, as in the case of a sound such as [s], [z], or [r], the several dif-
ferent ways it may be produced.
Its Uses: Typical uses of the definition include:
n Making an informed decision about how to teach a sound

n Explaining to a student and family how a sound is produced
Illustration: This is the definition of [s]:
[s] is made in either of two ways. Some people produce [s] with
the tongue tip up behind the upper front teeth, others say it with the
tongue tip down behind the lower front teeth. Neither one is
the “right way.” Follow a student’s lead in deciding which way to
teach [s]. If a student appears to find it easier to say [s] with the
tongue tip up, teach the sound that way; if a student appears to
find it easier to say [s] with the tongue tip down, teach the sound
that way. For both varieties of [s], the airstream is continuous and
the vocal folds are apart.
A brief technical definition of the sound is also provided. This is the technical
definition of [s]:
[s] is a voiceless alveolar fricative.
2. Acquisition
What It Is: Acquisition data show the ages at which 50% and 75% of children
acquire a sound.
Its Uses: Acquisition data are widely used for two purposes:
CHAPTER 6: Overview 133
n Deciding if a student’s delay in acquisition of a sound is sufficient to

warrant therapy
n Selecting between possible treatment sounds (some clinicians choose
to treat earlier acquired sounds before treating later acquired ones)
Illustration: This is the acquisition data for [tʃ ]:
Fifty percent of children acquire [tʃ ] by 4;6 and 75% of children

acquire [tʃ ] by 5;6.
3. Relative Frequency
What It Is: Relative frequency is the level of repetitiveness in the occurrence

of a sound in the language. The data source for relative frequency is Shriberg
and Kwiatkowski (1983). The information is for consonants; vocalic [r] is
excluded from the calculations.
Its Use: A typical use of information on relative frequency includes:
n Evaluating the contribution of a possible treatment sound on intel-

ligibility (sounds with higher relative frequency are presumed to
have greater influence on intelligibility than those that occur less
frequently)
Illustration: This is the relative frequency for [z]:
[z] is ranked fifth in relative frequency compared with the other

late acquired consonants. It ranks fifteenth in relative frequency
compared with all other English consonants, and its percentage of
occurrence compared with all English consonants is 3.0%.
4. Error
What It Is: This resource shows the speech errors a student is likely to make
when unable to pronounce a sound.
Its Uses: Knowledge of speech errors is widely used for at least two reasons:
n Identifying errors that may lead the student to be stigmatized socially

n Determining possible influence of an error on intelligibility. (Errors
with a relatively large effect on intelligibility include those found in
the beginning of words, changes in place of pronunciation, and those
involving sound deletions.)
134 The late eight
Illustration: These are common [r] errors among students with errors affect-
ing late-acquired sounds:
The most common error is gliding — that is, [w] for [r]. Deletion of
[r] after vowels and in consonant clusters also is a common error.
5. Key Environment
What It Is: A key environment describes the phonetic position or context

in which a student is likely to pronounce a sound correctly. As discussed in
Chapter 1, key environments are the mirror image of phonological processes.
While phonological processes describe the “phonetic pitfalls” into which a
student may fall, key environments show phonetic contexts that assist rather
than hinder. Key environments are “best bets” rather than absolute laws.
Stated differently, a best bet is that a student will learn to pronounce a sound
in a key environment rather than in another environment. Importantly, key
environments for sounds overlap with similarly pronounced sounds sharing
similar key environments and less similarly pronounced sounds possessing
fewer common key environments.
Its Use: A key environment is widely used for one important purpose:
n Helping decide in which phonetic environments to establish a treat-

ment sound
Illustration: These are the key environments for [θ]
1. End of a syllable or word, as in teeth

2. Before a high front vowel, as in thin
6. Metaphor
What It Is: A metaphor provides a means to describe a sound.
Its Use: A metaphor is widely used for:
n Providing the clinician and student a handy way to refer to a treat-

ment sound
n Helping a student focus on speech
Illustration: These are possible metaphors for [z]:

Tongue placement: Tongue tip sound (tongue tip up or down)

Bump sound little (tongue tip up)
Hill sound bottom (tongue tip up)
Teeth sound (tongue tip down)
Fricative: Snake sound
Long sound
Hissing sound
Voicing: Motor-on sound
Voice box on
Voice-on sound
Buzzing sound
Word position: Starting sound Beginning of word
End sound End of word
Sound friends Consonant cluster
7. Touch Cue
What It Is: A touch cue draws attention to an aspect of a sound’s production,

typically the place of production.
Its Use: Typical uses of this resource include:
n Referring to a treatment sound through modalities (touch and sight)

other than hearing
n Reminding a student how a treatment sound is produced
Illustration: This is the touch cue for [l]:
Tip of finger on the middle of the upper lip.
8. Initial Screening
What It Is: An initial screening helps determine if a student may experience

difficulty pronouncing a late-acquired sound. It typically includes a spontane-
ous speech sample and a short screening test that assesses possible errors at
the word level in selected major phonetic contexts.
n Helping decide if a student is a candidate for treatment

136 The late eight
n Developing an initial hypothesis regarding types of errors made by a

student
n Pretesting a student’s ability to pronounce a sound
Illustration: This is the initial screening test for [S ]:
Instructions: I’m going to say some words. Please say the word
after me.
Example: “Dog. Now you say it.”
Word Beginning Student*

1. Shell _____________
2. Shutter _____________
3. Show _____________
4. Shrug _____________
5. Shrimp _____________
6. Shred _____________
Medial
7. Wishing _____________
8. Ocean _____________
9. Washer _____________
Final
10. Dish _____________
11. Crush _____________
12. Irish _____________
13. Mars _____________
14. Marsh _____________
15. Borscht _____________
*Suggestion: Transcribe an X if the sound is correct or, if incorrect, phoneti-

cally transcribe the error. Ignore errors produced elsewhere in the word.
Comments/Notes:
9. Screening for Stimulability
What It Is: A screening test for stimulability helps determine if a student

is capable of pronouncing a sound. Stimulability is assessed in imitation,
key environments, and favorite words and through phonetic placement and
shaping. A sound may also be stimulable if it occurs in low frequency across
a number of words; this is typically assessed through a spontaneous speech
sample or through asking someone who knows the student well, perhaps a
teacher or family member.
Its Use: The most typical use of this resource includes:
n Selecting between possible treatment sounds. (Note: Stimulability is a

controversial topic. Some clinicians prefer to select a sound for which
a student is stimulable, others prefer to select nonstimulable sounds.
The topic is discussed in Chapters 1 and 16 of this book.)
Illustration: This is the stimulability screening test for [tʃ ]:
Imitation
1. chip _____________
2. catch _____________
Best Bet Environments

End of a syllable or word
1. [tʃ ] _____________
2. watch _____________
After a high front vowel

1. beach _____________
2. itch _____________
Favorite Words
Names of family members:
Favorite people, heroes, and activities:
Phonetic Placement
1. Ask the student to make the train sound “choo choo.”
138 The late eight
Shaping
1. Instruct student to say “Bet you” slowly.
2. Next, instruct student to say “Bet you” fast, resulting in the produc-
tion of “Betcha.”
3. If “betcha” doesn’t work, repeat with “Got you.”
10. Demonstration
What It Is: Demonstration is a formalized explanation showing how a sound

is produced. Demonstrations can be simple or involved, some requiring no
implements and others making use of a mirror and other tools. In general,
simple demonstrations work best. If a clinician is going to put a hand in the
student’s mouth, all universal health care precautions should be followed.
n Helping explain to a student how to pronounce a sound

n Focusing a student’s attention on aspects of a sound pronounced
incorrectly
Illustration: This is a simple demonstration of [s]:
Objects: Q-tip and peanut butter or other favored food.
Instructions:
1. Instruct the student, “Please open your mouth.”
2. Once the mouth is open, with Q-tip dab a little peanut butter or
other favorite food on alveolar ridge (for tongue tip raised [s]) or
behind lower front teeth (for tongue tip lowered [s]).
3. Ask the student to touch the food with the tongue tip.
11. Phonetic Placement and Shaping Techniques
What They Are: Phonetic placement and shaping techniques are procedures
to teach sounds. Phonetic placement techniques entail instructing a student
how to place the articulators to make a sound. Phonetic placement techniques
are similar to demonstrations, the difference being that phonetic placement
techniques require a production from a student and demonstrations do not.
Shaping techniques rely on similarities between sounds to shape a sound a
student can pronounce into one he or she cannot pronounce. Techniques
presented in this book were culled from many sources, published and unpub-
lished. The main published sources were books long out of print, most espe-
cially Nemoy and Davis (1954). Unpublished sources include many talented
and creative clinicians that the author has had the pleasure to interact with
over the years.
What Phonetic Placement and Shaping Techniques Do

In essence, phonetic placement and shaping techniques
make an unstimulable sound stimulable. Once stimulable,
treatment then expands use of the sound in a student’s
speech.
Their Use: Typical uses of this resource include:
Establishing a sound in a student’s speech
Illustration: This is a phonetic placement technique for [θ], followed by tech-

nique for shaping vocalic [r] into consonantal [r]:
Phonetic Placement Technique for [θ]

Objects: Feather or small piece of paper
Instructions:
1. Place a feather or small piece of paper in front of the student’s mouth,
about a half-inch to an inch from the tongue.
2. Instruct the student to blow air over the tongue to move the feather
or paper, resulting in [θ].
Shaping Technique for [r]

Objects: None
Instructions:
1. Ask the student to say vocalic [r].
2. Next, ask the student to say vocalic [r] followed by [i] or some other
vowel.
3. Instruct the student to say [i] several times as quickly as possible,
resulting in vocalic [r] becoming [ri]. After [ri] is established, instruct
the student to say vocalic [r] silently, resulting in [ri].
12. Speech Exercise
What It Is: A speech exercise helps a student to gain experience pronouncing

or focusing on a treatment sound (see the discussion of speech discrimina-
tion in Chapter 1). Six different types of speech exercises are provided:
140 The late eight
Imitation: The student repeats the word after you.

Minimal Pairs: The student says a word that contains the treatment
sound, replaces the treatment sound to create a rhyming word, and then
again says the word with the treatment sound.
Deletion: The student says a word that contains the treatment sound,
says the same word with the treatment sound deleted, and then again
says the word with the treatment sound added.
Self-Correction: The student says a word containing the treatment
sound three times, self-correcting if errors in the treatment sound occur.
Old Way/New Way: The student says a word containing the treatment
sound, pronouncing the treatment sound the new way, the old way, and
then the new way again.
Similar Sound: The student says a word containing the treatment
sound, replaces the treatment sound with the most similar sound the
student can make, and then again says the word with the treatment
sound.
n Helping a student to master pronunciation of a late-acquired sound

n Helping a student learn to self-monitor and self-correct speech errors
n Focusing a student on the communication value of a late-acquired
sound
Illustration: This is a possible use of two speech exercises in a treatment

session.
Clinician: What is a word for ocean that starts with the snake sound?
Student: Sea.
Clinician: That’s right. Do you remember how you used to say the s
sound?
Student: th
Clinician: Good. Now say sea the new way, the old way, and then the
new way again.
Student: Sea. Thea. Sea.
Clinician: Great. Now say sea three times, listening to yourself and
trying to make the sound the new way.
Student: Sea. Sea. Sea.
13. Language Activity
What It Is: A language activity lets a student practice a treatment sound in

conversation and in school projects.
n Promoting generalization of a treatment sound to settings and persons

outside the treatment session
n Helping to make a treatment sound a student’s regular way of talking
n Practicing a treatment sound in linguistic contexts
n Promoting success on school assignments
Illustration: This is an awareness activity for [z] and a speech activity for [r],
followed by an example showing ways in which an activity might be varied.
Awareness Activity for [z]

Ask a student to silently read a newspaper or story and then circle or
write down words that contain [z].
Speech Activity for [r]

Give the student a printed story that has a sticker over words that
contain [r]. Ask the student to read the story aloud and “to guess” at the
words under the stickers. An easy alternative is to ask the student to
say each stickered word the new way, the old way, and then the new
way again.
14. Word List
What It Is: This book contains a list of approximately 4,000 different com-
monly found words containing late-acquired sounds. With very few excep-
tions, the words are short (one to two syllables) and easily pictured. The
word lists for each sound are divided into major phonetic environments in
which the sound occurs. Included in the word lists are lists of minimal pairs,
deletions, and themes.
Its Use: This resource is used in many different ways, including:
n Developing pre- and posttests

n Practicing treatment sounds in isolated words
n Focusing a student on the linguistic role of a treatment sound
n Developing language-based activities
142 The late eight
A Good Question
Someone may ask: Yes, but how do these word lists differ
from those in the 40,000 words book — in addition to that
book having 40,000 words and this book having only 4,000?
An Answer
The author has a well-worn copy of 40,000 Selected Words
(Blockcolsky, Frazer, & Frazer, 1987). The major differences
between the word lists in that fine book and those in this
book include:
n The Late Eight contains more than twice the number

of words containing late-acquired sounds.
n The present book contains more short (one to three
syllables), easily pictured words.
n Word lists in the present book are organized into
minimal pairs, deletions, and themes.
n Word lists in the present book are organized accord-
ing to phonetic environments frequently useful in
treatment.
Illustration: The following is a sample of the entry for [s] at the beginning
of words, followed by a theme for [l]:
Word List for [s]

Beginning of Words
Single Consonants Deletions Minimal Pairs
Sat at bat, mat, hat, cat, rat, pat
Salmon
Sail ale, ail tail, pail, nail, veil, rail,
whale, mail, jail
Salad ballad
Sailboat
Socks fox, rocks, box
Soap rope
Sew O, oh toe, row, hoe, no, bow,
mow, go
Sun fun, run, one, bun, gun
Sally alley tally
Silk ilk
Seagull eagle
Theme for [l]

Northern Places Deletions Minimal Pairs
Chilly hilly Willy, silly, Billy
Elk
Rudolph
Sled said fled
Sled dog
Sleigh bells
Sleet seat fleet
Glacier
Blizzard
North Pole
Cool fool, tool, pool
Wolf woof
Wolves
Sledding
Sleigh say
Snowflake
Companion Website
The accompanying companion website offers maximum portability and flex-

ibility. Information on the website replicates much of the book, but in formats
to download, print out, make into exercises, and adapt as a clinician deems
most suitable. The accompanying website includes the following printable
materials for each late-acquired sound:
n A “cheat sheet”
n Initial screening form
n Initial stimulability testing form
n Demonstrations
n Phonetic placement and shaping exercises
n Shells for speech exercises
n Shells for language activities
n Complete word list
n Minimal pairs
n Deletions
n Themes
Illustration of Clinical Resources
The order in which resources are described in the following sections is to

better approximate their use with a hypothetical student from the evaluation
through conclusion of treatment. The sequence is indicated in Table 6–1.
144 The late eight
Table 6–1. Clinical Resources Used in Evaluation and Treatment
Assessment Initial screening

Screening for stimulability
Definition
Acquisition
Relative frequency
Errors
Treatment Metaphors
Touch cues
Demonstrations
Phonetic placement and shaping techniques
Key environments
Word lists
Speech and awareness exercises
Language activities
Evaluation
The following resources are used primarily in assessment:
n Initial screening
n Screening for stimulability
n Definition
n Acquisition
n Relative frequency
n Errors
Guide to Resources
Evaluation
n An initial screening helps indicate if a student has a speech difficulty.

n Screening for stimulability helps determine if a student has the
capacity to pronounce a sound.
n Definition helps decide how a sound should be produced.
n Age of acquisition helps in making a decision regarding which
sound to teach.
n Relative frequency helps in making a decision regarding which

sound to teach.
n Errors help in making a decision regarding which sound to teach.
Treatment
n Metaphors help label a treatment sound.

n Touch cues help label a treatment sound through modalities of touch
and sight.
n Demonstrations show a student how a treatment sound is produced.
n Phonetic placement and shaping help establish a sound in a stu-
dent’s speech repertoire.
n Key environments suggest which phonetic positions may facilitate
pronunciation of a treatment sound.
n Word lists are a basis for activities involving words, minimal pairs,
n Speech exercises help a student to gain experience pronouncing a
treatment sound.
n Language activities help a student practice a treatment sound using
real world activities and resources.
Initial Screening, Screening for Stimulability
The most typical referral source for a student is a parent or teacher. A student
may then be observed in a classroom or playground before receiving an
initial speech screening and a screening test for stimulability.
Initial Screening
An initial screening helps determine if a student experiences difficulty pro-

nouncing a late-acquired sound. An initial screening assesses a treatment sound
at the word level in a variety of phonetic contexts. In addition to determining
if a problem with a sound exists, an initial screening often serves as a pretest
against which treatment progress is measured. If a student’s speech is found to
contain speech errors, a screening test for stimulability typically is administered.
Screening for Stimulability
Screening for stimulability helps determine if a student can pronounce a pos-

sible treatment sound. Information on stimulability is helpful in predicting
how rapidly treatment is likely to proceed. In general, if a student has some
initial capacity to pronounce a sound, treatment proceeds more rapidly than
if such a capacity must first be established.
146 The late eight
Definition, Acquisition, Relative Frequency, and Errors
These resources bundle together after stimulability testing is completed and

as a clinician decides between possible treatment sounds. Typically, decid-
ing which sound to select is based on weighing multiple factors, personal
and linguistic. Personal factors include a clinician’s judgment about a stu-
dent’s attention span, interests, and concerns. The linguistic aspect of sound
selection includes stimulability, definition, acquisition, relative frequency,
and errors. No single variable trumps the others. Rather, a clinician weighs
multiple considerations to reach a balanced decision.
Definition
The definition is a prose description showing how a sound is produced. The

definition contributes to treatment decisions because understanding how
a sound is made suggests which resources may be needed to teach it. To
illustrate, for [l] a clinician thinks about where the tongue is, how easily it
might be to teach a student this tongue position, what types of demonstra-
tions might be needed, what phonetic placement and shaping technique to
use, and the types of exercises available. Alternatively, for [s] an additional
consideration might be to develop short probes to determine which [s] is
easier for a student — tongue tip raised or lowered? Typically, a clinician
follows the student’s lead — that is, if a student already makes [s] with the
tongue tip lowered, the clinician teaches [s] with a lowered tongue. If a
student does not have a preferred way, a clinician may feel freer to select an
appropriate variant.
Acquisition
Acquisition data indicate the age at which 50% and 75% of children acquire
a sound. If all other things are equal (they seldom are), a clinician may
decide to first treat an earlier acquired sound. Indeed, for some clinicians
the importance of acquisition data is the primary criterion used in the selec-
tion process.
Relative Frequency
Relative frequency is the level of repetitiveness in the occurrence of a sound.

Typically, remediation of a sound with a higher frequency of occurrence
has greater impact on intelligibility than one with lower frequency. For this
reason, a clinician may incline to first teach more frequently occurring treat-
ment sounds. To illustrate, if a clinician is deciding between [s] and [z], [s]
might be selected because of its higher frequency of occurrence.
Errors
A sound may be susceptible to a number of major errors. This information

weighs in sound selection in at least two respects:
1. Some errors may be socially stigmatized.

2. Errors have varying effect on intelligibility.
In general, errors that may lead to a student being stigmatized socially

are a high treatment priority. To illustrate, a lisp and [w] for [r] are often early
treatment sounds because they may provoke teasing. Impact of an error on
intelligibility also influences sound selection. Errors that negatively affect
intelligibility are good candidates for treatment. These include deletions,
changes in place of production, and substitutions in the beginning of words.
Treatment
Once a sound or sounds have been selected for treatment, the following
resources are used:
n Metaphors
n Touch cues
n Demonstrations
n Phonetic placement and shaping techniques
n Key environments
n Word lists
n Awareness and speech exercises
n Language activities
Metaphors, Touch Cues, and Demonstrations
Metaphors, touch cues, and demonstrations all provide useful ways to refer
to treatment sounds, and especially during early treatment phases may help
focus a student on the task at hand. As treatment progresses, they serve as
reminders and prompts.
Metaphors
Metaphors provide useful analogies for a treatment sound. Typically, a clini-

cian presents several possible metaphors, allowing a student to select between
them. With a younger student, the metaphors make analogy with something
familiar—perhaps an engine starting, a hissing snake, or a leaky tire. With
148 The late eight
an older student, the metaphors often refer to an aspect of the treatment

sound—that is, an interdental may be the tongue-out sound, [s] with a lowered
tongue tip may be the tongue-down sound, or [l] may be the pointy sound.
For a student who is a teenager or an adult, many times a treatment sound is
called by its technical name. To illustrate, with an adult student a clinician may
decide to call [s] “a fricative sound” or “a fricative made at the alveolar ridge.”
Often, a metaphor proves more successful when a student helps select
it. Typically, a clinician presents several options and asks the student to
select one. Allowing a student to help select a metaphor entails the clinician
giving up a measure of control — after all, a student is not obliged to select
the metaphor that the clinician thinks best captures the nature of the speech
problem. A clinician weighs selection of the most appropriate metaphor
against a student’s need for involvement. In the author’s experience, most
often the issue does not arise and selection of a metaphor presents few
problems. If a question of appropriateness versus student involvement arises,
most clinicians give up the best, most appropriate metaphor in favor of
student involvement.
Touch Cues
Touch cues are finger positions that represent a treatment sound, allowing
a clinician to refer to a treatment sound using modalities other than speech.
Touch cues grossly mimic speech movements. An older student understands
that, for example, the touch cue for velar consonants is made parallel to
the back of the mouth, representing where the tongue is raised. A younger
student may benefit from a touch cue without realizing its mimicking quality.
For such a student, a touch cue is a visual and tactile reminder, a way to say,
“Remember: this is the sound we are working on.”
Demonstrations
Demonstrations show a student how a treatment sound is produced. By

drawing attention to such aspects of speech as tongue position and airflow,
a student may better understand how to pronounce a treatment sound. Older
students often find demonstrations intellectually engaging and interesting.
Others, especially those under 7 years, may find demonstrations more con-
fusing than helpful. Demonstrations find their most use early in treatment.
Later in treatment, an occasional demonstration may serve as a reminder
about how a treatment sound is produced.
Phonetic placement techniques show a student how to place the articulators

to pronounce a sound, and shaping techniques show a student how to convert
one sound into another. These techniques are used when a nonstimulable
sound is selected for treatment. Students 7 years or older typically possess
sufficient attention and language skills to benefit from these techniques. With
a younger student, success with these techniques is more hit-or-miss. The
techniques are typically inappropriate (and ineffective) with a child under
4 years.
Though every clinician has favorite phonetic placement and shaping
techniques, no single technique works for every student. In general, a clini-
cian selects one that makes intuitive sense and then engages in trial-and-error
dynamic assessment. Often, from a few to 5 to 10 minutes is sufficient to
determine if a particular technique will prove successful. In general, when
selecting a technique, most clinicians prefer those that are simpler and have
shorter instructions. Longer techniques are turned to when the shorter,
simpler ones do not yield results.
The phonetic placement and shaping techniques listed in this book are
“bare bones recipes” to expand and modify as a clinician desires. Often, the
actual phonetic placement or shaping technique used with a student contains
the following elements:
1. An initial self-demonstration by the clinician.

2. The student practices the steps in the technique. Use of a touch cue and
metaphors focus the student and help remind him or her about how the
sound is pronounced.
3. The student attempts to make the sound.
4. The clinician gives feedback about the success of the attempt.
The following illustrates one possible way to fully expand a bare bones
phonetic placement technique:
Instructions:
1. First demonstrate the method on yourself.
2. To begin, place your tongue between your upper and lower front teeth.
3. Place a feather or small piece of paper in front of your mouth, about a
half inch to an inch from your tongue.
4. Blow air over your tongue to move the feather or paper.
5. Explain, “That’s how you make the leaking tire sound. Now it’s your
turn.”
6. Instruct the student to stick out his or her tongue just as you did.
7. When the tongue is out, place the feather or paper before the mouth.
150 The late eight
8. Explain, “Now blow to make it move.”

9. If the sound is made correctly, say, “That’s right. You did it. You made [θ]
— the leaky tire sound.” If the sound is made incorrectly, say something
like, “Good try. Let’s try again.”
Key Environments
Key environments describe phonetic environments in which a student is

likely to pronounce a sound correctly. In addition to being used during the
evaluation to determine if a student has the capacity to make a sound, key
environments find good use after a treatment sound (or sounds) is selected,
providing a possible succession of environments in which to treat a sound.
The following illustrates how key environments might be used to establish
[s], [l], and [r] at the beginning of words and end of words, between vowels,
and in consonant clusters.
Beginning of Word
Establish [s], [l], and [r] before a high front vowel. Once established, expand
the number of different vowels that follow. For a student who is strongly
affected by the adjacent vowel, back high vowels are likely to be more chal-
lenging than front ones.
End of Word
[s] is more likely to be established here than [l] and [r]. Establish after a high
front vowel. Next, to make word-initial sounds, have the word-final sounds
be followed by a word beginning with a vowel, such as “bus and.” This
encourages the sound to “migrate” to start the following word, resulting in,
for example, “bu sand.”
Between Vowels
[l] and [r] are more likely to be established here than [s], though some
students find [s] easier to make here, too. For all three consonants, establish
between two high front vowels, as in ili. Once established, add different
adjacent vowels. To expand to word-initial position, have the student drop
the first vowel, resulting in, for example, [li]. To expand to word-final posi-
tion, follow the same procedure, resulting in, for example, [il].
Consonant Clusters
For [s], establish after [t] as in “pizza” or the nonsense word [tsi]. To expand
the environments in which [s] occurs, have [ts] be followed by different
vowels. To help expand [s] to syllable-initial position, encourage the student

to drop the [t]. For [l] and [r], establish after a consonant with a different
place of production than [l] and [r] (most often, select [p] or [b]) followed by
a high front vowel. Next, to help expand [l] and [r], ask the student to drop
the initial consonant in the consonant cluster.
Word Lists
Word lists are used to generate stimuli to help establish a sound in a student’s
speech, and then to practice it. Words, rather than nonsense syllables, are the
vehicle for teaching a treatment sound for two reasons:
1. Words, carefully selected, offer relatively simple phonetic contexts in

which to teach a sound, and
2. Words, being a student’s everyday means of communication, are used both
in and outside of treatment, making them a critical bridge to generalization.
Word lists in this book are divided by phonetic environment; on the

accompanying companion website, lists of minimal pairs, deletions, and
themes also are included. Word lists are therapeutic building blocks for
many different exercises and activities. The value of using isolated words
diminishes as treatment proceeds and the clinician shifts to more naturalistic
activities.
Awareness and Speech Exercises
Awareness exercises focus a student’s attention on the treatment sound. They

are used frequently early in therapy to orient a student, and later in therapy
primarily as prompts and reminders.
Speech exercises help a student to gain experience with a treatment
sound, providing practice in pronouncing, self-monitoring, and self-correcting
speech. The most frequently used exercises are imitation, minimal pairs, dele-
tions, multiple productions, old way/new way, and similar sounds. Speech
exercises are used most often in language activities and, less frequently, as a
list of words. Many times a mix of exercises is used. For example, a student
may be asked to delete the treatment sound and then say the word with the
treatment sound three times.
Language Activities
Language activities use school books and other outside materials, including
stories a student is reading, favorite stories from home, and articles from
152 The late eight
newspapers and magazines. These materials, because they are familiar and
widely used, are easy to adapt by families, aides, and teachers. Many times
their use also has the practical advantage of improving a student’s academic
skills. Though the purpose of therapy is speech, much is gained if in the
process of learning speech a student also does better on classroom assign-
ments or gives a better oral report.
Summary
Resources contained in the first half of this book are “tools of the trade”
to assist a clinician in evaluating and treating such speech disorders. The
discussion in the second half of the chapter illustrates one way care might be
conceptualized and carried out. The resources are flexible and can be used
within a wide variety of therapeutic approaches and with a range of students,
including children and adults and both first and second language learners.
The hope in assembling these resources is to help provide clinical care to the
many students with this highly prevalent developmental difficulty.
References
Bernstein, N. (2005, January 19). Proficiency in English decreases over a decade.

New York Times.
Blockcolsky, V., Frazer, J., & Frazer, D. (1987). 40,000 selected words. San Antonio,
TX: Communication Skills Builder.
McDonald, E. (1964). A deep test of articulation. Pittsburgh, PA: Stanwix House.
Nemoy, E., & Davis, S. (1954). The correction of defective consonant sound. Magnolia,
MS: Expression.
Shewan, C. (1988). 1988 omnibus survey: Adaptation and progress in times of change.
Asha, 30, 27–30.
Shriberg, L., & Kwiatkowski, J. (1983). Computer-assisted natural process analysis
(NPA): Recent issues and data. In J. Locke (Ed.), Seminars in Speech and Lan-
guage, 4, 397.
Van Riper, C. (1978). Speech correction: Principles and methods (6th ed.). Englewood
Cliffs, NJ: Prentice-Hall.
Chapter Seven
[θ]
Definition
[θ] is made with the tongue tip between the upper and lower front teeth.
The airstream is a continuous hiss between the upper tongue and the
upper teeth. The vocal folds are apart. The technical definition of [θ] is
voiceless interdental fricative.
Acquisition
Fifty percent of children acquire [θ] by 4;6 and 75% of children acquire
[θ] by 6;0.
Relative Frequency
[θ] is ranked seventh in relative frequency compared with the other
late-acquired consonants. It ranks twenty-first in relative frequency com-
pared with all other English consonants, and its percentage of occur-
rence compared with all English consonants is 0.9%.
Errors
[s] for [θ] is a common error, as is [f] for [θ]. A less common error for [θ]
among school-aged students is [t] or [p] for [θ].
153
154 The late eight
Key Environments
End of a syllable or word, as in teeth
Before a high front vowel, as in thin
Possible Metaphors
Select metaphors based on the aspect of speech that is the focus of therapy.
Tongue placement: Tongue tip sound

Fricative: Leaky tire sound
Long sound
Hissing sound
Voicing: Motor off
Voice off
Not a buzzing sound
Voice box off
Touch Cue
Finger in front of lips.
Instructions
Place the student’s finger in the middle of the front of the lips.
Initial Screening Test for [θ]
Student’s Name:
Date: __________________
Referral:
Instructions: Say to the student, “I’m going to say some words. Please say
the words after me.”
Word Student*
Beginning
1. Thigh _____________
2. Thunder _____________
3. Thorn _____________
4. Threw _____________
5. Thriller _____________
6. Throne _____________
Medial
7. Nothing _____________
8. Python _____________
9. Without _____________
Final
10. Bath _____________
11. Oath _____________
12. Teeth _____________
13. Sixth _____________
14. Ninth _____________
15. North _____________
*Suggestion: Transcribe an X if the sound is correct or, if incorrect, phonetically tran-

scribe the error. Ignore errors produced elsewhere in the word.
Comments/Notes:
155
Stimulability Tests for [θ]
Student’s Name:
Date: __________________
Referral:
Imitation
1. Thumb _____________
2. Tooth _____________
Key Environments
1. teeth _____________
2. [iθ] _____________
Before a high front vowel

1. thin _____________
2. [θi] _____________
Favorite Words
Phonetic Placement _____________

1. Ask the student to place the tongue between the upper and lower teeth.
2. Instruct the student to put his or her hand in front of the mouth, and
blow through the teeth to feel the airflow.
Shaping [θ] from [s] _____________

1. Demonstrate the difference between the place of production for [s] and
the place of production for [θ].
2. Next, instruct the student to say /s/ while moving his or her tongue to
rest between the upper and lower teeth, resulting in [θ].
Notes/Comments:
156
CHAPTER 7: [T] 157
Demonstrations for [θ]
Place: Interdental
First Method
Object: Tongue depressor
Instructions:
1. Instruct the student, “Please stick out your tongue.”

2. Once the tongue is out, gently close the student’s mouth. If the tongue
is sticking out too far, gently push it back with a tongue depressor.
Second Method
Objects: Tongue depressor or stick of candy or other favored food
Instructions:
1. Place a tongue depressor or piece of food in front of the student’s mouth,

about half an inch before the lips.
2. Instruct the student, “Please touch it with your tongue.”
3. While the student touches the tongue depressor or food with the tongue
tip, gently close the student’s mouth.
4. Instruct the student, “Now pull your tongue back just a little until I say
stop.”
Manner: Fricative
First Method
Objects: Strip of paper or a feather
Instructions:
1. Place a strip of paper, a feather, or the student’s hand held in front of

your mouth while you produce several long voiceless fricatives.
2. Draw attention to the “hissing” quality and continuous nature of the
sounds.
158 The late eight
Second Method
Objects: A small paper flower on end of a pencil
Instructions:
Tape a small paper flower on the end of a pencil and encourage the student
to move the flower in the wind.
Third Method
Objects: None
Instructions:
Run your finger or the student’s finger down the student’s arm while making
several long voiceless fricatives to demonstrate the “hissing” quality and
length of fricatives.
Voicing: Voiceless
First Method
Objects: None
Instructions:
Instruct the student to listen to and identify the difference between a voice-
less and voiced [a].
Second Method
Objects: None
Instructions:
Place the student’s hands over the ears and instruct him or her to hum, which
heightens the sensation of vocal cord vibration.
CHAPTER 7: [T] 159
Third Method
Objects: None
Instructions:
If the student is able to produce a voiced and voiceless fricative, ask him or
her to cover the ears and make these sounds. Alternatively, ask the student
to make [h] and [a].
Fourth Method
Objects: None
Instructions:
You and the student place one hand on your throat and the other on the
student’s throat while making voiced and voiceless sounds together, telling
each other when the voicing goes on and off.
Fifth Method
Objects: Pencil or tongue depressor and small piece of paper or small

paper flower
Instructions:
If the student is able to produce a pair of voiced and voiceless oral stops,
attach a small piece of paper or a paper flower to the end of a tongue depres-
sor or pencil and ask the student to “make the paper (or flower) move.” The
paper is more likely to move when a voiceless consonant is produced than
when a voiced consonant is produced (be careful in providing instructions
to the student, however, because a strongly articulated voiced oral stop will
also move the flower).
160 The late eight
Placement and Shaping Techniques for [θ]
Phonetic Placement Techniques
Both these simple phonetic placement methods focus on tongue placement

(tongue between the teeth) and airflow (air over the tongue).
First Method
Instructions:
1. Place a feather or small piece of paper in front of the student’s mouth,

about one-half inch to an inch from the tongue.
2. Ask the student to blow air over the tongue to move the feather or paper,
resulting in [θ].
Second Method
Objects: Tongue depressor and Q-tip
Instructions:
1. Place a tongue depressor in front of the student’s mouth, instructing the

student to touch the depressor with his or her tongue tip.
2. When the student’s tongue is out, gently push up the student’s lower jaw
so that his or her teeth and tongue come into contact.
3. Instruct the student to blow air over the tongue. If the student produces
an interdental [t], gently insert a Q-tip between the student’s tongue tip
and upper teeth to create a sufficiently broad opening to allow continu-
ous airflow, resulting in [θ].
Shaping Exercises
[θ] from [f]
This method is for a student with a well-established [f].
Objects: None
CHAPTER 7: [T] 161
Instructions:
1. Demonstrate the difference between the places of production for [f] and
[θ].
2. Ask the student to say [f] while moving the tongue to lie between the
upper and lower front teeth, resulting in [θ]. (Note: To facilitate [ð],
develop from [v].)
[θ] from [s]
This method approaches [θ] from the opposite direction as the first method:
rather than from slightly anterior [f], this method approaches [θ] from slightly
posterior [s].
Objects: None
Instructions:
1. Demonstrate the difference between the place of production for [s] and
the place of production for [θ].
2. Next, instruct the student to say [s] while moving the tongue to lie
between the upper and lower front teeth, resulting in [θ]. (Note: To facili-
tate the [ð], develop from [z].)
Shell for Speech Exercises
Student’s Name:
Date: __________________
Treatment Sound: __________________
Word List: Student Responses:
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
162
Imitation
Student’s Name:
Date: __________________
Goal: Have the student repeat the word after you.
Instructions to Student: “You are going to hear a word with our sound.
Please say it after me. Here’s an example. I say sat, and then you say sat.”
Thin 1. __________________
Thumper 2. __________________
Thick 3. __________________
Thief 4. __________________
Thumb 5. __________________
Thank you 6. __________________
Thigh 7. __________________
Thunder 8. __________________
Thorn 9. __________________
Thumbtack 10. __________________
Total Correct: ________ / ________

Comments:
163
Minimal Pairs
Student’s Name:
Date: __________________
Goal: Have the student first say the word with the treatment sound, then say
the rhyming word, and then say the word with the treatment sound.
Instructions to Student: “You are going to hear a word that begins with
our sound. Please say the word, then replace our sound with another sound
to make the word have a different meaning, and then say the word with our
sound again. Here’s an example. I say seal. You say seal, then change [s] to
[w] to make wheel, and then say seal again. Like this: Seal. Wheel. Seal.”
Thin Chin 1. __________________

Thor Soar 2. __________________
Third Word 3. __________________
Thumper Jumper 4. __________________
Thatch Hatch 5. __________________
Think Pink 6. __________________
Thick Sick 7. __________________
Thief Chief 8. __________________
Thumb Gum 9. __________________
Thigh Bye 10. __________________
Total Correct: ________ / ________

Comments:
164
Deletion
Student’s Name:
Date: __________________
Goal: Have the student first say the word with the treatment sound, then
without the treatment sound, and then with the treatment sound.
Please say the word, and then say it with our sound deleted, and then say it
with our sound included. Here’s an example. I say red. You say red, then Ed,
then red. Like this: Red. Ed. Red.”
Thin In 1. __________________
Thick Ick 2. __________________
Thumb Um 3. __________________
Thigh I, eye 4. __________________
Thug Ugh 5. __________________
Thor Or 6. __________________
Thaw Awe 7. __________________
Thought Ought 8. __________________
Think Ink 9. __________________
Theory Eerie 10. __________________
Total Correct: ________ / ________

Comments:
165
166 The late eight
Self-Correction
Student’s Name:
Date: __________________
Goal: Have the student say the word three times, self-correcting if errors in
the treatment sound occur.
Please say the word three times, listening to how you say our sound and
changing it to make it correctly if you say it incorrectly. Here’s an example.
I say cheese, and then you say cheese three times, listening to how you say
our sound and changing it to make it correctly if you say it incorrectly. Like
this: Cheese. Cheese. Cheese.”
Thin 1. __________________
Thumper 2. __________________
Thick 3. __________________
Thief 4. __________________
Thumb 5. __________________
Thank you 6. __________________
Thigh 7. __________________
Thunder 8. __________________
Thorn 9. __________________
Thumbtack 10. __________________
Total Correct: ________ / ________

Comments:
CHAPTER 7: [T] 167
Old Way/New Way
Student’s Name:
Date: __________________
Goal: Have the student say the word the new way, the old way, and then
the new way again.
Please say the word, then say it the old way you used to say our sound, and
then say it the new way you say our sound. Here’s an example. I say thin.
You say thin, then *in, and then thin. Like this: Thin. *in. Thin.”
Note. Replace * with the way the student used to say the sound.
Thin 1. __________________
Thumper 2. __________________
Thick 3. __________________
Thief 4. __________________
Thumb 5. __________________
Thank you 6. __________________
Thigh 7. __________________
Thunder 8. __________________
Thorn 9. __________________
Thumbtack 10. __________________
Total Correct: ________ / ________

Comments:
Similar Sound
Student’s Name:
Date: __________________
with the most similar sound the student can make, and then with the treat-
ment sound again.
Please say the word, then replace our sound with * and then say the word
with our sound. Here’s an example. I say sun. You say sun, then *un, and
then sun again. Like this: Sun. *un. Sun.”
Note. Replace * with a sound the student can pronounce that is phonetically
similar to the treatment sound.
Thin 1. __________________
Thumper 2. __________________
Thick 3. __________________
Thief 4. __________________
Thumb 5. __________________
Thank you 6. __________________
Thigh 7. __________________
Thunder 8. __________________
Thorn 9. __________________
Thumbtack 10. __________________
Total Correct: ________ / ________

Comments:
168
CHAPTER 7: [T] 169
Complete Word List for [θ]
Beginning of Words
Thin in chin, pin

Thumper jumper, bumper
Thick ick sick, kick, tick, pick, wick,
lick
Thief chief, beef, leaf
Thumb um gum
Thank you
Thigh I, eye bye, high, pie, tie
Thunder sunder
Thorn corn, torn, horn, worn
Thumbtack
Thong long, song
Thighbone my bone
Thimble nimble, cymbal
Thug ugh bug, hug
Thelma Selma
Thebes dweebs
Thorny corny
Thorax Borax
Third bird, word, nerd, heard
Thor or soar, core, shore, floor
Thanks banks
Thursday
Third base
Thirty dirty
Thoreau
Thaw awe paw, saw
Things
Thinnest
Thought ought caught, bought
Thousand
Thirteen
Third world
Thermal
Thirsty
Thicket picket, wicket
Think ink rink, wink, pink
170 The late eight
Thermos
Theme song
Thebe dweeb
Thoughtful
Thatch batch, hatch
Theory eerie dearie
Thorough burrow
Thirst burst, nursed
Thistle missile
Consonant Clusters Deletions Minimal Pairs
Three tree
Throw row
Thrill rill
Throttle
Thrift shop
Thread read tread
Throat wrote
Threw rue true, crew
Throw rug
Thriller
Throne roan grown, prone
Thrifty
Throwing rowing
Threshold
Throng wrong prong
Thirsty
Thrive
Thrash rash crash, brash, lash
Through rue grew, true, crew
Thrush rush brush, crush
Threat
Thrust rust crust
Throb rob
CHAPTER 7: [T] 171
Medial
Single Consonants
Nothing Toothpick Author

South Seas Martha Nathan
Something Toothpaste Kathy
Playthings Bathroom Athens
Earthquake Toothless Carthage
Athlete Bathmat Earthling
Mouthwash Toothbrush Gothic
Panther Python Fifth grade
Playthings Without Bathtub
Southpaw Toothache Mathew
Consonant Clusters
Heartthrob Fourth grade North Star

Monthly Jethro Anthrax
Swarthmore Darth Mal Cutthroat
North Pole Darth Vader
Bathrobe Bathroom
All Environments
Mouthwash Earthquake Athens

Heartthrob Athlete Fourth grade
Nothing North Star Toothless
Darth Mal Something North Pole
Panther Author Bathmat
Jethro Cutthroat Monthly
Bathroom Nathan Fifth grade
Playthings Kathy Bathtub
Toothpick South Seas Toothache
Anthrax Darth Vader Gothic
Python Carthage Mathew
Martha Earthling Toothbrush
Swarthmore Toothpaste Bathrobe
172 The late eight
Ends of Words
Single Consonants Deletions
Mammoth
Bath baa
Oath oh
Dishcloth
Ruth rue
Teeth tea
Babe Ruth
Steam bath
Macbeth
Sith
Goldsmith
Sloth slaw
Keith key
Sweet tooth
Bike path
Swath
Birdbath
Tooth two
Sleuth slew
Math
Phone booth
Kenneth
Plymouth
Faith fey, Fay
South sow
Blacksmith
Sheath she
Path
Faith Fay, fey
Mouth Mao
Cheesecloth
Beth
Breath
Myth
Broth braw
Booth boo
Death
Wreath
CHAPTER 7: [T] 173
Consonant Clusters Deletions
Fourth four
Fifth
Sixth six
Seventh seven
Eighth eight
Ninth nine
Tenth ten
Eleventh eleven
Twelfth
North nor
Warmth warm
Themes for [θ]
Themes
Teeth Brushing Actions

Bath Time Numbers and Days
Star Wars Villains Days of Christmas
Around the Home Directions
It’s a Job People and Places
Nature
Teeth Brushing Deletions Minimal Pairs
Toothache
Toothless
Teeth T, tea wreath, Keith
Mouth Mao
Breath
Thirst burst, nursed
Sweet tooth
Tooth two
Toothbrush
Thirsty
Mouthwash
Toothpick
Toothpaste
174 The late eight
Bath Time Deletions Minimal Pairs
Thumb gum
Thigh I, eye bye, high, pie, tie
Mouth
Throat wrote
Bathmat
Bathtub
Bathrobe
Bathroom
Bath baa
Playthings
Star Wars Villains Deletions Minimal Pairs
Sith
Darth Mal
Darth Vader
Throne roan grown, prone
Threat
Around the Home Deletions Minimal Pairs
Bathmat
Bathtub
Thermos
Threshold
Bathrobe
Bathroom
Thimble nimble, cymbal
Throw rug
Thumbtack
Mouthwash
Playthings
Toothpick
Broth bra
Thread read tread
Toothpaste
Thong long, song
CHAPTER 7: [T] 175
It’s a Job Deletions Minimal Pairs
Athlete
Author
Sleuth slew
Blacksmith
Cutthroat
Thief chief, beef, leaf
Thug bug, hug
Nature Deletions Minimal Pairs
Path
Thistle missile
Thatch batch, hatch
Thrush rush brush, crush
Thicket picket
Mammoth
Sloth slaw
Bike path
Thaw awe saw, paw
Panther
Earthquake
Python
Thorny corny
Thunder
Thorn corn, torn, horn, worn
Actions Deletions Minimal Pairs
Throwing rowing
Thrive
Think ink rink, wink, pink
Thrash rash crash, brash, lash
Threaten
Thrust rust crust
Throb rob
Throw row crow, pro
Threw rue true
176 The late eight
Numbers and Days Deletions Minimal Pairs
Three tree
Fourth four
Fourth grade
Tenth ten
Monthly
Thursday
Third base
Thirty dirty
Thousand
Sixth grade
Fifth grade
Thirteen
Third world
Days of Christmas Deletions Minimal Pairs

Fourth four
Fifth
Sixth six
Seventh seven
Eighth eight
Ninth nine
Tenth ten
Eleventh eleven
Twelfth
Directions Deletions Minimal Pairs
North nor
South sow
CHAPTER 7: [T] 177
People and Places Deletions Minimal Pairs
North Star
Jethro
Thumper jumper, bumper
Swarthmore
North Pole
South Seas
Faith fey, Fay
Babe Ruth
Ruth rue
Thebe dweeb
Mathew
Thebes dweebs
Beth
Athens
Nathan
Kathy
Carthage
Martha
Nathan
Macbeth
Goldsmith
Keith
Kenneth
Plymouth
Thelma Selma
Thor or soar, core, shore, floor
Thoreau
Chapter Eight
[ð]
Definition
[ð] is made with the tongue tip between the upper and lower front teeth.
The airstream is a continuous hiss between the upper tongue and the
upper teeth. The vocal folds are together. The technical definition of [ð]
is voiced interdental fricative.
Acquisition
Fifty percent of children acquire [ð] by 4;6 and 75% of children acquire
[ð] by 5;6.
Relative Frequency
[ð] is ranked fourth in relative frequency compared with the other late-
acquired consonants. It ranks eleventh in relative frequency compared
with all other English consonants, and its percentage of occurrence
compared with all English consonants is 4.1%.
Errors
[d] for [ð] is a common error. A less common error among school-aged
students is [b] for [ð].
179
180 The late eight
Key Environments
Beginning of syllable and between vowels, as in weather
Before a high front vowel, as in these
Possible Metaphors

Fricative: Leaky tire sound
Long sound
Hissing sound
Voicing: Motor on
Buzzing sound
Voice box on sound
Touch Cue
Finger in front of lips.
Instructions
Place the student’s finger in the middle of the front of the lips.
Initial Screening Test for [ð]
Student’s Name:
Date: __________________
Referral:
Word Student*
Beginning
1. This _____________
2. Them _____________
3. Then _____________
4. The _____________
Medial
5. Clothing _____________
6. Weather _____________
7. Father _____________
8. Feather _____________
Final
9. Breathe _____________
10. Teethe _____________
11. Sheathe _____________
12. Soothe _____________

Comments/Notes:
181
Stimulability Tests for [ð]
Student’s Name:
Date: __________________
Referral:
Imitation
1. the _____________
2. mother _____________
Key Environments
Between vowels
1. weather _____________
2. either _____________

1. these _____________
2. this _____________
Favorite Words

1. Demonstrate placing the tongue between the upper and lower teeth.
2. Instruct the student to put his or her hand in front of the mouth and
blow through the teeth to feel the airflow with the voice box turned on.
Shaping [ð] from [z] _____________
1. Demonstrate the difference between the place of production for [z] and
the place of production for [ð].
2. Next, instruct the student to say [z] while moving his or her tongue to
rest between his or her upper and lower teeth, resulting in [ð].
Notes/Comments:
182
CHAPTER 8: [D] 183
Demonstrations for [ð]
Place: Interdental
First Method
Instructions:

2. Once the tongue is out, gently close the student’s mouth. If the tongue
is sticking out too far, gently push it back with a tongue depressor.
Second Method
Objects: Tongue depressor or stick of candy or other favored food.
Instructions:
1. Place a tongue depressor or piece of food in front of the student’s mouth,

about half an inch before the lips.
2. Instruct the student, “Please touch it with your tongue.”
3. While the student touches the tongue depressor or food with the tongue
tip, gently close the student’s mouth.
4. Instruct the student, “Now pull your tongue back just a little until I say
stop.”
Manner: Fricative
First Method
Instructions:

sounds.
184 The late eight
Second Method
Instructions: Tape a small paper flower on the end of a pencil and encour-
age the student to move the flower in the wind.
Third Method
Objects: None
Instructions: Run your finger or the student’s finger down the student’s arm
while making several long voiceless fricatives to demonstrate the “hissing”
quality and length of fricatives.
Voicing: Voiced
First Method
Objects: None
Instructions: Instruct the student to listen to and identify the difference

between a voiceless and voiced [a].
Second Method
Objects: None
Instructions: Place the student’s hands over the ears and instruct him or her
to hum, which heightens the sensation of vocal cord vibration.
Third Method
Objects: None
Instructions: If the student is able to produce a voiced and voiceless frica-

tive, ask him or her to cover the ears and make these sounds. Alternatively,
the student is asked to make [h] and [a].
CHAPTER 8: [D] 185
Fourth Method
Objects: None
Instructions: You and the student place one hand on your throat and the
other on the student’s throat while making voiced and voiceless sounds
together, telling each other when the voicing goes on and off.
Fifth Method

paper flower
Instructions: If the student is able to produce a pair of voiced and voice-

less oral stops, attach a small piece of paper or a paper flower to the end
of a tongue depressor or pencil and ask the student to “make the paper (or
flower) move.” The paper is more likely to move when a voiceless consonant
is produced than when a voiced consonant is produced (be careful in provid-
ing instructions to the student, however, because a strongly articulated voiced
oral stop will also move the flower).
Phonetic Placement and Shaping Techniques for [ð]
To facilitate [ð], follow the steps for [θ] but also use demonstrations to instruct
the student to turn on the voice box.
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
186
Imitation
Student’s Name:
Date: __________________
That 1. __________________
This 2. __________________
Them 3. __________________
Then 4. __________________
The Hague 5. __________________
Their 6. __________________
Those 7. __________________
These 8. __________________
They 9. __________________
There 10. __________________
Total Correct: ________ / ________

Comments:
187
Minimal Pairs
Student’s Name:
Date: __________________
say the rhyming word, and then say the word with the treatment sound.
They hay 1. __________________

Than can 2. __________________
Though toe 3. __________________
Their bear 4. __________________
Those nose 5. __________________
These bees 6. __________________
There bear 7. __________________
That sat 8. __________________
Then Ben 9. __________________
They bay 10. __________________
Total Correct: ________ / ________

Comments:
188
Deletion
Student’s Name:
Date: __________________
They A 1. __________________
Than Ann 2. __________________
Though O 3. __________________
Their air 4. __________________
Those Os 5. __________________
These ease 6. __________________
There air 7. __________________
That at 8. __________________
Then N 9. __________________
They A 10. __________________
Total Correct: ________ / ________

Comments:
189
Self-Correction
Student’s Name:
Date: __________________
That 1. __________________
This 2. __________________
Them 3. __________________
Then 4. __________________
The Hague 5. __________________
Their 6. __________________
Those 7. __________________
These 8. __________________
They 9. __________________
There 10. __________________
Total Correct: ________ / ________

Comments:
190
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Note: Replace * with the way the student used to say the sound.
That 1. __________________
This 2. __________________
Them 3. __________________
Then 4. __________________
The Hague 5. __________________
Their 6. __________________
Those 7. __________________
These 8. __________________
They 9. __________________
There 10. __________________
Total Correct: ________ / ________

Comments:
191
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
Please say the word, then replace our sound with _____*, and then say the
word with our sound. Here’s an example. I say sun. You say sun, then *un,
and then sun again. Like this: Sun. *un. Sun.”
Note: Replace * with a sound the student can pronounce that is phonetically
That 1. __________________
This 2. __________________
Them 3. __________________
Then 4. __________________
The Hague 5. __________________
Their 6. __________________
Those 7. __________________
These 8. __________________
They 9. __________________
There 10. __________________
Total Correct: ________ / ________

Comments:
192
CHAPTER 8: [D] 193
Complete Word List for [ð]
Beginning of Words
That at sat, mat, cat, fat, bat

This kiss, hiss
Them M REM
Then N Ben, hen, pen, men
The Hague
Their air bear, share, care, fair
Those Os nose, toes, bows
These ease bees, cheese, knees
They A hay, bay, say, day, gray
There air bear, share, care, fair
The a
Than Ann can, man, fan, ran
Though O, oh toe, bow, go, show, no
Medial
Single Consonants
Clothing Slither Northern

Weather Mother Earthquake
Father Leather Brother
Heather Breathing Bathrobe
Teething Arthur Bathing
Bather Feather Smoothest
Consonant Clusters
—
194 The late eight
End of Words
Breathe Bree
Teethe Tea
Sheathe She
Soothe Sue
Bathe Bay
Unsheathe
Smooth
Clothe
Scythe
Sun bathe
Themes for [ð]
Themes
Nature The Body

People and Places Grammatical Words
Bath Time Family
Earthquake
Slither
Sun bathe
Leather feather, weather, heather
Weather feather, leather
Feather weather, heather, leather
Heather feather, weather, leather
Northern
The Hague
Arthur
Heather feather, weather, leather
CHAPTER 8: [D] 195
Bather Bay
Bathing
Bathrobe
Clothe
Clothing
Bather Bayer
The Body Deletions Minimal Pairs
Breathe Bree
Breathing
Teethe T, tea
Teething
Grammatical Words Deletions Minimal Pairs
That At sat, mat, cat, fat, bat

This kiss, hiss
Them M
Then N Ben, hen, pen, men
Their Air bear, air, share, care, fair
Those nose, toes, bows
These Ease bees, cheese, knees
They A hay, bay, say, day, gray
The a
Than Ann can, man, fan, ran
Though O, oh toe, bow, go, show, no
Family Deletions Minimal Pairs
Brother mother, other

Father brother
Mother other, mother
Chapter Nine
[s]
Definition
[s] is made in either of two ways. Some people produce [s] with the
tongue tip up behind the upper front teeth, others say [s] with the tongue
tip down behind the lower front teeth. Neither one is the “right way.”
Follow the student’s lead in deciding which way to teach [s]. If a student
appears to find it easier to say [s] with the tongue tip up, teach the
sound that way; if the student appears to find it easier to say [s] with
the tongue tip down, teach the sound that way. For both varieties of [s],
the airstream is continuous and the vocal folds are apart. The technical
definition of [s] is voiceless alveolar fricative.
Acquisition
Fifty percent of children acquire [s] by 3;6 and 75% of children acquire
[s] by 6;0.
Relative Frequency
[s] is ranked first in relative frequency compared with the other late-
acquired consonants. It ranks 3rd in relative frequency compared with
all other English consonants, and its percentage of occurrence compared
with all English consonants is 7.1%.
197
198 The late eight
Errors
A common error for [s] is lisping. During lisping, [s] is pronounced with
the tongue tip between the teeth, as for [θ]. Another common error for [s]
is using the tongue blade instead of the tongue tip, which is sometimes
called bladed [s]. A third common error is lateralizing, in which instead
of air flowing over the top of the tongue, it flows over the sides of the
tongue, as for an [l].
Key Environments
End of syllables, as in bus
Next to [t], as in steep, pizza, beats
Next to high front vowels, as in see
Possible Metaphors

Bump sound (tongue tip up)
Little hill sound (tongue tip up)
Lower teeth sound (tongue tip down)
Long sound
Hissing sound
Voicing: Motor off
Voice off
Not a buzzing sound
Voice box off
Touch Cue
Finger on the corner of the mouth (finger up for tongue tip raised sound
or finger down for tongue tip down sound).
Instructions
Place the student’s finger in the corner of the lips, and remind the
student to keep upper and lower teeth close together.
Initial Screening Test for [s]
Student’s Name:
Date: __________________
Referral:
Word Student* Word Student*

Beginning
1. Soap _____________ 6. Skirt _____________
2. Sew _____________ 7. Smell _____________
3. Sun _____________ 8. Slap _____________
4. Sting _____________ 9. Strap _____________
5. Spicy _____________
Medial
10. Acid _____________
11. Messy _____________
12. Icing _____________
Final
13. Dice _____________ 17. Husk _____________
14. Moose _____________ 18. Toast _____________
15. House _____________ 19. Fierce _____________
16. Wasp _____________ 20. Wince _____________

Comments/Notes:
199
Stimulability Tests for [s]
Student’s Name:
Date: __________________
Referral:
Imitation
1. sun _____________
2. bus _____________
Key Environments

1. kiss _____________
2. [is] _____________

1. See _____________
2. Seat _____________
After [t] and before [i]

1. [tsi] _____________
2. pizza _____________
After a [t] occurring in the same syllable

1. beats _____________
2. [its] _____________
Favorite Words

200
1. Place a tongue depressor just behind the student’s upper or lower front
teeth, depending on which variety of [s] is being taught, and ask him or
her to use the tongue tip to hold it there.
2. Next, ask the student to keep the tongue tip still while you carefully
remove the tongue depressor.
3. Ask the student to breathe out, resulting in [s].
Shaping [s] from [θ] _____________

1. Ask the student to place the tongue tip between the front teeth and then
gently close the teeth together.
2. Ask the student to draw back the tongue tip behind the teeth. If needed,
gently push the tongue tip inward with a tongue depressor.
3. Ask the student to either raise or lower the tongue tip slightly, depending
on which type of [s] is being taught, and to blow air out through the
mouth, resulting in [s].
Notes/Comments:
201
202 The late eight
Demonstrations for [s]
Place: Alveolar
First Method
Objects: None
Instructions:

2. Once the tongue is out, for [s] with the tongue tip raised ask the student
to pull the tongue back to feel the bump on the roof of the mouth behind
the two front teeth. For [s] with the tongue tip down, ask the student to
pull the tongue back to feel the little bump behind the two lower teeth.
Second Method
Objects: Q-tip and peanut butter or other favored food
Instructions:

2. Once the mouth is open, with Q-tip dab a little peanut butter or other
favorite food on the alveolar ridge (for tongue tip raised [s]) or behind
lower front teeth (for tongue tip lowered [s]).
Manner: Fricative
First Method
Object: Strip of paper or a feather
Instructions:

sounds.
CHAPTER 9: [s] 203
Second Method
Objects: A small paper flower on the end of a pencil
Third Method
Objects: None
Voicing: Voiceless
First Method
Objects: None

between a voiceless and a voiced [a].
Second Method
Objects: None
Third Method
Objects: None

ask the student to make [h] and [a].
204 The late eight
Fourth Method
Objects: None
Fifth Method

paper flower
Instructions: If the student is able to produce a voiced and voiceless oral

stop, attach a small piece of paper or a paper flower to the end of a tongue
depressor or pencil and ask the student to “make the paper (or flower)
move.” The paper is more likely to move when a voiceless consonant is
produced than when a voiced consonant is produced (be careful in providing
instructions to the student, however, because a strongly articulated voiced
CHAPTER 9: [s] 205
Phonetic Placement and Shaping Techniques for [s]
A key to making [s] is correct tongue tip placement. To make [s] the tongue
tip is behind either the upper or lower front teeth, the upper and lower teeth
are relatively close, and a narrow stream of air hisses between the tongue
tip and the teeth. Once this is achieved, the hiss of air is achieved simply by
breathing out, and getting the jaw relatively closed so the upper and lower
teeth nearly touch is usually achieved with a few simple instructions. All the
following phonetic placement techniques focus on placing the tongue tip for
[s]. The first two methods are used either for [s] with the tongue tip raised or
lowered, the third and fourth are for [s] with the tongue tip raised, and the
fifth is for [s] with the tongue tip lowered.
First Method (tongue tip up or down)
This method and the following method work whether the tongue tip is up
or down.
Objects: None
Instructions:
1. Ask the student to place the tongue tip behind either the upper or lower
front teeth and then to pull the tongue back a little bit.
2. Close the student’s teeth so the teeth barely touch.
3. Place your finger in front of the center of the student’s mouth, and
say, “Breathe slowly over your tongue toward my finger.” The sound
produced by the student when breathing out approximates [s].
Second Method (tongue tip up or down)
Object: Tongue depressor (or Q-tip)
Instructions:
teeth and ask the student to use the tongue tip to hold it there.
2. Ask the student to keep the tongue still while you carefully remove the
tongue depressor.
206 The late eight
Third Method (tongue tip up)
This method is a little more involved than the previous two. It is useful for
a student who really doesn’t seem to “get” the idea that the tongue tip must
be raised.
Instructions:
1. Make a shelf by placing a tongue depressor against the lower edges of

the student’s upper teeth.
2. Next, ask the student to place the tongue on the shelf. If needed, place
a tongue depressor under the student’s tongue tip to bring the “elevator
up” so that the tongue depressor touches the lower front teeth.
3. Ask the student to breathe out through the mouth. The resulting sound
approximates [s].
Fourth Method (tongue tip up)
This somewhat involved method is for a student whose difficulty is raising

the tongue and who may also experience difficulty grooving the tongue. Dif-
fering from previous methods, this one utilizes the fact that the sides of the
tongue touch the inside of the teeth when making an [s]. Some children find
“anchoring” the tongue sides to the teeth a helpful strategy when attempting
to raise the tongue tip for [s].
Object: Drinking straw
Instructions:
1. Ask the student to raise his or her tongue so that the sides are firmly in
contact with the inner surface of the upper back teeth. (An alternative
method is to instruct the student to stick out the tongue slightly, lower
the upper teeth to come into contact with the sides of the tongue, and
then pull the tongue inside the mouth.)
2. Ask the student to groove the tongue slightly along the midline. (If
needed, ask the student to protrude the tongue and place a clean object
such as a drinking straw along the midline of the tongue. Then ask the
student to raise the sides of the tongue slightly around the straw.)
3. Carefully withdraw the straw.
4. Ask the student to place the tongue tip about a quarter of an inch behind
the upper teeth and then ask the student to bring the teeth together.
CHAPTER 9: [s] 207
5. Instruct the student to blow air along the groove of the tongue toward
the lower teeth. If the student has difficulty directing the air along the
tongue groove, insert a drinking straw into the student’s mouth and
instruct the student to blow through the straw, which often results in [s].
Fifth Method (tongue tip down)
This method works surprisingly well with some students. It can be tried for [s]
with the tongue tip raised, though my clinical experience is that it is usually
more effective for the tongue tip-lowered variety of [s].
Objects: None
Instructions:
1. Ask the student to brush his or her lower gums with the tongue while
attempting to say [s].
2. Ask the student to stop moving the tongue and to bring the upper and
lower teeth close together, but not touching.
3. Instruct the student to breathe out through the mouth, resulting in [s].
Shaping Techniques
[s] from [z]
If a student can make a [z], he or she can usually be taught to make an [s]
fairly easily.
Objects: None
Instructions:
Instruct the student to say [z] and then to turn off the voice box. For some
students, this is sufficient to result in [s]. (Note: To facilitate [z], instruct the
student to turn on the voice box while saying [s].)
[s] from [θ]
This method works well either for a student who lisps or for one who otherwise
has a well-established interdental consonant.
208 The late eight
Instructions:
1. Instruct the student to protrude the tongue between the teeth and to
say [θ].
2. As the student says [θ], instruct him or her to bring the tongue back into
the mouth and behind the upper or lower front teeth, depending on
which variety of [s] is being facilitated. An alternative method is to ask
the student to scrape the tongue tip back along the back of the front
teeth. (If needed, the tip of the student’s tongue can be pushed inward
with a tongue depressor.)
3. Next, ask the student to either raise or lower the tongue tip slightly,
depending on which type of [s] is being taught.
4. Ask the student to blow air through the mouth. The sound produced
approximates [s]. (Note: To facilitate [z], develop from [ð].)
[s] from [ls]
These four methods help a student to convert a lateral [s] into [s].
First Method (tongue tip raised)
The following description of the useful butterfly technique is a condensed

version of a Web page provided by Caroline Bowen at: http://members.tripod
.com/CarolineBowen/fsd-butterfly-procedure.htm. The technique can be
applied to lateral or palatal alveolar fricatives and requires a student to
be able to pronounce a correct [t] and [d].
Objects: None
Instructions:
1. Talk about the “butterfly position” for the tongue, or the position the
tongue is in when you prolong the i in pip or the ee in peep. Point out
to the student that the lateral margins of the tongue are in contact with
the teeth: like a butterfly with its wings up. Older students sometimes
like and are amused by the imagery of a butterfly assuming the “bracing
position.”
2. Draw the student’s attention to the way the tongue edges (wings) press
quite firmly on their teeth. You might mention that “floppy edges” or
“floppy wings” let the air out sideways, while “strong edges” or “strong
CHAPTER 9: [s] 209
wings” do not. Help the student imagine the midline of the tongue as the
butterfly’s body, visualizing the groove that forms along its center.
3. Tell the student the groove is there for her/him to “shoot” the air down,
straight out in front. It is there specially to guide the air in the right
direction for a super sounding ess. Use your hands to convey the idea of
“wings up,” “wings firmly tucked in against the teeth,” and language such
as, “a nice little groove where the butterfly’s body sits,” and a “straight
shot” of air. Employ imagery to talk about “shooting straight” and “shoot-
ing sideways.”
4. Next, model [t] and have the student imitate your production. Do the
same with [t-t], then [t-t-t] and then [t-t-t-t]. If the student is producing a
schwa or other vowel between the consonants, eliminate it if possible.
Aim for a “pure” sounding sequence of consonants. If the student needs
a vowel to get from one [t] to the next, use i as in pip (ti- ti- ti-) or ee
as in peep (tee- tee- tee-). Some clinicians prefer ee because it creates a
firmer “seal” between the tongue margins and the teeth, and, potentially
anyway, this discourages lateral airflow.
5. Increase the rate at which the student repeats [t-t-t-t]. Notice the subtle [s]
that starts occurring between the t’s. Point this out to the student in your
speech and in his/her speech. The sequence is now starting to sound
like [ts-ts-ts-ts].
6. The student will probably be unaware at this stage that the little “under-
articulated” [s] is there. In this step, tell the student to produce the [t] and
to let a little air come out at the end of the sound. Demonstrate what you
mean, without actually instructing the student to produce “t and then
s.” Just emphasize that you want to have “air happening” after the [t].
Gradually “sharpen” the [ts] thus produced, so that it becomes obvious
that there are two sounds, [t] and [s], being articulated clearly. Once it’s
perfect, have the student practice saying [ts] until he or she can do it very
easily. It is a good idea to stay on this level for several days.
7. Now put the [ts] combination into real words. Again using the vowels ee as
in feet or i as in fit to facilitate correct placement, present the student with a
practice list. For example, “He eats meat, she eats candy, it eats grain,” and
so forth; or, “It’s a boy, it’s a man, it’s a cow,” and so forth or, “It’s good, it’s
bad, it’s tall,” etc. In making up the phrases or sentences, do not include
other words containing [s] or [z]. This means don’t have items such as, “He
eats pasta” or “It’s a zoo” or “It’s silly.” Once [ts] is established in words,
practice [ts] in simple sentences that do not contain other s-words.
8. When the [s] the student is producing sounds clear and “adultlike,” it is
ready to separate from the [t]. Without mentioning the tongue too often,
instruct the student to say [ts] without moving the tongue, and then add
an ess, like this: [ts-s]. This may be difficult for the student at first, so take
it slowly and quietly and give plenty of support and encouragement.
9. Next, instruct the student to make the [ts] silent, resulting in [s].
210 The late eight
Second Method (tongue tip raised or lowered)
Instructions:
1. Demonstrate air flowing through a straw protruding from the side of the
mouth when a lateral [s] is made and air flowing through a straw placed
in the front of the mouth when a correct [s] is made.
2. Encourage the student to close the teeth and to direct the airflow through
a straw placed in front of the mouth. This typically results in [s]. (Note:
To facilitate [z], develop from lateral [z].)
Third Method (tongue tip raised or lowered)
Objects: Q-tip and picture of a small circle on a piece of paper
Instructions:
1. Instruct the student to produce a lateral [s] ([ls]).

2. Draw imaginary circles with a Q-tip where the groove should occur in
the center of the tongue to indicate to the student where the air should
flow during [s].
3. Next, draw a small circle on a piece of paper and hold it in front of the
student’s mouth at the point where air should be emitted if the air flows
over the top of the tongue.
4. Instruct the student to direct the air through the circle while saying [s].
An alternative method is to instruct the student to use the fingers instead
of paper. If the student’s fingers are used, the sensation of air is felt
more keenly if the fingers are wet. (Note: To facilitate [z], develop from
lateral [z].)
Fourth Method (tongue tip raised or lowered)
Objects: None
Instructions:
1. Ask the student to gently bite the sides of the tongue, drop the tongue
tip, and put it behind the front teeth.
2. Ask the student to smile and blow air out the front of the mouth, result-
ing in [s].
CHAPTER 9: [s] 211
[s] from [t]
These methods rely on the fact that [t] and [s] are made in the same place of
production. It is extremely helpful for the many students who have a well-
established [t]. A limitation on its utility is that it requires the student to follow
steps which some students find challenging.
First Method
Objects: None
Instructions:
1. Instruct the student to say [t] in tea with strong aspiration. If said quickly
and forcefully, [tsi] results. An alternative to this procedure is to ask the
student to say [tsi] instead of tea.
2. Instruct the student to say [tsi] without the vowel, resulting in [ts].
3. Ask the student to prolong the [s] portion of [ts], resulting in tsss.
4. Ask the student to make [t] silent, resulting in [s].
Second Method
Objects: None
Instructions:
1. Ask the student to open the mouth and to put the tongue in position for
[t].
2. Instruct the student to lower the tongue slightly and to send the air over
the tongue.
3. Place the student’s finger in front of the mouth to feel the emission of
air, which typically results in [s].
Third Method
This is a clever variation of the [s] from [t] method that was developed by
Gillian Fleming of Dunedin, New Zealand, who kindly consented to let it be
placed in this book. It works especially well for establishing [s] at the end of
words. Gillian writes, “I feel that by the time a child reaches school age, he/
she is very aware of the [s] sound. People have been trying to correct it for
ages, saying things like, ‘Put your tongue in’ or ‘It’s not [θ], it’s [s]’ and other
212 The late eight
unhelpful comments. Children are programmed to use their lateral sound or

their lisp as soon as they see or think about [s]. So, when they first present for
therapy, I tell them we are not going to work on [s] — we are going to work on
making good clear [t] sounds.”
Objects: None
Instructions:
1. Instruct the student to place the tongue tip on the ridge behind the top
teeth, resulting in a series of short [t] sounds (t — t — t — t — t).
2. Next, instruct the student to make [t] a little longer (ttt ttt ttt).
3. Next, make [t] a little longer still (ttttttt — tttttttt — ttttttt).
4. Lastly, put the long ttttttt on the end of a word (catttt — big cattttt — fluffy
cattttt — etc.), resulting in word final [ts].
5. Once clear [s] is established, practice final [ts] in other words (bats, boats,
kites, etc.).
6. When the clinician believes the time is right, point out that the student
is now making a correct [s] sound.
[s] from [ ʃ ]
As this method attests, sometimes the only thing that is needed to succeed is
a good smile. Retracting the lips to smile pulls the tongue forward into an [s].
Objects: None
Instructions:
1. Ask the student to say [ ʃ ].

2. Ask the student to retract the lips into a smile. Often, this moves the
tongue forward slightly into the position for [s]. If needed, however, ask
the student to move the tongue slightly forward, resulting in [s]. (Note:
To facilitate [z], develop from [ Z ] or instruct the student to turn on the
voice box.)
[s] from [f]
This method, like the one above, converts one fricative into another. The
difference is that it approaches [s] from an anterior position rather than a
posterior one. I have found it a little less successful than the previous method.
Objects: None
CHAPTER 9: [s] 213
Instructions:
1. Ask the student to lift the tongue tip slowly while making a prolonged
[f].
2. Ask the student to bring the front teeth close together but not quite
touching. If needed, gently pull out the student’s lower lip slightly.
3. Ask the student to smile while making the sound, which often results
in [s]. (Note: To facilitate [z], develop from [v] or use [s] and instruct the
student to turn on his or her voice box.)
[s] from [i]
Admittedly, this and the method that follows are a somewhat far stretch. This
method relies on the similarity in the place of production of [i] and [s], and
the following method relies on similarity in the frication created by [s] and
[h]. Neither would be my first choice for a method to remediate [s], but each
has a place in the clinical repertoire.
Objects: None
Instructions:
1. Instruct the student to say [i].

2. Ask the student to turn off the voice box and gradually close the teeth
until [s] results (Note: To facilitate [z], instruct the student to keep the
voice box on.)
[s] from [h]
Objects: None
Instructions:
1. Ask the student to gradually close the teeth while saying [h].
2. Ask the student to raise the tongue tip gradually while producing a pro-
longed [h] until the resulting sound is [s]. (Note: To facilitate [z], instruct
the student to turn on the voice box.)
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
214
Imitation
Student’s Name:
Date: __________________
Sat 1. __________________
Salmon 2. __________________
Sail 3. __________________
Salad 4. __________________
Sailboat 5. __________________
Socks 6. __________________
Soap 7. __________________
Sew 8. __________________
Sun 9. __________________
Sally 10. ________________
Total Correct: ________ / ________

Comments:
215
Minimal Pairs
Student’s Name:
Date: __________________
Sink think 1. __________________

Ceiling peeling 2. __________________
Sip whip 3. __________________
Soak poke 4. __________________
Sea me 5. __________________
Son fun 6. __________________
Sad mad 7. __________________
Sack back 8. __________________
Sun fun 9. __________________
Sick tick 10. ________________
Total Correct: ________ / ________

Comments:
216
Deletion
Student’s Name:
Date: __________________
Sat at 1. __________________
Sail ale, ail 2. __________________
Sew O, oh 3. __________________
Sally alley 4. __________________
Silk ilk 5. __________________
Seagull eagle 6. __________________
Sick ick 7. __________________
Sole ole 8. __________________
Sink ink 9. __________________
Sea E 10. ________________
Total Correct: ________ / ________

Comments:
217
Self-Correction
Student’s Name:
Date: __________________
Sat 1. __________________
Salmon 2. __________________
Sail 3. __________________
Salad 4. __________________
Sailboat 5. __________________
Socks 6. __________________
Soap 7. __________________
Sew 8. __________________
Sun 9. __________________
Sally 10. ________________
Total Correct: ________ / ________

Comments:
218
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Note. Replace * with the way the student used to say the sound.
Sat 1. __________________
Salmon 2. __________________
Sail 3. __________________
Salad 4. __________________
Sailboat 5. __________________
Socks 6. __________________
Soap 7. __________________
Sew 8. __________________
Sun 9. __________________
Sally 10. ________________
Total Correct: ________ / ________

Comments:
219
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
Sat 1. __________________
Salmon 2. __________________
Sail 3. __________________
Salad 4. __________________
Sailboat 5. __________________
Socks 6. __________________
Soap 7. __________________
Sew 8. __________________
Sun 9. __________________
Sally 10. ________________
Total Correct: ________ / ________

Comments:
220
CHAPTER 9: [s] 221
Complete Word List for [s]
Beginning of Words

Salmon
Sail ale, ail
tail, pail, nail, veil, rail,
whale, mail, jail
Salad ballad
Sailboat
Soap rope
Sew O, oh
toe, row, hoe, no, bow,
mow, go
Sally alley tally
Silk ilk
Seagull eagle
Sick Ick
Sole ole mole, goal, hole
Saber
Sink Ink think, pink, rink, wink
Surgeon
Sea E me, bee, key, knee, pea
Cellar teller
Sioux oo dew, coo
Saddle addle paddle
Surfboard
Sailboat
Son fun, run, bun, gun, one
Sidewalk
Sand and band, fanned, tanned, hand
Surfer
Sunrise
Sad add mad, bad, dad
Sundae fun day
Sydney kidney
Sunday fun day
Sunburn
Susan
Cycle Michael
222 The late eight
Circle
Sit it hit, mit, kit, knit, bit
Soldier
Sam am ham, lamb
Salesclerk
Six wicks, mix
Seaweed
Suit cute, hoot, boot
Cindy Indy windy
Soar or, oar four, more, tore, bore, core
Ceiling peeling, reeling, kneeling
Sub hub, cub
Sunlight
Saint ain’t paint, faint
Subway
Seal eel Neil, heel
Cement
Sour hour tower, shower, cower
Sunny honey, money, funny,
bunny
Suck uck buck, luck, shuck, muck
City kitty, witty
Soup loop, poop
Salt ought malt
Sign nine, fine, shine
Sandal handle
Sid id hid, kid, bid, lid
Song thong, long
Sank rank, lank, bank
Suds duds, cuds
Soak oak poke, choke, yolk, joke,
woke
Serve Merv, curve
Sound round, pound
Sue ooh boo, who, due
Soot foot
Sing wing, thing, king, ring
Sip whip, rip, lip, hip, dip
Cell L fell, dell, Mel
Sack back, rack, hack, pack, tack
Surf turf
Soil oil boil, coil
Sock lock, mock
CHAPTER 9: [s] 223
[sp]
Spot pot
Spell
Spicy
Spout pout
Spanish
Space pace
Spill pill
Spit pit
Spokes pokes
Spider
Sponge
Spear peer
Spark park
Spank
Spoon
Spareribs
Spin pin
Spy pie
Spade paid
Spooky Pooky
Spy pie
Spaceship
Spike pike
Spirit
Speak peak
Special
Spear peer
Speed peed
[st]
Stop top
Sting ting
Stoplight
Stink
Story Tory
Stack tack
Stork torque
Stagecoach
Steak take
Stick tick
224 The late eight
Storm
Stairs tears
Stone Age
Stalk talk
Stool tool
Stallion
Staff
Steam team
Steal teal
Starfish
Stamp
Stale tale, tail
Stock car
Stand
Stub tub
Star tar
Stew two
Staff
Stag
Stake take
Standard
Statue
Steady Teddy
[sk]
School cool
Ski key, C
Skin kin
Scale kale
Skinny
Skirt Kurt
Skier
Scarf
School bus cool bus
Scar car
Skate Kate
Scotland
Skunk
Skip Kip
Sky
Skillful
CHAPTER 9: [s] 225
Sketch
Skew Q
Skim Kim
Skull cull
Skid kid
Skill kill
[sf]
Sphinx finks
Sphere ear
Sphincter
[sl]
Slip lip
Sleigh lay
Slide lied
Sleep leap
Sled dog
Slug lug
Sling
Sled led
Slimy limey
Sleepy
Sleeve leave
Slippers
Sliver liver
Slime lime
Sloth
Slab lab
Slang
Slick lick
Slump lump
Slow low
Slash lash
Slink link
Slate late
Slave
Slop
Slay lay
Sleek leak
226 The late eight
[sw]
Swing wing
Swimmer
Sweater wetter
Sweatshirt
Sweet tooth
Sweat wet
Swiss
Sweet wheat
Switch witch
Swamp
Swim whim
Swan wan
Swelter welter
Swerve
Swear wear
Sweden
Swat watt
Sweep weep
Sway way
Swap
Swallow wallow
Swarm warm
Swift wift
[sm]
Small mall
Smell Mel
Smile mile
Smelly
Smog
Smoke
Smack Mack
Smoky
Smooth
Smallest
Smock mock
Smart mart
Smoky
Smash mash
CHAPTER 9: [s] 227
Smother mother
Smudge
Smite mite
[sn]
Snack knack
Snail nail
Snout
Snorkel
Snap nap
Snake bite
Snow no, know
Snarl gnarl
Snack bar
Snow bank no bank
Snow White no white
Sneakers
Snoopy
Snake
Sneeze knees
Snore nor
Sneer near
Snug
Sniff
Snippy nippy
Sniffle
Snub nub
Sneak
Snatch
Snob knob
Snort
[spr]
Spring
Spray pray
Sprite (soda)
Sprinkle
Spry pry
Spray gun
Sprint print
Sprinkles
228 The late eight
Springboard
Sprinkling
Springtime
Sprain
Spread
Sprig prig
Spree
Spruce
Sprout
[str]
Struck truck
Strum
Strike out
Strong
Stroller troller
Street treat
Stranger
Straw
Stronghold
Stripe tripe
String
Strike zone
Streetcar
Stream
Strap trap
Strike trike
Stretcher
Strict tricked
Stroke
Struggle
Strum
Strut
[skr]
Screen
Scribble
Scream cream
Scratch
Scrapper
CHAPTER 9: [s] 229
Scrooge
Screenplay
Scrub
Screw crew
Screen
Script crypt
Scramble
Scribe
Scrap crap
Scroll
Scrimp crimp
Scrabble
Screech
[skw]
Square
Squash
Squeal keel
Squeak
Squad quad
Squirt
Squaw
Squalid
Squirm
Squeeze
Squall
Squint
Squadron
[spl]
Splashdown
Splinter
Split
Splash
Splint
Spleen
Splat
Splice
Splurge
230 The late eight
[s] + Stops [p t k] Deletions
Sting ting
Spicy
Skirt Kurt
Steak take
Spanish
Staff
Skull cull
Steady Teddy
Skinny
Spill pill
Spider
Sponge
Sketch
Skew Q
Skim Kim
Spear peer
Scotland
Spark park
Skid kid
Spareribs
Steal teal
Spin pin
Staff
Spy pie
Skill kill
Spade paid
Stoplight top light
Spooky Pooky
Spy lie
Stone Age
Stallion
Starfish
Spaceship
Stop top
Spot pot
Stag
Stake take
Spit pit
Story Tory
Spirit
Stack tack
CHAPTER 9: [s] 231
[s] + Stops [p t k] Deletions
Spoon
Stork
Stagecoach
Space pace
Stick tick
Storm
Stairs tears
Spank
Stalk talk
Sky
Stool tool
Special
Skip Kip
Stamp
Spike pike
Speed peed
Stock car
Spokes pokes
Stand
Stub tub
Star tar
Stew two
School cool
Standard
Ski key
Speak peak
Skin kin
Spout pout
Scale kale
Spell
Skier
Scarf
Spear peer
School bus cool bus
Stink
Scar car
Steam team
Skate Kate
Statue
Skunk
Stale tale, tail
232 The late eight
[s] + Nasals [m n] Deletions
Small mall
Snarl gnarl
Sneeze knees
Smell
Snail nail
Smock mock
Sneer near
Snort
Smile mile
Snoopy
Smog
Snow White no white
Smoke
Snug
Snob knob
Smart mart
Smite mite
Snack bar
Smooth
Snoopy
Smoky
Smudge
Snake
Smallest
Snack knack
Snub nub
Sneak
Smother mother
Snout
Smack Mack
Snorkel
Snap nap
Smash mash
Snake bite
Smelly
Snow no, know
Smoky
Sniff
Snippy nippy
Sniffle
Snatch
Snow bank no bank
Sneakers
Snore nor
CHAPTER 9: [s] 233
[s] + Two Consonants Deletions
Squeal keel
Strike trike
Stretcher
Screw crew
Spread
Squeak
Spray pray
Squalid
Strap trap
Screen
Screech
Sprinkle
Sprinkles
Scrimp crimp
Scrabble
Street treat
Squash
Squirm
Sprinkling
Struck truck
Script crypt
Scramble
Scribe
Sprain
Squint
Squadron
Strum
Squall
Splash
Strike out
Squeeze
Springtime
Scrap crap
Scroll
Strong
Spray gun
Strict tricked
Stroke
Spruce
Stroller
Splint
Scream cream
Stranger
Sprig prig
234 The late eight
[s] + Two Consonants Deletions
Straw
Sprint print
Stronghold
Squad quad
Spree
Stripe tripe
Split
String
Strike zone
Squash
Struggle
Strum
Scrooge
Streetcar
Square
Scrapper
Splurge
Squirt
Stream
Splashdown
Spring
Sprite (soda)
Strut
Splinter
Screen
Spruce
Sprout
Scribble
Splat
Splice
Scratch
Screenplay
Scrub
Spleen
Squeak
Springboard
Squaw
CHAPTER 9: [s] 235
Medial
Single Consonants
Icy Racer Jason

Dress up Russell Glasses
Muscle Castle Lucy
Acid Fossil Mossy
Messy Grassy Posse
Icing Brussels Peso
Possum Bossy Kissing
Bison Tracy Bessie
Lassie Racing Casey
Faucet Listen Tracing
Dissect Tucson
Consonant Clusters
Hopscotch Shoe store Einstein

Ice skate Explore Casper
Crystal Pretzel Hairspray
Oscar Eskimo Bus stop
Costume Shakespeare Explode
Expressway Dog sled Pizza
Diskette Cub Scout Asleep
Ski slope Basking Baseman
Basement Shoestring Whisker
Whisper Postman Hot spring
Sixty Locksmith Houston
Chopsticks Escape Casket
Teaspoon Betsy Bracelet
All Environments
Shakespeare Dissect Costume

Icy Asleep Tucson
Dress up Racer Diskette
Sixty Postman Ski slope
Dog sled Russell Basement
Muscle Castle Whisker
Teaspoon Betsy Jason
236 The late eight
All Environments
Explore Hairspray Pizza

Acid Fossil Glasses
Basking Escape Hopscotch
Messy Grassy Lucy
Cub Scout Casper Mossy
Pretzel Bracelet Ice skate
Icing Brussels Posse
Shoe store Einstein Houston
Possum Locksmith Baseman
Chopsticks Bossy Peso
Oscar Whisper Kissing
Bison Expressway Crystal
Hot springs Shoestring Bessie
Lassie Tracy Bus stop
Eskimo Explode Casey
Faucet Racing Tracing
Casket Listen
End of Words
Toss
White house
Dice die
Goose goo
Moose moo
Courthouse
Ice eye, I
Noose new
Nervous
Famous
Trace tray
Gas
Red Cross
Race ray
Lighthouse
Glass
Fireplace
Mace May
Janis
CHAPTER 9: [s] 237
Greece
Kansas
Bruce brew
Porpoise
Press
Grass
Police
Gross grow
Palace
Grease
Air base
Lewis Louie
Cross
Mattress
Paris
Pass
Geese Gee
Necklace
Carlos Carlo
Rice rye
Dress
Alice alley
Blouse
Yes
Mouse Mao
Bus
Briefcase
Chris
Kiss
Congress
Class
Vase
Face Fay, fey
Bernice
Ace A
Hiss
Horse
Mice my
Bus
Boss
Moss
238 The late eight

[sp]
Wasp
Lisp lip
Grasp
Crisp
Gasp gap
[st]
Waist wait
Chest Chet
Frost fraught
Signpost
Fast fat
Midwest
Crust
Rust rut
Artist
Post
Fist fit
Breakfast
Mist mitt
August
Feast feet
Toast tote
Twist twit
Chemist
Most moat
Nest net
Forest
Gust gut
Signpost
Toothpaste
West wet
Typist
Vest vet
Conquest
Priest
August
Gymnast
Ghost goat
Wrist writ
Last
Slowest
CHAPTER 9: [s] 239
Key West
Lost
East eat
[sk]
Desk deck
Mask Mack
Disk Dick
Corn husk
Tusk tuck
Mollusk
Gas mask
Husk Huck
Ask
School desk
Face mask
Whisk wick
Task tack
Mosque mock
[sl]
Missile
Axle
Fossil
Muscle
Wrestle
[ls]
Convulse
Pulse Paul
[ns]
Fence fen
Dance Dan
Defense
Florence
Wince win
Immense
240 The late eight
France Fran
Balance
Science
Pounce
Tense ten
Prince
Bounce
License
Rinse
Lance
Entrance
[rs]
Force four
Divorce
Pierce peer
Golf course
Fierce fear
Hoarse whore
Horse whore
Air Force
Sawhorse
[ks]
Ax
Alex
Fox
Smallpox
Comics comic
Larynx
Phoenix
Mailbox
Box Bach
Tax tack
[s] + Consonant
Fast fat
Wasp
Waist wait
CHAPTER 9: [s] 241
Mosque mock
Chest Chet
Frost fraught
Signpost
Midwest
Crust
Lisp lip
Rust rut
Artist
Gasp gap
Fist fit
Crisp
Breakfast
Mist mitt
School desk
August
Feast feet
Facemask
Husk Huck
Toast tote
Twist twit
Mollusk
Chemist
Most moat
Gas mask
Nest net
Forest
Wrestle
Gust gut
Signpost
Toothpaste
West wet
Corn husk
Typist
Fossil
Tusk
Frost
Vest
Conquest
Priest
Muscle
Gymnast
242 The late eight
Wrist writ
Last
Grasp
Slowest
Key West
East eat
Desk deck
Post
Mask Mack
Ghost goat
Disk Dick
August
Axle
Ask
Whisk wick
Lost
Task tack
Missile
Consonant + [s]
Convulse
Rinse
Fence fen
Comics comic
Larynx
Florence
Fierce fear
Wince win
Box
Immense
Air Force
Dance Dan
Horse whore
Sawhorse
France Fran
Ax
Balance
Fox
Smallpox
Science
Force four
CHAPTER 9: [s] 243
Pounce
Hoarse whore
Tense ten
Defense
Prince
Phoenix
Bounce
Pulse Paul
License
Prince
Alex
Lance
Entrance
Divorce
Tax tack
Pierce peer
Golf course
Mailbox
Plural Markers Deletions
Bucks buck
Cats cat
Tops top
Punks punk
Picks pick
Spots spot
Pops pop
Shops shop
Tips tip
Carts cart
Skunks skunk
Sharks shark
Pops pop
Droughts drought
Types type
Spouts spout
Embarks embark
Plops plop
Sinks sink
Shouts shout
244 The late eight
Themes for [s]
Themes
Snack Time The Body

Let’s Bake Speech
Field and Forest Bath time
Horseback Riding Clothes to Wear
At the Beach Medieval Fun
People to See Bus Ride Around Town
Places to Go
Snack Time Deletions Minimal Pairs
Messy
Toast tote
Swallow wallow
Spare ribs
Soup loop, poop
Salt ought malt
Sip whip, rip, lip, hip, dip
Rice rye mice, lice
Salad ballad
Sundae fun day
Steak take
Sub hub, cub
Sour hour tower, shower, cower
Icy
Sprout
Icing
Squirm
Sprouts sprout
Squeeze
Squash
Skim Kim
Splurge
Spread
Spicy
Spree
Stew two
Sprinkle wrinkle
Snack bar
Snack knack
CHAPTER 9: [s] 245
Snack Time Deletions Minimal Pairs
Smell Mel
Sweet wheat
Sprinkles
Chopsticks
Pizza pita
Crust
Crisp
Frosting
Let’s Bake Deletions Minimal Pairs
Snack knack
Icing
Grease
Feast feet
Crust
Swallow wallow
Crisp
Frost fraught
Snack knack
Smell Mel
Sweet wheat
Sprinkles
Whisk wick
Teaspoon
Frosting
Spoon
Skim Kim
Splurge
Spread
Field and Forest Deletions Minimal Pairs
Fox
Fence fen
Corn husk
Tusk tuck
Sprig prig
Spruce
Husk Huck
246 The late eight
Field and Forest Deletions Minimal Pairs
Sliver liver
Ax
Salmon
Mouse Mao
Saddle addle
Sleek leak
Swerve
Swan wan
Swallow wallow
Sailboat
Sunrise
Swarm warm
Swift wift
Sunlight
Sunny honey, money, funny,
bunny
Soil oil boil, coil
Possum
Stag
Moose moo
Bison
Grassy
Skunk
Skip Kip
Mossy
Moss
Stork
Sky
Slug lug
Stallion
Stick tick
Storm
Horse whore
Mice my
Grass
Goose goo
Geese gee
Stream
Splash
Cycle Michael
Forest
CHAPTER 9: [s] 247
Horseback Riding Deletions Minimal Pairs
Fence fen
Saddle addle
Sunlight
Sunny honey, money, funny, bunny
Grassy
Swift wift
Stallion
Storm
Sleek leak
Swerve
Swelter welter
Horse whore
Grass
Stream
Splash
Forest
At the Beach Deletions Minimal Pairs
Mollusk
Salmon
Sail ale, ail tail, pail, nail, veil, rail,
whale, mail, jail
Sailboat
Seagull eagle
Sole ole mole, goal, coal
Sea E pea, me, key
Surfboard
Sailboat
Sunburn
Surfer
Sunrise
Squall
Sharks shark
Seaweed
Sunlight
Seal eel Neil, heel
Sunny honey, money, funny, bunny
Sandal handle
248 The late eight
At the Beach Deletions Minimal Pairs
Surf turf
Lighthouse
Porpoise
Sky
Stallion
Stick tick
Storm
Starfish
Splash
People to See Deletions Minimal Pairs
Alex
Lance
Sally alley tally
Sioux oo dew, coo
Lucy Louie
Susan
Russell
Sam am Pam, ram, lamb
Cindy Indy windy
Sid id hid, kid, bid, Sid
Sue ooh boo, who, due
Lassie
Tracy
Jason
Bessie
Casey
Janis
Bruce brew
Lewis
Carlos Carlo
Alice
Chris
Smoky
Snow White no white
Oscar
Shakespeare
Betsy Betty
Einstein
Casper
Snoopy
CHAPTER 9: [s] 249
Places to Go Deletions Minimal Pairs
Phoenix
France Fran
Florence
Sphinx
Sweden
Key West
Sydney kidney
Tucson
White House
Greece
Kansas
Scotland
Houston
Larynx
Smallpox
Skin kin
Smile mile
Sniffle
Splint
Spleen
Sprain
Stretcher
Stroke
Skull cull
Sneeze knees
Snore nor
Gasp gap
Lisp lip
Waist wait
Chest Chet
Wrist writ
Muscle
Pulse Paul
Fist fit
Sick ick tick, thick, kick, pick, lick,
wick
Snort
Speak peak
Squint
250 The late eight
Sniff
Slump lump
Speech Deletions Minimal Pairs
Slang
Speak peak
Lisp lip
Smile mile
Larynx
Swear wear
Splash
Steam team
Sting ting
Sponge
Spout pout
Spill pill
Face fay, fey ace
Faucet
Sing wing, thing, king, ring
Suds duds, cuds
Soak oak poke, choke, yolk, joke,
woke
Soap rope, pope
Sink ink think, pink, rink, wink
Clothes to Wear Deletions Minimal Pairs

Sew ooh toe, row, hoe, no, bow,
mow, go
Suit cute, hoot, boot
Sock lock, mock
Sneakers
Slip lip
Skirt Kurt
CHAPTER 9: [s] 251
Clothes to Wear Deletions Minimal Pairs
Dress up
Glasses
Necklace
Dress
Blouse
Scarf
Slippers
Strap trap
Costume
Silk ilk
Shoestring
Bracelet
Vest vet
Medieval Fun Deletions Minimal Pairs
Saber
Soldier
Spell
Story Tory
Saint ain’t paint, faint
Cellar teller
Sad add mad, bad, dad
Cell L fell, dell, Mel
Sack back, rack, hack, pack, tack
Casket
Sneak
Locksmith
Slave
Squalid
Stake take
Slay lay
Escape
Crystal
Straw
Swing wing
Scar car
Staff
Struggle
Spike pike
252 The late eight
Spirit
Splat
Strike trike
Spear peer
Speed peed
Scribe
Scroll
Sneer near
Slash lash
Slink link
Stairs tears
Spy pie
Spade paid
Spooky Pooky
Spider
Spear peer
Castle
Fireplace
Mace May
Palace
Cross
Spark park
Stalk talk
Swamp
Smoke
Stronghold
Squad quad
Conquest
Priest
Nest net
Forest
Mist mitt
Gust gut
Ghost goat
Lost
Mask Mack
Wrestle
Defense
Prince
Entrance
Force four
Pierce peer
CHAPTER 9: [s] 253
Fierce fear
Horse whore
Feast feet
Bus Ride Around Town Deletions Minimal Pairs

Sit it hit, mit, kit, knit, bit
Subway
City witty, kitty
Cement
Sign nine, fine, shine
Sidewalk
Salesclerk
Postman
Stroller
Street treat
Stand
Stop top
Pass
Courthouse
Police
Bus
Briefcase
Stoplight top light
School bus cool bus
Switch witch
Shoe store
Bus stop
Chapter Ten
[z]
Definition
[z] is made in either of two ways. As with [s], some people produce [z]
with the tongue tip up behind the upper front teeth, others say it with
the tongue tip down behind the lower front teeth. Neither one is the
“right way.” Follow the student’s lead in deciding which way to teach [z].
If the student appears to find it easier to say [z] with the tongue tip up,
teach the sound that way; if the student appears to find it easier to say [z]
with the tongue tip down, teach the sound that way. For both varieties
of [z], the airstream is continuous and the vocal folds are together. The
technical definition of [z] is voiced alveolar fricative.
Acquisition
Fifty percent of children acquire [s] by 4;0 and 75% of children acquire
[s] by 6;0.
Relative Frequency
[z] is ranked fifth in relative frequency compared with the other late-
acquired consonants. It ranks fifteenth in relative frequency compared
255
256 The late eight
Errors
[z] is affected by many of the same errors as [s]— lisping, bladed produc-
tions, and lateralizing are all common errors for [z]. Additionally, at the
end of words, [z] may be produced with little or no voicing, resulting
in an [s]-like sound.
Key Environments
Beginning of syllable and between vowels, as in zee and a zee
Before a high front vowel, as in zip
In consonant clusters after [d], as in beads
Possible Metaphors

Bump sound (tongue tip up)
Little hill sound (tongue tip up)
Lower teeth sound (tongue tip down)
Long sound
Hissing sound
Voicing: Motor on
Buzzing sound
Voice box on sound
Touch Cue
Finger on the corner of the mouth (finger up for tongue tip raised sound
or finger down for tongue tip down sound).
Instructions
student to keep upper and lower teeth close together.
Initial Screening Test for [z]
Student’s Name:
Date: __________________
Referral:
Word Student*
Beginning
1. Zen _____________
2. Zone _____________
3. Zombie _____________
Medial
4. Daisy _____________
5. Rosa _____________
6. Moses _____________
Final
7. Nose _____________
8. Buzz _____________
9. Hose _____________

Comments/Notes:
257
Stimulability Tests for [z]
Student’s Name:
Date: __________________
Referral:
Imitation
1. zoo _____________
2. buzz _____________
Key Environments

1. fizz _____________
2. [iz] _____________

1. zip _____________
2. zero _____________
After [d] and before [i]

1. [dzi] _____________
After a [d] occurring in the same syllable

1. beads _____________
2. ads _____________
Favorite Words

258
teeth, depending on which variety of /z/ is being taught, and ask him or
her to use the tongue tip to hold it there.
2. Next, ask the student to keep the tongue tip still while you carefully
remove the tongue depressor.
4. Ask student to turn voice box on, resulting in [z].
Shaping [z] from [s] _____________
Instruct the student to say [s] and then to turn on the voice box.
Notes/Comments:
259
260 The late eight
Demonstrations for [z]
Place: Alveolar
First Method
Objects: None
Instructions:

2. Once the tongue is out, for [s] with the tongue tip raised ask the student
the two front teeth. For [s] with the tongue tip down, ask the student to
Second Method
Instructions:

favorite food on alveolar ridge (for tongue tip raised [s]) or behind lower
front teeth (for tongue tip lowered [s]).
Manner: Fricative
First Method
Object: Strip of paper or a feather
Instructions:

sounds.
CHAPTER 10: [z] 261
Second Method
Objects: A small paper flower on the end of a pencil
Third Method
Objects: None
Voicing: Voiced
First Method
Objects: None

between a voiceless and a voiced [a].
Second Method
Objects: None
Third Method
Objects: None

262 The late eight
Fourth Method
Objects: None
Fifth Method

paper flower

Phonetic Placement and Shaping Techniques for [z]
To facilitate [z], follow the steps for [s] but also use demonstrations to instruct
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
263
Imitation
Student’s Name:
Date: __________________
Zoo 1. __________________
Zip 2. __________________
Zero 3. __________________
Zigzag 4. __________________
Zipper 5. __________________
Zach 6. __________________
Zest 7. __________________
Czar 8. __________________
Zip code 9. __________________
Zoom 10. __________________
Total Correct: ________ / ________

Comments:
264
Minimal Pairs
Student’s Name:
Date: __________________
Zoo new 1. __________________

Zap tap 2. __________________
Zipper ripper 3. __________________
Zen hen 4. __________________
Zeal meal 5. __________________
Zip hip 6. __________________
Zapped tapped 7. __________________
Z pea 8. __________________
Zinc pink 9. __________________
Zest best 10. __________________
Total Correct: ________ / ________

Comments:
265
Deletion
Student’s Name:
Date: __________________
Zoo oo 1. __________________
Czar R 2. __________________
Z E 3. __________________
Zen N 4. __________________
Zone own 5. __________________
Zinc ink 6. __________________
Zeal eel 7. __________________
Zion ion 8. __________________
Total Correct: ________ / ________

Comments:
266
Self-Correction
Student’s Name:
Date: __________________
Zoo 1. __________________
Zip 2. __________________
Zero 3. __________________
Zigzag 4. __________________
Zipper 5. __________________
Zach 6. __________________
Zest 7. __________________
Czar 8. __________________
Zip code 9. __________________
Zoom 10. __________________
Total Correct: ________ / ________

Comments:
267
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Zoo 1. __________________
Zip 2. __________________
Zero 3. __________________
Zigzag 4. __________________
Zipper 5. __________________
Zach 6. __________________
Zest 7. __________________
Czar 8. __________________
Zip code 9. __________________
Zoom 10. __________________
Total Correct: ________ / ________

Comments:
268
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
Zoo 1. __________________
Zip 2. __________________
Zero 3. __________________
Zigzag 4. __________________
Zipper 5. __________________
Zach 6. __________________
Zest 7. __________________
Czar 8. __________________
Zip code 9. __________________
Zoom 10. __________________
Total Correct: ________ / ________

Comments:
269
270 The late eight
Complete Word List for [z]
Beginning of Words
Zoo oo new, shoe, two, moo, goo,

boo, chew
Zip hip, chip, ship, whip, rip,
sip, lip
Zero hero
Zigzag
Zipper ripper, nipper
Zach sack, rack, Mack
Zest
Czar R tar, car, far
Zip code
Zoom room, boom, doom
Z E pea, me, key, D, tea
Zorro
Zap tap, rap, map
Zapped tapped, rapped,
mapped
Zulu
Zoe
Zebra
Zany
Zen N hen, men, Ben, Ken
Zone own moan, tone, bone
Zombie
Zealot
Zuni loony, goony
Zephyr heifer
Zinc ink pink, wink, sink, link
Zeal eel meal, peel, kneel
Zither
Zeppelin
Zing sing, wing, ping
Zeus moose, noose
Zurich
Zion ion tie on
Zenith
Zest best, west, pest
CHAPTER 10: [z] 271
Consonant Clusters
Medial
Single Consonants
Thousand Freezer Susan

Daisy Pisa Blizzard
Dozen Tuesday Zigzag
Rosa Brazil Scissors
Muzzle Pheasant Busy
Moses Dessert Aztec
Rosie Raisin Caesar
Wizard Buzzer Kansas
Busy Cheesecake Prison
Freezing Daisy Visor
Boise Trouser Puzzle
Muslim Suzanne Kansas
Desert Lizard Crazy
Nazgul Music Thursday
Grizzly Houses
Closet Husband
Consonant Clusters
Bronze Age Eavesdrop Wednesday

Thumbs up Thumbs down
All Environments
Thousand Wizard Freezer

Daisy Busy Pisa
Wednesday Freezing Tuesday
Dozen Boise Brazil
Rosa Muslim Pheasant
Muzzle Desert Eavesdrop
Moses Nazgul Dessert
Rosie Grizzly Raisin
Thumbs up Closet Buzzer
Cheesecake Susan Kansas
272 The late eight
All Environments
Daisy Bronze Age Prison

Trouser Blizzard Thumbs down
Suzanne Zigzag Visor
Lizard Scissors Puzzle
Music Busy Kansas
Houses Aztec Crazy
Husband Caesar Thursday
End of Words
Nose no, know

Buzz
Rose row
Cruise crew
Hose hoe
Jazz
Maze May
Liz
Samwise
Snooze
Graze gray
Cheese
Sneeze
Please plea
Oz
News new
Noise
Louise Louie
Consonant Clusters (Plural markers) Deletion
Tribes tribe
Bugs bug
Kings king
Dimes dime
Tadpoles tadpole
Bells bell
CHAPTER 10: [z] 273
Dwarves
Seashells seashell
Crabs crab
Weeds weed
Balls ball
Wolves
Sandals sandal
Nails nail
Waves wave
Ears ear
Lions lion
Wings wing
Drums drum
Claws claw
Seagulls seagull
Eggs egg
Roars roar
Leopards leopard
Rinds rind
Sneakers sneaker
Ponds pond
Trolls troll
Ribbons ribbon
Whales whale
Elves
Crowns crown
Spareribs sparerib
Stars star
Goblins goblin
Birds bird
Thumbs thumb
Tails tail
Wheels wheel
Kids kid
Baggins
Blackbirds blackbird
Worlds world
Dogs dog
Tears tear
Hands hand
Camels camel
Rugs rug
274 The late eight
Mountains mountain
Coins coin
Schoolrooms schoolroom
Pools pool
Skateboards skateboard
Themes for [z]
Themes
Animals People and Places

Frodo’s Journey to Moria Weekdays
New Oz Stories
Animals Deletions Minimal Pairs
Zoo ooh new, shoe, two, moo, goo,

boo, chew
Zebra
Tadpoles tadpole
Muzzle
Pheasant
Bugs bug
Seals seal
Lizard
Buzz
Crabs crab
Wolves
Lions lion
Wings wing
Claws claw
Tails tail
Eggs egg
Roars roar
Leopards leopard
Seagull seagull
Whales whale
Birds bird
Camels camel
Dogs dog
Blackbirds blackbird
CHAPTER 10: [z] 275
Frodo’s Journey to Moria Deletions Minimal Pairs
Wizard
Samwise
Nazgul
Baggins
Rosie
Dwarves
Rings ring
Blizzard
Freezing
Elves
Pools pool
Mountains mountain
Drums drum
Crowns crown
Kings king
Music
Roars roar
Claws claw
Maze May
Crazy
Goblins Goblin
New Oz Stories Deletions Minimal Pairs
Kansas
Oz
Tribes tribe
Zombie
Worlds world
Stars star
Dreams dream
Bells bell
Prison
Desert
Wolves
Lions lion
Wings wing
Leopards leopard
276 The late eight
Zach pack, rack, knack

Zorro
Czar R car, tar, mar
Daisy
Baggins
Rosa
Moses
Louise Louie
Aztec
Suzanne Sue Ann
Liz
Samwise
Susan
Caesar
Rose row
Zulu
Pisa
Brazil
Boise
Kansas
Oz
Zeus moose, noose
Zurich
Zion ion tie on
Weekdays Deletions Minimal Pairs
Tuesday
Wednesday
Thursday
Chapter Eleven
[l]
Definition
[l] is made with the tongue tip raised and touching the mouth roof. Air
flows over the sides of the tongue, and the larynx vibrates. The techni-
cal definition of [l] is voiced alveolar lateral. Two varieties of [l] exist in
English: “light [l],” which occurs at the beginning of syllables, as in leak
[lik], and “dark [l],” which occurs at the end of syllables, as in cool [kul].
In “dark [l]” the back of the tongue is raised in the velar region.
Acquisition
Fifty percent of children acquire [l] by 3;6 and 75% of children acquire
[l] by 6;0.
Relative Frequency
[l] is ranked second in relative frequency compared with the other late-
acquired consonants. It ranks seventh in relative frequency compared
277
278 The late eight
Errors
A common error for [l] is called gliding — that is, [w] or [j] (glide con-
sonants) substitute for [l] (a liquid consonant). Another common error
for [l] is to produce the sound with a wet, slushy quality. Often, a wet,
slushy sound occurs when [s] is made with the tongue blade raised
instead of the tongue tip.
Key Environments
Beginning of syllable and between vowels, as in lake and alone
Light [l] before a high front vowel, as in leaf
Dark [l] after a high back vowel at the end of a syllable, as in cool
Possible Metaphors
Tongue placement: Singing sound (la-la-la)

Pointy sound (tongue tip pointing to
alveolar ridge)
Bump sound
Little hill sound
Lateral: Side sound
Liquid: Flowing sound
Voicing: Motor on
Buzzing sound
Voice box on sound
Touch Cue
Tip of finger on the middle of the upper lip.
Instructions
Place the student’s finger on the middle of the upper lip.

Initial Screening Test for [l]
Student’s Name:
Date: __________________
Referral:
Word Student*
Beginning
1. Lamp _____________
2. Light _____________
3. Leg _____________
4. Plane _____________
5. Sleep _____________
6. Clip _____________
Medial
7. Sailor _____________
8. Billy _____________
9. Olive _____________
Final
10. Skull _____________
11. Mail _____________
12. Bell _____________
13. Apple _____________
14. Model _____________
15. Muscle _____________

Comments/Notes:
279
Stimulability Tests for [l]
Student’s Name:
Date: __________________
Referral:
Imitation
1. lie _____________
2. low _____________
3. all _____________
4. ill _____________
Key Environments
Light [l]:
1. leaf _____________
2. leap _____________
Dark [l]: After a high back vowel at the end of a syllable

1. cool _____________
2. bull _____________
Favorite Words

1. Touch the student’s alveolar ridge with a tongue depressor, peanut butter,
or lollipop to indicate the place of production for [l].
2. Ask the student to place his or her tongue tip in the place indicated, to
relax and to let air flow out from the sides of the tongue. The resulting
sound is voiceless [l].
3. Instruct the student to turn on the voice box, resulting in [l].
280
Shaping [l] from Interdental [t] _____________
1. Ask the student to place the tongue tip between the teeth as for an
interdental [t].
2. Lower the student’s jaw.
3. Ask the student to slowly draw the tongue tip backward but to keep the
tongue tip in contact with the back of the teeth and the ridge behind the
two front teeth.
4. Ask the student to say [l], being sure that contact between the tongue
and the roof of the mouth is maintained.
Notes/Comments:
281
282 The late eight
Demonstrations for [l]
Place: Alveolar
First Method
Objects: None
Instructions:

2. Once the tongue is out, ask the student to pull the tongue back to feel
bump on the roof of the mouth behind the two front teeth.
Second Method
Instructions:

favorite food on alveolar ridge.
Manner: Liquid
First Method
Objects: None
Instructions: Run your or the student’s finger down the student’s arm while
making several long glides or liquids to demonstrate the “flowing” quality
and length of this sound.
Second Method
Objects: Strip of paper, a feather, or a small paper flower taped on the end
of a pencil
CHAPTER 11: [l] 283
Instructions: Use a strip of paper, a feather, or the hand held in front of the
student’s mouth while you produce several glides or liquids to draw attention
to the “flowing” quality and continuous nature of the sounds. Alternatively,
tape a small paper flower on the end of a pencil and encourage the student
Special Demonstration: Lateral Airflow
First Method
Instructions: Place a straw on the groove of the tongue and blow out to
demonstrate central emission of air.
Second Method
Instructions: Ask the student to breathe in with the tongue as for [s]. Cool
air is felt at the central groove. Alternatively, perform the straw technique
above, remove the straw, and ask the student to breathe in with the tongue in
position for [l]. Cool air should be felt on the sides of the tongue over which
the air was emitted. An alternative method is to perform the straw technique
above, remove the straw, and ask the student to breathe in.
Voicing: Voiced
First Method
Objects: None

Second Method
Objects: None
284 The late eight
Third Method
Objects: None

Fourth Method
Objects: None
Fifth Method

paper flower

CHAPTER 11: [l] 285
Phonetic Placement and Shaping Techniques for [l]
Most often, the challenge with [l] is to help the student direct the airflow over
the sides of the tongue. These four methods each focus on helping the student
achieve lateral airflow. The first three methods focus on [l] in isolation and
the fourth focuses on [l] in consonant clusters.
First Method
Instructions:
1. Place a tongue depressor under the student’s tongue tip and then raise
the tongue tip behind the upper front teeth.
2. Ask the student to say [l] while maintaining contact between the tongue
tip and the roof of the mouth. The resulting sound is [l].
Second Method
Objects: Tongue depressor, small dab of peanut butter, or lollipop
Instructions:
1. Touch the student’s alveolar ridge with a tongue depressor, peanut butter,
or lollipop to indicate the place of production for [l].
2. Ask the student to place the tongue tip in the place indicated, to relax,
and to let air flow out from the sides of the tongue. The resulting sound
is voiceless [l].
3. Instruct the student to turn on the voice box, resulting in [l].
Third Method
This method works, though the number of steps limits its effectiveness, unless
the student has good motivation and attention.
Objects: Small piece of paper and two drinking straws

286 The late eight
Instructions:
1. Place a straw midline on the student’s tongue groove to demonstrate

central air emission. Ask the student to blow out onto an open hand or
piece of paper. An alternative (or additional) demonstration of central
air emission is to ask the student to prepare the mouth to say [s] but to
breathe in. Cool air is felt midline on the upper tongue surface.
2. Next, place a straw in each corner of the student’s mouth. Ask the student
to breathe out into his or her open hand or on a piece of paper. If
an additional demonstration is needed, remove the straws and ask the
student to breathe in and to feel the cool air on the sides of the tongue
over which the air is emitted. To demonstrate the feel of the air more
vividly, ask the student to suck on a piece of peppermint candy for a few
minutes before performing the demonstration.
3. After lateral emission of air is obtained, ask the student to place the
tongue tip in contact with the roof of the mouth behind the upper front
teeth and to blow out over the sides of the tongue. If needed, place
straws in the side of the student’s mouth while the tongue tip is held in
contact with the roof of the mouth.
4. Ask the student to blow air out the side straws, which results in the
voiceless [l].
5. Voicing is obtained by asking the student to turn on the voice box. The
resulting sound is [l].
Fourth Method
This method is for a student who needs to learn to pronounce [l] in conso-
nant clusters. The method works for consonant clusters in which the other
consonant in the cluster is not alveolar — for example, a velar or labial stop.
Objects: None
Instructions:
1. Instruct the student to place the tongue in the position for /l/.
2. Instruct the student to say “blue,” resulting in a [bl] consonant cluster.
CHAPTER 11: [l] 287
Shaping Techniques
[l] from [θ] or [ð]
If a student’s speech contains a well-established interdental, this can be con-

verted into [l]. Instead of an interdental, [s] or [z] can be used, though the task
is more difficult for most students, because [s] and [z] are harder to see move
than the interdental fricatives.
Objects: None
Instructions:
1. Ask the student to place the tongue tip between the teeth as for [ð].
2. Lower the student’s jaw.
3. Ask the student to slowly draw the tongue tip backward but to keep the
tongue tip in contact with the back of the teeth and the ridge behind the
two front teeth.
4. Next, instruct the student to say [l], being sure that contact between the
tongue and the roof of the mouth is maintained. If [θ] is used, instruct
[l] from [i] or [u]
This method sounds tricky. It works, though, with selected students.
Objects: None
Instructions:
1. Ask the student to open the mouth as wide as for [a] but to raise the
tongue tip as for [i].
2. Ask the student to keep the tongue up as for [i] but to say [a], resulting
in a light (alveolar) [l]. Note. For a dark (velar) [l], follow the same steps
but ask the student to say [u] instead of [i].
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
288
Imitation
Student’s Name:
Date: __________________
Log 1. __________________
Leather 2. __________________
Lick 3. __________________
Lock 4. __________________
Lake 5. __________________
Litter 6. __________________
Lump 7. __________________
Look 8. __________________
Low 9. __________________
Lip 10. __________________
Total Correct: ________ / ________

Comments:
289
Minimal Pairs
Student’s Name:
Date: __________________
Goal: Have the student first say the word with the treatment sound, then say
the rhyming word, and then say the word with the treatment sound.
Low bow 1. __________________

Larry berry 2. __________________
Lair fair 3. __________________
Lock sock 4. __________________
Lamp ramp 5. __________________
Look book 6. __________________
Log dog 7. __________________
Lump dump 8. __________________
Leg beg 9. __________________
Ladder sadder 10. __________________
Total Correct: ________ / ________

Comments:
290
Deletion
Student’s Name:
Date: __________________
Lick ick 1. __________________

Lake ache 2. __________________
Low O, oh 3. __________________
Lion ion 4. __________________
Lair air 5. __________________
Lamp amp 6. __________________
Leg egg 7. __________________
Ladder adder 8. __________________
Larry airy 9. __________________
Lou ooh 10. __________________
Total Correct: ________ / ________

Comments:
291
Self-Correction
Student’s Name:
Date: __________________
Log 1. __________________
Leather 2. __________________
Lick 3. __________________
Lock 4. __________________
Lake 5. __________________
Litter 6. __________________
Lump 7. __________________
Look 8. __________________
Low 9. __________________
Lip 10. __________________
Total Correct: ________ / ________

Comments:
292
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Log 1. __________________
Leather 2. __________________
Lick 3. __________________
Lock 4. __________________
Lake 5. __________________
Litter 6. __________________
Lump 7. __________________
Look 8. __________________
Low 9. __________________
Lip 10. __________________
Total Correct: ________ / ________

Comments:
293
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
Log 1. __________________
Leather 2. __________________
Lick 3. __________________
Lock 4. __________________
Lake 5. __________________
Litter 6. __________________
Lump 7. __________________
Look 8. __________________
Low 9. __________________
Lip 10. __________________
Total Correct: ________ / ________

Comments:
294
CHAPTER 11: [l] 295
Complete Word List for [l]
Beginning of Words
Log dog, hog, bog

Leather feather, heather, weather
Lick ick sick, tick, wick, pick, kick,
thick
Lock sock, knock, rock
Lake ache bake, cake
Litter sitter
Lump dump, pump
Look book, cook, hook
Low O, oh bow, sew, foe, no, know
Lip zip, rip, dip, whip, sip,
chip, ship, hip
Lettuce bet us
Lagoon
Lion ion
Legolas
Lair air fair, hair, mare, tear, chair
Lamp amp ramp, camp, damp
Light night, write, white, bite,
fight, kite
Leg egg beg, Meg,
Ladder adder sadder, madder
Line sign, mine, line, pine, nine
List mist, wrist, kissed, hissed
Letter better, setter
Lantern
Larry airy berry, Barry, merry, cherry
Lou oo new, chew, Sue, Rue, two
Leech each beech, reach
Ladies
Lemon
Lei A day, bay, say, gray, hay
Lime I’m dime, rhyme, mime
Lie I, eye buy, guy, sigh, rye, die, fly,
sigh, pie
Leopard
Lawrence
Long song, wrong
296 The late eight
Late ate date, rate, gate, hate, bait

Leonard
Lava Java
Lawn awn Shawn
Leak eek beak, meek, peak
Llama
Lois
Lobster
Luke nuke, kook
Leap peep, reap, seep
Laugh calf, half
Leash
Lisp wisp
Limp imp wimp, gimp
Lynn in win, sin, tin
Lincoln
Love dove, shove
Lumber number
Life knife
Leaf chief, thief
Lung sung, rung, hung
Lamb am Sam, ram, ham
Lace ace race, chase, face
Loaf oaf
Land and sand, band
Limb gym, Jim, him, rim
Lance dance, chance
Lucy juicy
Luggage
Lad add bad, mad, sad
Load ode code, node, bode
Lazy daisy
Lunch bunch, munch, hunch
Link ink sink, rink, mink
Lid id hid, bid, mid
Least east beast
Like Ike Mike, bike, pike
London
Lane mane, sane, bane
Lone own tone, moan
Label able sable, Mabel
Lap nap, cap
Locker succor
CHAPTER 11: [l] 297
Lame aim game, same, name

Lace ace race, case, base
Lady Sadie
Lye I, eye tie, die, sigh
[pl]
Plane pain, pane

Plywood
Plants pants
Plant food
Play pay pray
Pluto
Planet
Plank prank
Plato
Platoon
Plowed proud
Please peas
Plastic
Plaza
Plymouth
Pliers
Plate pate
Playground
Plum
Placard
[kl]
Clark quark
Clip Kip quip
Club cub
Classroom
Class
Clock cock crock
Clipper
Clap cap crap
Clifford
Clay K Kray
298 The late eight
Clamshell
Clerk Kirk quirk
Cliff
Clever
Cluck
Cloud cowed crowd
Clippers kippers
Clam cam cram
Clover
Clown crown
Claw caw craw
Climb crime
[bl]
Black back
Blue boo brew
Blind bind
Blizzard
Blossom
Bleed bead breed
Blackbird
Block Brock
Blindfold
Blender bender
Blank bank
Bloodhound
Blackmail
Blood bud
[gl]
Glove grove
Glass gas grass
Glacier
Glenn
Glad grad
Glitter
Globe
Glider
Glow go grow
Glue goo grew
CHAPTER 11: [l] 299
Gloomy
Glasses gasses grasses
[fl]
Floor four
Flashbulb
Flag
Fly fie fry
Flood food
Flight fight fright
Flagstaff
Flat fat frat
Flipper
Flash
Flea fee free
Flour
Florist forest
Flab fab
Flame frame
Flip
Flower
[sl]
Slip sip skip

Slaw saw
Sledding
Slide side spied
Slap sap
Sleigh bells
Sleet seat skeet, sweet
Slug
Sleep seep steep, sweep
Slop sop stop, swap
Sleeve sieve Steve
Slicing spicing
Slipper sipper skipper
Sled dog
Slum sum scum
Sled said sped
Sloth
300 The late eight
Sleigh say stay, spay, sway

Sling sing sting, swing
Sleepy
Slurp
[spl]
Splash
Splinter sprinter
Splendid
Splay play
Splashdown
Splatter
Splurge
Splice
Spleen
Splat
Split
Splutter
Splint sprint
Splotchy
Splashy
Splendor
All Consonant
Clusters Deletions Minimal Pairs
Plane pain, pane

Glasses gasses grasses
Plants pants
Sleep seep sweep, steep
Pluto
Slicing spicing
Plank prank
Platoon
Clip Kip quip
Plywood
Plowed proud
Clark quark
Play pray, prey
Clipper kipper
CHAPTER 11: [l] 301
All Consonant
Slop sop stop, swap

Club cub
Classroom
Plastic
Class Cass crass
Clock cock crock
Plant food
Clap cap crap
Glue goo grew
Globe
Clifford
Clay
Slipper sipper skipper
Clamshell
Slap sap
Flab fab
Sleigh bells
Planet
Sled dog
Slum sum scum
Clever
Blossom
Cluck
Cloud cowed
Sleeve sieve Steve
Clippers kippers
Clam cam cram
Clover
Gloomy
Slug
Clown crown
Plato
Claw
Playground
Climb
Black
Sled said sped
Blue boo brew
Plymouth
Blind bind
302 The late eight
All Consonant
Clerk Kirk
Flip
Pliers
Flower
Blizzard
Plate pate
Bleed bead breed
Glass gas grass
Block Brock
Flood food
Florist forest
Slide side spied
Cliff
Sliver
Blood bud
Fly fie fry
Plaza
Glove
Bloodhound
Glacier
Flight fight fright
Glenn
Splashdown
Glitter
Blank bank
Globe
Blackbird
Glider
Blender bender
Glow go grow
Splash
Floor four
Splinter
Flashbulb
Glad
Flag
Splendid
Sleigh say stray, stay, sway
Sleepy
Blindfold
Flagstaff
CHAPTER 11: [l] 303
All Consonant
Sling sing sting, swing

Flat fat frat
Flipper
Blackmail
Flash
Slurp
Flea fee free
Flour
Plum
Flame fame frame
Slip sip skip
Slaw saw
Sledding
Please peas
Sloth
Placard
Medial
Single Consonants
Sailor Ireland Dallas

Billy Chile Sailor
Olive Kelly Pillow
Smiling Cellar Aileen
Ceylon Julie Eyelash
Ballet Toilet Bowling
Valley Jailer Albert
Eyelid Zulu Boulder
Galleon Cello Melbourne
Boiling Shelley Gallon
Chilly Collar Jello
Gimli Children Chilly
Collar Alley Police
Ruler Island Ceiling
Palace Balloon Hilly
Delhi Salad Dallas
304 The late eight
Consonant Clusters
Airplane Milkshake Burglar

Apply School bus Cornflake
Applaud Wobbling Snowflake
Cobbler Giggling Goblin
Douglas England Stiffly
Duckling Wildfire Wrestler
Ticklish Gobbler Asleep
Weekly Cornflakes Nicely
Bubbling Ugly
Album Toddler
All Environments
Cobbler Chile Wrestler

Sailor Weekly Island
Bubbling Kelly Cornflake
Billy Cellar Balloon
Olive Gobbler Apply
Smiling Julie Salad
Album Toilet Dallas
Applaud Jailer Burglar
Ceylon Duckling Sailor
Ballet Zulu Pillow
Valley Cello Aileen
Eyelid Ticklish Stiffly
Galleon Shelley Eyelash
Boiling Collar Bowling
Chilly Children Albert
Airplane Alley Boulder
Gimli Wobbling Nicely
Douglas Giggling Melbourne
Collar England Gallon
Ruler Wildfire Jello
Milkshake Cornflakes Asleep
Palace Ugly Chilly
School bus Toddler Police
Delhi Snowflake Ceiling
Ireland Goblin Hilly
CHAPTER 11: [l] 305
End of Words
Roll row
Wheel whee
Rail ray
Tile tie
Skull
Mail may
Towel
Bell
Dial die
Seal sea, see
Boil boy
Mall
Snail
Seashell
Hole ho
Veil
Pile pie
Mole
Peel pea
Spool
Cell
School
Cool
Bowl bow
Nail
Drill
Troll toll
Pail pay
Mel
Bill
Goal go
Eel E
Gail gay
Bull
Baseball
Coal
Pill
Ball
Churchill
Steal
306 The late eight
Fall
April
Drool
Doll
Daniel
Jail J
Phil
Carol
Yell
Steel
Cheryl
Hall
Beach ball
Seagull
Brazil
Wall
Tadpole
Hotel
Oatmeal
Jackal
Whale way
Cartwheel
North Pole
[pl]
Apple
People
Scalpel
Steeple
Maple
People
[bl]
Cable
Bible
Fable
Hubble
Bubble
CHAPTER 11: [l] 307
Scrabble
Pebble
[dl]
Model
Pedal
Candle
Cradle
[gl]
Eagle
Beagle
Bugle
[fl]
Cheerful
Eiffel
Sniffle
Velar Nasal [l]
Jungle
Bungle
[nl]
Funnel
Colonel
Tunnel
Kernel
[kl]
Jackal
Ankle
Buckle
Knuckle
Snorkel
308 The late eight
[dl]
Devil
[sl]
Missile
Castle
Fossil
Pencil
Muscle
Capsule
[ ʃ ] + [l]
Marshal
[lv]
Twelve
[lt]
Salt sought
Belt bet
Vault
Bolt
Bank vault
[ld]
Child chide
Donald
World word
Old ode
Gold goad
Stronghold
Bald
Field feed
Windshield
Arnold
CHAPTER 11: [l] 309
[lf]
Elf F
Werewolf
Golf
Wolf woof
Shelf chef
Rudolph
Gandolf
[lb]
Light bulb
DeKalb
[lm]
Elm M
Helm hem
[lp]
Kelp
Alp
Scalp
[lk]
Milk
Silk
Elk
Hulk
Consonant + Syllabic [l]
Apple
Model
Muscle
People
Beagle
Steeple
Bugle
310 The late eight
Maple
People
Fossil
Cable
Scalpel
Bible
Pencil
Hubble
Snorkel
Bubble
Ankle
Pedal
Candle
Knuckle
Cradle
Eagle
Cheerful
Buckle
Eiffel
Sniffle
Jungle
Fable
Bungle
Funnel
Pebble
Colonel
Missile
Tunnel
Kernel
Jackal
Scrabble
Devil
Castle
Capsule
Marshal
[l] + Consonant
Stronghold
Twelve
Salt sought
Hulk
CHAPTER 11: [l] 311
Vault
Light bulb
Bolt
Bank vault
Child chide
Shelf chef
Donald
Bald
World word
Belt bet
Gold goad
Windshield
Arnold
Gandolf
Elk
Alp
Elf F
Werewolf
Silk
Wolf woof
Rudolph
Old ode
DeKalb
Golf
Elm M
Field feed
Scalp
Helm hem
Kelp
Milk
Themes for [l]
Themes
Northern Places Make a Healthy Lunch

Day at the Beach People to See
Sea Voyage to Old Hawaii Places to Go
Let’s Cook Animals
Lord of the Rings Make Up a Fairy Tale
312 The late eight
Northern Places Deletions Minimal Pairs
Chilly
Elk
Rudolph
Sled said sped
Sled dog
Sleigh bells
Glacier
Blizzard
North Pole
Cool coo
Wolf woof
Wolves
Sledding
Sleigh say stay, spay, spray
Snowflake
Day at the Beach Deletions Minimal Pairs
Lobster
Salt bought, taught
Snorkel
Pebble
Splash
Flipper
Clamshell
Beach ball
Seagull
Pail pay
Towel
Seal sea, see feel, meal
Snail
Seashell
Kelp
Whale way
Eel E
CHAPTER 11: [l] 313
Sea Voyage to
Old Hawaii Deletions Minimal Pairs
Sailor
Galleon
Clipper kipper
Lei A say, pay, may
Boil boy
Lava Java
Hilly
Island
Boiling
Let’s Cook Deletions Minimal Pairs
Lettuce
Lemon
Lime I’m dime, rhyme, mime
Milk
Apple
Bubbling
Cobbler
Boil boy
Slicing spicing
Slaw saw
Flour
Glass gas grass
Blender bender
Clam cam cram
Plate pate
Plum
Lunch bunch, munch, hunch
Lid id hid, bid, mid
Like Ike Mike, bike, pike
Peel pea
Loaf oaf
Olive
Bowl bow
Chili
Salad
Jello
Roll row
Oatmeal
314 The late eight
Let’s Cook Deletions Minimal Pairs
Duckling
Cornflakes
Lord of the Rings Deletions Minimal Pairs
Gandolf
Elrond
Gimli
Legolas
Gollum
Elf F
Wolf woof
Wolves
Eagle
Troll stroll
Trolls
Goblins
Lady Sadie
Make a
Healthy Lunch Deletions Minimal Pairs
Lettuce
Lemon
Milk
Apple
Slicing spicing
Glass gas grass
Plate pate
Plum slum
Peel pea
Loaf oaf
Olive
Bowl bow
Salad
Roll row
CHAPTER 11: [l] 315
Kelly
Gimli
Lance dance, chance
Lucy juicy
Gandolf
Lynn in win, sin, tin
Billy
Lincoln
Leonard
Larry airy berry, Barry, merry, cherry
Lou oo two, new, boo, goo, new,
chew, Sue, Rue, two
Gail gay
Julie
Legolas
Lawrence
Gollum
Lois
Luke nuke, kook
Elrond
Zulu
Shelley
Aileen
Arnold
Donald
Albert
Glenn
Cliff
Clifford
Clark quark
Plato
Douglas
(The) Hulk
Kelly
(The) Devil
Billy
Mel
Bill
Churchill
April
Daniel
Phil
Carol
Cheryl
316 The late eight
Ceylon
Ireland
Dallas
England
Delhi
London
Ireland
Chile
Dallas
Brazil
Pluto
(The) Hubble
Plymouth
Flagstaff
Boulder
Melbourne
Eiffel (Tower)
DeKalb
Leech each beach, reach

Lair air fair, hair, mare, tear, chair
Lion ion
Leopard
Lick ick sick, tick, wick, pick, kick,
thick
Llama
Lamb Sam, ram, ham
Eel E
Eagle
Beagle
Gobbler
Sloth
Flea fee free
Claw caw
Tadpole
Jackal
Blackbird
Slug
Wolf woof
Wolves
CHAPTER 11: [l] 317
Make Up a Fairy Tale Deletions Minimal Pairs
Valley
Lake ache bake, cake
Lock sock, knock, rock
Lamp amp ramp, camp, damp
Light night, write, white, bite,
fight, kite
Lawn Shawn
Elf F
Castle
Tunnel
Werewolf
Steeple
Ugly
Goblin
Lame aim game, same, name
Lace ace race, case, base
Lazy daisy
Lye I, eye tie, die, sigh
England
Flower
Flame fame frame
Jail J
Cell
Lady Sadie
Veil
Slipper sipper
Fable
Lagoon
Chapter Twelve
Vocalic
[r]
Definition
Vocalic [r] is a vowel rather than a consonant, and is included in this
book because often the road to a good [r] leads through first learning
to make vocalic [r]. Vocalic [r] is heard in the words heard, butter, and
girl. As with its consonant counterpart (called consonantal [r] or simply
[r]), it is produced in either of two ways. In the first way, called bunched,
the lips are rounded slightly, the tongue tip lowered, and the tongue
body bunched up near the area of the palate. In the second way, called
retroflex, the lips are rounded slightly and the tongue tip is raised either
toward the alveolar ridge or curled back toward the alveolar ridge. In
both varieties of vocalic [r], the sides of the tongue touch the insides
of the teeth about halfway back. Both bunched and retroflex types
of vocalic [r] can result in a good sound, though the author’s clinical
experience is that more students find the bunched variation somewhat
easier to learn than the retroflex one. For both types of vocalic [r],
the vocal folds are vibrating and the tongue root is retracted, creating
a contraction in the pharynx. The technical definition of vocalic [r] is a
mid-central rounded rhoticized vowel.
Acquisition
Vocalic [r] is acquired by 50% of children by 3;6 and 75% of children
by 5;6.
319
320 The late eight
Relative Frequency
—
Errors
The most common error is deleting the [r] part of the vowel, result-
ing in words such as fur, fare, and fear being pronounced fu, fa, fe,
respectively.
Key Environments
In a word consisting of a single stressed syllable, as in girl
Possible Metaphors
The best metaphor usually focuses on the way vocalic [r] closes (ends)
the vowel.
[r] quality: Mad dog or growling-tiger sound (grr)

Arm-wrestling sound (errr)
Pirate sound (aar)
Tongue placement: Tongue-tip flat sound (bunched)
Tongue-tip up sound (retroflex)
Voicing: Motor on
Buzzing sound
Voice box on sound
Touch Cue
Palm down and finger tips curled down (bunched) or palm up and
finger tips curled up (retroflex).
Instructions
Place the student’s hand beside the mouth.

Initial Screening Test for Vocalic [r]
Student’s Name:
Date: __________________
Referral:
Word Student*
Open
1. Grocer _______________
2. Racer _______________
3. Sister _______________
4. Monster _______________
5. Chester _______________
Closed
6. Bird _______________
7. Shirt _______________
8. Burn _______________
9. Hurl _______________
10. Nurse _______________

Comments/Notes:
321
Stimulability Tests for Vocalic [r]
Student’s Name:
Date: __________________
Referral:
Imitation
1. her _______________
2. curl _______________
Key Environments
In a word consisting of a single stressed syllable

1. her _______________
2. girl _______________
Favorite Words

Instruct the student to growl like a tiger (grrr). Alternatively, ask the student to
make the “arm wrestling sound” ([rrr]) while arm wrestling with the clinician.
Vocalic [r] (retroflex) from [ð]
1. Ask the student to place the tongue as for [ð].

2. Ask the student to quickly draw the tongue tip back and slightly up,
resulting in vocalic [r].
Notes/Comments:
322
CHAPTER 12: [r] 323
Demonstrations for Vocalic [r]
Place: Alveolar
First Method
Objects: None
Instructions:

2. Once the tongue is out, for vocalic [r] with the tongue tip lowered, ask the
student to pull the tongue back and touch the gums below the two lower
front teeth. For vocalic [r] with the tongue tip raised, ask the student to
pull back the tongue to feel the bump on the roof of the mouth behind
the two upper front teeth.
Second Method
Instructions:

favorite food on alveolar ridge (for tongue tip raised vocalic [r]) or behind
lower front teeth (for tongue tip lowered vocalic [r]).
Manner: Liquid
First Method
Objects: None
324 The late eight
Second Method
of a pencil
Special Demonstration: Bunched
A Q-tip, small piece of candy, or other favored food sometimes is helpful in

demonstrating where to place the tongue tip.
First Method
Objects: None
Instructions: Ask the student to place the tongue tip behind the lower front
teeth and to raise the body of the tongue toward the mouth roof.
Second Method
Objects: Q-tip or small piece of candy or other favored food
Instructions:
1. Touch behind the student’s lower front teeth with a Q-tip to demonstrate
where the tongue tip should be placed. Alternatively, place a small piece
of candy or other favored food behind the lower front teeth and ask the
student to hold it there with the tongue tip.
2. Once this is achieved, ask the student to raise the tongue body toward
the mouth roof.
CHAPTER 12: [r] 325
Special Demonstration: Retroflex

Method
Objects: None
Instructions:
1. Ask the student to place the tongue tip behind the upper front teeth.
2. Ask the student to curl the tongue backward without touching the roof
of the mouth until it cannot go back farther.
Sides of Tongue (Bunched and Retroflex):

Vocalic and Consonantal [r]
A good [r] often is more easily achieved if the student is encouraged to say the
sound while keeping the sides of the tongue touching the insides of the teeth.
The following simple demonstration can be practiced in isolation or as part
of the bunched and retroflex demonstrations.
First Method
Objects: None
Instructions:
1. Tell the student that his or her tongue is sleepy and wants to rest.
2. Instruct the student to let the tongue spread out in “its bed” until it is
touching the insides of the teeth.
Second Method
Objects: Q-tip, candy, or other favored food

326 The late eight
Instructions:
1. Touch the inside teeth with a Q-tip or some favored food to demonstrate
where the tongue should go.
Voicing: Voiced
First Method
Objects: None

Second Method
Objects: None
Third Method
Objects: None

Fourth Method
Objects: None
CHAPTER 12: [r] 327
Fifth Method

paper flower

328 The late eight
Phonetic Placement and Shaping Techniques for Vocalic [r]
The first three techniques are simple and quick. If they don’t work, try the
fourth or fifth methods.
First Method (retroflex or bunched)
Objects: None
Instructions: Ask the student to growl like a tiger (grrr). Alternatively, ask
the student to make the “arm-wrestling sound” (rrr) while you and the student
arm wrestle.
Second Method (retroflex)
I like this method — it is simple and quick, needs no objects, and is good both
for vocalic [r] and for shaping vocalic [r] into consonant [r]. It comes from
Gillian Fleming of Dunedin, New Zealand, who posted it on Caroline Bowen’s
website and kindly consented for it to be presented in this book.
Objects: None
Instructions:
1. Instruct the student that for this sound it is the tongue that does the work
and that the lips need to be “out of the road” in a half-smile so that the
upper and lower teeth can be seen.
2. Model a long vocalic [r], and then ask the student to curl the tongue
back to copy your model. Allow the student to move the tongue around
until a perfect production is reached. If the student has difficulty, liken
the sound to “a car starting on a frosty morning” to elicit a growly rrrrr
sound.
3. Once vocalic [r] is produced, ask the student to “feel” where the tongue
is.
4. Once established in isolation, practice vocalic [r] in syllables, such as
rrah and rrye.
5. Once rrah and rrye have been achieved, instruct the student to place the
tongue tip up and back until the correct [r] is achieved and then have
the student say ring.
CHAPTER 12: [r] 329
Third Method (retroflex or bunched)
This method works by stretching and spreading the sides of the mouth. Some-
what surprisingly, for some students it places the tongue in just the right
position to make vocalic [r].
Object: Thin drinking straw
Instructions:
1. Ask the student to “make a face” by hooking the first finger of each hand
in the corner of the mouth and stretching the mouth apart and back. The
same result can be achieved by placing a thin straw horizontally in the
student’s mouth.
2. With the mouth stretched, ask the student to say vocalic [r].
Fourth Method (retroflex or bunched)
This method works because if a student lies back and relaxes, the tongue
“bunches” and falls into the position for vocalic [r]. Though it seems funny,
sometimes after establishing vocalic [r] flat on the back, you need to work for
the student to say the sound when not reclining.
Objects: None
Instructions: Instruct the student to lie on his or her back, relax the mouth,
and say vocalic [r].
Fifth Method (bunched)
Objects: None
Instructions:
1. Ask the student to lower the tongue tip.

2. Next, ask the student to hump up the back of the tongue as for “a silent
[k].”
3. Ask the student to make the sides of the back of the tongue touch the
insides of the back teeth.
4. Lastly, ask the student to turn on the voice box, resulting in vocalic [r].
330 The late eight
Shaping Techniques
For many students, it is easier to shape vocalic [r] from another sound than
it is to teach it using phonetic placement techniques.
Vocalic [r] (bunched) from [w]
This method requires a number of steps, but is effective with the right student.
Object: Tongue depressor (optional)
Instructions:
1. Lower the student’s jaw slightly.

2. Ask the student to say [w].
3. Next, ask the student to make the tongue position for [d].
4. Lastly, ask the student to retract the tongue slightly while lowering the
tongue tip and to say vocalic [r].
Vocalic [r] (retroflex) from [n], [d], or [l]
This “stretching” technique is very similar to the third vocalic [r] phonetic
placement technique.
Object: Thin drinking straw
Instructions:
1. Ask the student to “make a face” by hooking the first finger of each hand
in the corner of the mouth and stretching the mouth apart and back. The
same result can be achieved by placing a thin straw horizontally in the
student’s mouth.
2. With the mouth stretched, ask the student to say a prolonged [n], [d], or
[l].
3. As the student says the prolonged [n], [d], or [l], ask him or her to curl
the tongue backward, resulting in ner, der, or ler.
4. Have the student delete the consonant, resulting in vocalic [r].
CHAPTER 12: [r] 331
Vocalic [r] (bunched) from [d]
Objects: None
Instructions: Lower the student’s jaw slightly as for [d]. While the student’s
jaw is lowered, ask the student to pull back the tongue slightly, to lower the
tongue tip, and to say vocalic [r].
Vocalic [r] (retroflex) from [ð]
Objects: None
Instructions:
1. Ask the student to place his or her tongue as for [ð].

2. Ask the student to quickly draw the tongue tip back and slightly up,
which typically results in vocalic [r].
Vocalic [r] (retroflex) from Alveolar Trill
The trick of this method is to get a student to make an alveolar trill.
Objects: None
Instructions:
1. Instruct the student to trill the tongue tip at the alveolar ridge.
2. Ask the student to stop the trill but to continue vocalizing, resulting in
vocalic [r].
Vocalic [r] (retroflex) from [l]
The authors of almost all phonetic placement and shaping techniques are
unknown. The exception is the first technique for shaping vocalic [r] from [l],
described by Shriberg (1975). The technique works well with a student who
can pronounce [l]. The other two techniques offer additional possibilities for
shaping [l] into vocalic [r].
332 The late eight
First Method (retroflex)
Objects: None
Instructions:
1. Instruct the student to place the tongue tip on the alveolar ridge in the
position for [l].
2. Ask the student to say [l] several times.
3. Ask the student to say [l] for 5 seconds.
4. Next, ask the student to say a long [l] but to drag the tongue tip slowly
back along the roof of the mouth until it is so far back that the student
has to drop it, resulting in vocalic [r].
Objects: None
Instructions:
1. Ask the student to say [l].

2. While the student says [l], gently pull down the student’s jaw until the posi-
tion for vocalic [r] is reached, resulting in vocalic [r]. (Alternatively, instead
of lowering the student’s jaw, ask the student to lower his or her jaw.)
Third Method (retroflex)
Objects: Tongue depressor or lollipop stick
Instructions:
1. Ask the student to say [l].

2. Using either a tongue depressor or lollipop stick, gently push back the
tongue tip until there is enough space between the tongue tip and roof
of the mouth to insert the tongue depressor or lollipop stick, resulting
in vocalic [r].
Vocalic [r] (retroflex) from [ ʃ ]
This clever technique relies on the surprising similarities between vocalic [r]
and [ ʃ ], both of which involve slightly rounded lips, raising of the tongue
CHAPTER 12: [r] 333
blade, and contact between the tongue sides and the insides of the teeth. Anne
Hommes of Corvalis, Oregon contributed to this technique.
Objects: None
Instructions:
1. Ask the student to say [ ʃ ], and then ask him or her to turn on the voice
box, resulting in [3].
2. Next, ask the student to curl the tongue tip back while keeping contact
with the insides of the back teeth, resulting in vocalic [r].
Vocalic [r] from ah
Here are two simple methods for converting ah into vocalic [r], For both,
watch carefully that the student does not round the lips, which results in a
vocalic [r] with [w] qualities. If need be, ask the student to hold down the lower
lip while practicing.
First Method (retroflex)
Objects: None
Instructions:
1. Ask the student to sweep the roof of the mouth with the tongue tip while
saying ah.
2. Tell the student to stop, but to keep vocalizing ah.
3. Instruct the student to lower the tongue tip slightly, which often results
in vocalic [r].
Objects: None
Instructions:
1. Ask the student to say a long ahhhhhh.

2. As the student says ahhhh, instruct him or her to raise and curl back the
tongue tip, resulting in ahhhhrrr (vocalic [r]).
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
334
Imitation
Student’s Name:
Date: __________________
Sir 1. __________________
Dagger 2. __________________
Finger 3. __________________
Singer 4. __________________
Bur 5. __________________
Winner 6. __________________
Glacier 7. __________________
Whisper 8. __________________
Fir 9. __________________
Author 10. __________________
Total Correct: ________ / ________

Comments:
335
Minimal Pairs
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
336
Deletion
Student’s Name:
Date: __________________
Singer sing 1. __________________

Winner win 2. __________________
Spider spied 3. __________________
Trailer trail 4. __________________
Steamer steam 5. __________________
Racer race 6. __________________
Chester chest 7. __________________
Cellar cell 8. __________________
Rooster roost 9. __________________
Dancer dance 10. __________________
Total Correct: ________ / ________

Comments:
337
Self-Correction
Student’s Name:
Date: __________________
Sir 1. __________________
Dagger 2. __________________
Finger 3. __________________
Singer 4. __________________
Bur 5. __________________
Winner 6. __________________
Glacier 7. __________________
Whisper 8. __________________
Fir 9. __________________
Author 10. __________________
Total Correct: ________ / ________

Comments:
338
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Sir 1. __________________
Dagger 2. __________________
Finger 3. __________________
Singer 4. __________________
Bur 5. __________________
Winner 6. __________________
Glacier 7. __________________
Whisper 8. __________________
Fir 9. __________________
Author 10. __________________
Total Correct: ________ / ________

Comments:
339
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
and then sun again. Like this: Sun. **un. Sun.”
Sir 1. __________________
Dagger 2. __________________
Finger 3. __________________
Singer 4. __________________
Bur 5. __________________
Winner 6. __________________
Glacier 7. __________________
Whisper 8. __________________
Fir 9. __________________
Author 10. __________________
Total Correct: ________ / ________

Comments:
340
CHAPTER 12: [r] 341
Complete Word List
Vocalic [r]
Open Deletions
Sir
Dagger
Finger
Singer sing
Bur
Winner win
Glacier
Whisper
Fir
Author
Spider spied
Barber
Trailer trail
Summer
Steamer steam
Grocer
Racer race
Sister
Monster
Chester chest
Cellar cell
Rooster roost
Dancer dance
Easter east
Hamster
Master mast
Thriller thrill
Dollar doll
Endure
Rider ride
Spencer Spence
Caesar seize
Plaster
Lobster
Toaster toast
Cancer
Freezer freeze
342 The late eight
Open Deletions
Satyr
Fur
Her
Over
Pepper pep
Closed
Lizard Burst Turk

Sneakers Sure Curve
Orchard Pearl Thunder
Songbird Girl Yogurt
Worm Curb Self-serve
Bird Herb T-shirt
Shirt Suburb Work
Burn Birch Nerve
Hurl Church Girl
Nurse Bird Squirrel
Purse Herd Germ
Hearse Leonard Cavern
Burst Mustard Dirt
Thirst Wizard Shirt
Bur Pittsburgh
Themes for Vocalic [r]
Themes
Creatures
It’s a Job
People to See
Creatures Deletions
Spider spied
Rooster roost
Hamster
Monster
Lobster
CHAPTER 12: [r] 343
Creatures Deletions
Songbird
Worm
Satyr
Lizard
Squirrel
Bird
Germ
It’s a Job Deletions
Author
Barber barb
Singer sing
Racer race
Dancer dance
Rider ride
Wizard
Nurse
People to See Deletions
Chester chest
Spencer Spence
Caesar seize
Pittsburgh
Turk
Herb
Leonard
344 The late eight
Reference
Shriberg, L. (1975). A response evocation program for vocalic [r]. Journal of Speech
and Hearing Disorders, 40, 92–105.
Chapter Thirteen
Consonantal
[r]
Definition
Consonantal [r] (henceforth simply called [r]) is the consonant counter-
part of vocalic [r]. [r] occurs before vowels in read, red, and three, and
after vowels in beard, hear, far, and four. In common with vocalic [r],
the consonantal [r] has two variations, the first (bunched) in which the
lips are rounded slightly, the tongue tip lowered, and the tongue body
bunched up near the area of the palate, and the second (retroflex) in
which the lips are rounded slightly and tongue tip is raised to the alveo-
lar ridge or curled back toward the alveolar ridge. In both varieties, the
sides of the tongue touch the insides of the teeth about halfway back.
As mentioned in the description of vocalic [r], both the bunched and
retroflex variations can produce an acceptable [r], though the author’s
clinical experience is that more students find the bunched variation
somewhat easier to learn than the retroflex one.
Acquisition
[r] is acquired by 50% of children by 5;0 and by 75% of children by 6;0.
345
346 The late eight
Relative Frequency
[r] is ranked third in relative frequency compared with the other late-
acquired consonants. It ranks eighth in relative frequency compared
Errors
The most common error is gliding — typically, [w] for [r], though [j] also
occurs. Deletion of [r] after a vowel and in consonant clusters also is
common.
Key Environments
Before a high front vowel, as in read
Beginning of syllable and between vowels, as in row and teary
In a consonant cluster with [t] or [k], as in tree or creek
Possible Metaphors
The metaphors for [r] are the same as for vocalic [r].
[r] quality: Mad dog or growling tiger sound (grr)

Arm wrestling sound (errr)
Pirate sound (aar)
Tongue placement: Tongue tip flat sound (bunched)
Tongue tip up sound (retroflex)
Voicing: Motor on
Buzzing sound
Voice box on sound
Touch Cue
The same touch cue is used for [r] as for vocalic [r].
Palm down and finger tips curled down (bunched) or palm up and
finger tips curled up (retroflex).
Instructions
Place the student’s hand beside the mouth.

Initial Screening Test for [r]
Student’s Name:
Date: __________________
Referral:
Word Student* Word Student*

Beginning
1. Rain _____________ 6. Crayon _____________
2. Root _____________ 7. Sprinkle _____________
3. Rat _____________ 8. Stream _____________
4. Priest _____________ 9. Scream _____________
5. Tribe _____________
Medial
10. Story _____________
11. Gary _____________
12. Earning _____________
Final
13. Oar _____________ 16. Airport _____________
14. Stair _____________ 17. Starve _____________
15. Spear _____________ 18. Mark _____________

Comments/Notes:
347
Stimulability Tests for [r]
Student’s Name:
Date: __________________
Referral:
Imitation
1. Rain _____________ 3. bear _____________

2. road _____________ 4. deer _____________
Key Environments

1. read _____________ 2. reek _____________
Between vowels
1. eery _____________ 2. teary _____________
In a syllable-initial consonant velar cluster

1. Creek _____________ 2. Gray _____________
Favorite Words

Phonetic Placement ___________
Instruct the student to make a sound like a motor starting up, rerrrr.
Shaping [r] from Vocalic [r] ___________
1. Ask the student to say vocalic [r] (as in girl).

2. Next, ask the student to say vocalic [r] followed by [i] or some other vowel.
3. Instruct the student to say vocalic [r] + [i] several times as quickly as
possible.
Notes/Comments:
348
CHAPTER 13: Consonantal [r] 349
Demonstrations for Consonantal [r]
Place: Alveolar
First Method
Objects: None
Instructions:

2. Once the tongue is out, for [r] with the tongue tip raised ask the student
the two front teeth. For [r] with the tongue tip down, ask the student to
Second Method
Instructions:

favorite food on alveolar ridge (for tongue tip raised [r]) or behind lower
front teeth (for tongue tip lowered [r]).
Manner: Liquid
First Method
Objects: None
350 The late eight
Second Method
of a pencil
Special Demonstration: Bunched

First Method
Objects: None
Instructions: Ask the student to place the tongue tip behind the lower front
teeth and to raise the body of the tongue toward the mouth roof.
Second Method
Objects: Q-tip or small piece of candy or other favored food
Instructions:
1. Touch behind the student’s lower front teeth with a Q-tip to demonstrate
where the tongue tip should be placed. Alternatively, place a small piece
of candy or other favored food behind the lower front teeth and ask the
student to hold it there with the tongue tip.
2. Once this is achieved, ask the student to raise the tongue body toward
the mouth roof.
Special Demonstration: Retroflex

Method
Objects: None
Instructions:
1. Ask the student to place the tongue tip behind the upper front teeth.
2. Ask the student to curl the tongue backward without touching the roof
of the mouth until it cannot go back farther.
Sides of Tongue (Bunched and Retroflex):

Vocalic and Consonantal [r]
A good [r] often is more easily achieved if the student is encouraged to say the
sound while keeping the sides of the tongue touching the insides of the teeth.
The following simple demonstration can be practiced in isolation or as part
of the bunched and retroflex demonstrations.
First Method
Objects: None
Instructions:
Second Method
Objects: Q-tip, candy, or other favored food

352 The late eight
Instructions:
1. Touch the inside teeth with a Q-tip or some favored food to demonstrate
where the tongue should go.
Voicing: Voiced
First Method
Objects: None

Second Method
Objects: None
Third Method
Objects: None

Fourth Method
Objects: None
Fifth Method

paper flower

354 The late eight
Phonetic Placement and Shaping Techniques for [r]
First Method
Objects: None
Instructions: Ask the student to make a sound like a motor starting up

(ruh).
Second Method
Instructions:
1. Ask the student to place the tongue tip behind the upper front teeth. (If
needed, place the student’s tongue tip on a shelf made with a tongue
depressor.)
2. Next, ask the student to curl the tongue backward without touching the
roof of the mouth until it cannot go back farther.
3. Lower the student’s jaw slightly and ask the student to say [ru].
Shaping Techniques
[r] from vocalic [r]
These two methods are for a student who has mastered vocalic [r]. They are
the methods the author uses most often to teach [r].
First Method
Objects: None
Instructions:

2. Next, ask the student to say vocalic [r] before a word beginning with [r].
For example, say read as vocalic [r] + [rid].
3. After the student pronounces the words with vocalic [r] followed by
consonantal [r], instruct him or her to say the vocalic [r] silently, which
typically results in initial [r].
Second Method
This method relies on the fact that a syllable that ends in vocalic [r] and is
followed by a syllable beginning with a vowel will often result in a syllable-
initial [r] as a type of transition between vocalic [r] and the vowel that follows.
Objects: None
Instructions:

2. Next, ask the student to say vocalic [r] followed by [i] or some other
vowel.
3. Instruct the student to say vocalic [r] + [i] several times as quickly as
possible, resulting in vocalic [r] + [ri]. After [ri] is established, instruct the
student to say vocalic [r] silently. The resulting sound is [ri].
[r] from [w]
This method is for a student who substitutes [w] for [r] (gliding), but whose
tongue is in the correct position for [r]. Such a student may need to be taught
to reduce lip rounding.
Instructions:
1. Lower the student’s jaw slightly.

2. Ask the student to say [w] but to “let the lips go to sleep” or “make it with
a little smile.” An alternative method is to tell the student, “No kissing
frogs” to prompt an unround lip position. If needed, gently push the
student’s lips back with a tongue depressor to an unrounded lip position.
[r] from [a]
This and the following method are for students for whom you wish to establish
[r] at the end of syllables. The methods demonstrate the technique for [ar] as
356 The late eight
in car and [ir] as in hear. The same technique works for all other vowels. To
illustrate, to teach [or] simply replace [a] or [i] with [o]. When teaching [r] in
this position, a useful trick is to have the student keep contact between the
sides of the tongue and the inner teeth.
Objects: None
Instructions:
1. Ask the student to say ah.

2. Next, ask the student to raise the tongue slightly toward the roof of the
mouth and say [ar]. (If needed, instruct the student to raise the tongue
tip or to raise the tongue slightly and to say [a] forcibly.) The resulting
sound is [ar].
[r] from [i]
Objects: None
Instructions:
1. Ask the student to say [i].

2. While the student says [i], ask him or her to lift the tongue and curl back
the tongue tip to say [ir].
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
357
Imitation
Student’s Name:
Date: __________________
Rain 1. __________________
Root 2. __________________
Relaxed 3. __________________
Rat 4. __________________
Rattle 5. __________________
Robot 6. __________________
Rug 7. __________________
Rainy 8. __________________
Red Sea 9. __________________
Raven 10. __________________
Total Correct: ________ / ________

Comments:
358
Minimal Pairs
Student’s Name:
Date: __________________
Rat sat 1. __________________

Rug bug 2. __________________
Root toot 3. __________________
Rattle saddle 4. __________________
Reach beach 5. __________________
Read bead 6. __________________
Rocks socks 7. __________________
Roast toast 8. __________________
Run sun 9. __________________
Rink sink 10. __________________
Total Correct: ________ / ________

Comments:
359
Deletion
Student’s Name:
Date: __________________
Rat at 1. __________________
Rattle addle 2. __________________
Read Ed 3. __________________
Rocks ox 4. __________________
Rhino I know 5. __________________
Red Ed 6. __________________
Reach each 7. __________________
Rose owes 8. __________________
Rita eat a 9. __________________
Rome om 10. __________________
Total Correct: ________ / ________

Comments:
360
Self-Correction
Student’s Name:
Date: __________________
Rain 1. __________________
Root 2. __________________
Relaxed 3. __________________
Rat 4. __________________
Rattle 5. __________________
Robot 6. __________________
Rug 7. __________________
Rainy 8. __________________
Red Sea 9. __________________
Raven 10. __________________
Total Correct: ________ / ________

Comments:
361
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Rain 1. __________________
Root 2. __________________
Relaxed 3. __________________
Rat 4. __________________
Rattle 5. __________________
Robot 6. __________________
Rug 7. __________________
Rainy 8. __________________
Red Sea 9. __________________
Raven 10. __________________
Total Correct: ________ / ________

Comments:
362
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
Please say the word, then replace our sound with _____ *, and then say the
Rain 1. __________________
Root 2. __________________
Relaxed 3. __________________
Rat 4. __________________
Rattle 5. __________________
Robot 6. __________________
Rug 7. __________________
Rainy 8. __________________
Red Sea 9. __________________
Raven 10. __________________
Total Correct: ________ / ________

Comments:
363
364 The late eight
Complete Word List for Consonantal [r]
Beginning of Words
Rain vein, mane, pane, pain

Root toot, moot
Relaxed
Rat at sat, mat, bat, pat, fat, hat,
cat
Rattle addle saddle, battle, cattle
Robot
Rug bug, mug, jug, hug
Rainy
Red Sea
Raven cave-in, maven
Read bead, seed, weed
Rabbit habit
Roast toast, coast, most
Rocks ox socks, box, fox
Rhino I know
Red Ed bed, wed, head
Reach each beach, teach, leech
Rowboat
Russia
Rose owes toes, mows
Richard
Reptile
Railroad
Ring sing, wing, king
Rita eat a pita
Rome om home, gnome
Raccoon
Rice ice mice, nice
Rope soap, hope
Row owe mow, no, know, sow, go
Rugby
Run sun, bun, one, gun, fun
Rachel
Road ode, owed toad, mowed
Rink ink sink, wink, pink, link
Room tomb
Wrestle trestle
Ron on gone
Roof goof
Rainbow
Realm elm helm
Rake ache bake, make, lake, shake
Race ace face, chase, lace
Reef leaf
Ruth
Rust dust, bust
Ram am Sam, Pam, lamb
Raisin lazin’
Rod odd mod, sod, nod, god
Roll bowl, goal
Raincoat
Roar oar, or tore, soar
Rip whip, lip, hip
Rinse mince
Racket
Write night, light, fight
Ran an can, man, pan
Reel eel kneel, feel, deal, Neal
Robed
Ripe pipe, type
Rail ale nail, whale, mail, jail, veil,
tail, pail
Rind mind, signed, bind
Roy oi boy, toy
Ray bay, say, May
Ranch
Rip tip, lip, whip, ship
Rag bag, sag, nag
Rebel
Raid aid maid, jade
Rhine mine, fine, sign
Rend end bend, send, mend
Ramon
Rake ache bake, take, lake
Rich itch witch, hitch
366 The late eight
[pr]
Prize pies
Price
Prince
Preschool
Preach peach
Prairie Perry
Prowl Powell
Pray pay
Proof poof
Prison
Press
Princess
Prune
Priest pieced
Prick pick
Pretzel
Pray pay
Pro
[tr]
Trip tip
Track tack
Train
Trent tent
Tractor
Tree tea, T
Trunk
Tray
Travel
Tribe
Tragic
Trick tick
Tramp
Traffic
Trap tap
Trail tail
Trash can
Truck tuck
Troll toll
Tree house
Trouble
Treat teat
Trailer tailor
Trash
Tracy
Trish Tish
[kr]
Crab cab
Crib
Cradle
Crown
Crawl
Crayon
Crumbs comes
Crow
Crash cash
Cricket
Crete
Christmas
Chris kiss
Croak Coke
Creak
Crossbow
Crutch
Crust cussed
Crisp
Cry
[br]
Bread bed
Broom boom
Brownie
Brian
Braces bases
Britain
Brick Bic
Broken
Bridge
Branch
368 The late eight
Brake bake
Broomstick
Brazil
Brain bane
Bronze Age
Brush
Break bake
[dr]
Drink dink
Driftwood
Drive dive
Driver diver
Drill dill
Dry die
Drugstore
Drag race
Dragon
Drum dumb
Drawer
Driveway
Drag
Dreaming deeming
Drip dip
Drizzle
Dress
Drain Dane
Drummer dumber
[gr]
Grass gas
Grease geese
Great gate
Grapefruit
Grant
Grave gave
Grover
Grizzly
Group
Grouchy
Grapes gapes
Ground
Greece geese
Great Dane
Gray gay
Green
Grow go
Grill gill
Grocer
[fr]
Front
Frown
Fruit
French fries
Friday
Fry fie
Francis
Frank
Freeze fees
Franklin
Frog fog
Frosting
Friend fend
Friar fire
France
[θr]
Three thee
Throw though
Thrill
Throttle
Thrift shop
Thread
Throat
Threw
Throw rug
Thriller
Throne
Thrifty
370 The late eight
Throwing
Threshold
Throng thong
Thrive
Thrash
Through
Thrush
Threat
Thrust
Throb
[Sr]
Shrew rue
Shredded
Shrug rug
Shrimp
Shrub rub
Shroud
Shreveport
Shrivel
Shriek reek
Shred red
Shrill rill
Shrink rink
Shrine Rhine
Shrewd rude
[spr]
Spring
Spray spay
Sprite (soda) spite
Sprinkles
Spray gun
Spruce
Spry spy
Sprint
Sprinkle
Springboard
Sprinkling
Springtime
Sprain Spain
Sprinkler
Spread sped
Spring
Sprig
Spree
Spruce
Sprout
Sprawl
[str]
Struck stuck
Strum
Strike out
Strong
Stroller
Street
Stranger
Straw
Stronghold
Stripe
String sting
Strike zone
Streetcar
Stream steam
Strap
Strike
Stretcher
Strict sticked
Stroke stoke
Struggle
Strut
[skr]
Screen
Scribble
Scream scheme
Scratch
Scrapper
Scrooge
372 The late eight
Screenplay
Scrub
Screw
Script skipped
Scramble
Scribe
Scrap
Scroll
Scrimp skimp
Scrabble
Screech
Consonant + [r] Deletions
Britain
Prize pies
Trap tap
Price
Prince
Throat
Preschool
Bridge
Prairie Perry
Frosting
Prowl
Pray pay
Grease geese
Prison
Trouble
Priest pieced
Trip tip
Crayon
Travel
Drummer dumber
Tribe
Drip dip
Trick tick
Prune
Tramp
Traffic
Grow go
Truck tuck
Frog fog
Troll toll
Driver diver
Trailer tailor
Trish Tish
Crib
Trash can
Crown
Prick pick
Crawl
Thrill
Crow
Track tack
Crash cash
Drugstore
Cricket
Trail tail
Crete
Dress
Croak Coke
Friar fire
Creak
Tree house
Crutch
Preach peach
Crust cussed
Princess
Crisp
Bronze Age
Cry
Bread bed
Tracy
Brownie
Tree tea, T
Brian
Tragic
Brake bake
Green
Broomstick
Crumbs comes
Brazil
374 The late eight
Crab cab
Brain bane
Shriveled
Brush
Pro
Break bake
Train
Crossbow
Trunk
Press
Tray
Drink
Friday
Driftwood
Throttle
Drive dive
Broken
Drill dill
Christmas
Dry die
Brick
Drag race
Friend fend
Drawer
Driveway
Trash
Drag
Tractor
Drizzle
Broom boom
Drain Dane
Grass gas
Prof
Great gate
Grapefruit
Grant
French fries
Grave gave
Freeze fees
Grizzly
Group
Grouchy
Drum dumb
Grapes gapes
Braces bases
Gray gay
Shroud
Grill gill
Branch
Grocer
Front
Frown
Pray pay
Fruit
Dreaming deeming
Fry fie
Trent tent
Francis
Chris kiss
Frank
Thriller
Franklin
France
Three
Shriek sheik
Throw
Thrush
Cradle
Thread
Dragon
Throw rug
Grover
Thrum thumb
Greece geese
Thrift shop
Shrimp
Pretzel
Shrub
Great Dane
Shrew shoe
Ground
Shrink
376 The late eight
Consonant + Consonant + [r] Deletions
Scribe
Spring
Scrooge
Strike out
Sprint
Sprawl
String bean
Sprinkle
Stream steam
Scream scheme
Straight state
Spray spay
Straw stall
Sprinkler
Strut
Spry spy
Scrawny
Sprinkling
Stride
Sprig
Street
Spruce
Stretcher
Springboard
Strudel
Stripe
Spread sped
Strap
Scratchy
Spree
Stretch
Scribble
Strange
Scrub
Stroller
Sprinkles
Screw
Springtime
Strong
Scrapbook
Spray gun
String sting
Consonant + Consonant + [r] Deletions
Sprout
Screech
Sprain Spain
Scratch
Sprite spite
Medial
Single Consonants
Story Garage Tourist

Gary Berry Beret
Earring Forest Syringe
Marry Laura Eric
Barrel Zero Arrow
Europe Merry Peru
Harry Sheriff Cairo
Arrest Burro Ferry
Irish Weary Sarah
Zorro Very Terry
Hero Carol Far East
Consonant Clusters
[pr]
Surprise Apron Depressed

Supreme Blueprint Cypress
Footprint Soundproof
Shipwreck April
[tr]
Country Portrait Mattress

Subtract Actress Pine tree
Pantry Waitress Subtract
Fire truck Race track Entrance
Matrix Detroit Patrick
378 The late eight
Consonant Clusters
[kr]
Secret Concrete King crab

Aircraft Witchcraft Akron
Across Red Cross Pie crust
Red Crescent Recruit Cockroach
Scarecrow Spacecraft
[br]
Umbrella Toothbrush Hairbrush

Fabric Hebrew Zebra
Cornbread Library Cambridge
[dr]
Laundry Gumdrop Hydrant

Address Bedroom Ear drop
Hundred Madrid Raindrop
Children Soft drink
[gr]
Regret Pilgrim School grounds

Hungry Bridegroom Background
Agree Photograph
Congress Angry
[fr]
Defrost Deep freeze French fries

Afraid Bullfrog Grapefruit
Cold front Boyfriend
[ðr]
Bathrobe Drive through Heart throb
[ʃr]
Mushroom Washrag Washroom
Consonant Clusters
[spr]
Hot springs Hair spray

Bedspread Offspring
[str]
Bloodstream Shoestring High-strung

Construct Backstroke Nostril
Monstrous Nostril Pastry
[skr]
Ice cream Corkscrew Subscribe

Describe Muskrat
All Consonant Clusters
Subscribe Ear drop Soft drink

Portrait Witchcraft Akron
Subtract Fire truck Regret
Construct Red Cross Hungry
Surprise Afraid Hundred
Depressed Recruit Agree
Cypress Pie crust Spacecraft
Country Gumdrop Congress
Cold front Bloodstream Deep freeze
Monstrous Cockroach Pilgrim
Entrance Umbrella Bedspread
Patrick Corkscrew Bridegroom
Secret Fabric April
Blueprint Hydrant Photograph
Muskrat Cornbread Hot springs
Aircraft Address School grounds
Raindrop Toothbrush Children
Across Hebrew Background
Red Crescent Pantry Apron
Shipwreck Defrost Angry
Scarecrow Bedroom Bullfrog
Matrix Hairbrush Library
Concrete Madrid Boyfriend
380 The late eight
All Consonant Clusters
King crab Heart throb Shoestring

Subtract Mushroom Backstroke
French fries Footprint Mattress
Supreme Washrag Nostril
Grapefruit Zebra High-strung
Bathrobe Laundry Nostril
Actress Washroom Pastry
Waitress Detroit Ice cream
Race track Hair spray Pine tree
Drive through Offspring Describe
Cambridge Soundproof Shoestring
All Environments
Subscribe Red Crescent Address

Portrait Shipwreck Toothbrush
Weary Carol Hebrew
Subtract Scarecrow Forest
Construct Matrix Pantry
Surprise Marry Defrost
Depressed Barrel Bedroom
Cypress Concrete Beret
Country Ear drop Hairbrush
Garage Witchcraft Madrid
Zero Fire truck Soft drink
Cold front Red Cross Akron
Monstrous Tourist Harry
Entrance Afraid Regret
Story Recruit Syringe
Gary Pie crust Hungry
Earring Gumdrop Hundred
Irish Laura Agree
Patrick Bloodstream Hero
Secret Cockroach Spacecraft
Very Umbrella Congress
Blueprint Arrest Arrow
Muskrat Corkscrew Deep freeze
Berry Fabric Pilgrim
Aircraft Hydrant Bedspread
Raindrop Cornbread Bridegroom
Across Europe April
All Environments
Photograph Bathrobe Sheriff

Hot springs Actress Hair spray
School grounds Waitress Offspring
Eric Zorro Ferry
Children Race track Soundproof
Background Drive through Shoestring
Apron Cambridge Terry
Angry Cairo Backstroke
Bullfrog Heart throb Mattress
Library Mushroom Nostril
Peru Sarah High-strung
Boyfriend Footprint Burro
King crab Washrag Nostril
Subtract Zebra Pastry
French fries Far East Ice cream
Supreme Laundry Pine tree
Merry Washroom Describe
Grapefruit Detroit
Hair spray Sheriff
End of Words
End of Words*
*Deletions are not included for [r] at the end of words. The [r] lowers the
preceding vowel, making the deletions task for this sound less useful for
most students.
Car
Guitar
Oar
Stair
Spear
Door
Poor
Jar
Seashore
Tear
Year
Bazaar
Bar
382 The late eight
End of Words
Ore
Pier
Software
Soar
Share
Hear
Ear
Space bar
Bookstore
Pour
Air
Snack bar
Stare
Frontier
War
Pear
Nightmare
Cheer
New Year
Star
Scar
Swear
Scare
North Star
Chair
Downpour
Steer
Senor
Mare
Shore
Air
Bear
Boar
Square
Hair
Éclair
Four
Floor
Boar
Store
[rt]
Art
Airport
Court
Port
Head Start
Heart
Tart
Starve
[rk]
Arc
Mark
Bark
Pitchfork
Denmark
Ark
Dark
New York
Pork
Fork
[rb]
Rhubarb
Barb
[rd]
Beard
Blackboard
Lord
Flashcard
Hard
Bored
Hoard
Award
384 The late eight
[rg]
Morgue
Borg
[rm]
Arm
Farm
Storm
Snowstorm
[rn]
Born
Corn
Horn
Thorn
Torn
Popcorn
Acorn
[rs]
Horse
[rʃ ]
Borscht
[rtʃ ]
Arch
March
Porch
Starch
Torch
Research
[rd]
Barge
Large
Forge
George
[r] + consonant
Snowstorm
Art
Denmark
Airport
Starve
Mark
George
Acorn
Bark
Torn
Pitchfork
Farm
Dark
Popcorn
Fork
Rhubarb
Port
Beard
Pork
Blackboard
Borg
Lord
Barb
Flashcard
Court
Hard
Tart
Bored
Arc
Hoard
New York
386 The late eight
Award
Morgue
Arm
Porch
Storm
Born
Forge
Horn
Torch
Thorn
Horse
Borscht
Arch
Heart
March
Corn starch
Research
Barge
Ark
Large
Head Start
Themes for Consonantal [r]
Themes
Around the Home Halloween Stories

Food People to See
Animals Places to Go
Scary Noises
Rug ugh bug, mug, jug, hug

Trash
Floor flow
Chair
Stair
Rake ache bake, take, lake
Rag bag, sag, nag
Garage
Roof goof
Room tomb
Door
Broom
Food Deletions Minimal Pairs
Roast toast, most, coast

Sprinkles
Strudel
String bean
Rice ice mice, nice
Rich itch witch, hitch
Fruit
French fries
Pear
Frosting
Snack bar
Éclair
Prune
Sprite spite
Cornbread
Raisin lazin’
Pretzel
Crab cab
Crumbs comes
Crust cussed
Bread bed
Brownie
Grapefruit
Grapes gapes
Shrimp
King crab
Pie crust
Gumdrop
Soft drink
Pastry pasty
Mushroom
Ice cream
Popcorn
388 The late eight
Food Deletions Minimal Pairs
Corn
Rhubarb
Pork
Tart
Borscht
Rat at sat, mat, bat, pat, fat, hat, cat

Dragon
Burro
Raven cave-in, maven
Rabbit habit
Rhino
Reptile
Frog fog
Raccoon
Ram am Sam, Pam, lamb
Great Dane
Shrew
Cockroach
Crow
Roar oar tore, soar, more, boar
Steer
Mare May
Bear bay
Boar
Grizzly
Shrimp
Bullfrog
Muskrat
Horse
Zebra
Cricket
Scary Noises Deletions Minimal Pairs
Hear he
Ear E
Croak Coke
Scary Noises Deletions Minimal Pairs
Creak
Scratchy
Screech
Shriek sheik
Drip dip
Cry
Bark
Roar oar tore, soar, more, boar
Halloween Stories Deletions Minimal Pairs
Trick tick
Treat teat
Hoard hoed
Heart
Rend end bend, send, mend
Afraid
Witchcraft
Strange
Shroud
Shriveled
Thriller
Thrill
Friar fire
Grave gave
Dreaming
Broomstick
Crossbow
Crown
Tree tea, T
Trunk
Princess
Scare
Nightmare
Spear
Arrow
Forest
Hero
Ring sing, wing, king
Rain vein, mane, pane, pain
Story
390 The late eight
Halloween Stories Deletions Minimal Pairs
Downpour
Hair hay, hey
Priest pieced
Secret
Children
Dark
Morgue
Storm
Thorn
Torch
Rose owes toes, mows

Richard
Rita eat a pita
Rachel
Ron on
Ruth
Rod odd mod, sod, nod, god
Roy Oi boy, toy
Ramon
Ray A bay, say, May
Gary
Harry
Zorro
Laura
Sarah
Terry
Carol
Eric
Tracy
Trish Tish
Brian
Patrick
April
Scrooge
Franklin
Grover
Francis
Frank
George
Barb Bob
Mark
Chris kiss
Red Sea
Russia
Rome om home, gnome, roam
Europe
Far East
Peru
Cairo
North Star
Rhine mine, fine, sign
Crete
Brazil
Britain
Detroit
Greece geese
France
(The) Matrix
Akron
New York
Denmark
Madrid
Chapter Fourteen
[ʃ]
Definition
[ ʃ ] is made behind the alveolar ridge, a little behind the position for [s].
The tongue blade is raised, and the lips are rounded. The airstream is
continuous and the vocal folds are apart. The technical definition of [ ʃ ]
is voiceless postalveolar fricative.
Acquisition
[ ʃ ] is acquired by 50% of children by 3;6 and by 75% of children by 5;0.
Relative Frequency
[ ʃ ] is ranked sixth in relative frequency compared with the other late-
acquired consonants. It ranks nineteenth in relative frequency compared
Errors
[s] for [ ʃ ] is a common error. A younger student may pronounce [ ʃ ] as [t]
or [d]. A less common, though not rare error, is pronouncing [ ʃ ] as [tʃ ].
393
394 The late eight
Key Environments
End of a syllable, as in fish
By a high back vowel, as in shoe
Possible Metaphors
The best metaphors for [ ʃ ] typically focus on the fricative nature of the
sound.
Tongue placement: Back of the hill sound

Fricative: Hushing sound
Shhh! sound
Quiet sound
Long sound
Voicing: Motor on
Buzzing sound
Voice box on sound
Touch Cue
Finger in front of lips and use the metaphor “quiet sound.”
Instructions
student that this is the quiet sound.
Initial Screening Test for [ ʃ ]
Student’s Name:
Date: __________________
Referral:
Word Student*
Beginning
1. Shell _____________
2. Shutter _____________
3. Show _____________
4. Shrug _____________
5. Shrimp _____________
6. Shred _____________
Medial
7. Wishing _____________
8. Ocean _____________
9. Washer _____________
Final
10. Dish _____________
11. Crush _____________
12. Irish _____________
13. Harsh _____________
14. Marsh _____________
15. Borscht _____________

Comments/Notes:
395
Stimulability Tests for [ ʃ ]
Student’s Name:
Date: __________________
Referral:
Imitation
1. shoe _____________
2. bush _____________
Key Environments

1. fish _____________
2. [ish] _____________

1. she _____________
2. shy _____________
Favorite Words

Phonetic Placement ___________
1. Ask the student to hiss like a snake.

2. While the student hisses, ask him or her to purse the lips.
Shaping [ ʃ ] from [s] _______________

1. Ask the student to say [s].
2. Instruct him or her to pucker the lips slightly and to draw the tongue
back a little until [ʃ] results.
Notes/Comments:
396
CHAPTER 14: [ S ] 397
Demonstrations for [ ʃ ]
Place: Postalveolar
First Method
Objects: None
Instructions: Ask the student to run the tongue to where the bump on the
mouth roof just begins to go down toward the back of the mouth, using an
analogy of a “hill and valley.”
Second Method
Instructions:

favorite food behind the alveolar ridge.
3. Ask the student to touch the food with the tongue blade.
Manner: Fricative
First Method
Instructions:

sounds.
Second Method

398 The late eight
Third Method
Objects: None
Voicing: Voiceless
First Method
Objects: None

Second Method
Objects: None
Third Method
Objects: None

Fourth Method
Objects: None
CHAPTER 14: [ S ] 399
Fifth Method

paper flower

400 The late eight
Phonetic Placement and Shaping Techniques for [ ʃ ]
Phonetic Placement Technique
Method
In this book there is only a single phonetic placement exercise for [ ʃ ]. Most
often, the sound is easily established through a demonstration or a shaping
exercise.
Objects: Tongue depressor (optional)
Instructions:
1. Ask the student to part the teeth and lips.

2. Touch the student’s tongue just behind the tip with a tongue depressor.
Ask the student to move the place just touched to the roof of the mouth
behind the “bumpy part.” (If needed, a tongue depressor may be used
to push the tongue back from the upper front teeth.)
3. Next, ask the student to lower the tongue slightly. (If needed, direct the
tongue down slightly with a tongue depressor.)
4. Ask the student to hold this position, pucker the lips slightly, and breathe
out through the mouth, resulting in [ ʃ ].
Shaping Techniques
[ ʃ ] from [s]
This is a good, efficient method for a student with a well-established [s].
Objects: None
Instructions: Ask the student to say [s]. While the student is saying [s],
instruct him or her to pucker the lips slightly and to draw the tongue back
a little until [ ʃ ] results.
[ ʃ ] from [Z]
Most students do not have a well-established [ Z] before having a well-established

[ ʃ ]. For those who do, however, this method works well.
CHAPTER 14: [ S ] 401
Objects: None
Instructions: Ask the student to say [Z] and then turn off the voice, which
often results in [ ʃ ].
[ ʃ ] from [i]
As for the [ ʃ ] from [i] shaping technique, this technique relies on the fact that
[ ʃ ] and [i] are made near the same place of production.
Objects: None
Instructions:
1. Ask the student to say [i], first with the voice on and then with the voice
off.
2. Next, ask the student to pucker the lips slightly.
3. Raise the student’s lower jaw slightly.
4. Ask the student to breathe out silently while raising the tongue. The
sound produced is [ ʃ ].
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
402
Imitation
Student’s Name:
Date: __________________
Shoe 1. __________________
Sheep 2. __________________
Shiny 3. __________________
Shut 4. __________________
Sharon 5. __________________
Shovel 6. __________________
Shell 7. __________________
Shutter 8. __________________
Show 9. __________________
Shannon 10. __________________
Total Correct: ________ / ________

Comments:
403
Minimal Pairs
Student’s Name:
Date: __________________
Word List: Student responses:
Shoe goo 1. __________________

Ship chip 2. __________________
Sheet feet 3. __________________
Show row 4. __________________
Shoe two 5. __________________
Shake lake 6. __________________
Shy hi 7. __________________
Shore tore 8. __________________
Shear tear 9. __________________
Shock knock 10. __________________
Total Correct: ________ / ________

Comments:
404
Deletion
Student’s Name:
Date: __________________
Shoe ooh 1. __________________

Sharon Aaron 2. __________________
Shell L 3. __________________
Shutter utter 4. __________________
Show o, owe 5. __________________
Sheet eat 6. __________________
Shade aid 7. __________________
Shy I, eye 8. __________________
Sheik eek 9. __________________
Shower hour 10. __________________
Total Correct: ________ / ________

Comments:
405
Self-Correction
Student’s Name:
Date: __________________
Shoe 1. __________________
Sheep 2. __________________
Shiny 3. __________________
Shut 4. __________________
Sharon 5. __________________
Shovel 6. __________________
Shell 7. __________________
Shutter 8. __________________
Show 9. __________________
Shannon 10. __________________
Total Correct: ________ / ________

Comments:
406
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Shoe 1. __________________
Sheep 2. __________________
Shiny 3. __________________
Shut 4. __________________
Sharon 5. __________________
Shovel 6. __________________
Shell 7. __________________
Shutter 8. __________________
Show 9. __________________
Shannon 10. __________________
Total Correct: ________ / ________

Comments:
407
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
Please say the word, then replace our sound with _____ *, and then say the
Shoe 1. __________________
Sheep 2. __________________
Shiny 3. __________________
Shut 4. __________________
Sharon 5. __________________
Shovel 6. __________________
Shell 7. __________________
Shutter 8. __________________
Show 9. __________________
Shannon 10. __________________
Total Correct: ________ / ________

Comments:
408
CHAPTER 14: [ S ] 409
Complete Word List for [ ʃ ]
Beginning of Words
Shoe oo goo, boo, new, dew, Sue

Sheep cheep, keep, peep, jeep,
deep, leap
Shiny
Shut mutt, gut
Sharon Aaron
Shovel hovel
Shell L bell, fell
Shutter utter gutter, butter
Show o, owe bow, go, toe, mow
Shannon cannon
Sheet eat feet, meat, neat, beet, beat
Shade aid paid, raid, wade
Shortcake
Shield field, kneeled
Sugar bugger
Cheryl barrel, Carol
Shock knock, rock, sock, lock
Shy I, eye hi, lie, die, buy, cry
Shellfish
Shine vine, sign, nine, line
Sherlock
Sheik eek beak, meek, seek, peek
Shower hour tower, power, cower
Shortcut
Shaw awe law, saw
Shed Ed dead, said, wed, head
Shout out pout
Shady
Shane pain, sane, bane, mane
Sherbet
Shamrock
Shore or, ore tore, more, core, chore
Shoelace
Shortbread
Shadow
Shirt hurt, dirt
410 The late eight
Shepherd
Shape ape cape, nape, tape
Shakespeare
Shark arc, ark dark, bark, lark
Sheriff
Ship chip, sip, hip, zip, whip,
rip, lip
Shampoo
Shush hush, mush
Shake ache lake, bake, make, rake
Short court
Shaft aft raft, laughed
Shuffle ruffle
Shoe oo two, new, boo, dew
Shadow
Shear ear tear, near, beer, seer
Shop hop, pop, mop
Sharp tarp, carp
Sham aim came, tame, same
Shed Ed bed, Ned, red
Shaggy Aggie baggy
Shift gift, lift
Shave pave, knave
Shanty ante
Shiver liver, giver
Shade aid laid, maid, paid
Shelter
Shabby abbey cabbie, tabby
Shape tape, nape
Shot hot, got, pot, rot
Shock rock, sock, knock
Shaking aching baking, making
Shower hour power, tower, bower
Shoulder older colder, bolder
Shelob
Shale ail, ale mail, nail, pail, tail
Shallow aloe callow, tallow
Shelf elf
Sham am ram, Pam, Sam, ham
Show O row, tow, mow, go
Share air, heir care, mare, tear
Shuttle
CHAPTER 14: [ S ] 411
Shrew rue grew, true, brew

Shredded breaded
Shrug rug drug
Shrimp crimp
Shrub rub grub
Shroud crowd
Shreveport
Shrug rug
Shrivel drivel
Shriek reek creek
Shred red tread, bread
Shrill rill trill, krill
Shrink rink brink
Shrine Rhine
Shrewd rude crewed, brewed
Medial
Single Consonants
Wishing Washcloth Woodshed

Ocean Bushes Fractions
Washer Dishes Flash card
Banshee Windshield Nashville
Fishing Ashes Dishcloth
Rickshaw Flashlight Push-ups
Sunshine Dashboard Seashore
Glacier Snowshoe Washtub
Handshake Washing
Fishy Steamship
Consonant Clusters
—
412 The late eight
End of Words
Mustache
Trash
Dash
Goldfish
Irish
Dish
Crush
British
Crawfish
Mash
Crash
Toothbrush
Fish
Cash
Catfish
Hush
Spanish
Ash
Wash
Welsh well
Paintbrush
Leash Lee
Clash
Trish
Push
Nailbrush
Flush
Wish
Splash
Car wash
Bush
Josh
Rubbish
Smash
Danish
Mouthwash
CHAPTER 14: [ S ] 413
Harsh
Marsh mar
Borscht bore
Themes for [ ʃ ]
Themes
People to See Watery Places

Places to Go Things to Eat
Animals Washing Dishes
Things That Go Bump in the Night
Sharon
Shannon cannon
Cheryl barrel, Carol
Sherlock
Shaw awe
Shane cane, bane, mane
Shakespeare
Irish
Ash
Wash
Welsh well
Spanish
British
Shaggy Aggie baggy
Shelob
Trish
Josh
Danish
Nashville
Shreveport
414 The late eight
Sheep cheep, keep, peep, jeep,

deep, leap
Shark dark, bark, lark
Goldfish
Fish
Crawfish
Catfish
Shrew rue true, brew, grew
Shrimp
Things That Go Bump Deletions Minimal Pairs
Banshee
Shelob
Shape tape, nape
Shiver liver, giver
Shade aid laid, maid, paid
Sharp tarp, carp
Shadow
Shock rock, sock, knock
Shaking aching baking, making
Shrivel drivel
Shriek reek creek
Watery Places Deletions Minimal Pairs
Shale ail, ale mail, nail, pail, tail

Shallow aloe callow, tallow
Ocean
Fishing
Seashore
Shelf elf
Fishy
Shark dark, bark, lark
Shore or, ore tore, more, core, chore
Ship chip, sip, hip, zip, whip,
rip, lip
Splash
Shell L bell, fell
Goldfish
CHAPTER 14: [ S ] 415
Watery Places Deletions Minimal Pairs
Shower hour power, tower, bower

Crawfish
Catfish
Shrimp
Steamship
Things to Eat Deletions Minimal Pairs
Shortcake
Sugar
Shellfish
Fish
Crawfish
Catfish
Shrimp
Shake ache lake, bake, make, rake
Sherbet
Shortbread
Borscht bore
Washing Dishes Deletions Minimal Pairs
Dish
Rubbish
Splash
Trash
Dishes
Washcloth
Washing
Washer
Shine vine, sign, nine, line
Chapter Fifteen
[tʃ ]
Definition
[tʃ ] is made with the body of the tongue touching the mouth roof behind
the bumpy ridge (alveolar ridge). The lips are slightly puckered. The
airstream is stopped and then becomes continuous, making it a short
stop ([t]) followed by a fricative ([tʃ ]). The vocal folds are apart. The
technical definition of [tʃ ] is voiceless postalveolar affricate.
Acquisition
[tʃ ] is acquired by 50% of children by 4;6 and by 75% of children by 5;6.
Relative Frequency
[tʃ ] is ranked eighth in relative frequency compared with the other
late-acquired consonants. It ranks twenty-second in relative frequency
compared with all other English consonants, and its percentage of
occurrence compared with all English consonants is 0.7%.
Errors
Errors for [tʃ ] typically keep either the stop or fricative component of
the sound. Both [t] for [tʃ ] and [s] for [ʃ ] are common.
417
418 The late eight
Key Environments
End of a syllable, as in batch
By a high back vowel, as in chew
Possible Metaphors
The best metaphors for [tʃ ] typically focus on the affricate (stop-fricative)
quality of the sound.
Affricate quality: Choo-choo sound

Sneezing sound (choo!)
Engine-chugging sound
Tongue placement: Back of the hill sound
Voicing: Motor on
Buzzing sound
Voice box on sound
Touch Cue
None
Initial Screening Test for [tʃ ]
Student’s Name:
Date: __________________
Referral:
Word Student*
Beginning
1. Chain _____________
2. Chip _____________
3. Chunk _____________
Medial
4. Peaches _____________
5. Itchy _____________
6. Teacher _____________
Final
7. Witch _____________
8. Sketch _____________
9. Itch _____________
10. Porch _____________
11. Starch _____________
12. Punch _____________

Comments/Notes:
419
Stimulability Tests for [tʃ ]
Student’s Name:
Date: __________________
Referral:
Imitation
1. chip _____________
2. catch _____________
Key Environments

1. [Itʃ ] _____________
2. watch _____________
After a high front vowel

1. beach _____________
2. itch _____________
Favorite Words

1. Ask the student to make the train sound, “choo choo.”
Shaping _____________
1. Instruct student to say “Bet you” slowly.

2. Next, instruct student to say “Bet you” fast, resulting in the production
of “Betcha.”
3. If “betcha” doesn’t work, repeat with “Got you.”
Notes/Comments:
420
CHAPTER 15: [tS ] 421
Demonstrations for [tʃ ]
Place: Postalveolar
First Method
Objects: None
Instructions: Ask the student to run the tongue to where the bump on the
mouth roof just begins to go down toward the back of the mouth, using an
analogy of a “hill and valley.”
Second Method
Instructions:

favorite food behind the alveolar ridge.
3. Ask the student to touch the food with the tongue blade.
Manner: Affricate
Method
Objects: None
Instructions: Have the student hold his or her hands together tightly and
then separate them quickly to indicate the stop onset and fricative release
of affricates.
Voicing: Voiceless
First Method
Objects: None

422 The late eight
Second Method
Objects: None
Third Method
Objects: None

Fourth Method
Objects: None
Fifth Method

paper flower

Phonetic Placement and Shaping Techniques for [tʃ ]
Phonetic Placement Technique
Method
Objects: None
Instructions:
1. Ask the student to pucker the lips slightly.

2. Ask the student to make the tongue tip touch “the bump” behind the two
upper front teeth.
3. Next, instruct the student to make the sneezing sound (choo!) while
keeping the lips slightly puckered and the tongue tip on the alveolar
ridge. If [ts] results, ask the student to move the tongue tip back slightly
while maintaining contact with the roof of the mouth. The resulting
sound is [tʃ ].
Shaping Technique
[tʃ ] from [ ʃ ]
Objects: None
Instructions: Ask the student to say a quick [ ʃ ] with the tongue tip touching
“the bump,” resulting in [tʃ ]. (Note: To facilitate [dZ], develop from [d].)
[tʃ ] from [t] and [ S ]
Objects: None
Instructions:
1. Explain that [tʃ ] is [t] and [ʃ ] said together very quickly.

2. Next, ask the student to say [ʃ ].
3. Instruct the student to say [t] and then to draw the tongue tip back a little
and say [t] again.
4. With the student’s tongue tip in the position for the “back” [t], instruct
the student to quickly say [t] followed by [ʃ ], which typically results in
[tʃ ]. (Note: To facilitate [dZ], develop from [d] and [dZ].)
424 The late eight
[tʃ ] from [ts]
This method modifies [ts], as in pizza into [tʃ ]
Objects: None
Instructions:
1. Instruct the student to say pizza.

2. Next, ask the student to say only the [ts] in pizza. (If needed, have the
student divide pizza into two parts — pizza — and then ask the student to
say only the second part — zza.
3. Next, ask the student to say [ts] farther back in the mouth, resulting in [tʃ ].
Student’s Name:
Date: __________________
1. __________________
2. __________________
3. __________________
4. __________________
5. __________________
6. __________________
7. __________________
8. __________________
9. __________________
10. __________________
Total Correct: ________ / ________

Comments:
425
Imitation
Student’s Name:
Date: __________________
Cheese 1. __________________
Chicken 2. __________________
Chief 3. __________________
Cheat 4. __________________
Chain 5. __________________
Chip 6. __________________
Chunk 7. __________________
Church 8. __________________
Chuck 9. __________________
Chop 10. __________________
Total Correct: ________ / ________

Comments:
426
Minimal Pairs
Student’s Name:
Date: __________________
Chore boar 1. __________________

Chill pill 2. __________________
Charge barge 3. __________________
Chunk skunk 4. __________________
Cheese peas 5. __________________
Cheep sheep 6. __________________
Chum mum 7. __________________
Chop shop 8. __________________
Chest test 9. __________________
Cheer fear 10. __________________
Total Correct: ________ / ________

Comments:
427
Deletion
Student’s Name:
Date: __________________
Cheese ease 1. __________________

Cheat eat 2. __________________
Chew oo 3. __________________
Chase ace 4. __________________
Chin in 5. __________________
Cheek eek 6. __________________
Chicks icks 7. __________________
Chess S 8. __________________
Chill ill 9. __________________
Cherry airy 10. __________________
Total Correct: ________ / ________

Comments:
428
Self-Correction
Student’s Name:
Date: __________________
Cheese 1. __________________
Chicken 2. __________________
Chief 3. __________________
Cheat 4. __________________
Chain 5. __________________
Chip 6. __________________
Chunk 7. __________________
Church 8. __________________
Chuck 9. __________________
Chop 10. __________________
Total Correct: ________ / ________

Comments:
429
Old Way/New Way
Student’s Name:
Date: __________________
the new way again.
Cheese 1. __________________
Chicken 2. __________________
Chief 3. __________________
Cheat 4. __________________
Chain 5. __________________
Chip 6. __________________
Chunk 7. __________________
Church 8. __________________
Chuck 9. __________________
Chop 10. __________________
Total Correct: ________ / ________

Comments:
430
Similar Sound
Student’s Name:
Date: __________________
ment sound again.
Cheese 1. __________________
Chicken 2. __________________
Chief 3. __________________
Cheat 4. __________________
Chain 5. __________________
Chip 6. __________________
Chunk 7. __________________
Church 8. __________________
Chuck 9. __________________
Chop 10. __________________
Total Correct: ________ / ________

Comments:
431
432 The late eight
Complete Word List for [tʃ ]
Beginning of Words
Cheese ease peas, keys, knees

Chicken sicken
Chief thief, beef, leaf
Cheat eat seat, meat, heat, wheat
Chain Spain, gain, lane, pain
Chip ship, hip, sip, rip, lip, whip,
zip, dip
Chunk skunk, junk
Church
Chuck luck, buck, tuck
Chop shop, cop, pop, top, hop,
mop
Chew oo zoo, moo, two, shoe, new,
boo
Chase ace pace, race, case
Chapter raptor
Charge barge, large, Marge
Chirp
Chin in pin, thin
Checkers
Charles
Cheek eek peek, seek, week, leak
Cheetah
Chicks eek six, mix
Chess S Wes, mess, less
Chill ill pill, gill, Bill, mill
Chest test, pest, vest, nest, west
Cherry airy Sherry, merry, berry
Chilly Willy, Billy, hilly
Champ amp ramp, lamp, damp
Chalk balk, talk
Chick ick lick, sick, wick
Child tiled, piled
Chili Willy, Billy, hilly
Cheer ear fear, hear, deer, near, year
Cheep sheep, jeep, deep, leap
Choke oak soak, poke
Chair air mare, care, fair, hair

China
Choice
Chad add mad, sad, bad, cad
Chore ore, or boar, core, more, tore
Chafe safe
Cheat eat beat, meet, seat
Chatter matter, tatter, batter
Chain mail
Chat at cat, rat, mat, pat
Chug bug, hug, mug
Chair air tear, wear, care
Choose ooze news, lose
Charcoal
Challenge
Chamber
Cherish perish
Chum um mum, hum, sum, come
Chief beef
Chopstick
Chance dance
Champagne
Church
Check peck, neck
Change mange, range
Channel panel
Chant ant can’t, rant, pant
Chap tap, map, cap
Chapel apple
Charm arm harm
Checkers
Charter barter, martyr
Churn earn burn, turn
Chase ace face, case, pace
Cheap peep, keep, deep
Consonant Clusters
—
434 The late eight
Medial
Single Consonants
Peaches Stitches Nature

Itchy Future Pitcher
Rachel Nachos Ketchup
Richard Rancher Vulture
Picture Inches Pitching
Teacher Roaches Watching
Matches Preacher Benches
Witches Gretchen Preacher
Pitchfork Question Torture
Consonant Clusters
Archway Lunchtime Lunches

Torchlight Parchment
Lunchroom Finches
All Environments
Archway Pitchfork Lunchtime

Peaches Stitches Pitcher
Itchy Future Ketchup
Finches Nachos Vulture
Rachel Lunchroom Pitching
Richard Rancher Parchment
Picture Inches Watching
Torchlight Roaches Benches
Teacher Preacher Preacher
Matches Gretchen Torture
Witches Question
Lunches Nature
End of Words
Teach tea, T
Witch
Peach pea, P
Sketch
Roach row
Coach
Ouch ow
Speech
Track coach
Watch
Ski coach
Wristwatch
Beach bee, B
Catch
Couch cow
Sandwich
Watch
Cockroach
Scratch
Ostrich
Fetch
[rtʃ ]
Arch R
Scorch score
March mar
Porch poor, pour
Starch star
[ntʃ ]
Trench
Punch pun
Branch
French
Bunch bun
Lunch
Bench Ben
Wrench wren
436 The late eight
Themes for [tʃ ]
Themes
Actions It’s a Job

Around the Home People and Places
The Body Lunch
Nature
Actions Deletions Minimal Pairs
Cheat eat seat, meat, heat, wheat

Chased aced paste, taste, raced, waist
Sketch
Watch
Teach tea, T
Catch
Fetch
Scratch
March mar
Matches
Pitching
Watching
Choke oak soak, poke
Cheer ear fear, hear, deer, near, year
Chain Spain, gain, lane, pain
Charge barge, large, Marge
Cheek eek peek, seek, week, leak
zip, dip
Chop shop, cop, pop, top, hop,
mop
Chew oo zoo, moo, two, shoe
Scorch score
Choose ooze news, lose
Check peck, neck
Change mange, range
Chant ant can’t, rant, pant
Chase ace face, case, pace
Chat at cat, rat, mat, pat
Cheat eat beat, meet, seat
Chatter matter, tatter, batter
Charm arm harm
Porch pour, poor

Starch star
Arch R
Archway
Couch cow
Wrench wren
Watch
Wristwatch
Picture
Checkers
Chess Wes, mess, less
Chalk balk, talk
Chopstick
Chair air mare, tear, wear, care
Chore ore, or boar, core, more, tore
Chin in pin, thin

Chest test, pest, vest, nest, west
Cheek eek leak, beak, meek
Roach row
Cockroach
Ostrich
Branch
Roaches
Nature
Vulture
Beach bee, B
Itchy
Cheetah
Chicks six, mix
Cherry airy Sherry, merry, scary
438 The late eight
It’s a Job Deletions Minimal Pairs
Preacher
Teacher
Ski coach
Rancher
Track coach
Coach
Chuck luck, buck, tuck

Gretchen
Rachel
Richard
China
Charles
Lunch Deletions Minimal Pairs
Peaches
Lunch
Chew oo zoo, moo, two, shoe
Lunchtime
zip, dip
Scorch score
Lunchroom
Cheese ease peas, keys, knees
Chicken sicken
Chili hilly, Willy, Billy
Nachos
Ketchup
Chop shop, cop, pop, top, hop, mop
Sandwich
Punch pun
Bunch bun
Peaches
Peach pea, P
Cherry airy Sherry, merry, scary
Pitcher
Lunches
Chapter Sixteen
Evaluation and Treatment:

An Illustration
Introduction
Resources in this book may be used in diverse ways within many different
approaches. This chapter illustrates how they are employed to evaluate and
treat students in one school setting. The illustration is descriptive rather
than prescriptive, suggesting how the resources might be used rather than
indicating how they should be used.
Clinical Orientation
Use of resources described in this chapter is based on three ideas:
1. Treatment of late-acquired sounds reflects the dual nature of speech.

2. Treatment success depends as much on human variables as linguistic
ones.
3. Treatment activities are functional.
The Dual Nature of Speech
Speech has a dual nature: it is both a channel of communication and a part

of language (Bleile, 2004). The dual nature of speech is the basis of the
conceptual distinction between an articulation disorder (disorder arising in
the channel of communication) and a phonologic disorder (a disorder in the
language component).
439
440 The late eight
Articulation
A primary reason the 8 are acquired late is that they are hard to pronounce.
What late-acquired sounds share is that none are made with the articulators
touching throughout (as stop consonants and nasals are) or with the articu-
lators relatively far apart (as glides and vowels are). Instead, late-acquired
sounds require a student to position the articulators not touching, not far
apart, but somewhere in the middle, making the airflow variously stop and
start (affricates), hiss (fricatives), flow over the sides of the tongue (lateral),
or flow around and over an atypical tongue configuration ([r]). Examples of
resources focusing primarily on the articulation aspect of speech include
definitions, metaphors, demonstrations, phonetic placement and shaping
techniques, and key environments.
Phonology
Being a skilled motor movement is only half of speech’s dual nature. Speech
also is an aspect of language, requiring language knowledge similar to but
distinct from knowledge that underlies syntax, morphology, semantics, and
discourse. A critical aspect of treating late-acquired sounds entails drawing
a student’s attention to the communication value of speech. In addition to
learning how to pronounce a sound, a student must also learn how sound
affects meaning, how a sound is similar to and different from other sounds,
and how to self-monitor and self-correct to ensure that communication
occurs. Examples of resources focusing primarily on the phonologic aspect
of speech include speech exercises, language activities, and word lists.
Human Variables
A speech problem does not exist independently from the person who has
the problem. Factors such as motivation, intelligence, family support, atten-
tion, and desire to learn are equally as important for clinical success as are
linguistic ones. To give just one illustration of the diversity of the people
attached to speech problems, one recent morning three students in the same
grade and school received speech therapy, one after the other. The first
was embarrassed by his speech problem, the second thought his speech
problem sounded pretty cool, and the third didn’t know he had a speech
problem. Later that same day another student was treated — a teenager with
a severe [r] difficulty who desperately wanted speech help for an upcom-
ing radio presentation with his class. He promised to do anything to have
better speech — except give up basketball practice for speech therapy. Radio
address or not, basketball had a higher priority. The point is not to criticize
this priority — only to emphasize that students bring far more than their
linguistic system to the therapy setting. Examples of resources focusing pri-
marily on human variables arising in the treatment of late-acquired sounds
include acquisition, relative frequencies, and errors.
CHAPTER 16: Evaluation and Treatment: An Illustration 441
Human Variables
What is more trite and less controversial than the assertion
that treatment success depends as much on human variables
as linguistic ones? Nonetheless, considering that most clini-
cians believe such variables are important, it is amazing how
poor our knowledge base is about human variables compared
with our knowledge of linguistic factors. Far more research is
needed before we understand how learner attributes interact
with speech factors to influence treatment outcome.
All students, children, and adults, gifted or delayed, learn and grow through-
out their lives. Time devoted to treatment of late-acquired sounds should
further this learning whenever possible. In practice, this entails using activi-
ties that encourage learning and personal growth. Class materials, books,
and projects are excellent sources of activities for school-aged students, as
newspapers and movies and upcoming social events are for older school-
aged students and adults. In addition to providing support for learning, a
critical benefit of treatment relying on such activities is that it encourages
use of a treatment sound in contexts that matter to a student. Examples of
resources that most directly support classroom and life-based activities are
the speech exercises and language activities.
Clinical Resources
The order in which resources are described in the following sections approxi-
mate their use with a hypothetical student from the evaluation through
conclusion of treatment. The sequence is indicated in Table 16–1.
Evaluation
The following resources are used primarily in assessment:
n Initial screening
n Screening for stimulability
n Definition
n Acquisition
n Relative frequency
n Errors
442 The late eight
Table 16–1. Clinical Resources Used in Evaluation and Treatment
Assessment Initial screening

Screening for stimulability
Definition
Acquisition
Relative frequency
Errors
Treatment Metaphors
Touch cues
Demonstrations
Phonetic placement and shaping techniques
Key environments
Word lists
Speech and awareness exercises
Language activities
Initial Screening, Screening for Stimulability
The most typical referral source for a student is a parent or teacher. A student
may then be observed in a classroom or playground before receiving an
initial speech screening and a screening test for stimulability.
Initial Screening
An initial screening helps determine if a student experiences difficulty pro-

nouncing a late-acquired sound. An initial screening assesses a treatment sound
at the word level in a variety of phonetic contexts. In addition to determining
if a problem with a sound exists, an initial screening often serves as a pretest
against which treatment progress is measured. If a student’s speech is found to
contain speech errors, a screening test for stimulability typically is administered.
Screening for Stimulability
Screening for stimulability helps determine if a student can pronounce a pos-

sible treatment sound. Information on stimulability is helpful in predicting
how rapidly treatment is likely to proceed. In general, if a student has some
initial capacity to pronounce a sound, treatment proceeds more rapidly than
if such a capacity must first be established.
Definition, Acquisition, Relative Frequency, and Errors
These resources bundle together after stimulability testing is completed and

as a clinician decides between possible treatment sounds. Typically, decid-
ing which sound to select is based on weighing multiple factors, personal
and linguistic. Personal factors include a clinician’s judgment about a stu-
dent’s attention span, interests, and concerns. The linguistic aspect of sound
selection includes stimulability, definition, acquisition, relative frequency,
and errors. No single variable trumps the others. Rather, a clinician weighs
multiple considerations to reach a balanced decision.
Definition
The definition is a prose description showing how a sound is produced. The

definition contributes to treatment decisions because understanding how
a sound is made suggests which resources may be needed to teach it. To
illustrate, for [l] a clinician thinks about where the tongue is, how easily it
might be to teach a student this tongue position, what types of demonstra-
tions might be needed, what phonetic placement and shaping technique to
use, and the types of exercises available. Alternatively, for [s] an additional
consideration might be to develop short probes to determine which [s] is
easier for a student — tongue tip raised or lowered? Typically, a clinician
follows the student’s lead — that is, if a student already makes [s] with the
tongue tip lowered, the clinician teaches [s] with a lowered tongue. If a
student does not have a preferred way, a clinician may feel freer to select an
appropriate variant.
Acquisition
Acquisition data indicate the age at which 50% and 75% of children acquire
a sound. If all other things are equal (they seldom are), a clinician may
decide to first treat an earlier acquired sound. Indeed, for some clinicians the
importance of acquisition data is the primary criterion used in the selection
process.
Relative Frequency
Relative frequency is the frequency of occurrence of a sound. Typically, reme-

diation of a sound with a higher frequency of occurrence has greater impact
on intelligibility than one with lower frequency. For this reason, a clinician
may incline to first teach more frequently occurring treatment sounds. To
illustrate, if a clinician is deciding between [s] and [z], [s] might be selected
because of its higher frequency of occurrence.
444 The late eight
Errors
Errors are the major errors to which a sound is susceptible. This information
weighs in sound selection in at least two respects:
1. Some errors may be socially stigmatized.

2. Errors have varying effect on intelligibility.
In general, errors that may lead to a student being stigmatized socially

are a high treatment priority. To illustrate, a lisp and [w] for [r] are often
early treatment sounds because they may provoke teasing. Impact of an
error on intelligibility also influences sound selection. Errors that negatively
affect intelligibility are good candidates for treatment. These include dele-
tions, changes in place of production, and substitutions in the beginning
of words.
Treatment
Three Questions
Before selecting treatment resources, at least three questions must be resolved:
n How many sounds should be treated?

n What constitutes a correct production of a treatment sound?
n Should a student be stimulable for a treatment sound?
How Many Sounds to Treat?
The assessment typically yields one or more possible treatment sounds. This
raises the following questions:
n If a student’s speech contains more than one possibility, which sound

to select?
n Should one sound be worked on to completion and then another?
n Should two be worked on simultaneously, changing from one to
another in the same treatment session or in alternate sessions?
n Does working on two or more treatment sounds confuse a student?
The author’s view is that answers to these questions have more to do with
human variables than linguistic factors. Some students — especially older
ones — can work on a sound from beginning to completion, while others
benefit from alternating between sounds, sometimes within a single treat-
ment session, sometimes in alternate sessions. A useful dynamic assessment
is to initially select several treatment sounds, alternating between them either

in a single session or in alternate sessions, and then reevaluate the choice
after several treatment sessions.
What Constitutes a Correct Production of a Treatment Sound?
Whenever possible, treatment should avoid practicing a speech error — some-

thing the student probably already has lots of practice doing! Ideally, a sound
should be entirely correct during practice. An analogy might be: suppose
a coach wanted to teach a student a new tennis stroke. Ideally, the coach
wants to establish the stroke perfectly and then engage in perfect practice.
However, in both speech-language pathology and tennis, sometimes some-
thing less than ideal is accepted, and both a clinician and a coach may need
to practice a skill that is better than before, but still not perfect. For this
reason, a “3,” “2,” “1” rather than a “correct/incorrect” system often proves
useful (Highnam, 2004). A student’s old speech pattern is a “3,” and the goal
is to establish it as a “1” (perfect). However, in many instances a “3” does not
automatically become “1,” and, instead, the student produces something like
a “2”— a more correct version of the old pattern, but one still not perfect.
Speech treatment often contains many more “2”s than “1”s. While practicing
a less than perfect sound, the student learns to make it a “1” through self-
reflection activities and prompts.
Should a Student Be Stimulable for a Treatment Sound?
An important, much debated question is: will a student self-correct stimulable

sounds without treatment (Dietrich, 1983; Powell, 1991; Powell, Elbert, &
Dinnsen, 1991; Shine, 1989)? Research suggests extensive individual varia-
tion, with some students self-correcting and others not. Some clinicians
choose to work with only stimulable sounds and others select only to treat
nonstimulable ones. Many other clinicians fall in the middle, working first
on a stimulable sound to build a student’s confidence before tackling more
difficult nonstimulable sounds.
In general, the author prefers to teach stimulable sounds. A useful “trick
of the trade,” especially with a younger or less motivated student, is to first
treat a stimulable sound to help build confidence before attempting the
more challenging nonstimulable sounds. However, selecting a stimulable
sound often is not an option for an older school-aged student (typically,
preteens and teenagers) or an adult nonnative speaker. In this situation, a
nonstimulable sound is selected for treatment.
A challenging situation can arise if a preteen or teenager with a non-
stimulable sound is an unwilling participant in therapy, “forced” to receive
treatment by parents or teachers. In this situation, after an initial period
of therapy a student may be placed on a semester by semester contract in
446 The late eight
which continued treatment is dependent on a student’s effort and success. The

purpose of the contract is to avoid a difficult situation in which an unmotivated
student continues in therapy semester after semester, bored, demoralized, and
unsuccessful. Better a therapeutic break than a broken spirit!
Stimulability and Religion
In the absence of research clearly supporting one posi-

tion or the other, the discussion of stimulability at times
almost seems religious, some fervently asserting this and
others just as fervently asserting that. An alternative to
accepting one or the other position is to be your own
researcher, experimenting with different perspectives.
Perhaps you will find that you have more success with
nonstimulable sounds than reported by some, or perhaps
you will have less. Or perhaps you will discover which
students on your caseload seem to require a treatment
sound that is stimulable and which do not. No matter what
you discover, experimenting with different approaches
may yield important insights about what works best for
you and the students you serve.
Once a sound or sounds have been selected for treatment, the following
resources are used:
n Metaphors
n Touch cues
n Demonstrations
n Phonetic placement and shaping techniques
n Key environments
n Word lists
n Awareness and speech exercises
n Language activities
Metaphors, Touch Cues, and Demonstrations
Metaphors, touch cues, and demonstrations all provide useful ways to refer
to treatment sounds, and especially during early treatment phases may help
focus a student on the task at hand. As treatment progresses, they serve as
reminders and prompts.
Metaphors
Metaphors provide useful analogies for a treatment sound. Typically, a clini-

cian presents several possible metaphors, allowing a student to select among
them. With a younger student, the metaphors make analogy with something
familiar — perhaps an engine starting, a hissing snake, or a leaky tire. With
an older student the metaphors often refer to an aspect of the treatment
sound — that is, an interdental may be the tongue-out sound, [s] with a
lowered tongue tip may be the tongue-down sound, or [l] may be the pointy
sound. For a student who is a teenager or an adult, many times a treatment
sound is called by its technical name. To illustrate, with an adult student a
clinician may decide to call [s] “a fricative sound” or “a fricative made at the
alveolar ridge.”
Often, a metaphor proves more successful when a student helps select
it. Typically, a clinician presents several options and asks the student to
select one. Allowing a student to help select a metaphor entails the clinician
giving up a measure of control — after all, a student is not obliged to select
the metaphor that the clinician thinks best captures the nature of the speech
problem. A clinician weighs selection of the most appropriate metaphor
against a student’s need for involvement. In the author’s experience, most
often the issue does not arise and selection of a metaphor presents few
problems. If a question of appropriateness versus student involvement arises,
most clinicians give up the best, most appropriate metaphor in favor of
student involvement.
Touch Cues
Touch cues are finger positions that represent a treatment sound, allowing
a clinician to refer to a treatment sound using modalities other than speech.
Touch cues grossly mimic speech movements. An older student understands
that, for example, the touch cue for velar consonants is made parallel to
the back of the mouth, representing where the tongue is raised. A younger
student may benefit from a touch cue without realizing its mimicking quality.
For such a student, a touch cue is a visual and tactile reminder, a way to say,
“Remember: this is the sound we are working on.”
Demonstrations
Demonstrations show a student how a treatment sound is produced. By

drawing attention to such aspects of speech as tongue position and airflow,
a student may better understand how to pronounce a treatment sound. Older
students often find demonstrations intellectually engaging and interesting.
Others, especially those under 7 years, may find demonstrations more con-
fusing than helpful. Demonstrations find their most use early in treatment.
448 The late eight
Later in treatment, an occasional demonstration may serve as a reminder

about how a treatment sound is produced.
Phonetic placement techniques show a student how to place the articulators

to pronounce a sound, and shaping techniques show a student how to convert
one sound into another. These techniques are used when a nonstimulable
sound is selected for treatment. Students 7 years or older typically possess
sufficient attention and language skills to benefit from these techniques. With
a younger student, success with these techniques is more hit-or-miss. The
techniques are typically inappropriate (and ineffective) with a child under
4 years.
Though every clinician has favorite phonetic placement and shaping
techniques, no single technique works for every student. In general, a clini-
cian selects one that makes intuitive sense and then engages in trial-and-error
dynamic assessment. Often, from a few to 5 to 10 minutes is sufficient to
determine if a particular technique will prove successful. In general, when
selecting a technique, most clinicians prefer those that are simpler and have
shorter instructions. Longer techniques are turned to when the shorter,
simpler ones do not yield results.
The phonetic placement and shaping techniques listed in this book are
“bare bones recipes” to expand and modify as a clinician desires. Often, the
actual phonetic placement or shaping technique used with a student contains
the following elements:
1. An initial self-demonstration by the clinician.

2. The student practices the steps in the technique. Use of a touch cue and
metaphors focus the student and help remind him or her about how the
sound is pronounced.
3. The student attempts to make the sound.
4. The clinician gives feedback about the success of the attempt.
The following illustrates one possible way to fully expand a bare bones
phonetic placement technique:
Instructions:
1. First demonstrate the method on yourself.

2. To begin, place your tongue between your upper and lower front teeth.
3. Place a feather or small piece of paper in front of your mouth, about a
half-inch to an inch from your tongue.
4. Blow air over your tongue to move the feather or paper.
5. Explain, “That’s how you make the leaking tire sound. Now it’s your turn.”
6. Instruct the student to stick out his or her tongue just as you did.
7. When the tongue is out, place the feather or paper before the mouth.
8. Explain, “Now blow to make it move.”
9. If the sound is made correctly, say, “That’s right. You did it. You made [θ]
— the leaky tire sound.” If the sound is made incorrectly, say something
like, “Good try. Let’s try again.”
Key Environments
Key environments describe phonetic environments in which a student is

likely to pronounce a sound correctly. In addition to being used during the
evaluation to determine if a student has the capacity to make a sound, key
environments find good use after a treatment sound (or sounds) is selected,
providing a possible succession of environments in which to treat a sound.
The following illustrates how key environments might be used to establish
[s], [l], and [r] in the beginning of words, end of words, between vowels, and
in consonant clusters.
Beginning of Word
Establish [s], [l], and [r] before a high front vowel. Once established, expand
the number of different vowels that follow. For a student that is strongly
affected by the adjacent vowel, back high vowels are likely to be more chal-
lenging than front ones.
End of Word
[s] is more likely to be established here than [l] and [r]. Establish after a high
front vowel. Next, to make word-initial sounds, have the word-final sounds
be followed by a word beginning with a vowel, such as “bus and.” This
encourages the sound to “migrate” to start the following word, resulting in,
for example, “bu sand.”
Between Vowels
[l] and [r] are more likely to be established here than [s], though some
students find [s] easier to make here, too. For all three consonants, establish
between two high front vowels, as in ili. Once established, add different
adjacent vowels. To expand to word-initial position, have the student drop
450 The late eight
the first vowel, resulting in, for example, [li]. To expand to word-final posi-
tion, follow the same procedure, resulting in, for example, [il].
Consonant Clusters
For [s], establish after [t] as in “pizza” or the nonsense word [tsi]. To expand
the environments in which [s] occurs, have [ts] be followed by different
vowels. To help expand [s] to syllable-initial position, encourage the student
to drop the [t]. For [l] and [r], establish after a consonant with a different
place of production than [l] and [r] (most often, select [p] or [b]) followed by
a high front vowel. Next, to help expand [l] and [r], ask the student to drop
the initial consonant in the consonant cluster.
Word Lists
Word lists are used to generate stimuli to help establish a sound in a student’s
speech, and then to practice it. Words, rather than nonsense syllables, are the
vehicle for teaching a treatment sound for two reasons:
1. Words, carefully selected, offer relatively simple phonetic contexts in

which to teach a sound, and
2. Words, being a student’s everyday means of communication, are used both
in and outside of treatment, making them a critical bridge to generalization.
Word lists in this book are divided by phonetic environment; on the

accompanying companion website lists of minimal pairs, deletions, and
themes also are included. Word lists are therapeutic building blocks for many
different exercises and activities. The value of using isolated words diminishes
as treatment proceeds and the clinician shifts to more naturalistic activities.
Awareness and Speech Exercises
Awareness exercises focus a student’s attention on the treatment sound. They

are used frequently early in therapy to orient a student, and later in therapy
may be used primarily as prompts and reminders.
Speech exercises help a student to gain experience with a treatment
sound, providing practice in pronouncing, self-monitoring, and self-correcting
speech. The most frequently used exercises are imitation, minimal pairs, dele-
tions, multiple productions, old way/new way, and similar sounds. Speech
exercises are used most often in language activities and, less frequently, as a
list of words. Many times a mix of exercises is used. For example, a student
may be asked to delete the treatment sound and then say the word with the
treatment sound three times.
Discrimination Versus Awareness

The difference between discrimination exercises and
awareness exercises lies in conception, not actual practice.
If a reader prefers, awareness exercises described in this
book may be used as and called discrimination exercises.
However, within the author’s perspective the conceptual
distinction between discrimination and awareness is impor-
tant. The term discrimination implies that a student’s dif-
ficulty lies in the auditory system’s inability to distinguish
between sounds; however, research strongly suggests that
the auditory system, in common with other sensory systems,
matures early and has adultlike capacities near the end of
a child’s first year (Pascallis, de Haan, & Nelson, 2002).
The term awareness implies the therapeutic challenge is
to focus a student’s attention on the difference between an
intended pronunciation and what comes out of the mouth.
A student with a speech problem, like most other persons,
is not likely to closely monitor his or her speech even when
what comes out of the mouth differs considerably from the
speech of the community. An awareness exercise is a little
verbal tap on the shoulder, saying, “Remember what sound
you are working on. Focus on what you are doing.”
Language Activities
Language activities use school books and other outside materials, including
stories a student is reading, favorite stories from home, and articles from
newspapers and magazines. These materials, because they are familiar and
widely used, are easy to adapt by families, aides, and teachers. Many times
their use also has the practical advantage of improving a student’s academic
skills. Though the purpose of therapy is speech, much is gained if in the
process of learning speech a student also does better on classroom assign-
ments or gives a better oral report.
Summary
The discussion in this chapter illustrates that one way care might be concep-
tualized and carried out. Within this perspective, treatment for late-acquired
sounds is conceptualized as helping a student learn new ways of speaking
and to unlearn old ones. This requires a treatment approach focusing on
452 The late eight
both the articulation and phonologic aspects of speech. Within this view,
a treatment program focused solely on articulation is like building a train
that doesn’t go anywhere, while a treatment program focused solely on
phonology is like a destination without a vehicle to get there. Treatment of
late-acquired sounds requires careful attention to building a good train to
reach a worthwhile travel destination. An additional characteristic of this
framework is that human variables such as motivation, intelligence, family
support, attention, and desire to learn are recognized as being at least equally
important for clinical success as linguistic ones. Lastly, the framework empha-
sizes the importance of using functional activities that contribute to the
advancement of a student’s education and social development.
References
Bleile, K. (2004). A manual of articulation and phonological disorders (2nd ed.).

Clifton Park, NY: Delmar Thomson.
Diedrich, W. (1983). Stimulability and articulation disorders. In J. Locke (Ed.), Semi-
nars in Speech and Language, 4.
Highnam, D. (2004). Personal communication.
Pascallis, O., de Haan, M., & Nelson, C. (2002). Is face processing species-specific
during the first year of life? Science, 296, 1321–1323.
Powell, T. (1991). Planning for phonological generalization: An approach to treat-
ment target selection. American Journal of Speech Language Pathology, 1, 21–27.
Powell, T., Elbert, M., & Dinnsen, D. (1991). Stimulability as a factor in the phonologi-
cal generalization of misarticulating preschool children. Journal of Speech and
Shine, R. (1989). Articulatory production training: A sensory-motor approach. In
N. Creaghead, P. Newman, & W. Secord (Eds.), Assessment and remediation of
articulatory and phonological disorders (pp. 355–359). Columbus, OH: Charles
E. Merrill.
Appendix A
Language Activities
Therapy seeks to make a treatment sound into a student’s regular way of

talking. Language and school-based activities help ensure that what is learned
in therapy is used in the “real world.” This appendix lists 35 language activi-
ties. Language activity forms are contained on the accompanying companion
website.
Language activities are divided according to whether their primary focus
is to facilitate awareness or to practice speech production. The list of activi-
ties is illustrative and should be modified, added to, and deleted based on a
clinician’s interests and philosophy. Most language activities can be carried
out either by clinicians, aides, or families.
The following speech activity illustrates some possible ways an activity
might be varied. The activity is:
Have the student make a book of words or pictures, each containing

the treatment sound, and then say each word to you.
A few of many possible variations include:
1. Make it an awareness activity by removing the speech component and

having the student make a book of words or pictures containing the
treatment sound.
2. Make it a group activity in which the student shows the book to other
students, or make a home activity in which the student and a family
member make the book and practice the words.
3. For a younger student, instead of a book of words or pictures, find
objects whose names contain the treatment sound, and then hide them
around a room for the student to find and name. For an older student,
453
454 The late eight
replace the book with stories, homework assignments, magazine articles,

or newspaper articles.
Language activities for speech may be easily modified by changing the

instructions in the following ways:
1. Imitation: To create an imitation exercise, have the student repeat the

word after you.
2. Minimal Pairs: To create a minimal pairs exercise, have the student first
say the word with the treatment sound, then say the rhyming word, and
then say the word with the treatment sound.
3. Deletion: To create a deletion exercise, have the student first say the
word with the treatment sound, then without the treatment sound, and
then with the treatment sound.
4. Self-Correction: To create a self-correction exercise, have the student
say the word three times, self-correcting if errors in the treatment sound
occur.
5. Old Way/New Way: To create an old way/new way exercise, have the
student say the word the new way, the old way, and then the new way
again.
6. Similar Sound: To create a similar sound exercise, have the student first
say the word with the treatment sound, then with the most similar sound
the student can make, and then with the treatment sound again.
Awareness Activities
1. Read aloud from a book, having the student listen and raise a hand, clap,
or ring a bell whenever a word containing the treatment sound is heard.
An easy variation is to tell a story aloud rather than read aloud from a
book.
2. Ask a student to silently read a newspaper or story and then circle or
write down words that contain the treatment sound.
3. Read a story to a therapy group, having the students compete to be the
first to raise their hand when they hear the treatment sound.
4. Read a story to the student and a stuffed animal, having the two “compete”
for who raises a hand first when a treatment sound is heard. Let the stuffed
animal often give the wrong answer and have the student correct it.
5. Create minimal pairs using household objects or school materials (e.g.,
wing/ring, light/write). Then say a minimal pair and ask the student
which word (first or second) contains the treatment sound.
6. Tape-record several word lists and ask the student to rate them as being
either the new way or the old way of producing the treatment sound.
7. Read paragraphs from stories to the student and occasionally mispro-
nounce the treatment sound (e.g., “Once upon a time there was a print-
Appendix A: Language Activities 455
heth who lived in a cathle”). Have the student raise a hand whenever
the treatment sound is mispronounced.
8. Make up and read silly stories/sentences that contain the treatment
sound produced the “old” way (e.g., “He gave her a diamond wing”).
Draw silly pictures to match the silly sentences.
9. In a therapy group, have a student who can pronounce the treatment
sound read sentences aloud, sometimes saying the treatment sound cor-
rectly and other times incorrectly. The student with difficulty on the
treatment sound does a thumb up/thumb down, depending on whether
the treatment sound is correct or not.
10. Work with the student to make a book of words, each containing the
treatment sound. An easy variation is to have the student find pictures
depicting objects that contain the treatment sound and then have the
student paste the pictures into the book.
Speech Activities
1. Ask the student to read a story or article and to say each word that
contains the treatment sound.
2. Create a therapy group containing some students who can pronounce a
treatment sound and others who cannot. Either read aloud or tell a story
to the group, asking the students to listen for the treatment sound and
having a student who can pronounce it do so every time it occurs. Ask
the student who cannot pronounce it to say it after the student who can.
3. Give the student a printed story that has a sticker over words that contain
the treatment sound. Ask the student to read the story aloud and “to
guess” at the words under the stickers.
4. Read the student a story, stopping at words that contain the treatment
sound. The student then says the word. For younger students, have a
puppet or stuffed animal tell the story.
5. For a younger student, find cards or objects that contain the treatment
sound. Place them around a room, turn off the lights, and give the
student a flashlight. The student then finds the cards or objects and says
them as they are found.
6. Have the student make a book of words or pictures, each containing the
treatment sound, and then say each word to you.
7. Play a board game and adapt the rules to make it a therapy tool (e.g.,
move ahead two spaces with an accurate production; go back one space
with an “old way” production).
8. Use checkers with words containing the treatment sound attached to the
back. Have the student say the word taped on the back before moving
a piece.
9. Adapt familiar song tunes to include treatment sounds and words (e.g.,
Larry had a little lamb).
456 The late eight
10. Have the student make a collage with pictures containing the treatment
sound and then name the pictures.
11. Have the student collect and name pictures of friends/teachers who have
the treatment sound in their names.
12. Have the student write a letter to someone (family/friends) using words
with the treatment sounds as many times as possible.
13. Ask the student to list all the toys, animals, foods, and so forth that
contain the treatment sound.
14. Have the student look through spelling words, classroom vocabulary
words, and reading group books to find as many words as possible that
contain the treatment sound.
15. Have the student substitute the treatment sound for another sound in
words in stories or books (e.g., pronounce polled as rolled).
16. Ask the student to fill in the correct treatment word in sentences from a
bank of words or have the student choose his or her own words.
17. Make up sentences for the student containing words with the treatment
sounds for the student to say. Alternatively, ask the student to make up
the sentences.
18. Place a word or picture containing the treatment sound on a card, make
two copies of each card, and play “Go Fish.”
19. Tell the student a story containing words with the treatment sound, and
then have the student retell the story to you.
20. For a student who likes jokes, you and the student develop tongue twist-
ers containing the treatment sound.
21. Create a scavenger hunt using words containing the treatment sound.
22. Have the student say a word in a book with the treatment sound, then
say it without it, then with it again (e.g., rain, -ain, rain).
23. For a younger student, set toys containing the treatment sound around
the room. Blindfold a stuffed animal and have the student tell it the name
of the toys.
24. Lay out picture sequence cards that contain the treatment sound and ask
the student to tell you the story.
25. Adapt a song to make a silly version containing the treatment sound (e.g.,
“Christmas is coming, a rooster ate a rat”).
Acknowledgment. The following clinicians and students kindly contributed

ideas to this appendix: Diane Highnam, Lindsay Deitloff, Jill Jensen, Kayla
Jiskoot, and Abby Sievers.
Appendix B
Quick Guide to Resources
Evaluation
n An initial screening helps indicate if a student has a speech difficulty

affecting a late-acquired sound.
n Screening for stimulability helps determine if a student has the
capacity to pronounce a sound.
n The definition helps decide how a sound should be produced.
n Age of acquisition helps in making a decision regarding which
sound to teach.
n Relative frequency helps in making a decision regarding which
sound to teach.
n Errors help in making a decision regarding which sound to teach.
Treatment
n Metaphors help label a treatment sound.

n Touch cues help label a treatment sound through modalities of touch
and sight.
n Demonstrations show a student how a treatment sound is produced.
n Phonetic placement and shaping techniques help establish a sound
in a student’s speech repertoire.
n Key environments suggest which phonetic positions may facilitate
pronunciation of a treatment sound.
n Word lists are a basis for activities involving words, minimal pairs,
457
458 The late eight
n Speech exercises help a student to gain experience pronouncing a

treatment sound.
n Language activities help a student practice a treatment sound using
real world activities and resources.
Index
Note: Page numbers in bold reference non-text material.
A Consonant clusters, Spanish, 62

Consonants, key environments for
Acquisition individual, 19t
as Late 8 resource, 132 Coupling, 123, 123
learning versus, 113 Curriculum, guidelines for linking
Acquisition performance, 113, 146 interventions to, 98
Activities, language, 141
of awareness, 141
of speech, 141 D
Arizona Articulation Proficiency Scale, Definition, 4–5, 132, 146d
3rd revision, 94 Demonstrations, 138, 148
Assessment. See also Evaluation Dialects, 64–66
frameworks for, 94–95 conservative, 65
resources for, 144 radical, 65–66
variation and, 69
B Disability, 16
Discrimination training, 20–22
Bankson-Bernthal Test of Phonology, DL. See Dual language programs
94 Dual language (DL) programs, 69
Bilabial trial, 83 one-way, 70
Bilingual children. See Multilingual two-way, 70
students; Spanish-English
children
Bilingual speech sound disorder (SSD) E
treatment, 60 EBP. See Evidence-based practice
Blading, 11 Education impact, gray areas of, 95–96
Brain development, 15 ELA. See English Language Arts
Brain injury, 6 Eligibility
compliance plans and, 94–95
rules, 94
C
“Engine lips” strategy, 81–82
Clinical vs. research settings, 42 English language
Cognate intervention, 71–74 consonants in, 60–61, 61f
Complexity, movement, 122–124 fricatives, 61
Compliance plans, 94–95 liquids, 62
Conservative dialects, 65 [l] phoneme in, 62
459
460 The late eight
English language (continued) Frequency, relative, 133, 146

phonemes, 60–61 Fricatives, Spanish/English, 61
word structure, 62–63
English Language Arts (ELA), 98
G
Environments, key, 134
definition of, 17–19 Glides, 6
for individual consonants, 19 Gliding, 278
Errors, 133–134, 147 Goal selection, 73–75, 76f
Evaluation. See also Assessment; Goldman-Fristoe 3 Test of Articulation,
Treatment 94
activities, functional, 441
articulation, 440
clinical orientation, 439–441
I
clinical resources, 441–444 ICEL. See Instruction, Curriculum,
phonology, 440 Environment and Learner
speech, dual nature of, 439 IDEA. See Individualized education
variable, human, 440, 440 programs
Evidence-based practice (EBP), 37–38, Individualized education programs
38 (IEPs), 95
conducting searches for, 54–55 Individuals with Disability Education
for Late Eight, 44–53 Act (IDEA, 2004), 94
resources, 38–39 compliance plans and assessment
evidence maps, 39 frameworks for, 94–95
SpeechBITE search strategies, Initial screening, 135–136, 144
41–43 Instruction, Curriculum, Environment
speech pathology databases, 39–41 and Learner (ICEL), 95
sources for, 2000–2016, 44–53t Interactional Dual Systems Model, 63
Evidence maps, 39 Interference, 63
searching with, 55 Internal feedback, 118
Experimental designs Interventions
nonexperimental, 40–41 guidelines for linking curriculum to,
quasi, 40 98
single subject, 40 materials for, 99
External feedback, 118–119
knowledge of performance (KP) type
K
of, 119
knowledge of results (KR) type of, 119 Key environments, 134
External focus, 117–118 definition of, 17–19
for individual consonants, 19t
Knowledge of performance (KP), 119
F Knowledge of results (KR), 119
Feedback post-, delay interval, 121
defined, 118
excessive, 119
L
external, 118–119
internal, 118 [l]
motor learning and, 118–121 acquisition, 277
Focus, external, 117–118 definition, 277
Index 461
demonstrations for Language ratios, 70

alveolar, 282 Late 8. See also Spanish-English
lateral airflow, 283 children
liquid, 282–283 articulation approach for, 8–10
voiced, 283–284 evidence-based practice (EBP) for,
environments, key, 278 44–53
errors, 278 reasons for, 5–6
exercises resources for
deletion, 291 acquisition, 132–133
imitation, 289 definition, 132
minimal pairs, 290 demonstration, 138
old way/new way, 293 error, 133–134
self-correction, 292 key environment, 134
shell for, 288 language activity, 141
similar sound, 294 metaphor, 134–135
expected errors, 79–80 phonetic placement/shaping
metaphors, possible, 278 techniques, 138–139
minimal pairs, 80 relative frequency, 133
phonetic placement, 80 speech exercise, 139–140
phonetic placement techniques, stimulability, 137–138
285–286 tests
relative frequency, 79, 277 initial screening, 135–137
shaping techniques, 80, 287 stimulability, 137–138
suggestions for practice, 80–81 touch cue, 135
tests word list, 141–143
initial screening, 279 schools and, 6–8
stimulability, 280–281 speech errors affecting, 10–11
touch cue, 278 Lateralization, 11
touch cues, 135 Lip rounding, 11
word lists Lisping, 11, 78
animals, 316 Literacy, identifying students struggling
beginning of words, 295–303 with, 97
day at beach, 312
end of words, 305–311
M
fairy tale, making up, 317
healthy, lunch, making, 314 Measurement, of motor learning,
let’s cook, 313–314 121–122
Lord of the Rings, 178 Meta-analysis, 40
medial, 303–304 Metaphors, 134–135, 147–148
northern places, 312 Midway sounds, 6
Old Hawaii, sea voyage to, 313 Morphology, 102–103
people, 315 Motor control, 108–109
places, 316 closed-loop control method, 109
themes, northern places, 143 open-loop control method, 109–110
[l] phoneme, in Spanish and English, 62 Motor learning, 113
Language/literacy disorders, research acquisition vs., 113
on speech sound disorders defined, 115
and, 96–97 feedback, 118–121
462 The late eight
Motor learning (continued) non-speech oral motor approaches

focus, 117–118 and, 25–26
measurement, 121–122 Phonetic placement techniques,
movement complexity and, 122–124, 138–139, 148–149
123 Phonological systems, of bilingual
practice, 115–117 children, 63
prepractice and, 113–115 Practice, 115–117
principles of, 113–124, 116f fatigue and, 115
feedback, 118–121 Prepractice, 113–115
focus, 117–118 PubMed website, searches on
learning versus acquisition, 113
measurement, 121–122
movement complexity, 122–124
Q
practice, 115–117 Quasi-experimental design studies, 40
prepractice, 113–115
Movement complexity, 122–124
MTSS model. See Multi-Tier System of
R
Supports model [r]: consonantal
Multilingual students. see also Spanish- acquisition, 345
English children definition, 345
clinical recommendations to guide demonstrations
clinical practice with, 74t alveolar, 349
treatment approaches for, 71 bunched, 350
treatment studies with, 72t liquid, 349–350
Multi-Tier System of Supports (MTSS) retroflex, 351
model, 95 sides of tongue (bunched and
retroflex), 351–352
voiced, 352–353
N environments, key, 346
National Center for Evidence-Based errors, 346
Practice in Communication exercises
Disorders (N-CEP), 38–39 deletion, 360
Nonexperimental designs, 40–41 imitation, 358
Non-speech oral motor approaches, minimal pairs, 359
25–26 old way/new way, 362
self-correction, 361
shell for, 357
O similar sound, 363
One-way dual language programs, 70 metaphors, possible, 346
Open-loop motor control, 109–110 phonetic placement techniques,
354
relative frequency, 346
P shaping techniques, 354–356
Phonemes, Spanish/English, 60–61 tests
Phonetic placement initial screening, 347
definition of, 22–23 stimulability, 348
examples of good, 23–25 themes
versus non-speech oral approaches, animals, 388
25–26 around the home, 386–387
Index 463
food, 387–388 phonetic placement techniques,

Halloween stories, 389–390 328–329
people, 390–391 relative frequency, 320
places, 391 shaping techniques, 330–333
scary noises, 388–389 technique for shaping, into
touch cue, 346 consonantal [r], 139
word lists tests
beginning of words, 364–377 initial screening, 321
end of words, 381–386 stimulability, 322
media, 377–381 themes
[r]: tap creatures, 342–343
error patterns for, 82t it’s a job, 343
expected errors, 81 people, 343
frequency, 81 touch cue, 320
minimal pairs, 84–85 word lists, 341–342
phonetic placement, 81–83 Radical dialects, 65–66
shaping techniques, 81–85 Randomized control trials, 40
suggestions for practice, 85 Reading fluency, 103
[r]: trill Relative frequency, 133, 146
error patterns for, 82t Research versus clinical settings, 42
expected errors, 81 Resources
frequency, 81 for assessment, 144
minimal pairs, 84–85 guide to, 144–147
phonetic placement, 81–83 illustration of clinical, 143, 144t
sample lesson plan, 86t for treatment, 147–149
shaping techniques, 81–85 Response to Intervention (RtI) model,
suggestions for practice, 85 95
[r]: vocalic, 5. Reviews, Interviews, Observations and
acquisition, 319 Tests (RIOT), 95
definition, 319 Radical dialects, 65–66
demonstrations Randomized control trials, 40
alveolar, 323 Reading fluency, 103
bunched, 324 Relative frequency, 133, 146
liquid, 323–324 Research versus clinical settings, 42
retroflex, 325 Resources
side of tongue (bunched and for assessment, 144
retroflex), 325–326 guide to, 144–147
voiced, 326–327 illustration of clinical, 143, 144t
environments, key, 320 for treatment, 147–149
errors, 320 Response to Intervention (RtI) model,
exercises 95
deletion, 337 Reviews, Interviews, Observations and
imitation, 335 Tests (RIOT), 95
minimal pairs, 336
old way/new way, 339
S
self-correction, 338
shell for, 334 [s]
similar sound, 340 acquisition, 197
metaphors, possible, 320 definition, 197
464 The late eight
[s] (continued) demonstrations

demonstrations for, 138 fricative, 397–398
alveolar, 202 postalveolar, 397
fricative, 202–203 voiceless, 398–399
voiceless, 203–204 environments, key, 394
environments, key, 198 errors, 393
errors, 198 exercises
exercises deletion, 405
deletion, 217 imitation, 403
imitation, 215 medial, 411
minimal pairs, 216 minimal pairs, 404
old way/new way, 219 old way/new way, 407
self-correction, 218 self-correction, 406
shell for, 214 shell for, 402
similar sound, 220 similar sound, 408
expected errors, 78 metaphors, possible, 394
metaphors, possible, 198 phonetic placement technique, 400
minimal pairs, 78 relative frequency, 393
phonetic placement, 78 shaping techniques, 400–401
phonetic placement techniques, 205–207 tests
relative frequency, 77, 197 initial screening, 136, 395
shaping techniques, 78, 207–213 stimulability, 396
suggestions for practice, 79, 79f themes
tests animals, 414
initial screening, 199 people, 413
stimulability for, 200 places, 413
themes things that go bump, 414
baking, 245 things to eat, 415
bath time, 250 washing dishes, 415
beach, 247–248 watery places, 414–415
body, 249–250 touch cue, 394
bus ride, 253 word lists
clothes, 250–251 beginning of words, 409–411
field and forest, 245246 end of words, 412–413
horseback riding, 247 Schema theory, 11–112
medieval fun, 251–253 Semantics, 100–101
people, 248 Shaping techniques, 138–139, 149
places, 249 definition of, 22–23
snack time, 224–245 examples of good, 23–25
speech, 250 versus non-speech oral approaches,
touch cue, 198 25–26
word lists non-speech oral motor approaches
beginning of words, 221–234 and, 25–26
beginning words, 142 Single subject experimental designs, 40
end of words, 236–243 SLPs. See Speech language pathologists
medial, 235–236 (SLPs)
[ʃ ] Sounds
acquisition, 393 determining number of, for treatment
definition, 393 sessions, 26–27
Index 465
providing treatment for stimulable, frequently asked questions by, 97–98

27–28 identifying students struggling with
Sound selection, 75–76 literacy, 97
Spanish, consonant clusters, 6 issues of workloads and determining
Spanish-English children. See also Late eligibility, 98
8 research strategies for, 40
cognate intervention for, 71–73 Speech perception, 20
dialects and, 64–66 Speech sound disorders (SSDs)
education programs for, 69–71 bilingual, treatment of, 60
late developing sounds for, 66–69, guidelines for linking interventions to
67–68 curriculum, 98
phonological systems of, 63 IDEA regulations definition of, 94
sample lesson plan, 86, 86t reasons for treating, in schools, 7–8
treatment sounds, 73–76 research on language/literacy
treatment techniques, 77–85 disorders and, 96–97
Spanish language Speech treatment. See Treatment
consonant clusters in, 62 Spelling, 103–104
consonants in, 60–61, 61f SSD. See Speech sound disorders
fricatives, 61 Stimulability screening, 137–138, 145
late developing sounds in, 66–69, Stops, 6
67–68t Syntax, 101–102
liquids, 62 Systematic reviews, 40
[l] phoneme in, 62
phonemes, 60–61
word structure, 62–63
T
Speech [tS ]
best age beginning treatment of, acquisition, 417
14–17 definition, 417
suggestions for practicing, 11–14 demonstrations
SpeechBITE database affricate, 421
accessing, 41 postalveolar, 421
features of, 39–41 voiceless, 421–422
searching with, 55 environments, key, 418
search strategies, 41–43 errors, 417
Speech discrimination, 20 exercises
Speech errors, 10–11 deletion, 428
Speech exercises imitation, 426
deletion, 140 minimal pairs, 427
illustration, 140 old way/new way, 430
imitation, 140 self-correction, 429
minimal pairs, 140 shell for, 425
old way/new way, 140 similar sound, 431
self-correction, 140 metaphors, possible, 418
similar sound, 140 phonetic placement techniques, 423
Speech language pathologists (SLPs) relative frequency, 417
bilingual children with speech sound shaping techniques, 423–424
disorders, 60 tests
dismissing students on caseloads, initial screening, 419
97 stimulability, 137–138, 420
466 The late eight
[tS ] (continued) Christmas, 176

themes days, 176
actions, 436 directions, 176
around the home, 437 home things, 174
body, 437 job words, 175
it’s a job, 438 nature, 175
lunch, 438 numbers, 176
nature, 437 people, 177
people, 438 places, 177
places, 438 Star Wars villains, 174
touch cue, 418 teeth brushing, 173
word lists touch cue, 154
beginning of words, 432–433 word lists, 151
end of words, 434–435 beginning of words, 169–170
medial, 434 ends of words, 172–173
Therapy tips, 29–31 medial position, 171
[T] [ð]
acquisition, 153 acquisition, 179
awareness exercises, 151 definition, 179
consonant clusters, 150–151 demonstrations
definition, 153 fricative, 183–184
demonstrations interdental, 183
fricative, 157–158 voiced, 184–185
interdental, 157 end of words, 194
voiceless, 158–159 environments, key, 180
environments, key, 150–151, 154 errors, 179
errors, 153 exercises
exercises deletion, 189
deletion, 165 imitation, 187
imitation, 163 minimal pairs, 188
minimal pairs, 164 old way/new way, 191
old way/new way, 167 self-correction, 190
self-correction, 166 shell for, 186
shell for, 162 similar sound, 192
similar sound, 168 metaphors, possible, 180
language activities, 151–152 phonetic placement techniques, 185
metaphors, possible, 154 (See also [T])
phonetic placement for, 139 relative frequency, 179
phonetic placement techniques, tests
149–152, 160 initial screening, 181
relative frequency, 153 stimulability, 182
shaping exercises, 160–161 themes
speech exercises, 151 bath time, 195
tests family, 195
initial screening, 155 grammatical words, 195
stimulability, 156 nature, 194
themes people, 194
actions, 175 places, 194
bath time, 174 body, 195
Index 467
touch cue, 180 W

word lists
beginning of words, 193 Word lists, 141–145
medial, 193 Word structure, English/Spanish, 62–63
Touch cues, 135, 148
Transcribing, for problem sounds, 29 Z
Transfer patterns, 63
Treatment. See also Evaluation [z]
best age for, 14–17 acquisition, 255
correct production of treatment definition, 255
sounds, 445 demonstrations
demonstrations, 447–448 alveolar, 260
discrimination versus awareness, 451 fricative, 260261
language activities, 451 voiced, 261–262
metaphors, 447 environments, key, 256
most important reason for success, errors, 256
31–32 exercises
phonetic placement technique for [T], deletion, 266
448–450 imitation, 264
phonetic placement techniques for, minimal pairs, 265
448 old way/new way, 268
sample hierarchy of, 125–126f self-correction, 267
sounds to treat, 444–445 shell for, 263
stimulable for treatment sounds, similar sound, 269
445–446, 446 metaphors, possible, 256
tips for, 29–31 relative frequency, 255
touch cues, 447 tests
Treatment sounds initial screening, 257
correct production of, 445 stimulability, 258–259
goal selection, 73–75, 76f themes
sound selection, 75–76 animals, 274
stimulable for, 445–446 Frodo’s journey to Moria, 275
Treatment techniques, 77–85 Oz stories, new, 275
21st Century Skills standards, 98–99 people, 276
Two-way dual language programs, 70 places, 276
weekdays, 276
touch cue, 256
V word lists
Variation, dialects and, 69 beginning of words, 270–271
Vocabulary, teaching, 100–101 end of words, 272–274
Vocalic [r]. See [r]: vocalic medial, 271–272

Bleile, Ken Mitchell - The Late Eight-Plural Publishing (2018)

Uploaded by

Copyright:

Available Formats

Bleile, Ken Mitchell - The Late Eight-Plural Publishing (2018)

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bleile, Ken Mitchell - The Late Eight-Plural Publishing (2018)

Uploaded by

Copyright:

Available Formats

The Late Eight

Ken M. Bleile, PhD

Copyright © 2018 by Plural Publishing, Inc.

Typeset in 11/13 Garamond by Flanagan’s Publishing Services, Inc.

All rights, including that of translation, reserved. No part of this publication

For permission to use material from this text, contact us by

Library of Congress Cataloging-in-Publication Data

Names: Bleile, Ken Mitchell, author.

Part I. New Essentials

Part II. Clinical Resources

Appendix A. Language Activities 453

Ken M. Bleile, PhD

Jennifer Walz Garrett, PhD

Carlin Hageman, PhD

Lindsey R. Leacox, PhD

Lauren K. Nelson, PhD

Primarily Practical Questions:

Primarily Conceptual Questions:

What are the Late 8?

[θ ð s z l r S tS ]. The Late 8 are the last eight English consonants acquired by

this reanalysis, Late 8 consonants are those acquired by 50% of students

In this book the Late 8 are [θ ð s z l r S tS ]. Information on vocalic [r] is included

Why are the Late 8 late?

Too many consonants, not enough mouth.

Table 1–1. Early Acquired Consonants

Do the Late 8 belong in school?

Yes, because treatment of the Late 8 is important educationally, socially, and

Table 1–2. Consonants Arranged by

1. Speech sound disorders are the world’s most frequently occurring

4. Students with speech sound disorders are at risk for educational

Should a clinician treat the Late 8 using

The difficulty with providing articulatory treatment for an articulation

n A student experiences an articulation problem but improves because

These examples suggest that speech treatment requires a clinician to

This is the pill-like aspect of speech treatment: diagnosing a student’s speech

Speech treatment is more complex than selecting to administer either an

What major speech errors affect the Late 8?

Any suggestions for practicing speech?

A major challenge in practicing speech is to do it in a way to promote

Chapter 5 on motor learning contains excellent principles for helping students

Whenever possible, practice consonants in the context of vowels. People

Dual Nature of Speech

Speech is both a motor activity (articulation) and an aspect of language

From Words to Conversation

Promote self-monitoring by not providing constant feedback. Rather than being

Provide opportunities for self-correction. Help students become aware of and

A student must learn to manage distractions when speaking, which can

Help a student learn about the communicative value of a treatment sound

Base treatment activities on a student’s interests, including, when appropri-

Keep people of importance in a student’s life informed about therapy and,

Typically, a student should pronounce a treatment sound 90% correctly in

The primary goal of speech practice is to bring students to a point where

What if a production is not quite right?

Think of “right” as being just one end of a scale.

Whenever possible, treatment should avoid practicing a speech error — some-

Is there a best age to begin speech treatment?

When it comes to treating speech, earlier is generally better.

Many factors contribute to a clinician’s decision regarding at which age or

n Brain weight, important for numerous brain functions, at birth is

n 5;0: [s] and [S ]