“We are in speech therapy. He can say “s” perfectly with you in speech sessions, but why aren’t we seeing the change in articulation at home?”
A common and a rather astute question: When should you expect to see measurable change at home after enrolling in speech therapy?
The answer: There are 2 aspects to consider when measuring progress: accuracy and automaticity. Both build over the course of therapy. Therapy starts with accuracy and moves to automaticity. Measuring each of these at every stage of therapy will help you gauge your child’s gains.
The short answer is: not right away. Typically, changes to everyday speaking will be part of only the final stage of therapy.
Clients who present with articulation disorders have difficulty in producing accurate speech sounds. For example, a classic example would be a frontal lisp where a child saying “th” for “s.” He or she may say “thun” for “sun.” Speech therapy is designed to make changes to a child's speech systematically. In this case, the therapy will address use of a more posterior tongue placement which allows for adequate airflow. Correction of errors requires a hierarchical approach which teaches accurate sound placement within increasingly complex linguistic contexts. Therapy then moves from teaching the sound to facilitating its use across contexts and situations so that it becomes part of the child’s manner of speaking and is automatic and effortless.
A therapist will model the sound, give cues to help the child achieve the positioning and eliminate incorrect movements or old patterns which are incorrect. Typically, a child will start at the sound level. For example, let’s once again consider a child is having trouble producing the “s” sound. Therapy would start by addressing accurate tongue placement in isolation ( “ssss…”), without putting this sound in words at all. The goal at this early stage would be to develop accurate production of the sound in isolation over many opportunities. Numerous trials will allow a child to shape better sound production, by refining placement and execution of the sound through skilled practice and repetition.
Once a child is able to produce a target sound at the sound level, increasing linguistic demands will be the next incremental step. Therapy moves to the syllable level ( e.g., “suh,” “say,” “soo”) and the word level ( e.g., “salty” or “Simon” /”missing” or “messy”/ “fuss” or “boss”). It is at the sound and word level where the focus is placed on the quality of the sound’s production to develop the best possible new and improved version of the sound. Again, as was the case in the isolation stage, movement patterns will be refined.
At the sentence level, after the word level is mastered, therapy begins to mimic speech patterns that are more similar to everyday speaking situations, but in small segments. At this time, you may see correct sound placement, articulation of the sound, filter into your child’s everyday speaking situations. Maybe. If this does not occur, you should not be alarmed. There is significant “work” that must take place in order to make changes to one’s manner of speaking. Not only does it require attention, focus, and effort initially, a child also has to juggle other demanding tasks simultaneous when speaking. These include paying attention to his or her language content, intention, the listener’s perspective, and response formulation, to name a few. Therefore, we do not expect that change in these more demanding speaking contexts will occur overnight or will be immediately apparent. Instead, with time and practice, the over-learned, new manner of articulation will ultimately override the old one, and this automaticity will begin to become evident in everyday speaking situations as it does. Commonly, it is not until a child has mastered the later stages of this hierarchy that we clearly begin to see change outside of the therapy sessions. This is normal. For example, a child may be able to say words and sentences with “s”- sound“, “I would like an apple cider doughnut” without much effort when mastering sentence level targets in speech therapy, but when actually out apple picking with the family, he or she may still resort to saying, “ I would like an apple thider doughnut!”
When a child is able to produce a target sound at each level of the hierarchy, we begin to shift our work to building automaticity in spontaneous speaking opportunities.
Its accuracy together with automaticity that makes the noticeable change you are looking for. At the discourse and conversational level, we expect the child to slowly attempt maintenance ( with our instruction) of this newly learned, practiced pattern to situations which require divided attention. For example, a child may be asked to complete a craft of making a “slivering snake” while telling the clinician about it using accurate “s” sounds. A task such as this one will require a child to stop and overtly consider how they are producing the “s” sound and with practice this too will become simple and effortless. Therapy will continue to purposefully increase distraction until this stage mimics everyday life.
In the final stages of therapy, we see the culmination of all the work that has been done within this hierarchy, and as a result we will achieve accurate, automatic, natural speech sound production that is fully generalized to all speaking situations. When a child is ready to be discharged from therapy, he or she is freely using the target sound without effort and without thinking about it, and the previously observed errors should no longer be evident in conversational level speech. It is important that a child continue in therapy until this final stage is achieved. If clients discontinue therapy too soon, regression is highly likely and then you will be back at the beginning again. If your child is not yet using what they learned in weekly therapy session at home (generalizing), hang in there! Once he or she has built precision and moves on to automaticity, you will begin to see change. In some cases, this will occur sooner than expected, but it remains important to remember, both components are critical. You cannot have automaticity without accuracy. Along the way, you can help accelerate progress. How? Good home practice. Proper homework can help a child move more quickly through the hierarchy. Under the guidance of your therapist, you can support the development of a target sound by practicing the sound at the level right below where your treating clinician is working within therapy.
If you are not noticing the gains that you expect, find out from your child’s therapist where your child is working within this framework. Is he or she still targeting accuracy? If so, at what level? You should be able to track gains within the therapy sessions with increasing complexity. Talk with your therapist to learn more and to monitor gains across time. Remain part of the process and be an active participant in tracking progress. While you may not notice changes at home yet, you should be able to observe your child’s accuracy improving within the therapy sessions over just a few weeks.
Once you can observe consistent improvement at home, you may forget the targeted sound was ever a concern in the first place—I hear that all the time, too-- This is exactly what we aim for. It is a clear indication that you are nearing the end of your therapy program.
Signs that therapy is on the right track ( I'm not suggesting that you need to find a new therapist, but you should ask some questions):
- Your child's accuracy levels are increasing each session
- Your child can produce the target sound in more and more placements( initial, final, and medial word positions) and contexts (words, sentence, spontaneous speech)
- Your child can show you what he/she can do with the therapists assistance
Signs that you may need to re-evaluate the effectiveness of your child's speech therapy:
- Your therapist can not demonstrate measurable improvement
- Your child is working on the same skill (same sound position or same linguistic context) over a long period of time. You should certainly see change ( demonstrated by data and child demonstration with appropriate clinician support) within a couple of months at most.