Have You Tried….?
Articulation therapy is a huge part of what we do as SLPs and it can be easy to downplay the complexity of speech sound disorder remediation. But, there are few moments more frustrating or nerve-wracking than that moment of realizing a child is not at all easily stimulable for a sound you’d like to target. In this series, we share elicitation ideas for stubborn, hard to treat sounds.
How to Teach Post-vocalic “er”
Have You Tried: Sound shaping from “ah” to elicit bunched “er” (with some placement cues to get started)
Need: a client who can imitate “ah” and maybe a mirror or tongue depressor for troubleshooting
What the SLP Can Do and Say:
First, start out with some placement cues and definition/identification of target structures. Instruct the client to bite the back sides of the tongue with his/her molars. Reinforce this attempt. Then, instruct the client to do the same thing, but this time, open his/her mouth, and keep the back sides of his/her tongue “glued to the upper molars.” Reinforce this and repeat.
Now, instruct the client to open his/her mouth and then lift the back sides of the tongue up to the upper molars. Reinforce and repeat.
Assuming the child has been successful with learning the appropriate movement of the tongue, they are ready to try the sound shaping portion of this instruction.
Instruct the client to say “ah” and reinforce (“great job!”) Repeat the placement exercise for a quick review (e.g. “Remember how we were lifting the back sides of your tongue? Do that for me again”).
At this point, instruct the client to sustain “aahhh” and then raise the back sides of the tongue to the upper molars (e.g. “Very nice, now this time, I want you to say “aaahhhhh” and while you’re saying it, lift your tongue like you just did”.)
What occurs is an “ah” that starts to have some rhotic tension.
This is a good time to reinforce, reinforce, reinforce! Have the child repeat this sequence 5-10 times.
With a little luck, they’ll have a great sounding “ar” already.
If you want more tension to get an even better “ar”, check the following:
1) Is the tongue actually going to the correct place? If not, go back through the placement cues.
2) Instruct the client to push up against their molars as hard as they can, like they’re trying to push their tongue clear to the ceiling.
3) Check the lower lip: “er” should have tension with partial lip rounding of the lower lip, with tension through the jaw. A mirror is helpful, with side by side modeling at this stage, if you’re trying to get that extra tension.
Some Common Pitfalls:
1) Don’t let you ear be tricked by adding laryngeal tension instead of lingual tension (i.e. “growling” through the “er”—listen carefully for tension that’s from the tongue and enhanced/supported by tension of the lower lip)
2) Be careful that in the first few sessions of teaching this method you’re demanding of perfect responses. Because proprioceptive feedback is so limited with “r” and “er,” it can be very challenging to refine later on in the hierarchy. You shouldn’t need to spend more than a session working at isolation level before you start getting high levels of accuracy. If not, figure out which component of the instruction is in error and try repeating those specific steps a few times.