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Basic Speech Production Intervention
For Children with Apraxia of Speech (AOS)
with and without Autism (ASD)

By
Monique Eurich, MS-CCC/SLP

 

Every child’s speech repertoire will vary based on the severity of their speech disorder.  In this handbook for children with AOS with or without ASD, the goal is to provide information addressing the most profoundly impaired scenario, thereby working from the most basic speech production intervention strategies upwards to more challenging speech production intervention skills.  While many children may be less severely impacted, the initial speech production strategies are worth reviewing as they include steps that have often been missed and will prove organizing for the child’s speech output overall.

This handbook will provide the stages between limited to no verbal output and guidelines for acknowledging and encouraging any and all vocalizations as well as shaping speech and language from limited output.

When child has almost no verbal vocal output, any single sound they have should be acknowledged, repeated, and accepted as a verbal assignment to whatever it appears they were referring at that moment.  Pam Marshalla’s Mutual Imitation strategy for facilitating conversational turns with vocalizations is an excellent intervention at this stage of a child’s speech production skills.  Initially, the therapist may be shaping imitation skills by imitating the child’s verbalizations or vocalizations.  As the child is able to imitate in addition to being imitated, any single sound the child produces, should be reduplicated (repeated in succession) and then elongated to give the child a pattern within their own repertoire to expand upon as well as to provide them with a sense of control over their output.  In this way, the therapist facilitates a neurological pathway that works repeatedly, as the foundation to subsequent intervention.

Eurich’s Vowel Approach -  The importance of good vowel production cannot be overstated.  Typically developing children do not tend to have difficulty with vowel production.  In fact, difficulty with vowels is characteristic of AOS and a serious red flag for AOS in the absence of hearing impairment and dysarthrias.  Poor vowel production and/or poor vowel control and distinction needs to be addressed from the very beginning with intervention, persistence and frequent practice. 

The Eurich Vowel Approach, aimed directly at children with AOS with and without ASD, was designed to support the limited verbal vocal output with which any given child might present, and organize that limited output, verbal or vocal, into repeatable and distinct component parts. 

The Eurich Vowel Approach, typically consists of starting with pure vowels, for example, “ah,” “ee,” and “oo”, encourage the child to produce these sounds first in isolation, but on cue, as an imitative task. When the child is able to imitate the single target vowel, reduplicating, or repeating that vowel, is addressed.  When the child can imitate both single and reduplicated variations of the target vowel, alternating between these two skills is practiced. Finally, an elongated version of the target vowel is modeled. Again, once consistency is achieved, the three variations of producing the vowels are addressed. By way of example, the three variations for the target vowel “ah” would be “ah,ah-ah, ahhhhh.”

While Eurich’s Vowel Approach targets the three pure vowels, the child with AOS with or without ASD, may not be able to produce these vowel sounds initially.  The goal for the child is to produce any single sound in isolation and on cue.  The therapist should imitate the child’s productions as a way of encouraging the child to repeat their efforts.  In this way, the single sound displayed by the child is organized for the child to occur by volitional control.  The child simply produces the sound they already have, on cue, when modeled, volitionally.  For example, if the child says “uh,” however imprecise or distorted, they are now saying it when it is modeled for them, thereby supporting their output and requiring it in an organized model/imitation format.  Once the child has achieved the ability to imitate the sound repeatedly when it is modeled for them, then the same sound will be modeled in a new way, specifically reduplicated or repeated.  To continue with our example, the sound “uh-uh” is now modeled.  This is same sound with which the child is familiar, taken from their repertoire, modeled twice in succession.  This may be difficult for the child at first.  The child may need to have the target modeled in individual chunks separated with a significant pause, yet nonetheless in close proximity to one another and before the child imitates the model.  For example, “uh…………uh.”  When this combination is mastered, the child will be given the same sound again, now modeled with vowel elongation, specifically, “uhhhhhhhhhhhhhhhhhh.”  The repetition of each of these three versions of producing the child’s sound, will increase the child’s control of the sound and will train automaticity of the skill, also known as muscle memory. 

Once these three distinct manners of producing the same sound have been mastered, the child will be required to alternate among them, strengthening the motor planning ability to produce one of the three, by now more familiar, versions of producing the speech sound taken directly from the child’s repertoire of output.  In this way, automatic speech ability is used to increase consistency and control of these preliminary stages of speech production. 

The initial goals for the severe to profoundly impacted child, is to progress to three pure vowels, “ah,” “ee,” and “oo.”  The order in which these are taught depends entirely on the child’s baseline abilities.  Nevertheless, the principal of moving from a single production to a reduplicated production and finally and elongated production, holds, regardless of the starting point.  One child may learn all three vowels and subsequently progress to consonant-vowel (CV) or vowel-consonant (VC) combinations while another may learn a single vowel and progress with that single vowel to CV or VC combinations.  When the child progresses to include a consonant, for example, the “m” sound, they will work on “mah,”  “mah-mah,” “mahhhhhhhhhhh,” combinations and so forth.

In all speech targets, the central or root vowel, the vowel receiving stress, is the vowel to focus on first.  Most of us have no difficulty considering the syllable that is stressed in a word, for example, in the word “donut,” the first syllable receives emphasis as it is the stressed syllable, hence “doughnut” versus “doughnut.”  Take into consideration a single syllable word, however, such as the word, “dough.”  If the word is elongated, stretched, and said very slowly, it will become apparent, that the vowel sound “oh” is a diphthong, a combination vowel made up essentially of “uh” and “oo” combined.  In the word “dough,” the first of the two vowel sounds receives the greatest stress and should be emphasized in the child struggling with speech production.  Therefore, when the child produces “duh,” for “dough,” it is accepted meaningfully despite its approximation. 

As treatment progresses, and the child learns to produce diphthongs, other single syllable words containing difficult to acquire consonants, such as “l” and “r” should be targeted for replacement with a vowel sound.  For example, in the word “hair,” the vowel combination “eh-uh” should be targeted to improve intelligibility, resulting in “heh-uh.”

Look for Eurich’s handbook coming soon!

To learn more about Monique Eurich’s practice visit
www.IndependentTherapistsNetwork.com
‘aka’ The Independent Speech Pathology Network.