Speech Evaluation
First, your child's speech must be analyzed. This can be difficult for parents, who have not been trained in the features that make speech sounds similar and different. For example, t and d are far apart in the alphabet but are nearly the same in the mouth. Contact your local school to find out how to have your child screened/evaluated.

If you do not have access to a qualified speech pathologist in your area OR if your child did not qualify for services and you would like to work on his speech, you can try some home tutoring. If you have questions, you can contact me (click on About Me at the left). I am in the process of setting up telepractice, which means that you could send me a video of your child, and I could guide you on how to help him improve. I will describe how the speech therapist chooses targets.

1. See which adult-like patterns are missing in your child's speech. For example, adults are able to say words with beginning consonants (Bat), ending consonants (naP), two consonants in a row (STop), etc. The speech pathologist will evaluate single words (Say "star.") and connected speech (when your child is just talking).

2. After checking which adult-like patterns are missing, the speech pathologist will determine which patterns are the highest priority for intelligible speech. The most critical patterns are explained on Cycles Slides.

Planning Therapy Sounds
Now that the speech pathologist knows which patterns are going to help your child speak more intelligibly, she will make a plan. You can ask for a copy of the tentative plan--things always change depending on how easy the adult speech patterns are for your child, but the speech pathologist should have a solid idea of where she is going.

The plan may look like this:
-Final consonants: /m, p, t/
-Anterior-posterior contrast: /k/ final
-S blends: /st, sp, sn/
-Liquids: /l, r/

That sample plan would cover nine weeks of therapy. Things can change a little. If your child turned out to pick up /k/ really easily, /sk/ might be added to the S blends, making the plan ten weeks long. Or if your child absolutely cannot do /s/ despite a whole session of trying all sorts of different things, /sp/ and /sn/ would be scrapped, making the plan seven weeks long. So things can change, but a definite plan should be jotted down.

Doing Therapy
Now you know which patterns your child will learn and which sounds will be targeted in each pattern. Therapy involves two components, production practice and metaphonological skills training. There is another page on metaphonological skills. I will just talk about production practice here. It is pretty straightforward: the child practices saying words that have the target sounds/patterns. For the above example, the child might practice the words mom, boom, or comb during the first week, because they all end with the /m/ sound. If the patterns are hard for your child, the therapist may use cues or touch your child's face. However, this will never be something that makes your child uncomfortable or causes him to dislike therapy, because we never want a child to have negative feelings about communication. If cues are used, they will be discontinued as soon as possible. We want to encourage your child to monitor his own speech using his ears, not the therapist's hands. Also, research shows us that kinesthetic cues (the way things feel) do not work as well as auditory cues (the way things sound).

Therapy will usually be 30-60 minutes weekly. Homework is critical; even 2 minutes daily makes a huge difference. If you read Carly's case study (link at the left), you will see how a mom did all of the therapy herself. She practiced two or three times each week for 15-20 minutes, as well as a quick run-through of the words every day.

Parent Homework
Your child's homework is to say the words at least once daily, spending a minute or two on it. First you say the word clearly but not terribly loudly, and then your child tries to say it. If he says it wrong, you give him feedback on what he said and again give a good example of the word. "You said boo, but you meant boom. Try again, boommm."

However, the most important homework is just for mom and dad (and grandma, and the daycare teacher, and so on). Your child does not do anything for this homework. It is called ear training, which is where you train your child to notice his own errors. If he does not notice the errors, he cannot fix them. When he says a word wrong and you know what he meant, you say, "Tee? You are not old enough to drink tea. OH, you meant tree." You let him know what he said by copying it exactly as he said it. You try to show a difference in meaning, if possible, such as tea/tree. Then with a relaxed, "silly me" smile, you let him know how the word is really said. He may ignore you, forcefully tell you that he did NOT say tee, look puzzled... It is okay, just keep training his little ears so that as he learns how to say the words correctly, he will begin to correct himself. The day he responds, "Yeah, tree," will be one for celebration.

Note: never do ear training when your child is upset. No need to frustrate him further. Again, we never want him to have negative feelings about communication.

It takes time to make progress, though this approach to speech sound learning brings about much quicker progress than any other method. The first pattern cycle is just plain hard, and you might wonder if the child will ever speak well. If the child's speech is in the severe range of disability, I usually see a jump in intelligibility after about four to five months of therapy, and a major jump after eight to ten months of therapy. If the child's speech is profoundly disordered, it takes more time to hear intelligible words, because the child had further to go. However, even profoundly unintelligible children are often intelligible within two years.

Keep in mind that intelligible means that the child is understood by everyone, just about all of the time. It does not mean perfect speech. Some errors, such as the "th" sound and /l/ at the ends of words, do not have much impact on speech. If your child says, "I wanna have dat one," you will understand what he said, even though he did not say the "th" correctly.

Adult Learning
If your child is three years old and still very hard to understand, I encourage you to purchase Dr. Hodson's book at www.phonocomp.com. It will help you understand not only the speech disorder but the strategies that have been proven to work and the pitfalls that need to be avoided. This book is written with speech pathologists as the audience, but it is not super dense. The reason I encourage families to learn about their children's speech disorders is because you are your child's first advocate. You need to know what to advocate for.

Teaching Specific Sounds