Preventative vs. Remedial Approaches

Have you taken a deeeep breath when you’ve gotten a referral for a middle school student that hadn’t mastered the /r/ sound?  As SLPs, we know that the longer a student has been speaking with an incorrect speech pattern, the more challenging it is to remediate it!   I have treated these older elementary and middle school students with /r/ errors and now I see mostly pre-k through K students but I in no way ignore the /r/ sound at these young ages.  There are preventative things we can do in speech therapy to lessen the gliding pattern for these younger students.  To quote Benjamin Franklin, “an ounce of prevention is worth a pound of cure.”  This approach is not meant to replace a remedial approach for the /r/ sound, rather to prevent the severity from worsening to the point that it is difficult to remediate.

In Wisconsin, (my state, go Badgers!), RTI is a general education initiative so why am I doing an RTI post?  Well, there are interventions SLPs perform that do or don’t (depending upon your intent, length of intervention and focus) fall under the RTI umbrella and in many cases, it’s a matter of semantics.

General Ed teachers introduce the r sound!

In 4K and Kindergarten classrooms, teachers introduce the letters and their accompanying sounds to their students in some systematic fashion.  This is an opportunity to “push into” these regular education settings and give students some additional teaching on how to produce the /r/ sound.  What better way for students to learn than from the SLP how to produce this tricky sound?  It can also be a way for the SLP to identify children who have not yet mastered the /r/ sound and provide either some small group intervention or a home program to help the child reduce the gliding pattern and perhaps prevent that student from needing speech therapy at a later date.  I go into the regular education classroom for a push-in session when or shortly after the general education teacher has introduced the letter R.

Equipment for the push-in session

Chattervox portable amplification system

I bring in all of my developmentally-appropriate tools of the SLP trade to enhance the auditory and visual experience for the students.

1.  An amplification system.  There are many amplification systems out there but I use the Chattervox because I travel and it’s portable.  Amplifying the /r/ sound gets students FULL attention for this tricky sound!  Click on the images to access the links.

There are also some personal amplification systems available on Amazon.  This one from ResponseBridge has good reviews and is at a reasonable price point.

2.  Mouth Model with tongue:  I used this small, rubber mouth muppet because I didn’t have anything larger.  Because of the small size, I had to take it around and show it so children could get a decent view.

Mouth Finger Puppet

 However, I’d recommend a larger model like the one from SMFK on Amazon. It comes with a removable tongue that moves but not in all directions. You could use a play-doh tongue for more flexibiity.

 Other  Teaching Tools for the push-in session:

Apps:  I also bring an Ipad app to show students how to produce the r sound from the frontal and lateral views.  I  I use Speech Tutor app by Synapse Apps. which I have reviewed in a prior blog post: Review of Speech Tutor.  It works on Macs,  Ipads and Iphones and there is also a pro version available.  I use it all the time in my speech therapy sessions!

Mirrors:  The last suggestion is a common tool for SLPs, a mirror.  Most of us have at least one in our therapy rooms but you will need multiple for a large group so each child in the classroom can watch themselves make the sound.  This pack from Amazon includes 16 mirrors and if you have a larger group, you could supplement by bringing some in from home or asking to borrow from other teachers.

General teaching sequence for Push-in Session(s):

1. Introduce the Letter Rr.
I introduce both the uppercase and lowercase r’s.  I might print some letters on the whiteboard and have a student come up and circle the r’s.  How much you focus on this introductory piece depends upon how extensively the regular education teacher has already introduced it!  You might give students small white or chalk boards and have them write the uppercase and lowercase Rr.   This is an important step so we can strengthen the letter-sound connection!

2.  Introduce the /r/ sound!
I spend time talking about how the tongue is a muscle and the /r/ sound uses the muscles in the tongue but not the lips.   I put my hand out flat and slowly tighten it into a fist to show the students what they want their tongues to do for this sound.  It’s beneficial for each student to have or share a mirror.  I borrowed small mirrors from our guidance counselor, and used some of my therapy mirrorrs.   Since I have the “small” mouth puppet, I walk around the room showing students how the tongue looks when it makes the r sound.

3.  Auditory Discrimination! 
Don’t skip this step!  Use minimal pairs to show students that if they use a w for the r sound, they change the word!  Teach that the /w/ gives the lips a workout and the /r/ gives the tongue a workout. I choose to contrast the r and the w for this lesson but you could also contrast the w, r AND y sounds. I hold up pictures (no words) of /r/ and /w/ words and have students tell me the initial sound.  I use the Chattervox at this step so students can have an audible model in a  noisy classroom!

4.  Multiple Repetitions and Practice.
Play games such as “ring around the rosie” or “reach and roll.”  In the latter, I have students choose to either reach for an /r/ card that I hold up so they have to stretch and reach for it and then say it. Students can also choose to roll a die and say an /r/ card the number of times on the die.  At the end, I give each student an /r/ themed exit ticket so families know what the child worked on with the SLP today!  You might also choose to pull the students that are unable to correctly produce the /r/ sound into a small group and use the speech tutor app for further instruction.

5.  Follow Up:  Short-term Intervention or a Home Program.
I keep a notepad near me and write down the students that distort the /r/ sound. (I typically find 2-4 per kindergarten classroom).  After the session, I briefly meet with the classroom teacher and discuss these students and develop a follow-up plan.   For some, I have sent home programs with students if they have a support system at home that will follow up with it.  On my home program, I am clear about explaining that the /r/ sound is a later-occurring sound and intervention at this age is more preventative than remedial.    

RTI for the R Sound Packet.

I have put all of the pictures and materials you need to conduct this type of push-in session into one packet.  Click on the image below to check it out.  If you don’t want to do a push-in sessions, it is also valuable for your speech therapy sessions or for a home program for initial r.

In states where response to intervention is considered a special education initiative, you could do some additional (short-term) /r/ intervention activities with the students that haven’t yet mastered the sound.  You might just prevent some challenging /r/ students from needing intensive speech therapy services in the future!

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