October 25 2016

When I found myself in the elementary setting for the first time, there was nothing more painful than inheriting 8 IEPs with /r/ goals. In looking at previous IEPs, the student usually had been working on the sound for at least a couple of years and had made no progress. Not only was this frustrating as an SLP, but the poor student was not excited about coming to speech. Imagine if you had gone to the gym every week for 2 years and had not lost a single pound?

I went on a mission. There HAD to be a way to teach this sound in a short amount of time! I bought all sorts of resources, but many focused on /r/ word lists or the order of how to teach /r/ words versus how to establish the “er” sound in isolation. Others were so technical they didn’t even make sense to me let alone trying to explain the directions to a 10-year-old. And that’s when it struck me - that’s EXACTLY the problem! It’s too technical. The directions were not task analyzed enough, the vocabulary wasn’t simple enough, and there was no way to give meaningful feedback to students as they repeated “uh-uh-uh” for “er-er-er” a thousand times.

So I developed a series of instructions to use with students to teach vocalic /er/ in isolation. Once I implemented this with my caseload, I had some students who mastered /er/ in isolation the very first session. The longest it took me to establish the sound in isolation was 6 weeks. This particular student additionally had a language and learning disability as well as low intrinsic motivation to learn the sound, which may have contributed to the time spent on isolation.

To teach the “r” trick, follow these steps: First, verify that the student can do the following things in isolation:

• Teeth: Have the student use a mirror to align top and bottom teeth both vertically and horizontally. Show the student the “line” separating the two top front teeth and the two bottom front teeth. This “line” should be completely vertical. The bottom teeth generally need to slide forward to line up directly beneath the top teeth. Cue the student by likening the lower jaw to a kitchen drawer which slides forward and backward. The teeth need to be aligned and open about 3/4 of an inch (the width of a tongue depressor turned on its side). This open position maintains jaw stability and allows the SLP to see inside the student’s mouth in order to provide feedback. Many students have difficulty maintaining this posture when other steps are added. Keeping the tip of the tongue depressor just barely in the mouth and having the student bite lightly helps maintain the position.

• Lips: The student must push top and bottom lips out similar to when making the “sh” sound. You can also cue them to make their lips boxy. This will help the student to avoid rounding the lips and also allow the SLP more visibility into the mouth for feedback purposes.

• Curl: Show the student how to curl the tongue tip back. Have them trace or sweep the top of their mouths if needed to imitate your model. I use a visual cue with my index finger curling back in a “come here” way. The purpose of this step is not to have a perfect retroflexive position but to just get the tongue moved to the anterior part of the mouth.

• Squeeze: Give the student the visual cue of a body builder with a pumped up bicep muscle. Tell them you want them to make a mountain with the back of their tongue. Have them look in the mirror and watch their tongues make a /k/ sound, thus demonstrating that they CAN squeeze their tongues up in the back. As they look in the mirror, have them squeeze up as for a /k/ but not release the sound. Tell them to act like they are about to say “cat” but someone stops them just before saying the word. Have them pay attention to how the tongue feels as they do this. For extra input, you can lightly and quickly touch the student’s tongue where it makes contact with the palate. Be careful that you don’t stimulate a gag reflex. :)

• Anchor: See if the student can flatten the tongue. Have the student gently bite on the sides of the flattened tongue, cueing the student to recognize the sensory input of the molars on the sides of the tongue. You can provide extra input by tapping on the upper back molars and sides of tongue with a tongue depressor.

Once a student can quickly and consistently demonstrate all 5 steps individually, it’s time to put them together. Instruct the student to watch himself in the mirror the entire time and to listen to you as you provide cues and feedback.

• Say “teeth” and once the student has attained the proper position and degree of openness, say, “lips”. If the student loses ‘teeth’ when the ‘lips’ step is added, start over and practice these two steps until the student can add ‘lips’ without losing ‘teeth’.

• Cue by saying, “curl”, watching the child as he watches himself in the mirror curling his tongue back. If either ‘teeth’ or ‘lips’ are lost, start over and add one after the other until the student can do the three in order without losing any of the steps.

• Say, “squeeze and anchor up on the molars”, watching the student’s tongue as he watches it in the mirror. Cue with your hand pulling back in a fist if necessary, saying “squeeze really hard, up and back”. Once the student has successfully combined all four steps, cue by saying, “say /er/”. If the student says /er/, HOORAY for you both. If not, then troubleshooting is in order.

Here are some common areas that require troubleshooting:

• Allowing the lower jaw to recede when doing the curl/squeeze sequence is a big problem. Jaw stability is necessary, and the student must be able to maintain an advanced, open position. Practice until he can do that. Use the tongue depressor until the posture can be consistently maintained, then gradually withdraw until the student can maintain without the help of the tongue depressor.

• Another big obstacle is inadequate squeezing, either medially or laterally in the posterior part of the tongue. Remind them of the bodybuilder. Have them watch themselves make the /k/ again to show them that they can do it, or have them bite on the sides of their tongue and push up against the molars for lateral difficulties.

• Some students need extra practice with the ‘anchor’ step, learning to disassociate the tongue squeezing on the molars and the jaw dropping down. Have them practice biting on the sides of the tongue, squeezing up on the molars, then dropping the jaw down as they maintain the squeeze.

• Sometimes the lips want to slip into a rounded position during the curl/squeeze phase. Provide verbal cues for “sh” lip shape.

Some students respond really quickly to troubleshooting, even getting an “er” within the first session. Others require several sessions to master the sound. Just continue to encourage the student and provide specific, individualized feedback after each attempt. It is often helpful to have the student continue to voice sound as they attempt to move the articulators and re-shape the sound. Praise change in the sound which indicates change in where the articulators are, but do not accept this as a correct production. It is confusing to the student (and also those who read your data collection after you). :) Also remember to have the student look at him/herself in a mirror, not at you. They will want to, because you are talking to them, and at times you may want to model a certain movement, but for the most part you want the student to become familiar with the articulators, both what they are and how they need to move in order to make an “er” sound.

Moving forward Once the student can consistently produce 10 clear “er” sounds in a row, you are ready to move on. Tips for establishing this sound in words and higher levels of articulation difficulty will be published in Part 2 of the /R/ you kidding me? series.

-Lisa