Expert: Sharon Rosen Lopez - 7/17/2009

Question
QUESTION: hi sharon.

i am acutely aware that i promised you that i would not be knocking on your doorstep any more. howsoever, here i am breaking my word [horrors...something neither my son nor i ever do!!] why, you ask? in all honesty, i felt compelled to write you once more, if only to thank you and tell you how impressed i am with you. after i read your last response, i went to your two websites, and i was able to witness your prolific body of work. i am in awe of you, to have accomplished so much and have extended yourself to help so many people.

it is nice to know there are people like you out there who give so unstintingly of themselves, and i, for one, am very grateful. thank you for being you.

p.s. i wanted to let you know that in exploring my son's articulation, i can see now that there is reason to be concerned, and thus, i do see the importance of having this addressed soon. thank you for helping clarify this.

i also wanted to seek some clear understanding of one other thing if you do not mind...in listening more intently now, and in using some of the words you listed, it appears that his major problem is the final "s" [the example i gave you was hou for house...eye for eyes, i for ice, plea for please... so even before i asked you [and after you gave me information] i am having him do it in two syllables, and he can clearly do this, but he can not yet put them together. as an example, he can say sassi very clearly, but when i asked him to say sass, he says sa

i apologize for imposing on you, but i wanted to find out very specifically if this is what you were saying to do...have him say it in two syllables, and then keep trying to get him to say it together?

would it be a further imposition to ask you what is the etiology of this?

sharon, i apologize for the verbosity of my email, and yet, as i am sure you know, it is an awesome responsibility raising children and doing the best we can for them. thus, once again, i want to express my appreciation to you.

ANSWER: Hi J,

Thanks for your nice comments -- appreciated!  

You might try having your son say the first syllable, and hold the word final 's' at the end...so that it's like another syllable in a way.  So it would be: hou..(pause)..ssssss; i....(pause)....ssss (ice);  mi...sss, ki....sss, pa...sss, me....ss, etc. (We would not include 'please' in this list because it ends with a 'z' sound, just like 'nose' and 'toes'. With words ending with a 'z' sound, you'd do the same drill, only separately from the 's' drill). Then, work slowly --using drill  -- towards seeing if he can imitatively reduce, and eventually delete entirely the pause between the syllables. I would use a fairly long list of common words ending in 's' so that  your son's muscles can build up a bit of muscle memory for the coordinating oralmotor pattern.  I think I mentioned in a previous note that playing a game during speech drill work helps to keep a child engaged though the entire 30-minute process! Again, the 30-minute duration of a speech session helps with reinforcing oralmotor patterning and auditory processing/awareness of the target sound/speech pattern.

Unfortunately, without having your son in front of my eyes, it's really impossible for me to trouble shoot all the things that might interfere with this drill working for him. I hope this tip helps.

One other thing you can do is to exaggerate in your own speech -- not excessively as to be obnoxious, but enough as to bring attention -- those word final 's' sounds in your spontaneous speech as you converse with your son. Again, this will help to bring his attention to this target speech pattern.

Best of luck!

Sharon Rosen Lopez, MA, CCC-SLP
Speech/Language Pathologist




---------- FOLLOW-UP ----------

QUESTION: thank you again for your time and energy in responding to my queries. as i said, and you confirmed, i am continuing to do the drill  [hou...ssss], and he has absolutely no problem doing it. and no, i do not know what game you are referring to, but he is quite amenable to doing it [albeit we have not done it for the 30 minutes yet]

i will continue to do this, but i was curious and had asked you in the earlier emails, if you knew what was the cause of this. he really can not say yes, but he can say ye...sssss. now that i am hyper vigilent, i believe there are other sounds that are missing [like tee for teeth] and yet he can say words like illuminate, patriotic, etc. just wondering if you could shed some light on how this occurred. are there any resources or books that would maybe assist me with further information and drills [for your sake at least, so i do not keep imposing on you]

also, in your opinion [and i certainly understand that you do not have a composite picture of his speech issues] notwithstanding your limitations, how long might this process take [to help him with these sounds at the end that he tries to say but evidently cannot]

"plea...zzz mommy, will you plea...zzz tell the nice lady thank you soooo much for helping me. she must be a realllly nice lady to want to help me" [a direct quote from my precious son]

ANSWER: Hello J,

There are several processes that impact speech and language development - oral sensorimotor structure and function, attention, memory, motivation, hearing, auditory processing, linguistic aptitude, cultural/environmental stimulation, and more -- and any/many  of these may play a role in the etiology of a child's speech errors. I cannot surmise just what specifically is at play with regard to the etiology of your son's speech errors.  I think I mentioned that simplification errors are common in the speech of young children...and word-final consonant deletion (hou/house, tee/teeth) is among those simplification errors commonly seen in toddlers. These common simplification errors may spontaneously dissolute in children around the age of 3-years, though sometimes a child --like your son-- needs some directed instruction to help her/him change the pattern that habit reinforces.  

Which game to play during speech therapy is child specific.  Any game or activity (moving ahead a piece on a board game, putting a block on a lego train, placing a peg in a hole) can work if it helps to maintain a child's interest without becoming too intrusive in the treatment. You make the target sound /word-- move a piece on the board game -- and then your son makes the sound/word, and similarly gets to move a piece on the board.  

Finally, how long treatment will take for your son is also something i can't surmise, as each child is different, each has a different motivation, awareness, ease in making the sounds etc. I'm sorry I can't be of more help.

I'm glad to hear that your son is amenable to working with you on his speech.   Best of luck!

Sharon Rosen Lopez, MA, CCC=SLP
Speech/Language Pathologist
http://www.SpeechSkillsForKids.com
http://www.SpeechArts.com



---------- FOLLOW-UP ----------

QUESTION: hi sharon,

i hope you do not cringe when you see another email from me, but i wanted to let you know that we are doing the exercises, and he is quite willing to do the two syllables [hou..sss], but unfortunately, he is no closer to saying them as one word.

what he can not do is make the zzz sound as in plea...zzz. he tries but is unable to date to say it. [any explanation as to why and how i could assist him or even how would a pathologist deal with this.]

i had asked you in the prior email if you knew what was the etiology of this. attention, memory, motivation, hearing, auditory processing, linguistic aptitude, cultural/environmental stimulation...are things you listed and things that do not exist in my son's situation. by stadnardized accounts, he excels in all of these areas.

also, was it that i was not vigilant enough and did not notice this? i am not looking to berate myself, i just want to understand what caused this and what i could have done differently, and even more importantly, if there is anything more i can do now. when school starts, i will take him in for an evaluation, but i would like to use the next few months to do what i can. you said that some children can spontaneously begin to put the endings on their words...could my son not be one of those or does this always occur in younger children? i am sorry for the cacophony of questions...i am just trying to get as clear a picture of this as i can and figure out how best to help him.

are there any resources/books that i could look to so i could better understand and better assess what to do for my precious son.

thank you again for your time and energy. we appreciate it very much.

Answer
Hi J,

I'm glad to hear that your son's able to produce the 'z' and 's' sounds after he produces the initial syllable of words, and expect that eventually the two parts of the words will come together as he becomes more aware of the target sounds, and more easily able to produce them.  Yes, he may be one of those children who will spontaneously begin to add word final endings...time will tell. As to what you can do until your son is seen by a professional, I can only advise that you continue to practice with your son (if he tolerates it) and see if it becomes easier for him to include these word-final sounds.

I'm sorry to say that I haven't any answers for the rest of your questions. I don't know of any specific resources that will better explain speech articulation in children in the depth that you seek though you might search for textbooks on pediatric speech and language development if that is something you wish to explore.  I am not current on these so I'm afraid I cannot guide you. And I cannot try to explain why your son has the articulation difficulties he has. I am sure that you'll get more understanding once he himself is seen in person by a speech/language pathologist. I am certain, though, that there is nothing you yourself did that has caused your son to have the speech difficulties he has.   

Best of luck!
Sharon Rosen Lopez, MA, CCC-SLP
Speech/Language Pathologist