Hot Topic Blog - Speech & Reading

CUED ORAL READING: A SIMPLE WAY TO HELP CHILDREN WITH CHILDHOOD APRAXIA OF SPEECH (CAS) AND OTHER ORAL MOTOR BASED COMMUNICATION DISORDERS DEVELOP CLEAR SPEECH, BETTER LANGUAGE, AND IMPROVED LITERACY SKILLS

Children with oral motor weakness and/or incoordination (e.g., childhood dysarthria) and/or speech motor planning disorders (i.e., childhood apraxia of speech) usually have unclear speech. And, a high percentage of these children have language and reading difficulties as well. Eight-five percent of children in special education classes have a speech and/or language disability as their core deficit (Francis, Shaywitz, Stuebing, Shaywitz, & Fletcher, 1996). For many of these children learning to read will be their greatest academic challenge, and many will continue to lag behind their peers during their school years (Lewis, Freebairn, Hansen, Iyengar, & Taylor, 2004). But, these children CAN learn to read, and oral reading can then be used as a way to improve oral motor, speech, and language skills. This is a win, win, win intervention!

COLTON AND CHARLIE

Here’s what happened recently with two children in my practice:

Colton (age 6 years, 11 months) increased his score on the Arizona Articulation Proficiency Scale (AAPS) from 64.5 to 93 (a score of 100 = perfect speech) in just 10 months. He now reads 3 grades above grade level. His language skills are above age level in all areas.

Charlie (age 7 years, 7 months) increased his AAPS score from 34.5 to 75 in just 9 months. He is now reading at grade level. A significant increase also occurred in his language ability.

So, what did Colton’s and Charlie’s interventions look like? First and foremost, Colton’s and Charlie’s parents and I worked as a team. Since one hour of therapy per week was not sufficient to produce such big changes, their home practice was key to the progress noted above. Charlie, Colton, and their parents practiced daily using activities I created that:

• Corrected speech sound errors
• Linked oral movements with speech sounds and letters
• Strengthened speech sound and syllable sequencing
• Improved word retrieval
• Helped to correct faulty/fuzzy word representations in memory
• Provided for correct sentence structure practice
• Built oral and written vocabulary
• Integrated speech, language, and reading instruction
• Improved visual tracking, visual figure-ground perception, and binocularity (i.e., using both eyes together)
• Helped them learn to coordinate their rates of visual tracking with their rates of sound, syllable, and word retrieval
• Were simple, fun, and easy to learn and use

KEY FEATURES OF CHARLIE’S AND COLTON’S PROGRAMS

We used four activities (described below) along with traditional speech correction methods in treatment. The four activities are part of the Cued Oral Reading: An Easy Way to Improve the Speech, Language, and Literacy Skills of Children with Apraxia and Other Communication Disorders program (McKinnis, 2008) and:

• Use repeated oral reading of specially designed books to practice oral movements for specific speech sound production
• Use a page cover to support and correct visual processing difficulties
• Use oral reading to integrate oral motor, speech, language, and decoding (i.e., sounding out words) practice
• Work on syllable sequencing

ORAL READING

The most effective activity by far for Colton and Charlie and for so many other children with whom I work was daily oral reading. This makes sense. Once they were taught the connection between appropriate oral movements, speech sounds, and letters, oral reading strengthened their skills in all three areas. But, the oral reading was done in a unique way using clinician-created books and a reading device I created called the Easy Eye Tracker Reading Tool (EET). Books were created using words from each child’s speech drills that he could say perfectly.

If you are a parent, you can do the same for your child as you “team-up” with your child’s speech-language pathologist. Use words your child can say perfectly and create books for speech and reading practice. The books do not need to be fancy; hand-written and hand-illustrated are good enough. The key, however, is that every word in every book must be a word your child can say perfectly. This key feature cannot be overstated. Perfect practice is of paramount importance for children with motor-based speech disorders. Using words a child can say perfectly creates an error-free learning activity in which the child practices what needs to be learned without mistakes.

Next, have your child read these books OUT-LOUD over and over. What is important here is that the child must read:

• The books out-loud
• To someone who can correct any errors they make
• To someone who can help the child learn how to accurately eye-track across the page

This simple activity provides a way to practice correct sound production, sound sequencing, oral movement to speech sound and letter linkage, and use of target words in grammatically correct sentences. Speech, language, and reading skills are improved by using this activity. Charlie’s first book had just 5 pictures with words, so this activity works for children at any level of speech and/or reading proficiency. As a child’s list of perfectly produced words increases, longer and longer books can be written. Then off-the-shelf books may be introduced. One-half hour per day of oral reading works best.

VISUAL PROCESSING SUPPORT

Many children with motor speech disorders also have trouble with certain aspects of visual perception. They often have difficulty matching their rate of sound/syllable/word retrieval with their rate of eye tracking across a line of print. These children frequently can visually track across a line of print faster than they can sound/syllable/word retrieve. They often omit letters, syllables, and sometimes entire words as they read. Many are overwhelmed by an entire page of print or are distracted by other print on the page when they try to sound out words at hand. For those children (and it’s nearly all the children with whom I work) the inexpensive Easy Eye Tracker Reading Tool (EET) or Reading Buddy helps.

The EET is a two-piece plastic page cover with a bottom piece that has a rectangular window and a moveable bean-shaped top piece (rotary slider). The rectangular window is used to frame one line of print, so the child is not distracted by other print on the page. The rotary slider is rotated across the window to expose single letters, syllables, or words. During initial training, the parent, teacher, or therapist work together with the child to move the slider. This is so:

• The rate at which letters, syllables, or words exposed can be controlled to ensure that they are read and said perfectly
• The key decoding skills of segmentation (breaking a word apart at the sound boundaries), alphabetics (saying the sound that goes with the letter or letters), and blending (reading the word) are taught

The EET comes with the Guided Decoding Strategies, which are an easy way to teach children the above mentioned decoding skills.

You can create your own eye-tracking tool by using a ruler under a line of print and your finger to expose letters, syllables, or words as your child reads. Just be sure that you match the rate at which you expose letters, syllables, or words to your child’s ability, so he or she can read them perfectly. And, be sure to correct errors as they occur.

INTEGRATING SPEECH AND READING PRACTICE

A favorite activity that integrates oral movement and speech practice with reading involves money! I reinforce correct speech productions by putting a penny above the letter or letters for the speech sounds the child says perfectly as they read. These pennies can then be used to purchase items from my Treasure Box or can, of course, be saved. I have found this to be highly reinforcing, and children love seeing their piles of pennies grow as they say and read words correctly. This is easy to do at home.

WORK ON SYLLABLE SEQUENCING ISSUES

Syllable sequencing is a common problem for children with motor speech disorders. An easy way to help children learn to sequence syllables can be done using the following simple activity. As your child reads, write the multi-syllabic words on which he or she struggled on strips of paper. Cut the strips at the syllable boundaries to create “syllable pieces.” Then have the child reassemble and verbally produce or decode (i.e., read) the words. You can create a fun game by putting 30 to 40 “syllable pieces” in a cup, shaking them, and dumping them on the table. Have the child first sort them into groups by first, middle, and last syllables. Then have the child reassemble the pieces to form the original words. The child can then read the words created verbally.

SUMMARY

I am confident that the above activities will help your child improve his or her oral motor, speech, language, and reading skills. If you would like more information about these and other helpful activities and materials, take a look at my websites www.yakketyakslp.com or www.easyeyetracker.com. You may also e-mail me directly at akspeech@mtaonline.net if you have any questions.

ABOUT SANDRA MCKINNIS

Sandra McKinnis, MA, CCC-SLP is a speech-language pathologist in private practice in Anchorage, Alaska. She has over 38 years of pediatric clinical experience in outpatient rehabilitation, public school, and private practice settings. In addition to the materials listed in this blog, she is the author of the Processing Program and Grammar Processing Program (both available from SuperDuper Publications). Sandra has created and taught two classes through the University of Alaska: The Language of Play and Concept Based Instruction in Communication, Reading, Writing, and Math.

REFERENCES

Francis, D. J., Shaywitz, S. E., Stuebing, K. K., Shaywitz, B. A., & Fletcher, J. M. (1996). Developmental lag versus deficit models of reading disability: A longitudinal individual growth curves analysis. Journal of Educational Psychology, 88(1), 3-17.

Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., & Taylor, G.H. (2004). School-age follow-up of children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 35(2), 122-133.

McKinnis, S. K. (2008). Easy eye tracker reading tool and guided decoding strategies. Anchorage, AK: Easy Eye Tracker. Retrieved from www.easyeyetracker.com

McKinnis, S. K. (2013). Cued oral reading: An easy way to improve the speech, language, and literacy skills of children with apraxia and other communication disorders. Anchorage, AK: Yakketyak. Retrieved from www.yakketyakslp.com