Presentation Overview Course Objectives What Is a Sibilant A

Home , Sibilant

The Entire World Presentation Overview of Sibilants™ • Targeted for intermediate level of knowledge. However, encompass entry- level to experienced clinicians. • Review S & Z first, then SH & CH, J, ZH. • Evaluation procedure.

Christine Ristuccia, M.S. CCC-SLP • Specific treatment strategies. www.sayitright.org • Case study examples.

Course Objectives What is a Sibilant • Know how to evaluate and treat the various word positions of the sibilant sounds:[s, z, ch, sh, sh, j, and zh]. A consonant characterized • Know how to use co-articulation to elicit correct tongue positioning. by a hissing sound. • Be able to write measurable and objective IEP goals. • Be able to identify 3 elicitation techniques S, Z,Z, SH, ZH, CH, and J • Identify natural tongue positioning for /t/, /n/, /l/ and /d/. • Know difference between frontal and lateral lisp disorders. ©2007 Say It Right ©2007 Say It Right

Facts About /s/ & /z/ Facts About [s] & [z]

• Cognates. Have same manner and [s] spellings S as in soup production with the exception of C as in city voicing. Sc as in science X as in box • Airflow restricted or released by tongue causes production and common “hissing” sound. [z] spellings s as in pans x as in xylophone • Different spellings, same production. z as in zoo

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Two Types of Lisp Frontal Lisp Disorders • Most common Frontal Lateral • Also called interdental lisp • Trademark sound - /th/ • Cause: Tongue is protruding too far forward. May actually be visible during speech. • Goal: To bring tongue tip back

Lateral Lisp Possible Causes of a Lisp Disorder • Less visible, more audible problem. • Thumb sucking • Caused by tongue in wrong location (too low) allowing air to escape • Tongue thrust (primarily from sides of the mouth). • Dental (front teeth missing) • Sound produced is often “wet” or spitty. Sometimes called a “slushy S.” • Cleft palate issues • Goal: Focus air stream out front of the mouth.

EW S & Z Approach to Categories of /s/ & /z/ Lisp Disorders

• Evaluation and treatment for • Initial, medial and final /s/ and /z/ frontal and lateral lisps are similar. • Correct production of both frontal • Initial /s/ clusters and lateral lisps disorders in the alveolar ridge region/behind • Final /s/ clusters bottom front teeth. • Use student’s strengths to elicit misproduced phonemes.

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Initial /s/ Blends Final /s/ Blend Clusters

• sp (spin) • sm (small) • -fs (coughs) •-ks(makes) • shr (shrimp) •sk(skate) • -sts (forests) •-sk(mask) • st (stump) •sw(swing) •-ps(cups) •-sks(asks) • str (string) •sl(slim) • -sps (wasps) •-st(fast) •sn(snail)

Start With a Comprehensive Evaluation

•Evaluate ALL /s/ and /z/’s in ALL positions to attain a comprehensive understanding of student’s ability. • Establish frontal or lateral lisp disorder. • Establish natural tongue positioning for /t/.

Choosing a Target Why establish natural tongue positioning for /t/? • Check stimulablity for /t/ and /ts/ • Because /t/ and /s/ have the final word productions. exact tongue placement.

• Find natural tongue positioning. • You are using the student’s success to elicit incorrect or improper tongue placements. • To practice student’s natural tongue positioning.

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Where do you Why not just refer to produce /t/? /s/ as /s/? • Goal: To set student up for • At the Alveolar ridge? success by using phonemes with similar production as /s/ or /z/. • Behind the bottom front teeth? • Student often goes back to “old” sound production. • Want to establish a new sound pattern.

Tenets for /s/ and /z/ Plan Remediation Approach • Treat frontal and lateral lisp • Base intervention on target selected. disorders in a similar manner. • Focus on one target at a time • Consistently focus only on target until until corrected. corrected. • Use elicitation techniques to • Choose appropriate elicitation establish tongue positioning. strategies matched to target selection. • Choose new target at 80% accuracy at sentence level. • Use phonetically consistent probe lists.

Why focus on one sound Begin Remediation and word position at a time? Isolation • Enhances motor planning. Single words • Provides consistent practice & repetition. Phrases • Ensures students know their goal. Sentences • Allows productions of other /r/ word combinations not yet targeted to Reading/Structured Conversation begin to generalize. Conversational Speech

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Cues to use with /t/ Auditory, Tactile and and /ts/ final words Visual

• Sharp not slushy sound. • Incorporate a multi-modality approach to learning. Involve as • Feel difference of tongue many senses as possible. placement. • E.g. snake sound • Slide finger down arm while color or trace a large “s” producing phonemes. use snake cue –wavy motion

Choices of Elicitation Big /s/ Techniques •Exploded /t/ • /ts/ final words, phrases and Sentences • Straw to demonstrate placement. • Elicitation Techniques • Alveolar target exercises

/ts/ Final Single Words /ts/ Final Phrases

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Final /ts/ Final /ts/ Sentences Sentences

Bill wants the kites.

Tom Bates bought new pants.

Garrett’s new darts are next to the weights.

/ts/ Final Stories Shaping an /s/ from a Robert’s dad coached the little league team, the phoneme combination Mets. The Mets needed new • Show the student screening equipment. They bought a results to educate student about few bats and nine mitts. The batter tried out the the /s/ & /z/ variations she can new bats and the catcher say. tried out the new mitts. Robert’s dad called out, • Use results of screening to “Now we’re ready.” “Let’s determine appropriate elicitation play ball and get lots of hits!” techniques.

/t/ Final Sentences + Elicitation Techniques /s/ Initial words • Sibilants are produced at the alveolar ridge region (behind the • Example: Cleo, the cat said meow. lower front teeth) as are other consonants - /l/, /n/, /d/. • Coarticulation used to stimulate medial /s/. • Use the other consonants to facilitate production. • If successful (80%) correct • E.g. Tan silo pens productions, try medial /s/ words (e.g lasso). Feel sad reads

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/l/ Final +/s/ Initial = /n/ final + /s/ Initial = /s/ Medial Words /s/ Medial Words

Darren will sail today. Tan silo.

/ls/ Sentence with /s/ When to move onto next Initial in Isolation sound/word Position

I feel sad today. Æ sad today • Once a word position for target /s/ is mastered (criterion is 80% for 5 Darren will sail Monday. consecutive sessions at sentence level), Æ sail Monday re-administer screening to assist in choosing the next target.

If successful (80%) accurate, try • Re-administer advanced screening to initial /s/ words (e.g. sun). choose next intervention target.

Case Study: Sally •Sally cannot produce any • Sally Morris is a 7 year-old second /s/’s correctly. grader at Seaford Avenue Elementary School. •The SLP determines • She is referred due to not being able to that she has a pronounce her /s/’s. Frontal Lisp • The sibilants each have voiced cognates. Disorder. Each sound has a twin, with the only difference being one sound is voiced (vocal cords vibrate) while the other is voiceless. ©2007 Say It Right ©2007 Say It Right

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Sally’s Remediation /s/ Blends and Final Strategy: /s/ Clusters • Teach “exploded /t/.” •Initial Blends: /sp/, /str/, /sl/, etc. • Practice /ts/ final words.

• Alveolar target exercises– /ns/, /ls/. • Final Clusters: /sk/, /sp/, /sks/,etc. • /s/ in initial, medial, final word positions. • Treat as necessary to correct specific articulation disorders. • Initial blends and final clusters. ©2007 Say It Right ©2007 Say It Right

Final /st/ Exercise

When to move onto /z/ Voiced Consonant Rule

When all word positions • In English when and clusters for /s/ are there is a voiced 80% or greater at the consonant preceding the sentence level final “s” the /s/ is pronounced as a /z/.

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Voiced Consonant Contextual Pronunciation

Rule use use As a diffuse As a verb diffuse noun or device it’s [z]: devise spouse espouse adjective misuse misuse it’s [s]: house house advice advise abuse abuse excuse excuse close close ©2007 Say It Right ©2007 Say It Right

Plural Endings Voice Ending Rule

Sometimes the /z/ is devoiced after remediating /s/

Cognates /s/ and /z/ Tenets of /s/ and /z/ Approach • Focus on one target at a time until it is voiced (bus) corrected. • Choose elicitation techniques according vs. to selected target. voiceless (buzz) • Eliminate elicitation techniques as quickly as possible. • Choose new target once carry-over has been achieved. • Try to elicit 150 responses per session.

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Always review previously How can students work mastered sounds together in a group?

• Check for stabilization and • Frontal lisp: Have other students generalization watch for tongue protrusion • Beginning of each therapy session (visual) • Use previously mastered sounds to • Lateral lisp: Student’s listen for help teach new sounds sharp vs. slushy speech. • Use well produced sounds to increase self-awareness of correct productions

Reasons for Lack of Send home appropriate Progress homework

• Wrong Target. If student is not 1. Practice natural tongue making progress in the first two positioning to reinforce sessions, try another target. kinesthetic awareness. • Not completing homework. 2. Send home words that the • Unable to move past mastered student can consistently say targets due to misunderstanding. perfectly in therapy.

Ways to Measure Student Progress: Challenges to Success

• Briefly review previously mastered • Wrong target targets to check for retention. • Tongue thrust • Use screening tool to collect current data and evaluate direction of therapy. • Missing top front teeth • Use rating system (1 to 5) for each • Motivation sound production. • Use Daily Data Collection or Daily Tally • Has not acquired auditory and Sheets to measure progress day to day. kinesthetic awareness.

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How do you know when Review: Intervention to dismiss a student?

• When students are able to say all • Treat only one target until mastered /s/ and /z/ variations with at least with criterion of 80% at sentence level 80% mastery at the sentence level. over 5 consecutive sessions. • When students, parents, and •Re-evaluate. teachers report it is no longer a problem. • Select new target and treat. • When articulation needs can be • Continue until all sounds correct. addressed at home or in the classroom. • Review and reinforce.

EW S & Z Strategy EW S & Z Strategy 6. /ts/ tactile and visual cues 1. Evaluation – Use Screening Kits 7. Final /ts/ 2. Interpret the Evaluation results 8. /ts/ phrases and sentences 3. Kinesthetic Awareness – client must have an awareness of tongue 9. Alveolar Phonemic production zone in mouth. - /ls/ and /ns/ 4. Phonemic Awareness-hissing sound 10. /s/ tactile and visual cues 11. Medial and final /s/ 5. Use student’s strengths-Begin

EW S & Z Strategy

13. Follow remediation hierarchy 14. Initial /s/ blends Questions? 15. Final /s/ clusters 16. Don’t forget /z/ - students may devoice. (voiced consonant rule) 17. Structured conversation 18. Review and reinforcement

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Course Objectives The Entire World of • Know to how to evaluate and treat the SH & CH™ various the sibilants. • Know how to use correctly produced phonemes to elicit misproduced phonemes. • Write measurable goals and objectives. • Be able to identify 3 and implement elicitation techniques.

Sh, Ch, J & Zh Sh & Zh

• Produced at the • /ʃ/ as in Ship and /ʒ/ as in palato-alveolar region. measure. Just slightly posterior of S & Z production • Described as “continuant fricative area. sibilants” for the steady, friction produced hissing sound emitted. • Sh and Ch are not voiced. • There are very few Zh words and no words in the initial position in • Zh and J are voiced. English.

Ch & J Cognates

•/ʧ/ as in chop and /ʤ/ as in judge • Traditionally called “affricates” since airflow is completely stopped at some point. •The /ʧ/ is a combination of /ʃ/ and /t/. •The /ʤ/ is a combination of /ʒ/ and /d/.

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Start with a Comprehensive Evaluation

• Evaluate ALL sibilants in all word positions. Spelling Challenges • Attain a comprehensive understanding of student’s ability. • Establish correct and incorrect productions

Sh, Ch, J & Zh Remediation Screening Results

Three basic outcomes: – All four target phonemes are misarticulated. – Ch and J are misarticulated. – Sh and Zh are misarticulated.

Sh, Ch, J & Zh Choosing a Target Remediation Treat the misproduced sibilants by using the successfully produced • Each action uses combination clusters to approximate the target sounds. phonemes to elicit the misproduced phonemes. • For example to obtain a ch medial sound, combine a /t/ final word with /j/ initial word such as “get you”

This produces a ch medial sound.

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Plan Remediation Tenets of Treating SH & CH • Base intervention on target selected. • Focus on one target at at time • Consistently focus only on target until until corrected. corrected. • Use elicitation techniques to elicit misproduced phonemes. • Choose appropriate elicitation strategies • Choose new target after 80% matched to target selection. accuracy has been achieved at • Use phonetically consistent probe lists the sentence level.

Approximate Phonemic Don’t be Production Zone compelled to Assists remediate in any Using one sound with particular order. same placement to elicit the target sound desired.

Elicitation Techniques for ch & j

Ch:/t/ final + [y] initial = ch medial Get + you = getchew

J: /d/ final + [y] initial = j medial read + your = readgour

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Elicitation Techniques for Voiced vs. Voiceless sh & zh Cognates • Sh Medial: [ch] final + [sh] initial = [sh] medial each +shark = eachshark

• Zh: After you have established correct productions of [sh] demonstrate the voicing differences.

Samples of visual and Case Study: Sharon auditory cues • Sharon Miller is five year-old • Finger up to kindergartner at Carrillo Elementary mouth and say School. “shhh” the baby is sleeping • SLP determines she misproduces •Big Ch [sh], [ch], [j] and [zh]

Case Study Case Study: Sharon • Sharon’s Therapy Strategy: Determine Stimulability - Test stimulability for [ch] by combining /t/ + /j/ as in “bet you” or “get you.” - Test stimulability for [sh] by combining /s/ + /j/ as in “kiss you” or “place you.” • Sharon shows stimulability for [sh] because “kiss you” elicits [sh]

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Case Study: Sharon Use ability to produce • After working on [sh] medial [sh] medial address [sh] initial and final to create positions. [sh] final and [sh] initial • Remediate [ch] using [sh]. Use [t] + [sh] initial or [n] + [sh] initial combinations.

Case Study: Sharon Goals

•IEP Goal: Sharon will produce [sh] and [j] with 80% at the sentence level for 5 consecutive times accuracy as measured by SLP tally.

• Working File Goal: Sharon will produce [sh] medial at 80% accuracy at the sentence level for 5 consecutive times. The next target will be [sh] initial and then [sh] final. [j] will be treated with voicing techniques after successful production of [sh]. ©2007 Say It Right ©2007 Say It Right

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Always review Reasons for Lack of mastered sounds Progress • Check for stabilization and • Wrong Target. If student is not generalization making progress in the first two • Beginning of each therapy session sessions, try another target. • Use previously mastered sounds to • Not completing homework help teach new sounds • Use well produced sounds to increase • Unable to move past mastered self-awareness of correct productions targets due to misunderstanding

Ways to Measure EW Sh & Ch Strategy Progress Similar to Strategy for S & Z

• Briefly review previously mastered 1. Evaluation – Use Screening Kits targets to check for retention. 2. Interpret the Evaluation results • Use Daily Data Collection or Daily Tally Sheets to measure progress 3. Begin Remediation – using day to day. intervention targets • Re-administer screening. 4. Use auditory, tactile and visual cues.

EW Sh & Ch Strategy Summary 5. Work on each word position (initial, medial, final). Don’t be Use the elicitation concerned with order. techniques to facilitate 6. Follow remediation hierarchy proper production of target (isolation to conversational speech). sounds. 7. Practice conversational speech. 8. Review and reinforcement.

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Questions ?

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