I have several children on my caseload who continue to have difficulty with /r/ despite years of speech therapy. What are some techniques for dealing with this phoneme?
The /r/ phoneme is one of the most difficult phonemes to remediate for clients with persistent, long term /r/ problems. Identifying the exact nature of the problem with the /r/ production will allow you to choose appropriate remediation strategies for your client. Typical problems with incorrect /r/ productions include: rounding the lips, incorrect tongue placement, lack of tension with the tongue, tongue is too low in the oral cavity, use of a tense jaw, poor tongue-jaw differentiation, jaw instability, and incorrect productions patterned over time.
Here are several therapy facilitation techniques that I have found successful for clients with persistent /r/ problems:
- Teaching general awareness of the articulators (ie. tongue, lips, oral cavity) and their functions with stimulation (flavored tongue depressors, pretzel sticks, small suckers, toothettes) and visual cues (mirror, tongue drawings). Decreasing hyposensitivity by brushing the sides of the tongue and inside of the upper molars with various textures (ie. small toothbrush, toothette, tongue depressor, Popsicles) before and during practice of /r/ targets.
- Eliminate lip rounding by having the client smile during /r/ productions. You could also place a small bite block (ie. coffee stirrer) between the lips while smiling, as the bite block will fall out if the lips are rounded (use a mirror so client can visually monitor lip rounding/retracting).
- Create tongue tension by placing a wet toothette on the back of the tongue and directing the client to close his mouth and push the toothette up with the tongue (squeezing out all the water). Direct the client to complete this task for several trials before sound practice. Also, tongue tension increases by having the client produce the /r/ while pushing against a table/wall or saying the /r/ while lifting the chair he is sitting in.
- Be very picky with your target word choices for /r/ initial words. Choose words with velars in the final position to increase the use of /r/ (ie. rake, rug, rock). Produce a short, quick /r/ (do not prolong), pause for a second, overemphasize the vowel after the /r/, then finish out the word.
- Tongue/jaw differentiation tasks to improve jaw stability, which in turn allows the client to achieve correct tongue placement. Use a mirror and have the client open and close the mouth slowly with no head movement or lateralizing of the jaw. The client could increase jaw stability by opening and closing the mouth in increments for better control as well. Direct the client to open his mouth, leaving it open with a stable jaw, and slowly moving the tongue tip to the alveolar ridge and then behind the lower front teeth. Complete several trials for these tasks. You could also use a bite block (coffee stirrer) placed between the molars on one side to assure jaw stability for the client until he can do this on his own.
- Teach the bunched /r/ (high back) which includes humping up back of tongue for silent /k/; having the sides of the back of the tongue touch the insides of upper back molars and relaxing the jaw).
- Clients with persistent /r/ problems often benefit from the introduction of the retroflex /r/. Teach the retroflex /r/ (curled) which includes placing the tongue tip behind the upper front teeth; curling the tongue tip backward without touching the roof of the mouth; the lateral sides of the tongue should touch the insides of the upper back molars; and the jaw should be slightly lowered. The retroflex /r/ can also be facilitated by producing an /l/ with a slightly lowered jaw and sliding the tongue tip back farther and farther until you hear an /r/ production. If the client has a short frenulum, then the retroflex /r/ will be difficult. Frequently, in time, the retroflex /r/ naturally changes to a high back /r/.
- Shaping / sound modifications: using phonemes /l/, /n/, /d/, /w/, /g/, ''sh', ''y', /i/, /a/ to shape the /r/ sound.
- Use coarticulation if a client is successful with /r/ in the initial or final position of words, use this as a facilitation technique. For example, successful initial /r/ productions could increase the final position /r/ (ie. bear-red, car-read) due to anticipatory behaviors for the upcoming initial /r/. You would gradually work the /r/ initial word during practice as the final position /r/ emerges. Also, you could try the /kr-/ and /gr-/ blends for initial success.
- Drill, drill, drill. Expect accuracy. Once the client is successful with the /r/ production, increase complexity by establishing the /r/ in other contexts and positions. Encourage the client to ''feel' the difference with the /r/ productions.
Bauman-Waengler, J. (2000). Articulatory and phonological impairments: A clinical focus. Needham Heights, MA: Allyn & Bacon.
Marshalla, P. (2000). Oral-motor techniques in articulation and phonological therapy. Kirkland, WA: Marshalla Speech and Language.
Plass, B. (2002). SPARC R and S. East Moline, IL: LinguiSystems.
Rosenfeld-Johnson, S. (1999). Horns as therapy tools. Advance Magazine for Speech-Language Pathologists and Audiologists. 31 May, 1999.
Gilbert, D., Nypaver, K., Hicks, P., & Roden, S. (2000). The wizard of Rs: Tried and true techniques for /r/ remediation. Austin, TX: Pro-Ed.
Julie Hoffmann, M.A., CCC-SLP received her M.A. in Speech-Language Pathology from Northeast Missouri State University (Truman) in 1988. Currently, she is a clinical instructor at Saint Louis University. She teaches the courses of Phonetics, Articulation/Phonology Development & Disorders and Speech-Language Development & Disorder for the Classroom Teacher. She also provides graduate students with clinical instruction for diagnostics and therapy. Her areas of interest include: children with severe articulatory disorders, apraxia, fluency disorders and phonological awareness. She currently serves as Missouri Speech-Language-Hearing Association president.