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Interview with Christine Ristuccia, Speech-Language Pathologist, Owner and Founder of Say It Right

April 9, 2007
Linda Schreiber: Good morning Christine. Thank you for being willing to be interviewed about your phonemic-based approach to /r/ remediation this morning. Let's start by having you tell us a little bit about your background.Christine Ristuccia: I have worked with elementary and middle school childre
Linda Schreiber: Good morning Christine. Thank you for being willing to be interviewed about your phonemic-based approach to /r/ remediation this morning. Let's start by having you tell us a little bit about your background.

Christine Ristuccia: I have worked with elementary and middle school children and I'm presently working with preschool children in Head Start preschools and daycare centers in Chatham County, GA, where I live. I'm working with children who have phonological disorders, receptive and expressive language disorders, autism, and a wide range of preschool issues.

Schreiber: During your experience in the school setting while working with children, you saw a need for specific resources in the area of /r/ remediation. Tell us about that.

Ristuccia:: Well, when I first graduated as a speech-language pathologist in 1998, my CFY supervisor assigned me all of her /r/ students. She felt they needed a different approach because they were not improving their production of the /r/ sounds. I looked at all of the materials that were out on the market. I really liked using card decks for production practice so I bought every single /r/ card deck on the market. I started to categorize them according to the errors I was hearing the children say. And I noticed that the materials that were on the market were not congruent with the types of errors I heard the kids saying. For example, the materials only included initial, medial, and final consonantal /r/ and not much for vocalic /r/ (vowel + /r/). Initial vocalic /r/s (e.g., as in Ernie, Archie, ornament, etc.) were not addressed at all and the medial vocalic /r/s (e.g., farm, born and butterfly) and final vocalic /r/s (father, four, and star) were all grouped together in the same deck without consideration of their phonetic context. And so I went to the special education resource specialist at my school and inquired about how the /r/ sound was taught in the reading curriculum. And it was a lot different from how speech-language pathologists were teaching children to produce /r/.

Schreiber: How so?

Ristuccia:: In traditional articulation intervention, evaluation and treatment procedures for /r/ do not consider all the allophones of /r/, rather consonantal /r/ is considered and it is categorized according to the position in a word in which it occurs (initial, medial, or final). But there are vocalic /r/ variations that are not being taken into consideration. All of the vocalic /r/s (e.g., ar, er, or) are grouped into one category, called "vocalic r," instead of being recognized as individual allophones. However, sometimes a student can say one vocalic /r/ (e.g., or in Orville) but not another (e.g., ar in car). That means it's important to do a comprehensive evaluation, which evaluates all of the allophones of /r/, to figure out which of them the child can and cannot say. By evaluating the individual allophones and then remediating them specifically, you can really zero in on a particular error pattern.

Schreiber: And so you saw that there weren't materials that addressed all of the /r/ allophones?

Ristuccia:: There was nothing out there in 1999 that addressed any of that. All the materials were based on initial, medial, and final consonantal /r/ (based on the traditional approach) and that was it. There was nothing more. So I decided to develop my own 21 deck card set, and I included 21 variations of /r/, addressing them in all positions (initial, medial, and final) of words. And addressing all three positions is really important, especially for initial vocalic /r/ in words like Ernie and Archie and Orville. These are words that appear in our language and they need to be taken into consideration as much as red and run and race. And there's a big difference between Archie and red. People had been trying to remediate ar in Archie using words like red and run and race and it wasn't working.

A lot of standardized articulation tests out there still only look at initial /r/ in terms of red and run and race and they don't look at the vocalic /r/s, especially the initial vocalic /r/, which is a big problem. I recently completed a research study, and as an example, the research showed that 60% of the students could say "ear" initial, in words like earphone and earplug correctly right off the bat. So if you're not even evaluating "ear" in the initial position, you don't have a starting place for remediation and you're missing an opportunity. It's very important to take all vocalic /r/s into consideration.

Schreiber: So you created The Entire World of R 21 deck playing card set?

Ristuccia:: Yes.

Schreiber: How did you come up with 21 decks? How did you organize the card decks?

Ristuccia:: Remember that in 1999, I analyzed and reviewed every /r/ card deck and each only focused on initial, medial, or final word positions. Some words in the decks had more than one /r/ in them and that was confusing for students.

So, I organized my decks by the different mouth positions used to form the variations of /r/. Each vocalic /r/ is produced differently, so when I created the decks, the words represented the manner and placement of each production of vocalic /r/. Each word in a deck is phonetically consistent for the specific /r/ allophone (e.g., Archie, art, artifact for ar). Only one consonantal /r/ or vocalic /r/ occurs per word for "pure" practice (e.g., using for but not forever). All of the word positions are represented for each vocalic /r/ (e.g., Archie, barn, and star for ar). And finally, all words used are age-appropriate for 6-10 year olds and the art representing the words is motivating for that same age group. The cards are tools for eliciting the sounds.

Schreiber: So when you say "pure" practice, you are referring to focusing on one position of /r/ rather than multiple positions in a word.

Ristuccia:: Right, so you want to keep the words pure and only have one target /r/ in each word.

Schreiber: So you created card decks that addressed these needs. How did doing that form your company called Say It Right?

Ristuccia:: We started out with The Entire World of R 21 card deck set plus the 21 deck single-word screening assessment. Next, we added an Instructional Workbook to show speech-language pathologists how to use the card decks. I took for granted that people would know how to use the approach but I was mistaken. There needed to be more explanation since the approach was so new and unique to many SLPs. For example, the Los Angeles School District asked if I could turn the card decks plus the screening form methodology into a training program. I did and that became the first PowerPoint presentation and Instructional Workbook. We started making games and other workbooks based on this phonemic approach to /r/ remediation and we are making new products for /r/ as we speak. We are so successful that other companies have developed and are aggressively selling products based on this phonemic-based approach.

Schreiber: And so people recognize how helpful the products are.

Ristuccia:: Yes. However, since the approach was unique, original, and different from the traditional method of evaluating and treating /r/, some SLPs were skeptical. In my presentations, I had to gently encourage and challenge SLPs to really think "outside of the box" and give the phonemic-based approach a try. A lot of speech-language pathologists are convinced that kids with /r/ problems will just never get better and they will never say /r/ appropriately. And when I do presentations, I'll have some people in the audience say, "Oh right, this isn't going to work." They have a really negative outlook on remediating /r/ because they didn't learn in graduate school how to treat /r/ and they have been unsuccessful in their own practice using the traditional method. So at first, I had to really change people's minds and be very passionate about what I was saying. And then when they started to use the phonemic-based approach, they saw the results themselves.

We did a pilot study two and half years ago with the San Diego School District, so we now have the evidence showing that using this approach is statistically significant and effective.

Schreiber: So you have pursued research in this area and collected data on students, and the evidence shows that this approach really does work? And will that study be released soon also?

Ristuccia:: We're hoping. We submitted it to a journal so we're hoping that it will be published sometime fall 2007 or next spring 2008. We'll just have to see!

Schreiber: When the Say It Right Company began you were focused on remediation of /r/, but now you've really expanded into all sorts of articulation and language areas?

Ristuccia:: Yes, that is correct. We have language materials and most of our materials have an instructional base. We have fun games to go along with instructional, curriculum-based materials. The materials might focus on attributes or wh-questions but they also align with the curriculum and incorporate research on effective instructional techniques.

Schreiber: That's great because we all know we need to connect our work with what's going on in the classroom; aligning with the curriculum is really important. And I think knowing that you have collected data on the phonemic-based approach and knowing that you are establishing some efficacy for what you're promoting is also something that speech-language pathologists appreciate.

Ristuccia:: Yes, accountability is at an all time high with No Child Left Behind legislation. Some people look at our materials and say, "Well I can't use them. They look like fun but my materials have to be curriculum-based." And I say you can use these materials because they are curriculum-based. They're based on the literacy/reading curriculum for teaching /r/ controlled vowels. In literacy instruction, they are called /r/ controlled vowels, but we (SLPs) call them vocalic /r/. So they really are using curriculum-based materials when they're using this type of /r/ remediation.

Schreiber: I hadn't thought of that, that within reading and writing programs, kids are learning exactly the same information.

Ristuccia:: Yes, exactly and so if students are in remediation and they're also learning about /r/ in their classrooms, the instruction goes hand in hand, and so the student can learn it faster. And learning to produce /r/ ensures their reading, writing, and spelling skills won't be affected.

Schreiber: For readers who would like more information about your approach, we will have an article written by you posted at www.speechpathology.com beginning on April 16, 2007 and a Live Event presentation by you on April 25th www.speechpathology.com/ceus/livecoursedetails.asp?class_id=2692 also at www.speechpathology.com. The article will explain more about the categories of /r/ you have identified and in the live event you give additional information about the approach. Where can readers go to learn more about the Say It Right products that support this phonemic-based approach?

Ristuccia:: They can visit www.sayitright.org. I also wrote an article for Advance Magazine that is posted on our website too. And there's a PowerPoint on the approach at our website too for downloading if anyone wants to use it for staff training. We also have free downloadable games and informational pages that correspond to the research contained in The Entire World of R Instructional Workbooks and The Entire World of R Elicitation Techniques.

Schreiber: You are going to continue to focus on your approach so readers should watch for new things to come in the future as you continue to develop them?

Ristuccia:: Exactly.

Schreiber: Thank you for taking part in this interview today Christine. I wish you well in your ventures with the phonemic-based approach and your company Say It Right.

Ristuccia:: Well thank you Linda.