Got a Question about Vocalic R Articulation Disorders? 2007-Aug 2008

If you have a question about a vocalic /r/ articulation disorders, please post it here. If you have a question, there are most likely others that have the same question and could benefit from your post. What questions about vocalic /r/ do you have?

These are questions posted and answered from 2007-2008. For more questions and answers, see the post above for the current school year.

95 Comments

  1. From: SMeacMA@aol.com
    Subject: question

    I have been using your program and am generally pleased. I do have a question that has come up with several children. I know “er” is one of the later sounds to work on because of its difficulty to describe and produce. However, how do you get to an “ire” and an “air” if the child cannot produce “er”? Your advice would really be appreciated.
    Thank you.

    • do you work on /r/ in isolation?

  2. Sally,

    Treating /r/ is difficult because there are so many different types–32 in all, if you include all 21 vocalic /r/’s and 11 /r/ blends. The key is to do a complete evaluation to determine which sounds are producible by the child.

    The allophone [er] in the final word position is what many SLP’s tend to think of when they are treating /r/ (tower, flower, butter, etc.). [er] final, however, tends to be one of the hardest sounds for children to produce.

    Through research we’ve found that almost all (about 98%) students can say some /r/ in some word position (initial, medial, final).

    The best approach we’ve found is to build upon the sucess that the student already has. Pick an intervention target where the student (for example, [ar] initial: art, article, arm) has the greatest proficency below what you consiser correct (I suggest 80%). Focus on that intervention target exclusively until proficiency is attained and maintained over several session.

    When you re-evaluate you should notice improvement on other sounds. Use the new results to pick another intervention target. For example, after the child achieves correct production of [ar] intial, perhaps [ar] final would be the next logical target followed by [ar] medial. Once [ar] is correctly produced then you would move on to one of the word positions of [air] or [ire].

    Repeat until all the sounds are remediated. If you are disciplined to work consistently on only one sound until correction the results should fall into place. You’ll also notice your students getting more motivated, as success builds.

    • My student only produces /r/ initial so with the vowels I am going to target ar like you suggest. But like asked above how do you get to an “ire” and an “air” if the child cannot produce “er”?

      • Jess,

        You should do a complete evaluation using The Entire World of R Advance Screening. There are up to 32 different /r/ combinations, so if you haven’t done a complete screening you might find some /r/’s that are correct. Once you have a correct /r/ in a context, such as /r/ initial, it’s important to understand how the student’s tongue moves. Is it retracted or retroflex? Don’t teach a tongue position, reinforce what the student does naturally. The next step is to pick a target such as “ar final.” Employ coarticulation and whisper techniques (found in The Entire World of R Book of Elicitation Techniques. Use combinations such as “carrun.” Whisper “car.” Say “run” Then voice “ca-” with “run.” Then voice “car” and whisper “run” You might have to try different combinations to shape it, but with patience you should see some success. Once a correct allophone emerges practice it to consistent success. Once you get “ar final” move on to “ar initial and ar medial.” Rescreen, there will probably be some generalization for the other sounds. Pick a target and repeat the process.

        Also [er] is contained in [air] and [ire], but correct production of [er] is not necessarily an indicator for success for these allophones of /r/. That is the reason why we evaluate all 32 variations of /r/ so that we can determine the exact /r/ that the student can and cannot produce. Each of the /r/’s is mutually exclusive.

        Good luck.
        Christine

  3. I attended Christine Ristuccia’s conference last month in Pittsburgh, PA. In regard to the different /r/ tongue placements (retracted vs. retroflexed), I questioned the ability of a person to “roll” or “curl” his/her tongue (determined genetically) and how this may or may not relate to which tongue placement each person uses to prodcue the /r/ sounds.

    I asked a few neighboring SLP’s sitting at my table at this conference and noticed that the SLP’s that could “roll” their tongue, produced a retroflexed /r/ and those that could not “roll” their tongue produced a retracted /r/. If this was found to be consistent in the general population, I thought that this could be a good indicator for younger children for an SLP to know which tongue placement to teach to each client!

    Please let me know if anyone has any reaction to these ideas!

  4. I “attended” your on-line hour long instructional session through speechpathology.com.

    I had a question that did not get answered due to time constraints at the end. I was wondering if you could comment on my observations.

    I work at a middle school. I get the 2% of kids that are still working on the “r.” My girls almost always get the “r” in 6th or 7th grade. My boys almost always get the “r” in 7th or 8th grade. It is rare when I send
    someone to High School working on the “r.” I have sent 1 boy to the High School in 7 years that was continuing to work on his “r.”

    My two most severe “r” students sound hypo nasal. I can’t help but wonder whether physical maturation of the oral cavity and physical shrinking of the adenoids play a factor in the gradual ability to acquire proper resonance
    for the “r” vowel. According to my brief internet searches on ENT websites, the adenoids start shrinking at age 14.

    I guess I can’t help but wonder if these kids would grow into the “R” without speech therapy at all. In the adult population at large, I never hear a distorted “r” vowel unless the person has some other significantly noticeable disability such as Hearing Impairment or Down’s Syndrome. I can’t help but wonder if our best practice would be to help with 2nd and 3rd graders with learning to spell the various “r” phonemes, rather than years of helping them say something they would eventually acquire on their own.

    Thanks for any comments or leads on other places to read about this. I truly appreciate your work. I sound much more professional at IEP meetings with a research based model behind me.

  5. Leigh-

    First have you administered a comprehensive screening which includes all of the vocalic /r/’s and initial /r/ blends? It is difficult for me to answer your question as I have little information about the student.

    In general, I believe that as speech pathologists, it is our job to attempt to correct an articulation disorder as it has a significant impact on a person’s occupation, self esteem, other’s perception of them etc. regardless of the age of the student. However, it is our job as speech-language pathologists to employ teaching strategies that work and not attempt to premeditate the student in the same manner year after year without any signs of progress. I have heard of High School students and I have worked with
    Adults who are learning English as a Second Language and they are capable of learning the various /r/ allophones with proper evaluation and remediation strategies.

  6. I may be an over-zealous parent, but I have a 5.5-year-old who has some struggles with the r sound. She’s been in speech therapy before for other ariculation problems, but they felt she’d met her IEP goals when we moved out of that school system and did not recommend her for further therapy.

    6 months later it really seemed like she’d regressed. I took her to another place and had her reevaluated. They said the things she struggles with aren’t supposed to really emerge for a few more years and that her problems would not be treated in a public school setting until she’d bypassed the normal emerging phase for that sound (we’re a homeschooling family).

    I’d like to go ahead and work with her on these sounds on the front end and not wait until it’s “past that point.” However, I also don’t want to push her if that sound is really not supposed to be there yet. That doesn’t really sound right to me because she has two older sisters who never struggled with this, so it seems possible that the sound could be developed in her at this age.

    So… all that to say this: is it appropriate to go ahead and start doing some gentle activities with her at this age to work on the r sound, or is it truly in her best interests for me to wait a few years?

    Thanks for your help. I’m interested in your materials if you think they can be used on a 5.5 year old.

  7. Megan,

    It’s always good to address problems before they become ingrained habits.

    Each school district has their own standards and criteria for accepting students into services. So it sounds like the information you received concerning eligibility for articulation is correct.

    That’s not to say you can’t address the issue with some phonetically consistent practice. A phoneme is the smallest part of intellible speech. For example, the “or” sound in “door” or the “sh” sound in “wish.”

    With the “r” sound, most difficulties occur with the vocalic combinations. That is when the “r” is preceded by a vowel, as in the combinations AR, AIR, EAR, ER, IRE, and OR. We’ve found it best to address each sound individually and one at a time. The good news is that our treatment materials are all phonetically consistent for treating /r/. That is you treat one phoneme at a time, for example “or” final words; door, seashore, adore, more, floor, etc.

    The hard part is knowing which sounds to start with. There are at least 32 distinct /r/ sounds. We have screenings which can help you target exactly which sounds to start with. The Entire World of R Book of Elicitation Techniques is the single best resource for the “r” sound because it include the whole underlying theory of the program. It also contains a copy of our Advanced Screening for /r/.

    A little practice is not going to hurt. The key for a 5.5 year old is not to make practicing “work” but to keep it fun and motivating. If the child become too frustrated then it’s time to back off.

    Hope that helps.

  8. I have a student who has accomplished all /r/ sounds except er as in bird or first. I have tried many different techniques to elicit a correct er sound but he is still unable to. What suggestions do you have and which of your /r/ books would be most beneficial for me in order to help this child.
    Thanks

  9. Randie,

    The words bird and first are medial /er/ stressed words. If this is the only problem areas you should focus on similar words like, nurse, hurdle, hurting and thirty.

    Does the student have problems with any other vocalic /r/’s? How about just the /er/ phoneme (earth, urn, waterfall, tower, butter)? If this is the case, then you should do a complete evaluation for the other sounds.

    For materials you can purchase a card deck for /er/ medial stressed (SKU ER-002) ADD TO CART.

    Hope that helps.

    Christine

  10. How do the probe lists in your EWR Book of Elicitation Techniques differ from the separately published EWR Probe List book?

  11. Paige,

    Good question. The probe words provided in The Entire World of R Book of Eliciation Techniques are only intended to help you “elicit” the sounds. As such there are only 3 to 5 words provided for each sound. The probe words are organized by each consonantal-vocalic (vocalic-consonantal) combination. For example for AR Final the words are organized as: PAR, BAR, FAR, VAR, THAR, TAR, etc.

    Many words don’t exist for each combination, so we made up nonsense words as place markers to help you help your students elicit each combination. One of our techniques is to use voicing/devoicing, so having the cognate is helpful. For example, we included “papar” (nonsense word) for PAR, because it’s helpful to get the voiced “sandbar” (BAR).

    The Entire World of R Probe Lists is designed to be a resource for practicing specific R combinations. It is the result of all the word lists we’ve compiled over the years in creating R products. The Entire World of R Probe Lists contains only real words, listed alphabetically, for each possible vocalic and consonantal combination.

    Hope that helps.

    Christine

  12. I attended one of your seminars and am trying to use this program, but I’m running into this problem–Results of my evaluation indicated that the child can produce the /r/ correctly in the following blends: tr, dr, gr (but not kr which is weird), thr, spr. So like the book suggested, I split the words into sections (e.g. tr—ap, tr—uck) but when I have her say the word like this aloud or with the whispered technique on the second section, her initial /tr/ when said slowly has a disordered /r/ again. If I say just say the word normally at normal speed, it returns to a correct /r/. So it’s difficult to move from an initial /tr/ to a final /ter/ as in “water, sister”. Other therapists who attended the seminar don’t seem to have any suggestions due to lack of familiarity with use of this program. Any suggestions??

  13. Hi Christine–I have started using your program and have run into a problem. Results of the evaluation indicated that the child can correctly produce the following /r/ sounds: tr, dr, gr (but not kr which is weird), spr, and thr. When I split the word into sections (e.g. tr—ay, tr—uck) the child reverts back to a disordered /r/ sound when she says both sections aloud or the 1st section aloud and the second section whispered. And obviously we cannot move to a final ‘ter’ as in ‘water’ or ‘sister’ (0%)since we can’t get past saying the word in sections(20%). Unfortunately both the child and I are frustrated with this negative practice. Thank you for providing this service because I don’t want to abandon this approach so soon. I was very impressed with the 32 types of /r/ evaluation.

  14. Nora,

    First to elicit initial [kr], I would use the successfully produced gr words since kr and gr are cognates and differ only by voicing. You can produce grape for example and demonstrate that the vocal cords are vibrating. Have
    the student place his hands on your vocal cords to feel the vibration. Next have student produce grape and have them feel his own vocal cords vibrating. Next you produce crepe and have student feel that there is no vocal cord vibration. Have student produce crate. Progress to page 217 in the Elicitation Book and continually contrast grape vs. crate. Practice initial kr words on page 217.

    What other /r/ allophones on the screening could the student correctly produce? I would obtain an inventory of these percentages and chart them on the baseline results page on page contained either in the Advanced Screening or the Entire World of R Elicitation Book.

    [er] is not the only allophone that we are attempting to elicit. We are looking for all of the successfully produced allophones that were obtained on the Advanced Screening so that we can find the natural tongue position (retroflex versus retracted) page 133 that the student uses when making a correctly produced /r/.

    Use the natural tongue position as your hand cue and educate the student which tongue position that he is using when the correct /r/ was produced. Next, analyze the percentages of the /r/’s obtained by the screening to see which /r/ target the student is most stimulable for. Go through the Choosing a Target Checklist and Target Options Worksheet to help you decide
    which target your student will be the most successful for.

    I hope this helps.

    Good luck!

    Christine

  15. I am in the process of using the Adv. Screen for a student. He scored 0% on all blends and only 2.6% overall on the non-blend portions (so, virtually all contexts he is not producing an /r/ … MOST contexts he produces an /l/ for the /r/.).

    I’m confused at this point as to why I would go ahead and do the LENGTHY process of the elicitation probe since he didn’t do any /r/’s on the Adv. Screen. It seems to be a contradiction to me …. that on the one hand your manual says to use the probe if a student performs 0% on the Adv. Screen (bottom page 7) but then on page 59 it says (under #4) “if the intervention target is /or/ as determined by the Adv. Screen …”. Why would you be doing the probe if a student has an intervention target from the Adv. Screen (targets, I thought, were supposed to be areas greater than 50% but less than 80%, as stated page 7, #4.

    Help!
    (Thank you),
    Karen C.

  16. Karen,

    If he is substituting /l/ for /r/ then it sounds as though he is not retracting his tongue back far enough. Use the correctly produced /r/ as a kinesthetic and auditory cue as to what a correctly produced /r/ feels and sounds like.

    The reason is that you are looking for some place, any place to start treatment. If you recorded at least one word that was somewhat produced correctly then you can figure out the natural tongue positioning (retroflexed vs.. retracted) that your student uses when correctly producing the /r/ sound. Then you can use that correctly produced /r/ word (e.g. ar final as in star) and work on the other ar final words consistently until he has achieved 80% accuracy at the sentence level. You can also try the natural tongue positioning with some of the other misproduced /r/ words and see if it makes a difference as far as production goes.

    You could do The Entire World of R Elicitation Probe which is contained in the EWR Advanced Screening for the sound that he got at least one word correctly to help you narrow down the specific phoneme and word position (i.e. ear initial). You’ll test the vocalic /r/ against all possible consonantal contexts (i.e. earp, earb, eart, eard, etc. You are looking (and hoping) for some contexts that produces a correct or nearly correct /r/. Once you have that you can reinforce and build upon that context.

    In The Entire World of R Book of Elicitation Techniques, we meant that if you had an absolute zero percentage (which you isn’t your situation) then you could do a complete Elicitation Probe (for all contexts). This would be time consuming, but could reveal some contexts (not covered in the screening) that are or could be successful.

    The idea is to try and find a successful /r/and build upon that through the techniques rather than having to resort to “teaching /r/,” as is the traditional view which can become even more confusing for the student.

    I hope that helps clarify.

    Christine

  17. I came across this reference and was wondering if you got this published:

    Ristuccia, C., & Aldridge, M. (2007). [Effectiveness of a phonetically-consistent treatment program for /r/ articulation disorders in elementary school children]. Unpublished raw data.

    If so what journal?
    (I know you did a study on this, but I can’t seem to find the original text.) I have two of your books, but it isn’t listed in the reference section.

    Thanks

  18. Rachele,

    It’s completed, but being reworked. We hope to get it published in a journal some time this year.

    Christine

  19. hi..i am an slp in a public school setting…i would like to purchase 1 book that i may use at school..i would like to know which book to purchase…i am looking for word lists and/or activities that include all the different r sounds….thank you!

  20. I just received my order and I am looking forward to using the products soon. A couple of questions:

    1. When administering the Advanced Screening, do you have the child read the stimuli horizontally across the row, or vertically (all single words, then all phrases, then all sentences)? Reading horizontally might be facilitative for some students, and inflate their scores. Or does this matter?
    2. What do you do when a child is really aware of what you are eliciting, and they slow down and exaggerate their production in order to say it correctly?
    3. Is there a reason for using reading rather than imitation?

  21. Kerri,

    Thanks for your questions you bring up some really good points. Here are some comments:

    1. The screening was designed to be read horizontally, but you can mix it up to make it more random.

    2. Ask them to read at a normal speed. If the student slows down, note it and take that into consideration when determining your intervention target.

    3. Reading is better because the production will be purer. However if the student can’t read or had trouble with a word then you’ll have to faciliate. We thought about including pictures, but with almost 200 contexts we thought it too cumbersome (and expensive). If you have non-readers you can always use The Entire World of R Say & Sequence Cards or the 21 Deck Playing Cards. Select 5 or 10 cards from each vocalic /r/ and have the student say the word.

    The important advantage of using The Entire World Advanced Screening is that it provides you with multiple contexts [multiple words] in different complexities [words, phrases, sentences)] for each type of vocalic /r/. The response you get from the student, might not be clinically ideal, but this comprehensive screening should provide you with a clear direction on where to start.

    Hope that helps.

    Christine

  22. I teach third grade. I have a student who has an overbite and gets very frustrated pronouncing r blend words, which inhibits reading. She was screened for speech, but did not place. I know from my gut that this student’s speech is causing her problems. What can I do now, since the school is not supporting me?

  23. Lynn,

    Does the student have trouble with any other /r/ words like any of the vocalic combinations?

    The first step is to screen for all possible combinations of /r/. If it’s just the blend combinations, you’ll need to narrow it down. There are 11 different blend combinations. You should pick just one combination that the student has the most success with, but is still incorrect. Make that your target. Practice just that combination repeatedly should show improvement.

    It would also help to understand what the student’s tongue is doing. Is it retroflexed or retracted? Emphasizing what the student does naturally will also help.

  24. I am a high school English teacher/literacy coach. I have a male student in ninth grade who says he often confuses the letter r with the letter w when he reads.

    I would like to know if this is a common mistake, and I would also like to know if there are any successful intervention techniques that might help this young man.

    Any help you might provide will be greatly appreciated.

    Thank you!

    Jamie Swift

  25. Jamie,

    This is called W for R substitution. It is common, though not for a student in the 9th grade. Usually this problem should have been addressed much early. Not addressing it sooner, means that the (bad) habit is that much more difficult to correct since it’s had a long to set it.

    Substitution can be address using R/W contrast words: ride/wide, rip/whip, red/wed, read/weed, etc. Practicing these contrasts and motivation on the student’s part should make an impact.

    The student should be evaluated by a speech-language pathologist to ensure there are no other issues present.

  26. Kermit voice when learning to produce /r/:

    What can you do when a student changes his/her voice when learning to say /r/? It is my hypothesis that their tongue is too far back and this changes their voice. It has kind of a closed, kermit the frog type voice when they attempt /r/. Any suggestions?

    Thank you very much!

  27. Kyle,

    This often happens when the student is either been in speech for a long time using an unnatural tongue position and/or the wrong target. Administer the EWR Advanced Screening to determine the word (s) that the student can produce perfectly to determine natural tongue positioning (retroflexed or retracted).

  28. Hi Christine,
    I have an 8th grade boy who has been in Speech all throughout his schooling. He has the hardest time with words like “our,” “door”, “are”. He has difficulties in all areas, but those are the most significant. He gets made fun of quite a bit, and really wants to be able to improve a little bit before he has to step into high school. Suggestions?! Thanks so much!

  29. Shayne,

    Have you administered the EWR Advanced Screening to see which /r/ word(s) that he can say correctly? That’s really the best first step. You mention [ar] and [or] combination words. You might find that he can say words within that phoneme but in different word positions more easily (medial position vice final). Or you may find that [ear] words are closer to correct production and should be targeted for intervention first.

    You should also determine the natural tongue positioning (retroflexed vs. retracted) because this will help with how you reinforce how he produced the sound. Also, you didn’t mention if he could say his Spanish /r/’s but if he can that should give you another tool to work with.

  30. I find that students who are able to produce the retracted tongue position often generalize the /r/ to conversation much quicker than those who I try to teach a retroflexed position. For students who can produce retroflexed /r/, it often sounds slightly less natural than students who produce retracted. My question is, should I try to teach all students retracted position or will some simply not be able to do it? Also, if productions continue to be slightly unnatural to my ear, should I continue drilling the word level until they are perfect or move on to phrases?

    Thank you!

  31. Jane,

    Thanks for your observation on retracted tongue speakers generalizing quicker. I haven’t collected or seen any previous data on that. What I’ve observed is that people use retracted, retroflexed or both (depending on context) tongue positions to make /r/. Since there is no specific manner or place of articulation to create /r/, any way is correct.

    What I’ve found to be really powerful (and others too) is to emphasize what the student does naturally. Too often SLP’s will jump to “teach” /r/ a certain way. (usually the way the SLP does it). If this is unnatural for the student, then it makes a task–already difficult and incorrect–even more frustrating.

    In my research (and backed by other studies) is that all students can say /r/ in some context. Find that context and study how the student produces the /r/. Is it a retroflex or retracted? Use visual vowel [AR, AIR, EAR, OR] word contexts to get the mouth open. Is it consistent? Does it change with context? Use this information to reinforce to the student what they do already. Use hand signs, a mirror, diagrams, etc. to help the student gain kinesthetic awareness.

    For your second question, you should have chosen a single intervention target. That target should normally be the one allphone “most likely to succeed.” (See The Entire World of R Book of Elicitation Techniques for target selection). You should have a specific goal, say 80% correct at the sentence level. Work that single target up and down in complexity (single word, phrase, sentence, reading, conversation) until you reach your goal. More complex contexts sometimes aids in improving production. Also, varying what you are doing, just makes therapy more interesting and motivating.

    Good questions. I hope this helps.

  32. When I was in kindergarten I went to the school therapist. After a year they told me that they did all that they should do for someone my age and that i would grow out of it. That was over nine years ago. Now, I am a freshman in High school and I still can’t pronounce anything with the letter ‘R’. Is there anything i can do to talk normally, or will I always talk like this?

  33. Kacey,

    It’s hard to say what you sounded like in kindergarten, but since the “r” sound is later developing, your speech-language pathologist was most likely correct in deferring services. However, if your articulation (pronunciation) did not improve by 2nd or 3rd grade you should have been re-evaluated at that time (and probably provided services).

    What you should do now is, find the speech-language pathologist (SLP) at your school and see what she/he can do for you. At the very least the SLP should be able to evaluate which contexts you can and cannot say. From that the SLP should provide a treatment plan.

    Here’s a link with an article on written for parents [R at Home Article] but should give you a good overview. Show it to your SLP.

    Let me know what the SLP says.

  34. I have a 4th grade male student who can not produce any of the /r/ phonemes, including pre-vocalic /r/. We have been working on pre-vocalic /r/ all year and he still can not do it. He is doing everything anatomically correct. I had a more experienced SLP come in and she said to keep doing what we have been doing and he will get it because his mouth and tongue are in the correct positions. We began with with the retracted tongue position and then finally tried the retroflexed. He is producing it more like the vowel /u/ down deep in his throat. I have tried everything, even minimal pair practice, tape recording, etc. He is able to distinguish the difference but not produce it. I have both of your books (eliciation and probe list) and I tried all of the elicitation techniques. I have even tried shaping it out of other phonemes like /l/. Is there something else I can try? What should I do?

  35. Misty,

    You didn’t say specifically, but what were the results from The Entire World of R Advanced Screening? That should be the first step. The Advanced Screening looks at 32 different /r/’s in multiple contexts and complexities.

    If he scored zeros across the board, then I would administer the Elicitation Probe. The Elicitation Probe evaluates /r/ in every possibile consonantal-vocalic combination.

    Based on my research and that of others, I’ve found that just about all students can say /r/ in some context to some ability. However as you know, if a student has multiple disorders then that can compound and mask problems. (Though it sounds like your student does not.) Both the Advanced Screening and Elicitation Probe are excellent tools for flushing out which sounds are producible and stimulable. Though they take some time to administer it’s time well spent. The Elicitation probe tests a lot of nonsense combinations. I’ve found the use of nonsense words to be helpful in breaking incorrect lexical ties.

    Also, I’d suggest not “teaching” the retracted or retroflex tongue positions. You need to reinforce what the student does naturally.

    Hope that helps.

  36. I just finished watching your lecture on speechpathology.com and it was very helpful. The student was using a retracted at the beginning of the year so I will use that. Also, I only gave the probe list for a few targets and I didn’t try ear. Perhaps I can find something that I can shape using co-articulation,etc. Thanks so much for your reply!

  37. Misty,

    The evaluation process can take some time, but it’s a wise investment. Finding the best intervention target is just so critical to the whole treatment process. Once you get the first target, the others should fall into place.

    Be aware that treatment of the first target can take some time. For our research study the criteria was 80% correct for 5 consecutive times at the sentence level. Many students required treatment for several weeks (even, in some cases, months) before consistent sucessful production was achieved. It’s the phonetically consistent and repetitive productions that will enable success. Many SLPs have a tendency to want to “mix it up” and shift targets; don’t do it. Keep working on the same sound. There is a reward: Based on our research sucess will lead to generalizations. In the end you will save time.

    Let me know of your progress.

  38. I’m back again…
    I have never had a student with such a difficult /r/. I tried the probe list and I have not found any /r/ that he can say correctly in any contexts. He makes a more vowelized production. When I try to train the pre-vocalic /r/, he isn’t saying it as badly (he was gliding) as he was before, however it is still not right. What is even stranger is that he has no disabilities and he has an identical twin (99.9%) who has no articulation difficulties. The student also has allergy problems and the twin does not. Could this be contributing to his inability to say the /r/ correctly?

  39. Misty,

    When you say “probe list,” did you mean the complete Elicitation Probe? The Elicitation Probe will test against all possible combinations. Many contexts are nonsense words. These can help break lexical linkage.

    You’ll have to keep working at getting at least one context somewhat correct. You could try getting an /r/ in isolation (What sound does a pirate make? Arrrrgh!).

    You said his prevocalic /r/ wasn’t produced as badly; how did he do on the Elicitation Probe for all the CV contexts (ra, re, ri, ro, etc)? You could try introducing some prevocalic /r/ nonsense words (rok, ryk, rej, etc) perhaps that might help. Pick the context with the most stimulable production and work with it.

    Let me know how he does.

  40. I am having alot of difficulty determining which type of /r/ children make naturally. Any extra advice. Thanks

  41. Have the child say some of the visual vowel words–those that start with [or, ar] like orchid or arcade. The mouth tends to be the most open on these words.

    The [er] (tower, flower, earth) is not visual since the mouth doesn’t move and is relatively closed during production.

    Show the child the difference in mouth positions and ask him/her what the tongue does. Use hand gestures as a visual aid.

  42. My son has a problem with the /r/ sound and I have/had a number of complaints related to his speech problem. The school has been doing what one might call the traditional approach to addressing his problem with the /r/ sound. I tried to get them to adopt the Entire World of R without much success. When they failed to adopt the program, I filed a request for Prior Written Notice. There general response has been that my son is making progress. I have a couple of questions.

    1. Do you know of school districts around the country that are using the Entire World of R? And, do you have reports back from districts about their success with using the program.

    2. We are using the Entire World of R in private therapy. Our private therapist administered the shorter screening. I was talking to a school-based therapist in a different state that used the Entire World of R. She said they have people come in to administer and score evaluations. That made me wonder if you have any recommendation as to who should administer and score test or does it matter?

    3. Maybe I’m being dense when it comes to determining if my son is really making progress so here is a link to a post with some evaluation results at a board I moderate. Over the years the school has only used the Goldman Fristoe to evaluate my son’s articulation problem. Can anyone tell if he is making progress from the information posted?

    http://madisoniep.com/SMF/index.php?topic=167.0

    When I reviewed this post, I noticed that I had not included the results of the Entire World R screening. I’ll add that results to the thread for reference.

    Any feedback is greatly appreciated.

    Thank you,
    Becky

  43. Follow up question.

    I have an IEP meeting coming up August 7. I’m thinking of requesting that my son be dismissed from school-based speech therapy. Our current private therapist is semi-retired and arranging private therapy after school is difficult. And our school system is getting stingy about letting kids out for private therapy during school areas, especially in an area that they provide services. So, if I ask that my son be dismissed from school-based speech therapy then I would be providing therapy at home after school hours. Do you have a home-based program or what materials would you recommend for a home-based program?

    Thank you,
    Becky

  44. Becky,

    Thanks for providing so much detail in your post, this makes for an interesting case.

    First, to answer your questions:

    1. Yes, there are many, many school districts that have adopted The Entire World of R (EWR). We did our research with San Diego City Schools, they were so impressed with the result that the EWR was incorporated into their Articualtion Resource Center, here are two links on that might be of interest: http://www.csha.org/resource_center/CSHAArticulationManual.pdf (This is a blueprint on how to address articulation for school districts)

    http://slpath.com/docs/ASHA2007Handout1.pdf

    You are in Alabama. We’ve had a lot of support from SLPs in Alabama and from SHAA, but I can’t say specifically which districts from your state have adopted it as a whole. If any reader from Alabama knows, please share the info.

    2. We have 2 screenings, a short one-page screener The Entire World of R Screening Kit and a much more detailed The Entire World of R Advanced Screening. The results you posted were from the Advanced Screening. Our screening tool has not been normed, so it is not a test (we are working on it).

    The good news from the result you posted is that he’s good a fair amount of ability to produce /r/ in almost half of the positions. I can’t tell if he’s making progress because this is only one snapshot of ability. You’d need multiple results over a period of time. However, he can’t produce [ar] final, [or] final and [er] medial stressed among others, which accounts for a large number of /r/ words.

    My recommendation is to target [ear] initial or [air] initial and get those mastered. Retest and pick another target. Knock the sounds out one by one.

    3. One of the challenges with remediating articulation errors for SLPs is the tools we have to work with. The Goldman-Fristoe is one of main standards for testing articulation errors used in the field of speech-pathology. The test is used to determine elligibility for services, progress and dismissal.

    You really need to look at the word lists used for /r/ on that test. You’ll be shocked (Shocked!) at the lack of depth in evaluating /r/. Even for a lay person with just a little knowledge of vocalic /r/, it’s quite evident that it’s lacking. Considering your son’s competence with some of the /r/ sounds (including prevocalic /r/) it’s no wonder he could score 100% on the Goldman-Fristoe, and yet still be so unintelligible with /r/.

    The CPAC results obtained from the private SLP is more comprehensive, but still does not consider all the variations (allophones) the EWR Advanced Screening does. The CPAC results do confirm that his /r/ articulation ability it deficient.

    You really need a copy of the Goldman-Fristoe (the actual test and not just the results) to compare those to the results from the CPAC and EWR Advanced Screening. I think a good visual that will really help your case.

    To answer the questions in your follow-up post. We don’t have a specific home-based program per se. However, all our materials are straightforward enough to be used at home. We’ve had many parents purchase our products and use them with success. That said, nothing we produce is a substitute for an experienced speech-language pathologist (SLP). So I’d always recommend to work with an SLP for evaluation and guidance.

    Best of luck.

  45. Hi,

    Any good research articles on /r/ treatment that you can point me to? Thanks

  46. Yes, we had an article in ADVANCE for Speech-Language Pathologists & Audiologists
    Vol. 12 •Issue 39 • Page 21, Sept 30, 2002. You can view it on our website at http://www.sayitright.org.

  47. I was approached by a woman in her 70s regarding remediation of “r”. She has struggled all her life with correct articulation of “r”, and she achieves it sometimes (I would guess about 25%) of the time when she is concentrating. She wanted to know if articulation therapy would help. I treat children in my private practice, and would like to refer this woman to an SLP who could help, but began to wonder whether therapy could make a difference in a person who has misarticulated “r” for this long. Are there statistics on this? The woman has not had a stroke or brain trauma and there appears to be no obvious structural problem.

  48. I am one of the school SLPs that you refer to as being frustrated with my current approach to /r/. I was just given $80 to spend and would like you to suggest the best way to spend it on your materials. I was thinking the The Entire World of R Book of Elicitation Techniques
    and The Entire World of R Instructional Workbook. Is this what you would recommend? I noticed you have some money saving combo packs, do you have a combo pack that includes these two items.

    Thank you!

  49. Hello Mrs. R,

    My group is doing a project on therapy techniques that remediate articulation of /r/ disorders. We had some questions about your technique:
    1) how did your technique come about?
    2) what populations can this technique be used on?
    3) is there research done on your technique?
    4) can it be used on other articulation problems besides /r/?

    Thank you,
    Student3

    • Hi Student 3-
      My technique came about through frustration of the current materials that were on the market when I first started doing therapy. I started writing down the /r/ sounds that I heard the children produce as well as the /r/ sounds I heard in conversations. That is how I came up with the screening tool and the Entire World of R playing cards, which was our flagship product.
      The Entire World of R can be used with people of all ages.
      There is research on the program and it was conducted with the therapists at San Diego City Schools and their students. The research I conducted on /r/ is published in the Entire World of R Book of Elicitation Techniques. It would be difficult to use it on other articulation problems besides /r/, however we have other resources for other articulation disorders such as the Entire World of /s/ and /z/ Instructional workbook, The Entire World of Early developing sounds and the Entire World of sh and ch Instructional workbook. These are all popular and useful tools for speech-language pathologists.

  50. Just wanted to tell you all know how much I appreciate your postings guys.
    Found you though google!

  51. I am looking for a speech language patholigist who really understands r-controlled vowel problems and has many methods of approaching remediation. I found your blog and information and am intrigued. I see that you offer trainsing and workshops — do you by any chance keep a list of practicioners who have attended your trainings? I live in the Washington DC area.

    • Caroline,

      We don’t maintain a listing of SLPs, but the American Speech-Language Hearing Association (ASHA) does maintain a directory. It can be found at http://www.asha.org/findpro/. You’ll have to contact the SLPs in your area and ask him or her what their expertise is to find exactly what you need.

      Good luck,

      Christine

  52. Hi,

    Generally at what age should a child be saying /r/ sounds well?

    My daughter turned 5 recently and I notice that she often uses a w instead of a r (eg wabbit) and uses a w instead of an r in her name (her name is Marieke).

    Should I do something about this now or should I wait until she is a bit older?

    Thanks

    • The /r/ sounds does develop later than other sounds, so there is the possibility that it will self correct. However, it’s a good idea to provide a little help as well. If she’s unintelligible, then you should have her evaluated by a speech-language pathologist. Otherwise, you should try modeling and then asking her to repeat /r/ and /w/ words, such as ride/wide, whip/rip, ring/wing, run/won, read/weed, etc. Contrasting the words should help her hear the difference so that she can learn to self-correct.

      Christine

      • Thanks for that Christine.
        I’ve tried the words that you mentioned – she can hear the difference no problem (if I try and say “I will weed a book” instead of read, she laughs and tells me I’m saying it wrong), but she doesn’t seem to know how to make the r sound particularly for words starting with an r.

        How do I explain to her how to make the sound? Tip of the tongue on the roof of her mouth?

        Sorry to ask so many questions!

        Wilm

        • Wilm,

          It’s good that she can discriminate the sounds. One solution is to have your daughter smile when saying prevocalic /r/. If the child is rounding her lips then the word will sound like a /w/. If she smiles and looks in a mirror she will be able to see the difference between /r/ and /w/.

          Christine

  53. Thanks for that Christine. I’ll give that a try with her!

    Cheers, Wilma

  54. Hi Christine,

    I work in a school setup. I see a student in middle school who cannot produce vocalic /r/. He replaces with /l/ sound. He has been receiving speech therapy for /r/ sound since 4 or 5 yrs. I’m seeing him since 6 months only, but other SLP was seeing him since 3 yrs. He has a h/o tourettes syndrome and ADD. he has tics. Mom is very demanding as there is no progress seen since years. Other SLPs say that he should take a break from therapy. Can you help me with this. I’ve a meeting with mom on 12/7/09.

    Thanks & Regards,
    Nithya.

    • Nithya,

      The best first step is to administer The Entire World of R Advanced Screening to see which /r/’s the student can and cannot produce. Does he replace /r/ for all the /r/’s or just some? We/You need more specific information to present to the mom and the Advanced Screening will provide that for you.

      Christine

  55. My two kids, age 10 and 8, both have speech articulation issues, mainly with the letter R. Both have been receiving speech therapy for years. My younger who is much worse than the other has been in speech therapy for about 5 years. We have also switched around therapists because we have not seen any progress. Each tells me that progress is being made, but I have not seen nor heard it. The latest Speech Therapist I contacted evaluated my kids and suggested that their issue may be more anatomical. She further suggested to go to an ENT to have their tonsils evaluated. While their tonsils are not enlarged, she felt that may be getting in the way of making the R sound. Does anyone have experience with this? Any suggestions would be appreciated.

    • Alex,

      What evaluation tool is the SLP using to determine progress made? The Entire World of R Advance Screening considers 32 different types of /r/’s and provides percentages of correctness. This will give a good assessment of /r/ and can accurately track the response to intervention and thus progress made.

      Anatomical issues may be a factor and should be something discussed with a doctor. However, do your children make a correct /r/ in any context? We’ve found in our research that just about all children can make a correct /r/ in some context. If the child can produce a correct sound in one context, then the ability is present to transfer to other sounds. Using correct production of sounds to elicit incorrect sounds is one of the tenents of The Entire World of R program.

      I hope this information helps.

      Christine

  56. In which specific cases do kids substitute W for R? I’ve not that doesn’t happen for all words…

    • W for R substitution is a common misarticulation. It happens when children are rounding their lips as if making a /w/ and in fact they are making a /w/. Many times it stems from a phonological disorder.

  57. At first I would like to thank you for this wonderful effort, and my question is that my age is 27 and I have a problem with the pronunciation of the letter ”R” and this is causing me some problems at work
    1 – Is it my age fit for this treatment or that this program just for kids?
    2 – Are there programs for the treatment of those over 25 or adults in general?

    I hope that there is a cure

    Thanks you

    • Ali,

      My methodology can work for all ages. Usually treating /r/ is addressed at early ages. Generally, the younger the person receiving treatment, the the eaiser it is to overcome habits. It’s definitely possible to correct, it will just take effort.

      Best of luck.
      Christine

  58. Hi Christine,
    What a great site!!
    I have a student who is able to produce /r/ in all contexts except /or/. Other /r/ productions are not entirely clear however, with prompting he is able to articulate the sounds better. Words with /or/ are almost unintelligible. Do you have any suggestions?
    Thanks,
    Jen

    • Jen,

      Thanks for your kind comments. Really the best step is to evaluate the student using The Entire World of R Advances Screening. It looks at 32 different /r/’s in single word, phrase and sentence contexts. It sounds like this student is close on many sounds you just need to target in on exactly which are persistently not produced correctly. If you can determine the sounds that are half-way there and target those, I bet his productions will become more intelligible. Leave the /or/ words till last. You may even see some generalization.

      Good luck,
      Christine

  59. I have various boys in third grade who receive speech/language support for their vocalic /r/ variations. I DO use the EWOR books, but am still frustrated with their lack of production accuracy and carry-over with word productions into sentences and conversational speech. Any helpful hints.

    • The key with remediation is to pick one practice target sound and work it to success. If their production accuracy is not up to par, then the children are probably not ready for carry-over. I define carry-over as mixing allophones and word positions, with word lists like: art, barn, car or art, organize, iron.

      Stick to just a single allophone, such as [ar] initial. A sample word list could be: art, artist, army, Armando. Moving up and down in complexity (with phrases and sentences within the allophone is fine: The artist painted, Armando won the game, Armando the artist, etc. Before introducing other allophones, ensure that the child is consistently successful (5 consecutive times at 80% accuracy, or what ever your standard is). Just sticking to a single allophone might seem to take a while, but if you work it systematically, one target sound at at time, you’ll obtain success.

      Getting the children to conversational speech–the real goal–is going to require effort and awareness on the child’s part. If the child experiences some success, he or she will be more motivated to take it to the next level.

      I hope that helps.

  60. Hello,

    I am a graduate student who would like to present on the progress one of my students made using EWR program during my internship. I need to discuss how research influenced the treatment approach. I was wondering if the study you mentioned in the book is available (San Diego Unified School District study). Thank you for your time!

    Sincerely,
    Lindsay Valentino

    • Lindsay,

      The basic findings of the research study are presented in The Entire World of R Book of Elicitation Techniques. That book was not intended as a research book, so if you need more detail or have questions, let us know and we’ll try and help.

      In short the research we did was a big driver on how the Entire World of R approach evolved. Prior to the research, I’d developed the basic outline of the 21 types of R for all the different vocalic r variations. To do the research, however, we need to record data. Realizing how specific and useful the data form was for pinpointing an intervention target, quickly evolved into the EWR Advanced Screening. This assessment looks at multiple instances of /r/ in just about every context.

      For a long time, many SLPs had the question of, “Where do I start with R?” The R Advanced Screening answers that question in a methodical and clinical manner. It also makes determining the present level of performance (How is the child doing? How is she responding to the intervention? ) much easier and clearer.

      The research study also led to the facilitation of selective (and effective) intervention techniques. For example, having a really solid intervention target (starting point) made the investment in a deep probe (the R Elicitation Probe) possible. It takes a long time to do the probe; so is the time worth it? The R Elicitation Probe looks at every conceivable vowel-consonant and consonant-vowel combination. It provides really useful information which can be used with specific intervention techniques such a employing nonsense words and cognate productions. The results of the research led directly to the linkage of specific techniques tied to assessment results. This revelation really systemized the Entire World of R program such that it took a lot of the “witchcraft” out of treating /r/ and allowed the treatment process to be more methodical by following a specific protocol.

      The other result of the research that I was surprised about, was that 100% of the 31 children in the study, generalized sounds. That is all the students had sounds correct on their own without any treatment! This really showed the value of sticking to just one intervention target. It’s the phonetic consistency in the treatment that allows the child to “get it.” The /r/ is difficult to produce and too often, treatment will jump around with multiple sounds. This is confusing and leads to confusion and frustration. What the research showed was that, sticking to just one target sound, might take a while–even a month or six weeks on only ONE sound. However, this effort is mostly front loaded, once success is achieved the research showed that for the most part, success with other sounds (relatively) quickly falls into place.

      Hope that helps. When you are done with your report, please share it. We’d be very interested to hear your findings.

  61. I am a fairly new SLP and am beginning to tackle my first difficult R client.

    I purchased and have been using the Elicitation Techniques book. From what I can gather most kids have at least 1 context where they are stimulable for R. I ran my kiddo through the screening and have not been able to find a scenario where he is successful.
    I’m not sure where to begin, we have tried the AR to begin exaggerating the [a] moving to the [r]. We have talked about retroflexed vs bunched tongue with hand cues. I think his tongue position is closest to bunched when attempting [r]. I’ve tried /kr, gr/ to help with tongue retraction as well as “sh” to help shape tongue (e.g. “sure”). So far I have not had any success getting him started.

    Do you have any advice on where to start?

    Thanks!!

    • You’re correct, the purpose of the The Entire World of R Advanced Screening, a portion of which is found in The Entire World of R Book of Elicitation Techniques is to find the best context of /r/.

      In cases where after evaluating all 32 /r/ and you still cannot find a stimulable production of /r/, you should try the Elicitation Probe, which is part of the advanced screening. This is a deep probe that evaluates every consonantal and vocalic combination (VC, CV, CVC) of /r/. You can take an educated guess based on the student’s productions of where you think you might find a successful production or else you can administer the entire screening. It takes a little time, but provides a wealth of information. Many times the combination that you’ll find is stimulable for /r/ is one that has no English equivalent, that is it’s a nonsense word, because the lexical patterning is broken by the unique combination.

      The goal with both the screening and the probe is to find a starting point. Often it will take some experimenting to find the best production. This is where the “art” of our craft comes into play. Don’t get discouraged. There is a good /r/ in there some where. Notice in this video how bad his productions where, but with some shaping he was able to successful produce a vocalic /r/ at the end.

  62. Can you let me know a source for the study done at San Diego Unified School district in regards to /r/ remediation using the phonemic approach. I am doing a Grad. project and would like ot use the article.

    Thanks!!

    • The basic results are found in The Entire World of R Book of Elicitation Techniques. I will send you more detailed information for your project.

  63. Christine,

    We are a family whose 8.5 y/o daughter is currently seeing a SLP for r. I have been doing some research on how to help her more at home and found your Website.

    We live in Hilton Head. I wonder: do you see patients privately or only work through the school system? We would love to have our daughter see you and with summer approaching, I thought it might be a good time to ask. You can use my email address to respond privately if that works better.

    Thanks
    Katy

    • I do see kids privately, however, you would need to be willing to drive out to Tybee Island, GA. Let me know if you are interested in the month of June 2011.

  64. Do you have any therapy technique ideas for a 10th grade girl who adds labial stridency to her /r/ sounds? I just started working with her this year but she has had therapy for years. Previous year reports state that she can say initial /r/ but can not produce vocalic /r/. In my work with her I think her /r/ in isolation is incorrect and that initial r words have a /v/ inserted ie rved/red. I need some help with lip dissociation/stabilization. I have tried to describe to her the problem but another concern I have is that she gets a little defensive and I don’t want her to feel overly self-conscious about her speech in case it does not improve much. Any therapy ideas or helps?

    • Dear Jan-
      In my opinion I feel that you need to do a more comprehensive screening such as The Entire World of R Advanced screening which can be found by clicking on the link. You will be able to see if your students uses this pattern with all types of /r/ allophones or just with prevocalic /r/.

  65. Hi, I am a student majoring in English Language studies and I came across your website by accident when I was researching Labov (who researched the connections between pronunciation of the post-vocalic /r/ and social class in New York in the 1960s).

    I am English and in the majority of British accents we do not pronounce the post-vocalic /r/, i.e. at the end of words such as ‘car’ and ‘far’ the /r/ is not enunciated like it is in American accents. Basically, in Standard English pronunciations, we do not pronounce /r/ after vowels.

    According to Labov, the post-vocalic /r/ is socially prestigious in American accents (apparently not pronouncing the post-vocalic /r/ was considered ‘vulgar’ at one point) and is the standard pronunciation so I was wondering if your program is designed to ‘treat’ children who pronounce /r/ in the British way? If so, do you think this is at all to do with social reasons/class?
    Thanks.

    • Dear Grace- The Entire World of R program found on the Say It Right website can be adapted for all accents. The program was designed based on standard American English.

  66. I have an 8 year 10 mth old male student that was evaluated last year by another SLP in the school district and he did not qualify at that time. Our district does not qualify for a mild delay. The ARD committee requested speech testing again this year. Language skills are WNL and on the GFTA – 2 he only had 2 errors on the words presented giving him a SS of 100. The problem is that he has errors on the the vocalic r’s in conversational speech and words not on the GFTA (/ar/, /er/, /or/, /air/, /ear/, /ire/, /rl/). He is producing all prevocali r’s and his producing r in all initial blends(br, fr, gr, etc). Since he is almost 9, how would you address the misarticulations? Would you qualify him for speech and pick him up, or could you do some RTI interventions?. This is a tricky situation.

    • Hi Brian-
      To qualify a student for articulation therapy what many SLP’s do is administer The Entire World of R Advanced Screening and report the results along with the result of the GFTA. You could also do some RTI interventions with specific /r/ allophones and word positions.

      Good luck, Christine

  67. Hello,
    I am a parent of a 71/2 year old boy. He has difficulty pronouncing the er/ir sound as in bird, dirty, bigger.
    He pronounces it as “or”. It comes out bord, dorty (with the r very soft). How can I help him as he is getting frustrated by people laughing when he talks. Thanks for the advice.

  68. Hi Ms. Ristuccia,

    First of all I wanted to let you I really enjoy your products and have found them to be very useful. I am currently re-evaluating a 6th grade student that I see of articulation therapy…only the /r/ sound. He has been receiving articulation therapy all through elementary school, but I have only been working with him for the past three months. I have completed the “Advance Screener” (I don’t have it in front of me, since I am working from home right now) but he definitely has some perfect /r/ contexts and others that are far from perfect. I am struggling regarding what to do next. These are the factors that I am considering when determining the next step:
    1.)He is a very bright young man and very motivated, however it is evident that he is feed up with working on his /r/ sound. On the very first day he explained to me that he has been working on the same thing for many years with minimal progress.
    2.) He has a very distinct overbite.
    3.) He has very mild cerebral palsy (I can’t recall the exact type), which only appears to impact his fine motor skills.

    I thought I recalled reading something in your work about the impact of anatomy on a misarticulated /r/…but I can’t find it now. Would you be able to lead me to information regarding that topic? I have tried a google search but haven’t been able to figure out the best search wording to use that leads to the information I need. Any other information you can provide regarding this situation would be very much appreciated.

    Thanks for your help,
    Stephanie

    • Hi Stephanie-

      In my opinion if your student was able to produce any of the /r/ sounds found on The Entire World of R Advanced Screening then I would say that he does not have a structural abnormality or abnormal anatomy.
      I would re-screen the student to determine correct and incorrect productions so you can determine which target (s) you are going to work with in the remediation process.

      Good Luck!

      Christine

  69. Hi,

    My son has difficulty producing the or and ar sounds in all three positions. He sounds very gutteral and even dips his chin down for better placement. He can correctly pronounce all other r sounds, but is not yet carrying them all over to his everyday speech. Do you have any suggestions for the tricky or and ar words, and ways to help him carry over his successful r sounds to his every day speech?

    Thanks,
    Ellen

    • Dear Ellen-

      Does he dips his chin and sound gutteral for the other /r/ sounds? He may be using an unnatural tongue position which may be the cause of
      sounding guttral and dipping his chin. The Entire World of R Book of Elicitation Techniques would be a great resource for determining the
      natural tongue position and there are also lists of facilitating contexts for the various /r/ sounds.
      Good luck!

      Christine

  70. Hello,
    I have a student who sounds hyponasal when producing the vocalic /r/ in ar (all positions), er (medial stressed and unstressed) and OR. His advanced screening results indicated a 0-20% on all of these sounds and 100% on the others. I have suggested he visit the ENT since he is also snoring and my best guess is that he has enlarged adenoids. He is in 6th grade and all of his past teachers say he always sounds like he has a cold (I am the new SLP to the building).
    His tonsils are larger than normal but not enough that they would touch midline when phonating. I am at a loss as he is not making improvement in these sounds even when we try to “relax” his muscles (a different SLP suggested that he is just “over therapised” and needs to decrease the tension in his throat.). I have tried to see if changing the way he produces the /r/ alleviates some of this sound but it does not and it is obvious that it is not his natural way of production. He naturally produces a retroflex /r/. Any help would be greatly appreciated or if I need to stop seeing him in therapy until he is seen by an ENT. I just don’t know what to do or where to go next with him. I also see him 5-10 min 4x/week.

  71. Hi Mrs. R,
    I’m a college student who is hoping to enter the speech therapy profession. Another passion of mine is yoga and I was hoping to incorporate both of my loves into one by getting my yoga instructor certification as well. My problem is that the programs I have found are all a year long and I am constantly moving from one place to another. I have had people tell me to wait until I am in graduate school but I am very ambitious and want to get it done ASAP. Another option of mine was to get my certification through an at-home program that I can order offline, however I am not sure how reliable that would be. What is your take?
    Thanks,
    Dora

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