We use the words "speech" and "language" to refer to different things:

Speech: The physical act of making sounds and saying words.

Articulation: Mouth movements to create speech. Making speech errors is a natural part of acquiring language. For example, a child may say "wed" instead of "red". An SLP's role is to teach the mouth movements needed to change errors that don't disappear over time.

Fluency: Rhythm of speech. Disruptions in speech fluency (disfluencies) are a normal part of everyday speech. People who stutter tend to have a greater number of disfluencies, and specific types of disfluencies. An SLP's role may include strategies to manage stuttering and counseling.

You may also hear this word when talking about reading fluency; this is the ability to read quickly, accurately, and with appropriate expressiveness. Reading fluency can be impacted by speech fluency. 

Voice: Using the vocal cords and breath to create sounds for speech. Voice disorders are diagnosed by an otolaryngologist or Ear Nose and Throat doctor (ENT). An SLP's role is to teach healthy voice habits and practice after receiving that diagnosis.

Language: How we use and understand language.

Receptive Language: Understanding what is heard or read by using knowledge of the rules of language, meanings of words, and social conventions of language.

Expressive Language: Organizing thoughts into speech or writing by using knowledge of the rules of language, meanings of words, and social conventions of language.

Pragmatic (Social) Language: Using language in a manner that matches the social setting, situation, and communication partners. Requires knowledge of social conventions, cultural norms of communication, nonverbal communication (e.g., tone of voice, facial expression, implied meanings, etc.), and more.  

Speech-Sound Disorders

Though many of us make the movements of speech without thinking twice, speech is a very complex physical feat. Coordination of the tongue, teeth, lips, soft palate, and other articulators is needed to shape air from your lungs into speech sounds. 

Mispronouncing words is a natural part of a child's speech development. Children gain more control of their articulators as they grow, and their speech sounds gradually become more "adult-like" with time. This is an ongoing process in early childhood, and each child learns at their own rate.

Certain sounds tend to emerge sooner than others. It may be developmentally appropriate for a child to make errors on sounds that develop later. For example, it's not unusual for a 3-year-old to have difficulty saying R sounds - R sound errors are developmentally appropriate for a 3-year-old.

When speech sound errors persist beyond the age when most same-age peers have outgrown them, we may be seeing a speech sound disorder.

When do we consider school-based speech services?

When speech errors make it difficult for a student to fully participate in their general education classroom, school-based intervention may be considered. This can look like...

• Significant difficulty being understood by peers and adults
• Speech errors reflected in spelling / when sounding out words
• Avoidance of speaking situations
• Increasing frustration when they are not understood
• Difficulty connecting socially with peers

What does speech therapy for articulation involve?

• Students practice hearing the difference between their target sound and error sounds.
• Students receive instruction to adjust their articulators and change their speech sounds.
• Students practice internal awareness to understand how their articulators are moving. 
• Students practice their target sounds in increasingly challenging contexts:
  • In isolation - the sound by itself
  • Single words
  • Short phrases
  • Sentences
  • Connected speech (e.g., short responses, longer conversations)

Why do SLPs put slash marks around letters? (e.g., /r/, /t/)

In articulation therapy, we target phonemes (the distinct speech sounds in a language's sound system), not letters from the alphabet. To avoid confusion between spelling and speech sounds, we use the International Phonetic Alphabet (IPA), which assigns one symbol to one sound. Slash marks show we are talking about speech sounds specifically.  

Each IPA symbol represents a sound:

Some letters make different sounds in different words ("a" in rat and rate). 

• Rat → /ræt/
• Rate → /rɛɪt/

Some letters make the same sounds as other letters ("c" and "k" in cat and king).

• Cat → /kæt/
• King → /kɪŋ/

Some letter combinations make a single sound ("sh", "th", "ch").

• Shoe → /ʃu/
• Thing → /θɪŋ/
• Chin → /ʧɪn/

 

Augmentative and Alternative Communication (AAC)

Frequently Asked Questions

What is AAC?
When a person’s verbal speech doesn’t meet their everyday communication needs, they may add AAC to support their speech (augmentative) or use AAC instead of speech (alternative) to express themselves. 

Who uses AAC?
AAC is used by people with complex communication needs. This may be because of a developmental condition that’s present from birth/early childhood (e.g., autism or cerebral palsy) or a condition acquired later in life (e.g., traumatic brain injury or stroke). People of all ages and physical ability use AAC. It's not unusual for people with verbal speech to also support their communication with AAC.  

Is AAC the same for everyone?
AAC is based on a person’s unique communication needs. This is informed by their physical ability, communication partners, personal interests, and more. Even people experiencing similar challenges may use AAC in completely different ways - it all depends on what works best for their needs and communication style. 

What kinds of AAC are there?
AAC comes in many forms, including...

• High-tech: runs on electricity, may have a speech generating feature (voice output)
• Low/light-tech: non-electronic tools such as communication boards, writing tools
• "No-tech": requires no external tools; gestures, facial expressions, manual signs or American Sign Language (ASL)

Does using AAC mean giving up on verbal speech?
The introduction of AAC does not mean the end of practicing other modes of communication. All are legitimate forms of communication, and a student's educational team works together to find the combination that works best for their unique communication needs. 

The Total Communication approach is "a holistic approach to communication that promotes the use of all modes of communication, including sign language, spoken language, gestures, facial expressions, and environmental cues such as pictures and sounds." (ASHA)

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External Resources for AAC
All external links on this page are being provided for informational purposes only; they do not constitute an endorsement from the Mercer Island School District of any of the products, services, or opinions of the corporation, organization, or individual.

American Speech-Language-Hearing Association (ASHA) AAC page:
https://www.asha.org/public/speech/disorders/AAC/

Communication Bill of Rights (ASHA):
https://www.asha.org/NJC/Communication-Bill-of-Rights/

Augmentative communication and early intervention: Myths and realities.
By Maryann Romski & Rose Sevcik (2005)
https://depts.washington.edu/isei/iyc/romski_18_3.pdf

PrAACtical AAC (blog for professionals and families):
https://praacticalaac.org/

Parent’s and Teacher’s Guide to Getting Started with AAC (blog post):
https://www.speechandlanguagekids.com/teach-your-child-to-use-an-aac-device/

Talking with Tech (podcast by SLPs):
https://www.talkingwithtech.org/

What is Core Vocabulary?

Words can be separated into two broad categories: Core Words and Fringe Words.

Core Words are the seemingly simple words that actually make up most of what we say in our daily lives. These versatile words tend to be verbs, pronouns, prepositions, and adjectives. Core words can be applied to many situations and for many purposes. 

• Eat, ask, want, go
• They, I, we, our
• Under, on, out, beside
• Green, bright, small, hot

Fringe Words are what we may first think of when we imagine "vocabulary". They tend to be nouns, and can provide specificity and detail to what we communicate. Fringe words can often only be used in specific situations.

• Birthday, daffodil, science, chair, elephant, cellphone...

We can use the core word "go" in many situations:

• We will go home.
• Go away!
• Let's go eat lunch.
• Are you ready to go?

A fringe word like "birthday" is mainly used only when talking about birthdays:

• It's my birthday!
• Did you know their birthday was today?
• Here is your birthday present.
• Please come to my birthday party.

Why do we use core words in therapy?

"...it is easy to find pictures of nouns and to teach those [fringe word] concepts. It is easier to find a picture of a school bus or a bag of popcorn than a picture that describes the abstract concept of “go” (Adamson, Romski, Deffenbach, & Sevcik, 1992). However, when a student knows what “go” means and has that word available on a communication board, the impact on communication ability is far greater than that of accessing a series of nouns."
(Canon & Edmond, 2009)

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External Resources for Core Vocabulary
All external links on this page are being provided for informational purposes only; they do not constitute an endorsement from the Mercer Island School District of any of the products, services, or opinions of the corporation, organization, or individual.

A few good words using core vocabulary to support nonverbal students. by Cannon, B., & Edmond, G. (2009). The ASHA Leader, 14(5), 20-23.

What Are Core Words? Vocabulary to Increase Communication by Rachel Madel SLP (YouTube)

Let's Teach Core resources for teaching individual core words from Saltillo (communication device/app manufacturer)

Let's Learn! Core Word "More" by Special Vids for Special Kids (YouTube)

STUTTERING

Fluency refers to the rhythm of speech. Disfluencies are disruptions in speech fluency, such as...

• Interjections – "She um said she'd be back later ."
• Repeating whole words – "The popcorn, popcorn was the best."
• Repeating phrases – "I think-I think it's under the table."
• Changing words – "I had–I already drank the juice."
• Not finishing a thought – "They said we should go...Aah, I forgot where."

The examples above are a typical part of everyday speech - not stuttering. 

What is stuttering?

Stuttering is a complex communication disorder that involves involuntary interruptions in a person's rhythm of speech. People who stutter tend to experience a greater number of disfluencies than people who do not stutter. Stuttering disfluencies might sound like...

• Repeating part of a word – "C-c-can we go again?"
• Repeating a syllable – "I'll ta-ta-talk to her."
• Extending sounds – "He's good friends with my mmmmom."
• Blocks of silence – "I th- [silence with apparent struggle to get sounds out] -ink so."

While it is still a growing area of research, it is understood that the cause of stuttering is related to a person's neurological makeup (brain differences) and genetic makeup (family history). 

Stuttering is NOT caused by...

• Anxiety / nervousness 
• Fear of public speaking
• Breathing problems 
• Not knowing what to say
• Speaking too fast

These things may co-occur with stuttering, but they are not the cause of stuttering. For example, a person might stutter more when they feel nervous, but there's a good chance they will also stutter when they are completely calm and relaxed. Because of this, suggestions such as "take a breath", "calm down", or "slow down" are not helpful, and can feel patronizing. 

What does stuttering treatment look like?

Speech therapy can support a person who stutters in a few ways:

• Direct interventions - adjusting manner of speech to support effective communication
• Indirect interventions - adjusting the communication environment
• Counseling - addressing the social and personal challenges associated with stuttering

The ultimate goal of stuttering therapy is not necessarily to eliminate disfluencies, but to give the person who stutters the tools they need to continue communicating with confidence.

Stuttering Etiquette: 

DO focus on the person's message instead of their manner of speech.

DO NOT try to guess or complete words / sentences for them. 

DO use active listening skills and attentive body language to