sojourn (SOH-jurn):

/ˈsoʊdʒɜrn/ 
noun 1. a temporary stay: during his sojourn in Paris.
verb (used without object) 2. to stay for a time in a place; live temporarily: to sojourn on the Riviera for two months.

I am thrilled to have Mary Huston, Speech-Language Pathologist, as a guest blogger today!  She is the resident expert in Cycles for Phonology on Twitter and has been answering so many questions posed to her by other professionals that I invited her to blog about Cycles.  Happily for all of us, she accepted.  I thought I knew about Cycles and phonology until I met her and realized I don’t know nearly what I thought I did.  I hope that her post will enlighten you and help you with Cycles as much as it has helped me. ~Tanya

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Recently I have been asked several questions about Barbara Hodson’s Cycles Program for highly unintelligible children. I’m not quite sure how I became known as the “phono” person, but I will confess to a love of phonology. I also have the benefit of having been trained by someone who has worked closely with Dr. Hodson and will share some of her information as well as Dr. Hodson’s information.

I think the easiest thing to do is to start at the beginning and explain Dr. Hodson’s Cycles program. Cycles was designed to be used with highly unintelligible children and not with children with mild/moderate articulation errors2.

Let’s start at the first of many questions.

What’s the difference between articulation and phonology?

The easiest way to remember the difference between articulation and phonology is articulation is a “handful of errors” where phonology is much broader. It always surprises me to hear clinicians report a “severe articulation disorder” in children. Yes, I suppose it’s possible – but it’s important to look at the types and breadth of the errors to decide if it’s truly articulation or if it’s a sound-system disorder (aka phonological disorder).

Articulation is typically a placement disorder or distortions. The student has formed errors on phoneme placement. Most common of these of course is the /s/ and /r/ errors we have all come to know and dread. It’s important to realize that these are not classes of sounds – but rather certain sounds.

Phonology is a rules disorder1. For whatever reason, the child has not learned the rules of how sounds are made and which sounds can go together. The child will often omit sounds or substitute whole classes of sounds. These errors have a significant impact on a child’s intelligibility.

 Where do I start?

The first thing to consider is what errors are present. Dr. Hodson has a wonderful handout that explains the Primary Targets for Cycles therapy (available on the SLP Resource Share). Essentially, start with the first error the child shows that has the most impact on intelligibility. Let me say that again, start with what impacts the ability for the child to be understood first. 2

Omissions are the primary cause for concern and need to be targeted first2. If the child omits syllables – start there. If the child omits initial consonants, but has syllables – start at initial consonants. If the child can produce CV words but not CVC – start with final consonants. If the child has all of those – but can’t produce an /s/ cluster – start there. (Oh, and just to stave off the argument – I mean marking both parts of a cluster, not that the /s/ is distorted)

How do I pick the words I use? Is it really okay to only use 5-6 words?

It’s important to choose the words carefully, particularly for the first couple of cycles2. Assimilation is typically a major problem for clients with severe sound-system disorders so for the first few cycles we want to avoid words with their error sound in them. For instance, if a child is fronting and substitutes a /t/ for /k/ don’t use CAT as a target word. Use a neutral word such as COW or CAR or KING 2,4. The reason for limiting the number of words is two-fold. It gives the client the opportunity to be successful and to practice the words correctly. It also gives the clinician a break because it can be tricky coming up with good words. Keep the child interested by changing the activity. Most important is the client’s success. Cycles therapy is all about the child’s success. In fact, the clinician is supposed to provide enough prompts to have the child be 100% successful at all times and reduce the number of prompts needed as the skills emerge.

How long do I work with each sound?

According to Dr. Hodson, each phoneme or consonant cluster within a pattern is targeted for 60 minutes2. This can be tricky in the school system. What I typically do is work on each sound for 1 week (possibly 2) and then move onto the next sound. When you finish with one cycle meaning you worked all the way through /s/ clusters, /k, g/, and /l, r/ (yes, even /l/ and /r/)2, you “cycle” back through the sounds. Usually about the 3rd time through (2nd for those really quick learners) I start to introduce the carrier phrase of “It’s a ____,” and eventually sentences. When the student has “cycled” through all the target phonemes at least once, Dr. Hodson recommends mixing target phonemes within a pattern so each phoneme is targeted for 2-hours or more2. For instance work on /k/ and /g/ in the same sessions.

When do I work on /f/?

You don’t. Well, actually that’s not true. You do work on /f/ as a secondary target but only after the /s/ clusters are in conversation2, 3. The reason for this is 1) /f/ doesn’t generalize to other fricatives – you can work on /f/ until the cows come home and all you’ll get is /f/, but if you work on /s/ clusters they will generalize to all fricatives; 2) there’s a nasty little coalescence/assimilation1, 2 which can occur with /f/. Many times, kids with sound system disorders that have worked on /f/ will produce /f/ for /s/ clusters and it’s hard to break. Do yourself a favor – save /f/ for later.

When do I work on voicing errors?

Voicing errors are worked on as secondary targets only after /s/ clusters are in conversation and most of the other targets have had success at the word level2, 3. Voicing errors are annoying – and we notice them, but they don’t impact intelligibility nearly as much as the primary targets2.

I think that’s enough for now although I have the feeling I’ll be back later.

Happy Cycling. I look forward to hearing success stories.

Mary Huston, MS, CCC-SLP

Citations

 1Gordon-Brannan, M., & Weiss, C. (2007). Clinical management of articulator and phonologic disorders – third edition. Philadelphia, PA: Lippincott Williams & Wilkins. 

2Hodson, B. (2007). Evaluating & enhancing children’s phonological systems: Research & theory to practice. Greenville, SC: Thinking Publications.

 3Hodson, B. (2010). Potential optimal primary target patterns. Flowchart Handout provided via email.  (NOTE: This flowchart is available in the SLPeeps Resource Share folder in Google Docs under Artic/Phono subfolder).

 4Liddiard Buteau, C., & Hodson, B. (1989). Phonological remediation targets. Austin, TX: Pro-Ed.

gesticulate (je-STIK-yuh-leyt):

verb. /dʒɛˈstɪkyəˌleɪt/
1. to make or use gestures, esp. in an animated or excited manner with or instead of speech.
2. to express by gesturing.

After my last post I had a some comments via Twitter (Thanks @speechreka). I thought I would answer with my experiences and also add a dash of food for thought that came up on Twitter last week.

One comment was “I’d love to see something on good, useful first signs to teach.” I started with one or two signs that worked in different settings. It is important, however, to find highly motivating communicative signs – surrounding food, for instance. ‘Milk’, ‘eat’, ‘drink’, ‘more’, etc. This was true of my typically developing infant and when I use it for severe autism or similar non-verbal children. I think whatever sign is most motivating (and used for requesting) is key. I don’t think it matters WHICH sign, as long as the child would be motivated to use it to attempt to get something they want. Once a child recognizes the power of communication (through sign or speech), more communicative attempts and attention to language is almost inevitable.

This is where it gets tempting to use ‘more’ all on it’s own:

1) there is almost always an immediate response to using the ‘more’ sign (you get more of whatever you have been offered – food, game, book, etc) which makes it very rewarding in a well set-up situation.
2) it’s easy to model for the child and to help the child do hand-over-hand – some signs are not as easy to do hand over hand or are more complicated generally in their fine motor requirements. However, I always accept sign approximations, obviously, just as I would accept verbal approximations (e.g. “ba” for ball, bottle, or bath).

I admit that I HAVE used ‘more’ all on it’s own to attempt to have a child realize the power they can possess by actively communicating. Apparently that may not be the best course of action! Interestingly, only the day before my post, this conversation occurred on Twitter:

Food for thought. I have always been aware, in the back of my mind, that ‘more’ on it’s own is not helpful unless it is used in specific instances. Sometimes a child WILL attempt to request something out of the blue with ‘more’ and the logical question of the caregiver is: more what?

Obviously it’s not so clear cut about using ‘more’ as a first sign and can get you into some potential pitfalls. Please keep that in mind if you do introduce ‘more’ into a child’s sign (or spoken) repertoire and think carefully about when and why you are introducing it. If you do introduce it before the child can make 2-word combinations, be sure you have an ‘exit plan’ of sorts to ensure there isn’t overuse/overgeneralization that can lead to a communicative attempt that doesn’t communicate anything tangible!

I’d welcome any further thoughts, ideas and comments!

colloquy (KOL-uh-kwee):

noun. /ˈkɒləkwi/
1. a conversational exchange; dialogue.
2. a conference.

Being a speech-language pathologist, I am no stranger to using signs with young children. I have frequently taught signs to young children who are having difficulty speaking so they can communicate more effectively with their caregivers while they continue to develop speech skills. So, when I had my own baby, it only made sense that I would teach her signs as well.

I really enjoyed using the signs with my daughter, Emily. It was slow going at first – we had to use the signs a lot and for a long time while saying the words. I definitely had to be patient because she began using the signs much more slowly than my clients (since they were older and understood more language than her already). I’d say we began signing 3 specific words regularly when she was around 4 or 5 months old and she began using them back at around 7 or 8 months old. But once she began using them, it was fantastic. By the time she was a year old, she would sign words like eat, drink, milk, more, all done, bubbles, book, diaper, and bath. This helped us to know when she wanted or did not want something. For example, she might sign ‘all done’ at the dinner table or during an activity and you knew that she did not want to do that activity or eat anymore. Sometimes knowing when your child wants to stop an activity can be as valuable as knowing when they want to start. ‘Drink’, ‘eat’, ‘milk’, and ‘more’ were especially helpful surrounding wants and needs.

The other thing that my husband and I found really helpful with the signs was not just that she could initiate communication with us more specifically, though this was very helpful. We found that if she signed the words, it often solidified ideas in her mind and helped us to get through to her when she was not ‘listening’. For instance, if she was swinging at the park and it was time to stop and go home, having her sign ‘all done’ after we told her she was all done helped her to more happily get off the swing. I cannot express to you how magical this sometimes seemed.

I don’t feel that she developed spoken language skills more quickly because she was signing, as some people suggest. But the signs definitely helped to reduce frustrations for everyone when she could not yet speak or be understood. Conversely, signing definitely did not stop her from speaking in any way, as others have suggested. Once she was able to say words she did and sometimes signed the words at the same time as saying them. In fact, we were often glad for her signs because she began using them to clarify her spoken words when we didn’t understand her. When an 18-24 month old is speaking, it can be hard to tell the difference between words like ball, book, bird, and bath. Her signs clarified for us on many occasions.

Now Emily is two and a half and talks all the time – we no longer need the signs and they naturally dropped off over time. However, every once in a while we still catch her signing ‘more’ and ‘all done’ while saying it, especially if she is really excited or has her mouth full!