Min, Mod, and Max Cues: What does it all mean?

 

When a child begins therapeutic services, long-term and short-term goals or objectives are developed as a way to guide therapy and gauge progress. If your child is already partaking in speech, occupational, physical, or developmental therapy, you’ve probably seen the words “minimal,” “moderate,” or “maximal cues” written in his or her goals. Amongst sometimes “wordy” goals, it can be difficult to interpret meaning of the specific objective, let alone understand what exactly a “cue” means.

What is a cue?
When helping a child reach his or her therapeutic goals, a “cue” is simply something that is going to aid in that child’s success. When I am providing speech therapy to a child, my goal is ALWAYS for that child to be successful; however, the number and type of cues that child needs to be reach his or her goal may vary. Think of a cue as a hint; as a child becomes familiar with the goal, he or she is going to need less “hints” to be successful and, thus, will become more independent. As a child progresses in therapy, the quantity of cues required for a child to effectively complete an objective will decrease. This is one way that therapists gauge a child’s progress.

What types of cues are there?
Generally speaking, many therapists use tactile, visual, or verbal cues in therapy tasks. Each category of cues has several variations:

Tactile cues: Tactile cues are used when a therapist uses physical touch to guide a child towards successful completion of a therapy objective. In speech therapy, this may be demonstrated by gently touching under a child’s chin in an attempt to help produce the /k/ or /g/ sound, or gently tapping a child’s hand to help him or her produce the correct number of syllables in a word. In occupational or physical therapy, the therapist may tap a child’s arm/leg to remind a child to use that specific body part.

Visual cues: Visual cues are used when a therapist provides a visual reminder that helps the child complete his or her task. In speech therapy, this may be as simple as drawing a snake to remind a child to use his “snake” sound to produce /s/; the therapist may tap the picture if the child omits this sound. Gestural cues are a specific type of visual cue; when targeting this same sound, the therapist may run her finger down her arm to demonstrate the long, fluid motion of /s/. Have you ever used a sticky note to remind you to complete a specific task? That’s an everyday example of a visual cue!

Verbal cues: Verbal cues are used when a therapist provides a verbal reminder that helps the child complete his or her task. Using the same /s/ example as outlined above, the therapist may say, “don’t forget your snake sound!” One specific example of a verbal cue is called a phonemic cue. If a child is working on asking for “more,” the therapist may cue the child by vocalizing “mmm.” A carrier phrase is another form of a verbal cue. Instead of using the phonemic cue, “mmm,” the therapist may say, “I want ____” to encourage the child to finish the phrase. A verbal model may be provided if verbal cues are simply not enough at that time; in this example, the therapist may model the word, “more” before handing the child the desired item.

What does “min,” “mod,” “max” mean?
Now that you have a better understanding of the types of cues used in therapy, what does “min,” “mod,” and “max” mean?

“Min,” “mod,” and “max,” stand for minimal, moderate, and maximal. When developing goals, therapists determine how much cuing a child realistically needs to reach his or her goals. Ideally, the level of cuing necessary decreases as a child participates in therapy. While the criteria of minimal, moderate, and maximal is fairly subjective, many therapists determine that minimal cues are used approximately 25 percent of the time, moderate cues are used approximately 50 percent of the time, and maximal cues are used approximately 75 to 100 percent of the time. Therapists may also report using “faded” cues, which means a child may have required moderate cues as the session started, but required minimal cues as the sessions progressed.

Can I “cue” my child at home?
Of course you can! In fact, you’re probably already cuing your child and you may not even realize it. When your child is about to do something undesirable, do you ever catch yourself counting, “one, two, three…?” You just gave your child a verbal cue, which helped him or her to reflect on his or her behavior and (ideally) change it accordingly. If your child is currently receiving therapeutic services, ask his or her therapist for ideas to best cue him or her to reach his or her goals.

Questions or concerns?
If you have questions or concerns about your child’s therapeutic goals, please don’t hesitate to ask his or her clinician for more information. If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Photo Credit: Heriberto Herreravia via freeimages.com

Speech and Language Opportunities on the Road

Looking for some ways to work on your child’s speech and language while in the car?

Stuck in gridlocked traffic is not fun, but you can make it a little more interesting by working on your child’s speech and language skills while in the car! Below are some easy ways to work on your child’s speech and language development that do not require a phone, iPad, or any physical toy. Reduce the noise in the car and tune into your child during your next drive!

12 months to 24 months

-Sing songs! Some great songs to sing include Twinkle Twinkle Little Star, Row, Row, Row your Boat, Old McDonald, Five Little Monkeys Jumping on the Bed, Itsy Bitsy Spider, Wheels on the Bus, BINGO, Baby Bumblebee,If You’re Happy and You Know It, andBaby Shark.” As your child gets older you can leave out words at the end of phrases (“…Twinkle twinkle little _____”) to see if your child can fill them in!

-Model environmental sounds like “wee, woah, uh-oh, vroom, beep-beep” while driving. Make your sounds exaggerated and silly to capture your child’s attention!

-Name things you see during your car ride! Label objects you see as you pass them by.

-Phrase “Ready, set, ____ (go)!” when you start/stop at a red light

-Make silly sounds as you drive to see if your child can imitate you

24 months to 36 months

-Continue to name things you see during your car ride! If your child labels something they see as you are driving you can expand on what they say. For instance, if your child said “truck” you can model “red truck.”

-Model simple location phrases such as “in, on, under.” For instance, “doggie inwater” or “car onroad”

-Target basic concepts:

-Model the words “open/close” and “in/out” as you open and close doors and get into or out of the car

-Model a variety of action words as you drive such as “go, stop, drive, park, turn”

-Look for and identify objects that are “big” vs. “small”

-Work on quantity concepts as you drive, such as onecloud vs. manyclouds in the

-Talk about the colors of cars around you

-Talk about the types of cars you see (e.g., semi-trucks, cars, construction vehicles)

3 years to 4 years+

-Play “I spy” to work on labeling and naming things that you see and drive past

-Model more complex adjectives and more advanced location concepts as you drive.

-Ask your child a variety of wh-questions while driving such as “Where are we going?, What are we doing?, When did we leave?, What are we doing when we reach our destination?, What is mom/dad doing?, What are we making for dinner? Why are we going grocery shopping, etc.” If your child responds with a single word see if you can give them two choices or model a longer phrase. If they use vague and non-descript language such as “this, that, right here, etc.” provide them with two choices to see if you can promote your child’s use of more descriptive language.

-Play the Grocery Storegame: Have an adult start. “…I went to the grocery store and I bought _____ (apples). See if your child can repeat the item just said and add one to it. For instance, “I went to the grocery store and I bought apples and stickers.” You can provide hints if you don’t think your child can recall what was said last. When it’s too hard start again from the beginning!

-If your child is working on speech sounds you can practice their sounds in the car! Pick several words with the target sound and say it every time you stop at a red light or every time you see a certain object or item such as a tree.

-Tell your child that you’re thinking of an object that starts with a certain sound such as “b.” See if your child can think of things as you drive that start with that letter.

-Promote appropriate grammar and sentence structure. If you notice that your child made a grammatical error model their sentence with correct grammar and sentence structure.

-Talk about letters or numbers you see on license plates

-Talk about categories (e.g., types of transportation that you pass, types of weather, types animals you see, etc.)

Questions or concerns?

If you have questions or concerns about your child’s speech and language development, please contact us at info@playworkschicago.com or 773-332-9439.

Samantha Labus, MS, CCC-SLP
Speech-Language Pathologist

Photo Credit:Sandy Millar via unsplash.com

Is Articulation Therapy Appropriate for My Toddler?

My toddler’s speech isn’t 100% clear, and his preschool teachers say that they have a hard time understanding him. Should I be concerned?
Let’s set the scene: Your child walks up to you and says “mohmik peas,” and at first you don’t have a clue what they are trying to tell you! But by using the clues in your environment and by observing their gestures, you eventually figure out that they requested “more milk please.” You were able to meet your child’s needs (getting them more milk) even though they did not produce all of the correct sounds in each word. So are their speech sound (i.e. articulation) skills something to be concerned about?

As your child produces new words and phrases you might be noticing that their speech is not 100% clear. Your child’s speech clarity, also referred to as intelligibility, is your child’s current production of sounds which impacts how others can understand them. Intelligibility for a two year old should be approximately 50% to an unfamiliar person. By three-years of age your child should be approximately 75% intelligible, meaning that you should understand at least seven out of every ten sentences that they produce. It is important to remember that as your child is learning how to talk they may not sound exactly like an adult would, and that’s typical! In general, your child should be using a variety of consonants and vowels at two- to three-years of age but there is variability speech sound development.

Speech sound development: What should I expect?
Not all speech sounds are alike! Some speech sounds are considered early developing sounds, while others might develop when your child is older due to the complexity of oral movements required to make that sound. Early developing sounds include: “p, b, m, n, w, t, d, h.” Later developing sounds include: “sh, s, z, l, r, th.” Later developing sounds may be substituted with a different sound at two- to three-years of age due to their motoric complexity.

“So you’re saying that not all speech sounds need to be mastered by three-years of age?” That’s right! At three-years of age it is possible that your child may be substituting different sounds in real words, such as “wed” for “red,” and this is age-appropriate! At the age of three, a “w” for “r” substitution would be considered a developmental error, or an error that does not require direct therapeutic intervention. The majority of developmental errors will correct themselves as your child’s language and articulation skills develop.

What are phonological processes?
Phonological processes are patterns children use to simplify their speech as they are learning how to speak. For instance, your child may be saying “back” for “black.” Each phonological process is considered age-appropriate until it persists past a set age of elimination (the age in which the majority of children no longer present with that specific error pattern). The majority of children will correct their own speech and no longer use phonological process substitutions as their language and speech sounds develop. (Please see resources listed below to view an age-appropriate phonological processes chart.)

Is your child ready for articulation therapy?
Articulation therapy uses a hierarchical approach to master target speech sounds. For instance, you may first practice the sound “f” in isolation, or by itself, and then progress to practicing “f” with a vowel such as “fee” or “foe.” Articulation therapy requires your child to have the ability to follow directions given by the therapist, tolerate a variety of cues to help support appropriate production of their target speech sound, pay attention to the therapist, and imitate what the therapist is saying. At two years of age, your child’s attention span is shorter than a three- or four-year-old’s attention span, and they may become frustrated by some of the direct cueing provided during traditional articulation therapy. One critical component of articulation therapy is avoiding negative practice, or practicing your child’s target speech sound the incorrect way. Your child’s therapist wants to avoid negative practice because they want to support and encourage the accurate production of the speech sound and not have your child continue to practice incorrectly. A child who is not ready for articulation therapy is a child who is unable to follow directions provided by a therapist, unable to pay attention to a therapist’s face, or is unable to imitate what a therapist is saying.

Should my two-year old be receiving articulation therapy?
If you feel like you understand your child approximately 50% of the time, but notice that there are some sounds that are not the same as an adult’s production they may be using age-appropriate substitutions and/or phonological processes. For instance, if your child is deleting the end of words (final consonant deletion) at two years of age this is considered an age-appropriate phonological process that is typically eliminated around three years of age. In addition, at two years of age children are still learning how to use language and are increasing their phrase length and vocabulary, which are both age-appropriate skills to promote and target with a two-year old. If at two years of age you feel like your child is not using a variety of vowels or consonants, or you feel like producing speech sounds is effortful, your child may be a candidate for a speech and language evaluation.

So what can you do to help support your two-year-old’s speech intelligibility? Your mouth is a great cue for your child! Several early developing speech sounds can be seen on the lips and this visual cue makes it easier for your child to imitate you. For instance, “p” and “b” both require your lips to come together before making sound. Children learn a lot by what they see, so hold objects and toys near your face to encourage them to look at how your mouth is making sounds. You can also talk slowly and prolong different sounds to help your child imitate new sounds they may not be using such as “mmmma-mmmma” for ‘mama.’

Should my three-year old be receiving articulation therapy?
If your child is three years old or older and you feel like their intelligibility is less than 75%, have difficulty producing early developing speech sounds, have a limited variety of vowels, or are using phonological processes that are no longer considered typical for their age, your child may be a candidate for speech and language therapy. If you have concerns regarding your child’s articulation skills, talk to your speech-language pathologist or schedule an appointment for an evaluation.

Some things you can try at home include:

  • Encourage your child to look at your mouth! Your mouth is a great cue for your child to look at as you model a new sound.
  • Model the word with the correct sound for your child to hear the difference. For instance, if your child says “bid” for “big,” you can model the correct word “big” after your child’s attempt.
  • Tap or clap out syllables to promote the inclusion of all syllables in a word. Tapping or clapping can help your child know the exact number of syllables in the word, which can facilitate inclusion of all syllables within a target word. A word is much easier to understand when all of the syllables are produced clearly and do not run into the next word in a sentence!
  • Give your child two verbal choices to choose from if you’re having a difficult time understanding your child. By providing your child with two verbal choices for them to imitate you know what they are trying to say, even if their sounds don’t come out just right!. Also, it may be easier for your child to imitate one of the two choices you give rather than produce the word on their own.
  • If you notice that their speech sounds are ok in single words, but are incorrect when they try to produce a full sentence, try to decrease the number of words in your child’s sentence and have the imitate it back to you. For instance, your child attempts to produce a four-word phrase such as “puppy drink more water,” however, there are multiple words that are challenging to understand. You can model a shorter, three-word phrase such as “drink more water” to aid with increased intelligibility.

Resources:
Visit Mommy Speech Therapy to download the phonological processes chart!

Questions or concerns?
If you have questions or concerns about your child’s speech and language development, please contact us at info@playworkschicago.com or 773-332-9439.

Samantha Labus, MS, CCC-SLP
Speech-Language Pathologist

Reference:

Fabiano-Smith, L., & Goldstein, B. A. (2010). Early-, Middle-, and Late-Developing Sounds in Monolingual and Bilingual Children: An Exploratory Investigation. American Journal of Speech-Language Pathology,19(1), 66-77. doi:10.1044/1058-0360(2009/08-0036)

Sander, E. K. (1972). When are Speech Sounds Learned? Journal of Speech and Hearing Disorders,37(1), 55-63. doi:10.1044/jshd.3701.55

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