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PHONOLOGICAL REMEDIATION FOR CHILDREN WITH
COMMUNICATION HANDICAPS



This article attempts to show personnel working with hearing impaired children in a multi-disability programme, how to deal with a common difficulty in speech. Many communication disabled children, of whatever aetiology, exhibit confusion between pairs of sounds. Many hearing impaired children substitute oral sounds (/b/, /d/, /g/ resonated in the mouth) for nasal sounds (/m/, /n/, or /ng/ resonated in the nose) or vice versa; many children with cerebral palsy substitute plosive sounds (/p/, /t/) for fricative sounds (/f/, /s/, /sh/) due to an inability to control the precise degree of friction needed between the two articulators (upper teeth and lower lip in the case of /f/, and tongue and alveolar ridge in the case of /s/). Other children with cerebral palsy or immature phonology may substitute sounds made in the front of the mouth /t/ for a sound which should come from the back of the mouth /k/. For example, a hearing impaired child who has difficulty in producing nasal sounds, and who substitutes /b/ for /m/, says in English be for me; bide for mine; bodey for money; and bubby for mummy. In Tamil, this child might say abba for amma (mother) or barab for maram (tree). When dealing with these defects, it is important to work on one speech sound at a time. Teachers of hearing impaired children often race through correcting one sound after another, without systematically completing the tasks with one sound at a time. Speech is a process, and therefore needs to be developed in a systematic, developmental way. To this end, each of the following stages requires be achieved before the teacher moves onto the next stage in the process.

1. To start with, one gets a child to discriminate by hearing between two sounds, the target sound, and the sound that she is substituting, in this case /m/ and /b/. For younger children, pictures are used, usually an ice cream to represent /mmmm/ (an elongated m to help emphasise the difference), and a ball to represent /b/. One must stress here, that the teacher is not saying /ma/ or /ba/ as is common in Indian syllabic alphabets such as Kannada, Telegu and Tamil, but only saying the consonant without any following vowel. For older children, the written letter will suffice. The teacher should say each sound clearly, and point to the appropriate picture. Then repeat the sounds and get the child to point to the picture or letter of the sound which is said, without the child saying anything at all at this juncture. By stretching out /mmmm/, and shortening the sound of /b/ to make a more real comparison between the two sounds, discrimination between the sounds is not too difficult. This process is continued until the child can discriminate between the two sounds, even if the mouth is covered. In rare cases, where a child is so profoundly deaf that she cannot do auditory discrimination, she is encouraged to touch the face of the teacher to feel the difference between the sounds, the vibration in the nose for /m/, and the small puff of air coming out of the mouth for /b/.

2. In the next stage, ask the child to produce the sound in isolation (ie /m/), NOT as part of a syllable (i..e., /ma/, /mo/). With an older child, one might draw a picture of the mouth, and show the difference in the position of the soft palate which is raised for the oral sound /b/ and lowered for the nasal sound /m/. However, such a diagram will not help a younger child. Again, let the child feel the vibrations of the nose and cheeks as one says /m/ and the absence vibration during /b/. Encourage the child also to produce the sound /m/ while touching her own nose and cheeks. Teach the child the secondary differentiation between /m/ and /b/, that is /m/ can be prolonged and /b/ cannot be prolonged, but only repeated. Encourage the child also to "stretch out" /mmmmmm/ for as long as she is capable of doing.

3. From producing an elongated version of the target sound /m/, one can now move further. Often a hearing impaired child can produce a long /mmm/, but reverts to /b/ when a vowel such as /a/ is introduced immediately after /m/. This is due to the fact that the soft palate which was lowered to produce the nasal /m/ has to be quickly elevated to produce the oral vowel /a/. It is important not to progress too quickly here, but to break up the syllable, with a discrete pause between /m/ and /a/. It can be represented as /m......a/ in English, where there is a break between the two sounds. It may be represented by drawing many different coloured ice creams on the page, and writing on each one, /m....a/, /m....e/, /m....o/, /m....i/, /m....ai/, etc. for the child to practise saying each syllable. In syllabic alphabets, it is important to treat these sounds as two separate syllables, and to write them as such, instead of writing the more correct orthographic form. One would ask a Tamil speaking child to say /m/ followed by a short pause and all of the Tamil vowels, either long and short.

4. Now the child is ready to move on to saying syllables in the normal way of speaking: /ma/, /me/, /mo/, /moo/, /mi/, /mow/, /may/ or in the case of syllabic alphabets, all those syllables which start with /m/ followed immediately by a vowel. Once again, prepare sheets for the child to colour in as she practises saying these syllables. If at any stage she reverts to saying /ba/, or /bo/ etc, go back to stage 3 and repeat, making the pause between the /m/ and the following vowel gradually shorter.

5. Introduce normal short words beginning with the sound /m/ to the child now for her to repeat "my, me, more, milk, man, mouse, meal, mat", using such words as are likely to be within her vocabulary. Avoid using any word which contains the sound /b/ (or its voiceless counterpart, in this case /p/) which was previously being substituted, such as "maybe, map, mumps, mob, mop". It is too difficult at this stage for the child to be able to switch between the two types of oral and nasal sounds. Using these simple words, make short phrases for the child to repeat such as, Mummy made me drink more milk; Mary wants more mats; many mice are under the mat, and so on. Remember, you are only concerned with the sound of /m/ at the beginning of these words. Whatever else the child mispronounces should be ignored now, and dealt with much later, when /m/ is fully learnt and stabilised. Draw a picture to remind the child of the sentence, rather than asking her to repeat what one says as it is easier for her to remember /m/ correctly if she hears the teacher say it. The goal of these exercises is to produce the sound /m/ correctly by herself in the absence of a speech and language therapist or a teacher.

6. It is now time to produce /m/ at the end of words such as "Mum, him, aim, name, home, come" and so on. Most children will be able to imitate you if you slightly emphasise the final /m/. However, some children need extra help, and you need to repeat stages 3 and 4, i.e., /a....m/,/ee....m/, /o....m/, followed by /am/, /eem/, /om/ before tackling real words. Get the child to put a few words into a sentence such as "Mum came home". Again, avoid words with either /b/ or /p/ such as /pam/, /blame/, /broom/.

7. Now the child is ready to attempt /m/ in the middle of a word, such as, "Amy, hammer, farmer, coming, humming, foaming", and practise short phrases such as "the farmer is coming with a hammer"; "Amy and Mummy are humming".

8. After this, the child is ready for a barrage of sentences where /m/ can occur in any position such as "Mickey Mouse makes music on the mountain", "Mary and Amy came to my home", "Mummy gets milk from the farmer," and so on.

9. Only now, when /m/ is stabilised in the initial, final and medial positions, as demonstrated above, is it time to introduce the sound which was originally being substituted (i.e., /b/ or /p/), in words like "Pam, map, broom, album", where the new target sound is separated by a vowel from the earlier substituted sound.

10. At last, finally it is permissible to introduce words such as "camp, camping, hump, bump, emblem", and so on, where the two sounds are adjacent, and the child has to be very precise in what she says.

These ten stages can be followed to teach any sound which is being erroneously substituted with another. It is important to work only on ONE sound at a time, and to ignore mispronunciations of other sounds in words you are using to demonstrate /m/. Once you have worked through these 10 stages of /m/, it would usually be appropriate to apply the same methodology to a second common nasal/oral problem, such as the substitution of /d/ for /n/. It is invariably easier for children to work on sounds which are more visible than those which are less visible. Sounds made with the lips, /b/ and /m/ are more visible than those made with the tongue tip and teeth (or alveolar ridge), such as /d/ and /n/, which in turn are more visible than sounds made with the back of the tongue and the roof of the mouth, such as /g/ and /ng/. Similarly, if a child is having difficulty differentiating between voiced and voiceless sounds such as /b/ and /p/, /d/ and /t/, /D/ and /T/ and /g/ and /k/, it is better to start with /b/ and /p/, as they are more visible sounds. If the problem is failure to differentiate between plosive and fricative sounds, such as /b/ and /v/, /p/ and /f/, /d/ and /z/, /t/ and /s/, /T/ and /sh/, it will become easier for children to see what they are doing if one targets the more visible pair /b/ and /v/ first. As is always the case with rehabilitation, this structured method of teaching speech sounds works better if some of the child's family members are included in practising this therapy regularly.

FUNCTIONAL ACADEMICS FOR STUDENTS WITH MENTAL RETARDATION
- A GUIDE FOR TEACHERS

Authors: Vijayalakshmi Myreddi, Jayanthi Narayan

This guide is designed to train children with mental retardation and slow learners in special school and general school settings. It provides steps for systematic training to develop functional literacy.

Available from: Department of Special Education, National Institute for the Mentally Handicapped, Manovikasnagar, Secunderabad - 500 009, India.

Joanna Gill
Faha, Dripsey, Co. Cork, Ireland.
E-mail: jgill@iol.ie



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Friday Meeting Transactions
Associate Publication of Asia Pacific Disability Rehabilitation Journal
Vol.1 No.2 1999

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