Treatment strategies for /r/ distortions (Preston et al., 2020)

Purpose: This tutorial summarizes current best practices in treating American English /r/ distortions in children with residual speech errors.

Method: To enhance the effectiveness of clinicians’ cueing and feedback, the phonetics of /r/ production is reviewed. Principles of acquisition, which can inform how to practice /r/ in the early stages of therapy, are explained. Elements of therapy that lack scientific support are also mentioned.

Results: Although there is significant variability in /r/ production, the common articulatory requirements include an oral constriction, a pharyngeal constriction, tongue body lowering, lateral bracing, and slight lip rounding. Examples of phonetic cues and shaping strategies are provided to help clinicians elicit these movements to evoke correct /r/ productions. Principles of acquisition (e.g., blocked practice, frequent knowledge of performance feedback) are reviewed to help clinicians structure the earliest stages of treatment to establish /r/. Examples of approaches that currently lack scientific support include nonspeech oral motor exercises, tactile cues along the mylohyoid muscle, and heterogeneous groupings in group therapy.

Conclusion: Treatment strategies informed by phonetic science and motor learning theory can be implemented by all clinicians to enhance acquisition of /r/ for children with residual errors.

Supplemental Material S1. Sagittal ultrasound images of the tongue depicting distorted /r/ and correct /r/ productions from children.

Supplemental Material S2. Electropalatography images showing tongue–palate contact during distorted /r/ and correct /r/ productions from children.

Supplemental Material S3. Examples of cueing and feedback strategies implemented in treatment with children with /r/ distortions.

Supplemental Material S4. Introducing /r/ to clients: Figures (see Appendix).

Preston, J. L., Benway, N. R., Leece, M. C., Hitchcok, E. R., & McAllister, T. (2020). Tutorial: Motor-based treatment strategies for /r/ distortions. Language, Speech, and Hearing Services in Schools. Advance online publication. https://doi.org/10.1044/2020_LSHSS-20-00012