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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: https://doi.org/10.23641/asha. 12771329
For some children with speech sound disorders, distortions of American English /r/1 can be difficult to correct and may persist for years (Flipsen, 2015). A number of child and clinician factors may play a role in treatment outcomes for these residual speech errors (e.g., Kwiatkowski & Shriberg, 1998); however, implementing scientifically informed cueing and practice strategies for /r/ may help remediate these errors during therapy. A host of research has used instrumental approaches to elucidate the complex articulatory actions of correct and misarticulated /r/ through technologies such as ultrasound imaging of the tongue (e.g., Klein et al., 2013; Modha et al., 2008; Preston, McAllister Byun, et al., 2017), cineradiography (Delattre & Freeman, 1968), electropalatography (EPG; Hitchcock et al., 2017; Schmidt, 2007), magnetic resonance imaging (MRI; Boyce, 2015; Tiede et al., 2004), and electromagnetic articulography (van Lieshout et al., 2008). Although those technologies are not readily available to all clinicians, the information gained from these and other sources contributes to a deeper understanding of the articulatory actions required for /r/, which can in turn inform clinicians' phonetic cues and elicitation strategies....