"I can tell Orli makes progress because I understand her now. "


"I’m a twin and I speak all the twin words now — in two languages!"


"I’m happy that Orli is making friends, but we’ll always have our secret language."

Orli skips in to therapy with a wide smile. “Avital is here!” she announces. Now that she says her final consonants, she’s much easier to understand. Behind her, her twin Avital smiles shyly.

“Welcome, Avital.” I turn to Orli. “Tell me, how did you get here?”

Orli points to her mother. “In my mother dar.”

“My mother’s car,” Avital murmurs.

I nod. “And who sat behind your mother?”

Orli is proud. “Me! Tuz it’s my therapy!”

“Well, even though it’s your therapy, I’m sit behind Mommy on the way back,” Avital insists.

“I see you both like to sit behind your mother.” I pull out a Playmobil van and some menchies. “Here’s Ima, here’s Orli in the front… Here’s Avital.” I hold out the menchie. “Where can she go? Only one twin can go in the front at a time.” Before they start fighting, I quickly explain, “Speech is like that, too, Orli. Some sounds are made at the front of your mouth and some at the back.”

I guide Orli to put her hand on her throat. “Now cough. Kuh-kuh-kuh. Good! Do you feel it? You’re making that sound in the back of your throat.” I stand her next to me in front of a mirror. “Say B, Orli. Watch your lips. Buh-buh-buh. The B is made in the front of your mouth.”

It’s time to work on minimal pairs again. I pull out my paper dolls. Holding out a jacket and a handbag, I ask Orli, “Do you need the coat or the tote?” I guide her to pay attention to where in her mouth the sound is made.

“Tote,” Orli says. “She’s doind shoppind.”

“Going shopping. So will she need keys or peas?”

“Keys.” Orli struggles to form the sounds correctly.

“What will she buy?”

Orli thinks. “Dape. I like dape.”

Now I’m stumped. Capes? Canes? Doesn’t seem to fit.

“Careful about the front and back, Orli.”

“Gape,” she says, a little more clearly.

“Grapes,” Avital supplies. “Orli loves grapes.”

Orli dropped both the “gr” and the “ps.” “Orli, you and Avital are twins, right?” They nod proudly. “So you go lots of places together, right?” Another nod. “And since you’re both here, I talk to both of you. I wouldn’t ignore one of you, right? Many words have two letters that are cluster sounds. Clusters are twins — they go together — and we have to be careful not to ignore either of them.”

I shuffle quickly through my cards of minimal pairs and hold out two. “Listen carefully,” I cue Orli. “Which is the nail and which is the snail?”

As her awareness grows, we focus on pronouncing the twin sounds. Orli takes her doll shopping again while Avital plays cashier.

“Where is the bed?”

Avital snorts. “This is a grocery. We don’t sell beds.”

“Remember the twins, Orli.”

“I mean the bread…”

Their last word makes me smile. “Avital and I are win, ah, twins, too,” Orli reminds me.

I wink back. “Twins win!”

Orli is fronting: substituting a sound made at the back of the throat for a sound made at the front.

Minimal pairs are words that are the same except for one minimal difference.

Orli’s improvement is noticeable here — she didn’t drop the final sound.

The first step is becoming aware of the way it sounds. Only then do we move on to actually making the sound.

Take It Home

If your child’s speech is unintelligible, first check his hearing. If a child consistently has fluid in his ears, he’ll hear others’ speech as if from underwater. A buildup of wax can also create hearing loss. An audiologist can assess your child’s hearing and determine if there is permanent hearing loss.

Once you’ve determined that your child’s speech errors are not due to hearing loss, check with a qualified speech therapist to discover developmental norms. For example, a five-year-old who mispronounces the “s” sound is still within developmental norms. An eight-year-old is not and may need remediation.

Once your child is in therapy, the key to success always lies in your carryover at home. Here are some ways to make it work:

Identify the pattern of errors in your child’s speech. You may find it helpful to keep a log. This information will be particularly valuable if your child does not perform well or refuses to speak during a formal evaluation.

Create a list of target words that contain the process the therapist is working on. For example, if the therapist is focusing on final sound deletion, create a list of words that your child commonly uses (names of family members, favorite toys, or activities) and encourage your child to focus the new skills he is learning on those familiar and motivational words.

Keep a note on your fridge or another visible place to remind you of the target sounds or patterns. This will remind you to find opportunities to incorporate practice in real life.

Model the correct production of the sound or process. If your child is learning how to pronounce blended sounds, exaggerate them when you talk to him, as in, “You are doing GReat!” or “I’m so PRoud of you!”

Originally featured in Family First, Issue 571. D. Himy, M.S. CCC-SLP, is a speech-language pathologist in private practice for over 15 years. She is the creator of the Link-It reading comprehension and writing curriculum for elementary school students and directs continuing education programs for speech-language pathologists and educators.