Unit.4: Speech Therapy

4.1 Speech and Language intervention in class

4.2 Facilitation of speech and language training – Receptive skills

4.3 Facilitation of speech and language training – Expressive skills

4.4 Concept, meaning, definition and utility of Augmentative & Alternative Communication

4.5 Developing Teaching Learning aids for facilitating communication









4.1 Speech and Language intervention in class

Some language intervention programs target specific language skills (e.g., phonology, semantics, syntax, morphology), while others are more holistic in nature, targeting a broader range of language and communication skills (e.g., expressive language interventions and receptive language interventions). Language intervention approaches can include the following.

Clinician-Oriented—the clinician selects the goals and the treatment setting and determines the stimuli to be used and the type and schedule of reinforcement for accurate responses. These approaches utilize operant procedures and are often used to teach language form (e.g., syntax and morphology).

Child-Oriented—the clinician utilizes indirect language stimulation techniques and follows the child's lead in more natural, everyday settings and activities in an effort to stimulate language growth. These approaches are typically used with young children but can be modified for use with older children. Examples include

Hybrid—the clinician develops activities that are very natural, but at the same time, allow opportunities for the child's spontaneous use of utterances containing the targeted language forms. Examples include

Narrative Interventions

Narrative interventions focus on improving a child's story-telling ability, including the ability to provide context for the listener; use narrative structures (story grammars) to organize events; and utilize microstructure (e.g., syntactic complexity, temporal and causal conjunctions, coordinating conjunctions, elaborated phrases, and adverbs) to enhance the clarity of the narrative. Narratives can provide a naturalistic means of targeting specific language difficulties.


Peer-mediated or implemented treatment approaches incorporate peers as communication partners for children with language disorders in an effort to provide effective role models and boost communication competence. Typically developing peers are taught strategies to facilitate play and social interactions; interventions are commonly carried out in inclusive settings where play with typically developing peers naturally occurs 

Directive interventions

Directive interventions tend to include the following characteristics:

In directive interventions, the professional providing the intervention controls the antecedents and consequences presented to the child. Directive approaches use specific techniques such as modeling and prompting to elicit targeted language structures from the child. An example of modeling is having the professional name an object shown to the child and then prompting the child to name the object. Prompting involves the professional presenting a verbal command or question, or some nonverbal cue, to the child to elicit a desired verbal response. Directive interventions frequently use blocks of discrete trials or drills in a controlled environment.

Naturalistic interventions

Naturalistic approaches commonly include the following characteristics:

·         providing distributed learning opportunities rather than massed blocks of trials

·         following the child's focus of attention or interest

·         using antecedent and consequent stimuli naturally associated with a particular communication response

Naturalistic interventions use specific techniques that create opportunities for the child to use targeted language structures. This approach utilizes aspects of adult-child interaction that promote language acquisition. Deciding which techniques to use for an individual child requires the professional to draw upon knowledge about normal language acquisition and to be cognizant of the needs of the particular child. A critical aspect of naturalistic interventions is the professional's ability to read, interpret, and respond appropriately to the child's cues.

Naturalistic and enhanced or modified milieu methods (also called incidental teaching) involve the professional arranging materials in the environment in a way designed to elicit targeted responses from the child.

4.2 Facilitation of speech and language training – Receptive skills

Receptive language is the ability to understand words and language. It involves gaining information and meaning from routine (e.g. we have finished our breakfast so next it is time to get dressed), visual information within the environment (e.g. mum holding her keys means that we are going to get the car, a green light means go), sounds and words (e.g. a siren means a fire engine is coming down the street, the word ball means a round bouncy thing we play with), concepts such as size, shape, colours and time, grammar (e.g. regular plurals: cat/s, regular past tense: fetch/ed) and written information (e.g. signs in the environment like “no climbing”, written stories).

Some children who have difficulty understanding oral language (words and talking) may appear to be understanding because they may be able to pick up key words and get visual information from the environment or from gestures.

Importance of Receptive language

Receptive language is important in order to communicate successfully. Children who have understanding difficulties may find it challenging to follow instructions at home or within the educational setting and may not respond appropriately to questions and requests. Within the school setting, difficulties in understanding may lead to attention and listening difficulties and/or behavioural issues. As most activities require a good understanding of language, it may also make it difficult for a child to access the curriculum or engage in the activities and academic tasks required for their year level of school.

For a child to be able to develop adequate communication skills, receptive language is vital. Children with deficits in this area often show poor ability to follow instructions, requests or answer questions appropriately. These deficits usually affect the child’s engagement in their personal lives, as well as how they interact and perform in school. It is not uncommon for children with these difficulties to display poor concentration in class, inability to understand the curriculum, or behavioural problems. Moreover, it is pivotal to address any deficits as early as possible, as failure to do so will likely lead to ongoing communication problems in adolescence and adulthood, ultimately affecting the individual’s socialisation and ability to gain and maintain employment.

The facilitator’s job is to use strategies that highlight the main idea, in essence removing it from the “unacceptable” way in which it was delivered.Kaner (1996) suggests the following strategies:

Paraphrasing has both a calming and clarifying effect. It reassures the speaker that his or her ideas are worth listening to and it provides the speaker a chance to hear how others are hearing his/her ideas. The facilitator begins by saying “It sounds like what you’re saying is…” or “This is what I’m hearing you say…” or “Let me see if I’m understanding you….” The facilitator then restates what he/she heard, followed by a question asking if the paraphrasing was correct.

Drawing people out is a way of supporting people to take the next step in clarifying and refining ideas. It is particularly helpful in two situations: when someone is having difficulty clarifying an idea or when someone thinks that she/he is being clear but the thought is vague or confusing to the listener. The facilitator first briefly paraphrases the speaker and then asks open-ended, non-directive questions (e.g., Can you say more about that? What do you mean? How so?)

Stacking is a procedure for helping people take turns when several people want to speak at once. It lets everyone know that they are, in fact, going to have an opportunity to speak and when. This enables them to focus on what is being said rather than trying to get a turn. Stacking involves a four step process: 1) ask who wants to speak and have them raise hands, 2) create a speaking order by designating who will be first, second, third, and so on, 3) call on people when their turn has arrived, and 4) when the last person has spoken, ask if there are others who want to speak. If yes, repeat the process.

Tracking means keeping track of the various lines of thought that are going on simultaneously within a discussion. Participants may be focusing on different aspects of a specific topic. For example, in a discussion of the need to replace a pool car, two people could be talking about the type of car that is needed, two could be expressing concerns about the price and how to pay for it, and several could suggest ways to postpone the purchase until next year. The facilitator needs to step back and summarize the different trains of thought and then check for accuracy. It is important to capture all the tracks, not just the ones that seem most important.

Balancing is used after a few people have expressed their thoughts. To assure that the discussion doesn’t lead down one road, the facilitator invites others to contribute. For example, balancing questions might include the following: “Okay, now we know where three people stand; does anyone else have a different opinion?” “Are there other ways to look at this?” “We’ve heard two views, ‘A’ and ‘B’. Is there a third perspective?” “Let’s see where we stand on this. I’m not asking for a vote, just a sense of where you are right now. How many of you think it would be good if…? Balancing helps to draw people out and reassures people that they are encouraged to state their opinions.

Making space sends the quiet or reflective thinkers the message that what they have to say is important and that the facilitator wants to give them an opportunity to speak. Body language and facial expression can let a facilitator know when to say, “Was there a thought that you would like to express?” or “You look like you were going to say something.” If they decline, move on.

Listening for common ground is a powerful intervention when group members are polarized. It validates the groups’ areas of disagreement and focuses on their areas of agreement. When participants differ on strategies for how to solve a problem, they often forget that they still share the larger goal in common. Listening for common ground has four steps: 1) indicate that you are going to summarize the groups’ differences and similarities, 2) summarize them (use visual aid), 3) point out areas of common ground, and 4) check for accuracy.

4.3 Facilitation of speech and language training – Expressive skills

Expressive language is the use of words, sentences, gestures and writing to convey meaning and messages to others. Expressive language skills include being able to label objects in the environment, describe actions and events, put words together in sentences, use grammar correctly (e.g. “I had a drink” not “Me drinked”), retell a story, answer questions and write short story.

 Importance of Expressive language

Expressive language is important because it enables children to be able to express their wants and needs, thoughts and ideas, argue a point of view, develop their use of language in writing and engage in successful interactions with others.

A child who is struggling with expressive language is not always so difficult to spot (though it can get harder as they get older and becomes better at hiding the problem!) However, just because it’s easier to see that a child is struggling to get their message across, it doesn’t mean that it’s always obvious how best to support them. How can we involve the child fully in conversation, without putting too much pressure on them? Here are a few ideas:-

Check that the child understands

Wait a minute – I just said that I was talking about expressive language! That’s true, but the two are often linked. A child who has difficulty finding the words they want to say, or structuring sentences, can sometimes struggle with understanding vocabulary and grammar as well. Make sure they understand what you’re talking about.

Take time

We all feel more pressured if we need to say something quickly. And if you’re anything like me, the time you need to convey something under pressure, is the time when you find that your mind goes blank, and you just can’t find a succinct way to explain what you mean. I’m sure I’m not the only one who has sat in an exam hall only to find myself struggling to answer a question that I know I could have answered the day before. Take time yourself over what you’re saying and pause lots. When possible, let the child know that there is no rush. You can do this either by directly saying it or just by letting your own voice and body language give the message. We all tend to imitate back the way that someone talks to us, so think about slowing your own rate of speech down just slightly to make the child feel less pressured.

Comment, don’t question

This is a trap I still find myself falling into, as it’s so easily done. You really want to encourage a child to talk so you ask them questions: “What did you do?” “What’s this?”, “Where are you going?”…. That’s fine up to a point, but it can become a bit like an interview rather than a conversation and again, the child can feel quite under pressure to speak. This in turn can make a lot of children clam up. After all, who wants to be constantly made to do something they find difficult?! Often, a better way is just to comment on what’s happening instead. When a child is playing freely, give a simple commentary on what they’re doing eg “the train’s going over the bridge…. Choo choo…. Oh no, crash!” This works because you’re giving the child the words and phrases they might want to use in a far less pressured way as well as talking about what they’re interested in. Leave lots of pauses too and you may find the child soon starts to fill them.


This is one of those nice speech therapy words that I’m not sure make a lot of sense to other people sometimes. Certainly when I asked my husband to proof-read something for me that talked about modelling, he wondered why we were building models! What I mean is show your child how to say things. It’s usually best not to keep correcting them or telling them that what they have said is wrong, but (assuming that you understand what they meant) say it back to them with the errors corrected so that they can hear a good example. So if a child says “I goed to the park”, I might say “yes, you went to the park”.


This goes nicely with the “modelling”! When you’re saying a sentence back for a child to hear, add another word or two to what they said. It’s important not to go overboard with this – the idea is just to show them language one stage further on than what they are currently able to say. So, if a child says “sit on chair” I probably wouldn’t respond with “yes, that big teddy looks really comfy sitting on that soft chair”, but I might say “yes, teddy’s sitting on a chair”.

Offer choices

Often when faced with a question, a child with a language difficulty knows the answer but can’t think of the words they want to say to respond. Offering a choice of two things reduces the options and helps to cue them in to the vocabulary they want. For example, it’s easier to answer “do you prefer ice-cream or chocolate?” than “what’s your favourite food?” (unless you’re me that is – I love them both!...)

Use other ways to communicate as well as speech

Children who struggle to communicate verbally can often be really helped by using other ways to communicate as well as speech. This may include signing, gestures, pictures, communication books or other devices. Whatever method you are trying to encourage a child to use to supplement speech, the best way to encourage it is to use it yourself.

Use context

Whatever language a child needs to learn, the best way to learn it is in context. If you’re teaching past tense verbs the best way to teach them is to talk about what has just happened. If you’re teaching idioms, the best way to teach them is to use them in an appropriate context and then explain what they mean. If you’re teaching new vocabulary, use the words as often as you can yourself in context. We all need to hear a new word lots of times before we remember it. This is even more true for children with speech and language difficulties. Use a new word, then use it again. Refer back to it later that day. Try to use it again a few days later. The more a child hears the word in context the more likely it is to be stored well in their brain and found more easily when they want to use it.

4.4 Concept, meaning, definition and utility of Augmentative & Alternative Communication

Augmentative and alternative communication is a type of communication that combines gestures, eye pointing, vocalisations and pointing to symbols as communication for people with limited speech abilities.

Augment means to add to or to enhance. For example, we can augment speech by using gestures, eye pointing and body language.

Alternative means a choice or a substitute. We can use alternative communication to speech by pointing to symbols, signing or by spelling.

Communication means to send and receive messages with at least one other person.

This means augmentative and alternative communication (often shorted to AAC) is the term for all communication that is not speech, but other types used to enhance or to replace speech.

Augmentative and alternative communication systems can assist people who cannot speak to develop language skills and increase participation and inclusion in daily activities.  It’s an important tool that can give people more communication control and decrease frustration.

Therapists may suggest an augmentative and alternative communication system if speech is slow to develop or non-existent, or as a back-up if speech ability is very limited or difficult to understand.  An AAC system may be either a short or a long-term solution to communication difficulties being experienced.

What types of AAC are often used?

AAC incorporates all the tools and strategies a person can use to communicate, when they are not able to speak. Often we break them into 2 groups: Unaided and Aided AAC.

1. Unaided AAC – or AAC that does not require a physical aid or tool.

2. Aided AAC – or AAC that uses tools or materials.

We may use a high-tech tool (e.g. a Speech Generating Device, or AAC app on an iPad), or a light-tech/paper-based tool (e.g. a communication book, or board).

Text-based AAC

An AAC system may be a text-based system with a keyboard. This is generally for a person who types the words they want to say. They can often read and spell. 

Symbol-based AAC

Many people might need symbols or pictures when communicating. This includes those people who cannot yet read or spell. We can introduce visual symbols that represent words or maybe phrases. 

Benefits of AAC

Many people who cannot rely on speech, could benefit from AAC. And there are challenges when people do not have AAC.

People who use AAC describe benefits

These include:

Challenges for people without AAC

There are often difficulties without AAC, when someone cannot talk reliably.

People who use AAC say that, prior to having a communication system, they experienced:

4.5 Developing Teaching Learning aids for facilitating communication

Teaching is to communicate an idea. There are three important parts of a communication

a) sender of information           b) message/information           c) receiver.

In teaching process it is important to generate student’s interest. If interest is build properly, the learning process can take place effectively. For this purpose use of teaching material is important as they have the potentials to arouse interest in teaching-learning process. Richard (1981), in his study found that a normal human being remembers 10% of what they read, 50% of what they saw and heard, above 70% of what they heard, seen and done. An old Chinese proverb also explains the same view:

I hear and forget.

I see and remember

I do and I understand.

It seems important that for better teaching process, a teacher should arrange different aids with the help of which he should make learning easy, enjoyable and stable. As Goethe said “knowing is not enough we must apply, willing is not enough we must do.”

Teaching aids are tool and equipment used in teaching as a supplement in class room instruction to enhance the interest of students. Teaching materials are important catalysts of effective instructions. Besides the traditional teaching methods, there are wide varieties of teaching aids available to the teacher. They help students to improve reading and other skill.

Need of Teaching Aids: In teaching language, teaching aids/ materials are important because every individual has tendency to forget but proper use of these aids, help to remember lessons permanently. All teachings aids can be effectively used in class to motivate the students to learn better.

One other important factor about teaching materials is that the materials should meet students’ needs as every person has its own level of understanding. As Cunningsworth says, “Students particularly more sophisticated adults and teenagers need to feel that the materials from which they are learning have to be connected with the real world and at the same time they must be related positively to the aspects of their inner make up such as age, level of education, social attitudes, the intellectual ability and level of emotional maturity.”

Types of Teaching-Learning Materials:

1. Audio Aids:

Aids that facilitate learning by using the sense of hearing are known as audio aids. These aids help a teacher, especially in language teaching. For example, radio, tape recorder, audio cassette player, Linguaphone, etc.

2. Visual Aids:

Aids that facilitate learning by using visual organs are known as visual aids. These aids help in the attaining of Bloom's teaching objective i.e., cognitive, affective and psychomotor. For example, radio, tape recorder, audio cassette player, Linguaphone, etc. Some examples of visual aids are Blackboard, charts, maps, flannel board, flash cards, globe, etc.

3. Audio-Visual Aids:

The aids that engage in both the sense organs and visual organs of the students are known as audio-visual aids. These aids help in the attaining of Bloom's teaching objective i.e., cognitive, affective and psychomotor. For example, the LCD project, Film projector, TV, Computer, VCD player, Virtual Classroom, Multimedia, etc.

Apart from these teaching-learning aids, Textbook is also one of the most common teaching-learning materials used by the English language teachers in the teaching-learning process.


A textbook is an area in which the language material presented prescribed for teaching and learning. A good textbook not only teaches but it also tests the knowledge of students. The content of the book should be very clear, a proper beginning is required to prepare the learners for the upcoming content and a perfect conclusion is required to assemble the entire learning.

Language games: It develops the basic skills i.e. listening, speaking, reading and writing. It also develops self confidence and communication skill of the students.

Language Lab: It is modern teaching method used as audio or audio visual aids. Variety of listening and speaking skills are exposed to the students. It is provided with computer, video, electronic testing, word games, quizzes, debates etc.

 News Paper: It develops students reading skill. Selection of newspaper material is also very important because it strengthen creative writing, knowledge of structure and grammar. A teacher can make it interesting by giving different task to the students.

Improvisation: Improvisation is an interaction which can improve students’ communicative ability. It directly enhances languages skills, real life communication in a student. They enjoy learning in play way method through imitation, dramatizing, singing, dancing etc. It is natural aid without any cost.