Ben's Words: Showing Children How to Produce Sounds and Speech

The Zoom screen lights up when Ben pops in for his thrice weekly speech therapy session with Amber Postert. They greet each other and Ben begins working on the sound he’s been practicing — “lz” — and repeats words like “pulls” and “falls” over and over again.

When he gets it right several times in a row, a Star Wars character appears on the screen and Postert turns screen control over to Ben so he can move Baby Yoda or one of the Jedi around as he pleases. Then they return to working on the sound for the day.

A charming, confident and animated five-year-old, Ben met with Postert last summer for virtual sessions to learn how to produce different sounds that will eventually lead to effective speech. His family found it difficult to understand what he was saying since he struggled to produce a wide variety of sounds.

The speech-language pathologist he saw in preschool encouraged them to seek help from the speech language clinic at San Diego State University’s School of Speech, Language and Hearing Sciences which operates on a combination of state funding and generous donations from clients and community members.

Postert, a recent graduate of SDSU’s speech-language pathology master's program, was one of about 45 trainees that work with clients of all ages every semester under the close supervision of 11 licensed speech-language pathologists (SLPs). Growing up with a brother on the autism spectrum, “I could see the difficulties with communication and how important it was to help children become better communicators,” she said.

She made progress with Ben within weeks of working with him.

When the COVID-19 pandemic began and the in-person program pivoted completely online, trainees and program leads had to figure out how to adapt the program virtually while still keeping their young clients engaged and focused.

Their brainstorming led to the idea of incorporating favorite TV show characters into PowerPoint slides and giving the clients some sense of control and involvement. A lot of preparation went into planning each one-hour session and Postert would change it up for every session, embed a video game when possible, or bring in different characters that Ben loved.

“Practicing the sounds was hard for Ben but he really pushed through,” Postert said. “He was so self-aware that he began noticing the difference as he began making the sounds and soon he knew how to produce those sounds, where his tongue should go.”

Delivering critical services virtually

The services offered by the program have gained renewed importance during the pandemic, as children switched to online school and frustrations escalated both for them and their parents — an inability to communicate their needs for children struggling with speech, and the inability to understand them for parents.

Teletherapy also proved beneficial for the clinic’s many adult clients who were able to continue their growth in speech, language, and communication when the clinic was forced to close its physical doors due to the pandemic.

Face-to-face sessions that allowed clinicians to observe non-verbal cues and make connections with clients while delivering 5,500 hours of clinical service annually shifted rapidly to virtual sessions.

The amount of work faculty invested to adapt it to an online format has been unparalleled, said Tracy Love, the school’s director. “These are skills that can’t easily be transferred to a virtual modality.”

If the child has a cleft lip or palate, observing them closely to see how they produce speech is critical, but much harder to do via Zoom, explained Ignatius Nip, director of the school’s speech physiology lab and graduate students advisor.

Up-skilling has been a happy bonus that came out of the techniques used in the program, Nip and associate director of the school’s joint doctoral program Irina Potapova pointed out.

“When you treat specific types of sounds for children, other sounds come for free with it,” Nip said. “So if you teach them to pronounce words with ‘str’ or ‘spr’ or ‘scr’, the children also master other sounds in the process.”

This complexity approach of 'teaching up' practiced by the student clinicians was introduced to the San Diego community by SDSU researcher Jessica Barlow, a leading expert in speech sound treatment, in collaboration with her colleague, Professor Sonja-Pruitt Lord, as part of a feasibility study funded by the National Institutes of Health.

Potapova said this complexity principle also works when teaching math or with physical exercise training in schools.

“If you start with training for an entire tennis serve instead of each component, you will get throwing the ball at the right height, swinging your arm the right way,” said Potapova, who is also a licensed SLP. “Similarly, when we produce complex speech sounds, related sounds come with ease. When they work on complex goals, it naturally leads to these other sounds as well. And when you treat a couple levels up, the intermediate levels get filled in.”

Pediatric clients at the clinic fall within the age range of three to seven years. Typically, we can understand about 75% of what a three-year-old says, but for children such as Ben who have speech impediments, that might only be at 25%. This makes early childhood intervention all the more critical, so they master the life skill of communication instead of slipping into a spiralling vortex of frustration.

“Since we have faculty doing critical research in this field, we’ve been on the cutting edge of bringing this complexity approach to our clinics and delivering benefits in the fastest way possible. It has really spread and had a positive impact with hundreds of children in the local community,” said Carrie Goodwiler, director of the clinic and a speech-language pathologist.

Since parents are required to be present in the background during Zoom sessions, they learn from observing student clinicians like Postert on ways to work with their children at home, an added benefit of teletherapy.

The clinic, which plans to return to in-person services in the fall, also works with adults and seniors who may have hearing loss, traumatic brain injury from an accident or a stroke. These circumstances often call for speech and language rehabilitation, as well as children with a wide range of developmental language and communication disorders.

Ben’s words

For Ben, the progress he made with the thrice weekly sessions has opened up new avenues for him and his family.

“He has been very difficult to understand ever since he began talking,” said Crista Beyenhof, his mother. “We decided to homeschool him in kindergarten, so we can’t receive services through the school district. We were super excited to find out about the SDSU program.”

Always a chatterbox, Ben takes care now when enunciating words and the tools he learned in speech therapy have helped him communicate better and be understood by his family.

He would meet twice a week with Postert and once with Potapova, who teamed up to deliver complementary therapy and conduct frequent progress assessments.

“Each of them have different approaches, so he would apply what he learned from one therapist with the other,” Beyenhoff said. “In the fall he worked with different graduate students, building on the foundation that they gave him.

“I was so impressed with the different tools the program utilizes, the many ways in which they make the sessions engaging. I liked that Carrie supervises the sessions and pops in to mentor the student therapist with great suggestions. It’s not easy for Ben but he loves it because they make it fun, and since the graduate students are young, he really connects with them.”