Words and Pictures – Not Always Enough

Abraham Maslow once said that the way to help others change behavior is to help them become more aware of themselves. This awareness comes from being aware of the problem as well as when there isn’t a “problem”. Conventional wisdom tells us that behavior change is longer lasting, because it is more strongly internalized, when the “noticer” -parent, teacher, or SLP- notices and comments on what is “right” more often than when things are “wrong” and when the individual with the “problem” has personal awareness of both the present behavior and the “new” behavior.

Change in client communication behaviors relies on how well the SLP can raise client awareness of errors and then craft high frequency trials of productions that are “correct” in order to achieve automaticity and carryover. Much of the speech-language therapy process involves explaining and modeling . . . there may be some touch cues used, created gestures or looking at a physical model of the mouth. . . but the majority of what we do as SLPs with our clients (children or adults) is processed by clients through the auditory channel.

When attempting to help clients change articulation or phonological patterns, SLPs are often reliant on the auditory channel as the main input to build awareness and prompt/shape productions.  Remodeling sound productions with more emphasis & duration, perhaps while even using a low technology acoustical voice-feedback device such as a WhisperPhone, doesn’t always result in the impact hoped for.  Being creative thinkers, SLPs usually create unique ways to afford awareness and behavioral change in their clients, although the change process can take an extended amount of time. At times, these creative solutions involve gestures.

Why does the change process take an extended amount of time for some clients, while others seem to modify behaviors more quickly? One reason lies in the extent to which the client is aware of what they are doing compared to what the “new” skill is. What follows is a situation where the rate of change was slower than need be due to the reliance on the auditory channel as the main pathway to raising awareness and facilitating change.

A Kindergarten student arrives at the Speech room to work on her /k/ and /g/ sounds. The SLP gets two picture probe sheets out for the session, one for /k/ and one for /g/. They get to work on the /k/ words first. The student begins to name the pictures and is inconsistent after the first row, bringing the verbal prompt from the SLP, “remember your sound, OK?” The naming continues, with few errors in the next row and then the inconsistent productions show up again, followed by a “remember your sound is in the back of your mouth” prompt and a few trials of the target sound in isolation to regain “awareness”. A similar scenario follows for work on /g/. The SLP offers intermittent verbal comments about correct productions as she takes data on all of the production attempts and enters the data on a graph that she shares with the child. The session ends with little change in production accuracy and the inconsistency of the student’s awareness of “her sounds” as compared to the previous sessions.

One would think that pictures that had been used routinely would have facilitated a “trigger” for the target sounds, resulting in more consistent awareness that all of the pictures on the /k/ page require /k/ sounds – ditto for /g/.  Partially true . . . but the pictures were not strongly associated to the target sound and as a result, didn’t bring the sound automatically just from knowing the name of the object pictured. The simple act of viewing pictures did not connect to the “target” sound, but did connect to the “error” sound, which is the default (the automatic behavior) for the child’s auditory perceptual system.  The association connecting each picture with the SLP’s target sound wasn’t strong enough to trigger the new sound. Would there be any benefit if the associational trigger was strengthened?

This scenario would be different for the child if the SLP had taken advantage of the multisensory footprint of our brain. Researcher and author, Dr. John Medina (Brain Rules, 2008), offers these thoughts about the multisensory characteristic of our brains:

  • Sensory processes are wired to work together – one sensory system gets a boost when another sensory system is involved
  • Learning is less effective in a unisensory environment
  • Multiple cues dished up via different senses enhance learning. They speed up responses, increase accuracy, improve stimulation detection, and enrich coding at the moment of learning
  • Vision is probably the best single tool we have for learning anything

See the Sound/Visual Phonics (aka Visual Phonics) is a multisensory strategy that provides SLPS with a tool to engage more than one sense simultaneously, provides multiple cues via different senses, and has  definite visual components (hand shapes and written symbols). As such, the use of Visual Phonics increases awareness, boosts accuracy, and enriches coding at the moment of learning.

The scenario above would have a markedly different outcome with the implementation of Visual Phonics.

A Kindergarten student arrives at the Speech room to work on her /k/ and /g/ sounds. The SLP          gets two picture probe sheets out for the session, one for /k/ and one for /g/. They get to work on the /k/ words first. The SLP models each word while making the /k/ hand shape. Without being asked to do so, the student also makes the hand shape and produces the /k/ sound correctly on each trial. The SLP then changes the activity from imitated words to non-imitated words since the student shows proficiency with imitated words. The SLP makes the /k/ Visual Phonics hand shape as the student names each picture, resulting in a better  than 75% level of accuracy. The student also self-corrected on 50% of the 1st attempt errors. The SLP offers intermittent verbal comments about correct productions as she takes data on all of the production attempts and enters the data on a graph that she shares with the child. A major difference between the original scenario and this one is that the SLP has reduced any need for verbal prompts on incorrect trials, and has still gotten better results. A similar outcome results with the /g/ sound. The student not only showed improved sound production consistency but also improved awareness of both /k/ and /g/, as evidenced by self-correction.

Practice-based evidence by many SLPs who use Visual Phonics support the outcome illustrated by the scenario above –there is less verbal prompting & reliance on the auditory channel . . . better student awareness of the target behavior . . . increased progress . . . and better skill stability. As stated by an SLP who had implemented Visual Phonics for approximately 2 months, “I’ve seen my students moving faster through their sounds and going from isolation/word level to sentence level in shorter periods of time . . . for students who have been working on their sounds for a while (especially vocalic /r/and /s/), I am finding that they are able to produce target sounds with greater accuracy when given a hand-shape cue rather than a verbal or visual cue.“

When the Visual Phonics strategy is integrated into speech-language services, there is a noticeable shift in the amount of verbal cues and prompts required to facilitate behavior change and a corresponding shift in the level of awareness/ownership of the client. More specifically:

  1. What begins as an “SLP-owned” cuing strategy gradually becomes a shared strategy and the amount of verbal, visual and/or tactile cues decreases in frequency and intensity as the hand shape cues  make “connections” between the sound productions and the visual/tactile cues that align with each sound. . . just like a 2nd sense. As stated by Median above, “multiple cues dished up via different senses enhance learning . . . and enrich coding at the moment of learning.”
  2. The transition from Visual Phonics being the SLP’s strategy to a shared strategy between the SLP and client is accomplished via the use of multisensory inputs, plus the noticing and commenting on what is right vs. what isn’t.  Comments on what is right while making the hand shape cue, followed by a comment on what was heard + the use of a corresponding hand shape cue defines and distinguishes each sound attempt. For example, for a correct production, the comment might be “I noticed that you made the /th/ sound on thumb”, while an incorrect production would result in the comment, “I noticed that you made a /f/ when you said thumb.  Show me your /th/ sound . . . now let’s make /th/ on thumb as we say the word together.” The Visual Phonics hand shape is made each and every time a sound is being modeled. This results in clarity in the clients’ ability to differentiate between their target sounds and the sounds they produced in error, and raises their awareness by comparing/contrasting the two.

Despite the fact that SLPs are adept at using verbal descriptions of what to do with the articulators, creating gestural cues, and utilizing various types of pictures and illustrations to facilitate articulatory behavior change, words, pictures, and created gestures aren’t always enough to get the job done. Visual Phonics, as a multisensory strategy that is based on how sounds are produced, becomes a client-owned strategy and is “enough” to get the job done!

For articles on the importance of therapy being multisensory, read “A 2nd (and 3rd) Sense” in the drop down menu under SLP on the Home Page.

Medina, J. (2008). Brain Rules. Seattle WA: Pear Press

© 2011  Dave Krupke  All Rights Reserved