Creative Speech Therapy Ideas: Using Stickers for Articulation, Apraxia and Language Goals

I want to shine a spotlight on an often underrated but inexpensive versatile resource for targeting goals in our speech therapy sessions. They are  lightweight, require minimal prep, and the kids absolutely LOVE them! Yes, I’m talking about……

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What is it about sticky pieces of paper that is so intriguing? 

Recently, I’ve been using a Paw Patrol Puffy Sticker Book that I found at Marshalls (they also had a construction vehicle one!). It’s become a favorite among my kids, and I just had to share all the ways we can use stickers to target both speech and language goals.

Use stickers for……

Speech Sound Practice

• Working with kids with Childhood Apraxia of Speech. When adding stickers to a page or background scenes model  “power phrases” like “put on”, “take off” and  “my turn” and use self advocacy phrases like “help me” and  “it’s stuck”.

• Sticker Charts: Create a chart with different articulation targets. Each time a child successfully practices a target sound, they get to place a sticker on the chart. This visual reinforcement can be very motivating (ok,  so this one is overused and underwhelming, but I had to add it!)

• Sticker Stories: Have the children create a story using stickers. Each sticker represents a word or sound they are working on. They can narrate their story, practicing their target sounds as they go.

Language Development

• Sticker Sequences: Use stickers to create sequences or patterns. Have the child describe the sequence, focusing on using words like "first," "next," and "last."

• Sticker Descriptions: Give each child a set of stickers and have them describe what they see. This can help with vocabulary building and descriptive language.

• Sticker Scenes: Provide background scenes and let children create their own stories using stickers. Have them narrate their story, focusing on sentence structure and vocabulary.

STICKER SCENES

Add sticky magnets from a magnet tape roll to stickers to create magnetic stickers!

Social Skills

• Sticker Conversations: Use stickers to prompt conversations. For example, place a sticker of a happy face and ask, "What makes you happy?" or use a sticker of a group of friends and discuss friendship and social scenarios.

• Emotion Stickers: Use stickers depicting different emotions and discuss each one. This can help children identify and express their feelings.

Following Directions

• Sticker Maps: Create a simple map or scene on paper and use stickers to give directions. For example, "Place the dog sticker next to the tree" or "Put the car sticker on the road."

Examples with Paw Patrol Puffy Sticker Book

To give you some concrete examples, here’s how I’ve been using the Paw Patrol Puffy Sticker Book in my sessions:

• Prepositions: Receptive and expressive use. "Put Chase under the tree," "Where is Chickaletta?"

• Expanding Utterance Length: Targeting 2+ word phrases. "Go Ryder," "Marshall wants a ride," "Bye ___." I model and repeat these phrases throughout the session.

• Working with children with Apraxia: Power phrases like “put on”, “take off” and “my turn”. Self-advocacy phrases like “help me” and “it’s stuck”.

• Gestalt Language Processors: Mixing and matching phrases. For example, if a child uses "Rubble on the double" and "I'm fired up," I model a combination like "Rubble is fired up."

• Production of 2+ Syllable Words: We worked on "Mayor Humdinger" - a motivating 3-syllable word!

• Verb Tense: Using background scenes with minis, we practiced past tense: "The car jumped over the sign," "He drove away."

• Negatives: Using stickers on background scenes. "I don’t want it there," "Not in," "Not on my nose!"

PAINT STICKS WITH PACKING TAPE

Use paint sticks or tongue depressors and cover them with packing tape for repeated articulation trials.

Low Prep, Low Expense Ideas

Here are some additional low-prep, low-expense ideas to get plenty of repetitions with stickers:

1. Paint Sticks or Wooden Tongue Depressors: Add stickers for each target the child gets correct. I add packing tape to my paint sticks so kids can put on and take off stickers over and over for multiple trials!

2. Body Parts: Stick stickers on different body parts on you and the kids following each production, then have the kids take them off again while practicing their target sounds, words, or sentences.

3. Matching Games: Add matching stickers onto milk or juice lids, or cardboard circles or squares and play a matching game with them.

Stickers are a fantastic tool for making speech therapy sessions fun and engaging. I hope you find these ideas as helpful and enjoyable as I do. Happy sticking!

Best Christmas and Winter Books for Kids Ages 3-5

Winter and Christmas books are some of my favorite to use in speech therapy for facilitating language skills in preschoolers. Following is a list of books I use in my speech sessions each season with different target goals in the descriptions. I wanted to post this blog now if you are thinking about gift for this age children.

For more information on choosing books for children, go to Choosing Books for Preschoolers to Encourage Communication Skills

Each title has a link to the book on Amazon (these links are affiliate links, so I get a few cents if you purchase one- at NO extra cost to you). You can also find most of these books at your local library!

Holiday Books

Holiday and Winter Books can target an array of speech and language goals

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The Snowy Day by Ezra Jack Keats

  This is a classic book with simple colorful contrasting pictures of a journey of a little boy and his adventures through the snow.  I use the concepts of “toes pointed in” and “toes pointed out” when walking to incorporate some motor movement into speech therapy. I use my book companion for this story each winter!  We also work on opposites like “down the hill” and “up the hill”. You can have tons of supplemental craft extension activities with this sweet story.

The Snow Globe Family by Jane O’Conner. 

This story is about a real family living in a house, then the snow globe family living in a snow globe in the real family’s house and only the baby sees the snow globe family.  This is for 4-5 year olds and is also great for older children also. It lends itself to working on “pretend” versus “real”, “big” versus “little” and working on finding solutions for problems. This one has fun extension activities like making snow globes. 

Merry Christmas Big Hungry Bear by Audrey Wood

This is really a perfect Christmas book for this age! A little mouse initially tries to hide his presents from the big hungry bear, then realizes that the bear needs some presents too! 

This story has repetitive text and the reader is talking to the mouse keeping children interested in knowing how this will end up! I target asking the mouse questions for information and kids love to join in talking to the mouse. We also target “big and small” when talking about the bear versus the mouse, what they wear, the presents and where they live.

Are You Grumpy Santa by Gregg Spiridellis

Santa is grumpy in the beginning of this wonderful rhyming story then comes around. This is fun to read and kids think this grumpy Santa is hysterical because of all the reasons  he is grumpy (itchy suit, he’s on a diet..). This one is for 4-5 year olds and is perfect for working on emotions like “grumpy, happy, sad, frustrated, annoyed”. 

Merry Christmas, Stinky Face by Lisa McCourt

Stinky Face loves Christmastime...but he still has plenty of questions. What if a big, wintry wind blows his Christmas tree away? What if one of the reindeer gets his antlers stuck in the branches that hang over the roof? His  Mama knows how to answer these questions. This one is fantastic for working on “wh” questions!

Snowmen at Christmas  by Caralyn Buehner

This is one book in a series of 5 about Snowmen at different time (Winter, Night, Play). There are hidden items throughout the story that children can try to find (although it’s not easy even for me!).  Working on concepts like “behind’, “under” and “on top” when describing where the snowmen are as well as using descriptive language when describing the different snow people works well in this book. There is quite a bit of text, but remember, you do not have to read it all if you have a younger child.

Llama Llama Jingle Bells  by Anna Dewdney

This is a book for younger children or children with difficulty attending to longer stories. It has rhyming phrases where children can attempt to fill in the words. The pictures are engaging and good to work on pointing to pictures named. 

The Snowman by Raymond Briggs

This is a story about a little boy who makes friends with a snowman. I like the “lift the flap” version of this book with my younger children. There is very little text (or no text in the original version), so children can use their own words to tell the story.

Dream Snow by Eric Carle

This is one of my favorite winter books! A farmer dreams that snow has covered him and his farm animals. There is a snow cover plastic page covering each animal in the story, so children can guess what is under each page. This works well for answering and answering  “who” questions and labeling animals and using animal sounds for minimally verbal children.

Max’s Christmas by Rosemary Wells

Max has plans to stay up late to see Santa Claus, but his big sister, Ruby, won’t let him. Max asks questions throughout the book making it perfect for working on “wh” questions with children. It has limited text which is perfect for younger wiggly listeners!

Gingerbread Baby by Jan Brett

The repeated phrasing in this story makes it easy for children to “help” tell the story. The people and animals that the Gingerbread Baby meet continue to grow lending this story to working on sequencing of events with children. There is a “hint” with the side pictures of what is coming next, that children love to guess! You can find a ready made book companion here!

The Night before Christmas by Clement Moore

Need I say more?  Just had to include this for those of us who had to read this every Christmas Eve!

Check out my Winter Book Companion Kit in my TPT store for activities to use with some wonderful winter and holiday books!

Treatment of Childhood Apraxia of Speech

About 15 years ago, I got my first case of Childhood Apraxia of Speech (CAS) that was diagnosed by a developmental pediatrician as “verbal dyspraxia”. From that moment, I did some big digging into what CAS really is. Since then, I have had many children that I have worked with with CAS (most whom I diagnosed) and although complex, I really love working with kids with CAS because of the difference I can make! Kids with CAS are close to my heart and I want you to feel as comfortable as I do know with techniques for treatment. Understanding it better can help us make a significant impact on the lives of our young clients.

I recently took a refresher course by Alonna Bondar that I would highly recommend if you need more information on CAS, choosing targets and applying treatment techniques. There are also some videos on YouTube by Edyth Strand that provide some really practical therapy and treatment information!

1) What is Childhood Apraxia of Speech?

CAS is a speech disorder that affects a child's ability to plan and execute the precise movements required for clear speech. It's like the brain and mouth are not on the same page when it comes to talking. Unlike other speech sound disorders, CAS isn't caused by muscle weakness or muscle coordination problems but rather by neurological issues that disrupt the planning process.

2) How CAS Differs from Other Speech Sound Disorders

Unlike phonological disorders or articulation disorders, CAS is not about substituting one sound for another. It's about the brain struggling to coordinate all the movements required to produce the planning of speech sounds and combinations of sounds. CAS can sometimes be mistaken for other speech sound disorders like phonological disorders or articulation disorders. The key difference lies in the motor planning aspect. In CAS, the child knows what they want to say, but their brain has trouble coordinating the precise movements necessary for speech. This makes CAS unique and requires a different approach in therapy (see the earlier Blog Post: Principles of Motor Learning in CAS).

3) Early Signs of Apraxia of Speech

1. Limited babbling before 12 months

2. 5 or less consonants between 17-24 months

3. Limited vocalizations

4. Simple syllable shapes (vowel or consonant-vowel only)

5. Late or difficult development of first words

6. Words that appear then disappear

(Bondar 2023, Bjorem Speech Informal Motor Speech Assessment 2020, Davis and Velleman 2000)

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4)What characteristics distinguish Childhood apraxia of speech from other speech sound disorders?

• Awkward transition from one sound and/or one syllable to another

• Groping behavior while attempting word or sound production

• Vowel Distortions

• Errors with prosody (stress, loudness, intonation, pitch and rhythm

• Inconsistent voicing errors

• Inconsistency of word or phrase production over repeated trials 

• Struggling with longer and more complex words

• Inconsistent errors when trying to repeat words

(ASHA 2007, Strand 2020, Bondar 2023)

5) How do we know a child is ready for CAS Treatment?

• Does the child have an internet to communicate? Are they using some type of communication to make  wants and needs known (i.e. pointing, grunting, pulling the hand of a caregiver)

• Is the child able to focus on an activity (i.e focus on a favorite toy).

• Can the child imitate motor movements (i.e opening their mouth, pursing their lips)

• Is the child able to request items with gestures like pointing or reaching?

• Will the child look at an object near your face?

6) Techniques for Children with CAS

Let’s get to the fun part!  Treatment!  When working with kids who have CAS, we've got to be creative and choose the approach and feedback that best fits the individual child. Whatever treatment approach is used the key is working on MOTOR MOVEMENT.  Multisensory approaches work well for children with CAS.  Here are a few techniques that have worked for me (and many others based on the research!) this is not ALL of the treatment procedures, I am highlighting some that proven to be successful for my students:

• DTTC (Dynamic Temporal and Tactile Cueing): 

This is a dynamic approach that combines touch and sound cues. It helps kids improve speech motor planning by guiding them through the correct movements.

With DTTC, there is a specific hierarchy and cueing methodology to facilitate the acquisition and generalization of movement accuracy for speech. It is structured to slowly lengthen the amount of time between the clinician’s production of a motor movement and the child’s production of the word or motor movement. Initially the child says the word at the same time with the clinician, then the child voices the word while the clinician only produces the mouth shapes of the word and later is cued to say the word with no cues.

DTTC is designed for children with more severe CAS and is not intended for long-term use. 

For more detailed information regarding the DTTC hierarchy please see the references below
(https://www.bjoremspeech.com/collections/free-resources/products/dttc-hierarchy-flow-chart-for-apraxia-therapy, American Journal of Speech-Language Pathology, Strand, Edyth,  Vol. 29, 30–48 • February 2020, Apraxia Course, Bondar, Alonna 2023)

• Speech Sound Cue Cards: 

Visual aids can be a game-changer! Using cue cards with pictures and written prompts can help children understand and produce specific sounds. You can find the speech sound cue cards that I developed for my students with CAS that provide visual (pictorial and hand cues), and auditory cues to aid in motor movement. 

Using cue cards with pictures and written prompts can help children understand and produce specific sounds. Using a finger or pointer or marker on a wipe board to move from one sound cue card to another showing the child movement while elongating the sound (if possible) works well for a visual representation.

• Promote Functional Communication:

Encourage children to communicate using signs, gestures, or alternative communication methods while working on speech goals. This helps reduce frustration and builds their communication skills. 

7) Appropriate Target Selection

Choosing the right targets is key for the child to feel successful in the therapy program. Initially, if a child has very little verbal productions, begin with sounds and sound effects such as animal sounds (“baa, moo, neigh"), sounds like a car sound or “beep” and “uhoh” or” eeekk”. These sounds are fun to produce and promote the child’s engagement. It is important to reinforce the child’s attempts at vocalizations and imitate their vocalizations and assign some meaning to them. 

Start with functional verbal words that are relevant to the child's daily life and communication needs if the child is at this level. As progress is made, gradually work your way towards more complex sounds and words. Words like “on, up, pop, bye, ma, poo” are great powerful words for kids to start with, but what is meaningful to the child is the best way to choose the targets. Use words that are meaningful to that child such as favorite toys, family names, friends names and favorite foods.

Using games that have lots of pieces to them can provide many trials and motivation for CV, VC and CVC words like “out, in, up, pop, push, my, me and see”.(Games like Pop-up Pirate, Banana Blast and Jumpin’Jack are great for this!). 

Remember, progress may be slow, and that's okay. Every small victory is a step in the right direction. Celebrate those wins, no matter how tiny they may seem! CAS is a unique and challenging speech disorder that requires a specialized approach. By understanding the nature of CAS, spotting it early, and using appropriate techniques, we can make a world of difference in the lives of our young clients.

For more information: (https://www.bjoremspeech.com/collections/free-resources/products/dttc-hierarchy-flow-chart-for-apraxia-therapy, American Journal of Speech-Language Pathology, Strand, Edyth,  Vol. 29, 30–48 • February 2020, Apraxia Course, Bondar, Alonna 2023)

Principles of Motor Learning for Treatment of Childhood Apraxia of Speech (CAS)

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When learning about treatment for Childhood Apraxia of Speech (CAS), we hear that we need to use the principles of motor learning (PML), so what does that mean? These principles or processes are how we all learn new motor skills or plans. 

Speech is a motor skill that can improve using these principles. 

Treatment may be designed differently depending on the child (with differences in severity, attention and motivation ), but applying the PML will provide a roadmap to support and treat children with CAS.

Following is a guide for using principles of motor learning that I use when I treat children with CAS (based on research):

1) PRACTICE, PRACTICE, PRACTICE:

Imagine learning to swim. You didn't jump in the water and swim right away,  you had to practice moving your body in different ways to float and stay afloat, then to move forward, all the while breathing at the same time. The same goes for children with CAS. Regular practice is the most  important aspect for generalization of speech production. 

It's all about getting enough practice trials per session to make the motor speech movements second nature and automatic. But remember, quality matters as much as quantity. Be attentive to the child's response, and adjust cues accordingly. As they progress, you can gradually fade those cues.

2) MASSED PRACTICE VS. DISTRIBUTED PRACTICE:

Think of this as the difference between cramming for an exam and studying consistently over time. For CAS, research suggests that frequent, shorter sessions spread out over time are more effective for progress and generalization.

Starting with massed practice (practicing all at once- think one session weekly for a longer time period)  to build a strong foundation, then transitioning to distributed practice (therapy spread out across sessions- think 4, half hour sessions weekly). I know sometimes we don't have the luxury of changing a schedule like that in schools- but see principle number 3 for ways to change up practice within time constraints.

3) BLOCKED VS. RANDOM PRACTICE:

Blocked practice is practicing one target extensively before moving on, then later randomizing practice by mixing several targets together. An example is initially you might choose 5 words including bilabials plus vowels (like poo, ba, me, ma, and pee) and focus on those only. As the child improves, you can randomize the targets for example adding a vowel consonant productions in (i.e. “up, oop, um”)

The severity of CAS can be your guide here. For severe cases, more blocked practice might be necessary, but you can modify it by mixing targets within blocks. This variation allows you to get more repetitions of target movements within each blocked practice.

4) VARY CONTEXTS AND PROSODY

Facilitate practice in different contexts. Vary the types of consonants or vowels and the positions that they are in . For example, change the initial set, going from CV (consonant-vowel) to CVC (consonant-vowel-consonant). Increase complexity of movements as the child gains the accurate motor movement sequences.

Experiment with prosody, loudness, and emotional intonation. This variability engages different muscles, enhancing motor planning processing and efficiency – our ultimate goal.

5) FEEDBACK MUST BE EVER-CHANGING

Feedback is dynamic throughout a child’s therapy program. Feedback can be intrinsic (what the child perceives) or extrinsic (what we provide for the child). Extrinsic feedback can be knowledge of results (was that right or wrong) or knowledge of performance (specific guidance on what specifically needs improvement). 

Initially, provide more feedback to guide the child, but gradually fade it as they become more accurate and independent in their speech movements. We don’t want too much support for too long otherwise the child could become dependent on the supports. We want to fade supports so children know how to produce the movements independently.

Often the type of feedback can change depending on the target and the accuracy of that target.

Using the Principles of Motor Learning:

Using the Principles of Motor Learning is like having roadmap in the world of CAS therapy. These principles guide speech therapy leading our children toward improved communication skills. So, practice often and adapt to the child's needs whether it be with feedback, type of practice or contexts.

Speech Therapy Tips for Minimally Verbal Preschoolers

How do I get my child to talk? What can I do at home to help my child communicate what they want and need? If my child isn’t talking, is there anything I can do? 

These are some initial questions that I hear when I first see a minimally verbal child for a speech and language evaluation.  Although it is important for intervention (speech therapy) to be tailored to the individual child, there are some intervention techniques that are helpful for all children.  Some experts (Fish, 2016; Velleman, 2003) suggest intervention for young children include the following (modified from article by Megan Overby, PhD, CCC-SLP original article Sharon Gretz, M. Ed.):

• Learning to imitate gross motor skills

• Large motor movements (such as clapping, hands up to be picked up)

• Actions with objects (banging two blocks together)

• Imitating vocal play (i.e. raspberries, tongue clicks)

• Imitating oral-facial movements (i.e.,puffing cheeks out, blowing kisses)

• Vocalizing visible early sounds such as /m/, /b/, or /d/ (e.g., /mmmm/, “muh” or “buh”)

• Vocalizing to get attention (e.g., “uh” and pointing to a cookie)

• Sound effects: animal noises (e.g., “grr” for a tiger, vehicle sounds)

As children start using more of the above and begin to use more sounds imitatively and spontaneously, focus can include more functional vocalizations: 

•  Words with distinctive pitch patterns (e.g., “uh-oh,” “wow,” “whee,” “yay”)

• Words with strong emotional meaning (“no”, “up”)

• Vocalizations that can be paired with actions (e.g., “whee” as a car goes down a track, “hi,” with a wave and  “oops” when an object falls)

• Sound effect words (e.g., “woof’, “beep,” etc.). There are great books that use sound effects (see Blog post, 13 Tips for Choosing Books for Preschoolers)

• Verbal routines and singing (e.g., songs  like “5 Little Monkeys Jumping on the Bed,” favorite predictable books like “Brown Bear Brown Bear What Do you See”) : (see Blog post, 13 Tips for Choosing Books for Preschoolers)

• Words with very early consonants and simple syllable shapes (e.g., “hi,” “me”, “mama”, “oh no”)

Some helpful speech therapy tips: 

•  Use sounds already in the child’s repertoire to build simple productions (e.g., if a child has /p/, can they learn to say “pop” “up,” or an approximation of those words)

• Hold toys or objects of interest near the speaker’s mouth to direct the child’s attention to mouth movements during imitation tasks. 

• Use movement during practice (push a car down a track to work on “wheee” or build a tower and place block on top and practice “up” then “uhoh” when they fall down.

• Make it fun and incorporate play with stuffies or whatever the child is interested in to elicit speech and language (i.e. let your child see you “hiding” toys in the room and have them find them)

• Books and music are extremely helpful to facilitate skills. 

• Keep in mind, once a child begins to use sounds, it is  more important to expand their sound and syllable repertoire than to have them accurately produce the sounds ( that will come later!)

• The more repetitions you can get the better! Using target vocalizations in play is not only fun for the child, but also encourages the most engagement and in turn increased repetitions.

The primary goals for children who are exhibiting minimal communication skills are (modified from Davis and Velleman, 2000):

• Help the child establish a consistent form of communication. This could include sign language, pointing to pictures, using approximations of words, pointing to what a child wants, gestures and facial expressions (or a combination of these!). It is important that the child and the people in their environment agree what a gesture, sound, picture, or word approximation represents or means.

• Using alternative communication such as sign language, gestures, or pictures can help move a child toward verbal communication by relieving frustration and establishing a consistent, reliable means of communication (Fish, 2016). 

Once my child/student starts vocalizing, where do I go from there?

A hierarchy is suggested for working on production of syllable shapes for children with Childhood Apraxia of Speech (modified from Fish, 2016 and Velleman, 2003) but can also be applied to minimally verbal children. I have include the initial steps in this hierarchy: 

• CV (Consonant plus a vowel) (“me”)

• VC (vowel plus a consonant “up”)

• Reduplicated CV.CV (“bye-bye” or “no-no”)

•  CV.CV with a vowel change  (“mommy”, “nehnuh”)

• Variegated CV.CV (“bunny”)

• CVC (“pop”)

•  CVC with different consonants (“top”)

These are techniques and suggestions that speech language pathologists use in therapy and caregivers can use at home to elicit some speech and language skills. If you are concerned about your child’s speech and/or language development, it is recommended that you contact a speech-language pathologist through your local county or early intervention or preschool program to have a thorough communication evaluation to determine if speech therapy is required. 

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