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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FREE Scavenger Hunts
(egg carton and full sheet versions)

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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!

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)

Preposition and Spatial Concept Acquisition

“Hey Addie, please put your shoes in your cubby”, “Wyatt, stand in front of Cooper”, “Eliza throw the ball up in the air!” These are some real life examples of the functional need for children to understand spatial concepts.  

Working with young children, I find that the understanding and use of prepositions is incredibly important for daily life as a child (and the research backs me up!). Prepositions include words like “on, up, under,and behind” are critical in making requests, following directions and locating objects. 

I target prepositions daily in my work with pediatric children with speech and language differences.  A fundamental skill is being able to tell someone where an object is and being able to find an object when someone describes where it is- like “Mom, your keys are in the fridge”, and “Addie, your cup is under the table”. 

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Here is a chart that may be helpful for the acquisition of spatial concepts by age. Keep in mind that all children develop at different rates and these are estimates based on a compilation of  research literature. Click on the chart to get your own copy.

When Teaching Spatial Concepts or Prepositions the literature makes two important points to keep in mind:

•  1) Children should be hearing prepositions in many different contexts. “Target words said by a clinician in a variety of syntactic and situational contexts (i.e. with different objects) were more often acquired by the two-year-old late-talking children..” (Alt et al, 2014). Meaning the more kids hear prepositions in different ways, the more likely they are to acquire them. 

  Example: If a child is learning the location “under”, they hear the word under as they are crawling under the table, “Hey, Jake, you are going under the table”. Later the child hears the word “under’ again, “Your cup is under your blanket”.A third time that day they hear, “My keys fell under my seat” and so on. The objects are changing but the preposition is staying the same.

• 2) The second point is that it is important to vary those contexts where the prepositions are presented.  Those concepts should be presented in different places; at home, at the playground and the grocery store. 

  Example: If a child is working on the preposition “out”, The adult would say, “let’s go out the door”, then later in a different location, “Take the apple out of the cart” at the grocery store and later, “pull the piece out of the puzzle” when playing at home.

  How to Teach Spatial Concepts

Start simple and with objects that interest the child. If you are working on the concept “off” and your objects are a cup and a small pig, place the pig on top of the overturned cup and push the pig off and say “off”. Repeat this allowing the child to push the pig off several times. 

• Each time you or the child pushes the pig off you say “off”. Pause after at least five times to wait to see if the child says “off”. 

• Later use the same word, “off” with different objects and repeat the activity.

• Ask the child to push the pig off and celebrate when they do.

• This simple activity will allow the child to initially learn the concepts you are targeting.

After you have used the guidelines above, the fun part is helping children understand and use spatial concepts in play! 

HOW DO WE TEACH SPATIAL CONCEPTS ?

Here are some functional and fun ways to help a child learn spatial concepts:

1. “Hide” some plastic eggs around the room (allow the child to watch you hide them) and ask the child to find the eggs in different target locations  “Find the egg under the table”, “Look under the chair”, “Maybe under the blanket”.

2. Allow the child to “hide” them and tell you where to find them.

3. Place sticky notes in target locations in a book (ie. “on top of the dinosaur's head”, “on top of the car”, “on top of his shoe”.)

4. Use a playhouse to target prepositions “on top of the roof”, “Under the bathroom”, “next to the tree” and move people in the target areas.

5. Using play dough to target “between”. “Put the blue ball between the 2 yellow balls”.

6. Use a train track set to target “in front and in back”. “Put the engine in front of the red train”

7. Fill a bin with water and have items that float “on top” or stay “on the bottom”.

8. Incorporating motor skills is a great way to engage children in learning spatial concepts. Make a blanket fort or use a chair and ask them to move to different areas, “Hide under the fort”, “Stand behind the chair”, “crawl between your friends”.

Digital Work with Prepositions (click the picture for a preview)

Alt M, Meyers C, Oglivie T, Nicholas K, Arizmendi G (2014) Cross-situational statistically based word learning intervention for late-talking toddlers. Journal of Communication Disorders 52: 207–20.

Hicks, S., Rivera, C., & Wood, C. (2015). Using Direct Instruction: Teaching Preposition Use to Students With Intellectual Disability. Language Speech and Hearing Services in Schools Lang Speech Hear Serv Sch, 46, 194-206.

Katrina Nicholasu, Mary Alt, and Ella Hauwille (2019).  Variability of input in preposition learning by preschoolers with developmental language disorder and typically-developing language.