You may or may not have heard the term, “negative practice” in motor speech therapy. If your child has a motor speech disorder such as Childhood Apraxia of Speech (CAS), and you have not heard this term, it’s an important one to know and understand.
For a child in motor speech therapy, the brain and mouth are being trained to work together so those speech signals get to the right place. Your child is learning to program/plan the sequence and subsequent movement of sounds to produce speech. The process is intense and repetitive, and this is why words and phrases, or “targets,” are selected (rather, should be selected) with your child’s phonetic repertoire AND interests in mind. Put another way, the targets being addressed should be highly motivating, functional, and within your child’s capabilities. They should also be well varied. If your child is sent home with a list of s-blends, this is a phonological pattern being addressed, not movement of speech sounds. Let’s say your child has an emerging /s/, but very few additional sounds. Words like “stop, spider, smile, swing, skateboard” are too complex and reflect an initial s-blend pattern. More appropriate targets may be “us, mess, sad ” (depending on child’s vowel and additional consonant repertoire). These targets reflect less complex phonotactic patterns than the s-blends listed above such as vowel-consonant (VC), consonant- vowel (CV) and consonant-vowel-consonant (CVC). They also hold meaning vs. arbitrary vocabulary containing emerging sounds. In other words, how will being able to say “skateboard” help your child communicate their wants and needs on a daily basis? Functionality should be at the forefront when deciding appropriate targets for your child.
When a child is practicing outside of the therapy room, they are continuing to learn how to plan, sequence, and execute the movements for their specific targets. If the target is “teddy” and they are producing it as “beddy,” at home, the brain and mouth are learning to program “beddy.” The brain is starting from scratch and is unaware the true target is “teddy.” The brain isn’t grabbing a post-it note for a reminder to “switch that /b/ to a /t/ later on.” Their brain is learning to tell the mouth “beddy,” and that will STICK.
Enter “negative practice.” This is when a child is practicing a target incorrectly and repeatedly and so committing it to muscle memory. Some examples of negative practice are:
- Incorrect sound production – like our “teddy” vs. “beddy” example above
- Incorrect emphasis of sounds or syllables – resulting in incorrect prosody (oPEN vs. Open)
- Halting between sounds or syllables – this is known as “segmenting” – e.g., “Ma…king!” (Making) “Bed-uh!” (bed). That little “uh” at the end of the word is an intrusive schwa, and we will get to that another time.
In all the examples above, the child is getting close to the word, which often parents think is good enough. This is not the case for children with CAS. Movements should be as accurate as possible as often as possible. Much of the negative practice instituted during at-home work is , of course, unintentional and innocent, only intended to HELP the child. However, for motor speech disorders, natural, fluent movements are the MOST important to model and encourage.
Depending on the severity of CAS and accuracy of the targets in sessions, 1-5 targets for at-home practice should be sent home ONLY if a child can say them spontaneously and with minimum to moderate cueing and can endure high repetitions. This can include a verbal cue (e.g., “What was that?”), a visual cue, (popping the lips to remind them of a /b/ or a /p/), or both. If your child needs tactile cues for particular speech sounds, that target should be addressed longer in therapy before being sent home! This is based on the principles of motor learning and the Dynamic Temporal and Tactile Cueing approach (DTTC). If a child is unable to produce the target spontaneously with only cues as described above, I tell the family to stop practice. We do NOT want the child practicing the word incorrectly. The target could become “fossilized” and very difficult to correct.
If you have any concerns about whether your child is participating in negative practice, talk with your specialized SLP or reach out to Erin today! Erin is always open to consultations regarding your child’s (suspected) diagnosis and/or motor speech therapy.