Hello again Sandra, I have a question! I took your online course on /r/ from Basics to Habituation and I have a client at the moment who is not making much progress. She is 7 1/2, no cognitive concerns. Oral periph: grossly normal, possibly slightly enlarged tonsils, though somewhat difficult to visualize due to small oropharyngeal cavity?? That’s my thought, anyway. No hx of allergies, chronic colds, etc. Does have a sensitive gag reflex, which she triggers when trying to pull tongue back from /l/ to ‘er’. Independent movements of tongue are ok, however she can NOT maintain suction. She can click and cluck all day but can’t prolong that after many sessions trying. We have moved on to ‘er’, assuming we may have maximized her suction ability. She has happened upon a decent ‘er’ two sessions ago, several time s and was able to maintain it for a couple seconds, but the last two sessions we haven’t gotten close again. What am I missing?
Many /r/ kids have high and/or narrow palates, which could explain difficulty with suctioning and making the ER sound. When she clicks/clucks, try to get a quick view of how well her tongue fits with her upper arch/palate. If there is a substantial amount of overlap (ie. sides of tongue spread way beyond the dentition), you can look more carefully whether her palate is sufficiently wide to handle the tongue, if she could suction it. I don’t know how familiar you are with restricted lingual frena, but they need not be real obvious to cause a problem. For example, if the lingual attachment is more anterior than half way and/or the mouth floor attachment of the ling frenum is onto the lower alveolar ridge, or if the frenum is short….or a bad combination of any of the above: that could be a primary factor, also. Additionally, those who have the parent right there when you are working on obtaining the ER, have a better chance of quicker success. It doesn’t hurt if the parent has a good “ear” for the sound, of course. I have a brother and sister currently who have had ER in the schools for 6 years and 3 years respectively with zero progress. In 6 sessions, the girl (8 years old) has habituated close to 100% and the boy is doing a miraculous job as well. I have to say that the mom drives 45 minutes to see me and has a background in linguistics! Doesn’t hurt! Besides sliding from an /L/, other methods might prove better. I almost always lift the tongue into position with a tongue depressor, careful not to impinge on the frenum, of course. I don’t let them repeat ER several times. Instead I put the tongue where it should be and tell them to make ANY sound, explaining that if I have the right location ONLY ER can come out. It might be nasal, but that’s OK as a starting place. If she has maximized prof exam #1 of the Myo Manual (from your comments, I think you have the Myo Manual…if not, this might not make sense), then it’s just a matter of patience and slow progress until the ER is achieved consistently. Often, I spend more time on that than the rest of the program. And for home assignment, don’t have her practice anything which she hasn’t shown competence to do in your session or you could end up reinforcing incorrect attempts. Hope this helps….let me know, Sandra