October 24, 2025 · 2:27 · Target selection · DTTC
When a Target Word Is Too Hard
What to do when a child is reluctant to practice a challenging word: use a smaller block, move down the cueing hierarchy, and if needed, set the word aside to avoid negative practice.
Full transcript
Hi, it's Nicole from the NYU Motor Speech Lab. A question came in: what do you do when a target is hard in your pediatric motor speech therapy? I mean, most of the words are going to be hard; that's why we're doing the therapy. But what about when the child is reluctant to practice? You're going to come across this. What do you do in these instances?
The first thing you want to do is use this challenging word to organize your blocks in what we call a modified block schedule. The block with this challenging word is going to be a smaller block, meaning fewer repetitions. With a word they have a little more skill with, you could get to 20 repetitions and you're flowing in that block. That's not this block with the hard word. It's a smaller set. Maybe it's only five productions.
The other thing to think about is the hierarchy. If they cannot do it in direct imitation, you go to simultaneous. If simultaneous is hard, you slow down. So if the target word is "mom," and "mom" together is too hard, you say, "Okay, let's slow it down. Say it with me like this: mom." When we slow it down, we're essentially elongating the vowel.
If that is too hard, you might say, "Okay, let's say it in a whisper." Still too hard? "Okay, let's just move our mouths with no sound whatsoever." And if that is still too hard, I'll say, "Okay, just watch me. Watch my mouth. Notice how my lips come together, my mouth opens, and they come back together." And then I stop.
The idea is that we don't want to engage in negative practice, meaning we don't want these children to lay down a motor plan for an incorrect production. So we don't want to sit in a block where they're continuously saying the word incorrectly. And honestly, if it's getting to that point, let the word go. That is okay. Take this word, put it to the side, don't practice it for a little bit. Then one day, when you feel like it's the right time, bring it back in and see how they're doing with it. You just don't want them saying the word incorrectly over and over and over again.
I hope that's helpful.
