“While a majority of the SLPs surveyed agreed that prosody is within their scope of practice, they also reported that their knowledge and clinical training on assessing, diagnosing, and treating prosodic impairments is not adequate.” -Sarah Elizabeth Fischer,  2018

This excerpt comes from a thesis project submitted to the University of Mississippi. I came across it when I was trying to figure out if I was the only one who felt uncomfortable and unsure about treating prosody. My answer: not in the slightest. 

Sure, I knew what prosody was. Sure, I knew it was part of my scope. But, I wasn’t really sure how to tackle it. Or when to prioritize it. So I started digging, trying to find all I could that might support me – that might help me support my clients.

Here’s a little snapshot of what I found:

What is Prosody (a refresher):

Prosody refers to the suprasegmentals of speech – pitch or intonation, stress, loudness, rate including pausing and overall rhythm. 

Prosody as it relates to Apraxia of Speech

Why it’s important: Often children with apraxia of speech present with unusual prosody. Speech may sound robotic-like with equal stress, prosody may be flat without variation or with unusual variation, and rate may be too fast or too slow. These irregularities often impact speech intelligibility. Check out this post for more.

How to target it: Don’t wait, start right away! Preston (2018) suggests that prosodic variation supports the motor learning principle of variable practice, in that it can increase speech motor learning for children with Childhood Apraxia of Speech. Dynamic Temporal Tactile Cueing (DTTC) includes prosodic variation in the early stages of its hierarchy for motor learning. The idea is that the variation in prosody helps to solidify the motor plan. Check out Jennie Bjorem’s visual for DTTC here and the free online course by Edythe Strand clicking here, then selecting ongoing events & more information. When a child can accurately produce a word, immediately vary its prosody. You can do this by changing its stress pattern, increasing or decreasing loudness and/or pitch, increasing or decreasing rate. A fun way to introduce this is by using silly voices (i.e. use your mouse voice, your dinosaur voice, etc.)

Prosody as it relates to Expressive and Receptive Language

Why it’s important: Although more subtle, prosody is impacted in children with language impairment (Gerken & McGregor, 1998). Children with language impairment often omit weak syllables from phrases, and have difficulty perceiving prosody which may lead to difficulties using prosody to learn syntax. 

How to target it: Use a therapeutic prosody to highlight intervention targets, as research suggests rate reduction and increased pitch and loudness aid word learning for children with language impairment (Gerken & McGregor, 1998). Present target forms at the end of clauses, because we naturally lengthen words in clause-final position (Gerken & McGregor, 1998). For example, when defining an apple you could say “A round red, green or yellow fruit that grows on tress is called an apple.” Or when working on “is” you can ask a question such as “Who is happy?” And include the response “He is,” which draws attention to “is” by placing it in the clause final position. (I love this! Because it also goes along with the complexity approach for grammar research by Van Horne which suggests targeted “is” in question form may generalize to “is” in sentences).

Prosody as it relates to Social Language

Why it’s important: Prosody often indicates meaning. We change our intonation based on our mood, an important skill for both understanding a message and conveying a message. We must make inferences based on tone of voice to figure out someone’s mood or intention. We use prosody to indicate if we are making a statement or asking a question, or even to use sarcasm and tell jokes. If we are unable to interpret and use prosody appropriately, it may lead to communication breakdowns and misunderstandings. 

How to target it: A great place to start is identification. Having a child listen to variations in prosody to infer mood, or meaning of a message. Varying the stress in a sentence to differentiate meaning and identifying. Often having a word bank to select from to start and then fading those cues. After identification is successful, working on role playing and charades of emotions, statements and questions. Often sarcasm is the most challenging so contrasting statements using a sarcastic tone of voice vs. a serious tone of voice for identification to start, followed by expressive practice. Watching videos and movie clips can also be a great way to see several different models of varying intonation.

This serves as a starting point and general overview of prosody as it relates to different treatment areas. For more, check out my instagram account @iowaspeechie, where I occasionally share how I’m working on prosody in my therapy room. I’d love to hear your ideas and input as well!

Sources

Fischer, Sarah E. “Speech Language Pathologists and Prosody: Knowledge and Clinical Practices.” Oxford, 0AD.

Gerken, Louann, and Karla Mcgregor. “An Overview of Prosody and Its Role in Normal and Disordered Child Language.” American Journal of Speech-Language Pathology, vol. 7, no. 2, 1998, pp. 38–48.

Meredith, Amy. “Prosody and Articulation.” Apraxia Kids, 28 Nov. 1970, www.apraxia-kids.org/apraxia_kids_library/prosody-and-articulation/.

Preston, Jonathan L., et al. “Variable Practice to Enhance Speech Learning in Ultrasound Biofeedback Treatment for Childhood Apraxia of Speech: A Single Case Experimental Study.” American Journal of Speech-Language Pathology, vol. 26, no. 3, 2017, pp. 840–852.

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