What are cues in speech-language pathology?
I like to explain cues and “clues” to help guide patients and students toward more effective communication. In speech-language pathology, you may have heard the time “maximum cues,” “fading cues,” visual cues,” “minimal support,” and many more when reading a document following an Individual Educational Program (IEP) Meeting or Evaluation. Here, we delve into the various forms these cues can take and how they empower patients on their path to better communication.
Types of Cues
1. Verbal Cues/Support: The SLP provides positive reinforcement and verbal encouragement throughout the session. They praise the child for their efforts and provide specific feedback on their speech attempts. For example, if the child attempts to produce a difficult sound, the SLP might say, "Great job trying! Let's try that again, focusing on the sound at the beginning of the word."
2. Visual Cues/Support/Aids: The SLP uses visual aids such as pictures, diagrams, or videos to demonstrate correct mouth positioning and articulation. They show the child how to produce the target sound or word by pointing to the relevant images and modeling the correct pronunciation. For example, they might use a picture card showing the mouth shape for the target sound and encourage the child to imitate it. Another common use would be a graphic organizer of all the concepts the student must report when reading a story.
3. Hands-On Assistance: Tactile cues involve the SLP providing physical guidance to help the child feel the correct tongue placement or lip movement. They may gently guide the child's articulators (such as the tongue or lips) to the correct position while modeling the target sound. For example, the SLP might place their hand under the child's chin to help them feel the movement of their jaw while producing a specific sound. Another would be hand-over-hand support when a child is making a sign or selecting an icon.
4. Imitation and Modeling: The SLP models clear, precise speech for the child to imitate. They exaggerate their articulation and use rhythmic patterns to help the child grasp the nuances of language and fluency. The child then attempts to imitate the SLP's speech, with the SLP providing feedback and guidance as needed.
5. Contextual Reinforcement: The SLP provides opportunities for the child to practice speech in real-world situations. They engage the child in conversation during various activities, such as playing with toys, completing tasks, or interacting with peers. The SLP reinforces the connection between speech and meaningful communication by encouraging the child to use their speech skills to express their needs, desires, and thoughts within different contexts.
Level of Cueing
Minimal Cues:
Description: Minimal cues provide subtle prompts or hints to guide a child's speech production without directly providing the correct answer or overtly correcting errors. These cues are designed to encourage independent problem-solving and self-correction.
Example: Instead of directly stating the correct pronunciation of a word, I may provide a minimal cue by asking the child to "try that again" or to "listen carefully to the sound."
Moderate Cues:
Description: Moderate cues offer more explicit guidance compared to minimal cues, providing additional support while still allowing the child to actively participate in the learning process. These cues may involve providing partial information or offering hints to help the child arrive at the correct response.
Example: If a child is struggling to produce the /k/ sound in the word "cat," the SLP might provide a moderate cue by saying, "Focus on the back of your throat when saying the sound."
Maximum Cues:
Description: Maximum cues provide direct instruction or full assistance to help the child achieve the correct speech production. These cues are typically used when a child requires significant support or when learning a new skill or concept.
Example: If a child is unable to produce a particular sound even with minimal or moderate cues, the SLP might provide a maximum cue by physically guiding the child's articulators to the correct position while modeling the sound. Another would be using hand-over-hand support to help a child correctly produce the sign or select an icon.
Fading Cues:
Description: Fading cues involve gradually reducing the level of support provided to the child as they become more proficient in their speech skills. The goal of fading cues is to promote independence and generalization of skills by gradually decreasing the reliance on external prompts.
Example: Initially, SLP’s use maximum or moderate cues to help the child learn a new sound or word. As the child demonstrates improvement and increased confidence, the cues gradually fade, transitioning to minimal cues and eventually to independent production.
How do cues change over time?
We start new goals with a description of how to target the goal and then provide moderate to maximum cues, as children continue to learn correct production/placement/whatever the goal is. It is the knowledge of the performance that we are providing. Feedback that helps the child see what they are doing and how to scale accordingly.
While targeting, I frequently consider how I can scaffold levels. If the child is doing too well, I will provide less feedback so they can keep themselves accountable. I may even have them report what they did wrong to increase their understanding of the target. If it appears to be too difficult, I will either make the targets easier (e.g., working at the syllable level than the whole world) or provide more feedback/support during sessions. Sometimes, students may be experiencing emotional distress and I scaffold to easier targets/more support.
To conclude:
Navigating the terrain of speech development with your child can feel like embarking on a journey filled with twists and turns, but armed with the understanding of cues, you're equipped to guide them toward clearer communication with confidence.
In speech-language pathology, cues aren't just aids; they're the building blocks of progress, each one a stepping stone toward greater independence and fluency. From verbal encouragement to hands-on assistance, each cue plays a vital role in shaping your child's speech journey.
As we've explored the various types of cues - from minimal to maximum, and the concept of fading cues - it becomes evident that our approach evolves alongside your child's growth. We start with clear goals and provide tailored support, adjusting the level of cues as they progress. With cues as our compass, let's embark on this adventure towards clearer communication, one step at a time.
