197. Ten Predictors of Poor Progress in Speech Therapy—and How to Turn It Around

The Preschool SLP

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25d ago 41:24

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If you treat speech sound disorders (SSD) and you’re not seeing the gains you expect, this episode is your playbook. We cut through the noise and name the 10 research-informed predictors of slower progress—attention/self-monitoring limits, sensitive temperament, co-occurring language/working-memory load, hearing impairment (fricatives/affricates), motor speech factors, structural constraints (e.g., open bite), low stimulability, later start to intervention, low therapy intensity/irregular attendance, and environmental barriers. Then we pivot hard into the three levers that consistently move outcomes: choosing complex, maximally distinct targets (e.g., SW-blends), delivering dynamic temporal tactile cueing (DTTC-style), and holding the ~80% challenge point to avoid reinforcing error patterns. Concrete therapy examples, parent carryover, and generalization strategies included.

What you’ll learn:

📈How attention and self-monitoring mask progress until generalization “pops”

📈Why a sensitive temperament demands predictability and a responsive start

📈How co-occurring language and limited verbal working memory can look like CAS—but aren’t

📈What hearing loss really means for fricatives/affricates and consonant deletion patterns

📈Practical expectations for motor speech and structural constraints (e.g., open bite)

📈How stimulability with maximal cueing informs prognosis

📈Why start age and habit strength matter for entrenched /r/ and /s/ errors

📈Why frequency > duration for home practice, and how to embed one daily rep

📈The “no-data-during-DTTC” mindset: probe quickly, cue deeply, fade fast

The 3 levers (non-negotiables):

📈Target selection: Complex, maximally distinct clusters (SW > ST/SP/SK) to drive system-wide change.

📈Delivery: DTTC-style, moment-to-moment cueing (choral → fade), with brief probes to verify learning.

📈Challenge point: Keep accuracy near ~80%—high enough to learn, low enough to adapt. If you’re reinforcing errors, pivot.

00:00 Why progress “flatlines” then explodes

03:10 Predictor #1: Attention/self-monitoring

06:20 #2: Sensitive temperament & predictable routines

10:00 #3: Language/working memory vs. “looks like CAS”

14:15 #4: Hearing impairment (HF cues, fricatives/affricates)

17:10 #5: Motor speech considerations

20:05 #6: Structural constraints (open bite, dental)

22:40 #7: Stimulability with maximal cueing

25:00 #8: Older start age, entrenched habits

27:10 #9: Intensity/attendance

28:45 #10: Environmental barriers

30:45 The 3 levers: complex targets, DTTC, 80% challenge point

38:00 One-rep-a-day home carryover that actually sticks

Call to action: Stop reinventing materials. Make your work easy with effective, educationally-rich SSD tools at your fingertips—complex target sentence strips, paragraphs, and movement-literacy activities ready so you can focus on cueing, not prep. 👉 Join the SIS Membership: https://www.kellyvess.com/sis

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#Higher Education #Podcasting Education #Kelly Vess, MA, CCC-SLP #Kelly Vess #Continuing Education #Early Childhood #With Speechlanguage Pathologists #Preschool #Special Needs #Early Intervention #The EvidenceBased Practice #Autism Spectrum Disorders #Speech And Language Impairments #Developmental Delay #Digital Courses #Seminar