Frequently Asked Questions
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- When do I need to introduce new nonsense words?
- What if I’m not sure whether the word was correct or incorrect?
- What if I finish the work sooner than an hour?
- What if the child really can’t do one of the words in the Training phase?
- What if the child restarts and the second attempt is correct?
- What if the child gets stuck on a word or a particular production and can’t change it?
- Can the child just read the word without hearing my model?
- What if the child is getting very few right in Practice?
- What if the child can only say the words very slowly or very softly?
- Can I include articulation therapy to correct poor sound production?
- Some children with CAS have resonance problems, can we treat this in ReST?
- Lots of children with CAS have prosodic problems, can we treat this in ReST?
- This is really hard. Typically developing children couldn’t do it either!
- Can you provide me with a premade list of words?
- How do you keep children engaged in drill treatment without pictures?
- Is the goal of ReST only to teach prosodic variation, or can it include work on speech sound accuracy?
- Do you think that treatment effects might generalize better if you used real words rather than nonsense words?
- If a child has two sessions of treatment but is then away for a week, does the program have to start afresh or pick up from where it left off?
- Can I use clusters?
Introduce new nonsense words when you start a new block of 12 sessions. You should use the same words for all 12 sessions but in a different order each day.
If you’re not sure, you should tell the child that the word was incorrect.
That’s no problem! If the child gets through the Training phase and then 100 practice trials quicker than an hour that’s fine.
That’s OK. Give him or her some cues to help with the production, but if they can’t say the word you can move on to another word. Keep the ‘tricky’ word in the set, use it in Practice, and try teaching it in the next Training block.
The word is counted as incorrect. Remind the child to wait until they are ready to start the word. This might be something to focus on in the next Training phase.
In the next Training phase, try teaching the child to practice the word in their head (silently and without moving their lips) before they say it, you could also ask the child to wait for a couple of seconds after they hear the word before they make an attempt. We use ‘think then say’ cues for this.
Many children with CAS also have difficulties reading aloud. We suggest that no children read aloud spontaneously for the first three sessions. If they are excellent readers, they can read the items from the fourth session. We don’t want speech errors to be because of reading difficulties.
If the child gets fewer than 4/40 correct in the first two blocks of practice then insert another block of Training and then go on to the next 40 practice trials.
The word is incorrect. In the next Training phase teach the child say the item quicker or louder. You can adjust your models to be quicker and faster to assist with this. Just before the start of the next block of Practice remind him/her that he needs to do it at the same speed and/or volume as the model.
Yes, but only in a Training phase.
Yes. The Murray, McCabe and Ballard (2015) stimuli deliberately have a /m/ and /n/ in the stimuli so you can teach oral versus nasal resonance as part of the therapy. You can add more nasal targets in the nonsense words you use to make this a major goal. Ideally, you would want some oral only words as part of this.
Resonance can be taught in the Training blocks. You can teach oral versus nasal resonance, link this with the written sounds and help the child feel the difference between oral and nasal airflow (e.g. feeling where the air comes out using their hand or a tissue). Resonance errors in ReST are considered sound errors on your data sheet.
Yes, ReST specifically treats prosody as a major goal of therapy. All the stimuli address lexical stress – that is alternate stress across syllables in words. When you select treatment targets, you need 20 words: 10 will have strong-weak lexical stress and the other 20 weak-strong lexical stress. As a clinician giving models, you need to be clear on what lexical stress your treatment words have and know how to say these accurately and consistently.
Children with CAS tend to make weak syllables strong or to delete weak syllables, so that stress across a word or phrase is all strong. Teaching in the Training phase helps children understand they need weak syllables also. Strong syllables are those that are longer, louder or higher pitched than those around it. Therefore you can teach children to make weak syllables ‘short’, ‘soft’ or ‘deep’ depending on their needs. Prosodic errors in ReST are considered beat errors on your data sheet. This means the beats of each syllable (their stress) did or did not match the model.
We tested ReST on typically developing children aged 4-12 and they learnt how to say the words in 3-5 sessions. So far none of the children with CAS have had normal speech after a short block of ReST but all have improved substantially.
Yes but it is really important for each child to use words which include sounds in their own sound inventory. You can use the lists on the website but please make sure the child can use the sounds in the lists or modify the lists. If you make new word lists, we’d love it if you email us the list and any supporting materials so we can add them to the site.
Using a visual timetable is really helpful. Show the child how many blocks of Training and Practice they need to do. Other things we’ve found helpful are counting down how many items are left in a block, praising the child for their attention, having a range of games for the child to choose from in the break time. The games can be anything that motivates the child, including active games such as star jumps and running races.
School aged children respond really well to “gamification” – use the language of video games – personal best, game high. Older children respond well to being shown the changes in their scores from day to day and beating their own best score. They also love “levelling up” and understand that the new level will be harder.
Early on we used pictures of aliens with the nonsense words but learning 20 of them was too much to ask so we were left with reading the words or imitating a spoken or recorded model.
Is the Goal of Rest Only to Teach Prosodic Variation, or Can It Include Work on Speech Sound Accuracy?
The goal of ReST is to address the three core features of CAS simultaneously. While it is a great treatment for prosody, it also works on sequencing of sounds and the production of the specific sounds selected in the nonsense words. If a sound (or sound class) needs attention, select it as one of the phonemes in the nonsense words. Ideally, however the sound you choose should be stimulable (produced accurately some of the time) otherwise it is difficult to treat all 3 aspects simultaneously.
Do You Think That Treatment Effects Might Generalize Better if You Used Real Words Rather Than Nonsense Words?
The whole point of ReST is to avoid real linguistic forms – we believe have great generalisation BECAUSE the semantic system is not engaged in the nonsense words – the child is compiling a new and unexpected motor plan without the assistance or interference of the semantic system. No already learnt incorrect productions need to be corrected in the nonsense words. The phrases are real phrases except for the nonsense word(s). If you are interested in this topic, you could read the treatment journal articles on both ReST and on generalization of nonsense words to real words in other speech sound disorder treatment also (Gierut & Morrisette, 2010).
If a Child Has Two Sessions of Treatment but Is Then Away for a Week, Does the Program Have to Start Afresh or Pick Up From Where It Left Off?
It’s best to schedule a block of ReST at a time when the child and parent can commit to regular intense treatment. School holidays are a good time for many school-aged clients. Even with the best planning, unforeseeable events and illnesses sometimes happen. If a child has missed several sessions in a week they are likely to need longer in the Training phase of the next session in order to re-orientate them to the treatment.
You can use clusters if the child has clusters in their inventory. But in English, true clusters are rarely word-medial. Therefore, we do not recommend using word-medial clusters. However, you can use them if you would like.