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