Intensive Treatment for Persisting Rhotic Distortions: A Case Series
Jonathan L. Preston, PhD & Megan C. Leece
American Journal of Speech-Language Pathology, 26(4), 1066–1079
Purpose: This study examined whether an intensive 1-week therapy program could improve American English rhotic accuracy in adolescents and young adults with residual speech sound errors that had not resolved with previous treatment.
Key Findings
- All four participants (ages 13-22) demonstrated statistically significant improvement in R sound accuracy
- Word-level accuracy improved from 35% at baseline to 83% post-treatment
- Sentence-level accuracy increased from 11% to 66% within one week
- Improvements maintained or continued to improve at 3-week follow-up
- Treatment delivered over 300 structured practice trials per hour
Clinical Implications: The authors conclude that rapid change in speech sound accuracy can be achieved through intensive treatment incorporating motor learning principles, ultrasound biofeedback, and auditory training. Results demonstrate that sufficient neuroplasticity exists even for long-standing errors in adolescents and young adults.
Auditory-Perceptual Acuity in Rhotic Misarticulation: Baseline Characteristics and Treatment Response
Laine Cialdella, PhD; Heather Kabakoff, PhD; Jonathan L. Preston, PhD; Sarah Dugan, PhD; Caroline Spencer, PhD; Suzanne Boyce, PhD; Mark Tiede, PhD; Douglas H. Whalen, PhD; Tara McAllister, PhD
Clinical Linguistics & Phonetics, 35(1), 19–42
Purpose: This multisite study examined whether children with residual R sound errors demonstrated reduced auditory-perceptual acuity compared to typically developing peers, and whether perception abilities predicted treatment response following visual biofeedback intervention.
Key Findings
- Children with R errors showed significantly poorer perception of the /r/-/w/ contrast compared to typically developing children (large effect size: Cohen's d=0.90)
- Visual biofeedback treatment (ultrasound and acoustic feedback) was effective across participants
- Females with better auditory perception responded significantly better to treatment, while males responded regardless of perception abilities
- Large multisite sample: 107 participants (59 with R errors, 48 controls) ages 9-15 across four institutions
- Treatment responders showed effect sizes greater than 1.0 in acoustic improvement measures
Clinical Implications: This research demonstrates that visual biofeedback is an evidence-based approach for treating persistent R errors. Importantly, even individuals who struggle to hear the difference between R and W sounds can benefit from treatment. The findings suggest that personalized treatment planning should consider both auditory-perceptual abilities and gender-specific response patterns, highlighting the importance of individualized intervention approaches.
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