The /r/ sound is one of the most difficult sounds for a clinician to target. Where do we start? The R that initiates a syllable is very different from the R that is vowelized, and the R that is stressed within a word is different from the unstressed R at the end of words...or are they? Covered will be seven basic steps that are necessary to move clients onward toward habituation. Participants will learn the secrets of taking the correct steps in the correct order. You will no longer be left in limbo, unsure whether to begin with the initial sound in isolation, or in the final position, or with clusters....or whether to simply pull your hair out in frustration!
Certain structural and functional complications that interfere with the treatment process are described and ruled out. Basic lingual skills necessary for success are introduced early in the treatment program. Participants will progress — much as their clients will — through small, critical steps along a smooth and sensible pathway leading to the final goal of habituation. Offered for 0.15 ASHA CEUs – 1.5 contact hours.
While the content of this online CE course does not focus exclusively on any specific proprietary product or service, the methods in this course are derived from the text, Orofacial Myology: From Basics to Habituation. Course author, Sandra Holtzman, is the author of this text and receives royalties on its sale. Additional financial and non-financial disclosures may be found by clicking on the Presenter & Disclosures tab.
Video PowerPoint presentation with author narration & downloadable handout.
This online CE course is an updated version of a previously offered eCourse - #e54. While some of the content material may be the same, this course is considered a different offering with ASHA.
Sandra R. Holtzman, MS, CCC-SLP, COM, QOM, is an ASHA certified speech-language pathologist who has specialized in orofacial myology for more than 30 years. She is a certified orofacial myologist and a member of the International Association of Orofacial Myology (IAOM). Sandra is presently serving on both the Board of Directors and the Board of Examiners of the IAOM.
Sandra has addressed SLPs, dental professionals, and other specialists across the United States on the connection between orofacial musculature and speech disorders, tongue-tie (ankyloglossia), thumb and digit sucking habits, mouth breathing, and other topics. In 2000, Sandra established Neo-Health Services, Inc., which provides continuing education workshops, therapy for orofacial myofunctional disorders and other speech-language disorders, and supplies oral myofunctional products. She is the author of Orofacial Myology: From Basics to Habituation (aka the "Myo Manual").
Financial — Sandra Holtzman is a presenter of online CE courses sponsored by Northern Speech Services; receives royalty payments.
Financial — Sandra Holtzman is the author of the text "Orofacial Myology: From Basics to Habituation"; receives royalty payments.
Financial — Sandra Holtzman is the owner of Neo-Health Services, Inc; ownership interests.
Nonfinancial — Sandra Holtzman has no relevant nonfinancial relationships to disclose.
This program is offered for 0.15 ASHA CEUs (Intermediate Level; Professional Area).
ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.
ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:
If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.
Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.
Additional accrediting agencies by which Northern Speech is an approved CE provider:
Course Completion Timeframe:
You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.
However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.
Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.
Certificate of Completion:
On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.
ASHA CE Registry Submission:
During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
Purchase orders are currently not accepted for online orders, if you wish to submit a purchase order please do so at firstname.lastname@example.org or fax to 888-696-9655.
What is an Online Course?
Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.
Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online. Please note that courses offered for university students are not applicable for CEUs.
Registering for an online course:
You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.
Accessing your purchased course or returning to a purchased course:
You will be able to access your online course by logging into your Northern Speech account and then clicking the My Online Courses tab on your profile screen. Click the course you would like to start or to resume. From there, proceed through the course sections until you are ready to complete the post test. You do not have to complete your course all at once. You may log on and off as you wish.
Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.
Number of CEUs offered:
We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.
State licensing boards and online CEUs:
NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.
Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page. Most courses include closed captioning.
Most of our online courses provide a link to download the accompanying handout as a PDF file.
Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.
For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.
Course Cancellation Policy:
A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded.
Please click here for any special needs requests, and we will do our best to accommodate them.
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"Each step/technique was very informative and I will definitely use this in my daily practice. The course was easy to follow and understand; handouts were helpful; videos were especially helpful." K.B. (Nov. 2021)
"It was practical and right to the point- very efficient use of time." N.M. (Nov. 2021)
"Strengthening and coordination of the articulators is so over looked because of misinformation in the field. For so long we have been taught NOT to address the strength and coordination of the muscles in the mouth. This research shows evidence to the contrary. The course was very easy to listen to. Good practice advice." E.F. (Nov. 2021)
"How to work on moving tongue and lips independently from the mandible was beneficial for my daily practice. I liked the video examples." H.E. (Oct. 2021)
"The practical application of the pyramid will be most beneficial to my application of what I've learned in this course. For example, understanding the progression of sounds to introduce in syllables from easiest to most difficult will be helpful in assisting patients to produce /r/ correctly. The course was easy to understand, engaging, and helpful in practical application of the knowledge to the therapy setting." S.H. (Sept. 2021)
"It gives a step-by-step and addressed complications with oral-motor and structural issues." M.T. (Oct. 2021)
"I liked the reasoning for the progression-sound families, and working on the stressed /er/. I liked the scope and sequence. I'm glad I have learned new strategies for working with the /r/ sound." J.A. (Oct. 2021)
"The recommended sequence in which to teach -er and the lists is beneficial for my daily practice." J.J. (Sept. 2021)
"I found the mixture of video and audio examples to be very helpful." A.C. (Sept. 2021)
"Discussion of systematically establishing the basics of production was beneficial for my daily practice. I liked the systematic presentation and examples used." D.M. (Sept. 2021)
"I thought the explanations of the 7 steps to habituation was very informative. I love the examples given and the videos provided. Easy to read and follow handoutsStep by step guide of each step." N.R. (Sept. 2021)
"I liked all the video's. I learned that you don't move on to the next step until you get proper tongue placement...even though it's boring!" L.M. (Sept. 2021)
"The speaker provided video examples and detailed outline of how to produce the /r/ sound." K.C. (Sept. 2021)
"How to make 'er' the initial goal, then to carry it over and the specific steps to how to break down /r/ were good." M.P. (Sept. 2021)
"The pulmonary and respiratory systems & how they impact swallowing was beneficial. Allowing us to revisit the lectures helps with retaining of information." J.L.(Sept. 2021)
"The steps that I can follow for correction of the /r/ sound were beneficial." E.S. (Sept. 2021)
"This was the best /r/ training I have ever watched! The step-by-step approach is one I can implement immediately. I liked the video demonstrations." C.S. (Aug. 2021)
"I liked that it covered a good bit of information in a short period of time." H.G. (Aug. 2021)
"Each of the seven steps was important in order for me to incorporate the program into my daily practice. I liked the example videos, voice recordings, and example words and sentences." K.S. (Aug.)
"The hierarchy of consonants to incorporate with vocalic "r" and the examples of words used to target "r" production will help my with my daily practice." C.S. (July 2021)
"The ruling out basic factors and the lingual basics were very helpful. I liked the clarity of the 7 Stages, word examples, and video samples of clients." M.C. (July 2021)
"The 7 steps for teaching /er/ production and for it to become more natural in conversational speech were beneficial. I enjoyed the client videos and real-life examples of how the treatment techniques should be implemented in practice." K.S. (July 2021)
"The presenter was excellent and handouts were fantastic!" R.H. (July 2021)
"Very informative, easy to listen to speaker." R.P. (May 2021)
“I liked that this course provided clear precise examples with words in order of proven treatment method.” – S.P. (Mar. 2021)
“I liked that the activities suggested examples given for the program to move forward (word lists with ER) as progression occurs. Also, the videos very helpful.” J.P. (Feb. 2021)
“I liked how each step was broken down. And that it provided video illustrations and word lists that you can use in practice, so you don't have to develop things on your own!” – D.S. (Jan. 2021)
“I enjoyed how the presenter discussed the progression of the therapy very clearly. It's so easy to apply a technique clinically if it's explained well with good examples, and that is exactly what this course provided.” – L.S. (Dec. 2020)
“I liked the examples provided. I also appreciate that they addressed the oral motor movement in a way that makes sense.” – B.D. (Nov. 2020)
“I really appreciated this content taking me back to the basics of the oral cavity and lingual movements. I tend to rush /r/ therapy, and it helped me understand I am missing steps and need to start from the beginning.” – C.S. (Oct. 2020)
“I enjoyed the practical treatment and sequential steps for /r/ production.” M.M. (Sep. 2020)
“I never really thought about the /r/ sound being broken down into the /er/ sound. I like that idea, it makes a great deal of sense. I will use this information along with the hierarchy of treatment to see if I can get better results with my /r/ kiddos.” – E.B. (Aug. 2020)
“The specific steps/procedures shared within the early stages was very interesting. The total progression of the program is helpful. I have students who are at various stages, and knowing where I should go (or back up because I didn't spend enough time with an early skill) is very practical and useful. I also liked the video clips and specific examples of the word lists and therapy. Over-all, it was an easy to follow course that made me feel empowered to work on R, rather than over-whelmed.” – A.F. (Jul. 2020)
“The sequence of steps from ER in isolation through syllables, words, and sentences are very interesting. The client videos added nicely to the lecture content.” – J.B. (Jun. 2020)
"I felt that learning about the 7 different stages of how to produce /r/ was beneficial. I liked that the presenter provided videos and audio to show how to implement the different techniques. I felt this course was very informative." – L.S. (May 2020)
“I enjoyed the videos and demonstrations for therapy tasks. I also liked the hierarchy of /r/ presented. This will assist me in choosing appropriate targets while working with my struggling clients.” – E.B. (Apr. 2020)
“I liked the hierarchy presented. The natural, sequential ordering of the targets makes sense to me. It provided a substantial amount of actionable information in a relatively short course, and I thought it was great for the format.” – A.J. (Mar. 2020)
"I liked the step-by-step process of teaching the correct tongue placement for /r/. I think this will be a more beneficial starting point for several of my students. I appreciated that the information was presented in a clear, precise, and linear manner. I also appreciated the video clips demonstrating the different techniques." – T.Y. (Feb. 2020)
"I enjoyed the detailed outline of the 7 steps and the earlier foundation/basic steps necessary on which to build. I liked the practical applications and video demonstrations." – H.Y. (Feb. 2020)
"Very usable information! It provides excellent guidance on how to start and progress through /r/ instruction. I also liked the discussion about naturalization and the ways that we actually produce some /r/ words in context, which are different from how we practice them in isolation." – L.F. (Jan. 2020)
"I liked the clear outline of the different stages - especially the information on getting an ER sound and how to then move to the word level." – S.G. (Dec. 2019)
"All of it was helpful starting from what to think about at the beginning stages, techniques for oral movements, and success in learning how to say target sounds, as well as success with habituation. The information was all useful and well organized." – M.M. (Dec. 2019)
"I really liked the different examples of words, sentences, and activities to use at each step of the pyramid." – K.B. (Nov. 2019)
"I appreciated going over identifying tongue tie and other palatal issues before starting articulation targeting the /r/ phoneme. I liked the practical tips to use in therapy." – C.Y. (Oct. 2019)
"Clear presented steps and rationale. Plenty of examples I can incorporate into my practice. The presenter is top notch!" – A.D. (Oct. 2019)
"I work with non-native speakers who have a very difficult time producing the /r/. This was very helpful in delineating an organized and clear progressive program towards successful /r/ production. The video examples were very helpful, as were the word lists." – S.S. (Sept. 2019)
"Easy to understand and follow. Can't wait to try it!" – K.S. (Aug. 2019)
"Mostly stages 1-3 were the best part. They gave me a process and system for breaking down the /r/ and shaping it. Some techniques I have tried before but there were some new ones." – S.M. (Aug. 2019)
"I enjoyed the specific sequence of skills to proceed through to maximize the effectiveness of "R" therapy. I like that the presenter presented specific examples of each step of therapy. I expected more examples of how to elicit the "er." " – L.M. (Aug. 2019)
"I LOVED that this was laid out step by step with such an easy to follow the format for SLPs. I always feel like I am lost when attempting to teach /r/ phoneme. I liked how straight forward it was and that I am walking away feeling like I know how to tackle the dreaded /r/ phoneme." – M.P. (July 2019)
"I found that the discussion on the importance of lingual basics and how barriers interfere with correct R sound production. I liked the visual supports and the fact that I could replay or re-listen to the speaker's explanations. I also like that the speaker provided a hierarchy of sounds to practice and explained the reasons for the hierarchy. I enjoyed the course." – J.S. (June 2019)
"I love the 'roadmap' for progressing through the stages of the R sound, rather than wondering what to work on next. I love how Sandra gives the information clearly and it's not too fast so I can take notes. Everything in this CEU was beneficial, and I learned a lot of new things that I think will be very helpful in my daily practice." – K.W. (June 2019)
"I especially enjoyed the activities to increase the accuracy of /er/ in isolation before moving on to the word stage. It offered practical suggestions and word lists to begin implementing the information learned in the course immediately." – K.C. (May 2019)
"The specific techniques to help clients transition from /r/ production to correct /r/ production. I love Sandra and all of her courses. I take every one that I can. She is my idea of a truly professional SLP." – D.S. (Apr. 2019)
"I found that knowing the steps leading up to habituation was really helpful. I feel like we are never really explicitly taught that we need to have so many foundational skills to even be able to produce the /er/ sound." – M.F. (Mar. 2019)
"I loved how thorough and informative this was. It took me literally from 'basics' to 'habituation.' Very useful, practical, and applicable information that I can start using and implementing tomorrow." – K.S. (Mar. 2019)
"I loved hearing your ideas on how to very methodically progress through therapy! It makes so much more sense to add consonants in the very specific way you suggested and to consistently use coarticulation to build the child's success as they move from the syllable, word, and sentence levels. I will definitely be using this progression with my students who are working on /r/ from now on!" – A.O. (Feb. 2019)
"I found the entire course to be extremely beneficial. I am transitioning from an early intervention position to school position and, after being an SLP for 12 years, found myself in the position of treating /r/ for the first time. This program offers me a very systematic, step-by-step means of helping my kids. It was an excellent course!" – L.W. (Jan. 2019)
"I appreciated the fact that /r/ remediation is able to be broken down to target /er/ specifically! Great strategies and wonderful information! I really enjoyed the videos! Thank you!" – L.D. (Dec. 2018)
"Going over the ways to motivate a client to work on er in isolation and to pair this with raising pitch was most beneficial." – A.S.M. (Nov. 2018)
"I like that it gave different ideas to producing the /r/ sound." – J.R. (Oct. 2018)
"The videos were extremely helpful! This online course gave me hands-on strategies I can quickly and easily use in therapy!" – A.G. (Sept. 2018)
"This course was very systematic and straightforward. I especially thought the instructor had a great background in the medical model as well as research-based practices. The videos were also extremely helpful in understanding the concepts." – P.E. (Sept. 2018)
"The stages were simple yet clear. I am always looking for new ways to facilitate /r/." – H.K. (July 2018)
"Starting with the /er/, as I had always been taught to start with prevocalic /r/ in therapy. I like that the presenter gave A TON of activities to utilize that are simple and easy to use!" – A.S. (May 2018)
"This is the only /r/ method that has worked for my clients!! I like that the course is direct, to the point. Great how-to seminar. Thanks!!" – D.N. (Apr. 2018)
"I appreciated the steps to follow to draw out /r/, and I really enjoyed the video clips." – K.M. (Apr. 2018)
"The videos of various techniques used to achieve success of "er" in isolation. I liked breaking the interventions down into the 7 stages." – S.M. (Mar. 2018)
"I liked being reminded about what to rule out before the beginning of the program. I love how Sandra actually shared what steps to take in treatment in a very clear manner. I wish more continuing education videos were as thorough about treatment implementation as Sandra's was." – M.M. (Mar. 2018)
"Starting with the purest 'er' and then moving to the "her" as a phrase; I will find this very beneficial. I liked the step by step instructions. Very easy to follow and implement." – M.B. (Feb. 2018)
"It was a great, very detailed and explained well course. I especially enjoyed the videos as it helped to solidify the concept. I appreciated the seven steps broken down. I also really found the various activities (e.g., hot/cold search game, role reversal) to be so helpful and keep it fun!" – K.K. (Jan. 2018)
"The breakdown of the /r/ sound and the emphasis on the need to meet each critical step was very beneficial." – A.L. (Dec. 2017)
"I enjoyed the steps and concrete hierarchy to help with /r/ (with EBP to support it) and learning a new method." – B.P. (Dec. 2017)
"Learning how to move into habituation was especially helpful. I like that the course provided examples I can use in my sessions." – M.S.L. (Nov. 2017)
"Great intro into R therapy! I liked the examples of therapy as well as transitioning from ER and breaking words down." – A.W. (Oct. 2017)
"The entire thing was so helpful and most is the sequence for me! I now realize I was starting in the wrong place and worse, not moving through stimuli in a sequential and thoughtful manner. I liked the resources and examples! The pace was so perfect for maximum absorption. The videos gave me hope for my really awful R kiddos!!!" – K.M. (Oct. 2017)
"It is very practical and easy to implement. I liked the step by step gradual development. I know exactly where to start and how to target the /r/ sound. Thank you very much! This course was extremely beneficial to me." – P.C. (Oct. 2017)
"The /r/ in general is very difficult to teach. I think breaking it up into stages was very helpful." – J.W. (Sept. 2017)
"The detailed sequence of the therapy process for /R/ remediation was very helpful. The visuals in the handout were very clear, and the videos of therapy were informative." – J.D. (Aug. 2017)
"Going over which combinations of /er/ sounds to start with after a child is able to produce the /er/ and how to move along to get into habituation were the most useful discussions. I liked the easy of the steps and examples for each." – D.S. (July 2017)