Sale thru 7/31/24

$39.00 USD

$31.00 USD

98% rating - reviews

0.15  ASHA CEUs

R: Techniques And Interventions To Correct /r/ — Seven Steps, From Basics To Habituation #e172

Presenter: Sandra R. Holtzman, MS, CCC-SLP, COM, QOM

Learn seven steps necessary to move clients onward toward habituation.

"This was the best /r/ training I have ever watched! The step-by-step approach is one I can implement immediately. I really liked the video demonstration."

– C.S., prior course participant

Read more comments about this course!

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. 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.

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.

Course is offered for 0.15 ASHA CEUs – 1.5 Contact Hours.

Course Overview – Run Time: 1:30:18

  1. Ruling out various etiologies prior to initiating a /r/ therapy program.
  2. Basic lingual skills to be maximized before initiating a program of articulation.
  3. The seven stages of therapy from "basics to habituation."
  4. Benefits of presenting ER in the final position of words instead of the initial position.

"Each step/technique was very informative and I will definitely use this in my daily practice. This course was easy to follow and understand; handouts were helpful; videos were especially helpful."

– K.B., prior course participant

Read more comments about this course!

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 presenter, 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. Stop and re-start the course at any point. Learners retain access to course content after completion for ongoing reference and review.


"I liked that the course outlined how to start and progress treatment. The course gave practical treatment techniques." A.M. (Jul. 2024)

"The hierarchy of mastering R was a beneficial topic. I enjoyed the videos and photos to explain her methods. Always helpful to see the progression of patients." J.A. (Jul. 2024)

"Discussing what to rule out before working on /r/ was helpful. The course was very thorough and easy to follow." M.J. (Jul. 2024)

"I liked the step by step guide to how to apply this information to therapy sessions. I liked that I have a better understanding of how to work on "r" and some concrete ways to apply the course material to my therapy sessions." J.D. (Jul. 2024)

"It was beneficial to discuss how each sound can be broken down into "er" and the order in which to introduce targets. I enjoyed the systematic approach of target introduction." C.T. (Jul. 2024)

"The steps broken down to help a child produce the /r/ sounds were beneficial. Everything was broken down allowing for a step-by-step treatment approach." E.D. (Jul. 2024)

"I appreciated the systematic, sequential, and sensible approach described by Ms. Holtzman. In providing /r/ articulation therapy, it has been challenging to know where to begin and how to proceed. I believe this course will prove very helpful in working with my /r/ students. I liked that videos of real clients were presented, and I liked the idea of "drawing out" from clients/students rather than just "putting in." K.K. (Jul. 2024)

"Sequence of steps was beneficial. I liked the actual video of clients." T.E. (Jul. 2024)

"Working on the lingual base prior to intervention on /r/ was helpful. Informative course with video examples." A.D. (Jun. 2024)

"Beneficial demonstration of various treatment methods to elicit tongue placement. I liked the word list." A.C. (Jun. 2024)

"Elicitation strategies were helpful. I liked that I could take the course on my own time." S.A. (Jun. 2024)

"The amount of detail provided about each step was beneficial. I enjoyed seeing video examples." B.E. (Jun. 2024)

"I enjoyed the breakdown hierarchy of R start to habituation. Succinct and clear information." A.S. (Jun. 2024)

"Pre-r skills and how to elicit r was beneficial. Everything was very functional." A.P. (May. 2024)

"The pre-requisite step will add a lot to my daily practice as it will rule our obstructions that are blocking appropriate tongue formation. Also the program being laid out in applicable steps was the most beneficial. This course had detailed ways to apply the steps to different clients." S.C. (May. 2024)

"The stages were helpful to discuss. I liked everything in this course." K.W. (Apr. 2024)

"I have a lot of students working on /r/ so I found everything very beneficial for my daily practice. The course was easy to digest and implement." M.W. (Apr. 2024)

"The exact plan of how to progress was helpful to discuss. Thank you! So practical." S.Q. (Apr. 2024)

"The sequence in which to target variations of /r/ was beneficial." A.M. (Apr. 2024)

"I appreciated the systematic approach for "R" intervention. I liked the video examples and practical visuals." K.G. (Mar. 2024)

"Tongue tie information was beneficial. I liked pictures and examples of words/sentences for each /r/ variation." K.B. (Mar. 2024)

"I enjoyed the myofunctional perspective prior to articulation therapy." D.L. (Mar. 2024)

"I liked the idea that all R sounds can be broken down into "er" and that all other R sounds come from "er". Great presentation with a lot of examples and videos." M.Z. (Mar. 2024)

"Targeting /er/ before everything else was beneficial to discuss. I liked the examples." K.N. (Mar. 2024)

"I liked the pictures, examples, and OMEs before eliciting sound." M.S. (Mar. 2024)

"Discussing the principle of -er was helpful. I liked the info." M.D. (Feb. 2024)

"All was beneficial, great practical information." P.G. (Feb. 2024)

"Moving to natural-sounding speech rather than robotic. I liked all of the provided word lists." M.P. (Feb. 2024)

"The base of /r/ production (oral structure) and the 7 steps, especially the establishment of /r/ were beneficial to discuss. I enjoyed all of the examples with actual students." C.P. (Feb. 2024)

"The outlined steps and the research backing the steps were helpful." E.T. (Jan. 2024)

"I loved how the course outlined a method that was easy to follow. It was a very practical method with great examples that I can implement into my practice." B.A. (Jan. 2024)

"Moving through to natural-sounding speech was beneficial. I liked the visual representation/examples." A.P. (Jan. 2024)

"Discussing the tongue movements needed prior to beginning the stages was helpful. I enjoyed the knowledge of the presenter and the ease of access to the course. It's helpful to be able to watch at my leisure." M.O. (Jan. 2024)

"This course gave real-life therapy considerations and examples. I liked the myofunctional considerations for /r/." T.P. (Jan. 2024)

"I will use all of these steps when a student has difficulty habituating the /r/. Step-by-step process to implementation into practice." A.R. (Jan. 2024)

"Identifying barriers and moving through a logical sequence of progression for success with inclusion of habituation. Sequential outline to move through logically. Love that Sandra always includes “make it fun!”." A.B. (Jan. 2024)

"Discussing habituation was beneficial. Very organized course; specific steps with examples." A.C. (Jan. 2024)

"The sequence to present each /r/ family group of sounds was beneficial. The course was clear and systematic." M.S. (Jan. 2024)

"It was awesome that all of this was in line with how I teach r, including the use of nonsense syllables. Great reasoning to help explain WHY this method works. I liked the clarity and organization." D.W. (Jan. 2024)

"Everything about this course was incredibly useful. My practice was reinforced when discovering many things that I already do; however, I was missing a most important component of the sequence of introducing sounds and sound productions. I cannot wait to adapt my practice using this critical information." J.B. (Jan. 2024)

"I work with a lot of students with /r/ goals. I'm going to be implementing these techniques into my sessions. I liked how easy course was to follow." E.S. (Jan. 2024)

"The hierarchy of er production starting with bilabials was beneficial to discuss. It's helpful for me to know where to start with many of my students still struggling with the r sound and to have a hierarchy to follow." T.W. (Jan. 2024)

"Identifying and practicing basic lingual movements was beneficial. I didn't think about how these are a precursor to formulating a pure R sound. I enjoyed how the treatment was broken down into steps, making it easy to follow." A.S. (Jan. 2024)

"Starting ER in words with a consonant or cluster before the ER. A good amount of videos, clear presentation." C.H. (Dec. 2023)

"I liked the different videos to show how to elicit the /r/ sound. A good course." E.C. (Dec. 2023)

"The word list examples were beneficial. I liked the videos of clients." L.G. (Dec. 2023)

"Specific treatment of /r/. I liked the step-by-step approach." C.H. (Dec. 2023)

"Use of the /er/ sound was helpful. I liked that the steps were broken down clearly." A.R. (Dec. 2023)

"Discussing how to get to habituation. Easy to follow course with lots of video examples." T.D. (Dec. 2023)

"The information was precise, and the speaker was knowledgeable on the topic. I realize now that some of my "habitual poor /r/" students that I have inherited need to go back to the beginning and start with oral motor." K.W. (Dec. 2023)

"All of the content was beneficial to my daily practice. I enjoyed learning what to look for and how to best produce /r/." K.H. (Nov. 2023)

"I appreciate the breaking down of each stage in that hierarchical fashion. I liked that I could stop and start as I needed due to schedule constraints." L.M. (Nov. 2023)

"I learned that I need to spend more time on the "base" during evaluation and the lingual basics at the beginning of therapy. I have always recognized that all Rs are actually "er," but this presentation broke it down more systematically for me. I enjoyed the hierarchy of skills to achieve habituation of R." D.K. (Nov. 2023)

"Eliciting /er/ with a tongue depressor was beneficial. I liked that there are solid phases to cover prior to moving on." J.C. (Nov. 2023)

"Starting a student out with /er/ and why was really helpful for me. Moving through steps helped me think about what I'm currently doing and what I can do to change to help a student/client to habituation." J.C. (Nov. 2023)

"I liked how systematically the ER was paired with a combination of another consonant and how these combinations were systematically introduced. I liked the video examples and specific word lists." M.R. (Nov. 2023)

"Quick and easy to understand. The different steps and what to focus on were helpful." S.H. (Nov. 2023)

"I liked breaking down the R into manageable parts and the videos of actual clients." S.B. (Nov. 2023)

"I appreciate the step-by-step approach that gives a practical way to go through /r/ treatment without getting overwhelmed. I liked the clear examples and steps." L.S. (Nov. 2023)

"Using the smile position as a starting point after checking oral structures to achieve ER was beneficial. Great examples all along the way." L.F. (Oct. 2023)

"I GREATLY appreciated the step-by-step nature of teaching the clinician how to shape the "er" or /r/ production. I appreciate the emphasis on ruling out the contributing orofacial issues (e.g. tongue tie, breathing issues, maladaptive oral habits, etc.) before actually targeting the /r/ production. I am so glad that I now have this wonderful resource to use in my clinical practice "toolkit" moving forward." A.W. (Oct. 2023)

"The sequential steps taken to ensure habituation were beneficial. I liked the videos and handouts." K.P. (Oct. 2023)

"I really liked that the course instructor provided step-by-step instructions that I could easily follow. I can modify as I see fit, and this helps me to build my confidence and skills." A.W. (Oct. 2023)

"The progression from easy to hard phonemes for coarticulation was beneficial. I liked all the examples of phrases and sentences." E.G. (Oct. 2023)

"The complete seven steps was great. I liked how thorough the presenter was." T.P. (Oct. 2023)

"I loved seeing the hierarchy broken down into each individual step. Step by step instructions with examples of real clients." L.S. (Oct. 2023)

"I would never have guessed that starting with "er" would be the best example of /r/. This will be really helpful for me to know what path to take in therapy with some of my students who have been receiving speech for several years! The video examples were very helpful to understand what the presenter was talking about and see it in practice with real clients." R.M. (Oct. 2023)

"Very concise course with lots of information, useful therapy suggestions, and informational video clips. Most beneficial was the discussion in reference to ruling out structural barriers to the correct formation of the /r/ development." K.Q. (Oct. 2023)

"Discrete breakdown of the skills needed for ER across coarticulation settings and how to systematically build up to consistent accuracy was beneficial. I liked the specific examples of what, when, and how to practice." L.N. (Oct. 2023)

"The illustrations and videos were helpful." D.P. (Oct. 2023)

"I will be able to immediately utilize this information with my clients. The information regarding what to check prior to beginning work on the /r/ sound was very helpful. The specific information about how to work on the progression of the sound was beneficial." B.K. (Oct. 2023)

"The speaker was knowledgeable and provided information in a well-organized and well-explained manner. She provided good clinical information that could be readily utilized by the SLP with clients." B.K. (Oct. 2023)

"I have an older child on my schedule with an /R/ that just won't get better! I think this program is going to get him there! I liked the step-by-step instructions for the program....great examples, and therapy techniques and suggestions." S.S. (Sep. 2023)

"I will implement the seven steps into my therapy. I liked the course pause and resume video feature." A.J. (Sep. 2023)

"Things you need to accomplish with success before even starting an R program! I liked the video examples and the word/sound list examples. I enjoyed listening to the speaker." J.D. (Sep. 2023)

"I liked the 7 concrete steps including orofacial myology concepts." L.L. (Sep. 2023)

"The progression at each stage was most beneficial. I liked the video examples of the clients demonstrating the skills." J.S. (Sep. 2023)

"Practical stimuli and activity examples. Course was informative and quick." H.R. (Sep. 2023)

"Eliminating the use of lip rounding for /r/ production, and breaking the sound production in words into stages based on the letter and production area in the oral cavity were beneficial topics. I liked the examples given and the breaking out of stages for each sound in words where /r/ was embedded." S.D. (Aug. 2023)

"The 7 basic steps and how to transition through each stage successfully was helpful." C.G. (Aug. 2023)

"I liked the speaker's step-by-step approach to intervention. Incorporating pre-learning strategies and evaluating oral functioning prior to therapy was beneficial. I will utilize her approach along with others I've accumulated over the years." K.C. (Aug. 2023)

"Very organized hierarchy of treatment. Lots of examples." M.S. (Aug. 2023)

"I'm returning to providing therapy after a long hiatus in management and was looking for a good R refresher. This course actually had some techniques I hadn't heard before. I loved that it came from an orofacial myologist." L.N. (Aug. 2023)

"This course was quick and provided good techniques and information. I liked the practical tips and example word and sentence lists." A.B. (Aug. 2023)

"I loved the sequential features of habituating /r/. And going at my own pace." C.S. (Aug. 2023)

"Vowel combinations and word lists with hierarchy. It was beneficial breaking down the steps and giving word lists and Family Groups of sounds that should go in order." K.A. (Aug. 2023)

"Specific examples of sounds easiest to hardest. I liked the order of acquisition." A.A. (Aug. 2023)

"I liked all of the steps for therapy." G.M. (Aug. 2023)

"This systematic approach to /r/ therapy is beneficial. I liked the client videos and pace of presenter." J.L. (Jul. 2023)

"I really appreciated focusing on the /er/ before moving to the more challenging sounds. It makes sense and will help the child become successful. The content was presented clearly with a knowledge base and experience that will, when implemented effectively, will afford success." C.P. (Jul. 2023)

"I liked the examples and hierarchy. The presenter was knowledgeable." S.P. (Jul. 2023)

"The hierarchy of how and when to work on different ER sounds was very helpful. I liked having video examples." N.B. (Jul. 2023)

"I liked the /r/ strategies. Course was very clear, and can be accessed multiple times as necessary for review." P.S. (Jun. 2023)

"ER at different rates and pitch as a transition to the next skill level was beneficial along with more practice at ER with h, then moving to bilabial, labiodental etc. I had not thought of breaking it down like that. The video examples were helpful." C.M. (Jun. 2023)

"Information about oral structures and their impact was beneficial. The information confirmed the practices and beliefs I possess." A.Q. (Jun. 2023)

"I liked this perspective program. And the information and research that was provided." R.S. (Jun. 2023)

"The systematic sequence and starting with a pure ER was beneficial." N.H. (May 2023)

"Love the breakdown. Simple to follow and implement immediately." W.N. (May 2023)

"I liked the systematic approach from beginning to end. The video examples were beneficial." L.P. (May 2023)

"Step by step process when initiating therapy for the /r/ production. I liked the examples and clarity of this therapeutic approach." K.W. (Apr. 2023)

"Informational course, I enjoyed the included videos. The discussion of the breakdown of R to ER before moving forward was beneficial." D.G. (Apr. 2023)

"I liked the demonstrations, and the co-articulation method was beneficial." S.H. (Apr. 2023)

"The elicitation techniques, as well as the live examples, were very helpful." R.R. (Apr. 2023)

"Sequence of therapy was beneficial. I liked the written and video examples." J.S. (Apr. 2023)

"I appreciated the progression of this program. This was a clearly articulated and easy-to-follow course. The visual supports were helpful." T.E. (Apr. 2023)

"Great approach to R. Made treating R less intimidating." T.P. (Apr. 2023)

"Assessing the lingual movement prior to therapy and why the sequence used for stabilizing the ER with consonants was beneficial. The course was easy to access. Liked that I can view recording again so video examples can be reviewed. Good handouts with examples." J.F. (Apr. 2023)

"I was literally able to start using this in sessions immediately! I loved the steps and working on multiple sound combinations in each step with directions to move to the next most appropriate sounds." K.F. (Mar. 2023)

"I liked the video examples. Tongue tie and the production of /er/ to start and working into final position was beneficial." J.F. (Mar. 2023)

"I liked the presentations and the videos. The topic of having the student "teach" the clinician was beneficial." A.H. (Mar. 2023)

"Loved the myofunctional tips. Good ideas for therapy and the development of proficiency." P.R. (Mar. 2023)

"The initial section on what could be barriers to all articulation success was beneficial. I liked the section about tongue tie, breathing issues, etc." J.H. (Mar. 2023)

"All of the stages were beneficial. I did appreciate the factors you need to consider for the base of articulation therapy. I always appreciate how I can follow along and make notes on my printed handouts. The handouts are great to have for reference and for the examples." H.O. (Mar. 2023)

"Stages of treating /r/ in a more efficient way. I liked the logical thinking about /r/." C.S. (Mar. 2023)

"The entire presentation will be beneficial for my daily practice. The presenter was very knowledgeable about the steps involved in achieving correct production of the /r/ sound." M.H. (Feb. 2023)

"Made "R" seem much less intimidating. This course moved thoroughly through all stages of therapy and provided much needed word lists. It provided useful videos and talked about normal speech production. The word lists will make planning therapy sessions a breeze. None of this was discussed in my graduate classes EVER." A.W. (Feb. 2023)

"Course was very well organized and very relevant with specific treatment ideas. Specific examples of sequential and systematic /r/ content (syllables, words, sentences)." T.M. (Feb. 2023)

"I liked that it was explained step by step and that the information in the handouts was exactly what she talked about in the video presentation. This way I can go back and do the steps by following the handouts." L.C. (Feb. 2023)

"The first few stages were beneficial. It gave me a starting point. Liked the way the program was laid out." A.D. (Feb. 2023)

"The idea that "ER" is really the basic sound has been very helpful. I especially liked the video examples." D.W. (Feb. 2023)

"OME's to help with correct productions. OME's, step-by-step guidelines to achieve goals." J.B. (Feb. 2023)

"Being mindful of the selection of words we use with students. I liked the level of information, no extraneous info. Everything was to the point." I.R. (Feb. 2023)

"The transition process from where to start was beneficial because starting articulation therapy for R has been difficult. I liked the video examples that showed therapy with the clients." J.L. (Feb. 2023)

"The step-by-step "how to" and "where to start guide" towards habituation is exactly what I needed. I liked the step-by-step instruction with video and real-life examples." M.G. (Jan. 2023)

"Lingual basics. The understanding and application of myofunctional techniques were beneficial." C.S. (Jan. 2023)

"Mastery of intra oral skills before beginning any articulation programming. I liked that course was taught by Sandra. She is just the best." J.P. (Jan. 2023)

"Understanding basics before undertaking /r/ therapy. Liked step-by-step style. SMART goals provided." J.C. (Jan. 2023)

"Establishing the base and practicing ER was beneficial. This course went through the 7 steps in an organized manner." K.T. (Dec. 2022)

"Learning how to begin and complete r therapy correctly. Each stage of therapy was presented in a timely and correct manner." E.S. (Dec. 2022)

"The entire presentation was essential to R instruction and can readily be applied to therapy practice. The video examples were excellent in demonstrating application." J.S. (Dec. 2022)

"The course was clear and easy to follow. I liked the specific ways presented to treat /r/." H.C. (Dec. 2022)

"Practical applications. Videos were excellent. Presenter had great ideas and was VERY clear and knowledgeable. I learned about the two and three way mouth props. Just bought them and cannot wait to use them in therapy." B.P. (Dec. 2022)

"The examples of activities and words/sentences to use in therapy were good. I liked that I could take course at my own pace." M.H. (Dec. 2022)

"Liked the ideas for making habituation sound natural instead of robotic. And the video and audio examples that helped illustrate points." L.H. (Dec. 2022)

"I liked the general structure and order of working through the /r/ sound." M.L. (Dec. 2022)

 "I liked the way the presenter simplified the information into stages from basics to habituation." B.M. (Nov. 2022)

"Clear, precise instructions for each stage." J.A. (Nov. 2022)

"I found the stages of /r/ most beneficial. I am looking forward to trying them with my articulation students. I liked the examples and real-life videos to help the viewers understand what each stage looks like." M.C. (Nov. 2022)

"I liked the exercises to do at the beginning, not rounding lips to produce /r/, and starting with "ER". Word Lists provided were good." A.W. (Nov. 2022)

"I liked the step-by-step approach and how specifically broken down by how each surrounding sound affects production." C.O. (Nov. 2022)

"Since taking this course, I have tried to incorporate some of the major points into my therapy sessions, doing my best to apply what I've learned, especially discouraging children from rounding their lips! I was always taught how challenging the "R" sound is to learn and teach." A.H. (Nov. 2022)

"Stage 1 - Lingual basics was all new information for me. The videos were very helpful." L.A. (Nov. 2022)

"I appreciate the fact that you have to work on and stay at the level of oral motor skills before being able to move on to the production of the sounds. Also, how organized and laid out the information was. The word lists and how they advance from easiest to hardest is so helpful." M.M. (Oct. 2022)

"I liked how the process was broken down into steps and the examples of target words." M.S. (Oct. 2022)

"The course was clear and step-by-step." D.T. (Oct. 2022)

"The videos of kids and lists of words to use for therapy were good." J.S. (Oct. 2022)

"Very thorough and loved the videos." M.G. (Oct. 2022)

"The speaker was very interesting, and videos added to the presentation." N.S. (Oct. 2022)

"Sandra Holtzman! Wonderful at what she does for speech therapy." J.G. (Sept. 2022)

"The course was to the point!" A.B. (Sept. 2022)

"The detailed description of every step in the habituation of the /R/ sound, as well as the many examples provided in each step, were informative." A.P. (Sept. 2022)

"The courses organization (and delivery) and the amount of time devoted to watching the videos which allowed us to observe the progress of the various children was good." E.B. (Sept. 2022)

"I like the videos with clients, the sample sentences." R.M. (Aug. 2022)

"The entire presentation was helpful. I like that it was broken down into 7 steps that were clearly presented. I also thought the video examples were great in helping explain the concepts." R.K. (Aug. 2022)

"I thought using stages to work through correct /r/ production was very helpful." C.H. (Aug. 2022)

"The course taught me how to break down therapy into easy, manageable steps that maximize success. I like that it was easily accessible, self-paced." L.B. (Aug. 2022)

"The course was easy to follow and understand." K.H. (Aug. 2022)

"I liked the video examples of how to elicit the /-er/ and gradually shape it for other vocalic /r/'s." F.F. (Aug. 2022)

"Lots of examples of what to use with the client. Lots of video examples." C.E. (Aug. 2022)

"I am excited to try the tongue depressor trick. The printed handouts made it easier to follow along, and will be helpful for refreshing my knowledge later." A.C. (Aug. 2022)

"I liked the practical information and activities she provided. I also thought her explanations were very easy to understand and grasp." K.H. (Aug. 2022)

"I learned about a systematic progression for /r/ therapy and why it is critical not to omit steps within the program. Ms. Holtzman provided plenty of examples and logical explanations for the progression of the program steps." E.A. (July 2022)

"It provided an easy to understand and systematic way of working on a very daunting and difficult speech sound. The discussion about what to rule out prior to initiating the r sound, the order of how to present the /r/ in context for therapy, as well as the sample words and videos were all helpful in my understanding and use for therapy. " A.M. (June 2022)

"I liked the exercises before initiating /r/ and the videos and direct therapy." B.B. (June 2022)

"I liked the example word lists and the videos were helpful too. Very practical information - I had never considered starting with a vowelized /r/." A.P. (June 2022)

"The liked the entire course. And how detailed all the steps were and with examples." J.M. (June 2022)

"The liked how the speaker broke down each step." A.S. (June 2022)

"I like that it actually told me what to do and how to do it. The videos were very helpful as are the word lists." J.G. (May 2022)

"The breakdown in how to remediate and which sound categories to start with was good. The use of the tongue depressor was good, in place of some of the other more expensive tools on the market." A.P. (May 2022)

"I liked the simplicity and following the 7 stages." A.S. (May 2022)

"The whole lecture is beneficial. It easily explained how to implement the techniques into therapy." E.A. (Apr. 2022)

"The hierarchy for approaching /r/, specifically addressing lingual basics is beneficial. I like the sentence examples to share with students." A.M. (Apr. 2022)

"I liked how I could immediately begin using these techniques with my students!" J.E. (Apr. 2022)

"I liked the steps, especially the Stages 4 and 5. The videos helped comprehension. The course was easy to follow and the steps make sense." T.D. (Apr. 2022)

"Oral motor exercises, detailed steps for elicitation. Liked detailed breakdown of steps with examples." R.B. (Apr. 2022)

"I liked the tips for /r/ production and real-life videos of techniques." C.O. (Apr. 2022)

"I liked the order of sounds to work on, and images of structural differences." V.F. (Apr. 2022)

"I liked the specific examples of the process when working with er, then final word position, then to phrases etc to increase naturalness. I thought it was very actionable in therapy. Good use of video examples at each stage. Good start of word lists." M.E. (Mar. 2022)

"Rigorous, systematic program - very straightforward, excellent examples to illustrate." M.D. (Mar. 2022)

"Starting with Phase 1 (improving the student's ability to produce isolated movements of the tongue) before you introduce the articulation therapy will be very helpful for me moving forward. It was well-organized with lots of examples provided at each step." C.D. (Feb. 2022)

"It was clear and well thought out." C.A. (Jan. 2022)

"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. (Oct. 2021)

“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. 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 handouts. Step by step guide of each step." N.R. (Sept. 2021)

"I liked all the videos. 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 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 really 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. 2021)

"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. (Jul. 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. (Jul. 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. (Jul. 2021)

"The presenter was excellent and handouts were fantastic!" R.H. (Jul. 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)

Course Objectives

  1. Rule out various etiologies prior to initiating a program of /r/ therapy.
  2. Understand the basic lingual skills to be maximized before initiating a program of articulation.
  3. Name and describe the seven stages of therapy from "basics to habituation."
  4. Give at least two examples of methods to obtain a pure, stable and consistent ER in isolation.
  5. Explain the benefits of presenting ER in the final position of words instead of the initial position.

Presenter & Disclosures

Sandra R. Holtzman, MS, CCC-SLP, COM, QOM, is an ASHA certified speech-language pathologist who has specialized in orofacial myology for most of her career. She is director of Neo-Health Services, Inc., an organization that provides continuing education training and supplies related to orofacial myology. Sandra and her team developed the Qualification in Orofacial Myology (QOM) to provide this highly respected and recognized credential to professionals in speech pathology and dentistry/orthodontics. She is author of Orofacial Myology: From Basics to Habituation (aka the “Myo Manual”) as well as programs for elimination of oral habits.

Speaker Disclosures:

Financial — Sandra Holtzman is a presenter of online CE courses sponsored by Northern Speech Services; receives royalties.

Financial — Sandra Holtzman is the author of the text "Orofacial Myology: From Basics to Habituation"; receives royalties.

Financial — Sandra Holtzman is the owner of Neo-Health Services, Inc; ownership interests.

Nonfinancial — Sandra Holtzman has no relevant nonfinancial relationships to disclose.

Intended Audience / Accreditation

asha ce approved provider

This program is offered for 0.15 ASHA CEUs (Intermediate Level; Professional Area).

Intended Audience

  • Speech-Language Pathologists

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:

  • Current ASHA Member.
  • ASHA Certificate of Clinical Competence (CCC) Holder.
  • Licensed by a state or provincial regulatory agency to practice speech-language pathology (SLP) or audiology.
  • Credentialed by a state regulatory agency to practice SLP or audiology.
  • Credentialed by a national regulatory agency to practice SLP or audiology.
  • Engaged in a Clinical Fellowship under the supervision of an individual with their ASHA CCC.
  • Currently enrolled in a master's or doctoral program in SLP or audiology.

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:

  • California: NSS is approved as a provider of continuing education by the California Speech-Language Pathology & Audiology Board. Provider #PDP4. Online CEU limits may apply; please contact SLPAHADB for current online CEU acceptance policies.
  • Iowa: NSS is approved as a provider of continuing education by the Iowa Board of Speech Pathology and Audiology Examiners. Provider #169.
  • Kansas: NSS is approved as a provider of continuing education by the Kansas Department of Health and Environment. Provider #LTS-S0005.
  • Florida: NSS is approved as a provider of continuing education by the Florida Speech-Language Pathology and Audiology Board. Provider #SPA-026.
  • New Jersey: NSS is approved as a provider of continuing education by the New Jersey Department of Education. Provider #1654.

Frequently Asked Questions

Customer Support: Please phone 888.337.3866 or email

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.

Content Access:

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:

Purchase orders are currently not accepted for online orders, if you wish to submit a purchase order please do so at 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 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.

Receiving CEUs:

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.

Testing requirements:

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.

Course formats:

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.

Course handouts:

Most of our online courses provide a link to download the accompanying handout as a PDF file. 

Group discounts:

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.

Computer requirements:

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. 

Special Needs:

Please click here for any special needs requests, and we will do our best to accommodate them. 

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