Speech Hierarchy

Nayi Disha organized a speech therapy workshop with speech and language pathologist, Ms.Chitra Thadathil. The workshop conducted discussions on various topics such as hearing, language and speech concerns in children with Down syndrome, Sensory issues in children with Down syndrome and the importance of ORO-MOTOR exercises.

Speech hierarchy is crucial for speech and language development. This article is based on the above video that talks about and explains this. You can check the other videos here.

Speech sound hierarchy 

According to Ms. Chitra, it’s important to follow the speech hierarchy for effective vocalisation.

• /p,b,m/
• /f,v/
• /tha,da/
• /t,d,n,l/
• /kha,g/
• /s,z,sha,cha,dz/
• /r/

Key tips

• Children may not always learn speech sounds in the “expected” order. 
• Be open and supportive—choose sounds that are easiest and most suited to your child’s current oro-motor skills.
• Progress is more important than strict sequence.
• Start simple: Begin with easy sounds, especially vowel combinations. These are less demanding and help build confidence.
• Use meaningful words:  Always teach sounds within words that have meaning for the child.
  • Example: For the “p” sound, use words like park, pooh, paint.
  • Avoid meaningless repetition, which can frustrate the child.
• Follow a clear order:
  • Teach the sound in isolation (e.g., “p”). 
  • Practice the sound in simple words – with the sound 1st as the beginning – park, then as the median sound – apple and last as the ending sound -cup
  • Use the sound in short sentences.
  • Gradually expand to longer phrases and everyday conversation.

What is arousal in speech therapy?

According to Ms. Chitra, one of the most important aspects of working with a child is ensuring they are not just participating, but attending and engaging meaningfully.

• The phase where the child is attentive, focused, and responsive is called the “optimal stimulation band.”
• This is the ideal state for learning and therapy, as the child is ready to work and benefit from activities

However, there may be times when the child is unable to participate in the activity. There may be two contributing factors for this:

1. No Response Levels

• Cause: The child may be bored due to repetitive tasks.
• Strategy: 
  • Use fun, playful activities to re-engage them.
  • Examples: tickling, peek-a-boo, or other light games.

Once attention is regained, transition back to meaningful activities.

2. Inattentive / Avoidance Levels

• Cause: The child may be frustrated or overwhelmed by too much pressure or difficulty of the activity.
• Strategy:
  • Reduce the intensity of the activity.
  • Offer breaks or switch to simpler tasks.
  • Provide reassurance and encouragement to lower frustration.

For visible results, it is essential to keep the child within the optimal stimulation band—where they are attentive, engaged, and responsive.

Remember, engagement is more important than mere participation.

Additionally, you may download this caregiver’s manual to understand the long-term care and health of individuals with Downs Syndrome. 

If you have questions about Autism, Down Syndrome, ADHD, or other intellectual disabilities, or have concerns about developmental delays in a child, the Nayi Disha team is here to help. For any questions or queries, please contact our FREE Helpline at 844-844-8996. You can call or what’s app us. Our counselors speak different languages including English, Hindi, Malayalam, Gujarati, Marathi, Telugu, and Bengali

DISCLAIMER: Please note that this guide is for information purposes only. Please consult a qualified health practitioner for safe management.