Ask A Therapist: Horn Help


I purchased the TalkTools Parent Kit back in December, and have been implementing the oral placement therapy with the support of my daughter’s speech therapist since January.

We are making great progress with the straws and the bite tubes, but have hit a road block with the horns. My daughter, who will be two years old next month and has Down syndrome, is able to make a sound on Horn #1, but she also bites on the horn when she blows. As well, she sometimes uses her voice as well as blowing (sort of like a kazoo).

I’m not sure where to go from here.

Her speech therapist suggested stopping the horn hierarchy for a while and trying to get her to blow bubbles. I’ve tried blowing bubbles, and she can do it but isn’t much interested. We’ve also taken a break from the horn, but any time I go back to it she does the same thing…although she’s interested in the horn.

Please help! It is amazing what an improvement we’ve seen in such a short time. I know the horn hierarchy is an important component of what we’re trying to do here, and I don’t want to miss out on the benefits!

Thank you for the important work you are doing. I know my daughter is a bright, funny little girl. I want others to see what I see. Speech clarity and her appearance (tongue retraction) are critical to creating a positive first impression and breaking down negative stereotypes about people with Down syndrome.

Words cannot properly express the hope it gives me for her future to hear her speak clearly with confidence, when we were told she wouldn’t be able to do that. Thank you for not accepting the status quo.  Thank you for using your expertise to help my little girl and others like her who needed someone to take the time to figure out the why and come up with the how.


Hi Jerilee,

Let me begin by saying how pleased I am that you are seeing such good progress in the short time you are using the Straw Hierarchy and the Bite-Tube Hierarchy with your two-year-old!

Your speech therapist’s suggestion to go to bubble blowing was a good one, as it will establish the motor plan for blowing without making a vocal sound. Here is what I would suggest:

1. Have your daughter blow the bubble 1 time as you say “blow.” Remove the bubble wand.

2. Place your non-dominant hand under her chin with your thumb against her lower jaw to keep her from biting on the horn.

3. Place the mouthpiece of the horn on her lower lip as you say “blow.” Remove the horn, and if necessary, go back to the bubbles to establish the motor plan.

Thank you for your kind words about the work we are doing at TalkTools. Your comments about your daughter’s emerging speech clarity put a smile on my face. Please let us know if you have any additional questions as you work through the program.

Sara Rosenfeld-Johnson, MS, CCC-SLP

Talktool admin 06 Jun 15

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