Cueing Hierarchy in Speech Therapy: How SLPs Add and Fade Support
A cueing hierarchy is an ordered set of supports an SLP uses to help a child say a target correctly — from a lot of help (saying it together, touch cues, watching the mouth) to none (saying it alone). The SLP adds a cue when the child misses and fades it as they succeed, so the child ends up doing it alone.
What a cueing hierarchy is
When a child cannot yet produce a sound or word on their own, an SLP gives support — a cue — that makes success possible. A cueing hierarchy is simply those supports arranged from most help to least. The aim is always the bottom rung: the child producing the target independently, without any cue.1
ASHA describes sensory cueing approaches as using the child’s senses to teach speech movements, either separately or combined into a multisensory approach, to give extra feedback when a child is not getting enough from their own internal sense of the movement.1
The three kinds of cues
| Type | Examples |
|---|---|
| Visual | Watching the SLP’s mouth, a mirror, hand gestures for place or manner (a long sweep for a long sound, a short chop for a stop), ultrasound or other biofeedback |
| Verbal / auditory | Explicit instructions (“make a circle with your lips”), saying the word together (simultaneous production), hearing a clear model |
| Tactile | Touch cues on the face, neck, or jaw; a tongue depressor showing where the tongue should go |
ASHA notes that simultaneous productions — the child and SLP saying the target at the same time — are often beneficial when a child is learning a new speech movement, because they give auditory and visual information at once.1
An example ladder, from most to least support
Every SLP tailors the order to the child, but a typical most-to-least ladder for a new word looks like this.
| Step | What happens |
|---|---|
| 1. Together, slowly, with a touch or gesture cue | SLP and child say the word at the same time, slowed down |
| 2. Together, normal speed | Same, without the extra cue |
| 3. Immediate imitation | “Watch me, listen, now you.” The child copies straight after the model |
| 4. Delayed imitation | A short pause between the model and the child’s attempt |
| 5. Prompted | A question or picture, no model (“What is this?”) |
| 6. Independent | The word comes up naturally in talk or play |
An illustrative most-to-least cueing ladder.
This mirrors the principle behind Dynamic Temporal and Tactile Cueing (DTTC), which ASHA describes as an integral-stimulation approach — “look, listen, do what I do” — in which the clinician constantly adds or fades auditory, visual, and tactile cues after each attempt. A 2020 tutorial describes DTTC’s temporal hierarchy and grounds its decisions about practice and feedback in principles of motor learning.1,3
Why cues are faded
A cue that never goes away becomes a crutch. Motor learning research distinguishes performing well during practice from learning that lasts; a tutorial on motor speech treatment reviewed how practice and feedback conditions affect acquisition, retention, and transfer, and found these principles promising for speech. For R, a 2020 tutorial recommends frequent, specific feedback in the earliest stages of establishing the sound; as the sound stabilizes, the goal shifts to the child doing it without help.5,6
Whether a child can copy a sound with a model at all — called stimulability — tells the SLP where on the ladder to start. A classic review describes stimulability as easily measured and useful for prognosis and treatment planning.7
Where the evidence is strongest
Structured cueing is central to motor-based treatment for childhood apraxia of speech. ASHA lists DTTC among evidence-based motor programming approaches, and the authors of a randomized trial protocol note that the CAS literature commonly recommends intensive, motor-based treatment, with some of the best evidence supporting DTTC.1,4
Using cues at home
- Start where your child succeeds: if they cannot say it alone, say it together.
- Use the SLP’s cues: ask which gestures or reminders they use, so your child hears one consistent system.
- Fade on purpose: once your child gets a word right with your help several times, try it with less help.
- Model in daily life: ASHA’s parent guidance centers on talking with your child and modeling clear speech.
ASHA’s suggestions for parents emphasize everyday modeling — talking, reading, and repeating your child’s words back clearly.8
Free Home Sound Practice
Practice words with a clear model to copy — listen-and-compare, with an instant AI check for R.
If your child needs a lot of support to say sounds that peers say easily, or makes different errors each time they try the same word, ask a speech-language pathologist for an evaluation. Find one through ASHA’s ProFind directory.9
Frequently asked questions
What is a cueing hierarchy in speech therapy?＋
It is a planned order of supports, from most help to least, that an SLP uses so a child can produce a target correctly and then gradually do it alone. ASHA describes cues as visual (watching the mouth, hand gestures, biofeedback), verbal or auditory (explicit instructions, saying the word together), and tactile (touch cues on the face or neck).
What does “adding and fading cues” mean?＋
After each attempt, the SLP decides whether to give more support or less. ASHA describes Dynamic Temporal and Tactile Cueing (DTTC), an approach for childhood apraxia of speech, as one in which the clinician constantly adds or fades auditory, visual, and tactile cues as needed after each practice trial.
Is a cueing hierarchy only for apraxia?＋
No. Cues are used in all speech sound treatment — a mirror, a hand gesture, or a reminder about tongue placement are all cues. Structured hierarchies are especially central in motor-based approaches for childhood apraxia of speech, where ASHA lists DTTC among evidence-based approaches.
Can parents use cues at home?＋
Yes — simple ones. Say the word together, let your child watch your mouth, then let them try alone. Ask your child’s SLP which cues they use in sessions so you can use the same ones and fade them the same way.
Put this into practice today
Try the free home sound practice, or start daily AI speech practice — every child takes one SpeechStep at a time.
References
9 sources from authoritative bodies. Last reviewed October 2026.
- 1.ASHAChildhood Apraxia of Speech — Practice Portal page.
- 2.ASHASpeech Sound Disorders: Articulation and Phonology — Practice Portal page.
- 3.Peer-reviewedStrand — Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech — Clinical tutorial (AJSLP), 2020.
- 4.Peer-reviewedIuzzini-Seigel et al. — Dose Frequency Randomized Controlled Trial for DTTC Treatment for Childhood Apraxia of Speech: Protocol — Randomized trial protocol (BMC Pediatrics), 2023.
- 5.Peer-reviewedMaas et al. — Principles of Motor Learning in Treatment of Motor Speech Disorders — Tutorial/review (AJSLP), 2008.
- 6.Peer-reviewedPreston, Benway, Leece, Hitchcock & McAllister — Tutorial: Motor-Based Treatment Strategies for /r/ Distortions — Clinical tutorial (LSHSS), 2020.
- 7.Peer-reviewedPowell & Miccio — Stimulability: A Useful Clinical Tool — Review (Journal of Communication Disorders), 1996.
- 8.ASHASuggestions for Parents: Speech and Language Development — Consumer guide.
- 9.ASHAASHA ProFind: Find a Certified Speech-Language Pathologist — Referral directory.
Keep reading
Articulation Therapy
Where cueing fits in teaching a new sound.
Read →Stimulability
Whether a child can copy a sound with a model — the first rung of cueing.
Read →Childhood Apraxia of Speech
Where cueing approaches have the strongest evidence.
Read →Articulation Exercises
Level-by-level practice for home.
Read →