logy in Children
This chapter focuses on the management of articulation and phonological disorders demonstrated
by children.Each phoneme in a language consists
of a bundle of binary features in which the presence or absence of these features is specified (e.g.,
+voicing/"voicing, +nasal/"nasal, +continuancy/"continuancy; Jakobson, 1968). Some phonemes,
such as /t/ and /d/, differ by only one feature contrast -- in this case, voicing. Other phonemes,
such as /s/ and /g/, differ by many feature contrasts, including voicing, continuancy, placement, and
stridency. Table 3-1 presents a complete list of the 11 distinctive features originally identified by
Chomsky and Halle (1968). For the purposes of clinical application, however, sounds are usually
analyzed according to three basic feature categories: place, manner, and voicing. This breakdown is
illustrated in Table 3-2. Table 3-1
Distinctive Feature Analysis Chart
Consonants
Features
k g t d p b f v ? ? ! s z ? ? ? ? t? t? d? d? m n n n l r h w j j ? ? Vocalic" " " " " " " " " " " " " " " " " " " + +" " " "
Consonantal + + + + + + + + + + + + + + + + + + + + +" " " "
High + +" " " " " " " " " " + + + +" " +" " " + +"
Back + +" " " " " " " " " " " " " " " " +" " " +" "
Low" " " " " " " " " " " " " " " " " " " " " +" " +
Anterior" " + + + + + + + + + +" " " " + +" +" " " " "
Coronal" " + +" " " " + + + + + + + +" + + + +" " " "
Voiced" +" +" +" +" +" +" +" + + + + + +" + +"
Continuant" " " " " " + + + + + + + +" " " " " + + + + + +
Nasal" " " " " " " " " " " " " " " " + + +" " " " " "
Strident" " " " " " + +" " + + + + + +" " " " " " " " "
Note.This "deep" approach to intervention tends
to be most appropriate for clients with relatively few articulatory/phonological errors. Chapter 3 Intervention for Articulation and Phonology in Children 81
In contrast to training deeply, a horizontal strategy attacks goals broadly. It assumes that simul-
taneous exposure to a wide variety of targets will facilitate a client's ability to produce phonemes or
sound patterns. The clinician provides less intense practice on a larger number of targets, even within
the same session. This strategy focuses on efficient generalization of target behaviors across the speech
sound system and tends to be most appropriate for clients with multiple errors. Clinicians may choose to combine aspects of the vertical and horizontal strategies into the cycles
approach. Recall that instead of attacking therapy targets deeply or broadly, this strategy provides
a client with practice on a given target for a predetermined amount of time, and then moves on
to another target (Hodson & Paden, 1991; Sugden et al., 2018). This approach gives the client an
opportunity to internalize the original sound or pattern while the clinician introduces the new target. Focus on the original target resumes later in the therapy program. This cycle is repeated until the
target(s) emerges in spontaneous speech. Example Profiles for Functional Articulation Disorders
This section presents three commonly seen profiles of childhood articulation problems. These
examples have been designed to illustrate the selection of intervention targets as well as specific
therapy activities and materials. Most of the chosen activities are easily implemented in either indi-
vidual or group therapy settings. For many children, it may be necessary to teach the phonetic placement of target sounds prior
to the introduction of actual activities. Appendix 3-A on the companion website provides specific
instructions for establishing the correct placement for consonants that are typically considered dif-
ficult to elicit. The first profile describes a young child with multiple errors. PROFILE 1: FUNCTIONAL ARTICULATION--3-YEAR-OLD
-/s
Blends b/bl, f/fl, w/kl, t/sl, t/skw, fw/kr, b/br, d/dr, w/pr
Selection of Therapy Targets Using a Developmental Approach. Based on this
child's chronological age, the errors to be targeted first are d/g, b/m, p/f, j/n, -/n, because these
are the earliest emerging sounds, as can be seen in Table 3-4. The second set of target sounds
Jill is 3 years old and demonstrates the following articulation errors (error sound/intended target):
Initial Medial Final
d/g d/g ?/t? j/l w/r -/s
b/v f/? -/k
-/s j/l -/d
p/f ?/t s/f
b/m j/n -/n
82 Providing Treatment for Communication Disorders Part Two
consists of -/k, -/d, and ?/t. The remaining errors would not be considered appropriate targets
for intervention, because they emerge well beyond 3 years of age. Selection of Therapy Targets Using a Nondevelopmental Approach. The errors
to be targeted are /?/, /v/, /m/, /f/, /g/, and /s/. The /?/ and /v/ sounds were chosen despite
developmental considerations, because Jill was highly stimulable for these sounds in isolation
during the diagnostic session. The /m/ and /f/ sounds were selected because they are visible when
produced, which facilitates learning of correct articulatory placement. The /f/ and /g/ sounds
were included as beginning targets, because their status as initial-position errors make them
significant contributors to Jill's overall unintelligibility. Sample Activities
1. Modify a board game, such as Hasbro's Candy Land by requiring a child to produce
a target sound in isolation, following the clinician's model, in order to move a game
piece. Close approximations, rather than accurate productions, of the target phoneme
may be acceptable in the very early stages of therapy. Once the child improves her perfor-
mance by 30% to 50% over baseline measures, clinician models should be faded. Three
consecutive spontaneous productions can then be required for the child to take a turn in
the game. 2. Create a game with colored paper fish. Each fish has a picture on it designed to elicit a
target sound in the desired position. Attach paper clips to the back of each fish, and give
the child a "fishing pole" with a magnet on the end of its string.(See
Appendix!B on the companion website for International Phonetic Alphabet symbols.) It is imperative
that clinicians take a child's cultural and linguistic background into account in determining whether
the production of a given speech sound represents an error or a dialectal difference. Selected examples of
classic and more recent remediation approaches are described in the following sections. - Absence of feature. + Presence of feature. Vocalic: Oral cavity constriction is less than required for the high vowels /i/ and /u/. Consonantal: Marked constriction in the midline
region of the vocal tract.High: Body of the tongue is raised above the neutral or resting position. Back: Body of the tongue is retracted from the neutral or resting position. Low: Body
of the tongue is lowered below the neutral or resting position. Anterior: Point of constriction is farther forward than required for /?/. Coronal: Tongue blade is elevated toward alveolar
ridge/palate from the neutral position. Voiced: Vocal folds vibrate during sound production. Continuant: Partial constriction of oral cavity; sound can be sustained in a steady state. Nasal: Velum is lowered to allow sound stream to escape through the nose. Strident: Turbulent noise is created by rapid airflow released through a small opening. Chapter 3 Intervention for Articulation and Phonology in Children 74 Providing Treatment for Communication Disorders Part Two
Table 3-2
Place, Manner, and Voicing Chart for English Consonants
Manner Place Voiced Voiceless
Stop Bilabial
b
p
Alveolar
d
t
Velar
g
k
Glottal
--
? Fricative Labiodental
v
f
Linguadental
#
? Alveolar
z
s
Palatal
? ? Glottal
--
h
Affricate Palatal d? t? After establishing the
feature contrast in auditory discrimination activities, the clinician moves therapy through the tradi-
tional speech production hierarchy from isolation/syllables through conversation. No explicit instruction on articulatory placement or sound
production is given. Instead, this approach emphasizes the use of the child's communication success
or breakdown to teach target sound productions. Children who persist in using these processes
beyond the age of 4 years are frequently referred for speech-language services because their speech is
now perceived as difficult to understand. Some children exhibit phonological processes that are not
typical of normally developing children. le/ bottle, chi? en/chicken, mi? ey/
mickey).For this reason, clinicians
often adopt a "what works" approach (Stanovich, 2000) to intervention that utilizes the best features
of multiple approaches. For more information on SLPs' use of evidence-based practices, see Baker
and McLeod (2011) and Hoffman et al. (2013). Target Selection for Intervention Programming
Two primary approaches are used for choosing initial therapy targets for children with articulation/
phonological disorders: developmental and nondevelopmental. Developmental
In this approach, therapy targets are identified based on the order of acquisition in normally devel-
oping children. Table 3-4 provides a list of English consonants in the order of their emergence. Table!3-3, earlier in the chapter, outlines the most common phonological processes exhibited by
young children. Chapter 3 Table 3-4
Age of Acquisition of English Consonants
Intervention for Articulation and Phonology in Children 79
Consonant
Poole
(1934)
Templin
(1957)
Prather
et al.
(1975)
Smit et al. (1990)
Females Males
m 3$ 3 2 3 3
n 4$ 3 2 3$ 3
h 3$ 3 2 3 3
p 3$ 3 2 3 3
f 5$ 3 2-4 3$ 3$
w 3$ 3 2-8 3 3
b 3$ 4 2-8 3 3
h 4$ 3 2 7-9 7-9
j 4$ 3$ 2-4 4 5
k 4$ 4 2-4 3$ 3$
g 4$ 4 2-4 3$ 4
l 6$ 6 3-4 6 6
d 4$ 4 2-4 3 3$
t 4$ 6 2-8 4 3$
s 7$ 4$ 3 7-9 7-9
r 7$ 4 3-4 8 8
t?-- 4$ 3-8 6 7
v 6$ 6 4 5$ 5$
z 7$ 7 4 7-9 7-9
? 6$ 7 4 -- --
? 7$ 6 4 6 8
d?-- 7 4 6 7
? 6$ 4$ 3-8 6 7
# 6$ 7 4 4$ 7
Note. Variability in reported ages of acquisition is partly due to the different criterion levels used across
studies to determine mastery of each sound. Poole (1934) = 100%, Templin (1957) = 75%, Prather et al.
(1975) = 75%, Smit et al. (1990) = 90%. 80 Providing Treatment for Communication Disorders Part Two
Nondevelopmental
In this approach, developmental norms are not used in the selection of target behaviors. Instead, the
determining factors fall into two groups. One strategy is client specific and bases the selection of
therapy objectives on several factors:
? Target(s) should be most relevant to a child or parent (e.g., a sound in the child's name). ? Target(s) should be most stimulable in a given child's error repertoire regardless of
developmental sequence. It should be noted that several authors take the opposite view and
recommend choosing the least stimulable sounds as targets for intervention. They suggest
that stimulability is indicative of some degree of phonological knowledge, and these sounds
may be likely to emerge naturally; in contrast, nonstimulable sounds would benefit most from
targeted intervention. (For more detailed information, see Gierut et al. [1987]; McLeod &
Baker [2016]; Rvachew [2005]; and Williams [2002].)
? Target(s) should be most visible when produced (e.g., /?/ versus /g/). The second nondevelopmental strategy is based on the degree of perceived deviance associ-
ated with a child's errors. This strategy can be applied to both articulation and phonological errors,
as follows. Articulatory
? Omission errors contribute most to unintelligibility, followed by substitutions, and then
distortions. ? Errors in the initial position of words contribute most to unintelligibility, followed by medial,
and then final. ? Errors that occur on the most frequent sounds in a language contribute significantly to
unintelligibility. Phonological
? Patterns of initial consonant deletion and glottal replacement of medial consonants tend to
contribute significantly to listener perception of unintelligibility. In addition to choosing therapy targets, clinicians must determine the most appropriate "goal-attack
strategy" for each client (Fey, 1986).It relies on sensory training (i.e., auditory discrimination or "ear-training") either before
or concurrently with speech production training to provide the client with an internal standard with
which to compare correct versus incorrect productions of sounds. The typical sequence for training
in the traditional approach involves (a) speech sound discrimination training, including identifica-
tion, isolation, and bombardment of specific target sounds; (b) achieving phonetic placement of the
articulators for the sound; (c) producing the sound in isolation; (d) producing the sound in nonsense
syllables; (e) producing the sound in the initial, medial, and final positions of words; (f ) produc-
ing the sound in phrases and sentences; and (g) producing the sound in conversational speech. It
incorporates several teaching strategies, such as imitation, multisensory cues for phonetic placement
and production, and successive approximation. For more detailed information on this approach, see
Bauman-Waengler (2016) and Rvachew et al. (2004). Motor Kinesthetic (Stinchfield-Hawk & Young, 1938)
This phonetic approach emphasizes development of correct movement patterns and requires the
clinician to manipulate the articulators to facilitate sound production. This method is based on the
assumption that it is possible to establish positive kinesthetic and tactile feedback patterns through
direct manipulation of the client's articulators. As a result of the feedback, the client is helped to
recognize and then to produce the movements of speech. In this approach, the basic unit of therapy
is the isolated sound; only later are words and sentence patterns introduced and established. A more
recent iteration of the motor-kinesthetic philosophy concept is PROMPT, which stands for Prompts
for Restructuring Oral Muscular Phonetic Targets (Chumpelik, 1984). Originally developed for
children with severe speech motor production difficulties, PROMPT is a multidimensional approach
that incorporates three main domains: motor-sensory, cognitive-linguistic, and social-emotional. Speech production is facilitated through the use of tactile cues that focus on jaw height, labial/facial
positioning, and mylohyoid posture for each sound/word (Grigos et al., 2010; Hayden et al., 2010). The program is highly structured, and therapists must be trained/certified through the PROMPT
Institute (https://www.promptinstitute.com) in order to utilize this therapy approach. In summary,
the motor-kinetic method also advocates for the use of tactile, kinesthetic, and proprioceptive cues
to facilitate "motor maps" for production of individual speech sounds.Tell the child that she is
going to pretend to be a detective who has to find the "magic square" in the dark. Hand the
child a penlight, turn out the lights, and instruct her to aim the beam at the square that she
thinks is the magic one. As each square is lit up, ask the child to produce the target item at
the appropriate level of complexity. 4. Assemble the following materials to make two puppets: two glue sticks, two brown paper
bags, yarn, two sets of paper cutouts of facial features, and other accessories such as earrings,
mustaches, and eyeglasses. Collect 25 pictures containing the targeted therapy sounds and
place them in a pile on the table. Explain that the clinician and child will construct puppets
using the paper bags and other materials. The clinician selects one picture from the pile,
models the correct production of the word, and then glues one feature/accessory to one
of the bags. Instruct the child to select the next picture from the pile, produce the word
correctly three times, and glue a feature/accessory on the other bag. Alternate turns until
both puppets are completed. Chapter 3 Intervention for Articulation and Phonology in Children 83
The second profile describes a school-age child with multiple articulation errors. Initial Medial Final
j/l j/l j/l
s/? s/? ?/t? ?/t? ?/t? -/d
?/f ?/f
s/f
b/v b/v
w/r w/r
PROFILE 2: FUNCTIONAL ARTICULATION--6-YEAR-OLD
Joe is 6 years old and demonstrates the following errors:
Blends: s/sl, b/bl, k/kl, fw/fl, fw/fr, tw/tr, k/skw, fw/kr, t/st
Selection of Therapy Targets Using a Developmental Approach. Based on this
child's chronological age, the errors to be targeted first are -/d, ?/f, b/v, and j/l, because these are
the earliest emerging sounds as shown in Table 3-4. The second set of targets consists of the
remaining sound and blend errors, because all of these are typically acquired by 6 years of age. Selection of Therapy Targets Using a Nondevelopmental Approach. The errors to
be targeted are /r/, /fr/, /fl/, and /?/. The /r/ was chosen because it is one of the most frequently
occurring sounds in English (Table 3-5). The /fr/ and /fl/ blends were selected because these
are the only phonetic contexts in which Joe can correctly produce his otherwise misarticulated
/f/ sound. The blends can provide a starting point for facilitating the correct production of /f/ as
a singleton. Finally, the /?/ was chosen because its articulatory placement is highly visible and is
therefore relatively easy to approximate. Sample Activities
1. Draw 10 pictures on a dry-erase board, each containing one instance of a target sound. Give the child a beanbag and tell him to hit one of the pictures. Instruct the child to
produce the stimulus item at the appropriate level of complexity (e.g., single word, carrier
phrase, sentence, narrative). 2. For a group activity, gather at least 20 pictures/objects that contain the target sound(s) and
place them around the room. Give each child a "suitcase" (box) and tell them that the group
is going on a trip.Process Definition Examples
Suppressed by 3 years
Assimilation (harmony) A sound becomes similar
to or is influenced by
another sound in the same
word
guck/duck
toat/coat
doddie/doggie
Final consonant deletion Omission of the last sound
in word
be/bed
f i/fish
so/soap
Syllable deletion Omission of weak or
unstressed syllable(s)
nana/banana agator/alligator
zert/dessert
Suppressed after 3 years
Cluster reduction Omission of at least one
consonant from a cluster
top/stop
mall/small
net/nest
Epenthesis Addition of sounds in a
word
bulack/black
sthoap/soap
pulay/play
Fronting Substitutions are produced
anterior to their usual
place of production
tome/come
cats/catch
dum/gum
Metathesis The order of sound
segments is reversed
aminal/animal
flutterby/butterfly
bakset/basket
Stopping Fricatives/affricates are
replaced by stops
tun/sun
dat/that
dump/jump
Voicing/devoicing Voiced consonants replace
voiceless sounds in the
initial position; in the final
position voiced consonants
become voiceless
gup/cup
doe/toe
bet/bed
Chapter 3 Intervention for Articulation and Phonology in Children 77
Metaphon (Howell & Dean, 1994)
This approach is more accurately labeled a "philosophy" rather than a program; it is designed
to provide children with explicit information that will enable them to consciously reflect on the
phonemic structure of language. Heavy emphasis is placed on the child's awareness/understanding
of the detailed aspects of speech sounds (separately from word meaning) to facilitate accurate sound
production. It utilizes a "word-pair" technique to highlight the salient differences between individual
sounds in similar words ("deep/keep").Cycles Approach (Hodson & Paden, 1983)
One of the better known phonological process intervention programs is the "cycles" approach, which
is intended for children with highly unintelligible speech. The clinician identifies phonological
patterns that are targeted for a designated amount of time (i.e., cycles lasting 5-16 weeks). A typical
session sequence includes (a) auditory bombardment, (b) production training, (c) stimulability probes,
and (d) take-home activities for generalization. After approximately 2 to 6 hr of direct intervention,
the child is given time to internalize the pattern while the clinician introduces new targets. Thus, the
child's progression through the program is not based on achieving a criterion level of mastery. Focus
on the original target resumes later in the therapy program. Each cycle is repeated until the target
pattern emerges in spontaneous speech. For more detailed information, see Rvachew et al. (1999),
Stoel-Gammon et al. (2002), Hassink and Wendt (2010), and Hodson (2010). Core Vocabulary (Dodd et al., 2010)
This approach focuses on functional outcomes in which consistency, as opposed to accuracy, is
targeted. The speech-language pathologist (SLP) selects 50 to 70 "functionally powerful" words and
targets up to 10 at once.Most proponents of this approach
subscribe to one or more of the following basic rationales: (a) speech is founded on earlier developing
nonspeech motor patterns, such as sucking and chewing (Marshalla, 1985; Ruark & Moore, 1997);
(b) reduced muscle tone in the oral-facial area results in limited strength of speech articulators (Robin
et al., 1991); (c) normal movement and sensation significantly influence motor learning, a Piagetian
construct (Piaget, 1951; Thelen & Smith, 1994); and (d) speech is a highly complex behavior that
is more easily learned when broken into smaller components (Magill, 1998).For example, young children frequently omit
weakly stressed syllables in multisyllabic words (e.g., ephant/elephant, jamas/pajamas), reduce consonant
clusters (e.g., bue/blue, dek/desk), assimilate consonants in words (e.g., goggie/doggie, chichen/chicken),
and delete final consonants (e.g., ba/ball, hou/house).Glide Bilabial
w
--
Palatal
j
--
Liquid Alveolar
l
--
Palatal
r
--
Nasal Bilabial
m
--
Alveolar
n
--
Velar
n
--
The clinician selects a feature for training (e.g., continuancy) and presents syllable or word
pairs that contrast presence with absence of the feature (e.g., /fo/ versus /po/).In 2003, Weston and Bain con-
ducted a meta-analysis of 41 peer-reviewed articulation and phonology studies.????3.0.9 97.4
?4.3...