Online English Summarizer tool, free and accurate!
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
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
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
logy in Children
This chapter focuses on the management of articulation and phonological disorders demonstrated
by children. An articulation model emphasizes the motor component of speech, whereas a pho-
nologic orientation stresses the linguistic aspect of speech production. Most articulation approaches
focus on the incorrect production of individual phonemes, traditionally classified as substitution,
omission, and distortion errors. In contrast, phonological approaches concentrate on rule-based errors
that affect multiple speech sounds that follow a predictable pattern. The phonological system governs
the ways in which sounds in a language can be combined to form words. Children with phonologically
based problems demonstrate difficulty in applying sound-system rules, not necessarily in production
of the sounds. These children do not simply possess an incomplete system of speech sounds; rather,
their errors have logical and coherent principles underlying their occurrence.
Articulation disorders can be classified as functional or organic in nature. Articulation disorders
are considered functional when no known pathology is causing the errors. Children with func-
tional articulation disorders demonstrate speech production errors in the absence of any identifiable
etiology. These children present with adequate hearing acuity and intellectual abilities and with no
signs of significant structural abnormalities or neurological dysfunction. The specific errors displayed
vary greatly from one child to the next and are not as readily predictable as those found in organically
based disorders. Organic disorders result from known physical causes, such as cleft palate, neuro-
logical dysfunction, or hearing impairment. Some children may demonstrate both functional and
organic deficits.
The information provided in this chapter is based on Standard American English. (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. (See Chapter 12
for more about multicultural and English-language learner treatment.)
Treatment Approaches
There are a variety of phonetic (i.e., articulation) and phonological (i.e., linguistic rules) approaches
to intervention. Williams et al. (2010) identified 23 approaches that have been utilized in the treat-
ment of speech sound disorders and Cabbage and DeVeney (2020) identified some considerations
and approaches commonly used by speech-language pathologists (SLPs) in school settings. Some
approaches place heavy emphasis on perceptual/sound discrimination (Cabbage & Hitchcock, 2022)
while others focus mainly on sound production (DeVeney & Peterkin, 2022). Selected examples of
classic and more recent remediation approaches are described in the following sections.
71
72 Providing Treatment for Communication Disorders Part Two
Traditional (Van Riper, 1978)
This phonetic approach to intervention is also known as the sensory-perceptual or motor-based
approach. 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. For additional information and
techniques, see Dale and Hayden (2013), Dodd and Bradford (2000), Sugden et al. (2019), Ward
et!al. (2014), and Yu et al. (2018).
Distinctive Features (McReynolds & Bennett, 1972)
Distinctive feature therapy is a phonological approach based on the theory that speech sounds can be
defined in terms of articulatory patterns and acoustic properties. 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 θ θ ! s z ʃ ʃ ʒ ʒ tʃ tʃ dʒ dʒ m n ŋ ŋ l r h w j j ʔ ʔ
Vocalic" " " " " " " " " " " " " " " " " " " + +" " " "
Consonantal + + + + + + + + + + + + + + + + + + + + +" " " "
High + +" " " " " " " " " " + + + +" " +" " " + +"
Back + +" " " " " " " " " " " " " " " " +" " " +" "
Low" " " " " " " " " " " " " " " " " " " " " +" " +
Anterior" " + + + + + + + + + +" " " " + +" +" " " " "
Coronal" " + +" " " " + + + + + + + +" + + + +" " " "
Voiced" +" +" +" +" +" +" +" + + + + + +" + +"
Continuant" " " " " " + + + + + + + +" " " " " + + + + + +
Nasal" " " " " " " " " " " " " " " " + + +" " " " " "
Strident" " " " " " + +" " + + + + + +" " " " " " " " "
Note. – 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 /ʃ/. 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
—
ʔ
Fricative Labiodental
v
f
Linguadental
θ
Alveolar
z
s
Palatal
ʒ
ʃ
Glottal
—
h
Affricate Palatal dʒ tʃ
Glide Bilabial
w
—
Palatal
j
—
Liquid Alveolar
l
—
Palatal
r
—
Nasal Bilabial
m
—
Alveolar
n
—
Velar
ŋ
—
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/). 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. For more detailed
information, see Blache (1989), Stevens and Hanson (2013), and Ball (2016).
Paired Oppositions — Minimal and Maximal (Weiner, 1981)
These phonologically based approaches target phonemic contrasts (errored versus correct) that signal
differences in meaning between two words. 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. Minimal opposition pairs differ in only one feature
of sound production (e.g., ban versus pan differ only in voicing) and are generally used with children
who demonstrate relatively fewer errors, primarily characterized by sound substitutions. Maximal
opposition word pairs differ in several features (e.g., sad and bad vary in place, manner, and voicing)
and are generally used with children who display a larger number of errors that also include omissions
and distortions. Four major steps are commonly used with this approach: (a) client is introduced
to pairs through pictures or objects; (b) client identifies picture/object named by clinician; (c) roles
are reversed and client must request or label picture/object; and (d) client is rewarded by clinician’s
Chapter 3 Intervention for Articulation and Phonology in Children 75
selection of correct stimulus or is given a chance to repair the communication breakdown caused
by inaccurate sound production. Gierut (2001, 2007) has advocated for an intervention strategy
to speech production that focuses on across-sound class generalizations to facilitate system-wide
phonological change. Storkel (2022) recently discussed minimal, maximal, or multiple opposition
approaches for speech sound disorders.
In this approach, targets selected for treatment based on complexity principles would include
those more complex, later developing, and less stimulable (Storkel, 2018). For more detailed informa-
tion on oppositions as an approach to treatment, see Barlow and Gierut (2002), Stoel-Gammon et!al.
(2002), and Wren et al. (2018).
Phonological Processes (Oller, 1975)
This phonological approach to intervention is based on the strategies used by young, typically develop-
ing children between 1$ and 4 years of age to simplify the production of an entire class of adult speech
sounds (Hodson & Paden, 1991; Khan & Lewis, 2002). 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). 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. These nondevelopmental processes include (a)!backing, the
substitution of sounds that are more posterior than the usual place of production (e.g., koe/toe, mackiz/
matches, gipper/zipper); (b) initial consonant deletion (e.g., ouse/ house, amp/lamp, ellow/yellow); and (c)
glottal replacement, substitution of a glottal stop for a consonant (e.g., boʔ le/ bottle, chiʔ en/chicken, miʔ ey/
mickey). Table 3–3 describes the most common phonological processes exhibited by normally develop-
ing children. For more detailed information, see Baker and McLeod (2011) and Baker et al. (2018).
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. Children learn to produce their best pronunciation of the words consistently,
both in isolation and connected speech. It targets the ability to generate consistent plans for words;
the ability to create a phonological plan is improved by providing detailed, specific feedback about a
limited number of words. This approach relies heavily on systematic practice in a drill-like format.
76 Providing Treatment for Communication Disorders Part Two
Table 3–3
Selected Developmental Phonological Processes
Sources: Based on the works of Bauman-Waengler (2007), Bernthal et al. (2009), Hodson (2004), and Shriberg
and Kwiatkowski (1980).
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”). The clinician does not provide specific or corrective feedback
regarding the accuracy of the child’s tongue placement or manner of sound production. Instead, the
environment is deliberately structured to give the child repeated opportunities to distinguish between
effective and ineffective communication attempts.
Oral-Motor Considerations
Some children with speech impairments (particularly those with organically based disorders) may
exhibit deficits in oral-motor function that affect the neuromuscular control and organization needed
for the production of intelligible speech. These deficits may manifest themselves as hyposensitivity
(reduced reactions to sensation); hypersensitivity (overly strong reactions to sensation); and weakness
or incoordination of oral structures, including the jaw, tongue, lips, or palate. Please see Appendix
D on the companion website for a schematic of the vocal tract structures discussed in this section.
It is important to realize that speech is not an isolated act, but the product of a highly complex and
synchronized oral-motor system. Oral-motor therapy for children with functional articulation disor-
ders generally consists of a variety of tongue, lip, and jaw exercises. 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). However, controversy
exists regarding this approach to intervention. The few controlled studies present correlational rather
than causal findings and report no significant connection between nonspeech oral-motor exercises
(NSOMEs) and speech sound production (Bunton, 2008; Clark, 2003; Love, 2000; Moore & Ruark,
1996; Nittrouer, 1993). See Forrest (2002), Lass and Pannbacker (2008), and McCauley et al. (2009)
for a comprehensive discussion of the efficacy of oral-motor intervention for functional articulation
errors. In 2015, Kent suggested that NSOMES may have more value with disorders such as obstruc-
tive sleep apnea and jaw hypermobility.
The authors of this book do not endorse the use of NSOMEs for any specific clients or groups
of clients, especially those with speech sound disorders of nonorganic origin.
Treatment Efficacy and Evidence-Based Practice
Gierut (1998) reviewed 64 publications whose subject matter included intervention effectiveness
for functional articulatory/phonological disorders in children. The summary includes mainly small
sample studies that focused on the treatment of consonant sounds. In 2003, Weston and Bain con-
ducted a meta-analysis of 41 peer-reviewed articulation and phonology studies. The studies included
78 Providing Treatment for Communication Disorders Part Two
descriptive and experimental designs involving children from ages 3 to 8+ years. Similar conclusions
were reached in both analyses: (a) intervention is generally effective in improving correct sound
production and increasing speech intelligibility; and (b) no one treatment approach was identified as
being more effective than any other. Other factors to consider include the following:
● Minimal pair treatment and cycles approach treatment generally result in phonological gains.
● Computerized instruction is an effective supplement to direct clinical intervention.
● Efficacy data are needed to determine the relative effectiveness of specific treatment proce-
dures as well as their efficiency (i.e., time needed for completion of the therapy programs).
● Clinician and family variables may have an impact on outcomes and should be examined in
treatment studies (e.g., level of clinical expertise, parental/family attitudes and motivation).
● Scheduling of treatment (i.e., session frequency and intensity) requires further study as a
potential variable in treatment outcomes. However, more recent studies have begun to suggest
that higher intensity delivery schedules are associated with improved outcomes (Hegarty
et!al., 2018; Kaipa & Peterson, 2016; Tyler, 2005; Wren et al., 2018).
In 2004, Law et al. conducted a meta-analysis of studies focusing on intervention for children
with speech-language difficulties. Not surprisingly, the results indicated a significant effect favoring
speech interventions compared with no treatment conditions. Courses of therapy lasting less than
8!weeks appeared to be less effective than longer programs. Finally, parent-administered interventions
based on receptive auditory techniques (e.g., auditory bombardment) did not significantly affect
speech sound production. In 2018, Wren et al. published a systematic review of interventions for
speech sound disorders and found that there continues to be a relative lack of highly graded evidence
for treatment effectiveness with any specific approach to speech sound disorders. An evidence-based
practice (EBP) approach to treatment comprises three basic elements: (a) scientific research, (b)!clinical
expertise, and (c) client/family values. Because the existing literature on treatment efficacy does not
clearly identify any gold standard approach to intervention for articulation/phonology deficits, the
SLP’s clinical judgment becomes the driving force in the EBP process. 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
tʃ— 4$ 3–8 6 7
v 6$ 6 4 5$ 5$
z 7$ 7 4 7–9 7–9
ʒ 6$ 7 4 — —
θ 7$ 6 4 6 8
dʒ— 7 4 6 7
ʃ 6$ 4$ 3–8 6 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., /θ/ 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). Several strategies can be utilized in the design of a client’s
therapy program: vertical, horizontal, and cyclical. The basic assumption of vertical training is that
the best route to target mastery is through intense practice on a limited number of targets. If therapy
is being programmed with a focus on motor learning, the clinician is encouraged to design session
activities that provide the opportunity for a high rate of responses or massed practice (e.g., 150 target
productions in 30 min). The clinician focuses on one or two targets until the client achieves some
predetermined level of mastery, usually at the level of conversation. Therapy then moves on to the
next target(s) identified in a hierarchical level of difficulty. 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, -/ŋ, 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 ʃ/tʃ
j/l w/r -/s
b/v f/θ -/k
-/s j/l -/d
p/f ʔ/t s/f
b/m j/n -/ŋ
82 Providing Treatment for Communication Disorders Part Two
consists of -/k, -/d, and ʔ/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 /θ/, /v/, /m/, /f/, /g/, and /s/. The /θ/ 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
l 5.3 65.8
k 5.1 70.9
w 4.9 75.8
h 4.4 80.2
b 3.3 83.5
p 3.1 86.6
g 3.1 89.7
f 2.1 91.8
h 1.6 93.4
j 1.6 95.0
v 1.5 96.5
ʃ 0.9 97.4
θ 0.9 98.3
dʒ 0.6 98.9
tʃ 0.6 99.5
Summarize English and Arabic text using the statistical algorithm and sorting sentences based on its importance
You can download the summary result with one of any available formats such as PDF,DOCX and TXT
ٌYou can share the summary link easily, we keep the summary on the website for future reference,except for private summaries.
We are working on adding new features to make summarization more easy and accurate
ديم إشكالي نهجت الأنظمة الدكتاتورية سياسة التوسع لمواجهة آثار الأزمة الاقتصادية، فاصطدمت بمصالح الأن...
يُمثل الفضاء الجيوسياسي لمنطقة الساحل الإفريقي بُعداً حيوياً ومحورياً في صياغة العقيدة الأمنية والسي...
The study deals with one of the important topics in semantics, which is minor derivation, represente...
فقد هدفت دراسة () الي سهولة استخدام استخدام بيئة تعليم إلكتروني مُدمجة بمقاطع فيديو للغة الإشارة، وع...
قادة الشباب في مجال المناخ يلتقون وزير الشباب قبيل مشاركتهم في مؤتمر الأمم المتحدة لتغير المناخ (COP...
المدير العام يترأس اجتماعا مع اللجان الاستشارية لبحث تطوير الخدمات الطبية التخصصية والاستقدام الطبي...
Hydrogen production technologies have been a significant area of solar chemical research since the 1...
How Ergonomics Supports Safety and Wellbeing in Healthcare Ergonomics is the practice of designing ...
1. غالبًا ما تكون العوامل المحددة المعتمدة على الكثافة من العوامل الحيوية في البيئة.✔️ 2. تكون الشبك...
السلام عليكم مختصر الحياة ما قاله جبريل للنبي: يا محمد عش ما شئت فإنك ميت واعمل ما شئت فإنك مجزي به ...
إليكم أبرز الأعمال بإدارة المشاريع بالقطاع الجنوبي للنصف الأول من شهر يونيو 2026، حيث تم تنفيذ أطوال...
توصلت الدراسة إلى أن رقمنة القطاع الصحي والصحة الإلكترونية لم تعودا خياراً ترفيهياً أو شكلياً، بل أص...