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Articulation and Phonology Treatment

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Sameh El Saghir

on 26 November 2017

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Transcript of Articulation and Phonology Treatment

Historically, the treatment of speech sound errors involved teaching the motor skills needed for the articulation of speech sounds. Since the 1970s, speech sound disorders have also been viewed from a linguistic or phonological perspective.
Both approaches might be used in therapy with the same individual at different times or for different reasons.
Treatment Approaches
1. Contextual Utilization Approaches:
Contextual utilization approaches are based on the recognition that speech sounds are produced in syllable-based contexts in connected speech and that some contexts can facilitate correct production of a particular sound. Instruction for that sound is initiated in the context(s) where the sound can be produced correctly (McDonald, 1964). The syllable is used as the building block for practice at more complex levels. These approaches may be helpful for children who use a sound inconsistently and need a method to facilitate consistent production in other contexts. For example, production of a "t" may be facilitated in the context of a high front vowel (Bernthal et al., 2013). Facilitative contexts or "likely best bets" for production can be identified for voicing, velar, alveolar, and nasal consonants. For example, a "best bet" for nasal consonants is before a low vowel, as in "mad" (Bleile, 2002).
Treatment Approaches ... Continued
3. Core Vocabulary Approach
Focuses on whole-word production
Used for children with inconsistent speech sound production who may be resistant to more traditional therapy approaches.
Words selected are used frequently in the child's functional communication.
A list of words is developed (e.g., based on observation, parent report, and/or teacher report)
A number of words are selected each week for treatment.
The child is taught his "best" word production.
Words are practiced until consistently produced (Dodd, Holm, Crosbie, & McIntosh, 2006).
Target Selection
Developmental Approaches:
Target sounds are selected based on order of acquisition in typically developing children.
Sameh El Saghir
Target Selection & Treatment Strategies for
Articulation & Phonological Disorders

Prepared & Presented By
Head of SLP Dept. - Rehabilitation School for Boys
Ali Al Attar
Supervised By
SLP Supervisor - Dept. of Special Education
Khaled Al Naqi
Manager - Rehabilitation School for Boys
Phases of Therapy
1. Establishment:
Eliciting target behaviors and stabilizing production on a voluntary level.
2. Generalization:
Facilitating carry-over of sound productions at increasingly challenging levels (e.g., syllables, words, phrases/sentences, conversational speaking).
3. Maintenance:
Stabilizing target behaviors and making production more automatic; encouraging self-monitoring of speech and self-correction of errors.
Non-developmental/theoretically motivated approaches:
1. Complexity approach:
targets more complex, linguistically marked phonological elements not in the child's phonological system to induce cascading generalization learning of sounds (Gierut, 2007);
2. Dynamic systems approach:
focuses on teaching and stabilizing simple target phonemes that do not introduce new feature contrasts in the child's phonological system to assist in the acquisition of target sounds and more complex targets and features (Rvachew & Bernhardt, 2010);
3. Systemic approach:
bases treatment on the function of the sound in the child's phonological organization to achieve maximum phonological reorganization with the least amount of intervention. Target selection is based on a distance metric. Targets can be maximally distinct from the child's error in terms of place, voice, and manner and can also be maximally different in terms of manner classes, places of production, and voicing (Williams, 2003b).

Other approaches, including:

selecting client-specific targets based on factors, such as relevance to the child and his family (e.g., sound is in child's name), stimulability, and/or visibility when produced (e.g., /f/ vs. /k/);
selecting targets based on degree of deviance and impact on intelligibility (e.g., errors of omission and error patterns, such as initial consonant deletion, that contribute most to intelligibility).

2. Contrast Therapy:

Contrast Therapy focuses on production using contrasting word pairs instead of individual sounds and emphasizes sound contrasts necessary to differentiate one word from another and includes four different contrastive approaches:
Minimal Oppositions:
also known as "minimal pairs" therapy, uses pairs of words that differ by only one phoneme or single feature signaling a change in meaning, in an effort to establish contrasts not present in the child's phonological system (e.g., door vs. sore, pot vs. spot, key vs. tea; Baker, 2010; Blache, Parsons, & Humphreys, 1981; Weiner, 1981). 
Maximal Oppositions:
uses pairs of words in which one speech sound known and produced by the child is contrasted with a maximally opposing sound not known or produced by the child (e.g., manner of production and place of production, such as /m/ vs. /s/; Gierut, 1989, 1990, 1992).
Treatment Of The Empty Set:
similar to maximal opposition contrasts, but uses pairs of words containing two maximally opposing sounds that are unknown to the child—ideally, an obstruent with a sonorant (e.g., /l/ vs. /s/; Gierut, 1992).
Multiple Oppositions:
a variation of the minimal opposition contrast approach that uses pairs of words contrasting a child's error sound with three or four strategically selected sounds that reflect both maximal classification and maximal distinction (Williams, 2000a, 2000b).
Contrast Therapy Comparison
Treatment Approaches ... Continued
4. Cycles Approach

Targets phonological pattern errors and is designed for highly unintelligible children who have extensive omissions, some substitutions, and a restricted use of consonants.
The goal is to increase intelligibility within a short period of time, and treatment is scheduled in cycles ranging from 5 to 16 weeks. During each cycle, one or more phonological patterns are targeted.
The next cycle targets one or more different phonological patterns.
Recycling of phonological patterns continues until the targeted patterns are present in the child's spontaneous speech (Hodson, 2010; Prezas & Hodson, 2010).
The goal is to approximate the gradual normal phonological development process.
There is no predetermined level of mastery of phonemes or phoneme patterns within each cycle.
5. Distinctive Feature Therapy

It focuses on elements of phonemes that are lacking in a child's repertoire (e.g., frication, nasality, voicing, and place of articulation).
It is typically used for children who primarily substitute one sound for another.
It uses tasks (e.g., minimal pair contrasts) that compare the phonetic elements/features of the target sound with those of its substitution or some other sound contrast.
Patterns of features can be identified and targeted; producing one contrast often generalizes to other sounds that share the targeted feature (Blache & Parsons, 1980; Blache et al., 1981).

6. Metaphon Therapy

It is designed to teach metaphonological awareness, the awareness of the phonological structure of language.
This approach assumes that children with phonological disorders have failed to acquire the rules of the phonological system, and the focus is on the sound properties that need to be contrasted.
For example, for problems with voicing, the concept of "noisy" (voiced) versus "quiet" (voiceless) are taught.
Targets typically include processes that impact intelligibility, can be imitated, or are not seen in typically developing children of the same age (Howell & Dean, 1994).
Treatment Approaches ... Continued
7. Naturalistic Speech Intelligibility Intervention

Naturalist speech intelligibility intervention directs treatment of the targeted sound in naturalistic activities that provide the child with frequent opportunities for the sound to occur. For example, using a McDonald's menu, the child can be asked questions about items that contain the targeted sound(s).
The child's error productions are recast without the use of imitative prompts or direct motor training.
This approach is used with children who are intelligible enough to be able to use the recasts effectively (Camarata, 2010).
8. Non-Speech Oral-Motor Therapy

Non-speech oral-motor therapy involves the use of oral-motor training prior to teaching sounds or as a supplement to speech sound instruction.
The rationale behind this approach is that immature or deficient oral-motor control or strength may be causing poor articulation and that it is necessary to teach control of the articulators before working on correct production of sounds.

9. Speech Sound Perception Training

Speech perception training is a procedure used to help the child acquire a stable perceptual representation for the target phoneme or phonological structure. 
The goal is to ensure that the child is attending to the appropriate acoustic cues and weighting them according to a language specific strategy (i.e., one that ensures reliable perception of the target in a variety of listening contexts).
Recommended procedures include:
(1) Auditory bombardment in which many and varied exemplars of the target are presented to the child, sometimes in a meaningful context such as a story and often with amplification.
(2) Identification tasks in which the child identifies correct and incorrect versions of the target.
American Speech-Language-Hearing Association, (n.d.).
Speech sound disorders - articulation and phonology
Retrieved. from
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