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Treatment of Phonological Disorders

Treatment focused on the child's phonological system. It targets phoneme function.

Minimal Pair Therapy

Therapeutic use of pairs of words that differ by one phoneme.

Minimal Oppositions Contrast Therapy

Near minimal pairs: pairs of words that differ by more than one phoneme, yet the vowel following (or preceding), remains constant

  • AKA minimal opposition contrast therapy, method of meaningful minimal contrast, and minimal opposition contrast therapy.

  • Choose a phonological process based on the developmental order of suppression, the child's age and phonological development, the frequency of occurrence, how many sounds are affected, how it affects intelligibility.

  • Typically pair a phone the child can produce with one that is not produced correctly

  • Children who may benefit

    • mild to moderate phonological disorder​

      • or phonological delay​

    • stimulable for the target sound

  • After minimal pairs are chosen, suggested steps:

    • discussion of words: make sure the child knows the concepts of the words​

    • discrimination testing and training

    • production training

    • carryover training

Multiple Oppositions Approach

  • Alternative approach to contrastive minimal pairs

  • Addresses the collapse of multiple phonemes

  • The child is presented simultaneously with several sounds that address their collapse of phonemes

    • two- four sounds used in minimal pairs of the error sound versus the substitution​

  • Children who may benefit

    • severe speech sound disorder

    • consistent phonological disorder

    • a collapse of phoneme contrasts that incorporates several sounds

  • Target sounds

    • maximal distinctions and maximal classifications​

    • potential for greatest impact

  • Steps:

    • Familiarization and initial production of contrasts​

      • introduction to the rule set​

      • familiarization with the pictures and vocabulary

      • initial production of contrasts

    • Production of contrasts and interactive play

      • imitation​

      • spontaneous production

      • interactive play

    • Contrasts within communicative contexts

    • Conversational recasts

Target Selection for Minimal Pair Therapy

Maximal Oppositions

  • Target selection method

  • Based on minimal word pairs

  • Children who may benefit

    • large gaps in phonemic inventory​

    • moderate to several phonological disorder

    • consistent phonological disorder

  • Target sounds

    • two sounds not in child's inventory​

    • maximally different according to distinctive features

      • the nature of the features (son​orant, consonantal, and approximant)

      • the number of distinctive features

  • Steps

    • Imitation phase​

    • Spontaneous production phase

The Complexity Approach

  • Target selection method

  • Children who may benefit​

    • moderate to several phonological disorder

    • consistent phonological disorder

    • (children with phonemic structure difficulties are not good candidates)

  • Target sounds

    • Not in child's inventory

    • Not stimulable

    • Implicational universals

      • [s, ], [z, ], and [l, r] have priority​

      • presence of affricates predicts the presence of fricatives

      • presence of fricatives predicts the presence of stops

      • the presence of liquids predicts the presence of nasals

    • Later-developing sounds have priority

    • Can target one consonant cluster

      • cluster not in child's inventory​

      • the smallest sonority difference is demonstrated between consonants within a cluster

  • Nonwords are used

  • Probes used periodically 

  • Steps

    • Imitation phase​

    • Spontaneous production phase

Probe words: not being targeted in therapy, but contain the sound or sounds you are trying to also achieve as well as other sounds that were not in child's inventory

Cycles Phonological Remediation Approach

  • Purpose is to remediate unintelligible speech in children

  • No predetermined level of mastery for phonemes or patterns

  • Used to stimulate the emergence of a sound or pattern, not mastery

  • Children who may benefit

    • highly unintelligible​

    • severe to profound on the Hodson Assessment of Phonological Processes-Revised

  • Targets

    • presence and frequency of phonological processes​

    • phonological process must be present 40% of the time

      • glides and nasals must show deficiency level of at least 60%​

    • primary and secondary targets

  • Each phoneme in a pattern is targeted for 60 minutes per cycle

  • At least two exemplars of the goal pattern should be presented in two consecutive 60 minute time intervals before moving to the next phoneme or pattern

  • Steps of each therapy session

    • Review preceding session's word cards

    • Auditory bombardment

    • Target word cards

    • Production practice through experiential play

    • Stimulability probes

    • Auditory bombardment

    • Home program - 2 minutes per day 

The Core Vocabulary Approach

  • For children with inconsistent speech disorder

  • Most severe speech problems

  • Primary goal is to stabilize productions

    • it does not need to be an error-free production​

  • 50-70 functionally relevant words

    • and pictures to go with them

The Metaphon Approach

  • Based on metalinguistic awareness

  • Children with phonological disorders generally do not perform as well as typically developing children on different metaphonolgical tasks

  • Children who may benefit

    • very restricted phonetic inventories​

    • unusual or idiosyncratic processes

    • at least two or three processes that predominate their speech patterns

    • moderate to severe phonological disorders

  • Targets

    • should not be the same as the ones seen in typically developing same age peers

    • inconsistent use of a simplifying process should be given priority

    • the effect of the phonological process on intelligibility

    • sounds that are not in inventory but can be imitated

  • Steps

    • Phase 1 Therapy: Developing Phonological Awareness​

      • concept level​

      • sound level

      • phoneme level

      • word level

    • Phase 2 Therapy: Developing Phonological and Communicative Awareness

Metalinguistic awareness: the ability to think about and reflect on the nature of language and the way it functions.

Metaphonology: the ability to pay attention to and reflect on the phonological structure of language

Speech Sound Disorder with Concurrent Language Problems

  • Estimated 35% - 60% co-occurrence rate

Connecting Phonology to Morphosyntax: Morphosyntax Intervention

  • Children with specific language impairment (SLI) use grammatical morphemes less frequently

    • such as plurals, regular and irregular past tense, possessives, third-person singular, and copula/auxiliary sentence forms​

      • these often result in final consonant clusters, so attention must be given to final consonants and clusters​​

  • If goal is to eliminate final consonant deletion, words that incorporate specific grammatical morphemes in contrasting word pairs can be chosen

  • If goal is to reduce consonant cluster reduction or deletion, contrastive word pairs that incorporate grammatical morphemes in a word-final VCC structure can be chosen

  • In sentences, minimal pair words can be used to represent other grammatical morphemes

Connecting Phonology to Semantics: Vocabulary Intervention

  • Often children with language impairment are slow in using their first words and therefore vocabulary development occurs at a slower rate than typically developing children

  • Verbs and verb-related grammatical properties can be a particular problem for children with language impairments

    • verbs can be chosen in minimal pairs​

The Child with an Emerging Phonological System: Expanding the System and Vocabulary

  • Develop expressive language skills

    • expand the number of vocabulary items​

    • expand the consonant inventory

    • expand the syllable shapes

    • use two-word utterances

Treatment of Multiple Vowel Errors

The Child with a Very Limited Vowel Inventory: Therapeutic Suggestions

  • Characterized by only two or three vowels

    • lax and non-high​

  • Can use one known and one unknown vowel in minimal pairs

    • or two unknown vowels in minimal pairs​

The Child with a High Proportion of Vowel Substitutions: Therapeutic Suggestions

  • Relatively intact vowel inventory, but vowel substitutions

  • Error pattern analysis helpful

  • Contrasts the target vowel with the substituted vowel in minimal pairs

    • or multiple oppositions approach​

Bauman-Wängler, J. A. (2020). Articulation and phonology in speech sound disorders: a clinical focus (6th ed.). Hoboken: Pearson Education.

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