■SPECIFIC
TREATMENT
PROGRAMS
AND
APPROACHES
(chapter 8)
I. INTRODUCTION**
■ Intervention for speech sound disorders is very
exciting
■ There is nothing in the world like the feeling you
get when a child first says a sound correctly!!
These are ideas I use as an SLP in my job in the
schools:
Using classroom language arts books for
therapy—helps us help kids achieve Common
Core State Standards:
According to our text ch. 8:**
■ Most tx approaches move from a simple to complex level of training
(except the concurrent approach)
■ Some approaches do contradict each other (e.g., start w/
stimulable vs. nonstimulable sounds)
The point is to remain flexible…**
■ And do what is best for
each individual client
Non-Speech Oral-Motor Exercises**
■ PBH do not believe that oral motor exercises
are beneficial for anybody
■ They say research has not proven that oral
motor exercises help
■ Roseberry’s position: these exercises are very
helpful for children with oral motor problems
■ **Kent, R.D. (2015 November ). Nonspeech oral motor
movements and disorders: A narrative review. American
Journal of Speech-Language Pathology.
■ He said that NSOMMs can be part of practice in orofacial
myology
■ Can be used with persons with dysarthria and dysphagia
■ Don’t just reject NSOMMs wholesale
II. TRADITIONAL APPROACH (Van
Riper)**
■ Around since 1920s
■ Still popular and widely-used today
■ However, most SLPs really don’t do ear training any more (info on ear
training on p. 402 is not on exam)
A. Production Training: Sound
Establishment
B. Production Training: Sound Stabilization**
■ Stage 6 Conversation
■ ↑
■ Stage 5 Sentences
■ ↑
■ Stage 4 Phrases
■ ↑
■ Stage 3 Words
■ ↑
■ Stage 2 Nonsense syllables
■ ↑
■ Stage 1 Isolation
■ 1. Isolation—use variety of fun activities** (p. 404 has some)
■ 2. Nonsense syllables —I don’t really use these
■ 3. Words —begin with words that are meaningful to the child. I work on
sounds:
■ 1.word-initial
■ 2. word-final
■ 3. word-medial
■ 4. Clusters
For example, with /s/:**
■ Begin with soup, see, sun (word-initial)
■ Next: bus, face, piece (word-final)
■ Then: Classes, lesson (word-medial)
■ Last: Crust, stop, faster (clusters)
■ **4. Phrases – in-between stage—carrier phrases common—e.g.:
■ I see ____
■ This is___
■ 5. Sentences – various length and complexity (examples bottom of p.
405)
To establish sound in sentences:
■ 6. Conversation**
■ Start with structured conv.—e.g., SLP gives a topic or specific pictures to
talk about
■ Transition to natural conv.—open ended. E.g., “Tell me what costume
you wore for Halloween.’
C. Transfer and Carryover**
■ Vary the audience and settings
■ Speech assignments
■ In small groups—what are some practical strategies for implementing
these ideas in a school setting?
D. Maintenance
III. CONCURRENT APPROACH
(lecture notes only—not text)**
■ Said SLPs don’t have to use hierarchy we just described
■ First establish sound in isolation and CV, VC combos—80%
accuracy
■ Then,
mix it up in tx!
CSHA Dr. Steve Skelton
For example, in one
session:**
■ 1. /r/ in final position of words
■ 2. /r/ in VC combos
■ 3. /r/ in sentences in word-initial position
■ 4. /r/ in word-medial position in phrases
Dr. Skelton: ACTIVITIES AND IDEAS FOR
ELICITING AT LEAST 150 PRODUCTIONS
PER GROUP SESSION
■ Post charts  individual/group competition**
■ Create stations--students do something different every minute or so while
practicing sounds
■ E.g., one ch on whiteboard, one putting puzzle together, one lying on floor,
one using flashcards at table
■ E.g., “Say /r/ 10 times by itself while you are doing jumping jacks.”**
■ “Say at least 3 sentences with /s/ while you draw a picture on the
whiteboard.”
■ “Say ‘the’ while you are doing hopscotch”
■ Echo microphone**
■ Puppets, costumes
■ Roll a dice or draw number from envelope to determine how many
productions they have to make
OTHER IDEAS FOR CENTERS**
■ Read books or stories with target sound
■ Hula hoops
■ Jump rope
IV. PHONOLOGICAL
CONTRAST APPROACHES**
■ A. Introduction
■ These approaches have become popular and are supported by
research
■ B. Minimal contrast training**
■ use minimal pairs which only differ by one
feature such as
– voicing (to-do, pan-ban)
– Place of articulation (tea-key)
C. Maximal contrast training
I really like contrast training
because:
V. COMPLEXITY APPROACH (Lecture
only, not book)**
■ Most research done with individual children in a
university setting (not tried in schools w/ diverse
groups)
■ Best for ch with individual sound errors (e.g., w/r; j/l)
■ Assumes that the complex sounds are affricates,
fricatives, and clusters and sounds that are not
stimulable
■ Also assumes that later-developing sounds (e.g., /tʃ/,
/r/ ) are more complex than earlier-developing
sounds (e.g., /m/ and /p/)
Premise:
VI. HODSON’S CYCLES APPROACH
(emphasized on exam!)**
■ A. Introduction
■ General Procedures
1. Stimulation—use of auditory, tactile, visual cues to ↑awareness
of target sounds
2. Production training —produce correct sound
3. Semantic awareness contrasts —minimal pair training
■ Remediation program planned around a cycle**
■ Cycle: time period required for child to focus on each
deficient phonological pattern for 2-6 hours
■ Pattern = phonological process
■ Focuses on teaching stimulable sounds
■ Early on, stick to simple CVC words
B. Selection of Target Patterns and
Phonemes**
■ Top Priority:
■ 1. Early-developing phonological patterns:
■ Initial and final consonant deletion of stops, nasals, and
glides
■ CVC and VCV word structures
■ Posterior-anterior contrasts (k-g, t-d, h)
■ /s/ clusters--word initial clusters /sp, st, sm, sn, sk/ and
word-final clusters /ts, ps, ks/
■ Liquids /r/ and /l/ and clusters containing these liquids
In order to move onto secondary patterns
(next slide), the child must demo:**
■ Appropriate syllableness
■ Production of single consonants
■ Some emergence of velars and /s/ clusters
■ Productions of practice words with /l/ and /r/ without gliding (no
w/r or j/l)
2. Secondary Patterns (for later—see
criteria bottom of p. 414)
C. Structure of Remediation Cycles**
■ 1. Train each phoneme exemplar within a target pattern for 60
min per cycle before going to the next phoneme
■ 2. Train 2 or more target phonemes in successive weeks within
a pattern before changing to the next target pattern
■ (2+ hours on each pattern within a cycle)
■ **
Final cons. Del.
Fronting
Cluster
reduction
D. Structure of Therapy Sessions
■ 1
E. Home Program**
■ Caretakers are asked to read the
12-item word list once a day.
■ Child is asked to name the 3-5
pictures once a day (may also
produce other target words)
VII. NATURALISTIC
APPROACH**
■ A. Introduction
■ Focuses on improving child’s overall intelligibility and wholeword accuracy first, then works on individual phonemes in
error
■ For severely involved children like preschoolers, those with
Down Syndrome, autism spectrum disorder, cerebral palsy
■ Approximations of sounds OK
This is what DJ and I do a lot in our
preschool SDC at Grand Oaks Elementary
Work in the child’s natural
settings—and have fun!**
■ Establish word and sound approximations so listener
understands ch better
■ Use natural recasts —corrective feedback given in naturalistic
fashion—correct model given without ch being interrupted and
asked to repeat
Working outside with RJ….
Speech recast:
Example of a speech recast I just did
with 3-yr old Brandon (Down
Syndrome):**
■ Brandon (pointing to Candyland card): “u!!”
■ Dr. R.: “That’s right, Brandon! Yay!  That is blue.”
■ Brandon (Dr. R’s lucky day): “b-u!” (A CV combination with lip
rounding and everything!!)
VIII. CORE VOCABULARY APPROACH (a fave
)**
■ A. Introduction
■ Designed for the 10% of children with functional SSDs
characterized by inconsistent errors on the same words
■ These children don’t have childhood apraxia of speech
■ Been used with 2-year olds, bilingual children, Down
Syndrome
Inconsistent SSD: assess child’s multiple productions
of the same word in the same phonetic context**
For example: (25 different pictures on 3 separate
trials within one session)
■ 1. Child is asked to produce “cat”
■ 2. Activity
■ 3. Asked to produce “cat”
■ 4. Activity
■ 5. Asked to produce “cat”
Scoring:
B. Structure of Intervention
I love it!!
IX. Language Treatment for
Phonological Disorders--PBH**
■ PBH: research is inconclusive re: the question: Can
language therapy improve children’s speech skills?
■ Bottom line: If the child has a language and
speech disorder, best to do both language and
speech therapy simultaneously.
■ In other words, don’t just do language therapy and
hope that somehow better speech sound
production will magically improve follow 
X. Combining Therapy for
Language and Speech Sound
Disorders**
■ We can connect speech sound production to children’s
morphosyntactic skills
■ If children have final consonant deletion or cluster reduction, they
will have problems with some morphemes
Ann Tyler—ASHA 2015 (The phonologymorphology interface in children with SSD:
Development, assessment, and treatment
considerations.**
■ Concomitant SSD and language impairment (LI) is the strongest
predictor of literacy outcomes
■ Children with both SSD and LI have many omissions, while children with
just SSD have many more substitutions
Tyler 2015:
Tyler 2015:
Speech
Language
These morphemes include:**
■ Past tense –ed (jumped, scared)
■ Plural –s (pots, sidewalks)
■ Regular 3rd person –s (eats, runs)
■ Possessive –s (Grant’s, Bob’s)
Therapy suggestions:
For example (FCD):**
■ Plurals: toe-toes
key-keys
■ Possessives: Joe-Joe’s
Ray-Ray’s
■ Regular past tense –ed
showed
show-
If the child uses cluster
reduction:**
■ Plurals
boat-boats cup-cups
■ Possessives
cat-cat’s
Dad-Dad’s
■ Regular past
walk-walked
■ Irregular past
drink-drank hold-held
We can also connect phonology
to semantics:**
■ Children with language impairments often have
difficulty with verbs
■ For velar fronting:
tame-came; taught-caught
■ Stopping of fricatives: tee-see, toe-sew, tip-ship
■ Final consonant deletion: shoe-shoot, ray-rake;
say-sail