I needed to up my articulation therapy game...
Since grad school (a very long time ago), I've used a slightly evolving set of articulation therapy techniques.
Over the years, my ability to elicit speech sounds, keep kids engaged and motivated, and pivot when things aren't working has developed and improved but, like so many other SLPs, I've leaned heavily on traditional articulation therapy techniques, à la Van Riper. It's logical and predictable and there are so many materials out there to support it. Super Duper's Jumbo Artic book, anyone?
I've also peppered in some Cycles ideas, some minimal pair work, some self-monitoring, some reading/spelling, etc. -- a real pot-pourri of artic therapy! I'm pretty sure this will be familiar to many of you reading this.
I really enjoyed this episode of the See Hear Speak podcast, my absolute favorite SLP podcast, where Drs. Kelly Farquharson, Katy Cabbage, and Shari Deveney talked about speech sound disorders (SSDs) and various treatment approaches. I especially appreciated how open they were about the fact that learning how to treat SSDs evolves as the research does, and how they acknowledged that all SLPs will make mistakes in our SSD treatment at some point!
As with so much in our field, we just have to keep learning and trying. There is no one-size-fits all approach that'll work with all kids. We need to have a variety of tools at our disposal and the ability to discern when (and when not) to use them.
So, in the spirit of adding to the ol' tool kit, especially for my kiddos with multiple speech sound errors, I'm sharing my takeaways from a Tutorial by Holly Storkel that came out in July, 2022, in the Language, Speech, and Hearing Services in Schools journal about contrastive intervention approaches for kids with SSDs (reference below).
CONTRASTIVE INTERVENTION APPROACHES for SSDs
The key to contrastive approaches is that they use minimal pairs to "spark" phonological learning. This is done by highlighting the way that correct articulation of specific parts of words can cause a change in meaning. For example, I currently have a student who is substituting /θ/ for/s/, so I could contrast these sounds by using the minimal pair MOUTH versus MOUSE to highlight how my student's correct articulation of /s/ results in my being able to understand him as meaning the rodent, rather than the body part, when he produces /s/ correctly.
Holly Storkel's tutorial describes three types of contrastive approaches: minimal, maximal, and multiple. They've been found to accelerate kids' progress in speech therapy (yes please).
Here's a description of each approach below, plus a tool I'm going to start using to help me implement them more easily:
Minimal Pair/Minimal Oppositions Approach
While there is no comprehensive formula for how to use this approach, the main idea is that you choose minimal pairs that highlight the sound the child needs to learn to produce and the sound they are producing instead, and then create situations where communicative breakdowns occur.
While this was not mentioned in the tutorial, I've had great success implementing this approach by playing Go Fish with minimal pair cards. Using the error pattern example from above, my student will say, "Do you have MOUTH?" when he really means MOUSE. I'll give him the MOUTH card, which creates a moment of confusion, followed by insight (that phonological "spark" Storkel mentioned), followed by a real effort to produce the sound correctly. This is SLP GOLD right here, because it's so concrete and meaningful for the student!
Other aspects of this approach, including sound selection and how to support the student in correcting the error, is left up to the SLP.
Storkel adds that this approach is best suited for students with fewer error patterns, since the focus is on one sound class or phonological process at a time.
Maximal Oppositions Approach
The main idea of this approach, developed by Judith Gierut, is that you use minimal pairs with target sounds that differ more significantly, or maximally, from each other, as a means to teach kids with SSDs both how to articulate needed sounds and to "highlight the diversity of the phonological system."
You can use minimal pairs where kids cannot produce either key sound in the minimal pair (known as "treatment of the empty set"), or you can also choose one sound the child can say and one they can't (similar the minimal pair/minimal oppositions approach) in the minimal pair.
Target sound selection is more technical and draws on details I first learned in my Phonology class during my undergrad in Linguistics about "distinctive features," which are based on place, voice and manner of articulation (don't panic).
Here is a link to a chart that illustrates these features for sounds in English. The idea is that the sounds you choose to target in your minimal pairs must differ in a more significant, or maximal, way, i.e., one sonorant and one obstruent (again, don't panic!).
So my example earlier of MOUTH and MOUSE does not contain a maximally opposed minimal pair, because /θ/ and /s/ are both voiceless fricatives and only differ by the place of articulation feature.
I'll confess to you that, at this point in the tutorial, I panicked and felt a powerful urge to go make myself a procrastination snack and to do some deep breathing...
There's a video made by Storkel to guide you through the process of choosing target sounds here. While it is helpful, I also found it a bit overwhelming.
But I found a few hacks (didn't I tell you not to panic?):
Caroline Bowen's site has minimal pair images for maximal oppositions for the following sounds: /m/, /n/, /dʒ/, /b/, /w/, /d/, /p/, /h/, /t/, /k/, /g/, /r/.
And I was pretty pleased to find this app, called SCIP, that facilitates choosing target sounds and implementing ALL of these contrastive approaches. It has summaries of the treatment approaches, assists you in choosing your target sounds for each approach, and has corresponding, kid-friendly pictures for all of the minimal pairs it generates. It cost $59.99 (USD), which is super not cheap, but I like it so far, and it has already proven to be a time-saver.
Multiple Oppositions Approach
This approach is for kids with moderate-to-severe SSDs, with something called a "global phoneme collapse." This is the speech nerd way of saying that the child is substituting one sound for a lot of different sounds. For example, we've probably all seen a kiddo who uses /d/ (or /f/ or /n/, etc.) for many different sounds. When kids do this, their intelligibility really suffers because so many words end up sounding the same.
You implement the multiple oppositions approach by targeting sounds in the phoneme collapse, along with the sound they're using as a substitute, in minimal triplets or quadruplets (i.e., groups of three or four words that differ only by the target sounds). You're supposed to choose sounds in your quadruplets by "maximal classification" (sounds that "represent the breadth of the collapse", including singletons versus clusters, as well as place, voicing, and manner features) and "maximal distinction" (sounds that are as different as possible from each other, like in the maximal oppositions approach).
Again, I intend to use the SCIP app (linked above) to help me in choosing sounds and implementing this approach, because who has time to figure this all out each time we start working with a new kiddo like this?
So... we'll see how it goes. I'm glad to have learned more about these approaches and am pleased to have some new ideas and tools in my toolkit. I really like the concept of the "phonological spark" and will aim to create more of them during my artic therapy.
But, as we all know, an exuberant 6 year-old can defy even the most thought-out, evidence-based activities! It can be hard implementing this stuff IRL.
Comment below if you'd like to share any personal experiences with these treatment approaches. I'd love to hear!
Storkel HL. Minimal, Maximal, or Multiple: Which Contrastive Intervention Approach to Use With Children With Speech Sound Disorders? Lang Speech Hear Serv Sch. 2022 Jul 6;53(3):632-645.
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