How can we remediate speech sound disorders quickly?
Our primary goal in articulation therapy is to correct speech sound errors as quickly and efficiently as possible. Children who fail to communicate clearly are at risk for increased anxiety, social and emotional challenges, and stigmatization. Additionally, difficulties with speech sound perception may impact a child’s ability to read. Approximately 25% of children with a speech sound disorder will also have a reading disability. (Tambyraja, 2020) When children can speak clearly, they are more likely to succeed both academically and socially.
Phonological Disorders
Phonological speech sound disorders involve difficulties in organizing and using speech sounds. Children with phonological disorders continue to exhibit patterns of speech production that usually disappear at younger ages. For example, when learning to speak, children will often delete the final consonant in words (e.g. “cat” produced as “ca”). While this pattern is typical for children up to age 3, we may become concerned if we observe it at age 4 or 5. Other phonological processes include “cluster reduction” [in which sounds in a consonant cluster are deleted (e.g. “side” for “slide”)] and “gliding” [in which sounds are replaced by a “w” or “y” (e.g. “wabbit” for “rabbit”)]. As children grow older, these phonological processes usually subside, and speech is generally almost 100% intelligible at 4 years of age.
Traditional Therapy
Traditional articulation therapy involves selecting speech sounds and training the child to produce them in isolation, in words, in phrases and sentences, and finally in connected speech. This is the oldest model of articulation therapy, and it is effective. We begin with the earliest developing sounds, which may be easier to produce, and work up the ladder towards more difficult sounds. However, when determining the best way to correct speech sound disorders efficiently, it’s helpful to think outside the box.
The Complexity Approach
One of the therapeutic strategies I have found most effective is referred to as the “complexity approach.” Unlike traditional articulation therapy, the complexity approach involves choosing the most difficult sounds, placing them in the most challenging positions in words and asking the child to produce them in linguistically complex sentences. (Vess, 2021, p. 62) The more challenging the sound combinations, the better the outcome.
The “r” sound is typically mastered at around age 5 and is one of the most difficult sounds to produce. The “s” in consonant clusters (e.g. “slip,” “smile”) is also difficult to vocalize and is typically mastered at around age 5 or later. I usually target these sounds when using the complexity approach. However, many of my clients produce speech that is highly unintelligible. They struggle to produce sounds that are easier to articulate, like “k” and “g.” Does it make sense to train them to produce the most difficult sounds in the most challenging combinations? According to the available research, the complexity approach is a highly effective treatment, even for children like these with severe speech sound disorders (Williams, 2021), including those who have autism or developmental language disorders. My personal experience aligns with these findings.
Cueing for Success
“Cueing” is a set of techniques that we use to remind children how to say a target word. In order to treat children using the complexity approach, we need to provide a very high level of cueing and support. We model words using slow, stretched speech, and we employ extensive gestural and visual cues. This gives children the time to adequately hear each sound, and the associated visual supports allow the brain to process the sound through various modalities. I select challenging consonant clusters (e.g., “skr” in “scrape”) and train my clients by using linguistically complex sentences (“can you scrape, spray or drop it to me please?”). (Vess, 2021, p. 57)
Outcomes
The complexity approach has significantly improved outcomes for my students. After they are exposed to this method, they typically progress in their ability to produce target sounds, and I have observed systemic changes in their speech production. For example, I recently trained a child to say “scrape” in a complex sentence, and this resulted in a generalized change in her speech system. She is now able to produce “sh,” “ch” and other sounds as well, even though we did not directly target them in therapy.
When considering articulation treatment styles, especially for children whose speech is highly unintelligible, it’s best to embrace approaches that are research and evidence-based, even though they may be novel. In my experience, the complexity approach is an effective treatment that can substantially decrease the duration of therapy.