Speech Therapy -> Phonology


Phonology can be described as an aspect of language that deals with rules for the structure and sequencing of speech sounds. A phonological disorder may be characterized as a child who has numerous phoneme errors that can usually be grouped into categories (phonological processes), and they are usually not linked to oral motor difficulties and/or normal development.

Skilled interventions

  • Chaining Therapy Approach

    Chaining therapy approach is a procedure used by the SLP to elicit consonants in pre, post, and intervocalic contexts using functional phrase combinations.

    Chaining therapy approach was designed for unintelligible patients who persist in the use of open syllables (pick up = “pi uh” and wash it = “wa ih”. The approach attempts to achieve syllable closure and improve syllable shapes by linking syllables and/or words together using overlapping, coarticulatory ballistic movements. Emphasis is on teaching transitions between sounds rather than on teaching the specific sounds.

    Example: “Wash out” teach as “wa-shout’ and show the patient a picture of “shout. “Wake up” teach as “we-cup” and show the patient a picture of “cup” (Johnson & Hood, 1988).

  • Co-articulation Therapy Approach

    Co-articulation therapy approach: SLP creates strings of syllables called 'Coarticulation Runs'. Coarticulation methods include coarticulation runs and awareness of vCv and vCvCv levels.

    1) The syllable is the unit of production.
    2) The phrase is the unit of communication.
    3) The phrase is built up a syllable at a time to a length of 5 syllables.
    4) Initially the phrase is begun using the pronoun “I” plus the first CV syllable of an action word. This happens after the target phoneme is elicited in strings of CV syllables.
    5) Strings of CV syllables contain parts of several words.
    6) The beginning and ending consonants of all words are blended into the adjacent vowel. This is very important as prosody is taught and their coarticulatory effects are felt across word boundaries.
    7) Drill is effective. It’s the content of the drill that is important. Each syllabic unit that is presented is controlled and serves a specific purpose.
    8) Each new length of syllables is repeated 3-5 times. 100% accuracy is needed to add a new syllable. If there is an error then that segment is pulled out and practiced. If 100% accuracy is achieved it is then reinserted in the string and therapy moves on. The target phrase is then put into functional use. The patient is praised for each production and achieves a sense of accomplishment. If the patient is too young for drill then a short phrase containing a specific syllabic sequence could be modeled for the patient during language therapy. Length of utterance is controlled.
    9) Ideally the presentations by the therapist and the productions of the patient are produced in a turn taking manner with new instructions given if needed. The therapist should have a predetermined sequence with a final target in mind.

    (Siegelman, 2008)

  • Contrast Approach

    Contrast approach is a cognitive-linguistic approach to articulation and phonology that the SLP incorporates word pairs with phonemic differences in the target sounds. It is used to teach the idea that a contrast in sound signals a contrast in meaning (Hodson & Paden, 1983; Pena-Brooks & Hegde 2007).

    • Minimal Pair Contrast Method

      This cognitive-linguistic approach is a therapeutic use of pairs of words that differ by one phoneme only. Minimal pairs are use to establish contrast not present in the patient's phonological system.

      1) Write minimal contrast word pairs. Example; FCD boat-bow, tee-teeth, and bead-bee or Fronting can-tan, key-tea, and gate-date.
      2) Have picture stimuli for words in selected pairs.
      3) Model the target and the contrast word to the patient.
      4) Extensive trials on the imitative production of the target and contrast word.
      5) Patient names the picture pairs and SLP IDs the production picture

      (Weiner, 1981)

  • Cycles Approach

    Cycles approach is a phonological pattern approach the SLP designs to treat patients with multiple misarticulations and highly unintelligible speech. The approach consists of treatment cycles that vary between 5 weeks and 16 weeks which include auditory stimulation and production practices.

    Method: Arrange a hierarchy of stimulable phonological patterns that occur in at least 40% of the relevant contexts. Treat the most stimulable pattern first, then next most stimulable pattern, and so on. Target only one pattern in any single session. Treat each phoneme within a target pattern for about 60 minutes per cycle (1-60 minutes, 2-30 minutes, 3-20 minutes) before moving to other phonemes within the pattern or to other patterns. Review the prior weeks’ production practice words cards but skip this step if you are introducing a new pattern for treatment. Begin treatment with auditory bombardment of a selected 12 word list. Use five production-practice word cards.

    Begin production practice:

    1) Ask the client to name about five target pictures.
    2) Model the target word; use auditory, tactual, and visual cues
    3) engage the client in conversation or use a game format.
    4) Probe for stimulability of the next session’s target sounds.
    5) Repeat the auditory bombardment; present the same 12 words as before.
    6) Ask the family to read the same 12 word list to the patient and ask the patient to name the 5 picture cards used in the production practice.
    7) Recycle a pattern that persists in conversation.

    (Hodson & Paden, 1983)

  • Distinctive Features Approach

    Distinctive feature approach is used by the SLP after a distinctive feature analysis of the patient’s speech errors is completed. The goal of the approach is to establish missing distinctive features and assumes that teaching a feature in the context of a few sounds will result in generalized production of other sounds with the same feature. Distinctive features are place, manner, and voicing of sounds. Distinctive features are place, manner, and voicing of sounds. After completing a distinctive feature analysis the SLP selects a specific distinctive feature.

    For example: a patient might make the following errors: pan/fan, base/vase, toap/soap and tun/sun. The target sounds for which the patient substituted other sounds all share a common feature: stridency. The SLP might begin by teaching /f/ in hopes that the feature of stridency would generalize to /v/ and /s/ without direct training of /v/ and /s/. SLPs use DFA to try to find the patient’s underlying patters and then train one or several sounds in that pattern. SLP can use minimal pair words. More research is needed to fully support the DFA; currently, it is not widely used by SLPs (McReynolds & Bennett, 1972; Pena-Brooks & Hegde, 2007, Costello & Onstein, 1976, Ruder & Bunce, 1981).

    • Maximal Opposition Contrast Therapy

      A therapy method using the concept of distinctive features in which the SLP chooses word pairs that have target sounds that are most different. Differences vary along two dimensions:

      1) The number of unique features that differentiate between the two phonemes and
      2) The nature of the features; major or nonmajor class features. This is similar to minimal opposition contrast therapy in that minimal word pairs are used as the beginning unit of training. However, target sounds are selected by having the most number of differences in production features and you choose two sounds that are NOT in the patient's inventory. The SLP works through the selection process of sounds present and not present in the patient's inventory, and you identify the major class difference. If a patient does not have /r,l,k,g,s,z/ 2 appropriate target phonemes would be /l/ and /k/ and you would create minimal pairs such as: lane-cane, leg-keg, and lamp-camp.

      1) Discussion of words
      2) Discrimination testing/training
      3) Imitation/Production Phase
      4) Carryover Training

      (Gierut, 1989)

    • Minimal Opposition Contrast Therapy

      A therapy method using the concept of distinctive features in which the SLP chooses word pairs that have target sounds that differ by one feature. Differences vary along two dimensions:
      1) The number of unique features that differentiate between the two phonemes and
      2) The nature of the features; major or nonmajor class features.

      This approach is most appropriate for clients who are stimulable for the target sound.

      How to choose target sounds:
      1) Norm production and substitution(s) are analyzed.
      2) Place, manner, and voicing features for both the target sound and substitution are considered and counted. For example: patient has f/v and d/v substitutions: f/v differ in voicing and d/v differ in manner and place.
      3) The sound substitutions chosen should reflect the least number of differences in production features. Therefore, be f/v since they have only 1 production feature difference.
      4) Age of the patient and developmental level of patient’s phonemic system. Example: t/s and p/b substitutions represent differences of one production feature. However, /b/ is earlier than /s/ so p/b contrast is the better choice.
      5) Sound substitutions that affect the patient’s intelligibility most should have priority over those with little negative effect. This choice is primarily related to the frequency of occurrence of the two sounds.
      6) Stimulable sounds have priority over those that are not stimulable. Example: 5:6 substitutions: w/r, th/s, th/z, d/j, t/ch, w/sh. Best selection of target sounds would be /th/ and /s/. Word choices are think-sink, thing-sing, or sick-thick. SLP can also use near-minimal pairs (words that differ by more than one phoneme and the vowel preceding or following the target sound remain constant in both words) sir-third, thorn-sore.

      1) Discussion of words
      2) Discrimination testing/training
      3) Imitation/Production Training
      4) Carryover Training

      (Gierut, 1989)

  • Focused Auditory Input

    Focused auditory input is a procedure for very young children where the SLP designs the environment to provide lots of opportunity for the child to hear the target sound or patterns. Focused auditory input is a procedure that is intended for very young children who are unwilling or unable to produce targets when we first begin therapy. No production is demanded but the SLP designs the environment to provide for lots of opportunity for the child to hear the target sound or pattern (Hodson & Paden 1991).

  • Focused Auditory Stimulation

    Focused auditory stimulation is a procedure in which the SLP provides the patient with intensified, repeated, systematic exposure to multiple exemplars of phonological targets and contrasts. Focused auditory stimulation is a procedure where the patient listens to targets words at the beginning and end of every session. (used to be called auditory bombardment) (Hodson & Paden 1983).

  • Metaphon Therapy Approach

    Metaphon therapy approach is based on metalinguistic awareness and the SLP designs treatment sessions to enhance the patient’s metaphonological skills. Metaphon therapy assumes the patient’s difficulties are not with the actual motor production of speech sounds but in the acquisition of the rules of the phonological system. SLP operates from the premise that the best way to help the patient improve their rules systems is to give them information that will encourage them to make their own changes and thus sound more intelligible. Use with preschool children who have moderate to severe phonological disorders.

    Method: Develop awareness that sounds can be classified by characteristics such as place (front-back), duration (long-short), and others. Example activities: Play games where patient matches long and short ribbons to exemplify long and short sounds; place a block at the front or back of a dollhouse (to exemplify front and back sounds); play train game with engine, middle car, and caboose to signify beginning, middle, and end sounds in words. For FCD, Show picture of a cat, patient says “ca” you say “I heard the engine and the middle train car, but the caboose was left out. Can you say word again with the caboose too?” (Bankson & Bernthal, 2004, Howell & Dean, 1994).

  • Multiple Opposition Approach

    Multiple Opposition Approach is a procedure where the SLP uses minimal word pairs to target errors simultaneously and is for patient’s who substitute a single sound for several sounds. Multiple Opposition Approach is a procedure where the SLP uses minimal word pairs to target errors simultaneously and is for patient’s who substitute a single sound for several sounds. This procedure uses minimal word pairs, but the pairs are created to treat all or most of the errors simultaneously. Use this approach for patients who substitute a single sound for several sounds.

    For example: a patient who substitutes /t/ for /s, k, ch, tr/ will substitute a singe words such as tip for multiple words-sip, kip, chip and trip. Method: Create multiple sets of minimal pairs (tip-kip, tip-chip) and teach the contrasts simultaneously (Hedge, 2008, Williams 2000).

  • Paired-Stimuli Approach (PSA)

    Paired Stimulation Approach (PSA) is based on principles of operant reinforcement contingencies and depends on identifying a key word in which a target sound appears once, in either initial or final position, and is produced correctly 9/10 times. Key words are used to teach the production of sounds in other contexts. Pictures are used to evoke the target words. A single speech sound is targeted at any one time, as opposed to approaches that target multiple speech sounds simultaneously.

    1) Select target sound for instruction (e.g., /r/)
    2) Find/create 4 key words (rock, run, red, rain).
    3) Select 10 training words in which target sound is misarticulated and the sound appears only once in the same position as the key word.
    4) Select pictures as stimuli to evoke the word productions
    5) Put the first key word in initial position in the center and arrange the 10 training words (pictures) around it; this is known as a training string.
    6) Instruct the patient to say the key word, name one of the target words, and say the key again (ring-rock-ring)
    7) Patient names another target word; alternate the key word and all training words in this manner.
    8) Include 3 training strings in each session
    9) Reinforce correct productions and adhere to a training criterion of 8-10 correct productions of the training words in 2 successive training strings without reinforcement.

    Note: Word level training would be followed by training at the sentence and conversational levels. PSA is effective because it usually builds on behaviors already in the patient's repertoire, takes little time to teach, and practices sound in a variety of phonetic contexts (Irwin & Weston, 1975).

  • Phonological Process Approach

    Phonological process approach focuses on targeting the elimination of phonological processes, rather than one sound at a time. This is used by the SLP when a patient presents with multiple sound errors that can be grouped into characteristics/patterns. Phonological Process Approach: Method: Select phonological process for elimination through teaching specific sounds or groups of sounds. Identify all phonemes that are misarticulated within a process (example: FCD) Teach only a few final consonants. Use any effective procedure to teach the consonants. Use the comprehensive treatment approach of modeling, shaping, manual guidance, positive reinforcement, and corrective feedback (Pena-Brooks & Hedge, 2007).

Reference links

  • Red Flags For Speech-Language Impairment In Bilingual Children 1
    Author: Scott Prath On ASHA Wire - Red Flags for Speech-Language Impairment in Bilingual Children Differentiate disability from disorder by understanding common developmental milestones.
  • Bilingual Language Development Video 1
    Author: Kathy Kohnert - YouTube Video on Bilingual Language Development by Kathy Kohnert
  • Language Difference vs Language Disorder: Assessing English Learners 1
    Author: Carol Westby and Kimberly Murphy - Video available Language Difference vs Language Disorder: Assessing English Learners Carol Westby, Bilingual and Multicultural Services, Albuquerque, NM Kimberly Murphy (Host), Old Dominion UniversityFollow Document Type Presentation Publication Date 5-20-2020 Abstract To a large extent, determining whether an English learner has a language/learning disability is a process of elimination. There are no tests that can definitely tell us whether the student has a language/learning disability. Inappropriately identifying an EL student as having a language/learning disability can result in stigmatization or reduced access to academic content, but waiting too long to identify a student who truly has a language/learning disability can be the beginning or the extension of a cycle of communicative, academic, and/or social failure. Assessment of EL learners requires collaboration between classroom teachers and speech/language pathologists. This session will cover (1) factors that complicate the assessment of English learners; (2) multi-tiered systems of support (MTSS) and performance-based assessment; (3) process assessments, and (4) dynamic narrative assessment. Comments This professional development webinar was presented by Dr. Carol Westby for speech-language pathologists in Virginia. It was funded by the Virginia Department of Education and hosted by Dr. Kimberly Murphy, Old Dominion University.
  • Bilingual (English/Spanish) Therapy Materials By Bilinguistics 1
    Author: Bilinguistics - Downloads and resources for providing bilingual therapy (Spanish/English)
  • Nonword Repetition Tasks For Dynamic Assessment or Bilingual Evaluations 1
    Author: LeadersProject - Nonword Repetition Tasks (NWRT) can be used as a dynamic assessment as opposed to static assessment. NWRTs assess phonological working memory, speech perception, phonological assembly, and short term memory. These skills can have an impact on phonological awareness, word learning, and overall language acquisition. NWRTs are a useful tool to identify children/students with developmental language disorders because they are less culturally and linguistically biased than standardized language tests, as they do not call upon a child’s/student’s prior knowledge as many standardized tests do. Rather, NWRTs ask the child/student to repeat a series of nonwords of differing syllable length and complexity of sound combinations, thereby assessing linguistic abilities that have not been taught or learned previously. Nonword repetition tasks have been analyzed by number of consonants correct or number of items correct. There are different NWRTs for several languages, which contain phonemes specific for that particular language.
  • Evaluation of Bilingual Children- Considerations 1
    Author: Alejandro E. Brice and Roanne G. Brice - An overview of considerations when evaluating bilingual (Spanish/English) children
  • Bilingual (Spanish/English) Evaluation Resources 1
    Author: Bilinguistics - Dozens of speech, language, fluency, and other evaluation resources for bilingual evaluations
  • Language In Brief 1
    Author: The American Speech-Language-Hearing Association - Language is a rule-governed behavior. It is defined as the comprehension and/or use of a spoken (i.e., listening and speaking), written (i.e., reading and writing), and/or other communication symbol system (e.g., American Sign Language).
  • Tutorial: Speech Motor Chaining Treatment For School-Age Children With Speech Sound Disorders 0
    Author: Jonathan L. Preston, Megan C. Leece, and Jaclyn Stortoa - Operationalized treatments for school-age children with speech sound disorders may result in more replicable and evidence-based interventions. This tutorial describes Speech Motor Chaining (SMC) procedures, which are designed to build complex speech around core movements by incorporating several principles of motor learning. The procedures systematically manipulate factors such as feedback type and frequency, practice variability, and stimulus complexity based on the child’s performance.
  • Bilingual Service Delivery 1
    Author: ASHA - Information and resources regarding bilingual service delivery by SLPs (from ASHA)
  • Spanish Phonemic Inventory 1
    Author: ASHA - Spanish Phonemic Inventory and Facts about Spanish Phonemes by ASHA
  • Learning Two Languages: Bilingualism 1
    Author: ASHA - Information and resources for SLPs and parents of bilingual children
  • Multilingual, Multicultural, Bilingual Resource Link For SLPs 1
    Author: ASHA - Link includes ASHA resources and information related to evaluation and treatment of clients from linguistically and culturally diverse backgrounds. Link includes ASHA resources to: Accent Modification Bilingual Service Delivery Collaborating With Interpreters, Transliterators, and Translators Cultural Competence Voice and Communication Services for Transgender and Gender Diverse Populations Dynamic Assessment Micro Course Cultural Competence Self Assessment Phonemic Inventories and Cultural and Linguistic Information Across Languages Collaboration With Interpreters: Securing Positive Outcomes Practical Assessment and Treatment Strategies for English Language Learners with Language Impairments Serving Clients From Diverse Backgrounds: Speech-Language Difference vs. Disorder Langu Continuing the Dialogue on Dialect: Positive Steps Toward Less Biased Assessments of Children Who Speak African American Englishage and Identity--Shifting Away from a Deficit Perspective on African American English Información en español
  • The Link Between Language and Spelling: What Speech-Language Pathologists and Teachers Need to Know 3
    Author: Carol Moxam - SLPs have expertise in the key speech and language domains such as phonology, morphology, and semantics and are therefore well placed to play an important role in supporting learners in making links between these domains in relation to spelling development and intervention.
  • Articulation and Intelligibility Norms For Spanish and English 1
    Author: Bilinguistics - Articulation and Intelligibility Norms for Spanish and English by Bilinguistics
  • Speech Development In Spanish and English: What the Differences Mean to SLPs 1
    Author: Bilinguistics - Speech Development in Spanish and English: What the differences mean to SLPs by Bilinguistics
  • Prosodic Patterns In Children’s Multisyllabic Word Productions 2
    Author: Margaret M. Kehoe - This paper reviews results from a series of studies that examined the influence of metrical and segmental effects on English-speaking children’s multisyllabic word productions. Three different approaches (prosodic structure, trochaic template, and perceptual salience) that have been proposed in the literature to account for children’s prosodic patterns are presented and evaluated. An analysis of children’s truncation or syllable deletion patterns revealed the following robust findings: (a) Stressed and word-final unstressed syllables are preserved more frequently than nonfinal unstressed syllables, (b) word-internal unstressed syllables with obstruent onsets are preserved more frequently than word-internal syllables with sonorant onsets, (c) unstressed syllables with non-reduced vowels are preserved more frequently than unstressed syllables with reduced vowels, and (d) right-sided stressed syllables are preserved more frequently than left-sided stressed syllables. An analysis of children’s stress patterns revealed that children made greater numbers of stress errors in target words with irregular stress. Clinical implications of these findings are presented and additional studies that have applied a metrical approach to clinical populations are described.
  • School-Aged Children's Phonological Accuracy In Multisyllabic Words On a Whole-Word Metric 2
    Author: Glenda K. Mason - Phonological accuracy in MSW production was differentiated for elementary school–aged children with TD and PPD, using a whole-word metric. To assist with the identification of children with ongoing PPD, the metric has the ability to detect weaknesses and track progress in global MSW phonological production.
  • The Complexity Approach to Phonological Treatment: How to Select Treatment Targets 3
    Author: Holly L. Storkel - There are a number of evidence-based treatments for preschool children with phonological disorders (Baker & McLeod, 2011). However, a recent survey by Brumbaugh and Smit (2013) suggests that speech-language pathologists are not equally familiar with all evidence-based treatment alternatives, particularly the complexity approach. The goal of this clinical tutorial is to provide coaching on the implementation of the complexity approach in clinical practice, focusing on treatment target selection. Incorporating the complexity approach into clinical practice will expand the range of evidence-based treatment options that clinicians can use when treating preschool children with phonological disorders.
  • Children's Consonant Acquisition In 27 Languages: A Cross-Linguistic Review 2
    Author: Sharynne McLeod and Kathryn Crowe - The aim of this study was to provide a cross-linguistic review of acquisition of consonant phonemes to inform speech-language pathologists' expectations of children's developmental capacity by (a) identifying characteristics of studies of consonant acquisition, (b) describing general principles of consonant acquisition, and (c) providing case studies for English, Japanese, Korean, and Spanish. Children across the world acquire consonants at a young age. Five-year-old children have acquired most consonants within their ambient language; however, individual variability should be considered. https://www.theinformedslp.com/review/that-one-time-a-journal-article-on-speech-sounds-broke-the-slp-internet
  • How Do Phonological Processes Differ Between Spanish and English? 1
    Author: Scott Prath - Description of how do Phonological Processes differ Between Spanish and English.
  • The Effect of Dose Frequency On Treatment Efficacy For Children With Speech Sound Disorders 1
    Author: Kristen Marie Giesbrecht - Speech-language pathologists (SLPs) are urged to make evidence-based treatment decisions, but it is challenging to determine the appropriate intervention intensity for children with speech sound disorders (SSD) due to limited published information. This study is a single subject, multiple baseline design that compares the phonological changes of four preschool children (4;0 to 4;9) who received therapy either twice a week or four times a week for a total of twenty, 50-minute sessions.

Activity List(s)

Visual Schedule Cards

Related Disorder(s)

  • Speech sound disorders - Speech sound disorders is an umbrella term referring to any difficulty or combination of difficulties with perception, motor production, or phonological representation of speech sounds and speech segments—including phonotactic rules governing permissible speech sound sequences in a language.
  • Motor Speech Disorders - Dysarthria can be related to neurological damage, however it can be related to many other causes. Dysarthria is a motor speech disorder above all. A dysarthria diagnoses can come from a weakened Parkinson’s patient, a anatomy damaged TBI patient, a stroke patient with cranial nerve and strength deficits, etc).
  • Childhood apraxia of speech - Childhood apraxia of speech (CAS) is a disorder that involves difficulty in making speech sounds voluntarily and stringing these sounds together in the correct order to make words. A person with childhood apraxia of speech is not intellectually impaired. Speech pathologists assess, diagnose and support people with CAS.


Goal Bank

  • Luke will decrease gliding errors over a 6 week therapy period. 0


Therapists who selected this major focus area as their top area of expertise.

  • Heather McCrillis

    Heather McCrillis

    Full-time Therapist CCC-SLP

    I love working with PreK and elementary school students. I really enjoy working with children who...

    • Sidekick Therapy Partners Sidekick Therapy Partners
  • Victoria Odell

    Victoria Odell

    Full-time Therapist CF-SLP