The treatment approach varies depending on the nature of a speech sound disorder, the age of the child, and the child's schedule. Finding the right approach is not one size fits all; it may take a couple of attempts to find the approach that is right for your child. A couple of common approaches are outlined below.
Speech-Language Pathology is an evidence-based practice (EBP). EBP means we consider the evidence when we determine our treatment plan. Evidence comes in the form of a formal research, our experience in the clinic, and the knowledge we have of what has and hasn't worked for your child.
Good for kids that need phonological awareness skills. These kids are the ones who have trouble knowing which sounds go where or are missing sounds they should have by their age.
The Cycles approach is appropriate for children aged 2.5 to 4 years who are diagnosed with moderate-severe speech sound disorder, Childhood Apraxia of Speech, mild-moderate hearing loss, repaired cleft palate and cognitive delays.
- Benefits: Great for generalization! Research based!
- Limits: Child has to be stimulable for all the sounds targeted.
The Minimal Pairs approach is appropriate for 3 to 6 year olds diagnosed with mild-moderate phonological impairment who don't have another diagnosis in oral motor or language.
- Benefits: Great for kids with just a few errors or sounds they need to tidy up. Widely used and researched. Helps children realize a change in sound means a change in meaning.
- Limits: Not great for non-developmentally delayed sounds. Limited age ranges have been researched.
Metaphon therapy is most typically used with four to five year olds (or older). The ideal candidate has been diagnosed with phonological speech sound disorder.
- Benefits: This is a great “side dish” to other therapy techniques. Helps with literacy acquisition (which is really important)!
- Limits: Only use when paired with other approaches. No research on use with severe issues or cognitive abilities.
Multiple oppositions is best suited for 3 to 5 year olds who have been diagnosed with a speech delay. The ideal child is missing quite a few sounds or making the sounds they have in error. Often these children have severe to profound speech sound disorders and may have an additional language or reading issue.
- Benefits: Has specific benchmarks kids have to meet before their therapist can promote them to the next level. Great for kids with multiple errors. Good for kids who collapse sounds.
- Limits: So far it's mostly used only university clinics. Takes a lot of planning and thought in how to select and attack the targets. The strict targets can also hold up progress in some kiddos!
Parents and Children Together (PACT)
PACT is ideal for children who are three to six year old with a diagnosis of poor to severe intelligibility or mild-severe speech sound. It isn't thoroughly researched in a lot of populations, but if your child fits the criteria and the parent can commit to conducting therapy a few days each week, this could be a fantastic approach.
- Benefits: Uses parents as partners in the treatment process. It also helps give SLPs some freedom in their time management. If your therapist hasn’t mentioned this approach, ask (it may just mean few trips to visit the SLP)!
- Limits: Requires a specific parent training. The child can go periods of time without direct face-to-face time with the SLP.
When my child just needs help getting their mouths and tongues to say the sounds and words correctly.
Core Vocabulary is best for children who are two years+ who are diagnosed with speech sound with inconsistent errors, have multiple errors, and other treatments haven’t been super successful. It is not appropriate for those with Childhood Apraxia of Speech.
- Benefits: Promotes use of functional words so that it has an immediate impact on improving the child’s intelligibility. If you’re running out of hope for a kid, this is great!
- Limits: It’s a little under-directed in how to pick targeted words other than they are high frequency words for the child. It also would require a lot of coordination between home, therapy, and school setting.
(2-4 year olds)
Stimulability Intervention is best for children two to four years old who have a small phonetic inventories (don’t make a lot of different sounds) or aren’t even able to kind of make the sounds they are missing. The small inventory typically indicates these children have low intelligibility to unfamiliar listeners. Research has shown this approach works best for children who have normal oral-motor, hearing, and language.
- Benefits: Engaging for the little ones. Stimulability is great for any intervention.
- Limits: It doesn’t have a lot of research saying it can work as a stand-alone treatment. It’s a little limited in its current format.
Wait, isn’t an ultrasound used by doctors to monitor a woman's pregnancy? Well, yes, but really ultrasound technology can be used to see anything in the body.
This can be good for any client who has been diagnosed with persistent speech sound error that no other treatments have really worked well with, like /r/ sound or lisps. An ultrasound machine is used to help give visual feedback to a child so they can see that exact moment when their tongue and teeth are all in the right place to make the sound that’s eluded them!
- Benefits: Lots of potential in this area. Shown to work on small scale.
- Limits: Haven’t quite figured out how to help a child generalize the sound when not using the machine. And duh, it requires a fancy machine and training that lots of SLPs don’t have access to.
This tool can be used for individuals of any age. We most frequently used for persistent speech sound errors and cleft palate. It is basically a custom retainer type device is fitted for a child. The device has sensors for where their tongue should go for each sound. Through a monitoring tool, the child is able to know when they hit the target!
- Benefits: Gives visual and immediate feedback to kids without a therapist having to be sitting right there with them. Offers a great option for repaired cleft palates.
- Limits: It’s a little expensive, not super pervasive in the U.S. All the sound target spots are pre-programmed so a child doesn’t have a lot of flexibility in how a sound is produced and considered accurate.
Non-Speech Oral Motor Exercises
These exercise are often used for individuals of any age or disorder however, we recommend that you DO NOT USE this approach. If your child’s speech therapist sends you home and with a chew stick or weird tongue and mouth “exercises”, find another therapist. These aren’t appropriate for anyone. NO research backs their efficacy. And shouldn't we be practicing speech to improve speech?
- Limits: This is a scam.
Deciding when to treat or not treat
A special note should be made for children with culturally or linguistically different backgrounds: If an SLP is unfamiliar with your background, they may recognize a language difference as a language disorder. SLPs are careful to preserve cultural differences when they are aware of them. If your child is from a multicultural background please work with your SLP to understand what is appropriate for her to target and what is not. Also, keep in mind a language disorder, and some speech sound disorders, will appear in any language a child speaks. A perseverance in multiple languages may be a reason to treat despite a cultural difference.
It is also within the scope of practice for SLPs to help with accent modification. You can see how this can get sticky. If you, or your child, is from a multicultural background make sure you have a conversation with your SLP about it so they don't "treat" something that isn't a problem.
We've put together sample activities so you can see what we may do in therapy. Many of the activities can be implemented by you to supplement therapy time.