FAQs about Phonological Intervention - General
In response to presentations on phonological contrast pair intervention at SpeechPathology.com, and national, state and regional conventions, I often receive (and welcome!) email questions about implementation. Here are a few of the most common questions and answers based on my experience using Gierut's Productive Phonologic Knowledge theory on a daily basis. Please feel free to post follow-up questions in the Comments.
1. Do you have a specific word list that you use for finding targets, or do you use the a standardized test list for your analysis?
When I began using this approach, I most often used the now rather dated Bankson-Berthal Test of Phonological Processing (BB-TOPP) because it provided a larger sampling of individual phonemes than most articulation tests. The Goldman-Fristoe-3 provides a much larger sampling of phonemes than previous editions, and is more recently standardized, so this is the assessment I use most often now. Gierut and Dinnsen’s book, Optimality Theory, Phonological Acquisition and Disorders, contains a word list which is organized by phoneme and intended as a means of “deep testing” phonemes found to be in error on initial testing.
Another simple, no-frills approach is to get out an articulation card deck for each sound in error, and simply run through all or part of the deck to test the sound in multiple phonetic contexts, albeit unstructured phonetic contexts. At this point, I am not concerned with whether the child produces the word spontaneously or in repetition, because production in repetition also gives me information about stimulability.
2. How do you deal with phonemic deletions using this approach?
Deletion should be addressed first, or, based on my sad experience, you’ll be dealing with errors for a much longer period of time. Since the absence of a phoneme could be thought of as the ultimate maximal contrast with an actual phoneme, start with multiple contrasts in the deleted position which include unknown phonemes as well as phonemes already used in other positions. An example set for final deletions: cat, can, cap, Cass (represented by a picture of an unknown person now named “Cass”), cab, etc. Three or 4 words in a contrast set is probably enough. The contrast set in this case is made up of words with the same onset. Use several (4-5) onset sets, such as: [kæ_] (already listed), [ta_] (top, Tom, toss, talk), [bɪ_] (bit, Bill, Bic, big).
Early on, it is usually difficult for the child to blend words together. For deletions, marking a phoneme in the deleted position, even as a segmented sound (e.g. [kæ p]), is an improvement on deleting the phoneme, as it demonstrates understanding that some sound belongs there. If the deletion contrast sets used include several phonemes that the child more readily produces, the child will be able to work those phonemes into words fairly quickly. This paves the way for blending unknown sounds into words later. As soon as the child begins to add consonants in the deleted position in larger deletion contrast sets, it is time to shift the focus to maximal contrasts with unknown sounds (e.g. crash/crack, if the child doesn’t have velars or fricatives).
3. How long do you stick with a contrast pair before you see success? In other words, how long do you work before deciding to try a different contrast pair?
The key is to give the child as many opportunities as possible during each session to practice saying the sound correctly (see my post about what a therapy session looks like). Even then, with 1-2 sessions each week, it may take as much as 6 weeks to get a really solid imitation of unknown phonemes. However, as you and the child are straining to teach or learn these new phonemes, listen carefully to what is happening in the child's overall intelligibility - most likely a general improvement. It has now come to be almost predictable that the children that I begin with in September, who are working on unknown, nonstimulable targets and continuing to need significant cues to produce those phonemes correctly, are the ones whose parents, right before Christmas, report that "Grandma is thrilled with his improvement! She can understand him on the phone!" If I could write "Grandma will understand what the child is saying on the phone" as an IEP goal, I would! Talk about genuine progress.
It is really important to keep things fun in this initial, difficult phase. This is why teaching stimulability through practicing the entire English consonant inventory at each session is critical. Miccio and Elbert (1996) developed fun strategy for teaching a wide variety of phonemes to a 3-year-old child using animals or objects and a special motion to represent each consonant. For example, [v] was "Viney Violet," with upward vine-like arm movement. Giving the child multiple associations for each sound is simply sound teaching - the more connections, the more rapid and permanent the learning.
References
Dinnsen, DA, Gierut, JA (2008). Optimality Theory, Phonological Acquisition and Disorders. Oakville, Connecticut: DBBC.
Miccio, A., & Elbert, M. (1996). Enhancing stimulability: A treatment program. Journal of Communication Disorders, 29, 335-351.