treatment

In this comprehensive guide, we’ll explore phonological disorders, discuss age-related expectations, and outline your role in supporting phonological goals at home. Whether early intervention or the school system has identified your child for services, this post provides valuable insights.

Evaluation, treatment planning, and homework for phonological disorders differ significantly from articulation and childhood apraxia of speech due to their distinct nature. Please note that this post does not take the place of a comprehensive and diagnostic evaluation for your child. There are many factors that we assess when developing an appropriate treatment plan. Talk with your pediatrician, child’s teacher, and/ or speech pathologist if you have questions and concerns specific to your child.

Understanding Phonological Processes in Phonological Disorders

There are nine phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, gliding, and devoicing. Below are definitions, examples, and age expectations for suppression of each of these processes.

1. Syllable reduction: eliminating a syllable in a word should cease by 4 years old. For example, “puter” for “computer”.
2. Syllable structure: inability to produce part of a syllable. There are four of these such shapes (CV, VC, CVC, CVCV) with “C” representing “consonants” and “V” meaning “vowels.” Some examples of these shapes are: (CV) “bee”; (VC) “up”; (CVC) “cat”; and (CVCV) “baby.” A child with a phonological disorder may have difficulty producing several of these combinations for an undetermined length of time. Errors will be consistent unlike apraxia.
3. Cluster reduction: occurs when a child omits part of a blend, most often /s/ blends /sk, sm, sn, sp, st/. You may hear him say “kin” or “sin” for the word “skin.”  Children should be able to produce blends together between 4-5 years old.
4. Final consonant deletion: omitting the last sound in a CVC word (“ca” for “cat”) should suppress by 3 years old.
5. Stopping: producing a sound that should be stretched like /s/ with a /b, d, p/ (“bun”, “dun”, or “pun” instead of “sun”) should end between 3-5 years old.
6. Fronting: making sounds that are produced further back in the mouth more towards the front. For back sounds /k, g, ng/, the tongue lifts in the back while the tongue tip stays down in the front of the mouth. A child who fronts sounds lifts the tongue tip to touch his palate and substitutes /t, d/ for back sounds. You may hear “tan” for “can” or “tookie” for “cookie” if your child is fronting. This process ends at 3.5 years old.
7. Backing: the reverse of fronting. Here, your child continues producing sounds made with the tongue towards the front of the mouth, lifting the back of his tongue.  So, you may hear “do” for “goo” or “gog” for “dog.” This process is often seen in children with severe phonological delays.
8. Gliding: substituting an /r/ with /w/ (“wun” for “run”) or /l/ sound with /w, y/ (“yeyo” for “yellow”.) This process may continue through 6 years old.
9. Devoicing: occurs when a voiced sound at the end of a word is pronounced as a voiceless sound. For example, a child might say “bak” instead of “bag.” This occurs as children simplify speech patterns, typically resolving by age four.

Evaluating Phonological Disorders

Speech pathologists observe and screen before evaluations, guiding test choices. Analysis and probes help develop treatment plans for phonological delays.

A phonological delay is when your child omits, substitutes, and/or distorts a process. This is something that all children demonstrate at various ages, but eventually suppress as they enter the preschool years. These errors occur at a young age because a child’s speech mechanism (lips, tongue, jaw) is not yet fully, physically developed to move swiftly and precisely. As children grow physically, their speech becomes more intelligible. Those with phonological disorders may need auditory training to improve accuracy.

A phonological delay means multiple sound errors. For instance, using /d/ for /th/ in “thumb” doesn’t signify a delay. This example would likely be an articulation delay. However, if he uses /d/ in addition to one of more of these sounds: /j, sh, ch, th/ (i.e., “padama” for “pajama”, “dells” for “shells”, “lund” for “lunch”, and/or “dum” for “thumb”), then he has not suppressed a phonological process of stopping and needs intervention, especially if he is five years old or older.

One of my most popular, phonological goals is: Reduce cluster reduction for /s/ blends (sk, sm, sn, sp, st) in initial positions of words with 80% accuracy given supports as needed.

Treating Phonological Disorders

In phonological therapy, we work towards helping the child learn to suppress the process. The speech pathologist prioritizes processes occurring over 40% in a speech sample. Unlike articulation issues, phonological delays vary contextually. Two options for treating phonological processes are the cycles and complexity approaches.

Auditory Bombardment:

Auditory bombardment involves repeatedly exposing your child to correct target sounds in different contexts. By hearing these sounds frequently, your child’s ears get used to them, helping them understand and recognize the correct sounds better. Hearing the correct sounds over and over helps your child learn and imitate these sounds, making it easier for them to produce the target sounds correctly.

This technique strengthens your child’s ability to hear and produce correct speech sounds, enhancing their overall speech clarity and phonological awareness. Auditory bombardment provides essential auditory input, supporting your child’s speech sound development and helping them improve more effectively in therapy.

Homework

It is nearly impossible to skip homework practice and make progress in phonological therapy. Again, your child’s speech pathologist will want a certain level of mastery in the therapy room before assigning homework practice. Once targets are identified, clients with phonological delays can benefit from engaging in listening training at home. Ask for appropriate book suggestions. The sooner you start, the better.

Conclusion

In conclusion, grasping the nuances of phonological processes is vital for effective intervention strategies. With thorough evaluation and targeted treatment plans, accompanied by diligent home programming, children can overcome phonological challenges more effectively. Encouraging parental involvement in home practice reinforces therapy gains and fosters lasting progress in speech development.