Speech Sound Disorders: Where Do I Begin? Try these tips on successful starting points and target selection in phonological intervention. School Matters
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School Matters  |   May 01, 2017
Speech Sound Disorders: Where Do I Begin?
Author Notes
  • Sherry Sancibrian, MS, CCC-SLP, BCS-CL, is the program director for speech-language pathology at the Texas Tech University Health Sciences Center. She is an affiliate of ASHA Special Interest Group 1, Language Learning and Education. sherry.sancibrian@ttuhsc.edu
    Sherry Sancibrian, MS, CCC-SLP, BCS-CL, is the program director for speech-language pathology at the Texas Tech University Health Sciences Center. She is an affiliate of ASHA Special Interest Group 1, Language Learning and Education. sherry.sancibrian@ttuhsc.edu×
Article Information
Speech, Voice & Prosodic Disorders / School Matters
School Matters   |   May 01, 2017
Speech Sound Disorders: Where Do I Begin?
The ASHA Leader, May 2017, Vol. 22, 30-32. doi:10.1044/leader.SCM.22052017.30
The ASHA Leader, May 2017, Vol. 22, 30-32. doi:10.1044/leader.SCM.22052017.30
As speech-language pathologists, we know students with speech sound disorders (SSDs) are at risk for academic failure, particularly in literacy. And ASHA’s schools surveys indicate nearly 90 percent of school-based SLPs treat students with SSDs. We need to find ways to maximize our treatment outcomes for SSDs. However, providing intervention that is effective, efficient and evidence-based is a considerable challenge!
Where to start may be the most important decision you make. You may be surprised to learn that deciding how to treat an SSD doesn’t matter as much as choosing what to treat. The long-term goal for students with SSDs is normalized speech and successful communication. The steps we take to reach these goals reflect the unique combination of traits, skills and experiences each student brings to the treatment process.
Consider the cases of Ryan, Marcos and Sarai. Ryan is a preschooler who produces only five different consonants and relies on gestures to communicate. Marcos is a second-grader whose speech production is affected by gliding, stopping of fricatives and cluster reduction. Sarai is a middle school student whose residual lateralization of sibilants makes her reluctant to speak in class. For Ryan and Marcos, the focus of treatment is on function (creating meaningful contrasts between words), while for Sarai we focus on form (accurate motor production of the error sounds).

You may be surprised to learn that deciding how to treat a speech sound disorder doesn’t matter as much as choosing what to treat.

Form
When I work with students on form (correctly articulating phonemes, for example), traditional target selection criteria apply. I choose stimulable sounds—those that are easier to produce, early developing, frequently occurring and likely to affect intelligibility. However, there are always special considerations. Sarai’s SLP may choose to target /s/ because this sound occurs so frequently in connected speech. It also affects Sarai’s production of her name. But /z/ might present a better choice because of its voicing feature. This feature masks minor differences in production, requires less air pressure and thus less effort, and may make it easier to combine with vowels to produce syllables and words.
Function
When the focus is on function—using sounds to contrast meaning—begin treatment at the word level. Consider these principles when choosing target words:
Build the frame first. Children need to produce initial and final consonants and a variety of syllable shapes, including consonant clusters. To increase the likelihood a student will produce final consonants, I begin with words that include lax vowels and the same consonant in initial and final—for example, pop, kick and dad.
Consider frequency and density. Words that children use frequently in everyday interactions make good targets. Personalized choices are even better! For Ryan, words like “pie,” “push,” “puppy” and “up” may be more motivating than the words in a commercial card deck. Density refers to the number of phonetically similar words, based on changing one phoneme. So a frequently used word like “ball” has many phonological neighbors—fall, bull, boss—which can make it more challenging for the child to focus on correct production. Ideal targets are high-frequency, low-density words like “drive,” “house” and “three.”
Control the context. As Marcos’ SLP, you might decide to address his stopping pattern first because it significantly affects intelligibility. When developing a set of target words, consider that voiceless fricatives are often easier to produce in word-final contexts. If there is a second consonant in the target word, it should be a sound that Marcos typically produces correctly, and it should not be a stop (because consonant assimilation increases the likelihood that Marcos will produce both consonants as stops). So, example target words would be “miss,” “niece,” “mash,” “house,” “wash” and “off.” Targets like “less” or “race” will be more challenging because /l/ and /r/ are error sounds for Marcos.
When making the crucial decision about where to begin treatment, ask these questions: What will affect intelligibility the most? What will expand the child’s sound system? What personal factors are worth consideration?
SLPs might worry that there isn’t a “gold standard” for treating all speech sound disorders. Instead, focus on your treatment goals. Knowing precisely what you want to achieve can help you choose an intervention approach that matches the unique needs of your student.
Find More on Treating Speech Sound Disorders at Schools Connect

ASHA’s Schools Connect, July 7–9 in New Orleans, is a conference designed specifically to meet the continuing education needs of school-based clinicians. Dozens of sessions will focus on working with special populations of children, language and literacy, service delivery in schools, and professional issues in schools.

Schools Connect is co-located with Private Practice Connect and Health Care Connect. Attendees may participate in sessions at any of the three conferences.

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May 2017
Volume 22, Issue 5