I find out via Twitter (don’t you love twitter!) that “teach complex sounds first” is making the rounds again (still!) and I am prompted to respond. Besides the fact that I have disproven the theoretical underpinnings of this idea, it bothers me that so many of the assumptions wrapped up in the assertion are unhelpful to a successful intervention. Specifically, we should not be treating “sounds”, there is no agreed upon and universal ordering of targets from simple to complex, and there is no reason to teach the potential targets one at a time in some particular order anyway. So what should we do? I will describe a useful procedure here with an example.

There is this curious rumour that I promote a “traditional developmental” approach to target selection that I must lay to rest. In fact, I have made it clear that I promote a dynamic systems approach. An important concept is the notion of nonlinearity: if you induce gradual linear changes in several potential targets at once, a complex interaction will result causing a nonlinear change across the system known as a phase shift. How do you choose the targets to work on at once? Francoise and I show how to use a “quick multilinear analysis” to identify potential targets  at all levels of the phonological hierarchy, in other words phrases, trochaic or iambic feet, syllables, onsets, rimes or codas, clusters, features or individual phonemes. Many case studies and demonstrations are laid out in our book that will shortly appear in a beautiful second edition. Then we show how to select three targets for simultaneous treatment using Grunwell’s scheme designed to facilitate progressive change in the child’s phonological system. I will demonstrate both parts of this process here, using a very brief sample from a case study that is described in our book. The child’s speech is delayed for her age of two years which can be established by comparing the word shape and phonetic repertoire to expectations established by Carol Stoel-Gammon.

Potential treatment targets can be identified by considering strengths and weaknesses at the prosodic and segmental tiers of the phonological hierarchy (full instructions for this quick multilinear analysis are contained in our book). The table below describes units that are present and absent. Note that since her language system is early developing, her phonology is probably word-based rather than phoneme based; therefore ‘distinction’ refers to the presence of a phonetic distinction rather than a phonemic contrast.

Now that we have a sense of potential targets from across the whole system, how do we select targets using Grunwell’s scheme? We want to ensure that we address word shape and segmental goals. We also want to choose one goal to stabilize a variable structure in the system, another to extend something that is established to a new context, and a third to expand the system to including something new. Here are my choices (others are possible):

There is a good chance that fricatives and codas will emerge spontaneously with this plan because we will have laid down the foundation for these structures. If they don’t it should not be hard to achieve them during the next therapy block. The idea that you can only induce large change in the system by teaching the most complex targets first is clearly not true as I have explained previously – in fact, complex sounds emerge more easily when the foundation is in place. Furthermore, Schwartz and Leonard (1982) also recommended in their study on selection effects in early phonological development that it was best to teach IN words to children with small vocabulary sizes – in other words expand the vocabulary size gradually by using word shapes and phonemes that are in the inventory, but combined in new ways.

It would be possible to use the stabilize-extend-expand scheme and choose different, more complex goals. For example, we could consider the nonreduplicated CVCV structure (cubby, bunny, bootie) to be the stabilize goal. Then we could introduce word final labial stops as the extend goal, generalizing these phones from the onset where they are well established to a new word position (up, tub, nap). Finally, we could introduce a word initial fricative as the expand goal (see, sock, soup). This plan with more complex targets might work but you are risking slower progress, given the empirical findings reported in Rvachew & Nowak (2001) and in Schwartz & Leonard (1982). Furthermore, you would be failing to recognize a major constraint on the structure of her syllables (the limitation to only 2 segments, VV or CV with CVV and CVC currently proscribed). If you focus only on introducing “complex sounds” without attending to this major issue at the prosodic levels of her phonological system, you will be in for a rough ride.

I attach here another example, this one a demonstration from the second edition of our book, chapter-8-demonstration-8-2, to appear in December 2016. Francoise and I have taken a great effort to show students how to implement an evidence based approach to therapy. I invite readers to take a peak!

Reading List

Rvachew, S., & Brosseau-Lapré, F. (2018). Developmental Phonological Disorders: Foundations of Clinical Practice (Second Edition). San Diego, CA: Plural Publishing. (Ready for order in December 2016)

Grunwell, P. (1992). Processes of phonological change in developmental speech disorders. Clinical Linguistics & Phonetics, 6, 101-122.

Stoel-Gammon, C. (1987). Phonological skills of 2-year-olds. Language, Speech & Hearing Services in Schools, 18, 323-329.

Rvachew, S., & Bernhardt, B. (2010). Clinical implications of the dynamic systems approach to phonological development. American Journal of Speech-Language Pathology, 19, 34-50.

Rvachew, S. & Nowak, M. (2001). The effect of target selection strategy on sound production learning. Journal of Speech, Language, and Hearing Research, 44, 610-623.

Schwartz, R., & Leonard, L. (1982). Do children pick and choose? An examination of selection and avoidance in early lexical acquisition. Journal of Child Language, 9, 319-336.