Assessment and Treatment of Phonological Disorders

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Hi Everyone!

I have posted quite a bit on the process of traditional articulation therapy  – which is a great method to use when a child has only one or just a few sounds in error.  It can also be used in other situations as determined by the therapist.

But what do you do when you have a child who has MANY articulation errors?  What about the child who is very, very hard to understand? For this type of child, a phonological approach to assessment and treatment is recommended.  Often times, children with severely unintelligible (very very hard to understand) speech will also have a difficult time with reading and spelling as they begin pre-literacy and literacy activities.

Phonological Therapy

In a nutshell, phonological therapy is the process of looking at the types of error patterns a child is producing and in what contexts.  A traditional articulation therapy approach focuses on teaching each sound by itself in order to “fix” or “teach” that one sound.  However, a phonological approach is needed when there are multiple articulation errors and treating each sound, one at a time, is NOT the most effective way to fix the errors.

A therapist may need to incorporate more strategies into therapy such as: treating a habit of leaving off the last sound in a word, or treating a later developing sound that is not yet in the child’s repertoire, or using a 3-element, complex-cluster (sqw), to bring in more sounds that are not being treated directly.  (Let me just tell you, there is a whole science behind phonological therapy and it is fascinating!)  I won’t bore you with the “why” – but just trust me…the strategies and targets used really do produce great results for these kids.

A speech therapist will use assessment procedures to determine which sounds are in error and in what contexts.  Phonological assessment typically takes longer than a basic articulation assessment.  Once assessment is complete, the therapist will identify which error patterns are being produced and systematically choose targets that will help make the most change in the child’s system.

Phonological Error Patterns

Speech therapists refer to these error patterns as “phonological processes.”  Some phonological processes are developmental (or considered normal) at certain ages, i.e. nana for banana.  If a child does not outgrow these immature speech patterns by a certain age, he or she is said to have a phonological disorder.

Types of Phonological Processes/Error Patterns

Speech therapists use these names to describe what a child is doing when the speak.  These errors make their speech very hard to understand during conversation!

Weak Syllable Deletion: “nana” for banana

Final Consonant Deletion: “for” for fork

Reduplication (CVCV): “wawa” for water

Consonant Harmony: “gog” for dog

Cluster Reduction: “pot” for “spot”

Stopping:  “pish” for fish

Velar and Palatal Fronting:  “tite” for kite  and “doe” for go “tare” for share

Gliding:  “wan” for ran and “wite” for light

Pre-vocalic voicing:  “gup” for cup

Post-vocalic devoicing:  “ret” for “red”

Treating Phonological Disorders

I love Jennifer Taps’ approach to treating phonological disorders.  I also like Dr. Secord’s and Dr. Hobson’s approaches.

I want to share with you Dr. Wayne Secord’s recommendations for the “Top Five and First Priority” speech targets for children with highly unintelligible speech and multiple articulation errors.  I just heard him present at ASHA Schools Conference 2013.  It was so good! Here are his top 5-first priority goals/targets for phonological therapy:

1.  Target simple syllable shapes (CV, VC)

2.  Target Final Consonant Deletion

3.  Target front vs. back of mouth differences (alveolars vs. velars…i.e. t vs. k)

4.  Target stridency – (elicit s/f/sh/ etc.)

5.  Target glides vs. liquids (stimulate and begin to emphasize the r and l sounds!)

I think My Child May Have a Phonological Disorder. What do I do?

If your child is very hard to understand then it may be a good idea to have them assessed ASAP by a speech therapist who can see if there is a problem.  The earlier a child can begin working to change their whole sound system the better!

I hope this has helped you understand the difference between a phonological approach to therapy and a traditional approach.  If you have any questions, please comment below and I will be happy to answer!



5 Responses to “Assessment and Treatment of Phonological Disorders”

  1. Melissa says:


    I was just wondering your view on the progression of phonological process therapy (e.g., Final Consonant Deletion). Do you progress through phonological therapy just as you would with articulation therapy (e.g., word level, phrase level, sentence level, conversation)?

    Thank you!

  2. Ashlee says:

    Im a SLP student and I’m wondering about targeting consonant harmony/assimilation. I find this process to have the least amount of information. Which types of words do you use? My instinct is to use cvc words and then move on to cvcv, etc. But I’ve noticed that consonant harmony presents itself all over the place– not always the same sounds are being affected. Any advice or resources are helpful. Thank you very much!


  3. Sheryl says:

    Hi Heather,
    I am an SLPA student. I was looking for how to treat initial consonant deletion on your web site. Did I miss it, or is it not there? I have to do a report on web site research.


  4. Gloria says:

    Hi Heather. I have a 4 year old who has been in speech therapy for 2 years and has made great strides. She goes through the school system, and they have mentions phonological delays (she deletes some final sounds, and does some cluster reduction) but they seem to still be addressing her problems like typical articulation, working on separate sounds. Is there anything I can do at home to help her?

    • Heather says:

      Hi Gloria!
      Thanks for your question! The sounds or patterns targeted may be working on a specific pattern. For example, for stridency deletion (omitting the sounds with a continual flow of air) an SLP might choose /s/ or /f/ or /th/ depending on what the child’s whole system looked like. So working on one sound doesn’t mean they are not using a phonological approach to treating her errors. Just ask her therapist to clarify which sounds she is working on and why. I’m sure there is a very good reason and I’m so happy she is making great strides! Keep me posted!
      All the very best,

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