Assessment and Treatment of Phonological Disorders

By August 14, 201324 Comments

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!


  • 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,

  • 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.

  • 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!

    • Traci Terpstra says:

      I have most frequently used the “Moving Across Syllables” book for treating assimilation/consonant harmony. It has a systematic progression from bilabial-to-bilabial, then bilabial-to-alveolar, etc. which lends itself well to working on this process.

  • 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!

    • Heather says:

      Hi Melissa!
      Yes, in general I use that same progression through therapy (treating syllables then moving up to more complex contexts) however, more current research says that we need to practice the target sounds in higher levels throughout out our therapy! So now, I will throw in some phrases, sentences when they haven’t yet “mastered” lower levels. The research says that it is very important to stimulate these more complex contexts even at the beginning. Thank you for your question. I hope that helps!

  • Edith says:

    Hi Heather, my 4 year old pronounces instead of the “L” sound a “ING” sound, how can I go about changing this?

    • Heather says:

      Hi Edith,
      I would start by helping him/her understand the place difference in the mouth. Get a mirror so he/she can see their own tongue. Start with the “ng” sound and show and explain how it is a “back of the mouth” and “back of the tongue” sound then contrast that with the /l/ sound which is a more “front of the mouth” and “tip of the tongue” sound. Then get some pictures of words that can end in /l/ and pictures of words and/or actions that end with /ing/ and contrast the two sounds emphasizing the difference in the ending sounds and your tongue position. See if this helps! Please let me know how it’s going!

      • Edith says:

        Hi Heather
        Thanks for replying, we have been working in Speech therapy sessions for about 6 weeks to try and get her to say the L sound which she is unable to. The speech therapist has decided to stop trying at this point and try again at another time, do you think this is a good idea or should I still persevere with her at home?. Also she is using the ING sounds for many other front sounds e.g TH, N……any ideas, is this usual?

        • Heather says:

          I would trust your SLP’s decision. She is able to assess what is the best treatment plan and which sounds are best to work on for your daughter at this time. I would probably at least continue to work on the /l/ and final /ng/ sounds informally now and then. But focusing on other targets is fine, too. It does sound unusual to me that she is substituting the /ing/ sound for front sounds! Some kids have “favorite sounds” that they tend to substitute for other sounds which don’t really follow the “normal” pattern that we would see for sound substitutions. I’m sure your therapist has a good plan to address those errors! Be patient – these habit are not always easy to re-train. 🙂

          • Jenny says:

            Edith, hope you don’t mind my jumping on this conversation. 🙂 I’m also an SLP, and I’ve found that sometimes kids need tactile cues in addition to visual and verbal cues. Maybe try putting peanut butter (or jam/frosting/anything sticky if allergic to nuts) on the ridge just behind her top teeth. Have your daughter lick the peanut butter off while voicing. This may give her some assistance in figuring out where to put the tip of her tongue.

          • Heather says:

            Thanks, Jenny! 🙂 Yes, flavored tongue depressors are always a hit with my kids. You can also tap the tip of the tongue and the place on the roof of the mouth that it needs to touch! Tell her to put those two together.

  • Hope says:

    Hi Heather. My 4yo son does initial consonant deletion on most of his words. He can say the initial consonant by it self and when practised put it together with the rest of the word but in general wont keep up doing it so his hard to understand when he speaks. We have been in speech therapy for a while now and my question is.. is it completely fixable so he will have normal speech?

    • Heather says:

      Hi Hope!
      I’m so sorry I haven’t responded. Initial Consonant Deletion is a speech error that we do see in kids, but its not one of those that are super typical. I’m glad to hear he is getting speech therapy. Sometimes phonological errors such as initial consonant deletion might take longer to fix and retrain the new pattern or habit. Has your therapist tried using minimal pairs? Or even more sequencing-type activities. I am wondering if an apraxia type therapy would be beneficial for your son. Yes, it is definitely a pattern that is fixable! Don’t worry! These things can sometimes take time. It is difficult to say for sure without seeing your son in person. But don’t give up! He will get it!
      All the best,

    • Nicola says:

      Hi Hope, my 4 year old son also has initial consonant deletion. How is your son getting on, did you find any areas, games from therapy especially helpful. At the moment, I am not sure therapy is helping.

  • Wendy Duke says:

    I have two sons one 14 and one 12 they both have a Phonological Disorder since they were little.. They have been getting up though the school and I can now understand them so much better. But we still at times can’t understand them.. It just breaks my heart when they look at me and say Mom will I ever speak normal.. My heart just sinks. I say yes we just have to keep working on your speech….love my boys I just can’t wait till the time comes when they do speak normal. We have been working with them with speech since they were 3 years old..Anything else I can do at home to help them?

    • Heather says:

      Hi Wendy!
      I know that feeling of heart ache for your kids. You just don’t ever want to see them struggle or feel discouraged! One thing you can always do (and i’m sure you already are!) is to really emphasize their strengths! Any sports, arts, hobbies, anything they enjoy – pour into those and give tons and tons and then more praise and positive attention and reinforcement for those things they excel at that have nothing to do with speech. I have found that kids NEED this so much once they reach the age when they are comparing themselves to their peers and have a keen awareness of being or talking “different.” What errors are they still working on? I can try to give you some more specific tips if I know the patterns that are still making their speech hard to understand! Thank you so much for writing!
      Love and hugs!

  • Brooke says:

    Hi Heather,
    I am an SLP and I have a student who uses fronting/backing with assimilation (for example- “take” is “cake” and “dog” is “gog” but he can say “tail” or “door” appropriately). What strategies would you recommend in treating him? I have tried minimal pairs, direct articulation therapy, using tactile approaches (I have him hold a cheerio on the alveolar ridge and say “t”) and nothing is working! Help!

    • Heather says:

      Hi Brooke!
      Great question! Sounds like he can make the sound physically as in your example of him saying “tail” and “door.” Try having him watch you and listen and use auditory bombardment (the sound correctly a bunch of times while he focuses on your mouth and listens!) Also use the LIPS program by LIndamood bell to give each sound a name and feeling! So a /t/ is called a “Tip tapper” and you discuss how his mouth feels when he makes that using a mirror, etc. then just keep contrasting the two sound with LOTS of opportunities to see that the sound difference means a meaning difference. I know you are already doing that, but maybe spend more time there and with the LIPS approach. I LOVE LIPS! It’s so effective!
      Thank you so so much for your question! Please keep me posted!

  • manal says:

    Hi Heather I have a 4 year old son, he making mistakes speech sound which made his speech hard to understand
    he say tate for straight, dak for dark and tum for gum

  • Jen says:

    What targets do you use when treating consonant harmony?

  • Jennifer Mueller says:

    would like to know the answer to this question as well?

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