Introduction:

The following page is a guide to the evidence that is currently available regarding treatment of preschool articulation and phonological impairments. It aims to give readers an idea of what therapy approaches are available, the premise behind them and who may benefit from them as evidenced in the literature. It is our hope that speech pathologists and students accessing the information here will use their own clinical judgement to make appropriate decisions when choosing an intervention approach within an evidence-based framework. The approaches which are outlined represent a selection of key approaches currently available. Readers should also be aware that there are a wide number of programs and techniques available that cannot all be mentioned.

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The literature at present:

The management of articulation disorders and phonological disorders in preschool children continues to be a source of much debate in the literature. Many studies have been conducted in this area; however few seem to properly address the issue of treatment efficacy (Gierut, 2001) or make attempts at more comparative research (Baker, 2006). After reviewing the available literature it is clear that research, in general, has demonstrated therapy for articulation/phonological disorders to be effective (Joffe & Serry, 2004; Law, Garret and Nye, 2004). However, there are still a number of gaps in the research (Law, Garret and Nye, 2004) and definitive answers with regard to which treatment approach is best, remains unknown. One study by Dodd and Bradford (2000) concluded that no single treatment approach is suitable for all children with disordered phonology. This statement emphasises that there are numerous variables in each child’s case which must be considered before selecting an appropriate therapy program. Baker (2006), summarises the current situation by stating that “children with a speech impairment each have a unique combination of symptoms that requires consideration in the development of individualised management plans” and “to suggest that one approach fits all…would be remiss of a relatively young field” (Baker, 2006, p. 159).

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The history of articulation and phonological disorders:

Articulation and phonological disorders are not one in the same. However it has become clear that approaches aimed at eradicating such impairments are often quite similar. Clearly there is a degree of cross-over between these two types of deficits, which adds to the confusion that already exists in this area. In the past, more emphasis was given to articulation approaches, and a phonetic orientation dominated the treatment of paediatric speech impairments (Monahan, 1986; Joffe & Serry, 2004; Baker, 2006). During the late 1970’s and 1980’s, however, a new line of thinking emerged which resulted in various phonological approaches being developed. Phonology offered clinicians a different perspective, and interventions derived from these theories allowed clinicians to understand and treat speech impairments of unknown origin more efficiently (Baker, 2006).

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Additional Considerations:

One author, Gierut (2005), suggests that it may not necessarily be what therapy approach we choose as much as how we teach it that will make the real impact. This idea adds a new level of complexity to the research being conducted. As a result, clinicians nowadays must consider aspects such as target selection methods and goal-attack strategies as these form part of the evidence which is currently evolving.

Target Selection: Choosing which sounds to target during treatment has become a focus of research in recent studies (Gierut, 2001; Gierut, 2005). There are essentially two primary approaches one may take when choosing initial therapy targets. A clinician may choose to either base targets on a developmental approach or a non-developmental approach. Roth & Worthington (2005) suggest the following:

• Developmental: Targets will be chosen based on the order of acquisition seen in normally developing children. Rvachew and Nowak (2001) concluded that children who received treatment for target sounds from a developmental perspective, showed greater progress toward acquisition of the target sounds than did the children who received treatment for target sounds from a non-developmental perspective.

• Non-developmental: Gierut (2005) suggests that targets which are more complex, such are non-stimulable and later-developing sounds, may actually result in greater system-wide phonological generalisation. An earlier study conducted by Powell, Elbert and Dinnsen (1991), drew similar conclusions and reported that generalisation is maximised when non-stimulable sounds are targeted. Rather than basing targets on developmental norms, non-developmental targets may be selected according to either client-specific factors or according to the degree of unintelligibility that the errors produce.

Examples of client-specific factors are:

• Targets which have particular relevance to the child/parent (sounds in the child’s name)
• Targets which are most visible (/b/ versus /g/)

Examples of targets associated with higher contribution to unintelligibility are:

• ARTICULATORY: Errors of omission followed by substitution then distortion, errors in initial position followed by medial then final positions, and errors which occur on sounds most frequently used in a language.
• PHONOLOGICAL: glottal replacement of medial consonants and initial consonant deletion processes.

Goal Attack strategies: This refers to the process by which a clinician will achieve goals in therapy. The three types of goal attack strategies which can be adopted into a therapy design are vertical, horizontal and cyclical (Roth & Worthington, 2005).

• Vertical: This strategy assumes that the best route to mastery of a sound is through intense practice of one or two targets. The clinician will target these sounds in therapy in a hierarchical fashion until they are mastered, usually at conversation level. This approach tends to be suitable for clients who have few errors in their speech (Roth & Worthington, 2005).

• Horizontal: This strategy, by contrast, assumes that by targeting a number of sounds simultaneously, the client will be better able to produce correct sounds and patterns in a variety of contexts, thus facilitating generalisation. This approach tends to be most suitable for clients who display multiple errors in their speech (Roth & Worthington, 2005).

• Cyclical: This strategy combines the previous two. It is used in the Cycles Phonological Remediation Approach (Hodson & Paden, 1983). Instead of using a deep approach (like vertical) or a broad approach (like horizontal), the clinician focuses on a particular sound/process for a certain amount of time and then moves on to a different target. At a later time, the clinician will again focus on the original target. The cycle is repeated until the target/s is/are mastered (Roth & Worthington, 2005).

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The treatment options:

Click on one of the following…

1. Core Vocabulary
2. Cycles Phonological Remediation Approach
3. Maximal Oppositions
4. Metaphon
5. Minimal Pairs
6. Multiple Oppositions
7. Non-linear phonology
8. PACT – Parents and Children Together
9. Phonetic Placement
10. S-PACK - The S Programmed Articulation and Control Kit
11. Speech Perception Training e.g. SAILS
12. Traditional Articulation therapy

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1.
Title:
Core Vocabulary

Who:
Dodd & Bradford, 2000

Explanation:
Children who have inconsistent errors often do not respond well to therapy programs which seem to resolve other children’s speech impairments (The University of Queensland, 2006). According to this approach the ultimate goal is error-free spoken communication with a long-term aim of establishing consistency of best production of 50 words as a minimum (Dodd, Holm, Crosbie & McIntosh, 2006). If a child’s errors are variable and they demonstrate different error patterns on a sound in the same word context, it tends to be difficult for clinicians to select targets for therapy. This then forms the rationale for choosing a Core Vocabulary approach.

Population:
Suitable for children who display inconsistent phonological errors (Dodd & Bradford, 2000).

Procedure:
Dodd et al. (2006) suggest the following procedure:

• Target selection: Parents, teacher and client should decide on a minimum of 50 words that will be targeted. These words should be functionally powerful.
• Establishing best production: The child attends sessions each week. Up to ten words are selected randomly from the 50 targets, and broken down into syllables. The clinician elicits best production on each syllable by providing feedback and modelling after child’s attempts. An effective technique is to link sounds to letters.
• Drill: This part of the session involves practice of the target words using games that require repetition (100 responses in 30 minutes is suggested). The carers of the child need to be involved as they will continue to practice these target words at home.
• Treatment on error: To assist the client’s understanding of the reason for attending therapy, the clinician/carer/teacher explains the client’s error to him/her and compares it to the correct version.
• Monitoring consistent production: Client produces set of target words three times each at the end of the session. If the client produces a word consistently using his/her best production it is removed from the list. Words not mastered may be readdressed in further sessions.

Resources/Training:
No specific training is indicated however The University of Queensland currently sells a Core Vocabulary CD which may assist clinicians who are unfamiliar with this program. Order forms are available from their website (see references) and the cost is approximately $50. The CD includes a checklist for diagnosis of inconsistent speech disorder, how to do Core Vocabulary intervention as well as parent and teacher resources.

Time frame:
Dodd et al. (2006) suggest a block of 8 weeks intervention.

EVIDENCE:

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2.
Title:
Cycles Phonological Remediation Approach

Who:
Hodson & Paden, 1983

Explanation:
This approach stems from various phonological theories including cognitive psychology principles, phonological acquisition research and clinical phonology research (which is ongoing) (Hodson, 2006). The underlying concepts of the Cycles approach are:

1. Phonological acquisition is a gradual process
2. Children with “normal” hearing typically acquire the adult sound system primarily by listening.
3. Children associate kinaesthetic and auditory sensations as they acquire new patterns, enabling later self-monitoring.
4. Phonetic environment can facilitate (or inhibit) correct sound production.
5. Children are actively involved in their phonological acquisition.
6. Children tend to generalise new speech production skills to other targets.
7. An optimal “match” facilitates a child’s learning (Hodson, 2006, p. 258).

Population:
Highly unintelligible children, aged 3 years and older (Bauman-Waengler, 2004)

Procedure:

1. Auditory Bombardment (using approximately 20 words containing the target pattern, and lasts about 30 seconds)
1. Production Practice
2. Probing
3. More auditory bombardment
4. Home Program (2 minutes per day)
5. Review (at beginning of each subsequent session)
(Hodson & Paden, 1983)

Resources/Training:
The following text may be useful in becoming familiar with particular aspects of the above procedure:

Hodson, B. & Paden, E. (1983). Targeting intelligible speech: A phonological approach to remediation. San Diego: College-Hill Press.

Time frame:
Restrict focusing on a pattern to 2-4 weeks (different phoneme or sequence each week). In this way, several patterns can be targeted over a “natural” time block. For practicality purposes this time block is usually a semester or 12 weeks. The first block is referred to as Cycle 1 the second is Cycle 2 and so on.

EVIDENCE:

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3.
Title:
Maximal Oppositions

Who:
Gierut, 1989

Explanation:
Maximal Oppositions Approach directly contrasts that of Minimal Pairs. This approach provides the child with an opportunity to learn about the target sound/rule in his or her own unique way by addressing multiple feature dimensions rather than just one (Gierut, 1989). While Minimal Pairs is more widely known and used, the evidence suggests that Maximal Oppositions yields better results for children with phonological impairment (see table below).
To demonstrate what a ‘maximal opposition’ is, here is an example that contrasts with a ‘minimal pair’:

• Minimal Pair: ‘bin’ and ‘pin’ (differs in voicing of the initial phoneme only)
• Maximal Opposition: ‘sad’ and ‘mad’ (differs in place, manner and voicing of initial phoneme).

Population:
Children with a minimum of six or more sounds missing from their phonetic and phonemic inventories and children who are 3-4 years of age. (Bauman-Waengler, 2004)

Procedure:

• Select appropriate treatment targets (must be maximally distinct) e.g. if child produces /t/ for /s/ the clinician must choose sounds other than /t/ to contrast with /s/ therefore an example is /m/. The sound which is contrasting the target must be one that is produced correctly by the child.
• Sessions are held twice weekly for 30 minutes.
• Five pictorial word pairs are chosen for therapy sessions.
• Begin with imitative phase: child names the item following clinician’s verbal model.
• Progress to spontaneous phase: includes drill, sorting and matching tasks (Gierut, 1990).

Resources/Training:
Not required

Time frame:
Not specified

EVIDENCE:

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4.

Title:
Metaphon

Who:
Howell & Dean 1994

Explanation:
Metaphon is a cognitive-linguistic treatment that aims to increase metalinguistic awareness as a means of improving phonological change and sound production (Gierut, 1998). Similar to Minimal Pairs treatment, this approach highlights the contrasts among speech sounds and sound properties. Metaphon places emphasis on the child being an active participant in the intervention process (Hulterstam, 2002). Furthermore, it provides an opportunity for the child to learn by experience e.g. if the child makes pronunciation errors he/she will be faced with communicative breakdowns. These theories form the starting point for metaphonological and ideally the child will correct his/her speech production (Hulterstam, 2002). Metaphon is unique because it includes a teaching aspect that uses recognition, matching and categorisation of sound-abilities. These are associated with metalinguistic skills and early reading skills.

Population:
Phonologically disordered children (Howell & Dean, 1998)

Procedure:
1st Phase-
This phase involves teaching the child to conceptualise opposites that will represent key properties of speech sounds e.g. long vs short, front vs back, noisy vs quiet. This is done at the concept level, the sound level then followed by the phoneme level e.g. long (sh) vs short (j), front (t) vs back (k). The clinician then works on the syllable level followed by word level.
2nd Phase-
The clinician transfers these concepts and what has been learnt in Phase 1 to address more ‘communicative’ situations.

Resources/Training:
The following text is a helpful resource and provides detail and examples regarding each phase of therapy:

Howell, J. & Dean, E. (1998). Treating phonological disorders in children: Metaphon – theory to practice. (2nd ed). London: Whurr Publishers.

Time frame:
Not specified although Howell & Dean (1998) comment that the average number of sessions required for clients in their efficacy study was 22.5 (one session each week)

EVIDENCE:

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5.

Title:
Minimal Pairs

Who:
Weiner, 1981

Explanation:
‘Minimal pairs’ refer to two words which differ by one sound only e.g. ‘pin’ and ‘fin’. Minimal Pairs treatment usually involves presenting pairs of pictures/words which associate the target sound with its incorrect substitute (Gierut, 1998). By doing this, it is hoped that the child will learn that it is necessary to use different sounds to convey different meanings between words. This approach has now become widely used in the treatment of phonological disorders and in some instances plays an integral role in other programs/approaches e.g. PACT.

Population:
Children who have a mild to moderate phonological impairment. (Richardson & Weirich, n.d.)

Procedure:
The following step-by step guide was adapted from Richardson & Weirich (n.d.):

• Analyse the client's errors. This can be done by conducting a relational analysis to compare the client's production to the correct production.
• Develop minimal contrast pairs of target sound with an error sound (e.g. tea/key)
• Commence treatment by modeling both target and contrast words. Have the child imitate both.
• Provide multiple trials of imitative production of the target and contrast words.
• Have the client spontaneously name picture pairs.
• Have the client produce target words as clinician picks the correct picture (the child says key and the clinician picks up the picture of ‘key’; if the child says tea, clinician picks up the picture of ‘tea’ and then corrects the client).
• Have the client match two pictures by first picking the picture from several displayed and then selecting its minimal pair match (Hegde, 1996 as cited in Richardson & Weirich, n.d.)

Resources/Training:
Not required although various websites can be located which provide materials for Minimal Pairs treatment.

Time frame:
Not specified

EVIDENCE:

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6.
Title:
Multiple Oppositions

Who:
Williams, 2000

Explanation:
This type of therapy offers an alternative contrastive approach to phonological treatment. Essentially, treatment according to this approach states that a number of contrasts should be used as targets, rather than just one (as in Minimal Pairs). Williams (2000a) suggests that children who display phonological disorders frequently collapse several speech sounds to a single sound, rather than displaying simply one process. This is the rationale behind offering a Multiple Oppositions approach which can facilitate the suppression of several processes simultaneously. An example of this would be a child who collapsed the sounds /s/ and /k/ to /t/. The child would then produce ‘key’ and ‘see’ as ‘tea’. Multiple errors of this kind result in reduced intelligibility and can cause significant communicative breakdowns (Williams, 2000a). In a Multiple Oppositions approach, the child would be confronted with several target sounds in contrast to the common sound which is in error. In this sense, the approach is more efficient than Minimal Pairs.

Population:
Children with a minimum of six sounds across three manner categories excluded from their phonetic and phonemic inventories. Children were approximately between the ages of 3:6 and 6;6 years, however this approach may be used with any population. (Bauman-Waengler, 2004).
Williams (2000a) suggests it is suitable for children who exhibit severe speech disorders.

Procedure:

• Treatment occurs twice weekly for 30 minute sessions.
• Analyse child’s errors (can take hours to obtain detailed analysis).
• Select treatment targets (the clinician must have knowledge of child’s unique error patterns and targets must be 1. maximally distinctive from the child’s error and 2. salient (therefore presumably more learnable).
• The error sound is presented by the first treatment card.
• Target sounds are represented by subsequent treatment cards. Every time a new card is presented the error card is presented with it.
• Begin with imitative phase until 90% accuracy across two consecutive training sets is reached. (a training set involves 20-50 responses depending on number of contrasts)
• Progress to spontaneous phase.

Resources/Training:
The following text may be useful in delivering therapy:
Williams, A.L. (2003). Speech disorders resource guide for preschool children. Singular Resource Guide Series. Thomson: Delmar Learning.

Time frame:
One to two years (Williams 2000b)

EVIDENCE:

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7.
Title:
Non-linear phonology

Who:
Bernhardt & Stoel-Gammon, 1994

Explanation:
For years linear phonology has dominated the clinical phonology scene e.g. phonological processes. This relatively recent advance offers a fundamentally different perspective on phonological impairments. Nonlinear phonology (also referred to as ‘autosegmental’, ‘metrical’ and ‘prosodic’) focuses on the hierarchical relationships between phonological units e.g. phrases are made up of words, words are made up of syllables and syllables are made up of onsets and rimes (Bernhardt & Stoel-Gammon, 1994). This new framework enables clinicians to develop a far deeper understanding of a child’s phonological system and thereby plan more specific treatment goals.

Population:
Not specified

Procedure:

• The client’s strengths/needs are identified at different levels of the phonological hierarchy i.e. features, segments, syllable, word and phrase structure.
• Targets are selected according to associated factors such as perceptual deficits, oral mechanism constraints, personality etc (Bernhardt, Stemberger & Major, 2006). If associated factors are involved, early-developing treatment targets may be chosen.
• The intervention procedure will depend heavily on the results of the analysis.
• Bernhardt & Stemberger (2000) propose some examples of strategies to work on in intervention include:
  - Word structure: (length, stress and segment use):
  Fluency strategies: first model slow and rhythmic words, create longer words, introduce words with new stress patterns etc.
  Musical and rhythmic support: emphasise number of syllables or difference between strong and weak syllables through music or drumming.
  Visual support for stress patterns: using podium setups demonstrate strong versus weak syllables e.g. strong syllable is on the highest step.
  - Subsyllabic structure:
  Verbal Stimuli that focus on onset or rime:
  For onset do alliteration, tongue twisters etc.
  For rime do poetry, nursery rhymes and songs.
  Analogies/visual support for onset/rime: metaphonological strategies include labelling onsets as the ‘head’ or ‘engine’ of the word, rimes can be labelled as the ‘tail’ or ‘caboose’.

Resources/Training:
The following text is a helpful resource:

Bernhardt, B & Stemberger, J. (2000). Workbook in nonlinear phonology for clinical application. Austin: Pro-Ed.

Time frame:
Not specified

EVIDENCE:

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8.
Title:
PACT (Parents And Children Together)

Who:
Bowen, 1996

Explanation:
PACT is described as a family-centred approach for children with phonological impairment (Bowen & Cupples, 2006). This program is relatively new to the clinical phonology scene. It’s often referred to as being broad-based and eclectic because PACT takes into account phonemic, phonetic as well as auditory perceptual factors (Bowen & Cupples, 2006).
The rationale behind this approach derives from Ingram’s (1989) theory of phonology which encompasses the following levels:
- how speech sounds are stored in the mind
- how speech sounds are physically articulated
- the phonological rules or processes that link the two previous levels. (Bowen, 1996)
PACT involves 5 main components: parent education, metalinguistics training, phonetic production training, multiple exemplar training and homework. Baker (2006) also describes this program as consisting of procedures common to Minimal Pairs, Cycles and Metaphon however within a family-centred framework.

Population:
Most suited to the 3-6 year old child with functional phonological disorders (Bowen & Cupples, 2006).

Procedure:

• Therapy sessions occur once weekly
• Treatment sessions are usually 50 minutes in length
• The child and clinician spend 30 to 40 minutes alone without parent/carer
• The parent is present in the session for a minimum of 10-20 minutes and maximum of 25 minutes at the end of a session (so that the clinician is able to show the parent what to do as homework)
• Summary of the 5 components from Bowen & Cupples (2006):
  - Parent Education: Parents learn techniques such as modelling, recasting, providing focused auditory input and how to encourage self-correction.
  - Metalinguistic training: The child, clinician and parent discuss speech sounds and how they convey meaning. The clinician uses various games and activities to demonstrate. During this time the clinician also introduces phonological awareness tasks such as rhyming and onset-matching.
  - Phonetic Production training: The clinician teaches the child to correctly produce his/her difficult sounds using stimulability techniques. PACT therapy is generally conducted at the word-level except in stimulability tasks.
  - Multiple Exemplar training: Clinician and parent read aloud word-lists (up to 15 words which include target sound) to the child and the child then learns to sort them according to sound properties.
  - Homework: Parents are instructed to practice with child at home for 5-7 minutes, 1-3 times daily. Homework activities are based on the last therapy session.

Resources/Training:
Not required, although Caroline Bowen’s website provides a comprehensive overview of this program (see reference list for details).

Time frame:
Approximately 10 week blocks alternated with 10 week breaks from therapy. Therapy blocks diminish over time (Bowen, 1996; Bowen & Cupples, 2006)

EVIDENCE:

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9.
Title:
Phonetic Placement

Who:
Van Riper, 1963

Explanation:
Described as “a method for teaching a new sound by the use of diagrams, mirrors or manipulation whereby the essential motor features of a sound are made clear” (Van Riper, 1978, p. 459). This technique appears to be a key component in Traditional Articulation Therapy at the sound level. Van Riper (1963) also described this method as being old and traditional, stating that speech pathologists have used it for centuries.

Population:
Especially useful for individuals with hearing impairments (Van Riper, 1978)

Procedure:
The following is an example from Roth and Worthington (2005, p. 128) of how to use phonetic placement and instruct the child to produce the sounds /k/ and /g/:

1. Put the back of your tongue up against the roof of your mouth and hold your breath for a second.Drop your tongue quickly and release your breath with a coughing sound to produce /k/.
2. Pretend you are a puppet with an imaginary string attached to the back of your head. As I pull the string, raise the back of your tongue against the roof of your mouth. Drop your tongue quickly to allow a sudden escape of air to say /k/ as I let go of the string.
3. (Use a tongue depressor to hold down the tongue tip while at the same time pushing the tongue backward and upward until it comes into contact with the soft palate.) When I remove the tongue depressor, quickly lower the back of your tongue to say /k/.

Resources/Training:
Diagrams and descriptions of various speech sounds

Time frame:
Not specified

EVIDENCE:

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10.
Title:
S-PACK (The S Programmed Articulation and Control Kit)

Who:
Mowrer, Baker and Shutz (1968)

Explanation:
This program has derived from operant learning theory and employs behavioural modification principles. It is one of several ‘programmed’ approaches that has been developed. Another example of a programmed approach is the Monterey Articulation Program which is not discussed here. The S-PACK program is generally used in a 1:1 service delivery model and is predominantly conducted in the clinic or at school. Clinicians administer the program however parents, teachers and teacher-aids may be trained to deliver it also.

Population:
Children with a functional central or frontal lisp (substitution of /th/ for /s/). S-PACK was not designed to target lateral lisps, /s/ omissions, /s/ distortions or substitutions other than /th/ (Mowrer, Baker & Shutz, 1968).
It is suitable for children in Preschool through to Grade 3.

Procedure:

• Criterion Pretest
• Part 1: /s/ in words and short sentences.
• Part 2: /s/ in all word positions and continuous discourse.
• Part 3: /s/ in connected speech and social discourse – parts 1 and 2 are reviewed then /s/ is produced in a story presented through sequences.
• Criterion Posttest (same as pretest)
  

Resources/Training:
Clinicians wishing to use this program will require the following kit:

Mowrer, D., Baker, R. & Shutz, R. (1968). Modification of the frontal lisp programmed articulation control kit manual – S-PACK. Tempe: Educational Psychological Research Associates.

(call number at Latrobe Library Bundoora Audio-Visual Department 618.9285506)

Time frame:
Takes approximately 4 weeks to complete.

EVIDENCE:

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11.
Title:
Speech perception training e.g. SAILS (The Speech Assessment & interactive Learning System)

Who:
Rvachew, 1994 (in collaboration with D.G. Jamieson)

Explanation:
SAILS combines assessment procedures with an intervention program. It was derived from Behavioural Theory and is a form of operant conditioning as it provides modelling. Rvachew (1994) explains that speech perception training has been a controversial topic in the history of speech pathology. Earlier, this form of treatment was referred to as ‘ear training’ which was a period of time preceding sound production activities (Van Riper, 1963).
Rvachew (1994) argues that while many authors have discouraged the use of speech perception training, it happens to already exist as a key component of some other approaches e.g. minimal pairs and auditory bombardment.
Speech perception training like the computerised instruction program, SAILS, acts as an effective supplement to direct clinical intervention (Roth & Worthington, 2005).

Population:
Children who have moderate or severe expressive phonological delays (Rvachew, 2004) without evidence of organic etiology.

Procedure:

• The program runs for 20 minutes and is designed for use in the clinic environment.
• The program is grouped into modules. The clinician creates the modules according to the needs of the child.
• A module contains audio-files and images that are used to target a sound.
• Modules are ordered so that there are increasing levels of difficulty.
• The child hears words depicting an image on the screen. If the child hears the correct word, he/she clicks on the picture. If the audio cue is not correct then the child clicks on the X image.
• SAILS can be adjusted to suit different clinical situations. If it is to be used in an assessment format, then the clinician may adjust the program so that the child is not provided with any contingent feedback.
• At the end of each module the program calculates the results. These can be used to monitor performance over the treatment period.

Resources/Training:
If using the computer-driven program as in the study conducted by Rvachew (2004), the clinician may require the following SAILS program:

AVAAZ Innovations. (1994). Speech Assessment and Interactive Learning System (Version 1.2) [Computer software]. London, Ontario, Canada: Author.

Time frame:
Not specified

EVIDENCE:

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12.
Title:
Traditional Articulation Therapy

Who:
Van Riper, 1963

Explanation:
The approach causes significant confusion as it has come to mean different things to different people. Van Riper (1978) however, probably described traditional articulation therapy best as a sequence of activities for:

1. identifying the standard sound, 2. discriminating it from its error through scanning and comparing, 3. varying and correcting the various productions of the sound until it is produced correctly, and finally, 4. Strengthening and stabilising it in all contexts and speaking situations. This process is usually carried out first for the standard sound in isolation, then in the syllable, then in a word, and finally in sentences. (p. 179)

Van Riper argues that a clinician must work in this hierarchy because if the sound in isolation is misarticulated it will spoil the syllable which spoils the word which spoils the sentence and ultimately impacts on conversational speech. He states, therefore, that the acquisition and use of the sound which is misarticulated should be the clinician’s goal.

Population:
Not specified

Procedure: (see also explanation above)

• Usually only work on one to two target sounds at a time
• Identify the target sound and its characteristics
• Discriminate the target sound from its error
• Make the child aware of speech errors in a positive way so he/she can self-monitor articulation (scanning/comparing)
• Have the child vary their attempts and try correct production again and again. Variation is said to precede approximation
• The new sound needs to be practiced and strengthened or it may be lost. Have the child repeat and prolong the sound using various methods such as ‘babbling’ and ‘simultaneous talking-and-writing’
• Following the sound level, the child should progress through syllable level, word level and finally sentence level (Van Riper, 1978).

Resources/Training:
It may be helpful to become familiar with Van Riper’s method in the following text:

Van Riper, C. (1978). Speech correction: Principles and methods (6th ed.). Englewood Cliffs: Prentice Hall.

Time frame:
Not specified

EVIDENCE:

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