phonological processes

My child’s speech is hard to understand. Which therapy approach is appropriate?

David Kinnane · 17 January 2021 ·

Speech sound disorders are some of the most common communication disorders for preschoolers.

Having a speech sound disorder increases risks for later difficulties with school performance, reading, social skills, and employment opportunities. Early help from a speech pathologist is recommended.

No universal treatment solution exists for speech sound disorders, in part because of the:

diversity of people with speech issues; and
number of speech sound disorder subtypes and causes, including motor programming issues (as in childhood apraxia of speech), and speech issues associated with sensory or anatomical differences (e.g. hearing impairments and cleft palates).

For the majority of children with speech sound disorders, there is no known cause.

Speech error types include:

articulation-based errors that don’t on their own have a major impact on speech clarity, like lisps; and
phonologically-based, patterns of errors, which affect multiple speech sounds across different classes, and which can make children hard to understand.

Some children make both types of errors.

Which approaches are appropriate?

For children with isolated articulation errors, traditional motor-based articulation approaches and treatments based on principles of motor learning may be appropriate.
For children with mild-to-moderate, consistent phonological deficits, Minimal Pairs therapy may be appropriate.
For children with moderate-to-severe phonological deficits that include the use of a “preferred” speech sound, Multiple Oppositions therapy may be appropriate.
For children with phonological deficits and who cannot say six or more speech sounds, Maximal Oppositions therapy may be appropriate.
For children with multiple patterns of phonological errors who are very hard to understand, Cycles phonological remediation and Complexity therapy approaches may be appropriate.

Summaries of these treatment approaches are available here on our website (see ‘Related articles’ below). In practice, many speech pathologists ‘mix and match’ different approaches to tailor therapy for the client in front of them.

We need more, higher quality research studies to guide us on which approaches are more effective than others, and when, to help children with speech sound disorders.

For an accessible audio version of the infographic, check out our video below:

Principal source: Cabbage, K.L. and DeVeney, S.L (2020). Treatment Approach Considerations for Children with Speech Sound Disorders in School-Based Settings. Topics in Language Disorders, 40(4), 312-325.

Related articles:

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

How to treat speech sound disorders 3: Contrastive Approach – Minimal and Maximal Pairs (with demo)

Vivien Wong · 2 February 2019 ·

Apart from the Cycles Approach and the Complexity Approach, the “Contrastive Approach” is another common way to treat children with phonological speech disorders. In this article, we explore both the so-called “Minimal Pairs Approach” and the “Maximal Pairs Approach”. Both are contrastive approaches and are used for phonological intervention.

Let’s dive into the nuts and bolts of these two approaches.

Who developed them?

The Minimal Pairs Approach was developed by Dr Frederick F. Weiner, whilst the Maximal Pairs Approach was developed by Professor Judith Gierut and her colleagues at Indiana University.

Who is it for?

The Minimal Pairs Approach is suitable for children with mild or moderate speech sound disorders, with one or two phonological processes that are no longer age-appropriate. It can also be used with people who are looking to modify their accent.
The Maximal Pairs Approach is geared towards children with at least six sounds missing from their speech sound inventories with normal oral and speech motor abilities.

What are they?

In essence, both approaches focus on contrasting differences between phonemes (i.e. speech sounds) in order to reorganise a child’s sound system.

Phonemes can differ by:

Place – some sounds are made with the lips, tongue tip or the back of the tongue.
Manner – some sounds uses a long continuous flow of air (e.g. /s/, /z/), some sounds are short and stop as soon as they begin (e.g. /t/, /p/), etc.
Voicing – we switch our voices on to make some sounds (e.g. /b/, /g/), but turn our voices off for others (e.g. /p/, /k/).

In the case of a minimal pair, the two words differ by a single phoneme and by one or two features across place and manner of articulation and voicing.

For example, let’s look at the pair “cap” and “tap”. These two words are identical in terms of the vowel /ae/ and final consonant /p/. They only differ by the initial phoneme – /k/ and /t/ – and this involves a small difference in place of production (velar vs alveolar).

In comparison, a maximal pair includes two words that differ by a single phoneme across many featural dimensions of place, manner and voicing. An example would be the pair “be” and “see”, where the phonemes /b/ and /s/ differ across all three aspects of place (labial vs coronal), manner (stop vs fricative) and voicing (voiced vs voiceless).

In both approaches, the paired words would contain a sound a child is familiar with and a target (unfamiliar) sound.

What happens in the sessions?

For the Minimal Pairs Approach:

Identify the target phonological process. For example, a 3-year-old boy, Ben, has voicing errors. He “turns off” his voice at the start of his words when he should be “turning it on” (e.g. he says “pig” instead of “big”). In this case, we want Ben to say /b/. We call this the “target”.
Before the session, select 3-5 minimal pairs of words that contrast the paired phonemes. According to research, only three to five word pairs are needed to make permanent changes in a child’s phonological system (Elbert et al., 1991). In Ben’s case, we can choose pig/big, pay/bay, park/bark, peg/beg, pea/bee.
Introduce the minimal pair words to the child by showing them pictures of the pairs and naming them aloud. We want to make sure Ben knows the vocabulary – this is sometimes tricky when contrasting sounds with few word options.
Have the child point to the words you name. This gives us an idea whether the child can hear the difference between the two contrasting phonemes (e.g. /p/ vs /b/). This is sometimes called auditory discrimination.
Now, reverse the roles and have the child name the words.
When the child uses the “wrong sound” (e.g. pig) for the target (e.g. big), pick up the picture that the child named and not the one intended. For example, when Ben points to the picture card big but says, ‘pig’, pick up the picture of the pig.
Give the child feedback to signal he/she has made a mistake. In Ben’s case, I might say, “Oh, do you mean pig or big? I’m not sure what you mean, tell me again.” This is the teaching moment, where Ben learns he needs to say the word differently for others to understand him.
Work with the child till he/she gets it right about 60% of the time.
Move onto the other paired words (one set at a time) at sentence level. You can use carrier phrases at this stage.

Here’s a demonstration (voice and hand talents Vivien Wong and Cherie Finocchiaro):

For the Maximal Pairs Approach:

Identify the two target phonemes. For example, the sounds /m/ and /f/ are maximally opposed across by place, manner and voicing (with /m/ being a bilabial voiced nasal and /f/ being a labiodental voiceless fricative). Remember the pair should include a known versus an unknown phoneme.

Create eight pairs of words containing the target phonemes. Where no true words are available, use nonsense words, which could be associated with different monster or fairy names. For example, Mip/Fip.

Have the child imitate you and then say it on their own.

In both approaches, we also plan to add auditory bombardment and discrimination tasks.

How long does it take?

Like other approaches, the duration of therapy required is dependent on the child, the child’s phonological processes, the amount of treatment within sessions and home practice. The more repetitions we could fit into our sessions, the better.

As both approaches are suited for children with mild-to-moderate phonological impairments, with only a few age-inappropriate errors remaining, in theory at least, it should take less time than more intensive treatment approaches such as Cycles.

The idea is that, once a difference between phonemes is introduced, the gains are likely to “transfer” to untreated phonemes. (You can read more about this here.)

What does this mean?

If we think back to our earlier example with Ben, the phonemes /p/ and /b/ differ only by voicing (voiceless vs voiced). If Ben learns to “turn on” his voice in treatment of /p/ vs /b/ pairs, this same voicing contrast should be carried over to other voiceless-voiced pairs such as /t/-/d/ or /k/-/g/.

Does it work?

The Minimal Pairs Approach has been used for over twenty years, with a robust body of research supporting its clinical effectiveness (Barlow and Gierut, 2002). Tyler, Edwards and Saxman (1987) also found that this approach was best suited for children with only one or a select few phonological processes. Research comparing both the Minimal and Maximal Pairs Approach found that targeting a maximally opposed pair led to greater generalisation than a minimally opposed pair.

It is important to note that to date, most of the studies on contrast approaches are fairly small, without control groups. The current main body of available evidence is based primarily on non-randomised experimental and non-experimental studies (Baker & McLeod, 2004). More higher-quality research would help clinicians (and our clients).

Helpful Resources:

Head over to leading speech pathologist Caroline Bowen’s website, for her incredibly extensive library of useful information about both approaches, as well as her widely used resources for therapy.

Related articles:

Principal sources:

Baker, E., & McLeod, S. (2004). Evidence-based management of phonological impairment in children. Child Language Teaching and Therapy, 20(3), 261–285. Abstract available here.
Barlow, J., & Gierut, J. (2002). Minimal Pair Approaches to Phonological Remediation. Seminars In Speech And Language, 23(1), 057–068. Abstract available here.
Elbert, M., Powell, T., & Swartzlander, P. (1991). Toward a Technology of Generalization: How Many Exemplars Are Sufficient? Journal of Speech, Language, and Hearing Research, 34(1), 81–87.Abstract available here.
Tyler, A.A., Edwards, M.L., & Saxman, J.H. (1987). Clinical application of two phonologically based treatment procedures. Journal of Speech and Hearing Disorders, 52m, 393-409.

Image: https://tinyurl.com/yck6xsfg

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

FAQ: 10 common speech error patterns seen in children of 3-5 years of age – and when you should be concerned

David Kinnane · 22 July 2015 · Leave a Comment

Speech is a wonderfully complex skill, and children need lots of practice to learn how to do it. As with any motor skill, children make plenty of mistakes as they learn to speak clearly.

In English, we hear several common patterns of error in children’s speech as they grow up. Here are 10 common types of error pattern, and the approximate age by which we expect them to be ‘fixed’ (gone) in typically developing children:

1. Assimilation:

Lala wants the lellow kuk. (Lara wants the yellow truck.)

It’s human nature to do as little work as possible, and our tongues, lips and other ‘articulators’ can be just as lazy as the rest of us! Often one sound in a word will affect one or more other sounds in the word. This is called assimilation (or consonant harmony). Sometimes, the first sound in a word will change later sounds, e.g. if the child said ‘beb’ for ‘bed’. This is called progressive assimilation. Other times, later sounds in a word affect earlier sounds, e.g. if a child says ‘lellow’ for ‘yellow’. This is called regressive assimilation.

When to consider seeking help: if assimilation is still a feature of your child’s speech at the age of 2½-3 years of age.

2. Reduplication:

The taitai needs wawa. (The tiger needs water.)

When children repeat a syllable twice, rather than pronouncing both syllables of the word, they can sound a bit like babies babbling (e.g. mama, dada). When we hear it in 3-5 year olds, we call this error pattern reduplication. It almost always happens when the child repeats the stressed syllable twice, at the expense of the weak syllable, e.g. as in tiger and water above.

When to consider seeking help: if your child is 2½-3 years old or older and reduplicating syllables more than occasionally.

3. Voicing:

I fount a pek for the bram. (I found a peg for the pram.)

The sentence above makes no sense whatsoever. But it allows me to illustrate voicing errors. In English, we produce some of our sounds with our vocal cords apart. These are called unvoiced sounds, which include sounds like p, t, k, s and sh. For other sounds, we bring our vocal cords together to ‘turn on’ our voices. These are called voiced sounds and include b, d, g, z and n. It takes a lot of control to turn your voice on and off during speech, and it’s not unusual for some children to make errors like not voicing sounds when they should (e.g. pek instead of peg) or voicing sounds when they shouldn’t (e.g. bram instead of pram).

Age at which you should you consider therapy: 3 years (or younger if your child is being teased for it).

4. Final consonant deletion:

Gi me my du ma ba. (Give me my duck mat back.)

Young children often omit the final consonants in their words. This is called (appropriately enough) final consonant deletion. It can have a big impact on how easy your child is for others to understand – could you understand the example sentence above without the translation?

When to consider seeking help: if your child is regularly omitting final consonants in words at the age of 3 years, 3 months.

5. Fronting:

Sorn tan’t find any eds to teep. (Sean can’t find any eggs to keep.)

This type of error is called fronting. It occurs when sounds normally produced with the tongue positioned at the back of the mouth (e.g. k, g and sh) are instead produced with the tongue positioned towards the front of the mouth (e.g. like t, d, and s).

Age at which you should you consider therapy: 3½-4 years of age (or younger if your child is hard for others to understand or being teased for it).

6. Stopping:

Da ban crac into dit debra. (The van crashed into this zebra.)

This ghoulish sentence illustrates stopping. In English, many speech sounds can be stretched out and held continuously until you run out of breath. Sounds like s, z, f, v and th, are good examples. Other speech sounds can’t be held continuously, e.g. p, b, t, d, k and g, which are all examples of ‘plosives’. It’s common for young children to substitute plosives for continuous sounds. We call this ‘stopping’ because the children are ‘stopping’ the sounds, e.g. turning the ‘this’ with its nice continuous ‘th’ and ‘s’ sound into ‘dit’.

Age at which you should you consider therapy:

3 years of age for ‘f’ or ‘s’ (or younger if your child is being teased for it);
3½ years of age for ‘v’ or ‘z’ (or younger if your child is being teased for it);
4½ years of age for ‘sh’, ‘j’ or ‘ch’ (or younger if your child is being teased for it); and
5-7 years of age for ‘th’ (as in ‘thin’) and ‘th’ (as in ‘the’) (or younger if your child is being teased for it).

7. Weak syllable deletion:

The efant needs a brela. (The elephant needs an umbrella.)

When we speak, we don’t emphasise each of our syllables equally. For example, in the word ‘telephone’, we usually place the stress on the ‘te’ and ‘phone’, leaving the ‘le’ syllable in the middle un-stressed and weak. In ‘umbrella’, we stress the ‘bre’, leaving the ‘um’ unstressed and weak. I’ll spare you a lecture about Trochaic and Iambic stress patterns in English. Why I mention stress patterns is that it’s common for young children to omit weak syllables. We call this weak syllable deletion.

Age at which you should you consider therapy: 4 years (or younger if your child is being teased for it).

8. Cluster Reduction:

There’s a ‘cary ‘pider in my room! (There’s a scary spider in my room!)

Many words in English contain combinations or ‘clusters’ of consonants, e.g. squawk, crab or flower. It’s common for young children to omit one or more of the consonants in a cluster (so called cluster reduction), and there are some clever rules of thumb speech pathologists use to help us predict which ones.

Age at which you should you consider therapy: 4-5 years (or younger if your child is hard for others to understand or is being teased for it).

9. Deaffrication:

I broke my wash on the frids door. (I broke my watch on the fridge door.)

This one has a fancy name – deaffrication. Let me explain: in English, ‘ch’ and ‘j’ are actually made up of two sounds each. Ch = t + sh. J = d + zh (as in measure or vision). Affricate comes to us via German from the same Latin root as friction, meaning ‘rub together’. Because they are made by rubbing together two sounds, ch and j are called affricates. It’s common for children to drop one of the two sounds (i.e. to de-affricate them), e.g. the ‘t’ in watch.

Age at which you should you consider therapy: 5 years of age (or younger if your child is being teased for it).

10. Gliding:

The wabbit woves wed wibbons. (The rabbit loves red ribbons.)

We call this error pattern gliding. It’s most common with r and l. Two year olds who glide are often praised for their cuteness. Gliding is not so adorable when you’re seven.

Age at which you should you consider therapy: 5-6 years of age (or younger if your child is being teased for it).

Other considerations

In reality, young children – especially 2 and 3 year olds – often make many of these errors in the same sentence, e.g. ‘dec a tary fwigt’n pider in my woo’. This can make it very difficult for adults who don’t know a child well to understand what he or she is trying to communicate.

The above suggested ages for considering seeking help are, of course, only guides. You are the expert on your child and you should always feel free to discuss your child’s speech development with a speech pathologist.

As a general rule, if:

your child’s speech is noticeably less developed or easy to understand than that of his or her peers;
your child shows signs of anxiety or frustration about his or her speech;
your child is self-conscious about his or her speech, or is being teased or bullied;
your child’s childcare, pre-school or school teachers flag concerns about your child’s speech;
you simply want to check that there’s nothing to worry about; or
your child’s speech features any of these error patterns at 5 years of age,

we recommend you contact a speech pathologist to discuss your concerns.

Principal sources: Dodd, Hua, Crosbie, Holm & Ozanne (2002); Grunwell (1987); McLeod (1996); Bowen (1998).

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