General and nonlinear phonological intervention perspectives for a child with a resistant phonological impairment

An N-of-1 Randomized Controlled Trial of Interventions for Children With Inconsistent Speech Sound Errors

Purpose The aim of this study was to test the hypothesis that children with inconsistent speech errors would respond differentially to 1 of 3 specific interventions depending on their primary underlying impairment: Children with deficient motor planning were expected to respond best to an auditory-motor integration (AMI) intervention, and children with deficient phonological planning were expected to respond best to a phonological memory and planning (PMP) intervention. Method Twelve participants were diagnosed with a motor planning (n = 7) or phonological planning (n = 5) deficit based on a comprehensive assessment, which included the Syllable Repetition Task as an important source of diagnostic evidence. An N-of-1 randomized controlled trial was used. Each child experienced all 3 interventions: AMI, PMP, and control (CTL); however, these interventions were randomly allocated to sessions within weeks (3 sessions per week × 6 weeks for 18 sessions). The AMI intervention procedures targeted knowledge of the acoustic-phonetic target and integration of auditory and somatosensory feedback during speech practice. The PMP intervention procedures targeted segmenting and recompiling the phonological plan for each word. The CTL intervention was standard drill practice. The child was taught 5 pseudowords in a meaningful context in each intervention condition. Results Same-day (SD) probes assessed transfer from taught pseudowords to untaught real words, and next-day (ND) probes assessed retention of that learning. Nonparametric resampling tests with pooling of p values across children with the same diagnosis were used to assess the results. Pooled p values indicated a significant benefit of AMI over PMP for the group with a motor planning deficit (p = 2.01E-04 for SD probes and 2.97E-03 for ND probes) and a significant benefit of PMP over AMI for the group with a phonological planning deficit (p = 1.22E-02 for SD probes and 1.32E-02 for ND probes). Response to the CTL intervention was variable within groups. Conclusion In this study, the child's underlying psycholinguistic deficit helped to predict response to intervention.

A Randomized Trial of 12-Week Interventions for the Treatment of Developmental Phonological Disorder in Francophone Children

PURPOSE

This study was designed to test the relative efficacy of different combinations of intervention approaches when targeting speech production accuracy and phonological awareness skills. All children received individual speech therapy, a home program, and a small-group phonological awareness intervention.

METHOD

Sixty-five 4-year-olds with a developmental phonological disorder received these intervention components in different combinations over 12 weeks, resulting in 4 groups: output-oriented individual intervention and articulation practice home program, output-oriented individual intervention and dialogic reading home program, input-oriented individual intervention and articulation practice home program, and input-oriented individual intervention and dialogic reading home program.

RESULTS

A significant interaction of the individual treatment condition and the home program condition was observed for 2 outcome measures: targeted feature match (which reflected changes in speech production accuracy for features and word shape structures that were targeted in therapy) and explicit phonological awareness skills.

CONCLUSION

In this context, in which the children received a brief period of direct therapy and a home program component provided sequentially, the most effective strategy was to teach the parents to use treatment procedures at home that were congruent with the direct therapy component.

Clinical implications of dynamic systems theory for phonological development

PURPOSE

To examine treatment outcomes in relation to the complexity of treatment goals for children with speech sound disorders.

METHOD

The clinical implications of dynamic systems theory in contrast with learnability theory are discussed, especially in the context of target selection decisions for children with speech sound disorders. Detailed phonological analyses of pre-and posttreatment speech samples are provided for 6 children who received treatment in a previously published randomized controlled trial of contrasting approaches to target selection (Rvachew & Nowak, 2001). Three children received treatment for simple target phonemes that did not introduce any new feature contrasts into the children's phonological systems. Three children received treatment for complex targets that represented feature contrasts that were absent from the children's phonological systems.

RESULTS

Children who received treatment for simple targets made more progress toward the acquisition of the target sounds and demonstrated emergence of complex untreated segments and feature contrasts. Children who received treatment for complex targets made little measurable gain in phonological development.

CONCLUSIONS

Treatment outcomes will be enhanced if the clinician selects treatment targets at the segmental and prosodic levels of the phonological system in such a way as to stabilize the child's knowledge of subcomponents that form the foundation for the emergence of more complex phoneme contrasts.