Clinical Methods Final

Final Exam Assessment Report with Evidence-Based Treatment Plan

Emily Edwards & Michelle Handy

Southeastern University
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The topic of speech sound disorders is incredibly broad, as it includes disorders in both

articulation and phonology. We will be focusing our research on phonological disorders and how

they can be treated. According to ASHA, a phonological disorder is a speech sound disorder that

“focuses on predictable, rule-based errors (e.g., fronting, stopping, and final consonant deletion)

that affect more than one sound.” We will be comparing two types of intervention approaches,

phonological contrast, and core vocabulary.

Phonological contrast is a type of intervention that targets speech sound error patterns.

When using this approach, the goal is to reorganize the child’s linguistic system. By showing the

meaningful contrasts of words, the clinician shows the child that phonemes contrast a difference

in meaning. More importantly, the clinician shows the child that these contrasts need to be made

in order to avoid misunderstanding (Crosbie & Dodd, 2005, pg 7). For example, saying the /t/

phoneme instead of the /k/ phoneme completely changes the meaning of the word “key.” When

clinicians are able to point out these differences, children are able to organize sounds into classes

and sequences into structures.

There are four different phonological contrast approaches: minimal oppositions, maximal

oppositions, treatment of the empty set, and multiple oppositions (ASHA). The minimal

oppositions, also known as minimal pairing, uses pairs of words that differ by only one phoneme

or single feature signaling a change in meaning. This approach is most commonly used, as it

clearly targets words that sound similar but have different meanings. Minimal pairing is used

with multiple oppositions when it is possible (Crosbie & Dodd, 2005, pg 14). In the multiple

oppositions approach, pairs of words contrasting a child’s error sound with three or four

strategically selected sounds that reflect both maximal classification and maximal distinction

(ASHA). An example of this would be to reduce backing in pairs like “dough” and “go.”
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Whereas phonological contrast teaches articulation of each spoken sound separately, the

core vocabulary approach focuses on whole-word production because the majority of those with

inconsistent speech disorder are said to have no trouble articulating speech sounds at an age-

appropriate level and it is for children with irregular speech sound production who may be

reluctant to more traditional therapy methods. Inconsistency in speech is characterized by “a high

proportion of differing repeated productions with multiple error types, that include errors at both

the phonemic (e.g. fronting of velars, /h/ deletes word-initially) and syllable level (e.g. syllable

deletion or addition; final consonant deletion)” (McIntosh & Dodd, 2008). This intervention

approach takes a list of a minimum of fifty frequently used words that are important to their

functional communication and from this list, a few words are chosen each week for therapy.

These words consist of peoples names (mom, dad, siblings), places (school, bathroom, home),

function words (please, thank you, sorry), food (drink, dinner, snack), and some of their favorite

things (toys, games, tv). They are then taught their best production and work on it until it is

consistently produced (ASHA). The target of this approach is to get the child to say the word

consistently, not necessarily correctly. It instructs children how to put words together

phonologically, first in single words, then in connected speech (Crosbie et al., 2005).

In core vocabulary, it is very important to be clear about the goal of the treatment, the

types of mistakes made, and the best way to improve them. If any child produced a goal that was

not as good as the optimum output, the clinician would copy the targeted goal and make it clear

that the word was different and how it was different. For example, if the child were to say the

word “dat” when the target word is “sat” the therapist would repeat the way the child had

originally said it, “dat”, and point out the fact that it is different from the way she says it by

addressing that the child said it with a /d/ sound when it should be an /s/. Steer clear of asking
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them to copy what you say because inconsistent children might implement that phonological

plan due to copying rather than coming up with their own strategy for the word. Alternatively,

the clinician gave details on the plan (McIntosh & Dodd, 2008).

Knowing this information, we wanted to see which type of intervention most benefited

those with phonological disorders. To guide our research, we chose one question to compare the

phonological contrast and core vocabulary approaches. Would phonological contrast intervention

or core vocabulary intervention show greater improvement in children who present with

phonological disorders?

There is an important distinction between the types of phonological disorders present in

children. Some phonological disorders are inconsistent while others are consistent. Inconsistent

phonological disorders are present when a child inconsistently produces the same lexical item in

a single-word production task (Bradford and Dodd, 2000, pg 2). Consistent phonological

disorders are present when a child consistently produces the same error pattern. Disorders

characterized by consistent error patterns are considered non-developmental, as these patterns

typically do not occur in normal development.

When both types of intervention are given to students who are either inconsistent or

consistent, the results tend to vary. Phonological contrast & core vocabulary have been given to

children with both types of speech patterns, and differences have been shown when looking at

the results. In one study, it was found that “children with inconsistent phonological disorder

made greatest improvement when they received Core Vocabulary intervention and children with

consistent phonological disorder made greatest progress when they received phonological

contrast therapy (Dodd & McIntosh, 2008, pg 14).” This may be due to difficulty in selecting
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and sequencing phonemes for children whose speech is characterized by inconsistent speech

errors (Dood & McIntosh, 2008, pg 3).

During phonological contrast, clinicians target speech sound error patterns through

specific phonemic sounds. They show that contrasts need to be made in order to avoid

misinterpretation and misunderstanding. When these are made apparent to the client, they are

better able to organize their sounds into structures and sequences. This approach works well for

children with consistent errors because they are able to sequence the phonemes. However,

children with inconsistent errors do not have the ability to come up with a strategy or plan for the

word. Therefore, phonological contrast therapy is not always effective for them.

Because a bulk of children with inconsistent speech disorders are believed to have no

problem articulating speech sounds, the core vocabulary method concentrates on whole-word

production. They have difficulty in organization and planning for a word so the aim of this

intervention is not to say the word correctly, more so, they say the word the same way on a

consistent basis to wire in their brain a plan for that word. Since this is the case, it is imperative

that the clinician does not ask them to repeat what they say because that gives them the plan

instead of describing the plan and making them create it on their own.

Looking at this, it seems as though these interventions have their differences and are

more catered towards one specific group of children in terms of who they work best for. The

phonological contrast approach works best for those who have consistent error patterns and

target those specific phoneme sounds that need to be worked on. This makes it easier for the

clients to organize their sounds into sequences and structures which is a giveaway that this would

not be as beneficial for those who have an inconsistent phonological disorder. Core vocabulary is

what the children who are inconsistent need to improve their phonological error patterns. They
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need help in planning and coming up with a strategy for the word they struggle with. Saying the

word the same way consistently is much more important than saying it correctly in this instance.

However, children who already have consistent error patterns are more in need of finding a way

to organize specific phonemic sounds into sequences.

It is difficult to justify one of the interventions over the other because of these

differences. There is evidence of both of these interventions being effective in treating

phonological disorders. It seems as though phonological contrast approaches work really well for

children who are already consistent in their speech sounds (Dodd & McIntosh, 2008, pg 14).

This is because they are able to organize sounds into classes and sequences into structures seeing

the contrast of the meaning of words. This approach is not as helpful for students who produce

speech sound errors inconsistently for more than one reason. On the other hand, core vocabulary

works really for building consistency among children who present with inconsistent speech

sound errors. Core vocabulary targets producing the sounds in whole words more consistently. It

is possible that phonological contrast would be beneficial for a child with a developmental,

inconsistent phonological disorder after they have received core vocabulary training (Bradford

and Dodd, 2000, pg 20).

As aforementioned, both of these interventions are effective ways of treatment for

children with phonological disorders. Each strategy is catered to a different population of

children with phonological disorders. However, if we had to choose just one intervention over

the other we would pick core vocabulary. While phonological contrast works very well with

those who have a non-developmetal consistent phonological disorder, it is believed that a larger

number of children have a developmental inconsistent phonological disorder. Because of this,

core vocabulary is the better intervention for treating phonological disorders as a whole.
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Works Cited

American Speech-Language-Hearing Association (n.d.) Speech Sound Disorders: Articulation

and Phonology. (Practice Portal). Retrieved December, 5th, 2022, from www.asha.org/Practice-

Portal/Clinical-Topics/Articulation-and-Phonology/.

Crosbie, S., Holm, A., & Dodd, B. (2005). Intervention for children with severe speech disorder:

A comparison of two approaches. International Journal of Language & Communication

Disorders, 40(4), 467–491. https://doi.org/10.1080/13682820500126049

Dodd, B., & Bradford, A. (2000). A Comparison Of Three Therapy Methods For Children With

Different Types Of Developmental Phonological Disorder. International Journal of Language &

Communication Disorders, 35(2), 189–209. https://doi.org/10.1080/136828200247142

McIntosh B, & Dodd B. (2009). Evaluation of Core Vocabulary intervention for treatment of

inconsistent phonological disorder: three treatment case studies. Child Language Teaching &

Therapy, 25(1), 9–29. https://doi-org.seu.idm.oclc.org/10.1177/0265659008100811