What are the primary treatment strategies used in articulation or motor-based approaches for speech sound disorders?
The primary strategies utilized in motor-based approaches include:
Auditory stimulation or imitation: The clinician provides a model of the target sound for the client to imitate. The level of difficulty can be modified by adjusting the time from auditory model to the child’s production (Jakielski, 2011; Strand, Stoeckel, Baas, 2006; Strand & Skinder, 1999). As the amount of time from the presentation of the model to when the child produces or imitates the model increases, the level of task difficulty also increases (Strand, Stoeckel, Baas, 2006). Simultaneous imitation, or choral imitation, is when the clinician and the child produce the target at the same time. Mimed imitation is when the clinician silently mouths the target, providing a visual model of articulatory postures, as the child observes and then the child produces the target aloud (Jakielski, 2011). Immediate imitation is when the child repeats the target immediately following the clinician’s auditory model. Imitation in successive repetition is when the clinician provides a verbal model and the child produces the target several times in succession without receiving an additional model (Jakielski, 2011). Delayed imitation is when the child produces the target several seconds after the clinician provides the model, including additional linguistic information (Strand et al., 2006). For example, the clinician might say, “This is a cat. He has black and white fur. What is this?”
Phonetic placement: When a client is not able to produce the target sound in imitation, the clinician begins providing instruction for the correct position or placement of the articulators for production of the sound. The verbal instructions include descriptions of the positioning of the articulators, the points of contact between the articulators, and the motor movements needed to accurately produce the target sound. For example, the clinician may instruct the child to “make your upper teeth touch your lower lip and blow air to produce the /f/ sound”. Visual or physical/tactile strategies that may be incorporated into the phonetic placement approach include: directly observing the mouth and placement of the articulators (Secord et al., 2007), using a mirror for visual feedback, drawings that depict the position of the articulators (McLeod & Singh, 2009), and the use of tongue blades to manipulate the articulators (Bleile, 2006; Secord et al., 2006) or to direct the airstream.
The procedure for successive approximation involves the shaping of new sounds from sounds or articulatory postures in the clients existing sound inventory. This approach builds from the placement of an existing sound that is similar to the target sound. Analysis of the existing inventory and the potential targets may reveal phonemes that share common production features. The existing sound serves as the starting point. Through successive modification or adjustments in either the position or movement of the articulators or the manner of production, each step results in a closer approximation of the target sound. For example, the phoneme /t/ may be used to facilitate the correct production of /s/ (Secord et al., 2007). The alveolar place of articulation is similar for both sounds. When the client is instructed to release the /t/ with a strong burst of air, while slowly retracting the tongue lightly from the alveolar ridge, the resulting sound can be prolonged and will approximate a /s/ sound. Once a sound close to the target is produced, auditory stimulation, imitation, or phonetic placement strategies can be utilized to refine the production accuracy of the target phoneme.
Contextual facilitation: Another strategy for establishing a sound involves identifying a phonetic context that results in a correct production, even when the sound is typically produced in error in other contexts (Bleile, 2006). Some contexts may facilitate the correct production of a sound. If a context that results in the correct production of a sound can be identified, that context can facilitate correct production of the sound in other contexts. An example of a facilitating context is the phoneme /t/ before the phoneme /s/. The articulatory contact of the tongue tip elevated to contact the alveolar ridge may facilitate correct production of the /s/ sound that may otherwise be produced as an interdental phoneme. In this example, a word pair such as hot-seat would provide a potential facilitating context to establish a correct sound production of /s/. This strategy of using a phonetic context to establish a new sound production builds from an existing skill in the client’s speech production abilities. In this way, the strategy is also considered to be a form of shaping. One phonetic context is being utilized to shape, elicit, and establish production of a target phoneme.
Methaphonological cues and metaphors: Metaphonological cues are verbal cues provided by the clinician that reflect information about either an acoustic or visual feature of the target sound that the child needs to use (Howell & Dean, 1994). For example, a child may say [ti] for the word “see”. The clinician might respond with, “I heard you use a short sound when you said ‘see’. Try saying it again with a long sound like ‘sssss’.
Metaphors can be used as a means for describing a sound or prosodic features of sounds (Fish, 2011). This strategy allows a rich context for talking about and defining sounds targeted in therapy. For example, [ʃ] may be described as the “quiet sound” and may also be accompanied by a single finger gesture to the mouth when the sound is modeled. Using metaphors or metaphonological cues provides a clinician with a way to prompt the client without providing a model for imitation.
Please refer to the SpeechPathology.com course, 20Q: Speech Sound Disorders: "Old" and "New" Tools for more information on the clinical management of speech sound disorders, including target selection and intervention strategies.