Question
I was wondering what therapy approach or technique I should use with a client who is in 3rd grade and is highly unintelligible.
Answer
If you don't have strong assessment information on this child, I would start there. I would do a complete phonological error pattern analysis using one of the published products (e.g. Bankson Bernthal Test of Phonology, Hodson Assessment of Phonological Patterns, Khan Lewis) or your own phonological analysis. I would also want to know if there are other structural, motor, cognitive concerns. I would also want to examine whether there are indications of apraxia.
If these analyses show that the child exhibits a phonological disorder, I would consider using Hodson's cycles approach -- or examine the work of Gierut and colleagues to consider how to select targets based on phonological knowledge, developmental issues, etc. If the child does have a phonological disorder without other complications, then it is critical to use an approach that offers the opportunity for rapid widespread change in the child's phonological system. Approaches that target groups of sounds at the time based on phonological error patterns can support such change.
If a good assessment suggests other complications that may be causing the child's lack of intelligibility, then a different or combined approach may be warranted.
The following are references that give both broad information about treating children who are unintelligible and also specific information about the approaches that I have mentioned.
Bernthal, J., Bankson, N., (2004). Articulation and Phonological Disorders. Pearson.
Bleile, K. (2004) Manual of articulation and Phonological Disorders: Infancy through Adulthood. Thomson Delmar Learning
Hodson, B., Paden, E. (1990). Targeting Intelligible Speech: A Phonological Approach to Remediation. ProEd
Gierut, J. (2001). Complexity in phonological treatment: Clinical factors. LSHSS, 32, 229-241.
Gierut, J. (1998) Treatment efficacy: Functional phonological disorders in children. JSLHR, 41, S85-S100.
Nancy Creaghead is a speech-language pathologist and professor at the University of Cincinnati, where she teaches in the area of language disorders in preschool and school-age children. She can be reached at nancy.creaghead@uc.edu
