A comparison of therapy approaches: multiple oppositions and maximal oppositions in phonological intervention ���

Melanie Carlson, B.S. & Abbie Olszewski, Ph.D., CCC-SLP ���University of Nevada, Reno���

Introduction

§  Children with moderate to severe phonological

impairments typically present with multiple phonemic collapses.

§  Multiple oppositions is a treatment approach in phonological intervention which contrasts several target sounds to a comparison sound.

§  Maximal oppositions is an intervention approach which targets several error sounds within the same phoneme collapse and contrasts them to the child’s production.

§  Research shows that children with multiple phonemic collapses benefit from both multiple and maximal oppositions.

The purpose of this research project was to:

Determine which approach to intervention, multiple oppositions (I) or maximal oppositions (C), results in faster acquisition of error sounds (O) in preschool aged children with moderate to severe phonological impairments (P).

I am a graduate student clinician at the University of

Nevada, Reno. I have a three-year-old client with

phonological disorder. Her test results indicate that

she reduces all clusters to single sounds, but is

stimulable for some clusters. An area of concern is

intelligibility. During the fall 2013 semester, I took

advanced speech pathology, which focused on

phonology. The instructor provided research proving

that effective phonological intervention

approaches include maximal and multiple

oppositions due to the fact that each approach treats

higher order, later developing phonemes, which can

bring about greater change in the child’s

phonological system without direct treatment. My goal

is to determine which approach is most beneficial for

my client.

Search terms: multiple oppositions, maximal

oppositions, phonology, and intervention

Electronic databases:

• PsychInfo

• ERIC

• PubMed

Ten research articles were appraised and evaluated for validity

and reliability.

Purpose

Results

Method

Discussion

References

Title/Authors/Date/Research Design

Purpose of Investigation

Participants

Dependent Variable

Results

Intervention efficacy and intensity for children with speech sound disorder

Allen (2013)

Quasi-Experimental

Examine the effect of dose frequency of intervention on phonological performance using the multiple oppositions approach.

N=54

 

• Preschool children

• Speech sound disorder (SSD)

Percentage of consonants correct (PCC)

Groups:

P1: 1x/wk

P3: 3x/wk

C: story book

PCC

After 8 weeks P3 > P1, ANCOVA p = 0.02, partial η2 = .15

After 24 sessions P3 > P1, ANOCVA p =.049, partial η2 = .11

The group that attended sessions three times a week for 8 weeks (P3) showed significant changes in phonology, more than the group receiving intervention once weekly for 24 weeks (P1) or the control group (C)

 

P3 adjusted mean (M = 63.7%) was significantly larger than P1 (M = 59.3%)

Intervention for children with severe speech disorder: A comparison of two approaches

Crosbie, Holm, & Dodd (2005)

Single Subject Multiple Baseline

Examine the effect of two different therapy approaches on speech accuracy and consistency of word production of children with consistent and inconsistent speech disorder.

N=18

 

• 4;8-6;5 years

• Severe speech disorder

Percentage of consonants correct (PCC)

 

PCC

Alternating phonological and morphosyntactic goals may be preferable when children have co-occurring deficits

• The effect of therapy on consistency of word production and on speech accuracy were significant p < 0.05

The efficacy of treatment for children with developmental speech and language delay/disorder: A meta-analysis

Garrett & Nye (2004)

Meta-analysis

Examine the effect of intervention on expressive and receptive phonology, syntax, and vocabulary, as a result of combined parent/clinician treatment, clinician treatment only, or parent treatment only.

13 studies

• Preschoolers to adolescents

• Primary developmental speech and language delays/disorders

 

Expressive phonology

Receptive phonology

 

Expressive phonology

• d = 0.67 for clinician treatment only

• d = 0.44 for combined parent/clinician treatment

Receptive phonology

• d = 0.53 for combined parent/clinician treatment

• d = 0.53 for parent treatment only

Maximal opposition approach to phonological treatment

Gierut (1989)

Single Subject Multiple Baseline

Examine a phonological treatment program of maximal rather than minimal feature contrasts by recording the course of learning in child with a systematic error process.

N=1

• 4;7

• Severe phonological disorder

Number of consonants correct (NCC)

NCC

Improved from using only four phonemes word-initially (/m/, /b/, /w/, and /j/) to using 20 consonants word-initially after having three sets of training on maximal opposition contrasts. The change was evaluated using treatment and generalization probe measures.

Severe speech sound disorders: An integrated multimodal intervention

King, Hengst, & DeThorne (2013)

Single Subject Multiple Probe

Examine the effect of integrated multimodal intervention (IMI) in treating severe speech sound disorders.

N=3

• 4-8 years

• Severe speech sound disorders

Speech sound accuracy in target words

Speech Sound Accuracy in treatment words

• John: 0% (baseline) to 55.3% (post-treatment)

• Thomas: 0% (baseline) to 73.5% (post-treatment)

• Luke: 13.2% (baseline) to 53.4% (post-treatment)

Outcomes of different speech and language goal attack strategies

Tyler, Lewis, Haskill, & Tolbert (2003)

 

Quasi-Experimental

Examine phonological and morphosyntactic change using different goal attack strategies.

N=47

 

• Preschoolers

• 3;0-5;11

• Impairments in both speech and language

Speech sound accuracy in treatment words across different intervention strategies

Speech Sound Accuracy in treatment words across different interventions

• Morphosyntax first group: p = .05, d = .85

• Alternating group: p = .03, d = .94

• Simultaneous group: p = .01, d = 1.22

• Phonology first group: p = .06, d = .81

Clinical Scenario

• Both maximal and multiple oppositions are beneficial in brining about greater phonological change in those with severe phonological impairments.

• Training broadly may help bring in additional phonemes without direct treatment using the multiple oppositions therapy approach.

• Using the maximal oppositions therapy approach to contrast phonemes that are not in the child’s phonological system with phonemes that are in the system helps them to make distinctions.

• The appropriateness of each therapy approach depends on the temperament and specific system collapses of the child.

• Multiple oppositions may result in faster acquisition of error sounds in my three-year-old client with phonological impairment.

Allen, M. M. (2013). Intervention efficacy and intensity for children with speech sound disorder. Journal of

speech, language, and hearing research, 56, 865-877. doi:10.1044/1092-4388(2012/11-0076)

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

comparison of two approaches. International Journal of Language and Communication Disorders, 40(4),

467-491. doi: 10.1080/13682820500126049

Garrett, J. & Nye, C. (2004). The Efficacy of Treatment for Children with Developmental Speech and

Language Delay/Disorder: A Meta-Analysis. Journal of Speech, Language, and Hearing Research. 47,

924-943. doi:10.1044/1092-4388(2005/077)

Gierut, J. A. (1989). Maximal opposition approach to phonological treatment. Journal of Speech and Hearing

Disorders, 54, 9-19. doi:10.1044/jshd.5401.09

King, A. M., Hengst, J. A., & DeThorne, L. S. (2013). Severe speech sound disorders: an integrated

multimodal intervention. Language, Speech, and Hearing Services in schools, 44, 195-210. doi:

10.1044/0161-1461(2012/12-0023)

Tyler, A.A., Lewis, K.E., Haskill, A., & Tolbert, L.C. (2003). Outcomes of different speech and language goal

attack strategies. Journal of speech, language, and hearing research, 46, 1007-1094. doi:

10.1044/1092-4388(2003/085)

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