Asmy Anto

M.Sc. (ASLP)-II

CURRENT LITERATURE IN CLINICAL

PHONOLOGY

INTRODUCTION

For the past 20 years, linguistics has influenced the study of

communication disorders by providing new theoretical frameworks and
innovative clinical approaches to the field of speech-language pathology.
Basic linguistic constructs such as phoneme, morpheme, and distinctive
feature are now integral parts of descriptions of speech and language
disorders. Application of linguistic theory has led to significant changes in
assessment and intervention procedures.

Chomsky and Halle's (1968) introduction to generative phonology

profoundly influenced the area of clinical phonology. Later with the
emerging

Of behavioral approaches from skinner,

Distinctive features of sound system (Chomsky & Halle, 1968)

Usage of phonological patterns for therapeutic purpose (e.g., Edwards

& Bernhardt, 1973; Hodson, 1980; Hodson & Paden, 1983, 1991;
Shriberg & Kwiatkowski, 1980; Weiner, 1979).

Usage of minimal Meaningful contrasts (MMCs), Wiener (1981), and

Maximal oppositions (Gierut, 1989),

Usage of metaphonological awareness for therapy,

has resulted in the development of a number of

approaches for the assessment and treatment of children with
phonological disorders.
 In the present review we will be discussing about the background
and limitations of the various approaches for treating the children with
phonological disorders. This includes the

Phonological process approach

Minimal pair approaches
Maximal opposition approach
Pattern based approaches – Cycles approach (Hodson & Paden, 1983,
1991)
Metaphonological therapy for developing phonological awareness (Howell
& Dean, 1994)

The discussion further includes the details about the computerized

software programs for phonological analysis, and a mentioning of the
areas in which the further research has to be undertaken.

Background

Early attempts at assessment of children with "articulation" problems

gave rise to descriptions of their word productions in a sound-by-sound
fashion. A typical analysis would include a list of speech sound errors,
with the clinician classifying each error as a substitution, omission, or
distortion (Van Riper, 1963). Consequently, substitutions of [b] for Iv/, [t]
for /s/, and [d] for /z/ were categorized as independent error types rather
than as a general pattern in which stops are substituted for target
fricatives. This phoneme-by-phoneme approach to the analysis of speech
also influenced the design of treatment programs, leading clinicians to
target phonemes one at a time with no expectation for generalization from
one speech sound to another.

A major change occurred in the 1970s when the field of speech-

language pathology adopted methodologies used by linguists to analyze
phonological and grammatical aspects of language. Application of linguistic
methodology in the area of phonological disorders led to approaches that
differed fundamentally from those of the preceding decades. The child's
(mis)pronunciations were no longer viewed as sound-by-sound deviations
from the adult target, but as systematic, rule-governed productions.

The distinctive feature framework was also incorporated into a

child's remediation program, with features, rather than phonemes, targeted
for treatment. The expectation of the treatment was that remediation based
on distinctive features would enhance generalization; i.e. once the child
learns a particular feature, it would appear in all phonemes having that
feature, thereby eliminating the need to teach each phoneme individually
(Costello & Onstine, 1976; McReynolds & Bennett, 1972; McReynolds &
Engmann, 1975).

Although the distinctive feature approach was seen as an advance

in terms of assessment and remediation, it failed to gather widespread
support among practicing clinicians. One reason for this failure stemmed
from a lack of consensus among linguists and clinical researchers as to
which feature system to adopt; although most researchers used the
system proposed by Chomsky and Halle (1968), alternative feature
systems (e.g., those of Jakobson, Fant, & Halle, 1952; Singh, 1976).
Analysis tended to focus primarily on substitution errors affecting
segments, but researchers and clinicians were beginning to recognize the
need to move beyond the segment in order to characterize error patterns
involving syllable structure and assimilations.

Phonological process approach

Remediation programs based on phonological process analysis
emerged in the 1970s and early 1980s (e.g., Edwards & Bernhardt, 1973;
Hodson, 1980; Hodson & Paden, 1983, 1991; Shriberg & Kwiatkowski,
1980; Weiner, 1979). In these programs, the clinician selects as treatment
targets those phonological processes that occur frequently in a child's
speech, particularly those that contribute to high unintelligibility. The
clinician does not "teach" the process, but rather works to help the child
eliminate the process so that the child's productions can approximate more
closely the adult model. Targeting the development of phonological
contrasts was regarded as the primary therapy goal.

Treatment designed to eliminate phonological processes is viewed

as being more efficient than traditional phoneme-by-phoneme approaches
because targeting one representative exemplar of the process will lead to
generalization to other phonemes affected by that process. Thus, for
example, teaching /k/ may lead to elimination of Velar Fronting on all three
velar targets, /k/, /g/, and /i/. Phonological process analysis provides a
relational account for differences between the adult target and a child's
pronunciation of a word.
Weakness

Although this approach can adequately describe some aspects of a child's

phonology, it has some basic weaknesses:

1. It is negatively focused in that it only describes error patterns occurring

in the child's output. Additional analyses, such as phonetic, phonemic,
and syllable inventories, need to be performed in order to provide a full
description of a child's phonological system.

2. Although there is some (but not complete) agreement as to the nature

of phonological processes that characterize the speech of the typically
developing child, there is less consensus about the characterization of
processes in the speech of children with phonological disorders. Actual
phonological process lists and general approaches to assessment and
remediation vary notably among authors and clinical packages (cf.
Grunwell, 1985; Hodson & Paden, 1991; Shriberg & Kwiatkowski, 1980;
Weiner, 1979).

Minimal pair approach

Minimal pairs are pairs of words or phrases in a particular
language, which differ in only one phoneme that occurs in the same place
in the string, and have a distinct meaning.

The minimal pair approach is a linguistic treatment approach which

uses word pairs that have minimal phonemic contrast. This contrast
involves pairing two words that differ by only one phoneme (Gierut, 1992).
Its goal is to instruct the child that, it is necessary to use two different
sounds to signal a difference in meaning (Gierut, 1998) and to eliminate
homonymy by inducing a phonemic split. Children who have a mild to
moderate phonological impairment would be benefited by this approach.

Procedure:

Analyze client's misarticulations. This can be done by performing a

relational analysis to compare the client's production to the adult
production. Develop minimal contrast pairs of target phoneme with an
error phoneme (i.e. tea/key, bow/boat). Begin treatment by modeling both
the target and the contrast words; ask the child to imitate both. Provide
extensive trials on imitative production of the target and contrast words.

Ask the client to spontaneously name picture pairs.

Ask client to produce target word as clinician picks correct picture (the
client says boat and the clinician picks up the picture of boat; if the client
says bow, clinician picks up the picture of bow and then correct the
client).
Ask the client to match two pictures by first picking the picture from several
displayed and then selecting its minimal pair match (Hegde, 1996).

Comment

Learning the parts of minimal pairs may be easier, but more difficult
to place in the whole.

Maximal Oppositions Approach

(Jennifer Francois, Eric Hardeman, Traci VanNostran)
Maximal Oppositions Approach provides a child with an opportunity
to learn about the target phonology in his or her own unique way by filling
in gaps along these extremes of multiple feature dimensions (Gierut,
1989).

The sounds that are selected to be as Target Sounds for Maximal

Oppositions Approach should be

Independent of Childs errors

Ex: Child produces t/s which is unknown in child's language.
Therefore, you pick different sounds other than /t/ that contrasts
with /s/ which is voiceless alveolar obstruent.

Must be sound that child produces correctly

Compared sound must be maximally distinct from target sound

Example: Comparison could be /m/ on the basis that it is already
produced correctly by the child and it is also voiced bilabial sonorant
which is maximally distinct from /s/.
For example, Child X, a 7 year, 5 month old boy, word-initially collapsed
obstruents and clusters to the voiced stop [g]. The following is an
example of one phoneme collapse and treatment target selection.

d
f
g /#__ s
dz
dr
The following are treatment exemplars to elicit the target
sounds word-initially.
foal
goal sole
droll

fill
gill sill
drill

fink
gink sink
drink

fat
gat sat
drat

foo
goo Sue
Drew

Minimal Pairs is a more widely used approach that enhances a

child's idea of sounds as phonemes. This approach teaches a child to
contrast his or her error with appropriate target sounds. Research has
shown that Maximal Oppositions has yielded better results because the
child may focus attention on more than one distinction. These distinctions
are more universal along the broad multiple dimensions of voice, place,
and manner (Gierut, 1989).
 Minimal Pairs Maximal Oppositions
Uses child's error as contrast Uses phoneme child already
sound knows to contrast with error
Target and contrast sounds are Target and contrast sounds are
distinctly similar maximally distinct
Works best with mild to Works best with severely
moderately phonologically phonologically impaired
impaired children children
ex: child produces t/s ex: child produces t/s

tip vs. sip see vs. me

two vs. sue sap vs. map

tack vs. sack sue vs. moo

Summary— why choose Maximal Oppositions as therapy approach?

Learning the parts of minimal pairs may be easier, but more difficult to
place in the whole,
Maximal oppositions gives a greater opportunity for generalization.
Maximal oppositions is more learnable than minimal pairs because it is
perceptually different instead of perceptually similar.
Focus is on the nature of the sound being contrasted.
To reduce the occurrence of Homonymy in a child's phonological system.

Pattern based approaches to phonological intervention –

“Cycles” approach
 Intervention based on phonological processes target -- one process
at time, moving from one process to another once the child has been able
to suppress the process. Hodson and Paden (1991) developed the cycles
approach as an alternative to methods used to teach individual phonemes,

Procedure

In this method, a variety of processes are targeted for therapy, each

for a relatively short period of time. In the program, the child is introduced
to new phonological patterns with the goal that production of the new
patterns will suppress the old processes, The PP targeted for elimination
are those occurring at least 40% of the time on the analysis with the APP –
R (Hodson,1986),

Components of Hodson and Paden’s treatment program

Auditory bombardment – clinician provides the child with slightly amplified

auditory stimulation of new phonological patterns,

Practice with word exemplars that illustrate new PPs via different phoneme
or syllable combinations,

Regular, but brief, home practice carried out by a child’s parent.

Treatment is organized in cycles – a different framework from

traditional apps. A cycle is a unit of time in which a child works on all or
most of the P. processes occurring 40% or more on the APR-R. Individual
error patterns are targeted for only a few sessions within the cycle (these
sessions – phase). Phases targeting different phonological patterns
continue consecutively until the child has completed work on all
appropriate error patterns. During a cycle, a child progresses to new p
patterns (new phases) regardless of the level of accuracy achieved during
practice activities. The emphasis is to make the experience across a
range of the phonological system rather than mastery of specified targets.
At the end of a cycle, the clinician reassess the child as a means of
determining the possible need for continuous remediation. If
pp>40%/greater, -- targeted again in next cycle. New cycle is another
series of phases that target several PPs. In this new cycle, child goes
back to PPs worked on previous cycles as well as practicing more
advanced processes.

Conclusion

This approach is designed to stimulate the phonological system

over time into a natural growth process. Progress is expected to be slow
in 1st cycle, the increasing in 2nd and 3rd cycles, rather than in incremental
steps – match the steps of a behavioral teaching program.

Phonological therapy to phonological awareness

Wiener, (1981) used Meaningful Minimum Contrast (MMC) therapy

to reduce the frequency of 3 P. simplifying processes in the speech of 2
children with phonological disability. MMC therapy involves selecting pairs
of words, where one member of the pair corresponds to the Child’s
intended meaning (e.g., “key”) and the other corresponds to the child's
mispronunciation of the word (e.g., “tea”)

Comment

If the child asks an adult (clinician) to the “key” but mispronounces

the word as “tea”, then the adult will point to the picture of the tea. This
confronts the child with a discrepancy between the meaning intended and
the meaning understood. In some cases this confrontation may merely
confuse the child or lead the child to assign the fault of the communication
breakdown to the listener. However, children with more advanced
metalinguistic skills will reflect on their own speech production and will
recognize the need to alter their own pronunciation to eliminate the
ambiguity. Thus an approach to therapy which focuses on facilitating the
child’s awareness of the nature and function of speech sound contrasts
and awareness of communicative effectiveness was assumed to help the
child.

Metaphon program
 The Metaphon program (Howell J, Dean E, 1994), is a good
example of a structured Metaphonological approach to therapy for speech
difficulties. The program aims to provide children with information about
the sound system of their language and to enable them to bring about
changes in the speech output.

Procedure

Therapist and child shares the knowledge about speech “sounds”

that is built up during the course of a therapy

e.g., “long” to talk about frication sounds - ‘fffffffff’, and “short” for
plosive sounds, /p/).

Metaphon has two phases. Phase I consists of games and activities that
center on the sound system and phase II gives opportunities for children to
use their newly acquired knowledge in communication settings.

Comments

The MP is described as moving beyond typical MMC therapy because –

the child is provided with explicit information about the nature of the
target contrasts and about how such targets can be achieved (Dean E,
Waters D et al, 1995).

The program has been positively evaluated as an effective therapy tool

(Howell J, Dean E, Waters D 1995, Reid J et al, 1996). However,
individual differences need to be considered when implementing these
kind of programs, which rest on assumptions about the child motor and
Metaphonological phases of development. First – A child can change
his/her speech production when confronted with the errors only if she or
he has enough articulatory ease to produce the target contrast. Second
– Success is dependent on the child having sufficient phonological
awareness skill to take advantage of this ”meta” approach. Children
who have little awareness of the internal structure of words will be
unlikely to benefit from an approach that gives them information about
the individual phonemes in a word (Reers R, 2001).
It has also been questioned that whether the extra information given
regarding the properties of individual phonemes in the shared
vocabulary is really necessary

Literature on effectiveness of phonological awareness training

A number of research papers have been published that address the
issue of whether phonological awareness training can be used to promote
the speech skills of children with speech and language deficits. Some
studies have contrasted (e.g., Gillon and Dodd, 1995) and others
combined (e.g., Major and Bernhardt, 1998, Wise et al, 1999)
phonological awareness intervention with other types of more traditional
phonological or articulatory therapy for children with speech and
difficulties. However, there is a problem for studies comparing intervention
approaches within phonology. This is because no approach to therapy for
speech difficulties is “meta-free”. Therapy activities targeting speech are
on a continuum from implicit to explicit phonological awareness. For e.g.,
activities from Metaphon program (Howell J Dean E) address the more
explicit end of the continuum. Whereas other approaches such as MMC
therapy (Wiener, 1981) incorporate phonological awareness more implicitly
and studies to date have been contaminated to some extent by this (Dodd
and Gillon, Hesketh and Adams, 2001). This may give explanation for
some of the conflicting findings.