Phonological Disorders: Dx, Goals, Tx

One of my favorite things about this blog is the way I get to share information with fellow SLP’s. Today I asked my colleagues, Jacqueline Whitney, to share her POV on phonological disorders. If you’re brand new or getting back into preschool after a break you’re going to love this post! 

Phonological Disorders: How to diagnose, write goals, and treat

Jacqueline Whitney, M.A., CCC-SLP
Public School Based and Home Health Pediatric Speech-Language Pathologist
#1 fan of Speech Room News and colleague of Jenna Rayburn

I’m sure many of you, just like me, learned about phonology for about 30 minutes in grad school. Under the huge umbrella of the “Articulation/Phonology” course, phonology was breezed over. I never even had a phonology client as a grad student. I was on a hearing impairment grant so most of my students were hearing impaired. I did my student teaching at the high school level with included mostly low incidence disorders. I can say with honesty that when I left graduate school I could probably only tell you what “fronting” and “stopping” are. I really didn’t know how to evaluate and diagnose a child with a phonological disorder, determine what to target first, or even how to write goals. It wasn’t until my clinical fellowship that I learned SO much about phonology (shout out to Jen S. who had quite a bit to do with my phonology education). I now know how to evaluate, diagnose, write goals, treat, and remediate phonological disorders with a modified version of Barbara Hodson’s Cycles Approach. I say that it’s modified because in the school setting, things can’t always be textbook. Am I right??

Last year I did play-based assessments at the preschool level, I basically salivated when the school psych told me it was a potential “speech only” evaluation. I’m kind of like the surgeons on Grey’s Anatomy when they get a really exciting surgery, except that’s how I get with phonology evaluations. So what I would like to share is a Goldman-Fristoe-2 with my “client,” Freddy Phonology, who presents with severe, but very common phonological processing errors. Also, I will explain how I organize myself to begin therapy and how to WRITE GOALS based on the assessment. How many of you are now being told to write goals with 6 components? Here in Ohio we are now required to do that. I’ll give you some templates to be able to write your goals according to the Ohio Department of Education and your school district.

Client Background Information

Name: Freddy Phonology

Chronological Age: 4;0

Developmental Summary: No pre-academic, social emotional, fine motor, or cognitive impairments suspected. The only area of concern is speech and language skills

Based on observations, Freddy presents with age appropriate receptive language skills. His MLU is 3.6 (0.4 below average).

Results of the Evaluation

Freddy presents with a significant speech sound disorder. He achieved a standard score of 48 on the GFTA-2 (average 85-115) indicating significantly delayed phonological skills when compared to his same aged peers. He presents with the following phonological processes (or simplification patterns):

·      Final Consonant Deletion: Final consonant deletion is described as deleting the final sound off of a word. For example, Freddy produced “hou/house” and “du/drum.” He did produce some final consonants in words, which indicates that his final consonant production is emerging; however it is still significantly delayed.

·      Cluster Reduction: Cluster reduction is described as deleting a sound from a consonant cluster. For example, Freddy produced “pun/spoon,” “ta/star” and “bu/blue.”

·      Velar Fronting: Velar fronting is described as substituting t/k and d/g such as “dirl/girl” and “tup/cup.” Freddy is demonstrating velar fronting in both the initial and medial positions. Final positions were not observed as he deleted final consonants in these contexts.

·      Stopping of Fricatives: Stopping of fricatives is described as producing a stop sound for a continuant. For example, t/sh, t/s, d/z, p/f, and b/v. Freddy produced “tubuh/shovel” and “piti/fishing.”

·      Gliding: Gliding is described as substituting w/l and w/r. Examples include “wam/lamp” and “tewi/carrot.” Gliding is considered developmental until between the ages of 7-8.

·      Substitutions of /f/ for voiceless “th” (fum/thumb) and /d/ for voiced “th” (feader/feather). This is considered developmental until between the ages of 7-8. (I think this is technically stopping, but of course I would not work on these sounds with a 4 year old)

IEP Goals and Objectives

So, now that we have found the error patterns, what goals am I going to write? I put the processes in the order that I would target them. So, I will write an objective for each process. ODE is requiring Who, Will do what?, to what level or degree?, under what conditions?, in what length of time?, and How will progress be measured?

·      IEP Goal: By the IEP review date, in a small group setting, Freddywill reduce the occurrence of deviant phonological processes by producing targeted phonemes at the word level with 80% accuracy, 4/5 data collections. (Through observations and anecdotal records)

o   ***Only target word level if you are just beginning the Cycles Approach

·      Objective 1.1: By the IEP review date, in a small group setting, Freddy will reduce final consonant deletion by producing final consonants in CVC wordswith 80% accuracy, 4/5 data collections.  

o   Target final /t/ for 60 minutes (in the schools that’s 3 weeks if you do 20 minute sessions 1x/wk)

o   Target final /d/ for 60 minutes

o   Target final /p/ for 60 minutes

o   Target final /b/ for 60 minutes

o   Even if they don’t have final consonants in their conversational speech at this point (which is unlikely), move on. This is a total of 12 weeks. Sometimes I will cut this short and only work on it for a quarter, but still enforce it while I focus on another process.

o   Probe for velars during these sessions. Some kids take a long time to become stimulable for /k/ and /g/.

·      Objective 1.2: By the IEP review date, in a small group setting, Freddy will reduce cluster reduction by producing 2 sounds in a consonant cluster (focus on S-blends) at the word level with 80% accuracy, 4/5 data collections

o   I target S-blends before I target velars because I think it’s easier to teach, plus kids get the idea of fricatives. Then, when you start to remediate stopping they have some prior knowledge.

o   Target whichever blends they are stimulable for first.

o   Target SP for 60 minutes

o   Target ST for 60 minutes

o   Target SM for 60 minutes

o   Target SN for 60 minutes

o   Probe for velars

o   MOVE ON

·      Objective 1.3: By the IEP review date, in a small group setting, Freddy will reduce velar fronting by producing /k/ and /g/ in the initial and final positions of words with 80% accuracy, 4/5 data collections.

o   Target final /k/ for 60 minutes

o   Target initial /k/ for 60 minutes

o   Target initial /k/ for 60 minutes

o   Do NOT target final /g/. When you put emphasis on this word, a vowel is typically put on the end. The final /g/ should emerge on it’s own.

·      Objective 1.4 By the IEP review date, in a small group setting, Freddy will reduce stopping by producing fricatives [/f/, /v/, /s/, /z/, and/or “sh”] in the initial position of words with 80% accuracy, 4/5 data collections.

o   (This way you can leave it open to which sound he will be most successful with. There is no way that you will have enough time to target each sound in 5 different sessions during one IEP year, but you are always targeting a fricative. **the underlying goal is to remediate the PHONOLOGICAL PROCESS).

o   You can also target the final position, but you might run out of time by the IEP. Save it for next year!

My typical phonology sessions:

·      Start with auditory bombardment

·      Auditory discrimination (not every session, but I like to check and make sure they can hear the difference before I ask them to produce. I used to write a goal on auditory discrimination, but I don’t anymore. I just make sure I target it.)

·      Word drill embedded with fun activities:

o   Reading a book with high occurrence of target phoneme

o   Articulation Station

o   Articulation Scenes

o   Coloring activity (e.g., have them color their homework)

o   Memory

o   Go fish

o   Board games

o   Puzzles with high occurrence of target phoneme

o   Jenna’s Candyland Phonology

o   I Spy (a fav for S-blends)

o   Bury cards in a tub of dried rice and beans and unbury them!

o   MUCH more!

·      End with auditory bombardment

·      I also like to end the session with the student producing some of their best productions for their teacher. That way the teacher knows what sound I am targeting and the student feels proud of themselves.

Again, this is what I do. This is not to say that this is the only way to do phonology therapy. Last year my success rate with exiting “speech only” students was pretty high using this method and these goals. I had a personal goal for myself that no student should enter Kindergarten without being able to produce final consonants, S-blends, /g/, /k/, and at LEAST one fricative in the initial position at the word level. Of course those extremely unintelligible students are an exception to this.

I hope these goals and therapy targets will be helpful for at least some of you!

Enjoy J

Jacqueline Whitney 

Thank you Jacqueline! Jacqueline is the person I can text at 11pm to ask her opinion about a therapy idea. So happy she moved to my district this year! You can become a follower of her brand new TPT store. Click ‘follow me’ and you will get updates when she posts new content. 

Lovely comments

  1. 1

    says

    I LOVE this post! I am in my 2nd year of grad school and have had a lot of phonology but its always great to read about real SLPs take on writing goals and evaluation! Thanks so much for writing it, it is SO helpful to me!

  2. 2

    says

    Such good information! I have a ton of phonology kiddos on my caseload and I keep getting more so this was totally helpful! Thanks!!

  3. 8

    says

    Hi Jenna and Jacqueline! I really enjoyed this post and it since it concerned phonological disorders I was wondering if either one of you were familiar with the work of Jen Taps Richards. In my school district last year she did a presentation about using the complexity approach developed by Geruit to work with severely phonologically disordered students. At first I was skeptical about the idea about using something other than the cycles approach, and also about targeting complex clusters for students who had so many phonological processes. However much to my surprise these method has worked wonders for some of my most unintelligible students even since last year. The link to her website is http://www.slpath.com and she has a large amount of free resources on her website!

  4. 10

    says

    The Khan-Lewis Phonological Analysis (KLPA-2) is set up to accompany the GFTA if a phonological disorder is suspected. The KLPA is a form/fill-in that takes all the responses from the GFTA and sorts out responses by phonological process being utilized. VERY HELPFUL… and it has a computerized program for input. I’ve not used the computerized side, as I think it helps to still be analyzing (or I lose my skills!) as a diagnostician.

  5. 12

    Anonymous says

    Jacqueline and Jenna, have you seen these resources? They have been super helpful for me :)

    This chart (by Caroline Bowen) is linked by ASHA and shows a table to when phonological processes should typically disappear
    http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=31:table3&catid=11:admin&Itemid=117

    I also like this chart on typical speech sound development (broken down by age and position of sound in words)based on norming information in the GFTA-2:
    http://mommyspeechtherapy.com/wp-content/downloads/forms/sound_development_chart.pdf

  6. 14

    says

    Thank you so so much Jaqueline!! I have Freddie Phonology on my caseload this year, except he’s 5 1/2 (Kindergarten) and also has prevocalic voicing (or voicing confusion in general). I have been wondering about how to do the cycles approach in the school setting and this is just PERFECT to get me started.

    I have a couple of questions: Do you do individual or group sessions with kids that are this severe? Do you probe for progress for each phonological process at the end of that cycle only, or at the end of each quarter (for IEP progress note) even if you haven’t been recently targeting that process?

    Thanks again!!

    • 15

      says

      For kids that are that severe I would try to see them individually. If you have to group them make sure they are working on the same process. I probe ALL the time. For example, right now I am working on S-blends with a student. He still needs quite a bit of work on his S-blends (at least a few more weeks), but today I probed him for his /f/ sound. Right now he isn’t stimulable with visual and verbal cues. I literally had to push his bottom lip under his top teeth, hold his lip, and say “blow.” For this child I can tell that eliciting an /f/ will be an endeavor in it’s own which can take a lot of time. So, at least if I start probing for it a few minutes at the end of each session he will have some prior knowledge when we get to fricatives.

      To answer your question about IEP progress notes, if I haven’t targeted an objective I will by probe by the end of the quarter. So, if we are working on S-blends, I might throw and /s/ in the initial position in a word like “sun” and see if he can do it. If he produces “ssssdun” then I can comment on that in the IEP. I would comment that we haven’t targeted /s/ in the initial position (under the reduction of stopping goal), but I would comment on the status of the objective. Does that help?

      About probing at the end of the cycle: Typically because I have so many preschoolers and can only see some of them for 20 minutes a week, one school year is the end of the cycle (for a kid like “Freddy”). At the beginning of the following year I would reassess using a screener then start a new cycle.

  7. 17

    says

    Great post! I consider myself lucky that I did have a decent Artic/Phonology course and we did focus quite a bit on Phonology. Still, I think it’s often “easier” to think in terms of artic, especially in the schools, and especially in terms of goal writing! Thanks for the refresher & sample goals!

    Carrie
    Carrie’s Speech Corner

    PS, I’m glad I’m not the only one who finds it easier to get an /s/ blend than an /k/!!!

  8. 18

    says

    Ahhh, thanks for the refresher course! I am loving all the resources coming through in the comments!

    Abby
    slp123.blogspot.com

  9. 20

    says

    Any great apps for phonological disorders? I have been using “minimal pairs” (I think that’s the name). Today I found myself making a multi-syllable bingo-like game thinking there must be an app for this.

  10. 21

    Anonymous says

    Do you find that when you only target sounds in words, it generalizes to spontaneous conversation?

  11. 22

    Anonymous says

    I have a student who is backing. He is totally unstimulable for the /t and d/ sounds and has a sound preference for /k/. What is the best approach to use with this 5.5 year old child?

    • 23

      says

      Oh those tricky backers. I found quite a bit of success with backing by spending a lot of time on S-blends. That way you are working on oral placement of the alveolar ridge. Sometimes the /t/ and /d/ are tricky because they are stops. When they prefer a back stop, their phonological system is used to back consonants. Changing the place AND manner is a way to target that… Similar to maximum oppositions approach.

  12. 24

    says

    Yes, I do find that when I target sounds at the word level that it generalizes to spontaneous conversation… This typically happens more quickly when the parents are highly involved.

  13. 25

    Betty says

    I have recently begun tutoring one of my grandsons. He is in Grade 4 but barely reads at a Grade 1 level. Although my emphasis was on teaching him to read I believe your information here is pertinent. He has three older brother, all diagnosed with ADHD, autism specter disorder and/or various other problems. All the boys have speech problems. His father, (my son) was diagnosed with a learning disability and his mom speaks rapid fire. He has been diagnosed with a LD and also has a hearing impairment. In working with him I have discovered that many times he has trouble reading a word because he doesn’t know what it really is supposed to sound like. What he should be reading does not match up with the way the word sounds in his head. I believe this to be a combination of not hearing words spoken correctly at home plus not hearing properly. Any suggestions or help would be appreciated. Thank you.

    • 26

      Jacqueline (Whitney) Culley says

      That’s great you are tutoring your grandson! From the information that you’ve given me, I feel like he would need an in depth evaluation from a speech-language pathologist before I would feel comfortable giving any treatment advice. It sounds like there is more going on with him than a phonological disorder. I hope this helps!

      • 27

        Betty says

        I agree with you. He has been tested through the school system and I believe independently. However, I have not seen any of the reports and only get a general rundown from mom. So basically all I have to go on is what I personally observe in working with him. I am using a variety of resources, including flash cards, work books, story books and computer. (Turtlediary.com) It is working because I now have him reading at Grade Two level. He still has some problems, especially with th and wh blends right now. His own confidence level with his reading is increasing and mom reports that at home he is reading off the television and such on his own. I guess basically I can only continue with what I am doing as long as it is working. Thank you for your reply.

  14. 28

    Azael says

    Freddy Phonology is a 4:0 Male but you gave him a female Standard score of 48 instead of a male standard score of 57 :(

    • 29

      Jacqueline (Whitney) Culley says

      Whoops! I guess I need to make sure I check the gender of my imaginary clients! :) Thanks for keeping me on my toes.

  15. 30

    Sammy says

    I have a late question/comment to this post. I have a 4 year old girl who I’ve been seeing for close to a year now. She has several phonological process errors and is making improvements with most of them except ‘backing’. She backs her /t/ and /d/ sounds and I feel like I’ve tried everything!…Tongue depressor on bumpy spot, auditory bombardment, auditory discrimination, etc, etc. She is starting to produce some initial /t/ words correctly at the spontaneous speech level such as ‘two’ but given the amount of time I’ve seen her, progress has been slow. I suspect there is some Apraxia as well in addition to phonological process errors. She is making progress with /f/ and we have begun to work on /s/ and /sh/ as well Help!

    • 31

      Jacqueline (Whitney) Culley says

      I have a few questions:
      1. Can she produce alveolar stops in the final position? If she can’t and you haven’t yet targeted this, then I would spend some time in the final position. If that is still too tricky (after 3-6 weeks of the cycle; 3 on /t/ and 3 on /d/), I would move to another process all together. I would say two things are happening One, she is not ready for alveolars or two, you’ve done your job and they will start to emerge once you leave them alone for a while.

      2. If you are working on /f/, /s/, and “sh” you must be working on stopping. Is she stopping these sounds AND backing?

      3. Does she reduce /s/ blends? I often find that working on reduction of cluster reduction is a great way to bring awareness to the alveolar ridge. Sometimes the /t/ and /d/ are tricky because they are stops. When they prefer a back stop, their phonological system is used to back consonants. Changing the place AND manner is a way to target that… Similar to maximum oppositions approach.

      I hope this helps. If you need more help let me know.

      • 32

        Sammy says

        Hi Jacqueline,

        Thanks so much for your help!

        1. I hadn’t tried final /t/ and /d/ in awhile with her and she was able to get them both during our last session with 80-90% accuracy and max cueing provided! When I do not cue her, it becomes a /k, g/ sound. She was also able to get /t/ in the initial position with 90% accuracy and moderate cues! Could you give me a good article or reference for the Cycles Approach? I could probably use some brushing up on it. When you say 3-6 weeks of the cycle; 3 on /t/ and 3 on /d/ is that all positions of the word? Also, I only see this child 1x/week. Does that length of time still apply?

        2. Yes, she is stopping those sounds (/f/, /s/, /sh/) in addition to backing.

        3. She does also reduce blends.

        Sammy

        • 33

          Jacqueline (Whitney) Culley says

          1. Anything written by Barbara Hodson is good for the Cycles Approach. (http://www.ushaonline.net/Resources/Documents/Hart-Cycles%20Approach%20Handout.pdf) This is a PDF os a powerpoint, and I reference it a lot. When I say 3 of final /t/ I mean 3- 20 minute sessions. Typically (if you are working in the schools), that would be enough for a sound. If you can do 30 minute sessions, then two may be enough PER SOUND WITHIN A CYCLE. Yes, that’s fine if you only see her/him once per week. Just focus on each sound in each position for 60 minutes. That’s great to hear she was able to mark those sounds with cueing! Great step!!

          2. Interesting! Keep bringing awareness to the alveolar ridge! You’re on the right track.

          3. After you work on final alveolars (60 minutes of final /t/ and 60 minutes of final /d/), I would move to /s/ blends. You will spend a lot of time on /s/ blends and that’s okay!

          Keep me posted! I hope this helps!

  16. 34

    V.Vazquez says

    THANK YOU for sharing such detailed and well written approach! Keep up the great work! :D

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