Adapted from Speech Sound Disorders: For Clinicians and Students
The Developmental Logic of Treatment
Knowledge of speech development is a foundation of speech treatment. To illustrate this relationship, suppose you determine that a child of 3 years has a speech sound disorder. Next, you might ask what I believe is the best question in our profession, “What am I going to do about it?” Consciously or unconsciously, your answer likely entails asking two, maybe three additional questions:
- At 3 years, what does a child without speech difficulties know about speech?
- How does a child of 3 years acquire speech?
- How can I make speech easier to learn for a child with speech challenges?
What and When?
The first question asks what and when a child learns about speech. For this illustration, suppose your understanding is that a child of 3 years should be 75% intelligible, have a large expressive vocabulary, and speak in short sentences; those might then become possible treatment goals for this potential 3-year-old client. Importantly, another clinician might consult her knowledge base on speech development and decide that elimination of certain phonological processes offers this child the best help. Your answers may differ, but both you and the other clinician looked for answers from your knowledge of speech development.
The second question asks how a child of 3 years learns about speech. For the sake of illustration, suppose you decide that the child would benefit from decreasing the occurrence of a phonological process—fronting, for example. Next, you might consider—either consciously or not—how children typically learn to overcome phonological processes. If you believe in the central role of social relations in speech learning, you will focus your treatment on fostering child-caregiver relationships, and you will likely use treatment techniques that simplify speech input within meaningful social contexts. Alternatively, if you believe that children learn speech mainly through reinforcement, then you will build your treatment on those principles.
Everything in the previous discussion is based on a developmental perspective. There are other perspectives, of course, and there are also important differences between developmental viewpoints. At some point in your career, I hope you have (or already had) the opportunity to sort out your own perspective.
If you are a strict developmentalist, what (what is learned?), when (at what age is it learned?), and how (how does a child learn it?) are the only foundations needed for speech treatment. Like many clinicians of my generation, my training was to undertake treatment as a strict developmentalist.
Less Strict Developmentalists
Many clinicians today, myself included, have become less strict developmentalists over time, incorporating ideas and concepts into our clinical work. This “reformist” perspective often came about because a strict developmentalist approach can amount to replicating an environment that had proven unsuccessful for a child with a speech sound disorder. That is, when a child came from a home environment sufficient for speech learning, a strict developmental approach only continues an environment already shown to be insufficient for the child.
Another Type of How?
The third question (“How can I make speech easier to learn for a child with speech challenges?”) recognizes that you may wish to include nondevelopmental ideas in your treatment—perhaps hoping to “tweak” an environment to make it an easier place from which to learn. For example, you might decide that our 3-year-old child needs intensive speech production practice, far greater than found in a typical home environment, so you modify the naturalistic family-centered treatment to include more speech production activities.
From Development to Developmental Speech Goals
Speech development offers you—literally—hundreds of options to turn into developmental speech goals. As a shortcut, you can also turn to a published treatment approach, most of which contain one to many developmental speech goals. Baker and McLeod (2011a, 2011b) contains a wonderfully long list of 134 studies representing 46 different approaches. You can also find an excellent collection of treatment approaches with developmental speech goals in Williams, McLeod, and McCauley (2010).
Baker, E., & McLeod, S. (2011a). Evidence-based practice for children with speech sound disorders: Part 1 narrative review. Language, Speech, and Hearing Services in Schools, 42, 102–139.
Baker, E., & McLeod, S. (2011b). Evidence-based practice for children with speech sound disorders: Part 2 application to clinical practice. Language, Speech, and Hearing Services in Schools, 42, 140–151.
Williams, L., McLeod, S., & McCauley, R. (Eds.). (2010). Interventions for speech sound disorders in children. Baltimore, MD: Paul H. Brookes.