Falling Down the Wabbit Hole

Adapted from Speech Sound Disorders: For Class and Clinic, Fourth Edition

Ken Bleile

Perception training is part of most approaches to treatment sounds (Williams, McLeod, & McCauley, 2010).  Discrimination training (helping a child hear the difference between sounds) is the traditional view of perception training.  Established by clinical researchers in the 1930s, it remains the dominant perspective today.  Another approach, promoting awareness, is on the horizon.

Discrimination Training

Discrimination training addresses the well-known phenomenon that some children do not appear to hear their own speech errors.  Sometimes called “the rabbit kids,” these are children who pronounce rabbit as wabbit, but who, when asked if they say rabbit as wabbit, may reply, “No. I say wabbit as wabbit.”  In addition to making a good story, the reply of “the rabbit kids” suggests they do not hear their speech error.

Something Broken

The presumed explanation for failure of children to hear their own errors is that their speech discrimination mechanism has sustained damage.  The intervention is to repair the mechanism through discrimination training.  The most typical training activity within this approach is identification.  To illustrate, the clinician instructs, “I’m going to read a list of words.  When you hear our treatment sound, I’d like you to raise your hand.”  Of course, instead of a list, the activity could involve a story, pointing to objects, and so forth.  After you establish discrimination (that is, once the child can discriminate the treatment sound from other sounds), treatment moves to production practice.


Promoting Awareness

Promoting awareness (promoting a child’s awareness of the difference between sounds) offers a more cognitively oriented perspective on perception training.  Promoting awareness begins by noting that it is highly unlikely that “the rabbit kids” fall down the wabbit hole because they have a broken discrimination mechanism.  Speech perception, in common with other sensory systems, develops and matures months before an infant’s first birthday (Kuhl, 2010; Pascallis, de Haan, & Nelson, 2002).).  Like all parts of the body, damage can affect speech perception.  However, because it is a critical foundation for speech learning, the outcome would be catastrophic and not limited to one or several late acquired sounds.

Something Normal

If perception problems are not the result of an immature or broken speech perception system, what is the problem?  And, equally importantly, what can we as clinicians do about it?  The answer may be that when children speak their attention is on their intention, not the sounds tumbling out of their mouth.

Fast-fading Memories:  This attention on intention is true for children with and without speech disorders, and for adults as well.  In many ways, our perceptual system makes it difficult to monitor speech sounds.  To illustrate, echoic memory lasts only milliseconds and then fades.  Short-term memory lasts slightly longer, from 10 to 15 seconds up to a minute.

Just Like Adults:  Adults—including highly trained speech-language pathologists—find it difficult to pay attention to small differences in their own speech.  To illustrate, even an experienced clinician may not realize that their [r] in ride is voiced and their [r] in pride is voiceless, that [k] in key is made much more forward in the mouth than [k] in cool, and that [p] is aspirated in pie but is unaspirated in spy.  In other words, a child with a speech sound disorder does whatever everyone does:  not pay attention to the actual sounds coming out of their mouth.  The difference between children with and without speech disorders is that we notice the child with the speech disorder because their intended production differs so markedly from their actual production.

Treatment Goal

Within this perspective, the goal of promoting awareness is to focus a student’s attention on their speech.  Promoting awareness also helps to promote generalization of treatment sounds to persons and settings outside the clinic.  Almost all children and students need this assistance and so almost all receive ongoing help promoting awareness integrated with speech production practice (Anthony et al., 2011).

 Awareness Activities 

A clinician has a wide range of clinical tools to turn into awareness activities.   Table 1 lists 9 options.

Table 1.  Clinical Options to Promote Awareness


Touch cues



Minimal Pairs



Old Way/New Way

Similar Sound

These options are useful with any child whose development is sufficiently advanced to allow them to reflect on their speech, typically late preschoolers and older.  The following brief annotated dialogue illustrates promoting awareness with a late preschooler receiving speech work on [s].


Clinician:  Do you remember what we call our treatment sound?

Child:  The snake sound.

The metaphor reminds the child that [s] is continuant.


Clinician:  Do you remember how you used to say [s]?

Child:  I said ta.

Clinician:  Now you’re a big kid and say [s].  I know. Can you say [s] the big kid way, the little kid way, and then the big kid way again.

Child:  ta sa ta.

Old way/new way focuses the child on the difference between [t] and [s] while building self-esteem through demonstration of progress.


Clinician:  And now can you say sa three times in a row, listening to yourself, without me saying anything?

Child:  sa sa sa.

Clinician:  How do you think you did?

Self-correction promotes self-monitoring, which the child needs to do to generalize treatment success.


 Distraction Activities

When a child leaves speech treatment, the world is full of distractions that may push his awareness of speech right out the window.  You may find that including some distractions during speech tasks helps maintain hard won speech gains outside the treatment session.  Children enjoy—and may find it challenging—to say words with treatment sounds while hopping on one foot, or rolling a ball in miniature bowling, or—for a student—practicing a class speech that contains the treatment sound.


Anthony, J. L., Aghara, R. G., Solari, E. J., Dunkelberger, M. J., Williams, J. M., & Liang, L. (2011). Quantifying phonological representation abilities in Spanish-speaking preschool children. Applied Psycholinguistics, 32(1), 19–49

Kuhl, P. (2010). Brain mechanisms in early language acquisition. Neuron, 67, 713–727.

Pascallis, O., de Haan, M., & Nelson, C. (2002). Is face processing species specific during the first year of life? Science, 296, 1321–1323.

Williams, L., McLeod, S., & McCauley, R. (2010), Interventions for speech sound disorders in children. Baltimore, MD: Brookes Publishing.

Confessions of a Reformed Developmentalist

Adapted from Speech Sound Disorders:  For Clinicians and Students

Ken Bleile

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.

Strict Developmentalists

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.

Practicing Clinicians Need Practical Ideas

Phonological Treatment of Speech Sound Disorders in Children: A Practical Guide

Jackie Bauman-Waengler, Ph.D., CCC-SLP and Diane Garcia, MS, CCC-SLP

Why should I buy this book? What is unique about it?

The first unique feature of this workbook is that it is intended for practicing clinicians who work with children with speech sound disorders. From this workbook’s inception, the goal was to make something user-friendly that clinicians could use in various ways with a limited investment of time.  Another distinguishing feature is its summary of several of the most frequently used approaches for treating phonological disorders in children. While there are other textbooks that give a broad-based understanding of treatment of phonological disorders, this workbook offers a more in-depth discussion of eight different approaches. It describes the type of children this therapy would be optimally suited for, the diagnostic information needed, how to select targets for treatment, how to structure therapy, how to monitor progress, examples of intervention goals, and group therapy ideas. And, for every therapy concept, it provides examples of research which support evidence-based practice with this treatment protocol.

What are the strengths of this book?

This workbook has several areas of strength. First, its structure is a strength. Every therapy chapter offers a brief overview of the method, examples of supporting research, target selection procedures, sample goals, data collection strategies, treatment guidelines, and group therapy ideas. This structure provides the clinician with an easy to follow process from beginning implementation to monitoring therapy progress. Second, many worksheets are offered which can be tailored to meet the needs of individual children. This saves the clinician time during the assessment and intervention process. Third, case studies are offered in each of the chapters to demonstrate the concepts. There is also a separate chapter at the end of the book which is devoted to four children of different ages with varying degrees of severity. Assessment data for each child are given as well as a brief glimpse of a portion of therapy. Fourth, group therapy ideas are included in many of the chapters. To account for increased caseloads, many clinicians must often structure therapy within a group. These ideas offer group application possibilities for children with speech sound disorders and possibly language impairments.

How will this book help me practically in my job setting?

Many clinicians in a variety of settings are working with children with phonological disorders. With caseloads increasing, we often do not have a large amount of time to become experts in the various treatment options available, nor to decide which treatment protocol might be the most effective for an individual child. This workbook gives clinicians a streamlined version which is easy to use while offering specific data collection forms and protocols which assist and guide the therapist throughout the entire process. It also offers a large quantity of practical information that can be immediately used in therapy. Clinicians will find the progression through each of the treatment options easy to follow and practical to implement. In addition, every chapter contains two case studies that demonstrate the application of assessment information to structuring therapy. These case studies will give clinicians further support in developing appropriate intervention plans for their own clients.

What phonological intervention approaches are addressed in this workbook and how were they chosen?

The eight approaches in this book are: Minimal Pair Therapy; Multiple Oppositions; Maximal Oppositions; Complexity Approaches; Phonotactic Therapy; Core Vocabulary Intervention; Cycles Approach; and Phonological/Phonemic Awareness.  These eight were selected based upon several factors: research demonstrating positive evidence-based practice, frequent use of the method, ease of implementation, and availability of resources to support application.  Some of the approaches included represent comprehensive therapeutic protocols, while others primarily describe a specific target selection strategy.  All are designed to remediate phonological difficulties, yet do not necessarily exclude the principles which govern a traditional sound-by-sound approach.

What are the characteristics of children who would most benefit from phonological intervention?

As the name implies, phonological intervention approaches are designed for children with phonological disorders.  That said, all children who demonstrate a speech sound disorder, regardless of etiology, may potentially benefit from the principles of phonological therapy.  Appropriate recipients typically demonstrate more than one or two speech sound errors. They may demonstrate pervasive sound error patterns and exhibit highly unintelligible speech. With specific methods it is important that the child demonstrates a collapse of phonemic contrasts. In other words, one phoneme replaces many other phonemes. For example, the child uses “t” for “s”, “z”, and both the voiceless and voiced “th” sounds.  With other therapy protocols the child fits best if a very restricted phonemic inventory is noted.  Specific characteristics of children who would benefit from each therapy approach, such as age, severity, and types of errors, are provided in this workbook.  This information gives clinicians concrete and verifiable guidelines for selection of appropriate intervention methods for individual children.

What are the advantages of using a phonological intervention approach, as opposed to a traditional motor approach?

There are many advantages!  Phonological intervention targets often include patterns or groups of phonemes, rather than individual sounds.  This results in broader change across a child’s entire phonological system.  Phonological approaches have successfully demonstrated generalization to other sounds or patterns through careful selection of targets according to specific guidelines (Gierut, 2007). On the other hand, the traditional motor approach focuses on correct remediation of the physical production of individual sounds in a sound-by-sound manner. The traditional approach can take a much longer therapy time and generalization to other sounds does not seem to occur (e.g., Bowen, 2011; Dinnsen, Chin, & Elbert, 1992). In addition, phonological therapy targets the linguistic function of sounds, that is, the use of phonemes to create meaningful words.  This shift in focus allows clinicians to facilitate functional communication in natural contexts, thus improving children’s ability to communicate during daily interactions.

I have just been using the traditional-motor approach. Is that wrong?

The traditional motor approach, sometimes called the phonetic approach, is not intended for every child with a speech sound disorder. Decades of research have documented that some children make faster, and more broad-based progress with some of the phonological treatment options (Gierut, Elbert, & Dinnsen, 1987; Gierut, Morrisette, Hughes, & Rowland, 1996; Tyler & Figurski, 1994 ). If you have children on your caseload with multiple errors, then the traditional approach, going sound-by-sound through the child’s errors, can take an enormous amount of time. This is time they are spending in speech therapy and not within the classroom. The goal is to get these children out of therapy as soon as possible. Phonological treatment methods are one very successful way to do this.


Bowen, C. (2011). Target selection in phonological intervention. Retrieved from http://www.speech-language-therapy.com/ on 8/12/2018.

Dinnsen, D. A., Chin, S. B., & Elbert, M. (1992). On the lawfulness of change in phonetic inventories. Lingua, 86, 207–222.

Gierut, J. A. (2007). Phonological complexity and language learnability. American Journal of Speech-Language Pathology, 16, 6–17.

Gierut, J. A., Elbert, M., & Dinnsen, D. A. (1987). A functional analysis of phonological knowledge and generalization learning in misarticulating children. Journal of Speech and Hearing Research, 30, 462–479.

Gierut, J. A., Morrisette, M. L., Hughes, M. T., & Rowland, S. (1996). Phonological treatment efficacy and developmental norms. Language, Speech and Hearing Services in Schools, 27, 215–230.

Tyler, A. A., & Figurski, G. R. (1994). Phonetic inventory changes after treating distinctions along an implicational hierarchy. Clinical Linguistics & Phonetics, 8, 91–107.