Abstract
There are a number of evidence-based treatments for preschool children with phonological disorders (Baker & McLeod, 2011). However, a recent survey by Brumbaugh and Smit (2013) suggests that speech-language pathologists are not equally familiar with all evidence-based treatment alternatives, particularly the complexity approach. The goal of this clinical tutorial is to provide coaching on the implementation of the complexity approach in clinical practice, focusing on treatment target selection. Evidence related to selecting targets for treatment based on characteristics of the targets (i.e., developmental norms, implicational universals) and characteristics of children's knowledge of the targets (i.e., accuracy, stimulability) is reviewed. Free resources are provided to aid clinicians in assessing accuracy and stimulability of singletons and clusters. Use of treatment target selection and generalization prediction worksheets is illustrated with 3 preschool children. Clinicians can integrate multiple pieces of information to select complex targets and successfully apply the complexity approach to their own clinical practice. Incorporating the complexity approach into clinical practice will expand the range of evidence-based treatment options that clinicians can use when treating preschool children with phonological disorders. https://doi.org/10.23641/asha.6007562. http://hdl.handle.net/1808/24767.
Highlights
Consonant SingletonsA singleton is a sound that occupies a syllable position in isolation (e.g., “bake” contains two singleton consonants: /b/ in the syllable onset and /k/ in the syllable coda)
The results showed that children experienced broader system-wide change when treatment began with least knowledge targets
Each cluster is targeted in two words. This is a small sample of each individual cluster, the analysis focuses more on patterns across classes of clusters: either classes organized by sonority difference, which is important for the complexity approach, or classes organized by a common sound in the cluster (e.g., l-clusters, r-clusters), which may be useful when sharing results with parents or teachers
Summary
A singleton is a sound that occupies a syllable position in isolation (e.g., “bake” contains two singleton consonants: /b/ in the syllable onset and /k/ in the syllable coda). One study of eight children with hearing impairment (McReynolds & Jetzke, 1986) showed that children who were taught a voiced stop (i.e., /d/ or /g/) made greater change in accuracy of cognate stops (i.e., voiceless stop /t/ or /k/) than children who were taught a voiceless stop (i.e., /t/ or /k/) This suggests that treatment of Storkel: Sound Selection 465. Specific implicational universals (e.g., fricatives imply stops) have only been tested typically in one single-subject study, the results across studies demonstrate a consistent pattern: Treatment of more complex, marked targets leads to greater system-wide change than treatment of less complex, unmarked targets
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