When I trained to become a speech-language pathologist, the Complexity Approach was never even mentioned in my speech sound disorders course.
So when I learned about the theory and the principles — that we target complex structures, often later-developing, non-stimulable two- or three-element consonant clusters — I’ll be honest, I had my doubts. These are hard words, and it’s unlikely you’ll be doing high practice trials with them in your very first session.
But here’s the thing: there is strong and continually growing evidence on the effectiveness of using the Complexity Approach to treat children with phonological impairments.
So even if it “feels” counterintuitive to practice something really hard, carefully selecting and prioritizing a complex target can trigger change across the whole speech sound system — not just in the sound you’re working on.
Here’s what that looked like for one of my students. I chose SL clusters as the target — not because SL itself was the priority, but because it let me address three patterns at once: the student was reducing two-element clusters (so “play” became “pay”), they were stopping S, and they were gliding L and weren’t yet stimulable for it. By targeting SL, I was hoping to shake up their speech sound system, introduce some new features, and hopefully increase their intelligibility across the board — not just in the cluster I was directly teaching.
In simple speech therapy terms: sounds and structures you haven’t directly targeted can “come through on their own,” because you’ve triggered change across the system.
Tips from my therapy room
Here’s what that looks like in practice, session to session:
1. Plan for a block of about ten to twelve weeks — with two distinct phases.
I generally target one or two complex clusters per block, and I like to think of it as a school term. Within that block, the first stretch (roughly the first seven sessions, or until the child hits 75% accuracy across two consecutive sessions) is really an imitation phase, where you’re teaching the child to imitate these hard clusters. After that, we move into a spontaneous phase, where the child names targets without your model, until they reach around 90% accuracy across three consecutive sessions. This is where less-taught clusters tend to come through on their own — which means less time in therapy overall for these children!!
2. Not every child is ready for this approach — know the signs.
I generally choose this approach for children with more resilience and perseverance. Remember, not all children are ready to tackle something that is hard! Signs that this approach may not be best suited for your child include: refusal to copy words or participate in therapy, saying, “this is too hard” or “I can’t do it” over a number of sessions, withdrawing from consecutive sessions.
3. Come prepared with a range of cues — you won’t know which one will land.
You will still likely have to provide many cues at the start of therapy to help the child learn a new, complex consonant cluster. I always set up my table with a range of cues — a phonetic placement cue so I can show the tongue, animal/gestural cues (like an elephant cue or a snake cue for a long S sound), and forward or backward chaining cards — because I never know in advance which one is going to help a particular child. It may take one or two sessions just to find the cues that work.
4. Reassess after a break to check the change actually triggered.
It is important to reassess the child’s speech after your block of therapy to determine whether the consonant cluster you chose triggered the changes we predicted. I like to leave a two-week to two-month break after the block before reassessing, so the system has time to settle before you check for change. I personally use a consonant cluster probe for this task.
5. Have a backup plan — this approach isn’t right for every student.
Remember that other phonological interventions might be better suited to your student (e.g., minimal pairs, multiple oppositions, cycles approach) and that you should have a “backup plan” if this approach is not suited to your student.
Go deeper on target selection
If you want to learn HOW to select your treatment targets for this approach, I would suggest the following open access article:
Storkel, H. L (2018) The Complexity Approach to Phonological Treatment: How to Select Treatment Targets. Language, Speech & Hearing Services in Schools, 49, 463-481. https://pubs.asha.org/doi/10.1044/2017_LSHSS-17-0082
Bring it into your therapy room
Once you’re ready to actually implement the Complexity Approach in session, Adventures in Speech Pathology has a Complexity Approach Starter Kit that turns that theory into ready-to-use materials, including:
- Target selection chart sheet
- Speech sonority chart
- Therapy steps to help you feel more confident
- Consonant Cluster Probe + record form to support your assessment
- Flashcards covering 10 clusters (3-element: skr, spr, str, spl and skw and 2-element: fl, fr, sl, shr and thr)
- Printable homework sheets for all sounds
