Have you ever used the Nuffield program for Childh Have you ever used the Nuffield program for Childhood Apraxia or Speech?

We’re working on quiet plosives in CV and VC positions. I love that the program contains four cards for each word!

I’m also using @bjoremspeech cards to cue for the /p/ sound.

The reinforcer activity was to give felt pieces that then make a tangram picture!

#apraxiaofspeech #speechpathologist #childhoodapraxiaofspeech #slpa #speechtherapy #apraxiakids #adventuresinspeechpathology
This page always gets a lot of laughs!!! Using th This page always gets a lot of laughs!!!

Using the metaphor of “tail sounds” is such a fun way to talk about final consonant deletion with your kids ❤️

#adventuresinspeechpathology #speechpathology #speechtherapy #slp #slpeeps #phonology #minimalpairs
First therapy session for /r/. No, I did not focu First therapy session for /r/.

No, I did not focus on isolation.

I found words that the child COULD SAY correctly, and practiced those 🙌🏻

Can you see any patterns of where they are most accurate?

#articulation #speechtherapy #adventuresinspeechpathology #speechsounddisorders #articulationdelay
Love being able to SEE how much we have practiced, Love being able to SEE how much we have practiced, and what words the child can say correctly!

ALSO... THIS PAGE IS 100 TRIALS 🥳

Which means it’s one of my favourite pages to send for home practice!

#speechtherapyactivities #speechtherapy #slp #slpa #slpeeps #articulation #articulationtherapy
Simple therapy activity. You don’t need to be re Simple therapy activity. You don’t need to be really fun.

🥳 Just be fun enough! 🥳

We used a simple dinosaur mouth to practice our words. He was engaged, and we got 13 practices in a minute 🙌🏻That’s all that matters!!

Please don’t think that you need every fancy toy! Simple activities can be so effective.

FYI: two weeks ago I taught this little one /kl/ and /gl/ blends and they have generalised to final position!!! 💪🏻💪🏻

#articulationtherapy #Speechtherapy #Speechsounddisorders #spla #slpeeps #speechsounds #Adventuresinspeechpathology
Cues and syllables. At around the age of 4, I real Cues and syllables. At around the age of 4, I really like to check those early phonological awareness skills, especially for those kids who have been seeing me for a little while due to a severe speech sound delay.

Many of my kids show weak syllable deletion, difficulties perceiving and identifying sounds, or just lack awareness of “syllableness”.

While I love to use the body to clap and tap the syllables in words, I also little to use real objects to represent the “beats”. With this little one, I use Cued Articulation gestures to help them “see” the sounds.

What’s your fave thing to use to work on beats?

#articulation #phonologicalawareness #preschoolslp #speechsounddisorders #Adventuresinspeechpathology
Any guesses what this is?? I am LOVING making new Any guesses what this is??

I am LOVING making new metaphors for speech patterns and substitutions that you see in your caseload.

I think I have 5 new Minimal Pair Toolkits that I’m halfway through 🤗 it’s been so fun to get back to creating (vs. attending meetings, replying to emails and fixing problems 😅).

#minimalpairs #speechtherapy #phonology #articulation #slpsontpt
I saw a psychologist yesterday! And I was excited I saw a psychologist yesterday!

And I was excited. I have ups and downs. High expectations of myself. Difficulties balancing being a mum, SLP, wife and small business owner.

I have mum guilt. I’m stressed. I love working... maybe too much.

Anyway. It’s okay to admit that you need someone to help ❤️

FYI: before you ask, my jumper is from @beetheslp

#adventuresinspeechpathology #itsokaynottobeokay
Why do the SLOW way when you can make BIG CHANGES Why do the SLOW way when you can make BIG CHANGES and maybe have a child in and out of your door in three sessions?

👉🏻 I posted this last year, but I want to remind you all again!

So it might not always go like this, but for some kids, it is literally like you flicked a switch and their sound system almost instantly goes, “ohhhhhh.... L and W are different sounds so I should be saying them differently”. With this little example, I DID have to give placement cues in my first session as he wasn’t stimulable for /l/. And you’re allowed to!

But I stuck to my guns with the minimal pairs approach to help him understand that he has to contrast the sounds so that they make sense to people like me ☺️ At the end of the day, we shouldn’t be keeping our kids longer in therapy than they need to. Choosing an approach that thinks ‘big picture’ and can make big changes can speed up how long they’re on your caseload.

#phonology #speechtherapy #slp #preschoolslp #ashaweb #slp2b #speechlanguagepathology #slpeeps #schoolslp #slpbloggers #speechies #adventuresinspeechpathology
One set of cards, one type of gesture, one special One set of cards, one type of gesture, one special trick that you learned WILL NOT WORK for every child!!!

I get asked a lot what I’d do for kids who can’t say /k/, /r/, or a frontal lisp.

And it’s different every time, because what my kids do is different!

So don’t keep using the same cue and wondering why it isn’t working. Try DIFFERENT visuals, see how metaphors, orthographic and pragmatic cues work.

Try a mirror, give phonetic placement cues, facilitate using vowels, and trial the sound in different positions including clusters!

Your bag of tricks need to be BIG!

#articulationtherapy #slpa #slpgradstudent #speechsounddisorders #slpeeps #slpsofinstagram #slpbloggers #articulation #speechsounds #adventuresinspeechpathology
Have you ever used the Nuffield program for Childh Have you ever used the Nuffield program for Childhood Apraxia or Speech?

We’re working on quiet plosives in CV and VC positions. I love that the program contains four cards for each word!

I’m also using @bjoremspeech cards to cue for the /p/ sound.

The reinforcer activity was to give felt pieces that then make a tangram picture!

#apraxiaofspeech #speechpathologist #childhoodapraxiaofspeech #slpa #speechtherapy #apraxiakids #adventuresinspeechpathology
This page always gets a lot of laughs!!! Using th This page always gets a lot of laughs!!!

Using the metaphor of “tail sounds” is such a fun way to talk about final consonant deletion with your kids ❤️

#adventuresinspeechpathology #speechpathology #speechtherapy #slp #slpeeps #phonology #minimalpairs
First therapy session for /r/. No, I did not focu First therapy session for /r/.

No, I did not focus on isolation.

I found words that the child COULD SAY correctly, and practiced those 🙌🏻

Can you see any patterns of where they are most accurate?

#articulation #speechtherapy #adventuresinspeechpathology #speechsounddisorders #articulationdelay
Love being able to SEE how much we have practiced, Love being able to SEE how much we have practiced, and what words the child can say correctly!

ALSO... THIS PAGE IS 100 TRIALS 🥳

Which means it’s one of my favourite pages to send for home practice!

#speechtherapyactivities #speechtherapy #slp #slpa #slpeeps #articulation #articulationtherapy
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Adventures in Speech Pathology

Feel confident treating speech sound disorders

Therapy Topics · May 16, 2020

When to use the multiple oppositions approach in speech therapy

Answer this question honestly: Have you ever NOT chosen a particular phonological approach because you just didn’t quite believe what the journal article was telling you? Or it was too hard to implement, and so you stuck to something a little easier?

I get it. Phonological interventions can be confusing, especially when there are so many approaches that you can choose for one child.

I was feeling particularly brave when I went for multiple oppositions one day. It was a first-year SLP, and I remember thinking, why not give it go? I had a ‘g’ student. Everything was ‘g’. Every sound. And I knew that this was a child who needed ME to choose an approach that would shake up their system.

I started off using the multiple oppositions approach, and within 6 months, this hard-working student had EVERY single consonant sound, including all blends. It was amazing. And it was just the evidence I needed very early on in my career to try some of those lesser-known phonological therapies. 

Choosing the multiple oppositions approach

I usually start thinking about the multiple oppositions approach during my assessment, believe it or not.  When I start to think “they’re substituting a lot of sounds for the ‘d’ sound”, or “hmm… they use the ‘h’ sound at the start of a lot of words”, I look more to see whether that child has what I call a “favored” or “preferred” sound.

Sometimes I’ll ask parents, “Do you find that Jimmy uses the ‘d’ sound a lot in his speech?”.  And I always probe further to assess clusters in more depth. 

The approach is typically geared towards children who have moderate-severe phonological difficulties with the aim to really shake up and reorganize their phonological system. 

Identifying the phoneme collapse

I find that getting visual is the easiest way for my brain to “see” and understand a phoneme collapse. I systematically go through my single-word assessment, cluster assessment, and conversational sample, and start mapping out the number of sounds that are collapsing to that one (or two) sounds. 

Map out a phoneme collapse for multiple oppositions

By getting visual like this, I can see the big picture more clearly. I’m looking beyond fronting, stopping, cluster reduction, and voicing. I’m noticing, this ‘d’ sound is being substituted for 13 other sounds, so what can I do about this?

After I have identified that there is a collapse and decided that the multiple oppositions is the best fit for the child (read my blog post on choosing phonological interventions for what I consider when choosing an approach), I move on to target selection.

With multiple oppositions, you choose at least two and up to four targets from their phoneme collapse. Think of it like minimal pairs therapy, but with a few extra sounds thrown in. 

Choosing your targets

Now I think this is the part when most therapists think ‘okay, this is too hard, I’m just going to work on fronting’. It’s really not hard. 

Your goal is to choose two to four targets that are different from each other, and different from the substituted sound.

We want to introduce change into our child’s speech. If their favorite sound is ‘d’, well then we know that they can use their voice, make an alveolar and stop their airflow. By choosing target sounds that are DIFFERENT, means that we can introduce more change into their speech system. And this change is the shake-up that they need.

I always sit down and start to scribble targets that could work, based on how many sounds were in the child’s collapse. I think in terms of theories like phonological complexity (later developing, nonstimulable sound), markedness (e.g., affricates imply fricatives and stops, voiced implies voiceless, etc.) and distance metrics (maximal differences in terms of place-manner-voice, etc.).

How to choose targets for multiple oppositions

A place-manner-voice chart (this chart is a free download for those who sign up to my email) is something that I use to help choose my targets. I can visually make sure that I’m covering maximal differences, and feel more confident in my choices.

Here are some things that I have chosen in the past:

  • At least one cluster. Clusters are more complex and later developing. They also imply single sounds (so the two sounds in the cluster might come through without us having to directly target them).
  • An affricate. Based on markedness theory, affricates imply fricatives and stops. I might get the ‘t’ and ‘sh’ sound for free if I choose ‘ch’ as a target word.
  • A stimulable or early developing sound. This might be me, but I like my students to feel a bit of success. When you are contrasting up to four sounds that they are not using, having at least one sound that they say correctly can feel pretty good!

Finding the right words

Once you have your target sounds, you need to think of rhyming sets of words. For example, if you settled on the contrasts d vs. k, ch, sl, you might choose the words:

  1. deep vs. keep, cheep, sleep
  2. dip vs. Kip, chip, slip

Make word sets for multiple oppositions

You might make different words ‘sets’ and have a set 1, set 2, and set 3. You can also use nonwords (such as a made-up name for an alien or monster). 

I have always used the Sound Contrasts in Phonology program, (so I’ve never had to sit and think of the contrasts) and this program does it all for me in terms of generating the actual targets and pictures.

If you are making the targets up yourself, you can do a search and find appropriate clip art to make your own cards, or even draw them with your child. The actual implementation of the multiple oppositions approach is a whole other blog post. In the meantime, read the following articles by Dr A. Lynn Williams  if you are interested in learning more.

  • Multiple oppositions: Case studies of variables in phonological intervention
  • Multiple oppositions: Theoretical foundations for an alternative contrastive intervention approach

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Reader Interactions

Comments

  1. Rachel Serpas says

    July 31, 2020 at 11:12 pm

    Brilliant!! Thank you so much for sharing this approach.

    Reply
  2. Alex says

    August 15, 2020 at 3:20 am

    I love how you map out how to pick the right sounds for a child with a phoneme collapse! I’m wondering what goals might look like for a multiple oppositions approach? Thank you for sharing!

    Reply
    • Hayley says

      October 2, 2020 at 10:29 pm

      I am wondering the same thing!

      Reply
  3. Shaina Rafkin says

    November 3, 2020 at 6:17 am

    Thank you for explaining this so clearly!

    What if my student has a phoneme collapse with 4 different sounds. Would I choose just one to start with or would I choose a different approach?

    Reply
    • Rebecca Reinking says

      November 24, 2020 at 9:15 pm

      I’d suggest getting in touch with Dr. Lynn Williams and asked her this question.

      Reply
  4. annie says

    November 5, 2020 at 2:57 pm

    I would love to have a few goal examples! Thanks so much for sharing!

    Reply
  5. Brooke Andrade says

    January 7, 2021 at 8:23 am

    Hi,
    I love how detailed you were with this approach. I am new to it and am still having difficulty with selecting appropriate targets. I know there should be around 4 targets, and that they should differ in place and manner. But do they also need to differ in voicing or should the voicing stay the same as the sound they substitute for everything? (i.e. in my case /d/). Also any examples of how you write your goals for this intervention approach would be helpful!! Thank you!!

    Reply
    • Rebecca Reinking says

      March 4, 2021 at 8:01 am

      Hi there,

      They should differ in terms of voicing, so I would not choose all voiceless sounds for example, but a mixture.

      Reply
  6. Fiona says

    March 11, 2021 at 10:04 pm

    Thanks for writing such a great article on this.
    Can you use this approach for medial position phoneme collapse too? My student can produce sounds in initial position but 10 medial phonemes are produced as /g/.

    Reply

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I encourage SLPs to feel more confident treating speech sound disorders, and make faster progress with their students.

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