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. 

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.).

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

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