Multiple Oppositions Approach

Multiple oppositions is one of my favorite phonological approaches to use for kids who demonstrate a phoneme collapse. A phoneme collapse is when a child uses one sound in place of many other sounds (ex: a child uses /d/ for /b, t, g, k, s, sh, th, l/). It is extremely difficult to understand these kids. It can also be difficult to pick a starting point in therapy because there are just so many errors. But, if you were to treat each error sound individually in succession, a child could spend years in therapy. This is why the multiple oppositions approach is so helpful.

This approach is based on the premise that multiple error sounds need to be targeted simultaneously. You work on contrasting the child’s error sound with 2-4 strategically selected sounds that are demonstrate both maximal classification and maximal distinction (McLeod et al, 2021). Maximal classification means target sounds are chosen that differ in manner or production, place of production, and voicing. Maximal distinction means picking target sounds that are maximally different from the child’s error sound. This requires you to analyze the child’s data and pick targets that fit these parameters. In the example above, you might pick /sh, g, th, and l/ as targets. You wouldn’t want to pick /t/ because it shares the same place and manner of production and only differs in voicing from the error sound. Picking target sounds that are as different from each other as possible helps generalization.

There are 4 different phases of therapy: 1-Familiarization and production of the contrasts 2- Production of the contrasts 3-Production of contrasts within communicative contexts 4- Conversational recasts. To learn more about these phases, I highly recommend this book- there’s an entire chapter detailing Multiple Oppositions. To summarize the phases briefly, you need to help the child learn the new target words and teach the rules about how the new target sounds are made. Using pictures helps the child create meaningful contexts for the target words. Then you need to practice-a lot. First have the child directly imitate you and then move to spontaneous productions as they become more accurate and needs less cueing.

The criteria for the imitated production phase is 70% accuracy across 2 consecutive treatment sets. Once a child has met this, you move on to targeting spontaneous productions of the paired words. It’s important to note that during phase 2, play activities using the target sounds are incorporated at the end of sessions. An example would be hiding mini objects of the target sound around the room and then checking if the child says the target words accurately as they find them.

Generalization is monitored by testing 10 untrained words for each target sound (ex: 10 /sh/ words, 10 /th/ words, 10 /l/ words, etc…) every 3rd session (McLeod et al, 2021). This probe list of words is administered before therapy is started to establish a baseline. Once the child achieves 90% accuracy for a target sound, then you do a structured conversational sample with lots of opportunities for the target word to be produced. When the child is 50% accurate in conversational speech, then that sound no longer needs to be targeted in therapy.

There’s research that shows that this intervention works. This study showed that after 12-16 weeks of treatment, children improved the production of both targets sounds and non-targeted singleton consonants (Lee, 2018). I have seen this happen in my practice as well. Sounds that I haven’t targeted at all tend to improve when I do a probe after 12 sessions.

I love using the SCIP app for multiple oppositions-it’s my go-to app. You enter the error sound and the contrasting target sounds and the app generates words with pictures for you. You can use the app, print the pictures, and email them to parents. It saves so much time.

One of the parts I love about multiple oppositions is that when you first start therapy and the child tries to say the new target sounds but uses their go-to error sound instead, you can immediately point to the picture of what they actually said and show them the difference (‘Oh you said ‘toe’. This is what ‘show’ looks like. ‘Show’ is a longer sound that you make further back in your mouth). And they start learning there’s a difference in what they’re saying vs what they think they’re saying.

Below is a video of a session where I had just started the multiple oppositions approach with a little kid. I’m using pictures from the SCIP app. You can see him begin to notice that he is actually saying the same word for all the words and he starts to correct himself with a little prompting. I love when the wheels start turning and kids start making changes. It’s so neat!

This approach is awesome for the kids with really severe phonological disorders. Grab the SCIP app and try it out!

Sources:

McLeod, S., Williams, A. L., & McCauley, R. J. (2021). The Complexity Approach. In Interventions for Speech Sound Disorders in Children, 2nd Edition (pp. 103–104). essay, Paul H Brookes.

Lee, S (2018). The treatment efficacy of multiple opposition phonological approach via telepractice for two children with severe phonological disorders in rural areas of West Texas in the USA. Accessed October 17, 2024.