The Complexity Approach

The complexity approach is a phonological intervention for kids who are highly unintelligible (very difficult to understand). In research studies, this approach has been used with kids ages 3-6 who have very low scores (below the 6th percentile) and are missing at least 5-7 sounds (Storkel, 2018). The goal of the complexity approach is to target more difficult sound combinations in order to trigger a system-wide change in a child’s phonetic inventory, therefore shortening the amount of time a child is in speech therapy. Instead of spending months and months sequentially targeting one sound after another, this approach focuses on targeting advanced, more complex sounds. This typically leads to generalization of easier, less advanced sounds without direct treatment. An example of this would be teaching a child the /r/ sound and then the child learns how to produce ‘l’ as well without intervention. I like to tell parents that this is more of a top-to-bottom approach where they’ll see a ‘trickle down effect’ where easier sounds that I don’t directly target will start to improve as well as the target words.

This approach can be difficult to implement. You need to analyze a child’s speech and pick targets according to their specific sound inventory. You’ll want to gather baseline productions of all singletons and onset clusters. This pretreatment probe data is your starting point (McLeod et al, 2021). After analyzing this data, you’ll want to pick targets that are more complex and have a good sonority score (check out this article for details about sonority scoring and complexity). I tend to pick consonant clusters with a sonority score difference of +3 or +4.

If you want to target a 3-element cluster (str, spr, skr, skw, spl), the child needs to be able to produce the second and third consonants, but doesn’t have to be able to produce the intial ‘s’. That means if you want to target ‘str’ words, a child must be able to say ‘t’ and ‘r’, but not ‘s’. If the child doesn’t have the second and third consonants in a 3-element cluster, consider targeting a 2-element consonant cluster. A child does NOT need to be stimulable for either sound (in the 2-element cluster) in order to be targeted in therapy.

Once you have your target words, you’ll work on them for 12 weeks. During the first phase of treatment, teach the target words with a verbal model so the child can more easily imitate the words accurately. Give feedback so the child can be more accurate. Do this for 7 sessions or until the child is 75% accurate across 2 sessions. After this, you’ll want to monitor the child’s production of singletons and clusters using single-word probes. Then you’ll work on treating the target words spontaneously (no verbal model) until the child is 90% accurate across 3 sessions-or, if the child doesn’t reach this point- for a total of 12 sessions. After this timeframe, you’ll monitor the child’s production of singletons and clusters at 2 weeks and 2 months following treatment using single-word probe measures.

A word of caution- this approach can be challenging because it’s…complex 😆. A child’s personality is a large factor when considering this approach. Because the target words will likely be difficult for the child to say correctly (especially in the beginning) the child needs to be fairly resilient and open to feedback. If you’re working with a child who gets upset when you tell them they said a sound incorrectly, this approach is not for them. You need to be able to get a lot of trials during a session, so if you struggle to get high reps with certain kids, this approach would not be a good choice for them either.

I typically try out an approach for 2-3 sessions and then re-evaluate if it isn’t going well. If you start with the complexity approach and realize it isn’t a good fit, don’t be afraid to pick a different approach. You can consider multiple oppositions, the cycles approach, or minimal pairs. This approach can be very effective in quickly changing a child’s phonetic inventory, but it isn’t for everyone. It’s ok to try it out and make changes as needed.

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.

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