Cycles Phonological Pattern Approach (CPPA)


CPPA


This approach combines traditional and linguistic approaches and was devised for SLPs/SLTs working with highly unintelligible children. There is a full description of the approach in Hodson (2006) listed below in the references section with a link to the article.


Assessment

The HAPP-3 (Hodson, 2004) is administered, before beginning treatment, to determine which patterns need to be targeted. Deviations are analysed in order to select optimal (for the individual child) target phonological patterns.

Background

This approach combines traditional and linguistic approaches and was devised for speech-language clinicians working with highly unintelligible children (Hodson & Paden, 1983, 1991). The eight underlying concepts of the Cycles approach (adapted from Hodson, 2010) are:

  1. Children with normal hearing typically acquire the adult sound system primarily by listening.
  2. Phonological acquisition is a gradual process.
  3. Phonetic environment in words can facilitate or inhibit correct sound productions.
  4. Children associate auditory and kinaesthetic sensations that enable later self-monitoring.
  5. Children generalise new speech production skills to other targets.
  6. An optimal ‘match’ facilitates learning.
  7. Children learn best when they are actively involved/engaged in phonological remediation.
  8. Enhancing a child’s metaphonological skills facilitates the child’s speech improvement and also development of early literacy skills.  

Target Selection

Phonological patterns analysis (Hodson, 2004) is performed to identify treatment targets. Targets are consistent phonological deviations or patterns occurring 40% or greater. Targets must be stimulable.

Primary patterns are targeted first: early syllable structure patterns, anterior-posterior contrasts, and /s/ clusters. Liquids are 'facilitated' at the end of each cycle; then secondary patterns: palatals, other consonant sequences, singleton stridents, prevocalic voicing contrasts, vowel contrasts, assimilations and any remaining idiosyncratic deviations.

Hodson (2004) wrote, 'Potential secondary target patterns need to be reviewed to ascertain if any of these need to be targeted after the following three criteria are reached: (a) All early developing patterns (e.g., “syllableness”) are established; (b) /s/ clusters are emerging in conversation; and (c) anterior and posterior consonants are used contrastively. Although a number of these secondary patterns may have been evidenced during the initial evaluation, many will have "normalized" during the time that the client was working on the Primary patterns'.

Some children above the age of 8;0 require help with “advanced target patterns”: multisyllabic words such as “aluminium” and “thermometer” and complex consonant sequences as in “excuse” and “extra” (Hodson, 2010  p.100).  

Intervention Procedures

1.     Cycles

Rationale
Normal phonological acquisition is gradual.

Implementation
A phoneme within a pattern is presented/stimulated/targeted for 1 hour (sometimes 2); then another phoneme for that same pattern (always at least 2 phonemes per pattern; then the next pattern, etc. The patterns are recycled, adding complexity with each ensuing cycle. Cycle One is 6-18 hours. Phonological assessment (Hodson, 2004) is performed at the end of each cycle. Typically 3 or 4 cycles (requiring approximately 30-40 hours) are required for clients with extremely disordered phonological systems to become intelligible.

According to Hodson (personal correspondence, 2015) a cycle is not complete until all of the deficient Patterns [primary; then secondary] that have been identified/specified have been targeted. For example, Cycle One for most children with highly unintelligible speech involves at least 2 hours for each of the following patterns: 'syllableness', final 'consonantness', /s/ clusters, velars, liquids. Typically 'syllableness' and final 'consonantness' do not need to be 'recycled', but /s/ clusters, velars, and liquids virtually always need to be recycled 2 or 3 times. Also /s/ clusters [initial; then final (e.g., /ts/)] are often targeted for 4-5 hours for each early cycle. And then more complex [internal] /s/ sequences (e.g., basket) are targeted under Secondary patterns.

2.     Focused Auditory Input

Rationale
Speech acquisition occurs through listening. Focused input ‘tunes up’ the child’s sound system in order to maximise the effect of production practice.

Implementation
The child listens for <30 seconds to 15-20 words, spoken by an adult, through headphones at the beginning and end of each session and once daily at home without amplification.

3.     Facilitative Contexts, Active Involvement, Self-monitoring and Generalisation

Rationale
This promotes the development of new kinaesthetic and auditory images. These are internalised through practice, facilitating the child’s self-monitoring skills.

Implementation
In a drill-play format the child does production practice of individual words, carefully selected for optimal phonetic environment (Kent, 1982), involving that is, facilitative phonetic contexts.

A small set of production practice words (target words) is included in each session. Models and tactile cues are used to help the child consistently produce the targets correctly, to facilitate new auditory and kinaesthetic images. Four or five words with captions are drawn on large 5x8 inch index cards. The child actively participates in drill-play  throughout the session. Activities are changed every 7-8 minutes while the child is still interested; many activities can then be repeated in following sessions

4.     Optimal Match

Rationale
Matching the child’s current 'phonological level' with a corresponding treatment level allows the child to be optimally challenged and yet experience success.

Implementation
When it is initiated, treatment is geared to ‘one step higher’ than the child’s current phonological level, so that the child is successful, but optimally challenged.

 

References

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Hodson, B. (2004). Hodson Assessment of Phonological Patterns, 3rd Ed. Austin, TX: Pro-Ed.

Hodson, B. (2006). Identifying phonological patterns and projecting remediation cycles: Expediting intelligibility gains of a 7 year old Australian child. Advances in Speech-Language Pathology, 8(3), 257-264. Click here

Hodson, B. W. (2009). Enhancing phonological patterns to expedite intelligibility gains. In C. Bowen, Children's speech sound disorders. Oxford: Wiley-Blackwell, pp. 19-21.

Hodson, B. (2010). Evaluating and enhancing children’s phonological systems: Research and theory to practice. Greenville, SC: PhonoComp Publishing.

Hodson, B. W. (2011, 4/5/2011). Enhancing phonological patterns of young children with highly unintelligible speech. The ASHA Leader.

Hodson, B. W. (2015). Cycles phonological patterns approach. In C. Bowen, Children's speech sound disorders (2nd ed.). Oxford: Wiley-Blackwell, pp. 36-40.

Hodson, B.W., Chin, L., Redmond, B., & Simpson, R. (1983). Phonological evaluation and remediation of speech deviations of a child with a repaired cleft palate: A case study. Journal of Speech and Hearing Disorders, 48, 93-98.

Hodson, B.W., & Paden, E.P. (1981). Phonological processes which characterize unintelligible and intelligible speech in early childhood. Journal of Speech and Hearing Disorders, 46, 369-373.

Hodson, B. W., & Paden, E. (1983). Targeting intelligible speech: A phonological approach to remediation. San Diego, CA: College-Hill Press.

Hodson, B.W., & Paden, E. P. (1991). Targeting intelligible speech: A phonological approach to remediation, 2nd Ed. Austin, TX: Pro-Ed.

Hodson, B.W., Scherz, J.A., & Strattman, K.H. (2002). Evaluating communicative abilities of a highly unintelligible child.American Journal of Speech-Language Pathology, 11, 236-242.

Prezas, R. F., & Hodson, B. W. (2010).The cycles phonological remediation approach. In A. L. Williams, S. McLeod, & R. J. McCauley (Eds), Interventions for speech sound disorders in children (pp. 137–157). Baltimore, MD: Paul H.  Brookes Publishing Co.