The Wonder of Cycles

Created by Barbara Hodson

Shared by Anne Hasting
2014
Where credit is due
Created by Barbara
Hodson
Evaluating and
Enhancing Childrens
Phonological Systems
www.phonocomp.com
This approach
Created for severe-profound intelligibility
problems
More closely matches natural acquisition
Evidence-based
Ages 2-14
Variety of disorders
Refined over 35 years
Works
Poorly intelligible kids
Not auditory self-monitoring
Rely on inaccurate kinesthetic self-monitoring
Order in disorder
More likely to evidence certain processes
Lag behind in basic literacy and spelling later
Whats important?
Intelligibility!
Not number of errors
Child with /s/ lisp and /s/ omission have same
number of errors on GFTA-2
Intelligibility in connected speech how to
estimate?
Sentence imitation
HAPP-3
Identify errors
Tests are for identifying disability
Avoid teaching to the test
Not very helpful anyway
Play and listen, take notes
Put parents to work if kid doesnt cooperate
Video recording, audio recording, notes
Full analysis not necessary
First look for absence of primary patterns (slide 11)
What do you want?
Cycles terminology focuses not on the deficits,
but on what you want the child to do
Syllable reduction? Syllableness
Initial/final consonant deletion? Singleton
consonants, initial and final
Fronting/backing? Anterior-posterior contrasts
Cluster reduction? /s/ clusters
Liquid gliding? Liquids
Processes? Patterns
Cycles has cycles
Cycle: series of target patterns
Work on each target pattern in succession
5-20 weeks, depending on number of deficiencies
and on stimulability
Then start over, add phonemes to patterns if
possible
First you cycle primary patterns
When primary patterns reach accuracy criteria
(3-5 cycles), begin cycling secondary patterns
Priorities
Omissions and additions are top
Substitutions are next critical after o & a
Distortions have much less impact on intelligibility
Structural changes
Syllable deletion
Singleton consonant deletions (initial and/or final)
Cluster reduction
Epenthesis
Syllable addition
What are we working on again?
Patterns NOT sounds
Need to use sounds to work on patterns
Catch-22? Just keep in mind that the sounds
are a means to an end.
Do NOT work on every sound in error
Choose a few *stimulable* sounds to teach
patterns
One clinical hour per target sound
Number of target sounds depends on stimulability
Primary Patterns
Primary patterns:
Syllableness
Singleton consonants
Initial
Final
/s/ clusters
Anterior-posterior contrasts
Liquids
Target what the child needs
Syllableness
Spondees (equal-stress words)
Targeting non-spondee two-syllable words results
in inappropriate prosody or encourages syllable
deletion
Target is producing multiple syllables
Hows he doing?
ice cream -> cream
ice cream -> eye ee
ice cream -> ha ha
Singleton consonants
Initial singleton consonants (if in error)
Choose 2-6 target phonemes
Stops /b, p/ possibly /d, t, g, k/
Nasals /m, n/
Glide /w/
Always use real words, not made-up syllables
Always use words the child can say
If CVC is not stimulable, try CV
Singleton Consonants
Final singleton consonants
Choose 2-6 target phonemes
Voiceless stops /p, t, k/
Nasals /m, n/
Always use real words, not made-up syllables
Always use words the child can say
If CVC is not stimulable, try VC
/s/ clusters
/s/ clusters
Initial
/st, sp, sk, sm, sn/ (careful fronting/backing)
Video 1, s clusters M
Final
/ts, ps, ks/ (careful fronting/backing)
Yay for morphology: plurals, 3p singular verbs
ONLY if singleton consonants are present
If fluent words: Its a spoon. Its a snail.
Video 2, its a sk I
Anterior-posterior contrasts
If not stimulable, target as a secondary pattern
Most kids are fronters or velar deleters; you want
velars
Final /k/
Initial /k/, /g/
Some kids are backers; you want alveolars
Initial /t/, /d/
Final /t/
Avoid words that have both front and back
sounds: dog, coat, take, kiss, knock
Liquids
3 y/o vs. 7 y/o working on /r/ for first time
Developmentally appropriate acquisition
Hodsons data
Not a glide
Derhotacized/lax /r/ and vowels are acceptable
Data collection:
Run -> wun
Run -> oowun
Run -> oo uuuun
Run -> r)un
Video 3, liquids I
Liquids
Target initial /l/
Stable jaw tongue clicking for a week at home before
targeting
Target initial /r/ (er)
Needs to be er a:k
Jaw wide open for onset, keep it open during pause
and rime (no /w/ insertion)
Target /r/ blends if stimulable for velars
/k, g/ are facilitative
Target velar and alveolar /l/ blends when /l/ is
solid
/p, b, m, f, v/ encourage gliding, so rope, roof,
rabbit, lamp, and leaf would be out
Nitty gritty, part 1
One clinical hour per target phoneme (2-6 hours per
target pattern)
Hodson recommends one hour per week total: three 20-
minute, two 30-minute, one 60-minute
Double time if child has intellectual disability
MUST be stimulable
Use sounds the child can say (maybe not easily) to work on
patterns the child has not mastered
Stimulable doesnt mean easy
Focused auditory input cycle for nons (nonstimulable,
nonverbal, or noncompliant)
One cycle of primary patterns: only input, no production
requirements
Usually needed for children younger than 3 years
2 weeks on each primary pattern except liquids (10 weeks)
Primary Pattern Graduation
Move from primary to secondary patterns
when:
Initial /m, n, w/ and stops 60% correct in
conversation
Final /m, n, p, t, k/ 60% correct in conversation
A-p contrasts 60% in conv. in one word position
/s/ clusters emerging in conversation
Liquid approximations at the word level
Listen during liquids
Not reached criteria? Cycle error patterns again
Severe intelligibility = 3-4 primary cycles

Secondary Patterns
Begin after criteria have been reached for
primary pattern graduation
Do NOT kill yourself analyzing all patterns early
Listen during liquids

Possible Secondary Patterns
Some common ones:
Voicing contrasts
Vowel contrasts
*Anterior-posterior contrasts
Stridency
Palatals
Other consonant clusters
Context-related processes
Assimilations
Metathesis
Idiosyncratic rules
Voicing Contrasts
Errors with voiced/voiceless cognates
p/b, t/d, s/z, etc.
Prevocalic voicing
Use minimal pair words and some
amplification
Vowel Contrasts
Usually get the vowels sorted out during the
primary cycles
Use minimal pairs and some amplification
Anterior-Posterior Contrasts
Target in secondary cycles if not stimulable
during primary cycles
See slide 16
Stridency
Stridents: f, v, s, z, sh, zh, ch, j
Stridency deletion: substituting non-stridents
or deleting the strident altogether
Fan->pan, Sue->new, peach->pea, fishing->fitting
Stridents are often stopped but not always
Usually working on /s/ clusters generalizes but
if not:
Target /f/ and /s/ first, usually in final position
Palatals
Palatals: y, sh, ch, j
Target y first
Then insert y after other palatals
Chyair (child will probably say tsyair)
Shyoe (syoe)
Jyump (dzyump)
Usually ch is more stimulable than sh or j
Other Consonant Clusters
Examples: kw, tw, sw, by, hy, fy, ky, my
/s/+stop final clusters (e.g. toast)
Medial /s/ clusters (boxes, sister)
Three consonant sequences (straw, square)
Context-related Processes
Assimilations:
Labial, e.g. pin -> pim
Alveolar, e.g. take -> tate
Velar, e.g. green -> gring
Nasal, e.g. mat -> man
Assimilations multiply with other errors
Pin -> im (adding initial consonant deletion)
Take -> date (adding prevocalic voicing)
Green -> wing (adding cluster reduction & gliding)
Mat -> many (adding diminutization)
Context-related Processes
Metathesis (switching positions)
Ask->aks, take->kate
Reduplication
Bottle->baba, TV->beebee
Idiosyncratic rules - some fun ones:
Alveolar and velar stops, and all stridents = /h/
All fricatives, affricates, and clusters = /d/
(except /h/ )
Minimal pairs

Advanced Patterns
Upper elementary, middle (~age 9 and up)
Look fine on artic tests but have intelligibility
issues in the real world
Usually have language/learning disabilities
Complex consonant sequences (extra, excuse)
Video 4, complex sequences I
Multisyllabicity (apostrophe, aluminum)
Segment phonemes syllable by syllable
Teach phonics writing
Once youve broken it up, put it all back together
Example: Morgan, age 4:10
Morgan is poorly intelligible in conversation
but between the GFTA and mom you get:
House -> how
Stop -> top
Big -> bid
Carson -> tawtuh
Make -> nay
Like -> wipe
Play -> pay
What will you do with her?
Example: Morgan
Primary patterns
Singleton consonants (final)
/s/ clusters
Anterior-posterior contrasts
Liquids

Example: Adam, age 6:1
Adams intelligibility in conversation varies
Errors include:
Stop -> chop
Likes -> wite
Chair -> tayoh
Tree -> tee
Susannah -> Chuchannah
Skates -> chate
Christmas -> Kimuch
Shoes -> chooch
Zero -> jeewo

Example: Adam
Primary patterns:
/s/ clusters (avoid sk)
Anterior-posterior contrasts
Liquids



Example: Hannah, age 3:3
Hannah doesnt say much. Mom understands
very little of what Hannah does say. Imitated
single words include:
Drum -> uh
Mommy -> um
Me = correct
Green -> nee
Blue -> woh
Chair = refused to attempt
Baby -> bee

Example: Hannah
Auditory input cycle?
Primary patterns
Syllableness
Singleton consonants (initial)
Singleton consonants (final)
/s/ blends when singleton consonants emerging
Anterior-posterior contrasts
Liquids
Example: Nathan, age 10:6
Nathan has had 7 years of remediation but
remains unintelligible at times. You hear:
Skinny -> sinny
Color -> coloh
Electricity -> elekitsy
Christina -> wikseeta
Lightning = correct
Germany = Johmany
Mixture -> mistoh
Hopping = correct
Sneeze -> seeze
Huge = correct

Nathan
Primary Patterns
/s/ clusters
Liquids (/r/)
Secondary Patterns
Metathesis and migration best addressed in:
Advanced Patterns
Complex consonant sequences
Multisyllabicity


Whew
Enough framework for you?
Its the most important part!
Organization of overall treatment
What does a session look like?
Sessions
Review
Listening words
Practice patterns
Metaphonological skills
Listening words
Stimulability
Session Structure
Review last weeks targets IF same pattern 2
minutes
Listening words (amplified auditory
stimulation) 15 seconds
12-15 words at slight amplification (6-12 dB)
Clinician reads, child listens
Speak normally
Child can attempt a few production practice words
(see next slide) while wearing amplification
Try PVC piping or Whisperphone Duet
Evidence-based
Session Structure
Production practice main bulk of session
Choose 2-5 target words (no nonsense syllables)
Ages 1-too immature to sit and attend:
Opportunities for targets to be produced naturally in
context
Ages 3ish and up:
Create practice cards
Draw, write, color targets on index cards
Can play and say or produce in context or a little of
both
Metaphonological skillssee next slide
Able to read:
Short oral reading period focusing on target pattern
Metaphonological Skills
Struggle with basic literacy and spelling
A few minutes each session targeting:
Rhyming
Segmentation and blending of:
Syllables, Video 5, syllable blending M
Onset and rime, Videos 6 & 7, blending I, seg E
Phonemes, Videos 8, 9, & 10, blending D, seg D & J
Manipulation
Send home short rhymes like Jack and Jill
Video 11 nursery thyme cloze s
Increase the time in final cycles
Session Structure
Listening words 15 seconds
Same list, same amplification
Stimulability 2 minutes
Select next sessions practice words
Nitty gritty, part 2
Evidence-based but may not work if you do not
follow the protocol
Quality over quantity
STIMULABLE
No data collection measures are provided at the
end of each cycle not each session
Interferes with naturalistic interactions
Mixing errors with correct leads to fuzzy phonological
representation
Dont say good job when you mean good try
Give accurate feedback and immediately try to correct
the error
Nitty gritty, part 3
Group therapy
FAPE, individualization
Progress is known to be slower
Listening to several targets in one session may
lead to fuzzy phonological representation
Choosing targets
Listening list: anything with target pattern
Practice words: stimulable, phonetic environment,
can teach semantics
Metaphonological words: child must already know
Fine if production is imperfect

Homework
Homework 2 minutes per day
School age: para/aide or educator can do this
Parent reads listening words, child says each
practice word once, read rhyme if applicable
Good luck
I train parents/teachers on ear training
Ear training
Supports Cycles
Important: limited to current target pattern
Five types:
Modeling
Auditory awareness
**Feedback**
Praise
Corrections
Ear training
Modeling (auditory bombardment)
Focused play, say targets often without requiring the
child to imitate
Auditory awareness
Johnny, want to gohey, go has your /g/ sound!
Want to go outside and play?
Feedback Ditzy dame routine
The tea? Hm, I dont see any tea out there to drink
Oh, you mean tree! Sorry, I heard tea. I do see the
snow on the tree.
Nack? I dont know what a nack is Oh, snack! Sure,
you can have a snack.
Ear training
Praise
Nice /s/ in sit!
I heard that good /k/ sound when you said keys.
Corrections
No? Try again: snow. Thats right!
I require an equal number of praise and
corrections, max 5 corrections per day
Impossible until child is generalizing
No praise = no corrections
IEP objectives
(Auditory input cycle) Will participate in activities
targeting correct speech patterns
Will produce words beginning or ending with /k/
Will produce at least two of the following at the
word level: /sp, st, sk, sm, sn/
Will produce at least two of the following at the
end of words: /p, t, k, m, n/
Will produce words with two syllables
Will attempt words beginning with /l/ sound
Will produce an approximation of /r/
Will produce words ending with /s/
Evidence
Randomized, single-blind clinical trials
Comparisons with other treatments
Hundreds of kids
Less than a year for most preschoolers to become
intelligible (30-40 clinical hours)
Closer to two years for extremely disordered
phonological systems but normal cognitive
Cleft palate, recurrent otitis media, apraxia, mild-
severe hearing impairment, cochlear implant,
cognitive delays
My Evidence
All names are changed
Progress in a single school year

Evidence: Hugh
Began Cycles age 3:10
No previous tx
Embarrassed, avoided speaking
Data game
Otitis media history, resolved
Poor stimulability
Fantastic follow through on ear training
Intelligibility jump after 3 months
>80% intelligible at end of school year

Hughs progress in conversation
Target Pattern Occurrence
Final consonants 100%
A-P contrast 100%
Stridents 100%
/s/ clusters 100%
Other clusters 100%
Liquid /l/ 0%
Liquid /r/ 20%
Target Pattern Occurrence
Final consonants 0%
A-P contrast 60%
Stridents 0%
/s/ clusters 0%
Other clusters 0%
Liquid /l/ 0%
Liquid /r/ 0%
Evidence: Bella
Began Cycles age 3:3
Otitis media history
Good stimulability
Resistant to practice
Bribery
Intelligibility jump age 3:6, again age 3:9
Dx mild-mod conductive hearing loss, got
hearing aids age 3:10
Discontinued artic age 4:1
Bellas progress in conversation
Target Pattern Occurrence
Final consonants 100%
A-P contrast 0%
Stridents 0%
/s/ clusters 0%
Other clusters 0%
Liquid /l/ 0%
Liquids /r/ 0%
Palatals 0%
Target Pattern Occurrence
Final consonants 100%
A-P contrast 100%
Stridents 100%
/s/ clusters 100%
Other clusters 100%
Liquid /l/ 100%
Liquids /r/ 0%
Palatals 100%
Evidence: David
Age 4:10
1.5 years previous tx: worked final consonants
to sentences, /k/ in isolation
Poorly intelligible, glottal stops for nearly all
medial phonemes
Poor stimulability
Very active!
Intelligibility jump age 5:3

Davids progress in conversation
Target Pattern Occurrence
Final consonants 80%
A-P contrast 0%
Stridents 40%
/s/ clusters 0%
Other clusters 0%
Liquid /l/ 0%
Liquid /r/ 0%
Voicing contrast 0%
Palatals 0%
Target Pattern Occurrence
Final consonants 100%
A-P contrast 100%
Stridents 100%
/s/ clusters 100%
Other clusters 80%
Liquid /l/ 20%
Liquid /r/ 0%
Voicing contrast 100%
Palatals 80%
Evidence: Carly
Began Cycles age 4:4
No previous tx
Selective mutism
Mom does all treatment with my guidance
Home visits to teach mom, email
Small sessions throughout the week
Pals services for personal/social
Carlys progress in conversation
Target Pattern Occurrence
Final consonants 100%
A-P contrast 0%
Stridents 40%
/s/ clusters 0%
Other clusters 0%
Liquid /l/ 0%
Liquid /r/ 0%
Voicing contrast 0%
Target Pattern Occurrence
Final consonants 100%
A-P contrast 60%
Stridents 60%
/s/ clusters 40%
Other clusters 60%
Liquid /l/ 0%
Liquid /r/ 0%
Voicing contrast 40%
Data from 5 months into tx
All at 100% except liquids after 8 months tx
Evidence: Michael
Began Cycles age 3:2
No previous tx
Recurrent otitis media through age 3:8
Behavior, attention difficulties
Language processing
Mom sat in on sessions, good follow through
at home
Michaels progress in conversation
Target Pattern Occurrence
Final consonants 100%
A-P contrast 40%
Stridents 40%
/s/ clusters 0%
Other clusters 0%
Liquid /l/ 0%
Liquid /r/ 100%
Voicing contrast 0%
Target Pattern Occurrence
Final consonants 100%
A-P contrast 60%
Stridents 60%
/s/ clusters 0%
Other clusters 0%
Liquid /l/ 0%
Liquid /r/ 100%
Voicing contrast 60%
Data from 4 months into tx
All at 100% except other clusters after 10 months tx
Every speech sound correct including complex consonant sequences after 14 months tx
Dismissal
All deviation percentages of occurrence
(except liquids) below 40%
TOMPD (total occurrences of major
phonological deviations) on HAPP-3 below 50
Probably need to continue phonological skills
training
Follow-up after 6 months
The last word
3-6 months to generalize to conversation after
fluent productions at word level
Key is to KEEP MOVING ON
Dont get stuck on something they havent
generalized
Dont expect Cycles to work if you modify it
myspeechteacher.wikispaces.com
Listenandtalk@me.com
Appendix A
History of Therapy Approaches
from Hodson 2010 (see note)
Overview
Early Approaches
Phoneme-Oriented Intervention
Phonetic Placement
Moto-Kinesthetic
Stimulus Approach
Sensory-Motor Approach
Discrimination Approach
Behavioristic Approaches
Linguistic-Based Approaches
Early: Phonetic Placement
Circa 1927
Emphasis on articulators: tongue and lips
Modification of placement and airflow
Use of diagrams and demonstrations
Assumption (incorrect) that phonemes are always
articulated with the same placement
Neglects coarticulatory changes
Poor efficacy
May still be useful in early phases of articulation
intervention to demonstrate how a phoneme is
produced
Early: Moto-Kinesthetic Approach
Circa 1938
Speech is a dynamic event
Involved external manipulation of the articulators
Articulatory movement must be felt and
developed as a muscle sense of kinesthetic image
Sounds are taught in syllables with schwa,
reduplicated syllables, multisyllabic words,
phrases, then sentences
Tactile cuing, such as pressing under chin to
stimulate /k/
Poor efficacy
Early: Stimulus Approach
Van Riper 1939-1978
Aka Traditional Approach
Misarticulations are more than placement or
production errors
Poor auditory sensory perception contributes
Auditory training prior to production practice
Only one sound targeted at a time
Five steps: sensory-perceptual training, sound
elicitation, sound production stabilization (isolation to
sentences), transfer, maintenance
Useful for one or two phoneme errors
Problems: insufficient for multiple errors, limited
emphasis on generalization to untargeted phonemes
Early: Sensory-Motor Approach
McDonald 1964
Attention to position in words (init, med, fin)
Speech is a sequence of syllables rather than
sounds in individual words
Recommended deep assessment to examine
coarticulatory effects
Use 2- to 3-syllable words
Correct production in varied phonetic contexts
No ear training or production in isolation
Poor efficacy, though better than previous three
Useful for determining facilitative phonetic
environments


Early: Discrimination Approach
Winitz and Bellerose 1962
Teach auditory discrimination of error sound
from target sound
Begin with gross contrasts then finer contrasts
Ship/lock before ship/chip
Controversy about whether discrimination
tasks are necessary
Requires metalinguistic skills, discussion of
word structures as opposed to word meaning
Not developmentally appropriate for younger
children
Behavioristic Approaches 1
1970s
Articulation hierarchy
Isolation, nonsense syllables (CV, VC, CVC)
All word positions, then phrases, sentences
Must meet specific criterion (ex. /k/ 90% in
phrases) before moving up a level
More prompting if productions are
consistently incorrect
Test transfer or generalization to nontreated
words to determine progress
Behavioristic Approaches 2
Response to needs for efficiency and
documentation
Two popular behavioristic phoneme-oriented
approaches: Programmed Instruction (1977)
and Multiple Phonemic Approach (1975)
Behavioral objectives have become required
for IEPs
Behavioristic: Programmed Instruction
Mowrer, Baker, & Schutz 1968
Reinforcement schedules: stickers, tokens
Penalties for incorrect production
Many responses required--tedious, boring (for
clinician and child)

Behavioristic: Multiple Phonemic
McCabe & Bradley 1975
Establishment phase: all phonemes in isolation
Even correct phonemes
Every phonemes produced at least once each session
Transfer phase: similar to Stimulus Approach
Articulation hierarchy
Whole word accuracy is calculated
Maintenance phase: Conversation outside the session and
over time
Working on so many targets at the same time is confusing
for children with many errors
Data collection and organization cab be difficult
SLPs often modify this programseveral not all phonemes

Linguistic: Distinctive Features
Blache 1978
Distinctive features: classification system to distinguish
phonemes across languages
Place, manner, voice, etc.
Experimental, limited clinical application
Target features rather than phonemes
Subsequent substitutions that include desired features are
reinforced and viewed as progression toward correct
production
No isolated phonemes; use minimal pairs
Distinctive features are helpful for classifying sounds, but this
approach does not account for omissions
Distinctive feature analysis has been subsumed under
phonological analysis
Linguistic: Phonological Approaches
Hodson & Paden 1983, 1991; Stoel-Gammon &
Dunn 1985
Goals: intelligibility, reorganized phon. System,
enhanced strategies for phon. Processing
Early approaches focused on suppression of
processes through intervention of sounds
affected by the processes
Cycles, Metaphon, Phonological Awareness
Cycles
Um.. Go back to the beginning
Linguistic: Metaphon
Howell & Dean 1994
Cognitive-linguistic approach
Premise is children can change sound productions by
developing awareness of place, manner, voice
similarities & differences
Emphasis on classification rather than production
Phase one: phonological production concepts and
terms are targeted through sorting of nonspeech
sounds
Phase two: judgment of minimal pair words
1995 study showed that preschoolers improved
expressive phonological productions
Linguistic: Phonological Awareness
Not a separate approach
Expressive phonology impacts literacy
Phonological awareness ability is highly
correlated with literacy success
Awareness of sound structure, ability to
manipulate sounds in words, etc.
Phonological awareness can be taught
Intervention can change both phonological
awareness and expressive phonology
Linguistic: Whole Language
Children with expressive phon. Problems often have other
language impairments
Interactive story-telling can improve phonological
development, as well as semantic, and syntactic skills
Child describes picture, SLP scaffolds
Encourage child to clarify sounds, sentence structure, semantic
relationships
Encourage to add information
Encourage to increase complexity by including relationships (ex.
cause-effect) and motivation (ex. feelings)
SLP models enhanced language, children restate
Efficient and effective for children with mild impairment
Children with more severe deficits need more direct
phonological intervention
Appendix B
Target Selection
from Hodson 2010
Phoneme-Oriented Approaches
Chronological or developmental age
Early-developing phonemes are considered a
prerequisite for later-developing phonemes
Phoneme frequencyex. /s/
Stimulabilitystimulable before non
Visibilityex. labial consonants
Variability inconsistencysounds produced
sometimes are chosen
Utilityex. sound in the childs name
Phoneme-Oriented Approaches
Elbert 1992; Gierut, Morrisette, Hughes, &
Rowland 1996 suggest selection of phonemes
with least productive phonological knowledge
Nonstimulable, later developing
A series of single-subject design studies suggested
some benefit
Rvachew and Nowak 2001 challenged this
based on results of a randomized-control
study
Results were poorer for children working on least
phonological knowledge targets first