Cycles 2013 - myspeechteacher

The Wonder of Cycles
Created by Barbara Hodson
Shared by Anne Hasting
Where credit is due
• Created by Barbara
• Evaluating and
Enhancing Children’s
Phonological Systems
This approach
• Created for severe-profound intelligibility
• 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
What’s 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
– 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 doesn’t 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
• First you cycle primary patterns
• When primary patterns reach accuracy criteria
(3-5 cycles), begin cycling secondary patterns
• 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
• 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
• Spondees (equal-stress words)
– Targeting non-spondee two-syllable words results
in inappropriate prosody or encourages syllable
• Target is producing multiple syllables
• How’s 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: “It’s a spoon.” “It’s a snail.”
– Video 2, it’s a sk I
Anterior-posterior contrasts
• If not stimulable, target as a secondary pattern
• Most kids are fronters or velar deleters; you want
– 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
• 3 y/o vs. 7 y/o working on /r/ for first time
– Developmentally appropriate acquisition
– Hodson’s 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
• Target initial /l/
– Stable jaw tongue clicking for a week at home before
• 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
• /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 20minute, 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 doesn’t mean easy
• Focused auditory input cycle for nons (nonstimulable,
nonverbal, or noncompliant)
– One cycle of primary patterns: only input, no production
– 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
– Initial /m, n, w/ and stops 60% correct in
– 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
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
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
• 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: 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 you’ve 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
• Adam’s 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 doesn’t 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
• Primary Patterns
– /s/ clusters
– Liquids (/r/)
• Secondary Patterns
– Metathesis and migration best addressed in:
• Advanced Patterns
– Complex consonant sequences
– Multisyllabicity
• Enough framework for you?
– It’s the most important part!
– Organization of overall treatment
• What does a session look like?
Listening words
Practice patterns
Metaphonological skills
Listening words
Session Structure
• Review last week’s targets IF same pattern – 2
• 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
– 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
• Metaphonological skills—see 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 session’s practice words
Nitty gritty, part 2
• Evidence-based but may not work if you do not
follow the protocol
• Quality over quantity
• 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
• Don’t 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 – 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 go—hey, go has your /g/ sound!
Want to go outside and play?”
• Feedback – “Ditzy dame routine”
– “The tea? Hm, I don’t 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 don’t 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. … That’s 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/
• 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, mildsevere 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
Hugh’s progress in conversation
Target Pattern
Target Pattern
Final consonants
Final consonants
A-P contrast
A-P contrast
/s/ clusters
/s/ clusters
Other clusters
Other clusters
Liquid /l/
Liquid /l/
Liquid /r/
Liquid /r/
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
Bella’s progress in conversation
Target Pattern
Target Pattern
Final consonants
Final consonants
A-P contrast
A-P contrast
/s/ clusters
/s/ clusters
Other clusters
Other clusters
Liquid /l/
Liquid /l/
Liquids /r/
Liquids /r/
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
David’s progress in conversation
Target Pattern
Target Pattern
Final consonants
Final consonants
A-P contrast
A-P contrast
/s/ clusters
/s/ clusters
Other clusters
Other clusters
Liquid /l/
Liquid /l/
Liquid /r/
Liquid /r/
Voicing contrast
Voicing contrast
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
Carly’s progress in conversation
Target Pattern
Target Pattern
Final consonants
Final consonants
A-P contrast
A-P contrast
/s/ clusters
/s/ clusters
Other clusters
Other clusters
Liquid /l/
Liquid /l/
Liquid /r/
Liquid /r/
Voicing contrast
Voicing contrast
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
Michael’s progress in conversation
Target Pattern
Target Pattern
Final consonants
Final consonants
A-P contrast
A-P contrast
/s/ clusters
/s/ clusters
Other clusters
Other clusters
Liquid /l/
Liquid /l/
Liquid /r/
Liquid /r/
Voicing contrast
Voicing contrast
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
• 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
• 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
• Don’t get stuck on something they haven’t
• Don’t expect Cycles to work if you modify it
• [email protected]
Appendix A
History of Therapy Approaches
from Hodson 2010 (see note)
• 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
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
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
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
• 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 program—several 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
• 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
• 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
• 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
– 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 frequency—ex. /s/
Stimulability—stimulable before non
Visibility—ex. labial consonants
Variability inconsistency—sounds produced
sometimes are chosen
• Utility—ex. sound in the child’s 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
– Results were poorer for children working on least
phonological knowledge targets first

similar documents