Articulation and Phonology Disorders 33Substitutions are identified by the required phoneme and the one that replaces it. For
example, using the /w/ phoneme in place of the desired /r/ speech sound is written “w/r,” and the
position of the syllable or word is also indicated. A client who lisps in the middle of words (θ/s,
medially) may be described as having a “/θ/ for /s/ substitution in the medial position.” There are
several phonological pro cesses involving substitutions, including gliding of fricatives, in which a
glide is replaced by a fricative, and stopping, in which a fricative is replaced by a stop consonant.
Additions are insertions of unwanted or unnecessary sounds or phonemes in syllables or
words. They are often a result of the child’s strug gle to speak. Addition of the schwa phoneme
“uh” frequently occurs in stuttering. Additions are complication errors seen in motor speech
programming disorders. Additions, although also occurring in articulation and phonological
disorders, are frequently symptomatic of stuttering, apraxia of speech, and other neuromuscular
disorders.
Im por tant aspects of articulation and phonology disorder assessments are stimulability test-
ing and phonological pro cess analyses. A client who is stimulable can imitate the error phoneme
correctly with visual and auditory prompts from the speech- language pathologist. Stimulability
assessment can occur in a variety of contexts, including the phoneme in isolation and at the syl-
lable, word, and phrase levels. Phonological pro cess analy sis is the assessment and description
of the errors, emphasizing their linguistic attributes. Distinctive feature analy sis involves deter-
mining the common linguistic attributes of phonemes that differentiate them from one another,
such as place, manner, and voicing. At the conclusion of the diagnostic pro cess, the clinician has
a comprehensive picture of the client’s articulation and phonology patterns from which to design
therapies.
Therapies for Articulation and Phonology Disorders
In the not so distant past, one primary articulation therapy existed. Certainly, there were
variations in the traditional approach based on the client’s age and specific factors related to
the etiology of the disorder, but essentially the therapy involved auditory perceptual training,
production exercises, and carryover practice. Auditory perceptual training consisted of exercises
to improve the client’s ability to discriminate the error phoneme from others and to learn the
perceptual qualities of correctly produced speech. Production exercises began with simple, non-
complex articulation of the phoneme and progressed to more complex, conversational use of it.
The therapy always involved the treatment of only one phoneme until the client had mastered it
with greater than 90% success in off- guard, conversational speech (carryover). Clinicians first
corrected the phoneme that occurred most frequently, and that contributed most to reduction in
intelligibility, and then addressed phonemes of less importance. Today the traditional approach
is best suited for individuals with one or two articulation errors, such as an θ/s or /w/ for /r/
substitution, isolated omissions or occasional distortions, and reduced intelligibility.
Plante and Beeson (2004) identify three approaches to articulation therapy for children:
semantic, cross- modality, and coarticulatory. The semantic method emphasizes minimal pairs
and changes in meaning that may accompany phonological errors. Cross- modality articulation
therapy uses mirrors and other types of feedback to facilitate correct articulatory placement.
The coarticulatory approach uses coarticulation and assimilation princi ples to promote correct
articulation. The sounds preceding and following the error are changed to help the child pro-
duce correct articulation.
Articulation therapy for structural defects depends on the abnormal structure and often
involves concurrent reconstructive surgeries and prosthetics. The type of paralysis or move-
ment disorder seen in neuromuscular impairments also dictates the type of therapy. Therapy for
f laccid, spastic, or ataxic paralysis and for the vari ous movement disorders has dif fer ent goals
and objectives. Traditional therapies and recent advances in articulation disorders theory have
increased the therapy options for clinicians. “The most effective speech- language pathologists