A comparison of therapy approaches: multiple oppositions and maximal
oppositions in phonological intervention Melanie Carlson, B.S. & Abbie Olszewski, Ph.D., CCC-SLP
University of Nevada, Reno
Introduction
Results
§  Children with moderate to severe phonological
impairments typically present with multiple
phonemic collapses. §  Multiple oppositions is a treatment approach in
phonological intervention which contrasts several
target sounds to a comparison sound. §  Maximal oppositions is an intervention approach
which targets several error sounds within the same
phoneme collapse and contrasts them to the child’s
production. §  Research shows that children with multiple
phonemic collapses benefit from both multiple and
maximal oppositions.
Title/Authors/Date/Research Design
Intervention efficacy and intensity for
children with speech sound disorder
Allen (2013)
Quasi-Experimental
Purpose of Investigation Examine the effect of dose frequency of
intervention on phonological performance
using the multiple oppositions approach.
Participants
N=54
• Preschool children • Speech sound disorder (SSD)
Dependent Variable
Percentage of consonants
correct (PCC)
Groups:
P1: 1x/wk P3: 3x/wk C: story book
Intervention for children with severe
speech disorder: A comparison of two
approaches
Crosbie, Holm, & Dodd (2005)
Single Subject Multiple Baseline The efficacy of treatment for children
with developmental speech and
language delay/disorder: A metaanalysis
Garrett & Nye (2004)
Meta-analysis
Maximal opposition approach to
phonological treatment
Gierut (1989)
Single Subject Multiple Baseline
Severe speech sound disorders: An
integrated multimodal intervention
King, Hengst, & DeThorne (2013)
Single Subject Multiple Probe Outcomes of different speech and
language goal attack strategies
Tyler, Lewis, Haskill, & Tolbert (2003)
Quasi-Experimental
Examine the effect of two different
therapy approaches on speech accuracy
and consistency of word production of
children with consistent and inconsistent
speech disorder.
N=18
• 4;8-6;5 years
• Severe speech disorder Percentage of consonants
correct (PCC)
Examine the effect of intervention on
expressive and receptive phonology,
syntax, and vocabulary, as a result of
combined parent/clinician treatment,
clinician treatment only, or parent
treatment only.
13 studies
• Preschoolers to adolescents
• Primary developmental speech
and language delays/disorders
Expressive phonology
Receptive phonology
Expressive phonology
• d = 0.67 for clinician treatment only • d = 0.44 for combined parent/clinician treatment
Receptive phonology
• d = 0.53 for combined parent/clinician treatment
• d = 0.53 for parent treatment only
Examine a phonological treatment
program of maximal rather than minimal
feature contrasts by recording the course
of learning in child with a systematic
error process.
N=1
• 4;7 • Severe phonological disorder
Number of consonants
correct (NCC)
NCC
Improved from using only four phonemes word-initially (/m/, /b/, /w/, and /j/) to
using 20 consonants word-initially after having three sets of training on maximal
opposition contrasts. The change was evaluated using treatment and generalization
probe measures.
Examine the effect of integrated
multimodal intervention (IMI) in treating
severe speech sound disorders.
N=3
• 4-8 years
• Severe speech sound disorders
Speech sound accuracy in
target words
Speech Sound Accuracy in treatment words
• John: 0% (baseline) to 55.3% (post-treatment)
• Thomas: 0% (baseline) to 73.5% (post-treatment)
• Luke: 13.2% (baseline) to 53.4% (post-treatment)
Examine phonological and
morphosyntactic change using different
goal attack strategies.
N=47 • Preschoolers • 3;0-5;11
• Impairments in both speech and
language Speech sound accuracy in
treatment words across
different intervention
strategies
Speech Sound Accuracy in treatment words across different interventions
• Morphosyntax first group: p = .05, d = .85
• Alternating group: p = .03, d = .94
• Simultaneous group: p = .01, d = 1.22
• Phonology first group: p = .06, d = .81
Purpose
The purpose of this research project was to:
Determine which approach to intervention, multiple
oppositions (I) or maximal oppositions (C), results in
faster acquisition of error sounds (O) in preschool aged
children with moderate to severe phonological
impairments (P). Clinical Scenario
I am a graduate student clinician at the University of
Nevada, Reno. I have a three-year-old client with phonological disorder. Her test results indicate that
she reduces all clusters to single sounds, but is
stimulable for some clusters. An area of concern is
intelligibility. During the fall 2013 semester, I took
advanced speech pathology, which focused on
phonology. The instructor provided research proving
that effective phonological intervention
approaches include maximal and multiple
oppositions due to the fact that each approach treats
higher order, later developing phonemes, which can
bring about greater change in the child’s
phonological system without direct treatment. My goal
is to determine which approach is most beneficial for
my client.
Method
Search terms: multiple oppositions, maximal
oppositions, phonology, and intervention Electronic databases:
• PsychInfo
• ERIC
• PubMed Ten research articles were appraised and evaluated for validity
and reliability.
Results
PCC
After 8 weeks P3 > P1, ANCOVA p = 0.02, partial η2 = .15
After 24 sessions P3 > P1, ANOCVA p =.049, partial η2 = .11
The group that attended sessions three times a week for 8 weeks (P3) showed
significant changes in phonology, more than the group receiving intervention once
weekly for 24 weeks (P1) or the control group (C) P3 adjusted mean (M = 63.7%) was significantly larger than P1 (M = 59.3%)
PCC
Alternating phonological and morphosyntactic goals may be preferable when children
have co-occurring deficits • The effect of therapy on consistency of word production and on speech accuracy
were significant p < 0.05
Discussion
References
• Both maximal and multiple oppositions are beneficial in brining about greater
phonological change in those with severe phonological impairments.
• Training broadly may help bring in additional phonemes without direct treatment using
the multiple oppositions therapy approach.
• Using the maximal oppositions therapy approach to contrast phonemes that are not in
the child’s phonological system with phonemes that are in the system helps them to
make distinctions.
• The appropriateness of each therapy approach depends on the temperament and
specific system collapses of the child.
• Multiple oppositions may result in faster acquisition of error sounds in my three-yearold client with phonological impairment.
Allen, M. M. (2013). Intervention efficacy and intensity for children with speech sound disorder. Journal of speech, language, and hearing research, 56, 865-877. doi:10.1044/1092-4388(2012/11-0076)
Crosbie, S., Holm, A., & Dodd, B. (2005). Intervention for children with severe speech sound disorder: a comparison of two approaches. International Journal of Language and Communication Disorders, 40(4), 467-491. doi: 10.1080/13682820500126049
Garrett, J. & Nye, C. (2004). The Efficacy of Treatment for Children with Developmental Speech and Language Delay/Disorder: A Meta-Analysis. Journal of Speech, Language, and Hearing Research. 47, 924-943. doi:10.1044/1092-4388(2005/077)
Gierut, J. A. (1989). Maximal opposition approach to phonological treatment. Journal of Speech and Hearing Disorders, 54, 9-19. doi:10.1044/jshd.5401.09
King, A. M., Hengst, J. A., & DeThorne, L. S. (2013). Severe speech sound disorders: an integrated multimodal intervention. Language, Speech, and Hearing Services in schools, 44, 195-210. doi:
10.1044/0161-1461(2012/12-0023)
Tyler, A.A., Lewis, K.E., Haskill, A., & Tolbert, L.C. (2003). Outcomes of different speech and language goal attack strategies. Journal of speech, language, and hearing research, 46, 1007-1094. doi:
10.1044/1092-4388(2003/085)
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