Translating research into practice
JCPSLP
Volume 16, Number 1 2014
45
Around the journals
intervention groups made gains in the maintenance period;
however, there was no significant difference between the
two phonological intervention conditions in terms of PCC
gain.
This study is the first independent and randomised
controlled trial for the multiple oppositions approach. What
is also good about this study is that an attempt was made
to keep all constituents of intensity constant, manipulating
only dose frequency and total intervention duration. This
study provides evidence to support more frequent therapy
sessions for preschoolers with speech sound disorder
using the multiple oppositions approach, rather than more
spaced out sessions. The children who received more
spaced out (1 x a week) sessions did make progress but
it was similar to the progress made by those in an active
control group, not targeting phonological skills.
The researchers carefully reported the fidelity of how
they delivered the intervention – something that is needed
for intervention research but should also be considered in
a clinical context. The fact that the children who received
the phonology intervention (P1 and P3 groups) continued
to show gains in speech production accuracy 6 weeks
later raises important clinical issues of balancing the need
for further intervention and applying a dismissal/discharge
criterion (something that also requires further research!)
The multiple oppositions approach is usually indicated
for children with moderate–severe speech sound disorder;
however, some children in the study had mild–moderate
speech sound disorder. The outcome measure used –
PCC from a single word articulation test – may also not
have been the most sensitive measure. A measure which
includes multiple opportunities to sample each singleton
consonant in initial and final position as well as consonant
clusters and sounds within polysyllabic words may have
provided a more sensitive and suitable measure in order to
assess change in phonological skills.
speechBITE ratings on the
PEDro-P scale
Eligibility specified: Y
Random allocation: Y
Concealed allocation: N
Baseline comparability: Y
Blind subjects: N
Blind therapists: N
Blind assessors: N
Adequate follow-up: Y
Intention-to-treat analysis: N
Between-group comparisons: Y
Point estimates and variability: Y
References
Baker, E., & McLeod, S. (2011). Evidence-based practice
for children with speech sound disorders: Part 1 – Narrative
review.
Language, Speech and Hearing Services in schools,
42
(2), 102–139.
Multiple oppositions approach for phonological
impairment: Efficacy and intensity for
preschoolers with speech sound disorder
Allen, M. M. (2013). Intervention efficacy and intensity for
children with speech sound disorder.
Journal of Speech,
Language and Hearing Research
,
56
, 865–877.
speechBITE review – Rosemary Hodges
and Natalie Munro
While research indicates that phonological interventions are
effective with preschool children (e.g., Baker & McLeod,
2011), speech pathologists have little to guide them when it
comes to making decisions about the optimal intervention
intensity for children with speech sound disorders.
In this study, the author takes one phonological
intervention – the multiple oppositions approach (Williams,
2000a, b) – and examines the effect of dose frequency (i.e.,
the number of sessions per time unit) and total intervention
duration (i.e., the interval for which an intervention is
provided) on phonological improvement in preschool aged
children (for more information about the constituents of
intensity, see Warren, Fey & Yoder, 2007). Preschoolers
with speech sound disorder were assigned to one of three
conditions – a) multiple oppositions approach provided 3 x
a week for 8 weeks (P3), b) multiple oppositions approach
provided 1 x a week for 24 weeks (P1), and, c) an active
control group which received a storybook intervention (C).
While the two phonological interventions (P3) and (P1) have
different dose frequencies and total intervention durations,
they have equal cumulative intervention intensities.
The children were randomly allocated to groups and
a blocking procedure was used to control for age and
severity of phonological impairment. The percentage of
consonants correct (PCC) on a single word test were
evaluated after 8 weeks, after 24 sessions and after
6-weeks maintenance. Evaluating outcomes at multiple
intervals (e.g., after 8 weeks, 24 sessions and 6-weeks
maintenance) allowed the author to address multiple
research questions. Allen hypothesised about the possible
outcomes. If it is the number of sessions alone that matters,
then, at the 8-week evaluation, the P3 condition should
be superior; however, after both groups had received 24
sessions, there should be no differences between groups.
Yet, if the dose frequency matters, there will be differences
seen between the P3 and P1 groups after 24 sessions.
After 6 weeks maintenance, three possible results were
suggested – regression, no gain or continued gains.
Results indicated that at 8 weeks, as expected, the P3
group outperformed both the P1 and the active control
group. Surprisingly, there was no significant difference
between the P1 and the active control group in PCC after 8
weeks. After 24 sessions, the P3 group again outperformed
the P1 group, thus suggesting that receiving 24 sessions of
therapy more frequently – 3 times a week – is more effective
than receiving 24 sessions of therapy once a week. Both
