Articulation or Phonological Therapy, that is the Question

Often, caregivers mistake an articulation disorder for a phonological one.  There is one distinct difference between the two and it is this:  a child with an articulation disorder substitutes or distorts one or more sounds while a child with a phonological disorder omits, substitutes, and/or distorts a process.  

Let's start with the term: phonological process.  This is something that all children demonstrate at various ages, but eventually suppress as they enter the preschool years.  For example, typically developing children may go through a period of time when they omit or delete final sounds in words (e.g. ca for car), but eventually, they suppress this process of final consonant deletion and use the final sound.  Children with a phonological disorder do not move on, rather, they continue to drop sound endings.  This makes therapy distinctly different between these two groups.  

In phonological therapy, we work towards helping the child learn to suppress the process.  So the child who needs to suppress the process of final consonant deletion will work on a different sound each session, BUT the sound will always appear at the end of the word.  In this way, we hope to teach the child to listen to sound endings, first, by listening to the therapist say a list of words, and then the child takes a turn.  

In articulation therapy, we typically address sound placement by teaching the child where to put his/her lips and/ or tongue to make a target sound.  We work in levels here by ensuring the child can produce targets in isolation, words, phrases, and sentences.  We also work on making these target sounds in various word positions: initial, medial, and final.  So someone working on the /s/ sound may practice "sun", "glasses", and "cats."  Typically, we look at mastery in one position before moving onto another.  Here, we target the same sound each session and increase the level as the child progresses.  We also need to ensure that we are targeting developmentally appropriate sounds, meaning sounds that are expected of a child by a certain age.  For example, we would not work on the /s/ sound with a three year old because most children this age can not master this sound.  A toddler's oral cavity may not be large enough to accommodate a large tongue to make those swift movements with finesse.  Since physical growth can vary from one child to the next, it is impossible to predict the exact age for sound mastery; therefore, we look at expectancy ranges to account for a larger population.