Phonological Intervention for Multilingual Children: Expanding the Cycles Approach

Editor's Note: This text is a transcript of the course Phonological Intervention for Multilingual Children: Expanding the Cycles Approach, presented by Raul F. Prezas, PhD, CCC-SLP.

Learning Outcomes

After this course, participants will be able to:

• Identify primary, secondary, and inappropriate targets for multilingual preschoolers.
• Describe recommended speech-sound intervention practices for multilingual children.
• Describe recommendations for monolingual practitioners working with multilingual children.

Introduction

Thank you all for being here as well. My name is Raul Prezas, and I will discuss phonological intervention for multilingual children. How do we adapt the Cycles Approach not only for Spanish-speaking children or children who are Spanish speakers and English speakers, but speakers of other languages as well? In this course, I will talk about intervention, particularly which sounds to target, the shared sounds versus the unshared sounds across different languages.

Becoming a Phonologist

How did I get into this profession?  I come from Texas originally, so when I present, I tell participants they will hear me say "y'all" or "all y'all".  I love "all y'all."  It is encompassing, very inclusive. I've lived in Florida and Texas.

I started in music vocal performance at Trinity University and the University of Colorado at Boulder. During my music pursuits, I developed mild muscle tension dysphonia and pre-nodules, which led me to an ENT and a speech-language pathologist to work on my speaking voice and my singing voice. That's when I fell in love with our field, having had very little prior knowledge about what we do.

Family circumstances then led me to Kansas, where I studied at Wichita State University. I didn't know much about speech-language pathology at that time. I visited the speech-language-hearing clinic on a very quiet Friday afternoon and unexpectedly walked right into Barbara Hodson's office. I can't express how grateful I am for Barbara. She has been such a wonderful mentor over my career, and I dedicate what I do to her and her experiences. Her mentorship is incredible, and I feel very fortunate because I got to work with her in my Master's and PhD programs. During that time, I did much work on the Cycles Approach with her. We studied different languages together, primarily focusing on Spanish and English. I have worked on different treatment models with her, and we've looked at different things.

In my career, I've conducted many bilingual assessments. I've worked for school districts. I've been on early childhood assessment teams, autism units, et cetera, primarily in the school setting.  I've loved every minute of it and am grateful to share that with you all.

I'm currently at Lamar University, one of the best places in the world. I love my colleagues and my university, and I am so very thankful.

Multilingual Phonological Intervention

In this c course, I will discuss why to expedite intelligibility and with whom.  We will look at a bilingual Spanish/English Cycles Approach for speakers of predominantly Spanish but also adaptable to more predominantly English. We will look at a blend of what can be done in the English language as a monolingual SLP. Then, we'll look at Cycles Approach ideas with speakers of other languages. Finally, I will share some strategies for working with multilingual families.  

Why Do We Expedite Intelligibility?

For children whose intelligibility is severe or profound, it's important to target sounds in a cyclical fashion. If we only target one sound at a time until it's mastered, reminiscent of the stimulus approach/artic approach, it takes so much time for a child to target a sound later on. It could take several years until a child gets to the "R" sound, for example, or they get to another phoneme sound. Therefore, this cyclical fashion helps expedite intelligibility for those speakers who truly are struggling with understandability in their homes, at school, etc. 

When considering dynamic systems versus learnability, there are some important factors regarding more complex sounds. The Cycles Approach naturally blends the earlier developing phonemes with more complex targets in the cycles. For example, we can target liquids at the end of every cycle because we know that many children who are in speech become persistent SSD cases later on when they have /l/ or /r/ on their caseload. But if we start sooner and qualify them for different phonemes when they're younger, why not stimulate those liquids? Again, we are blending the earlier phonemes versus the complex patterns.

Find the right balance. Recalling Vygotsky's zone of proximal development (ZPD, 1962) we are having the child go just outside their comfort zone, for example, by stimulating the sound so that they can attain it. We can do that with multilingual speakers, too.

Stimulable versus Non-stimulable Sounds

We all know that stimulable targets are great because they're easier to acquire more quickly. There is increased intelligibility much sooner with stimulable sounds than if we were to target the non-stimulable sounds.  However, it is important to include non-stimulable sounds, for example, liquids or liquid clusters, to facilitate generalization. Again, that's where the balance becomes important to find the right amount of earlier developing and later developing sounds for children to become more intelligible.

Shared versus Unshared Sounds

Most English consonants are acquired by age five (Crowe and McLeod, 2020). For multilingual speakers such as French, Spanish, Portuguese, Jamaican-Creole, and many of the languages studied by McLeod and Crowe in 2018, most sounds are usually acquired by age five. Therefore, some of the things that we expect to see with multilingual speakers, we also expect to see with speakers of other languages as well. Remember that you will look for those things to occur in both languages, not just one.

Brian Goldstein's work talks about how children are often over or under-identified for services when they're bilingual. We've had this tendency where we've primarily looked at English, but if we look at the English phonemes, we're not getting the full picture for the multilingual child. But the good news is that we're looking for some of the same things across the languages. For example, initial consonant deletion is not something we expect to see in speakers of other languages like Spanish, French, German, and Vietnamese. Initial consonants are important in those languages. Fronting and backing can occur in many different languages. So, this is something that we also want to look at. Cluster sequence reduction can occur in some languages and maybe not in others.  So, we want to look at clusters and sequences that are considered native to that anguage. Liquid stridency changes can occur.

Reduction to monosyllables is also something that we look for in other languages if they are multisyllabic. This only applies to speakers of other languages that have multisyllabicity. Again, you want to make sure that, through the use of an interpreter or with a clinically-trained SLP, you're making a good-faith attempt to collect information in that native first language as well as English, which will be L2 for many children who are multilingual.

Looking further at various languages, interestingly, many of them share many common phonemes, give or take voice onset time or slight placement differences.  These slight changes, or beautiful varieties, we associate as accents. But, mostly, these phonemes are shared sounds across languages:

• Initial /p/ /b/ /m/ (in many cases /w/)
• Initial /t/ /d/ /k/ /g/
• Liquid /l/ (in some cases)

If you can, memorize these phonemes because if you have a client who speaks a language other than English, chances are in therapy, you could pick one of these phonemes, and it'll appear in their native language as well. By doing this, you are doing evidence-based practice. You're starting with the shared sounds first, followed by unshared sounds, which, for the majority of us, would be in English.  We would start with the shared sounds: /p, b, m, w, t, d, k, g/ and sometimes /l/. Then, we would move to the unshared sounds in English, such as the American R and others. With this knowledge, we follow evidence-based models of practice when working with multilingual children.

The Speech Accent Archive

This is a website I always recommend to individuals I speak with - http://accent.gmu.edu/browse_language.php. I don't have any rights to the website or contact with its makers, but it's the Speech Accent Archive. It's a valuable tool with a database of languages. If you've never visited this website, you'll find a list of several of the world's different languages. 

There are also recordings of speakers of various native languages speaking in English. All the recordings feature individuals primarily reciting the Stella passage in English, allowing you to appreciate their beautifully accented language variations. The website also provides a phonetic transcription of the passage, offering a narrow transcription of how the Stella passage was spoken. This allows you to explore these different varieties and observe both the distinctions and similarities in their English pronunciation. It's an excellent starting point for researching information about another language when a child with that language background is on your caseload.

Another valuable resource, to which I have no personal affiliation, is Bilinguistics. If you visit bilinguistics.com, you'll find an array of useful tools and information. They cover topics like the distinction between difference and disorder, shared and unshared sounds. Furthermore, they provide insights into dynamic assessment along with practical examples, which I find extremely valuable.

The Intelligibility in Context Scale

Additionally, there's a free online resource called the Intelligibility in Context Scale by McLeod and colleagues. This resource offers excellent references for speakers of other languages, specifically the ICS. It's a quick seven-question screening tool designed to assess how well a family understands their child. However, it can also be applied to teachers, individuals who are unfamiliar with the child, or even with interpreters, making it a versatile and practical tool.

When I work with an interpreter for a speaker of another language, I typically have them meet the child, conduct the assessment, and then engage in a consultation afterward. During this consultation, I ask the interpreter to fill out the Intelligibility in Context Scale, gathering their insights on the child's intelligibility and understandability. It is a valuable baseline assessment to gauge the child's communication status.

Following intervention, I can then share the scale with the family to assess whether they have noticed any changes in the child's intelligibility. The scale is available in several languages, and it has demonstrated evidence of validity. This means it's a reliable measure for various languages, showing its potential as a valuable assessment tool.

Bilingual Intervention

We currently follow a well-established model for bilingual intervention, which has proven effective over the past few years. However, there is still room for growth, and the field would benefit from additional data and research studies to further refine bilingual and multilingual intervention strategies.

Bilingual Approach

Our model incorporates two distinct approaches, and we often use a combination of both. Firstly, we employ the bilingual approach, which focuses on addressing language constructs that are common to both languages. This typically involves working on shared sounds like /p, b, m, w, t, d, k, g, l/. We begin by targeting these shared sounds in the bilingual approach.

Cross-linguistic Approach

Additionally, we also utilize the cross-linguistic approach, which emphasizes skills that are unique to each language. For instance, let's consider a child who speaks both Spanish and English, and the clinician is proficient in both languages. In this scenario, we can implement the cross-linguistic approach to address specific sounds like the Spanish trilled R or the American R in English. This approach allows us to work on unshared sounds in each language.

For clinicians who are monolingual, it is still entirely suitable, and they can focus on addressing sounds that are unique to the English language without the need to target the language-specific sounds of other languages. Some clinicians take a creative approach by pairing younger students with older students who are fluent in the target language. This arrangement enables the younger students to practice and hear models of the older students, especially when they are intelligible in both languages but may have language impairments.

Another strategy discussed by Gina Glover involves labeling objects in the therapy room in the target language. For example, labeling a chair as "silla" in Spanish or a table as "mesa." This approach demonstrates an effort to meet students halfway and shows that we are making an attempt to connect with them. Even simple gestures like greeting families in their native language, especially if we don't speak the language fluently, can be highly impactful for families and students.

Importantly, there is evidence suggesting that intervention in one language can have a positive impact on the other language, indicating the potential for cross-linguistic generalization, which is a significant finding in our work.

Classic Treatment Approaches

Vertical Approach. In the realm of classic treatment approaches for children with speech sound disorders, there are various methods available. One such approach is the vertical approach, as mentioned earlier, where a single sound is targeted until it meets a predefined criterion. This approach is particularly effective for students with mild to moderate speech sound disorders who are addressing only a limited number of sounds.

Horizontal Approach. Another valuable approach is the horizontal approach, which involves targeting multiple objectives within a single session. This may include addressing one sound in the first language (L1) and another in the second language (L2), or working on two distinct sounds within the context of speech sounds. This approach is generally more suitable for students with moderate to severe speech sound disorders.

Cyclical Approach.  Another approach to consider is the cyclical approach, which is pattern-oriented and tends to be more suitable for severe or profound cases of speech sound disorders. In this method, the focus is on addressing sounds in a cyclical manner, targeting the phonemic or phonological patterns that the child struggles with. To begin, we choose sounds that the child already possesses in their repertoire. For example, if the child exhibits initial consonant deletion, we might select a sound they already have, such as /b/, /p/, /m/, and place it within the context of the initial consonants that they find challenging.

This approach effectively teaches a sound the child already has but positions it where it is needed most. This approach seeks to strike the right balance and find the child's zone of proximal development, tailoring the intervention to their specific needs.

Bilingual Children with Highly Unintelligible Speech

What suggestions are there for children with highly unintelligible speech? These are the kids who, if they have profound difficulties, are more challenging to understand. For example, when you ask them, "What do you want to play with?" and they respond, you may act like you understand, but in reality, you don't.

In such cases, caregivers, whether they are parents, aunts, uncles, grandparents, or even social workers or foster parents, often understand the child better than unfamiliar speakers. They might say something like, "Oh, they want to go to the kitchenette and play with the stove," leaving you surprised at how they deciphered the child's words.

For these children with highly unintelligible speech, we want to do a pattern-oriented approach. The goal is to focus on sounds that are stimulable initially, but we also aim to stimulate non-stimulable sounds. The objective is to avoid prolonging their treatment intervention unnecessarily and address all aspects sooner rather than later.

In an ideal scenario, starting therapy in the native language is the preferred approach. Often, school districts prioritize students, especially when dealing with a child coming from a home where their primary language (L1) is the only language spoken. This is in contrast to a student in second or third grade who has been receiving English instruction for a while. While the desire is to provide intervention in both languages, if a choice must be made, the priority leans toward the younger child. The focus is on helping them transition into the classroom environment where they can begin learning more of their second language (L2).

According to historical perspectives from Connor and Bates, it could take as long as five to seven years for a student to master the English language academically. This underscores the need for patience and understanding that language acquisition is a gradual process. Imagine suddenly being in a foreign country, like Germany, attending a lecture entirely in German—it would undoubtedly take time to feel comfortable and grasp the language.

Some discussions challenge the concept of a "silent period," suggesting it's more accurately described as a learning period. During this time, students still actively use their native language at home while simultaneously acquiring their second language, such as English. Recognizing this, it becomes apparent that language acquisition is a gradual and ongoing process. As English is established in educational settings like Head Start or early childhood facilities, it is best to incorporate therapy in both languages whenever possible.

A Cycles Approach for Spanish-English Children

Cycles Phonological Pattern Approach (Hodson, 2024; Prezas et al., 2020; Prezas et al., 2023)

In adapting the Cycles Approach for Spanish/English children, the overall process closely mirrors the traditional Cycles Approach, with a few modifications to address the bilingual context. The goal progression strategy remains cyclical, typically spanning from five to 16 weeks based on the child's needs. The approach involves selecting stimulable but deficient sounds initially and gradually increasing complexity. If a child excels at the sound in one word, the progression moves swiftly to incorporating that sound into phrases, continuously building complexity.

The goal is to keep the child engaged while maintaining an appropriate difficulty level for acquiring the necessary sounds efficiently. The therapy sessions typically range from one to two contact hours per week for the five to 16 weeks. 

The approach involves selecting stimulable but deficient sounds initially and gradually increasing complexity. If a child excels at a specific sound in isolation, the progression moves swiftly to incorporating that sound into phrases, continuously building complexity.

The aim is to keep the child engaged while maintaining an appropriate difficulty level for acquiring the necessary sounds efficiently. The therapy sessions typically range from one to two contact hours per week over the designated cycles. Patterns are targeted, focusing on the correct phonemes within specific patterns. For instance, addressing fronting by working on velar sounds. Each week involves cycling through different phoneme patterns, reassessing progress, and advancing to the next cycle.

The traditional cycle structure persists, with cycle three involving fine-tuning aspects, emphasizing generalization, and incorporating more secondary target patterns like voicing contrasts. The cyclical nature allows for ongoing reassessment and adjustment as needed.

Considering the child's language learning context, whether they are in an English immersion or dual language program, is crucial. Awareness of the child's overall linguistic development within the school setting informs the therapy approach.

Underlying Concepts of Cycles

Examining the foundational concepts of cycles, we have the traditional seven to eight, with an additional eighth being included: phonological awareness activities, a long-standing component of cycles. Two more concepts are introduced when considering working with multilingual populations.  I'll highlight these two.

1. Phonological acquisition is a gradual process (Ingram, 1976)
2. Children with normal hearing typically acquire the adult sound system primarily by listening (Beyers-Heinlein & Lew-Williams, 2013; Van Riper, 1939).
3. Children associate kinesthetic and auditory sensations as they acquire new patterns, enabling later self-monitoring (Fairbanks, 1954). 
4. Phonetic environment can facilitate (or inhibit) correct sound production (Kent, 1982). 
5. Children are actively involved in their treatment. 
6. Children tend to generalize new speech production skills to other targets, including multilingual children (McReynolds & Bennett, 1972; Paradis, 2001). 
7. An optimal match facilitates a child’s learning (Hunt, 1961). 
8. Phonological awareness activities in therapy are beneficial for children (Gillon, 2017).
9. Cross-linguistic effects are a normal part of multilingual development and multilingual speech production (Paradis, 2001; Pearson, 2008).
10. Targeting shared sounds, followed by unshared sounds, is optimal and honors the native languages of the family (Kester, 2014; Palafox, 2019).

Number nine emphasizes that cross-linguistic effects are inherent in multilingual development and speech production. This implies that we don't aim to eliminate these effects but rather appreciate and honor the variations they bring. For instance, if a bilingual child, proficient in Spanish and English, articulates the word "car" with a trilled R as in "carr, carr," we celebrate the presence of the R sound without attempting to eradicate the cross-linguistic influence. The term "substitutions" is avoided, recognizing that these variations are genuine and a part of the child's identity.

The focus isn't on these variations per se; instead, attention is directed towards specific concerns outlined in the red flag list, such as initial consonant deletion or cluster reduction if present in both languages. Moving on to the next concept, number 10 stresses that targeting shared sounds followed by unshared sounds is optimal and respects the native languages of the family. I want to highlight the work of Ellen Kester and Bilinguistics, particularly their exploration of shared versus unshared sounds. Additionally, Phuong Palafox's valuable contributions, emphasizing the importance of honoring families, are acknowledged. This inclusion of their work enhances the foundational concepts of cycles tailored for a multilingual population.

Treatment Session – Basic Structure

For a treatment session with multilingual populations, the established model remains consistent. Begin by reviewing the practice words from the previous session. Conduct a listening activity where the selection of words for a specific pattern, like velars or initial consonants, is not meticulously chosen. The goal is to present words that haven't been carefully selected, with slight amplification.

Prepare a set of words, usually five to six, for the chosen pattern. Starting with shorter words is preferred, minimizing the chances of assimilation or external influences causing errors. If the child successfully masters the short words in the first session, have additional words ready—perhaps two or three syllables—for a more challenging experience.

Conversely, if the child struggles with a particular word among the selected set, focus on repetition and mastery of that specific word, gradually incorporating additional words as the session progresses. That's part of that in increasing complexity as you go and making it gradual.

The overarching objective is to approach as close to 100% accuracy as possible for the targeted sounds during the session, even if this level of accuracy is not the ultimate goal for the child. For instance, if the focus is on velars at the word level, achieving 100% accuracy with one word is a great accomplishment in that session. Then, in the next session, I can increase the complexity by introducing four words with velars, for example. 

You're building that complexity and tailoring it to each child's individualistic needs. Utilize whatever cues are necessary, whether minimal, moderate, or maximum. Incorporate a metaphonological activity, such as a rhyming exercise. Look ahead to the next sound in the sequence and gauge the support the child requires for that particular sound. Repeat the listening activity, and, of course, provide a home practice assignment, even if it's just two minutes a day.

Have a colleague assist in translating the information into the parent's home language. You can provide materials in both the home language and English, acknowledging that we shouldn't assume they can't read English. Families can choose to read the information in either language, offering them a convenient option. If further explanation is needed, schedule a meeting with the families and arrange for an interpreter or someone at the facility who speaks the native language to aid in communication. It's about considering what we would desire if it were our child in therapy, right? Reflecting on how we'd want to be communicated with by the school or practitioners ensures a thoughtful approach.

We still allocate approximately 60 minutes for each phoneme target, focusing on two phonemes per target pattern. We are reassessing periodically and incorporating secondary patterns as necessary.

Primary Target Selection – English Cycles

Traditionally, with English cycles, we begin with syllableness, followed by initial, final, and medial consonants, and then S clusters. Subsequently, we address anterior-posterior contrast with /t, d, k, g? And, even if not initially stimulable, we target /l/ and /r/.

For multilingual cycles, recognizing shared sounds across languages, such as /p, b, m, w, t, d, k, g/ and occasionally /l/, prompts an adjustment. We prioritize /t, d, k, g/ earlier to align with shared sounds versus unshared ones.

A noteworthy shift occurs between number five, posterior-anterior contrast, and stridency. Velars and alveolars are moved ahead of S clusters for multilingual populations as a model.

Potential Optimal “Primary” Spanish Target Patterns – Word Structures and Anterior/Posterior Contrasts

Examining Spanish/English, if you are working with a Spanish-speaking child requiring a pattern-oriented, cyclical approach, you can confidently follow the exact order outlined in the first slide for a Spanish/English Cycles Approach. It's essential to note that, unless specified otherwise, each sound addressed is a shared sound.

For instance, syllableness is a shared quality between English and Spanish, both having multisyllabic features. Consequently, you can employ two-syllable word combinations. Often, we initiate the process with vowel sequences in Spanish, later progressing to other combinations.

For those unfamiliar with Spanish, there's no obligation to use Spanish words. However, you can seamlessly integrate them with English words, recognizing the shared conceptual framework.

For assessment purposes, it is imperative to evaluate bilingual and multilingual children in their native language, and this should be done with the aid of an interpreter or a clinician trained in bilingualism. However, in treatment intervention, there isn't a federal mandate dictating a specific approach. This gives a bit more flexibility to incorporate English while comfortably integrating Spanish words, including clapping them out for syllableness if appropriate. Following this, singleton consonants are addressed, along with consonant-vowel combinations and word-initial /p, b, m, w/ if they are lacking. 

Interestingly, the traditional Cycles Approach aligns with the early development of sounds that are quite similar to those found in English. Stops, nasals, and glides are typically the initial sounds to emerge across various languages. This is reflected in the varied nomenclature for "mother" and "father" in many languages, often expressed as ma, pa, or da. The logic behind this lies in the shared nature of these early developing sounds, making them a commonality between English and Spanish. Consequently, these sounds can be utilized in the initial position, and English words can be used with the understanding that they may have a cross-linguistic impact, hopefully in the native language.

Continuing along, our next focus is on anterior-posterior contrasts. We start by addressing word-initial /k/ and /g/. It's worth noting that final /k/ is primarily an English phenomenon unless it stands alone in a Spanish word. So, if you're dealing with final /k/, work on it in English. Moreover, if there's a tendency for backing sounds in word-initial  /t/ and /d/, those can be addressed too. These are all shared sounds in English and Spanish.

Potential Optimal “Primary” Spanish Target Patterns - /s/ Sequences and English /s/ Clusters

Next, we work on /s/ sequences and English /s/ clusters. For monolingual English speakers, the focus can be to work on English /s/ clusters. However, for individuals proficient in both English and Spanish, a blended approach involving both English and Spanish /s/ sequences can be adopted. In Spanish, we have a syllable in front of what I call the "/s/ blend." Bilingual children often exhibit a linguistic phenomenon where they will say "eschool" and "estar" instead of "school" and "star," when they speak English. They're borrowing that rule from Spanish where we say "escuela" for school and  "estrella" for star.

If a Spanish speaker does not produce the /s/ sound in their dialect (emphasizing "does not produce" over "delete or substitute"), it is not necessary to target it in Spanish intervention. With bilingual Spanish speakers, we have the option to work on English /s/ clusters or address weak syllables in Spanish, allowing for a tailored approach based on each child's individual needs.

To add some complexity, integrating phrases in either English or Spanish is a valid strategy. Using tactile cues, visual prompts, and verbal models are always a good approach. Priming and modeling the phrase are also good strategies to use.  Even with older students, such as those in first or second grade, engaging in discussions about tongue movements and articulation is helpful. Strategies that are successful with monolingual English-speaking children easily apply to our multilingual learners, eliminating the need for a complete overhaul. It's simply a matter of understanding the shared sounds versus the unshared sounds to help guide you.

Potential Optimal “Primary” Spanish Target Patterns - Liquids

We end each cycle by focusing on liquids, recognizing that children exhibiting high unintelligibility often develop into persistent Speech Sound Disorder (SSD) cases later on. Picture this scenario: you're in middle school with a student who nonchalantly declares, "I don't care anymore about the "awe" (/r/) sound, with a hint of sass. As someone who has had teenagers at home, the teenage years are undoubtedly filled with charm and spirited moments.

Yet, if we could circumvent the need for them to remain in speech services during middle school, that would be quite the accomplishment, wouldn't it? So, the decision to target /l/ and /r/ while they are already in therapy for other speech-related matters makes sense. This becomes an opportune time to address the shared /l/ sound and the unshared, though technically shared, tapped /r/ sound. For instance, when pronouncing words like "butter," it's similar to a tapped /r/, technically shared across languages. I refer to it as the "schawty," reminiscent of "schawty on the dance floor" or "shorty on the dance floor." It involves rapidly combining an "uh" sound and a "D" sound. This can be practiced with bilingual children, not only in Spanish but also in various other languages that incorporate the tapped /r/.

However, be aware that some speakers of Spanish, particularly those with Puerto Rican or other Caribbean dialects, may produce /l/ instead of the tapped /r/. While the term "substituted" is commonly used, it's essential to adopt the perspective of the client by saying "produce" or "not produce." For instance, in the Puerto Rican dialect, instead of saying "verde" for green with a tapped /r/, they might beautifully articulate "velde." This /l/ for /r/ substitution can occur in certain Spanish speakers. In therapy, you can work on /l/ clusters and tapped /r/ clusters in speakers of other Spanish dialects, with the flexibility to target these clusters in English and transfer the skills to Spanish.

If, for example, they pronounce "truck" with a dentalized t/t and a tapped /r/, that is completely acceptable. What matters is that they are producing sounds that align with their unique dialect, contributing to their diverse repertoire of accented English phonemes.

Secondary Targets

Targeting secondary patterns is beneficial. One example is the variation in Spanish, resembling the /j/ and /tʃ/ sounds. Trilled R is unshared, and you're welcome to work on it. I always instruct my graduate students and speech-language pathologists (SLPs) to approach the trilled R by placing the tongue at the alveolar ridge and blowing through it with the /h/ sound.

Singleton stridents typically generalize. Additionally, various consonant cluster combinations should be addressed. Any assimilations observed while introducing multi-syllabic words can also be targeted in later cycles as well.

Cycles and Multilingual Populations

In the United States, Spanish follows English as the second most spoken language. However, beyond Spanish, there are other languages to consider.

While prioritizing the native language is optimal, we can strategically explore shared sounds, as previously mentioned. Recall the consonants /p, b, m, w, t, d, k, g/ and sometimes /l/. If we exclude English and Spanish from the equation, a glance at the languages spoken by state reveals a variety, including Vietnamese, German, Navajo, Tagalog, Russian, French, French-Creole, Korean, and Arabic. Considering these diverse languages, it becomes essential to examine shared sounds and factors relevant to each. When assembling a model, especially if opting for a Cycles Approach, these considerations are important.

Primary Target Selection – Other Languages

If the child exhibits syllableness in both languages, and it is a shared feature, beginning with syllableness is advisable. Addressing syllableness is important if it is lacking. Nasals, glides, and bilabials are particularly important due to their visual nature in most cases. Focus on final consonants and anterior-posterior contrasts before working on /s/ blends because of the presence of /t, d, k, g/ across various languages.

Proceed to /s/ clusters if they are present in the child's two languages or more. However, if they are absent in both languages, it is acceptable to target unshared /s/ clusters in English. Following this, address /l/ and /r/, even if not stimulable. Starting with /l/ is recommended, given that there's a likelihood that it is shared in that language.

You can also address the unshared trilled /r/, the tapped /r/, and the American /r/, in this case.

Vietnamese and English Consonants

For Vietnamese and English, there are certain factors to consider. Syllableness, primarily, is an unshared concept, typically addressed in a later cycle, perhaps cycle two. Start with shared elements such as /p, b, m, w/. Subsequently, address final /p, t, k, m, n/ if necessary, especially if issues like initial consonant deletion or final consonant deletion are observed. Proceed to anterior-posterior contrast with /t, d, k, g/. 

Stridency is unshared, but you may choose to target /s/ clusters in English or incorporate the broader concept of syllableness. Moving on, focus on liquids, where /l/ is a shared. Additionally, consider introducing the English /r/, which is unshared in this case. 

German and English Consonants

For German and English, syllableness is a shared. Begin by addressing singleton consonants, focusing on /p, b, m/. Notably, /w/ is not present in German, so it can be omitted, at least in the initial cycle and then work on unshared in English later if needed. Final /p, t, k, m/ and /n, t, d, k, g/ and /s/ clusters are shared.

In the initial position, address shared sounds such as clusters initial /sp, st/ and final /st/. Liquid /l/ is a shared element as well. Additionally, introduce the unshared English /r/, when starting with German speakers.

French and English Consonants

For French and English, the shared concept of syllableness is a good starting point. Begin with /p, b, m, w, t, d, k, g, l/ as they are common elements. This repetition serves a purpose, highlighting the recurring patterns across different languages. Move on to /s/ clusters in the initial position, followed by addressing /l/. You can also facilitate the introduction of English /r/ for the child.

Russian and English Consonants

For Russian and English, there's a shared concept of syllableness. Begin with  /p,b,m/ and initial consonants, noting the absence of /w/. Address final consonants, including /p, t, k/, and move on to /t, d, k, g/, and /s/ clusters in the initial position. L is also a shared element, along with the introduction of unshared English /r/.

Polish and English Consonants

Polish and English are included here, sharing the concept of syllableness. Focus on /p, b, m, w/ and mostly English final consonants, except for loaner words, address /t, d, k, g/.

In /s/ clusters, Polish exhibits a unique variety, which, interestingly, may be easier for children to produce than the voiceless variety. Examples include /sb/ for /sp/, making spider pronounced as "sbider"; /sd/ for /st/, so star becomes "sdar"; and /sg/ for /sk/, with school pronounced as "sgool." This is also observed in other dialects, such as the Welsh language. Liquid /l/ is another shared feature, and as needed, you can introduce the unshared English /r/. Recycling and gradual complexity building still apply when working with speakers of other languages.

Tagalog and English Consonants

Tagalog is very similar to Spanish.  You can address syllableness along with /p, b, m, w/ Focus on final /n/ only, followed by /t, d, k, g/. While /s/ clusters are unshared, you can introduce them in English. Include liquid /l/ and facilitate English /r/. It's important to note that this model is presented from the perspective of a monolingual English speaker, serving as a starting point for therapy.

For advanced targets, consider working on multisyllabicity and complex consonant sequences as needed. In many cases, these may be unshared, and you can work on them in English, unless multisyllabicity exists in their native language, making it a shared.

Cycles and Increasing Complexity

We've discussed the goal of preventing children from developing a persistent SSD case. Prioritizing more complex sounds early is crucial, aiming for generalization. If a child can produce a more complex sound with support, introduce it in the first cycle. Challenge them, ensuring the goal is attainable—this attainability is a key consideration.

Employ as Needed

Utilize various strategies, such as amplification, models, tactile cues, and minimal pairs. A particularly effective approach is oral reading at a lower reading level, with both the child and therapist reading together. During this activity, identify words containing the target sound, pull them apart, and specifically address the sound.

All of these methods apply effectively. Additionally, consider priming multilingual learners in advance within the speech room. For instance, if the classroom is covering transportation next week, introduce the topic in the speech room a week earlier. This proactive approach provides the child with additional knowledge, empowering them when they enter the classroom.

Narrative Speech Sample

Utilizing pictures for a narrative speech sample is a strategy I find highly effective. It involves telling a story while incorporating pictures and prompting the child to respond to questions. This method allows me to collect data on percent consonants correct and the percentage of intelligible words. The information gathered from these narrative speech samples is valuable for creating progress reports and establishing benchmarks.

Miscellaneous Considerations

I always recommend modeling a soft, precise /s/, considering it as a shared sound in the dialect. Employing focused auditory input is particularly beneficial for children under the age of three.

Maintaining motivation is crucial, and I strive to incorporate enjoyable and engaging activities for the child. Whether it's participating in recess and kicking a soccer ball to capture their attention or finding other fun approaches, create a motivating environment. Recognizing the significance of these elements is essential in providing effective and engaging therapy.

Focused Auditory Input [FAI] for Non-Talking Toddlers

The Focused Auditory Input model, essentially a one-person show, involves selecting a pattern that the child doesn't have, with no expectation for them to produce it. Instead, the therapist models it during the session, incorporating ample repetition and engaging in more cognitive-linguistic activities, possibly involving books and receptive exercises. For example, prompting the child to point to objects like, "Show me where the star is, show me where the stick is."

Cycles for Younger Children

When considering cycles for younger children, especially two-year-olds who vary widely in their development, it's important to assess their individual needs carefully. Some children respond well to a pattern-oriented approach early on, while others may benefit more from a focused auditory input approach.

Picture books prove to be invaluable, especially those that feature both the native language and the second language. It allows the child to recognize familiar words and articulate them, creating a meaningful connection. Simultaneously, it enhances your understanding and provides clarity about the child's expressions.

Engaging with words in both languages, for instance, when a child identifies the term "dulce" and associates it with "sweets," provides a shared experience. Collaboratively pointing to images on the page fosters a sense of connection to their linguistic culture and background. These interactions not only build rapport but also create a powerful and enriching experience for the child.

General Therapy Reminders

As a recap reminder, employ slight amplification and strive to elicit correct responses whenever possible. In therapy, using real words is particularly beneficial, especially for children with concomitant language impairment. This approach aids in expanding their vocabulary and enhancing utterance length, aligning well with a pattern-oriented strategy.

When initially selecting words, exercise caution, as some may contain the same consonant at the same place of articulation as the error (e.g., /d/ for /g/). This similarity might lead to assimilation, so be mindful of these words initially. However, as the child progresses, reintroduce these words to the therapy sessions to further their progress.

Targeting /r/

I always emphasize that if a child has an /r/ sound that's correct, I consider that a success. However, if a family expresses a strong desire for the child to acquire a trilled /r/ in their native language, and they're in therapy for other reasons, I am open to facilitating that in therapy, provided it aligns with the family's wishes.

I will not qualify a child solely based on their /r/ sound, as long as they have at least one correct /r/ sound in one of their languages.

Allophonic Variations/Cross-Linguistic Effects

It's crucial to honor allophonic variations and recognize cross-linguistic effects. A language accent, in my view, is something beautiful. Ultimately, the key consideration is whether the family and others can understand the child. That, to me, is the most important aspect.

Intervention Summary

When working with a multilingual population, use your existing knowledge and integrate it to address shared versus unshared sounds. Begin with shared sounds, followed by unshared ones, including /p, b, m, w, t, d, k, g/ and sometimes /l/. This approach sets a solid foundation for selecting targets tailored to multilingual populations.

Maintain open communication with parents, consistently sharing positive news and keeping them well-informed. Seek effective ways to communicate with speakers of other languages, fostering a collaborative environment. Emphasize the importance of families continuing to speak to the child in their native dominant language, even when dealing with language impairment. There are numerous resources that support the family language and ensure a vital connection between the child and their family.

Consider additional modifications, incorporate ESL strategies, and involve the child in the therapeutic process. Encourage them to actively understand and take ownership of what they're working on in speech. This approach can be highly motivating and empowering for the child.

Questions and Answers

Can you briefly describe the process that you use to determine primary language in bilingual children?

Historically, school districts have done the language dominance testing to determine primary language. I check in with the families. I try to ask families particular questions about the home environment and family members living in the home. Sometimes, it's an adult sibling who speaks English and the native language. Sometimes, it's a grandparent who only speaks the native language. Sometimes, a parent speaks a combination of both languages. So, to me, it is what the child is getting at home predominantly. I start there. Then I look at whether or not they are in school. If they're in school, what kind of program are they in?  Are they in a dual language program? Are they in the English immersion program? I collect all of that data to determine what is the best possible scenario for this particular child.

Usually, we use only stimulable targets. I know this approach recommends incorporating non-stimulable sounds and processes as therapy targets. But by definition, if it is non-stimulable, doesn't that mean we are setting up the child to make erroneous productions over and over? Could you give an example of what this looks like in practice?

We want to stimulate non-stimulable sounds at the child's pace. I definitely don't want to target /l/ or /r/ if they're unable to do it for a long period of time or at all. So I'll start a session, and my goal is that I can stimulate /l/, for example.  I'll start with tongue-tip-clicking, and if they can't do that, we'll pause. We'll do another pattern that they can do with help to experience that success. And then, each week, I will still try to stimulate tongue-tip clicking until they can get it. Once they get that, I go from tongue-tip-clicking on /l/ to just a real simple "la la la."

I call it the sing-songy sound. And so we'll say "la, la, la, la, la." Same place, very visual, showing them where my tongue is going, hoping to get that sound more accurate. And then, similar to the stimulus approach, but in a smaller setting, hierarchical model, we'll go to the first word, then the second word. So it might be that you don't spend a whole session initially on /l/, but you're trying to get it going. A lot of times, they can do the tongue tip clicking right away, and they'll start modeling the correct placement, but it may not be the actual phoneme yet. The goal is to get there.

References

Baker, E., Williams, A.L., McLeod, S., & McCauley, R. (2018). Elements of phonological interventions for children with speech sound disorders: The development of a taxonomy. American Journal of Speech-Language Pathology, 27, 906-935.

Crowe, K., & McLeod, S. (2020). Children’s English consonant acquisition in the United States: A review. American Journal of Speech-Language Pathology, 29, 2155-2169.

Gildersleeve-Neumann, C.E. & Goldstein, B. A. (2022). Speech sound development and disorders. In B.A. Goldstein (Ed.), Bilingual language development and disorders in Spanish-English speakers (3rd ed.) (pp. 307-347). Baltimore, MD: Paul H. Brookes Publishing.

Hodson, B.W. (2024). Evaluating and enhancing children’s phonological systems: research & theory to practice (4th Ed.). PhonoComp.

Kohnert, K. and Derr, A. (2004) Language intervention in bilingual children.  In B.A. Goldstein (Ed.), Bilingual language development and disorders in Spanish-English speakers (pp. 311-338).  Baltimore, MD:  Brookes.

McLeod, S. (2023, January). Multilingual children’s speech development. Peer-reviewed, Invited Webinar Presentation at the 2023 Bilinguistics SLP Virtual Conference on Speech Sound Disorders.

McLeod, S., & Crowe, K. (2018). Children’s consonant acquisition in 27 languages: A cross-linguistic review. American Journal of Speech-Language Pathology, 27, 1546-1571.

Patterson, J.L., & Pearson, B.Z. (2022). Bilingual lexical development, assessment, and intervention. In B.A. Goldstein (Ed.), Bilingual language development and disorders in Spanish-English speakers (3rd ed.) (pp. 119-148). Baltimore, MD: Paul H. Brookes Publishing.

Prezas, R.F. (2023, January). Expediting intelligibility for multilingual children with unintelligible speech. Peer-reviewed, Invited Webinar Presentation at the 2023 Bilinguistics SLP Virtual Conference on Speech Sound Disorders.

Prezas, R. F., Magnus, L., & Hodson, B. W. (2020). The Cycles Approach. In L. Williams, S. McLeod, & R. McCauley (Eds.). Interventions for speech sound disorders in children. Baltimore, MD: Brookes Publishing Co.

Prezas, R.F., Magnus, L.C., & Hodson, B.W. (2023). The Cycles Phonological Pattern Approach: Expediting Intelligibility. In C. Bowen, Children’s speech sound disorders (3rd ed.). Wiley-Blackwell.