Treating phoneme collapse with a Multiple Opposition Approach

Phoneme collapse sounds like a linguistic catastrophe, and in some ways, it is. A phoneme collapse means a child substitutes a single phoneme for multiple (sometimes 10 or more!) phonemes. This pattern is known to majorly impact intelligibility. It can also be difficult to treat, because, um, where do we even start?


Lee (2018) examined the effectiveness of the Multiple Opposition Approach (based on Williams (2000), among others) in treating extensive phoneme collapses in two children, ages 4 and 6. She also investigated a telepractice delivery model (extra side money, anyone?!), but this review will focus specifically on the treatment method.

We’ll use a hypothetical case to illustrate this approach. Charlie, a 5-year-old, substitutes /t/ for /p, b, d, k, g, s, z, ʃ/. That’s 10 sounds collapsed into one! With this pattern, the words pea, bee, D, key, see, and she will all be “tee.”

The Multiple Oppositions Approach says we need to target multiple error sounds from the phoneme collapse at the same time. For Charlie, we’ll pick a group of target sounds to work on first, such as /p, b, d/. Target sounds for these sessions would be tee, pea, bee and D (as in the letter). The second group of target sounds could be /k, g/ which means the targeted words might be tie, Kai, guy.

After ensuring the child understands each word receptively, the clinician works on these sounds using verbal cues such as: “Those two words you just said sounded the same—can you make them sound different?” When the child begins to demonstrate mastery of the first group of target sounds, the clinician moves on to the next group. The clinician may also choose to move on to different sounds if the child is becoming frustrated.

After using this intervention approach for 12–16 weeks (two sessions per week), the author found that the participants demonstrated improvement in production of target sounds, but also improved non-targeted singleton consonant sounds. Two months post-intervention, the children had expanded their phonemic repertoires to include sounds that hadn’t even been directly targeted. Although this study used only two participants, it suggests that the Multiple Opposition Approach is definitely something to investigate for children with severe phoneme collapse.

Lee, S. S. (2018). The treatment efficacy of multiple opposition phonological approach via telepractice for two children with severe phonological disorders in rural areas of West Texas in the USA. Child Language Teaching and Therapy. Advance online publication. doi:10.1177/0265659018755527.