Multiple oppositions intervention: effective phonological treatment of two children with cleft lip and palate and severe speech sound disorder

ABSTRACT

The purpose of this study was to investigate if multiple oppositions intervention (MOI) generated widespread change in the phonological systems of two children with cleft lip and palate (CLP) and severe speech sound disorders (SSD). We treated two children (ages 5;4 and 5;6) with CLP and severe SSD using MOI for 24 and 29 sessions. We measured the percentage consonants correct (PCC) for target consonants and untreated consonants in non-treatment single words, as well as PCC for connected speech. Data points were collected in the baseline, intervention, and maintenance phase with post-tests conducted immediately after intervention and at 1, 3, 6 and 12 months. Two speech and language therapists (SLTs) unfamiliar with the children performed phonetic transcriptions, and we calculated intra- and inter-rater agreement. We graphed the data, and used permutation tests to analyse the probability that the observed increases in PCC were due to random chance. Both children experienced considerable improvements in PCC across all measures at the first post-test, supporting the impact of MOI on their entire phonological system. The PCC continued to increase during the maintenance phase. By the final post-test, the PCC in connected speech exceeded 90% for both children, reducing their SSD classification to mild. Our findings support that a phonological, contrastive intervention approach targeting multiple consonants simultaneously can create system-wide phonological change for children with CLP and severe SSD. Further research with more participants is needed to strengthen these findings.

KEYWORDS:

• Speech sound disorder
• cleft lip and palate
• phonological intervention
• multiple oppositions intervention

Acknowledgments

This study was possible due to the good will of the cleft palate centres in Denmark, especially the heads of department Kirsten Mølsted^a and Louise Leturgie^b. We would like to thank the children and their families who participated. In addition, we thank Maria Boers^a, Joan Bogh-Nielsen^b, Berit Emborg^b, Pernille Hartmann Pedersen^a, Hanne Bundgaard^a for data collection, transcriptions and scholarly discussions.

^aCopenhagen Cleft Palate Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Rygårds Allé 45, DK-2900, Denmark.

^bAarhus Cleft Palate Center, Institut for Kommunikation & Handicap, Peter Sabroes Gade 4, DK-8000 Aarhus, Denmark.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02699206.2024.2339308.

Notes

¹ Consonant correctness was measured as the percentage of consonants correct revised (PCC-R). This method was originally designed to measure connected speech (Shriberg & Kwiatkowski, 1982; Shriberg et al., 1997) but has later been modified and used on target sounds in single words (e.g. Lohmander & Persson, 2008). In this study we use the term PCC for PCC-R in both single-words and connected speech, but we only use the PCC severity index in connected speech as intended.