While there is no one right or wrong way to choose a speech sound therapy, this flow chart will give you a basic logic to get you started.  Not all children will fall neatly into one of these categories but you can start here and move on from there.

• For children working on a single sound error or substitution that is not part of a whole class of sounds
• Some children have more than one articulation error
• Some children have articulation errors in addition to phonology errors
• This is the most straight-forward type of therapy to do
• Start with sounds in isolation, then nonsense syllables, single words, phrases, sentences, structured conversational tasks, unstructured conversation

Click Here to Start by Teaching Sounds in Isolation Using the Articulation Therapy Approach

• For children who have phonological processes, or problems with entire classes of sounds
• These children are often difficult to understand due to many sound errors
• All children use phonological processes up to certain ages but they disappear between 3-5 years
• Therapy differs from articulation because you don’t start with sounds in isolation, you start with minimal pairs of whole words to show the difference between the correct production and the child’s error
• Therapy Phases: Auditory discrimination, production at the single word level, phrase, sentence, unstructured conversation, structured conversation

Click Here to Learn More About Therapy for Phonological Disorders

• For children who meet the following criteria:
  • Highly unintelligible (very difficult to understand)
  • Frequently leave out or omit speech sounds
  • Replace some sounds with other sounds
  • Don’t use very many different consonant sounds
• Instead of working on one phonological process until it is mastered, the children works on each process for a few sessions before moving on to the next.  Then, processes are cycled through and targeted again
• This approach is supposed to mirror typical phonological development

Click Here to Learn More About Using the Cycles Approach

• Good for children with very severe speech problems (like severe childhood apraxia of speech) or those with limited attention for drill and practice.  Also helpful for children who make very slow progress in speech or who only say a few words because of their speech problems
• A short list of common words that the child mis-pronounces is assembled
• These words are practiced in isolation and then the child gets to play with whatever he wants (as long as he will talk with the therapist).  When those words come up in conversation, they are practiced with correct production

• Contextual Utilization: Pair the target sound in syllables with other sounds that will make it easier for the child to produce it (For example, production of a “t” may be facilitated in the context of a high front vowel)
• Minimal Oppositions Contrast Therapy: also known as “minimal pairs” therapy, uses pairs of words that differ by only one phoneme or single feature signaling a change in meaning, in an effort to establish contrasts not present in the child’s phonological system
• Maximal Oppositions Contrast Therapy: uses pairs of words in which one speech sound known and produced by the child is contrasted with a maximally opposing sound not known or produced by the child
• Treatment of the Empty Set: similar to maximal opposition contrasts, but uses pairs of words containing two maximally opposing sounds that are unknown to the child—ideally, an obstruent with a sonorant (e.g., /l/ vs. /s/
• Multiple Oppositions Contrast Therapy: a variation of the minimal opposition contrast approach that uses pairs of words contrasting a child’s error sound with three or four strategically selected sounds that reflect both maximal classification and maximal distinction
• Distinctive Feature Therapy: Target distinctive features that are missing in the child’s repertoire (frication, nasality, voicing, and place of articulation)
• Metaphon Therapy: Metaphon therapy is designed to teach metaphonological awareness, the awareness of the phonological structure of language.  You teach the child about phonological rules, like the difference between noisy and quiet sounds for voiced vs. voiceless
• Naturalistic Speech Intelligibility Intervention: During natural activities, the child’s errors are recast when the child is most likely to repeat them but the child is not demanded to do so

More Information on the Additional Approaches Here: https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/#collapse_6