Here is the same methodology and structure you liked — concise, clinically-focused, and
organized by domains → definition → what you see → how to assess → how to treat — but
now for SPEECH SOUND DISORDERS (SSD).
Speech Sound Disorders – Clinical Cheat
Sheet
(Same format you approved for dementia + simplified, practical, session-ready)
1. PHONOLOGICAL PROCESSING
DEFICITS
What it is
Difficulty organizing sound rules of the language (linguistic-level problem). Errors are pattern-
based, not motor-based.
What you see clinically
Many substitutions (t/k, d/g)
Processes persisting past age norms
(final consonant deletion, cluster reduction, stopping, fronting…)
Intelligibility severely reduced
Inconsistent error patterns
Assessment
Standardized: GFTA-3, KLPA, DEAP, BBTOP
Process analysis: identify active phonological patterns
Stimulability testing
Intelligibility rating (word/sentence/conversation)
Treatment Approaches
1. Cycles Approach
o Best for severe, unintelligible phonological disorders
o Work on patterns in cycles, not mastery
o Activities focus on awareness + production
2. Minimal Pairs
o Target contrasts differing by a single feature
o Good for mild–moderate disorders
3. Maximal Oppositions
o Pair sounds differing by maximal features
o Good for moderate–severe
4. Multiple Oppositions
o For phoneme collapse — one sound replacing many
o Example: t → /k, s, sh, ch/
5. Metaphon Therapy
o For children who need improved phonological awareness of sound properties
(long vs short, noisy vs quiet, stopping vs spirant)
Start with these sounds first
Early-developing: /p, b, m, n, t, d, k, g/
Stimulable sounds first (easier success → faster generalization)
Non-stimulable later
High-frequency words
High functional impact (final consonants before clusters)
2. MOTOR-BASED SPEECH DISORDERS
Includes:
Childhood Apraxia of Speech (CAS)
Dysarthria
A. Childhood Apraxia of Speech (CAS)
What it is
A motor-planning/programming disorder: the brain struggles to sequence speech movements.
What you see clinically
Inconsistent errors
Difficulty with longer words
Groping movements
Prosody abnormalities
Poor imitation of multi-syllabic words
Assessment
Dynamic assessment (DTTC probing)
Syllable repetition tasks
Lexical stress analysis
SMR/AMR tasks
Treatment Approaches
1. DTTC
o Most evidence-based
o Uses imitation → simultaneous → direct imitation → delayed imitation
o High repetitions
2. ReST (Rapid Syllable Transition Treatment)
o For prosody + multisyllabic sequencing
3. Nuffield Dyspraxia Programme
o Structured hierarchies from phonemes → words → connected speech
4. PROMPT
o Tactile cues for jaw/lip/tongue movements
What sounds to target first
Simple syllable shapes (CV → CVC → CVCV)
Early consonants
Sounds child can approximate with cueing
Build core functional vocabulary first
B. Dysarthria
What it is
A motor execution problem caused by weakness, slowness, or incoordination of muscles used for
speech.
What you see clinically
Slurred or imprecise consonants
Reduced loudness
Monotone
Drooling or poor breath support
Hypernasality
Assessment
Observe respiration, phonation, articulation, resonance, prosody
AMR/SMR
Intelligibility rating
Oral mech exam
Treatment Approaches
Strength + precision: jaw/lip/tongue exercises
Respiratory support: sustained phonation, breath training
Rate control: pacing boards, tapping
Loudness: LSVT-style cues
Prosody practice
Start with these sounds
Strong early consonants
Reduce cluster complexity
High functional intelligibility targets first
3. ARTICULATION DISORDERS
What it is
Difficulty producing specific sounds due to incorrect motor placement.
What you see clinically
Limited to a few sounds
Distortions (/s/, /r/, /l/)
Errors are consistent, not pattern-based
Good overall intelligibility
Assessment
Sound-specific probe lists
Stimulability
Position analysis (initial/medial/final)
Treatment Approaches
The Classic Articulation Hierarchy:
1. Isolation
2. Syllables
3. Words
4. Phrases
5. Sentences
6. Reading
7. Conversation
Techniques
Phonetic placement
Shaping from known sound
Visual/tactile cues
Minimal pairs if substitution exists
Start with these sounds
Stimulable sounds
Visible sounds first (p, b, m, f, v)
Later focus on hard sounds (r, s, l, th)
4. INCONSISTENT SPEECH DISORDER
What it is
Difficulty selecting a phonological plan → inconsistent productions.
What you see clinically
Same word produced differently each attempt
No groping
Not motor planning (unlike CAS)
Assessment
DEAP inconsistency subtest
25–50 word list repeated 2–3 times
Treatment
Core Vocabulary Therapy
o Teach consistent production of ~70 functional words
o Aim: consistency, not accuracy first
Move to phonological therapy after consistency increases
How to Prioritize What Sounds/Processes to
Target
1. Functional impact
Final consonants
Early stops/nasals
High-frequency everyday words
2. Stimulability
Stimulable sounds → earlier
Non-stimulable → later or use complexity approach
3. Developmental norms
Earlier sounds before later developing ones
4. Severity
Severe phonological disorder → Cycles or Multiple Oppositions
Mild → Minimal Pairs
5. Complexity principle (optional alternative)
Target complex sounds first (clusters, fricatives) → global system change
Works well for very severe phonological disorders
If you want, I can now create:
✅ A 3-session plan for a severe SSD
✅ A hierarchy for selecting sounds for YOUR specific patient
✅ A one-page cheat sheet version
✅ A therapy materials list (minimal pairs, word lists, session scripts)
Just tell me what you want next.