Treatment decisions for children with speech-sound disorders

In this article, I consider how research, clinical expertise, client values, a clinician's theoretical perspective, and service delivery considerations affect the decisions that clinicians make to treat children with speech-sound disorders (SSD).

After reviewing the research on phonological treatment, I discuss how a clinician's theoretical perspective influences goal selection. Five perspectives are considered: (a) normative; (b) bottom-up, discrete skill; (c) language-based; (d) broad-based; and (e) complexity-based. The literature on treatment efficiency is then considered, followed by a discussion of service delivery factors, client values, and clinician factors.

I believe like M. Ylvisaker (2004) that treatment decisions are influenced the most by the changes that occur in client behaviors. These changes must, however, be experimentally validated, which is not always easy to do. M. Ylvisaker suggests that validation could take the form of trial therapy, diagnostic teaching, or dynamic assessment, but it may also be important to show that the treatment provided, not some other variable, was primarily responsible for the behavioral change (A. Tyler, personal communication, January 11, 2006).