This article addresses 2 questions of importance to the treatment of speech sound disorders: (1) When selecting treatment targets, is it best to begin with the most or the least stimulable potential phoneme targets? (2) When treating unstimulable phonemes, which treatment procedures will result in the best outcome? A summary of the findings from 3 randomized controlled trials is provided. In these studies, outcomes were generally better when stimulable targets were treated; however, outcomes for unstimulable targets were improved by including phonemic perception training alongside phonetic placement procedures in the treatment program. The clinician must take final responsibility for judging the applicability of these research findings to each individual case. Clinical decisions should be made after discussing the known benefits and risks of any given treatment practice with the client and/or the client's family.
School of Communication Sciences and Disorders, McGill University, Montreal, Quebec, Canada.
Corresponding author: Susan Rvachew, PhD, School of Communication Sciences and Disorders, McGill University, 1266 Pine Avenue West, Montreal, Quebec, Canada H3G 1A8 (e-mail: firstname.lastname@example.org).
The author helped develop and has a financial interest in Speech Assessment and Interactive Learning Systems, a treatment procedure that was evaluated in several of the studies summarized in this article.
This article was prepared with support from the Canadian Language and Literacy Research Network (www.cllnet.ca). Portions of this article were presented as part of a seminar on “Evidence-Based Practice: The Why and the How” chaired by Amy Weiss and Rebecca McCavley, at the 2004 annual convention of the American Speech-Language-Hearing Association.