Cycles Approach

The Cycles Phonological Pattern Approach

Many children and some adults have difficulty producing the sounds of speech.  The child might have a lisp, a problem with r, or just be so difficult to understand you don't know where to begin. A basic guideline to see if your kids may need some help is:

By 2, a child should be 50% intelligble.

By 3, a child should be 75% intelligible.

By 4, a child should be 100% intelligible.

While there are many tools SLPs use to address many of these concerns, I wanted to write a special article on my personal favorite-- The Cycles Phonological Pattern Approach. Also called the "Cycles Approach," this treatment technique for articulation disorders was created by Barbara Hodson to treat extremely unintelligible children. The original approach has eight underlying principles:

1. Typical children learn language by listening.
2. Gaining sounds (also called phonological acquisition) is a gradual process.
3. The sounds around a target sound (also called phonetic environment) can help or inhibit correct sound production.
4. Children use sound and movement sensations to self-monitor their productions. 
5. Children generalise new speech skills to other targets (for example, if they are learning /s/, they may use /s/ for /s/, /z/, /th/, and /f/ because they are similarly produced.
6. A good developmental ‘match’ facilitates learning (for example, if the child is 3, the clinician should work on sounds that a typical 3-4 year old would make)
7. Children learn best when they are actively involved/engaged in therapy
8. Enhancing a child’s metaphonological skills facilitates and enhances the child’s speech. improvement and also development of early literacy skills. (For example, working on learning what a syllable is can help both reading and speaking) (See CPPA by Caroline Bowen)

Additionally, Dr. Hodson uses a very specific pattern for target selection (what the therapist will work on during therapy) which begins with easier, earlier developing speech patterns and then advances to more difficult speech patterns.

There are four main intervention procedures:

1. Cycles: Each target is presented for a 1 hour (normally that means 2 sounds per 1 hour therapy session, but could also mean 2 sounds for 2 30-min sessions). After each hour, other targets are introduced until you have an initial "cycle" of 6-18 hours (dependent on how unintelligible the child is). Each "cycle" is then repeated or phased out upon mastery of the target. The  very unintelligible child will take 3-4 cycles (approximately 30-40 hours) to become intelligible.
2. Focused Auditory Input or Auditory Bombardment: This is when a child listens to words that utilize their target sound at a slightly louder level than typical. The theory is that children learn sounds by listening and this will help them "tune in" to the targets they are working on.
3. Facilitative contexts, Active involvement, Self-monitoring, and Generalization: Using activity to learn and models and cues to help the child produce target sounds correctly each time, the child gains new auditory and kinesthetic memory for the correct production of each sound. The child actively participates in a drill-play activity (for example: playing candyland while producing target words on each turn). For homework, the child will listen to words read by their parent/guardian and then attempt to produce a few target words.
4. Optimal Match: Essentially, Dr. Bowen asks that you use developmentally appropriate targets to both challenge the child and allow the child to have success in therapy. (For example you would not work on the /r/ sound with a child who is 3, as that would not be developmentally appropriate for them to produce yet).

I love using cycles therapy with kids and adults. I have seen some amazing growth with my clients while utilizing this approach. When I use cycles therapy, it helps my clients to avoid boredom by working on different sounds. While I modify the cycles approach somewhat to better target the goals from my clients, I try to stick to as many of the main research-based principles as possible. Additionally, I like to utilize further articulation research and work on just voiceless sounds (t, k, s, sh, ch, f, p) to help those sounds generalize to the voiced sounds (d, g, z, dj, v, b). The evidence I have seen while using this approach is overwhelming that it is effective.  I will continue to use it with my clients and hope to see more exciting growth!

Resources

• CPPA by Caroline Bowen
• Published CPPA by Dr. Hodson
• When Should I Worry If My Child is Behind?
• Artic vs Phonology...What's a busy therapist to do?