Repost – Stimulable or Non-Stimulable First? That Is the Question…

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I originally published this post in April, 2021. It’s now March, 2023, but this particular post has gotten considerable traffic lately. So, I decided to repost it at the top of the blog.

As always, thanks for reading and please get in touch if you have any questions!

Conventional wisdom in the treatment of SSD holds that speech-language pathologists should treat speech sound error patterns for which kids are stimulable first. Being stimulable for a sound means that the child is able to imitate correct production in some context. That might be in isolation or at the syllable or word level.

It’s this idea of stimulability that has lead to the misinterpretation of Sander’s (1972) When Are Speech Sounds Learned chart. Conventional wisdom holds that children should be ‘ready’ for treatment on particular sounds because they are able to imitate them.

But, conventional wisdom is not evidence-based practice (EBP). The 3 tenets of EBP state that we should strive to incorporate the current external scientific evidence with our own clinical expertise and the client’s/family’s perspectives. We also have an ethical responsibility to be lifelong learners as part of the service to our clients.

What does the external scientific evidence say? For about 15 years now, the evidence has been clear. Treating stimulable sounds initially will result in quick and easy treatment success for the child and the SLP. Why? Because those sounds are already on their way ‘in’ to the child’s system. But, treating stimulable sounds first or only sounds that are stimulable substantially extends time in treatment. Why? Because the SLP is piggybacking onto the developmental changes which are already happening in the child’s system.

The research evidence overwhelmingly demonstrates SLPs should spend time treating non-stimulable sounds to create the greatest amount of change in the shortest amount of time for the client.

So, what role should stimulability play in treatment decisions in SSD? Should you determine stimulability in an eval or progress monitoring of a child with SSD? Yes, but you should be interested in the sounds that are non-stimulable from a treatment perspective. Should you monitor stimulability every time you probe for system-wide phonological change? Absolutely. Change in stimulability is change in underlying phonological knowledge on the child’s part and informs treatment target selection on your part.

One of my favorite resources for determining stimulability during the initial eval and during progress monitoring probes is the Secord Contextual Articulation Tests or S-CAT. I especially like it because it assesses stimulability across all contextual levels and does so in real words. As a proponent of using nonsense words in therapy, I want to know that I am getting demonstrable carryover to the child’s everyday life.

I’ll take up the theoretical and research evidence for using nonsense words in phonological intervention in the next post.

Thank you for reading. Please feel free to contact me with any questions you may have and/or to discuss setting up a treatment plan for a client. If you’d like an example of this type of intervention, please click here.

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