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For children with severe phonological disorders, traditional speech therapy approaches can sometimes fall short. Enter the Cycles Approach—a powerful method originally developed by Dr. Barbara Hodson and her colleagues that has revolutionized how speech-language pathologists tackle these complex cases.
Unlike traditional articulation therapy, which focuses on one sound at a time, the Cycles Approach targets multiple phonological processes within a structured and cyclical framework. The primary goal of this approach is not to achieve mastery of each sound, but rather to stimulate the emergence of correct sound patterns, thereby improving overall intelligibility.
In this guide, we’ll explore the foundational principles of the Cycles Approach, its key steps, and how to effectively implement it in therapy sessions. We will also discuss how to write IEP goals using this approach, offering practical examples and insights from speech-language pathology experts Marisha Mets and Amy Graham.
Whether you are new to the Cycles Approach or looking to refine your practice, this guide will provide valuable tools and strategies to enhance your therapeutic interventions.
Let’s dig in!
What is the Cycles Approach in Speech Therapy?
The Cycles Approach is designed to address the needs of children with highly unintelligible speech by focusing on phonological processes rather than individual sounds. This method is particularly effective for children who exhibit multiple phonological errors, such as cluster reduction, final consonant deletion, and fronting, which significantly impact their speech intelligibility.
Background of the Hodson Cycles Approach
Originally developed by Dr. Barbara Hodson and her colleagues in the late 1970’s, the Cycles Approach was inspired by cognitive and developmental psychology principles.
The method was designed to work with the natural learning processes of children, particularly those who struggle to grasp the rules of sound production and usage. The Cycles Approach differs from traditional methods by its emphasis on cycling through different phonological targets over a predetermined period, rather than working on a single sound until mastery.
Phonological Cycles Approach: Key Principles
- Targeting Patterns, Not Sounds: The Cycles Approach focuses on phonological patterns (e.g., fronting, stopping) rather than isolated sounds. By targeting these patterns, the approach helps children understand and apply the rules of phonology more effectively.
- Stimulability: Only sounds that the child can produce with some level of accuracy are included in the cycle. This ensures that the child experiences success early in the process, which is crucial for motivation and continued progress.
- Dynamic and Flexible: The approach is dynamic, allowing SLPs to adapt the therapy plan based on the child’s progress. It is not a one-size-fits-all method but rather a flexible framework that can be tailored to each child’s unique needs.
- Structured Sessions: Each cycle is composed of several sessions that follow a structured format, including auditory bombardment, production practice, and stimulability testing. This structured approach helps to solidify the child’s understanding of the phonological rules being targeted.
I’ve found the cycles approach to be really effective for my kids who are more on the severe end of the spectrum, when it comes to phonological deficits. But also it was really adaptable if I went into preschool classrooms…
Amy Graham
The Cycles Approach has proven to be a powerful tool in the SLP’s arsenal, particularly for children who have multiple phonological errors that severely impact their ability to communicate effectively.
By addressing the underlying patterns of speech errors, rather than focusing on individual sounds, the Cycles Approach fosters more rapid and comprehensive improvement in speech intelligibility.
The Steps Involved in the Cycles Approach
The Cycles Approach is a structured method that follows a specific sequence, ensuring that therapy sessions are consistent and effective.
To get a better idea of How to Implement the Cycles Approach, here are the steps typically involved:
1. Select Phonological Patterns to Target
The first step involves identifying the phonological patterns that need to be addressed. Instead of focusing on individual sounds, the Cycles Approach targets broader patterns, such as fronting, stopping, or final consonant deletion, which are impacting the child’s intelligibility.
2. Organize Therapy Sessions with a Structured Format
Each therapy session is highly structured, following a set format that Amy describes as especially beneficial for new clinicians. This structure typically includes several components designed to reinforce correct phonological patterns through repetition and consistency.
3. Auditory Bombardment
Sessions typically begin with auditory bombardment, where the child listens to a list of target words that highlight the specific phonological pattern being addressed. The goal here is to provide the child with a concentrated exposure to the correct production of sounds, reinforcing their auditory perception of the targeted phonological pattern.
4. Production Practice
During this step, the child practices producing the target sounds within the context of fun, engaging activities. Amy highlighted that working on these patterns rather than individual sounds is crucial, as it helps the child understand and apply the rules of sound usage in various contexts.
5. Stimulability Testing
At the end of each cycle or after a set period, the SLP assesses the child’s ability to produce the target sounds with cues. This step, implied in Amy’s discussion, helps determine if the child is ready to move on to new sounds or if additional practice is needed.
6. Home Practice
To reinforce learning between sessions, children are often provided with simple home practice activities. These might include a list of target words or games that parents or caregivers can do with the child. Home practice is essential for maintaining progress and ensuring that the child continues to engage with the targeted phonological patterns outside of the therapy setting.
7. Adjust and Adapt
Amy emphasizes the adaptability of the Cycles Approach. Based on the child’s progress, the SLP may need to revisit certain sounds or patterns, or introduce new ones. This flexibility ensures that therapy remains effective and tailored to the child’s evolving needs.
8. Cycle Completion and Review
After completing a cycle, the SLP reviews the child’s progress to determine if the targeted phonological patterns have started to emerge in spontaneous speech. If so, new targets are introduced in the next cycle. If not, the current targets may be revisited.
These steps provide a clear and effective framework for implementing the Cycles Approach in speech therapy, ensuring that each session builds towards significant improvements in the child’s speech intelligibility.
“The Cycles Approach is really adaptable, because it’s so structured. I really enjoyed that aspect of it. Especially as a newer clinician, it was pretty much a step-by-step guide to what you do in your 30 minutes or 60 minutes of therapy. Because it was like literally, here are the components of a therapy session, and your lesson plan is done.”
– Amy Graham
Dynamic Assessment in the Cycles Approach
A critical component of the Cycles Approach is the dynamic assessment process, which plays a key role in tailoring the therapy to each child’s specific needs.
This approach emphasizes the importance of understanding the underlying phonological patterns that are contributing to the child’s speech difficulties, rather than merely addressing surface-level speech errors.
The Importance of Phonological Assessment in Speech Therapy
Amy highlights that a thorough and appropriate assessment is the foundation of any effective therapy plan.
She notes that traditional articulation assessments, which often focus on individual sound production, may not be sufficient for children with phonological deficits. Instead, SLPs should perform a comprehensive analysis of the child’s speech patterns to identify consistent phonological errors.
“We have to understand whether or not the child does have a phonological deficit. If we just take a traditional articulation approach and throw it against the wall hoping something sticks, we’re going to be spinning our wheels with most of our kids.”
This underscores the necessity of using a diagnostic approach that goes beyond simple sound production tests like the GFTA (
Tailoring the Approach Based on Assessment
Once the phonological patterns have been identified, the Cycles Approach allows for the therapy to be tailored dynamically based on the child’s progress. Amy emphasizes that this adaptability is one of the strengths of the approach. The SLP can adjust the targets and methods as needed, depending on how the child responds to the initial cycles.
For example, if a child is not making expected progress on certain phonological targets, the SLP might revisit earlier assessments to ensure the correct patterns are being addressed. This ongoing evaluation is crucial to ensuring that therapy remains effective and responsive to the child’s needs.
“Make sure that you’ve not only done your assessment, don’t just give that Goldman Fristoe, but analyze the child’s speech. Are there patterns to the types of omissions or substitutions that they have? If there are consistent omissions and substitutions – that’s where the Cycles Approach shines.”
– Amy Graham
Dynamic assessment is a cornerstone of the Cycles Approach. It ensures that therapy is not only targeted but also flexible enough to adapt to the child’s unique phonological challenges, leading to more effective and efficient intervention.
Resources for Phonological Assessment
To assist in developing specific phonological goals and conducting thorough assessments, SLPs can utilize the following resources:
ASHA Phonological Processes Chart
This chart provides a comprehensive overview of selected phonological processes, which can be invaluable in identifying which processes to target during therapy. You can access the ASHA Phonological Processes Chart here.
Assessment Checklist:
Make sure to grab a copy of Amy Graham’s assessment checklist here on her site.
Developing Goals for the Cycles Approach
Writing effective IEP (Individualized Education Program) goals is a critical step in the Cycles Approach, particularly for children with significant phonological disorders.
Your goals must be specific, measurable, and flexible enough to adapt to the child’s progress throughout the therapy.
Writing Effective Cycles Approach Goals: A Focus on Flexibility
Amy stresses the importance of writing goals that are not tied to a specific therapeutic approach but are instead focused on the desired speech outcomes. This allows the therapist to adjust the approach if the child is not responding as expected.
“I actually don’t write goals to a specific approach… I write my goals to the specific speech task that I want the child to acquire, regardless of how I get there.”
This approach to goal-setting ensures that the therapy remains adaptable, giving the SLP the freedom to switch strategies if needed without having to revise the entire IEP.
Example of SMART Goals in the Cycles Approach
When creating goals, it’s essential to follow the SMART criteria—goals that are Specific, Measurable, Attainable, Relevant, and Time-bound. For example, a goal might be:
“By the end of the 12-week period, the child will reduce the occurrence of the phonological error pattern of fronting by producing /k/ and /g/ sounds in the initial and final positions of words with 90% accuracy, with no cues, across two consecutive therapy sessions.”
– Amy Graham
This goal is clear and focused on a specific phonological pattern, with a measurable outcome that can be tracked over time. It also allows flexibility in the method used to achieve this outcome, whether through the Cycles Approach or another suitable strategy.
Incorporating Intelligibility and Stimulability Goals
In addition to targeting specific phonological patterns, Amy also emphasizes the importance of including goals related to overall speech intelligibility.
For instance, an intelligibility goal might involve improving the child’s ability to be understood by unfamiliar listeners, which can be measured using tools like the Intelligibility in Context Scale.
In summary, developing goals within the Cycles Approach involves focusing on the broader speech tasks that need improvement, rather than being rigidly tied to a single method. This flexibility allows for a more responsive and individualized approach to therapy, ensuring that each child can make meaningful progress.
Implementing the Cycles Approach in Therapy Sessions
Implementing the Cycles Approach effectively in therapy sessions requires a structured framework that can adapt to the individual needs of the child. Amy emphasizes that while the approach is highly structured, it also allows for flexibility based on the child’s progress and specific needs.
Keys to Successful Cycles Approach Implementation
- Structured Therapy Sessions The Cycles Approach is designed with a clear structure in mind, which is particularly beneficial for clinicians. Each session typically includes components like auditory bombardment, production practice, and stimulability testing. Amy highlights how this structure provides a reliable framework for conducting therapy:
- Target Selection and Rotation In the Cycles Approach, phonological targets are selected based on the child’s specific needs and are rotated in a cyclical manner. Each target is addressed for a set period before moving on to the next. This rotation helps address multiple phonological patterns, promoting the generalization of correct sound usage across different contexts.
- Engagement and Motivation Keeping children engaged is crucial to the success of therapy. While the Cycles Approach is structured, it also allows for the integration of engaging activities that make therapy enjoyable for the child. This engagement is vital for maintaining the child’s motivation and reinforcing learning.
- Continuous Assessment and Adaptation Regular assessment is key to ensuring that the Cycles Approach is working effectively for each child. Amy discusses the importance of being flexible in therapy and adjusting the approach as needed:
“Sometimes I might have the best of intentions with a child and think, yep, this is the approach I’m going to go with… and then we get into a few sessions and I think to myself, ooh, this isn’t working. They’re not responding to the construct of this approach.”
– Amy Graham
This ongoing evaluation ensures that therapy remains responsive to the child’s needs and that adjustments can be made to improve effectiveness.
Phonological Treatment Approaches for Different Age Groups
The Cycles Approach is versatile and can be tailored to meet the needs of children at different developmental stages and with varying levels of phonological deficits. For younger children, therapy may involve more play-based activities, while older children might benefit from more structured practice. Amy underscores the importance of understanding the child’s individual needs and adapting the approach accordingly.
By carefully implementing the Cycles Approach, SLPs can ensure that therapy sessions are both effective and enjoyable, leading to significant improvements in the child’s speech intelligibility over time.
Cycles Approach Success Stories
The effectiveness of the Cycles Approach in treating phonological disorders is well-documented through various success stories and case studies.
Amy has personally seen remarkable progress in children using the Cycles Approach. These success stories often involve children who were initially highly unintelligible, with numerous phonological processes, such as cluster reduction, final consonant deletion, and fronting.
And there are many other real-life examples that highlight the approach’s ability to significantly improve speech intelligibility in children who struggle with multiple phonological processes.
Cycles Approach Case Study: Addressing Severe Phonological Deficits
A notable case study, as discussed on SLP Now, involves a four-year-old child named Jayden, who presented with severe phonological disorders, including cluster reduction, fronting, and stopping. The Cycles Approach was applied, with targeted interventions focusing on specific patterns like /k/ and /s/-clusters. Over time, Jayden showed measurable improvements in his speech intelligibility, demonstrating the effectiveness of the Cycles Approach when applied consistently and with clear, structured goals.
This patient, step-by-step approach ensures that each phonological pattern is addressed thoroughly, leading to better generalization of correct speech sounds in the child’s everyday language.
You can read the detailed case study of Jayden’s progress here.
Resources for Learning More About the Cycles Approach
Make sure the check out these free resources deepen their understanding of the Cycles Approach and its application in speech therapy:
- SLP Now Goal Bank
- #005: How to Implement the Cycles Approach – SLP Now
- Intelligibility in Context Scale – Multilingual Children’s Speech
- Amy Graham’s Speech Assessment Checklist
- The Cycles Approach for Articulation Therapy: A Case Study – SLP Now
Frequently Asked Questions About Cycles Approach
1. What is the Cycles Approach?
The Cycles Approach is a speech therapy method designed to improve speech intelligibility in children with severe phonological disorders. It targets multiple phonological patterns in a cyclical manner, focusing on the gradual emergence of correct speech patterns rather than immediate mastery.
2. How is the Cycles Approach different from the traditional approach?
Unlike traditional articulation therapy, which targets one sound at a time until mastery, the Cycles Approach addresses broader phonological patterns and cycles through them. This method promotes generalization and more comprehensive improvement in the child’s speech.
3. What resources does ASHA provide for the Cycles Approach?
ASHA provides resources and guidelines for implementing the Cycles Approach, emphasizing its use for children with multiple phonological errors. The approach is recommended for addressing severe phonological disorders, and ASHA highlights its effectiveness in improving overall speech intelligibility.
4. What are the primary targets in the Cycles Approach?
The primary targets in the Cycles Approach include common phonological patterns such as final consonant deletion, cluster reduction, fronting, and stopping. These patterns are selected based on their impact on speech intelligibility and are addressed systematically over several cycles.
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Transcript
Marisha (00:01)
Hello there and welcome to the SLP Now podcast. I am really excited to be chatting with Amy Graham today. We are continuing the Goal Series and chatting about goals when implementing the cycles approach. And just a little bit of background, you might, well, I think if you're an SLP, you probably already know Amy Graham. She has been on the podcast twice already. So if you're...
You can head to check out episode 17 where she talks about oral facial exams and episode 31 where she talks about childhood apraxia of speech. And I'll just do a super quick intro and then we'll get into the content. But Amy Graham, she specializes in the assessment and treatment of children with speech sound disorders. She has a boutique private practice and only sees kiddos who
for your SSD. And she also has, she's just a phenomenal resource. She presents all over the place and she has a really helpful Instagram account where she actually has videos of her implementing strategies and she answers all of the questions. Just a phenomenal resource. And I'm so, so grateful that she's here with us today. So hello Amy.
Amy Graham (01:23)
It's so good to see you again. Thanks for having me on.
Marisha (01:25)
Good to see you too. And so I'm, I feel like I didn't even do your bio any justice, but I'm curious too. I think it's always interesting to hear kind of your story or anyone's story. But how did you end up learning so much about speech sound disorders or the cycles approach in particular? Can you share a little bit of your journey there?
Amy Graham (01:49)
Well, yeah, I mean, it probably starts with my SLP origin story, which everybody seems to have one, which was my sister had speech therapy when she was little and she's younger than I am by about three and a half years. And knowing what I know now, she had a phonological deficit. And so when she was like, you know, four, five, six, I kind of got dragged along to all of her speech therapy sessions. And so in my mind, I thought.
that's what speech therapists do. They help kids with their sounds. And at that point I thought, that's all we did, right? We fixed S's and R's. And so I thought as I was in school, I thought, you know, that's kind of sounds like after I changed my major like three or four times, I thought, that would be kind of fun. I remember going to that office with the aquarium and the fish tank that my sister was in. I think that would sound like a fun job. You help kids, you know, learn how to say sounds and then you get into the program.
and you learn that our scope of practice is insane. And so I kind of took little detours here and there. I really loved adult neuro. I thought I might go into that, but they weren't hiring when I graduated. They weren't hiring CFYs anyway, or CFs. And so I went into the schools, which I'm really glad that I did because as you know, if you're in the schools,
your caseload is composed of a lot of kids, especially if you're in the elementary ages or even preschool, a lot of speech sound disorders. And so I kind of rediscovered why I like the field with those kids, because I soon discovered too that if I were to match the particular approach,
to the right kid who has the right severity, the right kind of speech sound disorder, I could literally see improvement in real time in one session. And I loved that because that is not necessarily true about a lot of other areas that we treat. And so I love that about speech sound disorders. And I think I was also really fortunate in that my graduate program, I went to California State University Fullerton in Southern California, where I'm originally from.
Colorado now though, but they had a really great SSD class course. And so I felt like I felt really comfortable in kind of tackling speech sound disorders. And now I went to the school in the 90s. So if you went to school in the 90s, you learned all about the cycles approach. That was like the approach of the moment. And so that's what I learned was one of my favorite approaches.
And so even when I did clinicals as a grad student, I had a kid on my caseload who was pretty significantly impaired phonologically. And so I could use cycles as a student and have my supervisor observe and critique. And so I kind of learned how to do the approach that way. And yeah, and so working in the schools, I just found it to be really effective for my kids who are kind of more on the...
severe end of the spectrum when it comes to phonological deficits. But also it was really adaptable if I went into preschool classrooms. And if I had time where I had to push in and we had centers and it's really adaptable because it's so structured. So I really enjoyed that aspect of it. I also really liked the fact that, especially as a newer clinician, that it was pretty much here's a step -by -step.
guide to what you do in your 30 minutes or 60 minutes of therapy. Because it was like literally here's the seven components of a therapy session. And so your lesson plan is done. So I love that. That's how I kind of got into the speech sound disorders aspect of it and how I started using the cycles approach.
Marisha (05:29)
I love that. And I'm excited. Like I have all of the questions now. So the goal of this podcast is to chat about goals. That's a question that we get all of the time. Like, okay, so I decided I want to use this approach. Like, how do I write the goals? But that's like a tiny part of the puzzle, because you mentioned like, we need to know which approach is appropriate. And we want to make sure that we have a thorough assessment.
Amy Graham (05:35)
good.
Marisha (05:57)
to help us make that decision. And so there's a lot of other elements that we want to consider and it's not just, okay, let's write some goals. So what are, and that's, we're not going to focus on that during this podcast episode, but what are some resources that you would recommend? Maybe just kind of in speech, for speech sound disorders in general, where we can do like a good assessment and help narrow things down and then.
Amy Graham (06:19)
Mm -hmm.
Marisha (06:24)
kind of just learning more about implementing the cycles approach.
Amy Graham (06:28)
you're right, absolutely all of it starts with a really appropriate and thorough assessment. Because until we understand the nature of the child's deficit, if we just take a traditional articulation approach and just throw it against the wall hoping something sticks, we're going to be spinning our wheels with most of our kids because that traditional articulation type of intervention where, you know, we just pick a sound that they don't have and we're just going to work on that sound and that traditional hierarchy of isolation, syllable word, phrase, so on.
not appropriate for kids with phonological deficits. So we have to understand whether or not the child does have a phonological deficit. And if it gets loud right now, I'm in Colorado and we've got hail. So it's literally going on in the background. So sorry about that if you hear it. But yeah, we do have, we have to understand what's going on. So make sure that you've not only done your assessment, don't just give that Goldman Fristow, but analyze the, analyze the child's speech. Like,
okay, what is going on there? Are there patterns to the types of omissions or substitutions that they have? And if there are, if there are those consistent omissions and substitutions and they're highly unintelligible because that's what cycles is meant for. Cycles approach, and I think that's commonly misunderstood. Well, you know, can we do the cycles approach for everybody? It's really most appropriate for kids who are on the moderate to severe to even profound end of the spectrum where they're missing so many sounds.
in their inventory or they have so many phonological errors. Everybody has this kid. If you work with preschoolers or even early elementary age kids, you've got the kid who has cluster reduction and stopping and final consonant deletion and gliding and fronting and it's like, wow, that is a lot of phonological errors. And that kid is highly unintelligible. And so when you get a kid like that, we're often like,
Well, where do I start? Do I work on K and G until they get it? Do I work on S's? Like, where do I begin? And the cycles approach, we work on all of it in a very cyclical way. And so that's what I love about all phonological interventions is that we're not just teaching motor production of a sound because that is not the nature of a phonological deficit. Yes, they may have trouble learning how to produce a sound if they're not immediately stimulable.
So there's always a motor component to speech, but the nature of a phonological deficit is that the child does not necessarily understand the rules for when we use sounds to change meanings of words, which is why we are always operating within the context of words. So our speech therapy is with words because that's how we teach the rule. And I love this. I talk about this all the time because I had a parent, it illustrates this point really well.
I had a parent who messaged me on Instagram and was really concerned about her, I think it was five year old son. She thought there was something wrong with him because she said, okay, can you say the snake sound? Cause he wasn't doing any S's apparently. And she said, and he could do it immediately. He could do the snake sound when she said it like that. When she said, just make the snake sound, you know, do that, that sound effect and he could do it. And then she's thinking, great, he has S. So she's, so she would ask him, okay, now say snow. And he went, no.
not because it was a motor issue with being able to produce a sound. He did not know the rule that the word snow has to have an S on it to change the meaning from no to snow. And that's what the cycles approach does. That's what all phonological interventions do. Complexity approach, minimal pairs, multiple oppositions, they all teach the rules along with the motor production. And so, yeah, so that's what the cycles approach does. And I think I...
probably forgot what your question was because I just went off on a little tangent there.
Marisha (10:08)
No, I love that answer. And so you gave us a little bit of insight on in terms of what we want to consider in our assessment, like going beyond the basic articulation test and looking at the patterns. And I think you did an episode about oral facial exams, which could be helpful too. Do you have any, because we don't have time to dive into all of that.
Amy Graham (10:19)
Mm -hmm.
Marisha (10:32)
But do you have a favorite resource if someone is wanting to learn more about, okay, I know I feel like I could some SLPs might be listening and they're like, okay, I know, like I have a good system for my evaluations. So I'm good there. But for the people who are listening to this is like, Ooh, that could be an area that I really want to learn more about. Do you have recommend?
Amy Graham (10:53)
about assessments, I know it's actually on my agenda to do a differential diagnosis. And actually I've done a two hour course and I've traveled and I do it a lot over Zoom. I just haven't recorded it yet to have it on my website. So that's in the works, a differential diagnosis course for yeah, absolutely. But I would say just kind of.
going through what we know from and hopefully, you know, we all had a course like that, but remembering and going back, what do we all need to include? And so I do have a free assessment checklist that I made for myself to kind of keep in mind, okay, what do I need to remember to do? I need a connected speech sample. I need to do the oral facial exam. I got to analyze the Goldman Fristo or the articulation tests for patterns. And so I do have a free assessment checklist.
that people can download and it's got links to different assessments that you might want to consider, links to intelligibility ratings from Dr. Sharon McLeod. So you can download that. It's on the freebies portion of my website and I'm sure maybe we can even link it in the show notes.
Marisha (12:00)
Yeah, we will link that in the show notes. Perfect. And then because we are recording this quite a bit ahead of time. So I'll connect with Amy before the podcast airs to see if we can add the link to the differential diagnosis course, if it happens to be ready by then. So I'll make sure to check in about that. And then, yeah. And then so that like.
Amy Graham (12:15)
I'm hoping so. I have a lot of plans.
Marisha (12:25)
So we have some resources in place for the assessment and hopefully we'll have the course for differential diagnosis. And then what about the cycles approach specifically? Because we'll chat a little bit about considerations for goals. But if the site goals approach is really new to an SLP, do you have any resources that you'd recommend?
Amy Graham (12:45)
Yes. So I'm going to share this book that is just amazing. So it's Interventions for Speech Sound Disorders in Children. And this is by Dr. Lynn Williams, Sharon McCloud, Rebecca McCauley. And it's a compilation of every chapter is a different approach. And so you can actually go to the cycles approach chapter and learn all about it. And it's a really great reference. It's a great reference for all speech sound disorders interventions.
I also recorded a two hour webinar on the cycles approach. So, cause I got questions, I consult with a lot of SLPs. I do consultations. And so I would find out that as I talked to more SLPs, there was very frequently misunderstanding about what a cycle is, about when you target certain sounds, how long you target those sounds. And so I decided, you know, I'm just going to do a course and really go through it step by step. We go, we even go through assessment.
We go through analyzing their speech errors and we go through the construct of what a cycle is, but we also go through, here's what a therapy session can look like and here are the different components of a therapy session with a lot of actual videos of therapy so that you can kind of see it in action. So, yeah, and I know there's a cycles approach resource page on my website as well too, that all of that is linked in addition to a lot of other resources that I have for the cycles approach.
Like I do have, I have these over here, my cycles decks. I have six authored for Bjorum speech and they're divided by particular phonological pattern. So all of the work has been done for you in those decks as when you're thinking of target selection, because that's another thing we got to think about for target selection. It's very different in the cycles approach and really a lot of phonological interventions because we have to think through, you know, monosyllabic words.
phonetic context, and all of that work has been done for you on those decks as well.
Marisha (14:41)
Awesome. So we have lots of great resources and again, we'll add those all to the show notes. So everyone has easy access to them. Okay, so now let's get to the like the meat of the episode where we get to chat about goals. So once we've done a great assessment and we've decided that the cycles approach is a great fit for our students, how would you like what tips or recommendations would you have when it comes to?
starting to develop goals for that student and kind of whatever you think would be helpful here.
Amy Graham (15:12)
Mm -hmm.
Yeah, so when it comes to writing goals for kids who are pretty significantly impaired, because that's who the cycles approach is appropriate for kids who have a lot of phonological errors going on. It's really important one. I mean, we want smart goals, right? It has to be, you know, specific, measurable, attainable, relevant to the child and timely. The timeliness part is going to differ based on your setting.
You know, in the schools we write annual goals. For me, I write 12 week goals because I'm private practice. And I feel like after 12 weeks, a lot of times I can kind of get a feel, most of the time I can get through a cycle, not always, but I can kind of get a feel for how that child is doing in therapy after about 12 weeks. So that can vary, but you have to think, okay, what do I think by the time my time period is over? What do I want that child to achieve? And so if you're thinking about,
Goals specific to an approach. I'm going to give an answer that might be a little, a little different than most people might think. I actually don't write goals to a specific approach. And here's why. cycles approach is not the only option for kids who have, you know, severe or moderate to severe phonological deficits. There are other interventions out there. There are multiple oppositions. There's the complexity approach. And so,
sometimes I might have the best of intentions with a child and think, yep, this is the approach I'm going to go with, go for with this child. And then we get into a few sessions and I think to myself, ooh, this isn't working. They're not responding to the construct of this approach or the targets that we've selected based on this approach over here. And so when that happens, I want my goals to be flexible enough to where I can switch approaches and my goals are still going to be appropriate. So I don't really write goals.
to the cycles approach or to the complexity approach, others do, and I know that's how others do it. That's just not how I do it because I want to give myself some flexibility. So I write my goals to the specific speech task that I want the child to acquire, regardless of how I get there. So if you have a child who is stopping and cluster reducing and fronting, that's what I'm going to write my goal for. I want to write my goal for the sounds that I want them to achieve. So.
My goal might sound something like this. And this is just one example. Say we're gonna write a goal for fronting. Maybe they're fronting all the Ks and Gs or T and Ds. So I might say something like, by a certain amount of time, the child will reduce the occurrence of the phonological error pattern of fronting by, and I like to include both. I know some people don't like the negative, but I like both.
I want to know, well, why am I working on K and G? What are they doing? they're fronting. Got it. So we're going to reduce fronting by producing K and G in initial and final position of words with 90 % of the time, with no cues across maybe two sessions or whatever. You can be pretty flexible with that, however you like to write your goals. So that might be how I write a goal.
And the way that I get there might be through the complexity approach. It might be through the multiple oppositions approach. It might be through the cycles approach. And so I might have multiple goals. So if a child has a lot of different phonological error patterns with the cycles approach, actually, as with most phonological approaches that are appropriate for kids with severe phonological errors, you can target a bunch of sounds in a year, in 12 months.
the way we do it might be a little different depending on the approach. So that's how I like to do it. And I have a goal for each phonological error pattern that I want that child to eliminate or reduce in the time period that I'm going to be working with them.
Marisha (18:57)
That makes a lot of sense. And it's okay.
Amy Graham (18:59)
I might have another goal too, just to add to that, because the goal with the cycles approach is a little different than others in that the overall goal is to increase intelligibility. And so I might write a goal for intelligibility. And I love writing a goal for the intelligibility in context scale, which is a free resource to help you gauge intelligibility of kids based on parent or caregiver report. And so I will write a goal to that.
And I have that linked on my, again, on that free assessment checklist. So if a parent, it's a seven question questionnaire basically that a parent answers and you ask them, how much does a stranger understand your child? Five, I forget, it's like one to five from not at all to often, I think, if I'm remembering correctly. And you can score it. And so I've actually written goals to that.
Like if a parent is reporting 20 out of 35 or 15 out of 35 when you calculate their score, my goal might be, based on parent report, intelligibility will improve to 25 out of 35 on the ICS when administered to the parent. So there's some different ways that you can measure improvement. And those are just a couple of ways I like to do it.
Marisha (20:15)
Yeah, and so I love that. And because we do, it could be that for whatever reason, the approach that we chose isn't the ideal approach. I love the suggestion to take that into consideration. That makes a lot of sense. And then in the show notes, I'll put like a sample goal in case anyone was scrambling to try and write it down. But that'll be in the show notes. And I'll also link the...
intelligibility and context scale. And I love that as a goal too, because especially if our, our student, if we're in the schools and we have a student is exhibiting a really, really long list of processes. I mean, we may want to write a goal for each one of them, but we could also like pick the biggest thing for our book and then add the intelligibility goal as well.
Amy Graham (21:04)
Yep. Yeah.
Marisha (21:10)
Like is that what you would recommend or?
Amy Graham (21:12)
You know, it kind of depends on the child. Like I like to, I mean, it might be more goals than you're used to, but if you are, if you've got a kid that's that impaired, I think that's, I think that's okay. Especially if you're using an approach that you know, yeah, I'm using the cycles approach. So when, you know, 15 weeks or so, I can absolutely target all of those error patterns, then why not write a goal for it? That doesn't mean that.
Maybe they'll achieve all of those. Maybe if they're not stimulable for K or G, I may not write a goal for that yet, but I'm going to still, you know, at every session, see if I can get them to be stimulable. But I maybe I don't think they're going to be able to achieve that by the end of my reporting period. So maybe I don't include that yet, but I might down the road. So there's, or maybe I'll write a goal for child will be stimulable for the K and G sound in isolation, right? If they're not stimulable yet.
So again, that's another goal that you can write for any approach if it's a sound that you want that child to eventually acquire. Yeah, so I think if we're creative, I think we need to step away from this idea of we have to pick one sound and that sound has to be 90 % accurate in all word position. That's an articulation approach, right? That's articulation. I want to know, I want that child to start learning about these particular sounds.
that we're trying to teach. And that's why another goal, I'll give you another example. With the cycles approach, when we get through an entire cycle and we've targeted all the patterns and all the sounds that we are gonna target in that cycle, we reassess to see if any of those sounds begins to emerge in spontaneous speech. And so when, according to the cycles approach, when a child starts to use, let's say, let's keep fronting for example, when they start to use K and G,
in spontaneous speech at about 50 % accuracy. So 50 % of the time, they're saying it correctly. You don't have to target it in the next cycle. So I have often written a goal too, and I'll write this across the board for other phonological, because this really is true for phonological learning. Once a child reaches past that 50%, most of the time they're saying it correctly.
The rest is likely to emerge on its own without direct intervention. So I might even write a goal for, you know, child will produce K and G at over 50 % accuracy during a spontaneous speech sample of 10 minutes, you know, across two sessions or whatever, you know, you can kind of get as specific as you need to, but write a generalization goal and thinking about what we know about phonological development, because again, we're teaching the rule.
And once the child starts to learn that rule and it starts to emerge in their spontaneous speech, we know that rule is probably taking hold. And then we can just monitor it without having to necessarily directly target that in their speech.
Marisha (23:58)
Yeah, that's a great suggestion. And then, so going back to the word level goal, and I'm just curious, kind of in your practice, what you've seen. So if we write the goal at the word level, and let's say they achieve like the criteria and 90 % accuracy, do you typically see that go into conversation or?
Amy Graham (24:14)
Mm -hmm.
Not always. So that's another thing to consider too, because that is acquisition of the skill during your assessment. You know, that's what they're, you know, when you show them the pictures, can they do the sound? But generalization is our ultimate goal. So we have in phonological interventions, we have this narrow measure of generalization, which would be that. Like maybe give them a list of 10 words that have the target sound that you've been working on, but you haven't addressed those in therapy. Is it generalizing to untrained words?
So you can write a goal and add untrained word list to that goal at the word level. But once they're about 90 % of that time, they're producing that in untrained words that you haven't addressed in therapy. Once they get there, then it's time to start looking at that generalization to spontaneous speech. And we continue to address it until we hear that child start to use it in spontaneous speech, even if they're like 100 % accurate over here. We got to still address it.
that because just because they're accurate with at the word level doesn't mean learning has taken hold. So we have to continue to address it. We might even tweak what we're doing in the therapy session, which I go into in my course, like maybe we're gonna use those words in phrases and those kinds of things. We're gonna make the, you know, change the linguistic context a little bit about what we're practicing, but we're gonna keep addressing it until the ultimate goal is to get to that.
at least 50 % I like to shoot for a little more even spontaneous production.
Marisha (25:47)
Perfect. And then are there any other goals that you would add? Because we talked about at the word level, kind of spontaneous speech. Would you ever write goals kind of in between that, or would you always just?
Amy Graham (25:59)
I don't because I think some people think of the in -between goal might be use them in phrases, use them in sentences. Again, that's a traditional articulation goal. That's not what I'm going for. I'm going for is the child learning the rule for these words have to have the back sound, right? The K and G versus the T and D. And we do that most of the time, we're doing that at the word level. So that narrow, we have that narrow measure of generalization when it comes to phonological interventions. And we have a generalized, you know, a general or a broad measure of generalization, which we.
spontaneous speech. So those are kind of the only two that I go into. But I also, like I said, I do like that intelligibility goal because here's why. When you have a child who's so impaired, let's take, for example, maybe they have final consonant deletion, right? And they're saying, I don't know, like cat, for cat, they're saying cat, right? They just drop it off altogether.
And so you're doing your cycles, you're targeting final consonant deletion and everything else and maybe S clusters and gliding and fronting and all of it. And then you get to the end of your cycle and you're reevaluating and the child says something like, pass. Well, is it accurate? No, it's not accurate. But is it better? Because now they're at least marking a final consonant? Yes.
So if a child says, I want to pet the cats versus I want to pet the cat, is it more intelligible? Likely it is. And so that's why I like an intelligibility goal because as the child's speech system improves, the sounds may not always be perfect and accurate, but we want them to get closer and closer and closer until it is accurate. And so that's why I like that measurement of intelligibility too, because it looks at not just, is that sound perfect in that word position? It looks at, yeah, but are they being understood a little bit more?
Marisha (27:49)
Yeah. And that's the ultimate goal. So I love that. And then, cause you also mentioned, so to recap, we did the word and spontaneous conversational speech goals. Then we talked to the intelligibility and context. And you also mentioned a stimulability goal.
Amy Graham (27:51)
Absolutely.
Yeah, yeah, because some kids for the cycles approach, we don't address word level practice. We don't do an entire session at words until they can actually produce it correctly, because this is one of those approaches where we want errorless learning. We don't want to reinforce inaccurate productions. But what if you have a kid who can't do K or G yet, right? I get a lot of those kids who takes time. And so we don't focus an entire session on that. We maybe focus five minutes at the end of the session.
to see if I can get them, if I can use new cues to get them to be stimulable. And then we can, once they are stimulable, then we're gonna spend an entire 60 minutes of therapy on that sound with particular words. And so if a child is not stimulable, absolutely, I will maybe even write, child will produce or child will exhibit stimulability of this particular sound.
I'll even write in any phonetic context. Maybe they can get it at the end of a word. I just want them to show me that they're stimulable. So in any phonetic context, or you can say in isolation, given maximal multisensory cues, because we're going to go through our entire toolbox until we can get that kid to say that sound. And then, you might even say like five times out of 10 trials or six out of 10 trials or eight out of 10 trials.
whatever you think that child will be able to achieve within that time frame. Because once they can achieve that, then you can start targeting at the word level and then you can rewrite for that next reporting period, you can rewrite that goal to address word level practice.
Marisha (29:40)
Perfect. And anything else that you would add in terms of goals?
Amy Graham (29:45)
I'll probably have something to add after we stop recording. I'll probably think of something, but I don't, nothing that's coming to mind at the moment.
Marisha (29:48)
That's always how it works.
Yeah, and I love this because it's like once you have a little bit of a framework and everything, like it feels so simple and it like it makes sense. So.
Amy Graham (30:04)
And I think it is. It's a lot simpler than we think. I think most things like apraxia therapy, it's a lot easier than we think. Not easy, but simple. It's a lot simpler than we think as far as choosing targets and thinking of what do we actually want. If you stand back and you kind of take a big picture as opposed to getting up close and looking at the 45 sound substitutions and omissions that the child has, step back. What's the big picture? What do we want to happen? What sounds do we want them to acquire? It really is simple.
Marisha (30:31)
Yeah. And I, especially with speech sound disorders, it seems like, like the cycles approach and like DTTC for apraxia, a lot of them have really nice like step -by -step guidelines to at least guide the intervention. and I love what you said about writing goals for the specific speech task and not having it be for a specific approach. because that, that makes it simpler too.
Amy Graham (30:43)
Yeah.
Absolutely.
And it gives you freedom to change your mind. I love the complexity approach. It's one of my favorite approaches where we target a complex cluster or two that it might be challenging for the child that they may not even be stimulated before, but that's what we're doing. But that depends on the resilience of the child, the maturity of the child, the age of the child. I've had some kids, I go in and I'm like, yep, this is what we're doing. And the minute I challenge them with something that's hard, they're under the table and I've lost them. And so I think, okay.
you know what, this is not working, I'm gonna switch to the cycles approach because we're working within their zone of proximal development for the cycles approach, where they just need a little bit of help to be accurate. And sometimes kids need to feel that success right away in order for you to get buy into the whole therapy process. And the cycles approach can be a really great way to do that.
Marisha (31:45)
Yeah, that's great. So any last tips or tricks before we wrap things up? I mean, you could speak for hours and hours and hours and hours. We could be here next week still.
Amy Graham (31:53)
man.
I could go on and on. I think my biggest tip for any SLP, and this kind of goes even beyond goals, is to understand the nature of the child's speech sound disorder. Meaning, again, we're going back to assessment, but what's going on? Is it articulation? Is it a distortion, like our lateral lispers, those are distortions where we should use a motor -based intervention? Or is it phonological? Do we really need to...
to even if they're not stimulable, just because I think this is a common misunderstanding. If a child is not stimulable for a sound, then it must not be phonological. That is not true. A child does not have to be stimulable for their primary deficit to be phonological in nature. Just means we're going to have to work extra hard and use a lot of cues in our toolbox to help them become stimulable for that sound. But once you understand, OK, what's the nature of the child, it's going to help you choose a better approach.
And honestly, it's gonna help kids get off your caseload faster. And I tell when I do my courses, that is my goal for parents, for the kids, for SLPs. I wanna get kids off your caseload and I don't wanna see it this time next year because I want to have implemented an approach that matched the child's deficit so that we can make them intelligible so much faster. And using a phonological intervention for phonological deficits is so much faster than using that traditional articulation approach. So I think that would be my takeaway.
specific necessarily, but find out, make sure you know what the deficit is so you can be much more effective and efficient in your service delivery.
Marisha (33:34)
Yes, a thousand percent. And everyone wins if we're able to do that. Because like you said, our caseload's more manageable, kids get like, they don't have to come to speech, they get to be, if they're in the schools, they get to be in the least restrictive environment. And if they're able to be intelligible, their quality of life will be that much better. So lots and lots of wins with that.
Amy Graham (33:36)
yes.
Yes.
Absolutely.
Marisha (33:58)
yeah, and I'm just so grateful for you, Amy, for continuing to share so generous generously. I'm always super inspired whenever I hear you speak or I get to chat with you on the podcast. yeah, just really grateful for your time and that you're sharing your expertise with us. And I think that's a wrap.
Amy Graham (34:19)
Thanks, Marisha. I really appreciate it. Thanks for having me back on. It's been fun.
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