Implementing the Cycles Approach in Speech Therapy Sessions

Cycle's Approach Background:

• This approach was developed by Hodson and Paden (1983, 1991).  Phonological patterns are trained in succession during specific time periods known as cycles.  This approach is based on principles of developmental phonology, cognitive psychology and research in phonological acquisition.
• Each phoneme (e.g. Final K) within a pattern (e.g. Velars) is targeted for 60 minutes a week.  
• This can be one session a week that is 60 minutes in length, two 30 minute sessions or three 20 minute sessions etc. 
• Patterns are recycled as needed until they emerge in conversation.  There are multiple patterns targeted per cycle.
• No pre-determined level of mastery for phonemes or patterns within each cycle.  Children don't have to reach 80% accuracy of any phoneme to move onto the next pattern or cycle.
• Cycle one is 6-18 hours – phonological assessment is performed at the end of each cycle.
• Typically 3 or 4 cycles (30-40 hours) are required for clients with extremely disordered phonological systems to become intelligible.
• At least two exemplars of the pattern should be presented in two consecutive 60 minute time intervals before moving on to the next pattern or phoneme.  (e.g. If Final Consonant Deletion is the target pattern, complete 60 minutes targeting Final T and 60 minutes targeting Final P).

In Cycle 1, all patterns determined from the assessment are presented consecutively.  This cycle contains between three and six different patterns of phonemes. Target one pattern intensively for a fixed time then move onto the second pattern (even if the child has not mastered the initial pattern or error sound), then moving on to the third pattern and so on until all initial primary patterns of error have been worked on, marking the completion of one cycle.
Cycle Example (30 minute sessions 2x a week)
Targets: 
Final Consonant Deletion: CVC Final Nasals: Final M (Session 1 & 2), Final N (Session 3 & 4). CVC Final Voiceless Stops: Final P (Session 5 & 6), Final T (Session 7 & 8).
Fronting: Final K (Session 9 & 10), Initial K (Session 11 & 12), Initial G (Session 13 & 14)
S blends: SP Initial cluster (Session 15 &  16), SM cluster (Session 17 & 18).

Goal of the Cycles Approach:

• Expedite intelligibility gains in a short amount of time so that children can be intelligible in time to succeed in school.
• The Cycles Approach is meant to reflect the way phonological development typically occurs in young children, as a gradual process, mastering early developing patterns initially.

Ideal Candidates for Cycles:

• Severe to profound speech sound disorders are ideal candidates
• Children who exhibit extensive omissions, substitutions and limited or restricted consonant repertoires
• Children with a lot of phonological error patterns for whom minimal pairs or other approaches are not working.
• Children who are hesitant and not risk-takers.  It is not as challenging to work on stimulable sounds.​

Choosing Targets:
The order of phonological patterns within cycles is based on developmental and clinical phonology research findings and on each individual's phonological abilities.  Remember, we are not targeting individual phonemes, but rather entire sound patterns.

The clinician should select the client’s most stimulable sounds or patterns, so that the child can experience immediate success.  Stimulate any non-stimulable sounds for a few minutes during sessions until they become stimulable (& always facilitate liquids if they are not stimulable).

The targeted patterns within the cycle are used to stimulate emergence of a specific sound or pattern in spontaneous language, not mastery of it.  Target only those that are consistent deviations and errors that occur at least 40% of the time.

Primary First Cycle Targets:

• Syllableness: Target omitted segments – compound words, two and three syllable words, equal stress word combinations such as cowboy, cowboy hat, elephant.  Remember the focus is on marking syllables.  If the child says eh-phant for elephant, this is not marking all the syllables.  If the child says "eh-wa-bint", this is correctly marking all three syllables (it doesn't matter that certain phonemes are not produced correctly).
• Word initial singleton consonants (Initial Consonant Deletion): begin with CV words starting with /p,b,m,w/ sounds.
• Word final singleton consonants (Final Consonant Deletion): begin with VC structures starting with /p t k m n/ sounds (don’t target final voiced stops).
• Other word structures CVC and VCV words.
• S clusters (Cluster Reduction): Begin with word initial sp, st, sm, sn and then word final ts, ps if difficulty with all S blend words. Add /s/ to consonants that child already produces, if they produce /b/ or /p/ then target /sp/ blends etc. Incorporate phrases after word level, usually on third cycle. This is only for omissions not for substitutions or distortions of s blends.
• Posterior and anterior contrasts (Fronting and Backing): For children who are fronting, begin with word final /k/, then initial /k/, /g/ and/or /h/ (never final g).  For children who are backing, begin with word final /t/, then initial /t/, /d/ and possibly /n/.
• Liquids (Gliding): If absent, these phonemes should be stimulated during each cycle. Stimulate word initial /l/ first (preceded by week of tongue tip clicking) and then word initial /r/ (suppress gliding and exaggerate and prolong the vowel rather than the /r/). Don't blend initially. Incorporate /kr/ and /gr/ when child has velars, typically by third cycle.

Secondary Target Patterns:

• Reassess and recycle primary patterns as needed before progressing to secondary target patterns.
• Only move to secondary targets after establishment of early-developing phonological patterns, contrastive use of velars/alveolars, emergence of /s/ clusters in conversation and suppression of gliding while producing liquids in carefully selected production practice words.
• Target any secondary patterns that are still consistently lacking and problematic.  Incorporate minimal pairs whenever possible.
• Voicing Contrasts/prevocalic only 
• Palatal /j/ then Palatal Sibilants /sh/
• Singleton Stridents (Anterior) /f/ and /s/
• Consonant Clusters such as glide clusters, medial CC sequences (e.g. Mustard)
• Other Consonant Sequences (e.g. gold, straw)
• Word-Medial Consonants
• Postvocalic/Syllabic /r/
• Assimilations
• Vowel Contrasts
  
• Any remaining idiosyncratic deviations
  

Advanced Target Patterns:

• These are for upper elementary children with intelligibility problems.
• Complex Consonant Sequences (e.g. Pumpkin, Extra).
• Multi-syllabic Words (e.g. Evacuation).​

Session structure:

1. Auditory bombardment with amplification: ~30 seconds or 15-20 words that contain the target pattern for this  session.  Child does not repeat words here, just listens. Child then names a few potential practice words using amplifier with microphone near child’s mouth.
2. Target word cards/familiarize child with the targets for this session: The client draws, colors or pastes pictures of familiar 3-5 target words on large index cards, during this phrase the child repeats the words modeled by the clinician.
3. Production practice through experiential play: Taking turns (5 reps a turn) naming the pictures while clinician provides cues – we want 100% success on the target patterns.
4. Stimulability probes: Child’s stimulability is assessed for potential targets for the next session.  If s clusters are next, child is asked to model several words that contain different s clusters. The most stimulable s cluster is then targeted the next session.
5. *Also include Metaphonological tasks like rhyming, onset, rime, syllable segmentation etc in practice. This is often increased during final cycles. (e.g. Target word: /cap/ -> work on rhyming words by having child choose the correct one from stop, moon, map).
6. Auditory bombardment step: Repeated
7. Home program: 2-5 minutes a day, parent reading the week's listening list and the child names the picture cards of the production practice words. Parent can also read listening list and have four line rhymes. After several readings, the parent pauses so the child can fill in the rhyme word.

Typical Metaphonological Development:
3 & 4 year olds (Rhyming and Alliteration, Segmentation, Blending and Manipulation of words and syllables as well as phoneme and grapheme awareness)
5 & 6 year olds (Onset/Rime and Blending, Segmentation, Blending and Manipulation of phonemes as well as grapheme and phoneme correspondence).

Important Components of Cycles:
Focused Auditory Input: 

1. It's important to incorporate auditory stimulation with slight amplification because typically hearing individuals acquire the adult sound system primarily through listening. 
2. It's also important so that children become aware of the acoustic characteristics of sounds they are not yet producing and also how their own error productions sound.

Facilitative Contexts: 

1. Facilitative phonetic environments are very important! Monosyllable words are optimal. Choose words in which the only potential error is the target.  (e.g. Do not use the word Chick for a Final K target if the child is unable to produce the /CH/ sound or Don't use the word Cat for those children who are fronting since it contains their error sound).  Object and action words are preferred.

Optimal Match:

1. Target words in child's lexicon.
2. Avoid selecting words with consonant at same place of articulation as substitute.
3. Don't target aspects that peers are not fully producing.
4. Don't target word final voiced obstruents (b, d, z, g).
5. Don't target unstressed weak syllables (e.g. banana, refrigerator).
6. Don't target voiced and voiceless TH.
7. Don't target "ing" such as in the word "going".
8. Don't target vocalic L such as in the word "ball".

References:
Rudolph, J.M. and Wendt, O. (2014). The efficacy of the cycles approach: A multiple baseline design. Journal of Communication Disorders, 47, 1-16.

Evaluating and Enhancing Children's Phonological Skills; A Systematic Approach by Barbara Williams Hodson, PhD, CCC-SLP CEU

Bauman-Wängler, Jacqueline A. Articulatory and Phonological Impairments: A Clinical Focus. Boston: Pearson, 2012. Print.

Williams, A L, Sharynne McLeod, and Rebecca J. McCauley. Interventions for Speech Sound Disorders in Children. Baltimore: Paul H. Brookes Pub, 2010. Print.