Information Handout- Professionals

Multiple Oppositions Therapy

What is Multiple Oppositions?

ASHA describes the Multiple Oppositions Approach as:

o a variation of the minimal opposition contrast approach that uses pairs of
words contrasting a child's error sound with three or four strategically
selected sounds that reflect both maximal classification and maximal
distinction (ASHA, 2017).
This approach is used to help a child identify and distinguish meaning through
contrastive phonemes. This includes targets that are maximally different fronm each
other in terms of place, manner, and voicing. These can include non-words.
o Example: tie sigh, pie, hi, and bye

Which client would likely benefit from this approach?

Research has indicated that children with a speech sound disorder (moderate to
severe) between the ages of 3 and 6 years old are good candidates for this
approach. These children may present with a limited sound inventory and significant
phonological delay. These children may be substituting multiple sounds with a single
sound, which is often referred to as phonological collapse (for example: /t/ for /s/,
/h/, /tr/, and /k/). As well, reading difficulties may be observed in these children.

What are the components of this approach?

Multiple Oppositions Therapy is a comprehensive approach that typically is

completed 2x/week for an average of 30-45 minutes. Depending on the severity of
the phonological errors the client is exhibiting, the time available, and how frequently
you can see the client-- the number of sessions may range from about 21 to 42
sessions. The multiple oppositions approach uses a criterion of mastery to move
the child through the program and is broken down into 4 active phases:
o Phase 1: Familiarization and Production of the Contrasts
Introducing the target sound and having the client produce it several
times
o Phase 2: Production of the contrasts and interactive play
Imitation of productions that move to spontaneous productions in a
play setting
o Phase 3: Production of the contrasts with communicative contexts
Spontaenous productions

Chris Goodman and Amanda Kidd

3rd Year Advanced Speech Sound Disorders
 Emphasis on contrasts of targets in the initial positions of words
o Phase 4: Conversational recasts
Providing immediate auditory feedback of errors for incorrect
productions
Encourages the client to self-correct
Criterions include the following:
o 70% accuracy across 2 sets to move to Phase 3
o 90% accuracy across 2 contrastive sets to move to Phase 4
o Generalization probe using 10 untrained words:
If 90% accuracy is achieved on 10 untrained words, new stimuli is
given and move back to Phase 1.
Parent involvement and home practice is emphasized to help move the client
through the protocol more quickly and encourage generalization.
Therapists should focus on careful data collection through appropriate games, play,
picture stimuli, and word selections that are broken down by initial, medial, and final
positions.

What does the research say about this approach?

The Multiple Oppositions Approach is evidence based. Case studies have indicated
this approach is successful for children with limited sound systems (Williams, 2000).
Research studies show that Multiple Oppositions is more effective than a storybook
approach and that variations in intensity and frequency of the approach still leads to
to overall improvement at the maintenance phase (Allen, 2013). Further research is
needed to examine its effectiveness in a variety of populations and conditions.

Multiple Oppositions encourages wide-spread change to a childs phonological system

and can significantly increase intelligibility.

Clinician Resource:
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935321&section=Treatment

References:

Allen, M. M. (2013). Intervention efficacy and intensity for children with speech sound disorder.
Journal of Speech, Language, and Hearing Research, 56(3), 865-877.

ASHA (2017). Speech sound disorders-Articulation and phonology. Retrieved from ASHA.org.

Williams, A. L. (2000). Multiple oppositions: Case studies of variables in phonological

intervention. American Journal of Speech-Language Pathology, 9(4), 289-299.

Chris Goodman and Amanda Kidd

3rd Year Advanced Speech Sound Disorders