Reimagining Phonological Therapy with the Complexity Approach

Written By: Michelle Altamura, M.S. CCC-SLP TSSLD CAS

Unlocking meaningful change in a child’s speech sound system often requires thinking beyond traditional approaches. The Complexity Approach is an evidence-based method that focuses on teaching later developing sounds before targeting earlier developing sounds, which can lead to faster and broader improvements in speech.

Understanding the Complexity Approach

Although it might seem counterintuitive, starting with complex sounds helps children learn easier sounds more naturally. This approach can lead to more effective and lasting speech improvements, making it useful for both speech therapists and parents wanting to support their child’s progress.

What is Phonological Therapy?

A  phonological approach to speech therapy focuses on patterns of sound errors instead of only working on one sound at a time. This is helpful for children who are not just mispronouncing one or two sounds but are using rules or habits that affect groups of sounds.

Examples of Phonological Patterns

For example, a child might say “tat” for “cat,” “doe” for “go,” and “tup” for “cup”—this is a pattern called fronting (where sounds made at the back of the mouth are replaced by sounds made at the front of the mouth). Another child may say “pane” for “plane”, “top” for “stop”, and “tick” for “stick”— this is called cluster reduction (dropping one sound in a consonant blend).

Phonological therapy addresses error patterns, helping individuals reorganize their speech production of sounds and patterns effectively. This can lead to more efficient and generalized change than working on each sound individually.

Traditional vs. Phonological Approaches

If a child replaces the /k/ sound with /t/ (saying “tat” instead of “cat”), traditional therapy might focus on practicing /k/ in isolation. A phonological approach would look at why your child is saying /t/ instead of /k/, and target that fronting pattern using a variety of words with /k/, not just “cat.” The goal is system-wide change, not just improving one sound. After using the phonological approach, you might see your child reducing their fronting overall, such as accurately producing /g/ along with the /k/.

What Makes the Complexity Approach Different?

The Complexity Approach is a type of phonological therapy that starts with more difficult, later-developing sounds instead of easier, early developing ones. Research shows that teaching complex sounds first can help children learn simpler sounds more quickly through a process called generalization.

Studies indicate that focusing on harder sounds like clusters or late-acquired sounds results in broader improvements across the child’s speech system, even on sounds that weren’t directly targeted. This method may be slower to demonstrate progress initially but often leads to more comprehensive progress.

Who Benefits from Phonological Therapy and the Complexity Approach?

This method is especially suitable for preschool and early elementary children between the ages of 3 and 6 years old, who display moderate to severe phonological disorders, score below the fifth percentile on articulation assessments, are missing five to seven or more sounds, and are unable to produce a specific speech sound or sounds (the “key targets”) correctly, even when given direct auditory and visual models and cues from the therapist. 

Guidance for Clinicians Using the Complexity Approach

Speech Language Pathologists (SLPs) who use the Complexity Approach should first begin by conducting a comprehensive phonological inventory with the child to assess sound production and stimulability. Next, when selecting therapy targets, SLPs should select the most complex sounds by prioritizing: non-stimulable sounds, sounds with low accuracy (0–10%), late-acquired sounds (based on Smit et al. norms), and marked targets identified through implicational universals.

Therapists may use structured practice techniques, starting with drills and cues, using both real and nonsense words in word-initial positions, and should provide consistent feedback and repetition to reinforce learning. Additionally, SLPs must monitor generalization by tracking improvements in both treated and untreated sounds to evaluate whether therapy is creating the broader, system-wide phonological changes.

How Parents and Caregivers Can Support Phonological Therapy

Parents and caregivers can support their child’s speech language pathologist in implementing the Complexity Approach, even outside of the therapy environment.  In fact, the more that a child practices throughout their daily routines, the more likely they are to make progress.

Parents can help their child by talking about “tricky sounds.” This can help children understand that some sounds are more challenging than others and it may be harder for them to say than others, but that is a normal part of learning. Framing speech as a learning opportunity reduces frustration and normalizes challenges, similar to mastering other skills like bike riding.

Encouraging Practice and Reducing Pressure

For example, you might say, “This one’s a tricky sound, and I love how you’re working hard to say it!” It is beneficial to model correct pronunciation naturally and positively rather than correcting every mistake, which helps reduce pressure. For instance, if a child says “tuck,” a parent can respond with “You see a truck! The truck is so cool!” Incorporating target words with tricky sounds into daily routines can reinforce practice in real-life contexts.

During snack time, asking, “Would you like a spoon or a fork?” or on a drive, saying, “Let’s look for a green truck together!” encourages hearing and practicing sounds naturally. Celebrating effort rather than perfection is also important; praising attempts, such as saying, “You really tried that big sound—high five!” builds confidence and emphasizes that trying is as valuable as getting it right.

Final Thoughts on Phonological Therapy

The Complexity Approach offers a research-backed way to treat speech sound disorders. Although it may seem unconventional to start with difficult sounds, this method often results in broader, deeper, and more efficient improvements. As research suggests, targeting complex sounds can help children develop speech skills more quickly and prepare them for school success.

References

Storkel H. L. (2018). The Complexity Approach to Phonological Treatment: How to Select Treatment Targets. Language, speech, and hearing services in schools, 49(3), 463–481. https://doi.org/10.1044/2017_LSHSS-17-0082