Volume 14, Issue 2, November 2019

EBP briefs
A scholarly forum for guiding evidence-based
practices in speech-language pathology

Service Delivery for Children With

Speech Sound Disorders: Evidence for
the Quick Articulation! Model

Elizabeth Roepke, MS, CCC-SLP

Tamar Greenwell, MS, CCC-SLP
Françoise Brosseau-Lapré, PhD, CCC-SLP
Purdue University
EBP Briefs
Editor
Mary Beth Schmitt
Texas Tech University Health Sciences Center

Editorial Review Board

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Emerson College University of Arkansas
Erin Bush Sherine Tambyraja
University of Wyoming The Ohio State University
Angela Van Sickle
Texas Tech University Health Sciences Center

Managing Director
Tina Eichstadt
Pearson
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Cite this document as:

Roepke, E., Greenwell, T., & Brosseau-Lapré, F. (2019). Service delivery for
children with speech sound disorders: Evidence for the Quick Articulation!
model. EBP Briefs, 14(2), 1–9. Bloomington, MN: NCS Pearson, Inc.

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EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

Structured Abstract

Clinical Question: Would a school-age child with speech sound disorder (SSD) benefit
more from individual drill therapy (Quick Articulation!) or traditional school-based group
therapy as measured by improved speech accuracy?

Method: Systematic Review

Study Sources: ASHAWire, Google Scholar, PubMed, and Scopus

Search Terms: speech sound disorder AND service delivery, school-age, intervention
intensity, individual OR group

Number of Included Studies: 5

Primary Results:

1. Individual therapy sessions, at least twice a week, benefit school-age children with
speech sound disorders.

2. A dose of at least 50 trials per target, per session is recommended.

Conclusions: There is limited research on the optimal intervention intensity for children
with speech sound disorders (SSD). The evidence available suggests that high-frequency
(Allen, 2013) individual sessions with a dose of at least 50, but preferably 70 or more,
trials per session (Williams, 2012) may be most effective in treating this population. In
addition, the majority of published studies report intervention intensity of two to three
group sessions a week and an average of 50 perception or 77 production trials per session
(Sugden, Baker, Munro, Williams, & Trivette, 2018). Therefore, we suggest that a Quick
Articulation! model, treating children individually two or three times a week for 50–100
focused trials rather than in groups, may be appropriate for children with SSD. However,
clinical decisions regarding treatment intensity would benefit from further research in
this area.

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Copyright © 2019 NCS Pearson, Inc. All rights reserved.
 Service Delivery for Children With Speech Sound Disorders:
Evidence for the Quick Articulation! Model

Elizabeth Roepke, MS, CCC-SLP

Tamar Greenwell, MS, CCC-SLP
Françoise Brosseau-Lapré, PhD, CCC-SLP
Purdue University

Clinical Scenario Based on student rate of progress and schedule

management, Julie concluded that using a Quick
Julie, a speech-language pathologist (SLP) with 10 Articulation! model for all students receiving speech
years of experience, has just ended her first year in a new
production services should be considered. Julie shared her
position in a K–3 elementary building. She reviews student
data analysis with her school principal and special education
progress over the course of the year and determines the most
coordinator. Although the administration was interested
effective service delivery models for all her students for the
in exploring alternative service delivery models, they were
upcoming school year. Julie provides services to students
apprehensive of the increase in number of times children
identified with speech and language impairments through
the Individuals with Disabilities Education Improvement were pulled out of the classroom and the proposed decrease
Act (IDEIA, 2004) with an Individual Education Program in actual service time. The administration requested further
(IEP) and students receive speech interventions through exploration of research to support serving all speech students
a multitiered system of support (MTSS) intervention using a Quick Articulation! model.
plan. This school year, Julie used two different service
delivery models for speech production services. She used
a traditional approach for children with IEPs for speech Background Information
impairments, treating them twice a week for 30 minutes in Intensity of Service Delivery
a group of three children. She used a Quick Articulation!
service delivery model to treat children with speech sound SLPs make decisions about intervention intensity when
errors through an MTSS three times a week for 5 minutes planning treatment. Intervention intensity components
individually. Julie compared the baseline and quarterly include dose form (e.g., drill activity), dose (e.g., 25 trials),
benchmark data she collected on all students to look for dose frequency (e.g., twice a week), and total intervention
patterns of improvement. Her review of the results at the duration (e.g., 16 weeks). The cumulative intervention
end of the year showed substantially more progress among intensity is the total number of trials performed throughout
the MTSS students who received the Quick Articulation! therapy (Warren, Fey, & Yoder, 2007). In this case, the
services versus those who received group instruction. Quick cumulative intervention intensity is 800 trials (25 trials/
Articulation! students consistently demonstrated increased session x 2 sessions/week x 16 weeks). This paper refers
and sustained gains across all target sounds compared to to a “traditional model” of school therapy: small group
their same-age peers receiving traditional group therapy for pull-out intervention, usually for 30-minute sessions
speech impairment. (Brandel & Loeb, 2011). This traditional model allows
In addition to student progress, Julie considered her SLPs to meet the therapy requirements for high caseloads by
schedule and how to manage her workload. Her scheduled seeing multiple children at one time. However, seldom do
time for three students in a Quick Articulation! model children’s schedules allow for the group to focus on a single
three times a week is 45 minutes. Her scheduled time for a target. Often, children with phonological disorders may
group of three twice a week for 30 minutes is 60 minutes. be seen together with children who have language goals,
When applied over multiple groups, this reduction in time and the SLP must focus intervention on only one child at
for current services could allow time for additional student a time. When children with SSD are together in a group,
support services and programming to support student rarely does each child mispronounce the same targets in the
growth and achievement.

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EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

same manner. This service delivery model may not be the models, whether the time spent in therapy or the number
most efficient model for children with SSD because it can of doses was more important for speech outcomes. Julie
keep children out of the classroom more than necessary. used ASHAWire, PubMed, Scopus, and Google Scholar
Nonetheless, school-based SLPs rarely vary the service to search for peer-reviewed articles that would help
delivery options they offer to the children on their caseload her answer her PICO question, using the search terms
because of the challenge of coping with high caseload sizes speech sound disorder AND service delivery, school-age,
(Brandel & Loeb, 2011). intervention intensity, individual OR group. She used
Recent research has found that, not surprisingly, the the following inclusion criteria: (1) the research must be
service delivery intensity used by SLPs differs from the peer-reviewed, (2) the articles must be written in English,
intensity used by researchers. Sugden et al. (2018) compared (3) the population must be school-age children with
the clinical practices of SLPs in Australia with the practices phonological impairments, (4) the research question must
reported in research articles. Sugden et al. (2018) found address intervention intensity, and (5) the studies must be
that most research articles reported two to three sessions in Levels 1 to 3 of the ASHA (2004) Levels of Evidence. She
a week, 30–60 minutes per session, and 100 trials per excluded articles that were expert opinion, surveys of clinical
session. In practice, however, almost half of the Australian practice, and articles that dealt with motor speech disorders
SLPs reported eliciting fewer than 50 trials per session, rather than phonology. She read the abstracts of 13 articles
and the majority reported seeing children for therapy and identified nine that related to her PICO question.
once a week. Similarly, SLPs in the U.K. reported seeing However, she excluded four of these articles from her review
clients once a week and eliciting 10–30 trials per session because they were either surveys of clinical practice or expert
(Hegarty, Titterington, McLeod, & Taggart, 2018). It is opinion.
clear that there is a gap between research and practice when She then scanned the titles of the references in the five
making decisions about intervention intensity for children papers that she read and found an additional six articles
with SSD. with titles related to her PICO question. However, upon
reading the abstracts, she determined that these papers did
not include outcome data relative to treatment intensity
Clinical Question and therefore did not include these in her analysis. Figure 1
As recommended by the American Speech-Language- contains a flowchart detailing Julie’s search for evidence.
Hearing Association (ASHA), Julie formulated a PICO
(population, intervention, comparison, outcome) question
to direct her search for evidence. She identified (1) the Evaluating the Evidence
population, school-age children with SSD; (2) the To evaluate the evidence she gathered, Julie considered
intervention, individual short therapy sessions two to two factors: the level of evidence and the quality of the
three times per week (Quick Articulation! model); (3) the study. Julie first used the Oxford Centre for Evidence-
comparison treatment, group therapy twice per week; and Based Medicine Levels of Evidence rating system (CEBM,
(4) the outcome, speech accuracy. 2009) to evaluate the level of evidence for the five relevant
Julie’s clinical question was: Would a school-age child studies she had identified. CEBM is an evidence ranking
with SSD benefit more from individual Quick Articulation! scheme, with systematic reviews providing the highest
or traditional school-based group therapy as measured by level of evidence and expert opinions providing the lowest.
improved speech accuracy? According to CEBM, if there are consistent Level 1 studies
for a clinical practice, then the findings receive a grade “A”
for providing clinical recommendations. Consistent Level
Search for the Evidence 2 or 3 studies receive a grade “B,” Level 4 studies receive
Julie conducted a systematic review of studies a “C,” and Level 5 or inconsistent/inconclusive evidence
examining service delivery options for phonological therapy receives a “D.”
with preschool and school-age children. She specifically Because the studies used different methodologies and
wanted to find articles that reported improvements investigated different aspects of therapy intensity, Julie
in speech accuracy following different service delivery chose to evaluate each study individually. She used the

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EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

15-question Critical Appraisal of Treatment Evidence rating the relevance of the results for Julie’s patients and practice.
scale (CATE; Dollaghan, 2007) to evaluate the articles for Overall, the review by Sugden et al. (2018) carried a high
quality. The first 10 questions of the CATE scale relate to level of evidence and of validity, supporting Julie’s decision
the validity of the study. These yes/no questions address the to use the findings from this review in her clinical decision-
study design, such as the presence of a control group; the making process.
randomization of group assignment; and measure validity. The second article Julie evaluated, Intervention Efficacy
If 7–10 of these questions are answered affirmatively, then and Intensity for Children With Speech Sound Disorder
that study is said to have compelling validity. A total of (Allen, 2013), was a randomized control trial that compared
four to six affirmative answers classifies a study’s validity outcomes for children receiving different dose frequencies
as suggestive, whereas fewer than four answers of yes of intervention. As a randomized control trial, it received a
classifies a study’s validity as equivocal. Similarly, the last CEBM rating of 1b, suggesting that the findings could be
five questions relate to the study’s importance. A score of incorporated into clinical practice. Allen (2013) randomly
4–5 is compelling importance, a score of 3 is suggestive assigned preschool children with SSD to one of three
importance, and a score below 3 is equivocal importance. groups: (1) received intervention once a week, (2) received
Julie began with the systematic review Service Delivery intervention three times a week, and (3) storybook control.
and Intervention Intensity for Phonology-Based Speech Sound The children in the intervention groups all received the
Disorders (Sugden et al., 2018). Sugden and colleagues same type of intervention, the Multiple Oppositions
investigated 206 studies on phonological intervention approach (Williams, 2010). In addition, each child received
published between 1979 and 2016. These studies were 24 sessions of intervention overall. This study resulted
coded by service delivery model, dose frequency, session in a significant difference between the two intervention
duration, and dose. Findings included that the majority of groups in the outcome measure—the change in percentage
published studies used individual therapy (75.5%) provided consonants correct (PCC) on the Goldman-Fristoe Test
by an SLP (86.8%) between one to three sessions per week of Articulation (2nd ed., GFTA-2; Goldman & Fristoe,
(71.7%) and between 30–60 minutes per session (61.2%). 2000)—transcribed by raters who were blind to the group
The average dose per session was 77 production trials assignment of the child. There was a medium effect size
(range: 23–200) or 51.5 perception trials (range: 10–120). for the difference in PCC change between the intervention
Perception trials were calculated as the number of times a groups. This study received ratings of compelling for both
child completed an input-based teaching episode, such as validity and importance on the CATE, indicating that
raising a wand every time the child hears a target sound clinicians should consider adopting the findings into their
during a story (Sugden et al., 2018). own practice.
According to the CEBM hierarchy, a systematic review Although this study found that higher dose frequency
of randomized control trials receives a rating of 1a, whereas results in improved speech production outcomes, this
a systematic review of case-control studies receives a rating finding only addressed half of Julie’s question. She also
of 3a. Both types of studies were included in the systematic needed to determine how dose, or the number of trials
review by Sugden and colleagues. Because this article was produced in a single session, affects speech outcomes.
not a treatment study, Julie used the Critical Appraisal of Julie then evaluated the article Intensity in Phonological
Systematic Review or Meta-Analysis (CASM; Dollaghan, Intervention: Is There a Prescribed Amount? (Williams, 2012).
2007) to evaluate the review’s validity and importance. This This article reported the results for 22 individual children,
review was clear in its search methodology: search terms, ages 3–6 years, who received speech therapy across three
databases, inclusion criteria, exclusion criteria, and coding different studies. The first study included 14 children and
system were provided. Inter-rater reliability for article examined speech outcomes after 42 or fewer half-hour
coding was high (96.8% and 97.5%). The methodological therapy sessions utilizing the Multiple Oppositions approach
transparency and reliability reported in this systematic (Williams, 2010). The second study included four children
review suggest a high level of validity to the study. However, who received Multiple Oppositions therapy for one target
the review did not conduct meta-analyses of the findings, so sound and minimal pair therapy for a second target sound.
the CASM rated the importance of this study lower than its The third study also included four children and compared
validity. One point in favor of this study’s importance was computer-based intervention and traditional intervention.

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EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

The outcome measure was the change in percentage correct significant improvements on his articulation of /s/ following
of underlying representation. This measure was calculated the intensive therapy. Because the case study lacked a control
based on the child’s performance on the Systematic group and randomization, the CATE rating for validity was
Phonological Protocol (Williams, 2002), which is a 245- only suggestive. The importance was also rated as suggestive
word elicited sample. When comparing the children with because there was not a clear substantial cost-benefit
high outcomes to those with lower outcomes, Williams advantage to a “boot camp” style of articulation treatment
(2012) concluded that these children benefited from a compared to traditional treatment scheduling.
therapeutic dose of 70 trials. Further, a dose of less than 50 Lundeborg Hammarström, Svensson, and Myrberg
trials was limited in its effectiveness. This study received a (2018) reported on an intensive therapy program for a
CEBM rating of 3a, as a systematic review of three case- 4-year-old Swedish boy with severe SSD. This child received
control studies. speech therapy four times a week for three weeks, followed
Although this study directly addressed Julie’s question by seven weeks of break, and then another block of four
of dose intensity, Julie noted some limitations in its times a week for three weeks, for a total of 24 sessions.
validity and importance from the CATE. Overall, the Target words were selected based on the Core Vocabulary
validity of Williams (2012) was suggestive because of approach (Dodd, Holm, Crosbie, & McIntosh, 2006) as
the lack of control group, lack of randomization, and well as nonlinear analysis of the child’s speech. Seven words
lack of blinding. In addition, the article was unclear as were targeted during the first block and 10 during the
to whether the methods and participants were specified second block. The dose used was 30 productions of each
prospectively. However, there were strengths to the validity target word during each intervention session. Following
of this article: the treatment was described clearly, the intervention, the child improved on measures of speech
rationale was plausible, the outcome measure (Systematic accuracy, including percentage consonants correct and word
Phonological Protocol) was valid, and the patients were shape match. However, the article did not report statistical
representative and recognizable at the beginning and end significance for the change in production accuracy, nor effect
of the study. Moreover, the importance of the study was size. For this reason, the CATE rating for the importance of
rated as equivocal because the study did not report statistical this article was equivocal. As in the previous case study, the
significance, power, or effect size. Overall, Julie decided validity was suggestive because there was no control group
that this study was helpful but could not be the sole base of or randomization used. In addition, one possible factor that
evidence for dose intensity. limits the application of these results is the diagnosis of the
The remaining two articles were single case studies, child’s SSD. The authors hypothesized that the child’s speech
each with a single participant and no control. These studies disorder might be caused by childhood apraxia of speech
both investigated whether intensive speech therapy led to rather than a phonological disorder. Treatment approaches
significant gains in speech accuracy. Both studies were rated for these two types of speech disorder differ because of the
at Level 4 according to the Oxford CEBM scale. different presentations of the disorders.
Nissen, Peris, and Tanner (2017) conducted a “boot
camp” treatment for an 8-year-old boy with interdental /s/
production. Treatment occurred over two consecutive days The Evidence-Based Decision
for 5.5 hours a day. No data were provided concerning the Julie began this review by asking which intervention
number of elicited trials. Therapy followed the traditional option is more effective for children with SSD: group
articulation hierarchy: moving up the hierarchy when the therapy or individual therapy. She knows that group therapy
participant reached 90% accuracy at a given level. For allows her to see more children at one time, but she seldom
example, when targeting the sound /s/, the child began by has children in the same group who produce the same error
producing the sound in isolation. When the child reached in the same way. With her high caseload, she is unable to
90% accuracy in isolation, the child then produced /s/ at see each child individually for 30 minutes a session, and she
the syllable level, followed by words, phrases, sentences, and does not want her students to miss more class time than
finally conversation. Audio recordings were taken of a list necessary. Will shorter sessions with a higher number of
of probe words both before and following treatment and trials per session yield better results than longer sessions with
used as the outcome measure. Overall, the participant made fewer trials?

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EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

Julie knew that making an evidence-based decision Williams (2012). Julie will track her students’ progress to
that was appropriate for her caseload involved three factors: confirm whether her target number of trials is appropriate
the scientific evidence, her clients’ individual needs, and for her students, and she will continue to read published
her clinical judgment. Based on her review of the scientific literature and update her approach if future findings suggest
evidence, Julie felt confident in her decision to see children a different number of trials per session is optimal.
with SSD with high dose frequency (i.e., multiple times a For an evidence-based decision, Julie needed to consider
week), because the Allen (2013) study showed that higher the individual needs of her clients and her own clinical
frequency therapy is associated with improved speech judgment. One need raised by the school administration
production outcomes. This study was a Level 1 study was for her students to maximize learning time in the
according to the CEBM rating system and compelling in its classroom. Although the administration was concerned
validity according to the CATE classification. about the possible disruption of the increased number of
However, Julie found less compelling evidence pull-out sessions a week, Julie believed that if the children
regarding the optimal dose, or number of trials, to use in could make the same or better progress in 5–10 minutes of
her therapy sessions. The systematic review by Sugden et intensive treatment as in 60 minutes, they would experience
al. (2018) reported that the average dose in peer-reviewed less disruption by missing less classroom instruction. Julie
studies is 77 production or 51 perception trials. This article noted that the children seen in a group missed class for 60
also referenced a finding from ASHA (2011) that individual minutes a week, whereas those seen individually only missed
therapy leads to better outcomes than group therapy, which class 15 minutes a week. Additionally, an informal survey
Julie found relevant for her own clinical decision-making. of teachers with students who had participated in both
The review of the three studies in Williams (2012) suggested the traditional and Quick Articulation! programs showed
that children with severe SSD benefit most from 70 or more a preference for the more frequent shorter sessions versus
trials per session, whereas fewer than 50 trials per session has the longer times out of the classroom. The teachers agreed
limited effectiveness even for children with moderate SSD. the disruption of missing 5 minutes at a time was minimal
In addition, the two case studies she reviewed suggested compared to missing 30 minutes.
that high-intensity therapy can lead to improvements in Julie’s previous comparison of data for students who
speech accuracy, but these case studies lacked a control for received therapy under the traditional model (groups of
comparison. Therefore, Julie found that the evidence was three children seen twice a week for 30 minutes) with data
more compelling for 50–100 trials per session, depending for those who received the Quick Articulation! service
on the severity of the child’s SSD. Julie noted, however, that delivery (individual sessions three times a week for five
more research is needed in this area to help her make a more minutes) showed that the Quick Articulation! students
informed clinical decision. consistently demonstrated increased and sustained gains
A limitation of Julie’s decision-making process is that across all target sounds. Following her findings on the
the target numbers of trials reported in Williams (2012) importance of dose and frequency versus the length of
were gathered using the Multiple Oppositions approach. service time, Julie further compared individual student
Because Julie does not always use the Multiple Oppositions data by number of trials on target sounds within a session
approach with her students, she had to consider whether and across the week. All students targeted two sounds per
these findings would apply to the children on her caseload. session. The Quick Articulation! students’ production dose
Julie reasoned that the Multiple Oppositions approach was was 50–70 word-level trials on each target per session,
used with a population similar to those on her caseload for three sessions per week. Students in groups produced
and that it shares many features with other approaches she 25–30 word-level trials on each target per session for 25+
uses, such as perception training and word production tasks productions on each target twice per week, a notably smaller
that increase in difficulty with consistent feedback from treatment dose. The Quick Articulation! students produced
the SLP. Beyond these shared features, Julie reasoned that three times as many attempts than their IEP peers. Julie
the systematic review by Sugden and colleagues (2018) attributed the high number of trials per session (dose) and
found that published studies on a variety of speech therapy the number of sessions per week (frequency) as the largest
approaches averaged 77 production trials per session, factors in the rate of improvement difference between the
which aligns with the findings for Multiple Oppositions in two groups of students. Using the Quick Articulation!

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EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

service model would allow all students working on speech Authors’ Note
sounds to achieve 50+ productions per target per session
while receiving an additional session per week. Julie’s data Elizabeth Roepke is a PhD student in speech, language,
review aligned with the research she read about dose and and hearing sciences at Purdue University studying speech
frequency. Therefore, reducing the number of minutes of sound disorders in children.
services will not negatively affect progress as long as dose Tamar Greenwell is a clinical assistant professor in the
and frequency are at recommended levels. Department of Speech, Language, and Hearing Sciences at
Finally, Julie needed to consider how the severity of Purdue University. Her clinical practice and education is in
the speech disorder impacted her decision-making. Julie the identification, evaluation, and clinical management of
decided to apply the findings of the Williams (2012) study speech and language disorders in school-age children.
by eliciting at least 70 trials per session for children with Françoise Brosseau-Lapré is an assistant professor in
severe SSD and at least 50 trials per session for children the Department of Speech, Language, and Hearing Sciences
with moderate SSD. In addition, some of the children at Purdue University. Her research and teaching focus
on Julie’s caseload had concomitant speech and language on speech sound disorders in children and how speech
impairments. The service delivery for these children is perception impacts speech production and interacts with
typically three times a week for 30 minutes a session. For language factors in these children.
these children, Julie would provide SSD services using the Corresponding author:
Quick Articulation! model with an additional 30-minute Françoise Brosseau-Lapré
language group once a week. She will keep data to evaluate [email protected]
whether the Quick Articulation! and weekly language group Purdue University, Lyles-Porter Hall
is sufficient to meet the students’ needs. 715 Clinic Drive
After considering the evidence from the research West Lafayette, IN 47906
combined with analysis of her data and clinical judgment,
Julie will recommend the Quick Articulation! service
delivery approach for all students with SSD to the
References
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Myrberg, K. (2018). A shift of treatment approach 14(5), 456–461. doi:10.3109/17549507.2012.688866
in speech language pathology services for children
with speech sound disorders–a single case study of an
intense intervention based on non-linear phonology
and motor-learning principles. Clinical Linguistics &
Phonetics, 33(9), 518–531. doi:10.1080/02699206.201
8.1552990

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Copyright © 2019 NCS Pearson, Inc. All rights reserved.
EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

Table 1. Selected Research Articles

Oxford CEBM
hierarchy of
Study evidence Participants Intensity Therapy approach Relevant findings
Sugden, Baker, 1a/3a 206 studies published 2–3 sessions/week; 30– Multiple Published studies use
Munro, Williams, between 1979 and 60 minutes/session; 77 individual therapy
& Trivette, 2018 2016 trials/session at high intensity, in
contrast to much
clinical practice
Allen, 2013 1b 54 preschool children 3 conditions: (1) Multiple oppositions Children who received
with SSD Therapy 3x/week for (Williams, 2010) therapy 3x/week made
8 weeks, (2) Therapy significantly greater
1x/week for 24 weeks, gains than those
(3) Control storybook receiving therapy 1x/
intervention week or the control
group
Williams, 2012 3a 22 children ages Varied across Three studies: (1) The most effective
3:7–6:6 participants Multiple oppositions, intensity for children
(2) Multiple with severe SSD is
oppositions and at least 70 trials per
(Study 1: N = 14, minimal pairs, (3) session across at least
Study 2: N = 4, Study Computer-based 40 sessions, though
3: N = 4) intervention and gains were noted for
traditional tabletop moderate SSD with 50
intervention with trials per session across
minimal pairs 30 sessions.
Nissen, Peris, & 4 Single case study, “Boot camp”: 5.5 Traditional articulation Production accuracy
Tanner, 2017 8-year-old male hours a day for 2 hierarchy; target: of target phoneme
consecutive days interdental /s/ improved immediately,
and gains were
generally maintained
at 1 week post-therapy
Lundeborg 4 Single case study, male 4 days/week for 3 Motor learning Improvements in CV
Hammarström, age 4:10 weeks, then 7-week principles with word shape match and
Svensson, & break, then 4 days/ targets selected from PCC after intervention
Myrberg, 2018 week for 3 weeks; nonlinear analysis and
target words were each core vocabulary
elicited 30 times per
session

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Copyright © 2019 NCS Pearson, Inc. All rights reserved.
EBP Briefs Volume 14, Issue 2 Service Delivery for Children With Speech Sound Disorders:
November 2019 Evidence for the Quick Articulation! Model

Literature Search
Databases: Scopus, ASHAWire, PubMed, Google
Scholar
Search terms: speech sound disorder AND
service delivery, school-age, intervention
intensity, individual OR group

13 articles Read titles and

returned abstracts

Apply exclusion criteria

Exclude expert opinion
9 articles related to Exclude survey data of clinical
PICO question practice
Exclude motor speech diagnoses
(CAS, Down syndrome)

5 articles included Review titles in

in review reference lists

No additional
studies found

Figure 1. Process to Select Relevant Research

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