Multiple Oppositions

This approach uses pairs of words that vary on multiple dimensions (voice, place, manner, linguistic unit) to create wide-spread change for the child's phonological system.

Who It's For:

This is appropriate for moderate to severe speech disorder with consistent phonological errors and phoneme collapse (5+ sounds are substituted for 1 sound). Children who are 3-9 years old, have at least 6 sounds in error across 3 different manner classes of sound production. This approach can also be appropriate for children with speech delay-otitis media with effusion and speech sound disorders of known origin (cleft palate, Down Syndrome, etc.).

How It's Practiced:

Contrast a known sound with 2-4 unknown sounds. The inventervention process will include the following phases: familiarization, imitation, independent production in play/drill-play, and conversation.

Target selection

  • Maximal Classification: Different in manner of production, place of production, voicing and linguistic unit (single sound vs. cluster).
  • Maximal Distinction: Maximally different from the child’s error substitute.
  • Consider frequency that target appears in English language.

Goal Attack Strategy

  • Horizontal = simultaneous
  • Vertical = sequential
  • Cyclical = rotating


Phase 1: Familiarization and Production of Contrasts

  • Introduce the rule, target sounds, picture stimuli and vocabulary. The rule will focus on the phoneme collapse being targeted. You will teach the child about sounds using child-friendly terms (long sound, short sound, buzzy sound, etc.). Remember to include the written word with picture, highlight written word to draw child’s attention to it. You usually spend 1 session here.

Phase 2: Production of the Contrasts and Interactive Play

Step 1: Focused Practice (Imitative Productions)
  • The child will repeat your productions. You will provide support as needed. Support can include but is not limited to: simultaneous production, shadowing child’s production, comparison word followed by target word. You will begin to fade support once the child reaches 40-50% accuracy. The goal is for the child to produce targets with 70% accuracy in 20 to 30 responses for 2 consecutive sessions to move to phase 2.
Step 2: Focused Practice (Spontaneous Productions)
  • The child will produce targets spontaneously. Begin the session with a drill activity then use naturalistic play activities at the end of the session. Naturalistic play usually focuses on the target word (choose the target word that is most difficult). If child produce target inaccurately, SLP provides 3 models in sentences then encourages child to try it. This activity should last 5-8 minutes with about 20 elicitations from child. The child must produce targets with 90% accuracy in 20 to 30 responses for 2 consecutive sessions to move to phase 3. The majority of the treatment approach will be spent in Phase 2.

Phase 3: Production of Contrasts within Communicative Contexts

  • You will engage in turn-taking play-based activities. You will provide feedback for inaccurate production by showing confusion or repeating inaccurate word back to the child to give them to opportunity for correction.

Phase 4: Conversational Recasts

  • You will engage the child in conversational activities. When a child produces an inaccurate production you will repeat the inaccurate production to give the child an opportunity to correct.

Checking for Generalization

  • You will have a list of 10 untrained words with the target sound in the same position. When the child obtains 90% accuracy on the untrained targets, a conversational speech sample will be obtained. There should be frequent opportunities to target the sound. When the the child produces the target sound in their conversational speech with 50% accuracy, you will no longer treat that sound.

Download Multiple Oppositions Handout Here


3 sessions per week, aim for 50+ trials per session for 10 weeks.


Lee, S. S. (2018). The treatment efficacy of multiple opposition phonological approach via telepractice for two children with severe phonological disorders in rural areas of West Texas in the USA. Child Language Teaching and Therapy.

Storkel, H. L. (2022). Minimal, maximal, or multiple: Which contrastive intervention approach to use with children with speech sound disorders? Language, Speech, and Hearing Services in Schools, 53(3), 632–645.

Williams, A.L., & Sugden, E. (2021). Multiple Oppositions Approach. In Interventions for Speech Sound Disorders in Children (2nd ed., pp. 61-90). essay, Paul H. Brookes Publishing Co.