New to this topic? Start with our companion article: Atypical Speech Sound Errors in Children: What Brisbane Parents Should Know
So you've read that your child's errors may be atypical rather than simply delayed — the patterns don't follow the usual developmental path, and they're unlikely to resolve without targeted help. (If you're still working out whether that description fits, our companion article unpacks what atypical errors actually look like.)
The natural next question is: what kind of therapy works for these children, and how is it different from the therapy a child with a straightforward delay would receive? That's what this article is for. We'll focus on the approach that the evidence supports for consistent atypical errors, phonological contrast therapy with targets chosen for the atypical pattern, explain why the core vocabulary approach that many parents read about is designed for a different profile, and show why matching the therapy to the profile matters so much.
How Are Atypical Speech Sound Errors Identified?
The general flow of a speech sound assessment — parent interview, sampling, standardised testing with a tool like the DEAP, stimulability, intelligibility rating — is the same regardless of whether we're investigating a delay or an atypical profile. We walk through that whole process in Helping Your Child with Speech Sounds: Assessment and Therapy, so we won't repeat it here.
What's different for a suspected atypical profile is what we're listening for in the analysis. Two things in particular:
Typical vs Atypical Substitutions
When we analyse the speech sample, we're not just noting which sounds are in error — we're asking whether the substitutions follow typical developmental patterns (like fronting or stopping) or whether they are atypical (like backing, initial consonant deletion, or glottal replacement). That distinction is what places a child in a different subgroup of Dodd's classification model, and it directly changes which therapy approach is recommended.
Checking Consistency
The second key question is consistency. If your child says "bottle" three times, do they produce it the same way every time, or differently each time? Children with consistent atypical errors — who always make the same atypical substitutions — respond well to the contrast-based therapy discussed below. Children whose errors are genuinely inconsistent (the word changes from attempt to attempt) have a different profile again, one that calls for the core vocabulary approach, which we cover in Disordered Speech Sound Production. The full four-category Dodd framework sits there as well.
Worth checking before we start. Therapy for atypical errors works best when we know exactly what a child is hearing. If you haven't been to an audiologist recently, that's a great place to begin — it's a simple step that can genuinely change the direction of therapy.
Why Atypical Errors Need Targeted Intervention
As we discussed in our previous article, atypical speech sound errors are unlikely to resolve on their own. But it's not just about waiting — it's about using the right kind of therapy.
The reassuring finding from the research is that children with consistent atypical errors respond well to the same family of approaches used for delays, phonological contrast therapy, as long as the targets are chosen for their specific atypical pattern (Crosbie et al., 2005). What doesn't work is waiting for the pattern to resolve, or treating it sound by sound as if it were an articulation problem, because the difficulty is in the rule the child is using, not in the movement.
This is why the assessment process is so important. The better we understand the nature of your child's errors, the more effectively we can treat them.
Evidence-Based Therapy Approaches
Phonological Contrast Therapy
For consistent atypical errors, therapy targets the rule the child is applying and shows them, through carefully chosen word pairs or sets, that the rule changes meaning. A child who backs ("tea" becomes "key") practises pairs where the front sound and the back sound are the only difference. A child who drops first sounds works on pairs like "all" and "ball" where the first sound is the whole point. Minimal pairs, multiple oppositions and similar contrast methods all belong to this family, and the choice between them depends on how many sounds are affected. Crosbie, Holm and Dodd (2005) found that children with consistent errors made more progress with this kind of therapy than with the core vocabulary approach below.
Core Vocabulary Approach: For Inconsistent Speech
The core vocabulary approach was developed by Professor Barbara Dodd and her colleagues in Australia for children whose speech is inconsistent, meaning the same word comes out differently each time (Crosbie et al., 2005). Parents of children with consistent atypical errors often read about it, so it's worth explaining what it is and why it isn't usually the first choice for a consistent profile.
In broad strokes, a speech pathologist works with the family to choose a set of high-use words that genuinely matter to the child — a sibling's name, a favourite food, a common request — and those words become the focus of carefully structured, repeated practice in sessions. The goal is for the child to produce each word the same way every time, rather than five different ways. Over time, the consistency built with those core words starts to generalise to the wider speech system. It's quite different from traditional articulation therapy: core vocabulary focuses on whole words and the planning behind them, and the choice of words and how they're practised is very much clinician-led — which is why it doesn't lend itself to a DIY version. Across many years of working with children whose speech is inconsistent, I've seen how meaningful it is for a parent to hear a word said the same way twice in a row for the first time. If assessment shows your child's errors are consistent, though, contrast therapy is where we'd start, and we'd explain why.
Other Evidence-Based Programmes for Motor-Based Speech Difficulties
For children whose inconsistency comes from a motor-planning difficulty, childhood apraxia of speech, several structured programmes with research behind them exist, and we go through them properly in Therapy Approaches for Disordered Speech. In short, these include the Nuffield Dyspraxia Programme (NDP3) and Rapid Syllable Transition Treatment (ReST), the latter developed by Professor Patricia McCabe and colleagues at the University of Sydney (Murray, McCabe & Ballard, 2014). These programmes are delivered by speech pathologists who have completed the official training in those specific approaches. If your child's profile suggests motor-planning difficulties, your speech pathologist can help you understand which programmes might be most relevant and refer you to a clinician with the appropriate training where needed.
Combining Approaches
In practice, therapy for atypical speech sound errors often draws on elements from more than one approach, matched to your child's profile. A speech pathologist will choose the approach that best matches your child's error pattern, monitor progress closely and adjust as needed, and weave in phonological awareness where it supports literacy development alongside speech.
Augmentative and Alternative Communication (AAC)
For children whose speech is very difficult to understand — even within their own family — AAC (picture boards, key word sign, communication apps, speech generating devices) can be a powerful part of the plan, sitting alongside speech therapy rather than replacing it. The research is clear that AAC doesn't delay speech — if anything, it supports it — and we've covered the "won't it stop them talking?" worry in more depth over in Therapy Approaches for Disordered Speech. If your child's intelligibility is significantly impacting daily life, it's worth asking your speech pathologist whether AAC might form part of the picture.
Working with Your Speech Pathologist
Therapy for atypical speech sound errors is a collaborative process. Here's what you can expect:
Regular Sessions
How often we see your child depends on the approach we're using and how your child responds, and we review it as we go. Regular sessions matter because they build and maintain the sound-system changes we're working on.
Targeted Home Practice
A speech pathologist will usually send home short, focused practice activities specific to what your child is working on. This is very much "extending session work into the week" rather than parents running the therapy — it's a few minutes of something the clinician has set up with you.
Progress Monitoring
We regularly re-assess to check how your child is progressing and whether the therapy approach is working. If progress is slower than expected, we'll consider whether a different approach might be more effective. Evidence-based practice means being responsive to your child's individual response to therapy, not just following a set programme regardless.
How Long Does Therapy Take?
Children with atypical speech sound errors can need a longer course of therapy than children with straightforward delays, but the label on its own doesn't tell us how long. What does is your child's particular profile, the goals we set together and how they respond once the right approach is in place. Atypical patterns weren't going to resolve by themselves, so there's real work to do; how much is something we can say more about once therapy is under way.
That said, every child is different. Some children respond quickly and make rapid gains once the right approach is in place. Others need more time and more intensive support. We'll give you an honest picture of what to expect based on your child's assessment results, and we'll review progress regularly.
Every child with atypical speech errors has a unique profile, and getting the therapy approach right from the start makes a real difference. If your child's speech patterns don't seem to follow the usual path, we can help you understand what's going on and put an effective plan in place. get in touch — Speaking Speech Pathology offers mobile speech pathology in your home across Brisbane's south side and Logan. Any actual clinical work — assessment, diagnosis, or therapy — happens in a consultation about your child, not from an article.
Alexandra Bouwmeester is a Senior Speech Pathologist (MSPA, CPSP) with over 14 years' experience in paediatric speech sound assessment. She uses Dodd's classification framework to match the therapy approach to each child's profile.
References
- Dodd, B. (Ed.). (2005). Differential diagnosis and treatment of children with speech disorder (2nd ed.). Whurr.
- Crosbie, S., Holm, A., & Dodd, B. (2005). Intervention for children with severe speech disorder: A comparison of two approaches. International Journal of Language & Communication Disorders, 40(4), 467–491.
- Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23(3), 486–504.
