The book, Normal Speech and Speech Deviations (Travis, 1931) contained just one paragraph on articulation therapy and an appendix containing a list of initial–medial–final-sound production practice words. Although ‘the Travis Handbook’, as it was affectionately or even reverently called, offered a minuscule contribution as far as articulation therapy was concerned, it was highly regarded as a standard text, providing outlines of the neurophysiological bases and clinical subtypes of fluency, articulation and voice problems and aphasia. Uninfluenced by linguistics theory of the day – the Linguistic Society of America was founded in 1924 – Travis presented a view of disorders that had the speech sound (or segment) as the basic unit of speech. There was a hopeful sign in the same year that more was to come when Wellman, Case, Mengert and Bradbury (1931) reported on the development of ‘speech sounds’ in young children. Publications by other American SLPs soon followed with such revealing titles as: The Rehabilitation of Speech (West, Kennedy, & Carr, 1937), Reading, Writing and Speech Problems in Children (Orton, 1937), and Children with Delayed or Defective Speech: Motor-Kinesthetic Factors in Their Training (Stinchfield & Young, 1938). Robert West (1892–1968) wrote the first section of West, Kennedy and Carr (1937) and introduced information about articulation difficulties due to oral deformities and hearing impairment. Speech remediation suggestions in the second half of the book included muscle relaxation, non-speech oral motor exercises (NS-OME), phonetic placement strategies and drill.

Another flurry of influential ‘child speech’ speech pathology publishing activity between 1939 and 1943 started with the first of the nine editions of Speech Correction: Principles and Methods (Van Riper, 1939). Charles Van Riper (1905–1994), who had a doctorate in clinical psychology and no formal SLP qualification, emphasised the significance of social context on the day-to-day experience of speech-impaired individuals, with portents of the ICF-CY (McLeod, A1). His social perspective is revealed in his famous definition: ‘Speech is defective when it deviates so far from the speech of other people in the group that it calls attention to itself, interferes with communication, or causes its possessor to be maladjusted to his environment’ (Van Riper 1939, p. 51). Van Riper’s cultural sensitivity and inimitable insight into what he called the ‘penalties’ of communication impairment may have stemmed from his intrapersonal and interpersonal experiences of stuttering. Discussing what people with communication ‘differences’ might make of their social situations, and what they might perceive others to read into their symptoms, he wrote, ‘The difference in itself was not so important as its interpretation by the speech defective’s associates’ (p. 66). He reflected sourly on the likely reactions of the said associates, writing: ‘Personality is not merely individuality but evaluated individuality’ (p. 67). So intensely important was the social level for Van Riper that he recommend trainee speech correctionists undertake assignments, such as lisping for a day, to develop empathy for individuals with speech difficulties and a deeper appreciation of their emotional landscapes. The social aspect was present in his intervention advice, too, when he suggested that correctionists should work with teachers and parents in pursuing therapy goals.

Paradoxically, although Van Riper espoused and sustained a sincerely held social view of speech impairment and of disability, his speech intervention approach—classically referred to as ‘Traditional Articulation Therapy’ or, slightly tongue-in-cheek, ‘Van Riper Therapy’—could never have been regarded as communication focused. He incorporated many disparate elements in an atomistic array of peripheral procedures that included stimulus–response routines; sensory training that he called auditory stimulation comprising auditory discrimination, ‘ear training’ and auditory sequencing; and production drill. These all became part of an auditory–phonetic (or sensory–motor) therapy that is still implemented (Hegde & Peña-Brooks, 2007). In the same productive period, practical manuals, books of exercises, source books and workbooks for the speech correctionist began to appear, replete with word and sentence lists for production practice, listening lists, rhymes, stories, therapy tips, advice and ideas and techniques and activities to be used in speech lessons (Fairbanks 1940; Nemoy & Davis, 1937; Robbins & Robbins, 1937; Twitmeyer & Nathanson, 1932).

Among the techniques that Van Riper did not incorporate into his intervention, but which were gaining in popularity, were the motor-kinesthetic (or motokinesthetic) tactile manoeuvres. Van Riper (1939, pp. 198–201) describes them with heavy sarcasm.

We have previously mentioned the Motokinesthetic Method invented by Edna Hill Young as one of the approaches used in teaching a child with delayed speech to talk. It has also been used in the elimination of misarticulations. Essentially, this method is based upon intensive stimulation; however, the stimulation is not confined to sound alone but to tactile and kinesthetic sensations as well. The therapist, by manipulation and stroking and pressing the child’s face and body as she utters the stimulus syllable, helps him recognize the place of articulation, the direction of movements, the amount of air pressure, and so on. Watching an expert motokinesthetic therapist at work on a lisper is like attending a show put on by a magician. The case lies on a table with the therapist bending over him. First she presses on his abdomen to initiate breathing as she strongly makes the s sound; then to produce a syllable from the patient, her fingers fly swiftly to close his jaws, spread the lips, and tap a front tooth, thereby signaling a narrow groove of the tongue or the focus of the airstream. Then her magical fingers squeeze together to draw out the sibilant hiss as a continuant.

One therapist, when working with a child, used to “draw out” the s, wind it around the child’s head three times then insert it into her ear, thus insuring that it would be prolonged enough to be felt. Each sound has its own unique set of deft manipulations, and considerable skill is required to administer motokinesthetic therapy effectively.

Viewed by the cold eye of the modern speech scientist, many of the motokinesthetic cues seem inappropriate; and a therapist would need sixty fingers and thirty arms to provide sufficient cues to take care of the necessary integration and coarticulation. Moreover, much of our research has indicated that standard sounds are produced in different ways by different people, and that their positioning vary widely with differing phonetic contexts. We suspect that much of the effectiveness of this method is due to its powerful suggestion (the laying on of hands), to its accompanying auditory stimulation, or to the novelty to the situation, which may free the case to try new articulatory patterns. We have used it successfully with some very refractory cases, but we always have felt a bit uncomfortable when doing so, as though we were the Magical Monarch of Mo in the Land of Hocus Pocus.

The release in 1943 of The Defective in Speech (Berry & Eisenson, 1942, 1956) provided an alternative interpretation of what might improve children’s speech production. They guided a swing away from Van Riperian auditory perceptual and ear training, refocusing on auditory memory span and the motor execution component of speech output, in treatment that saw the therapist administering general bodily relaxation procedures and speech musculature exercises. Today, these are generally referred to synonymously as non-speech oral motor exercises (NS-OME), oral motor therapy, oral motor treatment or oro-motor exercises (the more prominent UK term) sometimes called oro-motor work. Apparently ignoring the social context of and consequences for the client of his or her communication impairment, Berry and Eisenson wrote about the mechanism of first-language learning for the first time in the speech pathology literature. They embraced the associative–imitative model (Allport, 1924) from psychology theory, conceptualising speech in linguistic–mentalist terms. But again, these insights were not reflected in their intervention suggestions. Like Van Riper’s, their therapy belied any appreciation of language, and they proceeded from bottom up, starting with tongue, lip and jaw exercises, with stimulation of individual phones, and using phonetic placement techniques and repetitive motor drill.

In her analysis of these inconsistencies, Duchan (2001) highlights the genesis of ‘a familiar trait in our professional development, the theory–therapy gap’, also commenting that ‘a second identifiable gap was between research findings and therapy practices’, pointing to an evident interdisciplinary gap that saw speech pathologists failing to take much advantage of the developmental psychology research that flourished from the 1920s to the 1950s.

SLP/SLT was a young profession when speech sound disorders in children were called ‘dyslalia’ or ‘functional articulation disorders’. In its Terminology for Speech Pathology, the College of Speech Therapists (1959) defined dyslalia as: ‘Defects of articulation, or slow development of articulatory patterns, including: substitutions, distortions, omissions and transpositions of the sounds of speech.’ Almost simultaneously in the United States, Powers (1959, p. 711) defined it, with a different name, using the word ‘functional’ in its medical pathology connotation ‘of currently unknown origin’ or ‘involving functions rather than a physiological or structural cause’. The acronym ‘SODA’ may have been far from Powers’ thoughts when she said, ‘the term functional articulation disorder encompasses a wide variety of deviate speech patterns. These can be described in terms of four possible types of acoustic deviations in the individual speech sounds: omissions, substitutions, distortions, and additions. An individual may show one or any combination of these deviations.’

How interesting it is to find that as early as 1959 SLPs/SLTs in Britain and the United States had an agreed definition and terminology and included the notion of speech patterns when they described speech development and disorders. Nonetheless, it must be remembered that they did so without taking into account speech sounds’ organisation and representation, cognitively. The ‘phoneme’ and constructs like it were the domain of clinical linguistics, and it would not be until 20 years or more after the formulation of the British and American definitions that the beginnings of a practical assessment and ‘therapy connection’ (Grunwell, 1975; Ingram, 1976) would be forged between phonological theory and SLP/SLT practice.

In the United Kingdom and Australia, the name ‘dyslalia’ remained in vogue until the 1960s when the preferred US term, functional articulation disorder, gained currency. The preoccupation of therapists, in the 1960s through to the mid-1970s, with individual sounds in the so-called ‘three positions’ (initial, medial and final), still constituted a strictly phonetic approach to the problem, somehow isolating the linguistic function of speech from the mechanics or motoric aspects of speech. It is enlightening to return to Grunwell’s 1975 critique of contemporary practice and her proposal for a more linguistically principled approach to assessment and remediation than the ones that had evolved from practice in the 1930s.

Functional articulation disorders were graded in severity as mild, moderate or severe. In the severe category were the children with ‘multiple dyslalia’ or ‘multiple misarticulations’ whose speech was generally unintelligible to people outside of their immediate families. It was readily acknowledged that children with severe functional articulation disorders could usually imitate or quickly be taught how to produce most speech sounds (Morley, 1972). In other words, the supposed motor execution problem or ‘articulation’ disorder appeared to reside in the children’s difficulty in employing speech sounds for word production, which they could produce in isolation. Intervention concentrated on the mechanical aspects of establishing the production of individual phonemes, one at a time, context by context.

By defining the problem in articulatory terms and focussing in therapy on speech and accuracy of production, SLPs/SLTs failed to take into account something that they already knew: that speech serves as the spoken medium of language in a system of contrasts and combinations that signal meaning–differences. That is, when children are acquiring the agreed pronunciation patterns of a language and learning the correspondences between articulatory movements and sounds, they are also discovering relationships between meanings and sounds.

In the 1940s and beyond, linguistics theory blossomed in the hands of scholars like Jakobson (1941/1968), who studied child language, aphasia and phonological universals; Velten (1943), who investigated in the growth of phonemic and lexical patterns in infants; and Leopold (1947), who explored sound learning in the first two years of life. These linguistics developments eventually proved highly relevant to practice, but, in and around the World War II period, the profession tended towards physiology, psychology and psychiatry for elucidation, and not linguistics or education. By the 1950s, however, the literature revealed that thinkers knew something more was going on in speech besides auditory, visual and tactile perception and motor execution of sounds. The idea of an inner process or underlying representation as a clinical construct was imminent. Eisenson (1968) talked about symbol formation; Goldstein (1948) and Myklebust (1952) alluded to inner language; and Osgood (1957) used two terms: mediation and psycholinguistic processing.

The linguistic linkage that enticed speech–language clinicians to consider speech disorders in terms of sound systems or patterns came about when researchers in the area of generative linguistics, Chomsky and Halle (1968), expounded distinctive features theory in The Sound Patterns of English, a book so famous and influential in linguistics circles that it is commonly referred to simply as SPE. Contemporaneously, Ferguson (1968) looked at contrastive speech analysis and phonological development (see also Ferguson, 1978; Ferguson & Farwell, 1975; Ferguson, Peizer, & Weeks, 1973). Then, Stampe (1973, 1979) forged another link, but this time in the area of natural phonology, leading most saliently for us to Ingram and his innovative work (Ingram, 1974; 1976) uniquely dedicated to the understanding of disordered speech, and to Grunwell (1975, 1981).

In the 1970s, linguists and SLPs/SLTs were talking to each other about language in general and clinical phonology in particular. Finally, what SLPs/SLTs had perceived as multiple individual errors came to be seen as sound class problems, involving multiple members of those classes.

For two phonologists, Pamela Grunwell and David Ingram, there was a clear mission to help the SLP/SLT profession in the practical application of phonological principles to the treatment of children with ‘phonological disability’; and many clinicians, myself included, devoured every word they wrote! Clinical phonology, according to Grunwell (1987), a British linguist working in the United Kingdom, was the clinical application of linguistics at the phonological level. Ingram (1989a), an American located in Canada at the time, considered that phonology embraced the study of: (1) the nature of the underlying representations of speech sounds (how they are stored in the mind); (2) the nature of the phonetic representations (how the sounds are articulated); and (3) phonological rules or processes (the mapping rules that connect the two). Around the same period in the United States, Stoel-Gammon and Dunn (1985) provided further theoretically principled guidance in a book about assessment and intervention, as did Elbert and Gierut (1986).

From a therapy point of view, the most radical aspect of the new principles was their focus on changing phonological patterns by stimulating children’s underlying systems for phoneme use. There was an apprehensive feeling abroad in the clinical community that, because of the theoretical paradigm shift, therapeutic approaches, intervention goals and therapy procedures and activities should now be different, or at least revamped. Fey (1985, p. 255) answered these concerns and uncertainties in a reassuring article, in which he wrote:

.…adopting a phonological approach to dealing with speech sound disorders does not necessitate the rejection of the well-established principles underlying traditional approaches to articulation disorders. To the contrary, articulation must be recognized as a critical aspect of speech sound development under any theory. Consequently phonological principles should be viewed as adding new dimensions and new perspectives to an old problem, not simply as refuting established principles. These new principles have resulted in the development of several procedures that differ in many respects from old procedures, yet are highly similar in others.

In their response to Q3, Nicole Müller and Martin Ball, both linguists, explore the development of the application of linguistic sciences to speech SLP/SLT practice.

Dr. Nicole Müller received a Master’s degree from the University of Bonn, Germany, and a doctorate from the University of Oxford, England. She has taught at the University of Central England, Birmingham, at Cardiff University, Wales, the University of Louisiana at Lafayette and since June 2014 has been a Professor of Speech and Language Pathology at Linköping University, Sweden. Her research combines interests in clinical linguistics (specifically systemic functional linguistics), dementia and bilingualism, with occasional forays into phonetics, speech disorders and aphasia. She co-edits the journal Clinical Linguistics and Phonetics and the book series Communication Disorders across Languages.

Dr. Martin J. Ball is Professor of Speech and Language Pathology at Linköping University in Sweden. He is co-editor of the journal Clinical Linguistics and Phonetics (Taylor & Francis) and the book series Communication Disorders Across Languages (Multilingual Matters). His main research interests include sociolinguistics, clinical phonetics and phonology and the linguistics of Welsh. Professor Ball is an honorary Fellow of the Royal College of Speech and Language Therapists and a Fellow of the Royal Society of Arts. Among his recent books are Research Methods in Clinical Linguistics and Phonetics: A Practical Guide (co-edited with N. Müller, 2013b) and Phonology for Communication Disorders (co-authored with N. Müller and B. Rutter, Psychology Press, 2010).

In work whose impact was far-reaching, Irene Poole, a speech teacher at the University Elementary School in Ann Arbor, MI, pursuing a doctorate, produced a developmental schedule for phonetic development (Poole, 1934). This was consistent with the prevailing, and persisting, view that intervention for speech impairment should be based on typical developmental expectations of ‘articulatory proficiency’. Other accounts of phonetic mastery criteria have followed, up to the present day (e.g., Templin, 1957; Sander, 1972; Prather, Hedrick, & Kern, 1975; Arlt & Goodban, 1976; Kilminster & Laird, 1978; Smit, Hand, Freilinger, Bernthal, & Bird, 1990; and so on, through to more contemporary summaries of acquisition by Stoel-Gammon (2010) and McLeod (2013)).