I was recently at a wonderful two-day conference presented by Jennie Bjorem, MA, CCC-SLP and Amy Graham, MA, CCC-SLP. Each clinician spoke for a full day and was incredibly generous in sharing videos of her therapy. Both were engaging, insightful, and showed lovely progress in their clients’ speech.

What struck me most, though, was how different their therapy styles were (activity choices, movement vs. table-based etc.). It reminded me just how much creativity, flexibility, and individuality our field allows, and how many paths can lead to meaningful change.

That idea - that there are many ways to “bake the cake” of successful therapy - is what inspired this reflection.

Two Chefs in the Kitchen

Let's consider this scenario: two clinicians, one with a motor bias and the other with a phonology bias treat the same child with largely predictable error patterns — maybe velar fronting, gliding, or final consonant deletion (or a combination of all three and some extra sound errors just for fun). [Note: In my scenario, these are parallel universes, and the clinicians are not treating the same kid at the same time!]

I will be fully transparent that my own clinical orientation leans towards motor-based therapy through the use of motivating activities and picture books. (I'll save the discussion on picture books for a different day!)

The motor-biased SLP is concerned about jaw instability, limited tongue-tip control, poor back-tongue elevation, and reduced lateral bracing - in short, articulatory control and precision that need motor-based intervention.

She analyzes which speech subsystems are affected, e.g. mandibular control (jaw), labial control (lips), lingual control (tongue), and the integration among them. The motor SLP leans into principles of motor learning, movement cues, tactile prompts if necessary, and carefully structured practice.

The phonology-biased SLP sees a child whose sound system needs reorganization — new contrasts, new rules, a “phoneme map” to tidy up. She considers which phonological intervention is best suited for this child, recognizing that she may change course as needed down the road if a different phonological intervention will better suit the child's needs. She might pull out a cycles plan, minimal pairs, or multiple oppositions.

It’s important to note that neither clinician completely disregards aspects of the other approach. The phonology-focused SLP recognizes that speech is, at its core, a motor act, and that successful therapy requires accurate motor execution of sounds. The motor-focused SLP recognizes that speech exists as the vehicle of language - a phonological, rule-based system.

In other words, the difference between the two approaches is less an either/or and more a how much of which.

From a parent’s perspective, the sessions might not even look that different. Both clinicians build good rapport, use motivating activities, high-intensity practice, suggestions for home practice, and the expertise to know when to scaffold and when to fade.

If - for argument's sake - both children make significant demonstrable progress in a similar timeframe, how does this happen?  

Now, of course, we don't really have a parallel universe to test the scenario, but we have all seen amazing clinicians with differing styles, approaches, priorities and considerations make great gains with clients. What could explain this? 

The Ingredients of Success

Maybe the magic lies not in which recipe we use, but in the ingredients that both share:

• Principles of motor learning - the flour of every good session. Repetition, variability, feedback, and gradual fading of support. These are well-documented pillars of motor learning that underpin successful change in speech production (Maas et al., 2008). It’s worth recognizing that many phonological approaches already weave these same ingredients into their sessions - often without labelling them as such. When clinicians use repeated word sets, vary exemplars, provide feedback that gradually fades, or prompt children to self-monitor, they’re applying the principles of motor learning that drive skilled movement change. In other words, phonological therapies may (possibly purposely or possibly inadvertently) contain the flour that makes the cake rise. 
• Motivating, meaningful activities - the sugar that keeps the child engaged and willing to try again. The OPTIMAL theory of motor learning (Wulf & Lewthwaite, 2016) - fantastic article, btw - incorporates a large body of research showing that learning is strongest when autonomy, confidence, and enjoyment are prioritized. Though the article focuses on motor learning, these aspects can easily be seen as part of both motor- and phono- based approaches to therapy.  
• Clinical judgment and adaptability - the eggs that bind it all together. Experienced clinicians fine-tune the level of challenge and feedback, a principle captured in the Challenge Point Framework (Guadagnoli & Lee, 2004). A strong clinician reads the moment, adjusts support, and stays attuned to the child. These are all critical to keeping a session - and the learning - effective and impactful.

Incidentally, all 3 of these "ingredients" correspond neatly with Dollaghan's E3BP framework for Evidence-Based Practice. You can link to the Apraxia Kids lecture I co-presented with  Aubrey Hagopian, MA CCC-SLP  here.

The motor SLP might explain the success in terms of improved articulatory control and stability. The phonological SLP might say the child reorganized their sound system and internalized new contrasts. In the end, both clinicians serve up a delicious cake - they just decorate it differently. 

NB: If you know me, you know I don't cook, and it's possible that I've never baked a a cake in my life. The analogy still stands. 

The Research Slice

Disclaimer: I am not a researcher.  The observations below all come from what I find interesting as a clinician.

While at the conference, several SLPs asked about a recently released article by Namasivayam et al. (2025) that was making a splash. The article - The Articulatory Basis of Phonological Error Patterns in Childhood Speech Sound Disorders - is cutting-edge research that shows compelling evidence that what we describe as phonological error patterns may, in many cases, be rooted in underlying biomechanical or coordinative challenges. The findings are based on a Randomized Control Test (RCT) derived data from a previous study on children with Speech Motor Delay (SMD). 

This article prompted a lively internal conversation among SLPs and researchers on where  the lines between artic/motor vs. phono are drawn with relation to speech sound disorders.

The debate is not new. In the late 80's/early 90's, Fey (1992) challenged the rigid divide between articulation and phonology, describing them as “inextricable constructs” thereby positing these domains as influencing each other, i.e. parts of one integrated bakery rather than separate kitchens. (Thank you to Dr. Tara McAllister for highlighting this article). 

As mentioned earlier, Maas et al. (2008) codified the ingredients we find in both approaches: distributed practice, feedback, variability, and gradual fading of cues - the hallmarks of motor learning that make speech change stick. 

Research from  Gibbon (1999) demonstrated through electropalatography that children with phonological disorders often show atypical tongue–palate contact patterns - direct motor evidence of articulatory underpinnings beneath linguistic labels.  Her concise article offers a powerful counter to the 'puzzle’ example in Fey's article - which posited a phonological explanation for a child's inconsistent errors. Gibbon writes:

One important finding was that standard transcriptions do not reliably detect UGs [undifferentiated lingual gestures], which are transcribed as speech gestures (e.g. phonological substitutions, phonetic distortions) in some contexts, but are transcribed as correct productions in others. In other words, abnormal articulatory gestures underlie a range of targets with different perceptual consequences.

In simple terms what a clinician transcribes as /t/ may not actually be an accurate /t/. As clinicians are relying solely on our own auditory perception, we are missing much of the imprecise lingual movement that may be affecting sounds which we do perceive as incorrect e.g. a lateral /s/ or /ʪ/.   

In their article The dorsal differentiation of velar from alveolar stops in typically developing children and children with persistent velar fronting, Cleland & Scobbie (2021) reinforce Gibbon's work, this time through the use of ultrasound imaging to show that children with persistent velar fronting made gains through increased dorsal-tongue differentiation - a motor shift driving what appeared to be phonological change.

Work from Preston and colleagues further remind us in their biofeedback and ultrasound studies, when we make articulatory movements visible, children gain the consistency and control needed for correct production. 

The studies I've seen such as Lousada's 2013 study that shows phonological approaches as more successful than articulatory ones, have a critical flaw where "the motor" portion of the study is an outdated articulatory approach which targets a single sound at a time as opposed to a more robust motor approach such as PROMPT which considers complete speech sub-systems instead. (See my post on the motor speech hierarchy for more.) 

This is just a sliver of several lines of research that suggest that what we call “phonological errors" are truly unrefined or undifferentiated motor movements, and what we see as "phonological interventions” may owe their success to motor learning processes. In short: the flour really matters - and without it, the cake may not rise.

Reframing Phonology - the Context, not the Culprit

Recognizing the motor basis of many speech-sound difficulties doesn’t mean dismissing phonology. Language structure - the rules and contrasts of a child’s sound system - is the environment in which motor learning takes place.

When a child velar fronts /k/ or /g/ or glides /ɹ/ or /l/, it’s not that they’ve misunderstood English phonology - they can usually hear when someone else says it “wrong.” The issue lies in the execution: the coordinated movements required to achieve the target gesture and the ability to monitor and adjust those movements in real time.

That’s why so many children laugh when I let them "be the therapist" and I intentionally make their error - they recognize the mismatch - but still can’t correct their own productions yet. It’s a feedback-loop issue, not a conceptual one.

And - in my opinion - because we always teach motor skills within the phonological context of the language being spoken, phonology is inherently embedded in every motor-based session. I’m not teaching /l/ using Italian or Russian words to an English-speaking child; I’m shaping the movement patterns needed for /l/ in the English phonological environment.

So phonology is always there as the context - as the cake pan if you will - the meaningful framework - but the chemistry that makes it rise is motoric.

In the end

There are many ways to bake a cake. Whether you lean motor or phonological, your expertise, responsiveness, and the incorporation of principles of motor learning matter most.

While the research hasn’t yet neatly sifted apart how much of our therapy success comes from phonological insight versus motor learning, what is increasingly clear is that the motor element is critical and non-negotiable.

Let's continue learning from one another - and keep our eyes (and ears) on the prize - the unique individual communication skills of the child in front of us. 

Author’s note

Elements of this article were refined using AI-assisted writing tools to enhance readability and organization. The conceptual framework and interpretations reflect the author’s own professional perspective.

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