The Multiple Oppositions Approach (MOA) is an evidence-based intervention designed to treat children with phonological disorders, which are characterized by speech sound errors that follow predictable patterns. Unlike simple articulation errors, these disorders involve difficulty with the sound system’s rules, leading to a breakdown in communication. MOA is a type of contrastive therapy that reorganizes the child’s entire sound system by highlighting how their error patterns cause words to lose their distinct meaning. This approach confronts the child with the consequences of their sound substitutions in a structured and systematic way.
Foundational Principles of the Approach
The core philosophy of the Multiple Oppositions Approach is systemic change, not just the correction of a single sound. MOA simultaneously addresses an entire group of errors the child makes rather than targeting one sound error in isolation. The approach is rooted in the linguistic principle that speech sounds must maintain contrast to differentiate meaning between words. When a child substitutes one sound for many, they lose this contrast, a phenomenon known as homonymy.
MOA is an adaptation of minimal pair therapy, expanding the concept by contrasting the child’s error sound with several target sounds at once. This strategy accelerates progress by teaching the child that multiple different sounds must be used to create multiple different meanings. By confronting several different sounds simultaneously, the goal is to induce multiple phonemic “splits” in the child’s sound system, thereby reducing the use of homonyms.
Who Benefits from Multiple Oppositions?
The Multiple Oppositions Approach is intended for children who demonstrate severe to profound phonological impairment. This severity is characterized by significantly reduced speech intelligibility, meaning unfamiliar listeners can understand little of what the child says. The defining characteristic that makes a child a suitable candidate for MOA is the presence of an extensive phoneme collapse.
A phoneme collapse occurs when the child uses a single sound to replace multiple different target sounds from the adult language system. For instance, a child might consistently use the sound /t/ (like in “tea”) in place of /k/, /g/, /s/, and /ʃ/. This results in many words sounding the same, severely restricting the child’s ability to communicate effectively. If a child only has a few isolated sound errors, MOA is typically not the most appropriate intervention, as the approach is designed to reorganize a widely disorganized system.
Selecting the Oppositions
Target selection is a defining aspect of the Multiple Oppositions Approach, relying on the principle of maximal opposition or a distance metric. The clinician first identifies the child’s phoneme collapse—the single sound the child uses to substitute for the largest number of target sounds. The intervention then targets two to four sounds that the child is not producing, all of which are part of that collapse.
These target sounds must be chosen because they are maximally different from the child’s substitution sound across three dimensions: place of articulation, manner of articulation, and voicing. For example, if a child substitutes the sound /d/, a clinician would seek target sounds that differ significantly in these features, such as /ʧ/ or /s/.
The goal of this strategic selection is to introduce the greatest possible change into the child’s sound system, promoting system-wide generalization. By teaching the child the most distant contrasts first, the approach attempts to encourage learning a broader range of distinctions. This creates a treatment set where the child’s error sound is contrasted with the multiple chosen targets simultaneously, often using word sets of three to five items.
The Therapy Process
Once the maximally opposing target sounds are selected, the therapy process moves through a structured sequence, beginning with intensive practice to establish the new contrasts.
Familiarization and Production of Contrasts
The clinician introduces the target words and explains how the different sounds change the meaning. The child practices imitating the target words, and feedback focuses on the communicative function of the sounds.
Spontaneous Production
The child is asked to produce the words without the clinician’s model. Contrastive minimal sets are used in structured activities, often through games that highlight the communicative breakdown when the error sound is used. For instance, if the target set contrasts “toe” with “key,” “chew,” and “shoe,” the child must use the correct sound to pick the right picture or object. Progression relies on achieving specific accuracy criteria, such as 70% correct imitation across two successive sets before advancing.
Spontaneous Contrasts
This phase integrates the target words into more naturalistic, interactive play activities, shifting the focus from drill to functional communication. Achieving 90% accuracy in spontaneous production across two sessions is often the benchmark for advancing.
Generalization
This final phase focuses on encouraging the child to use the newly learned sounds in conversational speech outside of structured therapy tasks. Therapy on a specific target is typically discontinued when the child reaches a predetermined level of accuracy, such as 50% correct production in unprompted conversation.