Q: Does a client have to be stimulable for a sound, or sound class, before therapy should be initiated?

No. Sometimes we target a phoneme or class for which the client is stimulable. Other times we teach the client a new phoneme or a new sound class for which the client is not stimulable.

For example, the client who cannot pronounce R needs to learn R. He is un-stimulable for R and must learn it. I have worked with hundreds of kids who were completely un-stimulable for their target sounds. That’s the point – they can’t do it. But that’s what therapy is supposed to do – to teach the client to do things he cannot do on his own. The client is not stimulable for his error phoneme, so therapy is designed to make him so.

The concept of “stimulability” has its place in treatment, of course, and it is always discussed in phonological circles. The process of targeting phonemes, or phonological patterns, for which the client is stimulable is a great plan for clients who have multiple sound errors and severe phonological delay. In the midst of therapy, we move toward, or target, phonemes or phonological patterns for which the child is stimulable. And we hold off on phonemes or phonological patterns for which the client does not seem ready. We “go with the flow,” so to speak.

The question is an example of the all-or-none thinking that seems to be creeping in to the practice of speech-language pathology today. It’s not the case that we only work on phonemes for which the client is stimulable. Neither is it the case that we only work on phonemes for which the client is not stimulable. Clinicians make clinical decisions about the course of treatment. Sometimes we work on phonemes for which the client is stimulable, and sometimes we work on phonemes for which the client is not stimulable. It is our call. That is why we are professionals and not technicians. We make professional decisions. We do not follow rigid technical treatment protocols.