The Phonological Understanding: Modified cycles Approach (PUMA) program is designed for students in grades PK-2 with highly unintelligible speech due to a speech sound disorder characterized by many phonological impairments. These students are hard to understand, as they have profound difficulty forming the sound patterns used to communicate verbally. PUMA aims to help these students rapidly increase their speech intelligibility and subsequently improve their ability to succeed in school.

The PUMA program is a modified version of the Cycles Phonological Remediation Approach (Hodson & Paden, 1983) that has been shown to facilitate significant improvement in students with moderate to severe speech sound disorders (Bishop & Adams, 1990). PUMA’s structure follows the developmental sequence of sounds (Figueira, 2019) and is organized by phonological process. Speech-Language Pathologists (SLPs) can tailor their use to individual student needs with the language sample and process-specific stimulability probes. PUMA’s lessons include repeated and varied exposure to correct productions, speech sound production, and the development of metaphonological skills.

Individual phonological lessons are systematically provided in various formats which are engaging for students. These lessons include motivational activities, review, auditory discrimination, and metaphonological activities, which help students to be more successful on literacy tasks (Gillon, 2017), with the overarching goal of accurate sound production to increase speech intelligibility.

Students are guided through lessons designed to be completed in sequential order, that focus on the following components: Production Practice, in which the student practices the target words for the phonological process in drill activities; Auditory Bombardment, in which the student is auditorily exposed to the target words; Production Practice Again, in which the student practices the target words for the phonological process in drill activities again; Motivational Production Practice, which consists of fun sound-loaded scenes for production practice; Metaphonological Activity, which builds the student’s phonological awareness skills; and Auditory Bombardment Again, in which the student is auditorily exposed to the target words again.

The PUMA program is a modified version of the well-researched Cycles Phonological Remediation Approach (Hodson & Paden, 1983) that has been shown to facilitate significant improvement in students with moderate to severe speech sound disorders.

The prevalence of speech sound disorders (SSDs) in young children is 8 to 9 percent of the population (ASHA, 2020). SSDs impact the largest percentage of school-age children on a Speech-Language Pathologist’s caseload (ASHA, 2020). Implementation of the cycles approach has been successful for children with recurrent otitis media (Churchill, Hodson, Jones, & Novak, 1988), children with cochlear implants (Hodson, 2001), children with apraxia (Hodson & Paden, 1983), children with repaired cleft palate (Hodson, Chin, Redmond, & Simpson, 1983), children with mild-to-moderate (Gordon-Brannan, Hodson, & Wynne, 1992), and individuals with cognitive delays (Buchsbaum, Baldo, Okada, Berman, Dronkers, D’Esposito, & Hickok 2001). Children with severe to profound SSDs are ideal candidates for the cycles approach (Hodson, 2010), where the aim is to expedite intelligibility gains in time to succeed in school (Bishop & Adams, 1990).

The goal of the Cycles Phonological Remediation Approach is to enhance and promote the accuracy and consistency of speech sounds and patterns within a cognitive linguistic framework. Children have been found to demonstrate greater gains when stimulable sounds are targeted; therefore, working on stimulable sounds is the central tenet of the cycles approach. Nonstimulable sounds are presented during each session but not targeted until the child can produce the sound because practicing an error sound reinforces an inaccurate kinesthetic image. This program focuses on targeting carefully selected earlier and later developing sounds (e.g., stops, consonant clusters, liquids). Focusing on more stimulable sounds and pairing them with optimal and achievable more complex or later developing sounds and patterns (e.g., clusters, liquids), is a critical and important component of the cycles approach (Williams, 2021).

The Cycles Phonological Remediation Approach aims to increase the intelligibility of the student by cycling through stimulable sounds. Cycling through multiple sounds increases speech intelligibility, and may encourage new sounds/patterns to emerge. A cycle is completed after each of the phonological patterns that need to be targeted during a cycle has been facilitated. The duration of each cycle depends on the number of deficit patterns and the number of deficient sounds in each pattern that is stimulable, typically 10-15 weeks (Williams, 2021).

Each phoneme (e.g., final /k/) within a pattern (e.g., velars) is targeted for 60 minutes a week, (i.e., one 60-minute session, two 30-minute sessions, or three 20-minute sessions per week) (Williams, 2021), then another phoneme for that same pattern, then the next pattern, etc. (Bowen, C., 2013) Patterns are recycled as needed until they emerge in conversation (Williams, 2021).

When targeting a phonological pattern it is recommended to target at least 2 examples of that phonological pattern. About 2-6 patterns are recommended to be targeted each cycle-- cycle 1 is about 6-18 hours. Typically 3 or 4 cycles (requiring approximately 30-40 hours) are required for clients with extremely disordered phonological systems to become intelligible (Bowen, 2013). The goal in the cycles approach is 100% accuracy for all target productions so that the child can develop a new, accurate kinesthetic image (Williams, 2021).