SThis document describes the appropriate hierarchy of speech therapy for a child after they have received surgery to repair their cleft palate.

Cleft Palate Speech Therapy Hierarchy

Download Link: Cleft Palate Speech Articulation Hierarchy

  1. Discrimination. Begin with discrimination between the correct production and the compensatory production (ex. bilabial plosive P production versus a glottal stop)
  2. Single Sounds. Work on the sound in isolation.
  3. Syllables*. Work on the sound in syllables. (Acevedo Spoke: consonant-vowel CV, VCV, VC). E.g. CV-pa, pa, pa, pa, then pa, pe, pi, po, pu, then VC ap, ap, ap, then ap, ep, ip, op, up, then, VCV-apa, epe, ipi , opo, upu.
  4. Words**. Target the sound in words*
    1. Begin with the sound in initial position (first sound in a word)
    2. Then the sound in final position (last sound in a word)
    3. Then the sound in the medial position (middle sound in a word)
  5. Phrases and Sentences. Target the sound in short phrases and then sentences.
  6. Conversation. Target the sound in conversation.
  7. Begin hierarchy again with the next sound on the patient’s therapy plan

* See the Acevedo Spoke video on to learn speech therapy strategies when the child is at the syllable stage

** Use the cleft palate speech therapy books on These books each focus on particular high-pressure oral sounds and eliminate others that are challenging to those with cleft palate speech

NB: Voiceless cognate is generally targeted before the voiced sound of the same manner and place. E.g., target P (voiceless) before B (voiced)

NB: The client must be able to produce the sound with 100% accuracy at one stage on the hierarchy before moving to the next stage.


See below for translations of this information:

ITALIAN: Cleft Palate Speech Therapy Hierarchy