We describe the case of a child with severely unintelligible speech, referred to our clinic after unsuccessful therapy elsewhere. Thomas's speech was characterized by deapicalization and velodorsal articulations, together with hypernasality. Unusually, Thomas was also able to produce a small number of items normally. His speech was investigated by videofluorography as previous impressionistic transcription had been inconclusive. Thomas's history suggested that these speech characteristics were learned behaviour, adopted because of irritation in the upper oro-pharynx. Previous therapy had concentrated on articulatory drills with little success. A new strategy of a contextually embedded, meaning-based approach to speech remediation was undertaken, and within a short time Thomas was using mainly intelligible speech with age-appropriate phonological patterns.