The speech patterns of toddlers and young children can be charming. But enduring speaking mistakes may suggest a speech sound disorder if children don’t outgrow them by a certain age. Knowing the symptoms, diagnostic process, and treatments will help you learn how to support your child in meeting the challenges of a speech sound disorder.

Speech Sound Disorders

There are two main types of speech sound disorders: articulation disorders and phonological disorders. Read on to understand the symptoms and treatments for each.

# Description

Articulation disorders refer to how well a person makes the sounds needed to produce speech. People with an articulation disorder have difficulty precisely and accurately forming specific sounds; may omit or substitute certain sounds for the correct ones; or may alter sounds in ways that make it difficult for strangers to understand their speech.

Children commonly make many of these mistakes when they begin to talk (think of the child who says “wed" when she means “red"), but they typically outgrow these pronunciation errors as they get older; those who don’t may have a speech sound disorder.

Phonological disorders involve patterns of mistakes in producing and manipulating the sounds that make up words. For example, a child may always say sounds that ought to be formed at the back of the mouth at the front, such as speaking t’s for k’s and saying “tat" for “cat." As children’s speech becomes increasingly complex, moreover, those with a speech sound disorder may consistently omit one of the initial consonant sounds in words that should contain two — as in saying “poken" instead of “spoken." While this may be a common and familiar speech pattern in young children, it should not persist as they get older.

It’s important to note that children are not expected to say all sounds accurately when they are just learning to speak, nor is it expected that their speech will be intelligible to an unfamiliar listener before they are four years old; these types of mistakes that young children make at first but eventually outgrow are not symptoms of a speech sound disorder.

There are, moreover, pronunciation differences that result from multilingualism or dialect patterns, and these variations are not indicative of a speech sound disorder.

_For more information about what is and isn't normal in a child's development, refer to this article on language development milestones._

# Symptoms

Articulation Disorder Symptoms

• Substituting one letter sound for another, such as replacing the “r" in “rabbit" with a “w" to make “wabbit"
• Omitting or adding sounds in words, such as saying “nana" for "banana" or “bahlue" for "blue"

Phonological Disorder Symptoms

• Consistently substituting the same types of sounds for other sounds, such as repeatedly replacing the "c" in "cup" with a "t" to say "tup"
• Consistently dropping one of two consonants at the beginning of a word, such as saying "lue" for "blue" or “poon" for spoon
• Consistently leaving off the final sound of a word, such as “dah" for dog, or “pah" for pot

# Characteristics

Although speech disorders (involving sounds) and language disorders (involving content and form) can co-occur, typically when a child has a speech sound disorder, the content of what she says makes sense — and may even be advanced for her age. That said, these children are often unintelligible (or difficult to understand) for strangers or unfamiliar listeners, particularly when language is not contextualized. Parents and teachers tend to understand children with speech sound disorders because they are familiar with the children’s speech patterns and have more context about what is being said. Even still, this disorder can be especially frustrating for older children when their communication breaks down on a consistent basis.

Diagnosis

Read on for factors to consider if you’re looking into getting a diagnosis about a possible speech sound disorder.

# Diagnostician and Testing

If you suspect your child has this learning disability, she will need to be evaluated by a speech language pathologist (SLP). SLPs typically do the following assessments to diagnose speech sound disorders:

• Hold a conversation or ask a child to narrate a book in order to get a spontaneous speech sample.
• Listen to how the child produces each sound in different word positions (since children with phonological issues may be able to say a sound at the beginning of a word but not at the end).
• Differentiate between words or sounds spoken in isolation and those said in a sentence (since sounds are less intelligible in sentences or conversations than when they stand on their own).
• Assess “stimulability," which is the ability to produce sounds based on models or clear directions (such as imitating the “l" sound when someone else says it, as opposed to producing the “l" sound by being instructed where to place the tongue on the palate).

_See Noodle’s article about learning disabilities in children for a more detailed description of the diagnostic process._

# Age of Diagnosis

Babies typically begin to make sounds — distinct from crying — when they are just a few months old, and will continue to acquire new sounds as the foundation for speech throughout early childhood. The ages and rates at which toddlers produce these sounds can differ, so young children would not ordinarily be diagnosed with a speech sound disorder before the age of two years old.

Children begin to make specific sounds — such as p, n, and h — around the age of one year old. They continue to master new and increasingly complex sounds through the age of eight. Boys and girls may learn to produce sounds at slightly different ages, and their rates of mastery may vary, as well.

To learn more about when children are typically able to produce each sound, this chart shows mastery ages and ranges.

It’s important to note that children born with certain disorders — such as Down’s syndrome, cleft palate, or cerebral palsy — are likely to have a speech sound disorder. In these instances — or if you notice your child is not producing the sounds p, b, m, h, or w by the age of two years old, talk to a teacher or speech language pathologist to discuss early intervention options.

# Prevalence

According to the American Speech-Language-Hearing Association (ASHA), the prevalence of speech sound disorders ranges from two to 25 percent in the general population. There is a slightly higher likelihood of boys and individuals with low socioeconomic status (SES) receiving this diagnosis. That said, data on people with speech disorders is difficult to obtain since speech sound disorders often occur along with other disabilities, such as cerebral palsy, autism spectrum disorder, Down’s syndrome, and cleft palate; the prevalence of speech disorders is thus not gathered or reported in isolation.

The Brain and Speech Sound Disorders

Speech sounds get produced in “Broca’s area" of the brain, which is in the frontal, left hemisphere. That said, there are entire networks devoted to the complex task of producing speech. For example, the neurological network responsible for articulation includes the rolandic operculum, primary motor cortex, cerebellum, and putamen areas of the brain. Some neurological scans have revealed that individuals with inherited speech and language disorders have less gray matter in motor- and speech-related brain regions than those without these disorders (although it should be noted that speech and language difficulties were grouped together in this study, a fact that makes it difficult to draw conclusions exclusively about speech sound disorders). The complexity of speech production makes it probable that there are multiple affected areas of the brain in those with a speech sound disorder.

Recognition of the Positives

Individuals who have only speech sound disorders typically experience a high rate of success with a trained speech language pathologist as a guide. ASHA reports that “70 percent of preschool-aged children who received phonological treatment exhibited improved intelligibility and communication functioning," while another study states that 78 percent of articulation errors resolve in those who work with trained speech disorder professionals.

While speech sound disorders and language disorders can overlap, they are not inherently linked. The quality of what your child says, therefore, need not be affected by how she is saying it. That is, children with speech sound disorders may struggle with the production of spoken language, but they do not necessarily have a disability affecting the neurological processes of creating language in general.

For individuals with other disabilities for whom treatment does not produce intelligible speech, there are alternative and augmentative forms of communication (AAC) — that is, assistive technology — to help supplement or replace speech. These can be used in conjunction with a child’s speech to make it more intelligible. They are available on iPods, iPads, or individual AAC devices, such as Dynavox, Tobii, or PRC Unity.

Evidence-Based Interventions

To begin with, hearing should be assessed as part of an evaluation, since hearing impairments result in speech sound disorders. If an SLP finds that your child needs speech and language therapy, the following approaches or therapies are supported by the American Speech-Language-Hearing Association:

• Speech Sound Perception Training focuses on the child’s perception of differences in sounds before beginning to target her ability to produce various sounds.

• Distinctive Features Approach relies on analyzing speech errors and finding target words that home in on those differences. It uses a practice known as minimal pairs, which are words that differ in only the key feature that a child is having difficulty differentiating. For example, if she is saying l and w in the same way, a speech therapist would develop games with words like “lake" and “wake" to enable her to learn the importance of differentiating the l and w sounds.

• Metaphonological or “Metaphon" Approach also uses minimal pairs. It is designed to raise children’s phonological awareness (i.e., their ability to distinguish the differences between sounds).

• Cycles Approach is for children who have difficulty producing a number of sounds. (Targeting too many different sounds during one speech therapy session is often unsuccessful.) In a cycles approach, speech therapists rotate the sounds that they focus on, thus allowing children get an exposure to all the sounds they’re having trouble producing without becoming overwhelmed.

Please note that these strategies should be designed and provided by a licensed speech and language therapist.

# A Word of Caution

There are multiple studies confirming the inefficacy of non-speech Oral Motor Therapies. In fact, there is no peer-reviewed literature demonstrating its success. Non-Speech Oral Motor Therapies are based on strength training for children’s tongues or lips (e.g., blowing bubbles, puffing cheeks), and they simply do not help children meet the challenges of speech sound disorders.

A Final Note

Schools need to monitor reading ability and phonological awareness in children with a history of speech sound disorders. Reading relies on phonological awareness, which is, in turn, built on strong representations of sounds in the brain. Studies have found that individuals with reading difficulties, as well as those with speech sound disorders, have “fuzzy" neurological representations of sounds.

Further Reading

Noodle’s range of articles on speech sound disorders, including:

• Expert-Approved Assitive Technology for Children with Autism, which offers greater detail about how AACs can help children facilitate speech
• The Polite Way to Advocate for Your Kids at School
• Language Development Milestones: What to Watch for in Your Child

The following outside resources are well-established authorities in the field of speech sound disorders. You will find in-depth coverage here:

• ASHA’s Overview of Speech Sound Disorders
• Phonological Development Chart
• Super Duper’s Guide to Articulation Mistakes
• Super Duper’s Guide to Phonological Disorders

Sources:

Bowen, C. (2011, November 1). Literacy and Children with Speech Sound Disorders. Retrieved March 15, 2015, from Speech-Language-Therapy.

Controversial Practices - Oral Motor Therapies - readings, abstracts, references. (2015, March 28). Retrieved March 29, 2015, from Speech-Language-Therapy.

Gierut, Ph.D., J. (n.d.). Treatment Efficacy Summary. Retrieved March 12, 2015, from American Speech-Language-Hearing Association.

Kahn, A. (2012, July 8). Speech Disorders. Retrieved March 13, 2015, from Healthline.

King, A., Hengst, J., & DeThorne, L. (2013). Severe speech sound disorders: An integrated multimodal intervention. Language Speech Hearing Serv. Sch., 44(2), 195-210. Retrieved March 17, 2015, from NCBI.

Law, J., Boyle, J., & Harris, F. (1999). Prevalence and natural history of primary speech and language delay: Ž findings from a systematic review of the literature. International Journal of Language & Communication Disorders, 35(2), 165–188-165–188. Retrieved March 12, 2015, from CCKM.

Liégeois, F., Mayes, A., & Morgan, A. (2014). Neural Correlates of Developmental Speech and Language Disorders: Evidence from Neuroimaging. Current Developmental Disorders Reports, 1(3), 215-227. Retrieved March 15, 2015, from Springer Link.

Speech Sound Disorders-Articulation and Phonology. (n.d.). Retrieved March 13, 2015, from American Speech-Language-Hearing Association.