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What Are Speech Sound Disorders in Children?




The prevalence of speech sound disorders is evident: Approximately 10% to 15% of preschoolers and 6% of students are affected by them.

Four out of five of those children will require treatment. If left untreated, these children may suffer academically. That’s why we are here to help.


In this article, you will learn more about these speech sound disorders, and the kind of treatment we fund to help these kids to live happier and more successful lives.


What Is a Speech Sound Disorder?


Children are expected to hit certain milestones when it comes to their language development. If they are experiencing a speech delay, it could be indicative of a speech disorder.


A speech sound disorder is a disorder in which speech sound production is not at the level of what is expected at the child's developmental stage and age.


SPEECH SOUND MILESTONES


Here are the typical speech sound milestones during children’s developmental years:


  • By age 3: The child should be able to be understood at least half the time when they communicate


  • By age 4 to 5: Most sounds are being pronounced correctly. Sounds they may still struggle with are “l”, “s”, “r”, “v”, or similar sounds.


  • By age 7 to 8: The child should be able to pronounce harder sounds like those mentioned above.


If the child continues to have issues after the expected age has passed, they may need to see a pediatric doctor who will refer them to a speech-language pathologist (SLP) to diagnose and treat a speech sound disorder.


CATEGORIES OF SPEECH SOUND DISORDERS


According to the American Speech-Language-Hearing Association (ASHA), speech sound disorders are communication disorders that can be either organic or functional.


  • Organic speech sound disorders: These are either developmental disorders or acquired disorders. They can result from motor/neurological disorders, structural abnormalities, or sensory/perceptual disorders.


  • Functional speech sound disorders: These have no known cause. They include disorders that involve the motor production of speech sounds and the inability to produce language. The disorders could fall under articulation disorders or phonological disorders. Articulation disorders center around errors in the production of individual speech sounds, while phonological disorders include errors beyond individual sounds. For example, phonological errors would include fronting, stopping, or deleting consonants.


Because it can be difficult to discern between articulation and phonological disorders in a patient, oftentimes clinicians will refer to it simply as a speech sound disorder if the cause of the speech difficulties is unknown.


Types of Speech Sound Disorders


Children with functional or organic deficits make four kinds of errors in the acronym SODA. They are classified as:


  • Substitutions: When one or more sounds are substituted for another. For example wabbit for rabbit or tow for cow.


  • Omissions: Certain sounds aren’t produced and entire syllables may be deleted. For example fi' for fish or 'at for cat.


  • Distortions: Sounds are changed slightly.


  • Additions: An extra sound or sounds are added to the intended word. For example puh-lane for plane.


The types of errors the child makes will determine which speech sound disorder he or she is suffering from. Let’s explore these disorders in greater detail.





ARTICULATION DISORDER


An articulation disorder occurs when the child cannot produce speech sounds correctly because of problems with placement, timing, speed, or pressure problems. It may also be a result of imprecise movements of the lips, throat, or tongue.


With articulation disorders, it is common for sounds such as “r”, “l”, or “s” to be changed. Due to these predictable speech errors, close family members are usually able to understand the child.


Symptoms:


Common speech impairments within an articulation disorder include:


  • Deltacism: Difficulty with producing the “d” sound

  • Etacism: Difficulty with producing the “e” sound

  • Gamacism: Difficulty with producing the “g” sound

  • Hitism: Difficulty with producing the “h” sound

  • Iotacism: Difficulty with producing the “j” sound

  • Kapacism: Difficulty with producing the “k” sound

  • Lambdacism: Difficulty with pronouncing “l” and similar sounds

  • Rhotacism: Difficulty with producing “r” sounds

  • Sigmatism or Lisp: Difficulty with producing “s”, “z”, and similar sounds

  • Tetacism: Difficulty with producing the “t” sound

  • Tetism: Replacing “s”, “k”, and similar sounds with “t”, and replacing “z” and similar sounds with “d”


When a child is aware of their articulation issues, he or she might often be quiet or seem shy, get frustrated when speaking, or just stop saying some words completely. It is quite often the child will struggle with a lack of confidence and self-esteem.


Children with a cleft lip or cleft palate may experience articulation errors such as glottal stops, nasal fricatives, pharyngeal fricatives, and mid-dorsum palatal stops.


Causes:


In most young children, there is no known cause for their articulation disorders. However, some articulation errors are known to be caused by things like:


  • Brain injury

  • Development or cognition issues (For example Down syndrome)

  • Deafness or auditory impairment

  • Physical disabilities that impact speech like cleft palate or cleft lip

  • Any nerve disorder that affects the nerves associated with speech

Treatment options:


To treat articulation disorder, it is very helpful for the child to attend speech therapy sessions. Having regular appointments with an SLP will improve articulation errors.


To treat articulation errors, SLPs will focus on:


  • Figuring out the exact sounds your child has difficulty with

  • Correcting the way he or she creates sounds to produce the right sound

  • Teaching or re-learning ways to control the motor functions of speech. This can include how to shape the lips to express a particular sound

  • Introducing exercises that strengthen the muscles involved in speech

  • Giving you exercises for your child to practice sound formation at home


PHONOLOGICAL DISORDER


A phonological disorder, also known as a phonemic disorder, occurs when children find it difficult to sound out words correctly and struggle to recognize and process language patterns. As a result, these children will use phonological processes to simplify adult speech patterns.


However, those with a phonological disorder will use these shortcuts longer than normal. Children with a phonological disorder may make mistakes when producing sounds and some sounds such as consonants may be omitted.


Symptoms:

  • If the child is suffering from speech intelligibility by age 3, this could be a sign of a phonological disorder.

  • Is unable to pronounce most phonetic sounds correctly by age 4 or 5. Some exceptions can include these sounds: l, s, r, v, z, ch, sh, and th.

  • Has difficulties forming longer sentences or understanding context

  • Produces a certain sound correctly, but uses it in the wrong position or in the wrong word. For example, he or she may use the 'd' sound instead of the 'g' sound, and say 'doe' instead of 'go'.

  • Makes mistakes with sounds in particular words, such as making the 'k' sound in 'kite' but will leave it out in other words.

  • Lower self-confidence

Causes:


Phonological disorder is more prevalent in boys. However, the causes are mostly unknown. However, there are some risk factors associated with this disorder:


  • Family history of speech-language disorders

  • Hearing loss

  • Developmental delays

  • Genetic diseases

  • Neurological disorders


Treatment options:

  • Work with an SLP to understand the phonological issues the child is having. He or she will present exercises for the child to teach them how to produce the correct sounds.

  • The SLP will coach the child on how to move the jaw, lips, and tongue effectively to teach them how to use the correct muscles when pronouncing words

  • Parents or caregivers can help the child with home exercises by mimicking the proper speech patterns. It helps if they focus on making the right movements, in the right context, with the right output of sound.


CHILDHOOD APRAXIA OF SPEECH


Apraxia of speech, or verbal apraxia, refers to the speech sound disorder in which brain damage has impaired a person’s motor skills that affect one’s ability to make speech sounds. The person often knows the words they want to say, but are simply physically unable to.


Language problems like Aphasia can co-occur with speech disorders like apraxia of speech or dysarthria. These are all the results of brain damage. Aphasia is when the person is impaired in linguistic capabilities rather than motor skills used to speak.


Apraxia of speech can also occur in children upon birth, though this is uncommon. It is called childhood apraxia of speech (CAS), or developmental verbal dyspraxia.


Symptoms:


These are some common symptoms of CAS:


  • Difficulty pronouncing vowels

  • Stressing the wrong part of the word

  • Difficulty transitioning from a sound, syllable, or word to another

  • Putting a pause between syllables

  • Inconsistency in pronunciations; making different speech sound errors on the same word

  • Difficulty pronouncing simple words

Causes:


In most cases of CAS, the causes are not known. However, there are a few known causes of CAS:


  • Neurological impairment: This may be caused by infection, illness, or injury, during or after birth. Some genetic conditions can also cause neurological impairment associated with CAS.


  • Autism: Apraxia related to autism can be very difficult to diagnose. Take a few sessions with your SLP before a conclusion is drawn.


  • Genetic disorder: Many different complex disorders have CAS as a secondary characteristic. That being said, not all children with that particular genetic disorder will have CAS. One common genetic disorder associated with CAS is galactosemia.

Treatment options:


  • Speech therapy: Working with an SLP 3-5 times a week, in the beginning, can make a difference with CAS and language skills. Speech therapy may include speech drills, sound and movement exercises, speaking practice, vowel practice, and paced learning.


  • Home practice: The SLP can give words or phrases for the child to practice at home, which can be done in a quick 5-minute session, twice a day. They can also get some practice in real-life situations by creating situations where it is appropriate for the child to say the word or phrase.


  • Other communication alternatives: If the child has a severe case of CAS, it may be helpful to learn other communication methods, like sign language or natural gestures like pointing. However, as their speech gets better, these methods can be abandoned.


DYSARTHRIA


Dysarthria is a speech sound disorder characterized by muscle weakness or difficulty controlling them. Muscle weakness or loss of control occurs in the parts that are needed for speech including the face, lips, tongue, throat, or chest. The speech is often slurred or slowed, making it difficult to understand.


Symptoms:


Common symptoms of dysarthria speech problems include:


  • Slurred, gurgly, monotonous, nasally, or breathy speech

  • Mumbling

  • A voice that is strained or hoarse

  • Speaking too quickly or too slowly

  • Very soft or quiet speech

  • Difficulty moving tongue or mouth; may involve drooling

  • Unable to speak in a regular rhythm due to hesitative speech

Causes:


The cause of dysarthria can be either developmental or acquired. Some common causes could be:


  • Brain or head injury

  • Brain tumor

  • Cerebral palsy

  • Lyme disease

  • Muscular dystrophy

  • Some medications including certain sedatives or seizure drugs

Treatment options:


When it comes to dysarthria, it is important to treat the underlying cause of the issue. If it was caused by prescription medications, change or discontinue the medications to relieve the issue. For those suffering from dysarthria that persists, it is a good idea to get treatment from an SLP.


Depending on the child’s level of impairment, he or she will work with the child on:


  • Slowing down the rate of speech

  • Learning how to use more breath to raise voice volume

  • Practicing mouth exercises to strengthen muscles

  • Practicing lip and tongue exercises to strengthen muscles

  • Enunciating words and sentences more clearly

  • Introducing other communication methods including gestures, writing, or devices


Children Need a Differential Diagnosis for Speech Sound Disorders


Keep in mind that some children may be suffering from several speech sound disorders we’ve listed, along with other language impairments or learning disabilities. That is why they must see a specialist highly qualified in the field of speech-language pathology to receive a differential diagnosis and treatment plan.


Luckily, our Rite Care Centers are staffed with educated and experienced SLPs to diagnose all of the above speech sound disorders. But they can’t do it without your help. Donate today!




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