Speech Sound Disorders
The causes, types, and treatment of speech sound and articulation disorders
As young children learn to speak, they may struggle to pronounce certain sounds correctly. This is a part of typical development. After all, speech skills naturally develop over time, and errors are often part of the learning process.
As children grow older, some sounds come easy, like /p/, /m/, and /w/. Others are more difficult, such as /z/, /sh/, and /th/. By age 5, most children should be able to pronounce almost all types of speech sounds.
However, when a child has a hard time saying sounds or words correctly past a certain age, this can be a sign of a speech sound disorder. As a caregiver, it can be stressful to watch your child struggle to clearly communicate their thoughts and ideas.
Adults, too, can struggle with speech sound disorders. Some adults have problems that started as a child and were never properly treated, so they've persisted over time. Other problems may have developed as a result of a stroke or traumatic brain injury.
Learning about speech sound disorders is the first step toward helping yourself, your child, or a loved one. To offer education and support, we’ve put together this informational guide to answer your questions about speech sound disorders, help you identify common signs and symptoms, and explain how speech sound disorders are treated.
What is a speech sound disorder?
Producing speech sounds correctly requires both the knowledge of a desired speech sound, as well as the ability to coordinate the jaw, tongue, and lips with breathing and vocalizing.
Children who can't pronounce certain sounds or words by an expected age may have a speech sound disorder. It's often difficult to understand someone with a speech sound disorder and, in many cases, it can affect a person’s social, academic, and professional development.
Broadly speaking, there are two types of speech sound disorders: functional and organic. This is why assessment and diagnosis by a certified speech-language pathologist, also known as a speech therapist, is so important. Speech delays can be effectively treated, and research has shown that earlier interventions lead to better outcomes.
Functional speech sound disorders
For these disorders, the cause is unknown:
Articulation disorders: The production of sounds involves the coordinated movements of the lips, tongue, teeth, palate (top of the mouth), and respiratory system (lungs). Children with articulation disorders have difficulty using these motor functions to physically produce the correct speech sounds. The result is the inability to form legible words past a certain age. Sounds may be distorted or swapped altogether.
Phonological disorders: Phonological disorders are characterized by a regular pattern in which a person may be able to produce individual sounds correctly, but they have difficulty putting these sounds together to form words. For example, they may be able to produce the /d/ sound, but they may swap it out for the /g/ sound in certain words, saying “doe" instead of "go."
Organic speech sound disorders
For these disorders, the cause is known:
Motor/neurological: Motor speech disorders occur when muscle coordination or strength is impacted. Motor speech disorders can be developmental or acquired after neurological damage, such as a stroke or traumatic brain injury. Structural: Differences in the oral and facial structures can impact speech sound production, as is the case for cleft lip and palate. Structural differences can also be caused by trauma or surgery. Sensory/perceptual: Hearing impairment can cause speech sound difficulties, as children aren't able to hear sounds the way others produce them. Speech problems vary depending on the severity of the hearing loss.
What is the difference between articulation and phonological disorders?
An articulation disorder is a difficulty at a phonetic/motoric level. People with this disorder have trouble making individual speech sounds. A phonological disorder is a difficulty at the phonemic level, in the brain. The person can say sounds correctly, but they struggle to form the sounds into words.
Compared to articulation disorders, it is often more difficult to understand someone with a phonological disorder. Many children with phonological disorders and phonemic awareness disorders (the understanding of sounds and sound rules in words) also have problems with language and literacy, which can affect their classroom performance.
Distinguishing between articulation and phonological disorders isn't always easy. However, a proper diagnosis is extremely important, as it will largely determine a person’s treatment plan. Therefore, if you suspect your child has a speech sound disorder, it’s imperative that you receive an evaluation from a certified speech-language pathologist, more commonly referred to as a speech therapist.
How common are speech sound disorders?
The prevalence of speech sound disorders (both articulation and phonological disorders) in young children is approximately 8% to 9%. By the first grade, about 5% of children have noticeable speech problems.
According to a 2012 survey from the National Center for Health Statistics, speech problems were the most common type of communication disorder in children:
42% of children 3 to 10 years of age had speech sound problems
24% of children 11 to 17 years of age had speech sound problems
In addition, poor speech sound production skills in kindergarten children have been associated with lower literacy outcomes. Studies have also shown that children with speech sound difficulties in their preschool years were more likely to have trouble reading as they got older.
What are the signs and symptoms of a speech sound disorder?
It's completely normal for children to pronounce sounds incorrectly as they’re growing up. They may substitute one sound for another, for example, swapping the /w/ sound for an /r/ sound and saying “white” instead of “right.” Or they may add and omit certain sounds altogether, pronouncing “nana” instead of “banana.”
While these mispronunciations can easily be overlooked as cute in young children, they can potentially lead to serious issues if they continue as children age.
While all children develop at different speeds, there are certain sounds they should be able to make by certain ages. According to the American Speech-Language-Hearing Association (ASHA), these are the ages when most English-speaking children should develop certain sounds.
By 3 months:
Makes cooing sounds
By 5 months:
Laughs and makes playful sounds
By 6 months:
Makes speech-like babbling sounds like puh, ba, mi, da
By 1 year:
Makes longer strings of sounds like mimi, upup, bababa
By 3 years:
Says /m,/ /n/, /h/, /w/, /p/, /b/, /t/, /d/, /k/, /g/, and /f/ in words
People familiar with the child can understand their words
By 4 years:
Says /y/ and /v/ in words
May still make mistakes on /s/, /sh/, /ch/, /j/, /ng/, /th/, /z/, /l/, and /r/ sounds
Most people understand the child’s speech
According to Stanford Children’s Health, there are some common signs and symptoms your child may have with an articulation or phonological disorder.
Symptoms of articulation disorders: There is a regular pattern of mistakes common among certain words. Symptoms may include:
Errors due to differences in the orofacial structures (saying “hip” instead of “ship”)
Distorting sounds in words (saying "thith" instead of "this")
Swapping sounds in words (saying "wadio" instead of "radio")
Symptoms of phonological disorders: There is a regular pattern of mistakes common among certain words. Symptoms may include:
Saying only one syllable in a word (saying "bay" instead of "baby")
Simplifying a word by repeating two syllables (saying "baba" instead of "bottle")
Leaving out a consonant sound (saying "at" or "ba" instead of "bat")
Changing certain consonant sounds (saying "tat" instead of "cat") Note: Having an accent is not a speech sound disorder. While the mispronunciation of certain sounds and words can sound like a speech problem, it may simply be the result of an accent.
Why is the /r/ sound so tricky?
While on the surface the /r/ sound seems like any other letter, dig a layer deeper and you’ll soon discover why it’s so complex and hard to pronounce.
For example, depending on the location of the /r/ sound relative to the vowel it follows, the /r/ will change pronunciation. The six different vocalic combinations include ar, air, ear, er, or, and ire. Repeat these variations out loud to yourself and notice the different sound of each. To make this even more clear, repeat these words: "bar," "gear," and "for." See what we mean? The /r/ takes on the characteristic of the vowel depending on context and combination.
If that wasn’t challenging enough, consider that sounds can be pronounced differently if they’re placed in the beginning, middle, or end of a word. When you consider the vocalic /r/ combinations mentioned previously, along with the different possible word positions, as well as several other factors, there are actually over 30 separate and distinct /r/ sounds.
If a kindergartener has difficulty pronouncing /r/ sounds but can generally be understood by strangers, they may naturally develop their abilities over time, or with a bit of at-home practice. However, by the time a child reaches second grade, they should be well versed in the /r/ sound. If not, intervention by a speech therapist is highly recommended.
What causes a speech sound disorder?
Often, a speech sound disorder has no known cause. In other cases, several factors could be involved. Below are some possible factors that may cause or contribute to a speech sound disorder:
Brain damage, such as a head injury
Intellectual or developmental disability, such as autism
A genetic disorder, such as Down syndrome
Problems with hearing or hearing loss, such as a history of ear infections
Physical abnormalities that affect speech, including cleft palate or cleft lip
Disorders affecting the nerves involved in speech
Two other conditions called apraxia and dysarthria fall into the category of motor speech disorders, and they can also cause speech problems.
Apraxia: Childhood apraxia of speech and acquired apraxia of speech (more common in adults) are a neurological condition that affects how the brain sends messages to the muscles involved in speech production (lips, tongue, and throat). A person with apraxia has the language capacity to talk, but the signals between the brain and the muscles are not sent correctly, so the person can't properly plan the required speech movements. Dysarthria: Dysarthria is a separate motor speech disorder characterized as a weakness or inability to control the speech muscles. While dysarthria often gets confused with apraxia, they are two separate disorders. People with dysarthria may have a hoarse, soft, or even strained voice, or slurred or slow speech.
What are the risk factors for speech sound disorders?
As mentioned, often the cause of a speech sound disorder is not known. However, there are certain risk factors that can make a child more prone to speech sound disorders. According to Stanford Children’s Health, these can include:
Developmental disorders such as autism
Genetic disorders such as Down syndrome
Nervous system disorders such as cerebral palsy
Illnesses such as frequent ear infections
Physical problems such as a cleft lip or palate
Too much thumb-sucking or pacifier use
Low education level of the parent or caregiver
Lack of support for learning in the home
According to ASHA, research has shown that the following risk factors may also increase a child’s likelihood of developing a speech sound disorder:
Gender: The incidence of speech sound disorders is higher in males than in females.
Pre- and perinatal problems: Factors such as maternal stress or infections during pregnancy, complications during birth, preterm delivery, and low birthweight were found to be associated with delay in speech sound acquisition and with speech sound disorders.
Family history: Children who have family members such as parents or siblings with speech and/or language difficulties may be more likely to have a speech disorder.
How are speech sound disorders diagnosed?
As with any condition, you should contact your healthcare provider if you suspect signs of a speech sound disorder. Most likely they will start by checking your child’s hearing. Many children with hearing loss are unable to properly listen to the words and sounds they make.
If hearing loss is ruled out, you should speak with a certified speech therapist. They are the most qualified professionals to evaluate, diagnose, and treat speech sound disorders. The earlier the intervention starts, the quicker the issue can be addressed and corrected. Your speech therapist will watch and listen to your child. They can help determine if your child's speech issues are a normal part of development and will gradually go away, or if they're the result of a speech sound disorder. To do this, the speech therapist will evaluate a variety of factors, including your child's speech and language skills, medical history, and how they move their lips, jaw, and tongue.
How are speech sound disorders treated?
With appropriate speech therapy, many children with articulation and phonological disorders see significant improvement in their ability to speak.
Speech therapists work with you and your child to develop an individualized treatment plan to help overcome speech challenges. They’ll work with you and your child to:
Provide preventive exercises so the condition doesn’t worsen
Identify and fix sounds your child is pronouncing incorrectly
Learn how to correctly form certain sounds
Practice and repeat sounds in different words and in longer sentences
Offer at-home strategies and activities that parents can use with their child for daily practice
Some children have difficulty with a certain group of sounds that share similar characteristics. For example, your speech therapist may focus on improving speech sounds that are produced in the back of the mouth (like /k/ or /g/), or sounds that require air flow to be produced (like /f/ or /s/). This practice is called a phonological therapy approach.
How does Expressable assess and treat speech sound disorders?
Expressable matches families with a certified speech therapist trained to evaluate and treat speech delays and disorders. All therapy is delivered online via face-to-face video conferencing
Your child’s age and development will influence how your speech therapist interacts with them through these video chat capabilities.
Ages 0-3: Caregivers work directly with their child's speech therapist to learn cues and at-home strategies. This way they can confidently practice with their child outside the session and improve their child's communication. Learn more about the importance of caregiver involvement in children’s speech therapy.
Ages 3-6: Caregivers attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.
Ages 7 and up: Most children attend video sessions independently, but caregivers are kept in the loop with updates and tips during each session. Adults: Adults attend sessions by themselves but are welcome to bring loved ones to the sessions as well.
How can I help support my child at home?
It's hard to overstate the importance of caregiver involvement in their child's speech therapy. Overcoming speech sound disorders takes time and persistence, and caregivers are essential to putting new skills taught in therapy into everyday practice. Here are a few tips to help you support your child in meeting their goals:
Listen carefully and write down any sounds or words your child seems to be struggling with. Share these with your speech therapist, as it can help inform their treatment plan.
Make sure your speech therapist gives you fun and enjoyable speech therapy activities you can do with your child at home.
Create flashcards or lists of common household objects to help your child practice certain sounds or words. Turn these into a game and reward your child as they continue to practice and make progress.
If your child’s speech includes incorrect sounds, provide natural modeling by restating what they’ve said with accurate sounds (“I’m pwaying wif da ball!” “You’re playing with a red ball!”).