What are speech sound disorders?
A. Most children make some mistakes as they learn to
say new words. A speech sound disorder occurs when mistakes continue past a
certain age. Every sound has a different range of ages when the child should
make the sound correctly. Speech sound disorders include problems with
articulation (making sounds) and phonological processes (sound patterns).
Q. What are some signs of a speech sound disorder?
An articulation disorder involves problems making
sounds. Sounds can be substituted, deleted, added or changed. The development of speech sound acquisition varies with each
child. However, the following sounds are
typically the earliest developing phonemes children acquire: “p, b, m, n, h, w,
t, d, k, and g.” These sounds should be
clearly produced in conversation by 4.5 years of age. Most children acquire later developing
phonemes including: “f, v, r, l, s, and z” between the ages of 5-6. The latest developing phonemes: “j, ch, sh,
th” are typically developed between 6-7 years of age. The ultimate goal is for your child to be
approximately 100% intelligible, to an unfamiliar listener, given the context, by
6 years of age. The child may have an articulation disorder if these
errors continue past the expected age. It is important for children to clearly articulate most sounds
prior to entering Kindergarten, to prevent academic delays in reading, writing,
Q. How will a Speech and Language Pathologist
assess my child?
pathologist (SLP) will listen to your child and use a formal articulation test
to record sound errors. The SLP will tell you exactly what sounds your child is struggling
with, in what position of the word (beginning, middle or ending), and what
sound, if any, he is substituting it with.
The therapist will also determine if your child is stimulable for the
correct sound. A child is “stimulable”
if he or she can say the sound in direct imitation of the therapist. An oral mechanism
examination is also done to determine whether the muscles of the mouth are
working properly and to ensure that she has
good independent control of her lips, tongue and jaw, as well as good range of
motion. The SLP will also evaluate your child’s language
development to determine overall communication functioning. Whenever there is an
articulation delay, it is always recommended to rule out a hearing
impairment and/or fluid in the middle ear.
Q. What causes speech sound disorders?
Many speech sound disorders occur without a known
cause. A child may not learn how to produce sounds correctly or may not learn
the rules of speech sounds on his or her own. These children may have a problem
with speech development, which does not always mean that they will simply
outgrow it by themselves. Children who
experience frequent ear infections when they were young are at risk for speech
sound disorders if the ear infections were accompanied by hearing loss.
A phonological processing disorder involves patterns
of sound errors that children use to simplify the sounds
of speech. While it is common for young children learning
speech to leave one of the sounds out of the word, it is not expected as a
child gets older. Most phonological processing errors typically disappear by 3.0
years of age. If they persist past 3.0
years of age and negatively affect intelligibility, therapy is typically
recommended. The following are common
errors many children present with.
Pre-Vocalic Voicing: “Pig→big”
Word-Final de-voicing: “Pig→pick”
Final Consonant Deletion: “cat→ca” This is the most common pattern that
children present with. The final
consonant in a CVC word typically has less “stress” and therefore, is often
difficult to hear in connected speech.
Since these sounds are difficult to hear, they are often deleted.
Fronting: “tite→kite,” “dod→dog.” The
“t/k” and “d/g” phonemes are often substituted for each other because they
share the same manner of articulation with different tongue placements.
Consonant Harmony: “gog→dog,” Due to consonant assimilation,
which is the propensity for one consonant to take on similar characteristics of
another consonant in the same word, many children confuse k/g for t/d,
especially when they are presented in the same word.
“back→black”, and “boo→blue.” Blends can be very difficult for children to
produce because each consonant is difficult to perceptually discriminate when
adjacent to each other.
reduction: “nana→bannana.” As words increase in length and complexity,
children often omit one or more syllables.
Stopping: /p→f/, /t→s/, /d→th/. Your child’s airflow is literally “stopped”
and substituted with a plosive sound, typically the /t/, /d/, /p/
Gliding: /w→r/ and /y→l/. The
/r/ sound is the most frequently produced phoneme in the English Language,
making it an important phoneme to acquire for improved overall intelligibility.
Q. How can a Speech and
Language Pathologist help my child?
Sound elicitation is the process we go through to teach
the child how to say the targeted sound. For example, if your child cannot say
the /th/ sound in imitation, your therapist will break down the process for him. She
might say, “Put your tongue between your teeth then blow.” After the sound is
learned, then the sound(s) is practiced in isolation.
Isolation: Practicing a sound in isolation means saying
the sound all by itself without adding a vowel. For example, if you are
practicing the /t/ sound you would practice saying /t/, /t/, /t/ multiple times
in a row. When the child is 80% accurate producing the sound in isolation over
three consecutive sessions, she is ready to move onto syllables.
Syllable Level: Practicing sounds
in syllables simply means adding each long and short vowel before, after, and
in the middle of the target sound.
Word Level: At this point, your
therapist has decided which position of the word she wants to target and will
begin practicing words in the initial, medial or final position of the word.
When your child is 80% accurate producing the target sound(s) in all positions
at the word level, she will move on to the next step, which is using the word
Sentence Level: A great way to practice
sounds in sentences is with a “rotating sentence”. In a rotating sentence only one target word
changes. For example, the sentence might say, “Put __ in pink purse.” Then the
child rotates all the target words through the sentence. This is an especially
great way to practice sentences for young children who can’t read yet.
Sounds in Stories: For younger children, we prepare a story
for them to practice using the sounds they have been practicing. We try to include as many picture cues as
possible so young children can retell the story without being able to
Conversation: The biggest leap in progression
occurs from the sentence to conversational speech level. This last stage of therapy typically takes
the longest amount of time, as the child is required to produce the sound(s)
with automatic, habitual, overlearned, effortless productions without using any
What are different therapy approaches?
approach: Focuses on whole-word production and is
used for children with inconsistent speech sound production who may be
resistant to more traditional therapy approaches. The words selected for
practice are those that are used frequently in the child's functional communication
Cycles approach: Targets phonological pattern errors and is designed
for highly unintelligible children who have extensive omissions, some
substitutions, and a restricted use of consonants. During each cycle, one or more phonological
patterns are targeted rather than specific sounds.
therapy: This approach is typically used for children who
primarily substitute one sound for another. This approach uses minimal pair
contrasts that compare the target sound with the error sound (chip/ship).
Metaphon therapy: Designed to
teach metaphonological awareness, the awareness of the phonological structure
of language. For example, for problems with voicing, the concept of
"noisy" (voiced) versus "quiet" (voiceless) are taught.
therapy: Involves the use of oral-motor training prior to
teaching sounds or as a supplement to speech sound instruction. The rationale
behind this approach is that immature or deficient oral-motor control or
strength may be causing poor articulation and that it is necessary to teach
control of the articulators before working on correct production of sounds.
procedures include auditory bombardment and identification tasks in which the
child identifies correct and incorrect versions of the target through
inter-auditory discrimination (e.g., "rat versus wat").
Q. What are some
things I can do at home to help my child?
There are many fun ways for your
child to practice sounds outside of therapy!
Ø When you
are driving, play the “Alliteration Game.”
For example, if your child is targeting the phoneme /r/ in therapy, see
who can come up with more words that either start or end with the /r/ sound.
you’re in a store with your child, ask your child to find as many products that
include their target sound(s). For
example, if your child is working on clearly producing /s/ blends, he can find and
say: “strawberries, spices, string cheese, snacks, and spaghetti.”
Ø When your
therapist provides you with pictures of the target sound(s), cut them out and
tape the pictures above your child’s bed.
Every night, turn out the lights, focus a flashlight on each picture,
and model the correct production of the word. You can also play a scavenger
hunt game, producing the sound(s) each time a picture is found.
Ø Buy a
child’s magazine and cut out all the pictures that contain the target
sound(s). Make a collage of all the pictures
and practice saying the sound.
Ø When your
child is brushing her teeth, practice the sound in isolation. Ask your child to see what’s happening to
their lips, tongue, and jaw when they produce the sound correctly. The mirror
provides excellent visual feedback.
of saying comments such as: “What did you say?” or “Say that again” try
repeating everything that you heard your child say, but omit the word(s) that
were unclear. This will reduce your
child’s frustration and improve their awareness of which sound(s) are
Ø Feed your child’s speech cards to puppets after they have
Ø Once your child is aware of the correct production of a
target sound, try saying a word incorrectly to see if your child corrects
Ø When your
child is at the “generalization stage” of therapy and expected to say the
sound(s) correctly in conversational speech, model a faster rate of speech when
practicing their speech homework.
Ø If your
child is learning to read, highlight the target sound in your books at
home. This visual prompt will remind
them to produce the sound correctly while reading.