Speech Sound Disorders

Q. 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, and spelling.

Q.  How will a Speech and Language Pathologist assess my child?

A.  A speech-language 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.

Q.  What are some signs of a phonological disorder?

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.  

Cluster reduction:  “cool→school”, “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. 

Syllable 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/ phonemes. 

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 in sentences.

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 read. 

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 mental effort.   

Q. What are different therapy approaches?

Core vocabulary 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 system.

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.

Distinctive feature 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.

Oral-motor 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.

Speech perception training:  Recommended 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.

Ø  When 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.

Ø  Instead 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 mispronounced.

Ø  Feed your child’s speech cards to puppets after they have been said.

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 you.  

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.

Additional resources: mommyspeechtherapy.com, ASHA.org