Signs & Symptoms

Articulation and Phonology
Language Comprehension and Expression
Pragmatics
Voice
Fluency

What are speech sound disorders?
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).

What are some signs of an articulation disorder?
An articulation disorder involves problems making sounds. Sounds can be substituted, left off, added or changed. These errors may make it hard for people to understand you.

Young children often make speech errors. For instance, many young children sound like they are making a “w” sound for an “r” sound (e.g., “wabbit” for “rabbit”) or may leave sounds out of words, such as “nana” for “banana.” The child may have an articulation disorder if these errors continue past the expected age.

Not all sound substitutions and omissions are speech errors. Instead, they may be related to a feature of a dialect or accent. For example, speakers of African American Vernacular English (AAVE) may use a “d” sound for a “th” sound (e.g., “dis” for “this”). This is not a speech sound disorder, but rather one of the phonological features of AAVE.

To see the age range during which most children develop each sound, visit Talking Child’s speech chart.

What are some signs of a phonological disorder?
A phonological process disorder involves patterns of sound errors. For example, substituting all sounds made in the back of the mouth like “k” and “g” for those in the front of the mouth like “t” and “d” (e.g., saying “tup” for “cup” or “das” for “gas”).

Another rule of speech is that some words start with two consonants, such as broken or spoon. When children don’t follow this rule and say only one of the sounds (“boken” for broken or “poon” for spoon), it is more difficult for the listener to understand the child. 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. If a child continues to demonstrate such cluster reduction, he or she may have a phonological process disorder.

How are speech sound disorders diagnosed?
A speech-language pathologist (SLP) is the professional that evaluates children or adults with speech and language difficulties. The SLP listens to the person and may use a formal articulation test to record sound errors. An oral structure examination is also done to determine whether the muscles of the mouth are working correctly. The SLP may recommend speech treatment if the sound is not appropriate for the child’s age or if it is not a feature of a dialect or accent. For children, the SLP often also evaluates their language development to determine overall communication functioning.

This information adopted from asha.org.

Language Comprehension:
Receptive language or language comprehension refers to one’s ability to process, comprehend, or integrate spoken language. Generally, it involves being able to understand what someone says to you. People with language comprehension difficulties may have trouble following long directions, remembering lists of words, and understanding multiple meanings of words. Difficulties with language comprehension may also be associated with a language-based learning disability.

Language Expression:
Expressive language involves putting words together to form sentences and express one’s self. Areas of expressive language include syntax or word order, grammar, and vocabulary. Some with expressive language difficulties may seem to “forget” names of things around them or seem to “talk around” a word (e.g., saying, “that thing you eat with” instead of “fork”). Others may also have difficulty with grammar or morphology (changes in verb tense), for example, a one might say “He running” instead of “He is running.”

Pragmatics involves the use of language for social purposes. With younger children, it involves using language for requesting objects, actions, information; answering questions, and refusing. For older children and adults, pragmatics also involves social reasoning and problem solving skills. People with pragmatic language difficulties may have difficulty using language in specific situations such as greetings, informing, promising, and requesting. They may also have difficulty changing their language for different listeners (e.g., you talk with your children differently than adults), and with following conversational rules (e.g., turn taking, staying on topic, starting and ending conversations, etc.).

Voice disorders can be characterized by a hoarse, scratchy, breathy voice or even the absence of a voice. We’ve all experienced vocal abuse due to coughing too much from a cold. Common chronic voice problems can include the following:

Vocal fold nodules and polyps:
These are growths on the vocal folds due to continuous vocal abuses. For children, vocal abuses can include: crying, coughing, shouting, and making funny noises. For adults, vocal abuses include the above listed factors in addition to gastric reflux and smoking. Physical examination by an ENT (Ear Nose and Throat Specialist) is required to diagnose nodules/polyps.

Voice therapy involves teaching good vocal hygiene, reducing/stopping vocal abusive behaviors, and direct voice treatment to alter pitch, loudness, or breath support for good voicing. Stress reduction techniques and relaxation exercises are often taught as well.

Vocal fold paralysis:
This happens when one or both of the two vocal cords is paralyzed. Treatment can involve both medical and behavioral intervention. Speech therapy focuses on pitch alteration, increasing breath support and loudness, and finding the correct position for optimal voicing (such as turning the head to one side or manipulating the thyroid cartilage).

This information adopted from asha.org.

This involves the fluid forward movement of speech. Breaks in this fluid movement are disfluencies, or “stuttering” moments as they are more commonly known. This disorder often begins in childhood and continues throughout one’s life. Stuttering involves repetitions of whole words and word parts, blocks or “stops” in speech, as well as prolongations or “holding on” of speech sounds.

Therapy for stuttering involves a combination of behavioral and speech therapy. Individuals and parents learn to modify their environments and also learn ways to speak in a slower and less physically intense manner.

For more information on stuttering check out the following links:

http://www.asha.org/public/speech/disorders/stuttering.htm#four

http://www.stutteringcenter.org/