Articulation. Speech. Speech Sound Disorder. Intelligibility. Consonants and Vowels. Syllable Shapes. Apraxia of Speech. Phonology. Phonological Disorder. A lot of fancy words to describe the same thing… how well your child forms sounds/words and how well they are understood.
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Hi, Chelsea here. I have been a pediatric speech-language pathologist (fancy name for a speech therapist) since 2015. 9 times out of 10 when I tell people what I do, they say something along the lines of “you help kids who can’t say their ‘r’s?”. And while this is not untrue, I laugh (to myself) because being a speech therapist encompasses much more than that!!! But here, I am going to share some of the main reasons why you are having difficulty understanding your child, including them not being able to say their ‘r’s.
Some Terms
- Articulation: This will be the term I use for most of the reference to how your child produces sounds.
- Speech Sounds: The sounds we use to form words.
- Disorder: I may use this term with several others (e.g. articulation disorder, speech sound disorder) to reference any type of production that is not typical in development
- Articulators: The oral structures involved in producing speech sounds. This includes lips, jaw, tongue, palate (hard and soft), and cheeks.
Development
As children grow from infants to toddlers and on up, they go through different developmental stages. Each of these stages serves a purpose for development.
Articulation develops starting with the earliest sound productions, such as coos and babbles. But, articulation development is directly affected by the development of all the articulators, which are the same muscles and structures used for eating and swallowing.
Many people do not put together the connection between eating & swallowing and speech! In fact, so often, people are confused by why a speech therapist works with children with feeding challenges!! And while I could provide quite a lengthy response to this question, I usually, simply say “same muscles”.
Speech, Feeding, and Swallowing Connection
When an infant is first learning to coordinate suck-swallow-breathe during nursing and/or bottle feeding, this is the first developmental stage for articulation as well!
The jaw is responsible for stabilizing; while the tongue learns to move effectively and efficiently to expel the milk; the lips and the cheeks create the right amount of suction; the soft palate moves up and down to direct the milk down toward the stomach and keep it out of the nose; the airway closes to allow a safe swallow; and the esophagus opens to allow the milk into the “correct pipe”.
Comparatively, think of what happens when we say the word “dad”. The jaw is responsible for stabilizing; while the tongue moves effectively and efficiently around the mouth to briefly stop the air at the alveolar ridge (bumps behind your top teeth) for “d”, lower in the front but slightly raised in the back for “a”, and swings back up to briefly stop the air at the alveolar ridge again for “d”; the lips stay open and cheeks stay in place; the soft palate elevates to prevent the air from going through the nose; the airway directs vibration up through the mouth to allow the sound to be heard; and the upper esophagus is closed.
You can see how the articulators start developing right from the beginning! It is crucial that problems with feeding are identified and corrected early on, so that children can develop the appropriate oral patterns for both successful eating and speech and language skills. For more on the infant “side of things”… check out Why Infants Don’t Need Baby Food When Starting Solid Food or Help! My Baby Doesn’t Like Solid Food.
If you are already past the infant stage, keep reading, and we will go into more detail to help you sort out the difficulty your child may be having with their speech.
Differential Diagnosis
There are several different possible reasons why your child is difficult to understand. In this section, I will go into a little detail about each to help guide you.
Now, this absolutely does not replace the professional judgment of a speech-language pathologist (or other medical professional) working with your child. I do not know your child. This list is here to help you understand the possible deficits your child may be experiencing and maybe provide you some guidance for treatment options, questions, or conversations to have with your SLP or other healthcare professional. Additionally, this list is meant to be an overview.
Articulation Disorder:
The definition taken directly from the American Speech-Language Hearing Association (ASHA): “Speech sound disorders (SSDs) refer to any difficulty or a combination of difficulties with perception, motor production, or phonological representation of speech sounds and speech segments, including phonotactic rules governing permissible speech sound sequences in a language.”
What does this mean? The inaccurate productions of sounds, words, or parts of words that impact how a child is understood.
Hallmark characteristics of articulation disorders: substitutions, omissions, distortions or additions.
- Substitutions: “w” for “r” is very commonly known – “wun” instead of “run”
- Omissions: deleting sounds, such as “ganpa” instead of “grandpa”
- Distortions: sounds are not quite how they should be produced, such as “shun” instead of “sun”
- Additions: adding sounds or syllables, such as “mom-mom-y”
Phonological Disorder:
The definition taken directly from ASHA: “Speech sound disorders (SSDs) refer to any difficulty or a combination of difficulties with perception, motor production, or phonological representation of speech sounds and speech segments, including phonotactic rules governing permissible speech sound sequences in a language.”
What does this mean? The inaccurate productions of sounds, words, or parts of words that impact how a child is understood.
While the definition of this and articulation disorders is the same, the hallmark characteristics are different. Hallmark characteristics of phonological disorders are error patterns, such as final consonant deletion “ca” instead of “cat” or fronting “tat” instead of “cat”.
Most of the phonological patterns are normal at some point in development. They are supposed to “go away” at different ages, but if they don’t they can negatively affect how we understand a child when they talk.
Childhood Apraxia of Speech:
The definition taken directly from ASHA: “Childhood apraxia of speech (CAS) is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone).”
What does this mean? The child has difficulty forming precise and consistent speech sounds.
Hallmark Characteristics of CAS: Inconsistent errors, difficulty with longer and more complex syllables, words, sentences, etc. and inappropriate oral movements while trying to form the words (e.g. groping).
Weakness or Myofunctional Disorder:
Weakness is basically what it sounds like… the articulators are weak. You may hear this called oral motor deficits or oral motor weakness. Weakness can be a stand alone diagnosis, but it often leads to the next definition of orofacial myofunctional disorders (OMDs).
The definition taken directly from ASHA: “Orofacial Myofunctional disorders are atypical movement patterns of the face and mouth”. They can affect breathing, eating, swallowing, speech sound production, and more.
What does this mean? When the articulators are weak, or there are other contributing factors (e.g. oral habits, allergies), the child cannot correctly form the speech sounds and/or has inappropriate oral patterns that prevent them from correctly making the sounds.
Hallmark Characteristics of Weakness and OMDs: There are several different hallmark characteristics, but I am listing just a few that I often see: difficulty with longer words and phrases, lax sound productions, lisping, and/or excessive pooling of saliva or drooling.
Hearing Impairments:
Any deficit with the ability to hear can impact speech production. Usually, the more severe the hearing deficit, the more severe the speech and language deficits.
Other:
While most of the items listed in this section are rare, they are important to mention.
Dysarthria: The definition taken directly from ASHA: “Dysarthria is a motor speech disorder. This happens when brain or nerve damage changes the way your muscles work.”
Structural Deficits: These refer to an impairment in the structures related to articulation. The most common would be cleft lip or cleft palate, but they can also be structural damage after surgery or trauma.
Combination of Multiple Disorders:
Now that we have broken down each of the different types of disorders, it is important to note that children can have just one of these disorders, but very commonly, they can have more than one of the disorders in combination with each other. This is what can make it very challenging to determine what is exactly causing the issues and the best place to start addressing it. Hence why it is a wise choice to seek the guidance of a speech-language pathologist if you feel your child is difficult to understand or having difficulty producing speech sounds, outside of what is typical for their age.
How do I know what area(s) my child is struggling with
Up to this point, I have really given you a bunch of information that can be hard to decipher or apply to your specific child. If you have stuck with me to this point, I am glad 🙂 I will provide some examples below that might help you.
I use a lot of quotation marks here, because I am often quoting how most parents describe their child who might fit into this category. Also note that these are simple summaries, your child may not “fit” into one box entirely, because they are unique individuals with unique needs!!!
Below each category, I will list a few things that would come to my head if I heard a parent describe their child this way. This is not a diagnosis if your child fits into this category, but a starting place for you to investigate further, with the help of a qualified professional!!!
Mumbling
Is your child a “mumbler”? They may be quiet, their sounds kind of blend together, and they “don’t open their mouths” when talking or even doing non-speech tasks.
What comes to mind when I hear this… Weakness or OMDs and childhood apraxia of speech. Rule out hearing as a contributing factor.
Why: If the articulators are weak, they may lack the stability and range of motion to produce a variety of sounds, so their mouth remains in a small/lax position to maintain stability. They may lack the ability to precisely articulate multiple sounds in longer, more complex sentences, so they compensate with smaller movements and less motor plans.
Fast Talker
Is your child a fast talker? Do all their words run together? Do they delete sounds or even small words? Does it seem like their tongue doesn’t really move much? Do they drool when talking?
What comes to mind when I hear this… Weakness or OMDs, childhood apraxia of speech, phonological disorder. Rule out hearing as a possible contributing factor.
Why: I had an OT friend one time explain to me that many kids who are weak do things fast. It is their way to compensate and “get it done” before they run out of energy or strength. They may not be able to sequence all of the complex sounds to form all of the words in a sentence. A child with very few correctly produced sounds, may string together the few sounds they do have in quick utterances.
Single Words but Not Sentences
Can your child say single words well, with all (or most) of the sounds correctly produced? Do they copy you in single words correctly but then when they try to say it in a sentence, it is incorrect?
What comes to mind when I hear this… Childhood apraxia of speech, weakness or OMDs, articulation disorder. Rule out hearing as a possible contributing factor.
Why: Length and complexity are hallmarks of CAS, and so they can make single words or even very short phrases correctly but not full sentences. Similarly to what I have described above, they may lack the strength or endurance to produce a full sentence. A child with an articulation disorder, may go through phases or learning how to produce the word by itself then generalize it to sentences – they may not have learned to produce it in the sentences yet.
Copies Well
Does your child say things incorrectly, but when you stop them, and they focus on trying to produce it correctly with your model, they can?
What comes to mind when I hear this…Articulation disorder, weakness or OMDs. Rule out hearing as a possible contributing factor.
Why: Many children with articulation disorders have developed a “habit” of producing the sound incorrectly – they have to relearn how to produce it correctly, and sometimes they need a reminder. Similarly to the “Fast talking” description of weakness – the child may not have the strength to say all the sounds correctly yet, but when you stop them and they can fully focus on “telling their muscles what to do” they can do it.
Does Not Copy Well
Does your child say things incorrectly, but when you stop them, and they focus on trying to produce it correctly with your model, they can’t?
What comes to mind when I hear this…Childhood apraxia of speech, weakness or OMDs. Rule out hearing as a possible contributing factor.
Why: Oftentimes with CAS, pressure impairs the child’s ability to sequence the correct motor plan, and they cannot make their mouths make the sounds, no matter how hard they try. They may not have the strength or coordination of movements to even form the sounds, despite your cueing and their effort.
Things to Consider
As you can see, weakness or OMDs made it on the list every time. There is an increasing body of evidence to suggest that a lot of kids with speech sound deficits of any type are demonstrating some degree of underlying weakness or orofacial myofunctional disorder.
In the upcoming posts in this “Articulation Series”, I will share some ways that you can help support your child’s appropriate oral structure development.
Another item that made the list every time was to rule out hearing as a contributing factor. While many kids do not have hearing loss, it is an often overlooked diagnosis that can make a real difference in sound production. Children may have known/identified hearing loss, history of reoccurring ear infections, or even persistent fluid in the ears. Any of these things can negatively impact your child’s speech development, so it is important to rule it in – and address this issue – or rule it out and continue toward a differential diagnosis and speech treatment.
Final Note
If you are reading this and feeling like your child may have some sort of speech sound disorder, we recognize it can feel overwhelming and discouraging. You can discuss your concerns with your child’s healthcare provider or reach out to any of the following possible service locations to get your child’s articulation skills moving in the right direction.
0-3 years of age:
- Early intervention. Every State has an EI program and the services are rendered in your home or other “natural environment” (e.g. daycare). You can likely self-refer or ask your child’s healthcare provider to send a referral.
- Outpatient. This may be a hospital or clinic setting that you take your child to for services.
- Private Practice. This may be a clinic setting or even a private SLP who comes to your home to provide services.
3+ years of age:
- Public school system. Parents of a child who is 3 years of age or older can request a speech therapy evaluation through the public school system.
- Outpatient. This may be a hospital or clinic setting that you take your child to for services.
- Private Practice. This may be a clinic setting or even a private SLP who comes to your home to provide services.
More Information:
If you are interested in learning what exactly is typical for your child’s age, check out some of these developmental milestones:
Overview of Speech-Language Milestones: https://www.asha.org/public/developmental-milestones/communication-milestones/?srsltid=AfmBOopBQSRr-EaATYYf4X2FBN0fC3DkkbNKXnnnGqYR1cYWMPcVxXoJ
Specific Speech Sound Development: https://dpi.wi.gov/sites/default/files/imce/sped/pdf/sl-sound-development-chart.pdf
References:
Childhood Apraxia of Speech Practice Portal. Retrieved from: https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/
Speech Sound Disorders – Articulation and Phonology Practice Portal. Retrieved from: https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/#collapse_2
Selected Phonological Patterns. Retrieved from: https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/selected-phonological-patterns/
Orofacial Myofunctional Disorders. Retrieved from: https://www.asha.org/public/speech/disorders/orofacial-myofunctional-disorders/?srsltid=AfmBOop9JvZvPOcFN8YpoboLfgYaa5amQHiEM1kI5NTeK9wWIZ87Ix6r
Dysarthria. Retrieved from: https://www.asha.org/public/speech/disorders/dysarthria/?srsltid=AfmBOopxhCiDM7ME513c30Y_HlI4jvs_X9Lq2NadzVFbVd65BX32BF91
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