Speech Sound Disorders

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By Sarah Fowler

When I was in kindergarten, I had a frontal lisp. My name is Sarah, but I would pronounce it as “Tharah.” I was completely unaware of my lisp until my father pointed it out. I remember clear as day, I was 5 years old, getting ready for a bath. My dad asked me what my name was. Thinking my dad forgot my name, I quickly replied, “It’s Tharah, Daddy!” To which my dad replied, “It’s Sssssarah, not Thhharah.” And thus began my journey in speech therapy. You’ll be happy to know that, despite my persistent tongue thrust, I now produce the “s” sound correctly and have been doing so since I finished speech therapy in 1st grade. As an adult, I’ve dedicated my career to helping other kids overcome their articulation struggles as a speech-language pathologist.

Inspirational Quote about Speech-Language Pathology
“I was born to be a speech-language pathologist. To teach, to love, to guide, to encourage. It is who I am. It’s my passion & my calling.”

We have all heard a child mispronounce a word while whole-heartedly believing they said it correctly. You may even try to correct them, but when they attempt to imitate the new production, the incorrect sound pops out again. Watch the video below for an amusing example:

Video of a child trying to say “shamrocks” but repeatedly saying “samrocks” instead.

This little girl was trying to explain to her father that her class made “shamrocks” at school. However, she had an articulation error, and could not produce the “sh” sound. Instead, she substituted the “sh” sound with an “s” sound. Her father repeatedly imitated exactly what she said back to her, and while she knew his production was incorrect, she was unable to correct her own.

If you were to label this error what would you call it? A lisp? A speech impediment? What is the correct terminology for this error?

Speech Sound Disorders

According to the American Speech and Hearing Association (ASHA), a speech sound disorder is an umbrella term that refers to difficulty with perception, motor production, or phonological representation of speech sounds/segments including phonotactic rules which govern speech sound sequences [1].

In layman’s terms, a speech sound disorder is when an individual has difficulty producing certain sounds or patterns of sounds. A speech sound disorder can be organic – a result of an underlying motor/neurological, structural, or sensory/perceptual cause OR it can be functional – an idiopathic speech sound disorder with no known cause [1].

Speech Sound Disorders Umbrella
Graphic from https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/

Functional speech sound disorders are more common and are related to the motor production of speech sounds. You may have heard these referred to as speech impediments, articulation disorders, or phonological disorders. Articulation disorders, often referred to as speech impediments, focus on errors (e.g., distortions and substitutions) in specific speech sounds. A lisp, similar to the video above (e.g., substituting “s” for “sh”) would be considered an articulation disorder [1].

The chart below shows the ages when most English-speaking children develop sounds. Children learning more than one language may develop some sounds earlier or later [2].

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 Babbles 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
Familiar people understand the child’s speech
By 4 years Says y and v in words.
May still make mistakes on the s, sh, ch, j, ng, th, z,
l, and r sounds.
Most people understand the child’s speech
Sound acquisition chart from ASHA [2].

A phonological disorder, on the other hand, focuses on a pattern of errors (see phonological processes chart). Some of the most common phonological error patterns include fronting, stopping, and final consonant deletion. These patterns affect more than one sound. While it seems cut and dry, it can be difficult to differentiate between articulation disorders and phonological disorders. This is where the umbrella term “speech sound disorders” comes in [1].

Who is at risk for a speech sound disorder?

Those with…
  • Developmental disorders such as autism
  • Genetic disorders such as Down syndrome
  • Hearing loss or frequent ear infections
  • Nervous system disorders such as cerebral palsy
  • Physical problems such as cleft lip or palate
  • Low education level of the parent
  • Lack of support for learning in the home [3].

Late Bloomers

It is important to differentiate between a speech delay and a speech sound disorder. A delay is when speech develops in a normal sequential pattern, but later than typical. A speech sound disorder is when a child cannot produce speech sounds correctly. For example, a sound substitution at 2 years old may be age-appropriate, but the same error at 5 years old might need remediation. A website called Kidmunicate put together a list of speech milestones and red flags. Always keep in mind that children develop at different rates [4].

How common are speech sound disorders?

Overall, 2.3%-24.6% of school-aged children are estimated to have a speech delay or speech sound disorder. There are also differences in prevalence based on intersectionality. For example, prevalence rates are ~5.3% of African American children vs. 3.8% in white children. Speech sound disorders are also more prevalent in boys than girls, with a ratio of 1.5-1.8:1 [1].

Signs and symptoms

  • Omissions/deletions: “cu” for “cup” or “poon” for “spoon”
  • Substitutions: “thing” for “sing” or “wabbit” for “rabbit”
  • Additions: “buhlack” for “black”
  • Distortions: lateral lisp – air comes out the sides of cheeks making a distorted “s”
  • Syllable-level errors: “tephone” for “telephone” [1]
Lisp Cartoons and Comics - funny pictures from CartoonStock

Considerations

Both accents and dialects can influence speech sounds. The first language acquired by a bilingual or multilingual individual can influence speech sound production and phonological rules of other languages learned.

Regarding dialect, not all sound substitutions and omissions are considered speech errors. Dialectical variations of language may look like a speech sound disorder, but really just be a part of the dialect. An example of this occurs in African American English, when a “d” sound substituted for the “th” sound (e.g. “dis” for “this”) [1].

Color illustration icon for thoughtful considerate thinking

It is also important to differentiate language vs. speech. Speech is how we say sounds and words. Conversely, language is considered the words we use to share ideas and get what we want. A person with a language disorder may struggle with understanding language, getting their message across, reading, and/or writing [5].

In the first years of life, it is hard to differentiate whether language or speech delays are due to a language disorder, speech sound disorder, or both. A speech-language pathologist can help you tease out where the root of the problem lies by giving a comprehensive and dynamic assessment [6].

Why can’t my child hear their errors?

In the video above, the little girl has absolutely no idea that she is producing the “sh” sound incorrectly. You can see her frustration as her father imitates what she says back to her, pretending he doesn’t know that she’s attempting to say “shamrocks.”

Self-awareness refers to a child’s ability to monitor themselves to figure out if they are doing something correctly. Most children with speech sound disorders are unaware of their incorrect productions. However, self-awareness is extremely important for a child to carry their skills from speech therapy to everyday life [7].

How can a speech-language pathologist help?

  • Specific instruction: When teaching a new sound, a speech-language pathologist (SLP) will first teach your child about how to correctly produce their target sound. For example, if a child has a frontal lisp (e.g., thing for sing) the SLP will instruct the student to place their tongue behind their upper teeth.
  • Sound discrimination: Next, the SLP may engage in an auditory discrimination task. The SLP will say a word with the student’s target sound in two different ways. First, they will demonstrate the correct production, then imitate the child’s articulation error. The student will label if it was a “strong s” or a “weak s.” As the child becomes more aware of the differences in production, the speech therapist may cover their mouth while producing the sound to help the child focus on the sound rather than the visual place of articulation.
  • Therapy hierarchy: The SLP will help the child correctly produce the sound in isolation (e.g. “sssss”). As the child masters the production of their target sound, they move up the following hierarchy.
Image depicting speech therapy pathway as a stairway:
“Sound discrimination, sound level, word level, sentence level, conversation level”
  • Recording productions: For some children, it may be really helpful for the SLP to record the child using their correct production and using incorrect production. The SLP will play the recording back for the child and have them determine whether it was a correct or incorrect production. It is important to note that some children may become self-conscious if this technique is used, whereas others may become motivated to fix the sound once they’ve heard what it sounds like [7]. Thus, it is up to the discretion of the SLP and the student’s parents to determine if this technique is appropriate.

When is it time to see a speech therapist?

Some therapists say therapy should start therapy around 4 years old if the child is ready for therapy, taking into consideration the child’s attention and listening skills, the ability to follow instructions, and whether or not they can produce the sound on their own [8]. Typically, if your child’s speech sound errors interfere with overall communication and intelligibility (e.g., the ability to be understood) by unfamiliar listeners around age 4, it’s best to err on the side of caution and visit a speech pathologist for a comprehensive assessment.

If you are questioning whether or not your child may have a speech sound delay or disorder, head over to our website for a free 20-minute consultation!

Quote with floral clipart, “The earlier that intervention starts, the quicker the disorder can be addressed and corrected.”

References

  1. https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/#collapse_2
  2. https://www.asha.org/public/speech/disorders/Speech-Sound-Disorders/
  3. https://www.stanfordchildrens.org/en/topic/default?id=speech-sound-disorders-in-children-160-236
  4. https://kidmunicate.com/speech_language_disorders/speech-delay-or-disorder/
  5. https://www.asha.org/public/speech/disorders/
  6. https://www.ncbi.nlm.nih.gov/books/NBK356270/
  7. https://www.speechandlanguagekids.com/increase-self-awareness-and-carry-over/
  8. https://www.mybaba.com/lisps-young-children-worried-can-help/
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