Speech Sound Disorders

What are speech sound disorders in children?

It’s normal for young children learning language skills to have some trouble saying words the right way. That’s part of the learning process. Their speech skills develop over time. They master certain sounds and words at each age. By age 8, most children have learned how to master all word sounds.

But some children have speech sound disorders. This means they have trouble saying certain sounds and words past the expected age. This can make it hard to understand what a child is trying to say.

Speech sound problems include articulation disorder and phonological process disorder.

• Articulation disorder is a problem with making certain sounds, such as “sh.”

• Phonological process disorder is a pattern of sound mistakes. This includes not pronouncing certain letters.

What causes speech sound disorders in a child?

Often, a speech sound disorder has no known cause. But some speech sound errors may be caused by:

• Brain injury

• Thinking or development disability

• Problems with hearing or hearing loss, such as past ear infections

• Physical problems that affect speech, such as cleft palate or cleft lip

• Disorders affecting the nerves involved in speech

Which children are at risk for speech sound disorders?

The cause often isn't known, but children at risk for a speech sound disorder include those with:

• Developmental disorders, such as autism

• Genetic disorders, such as Down syndrome

• Hearing loss

• Nervous system disorders, such as cerebral palsy

• Illnesses, such as frequent ear infections

• Physical problems, such as a cleft lip or palate

• Too much thumb-sucking or pacifier use

• Low education level of the parent

• Lack of support for learning in the home

What are the symptoms of speech sound disorders in a child?

Your child’s symptoms depend on what type of speech sound disorder your child has. They may have trouble forming some word sounds correctly past a certain age. This is called articulation disorder. Your child may drop, add, distort, or swap word sounds. Keep in mind that some sound changes may be part of an accent. They are not speech errors. Signs of this problem can include:

• Leaving off sounds from words (example: saying “coo” instead of “school”)

• Adding sounds to words (example: saying “puhlay” instead of “play”)

• Distorting sounds in words (example: saying “thith” instead of “this”)

• Swapping sounds in words (example: saying “wadio” instead of “radio”)

If your child often makes certain word speech mistakes, they may have phonological process disorder. The mistakes may be common in young children learning speech skills. But when they last past a certain age, it may be a disorder. Signs of this problem are:

• Saying only 1 syllable in a word (example: “bay” instead of “baby”)

• Simplifying a word by repeating 2 syllables (example: “baba” instead of “bottle”)

• Leaving out a consonant sound (example: “at” or “ba” instead of “bat”)

• Changing certain consonant sounds (example: “tat” instead of “cat”)

How are speech sound disorders diagnosed in a child?

First, your child’s healthcare provider will check their hearing. This is to make sure that your child isn’t simply hearing words and sounds incorrectly.

If your child’s provider rules out hearing loss, you may want to talk with a speech-language pathologist (SLP). This is a speech expert who evaluates and treats children who are having problems with speech, language, and communication.                       

By watching and listening to your child speak, an SLP can determine if your child has a speech sound disorder. The SLP will evaluate your child’s speech and language skills. They will keep in mind accents and dialect. They can also find out if a physical problem in the mouth is affecting your child’s ability to speak. Finding the problem and getting help early are important to treat speech sound disorders.

How are speech sound disorders treated in a child?

The SLP can put together a therapy plan to help your child with their disorder. These providers work with children to help them:

• Notice and fix sounds that they're making wrong

• Learn how to correctly form their problem sound

• Practice saying certain words and making certain sounds

The SLP can also give you activities and strategies to help your child practice at home and at school. Public school districts may have access to SLPs who can evaluate your child. They can also work with your child and their teachers to create effective educational plans. If your child has a physical problem in the mouth, the SLP can refer your child to an ear, nose, and throat doctor (ENT or otolaryngologist) or an orthodontist if needed.

Spotting a speech sound disorder early can help your child overcome any speech problems. They can learn how to speak well and comfortably.

How can I help my child live with a speech sound disorder?

You can do things to take care of your child with a speech sound disorder:

• Keep all appointments with your child’s healthcare provider.

• Complete any home speech program as advised.

• Talk with your child's provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include experts, such as speech-language pathologists and counselors. Your child’s care team will depend on your child’s needs and the seriousness of the speech sound disorder.

• Tell others of your child’s disorder. Work with your child’s provider and school to create a treatment plan.

• Reach out for support from local community services. Being in touch with other parents who have a child with a speech sound disorder may be helpful.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider if your child has:

• Symptoms that don’t get better, or get worse

• New symptoms

Key points about speech sound disorders in children

• A speech sound disorder means a child has trouble saying certain sounds and words past the expected age.

• A child with an articulation disorder has problems making certain sounds the right way.

• A child with phonological process disorder regularly makes certain word speech mistakes.

• The cause of this problem is often unknown.

• A speech-language pathologist (SLP) can help diagnose and treat a speech sound disorder.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is advised and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Online Medical Reviewers:

• Ashutosh Kacker MD
• Marianne Fraser MSN RN
• Stacey Wojcik MBA BSN RN