Speech Disorders & Speech Delays

How speech pathology treats speech delays and speech disorders in children

What is a speech disorder?

Speech sound errors are common among children learning to talk. These errors are a normal part of speech development and normally resolve with time and practice. However, for some children, these errors do not go away. Speech disorders are diagnosed if your child is making speech sound errors that are not age appropriate. Speech therapy has a wide variety of proven techniques to help fix speech delays and disorders.

A speech sound disorder is an umbrella term. Meaning it refers to both articulation disorders and phonological disorders. An articulation disorder means difficulty organising and coordinating the placement of their lips, tongue and jaw. Therefore impacting a child ability to create clear, easy to understand speech sounds. This is more physical in nature[1].

A child with a phonological disorder has difficulty understanding the rules of a language’s speech sound system. This is therefore a meaning-based error[2]. It is not uncommon for a child to have an articulation disorder and a phonological disorder together.

"Speech sound disorder refers to speech errors of physical or linguistic in nature"

What causes a speech sound disorder?

For most children, the cause of their speech difficulties is unknown. Although some associated factors for speech difficulties include:

Structural problems (e.g., cleft palate or tongue-tie)

Physiological problems (e.g low tone)

Developmental disorders (e.g. autism spectrum disorder)

Genetic syndromes (e.g. Down syndrome)

Sensory deficiencies (e.g. hearing impairment).

Additional risk factors associated with speech sound disorders include:

oral sucking habits
ear, nose and throat problems
being male
family history of speech and/or language problems[3].

What does a speech sound disorder look like?

Articulation Errors

Articulation errors involve difficulty coordinating the lips, tongue or jaw to create clear speech sounds. Lisps are a common type of articulation error. The two most common lisps are interdental lisps and lateral lisps. An interdental lisp occurs when the tongue sticks out between the teeth for sounds such as “s” and “z”. This results in a “th” sound instead of an “s” or “z” sound. A lateral lisp occurs when air flows over the sides of the tongue instead of down the middle and over the tip of the tongue for sounds such as “s” and “z”. This results in a slushy “s” or “z” sound[4].

Phonological Errors

In contrast, a phonological disorder is a language-based error. This reflects a breakdown in a child’s understanding of the rules of a language’s speech sound system.

Most importantly, these types of errors have a linguistic origin. Phonological errors are related to the way that the brain is using, organising and contrasting the sounds of speech. For example, a child may replace speech sounds made at the back of the mouth (e.g. k, g) with speech sounds made at the front of the mouth (e.g. t, d). We call this “fronting”, and it results in errors such as saying “tar” for “car”, and “doe” for “go”.

We expect that a child’s speech is 70% intelligible to unfamiliar listeners at age 3 ½. While at 4 years old they should be 100% intelligible. Importantly, at age 4 your child may not have mastered all their speech sounds. But everyone should be able to easily understand what they are saying in conversation[5].

Motor Speech Errors

Sometimes a child may have difficulties due to low muscle tone. This can cause speech sounds to sound slurred. This is called dysarthria[6][7].

Occasionally, children may have difficulties accurately coordinating the muscle movements for speech. Even though they know what they are trying to say. This results in saying words differently each time, for example, ‘spaghetti’ → ‘serbetti’ or ‘derdetti’ or ‘sergetti’. This is a motor speech disorder called Childhood Apraxia of Speech (CAS)[8][9].

"It is never too early to seek help for speech sounds"

Impacts of a speech disorder on social development

Preschool can play a vital role in a child’s understanding and impression of social interactions. It is at preschool where a child’s social environment grows beyond their family and close friends. Preschoolers are looked after by someone who is not their family or caregiver, and are making friendships with their peers. Peer relationships and interactions become increasingly important to children at this time. One study found that preschoolers use communicative competence to measure peer popularity. Children who had difficulty with their communication, such as having a speech sound disorder, were more likely to be judged negatively compared to those with typical communication skills.

Other studies have also looked into how speech disorders can impact children later in their school years. They have shown that even a mild speech disorder can have negative consequences for the child’s social interactions and peer perception. Their typically developing peers may have more negative judgments on the child’s ability to talk, their popularity and their likelihood of success in later years.

Impacts of a speech disorder on learning

Studies have shown that having a speech sound error as a preschooler can affect a child’s academic success.

The ability to produce speech sounds accurately is highly correlated with learning to read and spell. There is much research that indicates children who have previously had speech sound disorders are at a higher risk of having decoding difficulties. This means that they struggle to relate letter-sound relationships when reading.

These difficulties include:

Phonetic discrimination: hearing the difference between similar sounds
Phonetic recognition: recognising a heard sound
Phonological representations: the brain’s representation of a word and its sounds

This is because children who have had resolved speech sound disorders may not have concrete representations of speech sounds and their associated letters, even if their speech sound error has been fixed during the preschool years and the first year of school. Monitoring a child’s phonological awareness skills, that is their knowledge of sounds in words, is critical for children with speech sound errors.

When to seek help

We recommend you contact us at Talkshop Speech Pathology if your child ^[10]:

Is more difficult to understand than his/her peers
Makes speech errors that his/her peers do not
Daycare, preschool or school teachers express concerns
Feels self-conscious about his/her speech (e.g. stops trying or gives up quickly)
Is frustrated by his/her speech
Gets picked on because of his/her speech
Understood less than 70% of the time at age 3 ½
Speech is not 100% intelligible and is easily understood by others at age 4.

It is never too early to seek help for speech sounds. For that reason, we welcome you to contact us at Talkshop Speech Pathology if you are worried about your child’s speech for any other reason.

How we can help

Initial Consultation

If you are unsure if your child’s speech is typical for their age or not, you can schedule a free initial consult to chat to one of our speech pathologists.

Screener

We provide a speech pathology screener service to pre-schools around around our clinic locations. A speech pathology screener is designed to be a highly affordable way to screen a child against a broad spectrum of developmental norms in their speech, language, pre-literacy, voice, and social skills. Screeners tell us whether we need to monitor their development. If they really do need further assessment and therapy. On the other hand, it can sometimes help you relax(!) as the ‘errors’ are a typical pattern of development.If your child’s pre-school has not arranged a speech pathology screener please contact us and your child’s pre-school so we can discuss providing screeners.

"Speech sounds also has impacts on oral (spoken) language development and literacy development"

Speech Assessment

A point of difference at Talkshop Speech Pathology is how thoroughly we assess speech sound disorders. In particular, we recognise the impact speech errors have on (spoken) language and literacy development[11][12]. We also know that early intervention is more effective, costs families less in the long-term and has greater results more rapidly.

Before the assessment:

Before a speech assessment at Talkshop Speech Pathology, we ensure there are no hearing concerns. We can refer you to local audiology services. Most importantly, reviewing hearing allows us to rule out hidden ear infections. Which may cause hearing difficulties in certain frequencies.

Oro-motor Assessment:

We review the shape and movement of the muscles of your child’s mouth. In particular, focusing on the jaw, tongue, cheeks and lips. Assessment addresses tone, strength, and coordination of these muscles. Next, we review swallowing to check for tongue thrust, and we look below the tongue for a tongue tie. You’d be surprised how many tongue ties we spot! This is called an oro-motor assessment. This allows us to look for any physical factors affecting the way the speech sounds are being made.

Formal and informal assessment:

Formal assessments use specifically designed tasks and activities. Specifically testing individual speech sound in a range of words. Such as saying ‘g’ at the start, middle and end of words. Like ‘g’ in “glove” “tiger” and “peg”. An informal assessment means reviewing your child’s speech in games and conversation. We look for patterns of inconsistency. Whether the sounds are always said in the same way during formal tasks and in games. Finally, identifying patterns in speech errors helps us to understand your child.

Intelligibility:

Considers how the speech sound errors impact the overall ability to be understood. We know by 4 years old a child should be understood 100% of the time.

Pre-literacy/Literacy skills:

Research shows a speech sound disorder places a child at risk for future literacy difficulties. This is because the early linguistic difficulties that show up as speech sound difficulties also impact the development and progress or early pre-literacy and literacy skills. Linguistic skills are the fundamental building blocks for learning reading and writing.

Language:

We also look at the impacts this has on their oral language development and social skills development. Children who are hard to understand often simplify what they say in order to be understood. They shorten their sentences, making grammar errors, or omit words that are ‘tricky’. They are less likely to explore new words so this can affect the development of language.

"Therapy for speech sound disorders involves teaching a hierarchy of skills"

Therapy Management Plan

At Talkshop we create individualised Therapy Management Plans. This means that as a parent you know exactly how we plan to support your child’s speech development. Most importantly we prioritise goals differently depending on the number and type of speech errors. This can be:

In step-by-step (Developmental) order:

This means we choose earlier developing sounds to practice first. We tend to use this approach with kids who have low confidence. Or who need quick success.

By functional impact:

In other words, we select the sounds that have the greatest impact on making your child easier to understand. For example, we may choose to work on the ‘s’ sound even though it is a later developing sound. This is because ‘s’ is one of the most commonly occurring sounds in the English language. In addition, it is also used grammatically for plurals (cars) and to help pronouns and verbs agree (‘I play’ vs. ‘he plays’)

By choosing to contrast 2 very different sounds together:

This allows us to highlight the contrastive features of the opposing sounds. Importantly, this strategy supports increased awareness of a second sound that is indirectly targeted during practice.

Therapy for speech

Typically we deliver therapy once a week. Then, this is followed up with home practice activities and games.

Most importantly, therapy involves finding the right balance of challenge and fun to keep your child motivated. Undoubtedly, the biggest factor towards progress in improving speech sounds is related to how you practice at home. For this reason, we work with you in each session to review weekly practice. We aim to give you the inspiration to make games as part of your daily routine so that you can roll practice in as you go.

Therapy for speech sound disorders involves teaching a hierarchy of skills. Firstly, for phonological disorders, learning awareness of the speech sounds and the rules of the speech sound system.

However, for articulation disorders, the hierarchy begins with the next step. First learning how to say the speech sound(s) on their own. Following on to combining them with other sounds in different positions in words. Eventually, your child will progress from one step to the next. Until they can say the speech sound(s) independently in all contexts of their everyday life.

Understandably, the steps in between vary according to your child’s strengths and weaknesses. So do the techniques used to help your child understand what they are doing wrong and how to make it right at each step.

In contrast, therapy for motor speech disorders such as Childhood Apraxia of Speech (CAS) are very different. Meaning we work with each family to ensure adequate intensity for effective outcomes.

Finally, at the end of each therapy block, we review the goals and the progress made.

"We aim to give you the inspiration to incorporate home practice into games and your daily routine"

References

¹ “Speech Sound Disorders: Articulation and Phonology: Overview – ASHA.”
https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/. Accessed 14 Jan. 2019.

² “Articulation and Phonological Disorders (Speech Sound Disorders ….”
https://csld.org/articulation-and-phonological-disorders-speech-sound-disorders. Accessed 14 Jan. 2019.

³ “Speech Sound Disorders: Articulation and Phonology: Overview – ASHA.”
https://www.asha.org/practice-portal/clinical-topics/articulation-and-phonology/. Accessed 14 Jan. 2019.

⁴ “Lisping – When /s/ and /z/ are hard to say – Caroline Bowen.” 23 Nov. 2011,
https://speech-language-therapy.com/index.php?view=article&id=86:lisp. Accessed 14 Jan. 2019.

⁵ “Fact Sheets – Speech Pathology Australia.”
https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Fact_Sheets/Fact_Sheets.aspx. Accessed 14 Jan. 2019.

⁶ “Dysarthria – Symptoms and causes – Mayo Clinic.” 18 May. 2018,
https://www.mayoclinic.org/diseases-conditions/dysarthria/symptoms-causes/syc-20371994. Accessed 14 Jan. 2019.

⁷ “Dysarthria – ASHA.”
https://www.asha.org/public/speech/disorders/dysarthria/. Accessed 14 Jan. 2019.

⁸ “Childhood Apraxia of Speech – ASHA.”
https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/. Accessed 14 Jan. 2019.

⁹ “Childhood apraxia of speech – Symptoms and causes – Mayo Clinic.” 9 Aug. 2017,
https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045. Accessed 14 Jan. 2019.

¹⁰ “Fact Sheets – Speech Pathology Australia.”
https://www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/Fact_Sheets/Fact_Sheets.aspx. Accessed 14 Jan. 2019.

¹¹ “McLeod, S., Crowe, K., Masso, S., Baker, E., McCormack, J., Wren, Y ….”
https://research-information.bristol.ac.uk/files/113237354/AJLD_SSS_in_press_.pdf. Accessed 14 Jan. 2019.

¹² “Children with Speech Sound Disorders at School – Research Online.”
https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=3277&context=ajte. Accessed 14 Jan. 2019.

Speech Pathology Australia Fact sheet: “The Sound of Speech: 0 to 3 years”

Speech Pathology Australia Fact sheet: “The Sound of Speech: Preschool and School Aged Children”

https://www.asha.org/public/speech/disorders/Speech-Sound-Disorders/

https://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=16:ssd&catid=11:admin&Itemid=120

McLeod, S., Crowe, K., Masso, S., Baker, E., McCormack, J., Wren, Y., … & Howland, C. (2017). Profile of Australian preschool children with speech sound disorders at risk for literacy difficulties. Australian Journal of Learning Difficulties, 22(1), 15-33.

A Systematic Review and Classification of Interventions for Speech-Sound Disorder in Preschool Children

Wren, Y., Harding, S., et al. (2018).

International Journal of Language & Communication Disorders, 53(3), 446-467.