What is Speech?
The term ‘speech’ refers to how we physically say sounds within words (Source: ASHA). Children who have difficulties producing correct speech sounds could be considered to have a speech sound delay or disorder. Speech sound disorders can be classed as either organic, meaning the speech sound difficulties are as a result of underlying structural (e.g. cleft palate), motor/neurological (e.g. childhood Apraxia of Speech) or sensory/perceptual causes (e.g. hearing loss); or more commonly, functional, which have no known cause or structural contribution (Source: ASHA). These functional difficulties can present as either difficulties in articulation or phonology (or sometimes a combination).
What is Articulation?
Difficulties in articulation refers to errors in the physical production of speech sounds based on the ways we use our lips, mouth and tongue. For example, a child who presents with a lisp would be classed as having an articulation disorder. Each speech sound has a specific age in which it should be acquired by, as detailed in the below table. If a child is unable to produce these sounds in isolation (on its own) by the expected age, it is possible that they are presenting with an articulation disorder. For instance, a 5 year old child who is unable to correctly produce the ‘ch’ sound on its own, and is therefore omitting or substituting it within words could be classed as having an articulation disorder.
Different types of articulation errors include:
- Deletion of sounds – a child deletes certain sounds from within words (e.g. ‘fog’ for ‘frog)
- Substitution of sounds – a child substitutes one or more sounds within words (e.g. ‘wed’ for ‘red’)
- Addition of sounds – a child inserts extra and unnecessary sounds within words (e.g. ‘buhlue’ for ‘blue’)
- Distortions of sounds – the production of specific sounds are changed (e.g. a lisp)
What is Phonology?
Difficulties in phonology are the most commonly seen speech sound errors in younger children, and relate to difficulties learning the rules around how speech sounds are combined to form words (Reference: Profile of Australian…). These errors are seen as predictable, rule-based errors that affect a group or class of sounds (Source: ASHA). For instance the ongoing simplification of /th/ into /f/ (e.g. a child may produce ‘fumb’ for ‘thumb’). The below table describes a number of phonological processes/errors seen in children. Some of these errors are typically occurring errors, in that it is appropriate to see children use these errors until a certain age, and some errors are atypical, meaning that it is not appropriate for these errors to be present at any age. Speech therapy is required for children who continue to use these error patterns past the expected age of elimination and/or if they use atypical processes at any age.
Speech Sound Errors
| Speech Sound Error | Example | Approximate age of elimination |
| Assimilation When a child uses a sound that becomes the same or similar to another sound that occurs earlier or later in the word | ‘dog’ becomes ‘gog’ | No longer using this error by 3 years old |
| Final consonant deletion When a child deletes the final sound in a word | ‘cat’ becomes ‘ca’ | No longer using this error by 3 years old |
| Reduplication When a child repeats a syllable in a word | ‘water’ becomes ‘wawa’ | No longer using this error by 3 years old |
| Prevocalic Voicing Voicing is when a child uses a voiced sound (a sound that uses the vibrations of the vocal folds; e.g. ‘b’, ‘d’, ‘g’) at the start of a word instead of a voiceless sound (a sound that doesn’t use the vibration of the vocal folds; e.g. ‘p’, ‘t’, ‘k’) | ‘pig’ becomes ‘big’ | No longer using this error by 3 years old |
| Postvocalic devoicingWhen a child uses a sound without the vibration of the vocal folds (voiceless; e.g. ‘p’, ‘t’, ‘k’) at the end of a word instead of a sound that uses the vibrations of the vocal folds (voiced; e.g. ‘b’, ‘d’, ‘g’) | ‘cub’ becomes ‘cup’ | No longer using this error by 3 years old |
| Stopping When a child uses a shorter sound by stopping the airflow (e.g. ‘b’ or ‘t’) instead of using a longer sound with more airflow (e.g. ‘f’ or ‘s’) | ‘sun’ becomes ‘tun’ | Early Developing SoundsNo longer using this error by 3;5 years old Later developing sounds No longer using this error by by 4;5 years |
| Weak syllable deletion When a child deletes a syllable from a word that has more than one syllable | ‘computer’ becomes ‘puter’ | No longer using this error by 3;11 years old |
| Fronting When a child replaces a sound that is typically made at the back of the mouth (e.g. ‘k’ or ‘g’) with a sound that is made at the front of the mouth (e.g. ‘t’ or ‘d’) | ‘car’ becomes ‘tar’ | No longer using this error by 3;11 years old |
| Cluster reductionWhen a child reduces the number of sounds in a ‘cluster’ (e.g. ‘st’ or ‘bl’) to only one sound | ‘frog’ becomes ‘fog’ | No longer using this error by 4;11 years old |
| Deaffrication When a child produces the ‘ch’ and ‘j’ sounds as ‘sh’ or ‘z’ | ‘chair’ becomes ‘share’ | No longer using this error by 4;11 years old |
| Gliding When a child produces the ‘r’ and ‘l’ sounds as ‘w’ or ‘y’ | ‘red’ becomes ‘wed’ ‘little’ becomes ‘wittle’ | No longer using this error by 5 years old |
| Fricative SimplificationWhen a child uses the ‘f’ or ‘v’ sound instead of the ‘th’ sound | ‘thumb’ becomes ‘fumb’ | No longer using this error by 6 years old |
| Vowelisation When a child uses a vowel sound in the place of a ‘l’ or ‘r’ sound | ‘bear’ becomes ‘bay-uh’ | No longer using this error by 6 years old |
| Coalescence When a child substitutes a set of two sounds for a different sound that has similar features | ‘spoon’ becomes ‘foon’ | No longer using this error by 6 years old |
| Epenthesis When a child adds a vowel sound between two other sounds | ‘blue’ becomes ‘buh-lue’ | No longer using this error by 6 years old |
| Backing When a sound that is typically made at the front of the mouth (e.g. ‘t’ or ‘d’) is instead replaced by a sound that is made at the back of the mouth (e.g. ‘k’ or ‘g’) | ‘tap’ becomes ‘cap’ | Unusual process(this is not a process we see in typical speech sound development) |
| Affrication When a child uses ‘j’ or ‘ch’ in the place of a shorter easier to produce sound (e.g. ‘d’) | ‘ship’ becomes ‘chip’ | Unusual process(this is not a process we see in typical speech sound development) |
| Initial consonant deletion When a child deletes the first sound in words | ‘kite’ becomes ‘ite’ | Unusual process(this is not a process we see in typical speech sound development) |
| Medial consonant deletion When a child deletes a sound from the middle of a word | ‘spider’ becomes ‘spi-er’ | Unusual process(this is not a process we see in typical speech sound development) |
| Denasalization When a child changes a nasal sound (e.g. ‘m’ or ‘n’) to a non nasal sound (e.g. ‘b’ or ‘d’) | ‘neck’ becomes ‘deck’ | Unusual process(this is not a process we see in typical speech sound development) |
| Favoured Sound When a child consistently uses a specific sound in the place of multiple other sounds. | E.g. a child uses ‘l’ to replace all ‘f,’ ‘r,’ ‘p’ and ‘g’ sounds | Unusual process(this is not a process we see in typical speech sound development) |
Prevalence of SSD
There is a shortage of current evidence to suggest the prevalence of speech sound disorders within children in Australia, however results of a 2014 study of 1,494 4-year olds estimated that approximately 3.4% of these children presented with a speech sound disorder (Source: Wiley). Similarly, this study also reported that research completed prior to 2014 with different age groups suggested that speech sound disorders were present in between 3-6% of preschool children.
Signs/Symptoms
Speech sound disorders vary significantly between children in terms of presentation and severity. Some things to look out for include:
- If your child deletes certain sounds from words (e.g. ‘fog’ for ‘frog)
- If your child substitutes one or more sounds within words (e.g. ‘wed’ for ‘red’)
- If your child inserts extra and unnecessary sounds within words (e.g. ‘buhlue’ for ‘blue’)
- The production of specific sounds are distorted (e.g. a lisp)
- If your child changes the structure of words by adding/deleting syllables (e.g. ‘puter’ for ‘computer’)
- If your child has a favoured sound that they use significantly more than others in ways/places within words that you would not expect that sound to be used
- If your child is older than 3 and cannot be understood by familiar listeners, or older than 4 and cannot be understood by less familiar people
How do I Know if my Child has a Speech Sound Disorder?
If you were reading through the signs/symptoms section above and realised that your child is demonstrating a few of the above signs, I’m sure you’re thinking “what now?”
First thing, don’t panic! Just because your child is currently exhibiting speech sound errors does not mean this will be the case forever. The best thing that you can do is to book your child in with a Speech Pathologist for a speech sound assessment. This speech assessment will likely involve:
- Completing a case history: This will look at factors that may be contributing to your child’s speech sound difficulties (e.g. family history, medical history, etc.).
- Oral Motor Assessment (OMA): your child will work with their speech pathologist to complete at OMA. Essentially, an OMA is a brief assessment that is used to look at the oral muscles and structures to determine if there are any structural abnormalities that could explain your child’s speech sound difficulties (e.g. tongue tie, tongue weakness, etc.).
- Speech Sound Assessment: finally your child will complete a speech sound assessment to determine what speech sounds are being produced in error and therefore what type of speech sound disorder they may present with. This speech sound assessment might look different depending on the age of your child and/or their engagement in standardised assessments. A few common speech sound assessments that might be used include the Articulation Survey, the Diagnostic Evaluation of Articulation and Phonology (DEAP), or the Goldman-Fristoe Test of Articulation 3 (GFTA-3).
Common Treatment Approaches (Phonology vs. Articulation)
There are many treatment options for speech sound disorders, and in particular disorders of articulation and phonology. Selection of treatment approaches for articulation therapy will depend on a number of elements, including the type and severity of the speech sound disorder, and the child’s age. It is also important to consider the format (e.g. group vs. individual), dosage (e.g. fortnightly or bi-weekly) and setting (e.g. home vs. clinic vs. school) of the treatment (Source: ASHA).
Here are a few examples of treatment approaches that we commonly use:
Articulation
Articulation approaches to speech sound disorder focus on the physical production of speech sounds (e.g. correct positioning of the tongue and lips). Sounds in error are targeted individually with use of specific strategies (e.g. verbal or visual cuing) to encourage correct articulation. An example of an articulation-based approach is ‘Traditional Articulation Therapy’ – the aim in this approach is to achieve correct articulation of the target sound/s across a hierarchy from most simple to most complex (e.g. in isolation, then in syllables, words, phrases, sentences and conversation).
Phonology
Approaches that target difficulties in phonology incorporate linguistic elements of speech production (Source: ASHA). These approaches target groups of sounds (and individual sounds within these groups) that all use similar error patterns. The aim of phonological approaches are to support a child in learning the phonological rules and patterns that govern speech production, to support generalisation across their speech (Source: ASHA). Some common examples of phonological approaches include Phonological Contrast Approaches (emphasise the contrasts between sounds within words; e.g. ‘Minimal Pairs’ and ‘Multiple Oppositions’), the Complexity Approach (this uses more complex linguistic targets to help promote generalisation of correct speech production to related, but untreated targets) and the Cycles Approach (targeting phonological pattern errors in children who are particularly hard to understand) (Source: ASHA).
*This is not an exhaustive list and only includes a small number of approaches available.
It is important to address speech sound errors early, as we know that persistent speech sound disorders can co-occur with language disorders and/or literacy difficulties. If you have concerns about your child’s speech development, please contact BillyLids Therapy here.
Further Reading
Websites
Speech Pathology Australia (SPA)
SPA is the national peak body for the speech pathology profession in Australia. Their website offers a wealth of resources, including fact sheets and articles, to help parents understand speech sound development and disorders. Visit the Speech Pathology Australia’s website here.
Raising Children Network
An Australian parenting website providing evidence-based information on children’s health, development, and behaviour. It includes articles and videos on speech development and related disorders. Learn more about the Raising Children Network.
Journal Articles
A systematic review and classification of interventions for speech‐sound disorder in preschool children.
Wren, Y., Harding, S., Goldbart, J., & Roulstone, S. (2018). A systematic review and classification of interventions for speech‐sound disorder in preschool children. International Journal of Language & Communication Disorders, 53(3), 446–467.
The article provides a systematic review and classification of interventions aimed at addressing speech-sound disorders in preschool children, offering insights into the effectiveness and types of interventions available in this context. It aims to consolidate knowledge on various intervention approaches to inform clinical practice and future research in treating speech-sound disorders in young children.
Children’s consonant acquisition in 27 languages: A cross-linguistic review.
McLeod, S., & Crowe, K. (2018). Children’s consonant acquisition in 27 languages: A cross-linguistic review. American Journal of Speech-Language Pathology, 27(4), 1546–1571.
The article presents a cross-linguistic review of consonant acquisition in 27 languages, examining the developmental patterns and milestones across diverse linguistic contexts. It offers insights into the universal and language-specific factors influencing children’s acquisition of consonant sounds, contributing to our understanding of typical speech development across different languages.
Profile of Australian preschool children with speech sound disorders at risk for literacy difficulties
McLeod, S., Crowe, K., Masso, S., Baker, E., McCormack, J., Wren, Y., Roulstone, S., & 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.
The article examines the characteristics of Australian preschool children with speech sound disorders who are at risk for literacy difficulties, providing insights into their profiles and potential challenges. It aims to enhance understanding of how speech sound disorders may impact literacy development in this demographic.
Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children
Eadie, P., Morgan, A., Ukoumunne O., Ttofari Eecen, K., Wake, M., & Reilly, S. (2014). Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children. Development Medicine & Child Neurology, 57(6), 578–584.
