Articulation and Phonological disorders, also known as Speech- Sound Disorders (SSDs), affect 2.3% to 24.6% of school-aged children (Black, Vahratian, & Hoffman, 2015; Law, Boyle, Harris, Harkness, & Nye, 2000). The effects of SSDs may persist into adulthood and affect various domains of the Activity Limitations and or Participations as defined by the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) model.

As such, a child with SSDs have increase risks of social, emotional and or academic challenges in comparison to their peers with typical speech (Hitchcock, E. R., Harel, D., & Byun, T. M.,2015).  Speech- Language Pathologists (SLP), can help with identifying SSDs through formalised assessments and evidence- based treatment.

Causes
The causes of SSDs can be of an organic nature, including those resulting from motor or neurological disorders including, but not limited to: dysarthria and childhood apraxia of speech (CAS).

Structural abnormalities can also be a contributing factor e.g.: cleft lip/ palate and or sensory of perceptual disorders including hearing impairment.

Functional SSDs include difficulties relating to motor production e.g.: challenges to accurately producing individual sounds (articulation disorder), or difficulty learning the sound systems of a language– when changing the sound in words alters the word meaning (phonological disorders).

Signs and Symptoms
Speech Sound Disorders can have a mild to significant impact on a child’s ability to communicate effectively. In Articulation Disorders, this may affect the production of one or two sounds however, it may also affect an inventory of sounds, which make it difficult for communication partners to understand.
There are a range of different errors in Articulation Disorder, these include but are not limited to:

  • Sound deletions(e.g.: ‘nana instead of banana’)
  • Additions (e.g.: ‘showger’ instead of ‘shower’
  • Distortions (e.g.: interdental or lateral lisp for /s/ and /z/ sounds) and
  • Substitutions (e.g.: /w/ for /r/ ‘wed’ instead of ‘red’)

Phonological Disorders include the production of consistent error- patters also known as phonological processes. Phonological processes are common in early childhood development. Examples of these processes include, but are not limited to:

  • ‘Fronting’, when sounds made at the back of the mouth, /g/, /k/ are made at the front, /d/, /t/ e.g.: ‘det for get’ and ‘tar for car’
  • ‘Cluster reduction,’ is also common e.g.: when consecutive consonants are reduced to one consonant, ‘sake for snake’ and ‘fower for flower’.
  • ‘Final Consonant Deletion’, when the end sound of a word is removed e.g.: ‘goat’ becomes ‘go’, ‘house’ becomes ‘how’.

Typically developing children will resolve phonological processes by age 7 however, children who continue to present with such processes, have difficulty learning the sound system of the language and may not comprehend that changing sounds can change word meanings.

Assessment and Treatment
Speech-language pathologist may complete an articulation screener, in conjunction to a formalised articulation and phonological assessment, and oro-motor assessment. This is to identify the severity and type of SSD a child may present with. The assessment involves the child saying sounds in different positions (initial, medial final position), in a variety of contexts e.g.: single-word picture naming, conversational sample, as assessing the as strength and coordination of articulators required for speech production.

There are range of evidence- base interventions that a SLP may implement depending on the type of SSD. For Articulation Disorders, the SLP may demonstrate the placement of articulators (lips, tongue and jaw), to produce sounds for the child to imitate. The child will practice saying the sounds in different position of words, phrases, sentences and at the conversation level. The role of the SLP is to provide feedback, monitor child progress and adjust treatment goals and intervention as the child learns to produce the sound(s) accurately.

Phonological intervention involves teaching children the sound system rules and linking such rules to word meanings. Children will practice identifying and producing word pairs that differ by only one sound (minimal pairs),  in order to learn these rules. In order to promote generalisation, SLPs will develop personalised home programmes for the child to practice outside of therapy.

 

Research by McCormack et al., 2009,  provides evidence that SSDs are associated with limitations on activities and participation across multiple domains.

Early identification and diagnosis of SSDs can help children resolve their speech errors and learn to communicate effectively, so that they may be understood by communication partners.

 

What to do now?

If your child is difficult to understand or has difficulty expressing themselves clearly, give us a call at Generation Physio, we have a friendly team of professionals that are dedicated to changing the lives of our clients. All of our clinicians are mobile and come to your own home. For an assessment, recommendations and treatment options, give us a call on 1300 122 884 to book a consultation today.


Article written by Tue Nguyen

Senior Speech and Language Pathologist – Sth Brisbane & GC

Tue has experience working with a range of complex communication clients who present with physical impairments, hearing loss, Cerebral Palsy (CP), Autism Spectrum Disorder (ASD), and Rett Syndrome.

Prior to joining Generation Physiotherapy, Tue was a Speech-Language Pathologist at the Queensland Department of Education (DoE). In this role, Tue focused on paediatrics and school age children. Tue is bilingual in Vietnamese and English and has previously focused on clients who are Culturally and Linguistically Diverse (CALD).

Learn more about Tue here.


References:

American Speech-Language-Hearing Association. (20016b). Scope of practice in speech-language-pathology [Scope of Practice]. Available from www.asha.org/policy/

Black, L. I., Vahratian, A., & Hoffman, H. J. (2015). Communication disorders and use of intervention services among children aged 3–17 years; United States, 2012 (NHS Data Brief No. 205). Hyattsville, MD: National Center for Health Statistics.

Bowen, C. (2011). Children’s speech sound disorders. Retrieved from http://www.speech-language-therapy.com

Hitchcock, E. R., Harel, D., & Byun, T. M. (2015). Social, Emotional, and Academic Impact of Residual Speech Errors in School-Aged Children: A Survey Study. Seminars in speech and language36(4), 283–294. doi:10.1055/s-0035-1562911

Law, J., Boyle, J., Harris, F., Harkness, A., & Nye, C. (2000). Prevalence and natural history of primary speech and language delay: Findings from a systematic review of the literature. International Journal of Language and Communication Disorders, 35, 165–188.

McCormack J, McLeod S, McAllister L, Harrison LJ. A systematic review of the association between childhood speech impairment and participation across the lifespan. Int J Speech Lang Pathol. 2009;11(2):155–170

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